bluuebunny/crossref_metadata_2025_split huggingface dataset:
Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review
Authors: Haines Mitchell , Pirlo Larissa , Bowles Kelly-Ann , Williams Cylie M. 
Published: April 2021

Abstract:

Objective:
To describe the frequency with which children are affected by lower-limb apophyseal injuries, and subgroups at greater risk.

Design:
Systematic review.

Setting:
N/A.

Participants:
N/A.

Interventions:
N/A.

Main Outcome Measures:
Systematic review of Medline OVID, PsycINFO, Cinahl, and PubMed from inception until February 21st, 2020. Articles reporting prevalence and/or incidence of an apophyseal injury (eg, calcaneal apophysitis) or its eponym (Severs or Sever disease). Per person data relating to the incidence or prevalence. Subgroup comparisons were made between sex groups and between activity participant groups.

Results:
There was wide variation in measurement approaches and follow-up timeframes with the majority of studies reporting on traction apophysitis of the tibial tubercle (Osgood–Schlatter disease). This condition had a point prevalence of 10% in the general population of children between the ages of 12 and 15 years, whereas the lifetime incidence has been reported as 13%. Point prevalence was higher among those who participated in sport compared with those who did not {relative risk [95% confidence interval (CI): 1.98 (1.31-2.99)]}, whereas lifetime incidence was higher among those who participated in sport at the age of 13 years compared with those who did not [relative risk (95% CI): 4.63 (2.31-9.26)]. Other apophyseal injuries did not report enough data to permit comparisons.

Conclusion:
Sports participation is likely to substantially increase the frequency of traction apophysitis of the tibial tubercle. Further research is required with standardized approaches to compare frequencies between different apophyseal injuries and subgroups of interest.
The effect of fluoxetine on morning blood pressure surge in patients with ischemic stroke: a prospective preliminary clinical study
Authors: He Yitao , Deng Jian , Zhang Yaqing , Cai Zhili , Zhang Hui , Guo Yi 
Published: April 2021

Objective
Our study aimed to evaluate the effect of fluoxetine on morning blood pressure surge (MBPS) in patients with ischemic stroke.

Methods
A total of 30 patients with acute ischemic stroke, 15 in the control group and 15 in the treatment group, were enrolled. Two patients in the control group and one in the treatment group were lost during follow-up. The patients in the treatment group were treated with fluoxetine (20 mg per day for 3 months) based on the treatments in the control group. Baseline characteristics, Patient Health Questionnaire 9 (PHQ-9) items scale score, mean blood pressure and MBPS were evaluated before and after treatment, and the correlation between the improvements of PHQ-9 scale score and MBPS was also analyzed.

Results
The mean SBP and the systolic and diastolic MBPS in the treatment group were significantly lower than that in the control group after 3 months of treatment (P = 0.024, P = 0.022, P = 0.001, respectively). Besides, the improvement of PHQ-9 scale score was significantly higher in the treatment group than in the control group (P = 0.049). There was no significant correlation between the improvement of systolic or diastolic MBPS and the improvement of PHQ-9 scale score in the treatment group (P = 0.289 and P = 0.206, respectively).

Conclusion
Fluoxetine might improve MBPS in patients with ischemic stroke.
The Effectiveness of Common Cannabis Products for Treatment of Nausea
Authors: Stith Sarah S. , Li Xiaoxue , Orozco Joaquin , Lopez Victoria , Brockelman Franco , Keeling Keenan , Hall Branden , Vigil Jacob M. 
Published: April 2021

Goals:
We measure for the first time how a wide range of cannabis products affect nausea intensity in actual time.

Background:
Even though the Cannabis plant has been used to treat nausea for millennia, few studies have measured real-time effects of common and commercially available cannabis-based products.

Study:
Using the Releaf App, 886 people completed 2220 cannabis self-administration sessions intended to treat nausea between June 6, 2016 and July 8, 2019. They recorded the characteristics of self-administered cannabis products and baseline symptom intensity levels before tracking real-time changes in the intensity of their nausea.

