bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum-specific Vital Sign Reference Ranges
Authors: Green L.J. , Pullon R. , Mackillop L.H. , Gerry S. , Birks J. , Salvi D. , Davidson S. , Loerup L. , Tarassenko L. , Mossop J. , Edwards C. , Gauntlett R. , Harding K. , Chappell L.C. , Knight M. , Watkinson P.J. 
Published: November 2021

(Obstet Gynecol. 2021;137:295–304. doi: 10.1097/AOG.0000000000004239. PMID: 33417320)
The majority of maternal deaths occur in the postpartum period (57% in the United States), compared with the antenatal and intrapartum periods. However, maternal deaths in the postpartum period have not been studied as extensively as the antenatal and intrapartum periods. Venous thromboembolism, hemorrhage, sepsis, and gestational hypertensive disorders are the leading causes of death during postpartum. Little data exists describing normal postpartum vital signs. This study aimed to estimate maternal postpartum vital sign ranges.
Women’s Experiences of Decision-making and Beliefs in Relation to Planned Cesarean Section: A Survey Study
Authors: Coates D. , Donnolley N. , Thirukumar P. , Lainchbury A. , Spear V. , Henry A. 
Published: November 2021

(Aust N Z J Obstet Gynaecol. 2021;61:106–115)
The decision for planned cesarean delivery (CD) is often based on the preferences and beliefs of the patient or clinician. When decision-making is shared, patient satisfaction improves. The extent to which shared decision-making (SDM) occurs in Australia is unclear. Moreover, no studies have directly compared the preferences and beliefs of women undergoing planned CD at the recommendation of the clinician or at their own request. This study aimed to assess the mode of birth preferences of women in Australia and their experiences with SDM for CD. It also aimed to compare the experiences of SDM depending on whether a woman requested a CD or it was recommended by a clinician.
Cesarean Section in the Second Delivery to Prevent Anal Incontinence After Asymptomatic Obstetric Anal Sphincter Injury: The EPIC Multicenter Randomized Trial
Authors: Abramowitz L. , Mandelbrot L. , Bourgeois Moine A. , Tohic A.L. , Carne Carnavalet C. , Poujade O. , Roy C. , Tubach F. 
Published: November 2021

(BJOG. 2021;128:685–693. doi: 10.1111/1471-0528.16452)
Anal incontinence negatively impacts the quality of life and sexual health of 14.8% of women in the United States. Third-degree and fourth-degree obstetric anal sphincter injuries, reported in 2% to 12% of vaginal deliveries (VD), contribute. Between 38% and 53% of obstetric anal sphincter lesions are associated with long-term anal incontinence. Up to 27% of women experience occult anal sphincter lesions following their first VD, and 9% of women with undiagnosed anal sphincter lesions experience anal incontinence. Instrumental delivery increases risk of anal incontinence with sphincter lesions occurring in 63% to 82% of forceps deliveries; 23% of these parturients experiencing anal incontinence. When anal sphincter injuries occur during the first VD, cesarean delivery (CD) is an option for future births. Although CD may have beneficial maternal outcomes, there are risks to both mother and neonate and no clear evidence to aid decision making. The aim of this study was to identify whether CD for the second delivery could prevent anal incontinence in women with a history of asymptomatic obstetric anal sphincter injuries.
Programmed Intermittent Epidural Bolus vs. Patient-controlled Epidural Analgesia for Maintenance of Labour Analgesia: A 2-Center, Double-blind, Randomized Study
Authors: Roofthooft E. , Barbé A. , Schildermans J. , Cromheecke S. , Devroe S. , Fieuws S. , Rex S. , Wong C.A. , Van de Velde M. 
Published: November 2021

(Anaesthesia. 2020;75:1635–1642)
Many institutions use patient-controlled epidural analgesia (PCEA) for pain relief during labor; however, programmed intermittent epidural bolus+PCEA (PIEB) has emerged as possibly superior to PCEA alone. PIEB has been found to provide pain relief with less local anesthetic, fewer or later patient-administered boluses and less motor block than PCEA strategies. PIEB has also been shown to reduce the need for instrumental vaginal delivery and manual bolus intervention by the anesthetist, and to improve maternal satisfaction. To date, there are no known studies comparing PIEB with PCEA without background infusion. The aim of this study is to compare the incidence of breakthrough pain with PIEB and PCEA.
Effect of a Stepwise Opioid-sparing Analgesic Protocol on In-hospital Oxycodone Use and Discharge Prescription After Cesarean Delivery
Authors: Landau R. , Romanelli E. , Daoud B. , Shatil B. , Zheng X. , Corradini B. , Aubey J. , Wu C. , Ha C. , Guglielminotti J. 
Published: November 2021

