bluuebunny/crossref_metadata_2025_split huggingface dataset:
A narrative review on antimicrobial therapy in septic shock: updates and controversies
Authors: Ling Lowell , Joynt Gavin Matthew , Lipman Jeffrey 
Published: January 2021

Purpose of review
Antibiotics are an essential treatment for septic shock. This review provides an overview of the key issues in antimicrobial therapy for septic shock. We include a summary of available evidence with an emphasis on data published in the last few years.

Recent findings
We examine apparently contradictory data supporting the importance of minimizing time to antimicrobial therapy in sepsis, discuss approaches to choosing appropriate antibiotics, and review the importance and challenges presented by antimicrobial dosing. Lastly, we evaluate the evolving concepts of de-escalation, and optimization of the duration of antimicrobials.

Summary
The topics discussed in this review provide background to key clinical decisions in antimicrobial therapy for septic shock: timing, antibiotic choice, dosage, de-escalation, and duration. Although acknowledging some controversy, antimicrobial therapy in septic shock should be delivered early, be of the adequate spectrum, appropriately and individually dosed, rationalized when possible, and of minimal effective duration.
Mechanical ventilation in septic shock
Authors: Maccagnan Pinheiro Besen Bruno Adler , Tomazini Bruno Martins , Pontes Azevedo Luciano Cesar 
Published: January 2021

Purpose of review
The aim of this study was to review the most recent literature on mechanical ventilation strategies in patients with septic shock.

Recent findings
Indirect clinical trial evidence has refined the use of neuromuscular blocking agents, positive end-expiratory pressure (PEEP) and recruitment manoeuvres in septic shock patients with acute respiratory distress syndrome. Weaning strategies and devices have also been recently evaluated. The role of lung protective ventilation in patients with healthy lungs, while recognized, still needs to be further refined. The possible detrimental effects of spontaneous breathing in patients who develop acute respiratory distress syndrome is increasingly recognized, but clinical trial evidence is still lacking to confirm this hypothesis. A new concept of lung and diaphragm protective is emerging in the critical care literature, but its application will need a complex intervention implementation approach to allow adequate scrutiny of this concept and uptake by clinicians.

Summary
Many advances in the management of the mechanically ventilated patient with sepsis and septic shock have occurred in recent years, but clinical trial evidence is still necessary to translate new hypotheses to the bedside and find the right balance between benefits and risks of these new strategies.
Cricothyroidotomy competence and injuries using nonmedical equipment
Authors: Nabecker Sabine , Hornshaw Tobias Alexander , Greif Robert , Conrad Carl , Rohrer Mara , Theiler Lorenz , Riva Thomas 
Published: January 2021

BACKGROUND
International guidelines recommend cricothyroidotomy as a life-saving procedure for ‘cannot intubate, cannot ventilate’ situations. Although commercially available sets facilitate surgical cricothyroidotomy, regular training seems to be the key to success.

OBJECTIVES
The goal was to investigate if trained anaesthetists are able to transfer their skill in one surgical cricothyroidotomy technique to another. The primary hypothesis postulated that trained anaesthetists could perform an emergency cricothyroidotomy equally fast and successfully with a pocketknife compared with a surgical cricothyroidotomy set.

DESIGN
Crossover noninferiority randomised controlled trial.

SETTING
After written informed consent and ethics committee approval, this single-centre study was performed at the University Hospital of Bern, Bern, Switzerland.

PARTICIPANTS
Altogether, 61 study participants already familiar with surgical cricothyroidotomy were included.

INTERVENTION
The use of a commercially available cricothyroidotomy set was compared with a short-bladed pocketknife and ballpoint pen barrel. A pig-larynx cadaver model including trachea, with pig skin overlaid, was used. Participants underwent additional training sessions in both procedures.

MAIN OUTCOME MEASURES
The primary outcome was the time necessary to position the tracheal tube or pen barrel in the trachea. Other outcome parameters were success rate, tracheal and laryngeal injuries and preferred device.

