bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impaired Tubular Reabsorption Is the Main Mechanism Explaining Increases in Urinary NGAL Excretion Following Acute Kidney Injury in Rats
Authors: Sancho-Martínez Sandra M , Blanco-Gozalo Víctor , Quiros Yaremi , Prieto-García Laura , Montero-Gómez María J , Docherty Neil G , Martínez-Salgado Carlos , Morales Ana I , López-Novoa José M , López-Hernández Francisco J 
Published: February 2020

Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a secreted low-molecular weight iron-siderophore-binding protein. NGAL overexpression in injured tubular epithelia partly explains its utility as a sensitive and early urinary biomarker of acute kidney injury (AKI). Herein, we extend mechanistic insights into the source and kinetics of urinary NGAL excretion in experimental AKI. Three models of experimental AKI were undertaken in adult male Wistar rats; renal ischemia-reperfusion injury (IRI) and gentamicin (G) and cisplatin (Cisp) nephrotoxicity. Alongside standard histological and biochemical assessment of AKI, urinary NGAL excretion rate, plasma NGAL concentration, and renal NGAL mRNA/protein expression were assessed. In situ renal perfusion studies were undertaken to discriminate direct shedding of NGAL to the urine from addition of NGAL to the urine secondary to alterations in the tubular handling of glomerular filtrate-derived protein. Renal NGAL expression and urinary excretion increased in experimental AKI. In acute studies in both the IRI and G models, direct renal perfusion with Kreb’s buffer eliminated urinary NGAL excretion. Addition of exogenous NGAL to the Kreb’s buffer circuit, reestablishment of perfusion with systemic blood or reperfusion with renal vein effluent restored high levels of urinary NGAL excretion. Urinary NGAL excretion in AKI arises in large proportion from reduced reabsorption from the glomerular filtrate. Hence, subclinical cellular dysfunction could increase urinary NGAL, particularly in concert with elevations in circulating prerenal NGAL and/or pharmacological inhibition of tubular reabsorption. More granular interpretation of urinary NGAL measurements could optimize the scope of its clinical utility as a biomarker of AKI.
Hypertensive Diseases of Pregnancy Increase Risk of Readmission With Heart Failure: A National Readmissions Database Study
Authors: Nizamuddin J. , Gupta A. , Patel V. , Minhaj M. , Nizamuddin S.L. , Mueller A.L. , Naseem H. , Tung A. , Rana S. , Shahul S. 
Published: February 2020

(Mayo Clin Proc. 2019;94(5):811–819)
Heart disease is responsible for a quarter of all deaths in women in the United States and a leading cause of maternal morbidity and mortality. The risk of cardiovascular disease-related mortality is higher in women who have had pregnancies complicated by hypertensive diseases of pregnancy (HDP). HDPs affect up to 8.2% of US deliveries. Previous studies have shown a long-term increase in postpartum heart failure in women diagnosed with HDP. There is a lack of data from large epidemiological studies on the prevalence of readmission in the immediate postpartum period for new-onset heart failure or postpartum cardiomyopathy (PPCM). This study hypothesized that rates of readmission for newly diagnosed heart failure or PPCM in the immediate postpartum period would be higher in women with HDP.
Trends in Postpartum Hemorrhage in the United States From 2010-2014
Authors: Reale S.C. , Easter S.R. , Xu X. , Bateman B.T. , Farber M.K. 
Published: February 2020

(Anesth Analg. 2019. Doi: 10.1213/ANE.0000000000004424)
Postpartum hemorrhage (PPH) is a major contributor to maternal morbidity and mortality in the United States, and its occurrence has increased 27.5% from 1995-2004 due to higher rates of uterine atony. There has been a number of concerted efforts to improve PPH care protocols at institutional, state, and national levels. These investigators conducted their study to analyze the frequency, etiology, and maternal morbidity of recent PPH trends in the United States. The National Inpatient Sample was used to identify and study subjects with a PPH diagnosis.
Incidence, Trends and Severity of Primary Postpartum Haemorrhage in Australia: A Population-based Study Using Victorian Perinatal Data Collection Data for 764,244 Births
Authors: Flood M. , McDonald S.J. , Pollock W. , Cullinane F. , Davey M.A. 
Published: February 2020

