bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications in Pediatric Regional Anesthesia
Authors: Walker Benjamin J. , Long Justin B. , Sathyamoorthy Madhankumar , Birstler Jennifer , Wolf Christine , Bosenberg Adrian T. , Flack Sean H. , Krane Elliot J. , Sethna Navil F. , Suresh Santhanam , Taenzer Andreas H. , Polaner David M. ,   on behalf of the Pediatric Regional Anesthesia Network Investigators
Published: August 2018

Abstract

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background
Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children’s hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children.

Methods
This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy.

Results
There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%).

Conclusions
The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.
Background Speech Disrupts Working Memory Span in 5-Year-Old Children
Authors: Grieco-Calub Tina M. , Collins Maya-Simone , Snyder Hillary E. , Ward Kristina M. 
Published: August 2018

Objectives:
The present study tested the effects of background speech and nonspeech noise on 5-year-old children’s working memory span.

Design:
Five-year-old typically developing children (range = 58.6 to 67.6 months; n = 94) completed a modified version of the Missing Scan Task, a missing-item working memory task, in quiet and in the presence of two types of background noise: male two-talker speech and speech-shaped noise. The two types of background noise had similar spectral composition and overall intensity characteristics but differed in whether they contained verbal content. In Experiments 1 and 2, children’s memory span (i.e., the largest set size of items children successfully recalled) was subjected to analyses of variance designed to look for an effect of listening condition (within-subjects factor: quiet, background noise) and an effect of background noise type (between-subjects factor: two-talker speech, speech-shaped noise).

Results:
In Experiment 1, children’s memory span declined in the presence of two-talker speech but not in the presence of speech-shaped noise. This result was replicated in Experiment 2 after accounting for a potential effect of proactive interference due to repeated administration of the Missing Scan Task.

Conclusions:
Background speech, but not speech-shaped noise, disrupted working memory span in 5-year-old children. These results support the idea that background speech engages domain-general cognitive processes used during the recall of known objects in a way that speech-shaped noise does not.
Impact of Pathways Triple P on Pediatric Health-Related Quality of Life in Maltreated Children
Authors: Lanier Paul , Dunnigan Allison , Kohl Patricia L. 
Published: August 2018

ABSTRACT:

Objective:
Child maltreatment is an adverse childhood experience associated with reductions in child well-being. This study examines whether an evidence-based parenting intervention delivered to families served by the child welfare system (CWS) affects pediatric health-related quality of life (HRQoL).

Method:
This study is a randomized controlled trial of Pathways Triple P (PTP) delivered to families with open child welfare cases for child physical abuse or neglect (N = 119). Children were 5 to 11 years old and remained in the home after the investigation. The primary outcome measure for this study was the Pediatric Quality of Life Inventory (PedsQL) 4.0, which measures HRQoL across 4 subdomains: physical functioning, emotional functioning, social functioning, and school functioning. Child- and parent-reported PedsQL 4.0 was assessed at baseline and post-test after the 14-week intervention.

Results:
Controlling for other factors, children in families randomly assigned to the PTP condition had a significant improvement in overall HRQoL after the intervention compared with families receiving usual services (βchild-report = 6.08, SE = 2.77, p = 0.03; βparent-report = 3.83, SE = 1.88, p = 0.04). Subdomain effect sizes differed when considering children's self-report or parents' proxy report. Children's self-report yielded the largest improvement in emotional functioning, whereas social functioning had the largest gain based on parents' proxy report.

Conclusion:
The PTP parenting intervention was associated with higher pediatric HRQoL as reported by both the child and parent. This intervention holds promise to improve child well-being when implemented in the CWS.
Diabetes Status and Susceptibility to the Effects of PM2.5 Exposure on Cardiovascular Mortality in a National Canadian Cohort
Authors: Pinault Lauren , Brauer Michael , Crouse Daniel L. , Weichenthal Scott , Erickson Anders , van Donkelaar Aaron , Martin Randall V. , Charbonneau Shannon , Hystad Perry , Brook Jeffrey R. , Tjepkema Michael , Christidis Tanya , Ménard Richard , Robichaud Alain , Burnett Richard T. 
Published: August 2018

