bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Neonatal and Adult Fibrin Clot Properties between Porcine and Human Plasma
Authors: Nellenbach Kimberly A. , Nandi Seema , Kyu Alexander , Sivadanam Supriya , Guzzetta Nina A. , Brown Ashley C. 
Published: February 2020

Abstract

Background
Recent studies suggest that adult-specific treatment options for fibrinogen replacement during bleeding may be less effective in neonates. This is likely due to structural and functional differences found in the fibrin network between adults and neonates. In this investigation, the authors performed a comparative laboratory-based study between immature and adult human and porcine plasma samples in order to determine if piglets are an appropriate animal model of neonatal coagulopathy.

Methods
Adult and neonatal human and porcine plasma samples were collected from the Children’s Hospital of Atlanta and North Carolina State University College of Veterinary Medicine, respectively. Clots were formed for analysis and fibrinogen concentration was quantified. Structure was examined through confocal microscopy and cryogenic scanning electron microscopy. Function was assessed through atomic force microscopy nanoindentation and clotting and fibrinolysis assays. Lastly, novel hemostatic therapies were applied to neonatal porcine samples to simulate treatment.

Results
All sample groups had similar plasma fibrinogen concentrations. Neonatal porcine and human plasma clots were less branched with lower fiber densities than the dense and highly branched networks seen in adult human and porcine clots. Neonatal porcine and human clots had faster degradation rates and lower clot stiffness values than adult clots (stiffness [mmHg] mean ± SD: neonatal human, 12.15 ± 1.35 mmHg vs. adult human, 32.25 ± 7.13 mmHg; P = 0.016; neonatal pig, 10.5 ± 8.25 mmHg vs. adult pigs, 32.55 ± 7.20 mmHg; P = 0.015). The addition of hemostatic therapies to neonatal porcine samples enhanced clot formation.

Conclusions
The authors identified similar age-related patterns in structure, mechanical, and degradation properties between adults and neonates in porcine and human samples. These findings suggest that piglets are an appropriate preclinical model of neonatal coagulopathy. The authors also show the feasibility of in vitro model application through analysis of novel hemostatic therapies as applied to dilute neonatal porcine plasma.

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Prevalence of a Good Perinatal Outcome With Cryopreserved Compared With Fresh Donor Oocytes
Authors: Eaton Jennifer L. , Truong Tracy , Li Yi-Ju , Polotsky Alex J. 
Published: February 2020

OBJECTIVE:
To compare the odds of a good perinatal outcome between cryopreserved and fresh donor oocytes.

METHODS:
We used the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System to conduct a retrospective cohort study of women undergoing donor oocyte in vitro fertilization (IVF) from 2012 to 2015. Cycles using cryopreserved embryos, a gestational carrier, or preimplantation genetic testing were excluded. The primary outcome was a good perinatal outcome, defined as a singleton live birth at 37 weeks of gestation or more with birth weight at or within 2,500 g and 4,000 g. Secondary outcomes included live birth, multiple birth, and prematurity. Generalized estimating equation models were used to test the effect of oocyte type on the primary outcome while accounting for covariates and the correlation induced by repeated cycles within a patient.

RESULTS:
Of the 36,925 cycles included in the analysis, 8,381 (22.7%) used cryopreserved and 28,544 (77.3%) used fresh oocytes. The odds of a good perinatal outcome were marginally but significantly lower with cryopreserved than with fresh oocytes before and after covariate adjustment (22.0% vs 24.1%, unadjusted odds ratio [OR] 0.90, 95% CI 0.85–0.96, adjusted OR 0.88, 95% CI 0.81–0.95). Compared with fresh oocytes, cryopreserved oocytes were associated with lower rates of live birth (39.6% vs 47.7%, OR 0.75, 95% CI 0.72–0.79), multiple birth (22.3% vs 31.2%, OR 0.63, 95% CI 0.58–0.69), and prematurity (27.6% vs 30.6%, OR 0.86, 95% CI 0.79–0.94).

CONCLUSION:
This retrospective national study demonstrated that the use of cryopreserved compared with fresh donor oocytes in IVF cycles is associated with marginally lower odds of a good perinatal outcome.
Association Between Time of Day and the Decision for an Intrapartum Cesarean Delivery
Authors: Son Moeun , Lai Yinglei , Bailit Jennifer , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Caritis Steve N. , Prasad Mona , Tita Alan T.N. , Saade George , Sorokin Yoram , Rouse Dwight J. , Blackwell Sean C. , Tolosa Jorge E. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: February 2020

OBJECTIVE:
To examine whether the decision and indications for performing intrapartum cesarean delivery vary by time of day.

