bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Maternal Morbidity Due to Sepsis: The Burden and Preventability of Disease in New Zealand
Authors: Lepine S. , Lawton B. , Geller S. , Abels P. , MacDonald E.J. 
Published: August 2019

(Aust N Z J Obstet Gynaecol. 2018;58:648–653)
Obstetric sepsis is a common cause of severe maternal morbidity (SMM) in New Zealand with its incidence appearing to be on the rise. Physiological changes of pregnancy and labor analgesia may sometimes mask symptoms of sepsis, making diagnosis of sepsis in parturients more difficult than in nonpregnant patients. Pregnancy also alters the immune system, leading to varied responses to infection. To diagnose sepsis in a more timely fashion and improve patient outcomes, obstetricians and anesthesiologists should have a low index of suspicion for sepsis in pregnant and postpartum women who present with signs of fever, tachycardia, dyspnea and other symptoms that could suggest sepsis. Over the past few years there has been the introduction of care bundles throughout medicine which are meant to improve the recognition, diagnosis, and management of sepsis. This article aimed to describe the degree of severe morbidity caused by obstetric sepsis in New Zealand, with special attention focused on possible methods of prevention.
Experimental Validation of the CompuFlo Epidural Controlled System to Identify the Epidural Space and Its Clinical Use in Difficult Obstetric Cases
Authors: Capogna G. , Camorcia M. , Coccoluto A. , Micaglio M. , Velard M. 
Published: August 2019

(Int J Obstet Anesth. 2018;36:28–33)
While epidural block is commonly used in obstetrics, it may be associated with a significant failure rate. Various devices have been designed in an attempt to aid in identification of the position of the epidural needle tip using visual or auditory end-points. The CompuFlo Instrument is a computer-controlled drug-delivery system which is able to distinguish different tissue types by measuring pressure at the tip of the needle in real time. This device provides audible signals and visual graphics of exit-pressure. This study aimed to determine whether the CompuFlo is suitable for difficult epidural placement as well as examined the utility of CompuFlo during epidural placement.
Ocular Ultrasonography for Diagnosing Increased Intracranial Pressure in Patients With Severe Preeclampsia
Authors: Simenc G.B. , Ambrozic J. , Prokselj K. , Tul N. , Cvijic M. , Mirkovic T. , Lucovnika M. 
Published: August 2019

(Int J Obstet Anesth. 2018;36:49–55)
In most patients (71% to 100%) with preeclampsia with severe features, signs of cerebral edema are present and confirmed by magnetic resonance imaging. Morbidity and mortality rates have been significantly improved when cerebral edema is promptly diagnosed and treated. Recently, ocular ultrasonography has been suggested to be a reliable means of detecting raised intracranial pressure (ICP) in nonpregnant populations. Specifically, optic nerve sheath diameter (ONSD) and optic disc height (ODH) as measured via ultrasound are increased in the setting of increased ICP. ONSD has been correlated to ICP measured invasively in nonpregnant patients. This study aimed to determine whether patients with preeclampsia with severe features have greater ONSD or ODH when compared with healthy pregnant women.
A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery
Authors: Lissauer D. , Wilson A. , Hewitt C.A. , Middleton L. , Bishop J.R.B. , Daniels J. , Merriel A. , Weeks A. , Mhango C. , Mataya R. , Taulo F. , Ngalawesa T. , Chirwa A. , Mphasa C. , Tambala T. , Chiudzu G. , Mwalwanda C. , Mboma A. , Qureshi R. , Ahmed I. , Ismail H. , Oladapo O.T. , Mbaruku G. , Chibwana J. , Watts G. , Simon B. , Ditai J. , Otim Tom C. , Acam J. , Ekunait J. , Unzia H. , Iyaku M. , Makiika J.J. , Zamora J. , Roberts T. , Goranitis I. , Bar-Zeev S. , Desmond N. , Arulkumaran S. , Bhutta Z.A. , Gulmezoglu A.M. , Coomarasamy A. 
Published: August 2019

