bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevention of Recurrent Ventricular Tachycardia in Patients With Implantable Cardioverter Defibrillators—A Network Meta-analysis
Authors: Malik Aaqib H. , Aronow Wilbert S. 
Published: April 2019

Background:
The optimal management for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators (ICDs) offers a challenge with no set guidelines regarding which therapy offers a best safety and efficacy profile.

Study Question:
Which therapeutic strategy, among antiarrhythmic drugs and catheter ablation (CA), offers the most effective and safe approach in patients with ICDs?

Data Sources:
Randomized controlled trials (RCTs) comparing the efficacy and safety of antiarrhythmic drugs or CA against a placebo group. RCTs were identified from a comprehensive search in PubMed, Embase, and Cochrane library.

Study Design:
Our outcomes of interest were reductions in appropriate ICD shocks, inappropriate ICD shocks, and overall mortality. We used the event rates in both groups, and then using a frequentist approach employing a graph theory methodology, we constructed a network meta-analysis model.

Results:
Fourteen RCTs with 3815 participants and 6 different interventions treatments were included in our network meta-analysis. The most effective treatment for the prevention of recurrent ventricular tachycardia after ICD is amiodarone followed by CA. Amiodarone is most effective in the reduction of appropriate and inappropriate ICD shocks with an odds ratio (OR) of 0.29 [95% confidence interval (CI), 0.11–0.74] and 0.15 (95% CI, 0.04–0.60), respectively. CA was effective in the reduction of appropriate ICD shocks (OR, 0.41; 95% CI, 0.20–0.87), whereas sotalol was effective in the reduction of inappropriate ICD shocks (OR, 0.46; 95% CI, 0.22–0.95). There was no significant reduction in the overall mortality from any therapy. There was a trend of increased mortality associated with amiodarone therapy (OR, 2.40; 95% CI, 0.92–6.26).

Conclusions:
Amiodarone remains the most efficacious therapy for the reduction of appropriate and inappropriate shocks in patients with ICD. No therapy resulted in mortality reduction, but amiodarone showed a trend toward increased mortality.
The lung microbiome and transplantation
Authors: Mitchell Alicia B. 
Published: April 2019

Purpose of review
Lung transplantation survival is still limited compared with other solid organ transplant modalities, due to a range of factors that are continuing to be elucidated. However, new research is emerging which indicates that the microbiome of the lungs, and of other organs, may have important implications for immune response and mediating transplant outcomes. Pathogenic bacterial and viral species are known to have deleterious effects on the allograft, but taking a more global view, and considering the overall composition of the community of microbial species may undercover a greater understanding of the complex interplay involved in allograft dysfunction.

Recent findings
The microbiome appears to have an important modulatory role on immune response in both normal development, and after transplantation. A range of microbial species contributes to the resident microscopic community, with the gut and blood microbiomes having a significant impact on the function of the lungs and resistance to infection. Movement of species from within and outside the respiratory tract occurs in the early transplant period, leading to a modified donor microbiome in the recipient. There is evidence to suggest that chronic lung allograft dysfunction may be facilitated by the respiratory microbiome and interactions with immune cells within the allograft.

Summary
Further investigation of the respiratory microbiome, interactions with the microbiome of other organs and impact on immune and allograft function posttransplantation is needed. Promising insights are being gained regarding certain microbial profiles which may be associated with negative outcomes, and the mechanisms through which this occurs. As our understanding expands, the ability to modify the microbiome offers novel treatment strategies for combating allograft dysfunction.
Community-acquired respiratory viruses
Authors: Gottlieb Jens 
Published: April 2019

Purpose of review
Incidence of community-acquired respiratory viruses (CARVs) after lung transplantation (LTx) is 10–68 cases per 100 patient-years. Infected patients may develop graft failure and there seems to be an association between CARV infection and development of chronic lung allograft dysfunction (CLAD). This review summarizes the impact of CARV infection after LTx and potential treatment strategies.

Recent findings
Detection rate of CARV depends on diagnostic methods. CARV infections after LTx are reported more frequently probably attributed to improved diagnostic methods, especially nucleic acid testing. Paramyxoviridae and picornaviridae are most frequent. For paramyxoviridae, the association with CLAD is reported in various single-center observational studies. Neuraminidase inhibitors are approved for influenza and can be safely used in flu-infected LTx patients. There is no approved treatment for paramyxoviruses, most centers use ribavirin in the infected LTx recipient.

