bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐term Morbidity of Choledochal Malformations in Children
Authors: Hyvärinen Ilona , Hukkinen Maria , Kivisaari Reetta , Parviainen Helka , Mäkisalo Heikki , Koivusalo Antti , Pakarinen Mikko 
Published: January 2021

ABSTRACTObjective:The aim of the study was to assess long‐term morbidity in children operated for choledochal malformation (CM) by relating clinical complications to liver histopathology, follow‐up imaging, liver stiffness, and biochemistry.Methods:A single‐center retrospective follow‐up study including all CM patients (n = 55, 71% girls) treated during 1976 to 2018 was performed. Mann‐Whitney U test and Spearman rank correlation were used for statistical analyses.Results:During median follow‐up of 5.8 (interquartile range, 2.5–12) years, 1 patient was lost to follow‐up whereas all survived. Intraoperative liver biopsies showed fibrosis in 32%, and patients with Metavir stage ≥2 were younger at surgery (0.36 [0.11–1.9] vs 3.8 [0.72–10.5] years, P = 0.024) than those without fibrosis. Overall, 21% had long‐term complications including cholangitis in 9 (>2 episodes in 5) patients, anastomotic stricture in 2 referred patients and adhesive volvulus or hepatocellular carcinoma in 1 each. Anastomotic strictures were successfully managed nonoperatively and hepatocellular carcinoma with thermoablation. In postoperative magnetic resonance cholangiography (MRCP) performed 6.4 (3.6–16) years after hepaticojejunostomy, diameters of both main intrahepatic ducts had decreased significantly to 3.0 (2.5–3.5) mm (P = 0.0001) but a distal cyst stump was remaining in 30% with a length of 6.0 (4.0–20) mm that associated with operation age (r = 0.71, P = 0.015) and fusiform CM type. Follow‐up ultrasound revealed mild dilation of intrahepatic bile ducts in 6.3% and mildly to moderately elevated liver biochemistry in 23%, and liver stiffness (>7 kPa) in 22%.Conclusions:Whilst cholangitis was the most common postoperative problem, individual patients experienced other more significant complications and one quarter of patients showed evidence of underlying liver dysfunction.
Comparison of Oral Sodium Bicarbonate and Solifenacin Treatment in Female Overactive Bladder Patients With Acidic Urine pH
Authors: Sönmez Mehmet Giray , Ecer Gökhan , Atıcı Ahmet , Özkent Mehmet Serkan , İyisoy Mehmet Sinan , Öztürk Ahmet 
Published: January 2021

(Abstracted from Female Pelvic Med Reconstr Surg 2020;26:649–653)
Overactive bladder (OAB) syndrome affects 1 of 7 US women. The syndrome is characterized by the presence of urinary urgency, with or without urgency urinary incontinence, usually accompanied by frequency and nocturia.
Increasing Obstetric Intervention for Fetal Growth Restriction Is Shifting Birthweight Centiles: A Retrospective Cohort Study
Authors: Selvaratnam R. J. , Davey M.-A. , Mol B. W. , Wallacea E. M. 
Published: January 2021

(Abstracted from BJOG 2020;127:1074–1080)
One way to reduce the risk of stillbirths is to focus on improving the detection of fetal growth restriction (FGR) and providing timely delivery of the small-for-gestational-age (SGA) fetus. Detecting and delivering the SGA pregnancy at less than 40 weeks of gestation are the recommended best practice.
Effect of Pretreatment Oral Contraceptives on Fresh and Cumulative Live Birth In Vitro Fertilization Outcomes in Ovulatory Women
Authors: Lu Yao , Wang Yuan , Zhang Ting , Wang Guiquan , He Yaqiong , Lindheim Steven R. , Yu Zhangsheng , Sun Yun 
Published: January 2021

(Abstracted from Fertil Steril 2020;114:779–786)
Oral contraceptives (OCs) consisting of estrogen and progesterone have extensively been used for cycle control and synchronization in the context of in vitro fertilization (IVF). Conflicting data exist among usage of OCs in women with dysmenorrhea.
Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya
Authors: Myers Justin G. , Nwakibu Uzoma A. , Hunold Katherine M. , Wangara Ali Akida , Kiruja Jason , Mutiso Vincent , Thompson Peyton , Aluisio Adam R. , Maingi Alice , Dunlop Stephen J. , Martin Ian B.K. 
Published: January 2021

Introduction
The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population.

Methods
Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups.

Results
Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves.

