bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fetal Scalp Blood Sampling During Second Stage of Labor—Analyzing Lactate or pH? A Secondary Analysis of a Randomized Controlled Trial
Authors: Stål Ingrid , Wennerholm Ulla-Britt , Nordstrom Lennart , Ladfors Lars , Wiberg-Itzel Eva 
Published: September 2022

(Abstracted from J Matern Fetal Neonatal Med 2022;35(6):1100–1107)
Cardiotocography (CTG) is widely used in pregnancy as a method to assess the well-being of the fetus. Although CTG has high sensitivity, it also has low specificity.
Restrictive State Abortion Bans—A Reproductive Injustice
Authors: Wilkinson Barbara , Onwuzurike Chiamaka , Bartz Deborah 
Published: September 2022

(Abstracted from N Engl J Med 2022;386:1197–1199)
In this perspective, the authors call on the medical community to come together to preserve reproductive rights in light of the challenge to Roe v Wade and Planned Parenthood of Southeastern Pennsylvania v Casey, both of which permit abortion before fetal viability under the constitutional right to privacy since 1973.
Pulse Oximetry and Race in Critically Ill Adults
Authors: Seitz Kevin P. , Wang Li , Casey Jonathan D. , Markus Shannon A. , Jackson Karen E. , Qian Edward T. , Self Wesley H. , Rice Todd W. , Semler Matthew W. 
Published: September 2022

OBJECTIVES:
For critically ill adults, oxygen saturation is continuously monitored using pulse oximetry (Spo
2) as a surrogate for arterial oxygen saturation (Sao
2). Skin pigmentation may affect accuracy of Spo
2 by introducing error from statistical bias, variance, or both. We evaluated relationships between race, Spo
2, Sao
2, and hypoxemia (Sao
2 < 88%) or hyperoxemia (Pao
2 > 150 mm Hg) among adults receiving mechanical ventilation in a medical ICU.

DESIGN:
Single-center, observational study.

SETTING:
Medical ICU at an academic medical center.

PATIENTS:
Critically ill adults receiving mechanical ventilation from July 2018 to February 2021, excluding patients with COVID-19, with race documented as Black or White in the electronic medical record, who had a pair of Spo
2 and Sao
2 measurements collected within 10 minutes of each other.

INTERVENTIONS:
None.

MEASUREMENTS:
We included 1,024 patients with 5,557 paired measurements within 10 minutes, of which 3,885 (70%) were within 1 minute. Of all pairs, 769 (14%) were from Black patients and 4,788 (86%) were from White patients. In analyses using a mixed-effects model, we found that across the range of Spo
2 values of 92–98%, the associated Sao
2 value was approximately 1% point lower for Black patients compared with White patients. Among patients with a Spo
2 value between 92% and 96%, Black patients were more likely to have both hypoxemia (3.5% vs 1.1%; p = 0.002) and hyperoxemia (4.7% vs 2.4%; p = 0.03), compared with White patients.

CONCLUSIONS:
Among patients with a measured Spo
2 of 92–96%, greater variation in Sao
2 values at a given Spo
2 resulted in a higher occurence rate of both hypoxemia and hyperoxemia for Black patients compared with White patients.
Lymphatic Function Decreases over Time in the Arms of Breast Cancer Patients following Treatment
Authors: Johannessen Andreas L. , Alstrup Mathias , Hjortdal Vibeke E. , Offersen Birgitte V. , Mohanakumar Sheyanth 
Published: September 2022

Background:
In patients with breast cancer-related lymphedema, distinct lymphatic patterns and changed lymphatic contractile function have been described, but it is unknown how these characteristics change over time and to what extent they appear before clinical edema is detectable. Recently, we described the lymphatic morphology and function in a cohort of breast cancer patients shortly after radiation therapy (RT). In the current study, we investigate lymphatic function and morphology in the same cohort after 1 year of follow-up.