(Aust N Z J Obstet Gynaecol. 2019;59:228–234)
Postpartum hemorrhage (PPH), a leading cause of maternal mortality, has reportedly increased in high resource countries such as Australia over the past few decades. Severe PPH has also become more prevalent. A detailed analysis of PPH in Victoria, Australia was last conducted with data up to 2002. This study analyzed PPH incidence data in Victoria from 2003-2013 and data on PPH severity from 2009-2013, with the aim to investigate trends and severe morbidity associated with PPH.
Maternal and Perinatal Mortality and Complications Associated With Caesarean Section in Low-income and Middle-income Countries: A Systematic Review and Meta-Analysis
Authors: Sobhy S. , Arroyo-Manzano D. , Murugesu N. , Karthikeyan G. , Kumar V. , Kaur I. , Fernandez E. , Gundabattula S.R. , Betran A.P. , Khan K. , Zamora J. , Thangaratinam S. 
Published: February 2020

(Lancet. 2019;393:1973–1982)
The vast majority (99%) of maternal deaths occur in low-income and middle-income countries (LMICs). While cesarean section access is an important factor for improving maternal care, cesarean sections sometimes are performed too often. Lack of skilled medical workers and resources in LMICs make complications related to cesarean section even more severe than in high-income countries (HICs). There is a lack of large studies in LMICs on maternal and neonatal deaths after cesarean section. This systematic review and meta-analysis aimed to determine the risk of mortality in women from LMICs after undergoing cesarean section. In addition, risk factors for maternal and perinatal morbidity and mortality following cesarean section were investigated.
Point-of-Care Fibrinogen Testing in Pregnancy
Authors: Katz D. , Hamburger J. , Batt D. , Zahn J. , Beilin Y. 
Published: February 2020

(Anesth Analg. 2019;129(3):e86–e88)
Postpartum hemorrhage (PPH) is a life-threatening event that affects pregnant women globally. A deficiency of fibrinogen in the blood can help physicians predict the severity of PPH. Historically, the Clauss method has been used to measure fibrinogen levels, but this approach is more time-consuming than point-of-care (POC) thromboelastography (TEG) or thromboelastometry testing. There has not been much research focused specifically on the correlation of TEG functional fibrinogen (FLEV) to Clauss levels in obstetric patients who may have distinctive coagulation profiles compared with trauma, cardiac, or transplant patients. These investigators conducted this study to discover if the POC FLEV is consistent with the laboratory Clauss fibrinogen measurement.
Multicentre Clinical Simulation Evaluation of the ISO 80369-6 Neuraxial Non-Luer Connector
Authors: Cook T.M. , Wilkes A. , Bickford Smith P. , Dorn L. , Stacey M. , Kinsella S.M. , Sharpe P. , Phillips P. 
Published: February 2020

(Anaesthesia. 2019;74(5):619–629)
The medical literature has reported incidents of “wrong route” administration of medicines, with much concern around errors involving neuraxial administration of intravenous agents. The risk of these errors increases when devices are fitted with the “universal” Luer connector. As a result, there have been efforts to introduce non-Luer neuraxial connectors into clinical practice. This article described a study conducted to assess the clinical usability and cross-connectability of non-Luer neuraxial connectors designed for anesthesia procedures. The study was conducted as part of the development phase of the International Organization for Standardization (ISO) 80369 standard, which included specifications for a series of 7 small-bore connectors of varying sizes designed to reduce the risk of accidental misconnections.
Placental Growth Factor Testing to Assess Women With Suspected Preeclampsia: A Multicentre, Pragmatic, Stepped-wedge Cluster-randomized Controlled Trial
Authors: Duhig K.E. , Myers J. , Seed P.T. , Sparkes J. , Lowe J. , Hunter R.M. , Shennan A.H. , Chappell L.C. 
Published: February 2020

(Lancet. 2019;393:1807–1818)
Approximately 3% of singleton pregnancies are affected by preeclampsia, which can be difficult to diagnose as many women are asymptomatic. Hypertension and increased urinary protein excretion are common factors used to establish the diagnosis, but there are challenges in testing and observing both of these features. The pathophysiology of preeclampsia involves angiogenic factors, and low circulating maternal placental growth factor (PlGF) concentrations have been found to be useful in the diagnosis of preeclampsia with high sensitivity and negative predictive value. However, this potential tool for diagnosing preeclampsia should first be tested in a real-world setting to understand both its practical benefits and challenges. This study aimed to determine whether a preeclampsia diagnosis could be more quickly reached in women with suspected preeclampsia by incorporating measurement of the PlGF circulating concentration into an already established clinical management algorithm. The study also investigated the effect of using this diagnostic approach on maternal and perinatal outcomes.
Comparison of the Potency of Phenylephrine and Norepinephrine Bolus Doses Used to Treat Postspinal Hypotension During Elective Cesarean Section
Authors: Mohta M. , Dubey M. , Malhotra R.K. , Tyagi A. 
Published: February 2020

