bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Tracheostomy Change in Neonates: Feasibility and Benefits
Authors: Zebda Denna , Anderson Brady , Huang Zhen , Yuksel Sancak , Roy Soham , Jiang Zi Yang 
Published: February 2021

ObjectivesTo compare outcomes of early and late tracheostomy change in neonatal patients. Early tracheostomy change (ETC) occurred 3 to 4 days after surgery, and late tracheostomy change (LTC) occurred 5 to 7 days after surgery.Study DesignRetrospective cohort.SettingTertiary neonatal/pediatric intensive care unit.MethodsA retrospective review of patients who underwent tracheostomy from 2015 to 2019 was performed for infants <1 year old. Data were recorded regarding age at tracheostomy, days until tracheostomy tube change, postoperative complications, and total number of days on sedative or paralytic drugs.ResultsForty‐six patients were included: 18 (39%) were male, with a mean age of 140 days (SD, 78). Of these, 28 (61%) received ETC. There were no accidental decannulation events in either group. Wound breakdown developed in 4 (14%) patients with ETC versus 5 (28%) with LTC (P =. 3). Use of FlexTend tracheostomy tubes was associated with decreased odds of breakdown (odds ratio, 0.03; P =. 01). Postoperatively, 46 (100%) patients received sedation, and 12 (26%) received paralysis. Mean duration of paralysis was 0.5 days in ETC as opposed to 2.2 days in LTC (P =. 02) on univariate analysis, but the significance was not maintained on multivariate regression (P =. 07).ConclusionsETC appears to be feasible in children less than a year of age. There does not appear to be an increased risk of accidental decannulation events or false passage tracts. Further investigations are warranted to investigate safety and possible impact on wound breakdown.
Developmental Anatomy of the Eustachian Tube: Implications for Balloon Dilation
Authors: Magro Isabelle , Pastel David , Hilton Jace , Miller Mia , Saunders James , Noonan Kathryn 
Published: February 2021

ObjectiveTo describe the developmental anatomy of the eustachian tube (ET) and its relationship to surrounding structures on computed tomography.Study DesignCase series with chart review.SettingA tertiary care hospital.MethodsET anatomy was assessed with reformatted high‐resolution computed tomography scans from 2010 to 2018. Scans (n = 78) were randomly selected from the following age groups: <4, 5 to 7, 8 to 18, and >18 years. The following were measured and compared between groups: ET length, angles, and relationship between its bony cartilaginous junction and the internal carotid artery and between its nasopharyngeal opening and the nasal floor.ResultsThe distance between the bony cartilaginous junction and internal carotid artery decreased with age between the <4‐year‐olds (2.4 ± 0.6 mm) and the 5‐ to 7‐year‐olds (2.0 ± 0.3 mm, P =. 001). The ET length increased among the <4‐year‐olds (32 mm), 5‐ to 7‐year‐olds (36 mm), and 8‐ to 18‐year‐olds (41 mm, P <. 0001). The cartilaginous ET increased among the <4‐year‐olds (20 mm), 5‐ to 7‐year‐olds (25 mm), and 8‐ to 18‐year‐olds (28 mm, P <. 0001). The ET horizontal angle increased among the <4‐year‐olds (17°), 5‐ to 7‐year‐olds (21°), and 8‐ to 18‐year‐olds (23°, P≤. 003), but the ET sagittal angle did not statistically change after 5 years of age. The height difference between the nasopharyngeal opening of the ET and the nasal floor increased among the <4‐year‐olds (4 mm), 5‐ to 7‐year‐olds (7 mm), and 8‐ to 18‐year‐olds (11 mm, P <. 0001).ConclusionThe ET elongates with age, and its angles and relationship to the nasal floor increase. Although some parameters mature faster, more than half of the ET growth occurs by 8 years of age, and adult morphology is achieved by early adolescence.
Caring ahead: Mixed methods development of a questionnaire to measure caregiver preparedness for end-of-life with dementia
Authors: Durepos Pamela , Akhtar-Danesh Noori , Ploeg Jenny , Sussman Tamara , Kaasalainen Sharon 
Published: February 2021

