bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review on the Use of Topical Ocular Hypertonic Saline in Corneal Edema
Authors: Chow Shing-Chuen , Chan Jonathan Cheuk-Hung 
Published: January 2021

Purpose:
To review the effectiveness of topical ocular hypertonic saline in corneal edema.

Methods:
Online literature search of published articles on the effectiveness of topical hypertonic saline in corneal edema, bullous keratopathy (BK), and other associated corneal conditions in humans was performed on April 16, 2020.

Results:
A total of 16 articles were reviewed after curation by the authors for relevance, with 4 randomized control trials, 6 prospective studies, 4 retrospective studies, and 2 case reports. Efficacy of hypertonic saline eye drops varied widely, depending on the specific corneal disorder being treated. Six of the studies involved BK (edema involves epithelium), 2 in corneal edema limited to the stroma, 5 in Fuchs dystrophy, 3 in filamentary keratitis (the presence of filaments attached to corneal epithelium), 2 in recurrent corneal erosion, and 1 in jellyfish stings. There was limited efficacy for hypertonic saline in BK, whereas clinical improvement was noted in most studies for corneal edema without epithelial involvement, especially if associated with Fuchs dystrophy or corneal hydrops in keratoconus. Hypertonic saline also seems to be beneficial for other corneal disorders, such as filamentary keratitis and jellyfish stings, but not in recurrent corneal erosion. Adverse effects from topical hypertonic saline include a mild stinging or burning sensation, with no serious complications having been reported.

Conclusions:
Topical ocular hypertonic saline seems to be a safe and effective treatment in the management of less severe forms of corneal edema and other corneal disorders such as filamentary keratitis.
Risk Factors for Ocular Involvement in Pediatric Graft-Versus-Host Disease
Authors: Hébert Mélanie , Archambault Cyril , Doyon Christelle , Ospina Luis H. , Robert Marie-Claude 
Published: January 2021

Purpose:
To identify risk factors for ocular graft-versus-host disease (oGVHD) in children with graft-versus-host disease (GVHD).

Methods:
This retrospective cohort study identified 38 children diagnosed with GVHD who underwent an ophthalmological examination. Survival to onset of oGVHD after transplant was analyzed using Kaplan–Meier analyses with log-rank tests. A multivariable Cox proportional hazards model was run for time to oGVHD using univariate risk factors.

Results:
The average age was 10.0 ± 5.4 years at the time of transplant. Underlying illness was acute lymphoblastic leukemia in 19 (50%) and acute myeloid leukemia in 8 (21%). Nonocular GVHD organ involvement included skin (84%), lungs (16%), intestines (50%), liver (24%), and bone marrow (3%). Fifteen children (39%) had oGVHD, of which 47% were asymptomatic. oGVHD was diagnosed 601 ± 878 days after GVHD. A significant association between risk of oGVHD and diagnosis of acute lymphoblastic leukemia (P = 0.10) or acute myeloid leukemia (P = 0.08) was not found. Organ involvement associated with oGVHD included skin (P = 0.03) and lungs (P = 0.02). Survival curves were significantly influenced by GVHD organ involvement (P = 0.02), but not underlying disease (P = 0.51). The adjusted Cox regression model yielded an independent hazard ratio of 8.82 (95% CI: 1.51–51.49; P = 0.016) for the presence of concomitant GVHD involvement of skin, lungs, and another organ.

Conclusions:
Children with multiorgan GVHD involvement including skin and lung disease are at increased risk for oGVHD. Given the proportion of asymptomatic cases found in this series, regular eye examinations are warranted in this population.
Implementation Experience With Meningococcal Serogroup B Vaccines in the United States
Authors: Fergie Jaime , Howard Ashley , Huang Liping , Srivastava Amit 
Published: January 2021

Background:
Meningococcal serogroup B (MenB) is the leading cause of invasive meningococcal disease among US adolescents and young adults, accounting for 62% of cases in 16–23-year-olds in 2018. Since 2015, the Advisory Committee on Immunization Practices (ACIP) has recommended vaccination of healthy adolescents against MenB based on shared clinical decision-making (previously called “Category B” or individual clinical decision-making). However, MenB vaccine coverage and series completion rates remain low. Herein we examine implementation experience of adolescent MenB vaccination in the United States under this nonroutine ACIP recommendation.

