bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative, intraoperative, and postoperative assessment of corneal biomechanics in refractive surgery
Authors: Dackowski Evan K. , Lopath Patrick D. , Chuck Roy S. 
Published: May 2020

Purpose of review
To review current and emerging methods and utilities of preoperative, intraoperative, and postoperative measurements of corneal biomechanics and their effects on refractive surgery decision-making.

Recent findings
Several recent clinical and preclinical studies have demonstrated the utility of corneal biomechanical analysis in refractive surgery. These studies focus on both screening surgical candidates for keratoconic disease as well as intraoperative and postoperative monitoring. The measurement of spatially resolved biomechanics is beginning to be studied in humans.

Summary
Clinically available screening methods combining corneal biomechanics with topographic and tomographic data provide increased utility when screening for keratoconic disorder. Spatially resolved measurement of corneal biomechanics holds great potential for preoperative, intraoperative, and postoperative evaluation of refractive surgery candidates as well as for more individualized procedures in the future.
Using Preventive Health Alerts in the Electronic Health Record Improves Hepatitis C Virus Testing Among Infants Perinatally Exposed to Hepatitis C
Authors: Hojat Leila S. , Greco Peter J. , Bhardwaj Amrita , Bar-Shain David , Abughali Nazha 
Published: May 2020

Background:
Perinatal exposure to hepatitis C virus (HCV) is a major public health issue, and poor testing rates leave many children with infection unidentified. We sought to use the electronic health record (EHR) to promote guideline-directed HCV testing among infants born to mothers with HCV infection in an urban, safety-net hospital system.

Methods:
Our study population was identified using our EHR database, Epic. Children were included in the study if they had perinatal HCV exposure, were 18 months to 18 years of age and had at least 1 encounter in a primary or urgent care clinic during the study period. Our study included retrospective (October 2011 to February 2015) and prospective (February 2015 to May 2018) arms. Our EHR-based intervention was initiated in the prospective arm and recommended a one-time HCV antibody test at or after the age of 18 months using a health maintenance reminder. The health maintenance reminder activated a point-of-care alert and a linked HCV testing order set in all prespecified encounters during the intervention period.

Results:
Median time to appropriate HCV testing decreased from 96.2 months preintervention to 9.1 months postintervention (P < 0.0001), and rate of completed antibody testing increased from 14% to 61% (P < 0.0001).

Conclusions:
Among children with perinatal HCV exposure, using a point-of-care alert within the EHR significantly increased the HCV antibody testing rate in accordance with American Academy of Pediatrics (AAP) recommendations. More effective EHR-based interventions combined with increased provider awareness of appropriate HCV testing in perinatally exposed infants is imperative.
Estimands and missing data in clinical trials of chronic pain treatments: advances in design and analysis
Authors: Cai Xueya , Gewandter Jennifer S. , He Hua , Turk Dennis C. , Dworkin Robert H. , McDermott Michael P. 
Published: May 2020

Abstract
In clinical trials of treatments for chronic pain, the percentage of participants who withdraw early can be as high as 50%. Major reasons for early withdrawal in these studies include perceived lack of efficacy and adverse events. Commonly used strategies for accommodating missing data include last observation carried forward, baseline observation carried forward, and more principled methods such as mixed-model repeated-measures and multiple imputation. All these methods require strong and untestable assumptions concerning the conditional distribution of outcomes after dropout, given the observed data. We review recent developments in statistical methods for handling missing data in clinical trials, including implications of the increased emphasis being placed on precise formulation of the study objectives and the estimand (treatment effect to be estimated) of interest. A flexible method that seems to be well suited for the analysis of chronic pain clinical trials is control-based imputation, which allows a variety of assumptions to be made concerning the conditional distribution of postdropout outcomes that can be tailored to the estimand of interest. These assumptions can depend, for example, on the stated reasons for dropout. We illustrate these methods using data from 4 clinical trials of pregabalin for the treatment of painful diabetic peripheral neuropathy and postherpetic neuralgia. When planning chronic pain clinical trials, careful consideration of the trial objectives should determine the definition of the trial estimand, which in turn should inform methods used to accommodate missing data in the statistical analysis.
Optical coherence tomography–based diabetic macula edema screening with artificial intelligence
Authors: Hwang De-Kuang , Chou Yu-Bai , Lin Tai-Chi , Yang Hsin-Yu , Kao Zih-Kai , Kao Chung-Lan , Yang Yi-Ping , Chen Shih-Jen , Hsu Chih-Chien , Jheng Ying-Chun 
Published: May 2020

