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2,335,800 |
Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination - PCORnet, United States, January 2021-January 2022.
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Cardiac complications, particularly myocarditis and pericarditis, have been associated with SARS-CoV-2 (the virus that causes COVID-19) infection (1-3) and mRNA COVID-19 vaccination (2-5). Multisystem inflammatory syndrome (MIS) is a rare but serious complication of SARS-CoV-2 infection with frequent cardiac involvement (6). Using electronic health record (EHR) data from 40 U.S. health care systems during January 1, 2021-January 31, 2022, investigators calculated incidences of cardiac outcomes (myocarditis; myocarditis or pericarditis; and myocarditis, pericarditis, or MIS) among persons aged ≥5 years who had SARS-CoV-2 infection, stratified by sex (male or female) and age group (5-11, 12-17, 18-29, and ≥30 years). Incidences of myocarditis and myocarditis or pericarditis were calculated after first, second, unspecified, or any (first, second, or unspecified) dose of mRNA COVID-19 (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) vaccines, stratified by sex and age group. Risk ratios (RR) were calculated to compare risk for cardiac outcomes after SARS-CoV-2 infection to that after mRNA COVID-19 vaccination. The incidence of cardiac outcomes after mRNA COVID-19 vaccination was highest for males aged 12-17 years after the second vaccine dose; however, within this demographic group, the risk for cardiac outcomes was 1.8-5.6 times as high after SARS-CoV-2 infection than after the second vaccine dose. The risk for cardiac outcomes was likewise significantly higher after SARS-CoV-2 infection than after first, second, or unspecified dose of mRNA COVID-19 vaccination for all other groups by sex and age (RR 2.2-115.2). These findings support continued use of mRNA COVID-19 vaccines among all eligible persons aged ≥5 years.
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2,335,801 |
Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial.
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Dietary restriction of sodium has been suggested to prevent fluid overload and adverse outcomes for patients with heart failure. We designed the Study of Dietary Intervention under 100 mmol in Heart Failure (SODIUM-HF) to test whether or not a reduction in dietary sodium reduces the incidence of future clinical events.</AbstractText>SODIUM-HF is an international, open-label, randomised, controlled trial that enrolled patients at 26 sites in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand). Eligible patients were aged 18 years or older, with chronic heart failure (New York Heart Association [NYHA] functional class 2-3), and receiving optimally tolerated guideline-directed medical treatment. Patients were randomly assigned (1:1), using a standard number generator and varying block sizes of two, four, or six, stratified by site, to either usual care according to local guidelines or a low sodium diet of less than 100 mmol (ie, <1500 mg/day). The primary outcome was the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visit, or all-cause death within 12 months in the intention-to-treat (ITT) population (ie, all randomly assigned patients). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT02012179, and is closed to accrual.</AbstractText>Between March 24, 2014, and Dec 9, 2020, 806 patients were randomly assigned to a low sodium diet (n=397) or usual care (n=409). Median age was 67 years (IQR 58-74) and 268 (33%) were women and 538 (66%) were men. Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653-3005) to 1658 mg/day (1301-2189) in the low sodium group and from 2119 mg/day (1673-2804) to 2073 mg/day (1541-2900) in the usual care group. By 12 months, events comprising the primary outcome had occurred in 60 (15%) of 397 patients in the low sodium diet group and 70 (17%) of 409 in the usual care group (hazard ratio [HR] 0·89 [95% CI 0·63-1·26]; p=0·53). All-cause death occurred in 22 (6%) patients in the low sodium diet group and 17 (4%) in the usual care group (HR 1·38 [0·73-2·60]; p=0·32), cardiovascular-related hospitalisation occurred in 40 (10%) patients in the low sodium diet group and 51 (12%) patients in the usual care group (HR 0·82 [0·54-1·24]; p=0·36), and cardiovascular-related emergency department visits occurred in 17 (4%) patients in the low sodium diet group and 15 (4%) patients in the usual care group (HR 1·21 [0·60-2·41]; p=0·60). No safety events related to the study treatment were reported in either group.</AbstractText>In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events.</AbstractText>Canadian Institutes of Health Research and the University Hospital Foundation, Edmonton, Alberta, Canada, and Health Research Council of New Zealand.</AbstractText>Copyright © 2022 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,335,802 |
Determinants of Longitudinal Measure Pulse Rate of Chronic Heart Failure Patients at Felege Hiwot Referral Hospital, Ethiopia: A Longitudinal Modeling Data Analysis.
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Heart rate is a significant modifiable factor in lowering mortality in heart failure patients. The heart rate, often known as the pulse rate, is the number of times the heart beats in a given amount of time. Irregular pulse rate or heart block are all measured using heart rate data. A higher heart rate has been associated with worse clinical outcomes. The main purpose of this study was to identify factors associated with the longitudinal pulse rate of congestive heart failure patients.</AbstractText>Hospital-based retrospective studies were conducted among 249 congestive heart failure patients who were 18 years old or older and who were on treatment follow-up from first February 2016 to thirty-one December 2017 in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.</AbstractText>Data were explored using descriptive statistics, individual and mean profile plots, and analyzed using linear mixed models. Out of the total 249 patients, 139 (55.8%) were females. The majority 179 (71.9%) of the CHF patients were rural residents. 65 (26.1%) patients had Hypertension, 30 (12.5%) patients had Diabetes Mellitus, 58 (23.3%) patients had Pneumonia. Thus age, LVEF, follow-up time in a month had a negative significant effect whereas NYHA class, male gender, pneumonia had a positive significant effect on the average evaluation of pulse rate of patients. The time interaction effect of NYHA Class (Time* NYHA Class), and LVEF (Time*LVEF) had a significant effect on average pulse rate evolution.</AbstractText>The variables age, LVEF, and follow-up time were negatively associated whereas, male gender, NYHA class, and presence of pneumonia were positively associated with the progression change of pulse rate of patients rate of progression of pulse rate decreases over time. Furthermore, health professionals give more attention to patients who are NYHA class IV, had low LVEF, pneumonic patients to reduce pulse rate during the follow-up time.</AbstractText>© 2022 Abebaw Moyehodie and Wale Muluneh.</CopyrightInformation>
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2,335,803 |
Recent advances in the development of active hybrid molecules in the treatment of cardiovascular diseases.
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Multifactorial nature of the underlying pathophysiology of chronic disorders hinders in the effective treatment and management of many complex diseases. The conventional targeted therapies have limited applications due to highly complicated disease etiology. Cardiovascular diseases (CVDs) are the group of disorders of the heart and blood vessels. Currently, there is limited knowledge on the underlying cellular and molecular mechanisms of many of the CVDs due to their complex pathophysiology and co-morbidities. Their management with conventional medications results in failure due to adverse drug reactions and clinical specificity of solo-targeting drug therapy. Therefore, it is critical to introduce an alternative strategy to treat multi-factorial diseases. In the past few years, discovery and use of multi-targeted drug therapy with hybrid molecules have shown promising results with minimal side effects, and thus considered a most effective approach. In this review article, prominent hybrid molecules combining with different active moieties are reported to synergistically and simultaneously block different pathways involved in CVDs. Here, we provide a critical evaluation and discussion on their pharmacology with mechanistic insights and the structure activity relationship. The timely information provided in this article reveals the recent trends of molecular hybridization to the scientific community interested in CVDs and help them in designing the next generation of multi-targeting drug therapeutics.
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2,335,804 |
Cutaneous Neonatal Lupus Erythematosus: A Case Report.
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Neonatal lupus erythematosus (NLE) is a rare autoimmune entity observed in infants born to mothers with autoantibodies against Ro/SSA and La/SSB. Neonatal lupus may present with rash, heart block, hepatic dysfunction, and cytopenia. Although the condition is usually self-limited, serious sequelae can occur. We present the case of a three-month-old infant who developed multiple erythematous, annular cutaneous lesions at six weeks of age who was ultimately diagnosed with NLE. This case highlights the importance of considering neonatal lupus erythematosus in infants with rashes in the first few months of life. In our case, clinical suspicion and laboratory evaluation helped confirm the diagnosis and facilitate appropriate treatment.
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2,335,805 |
Ultrasound-guided paravertebral nerve block anesthesia on the stress response and hemodynamics among lung cancer patients.
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Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response, loss of hemodynamic stability, and decreased immune function. Herein, we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia, in combination with general anesthesia, for thoracic surgery for lung cancer. The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.</AbstractText>To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.</AbstractText>The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020. Patients were randomly allocated to the peripheral + general anesthesia (observation) group (n</i> = 74) or to the general anesthesia (control) group (n</i> = 66). Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia, with those in the control group receiving an epidural block combined with general anesthesia. Measured outcomes included the operative and anesthesia times, as well as the mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation (SpO2</sub>) measured before surgery, 15 min after anesthesia (T1), after intubation, 5 min after skin incision, and before extubation (T4).</AbstractText>The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group (1.48 ± 0.43 mg, 760.50 ± 92.28 mg, and 72.50 ± 16.62 mg, respectively) than control group (P</i> < 0.05). At the four time points of measurement (T1 through T4), MAP and HR values were higher in the observation than control group (MAP, 90.20 ± 9.15 mmHg, 85.50 ± 7.22 mmHg, 88.59 ± 8.15 mmHg, and 90.02 ± 10.02 mmHg, respectively; and HR, 72.39 ± 8.22 beats/min, 69.03 ± 9.03 beats/min, 70.12 ± 8.11 beats/min, and 71.24 ± 9.01 beats/min, respectively; P</i> < 0.05). There was no difference in SpO2</sub> between the two groups (P</i> > 0.05). Postoperative levels of epinephrine, norepinephrine, and dopamine used were significantly lower in the observation than control group (210.20 ± 40.41 pg/mL, 230.30 ± 65.58 pg/mL, and 54.49 ± 13.32 pg/mL, respectively; P</i> < 0.05). Similarly, the postoperative tumor necrosis factor-α and interleukin-6 levels were lower in the observation (2.43 ± 0.44 pg/mL and 170.03 ± 35.54 pg/mL, respectively) than control group (P</i> < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P</i> > 0.05).</AbstractText>Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer, with no increase in the rate of adverse events.</AbstractText>©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.</CopyrightInformation>
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2,335,806 |
Comparing Duration of Analgesia after Intrathecal Administration of Opioids in Primary Paturients for Lower Segment Cesarean Section.
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A pain free post operative period is a boon to mother for caring the neonate. We compared injection butorphanol and fentanyl as an adjuvant to bupivacaine in primary parturients for LSCS (Lower Segment Caesarean Section) with respect to duration of analgesia.</AbstractText>To study the effect of butorphanol vs fentanyl on duration of analgesia when added to bupivacaine for LSCS amongst primi parturients and to observe the block characteristics as secondary outcome.</AbstractText>Study was carried out in 90 patients divided equally into three groups which included 12mg(2 mL) of 0.5% hyperbaric bupivacaine with 0.5 mL NS, 12mg (2 mL) of 0.5% hyperbaric bupivacaine 25 μg butorphanol made upto 2.5 mL with NS and 12mg(2 mL) of 0.5% hyperbaric bupivacaine with 25μg fentanyl made upto 2.5mL with normal saline. All patients were observed for duration of analgesia. Also Heart Rate (HR), Systolic and Diastolic Blood Pressure (SBP, DBP), two segment regression time of sensory block, motor block were assessed. The results were compiled and statistically analyzed using Chi-square test for nonparametric data and ANOVA for parametric data.</AbstractText>Two segment sensory regression is significantly prolonged in group with intrathecal administration of Bupivacaine with Butorphanol (190.33±15.86) than Bupivacaine with Fentanyl (170.67±20.83) and Bupivacaine with Normal saline (150.33±16.91). Duration of effective post operative analgesia was 349.67, 591.87 and 468.00 min in Group I, Group II and Group III respectively. There was no significant difference in onset of sensory and motor blockage in all three groups. HR, SBP and DBP were comparable among the groups.</AbstractText>Intrathecal bupivacaine with 25 μg butorphanol mixture was clinically better as it provided longer duration of analgesia along with prolonged sensory block when compared to intrathecal bupivacaine with 25μg fentanyl mixture in primary parturients for LSCS.</AbstractText>Copyright: © 2022 Anesthesia: Essays and Researches.</CopyrightInformation>
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2,335,807 |
Effects of Sodium/Glucose Cotransporter 2 (SGLT2) Inhibitors and Combined SGLT1/2 Inhibitors on Cardiovascular, Metabolic, Renal, and Safety Outcomes in Patients with Diabetes: A Network Meta-Analysis of 111 Randomized Controlled Trials.<Pagination><StartPage>299</StartPage><EndPage>323</EndPage><MedlinePgn>299-323</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s40256-022-00528-7</ELocationID><Abstract><AbstractText Label="INTRODUCTION" NlmCategory="BACKGROUND">Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of anti-hyperglycemic drugs that has been steadily increasing in popularity due to its cardiovascular and renal benefits. Dual SGLT1/SGLT2 (SGLT1/2) inhibitors have potentially augmented anti-hyperglycemic action due to additional SGLT1 inhibition. This network meta-analysis aimed to compare the treatment effect across various outcomes between pure SGLT2 inhibitors and combined SGLT1/2 inhibitors in patients with diabetes.</AbstractText><AbstractText Label="METHODOLOGY" NlmCategory="METHODS">Four electronic databases (PubMed, Embase, Cochrane, and Scopus) were searched for randomized controlled trials published from inception to 15th January 2022. Frequentist network meta-analysis was conducted to summarize the treatment effects reported in individual trials, stratified by type 1 (T1DM) and type 2 diabetes mellitus (T2DM). This meta-analysis was registered on PROSPERO (CRD42020222031).</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Our meta-analysis included 111 articles, comprising a combined cohort of 103,922 patients. SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin, ipragliflozin, ertugliflozin, and luseogliflozin) and SGLT1/2 inhibitors (licogliflozin and sotagliflozin) were compared. Frequentist network meta-analysis demonstrated that in T2DM patients, SGLT1/2 inhibitors led to a decreased hazard rate of myocardial infarction (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56-0.98) and stroke (HR 0.65, 95% CI 0.47-0.92) compared with SGLT2 inhibitors. SGLT2 inhibitors achieved a greater hemoglobin A1c (HbA1c) reduction than SGLT1/2 inhibitors (0.16%, 95% CI 0.06-0.26). In patients with T2DM, the risk of diarrhea (risk ratio [RR] 1.42, 95% CI 1.07-1.88) and severe hypoglycemia (RR 5.89, 95% CI 1.41-24.57) were found to be higher with SGLT1/2 inhibitor use compared with SGLT2 inhibitor use. No differences were observed for cardiovascular, metabolic, and safety outcomes between SGLT1/2 inhibitors and SGLT2 inhibitors in patients with T1DM.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">In patients with T2DM, compared with pure SGLT2 inhibitors, combined SGLT1/2 inhibitors demonstrated a lower risk of myocardial infarction and of stroke, but were associated with a higher risk of diarrhea and severe hypoglycemia.</AbstractText><CopyrightInformation>© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Teo</LastName><ForeName>Yao Neng</ForeName><Initials>YN</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y" EqualContrib="Y"><LastName>Ting</LastName><ForeName>Adriel Z H</ForeName><Initials>AZH</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Teo</LastName><ForeName>Yao Hao</ForeName><Initials>YH</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chong</LastName><ForeName>Elliot Yeung</ForeName><Initials>EY</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tan</LastName><ForeName>Joshua Teik Ann</ForeName><Initials>JTA</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Syn</LastName><ForeName>Nicholas L</ForeName><Initials>NL</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chia</LastName><ForeName>Alys Z Q</ForeName><Initials>AZQ</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ong</LastName><ForeName>How Ting</ForeName><Initials>HT</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Cheong</LastName><ForeName>Alex Jia Yang</ForeName><Initials>AJY</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Li</LastName><ForeName>Tony Yi-Wei</ForeName><Initials>TY</Initials><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Poh</LastName><ForeName>Kian Keong</ForeName><Initials>KK</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yeo</LastName><ForeName>Tiong Cheng</ForeName><Initials>TC</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chan</LastName><ForeName>Mark Yan-Yee</ForeName><Initials>MY</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wong</LastName><ForeName>Raymond C C</ForeName><Initials>RCC</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chai</LastName><ForeName>Ping</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sia</LastName><ForeName>Ching-Hui</ForeName><Initials>CH</Initials><Identifier Source="ORCID">0000-0002-2764-2869</Identifier><AffiliationInfo><Affiliation>Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 9, Singapore, 119228, Singapore. [email protected].</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D017418">Meta-Analysis</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>03</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>New Zealand</Country><MedlineTA>Am J Cardiovasc Drugs</MedlineTA><NlmUniqueID>100967755</NlmUniqueID><ISSNLinking>1175-3277</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007004">Hypoglycemic Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D051297">Sodium-Glucose Transporter 2</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000077203">Sodium-Glucose Transporter 2 Inhibitors</NameOfSubstance></Chemical><Chemical><RegistryNumber>9NEZ333N27</RegistryNumber><NameOfSubstance UI="D012964">Sodium</NameOfSubstance></Chemical><Chemical><RegistryNumber>IY9XDZ35W2</RegistryNumber><NameOfSubstance UI="D005947">Glucose</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D003922" MajorTopicYN="Y">Diabetes Mellitus, Type 1</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003924" MajorTopicYN="Y">Diabetes Mellitus, Type 2</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003967" MajorTopicYN="N">Diarrhea</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005947" MajorTopicYN="N">Glucose</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007003" MajorTopicYN="Y">Hypoglycemia</DescriptorName><QualifierName UI="Q000139" MajorTopicYN="N">chemically induced</QualifierName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007004" MajorTopicYN="N">Hypoglycemic Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D009203" MajorTopicYN="Y">Myocardial Infarction</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000071076" MajorTopicYN="N">Network Meta-Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016032" MajorTopicYN="N">Randomized Controlled Trials as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012964" MajorTopicYN="N">Sodium</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D051297" MajorTopicYN="N">Sodium-Glucose Transporter 2</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000077203" MajorTopicYN="Y">Sodium-Glucose Transporter 2 Inhibitors</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D020521" MajorTopicYN="Y">Stroke</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>2</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>3</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>5</Month><Day>6</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>3</Month><Day>22</Day><Hour>17</Hour><Minute>18</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">35316484</ArticleId><ArticleId IdType="doi">10.1007/s40256-022-00528-7</ArticleId><ArticleId IdType="pii">10.1007/s40256-022-00528-7</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. 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Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of anti-hyperglycemic drugs that has been steadily increasing in popularity due to its cardiovascular and renal benefits. Dual SGLT1/SGLT2 (SGLT1/2) inhibitors have potentially augmented anti-hyperglycemic action due to additional SGLT1 inhibition. This network meta-analysis aimed to compare the treatment effect across various outcomes between pure SGLT2 inhibitors and combined SGLT1/2 inhibitors in patients with diabetes.</AbstractText>Four electronic databases (PubMed, Embase, Cochrane, and Scopus) were searched for randomized controlled trials published from inception to 15th January 2022. Frequentist network meta-analysis was conducted to summarize the treatment effects reported in individual trials, stratified by type 1 (T1DM) and type 2 diabetes mellitus (T2DM). This meta-analysis was registered on PROSPERO (CRD42020222031).</AbstractText>Our meta-analysis included 111 articles, comprising a combined cohort of 103,922 patients. SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin, ipragliflozin, ertugliflozin, and luseogliflozin) and SGLT1/2 inhibitors (licogliflozin and sotagliflozin) were compared. Frequentist network meta-analysis demonstrated that in T2DM patients, SGLT1/2 inhibitors led to a decreased hazard rate of myocardial infarction (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.56-0.98) and stroke (HR 0.65, 95% CI 0.47-0.92) compared with SGLT2 inhibitors. SGLT2 inhibitors achieved a greater hemoglobin A1c (HbA1c) reduction than SGLT1/2 inhibitors (0.16%, 95% CI 0.06-0.26). In patients with T2DM, the risk of diarrhea (risk ratio [RR] 1.42, 95% CI 1.07-1.88) and severe hypoglycemia (RR 5.89, 95% CI 1.41-24.57) were found to be higher with SGLT1/2 inhibitor use compared with SGLT2 inhibitor use. No differences were observed for cardiovascular, metabolic, and safety outcomes between SGLT1/2 inhibitors and SGLT2 inhibitors in patients with T1DM.</AbstractText>In patients with T2DM, compared with pure SGLT2 inhibitors, combined SGLT1/2 inhibitors demonstrated a lower risk of myocardial infarction and of stroke, but were associated with a higher risk of diarrhea and severe hypoglycemia.</AbstractText>© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.</CopyrightInformation>
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Impact of socioeconomic deprivation on evaluation for heart transplantation at an urban academic medical center.
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For patients with advanced heart failure, socioeconomic deprivation may impede referral for heart transplantation (HT). We examined the association of socioeconomic deprivation with listing among patients evaluated at our institution and compared this against the backdrop of our local community.</AbstractText>We conducted a retrospective cohort study of patients evaluated for HT between January 2017 and December 2020. Patient demographics and clinical characteristics were recorded. Block group-level area deprivation index (ADI) decile was obtained at each patient's home address and Socioeconomic Status (SES) index was determined by patient zip code.</AbstractText>In total, 400 evaluations were initiated; one international patient was excluded. Among this population, 111 (27.8%) were women, 219 (54.9%) were White, 94 (23.6%) Black, and 59 (14.8%) Hispanic. 248 (62.2%) patients were listed for transplant. Listed patients had significantly higher SES index and lower ADI compared to those who were not listed. However, after adjustment for clinical factors, ADI and SESi were not predictive of listing. Similarly, patient sex, race, and insurance did not influence the likelihood of listing for HT. Notably, the distribution of the referral cohort based on ADI deciles was not reflective of our center's catchment area, indicating opportunities for improving access to transplant for disadvantaged populations.</AbstractText>Although socioeconomic deprivation did not predict listing in our analysis, we recognize the need for broader outreach to combat upstream bias that prevents patients from being referred for HT.</AbstractText>© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.</CopyrightInformation>
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Environmental data and methods from the Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) core measures environmental working group.
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This article describes geospatial datasets and exemplary data across five environmental domains (walkability, socioeconomic deprivation, urbanicity, personal safety, and food outlet accessibility). The environmental domain is one of four domains (behavioral, biological, environmental and psychosocial) in which the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project suggested measures to help explain variation in responses to weight loss interventions. These data are intended to facilitate additional research on potential environmental moderators of responses to weight loss, physical activity, or diet related interventions. These data represent a mix of publicly and commercially available pre-existing data that were downloaded, cleaned, restructured and analyzed to create datasets at the United States (U.S.) block group and/or census tract level for the five domains. Additionally, the resource includes detailed methods for obtaining, cleaning and summarizing two datasets concerning safety and the food environment that are only available commercially. Across the five domains considered, we include component as well as derived variables for three of the five domains. There are two versions of the National Walkability Index Dataset (one based on 2013 data and one on 2019 data) consisting of 15 variables. The Neighborhood Deprivation Index dataset contains 18 variables and is based on the US Census Bureau's 5-year American Community Survey (ACS) data for 2013-2017. The urbanicity dataset contains 11 variables and is based on USDA rural-urban commuting (RUCA) codes and Census Bureau urban/rural population data from 2010. Personal safety and food outlet accessibility data were purchased through commercial vendors and are not in the public domain. Thus, only exemplary figures and detailed instructions are provided. The website housing these datasets and examples should serve as a valuable resource for researchers who wish to examine potential environmental moderators of responses to weight loss and related interventions in the U.S.
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Rucaparib versus standard-of-care chemotherapy in patients with relapsed ovarian cancer and a deleterious BRCA1 or BRCA2 mutation (ARIEL4): an international, open-label, randomised, phase 3 trial.