(Reg Anesth Pain Med. 2021;46:151–156)
Between 1999 and the 2014, the use of opioids during and after pregnancy increased 5-fold. Between 2007 and 2016, opioid-related deaths during pregnancy tripled. One factor that may contribute to these increasing rates is exposure to opioids during hospitalization after cesarean delivery (CD). Implementing stepwise protocols for analgesia after CD both in-hospital and postdischarge is recommended to help minimize the risk of opioid use. The aim of this study was to examine the effect of a multimodal, stepwise opioid-sparing analgesic order set on oxycodone use in women undergoing CD.
Effect of Sugammadex During Transcranial Electrical Motor Evoked Potentials Monitoring in Spinal Surgery: A Randomized Controlled Trial
Authors: Liu Haiyang , Jian Minyu , Wang Chengwei , Nie Lanyi , Liang Fa , Liu Kuo , Zhang Kaiying , Qiao Hui , Han Ruquan 
Published: November 2021

Introduction:
Neuromuscular blockade suppresses transcranial electrical motor evoked potential (TceMEP) amplitude and is usually avoided during TceMEP monitoring. In this randomized controlled trial, we investigated whether rocuronium-induced suppression of TceMEP amplitude could be reversed by sugammadex in patients undergoing spine surgery.

Methods:
Seventy-six patients undergoing spinal surgery were randomly allocated into sugammadex and control groups. In the sugammadex group, a rocuronium infusion was titrated to maintain moderate neuromuscular blockade (2 twitches on train-of-four) until dural opening when the rocuronium infusion was discontinued and 2 mg/kg sugammadex administered. In the control group, no neuromuscular blockade was administered after induction of anesthesia. The primary outcome was a comparison between sugammadex and control groups of mean TceMEP amplitudes in the abductor pollicis brevis muscles of both upper extremities 5 minutes after dural. Secondary outcomes included TceMEP amplitudes at 10, 20, 30, and 60 minutes after dural opening.

Results:
Sixty-six patients were included in the analysis. TceMEP amplitudes were significantly greater in the sugammadex group (629 μV, interquartile range: 987 μV) than in the control group (502 μV, interquartile range: 577 μV; P=0.033) at 5 minutes after dural opening. TceMEP amplitudes were also greater in the sugammadex group at 10 minutes (P=0.0010), 20 minutes (P=0.003), 30 minutes (P=0.001), and 60 minutes (P=0.003) after dural opening.

Conclusions:
Moderate neuromuscular blockade induced by continuous infusion of rocuronium was effectively reversed by sugammadex. This suggests that sugammadex could be used to enhance TceMEP waveform monitoring during spine surgery requiring muscle relaxation.
Individualized Functional Knee Alignment in Total Knee Arthroplasty: A Robotic-assisted Technique
Authors: Clark Gavin W. , Esposito Christina I. , Wood David 
Published: November 2021

Introduction:
The use of robotic technology is becoming a well-recognized alternative to conventional total knee arthroplasty (TKA). The quantitative soft tissue information generated in robotic surgery can be used to balance the knee and achieve functional alignment (FA) of the components. This paper describes a novel FA technique using an individualized preoperative plan that is then adjusted to achieve soft tissue balance.

Materials and Methods:
We report on surgical technique, indications, considerations, and complications after our experience of performing 650 functionally aligned TKAs. We collected 2-year patient reported outcomes on 165 TKAs in this series (165 of 193 TKAs have reached 2 years follow-up in the series of 650 TKAs; 85% follow-up rate).

Results:
We found significant postoperative improvements with few infections and no revisions for mechanical reasons 2 years after surgery with this technique. Patients had improved knee range-of-motion (105 degrees° flexion preoperatively vs. 125 degrees flexion postoperatively; P<0.001), higher Forgotten Joint Scores (17 preoperatively vs. 77 postoperatively; P<0.001), improved Oxford Knee Scores (22 preoperatively vs. 43 postoperatively; P<0.001), higher KOOS Jr scores (48 preoperatively vs. 88 postoperatively; P<0.001) and lower visual analogue score pain scores (70 preoperatively vs. 12 postoperatively; P<0.001) 2 years postoperatively.

