bluuebunny/crossref_metadata_2025 huggingface dataset:
Development Research at High Geographic Resolution: An Analysis of Night-Lights, Firms, and Poverty in India Using the SHRUG Open Data Platform
Authors: Asher Sam , Lunt Tobias , Matsuura Ryu , Novosad Paul
Published: January 2021

The SHRUG is an open data platform describing multidimensional socioeconomic development across 600,000 villages and towns in India. This paper presents three illustrative analyses only possible with high-resolution data. First, it confirms that nighttime lights are highly significant proxies for population, employment, per capita consumption, and electrification at very local levels. However, elasticities between night-lights and these variables are far lower in time series than in cross section, and vary widely across context and level of aggregation. Next, this study shows that the distribution of manufacturing employment across villages follows a power law: the majority of rural Indians have considerably less access to manufacturing employment than is suggested by aggregate data. Third, a poverty mapping exercise explores local heterogeneity in living standards and estimates the potential targeting improvement from allocating programs at the village—rather than at the district—level. The SHRUG can serve as a model for open high-resolution data in developing countries.
Real-Time PCR Detection of the Onion Downy Mildew Pathogen Peronospora destructor From Symptomless Onion Seedlings and Soils
Authors: Fujiwara Kazuki , Inoue Hiroyoshi , Sonoda Ryoichi , Iwamoto Yutaka , Kusaba Motoaki , Tashiro Nobuya , Miyasaka Atsushi
Published: January 2021

An outbreak of downy mildew disease of onion, caused by Peronospora destructor, in Japan in 2016 necessitated a reevaluation of the primary inoculum sources to optimize disease management. Detection of the P. destructor pathogen in plants with asymptomatic infection and in soil would guide the application of fungicides according to the extent of infection before disease development. Here, we detected P. destructor in both plants and soil using newly developed primer sets (Pd ITS and Pd ITS 614) by both conventional and real-time PCR. Validation by real-time PCR with Pd ITS 614 showed that P. destructor DNA was amplified from symptomless seedlings at 3.7 × 102 to 1.0 × 100 conidium cells/50 mg leaf tissue, suggesting the detection of asymptomatic infection. Real-time PCR with Pd ITS amplified pathogen DNA from field soils at 1.6 × 103 to 8.3 × 101 oospore cells/g of soil. This real-time PCR assay provides a useful tool for identifying and quantifying inoculum sources, which may be the foundation of the design of integrated disease management strategies.
When to consider Pneumocystis jirovecii prophylaxis in HIV-negative patients
Authors: Dameron Matthew , Horowitz Mitchell , Gupta Neeraj , Abi Hatem Nathalie
Published: January 2021

Clinicians should be aware of the risk of opportunistic infections in patients who are immunocompromised. Opportunistic infections such as Pneumocystis jirovecii commonly are associated with HIV/AIDS, but less commonly considered in patients receiving immunosuppressive and/or immunomodulating therapies. This case report focuses on the management of an opportunistic infection in an HIV-negative patient on immunosuppressive medications for lymphoma and exacerbation of pulmonary fibrosis.
Exposure to point-of-care ultrasound in PA programs before employment
Authors: Smalley Courtney M.
Published: January 2021

Objectives:

Point-of-care ultrasound (POCUS) is integral to bedside evaluation of ED patients. This study examines POCUS exposure for physician assistants (PAs) before ED employment.

Methods:

A retrospective cross-sectional survey was distributed electronically to PAs employed in 13 EDs across a healthcare system. Participants were queried on POCUS education during PA training. Findings were reported as percentages of total respondents, using descriptive statistics.

Results:

The response rate was 70.1%. Only 14.9% of respondents received POCUS exposure in PA school. Of those who received training, most (66.7%) received 5 or fewer hours and 94.1% strongly agree or agree that POCUS education should be integrated into PA education.

Conclusion:

In this survey, most PAs practicing in the ED did not receive POCUS education during training. Practice location and year of graduation may contribute to this finding. Healthcare systems should consider additional training for PAs working in EDs to bridge gaps in knowledge.
Respiratory Syncytial Virus Vaccination During Pregnancy and Effects in Infants
Authors: Madhi Shabir A. , Polack Fernando P. , Piedra Pedro A. , Munoz Flor M. , Trenholme Adrian A. , Simões Eric A. F. , Swamy Geeta K. , Agrawal Sapeckshita , Ahmed Khatija , August Allison , Baqui Abdullah H. , Calvert Anna , Chen Janice , Cho Iksung , Cotton Mark F. , Cutland Clare L. , Englund Janet A. , Fix Amy , Gonik Bernard , Hammitt Laura , Heath Paul T. , de Jesus Joanne N. , Jones Christine E. , Khalil Asma , Kimberlin David W. , Libster Romina , Llapur Conrado J. , Lucero Marilla , Pérez Marc Gonzalo , Marshall Helen S. , Masenya Masebole S. , Martinón-Torres Federico , Meece Jennifer K. , Nolan Terry M. , Osman Ayman , Perrett Kirsten P. , Plested Joyce S. , Richmond Peter C. , Snape Matthew D. , Shakib Julie H. , Shinde Vivek , Stoney Tanya , Thomas D. Nigel , Tita Alan T. , Varner Michael W. , Vatish Manu , Vrbicky Keith , Wen Judy , Zaman Khalequ , Zar Heather J. , Glenn Gregory M. , Fries Louis F.
Published: January 2021

(Abstracted from N Engl J Med 2020;383:426–439)

