bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit
Authors: Stuebe A.M. , Kendig S. , Suplee P.D. , D’Oria R. 
Published: November 2021

(Obstet Gynecol. 2021;137:33–40)
Postpartum care is an underutilized resource, with up to 23% of women forgoing a clinic visit in the weeks following delivery. Given the increased maternal morbidity and mortality postpartum, the Alliance of Innovation in Maternal Health developed a set of strategies to improve outcomes for postpartum women. This “consensus bundle” includes recommendations for Readiness, Recognition, Response and Reporting.
Birth Outcomes in Women With Body Mass Index of 40 kg/m2 or Greater Stratified by Planned and Actual Mode of Birth: A Systematic Review and Meta-Analysis
Authors: D’Souza R. , Horyn I. , Jacob C.-E. , Zaffar N. , Horn D. , Maxwell C. 
Published: November 2021

(Acta Obstet Gynecol Scand. 2021;100:200–209)
Obese pregnant women are at increased risk of complications compared to those with normal body mass index (BMI). One systematic review found that pregnant women with BMI ≥40 kg/m2 were more likely to experience prepregnancy diabetes, gestational diabetes or hypertensive disorders during pregnancy compared with those with BMI ≤30 to 39.9 kg/m2. Among other factors, these conditions have been linked to higher rates of cesarean delivery (CD) and wound complications. Obesity in pregnancy has also been associated with increased risk of neonatal complications including Apgar scores <7 after 5 minutes and birth trauma. Vaginal delivery (VD) has generally been accepted as the preferred mode of delivery for this population. The aim of this study was to evaluate outcomes in obese pregnant women based on mode of delivery.
Association Between Neuraxial Labor Analgesia and Neonatal Morbidity After Operative Vaginal Delivery: A Retrospective Cross-sectional Study
Authors: Butwick A.J. , Wong C.A. , Lee H.C. , Blumenfeld Y.J. , Guo N. 
Published: November 2021

(Anesthesiology. 2021;134:52–60)
Operative vaginal delivery can be used to avoid intrapartum delivery and the morbidities it carries, though operative vaginal delivery is associated with neonatal and maternal risks compared with spontaneous vaginal delivery. Adequate maternal analgesia is a requirement for operative vaginal delivery, and neuraxial analgesia is the most common choice. Neuraxial analgesia may cause pelvic muscle relaxation and reduce the likelihood of neonatal injury and morbidity. This study investigated the association of neuraxial analgesia with risk of neonatal morbidity in patients undergoing vaginal delivery.
Intraoperative Hypotension and Acute Kidney Injury after Noncardiac Surgery in Infants and Children: A Retrospective Cohort Analysis
Authors: Schacham Nadav Y. , Chhabada Surendrasingh , Efune Proshad N. , Pu Xuan , Liu Liu , Yang Dongsheng , Raza Praneeta C. , Szmuk Peter , Sessler Daniel I. 
Published: November 2021

Background
Age- and sex-specific reference nomograms for intraoperative blood pressure have been published, but they do not identify harm thresholds. The authors therefore assessed the relationship between various absolute and relative characterizations of hypotension and acute kidney injury in children having noncardiac surgery.

Methods
The authors conducted a retrospective cohort study using electronic data from two tertiary care centers. They included inpatients 18 yr or younger who had noncardiac surgery with general anesthesia. Postoperative renal injury was defined using the Kidney Disease Improving Global Outcomes definitions, based on serum creatinine concentrations. The authors evaluated potential renal harm thresholds for absolute lowest intraoperative mean arterial pressure (MAP) or largest MAP reduction from baseline maintained for a cumulative period of 5 min. Separate analyses were performed in children aged 2 yr or younger, 2 to 6 yr, 6 to 12 yr, and 12 to 18 yr.

Results
Among 64,412 children who had noncardiac surgery, 4,506 had creatinine assessed preoperatively and postoperatively. The incidence of acute kidney injury in this population was 11% (499 of 4,506): 17% in children under 6 yr old, 11% in children 6 to 12 yr old, and 6% in adolescents, which is similar to the incidence reported in adults. There was no association between lowest cumulative MAP sustained for 5 min and postoperative kidney injury. Similarly, there was no association between largest cumulative percentage MAP reduction and postoperative kidney injury. The adjusted estimated odds for kidney injury was 0.99 (95% CI, 0.94 to 1.05) for each 5-mmHg decrease in lowest MAP and 1.00 (95% CI, 0.97 to 1.03) for each 5% decrease in largest MAP reduction from baseline.

