bluuebunny/crossref_metadata_2025_split huggingface dataset:
Levosimendan in paediatric cardiac anaesthesiology
Authors: Lapere Matthias , Rega Filip , Rex Steffen 
Published: July 2022

BACKGROUND
Low cardiac output syndrome (LCOS) after congenital cardiac surgery has an incidence of up to 25%. Preventing and treating LCOS is of pivotal importance as LCOS is associated with excess morbidity and mortality.

OBJECTIVES
This systematic review assesses the safety and efficacy of peri-operative levosimendan administration in the setting of paediatric cardiac surgery.

DESIGN
Systematic review of randomised controlled trials. Meta-analyses were performed on efficacy and exploratory outcomes.

DATA SOURCES
Literature was searched in the following databases (MEDLINE, EMBASE, Web of Science and CENTRAL) from inception to July 2021.

ELIGIBILITY CRITERIA
Randomised controlled trials comparing levosimendan with other inotropes or placebo in children younger than 18 years of age undergoing cardiac surgery.

RESULTS
Nine studies enrolling a total of 539 children could be included in the systematic review. All trials study the prophylactic administration of levosimendan in comparison with placebo (n
= 2), milrinone (n = 6) or dobutamine (n
= 1). Levosimendan dosing varied considerably with only three studies using a loading dose. Levosimendan reduced the incidence of LCOS [risk ratio (RR) 0.80] [95% confidence interval (CI), 0.40 to 0.89, P = 0.01] and increased cardiac index (MD 0.17 l min−1 m−2) (95% CI, 0.06 to 0.28, P = 0.003) without affecting other outcomes (mortality, ICU length of stay, hospital length of stay, duration of mechanical ventilation, serum lactate, central venous oxygen saturation, serum creatine or acute kidney injury).

CONCLUSION
The prophylactic use of levosimendan in children undergoing cardiac surgery reduced the incidence of LCOS and increased cardiac index compared with other inotropes or placebo. This effect did not translate into an improvement of other clinical endpoints.
Comparison of Ischemic and Bleeding Events Between Short-Duration Versus Long-Duration Tirofiban Regimens in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
Authors: Denny Olivia , Woodruff Ashley E. , Mills Kevin , Chilbert Maya R. 
Published: July 2022

Abstract:
Tirofiban has been used historically as a bridge to platelet inhibition with clopidogrel in ST-segment myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) to prevent stent thrombosis. However, ticagrelor and prasugrel reach similar levels of platelet inhibition at 30 minutes to that of clopidogrel at 6 hours, challenging the need for long-duration tirofiban. This 1-year, retrospective cohort study compared ischemic and bleeding outcomes of short-duration versus long-duration tirofiban regimens in patients with STEMI who received ticagrelor or prasugrel at the time of PCI. The primary outcome was major adverse cardiovascular events (MACEs) including cardiovascular mortality, recurrent myocardial infarction, urgent target vessel revascularization, or stroke. Secondary outcomes included individual MACE, all-cause mortality, bleeding events defined by the International Society on Thrombosis and Hemostasis, thirty-day readmissions for MACE and bleeding, and tirofiban pharmacy cost. A total of 283 charts were reviewed and 177 included (short duration n = 57; long duration n = 120). MACE rates were similar between short-duration and long-duration groups (0 [0%] vs. 5 [4.2%]; P = 0.18), including 4 cardiovascular deaths and 1 recurrent myocardial infarction. Bleeding event rates were also similar in short-duration versus long-duration groups including major bleeds (2 [3.5%] vs. 2 [1.7%]; P = 0.60) and clinically relevant nonmajor bleeds (3 [5.3%] vs. 9 [7.5%]; P = 0.75). Cost analysis indicated lower pharmacy cost with the short-duration group. In this cohort of patients with STEMI receiving a fast-acting P2Y12 inhibitor, the length of tirofiban infusion did not affect ischemic or bleeding outcomes, yet short-duration regimens were lower cost.
Immigration transition and gastrointestinal symptoms during menopausal transition: midlife women in the US
Authors: Im Eun-Ok , Choi Mi-Young , Kim Gayeong , Jin Ruiqi , Chee Wonshik 
Published: July 2022

Abstract

Objectives
This study aimed to explore the associations of immigration transition to gastrointestinal (GI) symptoms experienced during the menopausal transition among 974 midlife women in the US.

