bluuebunny/crossref_metadata_2025_split huggingface dataset:
Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice
Authors: Paul Caroline Rose , Joyce Alanna Higgins , Dallaghan Gary Beck , Keeley Meg , Lehmann Corinne , Schmidt Suzanne , Simonsen Kari , Christy Cynthia 
Published: July 2020

Abstract
Background
Acute otitis media (AOM) is the most frequent indication for antibiotic treatment of children in the United States. Its diagnosis relies on visualization of the tympanic membrane, a clinical skill acquired through a deliberate approach. Instruction in pediatric otoscopy begins in medical school. Medical students receive their primary experience with pediatric otoscopy during the required pediatric clerkship, traditionally relying on an immersion, apprentice-type learning model. A better understanding of their preceptors’ clinical and teaching practices could lead to improved skill acquisition. This study investigates how pediatric preceptors (PP) and members of the Council on Medical Student Education in Pediatrics (COMSEP) perceive teaching otoscopy.
Methods
A 30-item online survey was administered to a purposeful sample of PP at six institutions in 2017. A comparable 23-item survey was administered to members through the 2018 COMSEP Annual Survey. Only COMSEP members who identified themselves as teaching otoscopy to medical students were asked to complete the otoscopy-related questions on the survey.
Results
Survey respondents included 58% of PP (180/310) and 44% (152/348) of COMSEP members. Forty-one percent (62/152) of COMSEP member respondents identified themselves as teaching otoscopy and completed the otoscopy-related questions. The majority agreed that standardized curricula are needed (PP 78%, COMSEP members 97%) and that all graduating medical students should be able to perform pediatric otoscopy (PP 95%, COMSEP members 79%). Most respondents reported usefulness of the American Academy of Pediatrics (AAP) AOM guidelines (PP 95%, COMSEP members 100%). More COMSEP members than PP adhered to the AAP’s diagnostic criteria (pediatric preceptors 42%, COMSEP members 93%). The most common barriers to teaching otoscopy were a lack of assistive technology (PP 77%, COMSEP members 56%), presence of cerumen (PP 58%, COMSEP members 60%), time to teach in direct patient care (PP 46%, COMSEP members 48%), and parent anxiety (PP 62%, COMSEP members 54%).
Conclusions
Our study identified systemic and individual practice patterns and barriers to teaching pediatric otoscopy. These results can inform education leaders in supporting and enabling preceptors in their clinical teaching. This approach can be adapted to ensure graduating medical students obtain intended core clinical skills.
Clinical Features and Histopathological Changes of Skeletal Muscle in Patients with COVID-19: Two Case reports
Authors: Liao Mei-Yan , Duan Ping , Pan Zhen-Yu , Cai Yu-Xiang , Fan Wei , Ping An-Song 
Published: July 2020

Abstract
BackgroundTo the best of our knowledge, muscle soreness is a common manifestation for the coronavirus disease-19 (COVID-19) patients, but the mechanism of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) injury to skeletal muscle remains unclear, there has been no publication focused on muscle involvement in COVID-19 patients.Case presentationWe present the case of two Chinese men with COVID-19, whose common symptoms were fatigue and muscle soreness. They went through different treatments, patient 1, 81-year-old, eventually died of multi-organ failure, and patient 2, 53-year-old, underwent amputation of the mid-lower section of left thigh. Laboratory tests in both patients showed abnormal biochemical parameters associated with skeletal muscle injury. We obtained skeletal muscle samples from these two patients, one from postmortem biopsy of gastrocnemius muscle and the other from a resected left lower limb due to thrombosis. The pathological findings in patient 1 were mainly scattered atrophic muscles, while fiber necrosis and minor inflammation were identified in patient 2, and the mild infiltrations were confirmed by CD68 and LCA staining to be predominantly macrophages and lymphocytes.ConclusionsWe report the clinical and laboratory features together with histopathological findings in skeletal muscle tissues from two COVID-19 cases and speculate that the SARS-CoV-2 may cause skeletal muscle injury. Due to the particularity of individual differences in case reports, the background of chronic neuromuscular disease in patient 1 and a minimal compartment syndrome caused by thrombosis in patient 2 need to be excluded prior to the conclusion that the skeletal muscles have been involved in COVID-19.
Radial EBUS combined with a GS and VBN for diagnosis of peripheral lung lesions: a retrospective study
Authors: Zhang Jian , Qu Shuo-Yao , Zhang Yan , Zhang Yong , Wang Ming-Ming , Chang Ning , Ti Xin-Yu 
Published: July 2020

