bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastroparesis and functional dyspepsia: different diseases or different ends of the spectrum?
Authors: Cangemi David J. , Lacy Brian E. 
Published: August 2020

Purpose of review
This review assesses the relationship between gastroparesis and functional dyspepsia, in light of recent research assessing cause, pathophysiology and treatment.

Recent findings
The Gastroparesis Cardinal Symptom Index (GCSI) lacks the ability to readily distinguish functional dyspepsia from gastroparesis based on symptoms. Although prior studies found that the extent of delay in gastric emptying did not accurately predict severity of symptoms, when optimally measured, delayed gastric emptying may in fact correlate with gastroparesis symptoms. Enteric dysmotility may be an important risk factor for gastroparesis. Altered central processing may play a role in symptom generation for both gastroparesis and functional dyspepsia based on functional brain MRI. Treatment directed towards reducing low-grade inflammation and improving mucosal barrier function in the duodenum may represent a novel therapeutic target for functional dyspepsia, whereas gastric peroral endoscopy myotomy (G-POEM) remains a promising intervention for refractory gastroparesis.

Summary
Abnormalities on functional MRI of the brain have been identified in patients with functional dyspepsia and gastroparesis. Small bowel dysmotility and duodenal barrier dysfunction have been implicated in the pathophysiology of gastroparesis and functional dyspepsia, respectively. New treatments for functional dyspepsia may target low-grade duodenal inflammation and barrier dysfunction. The pylorus remains a target in gastroparesis.
Evaluation of very early-onset inflammatory bowel disease
Authors: de Mesquita Mirjam Bueno , Shouval Dror S. 
Published: August 2020

Purpose of review
Very early-onset inflammatory bowel disease (VEO-IBD) is a rare presentation defined as onset of intestinal inflammation at the age of <6 years. Some of these young children develop IBD because of inherent defects in immune or epithelial cell function resulting from deleterious mutations in genes involved in mucosal homeostasis. Here, we provide an overview of the clinical, genetic and immunologic approach in patients with VEO-IBD.

Recent findings
More than 50 different monogenic disorders directly causing IBD have been identified in the last decade; most of them present with unique clinical features in the first years of life. Such a diagnosis may facilitate the administration of targeted therapies and is important for genetic counseling. Nevertheless, a monogenic disorder is identified only in a minority of patients with VEO-IBD. Consequently, different demographic, clinical and histologic features should prompt a detailed genetic and immunologic workup in patients with IBD.

Summary
A diagnosis of monogenic IBD can have a huge impact on patient's care, enabling in some cases to provide personalized therapies. Clinicians should be aware of unique features of such disorders, and complete a detailed genetic and immune workup in selected cases, even when disease manifests beyond a young age.
New insights into IVIg mechanisms and alternatives in autoimmune and inflammatory diseases
Authors: Norris Peter A.A. , Kaur Gurleen , Lazarus Alan H. 
Published: August 2020

Purpose of review
Intravenous immunoglobulin (IVIg) is an effective treatment for an increasing number of autoimmune and inflammatory conditions. However, IVIg continues to be limited by problems of potential shortages and cost. A number of mechanisms have been described for IVIg, which have been captured in newly emergent IVIg mimetic and IVIg alternative therapies. This review discusses the recent developments in IVIg mimetics and alternatives.

Recent findings
Newly emergent IVIg mimetics and alternatives capture major proposed mechanisms of IVIg, including FcγR blockade, FcRn inhibition, complement inhibition, immune complex mimetics and sialylated IgG. Many of these emergent therapies have promising preclinical and clinical trial results.

Summary
Significant research has been undertaken into the mechanism of IVIg in the treatment of autoimmune and inflammatory disease. Understanding the major IVIg mechanisms has allowed for rational development of IVIg mimetics and alternatives for several IVIg-treatable diseases.
The benefit of exercise in children with congenital heart disease
Authors: Selamet Tierney Elif Seda 
Published: August 2020

Purpose of review
Children and adolescents with congenital heart disease (CHD) often have decreased exercise capacity and muscle mass. Exercise has numerous health benefits and can improve exercise capacity and muscle mass. As such, guidelines recommend 60 min of daily physical activity in the majority of pediatric CHD patients. Despite these known benefits and guidelines, children and adolescents with CHD often do not exercise regularly. The purpose of this review is to summarize the current literature on exercise in this population.

