bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases
Authors: Shi Wendan , Green Heidi , Sikhosana Nqobile , Fernandez Ritin 
Published: June 2023

Purpose:
The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD).

Review Methods:
An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized.

Summary:
From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.
Urate-lowering drugs for chronic kidney disease with asymptomatic hyperuricemia and hypertension: a randomized trial
Authors: Kohagura Kentaro , Satoh Atsushi , Kochi Masako , Nakamura Takuto , Zamami Ryo , Tana Takeshi , Kinjyo Kazushi , Funakoshi Ryo , Yamazato Masanobu , Ishida Akio , Sakima Atsushi , Iseki Kunitoshi , Arima Hisatomi , Ohya Yusuke 
Published: June 2023

Introduction:
Xanthine oxidase (XO) inhibitors may slow down chronic kidney disease (CKD) progression. The comparative effectiveness of the different urate-lowering drugs is unknown. The aim of this study was to determine whether urate-lowering therapy with an XO inhibitor (febuxostat) and that with a uricosuric drug (benzbromarone) are comparable in slowing renal function decline in patients with CKD complicated with hypertension and hyperuricemia.

Methods:
This study was an open-label randomized parallel-group clinical trial of 95 patients with stage G3 CKD in Japan. The patients had hypertension and hyperuricemia without a history of gout. They were randomized to receive febuxostat (n = 47; febuxostat group) or benzbromarone (n = 48; benzbromarone group) and titrated to reduce their serum urate level to <6.0 mg/dl. The primary end-point was change in estimated glomerular filtration rate (eGFR) from baseline to 52 weeks. The secondary end-points included changes in uric acid level, blood pressure, urinary albumin-to-creatinine ratio, and XO activity.

Results:
Of the 95 patients, 88 (92.6%) completed the trial. There were no significant differences in change in eGFR (in ml/min/1.73 m2) between the febuxostat [−0.23, 95% confidence interval (CI), −2.00 to 1.55] and benzbromarone (−2.18, 95% CI, −3.84 to −0.52) groups (difference, 1.95; 95% CI, −0.48 to 4.38; P = 0.115) nor in the secondary end-points, except for XO activity. Febuxostat significantly reduced XO activity (P = 0.010). There were no significant differences in primary and secondary outcomes between the groups. A decrease in eGFR was significantly less in the febuxostat group than that of the benzbromarone group in the CKDG3a, but not in CKDG3b, in the subgroup analysis. There were no adverse effects specific to either drug.

Conclusions:
No significant differences were found in the effects of febuxostat and benzbromarone in renal function decline in stage G3 CKD complicated with hyperuricemia and hypertension.
Interactive Effects of Ayahuasca and Cannabidiol in Social Cognition in Healthy Volunteers
Authors: Rossi Giordano Novak , Rocha Juliana Mendes , Osório Flávia L. , Bouso José Carlos , Ona Genis , Silveira Gabriela de Oliveira , Yonamine Mauricio , Bertozi Giuliana , Crevelin Eduardo José , Queiroz Maria Eugênia , Crippa José Alexandre S. , Hallak Jaime E. Cecílio , dos Santos Rafael G. 
Published: June 2023

Abstract

Background
Serotonergic hallucinogens and cannabinoids may alter the recognition of emotions in facial expressions (REFE). Cannabidiol (CBD) attenuates the psychoactive effects of the cannabinoid-1 agonist tetrahydrocannabinol. Ayahuasca is a dimethyltryptamine-containing hallucinogenic decoction. It is unknown if CBD may moderate and attenuate the effects of ayahuasca on REFE.

Procedures
Seventeen healthy volunteers participated in a 1-week preliminary parallel-arm, randomized controlled trial for 18 months. Volunteers received a placebo or 600 mg of oral CBD followed by oral ayahuasca (1 mL/kg) 90 minutes later. Primary outcomes included REFE and empathy tasks (coprimary outcome). Tasks were performed at baseline and 6.5 hours, 1 and 7 days after the interventions. Secondary outcome measures included subjective effects, tolerability, and biochemical assessments.

