bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Serum Leptin Levels and Cardiovascular Events in Patients with Rheumatoid Arthritis
Authors: Chen Jiliang , Xie Zhiping , Bin Zou 
Published: May 2020

Abstract

Objective
Cardiovascular diseases (CVDs) are important complications for patients with rheumatoid arthritis (RA). The study aimed to explore whether serum leptin is associated with a increased risk of cardiovascular (CV) events in patients with RA.

Methods
Two hundred twenty-three patients with RA were followed for a mean of 40 (range = 8-42) months. Serum leptin levels were measured at baseline. Cox regression analysis was performed to assess the association between leptin levels and the risk of CV events.

Results
The univariate analysis showed that patients with RA with higher serum leptin levels had higher rates of CV events and CV mortality, respectively (P &lt;.001). The logistic regression model showed that leptin was independently related to CVD history (odds ratio = 1.603, 95% confidence interval [CI], 1.329–2.195; P =.005) after adjusting for confounding factors in patients with RA at baseline. The multivariate Cox proportional hazard model suggested that leptin was an independent prognostic factor for CV events in patients with RA after adjustments were made for clinical confounding factors (hazard ratio = 2.467, 95% CI, 2.019–4.495; P &lt;.001). The Kaplan-Meier analysis showed that compared with patients with RA with leptin levels below the median value (≤15.4 mg/L), patients with leptin above the median value (&gt;15.4 μg/L) had a higher rate of CV events (P &lt;.001).

Conclusion
Leptin was significantly associated with CV events in patients with RA. Elevated serum leptin levels may be a reliable prognostic factor for predicting CV complications in patients with RA.
Factors Associated With Weight Gain in People Treated With Dolutegravir
Authors: Taramasso Lucia , Bonfanti Paolo , Ricci Elena , Orofino Giancarlo , Squillace Nicola , Menzaghi Barbara , De Socio Giuseppe Vittorio , Madeddu Giordano , Pellicanò Giovanni Francesco , Pagnucco Layla , Celesia Benedetto Maurizio , Calza Leonardo , Conti Federico , Martinelli Canio Vito , Valsecchi Laura , Cascio Antonio , Bolla Cesare , Maggi Paolo , Vichi Francesca , Dentone Chiara , Angioni Goffredo , Mastroianni Antonio , Falasca Katia , Cenderello Giovanni , Di Biagio Antonio 
Published: May 2020

AbstractBackgroundAn unexpected excess in weight gain has recently been reported in the course of dolutegravir (DTG) treatment. The aim of the present study was to investigate whether weight gain differs among different DTG-containing regimens.MethodsAdult naïve and experienced people with HIV (PWH) initiating DTG-based antiretroviral therapy (ART) between July 2014 and December 2019 in the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) prospective cohort were included. We used an adjusted general linear model to compare weight change among backbone groups and a Cox proportional hazard regression model to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for weight increases &gt;10% from baseline.ResultsA total of 713 participants, 25.3% women and 91% Caucasian, were included. Of these, 195 (27.4%) started DTG as their first ART regimen, whereas 518 (72.6%) were ART-experienced. DTG was associated with abacavir/lamivudine in 326 participants, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 148, boosted protease inhibitors in 60, rilpivirine in 45, lamivudine in 75, and tenofovir alafenamide (TAF)/FTC in 59. At 6 and 12 months, weight gain was highest among PWH on TDF/FTC+DTG and TAF/FTC+DTG. Baseline CD4 &lt;200 cells/mm3 (HR, 1.84; 95% CI, 1.15 to 2.96), being ART-naïve (HR, 2.24; 95% CI, 1.24 to 4.18), and treatment with TDF/FTC+DTG (HR, 1.92; 95% CI, 1.23 to 2.98) or TAF/FTC+DTG (HR, 3.80; 95% CI, 1.75 to 8.23) were associated with weight gain &gt;10% from baseline. Higher weight (HR, 0.97 by 1 kg; 95% CI, 0.96 to 0.99) and female gender (HR, 0.54; 95% CI, 0.33 to 0.88) were protective against weight gain.ConclusionsNaïve PWH with lower CD4 counts and those on TAF/FTC or TDF/FTC backbones were at higher risk of weight increase in the course of DTG-based ART.
Accuracy of Ultrasound-Guided Pudendal Nerve Block in the Ischial Spine and Alcock’s Canal Levels: A Cadaveric Study
Authors: Soucy Béatrice , Luong Dien Hung , Michaud Johan , Boudier-Revéret Mathieu , Sobczak Stéphane 
Published: May 2020