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Few prospective studies have compared poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors to chemotherapy for the treatment of BRCA1-mutated or BRCA2-mutated ovarian carcinoma. We aimed to assess rucaparib versus platinum-based and non-platinum-based chemotherapy in this setting.</AbstractText>In this open-label, randomised, controlled, phase 3 study (ARIEL4), conducted in 64 hospitals and cancer centres across 12 countries (Brazil, Canada, Czech Republic, Hungary, Israel, Italy, Poland, Russia, Spain, Ukraine, the UK, and the USA), we recruited patients aged 18 years and older with BRCA1-mutated or BRCA2-mutated ovarian carcinoma, with an Eastern Cooperative Oncology Group performance status of 0 or 1, and who had received two or more previous chemotherapy regimens. Eligible patients were randomly assigned (2:1), using an interactive response technology and block randomisation (block size of six) and stratified by progression-free interval after the most recent platinum-containing therapy, to oral rucaparib (600 mg twice daily) or chemotherapy (administered per institutional guidelines). Patients assigned to the chemotherapy group with platinum-resistant or partially platinum-sensitive disease were given paclitaxel (starting dose 60-80 mg/m2</sup> on days 1, 8, and 15); those with fully platinum-sensitive disease received platinum-based chemotherapy (single-agent cisplatin or carboplatin, or platinum-doublet chemotherapy). Patients were treated in 21-day or 28-day cycles. The primary endpoint was investigator-assessed progression-free survival, assessed in the efficacy population (all randomly assigned patients with deleterious BRCA1 or BRCA2 mutations without reversion mutations), and then in the intention-to-treat population (all randomly assigned patients). Safety was assessed in all patients who received at least one dose of assigned study treatment. This study is registered with ClinicalTrials.gov, NCT02855944; enrolment is complete, and the study is ongoing.</AbstractText>Between March 1, 2017, and Sept 24, 2020, 930 patients were screened, of whom 349 eligible patients were randomly assigned to rucaparib (n=233) or chemotherapy (n=116). Median age was 58 years (IQR 52-64) and 332 (95%) patients were White. As of data cutoff (Sept 30, 2020), median follow-up was 25·0 months (IQR 13·8-32·5). In the efficacy population (220 patients in the rucaparib group; 105 in the chemotherapy group), median progression-free survival was 7·4 months (95% CI 7·3-9·1) in the rucaparib group versus 5·7 months (5·5-7·3) in the chemotherapy group (hazard ratio [HR] 0·64 [95% CI 0·49-0·84]; p=0·0010). In the intention-to-treat population (233 in the rucaparib group; 116 in the chemotherapy group), median progression-free survival was 7·4 months (95% CI 6·7-7·9) in the rucaparib group versus 5·7 months (5·5-6·7) in the chemotherapy group (HR 0·67 [95% CI 0·52-0·86]; p=0·0017). Most treatment-emergent adverse events were grade 1 or 2. The most common grade 3 or worse treatment-emergent adverse event was anaemia or decreased haemoglobin (in 52 [22%] of 232 patients in the rucaparib group vs six [5%] of 113 in the chemotherapy group). Serious treatment-emergent adverse events occurred in 62 (27%) patients in the rucaparib group versus 13 (12%) in the chemotherapy group; serious adverse events considered related to treatment by the investigator occurred in 32 (14%) patients in the rucaparib group and six (5%) in the chemotherapy group. Three deaths were considered to be potentially related to rucaparib (one due to cardiac disorder, one due to myelodysplastic syndrome, and one with an unconfirmed cause).</AbstractText>Results from the ARIEL4 study support rucaparib as an alternative treatment option to chemotherapy for patients with relapsed, BRCA1-mutated or BRCA2-mutated ovarian carcinoma.</AbstractText>Clovis Oncology.</AbstractText>Copyright © 2022 Elsevier Ltd. All rights reserved.</CopyrightInformation>
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Effects of graduated compression socks on ankle inversion proprioception of half-marathon runners at different running distances.<Pagination><StartPage>529</StartPage><EndPage>534</EndPage><MedlinePgn>529-534</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jsams.2022.02.006</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S1440-2440(22)00040-8</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To determine the effect of graduated compression socks on ankle proprioception and the relationship between fatigue and ankle proprioception measures in half-marathon runners at successive 7 km intervals during a 21-km run.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">Repeated measures study.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Twenty well-trained half-marathon runners (mean ± SD: age 38.6 ± 11.3 y, weekly volume 42.3 ± 21.1 km, training experience 4.7 ± 3.5 y) performed two 21 km running trials on a treadmill wearing either graduated compression socks or looser, standard non-compression running socks. Each running trial was divided into three self-paced 7 km blocks, repeated at the same pace for each trial, heart rate was not controlled, but after each block, heart rate, blood lactate, rating of perceived exertion, and ankle inversion proprioception were measured, the latter by using the active movement extent discrimination apparatus.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">There was no differences between the graduated compression sock and non-compression running sock conditions in rating of perceived exertion scores (F = 0.524, p = 0.478), heart rate (F = 0.001, p = 0.975) and blood lactate (F = 0.004, p = 0.951). Overall, wearing graduated compression socks was associated with significantly better ankle proprioception after 21 km of running (p = 0.024, 95% CI = -0.066, -0.005). Heart rate, rating of perceived exertion and blood lactate were not correlated with ankle proprioception sensitivity in the graduated compression sock and non-compression running sock conditions at any point during the run (all p > 0.05).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Wearing graduated compression socks provides a positive effect on proprioceptive control of the ankle joint only after 21 km and may therefore reduce the possibility of injury associated with proprioceptive ability diminishing over time during exercise.</AbstractText><CopyrightInformation>Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Chang</LastName><ForeName>Lin</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>School of Kinesiology, Shanghai University of Sport, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fu</LastName><ForeName>Silin</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>College of P.E. and Sports, Beijing Normal University, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Sam</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Health and Medical Sciences, Swinburne University of Technology, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Witchalls</LastName><ForeName>Jeremy</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Research Institute for Sport and Exercise, University of Canberra, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Adams</LastName><ForeName>Roger</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Research Institute for Sport and Exercise, University of Canberra, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Waddington</LastName><ForeName>Gordon</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Research Institute for Sport and Exercise, University of Canberra, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Han</LastName><ForeName>Jia</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China; School of Kinesiology, Shanghai University of Sport, China; Department of Health and Medical Sciences, Swinburne University of Technology, Australia; Research Institute for Sport and Exercise, University of Canberra, Australia; College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, China. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>02</Month><Day>22</Day></ArticleDate></Article><MedlineJournalInfo><Country>Australia</Country><MedlineTA>J Sci Med Sport</MedlineTA><NlmUniqueID>9812598</NlmUniqueID><ISSNLinking>1878-1861</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007773">Lactates</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000842" MajorTopicYN="N">Ankle</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000843" MajorTopicYN="N">Ankle Joint</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007773" MajorTopicYN="N">Lactates</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000081642" MajorTopicYN="N">Marathon Running</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011434" MajorTopicYN="N">Proprioception</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012420" MajorTopicYN="Y">Running</DescriptorName><QualifierName UI="Q000502" MajorTopicYN="N">physiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D053828" MajorTopicYN="Y">Stockings, Compression</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Fatigue</Keyword><Keyword MajorTopicYN="N">Graduated compression socks</Keyword><Keyword MajorTopicYN="N">Half-marathon</Keyword><Keyword MajorTopicYN="N">Proprioception</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>10</Month><Day>23</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2022</Year><Month>1</Month><Day>6</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2022</Year><Month>2</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>3</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>6</Month><Day>7</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>3</Month><Day>16</Day><Hour>5</Hour><Minute>42</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">35292228</ArticleId><ArticleId IdType="doi">10.1016/j.jsams.2022.02.006</ArticleId><ArticleId IdType="pii">S1440-2440(22)00040-8</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedBookArticle><BookDocument><PMID Version="1">20301717</PMID><ArticleIdList><ArticleId IdType="bookaccession">NBK1674</ArticleId></ArticleIdList><Book><Publisher><PublisherName>University of Washington, Seattle</PublisherName><PublisherLocation>Seattle (WA)</PublisherLocation></Publisher><BookTitle book="gene">GeneReviews<sup>®</sup></BookTitle><PubDate><Year>1993</Year></PubDate><BeginningDate><Year>1993</Year></BeginningDate><EndingDate><Year>2023</Year></EndingDate><AuthorList Type="editors" CompleteYN="Y"><Author ValidYN="Y"><LastName>Adam</LastName><ForeName>Margaret P</ForeName><Initials>MP</Initials></Author><Author ValidYN="Y"><LastName>Mirzaa</LastName><ForeName>Ghayda M</ForeName><Initials>GM</Initials></Author><Author ValidYN="Y"><LastName>Pagon</LastName><ForeName>Roberta A</ForeName><Initials>RA</Initials></Author><Author ValidYN="Y"><LastName>Wallace</LastName><ForeName>Stephanie E</ForeName><Initials>SE</Initials></Author><Author ValidYN="Y"><LastName>Bean</LastName><ForeName>Lora JH</ForeName><Initials>LJH</Initials></Author><Author ValidYN="Y"><LastName>Gripp</LastName><ForeName>Karen W</ForeName><Initials>KW</Initials></Author><Author ValidYN="Y"><LastName>Amemiya</LastName><ForeName>Anne</ForeName><Initials>A</Initials></Author></AuthorList><Medium>Internet</Medium></Book><ArticleTitle book="gene" part="dcm-lmna"><i>LMNA</i>-Related Dilated Cardiomyopathy<Language>eng</Language><AuthorList Type="authors" CompleteYN="Y"><Author ValidYN="Y"><LastName>Hershberger</LastName><ForeName>Ray E</ForeName><Initials>RE</Initials><AffiliationInfo><Affiliation>Professor of Medicine, Divisions of Human Genetics and Cardiovascular Medicine The Ohio State University Columbus, Ohio</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jordan</LastName><ForeName>Elizabeth</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Assistant Professor, Division of Human Genetics The Ohio State University Columbus, Ohio</Affiliation></AffiliationInfo></Author></AuthorList><PublicationType UI="D016454">Review</PublicationType><Abstract><AbstractText Label="CLINICAL CHARACTERISTICS"><i>LMNA</i>-related dilated cardiomyopathy (DCM) is characterized by left ventricular enlargement and/or reduced systolic function preceded (sometimes by many years) by or accompanied by conduction system disease and/or arrhythmias. <i>LMNA</i>-related DCM usually presents in early to mid-adulthood with symptomatic conduction system disease or arrhythmias, or with symptomatic DCM including heart failure or embolus from a left ventricular mural thrombus. Sudden cardiac death can occur, and in some instances is the presenting manifestation; sudden cardiac death may occur with minimal or no systolic dysfunction.</AbstractText><AbstractText Label="DIAGNOSIS/TESTING">The diagnosis of <i>LMNA</i>-related DCM is established in a proband with suggestive findings and a heterozygous pathogenic variant in <i>LMNA</i> identified by molecular genetic testing.</AbstractText><AbstractText Label="MANAGEMENT"><i>Treatment of manifestations:</i> Chronic atrial fibrillation is treated initially with attempts to restore normal sinus rhythm, anticoagulation, and rate control. Symptomatic supraventricular arrhythmias are usually treated with pharmacologic therapy or ablation; symptomatic bradyarrhythmias or significant heart block is treated with an electronic pacemaker. Symptomatic ventricular arrhythmias, ventricular tachycardia, ventricular fibrillation, and resuscitated sudden cardiac death are treated with an implantable cardioverter defibrillator (ICD) and drug therapy as needed. Because risk for sudden cardiac death in <i>LMNA</i>-related DCM accompanies heart block and bradyarrhythmias, ICD use (rather than just pacemaker use) has been recommended for all indications. Treatment of symptomatic DCM, including heart failure, is pharmacologic with ACE inhibitors, beta blockers, and other conventional approaches. Progressive deterioration in left ventricular function is treated with an ICD. Cardiac transplantation or other advanced therapies may be considered for refractory disease in persons receiving comprehensive care from cardiovascular disease experts. <i>Surveillance:</i> Individuals with an <i>LMNA</i> pathogenic variant who are found to have any EKG abnormality should undergo a cardiovascular evaluation for disease progression (EKG, 24-48 hour rhythm monitoring, LV function measurement) at least annually. Asymptomatic individuals with a pathogenic <i>LMNA</i> variant should undergo cardiovascular evaluation (medical history, physical examination, echocardiogram, and EKG) every one to two years and/or whenever new symptoms arise. In families with a known <i>LMNA</i> pathogenic variant, at-risk individuals for whom genetic testing is not possible should have yearly cardiovascular evaluation. At onset of new symptoms an immediate evaluation for evidence of DCM and/or conduction system disease is indicated regardless of genetic status. <i>Evaluation of relatives at risk:</i> To facilitate prompt diagnosis, targeted <i>LMNA</i> genetic testing when the family-specific pathogenic variant is known; otherwise regular surveillance with cardiovascular screening tests. <i>Pregnancy management</i>: Pregnancy is contraindicated in women with DCM. Pregnant women with DCM should be followed by a high-risk obstetrician. At-risk women with unknown genetic status should undergo a cardiovascular evaluation and be offered genetic counseling, ideally prior to pregnancy.</AbstractText><AbstractText Label="GENETIC COUNSELING"><i>LMNA</i>-related DCM is inherited in an autosomal dominant manner. Some individuals diagnosed with <i>LMNA</i>-related DCM have an affected parent; the proportion of individuals with <i>LMNA</i>-related DCM caused by a <i>de novo</i> pathogenic variant is unknown. Each child of an individual with <i>LMNA</i>-related DCM has a 50% chance of inheriting the pathogenic variant. Once an <i>LMNA</i> pathogenic variant has been identified in an affected family member, prenatal testing and preimplantation genetic testing are possible.</AbstractText><CopyrightInformation>Copyright © 1993-2023, University of Washington, Seattle. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved.</CopyrightInformation></Abstract><Sections><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Summary">Summary</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Diagnosis">Diagnosis</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Clinical_Characteristics">Clinical Characteristics</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Genetically_Related_Allelic_Dis">Genetically Related (Allelic) Disorders</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Differential_Diagnosis">Differential Diagnosis</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Management">Management</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Genetic_Counseling">Genetic Counseling</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Resources">Resources</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Molecular_Genetics">Molecular Genetics</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.Chapter_Notes">Chapter Notes</SectionTitle></Section><Section><SectionTitle book="gene" part="dcm-lmna" sec="dcm-lmna.References">References</SectionTitle></Section></Sections><KeywordList Owner="NLM"><Keyword MajorTopicYN="N">Prelamin-A/C</Keyword><Keyword MajorTopicYN="N">LMNA</Keyword><Keyword MajorTopicYN="N">LMNA-Related Dilated Cardiomyopathy</Keyword></KeywordList><ContributionDate><Year>2008</Year><Month>6</Month><Day>12</Day></ContributionDate><DateRevised><Year>2022</Year><Month>3</Month><Day>17</Day></DateRevised><ReferenceList><Title>Published Guidelines/Consensus Statements</Title><Reference><Citation>Committee on Bioethics, Committee on Genetics, and American College of Medical Genetics and Genomics Social, Ethical, Legal Issues Committee. 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J Am Coll Cardiol. 2013;62:e147–239.</Citation><ArticleIdList><ArticleId IdType="pubmed">23747642</ArticleId></ArticleIdList></Reference></ReferenceList></BookDocument><PubmedBookData><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">20301717</ArticleId></ArticleIdList></PubmedBookData></PubmedBookArticle><PubmedBookArticle><BookDocument><PMID Version="1">20301547</PMID><ArticleIdList><ArticleId IdType="bookaccession">NBK1373</ArticleId></ArticleIdList><Book><Publisher><PublisherName>University of Washington, Seattle</PublisherName><PublisherLocation>Seattle (WA)</PublisherLocation></Publisher><BookTitle book="gene">GeneReviews<sup>®</sup></BookTitle><PubDate><Year>1993</Year></PubDate><BeginningDate><Year>1993</Year></BeginningDate><EndingDate><Year>2023</Year></EndingDate><AuthorList Type="editors" CompleteYN="Y"><Author ValidYN="Y"><LastName>Adam</LastName><ForeName>Margaret P</ForeName><Initials>MP</Initials></Author><Author ValidYN="Y"><LastName>Mirzaa</LastName><ForeName>Ghayda M</ForeName><Initials>GM</Initials></Author><Author ValidYN="Y"><LastName>Pagon</LastName><ForeName>Roberta A</ForeName><Initials>RA</Initials></Author><Author ValidYN="Y"><LastName>Wallace</LastName><ForeName>Stephanie E</ForeName><Initials>SE</Initials></Author><Author ValidYN="Y"><LastName>Bean</LastName><ForeName>Lora JH</ForeName><Initials>LJH</Initials></Author><Author ValidYN="Y"><LastName>Gripp</LastName><ForeName>Karen W</ForeName><Initials>KW</Initials></Author><Author ValidYN="Y"><LastName>Amemiya</LastName><ForeName>Anne</ForeName><Initials>A</Initials></Author></AuthorList><Medium>Internet</Medium></Book><ArticleTitle book="gene" part="drrs"><i>SALL4</i>-Related Disorders
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To determine the effect of graduated compression socks on ankle proprioception and the relationship between fatigue and ankle proprioception measures in half-marathon runners at successive 7 km intervals during a 21-km run.</AbstractText>Repeated measures study.</AbstractText>Twenty well-trained half-marathon runners (mean ± SD: age 38.6 ± 11.3 y, weekly volume 42.3 ± 21.1 km, training experience 4.7 ± 3.5 y) performed two 21 km running trials on a treadmill wearing either graduated compression socks or looser, standard non-compression running socks. Each running trial was divided into three self-paced 7 km blocks, repeated at the same pace for each trial, heart rate was not controlled, but after each block, heart rate, blood lactate, rating of perceived exertion, and ankle inversion proprioception were measured, the latter by using the active movement extent discrimination apparatus.</AbstractText>There was no differences between the graduated compression sock and non-compression running sock conditions in rating of perceived exertion scores (F = 0.524, p = 0.478), heart rate (F = 0.001, p = 0.975) and blood lactate (F = 0.004, p = 0.951). Overall, wearing graduated compression socks was associated with significantly better ankle proprioception after 21 km of running (p = 0.024, 95% CI = -0.066, -0.005). Heart rate, rating of perceived exertion and blood lactate were not correlated with ankle proprioception sensitivity in the graduated compression sock and non-compression running sock conditions at any point during the run (all p > 0.05).</AbstractText>Wearing graduated compression socks provides a positive effect on proprioceptive control of the ankle joint only after 21 km and may therefore reduce the possibility of injury associated with proprioceptive ability diminishing over time during exercise.</AbstractText>Copyright © 2022 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,335,812 |
[From the discovery of phlorizin (a Belgian story) to SGLT2 inhibitors].
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Most physicians do not know, or do not remember, the name of phlorizin. Hence this molecule has a major historical importance because it was the precursor of gliflozins, a new class of oral antidiabetic drugs with recent therapeutic perspectives beyond diabetes. This article recalls the history of phlorizin: its discovery in the 19th century by De Koninck and Stas, the demonstration of its ability to induce glucosuria and reduce hyperglycaemia by von Mering, its use to demonstrate the concept of glucose toxicity by the team of DeFronzo and finally the development of selective (phlorizin being not selective) sodium-glucose cotransporter type 2 inhibitors (gliflozins) which block glucose reabsorption in renal tubules. Gliflozins have increasing therapeutic indications, not only in type 2 diabetes, but also in cardiology and nephrology among non-diabetic people with heart failure or renal insufficiency.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Valdes-Socin</LastName><ForeName>H</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Service d'Endocrinologie, CHU Liège, Belgique.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Scheen</LastName><ForeName>A J</ForeName><Initials>AJ</Initials><AffiliationInfo><Affiliation>Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jouret</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Service de Néphrologie, Dialyse, Hypertension et Transplantation, CHU Liège, Belgique.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Grosch</LastName><ForeName>S</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Service de Néphrologie, Dialyse, Hypertension et Transplantation, CHU Liège, Belgique.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Delanaye</LastName><ForeName>P</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Service de Néphrologie, Dialyse, Hypertension et Transplantation, CHU Liège, Belgique.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Service de Néphrologie-Dialyse-Aphérèse, Hôpital Universitaire Carémeau, Nîmes, France.</Affiliation></AffiliationInfo></Author></AuthorList><Language>fre</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><VernacularTitle>De la découverte de la phlorizine (une histoire belge) aux inhibiteurs des SGLT2.</VernacularTitle></Article><MedlineJournalInfo><Country>Belgium</Country><MedlineTA>Rev Med Liege</MedlineTA><NlmUniqueID>0404317</NlmUniqueID><ISSNLinking>0370-629X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007004">Hypoglycemic Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D051297">Sodium-Glucose Transporter 2</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000077203">Sodium-Glucose Transporter 2 Inhibitors</NameOfSubstance></Chemical><Chemical><RegistryNumber>CU9S17279X</RegistryNumber><NameOfSubstance UI="D010695">Phlorhizin</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001530" MajorTopicYN="N" Type="Geographic">Belgium</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003924" MajorTopicYN="Y">Diabetes Mellitus, Type 2</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="N">drug therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007004" MajorTopicYN="N">Hypoglycemic Agents</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D010695" MajorTopicYN="N">Phlorhizin</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D051297" MajorTopicYN="N">Sodium-Glucose Transporter 2</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000077203" MajorTopicYN="Y">Sodium-Glucose Transporter 2 Inhibitors</DescriptorName><QualifierName UI="Q000494" MajorTopicYN="N">pharmacology</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading></MeshHeadingList><OtherAbstract Type="Publisher" Language="fre">La plupart des médecins ne connaissent pas, ou ne se souviennent plus, de la phlorizine. Pourtant, cette molécule a une grande importance historique car elle a été le précurseur des gliflozines, une nouvelle classe d’antidiabétiques oraux ouvrant maintenant de nouvelles perspectives thérapeutiques au-delà du diabète. Cet article retrace l’histoire de la phlorizine : sa découverte au 19ème siècle par De Koninck et Stas, la démonstration de l’induction d’une glucosurie abaissant la glycémie par von Mering, son utilisation pour conceptualiser la notion de glucotoxicité par l’équipe de DeFronzo et, enfin, le développement d’inhibiteurs sélectifs (la phlorizine étant non sélective) des cotransporteurs sodium-glucose de type 2 (SGLT2, gliflozines),dans les tubules rénaux, bloquant la réabsorption du glucose. Les gliflozines ont, maintenant, des indications thérapeutiques de plus en plus larges, non seulement dans le diabète de type 2, mais aussi en cardiologie et en néphrologie chez des personnes non diabétiques avec insuffisance cardiaque ou insuffisance rénale.
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2,335,813 |
A Comparison of Two Peripheral Nerve Blocks Combined With General Anesthesia in Elderly Patients Undergoing Arthroplasty for Hip Fractures: A Pilot Randomized Controlled Trial.
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Combined anesthesia can be a promising option for hip surgery when neuraxial anesthesia is contraindicated. Lumbar and sacral plexus blocks, and femoral nerve and lateral femoral cutaneous (LFC) nerve blocks in combination with general anesthesia (GA) are commonly used in elderly patients undergoing arthroplasty for hip fracture surgery. However, no study has compared these two anesthetic strategies in the perioperative period.</AbstractText>A total of 41 elderly patients scheduled for arthroplasty for hip fracture surgery were randomized into group A (n</i> = 20) and group B (n</i> = 21). Group A received femoral nerve block, LFC nerve blocks, and GA, and group B received lumbar plexus block, sacral plexus block, and GA. Primary outcomes were incidences of hemodynamic events and changes in blood pressure (BP) and heart rate (HR). Secondary outcomes included time and drug consumption, infusion and bleeding volume, eyes opening time after surgery, and postoperative quality recovery rate.</AbstractText>Compared with group B, group A showed a lower incidence of intraoperative hypotension (p</i> < 0.001), higher BP [including mean arterial pressure (MAP), systolic BP (SBP), and diastolic BP (DBP)] following induction (IN), and higher HR from mid-surgery. Time required for nerve blockade (p</i> < 0.001) and ephedrine consumption was significantly shorter in group A (p</i> < 0.001), while sufentanil consumption was higher as compared to group B (p</i> = 0.002). No significant differences in other intraoperative parameters and postoperative quality recovery rate were reported during the observation.</AbstractText>Our pilot data indicate that compared with lumbar and sacral plexus blocks, femoral nerve and LFC nerve blocks may provide more stable intraoperative hemodynamics and a comparable postoperative recovery for elderly patients undergoing arthroplasty for hip fracture under GA. Further studies with a larger sample size are needed to derive stronger evidence.</AbstractText>Copyright © 2022 Zhang, Ling, Wang and Cui.</CopyrightInformation>
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2,335,814 |
A Comparison of Puncture and Continuous Pump Analgesia With Two Different Approaches to Thoracic Paravertebral Block for Thoracic Surgery.
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This study aims to compare the success rate of thoracic paravertebral block (TPVB) and the effect of postoperative analgesia between two approaches.</AbstractText>A total of 34 patients with American Society of Anesthesiology (ASA) physical status score II-III, undergoing an optional thoracoscopic surgery, were randomly assigned to a parasagittal approach group (group P, n</i> = 17) and a transverse intercostal approach group (group T, n</i> = 17). The catheterization time, success rate of the puncture and catheterization, block plane and effect at the surgical site were compared between two groups. The mean arterial pressure and heart rate were recorded, as well as the cold tactile block plane and numeric rating scale (NRS) at 0.5, 2, 4, 8, 12, 24, and 48 h after surgery. The study was registered at http://www.chictr.org.cn/showproj.aspx?proj=9624 (Registration number: ChiCTR2100054642).</AbstractText>The catheterization time in group P was significantly longer than that in group T (P</i> < 0.05). The success rate of catheterization in group P was lower than that in group T, but no statistical significance (P</i> = 0.085). There was no significant difference in the success rate of Puncture and blocking effect of the surgical site at 30 min post-injection between two groups (P</i> > 0.05). There was no significant difference in the cold tactile block plane and NRS scores during coughing between two groups at 0.5, 2, 4, 8, 12, 24, and 48 h postoperatively (P</i> > 0.05).</AbstractText>This study suggests that there is no significant difference in postoperative block level or pain score during coughing for thoracoscopic surgery between ultrasound-guided parasagittal and transverse intercostal approach, but the parasagittal approach takes longer and has a higher failure rate.</AbstractText>Copyright © 2022 Huang, Lu, Li, Zhang, Jiang and Lin.</CopyrightInformation>
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2,335,815 |
Impact of lung block shape on cardiac dose for total body irradiation.
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Evaluating cardiac dose during total body irradiation (TBI) is of increasing interest. A three-dimensional beam model for TBI was commissioned and lung shielding was simulated in a treatment planning system with the cardiac silhouette partially blocked and unblocked. When blocked, the median heart dose decreased by 6% (IQR = 6%) and the median cardiac V12Gy decreased by 27% (IQR = 17%). The median left anterior descending artery dose decreased 20% (IQR = 12%) for blocked cases. Because using partial heart shielding may result in considerable changes in dose to cardiac structures, TBI protocols should explicitly consider lung block design parameters and their potential effects.
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2,335,816 |
Ultrasound-Guided Block of the Internal Branch of the Superior Laryngeal Nerve Reduces Postoperative Sore Throat Caused by Suspension Laryngoscopic Surgery: A Prospective Randomized Trial.
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Suspension laryngoscopy is commonly used in operative laryngology. Although it is efficient and minimally invasive in most cases, it can lead to postoperative sore throat (POST) and cough. Because of intensive stimulation by the rigid metal suspension laryngoscope, procedures must be implemented under general anesthesia. Together, these factors increase the possibility of postoperative complications. Blocking the internal branch of the superior laryngeal nerve (SLN) is useful in inhibiting the endotracheal intubation stress response. Thus, we evaluated the efficacy of ultrasound-guided block of the internal branches of the superior laryngeal nerve to improve postoperative complications.</AbstractText>A total of 64 patients was scheduled for elective laryngeal cancer resection, and suspension laryngoscopic surgery was performed under general anesthesia with a block of the internal branch of the superior laryngeal nerve (group iSLNB, n</i> = 32) and without a block (group C, n</i> = 32). Patients in group iSLNB received ultrasound-guided blocks of the internal branches of superior laryngeal nerve bilaterally (0.2% ropivacaine, 2 ml each side). The primary outcome measures were the incidence and severity of sore throat and cough assessed 0.5, 2, 6, and 24 h after tracheal extubation. The secondary outcome measures were heart rate and mean arterial pressure on arrival in the operating room (T0), at endotracheal intubation (T1), upon insertion of the suspension laryngoscope (T2), 5 min after insertion (T3), at tracheal extubation (T4), and 5 min after extubation (T5). Blood glucose levels were measured at T0, T3, and T5.</AbstractText>The incidence and severity of POST and cough in the iSLNB (internal branch of superior laryngeal nerve block) group were significantly reduced within 6 h after extubation compared with those in the control group, regardless of whether swallowing was present (P</i> < 0.05). Compared to the control group from T0-T5, except at T0, the iSLNB group had significantly lower heart rate and mean arterial pressure (P</i> < 0.05). Compared to T0, at other time points, the heart rates in the control group were significantly increased (P</i> < 0.05), and the mean arterial pressures at other time points in the iSLNB group were significantly lower than those at T0 (P</i> < 0.05). The blood glucose levels at T3 and T5 in the iSLNB group were significantly reduced compared with those in the control group (P</i> < 0.05).</AbstractText>Ultrasound-guided block of the internal branch of the superior laryngeal nerve might effectively ameliorate postoperative complications secondary to suspension laryngoscopic surgery with endotracheal intubation under general anesthesia and improve hemodynamic stability.</AbstractText>https://www.chictr.org.cn, identifier: ChiCTR2100049801.</AbstractText>Copyright © 2022 Bao, Xiong, Wang, Zhang, Zhong and Wang.</CopyrightInformation>
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2,335,817 |
Investigating the Effect of the 10° Reverse Trendelenburg Position on Spinal Block Characteristics and Hemodynamic Parameters in Lower Limb Surgeries.
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The primary goal of spinal anesthesia in lower limb surgeries is to achieve a successful sensory and motor block. Adequate level of spinal block for lower limb orthopedic surgery is T10. Due to multiple factors affecting the level of spinal anesthesia, it is not always easy to control the level of spinal anesthesia.We proposed that maintaining patients in a 10° reverse Trendelenburg position after spinal anesthesia can significantly control the height of the sensory block, resulting in stable hemodynamics.</AbstractText>This study is a single centric, prospective, single-blinded randomized clinical trial (CTRI/2018/08/015455) conducted in a tertiary care center in Sub-Himalayan region in India from July 2018 to June 2019. Total 60 patients fulfilling our inclusion and exclusion criteria were recruited in the study and were divided into two groups. In the supine group, patients were positioned in the supine position, and in the Trendelenburg group, patients were positioned in a 10° reverse Trendelenburg position after administering spinal anesthesia with 12.5 mg bupivacaine heavy. The two groups were compared in terms of sensory block, motor block, and analgesia duration. Heart rate, blood pressure, mean arterial pressure, and hypotension were also compared between the two groups.</AbstractText>Duration of sensory block, motor block, and analgesia were significantly higher in patients of the reverse Trendelenburg group (group T) compared to the supine group (group S). In group T, 26.6% had a sensory block level above T8, whereas in group S, 86.6% of patients had a sensory block level above T8. No hypotension was observed in the Trendelenburg group, which was present in 33% of patients in the supine group (group S).</AbstractText>Ten-degree reverse Trendelenburg position immediately after giving spinal anesthesia significantly limits the level of sensory block and provides better hemodynamic stability, and can be more beneficial, especially in geriatric patients and other high-risk patients for lower limb surgeries.</AbstractText>Copyright © 2022, Kumar et al.</CopyrightInformation>
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2,335,818 |
Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial.
