bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Trial of Progesterone in Women With Bleeding in Early Pregnancy
Authors: Coomarasamy A. , Devall A.J. , Cheed V. , Harb H. , Middleton L.J. , Gallos I.D. , Williams H. , Eapen A.K. , Roberts T. , Ogwulu C.C. , Goranitis I. , Daniels J.P. , Ahmed A. , Bender-Atik R. , Bhatia K. , Bottomley C. , Brewin J. , Choudhary M. , Crosfill F. , Deb S. , Duncan W.C. , Ewer A. , Hinshaw K. , Holland T. , Izzat F. , Johns J. , Kriedt K. , Lumsden M.A. , Manda P. , Norman J.E. , Nunes N. , Overton C.E. , Quenby S. , Rao S. , Ross J. , Shahid A. , Underwood M. , Vaithilingam N. , Watkins L. , Wykes C. , Horne A. , Jurkovic D.
Published: November 2019

(N Engl J Med. 2019;380(19):1815–1824)

This study aimed to determine whether the controversial use of progesterone therapy in women with early bleeding in pregnancy could result in a higher incidence of live births than use of a placebo. It was a multicenter, randomized, double-blind, placebo-controlled trial to evaluate progesterone, as compared with placebo, in women with vaginal bleeding in early pregnancy. Women received vaginal suppositories of progesterone, or a placebo, from presentation of bleeding to 16 weeks to determine if progesterone therapy helps improve pregnancy outcomes for women with vaginal bleeding in early pregnancy.
Reproduction, Fear of Childbirth and Obstetric Outcomes in Women Treated for Fear of Childbirth in Their First Pregnancy: A Historical Cohort
Authors: Möller L. , Josefsson A. , Lilliecreutz C. , Gunnervik C. , Bladh M. , Sydsjö G.
Published: November 2019

(Acta Obstet Gynecol Scand. 2019;98:374–381)

Fear of childbirth (FOC) affects between 7% and 20% of all pregnant women, and about 8% of pregnant women in Sweden receive counseling for FOC during their pregnancy. FOC is associated with a higher rate of cesarean section on maternal request. Previous data suggest that some FOC treatment methods may be inadequate for eliminating the fear, which may lead women to have negative birth experiences and potentially consider not having additional children. This study aimed to compare the long-term reproductive and obstetric outcomes in women treated for FOC during their first pregnancy with women who did not experience FOC with their first pregnancy.
Photoplethysmographic Evaluation of Sympathectomy During Lumbar Epidural Analgesia: A Randomized Comparison of 0.125% Ropivacaine and 0.125% Levobupivacaine
Authors: Reiner K. , Lukic A. , Martinus M. , Cacic M. , Mihaljevic S.
Published: November 2019

(Acta Anaesthesiol Scand. 2019;63(6):775–780)

The method of photoplethysmography measures blood flow in the skin through the use of infrared light to gage nervous system activity during both peripheral and central anesthesia blocks. Experts today believe that ropivacaine and levobupivacaine carry varying levels of cardiovascular safety, with ropivacaine being less dangerous, despite a lack of data supporting this opinion. These investigators hypothesized that these 2 local anesthetics actually carry the same cardiovascular safety risk, and aimed to measure the effects of both ropivacaine and levobupivacaine using photoplethysmography.
Ultrasound-Assisted Technology Versus the Conventional Landmark Location Method in Spinal Anesthesia for Cesarean Delivery in Obese Parturients: A Randomized Controlled Trial
Authors: Li M. , Ni X. , Xu Z. , Shen F. , Song Y. , Li Q. , Liu Z.
Published: November 2019

(Anesth Analg. 2019;129(1):155–161)

For cesarean deliveries, spinal anesthesia is typically performed with the use of manual palpation. However, some patients present challenges to this method, particularly patients with imperceptible surface landmarks or those who are obese. Because spinal anesthesia placement may be more difficult in these patients, there is an increased likelihood of postdural puncture headache, paresthesia, or spinal hematoma. It has been proposed that preprocedure ultrasound scanning can assist care providers with spinal anesthesia placement, but not much research has been done on this subject. These investigators conducted their study to determine whether lateral-positioned ultrasound scanning would result in more precise needle insertions than a blind manual palpation technique for obese patients.
Author-reported affiliations on abstracts accepted for the Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting: A retrospective review
Authors: Murphy Robert F. , Barfield William R. , Offerle Thomas , Osborne Davis , Mooney James F.
Published: November 2019

Professional education at academic medical meetings is under increasing scrutiny. No data have been published regarding the academic or institutional affiliations of authors who submit abstracts as part of the Pediatric Orthopaedic Society of North America (POSNA) Annual Meeting. We sought to study the self-reported institutional affiliations and other factors over a 6-year period. The POSNA annual meeting programs 2011-2016 were reviewed. The number of abstracts, including those for main program podium presentations, posters, e-posters, and subspecialty day were queried. The number of authors on each submission, presenting author’s reported institutional affiliation, and involvement of a study group or database were documented. Over the 5-year study period the abstract number increased (188 abstracts in 2011 and 294 in 2016, abstracts or a 56% increase). The mean number of authors listed per abstract was five (range, 4.9 to 5.4). Nineteen percent of abstracts were affiliated with three institutions: Texas Scottish Rite Hospital (103), Boston Children’s Hospital (95) and Rady Children’s Hospital (84). Boston Children’s Hospital and Texas Scottish Rite Hospital were most frequent in the main program. These two institutions accounted for 16% to 25% of main program podium abstracts across all years. The total number of abstracts with a study group affiliation increased over the evaluated period (five abstracts in 2011, 18 abstracts in 2016, a 4.5-fold increase). The abstract number at the POSNA annual meeting has increased substantially recently. Although the average number of authors listed on the abstract remained consistent over the review period, study groups/databases were reported as an author/source more frequently. Two academic pediatric orthopaedic centers were affiliated with approximately 20% of the main program abstracts each year.

