bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheostomy During the COVID‐19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries
Authors: Bier‐Laning Carol , Cramer John D. , Roy Soham , Palmieri Patrick A. , Amin Ayman , Añon José Manuel , Bonilla‐Asalde Cesar A. , Bradley Patrick J. , Chaturvedi Pankaj , Cognetti David M. , Dias Fernando , Di Stadio Arianna , Fagan Johannes J. , Feller‐Kopman David J. , Hao Sheng‐Po , Kim Kwang Hyun , Koivunen Petri , Loh Woei Shyang , Mansour Jobran , Naunheim Matthew R. , Schultz Marcus J. , Shang You , Sirjani Davud B. , St. John Maie A. , Tay Joshua K. , Vergez Sébastien , Weinreich Heather M. , Wong Eddy W. Y. , Zenk Johannes , Rassekh Christopher H. , Brenner Michael J. 
Published: November 2020

ObjectiveThe coronavirus disease 2019 (COVID‐19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID‐19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID‐19 pandemic.Data SourcesProtocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low‐ and middle‐income countries, 23 published or society‐endorsed protocols, and 36 institutional protocols.Review MethodsThe comparative document analysis involved cross‐sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management.ConclusionsTiming of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID‐19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID‐19 test results.Implications for PracticeWide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence‐based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
Hormonal Outcomes Following Hemithyroidectomy
Authors: Buehler Lauren Anne , Madhun Nabil Zuhayr , Bena James , Nasr Christian , Scharpf Joseph , Zhou Keren 
Published: November 2020

ObjectiveTo assess hormonal outcomes and thyroid hormone (TH) replacement after hemithyroidectomy (HT).Study DesignRetrospective chart review.SettingQuaternary care hospital system.MethodsA retrospective analysis was performed on patients who had an HT at Cleveland Clinic between 2000 and 2010 with outcomes assessed up to 5 years post‐HT. Patients with overt hypothyroidism (OH; thyroid‐stimulating hormone [TSH] >10 mIU/L, TSH >4.2 mIU/L on thyroid hormone [TH]), subclinical hypothyroidism (SH; TSH >4.2‐10 mIU/L, no TH), or euthyroidism (EU; TSH 0.4‐4.2 mIU/L, no TH) were compared. Patients with SH who returned to EU were compared to those who continued to have SH. For immediate start on TH, a receiver operating characteristic analysis was performed to determine dosage of TH above which suppression of TSH <0.4 mIU/L was predicted.ResultsWe identified 335 patients (average age 51 years, 78% female, median follow‐up of 50 months). Of the 210 not immediately started on TH, 32.4% were OH, 13.3% were SH, and 54.3% were EU. EU patients were younger (48 years), had more remaining gland, were less likely to have lymphocytic infiltrate, and had a lower preoperative TSH (1.2 mIU/L). In the SH group, 58.3% of patients normalized their TSH. With immediate TH start, 45% developed suppressed TSH. Those on LT4 >1.05 mcg/kg/d were more likely to suppress (sensitivity 89%).ConclusionMost patients post‐HT will remain EU, and immediate start of TH may lead to TSH suppression. Those with SH may ultimately normalize TSH. These findings together suggest that observation may be a better option than TH replacement after HT.
Coagulation States in Patients With Sudden Sensorineural Hearing Loss Evaluated by Thromboelastography
Authors: Li Chunyan , Zhou Huiqun , Feng Yanmei , Zhao Yan , Wang Jingjing , Chen Zhengnong , Yin Shankai 
Published: November 2020