Methods:
PubMed was searched for English-language articles published after 2015 examining MenB vaccination implementation in the United States. Studies reporting MenB vaccination awareness, coverage, knowledge of recommendations and implementation barriers or access disparities were included.

Results:
Identified studies provided evidence that ACIP’s MenB vaccination recommendation is poorly understood and prone to misinterpretation by US healthcare providers. Parental awareness of MenB vaccines is low, and racial and socioeconomic disparities exist regarding vaccine receipt. Parents rely on providers to learn about MenB disease risk and benefits of vaccination, with provider recommendations carrying substantial weight in vaccination decisions.

Conclusions:
Five years of evidence regarding the MenB vaccination implementation experience suggest that the nonstandard recommendation for MenB vaccines is partly responsible for low vaccine coverage. Further, inconsistent implementation of ACIP recommendations could be limiting access to MenB vaccines. Providers need additional support and guidance to implement the shared clinical decision-making recommendation, in turn ensuring equitable access for vaccine-eligible adolescents to enable comprehensive protection against meningococcal disease.
Liver Abscess in Children-experience From a Single Tertiary Care Center of North India
Authors: Lal Sadhna Bhasin , Venkatesh Vybhav , Kumar Aditi , Anushree Neha , Seetharaman Keerthivasan , Aneja Aradhana , Chaluvashetty Sreedhara B. , Sehgal Rakesh 
Published: January 2021

Background:
Liver abscess (LA), a common problem in children in the tropics, is believed to be mostly pyogenic (PLA), sometimes amebic (ALA). We aimed to analyze the clinical profile, etiology, risk factors for complications, management and outcomes of LA in children.

Methods:
The details of 81 children with LA managed in a tertiary set up over a period of 3 years were analyzed. A comparison of different parameters was performed with respect to etiology and complications.

Results:
ALA, PLA and mixed infection LA were diagnosed in 40 (49.4%), 32 (39.5%) and 9 (11.1%) children. The triad of fever, hepatomegaly and right upper quadrant tenderness was seen in 65 (80.2%). Coagulopathy was observed in 60 (77%) and jaundice in 12 (14.8%). Majority (71.6%) had a single LA in the right lobe (69%). Conservative, percutaneous needle aspiration, percutaneous catheter drainage and surgical drainage were done in 11.1%, 3.7%, 82.7% and 2.5%, respectively. Forty-three (53.1%) had complicated LA with rupture in 55.8% and vascular thrombosis in 16.2%. Children with complicated LA had higher alanine transaminase, prolonged prothrombin time/international normalized ratio, low serum protein and albumin levels (P < 0.05). Median duration of follow-up was 2 months and mean time to resolution of LA was 48.5 ± 18 days.

Conclusions:
ALA is the commonest cause of pediatric LA in endemic regions and is difficult to differentiate from PLA clinically. Percutaneous catheter drainage is safe and effective modality for the management of LA in children. A higher alanine transaminase, prolonged prothrombin time/international normalized ratio and low serum albumin levels (<3 g/dL) at presentation identify complicated LA.
Rates of Prophylaxis Among Pneumocystis jirovecii Pneumonia Cases Attributable to High-dose Steroid Therapy
Authors: Ludwig Amy , Krishnan Jay , Cinti Sandro 
Published: January 2021

Background
The incidence of Pneumocystis jirovecii pneumonia (PJP) among patients on high-dose steroid therapy is not well established, and few guidelines exist to help guide decisions regarding prophylaxis. We assessed provider prescribing practices regarding pneumocystis prophylaxis and conducted a retrospective chart review of 306 PJP cases at a tertiary care center to identify preventable cases and target interventions to reduce harm.

Methods
We surveyed providers regarding their threshold to initiate PJP prophylaxis among patients receiving steroid therapy. Subsequently, all encounters with a positive PJP PCR from sputum or bronchoalveolar lavage from June 2012 to November 2018 were reviewed for signs and symptoms, radiographic imaging, laboratory tests, and expert consultation consistent with a clinical diagnosis of PJP. Cases were reviewed for steroid exposure within 3 months before diagnosis to identify at-risk populations. We defined high dose steroids as prednisone 20 mg or higher for a period greater than 4 weeks.

