bluuebunny/crossref_metadata_2025_split huggingface dataset:
The noninferiority of transcatheter aortic valve implantation compared to surgical aortic valve replacement for severe aortic disease
Authors: Zhao Peng-Ying , Wang Yong-Hong , Liu Rui-Sheng , Zhu Ji-Hai , Wu Jian-Ying , Song Bing 
Published: July 2021

Abstract

Background:
Currently, transcatheter aortic valve implantation (TAVI) as an effective and convenient intervention has been adopted extensively for patients with severe aortic disease. However, the efficacy and safety of TAVI have not yet been well evaluated and its noninferiority compared with traditional surgical aortic valve replacement (sAVR) still lack sufficient evidence. This meta-analysis was designed to comprehensively compare the noninferiority of TAVI with sAVR for patients with severe aortic disease.

Methods:
A systematic search of PubMed, Embase, Cochrane Library, and Web of Science up to October 1, 2020 was conducted for relevant studies that comparing TAVI and sAVR in the treatment of severe aortic disease. The primary outcomes were early, midterm and long term mortality. The secondary outcomes included early complications and other late outcomes. Two reviewers assessed trial quality and extracted the data independently. All statistical analyzes were performed using the standard statistical procedures provided in Review Manager 5.2.

Results:
A total of 16 studies including 14394 patients were identified. There was no difference in 30-day, 1-year, 2-year, and 5-year all-cause or cardiovascular mortality as well as stroke between TAVI and sAVR. Regarding to the 30-day outcomes, compared with sAVR, TAVI experienced a significantly lower incidence of myocardial infarction (risk ratio [RR] 0.62; 95% confidence interval [CI] 0.40–0.97; 5441 pts), cardiogenic shock (RR 0.34; 95% CI 0.19–0.59; 1936 pts), acute kidney injury (AKI) > stage 2 (RR 0.37; 95% CI 0.25–0.54; 5371 pts), and new-onset atrial fibrillation (NOAF) (RR 0.29; 95% CI 0.24–0.35; 5371 pts) respectively, but higher incidence of permanent pacemaker implantation (RR 3.16; 95% CI 1.61–6.21; 5441 pts) and major vascular complications (RR 2.22; 95% CI 1.14–4.32; 5371 pts). Regarding to the 1- and 2-year outcomes, compared with sAVR, TAVI experienced a significantly lower incidence of NOAF, but higher incidence of neurological events, transient ischemic attacks (TIA), permanent pacemaker and major vascular complications respectively. Regarding to the 5-year outcomes, compared with sAVR, TAVI experienced a significantly lower incidence of NOAF, but higher incidence of TIA and reintervention respectively.

Conclusions:
Our analysis shows that TAVI was equal to sAVR in early, midterm and long term mortality for patients with severe aortic disease. In addition, TAVI may be favorable in reducing the incidence of both early, midterm and long term NOAF. However, pooled results showed superiority of sAVR in reducing permanent pacemaker implantation, neurological events, TIA, major vascular complications and reintervention.
Meta-analyzing the factors affecting the efficacy of gliflozins in patients with heart failure based on heart failure trials
Authors: Yin Daogen , Qiu Mei , Wei Xubin , Duan Xueyan 
Published: July 2021

Abstract

Background:
The factors affecting the efficacy of gliflozins in patients with heart failure (HF) are not clear. We aimed to evaluate the effects of 11 important factors on the efficacy of gliflozins in HF patients.

Methods:
Randomized trials assessing gliflozins in HF patients were included. The outcome of interest was composite HF outcome, a composite of cardiovascular death, or hospitalization for HF. Meta-analysis was done according to 11 factors: status of type 2 diabetes, sex, use of angiotensin receptor-neprilysin inhibitor, age, history of hospitalization for HF, estimated glomerular filtration rate, body mass index, New York Heart Association (NYHA) class, race, region, and left ventricular ejection fraction.

Results:
Compared with placebo, gliflozins reduced the risk of composite HF outcome by 14% in the subgroup of patients with NYHA class III or IV (hazard ratios [HR] 0.86, 95% confidence intervals [CI] 0.75–0.99), by 34% in the subgroup of patients with NYHA class II (HR 0.66, 95% CI 0.59–0.74), and by 85% in the subgroup of patients with NYHA class I (HR 0.15, 95% CI 0.03–0.73). This between-group difference was approximate to statistical significance (P
subgroup = .06). The benefit of gliflozins in HF patients was not affected by the other 10 factors (P
subgroup ≥ .123).