Results
Significant reductions (all P values <0.05) only in reaction times were observed in the 2 tasks in both groups, without between-group differences. Furthermore, significant reductions in anxiety, sedation, cognitive deterioration, and discomfort were observed in both groups, without between-group differences. Ayahuasca, with or without CBD, was well tolerated, producing mainly nausea and gastrointestinal discomfort. No clinically significant effects were observed on cardiovascular measurements and liver enzymes.

Conclusions
There was no evidence of interactive effects between ayahuasca and CBD. The safety of separate and concomitant drug intake suggests that both drugs could be applied to clinical populations with anxiety disorders and in further trials with larger samples to confirm findings.
Clinical Recommendations for Augmentation Agents in Obsessive-Compulsive Disorder Partially Responsive to Serotonin Reuptake Inhibitors
Authors: Gautam Mohan 
Published: June 2023

Abstract

Background
Obsessive-compulsive disorder (OCD) affects 2% to 3% of adults worldwide. Although serotonin reuptake inhibitors (SRIs) reliably demonstrate efficacy for this condition, 40% to 60% of patients only achieve partial recovery. The purpose of this systematic review was to assess the efficacy of other agents that may be used as augmentation agents for patients who are partial responders to SRI monotherapy.

Methods
Using PRISMA-P guidelines, PubMed and Embase were searched using the randomized controlled trial (RCT) filter and the key word “obsessive-compulsive disorder.” To be considered for analysis, a potential augmentation agent needed to have at least 2 RCTs. This review specifically analyzes the effect of each augmentation agent on OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale.

Results
The augmentation agents analyzed in this review are d-cycloserine (2 RCTs), memantine (4 RCTs), N-acetylcysteine (5 RCTs), lamotrigine (2 RCTs), topiramate (3 RCTs), riluzole (2 RCTs), ondansetron (2 RCTs), celecoxib (2 RCTs), aripiprazole (5 RCTs), risperidone (7 RCTs), quetiapine (9 RCTs), and olanzapine (3 RCTs).

Implications
The augmentation agents most supported by this review for OCD that is only a partial response to SRI monotherapy are lamotrigine, memantine, and aripiprazole. If an antipsychotic must be used and aripiprazole is not tolerated, risperidone may be considered as an alternative. Unlike the SRI class effect for OCD symptom reduction, augmentation agents demonstrate considerable intraclass variability.
To Compare the Effects of a Standard Versus Hydrophilic Polymer Coated Airway Stent in a Porcine Model
Authors: Cho Roy Joseph , Kadowaki Koji , Seelig Davis , Glumac Daniel E. , Kent Leslie A. , Hunter Ryan C. , MacIver Robroy H. , Peterson Gregory K. , Pandey Vidhu , Tanahashi Kazuhiro 
Published: June 2023

Background:
Stent encrustation with debris and mucostasis is a significant cause of airway injury and comorbidity, leading to ~25% of stent exchanges (1–3). Previous work from our group has shown that the experimental coating can reduce mucous adhesion in bench testing and demonstrated a signal for reducing airway injury and mucostasis in a feasibility study.

Objectives:
The aim of this study is to continue our inquiry in a randomized, single-blinded multi-animal trial to investigate the degree of airway injury and mucostasis using silicone stents with and without this specialized coating.

Methods:
We modified commercially available silicone stents with a hydrophilic polymer from Toray Industries. We conducted an in vivo survival study in 6 mainstem airways (3 coated and 3 uncoated) of 3 pigs to compare the degree of airway injury and mucostasis between coated versus noncoated stented airways. Both stents were randomized to either left or right mainstem bronchus. The pathologist was blinded to the stent type.

Results:
We implanted a total of six 14×15 mm silicone stents (1 per mainstem bronchi) into 3 pigs. All animals survived to termination at 4 weeks. All stents were intact; however, 1 uncoated stent migrated out. On average, all the coated stents demonstrated reduced pathology and tissue injury scores (75 vs. 68.3, respectively). The average total dried mucous weight was slightly higher in the coated stents (0.07 g vs. 0.05 g; respectively).

