bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-Term Implications of Abnormal Left Ventricular Strain During Sepsis
Authors: Beesley Sarah J. , Sorensen Jeff , Walkey Allan J. , Tonna Joseph E. , Lanspa Michael J. , Hirshberg Ellie , Grissom Colin K. , Horne Benjamin D. , Burk Rebecca , Abraham Theodore P. , Paine Robert , Brown Samuel M. 
Published: February 2021

Objectives:
Septic cardiomyopathy develops frequently in patients with sepsis and likely increases short-term mortality. However, whether septic cardiomyopathy is associated with long-term outcomes after sepsis is unknown. We investigated whether septic patients with septic cardiomyopathy have worse long-term outcomes than septic patients without septic cardiomyopathy.

Design:
Retrospective cohort study.

SETTING:
Adult ICU.

PATIENTS:
Adult ICU patients with sepsis.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Left ventricular global longitudinal systolic strain was our primary measure of septic cardiomyopathy. We employed a suite of multivariable survival analyses to explore linear and nonlinear associations between left ventricular global longitudinal systolic strain and major adverse cardiovascular events, which included death, stroke, and myocardial infarction. Our primary outcome was major adverse cardiovascular event through 24 months after ICU discharge. Among 290 study patients, median left ventricular global longitudinal systolic strain was –16.8% (interquartile range, –20.4% to –12.6%), and 38.3% of patients (n = 111) experienced a major adverse cardiovascular event within 24 months after discharge. On our primary, linear analysis, there was a trend (p = 0.08) toward association between left ventricular global longitudinal systolic strain and major adverse cardiovascular event (odds ratio, 1.03; CI, < 1 to 1.07). On our nonlinear analysis, the association was highly significant (p < 0.001) with both high and low left ventricular global longitudinal systolic strain associated with major adverse cardiovascular event among patients with pre-existing cardiac disease. This association was pronounced among patients who were younger (age < 65 yr) and had Charlson Comorbidity Index greater than 5.

Conclusions:
Among patients with sepsis and pre-existing cardiac disease who survived to ICU discharge, left ventricular global longitudinal systolic strain demonstrated a U-shaped association with cardiovascular outcomes through 24 months. The relationship was especially strong among younger patients with more comorbidities. These observations are likely of use to design of future trials.
Assessment of Electrical Impedance Tomography to Set Optimal Positive End-Expiratory Pressure for Venoarterial Extracorporeal Membrane Oxygenation-Treated Patients*
Authors: Soulé Christelle , Crognier Laure , Puel Floriane , Ruiz Stéphanie , Seguin Thierry , Fourcade Olivier , Georges Bernard , Conil Jean-Marie , Minville Vincent , Vardon-Bounes Fanny 
Published: February 2021

OBJECTIVES:
Patients on venoarterial extracorporeal membrane oxygenation have many risk factors for pulmonary complications in addition to their heart failure. Optimal positive end-expiratory pressure is unknown in these patients. The aim was to evaluate the ability of electrical impedance tomography to help the physician to select the optimal positive end-expiratory pressure in venoarterial extracorporeal membrane oxygenation treated and mechanically ventilated patients during a positive end-expiratory pressure trial.

DESIGN:
Observational prospective monocentric.

SETTING:
University hospital.

PATIENTS:
Patients (n = 23) older than 18 years old, on mechanical ventilation and venoarterial extracorporeal membrane oxygenation.

INTERVENTIONS:
A decreasing positive end-expiratory pressure trial (20–5 cm H2O) in increments of 5 cm H2O was performed and monitored by a collection of clinical parameters, ventilatory and ultrasonographic (cardiac and pulmonary) to define an optimal positive end-expiratory pressure according to respiratory criteria (optimal positive end-expiratory pressure selected by physician with respiratory parameters), and then adjusted according to hemodynamic and cardiac tolerances (optimal positive end-expiratory pressure selected by physician with respiratory, hemodynamic, and echocardiographic parameters). At the same time, electrical impedance tomography data (regional distribution of ventilation, compliance, and overdistension collapse) were recorded and analyzed retrospectively to define the optimal positive end-expiratory pressure.

