bluuebunny/crossref_metadata_2025 huggingface dataset:
Universal and Selective Interventions to Prevent Poor Mental Health Outcomes in Young People: Systematic Review and Meta-analysis
Authors: Salazar de Pablo Gonzalo , De Micheli Andrea , Solmi Marco , Oliver Dominic , Catalan Ana , Verdino Valeria , Di Maggio Lucia , Bonoldi Ilaria , Radua Joaquim , Baccaredda Boy Ottone , Provenzani Umberto , Ruzzi Francesca , Calorio Federica , Nosari Guido , Di Marco Benedetto , Famularo Irene , Montealegre Iriana , Signorini Lorenzo , Molteni Silvia , Filosi Eleonora , Mensi Martina , Balottin Umberto , Politi Pierluigi , Shin Jae Il , Correll Christoph U. , Arango Celso , Fusar-Poli Paolo
Published: May 2021

Background

Much is not known about the efficacy of interventions to prevent poor mental health outcomes in young people by targeting either the general population (universal prevention) or asymptomatic individuals with high risk of developing a mental disorder (selective prevention).

Methods

We conducted a PRISMA/MOOSE-compliant systematic review and meta-analysis of Web of Science to identify studies comparing post-test efficacy (effect size [ES]; Hedges’ g) of universal or selective interventions for poor mental health outcomes versus control groups, in samples with mean age <35 years (PROSPERO: CRD42018102143). Measurements included random-effects models, I2 statistics, publication bias, meta-regression, sensitivity analyses, quality assessments, number needed to treat, and population impact number.

Results

295 articles (447,206 individuals; mean age = 15.4) appraising 17 poor mental health outcomes were included. Compared to control conditions, universal and selective interventions improved (in descending magnitude order) interpersonal violence, general psychological distress, alcohol use, anxiety features, affective symptoms, other emotional and behavioral problems, consequences of alcohol use, posttraumatic stress disorder features, conduct problems, tobacco use, externalizing behaviors, attention-deficit/hyperactivity disorder features, and cannabis use, but not eating-related problems, impaired functioning, internalizing behavior, or sleep-related problems. Psychoeducation had the highest effect size for ADHD features, affective symptoms, and interpersonal violence. Psychotherapy had the highest effect size for anxiety features.

Conclusion

Universal and selective preventive interventions for young individuals are feasible and can improve poor mental health outcomes.
Effectiveness of “Priorix” Against Measles and Mumps Diseases in Children Born After 2004 in the United Kingdom
Authors: Povey Michael , Aris Emmanuel , Cheuvart Brigitte , Hall Gillian , Cohet Catherine , Willame Corinne
Published: May 2021

Background:

Evidence on vaccine effectiveness (VE) may encourage vaccination and help fight the reemergence of measles and mumps in Europe. However, limited data exist on real-life effectiveness of individual measles, mumps and rubella (MMR) vaccines. This study evaluated VE of GSK’s MMR vaccine (“Priorix”) against measles and mumps.

Methods:

This retrospective, case-control study used UK data from the Clinical Practice Research Datalink GOLD linked to the Hospital Episode Statistics database to identify children 1–13 years old diagnosed with measles or mumps from January 2006 to December 2018. Cases were matched to controls according to birth month/year and practice region. Cases were identified using clinical codes (without laboratory confirmation). “Priorix” exposure was identified using vaccine batch identifiers. Children exposed to other MMR vaccines were excluded. Adjusted VE was estimated for ≥1 vaccine dose in all children, and for 1 dose and ≥2 doses in children ≥4 years at diagnosis.

Results:

Overall, 299 measles cases matched with 1196 controls (87.6% <4 years old), and 243 mumps cases matched with 970 controls (74.2% <4 years old) were considered. VE for ≥1 dose in all children was 78.0% (97.5% confidence interval: 67.2%–85.3%) for measles and 66.7% (48.1%–78.6%) for mumps. In children ≥4 years old, VE after 1 dose was 74.6% (–21.7% to 94.7%) for measles and 82.3% (32.7%–95.3%) for mumps, and VE after ≥2 doses was 94.4% (79.7%–98.5%) for measles and 86.5% (64.0%–94.9%) for mumps.

Conclusions:

“Priorix” is effective in preventing measles and mumps in real-life settings.
Clinical Characteristics and Outcomes of a Cohort of Pediatric Oncohematologic Patients With COVID-19 Infection in the City of Bogotá, Colombia
Authors: Fonseca Eileen V. , Pardo Carlos A. , Linares Adriana , López Juan F. , Camacho German , Aponte Nelson H. , Bravo Diana L. , Orozco Daniela , Estupiñan Marcela , Chaparro Mauricio
Published: May 2021

Background:

In children, the complications of severe acute respiratory syndrome coronavirus 2 infection occur less frequently than in adults but the characteristics of this disease in oncology patients are not well characterized.

Methods:

This was a retrospective study in patients younger than 18 years of age with coronavirus disease 2019 (COVID-19) and cancer diagnoses between April and September 2020. Demographic variables, laboratory, and radiologic findings and complications of each case were identified. A descriptive analysis was performed.

Results:

A total of 33 patients were identified; the median age was 10 years. Fifteen patients (42%) were in chemotherapy at the time of the infection diagnosis, in two patients the chemotherapy protocol was permanently suspended. The most common symptom was fever in 20 patients (60%). Seven patients (21.2%) showed mild pneumonia, four patients (12.1%) severe pneumonia, and three cases (9.0%) were classified as critical. In the evaluated cohort, five patients (15.1%) died, and in two of those, death was caused by COVID-19 infection.

