bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population
Authors: Miller Lauren E. , Buzi Adva , Williams Ashley , Rogers Rachel S. , Ortiz Angel G. , Jones-Ho Kellye O. , Elden Lisa M.
Published: April 2020

Introduction:

Telemedicine is an increasingly prevalent component of medical practice. In otolaryngology, there is the potential for telemedicine services to be performed in conjunction with device use, such as with a nasolaryngoscope. This study evaluates the reliability of remote examinations of the upper airway through an iPhone recording using a coupling device attached to a nasopharyngolaryngoscope (NPL).

Methods:

A prospective, blinded study was performed for pediatric patients requiring an NPL during an office visit. The NPL was performed using a coupling device attached to a smartphone to record the examination. A second, remote otolaryngologist then evaluated the recorded examination. Both otolaryngologists evaluated findings of anatomic sites including nasopharynx, oropharynx, base of tongue, larynx including subsites of epiglottis, arytenoids, aryepiglottic folds, false vocal cords, true vocal cords, patency of airway, and diagnostic impression, all of which were documented through a survey. Results of the survey were evaluated through inter-rater agreement using the κ statistic.

Results:

Forty-five patients underwent an NPL, all of which were included in the study. The average age was 4.9 years. The most common complaint requiring NPL was noisy breathing (n = 16). The inter-rater agreement for overall diagnosis was 0.74 with 80% percent agreement, rated as “good.” Other anatomic subsites with “good” or better inter-rater agreement were nasopharynx (0.75), oropharynx (0.75), and true vocal cords (0.71), with strong percentage agreement of 89%, 91%, and 87%, respectively. Both users of the adaptor found the recording setup to run smoothly.

Conclusion:

A telemedicine device for NPL use demonstrates strong diagnostic accuracy across providers and good overall evaluation. It holds potential for use in remote settings.
Clinical Presentation of COVID-19: A Systematic Review Focusing on Upper Airway Symptoms
Authors: Lovato Andrea , de Filippis Cosimo
Published: April 2020

Aim:

Pharyngodynia, nasal congestion, rhinorrhea, smell, and taste dysfunctions could be the presenting symptoms of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. The aim was to perform a systematic review of current evidences on clinical presentation of COVID-19, focusing on upper airway symptoms in order to help otolaryngologists identifying suspected cases.

Methods:

We searched PubMed and Web of Science electronic databases.

Results:

We included 5 retrospective clinical studies for a total of 1556 hospitalized patients with COVID-19, 57.5% were male and mean age was 49.1 years. Pooled data revealed that pharyngodynia was present in 12.4% of patients, nasal congestion in 3.7%, and rhinorrhea was rare. No reports on COVID-19 and olfactory/gustative disorders matched inclusion criteria but preliminary evidences suggested they could be present. Common symptoms were fever (85.6%), cough (68.7%), and fatigue (39.4%). Frequent comorbidities were hypertension (17.4%), diabetes (3.8%), and coronary heart disease (3.8%); 83% of patients had alterations on chest computed tomography that were bilateral in 89.5% of cases. Ground-glass opacity was the most common finding (50%). Lymphopenia (77.2%) and leucopenia (30.1%) were common. Critical cases with complications were 9%, intensive care unit admission was required in 7.3%, invasive ventilation in 3.4%, and mortality was 2.4%.

Conclusion:

Otolaryngologists should know that pharyngodynia, nasal congestion, olfactory, and gustative disorders could be the presenting symptoms of COVID-19. Clinical presentation together with radiological and laboratory findings could help to identify suspected cases.
Multicenter Advanced Pediatric Otolaryngology Fellowship Prep Surgical Simulation Course with 3D Printed High‐Fidelity Models
Authors: Chang Brian , Powell Allison , Ellsperman Susan , Wehrmann Daniel , Landry April , Jabbour Noel , Goudy Steven , Zopf David
Published: April 2020

Objective

To assess the effect of 3‐dimensional (3D)–printed surgical simulators used in an advanced pediatric otolaryngology fellowship preparatory course on trainee education.

Study Design

Quasi‐experimental pre/postsurvey.

Setting

Multicenter collaborative course conducted at a contract research organization prior to a national conference.

Subjects and Methods

A 5‐station, 7‐simulator prep course was piloted for 9 pediatric otolaryngology fellows and 17 otolaryngology senior residents, with simulators for airway graft carving, microtia ear framework carving, and cleft lip/palate repair. Prior to the course, trainees were provided educational materials electronically along with presurveys rating confidence, expertise, and attitude around surgical simulators. In October 2018, surgeons engaged in simulation stations with direction from 2 attending faculty per station, then completed postsurveys for each simulator.

Results

Statistically significant increases (P <. 05) in self‐reported confidence (average, 53%; range, 18%‐80%) and expertise (average, 68%; range, 9%‐95%) were seen across all simulators, corresponding to medium to large effect sizes as measured by Cohen’s d statistic (0.41‐1.71). Positive attitudes around 3D printing in surgical education also demonstrated statistically significant increases (average, 10%; range, 8%‐13%). Trainees commented positively on gaining such broad exposure, although consistently indicated a preference for more practice time during the course.

