bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inferior mesenteric plexus block under computed tomography guidance
Authors: Park Jun-Mo , Hwang Seong-Min 
Published: May 2021

Abstract

Rationale:
Inferior mesenteric plexus block is indicated for left-sided lower abdominal pain. However, in patients with terminal cancer, severe abdominal pain can prevent the patient from maintaining the necessary posture during the procedure, and considerable anatomic deformation owing to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity can make the procedure difficult. In these cases, performing the procedures under computed tomography (CT) guidance can ensure greater safety and accuracy.

Patient concerns:
A 63-year-old man was referred for severe left-sided lower abdominal pain. He was unable to lie prone owing to severe lower abdominal pain and right hip surgery performed 15 years ago. His visual analog scale score was 9 out of 10.

Diagnoses:
The patient had terminal pancreatic tail cancer. Compared with abdominal CT findings obtained 50 days ago, hepatic metastasis and peritoneal seeding were still present, infiltration to the tissues around the pancreas and retrogastric area was increased, and most of the abdominal aorta was encased. In addition, metastatic lymph nodes were identified in several areas on the left including the left para-aortic area. However, the lesion causing the pain could not be identified. Therefore, an inferior mesenteric plexus block was performed according to the patient's complaint.

Interventions:
Epidural patient-controlled analgesia was performed first. The patient's pain consequently reduced to a certain level, and the prone position became possible to some extent, so a CT-guided inferior mesenteric plexus block was performed 2 days later.

Outcomes:
After the CT-guided inferior mesenteric plexus block, it became possible to control the patient's pain with a fentanyl patch 75 mcg/hour only, and his visual analog scale score was reduced to 4. After 4 weeks, the patient died without complaints of severe pain as before.

Lessons:
CT-guided inferior mesenteric plexus block can be performed in patients with left-sided lower abdominal pain, enabling a safer and more accurate procedure especially in patients with terminal cancer who are unable to lie prone owing to severe lower abdominal pain or with considerable anatomic deformation due to extensive growth, invasion, and metastasis of the tumor in the abdominal cavity.
Measurement of postpartum blood loss using a new two-set liquid collection bag for vaginal delivery
Authors: Wang Fang , Lu Nanjia , Weng Xiaofeng , Tian Yanping , Sun Shiwen , Li Baohua 
Published: May 2021

Abstract

Background:
Postpartum hemorrhage (PPH) is a major obstetric complication, and the real-time measurement of blood loss is important in the management and treatment of PPH. We designed a new two-set liquid collection bag (TSLCB) for measuring postpartum blood loss in vaginal delivery. The aim of this study was to evaluate the effectiveness of the TSLCB in separating the blood from the amniotic fluid during vaginal delivery and in determining the accuracy of the measured postpartum blood loss.

Methods:
A prospective, randomized, case control study was conducted in the Women's Hospital, Zhejiang University School of Medicine, from March 2018 to April 2018. Sixty single pregnant women with spontaneous labor at 37–41 weeks without maternal complications were randomly divided into the experimental and control groups. The TSLCB was used to evaluate separately the amount of blood and amniotic fluid. For the control group, visual estimation and traditional plastic blood-collecting consumables were used to estimate the amount of postpartum blood loss. The measured blood loss between the two groups was compared, and the association of the measured blood loss with various clinical lab indices and vital signs was investigated.

Results:
The TSLCB (the experimental group) improved the detection of the measured blood loss compared with visual estimation and the traditional method (the control group) (P < .05). In the experimental group, correlation analysis showed that the measured blood loss at delivery and within 24 h of delivery was significantly associated with the decreased hemoglobin level, red blood cell count, and hematocrit level of patients (r = −0.574, −0.455, −0.437; r = 0.-595, −0.368, −0.374; P < .05). In the control group, only the measured blood loss within 24 h of delivery was associated with the decreased hemoglobin level (r = −0.395, P < .05). No blood transfusion and plasma expanders were required in the treatment of PPH for both groups.

