bluuebunny/crossref_metadata_2025_split huggingface dataset:
Shock Severity Modifies Associations Between RBC Transfusion in the First 48 Hours of Sepsis Onset and the Duration of Organ Dysfunction in Critically Ill Septic Children*
Authors: Srouji Lara S. , Moore-Clingenpeel Melissa , Hensley Josey , Steele Lisa , Greathouse Kristin , Anglim Larissa , Hanson-Huber Lisa , Nateri Jyotsna , Nicol Kathleen , Hall Mark W. , Ramilo Octavio , Muszynski Jennifer A. 
Published: March 2020

Objective:
To test the hypothesis that early RBC transfusion is associated with duration of organ dysfunction in critically ill septic children.

Design:
Secondary analysis of a single-center prospective observational study. Multivariable negative binomial regression was used to determine relationships between RBC transfusion within 48 hours of sepsis onset and number of days in 14 with organ dysfunction, or with multiple organ dysfunction syndrome.

Setting:
A PICU at a quaternary care children’s hospital.

Patients:
Children less than 18 years old with severe sepsis/septic shock by consensus criteria were included. Patients with RBC transfusion prior to sepsis onset and those on extracorporeal membrane oxygenation support within 48 hours of sepsis onset were excluded.

Interventions:
None.

Measurements and Main Results:
Ninety-four patients were included. Median age was 6 years (0–13 yr); 61% were male. Seventy-eight percentage had septic shock, and 41 (44%) were transfused RBC within 48 hours of sepsis onset (early RBC transfusion). On multivariable analyses, early RBC transfusion was independently associated with 44% greater organ dysfunction days (adjusted relative risk, 1.44 [1.04–2.]; p = 0.03), although risk differed by severity of illness (interaction p = 0.004) and by shock severity (interaction p = 0.04 for Vasoactive Inotrope Score and 0.03 for shock index). Relative risks for multiple organ dysfunction syndrome days varied by shock severity (interaction p = 0.008 for Vasoactive Inotrope Score and 0.01 for shock index). Risks associated with early RBC transfusion were highest for the children with the lowest shock severities.

Conclusions:
In agreement with previous studies, early RBC transfusion was independently associated with longer duration of organ dysfunction. Ours is among the first studies to document different transfusion-associated risks based on clinically available measures of shock severity, demonstrating greater transfusion-associated risks in children with less severe shock. Larger multicenter studies to verify these interaction effects are essential to plan much-needed RBC transfusion trials for critically ill septic children.
An Adolescent With Progressive Shortness of Breath
Authors: Szadkowski Adam , Hagen Scott 
Published: March 2020

AbstractShortness of breath and wheezing are common presenting signs for children in the emergency department. In adolescence, it is often due to asthma or lower respiratory tract infections. We present a rare pediatric case of an adolescent with biphasic stridor and progressive exercise-induced shortness of breath who was found to have severe idiopathic subglottic stenosis.
Utility of Point-of-Care Ultrasound for the Diagnosis of Hill-Sachs Deformity in the Pediatric Emergency Department
Authors: Solomon Linda , Goldwasser Bernard , Huston Katherine , Meltzer James A. 
Published: March 2020

Abstract
We report a case of a 20-year-old man presenting to our pediatric emergency department with an anterior shoulder dislocation. Point-of-care ultrasound demonstrated a Hill-Sachs deformity. The potential role of ultrasound and the clinical importance of identifying patients with Hill-Sachs deformities are discussed.
Defining Pneumonia Severity in Children
Authors: Dean Preston , Schumacher Daniel , Florin Todd A. 
Published: March 2020

Objectives
Although community-acquired pneumonia (CAP) is one of the most common infections in children, no standardized risk classification exists to guide management. The objective of this study was to develop expert consensus for factors associated with various degrees of disease severity in pediatric CAP.

Methods
Using a web-based classical Delphi process, a multidisciplinary panel of 10 childhood pneumonia experts rated the degree of severity (mild, moderate, or severe) of clinical, radiographic, and laboratory factors, as well as outcomes relevant to pediatric pneumonia. Round 1 was open-ended, with panelists freely stating all characteristics they felt determined pneumonia severity. In rounds 2 to 4, panelists used a 9-point Likert scale (1–3, mild; 4–6, moderate; 7–9, severe) to rate severity for each item. Consensus was defined as 70% or greater agreement in ranking mild, moderate, or severe.

