Pharmacological strategies to prevent haemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A network meta-analysis.

Objective : This network meta-analysis (NMA) aimed to determine the relative efficacy and safety of pharmacological strategies used to mitigate haemodynamic instability by intubation for general anaesthesia in hypertensive parturient women undergoing caesarean section. Methods : We considered randomised controlled studies comparing the effects of pharmacological strategies used to alleviate haemodynamic instability during intubation in parturient women with hypertensive disorders of pregnancy. The primary endpoints were maximum blood pressure and heart rate after intubation, and secondary endpoints were the Apgar scores at 1 and 5 min. NMA allowed us to combine direct and indirect comparisons between strategies. Results : Twelve studies evaluating nine pharmacological strategies in 619 patients were included. According to the surface under the cumulative ranking curve, the maximal mean arterial pressure was lowest for high-dose remifentanil (99.4%) followed by nitroglycerin (73.6%) and labetalol (60.9%). The maximal heart rate was lowest for labetalol (99.9%) followed by high dose of remifentanil (81.2%) and fentanyl (61.6%). Apgar score at 1 min was higher with low-dose than with high-dose remifentanil (mean difference, 0.726; 95% confidence interval, 0.056 to 1.396; I2=0.0%). Conclusions : High-dose remifentanil produces minimum blood pressure changes, while labetalol is most effective in maintaining normal heart rate in parturient women with hypertensive disorders of pregnancy during caesarean section under general anaesthesia.

Gyroscope-Based Continuous Human Hand Gesture Recognition for Multi-Modal Wearable Input Device for Human Machine Interaction.

Human hand gestures are a widely accepted form of real-time input for devices providing a human-machine interface. However, hand gestures have limitations in terms of effectively conveying the complexity and diversity of human intentions. This study attempted to address these limitations by proposing a multi-modal input device, based on the observation that each application program requires different user intentions (and demanding functions) and the machine already acknowledges the running application. When the running application changes, the same gesture now offers a new function required in the new application, and thus, we can greatly reduce the number and complexity of required hand gestures. As a simple wearable sensor, we employ one miniature wireless three-axis gyroscope, the data of which are processed by correlation analysis with normalized covariance for continuous gesture recognition. Recognition accuracy is improved by considering both gesture patterns and signal strength and by incorporating a learning mode. In our system, six unit hand gestures successfully provide most functions offered by multiple input devices. The characteristics of our approach are automatically adjusted by acknowledging the application programs or learning user preferences. In three application programs, the approach shows good accuracy (90-96%), which is very promising in terms of designing a unified solution. Furthermore, the accuracy reaches 100% as the users become more familiar with the system.

Comparison of propofol monotherapy and propofol combination therapy for sedation during gastrointestinal endoscopy: A systematic review and meta-analysis.

BACKGROUND AND AIM: Previous randomized controlled trials have reported conflicting findings comparing propofol combination therapy (PCT) with propofol monotherapy (PMT) for sedation of patients undergoing gastrointestinal endoscopy. Therefore, a systematic review was carried out to compare the efficacy and safety of PCT and PMT in such patients. METHODS: We searched MEDLINE, EMBASE and CENTRAL databases to identify all randomized controlled trials that compared the efficacy and safety of PCT and PMT for sedation of patients undergoing gastrointestinal endoscopy. Primary endpoints were incidence of respiratory complications, hypotension and arrhythmia, dose of propofol used, and recovery time. Procedure duration and the satisfaction of patients and doctors were also evaluated. RESULTS: A total of 2250 patients from 22 studies were included in the final analysis. The combined analysis did not show any difference between PCT and PMT in the incidence of respiratory complications (risk ratio [RR], 0.80; 95% CI, 0.52 to 1.23; I2 = 58.34%), hypotension (RR, 1.06; 95% CI, 0.63 to 1.78; I2 = 72.13%), arrhythmia (RR,1.40; 95% CI, 0.74 to 2.64; I2 = 43.71%), recovery time (standardized mean difference [SMD], 0.16; 95% CI, -0.49 to 0.81; I2 = 95.9%), procedure duration (SMD, 0.04; 95% CI, -0.05 to 0.14; I2 = 0.0%), patient satisfaction (SMD, 0.13; 95% CI, -0.26 to 0.52; I2 = 89.63%) or doctor satisfaction (SMD, 0.01; 95% CI, -0.15 to 0.17; I2 = 0.00%). However, the dose of propofol used was significantly lower in PCT than in PMT (SMD, -1.38; 95% CI, -1.99 to -0.77; I2 = 97.70%). CONCLUSION: PCT showed comparable efficacy and safety to PMT with respect to respiratory complications, hypotension and arrhythmia, recovery time, procedure duration, patient satisfaction, and doctor satisfaction. However, the average dose of propofol used was higher in PMT.

