bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skin sympathetic nerve activity and nocturnal blood pressure nondipping in patients with postural orthostatic tachycardia syndrome
Authors: Liu Xiao , Rosenberg Carine , Reaso Jewel N. , Lee Andrew M. , Ricafrente Joselyn , Ebinger Joseph E. , Chen Lan S. , Li Xiaochun , Merz C. Noel Bairey , Rader Florian , Chen Peng-Sheng 
Published: May 2023

Objective:
Postural orthostatic tachycardia syndrome (POTS) is associated with abnormal blood pressure (BP) regulation and increased prevalence of nocturnal nondipping. We hypothesized that nocturnal nondipping of BP is associated with elevated skin sympathetic nerve activity (SKNA) in POTS.

Method:
We used an ambulatory monitor to record SKNA and electrocardiogram from 79 participants with POTS (36 ± 11 years, 72 women), including 67 with simultaneous 24-h ambulatory BP monitoring.

Results:
Nocturnal nondipping of BP was present in 19 of 67 (28%) participants. The nondipping group had a higher average SKNA (aSKNA) from midnight of day 1 to 0100 h on day 2 than the dipping group (P = 0.016, P = 0.030, respectively). The differences (Δ) of aSKNA and mean BP between daytime and night-time were more significant in the dipping group compared with the nondipping group (ΔaSKNA 0.160 ± 0.103 vs. 0.095 ± 0.099 μV, P = 0.021, and Δmean BP 15.0 ± 5.2 vs. 4.9 ± 4.2 mmHg, P < 0.001, respectively). There were positive correlations between ΔaSKNA and standing norepinephrine (NE) (r = 0.421, P = 0.013) and the differences between standing and supine NE levels (r = 0.411, P = 0.016). There were 53 (79%) patients with SBP less than 90 mmHg and 61 patients (91%) with DBP less than 60 mmHg. These hypotensive episodes were associated with aSKNA of 0.936 ± 0.081 and 0.936 ± 0.080 μV, respectively, which were both significantly lower than the nonhypotensive aSKNA (1.034 ± 0.087 μV, P < 0.001 for both) in the same patient.

Conclusion:
POTS patients with nocturnal nondipping have elevated nocturnal sympathetic tone and blunted reduction of SKNA between day and night. Hypotensive episodes were associated with reduced aSKNA.
Pacemakers, Implantable Defibrillators and 5G Technology: What We Need to Know
Authors: Mattei Eugenio , Vivarelli Cecilia , Franci Daniele , Pavoncello Settimio , Aureli Tommaso , Calcagnini Giovanni , Censi Federica 
Published: May 2023

Abstract
Pacemakers (PM) and implantable cardioverter defibrillators (ICD) are active implantable medical devices (AIMD) needed in case of cardiac arrhythmias. Given their potentially life-sustaining nature, the interaction between any source of electromagnetic field and these AIMDs is an ongoing concern of patients, industry, and regulators. According to the current regulatory framework, the required immunity of PM and ICD provides a reasonable unperturbed behavior in the presence of cell phones and base stations that use pre-5G technologies. PM/ICD international standards do not consider some peculiar characteristics of 5G technology and some of the 5G technology frequency bands (those above 3 GHz), since these frequencies are considered not to add risks to the AIMD functioning. Here we analyze the theoretical issues about the interference between 5G technology and PM/ICD and propose an experimental approach to perform a measurement campaign.
Influence of Body Posture on Internal Organ Dosimetry: Radiocesium Exposure Modeling Using Novel Posture-dependent Mesh Computational Phantoms
Authors: Carter Lukas M. , Bellamy Michael B. , Choi Chansoo , Kim Chan Hyeong , Bolch Wesley E. , Jokisch Derek , Kesner Adam L. 
Published: May 2023

