bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Value of the Signs and Symptoms Preceding Eclampsia
Authors: Hastie Roxanne , Brownfoot Fiona C. , Cluver Catherine A. , Walker Susan P. , Hesselman Susanne , Tong Stephen , Bergman Lina 
Published: September 2019

OBJECTIVE:
To estimate the predictive value of signs and symptoms that occur before onset of eclampsia among pregnant women.

DATA SOURCES:
Electronic databases, including MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov were searched from inception to 2018. Search terms included eclampsia, predict, likelihood ratio, predictive value, and risk.

METHODS OF STUDY SELECTION:
Abstracts and later full texts were selected for review if a diagnosis of eclampsia was made, a comparator arm included (women without a diagnosis of eclampsia), and predictors of imminent eclampsia reported. Of 2,791 retrieved records, 11 were selected. Significant heterogeneity existed between studies, with differing designs, settings, participants, and signs or symptoms. In total, 28 signs or symptoms were reported, with visual disturbances and epigastric pain most common (six studies), followed by headache (five studies), and any edema (four studies).

TABULATION, INTEGRATION, AND RESULTS:
Data on study characteristics and predictive value of signs or symptoms were extracted, and, where appropriate, bivariate mixed-effect meta-analysis was applied to raw data. None of the pooled estimates were able to accurately predict eclampsia nor rule out eclampsia in their absence, with moderate specificity (83–94%) and poor sensitivity (29–56%).

CONCLUSION:
There is a dearth of high-quality studies investigating the predictive value of imminent signs and symptoms of eclampsia. Owing to the small number of studies, heterogeneity, and inconsistent reporting, it is difficult to provide accurate estimates of the predictive value of prodromal symptoms of eclampsia. Of the most commonly reported symptoms—visual disturbances, epigastric pain, and headache—none were able to accurately predict, nor rule out, imminent eclampsia.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42018095076.
Association Between First-Trimester Subchorionic Hematomas and Adverse Pregnancy Outcomes After 20 Weeks of Gestation in Singleton Pregnancies
Authors: Naert Mackenzie N. , Muniz Rodriguez Alberto , Khadraoui Hanaa , Naqvi Mariam , Fox Nathan S. 
Published: September 2019

OBJECTIVE:
To assess the association of first-trimester subchorionic hematomas with pregnancy outcomes after 20 weeks of gestation in women with singleton pregnancies.

METHODS:
We conducted a retrospective cohort study of all women with singleton pregnancies presenting for prenatal care before 14 weeks of gestation over a 3-year period at a single obstetric practice. All patients underwent routine first-trimester ultrasound examinations. We compared rates of adverse pregnancy outcomes at more than 20 weeks of gestation in women with and without a subchorionic hematoma on the initial ultrasound examination, excluding women with pregnancy loss before 20 weeks of gestation.

RESULTS:
From January 2015 to December 2017, a total of 2,172 women met the inclusion criteria for the study, 389 (17.9%) of whom had a subchorionic hematoma (mean largest diameter 2.1±1.4 cm). Women with subchorionic hematomas had their first ultrasound examination at earlier gestational ages (8 5/7 vs 9 6/7 weeks, P<.001) and were more likely to have vaginal bleeding at the time of the ultrasound examination (31.9% vs 7.9%, P<.001). Maternal age, race, use of in vitro fertilization, body mass index, and medical comorbidities did not differ between the groups. On univariable analysis, subchorionic hematoma was not associated with any pregnancy outcomes at more than 20 weeks of gestation, including gestational age at delivery, preterm birth, birth weight, birth weight less than the 10th percentile for gestational age, gestational hypertension, preeclampsia, placental abruption, intrauterine fetal death at more than 20 weeks of gestation, cesarean delivery, blood transfusion, and antepartum admissions. On regression analysis including subchorionic hematoma, vaginal bleeding, and gestational age at ultrasound examination, vaginal bleeding was independently associated with preterm birth at less than 37 weeks of gestation and birth weight less than the 10th percentile. Subchorionic hematoma was not independently associated with pregnancy outcomes. This study had 80% power to detect a 5% absolute difference in the frequency of preterm birth; that is, from 10% to 15%.

