bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Indicators for the Diagnosis and Management of Menière's Disease
Authors: Cottrell Justin , Yip Jonathan , Agrawal Sumit , Archibald Jason , Chau Justin , Lea Jane , Lin Vincent , Mick Paul , Morris David , Parnes Lorne , Schramm David , Chan Yvonne , Crowson Matthew , de Almeida John , Eskander Antoine , Witterick Ian J. , Monteiro Eric 
Published: June 2021

Objective:
Menière's disease (MD) is a clinical disorder that often provides challenges in diagnosis and management. High-quality evidence to guide care providers is sparse, which can result in significant practice variations. Quality indicators (QIs) are one method that can be used to standardize and measure accepted care practices to improve healthcare quality and patient outcomes. Here, we developed practical, high-yield QIs that serve to measure and inform the quality of care provided to patients with MD.

Study Design:
Modified RAND Corporation University of California, Los Angeles appropriateness methodology for QI development.

Setting:
Multicenter nine-member expert panel.

Patients:
NA.

Interventions:
NA.

Main Outcome Measure:
Final QIs deemed appropriate measures of quality care with agreement by the expert panel.

Results:
Twenty-seven candidate indicators were identified after literature review. After the first round of evaluations, the panel agreed on three candidate indicators as appropriate QIs. A subsequent expert panel meeting provided a platform to discuss disagreements. Two agreed-upon QIs were revised during this discussion before final evaluations. The expert panel ultimately agreed upon five QIs as appropriate measures of high-quality care after completing final evaluations and reviewing updated literature. The five quality indicators measure audiometric documentation, minimization of electrocochleography, use of intratympanic dexamethasone, use of intratympanic gentamycin, and rate of labyrinthectomy/vestibular neurectomy in refractory MD patient.

Conclusions:
This study proposes five QIs that cover key aspects of care for MD, such as accurate diagnosis and management options including initial destructive therapies. These QIs can serve multiple purposes, the most important of which is to galvanize quality improvement initiatives.
A Web-Based Deep Learning Model for Automated Diagnosis of Otoscopic Images
Authors: Tsutsumi Kotaro , Goshtasbi Khodayar , Risbud Adwight , Khosravi Pooya , Pang Jonathan C. , Lin Harrison W. , Djalilian Hamid R. , Abouzari Mehdi 
Published: June 2021

Objectives:
To develop a multiclass-classifier deep learning model and website for distinguishing tympanic membrane (TM) pathologies based on otoscopic images.

Methods:
An otoscopic image database developed by utilizing publicly available online images and open databases was assessed by convolutional neural network (CNN) models including ResNet-50, Inception-V3, Inception-Resnet-V2, and MobileNetV2. Training and testing were conducted with a 75:25 breakdown. Area under the curve of receiver operating characteristics (AUC-ROC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were used to compare different CNN models’ performances in classifying TM images.

Results:
Our database included 400 images, organized into normal (n = 196) and abnormal classes (n = 204), including acute otitis media (n = 116), otitis externa (n = 44), chronic suppurative otitis media (n = 23), and cerumen impaction (n = 21). For binary classification between normal versus abnormal TM, the best performing model had average AUC-ROC of 0.902 (MobileNetV2), followed by 0.745 (Inception-Resnet-V2), 0.731 (ResNet-50), and 0.636 (Inception-V3). Accuracy ranged between 0.73–0.77, sensitivity 0.72–0.88, specificity 0.58–0.84, PPV 0.68–0.81, and NPV 0.73–0.83. Macro-AUC-ROC for MobileNetV2 based multiclass-classifier was 0.91, with accuracy of 66%. Binary and multiclass-classifier models based on MobileNetV2 were loaded onto a publicly accessible and user-friendly website (https://headneckml.com/tympanic). This allows the readership to upload TM images for real-time predictions using the developed algorithms.

Conclusions:
Novel CNN algorithms were developed with high AUC-ROCs for differentiating between various TM pathologies. This was further deployed as a proof-of-concept publicly accessible website for real-time predictions.
Rupture-Like Shrinkage and Regrowth of Endolymphatic Hydrops in Ménière's Disease During Remission
Authors: Fukushima Munehisa , Suekata Yu , Kusumoto Takuya , Akahani Shiro , Okamoto Hidehiko , Inohara Hidenori , Takeda Noriaki 
Published: June 2021

Objective:
To clarify pathophysiological characteristics of Ménière's disease during the remission phase.

