bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Children's Chronic Health Conditions and Their Strengths and Difficulties in Primary Care
Authors: Stefko Jordan M. , Stolfi Adrienne , Pascoe John M. 
Published: May 2021

ABSTRACT:

Objective:
This study explores parents' perceptions of their child's health status and their strengths and difficulties using 2 validated instruments in primary care settings.

Methods:
This cross-sectional study was conducted between February 2018 and October 2019. Parents of children aged 2 to 18 years completed the Children with Special Health Care Needs (CSHCN) screener and the Strengths and Difficulties Questionnaire (SDQ) as well as demographics. The CSHCN uses 5 questions to identify children with chronic health conditions. Three subgroups were created: children with no chronic health condition (NCHC), chronic health condition with no functional limitations (NFLs), and chronic health condition with functional limitations (FLs). Higher SDQ scores indicate higher degrees of a factor. Associations between CSHCN subgroups and SDQ scores, controlling for demographics, were analyzed with multiple linear regressions.

Results:
In total, 970 parents' surveys (87.9% completed surveys) were included in this analysis: 76.4% of respondents were married, 56.4% had an annual household income ≥$50,000%, and 61.7% were employed full time; 53.0% of the index children were males, 72.1% were White, and 61.4% had private insurance. Mean (SD) total SDQ scores across the 3 CSHCN subgroups were significantly different (NCHC, 7.7 [4.8]; NFL, 12.6 [6.6]; FL, 16.0 [6.7], p < 0.001). The mean SDQ prosocial scores were higher in the NCHC subgroup (p < 0.001), as hypothesized. The SDQ means for the 3 subgroups remained significantly different after controlling for demographics.

Conclusion:
Children with FLs had significantly higher total SDQ scores than children in the other 2 subgroups, which may aid clinicians in the early identification of children who would benefit from behavioral health resources.
Modified Antimesenteric Tapering Enteroplasty: An Alternative Technique for the Treatment of Dysfunctional Anastomosis in Patients With Short Bowel
Authors: Cruz Ruy J. 
Published: May 2021

INTRODUCTION:
Several techniques have been described to taper the dilated small bowel to improve intestinal motility and decrease complications related to overdilated small bowel, including longitudinal intestinal lengthening and tapering, serial transverse enteroplasty, and spiral intestinal lengthening and tailoring. We propose an alternative technique designed to optimize bowel function and minimize the effects of recurrent small-bowel bacterial overgrowth in patients with short or ultra-short gut syndrome and dysfunctional anastomosis with maintenance of the actual absorptive surface.

TECHNIQUE:
The dilated side-to-side anastomosis is identified, and the mesentery leaves from both the proximal and distal small-bowel loops are separated by using blunt dissection. The previous anastomosis is divided longitudinally with a GI stapler. Once the small-bowel transection is completed, 2 separate blind loops of intestine are created, each one with half the circumference of the dilated side-to-side anastomosis. The antimesenteric stapled line is then reinforced with an outer layer of running suture. The blind loops of the tapered small bowel are then trimmed and anastomosed in an end-to-end isoperistaltic fashion in 2 layers.

RESULTS:
There were no postoperative complications. The length of the tapering ranged from 10 to 23 cm, corresponding to approximately 16% (range, 13%–20%) of the remaining small-bowel length. Three of 4 patients presented significant improvement of their symptoms and were able to have their parenteral support discontinued.

CONCLUSIONS:
Modified antimesenteric tapering enteroplasty is an alternative technique to improve intestinal motility and treat patients with short-bowel syndrome and dysfunctional side-to-side anastomosis without the need for further small-bowel resection. This bowel-sparing technique represents a valuable option in the armamentarium of the surgeon who manages patients with intestinal failure.
Posterior-First Two-Stage Approach to En Bloc Resection of Locally Recurrent Rectal Cancer Involving the Pelvic Sidewall
Authors: Sakata Shinichiro , Karim S. Mohammed , Mathis Kellie L. , Kelley Scott R. , Rose Peter S. , Dozois Eric J. 
Published: May 2021

INTRODUCTION:
Using standard anterior-only or anterior then posterior approaches can make an R0 resection difficult to achieve in patients with pelvic sidewall recurrences because of confined working spaces and poor visibility.

TECHNIQUE:
Given the limitations of standard approaches, we have used a novel posterior-first then anterior 2-stage approach allowing us to widely expose and secure deep margins and control vessels under direct visualization.

