AUTHOREA
Log in Sign Up Browse Preprints
LOG IN SIGN UP

Preprints

Explore 39,763 preprints on the Authorea Preprint Repository

A preprint on Authorea can be a complete scientific manuscript submitted to a journal, an essay, a whitepaper, or a blog post. Preprints on Authorea can contain datasets, code, figures, interactive visualizations and computational notebooks.
Read more about preprints.

Post Infarction Ventricular Septal Rupture: Transcatheter intervention or Surgical re...
Fahad Alfares
Satinder Sandhu

Fahad Alfares

and 1 more

September 25, 2021
ABSTRACT Post infarction ventricular septal rupture (PIVSR) is an infrequent but potentially fatal complication of acute myocardial infarction. • The 30-day mortality rate with the transcatheter approach when performed in the acute phase (less than two weeks) was 25.3% compared to 50% when surgery is performed in the acute phase (within three weeks). • There is no correlation between defect size and mortality. • NYHA class IV and time to VSD closure are risk predictors for transcatheter closure for a 30-day mortality rate of 31.5%.
MANAGING PLACENTA ACCRETA SPECTRUM IN LOW RESOURCE SETTING USING A NOVEL DISSECTION-F...
Vakkanal Paily
Afshana Sidhik

Vakkanal Paily

and 10 more

November 08, 2021
Objective: Surgical management of Placenta accreta spectrum (PAS) is associated with profuse bleeding and increased risk of operative injury to the adherent pelvic structures. We propose the use of a novel aorta clamp that can occlude the abdominal aorta, without retro-peritoneal dissection, thereby making it easy for the obstetrician to use it. limiting the incident blood loss.Methods: This is a retrospective chart review of 33 women, with varying grades of histopathology confirmed PAS, who were managed as an elective or emergency procedure in a tertiary center in India. In all cases, the novel Paily Aorta Clamp (PAC) was applied just above the bifurcation of the abdominal aorta.Results: Twenty-nine women with advanced grades of PAS, underwent sub-total hysterectomies while four women with low grade (focal) PAS underwent a conservative procedure. The procedures were associated with median estimated intra-operative blood loss of 1000 ± 1500 ml with only 51.5% (n = 17) requiring any blood transfusions. PAC was applied for a median 55 ± 20 minutes and was not associated with any peri-operative aortic wall injury or distal thromboembolic phenomenon.Conclusion: Aortic clamping is feasible without retroperitoneal dissection using the PAC, which can be used to limit operative blood loss and surgical morbidity in PAS disorders.         
Gestational diabetes: False dichotomy and slippery slope
K.S. Joseph
Sid John

K.S. Joseph

and 1 more

September 25, 2021
Gestational diabetes: False dichotomy and slippery slope
Obstetrical management of cancer in pregnancy and risk of adverse pregnancy and neona...
Iben Greiber
Jakob Viuff

Iben Greiber

and 6 more

September 25, 2021
Objectives. To investigate the obstetrical management of cancer in pregnancy and to determine adverse pregnancy and neonatal outcomes. Design. A register-based nationwide historical prospective cohort study. Setting and population. We assessed all pregnancies (N = 4,071,848) in Denmark from 1 January 1973 to 31 December 2018. Methods. We linked data on maternal cancer, obstetrical, and neonatal outcomes. Exposure was defined as pregnancies exposed to maternal cancer (n = 1,068). The control group comprised pregnancies without cancer. The groups were compared using logistic regression analysis and adjusted for potential confounders. Main outcome Measures. The primary outcome was the iatrogenic termination of the pregnancy (induced abortions/labor induction or elective caesarean section). Secondary outcomes were adverse neonatal outcomes. Results. More women with cancer in pregnancy, as compared to the control group, experienced first-trimester induced abortion; adjusted odds ratio (aOR) 3.7 (95% CI 2.8─4.7), second-trimester abortion; aOR 9.0 (6.4─12.6), iatrogenic preterm delivery; aOR 10.9 (8.1─14.7), and iatrogenic delivery below 32 gestational weeks; aOR 16.5 (8.5─32.2). Neonates born to mothers with cancer in pregnancy had a higher risk of respiratory distress syndrome; aOR 1.5 (1.2─2.0), but not of low birth weight; aOR 0.6 (0.4─0.8), admission to neonatal intensive care unit more than seven days; aOR 1.4 (1.1─1.9), neonatal infection; aOR 0.9 (0.5─1.5) nor neonatal mortality; aOR1.3 (0.6─2.6). Conclusion. Cancer in pregnancy implies an increased risk of iatrogenic termination of pregnancy and iatrogenic premature birth. Neonates born to mothers with cancer in pregnancy had no increased risk of severe adverse neonatal outcomes.
Increased risk of abortion after frozen-thawed embryo transfer in women with polycyst...
Qiumin Wang
Yanjun Zheng