(Int J Obst Anesth. 2019;38:25–31)
Vasopressors to manage hypotension after spinal anesthesia are commonly used in obstetric patients. Phenylephrine has been considered the vasopressor of choice for many years, but it can result in reflex bradycardia and an associated fall in cardiac output. Norepinephrine is another potent vasopressor that has significant chronotropic effects that should limit bradycardia. However, there is little information about the preferred dose for managing postspinal hypotension in obstetric patients or its potency ratio compared with phenylephrine. This study aimed to calculate the 95% and 50% effective doses (ED95 and ED50) of both drugs and their potency ratio when administered as a bolus for the treatment of spinal-induced hypotension in women undergoing elective cesarean section.
Right Heart Masses Demonstrated by Echocardiography in a Patient With Amniotic Fluid Embolism During Labour
Authors: Maack K.H. , Munk K. , Dahl K. , Jørgensen H.H. , Christiansen A. , Helmig R.B. 
Published: February 2020

(Acta Anaesthesiol Scand. 2018;62(1):134–137)
This case report described a patient in active labor after an oral misoprostol induction. While initial vital signs of the patient and fetus were normal, membranes unexpectedly ruptured and the patient became unresponsive. The maternal pulse was not detected in the operating room, so care providers delivered a live male infant by cesarean section to facilitate resuscitation of the patient. Ultrasound imaging showed the inferior vena cava contained large masses protruding into the right atrium, through the tricuspid valve and into the right ventricle. Cardiovascular circulation was restored 12 minutes after cardiovascular collapse, and epinephrine was administered to assist with circulation stabilization. Observation through echocardiography showed the masses gradually disappeared and the right ventricle became a normal size again. Because of a high volume of blood loss, care providers performed a red blood cell and plasma transfusion before the patient was transferred to the intensive care unit (ICU). Disseminated intravascular coagulation was suspected and later confirmed through blood analyses.
Case 25-2019: A 41-Year-Old Pregnant Woman With Abdominal Pain
Authors: Saillant N.N. , Kilcoyne A. , Fagenholz P.J. , Lui R. , Krystel-Whittemore M. 
Published: February 2020

(N Engl J Med. 2019;381(7):656–664)
A 41-year-old women presented to the emergency room at 36 weeks and 3 days of gestation, complaining of abdominal pain. The pain was in the right lower quadrant and described as sharp and constant. She rated the pain at 8 on a 0 to 10 scale, with 10 indicating the most severe pain. The patient had had 4 previous pregnancies—2 were uncomplicated vaginal deliveries and 1 ended in spontaneous abortion. For her current pregnancy, her initial prenatal visit was normal and prenatal follow-up had been uneventful. Her obstetrician referred her to the clinic, where a transabdominal and transvaginal ultrasonography indicated no abnormal fetal findings. The patient was referred to another hospital’s emergency department.
Gonorrhea-positive sinus cultures in a 15-year-old with allergic fungal sinusitis
Authors: Donner Kimberly , Kou Yann-Fuu , Tomkies Anna , Rakheja Dinesh , Mitchell Ron B. , Shah Gopi 
Published: February 2020

ABSTRACT
This article describes a patient with gonorrhea in sinus cultures and allergic fungal sinusitis. A multidisciplinary team was assembled to deliver the results to the minor patient and her family and provide support and resources for long-term care.
Historical Perspective of Proactive and Reactive Regulations of E-cigarettes to Combat Nicotine Addiction
Authors: Gholap Vinit , Halquist Matthew S. 
Published: February 2020

Abstract:
Cigarettes and electronic cigarettes (e-cigarettes) are major sources of exposure to nicotine, an addictive chemical. Although these products are being regulated by the Food and Drug Administration (FDA) under the Tobacco Control Act, specifications about the nicotine content in these products have not been established yet. In e-cigarettes, nicotine concentration ranges from 0 to > 50mg/mL, and the recent e-cigarette devices provide control to change nicotine flux for higher nicotine delivery. Due to the lack of robust regulations in manufacturing, distribution and marketing, e-cigarettes have already infiltrated the market with youth appealing flavors and devices. As a result, the country is facing a youth epidemic of e-cigarette use. The unregulated nicotine levels in both cigarettes and e-cigarettes can lead to repeated and overexposure of nicotine to youth which can lead to the addiction and detrimental effects on their cognitive functions. Over the past decade, the corrective measures being taken by the FDA for cigarette and e-cigarette regulations also should focus on nicotine exposure levels. Before it is too late to prevent youth from lifetime addiction to nicotine, it is important to address the issues of nicotine concentration, nicotine flux and the e-cigarette device regulations while offering adults with smoking disorder less harmful alternatives to cigarettes.
Minimally Invasive Medial Plate Osteosynthesis of High-Energy Pediatric Tibia Fractures
Authors: Murphy Michael , Killen Cameron , Lynch Kyle , Cohen Joseph , Summers Hobie , Stover Michael , Lack William 
Published: February 2020