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Labor pain and anxiety are important concerns during labor, especially among the primigravidae. It may increase the duration of labor, increase stress hormones, and affect maternal and new-born related outcomes. This study examined the effectiveness of combined breathing exercises, foot reflexology, and massage (BRM) interventions on labor pain, anxiety, labor duration, stress hormone levels, maternal satisfaction, maternal vital signs, and the new-born's APGAR scores.</AbstractText>This single-blind-parallel randomized controlled trial (RCT) was conducted at the Maternity and Children Hospital (MCH), Makkah, Saudi Arabia, by recruiting primigravidae aged 20 to 35 years, without any medical complications, and who were block-randomized at six-centimeter cervical dilation and stratified by intramuscular pethidine. The intervention is BRM compared to standard care. The labor pain was measured via present behavioral intensity (PBI) and visual analogue scale (VAS), and the anxiety was measured via Anxiety Assessment Scale for Pregnant Women in Labor (AASPWL). The secondary outcomes were duration of labor, maternal stress hormone levels, maternal vital signs, maternal satisfaction, fetal heart rate, and APGAR scores. All outcomes were measured at multiple time-points during and after contraction at baseline, during BRM intervention, at 60, 120, and 180 minutes post-intervention. Generalized linear mixed models were used to estimate the intervention effects over time.</AbstractText>A total of 225 participants were randomized for the control (n = 112) and intervention group (113). BRM lowered the labor pain intensity at 60 minutes after intervention during (1.3 vs 3.5, F = 102.5, p < 0.001) and after contraction (0.4 vs 2.4, F = 63.6, p < 0.001) and also lowered anxiety (2.9 vs 4.2, F = 80.4, p < 0.001). BRM correspondingly lowered adrenocorticotropic (ACTH) (133 vs 209 pg/mL, p < 0.001), cortisol (1231 vs 1360 nmol/mL, p = 0.003), and oxytocin (159 vs 121 pg/mL, p < 0.001). It also shortened the labor duration (165 vs 333 minutes, p < 0.001), improved vital signs, which resulted in higher APGAR scores, and increased maternal satisfaction.</AbstractText>The labor unit management could consider adopting BRM as one of the non-pharmacological analgesia for healthy women in labor.</AbstractText>ISRCTN87414969, registered 3 May 2019.</AbstractText>© 2022 Baljon et al.</CopyrightInformation>
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2,335,819 |
Alpha-Calcitonin Gene Related Peptide: New Therapeutic Strategies for the Treatment and Prevention of Cardiovascular Disease and Migraine.
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Alpha-calcitonin gene-related peptide (α-CGRP) is a vasodilator neuropeptide of the calcitonin gene family. Pharmacological and gene knock-out studies have established a significant role of α-CGRP in normal and pathophysiological states, particularly in cardiovascular disease and migraines. α-CGRP knock-out mice with transverse aortic constriction (TAC)-induced pressure-overload heart failure have higher mortality rates and exhibit higher levels of cardiac fibrosis, inflammation, oxidative stress, and cell death compared to the wild-type TAC-mice. However, administration of α-CGRP, either in its native- or modified-form, improves cardiac function at the pathophysiological level, and significantly protects the heart from the adverse effects of heart failure and hypertension. Similar cardioprotective effects of the peptide were demonstrated in pressure-overload heart failure mice when α-CGRP was delivered using an alginate microcapsules-based drug delivery system. In contrast to cardiovascular disease, an elevated level of α-CGRP causes migraine-related headaches, thus the use of α-CGRP antagonists that block the interaction of the peptide to its receptor are beneficial in reducing chronic and episodic migraine headaches. Currently, several α-CGRP antagonists are being used as migraine treatments or in clinical trials for migraine pain management. Overall, agonists and antagonists of α-CGRP are clinically relevant to treat and prevent cardiovascular disease and migraine pain, respectively. This review focuses on the pharmacological and therapeutic significance of α-CGRP-agonists and -antagonists in various diseases, particularly in cardiac diseases and migraine pain.
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2,335,820 |
Analgesic effects of different concentrations of ropivacaine in transversalis fascia plane block during laparotomy.
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To explore the analgesic effects of different concentrations of ropivacaine in transversalis fascia plane (TFP) block during laparotomy.</AbstractText>Ninety patients who underwent laparotomy admitted to our hospital from March 2019 to March 2020 were selected as the study subjects and were divided equally into a low concentration group, a medium concentration group, and a high concentration group according to the randomized grouping method. The low concentration group adopted 0.4% ropivacaine 40 ml, the medium concentration group was given 0.5% ropivacaine 40 ml, and the high concentration group was given 0.6% ropivacaine 40 ml. The hemodynamic indexes and the incidence of adverse reactions in the two groups were compared. The Numerical Rating Scale (NRS) was used to assess the postoperative pain in the three groups, the Bruggrmann comfort scale (BCS) was used to assess the comfort level in the three groups, and the Mini-mental State Examination (MMSE) was used to evaluate the postoperative cognitive function of the three groups of patients.</AbstractText>The mean artery pressure (MAP) and heart rate (HR) levels at T1 and T2 were significantly lower in the medium concentration group than in the other two groups (P < 0.05). The low concentration group had a significantly higher NRS score at T2 than the medium concentration group and the high concentration group (P < 0.05). A significantly higher BCS score was observed in the high concentration group than the other two groups (P < 0.05). There were significantly higher Ramsay scores and MMSE scores in the medium concentration group than in the low concentration and high concentration groups (P < 0.05). The overall incidence of adverse reactions of the high concentration group was significantly higher than that of the low concentration group (P < 0.05), but showed similar results with the medium concentration group.</AbstractText>The medium concentration group exhibits a better analgesic effect than the low concentration group and higher safety than the high concentration group. Therefore, the use of medium concentration ropivacaine in TFP block may provide a referential basis for clinical treatment.</AbstractText>© 2022. The Author(s).</CopyrightInformation>
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2,335,821 |
Cancer and palliative care in COVID-19 and other challenging situations-highlights from the Uganda Cancer Institute-Palliative Care Association of Uganda 3rd Uganda Conference on Cancer and Palliative Care, 23-24 September 2021, held in Kampala, Uganda and virtually.
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The 3rd Uganda Conference on Cancer and Palliative Care was held in September 2021 with the theme: cancer and palliative care in COVID-19 and other challenging situations. It was hosted by the Uganda Cancer Institute and the Palliative Care Association of Uganda (UCI-PCAU). The conference was held virtually, with a mix of pre-recorded sessions, plenary sessions being broadcast live on television (TV) by the Uganda Broadcasting Corporation TV, live speakers at the studio and others presenting in real time via Zoom. The conference brought together >350 participants who participated on Zoom, along with those attending in person at the studio and those watching the plenary sessions on TV. At the heart of this joint UCI-PCAU conference was the commitment to not only continue but to improve the provision of cancer care and palliative care within Uganda. Key themes from the conference included: the importance of Universal Health Coverage; the impact of COVID-19 on the provision of cancer and palliative care; that both cancer care and palliative care are available in Uganda; education for all; the importance of working together to provide care and overcome challenges, e.g. through technology; the resilience shown by those working in cancer and palliative care; the grief experienced by so many people who have lost loved ones during the pandemic; the importance of good health seeking behaviour - prevention is better than cure; the challenge of funding; the need for health care equity for marginalised and vulnerable populations and finally we can't wait for the world to stop COVID-19 - COVID-19 is here to stay - we need to find solutions. The last few years have seen significant challenges due to the COVID-19 pandemic; however, despite this, cancer and palliative care service provision has continued. This conference, whilst unique and very different from previous conferences, was a great opportunity to share not only amongst each other, but also to share key messages with the public through the live broadcasting of the plenary sessions of the conference.
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2,335,822 |
The antidiabetic drug rosiglitazone blocks Kv1.5 potassium channels in an open state.
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An antidiabetic drug, rosiglitazone is a member of the drug class of thiazolidinedione. Although restrictions on use due to the possibility of heart toxicity have been removed, it is still a drug that is concerned about side effects on the heart. We here examined, using Chinese hamster ovary cells, the action of rosiglitazone on Kv1.5 channels, which is a major determinant of the duration of cardiac action potential. Rosiglitazone rapidly and reversibly inhibited Kv1.5 currents in a concentration-dependent manner (IC<sub>50</sub> = 18.9 μM) and accelerated the decay of Kv1.5 currents without modifying the activation kinetics. In addition, the deactivation of Kv1.5 current, assayed with tail current, was slowed by the drug. All of the results as well as the use-dependence of the rosiglitazone-mediated blockade indicate that rosiglitazone acts on Kv1.5 channels as an open channel blocker. This study suggests that the cardiac side effects of rosiglitazone might be mediated in part by suppression of Kv1.5 channels, and therefore, raises a concern of using the drug for diabetic therapeutics.
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2,335,823 |
Chemical Synthesis of a Functional Fluorescent-Tagged α-Bungarotoxin.
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α-bungarotoxin is a large, 74 amino acid toxin containing five disulphide bridges, initially identified in the venom of <i>Bungarus multicinctus</i> snake. Like most large toxins, chemical synthesis of α-bungarotoxin is challenging, explaining why all previous reports use purified or recombinant α-bungarotoxin. However, only chemical synthesis allows easy insertion of non-natural amino acids or new chemical functionalities. Herein, we describe a procedure for the chemical synthesis of a fluorescent-tagged α-bungarotoxin. The full-length peptide was designed to include an alkyne function at the amino-terminus through the addition of a pentynoic acid linker. Chemical synthesis of α-bungarotoxin requires hydrazide-based coupling of three peptide fragments in successive steps. After completion of the oxidative folding, an azide-modified Cy5 fluorophore was coupled by click chemistry onto the toxin. Next, we determined the efficacy of the fluorescent-tagged α-bungarotoxin to block acetylcholine (ACh)-mediated currents in response to muscle nicotinic receptor activation in TE671 cells. Using automated patch-clamp recordings, we demonstrate that fluorescent synthetic α-bungarotoxin has the expected nanomolar affinity for the nicotinic receptor. The blocking effect of fluorescent α-bungarotoxin could be displaced by incubation with a 20-mer peptide mimicking the α-bungarotoxin binding site. In addition, TE671 cells could be labelled with fluorescent toxin, as witnessed by confocal microscopy, and this labelling was partially displaced by the 20-mer competitive peptide. We thus demonstrate that synthetic fluorescent-tagged α-bungarotoxin preserves excellent properties for binding onto muscle nicotinic receptors.
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2,335,824 |
Bilateral lumbar ultrasound-guided erector spinae plane block versus local anesthetic infiltration for perioperative analgesia in lumbar spine surgery: a randomized controlled trial.
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Lumbar spinal surgery is associated with severe postoperative pain. We examined the analgesic efficacy of bilateral lumbar ultrasound-guided erector spinae plane block (ESPB) with ropivacaine compared with local infiltration.</AbstractText>Patients undergoing elective lumbar arthrodesis were randomly divided into two groups. Control group received 0.375% ropivacaine 40 mL through the wound, and ESPB group received preoperative bilateral ESPB with 0.375% ropivacaine 40 mL. Primary outcome was postoperative pain intensity at rest using a Numeric Rating Scale (NRS). Secondary outcomes included difference in pain intensity between preintervention and defined timepoints, total amount of opioid analgesic requested by the patients at the same timepoints, the incidence of any adverse event, and the length of hospital stay (LOS) after surgery.</AbstractText>Sixty patients were enrolled in the study. After surgery we detected a NRS value of 1.9±1.5 in ESPB group and 5.9±1.6 in control group (P<0.001). About the opioid consumption we found a total sufentanil tablets consumption of 17±6 and 10±3 at 48 hours for control group and ESPB group, respectively (P<0.001). Concerning LOS, 30 (100%) patients in the control group and 22 (73.3%) in ESPB group were discharged after 72 hours (P=0.005).</AbstractText>Bilateral ultrasound-guided ESPB offers improved postoperative analgesia compared with local infiltration in patients undergoing lumbar spinal surgery.</AbstractText>
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2,335,825 |
Effects of Nalbuphine Combined with Anterior Serratus Plane Block in Elderly Patients Undergoing Thoracoscopic Surgery.
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Postoperative pain in elderly patients with lung cancer after thoracoscopic surgery is still an important factor affecting the prognosis of patients. In this study, 200 elderly patients with lung cancer who were positive and planned to undergo video-assisted thoracoscopic surgery were randomly divided into four groups: control group, SAPB (serratus anterior plane block) group, Nalbuphine group and Nalbuphine + SAPB group. The effects of drugs and nerve block on the perioperative indexes of elderly patients were observed. The results showed that ① The VAS and SAS scores of postoperative analgesia in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ② The postoperative spontaneous respiratory recovery time, extubation time, resuscitation room stay time, extubation cough, restlessness and respiratory depression in the Nalbuphine + SAPB group were lower than those in the single group and the control group. ③ The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and blood oxygen saturation (SpO2) of patients in Nalbuphine + SAPB group before induction, T2 after intubation, T3 before skin incision, T4 after skin incision, T5 after chest closure and T6 after extubation were lower than those in single group and control group. Therefore, this study concluded that Nabufine combined with SAPB can make the vital signs of intraoperative patients more stable, which is worthy of clinical promotion.
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2,335,826 |
Serotonin-Mediated Activation of Serotonin Receptor Type 1 Oppositely Modulates Voltage-Gated Calcium Channel Currents in Rat Sensory Neurons Innervating Hindlimb Muscle.
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Serotonin (5-HT) is a multifaceted neurotransmitter that has been described to play a role as a peripheral inflammatory mediator when released in ischemic or injured muscle. Dorsal root ganglia (DRG) neurons are key sensors of noxious stimuli that are released under inflammatory conditions or mechanical stress. Little information is available on the specific 5-HT receptor subtypes expressed in primary afferents that help regulate reflex pressor responses. In the present study, the whole-cell patch-clamp technique was employed to examine the modulation of voltage-gated calcium channel (Ca<sub>V</sub>) 2.2 currents by 5-HT and to identify the 5-HT receptor subtype(s) mediating this response in acutely dissociated rat DRG neurons innervating triceps surae muscle. Our results indicate that exposure of 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI)-labeled DRG neurons to 5-HT can exert three modulatory effects on Ca<sub>V</sub> currents: high inhibition, low inhibition, and enhancement. Both 5-HT-mediated inhibition responses were blocked after pretreatment with pertussis toxin (PTX), indicating that 5-HT receptors are coupled to Ca<sub>V</sub>2.2 via G<i>α</i> <sub>i/o</sub> protein subunits. Application of selective serotonin receptor type 1 (5-HT1) agonists revealed that modulation of Ca<sub>V</sub>2.2 currents occurs primarily after 5-HT1A receptor subtype stimulation and minimally from 5-HT1D activation. Finally, the intrathecal administration of the selective 5-HT1A receptor agonist, 8-hydroxy-2-(di-n-propylamino)tetralin (8-OH-DPAT), significantly (<i>P</i> < 0.05) decreased the pressor response induced by intra-arterial administration of lactic acid. This suggests that 5-HT1A receptors are expressed presynaptically on primary afferent neurons innervating triceps surae muscle. Our findings indicate that preferential stimulation of 5-HT1 receptors, expressed on thin fiber muscle afferents, serves to regulate the reflex pressor response to metabolic stimuli. SIGNIFICANCE STATEMENT: The monoamine serotonin (5-HT), released under ischemic conditions, can contribute to the development of inflammation that negatively affects the exercise pressor reflex. The 5-HT receptor subtype and signaling pathway that underlies calcium channel modulation in dorsal root ganglia afferents, innervating hindlimb muscles, are unknown. We show that 5-HT can either block (primarily via serotonin receptor type 1 (5-HT1)A subtypes) or enhance voltage-gated calcium channel (Ca<sub>V</sub>2.2) currents. Our findings suggest 5-HT exhibits receptor subtype selectivity, providing a complexity of cellular responses.
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2,335,827 |
[Efficacy-related substances of blood-activating and stasis-resolving medicinals derived from Curcuma plants: a review].
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Derived from Curcuma plants, Curcumae Longae Rhizoma, Curcumae Rhizoma, Wenyujin Rhizoma Concisum, and Curcumae Radix are common blood-activating and stasis-resolving medicinals in clinical practice, which are mainly used to treat amenorrhea, dysmenorrhea, chest impediment and heart pain, and rheumatic arthralgia caused by blood stasis block. According to modern research, the typical components in medicinals derived from Curcuma plants, like curcumin, demethoxycurcumin, bisdemethoxycurcumin, curdione, germacrone, curcumol, and β-elemene, have the activities of hemorheology improvement, anti-platelet aggregation, anti-thrombosis, anti-inflammation, anti-tumor, and anti-fibrosis, thereby activating blood and resolving stasis. However, due to the difference in origin, medicinal part, processing, and other aspects, the efficacy and clinical application are different. The efficacy-related substances behind the difference have not yet been systematically studied. Thus, focusing on the efficacy-related substances, this study reviewed the background, efficacy and clinical application, efficacy-related substances, and &quot;prediction-identification-verification&quot; research method of blood-activating and stasis-resolving medicinals derived from Curcuma plants, which is expected to lay a theoretical basis for the future research on the &quot;similarities and differences&quot; of such medicinals based on integrated evidence chain and to guide the scientific and rational application of them in clinical practice.
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2,335,828 |
Efficient Spatiotemporal Attention Network for Remote Heart Rate Variability Analysis.
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Studies have shown that ordinary color cameras can detect the subtle color changes of the skin caused by the heartbeat cycle. Therefore, cameras can be used to remotely monitor the pulse in a non-contact manner. The technology for non-contact physiological measurement in this way is called remote photoplethysmography (rPPG). Heart rate variability (HRV) analysis, as a very important physiological feature, requires us to be able to accurately recover the peak time locations of the rPPG signal. This paper proposes an efficient spatiotemporal attention network (ESA-rPPGNet) to recover high-quality rPPG signal for heart rate variability analysis. First, 3D depth-wise separable convolution and a structure based on mobilenet v3 are used to greatly reduce the time complexity of the network. Next, a lightweight attention block called 3D shuffle attention (3D-SA), which integrates spatial attention and channel attention, is designed to enable the network to effectively capture inter-channel dependencies and pixel-level dependencies. Moreover, ConvGRU is introduced to further improve the network's ability to learn long-term spatiotemporal feature information. Compared with existing methods, the experimental results show that the method proposed in this paper has better performance and robustness on the remote HRV analysis.
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2,335,829 |
Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study.
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The dural puncture epidural technique may improve analgesia quality by confirming midline placement and increasing intrathecal translocation of epidural medications. This would be advantageous in obese parturients with increased risk of block failure. This study hypothesizes that quality of labor analgesia will be improved with dural puncture epidural compared to standard epidural technique in obese parturients.</AbstractText>Term parturients with body mass index greater than or equal to 35 kg · m-2, cervical dilation of 2 to 7 cm, and pain score of greater than 4 (where 0 indicates no pain and 10 indicates the worst pain imaginable) were randomized to dural puncture epidural (using 25-gauge Whitacre needle) or standard epidural techniques. Analgesia was initiated with 15 ml of 0.1% ropivacaine with 2 µg · ml-1 fentanyl, followed by programed intermittent boluses (6 ml every 45 min), with patient-controlled epidural analgesia. Parturients were blinded to group allocation. The data were collected by blinded investigators every 3 min for 30 min and then every 2 h until delivery. The primary outcome was a composite of (1) asymmetrical block, (2) epidural top-ups, (3) catheter adjustments, (4) catheter replacement, and (5) failed conversion to regional anesthesia for cesarean delivery. Secondary outcomes included time to a pain score of 1 or less, sensory levels at 30 min, motor block, maximum pain score, patient-controlled epidural analgesia use, epidural medication consumption, duration of second stage of labor, delivery mode, fetal heart tones changes, Apgar scores, maternal adverse events, and satisfaction with analgesia.</AbstractText>Of 141 parturients randomized, 66 per group were included in the analysis. There were no statistically or clinically significant differences between the dural puncture epidural and standard epidural groups in the primary composite outcome (34 of 66, 52% vs. 32 of 66, 49%; odds ratio, 1.1 [0.5 to 2.4]; P = 0.766), its individual components, or any of the secondary outcomes.</AbstractText>A lack of differences in quality of labor analgesia between the two techniques in this study does not support routine use of the dural puncture epidural technique in obese parturients.</AbstractText>Copyright © 2022, the American Society of Anesthesiologists. All Rights Reserved.</CopyrightInformation>
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2,335,830 |
Patient privacy in smart cities by blockchain technology and feature selection with Harris Hawks Optimization (HHO) algorithm and machine learning.
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A medical center in the smart cities of the future needs data security and confidentiality to treat patients accurately. One mechanism for sending medical data is to send information to other medical centers without preserving confidentiality. This method is not impressive because in treating people, the privacy of medical information is a principle. In the proposed framework, the opinion of experts from other medical centers for the treatment of patients is received and consider the best therapy. The proposed method has two layers. In the first layer, data transmission uses blockchain. In the second layer, blocks related to patients' records analyze by machine learning methods. Patient records place in a block of the blockchain. Block of patient sends to other medical centers. Each treatment center can recommend the proposed type of treatment and blockchain attachment and send it to all nodes and treatment centers. Each medical center receiving data of the patients, then predicts the treatment using data mining methods. Sending medical data between medical centers with blockchain and maintaining confidentiality is one of the innovations of this article. The proposed method is a binary version of the HHO algorithm for feature selection. Another innovation of this research is the use of majority voting learning in diagnosing the type of disease in medical centers. Implementation of the proposed system shows that the blockchain preserves data confidentiality of about 100%. The reliability and reliability of the proposed framework are much higher than the centralized method. The result shows that the accuracy, sensitivity, and precision of the proposed method for diagnosing heart disease are 92.75%, 92.15%, and 95.69%, respectively. The proposed method has a lower error in diagnosing heart disease from ANN, SVM, DT, RF, AdaBoost, and BN.
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2,335,831 |
<i>microRNA-135a-5p</i> regulates <i>NOD-like receptor family pyrin domain containing 3</i> inflammasome-mediated hypertensive cardiac inflammation and fibrosis <i>via thioredoxin-interacting protein</i>.
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Hypertension is a severe public health problem that induces cardiac injury with alterations of gene expressions. The current study sought to evaluate the mechanism of <i>microRNA</i>(<i>miR)-135a-5p</i> in NOD-like receptor family pyrin domain containing 3 (<i>NLRP3</i>) inflammasome-mediation of cardiac inflammation and hypertensive cardiac fibrosis. Firstly, hypertensive mouse models were established using angiotensin II (Ang II), followed by <i>miR-135a-5p</i> agomir treatment. Subsequently, mouse blood pressure and basic cardiac function indexes, histopathological changes, and cardiac fibrosis were all determined, in addition to detection of factors related to inflammation and fibrosis. Additionally, mice cardiac fibroblasts (CFs) were isolated and treated with Ang II. The binding relationship of <i>miR-135a-5p</i> and thioredoxin-interacting protein (<i>TXNIP</i>) was predicted and testified, while the interaction of <i>TXNIP</i> and <i>NLRP3</i> was detected by means of a co-immunoprecipitation assay. It was found that <i>miR-135a-5p</i> was poorly-expressed in Ang II-treated mice and further exerted cardioprotective effects against hypertensive heart diseases. Moreover, over-expression of <i>miR-135a-5p</i> resulted in inhibition of inflammatory infiltration and almost eliminated cardiac fibrosis, as evidenced by decreased Collagen (COL)-I, COL-III, a-smooth muscle actin, <i>NLRP3</i>, tumor necrosis factor-α, and interleukin-6. Mechanically, <i>miR-135a-5p</i> inhibited <i>TXNIP</i> expression to block the binding of <i>TXNIP</i> and <i>NLRP3</i>. On the other hand, <i>TXNIP</i> up-regulation reversed the protective role of <i>miR-135a-5p</i> over-expression in CFs. Collectively, our findings indicated that <i>miR-135a-5p</i> over-expression inhibited <i>TXNIP</i> expression to block the binding of <i>TXNIP</i> and <i>NLRP3</i>, thereby alleviating hypertensive cardiac inflammation and fibrosis.
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2,335,832 |
Hypertension promotes microbial translocation and dysbiotic shifts in the fecal microbiome of nonhuman primates.
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Accumulating evidence indicates a link between gut barrier dysfunction and hypertension. However, it is unclear whether hypertension causes gut barrier dysfunction or vice versa and whether the gut microbiome plays a role. To understand this relationship, we first cross-sectionally examined 153 nonhuman primates [NHPs; <i>Chlorocebus aethiops sabaeus</i>; mean age, 16 ± 0.4 yr; 129 (84.3%) females] for cardiometabolic risk factors and gut barrier function biomarkers. This analysis identified blood pressure and age as specific factors that independently associated with microbial translocation. We then longitudinally tracked male, age-matched spontaneously hypertensive NHPs (<i>Macaca mulatta</i>) to normotensives (<i>n</i> = 16), mean age of 5.8 ± 0.5 yr, to confirm hypertension-related gut barrier dysfunction and to explore the role of microbiome by comparing groups at baseline, 12, and 27 mo. Collectively, hypertensive animals in both studies showed evidence of gut barrier dysfunction (i.e., microbial translocation), as indicated by higher plasma levels of lipopolysaccharide-binding protein (LBP)-1, when compared with normotensive animals. Furthermore, plasma LBP-1 levels were correlated with diastolic blood pressure, independent of age and other health markers, suggesting specificity of the effect of hypertension on microbial translocation. In over 2 yr of longitudinal assessment, hypertensive animals had escalating plasma levels of LBP-1 and greater bacterial gene expression in mesenteric lymph nodes compared with normotensive animals, confirming microbes translocated across the intestinal barrier. Concomitantly, we identified distinct shifts in the gut microbial signature of hypertensive versus normotensive animals at 12 and 27 mo. These results suggest that hypertension contributes to microbial translocation in the gut and eventually unhealthy shifts in the gut microbiome, possibly contributing to poor health outcomes, providing further impetus for the management of hypertension.<b>NEW & NOTEWORTHY</b> Hypertension specifically had detrimental effects on microbial translocation when age and metabolic syndrome criteria were evaluated as drivers of cardiovascular disease in a relevant nonhuman primate model. Intestinal barrier function exponentially decayed over time with chronic hypertension, and microbial translocation was confirmed by detection of more microbial genes in regional draining lymph nodes. Chronic hypertension resulted in fecal microbial dysbiosis and elevations of the biomarker NT-proBNP. This study provides insights on the barrier dysfunction, dysbiosis, and hypertension in controlled studies of nonhuman primates. Our study includes a longitudinal component comparing naturally occurring hypertensive to normotensive primates to confirm microbial translocation and dysbiotic microbiome development. Hypertension is an underappreciated driver of subclinical endotoxemia that can drive chronic inflammatory diseases.
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2,335,833 |
Overcoming cognitive set bias requires more than seeing an alternative strategy.
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Determining when to switch from one strategy to another is at the heart of adaptive decision-making. Previous research shows that humans exhibit a 'cognitive set' bias, which occurs when a familiar strategy occludes-even much better-alternatives. Here we examined the mechanisms underlying cognitive set by investigating whether better solutions are visually overlooked, or fixated on but disregarded. We analyzed gaze data from 67 American undergraduates (91% female) while they completed the learned strategy-direct strategy (LS-DS) task, which measures their ability to switch from a learned strategy (LS) to a more efficient direct strategy (DS or shortcut). We found that, in the first trial block, participants fixated on the location of the shortcut more when it was available but most (89.6%) did not adopt it. Next, participants watched a video demonstrating either the DS (N = 34 Informed participants) or the familiar LS (N = 33 Controls). In post-video trials, Informed participants used the DS more than pre-video trials and compared to Controls. Notably, 29.4% of Informed participants continued to use the LS despite watching the DS video. We suggest that cognitive set in the LS-DS task does not stem from an inability to see the shortcut but rather a failure to try it.
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2,335,834 |
The Median Effective Concentration (EC<sub>50</sub>) of Epidural Ropivacaine With Different Doses of Oxycodone During Limb Surgery in Elderly Patients.