Abstract
Current practice in reference internal dosimetry assumes a fixed upright standing posture is maintained throughout the dose-integration period. Recently, the mesh-type ICRP adult reference computational phantoms were transformed into different body postures (e.g., sitting, squatting) for use in occupational dose reconstruction applications. Here, for the first time, we apply this phantom series to the study of organ dose estimates following radionuclide intake. We consider the specific cases of 137Cs and 134Cs ingestion (accidental/occupational intake) with attention to variability in absorbed dose as a function of posture. The ICRP Publication 137 systemic biokinetic model for soluble cesium ingestion was used to compute organ-level time-integrated activity coefficients for reference adults, over a 50-y dose-integration period, for 134Cs and 137Cs (and its radioactive progeny 137mBa). Mean posture time-allocations (h d−1 for standing, sitting, and lying) were taken from published survey data. In accord with modern dosimetry formalisms (e.g., MIRD, ICRP), a posture weighting factor was introduced that accounts for the fraction of time spent within each independent posture. Absorbed dose coefficients were computed using PHITS Monte Carlo simulations. ICRP 103 tissue weighting factors were applied along with the posture weighting factors to obtain committed effective dose per unit intake (Sv Bq−1). For 137Cs ingestion, most organ absorbed dose coefficients were negligibly to marginally higher (< ~3%) for sitting or crouched (lying fetal/semi-fetal) postures maintained over the dose commitment period, relative to the upright standing posture. The committed effective dose coefficients were 1.3 × 10−8 Sv Bq−1 137Cs for standing, sitting, or crouched postures; thus, the posture-weighted committed effective dose was not significantly different than the committed effective dose for a maintained upright standing posture. For 134Cs ingestion, most organ absorbed dose coefficients for the sitting and crouched postures were significantly larger than the standing posture, but the differences were still considered minor (< ~8% for most organs). The committed effective dose coefficients were 1.2 × 10−8 Sv Bq−1 134Cs for the standing posture and 1.3 × 10−8 Sv Bq−1 134Cs for the sitting or crouched posture. The posture-weighted committed effective dose was 1.3 × 10−8 Sv Bq−1 134Cs. Body posture has minor influence on organ-level absorbed dose coefficients and committed effective dose for ingestion of soluble 137Cs or 134Cs.
Sunless and Indoor Tanning Among U.S. Non-Hispanic White Women Ages 18–49 Years
Authors: Seidenberg Andrew B. , Julian Anne K. , Hartman Anne M. , Holman Dawn M. 
Published: May 2023

ABSTRACT
The use of indoor ultraviolet tanning devices (also known as “indoor tanning”) has declined in recent years. Less is known about use of dihydroxyacetone-containing products used for tanning (also known as “sunless tanning”). We analyzed data from the 2015 National Health Interview Survey. Analysis was limited to non-Hispanic white women ages 18–49 years. We estimated the proportion of women reporting spray tanning, self-applied lotion tanning, and indoor tanning and used weighted multivariable logistic regression models to examine the relationships between sociodemographic characteristics, skin cancer risk factors, and other cancer risk factors with sunless and indoor tanning. Overall, 17.7% of women reported sunless tanning. Lotion tanning was more common (15.3%) than spray tanning (6.8%), whereas 12.0% of women engaged in indoor tanning. Among sunless tanners, 23.7% also engaged in indoor tanning. Younger age, ever having a skin examination, skin reactions to the sun, binge drinking, and being at a healthy weight were associated with sunless tanning. Although sunless tanning may be less harmful for skin cancer risk than indoor tanning, the frequency with which the two behaviors co-occur suggests that efforts to address societal pressures for women to alter their skin color may have important public health benefits.
The incidence of perioperative lymphatic complications after radical hysterectomy and pelvic lymphadenectomy between robotic and laparoscopic approach : a systemic review and meta-analysis
Authors: Hwang Jong Ha , Kim Bo Wook 
Published: May 2023

Background:
Although many studies have reported perioperative complications after radical hysterectomy and pelvic lymph node dissection using robotic and laparoscopic approaches, the risk of perioperative lymphatic complications has not been well identified. The aim of this meta-analysis is to compare the risks of perioperative lymphatic complications after robotic radical hysterectomy and lymph node dissection (RRHND) with laparoscopic radical hysterectomy and lymph node dissection (LRHND) for early uterine cervical cancer.

Materials and methods:
We searched the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases for studies published up to July 2022 comparing perioperative lymphatic complications after RRHND and LRHND while treating early uterine cervical cancer. Related articles and bibliographies of relevant studies were also checked. Two reviewers independently performed the data extraction.