Level of Evidence:

Level IV.
Development of a Risk Prediction Model With Improved Clinical Utility in Elective Cervical and Lumbar Spine Surgery
Authors: Broda Andrew , Sanford Zachary , Turcotte Justin , Patton Chad
Published: November 2019

Study Design.

Retrospective cohort.

Objective.

We present a universal model of risk prediction for patients undergoing elective cervical and lumbar spine surgery.

Summary of Background Data.

Previous studies illustrate predictive risk models as possible tools to identify individuals at increased risk for postoperative complications and high resource utilization following spine surgery. Many are specific to one condition or procedure, cumbersome to calculate, or include subjective variables limiting applicability and utility.

Methods.

A retrospective cohort of 177,928 spine surgeries (lumbar (L) Ln = 129,800; cervical (C) Cn = 48,128) was constructed from the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Cases were identified by Current Procedural Terminology (CPT) codes for cervical fusion, lumbar fusion, and lumbar decompression laminectomy. Significant preoperative risk factors for postoperative complications were identified and included in logistic regression. Sum of odds ratios from each factor was used to develop the Universal Spine Surgery (USS) score. Model performance was assessed using receiver-operating characteristic (ROC) curves and tested on 20% of the total sample.

Results.

Eighteen risk factors were identified, including sixteen found to be significant outcomes predictors. At least one complication was present among 11.1% of patients, the most common of which included bleeding requiring transfusion (4.86%), surgical site infection (1.54%), and urinary tract infection (1.08%). Complication rate increased as a function of the model score and ROC area under the curve analyses demonstrated fair predictive accuracy (lumbar = 0.741; cervical = 0.776). There were no significant deviations between score development and testing datasets.

Conclusion.

We present the Universal Spine Surgery score as a robust, easily administered, and cross-validated instrument to quickly identify spine surgery candidates at increased risk for postoperative complications and high resource utilization without need for algorithmic software. This may serve as a useful adjunct in preoperative patient counseling and perioperative resource allocation.

Level of Evidence: 3
Half of Unplanned Readmissions Following One or Two-Level Anterior Cervical Decompression and Fusion Are Unrelated to Surgical Site
Authors: Sing David C. , Vora Molly , Yue John K. , Silveira Luke , Tannoury Chadi
Published: November 2019

Mini

In this study we analyze rates of readmission, and the timing and reasons for readmission after one to two level anterior cervical decompression and fusion. Among 18,833 patients who underwent anterior cervical decompression and fusion, 3% were readmitted to the hospital within 30 days. 39.5% of readmissions were for reasons related to surgical site.

Study Design.

Retrospective review of a national database.

Objective.

In this study we analyze rates of readmission, and the timing and reasons for readmission after one to two level anterior cervical decompression and fusion (ACDF).

Summary of Background Data.

The safety profile of ACDF has been previously described with readmission rates typically between 2% and 4%. However no studies have investigated the primary diagnoses driving readmission, and whether these diagnoses are related to the surgical site.

Methods.

Demographics, comorbidities, and procedural characteristics were collected for all patients undergoing one or two-level ACDF for degenerative indications identified by Current Procedural Terminology (CPT) coding in the National Surgical Quality Improvement Program (NSQIP) database. The incidence of 30-day complications and readmissions was calculated, and the reasons for readmission as well as the timing of readmission were reviewed. Multivariate logistic regression analyses were performed to identify risk factors associated with complications or readmissions within 30 days of surgery.

Results.

Eighteen thousand eight hundred thirty three patients underwent ACDF (15,464 single-level and 3369 two-level, mean age 53.7 yrs, standard deviation [SD]: 11.6; 50% male). Postoperative complication rate of was 4.3% in two-level fusions and 3.5% in single-level fusion (P = 0.027). Five hundred sixty nine unplanned readmissions were identified (3.0%), of which 39.5% were related to the surgical site and 49.7% were unrelated to the surgical site (10.5% unknown cause of readmission). The most frequent reason for 30-day readmission was pneumonia (9.3%, mean time to readmission of 11.3 d) followed by dysphagia (7.4%, 6.3 d), and acute postoperative pain (7.2%, 11.4 d).

Conclusion.

In this nationwide analysis of 18,833 ACDF cases, 3.0% of patients were readmitted within 30 days, of which at least 49.7% were for reasons unrelated to the surgical site.

Level of Evidence: 3
Effect of Tracheal Intubation Mode on Cuff Pressure During Retractor Splay and Dysphonia Recovery After Anterior Cervical Spine Surgery
Authors: Huang Wen-Cheng , Tan Elise Chia-Hui , Chang Chih-Chang , Kuo Yi-Hsuan , Hsu Xavier T. J. , Chang Wen-Kuei , Huang Shiang-Suo , Chen Pin-Tarng , Chu Ya-Chun
Published: November 2019

Mini

This randomized clinical trial showed different intubation mode in anesthesia did not affect the increase of endotracheal cuff pressure caused by the retractor splay in anterior cervical spine surgery. However, nasotracheal intubation improved postoperative dysphonia recovery after anterior cervical spine surgery.

