bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of Paediatric Nutrition Screening Tool (PNST) among Hospitalized Malaysian Children
Authors: Ong Shu Hwa , Chen Seong Ting 
Published: December 2019

Abstract

Background
It is recommended to screen hospitalized children to identify those at risk of malnutrition. Constricted schedule in tertiary care settings calls for the needs of a less burdensome yet effective nutrition screening tool. This study aimed to validate the use of Paediatric Nutrition Screening Tool (PNST) among hospitalized children in a Malaysian tertiary hospital.

Methods
This cross-sectional study recruited children below 18 years old admitting into general paediatric ward in a public hospital. The PNST and Subjective Global Nutritional Assessment (SGNA) were performed on 100 children (64 boys and 36 girls). The objective measurements include anthropometry (z-scores for weight, height and body mass index), dietary history and biochemical markers were measured. These were used to classify malnutrition as per Academy of Nutrition and Dietetics/American Society of Parental and Enteral Nutrition (AND/ASPEN) Consensus Statement for identification of paediatric malnutrition and WHO growth standards for children. Cohen’s kappa was computed to report the level of agreement.

Results
The PNST identified 57% of hospitalized children as being at risk of malnutrition. In this study, there was a stronger agreement between PNST with AND/ASPEN malnutrition classification (k = 0.602) as when PNST was compared with WHO (k = 0.225) and SGNA (k = 0.431). The PNST shows higher specificity (85.29%) and sensitivity (78.79%) when compared with AND/ASPEN than with WHO malnutrition criteria (55.81% specificity and 66.67% sensitivity).

Conclusion
This study showed the usefulness of routine use of PNST for screening the malnutrition risk of hospitalized children in Malaysian tertiary hospital settings.
Follicular helper T cells in type 1 diabetes
Authors: Shao Feng , Zheng Peilin , Yu Di , Zhou Zhiguang , Jia Lijing 
Published: December 2019

AbstractType 1 diabetes (T1D) is an autoimmune disease caused by the dysfunction of immune system and consequently the destruction of insulin‐producing β cells. In past decades, numerous studies have uncovered that CD4+ T cell subsets are critical in the pathogenesis of T1D, manifesting that type 1 T helper (Th1) and Th17 cells are pathogenic, while regulatory T (Treg) cells and Th2 cells are protective. More recently, the pathogenic role of another subset, follicular helper T (Tfh) cells that essentially regulate germinal center (GC) formation and humoral responses, has also been demonstrated in T1D and many other autoimmune diseases. In this review, we summarize the evidence for the aberrant differentiation and function of Tfh cells in T1D, and also discuss the underlying mechanisms. A better understanding on the pathogenic role of Tfh cells in T1D will inspire the design of potential therapeutic strategies to target this subset in the future.
Chemokine CCL2 contributes to BBB disruption via the p38 MAPK signaling pathway following acute intracerebral hemorrhage
Authors: Guo Fuyou , Xu Dingkang , Lin Yazhou , Wang Guoqing , Wang Fang , Gao Qiang , Wei Qingjie , Lei Shixiong 
Published: December 2019

AbstractIntracerebral hemorrhage (ICH) remains a devastating type of stroke that lacks an effective treatment. Recent evidence has demonstrated that CCL2 is involved in the blood‐brain barrier (BBB) disruption and propagermanium (PG) as a CCL2 receptor inhibitor is neuroprotective in ischemic stroke. However, whether PG therapy exert effective role in acute ICH still unclear. In this study, our goal was to investigate the potential role of CCL2 and the effects of PG in ICH. Differentially expressed RNAs including CCL2 were detected in human ICH. CCL2 and the activation of p‐p38 MAPK and AQP4 expression were analyzed in rats after ICH. Brain water content and BBB integrity as well as neurological function were also examined after PG administration. In addition, the mechanism by which CCL2‐mediated BBB injury was further investigated by cell coculture. Our findings showed that PG could effectively reduce brain edema and improve neurobehavioral functions. p‐p38 MAPK and AQP4 expression were significantly inhibited by PG in vivo and in vitro. To the best of our knowledge, this is the first demonstration of PG in neuroprotecting the BBB integrity by inhibition of CCL2‐CCR2‐p38 MAPK pathway following ICH, targeting CCL2 could be developed as a novel treatment for hemorrhagic stroke.
Early Postoperative Outcomes of Normal Pressure Hydrocephalus: Results of a Service Evaluation
Authors: D’Antona Linda , Blamey Sandra C. , Craven Claudia L. , Sewell Darreul , Manohara Shivani , Leemans Michelle , Worby Susannah , Thompson Simon D. , Golahmadi Aida K. , Funnell Jonathan P. , Thorne Lewis , Watkins Laurence D. , Luoma Astri M.V. , Toma Ahmed K. 
Published: December 2019