Results
Panelists identified 318 factors or outcomes in round 1; the panel reached consensus for 286 (90%). The majority of items without consensus straddled levels of severity (eg, mild-moderate). Notable clinical factors with consensus included age, oxygen saturation, age-based respiratory rate, and gestational age. Severity classification consensus was also reached for specific imaging and laboratory findings. Need for and duration of hospitalization, supplemental oxygen/respiratory support, and intravenous fluids/medications were considered important outcomes in classifying severity.

Conclusions
This study presents factors deemed important for risk stratification in pediatric CAP by consensus of a multidisciplinary expert panel. This initial step toward identifying and formalizing severity criteria for CAP informs critical knowledge gaps and can be leveraged in future development of clinically meaningful risk stratification scores.
Effects of Transcutaneous Neuromuscular Electrical Stimulation on Swallowing Disorders
Authors: Sun Yuanyuan , Chen Xiaoyun , Qiao Jianhong , Song Guixiang , Xu Yuedong , Zhang Yan , Xu Dongmei , Gao Wei , Li Yunfeng , Xu Cuiping 
Published: March 2020

Objective
The aim of the study was to evaluate the efficacy of transcutaneous neuromuscular electrical stimulation on swallowing disorders.

Design
MEDLINE/PubMed, Embase, CENTRAL, Web of science, and PEDro were searched from their earliest record to August 1, 2019. All randomized controlled trials and quasi-randomized controlled trial were identified, which compared the efficacy of neuromuscular electrical stimulation plus traditional therapy with traditional therapy in swallowing function. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to evaluate the quality of evidence.

Results
Eight randomized controlled trials and three quasi-randomized controlled trials were included. These studies demonstrated a significant, moderate pooled effect size (standard mean difference = 0.62; 95% confidence interval = 0.06 to 1.17). Studies stimulating suprahyoid muscle groups revealed a negative standard mean difference of 0.17 (95% confidence interval = −0.42, 0.08), whereas large effect size was observed in studies stimulating the infrahyoid muscle groups (standard mean difference = 0.89; 95% confidence interval = 0.47 to 1.30) and stimulating the suprahyoid and infrahyoid muscle groups (standard mean difference = 1.4; 95% confidence interval = 1.07 to 1.74). Stimulation lasting 45 mins or less showed a large, significant pooled effect size (standard mean difference = 0.89; 95% confidence interval = 0.58 to 1.20). The quality of evidences was rated as low to very low.

Conclusions
There is no firm evidence to conclude on the efficacy of neuromuscular electrical stimulation on swallowing disorders. Larger-scale and well-designed randomized controlled trials are needed to reach robust conclusions.
Decision-Making in Middle Vault Reconstruction following Dorsal Hump Reduction in Primary Rhinoplasty
Authors: Avashia Yash J. , Marshall Andre P. , Allori Alexander C. , Rohrich Rod J. , Marcus Jeffrey R. 
Published: March 2020

Background:
Dorsal hump reduction during open rhinoplasty disrupts the continuity between the upper lateral cartilages and the dorsal septum. Options to reconstitute the midvault include primary closure of the upper lateral cartilages to the dorsal aspect of the septum, placement of spreader grafts, and creation of spreader flaps. The authors sought to clarify from highly experienced rhinoplasty surgeons their decision-making rationale for midvault reconstruction, distilling down the group consensus into algorithmic guidelines.

Methods:
A panel of internationally recognized rhinoplasty surgeons participated in a two-part organized communication method. An introductory summit consisted of open discussions on various topics in midvault reconstruction. The summit transcription was analyzed by thematic content analysis to develop a survey encompassing clinical scenarios for primary rhinoplasty, which was then individually administered to each panelist. Data gathered from both parts were used to generate technical guidelines and a decision-making algorithm.

Results:
The panelists identified the following anatomical features as pertinent to their selection of midvault reconstruction method: size of the dorsal hump reduction, width of the midvault relative to the upper vault, presence of dorsal angulation, and presence of nasal obstructive symptoms. Individual panelist preference was gathered from the 24-scenario survey divided into either cosmetic or functional rhinoplasty cases.