Conclusions:
Gliflozins are applicable for a broad population of HF patients as for preventing HF events, while gliflozins may lead to greater benefits in patients with mild HF than in those with moderate to severe HF.
District-level HIV estimates using the spectrum model in five states of India, 2017
Authors: Kumar Pradeep , Sahu Damodar , Rajan Shobini , Mendu Vishnu Vardhana Rao , Das Chinmoyee , Kumar Arvind , Chandra Nalini , Camara Bilali , Rai Sanjay , Arumugam Elangovan , Godbole Sheela Virendra , Singh Shri Kant , Kant Shashi , Pandey Arvind , Reddy Dandu Chandra Sekhar , Mehendale Sanjay 
Published: July 2021

Abstract
Decentralized response has been the hallmark of the National AIDS Control Programme in India. District-level HIV burden estimates quantifying the distribution of the epidemics are needed to enhance this decentralized response further to monitor the progress on prevention, testing, and treatment interventions. In this paper, we describe the methodology and results of district-level estimates using the Spectrum model piloted in 5 states of India under National AIDS Control Programme.
Using state spectrum model for HIV estimations 2017, we disaggregated state results by the district in pilot states. Each district was considered a subepidemic and HIV epidemic configuration was carried out in its general population as well as in key population. We used HIV surveillance data from antenatal clinics and routine pregnant women testing to model the general population's epidemic curve. We used HIV prevalence data available from HIV sentinel surveillance and integrated biological and behavioral surveys to inform the epidemic curve for key population. Estimation and projection packgage classic platform was used for the curve fitting. District-wide estimates extracted from subpopulation summary in Spectrum results section were used to calculate relative burden for each district and applied to approved State HIV Estimations 2017 estimates.
No district in Tamil Nadu had an adult HIV prevalence of higher than 0.5% except for one, and the epidemic seems to be declining. In Maharashtra, the epidemic has shown a decline, with all except 5 districts showing an adult prevalence of less than 0.50%. In Gujarat and Uttar Pradesh, few districts showed rising HIV prevalence. However, none had an adult prevalence of higher than 0.50%. In Mizoram, 6 of 8 districts showed a rising HIV trend with an adult prevalence of 1% or more in 5 districts.
Disaggregation of state-level estimates by districts provided insights on epidemic diversity within the analyzed states. It also provided baseline evidence to measure the progress toward the goal of end of AIDS by 2030.
The prevalence and genotype distribution of human papilloma virus in cervical squamous intraepithelial lesion and squamous cell carcinoma in Taizhou, China
Authors: Jin Rongrong , Yang Xumei , Bao Jingjing , Zhang Wenyan , Dou Rongrong , Yuan Donglan , Yang Qinxin , Jiang Lin , Yu Hong 
Published: July 2021

Abstract
Human papillomavirus (HPV) infection is a common sexually transmitted disease worldwide and the leading cause of cervical cancer. Current vaccines do not cover all HPV genotypes whereas the distribution of HPV genotypes varies in different geographic regions. The study aimed to investigate the distribution of HPV genotypes in patients with cervical squamous intraepithelial lesion (SIL) and cervical squamous cell carcinoma (SCC) in Taizhou City of Jiangsu Province, China. A total of 940 patients including 489 cases with cervical low-grade squamous intraepithelial lesions (LSIL), 356 cases with cervical high-grade squamous intraepithelial lesions (HSIL), and 95 cases with cervical SCC, underwent a biopsy or surgery in Taizhou People's Hospital between January 2019 and December 2019. The HPV testing results were retrospectively analyzed. The overall prevalence of any, high-risk, and low-risk HPV was 83.83%, 81.91%, and 12.13%, respectively. The 5 most common HPV genotypes were HPV16 (35.64%), HPV52 (16.91%), HPV58 (13.94%), HPV33 (8.94%), and HPV18 (7.98%). The prevalence of any and HR-HPV in SCC was significantly higher than those in LSIL and HSIL, while the prevalence of LR-HPV in SCC was significantly lower than those in LSIL and HSIL (P < .01). Single and dual HPV infections were prevalent in SCC, LSIL, and HSIL. Furthermore, the prevalence of dual HPV infection in SCC was significantly higher than those in LSIL and HSIL (P = .002). The HPV prevalence varied by age, being highest among women with SCC, LSIL, and HSIL aged 40 to 49 years, 40 to 49 years, and 50 to 59 years, respectively. In conclusion, the findings revealed a very high prevalence of HPV in women with cervical lesions in Taizhou. Routine HPV tests must cover all common HPV genotypes in clinical practice.
Multiple small bowel perforations due to cytomegalovirus related immune reconstitution inflammatory syndrome in an HIV patient
Authors: Wang Yanli , Lin Xuyong , Li Yuji , Wen Ying 
Published: July 2021