Qiumin Wang

and 7 more

September 25, 2021
Abstract Objectives: To investigate pregnancy outcomes after frozen-thawed embryo transfer (FET) according to polycystic ovary syndrome (PCOS) phenotypes. Design: Retrospective study. Setting: University-based centre for reproductive medicine. Participants: 8903 patients who underwent FET between January 2017 and October 2019. Methods: All patients were divided into PCOS and control groups, with the former categorised into four phenotype groups (PCOS phenotypes A, B, C, D) based on Rotterdam criteria. All patient data were retrospectively collected and evaluated. Main outcome measures: Pregnancy outcomes after FET consisted of biochemical, clinical and ectopic pregnancies, abortion, premature delivery and live birth. Results: Women with PCOS phenotype A experienced an increased incidence of biochemical pregnancy, clinical pregnancy and premature delivery compared to those with PCOS phenotype D and in the control group (P < 0.001, P = 0.005, P = 0.006, respectively), while incidences of ectopic pregnancy and live birth were comparable between all groups (P > 0.05). We found significantly higher abortion (P = 0.010) and lower ongoing pregnancy (P = 0.023) rates for women with PCOS phenotypes A and D compared to those in the control group. After adjusting for potential confounders, PCOS phenotypes A and D (vs. control) were associated with an elevated risk of abortion (adjusted odds ratio [OR], 1.476, 95% confidence interval [CI], 1.077–2.024, P = 0.016; adjusted OR, 1.348, 95% CI, 1.080–1.682, P = 0.008, respectively). Conclusions: For the first time, our study demonstrates that women with PCOS phenotypes A and D show an increased risk of abortion after FET.
Impact of pharmacological Interventions on fertility outcomes in women with polycysti...
MOHAMMED ABDALLA
Najeeb  Shah

MOHAMMED ABDALLA

and 7 more

September 25, 2021
Background: Polycystic ovary syndrome (PCOS) is an endocrine condition associated with sub-fertility, infertility and poor reproductive outcomes. Objectives: To review the effectiveness of different pharmacological interventions on fertility outcomes in women with PCOS. Search Strategy: We searched PubMed, MEDLINE, Scopus, Embase, Cochrane Library, Web of Science in April 2020 and updated the search in PubMed March 2021. Selection Criteria: Two independent reviewers selected studies, and only randomised controlled trials (RCTs) were included. Data Collection and Analysis: Thirty-four RCTs that met the eligibility criteria were used to calculate odds ratios (OR) and the 95% confidence interval (95% CI) using the random effect model. Main Results: There was a significant increase in pregnancy rate with follicular stimulating hormone (FSH) vs clomiphene citrate (CC)+ metformin (Odd Ratio(OR):4.08; 95%CI:1.12-14.83,I²=79%), Letrozole vs CC (OR: 1.58; 95%CI: 1.34-1.86, I²= 0%), metformin vs placebo(OR: 3.00; 95%CI: 1.95-4.59, I²= 0%) and with CC+ metformin vs CC (OR: 1.48; 95%CI: 1.02-2.16, I²= 39%). There were significant increases in ovulation rate with CC+ metformin vs FSH (OR: 0.09; 95%CI: 0.02-0.37, I² = 75%), CC+ metformin vs CC (OR: 2.04; 95%CI: 1.35-3.08, I² = 63%) and with Letrozole vs CC (OR: 1.60; 95%CI: 1.02-2.52, I²= 88%). A significant increase in live birth with Letrozole vs CC (OR: 1.63; 95%CI: 1.21-2.21, I² = 0%) was observed. Conclusions: CC, letrozole alone or either added to metformin, were associated with a significant increase in the pregnancy rate, ovulation rate, and live birth rate in women with PCOS. Funding: No fund for the review.
The journey from infertility to uterus transplantation: A mixed-methods study of the...
Anji Wall
Liza Johannesson

Anji Wall

and 5 more

September 25, 2021
Objective: To study the impact of absolute uterine factor infertility (AUFI) and uterus transplantation (UTx) on women, and UTx recipients’ perceptions of Utx and reproductive autonomy Design: Convergent mixed-methods study. Setting: UTx program in a large academic medical centre in the United States. Population/Sample: 20 Utx recipients Methods: A medical chart review was conducted to collect patient demographic information, and clinical outcomes. Semi-structured interviews collected information regarding participants’ experience. Main Outcome Measure(s): The outcomes of interest were participants’ experience of infertility, experience with UTx, and general perceptions of UTx. Results: 7 participants were pregnant (one with a second child), 6 had experienced early graft failure and removal, 5 had delivered a healthy baby, and 4 had a viable graft and were awaiting embryo transfer. The primary themes identified were: the negative impact of AUFI diagnosis on psychological wellbeing, relationships, and female identity; the positive impact of UTx on healing the emotional scars of AUFI, female identity, and value of research trial participation; and the perception of UTx as an expansion of reproductive autonomy. All participants reported Utx was worthwhile, regardless of individual outcome. On bivariate analysis, disease aetiology, having a child after uterus transplantation, experiencing graft failure and current pregnancy were not significantly associated with the impact of AUFI or of UTx on participants’ identities. Conclusion: AUFI has a negative impact on women from a young age, affects multiple relationships, and challenges female identity. UTx helps reverse this impact, transforming women’s life narrative of infertility and enhancing female identity.
Impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK: a nati...
Jonathan Lewin
Ertan Saridogan

