bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined spinal epidural for labour analgesia and caesarean section: indications and recommendations
Authors: Guasch Emilia , Brogly Nicolas , Gilsanz Fernando 
Published: May 2020

Purpose of review
Even if its use is scarce in most countries, many articles concerning combined spinal epidural (CSE) were published. In this review, we present the latest advances concerning CSE in obstetrics.

Recent findings
During labour, CSE improves epidural analgesia quality. Epidural with intradural opioids can produce maternal hypotension and foetal heart rate abnormalities (FHR-Ab), without increasing the caesarean section rate. For caesarean section, CSE decreases the neuraxial block failure rate, with no significant increase of complications. Epidural volume extension (EVE) after CSE for caesarean section could be an interesting option even though more evidence is needed.

Summary
For labour analgesia, CSE has the fastest onset time of analgesia. Its side effects have no consequences on maternal, labour or foetal outcomes. It provides better analgesia than epidural analgesia and can be used for external cephalic version and high-risk patients. For caesarean section, CSE has become the reference neuraxial technique for low-dose spinal anaesthesia, with higher success rate compared with regular spinal anaesthesia. Recent systematic revisions did not confirm this superiority. CSE offers the advantage of EVE, intraoperative top-ups, postoperative administration of neuraxial opioids and local anaesthetics. The risk of complications is balanced by the benefits of the technique.
Cannabis, e-cigarettes and anesthesia
Authors: Lynn Rachael S. Rzasa , Galinkin Jeffrey L. 
Published: May 2020

Purpose of review
Both cannabis and e-cigarette use are increasing, particularly among adolescents. The use of cannabis products may impact patients’ physiology under anesthesia. Understanding the effects of cannabis and vaping are critical to the provision of safe and effective anesthetic care.

Recent findings
E-cigarettes have recently been implicated in a severe presentation of acute lung injury, often in association with vaporization of the cannabinoid, THC. E-cigarette use appears to be associated with other less-acute pulmonary adverse effects that are yet to be fully understood. Cannabis affects many organ systems with alterations in cardiovascular, respiratory and neurological function. Specifically, there is emerging evidence that cannabis use may reduce the efficacy of sedative agents and postoperative pain management efforts.

Summary
There is a very wide variety of cannabis products currently available, with respect to both route of administration as well as cannabinoid content. Patients using cannabis products prior to anesthesia may present with altered physiology that place them at increased risk for cardiovascular and respiratory complications. They may also be tolerant to the effects of propofol and opioid for pain management, thus consideration should be given to use of a multimodal regimen.
Assessing the Predictive Validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) in Alaska Native and American Indian People
Authors: Lillie Kate M. , Jansen Kelley J. , Dirks Lisa G. , Lyons Abram J. , Alcover Karl C. , Avey Jaedon P. , Hirchak Katherine , Herron Jalene , Buchwald Dedra , Donovan Dennis M. , McDonell Michael G. , Shaw Jennifer L. 
Published: May 2020

Objectives:
The objective of this study was to examine the predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) among Alaska Native and American Indian (ANAI) people with an alcohol use disorder.

Methods:
The sample was 170 ANAI adults with an alcohol use disorder living in Anchorage, Alaska who were part of a larger alcohol intervention study. The primary outcome of this study was alcohol use as measured by mean urinary ethyl glucuronide (EtG). EtG urine tests were collected at baseline and then up to twice a week for four weeks. We conducted bivariate linear regression analyses to evaluate associations between mean EtG value and each of the three SOCRATES subscales (Recognition, Ambivalence, and Taking Steps) and other covariates such as demographic characteristics, alcohol use history, and chemical dependency service utilization. We then performed multivariable linear regression modeling to examine these associations after adjusting for covariates.

Results:
After adjusting for covariates, mean EtG values were negatively associated with the Taking Steps (P = 0.017) and Recognition (P = 0.005) subscales of the SOCRATES among ANAI people living in Alaska. We did not find an association between mean EtG values and the Ambivalence subscale (P = 0.129) of the SOCRATES after adjusting for covariates.

Conclusions:
Higher scores on the Taking Steps and Recognition subscales of the SOCRATES at baseline among ANAI people predicted lower mean EtG values. This study has important implications for communities and clinicians who need tools to assist ANAI clients in initiating behavior changes related to alcohol use.
Time Course of Evolving Ventilator-Induced Lung Injury: The “Shrinking Baby Lung”
Authors: Marini John J. , Gattinoni Luciano 
Published: May 2020

Objectives:
To examine the potentially modifiable drivers that injure and heal the “baby lung” of acute respiratory distress syndrome and describe a rational clinical approach to favor benefit.