Conclusions:
Management of the midvault after dorsal hump reduction is important to establish proper aesthetic relationships and to provide functional integrity of the internal valve. Our authors present an algorithmic approach to decision-making based on the systematic analysis practiced by senior rhinoplasty surgeons.
“Disbelief and Sadness”: First-Year Health Profession Students’ Perspectives on Medical Errors
Authors: Davis Beth P. , Clevenger Carolyn , Dillard Rebecca , Moulia Danielle , Ander Douglas S. 
Published: March 2020

Objectives
The aims of the study were to examine the reactions of first-year health profession students to medical errors and determine whether differences exist between disciplines.

Methods
After viewing the Team STEPPS Program’s Susan Sheridan video that describes two separate medical errors, students from anesthesia assistant, medical imaging, medicine, nursing, physical therapy, and physician assistant programs provided unstructured open responses reflecting on initial impressions of medical errors depicted in the film. Student responses were assessed via inductive coding techniques and thematic analysis and stratified by discipline. Frequencies of key themes were calculated. Descriptive analyses characterized respondents and χ2 tests compared responses between disciplines.

Results
In a review of 373 student responses (80% response rate), 255 students expressed an emotion-based reply, of which 93.75 were negative with such comments as they felt horrified, appalled, and disappointed by the patient’s experience. Of the 227 students who commented on blame or fault, 70% felt that a system error was at fault, 45% felt that it was the provider and only 1.3% stated that it was the patient’s fault. Of the students who mentioned the context or situation, just more than half felt that the episode was preventable and there was a causal relationship between clinic workers’ actions and the medical error. Finally, a high percentage of students had a solutions-oriented response, noting the importance of teamwork and communication in the avoidance of medical errors.

Conclusions
First-year health profession students responded to medical error with strong emotion and distress. Their responses largely represent an individualistic view of healthcare in both the causes and solutions to medical errors. No differences in response themes were observed by discipline. This study represents our students’ emotional responses to a medical error scenario. The qualitative responses and reactions of students to the Sheridan video offered opportunities to tease out nuances that would otherwise be unavailable in a typical attitudes survey. We noted a individualistic view of healthcare in both the causes and solutions to medical errors. We view these results as an opportunity for interprofessional education in systems-level approaches to improve patient safety. Curricular efforts in interprofessional education, collaborative practice, and patient safety should be driven by these results.
Crohn's Disease Activity Quantified by Iodine Density Obtained From Dual-Energy Computed Tomography Enterography
Authors: Dane Bari , Duenas Sean , Han Joseph , O'Donnell Thomas , Ream Justin , Chang Shannon , Megibow Alec 
Published: March 2020

Objective
The objective of this study was to assess if bowel wall iodine density obtained from dual-source, dual-energy computed tomography enterography (DECTE) could be a biomarker of Crohn's disease activity.

Methods
Twenty-two patients with Crohn's disease imaged with DECTE from February 2016 to May 2018 were retrospectively identified by departmental report search. Iodine maps were created with commercial software (Syngovia). Iodine content was normalized to the aorta, and then manual dual-energy region-of-interest cursors were placed over the visibly assessed maximal and minimal iodine density within segments of involved as well as unaffected small bowel. The mixed Hounsfield unit value, maximum iodine density (I
max), and minimum iodine density (I
min) were recorded. The length of affected bowel demonstrating maximum disease activity as a percentage of overall involvement was subjectively assessed. A weighted iodine density (I
weighted) was calculated. The clinical assessment of disease activity using erythrocyte sedimentation rate, C-reactive protein, fecal calprotectin, colonoscopy/endoscopy, and surgery, if available, served as the reference standard. The Crohn's disease activity index was also used as a separate additional reference standard.

