bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of H-type bronchoesophageal fistula in a newborn
Authors: Li Huaying , Yan Li , Ju Rong , Li Biao
Published: February 2022

Rationale:

Congenital tracheoesophageal fistula (TEF) is a rare developmental malformation. The H subtype accounts for approximately 4% of TEFs. Unlike other TEFs, the H-type is not accompanied by esophageal atresia and has nonspecific clinical symptoms, and its specific anatomical abnormalities are not always readily apparent. Furthermore, none of the currently available diagnostic methods for H-type TEF have absolute sensitivity, resulting in misdiagnoses, and accurate diagnoses are often delayed even until adulthood; in our case, we detected a congenital bronchoesophageal fistula, which is even more rare than regular H-type TEF, through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope. We believe that we have provided this kind of case first in newborns.

Furthermore, because there is not one literature summarizing the clinical symptoms and the effective methods up to now, we still are not clear which detective method is more efficient or accurate, especially in newborns, so it is very necessary to summarize and compare for improving the early diagnosis of TEFs; our study makes a significant contribution to the literature because we collated previously reported cases, including the clinical features and the usefulness and success rates of major tests, which will be very helpful for the early diagnosis of TEFs.

Patient concerns:

A newborn male presented with an array of nonspecific clinical symptoms from birth, leading to pneumonia and mechanical ventilation. Oral feeding led to an improvement in most but not all symptoms, which returned when oral feeding was resumed. A second round of confirmatory tests was still unable to detect the cause.

Diagnosis:

The diagnosis of H-type bronchoesophageal fistula was established through a technique that was not previously reported for newborns, involving bronchoscopy, with methylene blue injected through an esophagoscope.

Interventions:

The surgery was performed after diagnosis, and the bronchoesophageal fistula was successfully repaired.

Outcomes:

The patient was discharged on postoperative day 7, and his status was reported to be normal at a follow-up visit 8 months after surgery.

Lessons:

H-type TEF is a rare congenital abnormality, and its early diagnosis is highly difficult, especially bronchoesophageal fistula. Increased oral saliva and air-filled stomachs are characteristic manifestations. Bronchoscopy combined with esophagoscopy can improve the rate of early diagnosis. A combination of tests can improve the detection rate.
The impact of COVID-19 on home, social, and productivity integration of people with chronic traumatic brain injury or stroke living in the community
Authors: García-Rudolph Alejandro , Saurí Joan , Cegarra Blanca , Opisso Eloy , Tormos Josep María , Frey Dietmar , Madai Vince Istvan , Bernabeu Montserrat
Published: February 2022

Compare community integration of people with stroke or traumatic brain injury (TBI) living in the community before and during the coronavirus severe acute respiratory syndrome coronavirus 2 disease (COVID-19) when stratifying by injury: participants with stroke (G1) and with TBI (G2); by functional independence in activities of daily living: independent (G3) and dependent (G4); by age: participants younger than 54 (G5) and older than 54 (G6); and by gender: female (G7) and male (G8) participants.

Prospective observational cohort study

In-person follow-up visits (before COVID-19 outbreak) to a rehabilitation hospital in Spain and on-line during COVID-19.

Community dwelling adults (≥18 years) with chronic stroke or TBI.

Community integration questionnaire (CIQ) the total-CIQ as well as the subscale domains (ie, home-CIQ, social-CIQ, productivity CIQ) were compared before and during COVID-19 using the Wilcoxon ranked test or paired t test when appropriate reporting Cohen effect sizes (d). The functional independence measure was used to assess functional independence in activities of daily living.

Two hundred four participants, 51.4% with stroke and 48.6% with TBI assessed on-line between June 2020 and April 2021 were compared to their own in-person assessments performed before COVID-19.

When analyzing total-CIQ, G1 (d = −0.231), G2 (d = −0.240), G3 (d = −0.285), G5 (d = −0.276), G6 (d = −0.199), G7 (d = −0.245), and G8 (d = −0.210) significantly decreased their scores during COVID-19, meanwhile G4 was the only group with no significant differences before and during COVID-19.

In productivity-CIQ, G1 (d = −0.197), G4 (d = −0.215), G6 (d = −0.300), and G8 (d = −0.210) significantly increased their scores, meanwhile no significant differences were observed in G2, G3, G5, and G7.

In social-CIQ, all groups significantly decreased their scores: G1 (d = −0.348), G2 (d = −0.372), G3 (d = −0.437), G4 (d = −0.253), G5 (d = −0.394), G6 (d = −0.319), G7 (d = −0.355), and G8 (d = −0.365).

In home-CIQ only G6 (d = −0.229) significantly decreased, no significant differences were observed in any of the other groups.

The largest effect sizes were observed in total-CIQ for G3, in productivity-CIQ for G6, in social-CIQ for G3 and in home-CIQ for G6 (medium effect sizes).