ObjectiveThe state of coagulation is controversial in patients with sudden sensorineural hearing loss (SSNHL). We used thromboelastography (TEG) to explore the relationships between blood coagulation parameters and SSNHL pathogenesis and recovery.Study DesignProspective study.SettingAffiliated Sixth People’s Hospital, Shanghai Jiao Tong University.MethodsA total of 104 newly diagnosed patients with SSNHL and 29 matched healthy controls were recruited. Hearing assessments, TEG, and conventional coagulation tests (CCTs) were performed, followed by standard treatments and follow‐up.ResultsThe TEG parameters of patients with SSNHL were in the normal range, but the group exhibited a significantly prolonged kinetic time (K; P =. 004) and a smaller angle (P =. 003) as compared with the controls. After grouping the patients with SSNHL according to audiograms and comparing them in pairs, we found that the differences were significant only when controls were compared with patients with low‐frequency SSNHL (K, P =. 023; angle, P =. 04) and flat‐type SSNHL (K, P =. 017; angle, P =. 014). Logistic regression analysis showed that neither TEG nor CCT parameters significantly affected hearing improvement after SSNHL treatment.ConclusionsAlthough the K value and angle were significantly increased and significantly reduced, respectively, in the test group as compared with the control group, the state of coagulation in patients with SSNHL was still within the normal range. No CCT or TEG coagulation parameters (except the angle) differed significantly among patients in each group according to hearing recovery status, which suggested that the coagulation status does not determine the prognosis of patients with SSNHL.
Revisiting the Recommendation for Contralateral Tonsillectomy in HPV‐Associated Tonsillar Carcinoma
Authors: Parhar Harman S. , Shimunov David , Brody Robert M. , Cannady Steven B. , Newman Jason G. , O’Malley Bert W. , Chalian Ara A. , Rassekh Christopher H. , Weinstein Gregory S. , Rajasekaran Karthik 
Published: November 2020

ObjectiveDespite epidemiologic evidence that second primaries occur infrequently in HPV (human papillomavirus)–associated oropharyngeal squamous cell carcinoma, recent recommendations advocate for elective contralateral palatine tonsillectomy. We aimed to study this discordance and define the necessary extent of up‐front surgery in a large contemporary cohort with long‐term follow‐up treated with unilateral transoral robotic surgery. We hypothesized that second primaries are discovered exceedingly rarely during follow‐up and that survival outcomes are not compromised with a unilateral surgical approach.Study DesignRetrospective cohort analysis.SettingTertiary care academic center between 2007 and 2017.MethodsRecords for patients with p16‐positive oropharyngeal squamous cell carcinoma of the tonsil and workup suggestive of unilateral disease who underwent ipsilateral transoral robotic surgery were analyzed for timing and distribution of locoregional recurrence, distant metastases, and second primary occurrence as well as survival characteristics.ResultsAmong 295 included patients, 21 (7.1%) had a locoregional recurrence; 17 (5.8%) had a distant recurrence; and 3 (1.0%) had a second primary during a median follow‐up of 48.0 months (interquartile range, 29.5‐62.0). Only 1 (0.3%) had a second primary found in the contralateral tonsil. The 2‐ and 5‐year estimates of overall survival were 95.5% (SE, 1.2%) and 90.1% (SE, 2.2%), respectively, while the 2‐ and 5‐year estimates of disease‐free survival were 90.0% (SE, 1.8%) and 84.7% (SE, 2.3%).ConclusionSecond primary occurrence in the contralateral tonsil was infrequent, and survival outcomes were encouraging with unilateral surgery. This provides a rationale for not routinely performing elective contralateral tonsillectomy in patients whose workup suggests unilateral disease.
Search Trends and Quality of Online Resources Regarding Thyroidectomy
Authors: Chen Lena W. , Harris Vandra Chatrice , Jia Justin Lee , Xie Deborah Xingchun , Tufano Ralph Patrick , Russell Jonathon Owen 
Published: November 2020

ObjectiveThyroidectomy is one of the most common procedures performed in head and neck surgery. The quality of online resources for thyroidectomy is unknown. We aim to evaluate search trends and online resource quality regarding thyroidectomy.Study DesignCross‐sectional analysis.SettingWebsites appearing on Google search.MethodsThe first 30 Google websites for thyroidectomy were reviewed, excluding research, video, and restricted sites. Search patterns were obtained with Google Trends. Quality was measured by readability (Flesch Reading Ease and Flesch‐Kinkaid Grade Level), understandability and actionability (Patient Education Materials Assessment Tool), and clinical practice guideline (CPG) compatibility. Fleiss kappa interrater reliability analysis was performed for 2 raters.ResultsTwenty‐one sites were evaluated. Search popularity for thyroidectomy has increased since 2004. Median reading ease was 42.2 (range, 15.4‐62.7) on a scale from 1 to 100, with 100 indicating maximum readability. Median reading grade level was 12 (range, 7‐16). Thyroidectomy resources were poorly understandable (median, 66%; range, 21%‐88%) and actionable (median, 10%; range, 0%‐60%). Median CPG compatibility was 4 out of 5 (range, 0‐5). Interrater reliability ranged from substantial to moderate for understandability (0.78), actionability (0.57), and CPG compatibility (0.58), with P <. 05 for all results.ConclusionOnline resources about thyroidectomy vary in quality and reliability and are written at grade levels above the average reading level of the public. Providers should be aware of existing resources and work to create education resources that meet universal health literacy guidelines. The framework provided in this article may also serve as a guide and provide tangible steps that providers can take to help patients access care.
Biomarkers as predictors of renal damage in neonates undergoing cardiac surgery
Authors: Borchert Evelyn , de la Fuente René , Guzmán Ana María , González Katia , Rolle Augusto , Morales Karina , González Rodrigo , Jalil Roberto , Lema Guillermo 
Published: November 2020