MEASUREMENTS AND MAIN RESULTS:
The median of this optimal positive end-expiratory pressure was 10 cm H2O in our population. Electrical impedance tomography showed that increasing positive end-expiratory pressure promoted overdistention of ventral lung, maximum at positive end-expiratory pressure 20 cm H20 (34% [interquartile range, 24.5–40]). Decreasing positive end-expiratory pressure resulted in collapse of dorsal lung (29% [interquartile range, 21–45.8]). The optimal positive end-expiratory pressure selected by physician with respiratory parameters was not different from the positive end-expiratory pressure chosen by the electrical impedance tomography. However, there is a negative impact of a high level of intrathoracic pressure on hemodynamic and cardiac tolerances.

CONCLUSIONS:
Our results support that electrical impedance tomography appears predictive to define optimal positive end-expiratory pressure on venoarterial extracorporeal membrane oxygenation, aided by echocardiography to optimize hemodynamic assessment and management.
A Randomized, Controlled, Evaluator-Blinded, Multi-Center Study of Hyaluronic Acid Filler Effectiveness and Safety in Lip Fullness Augmentation
Authors: Weiss Robert , Beer Kenneth , Cox Sue E. , Palm Melanie , Kaufman-Janette Joely , Bassichis Benjamin , Biesman Brian , Joseph John , Almegård Birgitta , Nilsson Anna , Edwartz Carolina 
Published: February 2021

BACKGROUND
HARK was recently approved in the US for lip augmentation and correction of upper perioral rhytids.

OBJECTIVE
To demonstrate noninferiority of HARK versus a control (HAJV) in lip fullness augmentation at Week 8 after last injection (blinded evaluation). Secondary objectives were to evaluate the effectiveness and safety of HARK in lip fullness augmentation and correction of upper perioral rhytids.

METHODS AND MATERIALS
Treatment with HARK or control (randomized 2:1) was administered on Day 1 in this 48-week, evaluator-blinded study with optional touch-up at Week 4. Primary endpoint was change from baseline to Week 8 in lip fullness. Secondary endpoints included lip fullness, wrinkle severity, aesthetic improvement, subject satisfaction, adverse events, and local tolerability (subject diary entries).

RESULTS
The primary objective was met; HARK was noninferior to control in lip fullness augmentation at Week 8. Lip fullness and wrinkle severity improvement persisted at Week 48, and was accompanied by high aesthetic improvement and subject satisfaction scores. The mean volume of HARK injected was approximately 20% lower than control. Treatment-related adverse events and local tolerability symptoms were predominantly mild and transient.

CONCLUSION
HARK was noninferior to control in lip fullness augmentation at Week 8, well-tolerated, and effective throughout this 48-week study.
Validation of LexisNexis Accurint in the Georgia Cancer Registry’s Cancer Recurrence and Information Surveillance Program
Authors: Woolpert Kirsten M. , Ward Kevin C. , England Cameron V. , Lash Timothy L. 
Published: February 2021

Background:
LexisNexis Accurint is a database of ~84 billion public records that includes an individual’s location of residence. Its ability to track residences longitudinally has not been validated. This study used the Georgia Cancer Registry’s (GCR’s) Cancer Recurrence and Information Surveillance Program (CRISP) to validate the U.S. state of residence and to examine characteristics of patients not included or who had an inaccurate entry in LexisNexis.

Methods:
The GCR is routinely linked to the National Death Index (NDI), providing information regarding the state of residence in which the patient died. We compared the state of residence reported in LexisNexis with the NDI gold standard state of residence at death. Multivariate logistic regression analyses estimated associations between demographic information and: (1) having a mismatch between LexisNexis and NDI and (2) being missed in LexisNexis.

Results:
Of the 69,494 patients in the CRISP cohort, 65,890 (95%) were found in LexisNexis and 9,597 (14%) had died. Among a subset of patients who were deceased, the sensitivity of LexisNexis for identifying persons who left Georgia was 42% and the specificity was 89%. Minority groups were more likely to be missed in the LexisNexis database as well as to have discordance between LexisNexis and NDI state of residence at death.

Conclusions:
LexisNexis Accurint failed to identify the emigration of more than half of deceased CRISP patients who had left Georgia but correctly identified most who had remained. The validity of the state of residence is important for studies using LexisNexis as a tool for follow-up.
HIV Viremia and Risk of Stroke Among People Living with HIV Who Are Using Antiretroviral Therapy
Authors: Harding Barbara N. , Avoundjian Tigran , Heckbert Susan R. , Whitney Bridget M. , Nance Robin M. , Ruderman Stephanie A. , Kalani Rizwan , Tirschwell David L. , Ho Emily L. , Becker Kyra J. , Zunt Joseph , Chow Felicia , Huffer Andrew , Mathews W. Christopher , Eron Joseph , Moore Richard D. , Marra Christina M. , Burkholder Greer , Saag Michael S. , Kitahata Mari M. , Crane Heidi M. , Delaney Joseph C. 
Published: February 2021

Background:
Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined.

