bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pessary Plus Progesterone to Prevent Preterm Birth in Women With Short Cervixes
Authors: Pacagnella Rodolfo C. , Silva Thaís V. , Cecatti José G. , Passini Renato , Fanton Tatiana F. , Borovac-Pinheiro Anderson , Pereira Cynara M. , Fernandes Karayna G. , França Marcelo S. , Li Wentao , Mol Ben W. ,   for The P5 Working Group
Published: December 2021

OBJECTIVE:
To test the effectiveness of cervical pessary in addition to vaginal progesterone for the prevention of preterm birth in women with midpregnancy short cervixes.

METHODS:
We performed a multicenter, open-label, randomized controlled trial in 17 perinatal centers. Asymptomatic women with singleton or twin pregnancies and cervical lengths of 30 mm or less, measured at 18 0/7–22 6/7 weeks of gestation, were randomized to cervical pessary plus vaginal progesterone (pessary plus progesterone group) or vaginal progesterone only (progesterone-only group) (200 mg/day). Treatments were used from randomization to 36 weeks of gestation or delivery. The primary outcome was a composite of neonatal mortality and morbidity. Secondary outcomes were delivery before 37 weeks and before 34 weeks of gestation. Analysis was performed according to intention to treat.

RESULTS:
Between July 9, 2015, and March 29, 2019, 8,168 women were screened, of whom 475 were randomized to pessary and 461 to progesterone only. The composite perinatal outcome occurred in 19.2% (89/463) of the women in the pessary group compared with 20.9% (91/436) of the women in the progesterone-only group (adjusted risk ratio [aRR] 0.88, 95% CI 0.69–1.12). Delivery rates before 37 weeks of gestation were 29.1% compared with 31.4% (aRR 0.86, 95% CI 0.72–1.04); delivery rates before 34 weeks were 9.9% compared with 13.9% (aRR 0.66, 95% CI 0.47–0.93). Women in the pessary group had more vaginal discharge (51.6% [245/476] vs 25.4% [117/479] [P<.001]), pain (33.1% [157/476] vs 24.1% [111/479] [P=.002]), and vaginal bleeding (9.7% [46/476] vs 4.8% [22/479] [P=.004]).

CONCLUSION:
In asymptomatic women with short cervixes, the combination of pessary and progesterone did not decrease rates of neonatal morbidity or mortality when compared with progesterone only.

CLINICAL TRIAL REGISTRATION:
Brazilian Clinical Trial Registry (ReBec), UTN:U1111-1164-2636.
Microbe-based management for colorectal cancer
Authors: Gao Zi-Yun , Cui Zhe , Yan Yu-Qing , Ning Li-Jun , Wang Zhen-Hua , Hong Jie 
Published: December 2021

AbstractColorectal cancer (CRC) is one of the most prevalent, most lethal cancers in the world. Increasing evidence suggests that the intestinal microbiota is closely related to the pathogenesis and prognosis of CRC. The normal microbiota plays an essential role in maintaining gut barrier function and the immune microenvironment. Recent studies have identified carcinogenic bacteria such asenterotoxigenic Bacteroides fragilis(ETBF) andStreptococcus gallolyticus(S. gallolyticus), as well as protective bacterial such asAkkermansia muciniphila(A. muciniphila), as potential targets of CRC treatment. Gut microbiota modulation aims to restore gut dysbiosis, regulate the intestinal immune system and prevent from pathogen invasion, all of which are beneficial for CRC prevention and prognosis. The utility of probiotics, prebiotics, postbiotics, fecal microbiota transplantation and dietary inventions to treat CRC makes them novel microbe-based management tools. In this review, we describe the mechanisms involved in bacteria-derived colorectal carcinogenesis and summarized novel bacteria-related therapies for CRC. In summary, we hope to facilitate clinical applications of intestinal bacteria for preventing and treating CRC.
Psychotropic Medication Use by Children with Autism Served in Publicly Funded Mental Health Settings
Authors: Caplan Barbara , Chlebowski Colby , May Gina , Baker-Ericzén Mary J. , Connor Willard , Brookman-Frazee Lauren 
Published: December 2021

Abstract:

Objective:
The aim of this study was to characterize patterns of and factors associated with psychotropic medication use in children with autism spectrum disorder (ASD) receiving publicly funded mental health services.

Method:
Data were extracted from 202 children with ASD participating in a cluster randomized trial of An Individualized Mental Health Intervention for ASD conducted in 29 publicly funded mental health programs. Children with ASD were aged 5 to 13 years (M = 9.1 years, SD = 2.4), and were 84.2% male and 59.9% Latinx. Child ASD and cognitive functioning were determined by standardized assessment. Caregivers reported child psychotropic medication use, behavior problems, ASD symptom severity, mental health symptoms, family demographics, and caregiver strain at the baseline.

