bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of an Innovative Nonanimal Training Model for Infant Pleural Effusion Drainage via Pigtail Catheter Placement
Authors: Zurca Adrian D. , Diaz-Sanchez Angel , Mackley Lisa , Rodgers David L. 
Published: November 2019

Background:
Chest tube placement is an important skill for providers and bedside nurses caring for critically ill infants, allowing for the evacuation of pleural fluid and pneumothoraces. No realistic simulation models are commercially available for trainees to practice and learn this skill on infants.

Purpose:
Our objective was to develop an inexpensive and reproducible model for percutaneous pleural pigtail placement for pleural fluid removal via the Seldinger technique.

Methods:
The model was developed using hardware material and a discarded infant resuscitation manikin. The rib cage was constructed using electrical cable wires. Discarded and expired 250-mL bags of intravenous fluids were placed inside the chest cavity to simulate pleural fluid. Shelf liner was wrapped around the chest and abdomen of the infant model to simulate the skin layer. Pediatric critical care faculty performed the procedure on the final model and scored it for realism and utility for teaching. Without including the discarded manikin and fluid bags, the cost of the materials for the model was less than $20.

Results:
Eight pediatric critical care faculty tested the pleural pigtail placement model. All faculty agreed the model provides a realistic simulated reproduction of placing a pleural pigtail, felt the model was simple to use, and indicated they would use it as a teaching tool in the future.

Implications for Practice:
An effective model for pleural pigtail placement can be inexpensively constructed using discarded bags of intravenous fluid and easy-to-find hardware materials.

Implications for Research:
Future studies are needed to assess whether this model helps providers and nurses develop and maintain the clinical skills for successful percutaneous pleural pigtail catheter placement.

Video Abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=35&autoPlay=true
Comparison of Clinical Outcomes After Intramedullary Fixation of Tibia Fractures Caused by Blunt Trauma and Civilian Gunshot Wounds: A Retrospective Review
Authors: Metcalf Kathryn B. , Smith Eric J. , Wetzel Robert J. , Sontich John K. , Ochenjele George 
Published: November 2019

Objective:
To assess the outcomes of patients who sustained blunt trauma tibia fractures compared with tibia fractures from civilian gunshot injuries when treated with intramedullary fixation.

Design:
Retrospective chart review.

Setting:
Level I trauma center.

Patients/Participants:
Two hundred and seven patients underwent intramedullary nailing for 211 tibia fractures.

Methods:
A retrospective review of tibia fracture(s) treated with intramedullary fixation with comparison of closed, open, and gunshot wound (GSW) fracture outcomes.

Main Outcome Measurements:
Outcomes included infection and nonunion.

Results:
The infection rate in closed and GSW tibia fractures was significantly lower compared with the infection rate of open fractures (1% vs. 9% vs. 20%; P = 0.00005). Significantly lower rates of nonunion in closed fractures compared with open fractures and GSW fractures were appreciated (8% vs. 20% vs. 30%; P = 0.003). There was no difference in infection or nonunion between GSW fractures with small wounds, no exposed bone, and minimal comminution and closed injuries (P = 0.24, P = 0.60). Conversely, there was a significantly higher nonunion rate in GSW fractures with large wounds, exposed tibia, and comminution compared with blunt injuries (P = 0.0014).

Conclusions:
This study suggests that tibia fractures from civilian GSWs are heterogeneous injuries, and outcomes are dependent on the extent of soft-tissue injury, bone exposure, and bone loss. There are comparable infection rates in all fractures due to civilian GSWs and closed fractures, which are lower than high-grade open fractures. Tibia GSW fractures with exposed bone and comminution have higher complication rates and should be treated accordingly.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Survival Rates and Prognostic Factors of Cervix Cancer Treated by Different Modalities
Authors: Viani Gustavo A. , dos Santos Fred M. , Pavoni Juliana F. 
Published: November 2019

Objective:
To assess the overall survival (OS) and prognostic factors in patients with cervix cancer treated by different modalities.