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Oxycodone can be used both intravenously and epidurally in elderly patients because of its strong analgesic effect and more slight respiratory inhibition compared with other opioids at the same effect. In this study, we determined the median effective concentration (EC50</sub>) of epidural ropivacaine required for great saphenous vein surgery in elderly patients in order to describe its pharmacodynamic interaction with oxycodone.</AbstractText>One hundred forty-one elderly patients scheduled for high ligation and stripping of the great saphenous vein surgery were allocated into three groups in a randomized, double-blinded manner as follows: Q2.5 group (2.5 mg oxycodone), Q5.0 group (5.0 mg oxycodone), and C group (normal saline). Anesthesia, was achieved with epidural ropivacaine and oxycodone. The EC50</sub> of ropivacaine for surgery with different doses of oxycodone was adjusted by using an up-and-down sequential methods with an adjacent concentration gradient at a factor of 0.9 to inhibit analgesia. Anesthesia associated adverse events and recovery, characteristics were also recorded.</AbstractText>The EC50</sub> of ropivacaine for the great saphenous vein surgery in elderly patients was 0.399% (95% CI, 0.371-0.430%) in the Q2.5 group, 0.396% (95% CI, 0.355-0.441%) in the Q5.0 group, and 0.487% (95% CI, 0.510-0.465%) in the C group, respectively (P</i> < 0.05). Specially, the EC50</sub> of ropivacaine in the Q2.5 and Q5.0 groups was lower than that in the C group (P</i> < 0.01), But the difference between the Q2.5 group and the Q5.0 group was not significant (P</i> > 0.05). There was no significant difference in the Bromage score from the motor block examination, heart rate (HR) or mean arterial pressure (MAP) at each observation time point after epidural administration among the three groups (P</i> > 0.05). No serious adverse reactions occurred in any of the three groups.</AbstractText>Oxycodone combined with ropivacaine epidural anesthesia can reduce the EC50</sub> of ropivacaine required for elderly patients undergoing the great saphenous vein surgery. There was no significant difference in anesthesia associated adverse events among the three groups. The recommended dose of oxycodone is 2.5 mg.</AbstractText>Copyright © 2022 Xie, Wang, Teng, He, Li and Huang.</CopyrightInformation>
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2,335,835 |
Approach to Diagnostic Cytopathology of Serous Effusions.
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Collection of most serous fluids from various effusions is a relatively simple procedure. Because of this, serous fluids are commonly submitted for pathologic examination including cytopathologic evaluation by various clinical institutions. As a consequence, even a general pathology laboratory which may not have expertise with highly trained cytopathologist would be confronted with serous fluids for cytologic evaluation. However, cytopathologic evaluation of serous fluids is complex as compared to evaluation of fine needle aspiration cytology. This signifies the fact that all pathologists, irrespective of subspeciality cytopathology training and level of subspeciality expertise, should be conversant with the diagnostic challenges and pitfalls of effusion fluid cytology. Although, majority of effusions are due to reactive and non-neoplastic etiologies, cancer is one of the causes of an effusion as a manifestation of advanced cancer. Detecting neoplastic cells in effusion specimens in most of clinical settings is related to the advanced status of the disease, which usually is equivalent to incurable stage. Thus, interpretation of cytopathology as positive for cancer cell is highly critical in planning the trajectory of the clinical management with an obvious negative impact of false positive interpretation. Apart from cancer, effusions may be secondary to hemodynamic pathologies such as heart failure, hypoalbuminemia, cirrhosis etc. in addition to the different inflammatory conditions including parasitic infestations, bacterial, fungal, or viral infections, and other non-neoplastic etiologies including collagen diseases. Due to the cytomorphologic overlap of reactive mesothelial cells with malignant cells, general cytologic criteria for diagnosis of malignancy in single cells cannot be applied in most of the effusion specimens. This challenge is further amplified because of surface tension related phenomenon which 'round up' the cells after exfoliation in serous fluids. As a result, the native shapes of cancer cells cannot be a guiding feature. Thus the cytomorphologic features of cancer cells in serous fluids may not be same as seen in routine cytopathology of exfoliative, brushing, and fine-needle aspiration specimens. The cancer cells may continue to proliferate after exfoliation in the nutrient rich effusion fluids and may form proliferation spheres. It is crucial to consider these factors when interpreting effusion cytology. Amongst malignant effusions, adenocarcinomas are the most common cause of metastatic cancers, but almost any type of malignancy including melanomas, hematopoietic neoplasms, sarcomas, and mesotheliomas may involve serous cavities. The interpreter must be aware of the wide range of the cytomorphologic appearances of reactive mesothelial cells in effusion fluids. It is essential to understand these and other nuances related to effusion fluid cytology. Understanding potential pitfalls during various stages from processing to application of ancillary studies would increase the diagnostic accuracy and minimize atypical interpretations and false positivity.
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2,335,836 |
Breastfeeding may benefit cardiometabolic health of children exposed to increased gestational glycemia in utero.
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There is altered breastmilk composition among mothers with gestational diabetes and conflicting evidence on whether breastfeeding is beneficial or detrimental to their offspring's cardiometabolic health. We aimed to investigate associations between breastfeeding and offspring's cardiometabolic health across the range of gestational glycemia.</AbstractText>We included 827 naturally conceived, term singletons from a prospective mother-child cohort. We measured gestational (26-28 weeks) fasting plasma glucose (FPG) and 2-h plasma glucose (2 hPG) after an oral glucose tolerance test as continuous variables. Participants were classified into 2 breastfeeding categories (high/intermediate vs. low) according to their breastfeeding duration and exclusivity. Main outcome measures included magnetic resonance imaging (MRI)-measured abdominal fat, intramyocellular lipids (IMCL), and liver fat, quantitative magnetic resonance (QMR)-measured body fat mass, blood pressure, blood lipids, and insulin resistance at 6 years old (all continuous variables). We evaluated if gestational glycemia (FPG and 2 hPG) modified the association of breastfeeding with offspring outcomes after adjusting for confounders using a multiple linear regression model that included a 'gestational glycemia × breastfeeding' interaction term.</AbstractText>With increasing gestational FPG, high/intermediate (vs. low) breastfeeding was associated with lower levels of IMCL (p-interaction = 0.047), liver fat (p-interaction = 0.033), and triglycerides (p-interaction = 0.007), after adjusting for confounders. Specifically, at 2 standard deviations above the mean gestational FPG level, high/intermediate (vs. low) breastfeeding was linked to lower adjusted mean IMCL [0.39% of water signal (0.29, 0.50) vs. 0.54% of water signal (0.46, 0.62)], liver fat [0.39% by weight (0.20, 0.58) vs. 0.72% by weight (0.59, 0.85)], and triglycerides [0.62 mmol/L (0.51, 0.72) vs. 0.86 mmol/L (0.75, 0.97)]. 2 hPG did not significantly modify the association between breastfeeding and childhood cardiometabolic risk.</AbstractText>Our findings suggest breastfeeding may confer protection against adverse fat partitioning and higher triglyceride concentration among children exposed to increased glycemia in utero.</AbstractText>© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.</CopyrightInformation>
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2,335,837 |
Colchicine for COVID-19: targeting NLRP3 inflammasome to blunt hyperinflammation.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is capable of inducing the activation of NACHT, leucine-rich repeat, and pyrin domain-containing protein 3 (NLRP3) inflammasome, a macromolecular structure sensing the danger and amplifying the inflammatory response. The main product processed by NLRP3 inflammasome is interleukin (IL)-1β, responsible for the downstream production of IL-6, which has been recognized as an important mediator in coronavirus disease 2019 (COVID-19). Since colchicine is an anti-inflammatory drug with the ability to block NLRP3 inflammasome oligomerization, this may prevent the release of active IL-1β and block the detrimental effects of downstream cytokines, i.e. IL-6. To date, few randomized clinical trials and many observational studies with colchicine have been conducted, showing interesting signals. As colchicine is a nonspecific inhibitor of the NLRP3 inflammasome, compounds specifically blocking this molecule might provide increased advantages in reducing the inflammatory burden and its related clinical manifestations. This may occur through a selective blockade of different steps preceding NLRP3 inflammasome oligomerization as well as through a reduced release of the main cytokines (IL-1β and IL-18). Since most evidence is based on observational studies, definitive conclusion cannot be drawn and additional studies are needed to confirm preliminary results and further dissect how colchicine and other NLRP3 inhibitors reduce the inflammatory burden and evaluate the timing and duration of treatment.
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2,335,838 |
A Randomised Controlled Trial to Assess the Analgesic Efficacy of Reduced Dose 0.2% Ropivacaine-Dexmedetomidine Combination Compared to Standard 0.375% Ropivacaine in USG Guided TAP Block for Paediatric Hernia Repair.
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Paediatric pain management has remained understated practice over a period of time. Recently ultrasound-guided (USG) guided techniques are gaining popularity for perioperative analgesia, especially in the paediatric population. So, the aim of the present study was to evaluate the efficacy of reduced dose ropivacaine-dexmedetomidine combination compared to standard 0.375% ropivacaine in USG guided transversus abdominis plane (TAP) block.</AbstractText>Sixty children of either sex, aged 2-10 years, posted for elective open herniotomy under general anaesthesia were randomly divided into two groups of 30 patients each. Group RD received 0.2% ropivacaine with dexmedetomidine 1 mg kg 1 while group R received 0.375% ropivacaine at 0.5mL kg 1. Meantime to first rescue and total analgesics, Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Ramsay sedation score, haemodynamic parameters and adverse effects were noted.</AbstractText>Time to first rescue analgesia in group RD and group R were 16.32 6 3.11 hours and 10.82 6 2.16 hours, respectively (P < .0001). Mean CHEOPS score were 4.48 6 1.1 and 6.3 6 1.74 (P < .024) in group RD and R. Post-op Ramsay sedation score was significantly greater in group RD. Heart rate and blood pressure remained similar in either of the group. No episode of respiratory depression, bradycardia or hypotension was noted perioperatively.</AbstractText>Combination of 1 mg kg 1 dexmedetomidine with reduced concentration of ropivacaine (0.2%) produced significantly longer duration of post-operative analgesia and lowered post-operative CHEOPS pain score in comparison with 0.375% ropivacaine alone in USG guided TAP block for paediatric hernia repair.</AbstractText>
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2,335,839 |
Metabolic and electrolyte abnormalities as risk factors in drug-induced long QT syndrome.
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Drug-induced long QT syndrome (diLQTS) is the phenomenon by which the administration of drugs causes prolongation of cardiac repolarisation and leads to an increased risk of the ventricular tachycardia known as torsades de pointes (TdP). In most cases of diLQTS, the primary molecular target is the human ether-à-go-go-related gene protein (hERG) potassium channel, which carries the rapid delayed rectifier current (I<sub>Kr</sub>) in the heart. However, the proarrhythmic risk associated with drugs that block hERG can be modified in patients by a range of environmental- and disease-related factors, such as febrile temperatures, alterations in pH, dyselectrolytaemias such as hypokalaemia and hypomagnesemia and coadministration with other drugs. In this review, we will discuss the clinical occurrence of drug-induced LQTS in the context of these modifying factors as well as the mechanisms by which they contribute to altered hERG potency and proarrhythmic risk.
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2,335,840 |
Enhanced Angiogenesis by 11βHSD1 Blockage Is Insufficient to Improve Reperfusion Following Hindlimb Ischaemia.
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<b>Background:</b> Critical limb ischaemia (CLI), which is estimated to affect 2 million people in the United States, reduces quality of life, is associated with high morbidity and mortality, and has limited treatment options. Direct stimulation of angiogenesis using proangiogenic growth factors has been investigated as a therapeutic strategy to improve reperfusion in the ischaemic leg. Despite positive outcomes in animal studies, there has been little success in clinical translation. This investigation addressed the hypothesis that angiogenesis could be stimulated indirectly in the ischaemic hindlimb by blocking 11β-hydroxysteroid dehydrogenase 1 (11βHSD1)-mediated reactivation of anti-angiogenic glucocorticoids. <b>Method and Results:</b> Corticosterone suppressed <i>ex vivo</i> angiogenesis in the mouse aortic ring assay. 11βHSD1 deletion (Hsd11b1<sup>Del1/Del1</sup>) or pharmacological inhibition (with 300 nM UE2316) which block the reactivation of glucocorticoid (i.e., the conversion of 11-dehydrocorticosterone (11DHC) to bioactive corticosterone) significantly reduced 11DHC-induced suppression of angiogenesis. In a sponge implantation model, 11βHSD1 deletion, but not pharmacological inhibition, enhanced inflammation-induced angiogenesis. By contrast, in the mouse hindlimb ischaemia model, post-ischaemic reperfusion and vascular density were not affected by either deletion or pharmacological inhibition of 11βHSD1 in young or aged mice. 3D vascular imaging suggested that hind limb reperfusion in the 1st week following induction of ischaemia may be driven by the rapid expansion of collateral arteries rather than by angiogenesis. <b>Conclusion:</b> 11βHSD1-mediated glucocorticoid reactivation suppressed angiogenesis <i>ex vivo</i> and <i>in vivo</i>. However, regulation of angiogenesis alone was insufficient to promote reperfusion in hindlimb ischaemia. Future investigation of post-ischaemic reperfusion should include other aspects of systemic vascular remodeling including arteriogenesis and collateral formation.
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2,335,841 |
Gamma-Aminobutyric Acid Transporters in the Nucleus Tractus Solitarii Regulate Inhibitory and Excitatory Synaptic Currents That Influence Cardiorespiratory Function.
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The brainstem nucleus tractus solitarii (nTS) processes and modulates the afferent arc of critical peripheral cardiorespiratory reflexes. Sensory afferents release glutamate to initiate the central component of these reflexes, and glutamate concentration is critically controlled by its removal <i>via</i> astrocytic neurotransmitter transporters. Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the nTS providing tonic and phasic modulation of neuronal activity. GABA is removed from the extracellular space through GABA transporters (GATs), however, the role of GATs in nTS synaptic transmission and their influence on cardiorespiratory function is unknown. We hypothesized that GATs tonically restrain nTS inhibitory signaling and given the considerable nTS GABA-glutamate cross-talk, modify excitatory signaling and thus cardiorespiratory function. Reverse transcription real-time polymerase chain reaction (RT-PCR), immunoblot and immunohistochemistry showed expression of GAT-1 and GAT-3 mRNA and protein within the rat nTS, with GAT-3 greater than GAT-1, and GAT-3 colocalizing with astrocyte S100B. Recordings in rat nTS slices demonstrated GAT-3 block decreased spontaneous inhibitory postsynaptic current (IPSC) frequency and reduced IPSC amplitude evoked from electrical stimulation of the medial nTS. Block of GAT-3 also increased spontaneous excitatory postsynaptic current (EPSC) frequency yet did not alter sensory afferent-evoked EPSC amplitude. Block of GAT-3 in the nTS of anesthetized rats increased mean arterial pressure, heart rate, sympathetic nerve activity, and minute phrenic nerve activity. These results demonstrate inhibitory and excitatory neurotransmission in the nTS is significantly modulated by endogenous GAT-3 to influence basal cardiorespiratory function.
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2,335,842 |
Understanding contributors to racial and ethnic inequities in COVID-19 incidence and mortality rates.
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Racial inequities in Coronavirus 2019 (COVID-19) have been reported over the course of the pandemic, with Black, Hispanic/Latinx, and Native American individuals suffering higher case rates and more fatalities than their White counterparts.</AbstractText>We used a unique statewide dataset of confirmed COVID-19 cases across Missouri, linked with historical statewide hospital data. We examined differences by race and ethnicity in raw population-based case and mortality rates. We used patient-level regression analyses to calculate the odds of mortality based on race and ethnicity, controlling for comorbidities and other risk factors.</AbstractText>As of September 10, 2020 there were 73,635 confirmed COVID-19 cases in the State of Missouri. Among the 64,526 case records (87.7% of all cases) that merged with prior demographic and health care utilization data, 12,946 (20.1%) were Non-Hispanic (NH) Black, 44,550 (69.0%) were NH White, 3,822 (5.9%) were NH Other/Unknown race, and 3,208 (5.0%) were Hispanic. Raw cumulative case rates for NH Black individuals were 1,713 per 100,000 population, compared with 2,095 for NH Other/Unknown, 903 for NH White, and 1,218 for Hispanic. Cumulative COVID-19-related death rates for NH Black individuals were 58.3 per 100,000 population, compared with 38.9 for NH Other/Unknown, 19.4 for NH White, and 14.8 for Hispanic. In a model that included insurance source, history of a social determinant billing code in the patient's claims, census block travel change, population density, Area Deprivation Index, and clinical comorbidities, NH Black race (OR 1.75, 1.51-2.04, p<0.001) and NH Other/Unknown race (OR 1.83, 1.36-2.46, p<0.001) remained strongly associated with mortality.</AbstractText>In Missouri, COVID-19 case rates and mortality rates were markedly higher among NH Black and NH Other/Unknown race than among NH White residents, even after accounting for social and clinical risk, population density, and travel patterns during COVID-19.</AbstractText>
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2,335,843 |
Blood Pressure Regulation by the Carotid Sinus Nerve: Clinical Implications for Carotid Body Neuromodulation.
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Chronic carotid sinus nerve (CSN) electrical modulation through kilohertz frequency alternating current improves metabolic control in rat models of type 2 diabetes, underpinning the potential of bioelectronic modulation of the CSN as a therapeutic modality for metabolic diseases in humans. The CSN carries sensory information from the carotid bodies, peripheral chemoreceptor organs that respond to changes in blood biochemical modifications such as hypoxia, hypercapnia, acidosis, and hyperinsulinemia. In addition, the CSN also delivers information from carotid sinus baroreceptors-mechanoreceptor sensory neurons directly involved in the control of blood pressure-to the central nervous system. The interaction between these powerful reflex systems-chemoreflex and baroreflex-whose sensory receptors are in anatomical proximity, may be regarded as a drawback to the development of selective bioelectronic tools to modulate the CSN. Herein we aimed to disclose CSN influence on cardiovascular regulation, particularly under hypoxic conditions, and we tested the hypothesis that neuromodulation of the CSN, either by electrical stimuli or surgical means, does not significantly impact blood pressure. Experiments were performed in Wistar rats aged 10-12 weeks. No significant effects of acute hypoxia were observed in systolic or diastolic blood pressure or heart rate although there was a significant activation of the cardiac sympathetic nervous system. We conclude that chemoreceptor activation by hypoxia leads to an expected increase in sympathetic activity accompanied by compensatory regional mechanisms that assure blood flow to regional beds and maintenance of hemodynamic homeostasis. Upon surgical denervation or electrical block of the CSN, the increase in cardiac sympathetic nervous system activity in response to hypoxia was lost, and there were no significant changes in blood pressure in comparison to control animals. We conclude that the responses to hypoxia and vasomotor control short-term regulation of blood pressure are dissociated in terms of hypoxic response but integrated to generate an effector response to a given change in arterial pressure.
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2,335,844 |
Blocking TNF signaling may save lives in COVID-19 infection.
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Global vaccination effort and better understanding of treatment strategies provided a ray of hope for improvement in COVID-19 pandemic, however, in many countries, the disease continues to collect its death toll. The major pathogenic mechanism behind severe cases associated with high mortality is the burst of pro-inflammatory cytokines TNF, IL-6, IFNγ and others, resulting in multiple organ failure. Although the exact contribution of each cytokine is not clear, we provide an evidence that the central mediator of cytokine storm and its devastating consequences may be TNF. This cytokine is known to be involved in activated blood clotting, lung damage, insulin resistance, heart failure, and other conditions. A number of currently available pharmaceutical agents such as monoclonal antibodies and soluble TNF receptors can effectively prevent TNF from binding to its receptor(s). Other drugs are known to block NFkB, the major signal transducer molecule used in TNF signaling, or to block kinases involved in downstream activation cascades. Some of these medicines have already been selected for clinical trials, but more work is needed. A simple, rapid, and inexpensive method of directly monitoring TNF levels may be a valuable tool for a timely selection of COVID-19 patients for anti-TNF therapy.
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2,335,845 |
Health Status, Persistent Symptoms, and Effort Intolerance One Year After Acute COVID-19 Infection.
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The long-term prevalence and risk factors for post-acute COVID-19 sequelae (PASC) are not well described and may have important implications for unvaccinated populations and policy makers.</AbstractText>To assess health status, persistent symptoms, and effort tolerance approximately 1 year after COVID-19 infection DESIGN: Retrospective observational cohort study using surveys and clinical data PARTICIPANTS: Survey respondents who were survivors of acute COVID-19 infection requiring Emergency Department presentation or hospitalization between March 3 and May 15, 2020.</AbstractText><AbstractText Label="MAIN MEASURE(S)">Self-reported health status, persistent symptoms, and effort tolerance KEY RESULTS: The 530 respondents (median time between hospital presentation and survey 332 days [IQR 325-344]) had mean age 59.2±16.3 years, 44.5% were female and 70.8% were non-White. Of these, 41.5% reported worse health compared to a year prior, 44.2% reported persistent symptoms, 36.2% reported limitations in lifting/carrying groceries, 35.5% reported limitations climbing one flight of stairs, 38.1% reported limitations bending/kneeling/stooping, and 22.1% reported limitations walking one block. Even those without high-risk comorbid conditions and those seen only in the Emergency Department (but not hospitalized) experienced significant deterioration in health, persistent symptoms, and limitations in effort tolerance. Women (adjusted relative risk ratio [aRRR] 1.26, 95% CI 1.01-1.56), those requiring mechanical ventilation (aRRR 1.48, 1.02-2.14), and people with HIV (aRRR 1.75, 1.14-2.69) were significantly more likely to report persistent symptoms. Age and other risk factors for more severe COVID-19 illness were not associated with increased risk of PASC.</AbstractText>PASC may be extraordinarily common 1 year after COVID-19, and these symptoms are sufficiently severe to impact the daily exercise tolerance of patients. PASC symptoms are broadly distributed, are not limited to one specific patient group, and appear to be unrelated to age. These data have implications for vaccine hesitant individuals, policy makers, and physicians managing the emerging longer-term yet unknown impact of the COVID-19 pandemic.</AbstractText>© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.</CopyrightInformation>
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2,335,846 |
Comparison of epidural analgesia with ultrasound-guided bilateral erector spinae plane block in aorto-femoral arterial bypass surgery.
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Thoracic Epidural Analgesia (TEA) was compared with ultrasound-guided bilateral erector spinae plane (ESP) block in aorto-femoral arterial bypass surgery for analgesic efficacy, hemodynamic effects, and pulmonary rehabilitation.</AbstractText>Prospective randomized.</AbstractText>Tertiary care centre.</AbstractText>Adult patients, who were scheduled for elective aorto-femoral arterial bypass surgery.</AbstractText>It was a prospective pilot study enrolling 20 adult patients who were randomized to group A (ESP block = 10) and group B (TEA = 10). Monitoring of heart rate (HR) and mean arterial pressure (MAP) and pain assessment at rest and deep breathing using visual analog scale (VAS) were done till 48-h post-extubation. Rescue analgesic requirement, Incentive spirometry, oxygenation, duration of ventilation and stay in Intensive Care Unit (ICU) were reported as outcome measures. Statistical analysis was performed using unpaired Student T-test or Mann-Whitney U test. A value of P < 0.05 was considered significant.</AbstractText>HR was lower in group B than group A at 1 and 2 h post- surgery and at 0.5, 16, 20, and 32 h post-extubation (P < 0.05). MAP were lower in group B than A at 60, 90, 120, 150, 180, 210, 240, 270 minutes and at 0 hour post-surgery and at 4 hours, every 4 hours till 32 hours post-extubation (P < 0.05). Intraoperative midazolam and fentanyl consumption, ventilatory hours, VAS at rest, incentive spirometry, oxygenation, and ICU stay were comparable between the two groups. VAS during deep breathing was more in group A than B at 0.5, 4 hours and every 4 hours till 44 hours post-extubation. The time to receive the first rescue analgesia was shorter in group A than B (P < 0.05).</AbstractText>Both ESP block and TEA provided comparable analgesia at rest. Further studies with larger sample size are required to evaluate whether ESP block could be an alternative to TEA in aorto-femoral arterial bypass surgery.</AbstractText>
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2,335,847 |
Simultaneous Polar Metabolite and N-Glycan Extraction Workflow for Joint-Omics Analysis: A Synergistic Approach for Novel Insights into Diseases.
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Bioinformatics and machine learning tools have made it possible to integrate data across different -omics platforms for novel multiomic insights into diseases. To synergistically process -omics data in an integrative manner, analyte extractions for each -omics type need to be done on the same set of clinical samples. Therefore, we introduce a simultaneous dual extraction method for generating both metabolomic (polar metabolites only) and glycomic (protein-derived N-glycans only) profiles from one sample with good extraction efficiency and reproducibility. As proof of the usefulness of the extraction and joint-omics workflow, we applied it on platelet samples obtained from a cohort study comprising 66 coronary heart disease (CHD) patients and 34 matched healthy community-dwelling controls. The metabolomics and N-glycomics data sets were subjected to block partial least-squares-discriminant analysis (block-PLS-DA) based on sparse generalized canonical correlation analysis (CCA) for identifying relevant mechanistic interactions between metabolites and glycans. This joint-omics investigation revealed intermodulative roles that protein-bound carbohydrates or glycoproteins and amino acids have in metabolic pathways and through intermediate protein dysregulations. It also suggested a protective role of the glyco-redox network in CHD, demonstrating proof-of-principle for a joint-omics analysis in providing new insights into disease mechanisms, as enabled by a simultaneous polar metabolite and protein-derived N-glycan extraction workflow.
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2,335,848 |
Physiological, Perceptual, and Performance Responses to the 2-Week Block of High- versus Low-Intensity Endurance Training.
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This study examined the physiological, perceptual, and performance responses to a 2-wk block of increased training load and compared whether responses differ between high-intensity interval (HIIT) and low-intensity training (LIT).</AbstractText>Thirty recreationally trained males and females performed a 2-wk block of 10 HIIT sessions (INT, n = 15) or 70% increased volume of LIT (VOL, n = 15). Running time in the 3000 m and basal serum and urine hormone concentrations were measured before (T1) and after the block (T2), and after a recovery week (T3). In addition, weekly averages of nocturnal heart rate variability (HRV) and perceived recovery were compared with the baseline.</AbstractText>Both groups improved their running time in the 3000 m from T1 to T2 (INT = -1.8% ± 1.6%, P = 0.003; VOL = -1.4% ± 1.7%, P = 0.017) and from T1 to T3 (INT = -2.5% ± 1.6%, P < 0.001; VOL = -2.2% ± 1.9%, P = 0.001). Resting norepinephrine concentration increased in INT from T1 to T2 (P = 0.01) and remained elevated at T3 (P = 0.018). The change in HRV from the baseline was different between the groups during the first week (INT = -1.0% ± 2.0% vs VOL = 1.8% ± 3.2%, P = 0.008). Muscle soreness increased only in INT (P < 0.001), and the change was different compared with VOL across the block and recovery weeks (P < 0.05).</AbstractText>HIIT and LIT blocks increased endurance performance in a short period. Although both protocols seemed to be tolerable for recreational athletes, a HIIT block may induce some negative responses such as increased muscle soreness and decreased parasympathetic activity.</AbstractText>Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.</CopyrightInformation>
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2,335,849 |
A novel 1-D densely connected feature selection convolutional neural network for heart sounds classification.