Results:
By 1 hour postconsumption, 96.4% of people had experienced symptom relief with an average symptom intensity reduction of −3.85 points on a 0 to 10 visual analog scale (SD=2.45, d=1.85, P<0.001). Symptom relief was statistically significant at 5 minutes and increased with time. Among product characteristics, flower and concentrates yielded the strongest, yet similar results; products labeled as Cannabis indica underperformed those labeled as Cannabis sativa or hybrid; and joints were associated with greater symptom relief than pipes or vaporizers. In sessions using flower, higher tetrahydrocannbinol and lower cannabidiol were generally associated with greater symptom relief (eg, within 5 min).

Conclusions:
The findings suggest that the vast majority of patients self-selecting into cannabis use for treatment of nausea likely experience relief within a relative short duration of time, but the level of antiemetic effect varies with the characteristics of the cannabis products consumed in vivo. Future research should focus on longer term symptom relief, including nausea-free intervals and dosing frequency; the risks of consumption of medical cannabis, especially among high-risk populations, such as pregnant women and children; and potential interactions between cannabis, conventional antiemetics, other medications, food, tobacco, alcohol, and street drugs among specific patient populations.
Gastric Peroral Endoscopic Myotomy
Authors: Reja Mishal , Mishra Avantika , Tyberg Amy , Andalib Iman , Martínez Guadalupe M. , Zamarripa Felipe , Gaidhane Monica , Nieto Jose , Kahaleh Michel 
Published: April 2021

Introduction:
Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel option for patients with gastroparesis. It involves submucosal tunneling across the pylorus, followed by pyloromyotomy, and subsequent closure of the endoscopic tunnel. The aim of this study was to determine the learning curve for G-POEM.

Methods:
Consecutive patients undergoing G-POEM by a single operator were included from a prospective registry over 2 years. Demographics, procedure info, postprocedure follow-up data, and adverse events were collected. Nonlinear regression and cumulative sum control chart analyses were conducted for the learning curve. Clinical outcomes were improvement in Gastroparesis Cardinal Symptom Index score and gastric emptying scintigraphy.

Results:
Thirty-six patients were included (16.7% M, mean age 46 y). The majority had idiopathic gastroparesis (n=16, 44%), with the remaining having diabetes (n=5, 17%), postsurgical (n=10, 28%), or other (n=4, 11%). Technical success was achieved in 35 of 36 (97%). There was a significant reduction in the total Gastroparesis Cardinal Symptom Index score (2.09 units, P<0.00001) and a significant reduction in postoperative gastric emptying scintigraphy (82.44 mins, P<0.00001). Mean follow-up was 15 months (SD, 1.05). Median procedure time was 60.5 minutes (range, 35 to 136). Cumulative sum control chart shows 60-minute procedure was achieved at the 18th procedure. Procedure durations further reduced with consequent procedures with the last 3 being 45 minutes, thus demonstrating continued improvement with ongoing experience (nonlinear regression P<0.0001).

Conclusion:
Endoscopists experienced in G-POEM are expected to achieve a reduction in procedure time over successive cases, with efficiency reached at 60.5 minutes and a learning rate of 18 cases with continuing improvement.
Exercise Medicine in the Management of Pancreatic Cancer
Authors: Luo Hao , Galvão Daniel A. , Newton Robert U. , Lopez Pedro , Tang Colin , Fairman Ciaran M. , Spry Nigel , Taaffe Dennis R. 
Published: April 2021

Abstract
The aim of this study was to examine the health-related effects of exercise in patients with pancreatic cancer (PanCa) through a systematic review of current evidence. Studies were obtained through searching PubMed, Web of Science, PsycINFO, Embase, CINAHL Plus, and Cochrane Library databases with additional hand searches. All intervention-based studies were included if it involved (1) adult patients with PanCa, (2) exercise training, and (3) findings in quality of life, cancer-related fatigue, psychological distress, and physical function. The review protocol was registered in PROSPERO: CRD42020154684. Seven trials described in 9 publications were included consisting of 201 patients with early-stage and advanced PanCa. Participants were required to perform supervised and/or home-based, low- to moderate-intensity resistance and/or aerobic exercise for 12 to 35 weeks or duration of neoadjuvant therapy. There were no exercise-related adverse events with a reported retention rate of 71% to 90% and exercise attendance of 64% to 96%. The programs were consistently associated with improvements in cancer-related fatigue, psychological distress, and physical function, with mixed effects on quality of life. Exercise training seems to be safe and feasible and may have a beneficial effect on various physical and psychological outcomes in patients with PanCa. Further work with rigorous study designs is required to consolidate and advance current findings.
Clinical Care Strategies That Support Parents of Children With Complex Chronic Conditions*
Authors: Bogetz Jori F. , Revette Anna , DeCourcey Danielle D. 
Published: April 2021

OBJECTIVES:
Children with complex chronic conditions often receive inpatient and end-of-life care in the ICU, yet little is known about the clinical care strategies that best support this unique group of parents. This study aimed to elucidate supportive clinical care strategies identified by bereaved parents of children with complex chronic conditions.