Results
Most survey respondents used their own clinical judgment in place of published guidelines (65%), though the majority used prednisone 20 mg as their threshold to prescribe PJP prophylaxis. Of 214 encounters with a clinical diagnosis of PJP, 65 (30%) cases were considered potentially preventable as they received high-dose steroid therapy without PJP prophylaxis. Of these 65 cases, 13 deaths occurred with PJP or its complications as a cause of death. We recommend consideration of prophylaxis in all patients on prednisone 20 mg or higher for greater than 4 weeks, especially if on concomitant immunosuppression.
Underpredicting pain: an experimental investigation into the benefits and risks
Authors: Peerdeman Kaya J. , Geers Andrew L. , Della Porta Delia , Veldhuijzen Dieuwke S. , Kirsch Irving 
Published: January 2021

Abstract
Expectancies can shape pain and other experiences. Generally, experiences change in the direction of what is expected (ie, assimilation effects), as seen with placebo effects. However, in case of large expectation–experience discrepancies, experiences might change away from what is expected (ie, contrast effects). Previous research has demonstrated contrast effects on various outcomes, but not pain. We investigated the effects of strong underpredictions of pain on experienced pain intensity. In addition, we assessed related outcomes including (certainty of) expectations, fear of pain, pain unpleasantness, autonomic responses, and trust. Healthy participants (study 1: n = 81 and study 2: n = 123) received verbal suggestions that subsequent heat stimuli would be moderately or highly painful (correct prediction), mildly painful (medium underprediction; study 2 only), or nonpainful (strong underprediction). Both studies showed that participants experienced less intense pain upon strong underprediction than upon correct prediction (ie, assimilation). Expected pain, fear of pain, and pain unpleasantness were generally also lowered. However, strong underprediction simultaneously lowered certainty of expectations and trust in the experimenter. Study 2 indicated that the effects of strong underprediction vs medium underprediction generally did not differ. Moreover, study 2 provided some indications for reduced heart rate and skin conductance levels but increased skin conductance responses upon strong underprediction. In conclusion, even strong underpredictions of pain can reduce pain (ie, cause assimilation), although not significantly more than medium underpredictions. However, strong underpredictions can cause uncertainty and undermine trust. These findings suggest that healthcare providers may wish to be cautious with providing overly positive information about painful medical procedures.
Knowledge of Vulvar Anatomy and Self-examination in a Sample of Italian Women
Authors: Preti Mario , Selk Amanda , Stockdale Colleen , Bevilacqua Federica , Vieira-Baptista Pedro , Borella Fulvio , Gallio Niccolò , Cosma Stefano , Melo Catarina , Micheletti Leonardo , Benedetto Chiara 
Published: January 2021

Objective
The aim of the study was to investigate the knowledge of vulvar anatomy and vulvar self-examination (VSE) in a sample of Italian women attending a gynecology clinic.

Methods
For this original research from May to July 2019, 512 women attending the Lower Genital Tract Clinic at the Department of Surgical Sciences of the University of Torino were invited to participate in a 29-question survey about vulvar anatomy, VSE, and sociodemographic details. Data were analyzed using descriptive statistics.

Results
Of 512 patients, 500 completed the questionnaire (98% response rate). The mean age of respondents was 41 years (range = 17–77 years). Education level was evenly distributed between elementary, high school, and university graduates. Only 15% of interviewed women were able correctly sketching vulvar anatomy. Seventy-six percent of the women had not heard about VSE, and 61% of the women approach their genitalia with feelings of shame and embarrassment. Only 23% of the women would seek medical advice after identification of possible abnormalities during VSE. A majority (69%) of the women would like to have more information about VSE and vulvar health through educational videos and social media.

Conclusions
Education about VSE may lead to earlier diagnosis of vulvar cancers and other pathologies. Further efforts are needed to disperse information about normal external female genital anatomy and VSE to achieve self-confidence among women.
Dynamic Spectral Imaging Colposcopy Versus Regular Colposcopy in Women Referred With High-Grade Cytology: A Nonrandomized Prospective Study
Authors: Booth Berit Bargum , Petersen Lone Kjeld , Blaakaer Jan , Johansen Tonje , Mertz Henrik , Kristensen Christina Blach , Lunde Søren , Dahl Katja , Bor Pinar 
Published: January 2021

Objective
The aim of the study was to evaluate the sensitivity of dynamic spectral imaging (DSI) colposcopy compared with regular colposcopy for women referred with high-grade cervical cytology.

