bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION BETWEEN BODY FAT DISTRIBUTION AND BLOOD PRESSURE IN NORMAL-WEIGHT CHINESE CHILDREN AND ADOLESCENTS
Authors: Cai Rongrong , Dang Jie , Dong Yangyang , Zhang Hao , Yang Qingmei , Ma Ping , Ding Wenqing 
Published: April 2021

Objective:
Body fat distribution is commonly considered as playing a significant role in blood pressure (BP), whether normal-weight children and adolescents whose body fat distribution confer BP risk that remains uncertain. Aim of this study was to assess the associations of body fat distribution with BP risk in normal-weight Chinese children and adolescents.

Design and method:
A cross-sectional study consisted of 898 normal-weight children and adolescents aged 10–18 years from China. Participants were selected using a cluster sampling method and underwent bioelectrical impedance analysis (BIA) for body fat distribution indexes.

Results:
Body fat distribution was related with an increased risk for BP in normal-weight children and adolescents. After adjustment for gender and age, visceral fat level(VFL) was positively associated with abnormal BP (OR:1.109 95%CI, 1.016–1.210; P < 0.05), and the same result also found when including fat mass percentage(FMP; P < 0.05). FMP, VFL and VFL/FMP ratio showed a positively association with abnormal BP in girls after adjustment for age, respectively (OR:1.08; 95%CI, 1.03–1.13; P < 0.01)(OR:1.22; 95%CI, 1.07–1.38; P < 0.01)(OR:1.08; 95%CI, 1.01–1.14; P < 0.05). However, when both FMP and VFL were adjusted for age, FMP but not VFL negatively associated with abnormal BP in boys (OR:0.94; 95%CI,0.88–1.00; P < 0.05), and the same result also found when additional including VFL/FMP ratio in the same model(P < 0.05).

Conclusions:
The body fat distribution (especially visceral fat) is associated with abnormal BP in normal-weight children and adolescents, especially in girls. Therefore, attention should be paid to the relative effect of body fat distribution (especially visceral fat) on BP in the prevention and treatment of hypertension in youths.
THE IMPACT OF HYPERGLYCEMIA FIRST DETECTED IN PREGNANCY ON OFFSPRING BLOOD PRESSURE IN SOWETO, SOUTH AFRICA
Authors: Boerstra Brittany , Soepnel Larskse M. , Nicolaou Veronique , Kolkenbeck-Ruh Andrea , Ware Lisa , Norris Shane A. , Klipstein Kerstin 
Published: April 2021

Objective:
In South Africa, the prevalence of pediatric hypertension in 5-year-old children is 1 in 5. It has been estimated that 60% of South African children with elevated blood pressure maintain this status into adulthood, contributing to the highest prevalence of hypertension in adults aged 50+ globally. Recent literature suggests that pediatric hypertension may be influenced by maternal factors during pregnancy, including hyperglycaemia first detected in pregnancy (HFDP). The long-term consequences for offspring born to mothers with HFDP are not yet well understood and its impact on childhood blood pressure has not previously been assessed in sub-Saharan Africa. The objective of this study is to evaluate the association between HFDP and offspring blood pressure in 3–6-year-old children in Soweto, South Africa.

Design and method:
Oscillometric blood pressure was measured in 183 children born to mothers with and without HFDP using a 75-g 2-hour OGTT for diagnosis. Blood pressure was categorized into normotensive, elevated, Stage 1 and Stage 2 hypertension according to the 2017 American Academy of Pediatrics Hypertension Guidelines. The association between maternal hyperglycemia and offspring blood pressure was analyzed using multiple linear regression

Results:
In 48.6% of children, blood pressure was above the normotensive range. Prevalence of hypertension did not significantly differ between the exposed and control group. There was no significant association between maternal hyperglycemia and offspring systolic blood pressure when adjusted for offspring age, height, and sex, [-0.323, 95% CI (-3.126–2.480), P = 0.821). Early life factors, including child BMI age z-score [1.529, 95% CI (0.067–2.990), P = 0.041] and exposure to maternal smoking [5.460, 95% CI (0.182–10.739), P = 0.043], were significantly associated with offspring systolic blood pressure. Maternal hypertension was not a significant predictor for offspring blood pressure.

