bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abnormal bleeding associated with preeclampsia: A population study of 315,085 pregnancies
Authors: ESKILD ANNE , VATTEN LARS J. 
Published: December 2008

AbstractObjective. To study the association of preeclampsia with abnormal bleeding in the first trimester and after delivery. Design. Register‐based population study. Setting. The Medical Birth Registry of Norway. Population. A total of 315,085 women in Norway with singleton deliveries after 21 weeks of gestation (1999–2004). Methods. We compared frequencies of vaginal bleeding in the first trimester between women who subsequently developed preeclampsia and women without preeclampsia development, and made similar comparisons for postpartum bleeding. Main outcome measures. Proportion of women with bleeding. Results. In the first trimester, vaginal bleeding occurred in 1.6% (215/13,166) of subsequent preeclampsia cases, compared to 2.0% (6,112/301,919) of normotensives (p<0.01). After delivery, excess postpartum bleeding (>1,500 mL) occurred in 3.0% (399/13,166) of preeclampsia cases and in 1.4% (4,223/301,919) of normotensives (p<0.01). Moderate bleeding postpartum (>500 mL) was also more common in preeclampsia cases (22.9% versus 13.9%, p<0.01). Similar patterns were present in first time mothers and in women with more than one birth, and the patterns did not vary according to type of delivery (cesarean section or not). Conclusions. These results suggest that factors associated with preeclampsia are inversely related to vaginal bleeding early in pregnancy, but positively associated with excess bleeding after delivery.
Myomectomy during cesarean section
Authors: LI HUI , DU JUAN , JIN LIANGYI , SHI ZHAN , LIU MINGYING 
Published: December 2008

AbstractObjective. To evaluate the safety and effectiveness of myomectomy during cesarean section (CS). Design. Retrospective case‐control study. Setting. Tertiary referral university hospital. Population and methods. A study group of 1,242 pregnant women with fibromyomas who underwent myomectomy during CS and three control groups of 200 matched pregnant women without fibromyomas who underwent CS deliveries (Group A), 145 patients with fibromyomas who underwent CS deliveries without removal of fibromyomas (Group B) and 51 patients with fibromyomas who had a hysterectomy during CS (Group C). Main outcome measures. The difference between pre‐ and postoperative hemoglobin levels, the incidence of hemorrhage, blood transfusion, postoperative fever, duration of operation and length of hospital stay. Results. No difference was found in the median parity or mean gestational age, but maternal age was higher and the gestational age lower in Group C than the study group. The median number and diameter of fibromyomas in Group B were lower than in the study group. Compared to the study group, Group B women had more single fibromyomas, while those in Group C had more multiple fibromyomas. Group B had more uterine cornual fibromyomas than the study group. There were no differences in the mean hemoglobin change, the incidence of postoperative fever and the length of hospital stay among groups. Conclusion. Myomectomy during CS was a safe and an effective procedure.
Lost in Translation? Reliability of Assessing Inpatient Antimicrobial Appropriateness With Use of Computerized Case Vignettes
Authors: Schwartz David N. , Wu Ulysses S. , Lyles Rosie D. , Xiang Yingxu , Kieszkowski Piotr , Hota Bala , Weinstein Robert A. 
Published: December 2008

Objective.To describe and measure reliability of a computer-assisted method of case vignette assembly and expert review to assess the appropriateness of antimicrobial therapy for hospitalized adults.Design.Feasibility and reliability analysis of computer-assisted tool used to compare the effects of antimicrobial stewardship interventions.Setting.Public teaching hospital.Patients.Randomly selected adult antimicrobial recipients admitted to inpatient medicine services.Methods.Clinical data abstracted from 504 paper medical records were merged with computerized laboratory and pharmacy data to assemble case vignettes that underwent expert review for appropriateness. We performed 3 validations, as follows: data for 35 vignettes abstracted independently by 2 research assistants were assessed for interrater agreement, expert review of 24 vignettes was compared with review of the corresponding paper medical records, and interrater reliability of antimicrobial appropriateness assessments by 2 experts was determined for 70 case vignettes.Results.Vignette assembly and expert review each required 10–12 minutes per case. Potentially important discrepancies occurred in 0%–32% of clinical findings abstracted independently by 2 research assistants. Expert review of 24 vignettes and the corresponding full paper medical records yielded fair agreement (kappa, 0.30). The 2 experts identified inappropriate initial antimicrobial therapy in 67% and 61% of case vignettes reviewed independently; interrater agreement was improved after sequential case discussion and stringent application of appropriateness criteria (kappa, 0.72).Conclusions.Our case vignette assembly and expert review method is efficient, but improvements in both technical and human performance are needed to be able to yield valid estimates of the prevalence of inappropriate antimicrobial use. Assessments of antimicrobial appropriateness require validation.
Preoperative Use of Statins Is Associated with Reduced Early Delirium Rates after Cardiac Surgery
Authors: Katznelson Rita , Djaiani George N. , Borger Michael A. , Friedman Zeev , Abbey Susan E. , Fedorko Ludwik , Karski Jacek , Mitsakakis Nicholas , Carroll Jo , Beattie W Scott 
Published: December 2008

