bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of pulse dexamethasone in non-systemic juvenile idiopathic arthritis: a double-blind randomized controlled trial
Authors: Bhardwaj Umang , Bagri Narendra K , Lodha Rakesh , Kabra Sushil K , Velpandian Thirumurthy , Pandey Ravindra M 
Published: December 2021

Abstract

Objective
Early aggressive therapy using biologicals is increasingly being used in JIA for early disease remission. Pulse steroids are used in induction regimes for rheumatic disorders such as SLE and systemic JIA; however, no controlled studies have demonstrated their use in non-systemic JIA. The objective of the present study was to evaluate the efficacy and safety of pulse dexamethasone therapy in children with treatment-naïve non-systemic JIA as early aggressive therapy in resource-limited settings.

Methods
Sixty treatment-naïve children with non-systemic JIA with an active joint count of ≥5 and/or involvement of hip or cervical joints were randomized to receive either pulse dexamethasone (3 mg/kg/day, max 100 mg/day) or placebo (normal saline) for three consecutive days during each visit at 0, 6 (±2) and 12 (±2) weeks; along with standard therapy (MTX and NSAIDs). The use of oral bridge steroids was permissible for persistent severe disease as per predefined criteria. The primary outcome was ACR-Pedi 70 response at 16 (±2) weeks after enrolment in the two groups.

Results
The proportion of children achieving ACR-Pedi 70 in the two groups at last follow-up was 11/30 (36.7%) in pulse dexamethasone arm vs 11/28 (39.3%) in the placebo arm (P-value 0.837, relative risk 0.93, 95% CI 0.48, 1.80). We did not observe any significant difference in the proportion of children requiring bridge steroids. Adverse events were comparable in the two groups.

Conclusion
The addition of pulse dexamethasone to standard treatment may not add any advantage in improving ACR-Pedi 70 scores at medium-term follow-up.

Trial registration
Clinical Trial Registry-India; www.ctri.nic.in CTRI/2018/08/015151.
STATISTICAL MODELING OF GLANDULARITY FROM MAMMOGRAPHY IMAGES
Authors: Castrillón Carolina Osorio , Puerta Jorge Anselmo 
Published: December 2021

Abstract
This study presents a methodology for estimation of breast glandularity, which is an important factor to assess radiological risk in mammography patients. The investigation took place in an institution located at department of Antioquia-Colombia, where 200 patients participated. The models were obtained using partial least squares regression, where Dance’s model was used as reference; parameters of mammography images, equipment and patient were used as predicting variables (kV, mAs, patient’s weight, breast area and mean gray value of breast images). Coefficients of correlation equal to 89 and 88 were obtained for training and validation respectively in mediolateral oblique (MLO) and 84 and 89 for craniocaudal (CC). These models were used to estimate the mean glandular dose for all patients and later to obtain the institutional reference levels, 0.87 and 0.96 mGy for CC and MLO, respectively, following the recommendations of the ICRP publication No. 135. This study suggests that glandularity could be estimated with few parameters from equipment and patient.
Carbon allocation strategies and water uptake in young grafted and own-rooted hazelnut (Corylus avellana L.) cultivars
Authors: Portarena Silvia , Gavrichkova Olga , Brugnoli Enrico , Battistelli Alberto , Proietti Simona , Moscatello Stefano , Famiani Franco , Tombesi Sergio , Zadra Claudia , Farinelli Daniela 
Published: December 2021

Abstract
In this study, grafted and own-rooted young hazelnut plants of three high-quality cultivars were cultivated in Central Italy to investigate possible differences in growth, fruit and flower production, and physiological processes encompassing water uptake, photosynthetic variables and non-structural carbohydrate allocation. Stable isotopes and photosynthetic measurements were used to study carbon and water fluxes in plants. For the first time, an ecophysiological study was carried out to understand the seasonal growth dynamics of grafted plants in comparison with own-rooted plants. The own-rooted hazelnuts showed rapid above-ground development with large canopy volume, high amount of sprouts and earlier yield. The grafted plants showed greater below-ground development with lower canopy volumes and lower yield. However, later, the higher growth rates of the canopy led these plants to achieve the same size as that of the own-rooted hazelnuts and to enter the fruit production phase. Different seasonal behaviour in root water uptake and leaf photosynthesis-related variables was detected between the two types of plants. The grafted plants showed root development that allowed deeper water uptake than that of the own-rooted hazelnuts. Moreover, the grafted plants were characterized by a higher accumulation of carbohydrate reserves in their root tissues and by higher stomatal reactivity, determining significant plasticity in response to seasonal thermal variations.
Clonal Distribution and Antibiotic Susceptibility ofStaphylococcus aureusfrom Pediatric Patients: 8-Year Trends in a Children’s Hospital in Colombia
Authors: Montes Oscar , Hernández Jordan , Correa Oscar , Reyes Jeison , Pinzon Hernando , Reyes Niradiz 
Published: December 2021

AbstractEmergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains in healthcare settings has changed the hospital epidemiology of MRSA in the last few years. Despite a global increase in MRSA frequency, infections caused by methicillin-susceptible S. aureus (MSSA) have persisted in healthcare settings and the community. Staphylococcus aureus isolates were collected between 2009 and 2017 at the Children’s Hospital of a Caribbean city in South America. Methicillin-resistant isolates were subjected to SCCmec typing. Representative isolates were analyzed by multilocus sequence typing (MLST) and spa typing. Antibiotic susceptibility was assessed by agar dilution method. D-zone test was performed in erythromycin-resistant isolates to determine macrolide/lincosamide/streptogramin resistance. Spa typing revealed 10 different spa types. The main epidemic clones circulating during the study period were: ST8-MRSA-IVc, ST923-MRSA-IVa and ST8-MRSA-IVa. The study found high frequencies of PVL genes and resistance to erythromycin and clindamycin in the isolates. This study provides the first description of the population structure of MRSA and MSSA causing infections attended in the participating Children’s Hospital. ST8-MRSA-IVc, ST923-MRSA-IVa and ST8-MRSA-IVa were the most prevalent in the isolate population.
Access to the EU Courts in Environmental and Public Health Cases and the Reform of the Aarhus Regulation: Systemic Vision, Pragmatism, and a Happy Ending
Authors: Leonelli Giulia Claudia 
Published: December 2021

Abstract
After years of debate, the Aarhus Regulation has finally been reformed. This article focuses on the amendments to the scope of application of the Regulation’s internal review and access to justice provisions, and demonstrates that these are the most important changes introduced by the reform. Not only do these amendments mark an important development towards full compliance by the European Union (EU) with its obligations under the Aarhus Convention; they also fill a vacuum, and solve the main problem which lay at the heart of the EU system of access to justice in environmental public interest cases. First, the article explores the obstacles faced by different stakeholders seeking access to the EU Courts by reference to specific categories of EU environmental law and risk regulation acts. This provides a systemic overview of different problematic aspects associated with different scenarios, unpacking all relevant implications. Secondly, it embraces a pragmatic perspective and draws a clear distinction between challenges to legislative and regulatory acts. Against the backdrop of this examination, the article identifies the main problem of the EU system: the application of the ‘complete system of legal remedies’ rationale to the specific case of regulatory acts. Further, it highlights that there is no ‘interpretative’ way out of the TFEU conundrum. Thirdly, the article analyses the Commission’s disappointing proposal for a reform of the Aarhus Regulation and the final text of the 2021 amendments to the Regulation. The story has a (surprisingly) happy ending. The EU institutions have finally acknowledged the main problem in the system of access to the EU Courts in environmental matters, and recognized the need to solve it in the specific context of the Aarhus Regulation.
Standardizing a Postoperative Protocol for Supracondylar Humerus Fractures
Authors: Heyer Jessica H. , Anari Jason B. , Baldwin Keith D. , Arkader Alexandre 
Published: December 2021

Background:
Supracondylar humerus fractures are the most commonly operated upper extremity fracture in pediatric orthopaedics, yet there does not currently exist a standardized recommendation for a postoperative protocol. As advanced practice providers take on larger roles in the care of fracture patients, it may alleviate confusion to standardize postoperative protocols. The aim of this study was to compare outcomes between three different postoperative management protocols following operative fixation of supracondylar humerus fractures.

Methods:
This is a retrospective study of all patients who underwent operative fixation of a supracondylar humerus fracture during the 2014 to 2015 academic year. Postoperative protocols were classified as either “liberal,” “intermediate,” or “conservative,” based on how quickly the surgeon allowed unrestricted motion of the elbow postoperatively. Patients were evaluated for range of motion, functional elbow motion, and elbow clinical function, as well for postoperative complications. Univariate analysis was conducted to detect the differences in outcomes between protocol groups with P<0.01 considered significant.