Conclusion:
Coated stents had lower airway injury compared with uncoated stents in this study. Of all the stents, 1 uncoated stent migrated out and was not included in the dried mucous weight totals. This could explain the slightly higher mucous weight in the coated stents. Nevertheless, this current study demonstrates promising results in lowering airway injury in stents incorporated with the hydrophilic coating, and future studies, including a larger number of subjects, would be needed to corroborate our findings.
Efficacy of Prophylactic Post-Operative Antibiotics in Tissue Expander-Based Breast Reconstruction: A Propensity Score-Matched Analysis
Authors: Sergesketter Amanda R. , Langdell Hannah C. , Shammas Ronnie L. , Geng Yisong , Atia Andrew N. , Rezak Kristen , Sisk Geoffroy C. , Hollenbeck Scott T. , Phillips Brett T. 
Published: June 2023

BACKGROUND:
Conflicting evidence exists regarding the utility of prophylactic post-operative antibiotics in tissue expander-based breast reconstruction. This study evaluated risk of surgical site infection between patients receiving 24 hours of perioperative antibiotics alone versus prolonged post-operative antibiotics within a propensity score-matched cohort.

METHODS:
Patients undergoing tissue expander-based breast reconstruction receiving 24 hours of perioperative antibiotics alone were propensity score-matched 1:3 to patients receiving post-operative antibiotics based on demographics, comorbidities, and treatment factors. Incidence of surgical site infection was compared based on duration of antibiotic prophylaxis.

RESULTS:
Of a total of 431 patients undergoing tissue expander-based breast reconstruction, post-operative antibiotics were prescribed in 77.2%. Within this cohort, 348 were included for propensity matching (No Antibiotics: 87 patients; Antibiotics: 261 patients). After propensity score matching, there was no significant difference in incidence of infection requiring intravenous (No Antibiotics: 6.9%; Antibiotics: 4.6%; p=0.35) or oral antibiotics (No Antibiotics: 11.5%; Antibiotics: 16.1%; p=0.16). In addition, rates of unplanned reoperation (p=0.88) and 30-day readmission (p=0.19) were similar. After multivariate adjustment, prescription of post-operative antibiotics was not associated with a reduction in surgical site infection (OR 0.5; 95% CI -0.3-1.3; p=0.23).

CONCLUSIONS:
Within a propensity-matched cohort accounting for patient comorbidities and receipt of adjuvant therapies, prescription of post-operative antibiotics after tissue expander-based breast reconstruction conferred no improvement in rates of tissue expander infection, reoperation, or unplanned healthcare utilization. This data underscores the need for multi-center, prospective randomized trials on the utility of antibiotic prophylaxis in tissue expander-based breast reconstruction.
“Quantifying the Impact of Prepectoral Implant Conversion on Patient Satisfaction and Quality of Life”
Authors: Seitz Allison J. , MacKenzie Ethan L. , Edalatpour Armin , Janssen David A. , Doubek III William G. , Afifi Ahmed M. 
Published: June 2023

Background:
Conversion of subpectoral reconstruction to the prepectoral plane has been increasing in popularity. However, there is a paucity of research assessing patient-reported outcomes following this operation. The primary aim of this study is to examine patient-reported outcomes following conversion of implants from the subpectoral to prepectoral plane through utilization of the BREAST-Q.

Methods:
We retrospectively examined patients who underwent subpectoral to prepectoral implant conversion by three surgeons at two separate centers from 2017-2021. Patient demographics, primary indication for the conversion, surgical characteristics, postoperative outcomes, and BREAST-Qs were obtained.

Results:
Sixty-eight breasts in 39 patients underwent implant conversion. The most common primary indications for implant conversion were chronic pain (41%), animation deformity (30%), and cosmetic concerns (27%). Average BREAST-Q scores improved significantly preoperatively to postoperatively in all the domains measured (“satisfaction with breasts”, “satisfaction with implants”, “physical well-being,” “psychosocial well-being,” and “sexual well-being”) (p<0.01). When examined by primary indication, all cohorts had significant preoperative to postoperative score improvement in “satisfaction with breasts” (p<0.001) and “physical well-being” (p<0.01) domains. Fifteen breasts (22%) developed postoperative complications, with implant loss in 9% of breasts.

