bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of Carbon Dioxide Versus Air Insufflation for Colonoscopy in Deeply Sedated Pediatric Patients
Authors: Dharmaraj Rajmohan , Dunn Rachel , Fritz Julia , Dasgupta Mahua , Simpson Pippa , Cabrera Jose , Miranda Adrian , Lerner Diana G. 
Published: February 2020

ABSTRACTObjectives:Studies have shown the advantages of carbon dioxide (CO2) over air insufflation in the adult population during colonoscopies. This study was designed to investigate the efficacy and safety of CO2 insufflation in deeply sedated children undergoing colonoscopy.Methods:This was a prospective, randomized, double‐blind clinical trial. We recruited 100 consecutive pediatric patients who had colonoscopy under deep sedation for various indications. Patients were first randomized by history of abdominal pain and then randomly assigned to either CO2 or air insufflation. Postprocedural abdominal pain scores were registered on a 10‐point visual analog rating scale and significant pain was defined as a score of 3 or higher. Abdominal circumferences and end tidal CO2 (ETCO2) levels were measured. Complications during and after the procedure were recorded.Results:We did not find statistically significant difference between CO2 and air insufflation on univariate analysis because of low number of children experiencing significant pain after colonoscopy. After adjusting for baseline pain, we found that pain was significantly lower in patients after CO2 versus air insufflation on multivariable analysis (P = 0.03). The significant factors related to pain were duration of the procedure (P = 0.006), history of abdominal pain (P = 0.002) and previous abdominal surgery (P = 0.02). CO2 insufflation was associated with decreased abdominal circumference after colonoscopy (P = 0.002). Girls were more likely to have pain regardless of intervention (P = .04).Conclusions:Most children tolerate endoscopic procedures without significant pain. Our study was underpowered to show significant difference between air and CO2 on univariate analysis. CO2 insufflation during colonoscopy, however, may reduce postprocedural abdominal pain. Significant factors for increased pain on multivariate analysis included colonoscopy length over 30 minutes, history of abdominal pain, and previous abdominal surgery.
Neurological Adverse Effects Associated With Anti‐tumor Necrosis Factor Alpha Antibodies in Pediatric Inflammatory Bowel Diseases
Authors: Bertrand Valérie , Massy Nathalie , Pigneur Bénédicte , Coopman Stéphanie , Durrieu Geneviève , Gaboriau Louise , Langlois Vincent , Gower‐Rousseau Corinne , Hugot Jean‐Pierre , Ruemmele Frank M. ,   GETAID (Groupe d’Etude thérapeutique des Affections Inflammatoires du Tube Digestif) Pdiatrique
Published: February 2020

ABSTRACTObjectives:Neurological adverse effects (NAEs) induced by biotherapies have been reported in the literature mainly in adult patients with inflammatory bowel disease (IBD), rheumatic diseases, or psoriasis. There are scant data in children. Aims of this study are to report and describe noninfective NAE associated with anti‐TNFα antibodies in pediatric IBD, and to evaluate their incidence.Methods:We retrospectively collected all reports of NAE in pediatric IBD treated with anti‐TNFα antibodies recorded in the French Pharmacovigilance Database. To estimate the national incidence of NAEs, we extrapolated data from the French regional inception population‐based cohort EPIMAD.Results:Between 2000 and 2018, 231 adverse events in pediatric IBD exposed to anti‐TNFα antibodies were reported to this Database. Seventeen NAEs (7.36%) were collected: 8 severe NAE (1 demyelinating neuropathy, 1 optic neuritis, 1 acute transverse myelitis, 1 polyradiculoneuritis, 1 sensorineural hearing loss, 1 seizure, 1 stroke, and 1 glioma), 7 moderate NAE (headaches), and 2 neuropsychic events. The median delay between anti‐TNFα start and NAE occurrence was 6 months (range: 13 days to 26 months). In 10 of 17 patients, anti‐TNFα antibodies were stopped. Nine of 17 patients had a complete resolution (including 2 severe NAE) and 8 of 17 a partial resolution (including 6 severe NAE). We estimate the incidence of severe NAE in pediatric IBD treated with anti‐TNFα antibodies at 1 case for 10,000 patients‐year in France.Conclusions:NAE associated with anti‐TNFα antibodies in pediatric IBD are rare. In severe NAE, we recommend to discontinue anti‐TNFα therapy and to consider alternative treatment.
Probiotics and Preterm Infants
Authors: van den Akker Chris H.P. , van Goudoever Johannes B. , Shamir Raanan , Domellöf Magnus , Embleton Nicholas D. , Hojsak Iva , Lapillonne Alexandre , Mihatsch Walter A. , Berni Canani Roberto , Bronsky Jiri , Campoy Cristina , Fewtrell Mary S. , Fidler Mis Nataša , Guarino Alfredo , Hulst Jessie M. , Indrio Flavia , Kolaček Sanja , Orel Rok , Vandenplas Yvan , Weizman Zvi , Szajewska Hania 
Published: February 2020

