bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimized acupuncture treatment (acupuncture and intradermal needling) for cervical spondylosis–related neck pain: a multicenter randomized controlled trial
Authors: Chen Ling , Li Minying , Fan Li , Zhu Xiaoping , Liu Jianhua , Li Hui , Xu Zhenhua , Chen Junjun , Liang Zhaohui , Liu Zhiyan , Feng Lingmei , Chen Xiaoyun , He Qing , Chen Xiaokai , Ou Aihua , He Jiangshan , Ma Rui , Ning Baile , Jiang Li , Li Sheng , Fu Wenbin 
Published: September 2020

Abstract
Cervical spondylosis (CS)-related neck pain is difficult to treat because of its degenerative nature. The aim of this 9-center, single-blinded, randomized controlled trial was to evaluate the efficacy of optimized acupuncture for CS-related neck pain. Participants who met the inclusion criteria were randomized to optimized, shallow, and sham acupuncture groups (1:1:1). The primary outcome was the change from baseline in the Northwick Park Neck Pain Questionnaire score at week 4. Participants were followed up until week 16. Of the 896 randomized participants, 857 received ≥1 intervention session; 280, 286, and 291 received optimized, shallow, and sham acupuncture, respectively. A total of 835 (93.2%) participants completed the study. At week 4, significant differences (P < 0.001) were observed in the changes in Northwick Park Neck Pain Questionnaire scores between the optimized acupuncture group and both the shallow {7.72 (95% confidence interval [CI], 5.57-9.86)} and sham acupuncture (10.38 [95% CI, 8.25-12.52]) groups. The difference in the scores at week 16 between the optimized acupuncture group and the shallow (8.84 [95% CI, 6.34-11.34]) and sham acupuncture (10.81 [95% CI, 8.32-13.30]) groups were significant. The center effect indicated wide variability in the treatment effects (Cohen's d = 0.01-2.19). Most SF-36 scores were higher in the optimized acupuncture group than those in the other groups. These results suggest that 4-week optimized acupuncture treatment alleviates CS-related neck pain and improves the quality of life, with the effects persisting for minimum 3 months. Therefore, acupuncture can have positive effects on CS-related neck pain, although the effect size may vary widely.
Sexual dimorphism in the contribution of neuroendocrine stress axes to oxaliplatin-induced painful peripheral neuropathy
Authors: Staurengo-Ferrari Larissa , Green Paul G. , Araldi Dionéia , Ferrari Luiz F. , Miaskowski Christine , Levine Jon D. 
Published: September 2020

Abstract
Although clinical studies support the suggestion that stress is a risk factor for painful chemotherapy-induced peripheral neuropathy (CIPN), there is little scientific validation to support this link. Here, we evaluated the impact of stress on CIPN induced by oxaliplatin, and its underlying mechanisms, in male and female rats. A single dose of oxaliplatin produced mechanical hyperalgesia of similar magnitude in both sexes, still present at similar magnitude in both sexes, on day 28. Adrenalectomy mitigated oxaliplatin-induced hyperalgesia, in both sexes. To confirm the role of neuroendocrine stress axes in CIPN, intrathecal administration of antisense oligodeoxynucleotide targeting β₂-adrenergic receptor mRNA both prevented and reversed oxaliplatin-induced hyperalgesia, only in males. By contrast, glucocorticoid receptor antisense oligodeoxynucleotide prevented and reversed oxaliplatin-induced hyperalgesia in both sexes. Unpredictable sound stress enhanced CIPN, in both sexes. The administration of stress hormones, epinephrine, corticosterone, and their combination, at stress levels, mimicked the effects of sound stress on CIPN, in males. In females, only corticosterone mimicked the effect of sound stress. Also, a risk factor for CIPN, early-life stress, was evaluated by producing both stress-sensitive (produced by neonatal limited bedding) and stress-resilient (produced by neonatal handling) phenotypes in adults. Although neonatal limited bedding significantly enhanced CIPN only in female adults, neonatal handling significantly attenuated CIPN, in both sexes. Our study demonstrates a sexually dimorphic role of the 2 major neuroendocrine stress axes in oxaliplatin-induced neuropathic pain.
Neuropathic pain: clinical classification and assessment in patients with pain due to cancer
Authors: Shkodra Morena , Brunelli Cinzia , Zecca Ernesto , Formaglio Fabio , Bracchi Paola , Lo Dico Silvia , Caputo Mariangela , Kaasa Stein , Caraceni Augusto 
Published: September 2020