CONCLUSION:
In singleton pregnancies, a first-trimester subchorionic hematoma is not associated with adverse pregnancy outcomes at more than 20 weeks of gestation.
U.S. Food and Drug Administration Statements About Transvaginal Mesh and Changes in Apical Prolapse Surgery
Authors: Winkelman William D. , Modest Anna M. , Richardson Monica L. 
Published: September 2019

OBJECTIVE:
To assess the effects of the U.S. Food and Drug Administration (FDA) safety communication and the reclassification of transvaginal mesh to a class III device on national trends in the treatment of apical prolapse.

METHODS:
A retrospective cohort study of surgical cases from 2008 to 2017 from the American College of Surgeons National Surgical Quality Improvement Program was conducted. Patients were included if they underwent apical prolapse repair, as identified by Current Procedural Terminology codes.

RESULTS:
We identified 36,523 eligible surgical cases. There were no clinically meaningful differences in postoperative complications when stratified by surgical approach. The use of transvaginal mesh decreased from 35.0% to 11.0% from 2008 to 2017. In the year immediately after the first FDA safety communication in 2011, there was a decrease in the proportion of apical procedures using transvaginal mesh of 4.4% per quarter (P<.001), and the proportion of intraperitoneal, extraperitoneal, and abdominal colpopexy all increased. The greatest increase was seen for abdominal colpopexy procedures, which rose by 2.6% per quarter (P<.001). In the year after the FDA reclassification of transvaginal mesh in 2016, there was no significant change in the proportion of apical procedures using transvaginal mesh (P=.56).

CONCLUSION:
The first FDA safety communication in 2011 was associated with a significant decline in the use of transvaginal mesh and a concurrent rise in abdominal colpopexy procedures using transabdominal mesh. We speculate that the 2019 FDA ban of transvaginal mesh will result in an even more substantial shift toward abdominal colpopexy procedures.
Detailed Fetal Anatomic Ultrasound Examination Duration and Association With Body Mass Index
Authors: Gupta Vivek K. , Adams Jacquelyn H. , Heiser Timothy , Iruretagoyena J. Igor , Hoppe Kara K. , Antony Kathleen M. 
Published: September 2019

OBJECTIVE:
To evaluate the association of the duration of the detailed fetal anatomic ultrasound examination with maternal body mass.

METHODS:
This was a retrospective chart review of patients presenting to our clinic for detailed fetal anatomic examinations between January 1, 2010, and June 30, 2017. After excluding multifetal pregnancies and other examinations expected to have a longer duration, a total of 6,522 examinations were performed between 18 0/7 and 22 0/7 weeks of gestation. Results were analyzed using analysis of variance and Student's t-test.

RESULTS:
Mean (SD) body mass index (BMI) was 29.3 (±7.7), and mean examination time was 51.5 (±10.4) minutes. We found that mean examination time was 48.8 (±9.6) minutes for patients with normal BMIs, 50.6 (±10.0) minutes for overweight patients, 52.2 (±10.4) minutes for patients with class I obesity, 54.6 (±10.3) minutes for patients with class II obesity, and 57.7 (±10.3) minutes for patients with class III obesity (P<.001). The duration of the detailed fetal anatomic ultrasound examination increased continuously with BMI (r=0.285, P<.001).

CONCLUSION:
We found that the duration of detailed fetal anatomic examinations increased with BMI. Examinations for gravid patients with class III obesity lasted 8.9 minutes longer than those for gravid patients with normal BMIs; examinations for gravid patients with BMIs of 50 or higher lasted 13.5 minutes longer. This information may be useful for fetal ultrasound examination scheduling.
Practical Heart Sparing Breast Cancer Radiation Therapy Using Continuous Positive Airway Pressure (CPAP) in Resource-Limited Radiation Oncology Clinics
Authors: Kil Whoon Jong , Lee Ik Jae , Pham Tabitha , Cho In Hye 
Published: September 2019

Purpose:
The purpose of this study was to report experiences of practical heart sparing breast radiation therapy (RT) using continuous positive airway pressure (CPAP) in resource-limited radiation oncology clinics.

