People living in disadvantaged areas faced greater challenges in staying active and using recreational facilities during the COVID-19 pandemic

This study aimed to understand the perceived effects of the COVID-19 pandemic on physical activity, recreation walking, and use of recreational facilities; and if the COVID-19 pandemic amplified disparities in physical activity, recreational walking, and use of recreational facilities related to the levels of neighborhood disadvantage. Recreational walking and the use of neighborhood streets and green spaces significantly decreased in high deprivation areas but not in low deprivation areas during the pandemic. While COVID-19 has negatively affected overall recreational activities, the inequitable impact on recreational walking and use of outdoor recreational facilities has been more evident in disadvantaged neighborhoods with greater deprivation.     

The landscape of international oral and maxillofacial surgery collaborations from 1996 to 2020: a scoping review of the published literature

The emerging field of global oral and maxillofacial surgery (OMS) aims to improve worldwide access to safe, timely, and affordable OMS care. However, there exists a dearth of literature thoroughly detailing the scope of academic global OMS collaborations between high-income countries (HICs) and low- and/or lower middle-income countries (LICs/LMICs). This scoping review was performed to characterize the landscape of global academic OMS collaborations between HICs and LICs/LMICs. A five-stage methodological framework was used. Academic global OMS collaborations from 1996 to 2020 were identified via an electronic database and grey literature review. A total 1318 articles were identified on December 17, 2020. Following the application of inclusion and exclusion criteria, 71 articles describing 81 unique global OMS academic collaborations were included in the final analysis. The most common HIC was the United States (44.4%); the majority of LIC/LMICs were within Africa (45.8%). Of the total interventions, 89.6% improved LIC/LMIC capacity development, and surgical (43.8%) interventions were the most common. By serving as a central report on current and past academic collaborations in global OMS, this review helps identify areas in need of surgical capacity building, lays the foundation for future research efforts on the topic, and serves as a resource for individuals aiming to become involved in global OMS.     

低分子量肝素对子痫前期产妇产后凝血指标的影响

目的探讨低分子量肝素在子痫前期患者中的应用效果。方法回顾性调查我院2019年1~4月290例子痫前期患者,根据产后1 d采用的治疗方法分为肝素组(190例)及对照组(100例),分析比较两组的一般资料和凝血指标差异。结果肝素组的新生儿体重和Apgar评分(1 min)低于对照组(P<0.05)。肝素组与对照组在产前仅凝血酶时间、D-二聚体、血小板体积分布宽度有差异,产后1 d肝素组纤维蛋白原含量、血小板计数、血小板压积低于对照组,凝血酶时间、D-二聚体、血小板体积分布宽度高于对照组(P<0.05)。产后3 d仅D-二聚体有差异。结论在产后1 d应用低分子量肝素有助于子痫前期患者产后凝血状态向正常恢复。     

An economic analysis of the cost of survival of micro preemies: A systematic review

ObjectiveThis study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g.MethodWe searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists.ResultsThe search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives.ConclusionDespite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.     

Feasibility of a method for low contrast CT image quality assessment using difference detail curves for abdominal scans

This work describes a measurement method for assessing dose-related image-quality of CT scans based on the difference detail curve (DDC) method, and showcases its use in a low contrast setting. The method is based on a phantom consisting of elliptical slices of different sizes into which contrast object modules can be inserted. These modules contain contrast objects based on (synthetic) resin mixtures with sucrose (native) or sodium iodine (contrast medium). Mixing ratios are provided to achieve a range of clinically relevant CT-numbers with these materials. The phantom is characterized in terms of contrast accuracy, energy dependency and long-term drift with satisfying results. Contrast accuracy and energy dependency are similar to that of water or soft tissue. Image quality of 655 scans of the phantom acquired at 30 different clinical institutions and with 16 different CT scanner models from 4 manufacturers was assessed by calculating a difference detail curve (DDC) from evaluation of up to 5 human observers using a custom-made software (RadiVates) described in this work. Based on these measurements, inter-observer variability was quantified using a bootstrap method and was shown to be a large contributor to the overall variability. This work demonstrates that assessment of CT image quality is feasible with the aforementioned phantom and DDC method.     

