bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Limbal Optical Coherence Tomography Angiography Outcomes in Patients With Overnight Contact Lens Wear
Authors: Bostanci Ceran Basak , Ozates Serdar , Arifoglu Hasan Basri , Tasindi Emrullah 
Published: July 2021

Objectives:
To evaluate the perilimbal vasculature of patients who wear contact lenses (CLs) overnight with optical coherence tomography angiography (OCTA) and compare the results with healthy population.

Methods:
Forty-two patients were included in this observational study. The OCTA imaging was performed in the temporal quadrant of the perilimbal region using a swept-source optical coherence tomography system (Triton DRI-OCT; Topcon Corporation, Tokyo, Japan). The assessments were made in two depths: starting from the conjunctival epithelium to 200 μm scleral depth and the scleral depth between 200 and 1,000 μm. The vessel density, vessel length density, vessel diameter index, and fractal dimension were the main outcomes and compared between overnight CL users and healthy population.

Results:
Twenty-two patients who have been using CLs overnight for at least 3 months and 20 healthy individuals were included in the study. The vessel density at the superficial layer was significantly higher in the CL group compared with the control group (P<0.001). Vessel diameter index, vessel length density, and fractal dimension at the superficial layer did not differ between the groups (P>0.05 for all). There was no difference in the vessel density, vessel diameter index, vessel length density, and fractal dimension in the deep layer between the groups (P>0.05 for all).

Conclusions:
Patients who use CL overnight exhibit increased vessel density in the superficial layers of the perilimbal region, which may suggest new vessel formation in the conjunctiva. Anterior segment OCTA may be useful to evaluate the initial changes in limbal vasculature in CL users.
Quality-of-Life Improvement After Scleral Lens Fitting in Patients With Keratoconus
Authors: Baudin Florian , Chemaly Alicia , Arnould Louis , Barrénéchea Elsa , Lestable Lolita , Bron Alain M. , Creuzot-Garcher Catherine 
Published: July 2021

Objectives:
To assess the quality-of-life improvement after scleral lens fitting in patients with keratoconus.

Methods:
We conducted a prospective observational study of all consecutive patients with keratoconus starting scleral lens fitting in 2019, from January 2 to December 27, at the Dijon University Hospital, France. Quality of life was assessed before and after wearing scleral lenses for 3 months through the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25) questionnaire. We investigated factors potentially influencing quality of life: final visual acuity, keratoconus stage, and maximum keratometry reading.

Results:
In total, 41 eyes of 24 patients were successfully fitted with scleral lenses, 92.9% were 18 mm in diameter and 7.1% were 17 mm. The visual acuity improved by −0.4±0.3 logarithm of the minimum angle of resolution (P<0.001) after scleral lens fitting. Visual gain increased with keratometry and keratoconus severity (P<0.001; P<0.01). The NEI-VFQ 25 score increased by 19.5±19.1 points on average (P<0.001). No association was found between the factors under study and improvement in quality of life.

Conclusion:
Our study confirms the functional improvement in patients with keratoconus fitted with scleral lenses, especially in patients with more advanced disease. Moreover, it suggests a major role of these lenses in improving quality of life, independently of the severity of the disease and the visual gain.
Diagnostic accuracy of the Pain (P), Enjoyment (E), and General activity (G) scale, a three-item questionnaire, for grading the impact of orofacial pain-related dysfunction
Authors: Roldán-Majewski Carolina , Broedel Elias , von Korff Michael , Rammelsberg Peter , Schindler Hans Jürgen , Giannakopoulos Nikolaos Nikitas 
Published: July 2021