Recent findings
With recent advancements in the field, clinical focus in pediatric cardiology has expanded from improving mortality to improving long-term outcomes and quality of life. As part of this paradigm shift, there is ongoing research on safety, impact, and effective delivery of exercise to this population with the overarching goal of promoting an active lifestyle.

Summary
Exercise interventions are generally safe, feasible, and beneficial in children and adolescents with CHD. There is growing evidence demonstrating the benefits and utility of exercise as a prescription rather than restriction in pediatric CHD patients. Novel approaches are needed for effective delivery of exercise in this population. Further studies are warranted for assessment of long-term benefits of exercise in pediatric CHD patients.
Procedural Training in Pediatric Emergency Medicine Fellowship
Authors: Weiss Anna , Myers Sage , Lockman Justin L. , Posner Jill , Shaw Kathy 
Published: August 2020

Background
Life-saving procedures are rarely performed on children in the emergency department, making it difficult for trainees to acquire the skills necessary to provide proficient resuscitative care for children. Studies have demonstrated that residents in general pediatrics and emergency medicine lack exposure to procedures in the pediatric context, but no studies exist regarding procedural training in pediatric emergency medicine (PEM). Although the Accreditation Council for Graduate Medical Education (ACGME) provides a list of procedures in which PEM fellows must be competent, the relevance of this procedure list to actual PEM practice has not been studied.

Objectives
This study sought to determine whether PEM fellowships currently provide sufficient exposure to the skills most relevant for practicing PEM physicians.

Study Design
Data were collected via anonymous electronic survey from physicians who graduated from PEM fellowship between 2012 and 2016. Survey items measured respondents' comfort with performing critical procedures, and their perceptions of the necessity of knowing how to perform each procedure in their current practice environment.

Results
A total of 133 individuals responded to the survey. Respondents unanimously agreed that 18 of the 36 procedures required by the ACGME are necessary to know in their current practice environment. For the remaining 18 mandated procedures, there was significant disagreement among respondents both as to the necessity of the procedure in current practice and respondents' degree of comfort with performing each procedure.

Conclusions
Among recent PEM fellowship graduates, there is significant variation in comfort with performing ACGME-mandated procedures. These data highlight important opportunities for curricular enhancement in the procedural training of PEM physicians.
Are Complex Skull Fractures Indicative of Either Child Abuse or Major Trauma in the Era of 3-Dimensional Computed Tomography Imaging?
Authors: Metz James B. , Otjen Jeffrey P. , Perez Francisco A. , Done Stephen L. , Brown Emily C. B. , Wiester Rebecca T. , Jenny Carole , Kelton Megan C. , Ganti Sheila N. , Feldman Kenneth W. 
Published: August 2020

Objective
The aim of the study was to determine whether complex skull fractures are more indicative of child abuse or major trauma than simple skull fractures.

Design
This is a retrospective chart and imaging review of children diagnosed with a skull fracture. Subjects were from 2 pediatric tertiary care centers. Children younger than 4 years who underwent a head computed tomography with 3-dimensional rendering were included. We reviewed the medical records and imaging for type of skull fracture, abuse findings, and reported mechanism of injury. A complex skull fracture was defined as multiple fractures of a single skull bone, fractures of more than 1 skull bone, a nonlinear fracture, or diastasis of greater than 3 mm. Abuse versus accident was determined at the time of the initial evaluation with child abuse physician team confirmation.

Results
From 2011 to 2012, 287 subjects were identified by International Classification of Diseases, Ninth Revision, code. The 147 subjects with a cranial vault fracture and available 3-dimensional computed tomography composed this study's subjects. The average age was 12.3 months. Seventy four (50.3%) had complex and 73 (49.7%) had simple fractures. Abuse was determined in 6 subjects (4.1%), and a determination could not be made for 5 subjects. Adding abused children from 2013 to 2014 yielded 15 abused subjects. Twelve of the abused children (80%) had complex fractures; more than the 66 (48.5%) of 136 accidentally injured children (P = 0.001; relative risk = 1.65 [1.21–2.24]). However, among children with a complex fracture, the positive predictive value for abuse was only 7%.