Conclusions:
The TSLCB can be used to accurately measure the postpartum blood loss in vaginal delivery by medical personnel.
Early prediction of response to neoadjuvant chemotherapy using contrast-enhanced ultrasound in breast cancer
Authors: Peng Juan , Pu Huan , Jia Yan , Chen Chuang , Ke Xiao-Kang , Zhou Qing 
Published: May 2021

Abstract
Early prediction of non-response is essential in order to avoid inefficient treatments. The objective of this study was to determine the contrast-enhanced ultrasound (CEUS) for early predicting pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in breast cancer patients.
Between March 2018 and October 2019, 93 consecutive patients with histologically proven breast cancer scheduled for NAC were enrolled. Conventional ultrasound and CEUS imaging were performed before NAC and after two cycles of NAC. CEUS parameters were compared with pathologic response. Multiple logistic regression analyses were utilized to explore CEUS parameters to predict pCR, and receiver operating characteristic analysis was used to evaluate the predictive ability.
Therapeutic response was obtained from 25 (27%) patients with pCR and 68 (73%) with non-pCR. Compared to non-pCR, pCR cases have a significantly higher proportion of homogeneous enhancement feature (56% vs 14%, P < .001) and centripetal enhancement (52% vs 23%, P = .012). A significant decrease in peak intensity (PI) was observed after two cycles of NAC. Compared with non-pCR patients, the kinetic parameters PI change (PI%) was higher in pCR patients (P < .001). Multiple logistic regression demonstrated two independent predictors of pCR: internal homogeneity (odds ratio, 4.85; 95% confidence interval: 1.20–19.65; P = .027) and PI% (odds ratio, 1.08; 95% confidence interval: 1.02–1.15; P = .007). In receiver operating characteristic curve analysis, internal homogeneity and PI%, with area under curve of 0.71 and 0.84, predicted pCR with sensitivity (56%, 95%) and specificity (85%, 70%), respectively.
Internal homogeneity and PI% of CEUS may be useful in the noninvasive early prediction of pCR in patients with breast cancer.
Medical expertise as a critical influencing factor on the length of stay in the ED
Authors: Trotzky Daniel , Tsur Avishai M. , Fordham Daniel E. , Halpern Pinchas , Ironi Avinoah , Ziv-Baran Tomer , Cohen Aya , Rozental Lior , Or Jacob 
Published: May 2021

Abstract
Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians, the ED team is supplemented with doctors from specialties including internal medicine, general surgery, orthopedics etc. Here we compare ED length of stay (ED-LOS), treatment time and decision time between EM physicians, internists and general surgeons.
A retrospective cohort study was conducted examining the Emergency Department length of stay (ED-LOS) for all adult patients attending Sheba Medical Center ED, Israel, between January 1st, and December 31st, 2014. Using electronic medical records, data was gathered on patient age, sex, primary ED physician, diagnosis, eventual disposition, treatment time and disposition decision time. The primary outcome variable was ED-LOS relative to case physician specialty and level (ED, internal medicine or surgery; specialist or resident). Secondary analysis was conducted on time to treatment/ decision as well as ED-LOS relative to patient classification variables (internal medicine vs surgical diagnosis). Specialists were compared to specialists and residents to residents for all outcomes.
Residents and specialists in either EM, internal medicine or general surgery attended 57,486 (51.50%) of 111,630 visits to Sheba Hospital's general ED. Mean ED-LOS was 4.12 ± 3.18 hours. Mean treatment time and decision time were 1.79 ± 1.82 hours, 2.84 ± 2.17 hours respectively. Amongst specialists, ED-LOS was shorter for EM physicians than for internal medicine physicians (mean difference 0.28 hours, 95% CI 0.14–0.43) and general surgeons (mean difference 0.63 hours, 95% CI 0.43–0.83). There was no statistical significance between residents when comparing outcomes.
Increasing the number of EM specialists in the ED may support efforts to decrease ED-LOS, overcrowding and medical errors whilst increasing patient satisfaction and outcomes.
The Lived Experience of Pain and Depression Symptoms during Pregnancy
Authors: Vignato Julie , Beck Cheryl Tatano , Conley Virginia , Inman Michaela , Patsais Micayla , Segre Lisa S. 
Published: May 2021

Abstract

Background:
Depressive symptoms and pain are prevalent during pregnancy. Untreated pain and depressive symptoms occurring together may have a negative effect on maternal and newborn outcomes, yet little is known about women's experiences with pain and depressive symptoms during pregnancy. The purpose of this study is to describe the lived experience of depressive symptoms and pain occurring in women during the third trimester of pregnancy.