Abstract
Background

More and more peripheral pulmonary lesions (PPL) have been found following the increased utilization of chest CT in China. But how to identify the nature of PPL accurately, safely and economically is the concern of Chinese doctors. The combination of radial endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation was a deluxe scheme to indicate the pathology of peripheral pulmonary lesions in nation’s current medical level. This study aimed to compare the diagnostic yield, safety and health economics of EBUS-GS-VBN versus radial ultrasonic small probe plus thin bronchoscopy (EBUS) for diagnosis of PPLs.
Methods

This study was a single-institution retrospective review of PLLs examined by using EBUS-GS-VBN or radial EBUS between March 2018 and September 2018 consecutive. The diagnostic yields, accuracy, operation time, complications, factors influencing the diagnostic outcome, tissue genetic test rate and medical cost were analyzed separately.
Results

there was no significant difference in the diagnostic yield between the two groups (92.31% vs 88.57%, p = 0.594). Although the searching time of EBUS-GS-VBN was shorter (1.47 ± 0.49 min vs 2.12 ± 1.36 min, p < 0.001), procedure time was extended (24.07 ± 5.53 min vs 17.41 ± 4.38 min, p < 0.001). The diagnosis yield of malignancy and benign disease were equal (84.62% vs 100% and 95.35% vs 84%). There was no difference in the rate of gene testing between the two groups (75% vs 70.58%), while the incidence of Intrapulmonary hemorrhage in the EBUS-GS-VBN group was significantly descended. Moreover, the average expense of EBUS-GS-VBN was higher than that of EBUS-GS (6315 ± 1817 RMB vs 3128 ± 1086RMB).
Conclusion

When performing TBLB of PLLs, we found EBUS-GS-VBN to be similar to EBUS in accuracy. Although the founding lesion time of EBUS-GS-VBN group were significantly shorter, the total examination time was longer. Furthermore, the complications of EBUS-GS-VBN group were fewer. There was no difference in genetic testing between the two groups. It is worth noting that the cost and radiation exposure was lower of EBUS group patients.
Trial registration:
retrospectively registered
Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing
Authors: Su Shanshan , Zeng Jiahao , Li Yunlei , Lin Pengcheng , Chen Junjie , Chen Chengshui , Zhou Ying , Li Yuping 
Published: July 2020

Abstract
Background

Legionella and Chlamydia psittaci cause atypical community-acquired pneumonia, which mimic each other. Our aim was to compare the clinical characteristics of Legionella pneumonia (LP) and psittacosis and assess whether metagenomic next-generation sequencing (mNGS) is an effective method for early diagnosis.
Methods

We conducted a retrospective study and compared seventeen patients with Chlamydia psittaci pneumonia and nine patients with LP, diagnosed by mNGS. This study was carried out in the First Affiliated Hospital of Wenzhou Medical University, China, from July 2018 to May 2020. mNGS was carried out from bronchial alveolar lavage fluid (BALF) and/or lung tissues.
Results

76.5% of psittacosis cases and 0% of legionellosis cases had an avian exposure history (p < 0.001). Compared with LP patients, psittacosis patients had significantly higher hemoglobin (118.9 ± 20.2 vs. 93.2 ± 23.2 g/L, p = 0.007), serum sodium (138.9 ± 5.4 vs. 133.9 ± 6.5 mmol/L, p = 0.047), and higher proportion of elevated aspartate aminotransferase levels (88.2 vs. 44.4%, p = 0.028). Other clinical parameters were similar in psittacosis and LP patients: normal or slightly elevated leucocytes (10.5 vs. 9.5 × 109/L, p > 0.05), neutrophils (9.4 vs. 8.3 × 109/L, p > 0.05), and procalcitonin (0.8 vs 5.1 ng/mL, p > 0.05); highly increased C-reactive protein levels (205.1 vs. 234.9 mg/L, p > 0.05); and decreased lymphocytes (0.7 vs. 0.6 × 109/L, p > 0.05). Extra-pulmonary manifestations and mortality (11.8% in psittacosis vs. 22.2% in LP group, p = 0.591) were also similar in both the groups. mNGS detected Chlamydia psittaci in 17/17 BALF samples, and Legionella in 8/8 BALF samples and 1/1 lung tissue sample.
Conclusions