Stratifying participants by injury, functionality, age or gender allowed identifying specific CIQ subtotals where remote support may be provided addressing them.
Clinical application of gelatin sponge microparticles-transcatheter arterial chemoembolization combined with synchronous antigen-presenting dendritic cell sequential reinfusion for treatment of advanced large liver cancer
Authors: Zhao Guang Sheng , Liu Song , Liu Ying , Li Chuang , Wang Ruo Yu , Bian Jie , Zhu Rui Ping , Zhou Jun , Zhang Yue Wei
Published: February 2022

To assess the clinical efficacy and safety of gelatin sponge microparticles-transcatheter arterial chemoembolization (GSMs-TACE) plus synchronous antigen-presenting dendritic cell (DC) sequential reinfusion for advanced large liver cancer (LC).

Patients with large LC were assigned to the experimental (combined sequential DC therapy) or control group. All patients received standardized GSMs-TACE. In the experimental group, 60 mL of peripheral blood was collected for in vitro culture of DCs (10–14 days). Then, intravenous reinfusion was conducted 3 times within 10, 20, and 30 days after surgery. Adverse reactions during the treatment were recorded and evaluated. The overall survival, transcatheter arterial chemoembolization frequency, and physical score (PS) were calculated.

The median survival time of the experimental group was significantly longer than that of the control group. There were significant differences in median progression-free survival between the 2 groups (P < .05) and the objective effective rate at 1 and 6 months and 1 year (P < .05), but not 2 years (P > .05). The PSs of 2 groups were significantly improved at 1 month after GSMs-TACE, with more obvious improvement in the experimental group (P < .05).

GSMs-TACE plus synchronous DC sequential reinfusion significantly prolonged the median survival time, improved the tumor response rate and PS, prolonged progression-free survival, and reduced intervention frequency. GSMs-TACE plus synchronous DC sequential reinfusion treatment is suitable for comprehensive treatment of patients with advanced larger LC in China.
A randomized controlled clinical study on Zuo's acupuncture treatment for prediabetes
Authors: Zeng Xuanli , Li Yang , Lu Liming , Wen Hao , Wang Guorui , Zuo Changbo
Published: February 2022

Introduction:

Prediabetes is a high-risk stage of transition to type 2 diabetes mellitus. Previous studies suggest that acupuncture has potential to prevent prediabetes’ conversion to type 2 diabetes mellitus, which lack of high-quality evidence. Zuo's acupuncture, a kind of acupuncture technique, is formed through long-term and repeated clinical practice by professor Zuo Changbo who integrates the internal meaning of Dong extra acupoints and Taoist medicine principle according to the theories of traditional Chinese medicine. It is used clinically to increase the regression toward normo-glycemi on prediabetes. The objective of this trial is to clarify the clinical effectiveness and safety of Zuo acupuncture for prediabetes.

Methods and analysis:

This study is a prospective randomized controlled trial in which 60 patients with prediabetes will be randomly allocated in a 1:1 ratio into either an acupuncture treatment group or a control group. Prediabetes patients in the control group will receive prediabetes health education for lifestyle interventions, whereas patients in the acupuncture group will receive lifestyle interventions plus Zuo Daliji and Yueku stitch treatment. Twenty-four treatment sessions will be performed over 3 months. The primary outcome is conversion rate from prediabetes to normal blood glucose. Secondary outcomes include fasting plasma glucose, 2-hour plasma glucose, glycosylated hemoglobin and blood lipid concentration.

Ethics and dissemination:

This study was approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medicine (permission number: YF2020-107-01) and the protocol conforms to the principles of the Declaration of Helsinki. Data collection will be completed by June 2022. Publications will be ready for submission in July 2022.
The incidence of uveitis after systemic lymphoma in Taiwan
Authors: Huang Yu-Te , Lin Chun-Ju , Liao Pei-Lun , Hsu Min-Yen , Chang Cheng-Hsien , Tien Peng-Tai , Lai Chun-Ting , Hsia Ning-Yi , Bair Henry , Chen Huan-Sheng , Chiang Chun-Chi , Tsai Yi-Yu
Published: February 2022

Although uveitis can be an intraocular presentation of systemic lymphoma, it may be associated with direct lymphomatous infiltration and immune-mediated alterations. There have been no published studies describing the incidence of uveitis after systemic lymphoma. We conducted a nationwide cohort study to investigate the incidence of uveitis after systemic lymphoma diagnosis in Taiwan. Data were collected from the Taiwan National Health Insurance system and included patients newly diagnosed with systemic lymphoma between 2000 and 2017. We observed the risk of uveitis among study population since the index date until December 2017. The 1:8 of systemic lymphoma patient and paired comparison was identified by time distribution matching and individual paired with sex and age. Subsequent propensity score matching (PSM) was used to select the 1:1 of systemic lymphoma patient and paired comparison by greedy algorism with caliper of 0.05. The multiple Cox proportional hazard regression model was used to compare the developmental risk of uveitis (time-to-uveitis) between the systemic lymphoma and non-systemic lymphoma, while controlling for selected covariates. After time distribution matching, we selected 6846 patients with systemic lymphoma, and 54,768 comparisons. Among patients with systemic lymphoma groups, there were more men than women (52.94% vs 47.06%) and the mean age was 53.32 ± 21.22 years old. Systemic lymphoma incidence rates (per 10,000 person-months) of uveitis were 1.94 (95% confidence interval [CI], 1.60–2.35) in the systemic lymphoma cohort and 1.52 (95% CI, 1.42–1.63) in the non-systemic lymphoma cohort. Compared with the non-systemic lymphoma cohort, adjusted hazard ratio (aHR) of developing uveitis were 1.24 (95% CI, 1.00–1.52) in people with systemic lymphoma. But not significant in after PSM, aHR of developing uveitis were 1.17 (95% CI, 0.90–1.53). This 18-year nationwide population-based cohort study in Taiwan, showed that the risk of uveitis in patients’ systemic lymphoma was not significantly higher than non-systemic lymphoma after PSM. In elderly and rheumatic patients with intraocular inflammation, it is important to first exclude uveitis masquerade syndrome, which could be a harbinger of intraocular involvement from systemic lymphoma. Further large-scale prospective clinical studies to investigate whether systemic lymphoma influences the incidence of uveitis are warranted.
Moxibustion for anorexia in COVID-19
Authors: Wang Xingxin , Hou Yi , Ding Lin , Zheng Xiaojun , Sheng Yawen , Yu Qiaoru , Bi Xiaoyun , Yang Jiguo
Published: February 2022