Conclusions:

Children with an oncologic disease, the search for COVID cases should be oriented to patients with fever, including febrile neutropenia, the presence of respiratory symptoms, and the search for epidemiologic contact. A higher frequency of complications and mortality attributed to COVID-19, two in pediatric oncohematologic patients was found. Institutional strategies to detect the infection early and lower institutional infection are indicated.
Achieving reliable pain change scores for individuals in the postoperative phase: carefully choose sampling density, test length, and administration mode
Authors: Obbarius Alexander , Schneider Stefan , Junghaenel Doerte U. , Stone Arthur A.
Published: May 2021

Despite tremendous efforts to increase the reliability of pain measures and other self-report instruments, improving or even evaluating the reliability of change scores has been largely neglected. In this study, we investigate the ability of 2 instruments from the Patient-Reported Outcomes Measurement Information System, pain interference (6 items) and pain behavior (7 items), to reliably detect individual changes in pain during the postsurgical period of a hernia repair in 98 patients who answered daily diaries over almost 3 weeks after surgery. To identify the most efficient strategy for obtaining sufficiently reliable estimates of change (reliability >0.9), the number of measurement occasions over the study period (sampling density), the number of items (test length), and the mode of administration (ie, static short form vs Computer adaptive testing) were manipulated in post-hoc simulations. Reliabilities for different strategies were estimated by comparing the observed change with the best approximation of “real” (ie, latent) change. We found (1) that near perfect reliability can be achieved if measures from all days over the whole study period, obtained with all pain interference or pain behavior items, were used to estimate the observed change, (2) that various combinations of the number of items and the number of measurement occasions could achieve acceptable reliability, and (3) that computer adaptive testings were superior to short forms in achieving sufficient reliability. We conclude that the specific strategy for assessing individual postoperative change in pain experience must be selected carefully.
Postoperative Rehabilitation of Multiligament Knee Reconstruction: A Systematic Review
Authors: Keeling Laura E. , Powell Sarah N. , Purvis Evan , Willauer Thomas J. , Postma William F.
Published: May 2021

Background:

Multiligamentous knee injuries (MLKIs) are rare, and heterogeneous in presentation and treatment options. Consequently, optimal postoperative rehabilitation of MLKI remains unclear.

Objective:

To summarize the latest evidence for postoperative rehabilitation protocols following multiligamentous knee reconstruction (MLKR).

Patients and Methods:

A multidatabase search was conducted with the aid of a health sciences librarian. Blinded reviewers conducted multiple screenings of studies evaluating postoperative rehabilitation protocols following MLKR. All included studies were then graded based on level of evidence, and data concerning patient demographics and rehabilitation protocols were extracted.

Results:

MLKR rehabilitation protocols differ widely in terms of weightbearing, bracing, initiation, and types of physical therapy, yet several established protocols were referenced frequently throughout the literature. Such protocols resulted in good outcomes, with patients returning to running in 6 to 12 months and returning to sport in 8 to 12 months.

Conclusion:

The rare nature of MLKI hinders the ability to create a standardized rehabilitation protocol. However, early postoperative physical therapy and range of motion consistently lead to improved outcomes. Randomized studies are needed to determine optimal postoperative rehabilitation following MLKR.
Normative and Psychometric Characteristics of the Health and Behavior Inventory Among Children With Mild Orthopedic Injury Presenting to the Emergency Department: Implications for Assessing Postconcussive Symptoms Using the Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5)
Authors: O'Brien Heidi , Minich Nori M. , Langevin Lisa Marie , Taylor H. Gerry , Bigler Erin D. , Cohen Daniel M. , Beauchamp Miriam H. , Craig William R. , Doan Quynh , Zemek Roger , Bacevice Ann , Mihalov Leslie K. , Yeates Keith Owen
Published: May 2021

Objective:

The study sought to present normative and psychometric data and reliable change formulas for the Health and Behavior Inventory (HBI), a postconcussive symptom rating scale embedded in the Child Sport Concussion Assessment Tool 5th edition (Child SCAT5).

Design:

Prospective cohort study with longitudinal follow-up.

Setting:

Pediatric emergency departments (EDs).

Participants:

As part of 3 studies conducted in the United States and Canada between 2001 and 2019, 450 children aged 8 to 16 years with mild orthopedic injuries were recruited during ED visits and assessed postacutely (M = 9.38 days, SD = 3.31) and 1 month and 3 months postinjury. Independent variables were rater (child vs parent), sex, and age at injury.

Main Outcome Measure:

HBI ratings.

Methods:

Children and parents rated children's symptoms at each time point; parents also rated children's preinjury symptoms retrospectively. Normative data (mean, SD, skewness, kurtosis, and percentiles) were computed for child and parent ratings. Internal consistency was assessed using Cronbach alpha (α), and test–retest reliability and interrater agreement were assessed with intraclass correlations (ICCs). Reliable change formulas were computed using linear regression and mixed models.

Results:

HBI ratings were positively skewed. Mean ratings and percentiles were stable over time. Child and parent ratings demonstrated good-to-excellent internal consistency (α 0.76-0.94) and moderate-to-good test–retest reliability (ICC 0.51-0.76 between adjacent assessments). However, parent–child agreement was poor to moderate (ICC 0.31-0.69).