Abstract
Purpose of this study was to examine the discriminative properties of the 3-item Pain (P), Enjoyment (E), and General activity (G) (PEG) questionnaire for grading impact of nondental orofacial pain. Two hundred eighty-six consecutive patients with orofacial pain of nondental origin filled out the PEG questionnaire and Graded Chronic Pain Scale (GCPS, version 2). Correlation between the PEG and GCPS scores, internal consistency of the PEG, and differences between groups were examined statistically (level of significance: P ≤ 0.05). The mean (±SD) age of the 213 patients (158 female) who were included in the analysis was 43.1 (±16.7) years. Of the sample, 48.8% (n = 104) had some degree of orofacial pain-related disability (mean overall characteristic pain intensity: 51.2 ± 23.2, average overall PEG score: 4.3 ± 2.7, and average PHQ-9 score: 8.2 ± 6.5). No significant differences were found between the sexes for any score. The number of disability points (GCPS) and overall PEG score showed a strong and positive correlation (Spearman ρ = 0.77, P < 0.001). The internal consistency of the PEG questionnaire was high (Cronbach α = 0.86). Assuming 3 different levels of orofacial pain-related disability (mild, moderate, and severe), we obtained overall accuracy of 69.01%, with high specificity for mild and severe cases. The 3 PEG groups (mild, moderate, or severe) differed from each other significantly regarding their clinical grading according to the GCPS (Kruskal–Wallis, P < 0.001). Analysis of the receiver operating characteristic curve showed that a single cutoff value of 3.8 points in the PEG score yields adequate validity (sensitivity = 0.91 and specificity = 0.78). The proposed 2 cutoff points (upper = 7 and lower = 4) yield low sensitivity for the upper threshold. The 3-item PEG questionnaire is suitable for grading impact of nondental orofacial pain.
Treatment of Pulmonary Carcinoid Tumors With Bronchoscopic Cryotherapy
Authors: Perikleous Periklis , Mayer Nora , Finch Jonathan , Beddow Emma , Anikin Vladimir , Asadi Nizar 
Published: July 2021

Background:
Pulmonary carcinoids are rare tumors originating from neuroendocrine cells in the lungs. Because of their potentially infiltrative nature, surgical resection remains the treatment of choice. However, not all patients with technically resectable disease will be able to undergo surgery, primarily because of poor lung function or medical co-morbidities. Centrally located, intraluminal tumors have been reported to be amenable to bronchoscopic treatment. We specifically examined the role of cryotherapy in the treatment of bronchial carcinoid tumors.

Methods:
Sixty-three patients (52.38% female) who underwent a combined total of 243 cryotherapy procedures for treatment of bronchial carcinoid between 1992 and 2020 in our institution were included in the study. Following discussion in multidisciplinary meetings, patients were considered for first-line cryotherapy when lung resection was deemed not possible or when they had rejected surgery.

Results:
Cryotherapy resulted in complete remission in 21 (33.33%) patients with maximum tumor diameter less than 20 mm (mean: 11.08 mm, 95% confidence interval: 8.76-13.40), and allowed 22 (34.92%) patients with larger lesions (mean: 24.04 mm, 95% confidence interval: 18.78-29.30) to proceed with parenchymal sparing resections. Marked symptomatic relief (P<0.001) was reported by 58 (92.06%) patients. The median follow-up was 33 months (range: 0 to 243 mo). One (1.59%) patient was diagnosed with recurrence in a contralateral lobe 3 years after surgery and was treated with radiofrequency ablation.

Conclusions:
In the absence of a definitive randomized controlled trial comparing bronchoscopic treatment with surgical resection, we provide evidence on the safety and efficacy of cryotherapy and encourage wider adoption of this inexpensive and minimally invasive technique for treatment of bronchial carcinoids.
Pediatric sarcoidosis with diagnostic and therapeutical insights
Authors: Sergi Consolato M. 
Published: July 2021

Purpose of review
Sarcoidosis is a chronic granulomatous disorder involving multiple systems and organs of undefined etiology. Although most of the morbidity relies upon lung disease, the function of several systems and organs can be affected. The natural history of lung disease consists of pulmonary involvement. An exaggerated and abnormal inflammatory response accompanies this aspect. There are noncaseating confluent epithelioid granulomas and, potentially, a progressive airway obstruction ab externo. As the disease is multisystemic, there is an increased likelihood of complications that may be serious and even fatal.

Recent findings
The American Thoracic Society (ATS) Core Curriculum updates clinicians annually in adult and pediatric lung disease, critical medical care, and sleep medicine. In late 2020, the ATS targeted sarcoidosis. Also, in 2019, the French Sarcoidosis Group thoroughly revised the literature on pediatric sarcoidosis. Currently, staging is based on chest radiograph findings, and the most commonly used system is the Scadding classification, which has been applied to both children and adults alike. Treatment may consist of oral or pulsed intravenous corticosteroids, but it should be implemented in union with a rheumatologist, as there are no randomized controlled studies in children.

