bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preterm Infant Incubator Humidity Levels
Authors: Glass Laurie , Valdez Anna 
Published: October 2020

Background:
Numerous scholars have reported that inconsistent levels of incubator humidity in the neonatal intensive care unit (NICU) require attention. Evidence synthesis was needed to identify optimal incubator humidity levels and duration to decrease transepidermal water loss (TEWL) and the potential for infection.

Purpose:
The purpose of this systematic review was to appraise and synthesize the evidence of preterm outcomes related to incubator humidity. The primary aim of this study was to determine how patient outcomes were impacted by incubator humidity levels and duration in premature infants born before 320/7 weeks cared for in the NICU.

Methods/Search Strategy:
The foundation of this systematic review was the Joanna Briggs Institute method for systematic reviews. Mefford's theory of health promotion for the preterm infant was used to address the wholeness of the preterm infant's body system. Evidence was classified using the Johns Hopkins evidence-based practice levels and quality of evidence.

Findings:
Twelve studies met inclusion criteria. The evidence demonstrated that the practice of incubator humidity is warranted; however, it does not come without risks. Microbial growth was increased in high levels of incubator humidity. Unnecessary TEWL was prevented by lowering high levels of incubator humidity after the first week of life, improving skin barrier formation.

Implications for Practice:
Incubator humidity of 60% to 70% in the first week of life was effective in preventing TEWL in infants born 26 weeks or more.

Implications for Research:
Future incubator humidity research is needed for infants born before 26 weeks.

Video Abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=39.
Improving the Quality of Nursing Care for Late Preterm Infants
Authors: Lohr Kimberly A. 
Published: October 2020

Background:
Late preterm infants in the Maternal Child Services Department at a Midwestern medical center were cared for in 3 separate nursing units. Standardization of care was a performance goal for the Department.

Purpose:
A quality improvement process was implemented that included planning, teaching, performance application, and evaluation of evidence-based practice guidelines for care of the late preterm infant.

Methods:
A web-based teaching module was developed to introduce nursing care guidelines for late preterm infants to the nursing staff.

Results:
Analysis of the pre-and posttest scores embedded in the educational video showed a statistically significant increase in the nurses' knowledge about potential complications of infants born between 34 and 36 weeks' gestation.

Implications for Practice:
Quality improvement process increases nurses' knowledge about care of the late preterm infant and can lead to standardization of care.

Implications for Research:
Ongoing quality improvement monitoring is needed for sustainability.
A three-microRNA panel in serum as novel biomarker for papillary thyroid carcinoma diagnosis
Authors: Zou Xuan , Gao Feng , Wang Zhi-Yan , Zhang Huo , Liu Qing-Xie , Jiang Lin , Zhou Xin , Zhu Wei 
Published: October 2020

Abstract

Background
Accumulating evidence has revealed that circulating microRNAs (miRNAs) can serve as non-invasive biomarkers for cancer diagnosis. This study aimed to identify differentially expressed miRNAs in serum which might become potential biomarkers for non-invasive diagnosis of papillary thyroid carcinoma (PTC).

Methods
The experiment was carried out between 2015 and 2017. In the screening stage, the Exiqon miRNA quantitative real-time polymerase chain reaction (qPCR) panel was applied to select candidate miRNAs. In the following training, testing, and external validation stages, the serum samples of 100 patients and 96 healthy controls (HCs) were analyzed to compare the expression levels of the identified miRNAs. The areas under the receiver operating characteristic curves (AUCs) were calculated to assess the diagnostic value of the identified signature.

Results
Three miRNAs (miR-25-3p, miR-296-5p, and miR-92a-3p) in serum were consistently up-regulated in PTC patients compared with HCs. A three-miRNA panel was constructed by logistic regression analysis and showed better diagnostic performance than a single miRNA for PTC detection. The AUCs of the panel were 0.727, 0.771, and 0.862 for the training, testing, and external validation stage, respectively. Meanwhile, the panel showed stable capability in differentiating PTC patients from patients with benign goiters, with an AUC as high as 0.969. For further exploration, the three identified miRNAs were analyzed in tissue samples (23 PTC vs. 23 HCs) and serum-derived exosomes samples (24 PTC vs. 24 HCs), and the altered expression in the tumor also indicated their close relationship with PTC disease.

Conclusion
We identify a three-miRNA panel in serum which might serve as a promising biomarker for PTC diagnosis.
Microscale endometrial sampling biopsy in detecting endometrial cancer and atypical hyperplasia in a population of 1551 women: a comparative study with hysteroscopic endometrial biopsy
Authors: Zhang Guo , Wang Yue , Liang Xu-Dong , Zhou Rong , Sun Xiu-Li , Wang Jian-Liu , Wei Li-Hui 
Published: October 2020

Abstract

Background
Endometrial cancer is one of the most common malignancies of the reproductive system. Effective and cost-effective screening method for populations at high risk is not available. This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.

