bluuebunny/crossref_metadata_2025_split huggingface dataset:
IMPACT OF FLUID COMPARTMENTS ON FUNCTIONAL OUTCOMES FOR PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Chaudhary Varun , Matonti Frédéric , Zarranz-Ventura Javier , Stewart Michael W. 
Published: August 2021

Purpose:
Understanding the impact of fluid in different retinal compartments is critical to developing treatment paradigms that optimize visual acuity and reduce treatment burden in neovascular age-related macular degeneration. This systematic review aimed to determine the impact of persistent/new subretinal fluid, intraretinal fluid, and subretinal pigment epithelial fluid on visual acuity over 1 year of treatment.

Methods:
Publication eligibility and data extraction were conducted according to Cochrane methods: 27 of the 1,797 screened records were eligible.

Results:
Intraretinal fluid negatively affected visual acuity at baseline and throughout treatment, with foveal intraretinal fluid associated with lower visual acuity than extrafoveal intraretinal fluid. Some studies found that subretinal fluid (particularly subfoveal) was associated with higher visual acuity at Year 1 and longer term, and others suggested subretinal fluid did not affect visual acuity at Years 1 and 2. Data on the effects of subretinal pigment epithelial fluid were scarce, and consensus was not reached. Few studies reported numbers of injections associated with fluid status.

Conclusion:
To optimally manage neovascular age-related macular degeneration, clinicians should understand the impact of fluid compartments on visual acuity. After initial treatment, antivascular endothelial growth factor regimens that tolerate stable subretinal fluid (if visual acuity is stable/improved) but not intraretinal fluid may enable patients to achieve their best possible visual acuity. Confirmatory studies are required to validate these findings.
COVID-19–associated Acute Disseminated Encephalomyelitis–like Disease in 2 Children
Authors: Akçay Nihal , Bektaş Gonca , Menentoğlu Mehmet Emin , Oğur Mustafa , Sofuoğlu Ayşe İrem , Palabiyik Figen Bakirtaş , Şevketoğlu Esra 
Published: August 2021

Background:
The coronavirus disease 2019 pandemic was caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the predominant clinical presentation is a respiratory disease, neurologic manifestations are being recognized increasingly.

Case Report:
We report 2 children 9 years of age who developed acute disseminated encephalomyelitis-like disease associated with SARS-CoV-2. Seizures and encephalopathy were the main central nervous system symptoms. The cerebrospinal fluid analysis performed within the first week of disease onset showed elevated protein in both children with normal cell count and no evidence of infection including negative SARS-CoV-2 by antibody and polymerase chain reaction. Brain magnetic resonance imaging revealed T2A, fluid-attenuated inversion recovery cortical and subcortical hyperintensity without restricted diffusion consistent with acute disseminated encephalomyelitis–like disease. They received methylprednisolone followed by therapeutic plasma exchange. One of them showed complete clinical improvement and resolution in magnetic resonance imaging findings. The other developed laminar necrosis in brain magnetic resonance imaging and showed significant clinical improvement after therapeutic plasma exchange. He was positive for positive SARS-CoV-2 antibody in cerebrospinal fluid on day 55 of admission. They were both positive for SARS-CoV-2 antibodies in serum after 2 weeks.

Conclusions:
Our two cases highlight the occurrence of acute disseminated encephalomyelitis–like disease as a postinfectious/immune-mediated complication of SARS-CoV-2 infection.
Chronic Obstructive Pulmonary Disease is a Risk Factor for Sensorineural Hearing Loss: A US Population Study
Authors: Sharma Rahul K. , Chern Alexander , Begasse de Dhaem Olivia , Golub Justin S. , Lalwani Anil K. 
Published: August 2021

Objectives:
The goal of this study is to determine if chronic obstructive pulmonary disease (COPD) is associated with sensorineural hearing loss (SNHL) in a national database.

Study Design:
Cross-sectional study.

Setting:
National sample of the United States population.

Patients:
Adults with audiometric and spirometry data from the National Health and Nutrition Examination Study (NHANES) database.

Interventions:
None.

