Ventilatory efficiency as a prognostic factor for postoperative complications in patients undergoing elective major surgery: a systematic review.

BACKGROUND: Major surgery is associated with high complication rates. Several risk scores exist to assess individual patient risk before surgery but have limited precision. Novel prognostic factors can be included as additional building blocks in existing prediction models. A candidate prognostic factor, measured by cardiopulmonary exercise testing, is ventilatory efficiency (VE/VCO2). The aim of this systematic review was to summarise evidence regarding VE/VCO2 as a prognostic factor for postoperative complications in patients undergoing major surgery. METHODS: A medical library specialist developed the search strategy. No database-provided limits, considering study types, languages, publication years, or any other formal criteria were applied to any of the sources. Two reviewers assessed eligibility of each record and rated risk of bias in included studies. RESULTS: From 10,082 screened records, 65 studies were identified as eligible. We extracted adjusted associations from 32 studies and unadjusted from 33 studies. Risk of bias was a concern in the domains 'study confounding' and 'statistical analysis'. VE/VCO2 was reported as a prognostic factor for short-term complications after thoracic and abdominal surgery. VE/VCO2 was also reported as a prognostic factor for mid- to long-term mortality. Data-driven covariable selection was applied in 31 studies. Eighteen studies excluded VE/VCO2 from the final multivariable regression owing to data-driven model-building approaches. CONCLUSIONS: This systematic review identifies VE/VCO2 as a predictor for short-term complications after thoracic and abdominal surgery. However, the available data do not allow conclusions about clinical decision-making. Future studies should select covariables for adjustment a priori based on external knowledge. SYSTEMATIC REVIEW PROTOCOL: PROSPERO (CRD42022369944).

Depot medroxyprogesterone acetate and breast cancer: a systematic review.

PURPOSE: Short-acting progestin-only injectables containing depot medroxyprogesterone acetate (DMPA) are a safe method of contraception. Although DMPA has been available for several decades, there is little data on its influence on the risk of breast cancer. Hence, the aim of this paper was to provide an overview of the existing studies and create clarity regarding a possible association with breast cancer. METHODS: Literature searches were executed in MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and ICTRP. Search terms were related to DMPA and breast cancer. After elimination of duplicates, 3'850 studies were identified and assessed according to inclusion and exclusion criteria. Finally, ten studies were selected and included in this review. RESULTS: All the selected papers were case-control-studies, except for one pooled analysis and one study comparing observed and expected number of cancer cases. Most of the included studies found no overall elevated breast cancer incidence in DMPA users, only one study found a slightly increased risk and two studies concluded with a significant increase for the overall breast cancer risk. CONCLUSION: There is little evidence that DMPA may increase the overall risk for breast cancer. However, the incidence of breast cancer is possibly increased in current and more recent users, especially in women younger than 35 years. Long-term use did not result in any risk increase. Nevertheless, further studies will be necessary to confirm these findings and weigh up the individual risks and benefits of this contraceptive method.

Apnoeic oxygenation during paediatric tracheal intubation: a systematic review and meta-analysis.