AbstractBackgroundBlockade of the pudendal nerve (PN) using ultrasound (US) guidance has been described at the levels of the ischial spine and Alcock’s canal. However, no study has been conducted to compare anatomical accuracy between different approaches in targeting the PN.ObjectiveTo investigate the accuracy of US-guided injection of the PN at the ischial spine and Alcock’s canal levels. This study also compared the accuracy of the infiltrations by three sonographers with different levels of experience.SubjectsEight Thiel-embalmed cadavers (16 hemipelvises).MethodsThree physiatrists trained in musculoskeletal US imaging with 12 years, five years, and one year of experience performed the injections. Each injected a 0.1-mL bolus of colored dye in both hemipelvises of each cadaver at the ischial spine and Alcock’s canal levels under US guidance. Each cadaver received three injections per hemipelvis. The accuracy of the injection was determined following hemipelvis dissection by an anatomist.ResultsThe injections were accurate 33 times out of the total 42 attempts, resulting in 78% accuracy. Sixteen out of 21 injections at the ischial spine level were on target (76% accuracy), while the approach at Alcock’s canal level yielded 17 successful injections (81% accuracy). The difference between the approaches was not statistically significant. There was also no significant difference in accuracy between the operators.ConclusionsUS-guided injection of the PN can be performed accurately at both the ischial spine and Alcock’s canal levels. The difference between the approaches was not statistically significant.
Catastrophic Drug Errors Involving Tranexamic Acid Administered During Spinal Anesthesia
Authors: Patel S. , Robertson B. , McConachie  
Published: May 2020

(Anaesthesia. 2019;74:904–914)
Drug administration errors during neuraxial anesthesia can result in dire outcomes. These authors had previously reported on neuraxial drug administration errors, but have since learned of several incidents of accidental intrathecal administration of tranexamic acid during spinal anesthesia. This article reviewed reports of these occurrences, identified contributing factors to the drug errors, and discussed prevention strategies.
Induction of Labor at Full-term in Pregnant Women With Uncomplicated Singleton Pregnancy: A Systematic Review and Meta-analysis of Randomized Trials
Authors: Saccone G. , Della Corte L. , Maruotti G.M. , Quist-Nelson J. , Raffone A. , De Vivo V. , Esposito G. , Zullo F. , Berghella V. 
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:958–966)
Some care providers have advocated for induction of labor for all pregnancies once they reach full-term, to avoid an elevated risk of perinatal morbidity and mortality. Critics assert that induction is commonly associated with an increased risk of cesarean delivery, although previous trials do not support this argument. Saccone and colleagues conducted this study to examine the effects of labor induction in women with full-term singleton gestations with no complications.
Incidence of Maternal Sepsis and Sepsis-related Maternal Deaths in the United States
Authors: Hensley M.K. , Bauer M.E. , Admon L.K. , Prescott H.C. 
Published: May 2020

(JAMA. 2019;322:890–892)
The burden of sepsis and sepsis-related deaths in pregnancy may be higher than currently estimated. Prior studies focused on select populations or did not follow patients longitudinally; therefore estimates of maternal sepsis following delivery have been limited. The aim of this study was to assess the nationwide incidence and outcomes of maternal sepsis within 42 days of delivery hospitalization discharge using all-payer data.
Measuring What Matters to Moms Most
Authors: Mhyre J.M. , Bateman B.T. 
Published: May 2020

(Anesthesiology. 2019;131:223–225)
In the United States, the risks of maternal morbidity and mortality have moved into public focus as the US falls behind other countries in terms of safe maternity care. Current quality measures are lacking, as they do not adequately represent safe maternal care and are not risk-adjusted. Poor performance in hospitals is often attributed to patient population and dismissed.
Guidelines for Postoperative Care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (Part 3)
Authors: Macones G.A. , Caughey A.B. , Wood S.L. , Wrench I.J. , Huang J. , Norman M. , Pettersson K. , Fawcett W.J. , Shalabi M.M. , Metcalfe A. , Gramlich L. , Nelson G. , Wilson R.D. 
Published: May 2020

