bluuebunny/crossref_metadata_2025_split huggingface dataset:
General Anesthesia versus Sedation, Both with Hemodynamic Control, during Intraarterial Treatment for Stroke: The GASS Randomized Trial
Authors: Maurice Axelle , Eugène François , Ronzière Thomas , Devys Jean-Michel , Taylor Guillaume , Subileau Aurélie , Huet Olivier , Gherbi Hakim , Laffon Marc , Esvan Maxime , Laviolle Bruno , Beloeil Helene ,   for the GASS (General Anesthesia versus Sedation for Acute Stroke Treatment) Study Group and the French Society of Anesthesiologists (SFAR) Research Network
Published: February 2022

Background
It is speculated that the anesthetic strategy during endovascular therapy for stroke may have an impact on the outcome of the patients. The authors hypothesized that conscious sedation is associated with a better functional outcome 3 months after endovascular therapy for the treatment of stroke compared with general anesthesia.

Methods
In this single-blind, randomized trial, patients received either a standardized general anesthesia or a standardized conscious sedation. Blood pressure control was also standardized in both groups. The primary outcome measure was a modified Rankin score less than or equal to 2 (0 = no symptoms; 5 = severe disability) assessed 3 months after treatment. The main secondary outcomes were complications, mortality, reperfusion results, and National Institutes of Health Stroke Scores at days 1 and 7.

Results
Of 351 randomized patients, 345 were included in the analysis. The primary outcome occurred in 129 of 341 (38%) of the patients: 63 (36%) in the conscious sedation group and 66 (40%) in the general anesthesia group (relative risk, 0.91 [95% CI, 0.69 to 1.19]; P = 0.474). Patients in the general anesthesia group experienced more intraoperative hypo- or hypertensive episodes, while the cumulative duration was not different (mean ± SD, 36 ± 31 vs. 39 ± 25 min; P = 0.079). The time from onset and from arrival to puncture were longer in the general anesthesia group (mean difference, 19 min [i.e., −00:19] [95% CI, −0:38 to 0] and mean difference, 9 min [95% CI, −0:18 to −0:01], respectively), while the time from onset to recanalization was similar in both groups. Recanalization was more often successful in the general anesthesia group (144 of 169 [85%] vs. 131 of 174 [75%]; P = 0.021). The incidence of symptomatic intracranial hemorrhage was similar in both groups.

Conclusions
The functional outcomes 3 months after endovascular treatment for stroke were similar with general anesthesia and sedation. Our results, therefore, suggest that clinicians can use either approach.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Basal Infusion versus Automated Boluses and a Delayed Start Timer for “Continuous” Sciatic Nerve Blocks after Ambulatory Foot and Ankle Surgery: A Randomized Clinical Trial
Authors: Finneran John J. , Said Engy T. , Curran Brian P. , Swisher Matthew W. , Black Jessica R. , Gabriel Rodney A. , Sztain Jacklynn F. , Abramson Wendy B. , Alexander Brenton , Donohue Michael C. , Schaar Adam , Ilfeld Brian M. 
Published: February 2022

Background
The common technique using a basal infusion for an ambulatory continuous peripheral nerve blocks frequently results in exhaustion of the local anesthetic reservoir before resolution of surgical pain. This study was designed to improve and prolong analgesia by delaying initiation using an integrated timer and delivering a lower hourly volume of local anesthetic as automated boluses. The hypothesis was that compared with a traditional continuous infusion, ropivacaine administered with automated boluses at a lower dose and 5-h delay would (1) provide at least noninferior analgesia (difference in average pain no greater than 1.7 points) while both techniques were functioning (average pain score day after surgery) and (2) result in a longer duration (dual primary outcomes).

Methods
Participants (n = 70) undergoing foot or ankle surgery with a popliteal–sciatic catheter received an injection of ropivacaine 0.5% with epinephrine (20 ml) and then were randomized to receive ropivacaine (0.2%) either as continuous infusion (6 ml/h) initiated before discharge or as automated boluses (8 ml every 2 h) initiated 5 h after discharge using a timer. Both groups could self-deliver supplemental boluses (4 ml, lockout 30 min); participants and outcome assessors were blinded to randomization. All randomized participants were included in the data analysis.