Objectives:
We report on the largest series to date of minimally invasive medial plate osteosynthesis of high-energy tibia fractures in skeletally immature patients.

Design:
Retrospective.

Setting:
Level 1 trauma center.

Patients:
Skeletally immature patients with high-energy tibia fractures treated with minimally invasive medial plate osteosynthesis between 2006 and 2017. We identified 28 fractures in 26 patients.

Main Outcome Measure:
We reviewed the record for patient, injury, and treatment factors as well as for complications and reoperation. We assessed the relationships between age, implant selection, and implant removal using χ2 and t test analyses.

Results:
Mean age was 12 years (4–15) with OTA/AO classifications including 42A (18), 42B (6), and 42C (4). There were 10 open fractures (1 type I, 2 type II, and 7 type III). Mean follow-up was 37.6 months (minimum 7). Mean time to full weight-bearing and union was 2 and 3 months, respectively. Plate stock (2.7, 3.5, and 4.5 mm) and length (6–20 holes) varied independent of age, P = 0.19. There were 2 superficial infections, one 15 mm leg length discrepancy, and one case of fasciotomy at the time of plate fixation for trauma-related compartment syndrome. Implant removal was more likely in younger patients (10.9 vs. 13.2 years, P = 0.04) and not associated with plate stock, P = 0.97. There were no neurovascular injuries, losses of reduction, or rotational deformities. Angulation was universally <5 degrees in the coronal plane and <10 degrees in the sagittal plane.

Conclusions:
Minimally invasive medial plate osteosynthesis of high-energy pediatric tibia fractures may be performed with a low rate of complications and should be considered in this select patient population with multiple injuries, high-energy mechanisms, and significant soft-tissue trauma.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
90-day Readmission Rates for Single Level Anterior Lumbosacral Interbody Fusion
Authors: Elia Christopher J. , Arvind Varun , Brazdzionis James , von Glinski Alexander , Schell Benjamin A. , Pierre Clifford A. , Ogunlade John , Chapman Jens R. , Oskouian Rod J. 
Published: February 2020

Study Design.
Nationwide Readmissions Database Study.

Objective.
To investigate the patterns of readmissions and complications following hospitalization for elective single level anterior lumbobsacral interbody fusion.

Summary of Background Data.
Lumbar interbody spine fusions for degenerative disease have increased annually in the United States, including associated hospital costs. Anterior lumbar interbody fusions (ALIFs) have become popularized secondary to higher rates of fusion compared with posterior procedures, and preservation of posterior elements. Prior national databases have sought to study readmission rates with some limitations due to older diagnosis and procedure codes. The newer 2016 International Classification of Diseases Tenth Revision, Clinical Modification (ICD-10 CM) includes more specification of the surgical site.

Methods.
We utilized the 2016 United States Nationwide Readmissions Database (NRD), this nationally representative, all-payer database that includes weighted probability sample of inpatient hospitalizations for all ages. We identified all adults (≥ 18 yrs) using the 2016 ICD-10 coding system who underwent elective primary L5-S1 ALIF and examined rates of readmissions within 90 days of discharge.

Results.
Between January and September 2016, a total of 7029 patients underwent elective stand-alone L5-S1 ALIF who were identified from NRD of whom 497 (7.07%) were readmitted within 90 days of their procedure. No differences in sex were appreciated. Medicare patients had statistically significant higher readmission rates (47.69%) among all payer types. With respect to intraoperative complications, vascular complications had statistically significant increased odds of readmission (OR, 3.225, 95% CI, 0.59 –1.75; P = 0.0001). Readmitted patients had higher total healthcare costs.

Conclusion.
The 90-day readmission rate following stand-alone single level lumbosacral (L5-S1) ALIF was 7.07%. ALIF procedures have increased in frequency, and an understanding of the comorbidities, age-related demographics, and costs associated with 90-day readmissions are critical. Surgeons should consider these risk factors in preoperative planning and optimization.

