bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurologically Devastating Intraparenchymal Hemorrhage in COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Case Series
Authors: Heman-Ackah Sabrina M , Su YouRong Sophie , Spadola Michael , Petrov Dmitriy , Chen H Isaac , Schuster James , Lucas Timothy 
Published: April 2020

Abstract

BACKGROUND AND IMPORTANCE
Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients.

CLINICAL PRESENTATION
We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified.

CONCLUSION
Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.
Smoking, Smoking Cessation, and Progression of Chronic Kidney Disease: Results From KNOW-CKD Study
Authors: Lee Sangmi , Kang Shinchan , Joo Young Su , Lee Changhyun , Nam Ki Heon , Yun Hae-Ryong , Park Jung Tak , Chang Tae Ik , Yoo Tae-Hyun , Kim Soo Wan , Oh Kook-Hwan , Kim Yeong Hoon , Park Sue K , Kang Shin-Wook , Choi Kyu Hun , Ahn Curie , Han Seung Hyeok 
Published: April 2020

Abstract

Introduction
In patients with chronic kidney disease (CKD), studies investigating the association between smoking and deterioration of kidney function are scarce.

Aims and Methods
We analyzed data for 1,951 patients with an estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m2 enrolled in the KoreaN cohort study for Outcome in patients With Chronic Kidney Disease (KNOW-CKD) from 2011 to 2016. Patients were categorized by smoking load. Primary outcome was a composite of a ≥50% reduction in eGFR, initiation of dialysis, or kidney transplantation.

Results
There were 967 never-smokers and 369, 276, and 339 smokers who smoked &lt;15, 15 to 29, ≥30 pack-years, respectively. During a mean follow-up of 3.0 years, the incidence rates (95% confidence interval [CI]) of the primary outcome were 54.3 (46.4–63.5), 46.9 (35.9–61.4), 69.2 (52.9–90.6), and 76.3 (60.7–96.0) events per 1,000 person-yr in never-, &lt;15, 15 to 29, and ≥30 pack-year smokers. In cause-specific hazard model after adjustment of confounding factors, smokers were associated with 1.09 (0.73–1.63), 1.48 (1.00–2.18), and 1.94 (1.35–2.77) fold increased risk (95% CI) of primary outcome in &lt;15, 15–29, and ≥30 pack-year smokers compared with never-smokers. The association of longer smoking duration with higher risk of CKD progression was evident particularly in patients with eGFR &lt; 45 mL/min/1.73 m2 and proteinuria ≥ 1.0 g/g. In contrast, the risk of adverse kidney outcome decreased with longer smoking-free periods among former-smokers.

Conclusions
These findings suggest potentially harmful effects of the degree of exposure to smoking on the progression of CKD.

Implications
Among patients with CKD, there has been lack of studies on the association between smoking and CKD progression and studies to date have yielded conflicting results. In this prospective cohort study involving Korean CKD patients, smoking was associated with significantly higher risk of worsening kidney function. Furthermore, the risk of adverse kidney outcome was incrementally higher as smoking pack-years were higher. As the duration of smoking cessation increased, the hazard ratios for adverse kidney outcome were attenuated, suggesting that quitting smoking may be a modifiable factor to delay CKD progression.
Development of an antimicrobial peptide-loaded mineralized collagen bone scaffold for infective bone defect repair
Authors: He Yuzhu , Jin Yahui , Ying Xiaoxia , Wu Qiong , Yao Shenglian , Li Yuanyuan , Liu Huiying , Ma Guowu , Wang Xiumei 
Published: April 2020