Patients:
Two Ménière's disease patients with different disease durations, whose endolymphatic hydrops was longitudinally observed using 3-T magnetic resonance imaging.

Interventions:
Diagnostic.

Main Outcomes and Measures:
Morphological changes of endolymphatic hydrops visualized using 3-T magnetic resonance imaging.

Results:
Rupture-like shrinkage and regrowth of endolymphatic hydrops during the remission phase was observed in both patients.

Conclusion:
The remission phase with hearing improvement could be as important as vertigo attacks in Ménière's disease.
A novel mask to prevent aerosolized droplet dispersion in endoscopic procedures during the coronavirus disease pandemic
Authors: Maehata Tadateru , Yasuda Hiroshi , Kiyokawa Hirofumi , Sato Yoshinori , Yamashita Masaki , Matsuo Yasumasa , Nakahara Kazunari , Yamamoto Hiroyuki , Itoh Fumio 
Published: June 2021

Abstract
Endoscopic procedures increase the risk of transmission of severe acute respiratory syndrome coronavirus 2 to medical staff, because aerosols are generated during upper gastrointestinal endoscopy. There have been several reported studies on devices for infection prevention; however, few reports have validated them. Therefore, we developed a novel mask to prevent the diffusion of aerosol droplets from patients undergoing endoscopy.
We compared microdroplet dispersion during coughing episodes when using the novel mask with microdroplet dispersion when using the conventional mouthpiece alone.
The mean number of microdroplets was significantly smaller in the group that used the novel mask (57.9 ± 122.91 vs 933.6 ± 119.80 droplets; P = .01).
The novel mask may aid in reducing the degree of exposure of medical personnel to microdroplets and the risk of subsequent infection.
Evaluation of the proper chest compression depth for neonatal resuscitation using computed tomography
Authors: Lee Juncheol , Lee Dong Keon , Oh Jaehoon , Park Seung Min , Kang Hyunggoo , Lim Tae Ho , Jo You Hwan , Ko Byuk Sung , Cho Yongil 
Published: June 2021

Abstract
This study was created to assess whether a 30-mm depth of chest compression (CC) is sufficient and safe for neonatal cardiopulmonary resuscitation.
This retrospective analysis was performed with chest computed tomography scans of neonates in 2 hospitals between 2004 and 2018. We measured several chest parameters and calculated heart compression fraction (HCF) using the ejection fraction formula. We evaluated whether one-third of the external anterior-posterior (AP) diameter and HCF with them are the equivalent to 25-, 30-, 35 mm and HCF with them, respectively, and the number of individuals with over-compression (internal chest AP diameter − compressed depth <10 mm) to estimate a safe CC depth. We divided the patients into term and preterm groups and compared their outcomes.
In total, 63 of the 75 included individuals were analyzed, and one-third of the external lengths was equivalent to 30 ± 3 mm (P < .001). When the patients were divided into term (n = 53) and preterm (n = 10) groups, the equivalent depth was 30 ± 3 mm in the term group (P < .001) and 25 ± 2.5 mm in the preterm group (P = .004). The HCF with 30 mm was equivalent to that for one-third of the external length (P < .001). When we simulated CCs with a 30-mm depth, over-compression occurred more frequently in the preterm group (20%) compared to the term group (1.9%) (P = .014).
A 30-mm depth could be appropriate for sufficient and safe neonatal resuscitation. Shallower CC should be considered in preterm babies.
Comparative efficacy and dysmenorrhea score of 6 object-separated moxibustions for the treatment of Chinese patients with dysmenorrhea
Authors: Wu Zi-Xuan , Cai Min-Jie , Huang Pei-Dong , Chen Jia-Yun , Lv Zhao-Hui , Huang Xu-Yan 
Published: June 2021

Abstract

Background:
Primary dysmenorrhea (PD), one of the most common diseases in women, is known to be effective with object-separated moxibustion. However, because there is no large sample size for comparison, it is difficult to choose the best method for the clinical treatment of these different treatments. Therefore, our aim was to compare and rank different moxibustion methods to determine the most effective treatment method for PD.

