bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contribution of Multimodal Analgesia to Postoperative Pain Outcomes Immediately After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Level 1 Randomized Clinical Trials
Authors: Maheshwer Bhargavi , Knapik Derrick M. , Polce Evan M. , Verma Nikhil N. , LaPrade Robert F. , Chahla Jorge 
Published: January 2021

Background: Anterior cruciate ligament reconstruction (ACLR) is associated with moderate to severe pain in the immediate postoperative period. The optimal individual preemptive or intraoperative anesthetic modality on postoperative pain control is not well-known. Purpose: To systematically review and perform a meta-analysis comparing postoperative pain scores (visual analog scale [VAS]), opioid consumption, and incidence of complications during the first 24 hours after primary ACLR in patients receiving spinal anesthetic, adjunct regional nerve blocks, or local analgesics. Study Design: Systematic review and meta-analysis. Methods: PubMed, Embase, MEDLINE, Biosis Previews, SPORTDiscus, Ovid, PEDRO, and the Cochrane Library databases were systematically searched from inception to March 2020 for human studies, using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. Inclusion criteria consisted of (1) level 1 studies reporting on the use of spinal anesthesia, adjunct regional anesthesia (femoral nerve block [FNB] or adductor canal block [ACB]), or local analgesia in patients undergoing primary ACLR and (2) studies reporting on patient-reported VAS, opioid consumption, and incidence of complications related to anesthesia within the first 24 hours after surgery. Non–level 1 studies, studies utilizing a combination of anesthetic modalities, and those not reporting outcomes during the first 24 hours were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine postoperative pain, opioid use, and complications based on anesthetic modality at multiple time points (0-4, 4-8, 8-12, 12-24 hours). Results: A total of 263 studies were screened, of which 27 level 1 studies (n = 16 regional blocks; n = 12 local; n = 4 spinal) met the inclusion criteria and were included in the meta-analysis. VAS scores were significantly lower in patients receiving a regional block as compared with spinal anesthesia 8 to 12 hours after surgery ( P < .01), patients receiving an FNB versus ACB at 12 to 24 hours ( P < .01), and those treated with a continuous FNB rather than single-shot regional blocks (FNB, ACB) at 12 to 24 hours ( P < .01). No significant difference in VAS was appreciated when spinal, regional, and local anesthesia groups were compared. Conclusion: Based on evidence from level 1 studies, pain control after primary ACLR based on VAS was significantly improved at 8 to 12 hours in patients receiving regional anesthesia as compared with spinal anesthesia. Pain scores were significantly lower at 12 to 24 hours in patients receiving FNB versus ACB and those treated with continuous FNB rather than single-shot regional anesthetic.
Validation of transcutaneous carbon dioxide monitoring using an artificial lung during adult pulsatile cardiopulmonary bypass
Authors: Garrison Lawrence , Riley Jeffrey B , Wysocki Steve , Souai Jennifer , Julick Hali 
Published: January 2021

Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis. tcCO2 measurements ( N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p < 0.001). The small median difference and acceptable IQR support the validity of the tcCO2 measurement. The multiple linear regression model for predicting the agreement between the submandibular tcCO2 and PaCO2 included the SvO2, the oxygenator gas to blood flow ratio, and the native perfusion index ( R2 = 0.699, df = 1, 60; F = 19.1, p < 0.001). Our experience in utilizing tcCO2 during CPB has demonstrated accuracy in estimating PaCO2 when compared to the gold standard arterial blood gas analysis, even during CO2 flooding of the surgical field.
Predicting Failure of Non-Invasive Ventilation With RAM Cannula in Bronchiolitis
Authors: Maamari Mia , Nino Gustavo , Bost James , Cheng Yao , Sochet Anthony , Sharron Matthew 
Published: January 2021

Introduction: In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response. Methods: We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children’s hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student’s t test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation. Results: Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], p < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], p = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both p < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response. Conclusion: In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.
Impact of Diet and Exercise on Weight and Cognition in Older Adults: A Rapid Review
Authors: Batsis John A. , Roderka Meredith N. , Rauch Vanessa K. , Seo Lillian M. , Li Xingyi , DiMilia Peter R. , Gooding Tyler , Gilbert-Diamond Diane , McClure Auden C. , Roth Robert M. 
Published: January 2021

