bluuebunny/crossref_metadata_2025 huggingface dataset:
Engineering a mobile platform to promote sleep in the pediatric primary care setting
Authors: Mitchell Jonathan A , Morales Knashawn H , Williamson Ariel A , Huffnagle Nicholas , Eck Casey , Jawahar Abigail , Juste Lionola , Fiks Alexander G , Zemel Babette S , Dinges David F
Published: April 2021

Study Objectives

Pediatricians lack tools to support families at home for the promotion of childhood sleep. We are using the Multiphase Optimization Strategy (MOST) framework to guide the development of a mobile health platform for childhood sleep promotion. The objective of this study is to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep.

Methods

Children aged 10–12 years were enrolled (Study #1: N = 30; Study #2: N = 43). Participants wore a sleep tracker to measure sleep duration. Data were retrieved by a mobile health platform, programmed to send introductory messages during run-in (2 weeks) and goal achievement messages during intervention (7 weeks) periods. In study #1, participants were randomized to control, gain-framed incentive or loss-framed incentive arms. In study #2, participants were randomized to control, loss-framed incentive, normative feedback or loss-framed incentive plus normative feedback arms.

Results

In study #1, 1514 nights of data were captured (69%) and sleep duration during the intervention was higher by an average of 21 (95% CI: −8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, 2,689 nights of data were captured (81%), with no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.

Conclusions

We have developed and deployed a mobile health platform that can capture sleep data and remotely communicate with families. Promising candidate intervention components will be further investigated under the optimization phase of the MOST framework.

Clinical Trials

Both studies included in this manuscript were registered at clinicaltrials.gov:

-Study #1: NCT03263338

-Study #2: NCT03426644
Effects of supplementation of nonforage fiber source in diets with different starch levels on growth performance, rumen fermentation, nutrient digestion, and microbial flora of Hu lambs
Authors: Guo Tongqing , Wang Zhi Lan , Guo Long , Li Fadi , Li Fei
Published: April 2021

The objectives were to evaluate the effects of fiber source and dietary starch level on growth performance, nutrient digestion, rumen parameters, and rumen bacteria in fattening Hu lambs. A total of 360 Hu lambs (BW = 24.72 ± 0.14 kg, 2 months old) were subjected to a 2 × 3 factorial arrangement. Lambs randomly assigned 6 treatments with 6 repetitions (10 lambs per repetition) of each treatment. Six treatments were formulated to include the fiber sources with three starch levels. The experiment lasted a 63 d. The amount of feed, orts, and total feces were sampled on the 42nd day of the experiment. Rumen fluid samples were collected after 2 h of morning feeding on day 56. Rumen contents were collected last day after the selected lambs were slaughtered. Increasing the starch content decreased the digestibility of neutral detergent fiber (NDF, P = 0.005). Increasing the starch level increased the proportions of propionate (P = 0.002) and valerate (P = 0.001) and decreased the proportion of acetate (P < 0.001) and the ratio of acetate to propionate (P = 0.005). The abundance of Fibrobacter succinogenes was affected by an interaction between the fiber source and the starch level (P < 0.001). Fibrobacter succinogenes tended to be greater in lambs fed SH than in lambs fed BP (P = 0.091), which was greater in lambs fed high starch levels than in lambs fed low starch levels (P = 0.014). Increasing the starch level increased Streptococcus bovis abundance (P = 0.029) and decreased total bacteria (P = 0.025). At the genus level, increasing the starch level reduced the abundance of Butyrivibrio_2 (P = 0.020). Nevertheless, the final body weight (BW) and acid detergent fiber (ADF) digestibility were greater (P < 0.01) in lambs fed soybean hull (SH) than in lambs fed BP. The proportion of butyrate was greater (P = 0.005), while the rumen pH was lower (P = 0.001) in lambs fed beet pulp (BP) than in those fed SH. The abundances of Succiniclasticum, Candidatus_Saccharimonas, Ruminococcus_1, and Christensenellaceae_R-7 were greater in lambs fed SH than in those fed BP (P < 0.050), whereas the abundance of Fibrobacter was lower (P = 0.011). The predominant microbial phyla in all of the groups were Firmicutes, Bacteroidetes, and Fibrobacteres. Changing the starch level for fiber sources mainly changed the rumen community in terms of the phylum and genus abundances. Lambs fed SH with low starch level increased the final BW without affecting total volatile fatty acids (TVFA) concentrations.
Implementation of a workplace physical activity intervention in child care: process evaluation results from the Care2BWell trial
Authors: Neshteruk Cody D , Willis Erik , Smith Falon , Vaughn Amber E , Grummon Anna H , Vu Maihan B , Ward Dianne S , Linnan Laura
Published: April 2021