Abstract
Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.
Avoidance behaviour performed in the context of a novel, ambiguous movement increases threat and pain-related fear
Authors: van Vliet Christine M. , Meulders Ann , Vancleef Linda M.G. , Vlaeyen Johan W.S. 
Published: September 2020

Abstract
The fear-avoidance model of chronic pain predicts that catastrophic (mis)interpretation of pain elicits pain-related fear that in turn may spur avoidance behaviour leading to chronic pain disability. Here, we investigated whether performing a movement to avoid a painful stimulus in the context of a novel movement increases threat and pain-related fear towards this novel movement and whether avoidance behaviour persisted when given the choice between performing the acquired movement to avoid a painful stimulus or an alternative, novel movement. Applying a robotic arm-reaching task, participants could choose between 2 movements to reach a target location: a short, but painful movement trajectory, or a longer nonpainful movement trajectory. After avoidance acquisition, the option to choose the painful trajectory was removed. The experimental group (N = 50) could choose between the longest trajectory or a novel intermediate trajectory, whereas the control group (N = 50) was allowed to only perform the novel trajectory. In a final test, participants of both groups were allowed to choose any of the 3 trajectories. After acquisition, experimental group participants showed elevated pain expectancy and pain-related fear towards the novel trajectory, compared with the control group. During test, the experimental group participants persisted in performing the longest pain-free (avoidance) trajectory and were less likely to choose the novel trajectory. In addition, these participants maintained higher levels of pain-related fear for the novel trajectory compared with the control group. These findings suggest that avoidance in the context of other neutral activities/movements may lead to the development and maintenance of threat appraisals and irrational fears.
Antenatal pain, intimate partner violence, and maternal bonding disorder: data from the Japan Environment and Children's Study
Authors: Yamada Keiko , Kimura Takashi , Cui Meishan , Kubota Yasuhiko , Tanaka Eizaburo , Wakaizumi Kenta , Ikehara Satoyo , Kimura Tadashi , Iso Hiroyasu ,   the Japan Environment and Children's Study Group
Published: September 2020

Abstract
This prospective study examined (1) whether antenatal pain is associated with postnatal maternal bonding disorder (MBD) through postnatal depression and (2) whether intimate partner violence (IPV) has a moderating effect on the association between antenatal pain and postnatal MBD. We analyzed 77,326 pregnancies of women who completed self-report questionnaires including the SF-8 bodily pain item, the Edinburgh Postnatal Depression Scale, the Mother-to-Infant Bonding Scale, and an assessment of IPV. We conducted a mediation analysis to assess whether postnatal depression mediated the association between antenatal pain and MBD 1 year after delivery. A moderated mediation model was used to examine the conditional effect of IPV during pregnancy on the association between antenatal pain and postnatal MBD, operating through postnatal depression. All analyses were adjusted for demographic factors, socioeconomic factors, perinatal and infant factors, medical history, and psychological status. Of the 77,326 pregnancies, 5420 (7.0%) were characterized by persistent moderate-to-severe pain. The total effect of antenatal pain on MBD was significant (standardized path coefficient = 0.06, 95% confidence interval, 0.05-0.06) and postnatal depression dominantly mediated the association between antenatal pain and postnatal MBD (70.8% mediation). Contrary to our hypothesis, IPV during pregnancy did not moderate the association between antenatal pain and postnatal MBD. However, IPV during pregnancy did have independent negative effects on both postnatal depression and MBD. Our findings suggest that antenatal pain and postnatal depression should be assessed and treated with consideration of the presence of IPV during pregnancy to better monitor and prevent the development of MBD.
Precipitating factors causing hyperbilirubinemia during chronic hepatitis C treatment with paritaprevir/ritonavir/ombitasvir and dasabuvir
Authors: Wang Yi-Kai , Lee Wei-Ping , Wang Ying-Wen , Huang Yi-Hsiang , Hou Ming-Chih , Chang Yuh-Lih , Lan Keng-Hsin 
Published: September 2020