Study Design.

Prospective, randomized, double-blinded trial.

Objective.

The aim of this study was to investigate whether the mode of tracheal intubation affects intraoperative endotracheal tube cuff pressure on retractor splay and post-anterior cervical spine surgery (ACSS) voice outcome.

Summary of Background Data.

The combination of endotracheal tube (ETT) and cervical retractors has been implicated in recurrent laryngeal nerve compression and neuropraxia after ACSS. The asymmetric position of the oroETT within the larynx, as being fixed distally by the cuff and proximally by taping on one side of the mouth, may contribute to unilateral vocal palsy.

Methods.

Adult patients undergoing ACSS were randomized to receive either nasotracheal or orotracheal intubation under anesthesia. The primary endpoint was the maximal endotracheal tube cuff pressure (ETCP) when the retractors were set up. After the maximal ETCPs were recorded, then ETCPs were controlled to less than 25 mmHg. Secondary endpoints were self-assessed hoarseness, pitch, and loudness of voice on postoperative days (PODs) 1, 2, 7, and 30.

Results.

We equally allocated 110 patients to nasotracheal and orotracheal intubation. The maximal ETCP during retractor splay did not differ for both the means and distributions of pressure range. After the surgery, more patients in the nasotracheal intubation group reported none or mild change of voice than did the orotracheal intubation group on PODs 1 and 2, in terms of hoarseness, pitch, and loudness (P = 0.001, 0.001, and 0.005, respectively, on POD 1; P = 0.002, 0.003, and 0.011, respectively, on POD 2). Mixed model analysis demonstrated that patients with nasotracheal intubation had significantly lower dysphonia scores after surgery (estimate treatment effect: −1.62, P < 0.0001). Statistics was adjusted to exclude interaction with ETT sizes.

Conclusion.

The tracheal intubation modes did not affect ETCP during retractor splay. However, nasotracheal intubation had a beneficial effect on dysphonia recovery after ACSS.

Level of Evidence: 2
Timing of Tracheostomy in Pediatric Patients: A Systematic Review and Meta-Analysis*
Authors: Abdelaal Ahmed Mahmoud M. Alkhatip Ahmed , Younis Mohamed , Jamshidi Negar , Hussein Hazem A , Farag Ehab , Hamza Mohamed K. , Bahr Mahmoud H. , Goda Ahmed Ahmed , Sallam Amr M. , Mohamed Hassan , Elayashy Mohamed , Hosny Hisham , Yassin Hany M. , Abdelhaq Mohamed , Elramely Mohamed A. , Reeves David , Mills Kerry E. , Kamal Ahmed M. , Zakaria Dina
Published: November 2019

Objectives:

Tracheostomy is a very common clinical intervention in critically ill adult patients. The indications for tracheostomy procedures in pediatric patients with complex conditions have increased dramatically in recent years, but there are currently no guidelines on the optimal timing of tracheostomy in pediatric patients undergoing prolonged ventilation.

Data Sources:

We performed a systematic search of the existing literature in MEDLINE via PubMed and Embase databases and the Cochrane Library to identify clinical trials, observational studies, and cohort studies that compare early and late tracheostomy in children. The date of the last search was August 27, 2018. Included articles were subjected to manual searching.

Study Selection:

Studies in mechanically ventilated children that compared early with late tracheostomy were included.

Data Extraction:

Data were extracted into a spreadsheet and copied into Review Manager 5.3 (The Cochrane Collaboration, Copenhagen, Denmark).

Data Synthesis:

Data were meta-analyzed using an inverse variance, random effects model. Continuous outcomes were calculated as mean differences with 95% CIs, and dichotomous outcomes were calculated as Mantel-Haenszel risk ratios with 95% CIs. We included eight studies (10 study arms). These studies were all retrospective cohort studies. Early tracheostomy was associated with significant reductions in mortality, days on mechanical ventilation, and length of intensive care and total hospital stay, although the lack of randomized, controlled trials limits the validity of these findings. Although variance was imputed for some studies, these conclusions did not change after removing these studies from the analysis.

Conclusions:

In children on mechanical ventilation, early tracheostomy may improve important medical outcomes. However, our data demonstrate the urgent need for high-quality, randomized controlled trials in the pediatric population.
Best bone of acetabulum for cup component placement in Crowe types I to III dysplastic hips: a computer simulation study
Authors: Zheng Lin-Li , Lin Yang-Yang , Zhang Xiao-Yan , Ling Qian-Hui , Liao Wei-Ming , Wu Pei-Hui
Published: November 2019

Background

During cup implantation, vertical height of the cup center (V-HCC) should be precisely controlled to achieve sufficient bone-cup coverage (BCC). Our study aimed to investigate the acetabular bone stock and the quantitative relationship between V-HCC and BCC in Crowe types I to III hips.