RESULTS:
We present a technical note describing this approach in patients with recurrent rectal cancer involving the pelvic sidewall with extrapelvic extension.

CONCLUSION:
The posterior-first approach may assist in achieving a higher number of R0 resections in patients with locally recurrent rectal cancer involving the pelvic sidewall.
Current Pharmacological Management of Aortic Aneurysm
Authors: Xiang Bitao , Zhu Shichao , Li Jun , Lai Hao , Wang Chunsheng , Zhu Kai 
Published: May 2021

Abstract:
Aortic aneurysm (AA) remains one of the primary causes of death worldwide. Of the major treatments, prophylactic operative repair is used for AA to avoid potential aortic dissection or rupture. To halt the development of AA and alleviate its progression into aortic dissection, pharmacological treatment has been investigated for years. Currently, β-adrenergic blocking agents, losartan, irbesartan, angiotensin-converting-enzyme inhibitors, statins, antiplatelet agents, doxycycline, and metformin have been investigated as potential candidates for preventing AA progression. However, the paradox between preclinical successes and clinical failures still exists, with no medical therapy currently available for ideally negating the disease progression. This review describes the current drugs used for pharmacological management of AA and their individual potential mechanisms. Preclinical models for drug screening and evaluation are also discussed to gain a better understanding of the underlying pathophysiology and ultimately find new therapeutic targets for AA.
Is Autonomic Nervous System Involved in the Epileptogenesis in Preterm Neonates?
Authors: Falsaperla Raffaele , Vitaliti Giovanna , Mailo Janette , Corsello Giovanni , Ruggieri Martino 
Published: May 2021

Abstract
Autonomic nervous system dysfunction has been described with focal and generalized epileptic seizures; occurring during their ictal, interictal, or postictal states. International League Against Epilepsy Seizure Classification Manual defines autonomic seizures as a distinct alteration of autonomic nervous system function involving cardiovascular, pupillary, gastrointestinal, sudomotor, vasomotor, and thermoregulatory functions. Autonomic seizures represent a great challenge for neonatologists and neurophysiologists; and distinguishing between ictal and non-ictal autonomic changes in neonates is rarely straightforward, especially in the premature ones. To avoid overdiagnosis and overtreatment, International League Against Epilepsy and the American Clinical Neurophysiology Society currently require electrographic correlation for any seizure diagnosis, including preterm neonates. There is very little scientific evidence about the pathophysiology of autonomic seizures. The data reporting on their incidence, clinical features, and diagnostic pathway is also insufficient. In this paper, we hypothesize that in the developing brain of preterm neonates, seizures involving deeper autonomic networks and subcortical structures might not propagate sufficiently to the cortex, and therefore the association of the seizures with specific ictal electrographic changes on surface electroencephalogram might be lacking. We propose considering autonomic seizures in the differential diagnosis of unexplained autonomic changes in neonates, especially preterm neonates, even in the absence of clear initial electrographic correlation. Unexplained autonomic changes could therefore be thought of as a “seizure alarm” in this population.
Determination of Free Valproic Acid Concentration in 569 Clinical Samples by LC-MS/MS After Hollow Fiber Centrifugal Ultrafiltration Treatment
Authors: Wu Xikun , Li Haoran , Dong Weichong , Yang Xiuling , Jin Yiran , Gong Ying , Zhang Zhiqing , Liu Xiujv 
Published: May 2021

Objective:
To perform therapeutic drug monitoring of total and free plasma valproic acid (VPA) concentrations in clinical samples and to analyze the related factors.

Methods:
The total VPA concentration in plasma was determined by ultrahigh-performance liquid chromatography with precolumn derivatization with α-bromoacetophenone, and the free VPA concentration was determined by liquid chromatography-tandem mass spectrometry after the plasma was treated by hollow fiber centrifugal ultrafiltration. Regression analysis was performed to examine the associations between free plasma VPA, total plasma VPA, and the plasma protein binding rate. The impact of individual situations, outpatient or inpatient factors, and drug combinations on VPA concentrations were examined.

Results:
Of the 569 clinical samples, 268 were inpatients and 301 were outpatients, and the total VPA concentration in 138 cases (24.2%) was lower than the effective treatment concentration range; the total and free VPA concentrations in outpatient samples were 11.0% and 26.1% higher than those of inpatients, respectively. There was no linear relationship between the free and total VPA concentrations. The relationship equation between the plasma protein binding rate and free VPA concentrations was as follows: Y = 0.0255X2 − 1.1357X + 97.429 (r = 0.8011). The total and free VPA concentrations were significantly decreased after the coadministration of phenobarbital (83.7% and 64.3% of the control group, P < 0.05) or carbapenem antibiotics (32.0% and 32.7% of the control group, P < 0.05).