Background:
Patients with normal pressure hydrocephalus (NPH) are often elderly, frail and affected by multimorbidity. Treatment is surgical with cerebrospinal diversion shunts. The selection of patients that are of an acceptable level of risk to be treated surgically has been a matter of debate for years and has deprived some patients of life-changing surgery. The aim of this service evaluation was to investigate the preoperative risk factors and early postoperative morbidity of patients with NPH using a standardized postoperative survey.

Materials and Methods:
Consecutive NPH patients admitted for neurosurgical management of NPH between May 2017 and May 2018 were included in this prospective service evaluation. In addition to the collection of traditional outcome measures, the cardiac version of the Postoperative Morbidity Survey (C-POMS) was conducted on postoperative days 4, 7, and 10 to identify postoperative morbidity.

Results:
Eighty-eight patients (63 males, age mean±SD, 75±7 y) underwent 106 surgical procedures (61 lumbar drains, 45 ventriculoperitoneal shunts). There was no 30-day mortality and no unexpected return to the operating room or admission to intensive care unit. There was 1 conservatively managed surgical complication. On postoperative day 4, the C-POMS identified no postoperative morbidity in 72% of the patients, and mild morbidity (postoperative nausea and mobility issues) in 28%. There was a delay in discharge in 50% of the patients with no postoperative morbidity on day 4, highlighting areas of our service requiring improvement.

Conclusions:
Early postoperative outcomes of NPH patients are good after both ventriculoperitoneal shunt insertion and lumbar drainage. This evaluation provides initial evidence on the utility of the C-POMS as a service evaluation tool in the standardized assessment postoperative outcomes in neurosurgery patients.
Increased Risk of Stroke Among Young Adults With Serious Traumatic Brain Injury
Authors: McFarlane Timothy D. , Love Josh , Hanley Shane , Dixon Brian E. , Hammond Flora M. 
Published: December 2019

Objective:
To quantify the risk of acute ischemic stroke (AIS) following traumatic brain injury (TBI) according to severity.

Setting:
Indiana Network for Patient Care, including medical records from more than 100 Indiana hospitals and affiliated practices.

Participants:
Individuals 18 years and older with TBI from 2005 to 2014.

Design:
Retrospective cohort.

Main Measures:
AIS incidence in the first 30, 31 to 180, and 181 days after TBI. Time to AIS using a stratified Cox proportional hazards model.

Results:
Among 58 294 patients with TBI, AIS risk was greatest in the first 30 days (incidence rate = 23.3 per 1000 person-months), declining to 3.1 and 1.3 per 1000 person-months after 31 to 180 and 181 days or more, respectively. Cervical artery dissection increased the risk of AIS in the first 30 days (incidence rate = 170.9 per 1000 person-months). In the first 30 days, serious TBI increased risk for all age groups, with the largest effect observed among those aged 18 to 24 years. Over time, serious TBI modified the effect of age on AIS only for those aged 18 to 24 years.

Conclusions:
These findings add to a growing body of work demonstrating that the acute and postacute stages of TBI play an accelerative role in AIS risk, particularly among younger patients, cervical artery dissection, and serious TBI.
High rates of serology testing for coeliac disease, and low rates of endoscopy in serologically positive children and adults in Israel: lessons from a large real-world database
Authors: Guz-Mark Anat , Feldman Becca S. , Ghilai Adi , Hoshen Moshe , Cohen Herman Avner , Shkalim Zemer Vered , Assa Amit , Zevit Noam , Shamir Raanan 
Published: December 2019