Methods:
Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five sites across the United States. We considered three parameterizations of viral load (VL) including (1) baseline (most recent VL before study entry), (2) time-updated, and (3) cumulative VL (copy–days/mL of virus). We used Cox proportional hazards models to estimate hazard ratios (HRs) for stroke risk comparing the 75th percentile (“high VL”) to the 25th percentile (“low VL”) of baseline and time-updated VL. We used marginal structural Cox models, with most models adjusted for traditional stroke risk factors, to estimate HRs for stroke associated with cumulative VL.

Results:
Among 15,974 people living with HIV, 139 experienced a stroke (113 ischemic; 18 hemorrhagic; eight were unknown type) over a median follow-up of 4.2 years. Median baseline VL was 38 copies/mL (interquartile interval: 24, 3,420). High baseline VL was associated with increased risk of both ischemic (HR: 1.3; 95% CI = 0.96-1.7) and hemorrhagic stroke (HR: 3.1; 95% CI = 1.6-5.9). In time-updated models, high VL was also associated with an increased risk of any stroke (HR: 1.8; 95% CI = 1.4-2.3). We observed no association between cumulative VL and stroke risk.

Conclusions:
Our findings are consistent with the hypothesis that elevated HIV VL may increase stroke risk, regardless of previous VL levels.
Transversus abdominis plane block in urological procedures
Authors: Zayed Mohamed , Allers Katharina , Hoffmann Falk , Bantel Carsten 
Published: February 2021

BACKGROUND
Transversus abdominis plane (TAP) blocks have been shown to successfully reduce pain and opioid consumption after general and gynaecological surgery.

OBJECTIVE
To evaluate whether TAP blocks alleviate pain and opioid consumption after urological procedures.

DESIGN
A systematic review and meta-analysis.

DATA SOURCES
MEDLINE, Embase and CENTRAL.

ELIGIBILITY CRITERIA
Without language restriction, randomised controlled trials (RCTs) that compared the effects of TAP blocks with placebo or no treatment in urological surgery.

MAIN OUTCOME MEASURES
Primary outcomes were pain intensities at rest and movement at 6, 12 and 24 h after surgery. Secondary outcomes were postoperative opioid consumption in the first 24 h after surgery and postoperative nausea and vomiting. We performed meta-analyses using random effects models. Effect sizes were expressed as mean differences for continuous variables. We used the Cochrane risk of bias tool (RoB 2.0) to assess risk of bias.

RESULTS
We analysed 20 RCTs comprising a total of 1239 patients. The risk of bias of the studies was relatively high. TAP blocks significantly reduced postoperative pain at all time points compared with placebo or no treatment. Mean differences on an 11-point pain intensity scale were between 0.55 (95% CI: −0.90, to −0.21; P = 0.002; I
2 = 94%) to 1.13 (95% CI: −1.62 to −0.65; P < 0.001; I
2 = 95%) less at rest and 0.74 (95% CI: −1.25 to −0.23; P = 0.005; I
2 = 79%) to 1.32 (95% CI: −1.83 to −0.81; P < 0.001; I
2 = 68%) less on movements. TAP blocks also reduced opioid consumption in the first 24 h after surgery significantly by 12.25 mg (95% CI: −17.99 to −6.52 mg; P < 0.001; I
2 = 99%) morphine equivalents. Possibly, this had no influence on postoperative nausea and vomiting (risk ratio: 0.98; 95% CI: 0.66 to 1.45; P = 0.91; I
2 = 30%).

CONCLUSION
TAP blocks seem to offer improved analgesia when used after urological surgery. However, due to the large heterogeneity between and the considerable risk of bias within the included studies results should be viewed with caution.