In situ heating transmission electron microscopy observation of nanoeutectic lamellar structure in Sn-Ag-Cu alloy on Au under-bump metallization.

We investigated the microstructural evolution of Sn(96.4)Ag(2.8)Cu(0.8) solder through in situ heating transmission electron microscopy observations. As-soldered bump consisted of seven layers, containing the nanoeutectic lamella structure of AuSn and Au5Sn phases, and the polygonal grains of AuSn2 and AuSn4, on Au-plated Cu bond pads. Here, we found that there are two nanoeutectic lamellar layers with lamella spacing of 40 and 250 nm. By in situ heating above 140°C, the nanoeutectic lamella of AuSn and Au5Sn was decomposed with structural degradation by sphering and coarsening processes of the lamellar interface. At the third layer neighboring to the lamella layer, on the other hand, Au5Sn particles with a zig-zag shape in AuSn matrix became spherical and were finally dissipated in order to minimize the interface energy between two phases. In the other layers except both lamella layers, polycrystal grains of AuSn2 and AuSn4 grew by normal grain growth during in situ heating. The high interface energy of nanoeutectic lamella and polygonal nanograins, which are formed by rapid solidification, acted as a principal driving force on the microstructural change during the in situ heating.

Effects of Pt junction on electrical transport of individual ZnO nanorod device fabricated by focused ion beam.

The electrical transport of individual ZnO nanorod devices manufactured by focused ion beam (FIB) was investigated by the direct measurement of electrical resistance at electrode junctions of cross-sectioned devices using two nanoprobes. The cathodoluminescence (CL) measurements were also performed to evaluate the crystallinity at the center and edge of the cross-sectioned ZnO nanorods. The electrical transport of the individual ZnO nanorod device depends strongly on the crystallinity of the ZnO nanorod itself and the carbon contents at Pt junctions. The ZnO-Au junction of the device acted as the fastest path for electrical transport.

The effects of nitrogen bonding on hardness of AIN/CrN multilayer hard coatings.

AIN/CrN multilayer hard coatings with various bilayer thicknesses were fabricated by a reactive sputtering process. The microstructural and mechanical characterizations of multilayer coatings were investigated through transmission electron microscope (TEM) observations and the hardness measurements by nano indentation. In particular, the variation of chemical bonding states of the bilayer nitrides was elucidated by near edge X-ray absorption fine structure (NEXAFS) spectroscopy. Many broken nitrogen bonds were formed by decreasing the bilayer thickness of AIN/CrN multilayer coatings. Existence of optimum AIN/CrN multilayer coatings thickness for maximum hardness could be explained by the competition of softening by the formation of broken nitrogen bonds and strengthening induced by decreasing bilayer thickness.

Hardness and nitrogen bonding structure of AlxTi1-xN/CrN multilayer hard coating.

AlxTi1-xN/CrN multilayer coatings were fabricated by magnetron sputtering and those hardness variations were studied by observing the crack propagation and measuring the chemical bonding state of nitrides by Ti addition. While AlN/CrN multilayer shown stair-like crack propagation, AlxTi1-xN/CrN multilayer illustrated straight crack propagation. Most interestingly, Ti addition induced more broken nitrogen bonds in the nitride multilayers, leading to the reduction of hardness. However, the hardness of Al0.25Ti0.75N/CrN multilayer, having high Ti contents, increased by the formation of many Ti-N bond again instead of Al-N bond. From these results, we found that linear crack propagation behavior was dominated by broken nitrogen bonds in the AlxTi1-xN/CrN multilayer coatings.

