bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patulous Eustachian Tube Patients With Respiratory Fluctuation of Tympanic Membrane in Both Sitting and Supine Positions: A Sign of Severity of Disease?
Authors: Kusano Yusuke , Kawamura Yoshinobu , Ikeda Ryoukichi , Oshima Hidetoshi , Kikuchi Toshiaki , Kawase Tetsuaki , Katori Yukio , Kobayashi Toshimitsu 
Published: May 2021

Objective:
The aim is to report four cases of patulous Eustachian tube (PET) patients with respiratory fluctuation of the tympanic membrane (TM) even in the supine position, and to examine the frequency and characteristics of such patients.

Patients:
There were 195 ears (99 right ears and 96 left ears) from 146 cases (56 male and 90 female subjects aged 8–88, average 48.0 ± 18.9 yrs) diagnosed with definite PET by diagnostic criteria proposed by Japan Otologic Society (JOS) between January 2017 and December 2019 at Sen-En Rifu Hospital. Patients who presented with respiratory fluctuation of the TM in both the sitting and supine positions were examined.

Main Outcome Measures:
Clinical patient records, the severity of subjective symptoms (PET handicap inventory-10 [PHI-10]), objective ET function tests (tubo-tympano-aerodynamic graphy [TTAG] and sonotubometry), and sitting three-dimensional computed tomography (3-D CT) were analyzed.

Results:
Six ears (3.1%) of four cases (2.7%) exhibited respiratory fluctuation of the TM, even in the supine position. In these six ears (four cases), the PHI-10 score ranged from 16 to 36 with three ears exhibiting PHI-10 score equal to or exceeding 26 (in the category of severe handicap). Sitting CT indicated the findings of completely open ET in only two ears. All ears but one were managed by conservative treatment.

Conclusion:
Respiratory fluctuation of the TM in both the sitting and supine positions was observed in 2.7% of the definite PET patients. Surprisingly, such findings can be an indication of neither the subjective nor objective severity of the disease. Therefore, even for PET patients with such findings, surgery should not be immediately proposed, but rather, conservative management should be undertaken first.
Novel extracorporeal magnetotransduction therapy with Magnetolith and high-energy focused electromagnetic extracorporeal shockwave therapy as bone stimulation therapy for scaphoid nonunion
Authors: Knobloch Karsten 
Published: May 2021

Abstract

Introduction:
The case report describes a non-invasive combination of novel Magnetolith Extracorporeal magnetotransduction therapy (EMTT) with high-energy focused extracorporeal shockwave therapy (ESWT) for scaphoid nonunion.

Patient concern:
In March 2020, a 31-year-old male presented with significant left wrist pain with the epicenter in the radial fossa, limiting daily activities and sports. Initial injury happened in 2005 when the patient was 16-years-old which was neglected. The first scaphoid non-union surgery took place in 2012 with bone-grafting and Herbert-screw. The second revision surgery took place in December 2019.

Diagnosis:
CT scan showed a non-healing atrophic bone graft in the scaphoid region.

Intervention:
In March/April 2020, combined novel Magnetolith (EMTT, 8  Hertz, 6000 shots, energy level 6/8) with high-energy focused electromagnetic ESWT (0.35mJ/mm2, 4000 shots, 4  Hertz) was performed in 3 sessions on a weekly interval to accelerate bony healing.

Outcomes:
Cone-beam CT in May 2020 (5 weeks after the last combined EMTT/ESWT treatment) revealing bony consolidation.

Conclusion:
The combination of novel non-invasive Magnetolith (EMTT) with focused high-energy ESWT for 3 sessions on a weekly interval can significantly improve bony healing in scaphoid nonunion. To the best of my knowledge, this is the first report to apply EMTT & ESWT for scaphoid nonunion after failed surgeries.
Using Lean Six Sigma to Increase the Effectiveness of an Evidence-Based Quality Improvement Program
Authors: Lavin Patricia , Vetter Mary Jo 
Published: May 2021

Background:
Evidence-based quality improvement (EBQI) is an established methodology for identifying nursing practice changes that improve health care quality and safety. However, EBQI itself does not provide a framework for navigating the barriers to practice change.