Respiratory syncytial virus (RSV) is a leading cause of hospitalizations of infants with lower respiratory tract infections. In 2015, approximately 3.2 million children younger than 5 years were hospitalized because of RSV-associated lower respiratory infection, and 118,000 died in hospital.
Randomized, Assessor-Blinded Trial Comparing Highly Purified Human Menotropin and Recombinant Follicle-Stimulating Hormone in High Responders Undergoing Intracytoplasmic Sperm Injection
Authors: Witz Craig A. , Daftary Gaurang S. , Doody Kevin J. , Park John K. , Seifu Yodit , Yankov Vladimir I. , Heiser Patrick W.
Published: January 2021

(Abstracted from Fertil Steril 2020;114:321–330)

Advancements in assisted reproductive technologies (ARTs) have led to patient-specific treatment including tailoring gonadotropin dose to ovarian potential. Anti–müllerian hormone (AMH) has demonstrated efficacy as a biomarker for ovarian potential when guiding gonadotropin dosing in ART and has been successfully used to predict likely high responders.
Reverse or Hemi Shoulder Arthroplasty in Proximal Humerus Fractures: A Single-Blinded Prospective Multicenter Randomized Clinical Trial
Authors: Laas Niels , Engelsma Yde , Hagemans Frans J.A. , Hoelen Max A. , van Deurzen Derek F.P. , Burger Bart J.
Published: January 2021

Objectives:

To compare outcomes between hemiarthroplasty (HA) and reversed shoulder arthroplasty (RSA) as a treatment for dislocated 3-part and 4-part proximal humerus fractures in the elderly population.

Design:

Prospective multicenter randomized controlled trial.

Setting:

Three Level-1 trauma centers.

Patients/Participants:

This study included 31 patients of which 14 were randomized into the HA group and 17 into the RSA group.

Intervention:

Patients randomized to the HA group were treated with a cemented-stem Aequalis-fracture HA and patients randomized to the RSA group with a cemented-stem Aequalis-fracture RSA.

Main Outcome Measurements:

Primary outcomes consisted of range of motion and constant score. Secondary outcomes were the visual analog scale for pain, DASH score, SF-12 scores, and radiographic outcomes.

Results:

After 6 and 12 months of follow-up, RSA showed a significant higher anterior elevation (105 degrees vs. 80 degrees, P = 0.002 and 110 degrees vs. 90 degrees, P = 0.02, respectively) and constant score (60 vs. 41, P = 0.01 and 51 vs. 32, P = 0.05, respectively) compared with HA. There were no significant differences in external and internal rotation. Also, visual analog scale pain, DASH scores, SF-12 scores, and radiological healing of the tuberosities and heterotopic ossification did not show any significant differences between groups.

Conclusion:

RSA showed significant superior functional outcomes for anterior elevation and constant score compared with HA for dislocated 3-part and 4-part proximal humerus fractures after short-term follow-up.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Long noncoding RNA SNHG1 promotes human prostate cancer progression by sponging miR-383-5p
Authors: Huang Guangyi , Guo Xiao , Yang Hao
Published: January 2021

Prostate cancer is the most common urinary malignancy in males. Long noncoding RNA small nucleolar RNA host gene 1 (lncRNA SNHG1) has been reported to play a crucial role in the development of various cancers. However, the understanding of SNHG1 in prostate cancer is still limited and needs further investigation. In this study, we found the level of SNHG1 was significantly upregulated in prostate cancer tissues and cells. Knockdown of SNHG1 significantly suppressed proliferation, migration and invasion and promoted cell apoptosis in prostate cancer cells. In addition, knockdown of SNHG1 significantly downregulated proliferating cell nuclear antigen and upregulated cleaved caspase-3. MiR-383-5p was identified to be a target of SNHG1 by bioinformatics analysis, dual-luciferase reporter assay, RNA immunoprecipitation assay and RNA pull-down assay. MiR-383-5p was significantly downregulated in prostate cancer tissues and cells. Inhibition of miR-383-5p could partially restore the effects of SNHG1 knockdown on prostate cancer cell proliferation, apoptosis, migration and invasion. Furthermore, murine xenograft models were established to investigate the effects of SNHG1 and miR-383-5p in tumorigenesis in vivo. We found SNHG1 knockdown or miR-383-5p overexpression repressed tumor growth in vivo. In conclusion, SNHG1 contributed to prostate cancer progression by targeting miR-383-5p, elucidating that SNHG1 might be a target for prostate cancer therapy.
Circular RNA hsa_circ_0000554 promotes progression and elevates radioresistance through the miR-485-5p/fermitin family members 1 axis in esophageal cancer
Authors: Wang Jianhua , Chen Yushan , Wu Rui , Lin Yong
Published: January 2021

Esophageal cancer is one of the most aggressive malignant cancers in the world. Circular RNA hsa_circ_0000554 (circ_0000554) and Fermitin family members 1 (FERMT1) are rated to the advancement of esophageal cancer. Nevertheless, the regulatory mechanisms between circ_0000554 and FERMT1 in the radioresistance of esophageal cancer are unclear. Quantitative real-time PCR (qRT-PCR) was applied to examine the expression of circ_0000554, FERMT1 mRNA, and miR-485-5p. Western blot analysis was employed to assess the protein expression levels of FERMT1, Ki-67, matrix metalloproteinase (MMP)-9 and MMP-2. Cell colony formation, migration, invasion, radiosensitivity and apoptosis were evaluated by cell colony formation, transwell or flow cytometry assays. The relationship between circ_0000554 or FERMT1 and miR-485-5p was verified with dual-luciferase reporter assay. Circ_0000554 and FERMT1 expression was enhanced in esophageal cancer tissues and radioresistant esophageal cancer tissues. Both circ_0000554 and FERMT1 repression blocked cell colony formation, migration, invasion and elevated cell radiosensitivity and apoptosis in esophageal cancer cells. Importantly, circ_0000554 served as a sponge for miR-485-5p in esophageal cancer cells. And FERMT1 acted as a downstream target for miR-485-5p. Additionally, circ_0000554 modulated FERMT1 expression via miR-485-5p. Furthermore, FERMT1 enhancement reversed circ_0000554 inhibition-mediated effects on the colony formation, migration, invasion, radiosensitivity and apoptosis of esophageal cancer cells. Circ_0000554 silencing repressed EC progression and enhanced cell radiosensitivity through downregulating FERMT1 via sponging miR-485-5p, which provided a possible method for improving the radioresistence of esophageal cancer.
Sesamin induces cell cycle arrest and apoptosis through p38/C-Jun N-terminal kinase mitogen-activated protein kinase pathways in human colorectal cancer cells
Authors: Wang Xuxu , Qiao Jiahao , Zou Chaoyi , Zhao Yutao , Huang Yefei
Published: January 2021

