bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Magnetic Resonance Imaging on the Diagnosis of High-Energy Ipsilateral Femoral Neck and Shaft Fractures
Authors: Rennard Justin , Rogers Nathan , Achor Timothy , Kumaravel Manickam , Gary Joshua , Choo Andrew , Munz John , Routt Milton L. , Warner Stephen J. 
Published: June 2021

Objective:
To evaluate the most common femoral shaft fracture morphology associated with an ipsilateral femoral neck fracture in high-energy blunt trauma using magnetic resonance imaging (MRI).

Design:
Retrospective review.

Setting:
Level 1 trauma center.

Patients/Participants:
219 consecutive patients sustaining 228 femoral shaft fractures from high-energy blunt trauma.

Main Outcome Measurements:
Fracture patterns were analyzed using the OTA/AO classification system. In addition, location of the fracture was measured as the distance from the distal aspect of the lesser trochanter to the center of the femoral shaft fracture.

Results:
An OTA/AO 31 type fracture was seen in 16.5% (20/121) of patients presenting with OTA/AO 32-A type fractures, 12% (6/50) of patients with OTA/AO 32-B type fractures, and 26.3% (15/57) of patients with OTA/AO 32-C type fractures. The fractures that occurred in the middle or distal third of the femur shaft constituted 95.1% (39/41).

Conclusions:
In this cohort, patients with middle and distal third OTA/AO 32-C type fractures had the highest association with an ipsilateral OTA/AO 31 type fracture. OTA/AO 32-A2 and 32-A3 type fractures had the highest association with femoral neck fractures seen only on MRI. The data presented suggest continued usage of the rapid sequence pelvic MRI for all patients with high-energy femoral shaft fractures in whom a femoral neck fracture was not seen on an x-ray or a computed tomography scan.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Machine Learning–Based Discovery of a Gene Expression Signature in Pediatric Acute Respiratory Distress Syndrome
Authors: Grunwell Jocelyn R. , Rad Milad G. , Stephenson Susan T. , Mohammad Ahmad F. , Opolka Cydney , Fitzpatrick Anne M. , Kamaleswaran Rishikesan 
Published: June 2021

Objectives:
To identify differentially expressed genes and networks from the airway cells within 72 hours of intubation of children with and without pediatric acute respiratory distress syndrome. To test the use of a neutrophil transcription reporter assay to identify immunogenic responses to airway fluid from children with and without pediatric acute respiratory distress syndrome.

Design:
Prospective cohort study.

SETTING:
Thirty-six bed academic PICU.

PATIENTS:
Fifty-four immunocompetent children, 28 with pediatric acute respiratory distress syndrome, who were between 2 days to 18 years old within 72 hours of intubation for acute hypoxemic respiratory failure.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We applied machine learning methods to a Nanostring transcriptomics on primary airway cells and a neutrophil reporter assay to discover gene networks differentiating pediatric acute respiratory distress syndrome from no pediatric acute respiratory distress syndrome. An analysis of moderate or severe pediatric acute respiratory distress syndrome versus no or mild pediatric acute respiratory distress syndrome was performed. Pathway network visualization was used to map pathways from 62 genes selected by ElasticNet associated with pediatric acute respiratory distress syndrome. The Janus kinase/signal transducer and activator of transcription pathway emerged. Support vector machine performed best for the primary airway cells and the neutrophil reporter assay using a leave-one-out cross-validation with an area under the operating curve and 95% CI of 0.75 (0.63–0.87) and 0.80 (0.70–1.0), respectively.