Results
The day after surgery, participants with automated boluses had a median [interquartile range] pain score of 0.0 [0.0 to 3.0] versus 3.0 [1.8 to 4.8] for the continuous infusion group, with an odds ratio of 3.1 (95% CI, 1.23 to 7.84; P = 0.033) adjusting for body mass index. Reservoir exhaustion in the automated boluses group occurred after a median [interquartile range] of 119 h [109 to 125] versus 74 h [57 to 80] for the continuous infusion group (difference of 47 h; 95% CI, 38 to 55; P < 0.001 adjusting for body mass index).

Conclusions
For popliteal–sciatic catheters, replacing a continuous infusion initiated before discharge with automated boluses and a start-delay timer resulted in better analgesia and longer infusion duration.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Telehealth Utilization and Follow-Up Visits in Developmental-Behavioral Pediatrics During the COVID-19 Pandemic in 2020
Authors: Ripp Asher , Steinway Caren , Katzow Michelle Weiss , Jan Sophia , Chen Jack , Chen Victoria 
Published: February 2022

ABSTRACT:

Objective:
The goal of this study was to understand the effect of transition to telehealth care on follow-up visit attendance in a developmental-behavioral pediatric (DBP) practice in 2020 versus in-person care in 2019.

Methods:
This was a retrospective observational cohort study of follow-up visits occurring in a large DBP practice during a 6-week period in March/April of 2019 and 2020. The primary outcome was follow-up visit adherence, defined as completion of scheduled follow-up visit. The primary exposure was telehealth visit in 2020 versus in-person visit in 2019. Covariates included patient demographics and clinical characteristics. Data were analyzed using descriptive statistics and logistic regression.

Results:
The cohort included 2142 visits for 1868 unique patients. The patient mean age was 9.2 ± 4.8 years, with 73.4% male, 56.5% non-Hispanic, 51.4% White, and 68.3% commercial insurance. There were 470 telehealth visits from March to April 2020 and 1672 in-person visits from March to April 2019. Compared with in-person visits, telehealth visits were more likely to be completed (75.3% vs 64.4%, p < 0.001). After adjusting for age, sex, race, ethnicity, insurance, and week of visit (weeks 1–3 vs 4–6), odds of having a complete follow-up visit were higher for telehealth visits than for in-person visits (odds ratio = 1.57; 95% confidence interval [1.23–2.00], p < 0.001).

Conclusion:
Follow-up visit attendance was higher for telehealth care in 2020 than in-person care in 2019. This association persisted after adjusting for insurance, age, race, and ethnicity, suggesting that telehealth is associated with increased follow-up visit attendance in DBP care. Further studies are needed to understand the impact of telehealth on DBP clinical outcomes in chronic disease management.
Prevention of multiple pregnancies in gonadotropin-insemination cycles
Authors: Dahdouh Elias M. , Zreik Tony G. , Ghaname Wadih , Garcia-Velasco Juan A. , Balayla Jacques 
Published: February 2022

Purpose of review
Although elective single embryo transfer has significantly reduced, the rate of multiple pregnancy in IVF cycles, this rate is still relatively high in gonadotropin-insemination cycles. Patients who fail to ovulate or to conceive with oral agents and have constraints for IVF are usually candidates for gonadotropin injections. The current review article provides an up-to-date summation of the different strategies that can be adopted to reduce the risk of multiple pregnancies in gonadotropin-stimulated intrauterine insemination cycles.

Recent findings
Gonadotropin-insemination treatments should be used judiciously by experienced providers. One should always start with the lowest effective gonadotropin dose (∼37.5 IU), monitor closely the ovarian response, and consider cycle cancellation or conversion to IVF whenever a high response is encountered. Therefore, every infertility practice should define its own cancellation and ‘rescue IVF’ criteria depending on the number of mature ovarian follicles and the age of the female partner.