Summary
Sarcoidosis is rare in childhood. Diagnosis is complex and relies on multiple diagnostic modalities with both staging and therapy progressively mirroring the sarcoidosis, which affects adults. In the majority of patients, spontaneous resolution will occur and observation is justified above treatment. Nevertheless, in case treatment is needed corticosteroids remain the mainstay of the treatment in some pediatric patients. Relapses are not uncommon and a long-term follow-up is essential.
Vitamin C for Sepsis and Septic Shock
Authors: Ammar Mahmoud A. , Ammar Abdalla A. , Condeni Melanie S. , Bell Carolyn M. 
Published: July 2021

Background:
Sepsis remains a leading cause of death in the critically ill. The combination of thiamine, vitamin C, and hydrocortisone has recently emerged as a potential adjunctive therapy and supportive care for patients with sepsis and septic shock.

Areas of Uncertainty:
Several randomized and observational controlled trials evaluated the role of vitamin C in sepsis and septic shock. However, there are variabilities in the findings of these studies that led to a substantial global debate on incorporating vitamin C therapy in clinical practice.

Data Sources:
A PubMed and Embase English language literature search through April 2021 was performed using the following terms: ascorbic acid, vitamin C, corticosteroid, hydrocortisone, thiamine, HAT, sepsis, and shock. Citations, including controlled trials, observational studies, review articles, guidelines, and consensus statements, were reviewed. The risk of bias for each clinical study was systematically evaluated. Relevant clinical data focusing on efficacy, safety, and special considerations regarding the use of vitamin C with and without thiamine and hydrocortisone in sepsis and septic shock were narratively summarized.

Results:
The most commonly used vitamin C dosing in sepsis and septic shock is 1.5 g every 6 hours with and without thiamine and hydrocortisone. Current literature is limited because of heterogeneity in vitamin C regimen used, initiation time, and duration of treatment. This limitation led to variability in outcomes evaluated. Vitamin C decreases proinflammatory mediators and slows the progression of endothelial injury in severe sepsis. There is an inconsistency between randomized controlled trials and observational controlled trials regarding mortality, resolution in organ failure, hospital and intensive care unit length of stay findings with the use of vitamin C in septic shock. Vitamin C seems to be safe in comparison with placebo.

Conclusions:
Future studies with consistent end points, initiation time with an emphasis on early initiation, and standard vitamin C dosing regimen are needed to determine the overall benefit of vitamin C in sepsis.
Secondary stroke prevention in patients with patent foramen ovale
Authors: Rhoades Ruben , Tzeng Diana , Ruggiero Nicholas 
Published: July 2021

Purpose of review
Although a patent foramen ovale (PFO) is an established risk factor for cryptogenic ischemic stroke, strategies for secondary prevention remain controversial. Increasing evidence over the past decade from well designed clinical trials supports transcatheter PFO closure for selected patients whose stroke was likely attributable to the PFO. However, patient selection using imaging findings, clinical scoring systems, and in some cases, thrombophilia testing, is crucial for determining patients most likely to benefit from closure, anticoagulation, or antiplatelet therapy.

Recent findings
Recent studies have found that patients with a high Risk of Paradoxical Embolism (RoPE) score and those with a thrombophilia benefit more from closure than medical therapy (including antiplatelet or anticoagulant therapy) alone. Meta-analyses have demonstrated an increased short-term risk of atrial fibrillation in closure patients, and that residual shunt after closure predicts stroke recurrence. Last, recent data have been inconclusive as to whether patients receiving medical therapy only benefit more from anticoagulation or antiplatelet therapy, so this remains an area of controversy.

Summary
Transcatheter PFO closure is an evidence-based, guideline-supported therapy for secondary stroke prevention in patients with a PFO and cryptogenic stroke. However, proper patient selection is critical to achieve benefit, and recent studies have helped clarify those patients most likely to benefit from closure.
Change in Incidence and Epidemiology of Inflammatory Bowel Disease in 2‐ to 9‐Year‐olds in Southwest England
Authors: Fernandes Sofia , Spray Christine H. , Whitmarsh Alex , Sandhu Bhupinder K. , Wiskin Anthony E. 
Published: July 2021

