bluuebunny/crossref_metadata_2025_split huggingface dataset:
LONG-TERM CARDIOVASCULAR OUTCOMES AFTER A PREGNANCY COMPLICATED BY HYPERTENSIVE DISORDERS
Authors: Piani Federica , Bragagni Alessio , Baracchi Alessandro , Cromi Debora , Ruscelli Federico , Scarduelli Sara , Vincenzi Sofia , Agnoletti Davide , Esposti Daniela Degli , Borghi Claudio 
Published: May 2024

Objective:
The maternal vasculature undergoes significant adaptations during pregnancy to meet the increased metabolic demands of the developing fetus. These adaptations include increased cardiac output and blood volume, as well as reduced systemic vascular resistance to support the fetoplacental unit. In Hypertensive disorders of pregnancy (HDP) there is an impaired cardiovascular adaptation to pregnancy with effects extending beyond the duration of the pregnancy. In the present study we aimed to characterize long-term cardiovascular status of women who suffered from HDP.

Design and method:
Fifty-eight women who attended at least one post-partum visit in our HDP Clinic (IRCCS Policlinico Sant’Orsola-Malpighi, Bologna, Italy) and a follow-up visit after at least 5 years from delivery were enrolled in the study. Exclusion criteria included multiple pregnancy, fetal genetic or congenital abnormalities, maternal history of organ transplantation or chronic kidney disease (CKD), and absence of a post-partum echocardiographic evaluation. In the follow-up visit participants underwent a complete cardiovascular assessment including echocardiography and multiparametric vascular function assessment.

Results:
Two major cardiovascular events occurred, one stroke and one myocardial infarction, both in women with index-pregnancy complicated by preeclampsia (PE). While not statistically significant, women with HDP-non-PE and PE displayed a trend towards an increased risk of developing composite cardiovascular outcome, and women with PE tended to experience it sooner (Figure 1). Nearly half of the women with a history of HDP, whether PE or HDP-non-PE, developed chronic hypertension. Some women also developed hyperuricemia, CKD, and type 2 diabetes at follow-up, most of them with a previous history of PE. Structural and functional cardiac changes were observed in a few cases, especially among women with PE, and vascular dysfunction was more common in women with a history of HDP compared to those with normotensive pregnancies (Figure 2).

Conclusions:
Results of the present study adds on literature on long-term cardiovascular impact of HDP and further emphasize the importance of a timely follow-up of women who suffered from HDP and particularly PE.
SFLT-1/PLGF RATIO AND HYPERTENSIVE STATES OF PREGNANCY IN REAL LIFE: ANALYSING RISK OF PREECLMAPSIA
Authors: Martínez-morales Eduardo , Rodriguez Claudia Martin , González Esther Rubio , Sánchez Paula López , Testillano Lucía Martín , Pujol Javier Relea , Garcia Irene Garcia , Sanchez Paola Carolina Villegas , García Maria Mercedes Pérez , Fernández Maria Isabel Galán , Arroyo Ana Maria Huerta , Briales Paula Sánchez , Vidas María Marques , Recio María De Valdenebro , Sánchez Ana Muñoz , Salazar Maria Luisa Serrano , Carratalá Rosario Llópez , Jarrín Felipe Zalamea , Sánchez Beatriz , Pérez Jose María Portolés 
Published: May 2024

Objective:
To analyse the relationship between sFlt-1/PlGF ratio and the occurrence and severity of preeclampsia.

Design and method:
An observational, retrospective, cross-sectional study; collecting data of pregnant women who undergo sFlt-1/PlGF ratio determination between Jan-Sept 2022 in a tertiary hospital. We collected baseline characteristics, data related with the pregnancy, birth and development and severity of hypertensive disorders of pregnancy (HDP),as well as treatment at discharge.