Superplastic deformation of defect-free Au nanowires via coherent twin propagation.

We report that defect-free Au nanowires show superplasticity on tensile deformation. Evidences from high-resolution electron microscopes indicated that the plastic deformation proceeds layer-by-layer in an atomically coherent fashion to a long distance. Furthermore, the stress-strain curve provides full interpretation of the deformation. After initial superelastic deformation, the nanowire shows superplastic deformation induced by coherent twin propagation, completely reorientating the crystal from <110> to <100>. Uniquely well-disciplined and long-propagating atomic movements deduced here are ascribed to the superb crystallinity as well as the radial confinement of the Au nanowires.

The Usefulness of Trabecular CT Attenuation Measurement at L4 Level to Predict Screw Loosening After Degenerative Lumbar Fusion Surgery: Consider Number of Fused Levels and Postoperative Sagittal Balance.

STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the absolute value of L4 trabecular region-of-interest (t-ROI) computed tomography (CT) attenuation, which can predict pedicle screw loosening, and determine the changes in value according to number of fused levels and sagittal balance in patients undergoing lumbar fusion surgery. SUMMARY OF BACKGROUND DATA: Although osteoporosis was not diagnosed in spinal dual x-ray absorptiometry preoperatively, we encountered several cases of screw loosening within 1 year of lumbar fusion surgery. METHODS: We enrolled 478 patients and analyzed factors related to screw loosening. We evaluated the association between L4 t-ROI CT attenuation and screw loosening and determined the best cutoff value of t L4 t-ROI CT attenuation for predicting screw loosening. RESULTS: The number of fused levels, postoperative C7-S1 sagittal vertical axis (SVA), and L4 t-ROI CT attenuation were independently correlated with screw loosening. According to number of fused level and postoperative C7-T1 SVA (≥36.9 mm or <36.9 mm), in patients with one-level fusion and C7-S1 SVA less than 36.9 mm, the optimal cutoff point of the L4 t-ROI CT attenuation predicting screw loosening was 106.5 Hounsfield unit (HU). L4 t-ROI attenuation did not change until two-level fusions. In patients with three-level fusions and C7-S1 SVA less than 36.9 mm, the optimal cutoff point of the L4 t-ROI CT attenuation predicting screw loosening was 159.0 HU. The optimal cutoff point of L4 t-ROI CT attenuation in patients with three-level fusions and C7-S1 SVA more than or equal to 36.9 mm was 191.0 HU. CONCLUSION: L4 t-ROI CT attenuation value considering number of fused levels and sagittal balance is an accurate measurement method to predict screw loosening. Spine surgeons should be aware of the L4 t-ROI attenuation before surgery to improve the fusion rate and reduce instrument-related complications of lumbar spine surgery in osteoporotic patients. LEVEL OF EVIDENCE: 3.

Acute exacerbation of COPD increases the risk of hip fractures: a nested case-control study from the Korea National Health Insurance Service.