ABSTRACTObjectives:The aim of the study was to characterize epidemiology, phenotype, and clinical outcome of Inflammatory Bowel Disease (IBD) diagnosed ages 2 to 9 years, and compare age groups 2 to 5 and 6 to 9 years.Methods:A population‐based retrospective cohort study of all <10‐year‐olds diagnosed with IBD between 2004 and 2017 in Southwest England was performed. Patients were divided into age groups at diagnosis. Demographics, investigations, and phenotype at diagnosis were collected. Treatments and outcomes were analysed at 1, 2, 5, and 10 years follow‐up. Poisson regression was used for IBD incidence rate ratios; Wald test for variation by age group; parametric/nonparametric tests for phenotype.Results:There were 666 new paediatric IBD (pIBD) patients ages ⩽16 years, from which 136 were 2 to 9 (2–5 years: 32; 6–9 years: 104). Incidence of pIBD increased from 4 to 6 cases per 100,000 whereas in A1a group was stable around 2 cases per 100,000. Crohn Disease (CD) children were majority boys, 2‐ to 5‐year‐olds were more likely to have ileal sparing than 6 to 9‐year group but had similar rates of surgery and anti‐TNF therapy. Two‐ to 5‐year‐olds with ulcerative colitis were more likely to have surgery but rates for anti‐TNF therapy were similar. Sixteen percent of 2‐ to 5‐year‐olds and 10% of 6‐ to 9‐year‐olds had IBD‐unclassified. No significant differences in symptoms or time to diagnosis were found.Conclusions:Twenty percent of pIBD in Southwest England are 2 to 9 years old. pIBD incidence has increased but is stable in that group. In terms of phenotypic differences, ileal sparing in CD and pancolitis and surgery in UC, are more likely in 2‐ to 5‐year‐olds.
Understanding and Responding to the Impact of COVID‐19 on Paediatric Gastroenterology Training & Practice of Young ESPGHAN Members
Authors: Niţă Andreia F. , Tsita Despina , Grima Anne‐Marie , Cameron Fiona , Rock Nathalie M. , Tapsas Dimitrios 
Published: July 2021

ABSTRACTObjectives:Limited data exist about the impact of the coronavirus disease 2019 (COVID‐19) pandemic on the training and clinical practice of young doctors. The aim of this study was to evaluate the impact on paediatric gastroenterologists in training posts during the first wave of the European COVID pandemic.Methods:All Young members of European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) (YE) members received a multiple‐choice questionnaire concerning the impact (if any) on their clinical practice, mental health, quality of care provided and fellowship/training experience. The survey was conducted between May 22, 2020 and June 10, 2020.Results:Of the 144 responders (40% of YE members), 85% (n = 123) reported an impact of COVID‐19. Ninety‐six percent reported an impact on their clinical practice, including more virtual patient consultation (n = 91), underutilization of ambulatory care (n = 113) and reduced or lack of planned admissions (n = 75). Endoscopy restrictions to semi‐urgent or emergency cases were reported in 82 and lack of medical equipment/drugs (n = 47) were also reported.Reported adverse mental health issues included poor concentration, increased stress levels, an impact on family life in 62% and a reduced quality of care in 45%; this was more often reported in doctors from Southern Europe (54%) than in those from other geographical areas.Seventy‐seven percent reported an impact on the content of their fellowship, including lack of participation in national/international meetings, withdrawn research time and limited mentoring.Conclusions:The impact of the COVID‐19 pandemic has been shown to affect the clinical practice, training and mental health of YE members. Adaptations of training programmes and targeted strategies to improve the clinical practice of young practitioners are needed and proposed in this manuscript.
Insight Into Illness and Psychological Defense Attitudes in People With Chronic Schizophrenia Using Markova's Insight Scale
Authors: Ogawa Yasuhiro , Fukuhara Keita , Tanaka Hiroyuki , Nagata Yuma , Ishimaru Daiki , Urakawa Mizuki , Nishikawa Takashi 
Published: July 2021

Abstract
Insight into illness is a multidimensional phenomenon, and various assessments are available. We focused on Markova's Insight Scale (IS) and investigated the relationship between insight, psychological defenses, and neurocognition in 38 patients with schizophrenia. Results showed that insight was significantly correlated with an immature defense style. Moreover, IS was significantly predicted by immature defense style after adjusting for clinical variables. Although insight is often assumed to be multidetermined with potential contributions from factors such as cognitive function and psychological defensive mechanisms, our results indicated that better insight assessed with the IS is more likely to reflect immature defenses. This may also be reflected in our result that a higher insight score correlated with earlier onset of illness. The insight score may reflect the immature psychological defensive attitudes of schizophrenia and may lead such patients to wish to comply with the views of clinicians.
Meeting Undergraduate Nursing Students' Clinical Needs
Authors: Leighton Kim , Kardong-Edgren Suzan , Schneidereith Tonya , Foisy-Doll Colette , Wuestney Katherine A. 
Published: July 2021

Background
Nurse educators expanded replacement of traditional clinical practice and face-to-face simulation experiences with screen-based simulation (SBS) during the COVID-19 (coronavirus disease 2019) pandemic.