Results:
Nearly half (49.5%) of participants used psychotropic medication(s) within the past 6 months, with stimulants being most commonly reported. Child co-occurring attention-deficit/hyperactivity disorder (ADHD) (B = 1.55, p < 0.01; 95% confidence interval [CI]: 0.53–2.57), lower cognitive functioning (B = −0.03, p = 0.02; 95% CI: −0.05 to <0.00), and non-Hispanic White ethnicity (vs Hispanic/Latinx; B = 1.02, p = 02; 95% CI: −1.89 to −0.14) were associated with a greater likelihood of using any type of medication. Factors associated with medication use varied by class: stimulants—ADHD, lower ASD symptom severity, and more intensive behavior problems; SSRIs—higher ASD symptom severity; alpha-2 agonists—ADHD, higher ASD symptom severity, lower cognitive functioning, and higher caregiver strain; and antipsychotics—none.

Conclusion:
The findings highlight factors associated with psychotropic medication use for a clinically complex population, which may inform community care improvement efforts.
Patterns and Correlates of Changes in Emotional and Behavioral Problems Among Children with Congenital Heart Disease
Authors: Hsiao Lu-Chi , Chiu Shuenn-Nan , Chang Ling-Yin , Wang Chia-Ching , Weng Wen-Chin , Chang Hsing-Yi 
Published: December 2021

ABSTRACT:

Objective:
The objective of this study was to examine patterns of changes in emotional and behavioral problems among children with congenital heart disease (CHD) and investigate associated factors in different domains.

Method:
The study sample comprised 327 pairs of children with CHD (aged 1.5–12 yrs) and their parents who participated in 2 waves of a survey in Taiwan from 2017 to 2019. The Child Behavior Checklist was used to evaluate the children's emotional and behavioral problems during both waves. The scores were later used to determine the patterns of changes in emotional and behavioral problems. Multinomial logistic regression was then applied to examine factors associated with varied patterns of changes in emotional and behavioral problems.

Results:
Five patterns of changes in emotional and behavioral problems were identified: “persistent normal,” “initial problematic,” “worsening,” “persistent problematic,” and “subclinical.” Among the factors examined, parenting stress was consistently associated with different patterns of change in emotional and behavioral problems. Specifically, children with parents who had higher levels of parenting stress were more likely to belong to the “initial problematic,” “persistent problematic,” or “subclinical” groups than to the “persistent normal” group. Other significant factors included sex, number of surgeries, and perceived health of parents.

Conclusion:
This study highlights the potential role of parenting stress in changes in emotional and behavioral problems. Accordingly, intervention programs aimed at relieving parenting stress may help reduce the development and worsening of emotional and behavioral problems among children with CHD.
Perceptions of obesity pharmacotherapy by nurse practitioners
Authors: Bottcher Katelyn , Chao Ariana M. 
Published: December 2021

ABSTRACT
Five medications are approved by the US Food and Drug Administration for chronic weight management, yet less than 2% of adults with obesity use these medications. The purpose of this study was to identify reasons nurse practitioners are reluctant to prescribe obesity pharmacotherapy. This was a cross-sectional study of a US sample of nurse practitioners. Questionnaires were administered online that evaluated practice patterns and attitudes concerning obesity pharmacotherapy. The survey was completed by 74 nurse practitioners, and of those, 17.6% prescribed obesity pharmacotherapy and 82.4% did not. Nurse practitioners who did and did not prescribe obesity pharmacotherapy had similar scores on weight bias. Nurse practitioners who did not prescribe obesity pharmacotherapy, compared with those who did, more often reported that patients do not ask for obesity pharmacotherapy (p = .01), patients did not want to use pharmacotherapy (p = .02), and that they were not familiar with obesity medications (p = .02). Although this survey was limited by a low response, we found many beliefs, opinions, and attitudes toward adults with obesity did not differ between the groups. However, nurse practitioners who did not prescribe obesity pharmacotherapy, compared with those who did, identified more barriers related to the lack of obesity pharmacotherapy awareness and education.
Relationship between noninvasive central blood pressure and brain natriuretic peptide levels in patients with hypertensive pulmonary edema
Authors: Algowhary Magdy Ibrahim Aldesowky Mohammed , Razik Nady A. , Youssef Amr Ahmed Aly , Fouad Lateef Gerges Lateef , Hassan Ayman Khairy M. 
Published: December 2021

Objective
Hypertensive pulmonary edema is a fatal condition unless early and properly diagnosed and managed. Central blood pressure (cBP) has been proven to be more associated with adverse cardiovascular events. We aimed to study the correlation between cBP and heart damage in patients with Hypertensive pulmonary edema.