DESIGN:
Qualitative analysis of 21 open-response items from the cross-sectional “Survey of Caring for Children with Complex Chronic Conditions” querying communication, decision-making, and end-of-life experiences.

SETTING:
Large tertiary care children’s hospital.

PATIENTS:
Parents of children with complex chronic conditions who received care at a large academic institution and died between 2006 and 2015.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
An iterative multistage thematic analysis of responses was used to identify key themes pertaining to clinical care strategies that support parents of children with complex chronic conditions. Open-ended responses were analyzed from 110 of 114 (96%) of survey respondents. The majority of parents had children with congenital/chromosomal complex chronic conditions who died 3.9 years (interquartile range, 2.2–6.7 yr) prior to their parents’ study participation. Although informational themes related to clear honest communication, consistent messaging, and enhanced care coordination were identified, parents emphasized the relational aspects of clinical care including inclusivity of their expertise about their child’s needs, recognition of their unique experience as parents, and maintenance of connection with clinicians through bereavement.

CONCLUSIONS:
Clinical care strategies that support parents of children with complex chronic conditions reflect the unique needs of this group of children. Relational strategies such as including parents as experts in their child’s care were paramount to parents of children with complex chronic conditions throughout their child’s medical journey and at end of life.
Age-Specific Dose Regimens of Dexmedetomidine for Pediatric Patients in Intensive Care Following Elective Surgery: A Phase 3, Multicenter, Open-Label Clinical Trial in Japan
Authors: Takeuchi Mamoru , Nemoto Shintaro , Suzuki Yasuyuki , Takahashi Naoki , Takenaka Nobuko , Takata Ami , Kobayashi Mihoko 
Published: April 2021

OBJECTIVES:
To demonstrate the efficacy, safety, and pharmacokinetics of dexmedetomidine as a potential sedative for pediatric surgery patients in the ICU.

DESIGN:
Phase 3, multicenter, open-label study.

SETTING:
This study included 61 patients at 13 tertiary hospitals in Japan.

PATIENTS:
Pediatric patients (≥ 45 wk corrected gestational age to < 17 yr) undergoing intensive care treatment with mechanical ventilation requiring greater than 6 hours estimated duration of sedation following elective cardiac surgery.

INTERVENTIONS:
Dexmedetomidine was IV administered without a loading dose at age-specific dose regimens 0.2–1.4 (< 6 yr) and 0.2–1.0 µg/kg/hr (≥ 6 yr). The primary endpoint was the percentage of patients who did not require a rescue sedative (midazolam) infusion during mechanical ventilation or for the first 24 hours of a greater than 24 hours ventilation following the commencement of dexmedetomidine administration.

MEASUREMENTS AND MAIN RESULTS:
Overall, 47 of the 61 patients (77.0%) did not require rescue midazolam. Adverse events were reported in 53 patients (86.9%). Frequently observed adverse events were hypotension (47.5%), bradycardia (31.1%), and respiratory depression (26.2%). Most of these adverse events were mild, a few moderate, and none severe. Although serious adverse events occurred in four patients, including one cardiac tamponade resulting in the withdrawal of dexmedetomidine, none of the adverse events resulted in mortality or were directly related to dexmedetomidine. The plasma dexmedetomidine concentration generally reached the target concentration of 0.3–1.25 ng/mL at 1–2 hours prior to completion of administration or immediately prior to the commencement of tapering.

CONCLUSIONS:
The age-specific dose regimens of dexmedetomidine without an initial loading dose achieved an adequate sedation level during mechanical ventilation and caused no clinically significant adverse events in the intensive care pediatric patients. These effects were achieved within the therapeutic range of dexmedetomidine plasma concentration and were accompanied by minimal effects on hemodynamics and respiration.
Circulating microRNA signatures that predict liver fibrosis progression in patients with HIV-1/hepatitis C virus coinfections
Authors: Franco Sandra , Buccione Daniela , Tural Cristina , Martinez Miguel Angel 
Published: April 2021

Objective:
The lack of available biomarkers for diagnosing and predicting different stages of liver disease with a noninvasive strategy is currently one of the main challenges that clinicians are facing. Recent evidence indicates that the plasma levels of specific microRNAs (miRNAs) may be significantly altered in patients with liver injury, including those with HIV type 1 (HIV-1) infections.

