bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting low-flow anaesthesia and volatile anaesthetic agent choice
Authors: Carter Louise A , Oyewole Molola , Bates Eleanor , Sherratt Kate 
Published: September 2019

BackgroundAs doctors, we are increasingly aware of the financial implications of our practice. The need to work in a more conscientious, efficacious and cost-effective manner is greater than ever before. Environmental and financial benefits can be seen through employing the use of low-flow anaesthesia.AimsThis quality improvement project aimed to make anaesthetic practice more environmentally friendly and to reduce departmental spending. This could be achieved by promoting the use of low-flow anaesthesia and by encouraging isoflurane use where appropriate.MethodsAll anaesthetic consultants and trainees were invited to fill out an initial questionnaire relating to their personal preferences and practices when conducting anaesthesia. There were specific questions relating to low-flow anaesthesia and isoflurane use. Our main measure of improvement was any decrease in the number of bottles of volatile agent ordered by the department from pharmacy. Monthly spot audits were conducted to assess gas flow rates and volatile agent use in theatre. Departmental spending figures relating to the purchase of volatile agent bottles were obtained from pharmacy. Information was then disseminated to anaesthetists on a monthly basis via a ‘low-flow board’, which showed pictorial and graphical representations of differing gas flows and volatile agent usage in relation to cost.ResultsOur project showed a trend for the increased use of low-flow anaesthesia within the department. We also showed a decrease in the number of bottles of volatile agent ordered: 18% fewer bottles ordered compared with the same period the previous year. This represented a 25% decrease in total departmental expenditure on volatile agents despite an increase in theatre activity.ConclusionIncreasing awareness regarding anaesthetic choices and promoting low-flow anaesthesia and isoflurane use, translated into an overall decreased departmental spend on volatile agents without affecting patient care.
Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: systematic review protocol
Authors: Goley Stephanie Michele , Sakula-Barry Sidonie , Kelly Ann , Wright Naomi 
Published: September 2019

IntroductionCongenital anomalies are the fifth leading cause of mortality in children under 5 years globally. The greatest burden is faced by those in developing countries, where over 95% of deaths occur. Many of these deaths may have been preventable through antenatal diagnosis and early intervention. This study aims to conduct a systematic review that investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in low-income and middle-income countries (LMICs).Methods and analysisA systematic literature review will be conducted using three search strings: (1) structural congenital anomalies, (2) LMICs and (3) antenatal diagnosis. Four electronic databases will be searched: MEDLINE, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening will be undertaken in duplicate by two reviewers independently using Covidence. Consensus will be sought from the wider authorship for discrepancies. Data extraction will be undertaken by the principal investigator. The primary analysis will focus on the availability and effectiveness of antenatal ultrasound for structural congenital anomalies. Secondary outcomes will include neonatal morbidity and mortality, termination rates and referral rates for further antenatal care. Descriptive statistics and a narrative synthesis will be included in the final report. The methodological quality of the included studies will be evaluated using the Cochrane-approved Risk of Bias for Non-Randomised Studies of Intervention and Risk of Bias in Randomised Trials V.2.0 tools.Ethics and disseminationEthical approval is not required for conducting the systematic review as there will be no direct collection of data from individuals. The results will be submitted for publication in a scientific journal and presented internationally.ConclusionThis is the first study, to our knowledge, to systematically review current literature on the use of antenatal ultrasound for the detection of congenital anomalies in LMICs. This is vital to define current practice, highlight global disparities and evaluate effects on health outcomes for infants in low-resource settings.PROSPERO registration numberCRD42019105620.
Transversus abdominis plane block and intrathecal morphine use in cesarean section: a retrospective review
Authors: Cole Jacob , Hughey Scott , Longwell Jason 
Published: September 2019

