bluuebunny/crossref_metadata_2025_split huggingface dataset:
Every child with congenital heart disease should be exercising
Authors: Hansen Katherine , Tierney Seda 
Published: October 2021

Purpose of review
Historically, children with congenital heart disease have been restricted from exercise, contributing to a sedentary lifestyle as well as increased cardiovascular risk factors. Given the large benefits and small risks of exercise in this population, guidelines have recently shifted towards exercise promotion. However, these recommendations have yet not gained traction and children with congenital heart disease continue to live sedentary lives. The purpose of this review is to summarize the current literature on exercise and exercise promotion in this population.

Recent findings
New literature reinforces the importance of recommending exercise and improving exercise capacity both in congenital heart disease in general and for specific lesions. Exercise recommendations should be individualized based on functional parameters using a structured methodology to approach the evaluation, risk classification, and prescriptions of exercise and physical activity.

Summary
Regular exercise is essential for children with congenital heart disease and providers must take an active role in providing exercise recommendations for their patients. Exercise promotion remains a challenge, necessitating novel approaches to promote exercise. Further studies are needed to improve the risk stratification of patients with congenital heart disease, assess the long-term outcomes of specific exercise interventions, and inform individualized recommendations to encourage children with congenital heart disease to safely engage in exercise and establish healthy lifelong habits that will decrease their cardiovascular risk.
CORRELATION BETWEEN FOCAL CHOROIDAL EXCAVATION AND UNDERLYING RETINOCHOROIDAL DISEASE
Authors: Gan Yuhong , Ji Yuying , Zuo Chengguo , Su Yongyue , Liao Nanying , Zhang Xiongze , Zeng Yunkao , Wen Feng 
Published: October 2021

Purpose:
To evaluate focal choroidal excavation (FCE) in eyes with various diseases using multimodal imaging modalities and to investigate the correlation of FCE and underlying chorioretinal diseases.

Methods:
This retrospective observational study included 62 eyes from 56 patients who were identified by optical coherence tomography as having FCE. All included patients underwent comprehensive clinical examinations and multimodal imaging to identify and detect the characteristics of FCE and its correlation with underlying chorioretinal diseases.

Results:
All included patients were of Chinese descent, and the median age at diagnosis was 43 years (range: 15–66). Seventy-three FCEs appeared in these included eyes. Most FCEs were formed at sites with anatomical changes caused by various chorioretinal diseases. Choroidal osteoma, punctate inner choroidopathy, and central serous chorioretinopathy were the most common etiologies of FCE. During follow-up, 14 eyes (22.58%) exhibited a pattern change and three eyes (4.84%) developed new-onset choroid neovascularization.

Conclusion:
Focal choroidal excavation is a common sign found in a variety of chorioretinal diseases. Processes that involve impairment or tissue loss of the outer retina and inner choroid and disrupt the balance of intraocular pressure and choroidal pressure because of mechanical disturbance may play a role in FCE formation.
EVALUATION OF MACULAR FLOW VOIDS ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY AS POTENTIAL BIOMARKERS FOR SILENT CEREBRAL INFARCTION IN SICKLE CELL DISEASE
Authors: Thangamathesvaran Loka , Ong Sally S. , Wang Jiangxia , Lance Eboni , Tekes Aylin , Scott Adrienne W. 
Published: October 2021

Purpose:
To determine the relationship between macular microvascular abnormalities on optical coherence tomography angiography and silent cerebral infarctions (SCIs) on cerebral magnetic resonance imaging in sickle cell disease.

Methods:
Patients (age <18 years old) from our previous pediatric sickle cell disease study cohort who had prior optical coherence tomography angiography and brain magnetic resonance imaging were identified. Brain magnetic resonance imaging images were compared with macular optical coherence tomography angiography scans to identify macular vascular density differences between patients with SCI and without SCI.

Results:
Sixty-eight eyes from 34 patients who underwent optical coherence tomography angiography were evaluated, of whom 28 eyes from 14 patients met the inclusion criteria for this study. Eight patients (57%) with SCI and 6 patients (43%) without SCI were identified. The mean age (17 years in SCI and 16.3 years in non-SCI) was comparable between groups. There was no statistically significant difference in systemic complications. Deep capillary plexus vessel density was lower in the temporal quadrant in patients with SCI (49.3% vs. 53.7%, P = 0.014).

