bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epstein-Barr Virus Negative Lymphoepithelioma-Like Cholangiocarcinoma in a Patient of European Descent: A Report of a Case
Authors: Tankel James , Haim Menahem Ben , Dagan Amir , Reissman Petachia , Doviner Victoria 
Published: June 2020

Abstract
Lymphoepithelioma-like carcinoma in the setting of cholangiocarcinoma in the absence of underlying Epstein-Barr virus is an incredibly rare entity. However, all of the reports that exist, which are few and far between, describe this vignette in patients of Far Eastern origin. We present the first case report of Epstein-Barr virus–negative lymphoepithelioma-like carcinoma–associated cholangiocarcinoma occurring in a patient of European descent. The 62-year-old woman described here presented with nonspecific symptoms of lethargy, low-grade pyrexia, and raised white blood cell count. Subsequent investigations revealed a large hepatic mass with subsequent hepatectomy yielding a large tumor containing poorly differentiated adenosquamous cholangiocarcinoma alongside a rich infiltrate of lymphocytes and lymphoplasmacytic inflammatory infiltrate. Epstein-Barr virus in situ hybridization was negative in both the malignancy and surrounding tissues. Reflecting its rarity, the pathogenesis of this specific malignancy is poorly understood, as also are the treatment and prognosis.
Role of Troponin Determination to Diagnose Chest Pain in the Pediatric Emergency Department
Authors: Brancato Federica , De Rosa Gabriella , Gambacorta Alessandro , Nunziata Alessia , Ferrara Pietro , Buonsenso Danilo , Covino Marcello , Chiaretti Antonio 
Published: June 2020

Objectives
Chest pain is a common cause to admission to the pediatric emergency department and often leads to an extensive cardiac evaluation. The objective of this study was to evaluate the usefulness of the troponin (TN) plasma level determination in the initial phase of the differential diagnosis of chest pain in children.

Methods
This is a retrospective observational study on 107 patients, aged 0 to 19 years, admitted for chest pain to the pediatric emergency department of our institution. Demographics, clinical data, and patient outcomes were analyzed. Troponin values of >0.03 ng/mL but <0.1 ng/mL were considered suspected for cardiac pathology, whereas levels of >0.1 ng/mL were indicative of cardiac pathology. In these latter patients, an echocardiographic examination was also performed.

Results
Only 99 patients were evaluated with electrocardiogram (ECG). In 91 of 99 patients of our series, both TN determination and ECG recording were performed. Troponin was higher than the cutoff value (0.03 ng/mL) in 9 patients (9.1%). Only 2 of the 9 patients who presented high TN values showed a nonpathological ECG, whereas 16 (17.5%) of 91 patients in whom both ECG and TN determination were performed had ECG abnormalities without a simultaneous elevation of TN. Of the 26 patients who had medical history and suggestive targets of cardiac pathology, only in 6 (23.1%) of them the diagnosis was confirmed. The final diagnosis of the 99 patients was idiopathic chest pain in 45.4% of cases.

Conclusions
Even with the low cost and the relatively easiness for the plasma level determination, TN should be measured only in children with chest pain associated to familiar history suggestive of cardiovascular disease and/or clinical symptoms and/or ECG alterations.
Implementation of Pediatric Emergency Care Applied Research Network Guidelines for Traumatic Brain Injury in a Rural Tertiary Care Center
Authors: Tsao Jackie , Hook Marcus , Shah Purvi , Bingham Peter M. 
Published: June 2020