Results:
One hundred patients were included in the final analysis, with 17 patients in the liberal group, 50 in the intermediate group, and 33 in the conservative group. There were no differences in patient population (age, sex, fracture type, concomitant nerve palsy, ipsilateral injuries, or physical therapy referrals) between the groups (P>0.01). There were no differences in range of motion, functional motion, or elbow clinical function (P>0.01) between the postoperative protocol groups. There were no postoperative complications (unplanned return to operating room, refracture, need for fixation revision, or infection) in any patient.

Conclusions:
There were no differences in postoperative complications or outcomes between the patients in the liberal, intermediate, or conservative protocol groups. In an efficiency-focused era, we conclude that a standardized liberal protocol be considered at a busy orthopaedic center.

Level of Evidence:
This study is a level III therapeutic study. It is a retrospective study that compares the outcomes after following 1 of 3 different postoperative protocols.
Reinjury Rates in Adolescent Patients 2 Years Following ACL Reconstruction
Authors: Kew Michelle E. , Bodkin Stephan , Diduch David R. , Brockmeier Stephen F. , Lesevic Milos , Hart Joseph M. , Werner Brian C. 
Published: December 2021

Background:
Sports injuries have increased dramatically in the pediatric and adolescent population. Return-to-sport testing and criteria are increasingly utilized, however, the guidelines for return to play in adolescents are unclear. The purpose of this study was to compare strength and function at the time of the return-to-sport progression to those with and without a failed anterior cruciate ligament reconstruction (ACLR).

Methods:
A total of 105 adolescent patients with primary ACLR were assessed at the time of return to sport. We identified graft failures/contralateral injury through medical records, clinic visits, or phone interviews at minimum 2 years of postsurgical follow-up. All patients completed bilateral isokinetic strength tests of the knee extensor/flexor groups and hop tests. Strength was expressed as torque-normalized-to-mass (Nm/kg), and limb-symmetry-index was expressed as a percentage of the uninvolved limb’s strength. All patients completed outcome surveys. The χ2 analysis was used to compare failures between sexes and graft types. Independent sample t tests were used to compare knee extensor/flexor strength, symmetry, and hop test results between patients with and without secondary anterior cruciate ligament (ACL) injury. One-way analysis of variance was used to compare knee extensor/flexor strength and symmetry, hop test, and survey results between those (1) without secondary injury, (2) ACLR graft failure, and (3) contralateral ACL injury.

Results:
A total of 100 of 105 patients (95.2%) were included with 4±1.2 years of follow-up, with 28 (28%) sustaining subsequent injury (12% graft, 16% contralateral). Patients with graft failure demonstrated (1) stronger quadriceps strength (2.00±0.46 Nm/kg) compared with those with contralateral ACL injury (1.58±0.35 Nm/kg, P=0.039) and patients that did not have a secondary injury (1.58±0.44 Nm/kg, P=0.007), (2) greater quadriceps strength symmetry (85.7±0.11.2%) compared with patients without secondary injury ACL (72.9±17.9%, P=0.046), (3) a greater proportion of hamstring grafts compared with those without reinjury (P=0.028).

Conclusions:
Adolescent patients who sustained ACLR graft failure had greater and more symmetric quadriceps strength at the time of return to sport compared with patients with no secondary injury. Objective measures of quadriceps strength at the time of the return-to-sport progression may not solely identify individuals that have a secondary ACL injury.

Study Design:
Level IV—retrospective cohort study.
A Daily, Respiratory Therapist Assessment of Readiness to Liberate From Venovenous Extracorporeal Membrane Oxygenation in Patients With Acute Respiratory Distress Syndrome
Authors: Pratt Elias H. , Mausert Sarah , Wilson Michael D. , Emerson Logan J. , Navuluri Neelima , Pulsipher Aaron M. , Brucker Amanda , Green Cynthia L. , Bonadonna Desiree K. , Bryner Benjamin S. , Rackley Craig R. 
Published: December 2021

Objectives:
We assessed the effect of implementing a protocol-directed strategy to determine when patients can be liberated from venovenous extracorporeal membrane oxygenation on extracorporeal membrane oxygenation duration, time to initiation of first sweep-off trial, duration of mechanical ventilation, ICU length of stay, hospital length of stay, and survival to hospital discharge.