Conclusion:
Patients with SCI were found to have lower vessel density in the deep capillary plexus compared with those without SCI. This finding suggests that deep capillary plexus vessel density may have utility as an imaging biomarker to predict the presence of SCI.
Corneal Structural Changes in Congenital Glaucoma
Authors: Drechsler Jennifer , Lee Adrianna , Maripudi Snehaa , Kueny Laura , Levin Moran R. , Saeedi Osamah J. , Bazemore Marlet , Karwoski Bethany , Birdsong Richard , Martinez Camilo , Jaafar Mohamad S. , Yousaf Sairah , Ahmed Zubair M. , Madigan William P. , Alexander Janet Leath 
Published: October 2021

Objective:
To identify corneal structure differences on quantitative high-frequency ultrasound biomicroscopy (UBM) among subjects with congenital glaucoma compared with controls.

Methods:
This prospective case–control study evaluated 180 UBM images from 44 eyes of 30 subjects (18 control and 12 glaucoma, mean age 5.2±8.0 years, range 0.2–25.8 years) enrolled in the Pediatric Anterior Segment Imaging and Innovation Study (PASIIS). ImageJ was used to quantify a comprehensive set of corneal structures according to 21 quantitative parameters. Statistical analysis compared corneal measurements in glaucoma subtypes and age-matched controls with significance testing and mixed effects models.

Results:
Significant differences between congenital glaucoma cases and controls were identified in 16 of 21 measured parameters including angle-to-angle, central and peripheral corneal thicknesses, scleral integrated pixel density, anterior corneal radius of curvature, and posterior corneal radius of curvature. Eight parameters differed significantly between primary congenital glaucoma and glaucoma following congenital cataract surgery.

Conclusion:
Multiple measurable corneal structural differences exist between congenital glaucoma and control eyes, and between primary and secondary congenital glaucoma, including but not limited to corneal width and thickness. The structural differences can be quantified from UBM image analysis. Further studies are needed to determine whether corneal features associated with glaucoma can be used to diagnose or monitor progression of congenital glaucoma.
The Role of Physical Therapy Following CAR T-Cell Therapy: A Case Report
Authors: Firestein Helaine 
Published: October 2021

Background:
Diffuse large B-cell lymphoma (DLBCL) affects 7 out of 100 000 people in the United States every year. Chimeric antigen receptor (CAR) T-cell therapy is approved by the Food and Drug Administration to treat patients with relapsed/refractory DLBCL who have not responded to 2 prior lines of therapy. CAR T-cell therapy can lead to debilitating side effects necessitating rehabilitation intervention.

Case Description:
This case report details a 38-year-old woman with refractory DLBCL who received CAR T-cell therapy. The patient experienced grade 2 cytokine release syndrome and grade 4 immune effector cell-associated neurotoxicity syndrome, which resulted in, among other symptoms, lower extremity paraplegia. Upon medical stabilization, the patient was referred to physical therapy.

Outcomes:
The patient participated in acute care rehabilitation for 8 weeks and progressed significantly toward her prior level of function before being discharged to an inpatient rehabilitation facility. Upon discharge, the patient was able to ambulate with a rolling walker, a knee orthosis, and supervision for safety and had initiated stair training.

Discussion/Conclusion:
Physical therapists need to understand and recognize the range of side effects that can occur following CAR T-cell therapy. As more patients receive CAR T-cell therapy to treat malignancies, acute care oncology units will undoubtedly be challenged with patients exhibiting severe side effects. Physical therapists are well trained to address physical impairments resulting from CAR T-cell therapy's side effects and will play a vital role in these patients' interdisciplinary care.
Value of neutrophil/lymphocyte ratio, N-terminal pro-B-type natriuretic peptide, urea, and creatinine for the prediction of acute kidney injury in acute heart failure: a retrospective observational study
Authors: Huang Lisi , He Jian , Lin Xianghua , Luo Ling , Zhong Rihui , Xie Xiaoying , Peng Xiaodan , Duan Chaohui 
Published: October 2021

Objective:
Early identification of acute kidney injury (AKI) is essential to improve the prognosis of patients with acute heart failure (AHF). We aimed to determine the utility of neutrophil/lymphocyte ratio (NLR), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), urea, and creatinine (Cr), as well as combinations of these, for the prediction of AKI in patients with AHF.