Discussion:
The described surgical technique is a promising method for conducting a robotic TKA. Benefits of FA include improved efficiency with preresection balancing, reduced soft tissue releases compared with a mechanical alignment technique, and accurate bony cuts with robotic assistance. Further studies are required to compare this technique with established methods to determine any differences in outcomes.
Acellular Porcine Cornea Produced by Supercritical Carbon Dioxide Extraction: A Potential Substitute for Human Corneal Regeneration
Authors: Liang Chang-Min , Hsieh Dar-Jen , Tseng Fan-Wei , Srinivasan Periasamy , Yeh Ming-Long , Tai Ming-Cheng 
Published: November 2021

Purpose:
The aim of this study was to develop a non-cytotoxic, biocompatible innovative acellular porcine cornea (APC) for corneal wound healing and corneal blindness treatment.

Methods:
APC was produced by using supercritical carbon dioxide (SCCO2) to decellularize the porcine cornea. Decellularization of the porcine cornea was examined by hematoxylin and eosin staining and 4,6-diamidino-2-phenylindole, dihydrochloride staining. The residual DNA content of APC was analyzed in comparison with the native porcine cornea. Virus inactivation up to at least 6 log10 was confirmed for the stepwise process of APC for 4 different model viruses. In addition, a series of in vitro and in vivo tests in accordance with ISO-10993 biocompatibility assay and animal performance tests were performed.

Results:
APC produced by the SCCO2 process revealed complete decellularization, without any residual non-collagenous proteins. The scanning electron microscopy structural features of the decellularized cornea were similar to those of human. APC was found to be nontoxic and exhibited excellent biocompatibility in both in vitro and in vivo studies. The animal performance test proved that APC exerted excellent adaptability on the cornea and no sign of irritation and good compatibility in lamellar corneal transplantation.

Conclusions:
APC manufactured by SCCO2 technology revealed complete cells and non-collagenous protein removal compared with the Triton–sodium dodecyl sulfate decellularization process. APC showed excellent biocompatibility in rabbit lamellar corneal transplantation with a follow-up to 1 year. APC can be a potential substitute for human-donated cornea for corneal transplantation in the near future.
Effects of Blood Flow Restriction Therapy for Muscular Strength, Hypertrophy, and Endurance in Healthy and Special Populations: A Systematic Review and Meta-Analysis
Authors: Perera Edward , Zhu Xi Ming , Horner Nolan S. , Bedi Asheesh , Ayeni Olufemi R. , Khan Moin 
Published: November 2021

Objectives:
Blood flow restriction (BFR) training is an increasingly applied tool with potential benefits in muscular hypertrophy, strength, and endurance. This study investigates the effectiveness of BFR training relative to other forms of training on muscle strength, hypertrophy, and endurance.

Data sources:
We performed systematic searches of MEDLINE, Embase, and PubMed and assessed the methodological quality of included studies using the Cochrane risk of bias tool.

Main results:
We included 53 randomized controlled trials with 31 included in meta-analyses. For muscular strength comparing low-intensity BFR (LI-BFR) training with high-intensity resistance training (HIRT), the pooled mean difference (MD) for 1 repetition maximum was 5.34 kg (95% CI, 2.58-8.09; P < 0.01) favoring HIRT. When comparing LI-BFR training with HIRT for torque, the MD was 6.35 N·m (95% CI, 0.5-12.3; P = 0.04) also favoring HIRT. However, comparing LI-BFR with low-intensity resistance training (LIRT) for torque, there was a MD of 9.94 N·m (95% CI, 5.43-14.45; P < 0.01) favoring BFR training. Assessing muscle hypertrophy, the MD in cross-sectional area was 0.96 cm2 (95% CI, 0.21-1.7; P = 0.01) favoring pooled BFR training compared with nonocclusive training. Assessing endurance, V̇o
2 maximum demonstrated a greater mean increase of 0.37 mL/kg/min (95% CI, −0.97 to 3.17; P = 0.64) in BFR endurance training compared with endurance training alone.

Conclusion:
Blood flow restriction training produced increases in muscular strength, hypertrophy, and endurance. Comparing LI-BFR training with HIRT, HIRT was a significantly better training modality for increasing muscle hypertrophy and strength. However, LI-BFR was superior when compared with a similar low-intensity protocol. Blood flow restriction training is potentially beneficial to those unable to tolerate the high loads of HIRT; however, better understanding of its risk to benefit ratio is needed before clinical application.