Level of Evidence: 3
Duration and Dosage of Opioids After Spine Surgery
Authors: Hills Jeffrey M. , Carlile Catherine R. , Archer Kristin R. , Wick Joseph B. , Butler Marjorie , Daryoush Joshua , Khan Inamullah , Call Richard , Devin Clinton J. , Pennings Jacquelyn S. 
Published: February 2020

Study Design.
Longitudinal Cohort Study

Objective.
The aim of this study was to determine whether duration of postoperative opioids is associated with long-term outcomes, and if initial postoperative opioid dosage is associated with opioid cessation after spine surgery.

Summary of Background Data.
Preoperative opioid use is associated with poor outcomes, but little evidence exists regarding the implications of opioid dosage and duration after spine surgery.

Methods.
Data from our state's prescription drug database was linked to our prospective clinical spine registry to analyze opioid dispensing and outcomes in elective surgical spine patients between 2010 and 2017. Patients were stratified based on preoperative chronic opioid use and multivariable regression was used to assess associations between duration of postoperative opioids and outcomes at one year, including satisfaction, chronic opioid use, and meaningful improvements in pain, disability, and quality of life. In a secondary aim, a Cox proportional hazards model was used to determine whether initial postoperative opioid dosage was associated with time to opioid cessation.

Results.
Of 2172 patients included, 35% had preoperative chronic opioid use. In patients without preoperative chronic opioid use, a postoperative opioid duration of 31 to 60 days was associated with chronic opioid use at 1 year (adjusted odds ratio [aOR]: 4.1 [1.7–9.8]) and no meaningful improvement in extremity pain (aOR: 1.8 [1.3–2.6]) or axial pain (aOR: 1.6 [1.1–2.2]); cessation between 61 and 90 days was associated with no meaningful improvement in disability (aOR: 2 [1.3–3]) and dissatisfaction (aOR:1.8 [1–3.1]). In patients with preoperative chronic opioid use, postoperative opioids for ≥90 days was associated with dissatisfaction. Cox regression analyses showed lower initial postoperative opioid dosages were associated with faster opioid cessation in both groups.

Conclusion.
Our results suggest that a shorter duration of postoperative opioids may result in improved 1-year patient-reported outcomes, and that lower postoperative opioid dosages may lead to faster opioid cessation.

Level of Evidence: 2
Effects of Specific Exercise Therapy on Adolescent Patients With Idiopathic Scoliosis
Authors: Liu Delong , Yang Yunlin , Yu Xuexiang , Yang Jingfan , Xuan Xiaoling , Yang Junlin , Huang Zifang 
Published: February 2020

Study Design.
A prospective controlled cohort study.

Objective.
The aim of this study was to explore the interventional effect of exercise therapy on idiopathic scoliosis (IS) and identify an optimal intervention window.

Summary of Background Data.
Early conservative treatment is helpful for IS. In addition to bracing, current evidence suggests that exercise can play an important role.

Methods.
We included 99 patients with IS who were treated at the Guangdong Xinmiao Scoliosis Center from August 2013 to September 2017. The inclusion criteria were: new IS diagnosis, Cobb angle 10° to 25°, Risser 0 to 3 grade, only treated with the Xinmiao treatment system (XTS; >3 days/week, >1 h/day), and follow-up >1 year. Patients were divided into three age groups: A, <10 years (n = 29); B, 10 to 12 years (n = 24); and C, 13 to 15 years (n = 46). The percentages of curve improvement (Cobb angle decrease ≥5°), stability (Cobb angle change × ±5°), and progression (Cobb angle increase ≥5°) were compared.

Results.
The groups showed significant differences for major curve correction, Risser sign, first referral, and final follow-up of the main curve (all P < 0.05). The major curve in group A decreased significantly by 6.8° (44% correction), compared to 3.1° (18% correction) and 1.5° (9% correction) in groups B and C, respectively. In group A, 69.0% (20/29) had curve improvement, 27.6% (8/29) stabilized and 3.4% (1/29) progressed. In group B, 45.8% (11/24) improved, 50% (12/24) stabilized, and 4.2% (1/24) progressed. In group C, 26.1% (12/46) improved, 63.0% (29/46) stabilized, and 10.9% (5/46) progressed. There was also a significant difference in final Risser grade among the groups (P < 0.05).

Conclusion.
For IS patients with Cobb angles between 10° and 25°, our exercise protocol can effectively control or improve curve progression. Younger patients with a lower Risser grade are most likely to respond.

Level of Evidence: 2