Conclusions:
Maternal HFDP was not associated with childhood blood pressure at 3–6 years, but the high prevalence of pediatric hypertension in this group of preschool-aged children is concerning. Future research should further evaluate offspring obesity and maternal smoking as potentially preventable risk factors that could be improved by public policy to reduce the cycle of hypertension and cardiovascular risk in an African setting.
EFFECTS OF METABOLIC SYNDROME ON BLOOD CELLS OF RATS
Authors: Birulina Julia , Petrova Irina , Ivanov Vladimir , Buyko Evgeniy , Trubacheva Oksana , Smagliy Ludmila 
Published: April 2021

Objective:
The study is focused on the effects of metabolic syndrome induced by high-fat, high-carbohydrate diet on erythrocytes and platelets of rats.

Design and method:
The 6-week old Wistar rats (n = 23) were used for study. Rats were divided into control and experimental groups. The rats from the control group were fed standard rat chow. The rats from the experimental group had a high-fat, high-carbohydrate diet. Body weight, blood pressure (BP) were assessed. After 12 weeks of a diet load an oral glucose tolerance test was carried out. Hematological and biochemical parameters in plasma were analyzed. The conductivity of the KCa-channels of the erythrocyte membrane was measured by potentiometric method, and the platelet aggregation was determined by turbidimetric method.

Results:
High-fat, high-carbohydrate diet feeding in rats for 12 weeks led to obesity, BP elevation, hyperglycemia, impaired glucose tolerance, dyslipidemia with triglyceridemia. Elevation of number of leukocytes due to granulocytes and platelets were observed in the experimental group. The collagen-induced aggregation of platelets was elevated in rats with metabolic syndrome. Red blood cell count in rats of the experimental group did not significantly differ from the control group. The multidirectional changes in the membrane potential were observed in response to the stimulation of the KCa-channels of the erythrocyte membrane of the experimental group with the Ca2 + ionophore A23187 or the redox-system.

Conclusions:
The data obtained indicate that a high-fat, high-carbohydrate diet leads to metabolic and hemorheological disorders, that are characteristic of metabolic syndrome.
THE IMPACT OF COVID-19 PANDEMIC AND LOCKDOWN ON CARDIOMETABOLIC STATUS ON PATIENTS WITHOUT EVIDENCE OF SARS COV-2 INFECTION IN THREE REGIONS OF LATIN AMERICA. A SUB-STUDY OF THE CORCOVID LATAM STUDY
Authors: Camilletti Jorge , Renna Nicolas , Santi Ricardo Lopez , Erriest Juan , Siller Grecia Perez , Garcia Maria Isabel , Martinez Carlos Garcia , Baranchuk Adrian 
Published: April 2021

Objective:
Background The purpose of the study was to evaluate regional related differences in Latin America on the impact of the pandemic in cardiometabolic patients without evidence of SARS-CoV-2 infection.

Methods:
A cross-sectional survey was conducted which included 38 questions about demography, clinical condition, change of health habits, medical treatments to cardio metabolic patients in outpatient follow-up. A total of 66 researchers from 13 Latin American countries enrolled patients from June 15 to July 15, 2020. The countries were divided into 3 geographic regions Region1 (NCCR) North, Central, and Caribbean Region; Region2 (AR) Andean Region; Region3 (SCR) Southern Cone Region. Isolation measures were estimated from national reports and correlated using the Spearman R coefficient.

Design and method:
4216 patients were analyzed, NCCR (33.82%); AR (32.23%) SCR (33.94%). Significant differences were found between regions in the AR, SCR and NCCR, in age, unemployment, CV risk, adherence, percentage of smokers, type of diet and vaccination coverage. This analysis of habitual medication showed, that discontinued medication was greater in AR, reaching almost 30% (1 in 3 patients), to a lesser extent in NCCR and ultimately less in SCR, showing a significant difference between zones (p < 0.001). The main finding of this study was the negative impact that restrictive measures have on adherence to medications and physical activity, Rs = 0.84 p = 0.0003 and Rs = 0.61 p = 0.0032, respectively.

Results:
Significant differences were found between regions, AR is the most vulnerable region, lower income, lower educational level, higher medication discontinuation. Restrictive measures imposed by the different countries (quarantine) showed a positive correlation with the discontinuation of medication and a negative correlation with the amount of physical activity. The impact of the consequences left by this pandemic will be very profound in most Latin American countries.
Prevalence of Depression or Anxiety During Antepartum Hospitalizations for Obstetric Complications
Authors: Toscano Marika , Royzer Rebecca , Castillo Daniel , Li Dongmei , Poleshuck Ellen 
Published: April 2021

OBJECTIVE:
To systematically review the prevalence of antenatal depression and anxiety in women hospitalized in an antepartum unit for obstetric complications.