Conclusions
:Conversion of subpectoral implants to the prepectoral plane significantly improves BREAST-Q outcomes in all aspects, including patient satisfaction with breasts and implants, as well as psychosocial, physical, and sexual well-being. Implant conversion to the prepectoral plane in now becoming our primary solution to most patients with chronic pain, animation deformity or cosmetic concerns after subpectoral reconstruction.
The Delay Procedure in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction
Authors: Beugels Jop , Levine Joshua L. , Vasile Julie V. , Craigie James E. , Allen Robert J. 
Published: June 2023

Background:
The delay procedure in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction, in which the reduced-caliber choke vessels play a major role, can provide more well-perfused tissue than a standard DIEP flap. The aim of this study was to review the authors’ experience with this technique, evaluate the indications, and analyze the surgical outcomes.

Methods:
A retrospective study was conducted of all consecutive DIEP delay procedures performed between March of 2019 and June of 2021. Patient demographic characteristics, operative details, and complications were registered. Patients had preoperative imaging by magnetic resonance angiography to select dominant perforators. The surgical technique involves a two-stage operation. During the first operation, the flaps were pedicled on a dominant perforator and a lateral skin bridge extending toward the lateral flank and lumbar fat; in a second stage, the flap was harvested and transferred.

Results:
A total of 82 extended DIEP delay procedures were performed to reconstruct 154 breasts. The majority were bilateral breast reconstructions (87.8%). The delay procedure was used for 38 primary reconstructions (46.3%) and 32 tertiary reconstructions (39.0%). The primary indication was the need for additional volume (79.3%), followed by extensive abdominal scarring and liposuction. After the first operation, seroma was the most frequently observed complication (7.3%). After the second operation, three total flap losses (1.9%) were observed.

Conclusions:
The delay procedure in DIEP flap breast reconstruction results in the harvest of a good amount of abdominal tissue by adding a preliminary procedure. This technique can convert cases previously considered unsuitable into suitable candidates for abdominal-based breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Association Between Payer Type and Risk of Persistent Opioid Use after Surgery
Authors: Srinivasan Sudharsan , Gunaseelan Vidhya , Jankulov Alexandra , Chua Kao-Ping , Englesbe Michael , Waljee Jennifer , Bicket Mark , Brummett Chad M. 
Published: June 2023

Objective:
To assess whether the risk of persistent opioid use after surgery varies by payer type.

Background:
Persistent opioid use is associated with increased healthcare utilization and risk of opioid use disorder, opioid overdose, and mortality. Most research assessing the risk of persistent opioid use has focused on privately insured patients. Whether this risk varies by payer type is poorly understood.

Methods:
This cross-sectional analysis of the Michigan Surgical Quality Collaborative database examined adults aged 18-64 years undergoing surgical procedures across 70 hospitals between January 1, 2017, and October 31, 2019. The primary outcome was persistent opioid use, defined a priori as 1+ opioid prescription fulfillment at (1) an additional opioid prescription fulfillment after an initial postoperative fulfillment in the perioperative period or at least one fulfillment in the 4-90 days after discharge and (2) at least one opioid prescription fulfillment in the 91-180 days after discharge. The association between this outcome and payer type was evaluated using logistic regression, adjusting for patient and procedure characteristics.

Results:
Among 40,071 patients included, mean age was 45.3 years (SD 12.3), 24,853 (62%) were female, 9,430 (23.5%) were Medicaid-insured, 26,760 (66.8%) were privately insured, and 3,889 (9.7%) were covered by other payer types. The rate of POU was 11.5% and 5.6% for Medicaid-insured and privately insured patients, respectively (average marginal effect for Medicaid: 2.9% (95% CI 2.3%-3.6%)).