(Am J Obstet Gynecol. 2019;221:247.e1–247.e9)
Enhanced recovery after surgery (ERAS) is a perioperative care program that is standardized in various formats for disciplines including colorectal, urologic, gynecologic, and hepatobiliary surgery. ERAS has been shown to reduce hospital length of stay, complications, readmissions, and cost. Creating a standardized ERAS guideline for perioperative care in cesarean delivery will provide best practice recommendations for part 1 (antenatal/preoperative), part 2 (intraoperative), and part 3 (postoperative phases) with a maternal focus.
Women’s Perceptions of Medication Use During Pregnancy and Breastfeeding: A Swedish Cross-sectional Questionnaire Study
Authors: Wolgast E. , Lindh-Åstrand L. , Lilliecreutz C. 
Published: May 2020

(Acta Obstet Gynecol Scand. 2019;98:856–864)
Medications are used frequently during pregnancy to treat an array of symptoms and conditions, from diabetes and asthma to nausea and depression. Women may view medication use as potentially unsafe during pregnancy, particularly due to the thalidomide scandal of the 1960s. One study on herbal medicine use during pregnancy found that 19% of women used herbal medicines during pregnancy and 20% believed they were safer than prescribed medications. This current study examined the perceptions among Swedish pregnant women of overall medication use and herbal medicine use during pregnancy and postpartum when breastfeeding. They also investigated patients’ sense of reliability of the sources from which they got their information about medication use during pregnancy.
Tranexamic Acid in the Routine Treatment of Postpartum Hemorrhage in the United States: A Cost-effectiveness Analysis
Authors: Sudhof L.S. , Shainker S.A. , Einerson B.D. 
Published: May 2020

(Am J Obstet Gynecol. 2019;221:275.e1–275.e12)
From 2011 to 2015, postpartum hemorrhage (PPH) was the cause of 11% of pregnancy-related deaths in the United States and the incidence of PPH is increasing. However, as major obstetric hemorrhage is uncommon and unpredictable, often requiring implementation of multiple nonpharmacological interventions after uterotonic administration, it remains difficult to study. Major obstetric hemorrhage requires significant resources.
Vaginal Delivery in Women With a Low-lying Placenta: A Systematic Review and Meta-analysis
Authors: Jansen C. , de Mooij Y.M. , Blomaard C.M. , Derks J.B. , van Leeuwen E. , Limpens J. , Schuit E. , Mol B.W. , Pajkrt E. 
Published: May 2020

(BJOG. 2019;126:1118–1126)
While physicians strive to avoid unnecessary cesarean sections, they must weigh this goal with the possible risks of hemorrhage in patients with low-lying placentas. Guidelines and recommendations vary widely on whether patients with low-lying placentas should deliver by cesarean delivery. The Royal College of Obstetricians and Gynaecologists states patients with a low-lying placenta should deliver via cesarean, while in the Netherlands, vaginal delivery is suggested for patients with an internal os distance (IOD) of >10 mm. This systematic review and meta-analysis aimed to evaluate the possibility of successful vaginal delivery with a low-lying placenta.
Providing Patient-centered Perinatal Care for Transgender Men and Gender-diverse Individuals: A Collaborative Multidisciplinary Team Approach
Authors: Hahn M. , Sheran N. , Weber S. , Cohan D. , Obedin-Maliver J. 
Published: May 2020

(Obstet Gynecol. 2019;134:959–963)
Over the course of the last decade, the experience of pregnancy in transgender men (and other gender-diverse people who were assigned female sex at birth) has secured higher visibility within medical journals. While some gender-affirming treatments eliminate fertility, such as hysterectomy or oophorectomy, some transgender men may retain or even desire reproductive capability. Both intended and unintended pregnancies after undergoing gender-affirming processes have occurred, and some transgender men aspire for subsequent pregnancy and parenthood depending on their stage of transition and age. As there is little clinical guidance for medical care from prenatal to postpartum, this is a divulsion of a case intended to help create a more equitable and inclusive health care experience for transgender men and to assure patient-centered care.
Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa
Authors: Alexander L.A. , Newton M.W. , McEvoy K.G. , Newton M.J. , Mungai M. , DiMiceli-Zsigmond M. , Sileshi B. , Watkins S.C. , McEvoy M.D. 
Published: May 2020

