bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound Assessment of Gastric Emptying in Premature Infants Treated With Non‐Invasive Ventilatory Support
Authors: Hlaing Arkar Ye , Weinberger Barry , Schanler Richard , Cerise Jane , Kurepa Dalibor 
Published: May 2021

ABSTRACTBackground:Nasal continuous positive airway pressure (CPAP) introduces positive pressure of air into both the trachea and stomach, which may affect gastric emptying. The rate of gastric emptying can be estimated by ultrasound (US) in neonates by two validated techniques: “antral cross‐sectional area” (ACSA, two‐dimensional estimate of the surface area at the gastric antrum), and “spheroid gastric volume” (spheroid, three‐dimensional estimate of the stomach volume).Objective:To compare gastric emptying rates in neonates on machine‐derived nasal CPAP (MD‐nCPAP, Avea and RAM cannula) with those on bubble CPAP (bCPAP, Fisher Paykel and Babi.Plus nasal prongs).Methods:Ultrasound measurements of the amount of the milk in the stomach were performed before feeding and at 1, 2, and 3 hours after the start of feeding, using both the ACSA and spheroid methods. Rates of gastric emptying were calculated during the “early” (1–2 hours) and “late” (2–3 hours) phases after feeding.Results:We recruited 32 infants (25–34 weeks gestational age, full enteral tube feedings, on nasal CPAP). Seventeen infants were treated with MD‐nCPAP (median birth weight 1015 g [interquartile range (IQR): 870–1300], gestational age 28 weeks [IQR: 27–29], postnatal age 20 days [IQR: 14–28]), whereas 15 infants were treated with bCPAP (median birth weight 960 g [IQR: 855–1070], gestational age 27 weeks [IQR: 26–28], postnatal age 17 days [IQR: 15–25]). Gastric emptying rates (% emptied/min) were significantly faster in the “early” compared to the “late” phase for all infants. There were no significant differences in the rates of gastric emptying (either “early” or “late”) or volumes of gastric residuals between infants receiving MD‐nCPAP or bCPAP, measured by either method. Although no feeding intolerance was seen in either group, the volumes of residual gastric contents measured by both methods were higher than the volumes traditionally considered abnormal when obtained by gastric tube aspiration.Conclusions:Gastric emptying is faster during the “early” compared to the “late” phase. Gastric emptying rates are not different in infants receiving MD‐nCPAP versus bCPAP. The presence of large residual gastric contents in infants who are tolerating feedings challenges the value of traditional gastric aspiration for the assessment of feeding tolerance in infants.
Receptor‐binding Domain Severe Acute Respiratory Syndrome Coronavirus 2‐specific Antibodies in Human Milk From Mothers With Coronavirus Disease 2019 Polymerase Chain Reaction or With Symptoms Suggestive of Coronavirus Disease 2019
Authors: Demers‐Mathieu Veronique , DaPra Ciera , Fels Shawn , Medo Elena 
Published: May 2021

ABSTRACTThis study aims to compare the receptor‐binding domain (RBD) severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐specific antibody titers in human milk between mothers with a confirmed coronavirus disease 2019 (COVID‐19) polymerase chain reaction (PCR) test and mothers with viral symptoms suggestive of COVID‐19. The area under the curve (AUC) for RBD SARS‐CoV‐2‐specific secretory immunoglobulin A (SIgA)/immunoglobulin A (IgA), secretory immunoglobulin M (SIgM)/immunoglobulin M (IgM), immunoglobulin G (IgG), and free secretory components (fSC) in milk samples from eight mothers with a confirmed COVID‐19 PCR, eight mothers with viral symptoms (no PCR testing), and six unexposed mothers (pre‐pandemic 2018). AUCs of RBD SARS‐CoV‐2‐specific SIgA/IgA, SIgM/IgM, IgG, and fSC in milk samples were comparable between mothers with confirmed COVID‐19 PCR and mothers with viral symptoms of suggestive COVID‐19. AUCs of RBD‐specific SIgA/IgA, IgG, and fSC were higher in the COVID‐19‐exposed group than in the unexposed group, and SIgM/IgM tended to be higher in the exposed mothers. In conclusion, women with viral symptoms suggestive of COVID‐19 could secrete antibodies and fSC specific to SARS‐CoV‐2 in human milk.
The Association of Workload and Outcomes in the Pediatric Cardiac ICU*
Authors: Fundora Michael P. , Liu Jiayi , Calamaro Christina , Mahle William T. , KC Diwas 
Published: May 2021