Material and Methods:
The authors studied a cohort of patients with cervix cancer International Federation of Gynecology and Obstetrics stage I-IVa treated in the last 15 years. Patients were treated with surgery followed by radiotherapy (S+RT), or surgery plus chemoradiation (S+CRT), or radiotherapy alone (RT), or chemoradiation alone (CRT). Univariate and multivariate analyses were conducted to identify significant prognostic factors (P<0.05).

Results:
A total of 380 patients with cervix cancer were included. The treatment groups were S+CRT (37.5%), CRT (33%), RT (20%), and S+RT (9.5%). The median follow-up was 7.6 years, the OS in 5 and 10 years according to the treatment groups was 43.3%, and 17.3% for S+RT, 47.8% and 41.9% for S+CRT, 40.7% and 27.9% for CRT, and 29.1% and 19.4% for RT (P<0.0001). The stage IIb-IVa, age 60 years or older, RT, and 2DRT were significant factors in the univariate and multivariate analyses. In stage I-IIa, no significant difference was found among the treatment groups (P=0.907). In stage IIb-IVa, a significant difference was observed (P=0.0001). CRT versus RT had significance, and no difference between S+RT versus S+CRT, and S+CRT versus CRT was seen for stage IIb-IVa.

Conclusions:
In a long-term follow-up, no significant difference among the treatment modalities was found for early disease. For stage IIb-IVa, significant differences were observed, with RT having the worst survival, and CRT similar to S+CRT. These outcomes show that tumor and patients characteristics can be used to decide the best treatment option outside a clinical trial.
Study of L-Asparaginase, Vincristine, and Dexamethasone Combined With Intensity-modulated Radiation Therapy in Early-Stage Nasal NK/T-Cell Lymphoma
Authors: Hu Yunfei , Chen Mengxiang , Song Yang , Liu Xiaomei , Gou Feng , Zhang Jing , Huang Yunhong 
Published: November 2019

Objectives:
Natural killer/T-cell lymphoma (NKTCL) is aggressive, and carries a poor prognosis worldwide. This retrospective study aimed to evaluate the clinical efficacy and safety of the LVD regimen (L-asparaginase, vincristine, and dexamethasone) combined with intensity-modulated radiation therapy (IMRT) for the treatment of early-stage nasal NKTCL in a Chinese population.

Methods:
The clinical data were collected from patients treated between March 2010 and January 2017. Patients received LVD chemotherapy combined with IMRT, and were followed for 30 to 90 months. All received radiotherapy at the end of the first/second cycle of chemotherapy. The survival curves were generated by the Kaplan-Meier method.

Results:
Among 94 patients who received 2 to 6 cycles (mean, 4 cycles) of treatments, 56 and 25 achieved complete and partial remission, respectively; 2 and 11 experienced stable disease and progressive disease. The overall objective response was 86.2%. Patients with elevated lactate dehydrogenase and skin invasion had a lower objective response rate. The progression-free survival rates at 1, 3, and 5 years were 90.3%, 73.5%, and 71.3%; the corresponding overall survival rates were 91.4%, 74.3%, and 74.3%. The main adverse events were myelosuppression (63.8% grades I to II, 12.8% grade III), gastrointestinal symptoms (63.8% grades I to II), hepatic lesion (55.3% grades I to II), hypoproteinemia (46.8% grades I to II), skin allergies (77.7% grades I to II, 3.2% grade III), and oral mucosal lesions (44.7% grades I to II, 33% grade III). No severe pancreatitis, anaphylaxis, or toxicity-related death was observed.

Conclusion:
In patients with early-stage nasal NKTCL, our LVD-IMRT regimen produced excellent, durable therapeutic benefit in most patients, with acceptable toxicity and no acute mortality.
BACILLARY LAYER DETACHMENT OVERLYING REDUCED CHORIOCAPILLARIS FLOW IN ACUTE IDIOPATHIC MACULOPATHY
Authors: Fernández-Avellaneda Pedro , Breazzano Mark P. , Fragiotta Serena , Xu Xiaoyu , Zhang Qinqin , Wang Ruikang K. , Freund K. Bailey 
Published: November 2019

Purpose:
To report new multimodal imaging features that enhance our understanding of the inflammatory and ischemic nature of acute idiopathic maculopathy (AIM) and to correlate structural and functional changes due to a reversible initial choroidal ischemia over a clinical course of 3.5 months.