Local Problem:
An EBQI program in an orthopedic specialty hospital fostered many successful quality improvement projects. However, program participants frequently encountered barriers to project implementation.

Methods:
Lean Six Sigma (LSS) principles, tools, and strategies were incorporated into the EBQI program to help participants overcome organizational barriers to successful implementation.

Interventions:
LSS interventions included stakeholder alignment, process analysis, change management, project management, structured check-ins, mentoring, and organizational recognition.

Results:
The addition of LSS principles gave EBQI project leaders new tools for gaining executive support, securing resources, and overcoming organizational inertia to facilitate effective practice change.

Conclusions:
Lean Six Sigma can increase the effectiveness of an EBQI program.
Lessons Learned Using Logic Models to Design and Guide DNP Projects
Authors: Idzik Shannon , Buckley Kathleen , Bindon Susan , Gorschboth Susan , Hammersla Margaret , Windemuth Brenda , Bingham Debra 
Published: May 2021

Background
A final culminating project that is derived from a practice immersion experience is a critical part of a doctor of nursing practice (DNP) program.

Problem
Many schools use well-designed quality improvement (QI) projects to meet this requirement, but there is no consensus on which QI methods and tools are the most effective for DNP students to demonstrate before graduation.

Approach
One Mid-Atlantic public university began using QI process models, one of which was a logic model, to guide their DNP projects. This led to subsequent changes in the curriculum, faculty preparation, and practice partner responsibilities.

Outcome
Many benefits and challenges were identified during the logic model implementation that may benefit other schools seeking to increase consistency and rigor. Although the learning process for students and faculty may be challenging, the outcomes included improved project conceptualization, clarity, concision, and feasibility of goal attainment.

Conclusions
Use of logic models expands DNP students' skills to develop and implement a successful project and supports clinical scholarship.
Nursing Education Amid a Pandemic
Authors: Amerson Roxanne , Fisher Beth , Bible Joe , Burgess Lena , Ravan Leslie , Ward Linda 
Published: May 2021

Background
The unprecedented pandemic presented new stresses and challenges in nursing education impacting the mental health of nursing students.

Purpose
The purpose of this study was to evaluate the relationship between virtual learning and the mental health of nursing students.

Method
This study used a descriptive, cross-sectional design with a convenience sample of 256 nursing students enrolled in a baccalaureate program. Data were collected through an online survey using 2 screening tools for stress, anxiety, and depression.

Results
Mean sum Patient Health Questionnaire-4 scores and subscale scores suggest that more than 40% of students experienced mild to moderate levels of psychological distress. Mean sum Perceived Stress Scale-10 scores indicate 84% of students experienced moderate levels of stress, and 14% experienced high levels of stress.

Conclusions
During periods of societal crisis, faculty must be hypervigilant to the mental health needs of students.
Longitudinal evolution of physical activity during and after chemotherapy for breast cancer
Authors: Girouard Alice , Michel Alexandra , Ouellet Marie-Michèle , Guimond Anne-Josée , Ruel Sophie , Ivers Hans , Savard Josée 
Published: May 2021

Abstract

Background:
Previous research has found that, on average, breast cancer patients tend to become less active during chemotherapy and to increase slightly their physical activity (PA) level afterwards. However, patients may show distinct trajectories of PA during and after chemotherapy. Objectives were to: investigate the global evolution of PA before (T1), during (T2), and after chemotherapy (T3), as well as 3 (T4) and 6 (T5) months later; document the distinct trajectories of PA from T1-T5; and explore the moderating effect of the initial PA level on subsequent PA trajectories (T2-T5).

Methods:
Fifty breast cancer patients (M age = 55.1, SD = 10.4) wore an actigraph for 7 consecutive 24-hour periods to measure the time spent in moderate-to-vigorous PA and completed the Godin Leisure-Time Exercise questionnaire (GLTEQ) at 5 time points.