METHODS:
We conducted a secondary analysis of a multicenter observational cohort of 115,502 deliveries (2008–2011), including nulliparous women with term, singleton, nonanomalous live gestations in vertex presentation who were attempting labor. Those who attempted home birth, or underwent cesarean delivery scheduled or decided less than 30 minutes after admission were excluded. Time of day was defined as cesarean delivery decision time among those who delivered by cesarean and delivery time among those who delivered vaginally, categorized by each hour of a 24-hour day. Primary outcomes were decision to perform cesarean delivery and the indications for cesarean delivery (labor dystocia, nonreassuring fetal status, or other indications). Secondary outcomes included whether a dystocia indication adhered to standards promoted to reduce cesarean delivery rates. Bivariate analyses were performed using χ2 and Kruskal-Wallis tests for categorical and continuous outcomes, respectively, and generalized additive models with smoothing splines explored nonlinear associations without adjustment for other factors.

RESULTS:
Seven thousand nine hundred fifty-six (22.1%) of 36,014 eligible women underwent cesarean delivery. Decision for cesarean delivery (P<.001) decreased from midnight (21.2%) to morning, reaching a nadir at 10:00 (17.9%) and subsequently rising to peak at 21:00 (26.2%). The frequency of cesarean delivery for dystocia also was significantly associated with time of day (P<.001) in a pattern mirroring overall cesarean delivery. Among cesarean deliveries for dystocia (n=5,274), decision for cesarean delivery at less than 5 cm dilation (P<.001), median duration from 5 cm dilation to cesarean delivery decision (P=.003), and median duration from complete dilation to cesarean delivery decision (P=.014) all significantly differed with time of day. The frequency of nonreassuring fetal status and “other” indications were not significantly associated with time of day (P>.05).

CONCLUSION:
Among nulliparous women who were attempting labor at term, the decision to perform cesarean delivery, particularly for dystocia, varied with time of day. Some of these differences correlate with labor management differences, given the changing frequency of latent phase cesarean delivery and median time in active phase.
Association of Oxytocin Rest During Labor Induction of Nulliparous Women With Mode of Delivery
Authors: McAdow Molly , Xu Xiao , Lipkind Heather , Reddy Uma M. , Illuzzi Jessica L. 
Published: February 2020

OBJECTIVE:
To evaluate the association between temporary cessation in oxytocin infusion (oxytocin rest) and mode of delivery in women undergoing induction of labor with a protracted latent phase.

METHODS:
We conducted a retrospective cohort analysis of nulliparous women with term, vertex, singleton gestations who were undergoing induction of labor with continuous oxytocin infusion at a large academic medical center. Episodes of oxytocin rest were identified among patients who were exposed to 8 hours of continuous oxytocin yet remained in latent labor (ie, protracted latent labor). Multivariable logistic regression analysis was performed to estimate the association between duration of oxytocin rest and mode of delivery while adjusting for duration of latent phase, maternal age, gestational age, body mass index, and indications for induction and oxytocin cessation. Maternal and neonatal morbidities were also compared among patients with different durations of oxytocin rest.

RESULTS:
From January 2012 to December 2016, 1,193 patients met eligibility criteria. Among these patients, 267 patients (22.4%) underwent an oxytocin rest that lasted at least 1 hour. After adjusting for potential confounders, the odds ratios of cesarean delivery for patients with oxytocin rest compared with those with no oxytocin rest were as follows: 1.12 (95% CI 0.79–1.58) for less than 1 hour, 0.78 (95% CI 0.48–1.27) for 1–2 hours, 0.60 (95% CI 0.35–1.04) for 2–8 hours, and 0.43 (95% CI 0.24–0.79) for 8 hours or more. We did not detect an association between oxytocin rest of more than 8 hours and a composite of maternal or neonatal morbidities.