Abstract

Rationale:
The presentation of multiple intestinal perforations is a severe complication of enteric cytomegalovirus (CMV) infection, sometimes associated with immune reconstitution inflammatory syndrome (IRIS) after the initiation of antiretroviral therapy (ART) in patients with human immunodeficiency virus (HIV). Here we reported a rare case of a patient with HIV infection who developed multiple perforations in the small bowel shortly after ART initiation without any prodromal gastrointestinal symptoms. We also reviewed the literature of reported cases to clarify their clinical characteristics for early diagnosis and rapid intervention.

Patient concerns:
A patient with HIV presented with fever after 16 days of ART initiation and was admitted to our hospital. He was treated with intravenous ganciclovir due to persistent CMV viremia. The fever resolved 10 days later. However, he reported persistent left lower abdominal pain.

Diagnoses:
The patient was diagnosed with multiple small bowel perforations, CMV-related IRIS, and acquired immune deficiency syndrome. An upright abdominal x-ray in a tertiary level hospital revealed bilateral moderate intraperitoneal free air. We performed a pathological examination and metagenomic next-generation sequencing. CMV enteritis was confirmed by immunohistochemical staining and other opportunistic infections were excluded by metagenomic next-generation sequencing.

Interventions:
The patient was treated with intravenous ganciclovir and 24 hours later, the patient underwent exploratory laparotomy. Partial resection and surgical repair of the small intestine were performed.

Outcomes:
The patient ultimately died from intestinal obstruction and septic shock 55 days after surgery.

Lessons:
Perforations due to CMV-related IRIS are very rare, and usually appear shortly after ART initiation. Most cases lack the prodromal symptoms of abdominal pain and diarrhea. Intestinal perforations are lethal, and early detection and surgical treatment are lifesaving.
Individualized positive end-expiratory pressure (PEEP) during one-lung ventilation for prevention of postoperative pulmonary complications in patients undergoing thoracic surgery
Authors: Li Pule , Kang Xia , Miao Mengrong , Zhang Jiaqiang 
Published: July 2021

Abstract

Background:
Positive end-expiratory pressure (PEEP) is an important part of the lung protection strategies for one-lung ventilation (OLV). However, a fixed PEEP value is not suitable for all patients. Our objective was to determine the prevention of individualized PEEP on postoperative complications in patients undergoing one-lung ventilation.

Method:
We searched the PubMed, Embase, and Cochrane and performed a meta-analysis to compare the effect of individual PEEP vs fixed PEEP during single lung ventilation on postoperative pulmonary complications. Our primary outcome was the occurrence of postoperative pulmonary complications during follow-up. Secondary outcomes included the partial pressure of arterial oxygen and oxygenation index during one-lung ventilation.

Result:
Eight studies examining 849 patients were included in this review. The rate of postoperative pulmonary complications was reduced in the individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37–0.73; P = .0001). The partial pressure of arterial oxygen during the OLV in the individualized PEEP group was higher with a mean difference 34.20 mm Hg (95% CI: 8.92–59.48; P = .0004). Similarly, the individualized PEEP group had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21–70.92; P < .0001).

Conclusions:
Individualized PEEP setting during one-lung ventilation in patients undergoing thoracic surgery was associated with fewer postoperative pulmonary complications and better perioperative oxygenation.
The educational and psychological impact of the COVID-19 pandemic on medical students
Authors: Bachir Bachir , Naji Amal , Tfayli Arafat 
Published: July 2021