Results:
A total of 19 eligible clinical trials (15 retrospective studies and 4 prospective studies) comprising 3,079 patients were included in this analysis. Only 107 patients (3.48%) had perioperative lymphatic complications, of which the most common was lymphedema (n=57, 1.85%), followed by symptomatic lymphocele (n=30, 0.97%), and lymphorrhea (n=15, 0.49%). When all studies were pooled, the odds ratio (OR) for the risk of any lymphatic complication after RRHND compared with LRHND was 1.27 (95% confidence interval: 0.86-1.89; P=0.230). In the subgroup analysis, study quality, country of research, and publication year were not associated with perioperative lymphatic complications.

Conclusion:
A meta-analysis of the available current literature suggests that RRHND is not superior to LRHND in terms of perioperative lymphatic complications.
Postmortem Tanning
Authors: Weber Brailyn , Roe Susan , Sens Mary Ann 
Published: May 2023

Abstract
A variety of changes, many predictable and others more aberrant, occur during the postmortem interval. A number of these changes are largely influenced by various environmental conditions. We describe 3 cases of an unusual postmortem change associated with prolonged sunlight exposure in both frozen and nonfrozen individuals. In each case, very well-delineated, dark tanning lines were present where clothing or another object blocked sunlight. This change appears distinct from mummification and scant literature references that describe a tanned skin transformation in cases associated with burials in high salt-containing bogs. Collectively, the cases highlight a novel postmortem phenomenon known as postmortem tanning. The potential mechanism(s) of this change is discussed within the context of known observations. Increased recognition and knowledge of postmortem tanning are exceedingly important in assessing how this change may assist in postmortem scene analysis.
Case Report of Lethal Concentrations of the Over-the-Counter Sleep Aids Diphenhydramine and Melatonin
Authors: Zimmerman Joel T. , Schreiber Sara J. , Huddle Lauren N. 
Published: May 2023

Abstract
Over-the-counter (OTC) medications are not typically considered “drugs of abuse” by the public, yet they are implicated in a portion of overdose cases. Although the toxicity of some OTC medications (such as acetaminophen, aspirin, and diphenhydramine [DPH]) has been extensively reported in the medical literature, the lethality of other substances (including melatonin) has not been well established.
We report the case of a 21-year-old woman who was found deceased within her secure residence. Scene investigation revealed the presence of 5 empty containers of DPH and a partially empty container of melatonin, as well as a handwritten note of apparent suicidal nature. Upon autopsy examination, the gastric mucosa was notable for a green-blue discoloration, and the gastric contents were consisted of a green-tan viscous material with admixed blue particulate material. Further analysis revealed elevated concentrations of both DPH and melatonin within the blood and gastric contents. The death was certified as a suicide by acute combined DPH and melatonin toxicity.
This paper will review the pharmacology of OTC sleep aid medications and provide a brief outline of their documented toxicity, in addition to reinforcing the role of death scene investigation and its correlation with autopsy findings.
Adaptive Clinical Trials in Pediatric Critical Care: A Systematic Review
Authors: Gilholm Patricia , Ergetu Endrias , Gelbart Ben , Raman Sainath , Festa Marino , Schlapbach Luregn J. , Long Debbie , Gibbons Kristen S. ,   on behalf of the Australian and New Zealand Intensive Care Society Paediatric Study Group
Published: May 2023

OBJECTIVES:
This systematic review investigates the use of adaptive designs in randomized controlled trials (RCTs) in pediatric critical care.

DATA SOURCES:
PICU RCTs, published between 1986 and 2020, stored in the www.PICUtrials.net database and MEDLINE, EMBASE, CENTRAL, and LILACS databases were searched (March 9, 2022) to identify RCTs published in 2021. PICU RCTs using adaptive designs were identified through an automated full-text screening algorithm.

STUDY SELECTION:
All RCTs involving children (< 18 yr old) cared for in a PICU were included. There were no restrictions to disease cohort, intervention, or outcome. Interim monitoring by a Data and Safety Monitoring Board that was not prespecified to change the trial design or implementation of the study was not considered adaptive.