Conclusion

We demonstrate the benefit of high‐fidelity, 3D‐printed simulators in exposing trainees to advanced procedures, allowing them hands‐on practice in a zero‐risk environment. In the future, we hope to refine this course design, develop standardized tools to assess their educational value, and explore opportunities for integration into use in milestone assessment and accreditation.
Trends in Ambulatory Surgery Center Utilization for Otolaryngologic Procedures among Medicare Beneficiaries, 2010‐2017
Authors: Kondamuri Neil S. , Miller Ashley L. , Rathi Vinay K. , Miller Lauren , Bergmark Regan W. , Patel Tushar S. , Gray Stacey T.
Published: April 2020

Objective

Surgical care is increasingly shifting to freestanding ambulatory surgical centers (ASCs). The extent to which otolaryngologists use ASCs has implications for patient safety and health care spending. This study characterizes trends in utilization and resultant financial implications for common otolaryngologic procedures performed at ASC and hospital outpatient departments (HOPDs).

Study Design

Retrospective cross‐sectional analysis.

Setting

ASCs, HOPDs.

Subjects and Methods

Subjects included Medicare beneficiaries undergoing outpatient otolaryngologic procedures between 2010 and 2017. Procedures included the 20 highest‐volume procedures performed by otolaryngologists at ASCs in 2017. Main outcomes included absolute and relative percentage difference in the proportion of procedures furnished at ASCs and HOPDs and estimated Medicare cost savings resulting from increased ASC utilization between 2011 and 2017.

Results

The proportion of outpatient otolaryngologic procedures performed at ASCs increased by 1.8% (relative difference: 10.0%; mean annual relative increase: 1.60%), and the proportion located at HOPDs decreased by 6.0% (relative difference: –11.8%; mean annual relative decrease: –1.6%) between 2010 and 2017. Rhinoplasty accounted for the largest absolute increase in ASC utilization over the study period (absolute [relative] 8.9% [33.5%]). Increased ASC utilization resulted in an estimated $7.1 million in cost savings to Medicare between 2011 and 2017.

Conclusion

Otolaryngologists shifted outpatient surgical care from HOPDs to ASCs between 2010 and 2017, with resultant reductions in Medicare expenditures. Further research is necessary to examine the impact of this shift on patient safety.
Comparing Kadish and Modified Dulguerov Staging Systems for Olfactory Neuroblastoma: An Individual Participant Data Meta‐analysis
Authors: Arnold Mark A. , Farnoosh Soroush , Gore Mitchell R.
Published: April 2020

Objective

To compare the Kadish and the modified Dulguerov staging of individual participants to determine the impact of stage and other prognostic factors on disease‐free (DFS) and overall survival (OS).

Data Sources

Systematic review of EMBASE, MEDLINE, Cochrane Library, and CINAHL databases.

Review Methods

The Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) was followed for this study. Articles including patients with olfactory neuroblastoma (ONB) staged with both Kadish and Dulguerov staging systems were reviewed. The raw data from eligible studies were requested to perform an individual participant data (IPD) meta‐analysis.

Results

Pooled data from 21 studies representing 399 patients with ONB undergoing treatment with curative intent showed that increasing age, treatment with chemotherapy, and positive or unreported margin status portended worse DFS (P <. 05). Increasing stage for both Kadish and Dulguerov staging systems was prognostic for worse DFS and OS (P <. 05), with Kadish C representing a heterogeneous group with regard to outcome and corresponding Dulguerov T stage. Using the Akaike information criterion, the Dulguerov staging system had superior performance to the Kadish system for DFS (1088.72 vs 1092.54) and OS (632.71 vs 644.23).

Conclusion

This study represents the first IPD meta‐analysis of ONB directly comparing the outcomes of Kadish and Dulguerov staging systems in patients treated with primary surgery. Both systems correlated with DFS and OS, with superior performance in the Dulguerov system. Furthermore, the Kadish C group represented a heterogeneous group with regard to outcomes after stratification by the Dulguerov system. Dulguerov T4 patients had the worst outcome, with most being approached with open resection.
Epidemiology of Pediatric Tympanostomy Tube Placement in the United States
Authors: Bhattacharyya Neil , Shay Sophie G.
Published: April 2020

The prevalence of pediatric tympanostomy tube placement (TTP) in the United States has not been reassessed in the past decade. To assess the prevalence of TTP and frequent ear infections (FEI), the National Health Interview Survey for the calendar year 2014 was used. Among 73.1 million children, 6.26 million (8.6%) had TTP. The incidence of FEI was 3.49 million (4.8%). Males (9.6%) were more likely than females (7.5%) to undergo TTP (P =. 004). Among children under 2 years of age, 9.1% reported FEI, compared to 3.9% of children aged 3 to 17 years. Among children under 2 years of age, 25% with FEI received TTP vs 1.5% without FEI (P <. 001). Among children aged 3 to 17 years, 31.1% with FEI received TTP vs 8.6% without FEI (P <. 001). TTP may be increasing nationally, although further assessment of adherence to clinical practice guidelines is needed to investigate this potential trend.
Astrocytic Modulation of Neuronal Activity in the Suprachiasmatic Nucleus: Insights from Mathematical Modeling
Authors: Sueviriyapan Natthapong , Tso Chak Foon , Herzog Erik D. , Henson Michael A.
Published: April 2020

