bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of a Model to Predict Anterior Segment Vision-Threatening Eye Disease Using Primary Care Clinical Notes
Authors: Singh Karandeep , Thibodeau Alexa , Niziol Leslie M. , Nakai Tejpreet K. , Bixler Jill E. , Khan Mariam , Woodward Maria A.
Published: October 2021

Purpose:

The purpose of this study was to develop a decision-support tool to predict anterior segment vision-threatening disease (asVTD) to aid primary care physicians (PCPs) with patient triage and referral.

Methods:

The University of Michigan electronic health record data between January 1, 2016, and May 31, 2019, were obtained from patients presenting to a PCP with anterior eye symptoms and then saw an ophthalmologist within 30 days. asVTD included diagnosis of corneal ulcer, iridocyclitis, hyphema, anterior scleritis, or scleritis with corneal involvement by an ophthalmologist. Elastic net logistic regression with 10-fold cross-validation was used for prediction modeling of asVTD. Predictors evaluated included patient demographics and PCP notes processed using clinical natural language processing software (clinspacy).

Results:

Two thousand nine hundred forty-two patients met the inclusion criteria, of which 133 patients (4.5%) had asVTD. The age was significantly lower among those with asVTD versus those without (median = 42 vs. 53 yrs, P < 0.001). Sex (P = 0.8) and race (P = 0.9) were not significantly different between groups. The final prediction model had an area under the curve of 0.72 (95% confidence interval 0.67–0.77). At a threshold achieving a sensitivity of 90%, the specificity was 30%, the positive predictive value was 5.8%, and the negative predictive value was 99%.

Conclusions:

The use of the prediction model increased the positive predictive value for asVTD compared with referral based on prevalence probabilities (17 patients vs. 22 patients needing to be evaluated to identify 1 case of asVTD). A prediction algorithm has potential to improve triage and initial management decision-making for PCPs because it performs better than probabilities in the absence of such a tool.
Severe Congenital Syphilis in the Neonatal Intensive Care Unit: A Retrospective Case Series
Authors: Aleem Samia , Walker LaShawndra S. , Hornik Chi D. , Smith Michael J. , Grotegut Chad A. , Weimer Kristin E. D.
Published: October 2021

Background:

There has been a 291% relative increase in congenital syphilis (CS) cases in the United States from 2015 to 2019. Although the majority of affected fetuses/infants are stillborn or are asymptomatic, a subset is born with severe clinical illness. We describe a series of severe CS cases in the neonatal intensive care unit.

Methods:

Retrospective review of infants with CS, admitted to the Duke Intensive Care Nursery from June 2016 to February 2020. We recorded birthweight, gestational age, medications, procedures, diagnoses, laboratory data and outcomes. Severe symptoms included: birth depression, hypoxic ischemic encephalopathy (HIE), disseminated intravascular coagulopathy and/or persistent pulmonary hypertension (PPHN).

Results:

Seven infants with CS were identified and 5 with severe presentations were included. Median gestational age was 35.1 weeks (range: 29–37 weeks, median: 35 weeks). All infants required intubation at birth, 2 required chest compressions and epinephrine in the delivery room. One had hydrops fetalis and died in the delivery room. All 4 surviving infants had HIE, severe PPHN, hepatitis and seizures. All infants had a positive rapid plasma reagin, and were treated with penicillin G. Maternal rapid plasma reagin was pending for 3 of 5 infants at delivery, and later returned positive; 2 were positive during pregnancy but not treated. Other infectious work-up was negative. Three infants survived to discharge.

Conclusion:

CS can be associated with HIE, PPHN and disseminated intravascular coagulopathy in affected infants. Clinicians should have a high index of suspicion and include CS in their differential diagnoses. This study also highlights the importance of adequate treatment of identified cases and screening during the third trimester and at delivery.
Radiofrequency in Facial Rejuvenation
Authors: Lyu Jia-Jie , Liu Sheng-Xiu
Published: October 2021

Rhytides and striae are prominent clinical signs of skin aging. Photoaging, characterized by a thinning epidermis and a decrease in collagens, is the main form of skin aging. Delaying the aging process is a concerning issue for dermatologists. Radiofrequency (RF) is a non-ablative technology used for skin rejuvenation, body contouring, and weight reduction. The selective electro-thermolysis stimulates collagen contraction and neocollagenesis. Compared to traditional cosmetic treatment, it has the advantages of fewer side effects and short patient downtime. This review aims to summarize the efficacy and safety of different RF devices and the limitations during RF treatments. Combinations of RF and other cosmetic technologies are demonstrated. Results have been approving for the various uses of RF, including skin laxity and wrinkles smoothening. However, many studies use subjective ways of evaluation. Further studies are needed to determine the optimization of RF treatments for facial rejuvenation.
The Effect of Early Traumatic Experiences on Attachment Styles in Sexual Gender Minority Individuals
Authors: Keskin Gülseren , Yig˘itog˘lu Gülay Taşdemir
Published: October 2021

Purpose

This study was carried out to specify the attachment characteristics of sexual gender minority individuals and to determine the effects of childhood traumatic experiences on attachment styles.

Design and Methods

A descriptive cross-sectional study was conducted on 141 sexual gender minority individuals from 2016 to 2017.