Conclusions
Complex skull fractures frequently occur from accidental injuries. This study suggests that the presence of complex skull fractures should not be used alone when making a determination of abuse.
Radiologic Assessment of Skull Fracture Healing in Young Children
Authors: Harper Nancy S. , Eddleman Sonja , Shukla Khushbu , Narcise Maria Veronica , Padhye Laura J. , Peterson Loralie J. , Murati Michael A. , George Caroline L. S. 
Published: August 2020

Background
Skull fractures are commonly seen after both accidental and nonaccidental head injuries in young children. A history of recent trauma may be lacking in either an accidental or nonaccidental head injury event. Furthermore, skull fractures do not offer an indication of the stage of healing on radiologic studies because they do not heal with callus formation as seen with long bone fractures. Thus, a better understanding on the timing of skull fracture resolution may provide guidance on the medical evaluation for accidental or nonaccidental head injury.

Objective
The aim of the study was to determine the time required for radiographic skull fracture resolution in children younger than 24 months.

Methods
This was a retrospective observational analysis of children younger than 24 months referred with skull fractures between January 2008 and December 2012. Analysis included children with accidental head injuries with a known time interval since injury and a negative skeletal survey who underwent serial radiographic studies. Complete healing of a skull fracture was defined as resolution of fracture lucency by radiograph.

Results
Of the 26 children who met inclusion criteria, 11 (42.3%) demonstrated resolution of skull fracture(s) on follow-up imaging. Fracture resolution on radiologic studies ranged from 2 to 18 weeks. Twelve fractures in 10 children demonstrated fracture resolution at 10 or more weeks after injury.

Conclusions
Healing or resolution of a skull fracture can take months in children younger than 24 months. With the high variability in skull fracture presentation and large window to fracture resolution, unexplained or multiple skull fractures in children younger than 24 months may be the result of a single or multiple events of head trauma.
Point-of-Care Ultrasound Used to Diagnose Sternal Fractures Missed by Conventional Imaging
Authors: Khalil Paul Adeeb , Benton Carleigh , Toney Amanda Greene 
Published: August 2020

AbstractSternal fractures have often been associated with high-impact thoracic trauma. In children, this is not always the case. X-ray and even computed tomography can miss subtle sternal fractures. Point-of-care ultrasound has been shown to be more sensitive and specific for detecting subtle sternal fractures as compared with plain X-ray. The following 2 cases describe sternal fractures that were missed by traditional imaging modalities, including a fracture missed by chest computed tomography. They also highlight other potential causative mechanisms for sternal fractures in children, including hyperflexion injuries and low-mechanism motor vehicle accidents.
Innovating Pediatric Emergency Care and Learning Through Interprofessional Briefing and Workplace-Based Assessment
Authors: Steiner Isabelle , Balsiger Audrey , Goldszmidt Mark , Huwendiek Sören 
Published: August 2020

Background
Managing pediatric emergencies can be both clinically and educationally challenging with little existing research on how to improve resident involvement. Moreover, nursing input is frequently ignored. We report here on an innovation using interprofessional briefing (iB) and workplace-based assessment (iWBA) to improve the delivery of care, the involvement of residents, and their assessment.

Methods
Over a period of 3 months, we implement an innovation using iB and iWBA for residents providing emergency pediatric care. A constructivist thematic analysis approach was used to collect and analyze data from 4 focus groups (N = 18) with nurses (4), supervisors (5), and 2 groups of residents (4 + 5).

Results
Residents, supervisors, and nurses all felt that iB had positive impacts on learning, teamwork, and patient care. Moreover, when used, iB seemed to play an important role in enhancing the impact of iWBA. Although iB and iWBA seemed to be accepted and participants described important impacts on emergency department culture, conducting of both iB and iWBA could be sometimes challenging as opposed to iB alone mainly because of time constraints.