Care2BWell was designed to evaluate the efficacy of Healthy Lifestyles (HL), a worksite health promotion intervention to increase child care workers’ physical activity. The purpose of this study was to use process evaluation to describe the implementation of HL and determine if different levels of implementation are associated with changes in workers’ physical activity. Data were collected from 250 workers randomized to HL, a 6 month, multilevel intervention that included an educational workshop followed by three 8 week campaigns that included self-monitoring and feedback, raffle incentive, social support, and center director coaching. Process evaluation data collection included direct observation, self-reported evaluation surveys, website analytics and user test account data, tracking databases and semi-structured interviews. Implementation scores were calculated for each intervention component and compared at the center and individual levels. Nearly a third of workers never self-monitored and few (16%) met self-monitoring goals. Only 39% of centers engaged with the social support component as intended. Raffle and social support components were perceived as the least useful. Implementation varied widely by center (25%–76%) and individual workers (0%–94%). No within- or between-group differences for high compared to low implementation groups for change in physical activity were evident. Interview themes included limited sustainability, competing priorities, importance of social support, and desire for a more intensive, personalized intervention. Wide variation in implementation may explain limited effects on intervention outcomes. Future worksite interventions designed for child care workers can use these findings to optimize health promotion in this setting.
Comparison of patterns of infarction in TB and cryptococcal meningitis
Authors: Kumar Mritunjai , Dhar Nikita , Tiwari Ashutosh , Siddiqui Md Sabah
Published: April 2021

Background

To compare the frequency and patterns of stroke, the specificity of tubercular zone (TBZ) infarction and its effect on outcomes in TB (TBM) and cryptococcal meningitis (CM).

Methods

This retrospective study was conducted at two tertiary centres in India from May 2018 to July 2020. Sixty-one patients with TBM and 22 with CM were included. The primary outcome was the proportions of TBM and CM patients with infarction. Secondary outcomes included the anatomical locations of infarction and in-hospital mortality.

Results

Infarction was noted in 52.5% of patients with TBM and in 54.5% of those with CM (p=0.87), with caudate head infarcts in 9.4% vs 41.7% (p=0.01), cerebellar in 9.4% vs 33.3% (p=0.05), thalamic in 25% vs 0% and lobar in 28.1% vs 0%, respectively. In TBM, the infarcts were located in the TBZ in 3 (9.4%), in the ischaemic zone in 23 (71.9%), while 6 (18.8%) patients showed infarcts in both, while in CM, the infarcts were in 0 (0%), 6 (50%) and 6 (50%) patients, respectively. Infarcts were not associated with in-hospital mortality, either in TBM or CM.

Conclusion

Caudate head and cerebellar infarction was more common in CM, while thalamic and lobar infarcts were more frequent in TBM. TBZ infarcts were not specific to TBM.
Teacher Professional Development around the World: The Gap between Evidence and Practice
Authors: Popova Anna , Evans David K , Breeding Mary E , Arancibia Violeta
Published: April 2021

Many teachers in low- and middle-income countries lack the skills to teach effectively, and professional development (PD) programs are the principal tool that governments use to upgrade those skills. At the same time, few PD programs are evaluated, and those that are evaluated show highly varying results. This paper proposes a set of indicators—the In-Service Teacher Training Survey Instrument—to standardize reporting on teacher PD programs. An application of the instrument to 33 rigorously evaluated PD programs shows that programs that link participation to career incentives, have a specific subject focus, incorporate lesson enactment in the training, and include initial face-to-face training tend to show higher student learning gains. In qualitative interviews, program implementers also report follow-up visits as among the most effective characteristics of their professional development programs. This paper then uses the instrument to present novel data on a sample of 139 government-funded, at-scale professional development programs across 14 countries. The attributes of most at-scale teacher professional development programs differ sharply from those of programs that evidence suggests are effective, with fewer incentives to participate in PD, fewer opportunities to practice new skills, and less follow-up once teachers return to their classrooms.
“No Country Will Rise above Its Home, and No Home above Its Mother”: Gender, Memory, and Colonial Violence in Nineteenth-Century Texas
Authors: Troester Patrick T
Published: April 2021

This article examines Anglo-American colonization in nineteenth-century Texas and the construction of its historical memory, highlighting the interwoven roles of kinship, women’s labor, and gendered ideology. Building upon social, economic, and cultural roots in the U.S. Southeast, settler colonialism in Texas was a multi-generational project structured heavily by kinship. Anglo-Texan women served as active colonial agents through their productive and reproductive labor, which bound them firmly to more overt forms of colonial violence by men and the emerging state. In the face of Native resistance, Anglo-Texans highlighted Indigenous acts of violence against White women and families in order to invert responsibility for colonial violence and to justify the dispossession and destruction of Native peoples. Beginning as early as the 1830s, direct Anglo participants, including many influential women, wrote the first histories of Texas colonization, interpreting that process and its violence from within the deeply gendered and personal framework of kinship. Their efforts have marked both popular memory and historical scholarship to the present day.
Integrative systematics of the tooth-tailed scorpions,Odontobuthus(Buthidae), with descriptions of three new species from the Iranian Plateau
Authors: Barahoei Hossein , Prendini Lorenzo , Navidpour Shahrokh , Tahir H Muhammad , Aliabadian Mansour , Siahsarvie Roohollah , Mirshamsi Omid
Published: April 2021