SYSTEMIC REVIEW REGISTRATION
PROSPERO CRD42018112737.
Effect of Negative Pressure Wound Therapy in Electrical Burns
Authors: Gómez-Ortega Viviana , Vergara-Rodriguez María José , Mendoza Bibiana , García Tatiana 
Published: February 2021

Summary:
Electrical burns are capable of damaging cells through both thermal and nonthermal mechanisms. The complexity of these wounds, the deterioration in time, and the conversion during the first days make managing them a challenge. Negative pressure wound therapy (NPWT) is a technology that can be used as a tool to improve outcomes in patients with burns in the acute and reconstructive phases of the treatment. We describe 2 cases in which we apply this technology in electrical injuries. We present 2 cases of patients with electrical burns who underwent NPWT with instillation (NPWTi) with saline solution in the acute phase, to block the conversion of the burn and to improve the granulation tissue and in the reconstructive phase, as a tool to improve the grafts take. Both patients showed early formation of granulation tissue adequate for surgical reconstruction, and neither of them presented loss of skin grafts. In the acute phase, NPWT with instillation when applied in these patients showed fast formation of granulation tissue adequate for early reconstruction, whereas NPWT in the reconstructive phase when applied to bolster grafts showed improvements in grafts take. NPWT is a useful tool to support the surgical management of the electrical injuries during the acute phase to prepare the wound for early reconstruction and after the skin grafts reconstruction to improve the grafts take.
A Modification to Enhance the Survival of the Island FDMA Flap by Adding a Skin Bridge
Authors: Al Lahham Salim , Ahmed Mohamed Badie , Aljassem Ghanem , Sada Ruba , Alyazji Zaki T. N. , Thomas Jimmy 
Published: February 2021

Background:
Distal thumb injuries are common in high construction load regions, and it is a challenging task for the plastic surgeon to find the optimum choice that preserves thumb length and provides a sensory substitute to the lost tissue. Introducing first dorsal metacarpal artery flap has solved the dilemma. One drawback is that the flap is susceptible to distal necrosis, which can happen because of tight tunneling or insufficient venous drainage. We combined Foucher and Holevich characteristics to design a flap that promises to solve the problem.

Methods:
This is a case series that includes 9 patients where we describe a technique that has the potential to enhance the survival of the first dorsal metacarpal artery (FDMA) flap and decreases the rate of distal necrosis via addition of a 5-mm skin bridge to the pedicle and by avoiding tunneling. Distal necrosis of the patients in this study patients was compared with that in a control of 10 patients in whom we did the conventional FDMA flap. Patients were followed for 6 weeks to trace early postoperative complications (infection, dehiscence, and necrosis) and the establishment of protective sensation (pain and temperature).

Results:
None of our patients had distal necrosis, infection, or dehiscence, and all had protective sensation in the flap. In comparison, 4 patients in the control group developed distal necrosis.

Conclusion:
FDMA is one of the best choices when it comes to distal thumb reconstruction, but it has the disadvantage of distal necrosis, which might be avoided when using the technique mentioned in this study.
Cardio-Oncology Rehabilitation (CORE) Exercise Prescription and Programming
Authors: Shultz Adam M. , Squires Ray W. , Shin John Y. , Durani Urshila , Pophali Priyanka A. 
Published: February 2021

Background:
Patients with cancer almost universally report diminished health-related quality of life. Many patients experience persistent fatigue and most have below-average exercise capacities. Despite the publication of exercise guidelines for cancer survivors that encourage physical activity, few patients exercise on a regular basis. Cardiovascular disease is a major cause of death in early-stage malignancies. Exercise training has been demonstrated to decrease cardiovascular events in patients with cancer. In addition, regular exercise improves exercise capacity, reduces fatigue, and improves quality of life in cancer survivors.

Clinical Considerations:
A 2019 American Heart Association scientific statement, endorsed by the American Cancer Society, provided a framework and rationale for partnering with existing multidimensional, interdisciplinary outpatient cardiac rehabilitation programs to provide supervised exercise training and risk factor control services for patients with cancer and cancer survivors: cardio-oncology rehabilitation. In addition, the American College of Sports Medicine has published recommendations for cancer exercise training.

Summary:
This article provides practical suggestions for incorporating patients with cancer into cardiac rehabilitation and for patient-specific exercise prescription. Illustrative patient case examples are provided.
Effects of Acute Exercise on Anxiety Ratings in Patients With Coronary Heart Disease and Elevated Anxiety
Authors: Malian Hannah M. , Smith Patrick J. , Hoffman Benson , Jiang Wei , Ammerman Katharine , Kraus William E. , Hinderliter Alan , Sherwood Andrew , Blumenthal James A. 
Published: February 2021

Purpose:
To explore individual differences in state anxiety following a single, acute bout of aerobic exercise among anxious patients with diagnosed coronary heart disease (CHD).