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Heart sound auscultation, due to it being a non-invasive, convenient, and relatively low-cost technique, remains the dominant method for detection of cardiovascular disease.</AbstractText>In this paper, we present a method for identifying abnormal heart sounds based on a novel Dense Feature Selection Convolution Network framework (Dense-FSNet). The Dense-FSNet is comprised of multiple, circular dense connectivity modules, called Clique Blocks. These Clique Blocks can allow low-level and high-level features to stimulate each other for cyclic updates, which subsequently enhances the information flow among layers. Inspired by the channel-wise attention mechanism from Squeeze-and-Excitation Networks (SENet), we adopted squeeze-and-excitation block to avoid the progressive growth of parameters. The effect of the model was assessed using the accuracy, specificity, sensitivity, and area under the curve (AUC) values. To improve model performance, in addition to the structures mentioned above, we incorporated a multi-scale attention mechanism into our framework.</AbstractText>Using this attention mechanism, our model was able to achieve adaptively spatial feature fusion by adjusting a hyper-feature that contains higher level visual information and lower-level features including edge details and context information. It is worth noting that data balance technology was also used in the process of building the model, and notable results have been achieved.</AbstractText>Experience using the PhysioNet/CinC 2016 dataset shows that our proposed Dense-FSNet models achieve state of the art levels in the classification and detection of abnormal heart sounds.</AbstractText>2021 Annals of Translational Medicine. All rights reserved.</CopyrightInformation>
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2,335,850 |
Perioperative Outcomes in COVID-19 Obstetric Patients Undergoing Spinal Anesthesia for Cesarean Section: A Prospective Observational Study.
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Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of parturients. The aim of this study is to examine perioperative adverse events and hemodynamic stability among COVID-19 positive parturients undergoing spinal anesthesia. This prospective observational investigation was conducted at a tertiary teaching hospital in Jordan between January and June 2021, during which 31 COVID-19 positive parturients were identified. Each COVID-19 positive parturient was matched with a COVID-19 negative parturient who received anesthesia under similar operating conditions as a control group. Of the 31 COVID-19 patients, 22 (71%) were otherwise medically free, 8 (25.8%) were emergency cesarean sections. The sensory level of spinal block after 10 min was T8 (T6-T10) among COVID-19 positive group, compared to T4 (T4-T6) among control group (<i>p</i> = 0.001). There were no significant differences in heart rate, SBP, DBP, and MAP intraoperatively (<i>p</i> > 0.05). Twelve (36.4%) neonates born to COVID-19 positive patients were admitted to NICU, compared to four (11.8%) among control group (<i>p</i> = 0.018). There was no statistically significant difference in postoperative complications. In conclusion, spinal anesthesia is considered a safe anesthetic technique in COVID-19 parturients, and therefore it is the anesthetic method of choice for cesarean deliveries among COVID-19 patients.
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2,335,851 |
Ultrasound-Guided Suprazygomatic Nerve Blocks to the Pterygopalatine Fossa: A Safe Procedure.
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Large-scale procedural safety data on pterygopalatine fossa nerve blocks (PPFBs) performed via a suprazygomatic, ultrasound-guided approach are lacking, leading to hesitancy surrounding this technique. The aim of this study was to characterize the safety of PPFB.</AbstractText>This retrospective chart review examined the records of adults who received an ultrasound-guided PPFB between January 1, 2016, and August 30, 2020, at the University of Florida. Indications included surgical procedures and nonsurgical pain. Clinical data describing PPFB were extracted from medical records. Descriptive statistics were calculated for all variables, and quantitative variables were analyzed with the paired t test to detect differences between before and after the procedure.</AbstractText>A total of 833 distinct PPFBs were performed on 411 subjects (59% female, mean age 48.5 years). Minor oozing from the injection site was the only reported side effect, in a single subject. Although systolic blood pressure, heart rate, and oxygen saturation were significantly different before and after the procedure (132.3 vs 136.4 mm Hg, P < 0.0001; 78.2 vs 80.8, P = 0.0003; and 97.8% vs 96.3%, P < 0.0001; respectively), mean arterial pressure and diastolic blood pressure were not significantly different (96.2 vs 97.1 mm Hg, P = 0.1545, and 78.2 vs 77.4 mm Hg, P = 0.1314, respectively). Similar results were found within subgroups, including subgroups by sex, race, and indication for PPFB.</AbstractText>We have not identified clinically significant adverse effects from PPFB performed with an ultrasound-guided suprazygomatic approach in a large cohort in the hospital setting. PPFBs are a safe and well-tolerated pain management strategy; however, prospective multicenter studies are needed.</AbstractText>© The Author(s) 2022. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected].</CopyrightInformation>
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2,335,852 |
Value of advanced interatrial block in the diagnosis of the ischemic stroke's aetiology: A cohort study.<Pagination><StartPage>278</StartPage><EndPage>282</EndPage><MedlinePgn>278-282</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.medcli.2021.11.012</ELocationID><ELocationID EIdType="pii" ValidYN="Y">S0025-7753(21)00719-3</ELocationID><Abstract><AbstractText Label="INTRODUCTION AND OBJECTIVES">Advanced interatrial block has been linked with atrial fibrillation (AF) (Bayes syndrome). On the other hand, the aetiology of the stroke remains unknown in approximately 20-25% of patients admitted due to ischaemic stroke. The aim of this study was to evaluate whether advanced interatrial block and CHADS2-VASC scale is linked to AF in patients admitted due to ischaemic stroke without previous AF history.</AbstractText><AbstractText Label="METHODS">A prospective analysis of consecutive in-hospital patients admitted with ischemic stroke between January/2018 and April/2019 in a stroke hospital was performed. Patients had to be in sinus rhythm at admission and without previous history of AF/atrial flutter. During follow up patients receive the usual care.</AbstractText><AbstractText Label="RESULTS">A total of 236 patients were included. The median follow-up was 540 days (407-695). 19 patients (8.1%) had advanced interatrial block at admission. Advanced interatrial block was associated with the diagnosis of AF during follow up (5 (26.3%) Vs 21 (9.7%) p=0.027). A CHADS2-VASC score>4 at admission was also associated with AF diagnosis during follow up (23(14.6%) vs 3(3.9%) p=0.009).</AbstractText><AbstractText Label="CONCLUSION">This study confirms the association of advanced interatrial block and CHADS2-VASC>4 at admission with the diagnosis of AF during follow up in patients with ischemic stroke. This association could have important implications in patients with ischemic stroke who present advanced interatrial block and without previous history of AF.</AbstractText><CopyrightInformation>Copyright © 2021 Elsevier España, S.L.U. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Vieitez Florez</LastName><ForeName>Jose Maria</ForeName><Initials>JM</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain. Electronic address: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sánchez Sánchez</LastName><ForeName>Arantxa</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Neurology Department, Ramón y Cajal University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Martínez Moya</LastName><ForeName>Rafael</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Masjuan Vallejo</LastName><ForeName>Jaime</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Neurology Department, Ramón y Cajal University Hospital, Madrid, Spain; IRYCIS Health Research, Facultad de Medicina, Universidad de Alcalá, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Franco Díez</LastName><ForeName>Eduardo</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jimenez-Blanco Bravo</LastName><ForeName>Marta</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Abellas Sequeiros</LastName><ForeName>Maria</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lorente Ros</LastName><ForeName>Alvaro</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zamorano Gómez</LastName><ForeName>Jose Luis</ForeName><Initials>JL</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Alonso Salinas</LastName><ForeName>Gonzalo Luis</ForeName><Initials>GL</Initials><AffiliationInfo><Affiliation>Cardiology Department, Ramón y Cajal University Hospital, Madrid, Spain; Cardiology Department, University Hospital of Navarra, Pamplona, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><Language>spa</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>01</Month><Day>14</Day></ArticleDate></Article><MedlineJournalInfo><Country>Spain</Country><MedlineTA>Med Clin (Barc)</MedlineTA><NlmUniqueID>0376377</NlmUniqueID><ISSNLinking>0025-7753</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002545" MajorTopicYN="Y">Brain Ischemia</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000074021" MajorTopicYN="Y">Interatrial Block</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000083242" MajorTopicYN="Y">Ischemic Stroke</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018570" MajorTopicYN="N">Risk Assessment</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012307" MajorTopicYN="N">Risk Factors</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Atrial fibrillation</Keyword><Keyword MajorTopicYN="N">Bloqueo interauricular</Keyword><Keyword MajorTopicYN="N">Cardiac embolism</Keyword><Keyword MajorTopicYN="N">Cerebral infarction</Keyword><Keyword MajorTopicYN="N">Embolismo cardiaco</Keyword><Keyword MajorTopicYN="N">Fibrilación auricular</Keyword><Keyword MajorTopicYN="N">Ictus isquémico</Keyword><Keyword MajorTopicYN="N">Interatrial block</Keyword><Keyword MajorTopicYN="N">Stroke</Keyword><Keyword MajorTopicYN="N">Síndrome de Bayés</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>7</Month><Day>31</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>11</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>11</Month><Day>21</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>1</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>9</Month><Day>23</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>1</Month><Day>18</Day><Hour>5</Hour><Minute>40</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">35039169</ArticleId><ArticleId IdType="doi">10.1016/j.medcli.2021.11.012</ArticleId><ArticleId IdType="pii">S0025-7753(21)00719-3</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedBookArticle><BookDocument><PMID Version="1">30285386</PMID><ArticleIdList><ArticleId IdType="bookaccession">NBK531491</ArticleId></ArticleIdList><Book><Publisher><PublisherName>StatPearls Publishing</PublisherName><PublisherLocation>Treasure Island (FL)</PublisherLocation></Publisher><BookTitle book="statpearls">StatPearls</BookTitle><PubDate><Year>2023</Year><Month>01</Month></PubDate><BeginningDate><Year>2023</Year><Month>01</Month></BeginningDate><Medium>Internet</Medium></Book><ArticleTitle book="statpearls" part="article-19680">Coenzyme Q10
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Coenzyme Q10 (CoQ10) is not FDA-approved to treat any medical condition, although it is widely available over-the-counter as a dietary supplement and recommended by primary care providers and specialists alike. Diseases such as neurodegenerative diseases, fibromyalgia, diabetes, cancer, mitochondrial diseases, muscular diseases, and heart failure are associated with decreased circulating levels of CoQ10. Statin drugs, of note, block the production of an intermediate in the mevalonate pathway, a biochemical pathway that leads to the production of CoQ10. Therefore, researchers hypothesize that statin drugs may deplete the body of CoQ10. As muscle pain and cramping are such a common adverse effect of statins, they believe this depletion of CoQ10 is the culprit. This activity will highlight the mechanism of action, adverse event profile, latest research, and relevant interactions pertinent to CoQ10 for members of the interprofessional team to treat patients with potentially relevant conditions.
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2,335,853 |
Pharmacokinetics and Pharmacodynamics of Dexmedetomidine Administered as an Adjunct to Bupivacaine for Transversus Abdominis Plane Block in Patients Undergoing Lower Abdominal Cancer Surgery.
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Despite the growing interest in dexmedetomidine as an adjunct to truncal blocks, little is known about the systemic absorption of dexmedetomidine after these blocks and its role in analgesia and in hemodynamics.</AbstractText>We investigated the pharmacokinetics and pharmacodynamics of dexmedetomidine as an adjunct to transversus abdominis plane (TAP) block in patients undergoing lower abdominal cancer surgery.</AbstractText>Twenty-four adult patients were randomized to receive a bilateral single-injection TAP block before surgery with 20 mL of bupivacaine 0.5% (TAP group, n = 12) or combined with 1 µg/kg dexmedetomidine (TAP-DEX group, n = 12) and diluted with saline to a volume of 40 mL (20 mL on each side). Plasma concentrations of dexmedetomidine and its pharmacokinetics were investigated using non-compartmental methods, postoperative analgesia, hemodynamics, and adverse events (nausea, vomiting, itching, hypotension, bradycardia, and respiratory depression).</AbstractText>Dexmedetomidine was detected in the plasma of 11 patients in the TAP-DEX group. The mean dexmedetomidine peak plasma concentration (Cmax) was 0.158 ± 0.085 (range, 0.045-0.31) ng/mL. The median time to reach peak plasma concentration of dexmedetomidine (Tmax) was 15 (15-45) min. From 2 to 8 h postoperatively, visual analog pain scale (VAS) scores at rest and during movement were significantly lower in the TAP-DEX group. Analgesia time was (11.3 ± 3.12 vs 9.0 ± 4.69 h; P = 0.213) and postoperative morphine consumption was (7.4 ± 3.24 vs 11.5 ± 4.46 mg; P = 0.033) in TAP-DEX and TAP groups, respectively. Lower mean heart rate and mean blood pressure were recorded in the TAP-DEX group intraoperatively and 2 h postoperatively (P < 0.05). Except for mild nausea and vomiting, no adverse events were recorded in either group.</AbstractText>Systemic absorption of dexmedetomidine administered in a TAP block is common. Direct central effects on the locus coeruleus caused by this systemic absorption may play a role in the analgesia and hemodynamic effects produced by TAP-dexmedetomidine in addition to local mechanisms.</AbstractText>ClinicalTrial.gov (identifier: NCT03328299).</AbstractText>© 2022 El Sherif et al.</CopyrightInformation>
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2,335,854 |
Counterion-insulated near-infrared dyes in biodegradable polymer nanoparticles for <i>in vivo</i> imaging.
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Polymeric nanoparticles (NPs) are highly attractive for biomedical applications due to their potential biodegradability and capacity to encapsulate different loads, notably drugs and contrast agents. For <i>in vivo</i> optical bioimaging, NPs should operate in the near-infrared region (NIR) and exhibit stealth properties. In the present work, we applied the approach of ionic dye insulation with bulky hydrophobic counterions for encapsulation of near-infrared cyanine dyes (Cy5.5 and Cy7 bearing two octadecyl chains) into biodegradable polymer (PLGA) NPs. We found that at high dye loading (20-50 mM with respect to the polymer), the bulkiest fluorinated tetraphenylborate counterion minimized best the aggregation-caused quenching and improved fluorescence quantum yields of both NIR dyes, especially of Cy5.5. In addition, bulky counterions also enabled formation of small 40 nm polymeric NPs in contrast to smaller counterions. To provide them stealth properties, we prepared 40 nm dye-loaded PEGylated NPs through nanoprecipitation of synthetic PLGA-PEG block copolymer with the dye/counterion salt. The obtained NIR NPs loaded with Cy5.5 dye salt allowed <i>in vivo</i> imaging of wild-type mice with a good contrast after IV injection. Compared to the bare PLGA NPs, PLGA-PEG NPs exhibited significantly slower accumulation in the liver. Biodistribution studies confirmed the preferential accumulation in the liver, although PLGA and PLGA-PEG NPs could also be distributed in other organs, with the following tendency: liver > spleen > lungs > kidney > heart > testis > brain. Overall, the present work validated the counterion approach for encapsulation of NIR cyanine dyes into biodegradable polymer NPs bearing covalently attached PEG shell. Thus, we propose a simple and robust methodology for preparation of NIR fluorescent biodegradable polymer NPs, which could further improve the existing optical imaging for biomedical applications.
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2,335,855 |
Subcutaneous ICD implantation under ultrasound-guided serratus anterior plane block: Single-center experience in the Netherlands.
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To avoid general anesthesia (GA) and improve postoperative pain management for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation there is a growing interest for alternative methods. We describe the first experience in the Netherlands of S-ICD implantation under Ultrasound-guided Serratus Anterior Plane Block (US-SAPB).</AbstractText>US-SAPB was performed 1 hour before S-ICD implantation. The two-incision technique was used and a pocket beneath the latissimus dorsi muscle was surgically created. Lidocaine was used to provide anesthesia of the skin. Sedation during defibrillation testing (DFT) was induced by intravenous Propofol. Periprocedural pain experience was monitored using the Numerical Rating Scale for Pain (NRS-Pain). The results were compared with a control group of patients undergoing S-ICD implantation under GA.</AbstractText>Forty consecutive patients (29 Male/11 Female, median age 59 years (range 34-84 years), median body mass index 26 (range 17-41) underwent S-ICD implantation; Twenty patients under US-SAPB and twenty under GA. Median procedure time was 42 min. (range 28-60 min.) with no differences between both groups. In both groups implantations went successful and defibrillation was accomplished using 65 J. US-SAPB was successful in 19 of the 20 patients and GA was successful in all cases. Median NRS-Pain in the US-SAPB group was 2 (range 2-6) and in the GA group 4 (range 2-6). In the US-SAPB group 5 patients required additional opioids postoperatively compared to 10 patients in the GA group.</AbstractText>S-ICD implantation under US-SAPB is feasible, safe and reduces the need for postoperative opioids significantly. S-ICD implantation under US-SAPB seems a good alternative for GA.</AbstractText>© 2021 The Author(s).</CopyrightInformation>
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2,335,856 |
Loperamide-Induced Torsades de Pointes.
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Loperamide, an over-the-counter antidiarrheal, works on the µ opioid receptor with minimal opioid activity if taken as directed. Recently, it has gained popularity as the "poor man's methadone" at supratherapeutic dosing. Opioid antagonism with naloxone is beneficial in reversing respiratory depression but has no effect on cardiotoxicity due to the human ether-a-go-go-related gene (hERG). We present the case of a 34-year-old female who presented for syncope after taking 48 tablets of 2 mg loperamide. On arrival, she was obtunded with variable heart block and a QTc of 560 ms. Subsequently, due to further QT prolongation from loperamide to 656 ms, she developed Torsades de Pointes requiring defibrillation at 120 J twice. Ultimately, she was discharged home with psychiatric and substance abuse outpatient follow-up. Patients and healthcare providers face new challenges with the increase in loperamide misuse due to easy access and delayed identification. It is important for clinicians to recognize and be familiar with loperamide overdose given the potential for multiorgan failure and increased mortality.
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2,335,857 |
Effects of delta-opioid receptor agonist pretreatment on the cardiotoxicity of bupivacaine in rats.
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Delta-opioid receptor is widely expressed in human and rodent hearts, and has been proved to protect cardiomyocytes against ischemia/reperfusion and heart failure. The antagonist of delta-opioid receptor could block the rescue effect of lipid emulsion against local anesthetic cardiotoxicity. However, no evidence is available for the direct effect of delta-opioid-receptor agonists on the cardiotoxicity of local anesthetics.</AbstractText>Anesthetized Sprague Dawley rats were divided into five groups. Group NS received 2 ml·kg-1</sup>·min-1</sup> normal saline, group LE received 2 ml·kg-1</sup>·min-1</sup> 30% lipid emulsion and group BW received 0.1, 1.0, or 5.0 mg/kg BW373U86, a delta-opioid-receptor agonist, for 5 min. Then 0.5% bupivacaine was infused intravenously at a rate of 3.0 mg·kg-1</sup>·min-1</sup> until asystole. The time of arrhythmia, 50% mean arterial pressure-, 50% heart rate-reduction and asystole were recorded, and the dose of bupivacaine at each time point was calculated.</AbstractText>All three different doses of BW373U86 did not affect the arrhythmia, 50% mean arterial pressure-reduction, 50% heart rate-reduction and asystole dose of bupivacaine compared with group NS. 30% LE significantly increased the bupivacaine threshold of 50% mean arterial pressure-reduction (17.9 [15.4-20.7] versus 7.2 [5.9-8.7], p = 0.018), 50% heart rate-reduction (18.7 ± 4.2 versus 8.8 ± 1.7, p < 0.001) and asystole (26.5 [21.0-29.1] versus 11.3 [10.7-13.4], p = 0.008) compared with group NS. There was no difference between group LE and group NS in the arrhythmia dose of bupivacaine (9.9 [8.9-11.7] versus 5.6 [4.5-7.0], p = 0.060).</AbstractText>Our data show that BW373U86 does not affect the cardiotoxicity of bupivacaine compared with NS control in rats. 30% LE pretreatment protects the myocardium against bupivacaine-induced cardiotoxicity.</AbstractText>© 2022. The Author(s).</CopyrightInformation>
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2,335,858 |
Dexmedetomidine as an adjunct to peripheral nerve blocks in pediatric patients.
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Combining local anesthetics with dexmedetomidine (DEX) for nerve blocks has been tested and confirmed as an alternative technique to strengthen analgesia in adults, but the evidence supported this proposal in pediatrics was not convincing enough. Thus, we intend to conduct a meta-analysis to make an appraisal of the effects of DEX as a local anesthetic adjuvant on peripheral nerve blocks in children.</AbstractText>The analysis has been registered on https://www.crd.york.ac.uk/prospero/ with the registration number CRD42021254029 on June 10th, 2021. PubMed, Ovid MEDLINE, Embase and Cochrane central register were searched for the randomized controlled trials (RCTs) that are relevant to child/pain/DEX or block up to April 30, 2021.</AbstractText>Eight RCTs were included for data analysis. The pooled results showed a significantly reduced number of patients who required postoperative analgesics within DEX groups [odds ratio = 0.1, 95% confidence interval (CI) 0.03-0.32, P < 0.001]. And DEX significantly prolonged the duration of analgesia of local anesthetics in the meantime [standardized mean difference (SMD) = 4.93, 95% CI 3.02-6.83, P < 0.001]. Nevertheless, adding DEX as an adjunct to local anesthetics would significantly decrease heart rate (SMD = - 0.95, 95% CI - 1.45 to - 0.45, P < 0.001) and increase sedation score (SMD = 1.6, 95% CI 0.53-2.66, P = 0.003) simultaneously.</AbstractText>Adding DEX as an adjunct to peripheral nerve blocks can prolong analgesia until postoperative 8 hours in pediatric patients. However, the benefits should be weighed against the increasing risk of bradycardia and sedation in critical children.</AbstractText>© 2022. Children's Hospital, Zhejiang University School of Medicine.</CopyrightInformation>
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2,335,859 |
Comparison of effects of dexmedetomidine added to ropivacaine versus ropivacaine alone infiltration scalp block for attenuation of the haemodynamic response to skull pin placement in neurosurgical procedures: A double-blind, randomised clinical trial.
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Skull pin head holder application is intensely painful and is accompanied with abrupt increase in heart rate and arterial blood pressure. We aimed to determine the effects of adding dexmedetomidine to ropivacaine scalp block in attenuating the haemodynamic response to skull pin insertion in neurosurgical procedures.</AbstractText>Sixty patients were randomly allocated to receive scalp block with 25 ml of 0.5% ropivacaine added with either normal saline (control group) or dexmedetomidine (1 μg/kg) after anesthesia induction. A standard uniform general endotracheal anaesthesia protocol was followed in all study subjects. Heart rate and blood pressure measurements were made at baseline, 1, 3, 5, 10, and 15 min following skull pin placement. Student's independent t</i>-test, Chi-square test and repeated measure analysis of variance were used to analyse the obtained data.</AbstractText>There was no significant attenuation of heart rate (P</i> = 0.418), systolic (P</i> = 0.542), diastolic (P</i> = 0.793) and mean blood pressure (P</i> = 0.478) with addition of dexmedetomidine to ropivacaine.</AbstractText>The addition of dexmedetomidine (1 μg/kg) to 25 ml of 0.5% ropivacaine offers no additional benefit over 25 ml of 0.5% ropivacaine alone scalp block in attenuating the haemodynamic response to skull pin placement in neurosurgical procedures.</AbstractText>Copyright: © 2021 Indian Journal of Anaesthesia.</CopyrightInformation>
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2,335,860 |
Limb development genes underlie variation in human fingerprint patterns.
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Fingerprints are of long-standing practical and cultural interest, but little is known about the mechanisms that underlie their variation. Using genome-wide scans in Han Chinese cohorts, we identified 18 loci associated with fingerprint type across the digits, including a genetic basis for the long-recognized "pattern-block" correlations among the middle three digits. In particular, we identified a variant near EVI1 that alters regulatory activity and established a role for EVI1 in dermatoglyph patterning in mice. Dynamic EVI1 expression during human development supports its role in shaping the limbs and digits, rather than influencing skin patterning directly. Trans-ethnic meta-analysis identified 43 fingerprint-associated loci, with nearby genes being strongly enriched for general limb development pathways. We also found that fingerprint patterns were genetically correlated with hand proportions. Taken together, these findings support the key role of limb development genes in influencing the outcome of fingerprint patterning.
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2,335,861 |
Effect of protein source and nonroughage NDF content in finishing diets of feedlot cattle fed free-choice hay on growth performance and carcass characteristics.
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One-hundred twenty crossbreed steers (initial body weight (BW) 566 ± 42 kg) were used to evaluate the interaction of protein source (PS) and nonroughage NDF content (NRFC) in finishing diets of feedlot cattle fed free-choice hay on performance and carcass characteristics. Steers were stratified by BW and randomly assigned to 8 pens (2 × 2 factorial) and fed for 104 ± 10 d. Four dietary treatments were investigated: (1) distillers' dry grains with solubles (DDGS) and a low NRFC (DLF), (2) DDGS and a high NRFC (DHF), (3) soybean meal (SBM) and a low NRFC (SLF), (4) SBM and a high NRFC (SHF). Free-choice grass hay and concentrates were offered in a different bunk. Data were analyzed as a randomized complete block design. Do to the confounded effect of PS and protein intake, a linear regression was used to evaluate the effect of protein intake in growth performance. For gain to feed ratio (G:F) an interaction tended to occur (<i>P</i> = 0.10) between PS and NRFC. Steers on the DHF treatment had a lower G:F compared with SLF and SHF. Feeding SBM increased (<i>P</i> = 0.05) final BW, tended to increase (<i>P</i> = 0.06) average daily gain (ADG), and decreased (<i>P</i> = 0.05) hay intake (HI) compared with steers fed DDGS. There was a positive association (<i>P</i> ˂ 0.01) of crude protein intake with ADG and FBW. Dietary NRFC did not change (<i>P</i> ≥ 0.3) final BW, ADG, DMI, and HI. Protein source did not affect (<i>P</i> ≥ 0.16) hot carcass weight (HCW), longissimus muscle (LM) area, dressing, 12th rib fat thickness, or marbling score (MS). No differences were detected between NRFC for dressing, HCW, LM area, or MS (<i>P</i> ≥ 0.18); but diets with greater NRFC decreased (<i>P</i> = 0.03) the 12th rib fat thickness. Steers in the SHF treatment presented the lesser kidney-pelvic-heart fat compared with the remaining treatments (PS × NRFC interaction, <i>P</i> = 0.04). Soybean meal inclusion/increase in protein intake improved growth performance of feedlot steers compared with DDGS, despite protein intake meet the protein requirement. Increasing the NRFC did not affect growth or HI but decreased feed efficiency of steers fed DDGS.
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2,335,862 |
ANNet: A Lightweight Neural Network for ECG Anomaly Detection in IoT Edge Sensors.<Pagination><StartPage>24</StartPage><EndPage>35</EndPage><MedlinePgn>24-35</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1109/TBCAS.2021.3137646</ELocationID><Abstract><AbstractText>In this paper, we propose a lightweight neural network for real-time electrocardiogram (ECG) anomaly detection and system level power reduction of wearable Internet of Things (IoT) Edge sensors. The proposed network utilizes a novel hybrid architecture consisting of Long Short Term Memory (LSTM) cells and Multi-Layer Perceptrons (MLP). The LSTM block takes a sequence of coefficients representing the morphology of ECG beats while the MLP input layer is fed with features derived from instantaneous heart rate. Simultaneous training of the blocks pushes the overall network to learn distinct features complementing each other for making decisions. The network was evaluated in terms of accuracy, computational complexity, and power consumption using data from the MIT-BIH arrhythmia database. To address the class imbalance in the dataset, we augmented the dataset using SMOTE algorithm for network training. The network achieved an average classification accuracy of 97% across several records in the database. Further, the network was mapped to a fixed point model, retrained in a bit accurate fixed-point environment to compensate for the quantization error, and ported to an ARM Cortex M4 based embedded platform. In laboratory testing, the overall system was successfully demonstrated, and a significant saving of ≅ 50% power was achieved by gating the wireless transmission using the classifier. Wireless transmission was enabled only to transmit the beats deemed anomalous by the classifier. The proposed technique compares favourably with current methods in terms of computational complexity and has the advantage of stand-alone operation in the edge node, without the need for always-on wireless connectivity making it ideal for IoT wearable devices.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Sivapalan</LastName><ForeName>Gawsalyan</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Nundy</LastName><ForeName>Koushik Kumar</ForeName><Initials>KK</Initials></Author><Author ValidYN="Y"><LastName>Dev</LastName><ForeName>Soumyabrata</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Cardiff</LastName><ForeName>Barry</ForeName><Initials>B</Initials></Author><Author ValidYN="Y"><LastName>John</LastName><ForeName>Deepu</ForeName><Initials>D</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>05</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>IEEE Trans Biomed Circuits Syst</MedlineTA><NlmUniqueID>101312520</NlmUniqueID><ISSNLinking>1932-4545</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000465" MajorTopicYN="N">Algorithms</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="Y">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006339" MajorTopicYN="N">Heart Rate</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016571" MajorTopicYN="Y">Neural Networks, Computer</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>1</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>1</Month><Day>4</Day><Hour>17</Hour><Minute>14</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34982689</ArticleId><ArticleId IdType="doi">10.1109/TBCAS.2021.3137646</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">34981061</PMID><DateRevised><Year>2023</Year><Month>04</Month><Day>05</Day></DateRevised><Article PubModel="Electronic"><Journal><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Dec</Month><Day>23</Day></PubDate></JournalIssue><Title>bioRxiv : the preprint server for biology</Title><ISOAbbreviation>bioRxiv</ISOAbbreviation></Journal>Interferon-induced transmembrane protein 3 (IFITM3) limits lethality of SARS-CoV-2 in mice.