Conclusions:

The HBI demonstrates acceptable normative and psychometric characteristics. Modest parent–child agreement highlights the importance of multiple informants when assessing postconcussive symptoms. The results will facilitate the use of the HBI in research and clinical practice.
The Effect of Cochlear Implantation on Tinnitus and Quality of Life: A Systematic Review and Meta-analysis
Authors: Yuen Erick , Ma Cheng , Nguyen Shaun A. , Meyer Ted A. , Lambert Paul R.
Published: May 2021

Objective:

To ascertain the effect of cochlear implantation (CI) on tinnitus and quality of life.

Databases Sources:

PubMed, Scopus, Web of Science, and Cochrane Library were searched through August 21, 2020. Search strategies used a combination of subject headings (e.g., MeSH in PubMed) and keywords for the following two concepts: cochlear implantation and tinnitus.

Study Selection:

English articles reporting on pre-intervention tinnitus-related patient-reported outcome measures (e.g., Tinnitus Handicap Inventory [THI], Tinnitus Questionnaire [TQ], Visual Analogue Scale [VAS] for loudness) and quality of life measures (e.g., Nijmegen Cochlear Implantation Questionnaire [NCIQ] and Hospital Anxiety and Depression Scale [HADS]) for CI recipients were included.

Data Extraction:

Demographics, baseline, and follow-up data.

Data Synthesis:

Total of 27 articles reporting on 1,285 patients (mean age 54.5 years, range 14–81) were included. Meta-analysis of all tinnitus-related measures demonstrated improvement following implantation, with a mean difference of −23.2 [95% CI: −28.8 to –17.7], –12.6 [95% CI: −17.5 to –7.8], and –4.5 [95% CI: −5.5 to –3.4] (p < 0.05 for all) for THI, TQ, and VAS, respectively. NCIQ increased by 12.2 points [95% CI: 8.2–16.2] (p < 0.05), indicating improved quality of life among CI recipients. Psychological comorbidities were also ameliorated, as evidenced by reductions in HADS depression (−1.7 [95% CI: −2.4 to −0.9]) and anxiety (−1.3 [95% CI: −2.1 to −0.5]) (p < 0.05 for both) scores.

Conclusion:

Following CI, patients reported significant improvement in tinnitus via several validated questionnaires. Additional benefits include improved quality of life and reduction in psychological comorbidities.
Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-Analyses Focused on Tinnitus
Authors: Rucker Brayden , Umbarger Erich , Ottwell Ryan , Arthur Wade , Brame Lacy , Woodson Elena , Wright Drew N. , Hartwell Micah , Khojasteh Jam , Vassar Matt
Published: May 2021

Hypothesis:

The objective was to investigate the prevalence of spin in abstracts of systematic reviews and meta-analyses covering the treatment of tinnitus. We hypothesized that spin would be present in these articles and a significant relationship would exist between spin usage and extracted study characteristics.

Background:

Spin, the misrepresentation of study findings, can alter a clinician's interpretation of a study's results, potentially affecting patient care. Previous work demonstrates that spin is present in abstracts of randomized clinical trials.

Methods:

Using a cross-sectional analysis, we conducted a systematic search using MEDLINE and Embase databases on June 2, 2020, for systematic reviews focused on tinnitus treatment. Investigators performed screening and data extraction in a masked, duplicate fashion.

Results:

Forty systematic reviews met inclusion criteria, and spin was identified in four of them. Spin in abstracts most frequently occurred when conclusions claimed the beneficial effect of the experimental treatment despite high risk of bias in primary studies (n = 3). The other form of spin found was the conclusion claims safety based on nonstatistically significant results with a wide confidence interval (n = 1). There was no significant association between spin and any of our extracted study characteristics.

Conclusion:

Spin was observed in 10% of abstracts of systematic reviews and meta-analyses covering the treatment of tinnitus. Although this percentage may be small, we recommend that medical journals provide a more detailed framework for abstract structure and require the inclusion of risk of bias assessment results in abstracts to prevent the incorporation of spin.
Evaluating Neurotrophin Signaling Using MicroRNA Perilymph Profiling in Cochlear Implant Patients With and Without Residual Hearing
Authors: Shew Matthew , Wichova Helena , Warnecke Athanasia , Lenarz Thomas , Staecker Hinrich
Published: May 2021

Hypothesis:

MicroRNAs predicted to regulate neurotrophin signaling can be found in human perilymph.

Background:

Animal and human temporal bone studies suggest that spiral ganglion health can affect cochlear implant (CI) outcomes. Neurotrophins have been identified as a key factor in the maintenance of spiral ganglion health. Changes in miRNAs may regulate neurotrophin signaling and may reflect neurotrophin expression levels.

Methods:

Perilymph sampling was carried out in 18 patients undergoing cochlear implantation or stapedotomy. Expression of miRNAs in perilymph was evaluated using an Agilent miRNA gene chip. Using ingenuity pathway analysis (IPA) software, miRNAs targeting neurotrophin signaling pathway genes present in a cochlear cDNA library were annotated. Expression levels of miRNAs in perilymph were correlated to the patients’ preoperative pure-tone average.