Results:
Among 109 recruited patients, 5 were excluded due to loss of follow-up. We analysed 104 women (mean age of 33.9 years SD 5.0). 52.5% were primiparous, 10.6% had in vitro pregnancies and 4.8% had twins. Nearly all were non-diabetic (99%), with 11.5% developing gestational diabetes.7.7% had pre-pregnancy hypertension and 15.4% had prior HDP (68.8% of them were preeclampsia). 90.4% women breastfed. Other characteristics are specified in table 1.
During pregnancy, 64.4% developed HDP, being the mean week of diagnosis 35.8 (SD 4.1): 45.2% presented pre-eclampsia (PE) / eclampsia; 4.8% had chronic hypertension and 14.4% had gestational hypertension. Just 18.3% received acetylsalicylic acid as prophylaxis. At discharge, 38.5% continued with antihypertensive treatment.
The sFlt-1/PlGF median ratio was 43.7, (interquartile range [13.0-81.6]) and a 53.9% obtained a pathological value (>38). It correctly classified PE in 77.9% cases, with a 83.7% sensitivity and 72.7% specificity. Positive and negative predictive values were 73.2% and 83.3% respectively.
A pathological sFlt-1/PlGF ratio is associated with a higher risk of PE (OR 13.7 CI95% [13.2-35.8]), regardless use of acetylsalicylic acid. Besides, when stratified it into tertiles, those patients with a range 26-63 (second tertil) had an OR of 6.5 [1.9-22.4] while in the range >63 (third tertil)had an OR 45.0 [11.0-184.0] vs first tertil: therefore the higher the ratio, the higher the risk of PE.

Conclusions:
The sFlt-1/PlGF ratio is an important tool to predict preeclampsia. A pathological sFlt-1/PlGFratio increases this risk of PE more than 13 times compared with a normal value. Moreover, the risk of PE increases as the ratio increases.
AORTIC FUNCTION AND NTRATIVE STRESS IN A RAT MODEL OF POLYCYSTIC OVARY SYNDROME
Authors: Benko Rita , Pang Kaito Skyler Senuma , Korsós-novák Ágnes , Bányai Bálint , Szekeres Mária , Várbíró Szabolcs , Horváth Eszter M. 
Published: May 2024

Objective:
Polycystic ovary syndrome (PCOS) represents the most prevalent endocrine disorder in women of fertile age; besides infertility, an elevated cardiovascular risk was described. Vitamin D hypovitaminosis affects about 80-90% of PCOS patients. Our team assessed aortic function and nitrative stress in a hyperandrogenic rat model and the effectiveness of Vitamin D substitution.

Design and method:
Female Wistar rats at the age of 3-4 weeks were randomly assigned into four groups. Eight rats received no treatment (controls, C), eight rats received weekly Vitamin D per os (140 IU/100 g body weight, group D), eight received cutaneous testosterone daily (3.3 mg/100 g, T) and eight received Vitamin D and testosterone (T+D). At the eighth week of the treatment, aortic rings were isolated for analysis: they were cut into 3-4 mm long segments for myography, other segments were formaldehyde fixed and paraffin embedded to assess, by immunohistochemical methods, nitrative stress markers (nitrotyrosine, NT) and DNA breaks signaled by nuclear poly(ADP-ribose) polymer (PAR) detection.

Results:
The weight gains of the two testosterone-treated groups were significantly higher between the 6-8 weeks compared to the other two groups, Vitamin D treatment did not influence body weight. Rats in the C and D groups had 3 or 4 estruses in the last 14 days. T rats had 1 or 2 estruses during the same period. T+D rats had 1-2 (N=3), or 3-4 (N=5) estruses.
Aortic contraction, induced by the alpha1-adrenergic agonist phenylephrine, was significantly elevated in T and T+D animals in comparison to controls and Vitamin D treated rats. The endothelium-mediated aortic relaxation, as a response to acetyl-choline and insulin, was unaltered; however, estrogen-induced relaxation was significantly impaired in T and T+D groups.
According to resorcin-fuchsin staining, no fibrotic alteration was detected. Nitrative stress and poly(ADP-ribosyl)ation were similar in all four groups.

Conclusions:
Eight weeks of testosterone administration caused increased weight gain and sex cycle lengthening. The latter was reversible by Vitamin D supplementation in 62.5% of the rats. Testosterone or Vitamin D did not alter vascular histology. Hyperandrogenism increased alpha1-adrenerg mediated vasoconstriction and compromised estrogen-mediated relaxation without altering nitrative stress.
ARTERIAL BLOOD PRESSURE PHENOTYPES DEFINED BY AMBULATORY BLOOD PRESSURE MONITORING IN PREGNANCY AND ITS PROGNOSTIC VALUE FOR FUTURE MATERNAL AND NEONATAL EVENTS
Authors: Aguiar Tiago , Cruz Inês , Costa Carlos , Carvalho Simão , Pacheco Adriana , Carvalho Diana , Barbosa Eliana , Bastos José 
Published: May 2024

Objective:
We have previously demonstrated that some ambulatory blood pressure monitoring (ABPM) values can predict maternofoetal evens in hypertensive pregnant women. The analysis of the different blood pressure (BP) phenotypes in pregnant women is still an unknown topic.