Background
Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention. Use of statins has been shown to decrease morbidity and mortality after major surgical procedures. The objective of this study was to determine an association between preoperative administration of statins and postoperative delirium in a large prospective cohort of patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods
After Institutional Review Board approval, data were prospectively collected on consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from April 2005 to June 2006 in an academic hospital. All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit. Multivariable logistic regression analysis was used to identify independent perioperative predictors of delirium after cardiac surgery. Statins were tested for a potential protective effect.

Results
Of the 1,059 patients analyzed, 122 patients (11.5%) had delirium at any time during their cardiovascular intensive care unit stay. Administration of statins had a protective effect, reducing the odds of delirium by 46%. Independent predictors of postoperative delirium included older age, preoperative depression, preoperative renal dysfunction, complex cardiac surgery, perioperative intraaortic balloon pump support, and massive blood transfusion. The model was reliable (Hosmer-Lemeshow test, P = 0.3) and discriminative (area under receiver operating characteristic curve = 0.77).

Conclusions
Preoperative administration of statins is associated with the reduced risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass.
Respiratory and Sleep Effects of Remifentanil in Volunteers with Moderate Obstructive Sleep Apnea
Authors: Bernards Christopher M. , Knowlton Susan L. , Schmidt Douglas F. , DePaso William J. , Lee Matthias K. , McDonald Susan B. , Bains Oneil S. 
Published: December 2008

Background
There is concern that opioid-based analgesia will worsen sleep-related respiratory insufficiency in patients with obstructive sleep apnea (OSA), resulting in serious morbidity or mortality. However, there are no studies that directly address the merit of this concern. Consequently, the authors designed this study as the first prospective, double-blind, placebo-controlled investigation of opioid pharmacology in patients with documented OSA.

Methods
Patients (n = 19) with moderate OSA documented by polysomnography (sleep study) were randomized to undergo an additional sleep study while receiving either a saline infusion or a remifentanil infusion (0.075 microg x kg x h). Sleep stages, apneas, hypopneas, and arterial hemoglobin oxygen saturation were continually recorded during saline or remifentanil infusion, and were compared with values obtained during the patients' earlier sleep study.

Results
Saline infusion had no effect on sleep or respiratory variables. In contrast, remifentanil increased Stage 1 sleep, markedly decreased rapid eye movement sleep, increased arousals from sleep, and decreased sleep efficiency. Remifentanil actually decreased the number of obstructive apneas, but markedly increased the number of central apneas. Arterial hemoglobin oxygen saturation was also significantly lower in OSA patients receiving remifentanil.

Conclusions
The decrease in obstructive apneas likely resulted from the marked decrease in rapid eye movement sleep caused by remifentanil. Despite fewer obstructions, OSA was worse during remifentanil infusion because of a marked increase in the number of central apneas. These data suggest that caution is warranted when administering opioids to subjects with moderate OSA, but that the primary risk may be central apnea, not obstructive apnea.
Effects of Propofol on Cyclic Strain-induced Endothelin-1 Expression in Human Umbilical Vein Endothelial Cells
Authors: Cheng Tzu-Hurng , Chen Jin-Jer , Chen Cheng-Hsien , Wong Kar-Lok 
Published: December 2008

Background
Propofol is one of the most popular intravenous induction agents of general anesthesia. Experimental results revealed that propofol exerted hypotensive and antioxidative effects. However, the intracellular mechanism of propofol remains to be delineated. The aims of this study were to test the hypothesis that propofol may alter strain-induced endothelin-1 (ET-1) secretion and nitric oxide production, and to identify the putative underlying signaling pathways in human umbilical vein endothelial cells.