Background:Although coeliac disease is common worldwide, little is known regarding screening patterns in unselected populations, and on real-life adherence to professional guidelines for coeliac disease diagnosis and management.Objective:To explore current practices in the diagnosis and management of coeliac disease, using data from a large Health Maintenance Organization in Israel that covers 54% of the population.Methods:A population-based electronic database of about 4.5 million individuals was reviewed during the period of 1 January 2008 to 31 December 2015. Rates and results of coeliac disease serology testing and endoscopy procedures were examined. Subgroup analysis was performed by age, sex, ethnicity and socioeconomic status.Results:Coeliac disease serology cumulative testing rate was 17.1% and 8.9% in the paediatric and adult population, respectively. The cumulative incidence of positive coeliac disease serology was 0.45% in children and 0.17% in adults, and was associated with age, sex, ethnicity and socioeconomic status sub-groups (P-value < 0.01). Gastrointestinal endoscopies were not subsequently performed in 44.1% of children and 47.1% of adults with positive coeliac disease serology. Within the study period, 36% of children and 56% of adults never achieved coeliac disease serology normalization.Conclusion:In a large real-life database, screening for coeliac disease was common. However, confirmatory intestinal biopsies were under-utilized, and coeliac disease serology often remained positive over a long period time in both children and adults.
Clinical score predicting a successful endoscopic approach of esophageal anastomotic leaks: external validation
Authors: Azevedo Richard , Coelho Mariana , Gouveia Catarina , Loureiro Rui , Freire Ricardo , Silva Rui , Cravo Marília , Pereira António Dias , Ribeiro Mário Dinis , de Ferro Susana Mão 
Published: December 2019

Background
Recently, a clinical prediction rule has been proposed to predict the chance of successful endoscopic stenting in benign esophageal anastomotic leakage, perforation and fistula. We aimed to validate this score in a cohort of patients with anastomotic leaks managed with self-expanding metal esophageal stents, by assessing technical and clinical success rates and comparing the agreement between the predicted and the actual clinical success.

Methods
A multicenter retrospective cohort study including patients submitted to endoscopic stenting due to anastomotic leak was conducted. Variables of the score (leak size, location and C-reactive protein) were collected and the chance of success (≤50, 50–70 and ≥70%) and its accuracy was assessed.

Results
Fifty-three patients, submitted to esophageal stenting after cancer (n = 47) and bariatric surgery were included. Clinical success was achieved in 62% of patients. The area under the ROC curve to differentiate between successful and failed therapies showed a good discriminative power of the score (AUC 0.705; P < 0.01). For a predicted chance of success >50%, the positive predictive value was 72.5%; for a chance of success ≤50%, the negative predictive value was 69.2%.

Conclusions
The application of this predictive model in patients with anastomotic leaks proved to be valid in a different cohort from that in which it was derived. Its usefulness in clinical practice may be anticipated, favoring stenting in patients with a chance of success >50%. However, we must be cautious in patients with a lower probability of success and a case-by-case decision should be made.
Orphenadrine in treatment of muscle cramps in cirrhotic patients: a randomized study
Authors: Abd-Elsalam Sherief , Ebrahim Shaimaa , Soliman Shaimaa , Alkhalawany Walaa , Elfert Asem , Hawash Nehad , Elkadeem Mahmoud , Badawi Rehab 
Published: December 2019

Objective
Many patients of liver cirrhosis are complaining of muscle cramps, which are annoying to them. There is no effective treatment for muscle cramps in cirrhotic patients till now. This study purposed to evaluate efficacy and safety of orphenadrine in the treatment of muscle cramps in cirrhotic patients.

Methods
One hundred and twenty four patients who had muscle cramps three or more times weekly were included. They were divided into two arms: 62 patients administrated orphenadrine and 62 administrated placebo. They were followed up till 2 weeks after the end of therapy. Muscle cramps were evaluated using questionnaire as regards severity, duration, and frequency. Also, side effects of orphenadrine were recorded.

Results
Frequency, duration of muscle cramps, and pain score improved significantly after 1 month of orphenadrine therapy in comparison to placebo. Few side effects were recorded in the form of dry mouth, drowsiness, and nausea.