Design/methods:
Large-scale deep sequencing analysis of small RNA expression was performed on plasma samples from 46 patients with HIV-1/hepatitis C virus (HCV) coinfections that did not exhibit liver fibrosis at the time of sampling.

Results:
A total of 1065 different miRNAs were identified. After a mean of 10.3 years, 26 out of the 46 patients developed liver fibrosis (stage F2–4) and 20 remained without signs of liver fibrosis (stage F0–1). We identified a signature of seven miRNAs: 100–5p, 192–5p, 99a-5p, 122–5p, 125b-2–3p, 1246 and 194–5p, which were highly correlated with progression to liver fibrosis. These seven miRNAs detected liver fibrosis progression with an area under the curve (AUC) of 0.910–0.806. Two miRNAs, 100–5p and 192–5p, which displayed the best AUC values, yielded a sensitivity of 88% and a specificity of 85% for detecting liver fibrosis progression.

Conclusion:
Our results demonstrated that circulating miRNA levels had potential in predicting liver fibrosis progression before the clinical detection of liver fibrosis or significant clinical signs, such as elevated liver transaminases or platelets. Thus, our results might facilitate predictions of liver injury progression in patients with HIV-1-infections.
Automated Pathology Detection and Patient Triage in Routinely Acquired Head Computed Tomography Scans
Authors: Finck Tom , Schinz David , Grundl Lioba , Eisawy Rami , Yigitsoy Mehmet , Moosbauer Julia , Pfister Franz , Wiestler Benedikt 
Published: April 2021

Objectives
Anomaly detection systems can potentially uncover the entire spectrum of pathologies through deviations from a learned norm, meaningfully supporting the radiologist's workflow. We aim to report on the utility of a weakly supervised machine learning (ML) tool to detect pathologies in head computed tomography (CT) and adequately triage patients in an unselected patient cohort.

Materials and Methods
All patients having undergone a head CT at a tertiary care hospital in March 2020 were eligible for retrospective analysis. Only the first scan of each patient was included. Anomaly detection was performed using a weakly supervised ML technique. Anomalous findings were displayed on voxel-level and pooled to an anomaly score ranging from 0 to 1. Thresholds for this score classified patients into the 3 classes: “normal,” “pathological,” or “inconclusive.” Expert-validated radiological reports with multiclass pathology labels were considered as ground truth. Test assessment was performed with receiver operator characteristics analysis; inconclusive results were pooled to “pathological” predictions for accuracy measurements. External validity was tested in a publicly available external data set (CQ500).

Results
During the investigation period, 297 patients were referred for head CT of which 248 could be included. Definite ratings into normal/pathological were feasible in 167 patients (67.3%); 81 scans (32.7%) remained inconclusive. The area under the curve to differentiate normal from pathological scans was 0.95 (95% confidence interval, 0.92–0.98) for the study data set and 0.87 (95% confidence interval, 0.81–0.94) in external validation. The negative predictive value to exclude pathology if a scan was classified as “normal” was 100% (25/25), and the positive predictive value was 97.6% (137/141). Sensitivity and specificity were 100% and 86%, respectively. In patients with inconclusive ratings, pathologies were found in 26 (63%) of 41 cases.

Conclusions
Our study provides the first clinical evaluation of a weakly supervised anomaly detection system for brain imaging. In an unselected, consecutive patient cohort, definite classification into normal/diseased was feasible in approximately two thirds of scans, going along with an excellent diagnostic accuracy and perfect negative predictive value for excluding pathology. Moreover, anomaly heat maps provide important guidance toward pathology interpretation, also in cases with inconclusive ratings.
Evaluation of the Diagnostic Performance of Positron Emission Tomography/Magnetic Resonance for the Diagnosis of Liver Metastases
Authors: Zhang Caiyuan , O'Shea Aileen , Parente Chiara Anna , Amorim Barbara Juarez , Caravan Peter , Ferrone Christina R. , Blaszkowsky Lawrence S. , Soricelli Andrea , Salvatore Marco , Groshar David , Bernstine Hanna , Domachevsky Liran , Canamaque Lina Garcia , Umutlu Lale , Ken Herrmann , Catana Ciprian , Mahmood Umar , Catalano Onofrio Antonio 
Published: April 2021

Objective
The aim of this study was to compare the performance of positron emission tomography (PET)/magnetic resonance (MR) versus stand-alone PET and stand-alone magnetic resonance imaging (MRI) in the detection and characterization of suspected liver metastases.

