bluuebunny/crossref_metadata_2025_split huggingface dataset:
Damping of Climate-Scale Oceanic Variability by Mesoscale Eddy Turbulence
Authors: Sévellec F. , Garabato A. C. Naveira , Huck T. 
Published: November 2020

AbstractThe impact of mesoscale eddy turbulence on long-term, climatic variability in the ocean’s buoyancy structure is investigated using observations from a mooring deployed in the Drake Passage, Southern Ocean. By applying the temporal-residual-mean framework and characterizing the variance contributors and the buoyancy variance budget, we identify the main source and sink of long-term buoyancy variance. Long-term buoyancy variance amplitude is set by long-term vertical velocity fluctuations acting on the steady stratification. This baroclinic buoyancy flux is also the main source of the variance, indicative of the effect of large-scale baroclinic instability. This source is balanced by a sink of long-term buoyancy variance associated with the vertical advection of the steady stratification by the eddy-induced circulation. We conclude that mesoscale eddy turbulence acts as a damping mechanism for long-term, climatic variability in the region of the observations, consistent with an “eddy saturated” behavior of the Antarctic Circumpolar Current.
A Pilot Study of the Waterless Empirical Taste Test
Authors: Jiang Rong-San , Liu Shih-An , Wang Ching-Ping , Wu Shang-Heng , Wang Jing-Jie 
Published: November 2020

Objectives: This study was performed to test the clinical applicability of a new taste test—the waterless empirical taste test (WETT). Methods: Sixty healthy volunteers and 20 patients with oral cancer were enrolled. They all received the conventional solution-based whole-mouth suprathreshold taste test (WMTT), which contained sucrose, citric acid, sodium chloride, and caffeine solutions for tastants, along with the WETT. The WETT used plastic strips to deliver tastants. The strip was embedded with sucrose, citric acid, sodium chloride, caffeine, or monosodium glutamate taste enhancer in 4 different concentrations. Each strip was tested twice. Thirty of the healthy volunteers received the WETT again to measure a retest reliability. Case–control matching by age and gender was used to compare the scores of WMTT and WETT between 13 healthy volunteers and 13 patients with oral cancer. Results: The correlation was not high between the WMTT and WETT ( r < 0.7) whether in the healthy volunteers or in patients with oral cancer. In terms of retest reliability of the WETT, the mean total score was 24.9 ± 7.3 for the first test and 25.8 ± 8.4 for the second test. The intraclass correlation coefficient was 0.85 ( P < .001). When case–control matching was performed, the WMTT scores were not significantly different between 13 healthy volunteers and 13 patients with oral cancer ( P = .266), but the WETT scores were significantly lower in patients with oral cancer ( P = .017). Conclusion: This study showed that the results of the WETT were not highly correlated with those of the WMTT. However, its retest reliability was high, and its results were significantly different between the healthy volunteers and the patients with oral cancer.
Comprehensive Treatment Strategy for Internal Carotid Artery Blowout Syndrome Caused by Nasopharyngeal Carcinoma
Authors: Zhao Zhouyang , Huang Lijin , Chen Jinhua , Huang Weijia , Zhang Xiaobin , Ma Yue , Zhu Hongshen , Liu Zhang 
Published: November 2020

ObjectiveTo evaluate a treatment strategy for internal carotid artery blowout syndrome caused by nasopharyngeal carcinoma.Study DesignA retrospective analysis of a case series was performed.SettingCarotid blowout syndrome is a catastrophic complication caused by malignant tumor of the skull base.MethodsA retrospective analysis based on 69 patients with internal carotid artery blowout syndrome admitted to our center between April 2018 and January 2020 was performed. The patients were divided into 2 groups: an EBBA (internal carotid artery embolization + bypass based on American Society of Intervention and Therapeutic Neuroradiology/Society of Interventional Radiology [ASITN/SIR]) group and an embolization/stent group. The follow‐up time was 6 to 9 months.ResultsIn the EBBA group, 41 patients (41/49, 83.7%) survived. Forty patients had a satisfactory quality of life after 3 months. No death occurred within 3 months. Nonoperative death occurred in 8 cases (8/49, 16.3%). The rate of mortality and disability was 18.4% (9/49). In the embolization/stent group, 16 patients (16/20, 80%) survived. Nonoperative death occurred in 4 cases (4/20, 20%), 3 of which occurred within 1 to 3 months. Four cases reported Modified Rankin Scale ≥2 after 3 months. The rate of mortality and disability was 40% (8/20).ConclusionA comprehensive revascularization strategy for internal carotid artery (ICA) embolization and intracranial and extracranial bypass grafting based on ASITN/SIR score for ICA blowout syndrome patients not only can prolong the patient survival but also greatly improve the survival probability and quality of life as well as reduce their rate of mortality or disability.
Does Ibuprofen Increase Bleed Risk for Pediatric Tonsillectomy?
Authors: Leung Peggy , DeVore Elliana Kirsh , Kawai Kosuke , Yuen Sonia , Kenna Margaret , Irace Alexandria L. , Roberson David , Adil Eelam 
Published: November 2020

