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The Journal of Surgical Research Jun 2021Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the...
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the technique is limited by the sequalae of ischemia distal to occlusion. Partial REBOA addresses this limitation, and the recent Food and Drug Administration approval of a device designed to enable partial REBOA will broaden its application. We conducted a systematic review of the available animal and clinical literature on the methods, impacts, and outcomes associated with partial REBOA as a technique to enable targeted proximal perfusion and limit distal ischemic injury. We hypothesize that a systematic review of the published animal and human literature on partial REBOA will provide actionable insight for the use of partial REBOA in the context of future wider clinical implementation of this technique.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, we conducted a search of the available literature which used partial inflation of a REBOA balloon catheter. Findings from 22 large animal studies and 14 clinical studies met inclusion criteria.
RESULTS
Animal and clinical results support the benefits of partial REBOA including extending the resuscitative window extended safe occlusion time, improved survival, reduced proximal hypertension, and reduced resuscitation requirements. Clinical studies provide practical physiologic targets for partial REBOA including a period of total occlusion followed by gradual balloon deflation to achieve a target proximal pressure and/or target distal pressure.
CONCLUSIONS
Partial REBOA has several benefits which have been observed in animal and clinical studies, most notably reduced ischemic insult to tissues distal to occlusion and improved outcomes compared with total occlusion. Practical clinical protocols are available for the implementation of partial REBOA in cases of life-threatening torso hemorrhage.
Topics: Animals; Aorta; Balloon Occlusion; Endovascular Procedures; Humans; Resuscitation; Shock, Hemorrhagic
PubMed: 33561721
DOI: 10.1016/j.jss.2020.12.054 -
Journal of Clinical Anesthesia Dec 2016This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The... (Comparative Study)
Comparative Study Meta-Analysis Review
This article reviews if a restrictive fluid management policy reduces the complication rate if compared to liberal fluid management policy during elective surgery. The PubMed database was explored by 2 independent researchers. We used the following search terms: "Blood transfusion (MESH); transfusion need; fluid therapy (MESH); permissive hypotension; fluid management; resuscitation; restrictive fluid management; liberal fluid management; elective surgery; damage control resuscitation; surgical procedures, operative (MESH); wounds (MESH); injuries (MESH); surgery; trauma patients." A secondary search in the Medline, EMBASE, Web of Science, and Cochrane library revealed no additional results. We selected randomized controlled trials performed during elective surgeries. Patients were randomly assigned to a restrictive fluid management policy or to a liberal fluid management policy during elective surgery. The patient characteristics and the type of surgery varied. All but 3 studies reported American Society of Anaesthesiologists groups 1 to 3 as the inclusion criterion. The primary outcome of interest is total number of patients with a complication and the complication rate. Secondary outcome measures are infection rate, transfusion need, postoperative rebleeding, hospital stay, and renal function. In total, 1397 patients were analyzed (693 restrictive protocol, 704 liberal protocol). Meta-analysis showed that in the restrictive group as compared with the liberal group, fewer patients experienced a complication (relative risk [RR], 0.65; 95% confidence interval [CI], 0.55-0.78). The total complication rate (RR, 0.57; 95% CI, 0.52-0.64), risk of infection (RR, 0.62; 95% CI, 0.48-0.79), and transfusion rate (RR, 0.81; 95% CI, 0.66-0.99) were also lower. The postoperative rebleeding did not differ in both groups: RR, 0.76 (95% CI, 0.28-2.06). We conclude that compared with a liberal fluid policy, a restrictive fluid policy in elective surgery results in a 35% reduction in patients with a complication and should be advised as the preferred fluid management policy.
Topics: Blood Loss, Surgical; Blood Transfusion; Elective Surgical Procedures; Fluid Therapy; Humans; Intraoperative Care; Length of Stay; Odds Ratio; Postoperative Complications; Postoperative Hemorrhage; Randomized Controlled Trials as Topic
PubMed: 27871539
DOI: 10.1016/j.jclinane.2016.07.010 -
Pediatric Research Apr 2022There is no consensus on the optimal pCO levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates.... (Review)
Review
There is no consensus on the optimal pCO levels in the newborn. We reviewed the effects of hypercapnia and hypocapnia and existing carbon dioxide thresholds in neonates. A systematic review was conducted in accordance with the PRISMA statement and MOOSE guidelines. Two hundred and ninety-nine studies were screened and 37 studies included. Covidence online software was employed to streamline relevant articles. Hypocapnia was associated with predominantly neurological side effects while hypercapnia was linked with neurological, respiratory and gastrointestinal outcomes and Retinpathy of prematurity (ROP). Permissive hypercapnia did not decrease periventricular leukomalacia (PVL), ROP, hydrocephalus or air leaks. As safe pCO ranges were not explicitly concluded in the studies chosen, it was indirectly extrapolated with reference to pCO levels that were found to increase the risk of neonatal disease. Although PaCO ranges were reported from 2.6 to 8.7 kPa (19.5-64.3 mmHg) in both term and preterm infants, there are little data on the safety of these ranges. For permissive hypercapnia, parameters described for bronchopulmonary dysplasia (BPD; PaCO 6.0-7.3 kPa: 45.0-54.8 mmHg) and congenital diaphragmatic hernia (CDH; PaCO ≤ 8.7 kPa: ≤65.3 mmHg) were identified. Contradictory findings on the effectiveness of permissive hypercapnia highlight the need for further data on appropriate CO parameters and correlation with outcomes. IMPACT: There is no consensus on the optimal pCO levels in the newborn. There is no consensus on the effectiveness of permissive hypercapnia in neonates. A safe range of pCO of 5-7 kPa was inferred following systematic review.