Findings

The number of childhood physical and sexual trauma episodes was found to be high in sexual minorities; in particular, the traumatized narratives were found to be associated with an avoidant attachment style (p > 0.05).

Practice Implications

The study results may contribute to healthcare professionals' understanding of childhood trauma as it relates to sexual identity development and attachment disorders sexual identity development and attachment disorders.
HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study
Authors: Dangerfield Derek T. , Ober Allison J. , Li Michael J. , Allen Sophia , Bluthenthal Ricky N.
Published: October 2021

The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group–specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
Not Quite Out of the Woods
Authors: Scott Erika , Hirabayashi Liane , Graham Judy , Krupa Nicole , Jenkins Paul
Published: October 2021

Objective:

This research reports on the health status, including chronic disease risk factors, among Maine loggers.

Methods:

Loggers completed a survey and health screenings were held across Maine, collecting data on a variety of health endpoints.

Results:

Seventy-five loggers participated. The majority were men (97.1%) with a median age of 46, and a mean BMI of 30.6 kg/m2 (SD 4.9). Nearly half of those screened (45.9%) had blood pressure at the level of stage II hypertension. Loggers with at least a single joint abnormality were 38.4%. The health screening cohort was similar to the non-health screening cohort for many attributes.

Conclusions:

Future research should focus on tailored interventions to improve cardiovascular and musculoskeletal risk factors among loggers.
Stress-Buffering and Health-Protective Effect of Job Autonomy, Good Working Climate, and Social Support at Work Among Health Care Workers in Switzerland
Authors: Hämmig Oliver , Vetsch Anders
Published: October 2021

Objective:

The relationship between work stress, job resources, and health has not yet been investigated among health professionals in Switzerland.

Methods:

Cross-sectional survey data, collected among hospital employees in German-speaking Switzerland, have been used for this study. Established measures were used to assess work stress as the main predictor and self-rated health and work-related burnout as the outcome variables. Validated measures for job autonomy, work climate, and social support at work were used as intervening variables.

Results:

The studied job resources were all found to be quite strongly and negatively associated with the two health outcomes but only partly explained and reduced the extraordinary strong positive association and clear dose–response relationship between work stress and poor self-rated health or burnout.

Conclusion:

Job resources like these cannot completely prevent health professionals from negative health-related consequences of work stress.
Trauma-informed care in the primary care setting: An evolutionary analysis
Authors: Varghese Latha , Emerson Amanda
Published: October 2021

Background:

The high prevalence of trauma in the United States and its adverse effects on patient wellbeing has led to the adoption of trauma-informed care (TIC) in some specialized health care services. However, the implementation of TIC in primary care, where many nurse practitioners (NPs) provide services, is relatively uncommon and the concept not well-defined. Trauma includes physically and emotionally devastating experiences that have a lasting impact on individuals.

Objectives:

To synthesize a definition of TIC in the primary care setting for NPs to guide future practice and research.

Data Sources:

We searched CINAHL, PsycINFO, Social Work Abstracts, Scopus, and PubMed for articles published 2010–2020 that described the use of TIC in primary care. Rodgers' evolutionary method and the framework method of analysis were used to identify attributes and contexts of TIC in primary care and synthesize a definition. Thirty-one articles from nursing, medical, and social work sources were selected, including data-based studies (n = 15) and thought pieces (n = 16). Attributes, antecedents, and consequences were combined to provide a definition grounded in the literature.

Conclusion:

Trauma-informed care in primary care is a strengths-based approach in which trained, trauma-aware health care professionals provide services that prioritize safety, empowerment, and support, resulting in improved patient satisfaction and health care engagement in individuals who have experienced trauma.

Implications for practice:

A clearly defined concept provides a starting point for developing strategies to help NPs recognize and respond more effectively to the needs of patients who have experienced trauma.
Long-Term Outcome With an Active Middle Ear Implant in Patients to Bilateral Aural Atresia
Authors: Lourençone Luiz Fernando Manzoni , Matuella Marina , da Silveira Sassi Tyuana Sandim , Dutka Jeniffer de Cássia Rillo , Brito Rubens
Published: October 2021

Objective:

To describe the audiological results and complications following active middle ear implant (AMEI) surgery in users with bilateral ear atresia.

Study Design:

Observational and retrospective longitudinal follow-up.

Setting:

A tertiary referral hospital for hearing rehabilitation and craniofacial malformations.

Patients:

Medical records of 27 patients with bilateral congenital aural atresia (34 ears) who underwent surgery for AMEI were reviewed. Data were analyzed using descriptive and inferential statistics. The alpha error was assumed to be 5%.

Outcome Measures:

Medical and technical complications and audiological results were observed during follow-up.

Results:

The median postoperative follow-up was 37.5 months (27.7–75.5 mo). Medical or technical complications occurred in 35.3% (n = 12) of patients during follow-up, 14.7% (n = 5) required surgical revision. The auditory thresholds in the free field improved from 53.75 dB (46.87–56.25) to 25 dB (21.25–32.5) after 6 months using the AMEI (p < 0.001) and remained stable till the last audiological evaluation (22.5: 21.25 26.25). Compared with the preoperative results, all speech perception tests also showed the benefits of AMEI at 6 months postoperatively and in the last audiological evaluation.