RESULTS
Cricothyroidotomy with the pocketknife was performed significantly faster and equally successfully as compared with the cricothyroidotomy sets. Tracheal and laryngeal injuries were similar in both groups. Paratracheal or submucosal placement of the pen barrel occurred in 32%, compared with 29% for the tracheal tube. Sixty-six per cent of participants preferred the cricothyroidotomy set.

CONCLUSION
Regularly trained anaesthetists are able to accomplish cricothyroidotomy irrespective of the equipment used. A pocketknife with a ballpoint pen barrel was just as effective as a commercially available surgical set.
Blood pressure control in Australian general practice: analysis using general practice records of 1.2 million patients from the MedicineInsight database
Authors: Roseleur Jacqueline , Gonzalez-Chica David A. , Bernardo Carla O. , Geisler Benjamin P. , Karnon Jonathan , Stocks Nigel P. 
Published: January 2021

Introduction:
Hypertension is mostly managed in primary care. This study investigated the prevalence of diagnosed hypertension in Australian general practice and whether hypertension control is influenced by sociodemographic characteristics, duration since diagnosis or prescription of antihypertensive medications.

Methods:
Cross-sectional study using a large national database of electronic medical records of patients attending general practice in 2017 (MedicineInsight).

Results:
Of 1.2 million ‘regular’ patients (one or more consultations per year in every year from 2015 to 2017), 39.8% had a diagnosis of hypertension (95% confidence interval 38.7–40.9). Of these, 85.3% had their blood pressure (BP) recorded in 2017, and 54.9% (95% confidence interval 54.2–55.5) had controlled hypertension (<140/90 mmHg). BP control was lower in females (54.1%) compared with males (55.7%) and in the oldest age group (52.0%), with no differences by socioeconomic status. Hypertension control was lower among ‘regular’ patients recently diagnosed (6–12 months = 48.6% controlled) relative to those more than 12 months since diagnosis (1–2 years = 53.6%; 3–5 years 55.5%; >5 years = 55.0%). Among recently diagnosed ‘regular’ patients, 59.2% had no record of being prescribed antihypertensive therapy in the last 6 months of the study, of which 44.3% had controlled hypertension. For those diagnosed more than 5 years ago, 37.4% had no record of being prescribed antihypertensive patients, and 56% had normal BP levels.

Conclusion:
Although the prevalence of hypertension varied by socidemographics, there were no differences in BP assessment or control by socioeconomic status. Hypertension control remains a challenge in primary care, and electronic medical records provide an opportunity to assess hypertension management.
INTERMEDIATE AND DEEP CAPILLARY PLEXUSES IN MACHINE LEARNING SEGMENTATION OF HIGH-RESOLUTION OPTICAL COHERENCE TOMOGRAPHY IMAGING
Authors: Spaide Richard F. , Caujolle Sophie , Otto Tilman 
Published: January 2021

Purpose:
To describe imaging produced by machine learning-based segmentation of high-resolution optical coherence tomography imaging of the intermediate capillary plexus and deep capillary plexus, layers of vessels not imaged well by dye-based angiography.

Methods:
Three healthy subjects with no ocular problems were imaged with spectral domain optical coherence tomography using an instrument with a scanning speed of 85,000 A-scans per second and 3 µm axial optical resolution. A random forest segmentation strategy was used to segment the intermediate capillary plexus and deep capillary plexus. The depth-resolved imaging data was visualized with the help of volume rendering.

Results:
The high-resolution optical coherence tomography showed the intermediate capillary plexus and deep capillary plexus at the outer borders of the inner nuclear layer. These vessels could be visualized with unprecedented detail in three dimensions. There were multiple bridging vessels connecting to the whorl-like patterns of capillary mesh of the deep capillary plexus, a feature only previously imaged in histologic evaluation of excised eyes.