Background: Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach. Aim: To develop a multi-dimensional questionnaire titled ‘Caring Ahead’ to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia. Design: A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019. Setting/population: Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States. Results: Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the ‘Caring Ahead’ preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing. Conclusions: Family caregivers’ feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability.
“Your Child Has Cerebral Palsy”: Parental Understanding and Misconceptions
Authors: Mohanty Mugdha , Beaulieu Forrest , Sampath Spoorthi , Tambunan Dimira , Kataria Shivangi , Rosman N. Paul 
Published: February 2021

Importance: Caregivers of children with cerebral palsy can best help their child if they understand the disorder and the correct terminology. Objective: To assess caregiver understanding of cerebral palsy. Design: This was a cross-sectional study from a large tertiary medical center in Boston, to assess understanding of the term cerebral palsy by primary caregivers of children and adolescents with cerebral palsy. All cases were obtained from hospital electronic medical records. Telephone surveys were conducted. Caregiver understanding of cerebral palsy was assessed by open-ended responses (50%) and success in answering true/false questions about cerebral palsy (50%). Participants: Primary caregivers of children 18 years and younger with cerebral palsy. Results: Thirty-three percent of caregivers denied ever being told that their child had cerebral palsy. Most caregivers identified cerebral palsy as a brain problem (79%), lifelong condition (73%), often caused by a perinatal (60%) or gestational (40%) insult. Fifty-two percent knew that cerebral palsy was nonprogressive. Sixty-two percent of caregivers believed they had a good, very good, or excellent understanding of cerebral palsy, whereas the investigators found 69% of caregivers had a good, very good, or excellent understanding of cerebral palsy (P = .006). Most caregivers rated very good or excellent the setting where cerebral palsy was discussed (58%), the explanations provided (55%), and the amount of time spent (45%), yet using a Pearson correlation coefficient, most important was the time spent ( r = 0.53). Conclusions: Following discussion with their child’s physician, most primary caregivers of children with cerebral palsy have a good, very good, or excellent understanding of cerebral palsy. Most critical to a good understanding of cerebral palsy was the time spent in explaining the diagnosis.
Intrahepatic Cholangiocarcinoma: State of the Art of FGFR Inhibitors
Authors: Wu Tianyu , Jiang Xiaoqing , Zhang Xin , Wu Bodeng , Xu Bin , Liu Xiaoliu , Zheng Lei , Wang Yu 
Published: February 2021

Objective: Intrahepatic cholangiocarcinoma (iCCA), the second most common type of primary liver tumor, has an increasing incidence in the past few decades. iCCA is highly malignant, with a 5-year survival rate of approximately 5-10%. Surgical resection is usually the prescribed treatment for patients with early stage iCCA; however, patients are usually in an advanced stage iCCA upon diagnosis. Currently, targeted therapy combined with chemotherapy and other comprehensive treatment measures have been mainly adopted as palliative treatment measures. As a common candidate of targeted therapy, FGFR inhibitors have demonstrated their unique advantages in clinical trials. At present, the prospect of FGFR targeted therapy is encouraging. The landscape of FGFR inhibitors in iCCA is needed to be showed urgently. Methods: We searched relative reports of clinical trials on FGFR inhibitors in PubMed as well as Web of Science. We also concluded other available clinical trials of FGFR inhibitors (Data were collected from clinicaltrials.gov ). Results: Several relatively effective targeted drugs are being used in clinical trials. Some preliminary results indicate the outlook of targeted therapy such as BGJ398, TAS120, and HSP90 inhibitors. Conclusions: In summary, FGFR targeted therapy has broad prospects for the treatment of iCCA.
Acute exudative paraneoplastic polymorphous vitelliform maculopathy in a patient with thymoma, myasthenia gravis, and polymyositis
Authors: Yu He , Ma Xinyu , Tong Nianting , Zhou Zhanyu , Zhang Yu 
Published: February 2021