ObjectiveTo evaluate risk factors for pediatric posttonsillectomy hemorrhage (PTH) and the need for transfusion using a national database.Study DesignRetrospective cohort study.SettingThe study was conducted using the Pediatric Health Information System (PHIS) database.MethodsChildren ≤18 years who underwent tonsillectomy with or without adenoidectomy (T±A) between 2004 and 2015 were included. We evaluated the risk of PTH requiring cauterization according to patient demographics, comorbidities, indication for surgery, medications, year of surgery, and geographic region.ResultsOf the 551,137 PHIS patients who underwent T±A, 8735 patients (1.58%) experienced a PTH. The risk of PTH increased from 1.33% (95% confidence interval [CI]: 1.15%, 1.53%) in 2010 to 1.91% (95% CI: 1.64%, 2.24%) in 2015 (P <. 001). Older age (≥12 vs <5 years old: adjusted odds ratio [aOR] 3.17; 95% CI: 2.86, 3.52), male sex (aOR 1.11; 95% CI: 1.05, 1.17), medical comorbidities (aOR 1.18; 95% CI: 1.08, 1.29), recurrent tonsillitis (aOR 1.15; 95% CI: 1.07, 1.24), and intensive care unit admission (aOR 1.74; 95% CI: 1.55, 1.95) were significantly associated with an increased risk of PTH. Use of ibuprofen (aOR 1.36; 95% CI: 1.22, 1.52), ketorolac (aOR 1.39; 95% CI: 1.14, 1.69), anticonvulsant (aOR 1.23; 95% CI: 1.03, 1.76), and antidepressants (aOR 1.35; 95% CI: 1.03, 1.76) were also associated with an increased risk of PTH. The need for blood transfusion was 2.1% (181/8735).ConclusionThe incidence of PTH increased significantly between 2011 and 2015, and ibuprofen appears to be one contributing factor. Given the benefits of ibuprofen, it is unclear whether this increased risk warrants a change in practice.
Association of maternal food insecurity before and during pregnancy with fetal structural anomalies: A multicenter case-control study protocol
Authors: Zaçe Drieda , Hoxhaj Ilda , Pasciuto Tina , D’Anna Rosario , Straface Gianluca , Reali Laura , De Santis Marco , Di Pietro Maria Luisa 
Published: November 2020

Background: Food insecurity, an issue also affecting developed countries, is associated with different negative outcomes. Particularly in pregnant women, a vulnerable population group, it has a double burden, as it affects both the woman and her child. Food insecurity has been associated with low birth weight and shorter gestational age, but there is less evidence on the association with fetal structural anomalies. Aim: To fill this gap, a study will be conducted to examine if pregnant women in a condition of food insecurity have a higher risk for fetal structural anomalies. Methods: A case-control study will be conducted in three centers. Cases will be pregnant women (>18 years old) diagnosed with a fetal structural anomaly during the prenatal ultrasound examination of the II–III trimester, while controls will be pregnant women (>18 years old) with a negative result for fetal structural anomaly at the II–III trimester prenatal ultrasound examination. The exposure of interest will be food insecurity during the last 12 months, measured using the validated Household Food Insecurity Access Scale. A dedicated questionnaire will be given to women after they sign the informed consent form. Summary: Finding a positive association between food insecurity in pregnant women and fetal structural anomalies could be the first step towards screening for it among pregnant women and designing policies that could mitigate this condition. Lowering food insecurity could prevent a certain number of fetal structural anomalies, leading to fewer negative pregnancy outcomes and health problems during childhood and adulthood.
The future of rehabilitation in the United Kingdom National Health Service: Using the COVID-19 crisis to promote change, increasing efficiency and effectiveness
Authors: Wade Derick T 
Published: November 2020