Data Sources:
Published experimental studies and clinical papers that address varied aspects of ventilator-induced lung injury pathogenesis and its consequences.

Study Selection:
Published information relevant to the novel hypothesis of progressive lung vulnerability and to the biophysical responses of lung injury and repair.

Data Extraction:
None.

Data Synthesis:
In acute respiratory distress syndrome, the reduced size and capacity for gas exchange of the functioning “baby lung” imply loss of ventilatory capability that dwindles in proportion to severity of lung injury. Concentrating the entire ventilation workload and increasing perfusion to these already overtaxed units accentuates their potential for progressive injury. Unlike static airspace pressures, which, in theory, apply universally to aerated structures of all dimensions, the components of tidal inflation that relate to power (which include frequency and flow) progressively intensify their tissue-stressing effects on parenchyma and microvasculature as the ventilated compartment shrinks further, especially during the first phase of the evolving injury. This “ventilator-induced lung injury vortex” of the shrinking baby lung is opposed by reactive, adaptive, and reparative processes. In this context, relatively little attention has been paid to the evolving interactions between lung injury and response and to the timing of interventions that worsen, limit or reverse a potentially accelerating ventilator-induced lung injury process. Although universal and modifiable drivers hold the potential to progressively injure the functional lung units of acute respiratory distress syndrome in a positive feedback cycle, measures can be taken to interrupt that process and encourage growth and healing of the “baby lung” of severe acute respiratory distress syndrome.
Use of a compact high-definition two-dimensional exoscope in surgical treatment of large vestibular schwannoma
Authors: Chen Xin , Gao Xiang-Liang , Chai Yan , Shi Ming-Ming , Zhang Jian-Ning , Yue Shu-Yuan 
Published: May 2020

Abstract

Background:
Extra-corporeal video telescope operating monitor system provides a necessary instrument to perform high-precision neurosurgical procedures that could substitute or supplement the traditional surgical microscope. The present study was designed to evaluate a compact high-definition two-dimensional exoscope system for assisting in surgical removal of large vestibular schwannoma (VS), as an alternative to a binocular surgical microscope.

Methods:
Patients with Koos grade 3 and grade 4 VS undergoing surgery were enrolled in this prospective cohort study between January 2013 and June 2018. The demographics and tumor characteristics (size, Koos grade, composition [cystic or solid mass]) were matched between the two groups of patients. The following outcome measurements were compared between the two groups: duration of surgery, volume of blood loss, extent of tumor resection, number of operating field adjustments, pre- and post-operative facial and cochlear nerve function evaluated at 3 months post-surgery, complications and surgeons’ comfortability.

Results:
A total of 81 patients received tumor resection through the retrosigmoid approach under either an exoscope (cases, n = 39) or a surgical microscope (control, n = 42). Patients in the two groups had comparable tumor location (P = 0.439), Koos grading (P = 0.867), and composition (P = 0.891). While no significant differences in the duration of surgery (P = 0.172), extent of tumor resection (P = 0.858), facial function (P = 0.838), and hearing ability (P = 1.000), patients operated on under an exoscope had less blood loss (P = 0.036) and a fewer field adjustments (P < 0.001). Both primary and assistant surgeons reported a high level of comfort operating under the exoscope (P = 0.001 and P < 0.001, respectively).

Conclusions:
The compact high-definition two-dimensional exoscope system provides a safe and efficient means to assist in removing large VSs, as compared to a surgical microscope. After the acquaintance with a visual perception through a dynamic hint and stereoscopically viewing corresponding to the motion parallax, the exoscope system provided a comfortable, high-resolution visualization without compromising operational efficiency and patient safety.
A Dynamically Cooled, Variable Spot-Sized 1,064 nm Neodymium-doped Yttrium Aluminum Garnet Laser as a Treatment Option for Facial Reticular Veins
Authors: Aleisa Abdullah , Goldman Mitchel P. 
Published: May 2020

BACKGROUND
Facial reticular veins can be treated with laser therapy, sclerotherapy, or surgical removal. The use of a 1,064 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser has been reported to be successful in the treatment of facial reticular veins.

OBJECTIVE
To report a large retrospective study examining the efficacy, side effects, and satisfaction of a dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser for the treatment of facial reticular veins in the periorbital and temporal area.