Conclusions:
The total VPA concentrations in patients with epilepsy at our hospital was lower than the effective treatment concentration range, which was inadequate for epilepsy control; the total VPA concentrations of outpatients were higher than those of inpatients; as phenobarbital affects VPA metabolism, therapeutic drug monitoring is recommended. Carbapenem antibiotic coadministration with VPA should be avoided because carbapenem antibiotics can lead to the failure of VPA antiepileptic treatment.
Transcatheter mitral valve replacement: an update
Authors: Aoun Joe , Reardon Michael J. , Goel Sachin S. 
Published: May 2021

Purpose of review
A significant number of patients with mitral valve disease are at high to prohibitive risk for surgical repair or replacement. Transcatheter mitral valve interventions have evolved over the last few years. We review the recent growing evidence on transcatheter mitral valve replacement (TMVR).

Recent findings
Tendyne is the first TMVR device commercially approved in Europe. All TMVR systems remain under investigation in the United States. Several early studies have reported the feasibility and safety outcomes for TMVR implanted via transapical or transseptal approach. TMVR using balloon expandable valve for degenerated bioprosthetic valves, surgical rings and mitral annular calcification appears feasible in selected patients.

Summary
Early experience with TMVR systems is promising. Larger ongoing studies will help understand longer term outcomes and offer insights into patient selection.
Comparison of Cardiorespiratory Fitness in Black or African American Versus Caucasian Patients With Heart Failure
Authors: Canada Justin M. , Park Tae Shik , Ravindra Krishna , Chiabrando Juan G. , Del Buono Marco Giuseppe , van Wezenbeek Jessie , Trankle Cory R. , Kadariya Dinesh , Keen Larry , Carbone Salvatore , Billingsley Hayley , Wohlford George F. , Arena Ross , Van Tassell Benjamin W. , Abbate Antonio 
Published: May 2021

Purpose:
Cardiopulmonary exercise testing (CPX) is a well-established assessment with important insight into prognosis and therapeutic efficacy in patients with heart failure (HF). Prior studies have identified several clinical differences between Black or African American (B-AA) and Caucasian patients with HF. Differences in key CPX responses between these two groups require further investigation.

Methods:
Using a database consisting of subjects with symptomatic HF who had undergone CPX for inclusion in various prospective randomized clinical trials, we identified 198 (n = 94 [47%] B-AA; n = 105 [53%] Caucasian) patients with a qualifying baseline CPX. Significant univariate predictors of peak oxygen uptake (V˙o
2peak) were included in a multivariate linear regression model.

Results:
When compared with Caucasian patients, B-AA were younger (mean ± SD = 54.8 ± 10.0 vs 57.9 ± 9.6 yr, P = .03), had higher C-reactive protein (CRP) (median [IQR] = 4.9 [2.3, 8.8] vs 1.9 [0.6, 5.5] mg/L, P < .0001), lower hemoglobin (13.0 ± 1.8 vs 13.8 ± 1.6 g/dL, P = .003), and lower left ventricular ejection fraction (LVEF) (40 [32, 51] vs 53 [43, 59]%, P < .00010). During CPX, B-AA patients also had lower V˙o
2peak (14.6 ± 3.9 vs 17.6 ± 4.8 mL·kg−1·min−1, P < .0001). No differences were observed between B-AA and Caucasian in the minute ventilation/carbon dioxide production (V˙e/V˙co
2) slope (P = .14). The difference in V˙o
2peak between B-AA and Caucasian was largely attenuated after adjusting for age, body mass index, CRP, N-terminal pro-brain natriuretic peptide, hemoglobin, LVEF, and peak HR (14.1: 95% CI, 13.2-14.9 vs 15.6: 95% CI, 14.4-16.8 mL·kg−1·min−1, P = .053).

Conclusions:
Directly measured V˙o
2peak was significantly lower in B-AA than in Caucasians with HF. This is largely explained by differences in clinical characteristics, whereas no significant differences were observed in the V˙e/V˙co
2 slope.
Association Between Daily Steps at Moderate Cadence and Vascular Outcomes in Patients With Claudication
Authors: Gardner Andrew W. , Montgomery Polly S. , Wang Ming , Shen Biyi 
Published: May 2021

Purpose:
We determined whether patients with peripheral artery disease (PAD) and claudication grouped according to tertiles of community-based daily steps taken at a moderate cadence had differences in vascular function and biomarkers and whether group differences in vascular function and biomarkers persisted after adjusting for demographic variables, comorbid conditions, and severity of PAD.