Conclusion
Orphenadrine is considered as promising safe drug for treatment of muscle cramps associated with liver cirrhosis.
Should we use papilla morphology to estimate the size of the terminal common bile duct during endoscopic retrograde cholangiopancreatography?
Authors: Lopes Luís , Canena Jorge , Fernandes João , Moreira Marta , Costa Inês , Gomes-Fonseca João , Araújo Tarcísio , Alexandrino Gonçalo , Lourenço Luís , Horta David , Giestas Sílvia , Ribeiro Helena , Ramada José , Familiari Pietro , Dinis-Ribeiro Mário 
Published: December 2019

Objective
A small common bile duct (CBD) diameter has been associated with complications and with a difficult biliary cannulation. Previous studies suggested that this diameter can be predicted during the endoscopic retrograde cholangiopancreatography (ERCP) simply by observing the papillary morphology. Despite this published suggestion there is no study addressing this topic. This study evaluated a possible association between the morphology of the major papilla and the diameter of the terminal CBD (t-CBD).

Methods
Observational cross-sectional study including consecutive patients with naïve papillae was referred for ERCP in two affiliated university hospitals. The transverse (p-transv) and longitudinal measures (p-long) of the papilla were obtained using a visual method. Papillae were classified into nonprominent, prominent, bulging or other. The t-CBD was measured 1 cm from the papilla using fluoroscopic images in prone/supine. Measurements were performed by two senior endoscopists and outcomes were evaluated using correlation and linear regression model.

Results
We included 245 patients with a median age of 76 years. The median p-transv for each type of papillae was as follows: nonprominent = 6 mm, prominent = 9 mm, bulging = 15 mm and other = 6 mm; P < 0.001. The median t-CBD for nonprominent = 7.62 mm, prominent = 8.34 mm, bulging = 8.60 mm and other = 8.52 mm; P = 0.40. The correlation between the transverse and longitudinal measures of papilla and the t-CBD were 0.0092 and 0.0614, respectively. In the regression model, the t-CBD diameter was not explained by papilla’s size or morphology (R
2 = 1.70%; P = 0.80).

Conclusion
The morphology of the papilla must not be used as a predictor of the diameter of the CBD as there is no correlation between these two items.
Activated Clotting Times Demonstrate Weak Correlation With Heparin Dosing in Adult Extracorporeal Membrane Oxygenation
Authors: Hohlfelder Benjamin , Kelly Daniel , Hoang Minh , Anger Kevin E. , Sylvester Katelyn W. , Kaufman Richard M. , Connors Jean M. 
Published: December 2019

Background:
The optimal monitoring strategy for anticoagulation management in extracorporeal membrane oxygenation (ECMO) remains a clinical controversy. The Extracorporeal Life Support Organization Anticoagulation Guidelines suggest that multiple anticoagulation assays may be needed but do not specify a preferred management strategy.

Study Question:
In adult ECMO patients, which anticoagulation assays demonstrate the highest correlation with unfractionated heparin (UFH) dose requirements?

Study Design:
We performed a retrospective chart review of adult patients cannulated to ECMO between February 2013 and July 2015.

Measures and Outcomes:
The primary outcome was the correlation between activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti-Xa and UFH dose. Secondary outcomes included correlations between anticoagulation assays. Correlations were calculated for the entire cohort, with subgroup analysis of venoarterial and venovenous ECMO patients.

Results:
Forty-eight patients were included in the analysis, 26 initially cannulated to venoarterial ECMO and 22 to veno-venous ECMO. The median duration of ECMO therapy was 7 days. Mean UFH requirements were 1149 units/h or 15.3 units/kg/h. Total UFH dose was most correlated with anti-Xa levels (r = 0.467), whereas weight-based heparin dose was most correlated with aPTT (0.405). For correlations between anticoagulation assays, anti-Xa and aPTT were more highly correlated with each other (r = 0.633) compared with ACT.

Conclusions:
In adult patients requiring ECMO, anti-Xa and aPTT monitoring were correlated more closely with UFH dosing than ACT.
Effects of Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer: A Structural Equation Approach With the Theory of Unpleasant Symptoms
Authors: Kim Mijung , Jung Mi Sook 
Published: December 2019

Background
Chemotherapy-induced peripheral neuropathy (CIPN) is a common neurotoxic effect. Chemotherapy-induced peripheral neuropathy symptoms have multidimensional characteristics that are associated with various physiologic, psychological, and situational factors and affect individual’s abilities to effectively function in performing daily tasks. The theory of unpleasant symptoms mediates the relationships among CIPN symptom experience, reduced performance in daily tasks, and causative factors.