ABSTRACTMore than 10,000 preterm infants have participated in randomised controlled trials on probiotics worldwide, suggesting that probiotics in general could reduce rates of necrotising enterocolitis (NEC), sepsis, and mortality. Answers to relevant clinical questions as to which strain to use, at what dosage, and how long to supplement are, however, not available. On the other hand, an increasing number of commercial products containing probiotics are available from sometimes suboptimal quality. Also, a large number of units around the world are routinely offering probiotic supplementation as the standard of care despite lacking solid evidence. Our recent network meta‐analysis identified probiotic strains with greatest efficacy regarding relevant clinical outcomes for preterm neonates. Efficacy in reducing mortality and morbidity was found for only a minority of the studied strains or combinations. In the present position paper, we aim to provide advice, which specific strains might potentially be used and which strains should not be used. In addition, we aim to address safety issues of probiotic supplementation to preterm infants, who have reduced immunological capacities and occasional indwelling catheters. For example, quality reassurance of the probiotic product is essential, probiotic strains should be devoid of transferable antibiotic resistance genes, and local microbiologists should be able to routinely detect probiotic sepsis. Provided all safety issues are met, there is currently a conditional recommendation (with low certainty of evidence) to provide either Lactobacillus rhamnosus GG ATCC53103 or the combination of Bifidobacterium infantis Bb‐02, Bifidobacterium lactis Bb‐12, and Streptococcus thermophilus TH‐4 in order to reduce NEC rates.
Quality and Safety in Healthcare, Part LXV
Authors: Harolds Jay A. 
Published: February 2020

Abstract
Matriculating medical students have a low degree of psychological distress. Yet, over time burnout, suicidal ideation, and evidence of depression become quite prevalent among medical students. Often, approximately 50% of the students and sometimes more suffer from burnout. The prevalence of depression in different studies varied but was often approximately 20%. Suicidal ideation in medical students in various articles had a prevalence of approximately 6% to 11%.
Longitudinal 18F-FDG Images in Patients With Alzheimer Disease Over More Than 9 Years From a Preclinical Stage
Authors: Ishibashi Kenji , Onishi Airin , Wagatsuma Kei , Fujiwara Yoshinori , Ishii Kenji 
Published: February 2020

Background
Brain 18F-FDG uptake reportedly starts to decline more than 10 years before the onset of cognitive decline in dominantly inherited Alzheimer disease (AD). We compared longitudinal 18F-FDG images in sporadic AD to aging data from a large sample size to expand the current knowledge of 18F-FDG reduction for AD progression.

Methods
Participants comprised 2 individuals (subjects A and B at ages 65 and 68 years, respectively) and 107 control subjects (67.9 [SD, 4.9] years). Subject A underwent 18F-FDG PET a total of 8 times over 9 years from the preclinical to early dementia stages. Subject B underwent 18F-FDG PET a total of 11 times over 12 years from the preclinical to mild cognitive impairment stages. Control subjects underwent 18F-FDG PET twice over a mean follow-up period of 7.8 years. After placing the volume of interest on the AD-related hypometabolic regions, the longitudinal 18F-FDG images were compared among the subjects and control subjects.

Results
For the control group, the rate of 18F-FDG reduction was 2.2% per decade (ie, aging effects). The rates of 18F-FDG reduction were 9.41% over 9 years and 9.07% over 12 years in subjects A and B, respectively. We estimated that 18F-FDG uptake started to decrease 4 and 2 years before indications of memory loss in subjects A and B, respectively.