Sesamin, a lignan compound, exhibits a variety of biological activities and possesses potent anticancer properties on some human cancers. However, its effect on human colorectal cancer (CRC) remains to be elucidated. To investigate the effects of sesamin on CRC cells and further to explore the mechanisms, cell viability, cell cycle and apoptosis assays were performed in this study. We found that sesamin had a selective antiproliferation of CRC cell line HCT116 in a dose- and time-dependent manner, but no obvious effect on human normal colorectal mucosa epithelial cell FHC. Further study showed that sesamin-induced cell cycle arrest and decreased the expression of Cyclin D1 significantly and dose-dependently in HCT116 cells. Moreover, sesamin dose-dependently triggered apoptosis of HCT116 but not FHC, and promoted the expression levels of proapoptotic biomarkers Bax, cleaved caspase-3 and cleaved PARP-1 and inhibited the expression of antiapoptotic biomarker Bcl-2. Western blot analysis was used to reveal the possible signaling pathways, and we found that sesamin upregulated the phosphorylation expression levels of C-Jun N-terminal kinase (JNK) and p38 except ERK1/2 in a dose-dependent way in both HCT116 and another CRC cell line SW480. Moreover, we found that the apoptosis effect induced by sesamin was partially eliminated by inhibiting JNK or p38 activation. Finally, we showed that sesamin effectively reduced the growth of xenograft tumors derived from cell lines with limited toxicity. Taken together, the potential ability of sesamin to induce cell cycle arrest and apoptosis was shown to be via the p38 and JNK mitogen-activated protein kinase signaling pathways, which may be one of the mechanisms of the anticancer activity of this low-toxic agent.
Is alectinib-induced elevation of creatine phosphokinase a predictive factor for response? Report of two cases and review of the literature
Authors: Shalata Walid , Massalha Ismaell , Agbarya Abed
Published: January 2021

We aim to describe two cases of creatine phosphokinase (CPK) and liver enzymes elevation occurring as adverse effects of alectinib (Alecensa) treatment for anaplastic lymphoma kinase (ALK)-mutated metastatic nonsmall cell lung cancer (NSCLC). A 56-year-old female and a 59-year-old male diagnosed with NSCLC exhibiting ALK gene rearrangements were treated by alectinib administration. The former had a complete response of widespread metastatic disease within 3 months, and the latter also had a substantial response. Both patients initially experienced an episode of CPK elevation and neither had dose modifications. At the end of the treatment, CPK and liver enzymes returned to normal range despite the continuation of alectinib full dose. A transient elevation of CPK and liver enzymes may take place during the alectinib treatment, indicating a tumor tissue damage thus contributing to a significant response.
Trends in male breast cancer mortality: a global overview
Authors: Pizzato Margherita , Carioli Greta , Bertuccio Paola , Malvezzi Matteo , Levi Fabio , Boffetta Paolo , Negri Eva , La Vecchia Carlo
Published: January 2021

Objectives

Recent trends in male breast cancer have been inadequately studied. We updated mortality trends in selected countries and regions worldwide using most recent available data and we predicted figures for 2020.

Methods

We extracted official death certification data for male breast cancer and population estimates from the WHO and the Pan American Health Organization databases, from 2000 to 2017. We computed age-standardized (world population) death rates for selected countries and regions worldwide. We used joinpoint regression analysis to identify significant changes in trends and to predict death numbers and rates for 2020.

Results

In 2015–2017, Central-Eastern Europe had a rate of 2.85/1 000 000, and Russia of 2.22, ranking among the highest. North-Western and Southern Europe, the European Union as a whole and the USA showed rates ranging between 1.5 and 2.0. Lower rates were observed in most Latin American countries, with values below 1.35/1 000 000, in Australia, 1.22, and Japan, 0.58. Between 2000–2004 and 2015–2017, age-adjusted death rates decreased between 10 and 40% in North-Western Europe, Russia, and the USA, and between 1.5 and 25% in the other areas under study, except Latin America (+0.8%). Except for Central-Eastern Europe, predicted rates for 2020 were favourable.