(Anesth Analg. 2019;128:993–998)
The maternal mortality rate in low- and middle-income countries (LMICs) is 20 times higher than in developed countries, at a rate of 239 deaths per 100,000 live births. Sub-Saharan Africa in particular is considered by the World Health Organization (WHO) to be the most dangerous place in the world for women undergoing childbirth. On the basis of the success of WHO’s surgical checklist, this current study investigated the development and use of a context-sensitive obstetric anesthesia checklist for use during cesarean delivery (CD) in East Africa, with the goal that they could demonstrate an improvement in adherence to best practice guidelines for anesthesia for CD in LMICs.
A Biased Coin Up-and-Down Sequential Allocation Trial to Determine the Optimum Programmed Intermittent Epidural Bolus Time Interval Between 5 mL Boluses of Bupivacaine 0.125% With Fentanyl 2 µg/mL
Authors: Bittencourt R. , Arzola C. , Zakus P. , Downey K. , Ye X.Y. , Carvalho J.C.A. 
Published: May 2020

(Can J Anesth. 2019 66:1075–1081)
Programmed intermittent epidural bolus (PIEB) for labor analgesia has garnered a lot of attention and is the focus of ongoing research. PIEB when compared with continuous epidural infusion results in higher maternal satisfaction, reduced local anesthetic consumption, lower incidence of motor block, fewer unilateral blocks, and less breakthrough pain. The optimal epidural solution and PIEB settings for labor analgesia have yet to be decided. This study aimed to determine the effective PIEB time interval when using 5 mL boluses of bupivacaine 0.125% with fentanyl 2 mcg/mL.
Intravenous Dexmedetomidine for the Treatment of Shivering During Cesarean Delivery Under Neuraxial Anesthesia: A Randomized-controlled Trial
Authors: Lamontagne C. , Lesage S. , Villeneuve E. , Lidzborski E. , Derstenfeld A. , Crochetieìe C. 
Published: May 2020

(Can J Anesth/J Can Anesth. 2019;66:762–771)
Neuraxial anesthesia is preferable for cesarean deliveries (CDs), as it allows mothers to be awake and avoids the associated risks of general anesthesia. However, an estimated 53% of patients under neuraxial anesthesia suffer from shivering. Uncontrolled shivering intervenes with vital sign monitoring, causes physiological stress, and affects a patient’s satisfaction and comfort. The most common pharmacological treatment for shivering is meperidine (a synthetic opioid). However, as this drug becomes increasingly scarce in North American hospitals, an effective alternative agent is desired. Dexmedetomidine is an alternative treatment for shivering and can alleviate shivering while avoiding side effects associated with opioids. The aim of this study was to test whether a single bolus of 30 μg intravenous (IV) dexmedetomidine, administered 5 minutes after childbirth, could reduce shivering during CD under neuraxial anesthesia.
The Impact of Reclassifying Suicides in Pregnancy and in the Postnatal Period on Maternal Mortality Ratios
Authors: Lommerse K. , Knight M. , Nair M. , Deneux-Tharaux C. , van den Akkerb T. 
Published: May 2020

(BJOG. 2019;126:1088–1092)
As lowering maternal mortality rates continues to be a global priority, attention should be given to maternal mental health care. UK experts estimate half of all maternal suicides could have been prevented by better care. The World Health Organization in 2012 introduced the International Classification of Diseases for Maternal Mortality, which changed all suicides in pregnancy and up to 12 months postpartum to be classifed as a direct obstetric death. This recommendation was meant to reduce underreporting, but some countries have raised concerns that some of these deaths should be regarded as “indirect” obstetric deaths, as many women who die by suicide had mental illness before pregnancy.
Systematic Review on Late Cochlear Implantation in Early-Deafened Adults and Adolescents: Clinical Effectiveness
Authors: Debruyne Joke A. , Janssen A. Miranda , Brokx Jan P.L. 
Published: May 2020

Objectives:
Cochlear implantation in early-deafened patients, implanted as adolescents or adults, is not always advised due to poor expected outcomes. In order to judge whether such reluctance is justified, the current systematic review aimed to gather all available evidence on postoperative outcomes obtained by early-deafened patients using a state-of-the art cochlear implant (CI).

Design:
Five electronic databases (PubMed, Embase, the Cochrane library, CINAHL, and PsycInfo) were systematically searched for studies in English, French, German, or Dutch, published between 2000 and September 2017. Studies that reported pre- and postoperative outcomes on any measure of speech or sound perception, audiovisual or subjective benefit (quality of life) were included. Study quality was assessed with the Institute of Health Economics quality appraisal tool for case series studies.