Objective: To determine where the current literature stands in regard to diet/exercise interventions on cognition in overweight or obese individuals. Data Source: A rapid review was conducted of English-language studies published in Medline from January 1965 to January 2020. Study Inclusion and Exclusion Criteria: Included studies were intervention studies lasting ≥12 weeks, with participants aged ≥65 years, with a body mass index ≥25 kg/m2 Data Extraction: Data extracted included study population, duration, intervention design, outcomes, and results. Data Synthesis: Outcomes were qualitatively measured due to paucity of RTC. Results: 1845 citations were identified, 31 full-text articles were reviewed, and 5 studies were included. Studies had usual care control groups and combined exercise/diet intervention groups with 31-3,526 participants randomized to each arm. Mean age of participants was 69.2-83.4 years. Studies reporting on cognitive changes showed marginally significant positive changes in cognition, and those that reported BMI indicated potential improvements in cognition. Conclusions: The number of interventions assessing the combined effects of both diet and exercise is low. Future studies should evaluate the impact of combined effects to ascertain whether cognitive decline may be reversed in older adults with a BMI ≥25 kg/m2.
Stability of continuous welded rails: A state-of-the-art review of structural modeling and nondestructive evaluation
Authors: Enshaeian Alireza , Rizzo Piervincenzo 
Published: January 2021

Continuous welded rails (CWR) are track segments welded together to form a continuous miles-long track. With respect to mechanically-jointed rails, CWR are stronger, smoother, require less maintenance, and can be traveled at higher speeds. Despite these advantages, CWR are prone to fracture during cold seasons and to instability during warm seasons when the increase in the steel temperature induces extreme compression. To better understand buckling mechanism, engineers studied the structural behavior of rails under static and dynamic loads. Some of these models represent the basis of noninvasive methods to measure longitudinal stress. Both structural analyses and nondestructive evaluation methods are tools to predict the temperatures and the field conditions at which rails experience extreme tensile or compressive stress. This article reviews the last three decades of research and development on the structural analysis and nondestructive evaluation of CWR. The scope of this document is to provide a holistic view of the developments in rail engineering and nondestructive evaluation relevant to the problem of thermal buckling. Advantages and limitations of the analyses and of the nondestructive methods are discussed based upon the information available in the scientific literature. Additionally, any knowledge gap to be addressed by the scientific community in the years to come is identified and discussed.
Toxic epidermal necrolysis after therapeutic plasma exchange in pediatric lupus patients and associated risk factors analysis
Authors: Lu Jing , Dong Liqun , Zhang Lijuan , Zhang Hui , Wang Lin , Zhang Junqing , Wan Chaomin 
Published: January 2021

Background Therapeutic plasma exchange (TPE) is an effective means of treating systemic lupus erythematosus in children and is safe for most pediatric patients with systemic lupus erythematosus, but severe complications such as toxic epidermal necrolysis (TEN) may occur, which is a life-threatening condition. Methods In this study, three systemic lupus erythematosus (SLE) children developed toxic epidermal necrolysis after TPE. We analyzed their medical history, clinical manifestations, SLEDAI scores, and immunological characteristics, compared to 117 cases of SLE patients without TEN after TPE, trying to find the possible risk factors. Results The three children with TEN after plasma exchange appeared to have a higher proportion of male (male: female = 2:1), fever (100% Vs 32.5%), erythema on the cheek (100% Vs 54.7%), itching rash (100% Vs 54.7%), ruptured rash (100% Vs 54.7%), oral ulcer (100% Vs 54.7%) and higher LDH level (1826.0 ± 1113.1 Vs 721.1 ± 799.5 U/L), but lower white blood cell count (5.5 ± 3.3 Vs 7.2 ± 4.2 × 109/L), neutrophil count (4.7 ± 3.7 Vs 5.2 ± 3.6 × 109/L), lymphocyte count (0.6 ± 0.5 Vs 1.5 ± 0.8 × 109/L), platelet count (133.7 ± 58.1 Vs 178.5 ± 103.1 × 109/L) and C-reactive protein (all normal Vs 47.9% elevated). Autoantibody spectrum revealed that positive anti-SSA seemed more common (100% Vs 42.7%) in the three children. Relative risk analysis revealed that male (OR 21.4, 95%CI 1.78–257.186), ruptured skin rash (OR 56.5, 95%CI 4.199–760.196) and rash with itching (OR 24, 95%CI 1.98–290.896) are the risk factors of SLE patients developing TEN after plasma exchange. Conclusions We should pay particular attention to TEN after plasma exchange in SLE patients (3/120, 2.5%). This condition may be related to male, ruptured skin rash and rash with itching. For SLE patients with risk factors. We should arrange plasmapheresis more carefully.
How do systemic lupus erythematosus patients with very-long disease duration present? Analysis of a monocentric cohort
Authors: Signorini Viola , Tani Chiara , Elefante Elena , Carli Linda , Stagnaro Chiara , Zucchi Dina , Parma Alice , Vagelli Roberta , Ferro Francesco , Mosca Marta 
Published: January 2021