Methods:
A total of 153 patients with AHF under the care of Sun Yat-sen Memorial Hospital, Sun Yat-sen University from October 2009 to October 2019 were included in this retrospective observational study. Their NLR, NT-proBNP, urea, and Cr concentrations were measured on admission. AKI was defined using the Acute Kidney Injury Network criteria. Receiver operating characteristic (ROC) curves, the areas under the curves (AUCs), sensitivity, and specificity were employed to evaluate the ability of each biomarker and their combinations to identify AKI. This study was approved by the Ethics Committee of Sun Yat-sen Memorial Hospital, Sun Yat-sen University (approval No. SYSEC-KY-KS-2021-126) on June 22, 2021.

Results:

Forty-six (30.1%) participants developed AKI during hospitalization. The NLR and NT-proBNP of the participants with AKI were higher than those without (NLR: median 7.886 vs 4.717,
P
< 0.0001; NT-proBNP, median 6774 vs 2786pg/mL,
P
< 0.0001). ROC analyses demonstrated that high NLR and NT-proBNP were associated with higher incidences of AKI (NLR: cut-off 5.681, AUC 0.716, sensitivity 58.9%, specificity 80.4%; NT-proBNP: cut-off 5320pg/mL, AUC 0.700, sensitivity 72.9%, specificity 65.2%). Moreover, a combination of NLR, NT-proBNP, urea, and Cr yielded an AUC of 0.815, sensitivity 80.4%, and specificity of 74.8%. In addition, the AUCs for the prediction of AKI in the participants with New York Heart Association (NYHA) classes II, III, and IV were 0.936, 0.860, and 0.772, respectively, using this combination.

Conclusion:
A combination of NLR, NT-proBNP, urea, and Cr, measured at admission, may represent a promising tool for the prediction of AKI in patients with AHF. This method performs best for AKI risk assessment in patients with NYHA II, followed by those with NYHA III or IV.
Increased Quality of Life Among Newly Diagnosed Patients With Heart Failure With Reduced Ejection Fraction in the Months After Initiation of Guideline-Directed Medical Therapy and Wearable Cardioverter Defibrillator Prescription
Authors: Burch Ashley E. , Colley Byron J. , Döring Michael , Gummadi Siva , Perings Christian , Robertson Michael , Sanchez Robert , Shroff Girish , Veltmann Christian , Sears Samuel F. 
Published: October 2021

Background
The patient experience of heart failure involves a multi-impact symptom response with functional limitations, psychological changes, and significant treatment burden.

Objective
The aim of this study was to examine the change in patient-reported outcomes in newly diagnosed patients with heart failure and reduced ejection fraction (HFrEF) prescribed a wearable cardioverter defibrillator.

Methods
Adults hospitalized for new-onset heart failure, due to ischemic or nonischemic cardiomyopathy, and prescribed a wearable cardioverter defibrillator within 10 days post discharge were approached for inclusion. Participants completed the Kansas City Cardiomyopathy Questionnaire at 3 time points: baseline, day 90, and day 180.

Results
A total of 210 patients (26% female) were included. All Kansas City Cardiomyopathy Questionnaire subscales (physical limitation, symptom frequency, quality of life, and social limitation) showed improvement from baseline to day 90 (all Ps < .001). Only quality of life continued to improve from day 90 to day 180 (P < .001). By day 90, nearly 70% of patients showed an improvement in quality of life (67.9%, n = 91), and by day 180, more than 80% (82.8%, n = 111) reported a net improvement. Five patients (3.7%) reported a net decrease, and 18 patients (13.4%) had no net change in quality of life during the 180-day period.

Conclusion
Patient-reported quality of life improved significantly among patients newly diagnosed with HFrEF and prescribed a wearable cardioverter defibrillator. These results suggest that pursuing guideline-directed medical therapy for HFrEF, while being protected by the wearable cardioverter defibrillator, is likely to provide symptom relief and improve quality of life.
The Association Between Dimethylacetamide Exposure and Liver Toxicity
Authors: Antoniou Evangelia E. , Gelbke Heinz-Peter , Ballach Jochen , Zeegers Maurice P. , Schrage Arnhild 
Published: October 2021

Objective:
This study examines the association between 8-h time weighted N, N-dimethylacetamide (DMAc) air exposure and potential hepatocellular injury in a retrospective study among fibre-production workers in four European factories.

