bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome: A Prospective Cohort Study
Authors: Ramadan Mohamad K. , Jarjour Ibtissam , Hubeish Manal , Itani Saad Eddine , Mneimneh Sirin , Badr Dominique A. 
Published: September 2021

Abstract

Objective:
To investigate the effects of spontaneous labor before elective repeat cesarean delivery (ERCD) on short-term maternal and neonatal outcomes.

Methods:
This was a prospective cohort study. All consecutive ERCDs, occurring at ≥37  weeks of gestation between July 1, 2017 and December 31, 2019 in Makassed General Hospital, were evaluated. The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery (URCD) group were compared with those of 204 women undergoing cesarean delivery (CD) without spontaneous labor (ERCD) group. Primary outcomes were “composite adverse maternal outcome” and “composite adverse neonatal outcome.” Fisher's exact and Student's t tests were used to assess the significance of differences in dichotomous and continuous variables, respectively. Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.

Results:
“Composite adverse maternal outcome” was significantly more common in women who underwent spontaneous labor ((40/183) 21.9% vs. (19/204) 9.3%, P = 0.001, relative risk (RR): 2.7, 95% confidence interval (CI): 1.50–4.90). Similarly, “composite adverse neonatal outcome” was significantly increased in the URCD group ((24/183) 13.1% vs. (12/204) 5.9%, P = 0.014, RR: 2.4, 95% CI: 1.18–4.98). These adverse effects persisted after adjustment for confounders. Multivariate regression models revealed that, besides labor, CD-order impacted maternal outcome (RR: 1.5, 95%CI: 1.02–2.30, P = 0.036), while CD-order and teenage pregnancy influenced neonatal outcome (RR: 2.1, 95%CI: 1.29–3.38, P = 0.003, and RR: 16.5, 95%CI: 2.09–129.80, P = 0.008, respectively).

Conclusion:
In our study, spontaneous labor before ERCD, including deliveries at term, was associated with adverse maternal and neonatal outcomes, indicating that it is preferable to conduct ERCD before the onset of labor. Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier. Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.
Febuxostat ameliorates high salt intake-induced hypertension and renal damage in Dahl salt-sensitive rats
Authors: Miura Takahiro , Sakuyama Akihiro , Xu Lusi , Qiu Jiahe , Namai-Takahashi Asako , Ogawa Yoshiko , Kohzuki Masahiro , Ito Osamu 
Published: September 2021

Objective:
Several clinical studies have reported that xanthine oxidoreductase inhibitors have antihypertensive and renal protective effects but their mechanisms have not been fully determined. This study aims to clarify these mechanisms by examining the effects of febuxostat, which is a novel selective xanthine oxidoreductase inhibitor, in Dahl salt-sensitive rats.

Methods:
Eight-week-old male Dahl salt-sensitive rats were fed a normal salt (0.6% NaCl) or high salt (8% NaCl) diet for 8 weeks. A portion of the rats that were fed high salt diet were treated with febuxostat (3 mg/kg per day) simultaneously. Additionally, acute effects of febuxostat (3 mg/kg per day) were examined after high salt diet feeding for 4 or 8 weeks.

Results:
Treatment with febuxostat for 8 weeks attenuated high salt diet-induced hypertension, renal dysfunction, glomerular injury, and renal interstitial fibrosis. Febuxostat treatment reduced urinary excretion of H2O2 and malondialdehyde and renal thiobarbituric acid reactive substances content. High salt diet increased xanthine oxidoreductase activity and expression in the proximal tubules and medullary interstitium. Febuxostat completely inhibited xanthine oxidoreductase activity and attenuated the high salt diet-increased xanthine oxidoreductase expression. Febuxostat transiently increased urine volume and Na+ excretion without change in blood pressure or urinary creatinine excretion after high salt diet feeding for 4 or 8 weeks.

Conclusion:
Febuxostat ameliorates high salt diet-induced hypertension and renal damage with a reduction of renal oxidative stress in Dahl salt-sensitive rats. The antihypertensive effect of febuxostat may be mediated in part by diuretic and natriuretic action.
The Impact of American College of Cardiology Chest Pain Center Accreditation on Guideline Recommended Acute Myocardial Infarction Management
Authors: Peacock W. Frank , Levy Phillip D. , Diercks Deborah B. , Li Shuang , Wang Tracy Y. , McCord James , Newby L. Kristin , Osborne Anwar , Ross Michael , Winchester David E. , Kontos Michael C. , Deitelzweig Steven , Bhatt Deepak L. 
Published: September 2021

Background:
Whether American College of Cardiology (ACC) Chest Pain Center (CPC) accreditation alters guidelines adherence rates is unclear.

