bluuebunny/crossref_metadata_2025_split huggingface dataset:
Horner’s Syndrome Following Obstetric Neuraxial Blockade: A Systematic Review of the Literature
Authors: Chambers D.J. , Bhatia K. 
Published: August 2019

(Int J Obstet Anesth. 2018;35:75–87)
Horner syndrome (HS), characterized by ipsilateral miosis, ptosis and anhydrosis, has been reported following regional anesthetic techniques such as cervical and brachial plexus blocks and epidural anesthetics. Although rare, HS has been reported in women who underwent obstetric neuraxial blockade (NB). The current authors undertook a systematic review of the literature that reported HS after obstetric NB in order to better inform anesthesiologists regarding the course and management of this condition.
Clearsight Use for Hemodynamic Monitoring During the Third Trimester of Pregnancy: A Validation Study
Authors: Duclos G. , Hili A. , Resseguier N. , Kelway C. , Haddam M. , Bourgoin A. , Carcopino X. , Zieleskiewicz L. , Leone M. 
Published: August 2019

(Int J Obstet Anesth. 2018;36:85–95)
Monitoring cardiac output (CO) in pregnant patients has been suggested as a means to improve outcomes for mother and child as blood pressure and clinical signs may not be sufficient proxys for CO. Currently, the gold standard for CO measurement is the thermodilution technique via a pulmonary artery catheter or transthoracic echocardiography (TTE). This study aimed to evaluate the Clearsight, a noninvasive hemodynamic monitoring system that uses “volume clamp” technology to produce a continuous arterial BP wave, as a valid monitor of CO and stroke volume (SV) in parturients compared with TTE.
Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism
Authors: van der Pol L.M. , Tromeur C. , Bistervels I.M. , Ni Ainle F. , van Bemmel T. , Bertoletti L. , Couturaud F. , van Dooren Y.P.A. , Elias A. , Faber L.M. , Hofstee H.M.A. , van der Hulle T. , Kruip M.J.H.A. , Maignan M. , Mairuhu A.T.A. , Middeldorp S. , Nijkeuter M. , Roy P.M. , Sanchez O. , Schmidt J. , Ten Wolde M. , Klok F.A. , Huisman M.V. 
Published: August 2019

(N Engl J Med. 2019;380(12):1139–1149. Doi:10.1056/NEJMoa1813865)
Pregnancy and venous thromboembolism (VTE) share many symptoms and physiological changes, presenting a challenge for VTE diagnosis in pregnant women. The threshold for testing pregnant women for pulmonary embolism is low, as this population is at higher risk for VTE and fatal pulmonary embolism. While some studies have examined the practice of ruling out pulmonary embolism in pregnant women without imaging tests (only using decision rules or D-dimer tests), there is a lack of international consensus regarding diagnostic approaches for pulmonary embolism during pregnancy. The YEARS study showed a low incidence of diagnostic failure when using the YEARS diagnostic algorithm in men and women. This study aimed to evaluate a pregnancy-adapted version of the YEARS algorithm for the management of suspected pulmonary embolism during pregnancy.
Gastric Ultrasound for the Regional Anesthesiologist and Pain Specialist
Authors: Haskins S.C. , Kruisselbrink R. , Boublik J. , Wu C.L. , Perlas A. 
Published: August 2019

(Reg Anesth Pain Med. 2018;43:689–698)
A significant cause of patient morbidity in the perioperative setting is pulmonary aspiration of gastric contents. Despite patients following the American Society of Anesthesiologists recommendations for fasting before a procedure, there is substantial variability in gastric-emptying time among patients. This may lead to a small percentage of patients that still have solid gastric contents at the time of operation. Gastric ultrasound has the potential to play an important role in the perioperative setting to provide reliable information regarding gastric content and assessment of aspiration risk.
Assessing Long-Term Neurodevelopmental Outcome Following General Anesthesia in Early Childhood: Challenges and Opportunities
Authors: Walkden G.J. , Pickering A.E. , Gill H. 
Published: August 2019