Design and method:
A retrospective cohort study which followed a sequential number of 274 pregnant women referred to Cardiology/Hypertension consult (mean age of 32 years), from 2007 to 2022, who underwent ABPM made with a Spacelabs 90207. Data was collected and analysed in SPSS Statistics through different parametric tests. An event was defined as the composite endpoint of multiple adverse events: preeclampsia or eclampsia, foetal or neonatal death, prematurity, low weight at birth, gestational diabetes, and maternal death.

Results:
In a survival Kaplan-Meier curve of events, when we compared normal versus hypertensive groups, those with hypertension had worse survival with a log rank of 6.594 (p=0.010). In a further comparison, Kaplan-Meier analysis revealed a worse survival in the hypertensive without medication group, followed by the non-controlled hypertensive and controlled hypertensive groups, with a log rank of 11.737 (p=0.003). (Fig 1)
An independent-samples T test followed by a multi-variate analysis was performed, revealing significant differences between the hypertensive and non-hypertensive group for maternal age (p=0.034) and birth weight (p=0.023). In the multi-variate analysis, the hypertensive group was notably associated with a higher rate of caesarean delivery (70.2% versus 34.6%, p=0.007). Further analysis showed significant differences in birth weight between the controlled hypertensive group and the hypertensive without medication (p=0.001) and non-controlled hypertensive (p=0.002) groups.

Conclusions:
This study further corroborates the importance of ABPM in the diagnosis and follow-up of hypertensive pregnant women, having a major impact in both maternal and neonatal morbidity. Normotensive pregnant women had a better prognosis as compared to hypertensive pregnant women, defined by ABPM values. ABPM should be an essential tool to manage pregnant women.
EVALUATING THE PROGNOSTIC VALUE OF DIFFERENT BLOOD PRESSURE PHENOTYPES ON AMBULATORY BLOOD PRESSURE MONITORING IN WOMEN
Authors: Aguiar Tiago , Cruz Inês , Costa Carlos , Carvalho Simão , Pacheco Adriana , Barbosa Eline , Bastos José 
Published: May 2024

Objective:
Ambulatory blood pressure monitoring (ABPM) is a highly valuable and well-validated tool in the diagnosis and treatment follow-up of hypertensive patients. It remains unclear whether the different blood pressure (BP) phenotypes have a different prognostic impact in women.

Design and method:
A retrospective cohort study which followed a sequential number of 947 patients who underwent ABPM. BP phenotypes were defined as: controlled hypertension (CH); resistant hypertension (RH); and white-coat uncontrolled hypertension (WCUH). A composite endpoint (CE) of all-cause mortality and hospitalization from cardiovascular causes was utilized.

Results:
The sample comprised of 50.8% women (n=486) and 48.2% men (n=461) (mean age of 59 years). The sampled included 129 (13.5%) cases of CH, 103 (10.7%) cases of RH, and 289 (30.1%) cases of WCUH.
A Kaplan-Meier survival curve analysis was performed, with women demonstrating a superior survival as compared to men, with a log rank of 31.7 (p<0.001). Women with WUCH and RH showed superior survival with a log rank of 11.5 and 15.2, respectively (p<0.001). (Fig 1)
In a multi-variate analysis, men showed a greater hazard ratio (HR) as compared to women in: 24h systolic BP (SBP) with a HR of 1.05 (p=0.08) versus 1.02 (p=0.43); 24h pulse pressure (PP) with a HR of 1.07 (p=0.05) versus 1.02 (p=0.34); night SBP with a HR of 1.04 (p=0.02) versus 1.03 (p=0.06); night PP with a HR of 1.10 (p<0.01) versus 1.04 (p=0.08); and SBP dipping with a HR of 0.93 (p=0.03) versus 0.95 (p=0.08). HR for RH women for night SBP, night DBP and SBP dipping were 1.06, 1.13 and 0.89, respectively (p<0.01).