Methods:
A descriptive phenomenological study was conducted. Women during postpartum were recruited from a previous cross-sectional study of women in their third trimester that evaluated the relationship between pain, depression, and quality of life. Twenty-four women entered their responses into an online secure research Web site. These data were analyzed using Colaizzi's method of descriptive phenomenological analysis.

Results:
Four themes that described the essence of women's experiences with both pain and depressive symptoms were identified. They were pregnancy: feeling minimized, unheard and overwhelmed; attempting or trying but not treated: living with pain and pain interference; pain, sleep loss, and suffering; and pain and depressive symptoms: helpless, hopeless, and suffering.

Clinical Implications:
If a woman presents with pain, additional nursing assessments of her sleep and emotional state may be needed. Likewise, a positive depression symptom screening suggests the need for a more in-depth exploration of pain, pain interference, poor sleep, and mental health symptoms. Because the women perceive their pregnancy as minimized, nurses may need to assist in setting realistic expectations and encouraging social support. Nurses listening to women describing these conditions may be essential in promoting the women's wellbeing.
Case Report: Role of Anterior Segment Optical Coherence Tomography in Late-onset Capsular Block Syndrome
Authors: Piá-Ludeña Jose Vicente , Montolío-Marzo Santiago , Lanzagorta-Aresti Aitor , Davó-Cabrera Juan María , Roig-Revert María José , Peris-Martínez Cristina 
Published: May 2021

ABSTRACT

SIGNIFICANCE
We report the use of anterior segment optical coherence tomography (AS-OCT) as a valuable tool for capsular block syndrome diagnosis and follow-up.

PURPOSE
The purposes of this study are to report a case of late-onset capsular block syndrome or lacteocrumenasia and to describe differential diagnosis with other more common phacoemulsification complications such as intraocular lens (IOL) or posterior capsule opacification.

CASE REPORT
We report the case of a 56-year-old man with a clinical history of cataract surgery in his left eye. Five years after cataract surgery, he complained of blurred vision and was referred for IOL removal to our hospital. After careful slit-lamp examination, we found that the lens was clear, and opacity belonged to the accumulation of a whitish material in the capsular bag behind the lens. AS-OCT gave the definite diagnosis of capsular block syndrome. Intraocular lens removal had been wrongly indicated, and we treated our patient by YAG laser posterior capsulotomy. AS-OCT confirmed the absence of a further accumulated material, so no other interventions were needed. After treatment, best-corrected visual acuity improved from 0.48 to 0.1 logMAR.

CONCLUSIONS
Capsular block syndrome is a rare late-onset complication of cataract surgery causing a deep visual acuity decay. A precise slit-lamp examination and AS-OCT, together, avoid misdiagnosis and unnecessary surgical treatment, which may be needed in case of IOL opacity or fibrotic-like lacteocrumenasia. AS-OCT also helps in determining the treatment outcome. Immediate best-corrected visual acuity improvement is reached after a successful intervention.
An Eye on COVID-19: A Meta-analysis of Positive Conjunctival Reverse Transcriptase–Polymerase Chain Reaction and SARS-CoV-2 Conjunctivitis Prevalence
Authors: Sopp Nicole M. , Sharda Vandhana 
Published: May 2021