Jonathan Lewin

and 4 more

September 25, 2021
Objective: To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level. Design: Population-based national cohort study. Population: All women undergoing endometriosis surgery requiring dissection of the pararectal space in the UK from 2017 to 2020 inclusive. Methods: The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space. Annual audits of this database were obtained from the BSGE. Publicly available data on COVID-19 deaths and population were obtained from the UK Office for National Statistics. Main outcome measures: Numbers of annual BSGE-registered endometriosis operations. Results: A total of 5916 operations were performed. The number of operations decreased by 49.4% overall between 2019 and 2020. The number of endometriosis centres remained the same, however the median number of operations per centre decreased from 21 to 12.5, with a median percentage decrease at each centre of 51.0% (IQR 29.4% – 75.0%). There was no significant change in the type of surgery performed. All 11 administrative regions of Great Britain had reduced numbers of BSGE-registered operations in 2020 compared with the average for 2017-2019, with a median 56.6% decrease (range 6.13% - 68.62%). Regional reduction in operations was significantly correlated with COVID-19 death rates (r=0.557, 95% CI of r 0.048 – 1.00, p=0.037). Conclusions: There has been a dramatic fall in the number of operations for severe endometriosis in Britain during the COVID-19 pandemic.
Maternal lipid profile in pregnancy and embryonic growth: a population-based prospect...
Dionne Gootjes
Anke Posthumus

Dionne Gootjes

and 5 more

September 25, 2021
Objective To investigate the association between the maternal lipid profile in early pregnancy and embryonic growth. Design Prospective population-based cohort study. Setting Rotterdam, the Netherlands. Population We included 1474 women from the Generation R(otterdam) Study. Methods The maternal lipid profile was defined as total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), remnant cholesterol, non-high-density (non-HDL-c) lipoprotein cholesterol concentrations and the triglycerides/high-density lipoprotein (TG/HDL-c) ratio. Additionally, maternal glucose concentrations were assessed. Associations were studied with linear regression models, adjusted for confounding factors: maternal age, pre-pregnancy BMI, parity, educational level, ethnicity, smoking and folic acid supplement use Main Outcome Measures Crown-rump length (CRL). Results Triglycerides and remnant cholesterol concentrations are positively associated with embryonic growth (fully adjusted models, 0.17 SDS: 95% CI 0.03 ; 0.30, and 0.17 SDS: 95% CI 0.04 ; 0.31, respectively). These associations were not present in women with normal weight (triglycerides and remnant cholesterol: fully adjusted model, 0.44 SDS: 95% CI 0.15 ; 0.72). Associations between maternal lipid concentrations and embryonic growth were not attenuated after adjustment for glucose concentrations. Total cholesterol, HDL-c, LDL-c, non-HDL-c concentrations and the TG/HDL-c ratio were not associated with embryonic growth. Conclusions Higher triglycerides and remnant cholesterol concentrations in early pregnancy are associated with increased embryonic growth, most notably in overweight women. Keywords Pregnancy, Cholesterol, Low-density lipoprotein (LDL-c), High-density lipoprotein (HDL-c), Triglycerides, Intrauterine development, Fetal growth, Early pregnancy Tweetable abstract The maternal lipid profile in pregnancy is associated with embryonic growth.
Addressing Beta-lactam Allergy: A Time for action
Elizabeth Philips
Pascal Demoly