Background:
Hepatic decompensation is a fatal on-treatment side effect during chronic hepatitis C treatment with paritaprevir/ritonavir/ombitasvir and dasabuvir (PrOD). Prompt bilirubin testing can reveal hepatic failure in susceptible patients, and clinical parameters precipitating early elevation of bilirubin can warn clinicians to avoid PrOD prescription.

Methods:
This retrospective study included 169 Hepatitis C virus (HCV)-genotype 1b patients who underwent a 12-week course of PrOD with or without ribavirin. Laboratory data underwent χ2 analysis with Fisher’s exact test to determine the precipitating factors causing hyperbilirubinemia in patients who had received 1 week of treatment.

Results:
Sustained viral response was achieved in 164 patients (97.0%). Total bilirubin was ≥2 mg/dL (21.3%) in 36 patients after 1 week of treatment. Pretreatment white blood cell (WBC) <4500/µL and platelet <100,000/µL correlated with total bilirubin ≥2 mg/dL (relative risk [RR]: 21.64, 95% CI: 5.23-89.64, p < 0.001) after 1 week of treatment. Pretreatment platelet ≥100 000/µL and WBC <4500/µL correlated with direct bilirubin ≥0.45 mg/dL (RR: 6.56, 95% CI: 1.42-30.38, p = 0.016) and indirect bilirubin ≥0.6 mg/dL (RR: 4.77, 95% CI: 1.03-22.15, p = 0.046). Pretreatment platelet <100,000/µL with F3/F4 fibrosis correlated with first week total bilirubin ≥2 mg/dL (RR: 3.57, 95% CI: 1.35-9.09, p = 0.010).

Conclusion:
PrOD is an effective antiviral regimen for HCV genotype 1b patients. Total bilirubin ≥2 mg/dL after 1 week of treatment serves as an early warning of irreversible progression toward hepatic decompensation, and the current study provides a guide by which to monitor chronic hepatitis C patients undergoing PrOD treatment.
Gastrointestinal Health Questionnaire for Rett Syndrome
Authors: Motil Kathleen J. , Khan Nabeel , Coon Jennifer L. , Barrish Judy O. , Suter Bernhard , Pehlivan Davut , Schultz Rebecca J. , Glaze Daniel G. 
Published: September 2020

ABSTRACTObjectives:We report the development and validation of a tool to assess gastrointestinal health in Rett syndrome (RTT). We hypothesized that the Gastrointestinal Health Questionnaire (GHQ) is a valid clinical outcomes measure of gastrointestinal health in RTT.Patients and Methods:We used parent interviews, surveys, and literature review to generate a questionnaire related to gastrointestinal health and function, mood and behaviors, and parental concerns for individuals with RTT. Parents of affected and unaffected individuals provided responses to the GHQ, assessed the relevance and importance of statements, and completed 5 surveys related to gastrointestinal health, child‐related mood and behaviors, and parent concerns. We used multivariate item analysis, 2‐sample t tests, and correlations to assess the validity of the GHQ.Results:We documented acceptable internal consistency of statements related to gastrointestinal health and function (Cronbach‐α = 0.91), RTT‐related mood and behaviors (Cronbach‐α = 0.89), and parent concerns (Cronbach‐α = 0.95) in the GHQ. We documented favorable external validity based on differences in response scores between parents of affected and unaffected individuals (P < 0.001) and correlations in parental response scores between the GHQ and 5 validated questionnaires addressing similar issues (P < 0.001).Conclusion:The GHQ is a valid tool for the assessment of gastrointestinal health in RTT and offers the opportunity to field test the safety and efficacy of novel drug therapies in clinical trials for individuals affected with this disorder.
Preoperative Optimism Related to Low Anxiety in Patients 1 Month After Open Heart Surgery
Authors: Ai Amy L. , McMullen Colleen A. , Smyth Susan S. 
Published: September 2020