Importance: This is the first reported case of acute exudative paraneoplastic polymorphous vitelliform maculopathy (AEPPVM) in a patient with thymoma, accompanied by myasthenia gravis (MG) and polymyositis. Objective: To examine the pathogenesis of ocular disease in a patient with yolk-like fundus lesions and thymoma, MG, and polymyositis throughout the body based on clinical manifestations, diagnosis, differential diagnosis, and genetic testing to determine the appropriate treatment course. Design, setting, and participants: We describe a 63-year-old woman who presented to our tertiary medical center with a 3-month history of reduced visual acuity in both eyes. Concurrent fundoscopy revealed a 2.0 × 1.7-mm, unifocal, yellow, round vitelliform lesion in the macular region, surrounded by multifocal, shallow, yellow-white pockets of subretinal fluid. The patient’s medical history included thymoma with thymectomy treatment, combined with pericardiectomy and postoperative radiotherapy (20 years prior), followed by a diagnosis of MG with suspect thymic association (15 years prior). Three years prior, the patient had been diagnosed with polymyositis related to paraneoplastic syndrome; 1 year prior, she had been examined for pleural thickening due to suspected metastatic tumor. Results: On her most recent follow-up visit at 3 months after initial diagnosis, the patient was stable with no clinically significant progression in ocular or systemic conditions.
Endothelial nitric oxide synthase (eNOS) mediates neointimal thickness in arteriovenous fistulae with different anastomotic angles in rats
Authors: Bai Hualong , Wei Shunbo , Xie Boao , Wang Zhiwei , Li Mingxing , Qiao Zhentao , Sun Peng , Wang Wang 
Published: February 2021

Background: It is known that the anastomotic angle can influence neointimal hyperplasia and patency in arteriovenous fistulae (AVF). Endothelial nitric oxide synthase (eNOS) is released from the vascular endothelium and can inhibit neointimal hyperplasia. Therefore, here, we aimed to test the hypothesis that the manipulation of eNOS expression could influence neointimal thickness in a rat AVF model with different anastomosis angles. Methods: Rat carotid artery (inflow, CA) and jugular vein (outflow, JV) AVF were created with acute, blunt, or end-to-end (ETE) anastomosis angles. Aspirin was used to increase eNOS expression in the acute angle group, while N(G)-nitro-L-arginine methyl ester (L-name) was used to decrease eNOS expression in the obtuse angle group. The rats were sacrificed on day 21, and tissues were harvested and analyzed histologically and with immunostaining. Results: A larger anastomosis diameter ( p < 0.016) and smaller neointimal area ( p < 0.01) were observed in the obtuse and end-to-end (ETE) groups compared to in the acute group. In the acute angle group, there were more proliferating cell nuclear antigen (PCNA) and α-actin dual-positive cells ( p < 0.0001) and fewer phospho (p)-eNOS-positive endothelial cells ( p < 0.0001) in the neointima than in the obtuse and ETE angle groups. On treating the acute angle and blunt angle groups with aspirin and L-name, respectively, no significant differences in the neointima/lumen rate were observed ( p = 0.6526) between the groups; however, there were fewer von Willebrand factor (vWF) and p-eNOS dual-positive cells in the obtuse angle group treated with L-name ( p = 0.0045). Conclusions: We demonstrated that eNOS plays an important role in neointimal hyperplasia in AVF with different anastomosis angles; further, eNOS could potentially be used as a therapeutic target in patients with AVF in the future.
Peripheral intravenous cannulae in neonates: To splint or not?
Authors: Serane V Tiroumourougane , Rajasekaran Rathnapratheep , Vijayadevagaran Vijayasankar , Kothendaraman Bhuvaneswari 
Published: February 2021