Methods:
The study population consisted of 28 breast cancer patients investigated 12 months after adjuvant locoregional RT. Lymphatic contraction frequency (CF), propulsion velocity, and the morphology of lymphatic vessels in the upper extremities were described in vivo using near-infrared fluorescence imaging. Lymphatic stress test was performed using hyperthermia.

Results:
At 1 year after RT, (n = 28) 46% of the patients presented with lymphatic morphological abnormalities with a degree of dermal backflow and 21% had developed clinical breast cancer-related lymphedema. In the ipsilateral arm, CF was 23% lower than in the contralateral arm (P = 0.04). Since primary examination, CF in the ipsilateral arm decreased by 40% (P = 0.03), whereas no change was observed in the contralateral arm. During hyperthermia, the ipsilateral arms with lymphatic complications were not able to increase CF as the remaining subgroups.

Conclusions:
Lymphatic function in the ipsilateral arm deteriorated over time after adjuvant breast cancer therapy. Furthermore, the presence of abnormal torturous lymphatic vessels in asymptomatic arms appeared to be associated with weak lymphatic reserve pumping capacity.
Optical Coherence Tomography and Visual Outcomes in Pediatric Abusive Head Trauma
Authors: Kelly John P. , Feldman Kenneth W. , Weiss Avery 
Published: September 2022

Abstract:

Purpose:
Compare follow-up optical coherence tomography (OCT) with visual function in children with abusive head trauma (shaken baby syndrome).

Methods:
Retrospective follow-up studies of 3 children who were victims of abusive head trauma (AHT) within the first year of life.

Results:
OCTs showed disrupted retinal layering, thick detached internal limiting membrane, focal posterior vitreous separation, and multilayered tractional retinoschisis. Significant vision loss occurred in 3 out of 4 eyes with a history of traumatic retinoschisis. Normal visual acuity and low-normal visual evoked potentials were measured in a child with foveal distortion, reduced global nerve fiber layer thickness, detached internal limiting membrane, and history of vitreous hemorrhage.

Discussion:
Significant abnormalities of retinal anatomy can be detected on OCT years after AHT. OCTs and assessment of visual pathways help to elucidate causes of visual dysfunction in children with AHT.
New pharmacologic agents for obstructive sleep apnoea: what do we know and what can we expect?
Authors: Hedner Jan , Zou Ding 
Published: September 2022

Purpose of review
This review provides a condensed description of pharmacological remedies explored in patients with obstructive sleep apnoea (OSA) as well as projections of what we might expect in terms of clinical performance of these drugs.

Recent findings
Conventional drug therapies explored in OSA have generally produced disappointing results and there is a shortage of pharmacological treatment alternatives in this disorder. Recent insights into pathophysiological mechanisms potentially involved in OSA suggest that the condition may be divided into distinct subgroups based on clusters or defined by means of unique functional endotypic criteria. In fact, positive outcomes in clinical trials have now resulted in several drug candidates that show a convincing reduction of sleep disordered breathing in both short and intermediate term. Such drugs may be particularly useful in certain variants of OSA but not in others. These insights have also raised the ambition to create personalized therapies in OSA. Another recent development is the insight that OSA-linked conditions such as obesity, daytime somnolence and various forms of cardiovascular/metabolic disease may provide drug-based targets. For instance, pharmacological obesity therapy may provide not only positive metabolic effects but may also be a way to eliminate the anatomic component in obese OSA patients.

Summary
Recent insights into the pathophysiology of OSA have opened possibilities to develop personalized therapy. Drugs addressing fundamental aspects of the sleep and breathing disorder provide a particularly promising avenue for development of novel forms of treatment in OSA.
Research into the mechanism of intervention of SanQi in endometriosis based on network pharmacology and molecular docking technology
Authors: Lin Zhiheng , Fan Weisen , Yu Xiao , Liu Jinxing , Liu Pengfei 
Published: September 2022

Background:
By using network pharmacology and molecular docking technology, we have explored the mechanism of action of Sanqi in the treatment of endometriosis (EMS), in order to provide reference for clinical studies of Chinese medicine treatment of Ems and Chinese medicine pharmacology.