Design:
Single-center retrospective before and after study.

Setting:
The medical ICU at an academic medical center.

Patients:
One-hundred eighty patients with acute respiratory distress syndrome managed with venovenous extracorporeal membrane oxygenation at a single institution from 2013 to 2019.

Interventions:
In 2016, our institution implemented a daily assessment of readiness for a trial off extracorporeal membrane oxygenation sweep gas (“sweep-off trial”). When patients met prespecified criteria, the respiratory therapist performed a sweep-off trial to determine readiness for discontinuation of venovenous extracorporeal membrane oxygenation.

Measurements and Main Results:
Sixty-seven patients were treated before implementation of the sweep-off trial protocol, and 113 patients were treated after implementation. Patients managed using the sweep-off trial protocol had a significantly shorter extracorporeal membrane oxygenation duration (5.5 d [3–11 d] vs 11 d [7–15.5 d]; p < 0.001), time to first sweep-off trial (2.5 d [1–5 d] vs 7.0 d [5–11 d]; p < 0.001), duration of mechanical ventilation (15.0 d [9–31 d] vs 25 d [21–33 d]; p = 0.017), and ICU length of stay (18 d [10–33 d] vs 27.0 d [21–36 d]; p = 0.008). There were no observed differences in hospital length of stay or survival to hospital discharge.

Conclusions:
In patients with acute respiratory distress syndrome managed with venovenous extracorporeal membrane oxygenation at our institution, implementation of a daily, respiratory therapist assessment of readiness for a sweep-off trial was associated with a shorter time to first sweep-off trial and shorter duration of extracorporeal membrane oxygenation. Among survivors, the postassessment group had a reduced duration of mechanical ventilation and ICU lengths of stay. There were no observed differences in hospital length of stay or inhospital mortality.
Fall 2021 Update
Authors: Schoonover-Shoffner Kathy 
Published: December 2021

ABSTRACT:
The COVID-19 pandemic and subsequent development of COVID vaccines have resulted in unique challenges for nurses. Nurses are being asked to make recommendations about vaccinations that have only been available since December 2020 even as vaccine information evolves on an almost daily basis. Standards of professional care and a Christian perspective on nursing to help guide nurses' practice in the current climate are discussed in this article. An overview of information and research findings published up to October 31, 2021 about COVID-19 vaccination is given to assist nurses in answering vaccination questions.
Rapid Initiation of Neoadjuvant Chemoradiotherapy After Diagnosis is Associated With Improved Pathologic Response in Locally Advanced Rectal Cancer
Authors: Lutsyk Myroslav , Turgeman Ilit , Bar-Sela Gil 
Published: December 2021

Introduction:
In rectal cancer, neoadjuvant chemoradiation (NCRT) is preferred because of toxicity profile, improved resectability and sphincter preservation, although with no impact on overall survival. Pathologic complete response (pCR) to NCRT has been linked with longer disease-free survival (DFS). The study purpose was to evaluate an association between clinical factors and treatment schedule with tumor response and treatment outcome, among patients with locally advanced rectal cancer.

Patients and Methods:
In this single-center retrospective study, conducted over 9 years (2011 to 2020), patients with stage II to III rectal cancer who had received NCRT were enrolled. The standard radiotherapy was 45 Gy to the pelvis, with a simultaneous integrated 50 Gy boost to the primary tumor. Continuous 5-Fluorouracil or oral capecitabine was administered concurrently. Surgery was preplanned within 6 to 8 weeks. Multinomial logistic regressions for evaluation of clinical factors, Kaplan-Meier method for DFS estimation, and receiver operating characteristic analysis for determination of the optimal timeframe were used.

Results:
Of 279 cases, pCR was observed in 72 (25.8%). In 207 cases, pTis-4N-negative was obtained in 137 (66.2%), pT0N-positive in 6 (2.9%), and pTis-4N-positive in 64 (30.9%). The pCR group had shorter diagnosis-NCRT time (P<0.01) and on-treatment time (P=0.05). DFS was longer for pCR and partial responders with clinical stage II and III (P<0.0001). Diagnosis-NCRT time was shown different between pCR and non-pCR groups. receiver operating characteristic analysis (P<0.01) showed that a diagnosis-NCRT time of <4.5 weeks predicts pCR with a sensitivity of 88% and specificity of 81% accuracy.

