bluuebunny/crossref_metadata_2025 huggingface dataset:
Must We Change? the Dark Side of Change and Change Resistance
Authors: Zorn Theodore E. , Scott Jennifer
Published: June 2021

Organizational change and innovation are generally treated as unquestioned goods, but some have argued that there exists a darker side to these phenomena. Change is often resisted or only grudgingly accepted by those involved and, given the assumed virtues of change and innovation, resistance has traditionally been considered an obstacle to overcome. This chapter will first consider the dark sides of change—that is, negative aspects, in particular change initiatives that are undertaken for ethically questionable reasons, using ethically questionable means, or resulting in deleterious consequences. Second, it reviews resistance to change—that is, an aversive cognitive, emotional, or behavioral response to a change initiative. Using a framework to consider the substance, processes, and outcomes of change initiatives, practical and theoretical implications are provided for a more nuanced approach to acknowledge the connections between perceptions of a change initiative as potential dark side judgments and resultant resistance behaviors.
Dualisms and Dualities in the Ongoing Development of Organization Development
Authors: Bartunek Jean M. , Putnam Linda L. , Seo Myeong-Gu
Published: June 2021

This chapter addresses three major developments in Organization Development (OD) over the course of its existence. Each of them involves tensions that may be experienced as dualisms (“either-or”) and/or dualities (“both-and”), and each of them has been playing an integral role in the ongoing journey of OD. These developments are: 1) intellectual distinctions between “diagnostic” and “dialogic” approaches to OD, 2) the organizational life of OD that coexists with continued proclamations of its death, and 3) the progressive separation between the scholarship and the practice of OD. Intellectually, tensions in these developments are usually handled in either-or fashion, and the practice of OD is a bit more likely to embody both-and approaches. We suggest implications for what the ongoing development of OD might mean in both theory and practice.
From Resistance to Resilience
Authors: Sutcliffe Kathleen M.
Published: June 2021

Two themes in the organizational change literature for decades have been of recurring interest to organizational scholars and practitioners and are central to Theodore Zorn’s and Jennifer Scott’s chapter—‘Why Change? The Dark Side of Change and Change Resistance’. The first theme centers on the idea that most change programs fail—they don’t produce change as intended. The second theme centers on the idea that most change programs are resisted. This essay seeks to add additional nuance to the analysis by emphasizing the contingent nature of change failures and resistance. That is, change and resistance are neither good nor bad in an absolute sense. Appraisals of change failure and resistance depend: they depend on the element of change that is being assessed; the point in time that assessment is being made, and whose perspective on change is being privileged. These considerations open our eyes to the possibility that resilience underlies resistance.
Connecting More Deeply with Life in Organizations
Authors: Deetz Stanley
Published: June 2021

Each chapter in this volume was asked to accomplish three very basic objectives: 1) Current state of research related to the theory; 2) Concrete description with some examples of the theory in practice, and 3) Research-based principles of change (how does the theory suggest change may be promoted and how does it deal with resistance?) This chapter reflects on how the various contributions achieve these objectives, with a particular focus on how they engaged with real organizations and their complexity at a crucial time of social and business environmental changes that stress systems and demand new responses.
Entangled Views of Exogenous and Endogenous Change
Authors: Feldman Martha S.
Published: June 2021

In keeping with identifying dialectics as one of four model of change, many of the chapters of this handbook identify various dualities as important to understanding organizational change. This chapter focuses particularly on the duality of exogenous and endogenous change (or external and internal change) and considers the various ways in which the two are entangled. It reflects on seven chapters of the handbook that provide a range of perspectives on the issue, and separates the range of orientations into three categories: chapters that take the difference between internal and external as an ontological fact and explore how separable entities interact with one another; chapters in which the difference between internal and external is an analytical process (and which are apparently agnostic about ontological differences); and chapters that reject an ontological distinction between exogenous and endogenous and explore the entangled nature of exogenous and endogenous within a single ontology.
AI, ML, and competition dynamics in financial markets
Authors: Grout Paul A
Published: June 2021

There is a common assumption that the adoption of AI and ML in financial markets will make markets more competitive and reduce consumer prices. This paper argues, however, that this is far from obvious and identifies when increases in competition are unlikely to arise. There are several key messages. It is argued that, in contrast to the experience in bigtech markets, the widespread use of AI and ML at the sector-wide level is unlikely to lead to any significant short-term changes in concentration in financial markets. In the longer term, however, the question of whether there will be more concentration will depend on the balance of two opposing forces. On the one hand, rapid acceleration of the nascent merging of the boundaries between bigtech and financial markets could increase concentration; but on the other, action around the significant tightening of bespoke regulations, notably regulatory mandated data sharing, could push in the opposite direction. At the micro-market level, it is also argued that the impact of adopting AI and ML will be very sensitive to the specifics of the market (e.g. the impact of any consequent reduction of asymmetry of information is highly sensitive to the underlying asymmetry).
Superstition and Statecraft in Late Qing China: Towards a Global History
Authors: Wu Albert
Published: June 2021