Materials and Methods
This multi-institutional retrospective performance study was approved by the institutional review boards and was Health Insurance Portability and Accountability Act compliant, with waiver of informed consent. Seventy-nine patients with confirmed solid extrahepatic malignancies who underwent upper abdominal PET/MR between February 2017 and June 2018 were included. Where focal hepatic lesions were identified, the likelihood of a diagnosis of a liver metastasis was defined on an ordinal scale for MRI, PET, and PET/MRI by 3 readers: 1 nuclear medicine physician and 2 radiologists. The number of lesions per patient, lesion size, and involved hepatic segments were recorded. Proof of metastases was based on histopathologic correlation or clinical/imaging follow-up. Diagnostic performance was assessed using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curve analysis.

Results
A total of 79 patients (53 years, interquartile range, 50–68; 43 men) were included. PET/MR had a sensitivity of 95%, specificity of 97%, positive predictive value of 97%, and negative predictive value of 95%. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were 88%, 98%, 98%, and 90% and for PET were 83%, 97%, 97%, and 86%, respectively. The areas under the curve for PET/MRI, MRI, and PET were 95%, 92%, and 92%, respectively.

Conclusions
Contrast-enhanced PET/MR has a higher sensitivity and negative predictive value than either PET or MRI alone in the setting of suspected liver metastases. Fewer lesions were characterized as indeterminate by PET/MR in comparison with PET and MRI. This superior performance could potentially impact treatment and management decisions for patients with suspected liver metastases.
An 11-year Institutional Review of Nipple-Areolar Complex Tattooing for Breast Reconstruction
Authors: Weissler Jason M. , Kuruoglu Doga , Curiel Daniel , Alsayed Ahmed , Dudakovic Amela , Harless Christin A. , Nguyen Minh-Doan T. 
Published: April 2021

Background
Nipple-areolar complex (NAC) tattooing remains a simple and safe procedure, which complements breast reconstruction. This study reviews 11 years of NAC tattooing to identify risk factors for tattoo-related complications.

Methods
Patients undergoing NAC tattooing from January 2009 to March 2020 were reviewed. Patient information, reconstructive, and tattoo procedural details were analyzed. Tattoo-related breast infections, defined as breast redness requiring antibiotic therapy within 30 days after tattoo, were captured. Patients with reactive breast redness during the first 2 postprocedural days were excluded.

Results
Overall, 539 patients (949 breasts) were included. Implant-based reconstruction (IBR) was performed in 73.6% of breasts (n = 698), whereas 26.4% (n = 251) underwent autologous-based reconstruction (ABR). Acellular-dermal matrix was used in 547 breasts (57.6%). There as a 13.7% (n = 130) of breasts that underwent pretattoo radiation. There was a 65.3% (n = 456) of breasts that underwent subpectoral IBR, whereas 34.7% (n = 242) breasts underwent prepectoral IBR. Tattoo-related infection rate was 2.2% (n = 21 breasts). Mean time to infection was 6.5 ± 5.3 days. There was a 85.7% (n = 18) of infections that occurred in IBR patients, one third occurring in radiated patients. There was a 95.2% (n = 20) of infections that were treated with oral antibiotics only. One explantation was performed after failed intravenous antibiotics. On multivariable analysis, radiation history (odds ratio, 4.1, P = 0.007) and prepectoral IBR (odds ratio, 2.8, P = 0.036) were independent predictors of tattoo-related infection. Among irradiated breasts, breasts with IBR had greater odds of developing tattoo-related infection versus breasts with ABR (P = 0.025).

Conclusions
Although tattoo-related infections were uncommon, previous radiation and prepectoral IBR were both found to be independent predictors of tattoo-related breast infection. There is a role for preprocedural prophylactic antibiotics in these patients to mitigate infectious risk.