ObjectivesTo evaluate changes in imaging practices for pediatric head trauma after publication of the Pediatric Emergency Care Applied Research Network (PECARN) guidelines, explore areas for quality improvement regarding neuroradiology referrals. We also sought to determine the prevalence of incidental findings discovered on computed tomographies (CTs) attained for minor head trauma and ascertain disposition in these cases.MethodsThis retrospective study was conducted at a rural academic center and included 156 children who received CTs for head trauma between 2005 and 2015. Subjects were divided into 2 groups: pre-PECARN publication and post-PECARN publication. Electronic medical records were reviewed to determine whether or not head CTs were obtained according to PECARN guidelines. The proportion of scanned cases and incidental findings in each group was then compared.ResultsSignificantly more subjects met PECARN criteria for head CT during the pre-PECARN period (67.1% vs 50.6%,P= 0.04). Among those who met PECARN criteria, severe mechanism of injury was the most common criterion met in both groups (43.8% pre-PECARN and 26.5% post-PECARN). Nine (5.7%) subjects had incidental findings (similar for both study periods), of which 3 prompted additional diagnostic testing or invasive intervention. Among those who did not meet PECARN criteria, the most common mechanism of injury was fall (<3 ft).ConclusionsImplementation of PECARN guidelines at our center remained limited in the 5 years after publication of this practice guide. Clinically insignificant incidental findings were often detected and may heighten patient anxiety.
Pediatric Intentional Self-poisoning Evaluated in the Emergency Department
Authors: Gonzalez-Urdiales Paula , Kuppermann Nathan , Dalziel Stuart R. , Prego Javier , Benito Javier , Mintegi Santiago 
Published: June 2020

Background
Suicide is a growing public health problem during late childhood and adolescence. The leading method of suicide attempts in this age group is intentional self-poisoning. A first self-poisoning episode is a strong predictor of subsequent suicide and premature death. The objective of this study was to analyze the presentation and management of children younger than 18 years with intentional self-poisonings admitted to an emergency department (ED) in a global research network of pediatric EDs.

Methods
We performed a secondary analysis of a large, international, multicenter, cross-sectional prospective registry of childhood poisoning presentations to 105 EDs in the Pediatric Emergency Research Networks (PERN) network. Data collection started at each ED between January and September 2013 and continued for 1 year.

Results
During the study period, we included 1688 poisoning exposures. Of these, 233 (13.8%) were intentional self-poisonings, with significant variation between regions. Female/male ratio was 4.7/1 and most occurred at home. The most common toxicants were therapeutic drugs, mainly psychotropics and analgesics. Ninety patients (38.6%) gave a history of a previous episode of intentional self-poisoning. Sixty-three children (27.0%) were not assessed by a psychiatric service nor transferred to a psychiatric inpatient facility. No patient died. There was significant variation in the involved toxicants and interventions among EDs in different global regions.

Conclusions
Most intentional self-poisoning presentations to pediatric EDs globally are related to intentional ingestions of therapeutic drugs at home by females. Best practices have to be translated into care to guarantee the best outcomes of these patients.
Effect of Comorbid Chronic Low Back Pain on Patient-Reported Outcome and Gait Parameters in Patients With Symptomatic Knee Osteoarthritis
Authors: Lee Se Won , Patel Jasal , Napatkamon Ayutyanont , Aguilla Eric , Hill Joseph , Bartels Matthew N. 
Published: June 2020

Abstract
Knee osteoarthritis and chronic low back pain are common and often coexist. There are limited studies on the impact of coexisting musculoskeletal disorders on gait parameters and its association with self-assessed functional outcome. This study compared gait parameters, self-assessed functional outcome measurements, and quality-of-life scales between patients with knee osteoarthritis against those with coexisting knee osteoarthritis and chronic low back pain using gait analysis, Western Ontario and McMaster Osteoarthritis Index, and Short Form-36. Three hundred sixty-seven patients underwent gait analysis after the question-based functional outcome measurement. Pain, function, and quality of life were worse in the coexisting knee osteoarthritis and chronic low back pain group (n = 197) compared with the knee osteoarthritis only group (n = 170, P = 0.017, P = 0.004, P < 0.001, P = 0.004, respectively). The coexisting knee osteoarthritis and chronic low back pain group had significantly lower gait velocity and cadence than the knee osteoarthritis group (P = 0.028 and P = 0.003). The Western Ontario and McMaster Osteoarthritis Index Pain subscore was associated with gait velocity (P < 0.001) in the knee osteoarthritis group, whereas Short Form-36 physical composite was associated with gait velocity (P < 0.001) in the coexisting knee osteoarthritis and chronic low back pain group. Comorbid chronic low back pain in patients with knee osteoarthritis was associated with worse pain, function, quality of life, gait velocity, and cadence. Compared with the Western Ontario and McMaster Osteoarthritis Index, Short Form-36 may be a more suitable tool to track mobility outcome measure, such as gait velocity, in the management of the coexisting knee osteoarthritis and chronic low back pain.
Stress Reactivity as a Contributor to Racial and Socioeconomic Disparities: Rationale and Baseline Results From the Richmond Stress and Sugar Study
Authors: Mezuk Briana , Lexima Evanise , Kalesnikava Viktoryia A. , Fleming Jacinda , Montgomery Joshua , Tuktur Wanderimam , Winston Jason , Perrin Paul B. , Green Tiffany , Wheeler David C. 
Published: June 2020