Methods:
We analyzed patient-level, hospital-reported, quality metrics for myocardial infarction (MI) patients from 644 hospitals collected in the ACC’s Chest Pain-MI Registry from January 1, 2019, to December 31, 2020, stratified by CPC accreditation for >1 year.

Results:
Of 192,374 MI patients, 67,462 (35.1%) received care at an accredited hospital. In general, differences in guideline adherence rates between accredited and nonaccredited hospitals were numerically small, although frequently significant. Patients at accredited hospitals were more likely to undergo coronary angiography (98.6% vs. 97.9%, P < 0.0001), percutaneous coronary intervention for NSTEMI (55.4% vs. 52.3%, P < 0.0001), have overall revascularization for NSTEMI (63.5% vs. 61.0%, P < 0.0001), and receive P2Y12 inhibitor on arrival (63.5% vs. 60.2%, P < 0.0001). Nonaccredited hospitals more ECG within 10 minutes (62.3% vs. 60.4%, P < 0.0001) and first medical contact to device activation ≤90 minutes (66.8% vs. 64.8%, P < 0.0001). Accredited hospitals had uniformly higher discharge medication guideline adherence, with patients more likely receiving aspirin (97.8% vs. 97.4%, P < 0.0001), angiotensin-converting enzyme inhibitor (46.7% vs. 45.3%, P < 0.0001), beta blocker (96.6% vs. 96.2%, P < 0.0001), P2Y12 inhibitor (90.3% vs. 89.2%, P < 0.0001), and statin (97.8% vs. 97.5%, P < 0.0001). Interaction by accredited status was significant only for length of stay, which was slightly shorter at accredited facilities for specific subgroups.

Conclusions:
ACC CPC accreditation was associated with small consistent improvement in adherence to guideline-based treatment recommendations of catheter-based care (catheterization and PCI) for NSTEMI and discharge medications, and shorter hospital stays.
Ophthalmic manifestations of dementing disorders
Authors: Douglas Vivian Paraskevi , Douglas Konstantinos A.A. , Cestari Dean M. 
Published: September 2021

Purpose of review
Dementia is a term for loss of memory, language, problem-solving, and other thinking abilities, which significantly interferes with daily life. Certain dementing conditions may also affect visual function. The eye is an accessible window to the brain that can provide valuable information for the early diagnosis of people who suffer from Alzheimer's disease, Parkinson's disease, dementia with Lewy bodies as well as from more rare causes of dementias, such as Creutzfeldt–Jacob and Huntington's diseases. Herein, we present the ocular manifestations of neurocognitive disorders focusing on the neuro-ophthalmic ones and further discuss potential ocular biomarkers that could help in early detection of these disorders.

Recent findings
Ophthalmic examination along with the recent developments in in-vivo testing have provided a strong foundation of useful knowledge about brain disorder in neurodegenerative diseases without the need for invasive studies. Currently, a number of visual measures, such as visual acuity, contrast sensitivity, pupil response, and saccades in addition to various ophthalmic tests, such as electroretinogram, visual evoked potential, optical coherence tomography (OCT), and OCT-angiography have been widely used and evaluated as potential biomarkers for different stages of dementia.

Summary
Ophthalmologic and neuro-ophthalmic evaluation is evolving as an important part of the early diagnosis and management of people with dementia. A particular focus on ocular biomarkers in dementing illnesses has arisen over the past few years and there are several promising measures and imaging tools that have been proposed as potential biomarkers for these diseases.
Therapeutic pipeline for individuals with cystic fibrosis with mutations nonresponsive to current cystic fibrosis transmembrane conductance regulator modulators
Authors: Fajac Isabelle , Sermet-Gaudelus Isabelle 
Published: September 2021

Purpose of review
Cystic fibrosis is a severe autosomal recessive disorder caused by mutations in the cystic fibrosis transmembrane conductance regulator gene (CFTR) encoding the CFTR protein, a chloride channel expressed in many epithelial cells. New drugs called CFTR modulators aim at restoring the CFTR protein function and they will benefit most of the patients with cystic fibrosis in the near future. However, more than 10% of CFTR mutations do not produce any CFTR protein for CFTR modulators to act upon, and the purpose of this review is to provide an overview of different approaches pursued to treat patients bearing mutations nonresponsive to CFTR modulators.