BACKGROUND: Supplemental oxygen administration by apnoeic oxygenation during laryngoscopy for tracheal intubation is intended to prolong safe apnoea time, reduce the risk of hypoxaemia, and increase the success rate of first-attempt tracheal intubation under general anaesthesia. This systematic review examined the efficacy and effectiveness of apnoeic oxygenation during tracheal intubation in children. METHODS: This systematic review and meta-analysis included randomised controlled trials and non-randomised studies in paediatric patients requiring tracheal intubation, evaluating apnoeic oxygenation by any method compared with patients without apnoeic oxygenation. Searched databases were MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), Scopus, and Web of Science from inception to March 22, 2023. Data extraction and risk of bias assessment followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendation. RESULTS: After initial selection of 40 708 articles, 15 studies summarising 9802 children were included (10 randomised controlled trials, four pre-post studies, one prospective observational study) published between 1988 and 2023. Eight randomised controlled trials were included for meta-analysis (n=1070 children; 803 from operating theatres, 267 from neonatal intensive care units). Apnoeic oxygenation increased intubation first-pass success with no physiological instability (risk ratio [RR] 1.27, 95% confidence interval [CI] 1.03-1.57, P=0.04, I2=0), higher oxygen saturation during intubation (mean difference 3.6%, 95% CI 0.8-6.5%, P=0.02, I2=63%), and decreased incidence of hypoxaemia (RR 0.24, 95% CI 0.17-0.33, P<0.01, I2=51%) compared with no supplementary oxygen administration. CONCLUSION: This systematic review with meta-analysis confirms that apnoeic oxygenation during tracheal intubation of children significantly increases first-pass intubation success rate. Furthermore, apnoeic oxygenation enables stable physiological conditions by maintaining oxygen saturation within the normal range. CLINICAL TRIAL REGISTRATION: Protocol registered prospectively on PROSPERO (registration number: CRD42022369000) on December 2, 2022.

Progestogens for endometrial protection in combined menopausal hormone therapy: A systematic review.

Menopausal women with an intact uterus choosing estrogens for menopausal symptom relief require a progestogen for endometrial protection. The aim of this systematic review was to evaluate the risks of endometrial hyperplasia resp. malignancy with different progestogens used in combined MHT. Overall, 84 RCTs were included. We found that 1) most studies were done with NETA, followed by MPA, MP and DYD and LNG, 2) most progestogens were only available as oral formulations, 3) the most frequently studied progestogens (oral MP, DYD, MPA, oral and transdermal NETA, transdermal LNG) were assessed in continuously as well as in sequentially combined MHT regimens, 4) FDA endometrial safety criteria were only fulfilled for some progestogen formulations, 5) most studies demonstrated endometrial protection for the progestogen dose and time period examined. However, 6) study quality varied which should be taken into account, when choosing a combined MHT, especially if off-label-use is chosen.

Reducing systematic review burden using Deduklick: a novel, automated, reliable, and explainable deduplication algorithm to foster medical research.

BACKGROUND: Identifying and removing reference duplicates when conducting systematic reviews (SRs) remain a major, time-consuming issue for authors who manually check for duplicates using built-in features in citation managers. To address issues related to manual deduplication, we developed an automated, efficient, and rapid artificial intelligence-based algorithm named Deduklick. Deduklick combines natural language processing algorithms with a set of rules created by expert information specialists. METHODS: Deduklick's deduplication uses a multistep algorithm of data normalization, calculates a similarity score, and identifies unique and duplicate references based on metadata fields, such as title, authors, journal, DOI, year, issue, volume, and page number range. We measured and compared Deduklick's capacity to accurately detect duplicates with the information specialists' standard, manual duplicate removal process using EndNote on eight existing heterogeneous datasets. Using a sensitivity analysis, we manually cross-compared the efficiency and noise of both methods. DISCUSSION: Deduklick achieved average recall of 99.51%, average precision of 100.00%, and average F1 score of 99.75%. In contrast, the manual deduplication process achieved average recall of 88.65%, average precision of 99.95%, and average F1 score of 91.98%. Deduklick achieved equal to higher expert-level performance on duplicate removal. It also preserved high metadata quality and drastically reduced time spent on analysis. Deduklick represents an efficient, transparent, ergonomic, and time-saving solution for identifying and removing duplicates in SRs searches. Deduklick could therefore simplify SRs production and represent important advantages for scientists, including saving time, increasing accuracy, reducing costs, and contributing to quality SRs.

Ion formation pathways of crown ether-fullerene conjugates in the gas phase.