(N Engl J Med. 2019;380:1012–1021)
It is unclear whether or not antibiotic prophylaxis prior to surgery to complete spontaneous abortion (removal of retained products of conception) can reduce postoperative pelvic infection. Evidence is lacking and international guidelines regarding this issue are also inconsistent. This issue is particularly concerning for women in low-income and middle-income countries, where rates of surgery for incomplete spontaneous abortion are high, and where pelvic infection can lead to serious illness and death. In order to help clarify this issue, the authors of the present study assessed the use of antibiotic prophylaxis (doxycycline and metronidazole, both inexpensive, heat-stable, and widely available) in women undergoing surgery to complete spontaneous abortion in low-resource settings.
Prophylactic Insertion of Large Bore Peripheral Intravenous Catheters in Maternity Patients for Postpartum Haemorrhage: A Cohort Study
Authors: Webster J. , Larsen E. , Booker C. , Laws J. , Marsh N. 
Published: August 2019

(Aust N Z J Obstet Gynaecol. 2018;58:548–552)
In Australia, most women undergoing labor and vaginal delivery receive a peripheral intravenous catheter (PIVC) for any needed IV fluids, blood products or medications. While the smallest gauge catheter necessary is recommended by guidelines for intravenous access, many women receive a large-bore, 16 or 18 G, PIVC due to concerns about potential obstetric hemorrhage. Insertion of large-bore PIVCs can be very painful, especially when inserted in the back of the hand or wrist. This current study aimed to assess the necessity of large bore PIVCs in laboring parturients by inquiring about: any existing evidence supporting the practice; how common this practice is in Australia; the proportion of inserted PIVCs that are 18 G or larger; and the number of women requiring blood products in the peripartum period.
An Evaluation of Fetal Heart Rate Characteristics Associated With Neonatal Encephalopathy: A Case-Control Study
Authors: Frey H.A. , Liu X. , Lynch C.D. , Musindi W. , Samuels P. , Rood K.M. , Thung S.F. , Bakk J.M. , Cheng W. , Landon M.B. 
Published: August 2019

(BJOG. 2018;125(11):1480–1487)
Neonatal encephalopathy (NE) is characterized by abnormal neurological function that presents with decreased level of consciousness or seizures, difficulty maintaining respirations, and abnormal reflexes or tone. This clinical condition is identified shortly after birth with an incidence of 2 to 6/1000 live births. There is incomplete understanding of the etiology of NE and no evidence-based interventions to prevent its occurrence. The objective of the study was to identify predelivery fetal heart rate (FHR) characteristics associated with NE. The hypothesis was category III FHR tracings would be associated with NE.
Transversalis Fascia Plane Block Provides Effective Postoperative Analgesia for Cesarean Section: New Indication for Known Block
Authors: Tulgar S. , Serifsoy T.E. 
Published: August 2019

(J Clin Anesth. 2018;48:13–14. Doi:10.1016/j.jclinane.2018.04.006)
Adequate analgesia after cesarean section (CS) requires sensorial blockade of the subcostal (T12), ilioinguinal (L1), and iliohypogastric (T12-L1) nerves’ cutaneous branches. However, the posterior transversus abdominis plane block, commonly used for CS, may not affect the T12 and L1 cutaneous branches. Therefore, in this study, the authors reported the first effective use of the transversalis fascia plane block (TFPB) in 2 patients, which should provide blockade of the ilioinguinal and iliohypogastric nerves.
Early Effects of the Trauma Collaborative Care Intervention: Results From a Prospective Multicenter Cluster Clinical Trial
Authors:   The Major Extremity Trauma Rehabilitation Consortium (METRC)
Published: August 2019

Objectives:
To evaluate the impact of the Trauma Collaborative Care (TCC) program's early intervention components on 6-week outcomes. TCC was developed to improve psychosocial sequelae of orthopaedic trauma and includes the Trauma Survivors Network and additional collaborative care services.

Design:
Prospective, multicenter, cluster clinical trial.

Setting:
Level I Trauma Centers.

Patients:
Individuals with high-energy orthopaedic injuries requiring surgery and hospital admission: 413 patients at 6 trauma centers implementing the TCC program and 374 patients at 6 trauma centers receiving usual care.