Methods

From November 2013 to March 2016, pelvic models of 51 patients (61 hips) with hip dysplasia were retrospectively reconstructed using a computer software. Acetabular height and doom thickness were measured on the mid-acetabular coronal cross section. V-HCC was defined as the vertical distance of cup rotational center to the interteardrop line (ITL). In the cup implantation simulation, the cup was placed at the initial preset position, with a V-HCC of 15 mm, and moved proximally by 3-mm increments. At each level, the BCC was automatically calculated by computer. Analysis of variance and Kruskal-Wallis test were used to compare the differences between groups.

Results

There were no significant between-group differences in maximum thickness of the acetabular doom; however, peak bone stock values were obtained at heights of 41.63 ± 5.14 mm (Crowe type I), 47.58 ± 4.10 mm (Crowe type II), and 55.78 ± 3.64 mm (Crowe type III) above the ITL. At 15 mm of V-HCC, median BCC was 78% (75–83%) (Crowe type I), 74% (66–71%) (Crowe type II), and 61% (57–68%) (Crowe type III). To achieve 80% of the BCC, the median V-HCC was 16.27 (15.00–16.93) mm, 18.19 (15.01–21.53) mm, and 24.13 (21.02–28.70) mm for Crowe types I, II, and III hips, respectively.

Conclusion

During acetabular reconstruction, slightly superior placement with V-HCC <25 mm retained sufficient bone coverage in Crowe I to III hips.
Metataxonomics of Internal Transcribed Spacer amplicons in cerebrospinal fluid for diagnosing and genotyping of cryptococcal meningitis
Authors: Zhu Ji-Ting , Lin Han , Wu Xuan , Li Zhi-Wen , Lin Ai-Yu
Published: November 2019

Background:

Cryptococcal meningitis is a severe infectious disease associated with high morbidity and mortality. Rapidity and accuracy of diagnosis contribute to better prognosis, but readily available tools, such as microscopy, culture, and antigens do not perform well all the time. Our study attempted to diagnose and genotype cryptococcus in the cerebrospinal fluid (CSF) samples from patients with cryptococcal meningitis using the approach of metataxonomics of Internal Transcribed Spacer (ITS) amplicons.

Methods:

The CSF samples were collected from 11 clinically suspected cryptococcal meningitis patients and four non-infectious controls. Samples were recruited from the First Affiliated Hospital of Fujian Medical University Hospital, Fuzhou Fourth Hospital and the 476th Hospital of Chinese People's Liberation Army from December 2017 to December 2018. ITS1 ribosomal deoxyribonucleic acid (rDNA) genes of 15 whole samples were amplified by universal forward primer ITS1 (CTTGGTCATTTAGAGGAAGTAA) and reverse primer ITS2 (GCTGCGTTCTTCATCGATGC), sequenced by Illumina MiSeq Benchtop Sequencer. The results were confirmed by sanger sequencing of ITS1 region and partial CAP59 gene of microbial isolates from 11 meningitic samples. Pair-wise comparison between infectious group and control group was conducted through permutational multivariate analysis (PERMANOVA) in R software.

Results:

The 30,000 to 340,000 high-quality clean reads were obtained from each of the positively stained or cultured CSF samples and 8 to 60 reads from each control. The samples from 11 infected patients yielded detectable cryptococcal-specific ITS1 DNA with top abundance (from 95.90% to 99.97%), followed by many other fungal groups (each <1.41%). ITS genotype was defined in 11 CSF samples, corresponding to ITS type 1, and confirmed by Sanger sequencing. A statistically significant difference (r
2 = 0.65869, P = 0.0014) between infectious group and control group was observed.

Conclusions:

The metataxonomics of ITS amplicons facilitates the diagnosis and genotype of cryptococcus in CSF samples, which may provide a better diagnostic approach of cryptococcal infection.
Epstein–Barr Virus-Positive Mucocutaneous Ulcer in a Pediatric Patient—Case Report
Authors: Coelho Karina Munhoz de Paula Alves , Bublitz Giuliano Stefanello , Condeixa de França Paulo Henrique , Stall Jaqueline , Hanauer Aline Denise , Sangueza Júlio Martín
Published: November 2019

The Epstein–Barr virus (EBV)-positive mucocutaneous ulcer is a rare entity in the spectrum of lymphoproliferative diseases associated with the EBV. It occurs typically in patients with immunosuppression associated with immunosenescence, as well as due to iatrogenic causes, posttransplant patients and primary immunodeficiency disorders. It is often a benign and self-limited disease that recedes by stopping or reducing the immunosuppressive agents in most of the cases. Histologically, it is characterized by a population of EBV-positive atypical lymphoid cells. Here, we present a rare case of a 5-month-old pediatric patient, born preterm at 24 weeks of gestational age, presenting a lump on the right shoulder, later evolving to EBV-positive mucocutaneous ulcer.
A Single-site Postmarket Retrospective Chart Review of Subdermal Coagulation Procedures with Renuvion
Authors: Doolabh Vaishali
Published: November 2019

