bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Sample Adequacy and Diagnostic Yield of the 21-G and 25-G EBUS TBNA Needles
Authors: Sood Rahul , Alape Daniel , Thakkar Dhaval , Shadchehr Sara , Acash Ghazwan , Tronic Bruce J. , Lamb Carla R. 
Published: February 2021

Background:
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) of mediastinal lymphadenopathy has been shown to be equivalent and possibly even superior to mediastinoscopy. Since the original dedicated 22-G aspiration needle, 21-G, 25-G, and recently 19-G needles have been introduced. Smaller needles may be more flexible and adept at accessing more difficult nodes, and may have less blood contamination compared with larger needles.

Patients and Methods:
This is a prospective observational study of 50 consecutive patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration with a 21-G needle and a 25-G needle for a total of 100 biopsies. The study slides were examined by a dedicated lung cytopathologist, who was blinded to the needle size used for each slide. Demographic data, and lymph node size were recorded. Comparisons between the 2 needles with regards to sample adequacy and diagnostic yield was performed using the McNemar test for dichotomous variables and marginal homogeneity test for nondichotomous variables since samples were related.

Results:
The majority of lymph nodes (96%) were at least >1 cm. Adequate specimens were obtained in 78% of cases with the 21-G needle and 86% of cases with 25-G needle (P-value=0.424). The overall diagnostic yield was 74% and 80% with the 21-G needle and 25-G needle, respectively (P-value=0.607).

Conclusion:
Our study demonstrates that the there is no difference in terms of specimen adequacy and diagnostic yield when the 25-G needle is compared with the 21-G needle.
Near-Histologic Resolution Images of Cervical Dysplasia Obtained With Gabor Domain Optical Coherence Microscopy
Authors: Paczos Tamera , Bonham Adrienne , Canavesi Cristina , Rolland Jannick P. , O'Connell Rachel 
Published: February 2021

Objective
Histopathology is the criterion standard for evaluating cervical squamous intraepithelial neoplasia (dysplasia). In this pilot feasibility study, we examined whether a novel 3-dimensional imaging device using Gabor-domain optical coherence microscopy (GDOCM) could distinguish features of cervical dysplasia comparable with histopathology.

Methods
A prospective observational pilot study enrolled a small sample of women undergoing loop electrosurgical excision procedure for cervical squamous intraepithelial neoplasia. Fresh ex vivo specimens were imaged with the GDOCM device. Digital images were reviewed by a pathologist who was blinded to the histopathology results. Histopathologic features were then compared with the digital observations.

Results
Standard histologic features of cervical squamous epithelium and of squamous intraepithelial neoplasia could be observed in GDOCM images. Cervical epithelium, stroma, basement membrane, and squamous papilla could all be identified. Human papillomavirus effects, such as vacuolization and cellular density, were also observed.

Conclusions
A GDOCM imaging system has the potential to obtain histologic resolution images of the cervix in the evaluation of squamous intraepithelial neoplasia. This pilot study allowed for optimizing the imaging system and paved the way for a future diagnostic accuracy study. The development of this technology could streamline the evaluation of patients at risk for cervical neoplasia.
Female Genital Tract Melanoma: 10 Years of Experience at a Single Tertiary Center
Authors: Lewin Jonathan , Egbe Azelle , Ellery Peter , Wilkinson Nafisa , MacDonald Nicola , Kotsopoulos Ioannis C. , Olaitan Adeola 
Published: February 2021

Objective
Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade.

Methods
Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist.

Results
We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.
Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026).

Conclusions
Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins.
The Viability and Growth of HaCaT Cells After Exposure to Bioactive Glass S53P4-Containing Cell Culture Media
Authors: Sarin Jussi , Vuorenmaa Minna , Vallittu Pekka K. , Grénman Reidar , Boström Pia , Riihilä Pilvi , Nissinen Liisa , Kähäri Veli-Matti , Pulkkinen Jaakko 
Published: February 2021

Hypothesis:
Bioactive glass (BG) S53P4 reduces the viability of epidermal keratinocyte-derived immortalized cell line, HaCaT in sufficient concentrations in vitro.

Background:
Although used in mastoid obliteration surgery, there is no data available on whether BG S53P4 granules have an inhibitory or excitatory effect on keratinocytes, found in normal skin and ear cholesteatoma in vivo.

Methods:
HaCaT cell cultures were incubated with a direct BG S53P4 granule contact. Microscopic evaluation of the cultures was performed and interleukin-6 (IL-6) and -8 (IL-8) concentrations were measured from the medium samples. In addition, BG granules were incubated in two cell culture media for 6 days and the pure media were used in confluent HaCaT cultures preceding cell viability assay. Finally, a scratch assay test was performed to reveal the possible BG effect on HaCaT cultures.