Methods:
A 31-year-old man presented with acute central vision loss in his right eye due to coxsackievirus-associated AIM. Serial multimodal retinal imaging including confocal true color fundus photography, blue-light fundus autofluorescence (BAF), near-infrared reflectance (NIR), spectral domain optical coherence tomography and swept-source optical coherence tomography (SD-OCT + SS-OCT), and en face SS-OCT angiography (SS-OCTA) were performed over a 3.5-month follow-up. Eidon true color confocal scanner camera (Centervue, Padova, Italy) was used for color and BAF imaging. Near-infrared reflectance and SD-OCT images were obtained with the Heidelberg Spectralis OCT (HRA2 + OCT; Heidelberg Engineering, Heidelberg, Germany). For SS-OCT and en face SS-OCT and SS-OCTA images, the PLEX Elite 9,000 (Carl Zeiss Meditec, Inc, Dublin, CA) was used. Central alterations in choriocapillaris flow were analyzed with SS-OCTA using the University of Washington choriocapillaris (CC) flow deficit quantification algorithm available through the ARI Network. Flow deficit area and density values were analyzed and compared between the first and last examinations. Corresponding en face OCT imaging was used to distinguish true flow defects from artifacts secondary to shadowing.

Results:
In the acute stage of AIM, a bacillary layer detachment appearing as a yellow-grayish foveal elevation surrounded by a hypopigmented parafoveal ring was evident in a Bull's eye configuration, corresponding to a hyperreflective ring upon NIR and a hyperautofluorescent ring with BAF. SD + SS-OCT showed mostly intraretinal fluid consistent with a bacillary layer detachment in conjunction with a thickened inner choroid. At presentation, SS-OCTA demonstrated a marked reduction of choriocapillaris flow signal. At 1 week, early resolution of retinal fluid was followed by restoration of the ellipsoid zone at 5 weeks, while restoration of the interdigitation zone and reduction in retinal pigment epithelium/Bruch membrane complex thickening occurred more slowly. Swept-source OCT angiography showed a gradual, but incomplete, recovery of inner choroidal flow signal at 3.5-month follow-up.

Conclusion:
Acutely, AIM may present with a photoreceptor splitting foveal bacillary layer detachment associated with a marked reduction in inner choroidal flow signal on SS-OCTA. Thereafter, restoration of the outer retinal layers and gradual normalization of choroidal flow signal appear to support the often-benign nature of the disease.
New procedure of high-frequency repetitive transcranial magnetic stimulation for central neuropathic pain: a placebo-controlled randomized crossover study
Authors: Quesada Charles , Pommier Benjamin , Fauchon Camille , Bradley Claire , Créac'h Christelle , Murat Marion , Vassal François , Peyron Roland 
Published: November 2019

Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a procedure increasingly used to treat patients with central neuropathic pain, but its efficacy is still under debate. Patients with medically refractory chronic central neuropathic pain were included in 2 randomized phases (active/sham), separated by a wash-out period of 8 weeks. Each phase consisted of 4 consecutive rTMS sessions and a final evaluation session, all separated from one another by 3 weeks. High-frequency (20 Hz) rTMS was delivered over the primary motor cortex (M1) contralateral to the patient's pain using a neuronavigated robotic system. Patients and clinicians assessing outcomes were blinded to treatment allocation during the trial. The primary outcome measured the percentage of pain relief (%R) from baseline. Secondary outcomes were VAS score, Neuropathic Pain Symptom Inventory, analgesic drug consumption, and quality of life (EQ-5D). Thirty-six patients performed the entire study with no adverse effects. The analgesic effect for the main criterion (%R) was significantly higher in the active (33.8% confidence interval [CI]: [23.88-43.74]) than in the sham phase (13.02% CI: [6.64-19.76]). This was also the case for the secondary outcome VAS (−19.34% CI: [14.31-25.27] vs −4.83% CI: [1.96-8.18]). No difference was observed for quality of life or analgesic drug consumption. Seventeen patients (47%) were identified as responders, but no significant interaction was found between clinical and technical factors considered here and the analgesic response. These results provide strong evidence that 3 weeks spaced high-frequency rTMS of M1 results in a sustained analgesic effect and support the clinical interest of this stimulation paradigm to treat refractory chronic pain.
Implementation of Systematic Community Resource Referrals at Small Primary Care Practices to Promote Cardiovascular Disease Self-Management
Authors: Makelarski Jennifer A. , DePumpo Megan , Boyd Kelly , Brown Tiffany , Kho Abel , Navalkha Chenab , Lindau Stacy T. 
Published: November 2019