Conclusions
In distinct contrast to adults, the authors did not find any association between intraoperative hypotension and postoperative renal injury. Avoiding short periods of hypotension should not be the clinician’s primary concern when trying to prevent intraoperative renal injury in pediatric patients.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Colonoscopic Ultrasound-Guided Fine-Needle Aspiration Using a Curvilinear Array Transducer: A Single-Center Retrospective Cohort Study
Authors: Cheng Spencer , Matuguma Sergio E. , de Oliveira Guilherme H. P. , Silva Gustavo L.R. , Cheng Henrique , Sánchez-Luna Sergio A. , Minata Mauricio K 
Published: November 2021

BACKGROUND:
Curvilinear array ultrasound transducers enable tissue sampling and have therapeutic capabilities. Nevertheless, colonic intubation and maneuvering with these transducers is technically challenging and is therefore typically limited to the rectosigmoid area. This retrospective cohort study aimed to evaluate the safety, feasibility, and diagnostic yield of colonoscopic ultrasound-guided fine-needle aspiration in deep colonic intubation.

IMPACT OF INNOVATION:
The impact of this innovation is to enable tissue sampling of colonic and extracolonic lesions guided by endoscopic ultrasound.

TECHNOLOGY, MATERIALS, AND METHODS:
Curvilinear array ultrasound is used in the evaluation of luminal and extraluminal colonic diseases. Thirteen patients underwent colonoscopic ultrasound with a curvilinear array ultrasound endoscope in a single center for subepithelial lesions, cancer staging, and extracolonic lesions from July 2015 to February 2021. Endosonography was performed using an Olympus EU-ME1 and GF-UCT 180 with a 5-12MHz curvilinear array transducer. The primary outcome was the percentage of patients who were successfully scanned with the endoscopic ultrasound. The secondary outcomes included the success rate of fine-needle aspiration, the diagnostic yield of the tissue samples, and the adverse events related to the procedure.

PRELIMINARY RESULTS:
A total of 13 female patients underwent colonoscopic ultrasound. All patients (100%, 13/13) were successfully scanned. Fine-needle aspiration was deemed necessary and successfully performed in 100% (5/5) of the patients. Tissue samples collected by fine-needle aspiration resulted in a diagnostic yield of 60%, and no adverse events resulted from this intervention.

CONCLUSIONS:
This study demonstrates the feasibility of performing colonoscopic ultrasound with a curvilinear array transducer. Fine-needle aspiration for subepithelial, colonic, and extracolonic lesions is feasible and safe in this setting with no adverse events reported in our study.

FUTURE DIRECTIONS:
Future research should be directed toward validating colonoscopic ultrasound with a curvilinear array transducer technique in prospective randomized trials. Studies evaluating the feasibility and safety of endoscopic ultrasound-guided interventions in the colon, such as abscess drainage and enteral anastomosis, should be considered.
Endothelium-Dependent Hyperpolarization: The Evolution of Myoendothelial Microdomains
Authors: Garland Christopher J. , Dora Kim A. 
Published: November 2021