Abstract
Anxiety can contribute to poor prognosis in cardiac patients. Few studies have examined the role of optimism in anxiety after open heart surgery (OHS). This study investigated the influence of preoperative optimism on post-OHS anxiety, adjusting cardiac indices used by cardiac surgeons. Data were collected before and 1 month after OHS in 481 patients (58% men; age, 62.4 ± 11.94 years). Optimism was measured using the Life Orientation Test. Anxiety was measured using the Trait Anxiety Inventory. Medical and cardiac indices were retrieved from the Society of Thoracic Surgeon's national database. Multiple regression analyses showed that greater pre-OHS optimism was associated with lower levels of post-OHS anxiety (F[6, N = 306] = 50.18, p < 0.001, R
2 = 0.502). No other factors showed similar protection. Pre-OHS anxiety, younger age, and minority status were associated with anxiety in the critical recovery month. The findings demonstrate the potential benefit of optimism against post-OHS anxiety, which may have clinical implications for improving disease management.
Prevalence of Cyberbullying in Patients Presenting to the Pediatric Emergency Department
Authors: Hellstrand Karl , Rogers Steven C. , DiVietro Susie , Clough Meghan , Sturm Jesse 
Published: September 2020

Objectives
Mental health (MH) complaints are increasingly responsible for visits to pediatric emergency departments (PEDs). Bullying is associated with MH problems. Most adolescents use social media and many experience problems with cyberbullying (CB). This study determines prevalence of CB in MH and non-MH adolescents in a PED, describes technology use in these groups, and measures influence of CB on presentation to the PED and on thoughts/acts of self-harm.

Methods
A prospective survey was administered to a convenience sample of 149 patients aged 11 to 17 years in a PED. Data were analyzed using descriptive and comparative statistical methods.

Results
Cyberbullying was significantly more common in MH than in the non-MH patients (17% vs 3%, P = 0.007). More MH patients reported that bullying led to the current PED visit than that in the non-MH group (25% vs 10%, P = 0.02), and they were significantly more likely to report that CB led to self-harm (22% vs 4%, P = 0.003). Mental health participants who spent more than 3 hours on the Internet report higher levels of bullying than non-MH patients (38% vs 6%, P < 0.001).

Conclusions
Prevalence of bullying in MH patients presenting to a PED is significantly greater than controls, and CB caused more MH patients to have acts or thoughts of self-harm. Bullying is a risk factor for self-harm and suicide in patients with MH problems. Future studies should evaluate CB as part of suicide screening tools for emergency MH patients.
Managing Pediatric Foreign Body Ingestions
Authors: Dipasquale Valeria , Romano Claudio , Iannelli Mauro , Tortora Andrea , Melita Giuseppinella , Ventimiglia Marco , Pallio Socrate 
Published: September 2020

Background
Foreign body (FB) ingestion is a common global issue in pediatrics. Most of the ingested FBs pass through the gastrointestinal tract, but up to 20% of cases require endoscopic removal. In this study, we retrospectively reviewed all pediatric cases of FB ingestion requiring endoscopic removal over a 10-year period in a tertiary hospital to compare the symptoms at presentation and outcomes with those reported in previous studies and to assess the association of the outcomes with patient and FB characteristics.

Methods
A retrospective chart review of children 16 years or younger who underwent upper endoscopy for FB ingestion from 2008 to 2018 in a tertiary hospital was included. Data on demographics, clinical presentation, characteristics of FBs, endoscopic findings, and outcomes were reviewed. The clinical data were further evaluated to determine the circumstances surrounding FB ingestion, FB management, and patient outcomes. Descriptive analysis of the data was performed using medians, frequencies, and percentage; χ2 or Fisher exact test was used to assess the dependence between categorical variables.