Purpose
The purpose of this research was to understand the student experience when learning in 3 types of clinical education environments.

Methods
This quantitative descriptive survey study used the Clinical Learning Environment Comparison Survey 2.0 (CLECS 2.0) to compare prelicensure nursing students' perceptions of learning in 3 clinical learning environments.

Results
The CLECS 2.0 was completed by 113 participants from 3 countries. Most scores were highest for the traditional clinical practice environment, and all were lowest for the SBS environment.

Conclusions
The findings are concerning as discussions about whether SBS can replace traditional clinical practice hours unfolds. The findings support the need for concentrated efforts to improve specific areas of the SBS experience.
A future with no MVC patients? Impact of autonomous vehicles on orthopaedic trauma may be slow and steady
Authors: Childs Benjamin R. , Simson Joshua E. , Wells Matthew E. , Macias Reuben A. , Blair James A. 
Published: July 2021

Abstract

Introduction:
Orthopaedic trauma results in significant patient morbidity. Autonomous vehicle (AV) companies have invested over $100 billion in product development. Successful AVs are projected to reduce motor vehicle collision (MVC)-related injuries by 94%. The purpose of this study was to estimate the timing and magnitude of AV impact on orthopaedic trauma volume.

Methods:
ICD 9 codes consistent with acetabulum (OTA 62), pelvis (OTA 61), hip (OTA 31), femur (OTA 32–33), tibia (OTA 41–43), ankle (OTA 44), and calcaneus (OTA 82) fractures and the proportion of cases caused by MVC were taken from the National Trauma Databank (NTDB) 2009–2016. Regression was performed on estimates of market penetration for autonomous vehicles taken from the literature.

Results:
For NTDB years 2009 to 2016, 300,233 of 987,610 fractures of interest were the result of MVC (30.4%). However, the percentage of MVC mechanism of injury ranged from 9% to 53% depending on fracture type. Regression of estimates of AV market penetration predicted an increase of 2.2% market share per year. In the next 15 years we project 22% market penetration resulting in a 6% reduction in orthopaedic lower extremity trauma volume.

Conclusion:
Adoption of AVs will result in a projected 8% reduction in MVC-related orthopaedic trauma-related injuries over a 15-year period. Although this represents a significant reduction in morbidity, the advent of AVs will not eliminate the need for robust orthopaedic trauma programs. The gradual rate of injury reduction will allow hospitals to adapt and reallocate resources accordingly.
Evaluation of post-production handling practices of monoclonal antibodies throughout the world
Authors: Fayek Rana , Soleyman Mostafa , Jiskoot Wim , Crul Mirjam 
Published: July 2021

Abstract

Introduction:
This survey aimed to create a snapshot of the post-production handling of monoclonal antibodies in daily practice in health-care facilities in several parts of the world.

Methods:
A worldwide web-based survey was distributed among pharmacists between November and December 2020.
The questions were categorized in sections related to storage conditions, reconstitution practices including the use of medical devices, administration practices, transportation, visual examination and shelf-life of mAbs, education of health-care professionals, and patient's home-administration.

Results:
A total of 247 responders from 37 countries around the world participated in the survey. Hospital pharmacists were the largest group of respondents (92%). Most of the respondents (92%) reported that they store the mAbs at 2 to 8°C and 71% protect the prepared ready-to-administer mAbs from light by secondary packaging. The participants used spikes (38%), closed system transfer devices (CSTDs) (12%), and needles (22%) or a combination of these (28%) as a medical device, and 89% perform the reconstitution practices manually, versus 4% by semi-automatic pump system, 1% by robot, and 5% by a combination of these reconstitution methods. The respondents reported that in their institution, after compounding mAbs are transported via a logistic employee on foot at ambient temperature (59%) or in a cool-box (20%), or via the tube system (7%). More than half (64%) do not have written guidelines for transportation, but 86% perform a visual examination for particles of prepared mAbs before administration. Furthermore, 52% of the responders answered that nurses as well as pharmacists and pharmacy assistants receive staff training on the potential risks of mAb handling.

Conclusion:
There is a high level of variability in daily practices of mAb handling in pharmacies worldwide.