bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal depression symptoms during the first 21 months after giving birth
Authors: Rosander Michael , Berlin Anita , Forslund Frykedal Karin , Barimani Mia 
Published: December 2020

Aims: The first year after childbirth involves a major transition for women, which can accentuate inadequacies and feelings of powerlessness, making them vulnerable to depression. The aim of this study was to investigate the prevalence and frequency of maternal postpartum depressive symptoms at different times after giving birth (0–21 months). Methods: Data were collected cross-sectionally using a web questionnaire containing the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with children in the age range 0–21 months responded. Results: The results showed different levels of depression over the range of months included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%. There were higher levels at 9–12 months and 17–21 months. The highest levels of symptoms of depression were found at nine, 12, and 17 months after birth, and the lowest levels at two and 16 months. Conclusions: Many mothers experience symptoms of depression after giving birth that can continue well beyond the child’s first year. We have identified different levels of depression at different points in time after giving birth, with highs and lows throughout the first 21 months. This highlights a need to screen for depression more than once during the first years, as well as a closer cooperation between midwives and child healthcare nurses in supporting mothers in the transition to motherhood. This is an important aspect of public health, which not only involves mothers with symptoms of depression, but also their ability to care for their child and a possible negative impact on the child’s development.
Experience With Anti-PD-1 Antibody, Camrelizumab, Monotherapy for Biliary Tract Cancer Patients and Literature Review
Authors: Shen Tian , Zheng Shanhua , Geng Lei , Liu Zhengtao , Xu Jun , Lin Bingyi , Qian Junjie , Zheng Shusen 
Published: December 2020

Background: Novel immunotherapy is one of the options for advanced biliary tract cancer (BTC) patients who are traditionally intolerant to chemotherapy. However, clinical evidence for single immunotherapy with pembrolizumab or nivolumab is limited. The present study assessed the safety and efficiency of the anti-PD-1 antibody, camrelizumab, as monotherapy in patients with unresectable or recurrent BTC. Methods: A retrospective evaluation was conducted among 4 patients with BTC, including 2 with intrahepatic cholangiocellular carcinoma (ICC), one with extrahepatic bile duct cancer, and one with gallbladder cancer. The patients with unresectable or recurrent BTC were refractory or intolerant to gemcitabine plus cisplatin treatment regimens and received at least one intravenous dose (3 mg/kg) of camrelizumab monotherapy every 3 weeks. Gene sequencing analysis was also performed for biomarker screening. Patient reaction was evaluated according to modified response evaluation criteria in solid tumor (RECIST) version 1.1, progression-free survival (PFS), and toxicity. Results: In this cohort, 1 patient with recurrent ICC had a positive response to treatment, with a substantial tumor size reduction in liver and lung metastases verified using a radiological test after receiving 3 cycles of camrelizumab. The PFS was 4.9 months. The remaining 3 patients showed no response to treatment and experienced disease progression. RNA sequence analysis didn’t found high expression on genes that related to PD-L1, microsatellite instability, tumor mutation burden, and DNA mismatch repair in these patients. Grade 3 treatment-related adverse event was observed in 1 patient. Conclusions: Anti-PD-1 antibody camrelizumab had a manageable safety profile in patients with advanced BTC. This initial assessment of camrelizumab monotherapy provides effective evidence for patients with refractory BTC in biomarker-unselected patients.
Acupuncture for Radiation-Induced Xerostomia in Cancer Patients: A Systematic Review and Meta-Analysis
Authors: Ni Xixiu , Tian Tian , Chen Dan , Liu Lu , Li Xiao , Li Fengmei , Liang Fanrong , Zhao Ling 
Published: December 2020