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In this paper, we propose a lightweight neural network for real-time electrocardiogram (ECG) anomaly detection and system level power reduction of wearable Internet of Things (IoT) Edge sensors. The proposed network utilizes a novel hybrid architecture consisting of Long Short Term Memory (LSTM) cells and Multi-Layer Perceptrons (MLP). The LSTM block takes a sequence of coefficients representing the morphology of ECG beats while the MLP input layer is fed with features derived from instantaneous heart rate. Simultaneous training of the blocks pushes the overall network to learn distinct features complementing each other for making decisions. The network was evaluated in terms of accuracy, computational complexity, and power consumption using data from the MIT-BIH arrhythmia database. To address the class imbalance in the dataset, we augmented the dataset using SMOTE algorithm for network training. The network achieved an average classification accuracy of 97% across several records in the database. Further, the network was mapped to a fixed point model, retrained in a bit accurate fixed-point environment to compensate for the quantization error, and ported to an ARM Cortex M4 based embedded platform. In laboratory testing, the overall system was successfully demonstrated, and a significant saving of ≅ 50% power was achieved by gating the wireless transmission using the classifier. Wireless transmission was enabled only to transmit the beats deemed anomalous by the classifier. The proposed technique compares favourably with current methods in terms of computational complexity and has the advantage of stand-alone operation in the edge node, without the need for always-on wireless connectivity making it ideal for IoT wearable devices.</Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Sivapalan</LastName><ForeName>Gawsalyan</ForeName><Initials>G</Initials></Author><Author ValidYN="Y"><LastName>Nundy</LastName><ForeName>Koushik Kumar</ForeName><Initials>KK</Initials></Author><Author ValidYN="Y"><LastName>Dev</LastName><ForeName>Soumyabrata</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Cardiff</LastName><ForeName>Barry</ForeName><Initials>B</Initials></Author><Author ValidYN="Y"><LastName>John</LastName><ForeName>Deepu</ForeName><Initials>D</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2022</Year><Month>05</Month><Day>09</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>IEEE Trans Biomed Circuits Syst</MedlineTA><NlmUniqueID>101312520</NlmUniqueID><ISSNLinking>1932-4545</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000465" MajorTopicYN="N">Algorithms</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001145" MajorTopicYN="N">Arrhythmias, Cardiac</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004562" MajorTopicYN="Y">Electrocardiography</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006339" MajorTopicYN="N">Heart Rate</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016571" MajorTopicYN="Y">Neural Networks, Computer</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="pubmed"><Year>2022</Year><Month>1</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>5</Month><Day>12</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2022</Year><Month>1</Month><Day>4</Day><Hour>17</Hour><Minute>14</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34982689</ArticleId><ArticleId IdType="doi">10.1109/TBCAS.2021.3137646</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">34981061</PMID><DateRevised><Year>2023</Year><Month>04</Month><Day>05</Day></DateRevised><Article PubModel="Electronic"><Journal><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Dec</Month><Day>23</Day></PubDate></JournalIssue><Title>bioRxiv : the preprint server for biology</Title><ISOAbbreviation>bioRxiv</ISOAbbreviation></Journal><ArticleTitle>Interferon-induced transmembrane protein 3 (IFITM3) limits lethality of SARS-CoV-2 in mice.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">2021.12.22.473914</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1101/2021.12.22.473914</ELocationID><Abstract>Interferon-induced transmembrane protein 3 (IFITM3) is a host antiviral protein that alters cell membranes to block fusion of viruses. Published reports have identified conflicting pro- and antiviral effects of IFITM3 on SARS-CoV-2 in cultured cells, and its impact on viral pathogenesis <i>in vivo</i> remains unclear. Here, we show that IFITM3 knockout (KO) mice infected with mouse-adapted SARS-CoV-2 experienced extreme weight loss and lethality, while wild type (WT) mice lost minimal weight and recovered. KO mice had higher lung viral titers and increases in lung inflammatory cytokine levels, CD45-positive immune cell infiltration, and histopathology, compared to WT mice. Mechanistically, we observed disseminated viral antigen staining throughout the lung tissue and pulmonary vasculature in KO mice, while staining was observed in confined regions in WT lungs. Global transcriptomic analysis of infected lungs identified upregulation of gene signatures associated with interferons, inflammation, and angiogenesis in KO versus WT animals, highlighting changes in lung gene expression programs that precede severe lung pathology and fatality. Corroborating the protective effect of IFITM3 <i>in vivo</i> , K18-hACE2/IFITM3 KO mice infected with non-adapted SARS-CoV-2 showed enhanced, rapid weight loss and early death compared to control mice. Increased heart infection was observed in both mouse models in the absence of IFITM3, indicating that IFITM3 constrains extrapulmonary dissemination of SARS-CoV-2. Our results establish IFITM3 KO mice as a new animal model for studying severe SARS-CoV-2 infection of the lung and cardiovascular system, and overall demonstrate that IFITM3 is protective in SARS-CoV-2 infections of mice.
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2,335,863 |
Prenatal predisposing factors associated with neonatal lupus erythematosus.
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To identify the prenatal predisposing factors related to neonatal lupus erythematosus (NLE).</AbstractText>A retrospective case-control study was made of 131 pregnant women with positive anti-Ro or anti-La autoantibodies and known neonatal outcomes between January 2002 and December 2019 at Siriraj Hospital, Bangkok, Thailand. There were 101 unaffected neonates and 30 NLE cases confirmed postnatally. Demographic and clinical data of the mothers and neonates with and without NLE were statistically compared.</AbstractText>NLE was diagnosed in 30 out of 131 cases. A multivariate analysis identified the following significant factors for NLE: maternal anti-La antibodies (odds ratio (OR), 3.591; p</i> = 0.030); and maternal treatment with either hydroxychloroquine (OR, 0.082; p</i> = 0.001) or prednisolone (OR, 0.136; p</i> = 0.017). Of the significant variables examined in the multivariate analysis models, high levels of maternal anti-La antibodies were found to be the strongest predictor of noncardiac NLE (OR, 4.558; p</i> = 0.032), while a female baby was significantly higher in pregnancies complicated by cardiac NLE (OR, 5.374; p</i> = 0.046). Hydroxychloroquine still provided a protective effect for both cardiac and noncardiac NLE (p</i> = 0.039 and 0.032, respectively).</AbstractText>The maternal anti-La antibodies were a beneficial predictor for NLE, especially as their high titers were influentially associated with noncardiac features. A female fetus seemed to present an increased risk for developing a congenital heart block. Nevertheless, the treatment with hydroxychloroquine during the pregnancies demonstrated a potentially protective factor against both cardiac and noncardiac manifestations.</AbstractText>
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2,335,864 |
Different Concentrations of Ropivacaine under Ultrasound Guidance on Quadratus Lumbar Muscle Nerve Block in Elderly Patients with Hip Replacement.
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To compare the effect of ropivacaine in different concentrations under ultrasound guidance on lumbar muscle nerve blocking in elderly patients undergoing hip replacement surgery.</AbstractText>60 elderly patients underwent hip replacement in our hospital over a period of April to December of 2019 were equally randomized into control and observation groups, with 30 each. Patients in the control group and observation group received 0.5% and 0.25% ropivacaine to block psoas muscle nerve, respectively. The anesthetic effect of ropivacaine at different concentrations was evaluated by time of sensory block onset and recovery and time of motor block onset and regression, blood pressure, heart rate, visual analogy scale, and postoperative nerve blocking degree.</AbstractText>The onset time of sensory and motor block in the observation group was dramatically higher than that in the control group (P</i> < 0.05), while the recovery time of sensory and motor was significantly shorter than that of the control group (P</i> < 0.05). The heart rate in the observation group was notably lower than that in the control group, while the average blood pressure was remarkably higher (P</i> < 0.05). After surgery, the degree of nerve block in the observation group was much lower compared with the control group (P</i> < 0.05), while no marked difference in the visual analogue scale in the control group before and after surgical intervention was observed (P</i> > 0.05).</AbstractText>The 0.25% ropivacaine method has distinctive advantages over 0.50% ropivacaine psoas nerve anesthesia in hip replacement surgery in elderly patients.</AbstractText>Copyright © 2021 Yi Han et al.</CopyrightInformation>
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2,335,865 |
Atovaquone and Berberine Chloride Reduce SARS-CoV-2 Replication In Vitro.
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Epidemic RNA viruses seem to arise year after year leading to countless infections and devastating disease. SARS-CoV-2 is the most recent of these viruses, but there will undoubtedly be more to come. While effective SARS-CoV-2 vaccines are being deployed, one approach that is still missing is effective antivirals that can be used at the onset of infections and therefore prevent pandemics. Here, we screened FDA-approved compounds against SARS-CoV-2. We found that atovaquone, a pyrimidine biosynthesis inhibitor, is able to reduce SARS-CoV-2 infection in human lung cells. In addition, we found that berberine chloride, a plant-based compound used in holistic medicine, was able to inhibit SARS-CoV-2 infection in cells through direct interaction with the virion. Taken together, these studies highlight potential avenues of antiviral development to block emerging viruses. Such proactive approaches, conducted well before the next pandemic, will be essential to have drugs ready for when the next emerging virus hits.
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2,335,866 |
Impact of Repeated Acute Exposures to Low and Moderate Exercise-Induced Hypohydration on Physiological and Subjective Responses and Endurance Performance.
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This study aimed to examine whether repeated exposures to low (2%) and moderate (4%) exercise-induced hypohydration may reverse the potentially deleterious effect of hypohydration on endurance performance. Using a randomized crossover protocol, ten volunteers (23 years, V˙O<sub>2max</sub>: 54 mL∙kg<sup>-1</sup>∙min<sup>-1</sup>) completed two 4-week training blocks interspersed by a 5-week washout period. During one block, participants replaced all fluid losses (EUH) while in the other they were fluid restricted (DEH). Participants completed three exercise sessions per week (walking/running, 55% V˙O<sub>2max</sub>, 40 °C): (1) 1 h while fluid restricted or drinking <i>ad libitum</i>, (2) until 2 and (3) 4% of body mass has been lost or replaced. During the first and the fourth week of each training block, participants completed a 12 min time-trial immediately after 2% and 4% body mass loss has been reached. Exercise duration and distance completed (14.1 ± 2.7 vs. 6.9 ± 1.5 km) during the fixed-intensity exercise bouts were greater in the 4 compared to the 2% condition (<i>p</i> < 0.01) with no difference between DEH and EUH. During the first week, heart rate, rectal temperature and perceived exertion were higher (<i>p</i> < 0.05) with DEH than EUH, and training did not change these outcomes. Exercise-induced hypohydration of 2% and 4% body mass impaired time-trial performance in a practical manner both at the start and end of the training block. In conclusion, exercise-induced hypohydration of 2% and 4% body mass impairs 12 min walking/running time-trial, and repeated exposures to these hypohydration levels cannot reverse the impairment in performance.
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2,335,867 |
[Study on medication laws of traditional Chinese medicine of 48 patients with coronavirus disease 2019 in intensive care unit based on data mining].<Pagination><StartPage>1175</StartPage><EndPage>1180</EndPage><MedlinePgn>1175-1180</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.3760/cma.j.cn121430-20210826-01285</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To analyze the data of Chinese medicine prescriptions for the treatment of coronavirus disease 2019 (COVID-19) in Shijiazhuang City, Hebei Province, with a view to further guide the clinical use of Chinese medicine in the prevention and treatment of COVID-19.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Forty-eight patients diagnosed with COVID-19 who were treated by critical care team of Hebei Traditional Chinese Medicine Hospital in the intensive care unit (ICU) of Hebei Chest Hospital (Hebei Provincial COVID-19 designated hospital) from January 7 to March 4, 2021, were enrolled in this study. The patients' gender, age, clinical classification, past history, and all Chinese medicine prescriptions for the first visit and follow-up visits during the hospitalization were collected. A database was established based on the Ancient and Modern Medical Records Cloud Platform (V2.2.1), and the methods of frequency analysis, correlation analysis, cluster analysis, and complex network analysis were used to analyze the prescriptions of traditional Chinese medicine.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Among the 48 patients with COVID-19, 20 were males and 28 were females; the average age was (62.4±13.7) years old. The patients' condition was generally severe, including 17 cases of common type, 25 cases of severe type, and 6 cases of critical type, most of whom were combined with hypertension, coronary heart disease, diabetes, chronic obstructive pulmonary disease and other basic illnesses. A total of 146 valid prescriptions were included, involving 59 prescriptions and 115 Chinese medicines. Frequency analysis of 146 prescriptions showed that the commonly used prescriptions for patients with COVID-19 were Qingfei Paidu decoction (30 times, 20.55%), Xuanbai Chengqi decoction (10 times, 6.85%), and Dayuan Yin (10 times, 6.85%). The common Chinese medicines were liquorice (80 times, 54.79%), tuckahoe (76 times, 52.05%), gypsum (70 times, 47.95%), bitter almond (70 times, 47.95%), ephedra (57 times, 39.04%), scutellaria (56 times, 38.36%), tangerine peel (53 times, 36.30%), patchouli (50 times, 34.25%), atractylodes macrocephala (50 times, 34.25%), and bupleurum (43 times, 29.45%). The main effects were clearing heat and detoxification (129 times), clearing heat-fire (129 times) and eliminating dampness and diuresis (110 times). The medicinal properties were mainly warm (509 times), flat (287 times), and cold (235 times). The medicinal tastes were mainly pungent (765 times), sweet (654 times), and bitter (626 times). The medicinal channel tropism were mainly lung (1 096 times), spleen (785 times), and stomach (687 times). The correlation analysis showed that there were 17 drug combinations in total, among which the top 3 drug pairs in support were bitter almond-gypsum (0.43), ephedra-bitter almond (0.38), tangerine peel-poria (0.36), and ephedra-gypsum (0.36). Cluster analysis showed that there were 3 groups of clustering formulas. The first group was ephedra, bitter almond, and gypsum. The second group was patchouli, tuckahoe, tangerine peel, and atractylodes macrocephala. The third group was scutellaria, licorice, immature orange fruit, oriental waterplantain rhizome, bupleurum, ginger, and cassia twig. The core drugs were composed of tuckahoe, bupleurum, tangerine peel, atractylodes macrocephala, patchouli, bitter almond, scutellaria, gypsum, ephedra, and licorice.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Middle-aged and elderly patients with COVID-19 are accompanied by Qi deficiency and internal invasion of toxins, and the pathogenesis evolves rapidly. Damp and turbid toxins often block the lungs and trap the spleen, leading to disorder of Qi movement, and even invaginate Ying and Xue, drain Yin and Yang. The treatment is based on removing turbidity and detoxification, and replenishing Qi and nourishing Yin are the principle treatments, so that the evil is eliminated and the Qi is restored.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Liu</LastName><ForeName>Yuan</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Unit, Hebei Traditional Chinese Medicine Hospital, Hebei University of Chinese Medicine, Shijiazhuang 050011, Hebei, China.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mei</LastName><ForeName>Jianqiang</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Emergency, Hebei Traditional Chinese Medicine Hospital, Hebei University of Chinese Medicine, Shijiazhuang 050011, Hebei, China. Corresponding author: Mei Jianqiang, Email: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chen</LastName><ForeName>Fenqiao</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Emergency, Hebei Traditional Chinese Medicine Hospital, Hebei University of Chinese Medicine, Shijiazhuang 050011, Hebei, China. Corresponding author: Mei Jianqiang, Email: [email protected].</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yang</LastName><ForeName>Yaru</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Intensive Care Unit, Hebei Traditional Chinese Medicine Hospital, Hebei University of Chinese Medicine, Shijiazhuang 050011, Hebei, China.</Affiliation></AffiliationInfo></Author></AuthorList><Language>chi</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>China</Country><MedlineTA>Zhonghua Wei Zhong Bing Ji Jiu Yi Xue</MedlineTA><NlmUniqueID>101604552</NlmUniqueID></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D004365">Drugs, Chinese Herbal</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D057225" MajorTopicYN="N">Data Mining</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004365" MajorTopicYN="Y">Drugs, Chinese Herbal</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008516" MajorTopicYN="Y">Medicine, Chinese Traditional</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000093485" MajorTopicYN="Y">COVID-19 Drug Treatment</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>12</Month><Day>27</Day><Hour>5</Hour><Minute>33</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>12</Month><Day>28</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>12</Month><Day>29</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34955124</ArticleId><ArticleId IdType="doi">10.3760/cma.j.cn121430-20210826-01285</ArticleId></ArticleIdList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">34954805</PMID><DateRevised><Year>2021</Year><Month>12</Month><Day>26</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1875-8312</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>Dec</Month><Day>26</Day></PubDate></JournalIssue><Title>The international journal of cardiovascular imaging</Title><ISOAbbreviation>Int J Cardiovasc Imaging</ISOAbbreviation></Journal>Epicardial fat volume is associated with preexisting atrioventricular conduction abnormalities and increased pacemaker implantation rate in patients undergoing transcatheter aortic valve implantation.
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Epicardial fat tissue (EFT) is a highly metabolically active fat depot surrounding the heart and coronary arteries that is related to early atherosclerosis and adverse cardiac events. We aimed to investigate the relationship between the amount of EFT and preexisting cardiac conduction abnormalities (CCAs) and the need for new postinterventional pacemaker in patients with severe aortic stenosis planned for transcatheter aortic valve implantation (TAVI). A total of 560 consecutive patients (54% female) scheduled for TAVI were included in this retrospective study. EFT volume was measured via a fully automated artificial intelligence software (QFAT) using computed tomography (CT) performed before TAVI. Baseline CCAs [first-degree atrioventricular (AV) block, right bundle branch block (RBBB), and left bundle branch block (LBBB)] were diagnosed according to 12-lead ECG before TAVI. Aortic valve calcification was determined by the Agatston score assessed in the pre-TAVI CT. The median EFT volume was 129.5 ml [IQR 94-170]. Baseline first-degree AV block was present in 17%, RBBB in 10.4%, and LBBB in 10.2% of the overall cohort. In adjusted logistic regression analysis, higher EFT volume was associated with first-degree AV block (OR 1.006 [95% CI 1.002-1.010]; p = 0.006) and the need for new pacemaker implantation after TAVI (OR 1.005 [95% CI 1.0-1.01]; p = 0.035) but not with the presence of RBBB or LBBB. EFT volume did not correlate with the Agatston score of the aortic valve. Greater EFT volume is associated independently with preexisting first-degree AV block and new pacemaker implantation in patients undergoing TAVI. It may play a causative role in degenerative processes and the susceptibility of the AV conduction system.
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2,335,868 |
Encapsulation of doxorubicin prodrug in heat-triggered liposomes overcomes off-target activation for advanced prostate cancer therapy.
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L-377,202 prodrug consists of doxorubicin (Dox) conjugated to a prostate-specific antigen (PSA) peptide substrate that can be cleaved by enzymatically active PSA at the tumor site. Despite the initial promise in phase I trial, further testing of L-377,202 (herein called Dox-PSA) was ceased due to some degree of non-specific activation and toxicity concerns. To improve safety of Dox-PSA, we encapsulated it into low temperature-sensitive liposomes (LTSL) to bypass systemic activation, while maintaining its biological activity upon controlled release in response to mild hyperthermia (HT). A time-dependent accumulation of activated prodrug in the nuclei of PSA-expressing cells exposed to mild HT was observed, showing that Dox-PSA was efficiently released from the LTSL, cleaved by PSA and entering the cell nucleus as free Dox. Furthermore, we have shown that Dox-PSA loading in LTSL can block its biological activity at 37°C, while the combination with mild HT resulted in augmented cytotoxicity in both 2D and 3D PC models compared to the free Dox-PSA. More importantly, Dox-PSA encapsulation in LTSL prolonged its blood circulation and reduced Dox accumulation in the heart of C4-2B tumor-bearing mice over the free Dox-PSA, thus significantly improving Dox-PSA therapeutic window. Finally, Dox-PSA-loaded LTSL combined with HT significantly delayed tumor growth at a similar rate as mice treated with free Dox-PSA in both solid and metastatic PC tumor models. This indicates this strategy could block the systemic cleavage of Dox-PSA without reducing its efficacy in vivo, which could represent a safer option to treat patients with locally advanced PC. STATEMENT OF SIGNIFICANCE: This study investigates a new tactic to tackle non-specific cleavage of doxorubicin PSA-activatable prodrug (L-377,202) to treat advanced prostate cancer. In the present study, we report a nanoparticle-based approach to overcome the non-specific activation of L-377,202 in the systemic circulation. This includes encapsulating Dox-PSA in low temperature-sensitive liposomes to prevent its premature hydrolysis and non-specific cleavage. This class of liposomes offers payload protection against degradation in plasma, improved pharmacokinetics and tumor targeting, and an efficient and controlled drug release triggered by mild hyperthermia (HT) (∼42°C). We believe that this strategy holds great promise in bypassing any systemic toxicity concerns that could arise from the premature activation of the prodrug whilst simultaneously being able to control the spatiotemporal context of Dox-PSA cleavage and metabolism.
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2,335,869 |
Thoracic Spinal Angiolipomas: A Systematic Review.
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 Spinal angiolipomas (SAs) are rare, benign tumors, representing 0.0004 to 1.2% of angiolipomas, usually located at the extradural and posterior thoracic level, with multimetameric extension.</AbstractText> A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The authors searched on PubMed and Scopus databases for published articles with the Mesh term "spinal angiolipoma" and pertinent associations. Language restriction to English papers was applied. The authors also reported three emblematic cases of patients who underwent surgical resection of spindle-shaped (type IA) and dumbbell-shaped (type II) SAs between 2014 and 2020.</AbstractText> Of the 256 retrieved articles, 33 were included in the meta-analysis. These 33 studies, together with our 3 reported cases, included a total of 60 patients, 36 females (60%) and 24 males (40%), with a mean age of 53.12 ± 12.82 years (range: 12-77 years).T5 was the most represented level (22 patients). Usually, the localization of SA was extradural, with 53 patients suffering from spindle-shaped type IA SA (88.3%) and 7 patients from dumbbell-shaped type II SA (11.6%). Almost all patients underwent laminectomy (78.3%) and presented a full recovery of motor deficits (85%). Gross total removal (GTR) was performed in 93.3% of patients. The mean follow-up was of 22.71 ± 21.45 months (range: 2-80 months). There was no documented recurrence at follow-up magnetic resonance imaging in any of the patients.</AbstractText> SAs are rare, benign tumors with a great vascular component that presents a favorable outcome. GTR is the gold standard treatment and usually an adjuvant therapy is not required. Even infiltrative lesions, which are more complex, can be treated successfully with a good prognosis. Dumbbell-shaped SAs must be differentiated from schwannomas and meningiomas, and require different surgical techniques, given the profuse bleeding associated with the attempt of debulking. En block resection is the key to treat these common benign tumors with acceptable blood loss.</AbstractText>Thieme. All rights reserved.</CopyrightInformation>
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2,335,870 |
A systematic review and metanalysis of diagnostic yield of BAL for detection of SARS-CoV-2.
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The gold standard for diagnosing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is microbiological confirmation by reverse transcriptase-polymerase chain reaction (RT-PCR)1</sup> most commonly done using oropharyngeal (OP) and nasopharyngeal swabs (NP). But in suspected cases, where these samples are false-negative, bronchoalveolar lavage (BAL) may prove diagnostic.</AbstractText>Hence, the diagnostic yield of BAL for detection of SARS-CoV-2 in cases of non-diagnostic upper respiratory tract samples is reviewed.</AbstractText>Databases such as MEDLINE, Scopus, and Google Scholar were searched using a systematic search strategy. The current study has been in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and has been registered with the International Prospective Registry of Systematic Reviews (CRD42020224088).</AbstractText>911 records were identified at initial database extraction, of which 317 duplicates were removed and, 596 records were screened for inclusion eligibility. We included total 19 studies in the systematic review, and 17 were included in metanalysis. The pooled estimate of SARS-CoV-2 positivity in BAL was 11% (95%CI: 0.01-0.24). A sensitivity analysis also showed that the results appear to be robust and minimal risk of bias amongst the studies.</AbstractText>The current study demonstrates that BAL can be used to diagnose additional cases primary disease and superadded infections in patients with severe COVID-19 lower respiratory tract infection.</AbstractText>Copyright © 2021 Elsevier Inc. All rights reserved.</CopyrightInformation>
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2,335,871 |
Fuzzy Logic Control of Heartrate by Electrical Block of Vagus Nerve.
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Although vagus nerve stimulation (VNS) can be used to reduce heartrate by enhancing parasympathetic activity, a fully controllable intervention would also require a method for downregulating parasympathetic activity. A direct current (DC) block can be applied to a nerve to block its action potential conduction. This nerve block can be used to downregulate parasympathetic activity by blocking afferent reflexes. The damaging effects of reactions that occur at the electrode-nerve interface using conventional platinum electrodes can be avoided by separating the electrode from the nerve. Using a biocompatible, ionically conducting medium, the electrode and the damaging reactions can be isolated in a vessel away from the nerve. This type of electrode has been called the Separated Interface Nerve Electrode (SINE). Fuzzy logic control (FLC) is a controller approach that is well suited to physiological systems. The SINE, controlled by an FLC, was utilized to block a stimulated vagus nerve and regulate heart rate. The FLC was able to maintain the heartrate at a pre-determined setpoint while still achieving instant recovery when the block was removed.
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2,335,872 |
NONMMUT140591.1 may serve as a ceRNA to regulate Gata5 in UT-B knockout-induced cardiac conduction block.
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We intended to explore the potential molecular mechanisms underlying the cardiac conduction block inducted by urea transporter (UT)-B deletion at the transcriptome level. The heart tissues were harvested from UT-B null mice and age-matched wild-type mice for lncRNA sequencing analysis. Based on the sequencing data, the differentially expressed mRNAs (DEMs) and lncRNAs (DELs) between UT-B knockout and control groups were identified, followed by function analysis and mRNA-lncRNA co-expression analysis. The miRNAs were predicted, and then the competing endogenous RNA (ceRNA) network was constructed. UT-B deletion results in the aberrant expression of 588 lncRNAs and 194 mRNAs. These DEMs were significantly enriched in the inflammation-related pathway. A lncRNA-mRNA co-expression network and a ceRNA network were constructed on the basis of the DEMs and DELs. The complement 7 (C7)-NONMMUT137216.1 co-expression pair had the highest correlation coefficient in the co-expression network. NONMMUT140591.1 had the highest degree in the ceRNA network and was involved in the ceRNA of NONMMUT140591.1-mmu-miR-298-5p-<i>Gata5</i> (GATA binding protein 5). UT-B deletion may promote cardiac conduction block via inflammatory process. The ceRNA NONMMUT140591.1-mmu-miR-298-5p-<i>Gata5</i> may be a potential molecular mechanism of UT-B knockout-induced cardiac conduction block.