Although tumescent liposuction provides debulking of body areas with excess subcutaneous fat and concurrent skin laxity, the ability to shrink and redrape the skin and soft tissue for added definition has remained an elusive goal. Many modalities employed to facilitate fat removal utilizing light energy, ultrasonic energy, or radiofrequency energy have provided modest skin shrinkage. Apyx Medical’s (formerly Bovie Medical) Renuvion (previously branded as J-Plasma) has Food and Drug Administration clearance for the cutting, coagulation, and ablation of soft tissue. The objective of this retrospective chart review was to collect safety and procedural information for patients who have previously undergone liposuction with which Renuvion was used as a tool for subdermal coagulation. All procedures occurred before August 2018. Thirty-two patients were identified (3 male and 29 female). The mean follow-up was 6 months (range, 3–8 months). None of the patients required a revision or secondary procedure suggesting 100% of patients had acceptable final outcomes. No device-related adverse events or complications were noted, suggesting that within this data set, Renuvion’s unique cool helium plasma technology can safely be used for skin contraction with or without tumescent liposuction or supplemental modalities used to facilitate fat removal that may otherwise contribute to the skin contraction.
Intrahepatic Cholestasis of Pregnancy
Authors: SMITH DEVIN D. , ROOD KARA M.
Published: November 2019

Intrahepatic cholestasis of pregnancy is a common disorder of pregnancy manifested by pruritus and elevated bile acids. The etiology of cholestasis is poorly understood and management is difficult due to the paucity of data regarding its diagnosis, treatment, and related adverse outcomes. In this article, we review the epidemiology, pathophysiology, risk factors, laboratory findings, complications, treatment, management, and current evidence surrounding intrahepatic cholestasis of pregnancy.
Pancreatic Disorders of Pregnancy
Authors: BECK STACY L.
Published: November 2019

The pancreas is an organ with both exocrine and endocrine functions that has a vital role in both digestion as well as glucose metabolism. Although pancreatic dysfunction and disorders are rare in pregnancy, they are becoming increasingly more common. Recognition of these disorders and understanding how they can affect pregnancy is imperative to allow for proper management. We provide an overview of the most common pancreatic disorders that are seen in pregnancy.
Proximal aortic diameter evolution in hypertensive patients with mild-to-moderate aortic dilatation: a 5-year follow-up experience
Authors: Leone Dario , Cina Andrea , Tosello Francesco , Sabia Luca , Vallelonga Fabrizio , Avenatti Eleonora , Astarita Anna , Mingrone Giulia , Veglio Franco , Ridolfi Luca , Milan Alberto
Published: November 2019

Background:

Aortic dilatation is common in hypertensive patients and is associated with higher risk of cardiovascular events. Parameters predicting further dilatation during lifetime are poorly understood.

Aim:

To predict the midterm aortic diameter evolution in a cohort of hypertensive patients with known aortic dilatation at Sinus of Valsalva (SOV) level.

Methods:

We prospectively analyzed a cohort of essential hypertensive outpatients without any other known risk factor for aortic dilatation. They underwent serial echocardiographic evaluations from 2003 to 2016.

Results:

Two hundred and forty-two hypertensive outpatients with a mild-to-moderate (37–53 mm) aortic dilatation were followed up for at least 5 years. Mean growth rate was 0.08 ± 0.35 mm/year. No clinical or anthropometric parameters were significantly different in patients with and without aortic diameter increase. Aortic z score (number of standard deviations from the average value observed in the general population) at baseline was inversely associated with growth rate (R
2 0.04, P < 0.05). Aortic diameter at first visit, demographic and echocardiographic variables were major determinants of aortic diameter at second visit, accounting for about 90% of its total variability.

Conclusion:

Mean growth rate of proximal aorta in hypertensive patients with known aortic dilatation was of about 0.1 mm/year. Dilatation over time is slower in patients with increased rather than normal aortic z score. Eventually, it could be possible to reliably predict aortic diameter at few months from first visit.
Thyroid Dose Estimates for a Cohort of Belarusian Persons Exposed in Utero and During Early Life to Chernobyl Fallout
Authors: Drozdovitch Vladimir , Minenko Victor , Kukhta Tatiana , Trofimik Sergey , Grakovitch Rimma , Hatch Maureen , Cahoon Elizabeth K. , Veyalkin Iliya , Polyanskaya Olga , Yauseyenka Vasilina , Ostroumova Evgenia , Mabuchi Kiyohiko , Rozhko Alexander
Published: November 2019

Thyroid radiation doses were estimated for a cohort of 2,965 Belarusian persons who were exposed in utero and during early life to fallout from the Chernobyl nuclear power plant accident. Prenatal and postnatal doses to the thyroid due to intake of 131I, external irradiation from radionuclides deposited on the ground, and ingestion of cesium isotopes (134Cs and 137Cs) were calculated for all cohort members. Dose estimation was based on personal interviews with subjects’ mothers; the interviews collected data on subjects’ residential history, consumption by mothers during time of pregnancy and breast-feeding, as well as consumption by subjects after birth. Direct instrumental measurements of radioactivity in mothers and the study subjects, if available, were also used for calculation of doses. Intake of 131I by mothers was found to be the predominant pathway for thyroid exposure for the study subjects. The average thyroid dose due to all exposure pathways was estimated to be 137 mGy (median dose of 25 mGy, maximal dose of 14.8 Gy), including 130 mGy (median dose of 17 mGy, maximal dose of 14.8 Gy) from 131I intake, 4.9 mGy (median dose of 3.0 mGy, maximal dose of 102 mGy) due to external irradiation, and 2.5 mGy (median dose of 1.7 mGy, maximal dose of 47 mGy) due to ingestion of 134,137Cs. The dose estimates will be used to evaluate the radiation-related risk of thyroid cancer and other thyroid diseases in this unique cohort.
HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS OF X-LINKED RETINOSCHISIS IN EARLY CHILDHOOD
Authors: Ling Kiet Phang , Mangalesh Shwetha , Tran-Viet Du , Gunther Randall , Toth Cynthia A. , Vajzovic Lejla
Published: November 2019

Background/Purpose:

Using handheld spectral domain optical coherence tomography (SDOCT) imaging to investigate in vivo microanatomic retinal changes and their progression over time in young children with juvenile X-linked retinoschisis (XLRS).