Conclusion:
The time elapsed between rectal cancer diagnosis and NCRT initiation is significantly associated with pCR. Reducing this time may increase the probability of achieving pCR.
Longitudinal Monitoring of Hair Cortisol Using Liquid Chromatography–Mass Spectrometry to Prevent Hypercortisolism in Patients Undergoing Glucocorticoid Replacement Therapy
Authors: Kostolanská Katarína , Šiprová Helena , Bartečků Elis , Juřica Jan , Řiháček Ivan , Táborská Eva , Souček Miroslav , Peš Ondřej 
Published: December 2021

Objective:
Currently available methods for endogenous cortisol monitoring in patients with hormonal insufficiency rely on measurements of plasma levels only at a single time point; thus, any kind of chronic exposure to cortisol is challenging to evaluate because it requires collecting samples at different time points. Hair cortisol levels acquired longitudinally better reflected chronic exposure (both cortisol synthesis and deposition) and may significantly contribute to better outcomes in glucocorticoid replacement therapies.

Design:
Twenty-two patients on cortisol substitution therapy were monitored for plasma, urinary, and hair cortisol levels for 18 months to determine whether hair cortisol may serve as a monitoring option for therapy setting and adjustment.

Methods:
Plasma and urinary cortisol levels were measured using standardized immunoassay methods, and segmented (∼1 cm) hair cortisol levels were monitored by liquid chromatography coupled to mass spectrometry. A log-normal model of the changes over time was proposed, and Bayesian statistics were used to compare plasma, urinary, and hair cortisol levels over 18 months.

Results and conclusions:
Hair cortisol levels decreased over time in patients undergoing substitutional therapy. The residual variance of hair cortisol in comparison to plasma or urinary cortisol levels was much lower. Thus, longitudinal monitoring of hair cortisol levels could prove beneficial as a noninvasive tool to reduce the risk of overdosing and improve the overall patient health.
Antibiotic Stewardship and Therapeutic Drug Monitoring of β-Lactam Antibiotics: Is There a Link? An Opinion Paper
Authors: Richter Daniel C. , Heininger Alexandra , Chiriac Ute , Frey Otto Roman , Rau Heike , Fuchs Thomas , Röhr Anka C. , Brinkmann Alexander , Weigand Markus A. 
Published: December 2021

Purpose:
In critically ill patients, changes in the pharmacokinetics (PK) of β-lactams can lead to significant variations in serum concentrations, with possibly detrimental effects on outcomes. The utilization of individually calculated doses, extended infusion regimen, and therapeutic drug monitoring (TDM)-guided dose adjustments can mitigate the PK changes and help to achieve and attain an individual PK target.

Methods:
We reviewed relevant literature from 2004 to 2021 using 4 search engines (PubMed, Web of Science, Scopus, and Google Scholar). Unpublished clinical data were also examined.

Results:
TDM-guided, individualized dosing strategies facilitated PK target attainment and improved patient outcomes. TDM-guided therapy is a core concept of individualized dosing that increases PK target attainment and identifies possible toxic β-lactam concentrations.

Conclusions:
Individualized dosing and TDM facilitate the rational use of β-lactams and are integral for antibiotic stewardship interventions in critical care, affording the optimal exposure of both pathogen and drugs, along with enhanced treatment efficacy and reduced emergence of antimicrobial resistance.
Extreme Gigantomastia Caused by Pseudoangiomatous Stromal Hyperplasia at Hopital Universitaire de Mirebalais: A Case Report
Authors: Jean-Louis Willy F. , Bowder Alexis , Dupont Claude R. , Delva Ruth , Jean-Louis McLee , Mixter Roger C. , Duffy Frederick J. 
Published: December 2021

Summary:
Gigantomastia is a rare pathologic condition characterized by an excessive and abnormal breast development. To date, there is no universally accepted definition or classification of this disease. The purpose of this article is to present a case of extreme and disabling gigantomastia caused by pseudoangiomatous stromal hyperplasia, the rarest etiology of gigantomastia. Very few cases have been listed in the literature. We believe this case of gigantomastia is unique because of its associated severe morbidity considerably impacting the patient’s life. Good aesthetic results and high patient satisfaction can be achieved with bilateral breast reduction and free nipple areola grafts.