Background:

As the outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread over the world, the World Health Organization has declared the outbreak of COVID-19 an international public health emergency. Besides typical respiratory symptoms and signs of COVID-19, digestive symptoms and liver injury have been frequently reported during the course of the disease. The purpose of this study was to evaluate the efficacy and safety of moxibustion in the treatment of anorexia in patients with COVID-19.

Methods:

According to the retrieval strategies, randomized controlled trials on moxibustion therapies for C19-A will be obtained from the China National Knowledge Infrastructure, WanFang Data, Chinese Scientific Journals Database, PubMed, Embase, and Cochrane Library, regardless of publication date or language. Studies will be screened based on inclusion and exclusion criteria, and the Cochrane risk bias assessment tool will be used to evaluate the quality of the literature. The network meta-analysis will be performed with the Markov chain Monte Carlo method and carried out with Stata 14.2 and WinBUGS 1.4.3 software. Ultimately, the quality of the evidence obtained from the results will be evaluated.

Results:

This study will evaluate whether moxibustion therapy can effectively treat anorexia in patients with COVID-19.

Conclusion:

This study will provide evidence for whether moxibustion therapy is beneficial to the treatment of anorexia in patients with COVID-19.

Trial registration number:

CRD42022302499
Cystic fibrosis transmembrane conductance regulator function in patients with chronic pancreatitis
Authors: Schlosser Tobias , Fischer Daniel , Büttner Sandra , Blank Valentin , Hoffmeister Albrecht
Published: February 2022

Background:

Pathogenesis of chronic pancreatitis (CP) is still not entirely understood with many patients probably having more than 1 underlying etiology. Besides toxic-metabolic factors, genetics contribute to disease development. Mutations in cystic fibrosis transmembrane conductance regulator (CFTR) are shown to increase risk for CP. Activity of CFTR can easily be accessed in vivo by measurement of nasal potential difference (PD).

Methods:

We compared in this monocentric study 17 CP patients from the outpatient unit of our university hospital with 30 healthy controls regarding nasal PDs by using a superfusion protocol. Additionally, demographic and lifestyle data of all persons were recorded.

Results:

Seventeen patients (12% female, median age 48 years) with CP and 30 healthy volunteers (47% female, 25 years) were included in the study. Patients with CP had a significant higher proportion of CFTR dysfunction (P = .04). Furthermore, demographics differed between the 2 groups with CP patients being older (P < .001). There were differences in daily alcohol consumption (P = .001) and smoking habits (smokers vs nonsmokers: P = .01, pack years: P = .002).

Conclusions:

PD measurement is an easily accessible way to show CFTR dysfunction as an etiological factor of CP. Cigarette smoking might impair CFTR function and therefore be 1 preventable cause of CP evolution.
Effects of traditional Chinese exercise on the treatment of COVID-19
Authors: Chen Li , Ji Yu , Wang QiPeng , Fu MingFen
Published: February 2022

Introduction:

Since the end of December 2019, corona virus disease 2019 (COVID-19) has caused a huge impact in many countries and has attracted great attention from countries around the world. In fact, many studies have shown that during the fight against the COVID-19 epidemic. Chinese traditional exercise plays an active role in promoting human health. The main purpose of this study is to provide a reliable method and credible evidence to improve the prognosis of patients with COVID-19 through traditional Chinese exercise.

Methods:

This protocol is guided by the preferred reporting items for systematic reviews. By searching the following electronic databases: PubMed, EMBASE, MEDLINE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database, China Biomedical Literature Database, China Science, and Wan-Fang Database. The whole process includes selecting high-quality literature, extracting and analyzing, and assessing the risk of bias in order to summarize the therapeutic effect of traditional Chinese exercise on COVID-19 patients.

Result:

Research shows that prevention and treatment through traditional Chinese exercise can provide strong evidence against COVID-19.