Patients and Methods:
Twelve patients underwent computed tomography-simulations with both free-breathing (FB) and CPAP under the individual maximum tolerable air pressure. For each patient, left-sided breast RT plans (9 with breast only, 3 with breast and regional nodal stations) with FB and CPAP were created using 3-dimensional conformal RT (supine tangential or wide tangential RT fields) according to RTOG 1304. For daily RT, patients started CPAP in the patients waiting area for 15 minutes before entering the treatment room and continued CPAP during RT. Treatment setup times between breast RT with and without CPAP were compared.

Results:
All patients tolerated CPAP well with 8 to 15 cm H2O of air pressure. Compared with FB, CPAP inflated the thorax and increased total lung volume by 35±16% (CPAP: 3136±751 vs. FB: 2354±657 cm3, P<0.01); caudally displaced the heart by 1.8 cm (P<0.01); and decreased heart volume within tangential RT fields on computed tomography–simulation scans by 96±4% (1.4±2.5 vs. 21±17 cm3, P=0.02) in all patients. Planning target volume coverage was acceptable in all RT plans. CPAP lowered mean dose (D
mean) to heart by 47±22% (2.5±1.5 vs. 5.4±3.3 Gy, P<0.01); heart volume receiving ≥25 Gy (V25) by 82±18% (2.2±2.6 vs. 9.1±7.1%, P<0.01); D
mean to left anterior descending coronary artery by 68±8% (4.7±1.9 vs. 14.8±3.3 Gy, P<0.01). CPAP decreased radiation dose to ipsilateral lung compared with FB: 9.1±5.8 versus 11.2±8 Gy (20% reduction, P=0.03) of D
mean; 15.7±12.5 vs. 20.5±17.5% (25% reduction, P=0.03) of V20. RT with CPAP did not increase treatment setup time compared with FB (week 1: 362±63 vs. 352±77 s; week 2 to 5: 217±13 vs. 201±14 s, all P>0.25).

Conclusion:
Novel use of CPAP allowed efficient and practical heart sparing breast RT without increasing infrastructural requirements in resource-limited radiation oncology clinics.
Cerebral Hemorrhage after Cosmetic Facial Injection
Authors: Wang Chenyu , Wang Xiaojun 
Published: September 2019

Summary:
Cosmetic facial injection is a mini-invasive surgical procedure and is widely used at present. Meanwhile, it may also cause severe complications like cerebrovascular infarction occasionally. A 49-year-old female patient presented to a local hospital with dysphoria, left eye and head ache, unconsciousness, orthocolosis, right upper extremity hemiplegic paralysis, and emesia after receiving facial injection of hyaluronic acid into the glabella. Low molecular weight heparin and clopidogrel were used to treat the patient, but there was no relief of symptoms. The patient gradually developed coma and was transferred to our hospital. Brain computed tomography showed mixed density in left temporal lobe, multiple high density in left frontal temporal parietal lobe and sulcus, and subarachnoid hemorrhage and high density in brainstem. The patient was diagnosed with cerebral hematoma and hernia, who gradually developed respiratory and circulatory failure and eventually died.
Thirty-day Emergency Department Utilization after Distal Radius Fracture Treatment: Identifying Predictors and Variation
Authors: Nasser Jacob S. , Chou Ching-Han , Chung Kevin C. 
Published: September 2019

Background:
Unplanned hospital visits are costly and may indicate reduced care quality. In this analysis, we aim to investigate the emergency department (ED) utilization for patients 30 days after treatment for a distal radius fracture (DRF) with an emphasis on DRF-related diagnoses of complications and examine nationwide variation in returns to the ED after treatment.

Methods:
In this population-based analysis, we used the Truven MarketScan database to identify adult patients who underwent treatment for their DRF. We examined primary diagnoses upon ED visits to assess for relation to treatment. Multivariable logistic regression was performed to evaluate the risk of DRF-related ED visits and pain-related diagnoses.

Results:
Of the patients who underwent treatment for a DRF, 2% of surgical patients and 4% of nonsurgical patients visited the ED within 30 days after treatment with a DRF-related diagnosis. The most common diagnoses for all patients were pain-related diagnoses. Patients receiving internal fixation were less likely to experience a DRF-related visit compared with patients receiving other surgical treatments most likely because of no exposed hardware. In addition, patients receiving surgical in the South were more likely to visit the ED with a pain-related diagnosis compared with any other region.