Summary
These preventive measures amongst others should mitigate the risk of multiple pregnancies that can arise from gonadotropin-insemination cycles.
Partial Second Toe Pulp Flap Transfer for the Coverage of Great Toe Hemipulp Flap Donor Site
Authors: Hattori Yoshitsugu , Tamemoto Tomoyuki , Niu Atsushi 
Published: February 2022

Summary:
The great toe hemipulp flap transfer is a viable reconstructive method for finger pulp defect. However, early functional recovery of the donor foot is essential for returning to daily life activities, and functional and aesthetic restoration of the donor site remains challenging. We present a case in which the great toe hemipulp flap donor site was reconstructed with pedicled partial second toe pulp flap transfer, aiming for early recovery of the donor foot and aesthetically and functionally satisfactory donor-site reconstruction. A 62-year-old man underwent left little finger-pulp crush amputation in Tamai zone 2 and received free great toe hemipulp flap transfer. For the defect following flap harvest, the partial second toe pulp flap was elevated and transferred. The donor site of the partial second toe pulp flap was primarily closed. The postoperative course was uneventful, and the patient started walking on postoperative day 2. Postoperatively, the sensory recovery of the transferred flap was excellent, and the reconstructed great toe was functionally and aesthetically satisfactory. The pedicled partial second toe pulp flap transfer may be a viable alternative for the coverage of great toe hemipulp flap donor site.
Risk Reduction Strategies for Adolescent Cannabis Use Considering COVID-19 Stressors
Authors: Mayfield Brenda L. , Fogger Susanne Astrab 
Published: February 2022

Abstract
The past 2 years has been a challenge as society made huge adaptations to keep people safe from COVID-19 and struggled to continue life on a day-to-day basis. Working with families, young adults, and adolescents, nurses are often faced with caring for individuals who recreationally use cannabis and believe use is harmless. Adolescents as a group tend to appraise information from a different lens than adults. In an evolving world, where cannabis is legalized for medicinal and recreational use, it is important to shift the paradigm of how we approach cannabis use in adolescents. This article will focus on COVID-19's impact on cannabis use in adolescents and apply the transtheoretical model of change to promote safer choices while supporting adolescent autonomy. In addition, we will incorporate behavioral health strategies to reduce risks of cannabis use by equipping adolescents with guidelines, boundaries, and tools.
Overcoming Barriers to Human Papillomavirus Vaccination
Authors: Domurat Paige A. , Nickasch Bonnie L. 
Published: February 2022

Introduction
Despite the human papillomavirus (HPV) vaccine's ability to help prevent certain types of cancer, rates of vaccination against HPV remain low, and choosing to have a child receive the HPV vaccine has become a controversial topic. The primary objective of this quality improvement project was to increase HPV vaccination rates through creating and distributing an all-in-one education and reminder system to pediatric clinic patients and their families once patients are eligible to receive the HPV vaccination.

Methods
Three barriers to increasing rates of HPV vaccination were identified: cost, lack of knowledge, and lack of provider recommendation. A flyer system was implemented that addressed these barriers. This flyer was given to all patients ages 11–18 years, with a strong verbal provider recommendation.

Results
One-sample proportion tests were run to determine significance in the differing series completion rates in 2018, 2019, and 2020. The pediatric clinic's HPV vaccination series completion rates increased significantly from 2018 to 2019. During the implementation of this flyer system, which occurred during the COVID-19 pandemic, the vaccination series completion rates decreased, but this decrease was not statistically significant.

Discussion
As control is gained over the pandemic, it is anticipated that regular provider visits will increase back to normal and therefore vaccination rates will recover as well. The findings from this study can be used to create or modify current practices in clinics anywhere that the HPV vaccination is administered. Future studies and trials should be implemented for a longer period, and not during a pandemic, ideally to yield more statistically significant results.
Contemporary risk prediction models in chronic kidney disease: when less is more
Authors: Canney Mark , Sood Manish M. , Hundemer Gregory L. 
Published: February 2022

Purpose of review
Clinicians have an ever-increasing number of prediction tools at their disposal for estimating the risk of kidney failure in their patients. This review aims to summarize contemporary evidence for chronic kidney disease (CKD) risk prediction models across the spectrum of kidney function, and explore nuances in the interpretation of risk estimates.

Recent findings
A European study using predominantly laboratory data has extended kidney failure prediction to patients with more preserved estimated glomerular filtration rate. For older patients with advanced CKD, prediction tools that censor for death (such as the Kidney Failure Risk Equation) overestimate the risk of kidney failure, especially over time horizons longer than 2 years. This problem can be addressed by accounting for the competing risk of death, as shown in well designed validation studies. The clinical utility of kidney failure risk prediction tools is being increasingly tested at a population level to inform policy and referral guidelines.