Results:
Eight to ten cell thick layers of dead HaCaT cells were noticed after a 2-day BG granule contact. With a BG concentration of 2.5%, IL-6 and IL-8 concentrations were smaller compared with the control group without BG after 2 days’ incubation. Overall, HaCaT cell viability decreased when BG was incubated in keratinocyte growth medium, but did not change in Dulbecco's modified Eagle's medium. In a scratch assay test, cell regrowth in the scratch area was notable in cultures without BG.

Conclusions:
BG S53P4 seems to have an inhibitory effect on HaCaT cell growth. Although further studies are needed, this observation seems advantageous for cholesteatoma treatment.
Drugs in Focus: Proton Pump Inhibitors
Authors: Orel Rok , Benninga Marc A. , Broekaert Ilse J. , Gottrand Frederic , Papadopoulou Alexandra , Ribes-Koninckx Carmen , Thomson Mike , Wilschanski Michael , Thapar Nikhil 
Published: February 2021

ABSTRACTProton pump inhibitors (PPIs) are amongst the most commonly prescribed drugs in infants and children with the last decades witnessing a dramatic rise in their utilization. Although PPIs are clearly effective when used appropriately and have been regarded as safe drugs, there is growing evidence regarding their potential adverse effects. Although, largely based on adult data it is clear that many of these are also relevant to pediatrics. PPI use potentially affects gastrointestinal microbiota composition and function, decreases defence against pathogens resulting in increased risk for infections, interferes with absorption of minerals and vitamins leading to specific deficiencies and increased risk for bone fractures as well as interferes with protein digestion resulting in increased risk of sensitization to allergens and development of allergic diseases and eosinophilic esophagitis. An association with gastric, liver and pancreatic cancer has also been inferred from adult data but is tenuous and causation is not proven. Overall, evidence for these adverse events is patchy and not always compelling. Overall, the use of PPIs, for selected indications with a good evidence base, has significant potential benefit but carries more caution in infants and children. Pediatricians should be aware of the concerns regarding the potential adverse events associated with their use.
The Influence of Multiple Chronic Conditions on Symptom Clusters in People With Solid Tumor Cancers
Authors: Saeidzadeh Seyedehtanaz , Perkhounkova Yelena , Gilbertson-White Stephanie , Cherwin Catherine H. 
Published: February 2021

Background
People with cancer who also have multiple chronic conditions (MCCs) experience co-occurring symptoms known as symptom clusters.

Objective
To describe MCC and symptom clusters in people with cancer and to evaluate the relationships between MCCs and symptom severity, symptom interference with daily life, and quality of life (QoL).

Methods
Weekly over a 3-week chemotherapy cycle, 182 adults with solid tumor cancer receiving chemotherapy completed measures of symptom severity, symptom interference with daily life, and QoL. Medical records reviewed to count number of MCCs in addition to cancer. Exploratory factor analysis was performed to identify symptom clusters. The relationships between the number of MCCs and the outcomes (symptom severity and symptom interference with daily life and QoL) at each time point were examined using the χ
2 test. Longitudinal changes in outcomes were examined graphically.

Results
The number of MCCs ranged from 0 to 9, but most participants (62.1%) had 2 or fewer MCCs. Obesity was the most prevalent chronic condition. Four symptom clusters were identified: nutrition, neurocognitive, abdominal discomfort, and respiratory clusters. At each time point, no significant differences were found for MCCs and any outcome. However, symptom severity in all the symptom clusters, symptom interference with daily life, and QoL demonstrated a worsening in the week following chemotherapy.

Conclusion
A majority of our sample had 2 or fewer MCCs, and MCCs did contribute to patient outcomes. Rather, timing of chemotherapy cycle had the greatest influence of patient outcomes.

Implications for Practice
Additional support on day 7 of chemotherapy treatment is needed for people with MCCs.
Existential Distress in Cancer Patients
Authors: Chen Weiling , Chen Ying , Xiao Huimin 
Published: February 2021

Background
Existential distress is a widely used concept used in describing cancer patients. However, this concept is vague and has failed to achieve a consensus. The lack of a recognized conceptual framework could hinder future research on existential distress.

Objective
The aim of this study was to clarify and analyze the concept of existential distress in cancer patients.

Methods
The Walker and Avant concept analysis approach was applied.

Results
For cancer patients, the concept of existential distress included 5 core attributes: (a) lack of meaning; (b) loss of autonomy; (c) loss of dignity; (d) hopelessness; and (e) death anxiety. Existential distress is a key factor causing poor quality of life, a poor emotional state, demoralization, and even suicide. It is often underpinned by uncontrolled physical pain, serious psychological morbidity, and a perceived sense of being a burden on others.

Conclusion
The concept analysis provides a theoretical framework for healthcare providers to better understand existential distress in cancer patients, to improve patient well-being.