ObjectivesCesarean delivery is an extremely common surgical procedure practiced worldwide. It is an open abdominal surgery, and is associated with significant postoperative pain. One modality that helps alleviate this pain is the transversus abdominis plane (TAP) block. This analysis sought to evaluate postoperative pain when this block was used in conjunction with intrathecal morphine.MethodsA retrospective review was performed of 142 patients who underwent cesarean section at our institution. Of those, 43 patients had a TAP block performed. The primary outcome for this analysis was the time to first opioid administration following discharge from the operating room. Secondary outcomes included differences in postoperative pain scores, and overall opioid consumption.ResultsThe average time to first opioid use postoperatively decreased in the TAP group when compared with the No-TAP group, 23.3 versus 12.1, respectively (difference of 48.2% (95% CI 74.0% to 24.3%); p<0.001) and opioid consumption was significantly decreased within the first 24 hours following surgery from 4.55 intravenous morphine equivalents (IVME) to 2.67 IVME, respectively (difference of 107.1% (95% CI 145.1% to 69.2%); p=0.006). Visual analog pain scores were significantly decreased in the TAP group versus the No-TAP group up to 36 hours postoperatively.ConclusionsTAP blocks performed in conjunction with intrathecal morphine may decrease opioid use in the first 24 hours and improve pain scores for at least 36 hours following cesarean section. Because of the favorable safety profile, TAP blocks may contribute meaningfully to multimodal anesthesia for cesarean sections.
Compliance of e-cigarette refill liquids with regulations on labelling, packaging and technical design characteristics in nine European member states
Authors: Girvalaki Charis , Vardavas Alexander , Tzatzarakis Manolis , Kyriakos Christina N , Nikitara Katerina , Tsatsakis Aristidis M , Vardavas Constantine I 
Published: September 2019

ObjectiveTo evaluate electronic cigarette (e-cigarette) product compliance with European regulations (Tobacco Products Directive (TPD), Implementing Decisions), with a focus on labelling/packaging practices and technical design/safety features.MethodsBefore the implementation of the TPD, in early 2016, we randomly selected e-cigarette refill liquids from the five top-selling companies in France, Poland, Germany, Netherlands, UK, Spain, Romania, Hungary and Greece. Identical products were purchased after the implementation of the TPD (early 2018) and assessment of compliance was performed on self-matched samples (n=107) using a prospective cohort design. Compliance with the Classification, Labelling and Packaging (CLP) regulations was also evaluated.ResultsFollowing the implementation of the TPD, improvements were noted with regards to the existence of text-only warnings (32.7% pre vs 86.0% post, p<0.001), child-resistant fastenings (93.3% pre vs 100.0% post, p=0.016), tamper-proof vials (58.9% pre vs 86.9%, post p<0.001) and maximum refill volume ≤10 mL in vials (86.9% pre vs 94.4% post, p=0.008). Lower compliance was noted with regards to the inclusion of a leaflet (26.2% pre vs 53.3% post, p<0.001), refilling instructions (28.0% pre vs 51.4% post, p<0.001) and health warnings on the box, vial or leaflet (32.7% pre vs 86.0%, p<0.001). Overall, 86.0% of products had a warning label in the post-TPD phase in comparison to 32.7% of products before the implementation of the TPD (p<0.001). Compliance with the CLP regulations, also increased in the post TPD follow-up phase.ConclusionsThis is the first study to evaluate the level of implementation of the e-cigarette regulations in nine EU member states. Our results indicate that refill liquids had substantial but not full compliance in most of the characteristics evaluated. Further effort is needed to ensure complete compliance.
Unsuspected Protumorigenic Signaling Role for the Oncometabolite GABA in Advanced Prostate Cancer
Authors: Taylor Renea A. , Watt Matthew J. 
Published: September 2019