DATA EXTRACTION:
We extracted the type of adaptive design, the justification for the design, and the stopping rule used. Characteristics of the trial were also extracted, and the results summarized through narrative synthesis. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.

DATA SYNTHESIS:
Sixteen of 528 PICU RCTs (3%) used adaptive designs with two types of adaptations used; group sequential design and sample size reestimation. Of the 11 trials that used a group sequential adaptive design, seven stopped early due to futility and one stopped early due to efficacy. Of the seven trials that performed a sample size reestimation, the estimated sample size decreased in three trials and increased in one trial.

CONCLUSIONS:
Little evidence of the use of adaptive designs was found, with only 3% of PICU RCTs incorporating an adaptive design and only two types of adaptations used. Identifying the barriers to adoption of more complex adaptive trial designs is needed.
DYNAMIC METABOLIC CHANGES OBSERVED IN AN LPS-INDUCED SYSTEMIC INFLAMMATION RAT MODEL USING CONTINUOUS LONG-TERM INDIRECT CALORIMETRY EXPERIMENTS
Authors: Murata Satoru , Yamashita Hayato , Kido Satoshi , Harada Daisuke , Ohtsuru Shigeru , Sato Norio 
Published: May 2023

ABSTRACT

Background: Nutritional management is crucial for severely ill patients. Measuring metabolism is believed to be necessary for the acute sepsis phase to accurately estimate nutrition. Indirect calorimetry (IDC) is assumed to be useful for acute intensive care; however, there are few studies on long-term IDC measurement in patients with systemic inflammation. Methods: Rats were categorized into the LPS received or control groups; LPS rats were categorized into underfeeding (UF), adjusted feeding (AF), and overfeeding (OF) groups. Indirect calorimetry measurement was performed until 72 or 144 h. Body composition was measured at −24 and 72 or 144 h, and tissue weight was measured at 72 or 144 h. Results: Low energy consumption and loss of diurnal variation of resting energy expenditure were observed in the LPS group compared with the control group until 72 h, after which the LPS group recovered. The resting energy expenditure in the OF group was higher than that in the UF and AF groups. In the first phase, low energy consumption was observed in all groups. In the second and third phases, higher energy consumption occurred in the OF group than in the UF and AF groups. In the third phase, diurnal variation recovered in all groups. Muscle atrophy caused body weight loss, but fat tissue loss did not occur. Conclusions: We observed metabolic changes with IDC during the acute systemic inflammation phase owing to differences in calorie intake. This is the first report of long-term IDC measurement using the LPS-induced systemic inflammation rat model.
The Impact of Preoperative Pain on Outcomes After Vaginal Reconstructive Surgery and Perioperative Pelvic Floor Muscle Training
Authors: Wang Rui , Tulikangas Paul K. , Sappenfield Elisabeth C. 
Published: May 2023

Importance
The impact of preoperative pain on outcomes can guide counseling.

Objective
The objective of this study was to compare outcomes after vaginal reconstructive surgery and pelvic muscle training between women with and without preoperative pain.

Study Design
This is a secondary analysis of the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, which randomized patients to a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (pelvic floor muscle training vs usual care). Preoperative pain was defined as a response of “5” or greater on the pain scale or answering “moderately” or “quite a bit” on the Pelvic Floor Distress Inventory question “Do you usually experience pain in the lower abdomen or genital area?”

Results
The OPTIMAL trial included 109 women with preoperative pain and 259 without pain. Although women with pain had worse pain scores and pelvic floor symptoms at baseline and postoperatively, they had greater improvement on pain scores (−2.3 ± 2.4 vs −0.2 ± 1.4, P < 0.001), as well as Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire scores. Among women with pain who underwent a sacrospinous ligament fixation, those who received pelvic floor muscle training had a greater reduction in pain compared with those in the usual care group (−3.0 ± 2.3 vs −1.3 ± 2.1, P = 0.008). Persistent or worsening pain was present at 24 months in 5 (16%) women with preoperative pain.

Conclusions
Women with preoperative pain experience significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery. Pelvic floor muscle training perioperatively may be beneficial for select patients.
Pain Catastrophizing and Impact on Pelvic Floor Surgery Experience
Authors: Powell T. Clark , Meyer Isuzu , Redden David T. , Maier Julia , Nguyen Christine , Richter Holly E. 
Published: May 2023

Importance
Understanding patients’ perceptions of symptoms and outcomes of urogynecologic surgery is essential for providing high-quality care.