The ‘tooth-tailed’ scorpions of the buthid genus Odontobuthus comprises six species with an allopatric or parapatric pattern of distribution in the Middle East, but the diversity of Odontobuthus in Iran appears to be underestimated, with the limits of several species remaining unclear. In the present contribution, an integrative approach to the systematics of Odontobuthus was applied, to determine the taxonomic validity and phylogenetic relationships among its species. Statistical analyses of five meristic characters, 38 morphometric characters and 21 morphometric ratios, combined with molecular phylogenetic analyses of DNA sequences from the mitochondrial cytochrome c oxidase subunit I (COI) gene, were conducted. All previously described species of Odontobuthus were found to be well supported, and new morphological diagnoses are here presented. Additionally, three new species: Odontobuthus baluchicus sp. nov. from the Makkoran Mountains, Odontobuthus chabaharensis sp. nov. from the coast of the Gulf of Oman (Sistan and Baluchistan Provinces) and Odontobuthus kermanus sp. nov. from Kerman Province, are described, raising the total number of Odontobuthus species to nine, six of which are endemic or subendemic to the Iranian Plateau. A distribution map and identification key to the species of Odontobuthus are also provided.
Exploring the diversity of the deep sea—four new species of the amphipod genusOedicerinadescribed using morphological and molecular methods
Authors: Jażdżewska Anna M , Brandt Angelika , Martínez Arbizu Pedro , Vink Annemiek
Published: April 2021

Collections of the amphipod genus Oedicerina were obtained during six expeditions devoted to the study of deep-sea environments of the Pacific Ocean. The material revealed four species new to science. Two species (Oedicerina henricisp. nov. and Oedicerina teresae sp. nov.) were found at abyssal depths of the central eastern Pacific in the Clarion-Clipperton Zone; one species (Oedicerina claudei sp. nov.) was recovered in the Sea of Okhotsk (north-west Pacific), and one (Oedicerina lesci sp. nov.) in the abyss adjacent to the Kuril-Kamchatka Trench (KKT). The four new species differ from each other and known species by the shapes of the rostrum, coxae 1 and 4, basis of pereopod 7, armatures of pereonite 7, pleonites and urosomites. An identification key for all known species is provided. The study of the cytochrome c oxidase subunit I gene of the four new species and Oedicerina ingolfi collected in the North Atlantic confirmed their genetic distinction. However, small intraspecific variation within each of the studied species was observed. In the case of the new species occurring across the KKT, the same haplotype was found on both sides of the trench, providing evidence that the trench does not constitute an insurmountable barrier for population connectivity. None of the species have so far been found on both sides of the Pacific.
How new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury
Authors: Saadat-Gilani Khaschayar , Zarbock Alexander
Published: April 2021

Purpose of review

Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evidence and explain why timely perioperative management does have impact on the development of AKI and overall outcomes for patients.

Recent findings

Damage biomarkers can reliably identify AKI earlier than conventional functional biomarkers, facilitating more timely preventive intervention. Although the interventions published in the Kidney Disease: Improving Global Outcomes guideline are all important, the most relevant preventive options perioperatively include maintenance of adequate volume status and perfusion pressure, and the focus on balanced crystalloid solutions as maintenance fluid.

AKI is a time critical syndrome that requires timely detection and damage biomarkers can help to adjust the perioperative management to prevent further injury.
Peripartum considerations for women with cardiac disease
Authors: Hussey Hanna , Hussey Patrick , Meng Marie-Louise
Published: April 2021

Purpose of review

The aim of this review of cardiac disease in pregnancy is to delineate current best practices and highlight emerging themes in the literature.

Recent findings

Cardiovascular disease is the leading cause of death among pregnant women in the United States. Many clinicians and institutions have developed care pathways to approach care in these high-risk patients including highly coordinated multidisciplinary teams. The diagnosis of pulmonary hypertension is the greatest risk factor for an adverse event in pregnant women. Vaginal delivery, with good neuraxial anesthesia, is usually the preferred mode of delivery in women with cardiac disease, although the rate of cesarean delivery is higher among women with heart disease.