SIGNIFICANCE
This analysis and review demonstrate that, although emerging data indicate that the prevalence of severe acute respiratory coronavirus 2 (SARS-CoV-2) on the ocular surface and coronavirus disease 2019 (COVID-19) conjunctivitis is rare, the ocular surface remains of interest as a potential inoculation and transmission site for SARS-CoV-2. Continued safety precautions should be taken as more data become available.
COVID-19, caused by SARS-CoV-2, is a novel, global pandemic that has infected millions and, up to this point, caused more than two million fatalities worldwide. The ocular surface has become of interest as a possible vector for transmission by acting as a direct inoculation site, being a conduit for the virus into the respiratory system or as a method of transmission from potentially infected conjunctiva or tears. The components necessary for SARS-CoV-2 to theoretically infect ocular tissues are present: binding receptors (angiotensin-converting enzyme 2 and cluster of differentiation 147) and mechanisms for cell entry (transmembrane protease serine 2 and cathepsin L). This meta-analysis of COVID-19 prevalence data indicates that SARS-CoV-2 RNA has been infrequently found in conjunctival samples when tested with reverse transcriptase–polymerase chain reaction. This review estimates the prevalence of SARS-CoV-2 on the ocular surface and prevalence of conjunctivitis in patients with laboratory-confirmed COVID-19. There is much to be learned regarding ocular tropism of SARS-CoV-2.
2017 National Optometry Workforce Survey
Authors: Heath David A. , Spangler Jennifer S. , Wingert Timothy A. , Chan Mamie , Smith Earl L. , Grover Lori L. , Flanagan John G. 
Published: May 2021

ABSTRACT

SIGNIFICANCE
Planning for the effective delivery of eye care, on all levels, depends on an accurate and detailed knowledge of the optometric workforce and an understanding of demographic/behavioral trends to meet future needs of the public.

PURPOSE
The purposes of this study were to assess the current and future supply of doctors of optometry and to examine in-depth trends related to (1) demographic shifts, (2) sex-based differences, (3) differences in practice behaviors in between self-employed and employed optometrists, and (4) the concept of additional capacity within the profession.

METHODS
The 2017 National Optometry Workforce Survey (31 items) was distributed to 4050 optometrists, randomly sampled from a population of 45,033 currently licensed and practicing optometrists listed in the American Optometric Association's Optometry Master Data File. A stratified sampling method was applied to the population of optometrists using primary license state, age, and sex as variables to ensure a representative sample.

RESULTS
With a response rate of 29% (1158 responses), the sample ensured a 95% confidence interval with a margin of error of <5%. Key results include finding no significant differences between men and women for hours worked (38.9 vs. 37.5), productivity (patient visits per hour, 2.0 vs. 1.9), or career options/professional growth satisfaction with 65% for both. The data indicate a likely range of additional patient capacity of 2.29 to 2.57 patients per week (5.05 to 5.65 million annually profession-wide).

CONCLUSIONS
The optometric workforce for the next decade is projected to grow 0.6 to 0.7% more annually than the U.S. population. The study found additional capacity for the profession more limited than previously suggested. Findings also illustrate an evolving/equitable workforce based on sex, in terms of both productivity and satisfaction. The trend toward employed versus self-employed was marked with 44% reporting they are employed, up from 29% in 2012.
Ocular Anatomical and Functional Characteristics in Anisometropic Chinese Children
Authors: Zhong Yuanyuan , Zeng Li , Chen Zhi , Yang Jianlong , Liu Jiang 
Published: May 2021

SIGNIFICANCE
This research found that anterior and posterior biometrics differ in many aspects between fellow eyes of anisometropic children. This might shed light on the mechanisms underlying the onset and progression of anisometropia and myopia.

PURPOSE
This study aimed to investigate the ocular biometric parameters, peripheral refraction, and accommodative lag of fellow eyes in anisometropic children.

METHODS
Anisometropic children were recruited. Axial length (AL), vitreous chamber depth (VCD), central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), simulated K readings, central and peripheral refractive errors, and accommodative lag were measured in both eyes. The subfoveal choroidal thickness, average choroidal thickness, and choroid vessel density of the 6 × 6-mm macular area were measured by optical coherence tomography.

RESULTS
Thirty-two children aged 11.1 ± 1.7 years were enrolled. The average degree of anisometropia was 2.49 ± 0.88 D. The AL, VCD, ACD, and simulated K reading values were significantly larger in the more myopic eyes, whereas the LT value was significantly smaller. Subfoveal choroidal thickness (P = .001) and average choroidal thickness (P = .02) were smaller in the more myopic eyes than in the contralateral eyes, whereas choroid vessel density (P = .03) was larger. The amount of anisometropia had a significant positive correlation with the difference in AL (r = 0.869, P < .001), VCD (r = 0.853, P < .001), and ACD (r = 0.591, P < .001) and a negative correlation with the difference in LT (r = −0.457, P = .009).