Abstract:
Endothelium-derived hyperpolarizing factor (EDHF) was envisaged as a chemical entity causing vasodilation by hyperpolarizing vascular smooth muscle (VSM) cells and distinct from nitric oxide (NO) ([aka endothelium-derived relaxing factor (EDRF)]) and prostacyclin. The search for an identity for EDHF unraveled the complexity of signaling within small arteries. Hyperpolarization originates within endothelial cells (ECs), spreading to the VSM by 2 branches, 1 chemical and 1 electrical, with the relative contribution varying with artery location, branch order, and prevailing profile of VSM activation. Chemical signals vary likewise and can involve potassium ion, lipid mediators, and hydrogen peroxide, whereas electrical signaling depends on physical contacts formed by homocellular and heterocellular (myoendothelial; MEJ) gap junctions, both able to conduct hyperpolarizing current. The discovery that chemical and electrical signals each arise within ECs resulted in an evolution of the single EDHF concept into the more inclusive, EDH signaling. Recognition of the importance of MEJs and particularly the fact they can support bidirectional signaling also informed the discovery that Ca2+ signals can pass from VSM to ECs during vasoconstriction. This signaling activates negative feedback mediated by NO and EDH forming a myoendothelial feedback circuit, which may also be responsible for basal or constitutive release of NO and EDH activity. The MEJs are housed in endothelial projections, and another spin-off from investigating EDH signaling was the discovery these fine structures contain clusters of signaling proteins to regulate both hyperpolarization and NO release. So, these tiny membrane bridges serve as a signaling superhighway or infobahn, which controls vasoreactivity by responding to signals flowing back and forth between the endothelium and VSM. By allowing bidirectional signaling, MEJs enable sinusoidal vasomotion, co-ordinated cycles of widespread vasoconstriction/vasodilation that optimize time-averaged blood flow. Cardiovascular disease disrupts EC signaling and as a result vasomotion changes to vasospasm.
Role of Circadian Rhythm and Impact of Circadian Rhythm Disturbance on the Metabolism and Disease
Authors: Han Hui , Dou Jinming , Hou Qingqing , Wang Huanjun 
Published: November 2021

Abstract:
Molecular circadian clocks exist in almost all cells of the organism and operate for approximately 24 hours, maintain the normal physiological and behavioral body processes, and regulate metabolism of many cells related to a variety of disease states. Circadian rhythms regulate metabolism, mainly including neurotransmitters, hormones, amino acids, and lipids. Circadian misalignment is related to metabolic syndromes, such as obesity, diabetes, and hypertension, which have reached an alarming level in modern society. We reviewed the mechanism of the circadian clock and the interaction between circadian rhythm and metabolism, as well as circadian rhythm disturbance on the metabolism of hypertension, obesity, and diabetes. Finally, we discuss how to use the circadian rhythm to prevent diseases. Thus, this review is a micro-to-macro discussion from the perspective of circadian rhythm and aims to provide basic ideas for circadian rhythm research and disease therapies.
Nanobodies as Probes and Modulators of Cardiovascular G Protein–Coupled Receptors
Authors: Wingler Laura M. , Feld Andrew P. 
Published: November 2021

Abstract:
Understanding the activation of G protein-coupled receptors (GPCRs) is of paramount importance to the field of cardiovascular medicine due to the critical physiological roles of these receptors and their prominence as drug targets. Although many cardiovascular GPCRs have been extensively studied as model receptors for decades, new complexities in their regulation continue to emerge. As a result, there is an ongoing need to develop novel approaches to monitor and to modulate GPCR activation. In less than a decade, nanobodies, or recombinant single-domain antibody fragments from camelids, have become indispensable tools for interrogating GPCRs both in purified systems and in living cells. Nanobodies have gained traction rapidly due to their biochemical tractability and their ability to recognize defined states of native proteins. Here, we review how nanobodies have been adopted to elucidate the structure, pharmacology, and signaling of cardiovascular GPCRs, resolving long-standing mysteries and revealing unexpected mechanisms. We also discuss how advancing technologies to discover nanobodies with tailored specificities may expand the impact of these tools for both basic science and therapeutic applications.
Pharmacological Inhibition of Mammalian Target of Rapamycin Attenuates Deoxycorticosterone Acetate Salt–Induced Hypertension and Related Pathophysiology: Regulation of Oxidative Stress, Inflammation, and Cardiovascular Hypertrophy in Male Rats
Authors: Temiz-Resitoglu Meryem , Guden Demet S. , Senol Sefika P. , Vezir Ozden , Sucu Nehir , Kibar Deniz , Yılmaz Sakir N. , Tunctan Bahar , Malik Kafait U. , Sahan-Firat Seyhan 
Published: November 2021