Conclusion:

To provide a way to help prevent and treat COVID-19 through traditional Chinese exercise.
Spontaneous complete uterine rupture with protrusion of foetal limbs at the third trimester following laparoscopic cornuostomy
Authors: Feng Jianyang , Kang Yahui , Chen Guixian , Zhang Yaoyue , Li Yuan , Li Yi , He Hong
Published: February 2022

Rationale:

Spontaneous complete uterine rupture during gestation is rare and has no specific symptoms; however, it is a life-threatening event for both the fetus and mother. The rupture typically happens in labor and is uncommon before labor. Herein, we present the case of a woman, encountering complete rupture at third trimester followed by laparoscopic cornuostomy.

Patient concerns:

A 26-year-old woman presented with acute right lower abdominal pain at 33 weeks and 5 days of gestation.

Diagnoses:

We made a diagnosis of threatened uterine rupture.

Intervention:

Urgent cesarean section performed. Exploration of the uterine dehiscence wound demonstrated that the myometrium was completely ruptured at the primary laparoscopic surgical scar with a defect of 40 mm, and live birth and preservation of the uterus was achieved.

Outcome:

On the third day of operation, she had a good recovery and was discharged. After a 6-week postpartum follow-up, she displayed a good level of rehabilitation.

Lessons:

Pregnancy after laparoscopic cornuostomy should be treated as high-risk gestation and the rupture during gestation of the uterine scar should be suspected once lower abdominal pain occurred. Swift diagnosis and prompt intervention play a crucial role in saving the lives of the fetus and the mother.
Association between IL8RB C1208T mutation and risk of cancer
Authors: Sun He-Yun , Min Zhi-Chao , Gao Lei , Zhang Zi-Yi , Pang Ting-Le , Gao Ying-Jun , Pan Hong , Ou-Yang Jun
Published: February 2022

Introduction:

The CXC chemokines are unique cytokines that play a vital role in the progression of many cancers. Association between chemokine (C-X-C motif) receptor 2 (IL8RB) C1208T mutation and cancer risk remains incomprehensive.

Methods:

We therefore utilized odds ratios and in silico analysis to explore the relationship of IL8RB polymorphism on risk to cancer. Furthermore, we adopted gene set enrichment analysis to investigate the IL8RB expression in prostate adenocarcinoma.

Results:

A total of 14 case-control studies combined with 5299 cases and 6899 controls were included in our analysis. We revealed that individuals carrying TT genotype had an 14% increased cancer risk compared with those with TC + colon cancer (CC) genotype (odds ratio [OR] = 1.14, 95% CI = 1.05–1.25, P = .003, I
2 = 35.6). Stratification analysis by race showed that East Asians with TT + TC genotype may have a 25% decreased cancer risk compared with control. Stratification analysis by cancer type revealed that individuals with TT genotype were associated with elevated risk of urinary cancer than control. The expression of IL8RB was attenuated in prostate adenocarcinoma.

Conclusions:

IL8RB C1208T may be correlated with the risk of cancer, especially prostate adenocarcinoma.
Effects of compound Danshen dropping pills on adverse cardiovascular events and quality of life after percutaneous coronary intervention in patients with coronary heart disease
Authors: Lv Lina , Yuan Xianying , Jiang Lihong
Published: February 2022

Background:

Percutaneous coronary intervention (PCI) is an important means for the treatment of coronary atherosclerotic heart disease and has effectively reduced the mortality of coronary heart disease. However, reperfusion can also cause certain damage to the vascular endothelium, leading to the major adverse cardiovascular events. Compound Danshen dropping pill is a Chinese patent medicine preparation. At present, many studies have evaluated the effect of compound Danshen dropping pill in reducing the incidence of adverse cardiovascular events after PCI. This study systematically evaluated the effect of compound Danshen dropping pills on major adverse cardiovascular events and quality of life after PCI and provides a reference for clinical application and research.

Methods:

All randomized controlled trials on the effects of compound Danshen dropping pills on adverse cardiovascular events and quality of life after PCI for coronary heart disease were searched for. The search was conducted from database inception to January 2022. Data extraction and quality assessment were performed by 2 reviewers according to the Protocol Guidelines for Systematic Reviews and Meta-analyses Protocols statement guidelines. Meta-analysis was performed using Review Manager Version 5.4 software and Stata 16 software.

Results:

The results of this study will allow for systematically evaluation of the effects of compound Danshen dropping pills on adverse cardiovascular events and quality of life after PCI for coronary heart disease.

Conclusion:

This study will provide objective evidence of a basis for compound Danshen dropping pills reducing adverse cardiovascular events and improving quality of life after PCI.
Retrospective analysis of ten cases of transabdominal follicular aspiration for Oocytes retrieval and cryopreservation in patients with malignant diseases
Authors: Abduljabbar Hassan , Hashim H. , Abduljabar Hanin , Gehad M. , Sabban Husain , Qora Ghada , Rund Nancy Mohamed Ali
Published: February 2022

Introduction:

Oocyte cryopreservation is used to preserve a woman's oocytes. It is a technique that enables females to postpone pregnancy to a later date, for reasons such as medical (cancer treatment) or in some countries for social reasons such as employment or study.

Patient concerns and diagnoses:

Cryopreservation of oocytes in ten young, single, and virgin women with malignant disease

Interventions:

Transabdominal follicular aspiration for oocyte retrieval and cryopreservation

Outcome:

A total of 148 oocytes were retrieved. The number of mature oocytes retrieved were 112. The operative time ranged from 45 minutes to 120 minutes. None of the patients had complications after the procedure.