Conclusions:

Monitoring the use of AMEI in this sample demonstrated the safety of these implants compared with data available in the literature. The rates of medical and technical complications were consistent with data published by other groups. Finally, the audiological results remained stable during follow-up.
The Curious Rise and Incomplete Fall of “Paracusis Willisii”
Authors: Quinn Kevin J. , Coelho Daniel H.
Published: October 2021

In 1672, Dr. Thomas Willis, a founder of the Royal Society and accomplished anatomist, described a peculiar phenomenon he had heard about “from a Credible Person” wherein two people with hearing loss appreciated some recovery of hearing when in the presence of increased background noise. Over time, this clinical entity came to bear his name, and Paracusis of Willis (or Paracusis Willisii) became a subject of both clinical interest as well as contention. In the early 1900s, a burgeoning appreciation for the diseases of the middle and inner ear heralded a boom in the study of paracuses, with many incorporating it as one of the diagnostic criteria of otosclerosis. At its peak interest, several potential etiologies were hypothesized in an effort to explain this puzzling entity—some plausible by today's understanding, many not. In the 1950s, however, its prominence in medical literature began to decline, though over the subsequent six decades it has yet to completely disappear. References to this peculiar phenomenon can still be found in prominent textbooks, review articles, and teaching resources. The fascinating story arc of paracusis of Willis serves as an illustration of how and why other questionable eponymic clinical descriptions can persist in conventional wisdom.
Post Heart Transplantation Outcomes of Patients Supported on Biventricular Mechanical Support
Authors: Jaiswal Abhishek , Gadela Naga Vaishnavi , Baran David A. , Dasgupta Oisharya , Gluck Jason , Radojevic Joseph , Arora Sabeena , Scatola Andrew , Ali Ayyaz , Hammond Jonathan , Jennings Douglas L. , Baker William L.
Published: October 2021

With the implementation of the new heart transplant (HT) allocation system, patients requiring biventricular support systems have the highest priority, a shorter waitlist time, and a higher frequency of HT. However, the short-term and long-term outcomes of such patients are often disputed. Hence, we examined the outcomes of these patients who underwent HT before change in allocation scheme. Additionally, we compared post-HT outcomes of extracorporeal membrane oxygenation (ECMO) with other nondischargeable biventricular (BiVAD) supported patients. We identified adult ECMO or BiVAD supported HT recipients between 2000 and 2018 in the Scientific Registry of Transplant Recipients database. We compared survival with the Kaplan-Meier method. Using overlap propensity score weighting, we constructed Cox proportional hazards regression models to determine the risk-adjusted influence of BiVAD versus ECMO on survival. Of the 730 patients HT recipients; 528 (72.3%) and 202 (27.7%) were bridged with BiVAD and ECMO, respectively. For BiVAD versus ECMO patients, the 30-day, 1-year, 3-year, and 5-year mortality rates were 8.0% versus 14.4%, 16.3% versus 21.3%, 22.4% versus 25.3%, and 26.3% versus 25.7%, respectively. Risk-adjusted post-HT survival of BiVAD and ECMO patients at 30-day (HR 1.24 [95% CI, 0.68–2.27]; P = 0.4863), 1-year (HR 1.29 [95% CI, 0.80–2.09]; P = 0.3009), 3-year (HR 1.27 [95% CI, 0.83–1.94]; P = 0.2801), and 5-year (HR 1.35, 95% CI, 0.90–2.05; P = 0.1501) were similar. Around three-fourth of the ECMO or BiVAD supported patients were alive at 5-years post-HT. The short-term and long-term post-HT survivals of groups were comparable.
A 6 transcription factors-associated nomogram predicts the recurrence-free survival of thyroid papillary carcinoma
Authors: Wang Tao , Tian Kun , Ji Xie , Song Feixue
Published: October 2021

Various researches demonstrated that transcription factors (TFs) played a crucial role in the progression and prognosis of cancer. However, few studies indicated that TFs were independent biomarkers for the prognosis of thyroid papillary carcinoma (TPC). Our aim was to establish and validate a novel TF signature for the prediction of TPC patients’ recurrence-free survival (RFS) from The Cancer Genome Atlas (TCGA) database to improve the prediction of survival in TPC patients.

The genes expression data and corresponding clinical information for TPC were obtained from TCGA database. In total, 722 TFs and 545 TPC patients with eligible clinical information were determined to build a novel TF signature. All TFs were included in a univariate Cox regression model. Then, the least absolute shrinkage and selection operator Cox regression model was employed to identify candidate TFs relevant to TPC patients’ RFS. Finally, multivariate Cox regression was conducted via the candidate TFs for the selection of the TF signatures in the RFS assessment of TPC patients.

We identified 6 TFs that were related to TPC patients’ RFS. Receiver operating characteristic analysis was performed in training, validation, and whole datasets, we verified the high capacity of the 6-TF panel for predicting TPC patients’ RFS (AUC at 1, 3, and 5 years were 0.880, 0.934, and 0.868, respectively, in training dataset; 0.760, 0.737, and 0.726, respectively, in validation dataset; and 0.777, 0.776, and 0.761, respectively, in entire dataset). The result of Kaplan–Meier analysis suggested that the TPC patients with low scores had longer RFS than the TPC patients with high score (P = .003). A similar outcome was displayed in the validation dataset (P = .001) and the entire dataset (P = 2e-05). In addition, a nomogram was conducted through risk score, cancer status, C-index, receiver operating characteristic, and the calibration plots analysis implied good value and clinical utility of the nomogram.