Implications for Practice
On the basis of the antecedents of this concept, cancer patients experiencing uncontrolled physical pain, severe psychological morbidity, and a perceived sense of being a burden on others are at a high risk of existential distress. These factors should be eliminated in a timely manner to prevent cancer patients from being caught in a state of existential distress. The 5 defining attributes and empirical referents of this concept could be used to develop tools to screen for existential distress in cancer patients and distinguish it from similar concepts.
Sexually Transmitted Infection Testing and Prevalence Before and After Preexposure Prophylaxis Initiation Among Men Aged ≥18 Years in US Private Settings
Authors: Tao Guoyu , Pearson William S. , Sullivan Jane M. , Henk Henry J. , Gift Thomas L. 
Published: February 2021

Background
The Centers for Disease Control and Prevention recommends initial and follow-up sexually transmitted infection (STI) and HIV testing when taking HIV preexposure prophylaxis (PrEP). We assessed frequencies of STIs and HIV testing and rates of STIs before and after PrEP initiation among men aged ≥18 years.

Methods
We used the OptumLabs database for this cohort study. We measured STI/HIV testing rates and prevalence in 2 time intervals: (1) within 90 days before and on the date of PrEP initiation and (2) within 45 days of the 180th day after the date of PrEP initiation.

Results
Of 4210 men who initiated PrEP in 2016 to 2017 and continuously used PrEP for ≥180 days, 45.7%, 45.7%, and 56.0% were tested for chlamydia, gonorrhea, and HIV, respectively, at the second time interval. These percentages were significantly lower than those at the first time interval (58.3%, 57.9%, and 73.5%, respectively; P < 0.01). Chlamydia and gonorrhea prevalence rates at the second time interval were 6.5% and 6.2%, respectively, versus 5.0% and 4.7%, respectively, at the first time interval. Most gonorrhea or chlamydia infections at the second time intervals seem to be new infections new infections.

Conclusions
Sexually transmitted infection/HIV testing for PrEP users in the real-world private settings is much lower than in clinical trials. High STI prevalence before and after PrEP initiation in this study suggests that patients taking PrEP have an increased risk of acquiring STI. Interventions to improve provider adherence for PrEP users are urgently needed.
The Estimated Impact of Implementing a Funding Allocation Formula on the Number of Gonorrhea Cases in the United States, 2014 to 2018
Authors: Aslam Maria Vyshnya , Chesson Harrell 
Published: February 2021

Background
The Centers for Disease Control and Prevention (CDC) allocates funds annually to state and local programs in the United States to monitor and prevent sexually transmitted diseases (STDs). In 2014, a funding formula was implemented to allocate prevention funds to jurisdictions according to their STD burden and population size. We estimated the effect of implementing the funding formula in terms of gonorrhea cases averted from 2014 to 2018, a period during which inflation-adjusted CDC STD prevention funding declined.

Methods
Our model assumed that STD prevention funds have a measurable effect on subsequent reported gonorrhea case rates, and the magnitude of this effect was as estimated in an empirical analysis of decades of state-level gonorrhea rates. In applying this equation-based model, we assumed all factors affecting jurisdictions' gonorrhea rates were constant over time except for their STD prevention funding allocations. We used data on CDC STD prevention funding allocated to each jurisdiction over time. We estimated gonorrhea rates under the “funding formula” scenario compared with a hypothetical “status quo” funding scenario, which reflected traditional methods to allocate prevention funds.

Results
In the model, gonorrhea cases increased from 2014 to 2018 by approximately 6% because of a decline in prevention funding, regardless of how funds were allocated. However, the estimated increase in gonorrhea cases was 5222 (range, 1181–9195) cases less in the funding formula scenario than in the status quo scenario.

Conclusions
By shifting resources toward jurisdictions with greater disease burden, the funding formula averted a substantial number of gonorrhea cases at no additional cost.
Epidemiology of Critical Interventions in Children With Traumatic Intracranial Hemorrhage
Authors: Chaudhari Pradip P. , Pineda Jose , Bachur Richard G. , Khemani Robinder G. 
Published: February 2021

Objective
To estimate rates of critical medical and neurosurgical interventions and resource utilization for children with traumatic intracranial hemorrhage (ICH).

Methods
This was a retrospective study of children younger than 18 years hospitalized in 1 of 35 hospitals in the Pediatric Health Information System from 2009 to 2019 for ICH. We defined critical intervention as a critical medical (hyperosmotic agents and intubation) or neurosurgical intervention. We determined rates of critical interventions, intensive care unit (ICU) admission, and repeat neuroimaging. We used hierarchical logistic regression to identify high-level factors associated with undergoing critical interventions, controlling for hospital-level effects.