Background:Diabetes is infrequently coded as the primary cause of death but may contribute to cardiovascular disease (CVD) mortality in response to fine particulate matter (PM2.5) exposure. We analyzed all contributing causes of death to examine susceptibility of diabetics to CVD mortality from long-term exposure.Methods:We linked a subset of the 2001 Canadian Census Health and Environment Cohort (CanCHEC) with 10 years of follow-up to all causes of death listed on death certificates. We used survival models to examine the association between CVD deaths (n = 123,500) and exposure to PM2.5among deaths that co-occurred with diabetes (n = 20,600) on the death certificate. More detailed information on behavioral covariates and diabetes status at baseline available in the Canadian Community Health Survey (CCHS)-mortality cohort (n = 12,400 CVD deaths, with 2,800 diabetes deaths) complemented the CanCHEC analysis.Results:Among CanCHEC subjects, comention of diabetes on the death certificate increased the magnitude of association between CVD mortality and PM2.5(HR = 1.51 [1.39–1.65] per 10 μg/m3) versus all CVD deaths (HR = 1.25 [1.21–1.29]) or CVD deaths without diabetes (HR = 1.20 [1.16–1.25]). Among CCHS subjects, diabetics who used insulin or medication (included as proxies for severity) had higher HR estimates for CVD deaths from PM2.5(HR = 1.51 [1.08–2.12]) relative to the CVD death estimate for all respondents (HR = 1.31 [1.16–1.47]).Conclusions:Mention of diabetes on the death certificate resulted in higher magnitude associations between PM2.5and CVD mortality, specifically among those who manage their diabetes with insulin or medication. Analyses restricted to the primary cause of death likely underestimate the role of diabetes in air pollution–related mortality. See video abstract at, http://links.lww.com/EDE/B408.
Parental Smoking and Risk of Childhood-onset Type 1 Diabetes
Authors: Magnus Maria C. , Tapia German , Olsen Sjurdur F. , Granstrom Charlotta , Mårild Karl , Ueland Per M. , Midttun Øivind , Svensson Jannet , Johannesen Jesper , Skrivarhaug Torild , Joner Geir , Njølstad Pål R. , Størdal Ketil , Stene Lars C. 
Published: August 2018

Background:
A few prospective studies suggest an association between maternal smoking during pregnancy and lower risk of type 1 diabetes. However, the role of unmeasured confounding and misclassification remains unclear.

Methods:
We comprehensively evaluated whether maternal smoking in pregnancy predicts lower risk of childhood-onset type 1 diabetes in two Scandinavian pregnancy cohorts (185,076 children; 689 cases) and a Norwegian register-based cohort (434,627 children; 692 cases). We measured cord blood cotinine as an objective marker of nicotine exposure during late pregnancy in 154 cases and 476 controls. We also examined paternal smoking during pregnancy, in addition to environmental tobacco smoke exposure the first 6 months of life, to clarify the role of characteristics of smokers in general.

Results:
In the pregnancy cohorts, maternal smoking beyond gestational week 12 was inversely associated with type 1 diabetes, pooled adjusted hazard ratio (aHR) 0.66 (95% CI = 0.51, 0.85). Similarly, in the Norwegian register-based cohort, children of mothers who still smoked at the end of pregnancy had lower risk of type 1 diabetes, aHR 0.65 (95% CI = 0.47, 0.89). Cord blood cotinine ≥30 nmol/L was also associated with reduced risk of type 1 diabetes, adjusted odds ratio 0.42 (95% CI = 0.17, 1.0). We observed no associations of paternal smoking during pregnancy, or environmental tobacco smoke exposure, with childhood-onset type 1 diabetes.

Conclusion:
Maternal sustained smoking during pregnancy is associated with lower risk of type 1 diabetes in children. This sheds new light on the potential intrauterine environmental origins of the disease.
Fibroblast growth factor–transforming growth factor beta dialogues, endothelial cell to mesenchymal transition, and atherosclerosis
Authors: Chen Pei-Yu , Simons Michael 
Published: August 2018

Purpose of reviewDespite much effort, atherosclerosis remains an important public health problem, leading to substantial morbidity and mortality worldwide. The purpose of this review is to provide an understanding of the role of endothelial cell fate change in atherosclerosis process.Recent findingsRecent studies indicate that a process known as endothelial-to-mesenchymal transition (EndMT) may play an important role in atherosclerosis development. Transforming growth factor beta (TGFβ) has been shown to be an important driver of the endothelial cell phenotype transition.SummaryThe current review deals with the current state of knowledge regarding EndMT's role in atherosclerosis and its regulation by fibroblast growth factor (FGF)–TGFβ cross-talk. A better understanding of FGF–TGFβ signaling in the regulation of endothelial cell phenotypes is key to the development of novel therapeutic agents.
Point-of-Care Ultrasound Diagnosis of Retinoblastoma in the Emergency Department
Authors: Giacalone Martina , Mastrangelo Greta , Parri Niccolò 
Published: August 2018

Abstract
An 18-month-old girl presented to the emergency department with the chief complaint of squinting. The right eye demonstrated esotropia, heterochromia, and anisocoria. Ocular point-of-care ultrasound facilitated the rapid diagnosis of retinoblastoma, which was confirmed by computed tomography scan and orbital magnetic resonance imaging.
Lyme Arthritis
Authors: Long Katharine Christina , Cohn Keri Anne 
Published: August 2018