Results:
At baseline, participants showed an average of 8.8 minutes of objectively measured moderate-to-vigorous PA per week and a mean score of 20.4 (moderate PA) on the GLTEQ. A significant time effect (i.e., increase) was obtained on both measures when analyzing the total sample (P = .001; P = .021, respectively). Latent class growth modeling revealed 2 distinct trajectories (“mild-to-moderate PA” and “strenuous PA”) of PA for the subjective measure, and 4 trajectories (“very low and stable MVPA,” “very low and slightly increasing MVPA,” “very low and highly increasing MVPA,” and “low and slightly decreasing MVPA”) for the objective one. With regards to the moderating role of baseline PA levels, no significant group X time interactions were found for the subjective and objective measures (P = .077 and.10, respectively).

Conclusions:
The evolution of PA during and after chemotherapy is variable across patients. However, it remains challenging for everyone to remain or be active during chemotherapy. More research is needed to design more effective PA intervention in this population.
Ammonia Exposure
Authors: Vadysinghe Amal Nishantha , Attygalle Uthpala , Ekanayake Ekanayake Mudiyanselage Kasun Bandara , Dharmasena Edurapotha Gamaralalage Inoka Amanthie 
Published: May 2021

Abstract
Exposure to high doses of ammonia gas can result in lethal injuries to humans. This case series presents 5 fatalities and an injured individual, caused by acute ammonia exposure, which occurred in the rubber industry. One of the fatalities and the survivor were reported in an incident of ammonia gas cylinder explosion, whereas the other 4 fatalities were accidentally exposed to gaseous ammonia, where they had started working at a reopened rubber factory that had been abandoned for a long time. Autopsy, scene investigation, and the toxicological findings of the deceased and the clinical forensic examination of the survivor revealed corrosive burns on the skin and the oropharynx, diffuse alveolar damage, and high level of ammonia in blood and the scene. These cases highlight how the comprehensive death investigation helps the forensic practitioner to conclude ammonia exposure as the cause of death/injury where there is a possibility of gas inhalation.
Decision-Making, Ethics, and End-of-Life Care in Pediatric Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review
Authors: Moynihan Katie M. , Dorste Anna , Siegel Bryan D. , Rabinowitz Edon J. , McReynolds Andrew , October Tessie W. 
Published: May 2021

Objectives:
Pediatric extracorporeal membrane oxygenation is associated with significant morbidity and mortality. We sought to summarize literature on communication and decision-making, end-of-life care, and ethical issues to identify recommended approaches and highlight knowledge gaps.

Data Sources:
PubMed, Embase, Web of Science, and Cochrane Library.

Study Selection:
We reviewed published articles (1972–2020) which examined three pediatric extracorporeal membrane oxygenation domains: 1) decision-making or communication between clinicians and patients/families, 2) ethical issues, or 3) end-of-life care.

Data Extraction:
Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.

Data Synthesis:
Of 2,581 publications screened, we identified one systematic review and 35 descriptive studies. No practical guides exist for communication and decision-making in pediatric extracorporeal membrane oxygenation. Conversation principles and parent/clinician perspectives are described. Ethical issues related to consent, initiation, discontinuation, resource allocation, and research. No patient-level synthesis of ethical issues or end-of-life care in pediatric extracorporeal membrane oxygenation was identified.

Conclusions:
Despite numerous ethical issues reported surrounding pediatric extracorporeal membrane oxygenation, we found limited patient-level research and no practical guides for communicating with families or managing extracorporeal membrane oxygenation discontinuation.
Clinical Deterioration and Neurocritical Care Utilization in Pediatric Patients With Glasgow Coma Scale Score of 9–13 After Traumatic Brain Injury: Associations With Patient and Injury Characteristics
Authors: Soysal Elif , Horvat Christopher M. , Simon Dennis W. , Wolf Michael S. , Tyler-Kabara Elizabeth , Gaines Barbara A. , Clark Robert S. B. , Kochanek Patrick M. , Bayir Hülya 
Published: May 2021

OBJECTIVES:
To define the clinical characteristics of hospitalized children with moderate traumatic brain injury and identify factors associated with deterioration to severe traumatic brain injury.

DESIGN:
Retrospective cohort study.

SETTING:
Tertiary Children’s Hospital with Level 1 Trauma Center designation.

PATIENTS:
Inpatient children less than 18 years old with an International Classification of Diseases code for traumatic brain injury and an admission Glasgow Coma Scale score of 9–13.