Methods
Cultured human umbilical vein endothelial cells were exposed to cyclic strain in the presence of propofol, and ET-1 expression was examined by Northern blotting and enzyme-linked immunosorbent assay kit. Activation of extracellular signal-regulated protein kinase, endothelial nitric oxide synthase, and protein kinase B were assessed by Western blot analysis.

Results
The authors show that propofol inhibits strain-induced ET-1 expression, strain-increased reactive oxygen species formation, and extracellular signal-regulated protein kinase phosphorylation. On the contrary, nitric oxide production, endothelial nitric oxide synthase activity, and protein kinase B phosphorylation were enhanced by propofol treatment. Furthermore, in the presence of PTIO, a nitric oxide scavenger, and KT5823, a specific inhibitor of cyclic guanosine monophosphate-dependent protein kinase, the inhibitory effect of propofol on strain-induced extracellular signal-regulated protein kinase phosphorylation and ET-1 release was reversed.

Conclusions
The authors demonstrate for the first time that propofol inhibits strain-induced ET-1 secretion and enhances strain-increased nitric oxide production in human umbilical vein endothelial cells. Thus, this study delivers important new insight into the molecular pathways that may contribute to the proposed hypotensive effects of propofol in the cardiovascular system.
Differential Effects of Propofol and Sevoflurane on Ischemia-induced Ventricular Arrhythmias and Phosphorylated Connexin 43 Protein in Rats
Authors: Hirata Naoyuki , Kanaya Noriaki , Kamada Noriko , Kimura Saori , Namiki Akiyoshi 
Published: December 2008

Background
The effects of anesthetics on ischemia-induced ventricular arrhythmias remain poorly studied. This study investigated the effects of propofol and sevoflurane on the survival rate and morbidity as a result of ventricular arrhythmias, and defined a possible mechanism for the arrhythmogenic properties of anesthetics during acute myocardial ischemia.

Methods
Under anesthesia with intraperitoneal sodium pentobarbital, Sprague-Dawley rats underwent 30 min of left anterior descending coronary artery ligation. The rats were divided into a low-dose propofol (Prop-LD) group (39 mg X kg(-1) X hr(-1), n = 18), a high-dose propofol group (78 mg x kg(-1) x hr(-1), n = 18), a sevoflurane group (2.5%, n = 18) and a control group (n = 18). The survival rate and morbidity as a result of ventricular arrhythmias were determined, and the amount of phosphorylated connexin 43 protein was measured 30 min after coronary artery ligation.

Results
The survival rate was 83% (15 of 18), 94% (17 of 18), 89% (16 of 18), and 67% (12 of 18, P = 0.038 vs. Prop-LD) in the control, Prop-LD, high-dose propofol, and sevoflurane groups, respectively. Sustained ventricular tachycardia was observed in 83% (15 of 18), 39% (7 of 18, P = 0.011 vs. control), 50% (9 of 18, P = 0.039 vs. control) and 94% (17 of 18, P < 0.01 vs. Prop-LD) in the control, Prop-LD, high-dose propofol, and sevoflurane groups, respectively. Immunoblotting showed a marked reduction in the amount of phosphorylated connexin 43 in the control and sevoflurane groups, as compared with the Prop-LD and high-dose propofol groups (P < 0.05).

Conclusion
The authors' results suggest that propofol preserves connexin 43 phosphorylation during acute myocardial ischemia, as compared with sevoflurane, and this might protect the heart from serious ventricular arrhythmias during acute coronary occlusion.
Manual In-line Stabilization Increases Pressures Applied by the Laryngoscope Blade during Direct Laryngoscopy and Orotracheal Intubation
Authors: Santoni Brandon G. , Hindman Bradley J. , Puttlitz Christian M. , Weeks Julie B. , Johnson Nathaniel , Maktabi Mazen A. , Todd Michael M. 
Published: December 2008

Background
Manual in-line stabilization (MILS) is recommended during direct laryngoscopy and intubation in patients with known or suspected cervical spine instability. Because MILS impairs glottic visualization, the authors hypothesized that anesthesiologists would apply greater pressure during intubations with MILS than without.