Conclusion:
High-resolution optical coherence tomography, machine learning, and advanced image display techniques have wide relevancy in studying the retina in health and disease. Application of this approach has provided images of the deeper vascular layers of the eye that approximate histologic imaging, but noninvasively.
Study of Profile of Swine Flu Cases Admitted in Tertiary Care Hospital: Lessons Learned!
Authors: Kamath Sangita D. , Kumar Manish , Sunder Ashok 
Published: January 2021

Introduction
Swine flu is caused by a novel strain of H1N1 influenza A virus that evolved by genetic assortment. The global pandemic affected India in May 2009. Sporadic cases continue to occur and cause significant morbidity and mortality.

Aim
To study the clinical profile, laboratory parameters, and outcome of the confirmed cases of swine flu.

Methods
This was a retrospective study involving confirmed swine flu cases admitted with category B2 and C symptoms from February to September 2019 in Tata Main Hospital. Their case records were analyzed for demographic characteristics, clinical features, treatment, and various outcomes. Reverse transcriptase polymerase chain reaction on the samples was used to confirm the infection.

Observation
Of the 12 cases, 33.7% were men and 66.7% were women. There were 66.7% in the age group 41 to 60 years. Case fatality ratio was 25%. Average duration of symptoms was 3.5 ± 2.4 days. Fever and breathlessness (100%) were the commonest symptoms followed by cough and weakness (83.3%). Comorbidities, like diabetes, hypertension and chronic kidney disease, were seen in 25% patients. Pneumonia was the commonest complication. Average length of hospital stay was 17.8 days. Twenty-five percent of the patients needed supplemental oxygen, whereas 25% required noninvasive ventilation and 50% needed mechanical ventilation. Male sex, older age, severity of hypoxemia, need for mechanical ventilation, and involvement of more than 3 radiological zones were the predictors of mortality (P < 0.0001).

Conclusions
H1N1 influenza can present with severe life-threatening illness. The most common cause of death is pneumonia. Mortality is higher in elderly, men, and those requiring invasive ventilation.
Evaluation of intraocular lens position and retinal shape in negative dysphotopsia using high-resolution magnetic resonance imaging
Authors: van Vught Luc , Dekker Cornelis E. , Stoel Berend C. , Luyten Gregorius P.M. , Beenakker Jan-Willem M. 
Published: January 2021

Purpose:
To assess potential relationships of intraocular lens (IOL) position and retinal shape in negative dysphotopsia (ND).

Setting:
Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands.

Design:
Case-control study.

Methods:
High-resolution ocular magnetic resonance imaging (MRI) scans were performed in patients with ND and pseudophakic controls, and subsequently used to determine the displacement and tilt of the in-the-bag IOL about the pupil and iris. In addition, anterior segment tomography was used to assess the iris–IOL distance. Furthermore, the retinal shape was quantified from the MRI scans by fitting an ellipse to the segmented inner boundary of the retina. Both the IOL position and retinal shape were compared between groups to assess their potential role in the etiology of ND.

Results:
In total, 37 patients with ND and 26 pseudophakic controls were included in the study. The mean displacement and tilt of the IOL were less than 0.1 mm and 0.5 degrees, respectively, in both groups and all directions. The corresponding mean iris–IOL distance was 1.1 mm in both groups. Neither of these values differed statistically significantly between groups (all P values >.6). The retinal shape showed large variations but was not statistically significantly different between the groups in both the left–right (P = .10) and the anterior–posterior (P = .56) directions.

Conclusions:
In this study, the in-the-bag IOL position and retinal shape did not statistically significantly differ between patients with ND and the general pseudophakic population. Given the large variation in retinal shape between subjects, however, it could still be an important factor in a multifactorial origin of ND.
Cost analysis of mydriasis strategies in cataract surgery care in the Netherlands
Authors: Simons Rob W.P. , Rondas Luigi U.E. , van den Biggelaar Frank J.H.M. , Berendschot Tos T.J.M. , Visser Nienke , de Crom Ronald M.P.C. , Nuijts Rudy M.M.A. 
Published: January 2021

Purpose:
To investigate the economic impact of an intracameral mydriatics and anesthetic agent (ICMA), topical mydriatics, and a mydriatic ocular insert in cataract patients.