CONCLUSIONS
Ocular biometrics differ in many aspects between the fellow eyes of anisometropic Chinese children, and the difference is correlated with the degree of anisometropia.
Nutritional Factors and Myopia: An Analysis of National Health and Nutrition Examination Survey Data
Authors: Harb Elise N. , Wildsoet Christine F. 
Published: May 2021

SIGNIFICANCE
The rise in the prevalence of myopia, a significant worldwide public health concern, has been too rapid to be explained by genetic factors alone and thus suggests environmental influences.

PURPOSE
Relatively little attention has been paid to the possible role of nutrition in myopia. The availability of the large National Health and Nutrition Examination Survey data set, which includes results from vision examinations, offers the opportunity to investigate the relationship between several nutrition-related factors, including body metrics, and the presence and magnitude of myopia.

METHODS
Cross-sectional survey data sets with vision examination, demographic, body metrics, and nutritional data, collected as part of the National Health and Nutrition Examination Survey over the years of 2003 to 2008, were extracted for analysis. Based on already published basic and epidemiological studies, the following parameters were selected for study: body height and body mass index, demographics, serum vitamin D and glucose/insulin levels, and caffeine intake, using multivariable models and objectively measured refractive errors as the main outcome measure.

RESULTS
Data from a total of 6855 ethnically diverse Americans aged 12 to 25 years were analyzed. In final multivariate models, female sex and age were the most significant factors related to myopia status and refractive error. In general, neither body metrics (body mass index) nor nutritional factors (serum vitamin D, glucose levels, and caffeine intake) were found to be associated with refractive error or myopia status; however, increased insulin levels were related to increased odds of having myopia.

CONCLUSIONS
These largely negative findings suggest that other environmental factors, such as those related to the visual environment, may contribute more to the development and/or progression of myopia and would argue for continued research in these areas in support of more evidence-based myopia clinical management.
The Profunda Artery Perforator Flap: A Versatile Option for Head and Neck Reconstruction
Authors: Largo Rene D. , Bhadkamkar Mohin A. , Asaad Malke , Chu Carrie K. , Garvey Patrick B. , Butler Charles E. , Yu Peirong , Hanasono Matthew M. , Chang Edward I. 
Published: May 2021

Background:
Although the profunda artery perforator flap has gained popularity in breast reconstruction, it has not been well described for reconstruction of head and neck defects. The authors report their experience with free profunda artery perforator flaps in postoncologic head and neck reconstruction.

Methods:
A retrospective review of all free profunda artery perforator flaps used for head and neck reconstruction from 2016 to 2019 was performed.

Results:
Overall, 61 profunda artery perforator flap reconstructions were performed: 45 single independent flaps, 12 in conjunction with a second free flap, and four in combination with two other free flaps. The profunda artery perforator flaps were most commonly used for reconstruction of the tongue (n = 19), cheek (n = 11), parotid (n = 10), and maxilla (n = 6). The profunda artery perforator flaps averaged 7.1 × 12.1 × 1.9 cm, with a mean pedicle length of 11.5 cm. The A, B, and C perforators were located at mean distances of 7.4 cm (range, 4 to 11.5 cm), 11.7 cm (range, 8 to 18 cm), and 16.1 cm (range, 14 to 20.5 cm) from the pubic tubercle along the axis of the adductor longus muscle and 7.9 cm (range, 7 to 11cm), 7.6 cm (range, 7 to 15.5 cm), and 7.2 cm (range, 6 to 16 cm) posterior and perpendicular to the axis. There were three partial flap losses. Eight patients (13 percent) had recipient-site complications necessitating operative intervention: four for vascular compromise of the profunda artery perforator flap, two for hematoma evacuation, and two for infection. Donor-site complications were noted in seven patients (11 percent), two of whom required operative intervention.

Conclusions:
The profunda artery perforator flap is a versatile and reliable flap with consistent anatomy and a low complication rate. The profunda artery perforator flap seems to be a reasonable alternative for reconstruction of head and neck defects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.