Methods
Nine anesthetized and pharmacologically paralyzed patients underwent two sequential laryngoscopies and intubations, one with MILS and one without, in random order. A transducer array along a Macintosh 3 laryngoscope blade continuously measured applied pressures, and glottic view was characterized.

Results
With MILS, glottic visualization was worse in six patients, and intubation failure occurred in two of these six patients. Maximum laryngoscope pressure at best glottic view was greater with MILS than without (717 +/- 339 mmHg vs. 363 +/- 121 mmHg, respectively; n = 8; P = 0.023). Other measures of pressure application also indicated comparable increases with MILS.

Conclusion
Pressures applied to airway tissues by the laryngoscope blade are secondarily transmitted to the cervical spine and result in cranio-cervical motion. In the presence of cervical instability, impaired glottic visualization and secondary increases in pressure application with MILS have the potential to increase pathologic cranio-cervical motion.
Rigid Laryngoscope-assisted Insertion of Transesophageal Echocardiography Probe Reduces Oropharyngeal Mucosal Injury in Anesthetized Patients
Authors: Na SungWon , Kim Chang Seok , Kim Ji Young , Cho Jin Seon , Kim Ki Jun 
Published: December 2008

Background
Intraoperative transesophageal echocardiography has become a routine part of monitoring in patients with cardiac disease. However, insertion of a transesophageal echocardiography probe can be associated with oropharyngeal, esophageal, and gastric injuries. The purpose of this study was to determine whether insertion of a transesophageal echocardiography probe under direct laryngoscopic visualization can reduce the incidence of oropharyngeal mucosal injury.

Methods
Eighty patients undergoing surgery with general anesthesia were randomly allocated to either the conventional group, in which the probe was inserted blindly, or the laryngoscope group, in which a rigid laryngoscope was used to visualize the passage of the probe. The incidence of oropharyngeal mucosal injury, the number of insertion attempts, and odynophagia were assessed.

Results
There was no significant difference in demographic and hemodynamic parameters between the 2 groups. The incidence of oropharyngeal mucosal injury was higher in the conventional group than in the laryngoscope group (55% vs. 5%, P < 0.05). The incidence of odynophagia was higher in the conventional group than in the laryngoscope group (32.5% vs. 2.5%, P < 0.05). The number of insertion attempts was also higher in the conventional group than in the laryngoscope group.

Conclusion
Rigid laryngoscope-assisted insertion of the transesophageal echocardiography probe reduces the incidence of oropharyngeal mucosal injury, odynophagia, and the number of insertion attempts.
Laryngoscopy via Macintosh Blade versus GlideScope
Authors: Nouruzi-Sedeh Parichehr , Schumann Mark , Groeben Harald 
Published: December 2008

Background
Tracheal intubation is the preferred technique to secure the airway and apply mechanical ventilation. However, when performed by untrained medical personnel, tracheal intubation via direct laryngoscopy has a high rate of failure. The GlideScope (Verathon Medical Europe, Ijsselstein, Netherlands) technique improves the success rate for difficult tracheal intubation performed by experienced physicians; whether this technique improves the success rate for normal intubations when performed by inexperienced personnel as well is unknown. Therefore, the authors compared the success rate of direct laryngoscopy versus the GlideScope technique performed by personnel inexperienced in tracheal intubations.

Methods
Twenty volunteers, who had had only manikin training for tracheal intubation, attempted 5 intubations with either technique in patients scheduled for general anesthesia within a time limit of 120 s.

Results
Two hundred patients were divided into 2 groups for intubation via direct laryngoscopy (n = 100) or the GlideScope technique (n = 100). Between groups, there was neither a clinically relevant difference in the anthropometric data nor in the medication used for anesthesia. The overall success rate was 93% for the GlideScope technique versus 51% for direct laryngoscopy (P < 0.01). Time for intubation was 89 +/- 35 s for direct laryngoscopy versus 63 +/- 30 s for GlideScope technique (P < 0.01).