Methods
A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included. Microscale endometrial sampling biopsy was performed, followed by hysteroscopic endometrial biopsy. We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling. Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed, and the medical costs of the two procedures were compared.

Results
The specimen adequacy was 81.2%. Patient age, menopausal status, endometrial thickness, and endometrial lesion type were correlated with specimen adequacy. There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy (kappa 0.950, 95% CI 0.925–0.975). The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy were 91.7%, 100.0%, 100.0%, and 99.3% for endometrial cancer screening, respectively, and 82.0%, 100.0%, 100.0%, and 99.4% for atypical hyperplasia screening. The medical cost of endometrial sampling biopsy was only 22.1% of the cost of hysteroscopic biopsy.

Conclusions
Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination. It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.
Treatment-emergent central sleep apnea: a unique sleep-disordered breathing
Authors: Zhang Jing , Wang Le , Guo Heng-Juan , Wang Yan , Cao Jie , Chen Bao-Yuan 
Published: October 2020

Abstract
Treatment-emergent central sleep apnea (TECSA) is a specific form of sleep-disordered breathing, characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea. The purpose of this review was to summarize the definition, epidemiology, potential mechanisms, clinical characteristics, and treatment of TECSA. We searched for relevant articles up to January 31, 2020, in the PubMed database. The prevalence of TECSA varied widely in different studies. The potential mechanisms leading to TECSA included ventilatory control instability, low arousal threshold, activation of lung stretch receptors, and prolonged circulation time. TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure (CPAP). However, central apneas persist even with the regular CPAP therapy in some patients, and new treatment approaches such as adaptive servo-ventilation may be necessary. We concluded that several questions regarding TECSA remain, despite the findings of many studies, and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities. Further, it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
Clinical characteristics of early and late drug-eluting stent in-stent restenosis and mid-term prognosis after repeated percutaneous coronary intervention
Authors: Zheng Jian-Feng , Guo Ting-Ting , Tian Yuan , Wang Yong , Hu Xiao-Ying , Chang Yue , Qiu Hong , Dou Ke-Fei , Tang Yi-Da , Yuan Jin-Qing , Wu Yong-Jian , Yan Hong-Bing , Qiao Shu-Bin , Xu Bo , Yang Yue-Jin , Gao Run-Lin 
Published: October 2020

Abstract

Background:
The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis (DES-ISR) have not been fully clarified. Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap.

Methods:
A total of 250 patients who underwent initial stent implantation in our hospital, and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved. The patients were categorized as early ISR (<12 months; E-ISR; n = 32) and late ISR (≥12 months; L-ISR; n = 218). Associations between patient characteristics and clinical performance, as well as clinical outcomes after a repeated percutaneous coronary intervention (PCI) were evaluated. Primary composite endpoint of major adverse cardiac events (MACEs) included cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR).

Results:
Most baseline characteristics are similar in both groups, except for the period of ISR, initial pre-procedure thrombolysis in myocardial infarction, and some serum biochemical indicators. The incidence of MACE (37.5% vs. 5.5%; P < 0.001) and TLR (37.5% vs. 5.0%; P < 0.001) is higher in the E-ISR group. After multivariate analysis, E-ISR (odds ratio [OR], 13.267; [95% CI 4.984–35.311]; P < 0.001) and left ventricular systolic dysfunction (odds ratio [OR], 6.317; [95% CI 1.145–34.843]; P = 0.034) are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months.

Conclusions:
Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients. The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.
Nationwide Study of Short-term Exposure to Fine Particulate Matter and Cardiovascular Hospitalizations Among Medicaid Enrollees
Authors: deSouza Priyanka , Braun Danielle , Parks Robbie M. , Schwartz Joel , Dominici Francesca , Kioumourtzoglou Marianthi-Anna 
Published: October 2020

Background:
Fine particulate matter (PM2.5) has been consistently linked to cardiovascular disease (CVD). Although studies have reported modification by income, to our knowledge, no study to date has examined this relationship among adults in Medicaid, which provides health coverage to low-income and/or disabled Americans.

Methods:
We estimated the association between short-term PM2.5 exposure (average of PM2.5 on the day of hospitalization and the preceding day) and CVD admissions rates among adult Medicaid enrollees in the continental United States (2000–2012) using a time-stratified case–crossover design. We repeated this analysis at PM2.5 concentrations below the World Health Organization daily guideline of 25 μg/m3. We compared the PM2.5–CVD association in the Medicaid ≥65 years old versus non-Medicaid-eligible Medicare enrollees (≥65 years old).

