bluuebunny/crossref_metadata_2025_split huggingface dataset:
Case Series of Rapid Surgical Interventions in Fulminant Intracranial Hypertension
Authors: Ploof Jillian , Aylward Shawn C. , Jordan Catherine O. , Drapeau Annie I. 
Published: July 2021

Aims: Examine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension. Methods: Patients under 21 years of age with a diagnosis of fulminant intracranial hypertension with temporary lumbar drain only, shunt after lumbar drain, and shunt only were included. Parameters investigated include lumbar drain data, medication freedom, time to resolution of papilledema, improvement in cranial nerve palsy, afferent pupillary defects, visual fields, visual acuity, and complications of each intervention. Results: Four patients had temporary lumbar drain, 2 temporary lumbar drain and cerebrospinal fluid shunt, and 3 shunt only. All achieved medication freedom and resolution of papilledema and cranial nerve palsies (if present). Most had resolution of preprocedure afferent pupillary defects. Minor residual visual field deficits occurred in 67%, and all had visual acuity improvement. One patient’s lumbar drain dislodged, and one patient had 2 cerebrospinal fluid shunt revisions. Conclusion: Temporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.
Prolonged Grief and Bereavement Supports Within a Caregiver Population Who Transition Through a Palliative Care Program in British Columbia, Canada
Authors: Wu Elizabeth X. , Collins Andrew , Briggs Shelley , Stajduhar Kelli I. , Kalsi Asha , Hilliard Neil 
Published: July 2021

Objective: To determine the prevalence of prolonged grief disorder (PGD), and self-reported resilience among bereaved caregivers within a palliative care program that serves a large region of the Lower Mainland in British Columbia, Canada. Additionally, to discern effective bereavement supports utilized by caregivers following the loss of a loved one. Methods: A descriptive study using both quantitative and qualitative methods. Sociodemographic information (n = 427) was collected from bereaved caregivers 3 months after their loss. PGD and resilience were prospectively assessed 12 months post-loss using the prolonged grief scale (PG-13, n = 212) and brief resilience scale (BRS, n = 215), respectively. A qualitative thematic analysis was conducted on responses to the open-ended question on what bereavement services or activities caregivers found helpful in coping with the loss of a loved one. Results: Of the 212 individuals that completed the PG-13, 4.7% met diagnostic criteria for PGD, 27.4% were moderate risk, and 67.9% were low risk for PGD. Of the 215 caregivers that completed the BRS, 48.4% had low resilience, 51.6% had normal resilience, and 0% had high resilience. The major themes of formal supports, informal supports, and self-care activities emerged from caregiver comments regarding effective bereavement supports. Conclusion: The incidence of PGD in caregivers is low within the Fraser Health Palliative Care program. Bereaved caregivers mainly utilize existing social networks and activities to cope with their loss. Focusing on a community-based approach to supports may improve bereavement experiences and lower rates of prolonged grief.
Oral Colonization and Virulence Factors of Candida spp. in Babies With Cleft Palate
Authors: de Souza Patrícia Tolentino da Rosa , Gonçalves-Wilhelmsen Nilza Cristina Valor , Rosa Rosimeire Takaki , Correia Clarice de Fatima Kamaroski Noan , Pereira Thais Munhoz , Kitahara Aldini Beuting Pereira , Ignácio Sérgio Aparecido , Azevedo-Alanis Luciana Reis , Rosa Edvaldo Antônio Ribeiro 
Published: July 2021

Objective: To examine oral colonization and virulence factors of Candida spp. in patients aged from 0 to 18 months with cleft palate (CP). Materials and Methods: Sixty babies were allocated into 3 groups: CP, CP with orthodontic plate (CPwP), and control group (Ctrl) without CP. Information on feeding habits, hygiene, and history of candidosis was collected. The presence of Candida spp. was investigated in samples of saliva. Fungal hydrophobicity, protease, esterase, phospholipase, and hemolysin were evaluated in a semiquantitative manner. Results: Positive oral isolations of Candida spp. were detected in CP (89.5%), CPwP (100%), and Ctrl (44%) groups. Candidosis was more reported in the cleft groups than in the Ctrl group ( P ≤ .023). There was a higher prevalence of Candida albicans, followed by Candida krusei, Candida tropicalis, and Candida parapsilosis in all groups. There was no uniformity of expression of virulence factors, either among different species or among different groups. Conclusion: Candida spp. colonization occurred in all groups, being superior in CPwP group. Candidosis episodes were more reported in patients from CPwP than in other groups, although candidosis was also registered in other groups. Candida albicans was the predominant species and virulence factors did not exhibit any pattern for species or groups of patients.
Early Communication Behaviors in Infants With Cleft Palate With and Without Robin Sequence: A Preliminary Study
Authors: van Eeden Stephanie , Wren Yvonne , McKean Cristina , Stringer Helen 
Published: July 2021