Background: Radiation-induced xerostomia is one of the most common symptoms experienced by cancer patients. The aim of our study is to evaluate the preventive and therapeutic effect of acupuncture for radiation-induced xerostomia in cancer patients. Methods: Eight databases were searched for all published randomized clinical trials (RCTs) on acupuncture for radiation-induced xerostomia in cancer patients up to December 31, 2019. Manual searching included other conference abstracts and reference lists. Meta-analysis was conducted using Revman V.5.3, and risks of bias for included studies was assessed following the Cochrane Handbook. Results: Eight clinical trials (725 participants) were analyzed, and 3 were included in a meta-analysis. All included trials had a high risk of bias, such as selection, performance, and detection bias. Analysis indicated favorable effects of acupuncture regarding the improvement of xerostomia symptoms (MD −3.05, P = 0.02, 95% CI −5.58 to −0.52), compared with sham acupuncture. There were no significant differences between real acupuncture and sham acupuncture regarding the stimulated salivary flow rate (MD 0.37, P = 0.08, 95% CI −0.05 to 0.79) and unstimulated salivary flow rate (MD 0.09, P = 0.12, 95% CI −0.02 to 0.21), which were whole salivary flow rate. Compared with no acupuncture (standard oral care, usual care, or no treatment), acupuncture produced a significant improvement in patient-reported xerostomia, without causing serious adverse effects. However, a Grading of Recommended Assessments analysis revealed that the quality of all acupuncture outcome measures was low. Conclusion: The present meta-analysis and systematic review suggests that acupuncture is effective at improving xerostomia symptoms in cancer patients but not at objective salivary flow measurements. The evidence is still limited due to the low quality of the published studies.
Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials
Authors: Spiteri Michelle , Giele Henk 
Published: December 2020

Background Osteoarthritis of the first carpometacarpal joint is a common condition. Various management options and surgical procedures have been described to treat symptomatic cases. Many systematic reviews examine aspects of thumb carpometacarpal joint osteoarthritis treatment, although none solely examines the outcomes of trapezial partial resection and interposition arthroplasty in stage II to III patients in detail, yet this technique is of growing interest as surgeons seek more nuanced, tailored approaches for osteoarthritis of the first carpometacarpal joint. Methods A systematic review of the thumb carpometacarpal joint hemiresection and interposition arthroplasty was performed with pain assessment as a primary outcome measure and patient-reported outcome measures (PROMs) and reoperation rate as secondary outcome measures. A search was performed between 2004 and 2019 using MEDLINE, Embase, and PubMed. Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines were used. Results Twenty-nine articles met the inclusion criteria and were included in the final review. Pain relief and improved PROMs were described in all the articles using this technique with all the interposition materials. Materials such as polyurethane urea matrix and poly-l/d-lactide scaffold had higher complication rates. Revision rates varied and were highest with the polyurethane urea matrix. Conclusions This review shows that hemiresection interposition arthroplasty is a useful technique and provides symptomatic benefit in patients with Eaton-Littler stage II and III osteoarthritis. Revision surgery rates due to persistent pain and instability were higher with the use of implants. Larger and long-term studies of this technique using autologous or more bioinert materials and implants are required to assess duration of symptomatic benefit.
Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience
Authors: Zhang Yu-Jing , Bai Lei , Wang Liang , Shi Hong-Rui , Liu Jiang-Long , Ma Fu-Zhen , Guo Shu-Ping , Li Xiao-Dong 
Published: December 2020

Objective The present study aims to analyze the outcomes of three cases of pre-fenestration and branch stent-graft endovascular repair of aortic disease with zone 2 aortic lesions. Methods From August 2017 to June 2018, three patients with zone 2 aortic lesions underwent thoracic endovascular repair with innominate artery, left common carotid artery, and left subclavian artery recannulation using pre-fenestration and branched stent-grafts to preserve the patency of the aortic arch branches. Results The technical success rate was 100%. One patient had a proximal type I endoleak with no need for additional treatment. The overall mortality was 0%. All branches were patent. The follow-up period lasted for 2–15 months, with one patient lost to follow-up. There were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde type A aortic dissection. Conclusion The use of a pre-fenestration and branch stent-graft for the thoracic endovascular repair of zone 2 aortic lesions is a feasible and effective method for aortic arch branch revascularization. The risk of this surgical procedure is high, requiring significant expertise. The procedure should be conducted only in experienced centers. Durability concerns should be assessed in future studies with long-term follow-up.
Difference of copy number variation in blood of patients with lung cancer
Authors: Heo Yeonjeong , Heo Jeongwon , Han Seon-sook , Kim Woo Jin , Cheong Hyun Sub , Hong Yoonki 
Published: December 2020

Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Copy number variation (CNV) in several genetic regions correlate with cancer susceptibility. Hence, this study evaluated the association between CNV and non-small cell lung cancer (NSCLC) in the peripheral blood. Methods: Blood samples of 150 patients with NSCLC and 150 normal controls were obtained from a bioresource center (Seoul, Korea). Through an epigenome-wide analysis using the MethylationEPIC BeadChip method, we extracted CNVs by using an SVS8 software-supplied multivariate method. We compared CNV frequencies between the NSCLC and controls, and then performed stratification analyses according to smoking status. Results: We acquired 979 CNVs, with 582 and 967 copy-number gains and losses, respectively. We identified five nominally significant associations (ACOT1, NAA60, GSDMD, HLA-DPA1, and SLC35B3 genes). Among the current smokers, the NSCLC group had more CNV losses and gains at the GSDMD gene in chromosome 8 ( P=0.02) and at the ACOT1 gene in chromosome 14 ( P=0.03) than the control group. It also had more CNV losses at the NAA60 gene in chromosome 16 ( P=0.03) among non-smokers. In the NSCLC group, current smokers had more CNV gains and losses at the ACOT1 gene in chromosome 14 ( P=0.003) and at HLA-DPA1 gene in chromosome 6 ( P=0.02), respectively, than non-smokers. Conclusion: Five nominally significant associations were found between the NSCLC and CNVs. CNVs are associated with the mechanism of lung cancer development. However, the role of CNVs in lung cancer development needs further investigation.
Is thoracoscopy superior to thoracotomy in the treatment of congenital lung malformations? An updated meta-analysis
Authors: Xie Junhua , Wu Yuhao , Wu Chun 
Published: December 2020

Background: A meta-analysis was performed for a comparison of outcomes between video-assisted thoracoscopic surgery (VATS) and thoracotomy for congenital lung malformations (CLM). Methods: Electronic databases, including PubMed, Scopus, Embase, and the Cochrane Library were searched systematically for literature aimed mainly at reporting the therapeutic effects for CLM administrated by VATS and thoracotomy. Results: A total of 40 studies meeting the inclusion criteria were included, involving 2896 subjects. VATS was associated with fewer complications [odds ratio (OR) 0.54; 95% confidence interval (CI), 0.42–0.69], less use of epidural anesthesia (OR, 0.08; 95% CI, 0.03–0.23), shorter length of hospital stay [standard mean difference (SMD) −0.98; 95% CI, −1.4 to −0.55] and chest drainage (SMD, −0.43; 95% CI, −0.7 to −0.17), as compared with thoracotomy. However, thoracotomy showed superiority in reduced operative time (SMD, 0.44; 95% CI, 0.04–0.84). Pearson analysis (Pearson r = 0.85, 95% CI, 0.28 to 0.98, p = 0.01) and linear regression ( R square 0.73) confirmed a positive correlation between percentage of symptomatic cases and conversion in patients using VATS. Conclusion: VATS is associated with fewer complications, less use of epidural anesthesia, shorter length of stay and length of chest drainage, but longer operative time, as compared with thoracotomy. Symptomatic patients with CLM using VATS may be prone to conversion to thoracotomy. The reviews of this paper are available via the supplemental material section.
Investigations, actions and learning from an outbreak of SARS-CoV-2 infection among healthcare workers in the United Kingdom
Authors: Saeed Kordo , Pelosi Emanuela , Mahobia Nitin , White Nicola , Labdon Christopher , Ahmad-Saeed Nusreen , Grieves Ashley , Johnstone Penelope , Higgs David , Jeramiah Sarah , Dailly Sue , Henderson Thelma , Stringfellow Mary , Wilson-Davies Eleri , Grundy Paul 
Published: December 2020