The late nineteenth-century age of empire was also an age of anti-superstition. In China, Western missionaries, diplomats and travellers labelled practices that resisted Western technologies and ideas as ‘superstitious’. This article examines how a group of Qing scholar-officials, all members of the diplomatic corps, interpreted and ultimately defended these customs. Conventionally viewed as tragic figures unable to transcend a ‘Sinocentric’ world view, they were deeply embedded in the global circulations of empire. During their time in Europe and the United States, they compared Western culture and the development of capitalism with the changes they saw in China. For these cosmopolitan actors, Chinese popular cultural practices offered potential sources of anti-imperial resistance to Western presence in China. Yet they also had differing, at times conflicting, visions for how the Chinese state should relate to the ‘superstitious’. Some argued that they needed to be kept in place, undisturbed from the onslaught of Western influence; others believed the ‘superstitious’ could be mobilized as an anti-imperial force.
Of Landlords and Tenants: Property in the Midst of a Pandemic
Authors: Ti Edward S W
Published: June 2021

This is an unprecedented Bill to deal with an unprecedented crisis. Over the coming months, every aspect of the way that we do things in Britain will come under strain. As in wartime, we will have to change the way that we do things, and when it is all over things will not revert to business as usual. Some things will have changed forever, and the way that we do business here will assuredly fall into that category. I am sure that everyone in your Lordships’ House wishes the Government well as they grapple with coronavirus. But democracies never give the Executive a blank cheque. As a Parliament, we must retain our critical faculties and, if we do so, it will help the Government and the country to get through this crisis together (Hansard HL Deb, vol 802, col 1659, 24 March 2020).
Simulation in PhD Programs to Prepare Nurse Scientists as Social Justice Advocates
Authors: Jenerette Coretta , Murillo Crystal L. , Chew Aaronson Y. , Barksdale Debra J.
Published: June 2021

Nursing students seeking a PhD often learn only conceptually about principles such as diversity and inclusion, social determinants of health, and interprofessional team science. With only a conceptual understanding of these important elements, future nurse scientists may not fully understand their role as advocates for social justice for vulnerable populations. Students’ real-life or hands-on experiences in these areas are often mentor dependent. Simulation in PhD Program is an innovative program to provide these experiences via various modalities, including authentic online activities and in-person experiences.
Examination of Early CNS Symptoms and Severe Coronavirus Disease 2019: A Multicenter Observational Case Series
Authors: Marra David E. , Busl Katharina M. , Robinson Christopher P. , Bruzzone Maria J. , Miller Amber H. , Chen Zhaoyi , Guo Yi , Lyu Tianchen , Bian Jiang , Smith Glenn E.
Published: June 2021

OBJECTIVES:

To determine if early CNS symptoms are associated with severe coronavirus disease 2019.

DESIGN:

A retrospective, observational case series study design.

SETTING:

Electronic health records were reviewed for patients from five healthcare systems across the state of Florida, United States.

Patients:

A clinical sample (n = 36,615) of patients with confirmed diagnosis of coronavirus disease 2019 were included. Twelve percent (n = 4,417) of the sample developed severe coronavirus disease 2019, defined as requiring critical care, mechanical ventilation, or diagnosis of acute respiratory distress syndrome, sepsis, or severe inflammatory response syndrome.

INTERVENTIONS:

None.

Measurement and Main Results:

We reviewed the electronic health record for diagnosis of early CNS symptoms (encephalopathy, headache, ageusia, anosmia, dizziness, acute cerebrovascular disease) between 14 days before the diagnosis of coronavirus disease 2019 and 8 days after the diagnosis of coronavirus disease 2019, or before the date of severe coronavirus disease 2019 diagnosis, whichever came first. Hierarchal logistic regression models were used to examine the odds of developing severe coronavirus disease 2019 based on diagnosis of early CNS symptoms. Severe coronavirus disease 2019 patients were significantly more likely to have early CNS symptoms (32.8%) compared with nonsevere patients (6.11%; χ2[1] = 3,266.08, p < 0.0001, φ = 0.29). After adjusting for demographic variables and pertinent comorbidities, early CNS symptoms were significantly associated with severe coronavirus disease 2019 (odds ratio = 3.21). Diagnosis of encephalopathy (odds ratio = 14.38) was associated with greater odds of severe coronavirus disease 2019; whereas diagnosis of anosmia (odds ratio = 0.45), ageusia (odds ratio = 0.46), and headache (odds ratio = 0.63) were associated with reduced odds of severe coronavirus disease 2019.

CONCLUSIONS:

Early CNS symptoms, and specifically encephalopathy, are differentially associated with risk of severe coronavirus disease 2019 and may serve as an early marker for differences in clinical disease course. Therapies for early coronavirus disease 2019 are scarce, and further identification of subgroups at risk may help to advance understanding of the severity trajectories and enable focused treatment.
Impact of Nonpharmaceutical Interventions on ICU Admissions During Lockdown for Coronavirus Disease 2019 in New Zealand—A Retrospective Cohort Study
Authors: Gonzenbach Tobias P. , McGuinness Shay P. , Parke Rachael L. , Merz Tobias M.
Published: June 2021

OBJECTIVES:

Nonpharmaceutical interventions are implemented internationally to mitigate the spread of severe acute respiratory syndrome coronavirus 2 with the aim to reduce coronavirus disease 2019–related deaths and to protect the health system, particularly intensive care facilities from being overwhelmed. The aim of this study is to describe the impact of nonpharmaceutical interventions on ICU admissions of non–coronavirus disease 2019–related patients.

DESIGN:

Retrospective cohort study.

SETTING:

Analysis of all reported adult patient admissions to New Zealand ICUs during Level 3 and Level 4 lockdown restrictions from March 23, to May 13, 2020, in comparison with equivalent periods from 5 previous years (2015–2019).