Elizabeth Philips

and 2 more

September 25, 2021
Addressing Beta-lactam Allergy: A Time for actionElizabeth J. Phillips, MD, FIDSA, FAAAAI, Pascal Demoly, MD, PhD, Maria J Torres, MD, PhD1 Department of Medicine, Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville Tennessee USA, 2Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch Australia, 3Division of Allergy, Department of Pulmonology, University Hospital of Montepellier, and IDESP, Univ. Montpellier – Inserm, Montpellier France,4Allergy Unit, Hospital Regional Universitario de Malaga-IBIMA-BIONAND-ARADyAL, and Departmento de Medicina, Universidad de Malaga, Malaga, SpainCorrespondence:Elizabeth J. Phillips, MD, FIDSA, FAAAAICenter for Drug Safety and ImmunologyVanderbilt University Medical Center1161 – 21st Avenue SouthNashville, TN 37232(615) 322-9174 (tel)Elizabeth.j.phillips@vumc.orgIt is now 93 years since the discovery of penicillins, and over 75 years since the first use of penicillin. We have entered yet another wave of challenges plagued with antibiotic resistance accelerating at a rate that well exceeds that of new antibiotic development. In the face of these uphill battles, 8-15% of a global population who has had access to care is labeled as penicillin allergic.1 In the United States (US) there are at maximum 6000 specialists who practice allergy out of a total of 700,000 practicing physicians, and not all allergists are proficient in and practice drug allergy. Conservatively out of 30,000,000 who are labeled as penicillin allergic at any one time in the US, this would mean that each allergist would need to delabel a minimum of 6000 patients. In Europe and the United Kingdom, the figures are proportionately identical, with some differences between countries. Even if all patients had equal access to care, this type of scalability remains impossible. This overwhelming burden that threatens to negatively impact healthcare through delays in treatment, higher healthcare utilization and cost, less effective treatment and increased antibiotic resistance and Clostridioides difficile infection, demands a risk-based approach that simplifies the penicillin allergy delabeling process and establishes bridges with non-allergists.1, 2What have we learned that now makes the population level goal of penicillin delabeling achievable? First off, prevention is better than cure. We should critically examine pediatric populations for antibiotic use to address over-prescription of antibiotics including penicillins for viral infections. We should avoid labeling children with benign delayed exanthems that occur in the setting of a likely viral infection as penicillin allergic. When continued treatment is necessary we should in fact encourage “treating through” such reactions. When a label of penicillin allergy seems inevitable in a child we should address this label early and pay particular attention to antibiotic stewardship. New data on serum sickness-like reaction suggests that many of these are likely virally mediated and do not reproduce on ingestion challenge.3 Community based education programs can help disseminate timely information on penicillin allergy to dispel myths and alleviate fears. A label of penicillin allergy should be both viewed and approached as a threat to both individual and public health. On a public health level addressing penicillin allergy should be seen as a broad stewardship tool that provides a level of herd protectiveness against antibiotic resistance. On an individual level a label of penicillin allergy should be approached with the same routineness as any other preventative health check, and primary care physicians and providers should be trained to understand and manage low-risk penicillin allergy labels.4 Patients should regularly discuss their drug allergy passport with their healthcare providers such as pharmacists and physicians. Allergy passports should enable interoperability, high traceability and time-stamped information solving the problem of frequent unavailability and inaccuracy of drug allergy information.5 Risk stratification should occur and if in a low-risk category a patient should be given the option of direct oral challenge and delabeling. Risk stratification to identify by clinical history the low-risk penicillin allergic patients who would be appropriate for simple procedures is key. Several mechanisms now exist to risk stratify those labeled as penicillin allergic in routine clinical practice. These clinical prediction rules provide an evidence base to identify the majority of low-risk penicillin allergy labeled patients who are at low risk for rechallenge reactions.6, 7 In current practice it is likely that less than 1% of such low-risk patients will be at risk for a reaction on ingestion challenge.1, 8To make widespread penicillin allergy delabeling an achievable and scalable goal we must be convinced of the safety of direct ingestion challenges. A randomized study allocated children 5 years or older with low-risk cutaneous reaction to penicillin skin testing followed by amoxicillin challenge versus 2 step direct oral challenge with amoxicillin with tolerance of amoxicillin of 96% of those with direct challenge and only minor reactions in the remainder.9These results have recently been confirmed in an European population of children.10 Aside from the inconvenience and potential need for specialty assessment, for very low-risk patients, the use of skin testing would be expected to perform poorly considering their low pre-test probability of a reaction. Several other studies have demonstrated that a single or two-step direct ingestion challenge with penicillins such as amoxicillin is a safe and practical strategy to remove a label of penicillin allergy.11 Although there is evidence to support the use of risk stratification tools to delabel penicillin allergy under allergist guidance, we require an educational program on drug allergy for primary care physicians as well validation of these risk stratification tools, to show that low-risk penicillin delabeling can be achieved in this setting.Even in the face of risk stratification and safety of direct ingestion challenge, populations are not equal in terms of their medical risk or antibiotic needs. Intuitively populations that serve to benefit from penicillins and other beta lactams have been shown to have inferior outcomes when labeled as penicillin allergic that would benefit from a delabeling intervention. This includes the association of penicillin allergy label and use of an alternative antibiotic with post-operative surgical site infections.12 Other settings where research has shown feasibility in delabeling include children in the emergency department, critically ill populations with high antibiotic needs, and pregnant women where the high rates of surgical delivery and group B Streptococcal colonization in pregnancy create a high demand for penicillin and cephalosporins as safe firstline drugs.1, 13, 14 Increasingly, assessment of unverified penicillin allergy has been recognized as an antibiotic stewardship intervention in immunocompromised states such as transplant and cancer where populations have much to gain by being delabeled.15There is a “time for action” for removal of penicillin allergy labels on a population level but how do we achieve widespread implementation (Figure 1)? Policy changes should be driven by collaboration with Infectious diseases specialists and allergists who should join forces to pair antibiotic allergy management with antibiotic stewardship. In the community we need to educate parents and pediatricians to make them aware of the hazards of both unnecessary antibiotics and penicillin allergy labels for mild rashes that are often related to a viral infection and unlikely to recur. Primary healthcare providers should be given greater incentives to delabel penicillin allergic patients at the point-of-care and armed with decision support tools to facilitate risk stratification. For those whose history is not consistent with allergy this could include direct delabeling without testing. In the future, evidence may support that routine direct ingestion challenge with a penicillin and delabeling is safe in the primary care setting. Finally, by off-loading low-risk reactions to primary care providers we can then prioritize care of the patients with a higher-risk allergy and/or medical history by engagement with specialists who can provide more in-depth assessments and give them the best antibiotic options.Figure 1: Addressing Beta-lactam Allergy: An Implementation Roadmap: There are currently many missed opportunities for community members and healthcare providers to take action forward on the “penicillin allergy delabeling” movement. This includes not only active measures to delabel patients by history and direct oral challenge and to identify high risk patients for prioritized penicillin allergy delabeling but also preventive measures to avoid unnecessary use and exposure to antibiotics and avoidance of unnecessary labeling in those with mild rashes of likely viral origin.
The Intestine-lung Trafficking of Memory-like Group 2 Innate Lymphoid Cells Orchestra...
Kaifan Bao
Yijing Zhou