Methods:
There are 123 intersecting targets between the active ingredients of Sanqi and disease targets. In the Protein-Protein Interaction network, Jun proto-oncogene, AP-1 transcription factor subunit, tumor necrosis factor, interleukin 6, etc., are the core proteins. The top 20 genes ranked by degree have been analyzed according to the Kyoto Encyclopedia of Genes and Genomes pathway and Gene Ontology analysis, and 20 pathways have been identified.

Results:
On the Kyoto Encyclopedia of Genes and Genomes pathway, the most important part is the phosphatidylinositol 3’-kinase-Akt signaling pathway, and on the Gene Ontology pathway, it is the Heme binding. The top 3 targets docked to quercetin have a certain affinity when it is docked to their degree value. Among the chemical components of Sanqi, quercetin has the most targets, suggesting that it may play a major role in the treatment of EMS.

Conclusion:
The results of molecular docking provide further evidence of the potential role of Sanqi for EMS. Overall, our study provides a new direction for the treatment of EMS and provides the basis for Sanqi as a drug for the treatment of EMS.
Reduction of C-reactive protein, low-density lipoprotein cholesterol, and its relationship with cardiovascular events of different lipid-lowering therapies: A systematic review and meta-analysis of randomized controlled trials
Authors: Yang Wenjia , Cai Xiaoling , Lin Chu , Lv Fang , Zhu Xingyun , Han Xueyao , Ji Linong 
Published: September 2022

Background:
To evaluate the reductions of C-reactive protein (CRP) and low-density lipoprotein cholesterol (LDL-C) in different lipid-lowering drugs, and to assess the relationships between the reductions of CRP, LDL-C, and cardiovascular (CV) events.

Methods:
We searched MEDLINE, EMBASE, and Cochrane CENTRAL up to September 1, 2021. Randomized controlled trials (RCTs) comparing statins, proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9-mAbs), or ezetimibe against placebo with a treatment duration of at least 4 weeks and data on the effects of cholesterol-lowering interventions on LDL-C and CRP were included in this meta-analysis. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated.

Results:
Compared with placebo treatment, statins and ezetimibe treatments resulted in a significant decrease in LDL-C level (statins: WMD −47.94 mg/dL, 95% CI −51.21 to −44.67 mg/dL; ezetimibe: WMD −22.84 mg/dL, 95% CI −26.76 to −18.92 mg/dL) and CRP level (statins: WMD −0.67 mg/L, 95% CI −0.90 to −0.45 mg/dL; ezetimibe: −0.64 mg/L, 95% CI −1.07 to −0.21 mg/dL). Compared with placebo treatment, treatment with PCSK9-mAbs resulted in significant decrease in LDL-C level (WMD −54.24 mg/dL, 95% CI −59.77 to −48.70 mg/dL), while the concentration of CRP did not decrease significantly. Meta-regression analysis showed no significant association between change in CRP level and change in LDL-C level. Subgroup comparisons suggested that treatment with PCSK9-mAbs showed a greater reduction in LDL-C level when compared with the statins group and ezetimibe group, while the risks of CV death, myocardial infarction (MI), and stroke showed no significant differences.

Conclusion:
Based on the current study, our results suggested that statins, ezetimibe, and PCSK9-mAbs are effective in reducing LDL-C levels. Treatment with statins and ezetimibe also demonstrated a significant effect on CRP. The traditional lipid-lowering strategy including statin and ezetimibe showed similar benefit on CV outcomes compared with the PCSK9-mAbs treatment.
Metabolism of barium in the human body after suicidal ingestion: A CARE-compliant case report
Authors: Zhang Qiantong , Wang Yuchao , Li Xueyan , Wang Zhoubo , Wang Heng , Yan Jianbo 
Published: September 2022

Rationale:
Thus far, barium poisoning has been seldom reported and the metabolism of barium in human body has not been explored.