Methods:
A total of 2,464 adults with spirometry and audiometry data from the NHANES database (2009–2012) were studied. Outcome measures included hearing, measured by high-frequency pure tone average (HFPTA; 3, 4, 6, 8 kHz) and low-frequency pure tone average (LFPTA; .5, 1, 2 kHz) frequencies. SNHL was defined as a HFPTA or LFPTA threshold more than 25 decibels (dB) in the better ear. Multivariable regression analyses explored the association between hearing loss and COPD.

Results:
The prevalence of COPD was 19.8% in individuals with SNHL in the better ear and 4.7% in individuals with normal hearing (p < 0.001). Presence of COPD was associated with elevated hearing thresholds (worse hearing) at each individual frequency. The presence of COPD was independently associated with a 3.29 dB (95% CI: 1.48, 5.09) increase in HFPTA (p < 0.001), and 2.32 dB (1.13, 3.50) increase in LFPTA (p < 0.001) after controlling for medical, social, and environmental covariates. The presence of COPD was independently associated with a 1.85-fold (1.12, 3.06) increased odds of isolated low-frequency SNHL (p = 0.017).

Conclusions:
COPD was independently associated with sensorineural hearing loss after controlling for multiple confounding factors. These results contribute to the evidence that COPD and pulmonary dysfunction can be comorbid with hearing decline.
Effect of community-based nutritional counseling intervention on children's eating habits
Authors: Dike Ibiwari Caroline , Ebizie Elizabeth N. , Chukwuone Chiamaka Adaobi , Ejiofor Ngozi Juliana , Anowai Chinwe Christiana , Ogbonnaya Ezeda Kalu , Ugwu Eunice Ifenyinwa , Nkechinyere Udeagha Scholastica , Chigbu Eberechukwu Francisca , Ezeaku Margret N. , Nnadi Grace Chinyere , Ihuoma Ekomaru Chinyere , Gera Nguvan Patience , Chikwendu Justina Ndirika 
Published: August 2021

Abstract

Aim:
This study aimed to assess the outcome of community-based nutritional counseling interventions on eating habits of rural-dwelling children.

Methods:
A group-randomized trial design was used in this study. A total of 108 rural-dwelling children from a community in the Enugu North agricultural zone, Enugu State, who participated in the study. The children were randomly assigned to 2 groups: the treatment group (n = 54) and the no-treatment control group (n = 54). The child eating behavior questionnaire was used for data collection. Parents of the participating children within each study group completed the child eating behavior questionnaire at 3 time points. The data collected were analyzed using an independent sample t test at a probability level of .05.

Result:
The outcome of the study showed that the children's eating habits in the treatment group improved positively following the community-based nutritional counseling intervention. The positive gain from exposure to the community-based nutritional counseling intervention program was sustained during follow-up for children in the treatment group compared with the no-treatment group.

Conclusion:
The community-based nutrition counseling intervention carried out among children in rural communities had a positive adjustment in children's eating habits. The intervention requires the constant collaboration of professional childhood educators, caregivers, home economists, school staff, healthcare specialists, families, and the children themselves. Furthermore, there is a need for future long-term evaluations of the effects of community-based nutritional counseling interventions on children's nutrition and eating habits.
Psychological nursing intervention improve the mental health status of young patients with lung cancer surgery during the perioperative period
Authors: Zhao Li , Ma Lina , Chen Xiaomin , Liu Zhuo 
Published: August 2021

Abstract

Background:
To explore the effects of psychological nursing on improving the mental health status of young patients with lung cancer surgery during the perioperative period.

Methods:
seventy-eight young patients (From February 2018 to February 2019) underwent lung cancer operation were selected. All these patients were randomly allocated to intervention group and control group. The patients in the control group were treated with general routine care. The patients in the intervention group were treated with a comprehensive and systematic family participation psychological nursing. The mental health status of the patients in the 2 groups were compared and analyzed.

Results:
The self-rating anxiety scale scores and self-rating depression scale scores of patients were significantly reduced in the intervention group compared with the control group (P < .05). The scores of somatization, obsessive symptoms, interpersonal relationship, depression, anxiety, hostile, phobic neurosis, stubborn, paranoia and psychosis were also significantly reduced in the intervention group compared with the control group (P < .05).