OBJECTIVES:
Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline provider (fellows, nurse practitioners, physician assistants) workload and outcomes. We hypothesize frontline provider workload, measured by bed occupancy and staffing, is associated with poor outcomes and unnecessary testing.

DESIGN:
A retrospective single-center, time-stamped orders, ordering provider identifiers, and patient data were collected. Regression was performed to study the influence of occupancy on orders, length of stay, and mortality, controlling for age, weight, admission type, Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality score, diagnosis, number of surgeries, orders, provider staffing, attending experience, and time fixed effects.

SETTING:
Twenty-seven bed tertiary cardiac ICU in a free-standing children’s hospital.

PATIENTS:
Patients (0–18 yr) admitted to the pediatric cardiac ICU, January 2018 to December 2019.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
There were 16,500 imaging and 73,113 laboratory orders among 1,468 patient admissions. Median age 6 months (12 d to 5 yr), weight 6.2 kg (3.7–16.2 kg); 840 (57.2%) surgical and 628 (42.8%) medical patients. ICU teams consisted of 16 attendings and 31 frontline providers. Mortality 4.4%, median stay 5 days (2–11 d), and median bed occupancy 89% (78–93%). Every 10% increase in bed occupancy had 7.2% increase in imaging orders per patient (p < 0.01), 3% longer laboratory turn-around time (p = 0.015), and 3 additional days (p < 0.01). Higher staffing (> 3 providers) was associated with 6% less imaging (p = 0.03) and 3% less laboratory orders (p = 0.04). The number of “busy days” (bed occupancy > 89%) was associated with longer stays (p < 0.01), and increased mortality (p < 0.01).

CONCLUSIONS:
Increased bed occupancy and lower staffing were associated with increased mortality, length of stay, imaging orders, and laboratory turn-around time. The data demonstrate performance of the cardiac ICU system is exacerbated during high occupancy and low staffing.
The Influence of Race, Sex, and Social Disadvantage on Self-reported Health in Patients Presenting With Chronic Musculoskeletal Pain
Authors: Cheng Abby L. , Bradley Ethan C. , Brady Brian K. , Calfee Ryan P. , Klesges Lisa M. , Colditz Graham A. , Prather Heidi 
Published: May 2021

Objective
The aim of the study was to better address sociodemographic-related health disparities. This study examined which sociodemographic variables most strongly correlate with self-reported health in patients with chronic musculoskeletal pain.

Design
This single-center, cross-sectional study examined adult patients, followed by a physiatrist for chronic (≥4 yrs) musculoskeletal pain. Sociodemographic variables considered were race, sex, and disparate social disadvantage (measured as residential address in the worst vs. best Area Deprivation Index national quartile). The primary comparison was the adjusted effect size of each variable on physical and behavioral health (measured by Patient-Reported Outcomes Measurement Information System [PROMIS]).

Results
In 1193 patients (age = 56.3 ± 13.0 yrs), disparate social disadvantage was associated with worse health in all domains assessed (PROMIS Physical Function Β = −2.4 points [95% confidence interval = −3.8 to −1.0], Pain Interference = 3.3 [2.0 to 4.6], Anxiety = 4.0 [1.8 to 6.2], and Depression = 3.7 [1.7 to 5.6]). Black race was associated with greater anxiety than white race (3.2 [1.1 to 5.3]), and female sex was associated with worse physical function than male sex (−2.5 [−3.5 to −1.5]).