Methods:

This retrospective analysis was of handheld SD OCT images obtained under a prospective research protocol in children who had established XLRS diagnosis based on genetic testing or clinical history. Three OCT graders performed standardized qualitative and quantitative assessment of retinal volume scans, which were divided into foveal, parafoveal, and extrafoveal regions. Visual acuity data were obtained when possible.

Results:

Spectral domain OCT images were available of both eyes in 8 pediatric patients with ages 7 months to 10 years. The schisis cavities involved inner nuclear layer in over 90% (15/16) of eyes in all 3 regions. Retinal nerve fiber and ganglion cell layer involvement was present only in the extrafoveal region in 63% (10/16) eyes and outer nuclear and plexiform layer in few others. In 7 children followed over 2 months to 15 months, the location of schisis remained consistent. Central foveal thickness decreased from the baseline to final available visit in 4/6 eyes. Ellipsoid zone disruption seemed to accompany lower visual acuity in 1/4 eyes.

Conclusion:

Early in life, the SD OCT findings in XLRS demonstrate differences in schisis location in fovea–parafoveal versus extrafoveal region, possible association between poor visual acuity and degree of ellipsoid zone disruption and decrease in central foveal thickness over time in this group. Furthermore, they illustrates that the pattern of XLRS in adults is already present in very young children, and unlike in older children and adults, those presenting with earlier disease may have a more aggressive course. Further studies in this early age group may provide more insights into treatment and prevention of progressive visual impairment in children with XLRS.
Frequency and Clinical Features Associated With Eczema Herpeticum in Hospitalized Children With Presumed Atopic Dermatitis Skin Infection
Authors: Hemani Sunita Ali , Edmond Mary Bond , Jaggi Preeti , Cooley Anthony
Published: November 2019

Background:

Atopic dermatitis (AD) predisposes to viral skin infections, such as eczema herpeticum (EH), and to bacterial skin infections, such as those caused by Staphylococcus aureus (SA) and group A streptococcus (GAS). This study evaluated clinical features of EH and its frequency of codetection with SA or GAS in children hospitalized for presumed AD skin infection.

Methods:

We retrospectively reviewed clinical data for children ≤18 years of age admitted to a large hospital system for AD with presumed skin infection from January 2004 to December 2018. Those with an alternate primary diagnosis or missing microbiologic data were excluded. Encounters with herpes simplex virus testing were identified as AD with EH (ADEH+) or without (ADEH−). Encounters with bacterial skin culture growth were identified as SA or GAS.

Results:

Among 180 AD encounters with suspected skin infection, 133 (74%) were tested for herpes simplex virus. Clinical findings associated with ADEH+ status (n = 61) included fever on admission (59% vs. 32% in ADEH−; P = 0.002), rash on the neck (30% vs. 13%; P = 0.015) and vesicular rash (70% vs. 49%; P = 0.011). Encounters in the ADEH+ group had a longer hospital length of stay compared with encounters in the ADEH− group [median 4 days (interquartile range 3–5 days) vs. 3 days (interquartile range 2–3 days); P < 0.001]. GAS was identified in only 1 ADEH+ encounter (2%) versus 15 ADEH− encounters (26%), P < 0.001.

Conclusions:

Providers should maintain a high index of suspicion for EH in children admitted for presumed AD skin infection. GAS was more commonly associated with ADEH− encounters.
Talk to PAPA
Authors: George Sheba , Dixon Lydia Zacher , Carrasco Elsa , Romo Oscar , Vides Lucia , Balcazar Hector
Published: November 2019

Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery.
A Closer Examination of the Patient Experience in the Ambulatory Space
Authors: Jurdi Zahi R. , Crosby Joseph F. , Harris James E. , Harvey Jillian B.
Published: November 2019

This qualitative study explores key patient experience impressions responsible for driving quality. Differences between primary and specialty care patient perspectives were analyzed using a mixed-methods design in high-, median-, and low-quality performing practices. We found that primary care patients highly value provider listening, time spent with provider, and consistent and effective coordination of care. Specialty care patients were found to highly value provider clinical skill acumen/outcomes, being kept informed with timely updates and care instructions, and a stress- and pain-free experience. We conclude that differing patient types attach greater value to different elements of their health care experiences.
Monitoring tissue temperature during photothermal therapy for cancer
Authors: West Connor L. , Doughty Austin C.V. , Liu Kaili , Chen Wei R.
Published: November 2019