Objective: To investigate the early communication behaviors in infants with nonsyndromic isolated cleft palate (iCP) and Robin sequence (RS). Design: Group comparison using parent report. Participants: There were 106 participants included in this study. Two groups were selected from the UK Cleft Collective resource. Parents had completed the Language ENvironment Analysis Developmental Snapshot questionnaire when their child turned 13 months. There were 78 participants in the iCP group and 28 in the RS group. Main Outcome Measure(s): Total number of communication behaviors reported on the questionnaire. Subdomains for expressive and receptive language and social communication behaviors were also analyzed. Results: There were no statistically significant group differences. Parents of infants with RS reported fewer later communication behaviors compared to the iCP group. Infants in both groups had fewer communication behaviors compared to the normative sample. Across the whole sample, post hoc analysis revealed a significant correlation between severity of the cleft and social communication behaviors and expressive but not receptive language. Infants with a cleft of the hard and soft palate were more likely to be in the RS group (odds ratio: 7.04 [95% CI: 1.55-32.04]; P = .01). Conclusions: Both groups reported similar levels of early communication. Some divergence of more complex language skills was seen, although there were no significant group differences. A relationship with the diagnosis of a cleft of the hard or soft palate with expressive language behaviors was found. Further study into the impact of cleft severity on early speech development and the relationship with later language skills is needed along with longitudinal follow-up of this population.
Telemedicine for the management of pediatric burn patients admitted to emergency services
Authors: Esberk Tugba , Das Koray 
Published: July 2021

Introduction Telemedicine when properly implemented can be used to facilitate consultations from physicians with little or no burn experience by providing access to qualified physicians in burn care to reduce the workload in emergency departments or elsewhere. In this study, the role of telemedicine in the management and triage of pediatric burn patients admitted to the emergency department of a tertiary care hospital is investigated. Methods This cross-sectional study was conducted between 1 January 2019 and 31 December 2020 and a total of 210 patients were enrolled in the study. Patients were initially evaluated in the emergency room by a pediatrician and consulted by an experienced burn specialist using lesion images. An in-person assessment of the patients was performed by another burn specialist according to the clinical decision made via telemedicine. The data of both assessments and clinical data of the patients were examined. Results The mean age of our patients was 3.35 ± 3.7 years. Most of the burns were scalds with hot liquids (71%). After the consultations, 73 patients were discharged from the emergency room. The rest were decided as follow-up at the burn outpatient clinic ( n = 99) or hospitalization ( n = 35) and in-person assessment was performed for these patients. The inter-rater reliability value for “clinical decision” was almost perfect (Cohen's kappa value is 0.923). Also, the level of concordance between the two assessments was very high for burned total body surface area (interclass correlation coefficient = 0.999). Conclusion In the management and triage of pediatric burn patients admitted to the emergency department, telemedicine and in-person examination resulted in almost perfect agreement in terms of clinical decision and total body surface area. Legal arrangements and regulatory changes are essential to support the safe and wide adoption of telemedicine, which is a reliable method in emergency room settings.
The Potential Diagnostic Accuracy of Let-7 Family for Cancer: A Meta-Analysis
Authors: Zhang Wen-Ting , Zhang Guo-Xun , Gao Shuai-Shuai 
Published: July 2021