Setting:
One public hospital in the Netherlands.

Design:
Prospective cohort study.

Methods:
Resource use data were collected from a healthcare and societal perspective on the day of surgery. Other outcome parameters included pupil size, surgeon satisfaction, postoperative pain, and Catquest-9SF scores.

Results:
A total of 368 patients were included, the mean costs per patient were €506 in the ICMA group (n = 122), €474 in the ocular insert group (n = 115), and €451 in the topical group (n = 131). The acquisition cost of ICMA was highest and resulted in longer surgical time. After correction for an imbalance in the distribution of fast and slow surgeons, the mean costs in the ocular insert and topical groups were comparable (€450 vs €444). There was no statistically significant difference in the use of additional mydriatics intraoperatively (P = .521). The mean ratio of pupil size to white-to-white distance was lower in the ICMA group during all intraoperative measurements (P < .001) but similar between the topical and ocular insert groups (P range .11–.82).

Conclusions:
In the investigated setting in the Netherlands, ICMA was the most costly strategy. In addition, pupil size was lowest in the ICMA group but did not result in more additional mydriasis measures intraoperatively. The ocular insert was comparable with topical mydriatics in costs and pupil size. Implementation of ICMA could be considered when availability of nurses or physical space for perioperative care is limited.
Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions
Authors: Jensen Mark P. , Hakimian Shahin , Ehde Dawn M. , Day Melissa A. , Pettet Mark W. , Yoshino Atsuo , Ciol Marcia A. 
Published: January 2021

Abstract
The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.
Effects of cycling bouts performed with different intensities and amounts of energy expended on central pressure and pulse wave reflection in normotensive and hypertensive men
Authors: de Paula Tainah , Cunha Felipe A. , Monteiro Walace , Farinatti Paulo , Oigman Wille , Midgley Adrian , Neves Mario Fritsch 
Published: January 2021

Objective
This study investigated pulse wave analysis in normotensive and hypertensive men after cycling bouts with different intensities and amounts of energy expended.

Methods
Twenty-four men were assigned into normotensive (n = 14; age: 40.7 ± 2.8 years; 24-h ambulatory SBP/DBP:121 ± 2/74 ± 1 mmHg) and hypertensive (n = 10; age: 39.2 ± 2.3 years; 24-h ambulatory SBP/DBP:139 ± 3/86 ± 2 mmHg) groups. Participants undertook a maximal cardiopulmonary exercise test, a nonexercise control session (CTL) and three cycling bouts [two prolonged bouts expending 300 kcal at 50% (i.e. P-MOD) and 70% (i.e. P-VIG) oxygen uptake reserve (VO2R) and one short bout expending 150 kcal at 50% VO2R (i.e. S-MOD)] performed in a randomized order. Central SBP (cSBP), pulse pressure (cPP), augmentation pressure, augmentation index (AIx), heart rate (HR) and AIx adjusted for HR (AIx@75) were determined 10 min before, and 30- and 70-min postintervention.

Results:
Compared to CTL, only the P-VIG changed the cSBP [70-min (Δ −11.7 mmHg)], cPP [70-min (Δ:−7.4 mmHg)], augmentation pressure [30-min (Δ:−5.7 mmHg); 70-min (Δ:−7.3 mmHg)], AIx [30-min (Δ:−15.3 %); 70-min (Δ:−16.4 %)], AIx@75 [30-min (Δ:−12.8 %); 70-min (Δ:−13.9 %)] and HR [70-min (Δ: 9.9 bpm)] in the hypertensive group. However, all exercise bouts mitigated the increased cSBP responses post-CTL in the hypertensive group.