Apart from sharing many features with legionellosis, psittacosis is a vital differential diagnosis for LP, especially in patients with avian exposure history. mNGS is a sensitive and promising method for early diagnosis of both psittacosis and LP.
The Association between Childhood Conditions and Heart Disease Among Middle-Aged and Older Population in China: A Life Course Perspective
Authors: Zhang Jingyue , Lu Nan 
Published: July 2020

Abstract
Background: Heart disease is a severe health problem among adult populations in China. The prevalence rates of heart disease increase with age. The pathogenic causes of heart disease are often related to conditions in early life. Using a nationally representative data from adults aged 45 or older in China, we examined the association between childhood conditions and heart disease in later life from a life course perspective.Methods: The data used in this study were derived from China Health and Retirement Longitudinal Study; specifically, the life history module and 2015 wave. Face-to-face interviews were used to collect data from respondents aged 45 or older. Missing data were handled by multiple imputation, generating a final analytic sample of 19,800. Doctor-diagnosed heart disease was the main dependent variable. Random-effects logistic regression models were conducted to test the hypotheses.Results: A total of 16.6% respondents reported being diagnosed with heart disease by doctors. Regarding childhood socioeconomic status, 8.2% of the respondents considered that they were (a lot) better off than their neighbors, and 31.1% considered that their health status in childhood was better than their peers. More than 90% of respondents did not have severe illnesses during their childhood, and around 80.3% had access to health resources nearby in childhood. Socioeconomic status, self-rated health, and severe illnesses in childhood were significantly associated with heart disease after controlling for conditions in adulthood and older age (socioeconomic status: odds ratio (OR) = 0.950; self-rated health: OR = 0.923; severe illnesses: OR = 1.191).Conclusions: Childhood conditions play important roles in influencing the onset of heart disease in middle and older age in China. Poor childhood conditions should be considered as screening criteria to identify populations at risk of heart disease. Community-based preventive strategies and interventions should also be implemented to enhance health in later life.
Stakeholders’ perception and intervention preferences regarding comprehensive sexuality education in male adolescents: a qualitative study from Iran
Authors: gelehkolaee keshvar samadaee , Maasoumi Raziyeh , Azin Seyed Ali , Nedjat Saharnaz , Parto Moslem , Hajiabadi Ilia Zamani 
Published: July 2020

Abstract
Background A coherent sexuality education program for adolescents is part of their sexual and reproductive rights and can help them have a healthier future. Therefore, the aim of this study was to explore the perceptions and intervention preferences of Iranian stakeholders regarding comprehensive sexuality education (CSE) in male adolescents based on the IMB model (Information, Motivation, Behavioral skills).Methods This qualitative study was conducted using directed content analysis. Iindividual interviews and focused group discussions (FGDs) were used for data collection. The data were collected through in-depth semi-structured interviews with stakeholders in two schools and the Education Department in Sari and the Ministry of Health and Ministry of Education in Tehran from March 2019 to August 2019. Data saturation was achieved after 28 interviews and 1 FGDs with 9 participants. Finally, two sets of data were coded and analyzed using directed content analysis.Results In this study, five themes emerged as (1) role of institutions; (2) role of organizations; (3) need for stakeholder’s partnership; (4) need for adolescent sexuality socialization management; and (5) need for enhancing the teachers’ professional competence, which seemed to influence the implementation of CSE in male adolescents. Participants also expressed a number of intervention preferences for CSE.Conclusions The results of this study revealed the need for a CSE program for adolescents' sexuality socialization. The finding showed that teachers required training to enhance their professional competence about sexuality issues. Therefore, it is necessary to design and implement culture-appropriate skill based programs to enhance the teachers’ professional competence regarding the adolescents’ sexual health.
Short-term Assessment of Radial Artery Grafts With Multidetector Computed Tomography
Authors: Qiao En , Wang Yuetang , Yu Jun , Wang Xu , Luo Xinjin , Wang Wei 
Published: July 2020