Conclusions
The present study suggests that the time between the beginning of 18F-FDG reduction and the onset of cognitive decline may be shorter in elderly individuals with AD compared with the recently estimated period in dominantly inherited AD.
Solitary Lip Extranodal Natural Killer/T-Cell Lymphoma on FDG PET/CT
Authors: Zhang Jianhua , Li Shusheng , Fan Yan , Li Qian , Nong Lin 
Published: February 2020

Abstract
A 54-year-old man presented with a history of upper lip pain for 4 weeks. Biopsy of the lip lesion revealed extranodal natural killer/T-cell lymphoma. 18F-FDG PET/CT scan showed the solely high uptake in the right upper lip without any other nodal or extranodal involvements.
Cost Utility Analysis of Staged Versus Single-Stage Cleft Lip and Palate Repair
Authors: Holzmer Stephanie , Davila Armando , Martin Mark C. 
Published: February 2020

Purpose
As one of the most common congenital craniofacial deformities, cleft lip and palate repair is a complex and much published topic. Proper treatment can require a multitude of appointments and operations and can place a significant burden on both the patients' families and the health care system itself. One proposed solution has been to combine multiple cleft procedures. However, these more complex operations have drawn concerns from institutions and providers regarding increased cost. This study provides a cost utility analysis between single-stage and staged unilateral cleft lip and palate repairs.

Methods
A retrospective review was conducted via current procedural terminology code identification of all cleft-related operations performed between 2013 and 2018. Patients were screened according to diagnosis, and only analysis on unilateral cleft lip and palate patients was performed. Patients were split into 2 cohorts: those that underwent a single-stage complete cleft repair, which includes palate, lip, alveolus, and nasal repair—termed “PLAN” at our institution, and those that underwent more traditional staged lip and palate repairs. Demographic and billing data were collected for any procedure performed between patient ages 0 and 24 months. χ2, t-tests, and parametric regression analyses were performed to compare the cohorts.

Results
Between 2013 and 2018, 968 (n = 968) cleft-related operations were conducted at Loma Linda University Children's Hospital. Seven hundred ninety-six (n = 796) noncleft lip/palate repairs and 38 (n = 38) bilateral cleft lip repairs were excluded. Of the remaining 135 (n = 135) patients with unilateral cleft lip and palate, detailed cost data were available for 86 single-stage and 28 staged repairs. The average combined total cost for single-stage repairs was US $80,405 compared with US $109,473 for staged repairs (P < 0.001). The average total intraoperative cost for single-stage repairs was US $60,683 versus US $79,739 for staged repairs (P < 0.001), and the average total postoperative cost for single-stage repairs versus staged repairs was US $19,776 and US $29,703, respectively (P < 0.001).

Conclusions
This analysis suggests that single-stage PLAN repair, provides an effective, cost-efficient solution to unilateral cleft lip and palate care, reducing burden on patients' families and the health care system at large.
Is Less Actually More? An Evaluation of Surgical Outcomes Between Endoscopic Suturectomy and Open Cranial Vault Remodeling for Craniosynostosis
Authors: Melin Alyson A. , Moffitt Joseph , Hopkins David C. , Shah Manish N. , Fletcher Stephen A. , Sandberg David I. , Teichgraeber John F. , Greives Matthew R. 
Published: February 2020

Background:
Both open cranial vault remodeling (CVR) and endoscopic suturectomy are effective in treating the anatomical deformity of craniosynostosis. While parents are increasingly knowledgeable about these 2 treatment options, information regarding the perioperative outcomes remains qualitative. This makes preoperative counseling regarding surgical choices difficult. The purpose of this study was to evaluate the outcomes in patients with craniosynostosis who underwent traditional CVR versus endoscopic suturectomy.

Methods:
Open and endoscopic craniosynostosis surgeries performed at our institution from January 2014 through December 2018 were retrospectively reviewed and perioperative data, including operative time, estimated blood loss, transfusion rate and length of stay, was analyzed. A student t test was used with significance determined at P < 0.05.

Results:
CVR was performed for 51 children while 33 underwent endoscopic procedures. Endoscopic suturectomy was performed on younger patients (3.8 versus 14.0 months, P < 0.001), had shorter operative time (70 versus 232 minutes, P < 0.001), shorter total anesthesia time (175 versus 352 minutes, P < 0.001), lower estimated blood loss (10 versus 28 ml/kg, P < 0.001), lower percentage transfused (42% versus 98%, P < 0.001), lower transfusion volume (22 versus 48 ml/kg, P < 0.001), and shorter length of stay (1.8 versus 4.1 days, P < 0.001) when compared to open CVR.