Intervention:
TCC early intervention: patient education, peer visits, and coaching calls.

Main Outcome Measurements:
Pain rating scale, Patient Health Questionnaire—9 depression, Post-Traumatic Stress Disorder Checklist, and self-efficacy for return to work and managing finances. For each outcome, a hybrid Bayesian statistical procedure, accounting for clustering within sites and differences in baseline characteristics between sites, was used to estimate the intention-to-treat (ITT) effect and the effect under full receipt of early intervention components.

Results:
Sites varied substantially in utilization of intervention components. The posterior estimates of the ITT (full receipt) effect favor TCC for 4 (5) of the 5 endpoints. The posterior probabilities of a favorable (ITT; full receipt) TCC effect were as follows: depression (89%–93%), pain (84%–74%), post-traumatic stress disorder (68%–68%), self-efficacy for return to work (74%–76%), and self-efficacy for managing finances (47%–61%).

Conclusions:
Results suggest TCC may have a small positive effect on early outcomes, but use of the services was highly variable among sites.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Pain During “Noncomplex” Electrophysiological Studies and Cardiac Rhythm Device Surgery
Authors: Fikenzer Sven , Fikenzer Kati , Bauer Yvonne , Kuehl Michael , Hindricks Gerhard , Bollmann Andreas , Bode Kerstin 
Published: August 2019

Background:
There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated.

Methods:
A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0–10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection.

Results:
In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)—maxNRS, peri: 3 (0–10) versus peri-post: 4 (0–9) (ns), and meanNRS, peri: 1.4 (0–7) versus peri-post: 2.0 (0–6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain.

Conclusion:
Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.
Pineal region metastasis with intraventricular seeding
Authors: Ji Junpeng , Gu Chunyu , Zhang Mingshan , Zhang Hongwei , Wang Haoran , Qu Yanming , Ren Ming , Ning Weihai , Yu Chunjiang 
Published: August 2019

Abstract

Introduction:
Tumors of the pineal region are rare, and metastatic carcinoma occurring in the pineal region is extremely rare. No previous reports have described pineal region metastasis with intraventricular seeding.

Patient concerns:
We report a case of a 51-year-old woman presented with a 1-week history of severe headache, nausea, and vomiting. Imaging examination revealed 2 lesions in the pineal region and the right lateral ventricle.

Diagnosis:
Pinealocytoma or germinoma was considered as the preoperative diagnosis. The postoperative pathological diagnosis was small cell neuroendocrine carcinoma. After bronchoscopic biopsy, small cell lung cancer was confirmed.

Interventions:
A right frontal craniotomy and a translateral ventricle approach were performed to remove 2 lesions completely. And regular radiotherapy and chemotherapy were initiated after surgery.

Outcomes:
The patient was discharged from the hospital 2 weeks after operation and went to another cancer hospital for bronchoscopic biopsy, radiotherapy, and chemotherapy. Finally, the patient died 2 years after surgical treatment.

Conclusion:
Metastatic tumors of the pineal region are very rare. For patients with pineal lesions, a diagnosis of a metastatic tumor should be considered. Retrograde cerebrospinal fluid circulation might be the reason for a secondary metastasis.
A unique fatal case of Waterhouse–Friderichsen syndrome caused by Proteus mirabilis in an immunocompetent subject
Authors: Ventura Spagnolo Elvira , Mondello Cristina , Roccuzzo Salvatore , Stassi Chiara , Cardia Luigi , Grieco Angela , Raffino Cataldo 
Published: August 2019

Abstract

Introduction:
The Waterhouse–Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS.

Patient concerns:
After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) after the primary care he was discharged. Subsequently, after 2 days of general malaise, he returned to the hospital due to the worsening of the clinical condition. During the hospitalization, hypotension, and neurological impairment appeared; the laboratory analysis showed leukocytosis and the alteration of renal, hepatic and coagulative parameters. Microbiological blood analysis resulted positive for a P mirabilis infection.

