bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Radiation Protection Methods for Assistant Staff during CT Imaging in High-energy Trauma: Lens Dosimetry with a Phantom Study
Authors: Ota Joji , Yokota Hajime , Kawasaki Tatsuya , Taoka Junichi , Kato Hideyuki , Chida Koichi , Masuda Yoshitada , Uno Takashi 
Published: February 2021

Abstract
Staff are exposed to radiation in the scanning room when assisting with CT scans of patients requiring ventilatory support during procedures. We measured lens doses using a phantom during a high-energy trauma protocol. Dosimetry showed that the unprotected lens received 2.02 mGy on the right and 1.91 mGy on the left, which are not negligible doses. Respective exposures to the right and left lens were 53.6% and 55.1% when wearing 0.07 mm Pb protective glasses with side covers; 53.7% and 64.2% when wearing 0.7 mm Pb glasses without side covers when facing away from the patient couch; and 92.1% and 91.2% using protective shielding in the gantry. Since the face direction may change during assistance with CT imaging, it is desirable that the protective glasses have a shape with a side cover. The protective shielding had a major radiation reduction effect, although it is expensive to acquire, install, and maintain.
Real-time intraoperative OCT imaging of the vitreolenticular interface during pediatric cataract surgery
Authors: Sillen Hedwig , Van Looveren Jan , Plaeke Philip , Van Os Luc , Tassignon Marie-José 
Published: February 2021

Purpose:
To report on the use of intraoperative optical coherence tomography (OCT) imaging of the vitreolenticular interface (VLI) during pediatric cataract surgery and to determine the incidence of VLI dysgenesis and surgical difficulties.

Setting:
Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.

Design:
Retrospective cohort study.

Methods:
This study included 51 pediatric patients who underwent cataract surgery between April 2016 and December 2018. Video recordings and OCT images of the VLI were analyzed and compared. VLI dysgenesis was considered present when intraoperative OCT images demonstrated partial or total adhesions between the posterior lens capsule and the anterior hyaloid membrane. Video recordings were analyzed to describe surgical difficulties, more specifically: inability to create a calibrated primary posterior continuous curvilinear capsulorhexis (PPCCC), occurrence of vitreous prolapse, need for anterior vitrectomy, and complicated IOL implantation.

Results:
Of the 51 patients included, VLI dysgenesis was demonstrated in 27 patients (52.9%). The incidence of VLI dysgenesis was greater in children with unilateral cataract (72.4%), and children with a posterior capsule plaque (90%). PPCCC was challenging in 20 patients. A defect of the anterior hyaloid membrane was found in 16 patients. Anterior vitrectomy or cutting vitreous strands with scissors was necessary in 10 patients.

Conclusions:
Intraoperative OCT images were an excellent tool to evaluate the VLI and to demonstrate the presence of VLI dysgenesis during pediatric cataract surgery. Performing a calibrated PPCCC was more challenging in the presence of VLI dysgenesis. This can subsequently expose a defect in the anterior hyaloid membrane, which may result in vitreous prolapse.
Surface ablation outcomes in high myopia with different epithelium removal techniques
Authors: D'Oria Francesco , Fernández-Buenaga Roberto , Casanova Laura , García-Corral María José , Vega Alfredo , Alio Jorge L. 
Published: February 2021

Purpose:
To study the outcomes of alcohol-assisted photorefractive keratectomy (PRK) when compared with transepithelial PRK (TransPRK) using 2 software programs, with or without SmartPulse Technology (SmartSurfACE), in high myopia.

Setting:
Vissum Miranza, University Miguel Hernandez, Alicante, Spain.

Design:
Retrospective, consecutive, case series.

Methods:
High myopic eyes undergoing surface ablation were included. The main inclusion criteria were preoperative spherical equivalent (SE) above −5.50 diopters (D) and no other ocular surgeries. Mitomycin-C was used in all the surgeries. The outcomes were analyzed using the 6-month follow-up visit data.