SUBJECTS:

Twelve-thousand one-hundred ninety-two ICU admissions during the time periods of interest were identified.

MEASUREMENTS:

Patient data were obtained from the Australian and New Zealand Intensive Care Society Adult Patient Database, Australian and New Zealand Intensive Care Society critical care resources registry, and Statistics New Zealand. Study variables included patient baseline characteristics and ICU resource use.

MAIN RESULTS:

Nonpharmaceutical interventions in New Zealand were associated with a 39.1% decrease in ICU admission rates (p < 0.0001). Both elective (–44.2%) and acute (–36.5%) ICU admissions were significantly reduced when compared with the average of the previous 5 years (both p < 0.0001). ICU occupancy decreased from a mean of 64.3% (2015–2019) to 39.8% in 2020. Case mix, ICU resource use per patient, and ICU and hospital mortality remained unchanged.

CONCLUSIONS:

The institution of nonpharmaceutical interventions was associated with a significant decrease in elective and acute ICU admissions and ICU resource use. These findings may help hospitals and health authorities planning for surge capacities and elective surgery management in future pandemics.
Race/ethnicity and advanced stage of renal cell carcinoma in adults: results from surveillance, epidemiology, and end results program 2007–2015
Authors: Dobyns Alyssa C. , Coutelle Nino A. , Suthumphong Corey Y. , Rodriguez Pura E. , Castro Grettel , Varella Marcia H.
Published: June 2021

Non-Hispanic Blacks were shown to have an earlier stage of renal cell carcinoma (RCC) at diagnosis compared to non-Hispanic Whites. It is less clear whether disparities in RCC staging occurs for other minority races/ethnicities. We aimed to assess the association between racial/ethnic minorities and stage at diagnosis of RCC, and test for potential effect modification by histological subtype. Sourced from the Surveillance, Epidemiology and End Results (SEER) database, patients ≥20 years diagnosed with RCC from 2007 to 2015 were included (n = 37 493). Logistic regression analyses were performed to assess the independent association between race/ethnicity [non-Hispanic White, non-Hispanic Black, non-Hispanic Asian Pacific Islander, non-Hispanic American Indian/Alaskan Native (AI/AN) and Hispanic] and advanced RCC stage at diagnosis (i.e. regional spread or distant metastasis). Interaction terms were tested and stratified regression was performed accordingly. Twenty-eight percent of patients had advanced RCC stage at diagnosis. After adjusting for age, gender, year of diagnosis, histological subtype and insurance status, compared to non-Hispanic Whites, non-Hispanic Blacks had lower odds of advanced stage at diagnosis [odds ratio (OR) = 0.79; 95% confidence interval (CI) = 0.72–0.87 for clear cell; OR = 0.48; CI = 0.30–0.78 for chromophobe and OR = 0.26; CI = 0.10–0.35 for other subtypes]. Higher odds of advanced stage at diagnosis were found for non-Hispanic AI/AN in clear cell (OR = 1.27; CI = 1.04–1.55) and for Hispanics in papillary subtypes (OR = 1.58; CI = 1.07–2.33). Racial disparities in the RCC stage at diagnosis varied according to histological subtype. Further investigation on the racial disparities reported is warranted to optimize detection and ultimately improve the prognosis of patients with RCC.
Quantifying the Digestion of Cross-Linked Hyaluronic Acid Fillers With Hyaluronidase
Authors: Ugradar Shoaib
Published: June 2021

BACKGROUND

Adverse events due to hyaluronic acid fillers (HAFs) may be treated with hyaluronidase, an enzyme that cleaves bonds within hyaluronic acid. This study reviews the efficacy of currently available hyaluronidase preparations in breaking down commercial, cross-linked HAFs.

METHODS

Three HAFs were used in this study (Restylane, Juvederm Voluma, and Belotero [BEL] Balance). A laser-based particle size analyzer (Malvern Mastersizer 3000) was used to calculate particle sizes in untreated HAFs (controls) and those treated with 450 units of hyaluronidase (Hylenex) for 5 and 30 minutes.

RESULTS

Particle size analysis revealed that when Restylane was treated with hyaluronidase for 5 minutes, the average particle size reduced modestly, from 472 to 440 μm. At 30 minutes, the average particle size was 419 μm. For Juvederm, the average size of particles reduced from 703 μm in controls to 676 μm after treatment with hyaluronidase for 5 minutes and 635 μm after treatment for 30 minutes. For Belotero, the average size of control particles was 410 μm, reducing to 376 μm after treatment with hyaluronidase for 5 minutes and 345 μm after treatment for 30 minutes.

CONCLUSION

After treatment with hyaluronidase for up to 30 minutes, there was only a modest breakdown of all 3 HAFs used. The results of this study raise questions regarding the efficacy of hyaluronidase in degrading cross-linked HAFs.
Spirituality in Nursing and Health
Authors: Lalani Nasreen , Chen Amity
Published: June 2021

This article aims to share the historical context of spirituality in nursing, meanings and expressions of spirituality, and different models of spirituality along with its significance in nursing education and practice. Several challenges and tools for the successful integration of spirituality in education and practice are also discussed.
Effects of Reiki on Mental Health Care
Authors: Morero Juceli Andrade Paiva , Pereira Sandra de Souza , Esteves Rafael Braga , Cardoso Lucilene
Published: June 2021

This systematic review aimed to identify the benefits of Reiki in mental health care. Eleven studies were included. Although the number of studies is limited, the results contribute to the potential beneficial role of Reiki in mental health care. Persistent studies using Reiki with broad samples, consistent randomized controlled trials, and patterned protocols are recommended.
Histopathological Characteristics of Limbal Stem Cell Deficiency Secondary to Chronic Vernal Keratoconjunctivitis
Authors: Donthineni Pragnya R. , Varma Shobhit , Kethiri Abhinav , Shanbhag Swapna , Mishra Dilip K. , Singh Vivek , Basu Sayan
Published: June 2021

Purpose:

To describe the histopathological characteristics of limbal stem cell deficiency (LSCD) due to chronic vernal keratoconjunctivitis (VKC).