The leading cause of morbidity and mortality in pregnant women is cardiac disease. Preconception counseling is useful for optimizing patients for pregnancy and setting appropriate expectations about care and outcomes. Ensuring that women are cared for in centers with appropriate multidisciplinary resources is key for improving outcomes for cardio-obstetric patients.
Anesthetic technique and cancer surgery outcomes
Authors: Dubowitz Julia , Hiller Jonathan , Riedel Bernhard
Published: April 2021

Purpose of review

Surgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes.

Recent findings

To date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to demonstrate long-term cancer outcome benefit. However, based on the consistent observation of protumorigenic effects of surgical stress and that of volatile anesthesia in preclinical studies, supported by in vivo models of tumor progression and metastasis, we await robust prospective clinical studies exploring the role of propofol-based total intravenous anesthesia (cf. inhalational volatiles). Additionally, anti-adrenergic/anti-inflammatory adjuncts, such as lidocaine, nonsteroidal anti-inflammatory drugs and the anti-adrenergic propranolol warrant ongoing research.

The biologic perturbation of the perioperative period, compounded by the effects of anesthetic agents, renders patients with cancer particularly vulnerable to enhanced viability of minimal residual disease, with long-term outcome consequences. However, low level and often conflicting clinical evidence equipoise currently exists with regards to optimal oncoanesthesia techniques. Large, prospective, randomized control trials are urgently needed to inform evidence-based clinical practice guidelines.
Anaesthesia for minimally invasive cardiac procedures in the catheterization lab
Authors: Reid Catherine , Meineri Massimiliano , Riva Thomas , Pilgrim Thomas , Räber Lorenz , Luedi Markus M.
Published: April 2021

Purpose of review

The share of cardiac procedures performed in settings involving nonoperating room anaesthesia (NORA) continues to grow rapidly, and the number of publications related to anaesthetic techniques in cardiac catheterization laboratories is substantial. We aim to summarize the most recent evidence about outcomes related to type of anaesthetic in minimally invasive cardiac procedures.

Recent findings

The latest studies, primarily focused on transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr), demonstrate the need for reliable monitoring and appropriate training of the interdisciplinary teams involved in this high-risk NORA setting.

Inappropriate sedation and concurrent inadequate oxygenation are main risk factors for claims involving NORA care. Current evidence deriving from TAVR shows that monitored anaesthesia care (MAC) is associated with shorter length of stay and lower mortality.
Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Synptoms
Authors: de Bruijn Thomas M. , de Groot Ingrid B. , Miedema Harald S. , Haumann Johan , Ostelo Raymond W.J.G.
Published: April 2021

Objectives:

Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS.

Materials and Methods:

Comprehensive literature searches for randomized controlled trials regarding steroid injections for LRS were conducted in PudMed, EMBASE, CINAHL, and CENTRAL from their inception to September 2018 (December 2019 for PubMed). For each homogenous comparison, the outcomes function, pain intensity and health-related quality of life at different follow-up intervals were pooled separately. The GRADE approach was used to determine the overall certainty of the evidence.

Results:

Seventeen studies were included. Two different homogenous comparisons were identified for which the randomized controlled trials could be pooled. In 36 of the 40 analyses no clinically relevant effect was found. The certainty of evidence varied between very low to high. Four analyses found a clinically relevant effect, all on pain intensity and health-related quality of life, but the certainty of the evidence was either low or very low. Two of the 33 subgroup analyses showed a clinically relevant effect. However, according to the GRADE approach the certainty of these findings are low to very low.

Discussion:

On the basis of the analyses we conclude there is insufficient evidence that ESIs for patients with LRS are clinically relevant at any follow-up moment. High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs. Until the results of these studies are available, there is reason to consider whether the current daily practice of ESIs for patients with LRS should continue.
Percutaneous Peripheral Nerve Stimulation (Neuromodulation) for Postoperative Pain: A Randomized, Sham-controlled Pilot Study
Authors: Ilfeld Brian M. , Plunkett Anthony , Vijjeswarapu Alice M. , Hackworth Robert , Dhanjal Sandeep , Turan Alparslan , Cohen Steven P. , Eisenach James C. , Griffith Scott , Hanling Steven , Sessler Daniel I. , Mascha Edward J. , Yang Dongsheng , Boggs Joseph W. , Wongsarnpigoon Amorn , Gelfand Harold ,   on behalf of the PAINfRE Investigators
Published: April 2021

Background

Percutaneous peripheral nerve stimulation is an analgesic technique involving the percutaneous implantation of a lead followed by the delivery of electric current using an external pulse generator. Percutaneous peripheral nerve stimulation has been used extensively for chronic pain, but only uncontrolled series have been published for acute postoperative pain. The current multicenter study was undertaken to (1) determine the feasibility and optimize the protocol for a subsequent clinical trial and (2) estimate the treatment effect of percutaneous peripheral nerve stimulation on postoperative pain and opioid consumption.