Methods:
Two hundred sixty-three patients were evaluated for 1 wk on steps taken at a moderate cadence (exceeding 60 steps/min), and patients were placed into low (group 1), intermediate (group 2), and high (group 3) tertiles.

Results:
Ankle/brachial index (ABI) at 1 min after exercise (mean ± SD) was significantly higher in groups 2 and 3 than in group 1 in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1: 0.34 ± 0.25; group 2: 0.38 ± 0.27; and group 3: 0.44 ± 0.28). Exercise time to reach the minimum calf muscle oxygen saturation (StO2) value during treadmill exercise was significantly longer in groups 2 and 3 than in group 1 in unadjusted (P < .01) and adjusted (P < .01) analyses (group 1: 127 ± 127 sec; group 2: 251 ± 266 sec; and group 3: 310 ± 323 sec). Fibrinogen was significantly lower in group 3 than in group 1 in unadjusted (P = .02) and adjusted (P = .05) analyses (group 1: 3.5 ± 1.2 g/L; group 2: 3.6 ± 1.5 g/L; and group 3: 3.0 ± 1.1 g/L).

Conclusions:
Compared with patients with claudication in the lowest tertile of community-based daily steps taken at a moderate cadence, patients in the second and third tertiles had better calf muscle StO2 and ABI values during and immediately after exercise. Second, the most active group had lower fibrinogen levels than the least active group.
Piloting the Feasibility and Preliminary Impact of Adding Birth HIV Polymerase Chain Reaction Testing to the Early Infant Diagnosis Guidelines in Kenya
Authors: Finocchario-Kessler Sarah , Wexler Catherine , Brown Melinda , Goggin Kathy , Lwembe Raphael , Nazir Niaman , Gautney Brad , Khamadi Samoel , Babu Shadrack , Muchoki Elizabeth , Maosa Nicodemus , Mabachi Natabhona , Kamau Yvonne , Maloba May 
Published: May 2021

Background:
In Kenya, standard early infant diagnosis (EID) with polymerase chain reaction (PCR) testing at 6-week postnatal achieves early treatment initiation (<12 weeks) in <20% of HIV+ infants. Kenya’s new early infant diagnosis guidelines tentatively proposed adding PCR testing at birth, pending results from pilot studies.

Methods:
We piloted birth testing at 4 Kenyan hospitals between November 2017 and November 2018. Eligible HIV-exposed infants were offered both point-of-care and PCR HIV testing at birth (window 0 to <4 weeks) and 6 weeks (window 4–12 weeks). We report the: proportion of infants tested at birth, 6-week, and both birth and 6-week testing; median infant age at results; seropositivity and antiretroviral therapy initiation.

Results:
Final sample included 624 mother-infant pairs. Mean maternal age was 30.4 years, 73.2% enrolled during antenatal care and 89.9% had hospital deliveries. Among the 590 mother–infants pairs enrolled before 4 weeks postnatal, 452 (76.6%) completed birth testing before 4 weeks, with 360 (79.6%) testing within 2 weeks, and 178 (39.4%) before hospital discharge (0–2 days). Mothers were notified of birth PCR results at a median infant age of 5.4 weeks. Among all 624 enrolled infants, 575 (92.1%) were tested during the 6-week window; 417 (66.8%) received testing at both birth and 6-weeks; and 207 received incomplete testing (93.3% only 1 PCR and 6.7% no PCR). Four infants were diagnosed with HIV, and 3 infants were initiated on antiretroviral therapy early, before 12 weeks of age.

Conclusions:
Uptake of PCR testing at birth was high and a majority of infants received repeat testing at 6 weeks of age.
Epidemiology of Pediatric Meningitis in South Korea From 2010 to 2018: A Population-based Retrospective Cohort Study
Authors: Kim Bit Gyeol , Jang Min Sik , Kim Jihye 
Published: May 2021

Background:
Studies evaluating the epidemiology of pediatric meningitis are limited in our region. This study aimed to describe recent trends in the incidence of pediatric meningitis.

Methods:
We estimated national trends in hospitalization rates for pediatric meningitis (<18 years) by analyzing data from the Health Insurance Review and Assessment database between 2010 and 2018. Meningitis cases were identified based on International Classification of Diseases, Tenth Revision (ICD-10) codes and hospitalization rates were calculated.