Objective: To determine the effect of splint on the dwell time of peripheral intravenous cannula in neonates. Setting: Level II Neonatal Intensive Care Unit (NICU). Patients: Consecutive babies with presumed need of peripheral intravenous access of at least 24 h. Methods: Enrolled subjects were randomized to “splint” or “splint-less” group. Insertion site was cleaned with Isopropyl alcohol and 2% Chlorhexidine and peripheral intravenous catheter was inserted under strict asepsis. Insertion sites was examined regularly for occurrence of complication which necessitated removal of the catheter. Results: Out of 159 neonates, 80 were allotted to splint group and the rest to splint-less group. Mean dwell time of intravenous line in splint group was 27.68 ± 13.03 h which was significantly less than in splint-less group (32.87 ± 15.79 h, mean difference: 5.11 h, p value: 0.03). Subgroup analysis in preterms showed mean dwell time of 28.54 ± 14.86 h in splint group which was less than that of splint-less group (35.10 ± 16.24 h) ( p value: 0.03). No such difference was noted in the term neonates. Subgroup analysis for catheters put across joints does not show difference in mean dwell times between splint and splint-less groups. Multivariate regression analysis did not identify any variable which independently affected the outcome. Conclusion: Use of splint does not prolong the dwell time of the catheter and is probably harmful in some neonates.
Vape Shop Proliferation and Noncompliance in Pennsylvania: A Pre- and Post-tax Analysis
Authors: Colditz Jason B , Tulikangas Megan C , Sidani Jaime E , Dodson Zan M , Woods Michelle S , James A Everette , Primack Brian A 
Published: February 2021

Background: The growing use of electronic nicotine delivery systems (ENDS) among adolescents is a public health concern. Taxation of these products is a viable approach to reduce ENDS use, particularly among adolescents. Opponents of taxation posit that it puts specialty retailers (ie, vape shops) out of business, thereby reducing availability of ENDS for adult smokers seeking harm reduction. Pennsylvania enacted substantial ENDS taxes in October 2016. This study sought to examine (1) the prevalence of Pennsylvania vape shops before and after ENDS taxes were enacted and (2) ENDS retail licensing compliance among vape shops. Methods: We employed standardized searches for vape shops in Pennsylvania on the Yelp business-listing platform a month prior to and for 18 consecutive months following the imposition of ENDS taxes. We then compared listings to a public database of ENDS-related retail licenses to determine compliance status. Results: The number of listed vape shops increased in a linear fashion by a magnitude of 23%. In addition, when we compared a final listing of retailers to data from the state tax authority, we found roughly a quarter (22%-29%) of vape shops to be noncompliant with maintaining a valid ENDS retail license. Conclusions: Overall, ENDS taxation in Pennsylvania has not appeared to reduce prevalence of vape shops as anticipated. However, stricter enforcement of the tax law is necessary to ensure compliance among retailers. These findings have implications for implementation and enforcement of ENDS tax policy nationwide, including states that currently lack such policies.
Do animated triangles reveal a marked difficulty among autistic people with reading minds?
Authors: Wilson Alexander C 
Published: February 2021

This meta-analysis tested whether autistic people show a marked, isolated difficulty with mentalising when assessed using the Frith-Happé Animations, an advanced test of mentalising (or ‘theory of mind’). Effect sizes were aggregated in multivariate meta-analysis from 33 papers reporting data for over 3000 autistic and non-autistic people. Relative to non-autistic individuals, autistic people underperformed, with a small effect size on the non-mentalising control conditions and a medium effect size on the mentalising condition. This indicates that studies have reliably found mentalising to be an area of challenge for autistic people, although the group differences were not large. It remains to be seen how important mentalising difficulties are in accounting for the social difficulties diagnostic of autism. As autistic people underperformed on the control conditions as well as the mentalising condition, it is likely that group differences on the test are partly due to domain-general information processing differences. Finally, there was evidence of publication bias, suggesting that true effects on the Frith-Happé Animations may be somewhat smaller than reported in the literature. Lay abstract Autistic people are thought to have difficulty with mentalising (our drive to track and understand the minds of other people). Mentalising is often measured by the Frith-Happé Animations task, where individuals need to interpret the interactions of abstract shapes. This review article collated results from over 3000 people to assess how autistic people performed on the task. Analysis showed that autistic people tended to underperform compared to non-autistic people on the task, although the scale of the difference was moderate rather than large. Also, autistic people showed some difficulty with the non-mentalising as well as mentalising aspects of the task. These results raise questions about the scale and specificity of mentalising difficulties in autism. It also remains unclear how well mentalising difficulties account for the social challenges diagnostic of autism.
Optimizing outcomes for patients with metastatic prostate cancer: insights from South East Asia Expert Panel
Authors: Schutz Fabio Augusto Barros , Sirachainan Ekaphop , Kuppusamy Shanggar , Hoa Nguyen Thi Thai , Dejthevaporn Thitiya , Bahadzor Badrulhisham , Toan Vu Quang , Chansriwong Phichai , Alip Adlinda , Hue Nguyen Thi Minh , Parinyanitikul Napa , Tan Ai Lian , Hoang Vu Dinh Khanh , Tienchaiananda Piyawan , Chinchapattanam Sai Naga Deepak , Garg Amit 
Published: February 2021