Topics: Carbon Dioxide; Humans; Hypercapnia; Hypocapnia; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Respiration, Artificial
PubMed: 34230621
DOI: 10.1038/s41390-021-01473-y -
Placenta Aug 2022Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of... (Review)
Review
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta.
Topics: COVID-19; Female; Humans; Placenta; Pregnancy; Pregnancy Complications, Infectious; SARS-CoV-2; Trophoblasts
PubMed: 35872511
DOI: 10.1016/j.placenta.2022.07.007 -
JMIR Public Health and Surveillance May 2017Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles...
BACKGROUND
Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children's eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity.
OBJECTIVE
The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research.
METHODS
Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed.
RESULTS
The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association.
CONCLUSIONS
This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs.
PubMed: 28550007
DOI: 10.2196/publichealth.6492 -
Intensive Care Medicine May 2022Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial.... (Meta-Analysis)
Meta-Analysis
PURPOSE
Hypercapnia is frequent during mechanical ventilation for acute respiratory distress syndrome (ARDS), but its effects on morbidity and mortality are still controversial. We conducted a systematic review and meta-analysis to explore clinical consequences of acute hypercapnia in adult patients ventilated for ARDS.
METHODS
We searched Medline, Embase, and the Cochrane Library via the OVID platform for studies published from 1946 to 2021. "Permissive hypercapnia" defined hypercapnia in studies where the group with hypercapnia was ventilated with a protective ventilation (PV) strategy (lower V targeting 6 ml/kg predicted body weight) while the group without hypercapnia was managed with a non-protective ventilation (NPV); "imposed hypercapnia" defined hypercapnia in studies where hypercapnic and non-hypercapnic patients were managed with a similar ventilation strategy.
RESULTS
Twenty-nine studies (10,101 patients) were included. Permissive hypercapnia, imposed hypercapnia under PV, and imposed hypercapnia under NPV were reported in 8, 21 and 1 study, respectively. Studies testing permissive hypercapnia reported lower mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients receiving NPV: OR = 0.26, 95% CI [0.07-0.89]. By contrast, studies reporting imposed hypercapnia under PV reported increased mortality in hypercapnic patients receiving PV as compared to non-hypercapnic patients also receiving PV: OR = 1.54, 95% CI [1.15-2.07]. There was a significant interaction between the mechanism of hypercapnia and the effect on mortality.
CONCLUSIONS
Clinical effects of hypercapnia are conflicting depending on its mechanism. Permissive hypercapnia was associated with improved mortality contrary to imposed hypercapnia under PV, suggesting a major role of PV strategy on the outcome.
Topics: Adult; Humans; Hypercapnia; Respiration; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 35294565
DOI: 10.1007/s00134-022-06640-1 -
Sleep Medicine Reviews Aug 2020Behavioral sleep problems in early childhood are common, affecting about 25% of children, and include symptoms such as problems going to sleep and staying asleep. This...
Behavioral sleep problems in early childhood are common, affecting about 25% of children, and include symptoms such as problems going to sleep and staying asleep. This review employed the developmental psychopathology framework and 4P model (Predisposing, Precipitating, Perpetuating, Protective) to organize the diverse risk/protective factors (distal variables experienced indirectly by the child) and processes (proximal variables experienced directly by the child) for child sleep problems among preschool (1-5 y) and school-age (6-10 y) children. Variables were categorized into biological, psychological, and environmental factors/processes at the individual, family/parent, and community levels. The quality of evidence was assessed using GRADE. A literature search identified 98 articles meeting inclusion criteria. Older child age, difficult temperament, previous sleep problems, externalizing psychopathology, internalizing psychopathology, and electronics use (e.g., bedtime TV viewing) were identified as child risk variables predicting sleep problems. Parental presence at bedtime (risk), negative parenting style (e.g., lax or permissive parenting; risk), consistent bedtime routines (protective), and lower composite socioeconomic status (risk) were identified as family/parent variables predicting child sleep problems. No well-established predictors were found at the community level. Future research should employ advanced research designs more frequently and investigate: 1) risk pathways across development; and 2) nightly fluctuations in sleep problems.
Topics: Child; Child, Preschool; Humans; Infant; Parenting; Protective Factors; Risk Factors; Schools; Sleep Initiation and Maintenance Disorders
PubMed: 32320935
DOI: 10.1016/j.smrv.2020.101303 -
L'Encephale Mar 2024Young people's exposure to online pornographic material has increased in the past years. Its impact is a complex topic but an important issue due to growing concerns....