Conclusion:
Both open CVR and endoscopic suturectomy are effective in treating deformities due to craniosynostosis. The endoscopic suturectomy had significantly shorter operative and anesthesia time as well as overall and PICU length of stay. CVR was associated with greater intraoperative blood loss and more frequently required higher rates of blood transfusions.
The Postoperative Changes of Nasal Septum and Maxilla After Alveolar Bone Grafts in Patients With Unilateral Alveolar Cleft
Authors: Kim Jeenam , Jun Dongkeun , Lee Myungchul , Shin Donghyeok , Kim Soonheum , Jo Dongin , Kim Cheolkeun , Choi Hyungon 
Published: February 2020

Background:
Alveolar clefts give rise to many aesthetic and functional problems among affected patients. Therefore, surgical adjustments of the bony defective anomalies are important. The authors performed secondary bone grafts and analyzed the effects particularly on the nasal septum and maxillary area (midface).

Methods:
The patients who had alveolar bone grafts were retrospectively reviewed with pre/postoperative 3-dimensional computed tomography; the measurements included distances between the anterior nasal spine (ANS) and the vertical midline, angles between the nasal septum and the transverse line, and angles between the floor of the pyriform aperture and the transverse line.

Results:
A total number of 23 patients were finally included in the study. The mean age of the patients was 9.7 ± 1.95 years (range, 7–14 years). The mean distance between the ANS and the vertical midline was 5.3 ± 4.70 mm/4.9 ± 4.15 mm pre/postoperatively, showing the mean paired difference of 0.4 ± 0.89 mm (P < 0.05). The mean angles between the nasal septum and the transverse line and between the floor of the pyriform aperture and the transverse line were 64.5 ± 14.69°/65.9 ± 13.73° and 21.7 ± 8.94°/11.5 ± 7.03° pre/postoperatively, showing the mean paired differences of −1.4 ± 2.78° and 10.1 ± 8.20°, respectively (both P < 0.05).

Conclusion:
The results suggest that secondary alveolar bone grafting has expanded effects on the adjacent midfacial structures.
ALPPS Improves Survival Compared With TSH in Patients Affected of CRLM
Authors: Hasselgren Kristina , Røsok Bård I. , Larsen Peter N. , Sparrelid Ernesto , Lindell Gert , Schultz Nicolai A. , Bjørnbeth Bjorn A. , Isaksson Bengt , Larsson Anna Lindhoff , Rizell Magnus , Björnsson Bergthor , Sandström Per 
Published: February 2020

Objective:
To evaluate the oncological outcome for patients with colorectal liver metastases (CRLM) randomized to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) or 2-stage hepatectomy (TSH).

Background:
TSH with portal vein occlusion is an established method for patients with CRLM and a low volume of the future liver remnant (FLR). ALPPS is a less established method. The oncological outcome of these methods has not been previously compared in a randomized controlled trial.

Methods:
One hundred patients with CRLM and standardized FLR (sFLR) <30% were included and randomized to resection by ALPPS or TSH, with the option of rescue ALPPS in the TSH group, if the criteria for volume increase was not met. The first radiological follow-up was performed approximately 4 weeks postoperatively and then after 4, 8, 12, 18, and 24 months. At all the follow-ups, the remaining/recurrent tumor was noted. After the first follow-up, chemotherapy was administered, if indicated.

Results:
The resection rate, according to the intention-to-treat principle, was 92% (44 patients) for patients randomized to ALPPS compared with 80% (39 patients) for patients randomized to TSH (P = 0.091), including rescue ALPPS. At the first postoperative follow-up, 37 patients randomized to ALPPS were assessed as tumor free in the liver, and also 28 patients randomized to TSH (P = 0.028). The estimated median survival for patients randomized to ALPPS was 46 months compared with 26 months for patients randomized to TSH (P = 0.028).

Conclusions:
ALPPS seems to improve survival in patients with CRLM and sFLR <30% compared with TSH.
Does Sex, Race, and the Size of a Kidney Transplant Candidate’s Social Network Affect the Number of Living Donor Requests? A Multicenter Social Network Analysis of Patients on the Kidney Transplant Waitlist
Authors: Gillespie Avrum , Gardiner Heather M. , Fink Edward L. , Reese Peter P. , Gadegbeku Crystal A. , Obradovic Zoran 
Published: February 2020

Background.
A kidney transplant candidate’s social network serves as a pool of potential living donors. Sex and racial differences in network size, network strength, and living donor requests may contribute to disparities in living donor kidney transplantation.