Conclusions
Compared with race and sex, social disadvantage is more consistently associated with worse physical and behavioral health in patients with chronic musculoskeletal pain. Investment to ameliorate disadvantage in geographically defined communities may improve health in sociodemographically at-risk populations.
Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair
Authors: Correia Fernando Dias , Molinos Maria , Luís Sara , Carvalho Diana , Carvalho Carlos , Costa Pedro , Seabra Rosmaninho , Francisco Gerard , Bento Virgílio , Lains Jorge 
Published: May 2021

Objective
The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation.

Design
The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion.

Results
Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group.

Conclusions
The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.
Level of evidence: II.
Theranostic Approach in Breast Cancer
Authors: Jokar Narges , Velikyan Irina , Ahmadzadehfar Hojjat , Rekabpour Seyed Javad , Jafari Esmail , Ting Hong Hoi , Biersack Hans-Jürgen , Assadi Majid 
Published: May 2021

AbstractBreast cancer is the most frequent invasive malignancy and the second major cause of cancer death in female subjects mostly due to the considerable diagnostic delay and failure of therapeutic strategies. Thus, early diagnosis and possibility to monitor response to the treatment are of utmost importance. Identification of valid biomarkers, in particular new molecular therapeutic targets, that would allow screening, early patient identification, prediction of disease aggressiveness, and monitoring response to the therapeutic regimen has been in the focus of breast cancer research during recent decades. One of the intensively developing fields is nuclear medicine combining molecular diagnostic imaging and subsequent (radio)therapy in the light of theranostics. This review aimed to survey the current status of preclinical and clinical research using theranostic approach in breast cancer patients with potential to translate into conventional treatment strategies alone or in combination with other common treatments, especially in aggressive and resistant types of breast cancer. In addition, we present 5 patients with breast cancer who were refractory or relapsed after conventional therapy while presumably responded to the molecular radiotherapy with177Lu-trastuzumab (Herceptin),177Lu-DOTATATE, and177Lu-FAPI-46.
Reconstruction of Cutaneous Nasal Alar Defects Following Melanocytic Nevus Resection
Authors: Gu Chuan , Lu Lin , Jin Rui , Luo Xusong , Sun Di 
Published: May 2021

Objective:
The reconstruction of nasal alar defects after resection of a melanocytic nevus becomes one of the most challenging procedures for surgeons. Choosing the most appropriate technique is still difficult sometimes. The authors reviewed our cases and published experience on choosing optimal surgical methods to repair different types of nasal alar defect following melanocytic nevus resection.

Methods:
A total of 152 patients who were treated between 2016 and 2019 in Shanghai Ninth People's Hospital were evaluated. The surgical methods included primary closure, full-thickness skin graft, composite auricular graft, interpolated melolabial flap, paramedian forehead flap including hair-bearing paramedian forehead flap.

Results:
Among the 152 patients with a melanocytic nevus, 49 underwent primary closure, 38 were treated with a full-thickness skin graft, 16 composite auricular graft, 28 were treated with interpolated melolabial flap, and 21were treated with paramedian forehead flap including 14 with hair-bearing paramedian forehead flap. Most skin graft, composite auricular graft, and flaps were survived. Patients who completed follow-up were satisfied with the contour of the nasal ala.

Conclusions:
After resection of the melanocytic nevus, the surgeon should choose the most appropriate surgical method for alar reconstruction according to the characteristics of the defect and personal desire of patient or the guardian.
Comparison of General, Epidural, and Spinal Anesthesia in Laparoscopic TEP (Total Extraperitoneal Repair) for Inguinal Hernia
Authors: Ferahman Sina , Donmez Turgut , Surek Ahmet , Akarsu Cevher , Aydin Husnu , Cayirci Can E. , Emir Nalan S. , Karabulut Mehmet 
Published: May 2021

Purpose:
Laparoscopic total extraperitoneal repair (TEP) is one of the most preferred minimally invasive methods for inguinal hernia repair. In our study, we aimed to compare the advantages and disadvantages of general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia (EA) for TEP operations.