Abstract:
The present study aimed to explore the contribution of mammalian target of rapamycin (mTOR) in deoxycorticosterone acetate (DOCA) salt–induced hypertension and related pathophysiological changes in cardiovascular and renal tissues. DOCA salt loading resulted in an increase in systolic blood pressure, diastolic blood pressure, and mean blood pressure along with the activity of ribosomal protein S6, the effector protein of mTOR. Treatment with rapamycin, the selective inhibitor of mTOR, initiated at the fourth week of DOCA- salt administration normalized the systolic blood pressure and attenuated ribosomal protein S6 activity in the heart, aorta, and kidney. Cardiac and vascular hypertrophy, oxidative stress, and infiltration of macrophages (CD68+), the marker of inflammation, were also reduced in rapamycin-treated, DOCA-salt, hypertensive rats. In addition, renal hypertrophy and dysfunction were also reduced with rapamycin-treated hypertensive rats. Moreover, these pathophysiological changes in DOCA-salt hypertensive rats were associated with increased NADPH oxidase (NOX) activity, gp91phox (formerly NOX2) expression, ERK1/2, and p38 MAPK activities in the heart, aorta, and kidney were minimized by rapamycin. These data indicate that mTOR plays an important role in regulating blood pressure and the development of cardiovascular and renal pathophysiological changes, most likely due to increased NOX expression/activity, ERK1/2, and p38 MAPK activity with macrophages infiltration in the heart, kidney, and aorta. Pharmacological inhibition of mTOR and related signaling pathways could serve as a novel target for the treatment of hypertension.
Immunological Biomarkers in Blood to Monitor the Course and Therapeutic Outcomes of COVID-19
Authors: Wieland Eberhard 
Published: November 2021

Background:
The COVID-19 pandemic has posed a great challenge to the medical community because little is known about its clinical course, therapeutic options, and laboratory monitoring tools for diagnosis, prognosis, and surveillance. This review focuses on immune biomarkers that can be measured in peripheral blood in a clinical laboratory under routine conditions to monitor the innate immune system response in the acute phase, as well as the adaptive immune response established both after infection and vaccination.

Methods:
A PubMed search was performed covering January 2020 to June 2021 to extract biomarkers suitable for monitoring the immune response and outcome of COVID-19 and therapeutic interventions, including vaccination.

Results:
To monitor the innate immune response, cytokines such as interleukin-6 or acute phase reactants such as C-reactive protein or procalcitonin can be measured on autoanalyzers complemented by automated white blood cell differential counts. The adaptive immune response can be followed by commercially available enzyme-linked immune spot assays to assess the specific activation of T cells or by monitoring immunoglobulin A (IgA), IgM, and IgG antibodies in serum to follow B-cell activation. As antigens of the SARS-CoV-2 virus, spike and nucleocapsid proteins are particularly suitable and allow differentiation between the immune response after infection or vaccination.

Conclusions:
Routine immune monitoring of COVID-19 is feasible in clinical laboratories with commercially available instruments and reagents. Strategies such as whether biomarkers reflecting the response of the innate and adaptive immune system can be used to make predictions and assist in individualizing therapeutic interventions or vaccination strategies need to be determined in appropriate clinical trials. Promising preliminary data are already available based on single-center reports and completed or ongoing vaccination trials.
A Systematic Review of Health State Utility Values in the Plastic Surgery Literature
Authors: Christopher Adrienne N. , Morris Martin P. , Patel Viren , Klifto Kevin , Fischer John P. 
Published: November 2021

Background:
Cost-utility analyses assess health gains acquired by interventions by incorporating weighted health state utility values (HSUVs). HSUVs are important in plastic and reconstructive surgery (PRS) because they include qualitative metrics when comparing operative techniques or interventions. We systematically reviewed the literature to identify the extent and quality of existing original utilities research within PRS.

Methods:
A systematic review of articles with original PRS utility data was conducted in accordance with the Preferred Reporting Items for a Systematic Review and Meta-Analysis guidelines. Subspecialty, survey sample size, and respondent characteristics were extracted. For each HSUV, the utility measure [direct (standard gamble, time trade off, visual analog scale) and/or indirect], mean utility score, and measure of variance were recorded. Similar HSUVs were pooled into weighted averages based on sample size if they were derived from the same utility measure.

Results:
In total, 348 HSUVs for 194 disease states were derived from 56 studies within seven PRS subspecialties. Utility studies were most common in breast (n = 17, 30.4%) and hand/upper extremity (n = 15, 26.8%), and direct measurements were most frequent [visual analog scale (55.4%), standard gamble (46.4%), time trade off (57.1%)]. Studies surveying the general public had more respondents (n = 165, IQR 103–299) than those that surveyed patients (n = 61, IQR 48–79) or healthcare professionals (n = 42, IQR 10–109). HSUVs for 18 health states were aggregated.