ABSTRACT
Quality improvement (QI) models and evidence-based self-management guidelines for reducing cardiovascular disease (CVD) risk require patients to access community resources. The purpose of this study is to describe outcomes from implementation of a community resource referral system into small clinical practices to reduce CVD risk. Practices were given the opportunity to complete an inventory of local CVD-related resources; these data were used to create a printed list of resources for patients (“HealtheRx-H3”). Practices could request updates to HealtheRx-H3s. We assessed implementation outcomes, including appropriateness, feasibility, and adoption. Practice populations were at high risk for CVD. It was feasible to create practice-specific HealtheRx-H3s. Systematic distribution of HealtheRx-H3s using digital electronic health record (EHR) integration was infeasible due to inconsistent use of EHR systems, workflow variation, and lacking data-sharing infrastructure. Of 76 practices, 38 completed the inventory; completion was similar by patient and practice characteristics. HealtheRx-H3 updates were requested by 39% of practices; practices that completed the inventory were significantly more likely to request an update compared with those that did not (61% vs. 18%, p-value <.01). Successful implementation of QI strategies to systematize community resource referral solutions is feasible at small practices, but more research is needed to understand what motivates small practices to participate in implementation of these solutions.
Observation of immediate and mid-term effects of partial spleen embolization in reducing hepatic venous pressure gradient
Authors: Zhao Yiming , Guo Liangliang , Huang Qiyang , Zhang Rugang , Sun Xuyang , Zhao Li , Li Chao , Nie Yan , Sun Gang , Liu Jiangtao 
Published: November 2019

Abstract

Objective:
To observe the immediate and mid-term effects of partial spleen embolization (PSE) in reducing hepatic venous pressure gradient (HVPG) in patients with cirrhotic esophagogastric varices.

Methods:
Patients diagnosed with cirrhosis and esophagogastric varices in our hospital between July 2016 and March 2018 were consecutively selected. Forty-three patients were selected based on the eligibility criteria to undergo PSE. The change in HVPG 5 minutes before and after embolization, was used to determine the immediate effect of PSE on HVPG reduction. HVPG was retested after 6 months to observe the change in the antihypertensive effect along with time.

Results:
Forty-three patients successfully underwent PSE and HVPG measurements. The HVPG was 17.7 ± 3.9 mmHg and 13.9 ± 3.1 mmHg before and after PSE, respectively, showing a significant decrease (21.5%, P < .05). Among them, 18 cases were retested for HVPG at 6 months after PSE, and the results showed significant differences in the HVPG levels before, immediately and 6 months after PSE. Compared with preoperative PSE, HVPG was decreased by 22.9% and 17.7% (P < 0.05) immediately and at 6 months after operation, respectively. There was no significant change at 6 months after PSE when compared with immediate postoperative PSE. No serious complications were observed in patients during their postoperative hospital stay.

Conclusion:
PSE immediately reduced the portal pressure, and HVPG remained stable at 6 months after surgery. PSE is considered as a safe and easy to implement method, and is expected to be one of the treatments for reducing the portal pressure.
A ball-slide-type interbody distractor is effective in posterior reduction and internal fixation for patients with mid- to high-grade isthmic spondylolisthesis enrolled in a randomized clinical trial
Authors: Li Pengfei , Zhao Zongmao , Jia Nan , Wang Litao , Sun Zhaosheng , Jin Xianhui 
Published: November 2019

Abstract

Study Design:
Clinical and radiographic results of a randomized, controlled, double-blind clinical trial

Objective:
To investigate the clinical applicability of a ball-point slide-type interbody distractor in posterior reduction and internal fixation for mid- to high-grade isthmic spondylolisthesis.