The problem: Rehabilitation services in the UK are inadequate, with insufficient capacity or flexibility to meet the needs of patients after Covid-19. History: Rehabilitation developed in a piecemeal way, focused on specific problems: spinal cord injury, burns, polio, stroke, back pain, equipment and adaptations etc. Rehabilitation is also provided using other names (e.g. intermediate care). Patients with complex needs do not fit easily within this system. System failure: After Covid-19, patients have problems that cross existing condition-specific and/or treatment-specific services. Covid-19 has exposed the lack of any coherent organisational principle underlying development or commissioning of rehabilitation services. Consequently, in order to have their needs met, patients either have to engage with two or more separate services or they receive good management for some problems and sub-optimal management for other problems. The goals: The multitude of small specific services need to coalesce into an integrated service able to meet all the needs of any patient referred. Second, rehabilitation needs to be fully integrated into all healthcare services. A solution: The purpose of healthcare is to ‘ improve our health and well-being . . . to stay as well as we can to the end of our lives’. (NHS constitution) All healthcare services need to consider patients holistically, giving equal attention to disease, disability, and distress. Rehabilitation, acute care, mental health and palliative care services need to work in parallel to achieve this purpose. Healthcare providers, supported by commissioners and rehabilitation experts, could achieve structural and organisational change, meeting the needs of patients.
Stationary cycling exercise for knee osteoarthritis: A systematic review and meta-analysis
Authors: Luan Lijiang , Bousie Jaquelin , Pranata Adrian , Adams Roger , Han Jia 
Published: November 2020

Objective: To evaluate effects of stationary cycling exercise on pain, function and stiffness in individuals with knee osteoarthritis. Data sources: Systematic search conducted in seven databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, and CNKI) from inception to September 2020. Review methods: Included studies were randomized-controlled trials involving stationary cycling exercise conducted on individuals with knee osteoarthritis. End-trial weighted mean difference (WMD) and 95% confidence interval (CI) were analyzed, and random-effects models were used. Methodological quality and risk bias were assessed by using the Physiotherapy Evidence Database scale and Cochrane Collaboration tool, respectively. Results: Eleven studies with 724 participants were found, of which the final meta-analysis was performed with eight. Compared to a control (no exercise), stationary cycling exercise resulted in reduced pain (WMD 12.86, 95% CI 6.90–18.81) and improved sport performance (WMD 8.06, 95% CI 0.92–15.20); although most of the meta-analysis results were statistically significant, improvements in stiffness (WMD 11.47, 95% CI 4.69–18.25), function (WMD 8.28, 95% CI 2.44–14.11), symptoms (WMD 4.15, 95% CI −1.87 to 10.18), daily living (WMD 6.43, 95% CI 3.19 to 9.66) and quality of life (WMD 0.99, 95% CI −4.27 to 6.25) for individuals with knee osteoarthritis were not greater than the minimal clinically important difference values for each of these outcome measures. Conclusions: Stationary cycling exercise relieves pain and improves sport function in individuals with knee osteoarthritis, but may not be as clinically effective for improving stiffness, daily activity, and quality of life.
Utilization of Private Sector Family Planning Services in Malaysia
Authors: Lai Siow Li , Tey Nai Peng , Mahmud Adzmel , Ismail Najihah 
Published: November 2020