MEASUREMENTS AND RESULTS:
We queried the National Trauma Data Bank for our institutional data and identified 177 patients with moderate traumatic brain injury from 2010 to 2017. These patients were then linked to the electronic health record to obtain baseline and injury characteristics, laboratory data, serial Glasgow Coma Scale scores, CT findings, and neurocritical care interventions. Clinical deterioration was defined as greater than or equal to 2 recorded values of Glasgow Coma Scale scores less than or equal to 8 during the first 48 hours of hospitalization. Thirty-seven patients experienced deterioration. Children who deteriorated were more likely to require intubation (73% vs 26%), have generalized edema, subdural hematoma, or contusion on CT scan (30% vs 8%, 57% vs 37%, 35% vs 16%, respectively), receive hypertonic saline (38% vs 7%), undergo intracranial pressure monitoring (24% vs 0%), were more likely to be transferred to inpatient rehabilitation following hospital discharge (32% vs 5%), and incur greater costs of care ($25,568 vs $10,724) (all p < 0.01). There was no mortality in this cohort. Multivariable regression demonstrated that a higher Injury Severity Score, a higher initial international normalized ratio, and a lower admission Glasgow Coma Scale score were associated with deterioration to severe traumatic brain injury in the first 48 hours (p < 0.05 for all).

CONCLUSIONS:
A substantial subset of children (21%) presenting with moderate traumatic brain injury at a Level 1 pediatric trauma center experienced deterioration in the first 48 hours, requiring additional resource utilization associated with increased cost of care. Deterioration was independently associated with an increased international normalized ratio higher Injury Severity Score, and a lower admission Glasgow Coma Scale score.
LBP Protects Hepatocyte Mitochondrial Function Via the PPAR-CYP4A2 Signaling Pathway in a Rat Sepsis Model
Authors: Song Zichen , Meng Leilei , He Zhixiang , Huang Jing , Li Fang , Feng Jingjing , Jia Zhuoran , Huang Yue , Liu Wei , Liu Anding , Fang Haoshu 
Published: May 2021

ABSTRACT

Objectives:
To explore the role of LPS binding protein (LBP) in metabolism and optimize sepsis treatment.

Design:
A sepsis model was established by injecting LPS into LBP−/− rats and WT rats and observing changes in the liver over time (0, 1, 6, and 24 h).

Setting:
Detecting liver inflammation and injury. Optimizing the treatment of sepsis.

Subjects:
WT rats and LBP−/− rats.

Interventions:
We established a sepsis model by injecting LPS intravenously.

Measurements and main results:
First, we induced sepsis in WT and LBP−/− rats with LPS. The rats were sacrificed, and serum and liver samples were collected at 1, 6, and 24 h after LPS injection. We found that the deletion of LBP reduced LPS-induced liver inflammation and injury at 1 and 6 h. Ballooning degeneration was clearly present in LBP−/− rat livers at 24 h after LPS injection. We found that mitochondrial damage and reactive oxygen species (ROS) levels were higher in LBP−/− rat livers than in WT rat livers at 24 h after LPS injection. According to the transcriptomic results, the peroxisome proliferator-activated receptor (PPAR) pathway may be the reason for lesions in LBP−/− rats. To further investigate the function of PPARα in sepsis, we inhibited mTOR with rapamycin and examined mitochondrial injury and ROS levels. The levels of mitochondrial damage and ROS were reduced after LBP−/− rats were pretreated with rapamycin in the context of LPS-induced sepsis. Inhibiting CYP4a2, one of the PPARα-target gene products, reduced the level of LPS-induced ROS in LBP−/− rats.

Conclusion:
LBP protects hepatic mitochondria against LPS-induced damage via the LBP-PPARα-CYP4a2 signaling pathway.
Cancer After Pediatric Kidney Transplantation: A Long-term Single-center Experience in Japan
Authors: Yabuuchi Tomoo , Miura Kenichiro , Shimizu Satoru , Kaneko Naoto , Ishizuka Kiyonobu , Kanda Shoichiro , Chikamoto Hiroko , Akioka Yuko , Fujieda Mikiya , Hattori Motoshi 
Published: May 2021

Background.
The cancer incidence, types, and risk factors after pediatric kidney transplantation (KT) have been reported in the United States, Canada, Europe, Australia, and New Zealand. However, no information is available about cancer in pediatric KT recipients in Asian countries.