(Anesth Analg. 2019;128(4):681–694. Doi:10.1213/ANE.0000000000004052)
While general anesthesia has long been considered a safe practice in pediatric surgery, there has been growing concern that it may have lasting neurodevelopmental effects on those exposed during early childhood or as fetuses. In the United Kingdom, general anesthesia is administered to ~5% of children before they reach age 6. Animal studies, including nonhuman primates, have showed an association between altered brain development in immature animals and commonly used IV and inhalational anesthetic agents. There have been conflicting results in human observational studies of anesthetic-induced neurotoxicity, but regulatory and professional bodies have released precautionary statements. This study aimed to better inform design of future clinical studies on this topic by reviewing 76 clinical studies of long-term neurodevelopmental outcome after general anesthesia exposure in early childhood or before birth.
United States State-Level Variation in the Use of Neuraxial Analgesia During Labor for Pregnant Women
Authors: Butwick A.J. , Bentley J. , Wong C.A. , Snowden J.M. , Sun E. , Guo N. 
Published: August 2019

(JAMA Netw Open. 2018;1:e186567)
Guidelines for levels of maternal care for obstetric analgesia and anesthesia, as per the American College of Obstetricians and Gynecologists, state that anesthesia services should be available in all hospitals offering maternal care. However, there is insufficient research to determine the extent or characteristics of the geographic variability across US states in neuraxial analgesia use. The authors of the present study used multilevel modeling, accounting for patient-level and state-level factors, to assess variability in neuraxial analgesia practices in the United States in 2015.
Comparison of the ED50 and ED95 of Intrathecal Bupivacaine in Parturients Undergoing Cesarean Delivery With or Without Prophylactic Phenylephrine Infusion: A Prospective, Double-Blind Study
Authors: Xiao F. , Drzymalski D. , Liu L. , Zhang Y. , Wang L. , Chen X. 
Published: August 2019

(Reg Anesth Pain Med. 2018;43(8):885–889)
Spinal-induced hypotension is a common problem resulting from the sympathectomy associated with the administration of intrathecal local anesthetic for cesarean delivery, and is associated with nausea, vomiting, loss of consciousness, impaired fetal oxygenation, and fetal acidosis. Prophylactic phenylephrine infusion is often used to decrease the risk of spinal-induced hypotension; however, its use has been associated with decreased rostral spread of intrathecal local anesthetic in pregnancy. The purpose of this study was to determine the median effective dose (ED50) and 95% effective dose (ED95) of spinal hyperbaric bupivacaine for cesarean delivery with and without a phenylephrine infusion.
Patterns of Recovery From Pain After Cesarean Delivery
Authors: Booth J.L. , Sharpe E.E. , Houle T.T. , Harris L. , Curry R.S. , Aschenbrenner C.A. , Eisenach J.C. 
Published: August 2019

(Pain. 2018;159:2088–2096)
There is a lack of knowledge about patterns of recovery from pain and its predictors after surgery. Often times, clinicians only witness pain experience if the patient returns for routine care after discharge, which overall limits the clinical ability to provide appropriate pain management. In order to establish clinically relevant, generalizable patterns of recovery, as well as identify predictors from preoperative and perioperative data, patients were followed for 2 months after elective cesarean delivery via text-messaging to assess daily pain scores.
Successful Spinal Anesthesia for Cesarean Section in a Patient With Marfan Syndrome Complicated by Dural Ectasia
Authors: Skjellerup N. 
Published: August 2019

(Int J Obstet Anesth. 2018;35:88–92)
Marfan syndrome (MFS) is an autosomal dominant condition characterized by connective tissue abnormalities across multiple systems. Patients with MFS may have a dilated aortic root, and this can place the parturient at increased risk during labor and delivery. Cesarean delivery is sometimes recommended for women with MFS who have an aortic root diameter >40 mm. However, reduced effectiveness of spinal anesthesia has been reported in some patients with MFS. The failure is thought to possibly be related to the dural ectasia that is present in many patients with MFS; this may lead to incomplete cephalad distribution of intrathecal local anesthetic. This case report detailed a parturient who was undergoing her second cesarean delivery after failed neuraxial anesthesia during her first delivery, with the author postulating that warmed isobaric bupivacaine, injected as far away as possible from the ectatic dural sac, may be able to overcome inconsistent intrathecal distribution.
Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan
Authors: van der Wal Martje H.L. , Waldréus Nana , Jaarsma Tiny , Kato Naoko P. 
Published: August 2019

Background:
Thirst is a distressing symptom and influences quality of life of patients with heart failure (HF). Knowledge about thirst in HF is insufficient; therefore, the aim of this study was to describe factors related to thirst, self-reported reasons for thirst, and interventions to relieve thirst in 3 different countries.