Methods and Results:
Twenty-nine (1.5%) of 1844 alanine aminotransferase (ALT) observations had liver values two times above normal; 0.2% three times above normal and 0.05% five times above normal. Two (0.1%) observations were indicative of hepatocellular injury. Logistic regression analyses showed an odds ratio for elevated ALT of 0.88 per 1 ppm (P trend = 0.39). Linear random effects regression analyses showed a decrease of one international unit (IU/L) ALT per 1 ppm increase of DMAc exposure (P = 0.002).

Conclusions:
This study found no association between DMAc exposure and hepatoxicity amongst European workers. The prevalence of elevated liver values was lower compared to the general population without occupational exposure.
Burden and Protection
Authors: de Carvalho Thalyta Gleyane Silva , Araújo Larissa Fortunato , Lima Eduardo de Paula , de Andrade Alan Lúcio Alencar , Bastos Maria Luiza Almeida , Lacerda Eliana Mattos , Ferreira Marcelo José Monteiro 
Published: October 2021

Objective:
To investigate the association between occupational stressors and Burnout dimensions among Brazilian firefighters.

Method:
A cross-sectional study about firefighters (n = 237) was developed in Fortaleza, Northeast of Brazil. Logistic regression analysis was applied to investigate the association between high strain (high demand and low job control), low social support, high operational exposure, and Burnout dimensions (emotional exhaustion, depersonalization, and low personal accomplishment).

Results:
High strain was associated to emotional exhaustion (odds ratio [OR] = 11.65; 95% confidence interval [CI]: 3.92 to 34.60) and depersonalization (OR = 5.43; 95% CI: 2.03 to 14.58). Low social support was associated to emotional exhaustion (OR = 2.86; 95% CI: 1.24 to 6.60) and low personal accomplishment (OR = 2.59; 95% CI: 1.36 to 4.93). High operational exposure did not increase the odds of emotional exhaustion and depersonalization and decreased the odds of low personal accomplishment (OR = 0.31; 95% CI: 0.10 to 0.94).

Conclusion:
The study highlights the heterogeneous effects that operational and organisational stressors have on each dimension of Burnout.
Usual Interstitial Pneumonia Associated With Crystalline Silica Exposure in Pneumoconiosis
Authors: Kang WonYang , Kim Daeho , Kim Mi-Yeon , Kim Boowook , Shin Jungah , Kim Eun Young , Choi Sungwon , Cha Wonseok , Choi Byung-Soon 
Published: October 2021

Objective:
We aimed to identify a relation between the level of silica exposure and the associated increase in the risk of radiologic usual interstitial pneumonia (UIP) pattern.

Methods:
We selected data of 796 individuals with pneumoconiosis who had undergone a chest computed tomography (CT). We estimated the silica exposure by comparing their occupational history with the data silica dust exposure.

Results:
Individuals employed as stonemasons demonstrated a 2.30-fold increase in the risk of developing UIP than coal mine workers (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.04 to 5.07). The high silica exposure group was associated with a 2.23-fold increase in the risk of developing UIP than the low silica exposure group (OR, 2.23; 95% CI, 1.07 to 4.69).

Conclusions:
This study suggests that silica exposure is associated with an increased risk of developing UIP pattern, highlighting a dose–response relationship.
Surgical Factors Influencing Wound Complication After Cochlear Implantation: A Systematic Review and Meta-Analysis
Authors: Laureano Jack , Ekman Brady , Balasuriya Beverly , Mahairas Anthony , Bush Matthew L. 
Published: October 2021

Objective:
To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI).

Data Sources:
PubMed, Web of Science, and Cochrane databases.

Study Selection:
Eligible studies included peer-reviewed research in English evaluating wound complications (wound infection, skin flap breakdown/dehiscence, seroma/hematoma) following CI. Studies with paired samples were included in the meta-analysis.

Data Extraction:
Surgical factors (techniques and perioperative management) in CI and reported wound complications were examined. Level of evidence was assessed using the Oxford Centre for Evidence-based Medicine guidelines and bias was assessed using the NIH Quality Assessment Tool.

Data Synthesis:
Twenty-six studies representing 10,214 cochlear implantations were included. The overall wound complications rate was 3.1% (range 0.03–13.9%). Eleven studies contained paired data and were used for meta-analysis regarding three different surgical factors: incision length, implant placement method, and antibiotic usage. Longer incision lengths (≥7 cm) demonstrated a higher risk of wound complications (risk ratio 2.27, p = 0.02, CI 1.16–4.43). Different implant placement techniques (suture fixation versus periosteal pocket) (p = 0.08, CI 0.92–3.69) and postoperative antibiotic regimens (postoperative use versus none) (p = 0.68, CI = 0.28–7.18) were not associated with differences in wound complication rates following CI.