AbstractThe repair of infective bone defects is a great challenge in clinical work. It is of vital importance to develop a kind of bone scaffold with good osteogenic properties and long-term antibacterial activity for local anti-infection and bone regeneration. A porous mineralized collagen (MC) scaffold containing poly(d,l-lactide-co-glycolic acid) (PLGA) microspheres loaded with two antibacterial synthetic peptides, Pac-525 or KSL-W was developed and characterized via scanning electron microscopy (SEM), porosity measurement, swelling and mechanical tests. The results showed that the MC scaffold embedded with smooth and compact PLGA microspheres had a positive effect on cell growth and also had antibacterial properties. Through toxicity analysis, cell morphology and proliferation analysis and alkaline phosphatase evaluation, the antibacterial scaffolds showed excellent biocompatibility and osteogenic activity. The antibacterial property evaluated with Staphylococcus aureus and Escherichia coli suggested that the sustained release of Pac-525 or KSL-W from the scaffolds could inhibit the bacterial growth aforementioned in the long term. Our results suggest that the antimicrobial peptides-loaded MC bone scaffold has good antibacterial and osteogenic activities, thus providing a great promise for the treatment of infective bone defects.
Investor Protection and Capital Fragility: Evidence from Hedge Funds around the World
Authors: Aragon George O , Nanda Vikram , Zhao Haibei 
Published: April 2020

Abstract
We find that capital flows to hedge funds in different countries are influenced by the strength and the enforcement of investor protection laws. Hedge funds located in weak investor protection countries exhibit greater sensitivity of investor outflow to poor performance, relative to funds in countries with strong protection. Furthermore, weak investor protection is associated with fund managers engaging in greater returns management. Our findings suggest that in countries with weaker investor protection, poor fund performance exposes investors to a greater risk of fraud and legal jeopardy, thus triggering a larger outflow of capital.
The Rise and Fall of the Tahrir Repertoire: Theorizing Temporality, Trajectory, and Failure
Authors: Said Atef 
Published: April 2020

Abstract
This article examines how and why the strategy of occupying Tahrir Square went from being the central mode of action and defining image of the Egyptian Revolution of 2011 to an ineffective strategy read by many as symbolic of the revolution’s ultimate failure during the transitional period of 2011–2012. This question speaks to a lacuna in the literature on repertoires, specifically a lack of attention to their temporality and the lessons to be learned from their failure. I propose a framework that examines the trajectory of repertoires and traces their 1) meaning; 2) internal composition; 3) relationality vis-à-vis the regime in relation to which the repertoire is practiced; and 4) temporal momentum. Using this framework, I chart the rise and fall of the Tahrir repertoire in a very short period: from February 12, 2011, to December 5, 2012. The article draws on ethnographic, qualitative, and historical data collected over three research trips taken between February 4, 2011, and January 7, 2015.
A procolophonid reptile from the Lower Triassic of Australia
Authors: Hamley Tim , Cisneros Juan C , Damiani Ross 
Published: April 2020

AbstractA new procolophonid reptile from the Lower Triassic Arcadia Formation of Queensland, Australia is described on the basis of abundant cranial and postcranial remains. Eomurruna yurrgensis gen. & sp. nov. is the first parareptile from Australia, being represented by more than 40 specimens from which a detailed description of the osteology is made. The most characteristic feature of Eo. yurrgensis is the presence of six to eight blunted, monocuspid maxillary teeth that are circular in basal cross-section. The new Australian taxon features an interdigitated tooth-occlusion system that represents an intermediate functional stage between the primitive procolophonoid pattern, without apparent tooth-to-tooth contact, and the crown-to-crown occlusion system characteristic of the horned procolophonids. Its dentition suggests good capabilities of oral processing and shows instances of replacement. A phylogenetic analysis suggests that the new taxon occupies a relatively basal position within the Procolophonidae. The taxonomic status of the procolophonoid species ‘Owenetta’ kitchingorum and Saurodektes rogersorum from South Africa and ‘Eumetabolodon’ dongshengensis from China is reassessed. The new genus Youngetta gen. nov. and the new combinations Saurodektes kitchingorumcomb. nov. and Youngetta dongshengensiscomb. nov. are here proposed.
Preterm Delivery Prediction Using Phosphorylated Insulin-Like Growth Factor in Rural Kenya [OP01-1A]
Authors: Shirazian Taraneh , Gilligan Lisa , K'Ouma Matete Thomas 
Published: April 2020

INTRODUCTION:
To evaluate the feasibility and accuracy of a test analyzing for the presence of phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1), in predicting preterm delivery in asymptomatic women in the rural Kenya.