Results
Significant heterogeneity within the affected segments was present. The average I
max and I
min of affected bowel was 4.27 ± 1.11 (2.4–7.4) mg/mL and 2.71 ± 0.51 (2.2–3.9) mg/mL, respectively. Iodine density of normal-appearing small bowel was 1.40 ± 0.26 (0.9–1.9) mg/mL. The I
max and I
min of affected bowel differed significantly from normal bowel (P < 0.0001). Mixed Hounsfield unit (101.82 ± 27.5) also statistically differed (46.33 ± 19.62) (P < 0.0001). Using overall clinical assessment as the reference standard, all patients with I
min of greater than 2.6 mg/mL, I
weighted of greater than 3.3 mg/mL, or I
max of greater than 4.7 mg/mL had clinically active disease. Sixteen of 17 patients with I
min of greater than 2.2 mg/mL and 14/15 with I
weighted of greater than 3 mg/mL had clinically active disease. Using Crohn's disease activity index as the reference standard, all patients with I
min of greater than 2.7 mg/mL, I
weighted of greater than 3.6 mg/mL, or I
max of greater than 5.4 mg/mL had clinically active disease. The median effective dose was 4.64 ± 1.68 mSv (range, 2.03–8.12 mSv).

Conclusions
Iodine density obtained from DECTE highlights regions of maximal activity within affected bowel segments. An iodine density of 2 mg/mL appears to be a threshold between normal bowel segments and those with active Crohn's disease. Iodine density measurement thresholds I
min of greater than 2.6 mg/mL, I
weighted of greater than 3.3 mg/mL, and I
max of greater than 4.7 mg/mL correlate with established clinical markers of disease activity, with I
min seemingly most useful in daily clinical practice.
Comparison of Model-Free and Model-Based Dynamic Contrast-Enhanced Magnetic Resonance Imaging Pharmacokinetic Parameters for Predicting Breast Cancers' Response to Neoadjuvant Chemotherapy
Authors: Lv Guangjie , Zhou Yiming , Zheng Dandan , Gao Jiayin , Xu Zhujin , Jiang Lei 
Published: March 2020

Objective
To prospectively compare the performance of model-based and model-free dynamic contrast-enhanced (DCE) pharmacokinetic parameters in monitoring breast cancers' early response to neoadjuvant chemotherapy (NACT).

Methods
Sixty patients, with 61 pathology-proven breast cancers, were examined using DCE magnetic resonance imaging before, after the first cycle, and after full cycles of NACT. Both model-based (K
trans and others) and model-free parameters, mainly time-intensity curve (TIC), were measured. According to Miller-Payne grading, patients were divided into response and nonresponse group. Mann-Whitney U test, Fisher exact test, multivariate logistic regression, and receiver operating characteristic curve were used in analysis.

Results
After the first cycle, among all the parameters, K
trans and TIC were strongly associated with tumors' early response. There was no significant difference between the areas under receiver operating characteristic curve of K
trans and TIC (0.768, 0.852, respectively).

Conclusions
Model-based and model-free DCE parameters, especially K
trans and TIC, have similar performance in predicting the efficacy of NACT for breast cancers.
Costal Cartilage and Costal Perichondrium Sandwich Graft in Septal Perforation Repair
Authors: Hanci Deniz , Üstün Onur , Yilmazer Ayça Başkadem , Göker Ayşe Enise , Kumral Tolgar Lütfi , Uyar Yavuz 
Published: March 2020

Background:
Repair of the septal perforation is a challenging procedure and there are many different surgical techniques. In this study, the authors present a novel method which the authors use costal cartilage and costal perichondrium sandwich graft as an interposition graft with bilateral opposing mucoperichondrial flaps.

Patients and Methods:
Fourteen patients (5 females, 9 males) underwent septal perforation repair. All surgeries were performed through an open approach septoplasty technique. The edges of the perforation were incised to excise the mucosa with a thickness of 2 mm. Bilateral mucoperichondrial flaps were raised. Then costal cartilage and costal perichondrium were harvested from the rib. The cartilage was divided into a smaller piece which is 2 mm thick and 1 cm wider than perforation size. The prepared cartilage was wrapped with perichondrium to obtain a sandwich graft. This sandwich graft was placed between the mucoperichondrial flaps, corresponding to the perforation.

Results:
After 9 months of follow-up, 11 (78%) of the 14 perforations were completely closed. Failure of the repair was observed in 3 patients; 2 of the perforations were medium size and one perforation was large size. No complications occurred.