Conclusions
Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.
Communication Between Primary Care Pediatricians and the Pediatric Emergency Department
Authors: Beamon Bradley D. , Cortright Lindsay M. , Pawlowski Callie B. , Vasquez-Rios Virginia , Tumin Dmitry 
Published: January 2021

Objectives
This study aimed to measure the quality of communication from primary care pediatricians (PCPs) to the pediatric emergency department (ED). We also sought to determine whether the quality of this communication affected patient outcomes.

Methods
We conducted a retrospective chart review of patients sent from their pediatrician to the pediatric ED during a 4-year period. The quality of communication was classified as no communication, incomplete communication, or complete communication, based on compliance with Joint Commission requirements. Outcome measures included overnight admission, total length of hospital stay, repetition of diagnostic tests, ED revisits, hospital readmissions, and initial follow-up pediatrician visit.

Results
Fifty-five patients were included in the analysis. Communication was complete in 22% of cases, incomplete in 16% of cases, and absent in 62% of cases. Medications and allergies were most often missing. The quality of communication was not associated with any of the prespecified covariates or outcome measures. Chief complaint of respiratory distress and greater severity score were associated with a greater likelihood of hospital admission from the ED.

Conclusions
Our study demonstrates a lack of documented communication between PCPs and a pediatric ED, albeit with no statistically significant impact on patient outcomes. Practices to increase the quality of PCP-ED communication could include standardizing interfacility referrals, maximizing shared electronic health record use between clinical environments, and increased collaboration between ED physicians and PCPs. Further research to investigate subjective outcomes, such as patient expectations or satisfaction associated with PCP-ED communication, may reveal other consequences of incomplete communication.
Agreement With Pediatric Suprapatellar Bursa Effusion Assessments by Point-of-Care Ultrasound After Remote Training
Authors: Riera Antonio , Leviter Julie I. , Iqbal Ammarah , Soma Gauthami , Malik Rabia N. , Chen Lei 
Published: January 2021

Background
The ease of instruction for point-of-care ultrasound (POCUS) to detect suprapatellar bursa (SPB) effusions in pediatric patients is unknown. Considering in person limitations because of the coronavirus pandemic, strategies for POCUS education by remote learning are necessary.

Methods
We crafted a 90-minute didactic training that was presented via a remote learning format. The main outcome of interest was the interobserver reliability of SPB effusion assessment by novice sonologists compared with POCUS faculty. Novice sonologists were pediatric emergency medicine (PEM) fellows. Pediatric emergency medicine fellows interpreted longitudinal SPB examinations obtained in our pediatric emergency department from July 2013 to June 2020. Assessments were performed 2 months after the remote training. Pediatric emergency medicine fellows had a limited experience performing these musculoskeletal scans and were blinded to POCUS faculty and each other's assessments. Interobserver reliability was assessed with Cohen κ coefficient. Second, we calculated test characteristics of knee radiography compared with PEM POCUS faculty determination of SPB effusion by ultrasound. We further explored how effusion size measured by POCUS impacted the diagnosis by knee radiography. A receiver operator characteristic curve of knee radiography diagnosis of SPB effusion was created using the maximal height of SPB effusion by POCUS as the predictor variable.

Results
A total of 116 SPB scans in 71 patients were assessed. From this group, 70 scans were of affected knees and 46 scans were of contralateral, asymptomatic knees. The mean age of patients was 10 years and 46% were girl. The prevalence of SPB effusions was 42%. The κ coefficients between the 3 novice sonologists and POCUS faculty were 0.75 (0.62–0.87), 0.77 (0.65–0.89), and 0.83 (0.72–0.93) with 88%, 89%, and 91% agreement. Knee radiography exhibited an overall sensitivity of 65% (95% confidence interval [CI], 46–79%), specificity of 84% (95% CI, 60–97%), negative predictive value of 55% (95% CI, 43–66%), and positive predictive value of 88% (95% CI, 73–96%) to diagnose SPB effusions. The area under the receiver operator characteristic curve was 0.850. With an SPB height cutoff of 4 mm as true positives, radiography had a sensitivity of 81% and a specificity of 83%.