Methods:

This retrospective study included 14 eyes of 13 patients who underwent simple limbal epithelial transplantation for total LSCD from 2017 to 2018. The histological characteristics of the excised fibrovascular pannus were compared between 2 groups of 7 eyes, each with LSCD due to VKC and chemical burns (CB). Histological characteristics and type of inflammation were studied using special stains and immunohistochemistry. Fisher exact test was used to detect the statistical significance of the histological differences between both groups.

Results:

Epithelial hypertrophy, epithelial downgrowth, and eosinophilic infiltration were noted in all eyes in the VKC group (7/7, 100%). Epithelial hypertrophy was noted in 3 of the 7 (42.8%) eyes in the CB group, whereas epithelial downgrowth and eosinophilic infiltrates were absent. The average chronic inflammatory score of the pannus (5.28) was higher in VKC than in CB (3.85; P = 0.1080). The presence of goblet cells was higher in the CB group (5/7, 1.4%) than in the VKC group (3/4, 2.8%), although not statistically significant. Other histological differences between the groups were not statistically significant.

Conclusions:

The histopathological features of LSCD in VKC reveal some distinctive characteristics. These include the presence of epithelial downgrowth, eosinophilic infiltration, and epithelial solid and cystic implants. Although this information may be used to establish the diagnostic criteria for VKC as the cause of LSCD, further studies are needed to elucidate the reasons behind these unique findings.
Descemet Membrane Endothelial Keratoplasty for Corneal Edema and Visually Significant Descemet Membrane Scrolls Due to Syphilitic Keratitis
Authors: Dzhaber Daliya , Shah Amar P. , Dubovy Sander , Patel Umangi , Koo Ellen H.
Published: June 2021

The presence of Descemet membrane scrolls is an uncommon finding reported in syphilitic interstitial keratitis. We herein describe a novel surgical strategy for this entity; this report demonstrates that Descemet membrane endothelial keratoplasty surgery can be performed with excellent visual outcomes in the event of corneal edema as a late sequela of syphilitic keratitis.
Control of an Intermittent Outbreak Caused by an Emerging Pandrug-Resistant Acinetobacter baumannii Clone ST457 in a Tertiary Hospital
Authors: Zhang Chuqiu , Xu Tingting , Ji Yang , Zheng Wenping , Wu Jingsong , Lu Yuemei , Li Huiping , Chen Rongchang , Qiu Chen , Zhou Kai
Published: June 2021

Acinetobacter baumannii is a frequent cause of nosocomial infections. Here we report an intermittent outbreak caused by the emerging carbapenem-resistant A. baumannii (CRAB) clone ST457 and assess the effectiveness of patient screening for outbreak control. CRAB isolates were collected from 74 patients admitted to the respiratory intensive care unit of a tertiary hospital between May 2018 and March 2019. Fourteen CRAB isolates were assigned to ST457, and 13 belonged to an outbreak clone, as determined by phylogenomic analysis. Strict patient screening was started at the respiratory intensive care unit on May 2019, through which a ST457-positive patient transferred from the intensive care unit was detected. No positive patients were detected within 3 months onwards. The results of this study highlight the importance of rigorous infection prevention and control measures, combined with patient screening, in controlling the CRAB outbreak.
Clinical factors and comorbidities affecting health-related quality of life in postrenal transplant patients
Authors: Adeeb Humera , Ullah Ihsan , Zeb Mubarak , Haq Mazharul
Published: June 2021

Background:

Health-related quality of life is different among different transplant cohorts with respect to different variables which predict mortality and graft survival. The aim of this study was to identify the effects of clinical factors on the health-related quality of life in postrenal transplant patients.

Methods:

This census study was conducted at the Institute of Kidney Diseases Peshawar, Pakistan. Data were collected on a questionnaire “ Kidney Diseases Quality of Life-Short Form-1.3 Urdu version” and were analyzed in the 3 main domains, for example, physical component summary (PCS), mental component summary, and kidney disease component summary using SPSS version 21. Mean scores for patients with diabetes mellitus (DM), hypertension, levels of hemoglobin, and serum creatinine were compared by unpaired t-test.

Results:

A total of 277 men (87.9%) and 38 (12.1%) women participated in the study. Mean age was 37.26 (±10.14) years (range 18–65 years). Hypertension was reported in 72.2% and DM in 10.8%. Hemoglobin was <12.5g% in 26.0% patients. Patients with DM had significant lower PCS (P = .001) and mental component summary (MCS; P = .001) scores. Patients with hypertension had significant lower MCS score (P = .01). Patients with hemoglobin <12.5g% had significantly lower PCS (P = .001) score than those with hemoglobin >12.5 g%. The PCS score in patients with serum creatinine level >2 mg% was significantly lower (P = .02) than those with serum creatinine <2 mg%.