Methods

Preoperatively, an electrical lead was percutaneously implanted to target the sciatic nerve for major foot/ankle surgery (e.g., hallux valgus correction), the femoral nerve for anterior cruciate ligament reconstruction, or the brachial plexus for rotator cuff repair, followed by a single injection of long-acting local anesthetic along the same nerve/plexus. Postoperatively, participants were randomized to 14 days of either electrical stimulation (n = 32) or sham stimulation (n = 34) using an external pulse generator in a double-masked fashion. The dual primary treatment effect outcome measures were (1) cumulative opioid consumption (in oral morphine equivalents) and (2) mean values of the “average” daily pain scores measured on the 0 to 10 Numeric Rating Scale within the first 7 postoperative days.

Results

During the first 7 postoperative days, opioid consumption in participants given active stimulation was a median (interquartile range) of 5 mg (0 to 30) versus 48 mg (25 to 90) in patients given sham treatment (ratio of geometric means, 0.20 [97.5% CI, 0.07 to 0.57]; P < 0.001). During this same period, the average pain intensity in patients given active stimulation was a mean ± SD of 1.1 ± 1.1 versus 3.1 ± 1.7 in those given sham (difference, −1.8 [97.5% CI, −2.6 to −0.9]; P < 0.001).

Conclusions

Percutaneous peripheral nerve stimulation reduced pain scores and opioid requirements free of systemic side effects during at least the initial week after ambulatory orthopedic surgery.

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Arthroscopic Biceps to Subscapularis Tenodesis: A Surgical Technique
Authors: Niemann Michael J. , Brooks William C. , Ghobrial Jonathan A. , Makani Ankur , Sraj Shafic
Published: April 2021

A wide variety of techniques are available for tenodesis of the long head of the biceps tendon, and current literature does not favor any one in particular. We present a simple method for arthroscopic soft tissue biceps tenodesis that uses the subscapularis tendon as the anchor. This 5-step technique is time-efficient, technically simple, cost effective, and does not require powered instruments or specialized implants.
Building Mental Health Capacity: Exploring the Role of Adaptive Expertise in the ECHO Virtual Learning Model
Authors: Sockalingam Sanjeev , Rajaratnam Thiyake , Zhou Carrol , Serhal Eva , Crawford Allison , Mylopoulos Maria
Published: April 2021

Introduction:

With the proliferation of virtual learning programs during the COVID-19 pandemic, there is increased need to understand learner experiences and impact on developing expertise. Project Extension for Community Healthcare Outcomes (Project ECHO®) is an established hub-and-spoke tele-education model aimed at building capacity and expertise in primary care providers. Our qualitative study explored how learning experiences within an ECHO mental health care program supported provider learning and ability to solve complex clinical problems.

Methods:

We sampled ECHO sessions across a 34-week cycle and analyzed audio transcribed data. Two individuals coded participant interactions during 2-hour recorded sessions using an iterative, constant comparative methodology.

Results:

The authors identified four key mechanisms of learning in ECHO: (1) fostering participants' productive struggle with cases, (2) development of an integrated understanding, (3) collaborative reformulation of cases, and (4) generation of conceptual solutions based on a new understanding. Throughout the ECHO sessions, learning was observed to be multidirectional from both the hub-to-spoke and between spoke sites.

Discussion:

Despite the widespread implementation of Project ECHO and other virtual learning models, a paucity of research has focused on mechanisms of virtual learning within these models. Our study demonstrated a bidirectional exchange of knowledge between hub specialist teams and primary care provider spokes that aligned with the development of adaptive expertise through specific learning experiences in Project ECHO. Moreover, the ECHO structure may further support the development of adaptive expertise to better prepare participants to address patients' complex mental health needs.
Application of logistic regression and convolutional neural network in prediction and diagnosis of high-risk populations of lung cancer
Authors: Yuan Huijie , Gao Zibo , He Xiaxia , Li Di , Duan Shuyin , Effah Clement Yaw , Wang Wei , Wang Jing , Qu Lingbo , Wu Yongjun
Published: April 2021

Objectives

The early detection, early diagnosis, and early treatment of lung cancer are the best strategies to improve the 5-year survival rate. Logistic regression analysis can be a helpful tool in the early detection of high-risk groups of lung cancer. Convolutional neural network (CNN) could distinguish benign from malignant pulmonary nodules, which is critical for early precise diagnosis and treatment. Here, we developed a risk assessment model of lung cancer and a high-precision classification diagnostic model using these technologies so as to provide a basis for early screening of lung cancer and for intelligent differential diagnosis.

Methods

A total of 355 lung cancer patients, 444 patients with benign lung disease and 472 healthy people from The First Affiliated Hospital of Zhengzhou University were included in this study. Moreover, the dataset of 607 lung computed tomography images was collected from the above patients. The logistic regression method was employed to screen the high-risk groups of lung cancer, and the CNN model was designed to classify pulmonary nodules into benign or malignant nodules.