The suprachiasmatic nucleus (SCN) of the hypothalamus consists of a highly heterogeneous neuronal population networked together to allow precise and robust circadian timekeeping in mammals. While the critical importance of SCN neurons in regulating circadian rhythms has been extensively studied, the roles of SCN astrocytes in circadian system function are not well understood. Recent experiments have demonstrated that SCN astrocytes are circadian oscillators with the same functional clock genes as SCN neurons. Astrocytes generate rhythmic outputs that are thought to modulate neuronal activity through pre- and postsynaptic interactions. In this study, we developed an in silico multicellular model of the SCN clock to investigate the impact of astrocytes in modulating neuronal activity and affecting key clock properties such as circadian rhythmicity, period, and synchronization. The model predicted that astrocytes could alter the rhythmic activity of neurons via bidirectional interactions at tripartite synapses. Specifically, astrocyte-regulated extracellular glutamate was predicted to increase neuropeptide signaling from neurons. Consistent with experimental results, we found that astrocytes could increase the circadian period and enhance neural synchronization according to their endogenous circadian period. The impact of astrocytic modulation of circadian rhythm amplitude, period, and synchronization was predicted to be strongest when astrocytes had periods between 0 and 2 h longer than neurons. Increasing the number of neurons coupled to the astrocyte also increased its impact on period modulation and synchrony. These computational results suggest that signals that modulate astrocytic rhythms or signaling (e.g., as a function of season, age, or treatment) could cause disruptions in circadian rhythm or serve as putative therapeutic targets.
Building a Medical Undergraduate Palliative Care Curriculum: Lessons Learned
Authors: Bush Shirley H. , Gratton Valérie , Kabir Monisha , Enright Paula , Grassau Pamela A. , Rice Jill , Hall Pippa
Published: April 2020

Previous literature demonstrates that current palliative care training is in need of improvement for medical students in global, European and Canadian contexts. The training of medical undergraduates is key to ensure that the ongoing and increasing need for enhanced access to palliative care across all settings and communities is met. We describe building a comprehensive palliative and end-of-life care curriculum for medical undergraduates at our university. As with recent European and US studies, we found that the process of university curriculum renewal provided a critical opportunity to integrate palliative care content, but needed a local palliative care champion already in place as an energetic and tireless advocate. The development and integration of a substantive bilingual (English and French) palliative and end-of-life care curriculum over the 4-year medical undergraduate program at our university has occurred over the course of 14 years, and required multiple steps and initiatives. Subsequent to the development of the curriculum, there has been a 13-fold increase in students selecting our palliative care clinical rotations. Critical lessons learned speak to the importance of having a team vision, interprofessional collaboration with a focus on vision, plans and implementation, and flexibility to actively respond and further integrate new educational opportunities within the curriculum. Future directions for our palliative care curriculum include shifting to a competency-based training and evaluation paradigm. Our findings and lessons learned may help others who are working to develop a comprehensive undergraduate medical education curriculum.
Bearing fault diagnosis based on teager energy entropy and mean-shift fuzzy C-means
Authors: Wan Shuting , Zhang Xiong
Published: April 2020

Feature extraction and fault recognition of vibration signals are two important parts of bearing fault diagnosis. In this article, a fault diagnosis method based on teager energy entropy of each wavelet subband and improved fuzzy C-means is proposed. First, bearing vibration signal is decomposed into wavelet packet and normalized teager energy entropy feature matrix is constructed as clustering index. Principal component analysis is applied to the high-dimensional teager energy entropy feature matrix, and the principal components are determined by cumulative contribution rate to construct feature vectors. Then, the mean-shift method is used to search for the high probability density region of principal components so as to determine the cluster number and cluster center. Finally, fuzzy C-means is used to update the clustering center and membership value, and confirm the optimal clustering center and the type of clustering. Through simulated and experimental analysis, the proposed method has two advantages. The feature vector constructed by this method has better specificity than wavelet energy entropy. The initial clustering center of fuzzy C-means is confirmed by the mean-shift method, which can improve the clustering performance of fuzzy C-means and solve the misclassification without preknowing the number of categories.
A review on classification of imbalanced data for wireless sensor networks
Authors: Patel Harshita , Singh Rajput Dharmendra , Thippa Reddy G , Iwendi Celestine , Kashif Bashir Ali , Jo Ohyun
Published: April 2020

Classification of imbalanced data is a vastly explored issue of the last and present decade and still keeps the same importance because data are an essential term today and it becomes crucial when data are distributed into several classes. The term imbalance refers to uneven distribution of data into classes that severely affects the performance of traditional classifiers, that is, classifiers become biased toward the class having larger amount of data. The data generated from wireless sensor networks will have several imbalances. This review article is a decent analysis of imbalance issue for wireless sensor networks and other application domains, which will help the community to understand WHAT, WHY, and WHEN of imbalance in data and its remedies.
Toward a More Comprehensive Type of Analysis in Photovoice Research: The Development and Illustration of Supportive Question Matrices for Research Teams
Authors: Wang Qingchun , Hannes Karin
Published: April 2020