Background: We report an outbreak of SARS coronavirus-2 (SARS-CoV-2) infection among healthcare workers (HCW) in an NHS elective healthcare facility. Methodology: A narrative chronological account of events after declaring an outbreak of SARS-CoV-2 among HCWs. As part of the investigations, HCWs were offered testing during the outbreak. These were: (1) screening by real-time reverse transcriptase polymerase chain reaction (RT- PCR) to detect a current infection; and (2) serum samples to determine seroprevalence. Results: Over 180 HCWs were tested by real-time RT-PCR for SARS-CoV-2 infection. The rate of infection was 15.2% (23.7% for clinical or directly patient-facing HCWs vs. 4.8% in non-clinical non-patient-facing HCWs). Of the infected HCWs, 57% were asymptomatic. Seroprevalence (SARS-CoV-2 IgG) among HCWs was 13%. It was challenging to establish an exact source for the outbreak. The importance of education, training, social distancing and infection prevention practices were emphasised. Additionally, avoidance of unnecessary transfer of patients and minimising cross-site working for staff and early escalation were highlighted. Establishing mass and regular screening for HCWs are also crucial to enabling the best care for patients while maintaining the wellbeing of staff. Conclusion: To our knowledge, this is the first UK outbreak report among HCWs and we hope to have highlighted some key issues and learnings that can be considered by other NHS staff and HCWs globally when dealing with such a task in future.
A deep-learning-based prognostic nomogram integrating microscopic digital pathology and macroscopic magnetic resonance images in nasopharyngeal carcinoma: a multi-cohort study
Authors: Zhang Fan , Zhong Lian-Zhen , Zhao Xun , Dong Di , Yao Ji-Jin , Wang Si-Yang , Liu Ye , Zhu Ding , Wang Yin , Wang Guo-Jie , Wang Yi-Ming , Li Dan , Wei Jiang , Tian Jie , Shan Hong 
Published: December 2020

Background: To explore the prognostic value of radiomics-based and digital pathology-based imaging biomarkers from macroscopic magnetic resonance imaging (MRI) and microscopic whole-slide images for patients with nasopharyngeal carcinoma (NPC). Methods: We recruited 220 NPC patients and divided them into training ( n = 132), internal test ( n = 44), and external test ( n = 44) cohorts. The primary endpoint was failure-free survival (FFS). Radiomic features were extracted from pretreatment MRI and selected and integrated into a radiomic signature. The histopathological signature was extracted from whole-slide images of biopsy specimens using an end-to-end deep-learning method. Incorporating two signatures and independent clinical factors, a multi-scale nomogram was constructed. We also tested the correlation between the key imaging features and genetic alternations in an independent cohort of 16 patients (biological test cohort). Results: Both radiomic and histopathologic signatures presented significant associations with treatment failure in the three cohorts (C-index: 0.689–0.779, all p < 0.050). The multi-scale nomogram showed a consistent significant improvement for predicting treatment failure compared with the clinical model in the training (C-index: 0.817 versus 0.730, p < 0.050), internal test (C-index: 0.828 versus 0.602, p < 0.050) and external test (C-index: 0.834 versus 0.679, p < 0.050) cohorts. Furthermore, patients were stratified successfully into two groups with distinguishable prognosis (log-rank p < 0.0010) using our nomogram. We also found that two texture features were related to the genetic alternations of chromatin remodeling pathways in another independent cohort. Conclusion: The multi-scale imaging features showed a complementary value in prognostic prediction and may improve individualized treatment in NPC.
Built Environment Airborne Infection Control Strategies in Pandemic Alternative Care Sites
Authors: Gordon David , Ward Jane , Yao Christopher J. , Lee Joyce 
Published: December 2020