Abstract
Lyme disease is the most common vector-borne illness in North America, with the majority of cases occurring in the Northeast and upper Midwest. Lyme arthritis is the most prevalent manifestation of late-stage Lyme disease. Lyme arthritis typically presents as a monoarthritis or oligoarthritis in large joints such as the knee. Accompanying positive 2-tier Lyme serologies or polymerase chain reaction from synovial fluid/tissue is considered diagnostic for patients from an endemic area. The mainstay of initial treatment is a prolonged course of oral antibiotics.
Ultrasound-Guided Interventions in Lateral Epicondylitis
Authors: Shergill Ravi , Choudur Hema Nalini 
Published: August 2018

Abstract
Lateral epicondylitis is a painful condition related to the myotendinous origin of the extensor muscles at the lateral epicondyle of the humerus. Primary treatment typically involves the use of rest, non-steroidal anti-inflammatory drugs (NSAIDs), and physiotherapy. However, in refractory cases where conventional therapy is ineffective, ultrasound-guided injection therapies have become a growing form of treatment. These include needle tenotomy, autologous whole blood injection (AWB), platelet-rich plasma (PRP) injection and steroid injection. The consensus regarding the efficacy of individual approaches of ultrasound-guided treatment is unclear in the literature, and is explored further in this review.
When evaluating these injection therapies individually, there are multiple case series describing the efficacy of each intervention in refractory lateral epicondylitis. A systematic review of needle tenotomy demonstrates an improvement in pain symptoms for patients with this condition, but all studies were poorly designed with no placebo or control group. Additionally, for PRP therapy, a systematic review performed in 2013 demonstrated a statistically significant improvement in pain and functionality for refractory lateral epicondylitis. However, these studies were similarly associated with a high risk of bias. Autologous whole blood injection has been evaluated through well-designed studies to show statistically significant reductions in pain with this intervention. But very few studies in total have been completed using AWB for lateral epicondylitis, and therefore no clear conclusions can be drawn at this time. Finally, corticosteroid use overall is unsupported in the evidence both in the short and long term, especially given that this condition is not an inflammatory pathology.
Considerations for Temporomandibular Joint Procurement in Vascularized Composite Allotransplantation
Authors: Khavanin Nima , Davidson Edward H. , Smith Ryan M. , Macmillan Alexandra , Byrne Patrick , Dorafshar Amir H. 
Published: August 2018

Abstract
Methods for harvest of the temporomandibular joint (TMJ) for transplantation may involve several anatomic levels. The authors aim to assess the feasibility and identify challenges with 2 such methods, resuspending the donor condyles from the recipient glenoid fossae and en bloc harvest of the joint and surrounding temporal bone with plate-fixation to the recipient skull base. Two mock face transplantations were carried out using 4 fresh cadavers. Computed tomography imaging was obtained before and after the procedures to assess the technical success of each method. Both techniques were technically successful, allowing for full passive jaw range of motion following graft transfer and appropriate condyle positioning as assessed by computed tomography. En bloc TMJ harvest allowed for transfer of the entire joint without violating its capsule or altering its biomechanics. The authors found this technique better able to avoid issues with size mismatch between the donor mandible and recipient skull base width. When no such mismatch exists, graft harvest at the level of the mandibular condyle is technically easier and less time consuming. Although both methods of TMJ harvest are technically feasible with acceptable immediate postoperative jaw position and range of motion, the en bloc technique allows for more natural jaw function with less risk of postoperative joint immobility by preserving the joint capsule and its ligamentous support.
Surgical Correction of Proptosis in Craniofacial Benign Bone Lesions Involving the Orbit
Authors: Chi Tzu-Yang , Yu Zheyuan , Xu Liang , Duan Huichuan , Shim Yoong Hoon , Cao Dejun 
Published: August 2018

Abstract
Craniofacial bone lesions involving the orbit are often associated with symptoms, including proptosis, orbital dystopia, and overall facial asymmetry. Fibrous dysplasia and osteoma are the 2 most commonly observed bone tumors in the craniofacial area. Nine patients with either craniofacial fibrous dysplasia or osteoma and an unacceptable aesthetic appearance were treated from January 2015 to July 2016. All patients underwent preoperative craniofacial 3-dimensional computed tomographic (CT) scanning, and standard photographs were obtained. Proptosis measurements were performed on CT images using an annotation ruler provided by the imaging system both pre- and postoperatively. All patients were treated surgically, and a coronal incision was used. Outcomes were assessed by CT scans, and photographs were obtained during routine follow-ups at 1 week, 3 to 6 months, and 1 year after surgery. The Likert scale was used to investigate patients’ postoperative satisfaction rate. Favorable outcomes were achieved in all patients. The mean difference between eyeball proptosis was reduced from 3.6 mm before surgery to 1.6, 0.6, and 0.3 mm after the surgery at 1 week, 3 to 6 months, and 1 year, respectively. No complications, such as facial and/or optic nerve injury, recurrence, and malignant degeneration, were noted. This study demonstrated that surgical treatment of craniofacial bone lesions involving the orbit achieved acceptable results shortly after the surgery, and more prominently, starting from 3 to 6 months.
3-Factor Versus 4-Factor PCC in Coagulopathy of Trauma: Four is Better Than Three
Authors: Zeeshan Muhammad , Hamidi Mohammad , Kulvatunyou Narong , Jehan Faisal , O’Keeffe Terence , Khan Muhammad , Rashdan Lana , Tang Andrew , Zakaria El-Rasheid , Joseph Bellal 
Published: August 2018