Abstract

Elucidating the events that underpin the transition from androgen-dependent to castrate-resistant prostate cancer (CRPC) remains a clinical challenge. In this issue of Cancer Research, Gao and colleagues identify that the γ-aminobutyric acid (GABA) shunt is upregulated with the onset of CRPC, via phosphorylation and activation of glutamate decarboxylase (GAD) 65. Overproduction of GABA, an oncometabolite, can directly regulate nuclear androgen receptor signaling to drive tumorigenesis, thereby providing a link between aberrant metabolism and protumorigenic signaling in advanced prostate cancer. The findings from this study support exploring the GABA shunt, GAD65 in particular, as a molecular target in the treatment of CRPC.
See related article by Gao et al., p. 4638
Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm
Authors: Tian Ying , Wittwer Erica D. , Kapa Suraj , McLeod Christopher J. , Xiao Peilin , Noseworthy Peter A. , Mulpuru Siva K. , Deshmukh Abhishek J. , Lee Hon-Chi , Ackerman Michael J. , Asirvatham Samuel J. , Munger Thomas M. , Liu Xing-Peng , Friedman Paul A. , Cha Yong-Mei 
Published: September 2019

Background:
Percutaneous stellate ganglion blockade (SGB) has been used for drug-refractory electrical storm due to ventricular arrhythmia (VA); however, the effects and long-term outcomes have not been well studied.

Methods:
This study included 30 consecutive patients who had drug-refractory electrical storm and underwent percutaneous SGB between October 1, 2013, and March 31, 2018. Bupivacaine, alone or combined with lidocaine, was injected into the neck with good local anesthetic spread in the vicinity of the left stellate ganglion (n=15) or both stellate ganglia (n=15). Data were collected for patient clinical characteristics, immediate and long-term outcomes, and procedure-related complications.

Results:

Clinical characteristics included age, 58±14 years; men, 73.3%; and left ventricular ejection fraction, 34±16%. At 24 hours, 60% of patients were free of VA. Patients whose VA was controlled had a lower hospital mortality rate than patients whose VA continued (5.6% versus 50.0%;
P
=0.009). Implantable cardioverter-defibrillator interrogation showed a significant 92% reduction in VA episodes from 26±41 to 2±4 in the 72 hours after SGB (
P
<0.001). Patients who died during the same hospitalization (n=7) were more likely to have ischemic cardiomyopathy (100% versus 43.5%;
P
=0.03) and recurrent VA within 24 hours (85.7% versus 26.1%;
P
=0.009). There were no procedure-related major complications.

Conclusions:
SGB effectively attenuated electrical storm in more than half of patients without procedure-related complications. Percutaneous SGB may be considered for stabilizing ventricular rhythm in patients for whom other therapies have failed.
Sex-Based Differences in Left Ventricular Assist Device Utilization
Authors: Joshi Aditya A. , Lerman Joseph B. , Sajja Aparna P. , Dahiya Garima , Gokhale Avantee V. , Dey Amit K. , Kyvernitakis Andreas , Halbreiner M. Scott , Bailey Stephen , Alpert Craig M. , Poornima Indu G. , Murali Srinivas , Benza Raymond L. , Kanwar Manreet , Raina Amresh 
Published: September 2019

Background:
Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVAD mortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVAD mortality by sex.

Methods and Results:

Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients—25.8% in 2004 to 21.9% in 2016 (
P
for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%,
P
<0.0001) but not in the continuous-flow era (13.3% versus 12.1%,
P
=0.27;
P
for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45–3.10;
P
<0.0001) but not during the continuous-flow era (1.18; 0.93–1.48;
P
=0.16).

Conclusions:
Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.
Association Between High‐Sensitivity Cardiac Troponin T and Echocardiographic Parameters in Chronic Kidney Disease: Results From the KNOW‐CKD Cohort Study
Authors: Kang Eunjeong , Ryu Hyunjin , Kim Jayoun , Lee Joongyub , Lee Kyu‐Beck , Chae Dong‐Wan , Sung Su Ah , Kim Soo Wan , Ahn Curie , Oh Kook‐Hwan 
Published: September 2019

Background

It is unclear whether high‐sensitivity troponin T (hs‐TnT) is associated with subclinical cardiac changes in chronic kidney disease (
CKD
). We evaluated the relationship between hs‐TnT and left ventricular structure and function in a
CKD
population, according to estimated glomerular filtration rate.