Methods
The data from 974 midlife women from 2 national Internet survey studies were used for this secondary analysis. Only the data related to background characteristics and, health/menopausal status, immigration transition, and the Gastrointestinal Symptom Index for Midlife Women were included. The data were analyzed using descriptive and inferential statistics including analyses of covariance, logistic regression analyses, and hierarchical multiple regression analyses.

Results
There were statistical differences in total numbers and total severity scores of total GI symptoms between immigrants and nonimmigrants (F = 7.08 and 6.20, respectively; both P < 0.05); Immigrants had fewer total numbers and lower total severity scores of GI symptoms than nonimmigrants. All immigration transition variables including immigration status, the length of stay in the US, and the acculturation level accounted for 11.8% of the total numbers (F = 32.79, P < 0.001) and 12.5% of the total severity scores of GI symptoms (F = 35.10, P < 0.001). However, only immigration status (being nonimmigrant) was a significant factor that was associated with greater total numbers and higher total severity scores of GI symptoms (β = 0.62, P < 0.001 and β = 0.65, P < 0.001, respectively).

Conclusions
This study supports that immigration status is a significant factor that influences GI symptoms during the menopausal transition.
Poor physical recovery after critical illness: incidence, features, risk factors, pathophysiology, and evidence-based therapies
Authors: Boelens Yente Florine Niké , Melchers Max , van Zanten Arthur Raymond Hubert 
Published: July 2022

Purpose of review
To summarize the incidence, features, pathogenesis, risk factors, and evidence-based therapies of prolonged intensive care unit (ICU) acquired weakness (ICU-AW). We aim to provide an updated overview on aspects of poor physical recovery following critical illness.

Recent findings
New physical problems after ICU survival, such as muscle weakness, weakened condition, and reduced exercise capacity, are the most frequently encountered limitations of patients with postintensive care syndrome. Disabilities may persist for months to years and frequently do not fully recover. Hormonal and mitochondrial disturbances, impaired muscle regeneration due to injured satellite cells and epigenetic differences may be involved in sustained ICU-AW. Although demographics and ICU treatment factors appear essential determinants for physical recovery, pre-ICU health status is also crucial. Currently, no effective treatments are available. Early mobilization in the ICU may improve physical outcomes at ICU-discharge, but there is no evidence for benefit on long-term physical recovery.

Summary
Impaired physical recovery is observed frequently among ICU survivors. The pre-ICU health status, demographic, and ICU treatment factors appear to be important determinants for physical convalescence during the post-ICU phase. The pathophysiological mechanisms involved are poorly understood, thereby resulting in exiguous evidence-based treatment strategies to date.
Nutrition before, during and after critical illness
Authors: Ridley Emma J. , Lambell Kate 
Published: July 2022

Purpose of review
This review describes considerations preintensive care unit (ICU), within ICU and in the post-ICU period regarding nutrition management and the current state of the literature base informing clinical care.

Recent findings
Within ICU, studies have focussed on the first 5–7 days of illness in mechanically ventilated patients who are heterogeneous and with minimal consideration to premorbid nutrition state. Many evidence gaps in the period within ICU remain, with the major ones being the amount of protein to provide and the impact of longer-term nutrition interventions. Personalised nutrition and nutrition in the post-ICU period are becoming key areas of focus.

Summary
Nutrition for the critically ill patient should not be viewed in isolated time periods; what happens before, during and after ICU is likely important to the overall recovery trajectory. It is critical that the impact of nutrition on clinical and functional outcomes across hospitalisation is investigated in specific groups and using interventions in ways that are biologically plausible to impact. Areas that show promise for the future of critical care nutrition include interventions delivered for a longer duration and inclusion of oral nutrition support, individualised nutrition regimes, and use of emerging bedside body composition techniques to identify patients at nutritional risk.
Update on glucose control during and after critical illness
Authors: Deane Adam M. , Plummer Mark P. , Ali Abdelhamid Yasmine 
Published: July 2022

Purpose of review
There is a complex bidirectional relationship between critical illness and disordered glucose metabolism. This review aims to provide a comprehensive summary of the recent evidence focused on the relationship between critical illness and disordered glucose metabolism through the distinct phases of prior to, during, and after an acute illness that requires admission to the intensive care unit (ICU).