BACKGROUND/AIMS: Hip fracture and acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) could increase mortality in patients with COPD. There are no data on the relationship between AE-COPD and hip fracture, which may significantly affect the prognosis of patients with COPD. Therefore, we conducted this study to determine the effects of AE-COPD on hip fractures in patients with COPD. METHODS: This retrospective, nested, case-control study included 253,471 patients with COPD (≥ 40 years of age) identified from the Korea National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) from 2002 to 2015. Among 176,598 patients with COPD, 1,415 patients with hip fractures were identified. Each case was matched to one control for age (within 10 years), sex, and year of COPD diagnosis. We estimated the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for hip fractures associated with AE-COPD using conditional logistic regression analysis, adjusting for underlying diseases and smoking history. RESULTS: In patients with AE-COPD, the risk of hip fracture was 2.50 times higher, regardless of systemic corticosteroid use and underlying disease (aOR, 2.50; 95% CI, 1.67 to 3.75). The risk of hip fracture increased if there was one episode of AE in the year before hip fractures (aOR, 2.25; 95% CI, 1.66 to 3.05). Moreover, the risk of hip fracture also increased in patients with more than two episodes of AE the year before hip fractures (aOR, 2.57; 95% CI, 1.61 to 4.10). CONCLUSION: AE-COPD increases the risk of hip fracture regardless of underlying diseases, including osteoporosis, and treatment with systemic corticosteroids.

Cochlear implantation for total deafness after ipsilateral ventriculoperitoneal shunt surgery: technical report.

BACKGROUND: Cochlear implantation (CI) becomes more challenging when a programmable ventriculoperitoneal (VP) shunt is present on the same side of the head. We report a successful ipsilateral CI in a patient who suffered bilateral hearing loss after shunt surgery. METHOD: We describe the CI case of a 49-year-old woman with an implanted VP shunt device, and perform a retrospective review of the clinical, audiological, and radiological features, surgical techniques, and postoperative functional outcomes. FINDINGS: During CI, the magnet in the core of internal antenna of the CI device was positioned approximately 8 cm from the shunt valve so that it would not be affected by the magnetic field of the programmable valve. Although the CI antenna tip and shunt catheter overlapped, we were very careful not to pull the shunt catheter out of position while the musculoperiosteal flap was elevated. CONCLUSIONS: The present result suggests that ipsilateral CI is an option for deaf adult patients who have a programmable shunt.

Automatic cell counting from stimulated Raman imaging using deep learning.

In this paper, we propose an automatic cell counting framework for stimulated Raman scattering (SRS) images, which can assist tumor tissue characteristic analysis, cancer diagnosis, and surgery planning processes. SRS microscopy has promoted tumor diagnosis and surgery by mapping lipids and proteins from fresh specimens and conducting a fast disclose of fundamental diagnostic hallmarks of tumors with a high resolution. However, cell counting from label-free SRS images has been challenging due to the limited contrast of cells and tissue, along with the heterogeneity of tissue morphology and biochemical compositions. To this end, a deep learning-based cell counting scheme is proposed by modifying and applying U-Net, an effective medical image semantic segmentation model that uses a small number of training samples. The distance transform and watershed segmentation algorithms are also implemented to yield the cell instance segmentation and cell counting results. By performing cell counting on SRS images of real human brain tumor specimens, promising cell counting results are obtained with > 98% of area under the curve (AUC) and R = 0.97 in terms of cell counting correlation between SRS and histological images with hematoxylin and eosin (H&E) staining. The proposed cell counting scheme illustrates the possibility and potential of performing cell counting automatically in near real time and encourages the study of applying deep learning techniques in biomedical and pathological image analyses.

Usefulness of Trabecular CT Attenuation Measurement of Lumbar Spine in Predicting Osteoporotic Compression Fracture: Is the L4 Trabecular Region of Interest Most Relevant?