Objectives, Purposes, or Aim: To identify design strategies utilized in airborne infection isolation and biocontainment patient rooms that improve infection control potential in an alternative care environment. Background: As SARS-CoV-2 spreads and health care facilities near or exceed capacity, facilities may implement alternative care sites (ACSs). With COVID-19 surges predicted, developing additional capacity in alternative facilities, including hotels and convention centers, into patient care environments requires early careful consideration of the existing space constraints, infrastructure, and modifications needed for patient care and infection control. Design-based strategies utilizing engineering solutions have the greatest impact, followed by medical and operational strategies. Methods: This article evaluates infection control and environmental strategies in inpatient units and proposes system modifications to ACS surge facilities to reduce infection risk and improve care environments. Results: Although adequate for an acute infectious disease outbreak, existing capacity in U.S. biocontainment units and airborne infection isolation rooms is not sufficient for widespread infection control and isolation during a pandemic. To improve patients’ outcomes and decrease infection transmission risk in the alternative care facility, hospital planners, administrators, and clinicians can take cues from evidence-based strategies implemented in biocontainment units and standard inpatient rooms. Conclusions: Innovative technologies, including optimized air-handling systems with ultraviolet and particle filters, can be an essential part of an infection control strategy. For flexible surge capacity in future ACS and hospital projects, interdisciplinary design and management teams should apply strategies optimizing the treatment of both infectious patients and minimizing the risk to health care workers.
The Development and Reliability of the Singaporean Environmental Assessment Tool (SEAT) for Facilities Providing High Levels of Care for People Living With Dementia
Authors: Sun Joanna , Fleming Richard 
Published: December 2020

Background: This article describes the development of the Singapore Environmental Assessment Tool (SEAT), a culturally appropriate, usable, reliable, and valid assessment tool designed to evaluate the extent to which the built environment in Singaporean aged care facilities is able to support the provision of high levels of care to people living with dementia. Methods: A multistage sequential mixed methods approach was carried out involving 16 raters in Stage 1 and six raters in Stage 2 using a culturally adapted English version of the Environmental Audit Tool–High Care (EAT-HC) in eight nursing homes. The first stage captured qualitative data on cultural sensitivities and usability of the tool. The SEAT was improved based on the findings, and in the second stage, the usability and psychometric properties of the modified tool were again assessed. Usability was determined by data collected via the System Usability Scale and the Questions to Assess Barriers and Facilitators survey. Psychometric properties were examined by the calculation of percentage agreement, item-level interrater agreement was measured using Fleiss’s κ, and Cronbach’s α was used to measure the internal consistency of the subscale scores. Results: The culturally adapted SEAT was found to have an acceptable level of usability and moderate level of reliability among subscales. Conclusion: The study indicated that the tool is reliable and valid when completed by users with knowledge of dementia-enabling environments. For the tool to be used with confidence education in the application of principles of design to the design of environments for people living with dementia is recommended prior to its use.
Opioid Use, Perioperative Risks, and Associated Postoperative Complications in Foot and Ankle Surgery
Authors: Ridenour Ryan , Kowalski Christopher , Ba Djibril , Liu Guodong , Bible Jesse , Garner Matthew , Leslie Douglas , Aynardi Michael , Dhawan Aman 
Published: December 2020

Introduction Opioid abuse has become a national crisis. Published data demonstrate that patients undergoing foot and ankle surgery are left with excess narcotic medications postoperatively. The purpose of our study was to evaluate factors associated with prolonged postoperative opioid use following foot and ankle surgery and identify associations between preoperative opioid use and postoperative complications. Methods MarketScan commercial claims and encounters database was searched to identify foot and ankle patients. Preoperative comorbidities were queried and documented. Patients utilizing opioids 1 to 3 months prior to surgery were identified. Adjusted odds ratios and 95% CIs were calculated using multivariable logistic regression to determine associations between opioid use (preoperatively and postoperatively), readmission, and complications. Results A total of 112 893 patients were included in the study. Preoperative use had a statistically significant association with postoperative use out to 1 year. Tobacco use, chronic pain, mental health diagnosis, and nonopioid medications had a statistically significant association with postoperative use. Preoperative opioid use had a statistically significant association with readmission and postoperative complications. Conclusion Our study found a number of factors associated with prolonged postoperative opioid use (preoperative use, tobacco use, chronic pain, mental health disorders, and certain nonopioid medications). We identified an association between preoperative opioid use and postoperative complications and readmission. Levels of Evidence Prognostic Level IV Evidence