Materials and methods:
A systematic search was carried out in PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature, to identify the randomized controlled trials (RCTs) investigated the object-separated moxibustion is associated with dysmenorrhea, as well as we also manually checked the bibliographies of eligible studies and topic-related reviews, RCTs from their inception to May 1, 2020. Three investigators read the citations and excluded quasi-randomized trials and trials that were incomplete. We extracted data following a predefined hierarchy. We assessed the studies’ risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The primary outcomes were efficacy (response rate) and dysmenorrhea scores. We estimated the summary odds ratio (OR) and mean difference (MD) using pairwise and network meta-analyses with random effects. STATA software version 16.0, ADDIS software version 1.16.5, and R software version 3.6.1 were used to statistically analyze all data.

Results:
Fifty-six RCTs with 5550 patients were included, comparing 6 object-separated moxibustion therapies with acupuncture or oral medicine. All moxibustions were more effective than ibuprofen, with OR ranging between 6.75 (95%CI: 3.58 to 13.22) for moxibustion at the navel. For relieving pain which uses dysmenorrhea score to evaluate, mild moxibustion (MD = −1.42, −4.24 to 0.85) was more effective than others. A total of 24 (42.8%) of 56 trials were rated as having a high risk of bias, 31(55.4%) as moderate, and 1(1.8%) as low, and the certainty of the evidence was moderate.

Conclusions:
Mild moxibustion cannot only effectively treat PD but also relieve pain in comparison with ibuprofen. Although GRADE evidence indicate low to moderate for most comparisons, mild moxibustion seems to be an advisable option for PD treatment to relieve symptoms.
Diagnostic complexity of rifampicin-induced coagulopathy in a patient with spontaneous muscle bleeding
Authors: Vučić Domagoj , Cvitkušić-Lukenda Katica , Dunđer Ivica , Gabaldo Krešimir , Knežević-Praveček Marijana , Miškić Blaženka 
Published: June 2021

Abstract

Introduction:
Rifampicin is currently used to treat various bacterial infections, with the most significant application in the treatment of tuberculosis. Dose-independent side effects of the drug can lead to the development of various coagulation disorders, among which disseminated intravascular coagulation is the most dangerous. The mechanism of coagulopathy itself is multifactorial, but it is thought to be mediated by an immune response (formation of antigen-antibody complexes) and consequent damage to platelets and the vascular endothelium.

Patient concerns:
A 66-year-old woman, with numerous comorbidities including chronic renal failure, condition after implantation of a permanent pacemaker, and a positive blood culture for Staphylococcus aureus, presented with spontaneous bleeding in the muscle wall, and in the clinical picture of hemorrhagic shock.

Diagnosis:
Knowing the multifactorial mechanism of rifampicin-induced coagulopathy, possible factors were considered, such as infections, comorbidities, drug use and drug-drug interactions, pathological laboratory parameters, and coagulograms. Clinical presentation of abdominal pain and intra-abdominal mass, with laboratory verification of prolonged activated partial thromboplastin time and computed tomography-proven hematoma suspected of acute bleeding, redirects clinical suspicion of drug-induced coagulopathy.

Interventions:
By discontinuing rifapicin and administering vitamin K and fresh frozen plasma, normalization of laboratory coagulation parameters was achieved. Bleeding from the muscle wall required correction of acute anemia with red cell concentrates, surgical intervention, and additional antibiotic therapy for secondary infection of the operative wound.

Outcomes:
At the end of 6 weeks of antibiotic (antistaphylococcal) therapy (due to the basic suspicion of possible infectious endocarditis), the normalization of inflammatory parameters occurred with a sterile control blood culture and a normal coagulogram.

Conclusion:
Clinicians should be aware of the possible side effects of the administered drugs, especially taking into account the overall clinical picture of a patient, including comorbidities and possible drug interactions.
Thrombomodulin gene polymorphism and the occurrence and prognostic value of sepsis acute kidney injury
Authors: Li Qin , Yang Wenjuan , Zhao Keming , Sun Xifeng , Bao Liuqian 
Published: June 2021