Background: Cancer is a global public health problem affecting human health. Early stage of cancer diagnosis, when it is not too large and has not spread is important for successful treatment. Many researchers have proposed that the let-7 microRNA family can be used as a biomarker for cancer diagnosis. The aim of this meta-analysis is to evaluate whether let-7 family can be used as a diagnostic tool for cancer patients. Methods: We conducted a comprehensive literature search on PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI) and Wanfang database, updated to October 23, 2020. A random effects model was used to pool the sensitivity and specificity. Besides, we measured the diagnostic value using positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) were pooled. In addition, meta-regression and subgroup analysis were performed to explore the possible sources of heterogeneity, and Deeks’ funnel chart was used to assess whether there was publication bias. Results: 31 studies from 15 articles were included in the current meta-analysis. The overall sensitivity, specificity, PLR, NLR, DOR and AUC were 0.80 (95% CI: 0.75-0.85), 0.81 (95% CI: 0.74-0.86), 4.2 (95% CI: 2.9-5.9), 0.24 (95% CI: 0.19-0.32), 17 (95% CI: 10-29) and 0.87 (95% CI: 0.84-0.90), respectively. Subgroup analysis shows that the let-7 family cluster of serum type showed a better diagnostic accuracy of cancer, especially the breast cancer. Although there is no publication bias, it still has some limitations. Conclusions: let-7 family can be considered as a promising non-invasive diagnostic biomarker for cancer.
Influence of pedal arch quality on 5-year survival and limb salvage in patients with diabetic foot ulcers undergoing peripheral angiography
Authors: Troisi Nicola , Guidotti Azzurra , Turini Filippo , Lombardi Renzo , Falciani Francesca , Baggiore Cristiana , Michelagnoli Stefano , Chisci Emiliano 
Published: July 2021

Introduction The aim of this study was to evaluate the influence of pedal arch quality on 5-year survival and limb salvage in diabetic patients with foot wounds undergoing peripheral angiography. Methods Between January 2014 and December 2014, 153 diabetic patients with foot wounds underwent peripheral angiography. Final foot angiograms were used to allocate patients according to pedal arch: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA). Five-year survival and limb salvage rates were analyzed with Kaplan–Meier curves and compared by means of Gehan–Breslow–Wilcoxon test. Associations of patient and procedure variables with overall survival and limb salvage outcomes were sought with univariate and multivariate analyses. Results A below-the-knee (BTK) artery was the target vessel in 80 cases (52.3%). Five-year Kaplan–Meier rates of survival were similar in all groups ( p = 0.1): CPA 30%, IPA 27.5%, and APA 26.4%. Five-year limb salvage rates were significantly better in patients with CPA/IPA ( p < 0.001): CPA 95.1%, IPA 94.3%, and APA 67.3%. In the whole population study, multivariate analysis showed significant association of smoking ( p = 0.01), chronic renal failure ( p = 0.02), and severity of foot wounds ( p < 0.001) with survival. Coronary artery disease ( p = 0.03), severity of foot wounds ( p = 0.001), and pedal arch status ( p = 0.05) showed strong association with limb salvage. Conclusions Pedal arch quality significantly affected limb salvage but not survival at 5 years in patients with diabetic foot ulcers. Smoking, chronic renal failure, and severity of foot wounds affected overall survival, whilst coronary artery disease, and severity of foot wounds limb salvage.
Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis
Authors: Bi Guoshan , Wang Quanwen , Xiong Guozuo , Chen Jie , Luo Dongyang , Deng Jiangbei , Qin Xiao 
Published: July 2021

Objective The objective is to investigate whether percutaneous access (pEVAR) is superior to cutdown access (cEVAR) in terms of safety and efficacy during endovascular repair of abdominal aortic aneurysms (AAAs). Methods We searched PubMed, Embase, and Cochrane Library from January 1999 to December 2020 for studies reporting on the comparison between percutaneous and cutdown techniques for endovascular repair of AAAs. Outcomes evaluated were technical success rates, access site-related complications and operative time, and hospital stay. Results Four randomized controlled trials and nine observational studies with a total of 1683 patients comprising 2715 groin accesses were eligible for the meta-analysis. pEVAR was associated with a lower risk of overall complications (odds ratio (OR) = 0.63; p = .005) and seroma/lymphorrhea (OR, 0.18; p = .0001) and shortened operation time (MD = −39.04; p = .002) and the length of hospital stay (MD = −0.75; p < .00001) compared with cEVAR. The technical success rate for pEVAR was 95.1% (694/729), with an overall OR of 0.27 (95% CI 0.14–0.55, p = .0003) comparing pEVAR with cEVAR. Furthermore, pEVAR did not increase the risk of site infection, femoral artery thrombosis, postoperative hematoma, nerve injury, dissection, and bleeding. Conclusion Percutaneous endovascular aneurysm repair is a safe and effective method for the treatment of AAA. It reduces the risk of overall complications and shortens the operation time and hospital stay. The technical success rate of pEVAR is lower than that of cEVAR, which may be linked to the selection of patients, operator experience, and the use of ultrasound. Large definitive trials are required to draw robust conclusions.
Treatment-emergent adverse events occurring early in the treatment course of cladribine tablets in two phase 3 trials in multiple sclerosis
Authors: Oh Jiwon , Walker Bryan , Giovannoni Gavin , Jack Dominic , Dangond Fernando , Nolting Axel , Aldridge Julie , Lebson Lori A , Leist Thomas P 
Published: July 2021