Results

The area under the curve of the lung cancer risk assessment model in the training set and the testing set were 0.823 and 0.710, respectively. After finely optimizing the settings of the CNN, the area under the curve could reach 0.984.

Conclusions

This performance demonstrated that the lung cancer risk assessment model could be used to screen for high-risk individuals with lung cancer and the CNN framework was suitable for the differential diagnosis of pulmonary nodules.
Skin diseases in the Da Qing Diabetes Study: a cross-sectional study
Authors: Shen Chang-Bing , Qian Xin , Yu Rui-Xing , Ji Xue-Lei , Shi Yin-Juan , Gao Jing , Li Cheng-Xu , Li Ke-Ke , Fei Wen-Min , Shen Xue , Wang Zi-Yi , Han Yang , Ning Xiao-Li , Ko Randy , Hsu Yi-Hsiang , Yin Xian-Yong , Li Guang-Wei , Cui Yong
Published: April 2021

Background:

The prevalence of skin diseases and diabetes mellitus (DM) are prominent around the world. The current scope of knowledge regarding the prevalence of skin diseases and comorbidities with type 2 DM (T2DM) is limited, leading to limited recognition of the correlations between skin diseases and T2DM.

Methods:

We collected 383 subjects from the Da Qing Diabetes Study during the period from July 9th to September 1st, 2016. The subjects were categorized into three groups: Normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and T2DM. The prevalence and clinical characteristics of skin diseases were recorded and investigated.

Results:

In this cross-sectional study, 383 individuals with ages ranging from 53 to 89-year-old were recruited. The overall prevalence of skin diseases was 93.5%, and 75.7% of individuals had two or more kinds of skin diseases. Additionally, there were 47 kinds of comorbid skin diseases in patients with T2DM, of which eight kinds of skin diseases had a prevalence >10%. The prevalence of skin diseases in NGT, IGT, and T2DM groups were 93.3%, 91.5%, and 96.6%, respectively; stratified analysis by categories showed a statistically significant difference in “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. The duration of T2DM also significantly associated with the prevalence of “disturbances of pigmentation” and “neurological and psychogenic dermatoses”. Subsequently, the prevalence of “disturbances of pigmentation” was higher in males than females in NGT (P < 0.01) and T2DM (P < 0.01) groups. In addition, the difference in the prevalence of “disturbances of pigmentation” was also significant in NGT and T2DM groups (P < 0.01).

Conclusions:

There was a high prevalence of skin diseases in the Da Qing Diabetes Study. To address the skin diseases in the Da Qing Diabetes Study, increased awareness and intervention measures should be implemented.
Clinical profiles and outcomes of acute type A aortic dissection and intramural hematoma in the current era: lessons from the first registry of aortic dissection in China
Authors: Duan Wei-Xun , Wang Wei-Guang , Xia Lin , Xue Chao , Yu Bo , Ren Kai , Yi Wei , Liang Hong-Liang , Dong Xiao-Chao , Zuo Jian , Liu Jin-Cheng , Yu Shi-Qiang , Yi Ding-Hua
Published: April 2021

Background:

Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.

Methods:

All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients’ selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student's t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.

Results:

A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).

Conclusions:

Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people's understanding. Meanwhile, the curing and transferring efficiency should also be improved.
Pneumoconiosis: current status and future prospects
Authors: Qi Xian-Mei , Luo Ya , Song Mei-Yue , Liu Ying , Shu Ting , Liu Ying , Pang Jun-Ling , Wang Jing , Wang Chen
Published: April 2021

Pneumoconiosis refers to a spectrum of pulmonary diseases caused by inhalation of mineral dust, usually as the result of certain occupations. The main pathological features include chronic pulmonary inflammation and progressive pulmonary fibrosis, which can eventually lead to death caused by respiratory and/or heart failure. Pneumoconiosis is widespread globally, seriously threatening global public health. Its high incidence and mortality lie in improper occupational protection, and in the lack of early diagnostic methods and effective treatments. This article reviews the epidemiology, safeguard procedures, diagnosis, and treatment of pneumoconiosis, and summarizes recent research advances and future research prospects.
Efficacy and safety of endocrine therapy for breast-cancer prevention in high-risk premenopausal or postmenopausal women: a Bayesian network meta-analysis of nine randomized controlled trials
Authors: Sun Rong , Chu Yan , Gao Yan , Cheng Wenke , Gao Shan
Published: April 2021

Importance:

Findings in this work might provide certain guidance for current clinical work.

Objective:

This study aimed to evaluate the efficacy and safety of these drugs based on the Bayesian network meta-analysis.