Conclusion
Tracheal intubation is the preferred technique to secure the airways in patients with a high risk of aspiration and is important in emergency medicine. Direct laryngoscopy with the Macintosh blade has a success rate of only 51% in our subjects. Using the GlideScope technique, a success rate of more than 90% within 120 s can be achieved after the first attempt, even in personnel untrained in intubation.
Glucose Infusion Suppresses Surgery-induced Muscle Protein Breakdown by Inhibiting Ubiquitin-proteasome Pathway in Rats
Authors: Mikura Mayumi , Yamaoka Ippei , Doi Masako , Kawano Yuichi , Nakayama Mitsuo , Nakao Reiko , Hirasaka Katsuya , Okumura Yuushi , Nikawa Takeshi 
Published: December 2008

Background
It appears to have been well established that after surgery, protein catabolism is accelerated and glucose infusion suppresses the catabolic reactions. However, in the early postoperative period, the effects of surgical stress and glucose infusion on muscle protein catabolism and the related mechanisms remain unclear.

Methods
Rats undergoing laparotomy were infused with acetated Ringer's solution (10 ml x kg(-1) x h(-1)) without glucose (control) or containing 1% or 5% glucose. The infusion was continued for a further 4 h after the surgical treatment. The catabolic index, excretion of urinary nitrogen and 3-methylhistidine, and release of tyrosine and 3-methylhistidine from isolated muscle were determined. Furthermore, muscular mRNA expression of proteolytic-related genes (atrogin-1/MAFbx, muscle ring finger-1, mu- and m-calpain, and cathepsin L and H) and phosphorylation of components of insulin signaling (forkhead box O3 and protein kinase B) were evaluated.

Results
Surgery increased the catabolic index, and this increase was suppressed by glucose infusion (both 1% and 5%). In the control group, mRNA expression of atrogin-1/MAFbx and muscle ring finger-1 was increased, and they were suppressed in the two glucose groups. Furthermore, insulin signaling (phosphorylation of protein kinase B and forkhead box O3) in muscles was stimulated by glucose infusion.

Conclusion
The present study indicates that glucose infusion, even at a relatively low rate, suppresses muscle protein breakdown in the early postoperative period. The mechanism of this effect is related to the suppression of the ubiquitin-proteasome pathway, accompanied by activation of insulin signaling.
Preoperative and Intraoperative Predictors of Cardiac Adverse Events after General, Vascular, and Urological Surgery
Authors: Kheterpal Sachin , O’Reilly Michael , Englesbe Michael J. , Rosenberg Andrew L. , Shanks Amy M. , Zhang Lingling , Rothman Edward D. , Campbell Darrell A. , Tremper Kevin K. 
Published: December 2008

Background
The authors sought to determine the incidence and risk factors for perioperative cardiac adverse events (CAEs) after noncardiac surgery using detailed preoperative and intraoperative hemodynamic data.

Methods
The authors conducted a prospective observational study at a single university hospital from 2002 to 2006. All American College of Surgeons-National Surgical Quality Improvement Program patients undergoing general, vascular, and urological surgery were included. The CAE outcome definition included cardiac arrest, non-ST elevation myocardial infarction, Q-wave myocardial infarction, and new clinically significant cardiac dysrhythmia within the first 30 postoperative days.

Results
Four years of data demonstrated that of 7,740 noncardiac operations, 83 patients (1.1%) experienced a CAE within 30 days. Nine independent predictors were identified (P < or = 0.05): age > or = 68, body mass index > or = 30, emergent surgery, previous coronary intervention or cardiac surgery, active congestive heart failure, cerebrovascular disease, hypertension, operative duration > or = 3.8 h, and the administration of 1 or more units of packed red blood cells intraoperatively. The c-statistic of this model was 0.81 +/- 0.02. Univariate analysis demonstrated that high-risk patients experiencing a CAE were more likely to experience an episode of mean arterial pressure < 50 mmHg (6% vs. 24%, P = 0.02), experience an episode of 40% decrease in mean arterial pressure (26% vs. 53%, P = 0.01), and an episode of heart rate > 100 (22% vs. 34%, P = 0.05).

Conclusions
In comparison with current risk stratification indices, the inclusion of intraoperative elements improves the ability to predict a perioperative CAE after noncardiac surgery.