Methods and Results

We analyzed 2017 patients with
CKD
stages 1 to 5 (predialysis) in the
KNOW
‐CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease) cohort. The predictor was hs‐TnT level measured at baseline, and the outcomes were left ventricular hypertrophy (
LVH
) and systolic and diastolic dysfunction shown by echocardiography at baseline and after 4 years. Participants were categorized into quartiles according to hs‐TnT levels. The associations between quartiles of hs‐TnT and outcomes were assessed using multivariable logistic regression analysis with confounders including demographics, medical history, and laboratory findings. A receiver operating characteristic curve was used to assess the diagnostic power of hs‐TnT for the outcomes as a continuous variable. For subgroup analysis, patients were stratified based on an estimated glomerular filtration rate of 60 mL/min per 1.73 m
2
. Elevated hs‐TnT was associated with
LVH
and diastolic dysfunction at baseline in an adjusted model but was not associated with systolic dysfunction. These associations remained significant for both estimated glomerular filtration rate subgroups. Receiver operating characteristic curve analysis showed that hs‐TnT as a continuous variable exhibited fair significance for detection of
LVH
(area under the curve: 0.689) and diastolic dysfunction (area under the curve: 0.744). Multivariable analysis showed that higher hs‐TnT levels at baseline were related to development of
LVH
but not diastolic dysfunction (n=864).

Conclusions

In
CKD
patients, hs‐TnT is strongly associated with alterations of left ventricular structure and diastolic dysfunction for both estimated glomerular filtration rate strata. Baseline hs‐TnT levels are predictive of new
LVH
on follow‐up.
Reduced Venous Oxygen Saturation Associates With Increased Dependence of Patients With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy
Authors: Ling Chen , Zhang Zihao , Wu Yue , Fang Xiaojing , Kong Qingle , Zhang Wei , Wang Zhaoxia , Yang Qi , Yuan Yun 
Published: September 2019

Background and Purpose—
Accumulating evidence has demonstrated hemodynamic abnormalities and cerebral hypoperfusion in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Increased venous susceptibility assessed by susceptibility weighted imaging and mapping has been shown to indicate a decrease in venous oxygen saturation. This study aimed to investigate whether altered venous oxygen saturation is related to clinical phenotypes of CADASIL patients.

Methods—
Using 7.0-T susceptibility weighted imaging and mapping, we compared venous susceptibility of cortical veins between 41 CADASIL patients and 43 age- and sex-matched healthy controls. The magnetic resonance imaging lesion load, mini-mental state examination score, Barthel Index, and modified Rankin Scale were examined in the patient group, and the correlations between venous susceptibility and clinical characteristics were analyzed.

Results—

Venous susceptibility increased with age (
r
=0.508,
P
=0.001) and was higher in CADASIL patients than in healthy controls (
t
=−4.673;
P
<0.001). We found a positive association between venous susceptibility and the age-related white matter change scores (
r
=0.364;
P
=0.019), number of lacunar infarctions (
r
=0.520;
P
<0.001), number of cerebral microbleeds (
ρ
=0.445;
P
=0.004), and small-vessel disease scores (
ρ
=0.465;
P
=0.002) in CADASIL patients. Moreover, increased venous susceptibility was associated with higher modified Rankin Scale scores in CADASIL patients after adjustment for age- and small-vessel disease scores (odds ratio=3.178; 95% CI, 1.101–9.179;
P
=0.033).

Conclusions—
Our findings indicate that extensive cerebral hypoperfusion may induce central nervous system impairment in CADASIL, and susceptibility weighted imaging and mapping could be used clinically to assess the condition of CADASIL patients.
Profiles of mitochondrial DNA methylation in the ridgetail white prawn, Exopalaemon carinicauda (Holthuis, 1950) (Decapoda, Palaemonidae) under heavy metal stress from chromium and cadmium
Authors: Ma Hangke , Sun Jinqiu , Xu Wanyuan , Dai Qin , Hu Guangwei , Lai Xiaofang , Yan Binlun , Gao Huan 
Published: September 2019

