bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart rate variability and haemodynamic factors associated with hypotension during spinal anaesthesia for caesarean delivery
Authors: Du Emma Wei , Tan Hon Sen , Tan Chin Wen , Sultana Rehena , Sng Ban Leong 
Published: June 2021

BACKGROUND
Hypotension frequently occurs during spinal anaesthesia for caesarean delivery, with potential adverse effects.

OBJECTIVE
To investigate heart rate variability and haemodynamic factors associated with spinal anaesthesia-induced hypotension.

DESIGN
Secondary case–control analysis of a randomised study.

SETTING
Single obstetric centre.

PATIENTS
Data were obtained from 230 healthy term singleton parturients who underwent elective caesarean delivery under spinal anaesthesia.

INTERVENTION
With parturients at rest, continuous haemodynamic measurements were recorded using a Nexfin cardiac monitor. Baseline pre-operative values were defined as the average of five minutes of continuous measurements. After initiation of standardised spinal anaesthesia, vasopressors were administered to maintain SBP within 10% of pre-operative values. Hypotension was defined as any 10 seconds average SBP less than 80% of pre-operative values from initiation of spinal anaesthesia to foetal delivery. Parturients were classified into cases (hypotensive) or controls (normotensive), and both univariate and multivariable logistic regression models were used to identify independent factors associated with hypotension.

MAIN OUTCOME MEASURES
Pre-operative standard deviation of the interbeat interval (SDNN), root mean square of successive interbeat difference, low-frequency to high-frequency ratio, SD1, SD2, approximate entropy, sample entropy, mean arterial pressure, SBP, stroke volume variation and systemic vascular resistance index were recorded, as were sensory block height, intravenous fluid volume and vasopressor use between spinal anaesthesia and foetal delivery.

RESULTS
Of 230 parturients, 113 (49.1%) experienced hypotension. Pre-operative lower SDNN [odds ratio (OR) 0.87, 95% confidence interval (CI) 0.78 to 0.97], higher SD2 (OR 25.06, 95% CI 2.41 to 261.06), and lower SBP (OR 0.98, 95% CI 0.97 to 1.00) were independently associated with hypotension. Between spinal anaesthesia to foetal delivery, lower sensory block height (OR 0.76, 95% CI 0.65 to 0.90) and higher intravenous fluid volume (OR 0.98, 95% CI 0.96 to 0.99 per 15 ml change) were associated with a lower incidence of hypotension. Area under the receiver operating characteristic curve was 0.701.

CONCLUSION
Pre-operative higher SD2, lower SDNN and lower SBP were associated with hypotension during spinal anaesthesia for caesarean delivery.

TRIAL REGISTRATION
NCT02277730.
GEOGRAPHIC ATROPHY INCIDENCE AND PROGRESSION AFTER INTRAVITREAL INJECTIONS OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS FOR AGE-RELATED MACULAR DEGENERATION
Authors: Eshtiaghi Arshia , Issa Mariam , Popovic Marko M. , Muni Rajeev H. , Kertes Peter J. 
Published: June 2021

Purpose:
Geographic atrophy (GA) is a complication of advanced neovascular age-related macular degeneration that can lead to permanent vision loss. We sought to estimate the incidence and progression of GA after intravitreal injections of antivascular endothelial growth factor agents in eyes with neovascular age-related macular degeneration.

Methods:
Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched from inception to May 2020. Included studies reported on the progression or development of GA in eyes with neovascular age-related macular degeneration after antivascular endothelial growth factor therapy.

Results:
Thirty-one articles and 4,609 study eyes (4,501 patients) were included. Eyes received a mean of 17.7 injections over 35.2 months. The prevalence of GA at baseline was 9.7%. The pooled incidence of GA was 30.5% at the end of follow-up. There was a positive, moderate linear correlation between the mean total number of injections and GA incidence at the final follow-up (R2 = 0.30; P = 0.01). Monthly treatment was associated with a significantly higher risk for GA development relative to pro re nata (relative risk = 1.40, 95% confidence interval = [1.21–1.61], P < 0.001). Risk factors for GA development included GA in the fellow eye, retinal angiomatous proliferation, drusen, and reticular pseudodrusen.