Conclusion:

Lower graft function and DM were associated with lower PCS and MCS scores. Hypertension was associated with lower MCS score and anemia with lower PCS score.
Personality types of patients with glaucoma
Authors: Tan Zhenyan , Tung Tao-Hsin , Xu Shi-Qing , Chen Pei-En , Chien Ching-Wen , Jiang Bo
Published: June 2021

Objectives:

To synthesize recent empirical research on the association between personality and glaucoma among this sub-population.

Methods:

PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus and ScienceDirect databases were searched to identify eligible studies published between January 1950 and March 2019 in any language. The quality of included observational studies was assessed using an 11-item checklist which was recommended by Agency for Healthcare Research and Quality (AHRQ). After using the checklist, 12 papers are included into the systematic review.

Results:

There are some differences on the studies about the negative personality of glaucoma patients. In spite of these differences, most included studies significantly showed that glaucoma patients tend to or do have some specific personality.

Conclusion:

The extant research could demonstrate that glaucoma patients tend to have some negative personality in some extent. Future studies are needed to provide more convincing support to personality of glaucoma patients.
Shortened leukocyte telomere length as a potential biomarker for predicting the progression of atrial fibrillation from paroxysm to persistence in the short-term
Authors: Wang Siyu , Gao Yuanfeng , Zhao Lei , Hu Roumu , Yang Xinchun , Liu Ye
Published: June 2021

This study aimed to assess the role of leukocyte telomere length (LTL) in the development of atrial fibrillation (AF) among Chinese patients.

This is a cross-sectional study. A total of 350 patients from June 2016 to December 2017 were retrospectively analyzed. These included 219 AF patients and 131 with sinus rhythm in the control group. Quantitative real-time PCR was used to measure relative LTL.

The relative LTLs of all subjects (n = 350) ranged from 0.4 to 2.41 (0.98 ± 0.29), showing a significant negative correlation (P < .001) with age. The AF-group had significantly shorter LTLs (0.93 ± 0.26 vs 1.07 ± 0.33, P < .001) and were older (61.50 ± 6.49 vs 59.95 ± 6.17, P = .028) than controls. LTLs among patients with persistent AF (PsAF), paroxysmal AF (PAF), and controls were significantly different (P < .001), with LTLs of PsAF patients being the shortest and controls being the longest. After adjusting for possible confounding factors, the PsAF group still showed significantly shorter LTLs than the PAF and control groups (P = .013 and P = .001, respectively). After an 18-month follow-up, 20 out of 119 PAF patients had progressed into PsAF and a relative LTL of ≤0.73 was an independent predictor for progression of PAF into PsAF.

LTL was found to be shorter in patients with AF than in age-matched individuals with sinus rhythm and positively correlated with severity of AF. LTL shortening could be an independent risk factor for progression from paroxysmal AF to persistent AF in the short term.
Association between the peripheral blood eosinophil counts and COVID-19
Authors: Huang Rong , Xie Liangcai , He Junpeng , Dong Hong , Liu Tianchun
Published: June 2021

Background:

The conclusions about the relationship between eosinophil counts and the severity of coronavirus disease 2019 (COVID-19) were controversial, so we updated the evidences and reassessed it.

Methods:

We searched the PubMed, Cochrane library, Excerpta Medica Database, and Web of Science to compare the eosinophil counts about non-severe disease group (mild pneumonia, moderate pneumonia, non-critical disease and recovery group) and severe disease group (severe pneumonia, critical pneumonia, critical disease and death group) in COVID-19.

Results:

A total of 1228 patients from 10 studies were included. Compared with non-severe group, severe group had strikingly lower average eosinophil counts (SMD 0.65, 95% confidence intervals [CI] 0.29–1.01; P < .001). The result of subgroup analysis of different countries showed SMD 0.66, 95% CI 0.26–1.06; P < .001. Another subgroup analysis between mild-moderate pneumonia versus severe-critical pneumonia showed SMD 0.69, 95% CI 0.25–1.13; P < .001, and no significant risk of publication bias (Begg test 0.063 and Egger test 0.057) in this subgroup. The heterogeneity was substantial, but the sensitivity analyses showed no significant change when individual study was excluded, which suggested the crediblity and stablity of our results.

Conclusions:

The eosinophil counts had important value as an indicator of severity in patients with COVID-19.

PROSPERO registration number:

CRD42020205497.
Laser-induced choroidal neovascularization
Authors: Li Caixin , Li Jianqing , Chen Xinzhu , Lu Peirong
Published: June 2021

Rationale:

Laser induced maculopathy includes retinal photoreceptor disruption, macular hole, macular hemorrhage, and rarely choroidal neovascularization (CNV). Here we report a case of laser induced CNV that was treated by intravitreal anti-vascular endothelial growth factor (VEGF) injection and resulted in visual improvement and CNV resolution during 1-year follow up. In addition, the case of laser induced CNV treated with intravitreal anti-VEGF injections are reviewed for the first time in literature.

Patient concerns:

A 7-year-old boy presented to our department with blurred vision in his right eye for 2 months. The symptom immediately happened after the boy staring at the laser beam for a few seconds. Examination of ocular fundus with slit lamp showed yellowish lesion in macula in his right eye.

Diagnoses:

CNV was confirmed by fundus examinations, including color fundus photograph, spectral domain optical coherence tomography, fluorescein angiography, and spectral domain optical coherence tomography angiography.