Results:
135 eyes were included. Alcohol-assisted PRK was performed in 65 eyes, transepithelial PRK (TransPRK1) in 32 eyes, and TransPRK2 in 38 eyes. The mean all groups preoperative sphere, cylinder, and SE were −6.00 ± 0.87 D, −1.13 ± 1.03 D, and −6.57 ± 0.69 D, respectively. The mean efficacy index in the alcohol-assisted PRK group was 0.91 ± 0.18 compared with 0.98 ± 0.1 and 0.98 ± 0.12 in the TransPRK1 and TransPRK2, respectively (P = .027). The mean safety index in alcohol-assisted PRK was 0.99 ± 0.05, whereas it was 1 ± 0.06 in the TransPRK1 and 0.99 ± 0.08 in the TransPRK2 (P = .780). A final SE of ± 0.50 D was achieved in 96.9% of eyes in the TransPRK1 group and in 100% eyes in the TransPRK2 group compared with 73.8% in the alcohol-assisted PRK group (P < .001).

Conclusions:
Surface ablation with the Amaris 500 excimer laser with flying spot pattern and mitomycin C use showed adequate refractive outcomes in high myopia correction in the 3 groups. TransPRK with or without SmartPulse Technology achieved statistically significant better outcomes than alcohol-assisted PRK in refractive predictability and efficacy.
Effects of Oral Administration of Alprazolam and Lorazepam as Hypnotics on Cardiovascular Parameters in Hypertensive Patients
Authors: Costa Alfredo , D'Angelo Angela , Ramusino Matteo Cotta , Perini Giulia , Bosone Daniele , Derosa Giuseppe , Fogari Roberto 
Published: February 2021

Abstract

Background
Previous studies have suggested that evening intake of benzodiazepine affects blood pressure (BP) and/or heart rate (HR) in healthy and hypertensive subjects. The aim of this study was to compare the effect of chronic oral administration of alprazolam and lorazepam as hypnotics on ambulatory BP and HR in patients with mild hypertension.

Methods
Consecutive outpatients of both sexes with newly diagnosed, never-treated mild hypertension were randomized, after a 4-week placebo run-in period, to receive alprazolam 0.5 mg plus placebo, lorazepam 1 mg plus placebo, or placebo plus placebo for 2 weeks in 3 crossover periods, each separated by a 1-week placebo wash-out period. At the end of the initial placebo run-in and of each treatment period, 24-hour ambulatory BP and HR monitoring was performed using a noninvasive device.

Results
In the 32 patients, no treatment had any effect on 24-hour and daytime systolic BP (SBP), diastolic BP (DBP), and HR, which remained unchanged. During the nighttime, SBP and DBP values were unaffected by alprazolam, as compared with placebo, whereas DBP was significantly higher after treatment with lorazepam (+3.7%, P < 0.05 vs placebo). Nocturnal HR mean values were significantly increased by lorazepam (+10.1%, P < 0.01 vs placebo), whereas they did not change after alprazolam.

Conclusions
In patients with mild hypertension, oral intake of alprazolam or lorazepam as hypnotics did not affect ambulatory BP or HR values. A slight increase in nighttime DBP was observed with lorazepam, whereas alprazolam showed no effect on nocturnal BP and HR, probably reflecting a stimulating effect of the drug on central α2-receptors.
Effects of Oxytocin on Emotion Recognition in Schizophrenia
Authors: Andari Elissar , Massa Nicholas M. , Fargotstein Molly D. , Taylor Nicholas B. , Halverson David M. , Owens Andrew V. , Currin Danielle L. , Bhattacharya Arpita , Gitman Dmitriy , Cuthbert Bruce C. , Young Larry J. , Duncan Erica J. 
Published: February 2021

Abstract

Background
Schizophrenia (SCZ) is a neurodevelopmental disorder that leads to poor social function. Oxytocin (OXT), a neuropeptide involved in social cognition, is a potential therapeutic agent for alleviating social dysfunction. Therefore, we investigated the effects of intranasal oxytocin (IN-OXT) on emotional processes in experimental interactive social contexts in individuals with SCZ.

Methods
In a male-only parallel randomized placebo-controlled double-blind trial, we investigated the effects of IN-OXT (24 IU) on visual fixation on pictures of faces and emotion recognition in an interactive ball-tossing game that probed processing of social and nonsocial stimuli.

Results
Intranasal oxytocin enhanced the recognition of emotions during an emotion-based ball-tossing game. This improvement was specific to the game that included social cue processing. Intranasal oxytocin did not affect eye gaze duration or gaze dwell time on faces in these patients.