We constructed and validated a novel 6-TF signature-based nomogram for predicting the RFS of TPC patients.
Clinical predictive risk factors prolonged the duration of SARS-CoV-2 clearance in 279 moderate COVID-19 patients
Authors: Wu Xinxin , Zhou Shuang , Liu Changya , Huang Tingrong , Zheng You , Zhang Wen , Qu Yao , Fang Bangjiang
Published: October 2021

The results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid as one of the criteria has been widely applied to assess whether the coronavirus disease 2019 (COVID-19) patients could discharge, however, the risk factors that affect the duration of the SARS-CoV-2 clearance remained to be an enigma. Our research was to identify risk factors correlated with prolonged duration of the SARS-CoV-2 clearance in moderate COVID-19 patients.

We retrospectively analyzed 279 consecutive ordinary COVID-19 patients in 3 hospitals in Hubei province including Huangshi Hospital of Infectious Disease, Wuhan Thunder God Mountain Hospital, and Tongji Hospital. Eight clinical characters were contained as risk factors. We used a logistic regression model and nomogram to assess the possibility that the SARS-CoV-2 nucleic acid may turn negative in 14 days.

Time from symptoms onset to diagnosis (odds ratio [OR] = 3.18; 95% confidence interval [CI] 1.56–6.46; P = .001), time from onset use of antiviral drugs to onset of symptoms (OR = 0.41; 95% CI 0.23–0.72; P = .02), and bacterial coinfection (OR = 0.07; 95% CI 0.01–0.86; P = .038) were independent risks factors for the duration of SARS-CoV-2 nucleic acid clearance. The regression model showed good accuracy and sensitivity (area under the curve  = 0.96). Nomogram was also provided to predict the negative conversion rate of SARS-CoV-2 nucleic acids within 14 days.

Time from symptoms onset to diagnosi, time from onset use of antiviral drugs to onset of symptoms, and bacterial coinfection were independent risk factors for the time of SARS-CoV-2 nucleic acid turning negative in ordinary COVID-19 patients. However, the age, gender, underlying disease, fungal coinfection, and duration use of antiviral drugs were irrelevant factors.
The impact of venous resection in pancreatoduodectomy
Authors: Filho João Emílio Lemos Pinheiro , Tustumi Francisco , Coelho Fabricio Ferreira , Júnior Sérgio Silveira , Honório Fernanda Cavalcanti Cabral , Henriques Alexandre Cruz , Dias André Roncon , Waisberg Jaques
Published: October 2021

Background:

Vein resection pancreatoduodenectomy (VRPD) may be performed in selected pancreatic cancer patients. However, the main risks and benefits related to VRPD remain controversial.

Objective:

This review aimed to evaluate the risks and survival benefits that the VRPD may add when compared with standard pancreatoduodenectomy (PD).

Methods:

A systematic review and meta-analysis of studies comparing VRPD and PD were performed.

Results:

VRPD was associated with a higher risk for postoperative mortality (risk difference: −0.01; 95% confidence interval [CI] −0.02 to −0.00) and complications (risk difference: −0.05; 95% CI −0.09 to −0.01) than PD. The length of hospital stay was not different between the groups (mean difference [MD]: −0.65; 95% CI −2.11 to 0.81). In the VRPD, the operating time was 69 minutes higher on average (MD: −69.09; 95% CI −88.4 to −49.78), with a higher blood loss rate (MD: −314.04; 95% CI −423.86 to −195.22). In the overall survival evaluation, the hazard ratio for mortality during follow-up on the group of VRPD was higher compared to the PD group (hazard ratio: 1.13; 95% CI 1.03–1.23).

Conclusion:

VRPD is associated with a higher risk of short-term complications and mortality and a lower probability of survival than PD. Knowing the risks and potential benefits of surgery can help clinicians to properly manage pancreatic cancer patients with venous invasion. The decision for surgery with major venous resection should be shared with the patients after they are informed of the risks and prognosis.
A refractory human T-cell leukemia virus type 1-associated myelopathy/tropical spastic paraparesis patient with lymphoma-type adult T-cell leukemia/lymphoma
Authors: Tamaki Keiko , Mera Hidekazu , Takeshita Sho , Fujioka Shinsuke , Goto Maki , Matsumoto Taichi , Yamano Yoshihisa , Takamatsu Yasushi , Tsuboi Yoshio
Published: October 2021

Rationale:

Adult T-cell leukemia/lymphoma (ATL) and human T-cell leukemia virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are caused by HTLV-1, but the coexistence of both disorders is rare. The estimated incidence is approximately 3%.

Patient concerns:

A 54-year-old man was unable to stand up because of spastic paraparesis 1 month after the onset. He developed lymphadenopathy in the left supraclavicular fossa 5 months after the onset. The spastic paraplegia and sensory symptoms below the thoracic spinal cord level worsened.