ABSTRACT

Objective
There are pronounced racial and socioeconomic disparities in type 2 diabetes. Although “stress” as a general phenomenon is hypothesized to contribute to these disparities, few studies have objective measures of stress reactivity in diverse samples to test hypotheses about purported mechanisms. This study describes the rationale and baseline characteristics of a cohort designed to address the question: how does stress contribute to disparities in diabetes risk?

Methods
The Richmond Stress and Sugar Study recruited 125 adults at elevated risk of type 2 diabetes using a two-by-two sampling frame wherein non-Hispanic whites and African Americans (AAs) were each recruited from neighborhoods of higher and lower socioeconomic status (SES). Stress reactivity was assessed using the Trier Social Stress Test (TSST) and salivary cortisol. Analyses of variance and multilevel modeling were used to examine how stress reactivity varied both within and across race and neighborhood SES.

Results
The mean (SD) age was 57.4 (7.3) years, 49% were female, 54% were AA or another racial/ethnic minority, and mean hemoglobin A1c level was in the prediabetes range (5.8%; range, 5.50%–5.93%). Living in a lower-SES neighborhood was associated with 16% (95% confidence interval [CI] = −0.04 to 34) higher pre-TSST cortisol, 8.4% (95% CI = −14 to −3) shallower increase in response to the TSST, and 1% (95% CI = 0.3 to 1.7) steeper decline post-TSST than living in the higher neighborhood SES. Post-TSST cortisol decline was 3% greater among AA compared with non-Hispanic whites. Race-by-SES interaction terms were generally small and nonsignificant.

Conclusions
SES is associated with stress reactivity among adults at high risk of diabetes.
The Discrepancy Between Perceived Importance and Actual Delivery of Business Education in Residency
Authors: Patrinely J. Randall , Davis Matthew J. , Abu-Ghname Amjed , Reece Edward M. , Perdikis Galen 
Published: June 2020

Background
In the contemporary healthcare environment, there is a need for physicians to understand business fundamentals. Nonsurgical residencies have implemented formal business education, but surgical training programs have been slower to adapt. Further research is needed to evaluate the status of business education in plastic surgery residency.

Methods
A 12-question survey was created. Ninety program director (PD) e-mails were obtained and the survey was distributed using SurveyMonkey. The survey evaluated program demographics and current resources, commitments, and attitudes toward business training. The survey also identified the most important topics to include in a business curriculum.

Results
Thirty-six surveys were completed (response rate = 40%). Whereas most PDs agreed that business education in plastic surgery residency was important (78%) and that their programs should have more business training (73%), only 39% currently offered business training. Only 42% of PDs believed that their chief residents were competent to handle the business aspects of plastic surgery upon graduation. No programs offered a formal gap year to pursue a professional business degree. The most important topics identified for a business curriculum were economics and finance (83.3%), management (64%), and marketing (53%).

Conclusions
There is disconnect between perceived importance and resources available for plastic surgery residents to receive business education. Increased attention is needed to resolve this discrepancy to ensure that future plastic surgeons are equipped to excel in their personal careers and stimulate the advancement of the field. Future research should aim to outline a business curriculum for plastic surgery trainees.
Endoscopic “Quick” Septoplasty in Preservation Rhinoplasty
Authors: D'Ascanio Luca , Ori Michele , Finocchi Valerio , Vione Nicola , Capalbo Maria , Ricci Giampietro 
Published: June 2020

Background
Preservation rhinoplasty (PR) is revolutionizing rhinoplasty surgery, based on new anatomical studies, advanced tip suture techniques, and refinement of surgical techniques. Septal surgery is a fundamental preparatory stage during PR, especially for the dorsal preservation let/push-down procedure. To increase the predictability of the septoplasty aesthetic effects on the nasal dorsum and further extend the principles of PR to septal surgery, we applied the endoscopic technology to the “quick” septoplasty technique we had already developed in the past decades.