Abstract
To investigate the relationship between thrombomodulin (THBD) gene single nucleotide polymorphisms (SNPs) and susceptibility to sepsis and the occurrence and prognosis of acute kidney injury (AKI) in sepsis patients.
The genotypes of THBD gene rs1962, rs3176123, and rs1042580 in 178 sepsis patients with AKI, 243 sepsis patients without AKI (No AKI), and 103 healthy controls were analyzed by direct sequencing. Enzyme-linked immunosorbent assay (ELISA) was used to detect the plasma THBD protein levels. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of plasma THBD levels in sepsis, AKI, and death of sepsis patients.
The C allele carriers of THBD gene rs1962 were more likely to develop AKI and sepsis than the T allele carriers (OR = 1.61, 95% CI: 1.18–2.19, P < .01; OR = 2.16, 95% CI: 1.42–3.29, P < .01). The rs3176123 G allele was associated with an increased risk of AKI in sepsis patients (OR = 1.41, 95% CI: 1.06–1.88, P = .02), the G allele had a significant association with a higher risk of sepsis susceptibility (OR = 1.91, 95% CI: 1.33–2.75, P < .01). Sepsis patients of rs1042580 C allele had a lower risk of AKI than those of T allele (OR = 0.58, 95% CI: 0.37–0.91, P = .02), the C allele was related to a reduced risk of sepsis susceptibility (OR = 0.38, 95% CI: 0.26–0.55, P < .01). The THBD gene rs1962, rs3176123, and rs1042580 TGT haplotype was linked to higher risk of AKI in patients with sepsis (OR = 1.96, 95%CI: 1.14–3.38, P = .02). Sepsis patients with the THBD gene rs1962 TC + CC genotype had a higher risk of death than those with TT genotype (OR = 10.93, 95%CI: 5.05–26.96, P < .01), but there was no significant difference in the risk of death in sepsis patients with different genotypes at rs3176123 and rs1042580 (P > .05).
The THBD gene rs1962, rs3176123, and rs1042580 SNPs are significantly associated with sepsis susceptibility and the risk of AKI. The rs1962 SNP is related to the risk of death in sepsis patients.
Prevalence of burnout in medical students in China
Authors: Li You , Cao Liang , Mo Chunbao , Tan Dechan , Mai Tingyu , Zhang Zhiyong 
Published: June 2021

Abstract
This meta-analysis aimed to estimate the prevalence of burnout among medical students in China.
A systematic search from the following electronic databases: China National Knowledge Infrastructure, Wangfang database, VIP database, Chinese biomedical literature database, PubMed, Embase, Web of Science, and Google Scholar was independently conducted by 2 reviewers from inception to September 2019. The data were analyzed using stata software Version 11. Heterogeneity was assessed using I
2 tests, and publication bias was evaluated using funnel plots and Egger's test. The source of heterogeneity among subgroups was determined by subgroup analysis of different parameters.
A total of 48 articles with a sample size of 29,020 met the inclusion criteria. The aggregate prevalence of learning burnout was 45.9% (95% confidence interval [CI] = 38.1%–53.8%). The prevalence rate of high emotional exhaustion was 37.5% (95% CI: 21.4%–53.7%). The percentage was 44.0% (95% CI: 29.2%–58.8%) for low personal accomplishment. The prevalence rate was 36.0% (95% CI: 23.0%–48.9%) in depersonalization dimension. In the subgroup analysis by specialty, the prevalence of burnout was 30.3% (95% CI: 28.6%–32.0%) for clinical medicine and 43.8% (95% CI: 41.8%–45.8%) for other medical specialties. The total prevalence of burnout between men and women was 46.4% (95% CI: 44.8%–47.9%) and 46.6% (95% CI: 45.5%–47.6%), respectively. The prevalence of burnout with Rong Lian's scale was 43.7% (42.1%–45.2%), and that with the other scales was 51.4% (50.4%–52.4%). The prevalence rates were 62.9% (61.3%–64.6%), 58.7% (56.3%–61.1%), 46.5% (42.9%–50.2%), and 56.0% (51.6%–60.4%) from Grades 1 to 4, respectively. There was a statistically significant difference among the different grades (P = .000).
Our findings suggest a high prevalence of burnout among medical students. Society, universities, and families should take appropriate measures and allot more care to prevent burnout among medical students.
STROBE-clinical characteristics and prognosis factors of gastric cancer in young patients aged ≤30 years
Authors: Zhou Liyun , Jiang Zhenhua , Gu Wenhui , Han Shuangyin 
Published: June 2021