Objective
The aim of the study was to assess association of pain catastrophizing with pelvic floor symptom distress and impact, postoperative pain, and voiding trial in patients undergoing urogynecologic surgery.

Study Design
Individuals whose self-identified gender was female and were undergoing surgery March 2020–December 2021 were included. Participants completed the Pain Catastrophizing Scale (range 0–52), Pelvic Floor Distress Inventory, and Pelvic Floor Impact Questionnaire preoperatively. Pain catastrophizing was score ≥30 and describes the tendency to magnify the overall threat of pain. Voiding trial failure was inability to void ≥2/3 of instilled volume (≤300 mL). The association between pain catastrophizing and symptom distress and impact was assessed with linear regression. A P < 0.05 is significant.

Results
Three hundred twenty patients were included (mean age, 60 years, 87% White). Forty-six of 320 participants (14%) had a pain catastrophizing score ≥30. The pain catastrophizing group had higher body mass index (33 ± 12 vs 29 ± 5), more benzodiazepine use (26% vs 12%), greater symptom distress (154 ± 58 vs 108 ± 60), and greater urogenital (59 ± 29 vs 47 ± 28), colorectal (42 ± 24 vs 26 ± 23), and prolapse (54 ± 24 vs 36 ± 24) subscale scores, all P ≤ 0.02. The pain catastrophizing group had greater impact (153 ± 72 vs 72 ± 64, P < 0.01) and urogenital (60 ± 29 vs 34 ± 28), colorectal (36 ± 33 vs 16 ± 26), and prolapse (57 ± 32 vs 22 ± 27) subscale scores, P < 0.01. Associations remained controlling for confounders (P < 0.01). The pain catastrophizing group had higher 10-point pain scores (8 vs 6, P < 0.01) and was more likely to report pain at 2 weeks (59% vs 20%, P < 0.01) and 3 months (25% vs 6%, P = 0.01). Voiding trial failure did not differ (26% vs 28%, P = 0.98).

Conclusions
Pain catastrophizing is associated with greater pelvic floor symptom distress and impact and postoperative pain but not voiding trial failure.
Bladder Instillation Patterns in a Cohort of Women With Interstitial Cystitis/Bladder Pain Syndrome
Authors: Niino Clarissa A. , Tholemeier Lauren N. , Bresee Catherine , De Hoedt Amanda M. , Barbour Kamil E. , Kim Jayoung , Freedland Stephen J. , Anger Jennifer T. 
Published: May 2023

Importance
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a prevalent disorder known to be notoriously difficult to treat.

Objective
The aim of the study was to determine intravesical instillation patterns among women receiving treatment for IC/BPS.

Study Design
This was a retrospective claims-based analysis using the Veterans Affairs Informatics and Computing Infrastructure. Females with an International Classification of Diseases, Ninth Revision, diagnosis of IC/BPS (595.1) were sampled randomly. Patients were considered to have IC/BPS if they had 2 visits with bladder pain in the absence of a positive urine culture 6 weeks or more apart or a history of bladder pain with another visit for bladder pain. Dates of intravesical instillations were extracted. A “course” of instillations was defined as 1 or more instillations made with less than 21 days between visits.

Results
We identified 641 women with a confirmed diagnosis of IC/BPS, 78 of whom underwent a total of 344 intravesical instillations. On average, each woman had 1.5 ± 0.8 courses between October 2004 and July 2016. Each course was an average of 3.1 ± 2.6 instillations. Fifty-five percent of courses consisted of 1 instillation. Only 22% of courses had 6 or more instillations, the number typically recommended to achieve clinical response. Each instillation within a course was an average of 9.4 ± 4.0 days apart. Most instillations (77%) involved a cocktail of 2 or more drugs.

Conclusions
In our cohort, few women with IC/BPS received a recommended treatment course of 6 weekly instillations, with most receiving only 1 per course. Future studies are needed to determine whether instillation courses were altered from the guidelines due to health care provider practice patterns, early improvement, or poor tolerance of instillations.