Methods
We included 50 patients admitted to the emergency department in a university hospital for hypertensive pulmonary edema, 27 women and 23 men aged 50 to 70 years. We excluded patients with suspected acute coronary syndrome, significant valvular heart disease, and pericardial diseases. We measured cBP non-invasively from pulse wave analysis of the brachial artery. Brain natriuretic peptide (BNP) and cBP were repeatedly measured for every patient.

Results
The median BNP levels of patients significantly decreased from 284 pg/ml (232–352.5) to 31.5 pg/ml (24–54) on discharge, P < 0.001. We found a significant correlation between admission BNP and central SBP (cSBP), urea, creatinine, arterial blood gases parameters, and left ventricular end-diastolic diameter (LVEDD). Concurrently, BNP at discharge was correlated with age, central DBP (cDBP), urea, creatinine, LVEDD, partial oxygen pressure (pO2), and oxygen saturation (SO2). Delta BNP was correlated with cSBP, peripheral SBP, urea, creatinine, pO2, and SO2. Linear regression analysis revealed that creatinine, and cSBP, were independent predictors of admission BNP, while urea and cDBP were the independent predictors of discharge BNP.

Conclusion
This simple, noninvasive method of cBP measurement was significantly associated with the extent of myocardial damage in patients presenting with hypertensive pulmonary edema.
Blood pressure altering method affects correlation with pulse arrival time
Authors: Heimark Sondre , Rindal Ole Marius H. , Seeberg Trine M. , Stepanov Alexey , Boysen Elin S. , Bøtker-Rasmussen Kasper G. , Mobæk Nina K. , Søraas Camilla L. , Stenehjem Aud E. , Fadl Elmula Fadl Elmula M. , Waldum-Grevbo Bård 
Published: December 2021

Objective
Pulse arrival time (PAT) is a potential main feature in cuff-less blood pressure (BP) monitoring. However, the precise relationship between BP parameters and PAT under varying conditions lacks a complete understanding. We hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and both SBP and DBP. Therefore, this study aimed to investigate the correlation between PAT and BP during two exercise modalities with differing BP responses using an unobtrusive wearable device.

Methods
Seventy-five subjects, of which 43.7% had a prior diagnosis of hypertension, participated in an isometric and dynamic exercise test also including seated periods of rest prior to, in between and after. PAT was measured using a prototype wearable chest belt with a one-channel electrocardiogram and a photo-plethysmography sensor. Reference BP was measured auscultatory.

Results
Mean individual correlation between PAT and SBP was −0.82 ± 0.14 in the full protocol, −0.79 ± 0.27 during isometric exercise and −0.77 ± 0.19 during dynamic exercise. Corresponding correlation between PAT and DBP was 0.25 ± 0.35, −0.74 ± 0.23 and 0.39 ± 0.41.

Conclusion
The results confirm PAT as a potential main feature to track changes in SBP. The relationship between DBP and PAT varied between exercise modalities, with the sign of the correlation changing from negative to positive between type of exercise modality. Thus, we hypothesize that simple test protocols fail to demonstrate the complex relationship between PAT and BP with emphasis on DBP.
Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery
Authors: Reinert Nathan J. , Patel Bansri M. , AlShaer Qasem N. , Wu Liwen , Wisniewski Stephen , Hager Eric S. , Dyer Mitchell R. , Thirumala Parthasarathy D. 
Published: December 2021

Background:
There is a paucity of data regarding cause-specific mortality following a perioperative stroke. In this study, we aim to establish the risk of cause-specific mortality associated with perioperative stroke following cardiac and vascular procedures at 30 days, 90 days, and 1-year postoperative. It is hoped that this fund of knowledge will enhance perioperative risk stratification and medical management for patients who have suffered a perioperative stroke.

Methods:
This is a retrospective cohort study evaluating 277,654 cardiac and vascular surgical patients dually documented within the Inpatient Discharge Claims Database and the Pennsylvania Department of Health Death Statistics database. A univariate assessment followed by a multivariate logistic regression analysis was used to determine the odds of cerebrovascular, cardiovascular, pulmonary, malignancy, infectious, and dementia causes of mortality following perioperative stroke.

Results:
Perioperative stroke significantly increased the odds of overall mortality (P<0.0001) as well as cause-specific mortality in all categories (P<0.05) except dementia (P=0.8907) at all-time endpoints. Cerebrovascular-related mortality was most impacted by perioperative stroke [adjusted odds ratio: 34.5 (29.1, 40.9), P<0.0001 at 30 d].