Abstract
Background

The clinical use of radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines, and the application of multidetector computed tomography (MDCT) in the evaluation of graft patency is still to be verified. This study aims to report the short-term results of RA in CABG with MDCT.
Methods

The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2007 to 2008, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis.
Results

MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. A total of 150 distal anastomoses were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). Functional graft patency of the left internal mammary artery (LIMA) was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of saphenous vein graft (SVG) of 81.1% (30/37). And the RA targeting the left coronary artery system might have better patency than that of the RA targeting the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686).
Conclusions

MDCT could provide excellent visualization of grafts in CABG. The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when targeted to the left but not the right coronary artery.
Evaluating Measles Incidence Rates Using Machine Learning and Time Series Methods in the Center of Iran; 1997-2020
Authors: Nazari Javad , Fathi Parnia-Sadat , Sharahi Nahid , Taheri Majid , Amini Payam , Almasi-Hashiani Amir 
Published: July 2020

Abstract
Background: Measles is a feverish condition labeled among the most infectious viral illnesses in the globe. Despite the presence of a secure, accessible, affordable and efficient vaccine, measles continues to be a worldwide concern. Methods: This study uses machine learning and time series methods to assess factors that placed people at a higher risk of measles. This historical cohort study contained the Measles incidence in Markazi Province, the center of Iran, from April 1997 to February 2020. Logistic regression, linear discriminant analysis, random forest, artificial neural network, bagging, support vector machine, and naïve Bayes were used to make the classification. Zero-inflated negative binomial regression for time series was utilized to assess development of measles over time. Results: The prevalence of measles was 14.5% over the recent 24 years and a constant trend of almost zero cases was observed from 2002 to 2020. The order of independent variable importance were recent years, age, vaccination, rhinorrhea, male sex, contact with measles patients, cough, conjunctivitis, ethnic, and fever. Younger age, less probability of contact and no fever is associated with less odds of zero cases. Only 7 new cases were forecasted for the next two years. Bagging and random forest were the most accurate classification methods. Conclusion: Even if the numbers of new cases are almost zero during the recent years, it has been showed that age and contact are responsible for non-occurrence of measles. October and May are prone to have new cases for 2021 and 2022.
Clinical Features and Long-term Survivals of Metastatic Hepatic Neuroendocrine Neoplasms Secondary to Gastro-entero-pancreatic Site: An Analysis by Applying the World Health Organization 2017 Grading Classification
Authors: Yang Min , Zeng Lin , Hou Sheng-zhong , Ke Neng-wen , Tian Bo-le , Liu Xu-bao , Xiang Bo , Zhang Yi 
Published: July 2020

Abstract
Background and Purpose

Hepatic neuroendocrine neoplasms (NENs) are very rare, in which metastatic hepatic NENs (MH-NENs) secondary to gastro-entero-pancreatic NENs (GEP-NENs) account for their majority. In 2017, World Health Organization (WHO) redefined GEP-NENs into G1 neuroendocrine tumors (NETs), G2 NETs and G3 NETs and G3 neuroendocrine carcinomas (G3 NECs), which has not been rigorously validated for MH-NENs secondary to GEP-NENs.
Method:

Data of patients who were surgically treated and clinicopathologically diagnosed as MH-NENs secondary to GEP-NENs at West China Hospital of Sichuan University from January 2006 to December 2018 were retrospectively analyzed by applying the WHO 2017 grading classification.
Results

We identified 150 patients with MH-NENs secondary to GEP-NENs, including 10 patients with WHO 2017 G1 NETs, 26 with G2 NETs, 33 with G3 NETs and 81 with G3 NECs. The estimated 3-year overall survival for each new grading group was 100%, 79.4%, 49.5% and 20.7%, respectively. Survival of G1 NETs or G2 NETs was significantly better than that of G3 NETs (P = 0.013, P = 0.037; respectively) and G3 NECs (P = 0.001, P < 0.001; respectively). Patients with G3 NECs present notably worse survival than those with G3 NETs (P = 0.012), while survival comparison between G1 NETs and G2 NETs wasn’t statistically different (P = 0.131). The WHO 2017 grading classification was effective independent predictor of survival for MH-NENs secondary to GEP-NENs (hazard ratio: 4.234; 95% confidence intervals: 1.984–6.763; P = 0.003).
Conclusion