Materials and Methods:
This is a retrospective study involving 221 patients who underwent TEP surgery for inguinal hernia between January 2018 and July 2020. Patients were divided into 3 groups as GA (n=77), SA (n=70), and EA (n=74). Demographic data of the patients, duration of anesthesia and surgery, perioperative and postoperative complications, postoperative pain, anatomical delineation, hospital stay and quality of life were evaluated.

Results:
Anesthesia time was the longest in the EA group (23.1±2.32 min) and significantly prolonged the operation time (P<0.001). When the visual analog scale scores were compared, it was observed that the patients in the GA group felt significantly more pain (P<0.001). While the rates of hypotension and headache were higher in regional anesthesia (P<0.001 and P<0.002), there was no significant difference in urinary retention, postoperative nausea/vomiting, and shoulder pain (P=0.274, 0.262, and 0.314, respectively). SA and EA groups were found to be superior compared with the GA group in terms of patient satisfaction (P<0.001).

Conclusion:
Regional anesthesia (SA and EA) can be safely performed in TEP surgeries, gives results similar to the anatomical delineation satisfactory and complication rates of GA, and results in less postoperative pain.
Outcomes of 601 Colorectal Endoscopic Submucosal Dissections in a Single Western Center: Is Right Colon Location Still a Major Concern?
Authors: Spychalski Michał , Włodarczyk Marcin , Winter Katarzyna , Włodarczyk Jakub , Dąbrowski Igor , Dziki Adam 
Published: May 2021

Background:
Endoscopic submucosal dissection (ESD), as a minimally invasive procedure for removal of early gastrointestinal neoplasms, is a standard approach in Asian countries. Outcomes of ESD in Western European countries significantly differ, which makes it more difficult to apply this procedure to daily-basis clinical routine. The aim of this study is to analyze the safety and efficiency of colorectal ESD based on a large series of cases performed by a single operator after finishing the learning curve period in a western referral center.

Materials and Methods:
We retrospectively studied 601 patients who underwent ESD procedure for colorectal neoplasm from January 2016 to December 2019 in a tertiary colorectal ESD center in Poland.

Results:
The overall en bloc resection was achieved in 88.02%. Complete histologic resection rate (R0) was reported at a level of 86.36%. Lesions located in the right colon were characterized by statistically lower en bloc, R0 resection, and success rate (73.95%, 71.43%, 69.75%, respectively). In 9.82% (n=59) of cases, the ESD procedure-related complications have been observed. Post-ESD bleeding occurred in 23 patients (3.83%) and perforation in 32 patients (5.32%). Twenty-seven patients were treated endoscopically (4.49%) and 5 required surgery (0.83%). Analysis of complications showed that tumors located within the right colon were characterized by the highest perforation rate at 10.92%. Within the rectum there were minimal number of perforations (2.69%), whereas the bleeding rate was 4.48%.

Conclusions:
Our results represent the largest material concerning ESD of colorectal lesions in the West and show that ESD is characterized by a high rate of successful resections with a low risk of complications. Thus, confirming that it is possible to obtain results similar to Asian centers and that colorectal ESD procedures can be implemented in clinical routine in western countries. Nevertheless, ESD in the right colon is still related with high rate of complications, so qualification for the ESD procedure should be very careful and discussed with the patient and should be performed by an experienced endoscopist after the learning curve.
Laparoscopic Versus Open Appendectomy for Appendicitis in Pregnancy: Systematic Review and Meta-Analysis
Authors: Zeng Qi , Aierken Amina , Gu Shen-Sen , Yao Gang , Apaer Shadike , Anweier Nuerzhatijiang , Wu Jing , Zhao Jin-Ming , Li Tao , Tuxun Tuerhongjiang 
Published: May 2021

Objectives:
The clinical safety, efficacy and feasibility of laparoscopic appendectomy (LA) compared with open appendectomy (OA) in pregnancy are still controversial. Herein, we are aiming to compare the clinical outcomes of LA and OA in patients with acute appendicitis during their pregnancy.