Diagnoses:

Both blood and cerebrospinal fluid (CSF) tests were positive for anti-HTLV-1 antibodies. The patient was diagnosed with rapidly progressive HAM/TSP. He was also diagnosed with lymphoma-type ATL by the biopsy specimen of the lymph node. CSF examination at the time of symptom exacerbation showed abnormal lymphocytes, suggesting central infiltration of the ATL in the central nervous system.

Interventions:

Methylprednisolone pulse therapy and oral prednisolone maintenance therapy were administered for rapidly progressive HAM/TSP. Intrathecal injection of methotrexate was administered for the suggested central infiltration of the ATL.

Outcomes:

Methylprednisolone pulse therapy and intrathecal injection of methotrexate did not improve the patient's exacerbated symptoms. Five months later, clumsiness and mild muscle weakness of the fingers appeared, and magnetic resonance imaging showed swelling of the cervical spinal cord. Clonality analysis showed monoclonal proliferation only in the DNA of a lymph node lesion, but not in the CSF and peripheral blood cells.

Lessons:

This was a case of rapidly progressive HAM/TSP associated with lymphoma-type ATL that was refractory to steroids and chemotherapy. The pathogenesis was presumed to involve ATL cells in the brain and spinal cord because of the presence of abnormal lymphocytes in the CSF, but DNA analysis could not prove direct invasion. This case suggests that when we encounter cases with refractory HAM/TSP, it should be needed to suspect the presence of ATL in the background.
The effect of infliximab dose escalation in inflammatory bowel disease patients with antibodies to infliximab
Authors: Tun Gloria S.Z. , Robinson Kerry , Marshall Laura , Wright Alison , Thompson Laura , Wild Graeme , Sargur Ravishankar , Brooks Alenka J. , Hale Melissa F. , Chew Thean S. , Lobo Alan J.
Published: October 2021

Background

Infliximab dose escalation (DE) can be used in inflammatory bowel disease patient; however, the long-term benefit remains unclear, especially in those with antibodies to infliximab (ATI). The aim was to assess the effect of DE in patients with ATI on drug level, clinical response and ATI status.

Methods

All patients undergoing infliximab DE (a reduction in dose interval between infusions <8 weeks ± an increase in dose up to 10 mg/kg) at a referral centre between April 2016 and August 2019 were included.

Results

Ninety-two patients were DE: 51 were men, 50 had CD and 63 were receiving immunosuppression. A total of 87 people received DE for a median of 44 weeks (range 4–176). Five stopped infliximab after 1 dose of DE: 2 for loss of response and 3 for infusion reaction. In patients with ATI ≤10 vs. >10 AU/mL, DE significantly increased drug levels: median infliximab levels of 1.4 and 0.9 at baseline, respectively, to 3.2 and 3.5 at week 24. After DE, 21/35 ATI-positive patients had a fall in ATI ≤10 AU/mL. At week 24 following DE 62/92 patients were in clinical remission. Duration of clinical remission was shorter in those with ATI >10 AU/mL (median 24 weeks, range 0–88) than in those with transient/ATI ≤10 AU/mL (median 36 weeks, range 0–126, P = 0.06).

Conclusions

A strategy of DE for selected patients receiving infliximab is associated with an increase in drug levels and reduced ATI positivity. This is associated with clinical remission in approximately 70% of patients at 6 months.
Diagnostic accuracy of lung ultrasonography in childhood pneumonia: a meta-analysis
Authors: Lu Xiaoxue , Jin Yanping , Li Ying , Weng Liang , Li Hui
Published: October 2021

This meta-analysis aimed to assess the diagnostic accuracy of lung ultrasonography in pneumonia-affected pediatric patients. Literature search of published articles in Medline, Web of Science, Scopus, Embase and Journal of Web till September 2020 were reviewed for the predescribed accuracy assessors. In compliance with the inclusion and exclusion criteria, two researchers independently screened the literature, collected the results and assessed the risks of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The pooled sensitivity and specificity, pooled positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were estimated for the meta-analysis. The overall efficiency of lung ultrasonography (LUS) was evaluated using a summary receiver operating characteristic curve. Q and I
2 statistics were used to determine heterogeneity. Meta disc software was used for the analysis of the study. Out of 1182 studies, only 29 articles were chosen; 25 of them were prospective studies and 4 studies were retrospective. The overall pooled sensitivity was 0.83 [95% confidence intervals (CI), 0.81–0.84] and specificity was 0.84 (95% CI, 0.81–0.86), depicting good diagnostic performance. LUS is an efficient imaging technique for detecting childhood pneumonia with a high accuracy rate. It is an appealing alternative to chest X rays to detect and follow-up pneumonia in children because it is simple to do, widely available, comparatively cheap and free of radiation hazards.
Three-dimensional semiquantitative analysis of gastric emptying SPECT
Authors: Kuan Tzu-Wei , Shen Chih-Chieh , Chen Jyh-Cheng , Tu Kao-Yin , Tsao Chin-Ho , Chen Tzu Hsuan
Published: October 2021

Objective

We used dynamic single-photon emission computed tomography (D-SPECT) to overcome the interference of the planar dynamic imaging due to the overlap of internal organs, thus more accurate physiological function can be obtained.