In this article, we present a comprehensive approach to analysis to assist researchers in conducting and analyzing photovoice studies. A screening of primary studies in four systematic reviews focusing on photovoice research revealed that the focus of analysis of researchers is the narrative provided with the photos from the participants, which undermines the potential of the photos themselves to provide meaning. In addition, the analytical effort of photovoice researchers is often limited to the interpretive phase in their projects. The question matrices we developed facilitate photovoice researchers who aim to give more weight to photos as an interpretive medium and wish to extend their analytical lens to different phases of a research cycle. They focus our analytical attention on three different sites—site of production, site of photo, and site of audiencing, and three different modalities—technological modality, compositional modality, and social modality. The matrices are designed to present an overview of the important dimensions that researchers might need to take into account when conducting photovoice research studies. We provide relevant examples to illustrate the potential risks and benefits of the analytical choices we make. Photovoice researchers should increase their awareness of the impact of our choices on the analytical process and avoid the analytical strategies that may disempower participants and reproduce existing power relationships.
Timing and Reasons Behind Single-Sport Specialization in Soccer: A Survey of 64 Major League Soccer Athletes
Authors: Knapik Derrick M. , Rizzone Katherine H. , Voos James E.
Published: April 2020

Background:

Single-sport specialization at the exclusion of other sports has become increasingly popular in youth sporting culture. The purpose of this study was to survey Major League Soccer (MLS) athletes to examine factors influencing the timing of single-sport specialization in soccer.

Hypothesis:

The majority of surveyed athletes will have participated in multiple sports prior to specialization and specialized primarily as a result of a coach’s recommendation, with no significant impact on specialization timing stemming from birth or high school location, obtaining a collegiate scholarship, MLS experience, or position.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 4.

Methods:

Anonymous surveys were distributed to 3 MLS organizations and completed by MLS athletes during preseason physicals. Surveys evaluated the age and reason(s) behind an athlete’s decision to specialize in soccer, birth location, geographic high school location for US-born athletes, participation in a developmental league, college scholarship, years in the MLS, and position played.

Results:

Approximately 74% (64/86) of athletes returned completed surveys. Athletes reported beginning soccer at a mean age of 5.1 ± 2.1 years and specializing at age 12.6 ± 4.3 years. Athletes who participated in no other sports prior to specialization ( P < 0.001), athletes reporting soccer to be their first sport played at an advanced level ( P < 0.001), and athletes receiving a college scholarship ( P = 0.02) specialized at a significantly younger age. Internationally born athletes specialized at significantly younger ages when compared with US-born athletes ( P < 0.001).

Conclusion:

The majority of athletes participated in multiple sports prior to specialization and eventually specialized to focus exclusively on soccer. The timing of sport specialization in professional MLS athletes was not associated with multisport participation prior to specialization, playing soccer at an advanced level prior to other sports, receiving a college scholarship, or being born outside the United States.

Clinical Relevance:

Timing of sport specialization is associated with multiple factors prior to athlete promotion to the MLS that warrant further investigation to better understand the impact of specialization on injury incidence, performance, and career length.
Pulmonary vessel casting in a rat model of monocrotaline‐mediated pulmonary hypertension
Authors: Zhu Zhongkai , Wang Yifan , Long Amy , Feng Tianyu , Ocampo Maria , Chen Sunny , Tang Haiyang , Guo Qiang , Minshall Richard , Makino Ayako , Huang Wei , Chen Jiwang
Published: April 2020

Pulmonary hypertension is a chronic vascular disease characterized by pulmonary vasoconstriction and pulmonary arterial remodeling. Pulmonary arterial remodeling is mainly due to small pulmonary arterial wall thickening and lumen occlusion. Previous studies have described intravascular changes in lung sections using histopathology, but few were able to obtain a fine detailed image of the pulmonary vascular system. In this study, we used Microfil compounds to cast the pulmonary arteries in a rat model of monocrotaline‐induced pulmonary hypertension. High‐quality images that enabled quantification of distal pulmonary arterial branching based on the number of vessel bifurcations/junctions were demonstrated in this model. The branch and junction counts of distal pulmonary arteries significantly decreased in the monocrotaline group compared to the control group, and this effect was inversely proportional to the mean pulmonary artery pressure observed in each group. The patterns of pulmonary vasculature and the methods for pulmonary vessel casting are presented to provide a basis for future studies of pulmonary arterial remodeling due to pulmonary hypertension and other lung diseases that involve the remodeling of vasculature.
Passively transferred IgG enhances humoral immunity to a red blood cell alloantigen in mice
Authors: Gruber David R. , Richards Amanda L. , Howie Heather L. , Hay Ariel M. , Lebedev Jenna N. , Wang Xiaohong , Zimring James C. , Hudson Krystalyn E.
Published: April 2020

Antibodies are typically thought of as the endpoint of humoral immunity that occur as the result of an adaptive immune response. However, affinity-matured antibodies can be present at the initiation of a new immune response, most commonly because of passive administration as a medical therapy. The current paradigm is that immunoglobulin M (IgM), IgA, and IgE enhance subsequent humoral immunity. In contrast, IgG has a “dual effect” in which it enhances responses to soluble antigens but suppresses responses to antigens on red blood cells (RBCs) (eg, immunoprophylaxis with anti-RhD). Here, we report a system in which passive antibody to an RBC antigen promotes a robust cellular immune response leading to endogenous CD4+ T-cell activation, germinal center formation, antibody secretion, and immunological memory. The mechanism requires ligation of Fcγ receptors on a specific subset of dendritic cells that results in CD4+ T-cell activation and expansion. Moreover, antibodies cross-enhance responses to a third-party antigen, but only if it is expressed on the same RBC as the antigen recognized by the antibody. Importantly, these observations were IgG subtype specific. Thus, these findings demonstrate that antibodies to RBC alloantigens can enhance humoral immunity in an IgG subtype-specific fashion and provide mechanistic elucidation of the enhancing effects.
Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery
Authors: Carey Marcus , Bali Anish , Pandeva Ivilina , Pradhan Ashish , Slack Mark
Published: April 2020

