bluuebunny/crossref_metadata_2025_split huggingface dataset:
Placenta Accreta Spectrum: We Can Do Better
Authors: Silveira C. , Kirby A. , Melov S.J. , Nayyar R. 
Published: February 2023

(Aust N Z J Obstet Gynaecol. 2022;62:376–382)
Placenta accreta spectrum (PAS) describes the range of placental disorders. Based on classifications by the International Federation for Gynecology and Obstetrics, Grade 1 PAS indicates an abnormal adherent placenta (accreta), Grade 2 PAS indicates an abnormal invasive placenta into the uterine muscle (increta), and Grade 3 PAS indicates an abnormal placenta that grows into the uterine wall and surrounding organs (percreta). Risk factors for PAS include increased maternal age, multiparity, previous cesarean delivery (CD) or uterine surgery, in vitro fertilization, and placenta previa. The incidence of PAS has been increasing from 0.4 per 1000 births in earlier studies to as high as 3.7 per 1000 births—a trend largely attributed to the worldwide increase in CD. Because PAS is associated with a number of severe pregnancy complications, such as maternal hemorrhage, hysterectomy, and mortality, its accurate diagnosis is important for the appropriate transfer of care and multidisciplinary team (MDT) management. The aim of this study was to determine the rate of antenatal detection of PAS and the impact of MDT management on pregnancy outcomes.
The Impact on Obstetric and Perinatal Outcomes in Term Infants Following the Introduction of a Color-coded, Hierarchical Cardiotocography Classification System: A Retrospective Noninferiority Study
Authors: Willis M. , Dunn L. , Okano S. , Janssens S. , Kumar S. 
Published: February 2023

(Aust N Z J Obstet Gynaecol. 2022;62:370–375)
The effectiveness of continuous cardiotocograph (CTG) monitoring relies on the accurate interpretation of the fetal heart rate (FHR) tracing, taken together with all available clinical information, and followed by appropriate clinical responses. CTG interpretation is dependent on the observations of the obstetrical team and subject to bias. Staff training and consistent, standardized FHR interpretation may help to improve the effectiveness of CTG monitoring. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ (RANZCOG) Intrapartum Fetal Surveillance recommends a CTG classification system using prose that defines fetal compromise as low, unlikely, maybe, or likely. A new color-coded system, the Queensland Clinical Guidelines (QCG), complements this prose-system, by using green, blue, yellow, and red to define fetal compromise, and recommends appropriate actions in response to each CTG category. The aim of this study was to assess the effectiveness of the color-coded CTG classification system on pregnancy outcomes before and after implementation.
Disconnected Perspectives: Patient and Care Provider’s Experiences of Substance Use in Pregnancy
Authors: Mitchell-Foster S.M. , Emon C.E. , Brouwer M. , Duncan Elder L. , King J. 
Published: February 2023

(Int J Gynaecol Obstet. 2021;155:170–178)
A negative stigma surrounds substance use in pregnancy and can lead to suboptimal care of parturient women from providers. Indigenous women in Northern British Columbia (BC) have preexisting risk such as generational abuse, racism, and systemic trauma that contribute to increase risk of substance use in pregnancy, putting an already underserved population at greater risk for adverse outcomes. The aim of this study was to discuss substance use in pregnancy from the patient and provider perspective to increase understanding and bridge the gap between patients and providers.
Assessment of Sensory Block During Labor Epidural Analgesia: A Prospective Cohort Study to Determine the Influence of the Direction of Testing
Authors: De Souza Soares E.C. , Balki M. , Downey K. , Ye X.Y. , Carvalho J.C.A. 
Published: February 2023

(Can J Anesth/J Can Anesth. 2022;69:750–755)
Sensory block, or a decreased sensitivity to sensory stimuli, occurs with epidural anesthesia during labor. Assessing the degree of sensory block is important both for clinical practice and for patient safety, yet the assessment procedure is not standardized. A variety of stimuli have been used, as well as a variety of endpoints for determining the level of sensory block. This lack of standardization causes not only a difference in the way independent clinicians determine sensory block, it can also result in inconsistent description of these levels for the same patient, as well as issues with replication of studies and implementation of clinical practice.
Pharmacokinetics and Tolerability of Intraperitoneal Chloroprocaine After Fetal Extraction in Women Undergoing Cesarean Delivery
Authors: Togioka B.M. , Zarnegarnia Y. , Bleyle L.A. , Koop D. , Brookfield K. , Yanez N.D. , Treggiari M.M. 
Published: February 2023