CONCLUSION:
An oxytocin rest of at least 8 hours is a clinical tool that may reduce the risk of cesarean delivery among women with protracted latent labor without significantly increasing maternal or neonatal morbidity.
Sensation of Pain Using Buffered Lidocaine for Infiltration Before Vulvar Biopsy
Authors: Villavicencio Jennifer C. , Kulkarni Amita , Luis Christine , Mendez Heidy , Raker Christina , Cronin Beth , Robison Katina 
Published: February 2020

OBJECTIVE:
To evaluate the effects of buffered lidocaine on pain scores during vulvar biopsy.

METHODS:
We conducted a double-blind, randomized controlled trial, using prefilled, sequentially numbered, randomized syringes to infiltrate either 3 mL of buffered or nonbuffered lidocaine before vulvar biopsy. The primary outcome was a pain score marked on a 100-mm visual analog scale during infiltration. Secondary outcomes included pain scores after the procedure and change from baseline to infiltration. Participants were recruited to detect a clinically meaningful 15-mm difference in pain scores between groups. Sample size was calculated based on the null hypothesis that the mean pain score would be the same in women treated with buffered lidocaine as in those treated with nonbuffered placebo based on prior studies. Categorical data were compared by Fisher exact test, and continuous data were compared between groups by t-test or Wilcoxon rank sum test.

RESULTS:
From July 2015 to April 2018, 129 participants were randomized to one of two groups: nonbuffered lidocaine or buffered lidocaine. One hundred twenty-five were analyzed (nonbuffered n=62, buffered n=63). Four patients were excluded. The majority of participants were non-Hispanic white women with a mean age of 59 years. There was no difference in the primary outcome of pain during infiltration with a mean pain score of 35.8 mm in the buffered lidocaine group compared with 42.2 in the nonbuffered lidocaine group (mean difference −6.4; 95% CI −18.4 to 5.6; P=.3 by Wilcoxon rank sum test). There was also no difference in secondary outcomes of pain over the entire procedure (mean difference −0.3, 95% CI −9.7 to 9.2; P=.7) or change in pain from baseline to infiltration (mean difference −6.9, 95% CI −18.4 to 4.7; P=.2).

CONCLUSION:
There was no difference in pain scores during vulvar biopsy infiltration between the buffered and nonbuffered lidocaine groups.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02698527.
Use of Uterine Tamponade and Interventional Radiology Procedures During Delivery Hospitalizations
Authors: Merriam Audrey A. , Huang Yongmei , Wright Jason D. , Goffman Dena , D'Alton Mary E. , Friedman Alexander M. 
Published: February 2020

OBJECTIVE:
To characterize use of uterine tamponade and interventional radiology procedures.

METHODS:
This retrospective study analyzed uterine tamponade and interventional radiology procedures in a large administrative database. The primary outcomes were temporal trends in these procedures 1) during deliveries, 2) by hospital volume, and 3) before hysterectomy for uterine atony or delayed postpartum hemorrhage. Three 3-year periods were analyzed: 2006–2008, 2009–2011, and 2012–2014. Risk of morbidity in the setting of hysterectomy with uterine tamponade and interventional radiology procedures as the primary exposures was additionally analyzed in adjusted models.

RESULTS:
The study included 5,383,486 deliveries, which involved 6,675 uterine tamponade procedures, 1,199 interventional radiology procedures, and 1,937 hysterectomies. Interventional radiology procedures increased from 16.4 to 25.7 per 100,000 delivery hospitalizations from 2006–2008 to 2012–2014 (P<.01), and uterine tamponade increased from 86.3 to 158.1 (P<.01). Interventional radiology procedures use was highest (45.0/100,000 deliveries, 95% CI 41.0–48.9) in the highest and lowest (8.9/100,000, 95% CI 7.1–10.7) in the lowest volume quintile. Uterine tamponade procedures were most common in the fourth (209.8/100,000, 95% CI 201.1–218.5) and lowest in the third quintile (59.8/100,000, 95% CI 55.1–64.4). Interventional radiology procedures occurred before 3.3% of hysterectomies from 2006 to 2008 compared with 6.3% from 2012 to 2014 (P<.05), and uterine tamponade procedures increased from 3.6% to 20.1% (P<.01). Adjusted risks for morbidity in the setting of uterine tamponade and interventional radiology before hysterectomy were significantly higher (adjusted risk ratio [aRR] 1.63, 95% CI 1.47–1.81 and aRR 1.75 95% CI 1.51–2.03, respectively) compared with when these procedures were not performed.