Interventions:

After the diagnosis of laser induced CNV, intravitreal ranibizumab (LUCENTIS, NOVARTIS) injection was performed.

Outcomes:

After 1 injection of intravitreal ranibizumab, the best corrected visual acuity improved from 20/50 to 30/50 and CNV gradually regressed during 1-year follow up.

Lessons:

For young patients with laser induced CNV, intravitreal anti-VEGF injections may be helpful in visual improvement and CNV regression. Moreover, age seems to be a significant factor thus we propose that old animals may be more appropriate for laser induced CNV animal models of age-related macular degeneration.
Meningioma preceding CASPR2 antibody limbic encephalitis with a stroke mimic
Authors: Lu Xiao-Jin , Li Ran , Chen Yong-Xing , Xu Xian-Kai , Shi Bao-Lin
Published: June 2021

Rationale:

Todd paralysis (a stroke-like presentation in some patients with epilepsy) caused by limbic encephalitis (LE) is not easily distinguished from acute ischemic stroke by clinicians in the emergency room.

Patient concerns:

We report a contactin-associated protein-like 2-antibody (CASPR2-Ab)-positive patient who presented with atypical LE.

Diagnoses:

CASPR2-Ab-positive LE was the presumed diagnosis. Re-evaluation of cerebrospinal fluid (CSF) samples revealed autoantibodies targeting CASPR2 at an immunoglobulin G titer of 1:1. The clinical presentation of subacute onset seizures, abnormal electroencephalography, hypermetabolism on positron emission tomography, good immunotherapy response, and the presence of specific antibodies in serum supports a diagnosis of autoimmune LE.

Intervention:

The patient received glucocorticoids (1 g for 3 days and 500 mg for 3 days), immunoglobulin (25 g for 3 days), sodium valproate (1 g for 3 days), and clonazepam (1 mg for 3 days).

Outcomes:

Remission of temporal lobe epilepsy symptoms and cognitive dysfunction was observed. Follow-up analysis of CSF and serological examination were not approved by the patient. His Mini-Mental State Examination score improved to 21/30. Stable remission of symptoms was achieved throughout the follow-up period of 50 days.

Lessons:

Autoimmune encephalitis (AE) should be considered in cases of late-onset epilepsy following meningioma peritumoral brain edema and resection. A diagnosis of AE should be considered in patients presenting with stroke-like symptoms if the magnetic resonance imaging abnormality does not match a known vascular territory. Early and correct diagnosis is crucial because immunotherapy is usually effective for this disease.
Predicting ventilator-associated pneumonia with machine learning
Authors: Giang Christine , Calvert Jacob , Rahmani Keyvan , Barnes Gina , Siefkas Anna , Green-Saxena Abigail , Hoffman Jana , Mao Qingqing , Das Ritankar
Published: June 2021

Ventilator-associated pneumonia (VAP) is the most common and fatal nosocomial infection in intensive care units (ICUs). Existing methods for identifying VAP display low accuracy, and their use may delay antimicrobial therapy. VAP diagnostics derived from machine learning (ML) methods that utilize electronic health record (EHR) data have not yet been explored. The objective of this study is to compare the performance of a variety of ML models trained to predict whether VAP will be diagnosed during the patient stay.

A retrospective study examined data from 6126 adult ICU encounters lasting at least 48 hours following the initiation of mechanical ventilation. The gold standard was the presence of a diagnostic code for VAP. Five different ML models were trained to predict VAP 48 hours after initiation of mechanical ventilation. Model performance was evaluated with regard to the area under the receiver operating characteristic (AUROC) curve on a 20% hold-out test set. Feature importance was measured in terms of Shapley values.

The highest performing model achieved an AUROC value of 0.854. The most important features for the best-performing model were the length of time on mechanical ventilation, the presence of antibiotics, sputum test frequency, and the most recent Glasgow Coma Scale assessment.

Supervised ML using patient EHR data is promising for VAP diagnosis and warrants further validation. This tool has the potential to aid the timely diagnosis of VAP.
Abnormal singing can identify patients with right hemisphere cortical strokes at risk for impaired prosody
Authors: Lin Rebecca Z. , Marsh Elisabeth B.
Published: June 2021

Despite lacking aphasia seen with left hemisphere (LH) infarcts involving the middle cerebral artery territory, right hemisphere (RH) strokes can result in significant difficulties in affective prosody. These impairments may be more difficult to identify but lead to significant communication problems.

We determine if evaluation of singing can accurately identify stroke patients with cortical RH infarcts at risk for prosodic impairment who may benefit from rehabilitation.

A prospective cohort of 36 patients evaluated with acute ischemic stroke was recruited. Participants underwent an experimental battery evaluating their singing, prosody comprehension, and prosody production. Singing samples were rated by 2 independent reviewers as subjectively “normal” or “abnormal,” and analyzed for properties of the fundamental frequency. Relationships between infarct location, singing, and prosody performance were evaluated using t tests and chi-squared analysis.

Eighty percent of participants with LH cortical strokes were unable to successfully complete any of the tasks due to severe aphasia. For the remainder, singing ratings corresponded to stroke location for 68% of patients. RH cortical strokes demonstrated a lower mean fundamental frequency while singing than those with subcortical infarcts (176.8 vs 130.4, P = 0.02). They also made more errors on tasks of prosody comprehension (28.6 vs 16.0, P < 0.001) and production (40.4 vs 18.4, P < 0.001).