Abstract
We aimed to determine the clinical characteristics and prognosis factors of young patients with gastric cancer (GC).
A total of 101 young patients with GC referred to Zhengzhou University People's Hospital, Henan province, China between January 1st, 2003 and June 1st, 2015 were retrospectively reviewed. The medical records included ages, genders, marital status, family history of tumors, comorbidity, Helicobacter pylori (H.pylori) infection, fibrinogen, prealbumin, alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), tumor location, tumor size, TNM stage, differentiation of the tumor, WHO type, treatment method and prognostic factors effect were further assessed.
The mean age of GC patients in our group was 26.0 years. The incidence was slightly higher in females (female: male = 1.1:1). Some patients had the family history of tumor and H.pylori infection (2.0%, 6.9%). The tumor sizes were mainly under 5 cm (52.4%) and the most locations were in the antrum (43.5%) and body (42.5%). A large number of patients were diagnosed as adenocarcinomas (66.3%) and the main histological of GC was poor differentiated (72.3%). Moreover, a high proportion of patients were diagnosed at the stages III-IV (61.4%), and most patients received surgery combined chemotherapy (63.4%), however, the survival outcome was poor. In univariate Cox analysis, tumor sizes, TNM stage were significantly associated with overall survival (OS) and the multivariate Cox analysis demonstrated that TNM stage was significantly associated with OS.
GC in young patients has its unique biological and clinical features. A large majority of young patients were diagnosed at their advanced stages with poor prognostic. TNM stage was an independent prognostic factor for young patients with GC, early GC screening in young people should be actively promoted.
GDS score as screening tool to assess the risk of impact of chronic conditions and depression on quality of life in hospitalized elderly patients in internal medicine wards
Authors: Argano Christiano , Catalano Nicola , Natoli Giuseppe , Monaco Marika Lo , Corrao Salvatore 
Published: June 2021

Abstract
Aging of population is characterized by multiple chronic conditions in the same individual. Health-related quality of life (HR-QOL) reflects the multidimensional impact of chronic disease on population and it is increasingly analysed as outcomes.
The aim of this study was the evaluation of the predictors of quality of life among elderly patients hospitalized in internal medicine ward, investigating the effect of comorbidities on health-related quality of life.
Data collected in this cross-sectional study were analysed. Socio-demographic, clinical characteristics, disease distribution and quality of life by the 12-Item Short Form Health Survey (SF-12) were evaluated.
Of 240 inpatients, subjects with Barthel Index (BI)≤40 were 23.7%, 55% had a Geriatric Depression Scale (GDS)≥2. After categorizing mental component score (MCS) and physical component score (PCS) in five classes, we found that diabetics and patients with cancer were more frequent in the first class of MCS while patients with NYHA III-IV are significantly more frequent in the first class of PCS. When we classified patients according to GDS≥2 or < 2, subjects with GDS≥2 had BI and MCS significantly lower. In the multivariate analysis GDS score ≥2 was independently associated with first MCS class [16.32 (3.77–70.68)] while NYHA III-IV class and claudicatio intermittents were strong predictors of the worst PCS class [9.54 (1.97–47.40), 2.53 (1.16–5.49), respectively]. Liver disease was independently associated with GDS≥2 [5.26 (1.13–24.39)].
Our study highlighted the impact of chronic diseases on health-related quality of life in elderly subjects hospitalized in an internal medicine ward pointing out the importance of taking into account patient's needs and perception and the setting up of a personalised health-care. Patients with diabetes and liver disease along with persons affected by cancer need psychological support to improve their quality of life. A GDS score ≥ 2 is a strong predictor of poor quality of life and should trigger an in-depth assessment of mental health in this kind of patients.
Fixation options for reconstruction of the greater trochanter in unstable intertrochanteric fracture with arthroplasty
Authors: Huang Guanning , Zhang Mingran , Qu Zhiguo , Zhang Youjia , Wang Xukai , Kang Wenbo , Zhang Minglei 
Published: June 2021

Abstract

Introduction:
With the aggravation of population aging, the incidence of intertrochanteric fracture also increases dramatically. Patients are often elderly accompany with severe osteoporosis and various complications. Therefore, we should select an individualized treatment based on the each patient's state. Arthroplasty is recommended for unstable fractures with obvious osteoporosis, ipsilateral femoral head necrosis or arthritis. Rigid fixation of the greater trochanter with arthroplasty is challenging because of the powerful pulling forces created by multiple muscles being transmitted to the greater trochanter. Currently, there are few contemporary literatures on the evaluation of unstable intertrochanteric fracture with efficient fixation of the greater trochanter. Moreover, there is no consensus to choose which implant to immobilize the greater trochanter. The purpose of this study was to review previous literatures and provide a valuable guidance.

Conclusions:
The locking plate, which not only provides rigid fixation but also results in lower rate of postoperative complications. However, further prospective randomized and cohort studies are needed.