Recent findings
Recent data suggest that preexisting glucose metabolism affects the optimal blood glucose target during critical illness, with preliminary data suggesting that glucose targets should be ‘personalized’ based on preexisting glycemia. Because of the close association between critical illness and disordered glucose metabolism, there is a need to optimize glucose monitoring in the ICU with rapid, precise, and cost-efficient measurements at the bedside. Recent studies have evaluated the use of various methodologies, with a focus on the use of near-continuous glucose monitoring. For those patients with preexisting diabetes who survive ICU, nocturnal hypoglycemia may be an unrecognized and important issue when discharged to the ward. There is increasing evidence that patients with high blood glucose during their acute illness, so called ‘stress hyperglycemia’, are at increased risk of developing diabetes in the years following recovery from the inciting event. Critically ill patients with COVID-19 appear at greater risk.

Summary
There have been important recent insights in the approach to glucose monitoring and glucose targets during critical illness, monitoring and administration of glucose-lowering drugs on discharge from the ICU, and longitudinal follow-up of patients with stress hyperglycemia.
Gonococcal Infection and Ventriculoperitoneal Shunts
Authors: Freeman Megan Culler , Lazzara Alexandra , Lennon Tyler , McAteer John , Pease Matthew , Sefcik Roberta , Radovic-Stakic Ana , Milstone Aaron M. , Nowalk Andrew , Trent Maria 
Published: July 2022

Abstract

Neisseria gonorrhoeae and Chlamydia trachomatis are pathogens commonly isolated in pelvic inflammatory disease. Neisseria gonorrhoeae may uncommonly spread outside the urogenital tract to cause complications. We present 2 cases of adolescents with ventriculoperitoneal shunt infection due to N. gonorrhoeae, requiring shunt externalization.
Cost-effectiveness analysis of pembrolizumab versus standard of care in recurrent or metastatic squamous cell carcinoma of the head and neck
Authors: Yeh Justin , Black William , Guddati Achuta K. 
Published: July 2022

Abstract
Increasing costs of cancer treatment and anticancer drugs can create a financial burden on society and the individual. Pembrolizumab is an anti-PD-1 inhibitor immunotherapy approved for use in recurrent or metastatic head and neck squamous cell carcinoma. Limited data exists on the cost-effectiveness of pembrolizumab in this setting. This study compares the costeffectiveness of pembrolizumab against traditional chemotherapy using data from KEYNOTE-040. Published data from KEYNOTE-040 were used to create a model estimating treatment costs and overall survival benefit of pembrolizumab and traditional chemotherapy. Costs of treatment of toxicity-related events were obtained from previous literature and were incorporated into the model. Derivation of survival benefit gained from treatment was measured in quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) of pembrolizumab compared to the investigator's choice (IC) was $801,864/QALY. The average drug cost of pembrolizumab would have to approximately decrease by 63% in order to reach the cost-effective threshold of $100,000/ QALY. Pembrolizumab would have to confer a survival benefit of 0.88 QALYs per patient over the IC to reach the cost-effective threshold. Pembrolizumab is not considered cost effective at a threshold of $100,000/QALY based on survival data reported in KEYNOTE-040. Improved long-term outcomes of patients on this relatively new immunotherapy have yet to be reported. Inclusion of these data in the future would likely improve the cost-effectiveness calculations of pembrolizumab and other immunotherapies.
Momentary Partner Involvement in Diabetes Self-Care and Continuously Measured Glucose: A Dynamic Analysis
Authors: Soriano Emily C. , Lenhard M. James , Gonzalez Jeffrey S. , Tennen Howard , Otto Amy K. , Perndorfer Christine , Shen Biing-Jiun , Siegel Scott D. , Laurenceau Jean-Philippe 
Published: July 2022

ABSTRACT

Objective
This study examined the dynamic, real-time associations between partner involvement in diabetes self-care and continuous glucose monitor (CGM) metrics in adults with type 2 diabetes.

Methods
For 1 week, 63 participants wore Dexcom G4 CGMs and provided momentary reports of partner involvement in diabetes self-care five times per day. Dynamic structural equation models were used to estimate the reciprocal lagged effects of partner involvement on next-hour CGM metrics (and vice versa).

Results
Partner involvement predicted improved next-hour glucose control for five of six CGM metrics in analyses adjusted for time-varying covariates. The hour after partner involvement, the model predicted a 26.34 mg/dl decrease in glucose level (standardized β = −0.19), 30% greater odds of meeting target time in target range (β = 0.07), 48% higher odds of target time below target range (TBR; β = 0.04; the only nonsignificant effect), 47% greater odds of target time above target range (β = 0.11), a 4.20 unit decrease in glucose standard deviation (β = −0.19), and a 0.01 unit decrease in glucose coefficient of variation (β = −0.08; all p values < .05). There was less consistent support for the reverse pathway, with only two metrics significantly related to next-hour partner involvement: glucose level (β = 0.15) and TBR (β = 0.21), such that having higher levels and meeting target TBR were significantly predictive of next-hour partner involvement.