Abstract
For the purpose of studying the epigenetic characteristics of the mitochondrial genome of the ridgetail white prawn, Exopalaemon carinicauda (Holthuis, 1950) under Cd2+ and Cr6+ heavy metal stress, the mitochondrial DNA methylation of E. carinicauda was analysed by bisulfite sequencing PCR (BSP). Many methylation sites were found at the 3′ end sequence of COX3 and at the starting region sequence of ND3, while only a few methylation sites were found at the 3′ end sequence of ND5. The mitochondrial genome was inferred to regulate the energy metabolism through the methylation process. In addition, under Cd2+ stress, mitochondrial DNA methylation was more common, and found during all stress periods (3, 6, 12, 24, 48, 72 and 96 h), while under Cr6+ stress, mitochondrial DNA methylation was less common, mainly occurring after 48 hours of stress. The sensitivity of the mitochondrial genome response to Cd2+ stress was inferred to be greater than that to Cr6+. This study revealed for the first time that methylation occurs in the mitochondrial genome of E. carinicauda in response to heavy metal stress.
Cheirocratus pseudosundevallii (Amphipoda, Cheirocratidae), a new species from Arcachon Bay, Bay of Biscay
Authors: Gouillieux Benoit 
Published: September 2019

Abstract
An examination of some benthic amphipods belonging to the genus Cheirocratus from Arcachon Bay revealed that they exhibited a combination of morphological character states that distinguished them from all previously described Cheirocratus species. In the form of the gnathopods, Cheirocratus pseudosundevallii is very close to two other European species: C. sundevallii and C. intermedius. An actualized key to the species of Cheirocratus is provided.
Prognostic implications of microcirculatory perfusion versus macrocirculatory perfusion in cardiogenic shock: a CULPRIT-SHOCK substudy
Authors: Wijntjens Gilbert WM , Fengler Karl , Fuernau Georg , Jung Christian , den Uil Corstiaan , Akin Sakir , van de Hoef Tim P , Šerpytis Rokas , Diletti Roberto , Henriques José PS , Šerpytis Pranas , Thiele Holger , Piek Jan J 
Published: September 2019

Background: After early revascularisation, restoration of macrocirculatory perfusion parameters is the primary objective in the management of cardiogenic shock complicated acute myocardial infarction. Nevertheless, vital organ perfusion may be compromised at the systemic microcirculatory level, even in patients with preserved macrohaemodynamics. Microvascular perfusion was shown to have independent prognostic value for early mortality. The present study aims to compare the prognostic value of microcirculatory versus macrocirculatory perfusion parameters. Methods: This substudy of the culprit lesion-only percutaneous coronary intervention versus multivessel percutaneous coronary intervention in cardiogenic shock (CULPRIT-SHOCK) trial examined the sublingual capillary network using videomicroscopy post-percutaneous coronary intervention to determine the proportion of perfused capillaries (<20 µm) and perfused capillary density. Thirty-day follow-up was performed to obtain the occurrence of a combined clinical endpoint of all-cause death and renal replacement therapy. Results: Videomicroscopy measurements were performed in 66 patients. There was a significant adjusted association between microcirculatory perfusion parameters and the combined clinical endpoint (proportion of perfused capillaries: P=0.020; perfused capillary density: P=0.035), whereas there was no significant adjusted association between macrocirculatory perfusion parameters and the combined clinical endpoint (systolic blood pressure: P=0.205). Normotensive patients with compromised microcirculatory perfusion parameters had a higher risk of the combined clinical endpoint than normotensive patients with preserved microcirculatory perfusion parameters (proportion of perfused capillaries: Breslow P=0.014; perfused capillary density: Breslow P=0.076). Conclusions: There is a significant and independent association between microcirculatory perfusion parameters perfused capillary density and proportion of perfused capillaries and the combined clinical endpoint of all-cause death and renal replacement therapy at 30 days follow-up. In patients with loss of haemodynamic coherence between microcirculatory and macrocirculatory perfusion parameters, microcirculatory perfusion parameters confer dominant prognostic value.