Background The private sector is playing an increasingly important role in family planning services globally. The active participation of private providers is associated with a higher contraceptive prevalence rate. Objectives To examine the differentials and determinants of the utilization of private providers for family planning services. Method This study used the 2014 Malaysian Population and Family Survey data. Cross-tabulations and logistic regression were performed on 1,817 current users of modern methods. Results Overall, 26% of modern method users obtained their supplies from private clinics/pharmacies and 15.2% from other sources, such as drug stores and sundry shops. The odds of utilizing the private sector for family planning services differ significantly across regions and socio-economic groups. The odds of obtaining supply from the private clinics/pharmacies were higher among the Chinese and urban women (AOR > 1), and it was lower among those from the eastern region (AOR = 0.47, 95% CI = 0.30–0.73). Non-Bumiputera, urban, higher educated, and working women, and those whose husbands decided on family planning had higher odds of obtaining the supply from the other sources (AOR > 1). Conclusion The private sector complements and supplements the public sector in providing family planning services to the public.
Sudden hearing loss following acute carbon monoxide poisoning: A case report and literature review
Authors: Li Chiao‐Zhu , Li Chiao‐Ching , Lin Meng‐Chi , Tseng Wei‐Shih 
Published: November 2020

Introduction:Acute carbon monoxide (CO) poisoning could lead to headache, dizziness, myocardial injury, neurological sequela, and death. Sudden hearing loss is a rare symptom of acute CO poisoning.Case Presentation:Here, we report a case of a 42‐year‐old woman who suffered from acute hearing loss after exposure to a suicidal environment of high concentration of CO. Partial recovery of hearing was demonstrated after a combination of corticosteroid and hyperbaric oxygen therapy was given.Discussion:The mechanism of sudden hearing loss caused by acute CO poisoning is not well‐established. It is believed to be related with the hypoxic damage to the cochlea. The characteristic of sudden hearing loss caused by acute CO poisoning is that it often affects in high frequency bilaterally.Conclusion:This report would prompt the clinician in early recognition of this sudden hearing loss of uncommon etiology.
The Hypoplasic Mandible: What Makes it Different From the Healthy Child?
Authors: Remy Floriane , Godio-Raboutet Yves , Captier Guillaume , Bonnaure Pierre , Burgart Philippe , Guyot Laurent , Thollon Lionel 
Published: November 2020

Objective: This study aimed to analyze the morphology of the hypoplasic mandible and its evolution during the growth period to better understand how it differs from the pediatric healthy mandible. Method: Three-dimensional mandibular models of hypoplasic and healthy children aged from 39 gestational weeks to 7 years old were analyzed with a morphometric method including data clustering. Morphological distinctions between pathological and healthy mandibles were highlighted. Bilateral and unilateral mandibular hypoplasia were distinguished. Results: The study sample was composed of 31 hypoplasic children and as many sex- and age-matched healthy children. Morphological distinctions between pathological and healthy mandibles were highlighted only from the first year of life. In bilateral hypoplasia, the overall mandibular dimensions were reduced while there was only a ramus asymmetry in unilateral mandibular hypoplasia (mean ± SD of the difference between the Grp03c and Grp03b subgroups: 6.80 ± 6.37 – P value = 1.64e–3 for the height of the left ramus versus 0.18 ± 4.18 – P value = .82 for the height of the right ramus). Supervised classification trees were built to identify the pathology and discriminate unilateral from bilateral mandibular hypoplasia (prediction rates = 81% and 84%, respectively). Conclusions: Based on a morphometric analysis, we demonstrated that mandibular hypoplasia significantly impacts the mandibular morphology only from the first year of life, with a distinction between bilateral and unilateral hypoplasia.
A short history of thrombectomy – Procedure and success analysis of different endovascular stroke treatment techniques
Authors: Friedrich B , Boeckh-Behrens T , Krüssmann V , Mönch S , Kirschke J , Kreiser K , Berndt M , Lehm M , Wunderlich S , Zimmer C , Kaesmacher J , Maegerlein C 
Published: November 2020

Background The historical development of interventional stroke treatment shows a wide variation of different techniques and materials used. Thus, the question of the present work is whether the technical and procedural differences of thrombectomy techniques lead to different technical and clinical results. Methods and results Analysis of a mixed retrospective/prospective database of all endovascular treated patients with an occlusion of the Carotid-T or M1 segment of the MCA at a single comprehensive stroke center since 2008. Patients were classified regarding the technical approach used. Six hundred sixty-eight patients were available for the final analysis. Reperfusion rates ranged between 56% and 100% depending on the technical approach. The use of balloon guide catheters and most recently the establishment of combination techniques using balloon guide catheters, aspiration catheters and stent retrievers have shown a further significant increase in the rates of successful recanalization, full recanalization and first-pass recanalization. Additionally, the technical development of interventional techniques has led to a subsequent drop in complications, embolization into previously unaffected territories in particular. Conclusion Technical success of MT has improved substantially over the past decade owing to improved materials and procedural innovations. Combination techniques including flow modulation have emerged to be the most effective approach and should be considered as a standard of care. Level of evidence: Level 3, retrospective study.
Differences in glucose level between right arm and left arm using continuous glucose monitors
Authors: Kim Nicole , Pham Kevin , Shek Allen , Lim Jeremy , Liu Xiaohan , Shah Sachin A 
Published: November 2020