Conclusion:
the comprehensive and systematic psychological nursing intervention improved the mental health status of young patients with lung cancer surgery during the perioperative period.
Recovery of an injured arcuate fasciculus via transcallosal fiber in a stroke patient
Authors: Jang Sung Ho , Seo Jeong Pyo , Kwon Young Hyeon 
Published: August 2021

Abstract

Rationale:
We report on a patient whose arcuate fasciculus (AF) and corticobulbar tract (CBT) recovered following an infarct in the middle cerebral artery (MCA) territory, demonstrated on serial diffusion tensor tractography (DTT).

Patient concerns:
The patient showed moderate conduction aphasia on the Western Aphasia Battery with an aphasia quotient of 46.5‰ (spontaneous speech: 35.0‰, auditory comprehension: 36.0‰, and naming: 53.1‰) at 1 month after onset. His aphasia improved with an aphasia quotient of 49‰ (spontaneous speech: 71.0‰, auditory comprehension: 52.0‰, and naming: 59.0‰) at 10 months after onset.

Diagnosis:
A 44-year-old right-handed male patient presented with aphasia and quadriplegia, which occurred at the onset of an infarct in the left MCA territory.

Intervention:
Diffusion tensor imaging data were acquired twice (1 month and 10 months after onset).

Outcomes:
On one-month DTT, the discontinuation of the left AF and severe narrowing of the right CBT were observed. However, on ten-month DTT, the left AF was connected to the opposite AF by a new tract that passed through the splenium of corpus callosum, and the right CBT had become thicker.

Lessons:
We believe that our results suggest a recovery mechanism of injured AF and CBT in stroke patients.
Caring for the Mental Health of Youth and Families
Authors: Bonham Elizabeth , Kwasky Andrea 
Published: August 2021

Purpose/Objectives
Children in our nation are experiencing the social, emotional, and physical impacts of an unprecedented time in history. Advanced practice nurses prepared as psychiatric clinical nurse specialists and nurse practitioners bring therapeutic interventions, psychopharmacologic management, and systems thinking to clinical environments of care. Insight into the mental health of youth and families and how clinical nurse specialists may provide solutions for forthcoming challenges is discussed.

Description of the Project/Program
Barriers to mental healthcare such as the invisibility of nurses at state and federal levels must be eradicated to mitigate the mental health challenges that youth, families, and communities endure. Contemporary issues such as effects of social media, stigma, and suicide present burdens that can be moderated through nursing interventions.

Outcome
The psychiatric clinical nurse specialist provides evidence and community-based nursing interventions that, through early identification and advocacy, contribute to positive mental health outcomes for youth and families.

Conclusion
The need for well-educated advanced practice nurses has never been greater for our vulnerable populations of children, adolescents, and families with mental health challenges. Nurse-delivered programs demonstrate that interventions are necessary for communication, psychoeducation, and prevention of consequences from unacknowledged social media, stigma, and suicide problems.
Telomere Shortening and Fusions: A Link to Aneuploidy in Early Human Embryo Development
Authors: Kohlrausch Fabiana B. , Wang Fang , Chamani Isaac , Keefe David L. 
Published: August 2021

ABSTRACT

Importance
It is known that oocytes undergo aging that is caused by exposure to an aged ovarian microenvironment. Telomere length in mouse and bovine oocytes declines with age, and age-associated telomere shortening in oocytes is considered a sign of poor development competency. Women with advanced age undergoing assisted reproductive technologies have poor outcomes because of increasing aneuploidy rates with age. Research has shown that aneuploidy is associated with DNA damage, reactive oxygen species, and telomere dysfunction.

Objective
In this review, we focus on the possible relationship between telomere dysfunction and aneuploidy in human early embryo development and several reproductive and perinatal outcomes, discussing the mechanism of aneuploidy caused by telomere shortening and fusion in human embryos.

Evidence Acquisition
We reviewed the current literature evidence concerning telomere dysfunction and aneuploidy in early human embryo development.

Results
Shorter telomeres in oocytes, leukocytes, and granulosa cells, related to aging in women, were associated with recurrent miscarriage, trisomy 21, ovarian insufficiency, and decreasing chance of in vitro fertilization success. Telomere length and telomerase activity in embryos have been related to the common genomic instability at the cleavage stage of human development. Complications of assisted reproductive technology pregnancies, such as miscarriage, birth defects, preterm births, and intrauterine growth restriction, also might result from telomere shortening as observed in oocytes, polar body, granulosa cells, and embryos.