Methods

3D printed gastric phantom was used to simulate gastric emptying (GE). First, the planar dynamic liquid GE procedure was used and served as the reference value; second, D-SPECT followed by repeated liquid GE procedures with three gamma cameras were used. The emptying flow rate of the gastric phantom simulated three flow rates of liquid, semisolid and solid. Third, we simulated the intestinal activity that interfered with the residual value obtained by 2D dynamic imaging, which was compared with D-SPECT. Then, we brought the 3D VOI data into the postprocessing program to obtain the residual activity curve and residual percentage.

Results

The residual amount obtained in the phantom at 60th minutes in the first stage is 14.57%; the residual amount of liquid emptying are Siemens: 3.33%, GE: 15.06%, PHILIPS: 1.12%; residual amount for semisolid are Siemens: 47.36%, GE: 54.25%, PHILIPS: 51.57%; residual amount for solids are Siemens: 63.98%, GE: 66.88%, PHILIPS: 63.76%. All values are within the normal range. Then, we simulated the intestinal activity that interfered with the residual value obtained by 2D dynamic imaging: 75–90 min: 10.42, 19.48, 19.51 and 11.02%; however, the residual values obtained with 3D SPECT VOI data: 75–90 min: 1.42, 1.41, 1.35 and 1.02%. These results show that the emptying data errors caused by intestinal overlap can be effectively corrected (P = 0.017).

Conclusion

D-SPECT imaging can overcome the interference in the semiquantitative data of residual GE caused in 2D mode.
FDG PETCT for assessing marrow involvement at staging pediatric nonhematological round cell malignancies
Authors: Shah Sneha , Purandare Nilendu , Kembhavi Seema , Puranik Ameya , Agrawal Archi , Bedmutha Akshay , Qureshi Sajid , Chinnaswamy Girish , Vora Tushar , Prasad Maya , Parambil Badira , Rangarajan Venkatesh
Published: October 2021

Background and hypothesis

Bone and lung are the common sites of metastasis in pediatric round cell tumors and its presence indicates poor outcomes. Staging workup for these malignancies thus includes bone marrow biopsy (BMB) along with evaluation of thorax, and tissue analysis for N MYCN status in neuroblastoma. BMB is an invasive procedure requiring general anesthesia with known disadvantages.

With an aim of avoiding an invasive BMB a study was taken up to evaluate efficacy of FDG PET CT in detecting marrow involvement in neuroblastoma and rhabdomyosarcoma at staging.

Materials and method

Prospective observational study evaluated 83 newly diagnosed treatment naïve patients of neuroblastoma (n = 43) and rhabdomyosarcoma (n = 42) who underwent conventional imaging of PETCT with CECT of local region along with a CT thorax and BMB (both iliac crest) done within 1 week. Findings of FDG PETCT were compared with bone marrow histology and accuracy parameters were calculated.

Result

The overall sensitivity, specificity, accuracy, positive-predictive value (PPV), negative-predictive value (NPV) of FDG PETCT for detection of marrow disease was 100%, 86.1%, 89.4%. 68.9% and 100%, respectively. Subset analysis showed sensitivity, specificity, PPV and NPV of 100%, 66%, 71.4% and 100%, respectively, for neuroblastoma, with rhabdomyosarcoma patients having few events NPV of 100% accuracy of 97.6%.

Conclusion

FDG PETCT with sensitivity and NPV of 100% can be considered as a first stop imaging and biopsy can be avoided in patients with a negative scan.
Prognostic value of lung shunt fraction in hepatocellular carcinoma and unresectable liver dominant metastatic colorectal cancer undergoing transarterial radioembolisation
Authors: Gosavi Atul , Puranik Ameya D. , Shah Sneha , Agrawal Archi , Purandare Nilendu C. , Shetty Nitin , Gala Kunal , Kulkarni Suyash , Patkar Shraddha , Goel Mahesh , Shrikhande Shailesh , Ramaswamy Anant , Ostwal Vikas , Rangarajan Venkatesh
Published: October 2021

Aim

To assess the overall survival and determine whether pre-TARE shunt fraction, tumor volume and tumor marker impact the outcome.

Methods

This is a retrospective study of 75 patients who were referred for 90Y-glass microsphere radioembolisation by a joint clinic decision between 1 January 2010 and 31 December 2014. All patients underwent pre-TARE CECT and 99mTc-MAA lung shunt fraction (LSF) imaging.

Results

Overall survival was 19 months for hepatocellular carcinoma (HCC) and 24 months for metastatic colorectal carcinoma. For hepatocellular carcinoma-LSF higher than 6.51 % was predictive of significantly decreased survival (P value 0.00). A progressive disease in survival was observed as LSF increased from less than 6.51 % to more than 20%. Tumor volume and tumor marker did show correlation with patient outcomes. For metastatic colorectal carcinoma-LSF and tumor marker did not show significant correlation with survival and tumor volume showed significant correlation with survival with P value of 0.049.
Associations of whole-body 18F-FDG PET/CT parameters and SCC-Ag level with overall survival in patients with cervical cancer
Authors: Guan Lili , Zuo Rui , Wang ZhengJie , Xu Lu , Liu Shuang , Pang Hua
Published: October 2021

Objective

To explore the whole-body metabolic tumour volume (WBMTV), whole-body total lesion glycolysis (WBTLG) and tumour whole-body maximum standardised uptake value (WBSUVmax) of post-treatment 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) in predicting the overall survival (OS) in patients with cervical squamous cell carcinoma (SCC).