Background:
Optical coherence tomography (OCT) is considered as a sensitive and noninvasive tool to evaluate the macular lesions. In patients with diabetes mellitus (DM), the existence of diabetic macular edema (DME) can cause significant vision impairment and further intravitreal injection (IVI) of anti–vascular endothelial growth factor (VEGF) is needed. However, the increasing number of DM patients makes it a big burden for clinicians to manually determine whether DME exists in the OCT images. The artificial intelligence (AI) now enormously applied to many medical territories may help reduce the burden on clinicians.

Methods:
We selected DME patients receiving IVI of anti-VEGF or corticosteroid at Taipei Veterans General Hospital in 2017. All macular cross-sectional scan OCT images were collected retrospectively from the eyes of these patients from January 2008 to July 2018. We further established AI models based on convolutional neural network architecture to determine whether the DM patients have DME by OCT images.

Results:
Based on the convolutional neural networks, InceptionV3 and VGG16, our AI system achieved a high DME diagnostic accuracy of 93.09% and 92.82%, respectively. The sensitivity of the VGG16 and InceptionV3 models was 96.48% and 95.15%., respectively. The specificity was corresponding to 86.67% and 89.63% for VGG16 and InceptionV3, respectively. We further developed an OCT-driven platform based on these AI models.

Conclusion:
We successfully set up AI models to provide an accurate diagnosis of DME by OCT images. These models may assist clinicians in screening DME in DM patients in the future.
Atherogenic Diet Accelerates Ectopic Mineralization in a Mouse Model of Pseudoxanthoma Elasticum
Authors: Zhao Jing-Yi , Kingman Joshua , Jacobs Ida Joely , Uitto Jouni , Cao Yi , Li Qiao-Li 
Published: May 2020

Abstract

Objective:
Pseudoxanthoma elasticum (PXE) is a multisystem heritable disorder caused by mutations in the Abcc6 gene. The disease is characterized by ectopic mineralization of the skin, eyes, and arterial blood vessels. Previous studies have suggested that cardiovascular complications in patients with PXE are caused in part by premature atherosclerosis. The aim of this study is to determine the effect of an atherogenic diet on ectopic mineralization.

Methods:
We used Abcc6

tm1JfK
mice (Abcc6

−/−
mice) as an established preclinical model of PXE. The offspring at age of 4 weeks were divided into two groups and fed the standard control laboratory diet (control group) and the atherogenic diet. Serum lipid profiles and bile acids were measured, and steatosis and tissue mineralization were evaluated by histopathologic analysis and chemical calcium quantification assay, respectively.

Results:
After 50–58 weeks of feeding an atherogenic diet, the concentrations of total cholesterol, low-density lipoprotein/very-low-density lipoprotein cholesterol, and bile acids were significantly higher in the Abcc6

−/−
mice on the atherogenic diet (180.9 ± 14.8 g/L, 145.9 ± 12.9 g/L, and 9.7 ± 1.4 μmol/L, respectively) than in Abcc6

−/−
mice on a control diet (85.2 ± 4.8 g/L, 25.1 ± 5.5 g/L, and 3.3 ± 0.5 μmol/L, respectively) (P < 0.001). Hypercholesterolemia was accompanied by extensive lipid accumulation in the liver and aorta, a characteristic feature of steatosis. The direct calcium assay demonstrated significantly increased mineralization of the muzzle skin containing the dermal sheath of vibrissae (57.2 ± 4.4 μmol Ca/gram tissue on the atherogenic diet and 43.9 ± 2.2 μmol Ca/gram tissue on control diet; P < 0.01), a reproducible biomarker of the ectopic mineralization process in these mice. An increased frequency of mineralization was also observed in the kidneys and eyes of mice on the atherogenic diet (P < 0.01).

Conclusion:
These observations suggest that the atherogenic diet caused hypercholesterolemia and accelerated ectopic mineralization in the Abcc6

−/−
mice. Our findings have clinical implications for patients with PXE, a currently intractable disorder with considerable morbidity and occasional mortality.
Epidemiology of Genital Chlamydial Infection in China in 2019
Authors: Yue Xiao-Li , Gong Xiang-Dong , Li Jing , Zhang Jia-Hui , Gu Heng 
Published: May 2020

Abstract

Objective:
Genital chlamydial infection is a globally common sexually transmitted infection caused by Chlamydia trachomatis. This study aimed to describe the epidemiological characteristics of the disease reported in China in 2019.