CONCLUSION:
This analysis found that uterine tamponade and interventional radiology procedures became increasingly common over the study period, are used across obstetric volume settings, and in the setting of hysterectomy may be associated with increased risk of morbidity, although this relationship is not necessarily causal.
Long-term Outcomes Following Vickers Ligament Release and Growth Modulation for the Treatment of Madelung Deformity
Authors: Del Core Michael , Beckwith Terri , Phillips Lee , Ezaki Marybeth , Stutz Chris , Oishi Scott N. 
Published: February 2020

Background:
Madelung deformity arises from a partial distal radial growth disturbance in combination with an abnormal hypertrophic ligament spanning the volar radius and carpus, termed, the Vickers ligament. The purpose of this study is to report long-term clinical and radiographic outcomes following Vickers ligament release and distal radial physiolysis in a population of skeletally immature patients with symptomatic Madelung deformity.

Methods:
Medical records were retrospectively reviewed of patients with Madelung deformity surgically treated between 1994 and 2005. All eligible patients who underwent a Vickers ligament release and distal radial physiolysis were contacted and invited to return to the clinic for follow-up.

Results:
Six patients (8 wrists) with Madelung deformity underwent Vickers ligament release and distal radial physiolysis. All were white females with a mean age at initial presentation of 11.4 years (10 to 12.8 y). Mean age at the time of initial surgery was 12.0 years (10.0 to 14.5 y). The median follow-up time was 10.6 years (5.8 to 21.9 y) and the average age at last follow-up was 23.1 years (17.5 to 32.2 y). Pain alone or in combination with concerns for deformity was the chief complaint in 6 of 8 of the wrists. At 1 year of clinical follow-up, 7 of 8 wrists were reported to be pain-free, and 6 of the 8 were noted to be completely pain-free at last follow-up. Motion in flexion, extension, pronation, supination, radial, or ulnar deviation was similar between the preoperative status and long-term follow-up. The average preoperative ulnar tilt was 35.1 degrees (SD: 8.5 degrees), average preoperative lunate subsidence was 1.9 degrees (SD: 1.8 degrees), and average preoperative palmar carpal displacement was 21.9 degrees (SD: 2.9 degrees). At the final follow-up, there was a large progression in lunate subsidence, but minimal change in ulnar tilt and palmar carpal displacement. At last clinical follow-up, 2 of the 6 patients had undergone a subsequent procedure including 1 radial dome osteotomy and 1 ulnar shortening osteotomy.

Conclusion:
In the skeletally immature patient population with Madelung deformity with growth potential remaining, distal radial physiolysis and Vickers ligament release is associated with relief of pain, preservation of motion, and, a reasonable rate of reoperation.

Type of Study:
This was a therapeutic study.

Level of Evidence:
Level II.
Pediatric Ganglion Cyst Recurrence: Location Isn’t the Only Risk Factor
Authors: Mooney Megan L. , Jacobs Cale A. , Prusick Vincent W. , Riley Scott A. 
Published: February 2020

Introduction:
Ganglion cysts represent the most common benign soft-tissue masses of the hand and wrist, most are treated nonoperatively, with relatively few local recurrences. Few studies have identified risk factors for recurrence in the pediatric population. The aim of this study is to identify risks of cyst recurrence and to establish if ultrasonographic imaging aids in the prediction of recurrence.

Methods:
A single-center retrospective chart review was performed, identifying patients diagnosed with a ganglion cyst of the hand or wrist. Demographic information, cyst characteristics, and ultrasound examination reports were documented. Standard statistical and logistic regression analyses were performed.

Results:
A total of 132 cysts were identified in 126 patients and the average age was 8.5 years old. The most common location was the dorsal wrist (57/132, 43.2%). There were 14 recurrences [11/14, (79%) dorsal wrist, 3/14 (21%) volar wrist, 0/14 (0%) in nonwrist locations]. The risk of recurrence was significantly greater for dorsal wrist cysts than nonwrist locations (odds ratio=18.1; 95% confidence interval: 1.02, 316.65; P=0.048); there was no statistical difference in recurrence rates between dorsal and volar cysts (P=0.15). Recurrence was noted in older patients (12.2 vs. 8.1 y, P<0.001) and those patients with painful masses (P=0.02). Patients undergoing surgical excision had a higher risk of recurrence than those who did not undergo surgical excision (P<0.001). Cyst volume as measured by ultrasound was performed in 37 cysts, with repeat ultrasounds in 12 cases demonstrating a decreased volume of 0.85 cm3 at baseline to 0.35 cm3 with repeat examination (P=0.40). In patients that received at least 1 ultrasound, there were no differences in cyst volume between those that recurred and those that did not (P=0.40).