Our demonstration revealed that the WHO 2017 grading classification could well stratify MH-NENs secondary to GEP-NENs into prognostic groups and supported its wide use in clinical practice.
Clinicopathological and prognostic features of early gastric cancer patients after surgery: a retrospective study
Authors: Qi Jing , Zhu Congbo , Liu Weihang , Liu Sheng , Cai Gaoqiang , Liao Guo-Qing 
Published: July 2020

Abstract
Background: Despite the decline in the incidence of gastric cancer, the incidence of early gastric cancer has increased. Hence, understanding the clinicopathological and prognostic features of early gastric cancers could help us understand the development of gastric cancer and improve the prognosis of early gastric cancer. Methods: A total of 244 patients diagnosed with early gastric cancer after surgery at Xiangya Hospital Central South University were retrospectively analyzed. Results: General data showed that in patients with a mean age of 54.30±10.68 years (M:F = 1.6:1), the median tumor size was 2.203±1.245 cm. A total of 15.6% of patients had lymph node metastasis. By univariate analysis, the longest diameter of the tumor, T stage, total number of dissected lymph nodes, number of metastatic lymph nodes, metastatic-to-total dissected lymph node (LN) ratio, vascular invasion, NLRc, and MLRc were associated with disease-free survival; tumor size, invasive depths, vascular invasion, NLRc, MLRc, NWRc and LWRc were associated with lymph node metastasis. Additionally, the longest diameter of tumor and total number of dissected lymph nodes were independent factors for early gastric cancer patients; tumor size, invasive depths, vascular invasion and NLRc were independent risk factors for lymph node metastasis in EGC. Conclusion: The longest diameter of the tumor and total number of dissected LNs were independent prognostic factors for EGC patients. Additionally, the longest diameter of the tumor, tumor invasive depths, vascular invasion and NLRc were the independent risk factors for lymph node metastasis in EGC patients.
Prevalence and risk factors of erectile dysfunction in men of infertile couples: A cross-sectional study from an in vitro fertility center in the northern Vietnam
Authors: The Son Trinh , Xuan Su Hoang , Van Ai Hoang , Ba Trinh Nguyen , Le Hoang , Van Trang Quan , Duc Minh Pham , Vinh Dung Dang , Thi Cuc Le , Thanh Tung Nguyen , Anh Tuan Ngo , Thu Trang Vu Thi , Van De Doan , Nhu Binh Do , Do Quyet 
Published: July 2020

Abstract
Purpose: The aim of this study was to investigate the prevalence and risk factors of erectile dysfunction (ED) in men of infertile couples from an in vitro fertility center in the northern Vietnam. Methods: A total of 138 men of infertility couples were enrolled in this study from January to May, 2018. The International Index of Erectile Function questionnaire scale was used to access the severity of ED and several related factors were also collected to determine risk factors. Results: The prevalence of ED among men of infertile couples was 18.1%, including 13 mild ED (9.4%), 7 mild to moderate ED (5.1%), 2 moderate ED (1.4%) and 1 severe ED (0.7%). Using logistic regression analysis, we showed that risk factors associated ED were smoking above 5 pack/years with OR = 3.16, CI = 0.98 – 10.18, p = 0.05; not graduating junior high school, OR = 5.11, CI = 1.11 – 23.8, p = 0.03, and azoospermia, OR = 7.55 , CI = 2.18 – 26.16, p = 0.001. We observed relatively high OR in men with smoking under 5 pack/years (OR = 2.51), abnormal semen analysis (hypospermia, oligozoospermia, asthenozoospermia, or teratozoospermia) (OR=2.36), but there was not significant differences compared with reference group. Conclusion: The prevalence of ED among men of infertile couples in this study was higher than infrtile men. Low level of education, smoking in a long period, and azoospermia were the main risk factors of ED in men. Further large-scale studies are needed to extend the results.