Results:

Expression of mRNAs coding for neurotrophins and their receptors were identified in tissue obtained from normal human cochlea during skull base surgery. We identified miRNAs predicted to regulate these signaling cascades, including miR-1207-5p, miR-4651, miR-103-3p, miR-100-5p, miR-221-3p, miR-200-3p. There was a correlation between poor preoperative hearing and lower expression of miR-1207 (predicted to regulate NTR3) and miR-4651 (predicted to regulate NTR2). Additionally, miR-3960, miR-4481, and miR-675 showed significant differences in expression level when comparing mild and profound hearing loss patients.

Conclusions:

Expression of some miRNAs that are predicted to regulate neurotrophin signaling in the perilymph of cochlear implant patients vary with the patient's level of residual hearing. These miRNAs may serve as biomarkers for changes in neurotrophin signaling.
A refugee child with multiple patterned ecchymoses: a diagnostic dilemma between nonaccidental injury and primary hemostatic defect
Authors: Makis Alexandros , Masina Vasiliki , Spiteri Evangelia-Anna , Aggeli Ioanna , Vartholomatos Georgios , Chaliasos Nikolaos , Pergantou Helen
Published: May 2021

A 4-year-old girl from Syria presented to the hospital with multiple bruises on her body. Bruises were observed in protected areas in a shape of fingerprints and objects, while no other bruises occurred during hospitalization. The parents also reported a history of bleeding diathesis from infancy. Both the initial laboratory evaluation and the secondary tests done for possible thrombocytopenia and coagulation factors deficiencies were normal. Thus, the nonaccidental injury protocol of the Hospital was activated, and the possibility of abuse was not quite evident. Investigation for platelet disorders followed. Platelet aggregation test and flow cytometry were indicative of Glanzmann's thrombasthenia. It is of great importance in these cases, that the doctor eliminates any possibility of physical abuse and examines the patient for common and rare primary hemostatic defects, although both can co-exist.
Colorectal Neoplasia Detection in Individuals With Positive Multitarget Stool DNA Tests
Authors: Anderson Joseph C. , Robinson Christina M. , Hisey William M. , Edwards David K. , Kneedler Bonny L. , Berger Barry M. , Butterly Lynn F.
Published: May 2021

Background:

The US Preventive Services Task Force (USPSTF) includes multitarget stool DNA (mt-sDNA) testing as a colorectal cancer (CRC) screening option in average-risk individuals, but data on colonoscopy outcomes after positive mt-sDNA tests in community settings are needed.

Aim:

The aim of this study was to investigate colonoscopy outcomes and quality following positive mt-sDNA in the population-based New Hampshire Colonoscopy Registry.

Methods:

We compared colonoscopy outcomes and quality between age-matched, sex-matched, and risk-matched patients from 30 endoscopy practices with and without a preceding positive mt-sDNA test. Main outcomes were colonoscopy findings of CRC, advanced noncancerous neoplasia, nonadvanced neoplasia, or normal examination. Quality measures included withdrawal time, bowel preparation quality, examination completion, and percentage of average-risk individuals with normal colonoscopies receiving a USPSTF-recommended 10 year rescreening interval.

Results:

Individuals with positive mt-sDNA tests (N=306, average age 67.0 y; 61.8% female) were significantly more likely than colonoscopy-only patients (N=918, 66.2 y; 61.8% female) to have CRC (1.3% vs. 0.4%) or advanced noncancerous neoplasia (27.1% vs. 8.2%) (P<0.0001). Neoplasia was found in 68.0% of patients having colonoscopy after a positive mt-sDNA test, (positive predictive value, was 68.0%), versus 42.3% of patients with colonoscopy only (P<0.0001). No significant differences in colonoscopy quality measures were observed between cohorts.

Conclusions:

Colonoscopy after a positive mt-sDNA test was more frequently associated with CRC and colorectal neoplasia than colonoscopy alone. Positive mt-sDNA tests can enrich the proportion of colonoscopies with clinically relevant findings. Follow-up recommendations suggest that endoscopists do not inappropriately shorten rescreening intervals in mt-sDNA-positive patients with normal colonoscopy. These findings support the clinical utility of mt-sDNA for CRC screening in community practice.
Risk stratification of indeterminate pulmonary nodules
Authors: Paez Rafael , Kammer Michael N. , Massion Pierre
Published: May 2021

Purpose of review

Lung cancer remains the leading cause of cancer-related death in the United States, with poor overall 5-year survival. Early detection and diagnosis are key to survival as demonstrated in lung cancer screening trials. However, with increasing implementation of screening guidelines and use of computed tomography, there has been a sharp rise in the incidence of indeterminate pulmonary nodules (IPNs). Risk stratification of IPNs, particularly those in the intermediate-risk category, remains challenging in clinical practice. Individual risk factors, imaging characteristics, biomarkers, and prediction models are currently used to assist in risk stratifying patients, but such strategies remain suboptimal. This review focuses on established risk stratification methods, current areas of research, and future directions.

Recent findings

The multitude of yearly incidental and screening-detected IPNs, its management-related healthcare costs, and risk of invasive procedures provides a strong rationale for risk stratification efforts. The development of new molecular and imaging biomarkers to discriminate benign from malignant lung nodules shows great promise. Yet, risk stratification methods need integration into the diagnostic workflow and await validation in prospective, biomarker-driven clinical trials.

Novel biomarkers and new imaging analysis, including radiomics and deep-learning methods, have been developed to optimize the risk stratification of IPNs. While promising, additional validation and clinical studies are needed before they can be part of routine clinical practice.
Study on the effect of percutaneous intervertebral foraminoscopic discectomy in the treatment of lumbar disc herniation
Authors: Ji Qing-hui , Xue Yu , Qiao Xiao-feng , Shi Lei , Liu Shi-chen
Published: May 2021

This study explored the effect of percutaneous intervertebral foraminoscopic discectomy (PIFD) in the treatment of lumbar disc herniation (LDH).