Methods

The clinical data of 74 patients with cervical SCC who received 18F-FDG PET/CT were retrospectively analysed. WBMTV, WBTLG and WBSUVmax, as well as the serum SCC-Ag level, were measured. The Kaplan–Meier method and Cox regression were used to analyse the relationships of PET/CT parameters with OS.

Results

The risk of death was 13.942-fold greater in the PET-positive group than in the PET-negative group (P < 0.001). In the PET-positive group, univariate analysis showed that OS was significantly correlated with WBMTV and WBTLG; it was not correlated with WBSUVmax, SCC-Ag, age, pathological stage or treatment after PET (P > 0.05). Patients with positive PET findings were divided into two groups according to the median of WBMTV or WBTLG; there was a significant difference in OS between the two groups. The risk of death in patients with positive PET imaging findings and high SCC-Ag level was 18.356-fold greater than in patients with negative PET imaging findings (P < 0.001).

Conclusions

WBMTV and WBTLG have important prognostic value in the prediction of OS in post-treatment patients with cervical SCC. OS was significantly decreased in patients who had both positive PET imaging findings and high SCC-Ag level.
Can the Enhanced Liver Fibrosis Score Be Used to Diagnose Children With Liver Fibrosis?
Authors: Thusing Iben , Antonsen Steen , Hoffmann‐Petersen Benjamin Søgaard , Rasmussen Helene Marlies , Wittenhagen Per
Published: October 2021

Objectives:

The noninvasive Enhanced Liver Fibrosis (ELF) score is used in adults with liver fibrosis as a diagnostic aid. The ELF score combines 3 serum markers of extracellular matrix remodeling and fibrogenesis: hyaluronic acid (HA), the N‐terminal pro‐peptide of collagen type III (PIIINP), and tissue inhibitor of metalloproteinase‐1 (TIMP‐1). We aimed to evaluate the clinical use of the ELF score in children.

Methods and Results:

A reference interval for the ELF score was established using 343 liver‐healthy children ages 6 to 17 years. The median ELF score of 8.9 in healthy children was significantly increased compared with healthy adults. ELF scores increased significantly in both female and male healthy controls with peak levels at puberty, driven by elevated levels of HA and PIIINP likely explained by increased growth. If adult normal values were applied to the group of liver‐healthy children, only 6.4% were in the normal range. Prospectively, we analysed ELF scores in patients with possible or confirmed liver fibrosis because of autosomal recessive polycystic kidney disease (ARPKD). All ELF scores in children with ARPKD were within the reference intervals generated from the group of healthy children.

Conclusions:

The usual diagnostic cut‐off ranges for the ELF score in adults are not applicable; instead age and gender‐appropriate cut‐off values should be used in children. The clinical value of ELF scores in children is questionable as children during pubertal growth showed elevated ELF scores and patients with ARPKD and liver fibrosis showed normal levels.
Impact of Patient Engagement and Social Determinants of Health on Care of Eosinophilic Gastrointestinal Disorders Patients
Authors: Kothawala Saad , Wang Yanzhi , Gupta Sandeep K.
Published: October 2021

The purpose of this study was to identify factors that influence eosinophilic gastrointestinal disorders (EGID) patients to switch gastroenterologists, assess the prevalence of social determinants of health (SDoH) in EGID patients, and the impact of SDoH on provider switching. 191 patients/caregivers participated in this cross‐sectional, online study distributed through Patient Advocacy Groups. The 35‐question survey took about 20 minutes to complete and was divided into three sections: demographics; 10 questions about provider switching; and nine‐domain SDoH screen.

Patients with EGIDs often switch providers, most commonly due to dissatisfaction with engagement in decision making. Additionally, these patients commonly have SDoH, some of which are associated with increased provider switching. Our results highlight the need to mindfully engage patients in decision‐making and disease management. Providers also need to look beyond the “clinic space” and into SDoH. These low‐cost/high‐impact changes in provider behavior can promote continuity of care and patient engagement.
Continued Basal Zone Expansion After Resolution of Eosinophilia in a Child With Eosinophilic Esophagitis on Benralizumab
Authors: Wenzel Amanda A. , Wadhwani Nitin , Wechsler Joshua B.
Published: October 2021

A 20‐year‐old woman presented with dysphagia at 8 years of age. She underwent esophagogastroduodenoscopy with biopsies (EGD), which was diagnostic of eosinophilic esophagitis. Diet elimination resulted in improvement in symptoms, reduction in eosinophilia, and resolution of basal zone hyperplasia (BZH) on repeat EGD; however, food reintroduction resulted in recurrence of eosinophilia. Subsequently, her pulmonologist started benralizumab, a monoclonal antibody against the interleukin‐5 receptor (IL5Rα) on eosinophils, for her asthma. Seven months after starting benralizumab, she underwent EGD for persistent dysphagia, which was notable for resolution of esophageal eosinophilia but demonstrated marked BZH in association with high numbers of CD3+ T cells and tryptase+ mast cells. She transitioned to dupilumab and had resolution of dysphagia. EGD was performed 10 months after starting dupilumab and demonstrated resolution of BZH and mast cell inflammation with significant reduction in T cells. Review of other patients at our center treated with biologics, most commonly dupliumab, reveals varying degrees of BZH in association with mostly CD3+ lymphocyte inflammation. Mast cells and T cells appear to be capable of coordinating mucosal inflammation and symptoms of EoE independent of eosinophilia in a subset of patients.
Validity, responsiveness, floor and ceiling effects of the Berg Balance Scale in patients with Guillain-Barré syndrome
Authors: Zupanc Aleksander , Puh Urška
Published: October 2021