Conclusion:

Transabdominal ultrasound-guided aspiration can be the modality of choice for women with malignant disease, especially unmarried/ virgin women who desire to retain intact hymen for cultural reasons.
Huge perianal basal cell carcinoma
Authors: Gan Zhi-ming , Xu Jian-hua , Zhang Chao , Luo Ya
Published: February 2022

Introduction:

Basal cell carcinoma (BCC) is a common skin malignancy, but perianal BCC is rare and usually small. Here, we present a patient with a condyloma-like huge perianal BCC.

Patient concerns:

A 60-year-old Chinese man presented with a progressively growing perianal mass that had been growing for 8 years. The diameter of the perianal mass was ultimately up to 7 cm, accompanied by intermittent bleeding.

Diagnosis:

Histopathological evaluation of the punch biopsy specimen revealed BCC.

Interventions:

Total excision of the mass and transverse colostomy was performed. The postoperative pathological result was BCC, but part of the specimen's incisal margin was infiltrated by cancer. Therefore, after a month of recovery, local radiotherapy was started, and the wound healed completely. Stoma reversal was performed 4 months after the surgery.

Outcomes:

Postoperative anal function was satisfactory. The patient was asymptomatic and showed no signs of BCC recurrence one year after surgery.

Conclusion:

We present a case of isolated large perianal BCC in a patient with no known risk factor. As for huge perianal BCC, local wide resection is the preferred treatment. If the wound is large and close to the anus, transverse colostomy is needed. However, it is difficult to ensure a safe incisal margin because of the large size of the tumor; therefore, radiotherapy is also required.
Do Financial Incentives Affect Utilization for Chronically Ill Medicare Beneficiaries?
Authors: Buttorff Christine , Girosi Federico , Lai Julie , Taylor Erin A. , Lewis Sarah E. , Ma Sai , Eibner Christine
Published: February 2022

Objective:

The objective of this study was to examine the price sensitivity for provider visits among Medicare Advantage beneficiaries.

Data Sources:

We used Medicare Advantage encounter data from 2014 to 2017 accessed as part of an evaluation for the Center for Medicare & Medicaid Innovation.

Study Design:

We analyzed the effect of cost-sharing on the utilization of 2 outcome categories: number of visits (specialist and primary care) and the probability of any visit (specialist and primary care). Our main independent variable was the size of the copayment for the visit, which we regressed on the outcomes with several beneficiary-level and plan-level control variables.

Data Collection/Extraction Methods:

We included beneficiaries with at least 1 of 4 specific chronic conditions and matched comparison beneficiaries. We did not require beneficiaries to be continuously enrolled from 2014 to 2017, but we required a full year of data for each year they were observed. This resulted in 371,140 beneficiary-year observations.

Principal Findings:

Copay reductions were associated with increases in utilization, although the changes were small, with elasticities <−0.2. We also found evidence of substitution effects between primary care provider (PCP) and specialist visits, particularly cardiology and endocrinology. When PCP copays declined, visits to these specialists also declined.

Conclusions:

We find that individuals with chronic conditions respond to changes in copays, although these responses are small. Reductions in PCP copays lead to reduced use of some specialists, suggesting that lowering PCP copays could be an effective way to reduce the use of specialist care, a desirable outcome if specialists are overused.
Comparing Gold-standard Copayment and Coinsurance Values From Claims Processing Engines to Values Derived From Behavioral Health Claims Databases
Authors: Friedman Sarah A. , Xu Haiyong , Azocar Francisca , Ettner Susan L.
Published: February 2022

Background:

While researchers use patient expenditures in claims data to estimate insurance benefit features, little evidence exists to indicate whether the resulting measures are accurate.

Objective:

To develop and test an algorithm for deriving copayment and coinsurance values from behavioral health claims data.

Subjects:

Employer-sponsored insurance plans from 2011 to 2013 for a national managed behavioral health organization (MBHO).

Measures:

Twelve benefit features, distinguishing between carve-in and carve-out, in-network and out-of-network, inpatient and outpatient, and copayment and coinsurance, were created. Measures drew from claims (claims-derived measures), and benefit feature data from a claims processing engine database (true measures).

Study Design:

We calculate sensitivity and specificity of the claims-derived measures’ ability to accurately determine if a benefit feature was required and for plan-years requiring the benefit feature, the accuracy of the claims-derived measures. Accuracy rates using the minimum, 25th, 50th, 75th, and maximum claims value for a plan-year were compared.

Principal Findings:

Sensitivity (82% or higher for all but 3 benefit features) and specificity (95% or higher for all but 2 benefit features) were relatively high. Accuracy rates were highest using the 75th or maximum claims value, depending on the benefit feature, and ranged from 69% to 99% for all benefit features except for out-of-network inpatient coinsurance.

Conclusions:

For most plan-years, claims-derived measures correctly identify required specialty mental health copayments and coinsurance, although the claims-derived measures’ accuracy varies across benefit design features. This information should be considered when creating claims-derived benefit features to use for policy analysis.
Utilization and Effectiveness of eHealth Technology in the Follow‐up of Celiac Disease
Authors: Månsson Alice Loft , Meijer‐Boekel Caroline , Mårild Karl
Published: February 2022

Objectives:

To systematically review the literature on the utilization and effectiveness of electronic‐health technologies (eHealth), such as smartphone applications, in managing patients with celiac disease (CD).