Results:
In this national population-based study, a total of 119,644 hospitalizations and 58 deaths due to pediatric meningitis were identified. The hospitalization rates of pediatric bacterial meningitis have declined by 50.0%, from 3.4 per 100,000 in 2010 to 1.7 per 100,000 in 2018. The mortality rates for bacterial and viral meningitis were 2.0% and 0.002%, respectively. Despite the decreased annual incidence of bacterial meningitis, its mortality rate did not change significantly during the study period. The only risk factor identified for mortality in bacterial meningitis patients among age group, sex, region of residence, and season was age below 1 year (P < 0.001). As children under 1 year have a high-mortality rate (4.2%), patients in this age group require close monitoring. The reasons behind indistinct seasonal patterns of bacterial meningitis warrant further investigation.

Conclusions:
Childhood bacterial meningitis has shown a significant decline in incidence from 2010 to 2018. In contrast, viral meningitis has not shown a trend over time. Knowledge of these changes may aid clinicians in the decision-making process and management of meningitis patients.
Factors Contributing to Late Cancellation and No-Show for Otolaryngologic Surgery: A Prospective Study
Authors: Kaplon Adam W. , Lindemann Timothy Logan , Patel Punam A. , Soliman Ahmed M.S. 
Published: May 2021

ABSTRACT

Purpose:
Late cancellations and no-shows for surgery place a burden on patients, healthcare providers, and the health system. We aim to identify risk factors contributing to this phenomenon.

Methods:
Patients who did not arrive for, or canceled within 24 hours of, their surgical appointment between January 2019 and 2020 were identified. Controls were matched by date, procedure, and gender. Demographic information was obtained by phone interview and chart review. Chi-square and Student t-test analyses were used to predict risk factors for cancellation.

Results:
Thirty-one patients were identified, of whom 21 completed phone interviews. Age, gender, race, language, marital status, and smoking status were not significantly different. Study patients reported more transportation challenges (33.3% vs. 4.8%, p = .01) yet lived closer to the hospital (4.53 miles vs. 14.05 miles, p = .01). Study patients lived in lower income zip codes ($48,145 vs. $63,406, p = .02) and more commonly had Medicaid as their primary insurance (70.9% vs. 38.7%, p = .04). Most commonly, no reason was given for cancellation (22.6%) followed by personal reasons (16.1%) and surgery reconsideration (16.1%).

Conclusions:
Transportation trouble and lower income are significant risk factors for surgery late cancellation. Prior no-show must also be considered. A targeted pilot program may help prevent late cancellations.
Relationship Between Various Coronary Artery Disease Risk Factors in Firefighters
Authors: Ras Jaron , Leach Lloyd 
Published: May 2021

Objective:
To determine the correlation between the various coronary artery disease risk factors in firefighters.

Methods:
The study used a quantitative, cross-sectional, and correlational study design. A total of 124 full-time firefighters were conveniently recruited to participate. Research procedures were based on the ACSM guidelines.

Results:
Significances were found between age and body mass index (BMI) (r = 0.42, P < 0.001), age and waist circumference (WC) (r = 0.52, P < 0.001), BMI and WC (r = 0.88, P < 0.001), BMI and diastolic blood pressure (DBP) (r = 0.48, P < 0.001), between WC and DBP (r = 0.48, P < 0.001) and between gender and cigarette smoking (χ
2[1] = 5.66, P = 0.017).

Conclusion:
There were significant strong relationships between BMI, SBP, DBP, dyslipidemia, and increasing age, especially in male firefighters. Reducing key risk factors should be emphasized.
Changes in Job Control and Perceptions of General Health
Authors: Taouk Yamna , Spittal Matthew John , Disney George , LaMontagne Anthony Daniel 
Published: May 2021

Objective:
This longitudinal study of Australian workers explores a possible causal relationship between job control and general health.

Methods:
Our sample included 105,017 observations (18,574 persons) over 13 annual waves from working age participants with information on job control, general health, and other sociodemographic and health factors. Three complementary longitudinal modeling approaches were used to explore the causal relationship.

Results:
There was a strong stepwise, mostly exposure to outcome, relationship between increasing job control and general health. Cumulative exposure to low job control resulted in increasingly worse general health. Taken together, these findings provide good evidence of a causal relationship between low job control and general health.

Conclusion:
This analysis with improved causal inference over previous research showed that change in job control is strongly associated with change in general health.