Methods:
A cross-sectional study was conducted in Sweden, the Netherlands, and Japan. Patients were recruited at the HF clinic or during HF hospitalization. Thirst was assessed by a visual analog scale (0–100); reasons for thirst and interventions to relieve thirst were assessed by an open-ended questionnaire. Patients were divided into low and high thirst based on the first and third tertiles of the visual analog scale.

Results:
Two hundred sixty-nine patients participated in the study (age, 72 ± 12 years). Mean thirst intensity was 24 ± 24, with a mean thirst of 53 ± 15 in the highest tertile. No significant differences in thirst among the 3 countries were found. Multivariable logistic regression analysis showed that a higher dose of loop diuretics (odds ratio, 3.47; 95% confidence interval, 1.49–8.06) and fluid restriction (odds ratio, 2.21; 95% confidence interval, 1.08–4.32) were related to thirst. The most reported reasons for thirst were salty/spicy food (20%) and low fluid intake (18%). Most of the patients (56%) drank more in case of thirst; 20% only drank a little bit, probably related to a fluid restriction.

Conclusions:
Thirst in patients with HF was related to a higher dose of loop diuretics and fluid restriction. Healthcare providers should realize that it is important to assess thirst regularly and reconsider the need of a fluid restriction and the amount of loop diuretics in case of thirst.
ECG pre-hospital teletransmission by emergency teams staffed with an emergency physician and paramedics and its impact on transportation and hospital admission
Authors: Sowizdraniuk Joanna , Smereka Jacek , Ladny Jerzy Robert , Kaserer Alexander , Palimonka Krzysztof , Ruetzler Kurt , Skierczynska Agnieszka , Szarpak Lukasz 
Published: August 2019

Abstract
Electrocardiography (ECG) is essential to detect and diagnose life threatening cardiac conditions and to determine further treatment. Correct interpretation of an ECG can be challenging, especially in the out-of-hospital setting and by less experienced emergency team members.
The aim of this study was to compare the rate of ECG transmission from an out-of-hospital emergency scene to an in-hospital cardiologist on call in EMS-B and EMS-S providers and its impact on direct transportation to a cardiac catheterization laboratory and hospital admission.
The study was designed as an observational study. Data from 3 separate emergency medical service teams were collected. Two teams are staffed by paramedics only (EMT-B), while another specialized team is staffed with an emergency physician (EMT-S). 5864 out-of-hospital emergencies were performed during a 12-month period and were analyzed for this study.
In 124 out of 5864 (2.1%) out-of-hospital emergencies, an ECG transmission from the out-of-hospital scene to an in-hospital cardiologist on call was performed. Rate of transmission was similar between both teams (EMT-B n = 70, 2.2% vs EMT-S n = 54, 2.0%, P = .054). After coordinating with the cardiologist on call, 11 patients (15.7%) of the EMT-B (15.7%) and 24 patients (44.4%) of the EMT-S were directly transported from the scene of emergency to a cardiac catheterization laboratory (P < .001). Overall, 80% of patients treated by EMT-S, compared to 52.5% treated by the EMT-B required subsequent hospital admission (P < .05).
Transmission of ECG from the out-of-hospital emergency scene to the in-hospital cardiologist is infrequently performed. The rate of STEMI in transmitted ECG's by emergency teams staffed with an emergency physician was higher compared to emergency teams staffed with paramedics only.
Posterior reversible encephalopathy syndrome with essential thrombocythemia
Authors: Zhang Yunqiao , Lu Zixiang , Li Yanping , Wu Jie , Liu Ting , Xie Xian , He Xiaolin , Zeng Yong 
Published: August 2019

Abstract

Rationale:
Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disease of the posterior subcortical white matter that manifests as headache, seizures, visual impairment, disturbance of consciousness, and changes in mental state. While PRES is associated with specific imaging findings involving the posterior circulation area of the brain. In the present study, we report the first case of PRES associated with essential thrombocythemia (ET).