Conclusions:
ABPM is an essential tool for the diagnosis and follow-up of different BP phenotypes. Women revealed a more favourable cardiovascular prognosis as compared to men, suggesting a lower dependence on blood pressure. In true RH women, nighttime variables showed a significant impact on cardiovascular events.
Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial
Authors: Kitt Jamie , Fox Rachael , Frost Annabelle , Shanyinde Milensu , Tucker Katherine , Bateman Paul A. , Suriano Katie , Kenworthy Yvonne , McCourt Annabelle , Woodward William , Lapidaire Winok , Lacharie Miriam , Santos Mauro , Roman Cristian , Mackillop Lucy , Delles Christian , Thilaganathan Basky , Chappell Lucy C. , Lewandowski Adam J. , McManus Richard J. , Leeson Paul 
Published: May 2024

(Abstracted from JAMA 2023;330:1991–1999
Worldwide, about 10% of pregnancies are affected by an abnormal rise in maternal blood pressure (BP). Individuals whose BP remains high 6 weeks after birth are more likely to have higher BP 5 to 10 years later.
Benzodiazepine Discharge Prescriptions From Emergency Departments Across the United States Between 2012 and 2019: A National Analysis
Authors: Ramdin Christine , Mina George , Nelson Lewis , Mazer-Amirshahi Maryann 
Published: May 2024

Objectives
Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED).

Methods
This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable.

Results
Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend (P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older.

Conclusion
Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.
Isolated Kratom Use Disorder Treated With Extended-Release Buprenorphine Taper
Authors: Swart Benjamin B. , Reznikoff Charles , Steen Katie 
Published: May 2024

Abstract
This case report highlights a 36-year-old male without history of psychiatric disease, chronic pain, or substance use disorder who developed severe substance use disorder per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to kratom. He was successfully treated with sublingual buprenorphine after a 3-year period of intermittent withdrawal management and trials of oral and extended-release injectable naltrexone. After a period of abstinence from kratom, he was tapered from buprenorphine using 2 monthly injections of 100 mg extended-release buprenorphine. His case underscores some of the current uncertainties around kratom use disorder diagnosis and treatment.
Immunomodulation occurs in high-enriched dietary docosahexaenoic acid in rat
Authors: Diau Guan-Yeu , Kuo Shih-Ming , Chen Shyi-Jou 
Published: May 2024

Abstract

Background
The immunomodulation dietary adjuvant therapy for clinical workup in surgery is a very common demand and challenge clinical concern. The enteral or parenteral use of n-3 polyunsaturated fatty acids is one of the common protocols in certain area. This animal study investigated the skin fatty acids tissue level and relationship between immunological parameters after various dietary docosahexaenoic acid (DHA, 20:6n-3) supplement after burn challenge.

Materials and Methods
Forty-five male 4-week-old Wistar rats were divided into three groups and received either a regular diet (RD) or DHA-enforced diet at 1% (1P) and 5% (5P) for 2 weeks. Then, all the animals treated with the same controlled scalding burn injury. Some of the rats killed during the acute stage at 5 days after the burn for tissue pathological examination CD3, CD4, CD8, and CD68. The rest of the rats data were collected at 4 weeks later. Tissue fatty acid levels were analyzed via gas chromatography. The pathological grading, subpopulation of blood immune cells CD4 and CD8, and the serum cytokine IL-2 and IFN-γ were also examined.

Results
The dietary supplementing DHA could increase the skin tissue DHS concentration. Tissue DHA increased in RD 2.40 ± 0.91% < 1P 6.07 ± 0.92% < 5P 13.53 ± 1.24%. In contrast, tissue 20:4n-6 concentrations were quite constant and not affected by the dietary manipulations. The skin pathology did not show differences in CD3, CD4, CD8, and CD68 in acute stage. Only the serum INF-γ did show elevation statistically in 5P 80.11 ± 29.45 > RD 42.90 ± 30.85 and 1P 50.77 ± 40.75 pg/mL (P = 0.029). The subpopulation of blood CD4, CD8, and serum IL-2 did not show differences statistically. Pathological grading of the burned skin tissue showed significant difference between RD and 1P 4 weeks after the burn (P = 0.012). The body weight gain was prominent in 5P.