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2,335,873 |
The Efficacy and Safety of Ultrasound-Guided, Bi-Level, Erector Spinae Plane Block With Different Doses of Dexmedetomidine for Patients Undergoing Video-Assisted Thoracic Surgery: A Randomized Controlled Trial.
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<b>Background:</b> The anesthetic characteristics of ultrasound-guided bi-level erector spinae plane block (ESPB) plus dexmedetomidine (Dex) remain unclear. We compared the efficacy and safety of ultrasound-guided bi-level ESPB plus different doses of Dex in patients undergoing video-assisted thoracic surgery (VATS). <b>Methods:</b> One-hundred eight patients undergoing VATS were randomized into three groups: R group (<i>n</i> = 38, 15 ml of 0.375% ropivacaine with 0.1 mg/kg dexamethasone), RD1 group (<i>n</i> = 38, 15 ml of 0.375% ropivacaine plus 0.5 μg/kg DEX with 0.1 mg/kg dexamethasone) and RD2 group (<i>n</i> = 38, 15 ml of 0.375% ropivacaine plus 1.0 μg/kg DEX with 0.1 mg/kg dexamethasone). The primary outcome was the pain 12 h after surgery. Secondary outcomes included the Prince Henry Hospital Pain Score; hemodynamics; consumption of sufentanil; anesthetized dermatomal distribution; recovery time; rescue analgesia; satisfaction scores of patients and surgeon; quick recovery index; adverse effects; the prevalence of chronic pain and quality of recovery. <b>Results:</b> The visual analog scale (VAS) and the Prince Henry pain score were significantly lower in both the RD1 and RD2 groups during the first 24 h after surgery (<i>P</i> < 0.05). Both VAS with coughing and the Prince Henry pain score were significantly lower in the RD2 group than in the RD1 group 8-24 h after surgery (<i>P</i> < 0.05). Both heart rate and mean arterial pressure were significantly different from T2 to T6 in the RD1 and RD2 groups (<i>P</i> < 0.05). The receipt of remifentanil, propofol, Dex, and recovery time was significantly reduced in the RD2 group (<i>P</i> < 0.05). The requirement for sufentanil during the 8-72 h after surgery, less rescue medication, and total press times were significantly lower in the RD2 group (<i>P</i> < 0.05). The time to the first dose of rescue ketorolac was significantly longer in the RD2 group (<i>P</i> < 0.05). Further, anal exhaust, removal of chest tubes, and ambulation were significantly shorter in the RD2 group (<i>P</i> < 0.05). The incidence of tachycardia, post-operative nausea and vomiting, and chronic pain was significantly reduced in the RD2 group, while the QoR-40 score was significantly higher in the RD2 group (<i>P</i> < 0.05). <b>Conclusions:</b> Pre-operative bi-level, single-injection ESPB plus 1 μg/kg DEX provided superior pain relief and long-term post-operative recovery for patients undergoing VATS. <b>Clinical Trial Registration:</b> http://www.chictr.org.cn/searchproj.aspx.
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2,335,874 |
Bayesian Regularized Strain Imaging for Assessment of Murine Cardiac Function In vivo.
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A cardiac strain imaging framework with adaptive Bayesian regularization (ABR) is proposed for in vivo assessment of murine cardiac function. The framework uses ultrasound (US) radio-frequency data collected with a high frequency (f<sub>c</sub> = 30MHz) imaging system and a multi-level block matching algorithm with ABR to derive inter-frame cardiac displacements. Lagrangian cardiac strain (radial, e<sub>r</sub> and longitudinal, e<sub>l</sub>) tensors were derived by segmenting the myocardial wall starting at the ECG R-wave and accumulating interframe deformations over a cardiac cycle. In vivo feasibility was investigated through a longitudinal study with two mice (one ischemia-perfusion (IR) injury and one sham) imaged at five sessions (pre-surgery (BL) and 1,2,7 and 14 days post-surgery). End-systole (ES) strain images and segmental strain curves were derived for quantitative evaluation. Both mice showed periodic variation of e<sub>r</sub> and e<sub>l</sub> strain at BL with segmental synchroneity. Infarcted regions of IR mouse at Day 14 were associated with reduced or sign reversed ES e<sub>r</sub> and e<sub>l</sub> values while the sham mouse had similar or higher strain than at BL. Infarcted regions identified in vivo were associated with increased collagen content confirmed with Masson's Trichrome stained ex vivo heart sections.Clinical Relevance-Higher quality cardiac strain images derived with RF data and Bayesian regularization can potentially improve the sensitivity and accuracy of non-invasive assessment of cardiovascular disease models.
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2,335,875 |
The role of β<sub>2</sub> adrenergic receptor on infection development after ischaemic stroke.
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Mechanisms underlying post-stroke immune impairments and subsequent development of fatal lung infection have been suggested to involve multiple pathways, including hyperactivation of the sympathetic nervous system (SNS), which results in the excessive release of catecholamines and activation of β-adrenergic receptors (βARs). Indeed, previous reports from experimental studies demonstrated that post-stroke infection can be inhibited with treatment of β-blockers. However, the effectiveness of β-blockers in reducing post-stroke infection has yielded mixed results in retrospective clinical trials and its use remain controversial. In this study, we performed mid-cerebral artery occlusion in mice either genetically deficient in β<sub>2</sub>-adrenergic receptor (β<sub>2</sub>AR) or treated with non-selective and selective βAR antagonists to explore the contributions of the SNS in the development of post-stroke lung infection. Stroke induced a systemic activation of the SNS as indicated by elevated levels of plasma catecholamines and UCP-1 activity. However, β<sub>2</sub>AR deficient mice showed similar degrees of post-stroke immune impairment and infection rate compared to wildtype counterparts, potentially due to compensatory mechanisms common in transgenic animals. To overcome this, we treated post-stroke wildtype mice with pharmacological inhibitors of the βARs, including the non-selective antagonist propranolol (PPL) and selective β<sub>2</sub>AR antagonist ICI-118551. Both pharmacological strategies to block the action of SNS signalling were unable to reduce infection in mice that underwent ischaemic stroke. Overall, our data suggests that other mechanisms independent or in combination with β<sub>2</sub>AR activation contribute to the development of post-stroke infection.
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2,335,876 |
Systemic erythematosus lupus and pregnancy outcomes in a Colombian cohort.
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Pregnant women with SLE have higher probabilities of maternal complications. SLE during pregnancy has alternating patterns of remission and flare-ups; however, most pregnant SLE patients tend to worsen with associated poor obstetric and perinatal outcomes. This study aimed to describe obstetric outcomes in pregnant women with SLE.</AbstractText>This retrospective study was performed between 2011 and 2020 at a highly complex referral health center in Cali, Colombia. Pregnant women with a diagnosis of SLE were included. Demographic, clinical, and laboratory features and obstetric and fetal outcomes, including intensive care unit (ICU) characteristics, were evaluated.</AbstractText>Forty-eight pregnant women with SLE were included. The median age was 29 (25-33.7) years. The SLE diagnosis was made before pregnancy in 38 (79.1%) patients, with a median disease duration of 46 (12-84) months. Thirteen (27.1%) patients had lupus nephritis. Preterm labor (34, 70.8%), preeclampsia (25, 52%), and preterm rupture of membranes (10, 20.8%) were the most common obstetric complications. A relationship between a greater systemic lupus erythematosus pregnancy disease activity index (SLEPDAI) and the development of hypertensive disorders during pregnancy was established (preeclampsia = p</i> < 0.0366; eclampsia = p</i> < 0.0153). A relationship was identified between lupus nephritis (LN) and eclampsia (p</i> < 0.01), preterm labor (p</i> < 0.045), and placental abruption (p</i> < 0.01). Seventeen (35.4%) patients required ICU admission; 52.9% of them were due to AID activity, 17.6% for cardiovascular damage, 11.7% for septic shock, and 5.8% for acute kidney failure. Fetal survival was 89.5% (N</i> = 43/48). Among the live births, two (4.2%) newborns were diagnosed with neonatal lupus, and two (4.2%) were diagnosed with congenital heart block. One maternal death was registered due to preeclampsia and intraventricular hemorrhage.</AbstractText>This study is the first to describe SLE during pregnancy in Colombia. SLE was the most prevalent AID in this cohort, and complications included preterm labor, preeclampsia, and postpartum hemorrhage. A higher SLEPDAI and lupus nephritis predicted adverse maternal outcomes.</AbstractText>
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2,335,877 |
Psychobiological Correlates of Aggression in Female Adolescents with Borderline Personality Disorder.
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Aggressive behavior in reaction to threats, frustration, or provocation is prevalent in borderline personality disorder (BPD). This study investigated aggressive behavior and its biological correlates in adolescents with BPD.</AbstractText>Twenty-one female adolescents with a DSM-IV BPD diagnosis and 25 sex- and age-matched healthy controls participated in the Taylor Aggression Paradigm (TAP), a laboratory-based experiment measuring aggressive behavior in the interpersonal context. Heart rate was measured and saliva samples were taken throughout the experiment.</AbstractText>Multilevel mixed-effects linear regression analyses revealed no significant group difference in aggressive behavior induced by the TAP. Additionally, the two groups did not differ in cortisol, testosterone, and heart rate responses to the aggression induction. The BPD group showed a significant cortisol increase in the time preceding the start of the TAP in contrast to the healthy control group, in whom a significant heart rate increase from baseline to the first block of the TAP was observed.</AbstractText>There was no evidence, either at the phenomenological or the biological level, of increased task-induced aggression in adolescents with BPD. The results may indicate that adolescents with BPD experienced fearful stress in anticipation of the experimental task in contrast to healthy controls who showed an adaptive response of the autonomic nervous system necessary to deal with the upcoming demand.</AbstractText>© 2021 The Author(s) Published by S. Karger AG, Basel.</CopyrightInformation>
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2,335,878 |
The effect of ultrasound-guided low serratus anterior plane block on laparoscopic cholecystectomy postoperative analgesia: A randomized clinical trial.
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Anterior serratus plane block for analgesia in many procedures, but there have been no reports of analgesia undergoing laparoscopic cholecystectomy (LC). We investigated the effects of ultrasonic-guided low serratory anterior block on patients undergoing LC.</AbstractText>One hundred patients who undergo LC were selected and randomly divided into 2 groups: Patients in group C with routine general anesthesia and patients in group S treat low anterior serratus block combined with general anesthesia. The serratus anterior block was performed at the T8 to T9 point after anesthesia induction, before cutting leather (T0), stamp card placement (T1), 2 groups of patients' heart rate (HR), blood pressure were recorded, at the same time dosage of analgesic drugs and postoperative 0.5, 6, 12, 24 hours when resting visual analogue scale (VAS) scores were recorded in 2 groups of patients.</AbstractText>The T0 point, patients' HR, blood pressure had significant difference (P > .05), the T1 point, patients' HR, mean arterial pressure in group S lower than group C (P < .05), the amount of intra-operative propofol and remifentanil, patients in group S were less than in group C (P < .05), and resting VAS pain score at the 0.5, 6, 12 hours after operation patients in group S were lower than group C also (P < .05), resting VAS pain had no significant difference at postoperative 24 hours between 2 groups (P > .05).</AbstractText>Low serratus anterior plane block in LC can provide safe and effective analgesia for patients.</AbstractText>Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.</CopyrightInformation>
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2,335,879 |
Incidence of urethrocutaneous fistula following distal hypospadias repair with and without caudal epidural block: A randomized pilot study.
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Recent investigations have raised a doubt regarding the safety of Caudal epidural block (CEB) administered to children with distal hypospadias undergoing tubularised incised plate (TIP) urethroplasty. The primary objective of the study was to investigate whether there is any association between CEB and the occurrence of urethrocutaneous fistula (UCF) in the postoperative period.</AbstractText>Fifty ASA 1 and 2 children with distal hypospadias aged 0-8 years were randomly allocated to CEB group (GA with CEB, 0.2% ropivacaine 1 ml/kg; n = 25) and Non-CEB group (GA without CEB; n = 25). Penile measurements were taken before and 20 min after administration of CEB to assess penile engorgement. Intraoperative hemodynamics were recorded at 10 min intervals after induction of anaesthesia. Consumption of IV fentanyl intraoperatively and postoperatively in first 24 h was recorded in both the groups. Rescue analgesia was administered for a score >4 on FLACC scale. After surgery children were followed up monthly for first three months and then at 6-months and yearly in paediatric surgery OPD to assess for development of UCF.</AbstractText>UCF was found to occur in only two children, one from each group on follow up, with an overall incidence of 4%. There was no difference in the incidence of UCF in the patients with and without CEB. A 26.8% increase in penile volume from baseline was recorded in CEB group (P = 0.000). The intraoperative heart rate and mean arterial pressure was significantly lower in the CEB group as compared to non CEB group at various time intervals. No additional intraoperative IV fentanyl supplementation was required in CEB group. Fentanyl consumption was significantly less in CEB group postoperatively in first 24 h (P = 0.000).</AbstractText>Administration of CEB was not found to have any impact on UCF formation. No relationship between the increase in penile volume after CEB block and occurrence of UCF was noticed.</AbstractText>Despite increase in penile volume after CEB, there was no difference between the two groups as regards to the occurrence of post operative UCF. CEB is an effective analgesic modality and can be continued to be used till the results of well powered prospective randomised trials with long follow up are reported.</AbstractText>Copyright © 2021 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.</CopyrightInformation>
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2,335,880 |
Successful implantation of S-ICD using the intermuscular two-incision technique in a patient with severe pectus excavatum.
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A patient with severe pectus excavatum, dilated ischemic heart disease, and indication for defibrillator implantation for primary prevention of sudden death underwent successful ultrasound-guided serratus anterior plane block and parasternal block with intermuscular two-incision technique implantation with no complications. At follow-up, all the parameters resulted stable with excellent signal sensing.
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2,335,881 |
Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation.
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Following a single seizure, or recent epilepsy diagnosis, it is difficult to balance risk of medication side effects with the potential to prevent seizure recurrence. A prediction model was developed and validated enabling risk stratification which in turn informs treatment decisions and individualises counselling.</AbstractText>Data from a randomised controlled trial was used to develop a prediction model for risk of seizure recurrence following a first seizure or diagnosis of epilepsy. Time-to-event data was modelled via Cox's proportional hazards regression. Model validity was assessed via discrimination and calibration using the original dataset and also using three external datasets - National General Practice Survey of Epilepsy (NGPSE), Western Australian first seizure database (WA) and FIRST (Italian dataset of people with first tonic-clonic seizures).</AbstractText>People with neurological deficit, focal seizures, abnormal EEG, not indicated for CT/MRI scan, or not immediately treated have a significantly higher risk of seizure recurrence. Discrimination was fair and consistent across the datasets (c-statistics: 0.555 (NGPSE); 0.558 (WA); 0.597 (FIRST)). Calibration plots showed good agreement between observed and predicted probabilities in NGPSE at one and three years. Plots for WA and FIRST showed poorer agreement with the model underpredicting risk in WA, and over-predicting in FIRST. This was resolved following model recalibration.</AbstractText>The model performs well in independent data especially when recalibrated. It should now be used in clinical practice as it can improve the lives of people with single seizures and early epilepsy by enabling targeted treatment choices and more informed patient counselling.</AbstractText>Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.</CopyrightInformation>
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2,335,882 |
Ultrasound-guided supra-inguinal fascia Iliaca compartment block for older adults admitted to the emergency department with hip fracture: a randomized controlled, double-blind clinical trial.
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Hip fracture is common in older adults, and can cause severe post-fracture pain. Fascia iliaca nerve block has consequently been used for preoperative analgesia.</AbstractText>We performed a randomized, controlled, double-blind clinical trial and recruited older patients with hip fractures. These patients were randomized into two groups and received ultrasound-guided fascia iliaca compartment block using either the supra-inguinal approach (group F) or the classical approach (group C). Heart rate, blood pressure, and resting and exercising visual analog scales were recorded before the procedure and at 30 min, and 6, 12, and 24 h after completion of the procedure. We recorded the duration of the procedure-as well as complications such as bleeding, hypotension, and intractable vomiting; the sleep duration in a 24 h period was also documented.</AbstractText>A total of 38 patients completed the trial, and we observed no differences in the baseline characteristics or pre-procedural measurements between the two groups. Compared with the patients in group C, patients in group F exhibited significantly lower exercising VAS scores at 6 and 12 h after the procedure, faster heart rates at 6 and 24 h after the procedure, a longer procedural duration, and a longer sleep duration. There were no differences in the frequencies of complications between the two groups. The percentages of patients who took oral analgesics and the numbers of medications consumed were also not different between the two groups.</AbstractText>The supra-inguinal FICB provided effective analgesia and improved exercise tolerance compared with the classical approach.</AbstractText>The trial was registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100045644, registration date: 2021 April 20).</AbstractText>© 2021. The Author(s).</CopyrightInformation>
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2,335,883 |
Bachmann's bundle-ridge related biatrial tachycardia with a long epicardial circuit.<Pagination><StartPage>134</StartPage><EndPage>136</EndPage><MedlinePgn>134-136</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1111/jce.15305</ELocationID><Abstract><AbstractText>Biatrial tachycardia (BiAT), involving Bachmann's bundle in the circuit, has sometimes been observed after mitral anterior line ablation. In this article, we present a case of BiAT, involving a long epicardial circuit, composed of Bachmann's bundle and the left atrial ridge (LAR). We discuss the optimal ablation technique for this tachycardia based on our experience in addition to the relationship between Bachmann's bundle and the LAR. Furthermore, the evaluation method for the mitral anterior block line is also discussed.</AbstractText><CopyrightInformation>© 2021 Wiley Periodicals LLC.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Shimeno</LastName><ForeName>Kenji</ForeName><Initials>K</Initials><Identifier Source="ORCID">0000-0002-9330-899X</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tamura</LastName><ForeName>Shota</ForeName><Initials>S</Initials><Identifier Source="ORCID">0000-0003-4685-9454</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hayashi</LastName><ForeName>Yusuke</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Abe</LastName><ForeName>Yukio</ForeName><Initials>Y</Initials><Identifier Source="ORCID">0000-0002-6775-6940</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Naruko</LastName><ForeName>Takahiko</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>12</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Cardiovasc Electrophysiol</MedlineTA><NlmUniqueID>9010756</NlmUniqueID><ISSNLinking>1045-3873</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001283" MajorTopicYN="N">Atrioventricular Node</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006325" MajorTopicYN="Y">Heart Atria</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012849" MajorTopicYN="N">Sinoatrial Node</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013610" MajorTopicYN="N">Tachycardia</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Bachmann's bundle</Keyword><Keyword MajorTopicYN="N">biatrial tachycardia</Keyword><Keyword MajorTopicYN="N">epicardial fiber</Keyword><Keyword MajorTopicYN="N">left atrial ridge</Keyword><Keyword MajorTopicYN="N">mitral anterior line</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>10</Month><Day>31</Day></PubMedPubDate><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>10</Month><Day>6</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>11</Month><Day>8</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>12</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>2</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>11</Month><Day>30</Day><Hour>7</Hour><Minute>6</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34845784</ArticleId><ArticleId IdType="doi">10.1111/jce.15305</ArticleId></ArticleIdList><ReferenceList><Title>REFERENCES</Title><Reference><Citation>Mikhaylov EN, Mitrofanova LB, Vander MA, et al. Biatrial tachycardia following linear anterior wall ablation for the perimitral reentry: incidence and electrophysiological evaluations. J Cardiovasc Electrophysiol. 2015;26(1):28-35.</Citation></Reference><Reference><Citation>Kitamura T, Martin R, Denis A, et al. Characteristics of single-loop macroreentrant biatrial tachycardia diagnosed by ultrahigh-resolution mapping system. Circ Arrhythm Electrophysiol. 2018;11(2):e005558.</Citation></Reference><Reference><Citation>Takatsuki S, Fukumoto K, Igawa O, et al. Ridge-related reentry: a variant of perimitral atrial tachycardia. J Cardiovasc Electrophysiol. 2013;24(7):781-787.</Citation></Reference><Reference><Citation>Jiang CX, Dong JZ, Long DY, et al. Ridge-related reentry despite apparent bidirectional mitral isthmus block. Heart Rhythm. 2016;13(9):1845-1851.</Citation></Reference><Reference><Citation>Cabrera JA, Ho SY, Climent V, Sánchez-Quintana D. The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation. Eur Heart J. 2008;29(3):356-362.</Citation></Reference><Reference><Citation>Ammar S, Luik A, Hessling G, et al. Ablation of perimitral flutter: acute and long-term success of the modified anterior line. Europace. 2015;17(3):447-452.</Citation></Reference><Reference><Citation>Maheshwari A, Shirai Y, Hyman MC, et al. Septal versus lateral mitral isthmus ablation for treatment of mitral annular flutter. JACC Clin Electrophysiol. 2019;5(11):1292-1299.</Citation></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="PubMed-not-MEDLINE" VersionID="2" Owner="NLM"><PMID Version="2">34845462</PMID><DateRevised><Year>2022</Year><Month>05</Month><Day>04</Day></DateRevised><Article PubModel="Electronic"><Journal><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Mar</Month><Day>01</Day></PubDate></JournalIssue><Title>medRxiv : the preprint server for health sciences</Title><ISOAbbreviation>medRxiv</ISOAbbreviation></Journal>Higher Limbic and Basal Ganglia volumes in surviving COVID-negative patients and the relations to fatigue.
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Biatrial tachycardia (BiAT), involving Bachmann's bundle in the circuit, has sometimes been observed after mitral anterior line ablation. In this article, we present a case of BiAT, involving a long epicardial circuit, composed of Bachmann's bundle and the left atrial ridge (LAR). We discuss the optimal ablation technique for this tachycardia based on our experience in addition to the relationship between Bachmann's bundle and the LAR. Furthermore, the evaluation method for the mitral anterior block line is also discussed.<CopyrightInformation>© 2021 Wiley Periodicals LLC.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Shimeno</LastName><ForeName>Kenji</ForeName><Initials>K</Initials><Identifier Source="ORCID">0000-0002-9330-899X</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tamura</LastName><ForeName>Shota</ForeName><Initials>S</Initials><Identifier Source="ORCID">0000-0003-4685-9454</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hayashi</LastName><ForeName>Yusuke</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Abe</LastName><ForeName>Yukio</ForeName><Initials>Y</Initials><Identifier Source="ORCID">0000-0002-6775-6940</Identifier><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Naruko</LastName><ForeName>Takahiko</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Department of Cardiology, Osaka City General Hospital, Osaka, Japan.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>12</Month><Day>06</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Cardiovasc Electrophysiol</MedlineTA><NlmUniqueID>9010756</NlmUniqueID><ISSNLinking>1045-3873</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D001281" MajorTopicYN="Y">Atrial Fibrillation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D001283" MajorTopicYN="N">Atrioventricular Node</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006325" MajorTopicYN="Y">Heart Atria</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012849" MajorTopicYN="N">Sinoatrial Node</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D013610" MajorTopicYN="N">Tachycardia</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Bachmann's bundle</Keyword><Keyword MajorTopicYN="N">biatrial tachycardia</Keyword><Keyword MajorTopicYN="N">epicardial fiber</Keyword><Keyword MajorTopicYN="N">left atrial ridge</Keyword><Keyword MajorTopicYN="N">mitral anterior line</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="revised"><Year>2021</Year><Month>10</Month><Day>31</Day></PubMedPubDate><PubMedPubDate PubStatus="received"><Year>2021</Year><Month>10</Month><Day>6</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>11</Month><Day>8</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>12</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2022</Year><Month>2</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>11</Month><Day>30</Day><Hour>7</Hour><Minute>6</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34845784</ArticleId><ArticleId IdType="doi">10.1111/jce.15305</ArticleId></ArticleIdList><ReferenceList><Title>REFERENCES</Title><Reference><Citation>Mikhaylov EN, Mitrofanova LB, Vander MA, et al. Biatrial tachycardia following linear anterior wall ablation for the perimitral reentry: incidence and electrophysiological evaluations. J Cardiovasc Electrophysiol. 2015;26(1):28-35.</Citation></Reference><Reference><Citation>Kitamura T, Martin R, Denis A, et al. Characteristics of single-loop macroreentrant biatrial tachycardia diagnosed by ultrahigh-resolution mapping system. Circ Arrhythm Electrophysiol. 2018;11(2):e005558.</Citation></Reference><Reference><Citation>Takatsuki S, Fukumoto K, Igawa O, et al. Ridge-related reentry: a variant of perimitral atrial tachycardia. J Cardiovasc Electrophysiol. 2013;24(7):781-787.</Citation></Reference><Reference><Citation>Jiang CX, Dong JZ, Long DY, et al. Ridge-related reentry despite apparent bidirectional mitral isthmus block. Heart Rhythm. 2016;13(9):1845-1851.</Citation></Reference><Reference><Citation>Cabrera JA, Ho SY, Climent V, Sánchez-Quintana D. The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation. Eur Heart J. 2008;29(3):356-362.</Citation></Reference><Reference><Citation>Ammar S, Luik A, Hessling G, et al. Ablation of perimitral flutter: acute and long-term success of the modified anterior line. Europace. 2015;17(3):447-452.</Citation></Reference><Reference><Citation>Maheshwari A, Shirai Y, Hyman MC, et al. Septal versus lateral mitral isthmus ablation for treatment of mitral annular flutter. JACC Clin Electrophysiol. 2019;5(11):1292-1299.</Citation></Reference></ReferenceList></PubmedData></PubmedArticle><PubmedArticle><MedlineCitation Status="PubMed-not-MEDLINE" VersionID="2" Owner="NLM"><PMID Version="2">34845462</PMID><DateRevised><Year>2022</Year><Month>05</Month><Day>04</Day></DateRevised><Article PubModel="Electronic"><Journal><JournalIssue CitedMedium="Internet"><PubDate><Year>2022</Year><Month>Mar</Month><Day>01</Day></PubDate></JournalIssue><Title>medRxiv : the preprint server for health sciences</Title><ISOAbbreviation>medRxiv</ISOAbbreviation></Journal><ArticleTitle>Higher Limbic and Basal Ganglia volumes in surviving COVID-negative patients and the relations to fatigue.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">2021.11.23.21266761</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1101/2021.11.23.21266761</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="UNASSIGNED">Among systemic abnormalities caused by the novel coronavirus, little is known about the critical attack on the central nervous system (CNS). Few studies have shown cerebrovascular pathologies that indicate CNS involvement in acute patients. However, replication studies are necessary to verify if these effects persist in COVID-19 survivors more conclusively. Furthermore, recent studies indicate fatigue is highly prevalent among 'long-COVID' patients. How morphometry in each group relate to work-related fatigue need to be investigated.<AbstractText Label="METHOD" NlmCategory="UNASSIGNED">COVID survivors were MRI scanned two weeks after hospital discharge. We hypothesized, these survivors will demonstrate altered gray matter volume (GMV) and experience higher fatigue levels when compared to healthy controls, leading to stronger correlation of GMV with fatigue. Voxel-based morphometry was performed on T1-weighted MRI images between 46 survivors and 30 controls. Unpaired two-sample t-test and multiple linear regression were performed to observe group differences and correlation of fatigue with GMV.<AbstractText Label="RESULTS" NlmCategory="UNASSIGNED">The COVID group experienced significantly higher fatigue levels and GMV of this group was significantly higher within the <i>Limbic System</i> and <i>Basal Ganglia</i> when compared to healthy controls. Moreover, while a significant positive correlation was observed across the whole group between GMV and self-reported fatigue, COVID subjects showed stronger effects within the <i>Posterior Cingulate, Precuneus</i> and <i>Superior Parietal Lobule</i> .<AbstractText Label="CONCLUSION" NlmCategory="UNASSIGNED">Brain regions with GMV alterations in our analysis align with both single case acute patient reports and current group level neuroimaging findings. We also newly report a stronger positive correlation of GMV with fatigue among COVID survivors within brain regions associated with fatigue, indicating a link between structural abnormality and brain function in this cohort.