Background: Acute Kidney Injury is a complication in children with heart disease undergoing cardiac surgery with cardiopulmonary bypass. The aim of this study is to describe the behavior of KIM-1 (Kidney Injury Molecule) and NGAL (Neutrophil Gelatinase Associated Lipocalin) as early predictors of renal damage, comparing them with serum creatinine and creatinine clearance, in neonates undergoing cardiac surgery. Methods: Twenty-one (21) neonates, under 4 kg, with complex congenital heart diseases, RACHS-1 > 3, without preoperative renal failure, were studied. Serum creatinine and creatinine clearance were measured preoperatively and at 24, 48, 72, 96 hours postoperatively. Urinary samples of KIM-1(pg/ml) and NGAL (ng/ml) were collected after induction of anesthesia at 24 and 48 hours post-operatively. Results: nRIFLE criteria were used to divide cohorts in “NO AKI” (12 patients) and “AKI” (nine patients). In the AKI group, serum creatinine increased significantly and creatinine clearance decreased significantly at 24, 48, and 72 hours compared with their respective baseline values. There was no difference in KIM-1 and NGAL values between patients who developed AKI and those who did not at any measured time. Conclusions: The deterioration of renal function continues to be one of the most frequent complications in this population. In our study, biomarkers did not show any correlation with the appearance of AKI. It remains to be seen whether this behavior of the biomarkers is linked with the non-consistent release of these types of molecules in immature kidneys. It is likely that a larger panel of biomarkers together with other glomerular filtration rate assessment methods will provide more information about AKI diagnosis.
Radiological Society of North America (RSNA) Expert Consensus Statement Related to Chest CT Findings in COVID-19 Versus CO-RADS: Comparison of Reporting System Performance Among Chest Radiologists and End-User Preference
Authors: O’ Neill Siobhan B. , Byrne Danielle , Müller Nestor L. , Jalal Sabeena , Parker William , Nicolaou Savvas , Bilawich Ana-Maria 
Published: November 2020

Purpose: The RSNA expert consensus statement and CO-RADS reporting system assist radiologists in describing lung imaging findings in a standardized manner in patients under investigation for COVID-19 pneumonia and provide clarity in communication with other healthcare providers. We aim to compare diagnostic performance and inter-/intra-observer among chest radiologists in the interpretation of RSNA and CO-RADS reporting systems and assess clinician preference. Methods: Chest CT scans of 279 patients with suspected COVID-19 who underwent RT-PCR testing were retrospectively and independently examined by 3 chest radiologists who assigned interpretation according to the RSNA and CO-RADS reporting systems. Inter-/intra-observer analysis was performed. Diagnostic accuracy of both reporting systems was calculated. 60 clinicians participated in a survey to assess end-user preference of the reporting systems. Results: Both systems demonstrated almost perfect inter-observer agreement (Fleiss kappa 0.871, P < 0.0001 for RSNA; 0.876, P < 0.0001 for CO-RADS impressions). Intra-observer agreement between the 2 scoring systems using the equivalent categories was almost perfect (Fleiss kappa 0.90-0.92, P < 0.001). Positive predictive values were high, 0.798-0.818 for RSNA and 0.891-0.903 CO-RADS. Negative predictive value were similar, 0.573-0.585 for RSNA and 0.573-0.58 for CO-RADS. Specificity differed between the 2 systems, 68-73% for CO-RADS and 52-58% for RSNA with superior specificity of CO-RADS. Of 60 survey participants, the majority preferred the RSNA reporting system rather than CO-RADS for all options provided (66.7-76.7%; P < 0.05). Conclusions: RSNA and CO-RADS reporting systems are consistent and reproducible with near perfect inter-/intra-observer agreement and excellent positive predictive value. End-users preferred the reporting language in the RSNA system.
“I Did It to Save My Children”: Parenting Strengths and Fears of Women Exposed to Intimate Partner Violence
Authors: Scrafford Kathryn E. , Miller-Graff Laura E. , Umunyana Aimee Gladys , Schwartz Laura E. , Howell Kathryn H. 
Published: November 2020