Conclusions and Relevance
Telomere length clearly plays an important role in the development of the embryo and fetus, and the abnormal shortening of telomeres is likely involved in embryo loss during early human development. However, telomere fusion studies have yet to be performed in early human development.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After completing this activity, the learner should be better able to identify telomere dysfunction; describe telomere length and aneuploidy during early development of preimplantation embryos in humans; and explain the possible effects of telomere fusions during early development of preimplantation embryos in humans.
Integrating New Therapies for Chronic Lymphocytic Leukemia
Authors: Burger Jan A. 
Published: August 2021

Abstract
Over the last 2 decades, treatment of chronic lymphocytic leukemia (CLL) therapy has drastically changed, resulting in greatly improved survival and treatment tolerance with current targeted therapies. First, the transition from chemotherapy (alkylating agents, nucleoside analogs) to chemoimmunotherapy with the addition of anti-CD20 antibodies resulted in deeper and more complete remissions, with an improvement in progression-free and overall survival. Over the last few years, chemoimmunotherapy has gradually been replaced by new targeted agents, based on further improvement in survival, especially in patients with high-risk CLL, and fewer adverse effects, that is, a lack of myelosuppression and lack of DNA damage and associated risk of secondary acute myeloid leukemia/myelodysplastic syndrome. The most active targeted treatments for CLL patients are the kinase inhibitors, which inhibit signaling of surface receptors, especially the B-cell antigen receptor, and the BCL-2 antagonist venetoclax. Among the kinase inhibitors, Bruton tyrosine kinase inhibitors are highly effective and generally well-tolerated and induce durable responses in the vast majority of patients. PI3 kinase inhibitors are alternatives for patients with intolerance to Bruton tyrosine kinase inhibitors. This review discusses the rationale for the transition from chemotherapy–based treatment to the novel agents, the activity, adverse effects, sequencing, and combinations of the novel agents and provides an outlook into future CLL therapy for the next decade.
An Outcomes Review of 330 Sternal Wound Reconstructions: Timing of Closure Does Make a Difference
Authors: Levy Adam S. , Altchek Chloe L. , McMillen Elizabeth M. , Karinja Sarah J. , Tiao Jonathan R. , Smith Craig R. , Ascherman Jeffrey A. 
Published: August 2021

Background:
Sternal wound infection and dehiscence following cardiac surgery remain difficult clinical problems with high morbidity. Older classification systems regarding timing to reconstruction do not take into account recent improvements in critical care, wound vacuum-assisted closure use, or next-generation antibiotic therapies, which may prolong time to reconstruction.

Methods:
Records of patients undergoing sternal wound reconstruction performed by the senior author (J.A.A.) from 1996 to 2018 at a high-volume cardiac surgery center were reviewed. Indications included sternal wound infection or dehiscence. All patients underwent single-stage removal of hardware, débridement, and flap closure. Patients were divided into two groups based on timing of wound closure after cardiac surgery: less than 30 days or greater than or equal to 30 days.

Results:
Of the 505 patients identified during the study period, 330 had sufficient data for analysis. Mean time to sternal wound surgery was 15.7 days in the early group compared to 64.4 days (p < 0.01) beyond 30 days. Postdébridement cultures were positive in 72 percent versus 62.5 percent of patients (p = 0.11), whereas rates of postoperative infection were significantly higher in the delayed group: 1.9 percent versus 9.5 percent (p < 0.01). Partial wound dehiscence rates were also higher after 30 days (1.9 percent versus 11.3 percent; p < 0.01), whereas total length of stay was decreased. Use of wound vacuum-assisted closure was significantly associated with reconstruction beyond 30 days (p < 0.01).

Conclusions:
Although performing sternal wound reconstruction more than 30 days after initial cardiac surgery was associated with a shorter overall hospital length of stay and higher extubation rates in the operating room, these patients also had elevated postoperative infection and wound complication rates. The authors thus recommend not delaying definitive surgical reconstruction when possible.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Obstructive and Nonobstructive Hypertrophic Cardiomyopathy
Authors: Palmisano Vitanio , Cossa Stefano , Esposito Antonio , Bassareo Pier P. , Porcu Michele , Cau Riccardo , Pontone Gianluca , Suri Jasjit S. , Saba Luca 
Published: August 2021

Purpose:
To evaluate any significant differences in myocardial strain between hypertrophic obstructive cardiomyopathy (HOCM) and nonobstructive ones (HNCM), as assessed by cardiac magnetic resonance feature tracking (CMR-FT).