Robot-assisted laparoscopy has been developed to overcome some of the important limitations of conventional laparoscopy. In particular, the provision of stable magnified three-dimensional vision, tremor filtering, motion scaling, and articulated instruments with robot-assisted surgery has the potential to enable more surgeons to perform more complex surgery compared with conventional laparoscopy. The aim of this study was to evaluate the utility of a new robot-assisted surgical system (Versius, CMR Surgical, Cambridge, UK) for gynecologic procedures in a preclinical setting. Cadaveric sessions were conducted to evaluate the ability of the system to complete all surgical steps required for a robot-assisted total laparoscopy hysterectomy. A live animal (porcine) model was used to assess the system in performing oviduct removal as a surrogate for robot-assisted total laparoscopy hysterectomy. Procedures were performed by experienced gynecologic surgeons, supported by a surgical team. The precise surgical steps conducted to conclude that the procedures could be fully completed were systematically recorded, as well as instruments used and endoscope angle. In total, six gynecologic procedures were performed in cadavers by four surgeons; 16/17 procedures were completed successfully. Positioning of the ports and bedside units reflected the surgeons’ preferred laparoscopic setup and enabled good surgical access and reach, as exemplified by the high procedure completion rate. Oviduct removal procedures performed in pigs were all completed successfully by a single surgeon. This preclinical study of a new robot-assisted surgical system for gynecologic procedures demonstrated the safety and effectiveness of the system in cadaver and porcine models. Further studies are required to assess its clinical utility.
A case report of thrombolysis resistance: thrombus ultrastructure in an ischemic stroke patient
Authors: Li Ye , Wang Heying , Zhao Lili , Jian Yating , Dang Meijuan , Jiang Yu , Zhang Yiheng , Zhang Lei , Wang Huqing , Zhang Ru , Chen Mingxia , Zhang Guilian
Published: April 2020

Background

Following acute ischemic stroke (AIS), approximately half of patients do not achieve recanalization after intravenous administration of tissue plasminogen activator (rt-PA). Thrombolysis resistance is a possible reason for recanalization failure. Thrombolysis resistance is likely related to the ultrastructure and composition of the thrombus. However, there is a paucity of published information on the relationship between thrombus ultrastructure and thrombolysis resistance.

Case presentation

Two patients who underwent mechanical thrombectomy were observed within 4.5 h after stroke onset. One patient failed to respond to rt-PA (defined as thrombolysis resistant), and the other patient did not receive rt-PA treatment (non-rtPA). In each patient, the occluded artery was the internal carotid artery or middle cerebral artery. According to the Trial of ORG 10172 in Acute Stroke Treatment classification, both patients had large atherosclerotic cerebral infarction. By scanning electron microscopy (SEM) and transmission electron microscopy (TEM), we found that the thrombus structure was significantly different between the two patients.

Conclusion

Grid-like dense fibrin, compressed polyhedral erythrocytes, and large accumulation of neutrophils may be characteristics of thrombolysis resistant thrombi.
Effects of date fruit (Phoenix dactylifera L.) on labor and delivery outcomes: a systematic review and meta-analysis
Authors: Bagherzadeh Karimi Alireza , Elmi Asghar , Mirghafourvand Mojgan , Baghervand Navid Roghaiyeh
Published: April 2020

Background

The rate of cesarean section is increasing in all over the world with different drafts in various countries. This growth increases unpleasant outcomes of delivery. Recent studies explained the benefits of date palm fruit on labor process improvement. Date fruit can be considered as a factor for increasing vaginal delivery and also reducing the frequency of caesarean section in order to prevent its great complications. This systematic review has been designed to review clinical studies that investigate the effects of date palm fruit on labor outcomes (duration of labor stages, bishop score, and frequency of cesarean section) compared with routine cares.

Methods

This study was performed in 2019. Required data has been collected from electronic databases and manual searches. All randomized clinical trials evaluating the effects of date palm fruit on labor and delivery that were published from January 2000 to August 2019 in English and Persian languages, were incorporated in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and were then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

Results

Eight studies were included in the qualitative and quantitative synthesis. Meta-Analysis showed that date fruit consumption can significantly reduce active phase of labor (three trials with 380 participants; (MD = − 109.3, 95%CI (− 196.32, − 22.29; I2 = 89%),P = 0.01), and also it can significantly improve the bishop score (two trials with 320 participants; MD = 2.45, 95%CI (1.87, 3.04; I2 = 0%),P < 0.00001). Date fruit consumption had no effects on the duration of first, second, and third stages of labor, and the frequency of cesarean section.