Objective to describe the disease path and the very long-term outcome in a monocentric cohort of patients with Systemic Lupus Erythematosus (SLE). Methods SLE patients with a disease duration of at least 15 years from diagnosis were enrolled. The number of hospitalizations, the disease flares occurred over the disease course and the organ damage accumulation were evaluated at 1, 2, 3, 4, 5, 10 years from diagnosis and at last observation in 2019 as well. Disease state, ongoing therapies and quality of life measures were also assessed at last visit. Results 126 Caucasian SLE patients were included in the analysis (95% female, median age 47.5 IQR 41–53, median disease duration 21 IQR19-26). At last visit, the majority of the patients (78.6%) was on LLDAS (remission included), 53.4% were on GC treatment and 35.7% on immunosuppressant. Furthermore, 53.2% had at least one organ damage. The majority of patients (66.7%) presented a relapsing-remitting course, for a total of 158 flares during the disease course (incidence rate: 0.79/patient-year); moreover, 84.9% of the cohort experienced at least one hospital admission, amounting to a total of 328 hospitalizations (incidence rate: 0.85/patient-year). The main reason for admission was disease activity, while the percentage of hospitalizations due to other causes has been growing over the 10 years of follow-up. Conclusion after a very long period of disease, most of the patients with SLE are in remission and are not taking GC therapy; however, the risk of incurring in disease flare remains a real problem.
Covid-19: Globalization—Will the Course Change?
Authors: Thangavel Packiaraj , Pathak Pramod , Chandra Bibhas 
Published: January 2021

The year 2020 will go down in world history as a time of great struggle. The Covid-19 pandemic has put a screeching halt to economic activities and movement of people across the globe. The difficulties associated with detecting and isolating asymptotic carriers, who are otherwise unaware that they are infected, undoubtedly facilitate the spread of virus in manifold. This article focuses on the speculations the pandemic caused on the future of globalization. The current movements, which were triggered by Covid-19, have given legitimate reasons to mistrust globalization. Many countries around the globe began to realize their over-dependence on other countries and struggle to meet their local customer needs now. Many are emphasizing the grave dangers associated with over-dependence on global value chains especially those controlled by China, leading to criticizing globalization. And the national leaders too followed suit to propagate protectionism and self-reliance. Globalization has given way to recent frustrations and concerns which cannot be quietened by reminding the benefits it brought. And crying for de-globalization is also not going to solve the issues the humanity faces. Isolation is a strategy that works only to stop the spread of a pandemic, but collectivism can help in counter and emerge from it stronger. The 2001 Nobel Peace Prize laureate Kofi Annan had rightly said once that ‘arguing against globalization is like arguing against the laws of gravity’. Collective actions of the countries only can meet global challenges such as climate change, terrorism, nuclear proliferation and cyber-attacks. No single nation on its own can make itself secure and self-reliant. Nobody can predict the next crisis. But the most reliable and efficient insurance by far is to build strong international exchange cooperation to safeguard the humanity.
Establishing a Corporate Responsibility Ombudsman: Enhancing remedy through state-based non-judicial mechanisms?
Authors: Saloranta Juho 
Published: January 2021

This article assesses the efficiency of non-judicial grievance mechanisms in providing victims of corporate human rights violations with improved access to remedy. As no such mechanism is currently available, this article formulates a proposal for a new mechanism in the form of a corporate responsibility ombudsman, which would offer a great deal of flexibility as well as being an inexpensive, expeditious and informal manner of dealing with such issues. The article argues in favour of utilizing states’ regulatory arsenal to improve victims’ access to remedy extraterritorially. Based on recent international developments, I elaborate approaches to human rights due diligence regulation and export credit financing by means of two corporate responsibility ombudsman proposals. In relation to these proposals, I divide the effectiveness criteria of Principle 31 of the United Nations Guiding Principles into three main categories: empowerment, investigation and enforcement. Since obtaining sufficient evidence is of paramount to those seeking remedies for violations of corporate responsibility, states should bestow quasi-judicial powers on corporate responsibility ombudsmen to achieve efficiency, which could also create legitimacy. This article provides decision-makers and scholars with insights into how access to remedy could be synchronized with the momentum of human rights due diligence legislation in the European Union and beyond.
Effect of Metformin on Circulating Levels of Inflammatory Markers in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Karbalaee-Hasani Amir , Khadive Tooka , Eskandari Mahsa , Shahidi Shabnam , Mosavi Maryam , Nejadebrahimi Zivar , Khalkhali Lida , Sangdari Amirhossein , Mohammadi Davoud , Soltani Ali , Khodabandehloo Hadi , Hosseini Hossein , Koushki Mehdi 
Published: January 2021