Methods.
Children aged <20 y who underwent initial KT from 1983 to 2016 were analyzed. We compared the cancer incidence with that in the general Japanese population using standardized incidence ratio and examined posttransplant cancer risk using Cox proportional hazards models.

Results.
A total of 356 children (median age, 11.7 y; interquartile range, 5.0–17.6) received KT with a follow-up period of 4466 person-years. The median age of cancer onset was 18.5 y (interquartile range, 8.0–32.3), and 13 cancers occurred in 12 patients (3.4%). Two patients died from cancer. The most common cancers were posttransplant lymphoproliferative disorders (PTLDs) (38.5%). The median time to PTLD and non-PTLD diagnosis after KT was 0.6 and 16.4 y, respectively. There was no occurrence of skin cancer. The posttransplant cancer incidence was 9.9 times higher than that in the general age-matched population (standardized incidence ratio = 9.9; 95% confidence interval, 4.80-18.39). The cumulative cancer incidence was 5.3% in 20 y after KT, which is lower than that reported in previous studies. We could not identify any risk factors for all cancer after KT in all patients, whereas subgroup analysis in 264 patients with available data of recipient Epstein-Barr virus serological status showed that recipient Epstein-Barr virus-negative serology was an independent risk factor for cancer development.

Conclusions.
The incidence of cancer is higher in Japanese pediatric KT recipients than in the general population. The cumulative incidence of cancer after KT was lower in our population than that previously reported. This may be because there was no skin cancer observed in the Japanese pediatric KT recipients in our study.
The state of telemedicine for persons with Parkinson's disease
Authors: van den Bergh Robin , Bloem Bastiaan R. , Meinders Marjan J. , Evers Luc J.W. 
Published: May 2021

Purpose of review
The COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders.

Recent findings

Teleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients, and provide opportunities for blended and proactive care models. Barriers include technological challenges, limited clinician confidence, and a suboptimal clinician-patient relationship. Telemonitoring using wearable sensors and smartphone-based apps can support clinical decision-making, but we lack large-scale randomized controlled trials to prove effectiveness on clinical outcomes. Increasingly many trials are now incorporating telemonitoring as an exploratory outcome, but more work remains needed to demonstrate its clinical meaningfulness. Finding a balance between benefits and burdens for individual patients remains vital. Recent work emphasised the promise of various teletreatment solutions, such as remotely adjustable deep brain stimulation parameters, virtual reality enhanced exercise programs, and telephone-based cognitive behavioural therapy. Personal contact remains essential to ascertain adherence to teletreatment.

Summary
The availability of different telemedicine tools for remote consultation, monitoring, and treatment is increasing. Future research should establish whether telemedicine improves outcomes in routine clinical care, and further underpin its merits both as intervention and outcome in research settings.
New developments in myotonic dystrophies from a multisystemic perspective
Authors: Montagnese Federica , Schoser Benedikt 
Published: May 2021

Purpose of review
The multisystemic involvement of myotonic dystrophies (DMs) intricates disease monitoring, patients’ care and trial design. This update of the multifaceted comorbidities observed in DMs aims to assist neurologists in the complex management of patients and to encourage further studies for still under-investigated aspects of the disease.

Recent findings
We reviewed the most recent studies covering pathogenesis and clinical aspects of extra-muscular involvement in DM1 and DM2. The largest body of evidence regards the cardiac and respiratory features, for which experts’ recommendations have been produced. Gastrointestinal symptoms emerge as one of the most prevalent complaints in DMs. The alteration of insulin signaling pathways, involved in gastrointestinal manifestations, carcinogenesis, muscle function, cognitive and endocrinological aspects, gain further relevance in the light of recent evidence of metformin efficacy in DM1. Still, too few studies are performed on large DM2 cohorts, so that current recommendations mainly rely on data gathered in DM1 that cannot be fully translated to DM2.

Summary
Extra-muscular manifestations greatly contribute to the overall disease burden. A multidisciplinary approach is the key for the management of patients. Consensus-based recommendations for DM1 and DM2 allow high standards of care but further evidence are needed to implement these recommendations.