This retrospective study collected a total of 88 patient cases for inclusion. Epidemiological and clinical data of patients with LDH at the First Affiliated Hospital of Jiamusi University between May 2017 and January 2020 were retrospectively analyzed. Of those, 44 patients received PIFD and were allocated to an intervention group. The other 44 patients administrated fenestration discectomy (FD), and were assigned to a control group. We compared surgery time (minute), incision length (cm), duration of hospital stay after surgery (day), pain intensity (as checked by Visual Analogue Scale (VAS), health-related quality of life (as examined by Oswestry Disability Index, ODI), and complications between 2 groups.

There were not significant differences in surgery time (minute) (P = .56), VAS (P = .33) and ODI (P = .46) after surgery between 2 groups. However, there were significant differences in incision size (cm) (P < .01) and length of hospital stay (day) (P < .01) after surgery between 2 groups. When compared before the surgery, patients in both groups had significant improvements in VAS (P < .01) and ODI (P < .01) after the surgery. Moreover, both groups had similar safety profiles (P > .05).

The findings of this study showed that both PIFD and FD benefit patients with LDH. However, PIFD can benefit patients more than FD in the incision size and duration of hospital stay after surgery.
The association between air pollution level and breast cancer risk in Taiwan
Authors: Li Yu-Chia , Chiou Jeng-Yuan , Lin Cheng-Li , Wei James Cheng-Chung , Yeh Ming-Hsin
Published: May 2021

Breast cancer has the highest incidence of cancer among women in Taiwan, and air pollutants have been documented to have multiple adverse effects on human health. There is no relevant data, there has been no research in Taiwan to discuss the relevance of air pollutants to breast cancer, and evidence is sparse and inconclusive.

Air quality data used in this study was collected from the 78 air quality monitoring stations situated in 74 municipalities in Taiwan during 2000 to 2011. The daily measurements taken at each monitoring station represented the level of exposure for each participant residing in that zone. The air pollution concentration is partitioned based on the concentration level in Quartile. We calculate the annual average air pollutants concentration (CO, NO, NO2, PM2.5, THC, and CH4) and the long-term average exposure levels of these pollutants until diagnosis of breast cancer, ending the study period for each individual.

Patients who were living in areas with the highest air pollutants concentration (Quartile 4) had the most people diagnosed with breast cancer (CO:1.47%, NO:1.41%, NO2:1.63%, PM2.5:0.91%, THC:1.53%, CH4:2.33%). The patients who were exposed to Quartile 1 level of CO, NO, and NO2 concentration were the oldest, and other patients who were exposed to Quartile 4 level of CO, NO, and NO2 concentration were living in the areas of highest urbanization. Participants exposed to Quartile 4 level concentrations of air pollutants were associated with highest hazards ratios for breast cancer incidences.

Most participants who were exposed to the high concentration of air pollutants (CO, THC and CH4) had a significantly higher risk of breast cancer. If we can improve air pollution in the environment, we can reduce the incidence of breast cancer and save precious medical resources.
Multidisciplinary treatment of primary intracranial yolk sac tumor
Authors: Xu Zhen-Ning , Yue Xiang-Yong , Cao Xiao-Ci , Liu Ya-Dong , Fang Bao-Shuan , Zhao Wen-Hao , Li Chen , Xu Shuai , Zhang Ming
Published: May 2021

Rationale:

Intracranial yolk sac tumors (YSTs) are rare malignancies with limited treatment options and a dismal prognosis. They are usually managed with surgical resection and chemoradiotherapy.

Patient concerns:

Here, we report a patient with primary YST in the pineal region who achieved long term survival. Despite undergoing treatment, he experienced several recurrences over a 15-year period.

Diagnosis:

Brain magnetic resonance imaging (MRI) demonstrated the presence of space-occupying lesions in the pineal region and the medial tail of the left lateral ventricle. The tumors were excised, and the histological diagnosis suggested an intracranial YST.

Interventions:

The patient achieved long term survival after combined modality therapy including surgery, stereotactic radiosurgery (SRS)/intensity modulated radiation therapy (IMRT), chemotherapy, and targeted therapy.

Outcomes:

The disease remained stable. However, the patient gave up treatment and passed away in October 2020, with a total survival of about 15 years.

Lessons:

To the best of our knowledge, this patient with intracranial YST had received a longer survival compared with other published reports. We summarize previously published reports of intracranial YST and discuss the importance of multidisciplinary treatment. SRS may have a role, as a focal boost to residual tumor after resection or in case of recurrence after conventional radiotherapy, in the multimodality management of intracranial YSTs.
Chronic eosinophilic pneumonitis due to the inhalation of aerosolized face lotion
Authors: Shimoda Masafumi , Morimoto Kozo , Tanaka Yoshiaki , Takemura Tamiko , Oka Teruaki , Yoshimori Kozo , Ken Ota
Published: May 2021

Rationale:

Inhalation of toxic agents can induce eosinophilic pneumonia. However, only a few case reports demonstrate that exposure to materials can induce chronic eosinophilic pneumonia (CEP). Here, we describe a rare case of CEP with mild alveolar hemorrhage due to the inhalation of aerosols from face lotion. This is the first report of eosinophilic pneumonia caused by face lotion exposure.