Conclusion

Advancements in management are likely the main drivers of the favourable trends in male breast cancer death rates over the last decades. Delayed diagnosis and limited access to effective care explain the higher mortality in some areas.
To Adjust or Not to Adjust? When a “Confounder” Is Only Measured After Exposure
Authors: Groenwold Rolf H. H. , Palmer Tom M. , Tilling Kate
Published: January 2021

Advice regarding the analysis of observational studies of exposure effects usually is against adjustment for factors that occur after the exposure, as they may be caused by the exposure (or mediate the effect of exposure on outcome), so potentially leading to collider stratification bias. However, such factors could also be caused by unmeasured confounding factors, in which case adjusting for them will also remove some of the bias due to confounding. We derive expressions for collider stratification bias when conditioning and confounding bias when not conditioning on the mediator, in the presence of unmeasured confounding (assuming that all associations are linear and there are no interactions). Using simulations, we show that generally neither the conditioned nor the unconditioned estimate is unbiased, and the trade-off between them depends on the magnitude of the effect of the exposure that is mediated relative to the effect of the unmeasured confounders and their relations with the mediator. We illustrate the use of the bias expressions via three examples: neuroticism and mortality (adjusting for the mediator appears the least biased option), glycated hemoglobin levels and systolic blood pressure (adjusting gives smaller bias), and literacy in primary school pupils (not adjusting gives smaller bias). Our formulae and simulations can inform quantitative bias analysis as well as analysis strategies for observational studies in which there is a potential for unmeasured confounding.
The differential impact of aerobic and isometric handgrip exercise on blood pressure variability and central aortic blood pressure
Authors: Seidel Maximilian , Pagonas Nikolaos , Seibert Felix S. , Bauer Frederic , Rohn Benjamin , Vlatsas Stergios , Mühlberger Dominic , Nina Babel , Westhoff Timm H.
Published: January 2021

Background:

Blood pressure variability and central SBP are independent markers of cardiovascular risk. Data on lifestyle-interventions to reduce these parameters are sparse. The present work reports the differential effects of aerobic vs. isometric handgrip exercise on blood pressure variability and central SBP in a prospective randomized trial.

Methods:

Seventy-five hypertensive patients were randomized to one of the following 12-week programs: isometric handgrip training five times weekly; ‘Sham-handgrip training’ five times weekly; aerobic exercise training (30 min three to five times/week). Blood pressure variability was assessed by the coefficient of variation in 24-h ambulatory blood pressure monitoring (ABPM). Central SBP was measured noninvasively by the SphygmoCor device (AtCor Medical, Australia).

Results:

The aerobic exercise program significantly decreased systolic daytime variability (12.1 ± 2.5 vs. 10.3 ± 2.8, P = 0.04), whereas diastolic daytime blood pressure variability was not significantly altered (P = 0.14). Night-time variability was not significantly affected (P > 0.05). Central SBP was reduced from 145±15 to 134 ± 19 mmHg (P = 0.01). Isometric handgrip and sham-handgrip exercise did not significantly affect blood pressure variability (P > 0.05 each). Isometric exercise tended to reduce central SBP (142 ± 19 to 136 ± 17 mmHg, P = 0.06). ANCOVA revealed significant intergroup differences for the change of daytime SBP and DBP variability (P = 0.048 and 0.047, respectively).

Conclusion:

Aerobic exercise reduces blood pressure variability and central SBP. Isometric handgrip exercise does not reduce blood pressure variability but tends to lower central SBP in this hypertensive population.
Review on the Use of Topical Ocular Hypertonic Saline in Corneal Edema
Authors: Chow Shing-Chuen , Chan Jonathan Cheuk-Hung
Published: January 2021

Purpose:

To review the effectiveness of topical ocular hypertonic saline in corneal edema.

Methods:

Online literature search of published articles on the effectiveness of topical hypertonic saline in corneal edema, bullous keratopathy (BK), and other associated corneal conditions in humans was performed on April 16, 2020.

Results:

A total of 16 articles were reviewed after curation by the authors for relevance, with 4 randomized control trials, 6 prospective studies, 4 retrospective studies, and 2 case reports. Efficacy of hypertonic saline eye drops varied widely, depending on the specific corneal disorder being treated. Six of the studies involved BK (edema involves epithelium), 2 in corneal edema limited to the stroma, 5 in Fuchs dystrophy, 3 in filamentary keratitis (the presence of filaments attached to corneal epithelium), 2 in recurrent corneal erosion, and 1 in jellyfish stings. There was limited efficacy for hypertonic saline in BK, whereas clinical improvement was noted in most studies for corneal edema without epithelial involvement, especially if associated with Fuchs dystrophy or corneal hydrops in keratoconus. Hypertonic saline also seems to be beneficial for other corneal disorders, such as filamentary keratitis and jellyfish stings, but not in recurrent corneal erosion. Adverse effects from topical hypertonic saline include a mild stinging or burning sensation, with no serious complications having been reported.

Conclusions:

Topical ocular hypertonic saline seems to be a safe and effective treatment in the management of less severe forms of corneal edema and other corneal disorders such as filamentary keratitis.
Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease
Authors: Hébert Mélanie , Archambault Cyril , Doyon Christelle , Ospina Luis H. , Robert Marie-Claude
Published: January 2021

Purpose:

To identify risk factors for ocular graft-versus-host disease (oGVHD) in children with graft-versus-host disease (GVHD).

Methods:

This retrospective cohort study identified 38 children diagnosed with GVHD who underwent an ophthalmological examination. Survival to onset of oGVHD after transplant was analyzed using Kaplan–Meier analyses with log-rank tests. A multivariable Cox proportional hazards model was run for time to oGVHD using univariate risk factors.

Results:

The average age was 10.0 ± 5.4 years at the time of transplant. Underlying illness was acute lymphoblastic leukemia in 19 (50%) and acute myeloid leukemia in 8 (21%). Nonocular GVHD organ involvement included skin (84%), lungs (16%), intestines (50%), liver (24%), and bone marrow (3%). Fifteen children (39%) had oGVHD, of which 47% were asymptomatic. oGVHD was diagnosed 601 ± 878 days after GVHD. A significant association between risk of oGVHD and diagnosis of acute lymphoblastic leukemia (P = 0.10) or acute myeloid leukemia (P = 0.08) was not found. Organ involvement associated with oGVHD included skin (P = 0.03) and lungs (P = 0.02). Survival curves were significantly influenced by GVHD organ involvement (P = 0.02), but not underlying disease (P = 0.51). The adjusted Cox regression model yielded an independent hazard ratio of 8.82 (95% CI: 1.51–51.49; P = 0.016) for the presence of concomitant GVHD involvement of skin, lungs, and another organ.