Abstract
The SARS- CoV-2 virus has been a public health crisis since its emergence in 2019. It has affected nearly all aspects of life. Education has been particularly hit, and a lot of effort has been put to implement more and more virtual platforms through online classes, meetings and conferences. Medical education has also been affected, especially because of the need for hands-on education, specifically in the clinical setting of the last 2 years. This had a huge psychological impact on the medical students currently enrolled in medical schools around the globe.
In this descriptive study, we sent all medical students at the American University of Beirut Faculty of Medicine (AUBFM) an online anonymous survey by email. The survey started with general questions (age, gender and medical school year), followed by 3 sections that contain questions pertaining to the attitudes of medical students towards clinical rotations and online classes. Data was then analyzed using SPSSv24 and was then reported as percentages.
Students were almost equally divided among the medical school classes (Med 1, 2, 3, and 4). The majority of clinical students (Med 3 and Med 4) reported that they feel nervous during their rotations in the hospital. Moreover, they reported that they have increased their use of disinfectants and personal protective equipment since the emergence of the pandemic. Moreover, the majority of medical students reported that they feel more stressed after shifting to online classes. Medical students also reported that they would be willing to go back to on-campus classes.
This study aimed at describing the response of medical students at AUBFM to the COVID-19 pandemic in terms of stress. Limited data exists in the literature concerning the psychological impact of the COVID-19 pandemic on medical students in the middle East. Medical students reported that they feel more stressed and nervous during their clinical rotations and after the shift to online education, affecting their academic and social life. Further studies using a larger sample size are needed.
Electrocardiogram Before Tricyclic Antidepressant Use: Minimal Impact in Pediatric Functional Gastrointestinal Disorders
Authors: Klein Lauren J. , Chamberlain Reid C. , Bonello Kristin , Milazzo Angelo S. , Noel Richard J. 
Published: July 2021

ABSTRACT

Objectives:
The aim of this study was to determine the effect of electrocardiogram (ECG) findings on the initiation of tricyclic antidepressants (TCAs) for functional gastrointestinal disorders (FGIDs) and to evaluate cardiac outcomes related to low dose TCA use.

Methods:
We performed a retrospective chart review of all pediatric outpatients at a tertiary pediatric hospital with an ECG ordered by a pediatric gastroenterologist when considering initiation of a TCA between January 2011 and February 2018. We collected demographics, previous cardiovascular testing results, TCA dosing, and pertinent outcomes, including cardiology referrals, emergency department, and hospital admissions, and death during the study period. All ECGs were reviewed for corrected QT (QTc) interval, heart rate, and other abnormalities.

Results:
Of 233 patients with screening ECGs, most (84.1%) were prescribed a TCA. Functional abdominal pain or dyspepsia account for 82.0% of diagnoses. Initial TCA dosing of amitriptyline varied widely, 10–50 mg/day, and the dose was not associated with QTc intervals. TCAs were not started in only 1.7% (4/233) due to ECG results. A significant ECG abnormality prompting cardiology referral was found in eight (3.4%) with a prolonged QTc interval in one (0.4%). In 10.7% (25/233) of patients, screening ECG was obtained despite available ECG in the chart. No deaths and no emergency department or hospital visits for arrhythmia or drug overdose occurred.

Conclusion:
Screening ECGs infrequently influence TCA initiation and may lead to increased resource utilization. The overall frequency of cardiology referral due to ECG results is low. Serious adverse cardiac events are unlikely with low dose TCA administration.
Experience Using Ustekinumab in Pediatric Patients With Medically Refractory Crohn Disease
Authors: Kim Francis S. , Patel Perseus V. , Stekol Emily , Ali Sabina , Hamandi Hassan , Heyman Melvin B. , Verstraete Sofia G. 
Published: July 2021

ABSTRACTIntroduction:Ustekinumab (UST), a human monoclonal antibody against interleukin‐12 and 23, is approved to treat adult patients with psoriasis or Crohn disease (CD). Outcomes data for off‐label use in pediatric patients with CD are limited.Aim:We conducted a retrospective cohort study to analyze the long‐term efficacy of UST, including dose adjustments, in the treatment of pediatric patients with medically refractory CD. Adverse events were documented.Methods:We identified 40 pediatric patients with CD treated with UST between January 1, 2016 and December 31, 2019. Electronic medical records were reviewed for demographics, Paris Classification, significant comorbidities, previous CD therapy, adverse events after initiation, and surveillance markers at the time of their first dose and most recent clinic visit. A validated abbreviated pediatric CD activity index (aPCDAI) was used to assess response to therapy.Results:Thirty‐eight pediatric patients with CD, including 34.2% with stricturing or penetrating disease, were analyzed after initiation of treatment with UST. Median age at diagnosis of CD was 12.5 years, and median age at UST induction was 17.2 years. No patients were anti‐TNF‐naive, and 34.2% were previously exposed to 2 or more anti‐TNF agents. At time of last follow‐up, 84.2% of patients remained on UST for a median duration on UST of 62.1 weeks, and 60.5% achieved clinical remission. Patients had significant improvement in aPCDAI scores, clinical remission rates, albumin, and hematocrit, and 89.5% of patients had no significant adverse events. Similar results were observed among those who required dose adjustment, including 61.1% achieving clinical remission, and among those with perianal disease, including 38.5% achieving clinical remission.Conclusions:Our data suggest that, within our cohort of pediatric patients with CD, UST has long‐term efficacy with no observed safety concerns. Dose adjustment may be helpful in achieving clinical remission.
COVID-19
Authors: Brockopp Dorothy , Monroe Martha , Davies Claire C. , Cawood Meghan , Cantrell Donita 
Published: July 2021