Methods
One hundred sixty-six patients (41 males, 125 females; mean age, 39.7 years; age range, 18–61 years) were submitted to endoscopic “quick” septoplasty for septal deviation during PR procedure. Preoperative evaluation of the nasal dorsum included external examinations of the size, shape, and orientation of the dorsum. Anterior active rhinomanometry was performed in all patients to determine nasal flow resistance preoperatively and 6 months after surgery. Preoperative and postoperative patients' scores on the Nasal Obstruction Septoplasty Effectiveness questionnaire were compared to assess the improvement of nasal symptoms after surgery. The duration of the septoplasty procedure was measured for all the patients. Standard nasal photographic assessment was performed before and 6 months after surgery.

Results
Postoperatively, 98.8% of our patients displayed an improvement of their nasal breathing function. No complication in terms of septal perforation, nasal infection, or bleeding was noticed. No case of turbinoseptal synechiae or cerebrospinal fluid leak was recorded. The dorsum preservation rhinoplasty procedure was successfully completed in all patients. The mean septoplasty operative time, excluding local anesthesia injection and other surgical procedures associated with septal surgery such as turbinoplasty and rhinoplasty, was 11.41 ± 6.23 minutes (range, 9–31 minutes).

Conclusions
Our results show that a short surgical time is needed to perform the proposed endoscopic septoplasty procedure. Such a short operative time allows the physician to both correct septal deviations quickly and correct/reduce the cartilaginous hump, thus representing a fundamental element of PR. In addition, the minimal tissue dissection reduces intraoperative nasal edema, favoring intraoperative aesthetic evaluation.
In-Depth Volumetric Analysis of Alveolar Cleft Defects Using Three-Dimensionally Printed Models
Authors: Chen Shuxiu , Liu Bing , Yin Ningbei , Wang Yongqian 
Published: June 2020

Abstract
Presurgical evaluation of the alveolar cleft defect is an essential and crucial step for procedural success. In this study, three-dimensionally printed models derived from computed tomography scans were used to measure the alveolar defect volume before bone grafting. The authors also explored the influence of cleft type, age, and gender on alveolar bone defect volume. Ninety-four patients with unilateral alveolar cleft were enrolled in this study. One-way analysis of variance and multivariate analysis were used to investigate the influence of age (8–14 years), gender, and cleft type on the outcome of alveolar bone defect volume. The mean volume of the alveolar cleft defect in all patients was 1.40 ± 0.37 ml, and the average age of the patients was 10.33 ± 1.75 years. One-way analysis of variance showed that alveolar defect volume was not influenced by age (P = 0.24 > 0.05). Multivariate analysis indicated that gender (P = 0.001 < 0.05) and cleft type (P = 0.028 < 0.05) had a statistically significant influence on alveolar defect volume. This study validates our clinical experience and further proves the importance of individualized presurgical volumetric assessment in achieving optimal therapeutic outcomes.
Saliva as a Potential Diagnostic Specimen for COVID-19 Testing
Authors: Harikrishnan Pandurangan 
Published: June 2020

Abstract
The current outbreak of the highly contagious, animal origin SARS-CoV-2 virus causes the disease COVID-19. The disease is globally pandemic and as per World Health Organization (WHO) has spread to 235 countries. There is global lockdown for containment of the virus transmission. Testing of symptomatic patients, healthcare workers and suspected individuals and mass screening is vital. WHO recommends nasopharyngeal (NP) and oropharyngeal (OP) swab for the quantitative assessment of SARS-CoV-2 RNA level through real-time reverse transcription polymerase chain reaction (rRT-PCR). The virus is shown to be consistently present in saliva and rRTPCR of saliva specimens and have advantages over NP and OP swabs such as self-collection of saliva, avoidance of healthcare workers for specimen collection, cost-effectiveness, etc. This article explores the current literature and suggests saliva as an emerging potential diagnostic specimen for COVID-19 testing.
Linguistic Validation of the Debriefing Assessment for Simulation in Healthcare in Spanish and Cultural Validation for 8 Spanish Speaking Countries
Authors: Muller-Botti Sacha , Maestre Jose M. , del Moral Ignacio , Fey Mary , Simon Robert 
Published: June 2020