Conclusions:

Children with multiorgan GVHD involvement including skin and lung disease are at increased risk for oGVHD. Given the proportion of asymptomatic cases found in this series, regular eye examinations are warranted in this population.
Implementation Experience With Meningococcal Serogroup B Vaccines in the United States
Authors: Fergie Jaime , Howard Ashley , Huang Liping , Srivastava Amit
Published: January 2021

Background:

Meningococcal serogroup B (MenB) is the leading cause of invasive meningococcal disease among US adolescents and young adults, accounting for 62% of cases in 16–23-year-olds in 2018. Since 2015, the Advisory Committee on Immunization Practices (ACIP) has recommended vaccination of healthy adolescents against MenB based on shared clinical decision-making (previously called “Category B” or individual clinical decision-making). However, MenB vaccine coverage and series completion rates remain low. Herein we examine implementation experience of adolescent MenB vaccination in the United States under this nonroutine ACIP recommendation.

Methods:

PubMed was searched for English-language articles published after 2015 examining MenB vaccination implementation in the United States. Studies reporting MenB vaccination awareness, coverage, knowledge of recommendations and implementation barriers or access disparities were included.

Results:

Identified studies provided evidence that ACIP’s MenB vaccination recommendation is poorly understood and prone to misinterpretation by US healthcare providers. Parental awareness of MenB vaccines is low, and racial and socioeconomic disparities exist regarding vaccine receipt. Parents rely on providers to learn about MenB disease risk and benefits of vaccination, with provider recommendations carrying substantial weight in vaccination decisions.

Conclusions:

Five years of evidence regarding the MenB vaccination implementation experience suggest that the nonstandard recommendation for MenB vaccines is partly responsible for low vaccine coverage. Further, inconsistent implementation of ACIP recommendations could be limiting access to MenB vaccines. Providers need additional support and guidance to implement the shared clinical decision-making recommendation, in turn ensuring equitable access for vaccine-eligible adolescents to enable comprehensive protection against meningococcal disease.
Liver Abscess in Children-experience From a Single Tertiary Care Center of North India
Authors: Lal Sadhna Bhasin , Venkatesh Vybhav , Kumar Aditi , Anushree Neha , Seetharaman Keerthivasan , Aneja Aradhana , Chaluvashetty Sreedhara B. , Sehgal Rakesh
Published: January 2021

Background:

Liver abscess (LA), a common problem in children in the tropics, is believed to be mostly pyogenic (PLA), sometimes amebic (ALA). We aimed to analyze the clinical profile, etiology, risk factors for complications, management and outcomes of LA in children.

Methods:

The details of 81 children with LA managed in a tertiary set up over a period of 3 years were analyzed. A comparison of different parameters was performed with respect to etiology and complications.

Results:

ALA, PLA and mixed infection LA were diagnosed in 40 (49.4%), 32 (39.5%) and 9 (11.1%) children. The triad of fever, hepatomegaly and right upper quadrant tenderness was seen in 65 (80.2%). Coagulopathy was observed in 60 (77%) and jaundice in 12 (14.8%). Majority (71.6%) had a single LA in the right lobe (69%). Conservative, percutaneous needle aspiration, percutaneous catheter drainage and surgical drainage were done in 11.1%, 3.7%, 82.7% and 2.5%, respectively. Forty-three (53.1%) had complicated LA with rupture in 55.8% and vascular thrombosis in 16.2%. Children with complicated LA had higher alanine transaminase, prolonged prothrombin time/international normalized ratio, low serum protein and albumin levels (P < 0.05). Median duration of follow-up was 2 months and mean time to resolution of LA was 48.5 ± 18 days.

Conclusions:

ALA is the commonest cause of pediatric LA in endemic regions and is difficult to differentiate from PLA clinically. Percutaneous catheter drainage is safe and effective modality for the management of LA in children. A higher alanine transaminase, prolonged prothrombin time/international normalized ratio and low serum albumin levels (<3 g/dL) at presentation identify complicated LA.
Acute Sialadenitis in Children With Acute Leukemia During Chemotherapy: A Case Series Study
Authors: Toret Ersin , Aksakal Berra Nur , Duzenli Kar Yeter , Ozdemir Zeynep Canan , Bor Ozcan
Published: January 2021

Complications and toxicities of chemotherapy are the significant causes of morbidity and mortality during the treatment of childhood leukemias. Respiratory viral infections are the most common cause of febrile neutropenia episodes and rarely spread to the salivary glands. We submitted 4 patients with acute leukemia who got diagnosed with acute sialadenitis during their chemotherapy period.
Rates of Prophylaxis Among Pneumocystis jirovecii Pneumonia Cases Attributable to High-dose Steroid Therapy
Authors: Ludwig Amy , Krishnan Jay , Cinti Sandro
Published: January 2021

Background

The incidence of Pneumocystis jirovecii pneumonia (PJP) among patients on high-dose steroid therapy is not well established, and few guidelines exist to help guide decisions regarding prophylaxis. We assessed provider prescribing practices regarding pneumocystis prophylaxis and conducted a retrospective chart review of 306 PJP cases at a tertiary care center to identify preventable cases and target interventions to reduce harm.