STUDY DESIGN: Retrospective study. OBJECTIVE: The aim of this study was to evaluate the usefulness of computed tomography (CT) attenuation in defining trabecular region-of-interest (t-ROI) at lumbar vertebral body in the assessment of osteoporotic compression fracture (OCF) compared to spinal dual x-ray absorptiometry (DXA). SUMMARY OF BACKGROUND DATA: Even though osteoporosis was not diagnosed in the bone mineral density measurement using DXA, we often experienced cases where the screw was weakly inserted due to low bone quality during screw insertion. METHODS: A total of 188 patients who met the inclusion criteria were enrolled. We determined best cutoff value of the simple t-ROI attenuation at the most relevant level for predicting OCF. We assessed correlations between the simple t-ROI attenuation at the most relevant level and OCF rate, and investigate the association between the number of compression fracture and simple t-ROI attenuation at the most relevant level. RESULTS: L4 ROI attenuation is the most accurate measurement for predicting osteoporotic compression fracture with an area under the curve of 0.798. The optimal cutoff point of L4 ROI attenuation was measured at 90.5 HU with 88.8% and 60.6% sensitivity and specificity, respectively. L4 ROI attenuation was significantly correlated with the osteoporotic compression fracture rate (r = -0.545, P < 0.001). The number of compression fracture (coefficient of determination R2 = 0.286; P < 0.001) was independently correlated with L4 ROI attenuation. CONCLUSION: Simple t-ROI computed tomography attenuation is an accurate measurement tool in predicting OCF compared to DXA T-score. The value of L4 t-ROI attenuation is the most relevant measurement for predicting osteoporotic compression fracture, is an alternative to DXA, and can predict the number and rate of compression fractures. Spine surgeons should be aware of L4 t-ROI attenuation to make successful fusion in spine surgery for elderly patients group.Level of Evidence: 3.

Thermal Impedance Characterization Using Optical Measurement Assisted by Multi-Physics Simulation for Multi-Chip SiC MOSFET Module.

In this paper, an approach to determine the thermal impedance of a multi-chip silicon carbide (SiC) power module is proposed, by fusing optical measurement and multi-physics simulations. The tested power module consists of four parallel SiC metal-oxide semiconductor field-effect transistors (MOSFETs) and four parallel SiC Schottky barrier diodes. This study mainly relies on junction temperature measurements performed using fiber optic temperature sensors instead of temperature-sensitive electrical parameters (TESPs). However, the fiber optics provide a relatively slow response compared to other available TSEP measurement methods and cannot detect fast responses. Therefore, the region corresponding to undetected signals is estimated via multi-physics simulations of the power module. This method provides a compensated cooling curve. We analyze the thermal resistance using network identification by deconvolution (NID). The estimated thermal resistance is compared to that obtained via a conventional method, and the difference is 3.8%. The proposed fusion method is accurate and reliable and does not require additional circuits or calibrations.

Evaluation of Cumulative and Conditional Antibiotic Release from Vancomycin-Embedded Fibrin Sealant and Its Antibacterial Activity : An In Vitro Study.

OBJECTIVE: Fibrin sealants have been used for hemostasis, sealant for cerebrospinal fluid leakage, and adhesive barrier in neurosurgery. Further, as its clinical use and role of an effective drug delivery vehicle have been proposed. This study was performed to measure antibacterial activity and continuous local antibiotic release from different concentrations of vancomycin-impregnated fibrin sealant in vitro. METHODS: Antibacterial activity was investigated by disk diffusion test by measuring the diameter of the growth inhibition zone of bacteria (methicillin-resistant Staphylococcus aureus, ATCC29213) from vancomycin-embedded fibrin sealant disc diluted at five different concentrations (C1-C5; 8.33, 4.167, 0.83, 0.083, and 0.0083 mg/disc, respectively). Continuous and conditioned release of vancomycin concentration (for 2 weeks and for 5 days, respectively) were also measured using high-performance liquid chromatography (HPLC) method. To mimic the physiologic wound conditions with in vitro, conditioned vancomycin release in phosphate buffer solution (PBS) was measured and replaced PBS for five consecutive days, half a day or completely daily. RESULTS: In the disk diffusion test, the mean diameters of bacterial inhibition zone were 2.54±0.07 cm, 2.61±0.12 cm, and 2.13±0.15 cm (C1, C2, and C3 respectively) but 1.67±0.06 cm and 1.23±0.15 cm in C4 and C5, respectively. Continuous elution test elicited the peak release of vancomycin from the fibrin sealant at 48 hours, with continued release until 2 weeks. However, conditioned vancomycin release decreased to half or more on day 2, however, the sustainable release was measured over the therapeutic dose (10-20 µg/mL) for 5 days and 4 days in assays of half and total exchange of PBS. CONCLUSION: This study suggests that fibrin sealant can provide an efficient vehicle for antibiotic drug release in a wide range of neurosurgical procedures and the safe and effective therapeutic dose will be at the concentration embedded of 4.167 mg/disc or more of vancomycin.