Conclusions:
Policy makers should include ED visits after treatment for outpatient hand conditions as indicators of care quality. Given the geographic differences in the ED utilization for this patient population, collaborative initiatives and institutional-level policy may help reduce variation in care for patients after treatment for their fracture care.
Improvement in Sleep Architecture is associated with the Indication of Surgery in Syndromic Craniosynostosis
Authors: de Goederen Robbin , Joosten Koen F.M. , den Ottelander Bianca K. , van der Oest Mark J.W. , Bröker-Schenk Els M.M. , van Veelen Marie-Lise C. , Wolvius Eppo B. , Versnel Sarah L. , Tasker Robert C. , Mathijssen Irene M.J. 
Published: September 2019

Background:
Children with syndromic craniosynostosis (sCS) often suffer from obstructive sleep apnea (OSA) and intracranial hypertension (ICH). Both OSA and ICH might disrupt sleep architecture. However, it is unclear how surgically treating OSA or ICH affects sleep architecture. The aim of this study was twofold: to explore the usefulness of sleep architecture analysis in detecting disturbed sleep and to determine whether surgical treatment can improve it.

Methods:
Eighty-three children with sCS and 35 control subjects, who had undergone a polysomnography (PSG), were included. Linear-mixed models showed the effects of OSA and ICH on sleep architecture parameters. In a subset of 19 patients, linear regression models illustrated the effects of OSA-indicated and ICH-indicated surgery on pre-to-postoperative changes.

Results:
An increase in obstructive-apnea/hypopnea index (oAHI) was significantly associated with an increase in N2-sleep, arousal index, and respiratory-arousal index and a decrease in REM-sleep, N3-sleep, sleep efficiency, and sleep quality. ICH and having sCS were not related to any change in sleep architecture. OSA-indicated surgery significantly increased the total sleep time and sleep efficiency and decreased the arousal index and respiratory-arousal index. ICH-indicated surgery significantly decreased REM-sleep, N1-sleep, sleep efficiency, and sleep quality.

Conclusions:
For routine detection of disturbed sleep in individual subjects, PSG-assessed sleep architecture is currently not useful. OSA does disrupt sleep architecture, but ICH does not. OSA-indicated surgery improves sleep architecture, which stresses the importance of treating OSA to assure adequate sleep. ICH-indicated surgery affects sleep architecture, although it is not clear whether this is a positive or negative effect.
Accuracy of fully automated oscillometric central aortic blood pressure measurement techniques
Authors: Gotzmann Michael , Hogeweg Maximilian , Seibert Felix S. , Rohn Benjamin Johannes , Bergbauer Martin , Babel Nina , Bauer Frederic , Mügge Andreas , Westhoff Timm H. 
Published: September 2019

Background:
Central aortic blood pressure (cBP) is a valuable predictor of cardiovascular risk. The lack of fully automated measurement devices impeded an implementation in daily clinical practice so far. The present study compares two novel automated oscillometric devices with invasively measured cBP.

Methods:
From March 2017 to March 2018, we enrolled consecutive patients undergoing elective coronary angiography to this cross-sectional study. Noninvasive assessment of cBP was performed by the SphygmoCor XCEL device and the Mobil-O-Graph NG device simultaneously to invasive measurement.

Results:
Our study included 502 patients (228 women, 274 men) with a mean age of 67.9 ± 11.6 years. The noninvasive measurement of cBP was successful in 498 patients (99%) with SphygmoCor XCEL device and in 441 patients (88%) with Mobil-O-Graph NG device (P = 0.451). Measurements of both devices revealed a high correlation to invasively measured systolic (SphygmoCor R
2 0.864, P < 0.001; Mobil-O-Graph R
2 0.763, P < 0.001) and diastolic (SphygmoCor R
2 0.772, P < 0.001; Mobil-O-Graph R
2 0.618, P < 0.001) cBP. Both devices slightly underestimated systolic and overestimated diastolic central blood pressure: biases were −5.0 ± 7.7/0.5 ± 6.2 mmHg with SphygmoCor XCEL and −6.0 ± 10.4/3.6 ± 8.3 mmHg with Mobil-O-Graph NG device. Correlations (R
2) were higher and biases were lower with the SphygmoCor device (P < 0.001 each).