Methods

We surveyed providers regarding their threshold to initiate PJP prophylaxis among patients receiving steroid therapy. Subsequently, all encounters with a positive PJP PCR from sputum or bronchoalveolar lavage from June 2012 to November 2018 were reviewed for signs and symptoms, radiographic imaging, laboratory tests, and expert consultation consistent with a clinical diagnosis of PJP. Cases were reviewed for steroid exposure within 3 months before diagnosis to identify at-risk populations. We defined high dose steroids as prednisone 20 mg or higher for a period greater than 4 weeks.

Results

Most survey respondents used their own clinical judgment in place of published guidelines (65%), though the majority used prednisone 20 mg as their threshold to prescribe PJP prophylaxis. Of 214 encounters with a clinical diagnosis of PJP, 65 (30%) cases were considered potentially preventable as they received high-dose steroid therapy without PJP prophylaxis. Of these 65 cases, 13 deaths occurred with PJP or its complications as a cause of death. We recommend consideration of prophylaxis in all patients on prednisone 20 mg or higher for greater than 4 weeks, especially if on concomitant immunosuppression.
Underpredicting pain: an experimental investigation into the benefits and risks
Authors: Peerdeman Kaya J. , Geers Andrew L. , Della Porta Delia , Veldhuijzen Dieuwke S. , Kirsch Irving
Published: January 2021

Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (ie, assimilation effects), as seen with placebo effects. However, in case of large expectation–experience discrepancies, experiences might change away from what is expected (ie, contrast effects). Previous research has demonstrated contrast effects on various outcomes, but not pain. We investigated the effects of strong underpredictions of pain on experienced pain intensity. In addition, we assessed related outcomes including (certainty of) expectations, fear of pain, pain unpleasantness, autonomic responses, and trust. Healthy participants (study 1: n = 81 and study 2: n = 123) received verbal suggestions that subsequent heat stimuli would be moderately or highly painful (correct prediction), mildly painful (medium underprediction; study 2 only), or nonpainful (strong underprediction). Both studies showed that participants experienced less intense pain upon strong underprediction than upon correct prediction (ie, assimilation). Expected pain, fear of pain, and pain unpleasantness were generally also lowered. However, strong underprediction simultaneously lowered certainty of expectations and trust in the experimenter. Study 2 indicated that the effects of strong underprediction vs medium underprediction generally did not differ. Moreover, study 2 provided some indications for reduced heart rate and skin conductance levels but increased skin conductance responses upon strong underprediction. In conclusion, even strong underpredictions of pain can reduce pain (ie, cause assimilation), although not significantly more than medium underpredictions. However, strong underpredictions can cause uncertainty and undermine trust. These findings suggest that healthcare providers may wish to be cautious with providing overly positive information about painful medical procedures.
Knowledge of Vulvar Anatomy and Self-examination in a Sample of Italian Women
Authors: Preti Mario , Selk Amanda , Stockdale Colleen , Bevilacqua Federica , Vieira-Baptista Pedro , Borella Fulvio , Gallio Niccolò , Cosma Stefano , Melo Catarina , Micheletti Leonardo , Benedetto Chiara
Published: January 2021

Objective

The aim of the study was to investigate the knowledge of vulvar anatomy and vulvar self-examination (VSE) in a sample of Italian women attending a gynecology clinic.

Methods

For this original research from May to July 2019, 512 women attending the Lower Genital Tract Clinic at the Department of Surgical Sciences of the University of Torino were invited to participate in a 29-question survey about vulvar anatomy, VSE, and sociodemographic details. Data were analyzed using descriptive statistics.

Results

Of 512 patients, 500 completed the questionnaire (98% response rate). The mean age of respondents was 41 years (range = 17–77 years). Education level was evenly distributed between elementary, high school, and university graduates. Only 15% of interviewed women were able correctly sketching vulvar anatomy. Seventy-six percent of the women had not heard about VSE, and 61% of the women approach their genitalia with feelings of shame and embarrassment. Only 23% of the women would seek medical advice after identification of possible abnormalities during VSE. A majority (69%) of the women would like to have more information about VSE and vulvar health through educational videos and social media.

Conclusions

Education about VSE may lead to earlier diagnosis of vulvar cancers and other pathologies. Further efforts are needed to disperse information about normal external female genital anatomy and VSE to achieve self-confidence among women.
Dynamic Spectral Imaging Colposcopy Versus Regular Colposcopy in Women Referred With High-Grade Cytology: A Nonrandomized Prospective Study
Authors: Booth Berit Bargum , Petersen Lone Kjeld , Blaakaer Jan , Johansen Tonje , Mertz Henrik , Kristensen Christina Blach , Lunde Søren , Dahl Katja , Bor Pinar
Published: January 2021

Objective

The aim of the study was to evaluate the sensitivity of dynamic spectral imaging (DSI) colposcopy compared with regular colposcopy for women referred with high-grade cervical cytology.

Methods

In a prospective, nonrandomized, multicenter study, we included women referred for colposcopy at hospital gynecology clinics with high-grade cytology. Women were examined using either a regular or DSI colposcope. In both groups, colposcopists located 1 area viewed as most suspicious. In the DSI group, this was done before viewing the DSI map. Subsequently, an area was chosen based on the worst color of the DSI map, and further additional biopsies were taken. All women had 4 cervical biopsies taken, all analyzed separately. The main outcome was sensitivity to find cervical intraepithelial neoplasia grade 2 or worse (CIN2+).