Intimate partner violence (IPV) is experienced by one in four women in the United States, and a wealth of quantitative research has underscored its detrimental effects on women’s mental health and parenting practices. Little research, however, has considered ways in which women exposed to IPV retain and foster parenting strengths and ways in which motherhood serves as a source of resilience for these women. The objective of the current study was to conduct a thematic analysis of IPV-exposed women’s parenting strengths and concerns as reported through focus groups conducted with IPV-exposed women ( n = 22) and service providers ( n = 31) in two urban areas in the Mid-West and Mid-South. Results of the thematic analysis indicated the emergence of three core themes: resilience and challenges of parenting in the context of IPV, leaving the violent partner, and intergenerational processes. Overall, service providers recognized far fewer strengths in parenting on all dimensions than did women, suggesting that service providers may be conceptualizing parenting in the context of IPV from a deficit model that underestimates the resilience demonstrated by these women. This has important consequences for the extent to which women may feel stigmatized or blamed when receiving resources and services critical to their families. Future research on parenting among women experiencing IPV would be enhanced by capturing the dynamic interplay between women’s parenting strengths and challenges, and the ways in which these capacities are affected by resource access within and across social ecological contexts.
Clinical characteristics and risk factors for severity of COVID-19 outside Wuhan: a double-center retrospective cohort study of 213 cases in Hunan, China
Authors: Hu Xingsheng , Hu Chunhong , Yang Yong , Chen Juan , Zhong Ping , Wen Yajing , Chen Xiangyu 
Published: November 2020

Aim: To investigate clinical characteristics and identify risk factors for severity of coronavirus disease 2019 (COVID-19) pneumonia outside of Wuhan, China. Materials and methods: We included 213 patients with confirmed COVID-19 who had been discharged or died by 15 March 2020. We retrospectively collected epidemiological, clinical, laboratory, computed tomography imaging and outcome data. Clinical characteristics were described and relative risk factors were compared. Results: Most clinical characteristics of this study were similar to those from studies in Wuhan, but there were lower mortality rate and milder severity. The median time from onset of symptoms to confirmation and hospitalization was 4 and 5 days, respectively. The median virus clearance and shedding times were 10 and 15 days, respectively. When the severe/critical group was compared with the mild/moderate group, significant risk factors included: older age; dyspnea; hypertension; poor appetite; fatigue; higher white cell count, neutrophil count, prothrombin time, creatine kinase, creatine kinase-MB, D-dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and C-reactive protein; and lower lymphocyte count and albumin ( p < 0.05). In the intensive care unit (ICU) group compared with the non-ICU group, risk factors included: older age; chronic obstructive pulmonary disease (COPD); dyspnea; poor appetite; higher white cell count, D-dimer, ALT, AST and LDH; and lower lymphocyte count and albumin ( p < 0.05). Independent risk factors associated with the severe/critical group were dyspnea [odds ratio (OR) = 19.48], ALT (OR = 6.02) and albumin (OR = 3.36). Independent risk factors associated with the ICU group were dyspnea (OR = 8.88), COPD (OR = 31.80), D-dimer (OR = 8.37), ALT (OR = 28.76) and LDH (OR = 9.95) ( p < 0.05). Conclusion: The severity of COVID-19 outside Wuhan, China was milder than that within Wuhan. The clinical infective period was long, and the longest virus shedding time was 35 days. The most important risk factors were dyspnea, COPD, D-dimer, ALT, LDH and albumin. The reviews of this paper are available via the supplemental material section.
MiR‐193‐3p attenuates the vascular remodeling in pulmonary arterial hypertension by targeting PAK4
Authors: Wu Zhenhua , Geng Jie , Qi Yujuan , Li Jian , Bai Yaobang , Guo Zhigang 
Published: November 2020

Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease associated with dysfunction of pulmonary artery endothelial cells and pulmonary artery smooth muscle cells (PASMCs). To explore the potential mechanism of miR‐193‐3p in pulmonary arterial hypertension, human PASMCs and rats were respectively stimulated by hypoxia and monocrotaline to establish PAH model in vivo and in vitro. The expressions of miR‐193‐3p and p21‐activated protein kinase 4 (PAK4) in the lung samples of PAH patients and paired healthy samples from the healthy subjects in PHA cells and rats were detected by quantitative reverse transcriptase‐PCR. Morphological changes in lung tissues were determined using hematoxylin and eosin staining. Right ventricular systolic pressure (RVSP) and ratio of right ventricle to left ventricle plus septum (RV/LV p S) were measured. The binding relationship between miR‐193‐3p and PAK4 was analyzed by TargetScan and verified by luciferase reporter assay. Cell viability, apoptosis, and migration were detected by 3‐(4, 5‐Dimethylthiazol‐2‐ yl)‐2,5‐diphenyltetrazolium bromide (MTT) flow cytometry, and wound‐healing assays, respectively. The protein expressions of PAK4, proliferating cell nuclear antigen (PCNA), P21, p‐AKT, and AKT in vivo or in vitro were determined by Western blot. In this study, we found that in pulmonary arterial hypertension, miR‐193‐3p expression was downregulated and PAK4 expression was up‐regulated. MiR‐193‐3p directly targeted PAK4 and negatively regulated its expression. Hypoxia condition promoted cell proliferation, migration, and inhibited apoptosis accompanied with increased expressions of PCNA and p‐AKT/AKT and decreased expression of P21 in PASMCs. MiR‐193‐3p overexpression attenuated the effects of hypoxia on PASMCs via downregulating PAK4. Monocrotaline treatment increased p‐AKT/AKT and decreased P21 expression and caused pulmonary vascular remodeling in the model rats. MiR‐193‐3p overexpression attenuated pulmonary vascular remodeling, decreased p‐AKT/AKT, and increased P21 levels via downregulating PAK4 in monocrotaline‐induced rats. The results in this study demonstrated that upregulation of miR‐193‐3p reduced cell proliferation, migration, and apoptosis of PAH in vitro and pulmonary vascular remodeling in PAH in vivo through downregulating PAK4.
A Pilot Study on Playback Theatre as a Therapeutic Aid after Natural Disasters: Brain Connectivity Mechanisms of Effects on Anxiety
Authors: Munjuluri Sarat , Bolin Peter K. , Amy Lin Y. T. , Garcia Nina L. , Gauna Leslie , Nguyen Tien , Salas Ramiro 
Published: November 2020

Background Natural disasters can affect mental health and result in symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD). Playback Theatre (PT) is a form of improvisation where actors play-back personal stories told by audience members. Whether PT can be therapeutic in post-disaster settings is not known. Method We used a series of PT performances and studied levels of depression, anxiety, and PTSD symptoms in a sample of 13 people affected by Hurricane Harvey that happened in Houston, TX, August 2017. Brain imaging, specifically resting state functional connectivity of the amygdala was also studied before and after the PT performances. Results Both anxiety ( p = .001, Cohen’s d = –1.25) and PTSD ( p = .002, Cohen’s d = –1.0) symptoms significantly decreased after a series of 4 PT performances from January 2019 – February 2019. Depression reduction was not significant. We performed resting state functional connectivity (RSFC) MRI before and after the series of performances. We used the right and left amygdala as seeds for RSFC analysis and found that the connectivity between the left amygdala and the bilateral supramarginal gyri was increased after PT. The bilateral supramarginal connectivity with the default mode and the saliency networks increased too, which correlated with reduction in anxiety scores. Conclusions PT may offer a form of intervention for anxiety caused by disasters. An increase in left amygdala/supramarginal gyri connectivity may be the underlying mechanism.