CONCLUSIONS:
We identified gene networks important to the pediatric acute respiratory distress syndrome airway immune response using semitargeted transcriptomics from primary airway cells and a neutrophil reporter assay. These pathways will drive mechanistic investigations into pediatric acute respiratory distress syndrome. Further studies are needed to validate our findings and to test our models.
Assessment of a Cellular Host Response Test as a Sepsis Diagnostic for Those With Suspected Infection in the Emergency Department
Authors: O’Neal Hollis R. , Sheybani Roya , Caffery Terrell S. , Musso Mandi W. , Hamer Diana , Alwood Shannon M. , Berlinger Matthew S. , Jagneaux Tonya , LaVie Katherine W. , O’Neal Catherine S. , Sanchez Michael A. , Walker Morgan K. , Shah Ajay M. , Tse Henry T. K. , Thomas Christopher B. 
Published: June 2021

Objectives:
Sepsis is a common cause of morbidity and mortality. A reliable, rapid, and early indicator can help improve efficiency of care and outcomes. To assess the IntelliSep test, a novel in vitro diagnostic that quantifies the state of immune activation by measuring the biophysical properties of leukocytes, as a rapid diagnostic for sepsis and a measure of severity of illness, as defined by Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation-II scores and the need for hospitalization.

Design, Setting, SUBJECTS:
Adult patients presenting to two emergency departments in Baton Rouge, LA, with signs of infection (two of four systemic inflammatory response syndrome criteria, with at least one being aberration of temperature or WBC count) or suspicion of infection (a clinician order for culture of a body fluid), were prospectively enrolled. Sepsis status, per Sepsis-3 criteria, was determined through a 3-tiered retrospective and blinded adjudication process consisting of objective review, site-level clinician review, and final determination by independent physician adjudicators.

MEASUREMENTS AND MAIN RESULTS:
Of 266 patients in the final analysis, those with sepsis had higher IntelliSep Index (median = 6.9; interquartile range, 6.1–7.6) than those adjudicated as not septic (median = 4.7; interquartile range, 3.7–5.9; p < 0.001), with an area under the receiver operating characteristic curve of 0.89 and 0.83 when compared with unanimous and forced adjudication standards, respectively. Patients with higher IntelliSep Index had higher Sequential Organ Failure Assessment (3 [interquartile range, 1–5] vs 1 [interquartile range, 0–2]; p < 0.001) and Acute Physiology and Chronic Health Evaluation-II (7 [interquartile range, 3.5–11.5] vs 5 [interquartile range, 2–9]; p < 0.05) and were more likely to be admitted to the hospital (83.6% vs 48.3%; p < 0.001) compared with those with lower IntelliSep Index.

CONCLUSIONS:
In patients presenting to the emergency department with signs or suspicion of infection, the IntelliSep Index is a promising tool for the rapid diagnosis and risk stratification for sepsis.
Physical Functioning After Admission to the PICU: A Scoping Review
Authors: Bossen Daniël , de Boer Rosa M. , Knoester Hendrika , Maaskant Jolanda M. , van der Schaaf Marike , Alsem Mattijs W. , Gemke Reinoud J. B. J. , van Woensel Job B. M. , Oosterlaan Jaap , Engelbert Raoul H. H. 
Published: June 2021

Objectives:
To conduct a scoping review to 1) describe findings and determinants of physical functioning in children during and/or after PICU stay, 2) identify which domains of physical functioning are measured, 3) and synthesize the clinical and research knowledge gaps.

Data Sources:
A systematic search was conducted in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines.

Study Selection:
Two investigators independently screened and included studies against predetermined criteria.

Data Extraction:
One investigator extracted data with review by a second investigator. A narrative analyses approach was used.

Data Synthesis:
A total of 2,610 articles were identified, leaving 68 studies for inclusion. Post-PICU/hospital discharge scores show that PICU survivors report difficulties in physical functioning during and years after PICU stay. Although sustained improvements in the long-term have been reported, most of the reported levels were lower compared with the reference and baseline values. Decreased physical functioning was associated with longer hospital stay and presence of comorbidities. A diversity of instruments was used in which mobility and self-care were mostly addressed.

CONCLUSIONS:
The results show that children perceive moderate to severe difficulties in physical functioning during and years after PICU stay. Longitudinal assessments during and after PICU stay should be incorporated, especially for children with a higher risk for poor functional outcomes. There is need for consensus on the most suitable methods to assess physical functioning in children admitted to the PICU.
Humanizing the ICU Patient: A Qualitative Exploration of Behaviors Experienced by Patients, Caregivers, and ICU Staff
Authors: Basile Melissa J. , Rubin Eileen , Wilson Michael E. , Polo Jennifer , Jacome Sonia N. , Brown Samuel M. , Heras La Calle Gabriel , Montori Victor M. , Hajizadeh Negin 
Published: June 2021

Objectives:
To understand how patients and family members experience dehumanizing or humanizing treatment when in the ICU.