HL301 in the treatment of acute bronchitis: a phase 2b, randomized, double-blind, placebocontrolled, multicenter study.

BACKGROUND/AIMS: There is insufficient quality data to recommend the use of herbs for the treatment of acute bronchitis. Small number of randomized trials of plant extracts for this purpose were determined to be low quality and there are concerns for the safety. HL301 is a combined product of seven medicinal plants. In the present study, we tried to evaluate the efficacy and safety of HL301 for the treatment of acute bronchitis with a randomized, double-blind, placebo-controlled, multicenter trial design. METHODS: A total of 166 patients with acute bronchitis were randomized to receive placebo or HL301 (600 mg/day) for 7 days. The primary endpoint was change in bronchitis severity score (BSS) from baseline visit (visit 2) to the end of treatment (visit 3). Other efficacy variables were the change of each component of the BSS (cough, sputum, dyspnea, chest pain, and crackle) with treatment, response rate, improvement rate, satisfaction rate and number of rescue medications taken. RESULTS: Changes in the BSS from visit 2 to visit 3 were higher in the HL301 group than in the placebo group both in the full analysis set (4.57 ± 1.82 vs. 3.15 ± 3.08, p < 0.01) and in the per protocol set (4.62 ± 1.81 vs. 3.30 ± 3.03, p < 0.01). Four BSS components (cough, sputum, dyspnea, and chest pain) improved more with HL301 treatment than with placebo treatment. Participants treated with HL301 showed higher response, improvement, and satisfaction rates and less use of rescue medication than the placebo group. CONCLUSION: HL301 (600 mg/day) was effective and safe for symptomatic treatment of acute bronchitis.

Data for oropharyngeal leak pressure, peak inspiratory pressure, and gastric tube insertion success rate of supraglottic airway devices in laparoscopic surgeries (A network meta-analysis dataset).

This article presents dataset of network meta-analysis (NMA) and systemic review, entitled, Comparison of supraglottic airway devices in laparoscopic surgeries: A network meta-analysis Yoon SW et al., 2019. The data tables demonstrate numeric values for endpoints: oropharyngeal leak pressure (OLP) before and after pneumoperitoneum, peak inspiratory pressure (PIP) before and after pneumoperitoneum, and gastric tube insertion success rate for each supraglottic airway device (SAD). All relevant randomized controlled trials published up to 31 March 2018 were collected from MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases. 26 studies with a total of 2142 patients that included eight different SADs were included. The data described in this article are available as a supplementary file.

The effective application of segmental image fusion in spinal radiosurgery for improved targeting of spinal tumours.

PURPOSE: As a result of experiences of failed image fusion, an improved protocol for effective CT and MRI image fusion was developed. Image fusion is a critical part of image-guided stereotactic radiosurgery (IG-SRS) and greatly influences the accurate measurement of gross tumour volume (GTV) and optimal dosimetry. Avoidance of any positional discrepancy is vital for optimal image fusion and results in improved targeting, which improves clinical results. This paper describes a protocol for effective image fusion and how it impacted on the clinical outcome of stereotactic radiosurgery for spinal tumours. METHODS: Fused MRI/CT images from 20 patients were examined and compared. A protocol for fusing images from thin slice MR images and CTs was developed for improved identification and measurement of tumour volume. Differences in individual GTV values both before and after image fusion were evaluated. The effectiveness of tumour targeting was also assessed by comparing discrepancies in individual and overall GTV values. RESULTS: Differences in mean GTVs using either CT or MRI alone compared with the mean found through combined CT/MR image fusion showed a difference of 30.5 +/- 4.8% and 14.5 +/- 3.3% respectively. Additionally, the median GTV values from CT- and MR-based imaging were 11.64 +/- 7.8 cm(3) and 11.72 +/- 6.6 cm(3) vs 14.06 +/- 8.0 cm(3). Median GTV from CT-MR fusion was 14.06 +/- 8.0 cm(3). Improved information provided by the fused images enabled us to prescribe more effective dosages, as the fused images gave more accurate information about tumour se due to better delineation of tumour perimeters. CONCLUSIONS: This protocol provides improved visualisation of spinal tumours and enables better treatment planning. Segmented image fusion was shown to provide significant advantages for planning stereotactic radiosurgery. Fused images provided more precise and accurate data and allowed better targeting of tumours, with improved tumour coverage that resulted in better clinical outcomes.