Conclusions
The immunomodulation did occur only at higher concentration dietary DHA supplement revealed by the increase serum INF-γ. However, only optimal concentration dietary group (1P) could decrease the tissue destruction after the burn. The increased body weight gain also indicated that the higher dietary supplement of DHA (5P) could serve the high energy requirement after burn.
Total Resection of Pediatric Desmoid Tumor of the Left Neck with Utilization of 3D Virtual Surgical Planning
Authors: Brown Hannah G. , Torres Bryan S. , Nuñez Julisa , Wong Richard J. , Hajjar Fouad M. , Abongwa Chenue , Sawh-Martinez Rajendra F. , Lopez Joseph 
Published: May 2024

Summary:
A 13-year-old girl with a painful left neck mass was referred to our institution due to suspicions of malignancy. The patient reported pain that accompanied her frequent neck spasms. Computed tomography revealed a large, soft-tissue mass in the left neck, deep to the sternocleidomastoid. The lesion anteriorly displaced the internal carotid artery and both displaced and crushed the internal left jugular vein. Uniquely, a three-dimensional virtual reality model combining magnetic resonance imaging and computed tomography data was used to determine the lesion’s resectability and visualize which structures would be encountered or require protection while ensuring total resection. During operation, we confirmed that the mass also laterally displaced the brachial plexus, cranial nerves X and XI, and spinal nerves C3–C5 (including the phrenic) of the cervical plexus. Postsurgical pathological analysis confirmed a diagnosis of desmoid tumor, also known as aggressive fibromatosis, whereas DNA sequencing revealed a CTNNB1 mutation, a somatic genetic marker found in approximately 90% of desmoid tumor cases. When possible, the most widely used method for the treatment of desmoid tumors has been gross resection. Chemotherapy, radiotherapy, and local excision are also used in the treatment of fibromatoses when complete resection is judged infeasible. In this case, a complete surgical resection with tumor-free surgical margins was performed. A standard cervical approach with a modified posterolateral incision site was implemented to avoid a conspicuous anterior neck scar. No flap, nerve repair, or reconstruction was warranted. At 1 year of postsurgical follow-up, the patient showed minimal scarring and no signs of recurrence.
Successful Intraoperative Salvage of a Venous Congested Deep Inferior Epigastric Perforator Flap Using a Cross-thoracic Saphenous Vein Graft
Authors: Yu Victor J. , Joseph Jeremy T. , Kemp Tamara L. , Ortiz Kenneth J. , DeJesus Ramon A. 
Published: May 2024

Summary:
For autologous breast reconstruction using the deep inferior epigastric perforator flap, the internal mammary vessels are a common choice for recipient vessels. However, if these vessels are discovered to be inadequate, this may require the utilization of alternative vessels for successful salvage. Here, we demonstrate the use of a venous conduit for flap salvage in a patient undergoing bilateral deep inferior epigastric perforator flap breast reconstruction. Intraoperative venous congestion was identified on the left side. A contributing factor was an unresolvable size discrepancy between the deep inferior epigastric and the internal mammary venae comitantes. A saphenous vein graft can be used to drain the donor inferior epigastric vein to the contralateral internal mammary venae comitantes. In this discussion, adequate venous drainage was obtained with this approach, and the flap remained viable with good Doppler signals without further complications over a year postoperatively.
Is “Clack” Enough? Rib Remodeling Guided by Ultrasound
Authors: Manzaneda Cipriani Raúl Martín 
Published: May 2024

Summary:
Rib remodeling is a surgical technique that allows waist contouring in women and men. This study proposes that the “clack” sound heard in ultrasound-guided scarless rib remodeling (RibXcar technique) is not evidence of the completion of the surgery, but rather, the use of ultrasound is necessary to identify angulations, loss of bone strength, and ultrasound visualization of the loss of bone continuity, and thus consider cosmetic rib surgery to be complete. This study was performed on 100 Peruvian women aged 18–40 years who voluntarily agreed to a rib remodeling procedure. The RibXcar technique was used, and intraoperative ultrasound was performed to obtain objective information during each patient’s procedure. Of the total number of patients who underwent surgery with the RibXcar technique, the “clack” sound was detected in 90% of patients, and no “clack” sound was detected in the remaining 10% of patients. However, the use of ultrasound revealed monocortical fractures in 100% of patients. It is observed that of the total number of patients, only in 90% was the “clack” heard; however, in 100% there was a monocortical fracture evaluated in the immediate postoperative period. We suggest not considering the “clack” as the end point of the surgery; instead, define the end point after the use of the ultrasound examination, which provides information on angulations, the loss of bone resistance, and ultrasound visualization of the loss of bone continuity.