New evidence supporting lung cancer screening with low dose CT & surgical implications

IntroductionLung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Following the NLST, new evidence has emerged from clinical trials and updates to previous trials prior to the anticipated update to the USPSTF guideline. We review the new evidence on lung cancer screening with low dose computed tomography (LDCT) and the surgical implications.MethodsA review of new literature was performed pertaining to lung cancer screening since implementation of UPSTF guidelines. Articles for inclusion were identified by both authors’, then search of the Pubmed and Cochrane database was performed from January 1st, 2013 through February 4th, 2020 using the MeSH search terms: “lung cancer”; “screening”; “low dose CT”. The results of these studies are summarized.ResultsWe identified multiple prospective randomized control trials and meta-analysis since the NLST supporting lung cancer-specific mortality with screening. We identified new nodule classification systems and the development of risk-models which may reduce false positive rates and identify high risk patients not currently eligible for screening. Finally, we discussed the surgical implications of screening.ConclusionNew data supports NLST findings and show ongoing benefit to LDCT for lung cancer screening. Standardized LDCT screening classification has been shown to reduce harm and lower false positive rates. Further study is needed regarding use of risk-modeling. Screening will require an increase in the thoracic workforce to accommodate the amount of surgically operable cancers.     

中西医结合治疗肺栓塞的临床疗效观察

目的:探析中西医结合治疗肺栓塞的临床疗效。方法:选取2017年3月-2019年3月期间我院收治的92例肺栓塞患者,按信封法分为联合组与对照组,每组46例。两组患者均接受常规溶栓、抗凝治疗,对照组在常规治疗基础上增加低分子肝素治疗,联合组在对照组基础上增加疏血通注射液治疗,对比两组治疗效果、不良反应,并对比两组患者治疗前后血气指标[氧分压(Partial Pressure of Oxygen,PaO2)、二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO2)]及D-二聚体水平的变化情况。结果:对照组治疗总有效率较联合组更低;治疗后,两组患者PaO2、PaCO2均显著上升,其中联合组PaO2上升幅度大,而两组患者D-二聚体水平均显著下降,其中联合组下降幅度大,差异有统计学意义(P<0.05);而两组患者治疗后PaCO2相比,差异无统计学意义(P>0.05);对照组不良反应发生率略低于联合组,差异无统计学意义(P>0.05)。结论:在常规溶栓、抗凝治疗基础上增加低分子肝素结合疏血通注射液治疗肺栓塞的效果显著,可有效改善血气功能,降低机体D-二聚体水平,且不增加不良反应。     

Source imaging of seizure onset predicts surgical outcome in pediatric epilepsy

ObjectiveTo assess whether ictal electric source imaging (ESI) on low-density scalp EEG can approximate the seizure onset zone (SOZ) location and predict surgical outcome in children with refractory epilepsy undergoing surgery.MethodsWe examined 35 children with refractory epilepsy. We dichotomized surgical outcome into seizure- and non-seizure-free. We identified ictal onsets recorded with scalp and intracranial EEG and localized them using equivalent current dipoles and standardized low-resolution magnetic tomography (sLORETA). We estimated the localization accuracy of scalp EEG as distance of scalp dipoles from intracranial dipoles. We also calculated the distances of scalp dipoles from resection, as well as their resection percentage and compared between seizure-free and non-seizure-free patients. We built receiver operating characteristic curves to test whether resection percentage predicted outcome.ResultsResection distance was lower in seizure-free patients for both dipoles (p = 0.006) and sLORETA (p = 0.04). Resection percentage predicted outcome with a sensitivity of 57.1% (95% CI, 34–78.2%), a specificity of 85.7% (95% CI, 57.2–98.2%) and an accuracy of 68.6% (95% CI, 50.7–83.5%) (p = 0.01).ConclusionIctal ESI performed on low-density scalp EEG can delineate the SOZ and predict outcome.SignificanceSuch an application may increase the number of children who are referred for epilepsy surgery and improve their outcome.