Patient concerns:

A 39-year-old woman was admitted to our hospital with cough and dyspnea for 2 months, which coincided when she started to use a new aerosolized face lotion. Laboratory findings showed high blood eosinophil levels, and chest computed tomography (CT) scans revealed bilateral peripheral consolidation and ground-glass opacity mainly in the left upper lobe. She underwent flexible bronchoscopy. Eosinophils in bronchoalveolar lavage fluid (BALF) were slightly elevated, and the gross appearance of BALF was bloody. The histological examination of the transbronchial lung biopsy showed infiltration of eosinophils and macrophages in alveolar septa with edema and without vasculitis and granuloma formation; a small number of hemosiderin-laden macrophages were also observed. An inhalation challenge test involving the face lotion was performed. Six hours after the test, the blood test showed an increased white blood cell (WBC) count, and chest radiography showed slight exacerbation. Forced vital capacity decreased the following day.

Diagnosis:

According to histological analysis and positive result of an inhalation challenge test, she was diagnosed with CEP with mild alveolar hemorrhage due to inhalation of aerosols from the face lotion.

Interventions and outcomes:

She gradually improved without medication after stopping the use of face lotion.

Lessons:

To the best of our knowledge, this is the first report of CEP with mild alveolar hemorrhage due to the inhalation of face lotion. Various inhaled agents, such as face lotion, can induce CEP in rare cases.
Inferior mesenteric plexus block under computed tomography guidance
Authors: Park Jun-Mo , Hwang Seong-Min
Published: May 2021

Rationale:

Inferior mesenteric plexus block is indicated for left-sided lower abdominal pain. However, in patients with terminal cancer, severe abdominal pain can prevent the patient from maintaining the necessary posture during the procedure, and considerable anatomic deformation owing to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity can make the procedure difficult. In these cases, performing the procedures under computed tomography (CT) guidance can ensure greater safety and accuracy.

Patient concerns:

A 63-year-old man was referred for severe left-sided lower abdominal pain. He was unable to lie prone owing to severe lower abdominal pain and right hip surgery performed 15 years ago. His visual analog scale score was 9 out of 10.

Diagnoses:

The patient had terminal pancreatic tail cancer. Compared with abdominal CT findings obtained 50 days ago, hepatic metastasis and peritoneal seeding were still present, infiltration to the tissues around the pancreas and retrogastric area was increased, and most of the abdominal aorta was encased. In addition, metastatic lymph nodes were identified in several areas on the left including the left para-aortic area. However, the lesion causing the pain could not be identified. Therefore, an inferior mesenteric plexus block was performed according to the patient's complaint.

Interventions:

Epidural patient-controlled analgesia was performed first. The patient's pain consequently reduced to a certain level, and the prone position became possible to some extent, so a CT-guided inferior mesenteric plexus block was performed 2 days later.

Outcomes:

After the CT-guided inferior mesenteric plexus block, it became possible to control the patient's pain with a fentanyl patch 75 mcg/hour only, and his visual analog scale score was reduced to 4. After 4 weeks, the patient died without complaints of severe pain as before.

Lessons:

CT-guided inferior mesenteric plexus block can be performed in patients with left-sided lower abdominal pain, enabling a safer and more accurate procedure especially in patients with terminal cancer who are unable to lie prone owing to severe lower abdominal pain or with considerable anatomic deformation due to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity.
Measurement of postpartum blood loss using a new two-set liquid collection bag for vaginal delivery
Authors: Wang Fang , Lu Nanjia , Weng Xiaofeng , Tian Yanping , Sun Shiwen , Li Baohua
Published: May 2021

Background:

Postpartum hemorrhage (PPH) is a major obstetric complication, and the real-time measurement of blood loss is important in the management and treatment of PPH. We designed a new two-set liquid collection bag (TSLCB) for measuring postpartum blood loss in vaginal delivery. The aim of this study was to evaluate the effectiveness of the TSLCB in separating the blood from the amniotic fluid during vaginal delivery and in determining the accuracy of the measured postpartum blood loss.

Methods:

A prospective, randomized, case control study was conducted in the Women's Hospital, Zhejiang University School of Medicine, from March 2018 to April 2018. Sixty single pregnant women with spontaneous labor at 37–41 weeks without maternal complications were randomly divided into the experimental and control groups. The TSLCB was used to evaluate separately the amount of blood and amniotic fluid. For the control group, visual estimation and traditional plastic blood-collecting consumables were used to estimate the amount of postpartum blood loss. The measured blood loss between the two groups was compared, and the association of the measured blood loss with various clinical lab indices and vital signs was investigated.

Results:

The TSLCB (the experimental group) improved the detection of the measured blood loss compared with visual estimation and the traditional method (the control group) (P < .05). In the experimental group, correlation analysis showed that the measured blood loss at delivery and within 24 h of delivery was significantly associated with the decreased hemoglobin level, red blood cell count, and hematocrit level of patients (r = −0.574, −0.455, −0.437; r = 0.-595, −0.368, −0.374; P < .05). In the control group, only the measured blood loss within 24 h of delivery was associated with the decreased hemoglobin level (r = −0.395, P < .05). No blood transfusion and plasma expanders were required in the treatment of PPH for both groups.