Patient concerns:
A 21-year-old young man was taken to the local hospital by “120 emergency medical services” after a suicidal attempt. About 100 mL of barium chloride solution with a concentration of 100 g/L was ingested, while the actual amount of ingested barium chloride solution was unclear because of immediate vomiting after the ingestion.

Diagnoses:
About 2 hours after the suicidal ingestion, the patient was presented with somnolence, the pulse rate was 67 beats per minute, the blood pressure was 158/92 mm Hg, but he exhibited no nausea or vomiting. About 3 hours after the ingestion, the blood concentration of potassium was 1.5 mmol/L.

Interventions:
The patient received gastric lavage by magnesium sulfate solution, intravenous sodium thiosulfate, and potassium supplementation. Other symptomatic treatments were applied simultaneously. To investigate the metabolism of barium in the human body, we measured the concentration of barium in 9 groups of paired serum and urine samples sequentially collected from the patient.

Outcomes:
The patient was rescued successfully.

Lessons:
The serum concentration of barium decreased rapidly in the first 24 hours. In this period, prompt and massive potassium supplementation and other symptomatic treatments are effective and recommended.
A quick scoping review of the first year of vaccination against the COVID-19 pandemic: Do we need more shots or time?
Authors: El-Menyar Ayman , Khan Naushad Ahmad , Mekkodathil Ahammed , Rizoli Sandro , Consunji Rafael , Elmenyar Eman , Galwankar Sagar , Al-Thani Hassan 
Published: September 2022

Background:
The emergence of new severe acute respiratory syndrome coronavirus 2 variants, along with the waning of vaccine-induced immunity, has increased breakthrough infections and urged booster jabs and debates. In the short term, the administration of booster doses has been reported to be safe and enhance severe acute respiratory syndrome coronavirus 2–specific neutralizing antibody levels. However, the effects of these doses on the pandemic trajectory and herd immunity are unclear. There is insufficient evidence that a third booster shot of the coronavirus disease 2019 (COVID-19) vaccine maintains longer immunity and covers new viral variants. The lack of sufficient evidence, combined with the fact that millions of people have not yet received 1 or 2 jabs of the COVID-19 vaccine, has raised concerns regarding the call for booster vaccinations.

Methods:
We conducted a quick scoping review to explore the literature on the need for a booster COVID-19 vaccination from January 1, 2021, to April 30, 2022.

Results:
Sixty-one relevant publications were identified, of which 17 were related to waning immunity after 2 doses of the vaccine among the general population or healthcare workers, 19 were related to the third or booster dose of vaccination after the second dose among the general population or healthcare workers, and 25 were related to booster dose among immunocompromised patient.

Conclusions:
Initially, the need for a booster dose was equivocal; however, several studies demonstrated the benefit of the booster dose over time. Adequate scientific information is required regarding the administration of booster doses to the general population as well as the high-risk individuals.
Optic neuropathy caused by orbital Kimura disease: A rare case report
Authors: Tsai Yung-En , Chen Yi-Hao , Liu Tung , Chien Ke-Hung , Hsu Chih-Kang 
Published: September 2022

Rationale:
Kimura disease (KD) is a rare, chronic inflammatory disease characterized by painless subcutaneous nodules predominantly located in the head and neck regions. Orbital KD, which intrudes into the intraconal space and results in compressive optic neuropathy, is rare and has not been previously reported.

Patient concerns:
A 68-year-old man presented with blurred vision and progressive proptosis in the left eye that had been present for 2 years.

Diagnosis:
Magnetic resonance imaging of the brain revealed soft tissue lesions with contrast enhancement and restricted diffusion involving the bilateral eyelids, orbits, and intraconal region; those on the left side were more prominent than those on the right side. The lesion encased the left optic nerve. Laboratory test results revealed elevated serum immunoglobulin E level and peripheral eosinophilia. An orbital mass biopsy demonstrated hyperplastic lymphoid follicles with germinal centers in the subcutaneous area and abundant mononuclear and binuclear eosinophils infiltrating the interfollicular area. A pathological diagnosis of KD was made based on the blood test results.