Diagnosis:
Multiorgan failure (MOF) with disseminated intravascular coagulation (DIC) due to sepsis was diagnosed.

Interventions:
The practitioners administered intensive support, antibiotic therapy, antithrombin III, vitamin K, and plasma.

Outcomes:
After 3 days the subject died. The autopsy and the microscopic investigation were performed revealing, also, the adrenal diffuse micronodular hyperplasia associated with a cortico-medullary hemorrhagic apoplexy.

Conclusion:
To our knowledge, this is the first case of MOF with WFS due to P mirabilis infection. This case report suggests that P mirabilis should be added to the list of unusual bacteria causing WFS. Furthermore, it supports the theory that any bacterium which causes DIC may cause adrenal hemorrhage and should suggest to clinicians the importance to consider a potential adrenal involvement in every patient with sepsis and DIC.
Correlation between CCL2, CALCA, and CX3CL1 gene polymorphisms and chronic pain after cesarean section in Chinese Han women
Authors: Ma Guoping , Yang Jingli , Zhao Bange , Huang Chengquan , Wang Rui 
Published: August 2019

Abstract

Objective:
Postoperative chronic pain is characterized by high incidence, long duration, and complex pathogenesis. The purpose of this study was to investigate the correlation between the single nucleotide polymorphisms of the CCL2 gene rs4586 (g.5974T>C), CALCA rs3781719 (−692T>C), CX3CL1 rs614230 (2342C>T), and the risk of postoperative chronic pain in Chinese Han women.

Methods:
We analyzed the CCL2 gene rs4586, CALCA rs3781719, CX3CL1 rs614230 single nucleotide polymorphism (SNPs) of 350 Chinese Han women with chronic postsurgical pain (CPSP) 6 months after cesarean section and 350 healthy women without chronic pain (HC). The levels of CCL2, CALCA, and CX3CL1 in serum were detected by enzyme-linked immunosorbent assay (ELISA).

Results:
The CCL2 rs4586 T allele and the CX3CL1 gene rs614230C allele were protective factors for CPSP risk (adjusted OR = 0.766, 95% CI: 0.675–0.865 and OR = 0.336, 95% CI: 0.644–0.835). The CALCA gene rs3781719C allele was a risk factor for CPSP (adjusted OR = 1.273, 95% CI: 1.125–1.424). CCL2 rs4586, CX3CL1 gene rs614230, and CALCA gene rs3781719 locus gene polymorphisms were associated with serum CCL2, CX3CL1, and CALCA protein levels.

Conclusion:
Our results support that CCL2 gene rs4586, CALCA rs3781719, CX3CL1 rs614230 gene polymorphism are associated with the occurrence of chronic pain after cesarean section in Chinese Han women.
A novel compound heterozygous KCNJ1 gene mutation presenting as late-onset Bartter syndrome
Authors: Li Jingyi , Hu Shoulong , Nie Yi , Wang Rongfeng , Tan Ming , Li Hongmei , Zhu Shuanli 
Published: August 2019

Abstract

Rationale:
Bartter syndrome is an autosomal-recessive inherited disease in which patients present with hypokalemia and metabolic alkalosis. We present 1 case with Bartter syndrome, due to a novel compound heterozygous mutation in the KCNJ1 gene encoding the ATP-sensitive inward rectifier potassium channel in the thick ascending limb of the loop of Henle.

Patient concerns:
A patient was admitted to our hospital because of weakness, polyuria, and polydipsia. At presentation to our hospital, the female Chinese patient was 34 years old and her physical examination was normal. Laboratory studies revealed hypokalemia, metabolic alkalosis, hypercalciuria, hyperparathyroidemia, and hyper-reninemia. In addition, urinary potassium was obviously higher. Computer tomography scan confirmed the patient had the bilateral medullary nephrocalcinosis.

Diagnosis:
Blood samples were received from the patient and her parents, and deoxyribonucleic acid was extracted. The genetic analysis of SLC12A1, SLC12A3, KCNJ1, CLCNKB, BSND, and CASR was performed. The compound heterozygous KCNJ1 gene mutation was validated using conventional Sanger sequencing methods.