Design:
Qualitative study included web-based focus groups and open-ended surveys posted to ICU patient/family social media boards. Focus groups were audio recorded and transcribed. Social media responses were collected and organized by stakeholder group. Data underwent qualitative analysis.

Setting:
Remote focus groups and online surveys.

Patients:
ICU patient survivors, family members, and ICU teams.

Interventions:
Not available.

Measurements and Main Results:
Semi-structured questions and open-ended survey responses. We enrolled 40 patients/family members and 31 ICU team members. Focus groups and surveys revealed three primary themes orienting humanizing/dehumanizing ICU experiences: 1) communication, 2) outcomes, and 3) causes of dehumanization. Dehumanization occurred during “communication” exchanges when ICU team members talked “over” patients, made distressing remarks when patients were present, or failed to inform patients about ICU-related care. “Outcomes” of dehumanization were associated with patient loss of trust in the medical team, loss of motivation to participate in ICU recovery, feeling of distress, guilt, depression, and anxiety. Humanizing behaviors were associated with improved recovery, well-being, and trust. “Perceived causes” of dehumanizing behaviors were linked to patient, ICU team, and healthcare system factors.

CONCLUSIONS:
Behaviors of ICU clinicians may cause patients and families to feel dehumanized when in the ICU. Negative behaviors are noticed by patients and families, possibly contributing to poor outcomes including mental health, recovery, and lack of trust in ICU teams. Supporting ICU clinicians may enable a more empathic environment and in turn more humanizing clinician-patient encounters.
PARACENTRAL ACUTE MIDDLE MACULOPATHY ASSOCIATED WITH COCAINE USE
Authors: Arepalli Sruthi , Ehlers Justis P. 
Published: June 2021

Background/Purpose:
To report a case of paracentral acute middle maculopathy in association with cocaine use.

Methods:
This is a case report of a 26-year-old man presented with acute vision loss in the left eye following cocaine use.

Results:
Fundus examination demonstrated faint retinal, whereas optical coherence tomography displayed hyperreflectivity predominantly in the middle retinal layers. Because of associated loss-of-consciousness and vision loss, a stroke work-up was initiated and ruled-out embolic and neurologic causes. The vision loss was attributed to paracentral acute middle maculopathy secondary to cocaine. The vision and retinal alterations on optical coherence tomography improved with observation.

Conclusion:
This case demonstrates a potential unique etiology of paracentral acute middle maculopathy following exposure to cocaine. Paracentral acute middle maculopathy may occur in the setting of cocaine use. Optical coherence tomography evaluation with close surveillance can be helpful to identify the often subtle findings of paracentral acute middle maculopathy in cases of vision loss associated with illicit drug use.
IRIS METASTASIS FROM BREAST CANCER SUCCESSFULLY TREATED WITH ABEMACICLIB AND LETROZOLE
Authors: Goduni Lediana , Ashkenazy Noy , Hansen Eric , Soyano-Muller Aixa , Correa Zelia M. , Harbour J. William 
Published: June 2021

Purpose:
To describe a patient with an unusual presentation of iris metastasis from breast cancer and her response to systemic therapy.

Methods:
Retrospective chart review of one patient.

Results:
A 57-year-old woman presented with a superonasal translucent vascularized iris stromal mass with fish egg–like structures budding from the surface. High-frequency anterior segment ultrasonography demonstrated a solid iris stromal mass measuring 6.0 mm × 3.3 mm × 1.9 mm. On optical coherence tomography, the egglike structures appeared as hyperreflective spheres, some of which were detached from the main iris stromal tumor. Oncologic evaluation revealed metastatic breast cancer involving the brain and lung. She was treated with oral abemaciclib and letrozole, as well as external beam radiotherapy to the brain. The iris mass had completely regressed within 4 months and remained undetectable through the 8-month follow-up. The other metastatic lesions responded well to therapy.