OBJECTIVES
Young people's exposure to online pornographic material has increased in the past years. Its impact is a complex topic but an important issue due to growing concerns. Therefore, we reviewed the literature on Internet pornography consumption and its impact on children and adolescents. Furthermore, we examined young people's thoughts about pornography and their reasons for consumption.
METHOD
We performed a systematic literature search in the online databases ERIC, PsycARTICLES, PsycINFO, and PSYNDEX for peer-reviewed articles in English, published between 2000 and 2022 and additionally identified secondary references.
RESULTS
We could determine associations between pornography consumption and demographic variables (e.g., age, gender), personal characteristics (e.g., [sexual] sensation seeking, sexual interest and experience, general risk behavior), environmental variables (e.g., peers, family), attitudes (e.g., gender role attitudes, permissive sexual attitudes), behavior (e.g. sexual risk behaviour, sexting) and sexual aggression (e.g., sexual cybervictimization, grooming). Moreover, we found that girls have a more negative attitude towards pornography than boys who have an ambivalent opinion on the subject. Most adolescents are aware that the majority of pornographic material is exaggerated and unrealistic. Furthermore, pornography is not only watched out of curiosity and for sexual arousal but also used as a source of sexual information, especially by minority groups.
DISCUSSION
Many effects that impair children's development have been documented. The results found in this review are often contradictory. Therefore, further replication studies are needed. In addition, we propose several preventive measures, e.g., sexual health education at schools for both heterosexuals and LGBT (Lesbian, Gay, Bisexual, and Transgender) people.
PubMed: 38519310
DOI: 10.1016/j.encep.2023.12.004 -
Aesthetic Plastic Surgery Dec 2023Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore,... (Review)
Review
BACKGROUND/PURPOSE
Permissive hypotension, defined as mean arterial pressure (MAP) of 60-70 mm Hg, has been regarded as favorable among surgeons performing rhinoplasty. Furthermore, management of blood pressure has been shown to promote greater visualization of the surgical field and decrease postoperative complications, such as ecchymosis and edema. While multiple therapies have been utilized to achieve permissive hypotension, it remains unclear how modalities compare in terms of safety and efficacy. The purpose of this study was to conduct a systematic review to better understand the specific modalities and associated outcomes in managing blood pressure during rhinoplasty.
METHODS
A systematic literature review was conducted in order to identify and assess therapeutics utilized in achieving permissive hypotension during rhinoplasty. Variables collected included year of publication, journal, article title, organization of study, patient sample, treatment modality, associated outcomes (i.e., intraoperative bleeding, edema, and ecchymosis), adverse events, complications, and satisfaction. Articles were then categorized by the level of evidence as set forth by the American Society of Plastic Surgeons. Any conflicts were resolved through discussion and full-text review among co-authors. Of note, the search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No funding was required to conduct this review of the literature.
RESULTS
Initial review yielded sixty-five articles. Title and abstract review followed by standardized application of inclusion and exclusion criteria resulted in a total of ten studies for analysis. Articles discussed multiple therapies for management of blood pressure during rhinoplasty, including dexmedetomidine, dexamethasone, gabapentin, labetalol, nitroglycerine, remifentanil, magnesium sulfate, clonidine, and metoprolol. Overall, intraoperative bleeding, as well as postoperative ecchymosis and edema were reduced when MAP was controlled.
CONCLUSION
Given its intra- and postoperative benefits, permissive hypotension can be leveraged to improve outcomes in rhinoplasty. This study presents an updated comprehensive review of various modalities used to achieve permission hypotension in rhinoplasty. Future studies should explore how comorbidities may impact choice of treatment regimen among patients undergoing rhinoplasty.
LEVEL OF EVIDENCE III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Hemorrhage; Hypotension; Rhinoplasty; Treatment Outcome; Postoperative Complications
PubMed: 36877227
DOI: 10.1007/s00266-023-03298-y -
Psychology & Health Nov 2020The prevalence of childhood overweight and obesity has been increasing globally, with poor diet a key contributor. Parents play an influential role over the food intake...
The prevalence of childhood overweight and obesity has been increasing globally, with poor diet a key contributor. Parents play an influential role over the food intake of young children. This review explores whether parenting styles (authoritative, authoritarian, permissive and disengaged) or parenting dimensions (warmth and control) are associated with pre-school children's dietary intake. Following the PRISMA guidelines, a systematic search of six electronic databases was conducted. Included articles were based on children aged 2-5 years and reported associations between parenting styles or dimensions and children's food intake. Two independent reviewers extracted the data and assessed the quality of the articles. Pre-school children's dietary intake. Seven articles met the inclusion criteria. Six of the seven articles found evidence of at least one association between parenting styles or parenting dimensions and children's dietary intake. Several different measurement tools were used to identify parenting styles (n = 3) and dietary intake (n = 6), with reliability and validity reported in varying ways. The quality score of the articles ranged from 33% to 58%. Overall, an authoritative parenting style or higher levels of warmth appear to be associated with healthier dietary intakes among pre-school children.
Topics: Child, Preschool; Diet; Female; Humans; Male; Parenting; Reproducibility of Results; Surveys and Questionnaires
PubMed: 32255381
DOI: 10.1080/08870446.2020.1743842