Phototherapies offer promising alternatives to traditional cancer therapies. Phototherapies mainly rely on manipulation of target tissue through photothermal, photochemical, or photomechanical interactions. Combining phototherapy with immunotherapy has the benefit of eliciting a systemic immune response. Specifically, photothermal therapy (PTT) has been shown to induce apoptosis and necrosis in cancer cells, releasing tumor associated antigenic peptides while sparing healthy host cells, through temperature increase in targeted tissue. However, the tissue temperature must be monitored and controlled to minimize adverse thermal effects on normal tissue and to avoid the destruction of tumor-specific antigens, in order to achieve the desired therapeutic effects of PTT. Techniques for monitoring PTT have evolved from post-treatment quantification methods like enzyme linked immunosorbent assay, western blot analysis, and flow cytometry to modern methods capable of real-time monitoring, such as magnetic resonance thermometry, computed tomography, and photoacoustic imaging. Monitoring methods are largely chosen based on the type of light delivery to the target tissue. Interstitial methods of thermometry, such as thermocouples and fiber-optic sensors, are able to monitor temperature of the local tumor environment. However, these methods can be challenging if the phototherapy itself is interstitially administered. Increasingly, non-invasive therapies call for non-invasive monitoring, which can be achieved through magnetic resonance thermometry, computed tomography, and photoacoustic imaging techniques. The purpose of this review is to introduce the feasible methods used to monitor tissue temperature during PTT. The descriptions of different techniques and the measurement examples can help the researchers and practitioners when using therapeutic PTT.
Association Between Neurohormone Levels and Exercise Testing Measures in Patients with Mechanical Circulatory Supports
Authors: Grosman-Rimon Liza , Kachel Erez , McDonald Michael A. , Lalonde Spencer D. , Yip Paul , Ribeiro Roberto V.P. , Adamson Mitchell B. , Cherney David Z. , Rao Vivek
Published: November 2019

Continuous-flow left ventricular assist device (CF-LVAD) recipients exhibit impaired exercise capacity. Long-term continuous blood flow also elevates norepinephrine (NE) and aldosterone (Aldo) levels. However, the relationship between exercise capacity and neurohormonal activation has not been elucidated. Our study objective was to assess the association between cardiopulmonary exercise testing (CPT) measures and neurohormonal levels in CF-LVAD recipients. Symptom-limited CPT on a treadmill, using the modified Bruce protocol was performed in 15 CF-LVAD recipients. Norepinephrine and Aldo levels were measured, and the association between their levels and CPT measures were assessed. Peak VO2 (13.6 ml/kg/min) and percent age, sex predicted VO2 max (49.4%), and oxygen pulse (O2 pulse) (9.0 ± 4.0 ml/beat) were low, whereas minute ventilation/carbon dioxide output (VE/VCO2) slope (35) was elevated. In addition, VO2 at anaerobic threshold (VO2 AT), and O2 pulse values negatively correlated with NE levels. Norepinephrine levels positively correlated with chronotropic responses and heart rate (HR) recovery. Aldo levels in CF-LVAD recipients were not related to any CPT measures. Continuous-flow left ventricular assist device recipients exhibited impaired exercise capacity and chronotropic incompetence (CI). Despite the association of NE levels with chronotropic responses at peak exercise, neither NE levels nor chronotropic responses predicted peak VO2. This suggests that CI may not be the primary factor responsible for the low peak VO2. O2 pulse, which is a combined measure for stroke volume and peripheral oxygen extraction during exercise, was an independent predictor of peak VO2. Future studies should examine the contribution of peripheral factors to exercise capacity limitations.
An Evidence-based Approach Towards Targeted Patient Education to Improve Bowel Preparation for Colonoscopy
Authors: Kutyla Marguerite J. , O’Connor Sam , Hourigan Luke F. , Kendall Bradley , Whaley Amanda , Meeusen Vera , Holtmann Gerald J.
Published: November 2019

Goals and Background:

Quality of bowel preparation is an important factor influencing adenoma detection. Patient education is believed to improve the quality of bowel preparation but might be resource-intensive. We aimed to (a) identify risk factors for failed bowel preparations and (b) develop and test the efficacy of a screening tool that allows to prospectively identify and target patients at increased risk.

Study:

Part 1: 76 consecutive outpatients with poor bowel preparation were compared with 76 age-matched and gender-matched outpatients with good preparation from the same procedure lists. Sociodemographic and clinical data were obtained from centralized databases. Univariate analysis and multivariate logistic regression was used to identify risk factors for poor bowel preparation. Part 2: on the basis of results of part 1, a screening tool for prospectively identifying patients at high risk was developed, and targeted education tested.

Results:

We identified the use of opioids or other constipating agents and low socioeconomic status as risk factors for poor bowel preparation [odds ratio (OR)=2.88; 95% confidence interval (CI): 1.22-6.80 and OR=2.43; 95% CI: 1.25-4.72]. Diabetes, hypothyroidism, age, and gender were found to have no effect on quality. When education was provided only to patients at increased risk, the targeted approach did not negatively affect the proportion of poor preparation (OR=6.12%; 95% CI: 4.79%-7.78% vs. OR=5.73%; 95% CI: 4.61%-7.10%).

Conclusions:

Poor bowel preparation is associated with specific risk factors. Identifying and specifically targeting education at patients with these risk factors appears to facilitate more efficient use of education resources in endoscopy.
Probiotics, prebiotics, and synbiotics for the treatment of asthma
Authors: Huang Ling , Guo Jing , Li Wenyuan , Jiang Mei , Wang Fei , Kang Jia , Liu Tiegang , Gu Xiaohong
Published: November 2019

Background:

Asthma is a common chronic disease with heavy burden. The number of asthma patients may continue to grow in the next 10 years. Existing conventional treatments have problems in which a small number of patients do not respond, often accompanied by side effects, or are too expensive. Probiotics, prebiotics, and synbiotics have been widely used in allergic and inflammatory diseases including asthma. However, their effectiveness and safety are still obscure and deserve further investigation.