Summary
Antivirals against CARV in LTx recipients have not yet demonstrated reduced morbidity in randomized clinical trials. Agents against CARV under development are inhibiting viral attachment and use silencing mechanisms of viral replication. The cohort of lung transplant recipients is a focus of intense research because of the high morbidity of CARV infection and intense surveillance of LTx recipeints.
A Consensus Study of the Grading and Typing of Intraductal Papillary Mucinous Neoplasms of the Pancreas
Authors: Furukawa Toru , Fukushima Noriyoshi , Itoi Takao , Ohike Nobuyuki , Mitsuhashi Tomoko , Nakagohri Toshio , Notohara Kenji , Shimizu Michio , Tajiri Takuma , Tanaka Mariko , Yamaguchi Hiroshi , Yanagisawa Akio , Sugiyama Masanori , Okazaki Kazuichi 
Published: April 2019

Objective
The grading and typing of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are challenging for pathologists. We aimed to clarify the points of consistency and disagreement in assessing the grades and types of IPMNs.

Methods
Digital slide images of 20 IPMNs were independently assessed by 10 Japanese pathologists, who then held a consensus meeting to discuss the points of disagreement and develop a consensus and recommendations.

Results
The average agreement rates for grade and type were 83.5% (range, 100%–40%) and 82.5% (range, 100%–50%) and the Fleiss' κ values were 0.567 and 0.636, respectively.

Conclusions
The disagreement points and recommendations were as follows: destructed ductal walls with desquamated neoplastic epithelia or mucin lakes partially lined with neoplastic cells could be invasion; intraductal stromal invasion could be dismissed unless vascular or lymphatic invasion existed; elastica staining may help visualize ducts in colloidal nodules; high-grade can be distinguished from low/intermediate grade by marked nuclear disarrangements and complex architecture in the intestinal papillae; oncocytic papillae are characterized by eosinophilic cells with round disoriented nuclei; high-grade gastric papillae can be distinguished from pancreatobiliary papillae by relatively low but complex architecture; and the most dysplastic papillae should be used to assess type in mixed papillae types.
Paediatric Endoscopy Global Rating Scale
Authors: Narula Priya , Broughton Raphael , Howarth Lucy , Piggott Anna , Bremner Ronald , Tzivinikos Christos , Gillett Peter , Henderson Paul , Rawat David , Cullen Mick , Loganathan Sabari , Devadason David , Afzal Nadeem A. , Maginnis Janis , McKenna Sharon , Thomson Mike , Green John , Johnston Debbie 
Published: April 2019

ABSTRACTIntroduction and Objectives:The endoscopy Global Rating Scale (GRS) is a web‐based self‐assessment quality improvement (QI) tool that provides a framework for service improvement. Widespread use of the GRS in adult endoscopy services in the United Kingdom (UK) has led to a demonstrable improvement in quality. The adult GRS is not directly applicable to paediatric endoscopy services. The objective of this study is to develop and pilot a paediatric endoscopy Global Rating Scale (P‐GRS) as a QI tool.Methods:Members of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Endoscopy Working Group collaborated with the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) to develop the P‐GRS. After a period of consultation, this was piloted nationally at 9 centres and data were collected prospectively at 2 census points, May and December 2016.Results:The P‐GRS mirrors the adult GRS by dividing care into 4 domains and includes 19 standards with several measures that underpin the standards. Eight services completed the online P‐GRS return in May 2016 and 6 in December 2016. All pilot sites identified areas that needed improvement and post‐pilot reflected on the key challenges and developments. Several positive developments were reported by the pilot sites.Conclusions:The national pilot helped ensure that the P‐GRS developed was relevant to the paediatric endoscopy services. The pilot demonstrated that even in the first year of engaging with this QI tool, services were starting to identify areas that needed improvement, share best practice documents, put in place QI plans, and support greater patient involvement in services.
Adverse Tracheal Intubation-Associated Events in Pediatric Patients at Nonspecialist Centers: A Multicenter Prospective Observational Study*
Authors: Matettore Adela , Ramnarayan Padmanabhan , Jones Andrew , Randle Elise , Lutman Daniel , O’Connor Maeve , Chigaru Linda 
Published: April 2019

Objectives:
In tertiary care PICUs, adverse tracheal intubation-associated events occur frequently (20%; severe tracheal intubation-associated events in 3–6.5%). However, pediatric patients often present to nonspecialist centers and require intubation by local teams. The rate of tracheal intubation-associated events is not well studied in this setting. We hypothesized that the rate of tracheal intubation-associated events would be higher in nonspecialist centers.