Summary
There is welcome trend to validate existing prediction tools in diverse clinical settings and identify their role in clinical practice. Clinicians should be cognizant of overestimating kidney failure risk in older patients with advanced CKD due to the competing risk of death. For moderate CKD and for short-term predictions, the Kidney Failure Risk Equation remains the most widely validated prediction tool.
Update on preclinical and clinical efforts on ex-vivo expansion of hematopoietic stem and progenitor cells
Authors: Huang Xinxin , Guo Bin 
Published: February 2022

Purpose of review
Ex-vivo expansion of hematopoietic stem cells (HSCs) is one potential approach to enhance the clinical efficacy of hematopoietic cell transplantation-based therapy for malignant and nonmalignant blood diseases. Here, we discuss the major progress of preclinical and clinical studies on the ex-vivo expansion of human HSCs and progenitor cells (HPCs).

Recent findings
Single-cell RNA sequencing identified ADGRG1 as a reliable marker of functional HSCs upon ex-vivo expansion-induced mitochondrial oxidative stress. Both SR1 and UM171 significantly promote ex-vivo expansion of human cord blood HSCs and HPCs, as determined in preclinical animal models. Encouraged by these findings from the bench, multiple phase I/II and phase II clinical trials have been conducted to evaluate the safety, feasibility and efficacy of SR1-expanded and UM171-expanded cord blood units in patients with hematological malignancy.

Summary
Preliminary data from multiple phase I/II clinical trials regarding transplants of ex-vivo-expanded HSCs and HPCs have demonstrated that ex-vivo expansion may be used to overcome the limitation of the rarity of HSCs without compromising stemness.
Randomized, Double‐Blind, Placebo‐Controlled Study to Assess the Effect of Two Probiotics on the Preterms’ Gut Microbiota
Authors: Moreno‐Sanz Bárbara , Montes María Teresa , Manzano Susana , Espinosa‐Martos Irene , Cárdenas Nivia , Esteban Sergio , Cruz Marta , Jiménez Esther , de Pipaón Miguel Sáenz 
Published: February 2022

ABSTRACTObjective:To evaluate the effect of a new probiotic strain combination, Ligilactobacillus salivarius subsp infantis PS11603 and Bifidobacterium longum PS10402, on gut bacterial colonization of preterm infants.Methods:A randomized, double‐blind, placebo‐controlled study was conducted in preterm infants from 28 weeks + 0days to 30 weeks + 6days of gestation. Thirty preterm infants were randomly selected after birth to receive either probiotics or placebo. Stool samples were collected before product intake and then sequentially during the first weeks of their admission. Classical microbiological, metagenomics and multiplex immunological analyses were performed to assess the bacterial and immune profile of the samples.Results:Twenty‐seven infants completed the study (14 vs 13, probiotic and placebo groups). A higher number of participants were colonized by Lactobacilli in the probiotic group than in the placebo group (93% vs 46%; P = 0.013). Similar results were obtained when analysing bifidobacterial colonization (100% vs 69%; P = 0.041). Earlier colonization was observed in the probiotics group versus the placebo group, specifically 5 weeks for Lactobacillus and 1 week for Bifidobacterium. Although no effect was observed in the faecal immunological profile, a decreasing trend could be observed in Th17 response during the first week of probiotic treatment. None of the adverse events (AEs) registered were related to product intake.Conclusion:Probiotic supplementation with L salivarius PS11603 and B longum subsp. infantis PS10402 enhanced an earlier colonization of Lactobacillus and Bifidobacterium in preterm infants’ guts in 5 and 1 week, respectively. A higher number of infants were colonized by Lactobacilli with the probiotics’ intake at the end of the study.
Magnetic Resonance Elastography in Intracranial Neoplasms: A Scoping Review
Authors: Aunan-Diop Jan Saip , Halle Bo , Pedersen Christian Bonde , Jensen Ulla , Munthe Sune , Harbo Frederik , Andersen Mikkel Schou , Poulsen Frantz Rom 
Published: February 2022

Abstract

Background:
Magnetic resonance elastography (MRE) allows noninvasive assessment of intracranial tumor mechanics and may thus be predictive of intraoperative conditions. Variations in the use of technical terms complicate reading of current literature, and there is need of a review using consolidated nomenclature.

Objectives:
We present an overview of current literature on MRE relating to human intracranial neoplasms using standardized nomenclature suggested by the MRE guidelines committee. We then discuss the implications of the findings, and suggest approaches for future research.