PATIENTS AND METHODS
Contact was made with 100 patients from 2006 to 2019 who underwent treatment with a 1,064 nm Nd:YAG laser for facial reticular veins through office follow-up or telephone interviews. Percent resolution of veins, satisfaction, and adverse effects were evaluated.

RESULTS
Eighty-nine of the 100 patients ranked their satisfaction with the treatment as 3 or very satisfied. Most patients reported 75% to 100% improvement. The most commonly reported adverse event seen after treatment was mild edema. Sixty-eight percent of patients reported no adverse effects at all.

CONCLUSION
The dynamically cooled, variable spot-sized 1,064 nm Nd:YAG laser is a safe and effective treatment for facial reticular veins with minimal side effects. The results are usually immediate and, based on the long-term follow-up, tend to be long lasting.
Pre-operative chronic opioid or glucocorticoid use and mortality after noncardiac surgery
Authors: Oh Tak Kyu , Kim Saeyeon , Song In-Ae , Jeon Young-Tae 
Published: May 2020

BACKGROUND
The chronic use of opioids and glucocorticoids is associated with serious side effects. Moreover, both medications are related to poor long-term postoperative outcomes.

OBJECTIVE
The study aimed to investigate the association between pre-operative chronic opioid and glucocorticoid use and 90-day mortality after noncardiac surgery.

DESIGN
Retrospective, population-based cohort study.

SETTING
Single tertiary academic hospital.

PATIENTS
The study enrolled adult (≥18 years of age) patients admitted to Seoul National University Bundang Hospital, between January 2012 and December 2018 for planned, elective, noncardiac surgery.

MAIN OUTCOME MEASURES
The study compared the 90-day mortality for patients using opioids or glucocorticoids chronically (≥3 months) prior to surgery and for opioid-naïve and glucocorticoid-naïve patients.

RESULTS
A total of 112 606 patients were included in the study. Among them, 107 843 (95.9%) were opioid-naïve and glucocorticoid-naïve patients; 3373 (3.0%), 1199 (1.1%) and 191 patients (0.2%) were chronic users of opioids, glucocorticoids or both, respectively. In the multivariable model, compared with opioid-naïve and glucocorticoid-naïve patients, the odds of dying within 90 days were significantly higher for chronic users of opioids [3.56-fold; 95% confidence intervals (CIs) 2.36 to 5.38; P < 0.001], glucocorticoids (4.17-fold; 95% CI 3.28 to 5.29; P < 0.001) and combined opioids and glucocorticoids (7.66-fold; 95% CI 3.91 to 15.01; P < 0.001).

CONCLUSION
Chronic pre-operative use of opioids and glucocorticoids, together or individually, were associated with increased 90-day mortalities after noncardiac surgery, compared with opioid-naïve and glucocorticoid-naïve patients. Our results suggest that chronic pre-operative use of opioids and glucocorticoids should be managed carefully.
Outcomes in adults with systolic blood pressure between 130 and 139 mmHg in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial and Systolic Blood Pressure Intervention Trial
Authors: Contreras Gabriel , Lu Lingyi , Tamariz Leonardo , Rocco Michael V. , Papademetriou Vasilios , Kostis John B. , Pisoni Roberto , Glasser Stephen P. , Sweeney Mary E. , Basile Jan , Gren Lisa H. , Zamanian Sara , Cushman William C. 
Published: May 2020

Background:
Patients with stage 1 systolic hypertension have increased risk of cardiovascular disease (CVD) events.

Methods:
Using Cox models, we assess the effect of targeting an intensive SBP goal of less than 120 mmHg compared with standard SBP goal of less than 140 mmHg on the risk of CVD events in adults with stage 1 systolic hypertension with diabetes mellitus enrolled in Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP) (n = 1901) and without diabetes mellitus enrolled in Systolic Blood Pressure Intervention Trial (SPRINT) (n = 3484) that used identical SBP goal interventions.

Outcomes:
In ACCORD BP, the primary composite CVD outcome was the first occurrence of myocardial infarction, stroke, or CVD mortality. In SPRINT, the primary composite CVD outcome was the first occurrence of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or CVD mortality.