DATA SOURCES:
We searched PubMed, EMBASE, CINAHL, PsycINFO, and ClinicalTrials.gov for English-language articles published from database inception through March 2020.

METHODS OF STUDY SELECTION:
We included cross-sectional, cohort, case–control, quasi-experimental, and randomized controlled studies from any country that reported the proportion of pregnant women with an elevated depression or anxiety screening scale or diagnostic interview during antepartum hospitalization of any duration and at any gestational age.

TABULATION, INTEGRATION, AND RESULTS:
We identified 8,799 articles and reviewed 79, 39 of which were included in a systematic review and 18 in meta-analysis of the primary outcome. Two raters independently assessed quality of individual studies using a 14-question tool. A random effects meta-analysis model was used to estimate prevalence and 95% CI of depression or anxiety. Heterogeneity was examined with the I2 test, and funnel plots were used to assess publication bias. After meta-analysis, the estimated prevalence of depression was 34% (95% CI 27–41%) and of anxiety 29% (95% CI 16–43%). There was expected substantial clinical and methodologic heterogeneity between studies that persisted even after planned a priori subgroup analyses and meta-regression. Even so, the direction of effect was consistent across studies. No publication bias was found.

CONCLUSION:
The current meta-analysis suggests that one in three women hospitalized during pregnancy for obstetric complications report clinical levels of depression or anxiety symptoms, twice the reported prevalence of antenatal depression or anxiety in the general obstetric population.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42020172111.
Uptake and Outcomes of Sentinel Lymph Node Mapping in Women With Atypical Endometrial Hyperplasia
Authors: Dioun Shayan , Chen Ling , Melamed Alexander , Gockley Allison , St. Clair Caryn M. , Hou June Y. , Tergas Ana I. , Khoury-Collado Fady , Hur Chin , Hershman Dawn L. , Wright Jason D. 
Published: April 2021

OBJECTIVE:
To examine the utilization, morbidity, and cost of sentinel lymph node mapping in women undergoing hysterectomy for complex atypical endometrial hyperplasia.

METHODS:
Women with complex atypical endometrial hyperplasia who underwent hysterectomy from 2012 to 2018 in the Perspective database were examined. Perioperative morbidity, mortality, and cost were examined based on performance of sentinel lymph node mapping, lymph node dissection or no nodal evaluation.

RESULTS:
Among 10,266 women, sentinel lymph node mapping was performed in 620 (6.0%), lymph node dissection in 538 (5.2%), and no lymphatic evaluation in 9,108 (88.7%). Use of sentinel lymph node mapping increased from 0.8% in 2012 to 14.0% in 2018, and the rate of lymph node dissection rose from 5.7% to 6.4% (P<.001). In an adjusted model, residence in the western United States, treatment by high-volume hospitals and use of robotic-assisted hysterectomy were associated with sentinel lymph node mapping (P<.05 for all). The complication rates were similar between the three groups. The median cost for sentinel lymph node mapping ($9,673) and lymph node dissection ($9,754) were higher than in those who did not undergo nodal assessment ($8,435) (P<.001).

CONCLUSION:
Performance of sentinel lymph node mapping is increasing rapidly for women with complex atypical endometrial hyperplasia but is not associated with increased perioperative morbidity or mortality.
Contribution of Prepregnancy Obesity to Racial and Ethnic Disparities in Severe Maternal Morbidity
Authors: Siddiqui Ayesha , Azria Elie , Egorova Natalia , Deneux-Tharaux Catherine , Howell Elizabeth A. 
Published: April 2021

OBJECTIVE:
To evaluate the role of prepregnancy obesity as a mediator in the association between race–ethnicity and severe maternal morbidity.

METHODS:
We conducted an analysis on a population-based retrospective cohort study using 2010–2014 birth records linked with hospital discharge data in New York City. A multivariable logistic regression mediation model on a subgroup of the sample consisting of normal-weight and obese women (n=409,021) calculated the mediation effect of obesity in the association between maternal race–ethnicity and severe maternal morbidity, and the residual effect not mediated by obesity. A sensitivity analysis was conducted excluding the severe maternal morbidity cases due to blood transfusion.