Results:
Using information on 3,666,657 CVD hospitalizations among Medicaid adults, we observed a 0.9% (95% CI = 0.6%, 1.1%) increase in CVD admission rates per 10 μg/m3 PM2.5 increase. The association was stronger at low PM2.5 levels (1.3%; 95% CI = 0.9%, 1.6%). Among Medicaid enrollees ≥65 years old, the association was 0.9% (95% CI = 0.6%, 1.3%) vs. 0.8% (95% CI = 0.6%, 0.9%) among non-Medicaid-eligible Medicare enrollees ≥65 years old.

Conclusion:
We found robust evidence of an association between short-term PM2.5 and CVD hospitalizations among the vulnerable subpopulation of adult Medicaid enrollees. Importantly, this association persisted even at PM2.5 levels below the current national standards.
Quantifying Lifecourse Drivers of International Migration
Authors: Zeki Al Hazzouri Adina , Zhang Lanyu , Murchland Audrey R. , Grasset Leslie , Torres Jacqueline M. , Jones Richard N , Wong Rebeca , Glymour M. Maria 
Published: October 2020

Background:
Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder–mediators of the effect of migration on health.

Methods:
We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

Results:
Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

Conclusions:
Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.
SUSPECTED INTRAUTERINE INJURY CAUSING ABUSIVE OCULAR TRAUMA
Authors: Bakhsh Saaquib R. , Reddy Devasis N. , Wa Christianne A. , Lee Ramon , Faia Lisa , Trese Michael T. 
Published: October 2020

Purpose:
The purpose of this report is to describe a patient who has fluorescein angiographic evidence and retinal changes suspicious for intrauterine abusive ocular trauma.

Methods:
A case report of a premature ward of the state with no prenatal care and a presentation suspicious for intrauterine abusive ocular trauma. We performed serial ophthalmologic examinations, reviewed available prenatal history with the infant's social worker, and all relevant hospital notes, laboratory results, and imaging results.

Results:
After initial empiric treatment for possible viral retinitis in the setting of a positive urine cytomegalovirus, repeat examinations demonstrated fluorescein angiographic evidence and clinical findings suspicious for abusive ocular trauma including neovascularization and no evidence of retinitis; therefore, the child was treated with laser photocoagulation.

Conclusion:
At-risk newborns will benefit from an examination of the retinal periphery and wide field fluorescein angiography. Intrauterine abusive ocular trauma should be included in the differential of retinal hemorrhage and avascular retinal periphery. It is imperative for clinicians to recognize this presentation to prevent progression of associated visual morbidity.
Simple Oral Mucosal Epithelial Transplantation in a Patient With Bilateral Limbal Stem Cell Deficiency
Authors: Kara Necip , Dogan Levent 
Published: October 2020

Purpose:
To present management of a patient with bilateral limbal stem cell deficiency (LSCD) by using “simple oral mucosal epithelial transplantation” (SOMET) technique.

Methods:
Case report.

Results:
A 65-year-old female diagnosed with bilateral LSCD based on clinical findings. After stabilizing the ocular surface, we performed SOMET in the right eye. At 13 months postoperatively, visual acuity improved from counting fingers to 10/100 and a stable epithelium with regressed corneal vascularization was observed.

Conclusions:
This report showed that SOMET seems to be an alternative technique in LSCD.
Novel Method to Determine Target Refraction in Cataract Surgery for Patients Dependent on Therapeutic Scleral Lenses
Authors: Ma Kevin K. , Luo Zhonghui K. 
Published: October 2020

Objectives:
To evaluate a novel approach to determine the refractive target for patients undergoing cataract surgery who are dependent on therapeutic scleral lenses, to avoid the need for postoperative scleral lens replacement.

Methods:
Retrospective single-surgeon case series. The target refraction for intraocular lens selection was determined by considering the effective scleral lens system power. This was calculated by adding the known scleral lens spherical power to the difference between the scleral lens base curve and the average keratometry value.

Results:
Six eyes from three patients with moderate myopia or emmetropia with ocular graft versus host disease dependent on therapeutic scleral lenses underwent cataract surgery with intraocular lens selection based on this method. All six eyes had corrected visual acuities of 20/30 or better while wearing their previous scleral lenses at the postoperative week 1 visit. All six eyes resumed full-time scleral lens use 1 week after phacoemulsification and did not require scleral lens replacement.