(Anesth Analg. 2022;135:777–786)
When neuraxial anesthesia is inadequate, there are few analgesic supplemental options that do not cause adverse outcomes for neonate or alter the maternal birth experience. Intraperitoneal chloroprocaine has been used perioperatively for decades to compensate for suboptimal neuraxial anesthesia due to its short in vitro half-life, however, there is a lack of data regarding absorption rate. This study aims to determine intraperitoneal chloroprocaine in vivo half-life and assess tolerability in the clinical setting.
The Enhancing Life Research Laboratory: Tools for Addressing Orientational Distress in the Medical Profession
Authors: Thomas Guenter , Bigger Sara , Kim Jenny , Kim Marie , Yoon John D. , Schweiker William 
Published: February 2023

Purpose
To explore distress in the medical profession and how it was highlighted by the ongoing COVID-19 pandemic. The term “orientational distress” was developed to name the experience of a breakdown in the patterns of moral self-understanding and one’s capacity to navigate professional responsibilities.

Method
The Enhancing Life Research Laboratory at the University of Chicago convened a 5-session online workshop (total 10 hours, May–June 2021) to explore orientational distress and to promote collaboration between academics and physicians. Sixteen participants from Canada, Germany, Israel, and the United States engaged in discussions of the conceptual framework and toolkit to address orientational distress within institutional settings. The tools included 5 dimensions of life, 12 dynamics of life, and the role of counterworlds. Follow-up narrative interviews were transcribed and coded using a consensus-based iterative process.

Results
Participants reported that the concept of orientational distress helped explain their professional experiences better than burnout or moral distress. Moreover, participants strongly endorsed the project’s supporting thesis that collaborative work on orientational distress and the tools provided in the research laboratory had a specific intrinsic value and provided benefits not found in other support instruments.

Conclusions
Orientational distress compromises medical professionals and threatens the medical system. Next steps include the dissemination of materials from the Enhancing Life Research Laboratory to more medical professionals and medical schools. In contrast to burnout and moral injury, the concept of orientational distress may better enable clinicians to understand and more fruitfully navigate the challenges of their professional situations.
Metabolomics as a tool to predict the risk of decompensation or liver-related death in patients with compensated cirrhosis
Authors: Nicoară-Farcău Oana , Lozano Juan J. , Alonso Cristina , Sidorova Julia , Villanueva Càndid , Albillos Augustín , Genescà Joan , Llop Elba , Calleja Jose L. , Aracil Carles , Bañares Rafael , Morillas Rosa , Poca Maria , Peñas Beatriz , Augustin Salvador , Tantău Marcel , Thompson Marcos , Perez-Campuzano Valeria , Baiges Anna , Turon Fanny , Hernández-Gea Virginia , Abraldes Juan G. , Tapias Edilmar A. , Torres Ferran , Bosch Jaime , García-Pagán Juan C. ,   on behalf of the PreDesCI Study Investigators
Published: February 2023

Background and Aims:
Patients with compensated cirrhosis with clinically significant portal hypertension (CSPH: HVPG >10 mm Hg) have a high risk of decompensation. HVPG is, however, an invasive procedure not available in all centers. The present study aims to assess whether metabolomics can improve the capacity of clinical models in predicting clinical outcomes in these compensated patients.

Approach and Results:
This is a nested study from the PREDESCI cohort (an RCT of nonselective beta-blockers vs. placebo in 201 patients with compensated cirrhosis and CSPH), including 167 patients for whom a blood sample was collected. A targeted metabolomic serum analysis, using ultra-high-performance liquid chromatography-mass spectrometry, was performed. Metabolites underwent univariate time-to-event cox regression analysis. Top-ranked metabolites were selected using Log-Rank p-value to generate a stepwise cox model. Comparison between models was done using DeLong test. Eighty-two patients with CSPH were randomized to nonselective beta-blockers and 85 to placebo. Thirty-three patients developed the main endpoint (decompensation/liver-related death). The model, including HVPG, Child-Pugh, and treatment received (HVPG/Clinical model), had a C-index of 0.748 (CI95% 0.664–0.827). The addition of 2 metabolites, ceramide (d18:1/22:0) and methionine (HVPG/Clinical/Metabolite model), significantly improved the model’s performance [C-index of 0.808 (CI95% 0.735–0.882); p=0.032]. The combination of these 2 metabolites together with Child-Pugh and the type of treatment received (Clinical/Metabolite model) had a C-index of 0.785 (CI95% 0.710–0.860), not significantly different from the HVPG-based models including or not metabolites.