Methods:
Genital chlamydial infection cases were identified in 105 national sexually transmitted disease surveillance sites from the National Notifiable Infectious Disease Reporting System, which covers 31 provinces, autonomous regions, and municipalities in Chinese mainland. Data were collected and used to calculate the overall incidence, and the incidences per surveillance site, province, sex, and age group.

Results:
In 2019, there were 50,874 new cases of genital chlamydial infection reported in China, corresponding to an incidence of 55.32 cases per 100,000 population, and comprising a 9.98% increase from 2018 (50.30 cases per 100,000 population). The highest incidences of genital chlamydial infection occurred in Zhejiang, Guangdong province, Guangxi autonomous region, and Hainan province (average 137.49–233.37 cases per 100,000 population). The incidence of genital chlamydial infection was much higher in females than males, with a female-to-male ratio of 3.09 (84.55 per 100,000 population vs 27.35 per 100,000 population). The highest incidence of genital chlamydial infection was reported in the 20–24-year age group (184.70 cases per 100,000 population), followed by the 25–29-year age group (180.79 cases per 100,000) and 30–34-year age group (151.53 cases per 100,000 population). The highest proportion (68.30%) of genital chlamydial infection was reported from general hospitals, followed by maternal and child health hospitals (25.59%).

Conclusion:
The incidence rate of genital chlamydial infection in 2019 has an increase trend from 2018 and be a common sexually transmitted infection in China. The incidence is much higher in females than in males. Sexually active young adults are the highest risk population. There is substantial geographic diversity in incidence, with the highest incidence occurring in the southeast coastal areas with a developed economy. Epidemic of genital chlamydial infection in China should be concerned, and its surveillance needs to be improved.
Screening, brief intervention, and referral to treatment training for family nurse practitioner students
Authors: Arends Robin , Anderson Elverson Cynthia , Pike Keefner Tamara , Mylant MaryLou 
Published: May 2020

ABSTRACT
Alcohol and substance-related disorders affect individuals throughout the global community. It is important that nurse practitioners understand the use of screening, brief intervention, and referral to treatment (SBIRT) in recognizing these disorders before development of chronic disease conditions. The SBIRT curriculum was adapted and integrated in a family nurse practitioner program. After completion of the curriculum in the didactic setting, students used what they learned in a clinical setting. Following the experience, students reflected on the encounters leading to increased awareness of personal feelings. Students were able to use their training in patient encounters and identified a variety of thoughts and feelings about working with patients who screened positive for overuse of alcohol or substances. The SBIRT is an important component of the education of nurse practitioners. It is through timely screening and intervention that conditions can be addressed early in substance use disorder. It is important for students to be aware of personal thoughts and feelings when working with this population.
Parent and child perceptions of the child's health at 2, 4, 6, and 13 months after sibling intensive care or emergency department death
Authors: Roche Rosa , Youngblut JoAnne M. , Brooten Dorothy A. 
Published: May 2020

ABSTRACT

Background:
Approximately 50,000 US infants and children die annually, leaving surviving children and families with long-lasting effects. In most studies, children's health is rated by parents, but not the children.

Purpose:
To compare the surviving children’s self-rated health with parents’ ratings at 2, 4, 6, and 13 months after sibling neonatal intensive care unit/pediatric intensive care unit/emergency department death death and identify the related factors.

Methods:
Children and their parents rated the child’s health “now,” “now compared with others your age,” and “now versus before” the sibling’s death.

Sample:
One hundred thirty-two children (58% girls, 72% school-aged, and 50% Black non-Hispanic), 70 mothers, and 26 fathers from 71 bereaved families.

Conclusions:
Children self-rated their health: “now” as lower than their mothers at 4, 6, and 13 months and their fathers at 2, 4, and 13 months; “now compared with others your age” as lower than their mothers at each time point and fathers at 4, 6, and 13 months; and “now versus before” their sibling’s death as higher than their mothers at 4, 6, and 13 months and fathers at 6 months. Ratings did not differ by age, gender, or race/ethnicity. At 6 months, children self-rated their health “now” as higher than their fathers in families with one to two surviving children but lower than their fathers in families with three to eight surviving children.