Methods:

PubMed, Scopus, and the Cochrane Library were all searched (until February 2021). Inclusion criteria were full‐text English articles reporting original data on the use of eHealth technologies in the follow‐up of CD patients, with no age restriction. Exclusion criteria were studies only using non‐interactive websites and phone consultation as the primary eHealth method. The results were summarized narratively.

Results:

Using identified keywords, 926 unique studies were identified. After title and abstract screening by two independent reviewers, 26 studies were reviewed in full text. Finally, eight studies were included in this systematic review, and their quality appraised using standardized forms. Of the eight studies, six were randomized‐controlled trials, one mixed‐methods study, and one cross‐sectional, observational study. Studies were assessed to be of “low” to “moderate” methodological quality. Studied eHealth technologies included web‐based interventions, smartphone applications, text messaging, and online consultations. The most consistently reported effects related to improved quality of life (number of studies = 4), knowledge on CD (n = 3), and dietary adherence (n = 2); notably, only one study reported reduced costs of eHealth vs. standard (in‐office) care.

Conclusions:

Although eHealth has the potential to improve the management of CD, so far, the research in the field is scarce and generally of low‐moderate methodological quality. Hence, the effectiveness of eHealth in CD management remains uncertain, and more high‐quality evidence is required before its utility is known.
Anaemia in Children Receiving Home Parenteral Nutrition
Authors: Cernat Elena , Ahmad Tania , Hill Susan , Köglmeier Jutta
Published: February 2022

Objectives:

Children receiving home parenteral nutrition (HPN) are at risk of iron deficiency anaemia. Our aim was to determine the incidence of iron deficiency anaemia in paediatric HPN and efficacy of each therapeutic approach.

Methods:

Retrospective data collection from children receiving HPN at a tertiary referral centre over a 12‐month period (2015). Full blood count, and whenever available, ferritin and C‐reactive protein were collected at least 3 times for each patient. Liver function tests were checked at the beginning and end of the study and number of blood transfusions/iron infusions recorded.

Results:

Forty‐one HPN patients (61% girls; 51% motility disorder, 29% enteropathy, 20% short bowel syndrome) were identified. Eighty‐three percent of children were anaemic at the beginning of the study with the number decreasing to 73% by the end. Iron deficiency anaemia was most commonly seen and treated with blood transfusion in 46% of cases and iron infusions in 29%. There was no statistical difference in the level of haemoglobin improvement between the 2 treatments (50% vs 33%, P = 0.657) nor a significant difference in haemoglobin (g/L) level achieved. The results for both were, however, more favourable in the infusion group. Patients receiving transfusions had a significantly higher incidence of abnormal liver function compared with those who hadinfusions (93% vs 37%, P = 0.009).

Conclusions:

Iron deficiency anaemia is common in children receiving HPN. A large proportion of patients still receive blood transfusions as first‐line therapy but intravenous iron can be a suitable alternative. Treatment guidelines are required.
Neonatal Antibiotics and Food Allergy Are Associated With FGIDs at 4–6 Years of Age
Authors: Kamphorst Kim , Vlieger Arine M. , Oosterloo Berthe C. , Garssen Johan , van Elburg Ruurd M.
Published: February 2022

Objectives:

Antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This study aimed to determine whether antibiotics during the first week of life, infantile colic in the first year of life, gut‐associated immune markers at 1 year of age, and allergies at 4–6 years of age in term‐born children were associated with a higher prevalence of FGIDs at 4–6 years of age.

Methods:

A prospective observational cohort of 436 term‐born infants was followed up at the age of 4–6 years; 151 received broad‐spectrum antibiotics (AB+), and 285 healthy controls (AB−). Validated Questionnaire On Pediatric Gastrointestinal Symptoms‐Rome III and International Study of Asthma and Allergy in Childhood questionnaires were sent to parents of 418 available children. The independent t‐test, chi‐squared test or non‐parametric test and logistic multivariate regression analyses were used.

Results:

In total, 340 of 418 (81%) questionnaires were completed. Only the presence of functional abdominal pain was significantly higher in AB+ than AB− (4% vs 0.4%, respectively, P = 0.045). Children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs 9%, P = 0.002 and 7% vs 1%, P = 0.043, respectively) compared to non‐allergic children. No differences in FGIDs existed at the age of 4–6 years between children with and without a history of infantile colic. There were significant differences in gut‐associated immune markers between children with and without FGIDs.

Conclusion:

Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4–6 years. Furthermore, food allergy was associated with IBS and abdominal migraine at 4–6years.
Mechanical Complications in Central Lines Using Taurolidine Versus Ethanol Lock Therapy in Children With Intestinal Failure
Authors: Strauss Jaclyn , Boctor Dana Liza , Silverman Jason A. , Casey Linda
Published: February 2022

Objectives:

Ethanol lock therapy (ELT) is effective in reducing rates of catheter‐related‐bloodstream infections (CRBSI) in the pediatric intestinal failure (IF) population; however, ELT may increase the risk of line occlusion and breakage, significantly impacting preservation of vascular access. During a period of ethanol shortage, Health Canada temporarily approved the use of taurolidine lock therapy (TLT) in pediatric iF patients previously utilizing ELT. This provided a unique opportunity to directly compare rates of central venous catheter (CVC) complications, including CRBSi, breaks, occlusions, repairs and replacements in patients who utilized both ELT and TLT.