Evidence review:

Two researchers systematically and comprehensively searched PubMed, Embase, and the central databases of the Cochrane Library from inception to September 15, 2020. The number of specific events and sample size were extracted from each of the included studies. This Bayesian theory-based network meta-analysis included indirect comparisons and mixed treatment analysis. Indirect comparisons compare the efficacy of at least three interventions simultaneously and are mostly used when there are few direct comparison studies. In addition, indirect comparisons are conducted on the basis of direct comparisons through mixed treatment analysis, which can thus improve the accuracy of analysis.

Findings:

A total of nine randomized controlled trials involving 60,732 participants were included. As a result, compared with placebo in high-risk pre- or postmenopausal women, endocrine therapy (ET) decreased the risks of total breast cancer (TBC, odds ratio [OR] 0.69, 95% confidence interval [CI] 0.56-0.85), invasive breast cancer (IBC, OR 0.69, 95% CI 0.53-0.89), estrogen receptor-positive breast cancer (ER+BC) (OR 0.49, 95% CI 0.38-0.64), and ductal carcinoma in situ (OR 0.74, 95% CI 0.56-0.98), but increased the risks of pulmonary embolism (OR 1.33, 95% CI 1.05-1.69), total venous thrombosis (OR 1.75, 95% CI 1.28-2.38), and endometrial carcinoma (EC, OR 1.84, 95% CI 1.17-2.88). In further network stratification analyses, anastrozole, exemestane, and tamoxifen were found to decrease the risks of TBC, IBC, and ER + BC relative to placebo. Similarly, raloxifene decreased the risk of IBC (OR 0.65, 95% CI 0.48-0.85), while tamoxifen increased the risk of EC (OR 2.42, 95% CI 1.10-7.35).

Conclusions and Relevance:

To sum up, ET decreased the risks of TBC, IBC, ER + BC, and ductal carcinoma in situ, while increasing the risks of pulmonary embolism, total venous thrombosis, and EC in high-risk pre- or postmenopausal women. Meanwhile, anastrozole, exemestane, and tamoxifen possibly exerted potential protective effects on TBC, IBC and ER + BC. Typically, raloxifene might be effective on IBC, while tamoxifen might increase the risk of EC. Therefore, clinicians should fully weigh the benefits and risks of ET to develop a rational individualized treatment.
The mediating and moderating effects of depression on the relationship between cognitive function and difficulty in activities of daily living among postmenopausal women
Authors: Gong Bingyan , Wu Chao
Published: April 2021

Objective:

Cognitive function and depression impact critically the daily functioning of menopausal women. This study aimed to explore the mediating and moderating effects of depressive symptoms on the association between cognitive function and activities of daily living (ADL) difficulty in postmenopausal women.

Methods:

A total of 2,596 postmenopausal women from the China Health and Retirement Longitudinal Study completed the Chinese version of the Mini-Mental State Examination, basic ADL (BADL) and instrumental ADL (IADL) scales, and 10-item Short-Form Center for Epidemiological Studies Depression. We constructed structural equation modeling to examine the association between cognitive function, depressive symptoms, and BADL/IADL difficulty.

Results:

The prevalence of BADL/IADL difficulty in postmenopausal women was 22.5% and 31.5%, respectively. After adjustments for demographic and health-related covariates, cognitive decline (contributed by four cognitive dimensions with different weights) was significantly associated with BADL/IADL difficulty (contributed by six-item daily activities with different weights). Depressive symptoms mediated and explained 28.8% and 23.2% of cognitive function associations with BADL and IADL difficulty, respectively. The Johnson-Neyman technique identified a threshold of eight and four for depressive symptoms, beyond which the protective effect of cognitive function on BADL and IADL emerged.

Conclusions:

Depressive symptoms mediated and moderated the association between cognition and BADL/IADL difficulty in postmenopausal women. Compared with BADL, IADL may be more sensitive to changes in cognitive function. More strength should be put on developing comprehensive intervention techniques focusing on simultaneous intervention of multidimensional cognitive function and depression to maintain and improve the quality of life of postmenopausal women.

Video Summary:

http://links.lww.com/MENO/A741.
Cost-effectiveness Analysis of Abdominal-based Autogenous Tissue and Tissue-expander Implant following Mastectomy
Authors: Thoma Achilles , Avram Ronen , Dal Cin Arianna , Murphy Jessica , Duku Eric , Xie Feng
Published: April 2021

Background:

Patients who had undergone both autologous abdominal tissue (AAT) and tissue expander and implant (TE/I) breast reconstruction reported satisfaction with their reconstruction. While aesthetics and quality of life are important, the cost associated with these procedures must also be considered when choosing one method over the other. The objective of this study was to determine whether AAT-based breast reconstruction is cost-effective compared with 2-stage TE/I reconstruction at a 12-month follow-up.