Results:
The systematic search and subsequent full-text evaluation identified 38 studies meeting the inclusion criteria. Only a limited number of studies were judged to be of high quality according to the Institute of Health Economics tool, with lack of (clear) presentation of relevant study information being a recurring problem. Twenty-five studies presented viable outcomes on open-set speech understanding in quiet: mean postoperative scores obtained with CI remained below 50% for the vast majority of studies; significant postoperative improvements were found in 16 studies, although this number might have been higher if appropriate statistical testing had been performed in all studies. Eight studies observed increased audiovisual performance after implantation, which was statistically significant in six studies. A validated measure of hearing-related quality of life was used in only 5 of the 16 studies assessing subjective outcomes, showing significant postoperative improvements for most questionnaire domains. The relation between auditory and subjective outcomes was assessed in two studies, with contradictory results.

Conclusions:
The current review showed that late cochlear implantation in early-deafened subjects resulted in significantly improved open-set speech perception, audiovisual speech perception, and (hearing-related) quality of life in the majority of the studies involved. Nonetheless, more and especially higher-quality research is needed in order to gain a more detailed understanding of the outcomes of cochlear implantation in this population.
A Feasibility Study of a New Muscle Sparing “C3 Dome-Hybrid Open-Door Laminoplasty”
Authors: Liu Gabriel , Fung Gerald , Tan Joshua , Ng Jing Han , Tan Jun-Hao 
Published: May 2020

Study Design.
Retrospective case series to investigate the result of a new C3 dome-hybrid open-door laminoplasty technique.

Objective.
This study reports the design and feasibility of a new hybrid laminoplasty technique aimed to reduce the complications of the conventional laminoplasty, with the incorporation of C3 dome-osteotomy, an open-door C4–6 instrumented laminoplasty and C7 cephalad dome-osteotomy.

Summary of Background Data.
Recent findings showed that the preservation of the dorsal muscles attached at either C2 or C7 cervical spine reduced the complications of C3–C7 open-door laminoplasty.

Methods.
A retrospective review of consecutive patients who underwent the C3 dome-hybrid laminoplasty technique by a single surgeon with at least 2 years follow-up was performed. The surgical technique was described in detail. Clinical and radiological outcome data were analyzed.

Results.
Twenty six patients with cervical cord compression who underwent C3 dome-hybrid laminoplasty were recruited. The mean postoperative follow-up was 45.6 ± 24.7 (24–101) months. Significant improvements were observed in the preoperative to postoperative mean Japanese Orthopaedic Association (JOA) score (13→15, P < 0.001), Nurick grade (2.3→1.2, P < 0.001), neck disability index (NDI) (23→11, P = 0.011), 36-item short form survey (SF-36) physical component score (40→46, P = 0.027), and neck visual analogue scale (VAS) (3.1→0.3, P < 0.001). There was no significant loss in cervical lordosis from 12° preoperatively to 8° at final follow-up. Postoperative cervical range of motion (ROM) was preserved at 85% and 78% of the preoperative ROM at 2 years and at final follow-up, respectively. When comparing the first 10 patients with the next 16 patients, there was a reduction in mean operation time from 252 ± 75 to 208 ± 7 minutes, mean blood loss from 359 ± 326 to 211 ± 177 mL, and median hospital stay from 7 days (interquartile range [IQR]: 34) to 5 days (IQR: 6).
At final follow-up, no patients had revision surgery, spinal infection, C5 palsy, symptomatic cervical kyphosis, or axial neck pain.

Conclusion.
The new C3 dome-hybrid laminoplasty technique is safe, feasible, and reproducible with good clinical outcomes. This technique may be considered as an alternative to traditional laminoplasty for patients with C3–C7 multi-level myelopathic disease.

Level of Evidence: 3
Emergency management of immune-related toxicity
Authors: Cooksley Tim , Stutman Robin , Klotz Adam 
Published: May 2020

Purpose of review
Emergency presentations in patients treated with immune checkpoint inhibitors (ICIs) are a clinical challenge. Clinicians need to be vigilant in diagnosing and treating immune-mediated toxicities. In this review, we consider the approach to managing an acutely unwell patient being treated with ICIs presenting as an emergency.

Recent findings
A minority of acutely unwell patients treated with ICIs will have an immune-mediated toxicity. Early recognition and intervention in those with immune-mediated toxicity can reduce the duration and severity of the complications. The use of early immunosuppressive agents along corticosteroid therapy may improve outcomes in patients with life-threatening immune-mediated toxicity.

Summary
Individualized management of immune-mediated toxicities is a key challenge for emergency oncology services; this has become part of routine cancer care.