Conclusion:
The present study is the largest validation study of noninvasive cBP measurement techniques so far and shows that two current automated oscillometric monitors are able to assess cBP with acceptable accuracy. Automated oscillometric devices may facilitate the implementation of cBP in daily clinical practice.
Epithelial Inclusion Cyst of the Bulbar Conjunctiva Secondary to Scleral Lens Impingement Managed With a MicroVault
Authors: Sherman Suzanne W. , Cherny Christina , Suh Leejee H. 
Published: September 2019

Abstract:
Acquired epithelial inclusion conjunctival bulbar cyst is a reported complication of scleral contact lens impingement commonly corrected with a diameter change or notch of the scleral contact lens. This case discusses an acquired epithelial inclusion conjunctival bulbar cyst due to microtrauma caused by prolonged scleral contact lens wear and corrected with a MicroVault.
Neonatal and pediatric platelet transfusions: current concepts and controversies
Authors: Patel Ravi Mangal , Josephson Cassandra 
Published: September 2019

Purpose of reviewIn this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets.Recent findingsRecent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study.SummaryOur review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.
Using minimal (measurable) residual disease assessments to guide decision-making for timing of allogeneic transplantation in acute myeloid leukemia
Authors: Fasan Omotayo 
Published: September 2019

Purpose of review
The current review aims to highlight recent and important developments in the detection and value of minimal (measurable) residual disease (MRD) testing in patients with acute myeloid leukemia (AML) and the impact on the timing of allogeneic hematopoietic cell transplantation.

Recent findings
The European LeukemiaNet MRD Working Party recently published guidelines to help standardize testing, utilizing flow cytometry and molecular techniques. The timing of MRD assessments, choice of assay and cutoff of for reporting positive results are all important. Patients known to be MRD-positive pretransplantation have a poor prognosis and consideration should be given to selecting a myeloablative regimen over a reduced intensity regimen (if appropriate) and offering posttransplantation maintenance therapy.

Summary
It may be best to think of MRD as a dynamic variable, where a rising MRD result is more specific and highly predictive of relapse. It is unclear how MRD results should impact the timing of allogeneic hematopoietic cell transplantation, if at all. There are currently no published randomized studies to help guide the practitioner in this situation, hence decision-making should be individualized.
Survey of Impediments to Prevention of Mother‐to‐infant Transmission of Hepatitis B Virus by International Societies
Authors: Chang Mei‐Hwei , Fischler Bjorn , Blauvelt Barri , Ciocca Mirta , Dhawan Anil , Ekong Udeme , Ni Yen‐Hsuan , Porta Gilda , Sibal Anupam , DAgostino Daniel , Wirth Stefan , Morhan Neelam , Schwarz Kathleen B. 
Published: September 2019

ABSTRACTObjective:Mother‐to‐infant transmission (MIT) is the leading cause of hepatitis B virus (HBV) infections globally. The aim of this international study was to assess the impediments to prevention of (MIT) of HBV.Methods:A cross‐sectional survey was developed by the Federation of the International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. (FISPGHAN) The survey was sent to HBV experts of the 5‐member societies of FISPGHAN, and 63 of 91 countries/regions responded. Main outcome measures include percentage of countries having vaccine programs, timing of the first dose of HBV vaccine, availability of HBV vaccine for outborn neonates, payment of HBV vaccine and hepatitis B immune globulin, screening HBV markers during pregnancy, and antivirals to highly infectious pregnant mothers.Results:Among the participating countries/regions, 11% did not implement infant HBV immunization programs. The first dose of vaccine was given >24 hours in 36% of the total countries and 100% of African countries. The recommended birth dose was unavailable for outborn neonates in 45% of the total countries, including 92% of African and 50% of Latin American countries/regions. During pregnancy, 44% countries do not screen maternal viral markers, and 46% do not provide third trimester antiviral therapy for highly viremic pregnant mothers.Conclusions:Our study demonstrated multiple obstacles to achieving the goal of preventing MIT of HBV. Comprehensive public health programs to enhance vaccine coverage rate, supply HBV vaccine for out‐born neonates, screening maternal HBV markers, treating highly viremic pregnant mothers are proposed to overcome these obstacles and achieve the goal of preventing MIT of HBV.