The ion formation of crown ether-[60]fullerene conjugates of the type (crown - H)-C60-H with crown = 12cr4, 15cr5 and 18cr6 has been studied with matrix-assisted laser desorption/ionisation (MALDI) and electrospray ionisation mass spectrometry (ESI MS). In total five different ways of ion formation are presented, including metalation (MALDI, ESI), protonation and oxidation (both in MALDI) in the positive-ion mode and deprotonation (MALDI, ESI) and reduction (MALDI) in the negative-ion mode. In line with thermochemistry, the deprotonation and electron transfer processes involve the C60 moiety as the charge-carrying entity, while protonation and metalation occur at the crown ether. Particular emphasis has been placed on the study of metal cation attachment in MALDI varying the crown ether size in the conjugate and using different alkali metal chlorides in the target preparation. Dissociation reactions of the metalated conjugates are influenced by the interaction strength of the metal cation to the crown ether fullerene conjugate. The data confirm an increase in bond strength with smaller metal cations, supporting the notion of charge density-driven interactions.

Polyoxopalladates encapsulating 8-coordinated metal ions, [MO8Pd(II)12L8]n- (M = Sc3+, Mn2+, Fe3+, Co2+, Ni2+, Cu2+, Zn2+, Lu3+; L = PhAsO3(2-), PhPO3(2-), SeO3(2-)).

A total of 16 discrete polyoxopalladates(II) [MO(8)Pd(II)(12)L(8)](n-), with a metal ion M encapsulated in a cuboid-shaped {Pd(12)O(8)L(8)} cage, have been synthesized: the phenylarsonate-capped series (1) L = PhAsO(3)(2-), M = Sc(3+) (ScPhAs), Mn(2+) (MnPhAs), Fe(3+) (FePhAs), Co(2+) (CoPhAs), Ni(2+) (NiPhAs), Cu(2+) (CuPhAs), Zn(2+) (ZnPhAs); the phenylphosphonate-capped series: (2) L = PhPO(3)(2-), M = Cu(2+) (CuPhP), Zn(2+) (ZnPhP); and the selenite-capped series (3) L = SeO(3)(2-), M = Mn(2+) (MnSe), Fe(3+) (FeSe), Co(2+) (CoSe), Ni(2+) (NiSe), Cu(2+), (CuSe), Zn(2+) (ZnSe), Lu(3+) (LuSe)). The polyanions were prepared in one-pot reactions in aqueous solution of [Pd(3)(CH(3)COO)(6)] with an appropriate salt of the metal ion M, as well as PhAsO(3)H(2), PhPO(3)H(2), and SeO(2), respectively, and then isolated as hydrated sodium salts Na(n)[MO(8)Pd(II)(12)L(8)]·yH(2)O (y = 10-37). The compounds were characterized in the solid state by IR spectroscopy, single-crystal XRD, elemental and thermogravimetric analyses. The solution stability of the diamagnetic polyanions ScPhAs, ZnPhAs, ZnPhP, ZnSe, and LuSe was confirmed by multinuclear ((77)Se, (31)P, (13)C, and (1)H) NMR spectroscopy. The polyoxopalladates ScPhAs, MnPhAs, CoPhAs, and CuPhAs were investigated by electrospray ionization mass spectrometry (ESI-MS) and tandem mass spectrometry (MS/MS). Electrochemical studies on the manganese- and iron-containing derivatives demonstrated that the redox properties of the Mn(2+), Fe(3+), and Pd(2+) centers in the polyanions are strikingly influenced by the nature of the capping group. These results have subsequently been verified by density functional theory (DFT) calculations. Interestingly, electron paramagnetic resonance (EPR) measurements suggest that the coordination geometry around Mn(2+) is dynamically distorted on the EPR time scale (∼10(-11) s), whereas it appears as a static ensemble with cubic symmetry on the X-ray diffraction (XRD) time-scale (10(-15) s). The octacoordinated Cu(2+) cuboid is similarly distorted, in good agreement with DFT calculations. Interestingly, g(∥) is smaller than g(⊥), which is quite unusual, needing further theoretical development.