Conclusion:
A case of iris metastasis was reported as the presenting sign of cancer dissemination that was successfully treated with targeted systemic therapy without ocular radiotherapy.
Comparison of Corneal Wave Speed and Ocular Rigidity in Normal and Glaucomatous Eyes
Authors: Kazemi Arash , Zhou Boran , Zhang Xiaoming , Sit Arthur J. 
Published: June 2021

Precis:
Ocular biomechanics were compared between treated glaucoma patients and healthy subjects matched for age, intraocular pressure (IOP), and axial length. There was no difference in corneal wave propagation speed, but ocular rigidity was lower in glaucomatous eyes.

Purpose:
Ocular biomechanical properties are important in understanding glaucoma pathogenesis but the affected tissues are unclear. In this study, we compared corneal wave speed (a measure of corneal elasticity) and ocular rigidity coefficient between glaucomatous and normal eyes.

Materials and Methods:
Twenty glaucomatous eyes from 10 patients and 20 normal eyes from 13 controls, matched for age, IOP, and axial length were included. Ocular rigidity was calculated based on the difference in supine IOP by pneumatonometry with and without a 10-g weight. Corneal wave speed was determined by ultrasound surface wave elastography. A small, 0.1-second harmonic vibration at 100 Hz was generated through the closed eyelids. Wave propagation was captured by an ultrasound transducer, and wave speed was determined from the phase change with distance. Comparisons were performed using generalized estimating equation models.

Results:
There were no significant differences in corneal wave speed between glaucomatous and normal eyes (2.16±0.25 vs. 2.07±0.16 m/s, P=0.17). However, ocular rigidity was significantly lower in glaucomatous eyes (0.0218±0.0033 vs. 0.0252±0.0050/μL, P=0.01). Corneal wave speed was not correlated with age and IOP in either group (P≥0.23) but was correlated with ocular rigidity (R=0.48, P=0.02) and inversely correlated with axial length (R=−0.53, P=0.01) in glaucomatous eyes.

Conclusion:
Glaucomatous eyes tend to have lower ocular rigidity than healthy eyes with similar age, IOP, and axial length. However, the lack of a difference in corneal wave speed suggests that corneal tissue may not be significantly affected, and scleral changes likely play a more important role in glaucoma.
The other connective tissue disease-associated interstitial lung diseases: Sjogren's syndrome, mixed connective tissue disease, and systemic lupus erythematosus
Authors: Lee Cathryn T. , Strek Mary E. 
Published: June 2021

Purpose of review
We review the clinical manifestations of three less common connective tissue disease (CTD)-associated interstitial lung diseases (ILDs): Sjogren's syndrome (SjS), mixed CTD (MCTD), and systemic lupus erythematosus (SLE).

Recent findings
SjS is classically associated with lymphocytic interstitial pneumonia and cystic lung disease, but the most common type of ILD in Sjogren's patients is nonspecific interstitial pneumonia. ILD is prevalent in MCTD and associated with worse survival. SLE-associated ILD, while rare, is more common in those with CTD overlap syndromes. Regardless of underlying cause, a subset of patients with fibrotic CTD-associated ILD develop a progressive course for which antifibrotic agents and lung transplantation should be considered.

Summary
An understanding of the characteristics of ILD in SjS, MCTD, and SLE is important for the pulmonary specialist. Future research should identify risk factors for progression and develop additional treatment modalities for both CTD-related autoimmune features and progressive ILD.
At a crossroads: coronavirus disease 2019 recovery and the risk of pulmonary vascular disease
Authors: Cascino Thomas M. , Desai Ankit A. , Kanthi Yogendra 
Published: June 2021

Purpose of review
The coronavirus disease 2019 (COVID-19) pandemic has led to almost 3,000,000 deaths across 139 million people infected worldwide. Involvement of the pulmonary vasculature is considered a major driving force for morbidity and mortality. We set out to summarize current knowledge on the acute manifestations of pulmonary vascular disease (PVD) resulting from COVID-19 and prioritize long-term complications that may result in pulmonary hypertension (PH).