Patients with RH cortical infarcts are more likely to exhibit impaired prosody comprehension and production and demonstrate the poor variation of tone when singing compared to patients with subcortical infarcts. A simple singing screen is able to successfully identify patients with cortical lesions and potential prosodic deficits.
Leukocyte kinetics during the early stage acts as a prognostic marker in patients with septic shock in intensive care unit
Authors: Li Qing , Xie Jianfeng , Huang Yingzi , Liu Songqiao , Guo Fengmei , Liu Ling , Yang Yi
Published: June 2021

The leukocytes play an important role in immune function during sepsis. We performed a retrospective study to investigate if leukocytes kinetics was associated with survival in critically ill patients with septic shock in intensive care unit (ICU).

Patients with septic shock from January 1, 2014 to June 30, 2018 in our ICU were included. We extracted the demographic, clinical and laboratory data, comorbidities from our clinical database. The number of white blood cell, neutrophil and lymphocyte on day 1 and day 3 after diagnosis were collected and neutrophil to lymphocyte ratios (NLR) were calculated. Our primary outcome was 28-day mortality. Univariate and multivariate logistic regression models and cox proportional risk model were used to analyze the association between the leukocytes kinetics during first 3 days after ICU admission and the day-28 mortality.

A total of 1245 septic shock patients with a 28-day mortality of 35.02% were included into analysis. There were no significant difference of lymphocyte number (0.83 ± 0.02 vs 0.80 ± 0.04, P = .552) between survival and non-survivals on day 1. However, the lymphocyte counts was significantly lower (0.95 ± 0.03 vs 0.85 ± 0.04, P = .024) on the third day. Both multivariate logistic and Cox regression analysis showed that lymphocyte counts on day 3 were associated with day-28 mortality. Moreover, Kaplan–Meier survival analysis revealed that increasing in lymphocyte counts and decreasing WBC, neutrophils and NLR during the first 3 days after diagnosis were associated with longer survival.

Leukocytes kinetics during the first 3 days is a valuable prognostic marker in patients with septic shock in the ICU.
Safety and efficacy of cold snare polypectomy for small colorectal polyps
Authors: Ito Takahiro , Takahashi Keitaro , Tanabe Hiroki , Sato Keisuke , Goto Mitsuru , Sato Tomonobu , Tanaka Kazuyuki , Utsumi Tatsuya , Fujinaga Akihiro , Kawamoto Toru , Yanagawa Nobuyuki , Moriichi Kentaro , Fujiya Mikihiro , Okumura Toshikatsu
Published: June 2021

Trial design:

Elimination of small colorectal polyps with cold snare polypectomy (CSP) is reported to be as safe as hot snare polypectomy (HSP). The effectiveness of CSP has not been clearly defined, and the incidence of long-term recurrence has not been determined. We conducted a randomized control study and one-year follow-up study to assess their safety and efficacy.

Methods:

Patients with small colorectal polyps were randomized to receive CSP or HSP. Polypectomy was performed to determine the pathological curability, and patients completed a questionnaire about the tolerability of the procedure. Follow-up colonoscopy was performed to determine the local recurrence of adenoma. The major outcome was the non-inferiority of CSP to HSP in the rate of delayed bleeding and minor outcomes, including the incidence of immediate bleeding and perforation, procedural time, and the resection rate.

Results:

A total of 119 participants were recruited in this randomized study and underwent polypectomy. Among the 458 polyps, 332 eligible polyps were analyzed. The rate of adverse events was 0.6% (1/175) for CSP and 0% (0/157) for HSP, which showed the non-inferiority of CSP. While the complete resection rate of CSP was very high (100%), the R0 rate was not satisfactory (horizontal margin, 65.5%; vertical margin, 89.1%). Two local recurrences (2.5%) were observed in the follow-up of 80 adenomas treated with CSP. No recurrence was found in 79 lesions in the HSP group, which was not significant (P = .06).

Conclusions:

Colorectal polyps were safely resected using CSP, similar to HSP. Most would agree to say that CSP is considered safer than HSP. The main question is then related to efficacy. Our results of the present study demonstrate that recurrence after CSP should be carefully managed for curative treatment.
Acupuncture treatment for emotional problems in infertile women
Authors: Hwang Su-In , Sung Soo-Hyun , Yoon Young-Jin , Park Jang-Kyung
Published: June 2021

Background:

Infertility causes emotional and psychological problems, including anxiety, depression, low self-efficacy, and chronic mental stress in women. These emotional problems can negatively affect fertility treatment. Numerous studies have reported the clinical therapeutic effects of acupuncture on emotional problems; however, the efficacy and safety of acupuncture treatment for emotional problems in infertile women remain unclear. This protocol aims to evaluate the efficacy and safety of acupuncture for treating emotional problems in infertile women.

Methods:

We will search the following databases from their inception to April 30, 2021: MEDLINE, EMBASE, Cochrane Library, Korean Medical Databases (KoreaMed, Korean studies Information Service System, Korean Traditional Knowledge Portal, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, and National Digital Science Library), and Chinese databases (CNKI and Wan Fang Database). We will include randomized controlled trials on acupuncture for emotional problems in infertile women. There will be no restrictions regarding language or publication date. The primary outcome will be assessed using an emotion-related assessment scale. The risk of bias of the included studies will be measured using the Cochrane risk of bias assessment tool. For meta-analysis, RevMan Version 5.4 software will be used to combine the relative risks for dichotomous outcomes, as well as the mean differences or standardized mean differences for continuous outcomes, with both having 95% confidence intervals.