Results

A total of 261 women were examined using DSI colposcopy, and 156 women were examined using regular colposcopy. The sensitivity for finding CIN2+ when using the DSI technology as an adjunctive technology was found to be 82.2% (95% CI = 75.9–87.4), based on an average of 1.4 biopsies. This was corresponding in sensitivity to 2 biopsies taken using regular colposcopy (80.3%; 95% CI = 72.3–86.8). There was no difference in sensitivity for CIN+ between the groups when 3 or more biopsies were taken.

Conclusions

We found that the DSI colposcope may help direct biopsy placement; however, the improvement is based on small differences in needed biopsies and the clinical significance of this may be small. Multiple biopsies were still superior.
Disseminated Intravascular Coagulation Score Is Related to Short-term Mortality in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Surgery
Authors: Wang Liangshan , Shao Juanjuan , Fan Eddy , Jia Ming , Wang Hong , Hou Xiaotong
Published: January 2021

Disseminated intravascular coagulation (DIC) score is associated with short-term mortality in various conditions but has not been studied in postcardiotomy cardiogenic shock (PCS) patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). The objective of this study was to evaluate the relationship between DIC score at day 1 from VA-ECMO initiation and short-term mortality. We included all PCS patients supported with VA-ECMO at the Beijing Anzhen Hospital between January 2015 and December 2018. Multivariable logistic regression analysis was performed to assess the relationship between DIC score at day 1 and in-hospital mortality, and adjust for potential confounding variables. Of 222 PCS patients treated with VA-ECMO, 145 (65%) patients were weaned from VA-ECMO, and median (IQR) ECMO support duration was five (3–6) days. In-hospital mortality was 53%. The median (IQR) DIC score at day 1 was five (4–6). Patients with DIC score ≥5 at day 1 (overt DIC) had higher in-hospital mortality as compared with patients with DIC score <5 (64% vs. 22%; P < 0.001). After adjusting for age, sex, ECMO indication, and peak serum lactate, a one-point rise in DIC score [OR, 2.20; 95% confidence intervals (CI), 1.64–2.95] or DIC score ≥5 at day 1 (OR, 4.98; 95% CI, 2.42–10.24) was associated with an increased risk of in-hospital mortality. The area under the receiver operating characteristic curve for DIC score at day 1 was 0.76 (95% CI, 0.69–0.82). Our study suggests that DIC score at day 1 is associated with short-term mortality in patients undergoing VA-ECMO after cardiac surgery, independent of age, sex, disease characteristics, and severity of illness.
Diagnostic Value of Persistently Low Positive TGA-IgA Titers in Symptomatic Children With Suspected Celiac Disease
Authors: Trovato Chiara Marja , Montuori Monica , Morelli Annalisa , Alunni Fegatelli Danilo , Vestri Annarita , Giordano Carla , Cucchiara Salvatore , Caio Giacomo , Oliva Salvatore
Published: January 2021

Objectives:

While the algorithm to diagnose celiac disease (CD) in children with elevated anti-transglutaminase IgA (TGA-IgA) titers (>10 times upper limit of normal, ULN) is well defined, the management of children with low TGA-IgA values represents a clinical challenge. We aimed to identify the diagnostic value of persistently low positive TGA-IgA titers in predicting CD in children.

Methods:

We retrospectively analyzed children with symptoms or signs of CD, not eligible for a no-biopsy approach. We included children with at least 2 TGA-IgA measurements, endomysial antibody (EMA) assessment and esophagogastroduodenoscopy with biopsies. TGA-IgA values were provided as multiples of ULN. Patients were classified in groups according to median TGA-IgA values: A (TGA-IgA>1 ≤ 5 × ULN; defined as “low-positive”), B (TGA-IgA > 5 < 10 × ULN; “moderate-positive”), and C (controls).

Results:

Data of 281 children were analyzed. Of 162 children in group A, CD was diagnosed in 142 (87.7%), whereas normal duodenal mucosa was found in 20. In group B, all 62 children (100%) received a CD diagnosis. Group C included 57 controls. EMA were undetectable in 31 (15%) of mucosal atrophy cases. On the receiver-operating characteristic curve (area under the curve = 0.910), a mean value of 1.7 ULN showed a sensitivity of 81.4% and specificity of 81.8% to predict mucosal damage.

Conclusions:

Repeated low or moderate TGA-IgA values (<5 ULN or <10 ULN) are good predictors of a CD diagnosis. Symptomatic children with persistently low positive TGA-IgA titers should undergo esophagogastroduodenoscopy regardless of their EMA status.
Effectiveness of Mentorship Program in the Emergency Department
Authors: Gayrama-Borines Zarah , Coffman Sherrilyn
Published: January 2021

Nurses transferring to other departments (transitioning registered nurses) can benefit from programs designed to improve their performance and intent to stay. This article describes a mentorship program for nurses who transfer into the emergency department, which included weekly meetings between mentor and mentee participants to share constructive feedback. A qualitative evaluation revealed that the program helped mentees feel more supported and mentors more empowered; it also improved teamwork significantly, created camaraderie, intensified confidence levels, enhanced professionalism, and boosted morale across the emergency department.
Vulvar Intraepithelial Neoplasia: A Review of the Disease and Current Management
Authors: Dockery Lauren E. , Soper John T.
Published: January 2021

Importance

Vulvar intraepithelial neoplasia (VIN) represents an increasingly common, yet challenging diagnosis that shares many common risk factors with cervical intraepithelial neoplasia. However, unlike cervical intraepithelial neoplasia, effective screening and treatment strategies are much less defined for patients with VIN.

Objective

The objective of this article is to review the underlying risk factors leading to the development of VIN, identify special populations at risk for VIN, and outline acceptable treatment strategies.

Evidence Acquisition

This literature review was performed primarily using PubMed.