Methods
In a prospective, nonrandomized, multicenter study, we included women referred for colposcopy at hospital gynecology clinics with high-grade cytology. Women were examined using either a regular or DSI colposcope. In both groups, colposcopists located 1 area viewed as most suspicious. In the DSI group, this was done before viewing the DSI map. Subsequently, an area was chosen based on the worst color of the DSI map, and further additional biopsies were taken. All women had 4 cervical biopsies taken, all analyzed separately. The main outcome was sensitivity to find cervical intraepithelial neoplasia grade 2 or worse (CIN2+).

Results
A total of 261 women were examined using DSI colposcopy, and 156 women were examined using regular colposcopy. The sensitivity for finding CIN2+ when using the DSI technology as an adjunctive technology was found to be 82.2% (95% CI = 75.9–87.4), based on an average of 1.4 biopsies. This was corresponding in sensitivity to 2 biopsies taken using regular colposcopy (80.3%; 95% CI = 72.3–86.8). There was no difference in sensitivity for CIN+ between the groups when 3 or more biopsies were taken.

Conclusions
We found that the DSI colposcope may help direct biopsy placement; however, the improvement is based on small differences in needed biopsies and the clinical significance of this may be small. Multiple biopsies were still superior.
Diagnostic Value of Persistently Low Positive TGA-IgA Titers in Symptomatic Children With Suspected Celiac Disease
Authors: Trovato Chiara Marja , Montuori Monica , Morelli Annalisa , Alunni Fegatelli Danilo , Vestri Annarita , Giordano Carla , Cucchiara Salvatore , Caio Giacomo , Oliva Salvatore 
Published: January 2021

ABSTRACT

Objectives:
While the algorithm to diagnose celiac disease (CD) in children with elevated anti-transglutaminase IgA (TGA-IgA) titers (>10 times upper limit of normal, ULN) is well defined, the management of children with low TGA-IgA values represents a clinical challenge. We aimed to identify the diagnostic value of persistently low positive TGA-IgA titers in predicting CD in children.

Methods:
We retrospectively analyzed children with symptoms or signs of CD, not eligible for a no-biopsy approach. We included children with at least 2 TGA-IgA measurements, endomysial antibody (EMA) assessment and esophagogastroduodenoscopy with biopsies. TGA-IgA values were provided as multiples of ULN. Patients were classified in groups according to median TGA-IgA values: A (TGA-IgA>1 ≤ 5 × ULN; defined as “low-positive”), B (TGA-IgA > 5 < 10 × ULN; “moderate-positive”), and C (controls).

Results:
Data of 281 children were analyzed. Of 162 children in group A, CD was diagnosed in 142 (87.7%), whereas normal duodenal mucosa was found in 20. In group B, all 62 children (100%) received a CD diagnosis. Group C included 57 controls. EMA were undetectable in 31 (15%) of mucosal atrophy cases. On the receiver-operating characteristic curve (area under the curve = 0.910), a mean value of 1.7 ULN showed a sensitivity of 81.4% and specificity of 81.8% to predict mucosal damage.

Conclusions:
Repeated low or moderate TGA-IgA values (<5 ULN or <10 ULN) are good predictors of a CD diagnosis. Symptomatic children with persistently low positive TGA-IgA titers should undergo esophagogastroduodenoscopy regardless of their EMA status.
Vulvar Intraepithelial Neoplasia: A Review of the Disease and Current Management
Authors: Dockery Lauren E. , Soper John T. 
Published: January 2021

Importance
Vulvar intraepithelial neoplasia (VIN) represents an increasingly common, yet challenging diagnosis that shares many common risk factors with cervical intraepithelial neoplasia. However, unlike cervical intraepithelial neoplasia, effective screening and treatment strategies are much less defined for patients with VIN.