Conclusions
After a remote teleconference didactic session, PEM fellows were able to successfully diagnose SPB effusions using a longitudinal view with substantial interobserver reliability. Knee radiography exhibited limited sensitivity to rule out SPB effusions.
Late Complication of Congenital Diaphragmatic Hernia Repair
Authors: Sivarajah Vishalini , Bhatnagar Priyank , Tom Katherine N. , Wong Jonathan P. , Gerstle J. Ted , Moodie Rosemary G. , Wong Peter D. 
Published: January 2021

Abstract
Congenital diaphragmatic hernia (CDH) is associated with high early mortality. However, advances in newborn care have led to improved survival into adolescence and early adulthood. We report a 17-year-old adolescent boy with recurrent small bowel obstruction after CDH repair at 2 days of age. Emergency physicians should be aware of late complications after neonatal CDH repair.
Targeted Treatment of Triple-Negative Breast Cancer
Authors: Young Joanna A. , Tan Antoinette R. 
Published: January 2021

Abstract
Triple-negative breast cancer is increasingly recognized as a heterogeneous entity that can be categorized according to histologic, molecular, and clinical subtypes. While chemotherapy remains the backbone of treatment for this disease, there are now several available targeted agents including immunotherapy, poly(adenosine diphosphate-ribose) polymerase inhibitors, and most recently a Food and Drug Administration–approved antibody-drug conjugate sacituzumab govitecan-hziy as a third-line treatment of metastatic triple-negative breast cancer. We review several actionable targets for triple-negative breast cancer and describe promising nonimmunotherapeutic agents including cyclin-dependent kinase inhibitors, androgen receptor inhibitors, mitogen-activated protein kinase inhibitors, phosphoinositide 3-kinase inhibitors, AKT (also known as protein kinase B) inhibitors, and antibody-drug conjugates.
Using phylogenetic surveillance and epidemiological data to understand the HIV-1 transmission dynamics in French Guiana
Authors: Arantes Ighor , Bello Gonzalo , Darcissac Edith , Lacoste Vincent , Nacher Mathieu 
Published: January 2021

Objective:
The aim of this study was to understand the transmission dynamics of the HIV-1 subtype B epidemic in French Guiana and the factors that shaped the expansion of major phylogenetic transmission clusters.

Design:
HIV-1 subtype B pol sequences with associated epidemiological data obtained from 703 treatment-naive patients living in French Guiana between 2006 and 2012, which correspond to 91% of all HIV cases diagnosed in that period, were employed in this study.

Methods:
Maximum likelihood and Bayesian methods were used to construct phylogenetic trees, identify transmission clusters and estimate intervals between successive infections. Statistical analysis was performed to evaluate epidemiological characteristics associated with cluster membership.

Results:
HIV-1 subtype B pol sequences from French Guiana were distributed in 10 large/medium transmission clades (LMTC, n > 10, 55%), 19 small transmission clades (STC, n = 3–8, 10%), 36 dyads (10%) or were nonclustered (25%). The rate of clustering did not differ by sex or clinical stage, but sex workers, crack-cocaine users, young individuals (15–20 years) and nationals or migrants from neighbouring South American countries were more likely to cluster within LMTC than individuals from other groups. We estimated that 53–63% of immigrants were infected after the arrival in French Guiana and that 50% of HIV transmissions within LMTC occurred during the first 2 years after infection.

Conclusion:
These findings reinforce the notion that high-risk sexual behaviours among young individuals and migrants (postmigration) combined with late HIV diagnosis are key drivers of onward dissemination of major HIV transmission clusters in French Guiana.
Brief Report: Financial Incentives and Real-Time Adherence Monitoring to Promote Daily Adherence to HIV Treatment and Viral Suppression Among People Living With HIV: A Pilot Study
Authors: Bien-Gund Cedric H. , Ho Joshua I. , Bair Elizabeth F. , Marcus Noora , Choi Rebekah Ji , Szep Zsofia , Althoff Amy , Momplaisir Florence M. , Thirumurthy Harsha 
Published: January 2021

Background:
Interventions to promote medication adherence and viral suppression are needed among HIV-positive individuals. We aimed to determine the feasibility, acceptability, and preliminary impact of daily financial incentives linked to real-time adherence monitoring among treatment-experienced individuals.

Methods:
At an HIV clinic in Philadelphia, we conducted a pilot randomized trial among treatment-experienced HIV-positive adults with unsuppressed viral loads (>400 copies/mL). Participants randomized to the intervention group were eligible for daily lottery-based financial rewards dependent on antiretroviral therapy (ART) adherence, measured by a wireless-enabled electronic pill bottle. Participants also received a financial incentive for achieving viral suppression at 3 months. The control group received the standard of care. We measured acceptance and feasibility through follow-up survey at 3 months, viral suppression at 3 months, and adherence.

Results:
Among 29 participants, 28 (93%) completed 3-month follow-up, and 24 (83%) completed a 3-month laboratory visit. Electronic pill bottles were highly acceptable to participants, with most strongly agreeing that they worked well, were reliable, and easy to use. Among those who received the intervention, 77% were very satisfied with their experience. Among those who completed the 3-month laboratory visit, viral suppression was achieved by 40% in the intervention group and 29% in the control group. ART adherence ≥80% was achieved by 36% and 25% in the intervention and control groups, respectively.