Conclusion:
We found an association between the frequency and number of treatments with antivascular endothelial growth factor agents and the development of GA in neovascular age-related macular degeneration. Future studies should clarify risk factors, population characteristics, and relative contributions of treatment and disease progression on GA development in this context.
Domestic Mass Shooters
Authors: Glick Ira D. , Cerfolio Nina E. , Kamis Danielle , Laurence Michael 
Published: June 2021

Abstract

Background
Given the relative lack of psychiatric information and data on the perpetrators of US mass shootings, the aim of our study was to understand who these “mass shooters” were and whether they had a psychiatric illness. If so, were they competently diagnosed, and if so, were they treated with appropriate medication for their diagnoses before the violence?

Methods
Because a prospective study of diagnosis and treatment could not, for obvious reasons, be carried out, we designed a retrospective, observational study of mass shooters, defined as those who killed 4 or more people with firearms between 1982 and 2012 or who killed 3 or more people with firearms between 2013 and 2019 in the United States. We used the Mother Jones database—a database of 115 persons identified as committing a mass shooting in the United States between January 1982 and September 2019. In the vast majority of the incidents identified in the database, the perpetrator died either during or shortly after the crime, leaving little reliable information about their history—especially psychiatric history. We focused on the 35 mass shooters who survived and for which legal proceedings were instituted because these cases presented the most reliable psychiatric information. For each of these 35 mass shootings, we interviewed forensic psychiatrists and forensic psychologists who examined the perpetrator after the crime and/or collected the testimony and reports by psychiatrist(s) at trial or in the postconviction proceedings contained in the court record. In addition, we reviewed available information from the court proceedings, public records, a videotaped interview of assailant by law enforcement, social media postings of the assailant, and writings of the assailant. After collecting the clinical information from multiple sources on each case to make a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis, we also completed a Sheehan Diagnostic Scale. After this, 20 additional cases where the assailant died at the crime were randomly selected form the remaining 80, to determine whether there were differences in psychiatric diagnoses and treatment between such assailants and those who survived.

Results
Twenty-eight of 35 cases in which the assailant survived had a psychiatric diagnosis—18 with schizophrenia, 3 with bipolar I disorders, 2 with delusional disorders, persecutory type, 2 with personality disorders (1 paranoid and 1 borderline), 2 with substance-related disorders without other psychiatric diagnoses, and 1 with posttraumatic stress disorder. Four had no psychiatric diagnosis, and in 3, we did not have enough information to make a diagnosis.
Of 15 of 20 cases in which the assailant died, 8 had schizophrenia. None of those diagnosed with psychiatric illnesses were treated with medication.

Conclusions
A significant proportion of mass shooters experienced unmedicated and untreated psychiatric disorder.
Intersectional Effects of Sexual Orientation Concealment, Internalized Homophobia, and Gender Expression on Sexual Identity and HIV Risk Among Sexual Minority Men of Color: A Path Analysis
Authors: Ramos S. Raquel , Lardier David T. , Opara Ijeoma , Turpin Rodman E. , Boyd Donte T. , Gutierrez José I. , Williams Chase Nicole , Nelson LaRon E. , Kershaw Trace 
Published: June 2021

Abstract
In the United States, 13 million people identify as sexual and gender minorities. The purposes of this article were to (a) examine the associations among sexual orientation concealment and internalized homophobia with HIV knowledge, health literacy, and transactional sex through sexual identity; and (b) assess whether gender expression moderates those relationships in sexual minority men of color. A multigroup mediation path model examined the association between sexual orientation concealment and internalized homophobia on HIV knowledge, health literacy, and transactional sex through sexual identity by gender expression. Results suggest that, among those with a masculine gender expression, as sexual concealment increased, health literacy decreased. The association between sexual orientation concealment and transactional sex varied by participant's gender expression as did the association between internalized homophobia and HIV knowledge. Multiple intersecting identities, when faced with anticipated discrimination and homophobia, can negatively affect health outcomes and increase HIV risk in sexual minority men of color.
Guidelines for the diagnosis and treatment of acute pancreatitis in China (2021)
Authors: Li Fei , Cai Shouwang , Cao Feng , Chen Rufu , Fu Deliang , Ge Chunlin , Hao Chunyi , Hao Jihui , Huang Heguang , Jian Zhixiang , Jin Gang , Li Ang , Li Haimin , Li Shengping , Li Weiqin , Li Yixiong , Liang Tingbo , Liu Xubao , Lou Wenhui , Miao Yi , Mou Yiping , Peng Chenghong , Qin Renyi , Shao Chenghao , Sun Bei , Tan Guang , Tian Xiaodong , Wang Huaizhi , Wang Lei , Wang Wei , Wang Weilin , Wei Junmin , Wu Heshui , Wu Wenming , Wu Zheng , Yan Changqing , Yang Yinmo , Yin Xiaoyu , Yu Xianjun , Yuan Chunhui , Zhang Taiping , Zhao Yupei 
Published: June 2021