Background Treatment-emergent adverse events (TEAEs) that occur close to treatment initiation may negatively affect overall tolerability and adherence. It is important to develop a clear understanding of potential early TEAEs after initiating treatment with cladribine tablets. Objective To identify TEAEs that begin early in the course of treatment in patients enrolled in CLARITY and ORACLE-MS studies. Methods This post hoc analysis of CLARITY and ORACLE-MS safety populations assessed the incidence of TEAEs, serious TEAEs, drug-related TEAEs, and TEAEs leading to discontinuation in patients receiving cladribine tablets or placebo within 2, 6, and 12 weeks after treatment initiation. Results By Week 12, 61.3% of patients treated with cladribine tablets 3.5 mg/kg and 55.2% treated with placebo experienced a TEAE. More patients receiving cladribine tablets versus placebo experienced a drug-related TEAE by Week 12 (34.7% vs. 23.2%). The most common TEAEs reported with cladribine tablets were: headache (7.2%), lymphopenia (6.8%), and nausea (6.0%). Patients receiving cladribine tablets and placebo reported similar proportions of serious TEAEs (2.2% vs. 1.7%) and TEAEs leading to treatment discontinuation (1.6% vs. 1.4%). Conclusion Cladribine tablets were well tolerated during the first 12 weeks as evidenced by a low incidence of TEAEs leading to treatment discontinuation.
A retrospective analysis of changes in lymphocyte levels in patients with multiple sclerosis during and after Tecfidera® treatment
Authors: Baeva Maria-Elizabeth , Baev Philip Boris , Nelson Jill , Kazimirchik Anna , Vorobeychik Galina 
Published: July 2021

Background There are currently no best practice recommendations for lymphocyte subset monitoring for patients with multiple sclerosis (pwMS) on disease-modifying therapies including Tecfidera® (dimethyl fumarate, DMF). However, there have been several cases of pwMS on DMF without severe lymphopenia who had high CD4:CD8 T cell ratios and went on to develop progressive multifocal leukoencephalopathy. Objective Our objective was to characterize the changes in immune profile during and after DMF treatment in pwMS. Methods A retrospective analysis of longitudinal data from 299 pwMS who have been treated with DMF at the Fraser Health Multiple Sclerosis Clinic in British Columbia, Canada. The blood test results were taken from January 1, 2013 to April 1, 2020. Results Our results suggest that CD8+ T cells had the highest proportional decrease compared to other lymphocyte subset populations and overall lymphocyte count in response to DMF treatment. CD56+ Natural Killer cells were similarly decreased in response to DMF treatment. CD4:CD8 T cell ratio was the measurement that had the highest rate of change in response to DMF initiation and discontinuation. Conclusion CD8+ T cell count and CD4:CD8 T cell ratio may be a more sensitive measurement of the immune landscape of patients with MS on DMF.
RISK FACTORS FOR FAILURE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN A PEDIATRIC POPULATION: A NOVEL PREDICTION ALGORITHM
Authors: Lemme Nicholas J. , Yang Daniel S. , Barrow Brooke , O’Donnell Ryan , Daniels Alan , Cruz Aristides I. 
Published: July 2021