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2,335,884 |
Pathophysiological metabolic changes associated with disease modify the proarrhythmic risk profile of drugs with potential to prolong repolarisation.
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Hydroxychloroquine, chloroquine and azithromycin are three drugs that were proposed to treat coronavirus disease 2019 (COVID-19). While concern already existed around their proarrhythmic potential, there are little data regarding how altered physiological states encountered in patients such as febrile state, electrolyte imbalances or acidosis might change their risk profiles.</AbstractText>Potency of human ether-à-go-go related gene (hERG) block was measured using high-throughput electrophysiology in the presence of variable environmental factors. These potencies informed simulations to predict population risk profiles. Effects on cardiac repolarisation were verified in human induced pluripotent stem cell-derived cardiomyocytes from multiple individuals.</AbstractText>Chloroquine and hydroxychloroquine blocked hERG with IC50</sub> of 1.47 ± 0.07 and 3.78 ± 0.17 μM, respectively, indicating proarrhythmic risk at concentrations effective against severe acute respiratory syndrome-coronovirus-2 (SARS-CoV-2) in vitro. Hypokalaemia and hypermagnesaemia increased potency of chloroquine and hydroxychloroquine, indicating increased proarrhythmic risk. Acidosis significantly reduced potency of all drugs, whereas increased temperature decreased potency of chloroquine and hydroxychloroquine against hERG but increased potency for azithromycin. In silico simulations demonstrated that proarrhythmic risk was increased by female sex, hypokalaemia and heart failure and identified specific genetic backgrounds associated with emergence of arrhythmia.</AbstractText>Our study demonstrates how proarrhythmic risk can be exacerbated by metabolic changes and pre-existing disease. More broadly, the study acts as a blueprint for how high-throughput in vitro screening, combined with in silico simulations, can help guide both preclinical screening and clinical management of patients in relation to drugs with potential to prolong repolarisation.</AbstractText>© 2021 The British Pharmacological Society.</CopyrightInformation>
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2,335,885 |
Quantitative Evaluation of Cardiac Cell Interactions and Responses to Cyclic Strain.
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The heart has a dynamic mechanical environment contributed by its unique cellular composition and the resultant complex tissue structure. In pathological heart tissue, both the mechanics and cell composition can change and influence each other. As a result, the interplay between the cell phenotype and mechanical stimulation needs to be considered to understand the biophysical cell interactions and organization in healthy and diseased myocardium. In this work, we hypothesized that the overall tissue organization is controlled by varying densities of cardiomyocytes and fibroblasts in the heart. In order to test this hypothesis, we utilized a combination of mechanical strain, co-cultures of different cell types, and inhibitory drugs that block intercellular junction formation. To accomplish this, an image analysis pipeline was developed to automatically measure cell type-specific organization relative to the stretch direction. The results indicated that cardiac cell type-specific densities influence the overall organization of heart tissue such that it is possible to model healthy and fibrotic heart tissue in vitro. This study provides insight into how to mimic the dynamic mechanical environment of the heart in engineered tissue as well as providing valuable information about the process of cardiac remodeling and repair in diseased hearts.
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2,335,886 |
Comparison of Thoracic Epidural Analgesia and Thoracic Paravertebral Block Applications in the Treatment of Acute Pain After Thoracotomy in Geriatric Patients.
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Background Thoracic epidural analgesia (TEA) and thoracic paravertebral block (TPVB) are commonly used in geriatric patients for pain management after thoracotomy. In this study, we aimed to investigate the effect of TEA and TPVB on postoperative analgesia in geriatric patients who underwent thoracotomy. Methodology Postoperative analgesia follow-up files of patients over 65 years of age who underwent thoracotomy were analyzed retrospectively. Patient's demographic data, diagnosis, type of surgery, postoperative 24-hour mean arterial pressure (MAP), heart rate, respiratory rate, peripheral oxygen saturation, static/dynamic visual analog scale (VAS) scores, need for additional analgesics, global pain assessment, and side effects such as nausea, vomiting, hypotension, bradycardia, and respiratory depression were examined. The patients were divided into two groups: those treated with TEA (Group 1) and those treated with TPVB (Group 2). Results There was no statistically significant difference between the groups in terms of demographic data (p > 0.05). MAP in the TEA group was statistically significantly lower than in the second and sixth-hour TPVB group (p = 0.008, p < 0.001). VAS static scores in the TEA group were statistically significantly lower at 30 minutes (p = 0.001), and at one, two, six, twelve, and twenty-four hours compared to the TPVB group (p < 0.001, except at 30 minutes). VAS dynamic scores were statistically significantly lower in the TEA group at 30 minutes, and at one, two, six, twelve, and twenty-four hours compared to the TPVB group (p < 0.001). There was no statistically significant difference between the groups in terms of nausea, vomiting, hypotension, and bradycardia (p > 0.05). The use of additional analgesics in the TEA group was statistically significantly lower than in the TPVB group (p < 0.001). Conclusions More effective postoperative analgesia results with stable hemodynamic conditions were observed in geriatric patients who underwent TEA for thoracotomy compared to TPVB. Regarding side effects, although there was a lower incidence in TPVB, this was not statistically significant when compared to TEA. TEA, as a component of the multimodal analgesia approach, can be accepted as a safe and effective method in the elderly patient group who underwent thoracotomy.
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2,335,887 |
On the taxonomic validity of Indian ground spiders: V. Genera Megamyrmaekion Reuss, 1834, Sosticus Chamberlin, 1922 and Gaviphosa gen. nov. (Araneae: Gnaphosidae).
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Indian Megamyrmaekion and Sosticus species are revised, mostly based on the type material available in the National Zoological Collection, Zoological Survey of India, Kolkata. The following new synonymies are recognised: Megamyrmaekion ashae syn. nov. is synonymised with Megamyrmaekion caudatum Reuss, 1834, Megamyrmaekion kajalae syn. nov. with Drassodes luridus (O. Pickard-Cambridge, 1874), Sosticus jabalpurensis syn. nov. and Sosticus sundargarhensis syn. nov., both with the liocranid species Sphingius barkudensis Gravely, 1931 and Sosticus poonaensis syn. nov. with the liocranid species Sphingius caniceps Simon, 1906. The following new combinations are recognised: Poecilochroa jodhpurense (Gajbe, 1993) comb. nov., ex. Megamyrmaekion, Urozelotes pawani (Gajbe, 1993) comb. nov., Sphingius dherikanalensis (Gajbe, 1979) comb. nov., Sphingius nainitalensis (Gajbe, 1979) comb. nov. and Sphingius solanensis (Gajbe, 1979) comb. nov., all ex. Sosticus. All the examined type material are imaged and supplementary descriptions for P. jodhpurense comb. nov. and U. pawani comb. nov. are provided. A new monotypic genus, Gaviphosa Sankaran, 2021 gen. nov. for Gaviphosa kera Sankaran, 2021 gen. et sp. nov., featured by dorsal tibial apophysis is described and illustrated in detail from the southern Western Ghats of India.
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2,335,888 |
Evaluation of the Analgesic Efficacy of Bilateral Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Post-Sternotomy Pain: A Randomized Controlled Trial.
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Transverse thoracic block is a new perioperative analgesic method for post-sternotomy discomfort. This study discusses the efficacy of an ultrasound-guided transversus thoracic muscle plane block (TTPB) in patients undergoing heart surgery, including sternotomy.</AbstractText>In this prospective trial, 60 patients were randomly assigned to two groups: transversus (T) or general anesthesia (GA). Patients in the T group received TTPB with GA and 15 mL of 0.25% bupivacaine was administered on either side. Patients in the GA group received TTPB along with GA, but 15 mL saline was injected on either side instead. The patients were followed up postoperatively. The percentage of patients receiving additional opioids, extubation time, intensive care unit (ICU) length, postoperative morphine dose, and adverse events were documented.</AbstractText>The percentage of patients requiring additional morphine was significantly lower in the T group (p<0.015). Pain scores were comparable between the groups at extubation time and 18 h postoperatively. At 8, 12, and 24 h after surgery, pain scores in the T group were significantly lower (P<0.001). The total amount of morphine required after surgery was much lower in the T group (8±0.74 mg), and the duration to initial analgesic necessity was significantly greater in the GA group (P<0.001). Patients in the GA group had a considerably longer ventilation time (11.07±0.64) (P<0.001). The ICU stay in the T group was substantially shorter (P<0.001), and postoperative complications were comparable.</AbstractText>For patients undergoing heart surgery, TTPB offers sufficient postoperative pain control, resulting in lower pain scores, lower postoperative analgesic doses, shorter extubation times, and shorter ICU stay lengths.</AbstractText>© 2021 Shokri et al.</CopyrightInformation>
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2,335,889 |
Sniffing the human body volatile hexadecanal blocks aggression in men but triggers aggression in women.
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In terrestrial mammals, body volatiles can effectively trigger or block conspecific aggression. Here, we tested whether hexadecanal (HEX), a human body volatile implicated as a mammalian-wide social chemosignal, affects human aggression. Using validated behavioral paradigms, we observed a marked dissociation: Sniffing HEX blocked aggression in men but triggered aggression in women. Next, using functional brain imaging, we uncovered a pattern of brain activity mirroring behavior: In both men and women, HEX increased activity in the left angular gyrus, an area implicated in perception of social cues. HEX then modulated functional connectivity between the angular gyrus and a brain network implicated in social appraisal (temporal pole) and aggressive execution (amygdala and orbitofrontal cortex) in a sex-dependent manner consistent with behavior: increasing connectivity in men but decreasing connectivity in women. These findings implicate sex-specific social chemosignaling at the mechanistic heart of human aggressive behavior.
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2,335,890 |
Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique.
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An interscalene brachial plexus block is a commonly conducted nerve block for anesthesia and analgesia in shoulder surgery. Due to its proximity to the targeted nerve, the phrenic nerve, which innervates the diaphragm, is typically inadvertently blocked by ventral spread of the local anesthetic. Although hemidiaphragmatic paresis is tolerable in healthy patients, it would be an irreversible risk to patients with compromised lung reserve.</AbstractText>To investigate the effect of interscalene brachial plexus block on hemidiaphragmatic paresis by comparing the conventional local anesthetic volume with a reduced experimental volume at a more specific position using an ultrasound-guided 2-point injection technique.</AbstractText>Prospective, randomized controlled study registered with the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp. KCT0005575. 04/11/2020).</AbstractText>This study was conducted at a single hospital affiliated with an academic institution between April and December 2020.</AbstractText>Patients undergoing brisement manipulation and arthroscopic shoulder surgery were randomized to the experimental (10 mL of ropivacaine 0.5%) and control groups (15 mL of ropivacaine 0.5%). Fifty-two patients who received an interscalene brachial plexus block for anesthesia and analgesia in the shoulder region. The interscalene block was performed using a 2-point injection and  observing the spread pattern of the local anesthetic. The primary outcome was the incidence of hemidiaphragmatic paresis, estimated by the thickening fraction of the diaphragm. The secondary outcomes included oxygen saturation, presence of dyspnea, resting pain score, and handgrip strength score.</AbstractText>Thickening fraction was significantly decreased in the control group compared with the experimental group (median [interquartile range], 13.9 [10.0-18.5] versus 28.5 [14.5-38.8], P < 0.001). The incidence of hemidiaphragmatic paresis was significantly higher in the control group than in the experimental group (92.3% versus 53.8%, P = 0.004). Handgrip strength was significantly reduced in the control group compared with the experimental group (P = 0.029).</AbstractText>We did not perform a phrenic nerve conduction study, as it is rarely performed in routine clinical operations. We did not formally assess the distance and spatial relationship of the phrenic nerve to the targeted nerve. Outcome variables including pain assessment were limited to the immediate postoperative period.</AbstractText>Reducing the local anesthetic volume by selective injection and observing the spread pattern resulted in a decreased incidence of hemidiaphragmatic paresis and preserved handgrip strength after interscalene block.</AbstractText>
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2,335,891 |
Effects of 16 weeks of pyramidal and polarized training intensity distributions in well-trained endurance runners.
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The aim of this study was to investigate the effects of four different training periodizations, based on two different training intensity distributions during a 16-week training block in well-trained endurance runners. Sixty well-trained male runners were divided into four groups. Each runner completed one of the following 16-week training interventions: a pyramidal periodization (PYR); a polarized periodization (POL); a pyramidal periodization followed by a polarized periodization (PYR → POL); and a polarized periodization followed by a pyramidal periodization (POL → PYR). The PYR and POL groups trained with a pyramidal or polarized distribution for 16 weeks. To allow for the change in periodization for the PYR → POL and POL → PYR groups, the 16-week intervention was split into two 8-week phases, starting with pyramidal or polarized distribution and then switching to the other. The periodization patterns were isolated manipulations of training intensity distribution, while training load was kept constant. Participants were tested pre-, mid- and post-intervention for body mass, velocity at 2 and 4 mmol·L<sup>-1</sup> of blood lactate concentration (vBLa2, vBLa4), absolute and relative peak oxygen consumption ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mrow><mml:mn>2</mml:mn> <mml:mtext>peak</mml:mtext></mml:mrow> </mml:msub> </mml:mrow> </mml:math> ) and 5-km running time trial performance. There were significant group × time interactions for relative <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mrow><mml:mn>2</mml:mn> <mml:mtext>peak</mml:mtext></mml:mrow> </mml:msub> </mml:mrow> </mml:math> (p < 0.0001), vBLa2 (p < 0.0001) and vBLa4 (p < 0.0001) and 5-km running time trial performance (p = 0.0001). Specifically, participants in the PYR → POL group showed the largest improvement in all these variables (~3.0% for relative <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mrow><mml:mn>2</mml:mn> <mml:mtext>peak</mml:mtext></mml:mrow> </mml:msub> </mml:mrow> </mml:math> , ~1.7% for vBLa2, ~1.5% for vBLa4, ~1.5% for 5-km running time trial performance). No significant interactions were observed for body mass, absolute <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mrow><mml:mn>2</mml:mn> <mml:mtext>peak</mml:mtext></mml:mrow> </mml:msub> </mml:mrow> </mml:math> , peak heart rate, lactate peak and rating of perceived exertion. Each intervention effectively improved endurance surrogates and performance in well-trained endurance runners. However, the change from pyramidal to polarized distribution maximized performance improvements, with relative <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow><mml:mover><mml:mi>V</mml:mi> <mml:mo>˙</mml:mo></mml:mover> <mml:msub><mml:mi>O</mml:mi> <mml:mrow><mml:mn>2</mml:mn> <mml:mtext>peak</mml:mtext></mml:mrow> </mml:msub> </mml:mrow> </mml:math> representing the only physiological correlate.
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2,335,892 |
Is Opioid-free Anesthesia Possible by Using Erector Spinae Plane Block in Spinal Surgery?
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Erector spinae plane (ESP) block can be a method to be used for postoperative pain control in lumbar herniated disc operations. The aim of this study is to investigate the effect of erector spinae block in lumbar herniated disc operation on intraoperative and postoperative opioid consumption.</AbstractText>Sixty patients scheduled for lumbar herniated disc surgery were included in the study. Patients were randomized into two groups: ESP block and control. Ultrasound-guided ESP block with 20 ml 0.25% bupivacaine at the bilateral L3 vertebral level was applied preoperatively to all patients in the ESP group. Patients in both groups were provided with intravenous patient-controlled analgesia (PCA) device containing fentanyl for postoperative analgesia. Fentanyl consumption and visual analogue scale (VAS) score were recorded at 15 min, 1, 6, 12, and 24 hours postoperatively.</AbstractText>Fentanyl consumption (group C: 59.3 ± 20.66, group E: 41.3 ± 21.61, p: 0,02) and VAS score (group C: VASm 4 (2-4), group E: 2 (2-4), p: 0.009) decreased with ESP block application at postoperative one hour. No difference was detected between the two groups in terms of fentanyl consumption and VAS score at 6, 12, and 24 hours postoperatively (p>0.05). The intraoperative heart rate of patients in the ESP group was lower than the control group (p<0.05).</AbstractText>ESP block decreases opioid consumption and VAS score at postoperative one hour in patients, and also patients who receive ESP block do not require intraoperative opioid administration.</AbstractText>Copyright © 2021, Taşkaldıran et al.</CopyrightInformation>
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2,335,893 |
The analgesic effect and inflammatory mechanism of nonsteroidal analgesics combined with nerve block in post-gynecologic surgery patients.
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To investigate the analgesic effect and inflammatory mechanism of nonsteroidal analgesics combined with nerve block in post-gynecologic surgery patients.</AbstractText>Sixty patients who underwent gynecological laparotomies in our hospital were enrolled in this retrospective cohort study, with 30 patients administered nonsteroidal analgesics combined with nerve block (the observation group) and 30 patients administered nonsteroidal analgesics alone (the control group). The patients in the observation group were administered an intravenous injection of flurbiprofen axetil 1 mg/kg before the end of the operation, and 0.375% ropivacaine was used for bilateral transversus abdominis plane block after the operation. The patients in the control group were administered only an intravenous injection of flurbiprofen axetil 1 mg/kg before the end of the operation. The blood pressure (BP), heart rate (HR), visual analogue scale (VAS) scores, and the numerical rating scale (NRS) scores were recorded before the operation (T0) and at 1 h (T1), 6 h (T2), 12 h (T3), and 24 h (T4) after the recovery from the anesthesia. The incidences of emergence agitation, and the operation and recovery times in the two groups were recorded. Blood samples were collected before and at one day after the operations to measure the inflammatory factor levels such as IL-6, IL-1β, and TNF-α.</AbstractText>The BP, HR, and the VAS and NRS scores in the observation group at T1, T2, T3, and T4 were lower than they were in the control group (P<0.01). The inflammatory factor levels after the operation in the observation group were lower than they were in the control group (P<0.01). There was no significant difference in the incidences of complications between the two groups (P>0.05).</AbstractText>Flurbiprofen axetil combined with ropivacaine for bilateral transversus abdominis plane block has a significant analgesic effect on patients after gynecologic surgery. The mechanism may be due to the fact that nonsteroidal analgesics combined with nerve block further reduce the inflammatory factors in the body, which proves the superiority of multimodal analgesia.</AbstractText>AJTR Copyright © 2021.</CopyrightInformation>
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2,335,894 |
Blockade of IL-6/IL-6R Signaling Attenuates Acute Antibody-Mediated Rejection in a Mouse Cardiac Transplantation Model.
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Acute antibody-mediated rejection (AAMR) is an important cause of cardiac allograft dysfunction, and more effective strategies need to be explored to improve allograft prognosis. Interleukin (IL)-6/IL-6R signaling plays a key role in the activation of immune cells including B cells, T cells and macrophages, which participate in the progression of AAMR. In this study, we investigated the effect of IL-6/IL-6R signaling blockade on the prevention of AAMR in a mouse model. We established a mouse model of AAMR for cardiac transplantation <i>via</i> presensitization of skin grafts and addition of cyclosporin A, and sequentially analyzed its features. Tocilizumab, anti-IL-6R antibody, and recipient IL-6 knockout were used to block IL-6/IL-6R signaling. We demonstrated that blockade of IL-6/IL-6R signaling significantly attenuated allograft injury and improved survival. Further mechanistic research revealed that signaling blockade decreased B cells in circulation, spleens, and allografts, thus inhibiting donor-specific antibody production and complement activation. Moreover, macrophage, T cell, and pro-inflammatory cytokine infiltration in allografts was also reduced. Collectively, we provided a highly practical mouse model of AAMR and demonstrated that blockade of IL-6/IL-6R signaling markedly alleviated AAMR, which is expected to provide a superior option for the treatment of AAMR in clinic.
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2,335,895 |
Cardiac risk assessment with the Revised Cardiac Risk Index index before elective non-cardiac surgery: A retrospective audit from an Australian tertiary hospital.
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Clinicians assessing cardiac risk as part of a comprehensive consultation before surgery can use an expanding set of tools, including predictive risk calculators, cardiac stress tests and measuring serum natriuretic peptides. The optimal assessment strategy is unclear, with conflicting international guidelines. We investigated the prognostic accuracy of the Revised Cardiac Risk Index for risk stratification and cardiac outcomes in patients undergoing elective non-cardiac surgery in a contemporary Australian cohort. We audited the records for 1465 consecutive patients 45 years and older presenting to the perioperative clinic for elective non-cardiac surgery in our tertiary hospital. We calculated individual Revised Cardiac Risk Index scores and documented any use of preoperative cardiac tests. The primary outcome was any major adverse cardiac events within 30 days of surgery, including myocardial infarction, pulmonary oedema, complete heart block or cardiac death. Myocardial perfusion imaging was the most common preoperative stress test (4.2%, 61/1465). There was no routine investigation of natriuretic peptide levels for cardiac risk assessment before surgery. Major adverse cardiac events occurred in 1.3% (18/1366) of patients who had surgery. The Revised Cardiac Risk Index score had modest prognostic accuracy for major cardiac complications, area under receiver operator curve 0.73, 95% confidence interval 0.60 to 0.86. Stratifying major adverse cardiac events by the Revised Cardiac Risk Index scores 0, 1, 2 and 3 or greater corresponded to event rates of 0.6% (4/683), 0.8% (4/488), 4.1% (6/145) and 8.0% (4/50), respectively. The Revised Cardiac Risk Index had only modest predictive value in our single-centre experience. Patients with a revised cardiac risk index score of 2 or more had an elevated risk of early cardiac complications after elective non-cardiac surgery.
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2,335,896 |
Enhanced Bone Regeneration in Variable-Type Biphasic Ceramic Phosphate Scaffolds Using rhBMP-2.
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Our aim was to investigate the bone regeneration capacity of powder-type biphasic ceramic scaffold (BCP powder), block-type BCP (BCP block), and collagen-added block-type BCP (BCP collagen) with different concentrations of recombinant human bone morphogenetic protein 2 (rhBMP-2) in an animal model. Four rabbits were assigned to each of the following groups: no graft + rhBMP-2 (0.1/0.2 mg/mL), BCP powder + rhBMP-2 (0.1/0.2 mg/mL), BCP block + rhBMP-2 (0.1/0.2 mg/mL), and BCP collagen + rhBMP-2 (0.1/0.2 mg/mL), i.e., a total of 32 rabbits. Polycarbonate tubes (Φ 7 mm × 5 mm) for supporting scaffolds were fixed into a 7 mm round border. Subsequently, 0.1 mL of rhBMP-2 solutions with different concentrations was injected into the tubes. Both radiological and histomorphometric analyses showed that osteogenesis was not enhanced by increasing the concentration of rhBMP-2 in all groups at both 3 and 6 weeks. Radiological analysis showed that bone formation was higher in the BCP collagen group than in the BCP powder and BCP block groups at both rhBMP-2 concentrations at 3 weeks. rhBMP-2 enhanced bone formation; however, as the concentration increased, bone formation could not be enhanced infinitely. Collagen-added alloplastic graft material may be useful for mediating rapid bone formation in initial stages.
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2,335,897 |
Factors predicting difficult spinal block: A single centre study.
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Several factors determine the success of dural puncture. We aimed to assess the association of first puncture success and number of attempts with characteristics of the patient, provider, technique and equipment.</AbstractText>This prospective, observational study was performed in 1647 adult patients undergoing surgery under spinal anesthesia. Patient characteristics, anatomical landmarks, spinal bony deformity, provider experience, technique, skin punctures, needle redirections, subarachnoid space depth, and complications, if any, were noted. Difficult dural puncture was assessed by first puncture success and number of attempts (skin punctures plus needle redirections) required for successful needle placement.</AbstractText>First puncture success was obtained in 872 (52.9%) patients. Failed dural puncture occurred in 4 (0.2%) of 1647 patients. Multivariate logistic regression analysis revealed that longer distance from C7 vertebral spine to tip of coccyx (P</i> = 0.04), lower subarachnoid space depth (P</i> = 0.001), good quality of bony landmarks (P</i> = 0.001) and absence of crowded spine (P</i> = 0.02) were associated with first puncture success. Male gender, poor or no spinal landmarks, presence of bony deformity and lower level of provider's experience predicted increased number of attempts for successful dural puncture.</AbstractText>First puncture success of spinal block was influenced only by patient's anatomical factors, whereas the number of attempts required for successful block were predicted by both provider and patient factors.</AbstractText>Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.</CopyrightInformation>
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2,335,898 |
Inadvertent life-threatening total spinal anesthesia following caudal block in a preschool child underwent urologic surgery: A rare case report.
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Caudal block is considered to be safe and provide optimal analgesia for pediatric patients undergoing sub-umbilical operations. It overcomes opioid-related side effects, particularly the dangers associated with respiratory depression in small children.</AbstractText>A 5-year-old male underwent uneventful hypospadias surgery under general endotracheal anesthesia. Caudal block planned to be administered postoperatively for postoperative analgesia then performed after palpation of sacral cornu with 8 ml of 0.25% bupivacaine. A few minutes later, the patient became apneic, heart rate, blood pressure, and oxygen saturation dropped abruptly-immediate resuscitation with ventilatory support, fluid bolus, and atropine administration. After a minute patients' vital signs returned to the normal range then 2 h later patient started to breathe spontaneously and consciousness is regained. After close follow-up for 24 h in the post-anesthesia care unit patient was discharged to the pediatric ward then discharged to home without any neurologic sequelae after 3 days.</AbstractText>Total spinal anesthesia in a very infrequent incident during central neuraxial blocks, especially in the pediatrics population where a caudal block is usually performed. Manifestation of this event can be detected by loss of consciousness, cessation of respiratory effort, hemodynamic instability, and dilated pupils. Delayed treatment can result in cardiopulmonary arrest.</AbstractText>Unanticipated total spinal anesthesia following central neuraxial blocks can potentially cause severe adverse consequences. Preventive modalities must be employed to avoid this incident. Early recognition and instant management should be instituted to avoid dangerous complications following the total spinal blockade.</AbstractText>Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.</CopyrightInformation>
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2,335,899 |
Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly.
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To compare the safety of different anesthesia methods combined with intravenous fast channel anesthesia in elderly lower extremity surgery and the effect on postoperative outcome.</AbstractText>A total of 106 elderly patients who underwent lower extremity orthopedic surgery in our hospital from February 2018 to February 2021 were selected and randomly divided into the control group (n</i> = 53) and the observation group (n</i> = 53) according to random number table. All patients received intravenous fast-track anesthesia. On this basis, the control group received spinal-epidural anesthesia, and the observation group received iliac fascial space block on the affected side combined with sciatic nerve block. The operation conditions, blood pressure and heart rate changes, awakening time, postoperative ICU admission rate, and complications were compared between the two groups.</AbstractText>There was no statistical difference in the success rate of one-time operation between the two groups (P</i> > 0.05). The times of using analgesics and vasoactive drugs and the dosage of propofol in the observation group during the operation were lower than those in the control group, and the difference was statistically significant (P</i> < 0.05). At T2, T3, and T4, the levels of HR, DBP, and SBP in the observation group were lower than those in the control group, and the difference was statistically significant (P</i> < 0.05). After operation, the time of awakening, spontaneous breathing recovery, and extubation in the observation group were lower than those in the control group, and the difference were statistically significant (P</i> < 0.05). The incidence of complications in the observation group was lower than that in the control group, the cognitive impairment was the most significant one in the incidence of single complication, and the difference was statistically significant (P</i> < 0.05).</AbstractText>Based on the combined intravenous fast channel anesthesia, the operation difficulty of the affected side iliac fascial space block combined with sciatic nerve block is the same as that of spinal-epidural anesthesia. It has a higher success rate of one operation, better analgesic and anesthetic effects during the operation, and little effect on blood flow of patients. It can maintain relatively stable heart rate and blood pressure and does not easily cause postoperative complications. Its safety is higher than that of spinal-epidural anesthesia.</AbstractText>Copyright © 2021 Peng Chen et al.</CopyrightInformation>
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