Recent findings
These different approaches constitute readthrough agents for nonsense mutations, nucleic acid-based therapies, RNA-based or DNA-based, and cell-based therapies. Some approaches using mRNA or cDNA combined with a delivery vehicle are mutation-agnostic therapies. Other approaches, such as the use of tRNA, antisense oligonucleotides, gene editing or cell-based therapies are mutation-specific therapies.

Summary
Most of these approaches are in preclinical development or for some of them, early clinical phases. Many hurdles and challenges will have to be solved before they can be safely translated to patients.
Telehealth and its implementation in respiratory sleep medicine
Authors: Nilius Georg , Schroeder Maik , Schoebel Christoph 
Published: September 2021

Purpose of review
The COVID-19 pandemic has clearly demonstrated that the technological progress in digitization is also essential for the medical sector. In the field of sleep-disordered breathing, the novel eHealth methods already do offer smart solutions for currently insufficiently addressed problems.

Recent findings
In general, the potential of telemedicine tools can be focused on three basic aspects: interaction between clinicians, interaction between clinician and patient, and interaction between patient and the mobile health technology. The pandemic situation resulted in a rapid development of reimbursement for telehealth services. In recent years, evidence on the positive benefits of using telemedicine-based support as part of respiratory therapy follow-up is increasing. It is important to consider patient groups, telemedicine methodology, type of intervention, and targeting criteria in all studies conducted.

Summary
Given the scarcity of resources for leading common diseases, we must keep an eye on the new digitization concepts in respiratory medicine care. It must be implemented precisely, cost-effectively, and also more connecting between sectors and disciplines and at eye level with our patients. By means of patient engagement systems, an important part of modern precision medicine can be established. Digital support systems are valuable for supporting medical staff. They are not meant to replace medical staff but to facilitate their work and improve its quality.
Leadership in Times of Crisis
Authors: Kane Robert L. , Egan Jennifer M. , Chung Kevin C. 
Published: September 2021

Summary:
In the wake of the death toll resulting from coronavirus disease of 2019 (COVID-19), in addition to the economic turmoil and strain on our health care systems, plastic surgeons are taking a hard look at their role in crisis preparedness and how they can contribute to crisis response policies in their own health care teams. Leaders in the specialty are charged with developing new clinical policies, identifying weaknesses in crisis preparation, and ensuring survival of private practices that face untenable financial challenges. It is critical that plastic surgery builds on the lessons learned over the past tumultuous year to emerge stronger and more prepared for subsequent waves of COVID-19. In addition, this global health crisis presents a timely opportunity to reexamine how plastic surgeons can display effective leadership during times of uncertainty and stress. Some may choose to emulate the traits and policies of leaders who are navigating the COVID-19 crisis effectively. Specifically, the national leaders who offer empathy, transparent communication, and decisive action have maintained high public approval throughout the COVID-19 crisis, while aggressively controlling viral spread. Crises are an inevitable aspect of modern society and medicine. Plastic surgeons can learn from this pandemic to better prepare for future turmoil.
Accuracy of Ultrasonography in Breast Implant Rupture Diagnosis: Systematic Review and Meta-Analysis
Authors: Lacerda Macedo Ana Cristina , Carvalho George , Uggioni Maria L. R. , Bavaresco Daniela V. , Simon Carla S. , Cruz Mateus , Silva Fábio , Rosa Maria I. 
Published: September 2021

Background:
Breast augmentation is the most common aesthetic operation performed in the United States and worldwide; 1,862,506 breast augmentation procedures were performed in 2018, an increase of 27.6 percent compared to 2014 data.

Methods:
In the present study, the authors performed a systematic review to identify the accuracy of ultrasonography for diagnosing breast prosthesis rupture. Studies in which the ultrasound diagnostic test was compared to a surgical finding as a reference standard were reviewed.