Conclusions
An acute low dose of IN-OXT had a modest effect on social cue processing and was limited to emotion recognition. Higher doses and long-term trials targeting emotional processing in SCZ may lead to improved social function.
Bilateral Vestibulopathy in Neuroborreliosis
Authors: Malara Pasquale , Martellucci Salvatore , Castellucci Andrea , Belvisi Valeria , Del Torso Aleardo 
Published: February 2021

Objective:
To describe a unique case of definite neuroborreliosis presenting with bilateral vestibulopathy (BV) due to simultaneous involvement of both vestibular systems highlighted by a complete assessment for all five vestibular receptors.

Patient:
A 72-year-old woman presented with disabling disequilibrium arisen about 4 weeks earlier and history of erythema migrans developing about 45 days before.

Interventions:
Assessing all five vestibular receptors with the video-head impulse test (vHIT), the suppression head impulse paradigm (SHIMP) and vestibular evoked myogenic potentials (VEMPs), a severe bilateral vestibulopathy was diagnosed. IgG and IgM Borrelia-specific antibodies on patient serum and cerebrospinal fluid analysis confirmed the diagnosis of neuroborreliosis. Following diagnosis, a course of doxycycline was started and the patients received an individualized vestibular rehabilitation program.

Results:
The patient exhibited slowly progressive improvements for disabling symptoms and the improving function of all five vestibular receptors was monitored with vHIT, SHIMP, and VEMPs over time.

Conclusions:
This is the first case report of bilateral vestibulopathy likely caused by neuroborreliosis. Although neurotologic involvement is an uncommon complication in this condition, clinicians should consider a vestibular testing battery when addressed by patient's history and bedside vestibular findings.
Use of Hemoadsorption in Patients With Severe Intoxication Requiring Extracorporeal Cardiopulmonary Support—A Case Series
Authors: Zickler Daniel , Nee Jens , Arnold Tim , Schröder Tim , Slowinski Torsten , Eckardt Kai-Uwe , Körner Roland , Kruse Jan Matthias 
Published: February 2021

Drugs intoxications often lead to severe vasoplegia and cardiogenic shock, and VA-ECMO represents a viable therapy option. However, as cardiopulmonary support is not contributing to the removal of the causal agent from the blood, detoxification by a new hemoadsorption device (CytoSorb) could represent a potential therapeutic tool due to its highly efficient elimination capacity of endogenous but also exogenous hydrophobic substances for which otherwise no effective antidote exist.
In this case series, four anecdotal cases of acute intoxications requiring VA-ECMO support used as extracorporeal cardiopulmonary resuscitation after intoxication-induced out-of-hospital cardiac arrest (OHCA) are presented, who were additionally treated with CytoSorb hemoadsorption in combination with renal replacement therapy. Combined treatment was associated with a considerable decrease in plasma levels of the overdosed drugs. Additionally, the combination of applied techniques was safe, practical, and technically feasible with no adverse or any device-related side effects documented during or after the treatment sessions.
Based on the reported dramatic decline in drug levels during treatment, that fits in the device’s characteristics, we strongly suggest to further investigate the potentially lifesaving role of CytoSorb therapy in patients with acute intoxications requiring multiple organ support techniques.
Esophageal Squamous Papilloma in Children: A Single-center Case Series
Authors: Tou Andrea M. , Al-Nimr Amer O. 
Published: February 2021

ABSTRACT

Objectives:
Esophageal squamous papilloma (ESP) is a rare epithelial lesion most commonly seen in adults, with an unclear etiology and limited pediatric data available. The aim of this study was to provide an estimated prevalence of this lesion in our pediatric population, as well as to identify any demographic, clinical, or pathologic associations—including human papilloma virus (HPV) infection, which has been linked with ESP in adult literature.

Methods:
ESP cases at University Hospitals Rainbow Babies & Children's Hospital were identified by conducting a retrospective search through all esophagogastroduodenoscopies (EGDs) performed in children under 18 years old, from January 1, 2000 to December 31, 2014. Histopathology reports were analyzed including Fluorescence In Situ Hybridization (FISH) for HPV, and a comprehensive chart review was performed for demographic data.