Results:
In SPRINT, targeting an intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.75 (95% confidence interval, 0.58–0.98); events 1.78 vs. 2.37%/year]. In ACCORD BP, the relationships of SBP goal with the primary CVD outcome was modified by the glycemia goal intervention (interaction P = 0.039). In the standard glycemia subgroup (A1c target 7–7.9%), intensive SBP goal significantly reduced the risk of the primary CVD outcome [hazard ratio 0.61 (0.40–0.94); events 1.63 vs. 2.56%/year]. In the intensive glycemia subgroup (A1c target <6%), the risk of the primary CVD outcome was not significantly different between groups [hazard ratio 1.20 (0.76–1.89); events 1.91 vs. 1.60%/year].

Conclusion:
Targeting an intensive SBP goal significantly reduced the risk of CVD events in patients with stage 1 systolic hypertension without diabetes and with diabetes on standard glycemia goal.
Misuse of a Medical Radioisotope: 125I Labeled Playing Cards in Germany, a Case Study
Authors: Kroeger Emily Alice , Rupp Alexander , Gregor Joachim 
Published: May 2020

Abstract
The security of medical radioactive sources, both open and sealed, is an important consideration for reducing the risk of an intentional or inadvertent additional radiation dose to the public, according to the principle of keeping any additional radiation dose as low as reasonably achievable. The detection and following radiological investigation of the misuse of iodine-125 (125I), a medically used radionuclide, in Germany is described in detail with the aim of sharing experience and raising awareness. The misuse of 125I shows that the security of 125I is not guaranteed completely at the present time.
Suspected Close Contacts as the Pilot Indicator of the Growth Trend of Confirmed Population During the COVID-19 Pandemic: A Simulation Approach
Authors: Huang Sisi , Zhu Anding , Wang Yan , Xu Yancong , Li Lu , Kong Dexing 
Published: May 2020

Abstract
Regarding to the actual situation of the new coronavirus disease 2019 epidemic, social factors should be taken into account and the increasing growth trend of confirmed populations needs to be explained. A proper model needs to be established, not only to simulate the epidemic, but also to evaluate the future epidemic situation and find a pilot indicator for the outbreak. The original susceptible-infectious-recover model is modified into the susceptible-infectious-quarantine-confirm-recover combined with social factors (SIDCRL) model, which combines the natural transmission with social factors such as external interventions and isolation. The numerical simulation method is used to imitate the change curve of the cumulative number of the confirmed cases and the number of cured patients. Furthermore, we investigate the relationship between the suspected close contacts (SCC) and the final outcome of the growth trend of confirmed cases with a simulation approach. This article selects four representative countries, that is, China, South Korea, Italy, and the United States, and gives separate numerical simulations. The simulation results of the model fit the actual situation of the epidemic development and reasonable predictions are made. In addition, it is analyzed that the increasing number of SCC contributes to the epidemic outbreak and the prediction of the United States based on the population of the SCC highlights the importance of external intervention and active prevention measures. The simulation of the model verifies its reliability and stresses that observable variable SCC can be taken as a pilot indicator of the coronavirus disease 2019 pandemic.
Penumbra volume predicts unfavorable outcome in patients with acute minor stroke or transient ischemic attack
Authors: Liao Chih-Hsiang , Liao Nien-Chen , Chen Wen-Hsien , Chen Hung-Chieh , Chang Ming-Hong , Tsuei Yuang-Seng , Shen Chiung-Chyi , Yang Shun-Fa , Chen Po-Lin 
Published: May 2020

Background:
A subgroup of patients with acute minor stroke (AMS) or transient ischemic attack (TIA) become disabled due to disease progression (DP) or recurrent stroke within 3 months. The aim of this article is to identify the risk factors for DP in AMS/TIA patients. In the literature, no studies focused on computed tomography perfusion (CTP) in AMS/TIA patients at the acute stage.

Methods:
This retrospective study included patients with AMS or TIA (onset of symptoms ≤4.5 hours, baseline National Institutes of Health Stroke Scale [NIHSS] score of 0-4). DP was defined as a deterioration of NIHSS score of ≥2 points during hospitalization or modified Ranking Scale ≥2 at 3-month follow-up. Clinical data and imaging results were retrieved and measured for statistical analysis.

Results:
From 2011 to 2017, total 135 patients were eligible for further analysis: 28 patients (20.7%, DP group) and 107 patients (79.3%, non-DP group). The DP group had significantly higher larger penumbra volumes (p = 0.028). In univariate model of the logistic regression, patients with the following risk factors tended to have unfavorable outcome: female gender, higher HbA1c, chronic kidney disease stage ≥3b, intracranial atherosclerosis, and penumbra volume were associated unfavorable outcome, but larger deadcore volume was not. In further multivariate analysis, only penumbra volume >5 cm3 (p = 0.049, odds ratio [OR] = 3.21, 95% CI: 1.00-10.27) had the statistical significance. The cut-point value of the penumbra volume for unfavorable outcome in AMS/TIA patients was 4.73 cm3.