Interventions:
Orbital decompression and debulking surgery of the orbital tumor in the left eye were performed to treat the compressive optic neuropathy.

Outcomes:
After systemic oral steroid and immunosuppressive agent therapies, the patient’s visual acuity in the left eye improved, and the KD activity was stable.

Conclusions:
We present a rare case of orbital KD-associated optic neuropathy, wherein early diagnosis and treatment preserved the patient’s vision. This complication should be considered in patients with a history of compressive optic neuropathy during the differential diagnosis.
Human Chorionic Gonadotropin—A Review of the Literature
Authors: Herkert Darby , Meljen Vivienne , Muasher Lisa , Price Thomas M. , Kuller Jeffrey A. , Dotters-Katz Sarah 
Published: September 2022

Importance
The measurement of human chorionic gonadotropin (hCG) levels in different body fluids is a commonly utilized tool in obstetrics and gynecology, as well as other fields. It is often one of the first steps in the medical workup of female patients, and the results and interpretation of this test can have significant downstream ramifications. It is essential to understand the uses and limitations of hCG as a testing and therapeutic measure to appropriately evaluate, counsel, and treat patients.

Objective
The purpose of this article is to review the current literature on hCG, including its origins, structure, pharmacokinetics, metabolism, and utility in testing and medical treatment.

Evidence Acquisition
Original research articles, review articles, and guidelines on hCG use were reviewed.

Conclusions and Relevance
While the primary function of hCG is to maintain early pregnancy, testing for hCG demonstrates that this molecule is implicated in a multitude of different processes where results of testing may lead to incorrect conclusions regarding pregnancy status. This could affect patients in a myriad of settings and have profound emotional and financial consequences. In addition, hCG testing may be revealing of alternative pathology, such as malignancy. It is imperative to understand the nuances of the physiology of hCG and testing methods to effectively use and interpret this test for appropriate patient management.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After participating in this activity, the provider should be better able to describe the origins, molecular structure, and effects of hCG and its isoforms; explain the mechanism, strengths, and limitations of different hCG testing modalities as well as potential causes of false-positive and false-negative tests; and evaluate the recommendations for, as well as the implications and limitations of, hCG testing in clinical research, the perioperative setting, and other common clinical scenarios.
Dropped head syndrome: report of a rare complication after multilevel bilateral cervical radiofrequency neurotomy
Authors: Bajaj Harnek S. , Chapman Andrew W. 
Published: September 2022

Abstract:

Introduction:
Cervical radiofrequency neurotomy is a safe and relatively low-risk procedure commonly used to treat facet joint–mediated axial neck pain. Severe complications are extremely rare and can be avoided with proper technique and appropriate imaging guidance. This article describes the development and subsequent management of a case of dropped head syndrome after cervical radiofrequency neurotomy.

Methods:
A 77-year-old man with cervicalgia, multilevel facet arthropathy, and a known kyphosis in the setting of cervical degenerative disk disease underwent successful conventional radiofrequency neurotomy to the bilateral C3, C4, and C5 medial branches. No immediate complications were noted.

Results:
Six weeks subsequent to the procedure, the patient reported difficulty keeping his head erect, and physical examination revealed weakness of the cervical paraspinal musculature, with restriction of active extension to about neutral. A diagnosis of dropped head syndrome was made. The patient was successfully managed with temporary use of soft cervical collar and physical therapy for progressive range of motion and strengthening.

Discussion:
Dropped head syndrome is a known, but likely underappreciated, complication of cervical radiofrequency neurotomy, with only 2 other cases reported and published in the literature to our knowledge. Mild cases may resolve with conservative management, but this is a potentially debilitating condition that we recommend should be routinely discussed during procedural consent for cervical radiofrequency neurotomy. Future studies should explore specific mitigating factors to reduce the risk of development of this possible complication.
The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology
Authors: Md Noh Mohamad Syafeeq Faeez , Abdul Rashid Anna Misyail , Hoo Fan Kee , Bahari Norafida 
Published: September 2022

Abstract:
Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.