Patient concerns:
A 49-year-old man suddenly experienced headache, followed by the gradual appearance of consciousness disorders and mental behavior abnormalities. Neurological tests showed that the patient had a Glasgow Coma Scale score of 12, normal muscle strength and tension of the limbs, and was negative for meningeal irritation.

Diagnosis:
Magnetic resonance imaging of the brain showed extensive vasogenic edema in the deep white matter of the right cerebellum and the left occipital and temporal lobes and a diagnosis of PRES was considered. Routine blood test showed that his platelet count was markedly increased, and the JAK2 V617F mutation analysis with allele-specific real-time polymerase chain reaction was positive. The bone marrow biopsy indicated an increasing number of megakaryocytes. These findings indicated ET.

Interventions:
PRES was treated with a dehydrating agent and supportive and symptomatic treatments. Aspirin tablets were prescribed to address the patient's ET.

Outcome:
After treatment, the abnormal findings on head imaging were completely reversed. His neurological symptoms were completely relieved.

Lessons:
PRES may be correlated with ET; specifically, ET may trigger PRES and be a risk factor for the acute onset of neurological deficits.
Liver abscess caused by ingestion of fishbone
Authors: Li Jiangfa , Zhao Daokang , Lei Liping , Zhang Longmiao , Yu Yaqun , Chen Qian 
Published: August 2019

Abstract

Rationale:
The penetration of a foreign body through the stomach wall and causing liver abscess is rare. A case of liver abscess caused by secondary bacterial infection was reported in the current study.

Patient concerns:
A 58-year-old male patient had a history of eating fish and presented with recurrent fever with chills. The patient had a previous fever for 9 days without any obvious inducement and the highest body temperature rose to 40.8°C, along with fear of cold and chills. Body temperature declined to normal value after 5 days of infusion treatment (drugs were unknown) in the local clinic. Two days afterward, his body temperature again rose to 40.3°C at its highest.

Diagnosis and intervention:
Abdominal computed tomography (CT) showed that there was a quasicircular low-density focus in the left hepatic lobe which was most likely a liver abscess. A dense strip was found in proximity to the left hepatic lobe, implying the retention of a catheter in the upper abdominal cavity or a foreign body. On conditions of related preoperative preparations and general anesthesia, the left hepatic lobe was resected with the laparoscope. During the operation, a fish bone was found in the liver. Postoperative symptomatic and supportive treatment was carried out without antibiotics for liver protection.

Outcomes:
The patient was cured through surgical treatment and found to be in a good condition. The patient was successfully discharged and recovered well in the follow-up visit 3 months after the operation.

Lessons:
Liver abscess caused by fish spines is rare. The contrast-enhanced CT of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.
Ozone and pulsed electro-magnetic field therapies improve endometrial lining thickness in frozen embryo transfer cycles
Authors: Merhi Zaher , Moseley-LaRue Rajean , Moseley Amber Ray , Smith André Hugo , Zhang John 
Published: August 2019

Abstract

Rationale:
In assisted reproductive technology, a persistently thin endometrial lining represents a huge challenge during frozen embryo transfer (FET) cycles.

Patient concerns:
Three patients who had a persistently thin endometrial lining despite the use of several medical agents known to improve endometrial lining thickness.

Diagnoses:
Infertility undergoing FET cycles.

Interventions:
A combination of transdermal and intravaginal ozone therapy along with Pulsed Electro-Magnetic Field (PEMF) therapy.

Outcomes:
Ozone with PEMF, both of which are known to have vasodilatatory, anti-inflammatory, and anti-oxidant actions, were successful in improving the thickness of the endometrial lining in all 3 patients. Two out of 3 patients became pregnant following single embryo transfer.