Conclusions:
The HSUV literature within PRS is scant and heterogeneous. Researchers should become familiar with these outcomes, as integrating utility and cost data will help illustrate that the impact of certain interventions are cost-effective when we consider patient quality of life.
Corneal Densitometry After Uneventful Descemet Membrane Endothelial Keratoplasty—5-Year Outcomes
Authors: Droutsas Konstantinos , Kappos Nikolaos , Giallouros Eleftherios , Schroeder Frank Michael , Sekundo Walter , Kandarakis Stylianos , Lazaridis Apostolos 
Published: November 2021

Purpose:
The purpose of this study is to analyze the course of corneal densitometry (CD), endothelial cell density (ECD), best-corrected visual acuity (BCVA), and central corneal thickness (CCT) 5 years after uneventful Descemet membrane endothelial keratoplasty (DMEK).

Methods:
Sixty uneventful cases (51 patients) with a minimum follow-up of 5 years were included. CD of various corneal layers (anterior, central, posterior, and total layer) and zones (0–2 mm, 2–6 mm, and 6–10 mm) were measured with Scheimpflug tomography. ECD, BCVA, and CCT were also evaluated.

Results:
Total CD at 0 to 2 mm and 2 to 6 mm zones significantly decreased from 33 ± 10 and 27.8 ± 8 grayscale units (GSU) preoperatively to 21.8 ± 3.1 and 22.2 ± 4.2 GSU at 5 years, respectively (P < 0.001). On the contrary, total CD at the 6 to 10 mm zone significantly increased from 30 ± 8.3 GSU preoperatively to 34.6 ± 7.8 GSU at 5 years (P < 0.001). ECD significantly decreased from 2496 ± 267 cells/mm2 preoperatively to 1063 ± 470 cells/mm2 at 5 years (P < 0.001). Similarly, CCT significantly decreased from 686 ± 109 μm preoperatively to 557 ± 37 μm at 5 years (P < 0.001). Postoperative BCVA was significantly better after DMEK for every examination time point.

Conclusions:
Despite a slight CD increase at all layers of all corneal zones from the second to the fifth postoperative year, the excellent visual outcome was maintained throughout 5-year follow-up. Thus, DMEK seems to effectively treat corneal endothelial disease in the long term.
Comparison of Donor Corneal Endothelial Cell Density Determined by Eye Banks and by a Central Image Analysis Reading Center Using the Same Image Analysis Method
Authors: Huang Heidi , Benetz Beth Ann , Clover Jameson M. , Titus Michael , O'Brien Robert C. , Menegay Harry J. , Lass Jonathan H. 
Published: November 2021

Purpose:
The purpose of this study was to evaluate agreement between eye banks (EBs) and an image analysis reading center on endothelial cell density (ECD) determinations using the same image analysis method.

Methods:
The Cornea Image Analysis Reading Center (CIARC) determined ECD with a single experienced analyst on EB-obtained central endothelial images from donors intended for keratoplasty from 2 eye banks, Eversight and Lions VisionGift, using the Konan center analysis method. The EBs performed ECD determination on their respective sets of images using the same analysis method with experienced eye bank technicians.

Results:
The mean age of the 200 donors was 54 years (range 30–75 years). Seventy (35%) of the 200 patients were women, and 57 (29%) were diabetic. The mean ECD was 10 cells/mm2 greater by the EBs than by CIARC (P = 0.39), with 95% limits of agreement of [−304 to 323 cells/mm2]. The mean difference was not substantially changed when the difference between EBs and CIARC ECD was adjusted for sex, donor age, donor diabetes, CV, HEX, number of cells analyzed, and EBs as a random effect (estimated mean difference of 20 cells/mm2 after adjustment in a linear mixed model; P = 0.73). The EB-determined preoperative ECD was within 10% of the CIARC-determined ECD for 178 (89%) image sets, with 15 (8%) higher by >10% and 7 (3%) lower by >10%.

Conclusions:
Well-trained eye bank technicians achieve comparable results for ECD determination with an experienced image analyst from an image analysis reading center when the same image analysis method is used.