Conclusions:
Perioperative stroke in the cardiac and vascular surgical population is associated with increased odds of overall, cerebrovascular, cardiovascular, pulmonary, malignancy, and infectious causes of mortality at 30 days, 90 days, and 1-year postoperatively when compared with patients who did not experience a perioperative stroke.
Cerebral Venous Sinus Thrombosis Associated With Coronavirus Disease 2019
Authors: Panichpisal Kessarin , Ruff Ilana , Singh Maharaj , Hamidi Massihullah , Salinas Pedro D. , Swanson Kyle , Medlin Stephen , Dandapat Sudeepta , Tepp Payton , Kuchinsky Genevieve , Pesch Amy , Wolfe Thomas 
Published: December 2021

Introduction:
Coronavirus disease 2019 (COVID-19) is associated with significant risk of acute thrombosis. We present a case report of a patient with cerebral venous sinus thrombosis (CVST) associated with COVID-19 and performed a literature review of CVST associated with COVID-19 cases.

Case Report:
A 38-year-old woman was admitted with severe headache and acute altered mental status a week after confirmed diagnosis of COVID-19. Magnetic resonance imaging brain showed diffuse venous sinus thrombosis involving the superficial and deep veins, and diffuse edema of bilateral thalami, basal ganglia and hippocampi because of venous infarction. Her neurological exam improved with anticoagulation (AC) and was subsequently discharged home. We identified 43 patients presenting with CVST associated with COVID-19 infection. 56% were male with mean age of 51.8±18.2 years old. The mean time of CVST diagnosis was 15.6±23.7 days after onset of COVID-19 symptoms. Most patients (87%) had thrombosis of multiple dural sinuses and parenchymal changes (79%). Almost 40% had deep cerebral venous system thrombosis. Laboratory findings revealed elevated mean D-dimer level (7.14/mL±12.23 mg/L) and mean fibrinogen level (4.71±1.93 g/L). Less than half of patients had prior thrombotic risk factors. Seventeen patients (52%) had good outcomes (mRS <=2). The mortality rate was 39% (13 patients).

Conclusion:
CVST should be in the differential diagnosis when patients present with acute neurological symptoms in this COVID pandemic. The mortality rate of CVST associated with COVID-19 can be very high, therefore, early diagnosis and prompt treatment are crucial to the outcomes of these patients.
Acute Lymphoblastic Leukemia Masquerading as Guillain-Barré Syndrome
Authors: Al-Chalabi Mustafa , Ali Nasar , Lim Taehong , Khalid Fatima , Mccracken Matthew , Alam Abdullah , Meisler Adam , Pirzada Noor 
Published: December 2021

Introduction:
Neurological manifestations of acute lymphoblastic leukemia (ALL) have been reported as cranial neuropathies or meningeal symptoms most common in children. However, ALL can rarely involve the nerve roots causing symmetrical polyradiculopathy which can present with rapid onset paralysis, mimicking Guillain-Barré Syndrome (GBS). The symmetrical polyradiculopathy can be the earliest manifestation of ALL occurring even before the hematological and systemic manifestations.

Case Report:
We report a case of a healthy 29-year-old man who presented with subacute bilateral lower extremity weakness and numbness preceded by a respiratory infection. He was initially treated as a suspected (GBS) but cerebrospinal fluid (CSF) findings suggested an alternative diagnosis. His prior TB exposure created a diagnostic confusion. Lumbar spine magnetic resonance imaging revealed nerve root enhancements at L4-L5 and L5-S1 that are seen in GBS and TB arachnoidids. Brain magnetic resonance imaging demonstrated bilateral distention of the optic nerve sheath complexes with CSF suggestive of intracranial hypertension. CSF revealed elevated protein, nucleated cells 2145 leukocytes/mm3, numerous atypical lymphoid cells. He was later diagnosed with ALL associated symmetrical polyradiculopathy presenting with GBS-like symptoms.