Conclusions:
Using this method, patients requiring therapeutic scleral lenses can quickly experience optimal vision, comfort, and ocular surface protection 1 week after cataract surgery. These patients can continue to use their existing scleral lenses and avoid the costs and burdens associated with lens replacement.
Scleral Lens Use in Neurotrophic Keratopathy: A Review of Current Concepts and Practice
Authors: Witsberger Emily , Schornack Muriel 
Published: October 2020

Objective:
Neurotrophic keratopathy (NK) is a rare corneal condition characterized by epitheliopathy, which is associated with reduced or absent corneal sensation. The main goal of treatment of this condition is the preservation of ocular surface integrity. Contact lenses provide a nonsurgical and reversible option to provide the necessary corneal protection. The purpose of this review was to summarize the available literature regarding the use of contact lenses in the management of NK, with particular emphasis on the use of scleral lenses.

Methods:
Literature related to both soft and scleral contact lens use as treatment options for NK was reviewed.

Results:
As of yet, randomized clinical trials have compared neither the efficacy of contact lens therapy for NK to other therapeutic alternatives nor outcomes of therapy with different contact lens modalities. However, clinical case reports and limited case series have suggested that scleral lenses may be a safe and effective treatment option for NK at any stage of the disease, preserving epithelial integrity and even improving visual function in patients with this condition.

Conclusions:
Scleral lenses may be effective in reducing the need for surgical intervention and improving the quality of life in patients with NK.
The Role of Antifungal Prophylaxis After Receipt of a Positive Donor Rim Fungal Culture: The Case for Not Routinely Treating Prophylactically
Authors: Price Francis W. 
Published: October 2020

Abstract:
Studies conducted in the United States suggest that 1% to 2% of corneal donor rims culture positive for fungus; the fungal agent is usually Candida, and the risk of an endothelial keratoplasty recipient developing an intraocular fungal infection is approximately 7% (1 in 15) if the donor rim was culture-positive. Routine culturing of corneal donor rims is useful because a positive fungal culture alerts the surgeon to carefully monitor the keratoplasty recipient for any signs of fungal infection. However, routine implementation of antifungal prophylaxis on receipt of a positive culture is problematic because there is a lack of definitive data regarding the optimal route of administration, necessary duration of prophylaxis, and relative efficacy of different antifungal agents. The use of topical prophylaxis alone has not been proven to be effective, and the systemic agents that are effective against Candida typically involve an azole, which has many side effects, including liver toxicity and potential interactions with other drugs. The data suggest that routine antifungal prophylaxis would needlessly expose 14 patients to systemic side effects for each person who would directly benefit. Treatment of postkeratoplasty fungal infection typically involves graft replacement, but selective removal of the involved area(s) has been used successfully with Descemet membrane endothelial keratoplasty.
Anatomical Changes in the Anterior Chamber Volume After Descemet Membrane Endothelial Keratoplasty
Authors: Onouchi Hiromi , Hayashi Takahiko , Shimizu Toshiki , Matsuzawa Akiko , Suzuki Yasuyuki , Kato Naoko 
Published: October 2020

Purpose:
To evaluate changes in the anterior chamber of eyes that have undergone Descemet membrane endothelial keratoplasty (DMEK) and to identify factors that affect these changes.

Methods:
This retrospective study included 25 pseudophakic eyes of 25 patients who underwent DMEK. We determined the preoperative and postoperative values of the best spectacle-corrected visual acuity, spherical equivalent (SE), anterior chamber volume (ACV), anterior chamber depth (ACD), central corneal thickness (CCT), and scleral spur angle (SSA) evaluated using anterior segment optical coherence tomography and iris damage score and iris posterior synechiae score. We defined ∆ as the average change rate from the preoperative to postoperative value for each factor at 1 month (SE at 6–12 months) postoperatively. We also analyzed correlations between ∆ACV, ∆SE, and other preexisting factors.

Results:
Compared with the preoperative ACV value (128 ± 28 mm3), the postoperative value significantly increased to 155 ± 21 mm3 (P < 0.001); ∆SE was +1.01 ± 1.09 diopters. ∆ACV was negatively correlated with preoperative ACD (R = 0.643, P < 0.001) and SSA (R = 0.555, P = 0.001) and positively correlated with ∆ACD (R = 0.799, P < 0.001) and ∆SSA (R = 0.608, P < 0.001). ∆CCT, iris damage score, and iris posterior synechiae score were not significantly correlated with ∆ACV. ∆SE was positively correlated with ∆ACV, ∆ACD, and ∆SSA (R = 0.680, 0.455, and 0.478; P < 0.001, <0.05, and <0.05, respectively).

Conclusions:
An increase in the ACV and hyperopic change was noted after successful DMEK, especially in eyes with narrow-angled shallow anterior chambers.