Lessons:
Ozone with PEMF constitute a novel experimental approach for women with persistently thin endometrial lining undergoing FET. This novel approach needs validation by large well-designed studies.
Effects of infrared laser moxibustion on cancer-related fatigue in breast cancer survivors
Authors: Mao Huijuan , Mao Jun J. , Chen Junchao , Li Qing , Chen Xuefen , Shen Xubo , Zhao Ling , Wei Jianzi , Shen Xueyong 
Published: August 2019

AbstractBackground:Cancer-related fatigue (CRF) is the most common and distressing symptom associated with cancer treatment that breast cancer survivors (BCS) experience. We previously found that laser moxibustion may be efficacious for CRF. The primary aim of this study is to determine the specific efficacy of 10.6 μm infrared laser moxibustion on CRF. The secondary aim is to evaluate the effect of infrared laser moxibustion on co-existing symptoms that BCS experience.Methods:We will conduct a randomized, sham-controlled, three-arm trial of infrared laser moxibustion (ILM) against sham ILM (SILM) and waitlist control (WLC) among BCS with moderate to severe fatigue. The two intervention groups will receive either real or sham infrared laser moxibustion on four acupoints (i.e., ST36 [bilateral], CV4, and CV6) for 20 minutes each session for 6 weeks (twice per week). The primary endpoint is the change in fatigue score from Baseline to Week 6 as measured by the Chinese version of the Brief Fatigue Inventory (BFI-C). Our secondary aim is to compare the severity of co-morbidities (e.g., depression, insomnia, and pain) among the 3 groups.Discussion:The results of our trial will establish evidence for the efficacy of infrared laser moxibustion for CRF, a very common and challenging symptom.Trial registration number:NCT03553355.
Facial nerve palsy presenting as rare neurological complication of Kawasaki disease
Authors: Yuan Ye , Lu Na 
Published: August 2019

Abstract

Rationale:
Facial nerve palsy (FNP) is one of the rare neurologic symptoms of Kawasaki disease (KD), associated with a higher incidence of coronary arteries lesions and may be an indicator of more severe disease.

Patient concerns:
A 3-month-old male infant with persistent fever, irritability, and facial asymmetry.

Diagnoses:
KD with FNP.

Interventions:
The infant received intravenous immunoglobulin (IVIG) (2 g/kg/16 hours) and aspirin (50 mg/kg/day) were started on the 8th day of illness.

Outcomes:
Fever and FNP resolved within 48 hours after IVIG treatment. The inflammatory markers all improved to normal or near-normal levels before discharge; all infectious studies returned negative. His left facial weakness was unappreciable at day of discharge.

Lessons:
FNP associated with KD is an uncommon finding but may indicate an increased risk of coronary artery involvement. KD should always be kept in mind in the differential diagnosis of a child who presents with prolonged unexplained fever, even with incomplete diagnostic features, as well as the need to be aware of unusual manifestations, such as FNP.
Single-cell transcriptional profiling reveals the heterogenicity in colorectal cancer
Authors: Dai Weier , Zhou Fangbin , Tang Donge , Lin Liewen , Zou Chang , Tan Wenyong , Dai Yong 
Published: August 2019

Abstract

Background:
Colorectal Cancer (CRC) is a highly heterogeneous disease. RNA profiles of bulk tumors have enabled transcriptional classification of CRC. However, such ways of sequencing can only target a cell colony and obscure the signatures of distinct cell populations. Alternatively, single-cell RNA sequencing (scRNA-seq), which can provide unbiased analysis of all cell types, opens the possibility to map cellular heterogeneity of CRC unbiasedly.

Methods:
In this study, we utilized scRNA-seq to profile cells from cancer tissue of a CRC patient. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed to understand the roles of genes within the clusters.

Results and Conclusion:
The 2824 cells were analyzed and categorized into 5 distinct clusters by scRNA-seq. For every cluster, specific cell markers can be applied, indicating each 1 of them different from another. We discovered that the tumor of CRC displayed a clear sign of heterogenicity, while genes within each cluster serve different functions. GO term analysis also stated that different cluster's relatedness towards the tumor of CRC differs. Three clusters participate in peripheral works in cells, including, energy transport, extracellular matrix generation, etc; Genes in other 2 clusters participate more in immunology processes. Lastly, trajectory plot analysis also supports the viewpoint, in that some clusters present in different states and pseudo-time, while others present in a single state or pseudo time. Our analysis provides more insight into the heterogeneity of CRC, which can provide assistance to further researches on this topic.