Kaifan Bao

and 10 more

September 25, 2021
Background: Recent works imply that immune memory might be expanded to group 2 innate lymphoid cells (ILC2s), but the cellular and molecular bases are largely unknown. Here, we investigated the memory and migrating properties of Lin -KLRG1 +IL-17RB + ILC2s (herein referred as mILC2s) and their contribution to asthma relapse. Methods: Clinical asthmatic subjects and HDM-induced mice asthma models were applied to investigate the memory-like characteristics of mILC2s including greater effector cytokine-producing potential and in vivo persistence. Parabiosis pairs of CD45.1 + and CD45.2 + mice were employed to determine whether mILC2s were circulating cells. Adoptive transplantation was performed to analyze the origin of the mILC2s accumulated in airway upon asthma relapse. CCR9 and S1P signaling blockade were used to confirm the migration of mILC2s during different asthma phases by In vivo imaging. KLRG1 neutralization was utilized to analyze the role of mILC2s in asthma relapse on Rag1 -/- mice. Results: mILC2s persisted in vivo and retained the potency of producing IL-13 and re-inducing allergic responses. Critically, parabiosis study and in vivo imaging showed that the vast majority of mILC2s migrated to and resided in small intestine during asthma remission, and subsequently moved to airway upon re-encountering antigens, regulated by CCR9 and S1P signaling. Blockade of S1P signaling markedly limited secondary exposure-induced airway inflammation. Furthermore, KLRG1 neutralization attenuated asthmatic responses of Rag1 -/- mice, supporting a pivotal role for mILC2s in mediating asthma relapse independent of adaptive immune cells. Conclusion: mILC2s exhibit memory-like and lung-small intestine migratory properties, which empowers them to drive asthma relapse.
Angioedema severity and impacts on quality of life: chronic histaminergic angioedema...
Marina Sabate-Bresco
Nuria Rodríguez-Garijo

Marina Sabate-Bresco

and 12 more

September 25, 2021
Background: Chronic histaminergic angioedema (CHA) is defined as recurrent episodes of isolated angioedema (without hives) of unknown cause that respond to the same treatment as chronic spontaneous urticaria (CSU). Quality of life (QoL) studies have not been performed for CHA, except those carried out in the context of CSU associated with angioedema attacks (CSU-AE). Moreover, biomarkers for monitoring disease activity in CHA have not been identified. We aim to describe the burden of CHA and impact on patient QoL, compare the findings to those in CSU-AE patients, and investigate biomarker associations with disease severity and QoL parameters. Methods: We performed a prospective multicenter study that included 68 patients with CHA and 63 patients with CSU-AE. Demographic and clinical variables were collected. Validated patient-reported questionnaires were employed to analyze the quality of life and disease activity. Blood and serological parameters, including blood cell count, C-reactive protein, D-dimer and total IgE, were also analyzed. Results: Angioedema disease activity was significantly higher in CSU-AE patients (median AAS7, IQR: 1, [0–1]) than CHA patients (0, [0–1]; p= 0.022). A considerable impact on QoL was found in both groups, although significantly worse values were found for CSU-AE (median AEQoL, IQR: 37, [10–65]; p=0.005). CHA patients were older than CSU-AE patients, and female predominance was not observed. Conclusions: Angioedema severity and QoL impacts are significantly worse in CSU than in chronic histaminergic angioedema. Angioedema should be included in severity urticaria scores (UAS) as well as in specific quality of life urticaria scales.
Automated dander dispersal in a cat Naturalistic Exposure Chamber (NEC)
Laura Haya
Rym Mehri