Recent findings
Acute COVID-19 infection can result in widespread involvement of the pulmonary vasculature, myocardial injury, evidence of persistent lung disease, and venous thromboembolism. Post COVID-19 survivors frequently report ongoing symptoms and may be at risk for the spectrum of PH, including group 1 pulmonary arterial hypertension, group 2 PH due to left heart disease, group 3 PH due to lung disease and/or hypoxia, and group 4 chronic thromboembolic PH.

Summary
The impact of COVID-19 on the pulmonary vasculature is central to determining disease severity. Although the long-term PVD manifestations of COVID-19 are currently uncertain, optimizing the care of risk factors for PH and monitoring for the development of PVD will be critical to reducing long-term morbidity and improving the health of survivors.
Sudden unexpected death in children: myth or reality?
Authors: Enner Stephanie , Pavkovic Ivan , Kothare Sanjeev V. 
Published: June 2021

Purpose of review
Despite many years of study, sudden unexplained death remains a tenuous diagnosis of exclusion. Here, we discuss the current science behind the uncertainties of sudden death, as well as the questions that still remain.

Recent findings
Failure in any part of the complex interplay between peripheral sensors and central cardiorespiratory regulation can result in sudden death. Diagnostic testing with electrocardiograms, electroencephalogram, sleep studies, or even genetic studies have increased our ability to identify patients at the highest risk.

Summary
Advances in the understanding of sudden unexplained death in children may show common pathways leading to sudden death from multiple different diseases. Although rare, the devastating implication prioritizes the importance in educating patients about how to live with the risk of sudden death.
Covid-19 skin manifestations: an update
Authors: Sanchez-Flores Xavier , Huynh Thy , Huang Jennifer T. 
Published: June 2021

Purpose of review
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 is a multisystemic disease manifesting mainly with dry cough, fever, and pneumonia and can present with a myriad of cutaneous manifestations. This chapter will review SARS-CoV-2 associated cutaneous findings, including incidence and relevance to the pediatric population.

Recent findings
The most commonly reported cutaneous findings described for COVID-19 in adults and children were chilblains-like lesions, followed by maculopapular eruption, urticarial lesions, vesicular lesions, and livedoid lesions. Children can also present with erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C).

Summary
There are numerous cutaneous manifestations of COVID-19, some of which are unique to children such as EM-like lesions and skin findings for MIS-C. Livedoid lesions do not commonly occur in the pediatric population. In mild cases, supportive care is indicated, whereas severe cases warrant intensive care and hospitalization.
Shared decision making in pediatric dermatology: context, opportunities, and practical examples
Authors: Kozina Yuliya , Politi Mary C. , Coughlin Carrie C. 
Published: June 2021

Purpose of review
Shared decision making (SDM) is an important part of patient-centered care. However, it is neither widely practiced nor researched in pediatric dermatology. In this article, we provide practical examples of how to engage in SDM in pediatric dermatology, and identify future areas of research.

Recent findings
Children and parents/guardians desire SDM in clinical encounters. The process is applicable to discussions of medical as well as surgical care. Additionally, SDM can help prepare children for the transition from pediatric to adult/general providers. Clinicians often want more guidance on its implementation, and there is a dearth of research on SDM or decision tools specific to pediatric dermatology.

Summary
SDM is underused and understudied in pediatric dermatology. This article highlights how to engage in SDM and presents opportunities for research and implementation in pediatric dermatology.
Antibiotic resistance: still a cause of concern?
Authors: DeBaun Malcolm R. , Lai Cara , Sanchez Mark , Chen Michael J. , Goodnough L. Henry , Chang Amy , Bishop Julius A. , Gardner Michael J. 
Published: June 2021

Abstract
Antibiotic resistance remains a global public health concern with significant patient morbidity and tremendous associated health care costs. Drivers of antibiotic resistance are multifaceted and differ between developing and developed countries. Under evolutionary pressure, microbes acquire antibiotic tolerance through a variety of mechanisms at the cellular level. Patients after orthopaedic trauma are vulnerable to drug-resistant pathogens, particularly after open fractures. Traumatologists practicing appropriate antibiotic prophylaxis and treatment regimens mitigate infection and propagation of antibiotic resistance.