Summary of Background Data:
Posterior reduction and internal fixation is the effective treatment for spondylolisthesis. However, for the mid and high-grade isthmic spondylolisthesis patients with the conditions of vertebral osteoporosis and extremely narrow intervertebral space, the reduction is difficult; post-surgery intervertebral space height lost becomes serious; the fracture and loosening rate of fixation system is higher. No study regarding the prevention of these adverse outcomes in this technique is reported.

Methods:
A total of 59 patients of mid and high-grade isthmic spondylolisthesis were randomly divided into random groups (investigational group and control group) applying simple randomized method in this study. In addition, 30 patients received posterior reduction and internal fixation as control. Twenty-nine patients received posterior reduction and internal fixation by ball-point slide-type interbody distractor were assigned to the investigational group. X-ray examination was performed before and after operation. The degree of reduction, height of intervertebral space were compared. The preoperative and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated. Additionally, rate of the fixation system fracture was also assessed.

Results:
Before treatment, there were no significant differences in ISH (P = .72), DR (P = .85), VAS of back pain (P = .55), VAS of leg pain (P = .83) and ODI (P = .68) were found between 2 groups. After 12-month treatment, there were no significant differences in ISH (P = .26), VAS of back pain (P = .09) and VAS of leg pain (P = .96) between two groups. Significant differences of DR (P = .02), ODI (P = .03) and adverse events (P = .00) were found between 2 groups.

Conclusions:
The results of this prospectively study showed that the ball-point slide-type interbody distractor in the posterior reduction and internal fixation produced good outcomes after 12-month treatment. More high quality randomized controlled trials and cases should still be needed to warrant the results of this study.
Efficacy and safety of bifid triple viable plus aminosalicylic acid for the treatment of ulcerative colitis
Authors: Chen Mu-yuan , Qiu Zhen-wen , Tang Hong-mei , Zhuang Kun-hai , Cai Qing-qun , Chen Xin-lin , Li Hui-biao 
Published: November 2019

Abstract

Objective:
Ulcerative colitis (UC), one of the most stubborn diseases, is mainly treated by aminosalicylic acid (ASA). However, the side effects of ASA include vomiting, nausea, rash, diarrhea, headache, etc, which seriously affect life-quality of UC patients. Probiotics such as bifid triple viable (BTV) could reduce drug-induced adverse reactions and has a good clinical effect on UC. Therefore, we aimed to evaluate the clinical efficacy and safety of BTV plus ASA in treating UC.

Methods:
PubMed, Cochrane Library, Embase, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure, and Wanfang databases were searched from the inception dates to October 12, 2018. Randomized controlled trials (RCTs) were included by comparing BTV plus ASA programs with ASA alone in patients with UC. Methodological quality was assessed by 2 independent researchers according to the inclusion criteria and exclusion criteria. Meta-analysis was performed by using the Review Manager 5.3 Software. Risk ratios (RRs), 95% confidence interval (CI), and standardized mean difference were calculated.

Results:
Sixty RCTs involving 4954 participants were selected for final review. Compared with ASA, BTV plus ASA significantly improved the clinical effect rate [RR = 1.23, 95% CI (1.20, 1.26), P < .00001]; reduced the relapse rate [RR = 0.34, 95% CI (0.18, 0.62), P = .0005]; and adverse effect rate [RR = 0.66, 95% CI (0.53, 0.82), P = .0002]. Compared with the controls, levels of tumor necrosis factor-α, interleukin-6 (IL-6), IL-8, C-reactive protein (CRP), hypersensitive CRP, erythrocyte sedimentation rate, and malondialdehyde were reduced; levels of IL-10, CD3+, CD4+, and superoxide dismutase were increased in BTV plus ASA group.

Conclusions:
BTV plus ASA has positive therapeutic effects on UC, and it might be a safe way to treat UC. However, comprehensive clinical trials are needed to obtain high level of clinical evidence.