Method:
We performed a systematic literature search in PubMed, Embase, and Web of Science; the articles were screened for relevance and then subjected to full text review. Technical terms were consolidated.

Results:
We identified 12 studies on MRE in patients with intracranial tumors, including meningiomas, glial tumors including glioblastomas, vestibular schwannomas, hemangiopericytoma, central nervous system lymphoma, pituitary macroadenomas, and brain metastases. The studies had varying objectives that included prediction of intraoperative consistency, histological separation, prediction of adhesiveness, and exploration of the mechanobiology of tumor invasiveness and malignancy. The technical terms were translated using standardized nomenclature. The literature was highly heterogeneous in terms of image acquisition techniques, post-processing, and study design and was generally limited by small and variable cohorts.

Conclusions:
MRE shows potential in predicting tumor consistency, adhesion, and mechanical homogeneity. Furthermore, MRE provides insight into malignant tumor behavior and its relation to tissue mechanics. MRE is still at a preclinical stage, but technical advances, improved understanding of soft tissue rheological impact, and larger samples are likely to enable future clinical introduction.
Is 3-Dimensional Scanning Really Helpful in Implant-Based Breast Reconstruction?
Authors: Huang Dun-Wei , Chou Yu-Yu , Liu Hung-Hui , Dai Niann-Tzyy , Tzeng Yuan-Sheng , Chen Shyi-Gen 
Published: February 2022

Background
Breast reconstruction is an integral part of breast cancer treatment, and implant-based breast reconstruction is the most commonly used method worldwide. However, there is still no technique that allows surgeons to predict the volume of the required implant. Although computed tomography and magnetic resonance imaging provide adequate representations of the breast, these procedures are time-consuming, expensive, and expose patients to radiation. Therefore, there is a need for safer, noninvasive alternatives for preoperative breast volume measurements.

Patients and Methods
This study is a prospective review of 12 patients with early-stage breast cancer who underwent nipple-sparing mastectomy and immediate breast reconstruction with implants. Preoperatively, the Artec Eva 3D scanner was used to acquire volumetric measurements of the breasts. Intraoperatively, the volume of the mastectomy specimen was measured using the water displacement method. Correlations among the preoperative breast, mastectomy specimen, and estimated and final implant volumes were analyzed through Pearson correlation coefficient. A correction prediction factor of 85% was applied where necessary. Patient and physician satisfaction were evaluated 3 months postoperatively.

Results
Our study found a statistically significant correlation between the preoperative breast volumes measured by the Artec Eva 3D scanner and intraoperative mastectomy specimen volumes (r = 0.6578). There was no correlation between the preoperative breast volumes and final implant volumes, mastectomy specimen volumes and final implant volumes, and estimated implant volumes and final implant volumes.

Conclusions
Although the Artec Eva 3D scanner can offer relatively accurate measurement of breast volumes, multiple studies still need to be done to determine how these data can be applied to the mastectomy procedure and breast implant selection. It may be more applicable for preoperative planning in breast augmentation surgery. Future surgeons should also take into account that variabilities in natural breast size, tumor size, cancer stage, and in patient and physician preferences all influence the outcome of breast reconstruction surgery.
Transitioning to a high renewable net-zero power generation system in Malaysia
Authors: Chan Hoy-Yen , Sopian Kamaruzzaman 
Published: February 2022

Malaysia is a net importer of coal, petroleum products and piped natural gas. Moreover, its primary energy supply is dominated by fossil fuels, at about 93% in total, with coal and natural gas constituting the highest shares in electricity generation. Thus, there is need for Malaysia to take swift action in transitioning to a high renewable energy system for long-term sustainability and meeting its climate action commitment under the Paris Agreement. A net-zero emissions vision guided by a roadmap may effectively motivate and catalyse carbon-free energy deployments. In this paper, we revisit the carbon-free energy roadmap that was developed in 2015 and compare it with the current generation development plan to identify the gaps between them. We argue that the roadmap is still relevant to the net-zero emissions vision; however, we have also identified gaps that merit further research and improvement. The identified gaps mainly relate to more recent data, along with technology and policy developments. Accordingly, we put forward potential research suggestions to bridge these gaps for future development of a roadmap that would assist Malaysia in shaping a long-term plan towards realizing a high renewable net-zero power generation system.
This article is part of the theme issue ‘Developing resilient energy systems’.