Conclusions
This is the first study showing that partner involvement in daily diabetes management predicts short-term glucose control. More research is needed to understand how partners influence glycemic control and evaluate interventions that promote their involvement in diabetes care.
A Novel Approach for Engagement in Team Training in High-Technology Surgery: The Robotic-Assisted Surgery Olympics
Authors: Cohen Tara N. , Anger Jennifer T. , Kanji Falisha F. , Zamudio Jennifer , DeForest Elise , Lusk Connor , Avenido Ray , Yoshizawa Christine , Bartkowicz Stephanie , Nemeth Lynne S. , Catchpole Ken 
Published: July 2022

Introduction
There is ongoing interest in the development of technical and nontechnical skills in healthcare to improve safety and efficiency; however, barriers to developing and delivering related training programs make them difficult to implement. Unique approaches to training such as “serious games” may offer ways to motivate teams, reinforce skill acquisition, and promote teamwork. Given increased challenges to teamwork in robotic-assisted surgery (RAS), researchers aimed to develop the “RAS Olympics,” a game-based educational competition to improve skills needed to successfully perform RAS.

Methods
This pilot study was conducted at an academic medical center in Southern California. Robotic-assisted surgery staff were invited to participate in the “RAS Olympics” to develop their skills and identify opportunities to improve processes. Impact of the activity was assessed using surveys and debriefs.

Results
Sixteen operating room team members participated and reacted favorably toward the RAS-Olympics (average score, 4.5/5). They enjoyed the activity, would recommend all staff participate, felt that it was relevant to their work, and believed that they practiced and learned new techniques that would improve their practice. Confidence in skills remained unchanged. Participants preferred the RAS Olympics to traditional training because it provided an interactive learning environment.

Conclusions
The successful implementation of the RAS Olympics provided insight into new opportunities to engage surgical staff members while also training technical and nontechnical skills. Furthermore, this shared experience allowed surgical staff members to gain a greater appreciation for their teammates and an understanding of the current challenges and methods to improve teamwork and communication while promoting safety and efficiency in RAS.
Impact of COVID-19 on the Postoperative Bariatric Surgery Patient Experience
Authors: Murtha Jacqueline A. , Alagoz Esra , Breuer Catherine R. , Eierman Lindsey , Jawara Dawda , Farrar-Edwards Dorothy , Voils Corrine I. , Funk Luke M. 
Published: July 2022

Objective:
To characterize patient and provider perceptions of the impact of coronavirus disease 2019 (COVID-19) on weight loss following bariatric surgery.

Background:
COVID-19 has disrupted routines and healthcare throughout the United States, but its impact on bariatric surgery patients’ postoperative experience is unknown.

Methods:
Semistructured interviews with bariatric surgery patients, primary care providers, and health psychologists were conducted from April to November 2020. As part of a secondary analysis, patients and providers described how the COVID-19 pandemic affected the postoperative experience within 3 domains: dietary habits, physical activity, and follow-up care. Interview guides were created from 2 conceptual models: Torain’s Surgical Disparities Model and Andersen’s Behavioral Model of Health Services Use. Study team members derived codes, which were grouped into themes using conventional content analysis.

Results:
Thirty-four participants were interviewed: 24 patients (12 Roux-en-Y gastric bypass and 12 sleeve gastrectomy), 6 primary care providers, and 4 health psychologists. Patients were predominately female (83%) and White (79%). Providers were predominately female (90%) and White (100%). COVID-19 affected the postoperative bariatric surgery patient experience via 3 mechanisms: (1) it disrupted dietary and physical activity routines due to facility closures and fear of COVID-19 exposure; (2) it required patients to transition their follow-up care to telemedicine delivery; and (3) it increased stress due to financial and psychosocial challenges.