Abstract
Acute pancreatitis (AP) is a common acute abdominal condition of the digestive system. In recent years, treatment concepts, methods, and strategies for the diagnosis of AP have advanced, and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients. On the basis of previous guidelines and expert consensus, this guideline adopts an evidence-based, problem-based expression; synthesizes important clinical research data at home and abroad in the most recent 5 years; and forms 29 recommendations through multidisciplinary expert discussion, including diagnosis, treatment, and follow-up. It is expected to provide evidence support for the treatment of AP in the clinical setting in China.
Novel delivery mechanisms for antigen-specific immunotherapy
Authors: Neef Tobias , Miller Stephen D. 
Published: June 2021

Purpose of review
Current therapies for autoimmune disorders often employ broad suppression of the immune system. Antigen-specific immunotherapy (ASI) seeks to overcome the side-effects of immunosuppressive therapy by specifically targeting only disease-related autoreactive T and B cells. Although it has been in development for several decades, ASI still is not in use clinically to treat autoimmunity. Novel ways to deliver antigen may be effective in inducing ASI. Here we review recent innovations in antigen delivery

Recent findings
New ways to deliver antigen include particle and nonparticle approaches. One main focus has been the targeting of antigen-presenting cells in a tolerogenic context. This technique often results in the induction and/or expansion of regulatory T cells, which has the potential to be effective against a complex, polyclonal immune response.

Summary
Whether novel delivery approaches can help bring ASI into general clinical use for therapy of autoimmune diseases remains to be seen. However, preclinical work and early results from clinical trials using these new techniques show promising signs.
Single scan SeHCAT studies: a model for the prediction of the 3-h counts
Authors: Smout Alexander , Scuffham James , Hinton Paul 
Published: June 2021

Objectives
As part of the 75-Selenium homocholic acid taurine (SeHCAT) study, counts are acquired as a baseline to allow the calculation of the retention at 7 days. In this work, we evaluated whether it was possible to replace the baseline image with a predictive model based on the patient’s height and weight.

Method
Height and weight data from 723 patients scanned at three hospitals using seven gamma cameras were compiled. A number of different models were trialled, with fitting parameters determined by regression. A predictive model based on height and logarithm of weight was found to have the best correlation with the measured counts in the 3-h study.

Results
There was a strong correlation (R
2 = 0.91) between the measured counts and the predicted counts using a model based on height and logarithm of weight. Treating the standard SeHCAT test result as the gold standard, the test result when predicted baseline counts were used had a sensitivity and specificity of 97.5 and 98.0%, respectively, at a threshold of 15%. In total 694/723 (96.0%) of patients had no change to their severity grading when using the predicted baseline counts.

Conclusion
This work presents a model that was able to predict the counts in the 3 h SeHCAT study for patients on seven gamma cameras. This can enable a single scan study, giving significant savings to patient and staff time and imaging resources.
PICU Follow-Up Clinic: Patient and Family Outcomes 2 Months After Discharge*
Authors: Ducharme-Crevier Laurence , La Kim-Anh , Francois Tine , Gerardis George , Beauchamp Miriam , Harrington Karen , Roumeliotis Nadezdha , Farrell Catherine , Toledano Baruch , Lacroix Jacques , Du Pont-Thibodeau Geneviève 
Published: June 2021

OBJECTIVES:
Hospitalization in a PICU is a life-altering experience for children and their families. Yet, little is known about the well-being of these children after their discharge. We are describing the outcome of PICU survivors at a PICU clinic 2 months after discharge.