Methods:

Thirty-five patients consented and complied to participate in the study with a follow-up of 12 months. The effectiveness of both AAT and TE/I was measured using the Health Utilities Index Mark 3 (HUI-3). From the HUI-3 results, quality-adjusted life years were calculated for each reconstructive approach. Direct healthcare and productivity costs were captured from surgeon billing codes, patient files, and patient diaries. The perspectives of both the Ministry of Health and of society were considered.

Results:

From the perspectives of both the Ministry of Health and of society, AAT was less effective and more costly when compared with TE/I.

Conclusions:

In this economic evaluation, TE/I dominated AAT, in that TE/I was more effective and less costly as compared with AAT from the perspectives of both the Ministry of Health and of society at 12 months of follow-up. This conclusion should be interpreted with caution due to a small sample size, the short timespan of the study, and the nonrandomized study design.
The “Crater” Arteriotomy: A Technique Aiding Precise Intimal Apposition in End-to-side Microvascular Anastomosis
Authors: Pafitanis Georgios , Nicolaides Marios , Kyprianou Katerina , O’Sullivan Justine , Sitpahul Ngamcherd , Kiranantawat Kidakorn , O’Connor Edmund Fitzgerald , Myers Simon , Chen Hung-Chi
Published: April 2021

End-to-side arterial anastomoses require a high level of technical competency. The main challenge to a successfully patent anastomosis is intimal interposition during the standardized microvascular suturing. Technical errors during arteriotomy pose a significant challenge for the microsurgical technique, making the end-to-side anastomosis prone to failure. We describe a basic yet fundamental method of performing an arteriotomy, the “crater” technique, which facilitates good visualization of all vessel layers before placement of microsurgical sutures. Using curved microsurgical scissors, the adventitia layer is dissected off the outer surface of the side vessel, a V-shaped cut is then made obliquely at a 30–45 degrees angle to the longitudinal axis of the vessel, and a full thickness oblique cut is made along an elliptical circumference, as the curved scissors enable the creation of a slope-like crater. This concept ensures the intimal layer is adequately exposed through the complete circumference of the arteriotomy rim, while enabling a variable increase in the arterial wall hypotenuse-width circumference. When performed in a standardized manner, the crater arteriotomy can minimize the risk of endothelial misalignment and further technical errors during suturing, thus minimizing the risk of anastomotic failure.
Breast Lift with and without Implant: A Synopsis and Primer for the Plastic Surgeon
Authors: Ramanadham Smita R. , Rose Johnson Anna
Published: April 2021

Breast ptosis is a common occurrence following weight loss, pregnancy, and breastfeeding, or as a consequence of normal aging. This results in loss of a youthful shape and contour of the breast, with a change in the position of the nipple–areolar complex. Mastopexy can restore this youthful appearance and transpose the nipple–areolar complex to a more aesthetic position on the breast. Various techniques exist that address the skin and parenchyma of the breast and are chosen based on the degree of ptosis and skin laxity, as well as the patient’s goals. These techniques all differ in scar burden and risk profile. Additionally, this can be done simultaneously or in a staged manner. In this literature review, we aim to provide an overview of mastopexy procedures, with and without augmentation. Further, we aim to detail recent advancements in technical approaches, and delineate common complications in certain patient demographics. To this end, we performed a literature search with a medical librarian, using PubMed/Medline to identify pertinent literature. In the context of the review, we discuss important considerations in patient selection and counseling to set expectations and ultimately, optimize surgical outcome and patient satisfaction.
An Artificial Intelligence Approach to the Assessment of Abnormal Lid Position
Authors: Thomas Peter B. M. , Gunasekera Chrishan D. , Kang Swan , Baltrusaitis Tadas
Published: April 2021

New artificial intelligence (AI) approaches to facial analysis show promise in the clinical evaluation of abnormal lid position. This could allow more naturalistic, quantitative, and automated assessment of lid position. The aim of this article was to determine whether OpenFace, an AI approach to real-time facial landmarking and analysis, can extract clinically useful measurements from images of patients before and after ptosis correction. Manual and AI-automated approaches to vertical palpebral aperture measurement of 128 eyes in pre- and postoperative full-face images of ptosis patients were compared in this study. Agreement in interpupillary distance to vertical palpebral aperture ratio between clinicians and an AI-based system was assessed. Image quality varied highly with interpupillary distance defined by a mean of 143.4 pixels (min = 60, max = 328, SD = 80.3 pixels). A Bland–Altman analysis suggests a good agreement between manual and AI analysis of vertical palpebral aperture (94.4% of measurements falling within 2 SDs of the mean). Correlation between the 2 methods yielded a Pearson’s r(126) = 0.87 (P < 0.01) and r2 = 0.76. This feasibility study suggests that existing, open-source approaches to facial analysis can be applied to the clinical assessment of patients with abnormal lid position. The approach could be extended to further quantify clinical assessment of oculoplastic conditions.