Conclusions
Interprofessional briefing and iWBA are promising approaches for not only resident involvement and learning during pediatric emergencies but also enhancing team function and patient care. Nursing involvement was pivotal in the success of the innovation enhancing both care and resident learning.
Scrub typhus: a reemerging infection
Authors: John Rebecca , Varghese George M. 
Published: August 2020

Purpose of review
Scrub typhus, caused by Orientia tsutsugamushi, is a widely neglected disease which is gaining global momentum because of its resurgence patterns. The disease is now being reported in newer regions as well as areas previously endemic areas. In this review, we aim to comprehensively review the data available to assist physicians in making an accurate diagnosis and appropriate management of the disease.

Recent findings
Several diagnostic tests have been developed for confirming scrub typhus. However, there is lack of clarity on which tests are most appropriate in a given clinical scenario. A recent study has demonstrated that in early disease (<7 days) when serological tests remain negative, the quantitative polymerase chain reaction is the most sensitive test. Among the serological tests, both IgM enzyme-linked immunosorbent assay as well as rapid diagnostic tests revealed excellent sensitivities and specificities.

Summary
With the reemergence of scrub typhus, a high degree of clinical suspicion is required to appropriately diagnose this disease which presents as an acute febrile illness. It can progress to develop various complications leading to multi-organ dysfunction syndrome. Mild illness responds well to antibiotic treatment with doxycycline and azithromycin. Further studies are required to determine the most optimal therapy in severe scrub typhus infections and superiority of one drug over the other.
Subarachnoid neurocysticercosis: emerging concepts and treatment
Authors: Nash Theodore E. , O’Connell Elise M. 
Published: August 2020

Purpose of review
Subarachnoid neurocysticercosis (SUBNCC) is caused by a morphologically unique proliferative form of Taenia solium involving the subarachnoid spaces. Prolonged therapy based upon the pathophysiology of SUBNCC and long-term follow-up have shed light on the course of disease and led to highly improved outcomes.

Recent findings
SUBNCC has a prolonged incubation period of between 10 and 25 years characterized by cyst proliferation and growth and invasion of contiguous spaces leading to mass effect (Stage 1). With induction of the host-immune responses, cysts degenerate leading to a predominately inflammatory arachnoiditis (Stage 2) causing hydrocephalus, infarcts, and other inflammatory based neurological manifestations. Inactive disease (Stage 3) may occur naturally but mostly is a result of successful treatment, which generally requires prolonged intensive anthelminthic and antiinflammatory treatments. Cerebral spinal fluid cestode antigen or cestode DNA falling to nondetectable levels predicts effective treatment. Prolonged treatment with extended follow-up has resulted in moderate disability and no mortality. Repeated short intensive 8–14-day courses of treatment are also used, but long-term outcomes and safety using this strategy are not reported.

Summary
SUBNCC gives rise to a chronic arachnoiditis. Its unique ability to proliferate and induce inflammatory responses requires long-term anthelmintic and antiinflammatory medications.
Brain calcification because of neurocysticercosis: a vast field to be explored
Authors: Bustos Javier A. , Coyle Christina M. 
Published: August 2020

Purpose of review
Neurocysticercosis is the most common helminthic infection of the central nervous system caused by the larval stage of the pork tapeworm, Taenia solium. Endemic regions include Latin American countries, sub-Saharan Africa, and large regions of Asia, including the Indian subcontinent and is a global health problem. Seizures are the most common manifestation and approximately 30% of adult-onset seizures in endemic regions are attributable to NCC. Calcifications because of neurocysticercosis is the most common finding on imaging in endemic regions and are important seizure foci contributing to the burden of epilepsy.

Recent findings
After treatment with antiparasitics for multiple viable parenchymal disease, approximately 38% of cysts that resolved after 6 months of therapy will result in residual calcifications, which represents a significant burden of residual disease. Calcified disease has been referred to as ‘inactive disease’, but there is accumulating evidence to suggest that calcified granulomas are actually dynamic and substantially contribute to the development and maintenance of seizures.