Conclusions:
Persistent opioid use remains common among individuals undergoing surgery, and higher among patients with Medicaid insurance. Strategies to optimize postoperative recovery should focus on adequate pain management for all patients and consider tailored pathways for those at risk.
Novel Gene-Modified Mesenchymal Stem Cell Therapy Reverses Impaired Wound Healing in Ischemic Limbs
Authors: Huerta Carlos Theodore , Ortiz Yulexi Y. , Li Yan , Ribieras Antoine J. , Voza Francesca , Le Nga , Dodson Caroline , Wang Gaofeng , Vazquez-Padron Roberto I. , Liu Zhao-Jun , Velazquez Omaida C. 
Published: June 2023

Objective:
Here we report a new method to increase therapeutic potential of mesenchymal stem/stromal cells (MSCs) for ischemic wound healing. We tested biologic effects of MSCs modified with E-selectin, a cell-adhesion molecule capable of inducing post-natal neovascularization, on a translational murine model.

Summary Background Data:
Tissue loss significantly worsens the risk of extremity amputation for patients with chronic limb-threatening ischemia (CLTI). MSCs-based therapeutics hold major promise for wound healing and therapeutic angiogenesis, but unmodified MSCs demonstrate only modest benefits.

Methods:
Bone marrow cells harvested from FVB/ROSA26SormTmG donor mice were transduced with E-selectin-GFP/AAV-DJ or GFP/AAV-DJ (control). Ischemic wounds were created via a 4 mm punch biopsy in the ipsilateral limb after femoral artery ligation in recipient FVB mice and subsequently injected with PBS or 1×10^6 donor MSCGFP or MSCE-selectin-GFP. Wound closure was monitored daily for 7 postoperative days (POD), and tissues were harvested for molecular and histological analysis and immunofluorescence. Whole-body DiI perfusion and confocal microscopy was utilized to evaluate wound angiogenesis.

Results:
Unmodified MSCs do not express E-selectin, and MSCE-selectin-GFP gain stronger MSC phenotype yet maintain trilineage differentiation and colony-forming capability. MSCE-selectin-GFP therapy accelerates wound healing compared to MSCGFP and PBS treatment. Engrafted MSCE-selectin-GFP manifest stronger survival and viability in wounds at POD 7. Ischemic wounds treated with MSCE-selectin-GFP exhibit more abundant collagen deposition, and enhanced angiogenic response.

Conclusion:
We establish a novel method to potentiate regenerative and pro-angiogenic capability of MSCs by modification with E-selectin/AAV. This innovative therapy carries potential as a platform worthy of future clinical studies.
Patient-controlled analgesia for the management of adults with acute trauma in the emergency department: A systematic review and meta-analysis
Authors: Sim Guek Gwee , See Amanda Huimin , Quah Li Juan Joy 
Published: June 2023

BACKGROUND
Patient-controlled analgesia (PCA) has potential as a form of analgesia for trauma patients in the emergency department (ED). The objective of this review was to evaluate the effectiveness and safety of PCA for the management of adults with acute traumatic pain in the ED. The hypothesis was that PCA can effectively treat acute trauma pain in adults in the ED, with minimal adverse outcomes and better patient satisfaction compared with non-PCA modalities.

METHODS
MEDLINE (PubMed), Embase, SCOPUS, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception date to December 13, 2022. Randomized controlled trials involving adults presenting to the ED with acute traumatic pain who received intravenous (IV) analgesia via PCA compared with other modalities were included. The Cochrane Risk of Bias tool and the Grading of Recommendation, Assessment, Development, and Evaluation approach were used to assess the quality of included studies.

RESULTS
A total of 1,368 publications were screened, with 3 studies involving 382 patients meeting the eligibility criteria. All three studies compared PCA IV morphine with clinician-titrated IV morphine boluses. For the primary outcome of pain relief, the pooled estimate was in favor of PCA with a standard mean difference of −0.36 (95% confidence interval, −0.87 to 0.16). There were mixed results concerning patient satisfaction. Adverse event rates were low overall. The evidence from all three studies was graded as low-quality because of a high risk of bias from lack of blinding.

CONCLUSION
This study did not demonstrate a significant improvement in pain relief or patient satisfaction using PCA for trauma in the ED. Clinicians wishing to use PCA to treat acute trauma pain in adult patients in the ED are advised to consider the available resources in their own practice settings and to implement protocols for monitoring and responding to potential adverse events.

LEVEL OF EVIDENCE
Systematic Review/Meta-Analyses; Level III.