METHODS:
This was a prospective cohort study conducted by Saving Mothers from 2013-2019. Asymptomatic women presenting for routine prenatal care in West Pokot, Kenya were enrolled. Pregnant women were recruited prior to 24 weeks and offered the opportunity to return at 28-32 weeks gestation to obtain the phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) assay. Dating was established by last menstrual period and confirmed by ultrasound. Patients who tested positive received betamethasone, and were referred to the maternity waiting home. Outcome data was collected after delivery and sensitivity, specificity, positive and negative predictive values were reported for the test.

RESULTS:
669 women were recruited. 469 returned for the second visit to receive the test, and presently 370 have complete data for analysis. 180 tested positive for preterm birth risk, 143 of whom delivered prior to 37 weeks gestation (Positive Predictive Value = 79.4%). 190 tested negative, 176 of whom delivered after 37 weeks (Negative Predictive Value = 92.6%). Sensitivity for the test was 91.0%. Specificity was 82.6%.

CONCLUSION:
The pIGFBP-1 point of care test is effective in predicting risk for preterm birth in asymptomatic women in rural Kenya. This allows for risk-stratification in low resource settings. Proper intervention may optimize utilization of scarce resources and improve maternal and child health.
Vaginal Cleansing and Azithromycin at Cesarean Delivery; A Quality Improvement Study [OP01-1C]
Authors: Quist-Nelson Johanna Rachel , Gomez Julie , Felder Laura , Di Mascio Daniele , Eckler Rebecca , Posencheg Michael 
Published: April 2020

INTRODUCTION:
The objective was to assess the stepwise implementation of pre-operative vaginal cleansing and intravenous (IV) azithromycin on the rate of surgical site infection (SSI) for women who undergo cesarean delivery (CD) intrapartum or after rupture of membranes.

METHODS:
This was a quality improvement study comparing 3 groups: 1). 12 months of pre-intervention; 2). 14 months of vaginal cleaning as infection prophylaxis; 3). 16 months of both vaginal cleansing and azithromycin IV as infection prophylaxis. The primary outcome, which was analyzed by control charts, was the rate of SSI as defined by the Center for Disease Control and Prevention (CDC). This study was IRB approved.

RESULTS:
There were 1,033 patients included from the 3 study periods. The total rate of SSI rate decreased from 22% to 12.5% after implementing vaginal cleansing. Special cause variation was seen with an 8-point shift starting 4 months after implementation of vaginal cleansing. This decrease was sustained during the following 26 months. Adding azithromycin IV did not significantly further lower the rate of SSI. When examined separately, deep SSI (P=.009) and endometritis (P=.001) significantly decreased in the post-intervention periods. Pre-operative vaginal cleansing compliance rose to 74%, and then further increased to 85% 1 year after implementation. Azithromycin IV compliance rose to 75%.

CONCLUSION:
In this quality improvement study, implementation of vaginal cleansing decreased the SSI rate by 43%, from 22% prior to either intervention to 12.5% after addition of vaginal cleansing. The addition of azithromycin IV did not result in any further change in SSI rate.
Does Robot Assistance for Benign Hysterectomy Increase the Risk of Trendelenburg Position-Related Complications? [OP02-3B]
Authors: Mandelbaum Rachel S. , Chang Erica , Matsuzaki Shinya , Im Dwight , Klar Maximilian , Matsuo Koji 
Published: April 2020

INTRODUCTION:
Recent studies have suggested that prolonged Trendelenburg positioning during robotic-assisted total laparoscopic hysterectomy (RA-TLH) may lead to fluid shifts and resulting pulmonary, airway, head and neck, and cranial complications, however national statistics are lacking. This study examined Trendelenburg position-related complications by hysterectomy approach for benign gynecological disease.

METHODS:
A population-based retrospective study utilizing the National Inpatient Sample was conducted to examine total hysterectomy for benign gynecologic disease from 2008-2015. Trendelenburg position-related complications were compared between RA-TLH (n=59,061), conventional TLH (C-TLH, n=58,864), and total abdominal hysterectomy (TAH, n=791,320). Pairwise propensity score inverse probability of treatment weighting (PS-IPTW) with a generalized estimating equation was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A classification tree model was used to examine factors contributing to complications.