Level of evidence:
Level 1.
Study on the Correlation Between Ischemic Leukoaraiosis and Cerebral Large Artery Stenosis Using the Stages of the Preinfarction Period Based on the Result of Computed Tomography Perfusion
Authors: Ren Taojie , Sun Shifu , Li Bo , Chen Yuan , Qu Xiaofeng , Li Chunxing , Deng Xiaowen , Ni Caifang 
Published: November 2021

Background and Objective:
The influence of cerebral large artery stenosis (CLAS) on ischemic leukoaraiosis (LA) remains elusive. Based on the proposed stages of the preinfarction period, this study aimed to adopt the staging system to assess the correlation between ischemic LA and CLAS.

Materials and Methods:
Patients with unilateral CLAS ≥50% and without cerebral stroke were screened. The severity and distribution of stenosis were evaluated on computed tomography angiography images. The degree of regional cerebral perfusion was rated according to the stages of preinfarction period: 0=normal, 1=stage Ia, 2=stage Ib, 3=stage IIa, 4=stage IIb. Stage I included stage Ia and stage Ib. Stage II included stage IIa and stage IIb. LA was scored with Fazakas scale on T2-weighted image and/or fluid-attenuated inversion recovery sequences.

Results:
The cohort consisted of 212 patients (mean age, 66.89±11.39 y), including 145 (68.40%) males. CLAS severity and distribution did not differ between patients with and without LA (P>0.05). Normal, stage I, and stage II had significantly different incidences of LA and hemispheric LA scores in the left and right hemispheres (P<0.05). The degree of regional cerebral perfusion was independently associated with LA in the left (P=0.0094) and right hemispheres (P=0.0091).

Conclusions:
Ischemic LA is not directly related to CLAS but is independently associated with the degree of CLAS-induced cerebral hypoperfusion. The stages of the preinfarction period are helpful in identifying people at high risk of LA progression.
High Serum Levels of Resistin is Associated With Acute Cerebral Infarction
Authors: Lee Kee Ook , Lee Kyung-Yul , Lee Cheol-Young , Kim Ji Hoon , Kang Jaeku , Lee Hoi Young , Na Sang-Jun , Oh Seung-Hun , Heo Ji Hoe 
Published: November 2021

Background:
The inflammatory process is involved in the pathogenesis of atherosclerosis and brain tissue injury following cerebral ischemia. Human resistin is a member of small cysteine-rich secreted proteins and has been implicated in inflammatory responses. This study investigated the association of serum resistin level with acute cerebral infarction (ACI). We also investigated its association with the short-term functional outcome.

Methods:
This study included 106 patients with ACI and 106 age-matched and sex-matched healthy control subjects. Serum resistin level was assessed by using enzyme-linked immunosorbent sandwich assay. The association of serum resistin levels with ACI was analyzed by logistic regression analysis.

Results:
The serum resistin level was significantly higher in patients with ACI than the control group [median (interquartile range), 35.7 ng/mL (13.0 to 70.5) ng/mL vs. 10.5 ng/ml (15.4 to 16.6), P<0.001]. Logistic regression analysis showed that serum resistin level was associated with an ACI (odds ratio=1.055, 95% confidence interval: 1.035-1.074, P<0.001). Among stroke subtypes, the serum resistin level was higher in the patients with large artery atherosclerosis than those with other subtypes (P=0.013). High resistin levels were also significantly associated with unfavorable functional outcome at discharge (odds ratio=1.043, 95% confidence interval: 1.024-1.063, P<0.001).

Conclusions:
This study suggests the potential association of resistin with stroke and cerebral atherosclerosis. Increased serum resistin levels were also associated with early unfavorable neurological outcome.
Quadriparesis Due to Delayed Tension Pneumoventricle
Authors: Maramattom Boby Varkey 
Published: November 2021

Introduction:
Although pneumocephalus is very common after intracranial or spinal surgeries, pneumoventricle is uncommon. Tension pneumoventricle (tPV) occurs when air in the ventricles expands to cause neurological deficits or mass effect. It is usually seen with a combination of a ball-valve defect postoperatively that sucks in air and a ventriculoperitoneal shunt that drains cerebrospinal fluid and allows the ingress of air.

Case Report:
A young man developed delayed tPV after surgery for craniopharyngioma. He required multiple surgeries and occlusion of the ventriculoperitoneal shunt before the tPV resolved.

Conclusions:
The probable mechanisms of tPV and the importance of early recognition and treatment are discussed. A review of the literature of this uncommon entity has also been performed.
Is Selenium Supplementation Beneficial in Acute Ischemic Stroke?
Authors: Ramezani Mahtab , Simani Leila , Abedi Sahar , Pakdaman Hossein 
Published: November 2021

Background:
Selenium (Se) plays a significant role in brain physiology. The existing human data demonstrate that stroke is associated with significantly reduced Se levels and glutathione peroxidase (GPx) activity. This study proposed to investigate the effect of intravenous Se (Selenase) administration in patients with acute ischemic stroke (AIS) on neurological outcomes, antioxidant enzyme activity, and inflammatory marker levels.