Conclusion

Date can reduce the duration of active phase and improve the bishop score; however, due to from the low to mediate quality of the studies; it seems that the other studies are needed to prove these results better than this.
Reliability of accelerometric assessment of balance in children aged 6–12 years
Authors: García-Liñeira J. , García-Soidán J. L. , Romo-Pérez V. , Leirós-Rodríguez R.
Published: April 2020

Background

Development and evaluation of an accelerometers technique for collecting data for asses balance had reported difficulty due to equilibrium reactions and continuous bursts. The aim of this study is to determine the reliability and internal consistency of accelerometric measurements, related to static equilibrium and gait in children aged 6 to 12 years.

Methods

This descriptive and cross-sectional study involved 70 healthy children (50% girls) with a mean age of 9 years old. At the height of the 4th lumbar vertebra and directly on the skin, an accelerometer was placed on each participant. All of them had to complete four trials three times: balancing on one leg with eyes closed and eyes open, dynamic balancing on one leg on a foam mat, and normal gait.

Results

Results show that tests performed in older children had higher internal consistency than those performed in younger children (vertical axis r = 0.82, sagittal axis r = 0.77, and perpendicular axis r = 0.74). Tests performed in children aged 8 years or older presented a strong correlation between trials (r > 0.71). The three static equilibrium tests obtained reliability values between 0.76 y 0.84. On the contrary, gait test obtained inferior and poorer results (0.6 < r < 0.71).

Conclusions

This method of assessment obtained positive results as an instrument for the quantitative assessment of balance in school-aged children. Values obtained for the three one-leg balance and static tests,were more strongly correlated than the normal gait test for all axes.
Clinical audit in the pediatric primary care office and overweight prevention in toddlers
Authors: Limauro Raffaele , Gallo Patrizia , Cioffi Luigi , Antignani Angelo , Cioffi Valentina , Calella Patrizia , Valerio Giuliana
Published: April 2020

Background

Clinical audit is a process by which physicians or other health care professionals perform a regular and systematic review of their clinical practice and amend it, when necessary. An internal audit allows to review the activities carried out by professionals, in order to assess the appropriateness, effectiveness, efficiency and safety of the services provided. Aim of this study was to apply the process of clinical audit to the obesity/overweight care in toddlers. After the correction of the nutritional errors that were considered potentially responsible for the excess weight gain, the effect of the changes of dietary advice on the frequency of overweight/obesity was assessed in a cohort of children aged 24–36 months.

Methods

Three Italian primary care pediatricians set up the audit strategy by recognizing the high prevalence of overweight and obesity in the entire cohort of toddlers born in 2005, 2006 and 2007 (Pre-Audit group, age 24–36 months old) under their care. By reviewing their clinical practice, they changed the protocol of weaning and feeding up to 36 months, mainly reducing protein and sugar excess. The change involved the cohorts of toddlers born in the years 2010, 2011 and 2012 (Post-Audit group).

Results

Change in the approach of pediatricians to children’s diet yielded a reduction of the frequency of overweight/obesity in children between 24 and 36 months of life from 26.3% in the Pre-Audit group to 13.9% in the Post-Audit group (p < 0.0001).

Conclusion

Clinical audit revealed high rates of obesity/overweight among toddlers. The practice developed a new strategy for nutritional counseling, which was effective in reducing the frequency of overweight/obesity in young children.
Adaptation and psychometric testing of the hoarding rating scale (HRS): a self-administered screening scale for epidemiological study in Chinese population
Authors: Liu Tai Wa , Lam Simon Ching , Chung Man Hon , Ho Ken Hok Man
Published: April 2020

Background

Hoarding disorder is a chronic and debilitating illness associated with restrictions on activities of daily living, compromised social and occupational functioning, and adverse health outcomes. However, researchers lack a brief and self-administered screening measurement to assess compulsive hoarding in the Chinese speaking population. This study aimed to adapt and validate the Hoarding Rating Scale-Interview (HRS-I) to as a tool for screening compulsive hoarding behavior in Chinese population.

Methods

This study comprised two phases. During Phase 1, the English-language HRS-I was translated into Chinese (CHRS) (comprehensible for most Chinese speaking population, e.g., Cantonese & Mandarin) and subjected to an equivalence check. In Phase 2, the CHRS was validated by examining internal consistency, stability, and construct validity. Different samples were used appropriately to verify the items and reflect the psychometric properties.

Results

In Phase 1, the CHRS yielded satisfactory content (S-CVI = 0.93) and face validity ratings (comprehensibility = 100%, N = 20 participants of general public with age 18–72) and the English and Chinese versions were found to be equivalent (ICC = 0.887; N = 60 university staff and students). Phase 2 revealed satisfactory levels of internal consistency (Cronbach’s α = 0.86; corrected item-total correlation = 0.60–0.74; N = 820 participants of general public), 2-week test-retest reliability (ICC = 0.78; N = 60 university students), and construct validity (one-factor CFA solution matched with the hypothesized model, χ2/d.f. = 2.26, RMSEA = 0.049, CFI = 0.99, IFI = 0.99, NFI = 0.99; n = 520 participants of general public).