Methods:

A retrospective study of pediatric IF patients managed by three Western Canadian intestinal rehabilitation programs was performed. Event rates in patients who used both ELT and TLT during the study period were compared using Poisson regression analysis.

Results:

In 13 patients with 10,187 catheter days (CDs), TLT (vs ELT) had lower rates of CVC breaks (1.11 vs 5.19/1000 CDs, P < 0.001), occlusions (0.83 vs 4.06/1000 CDs, P = 0.01) and repairs (1.94 vs 5.64/1000 CDs, P = 0.01). There was no difference in CRBSI rates (0.83 vs 2.03/1000 CDs, P = 0.25) or rates of CVC replacements due to mechanical events (0.28 vs 1.81/1000 CDs, P = 0.08).

Conclusions:

Although there was no difference in CRBSI rates, TLT was associated with lower rates of mechanical complications compared to ELT in this study. Taurolidine may be a suitable alternative to ethanol in preventing CRBSI and may be associated with improved preservation of central lines in children with IF.
Can We Be at Peace With Unsolvable Suffering? A Qualitative Study Exploring the Effectiveness of Supportive Communication and Resilience Building
Authors: Nagano Hiroaki , Chida Keiko , Ozawa Taketoshi
Published: February 2022

The authors provided six 180-minute interpersonal assistance workshops using teaching materials from the End-of-Life Care Association: 90 minutes each on supportive communication and role-playing. The content included the following:

・ Suffering people are “at peace” with someone who understands their suffering, which starts with building a relationship through empathetic listening. The goal is not to “understand them” but for them to “feel understood.”

・ Realizing the suffering of others and recognizing the internal moral and emotional strength of those who live with suffering.

・ Resilience building: helping caregivers face difficulties even when helpless; remembering one's support networks and valuing oneself.

Participants (n = 114) wrote reflective journals after each session. Two domains and 10 key themes were identified through thematic analysis. The domains comprised topics on the importance of using listening techniques, such as repetition, waiting in silence, and asking questions (not to understand but for dialogue). The 3-month postinterviews revealed that participants could ease their sense of weakness by helping suffering people, which is relevant to work, grief care, and daily life. Changes in relationships between participants and patients were also identified. Role-playing can teach supportive communication, such as listening attentively and accepting others, which may help supporters engage with people experiencing incurable suffering.
The Limited Value of Prior Change in Predicting Future Progression of Juvenile-onset Myopia
Authors: Mutti Donald O. , Sinnott Loraine T. , Brennan Noel A. , Cheng Xu , Zadnik Karla
Published: February 2022

SIGNIFICANCE

Identifying children at highest risk for rapid myopia progression and/or rapid axial elongation could help prioritize who should receive clinical treatment or be enrolled in randomized clinical trials. Our models suggest that these goals are difficult to accomplish.

PURPOSE

This study aimed to develop models predicting future refractive error and axial length using children's baseline data and history of myopia progression and axial elongation.

METHODS

Models predicting refractive error and axial length were created using randomly assigned training and test data sets from 916 myopic participants in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study. Subjects were 7 to 14 years of age at study entry with three consecutive annual visits that included cycloplegic A-scan ultrasound and autorefraction. The effect of adding prior change in axial length and refractive error was evaluated for each model.

RESULTS

Age, ethnicity, and greater myopia were significant predictors of future refractive error and axial length, whereas prior progression or elongation, near work, time outdoors, and parental myopia were not. The 95% limits for the difference between actual and predicted change were ±0.22 D and ±0.14 mm without prior change data compared with ±0.26 D and ±0.16 mm with prior change data. Sensitivity and specificity for identifying fast progressors were between 60.8 and 63.2%, respectively, when the cut points were close to the sample average. Positive predictive value and sample yield were even lower when the cut points were more extreme.

CONCLUSIONS

Young, more myopic Asian American children in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study were the most likely to progress rapidly. Clinical trials should expect average progression rates that reflect sample demographics and may have difficulty recruiting generalizable samples that progress faster than that average. Knowing progression or elongation history does not seem to help the clinical decision regarding initiating myopia control.
Rheological Behavior Patterns in Artificial Tears
Authors: Blasco-Martinez Alejandro , Mateo-Orobia Antonio , Blasco-Alberto Javier , Pablo-Julvez Luis
Published: February 2022

SIGNIFICANCE

Rheological patterns were objectively calculated considering the first and last viscosity, besides the difference of viscosity with a specific shear rate. Shear thinning, shear thickening, thixotropic, and Newtonian behavior patterns were found.

PURPOSE

This study aimed to describe, in an objective way, the rheological behavior of several artificial tears.