Laura Haya

and 7 more

September 25, 2021
A document by Laura Haya. Click on the document to view its contents.
Long-term consequences of trans-radial catheterization on the radial artery
Nicholas Clarke
Geetha Jagannathan

Nicholas Clarke

and 2 more

September 25, 2021
Background: The radial artery (RA) is often utilized for diagnostic coronary angiography and percutaneous intervention. Recent high-level evidence supports RA use in preference to saphenous vein as a conduit for coronary revascularization. Aim: To demonstrate gross and histologic changes of the RA following transradial access. Methods: We present two patients who had open RA harvest for coronary bypass surgery after transradial catheterization. Results: Examination 8 years after transradial catheterization demonstrated thickened intima and dissection, and examination 12 years following transradial catheterization with percutaneous coronary intervention demonstrated chronic dissection with thickened intima and near occlusion of the lumen. Conclusion: Transradial access via the RA, even after several years, is associated significant injury, making it unusable as a conduit for surgical coronary revascularization. A RA that has been utilized for catheterization should not be considered for coronary revascularization.
Acute Aortic Syndrome in Marfan Syndrome with Chest Pain and Negative Initial Imaging
Sorush Rokui
Edward Percy

Sorush Rokui

and 2 more

September 25, 2021
A 25-year-old male with Marfan Syndrome and previous aortic root surgery presented with severe chest and upper back pain. Initial CT angiogram showed mild aortic dilatation but no acute dissection. Anti-impulse therapy was initiated. Five days after presentation, follow-up CT angiography revealed a new pseudoaneurysm of the descending thoracic aorta. The patient underwent replacement of the mid-descending thoracic aorta with a collagen-impregnated woven polyester tube graft without complication. Despite negative initial imaging and relatively small aortic size, patients with Marfan Syndrome with acute chest pain should be treated with high suspicion and may benefit from admission and serial imaging.
Re-sternotomy for aortic valve replacement with patent coronary artery bypass grafts
Suvitesh Luthra
Pietro Malvindi

Suvitesh Luthra

and 4 more

September 25, 2021
Objective - The aim was to evaluate early and long-term outcomes of re-sternotomy for aortic valve replacement with previous patent coronary artery grafts. Methods - Data for re-sternotomy for aortic valve replacements (group 1 isolated AVR, group 2 AVR with concomitant procedure) were collected (2000-19). Logistic regression analysis was performed to identify predictors of in-hospital mortality and postoperative composite outcome (in-hospital death, TIA/stroke, renal failure requiring new hemofiltration, deep sternal wound infection, re-exploration for bleeding/tamponade and length of stay >30 days). Survival curves were compared using log rank test. Cox proportion hazards model was used for predictors of long term survival. Results – Total 178 patients were included (groups 1 - 90 patients, group 2 - 88 patients). Mean age was 75±4 years and mean log EuroSCORE was 17±12% (15 ± 8% - group 1 vs 19 ± 14% - group 2, p=0.06). Mean follow up was 6.3±4.4 years. Cardiovascular injury occurred in 12%. LIMA was most commonly injured. In-hospital mortality was 7.8% (5% - group 1 versus 10.2% - group 2, p=0.247). NYHA class III-IV, perioperative IABP and cardiovascular injury were independent predictors of in-hospital mortality (HR; 13.33, 95% CI; 2.04, 83.33, p=0.007). Survival was significantly worse with cardio-vascular injury at re-sternotomy up to 5 years (46% versus 67%, p=0.025) and postoperative complications (p=0.023). Survival was significantly lower than age matched first time AVR and UK population. Conclusions – Long term survival is significantly impaired by cardiovascular injury and perioperative complications of re-sternotomy.
Correlation of Coagulopathy and Frozen Elephant Trunk Use in Aortic Arch Surgery: A S...
Professor Mohamad Bashir
Hadi Abo Aljadayel