Conclusions

This study provides sufficient evidence of the reliability and validity of the CHRS for compulsive hoarding behavior screening in the Chinese population through self-administered method.
Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial
Authors: Lobban Fiona , Akers Nadia , Appelbe Duncan , Chapman Lesley , Collinge Lizzi , Dodd Susanna , Flowers Sue , Hollingsworth Bruce , Johnson Sonia , Jones Steven H. , Mateus Ceu , Mezes Barbara , Murray Elizabeth , Panagaki Katerina , Rainford Naomi , Robinson Heather , Rosala-Hallas Anna , Sellwood William , Walker Andrew , Williamson Paula
Published: April 2020

Background

The Relatives Education And Coping Toolkit (REACT) is an online supported self-management toolkit for relatives of people with psychosis or bipolar designed to improve access to NICE recommended information and emotional support.

Aims

Our aim was to determine clinical and cost-effectiveness of REACT including a Resource Directory (RD), versus RD-only.

Methods

A primarily online, observer-blind randomised controlled trial comparing REACT (including RD) with RD only (registration ISRCTN72019945). Participants were UK relatives aged > = 16, with high distress (assessed using the GHQ-28), and actively help-seeking, individually randomised, and assessed online. Primary outcome was relatives’ distress (GHQ-28) at 24 weeks. Secondary outcomes were wellbeing, support, costs and user feedback.

Results

We recruited 800 relatives (REACT = 399; RD only = 401) with high distress at baseline (GHQ-28 REACT mean 40.3, SD 14.6; RD only mean 40.0, SD 14.0). Median time spent online on REACT was 50.8 min (IQR 12.4–172.1) versus 0.5 min (IQR 0–1.6) on RD only. Retention to primary follow-up (24 weeks) was 75% (REACT n = 292 (73.2%); RD-only n = 307 (76.6%)). Distress decreased in both groups by 24 weeks, with no significant difference between the two groups (− 1.39, 95% CI -3.60, 0.83, p = 0.22). Estimated cost of delivering REACT was £62.27 per person and users reported finding it safe, acceptable and convenient. There were no adverse events or reported side effects.

Conclusions

REACT is an inexpensive, acceptable, and safe way to deliver NICE-recommended support for relatives. However, for highly distressed relatives it is no more effective in reducing distress (GHQ-28) than a comprehensive online resource directory.

Trial registration

ISRCTN72019945 prospectively registered 19/11/2015.
School-based interventions to promote personal and environmental hygiene practices among children in Pakistan: protocol for a mixed methods study
Authors: Pradhan Nousheen Akber , Mughis Waliyah , Ali Tazeen Saeed , Naseem Maleeha , Karmaliani Rozina
Published: April 2020

Background

Poor personal hygiene and inadequate sanitation practices among young children leads to communicable diseases. There remains a gap in the holistic assessment of school children’s hygiene literacy, practices and effectiveness of school-based hygiene interventions in Pakistan. Therefore, a school-based intervention protocol has been designed to promote personal and environmental hygiene practices for primary school children. Towards improving children’s hygiene behaviors, the study will also focus on enhancing mothers' hygiene knowledge and practices.

Methods

Using quasi-experimental design with mixed methods data collection approaches, this study will be conducted in schools located in an urban squatter settlements in Pakistan. To assess primary grade children and their mothers‘ hygiene status, a survey will be held in the pre-intervention phase. This phase also includes qualitative exploration of key stakeholders (mothers, teachers, health & education authorities representatives’) perceptions about the factors facilitating and impeding the adaption of hygiene behaviors among school children. In-depth guides and focus group discussion tools will be used for this purpose. This will be followed by multi-component intervention phase with behavior change strategies to improve children‘s and mothers’ hygiene literacy and behaviors. The post-intervention phase will assess the intervention effectiveness in terms of enhancing hygiene knowledge and practices among school children and mothers, alongside exploration of mothers and teachers’ insights into whether or not the intervention has been effective in improving hygiene practices among children. Pairedt-test will be applied pre and post-intervention to measure the differences between the mothers and children's hygiene literacy and knowledge scores. Similar test will be performed to assess the differences in children’s hygiene knowledge and practice scores, pre and post-intervention (< 50 = poor, 50–75 = good and > 75 = excellent). Thematic analysis will be carried out for qualitative data.

Discussion

Multi-component intervention aimed at improving personal and environmental hygiene among primary school children offers an opportunity to design and test various behavioral change strategies at school and in home settings. The study findings will be significant in assessing the intervention’s effectiveness in improving children‘s overall hygiene.

Trial registration

Retrospectively registered with ClinicalTrials.gov (NCT03942523) on 5th May 2019.
Imaging algorithm and multimodality evaluation of spinal osteoblastoma
Authors: Huang Zihuan , Fang Tingsong , Si Zhiguang , Li Youcai , Zhang Lan , Zheng Chunling , Li Shenmei , Su Manting , Liu Xiaomin , Li Xiaodan , Wu Yuankui
Published: April 2020

Background

To analyze the features of CT, MRI and PET/CT and their diagnostic value for spinal osteoblastomas (OBs).

Methods

The radiological and clinical data of 21 patients with histopathologically-confirmed spinal OBs were analyzed retrospectively.