Results
Eighty-six patients (median age, 5.1 years; 67% males) underwent endoscopy for suspected FB ingestion, with a confirmation rate of 91%. Coins were the most commonly ingested FBs (n = 49, 57%). Most patients were symptomatic (84%); 97% of patients in whom the FB had an esophageal location and all patients in whom the FB was not detected by endoscopy were symptomatic (P = 0.007). The most frequent symptoms were drooling (70%) and unexplained crying (48%). Unexplained crying was more common in younger than in older patients (P < 0.001). The FB was more likely to be located in the esophagus in patients with drooling (P < 0.001) and dysphagia (P < 0.001). The distribution of FB location differed according to the FB type, with coins most frequently located in the esophagus and sharp and other FBs in the stomach (P = 0.023). Only 7 patients (8%) developed mild FB-related mucosal injury. No complications occurred during FB removal. All patients had an uneventful outcome.

Conclusions
Foreign body ingestion is common among younger children, and the clinical presentation can be variable. The presence or absence of symptoms, as well as the type of symptom, could aid clinicians in implementing diagnosis and proper management approaches in patients who ingest FBs requiring endoscopy.
Distinguishing Multisystem Inflammatory Syndrome in Children From Kawasaki Disease and Benign Inflammatory Illnesses in the SARS-CoV-2 Pandemic
Authors: Corwin Daniel J. , Sartori Laura F. , Chiotos Kathleen , Odom John Audrey R. , Cohn Keri , Bassiri Hamid , Behrens Edward M. , Teachey David T. , Henrickson Sarah E. , Diorio Caroline J. , Zorc Joseph J. , Balamuth Fran 
Published: September 2020

Objective
The aim of the study was to compare presenting clinical and laboratory features among children meeting the surveillance definition for multisystem inflammatory syndrome in children (MIS-C) across a range of illness severities.

Methods
This is a retrospective single-center study of patients younger than 21 years presenting between March 1 and May 15, 2020. Included patients met the Centers for Disease Control and Prevention criteria for MIS-C (inflammation, fever, involvement of 2 organ systems, lack of alternative diagnoses). We defined 3 subgroups by clinical outcomes: (1) critical illness requiring intensive care interventions; (2) patients meeting Kawasaki disease (KD) criteria but not requiring critical care; and (3) mild illness not meeting either criteria. A comparator cohort included patients with KD at our institution during the same time frame in 2019.

Results
Thirty-three patients were included (5, critical; 8, 2020 KD; 20, mild). The median age for the critical group was 10.9 years (2.7 for 2020 KD; 6.0 for mild, P = 0.033). The critical group had lower median absolute lymphocyte count (850 vs 3005 vs 2940/uL, P = 0.005), platelets (150 vs 361 vs 252 k/uL, P = 0.005), and sodium (129 vs 136 vs 136 mmol/L, P = 0.002), and higher creatinine (0.7 vs 0.2 vs 0.3 mg/dL, P = 0.002). In the critical group, 60% required vasoactive medications, and 40% required mechanical ventilation. Clinical and laboratories features were similar between the 2020 and 2019 KD groups.

Conclusions
We describe 3 groups with inflammatory syndromes during the SARS-CoV-2 pandemic. The initial profile of lymphopenia, thrombocytopenia, hyponatremia, and abnormal creatinine may help distinguish critically ill MIS-C patients from classic/atypical KD or more benign acute inflammation.
Retiform Purpura as a Sign of Necrotizing Cellulitis in an Immunocompetent Boy
Authors: Aboul-Fettouh Nader , Nguyen Khang D. , Dominguez Arturo R. 
Published: September 2020

Abstract
Severe group A streptococcus (GAS) infections, particularly necrotizing soft tissue infections (NSTIs), have been associated with the development of streptococcal toxic-shock syndrome (STSS), a systemic illness caused by GAS-derived toxins. Traditional physical examination findings in NSTIs include skin necrosis, crepitus, and hemorrhagic bullae. However, these findings are limited in sensitivity and additional clinical markers may aid in making an early diagnosis of NSTI. We present a case of a superficial infection, specifically GAS necrotizing cellulitis, complicated by STSS in a healthy boy with an associated skin finding of retiform purpura that aided in early diagnosis of a NSTI.