Mohamad Bashir

and 7 more

September 25, 2021
Background: The advent of Frozen elephant trunk (FET) for reconstruction of elective and non-elective aortic arch surgery has augmented the treatment of complex aortic pathologies in a single-stage operation. To date, no studies have been focused on the prevalence and predictors of coagulopathy potentiated by FET procedure. Methods: In a systematic review, we searched databases up to June 2020 for studies reporting coagulopathy complications after FET procedure. A proportional meta-analysis was carried out using STATA software (StataCorp, TX, USA). Results: In total, 46 studies including 6313 patients were eligible. The pooled estimation of reoperation for postoperative bleeding was 7% (95% confidence interval [CI] 5 to 8; I2 = 84.73%; reported by 39 studies including 4796 patients). The mean volume of transfused packed blood cells and fresh frozen plasma was 1677 ml (95% CI 1066.4-2287.6) and 1016.5 ml (95% CI 450.7-1582.3). The subgroup by stent type showed a decrease in the heterogeneity (I2 = 0.01%, I2 = 53.95%, I2 = 0.01%, and I2 = 54.41% for Thoraflex® Hybrid, E-vita®, Frozenix®, and Cronus®, respectively). The subgroup by chronicity of operation resulted in less heterogeneity among patients undergoing elective compared to non-elective operation (I2 = 29.22% versus I2 = 80.56% in non-elective). Meta-regression analysis showed that age and male gender significantly impacted on the reoperation for postoperative bleeding. Conclusions: The FET procedure for arch replacement is associated with coagulopathy and the transfusion of blood products. Male, age, and selective choice of FET use were identified as heterogeneity sources of reoperation for postoperative bleeding.
Constrictive pericarditis with extensive pericardial calcification: case report and r...
Pranav Mahajan
Anant Naik

Pranav Mahajan

and 4 more

September 25, 2021
Constrictive pericarditis refers to inflammation of the pericardial sac, possibly leading to acute heart failure. More than 80% cases are presumed to be due to recent or remote viral illnesses. Prominent features include chest pain, dyspnea and electrocardiogram (ECG) revealing P-R segment depression, diffuse concave ST segment elevation, and T-wave inversion. Echocardiogram and cardiac magnetic resonance imaging (MRI) can help establish diagnosis. Over time, the pericardium can undergo fibrosis or calcification resulting in excessive symptoms. After medical management with ibuprofen, colchicine or steroids, partial or complete pericardiectomy is considered. We are presenting a case with constrictive pericarditis due to extensive pericardial calcification, and ultimate resolution with pericardiectomy.
Travel Time Modelling Using Time Series of Nitrate Concentration in Groundwater Impro...
Baibaswata Bhaduri
Muddu Sekhar

Baibaswata Bhaduri

and 3 more

September 25, 2021
Rivers can act as mirrors to in-catchment processes, but integrated concentration-discharge dynamics might not be sufficient for constructing a well-posed solute travel time determination problem. One remedy is to look inside the catchment and see if the extra information provided by long-term time series of groundwater solutes constrains the problem or provides us with some additional insight on retrieving the processes which the stream is aggregating. To test this notion, we used data for Kerrien, a well-studied agriculture dominated small headwater catchment of the French Critical Zone Observatory in Brittany. It contains long-term nitrate concentration time-series from a network of piezometers as well as a stream outlet. In this study, a parsimonious, conceptual dual-permeability mixing model already developed for streams was adapted for piezometers along with detailed uncertainty and sensitivity analysis. We found out the nitrate flushing times of mid to upslope piezometers were consistently higher than the stream outlet. We further observed an asynchronicity in seasonal concentration-discharge dynamics between the piezometers and the stream. We hypothesize the reason behind this counterintuitive finding to be extensive riparian denitrification, vertical stratification of groundwater and disconnect between the stream and the deeper flowpaths that carry legacy contamination, evidenced by the non-closure of water budget at the stream outlet. As a consequence, we argue that in headwater catchments the stream signature might not fully reflect internal processes which can be revealed only by using piezometer data. This adapted conceptual framework could be of great interest for semi-arid catchments where groundwater monitoring could be used in combination or as an alternate to ephemeral streams in travel time determination.
Uniformity in bioprosthetic mitral valve sizing -- when will we get there?
Cian Tan
Professor Mohamad Bashir

Cian Tan

and 2 more

September 25, 2021
Much has changed since the introduction of surgical valve repair in the 1950s, from the introduction bioprosthetic valves to percutaneous approaches to valve repair. Yet, despite substantial advancements in bioprosthetic valve technology, there has been a lack of direct, independent comparison between bioprosthetic mitral valve devices, accompanied by a marked heterogeneity in approaches to the sizing and selection thereof. Wang et al. have hence endeavoured to evaluate, head-to-head, the technical successes and biomechanical outcomes associated with three different bioprosthetic mitral valves (Epic, Abbott, IL; Mosaic, Medtronic, MN; Mitris Resilia, Edwards Lifesciences, CA) in a porcine model, under standardised haemodynamic and anatomical conditions. With a robust experimental technique, they have made clear the heterogeneity in both sizing and biomechanical properties between bioprosthetic mitral valves, and have further emphasised the need for a uniform approach to the manufacturing and sizing of bioprosthetic valves.
Reversible blindness after erroneous prescription of closantel: A case report
Hamed Cheraghmakani
Reza Jafari