Results

Sixteen of the 21 cases were benign and 5 were aggressive OBs. Tumors were located in the lumbar (n = 11), cervical (n = 4), thoracic (n = 5), and sacral (n = 1) spinal regions. Nineteen cases were centered in the posterior elements of the spine, 13 of which extended into the vertebral body. Punctate or nodular calcifications were found in all cases on CT with a complete sclerotic rim (n = 12) or incomplete sclerotic rim (n = 8). The flare phenomenon (indicative of surrounding tissue inflammation) was found in 17/21 cases on CT, thin in 11 cases and thick in 6 cases, and in 19/19 cases on MRI, thin in 1 case and thick in 18 cases. On 18F-FDG PET/CT, all cases (8/8) were metabolically active with the SUVmax of 12.3–16.0; the flare sign was observed in 8 cases, including 7 cases of hypometabolism and 1 case of coexistence of hypermetabolism and hypometabolism. Based on CT, 3, 12, and 6 cases were classified as Enneking stage 1, 2 and 3, respectively. Of 19 cases with MRI, 1 and 18 cases were classified as Enneking stage 2 and 3, respectively.

Conclusions

Spinal OB has multiple unique characteristic radiological features. Although a larger sample size is needed, combining CT, MRI and PET may be beneficial to optimize preoperative diagnosis and care of patients with OBs.
In vivo fluorescence molecular tomography of induced haemarthrosis in haemophilic mice: link between bleeding characteristics and development of bone pathology
Authors: Vøls K. K. , Kjelgaard-Hansen M. , Ley C. D. , Hansen A. K. , Petersen M.
Published: April 2020

Background

Haemophilic arthropathy is a chronic and debilitating joint disease caused by recurrent spontaneous joint bleeds in patients with haemophilia. Understanding how characteristics of individual joint bleeds relate to the subsequent development of arthropathy could improve management and prevention of this joint disease. Here, we aimed to explore relations between joint bleed characteristics and development of bone pathology in a mouse model of haemophilic arthropathy by using novel in vivo imaging methodology.

Methods

We characterised induced knee bleeds in a murine model of haemophilic arthropathy by quantitative in vivo fluorescence molecular tomography (FMT) and by measurements of changes in the diameter of the injured knee. Wild-type mice and non-injured haemophilic mice acted as controls. Development of arthropathy was characterised by post mortem evaluation of bone pathology by micro-CT 14 days after bleed-induction. In an in vitro study, we assessed the effect of blood on the quantification of fluorescent signal with FMT.

Results

In most injured haemophilic mice, we observed significant loss of trabecular bone, and half of the mice developed pathological bone remodelling. Development of pathological bone remodelling was associated with significantly increased fluorescent signal and diameter of the injured knee just 1 day after induction of the bleed. Further, a correlation between the fluorescent signal 1 day after induction of the bleed and loss of trabecular bone reached borderline significance. In the in vitro study, we found that high concentrations of blood significantly decreased the fluorescent signal.

Conclusion

Our results add novel insights on the pathogenesis of haemophilic arthropathy and underline the importance of the acute phase of joint bleeds for the subsequent development of arthropathy.
Surgical treatment of atlantoaxial subluxation by intraoperative skull traction and C1-C2 fixation
Authors: Guo Jianwei , Lu Wencan , Ji Xiangli , Ren Xianfeng , Tang Xiaojie , Zhao Zheng , Hu Huiqiang , Song Tao , Du Yukun , Li Jianyi , Shao Cheng , Xu Tongshuai , Xi Yongming
Published: April 2020

Background

Atlantoaxial subluxation (AAS) is a not rare abnormality between the atlas (C1) and axis (C2). For AAS patients with persistent neck pain and neurologic symptoms, surgical intervention is a good choice. Nevertheless, there were still few reports about the use of intraoperative skull traction and different fixation methods in treatment of AAS.

Methods

From January 2012 to December 2018, a total of 86 cases were admitted to our hospital and diagnosed as AAS. All the patients received atlantoaxial reduction with the help of intraoperative skull traction and C1-C2 fixation. Clinical and radiological parameters were collected through chart review.

Results

There were 86 cases included in this study. The mean operative time was 153.9 ± 73.9 min, and the mean amount of intraoperative blood loss was 219.1 ± 195.6 ml. 81 patients underwent posterior reduction, internal fixation and fusion. 5 patients underwent anterior release, followed by posterior internal fixation and fusion. 82 patients got satisfactory postoperative outcomes while complications occurred in 4 patients. Significant neurologic improvement was observed in these patients. Bone fusion was achieved on the midline sagittal reconstructed CT images at the latest follow-up in all these patients except 1 case. All the patients were followed up for 34.84 ± 15.86 months at average (range 12–60 months). The mean ADI value was 7.55 ± 1.67 mm at average preoperatively, and improved to 4.03 ± 1.21 mm postoperatively, and to 4.21 ± 0.99 mm at the latest follow-up. The mean A-A angle was 15.48 ± 9.82 degrees at average preoperatively, and improved to 21.61 ± 10.43 degrees postoperatively, and to 19.73 ± 8.13 degrees at the latest follow-up. The mean A-A height was 35.61 ± 7.66 mm at average preoperatively, and improved to 40.08 ± 8.5 mm postoperatively, and to 38.83 ± 6.97 mm at the latest follow-up. There were complications in 4 patients, including pedicle misplacement, pedicle screw fracture, infection and one death.

Conclusion

Intraoperative skull traction can effectively facilitate the surgical procedures for ASS caused by different etiologies. Further research will be needed to investigate the safety and effectiveness of this method in the future.