Results:
As a result, 20 primary studies were included in the analyses, with a total of 1987 patients and 3297 prostheses. The use of ultrasound for diagnosis of breast prosthesis rupture presented the following results: pooled sensitivity, 73.7 percent (95 percent CI, 70.2 to 77.1 percent); pooled specificity, 87.8 percent (95 percent CI, 86.5 to 89.0); area under the receiver operating characteristic curve, 0.7762; diagnostic odds ratio, 11.04 (95 percent CI, 5.79 to 21.08).

Conclusion:
This study supports that ultrasound of breast prostheses is an adequate tool in the diagnosis of rupture.
Differences in Heart Graft Survival by Recipient Sex
Authors: Foster Bethany J. , Zhang Xun , De Simone Alexia , Dahhou Mourad , Sapir-Pichhadze Ruth , Cardinal Heloise , West Lori 
Published: September 2021

Background.
We aimed to characterize patterns of differences in heart graft failure rates by recipient sex, accounting for modifying effects of donor sex and recipient age.

Methods.
We evaluated 69 246 first heart transplant recipients (1988–2019; Scientific Registry of Transplant Recipients). We used multivariable time-varying Cox models, considering recipient sex by donor sex by recipient age interaction and adjusting for potential confounders. Using the hazard ratio (HR) from the models and a fixed profile of recipient and donor characteristics, we also compared fitted absolute failure rates by recipient sex.

Results.
Among recipients of male donors, female recipients of all ages had higher failure rates than males (0–12 y: HR 1.36 (95% confidence interval [CI], 1.03-1.81); 13–24 y: 1.43 [1.09-1.88]; 25–44 y: 1.22 [0.95-1.57]; ≥45 y: 1.16 [1.06-1.27]); differences were statistically significant in all age intervals except 25–44 y. When the donor was male, 13 to 24-y-olds showed the largest absolute difference in fitted absolute failure rates, with rates higher by 11.3 failures per 1000 person-y in female than male recipients. Among recipients of female donors, there were no statistically significant differences in graft failure rates between female and male heart recipients of any age. Although point estimates suggested higher failure rates in female than male recipients <25 y (0–12 y: HR 1.19 [95% CI, 0.85-1.66]; 13–24 y: 1.17 [0.84-1.63]), these were not statistically significant.

Conclusions.
Female recipients tended to have poorer outcomes than males, particularly at younger ages and when the donor was male, consistent with observations in kidney transplants.
Biliary Complications Following Adult Deceased Donor Liver Transplantation: Risk Factors and Implications at a High-volume US Center
Authors: Matar Abraham J. , Ross-Driscoll Katie , Kenney Lisa , Wichmann Hannah K. , Magliocca Joseph F. , Kitchens William H. 
Published: September 2021

Background.
Biliary leaks and anastomotic strictures comprise the majority of biliary complications (BCs) following liver transplantation (LT). Currently, there are few large contemporary case series of BCs in adult deceased donor liver transplant (DDLT) recipients in the literature. The purpose of this study was to examine the pretransplant and intraoperative risk factors associated with BCs at a high-volume tertiary care center and determine the impact of these BCs on their posttransplant course and long-term transplant outcomes.

Methods.
We retrospectively reviewed all adult patients undergoing a DDLT from a donor after brain death (DBD) at Emory University between January 2015 and December 2019.

Results.
A total of 647 adult patients underwent DDLT from a DBD during the study period and were included in analyses. The median length of follow-up posttransplant was 2.5 y. There were a total of 27 bile leaks (4.2%) and 69 biliary strictures (10.7%). Recipient age and cold ischemic time were identified as risk factors for biliary leak, whereas alcoholic cirrhosis as transplant indication was a risk factor for biliary stricture. Placement of a biliary stent was associated with the development of both biliary leaks and anastomotic strictures. Posttransplant, biliary leaks were a significant risk factor for future episodes of acute rejection but did not impact overall survival. In contrast, biliary strictures were associated with a significantly reduced overall survival at 1- and 4-y post DDLT.

Conclusions.
BCs are a major source of morbidity and mortality following DDLT, with strictures and leaks associated with distinct posttransplant complications.
Significance of Asymptomatic Pyelonephritis Found on Kidney Transplant Biopsy
Authors: Aziz Fahad , Saddler Christopher , Jorgenson Margaret , Alstott James , Swanson Kurt , Parajuli Sandesh , Garg Neetika , Djamali Arjang , Mandelbrot Didier 
Published: September 2021

Background.
The clinical significance and appropriate management of graft pyelonephritis diagnosed by biopsy are poorly understood.