Results

Vulvar intraepithelial neoplasia can be separated into usual VIN (uVIN) and differentiated VIN (dVIN). The more common uVIN is related to underlying human papillomavirus infection, whereas dVIN occurs in the setting of other vulvar inflammatory conditions such as lichen sclerosis. Differentiated VIN carries a higher risk of progression to invasive malignancy. Extramammary Paget disease is a rare intraepithelial adenocarcinoma unrelated to uVIN and dVIN, although management is similar.

Conclusions and Relevance

Vulvar intraepithelial neoplasia is a preinvasive neoplasia of the vulva with few robust strategies for surveillance or management. Careful examination with targeted biopsy is warranted for suspicious lesions, and a combination of surgical and medical management can be tailored for individual patient needs.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After reading this article, the learner should be better able to evaluate the epidemiology and pathophysiology of VIN; assess risk for underlying malignancy, especially when comparing uVIN and dVIN; and compare different options for management of VIN including medical and surgical treatments.
Extracorporeal Life Support as a Treatment of Supraventricular Tachycardia in a Newborn
Authors: Matsudo Takahiro , Tsuboi Norihiko , Nishimura Nao , Nakagawa Satoshi
Published: January 2021

Supraventricular tachycardia (SVT) is the most common symptomatic tachyarrhythmia in children and requires medical treatment. Thus far, there have been few reports of the use of extracorporeal life support (ECLS) to provide cardiac support in children with low cardiac output resulting from arrhythmia. We present a case of a newborn in whom ECLS was used to provide support for cardiogenic shock secondary to intractable SVT. A 25-day-old girl presented with a 5-hour history of increasing pallor and listlessness. A clinical examination at presentation revealed retractions and peripheral coldness. An electrocardiogram showed a narrow-QRS tachycardia with a rate of 290 beats per minute. Adenosine triphosphate (maximum, 0.2 mg/kg) and synchronous direct current shock (maximum, 25 J) were ineffective. Chest x-ray showed a cardiac dilatation, and echocardiography showed a structurally normal heart with very poor function. The cardiogenic shock caused by SVT was refractory to treatment. The low cardiac output state persisted with worsening metabolic acidosis (bicarbonate, 5.8 mEq/L; lactate, 14.3 mmol/L). In view of the intractable tachyarrhythmia and worsening perfusion, blood access catheters were inserted, and ECLS was initiated. After commencing ECLS support, intravenous adenosine triphosphate (1.25 mg/kg) was administrated. The patient then reverted to a sinus rhythm with a rate of 180 beats per minute. There was considerable improvement of the heart function within 2 days of starting ECLS; the patient was weaned from ECLS support, and the blood access catheters were decannulated on day 3. After weaning from ECLS support, cardiac function returned to normal.
Tumor-Infiltrating Lymphocyctes in Triple-Negative Breast Cancer
Authors: Brown Lauren C. , Salgado Roberto , Luen Stephen J. , Savas Peter , Loi Sherene
Published: January 2021

Triple-negative breast cancer (TNBC) continues to represent an unmet need because of its significantly poorer outcomes, including higher relapse rates following early-stage disease and dismal survival times in the advanced setting, when compared with other breast cancer subtypes (Cancer 2012;118:5463–5472). Furthermore, there remains a lack of established systemic treatment options beyond conventional cytotoxic chemotherapy, with the exception of PARP inhibitors in the small subset of patients who harbor a BRCA mutation (N Engl J Med 2018;379:753; Lancet Oncol 2020;21:1269–1282; Ann Oncol 2019;30:558–566) and recently the use of immunotherapy in the first-line metastatic setting in those who are programmed death ligand 1–positive (Lancet Oncol 2020;21(1):44–59; N Engl J Med 2018;379(22):2108–2121). Suitable biomarkers for improving prognostication and directing therapy in both the early and advanced TNBC settings are required in order for improvements in survival outcomes to be continued to be attained. Tumor-infiltrating lymphocytes are gaining increasing relevance as an immunological biomarker in this arena.
The Use of Botulinum Toxin to Prevent Anastomotic Thrombosis and Promote Flap Survival
Authors: Hassan Abbas M. , Chappell Ava G. , Boyd Riley M. , Joshi Chitang , Wan Rou , Carabano Miguel , Bai Jennifer , Patel Anooj , Ullrich Peter , Ellis Marco F. , Galiano Robert D.
Published: January 2021

Background

Despite the possibility of using botulinum toxin to improve perfusion and prevent vasospasm, only a few studies have examined the use of botulinum toxin in the setting of flap surgery and thrombosis, and the mechanisms have not been fully explained.

Objective

The primary objective of this study was to provide a comprehensive review of the effectiveness of botulinum toxin in anastomotic thrombosis prevention and surgical flap survival to determine the value of conducting large-scale human trials.

Methods

Using the SYRCLE and CAMRADES criteria, a systematic review was performed. PubMed, Medline, EmBase, and the Cochrane Library were searched for studies that met our eligibility criteria.

Results

Twenty studies were included in the final selection. A total of 397 subjects were included. Eighteen studies used botulinum toxin type A alone, one used botulinum toxin type B alone, and only one used both botulinum toxin type A and botulinum toxin type B. The most commonly used injection technique was a preoperative intradermal injection. The most common procedure performed was a pedicled flap with random pattern skin flaps (65%). The mean injection dose was 28.17 ± 49.21 IU, whereas the mean reported injection time for studies using animal models was 7.4 ± 6.84 days.

Conclusions

Similar mechanisms demonstrated in animal models may be replicable in humans, allowing botulinum toxin to be used to prolong flap survival. However, many factors, such as optimal injection techniques, dosages, and long-term outcomes of botulinum use in flap surgery, need to be further assessed before applying this to clinical practice.