Conclusion:
One fifth of the AMS/TIA patients had unfavorable outcome at 90 days. In CTP performed within 4.5 hours after the onset of AMS/TIA, the penumbra volume (>5 cm3) was a significant risk factor for DP, and the cut-point value was 4.73 cm3. Further studies could be designed to involve this subgroup of patients for more aggressive treatment.
Redox reaction and clinical outcome of primary diffuse large B-cell lymphoma of the central nervous system: Prognostic role of metabolic and textural parameters of 62Cu-diacetyl-bis (N4-methylthiosemicarbazone) PET/computed tomography in a small patient cohort
Authors: Tsuchiya Junichi , Yoneyama Tomohiro , Ohtake Makoto , Tateishi Kensuke , Bae Hyeyeol , Kishino Mitsuhiro , Tateishi Ukihide 
Published: May 2020

Objective
This study aimed to clarify the relationship between tumor redox reaction evaluated by 62Cu-diacetyl-bis (N4-methylthiosemicarbazone) (62Cu-ATSM) PET/computed tomography (CT) and disease-free survival (DFS) in patients with primary diffuse large B-cell lymphoma of the central nervous system (DLBCL-CNS).

Methods
Fifteen consecutive patients with histologically confirmed DLBCL-CNS underwent preoperative 62Cu-ATSM PET/CT and 18F-fluorodeoxyglucose (FDG) PET/CT. Statistical features of seven first-order parameters, including the standardized uptake value (SUV); 12 second-order parameters, including gray-level co-occurrence matrices and gray-level zone size matrices; and 5 high-order parameters, including neighborhood gray-tone difference matrices, were calculated from the volume of interest. We compared DFS with parameters, including SUVmax and tumor-to-background (T/B) ratio of FDG, and SUVmax, T/B ratio, and other textural features of 62Cu-ATSM.

Results
The mean follow-up duration after PET/CT was 458 (range, 41–1071) days. The SUVmax of FDG was significantly higher than that of 62Cu-ATSM (P = 0.001), but the T/B ratio was not significantly different between the scans (3.49 ± 2.29 vs 2.48 ± 1.18; P = 0.244). A Mantel–Cox log-rank test revealed no significant association between SUVmax of FDG and DFS (P = 0.641). A high SUVmax of 62Cu-ATSM had a tendency of shorter DFS (P = 0.055). Total lesion reduction, reductive tumor volume, and T/B ratio of 62Cu-ATSM were significantly correlated with poor DFS by univariate analysis (P = 0.049, 0.031, and 0.007, respectively). Neighborhood gray-level co-occurrence matrix dissimilarity was significantly correlated with poor DFS (P = 0.015).

Conclusions
Metabolic and textural features derived from pretreatment 62Cu-ATSM PET/CT could be used for predicting DFS and establishing a novel treatment strategy in DLBCL-CNS patients.
Cystic fibrosis transmembrane conductance receptor modulator therapy in cystic fibrosis, an update
Authors: Egan Marie E. 
Published: May 2020

Purpose of review
Cystic fibrosis transmembrane conductance receptor (CFTR) modulators are a new class of drugs that treat the underlying cause of cystic fibrosis. To date, there are four approved medications, which are mutation-specific. Although the number of mutations that respond to these agents is expanding, effective CFTR modulators are not available to all cystic fibrosis patients. The purpose of this article is to review the approved CFTR modulators and discuss the mutations that can be treated with these agents, as well as, review the long-term benefits of modulator therapy.

Recent findings
More people with cystic fibrosis can be effectively treated with CFTR modulators. The new, highly effective triple therapy, elexacaftor/tezacaftor/ivacaftor is indicated for more than 90% of patients with cystic fibrosis and ivacaftor is now approved for children as young as 6 months of age with 1 of 30 CFTR mutations. Long-term use of modulator therapy is associated with fewer pulmonary exacerbations, maintenance of lung function, improved weight gain, and quality of life.

Summary
CFTR modulators are the first therapies developed to treat the underlying defect in cystic fibrosis. Their use is associated with preserved lung function and improved health in patients with cystic fibrosis.