Implications for practice:
Parents often perceive their children as healthier than children perceive themselves after sibling death, especially in larger families. Talking with children separately can identify the children at risk for emotional and physical illnesses earlier, providing more timely and appropriate interventions and referrals.
Elevated troponin levels in patients with atrial tachyarrhythmias
Authors: Rozenbaum Zach , Sapir Orly , Taieb Philippe , Ziv-Baran Tomer , Konigstein Maayan , Hochstadt Aviram , Rosso Raphael , Banai Shmuel , Chorin Ehud 
Published: May 2020

Objective
Data regarding the significance of elevated troponin in the setting of atrial tachyarrhythmia remain inconclusive. In the present study, we aimed to explore the discriminative ability of troponin for obstructive coronary artery disease (CAD) among patients with atrial tachyarrhythmias.

Methods
We retrospectively identified patients with atrial tachyarrhythmias and elevated serum troponin levels, who underwent invasive coronary angiography during the same admission. The prevalence of obstructive CAD among these patients was compared to that of historically matched patients who underwent coronary angiography due to suspected non-ST elevation myocardial infarction and had no arrhythmias.

Results
Overall 318 patients with suspected non-ST elevation myocardial infarction were analyzed (n = 159 with atrial tachyarrhythmias and n = 159 without arrhythmias). Obstructive CAD was detected in 39% of patients with an arrhythmia compared to 85.5% in the control group (P < 0.001). A multivariable analysis demonstrated that parameters associated with obstructive CAD among patient with atrial tachyarrhythmias and elevated troponin were diabetes mellitus [odds ratio (OR) 2.7, 95% confidence interval (CI) 1.23–5.91, P = 0.013], prior ischemic heart disease (OR 4.48, 95% CI 1.93–10.4, P < 0.001) and troponin level (OR 3.18 for every 1000 ng/L increment, 95% CI 1.85–5.48, P < 0.001).

Conclusions
Elevated troponin is not a reliable indicator for the presence of underlying obstructive CAD among patients who present with atrial tachyarrhythmias. Risk stratification of these patients should rely on the degree of troponin elevation, and the presence of diabetes mellitus and prior ischemic heart disease.
Noncoeliac wheat sensitivity and diet
Authors: Mańkowska-Wierzbicka Dorota , Stelmach-Mardas Marta 
Published: May 2020

Purpose of review
Noncoeliac gluten sensitivity (NCGS) can be suspected after exclusion of coeliac disease and wheat allergy. However, poorly understood pathogenesis of the NCGS, lack of gold standard for diagnosis and agreement in the definition for the NCGS condition, open the space for future investigation. This review aims to give an overview on the diagnosis and effective diet composition in the treatment of NCGS symptoms.

Recent findings
It appears that a diet low in fermentable oligo, di, and monosaccharides and polyols (FODMAPs) and gluten-free diet play a prominent role in the strategy of NCGS management. Considering available evidence with respect to diagnostic tools, it is challenging to prepare a standard guideline for NCGS diagnosis and treatment with clear cut-offs for symptom reduction/improvement that could directly be translated into test results. Nutritional support, including the use of pre/probiotics, has to be tailored to the individual situation of NCGS patients.

Summary
The exclusion of such components of wheat as amylase/trypsin inhibitors, wheat-germ agglutinins, or free of FODMAPs diet can reduce clinical symptoms of NCGS. The further investigation on microbiota changes may strengthen the knowledge in this area, where the major challenge is to develop biomarkers for NCGS investigation.
The role of taxane-based chemotherapy in the treatment of prostate cancer
Authors: Huebner Nicolai A. , Shariat Shahrokh F. , Resch Irene , Gust Kilian , Kramer Gero 
Published: May 2020

Purpose of review
Indications for chemotherapy have increased in prostate cancer (PCA), many of which are shared with new hormonal agents (NHA). With no head to head comparison available, defining the optimal sequence and identifying biomarkers to predict response, has been a focus of intense research in PCA. We aim to summarize the best currently available evidence in all stages of disease to help guide therapy.