Conclusion:
Symmetrical polyradiculopathy is a rare complication of ALL and can be confused with acute inflammatory demyelinating polyneuropathy. ALL associated polyradiculopathy in young individuals can be clinically indistinguishable from GBS. Our case highlights that when CSF findings are atypical for GBS, ALL should be considered on the differential diagnosis in patients presenting with GBS like symptoms.
Convalescent plasma for outpatients with early COVID-19
Authors: Millat-Martinez Pere , Gharbharan Arvind , Alemany Andrea , Rokx Casper , Geurtsvankessel Corine , Papageourgiou Grigorios , van Geloven Nan , Jordans Carlijn , Groeneveld Geert , Swaneveld Francis , van der Schoot Ellen , Corbacho-Monné Marc , Ouchi Dan , Ferreira Francini Piccolo , Malchair Pierre , Videla Sebastian , García Vanesa García , Ruiz-Comellas Anna , Ramírez-Morros Anna , Codina Joana Rodríguez , Simon Rosa Amado , Grifols Joan-Ramon , Blanco Julian , Blanco Ignacio , Ara Jordi , Bassat Quique , Clotet Bonaventura , Baro Bàrbara , Troxel Andrea , Zwaginga Jaap Jan , Mitjà Oriol , Rijnders Bart ,   for the ConV-ert,   CoV-Early and COMPILEhome study groups
Published: December 2021

AbstractBackgroundConvalescent plasma (CP) for hospitalized patients with COVID-19 has not demonstrated clear benefits. However, data on outpatients with early symptoms are scarce. We aimed to assess whether treatment with CP administered during the first 7 days of symptoms reduced the disease progression or risk of hospitalization of outpatients.MethodsTwo double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when <20% of their predefined sample size had been recruited. A Bayesian adaptive individual patient data meta-analysis was implemented. Analyses were done with Bayesian proportional odds and logistic models, where odds ratios (OR)<1.0 indicate a favorable outcome for CP. Fourteen study sites across the Netherlands and Catalonia in Spain participated in the trial. The two studies included outpatients aged ≥50 years and diagnosed with COVID-19 and symptomatic for ≤7days. The intervention consisted of one unit (200-300mL) of CP with a predefined minimum level of antibodies. The two primary endpoints were (a) a 5-point disease severity scale (fully recovered by day 7 or not, hospital or ICU admission and death) and (b) a composite of hospitalization or death.ResultsOf 797 patients included, 390 received CP and 392 placebo. At baseline, they had a median age of 58 years, 1 comorbidity, symptoms for 5 days and 93% tested negative for SARS-CoV-2 S-protein IgG antibodies. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The OR of CP for an improved disease severity scale was 0.936 (credible interval (CI) 0.667-1.311). The OR for hospitalization or death was 0.919 (CI 0.592-1.416). The effect of CP on hospital admission or death was largest in patients with ≤5 days of symptoms (OR 0.658, 95% CI 0.394-1.085). CP did not decrease the time to full symptom resolution (p=0.62).ConclusionTreatment with CP of outpatients in the first 7 days of symptoms did not improve the outcome of COVID-19. The possible beneficial effect in patients with ≤5 days of symptoms requires further study.RegistrationNCT04621123 and NCT04589949 on https://www.clinicaltrials.govFunding sourceZONMW, the Netherlands, grant number 10430062010001.SUPPORT-E, grant number 101015756YoMeCorono, www.tomecorono.comThe Fight AIDS and Infectious Diseases Foundation with funding from the pharmaceutical company Grifols S.A
SARS-COV-2 INFECTION IN PRIMARY CARE: A SINGLE-CENTERED, RETROSPECTIVE, OBSERVATIONAL STUDY
Authors: de Yébenes Pilar Galicia García , Gutiérrez Cuevas Juan José , Chen Chen Fang Fang , Larrégola Laura Santos , Briega Alberto Manzanares , Rufo Manuel Linares 
Published: December 2021

ABSTRACTPurposeto describe the clinical characteristics of patients with confirmed SARS-CoV-2 infection in primary care and to analyze the predictive role of different risk factors on prognosis, especially living conditions.MethodsRetrospective longitudinal observational retrospective study by reviewing medical records from a primary care center since March 1 to April 30, 2020. Case definition of confirmed SARS-CoV-2 infection, sociodemographic data, clinical characteristics, comorbidity and living conditions were collected. The statistical analysis consisted in description of the sample, comparison of prognosis groups and analysis of prognostic factors.ResultsA sample of 70 patients with confirmed SARS-CoV-2 infection was obtained, with comorbidity mainly related to arterial hypertension, overweight/obesity, hypercholesterolemia, diabetes and chronic pulmonary pathology. Pneumonia was present in 66%. Exitus occurred in 14% of the sample. Factors associated with mortality were advanced age (84 vs 55; p<0.0001), arterial hypertension (78% vs 41%; p=0.040), asthma-COPD (56% vs 13%; p=0.008) and atrial fibrillation (56% vs 5%; p=0.001).ConclusionsThe study reflects the clinical practice of a primary care center. This kind of studies are essential to strengthen and reorganize the Health System and to try to anticipate the medium- to long-term consequences of COVID-19 on global health.