Hamed Cheraghmakani

and 3 more

September 25, 2021
A 20-year-old girl referred with vision loss upon closantel use. Plasma exchange and high-dose corticosteroid pulse therapy were administered. A 2.5-year follow-up showed improved vision and increased layer thickness of the peripheral nerve fiber. Early treatment with plasma exchange and high-dose corticosteroid therapy can be beneficial to reverse closantel toxicity.
Survival of pediatric Hodgkin lymphoma patients treated with doxorubicin, bleomycin,...
Sebastian de Armas
Carolina Huertas-Ayala

Sebastian de Armas

and 7 more

September 25, 2021
Background: ABVD, the standard-of-care in adult Hodgkin lymphoma (HL), has not been directly compared to ABVE-PC, a pediatric regimen designed to reduce late-effects. We aimed to compare the effectiveness and associated toxicities of these two regimens used in the same institution. Methods: This retrospective cohort study evaluated a total of 224 patients diagnosed with HL between 1999 and 2018 at Children’s Hospital Los Angeles (CHLA), of which 93 patients were eligible having received ABVD (n=46) or ABVE-PC (n=47) chemotherapy as their initial treatment. Descriptive analyses were performed using the Student’s t-test or Fisher’s exact test. Survival analysis used the Kaplan-Meier method. Events included: death, relapse, secondary malignancy, need for radiation therapy, pulmonary toxicity and cardiomyopathy determined by shortening fraction <29%. Analyses followed an intention-to-treat principle. Results: There was no difference in baseline characteristics between the patients receiving ABVE-PC or ABVD in regard for stage, risk group or prognostic variables, such as the presence or absence of “B” symptoms, bulky disease, and extra-nodal involvement. A greater proportion of patients treated with ABVE-PC received consolidating external beam radiation treatment (XRT) either by randomization or by response compared to ABVD (59.6% vs 32.6% respectively, p=0.01). While not statistically significant, response to therapy, assessed by PET/CT where available, mirrored the need for radiation (rapid response 58.3% vs 90.0%, n=34, p=0.11). There was no difference in event-free survival (p=0.63) or overall survival (p=0.37) with a median follow up length of 3.9 years. Conclusion: ABVD and ABVE-PC achieved similar survival outcomes in our single-institution cohort
SIROLIMUS EFFICACY IN THE TREATMENT OF CRITICALLY- ILL INFANTS WITH CHYLOUS EFFUSIONS
sxagarw4@texaschildrens.org
Berkley  Anderson

Shreya Agarwal

and 5 more

September 25, 2021
Background: While rare in children, chylothorax is a significant cause of respiratory morbidity and can lead to malnutrition and immunodeficiency. Historically, the traditional pharmacological treatment has been octreotide. There are several treatments that have been utilized in the past few years including sirolimus, however data regarding their efficacy and outcomes is limited. Furthermore, sirolimus has proven efficacy in complex vascular malformations, and hence, its utility/efficacy in pediatric chylous effusions warrants further investigation. Methods: In this retrospective study at Texas Children’s Hospital, data were extracted for all patients with chylothorax who were treated with sirolimus between 2009 and 2020. Details regarding underlying diagnosis, co-morbidities and number of days from sirolimus initiation to resolution of effusion were collected. Descriptive statistics were used to analyze the study cohort. Results: Initially a total of twelve infants were identified. Among them, seven patients had complete data and were included in the study. The mean duration of sirolimus treatment needed for chest tube removal was 16 days, with a median of 19 days and range of 7- 22 days. Chest tube output corresponded with sirolimus serum trough levels and trended down prior to chest tube removal. Conclusion: With close monitoring, sirolimus is a safe and effective therapy for pediatric lymphatic effusions even in critically-ill infants. The study also demonstrates shorter duration of chest tube requirement after initiation of sirolimus compared to previous studies. Our conclusion is based on a small case series due to the rare incidence of the condition.
Reactogenicity of influenza vaccination in children with cancer and hematologic disea...
Almudena Laris-González
Martha Aviles-Robles

Almudena Laris-González

and 3 more

September 25, 2021
LETTER TO THE EDITOR
← Previous 1 2 … 954 955 956 957 958 959 960 961 962 … 1656 1657 Next →

| Powered by Authorea.com

  • Home