Materials and Methods:
A total of 17 patients (mean age: 54±14 y) with echocardiographic diagnosis of HOCM (left ventricular outflow tract obstruction peak gradient ≥30 mm Hg), 19 patients (mean age: 49±16 y) with HNCM (peak gradient <30 mm Hg), and 18 age-matched and gender-matched healthy controls (mean age: 42±14 y). All patients underwent cardiac MRI with SSFP-cine to assess left ventricular global and segmental strain analysis by CMR-FT. Late gadolinium enhancement (LGE) sequences were used for semiautomatic quantification of LGE volume, mass, and percentage.

Results:
The magnitude of global radial, circumferential, and longitudinal strain as well as strain rate were significantly lower in all patients in comparison to controls (P<0.001), except for radial and circumferential strain between HOCM and controls (P=0.270; P=0.154). The latter strain parameters were significantly higher in HOCM than HNCM (radial strain: 31.67±7.55 vs. 21.26±7.10, P<0.001; circumferential strain: −17.94±2.78 vs. −13.46±3.42, P<0.001). Radial and circumferential strain and circumferential diastolic strain rate were higher in mid-anterior (P<0.001), mid-anteroseptal (P<0.001), and all apical segments (P<0.005) between the 2 groups of patients. Moreover, longitudinal strain was higher only in apical segments in HOCM (P<0.02).

Conclusions:
HOCM patients showed higher left ventricular apical, mid-anterior, and mid-anteroseptal strain parameters compared with HNCM. These differences were independent of corresponding segmental thickness and LGE amount.
Gender Affirming Mastectomy Improves Quality of Life in Transmasculine Patients
Authors: Lane Megan , Kirsch Michael J. , Sluiter Emily C. , Svientek Shelby R. , Hamill Jennifer B. , Morrison Shane D. , Ives Graham C. , Alman Emma , Gilman Robert H. , Kuzon William M. , Cederna Paul S. , Wilkins Edwin G. 
Published: August 2021

Objective:
To determine the impact of gender-affirming mastectomy on depression, anxiety, and body image.

Background:
There are many cross-sectional and ad-hoc studies demonstrating the benefits of gender-affirming surgery. There are few prospective investigations of patient-reported outcomes in gender-affirming surgery using validated instruments.

Methods:
In this prospective study, patients presenting to the University of Michigan for gender-affirming Mastectomy were surveyed preoperatively and 6-months postoperatively. Primary outcomes were patient-reported measurements of anxiety measured by General Anxiety Disorder-7, depression measured by Patient Health Questionnaire-9, body image measured by BODY-Q and Body Image Quality of Life Index, psychosocial and sexual functioning measured by BREAST-Q, and satisfaction with decision measured by BREAST-Q. Linear regression analysis was used to control for presence of complication and existing history of mental health conditions.

Results:
A total of 70 patients completed the study. The average age of participants was 26.7. The mean Patient Health Questionnaire-9 score pre-operatively was 7.8 and postoperatively was 5.4 (P=0.001). The mean preoperative and postoperative General Anxiety Disorder-7 scores were 7.6 and 4.6, respectively (P<0.001). There were significant improvements in both psychosocial (35 to 79.2, P<0.001) and sexual (33.9 to 67.2, P< 0.001) functioning related to chest appearance as measured by the BREAST-Q and global psychosocial functioning (–15.6 to +32, P<0.001) as measured by the Body Image Quality of Life Index. Satisfaction with chest contour (14.3 to 93.8, P<0.001) and nipple appearance (29.3 to 85.9, P<0.001) measured by the BODY-Q significantly improved. Patients had a mean satisfaction with outcome score of 93.1.

Conclusions:
Patients undergoing gender-affirming mastectomy in this single-center prospective study reported significant improvements in anxiety, depression, body image, psychosocial, and sexual functioning after this procedure. Patients were extremely satisfied with the decision to undergo this operation.