Objective
The objective of this article is to review the underlying risk factors leading to the development of VIN, identify special populations at risk for VIN, and outline acceptable treatment strategies.

Evidence Acquisition
This literature review was performed primarily using PubMed.

Results
Vulvar intraepithelial neoplasia can be separated into usual VIN (uVIN) and differentiated VIN (dVIN). The more common uVIN is related to underlying human papillomavirus infection, whereas dVIN occurs in the setting of other vulvar inflammatory conditions such as lichen sclerosis. Differentiated VIN carries a higher risk of progression to invasive malignancy. Extramammary Paget disease is a rare intraepithelial adenocarcinoma unrelated to uVIN and dVIN, although management is similar.

Conclusions and Relevance
Vulvar intraepithelial neoplasia is a preinvasive neoplasia of the vulva with few robust strategies for surveillance or management. Careful examination with targeted biopsy is warranted for suspicious lesions, and a combination of surgical and medical management can be tailored for individual patient needs.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After reading this article, the learner should be better able to evaluate the epidemiology and pathophysiology of VIN; assess risk for underlying malignancy, especially when comparing uVIN and dVIN; and compare different options for management of VIN including medical and surgical treatments.
Extracorporeal Life Support as a Treatment of Supraventricular Tachycardia in a Newborn
Authors: Matsudo Takahiro , Tsuboi Norihiko , Nishimura Nao , Nakagawa Satoshi 
Published: January 2021

Abstract
Supraventricular tachycardia (SVT) is the most common symptomatic tachyarrhythmia in children and requires medical treatment. Thus far, there have been few reports of the use of extracorporeal life support (ECLS) to provide cardiac support in children with low cardiac output resulting from arrhythmia. We present a case of a newborn in whom ECLS was used to provide support for cardiogenic shock secondary to intractable SVT. A 25-day-old girl presented with a 5-hour history of increasing pallor and listlessness. A clinical examination at presentation revealed retractions and peripheral coldness. An electrocardiogram showed a narrow-QRS tachycardia with a rate of 290 beats per minute. Adenosine triphosphate (maximum, 0.2 mg/kg) and synchronous direct current shock (maximum, 25 J) were ineffective. Chest x-ray showed a cardiac dilatation, and echocardiography showed a structurally normal heart with very poor function. The cardiogenic shock caused by SVT was refractory to treatment. The low cardiac output state persisted with worsening metabolic acidosis (bicarbonate, 5.8 mEq/L; lactate, 14.3 mmol/L). In view of the intractable tachyarrhythmia and worsening perfusion, blood access catheters were inserted, and ECLS was initiated. After commencing ECLS support, intravenous adenosine triphosphate (1.25 mg/kg) was administrated. The patient then reverted to a sinus rhythm with a rate of 180 beats per minute. There was considerable improvement of the heart function within 2 days of starting ECLS; the patient was weaned from ECLS support, and the blood access catheters were decannulated on day 3. After weaning from ECLS support, cardiac function returned to normal.
Tumor-Infiltrating Lymphocyctes in Triple-Negative Breast Cancer
Authors: Brown Lauren C. , Salgado Roberto , Luen Stephen J. , Savas Peter , Loi Sherene 
Published: January 2021

Abstract
Triple-negative breast cancer (TNBC) continues to represent an unmet need because of its significantly poorer outcomes, including higher relapse rates following early-stage disease and dismal survival times in the advanced setting, when compared with other breast cancer subtypes (Cancer 2012;118:5463–5472). Furthermore, there remains a lack of established systemic treatment options beyond conventional cytotoxic chemotherapy, with the exception of PARP inhibitors in the small subset of patients who harbor a BRCA mutation (N Engl J Med 2018;379:753; Lancet Oncol 2020;21:1269–1282; Ann Oncol 2019;30:558–566) and recently the use of immunotherapy in the first-line metastatic setting in those who are programmed death ligand 1–positive (Lancet Oncol 2020;21(1):44–59; N Engl J Med 2018;379(22):2108–2121). Suitable biomarkers for improving prognostication and directing therapy in both the early and advanced TNBC settings are required in order for improvements in survival outcomes to be continued to be attained. Tumor-infiltrating lymphocytes are gaining increasing relevance as an immunological biomarker in this arena.