METHODS

Seventy-eight artificial tears were included in this experimental analytical study. Its viscous behavior was measured using a cone-plate rheometer. An ascending and descending measurement range was defined for the shear rate from 1 to 1000 s−1 and vice versa. Hysteresis was calculated with the initial and final difference of viscosity. The rheological behavior pattern was calculated as the viscosity difference for the shear rate between 100 and 1000 s−1.

RESULTS

Four rheological patterns with different magnitudes were found: shear thinning, shear thickening, thixotropic, and Newtonian.

CONCLUSIONS

The viscosity of artificial tears always depends on the shear rate. It is possible to find two patterns simultaneously depending on the shear rate. These rheological patterns could serve to optimize the treatment with lubricants for different conditions of the ocular surface. In vivo studies are necessary to evaluate the clinical significance of these findings.
Clinical Report: Correlation of Serum Vitamins and Chalazion
Authors: Cheng Haixia , Lv Xuehua , Yao Jiaqi , Chen Zhijun
Published: February 2022

SIGNIFICANCE

We demonstrate the clinical correlation between the vitamin A level with chalazion in East Chinese children. Vitamin A deficiency is likely to be a potential cause of childhood chalazion.

PURPOSE

Chalazion is the most common lid inflammatory lesion of the eyelid, which can be caused by retention of tarsal gland secretions. Studies have revealed that vitamin deficiency is an essential risk factor for children with chalazion. In this study, we measured the serum levels of vitamin A and 25-hydroxyvitamin D (25(OH)D), in patients with chalazion.

METHODS

The study included 180 subjects (90 patients with chalazion and 90 control healthy subjects) with an average age of 4.13 ± 2.01 years, and 47.8% of whom were female. Serums came from blood samples collected and used to measure the levels of vitamin A and 25(OH)D.

RESULTS

Both groups had statistically similar baseline characteristics, including age and body mass index. The average serum vitamin A levels in patients with chalazion (0.54 ± 0.15 μmol/L) were significantly lower than in their control counterparts (0.60 ± 0.15 μmol/L; P = .01). There was no significant difference in the serum 25(OH)D levels between the patients (70.15 ± 19.73 nmol/L) and control subjects (71.64 ± 24.46 nmol/L). The percentage of vitamin A deficiency in chalazion group (52.2%) was much higher than the control counterparts (28.6%; P = .001). The percentage of 25(OH)D deficiency showed no significant difference between patients with chalazion and control subjects (58.9 vs. 56.7%).

CONCLUSIONS

Low serum vitamin A was significantly associated with chalazion in children. The serum 25(OH)D level exhibited no correlation with chalazion.
Transfusion Ratios and Deficits in Injured Children With Life-Threatening Bleeding*
Authors: Spinella Philip C. , Leonard Julie C. , Marshall Callie , Luther James F. , Wisniewski Stephen R. , Josephson Cassandra D. , Leeper Christine M. ,   for the Massive Transfusion In Children (MATIC) Investigators and BloodNet
Published: February 2022

OBJECTIVES:

To assess the impact of plasma and platelet ratios and deficits in injured children with life-threatening bleeding.

DESIGN:

Secondary analysis of the MAssive Transfusion epidemiology and outcomes In Children study dataset, a prospective observational study of children with life-threatening bleeding events.

SETTING:

Twenty-four childrens hospitals in the United States, Canada, and Italy.

PATIENTS:

Injured children 0–17 years old who received greater than 40 mL/kg total blood products over 6 hours or were transfused under activation of massive transfusion protocol.

INTERVENTION/EXPOSURE:

Weight-adjusted blood product volumes received during the bleeding event were recorded. Plasma:RBC ratio (plasma/RBC weight-adjusted volume in mL/kg) and platelet:RBC ratio (platelet/RBC weight-adjusted volume in mL/kg) were analyzed. Plasma deficit was calculated as RBC mL/kg – plasma mL/kg; platelet deficit was calculated as RBC mL/kg – platelet mL/kg.

MEASUREMENTS AND MAIN RESULTS:

Of 191 patients analyzed, median (interquartile range) age was 10 years (5–15 yr), 61% were male, 61% blunt mechanism, and median (interquartile range) Injury Severity Score was 29 (24–38). After adjusting for Pediatric Risk of Mortality score, cardiac arrest, use of vasoactive medications, and blunt mechanism, a high plasma:RBC ratio (> 1:2) was associated with improved 6-hour survival compared with a low plasma:RBC ratio (odds ratio [95% CI] = 0.12 [0.03–0.52]; p = 0.004). Platelet:RBC ratio was not associated with survival. After adjusting for age, Pediatric Risk of Mortality score, cardiac arrest, and mechanism of injury, 6-hour and 24-hour mortality were increased in children with greater plasma deficits (10% and 20% increased odds of mortality for every 10 mL/kg plasma deficit at 6 hr [p = 0.04] and 24 hr [p = 0.01], respectively); 24-hour mortality was increased in children with greater platelet deficits (10% increased odds of 24-hr mortality for every 10 mL/kg platelet deficit [p = 0.02)]).

CONCLUSIONS:

In injured children, balanced resuscitation may improve early survival according to this hypothesis generating study. Multicenter clinical trials are needed to assess whether clinicians should target ratios and deficits as optimal pediatric hemostatic resuscitation practice.