Conclusion:
Using costal cartilage and costal perichondrium sandwich graft is a novel and useful technique especially in large septal perforations. Considering that septum surgery has an important role in the etiology of septum perforation, this method provides a good graft source for both perforation closure and simultaneous rhinoplasty surgery.
Unusual Mimicker of the Carotid Body Tumor: Synovial Sarcoma of the Carotid Space
Authors: Gozgec Elif , Ogul Hayri 
Published: March 2020

Abstract
Synovial cell sarcomas are malignant tumors originating from pluripotent mesenchymal stem cells, unlike its name. It is a common tumor in the periarticular area, accounting for 8% of all soft tissue sarcomas. Head and neck are among the rarest areas of this tumor. Synovial sarcomas of the head and neck are more aggressive than those seen in other regions and are associated with remarkable mortality and morbidity. Treatment of synovial sarcomas of the head and neck is usually extensive local excision and additional radiation and/or chemotherapy may be performed.
Idiopathic Orbital Inflammation With Superior Rectus and Levator Complex may be Misdiagnosed as Involutional Ptosis
Authors: Kim Seungheon , Yang Sungwon , Park Jinhwan , Lee Hwa , Baek Sehyun 
Published: March 2020

Abstract
Idiopathic orbital inflammation (IOI) is a benign inflammatory disease usually confined to the orbit. Two middle-aged patients with IOI have been reported who could have been misdiagnosed as involutional ptosis. Two patients presented to the clinic with eyelid ptosis. One patient's erythrocyte sedimentation rate was slightly increased; the other patient's immunoglobulin G4 (IgG4), IgG, and thyroid-stimulating hormone results were higher than the upper limits of normal. The computed tomographic images and orbit magnetic resonance imaging tests showed an inflammatory condition around the droopy eyelids. They were both admitted to the hospital with diagnosis of IOI, and intravenous antibiotic and steroid treatment were administered, which improved their symptoms.
Periorbital Emphysema Presenting With Diplopia After Rhinoplasty
Authors: Lee Ho Yun , Lee Jun , Choi Myoung Su , Kim Su Jin 
Published: March 2020

Abstract
Periorbital emphysema is a well-known but very rare complication after rhinoplasty. Here, we present a case of periorbital emphysema presenting with diplopia and eyeball deviation after rhinoplasty. All symptoms disappeared spontaneously within days, without any complications.
Histone deacetylase 6 inhibition improves survival in a swine model of lethal hemorrhage, polytrauma, and bacteremia
Authors: Biesterveld Ben E. , Wakam Glenn K. , Kemp Michael T. , Williams Aaron M. , Shamshad Alizeh , O'Connell Rachel L. , Siddiqui Ali Z. , Chtraklin Kiril , Bhatti Umar F. , Li Yongqing , Alam Hasan B. 
Published: March 2020

BACKGROUND
Trauma is the leading cause of death for young Americans. Nonspecific histone deacetylase inhibitors, such as valproic acid, have been shown to improve survival in preclinical models of lethal trauma, hemorrhage, and sepsis. The doses needed to achieve a survival benefit are higher than Food and Drug Administration–approved doses, and the nonspecificity raises concerns about unintended adverse effects. The isoform-specific histone deacetylase 6 inhibitor, ACY-1083, has been found to be as efficacious as valproic acid in a rodent model of hemorrhagic shock. We hypothesized that ACY-1083 treatment would improve survival in a swine model of lethal hemorrhage, polytrauma, and bacteremia.

METHODS
Swine were subjected to 45% blood volume hemorrhage, brain injury, femur fracture, rectus crush, splenic and liver lacerations, and colon injury. After 1 hour of shock (mean arterial pressure, 30–35 mm Hg), animals were randomized to normal saline resuscitation (control) or normal saline plus ACY-1083 30 mg/kg treatment (n = 5/group). After 3 hours (simulating delayed evacuation), packed red blood cells and antibiotics were administered, the colon injury was repaired, and the abdomen was closed. Animals were then monitored for another 4 hours. Survival was assessed using Kaplan-Meier and log-rank test.

RESULTS
This combination of injuries was lethal. All animals became bacteremic, in addition to the severe hemorrhagic shock. Survival in the control group was 0%, and ACY-1083 treatment increased survival to 80% (p = 0.019). There was no difference in the brain lesion size between the groups.

CONCLUSION
A single dose of ACY-1083 markedly improves survival in an otherwise lethal model of polytrauma, hemorrhagic shock, and bacteremia.