Conclusions:

The TSLCB can be used to accurately measure the postpartum blood loss in vaginal delivery by medical personnel.
Early prediction of response to neoadjuvant chemotherapy using contrast-enhanced ultrasound in breast cancer
Authors: Peng Juan , Pu Huan , Jia Yan , Chen Chuang , Ke Xiao-Kang , Zhou Qing
Published: May 2021

Early prediction of non-response is essential in order to avoid inefficient treatments. The objective of this study was to determine the contrast-enhanced ultrasound (CEUS) for early predicting pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer patients.

Between March 2018 and October 2019, 93 consecutive patients with histologically proven breast cancer scheduled for NAC were enrolled. Conventional ultrasound and CEUS imaging were performed before NAC and after two cycles of NAC. CEUS parameters were compared with pathologic response. Multiple logistic regression analyses were utilized to explore CEUS parameters to predict pCR, and receiver operating characteristic analysis was used to evaluate the predictive ability.

Therapeutic response was obtained from 25 (27%) patients with pCR and 68 (73%) with non-pCR. Compared to non-pCR, pCR cases have a significantly higher proportion of homogeneous enhancement feature (56% vs 14%, P < .001) and centripetal enhancement (52% vs 23%, P = .012). A significant decrease in peak intensity (PI) was observed after two cycles of NAC. Compared with non-pCR patients, the kinetic parameters PI change (PI%) was higher in pCR patients (P < .001). Multiple logistic regression demonstrated two independent predictors of pCR: internal homogeneity (odds ratio, 4.85; 95% confidence interval: 1.20–19.65; P = .027) and PI% (odds ratio, 1.08; 95% confidence interval: 1.02–1.15; P = .007). In receiver operating characteristic curve analysis, internal homogeneity and PI%, with area under curve of 0.71 and 0.84, predicted pCR with sensitivity (56%, 95%) and specificity (85%, 70%), respectively.

Internal homogeneity and PI% of CEUS may be useful in the noninvasive early prediction of pCR in patients with breast cancer.
Medical expertise as a critical influencing factor on the length of stay in the ED
Authors: Trotzky Daniel , Tsur Avishai M. , Fordham Daniel E. , Halpern Pinchas , Ironi Avinoah , Ziv-Baran Tomer , Cohen Aya , Rozental Lior , Or Jacob
Published: May 2021

Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians, the ED team is supplemented with doctors from specialties including internal medicine, general surgery, orthopedics etc. Here we compare ED length of stay (ED-LOS), treatment time and decision time between EM physicians, internists and general surgeons.

A retrospective cohort study was conducted examining the Emergency Department length of stay (ED-LOS) for all adult patients attending Sheba Medical Center ED, Israel, between January 1st, and December 31st, 2014. Using electronic medical records, data was gathered on patient age, sex, primary ED physician, diagnosis, eventual disposition, treatment time and disposition decision time. The primary outcome variable was ED-LOS relative to case physician specialty and level (ED, internal medicine or surgery; specialist or resident). Secondary analysis was conducted on time to treatment/ decision as well as ED-LOS relative to patient classification variables (internal medicine vs surgical diagnosis). Specialists were compared to specialists and residents to residents for all outcomes.

Residents and specialists in either EM, internal medicine or general surgery attended 57,486 (51.50%) of 111,630 visits to Sheba Hospital's general ED. Mean ED-LOS was 4.12 ± 3.18 hours. Mean treatment time and decision time were 1.79 ± 1.82 hours, 2.84 ± 2.17 hours respectively. Amongst specialists, ED-LOS was shorter for EM physicians than for internal medicine physicians (mean difference 0.28 hours, 95% CI 0.14–0.43) and general surgeons (mean difference 0.63 hours, 95% CI 0.43–0.83). There was no statistical significance between residents when comparing outcomes.

Increasing the number of EM specialists in the ED may support efforts to decrease ED-LOS, overcrowding and medical errors whilst increasing patient satisfaction and outcomes.
The Lived Experience of Pain and Depression Symptoms during Pregnancy
Authors: Vignato Julie , Beck Cheryl Tatano , Conley Virginia , Inman Michaela , Patsais Micayla , Segre Lisa S.
Published: May 2021

Background:

Depressive symptoms and pain are prevalent during pregnancy. Untreated pain and depressive symptoms occurring together may have a negative effect on maternal and newborn outcomes, yet little is known about women's experiences with pain and depressive symptoms during pregnancy. The purpose of this study is to describe the lived experience of depressive symptoms and pain occurring in women during the third trimester of pregnancy.

Methods:

A descriptive phenomenological study was conducted. Women during postpartum were recruited from a previous cross-sectional study of women in their third trimester that evaluated the relationship between pain, depression, and quality of life. Twenty-four women entered their responses into an online secure research Web site. These data were analyzed using Colaizzi's method of descriptive phenomenological analysis.

Results:

Four themes that described the essence of women's experiences with both pain and depressive symptoms were identified. They were pregnancy: feeling minimized, unheard and overwhelmed; attempting or trying but not treated: living with pain and pain interference; pain, sleep loss, and suffering; and pain and depressive symptoms: helpless, hopeless, and suffering.