Objectives
The aim of this study was to examine how influencing factors (physiologic, psychological, and situational) affect CIPN symptoms and the impact of symptom experience on functional interference in daily activities of chemotherapy-treated breast cancer survivors.

Methods
A cross-sectional survey about causative factors, CIPN symptoms, and functional interference was completed by 190 women treated with adjuvant chemotherapy for nonmetastatic breast cancer. The hypothetical model was tested using structural equation modeling analysis.

Results
The proposed model provided a good fit to the data. Physiologic and psychological factors accounted for 25.5% of the variance in CIPN symptom experience and explained 37.1% of the variance interfering with functional performance through CIPN symptom experience.

Conclusion
Disease- and treatment-related physiologic factors and coexisting psychological distress play crucial roles in explaining CIPN symptom experience and daily function in breast cancer survivors.

Implications for Practice
The findings help healthcare professionals to improve long-term care for breast cancer survivors in terms of education for self-monitoring, coping, and establishing supportive environment that can contribute to reducing the unmet needs and interference associated with persistent CIPN.
Functional Outcomes of Surgical Management of Mandibular Condylar Head Fractures
Authors: Lai Bo-Ru , Liao Han-Tsung 
Published: December 2019

Background
Various procedures have been described for the management of mandibular condylar head fracture, but a standard treatment is not yet conclusive. This report describes our experience with osteosynthesis of condylar head fracture at Linkou Chang Gung Memorial Hospital.

Methods
Sixteen patients with unilateral or bilateral mandibular condylar head fractures diagnosed by computed tomography and treated by open reduction and internal fixation between August 2014 and September 2016 were retrospectively reviewed. A preauricular approach was consistently used for internal fixation with 2 microplates and 4 screws after anatomic reduction. Occlusion, maximum mouth opening (MMO), radiographic outcome, and complications were recorded.

Results
Mean ± SD patient age was 29.5 ± 11.4 years, and mean ± SD procedure time was 264.3 ± 83.1 minutes. Mean ± SD postoperative MMO was 23.5 ± 10.2 mm at 1 month, 34.1 ± 8.6 mm at 3 months, 39.1 ± 5.7 mm at 6 months, and 40.0 ± 6.8 at 1 year. Early recovery of MMO of greater than 30 mm was achieved by 13 patients at 3 months after open reduction and internal fixation. There were no major complications.

Conclusions
Microplate fixation from the posterior aspect of the mandibular condylar head via the preauricular approach was safe for patients with mandibular condylar head fractures.
Risk of Free Flap Failure in Head and Neck Reconstruction
Authors: Wang Kuan-Ying , Lin Ying-Sheng , Chen Lee-Wei , Yang Kuo-Chung , Huang Wei-Chun , Liu Wen-Chung 
Published: December 2019

Background
Head and neck reconstruction is complicated and is made even more challenging by free flap failure. We identified risk factors associated with free flap failure in records extracted from a nationwide database of a 23 million populations.

Methods
We used International Classification of Diseases, Ninth Version, codes 140 to 149 and 161 to identify patients in Taiwan's National Health Insurance Research Database with head and neck cancer between 2000 and 2013. Patient's age, sex, neoadjuvant treatment, comorbidities, and anticoagulation use were also retrieved. Free flap reconstruction twice, or free flap and pedicle flap reconstructions during the same hospitalization were recorded as free flap failure. Logistic regression was used to identify factors that increased risk of free flap failure.

Results
A total of 21,548 patients with head and neck cancer were identified; 883 (4.1%) experienced free flap failure. Use of aspirin, clopidogrel, urokinase, prostaglandin (PGE1), low-molecular-weight heparin, and operation time were associated with free flap failure. However, some potential confounders could not be identified from the database.

Conclusions
Several statistically significant findings were prone to influence by potential confounders. The clinically applicable result was that longer operation time and preoperative chemotherapy could increase the likelihood of free flap failure. On the other hand, several factors were proved to be irrelevant to free flap failure.