Methods:
One hundred eighteen CHD patients with elevated symptoms of anxiety enrolled in the UNderstanding the Benefits of Exercise and Escitalopram in Anxious Patients WIth coroNary Heart Disease (UNWIND) clinical trial rated their level of anxiety using a 100-mm visual analog scale before and after a symptom-limited exercise treadmill test. A number of exercise (eg, peak oxygen uptake, exercise duration, maximum heart rate, anaerobic threshold) and psychological variables were examined as potential predictors of exercise response. Changes in anxiety and their association with psychological variables were examined using general linear models.

Results:
Fifty patients (42%) rated a reduction in anxiety relative to their pre-exercise ratings following the exercise treadmill test. While a number of factors were examined, the only factor that distinguished those individuals who reported a reduction in anxiety symptoms compared with those who either remained the same or actually reported an increase in anxiety was a higher pre-exercise visual analog scale anxiety rating. No differences were observed as a function of sex, severity of trait anxiety, the presence of an anxiety disorder, exercise test duration, or age.

Conclusions:
Although many variables were examined, only higher baseline anxiety distinguished those who showed a reduction in their visual analog scale ratings from those whose anxiety remained the same or got worse. The extent to which the response to acute exercise predicts the anxiolytic effects of chronic exercise needs further study.
Review of Trials on Exercise-Based Rehabilitation Interventions Following Acute Decompensated Heart Failure
Authors: Babu Abraham Samuel , Arena Ross , Satyamurthy Akhila , Padmakumar Ramachandran , Myers Jonathan , Lavie Carl J. 
Published: February 2021

Purpose:
Cardiac rehabilitation is an important intervention for patients with heart failure. However, its clinical application in acute decompensated heart failure (ADHF) remains underutilized with limited research available. An assessment of current research in this area will help guide future investigations. The aim of this review is to summarize the current research focusing on rehabilitation interventions following recovery from ADHF.

Review Methods:
A systematic search was carried out on all trials registered in the clinical trial registry database of the World Health Organization—International Clinical Trial Registry Platform (WHO-ICTRP). Studies focusing on ADHF and utilizing any exercise and rehabilitation-based intervention were included.

Results:
A majority of 11 trial protocols, including 3827 participants with low ejection fraction (<40%), were identified from the WHO-ICTRP database. Majority of the protocols (64%) focused on exercise-based interventions with approximately one-quarter (29%) focusing on neuromuscular electrical stimulation and one on noninvasive ventilation during exercise. Irrespective of the mode of exercise, all protocols employed low-moderate intensity training with outcomes focusing on physical function and quality of life.

Conclusion:
Studies on rehabilitative interventions for ADHF are still in their early stages. More research is needed using innovative methodologies and testing for feasibility and fidelity.
Evaluation of the American Association of Cardiovascular and Pulmonary Rehabilitation Exercise Risk Stratification Classification Tool Without Exercise Testing
Authors: Bhat Anusha G. , Farah Michel , Szalai Heidi , Lagu Tara , Lindenauer Peter K. , Visintainer Paul , Pack Quinn R. 
Published: February 2021

Purpose:
The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) recommends that patients starting cardiac rehabilitation (CR) undergo stratification to identify risk for exercise-related adverse events (AE), but this tool has not been recently evaluated.

Methods:
Among patients who enrolled in CR in 2016, we used the AACVPR risk stratification tool to evaluate the risk for AE and clinical events (CE). We defined AE as signs or symptoms that precluded or interrupted exercise during CR, and CE as events requiring an urgent evaluation outside of CR exercise sessions.

Results:
During the study period, 657 patients with cardiovascular diagnoses were included and classified as high (58%), medium (31%), or low risk (11%). Over the course of CR (76 d, 17 sessions), there were 63 AE and 33 CE. Adverse events were mostly minor (no cardiac arrests or deaths) and managed by CR staff members. When compared with the low- or medium-risk groups, the high-risk group was more likely to have AE (HR 3.0 [95% CI, 1.7-5.9], P = .002) and CE (HR 3.7 [95% CI, 1.5-10.8], P = .002) with fair model discrimination (area under the curve: 0.637, P < .001).

Conclusion:
The AACVPR risk stratification tool was predictive of both AE and CE with fair discrimination, although event rates were low and mostly minor. Thus, the AACVPR model may require reevaluation to better identify truly at-risk patients for major AE.