RESULTS:
In the PS-IPTW model, RA-TLH was not associated with increased risk of Trendelenburg position-related complications compared to C-TLH (4.5% versus 4.5%, OR 0.99, 95% CI 0.87-1.13, P=0.871) or TAH (4.5% versus 4.7%, 0.96, 95% CI 0.87-1.06, P=0.420). Charlson Comorbidity Index (CCI) and age were most strongly associated with Trendelenburg position-related complications; women ≥80 years with a CCI of ≥4 had a disproportionally high incidence (49.1%). Moreover, Trendelenburg position-related complications were the most predictive of inpatient death following hysterectomy in the whole cohort; mortality rate was 4.9% in patients with a CCI of ≥4 at rural hospitals.

CONCLUSION:
RA-TLH is not associated with an increased risk of Trendelenburg position-related complications. However, older age and higher comorbidity are two key risk factors for these complications and confer high mortality risk.
Evaluation of Ovarian Perfusion With Indocyanine Green Dye (ICG) in Patients With Suspected Adnexal Torsion [OP02-4B]
Authors: Nicholson Kaitlin , Urh Anze , Schwartz Benjamin , Holubyeva Anastasiya , LaPier Zoe , Cisneros-Camacho Ana 
Published: April 2020

INTRODUCTION:
The aim of this study is to assess the safety and feasibility of Indocyanine Green (ICG) dye in patients with adnexal torsion. Our hypothesis is that the use of ICG dye will aid in the surgical determination of tissue viability, ultimately preventing the resection of salvageable ovaries.

METHODS:
An IRB approved pilot study is currently enrolling patients 18-45 years old with suspected adnexal torsion in a multicentered tertiary care hospital setting. During laparoscopy, the involved adnexa is untwisted and ICG dye is injected intravenously. The untwisted ovary is then observed. Adnexal tissue demonstrating perfusion is preserved and patients are followed postoperatively with anti-Mullerian hormone level and ultrasound. Non-perfused tissue is resected and histologically evaluated for necrosis.

RESULTS:
Eleven patients with suspected adnexal torsion were enrolled, of which eight had surgically confirmed torsion. Six women demonstrated perfusion with the use of ICG dye even though three of these patients had minimal or no flow on preoperative ultrasound. The remaining 2/8 patients with confirmed torsion failed to demonstrate perfusion with the ICG dye and oophorectomies were performed. One of these patients had confirmed histologic necrosis. There have been no adverse events.

CONCLUSION:
The use of intravenous ICG dye appears to be a safe and valuable adjunct in the surgical management of adnexal torsion. This may be particularly helpful in patients with diminished adnexal perfusion on preoperative ultrasound. Further research is recommended to determine the generalized role of ICG dye in patients with adnexal torsion.
Impact of Retained Cystoscopy Fluid Following Laparoscopic/Robotic Hysterectomy: A Randomized Controlled Trial [OP02-5B]
Authors: Smith Rachael , Mahnert Nichole D. , Hu Chengcheng , Steck-Bayat Kayvahn , Stone Ashley , Mourad Jamal 
Published: April 2020

INTRODUCTION:
Spontaneous voiding is an important postoperative milestone following hysterectomy. We investigated the impact of retained cystoscopy fluid following laparoscopic and robotic hysterectomy with universal cystoscopy on time to spontaneous void and patient satisfaction.

METHODS:
This was an IRB approved, single-blind, randomized, controlled trial from October 2018 to October 2019 comparing 200-mL retained cystoscopy fluid and complete bladder emptying following laparoscopic and robotic hysterectomy for benign indications, excluding prolapse and incontinence. The primary outcome was time to spontaneous void. Secondary outcomes were urinary retention rates, length of stay, bladder discomfort, and patient satisfaction. A sample size of 120 was calculated to achieve 80% power (alpha = .05) to detect a 57 minute difference in time to spontaneous void.

RESULTS:
A total of 120 patients were randomized (59 in the retained fluid arm, 61 in the empty arm). There were no differences in baseline demographics or surgery characteristics between groups. There was an apparent although not statistically significant difference in time to spontaneous void (143 minutes vs 168 minutes, P=.20). Urinary retention rates and length of stay did not differ (13.6% vs 8.2%, P=.51 and 199 minutes vs 214 minutes, P=.40). There was no difference in postoperative bladder discomfort and patient satisfaction.