DESIGN:
Prospective cohort study.

SETTING:
PICU and PICU clinic of CHU Sainte-Justine.

PATIENTS:
Prospective cohort study of children admitted for greater than or equal to 4 days, greater than or equal to 2 days of invasive ventilation, odds ratio greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier Universitaire Sainte-Justine.

PATIENTS:
Prospective cohort study of children admitted for greater than or equal to 4 days, greater than or equal to 2 days of invasive ventilation, or greater than or equal to 4 days of noninvasive ventilation at Centre Hospitalier Universitaire Sainte-Justine PICU.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Patients were evaluated by a pediatric intensivist 2 months after discharge at the follow-up clinic. They were asked to fill out validated questionnaires. One hundred thirty-two patients were followed from October 2018 to September 2020. The PICU diagnoses were respiratory illness (40.9%), head trauma, and septic shock (7.6%). Average length of PICU stay was 28.5 ± 84.2 days (median 7 d). Sixty-one percent were intubated. Symptoms reported by families were as follows: fatigue (9.9%), sleep disturbances (20.5%), feeding difficulties (12.1%), and voice change and/or stridor (9.8%). Twenty-one percent of school-aged children reported school delays. Twenty-seven children demonstrated communication delays, 45% gross motor function delays, 41% fine motor delays, 37% delays in problem-solving, and 49% delays in personal-social functioning. Quality of Life scores were 78.1 ± 20.5 and 80.0 ± 17.5 for physical and psychosocial aspects, respectively. Fourteen percent of parents reported financial difficulties, 42% reported symptoms of anxiety, 29% symptoms of depression.

CONCLUSIONS:
PICU survivors and their families experience significant physical and psychosocial morbidities after their critical illness. PICU follow-up is crucial to determine the outcome of these children and develop interventions.
Electrocardiogram in Pediatric Syncope
Authors: Manouzi Anas , Sanatani Shubhayan , Doan Quynh 
Published: June 2021

Objectives
We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population.

Methods
We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. The survey questionnaire introduced 2 clinical vignettes presenting a typical vasovagal syncope and a presentation suggestive of a cardiac etiology. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation. We also evaluated which specific ECG findings were likely to change physicians' management and explored factors influencing the decision to perform or not perform the ECG.

Results
The analyzable response rate was 47% (105/225). In the low-risk scenario, 51% of respondents requested an ECG, and none consulted the cardiology service, given that all requested investigations are normal. Forty-five percent of physicians modified their management if an ECG was reported as anything but totally normal. In the high-risk scenario, all respondents requested either a 12-lead ECG or a high-lead ECG, and 94% consulted the cardiology service. Physicians also identified clear differences in the motivations behind their decision to perform an ECG in typical vasovagal syncope.

Conclusions
This study highlights the significant practice variation in the evaluation and management of typical vasovagal syncope among physicians, which is informed by complex interactions of patient, provider, and institutional factors and the perceived clinical significance of borderline ECG findings.
A Self-criticism of Diagnostic and Therapeutic Decision Making in Children Admitted With Acute Lower Respiratory Infection at a Single Pediatric Emergency Department
Authors: Akcan Yildiz Leman , Demirci Busra , Gunes Altan , Yakut Halil Ibrahim , Dibek Misirlioglu Emine 
Published: June 2021

Objectives
Acute bronchiolitis and community-acquired pneumonia are the most common acute lower respiratory infections (LRIs) leading to emergency admission and hospitalization in children. The aim of this study is to investigate clinical, laboratory, and radiology findings; diagnostic and therapeutic decisions; and the relationships between them in patients younger than 2 years of age, hospitalized for LRI.

Methods
Patients hospitalized for acute LRI (aged 28 days to 24 months) between November 1, 2017, and March 31, 2018, at a referral hospital were included. Patients' characteristics, clinical, laboratory, and radiologic findings and diagnostic and therapeutic decisions, along with reason for hospitalization, were recorded retrospectively. Chest x-rays were reinterpreted by the pediatric radiologist. Associations of these data with the radiologic signs and treatment modalities including antibiotics, bronchodilators, and high-flow oxygen therapy (HFOT) were assessed.