Background: Pediatric anterior cruciate ligament (ACL) reconstruction is becoming increasingly common, however, there is limited literature on the risk factors for failure in this demographic. Hypothesis/Purpose: In the present study we sought to: 1. To determine the rate of pediatric ACL reconstruction (ACLR) failure requiring revision surgery in a nationally representative sample. 2. To determine the associated patient/injury-specific risk factors for ACLR failure. 3. To examine the differences in the rate and risks of failure between pediatric and adult patients. Methods: Patient records were drawn from Humana individual health plans and Medicare medical records. Adult and pediatric patients who underwent primary ACLR and subsequent reoperation for either ACL revision surgery or a revision meniscal procedure between 2011-2016 were identified. Multivariate regression was used to determine the significant risk factors for ACL revision and overall reoperation rates in pediatric and adult patients. A risk algorithm was developed to predict the risk of ACL revision following pediatric ACL reconstruction. Results: Pediatric patients were significantly more likely to require ACL revision within one year (OR=1.97, 95%CI 1.57-2.45, p<0.0001) and five years (OR=3.22, 95%CI 2.77-3.72, p<0.0001) following their index ACLR compared to adults. Survivorship of the index ACL procedure was significantly decreased in pediatric patients (log-rank test p<0.0001) (Figure 1). Pediatric patients were also at higher risk of sustaining a contralateral ACL tear compared to adults (5.9% vs. 1.4%, respectively, p<0.0001). Meniscus injury was a risk factor for overall re-operation (OR=2.18, 95%CI 1.67-2.89 p<0.0001) as well as ACL revision (OR=2.28, 95%CI=1.66-3.21, p<0.0001) in the pediatric cohort. This increased risk was sustained despite the type of meniscal tear intervention, with patients undergoing concurrent meniscal repair (OR=1.84, 95%CI 1.43-2.38, p<0.0001) or meniscectomy (OR=2.20, 95%CI 1.72-2.82, p<0.0001) having a higher likelihood of requiring a revision ACLR. Concomitant MCL injury but not LCL injury was a risk factor for ACL revision in this cohort (OR=1.70, 95%CI 1.31-2.19, p<0.0001). Male sex and (OR=0.78, 95%CI 0.63-0.96, p=0.0204) and being >14 years old (OR=0.62, 95%CI 0.45-0.86, p=0.0035) was associated with a decreased risk of overall reoperation. The risk algorithm demonstrated the highest probability for ACLR failure in females, less than 15 years of age, with concomitant meniscus and MCL injury, demonstrating a 36% risk of failure (Table 1). Conclusion: Compared to adults, pediatric patients have an increased likelihood of ACL revision surgery, contralateral ACL tears, and meniscal reoperation within 5 years of an index ACLR. [Table: see text][Figure: see text]
RELIABILITY OF NOVEL ULTRASOUND MEASUREMENT FOR DETERMINING PATELLA POSITION
Authors: Greenberg Elliot , Rotunno Nicole , Brown Naomi 
Published: July 2021

Background: Patellar dislocations are common among youth athletes. A detailed understanding of patellofemoral anatomy is critical to determine patient prognosis and guide treatment and decision making. Recent literature suggests that measures of patella position relative to the trochlear groove may help identify individuals at risk of repetitive dislocations. While these measures were described using MRI, it is plausible that ultrasound imaging can be utilized to provide similar information in a more cost-effective and time-efficient manner. Purpose: To determine intra and inter-rater reliability of two newly described ultrasound-based measures of patella positioning within two novice examiners. Methods: Subjects were seated with the limb supported in full knee extension and neutral rotation. (Figure 1a) The examiners independently gathered all images and were blinded to each other’s measures for the duration of the study. The transducer was positioned transversely, on the anterior aspect of the knee such that the lateral trochlear ridge, center of trochlear groove, and proximal portion of the patellar tendon were all visible in cross-section. (Figure 1b) Two linear measures were obtained, representing the distance from midpoint of the patellar tendon to a) the center of trochlear groove (MPT-CTG) and b) the lateral trochlear ridge (MPT-LTR). Reliability was assessed using intraclass correlation coefficients (ICC). The average of two measures were used for data analysis. There was a minimum of 1 week between assessments for those subjects with repeated testing. Results: A total of 11 subjects (mean age 15.3) without history of knee pathology were included. There were no significant differences (p>0.05) in either measurement between limbs with MPT-CTG and MPT-LTR values (mean±sd) as follows: MPT-CTG right 8.4mm ± 3.0, left 8.4mm ± 3.3; MPT-LTR right 12.2mm ± 2.7, left 11.6mm ± 2.3. For reliability analysis, each knee served as a discrete variable, yielding a total of 22 data points for evaluation. Inter-rater reliability (n=22) was moderate to good for both measures, with ICC values of 0.724 and 0.814 for MPT-CTG and MPT-LTR, respectively. Intra-rater reliability (n=10) was good to excellent with ICC values of 0.913 and 0.794 for MPT-CTG and MPT-LTR, respectively. (Table 1) Conclusions: This new measure of patella positioning demonstrated moderate to excellent reliability and may be a practical, cost-effective alternative to MRI. While it is encouraging that the subjects in this sample demonstrated no side-to-side differences in either measure, future research should focus on establishing criterion validity and reliability amongst individuals with patellar instability. [Figure: see text][Table: see text]