Results:
Of 12,459 children who required an EGD, 10 children were identified with ESP on biopsy, with ages ranging from 2 to 17 years. This provides an estimated prevalence of 0.08% over the entire study period. Seventy percentage of patients underwent endoscopy for abdominal pain, and 40% presented with gastroesophageal reflux. Sixty percentage of lesions were in the proximal esophagus, and 80% of patients had isolated lesions. Notably, none of the lesions tested were positive for HPV on FISH analysis.

Conclusions:
ESP is a rare benign lesion found incidentally in the pediatric population. The prevalence at our institution was 0.08%. All samples tested for HPV via FISH analysis were negative. As a result, regular analysis for HPV may not be necessary in pediatric patients with ESP in the future.
Contracts and Contracting
Authors: Terra Sandra M. , Zimmerling John 
Published: February 2021

Purpose/Objectives:
The underlying guiding principles of case management services and practices of the Case Management Body of Knowledge include the following: “Case managers must possess the education, skills, knowledge, competencies, and experiences needed to effectively render appropriate, safe, and quality services to clients/support systems” and “Case management services are offered according to the clients' benefits as stipulated in their health insurance plans (http://www.cmbodyofknowledge.com/content/case-management-knowledge-2). Fulfilling these principles requires that the case manager engage in negotiating and contract execution.
This article explores the concepts of negotiation and some of the many ways case managers contribute to the contracting process.

Primary Practice Setting:
Acute care hospitals, individual practice, managed care.

Findings and Conclusions:
Case managers can provide valuable information during the contracting process, in many settings. In the managed care arena, case management can help identify the types of services needed by the population the organization serves. The same understanding of data can assist during the payer contracting process in the acute care setting and ensure that the hospital is fairly reimbursed by third party payers. The independent practitioners will, undoubtedly, face the need to negotiate for themselves as well as their clients.

Implications for Case Management:
The case manager, regardless of the setting, benefits from an understanding of the principles and processes associated with negotiation and contracting.
Factors Associated With Repeat Emergency Department Visits in a State-wide Cohort of Pediatric Patients With Mild Traumatic Brain Injury
Authors: Seligman Eva , Aslam Usman , Psoter Kevin J. , Ryan Leticia Manning , Nasr Isam W. 
Published: February 2021

Objective
To describe demographic, injury, and clinical characteristics of pediatric patients treated in the ED for mild traumatic brain injury (mTBI), and to evaluate characteristics associated with mTBI-related return emergency department (ED) visit within 1 month of initial presentation.

Methods
Retrospective cohort study from April 1, 2012, to September 30, 2017, of children 19 years or younger presenting to any Maryland ED for mTBI identified in the Maryland Health Services Cost Review Commission database using ICD-9/10 codes. Demographic, injury, and clinical characteristics of individuals were collected. The primary outcome was mTBI-related return ED visit within 4 weeks. Multiple logistic regression tested the associated of individual demographic, injury, and clinical characteristics with mTBI-related return ED visit.

Results
There were 25,582 individuals who had an ED visit for mTBI, of which 717 (2.8%) returned to the ED within 4 weeks and 468 (1.8%) within 1 week with a mTBI-related diagnosis. In multivariable logistic regression analyses, public insurance (adjusted odds ratio [aOR], 1.44; 95% confidence interval [CI], 1.21–1.72) and female sex (aOR, 1.34; 95% CI, 1.15–1.56) were associated with increased odds of return to the ED within 4 weeks. Age younger than 2 years (aOR, 0.39; 95% CI, 0.21–0.72) was associated with decreased odds of return visit. There was a trend toward decreased odds of return patients receiving computed tomography head imaging (aOR, 0.86; 95% CI, 0.74–1.01).

Conclusions
Although return to the ED for mTBI-related complaints is uncommon, girls, older children, and publicly insured individuals may be at increased risk. Future targeted study may identify areas to improve access to appropriate longitudinal care and justify ED programs to better coordinate follow-up for mTBI.
Quantity and Quality of Physical Medicine and Rehabilitation Clerkships in US Medical Schools
Authors: Benbassat Danny , Cervero Ronald M. , Miller Matthew E. , Hager Nelson , Konopasky Abigail 
Published: February 2021

Objective
The purpose of this study was to address two underreported issues in undergraduate physical medicine and rehabilitation medical education: quantity and quality of physical medicine and rehabilitation clerkships in US medical schools.