Conclusions:
In patients with compensated cirrhosis and CSPH, metabolomics improves the capacity of clinical models and achieves similar predictive capacity than models including HVPG.
IgY antibodies against cytolysin reduce ethanol-induced liver disease in mice
Authors: Cabré Noemí , Hartmann Phillipp , Llorente Cristina , Kouno Tetsuya , Wang Yanhan , Zeng Suling , Kim Hyun Young , Zhang Xinlian , Kisseleva Tatiana , Iyer Subramanian , Kudumala Sirisha , Schnabl Bernd 
Published: February 2023

Background and Aims:
Patients with severe alcohol-associated hepatitis have high morbidity and mortality. Novel therapeutic approaches are urgently needed. The aims of our study were to confirm the predictive value of cytolysin-positive Enterococcus faecalis (E. faecalis) for mortality in patients with alcohol-associated hepatitis and to assess the protective effect of specific chicken immunoglobulin Y (IgY) antibodies against cytolysin in vitro and in a microbiota-humanized mouse model of ethanol-induced liver disease.

Approach and Results:
We investigated a multicenter cohort of 26 subjects with alcohol-associated hepatitis and confirmed our previous findings that the presence of fecal cytolysin-positive E. faecalis predicted 180-day mortality in those patients. After combining this smaller cohort with our previously published multicenter cohort, the presence of fecal cytolysin has a better diagnostic area under the curve, better other accuracy measures, and a higher odds ratio to predict death in patients with alcohol-associated hepatitis than other commonly used liver disease models. In a precision medicine approach, we generated IgY antibodies against cytolysin from hyperimmunized chickens. Neutralizing IgY antibodies against cytolysin reduced cytolysin-induced cell death in primary mouse hepatocytes. The oral administration of IgY antibodies against cytolysin decreased ethanol-induced liver disease in gnotobiotic mice colonized with stool from cytolysin-positive patients with alcohol-associated hepatitis.

Conclusions:

E. faecalis cytolysin is an important mortality predictor in alcohol-associated hepatitis patients, and its targeted neutralization through specific antibodies improves ethanol-induced liver disease in microbiota-humanized mice.
Protocol Development and Initial Experience With Intravenous Sotalol Loading for Atrial Arrhythmias
Authors: Feuerborn Melissa L. , Dechand John , Vadlamudi Rohith S. , Torre Michael , Freedman Roger A. , Groh Christopher , Navaravong Leenhapong , Ranjan Ravi , Varela Daniel , Bunch T. Jared , Steinberg Benjamin A. 
Published: February 2023

Background:
Oral sotalol is a class III antiarrhythmic commonly used for the maintenance of sinus rhythm in patients with atrial fibrillation (AF). Recently, the Food and Drug Administration (FDA) approved the use of IV sotalol loading, based primarily on modeling data for the infusion. We aimed to describe a protocol and experience with IV sotalol loading for elective treatment of adult patients with AF and atrial flutter (AFL).

Methods:
We present our institutional protocol and retrospective review of initial patients treated with IV sotalol for AF/AFL at the University of Utah Hospital between September 2020 and April 2021.

Results:
Eleven patients received IV sotalol for initial loading or dose escalation. All patients were male, aged 56–88 years (median 69). Mean QT interval (QTc) intervals increased from baseline (mean 384 ms) immediately after infusion of IV sotalol (mean change 42ms), but no patient required discontinuation of the medication. Six patients were discharged after 1 night; 4 patients were discharged after 2 nights; and 1 patient was discharged after 4 nights. Nine patients underwent electrical cardioversion prior to discharge (2 prior to load; 7 post-load on the day of discharge). There were no adverse events during the infusion or within 6 months of discharge. Persistence of therapy was 73% (8 of 11) at mean 9.9 weeks to follow up, with no discontinuations for adverse effects.