Recent findings
In metastatic castration-resistant prostate cancer, Cabazitaxel has shown improved radiographic progression-free survival over another NHA after Docetaxel and one NHA. For hormone sensitive PCA (mHSPC) multiple meta-analyses have shown combination therapy with Docetaxel or an NHA to be superior to androgen deprivation therapy alone, yet no clear benefit over each other. For peri-interventional chemotherapy with local therapy, there is currently only one positive prospective trial, for very high-risk disease.

Summary
Cabazitaxel is underutilized and should be used earlier. NHAs should not be used in succession as there is significant cross resistance. Combination therapy should be used in mHSPC, yet there is no clear benefit for any combination. Peri-interventional chemotherapy might have a benefit for a small group of patients with very high-risk disease, yet this must be carefully evaluated, and side effects must be taken into account.
Pediatric Crohn Disease and Multisystem Inflammatory Syndrome in Children (MIS‐C) and COVID‐19 Treated With Infliximab
Authors: Dolinger Michael T. , Person Hannibal , Smith Rachel , Jarchin Lauren , Pittman Nanci , Dubinsky Marla C. , Lai Joanne 
Published: May 2020

ABSTRACTCoronavirus disease 2019 (COVID‐19) may lead to a severe inflammatory response referred to as a cytokine storm. We describe a case of severe COVID‐19 infection in a recently diagnosed pediatric Crohn disease patient successfully treated with tumor necrosis factor‐alpha (TNF‐α) blockade. The patient presented with 5 days of fever, an erythematous maculopapular facial rash, and abdominal pain without respiratory symptoms. SARS‐CoV‐2 polymerase chain reaction was positive. Despite inpatient treatment for COVID‐19 and a perianal abscess, the patient acutely decompensated, with worsening fever, tachycardia, fluid‐refractory hypotension, elevation of liver enzymes, and transformation of the rash into purpura extending from the face to the trunk, upper and lower extremities, including the palmar and plantar surfaces of the hands and feet. Cytokine profile revealed rising levels of interleukin (IL)‐6, IL‐8, and TNF‐α, higher than those described in either inflammatory bowel disease or severe COVID‐19 alone. The patient was treated with infliximab for TNF‐α blockade to address both moderately to severely active Crohn disease and multisystem inflammatory syndrome in children temporally related to COVID‐19. Within hours of infliximab treatment, fever, tachycardia, and hypotension resolved. Cytokine profile improved with normalization of TNF‐α, a decrease in IL‐6, and IL‐8 concentrations. This case supports a role for blockade of TNF‐α in the treatment of COVID‐19 inflammatory cascade. The role of anti‐TNF agents in patients with multisystem inflammatory syndrome in children temporally related to COVID‐19 requires further investigation.
Frequent Stools Were Related to Reduced Quality of Life and Capacity in Daily Activities
Authors: Enblom Anna , Steineck Gunnar , Börjeson Sussanne 
Published: May 2020

Background
Greater knowledge regarding stool frequency and infrequency during pelvic and abdominal irradiation is needed to accurately identify patients at risk of either.

Objective
To describe occurrence of frequent and infrequent stools during pelvic-abdominal radiotherapy, and to compare quality of life (QoL) and activities of daily living (ADLs) of those patients experiencing frequent stools with those of patients experiencing infrequent stools.

Methods
Longitudinally during radiotherapy, 193 patients (64% had gynecological tumors) documented stool frequency, medications, and QoL using the Functional Assessment of Cancer Therapy–General.

Results
Fifty (26%) experienced frequent stools (≥28 stools a week), and 17 (9%) experienced infrequent stools (<3 stools a week). The frequency of stools and the consumption of medication for diarrhea were highest the last week of the radiotherapy period (50% had ≥49 stools a week, and 50% could not even define the number of stools). Thirty-seven of the patients experiencing frequent stools used antidiarrhea medications. Patients with frequent stools experienced lower QoL (P = .035) and capacity in ADLs (P = .023) compared with patients not experiencing frequent stools.

Conclusions
A fourth of patients irradiated over pelvic or abdominal fields experienced frequent stools, defined as moderate to severe diarrhea, and those patients experienced lower QoL and capacity in ADLs compared with patients who did not experience frequent stools. Infrequent stools were rarely experienced.

Implications for Practice
Cancer nursing professionals should deliver evidence-based strategies to prevent frequent stools and treat frequent stools as an approach to lower the risk of impaired capacity in daily living and worsened QoL.