Background: Emerging evidence indicates that metformin has anti-inflammatory effect; however, the results differ concerning randomized controlled trails of the effect of metformin on inflammatory markers in type 2 diabetes (T2D) patients. Objective: This study reassessed the data on the effect of metformin treatment on inflammatory markers in T2D patients through a systematic review and meta-analysis. Methods: A systematic search was performed in the PubMed, ISI Web of Science, EMBASE, Cochrane Library and Scopus databases to collect relevant published data up to September 2020. Data of each study was combined using random-effects model. Subgroup analysis was performed based on subgroups of the treatment duration, dose and target population. Results: Thirteen RCTs including 1776 participants with T2D were analyzed. Although CRP levels significantly decreased [SMD: –0.76 mg/L; 95% CI (–1.48, –0.049); P = 0.036] in patients with T2D following metformin treatment, circulating levels of TNF-α [SMD: –0.17 pg/mL; 95% CI (–0.55, 0.20); P = 0.37] and IL-6 [SMD: –0.06 pg/mL; 95% CI (–0.38, 0.25); P = 0.69] were insignificant after metformin treatment. Compared to treatment duration of less than 24 weeks, longer treatment duration (more than 24 weeks) was associated with reduced level of CRP. Relevance to Patient Care and Clinical Practice: Based on available evidence from RCTs in this meta-analysis, metformin decreased CRP level. However, strategies for the treatment of inflammation should focus on metformin in patients with T2D. Conclusion: The present study evidences that therapy with metformin can reduce CRP level significantly in T2D patients compared to other inflammatory markers.
Common and rare complications following filtering surgery for children with congenital glaucoma; a5 years study
Authors: Sayed Khulood Muhammad 
Published: January 2021

Purpose: To determine the incidence of postoperative complications following combined trabeculotomy trabeculectomy with mitomycin C (CTTM) for congenital glaucoma (CG), in addition to documentation of some unusual complications and possible ways to manage these complications safely with minimal morbidity. Methods: A retrospective observational study was performed on 190 eyes with CG had a CTTM procedure. Included eyes were operated upon between February 2015 and February 2020 in Sohag University Hospitals. Medical records were reviewed and postoperative complications were reported. Incidence of postoperative complications and their management were the main outcome measures Results: Early complications developed the form of shallow anterior chamber (AC) (16.3%), hyphema (10.5%), serous choroidal detachment (2%), hemorrhagic choroidal detachment (2%). Unusual and rare complications occurred in the form of iatrogenic Cushing syndrome, unilateral toxic keratopathy developed, vitreous hemorrhage (VH), intercalary staphyloma and decompression retinopathy Late complications included: high postoperative intraocular pressure (IOP) (16.5%), thin cystic blebs (13.1%), hypotony disc edema (2%), cataract (3.2%), one eye developed blebitis and one eye developed endophthalmitis. Conclusion: Surgical management of CG is full of complications in early and late postoperative periods such as shallow AC, hyphema and thin cystic blebs. Some unusual and rare complications developed such as iatrogenic Cushing syndrome, unilateral toxic keratopathy, vitreous hemorrhage, intercalary staphyloma and decompression retinopathy. If identified early; all these complications could be managed properly leading to a successful and favorable outcome.
Establishing priorities for psychosocial supports and services among family carers of people with dementia in Ireland
Authors: Teahan Áine , Carney Patricia , Cahill Suzanne , O’Shea Eamon 
Published: January 2021

Introduction Many family carers, particularly those caring for people with dementia, report significant personal and social challenges associated with caring. The aim of this article is to identify the range of challenges experienced by family carers of people with dementia and to ascertain their preferences for various supports and services that address those challenges. Method Three modified nominal group technique (NGT) focus groups were conducted with family carers of people with dementia. The NGT groups were conducted with 17 participants in two stages, focusing separately on personal and social domains. Family carers identified challenges and individually ranked preferences for both existing and new services and supports. Data analysis consisted of qualitative content analysis and summative scoring of individual rankings. Findings Family carers identified the following personal-level challenges: needing a break, social isolation and relationship changes. Family carers’ combined preferences for personal-level supports and services to overcome these challenges were day care, family care support groups, short-term respite, long-break respite and social activities. Social challenges referenced by family carers included finances, rights and entitlements and stigma and awareness. Preferences for supports and services to address these social challenges were non–means-tested carer’s allowance, legal recognition, carer’s support grant, monthly wage and community awareness programmes. Conclusion Participants ranked day care and non–means-tested carer’s allowance as their top priorities under personal and social headings. Increased government investment in these two areas would not only help to maintain family carers’ contributions to community-based care in dementia but would also facilitate social inclusion, social connectedness and economic sustainability.