Conclusions:
Overall rate of wound complications following CI is low. Shorter incision length is associated with lower risk of wound complications. Differences in perioperative techniques and practices regarding implant placement and antibiotic use were not associated with differences in wound complication rates. Considering the low number and quality of studies, there is a need for research in CI outcomes using paired sample prospective designs and standardized reporting.
Histopathologic Analysis of Temporal Bones With Otosclerosis Following Cochlear Implantation
Authors: Hodge Sarah E. , Ishiyama Gail , Lopez Ivan A. , Ishiyama Akira 
Published: October 2021

Objective:
Analyze changes in osteoneogenesis and fibrosis following cochlear implant (CI) surgery in patients with otosclerosis and compare differences based on insertion technique.

Background:
When advanced otosclerotic disease extends to the otic capsule, severe and profound sensorineural hearing loss necessitates consideration of a cochlear implant. Histopathological analysis of the human temporal bone after implantation in the patient with otosclerosis may reveal important variables that predict CI success.

Methods:
Histopathological evaluation of archival human temporal bones from subjects with a history of CI for cochlear otosclerosis. A total of 17 human temporal bones (HTB) were analyzed, 13 implanted, and 4 contralateral non-implanted controls.

Results:
Histopathological studies revealed extensive osteoneogenesis and fibrosis which was more prominent at the cochleostomy insertion site in the basal turn of the cochlea often obliterating the scala tympani in the basal turn, and in some cases extending to the scala media and scala vestibuli. Cochlear hydrops was nearly universal in these cases. This contrasted with the round window insertion, which exhibited minimal osteoneogenesis within the cochlear duct. In addition, in the contralateral, unimplanted control ears, there was otosclerosis at the stapes footplate, fissula ante fenestrum but no osteoneogenesis within the cochlear duct.

Conclusion:
Cochleostomy approach to CI insertion in otosclerosis patients is associated with significant fibrosis, osteoneogenesis, and cochlear hydrops. A round window insertion technique can be utilized to help minimize these histopathologic findings whenever feasible.
Opioid Prescribing Patterns After Skull Base Surgery for Vestibular Schwannoma
Authors: Ren Yin , Mehranpour Pasha , Moshtaghi Omid , Schwartz Marc S. , Friedman Rick A. 
Published: October 2021

Objective:
Excessive opioid prescription is a source of prescription diversion and could contribute to chronic opioid abuse. This study describes the opioid prescribing patterns and risk factors for additional opioid prescription after surgical resection of vestibular schwannoma (VS).

Study Design:
Retrospective chart review.

Setting:
Single tertiary referral center.

Patients:
Adult VS patients undergoing surgical resection between May 2019 and March 2020.

Interventions:
Opioid use postoperatively and up to 60 days following surgery were characterized from medical records and by querying the state-wide Controlled Substance Utilization Review and Evaluation System.

Main Outcome Measures:
The presence of additional opioid prescriptions within 60 days of surgery.

Results:
A total of 109 patients (mean age 50 yrs, 65.5% female) were prescribed an average of 138.2 ± 117.8 mg of morphine equivalents (MME). Twenty-two (20.9%) required additional prescriptions of 163.2 ± 103.2 MME. Age, gender, tumor size, or surgical approach (translabyrinthine, retrosigmoid, versus middle fossa) were not associated with additional prescriptions. Patients with additional prescriptions had higher body mass index (BMI 28.8 vs. 25.8 kg/m2, p = 0.015) and required more opioid medications during hospitalization (51.8 vs. 29.1 MME, p = 0.002). On multivariate logistic regression, higher BMI (odds ratio [OR] 1.32; p = 0.001), history of headaches (OR 11.9, p = 0.011), and history of opioid use (OR 29.3, p = 0.008) were associated with additional prescription.

Conclusions:
Additional opioid prescriptions may be necessary in a portion of VS patients undergoing surgery. The choice of surgical approach is not associated with excess opioid requirements. Patients with higher BMI, history of headaches, or preoperative opioid use may require additional prescriptions.