Interventions:
The patient was treated with potassium supplementation. Her blood and urine chemistries improved over the next week. Serum potassium normalized with improvement in polyuria and polydipsia over the next month.

Outcomes:
Our patient was compound heterozygous for Thr234Ile and Thr71Met in the KCNJ1 gene. The c.701C>T variant predicted a change from a threonine codon to an isoleucine codon (p.Thr234Ile). The c.212C>T variant predicted a change from a threonine codon to a methionine codon (p.Thr71Met). The unaffected mother was heterozygous for the Thr234Ile mutation, whereas unaffected father was heterozygous for the Thr71Met mutation.

Lessons:
The phenotypes of the patient were similar to other patients with Bartter syndrome. The phenotypes of the patient could eventually be explained by the presence of the novel compound heterozygous p.Thr234Ile/p.Thr71Met variants in the KCNJ1 gene.
Management of tumor rupture and abdominal compartment syndrome in an infant with bilateral high risk stage 4 neuroblastoma
Authors: Lode Holger N. , Henze Günter , Siebert Nikolai , Ehlert Karoline , Barthlen Winfried 
Published: August 2019

Abstract

Rationale:
Tumor rupture and bleeding at initial presentation of infants with neuroblastoma (NBL) is a rare, but life threatening condition and challenge in pediatric oncology. Here, we report successful multidisciplinary management of an abdominal compartment syndrome as a result of tumor rupture and bleeding in an infant with bilateral high risk stage 4 NBL.

Patient concerns:
The patient was admitted to a cooperating hospital with vomiting, failure to thrive and a large mass in the abdomen and was then referred to our center.

Diagnoses:
Stage 4 NBL with MYC-N amplification and 1p36 deletion was diagnosed in an 11 months old girl. Due to rapid and massive tumor growth she developed abdominal compression with renal failure, severe bleeding, and tumor lysis syndrome (TLS).

Interventions:
Surgical decompression by enterostomy, local, and systemic bleeding control with platelets and coagulation factors, antiinfective and TLS therapy were effective in stabilizing the patient's condition. This allowed initiation of the multimodal antineoplastic treatment according to protocol NB 2004.

Outcomes:
Mechanical ventilation was stopped after 11 days, the abdominal wall was closed 3 months after the start of therapy, and treatment according to the protocol be started and successfully completed.

Lessons:
Only the immediate, coordinated multidisciplinary intervention managed to overcome the life-threatening abdominal compartment syndrome and its associated problems, eventually enabling successful curative treatment.
CTPA, DECT, MRI, V/Q Scan, and SPECT/CT V/Q for the noninvasive diagnosis of chronic thromboembolic pulmonary hypertension
Authors: Xu Shuanglan , Yang Jiao , Zhu Yun , Xu Shuangyan , Liu Jie , Deng Yishu , Wei Li , Yang Mei , Huang Xiaoxian , Cao Bing , Zhang Chunfang , Zhao Fangyun , Liu Xing , Xing Xiqian , Li Zhongming 
Published: August 2019

Abstract

Background:
To determine the diagnostic accuracy of techniques with chronic thromboembolic pulmonary hypertension (CTEPH) patients via a protocol for systemic review and network meta-analysis.

Methods:
We will search PubMed, EMBASE, Web of Science, and Google Scholar from inception to October 1, 2018. The reference lists of the retrieved articles are also consulted. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) will be used to assess the risk of bias in each study. The direct meta-analyses, network meta-analyses, and ranking of competing diagnostic tests will be used by STATA 12.0 and WINBUGS 1.4. Heterogeneity and inconsistency are assessed.

Results:
This study is ongoing, will be submitted to a peer-reviewed journal publication once completed.

Conclusion:
This study will provide a comprehensive evidence summary of diagnostic test accuracy in detecting the CTEPH, and can help patients and clinicians to select appropriate or best diagnostic test.

Ethics and Communication:
No ethical approval and patient consent are required, because it is based on published researches.

PROSPERO registration number:
CRD42019121279.