Methods.
We analyzed data from all patients with pyelonephritis on transplant kidney biopsy from January 1998 to December 2019. Patients were divided into 2 groups: those whose urinalysis was positive for urinary tract infection (UA+) and those whose urinalysis was negative (UA–).

Results.
There were a total of 101 patients with the diagnosis of pyelonephritis by biopsy during the study period. The mean time from transplant to pyelonephritis diagnosis was 3.3 ± 4 y. Thirty-six (35.6%) of the patients with pyelonephritis on biopsy had a negative UA. Out of 65 patients in the UA+ group, 54 (83%) received antibiotics. Only 12 of the UA– patients (33%) received antibiotics. The use of antibiotics in both the UA+ (P = 0.03) and UA– groups (P = 0.02) compared with no use of antibiotics was associated with better death-censored graft survival. On multivariate analysis, the use of antibiotics (hazard ratio = 0.22, P = 0.001, 95% confidence interval, 0.12-0.61) was associated with improved graft survival.

Conclusion.
The finding of pyelonephritis on a transplant kidney biopsy is almost always a surprise but is an important finding. Treatment with antibiotics, regardless of signs or symptoms of urinary tract infection, is associated with improved graft survival.
Impaired Absorption of Extended-Release Potassium Chloride in a Patient With a High-Output Ileostomy
Authors: Burka Abigail T. , Benge Cassandra D. 
Published: September 2021

BACKGROUND:
Best practices in the management of ileostomies include use of immediate release (IR) medications and elimination of enteric coated and prokinetic agents. Extended-release (ER) potassium chloride is designed for postpyloric release rather than colonic absorption and is postulated to be an appropriate option for potassium repletion in this patient subset.

CASE:
We present a patient with an ileostomy who received intravenous ER and IR oral potassium chloride supplementation following diverting loop ileostomy. Clinical responsiveness to ER potassium chloride was poor; 15 to 40 mEq was required to replace 0.1 mEq/L of potassium. However, upon transition to IR potassium chloride, only 6.67 mEq was required to replace 0.1 mEq/L of potassium.

CONCLUSIONS:
Our experience in this case suggests that patients with surgical alterations to their gastrointestinal tracts who fail to have expected rises in serum potassium levels may benefit from early conversion to IR potassium chloride.
Common and Best Nail Practices Among Nail Care Providers
Authors: Taylor-Thompson Kathy , Budde-Lang Jana , Carpenter Jacque 
Published: September 2021

PURPOSE:
The purpose of this project was to identify common and best practices for safe nail care among nail care providers.

DESIGN:
Descriptive study using online survey.

SUBJECTS AND SETTING:
The study was conducted by 2 credentialed foot and wound care nurses within a large Midwest healthcare system. Participants were nurses and physicians who provide nail care to patients and individuals in the hospital and community setting such as private homes and nursing homes and hospice agencies.

METHODS:
Email invitations with a link to the survey were sent to eligible individuals and organizations in which wound care specialists were employed. Information about the survey was posted on the Certified Foot Care Specialty homepage, and on the Wound, Ostomy and Continence Nursing (WOCN) Members-only Forum and Facebook page.

RESULTS:
An estimated 1000 surveys were sent of which 246 surveys were returned. Fifty-three percent (121/229) of respondents were certified through the WOCN Certification Board and 41% (93/229) were certified through the American Foot Care Nurse Association. Most respondents reported using some form of self-protection when filing (225/246, 91.5%), trimming (215/246; 87.4%), or using a rotary tool (204/246, 82.9%) on patients' nails. However, approximately one-fourth of respondents reported offering some type of protection for patients when filing (63/246, 25.6%), trimming (41/246, 16.7%), or using a rotary tool (64/246, 26.0%). Most of the nurses surveyed provided nail care in outpatient and foot care clinics, acute care settings, private homes, and nursing homes/hospice.

CONCLUSIONS:
When providing nail care, the patient/client protections should closely mirror the personal protective equipment used by the nurse. Future research is needed to contribute to a national consensus guideline for best practices and protections at all levels of nail care in the acute care and community settings.