Clinical Implications:

If a woman presents with pain, additional nursing assessments of her sleep and emotional state may be needed. Likewise, a positive depression symptom screening suggests the need for a more in-depth exploration of pain, pain interference, poor sleep, and mental health symptoms. Because the women perceive their pregnancy as minimized, nurses may need to assist in setting realistic expectations and encouraging social support. Nurses listening to women describing these conditions may be essential in promoting the women's wellbeing.
Case Report: Role of Anterior Segment Optical Coherence Tomography in Late-onset Capsular Block Syndrome
Authors: Piá-Ludeña Jose Vicente , Montolío-Marzo Santiago , Lanzagorta-Aresti Aitor , Davó-Cabrera Juan María , Roig-Revert María José , Peris-Martínez Cristina
Published: May 2021

SIGNIFICANCE

We report the use of anterior segment optical coherence tomography (AS-OCT) as a valuable tool for capsular block syndrome diagnosis and follow-up.

PURPOSE

The purposes of this study are to report a case of late-onset capsular block syndrome or lacteocrumenasia and to describe differential diagnosis with other more common phacoemulsification complications such as intraocular lens (IOL) or posterior capsule opacification.

CASE REPORT

We report the case of a 56-year-old man with a clinical history of cataract surgery in his left eye. Five years after cataract surgery, he complained of blurred vision and was referred for IOL removal to our hospital. After careful slit-lamp examination, we found that the lens was clear, and opacity belonged to the accumulation of a whitish material in the capsular bag behind the lens. AS-OCT gave the definite diagnosis of capsular block syndrome. Intraocular lens removal had been wrongly indicated, and we treated our patient by YAG laser posterior capsulotomy. AS-OCT confirmed the absence of a further accumulated material, so no other interventions were needed. After treatment, best-corrected visual acuity improved from 0.48 to 0.1 logMAR.

CONCLUSIONS

Capsular block syndrome is a rare late-onset complication of cataract surgery causing a deep visual acuity decay. A precise slit-lamp examination and AS-OCT, together, avoid misdiagnosis and unnecessary surgical treatment, which may be needed in case of IOL opacity or fibrotic-like lacteocrumenasia. AS-OCT also helps in determining the treatment outcome. Immediate best-corrected visual acuity improvement is reached after a successful intervention.
An Eye on COVID-19: A Meta-analysis of Positive Conjunctival Reverse Transcriptase–Polymerase Chain Reaction and SARS-CoV-2 Conjunctivitis Prevalence
Authors: Sopp Nicole M. , Sharda Vandhana
Published: May 2021

SIGNIFICANCE

This analysis and review demonstrate that, although emerging data indicate that the prevalence of severe acute respiratory coronavirus 2 (SARS-CoV-2) on the ocular surface and coronavirus disease 2019 (COVID-19) conjunctivitis is rare, the ocular surface remains of interest as a potential inoculation and transmission site for SARS-CoV-2. Continued safety precautions should be taken as more data become available.

COVID-19, caused by SARS-CoV-2, is a novel, global pandemic that has infected millions and, up to this point, caused more than two million fatalities worldwide. The ocular surface has become of interest as a possible vector for transmission by acting as a direct inoculation site, being a conduit for the virus into the respiratory system or as a method of transmission from potentially infected conjunctiva or tears. The components necessary for SARS-CoV-2 to theoretically infect ocular tissues are present: binding receptors (angiotensin-converting enzyme 2 and cluster of differentiation 147) and mechanisms for cell entry (transmembrane protease serine 2 and cathepsin L). This meta-analysis of COVID-19 prevalence data indicates that SARS-CoV-2 RNA has been infrequently found in conjunctival samples when tested with reverse transcriptase–polymerase chain reaction. This review estimates the prevalence of SARS-CoV-2 on the ocular surface and prevalence of conjunctivitis in patients with laboratory-confirmed COVID-19. There is much to be learned regarding ocular tropism of SARS-CoV-2.
2017 National Optometry Workforce Survey
Authors: Heath David A. , Spangler Jennifer S. , Wingert Timothy A. , Chan Mamie , Smith Earl L. , Grover Lori L. , Flanagan John G.
Published: May 2021

SIGNIFICANCE

Planning for the effective delivery of eye care, on all levels, depends on an accurate and detailed knowledge of the optometric workforce and an understanding of demographic/behavioral trends to meet future needs of the public.

PURPOSE

The purposes of this study were to assess the current and future supply of doctors of optometry and to examine in-depth trends related to (1) demographic shifts, (2) sex-based differences, (3) differences in practice behaviors in between self-employed and employed optometrists, and (4) the concept of additional capacity within the profession.

METHODS

The 2017 National Optometry Workforce Survey (31 items) was distributed to 4050 optometrists, randomly sampled from a population of 45,033 currently licensed and practicing optometrists listed in the American Optometric Association's Optometry Master Data File. A stratified sampling method was applied to the population of optometrists using primary license state, age, and sex as variables to ensure a representative sample.

RESULTS

With a response rate of 29% (1158 responses), the sample ensured a 95% confidence interval with a margin of error of <5%. Key results include finding no significant differences between men and women for hours worked (38.9 vs. 37.5), productivity (patient visits per hour, 2.0 vs. 1.9), or career options/professional growth satisfaction with 65% for both. The data indicate a likely range of additional patient capacity of 2.29 to 2.57 patients per week (5.05 to 5.65 million annually profession-wide).

CONCLUSIONS

The optometric workforce for the next decade is projected to grow 0.6 to 0.7% more annually than the U.S. population. The study found additional capacity for the profession more limited than previously suggested. Findings also illustrate an evolving/equitable workforce based on sex, in terms of both productivity and satisfaction. The trend toward employed versus self-employed was marked with 44% reporting they are employed, up from 29% in 2012.