Pharmacologic strategies to prevent hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A systematic review and network meta-analysis protocol.

BACKGROUND: Hypertensive disorders of pregnancy are major health issues affecting mothers and infants. General anesthesia is inevitable for certain mothers with these conditions and they may exhibit pronounced hemodynamic instability, especially during induction and airway manipulation. The aims of this study are to combine direct and indirect comparisons of the efficacies of different medications used in attenuating reflex hemodynamic responses and generate intervention ranking by network meta-analysis (NMA). METHODS: A systematic and comprehensive search will be performed using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases, beginning from their inceptions to November 2019. Only randomized clinical trials evaluating the efficacy and safety of pharmacologic interventions for preventing hemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy will be included. The primary endpoints will be maximal mean arterial pressure (MAP) and maximal heart rate after intubation. Maximal systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and maternal/fetal blood gas analysis, as well as safety issues, including Apgar score at 1 minute and 5 minutes after delivery, will be also assessed.We will conduct both pairwise meta-analysis and network meta-analysis. We will use surface under the cumulative ranking curve (SUCRA) values and rankograms to present the hierarchy of pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX). RESULTS: The results of this systematic review and NMA will be published in a peer-reviewed journal. CONCLUSION: This NMA will enable us to determine the order of effectiveness and safety of pharmacological interventions used in attenuating hemodynamic responses for mothers with hypertensive disorders of pregnancy. TRIAL REGISTRATION NUMBER: CRD42019136067.

High-degree centrum semiovale-perivascular spaces are associated with development of subdural fluid in mild traumatic brain injury.

BACKGROUND: Severe centrum semiovale perivascular spaces (CSO-PVSs) are associated with the onset of brain atrophy and dementia. This study explored the relationship between severity of CSO-PVS and development of subdural fluid (SDF) in patients with mild traumatic brain injury (TBI), with the aim of investigating independent radiological risk factors for development of SDF. METHODS: The study cohort comprised 222 patients with a mean age of 51 years (64.0% men) who presented with mild TBI from January 2013 to November 2016. In this study, mild TBI was defined as a Glasgow Coma Scale (GCS) of ≥ 13, Post-Traumatic Amnesia (PTA) of <1 day, and Loss of Consciousness (LOC) of <30 minutes. The severity of CSO-PVS was categorized as low or high-degree. RESULTS: Among the 222 enrolled patients, 38 (17.1%) and 90 (40.5%) had high-degree PVS in the basal ganglia (BG) and centrum semiovale, respectively. Compared with patients who did not develop SDF, the mean age of patients who developed SDF was significantly higher (47.41 years versus 60.33 years, P < 0.0001). The incidence of de novo SDF was significantly higher in men than in women (77.8% versus 59.5%, P = 0.0151). Patients who showed SDF on brain computed tomography at admission more frequently developed de novo SDF (68.5% versus 38.1%, P < 0.0001). In multivariate logistic regression analysis of risk factors, high-degree CSO-PVS, male sex, initial SDF on admission, and old age were independently associated with development of de novo SDF after mild TBI. In Cox proportional hazards models of risk factors for SDF-development free survival rate, high-degree CSO-PVS, old age, and initial subdural hemorrhage showed statistically significant differences. CONCLUSIONS: Our study might help neurosurgeons determine the frequency of brain CT or the duration of follow-up for patients who present with mild TBI with high-degree CSO-PVS.