Conclusions:
We employed a streamlined protocol that was successfully implemented to facilitate the use of IV sotalol loading for atrial arrhythmias. Our initial experience suggests feasibility, safety, and tolerability while reducing hospitalization duration. Additional data are needed to augment this experience as IV sotalol use is broadened across different patient populations.
Physical Properties and Interaction With the Ocular Surface of Water-Gradient Contact Lenses
Authors: Ponzini Erika , Recchioni Alberto , Cheloni Riccardo , Zeri Fabrizio , Tavazzi Silvia 
Published: February 2023

Abstract:
Since the introduction of silicone hydrogel contact lenses, many silicone-hydrogel materials have been produced, including water-gradient contact lenses with a silicone hydrogel core and a thin hydrogel outer layer (e.g., delefilcon A, verofilcon A, and lehfilcon A). Their properties have been investigated in various studies assessing both the chemical–physical characteristics and the comfort, but the overall picture is not always consistent. In this study, water-gradient technology is reviewed by looking at basic physical properties both in vitro and in vivo and at the interaction with the human ocular surface. Surface and bulk dehydration, surface wetting and dewetting, shear stress, interaction with tear components and with other environmental compounds, and comfort are discussed.
The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis
Authors: Worden Astin , Pike Francis , Allegretti Andrew S. , Kaur Harleen , Peng Jennifer L. , Kettler Carla D. , Orman Eric S. , Desai Archita P. , Nephew Lauren D. , Ghabril Marwan S. , Patidar Kavish R. 
Published: February 2023

Background:
The prognostic impact of acute kidney injury (AKI) recovery patterns in critically ill patients with cirrhosis is unknown. We aimed to compare mortality stratified by AKI recovery patterns and identify predictors of mortality in patients with cirrhosis and AKI admitted to the intensive care unit.

Materials and Methods:
Patients with cirrhosis and AKI from 2016 to 2018 at 2 tertiary care intensive care units were analyzed (N=322). AKI recovery was defined by Acute Disease Quality Initiative consensus: return of serum creatinine <0.3 mg/dL of baseline within 7 days of AKI onset. Recovery patterns were categorized by Acute Disease Quality Initiative consensus: 0–2 days, 3–7 days, and no-recovery (persistence of AKI >7 d). Landmark competing risk univariable and multivariable models (liver transplant as competing risk) was used to compare 90-day mortality between AKI recovery groups and to determine independent predictors of mortality.

Results:
Sixteen percent (N=50) and 27% (N=88) achieved AKI recovery within 0–2 and 3–7 days, respectively; 57% (N=184) had no-recovery. Acute on chronic liver failure was prevalent (83%) and patients with no-recovery were more likely to have grade 3 acute on chronic liver failure (N=95, 52%) compared to patients with AKI recovery [0–2: 16% (N=8); 3–7: 26% (N=23); p<0.001]. Patients with no-recovery had significantly higher probability of mortality [unadjusted-sub-HR (sHR): 3.55; 95% CI: 1.94–6.49; p<0.001] compared to patients with recovery within 0–2 days, while the probability was similar between 3–7 and 0–2 days (unadjusted-sub-HR: 1.71; 95% CI: 0.91–3.20; p=0.09). On multivariable analysis, AKI no-recovery (sub-HR: 2.07; 95% CI: 1.33–3.24; p=0.001), severe alcohol-associated hepatitis (sub-HR: 2.41; 95% CI: 1.20–4.83; p=0.01), and ascites (sub-HR: 1.60; 95% CI: 1.05–2.44; p=0.03) were independently associated with mortality.

Conclusion:
AKI no-recovery occurs in over half of critically ill patients with cirrhosis and AKI and is associated with worse survival. Interventions that facilitate AKI recovery may improve outcomes in this patient population.
Extracorporeal Membrane Oxygenation for Neonates With Congenital Diaphragmatic Hernia: Prevalence of Seizures and Outcomes
Authors: Danzer Enrico , Massey Shavonne L. , Flohr Sabrina J. , Mathew Leny , Hoffman Casey , Abramson Abigail , Selenski Paige , Canning Caroline E. , Eppley Elizabeth , Connelly James T. , Herkert Lisa , Rintoul Natalie E. , Adzick N. Scott , Abend Nicholas S. , Hedrick Holly L. 
Published: February 2023

OBJECTIVES:
We aimed to determine the prevalence of electrographic seizures and associated odds of adverse outcomes of electrographic seizures in neonates with congenital diaphragmatic hernia (CDH) receiving extracorporeal membrane oxygenation (ECMO).

DESIGN:
Retrospective, descriptive case series.

SETTING:
Neonatal ICU (NICU) in a quaternary care institution.