Aims: Clinical decision making is challenging in men with metastatic prostate cancer (mPC), as heterogeneity in treatment options and patient characteristics have resulted in multiple scenarios with little or no evidence. The South East Asia Expert Panel 2019 addressed some of these challenges. Methods: Based on evidence in the literature and expert interviews, 19 statements were formulated for key challenges in the treatment of men with castration-sensitive and -resistant prostate cancer in clinical practice. A modified Delphi process was used to reach consensus among experts in the panel and develop clinical practice recommendations. Results: The majority of the panel preferred a risk-based stratification and recommended abiraterone or enzalutamide as first-line therapy for symptomatic chemotherapy naïve patients. Abiraterone is preferred over enzalutamide as a first-line treatment in these patients. However, the panel did not support the use of abiraterone in high risk lymph-node positive only (N+M0) or in non-metastatic (N0M0) patients. In select patients, low dose abiraterone with food may be used to optimize clinical outcomes. Androgen receptor gene splice variant status may be a useful guide to therapy. In addition, generic versions of approved therapies may improve access to treatment to a broader patient population. The choice of treatment, as well as sequencing are guided by both patient and disease characteristics, preferences, drug access, cost, and compliance. Conclusion: Expert recommendations are key to guidance for the optimal management of mPC. Appropriate choice, timing, and sequence of treatment options can help to tailor therapy to maximize outcomes in men with mPC.
Head Impact Exposures Among Youth Tackle and Flag American Football Athletes
Authors: Waltzman Dana , Sarmiento Kelly , Devine Owen , Zhang Xinjian , DePadilla Lara , Kresnow Marcie-jo , Borradaile Kelley , Hurwitz Andrew , Jones David , Goyal Ravi , Breiding Matthew J. 
Published: February 2021

Background: Promoted as a safer alternative to tackle football, there has been an increase in flag football participation in recent years. However, examinations of head impact exposure in flag football as compared with tackle football are currently limited. Hypothesis: Tackle football athletes will have a greater number and magnitude of head impacts compared with flag football athletes. Study Design: Cohort study. Level of Evidence: Level 4. Methods: Using mouthguard sensors, this observational, prospective cohort study captured data on the number and magnitude of head impacts among 524 male tackle and flag football athletes (6-14 years old) over the course of a single football season. Estimates of interest based on regression models used Bayesian methods to estimate differences between tackle and flag athletes. Results: There were 186,239 head impacts recorded during the study. Tackle football athletes sustained 14.67 (95% CI 9.75-21.95) times more head impacts during an athletic exposure (game or practice) compared with flag football athletes. Magnitude of impact for the 50th and 95th percentile was 18.15 g (17.95-18.34) and 52.55 g (51.06-54.09) for a tackle football athlete and 16.84 g (15.57-18.21) and 33.51 g (28.23-39.08) for a flag football athlete, respectively. A tackle football athlete sustained 23.00 (13.59-39.55) times more high-magnitude impacts (≥40 g) per athletic exposure compared with a flag football athlete. Conclusion: This study demonstrates that youth athletes who play tackle football are more likely to experience a greater number of head impacts and are at a markedly increased risk for high-magnitude impacts compared with flag football athletes. Clinical Relevance: These results suggest that flag football has fewer head impact exposures, which potentially minimizes concussion risk, making it a safer alternative for 6- to 14-year-old youth football athletes.