Design
A multimethod sequential design was used to evaluate the curricula of US medical schools. Quantity (N = 154) of physical medicine and rehabilitation clerkships was assessed by counting the number of required, selective, and elective clerkships in each medical school. Quality (n = 13) was assessed by conducting a thematic analysis on physical medicine and rehabilitation clerkship curricula to identify learning objectives. These objectives were then compared with learning objectives in a model standard.

Results
Whereas few medical schools required a physical medicine and rehabilitation clerkship, most offered elective rotations in physical medicine and rehabilitation. Most medical schools only included 6 of the 12 model standard learning objectives. Medical schools also included 29 learning objectives not present in the model standard.

Conclusions
Physical medicine and rehabilitation clerkships are not underrepresented but are underemphasized, in undergraduate medical schools. Furthermore, these clerkships use inconsistent learning objectives. Thus, findings suggest the need to draw attention to physical medicine and rehabilitation clerkships by offering them as selectives and to develop a list of standardized learning objectives. This exploratory study developed such a groundbreaking list and invites the physical medicine and rehabilitation community to test it.
Implementation and Maintenance of a Pediatric Severe Burn Guidelines Quality Improvement Project
Authors: Dolan Kristin J. , Flint Jennifer L. , Benton Tara C. , Miller Mikaela , Miller Jenna O. 
Published: February 2021

Introduction:
Critically injured pediatric burn patients require specialized management, yet few verified pediatric burn centers exist in the United States. Many pediatric hospitals have resources to care for severely burned patients but lack standardized care guidelines, which improve outcomes. To improve the morbidity and mortality of severely burned pediatric patients admitted to the pediatric intensive care unit, we created a specialized burn team. We implemented Pediatric Severe Burn Guidelines, focusing on improving fluid resuscitation accuracy and providing timely nutritional support.

Methods:
This investigation is of a 9-year (2010–2019) retrospective preintervention and postintervention study of the effect of the formation of a multidisciplinary burn leadership committee and development and implementation of Pediatric Severe Burn Guidelines. The primary outcome measures are increasing the accuracy of fluid resuscitation and improving the timely administration of nutritional support. The process measure is the percentage of time the electronic health record power plan was used for burn admissions with burn leadership review of the cases. Balancing measures are pediatric intensive care unit and hospital length of stay.

Results:
Preprotocol patients received acceptable fluid resuscitation 25% (5/20) of the time compared to 61.5% (8/13) of the time in postprotocol patients (P = 0.04). In postprotocol patients, there is an improvement in the timely placement of postpyloric feeding tube and initiation of feeds 48 hours after admission.

Conclusions:
Extensive guidelines for standardized care require careful implementation and monitoring of adherence gaps. Creating a specialized burn team and implementing clinical guidelines standardize care leading to improvement in critical patient outcomes.
Posttraumatic Stress Disorder and the Associated Risk of Autoimmune Skin Diseases: A Nationwide Population-Based Cohort Study
Authors: Dai Ying-Xiu , Tai Ying-Hsuan , Chang Yun-Ting , Chen Tzeng-Ji , Chen Mu-Hong 
Published: February 2021

ABSTRACT

Objective
Posttraumatic stress disorder (PTSD) is known as a risk factor for various immune-related disorders; however, the association between PTSD and related autoimmune skin diseases (ASDs) remains unclear. This study aimed to investigate the association of PTSD with the risk of related ASDs.

Methods
Participants were recruited from the National Health Insurance Research Database in Taiwan. We included 9801 patients with PTSD and 39,204 matched controls to assess the risk of developing ASDs. Cox regression model was used for analyses.

Results
After adjusting for confounders, we found an increased risk of ASDs among the patients with PTSD (adjusted hazard ratio [aHR] = 3.00, 95% confidence interval [CI] = 2.21–4.07) compared with that among matched controls. Statistically significant associations were found between PTSD and five individual ASDs, including psoriasis (aHR = 3.81, 95% CI = 1.90–7.67), lichen planus (aHR = 31.63, 95% CI = 4.00–249.91), alopecia areata (aHR = 4.77, 95% CI = 2.47–9.20), autoimmune bullous diseases (aHR = 9.55, 95% CI = 1.98–45.99), and vitiligo (aHR = 16.06, 95% CI = 4.48–57.54).

Conclusions
Patients with PTSD had an increased risk of developing ASDs compared with the matched controls. Further studies are needed for better understanding of the underlying mechanisms.