Materials and Methods:
This was a systematic review and meta-analysis of studies comparing laparoscopic and OA in pregnancy identifying using PubMed, Web of science, Embase, The Cochrane Library, Ovid and Scopus. Two independent reviewers extracted data on surgical complication, fetal loss, preterm delivery, hospital stay, Apgar score in both groups.

Results:
Twenty-seven studies with total of 6497 patients (4464 in open and 2031 in laparoscopic group) were included. LA was associated with lower rate of wound infection [odds risk (OR)=3.13, 95% confidence interval (CI): 1.77-5.56, P<0.0001] overall complications (OR=2.15, 95% CI: 1.47-3.14, P<0.0001) and shorter hospitalization (mean difference=0.72, 95% CI: 0.43-1.02, P<0.00001) compared with open group. LA was in a lower risk for 5-minute Apgar score (mean difference=0.09, 95% CI: 0.02-0.17, P=0.01) group than open group. No difference was found regarding preterm delivery between 2 groups. LA was associated with higher fetal loss (OR=0.57, 95% CI: 0.41-0.79, P=0.0007) compared with open surgery. However, laparoscopy was not associated with increased fetal loss after 2010 (OR=0.74, 95% CI: 0.44-1.24, P=0.26) compared with open group.

Conclusions:
LA in pregnancy seems to be feasible with acceptable outcome, especially in patients with early and mid-trimester period, with sophisticated hands and experienced centers.
Comparison of Pelvic Floor Physical Therapy Attendance Based on Referring Provider Specialty
Authors: Fullerton Morgan E. , Mwesigwa Patricia J. , Tandel Megha D. , Kwan Lorna , Grisales Tamara , Tarnay Christopher M. 
Published: May 2021

Objective
The objective of this study was to determine whether pelvic floor physical therapy (PFPT) attendance differs based on referring provider specialty and identify factors related to PFPT initiation and completion.

Methods
This was an institutional review board-approved retrospective cohort study examining referrals from female pelvic medicine and reconstructive surgery (FPMRS) and non-FPMRS providers at a single academic medical center to affiliated PFPT clinics over a 12-month period. Demographics, referring specialty and diagnoses, prior treatment, and details regarding PFPT attendance were collected. Characteristics between FPMRS and non-FPMRS referrals were compared and multivariate logistic regression analyses were performed to identify factors associated with PFPT initiation and completion.

Results
A total of 497 referrals were placed for PFPT. Compared with non-FPMRS referrals, FPMRS referrals were for patients who were older (54.7 years vs 35.6 years), and had higher parity; more were postmenopausal (56% vs 18%) and had Medicare insurance (22% vs 10%) (all P < 0.001). Most FPMRS referrals were for patients with urinary incontinence (69% vs 31%), whereas non-FPMRS referrals were for patients with pelvic pain (70% vs 27%) (both P < 0.0001). Pelvic floor physical therapy attendance was similar in both groups when comparing rates of initiation (47% vs 45%) and completion (13% vs 16%). In multivariate analysis, factors associated with initiation were age 65 years or older, additional therapy provided at referring visit, private insurance, Asian race, pregnant or postpartum at time of referral, and more than 1 referring diagnosis (all P < 0.05). No factors were associated with completion.

Conclusions
Less than half of the patients referred to PFPT initiate therapy, and only 15% complete PFPT. The populations referred by FPMRS and non-FPMRS providers are different, but ultimately PFPT utilization is similar.