Methods:
AIS patients (n=50) were recruited from a neurology unit of a university-affiliated hospital. Patients were randomly assigned to receive either Selenase or placebo (saline) for 5 days. The modified ranking scale, the national institute of health stroke scale, and the mini-mental state examination, as primary outcomes, and the serum GPx concentration, total antioxidant activity, and tumor necrosis factor-α levels, as secondary outcomes, were measured at the baseline and on day 30.

Results:
Eventually, 44 patients with AIS completed the intervention study. A notable increase in GPx and total antioxidant activity levels was detected in the treatment group compared with the placebo group (110.63±52.48 m/mL, 1.34±0.30 mmol/L, P<0.05), whereas the serum tumor necrosis factor-α level in the Selenase group was significantly lower than that of the placebo group (58.58±61.33 pg/mL, P<0.05). In addition, Selenase improved the modified ranking scale and national institute of health stroke scale scores significantly (P<0.05 and <0.04, respectively), but no statistical difference was observed between the 2 groups in the mini-mental state examination score.

Conclusion:
Selenase, plausibly due to its antioxidant function, results in positive outcomes in terms of neurological deficits, antioxidant enzyme activity, and inflammatory marker levels.
CD4 Trends With Evolving Treatment Initiation Policies Among Children Living With HIV in Zambézia Province, Mozambique, 2012–2018
Authors: Carlucci James G. , De Schacht Caroline , Graves Erin , González Purificación , Bravo Magdalena , Yu Zhihong , Amorim Gustavo , Arinze Folasade , Silva Wilson , Tique Jose A. , Alvim Maria F. S. , Simione Beatriz , Fernando Anibal N. , Wester C. William 
Published: November 2021

Background:
Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with "Test and Start" wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique.

Methods:
This retrospective evaluation was performed using routinely collected data. Children living with HIV (CL aged 5–14 years) with CD4 data in the period of 2012–2018 were included. ART initiation “policy periods” corresponded to implementation of evolving guidelines: in period 1 (2012–2016), ART was recommended for CD4 <350 cells/mm3; during period 2 (2016–2017), the CD4 threshold increased to <500 cells/mm3; Test and Start was implemented in period 3 (2017–2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4 <200 cells/mm3) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency.

Results:
The cohort included 1815 children with CD4 data at enrollment and 1922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in period 1 vs. 16% in period 3 (P = 0.113) and 21% at ART initiation in period 1 vs. 15% in period 3 (P = 0.004). Children initiating ART in period 3 had lower odds of severe immunodeficiency at ART initiation compared with those in period 1 [adjusted odds ratio (aOR) = 0.67; 95% CI: 0.51 to 0.88]. Older age was associated with severe immunodeficiency at enrollment (aOR = 1.13; 95% CI: 1.06 to 1.20) and at ART initiation (aOR = 1.14; 95% CI: 1.08 to 1.21).

Conclusions:
The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of children living with HIV is imperative.
Why are rhizobial symbiosis genes mobile?
Authors: Wardell Grace E. , Hynes Michael F. , Young Peter J. , Harrison Ellie 
Published: November 2021

Rhizobia are one of the most important and best studied groups of bacterial symbionts. They are defined by their ability to establish nitrogen-fixing intracellular infections within plant hosts. One surprising feature of this symbiosis is that the bacterial genes required for this complex trait are not fixed within the chromosome, but are encoded on mobile genetic elements (MGEs), namely plasmids or integrative and conjugative elements. Evidence suggests that many of these elements are actively mobilizing within rhizobial populations, suggesting that regular symbiosis gene transfer is part of the ecology of rhizobial symbionts. At first glance, this is counterintuitive. The symbiosis trait is highly complex, multipartite and tightly coevolved with the legume hosts, while transfer of genes can be costly and disrupt coadaptation between the chromosome and the symbiosis genes. However, horizontal gene transfer is a process driven not only by the interests of the host bacterium, but also, and perhaps predominantly, by the interests of the MGEs that facilitate it. Thus understanding the role of horizontal gene transfer in the rhizobium–legume symbiosis requires a ‘mobile genetic element's-eye view' on the ecology and evolution of this important symbiosis.
This article is part of the theme issue ‘The secret lives of microbial mobile genetic elements’.