ABSTRACT

Introduction:
Coagulopathy of trauma (COT) is common and highly lethal. Prothrombin complex concentrate (PCC) has been advocated for correction of COT. However, the difference in efficacy between three-factor PCC (3-PCC) versus four-factor PCC (4-PCC) remains unclear. The aim of our study was to compare efficacy of 3-PCC versus 4-PCC in COT.

Methods:
Five-year (2013–2017) review of coagulopathic trauma patients at our Level-I trauma center who received 3- or 4-PCC. Patients were divided into two groups (4-PCC and 3-PCC) and matched in 1:1 ratio using propensity-score-matching for demographics, injury parameters, admission vitals, and hematological parameters. Primary outcomes were time to correction of international normalized ratio (INR), blood products transfusion, thromboembolic complications, and mortality. Secondary outcomes were hospital-length of stay (LOS), intensive care unit (ICU)-LOS, cost of therapy, and total hospital cost.

Results:
Six hundred fifty-seven patients met inclusion criteria of whom 250 patients (4-PCC:125; 3-PCC:125) were matched. The mean age was 50 ± 19.4 y, 64% were male, and median-injury severity score was 24[15–33]. 4-PCC was associated with accelerated correction of INR (365 vs. 428 min, P
= 0.01), decrease in red blood cells (7 units vs. 10 units, P
= 0.04) and FFP (6 units vs. 8 units, P
= 0.03) transfused. There was no difference in platelet transfusion, thromboembolic complications, mortality, hospital, and ICU-LOS. 4-PCC was associated with higher cost of PCC therapy, and lower cost of transfusion. There was no difference regarding the total hospital cost between the two groups.

Conclusion:
Compared with 3-factor PCC, the use of 4-factor PCC is associated with a rapid reversal of INR and reduction in transfusion requirement without increasing the overall hospital cost or the risk of thromboembolic events. 4-PCC may be preferred as an adjunct for the resuscitation of coagulopathic trauma patients.
Novel Benefits of Remote Ischemic Preconditioning Through VEGF-dependent Protection From Resection-induced Liver Failure in the Mouse
Authors: Kambakamba Patryk , Linecker Michael , Schneider Marcel , Kron Philipp , Limani Perparim , Tschuor Christoph , Ungethüm Udo , Humar Bostjan , Clavien Pierre-Alain 
Published: August 2018

Objective:
To investigate the impact of remote ischemic preconditioning (RIPC) on liver regeneration after major hepatectomy.

Summary Background Data:
RIPC is a strategy applied at remote sites to mitigate ischemic injury. Unlike other preconditioning approaches, RIPC spares target organs as it acts via systemic VEGF elevations. In the liver, however, VEGF is an important driver of regeneration following resection. Therefore, RIPC may have pro-regenerative effects.

Methods:
RIPC was applied to C57BL/6 mice through intermittent clamping of the femoral vessels prior to standard 68%-hepatectomy or extended 86%-hepatectomy, with the latter causing liver failure and impaired survival. Liver regeneration was assessed through weight gain, proliferative markers (Ki67, pH3, mitoses), cell cycle-associated molecules, and survival. The role of the VEGF-ID1-WNT2 signaling axis was assessed through WIF1 (a WNT antagonist) and recombinant WNT2 injected prior to hepatectomy.

Results:
RIPC did not affect regeneration after 68%-hepatectomy, but improved liver weight gain and hepatocyte mitoses after 86%-hepatectomy. Importantly, RIPC raised survival from 40% to 80% after 86%-hepatectomy, indicating the promotion of functional recovery. Mechanistically, the RIPC-induced elevations in VEGF were accompanied by increases in the endothelial transcription factor Id1, its target WNT2, and its hepatocellular effector β-catenin. WIF1 injection prior to 86%-hepatectomy abrogated the RIPC benefits, while recombinant WNT2 had pro-regenerative effects akin to RIPC.

Conclusion:
RIPC improves the regenerative capacity of marginal liver remnants in a VEGF-dependent way. If confirmed in patients, RIPC may become the preconditioning strategy of choice in the setting of extended liver resections.