Objective:

To assess the effect and safety of probiotics, prebiotics, and synbiotics in treating asthma.

Methods:

We will summarize and meta-analyze randomized controlled trials (RCTs) of probiotics, prebiotics, and synbiotics for the treatment of asthma. RCTs comparing probiotics, prebiotics, and synbiotics with blank control, placebo, or conventional therapies will be included. RCTs comparing probiotics, prebiotics, and synbiotics plus conventional therapies with conventional therapies alone will also be included. The following electronic databases will be searched: PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, VIP Chinese Science and Technology Periodical Database, and Wanfang Data. The methodological quality of RCTs will be assessed using the Cochrane risk assessment tool. All trials included will be analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software will be used for publication bias analysis. Grading of recommendations assessment, development, and evaluation pro GDT web solution will be used for evidence evaluation.

Results:

This review will evaluate the effects of probiotics, prebiotics, and synbiotics on symptoms, lung function, asthma exacerbations, quality of life, and safety in patients with asthma.

Conclusions:

This review will provide clear evidence to assess the effectiveness and safety of probiotics, prebiotics, and synbiotics for asthma.

OSF registration number:

DOI 10.17605/OSF.IO/V7DM9.
Efficacy of dialysis for the treatment of patients with diabetic nephropathy
Authors: Shao De-rong , Zhou Yue
Published: November 2019

Background:

This study aims to assess the efficacy and safety of dialysis for the treatment of patients with diabetic nephropathy (DN).

Methods:

We will comprehensively retrieve the following databases of Cochrane Library, PUBMED, EMBASE, Global health, CINAHL, PsycINFO, Scopus, CBM, Wangfang, and CNKI for studies related to the topic. We will search all those electronic databases from their inceptions to the present without restrictions of language and publication status. Two authors will independently conduct all procedures of study selection, data collection, and risk of bias assessment. We will apply RevMan 5.3 software for statistical analysis.

Results:

We will systematically investigate the efficacy and safety of dialysis for DN through assessing primary and secondary outcomes. The primary outcomes include improvement in renal function, as assessed by the urinary albumin/creatinine ratio, estimated glomerular filtration rate, and serum creatinine levels. The secondary outcomes consist of levels of inflammatory markers, endothelial dysfunction markers, quality of life, and any expected and unexpected adverse events.

Conclusion:

This study will present evidence on the efficacy and safety of dialysis for the treatment of patients with DN.

Systematic review registration:

PROSPERO CRD42019149699.
Uterine size and volume are associated with higher live birth rate in patients undergoing assisted reproduction technology
Authors: Gao Hong , Liu Dong-e , Li Yumei , Tang Jing , Wu Xinrui , Tan Hongzhuan
Published: November 2019

To investigate how uterine size and volume are associated with live birth rate in patients undergoing assisted reproduction technology.

This prospective cohort study was conducted at the Reproductive Medicine Centre from January 2010 to May 2017. Multivariate binary logistic regression was used to evaluate the relations between uterine size, total volume, and live birth outcomes, after they were adjusted for the main influencing factors.

A total of 7320 women of clinical pregnancy were enrolled. Compared with uterine lengths of 50 to 59 mm (referent), women with uterine lengths ≥60 mm had a lower live birth rate (RR = 1.541). Compared with uterine widths of ≥50 mm (referent), women with uterine widths <30 mm had a lower live birth rate (RR = 1.430). Compared with uterine anteroposterior diameters of <30 mm (referent), women with uterine anteroposterior diameters ≥50 mm had a lower live birth rate (RR = 1.636). Compared with uterine volumes of 30 to 49 mL (referent), women with volumes <30 mL and ≥70 mL had lower live birth rates (RR = 1.368 and 1.742, respectively).

Our findings indicate that uterine sizes and volumes that were too large or too small reduced the live birth rate.
The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy
Authors: Tan Xiaoyu , Fu Donglin , Feng Wubing , Zheng Xiangqi
Published: November 2019

Introduction:

The analgesic efficacy of paravertebral block for percutaneous nephrolithotomy remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of paravertebral block for patients with percutaneous nephrolithotomy.

Methods:

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases, and randomized controlled trials (RCTs) assessing analgesic efficacy of paravertebral block for percutaneous nephrolithotomy are included in this meta-analysis.

Results:

Five RCTs are included in the meta-analysis. Overall, compared with control group after percutaneous nephrolithotomy, paravertebral block is associated with the decrease in analgesic consumption (standard mean difference (Std. MD) = −1.55; 95% confidence interval (CI) = −2.18 to −0.92; P < .00001) and additional analgesics (risk ratio (RR) = 0.17; 95% CI = 0.07 to 0.44; P = .0003), prolonged time to first analgesic requirement (Std. MD = 1.51; 95% CI = 0.26 to 2.76; P = .02). There is no statistical difference of adverse events including nausea or vomiting (RR = 0.51; 95% CI = 0.11 to 2.35; P = .38), or itching (RR = 0.69; 95% CI = 0.26 to 1.81; P = .45) between 2 groups.

Conclusions:

Paravertebral block is effective for pain control after percutaneous nephrolithotomy.