Objective
The goal of this qualitative phenomenological study was to explore in-depth, critical care nurses' (CCNs) lived experience while caring for coronavirus disease 2019 (COVID-19) patients during the pandemic.

Background
CCNs play an important role during pandemics characterized by highly contagious, life-threatening disease. Understanding the experience of CCNs during a pandemic is particularly important because of the high rate of burnout within this group, as well as a shortage of these caregivers across the globe.

Methods
Using Heidegger's interpretive phenomenological approach, interviews were conducted with 10 CCNs caring for COVID-19 patients. The goal of the interviews was to access a deep layer of understanding regarding participants' lived experience.

Results
Themes of role frustration, emotional and physical exhaustion, and the importance of presence were revealed.

Conclusion
Themes revealed suggest a number of actions hospital administrators could take to support CCNs as they experience the challenges of a pandemic.
Time from Pain Assessment to Pain Intervention
Authors: Manworren Renee C.B. , Atabek Ata 
Published: July 2021

OBJECTIVE
The purpose of this study was to describe factors that influence nurses' time from pain assessment to intervention for acute postsurgical pain.

BACKGROUND
Nurses' time is a limited resource that must be optimized to manage patients' pain within budget constraints. Little is known about processes and activities nurses negotiate to manage pain.

METHODS
Human factors engineering and ethnography were used to quantify factors influencing time from pain assessment to intervention.

RESULTS
On the basis of 175.5 observation hours, nurses spent 11% of shifts (mean, 83 minutes) on pain care activities. Time from alert to intervention with PRN analgesics or biobehavioral strategies for 58 cases ranged from 0 to 48 minutes (mean, <11 minutes). Five factors influenced timeliness.

CONCLUSIONS
Nurses most efficiently managed postsurgical pain by giving analgesics ordered PRN on a scheduled basis. Nurse leaders can empower prompt responses to patients' pain through delegation, process improvements, real-time monitoring, and prescriber engagement.
A Novel Precise Optical Navigation System for Craniomaxillofacial Surgery Registered With an Occlusal Splint
Authors: Hou Yikang , Chai Gang , Qi Zuoliang 
Published: July 2021

Background:
An augmented reality tool allows visual tracking of real anatomical structures and superimposing virtual images, so it can be used for navigation of important structures during surgery.

Objectives:
The authors have developed a new occlusal splint-based optical navigation system for craniomaxillofacial surgery. In this study, the authors aim to measure the accuracy of the system and further analyze the main factors influencing precision.

Methods:
Ten beagle dogs were selected and a three-dimensional model was established through computed tomography scanning, dental model making, and laser scanning, and then registration was performed according to the tooth marking points. The bilateral mandibular osteotomy was performed on Beagle dogs under navigation system based on the occlusal splint. The left side was taken to compare the deviation between the preoperative plan and the surgical results, and the accuracy of distance and angle and the stability of the system were analyzed.

Results:
The average position deviation between the preoperative design and intraoperative navigation was: 0.01 ± 0.73 mm on the lateral height of the mandibular ramus, 0.26 ± 0.57 mm on the inner height of the mandibular ramus, and 0.20 ± 0.51 mm on the osteotomy length. The average angle deviation is 0.94° ± 1.38° on the angle between the mandibular osteotomy plane and ramus plane and 0.66° ± 0.97° on the angle of the retained mandibular angle. And most of the data showed good consistency.

Conclusions:
In summary, the accuracy of the system can meet clinical requirements and can be used as a useful tool to improve the accuracy of craniomaxillofacial surgery.