Results:

Based on current evidence, this study will assess the effectiveness and safety of acupuncture for emotional problems in infertile women.

Conclusion:

This study will provide evidence for evaluating the acupuncture efficacy for infertile women with emotional problems.

Registration number:

INPLASY202150082.
Ovarian dysgerminoma with pseudo-Meigs syndrome
Authors: Li Xuebo , Chen Deqing , Jin Xiuhui , Xu Guangtao , Hu Bo , Zeng Xiansi , Jin Xin
Published: June 2021

Rationale:

Dysgerminoma is a rare malignant tumor of the ovary, more frequently occurring in young women. The main signs of pseudo-Meigs syndrome (PMS) are ascites and hydrothorax accompanying benign or malignant ovarian tumors (no fibroma or fibroma-like tumor).

Patient concerns:

A 19-year-old woman with fever and chest tightness for 2 days.

Diagnoses:

Pectoral-abdominal computed tomography (CT) scan and contrast-enhanced magnetic resonance imaging revealed a large amount of right pleural effusion, a small amount of ascites, and a huge abdominopelvic mass measuring about 29.2cm × 11.8cm × 8.4 cm in the left ovary. The result of hydrothorax examination was consistent with the diagnosis of exudative pleural effusion. In addition, Rivalta-test showed a positive result and lactate dehydrogenase was elevated. The histopathological diagnosis was a giant germ cell tumor, which was consistent with dysgerminoma in terms of both morphology and immunophenotype. Based on these findings, a diagnosis of malignant ovarian neoplasm with PMS was made.

Interventions:

Surgical resection of the tumor was performed.

Outcomes:

The patient recovered well after operation, and the pleural effusion and abdominal ascites vanished. No recurrence was observed during the 1-year follow-up period.

Lessons:

Ovarian dysgerminoma with PMS is a rare malignant tumor of the ovary, which often occurs in young women. It should be considered in differential diagnosis of patients with a pelvic mass, ascites and pleural effusion. Early diagnosis and surgical treatment are beneficial to prolonged survival.
Association of posturography with clinical measures in balance rehabilitation of ataxic patients
Authors: Onursal Kilinç Özge , Ayvat Ender , Ayvat Fatma , Kilinç Muhammed
Published: June 2021

The assessment of balance includes posturography measures and clinical balance tests in individuals with ataxia. Although both advantages and disadvantages of these assessments have been stated, no relationship between them in individuals with ataxia has been shown in the literature. The aim of this cross-sectional study was to investigate the relationships between commonly used clinical balance tests and posturography measures in ataxic individuals. The study included a total of 42 patients (mean age: 33.90 ± 8.75 years) with different diagnoses causing ataxia. The sensory organization test (SOT), limits of stability (LOS), unilateral stance and rhythmic weight shift (RWS) tests in computerized dynamic posturography and the clinical balance tests of Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS) and timed up and go (TUG) test were used to assess balance. The Spearman correlation test was used to evaluate the relationships between the clinical balance tests and posturography variables. Moderate and strong correlations were found between the ICARS, BBS and TUG scores and Unilateral Stance sway velocity, directional control parameter of RWS and LOS (P < 0.01–0.05). The ICARS and BBS scores were correlated with the SOT-Composite Equilibrium Score (P < 0.01–0.05). The results of this study suggest the use of both posturography and clinical balance tests in the rehabilitation of ataxic individuals with mild-moderate balance impairment, because posturography variables determine the underlying cause of imbalance and clinical tests evaluate balance in functional activities.
High-grade Papillary Early Gastric Carcinoma With High Risk for Lymph Node Metastasis and Poor Prognosis
Authors: Cheng Yuqing , Du Mingzhan , Zhou Xiaoli , Guo Lingchuan , Xu Kequn , Huang Jin , Huang Qin
Published: June 2021

Papillary early gastric carcinoma (EGC) is believed to have a low risk of lymph node metastasis (LNM) and thus can be resected endoscopically. We observed anecdotally that some papillary EGC tumors showed conspicuous high-grade dysplastic features, but the significance of these observations is unknown. In this bicenter study we investigated papillary EGCs that were divided into high-grade (n=96) and low-grade (n=118) groups among 1136 consecutive EGC radical resection cases. Concurrent 464 well-moderately differentiated tubular EGCs were served as the control group. Compared with low-grade papillary and well-moderately differentiated tubular EGCs, high-grade papillary EGC displayed significantly larger sizes (mean 2.51 cm), higher frequencies of the elevated macroscopic type (51%), lymphovascular invasion (LVI) (38.5%), and LNM (31.2%). Low-grade papillary EGCs exhibited a higher prevalence of the elevated macroscopic type, but not LVI nor LNM, compared with tubular EGC. Independent risk factors for LNM included high-grade histology, female sex, distal location, submucosal invasion, and LVI. The 5-year overall survival rate was significantly lower in high-grade (79.6%) papillary than in low-grade (88.9%) papillary or tubular (92.8%) EGCs, while no significant difference in prognosis was observed in the latter 2 groups. Age of 66 years or older and LNM were independent risk factors for overall survival. In conclusions, high-grade papillary EGC was associated with high frequencies of LVI, LNM, and poor prognosis, and thus unsuitable for endoscopic therapy, while low-grade papillary EGC showed clinicopathologic features and prognosis similar to well-moderately differentiated tubular EGC and may be treated endoscopically in appropriate clinical settings.