CONCLUSION:
Retained cystoscopy fluid following laparoscopic and robotic hysterectomy did not significantly impact time to spontaneous void, urinary retention, length of stay, bladder discomfort, and patient satisfaction. Despite no differences, recovery nurses feel patients void faster with retained fluid. Our next step will be to perform a qualitative study of recovery nurse perceptions.
Assessing Hepatitis C Among Perinatal Women Undergoing Treatment for Opioid Use Disorder in Kentucky [03A]
Authors: Winter Kathleen , Adekunle Deborah , Harp Kathi , Barnhart Sheila , Critchfield Agatha 
Published: April 2020

INTRODUCTION:
HCV infection among women of child-bearing age in Kentucky is among the highest in the nation. Many women with opioid use disorders (OUD) are unaware of their HCV status and do not receive follow-up treatment for themselves or their infant.

METHODS:
Our IRB-approved cohort study evaluated HCV prevalence among pregnant and early parenting women receiving outpatient medication-assisted treatment for OUD. After informed consent, anti-HCV positive patients completed a survey and interview to assess HCV knowledge, perception of risk, and barriers to antiviral treatment.

RESULTS:
Of 129 clients, 76 (59%) had HCV antibodies and 52 (40%) had detectable HCV RNA; most were genotypes 1 or 3. Of the 63 eligible, 45 (71%) participated; 6 (14%) women were unaware of their current HCV infection status. Most (82%) were diagnosed with HCV prior to their most recent pregnancy and 55% were diagnosed >2 years prior; 28% had no knowledge of perinatal HCV transmission risk. Most (75%) reported that HCV treatment was important, however only 3 (7%) had received direct acting antiviral treatment; all achieved sustained virologic response. Perceived barriers included severe side effects and cost; nearly all were uninformed about Medicaid eligibility. One-third did not know anyone with prior HCV treatment.

CONCLUSION:
HCV prevalence in this cohort was high; despite prenatal testing, not all clients were aware of their status. Women were uninformed about perinatal transmission risk, and HCV treatment efficacy, protocols, and side effects. HCV testing and counseling is important for pregnant women even if a client has been previously diagnosed with HCV.
Association Between Preterm Birth and Chronic Toxoplasma gondii Infection in Latina Women [04A]
Authors: Ranaweera Indira , Ozorio Dutra Samia Valeria , Yoo Ji Yoon , Louis-Jacques Adetola , Duffy Allyson , Groer Maureen 
Published: April 2020

INTRODUCTION:
Chronic Toxoplasma gondii infects up to one-third of the world's population. Latina women have a higher rate of infection with more virulent serotypes. While acute infection can cause devastating effects in pregnancy, chronic infection had not been considered to have pathological effects. Our objective is to investigate the association between preterm birth and chronic T. gondii infection in Latina women.

METHODS:
We evaluated 178 Latina women for T. gondii status and followed them through pregnancy and up to 6 weeks postpartum. Demographic information, obstetric histories, pregnancy outcomes, and blood samples were obtained. T. gondii IgG positivity signified chronic exposure. We performed descriptive analyses, chi-square, and Student t-test.

RESULTS:
There were complete data on 157 Latina women. Thirty-three (21.0%) were T. gondii IgG positive and 124 (79.0%) were T. gondii IgG negative. Among T. gondii positive women, 9 (27.3%) delivered preterm as compared to 15 (12.1%) of T. gondii negative women. There was a significant difference when comparing the frequency of preterm birth in T. gondii IgG positive and T. gondii IgG negative mothers (phi coefficient=.172, P<.031). The mean gestational age of delivery was 36.9 weeks (SD±3.98) for seropositive mothers and 38.1 weeks (SD±2.96) for seronegative mothers (t(155)=1.931, P=.055).

CONCLUSION:
T. gondii IgG seropositivity was associated with a higher likelihood of preterm delivery in Latina women. Further studies are needed to examine the impact of chronic T. gondii infection on pregnancy outcomes.