Summary
Calcified parenchymal neurocysticercosis contributes significantly to the development and maintenance of seizures in endemic regions. Understanding the pathogenesis of the role of calcified NCC in seizure development and risk factors for development of calcifications after treatment is critical to decreasing the burden of symptomatic disease in endemic regions.
Localization of Foramen Ovale According to Bone Landmarks of the Splanchnocranium: Help for Transforaminal Surgical Approach to Trigeminal Neuralgia
Authors: Gibelli Daniele , Cellina Michaela , Oliva Giancarlo , Sforza Chiarella 
Published: August 2020

Abstract
Trigeminal neuralgia is a painful condition, usually treated through surgical procedures focusing on the foramen ovale (FO). A detailed localization of FO relative to reference landmarks is therefore crucial to avoid possible complications.
The present study aims at assessing the position of FO according to the surrounding bone structures: 100 CT-scans of patients, equally divided between sexes, aged between 18 and 86 years were examined. From each subject, the 3D models of FO and the maxillary bones, the zygomatic bones and the zygomatic process of the temporal bones were segmented through ITK-SNAP software. The distance between the center of the FO and subnasale, zygion, and the upper edge of the zygomatic bone at the origin of the frontal process were measured on 3D models. On CT-scans three cranial measurements were taken as well (distance between anterior and posterior nasal spine, upper facial height and bizygomatic breadth).
Statistically significant differences in the three distances according to side and sex were assessed through two-way ANCOVA test, using the three cranial measurements (ANS-PNS, NP, ZZ) as covariates (P < 0.05).
Distances between the centre of FO and subnasale, zygion and the upper edge of the zygomatic bone were on average 82.3 ± 3.4 mm, 41.9 ± 2.6 mm and 48.8 ± 3.5 mm in males, 77.3 ± 3.9 mm, 38.2 ± 2.5 mm and 45.5 ± 3.1 mm in females, with a significant difference according to sex (P < 0.05).
Results provide innovative data for the localization of FO and will be useful for the management of transforaminal procedures in case of trigeminal neuralgia.
Captain America's Shield Genioplasty
Authors: Ramieri Valerio , Vellone Valentino , Marianetti Sara , Marianetti Tito M. 
Published: August 2020

Abstract
The chin represents one of the most important determinants of the facial aesthetics. Like many aesthetic parameters, the “ideal” chin has changed in history regarding projection and prominence. From the retrusive profiles of the Renaissance, stronger and more defined mandibular contour are nowadays desired both by masculine and feminine population.
This change in the ideal references plays an important role in diagnosis and treatment planning. Various techniques for chin augmentation have been described, using both alloplastic materials and osteotomies.
An interesting osteotomy variant, so-called chin shield osteotomy, has been described by Triaca et al to avoid a deep mentolabial fold. The authors describe herein the use of a shield plate, very similar in his form to Captain America's shield, that can at the same time provide bone fixation and soft tissues sustain in the mentolabial fold region, preventing the invasion of the gap between the bone fragments by the connective tissue, as it happens in a guided bone regeneration procedure.
Sublingual Gland and Mylohyoid Muscle Advancement: A Novel Combined Local Soft Tissue Reconstruction
Authors: Benech Rodolfo , Bowen Luke , Handley Thomas 
Published: August 2020

Abstract
Here the authors present the surgical management of a 78-year-old female with a superficial squamous cell carcinoma of the mucosa overlying her edentulous mandibular alveolus with no evidence of bony invasion.
Combining the superficial nature of the lesion, patient age and substantial medical comorbidities, a limited intra-oral resection was planned, to avoid the need for free flap reconstruction. The operation required a wide local excision with clear clinical margins and a mandibular rim resection.
All of the currently available reconstructions would result in prolonged surgical time, donor site morbidity, and possible secondary procedures. To overcome these pitfalls, a sublingual gland and mylohyoid muscle advancement flap was designed and executed. By combining the mylohyoid muscle and sublingual gland tissue as an advancement flap in a tension-free manner, secured to the remaining circumferential mucosa, a watertight closure was achieved.
After an uneventful recovery without complication the patient was discharged the following day. Complete epithelialization was observed on day 25. Adjuvant radiotherapy was offered to reduce the risk of recurrence and progression. To date, no bony exposure and no pathological fractures have occurred.
In conclusion, the entire procedure is simple and innovative. There is minimal donor site morbidity, with an immediate return to oral diet and tolerable surgical risks. It requires a small amount of surgical time compared to other reconstructive options and an overall reduced inpatient stay.