Conclusions:
Risk factors for recurrence in pediatric patients with a ganglion cyst include older age, symptomatic masses, cysts located around the wrist, and those requiring surgical excision. Ultrasound examination of cyst volume did not predict recurrence.

Level of Evidence:
Level III—therapeutic.
Open Reduction of Neglected Supracondylar Humeral Fractures With Callus Formation in Children
Authors: Guo Meizhen , Xie Yan , Su Yuxi 
Published: February 2020

Background:
The standard treatment for supracondylar humeral fractures (SHFs) in children is closed reduction and percutaneous Kirschner (K)-wire fixation. In patients who present >14 days after injury and show callus formation, this procedure cannot be performed. There are 2 options in these cases: functional exercises with osteotomy performed at a later stage if cubitus varus is present, or immediate open reduction and percutaneous K-wire fixation. This study aimed to evaluate the outcomes of K-wire fixation through an anterior approach in children with neglected SHF and identify factors predicting the outcomes.

Methods:
This retrospective study assessed the files of 32 children treated for neglected SHF at our hospital between June 2015 and May 2018. An incision was made along the anterior transverse groove of the elbow. The callus was removed, the fracture was reduced, and K-wire fixation was performed. The outcome evaluation included the radiological Baumann angle, pin fixation construct, carrying angles, and the functional outcome was Mayo Elbow Performance Score and Flynn criteria. Binary regression analysis compared the functional outcome as the dependent variable with age, time from injury to operation, operation time, and the amount of callus.

Results:
The interval between injury and operation was 14 to 40 days (average, 22.4 d). Patients were followed for 12 to 36 months (average, 21.5 mo). Fracture healing took 5 to 8 weeks (average, 6.6 wk). No patient had a vascular injury or compartment syndrome. Twelve patients were intraoperatively assessed for radial and median nerve injury. No nerve repair was required. All nerve injuries recovered within 3 months. No iatrogenic ulnar nerve injury occurred. One patient had an infected incision. Binary regression analysis showed that the time elapsed between injury and operation (P=0.033) and Gartland type (P=0.008) were inversely correlated with outcomes; the longer the duration, the poorer the outcomes.

Conclusions:
The functional outcomes after open reduction and K-wire fixation through an anterior approach were poorer with longer time to surgery and Gartland type.

Level of Evidence:
Level III.
Long-term Outcomes Following Multilevel Surgery in Cerebral Palsy
Authors: Jones Mark D. , Gardner Richard , Pyman Jane , Gargan Martin F. , Witherow Peter , Monsell Fergal 
Published: February 2020

Background:
This long-term consecutive, retrospective single-center cohort study evaluates long-term outcomes of single-event multilevel surgery in diplegic cerebral palsy with respect to functional status, gait, and patient satisfaction.

Methods:
All patients with diplegic cerebral palsy who underwent single-event multilevel surgery >10 years previously were included. Retrospective gait assessment was performed using the Edinburgh Visual Gait Score (EVGS) and Gillette Functional Assessment Questionnaire Walking Scale (FAQWS) preoperatively and at midterm postoperative follow-up (median 2.6 y) and prospectively at most recent review [median 18 y, interquartile (IQ) range: 14.4 to 20.5 y]. The Short Form-36 (SF-36) was used prospectively to evaluate outcome compared with population norms for adults from the UK.

Results:
The complete assessment was possible in 26 of 39 patients who met the inclusion criteria. There was a statistically significant improvement at most recent follow-up compared with the preoperative assessment for EVGS and FAQWS [Wilcoxon Matched Pairs Signed Rank test −4.42 (P<0.0001) and 3.98 (P=0.0001), respectively]. The median Physical Health and Mental Health Component Summary scores for the SF-36 were 43.0 (IQ range: 32.8 to 46.8) and 55.3 (IQ range: 46.1 to 61.1), respectively.

Conclusions:
This study demonstrates significant long-term improvements in function, independence and patient satisfaction that continue into adulthood. This will inform discussions with patients and families considering this treatment option.

Level of Evidence:
Level IV—Retrospective cohort study.