Introduction
Debriefing Assessment for Simulation in Healthcare (DASH) is an instrument to assist in developing and evaluating faculty debriefing and instructional skills that, in the context of trained raters, yields reliable data and internal consistency. Support for its validity is grounded in both its content and the scores arising from its use. The utilization of this and other assessment tools, guidelines, and protocols is expanding internationally, but most of them are available only in English and there is not a single established methodology for translation. The objectives of this study were to demonstrate a translation technique and conduct a linguistic validation of the translation of the DASH from English to Spanish and to demonstrate and conduct a cultural validation across 8 Spanish-speaking countries.

Methods
A forward translation and review of the DASH score sheets and Rater's Handbook defined the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the translators to produce the approved harmonized version. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 5 monolingual subjects from 8 Spanish-speaking countries.

Results
During the forward translation, 16 discrepancies were detected in the Spanish DASH. Sixty-two participants were sent the Spanish cultural questionnaire and 48% responded. A total of 82 different interpretations and 57 extra recommendations (42% terms, 16% concepts, and 42% syntax) were made. Twenty-seven percent of them were applied.

Conclusions
The translated DASH has undergone a linguistic validation into Spanish, and a cultural validation across 8 Spanish-speaking countries. It may be used to assess debriefings in healthcare settings in these countries. The methodology used is applicable for translating and assessing a cross-cultural validation of assessment instruments.
Age, Not Sex, Modifies the Effect of Frailty on Long-term Outcomes After Cardiac Surgery
Authors: Sun Louise Y. , Spence Stewart D. , Benton Samantha , Beanlands Rob S. , Austin Peter C. , Bader Eddeen Anan , Lee Douglas S. 
Published: June 2020

Objective:
To examine the prevalence of frailty in surgical patients and determine whether age and sex modify the relationship between frailty and long-term mortality.

Background:
Frailty is a complex and prevalent clinical syndrome. The cardiac surgery literature consists mostly of small, single-center studies, and the epidemiology of frailty remains to be fully elucidated in a real-world surgical population.

Methods:
This retrospective cohort study included patients who underwent coronary artery bypass grafting, and/or aortic, mitral or tricuspid valve surgery in Ontario, Canada, between 2008 and 2016. The primary outcome was all-cause mortality. Survival probabilities were calculated using the Kaplan-Meier method, and the association of covariates with the hazard of death was assessed using multivariable Cox proportional hazard models. Frailty was assessed using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnoses indicator.

Results:
Of 72,824 patients, 11,685 (16%) were frail. At median 5 ± 2 years of follow-up, 2921 (25.0%) frail patients and 8637 (14.1%) non-frail patients had died [adjusted hazard ratio 1.60; 95% confidence interval (CI), 1.53–1.68]. The adjusted hazard ratio was highest in patients who underwent isolated mitral (2.18; 95% CI, 1.71–2.77) and mitral + aortic valve surgery (1.85; 95% CI, 1.33–2.58) and lowest after coronary artery bypass grafting + mitral valve surgery (1.38; 95% CI, 1.11–1.70). Age, but not sex, modified the effect of frailty on mortality; such that the rate of death decreased linearly with increasing patient age.

Conclusions:
We observed a high prevalence of frailty in patients undergoing cardiac surgery, and a statistically significant association between frailty and long-term mortality after cardiac procedures. Importantly, the rate of death was inversely proportional to age, such that frailty had a stronger adverse impact on younger patients. Our findings highlight the need to incorporate frailty into the preoperative risk stratification and investigate strategies to support younger patients who are frail.