PATIENTS:
All neonates with CDH receiving ECMO undergoing continuous electroencephalographic monitoring (CEEG) and follow-up between January 2012 and December 2019.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
All eligible neonates with CDH receiving ECMO underwent CEEG (n = 75). Electrographic seizures occurred in 14 of 75 (19%): they were exclusively electrographic-only in nine of 14, both electrographic-only and electroclinical in three of 14, and electroclinical only in two of 14. Two neonates developed status epilepticus. We identified an association between presence of seizures, rather than not, and longer duration of initial session of CEEG monitoring (55.7 hr [48.2–87.3 hr] vs 48.0 hr [43.0–48.3 hr]; p = 0.001). We also found an association between presence of seizures, rather than not, and greater odds of use of a second CEEG monitoring (12/14 vs 21/61; odds ratio [OR], 11.43 [95% CI, 2.34–55.90; p = 0.0026). Most neonates with seizures (10/14), experienced their onset of seizures more than 96 hours after the start of ECMO. Overall, the presence of electrographic seizures, compared with not, was associated with lower odds of survival to NICU discharge (4/14 vs 49/61; OR 0.10 [95% CI 0.03 to 0.37], p = 0.0006). Also, the presence of seizures—rather than not—was associated with greater odds of a composite of death and all abnormal outcomes on follow-up (13/14 vs 26/61; OR, 17.5; 95% CI, 2.15–142.39; p = 0.0074).

CONCLUSIONS:
Nearly one in five neonates with CDH receiving ECMO developed seizures during the ECMO course. Seizures were predominantly electrographic-only and when present were associated with great odds of adverse outcomes. The current study provides evidence to support standardized CEEG in this population.
The radial slump of a gravity current in a confined porous layer
Authors: Zheng Zhong 
Published: February 2023

The flow of a gravity current widely occurs in many geophysical, environmental and industrial processes. We focus on the overlooked process of radial slump of a gravity current in confined porous layers, which is related to the post-injection flow dynamics of many subsurface displacement processes, initiated by fluid injection through vertical wells. Specifically, we describe the time evolution of the interface shape and location of the propagating front, governed by a second-order nonlinear partial differential equation (PDE). By solving a nonlinear eigenvalue problem, we identify a self-similar solution to describe the dynamics of confined flows at early times, when the interface attaches to both the top and bottom boundaries of the porous layer. As time progresses, the flow gradually becomes unconfined, as gravity-driven slump causes the interface to detach from one boundary; the interface evolution at late times is then described by a self-similar solution of a nonlinear diffusion equation. Time transition from the early-time confined towards late-time unconfined self-similar solutions is also verified by comparing the self-similar solutions and numerical solutions of the governing PDE for both the interface shape and the frontal location. Interestingly, two special vertical locations have also been identified where the best agreement appears between the PDE numerical solutions and the early-time self-similar solutions for the interface shape, which is a novel feature of the radial flow, and the degree of agreement is not impacted by the time evolution.
An Explorative Assessment of ChatGPT as an Aid in Medical Education: Use it with Caution
Authors: Han Zhiyong , Battaglia Fortunato , Udaiyar Abinav , Fooks Allen , Terlecky Stanley R. 
Published: February 2023

AbstractObjectiveTo explore the use of ChatGPT by educators and students in a medical school setting.MethodThis study used the public version of ChatGPT launched by OpenAI on November 30, 2022 (https://openai.com/blog/chatgpt/). We employed prompts to ask ChatGPT to 1) generate a content outline for a session on the topics of cholesterol, lipoproteins, and hyperlipidemia for medical students; 2) produce a list of learning objectives for the session; and 3) write assessment questions with and without clinical vignettes related to the identified learning objectives. We assessed the responses by ChatGPT for accuracy and reliability to determine the potential of the chatbot as an aid to educators and as a “know-it-all” medical information provider for students.ResultsChatGPT can function as an aid to educators, but it is not yet suitable as a reliable information resource for educators and medical students.ConclusionChatGPT can be a useful tool to assist medical educators draft course and session content outlines and create assessment questions. At the same time, caution must be taken as ChatGPT is prone to providing incorrect information; expert oversight and caution are necessary to ensure the information generated is accurate and beneficial to students. Therefore, it is premature for medical students to use the current version of ChatGPT as a “know-it-all” information provider. In the future, medical educators should work with programming experts to explore and grow the full potential of AI in medical education.