Results
One hundred eighty-two patients were included. One hundred sixty (87.9%) had at least one of the following criteria for hospitalization: dehydration, feeding difficulties, young age (<12 weeks), and hypoxia. One hundred forty-five (79.6%) and 71 (39.0%) patients were administered antibiotic and antiviral therapy, respectively. Twenty-three patients (13.7%) were given HFOT, and 179 (99.4%) were given bronchodilators. None of the complaints, physical signs, or laboratory parameters had statistically significant associations with radiologic findings (P > 0.05). History of wheezing and presence of rales and dehydration in physical examination were associated with antibiotic use (P < 0.001).

Conclusions
The decision of hospitalization was generally appropriate. However, laboratory and radiologic tests and treatments including HFOT, bronchodilator, antibiotic, and antiviral therapies were used excessively and inefficiently. Physicians' decisions were not based on evidence or on the clinical findings of the patient. The results of this study should prompt investigations into the reasons underlying these clinical decisions and development of practice models that can provide solutions specifically targeting the decision-making processes of physicians caring for young children with LRI at the emergency department.
Reasons for Participation and Nonparticipation in Psychological Relapse Prevention for Anxiety and Depression: A Qualitative Study
Authors: SCHOLTEN WILLEMIJN , MUNTINGH ANNA , BATELAAN NEELTJE , DRAISMA STASJA , DE JONGE MARGO , VAN BALKOM ANTON 
Published: June 2021

Background:
Anxiety and depressive disorders frequently recur, but participation in effective psychological interventions to prevent relapse is limited. The reasons for nonparticipation are largely unknown, hampering successful implementation. The aims of this study were: (1) to investigate reasons why patients with remitted anxiety or depressive disorders refuse cognitive-behavioral therapy relapse prevention interventions (RPIs), (2) to compare these reasons with reasons to participate, and (3) to gain insight into patients’ preferences regarding relapse prevention.

Methods:
A qualitative study was conducted in which data were gathered from 52 semistructured interviews with patients who either refused or agreed to participate in psychological relapse prevention. The constant comparative method was used.

Results:
The data showed that those who refused to participate (1) did have knowledge about relapse risks in general, (2) but did not relate this risk to themselves, and therefore, did not feel the need for relapse prevention, or (3) declined to participate for logistical reasons or reasons related to the content of the intervention. Preferences concerning the form and content of RPIs were very diverse.

Conclusions:
Psychoeducation on relapse should be provided to patients to help them relate recurrence risks to themselves. RPIs should also be individually tailored.
Three-Dimensionally Printed Skin Substitute Using Human Dermal Fibroblasts and Human Epidermal Keratinocytes
Authors: Patel Jason , Willis Joseph , Aluri Akshay , Awad Shadi , Smith Metta , Banker Zena , Mitchell Morgan , Macias Liz , Berry Joel , King Timothy 
Published: June 2021

Introduction
Wound healing affects millions of people annually. After injury, keratinocytes from the wound edge proliferate, migrate, and differentiate to recapitulate the 3-dimensional (3D) structure needed to provide a barrier function. If the wound is too large, skin grafting may be required. We are interested in discovering novel strategies to enhance the wound healing process. It may be possible to recreate a viable and histologically accurate skin tissue using 3D printing. We hypothesize that keratinocytes and dermal fibroblasts can be bioprinted into a viable skin substitute.

Methods
Adult human dermal fibroblasts (HDFa) and adult human epidermal keratinocytes (HEKa) were cultured and subsequently printed with a 3D bioprinter within a hydrogel scaffold. After printing the HDFa and HEKa separately, cell viability and histological appearance were determined by sectioning the printed tissue and performing hematoxylin and eosin staining. The stained histological sections were analyzed for tissue morphology.

Results
The HEKa and HDFa cells suspended in the hydrogel were successfully printed into 3D scaffolds that resembled skin with hematoxylin and eosin staining.

Conclusions
The HEKa and HDFa cells can be grown on 3D-printed hydrogels successfully. In addition, HEKa and HDFa cells can survive and grow when suspended in a hydrogel and 3D printed. Future potential applications of these results could lead to the creation of viable skin tissue for wound healing and surgical repair.