Methods.
In this multicenter cross-sectional study, we performed an egocentric network analysis via a telephone survey of 132 waitlisted candidates (53% female and 69% Black) to identify demographic and network factors associated with requesting living kidney donations.

Results.
Female participants made requests to more network members than male participants: incidence rate ratio (IRR) 1.95, 95% confidence interval (CI) [1.24-3.06], P < 0.01. Black participants tended to make more requests than whites (IRR 1.65, 95% CI [0.99-2.73], P = 0.05). The number of requests increased with the size of the network (IRR 1.09, 95% CI [1.02-1.16], P = 0.01); however, network size did not differ by sex or race. Network members who provided greater instrumental support to the candidates were most likely to receive a request: odds ratio 1.39, 95% CI [1.08-1.78], P = 0.01.

Conclusions.
Transplant candidates’ networks vary in size and in the number of requests made to the members. Previously observed racial and sex disparities in living donor kidney transplantation do not appear to be related to network size or to living donation requests, but rather to the network members themselves. Future living donor interventions should focus on the network members and be tailored to their relationship with the candidate.
Frontotemporal dementias: main syndromes and underlying brain changes
Authors: Piguet Olivier , Kumfor Fiona 
Published: February 2020

Purpose of reviewFrontotemporal dementia (FTD) is a rare dementia, that accounts for about 15% of all dementia cases. Despite consensus diagnostic criteria, FTD remains difficult to diagnose in life because of its complex and variable clinical phenomenology and heterogeneous disorders. This review provides an update on the current knowledge of the main FTD syndromes -- the behavioural variant, semantic variant, and nonfluent/agrammatic variant-- their brain abnormalities and genetic profiles.Recent findingsThe complexity of the clinical features in FTD has become increasingly apparent, particularly in the domain of behaviour. Such behaviour changes are now also being recognized in the language variants of FTD. Initial interest on emotion processing and social cognition is now complemented by studies on other behavioural disturbance, that spans gambling, antisocial behaviours, repetitive behaviours, and apathy. At a biological level, novel pathological subcategories continue to be identified. From a genetic viewpoint, abnormalities in three genes explain nearly three quarters of familial cases of FTD.SummaryIn the absence of effective drug treatments, novel approaches are needed to target some of the most disabling features of FTD, such as language loss or behaviour disturbance. Recent interventions appear promising but will require confirmation.
What are the epileptic encephalopathies?
Authors: Trivisano Marina , Specchio Nicola 
Published: February 2020

Purpose of reviewTo review the evolution of the concept of epileptic encephalopathy during the course of past years and analyze how the current definition might impact on both clinical practice and research.Recent findingsDevelopmental delay in children with epilepsy could be the expression of the cause, consequence of intense epileptiform activity (seizures and EEG abnormalities), or because of the combination of both factors. Therefore, the current International League Against Epilepsy classification identified three electroclinical entities that are those of developmental encephalopathy, epileptic encephalopathy, and developmental and epileptic encephalopathy (DEE). Many biological pathways could be involved in the pathogenesis of DEEs. DNA repair, transcriptional regulation, axon myelination, metabolite and ion transport, and peroxisomal function could all be involved in DEE. Also, epilepsy and epileptiform discharges might impact on cognition via several mechanisms, although they are not fully understood.SummaryThe correct and early identification of cause in DEE might increase the chances of a targeted treatment regimen. Interfering with neurobiological processes of the disease will be the most successful way in order to improve both the cognitive disturbances and epilepsy that are the key features of DEE.
Why do seizures impair consciousness and how can we reverse this?
Authors: Lambert Isabelle , Bartolomei Fabrice 
Published: February 2020

Purpose of review
Consciousness disorders occurring during seizures are a major source of disability in people with epilepsy. The purpose of this review is to show recent developments in the assessment and understanding of consciousness disorders in epilepsy.

Recent findings
The most frequent alterations in consciousness are alterations in the level of awareness. They are linked to disruptions on a large-scale network of fronto-parietal associative systems in different forms of focal seizures or in absences. Different theories account for these alterations.

Summary
Although there is no specific treatment for ‘consciousness,’ high expectations are placed on brain stimulation techniques, which need to be better defined in the future in terms of targets and parameters.