Conclusions:
COVID-19 has exacerbated patient vulnerability. The pandemic is not over, thus bariatric surgery patients need ongoing support to access mental health professionals, develop new physical activity routines, and counteract increased food insecurity.
Prospective Study of Perioperative Circulating Tumor DNA Dynamics in Patients Undergoing Hepatectomy for Colorectal Liver Metastases
Authors: Newhook Timothy E. , Overman Michael J. , Chun Yun Shin , Dasari Arvind , Tzeng Ching-Wei D. , Cao Hop S. Tran , Raymond Victoria , Parseghian Christine , Johnson Benny , Nishioka Yujiro , Kawaguchi Yoshikuni , Uppal Abhineet , Vreeland Timothy J. , Jaimovich Ariel , Arvide Elsa M. , Cristo Jenilette V. , Wei Steven H. , Raghav Kanwal P. , Morris Van K. , Lee Jeffrey E. , Kopetz Scott , Vauthey Jean-Nicolas 
Published: July 2022

Objective:
To evaluate the association of perioperative ctDNA dynamics on outcomes after hepatectomy for CLM.

Summary Background Data:
Prognostication is imprecise for patients undergoing hepatectomy for CLM, and ctDNA is a promising biomarker. However, clinical implications of perioperative ctDNA dynamics are not well established.

Methods:
Patients underwent curative-intent hepatectomy after preoperative chemotherapy for CLM (2013–2017) with paired prehepatectomy/postoperative ctDNA analyses via plasma-only assay. Positivity was determined using a proprietary variant classifier. Primary endpoint was recurrence-free survival (RFS). Median follow-up was 55 months.

Results:
Forty-eight patients were included. ctDNA was detected before and after surgery (ctDNA+/+) in 14 (29%), before but not after surgery (ctDNA+/−) in 19 (40%), and not at all (ctDNA−/−) in 11 (23%). Adverse tissue somatic mutations were detected in TP53 (n = 26; 54%), RAS (n = 23; 48%), SMAD4 (n = 5; 10%), FBXW7 (n = 3; 6%), and BRAF (n = 2; 4%). ctDNA+/+ was associated with worse RFS (median: ctDNA+/+, 6.0 months; ctDNA+/−, not reached; ctDNA−/−, 33.0 months; P = 0.001). Compared to ctDNA+/+, ctDNA+/− was associated with improved RFS [hazard ratio (HR) 0.24 (95% confidence interval (CI) 0.1–0.58)] and overall survival [HR 0.24 (95% CI 0.08–0.74)]. Adverse somatic mutations were not associated with survival. After adjustment for prehepatectomy chemotherapy, synchronous disease, and ≥2 CLM, ctDNA+/− and ctDNA−/− were independently associated with improved RFS compared to ctDNA+/+ (ctDNA+/−: HR 0.21, 95% CI 0.08–0.53; ctDNA−/−: HR 0.21, 95% CI 0.08–0.56).

Conclusions:
Perioperative ctDNA dynamics are associated with survival, identify patients with high recurrence risk, and may be used to guide treatment decisions and surveillance after hepatectomy for patients with CLM.
Integrative analysis of viral entry networks and clinical outcomes identifies a protective role for spironolactone in severe COVID-19
Authors: Cousins Henry , Kline Adrienne Sarah , Wang Chengkun , Qu Yuanhao , Wang Mengdi , Altman Russ , Luo Yuan , Cong Le 
Published: July 2022

ABSTRACTTreatment strategies that target host entry factors have proven an effective means of impeding viral entry in HIV and may be more robust to viral evolution than drugs targeting viral proteins directly. High-throughput functional screens provide an unbiased means of identifying genes that influence the infection of host cells, while retrospective cohort analysis can measure the real-world, clinical potential of repurposing existing therapeutics as antiviral treatments. Here, we combine these two powerful methods to identify drugs that alter the clinical course of COVID-19 by targeting host entry factors. We demonstrate that integrative analysis of genome-wide CRISPR screening datasets enables network-based prioritization of drugs modulating viral entry, and we identify three common medications (spironolactone, quetiapine, and carvedilol) based on their network proximity to putative host factors. To understand the drugs’ real-world impact, we perform a propensity-score-matched, retrospective cohort study of 64,349 COVID-19 patients and show that spironolactone use is associated with improved clinical prognosis, measured by both ICU admission and mechanical ventilation rates. Finally, we show that spironolactone exerts a dose-dependent inhibitory effect on viral entry in a human lung epithelial cell line. Our results suggest that spironolactone may improve clinical outcomes in COVID-19 through tissue-dependent inhibition of viral entry. Our work further provides a potential approach to integrate functional genomics with real-world evidence for drug repurposing.