We investigated the measurement properties of the Berg Balance Scale in patients with Guillain-Barré syndrome. A retrospective analysis was performed of 81 patients with Guillain-Barré syndrome of age 17–84 years who had completed inpatient rehabilitation over a 5-year period. They were assessed with the Berg Balance Scale, the 10 Meter Walk Test, and the 6 Minute Walk Test at admission and discharge. The concurrent validity of the Berg Balance Scale was confirmed by very good correlations with the 10 Meter Walk Test at admission and discharge (ρ = 0.83 and 0.78, respectively) and by excellent and very good correlations with the 6 Minute Walk Test at admission (ρ = 0.91) and discharge (ρ = 0.77). The predictive validity of the Berg Balance Scale for the 10 Meter Walk Test and the 6 Minute Walk Test at discharge was moderate (ρ = 0.62 and 0.61, respectively) and very good (ρ = −0.87) for length of stay. The minimal clinically important difference of the Berg Balance Scale was estimated to be 10 points. The scale was highly responsive to changes in balance (Cohen’s d 0.9). No floor effect was identified. A ceiling effect was identified only at discharge. The Berg Balance Scale is feasible in patients with Guillain-Barré syndrome at admission and discharge from rehabilitation. However, a ceiling effect may occur at discharge in patients with high levels of balance.
Nurses' Ability to Identify Human Trafficking Victims
Authors: Sangha Manjit Rani , Birkholz Lorri
Published: October 2021

The failure of nurses to recognize human trafficking victims in the acute care setting is a serious problem. Nurses may fail to recognize common signs and symptoms of trafficked victims because of lack of experience, knowledge, or preexisting assumptions. This study identified nurses’ common assumptions about human trafficking victims while demonstrating how focused human trafficking education program improved knowledge and self-efficacy.
Resident- and Institutional-Level Factors, Frailty, and Nursing Homes Residents
Authors: Zhao Meng , Yang Zhenhua , Wang Yaqi , Li Ming , Wang Kefang
Published: October 2021

Background

Frailty is a major cause of adverse health outcomes, such as hospitalization, falls, disability, and morbidity, among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions.

Objectives

This study aimed to examine the trend of frailty over time (at baseline, 6-month follow-up, and 12-month follow-up) among Chinese nursing home residents and identify associated resident- and institutional-level factors.

Methods

This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff–resident ratio, and staff turnover rate). These data were subjected to a multilevel linear analysis.

Results

Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities.

Discussion

Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.
Meibomian Gland Changes in Open-angle Glaucoma Users Treated with Topical Medication
Authors: Soriano Diana , Ferrandez Blanca , Mateo Antonio , Polo Vicente , Garcia-Martin Elena
Published: October 2021

SIGNIFICANCE

Glaucoma patients treated with topical hypotensive eye drops often experience changes in the ocular surface, including the lid margin and the meibomian glands. In this study, the clinical parameters of the ocular surface have been analyzed to detect the presence of meibomian gland dysfunction–related dry eye disease.

PURPOSE

This study aimed to evaluate the meibomian gland dysfunction in glaucoma patients secondary to topical antiglaucomatous treatment.

METHODS

A total of 131 eyes from different patients with open-angle glaucoma treated with topical medication and 92 eyes from different patients with untreated ocular hypertension were consecutively and prospectively enrolled. The structure of the meibomian glands was assessed using noncontact meibography (Keratograph 5M; Oculus, Wetzlar, Germany), and their function was evaluated by measurement of meibomian glands expressibility, the duct appearance, and the Marx line location. Moreover, tear osmolarity measurement, corneal staining score (Oxford scale), and ocular symptom assessment (Ocular Surface Disease Index questionnaire) were performed. We also compared these variables in the glaucoma group according to the presence (or not) of preservative in topical treatment.

RESULTS

Meibomian gland depletion was higher in glaucoma patients with topical medication (P < .001). Furthermore, the quantity of meibomian glands and expressibility of meibum in these patients were altered compared with the control group (P < .001 in both cases). In addition, the glaucoma group presented a higher degree of corneal staining as measured with the Oxford scale (P < .001). The Marx line location score was higher (P < .001 in central Marx line and P < .003 in temporal Marx line) in patients using drugs containing preservative than in those having preservative-free treatment. Logistical regression found that Marx line central, Marx line temporal, quantity of meibum expression, and quality of meibum expression have predictive ability to detect meibomian gland dysfunction–related dry eye disease.

CONCLUSIONS

Glaucoma topical treatments produce meibomian gland dysfunction altering their structure and function, and this condition can be worsened using topical treatments containing preservative.