Results
There were 12,714 children with ICH included in the study. Median (interquartile range) age was 4.3 (0.7–11.0) years. Twelve percent (n = 1470) of children underwent a critical clinical intervention. Critical medical interventions occurred in 10% (n = 1219), and neurosurgical interventions occurred in 3% (n = 419). Intensive care unit admission occurred in 44% (n = 5565), whereas repeat neuroimaging occurred in 40% (n = 5072). Among ICU patients, 79% (n = 4366) did not undergo a critical intervention. Of the 11,244 children with no critical interventions, 39% (n = 4366) underwent ICU admission, and 37% (n = 4099) repeat neuroimaging. After controlling for hospital, children with isolated subdural (P = 0.013) and isolated subarachnoid (P < 0.001) hemorrhage were less likely to receive critical interventions.

Conclusions
Critical medical interventions occurred in 10% of children with ICH, and neurosurgical interventions occurred in 3%. Intensive care unit admission and repeat neuroimaging are common, even among those who did not undergo critical interventions. Selective utilization of ICU admission and repeat neuroimaging in children who are at low risk of requiring critical interventions could improve overall quality of care and decrease unnecessary resource utilization.
Pediatric Myopericarditis Presenting to the Emergency Department as Chest Pain
Authors: Babbitt Christopher J. , Babbitt Michael J. , Byrne Francesca , Morphew Tricia 
Published: February 2021

Objectives
Myopericarditis is a newly described entity that is primarily a pericardial syndrome with elevated cardiac enzymes that has been seen with increasing frequency in our pediatric intensive care unit. For this reason, we performed a retrospective cohort analysis with a goal of establishing differences between myopericarditis and myocarditis that could lead to proper diagnosis on emergency department presentation.

Methods
A database query was performed and identified patients over a 9-year period, and clinical data, laboratory data, and cardiac studies were extracted and analyzed from the electronic health record.

Results
A total of 36 patients were identified with the discharge diagnosis of myopericarditis and 22 with myocarditis. The median age for myopericarditis patients was 16.2 years, and 97% were male. The median initial troponin was 7.1 ng/mL, the peak was at 16.6 ng/mL, and 58% had ST changes on electrocardiogram. The median length of stay for myopericarditis patients was 1.7 days, and 50% were discharged home on nonsteroidal anti-inflammatory medication. Compared with myocarditis, myopericarditis patients were older, had a higher incidence of chest pain, and were less likely to have fever, vomiting, abdominal pain, upper respiratory infection symptoms, chest radiograph abnormalities, or T-wave inversion (P < 0.05). Myopericarditis patients also had lower Pediatric Risk of Mortality version 3 scores, B-type natriuretic peptide levels, and higher left ventricular ejection fractions on admission (67% vs 41%; P < 0.05). A classification model incorporating initial left ventricular ejection fraction, B-type natriuretic peptide, electrocardiogram, and chest radiograph findings distinguished myopericarditis from myocarditis with correct classification in 95% of patients.

Conclusions
Myopericarditis is a relatively common cause of chest pain for patients admitted to the pediatric intensive care unit, presents differently than true myocarditis, and carries a good prognosis.
Mental Health of Medical Staff During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis
Authors: Yan Haohao , Ding Yudan , Guo Wenbin 
Published: February 2021

ABSTRACT

Objective
This study aimed to quantify the prevalence of the adverse mental health outcomes in medical staff working in the hospital settings during the coronavirus disease 2019 (COVID-19) pandemic and explore the relative distribution of anxiety and depressive symptoms.

Methods
PubMed, EMBASE, China National Knowledge Infrastructure, WANFANG DATA, and VIP Database for Chinese Technical Periodicals were searched for articles published from January 1, 2019, to April 19, 2020. The prevalence estimates of adverse mental health symptoms in medical staff were pooled using the random-effects model.

Results
A total of 35 articles and data of 25,343 medical staff were used in the final analysis. The pooled prevalence estimates in medical staff during the COVID-19 pandemic were as follows (ordered from high to low): fear-related symptoms, 67% (95% confidence interval [CI] = 61%–73%); high levels of perceived stress, 56% (95% CI = 32%–79%), anxiety symptoms, 41% (95% CI = 35%–47%); insomnia, 41% (95% CI = 33%–50%); posttraumatic stress disorder symptoms, 38% (95% CI = 34%–43%); depressive symptoms, 27% (95% CI = 20%–34%); and somatic symptoms, 16% (95% CI = 3%–36%). The subgroup analysis revealed that the prevalence estimates of fear-related symptoms were consistently high.

Conclusions
Medical staff during the COVID-19 epidemic have a high prevalence of adverse mental health symptoms. Data-based strategies are needed to optimize mental health of medical staff and other health care professionals during times of high demand such as the COVID-19 and other epidemics.

PROSPERO Registration: CRD42020182433.