Background Continuous glucose monitoring (CGM) measures interstitial glucose levels through a sensor with a thin filament inserted under the skin. It is customary for patients to rotate sensor application sites between arms to minimize skin irritation. However, there is limited data regarding the degree of inter-arm differences with CGM technology. Methods Self-proclaimed right-handed (n = 5) and left-handed (n = 5) participants, regardless of concurrent comorbidities, were enrolled for CGM. Participants wore a FreeStyle Libre Pro sensor on each arm for a maximum of 14 days. Muscle mass and body fat analysis was conducted using a multi-frequency segmental body composition analyzer. Glucose levels from both arms were time-matched with the first 12 hours eliminated from analysis. Mean glucose and time in target range were compared between readings from the right and left arm. Results A total of 9830 paired glucose levels were included for analysis. In all participants (n = 10), mean glucose on the right arm was 89.1 mg/dL (SD, 19.9) and 85.3 mg/dL (SD, 19.3) on the left arm (P < 0.001). Glucose was out of target range (70-180 mg/dL) for 12.7% of the time in the right arm compared to 18.5% in the left arm (P < 0.001). Conclusions In a group of 10 nondiabetic and diabetic adults, there was a statistically significant difference in CGM readings between the right and left arms. Time in target range may differ based on arm selection when using a CGM. Arm dominance did not explain the inter-arm glucose level discordance.
How I diagnose and treatNPM1-mutated AML
Authors: Falini Brunangelo , Brunetti Lorenzo , Martelli Maria Paola 
Published: November 2020

AbstractMutations of the nucleophosmin (NPM1) gene, encoding for a nucleolar multifunctional protein, occur in approximately one-third of adult acute myeloid leukemia (AML). NPM1-mutated AML exhibits unique molecular, pathological, and clinical features, which led to its recognition as distinct entity in the 2017 World Health Organization (WHO) classification of myeloid neoplasms. Although WHO criteria for the diagnosis of NPM1-mutated AML are well established, its distinction from other AML entities may be difficult. Moreover, the percentage of blasts required to diagnose NPM1-mutated AML remains controversial. According to the European LeukemiaNet (ELN), determining the mutational status of NPM1 (together with FLT3) is mandatory for accurate relapse-risk assessment. NPM1 mutations are ideal targets for measurable residual disease (MRD) monitoring, since they are AML specific, frequent, very stable at relapse, and do not drive clonal hematopoiesis of undetermined significance. MRD monitoring by quantitative polymerase chain reaction of NPM1-mutant transcripts, possibly combined with ELN genetic-based risk stratification, can guide therapeutic decisions after remission. Furthermore, immunohistochemistry can be very useful in selected situations, such as diagnosis of NPM1-mutated myeloid sarcoma. Herein, we present 4 illustrative cases of NPM1-mutated AML that address important issues surrounding the biology, diagnosis, and therapy of this common form of leukemia.
Hereditary hemorrhagic telangiectasia: systemic therapies, guidelines, and an evolving standard of care
Authors: Al-Samkari Hanny 
Published: November 2020

Abstract
Hereditary hemorrhagic telangiectasia (HHT) management is evolving because of the emergence and development of antiangiogenic therapies to eliminate bleeding telangiectasias and achieve hemostasis. This progress is reflected in recent clinical recommendations published in the Second International Guidelines for the Diagnosis and Treatment of HHT, in which systemic therapies including antiangiogenics and antifibrinolytics are now recommended as standard treatment options for bleeding. This review highlights the new recommendations especially relevant to hematologists in managing bleeding, anticoagulation, and anemia in patients with HHT.