Conclusion:
The present study provides evidence that vigorous-intensity aerobic exercise reduces acute central pressure and pulse wave reflection in hypertensive men.
Does gallbladder wall thickness measurement predict esophageal varices in cirrhotic patients with portal hypertension?
Authors: Elkerdawy Mahmoud A. , Ahmed Mohamed H. , Zaghloul Mariam S. , Haseeb Mona T. , Emara Mohamed H. 
Published: January 2021

Background and study aim
Endoscopy is the gold standard investigation for diagnosis of gastroesophageal varices (GOVs), yet it is invasive, associated with complications. Many noninvasive parameters were investigated to predict the presence of GOVs. The current study investigated gallbladder wall thickening (GBWT) measurement as a noninvasive predictor of GOVs in posthepatitic cirrhotic patients with portal hypertension.

Patients and methods
In this cross-sectional study, 105 cirrhotic patients were divided into, group I and II according to the presence or absence of GOVs, respectively. Group I subdivided into, groups A and B according to the grade of GOVs either nonadvanced (grades I and II) or advanced (grades III and IV), respectively. Complete history taking, full clinical examination, full investigations, upper endoscopy and abdominal ultrasonography were performed to examine all patients.

Results
Both groups were comparable in their baseline characteristics except for AST to Platelet Ratio Index and Fibrosis-4 scores, which were significantly higher in group I. GBWT, portal vein diameter and spleen length were significantly associated not only with GOVs but also with its advanced grades. GBWT at a cutoff level >3.1 mm can predict the presence of GOVs with 54.29% sensitivity, 97.14% specificity, 97.4% positive predictive value (PPV), 51.5% negative predictive value (NPV) and 68.5% accuracy. GBWT can predict advanced grades of GOVs at a cutoff level >3.5 mm, with 45% sensitivity, 90% specificity, 64.3% PPV, 80.4% NPV and 77.1% accuracy.

Conclusion
GBWT was associated with the presence of GOVs, and with advanced GOVs in posthepatitis cirrhotic patients with portal hypertension.
Malnutrition and sarcopenia are prevalent among inflammatory bowel disease patients with clinical remission
Authors: Ünal Nalan Gülşen , Oruç Nevin , Tomey Okşan , Ömer Özütemiz Ahmet 
Published: January 2021

Aim
The aim of this study was to evaluate nutritional status and sarcopenia in patients with inflammatory bowel disease (IBD) in clinical remission.

Methods
A total of 344 patients with IBD in clinical remission were included in this cross-sectional study. Patients with clinical activity (Harvey-Bradshaw index >5 for Crohn’s disease and partial Mayo scores ≥5 for ulcerative colitis) were excluded. Sociodemographic, clinical, and anthropometric data were recorded. BMI was categorized according to WHO criteria. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire. Body composition included fat-free mass (FFM) analyzed with Tanita-330 ST. Muscle strength was measured with a Takei digital hand grip dynamometer using a standard protocol. Physical performance was measured as 4-m gait speed. Sarcopenia was defined based on the European Working Group on Sarcopenia in Older People 2 criteria.

Results
Overall, 5.5% of patients were underweight, 9.9% were malnourished, and 39.5% were at risk of malnutrition. Sarcopenia and probable sarcopenia were diagnosed in 41.3% of patients. Total number of flares requiring hospitalization (100%) was the most important predictor of sarcopenia, followed by total number of flares (80.1%), FFMI (46.5%), age (44.6%), BMI (31.8%), MNA score (27.7%), serum creatinine (23.6%), anti-tumor necrosis factor alpha use (23.3%), and gender (17.8%).

Conclusion
In conclusion, our findings revealed a considerable proportion of IBD patients in clinical remission to be malnourished or at risk of malnutrition along with a high rate of sarcopenia. This emphasizes the need for concomitant screening for nutritional status and body composition analysis in patients with IBD for provision of appropriate nutritional support, even during the remission period, and prevention of sarcopenia-related surgical and poor clinical outcomes.