Conclusions:
Daily financial incentives coupled with real-time adherence monitoring are a promising strategy to support ART adherence among HIV-positive individuals who are not virally suppressed. This novel approach warrants testing in a larger trial.
Performance of Methods to Estimate Low-Density Lipoprotein Cholesterol in Women With and Without HIV Infection
Authors: Rana Mariam N. , Kim Chang H. , Sullivan Claire E. , Longenecker Chris T. , Al-Kindi Sadeer G. 
Published: January 2021

Background:
Low-density lipoprotein cholesterol (LDL-C) is estimated from total cholesterol, high-density lipoprotein cholesterol and triglycerides using predefined equations which assume fixed or varying relationships between these parameters and may underestimate or overestimate LDL-C. Data on the performance of these equations in persons with HIV are limited. We sought to investigate the utility of the 3 most widely used methods (Friedewald, Hopkins, and the recently proposed NIH equation) to predict LDL-C in persons with HIV.

Methods:
We identified 7397 direct LDL-C (5219 HIV, 2127 uninfected controls, 51 seroconvertors) measurements in the Women's Interagency HIV Study, and used the 3 equations (Friedewald, Hopkins, and NIH) to calculate LDL-C. We compared the performance of the 3 equations using root mean square error and coefficient of determination (R2).

Results:
Overall, the Friedewald equation had the best performance characteristics, outperforming Hopkins and NIH methods with lower root mean square error and higher R2 at lower triglyceride levels. However, this association did not hold true at higher triglyceride levels (quartiles 3 and 4), whereas the Hopkins equation had better performance characteristics in quartile 3, none of the 3 equations were optimal in quartile 4. After adjusting for fasting status and triglycerides levels, HIV+ had larger mean difference compared with directly measured LDL using all 3 methods.

Conclusions:
All 3 methods have lower accuracy in HIV+ vs HIV− women, even after adjusting for triglyceride levels and fasting status. Further research should focus on identifying methods to estimate LDL-C in HIV.
Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia
Authors: Cutuli Salvatore Lucio , Grieco Domenico Luca , Menga Luca Salvatore , De Pascale Gennaro , Antonelli Massimo 
Published: January 2021

Purpose of review
We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia.

Recent findings
Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation.

Summary
Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research.
Same-day Discharge Is Safe and Effective After Implant-Based Breast Reconstruction
Authors: Hammond Jacob B. , Thomas Olivia , Jogerst Kristen , Kosiorek Heidi E. , Rebecca Alanna M. , Cronin Patricia A. , Casey William J. , Kruger Erwin A. , Pockaj Barbara A. , Teven Chad M. 
Published: January 2021

Background
Same-day discharge after mastectomy is a recently described treatment approach. Limited data exist investigating whether same-day discharge can be successfully implemented in patients undergoing mastectomy with immediate implant-based breast reconstruction (IBR).

Methods
Patients having mastectomy with IBR from 2013 to 2019 were reviewed. Enhanced recovery with same-day discharge was implemented in 2017. Patient characteristics, oncologic treatments, surgical techniques, and 90-day postoperative complications and reoperations were analyzed comparing enhanced recovery patients with historical controls.

Results
A total of 363 patients underwent nipple-sparing (214, 59%) or skin-sparing (149, 41%) mastectomy with 1-stage (270, 74%) or tissue expander (93, 26%) IBR. Enhanced recovery was used for 151 patients, with 79 of these patients (52%) discharged same-day. Overall, enhanced recovery patients experienced a significantly lower rate of 90-day complications (21% vs 41%, P < 0.001), including hematoma (3% vs 11%, P = 0.002), mastectomy flap necrosis (7% vs 15%, P = 0.02), seroma (1% vs 9%, P < 0.001), and wound breakdown (3% vs 9%, P = 0.05). Postoperative complication rates did not significantly differ among enhanced recovery patients discharged same day. Postoperative admissions significantly decreased after enhanced recovery implementation (100% to 48%, P < 0.001), and admitted enhanced recovery patients experienced a lower length of stay (1.2 vs 1.8, P < 0.001). Enhanced recovery patients experienced a lower incidence of ≥1 unplanned reoperation (22% vs 33%, P = 0.01); overall average unplanned and total reoperations did not significantly differ between groups.

Conclusions
In conjunction with enhanced recovery practices, same-day discharge after mastectomy with IBR is a safe and feasible treatment approach.