RESULTS:
Among 591,455 live births, we identified 15,158 cases of severe maternal morbidity (256.3/10,000 deliveries). The severe maternal morbidity rate among obese women was higher than that of normal-weight women (342 vs 216/10,000 deliveries). Black women had a severe maternal morbidity rate nearly three times higher than White women (420 vs 146/10,000 deliveries) and the severe maternal morbidity rate among Latinas was nearly twice that of White women (285/10,000 deliveries). Among women with normal or obese body mass index (BMI) only (n=409,021), Black race was strongly associated with severe maternal morbidity (adjusted odds ratio [aOR] 3.02, 95% CI 2.88–3.17) but the obesity-mediated effect represented only 3.2% of the total association (aOR 1.03, 95% CI 1.02–1.05). Latina ethnicity was also associated with severe maternal morbidity (aOR 2.01, 95% CI 1.90–2.12) and the obesity-mediated effect was similarly small: 3.4% of the total association (aOR 1.02, 95% CI 1.01–1.03). In a sensitivity analysis excluding blood transfusion, severe maternal morbidity cases found a higher mediation effect of obesity in the association with Black race and Latina ethnicity (15.3% and 15.2% of the total association, respectively).

CONCLUSION:
Our findings indicate that prepregnancy obesity, a modifiable factor, is a limited driver of racial–ethnic disparities in overall severe maternal morbidity.
An advanced double intravenous vasopressor automated system to treat hypotension during spinal anaesthesia for caesarean section
Authors: Nagarajan Singaraselvan , Chan Jason Ju In , Tan Chin Wen , Al-Hashim Zainab Ghalib A. , Sultana Rehena , Sia Alex Tiong Heng , Sng Ban Leong 
Published: April 2021

BACKGROUND
During spinal anaesthesia for caesarean section, haemodynamic instability may lead to maternal and foetal complications. We developed a novel advanced double intravenous vasopressor automated system (ADIVA) by using a continuous blood pressure and heart rate monitor. Treatment of hypotension was based on three criteria: the drug (phenylephrine or ephedrine) according to the heart rate; the dose of vasopressor determined by the degree of hypotension; a fast or slow bolus of vasopressor administered depending on whether there was a negative or positive gradient of SBP changes, respectively.

OBJECTIVE
The aim of this pilot study was to investigate the feasibility of the ADIVA algorithm.

DESIGN
A prospective pilot study.

SETTING
Single obstetrics and gynaecology centre in Singapore.

PATIENTS
Women undergoing elective caesarean delivery under spinal anaesthesia.

INTERVENTION
Automated administration of ephedrine or phenylephrine based on changes in blood pressure and heart rate (via the ADIVA algorithm) detected on continuous noninvasive haemodynamic monitoring using noninvasive continuous haemodynamic monitor (Nexfin).

MAIN OUTCOME MEASURES
The primary outcome was the incidence of hypotension, defined as SBP less than 80% of baseline. The secondary outcome measures were reactive hypertension, total vasopressor requirement, maternal and neonatal outcomes and system performance.

RESULTS
Forty-five women were recruited. Thirty-one women (69.9%) had at least one reading of hypotension. SBP was within ±20% of the baseline in a mean ± SD of 79.7 ± 17.6% of measurements. Forty-four (97.8%) women required phenylephrine before delivery, while 15 (33.3%) required ephedrine. No rescue medications were required. Three women (6.7%) had nausea and two (4.4%) vomiting. All neonates had APGAR scores of 9 at 5 min.

CONCLUSION
The ADIVA system, with noninvasive continuous haemodynamic monitoring, was able to maintain maternal SBP within ±20% of baseline for the vast majority of the measurements. This system had good maternal and foetal outcomes with minimal intervention from the attending anaesthetist.

TRIAL REGISTRATION
NCT03620942
Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia
Authors: Ogata Hiroki , Matsuki Yuka , Okamoto Takuma , Ueki Ryusuke , Kariya Nobutaka , Tatara Tsuneo , Shigemi Kenji , Hirose Munetaka 
Published: April 2021

BACKGROUND
Surgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available.

OBJECTIVES
To identify associations between major complications after gastrointestinal surgery and intra-operative quantitative values from intra-operative nociception monitoring.

DESIGN
A multi-institutional observational study.

SETTING
Two university hospitals.

PATIENTS
Consecutive adult patients undergoing gastrointestinal surgery under general anaesthesia.

MAIN OUTCOME MEASURES
Averaged values of nociceptive response index from start to end of surgery (mean NR index) and risk scores of the Surgical Mortality Probability Model (S-MPM) were calculated. Pre and postoperative serum C-reactive protein (CRP) levels were obtained. After receiver-operating characteristic (ROC) curve analysis, all patients were divided into groups with high and low mean nociceptive response index. Associations between mean nociceptive response index and postoperative major complications, defined as Clavien-Dindo grade at least IIIa, were examined using logistic regression analysis.

RESULTS
ROC curve analysis showed a nociceptive response index cut-off value for major complications of 0.83, and we divided patients into two groups with mean nociceptive response index less than 0.83 and at least 0.83. The incidence of major complications was significantly higher in patients with mean nociceptive response index at least 0.83 (23.1%; n = 346) than in patients with mean nociceptive response index less than 0.83 (7.7%; n = 443; P < 0.001). Multivariate analysis revealed emergency surgery, S-MPM risk score, mean nociceptive response index and postoperative CRP levels as independent risk factors for major complications.

CONCLUSION
Mean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery.

TRIAL REGISTRATION
The current observational study had no intervention, and was therefore, not registered.
Intra-operative esmolol and pain following mastectomy
Authors: Mendonça Fabrício T. , Tramontini Alex J. , Miake Henrique I. , Seixas Luciano F. , de Carvalho Luiz Sergio F. , Sposito Andrei C. 
Published: April 2021

BACKGROUND
Esmolol is a beta-1 selective blocker that has been shown to reduce postoperative pain. Its antinociceptive effects have not been tested following mastectomy.

OBJECTIVE
To evaluate the safety, efficacy and antinociception of intra-operative esmolol infusion after mastectomy.

DESIGN
Randomised, double-blinded, placebo-controlled trial.

SETTING
Tertiary referral centre, Brasília, Brazil. Recruitment: July 2015 to July 2017.

PATIENTS
Seventy women scheduled for mastectomy, ASA I to III, aged 18 to 75 years. Four were excluded.

INTERVENTIONS
All underwent general anaesthesia. The intervention group received a bolus of 0.5 mg kg−1 of esmolol over 10 min followed by a continuous infusion of 100 μg kg−1 min−1. The placebo group received saline.

MAIN OUTCOME MEASURES
The primary outcome was pain at rest 24 h after mastectomy as measured by a 0 to 10 numeric rating scale.

RESULTS
Pain scores at rest 24 h after mastectomy were lower in esmolol-treated patients compared with placebo (mean difference = −1.51, 95% confidence interval (CI), −2.36 to −0.65, P = 0.001). On arrival in the postanaesthesia care unit (PACU), the occurrence of pain was also lower in the esmolol group, at rest and on effort (P = 0.009 and P = 0.013, respectively), on discharge from PACU (P = 0.009 and P = 0.015), 12 h (P = 0.01 and P = 0.007) and on effort in the 24 postoperative hours (P = 0.003). Mean morphine consumption was reduced by 77% in the esmolol group compared with the placebo group (mean difference  = −2.52 mg, 95% CI = −3.67 to −1.38, P < 0.001). The length of hospital stay was shorter for the esmolol group (mean difference = −6.9 h, 95% CI, −13.4 to −0.31, P = 0.040).

CONCLUSION
Esmolol was well tolerated, allowed a notable reduction in the dose of rescue analgesics and demonstrated superior efficacy compared to placebo for pain management after mastectomy.

TRIAL REGISTRATION
ClinicalTrials/NCT02466542
An Analysis of the Controversial Relationship Between Anencephaly, Brain Death, and Organ Donation
Authors: Stiekema Jennifer L. 
Published: April 2021

Abstract
Anencephaly is a congenital defect in which the neural tube fails to fully close during the fourth week of embryonic development (Obeidi, Russell, Higgins, & O'Donoghue, 2010). The Medical Task Force on Anencephaly (1990) defined it as a condition with the following four characteristics: (a) A large portion of the skull is absent, (b) the scalp is absent over the skull defect, (c) the exposed tissue is hemorrhagic and fibrotic, and (d) the cerebral hemispheres are indistinguishable. Approximately one in every 4,647 births is affected by anencephaly, with an estimated 847 anencephalic infants born each year (Centers for Disease Control and Prevention, 2020). It is estimated that around 65% of anencephalic fetuses will die in utero, whereas those that survive to birth typically die within a few hours or days of life (Medical Task Force on Anencephaly, 1990). Anencephalic infants who do survive beyond birth often exhibit irregular breathing, requiring the use of mechanical ventilation to be kept alive. For decades, anencephalic infants have been the topic of a highly controversial and heated debate with regard to their status and potential as organ donors. Currently, anencephalic infants are not used as organ donors because they do not meet the criteria for brain death. To some, this seems like the elimination of a vital pool of organ donors, whereas others view this as preservation of the sanctity and dignity of human life. This highly disputed issue of anencephaly and how it relates to both brain death and organ donation is the topic of this discussion.