Design:
Prospective observational study.

Setting:
We conducted a multicenter study covering 47 local hospitals in the North Thames and East Anglia region of the United Kingdom.

Patients:
All intubated children transported by the Children’s Acute Transport Service from June 2016 to May 2018.

Interventions:
None.

Measurements and Main Results:
Data were available in 1,051 of 1,237 eligible patients (85%). The overall rate of tracheal intubation-associated events was 22.7%, with severe tracheal intubation-associated events occurring in 13.8%. Younger, small-for-age patients and those with difficult airways had a higher rate of complications. Children with comorbidities and difficult airways were found to have increased severe tracheal intubation-associated events. The most common tracheal intubation-associated events were endobronchial intubation (6.2%), hypotension (5.4%), and bradycardia (4.2%). In multivariate analysis, independent predictors of tracheal intubation-associated events were number of intubation attempts (odds ratio for > 4 attempts compared with a single attempt 19.1; 95% CI, 5.9–61.4) and the specialty of the intubator (emergency medicine compared with anesthesiologists odds ratio 6.9; 95% CI, 1.1–41.4).

Conclusions:
Tracheal intubation-associated events are common in critically ill pediatric patients who present to nonspecialist centers. The rate of severe tracheal intubation-associated events is much higher in these centers as compared with the PICU setting. There should be a greater focus on improving the safety of intubations occurring in nonspecialist centers.
Does an Antimicrobial Time-Out Impact the Duration of Therapy of Antimicrobials in the PICU?*
Authors: Adams Susan M. , Ngo Linh , Morphew Tricia , Babbitt Christopher J. 
Published: April 2019

Objectives:
Our aim was to perform an antimicrobial time-out 48–72 hours after commencing therapy in order to achieve a decrease in days of therapy per 1,000 patient days for vancomycin, meropenem, and piperacillin/tazobactam in all PICU patients during an 8-month period.

Design:
This is a pre- and postimplementation quality improvement study.

Settings:
A 30-bed PICU at a tertiary children’s hospital.

Patients:
Patients less than 21 years old admitted to the PICU from July 1, 2015, until March 31, 2016, or from July 1, 2016, until March 31, 2017, who received antibiotics for greater than 48 hours were eligible for inclusion.

Intervention:
An antimicrobial time-out was performed after 48–72 hours of antimicrobials for all patients in the PICU during postimplementation.

Measurements and Main Results:
The primary outcome measure was days of therapy per 1,000 patient-days for three target antibiotics: vancomycin, meropenem, and piperacillin/tazobactam. Ninety-five patients meeting inclusion criteria were admitted to the PICU during the pre–time-out period and 95 patients during the post–time-out period. The cohort that underwent time-outs had lower days of therapy for vancomycin (81.3 vs 138.1; p = 0.037) and meropenem (34.7 vs 67.1; p = 0.045). Total acquisition cost was 31 % lower for piperacillin/tazobactam and vancomycin and 46% for meropenem post implementation. Time-outs led to antimicrobial duration being defined 63% of the time and deescalation or discontinuation of antimicrobials 29% of the time.

Conclusions:
A 48–72-hour time-out process in rounds is associated with a reduction in days of therapy for antibiotics commonly used in the PICU and may lead to more appropriate usage. The time-outs are associated with discontinuation, deescalation, or duration being defined, which are key elements of Centers for Disease Control and Prevention–recommended antimicrobial stewardship programs.
Chromhidrosis
Authors: Suessman Anna , Srinivasan Saranya 
Published: April 2019

Abstract
Chromhidrosis is a rare condition characterized by the secretion of colored sweat. We report a case of a preadolescent healthy girl presenting with acute, recurrent blue discoloration of her armpits. The blue discoloration can be wiped off but recurs. As providers, it is useful to be familiar with this diagnosis and course of disease.
Utility of Neuroimaging in Children Presenting to a Pediatric Emergency Department With Ataxia
Authors: Luetje Maureen , Kannikeswaran Nirupama , Arora Rajan , Wang Bo , Farooqi Ahmad , Sivaswamy Lalitha 
Published: April 2019

Objectives
The aim of this study was to evaluate the utility of neuroimaging in children who present to the pediatric emergency department with acute-/subacute-onset ataxia. Neuroimaging is performed in many children with ataxia to rule out serious intracranial pathology. There is, however, limited evidence to support such practice.

Methods
This was a retrospective review of electronic medical records of children who presented to the emergency department with ataxia between 2007 and 2013. Patient demographics, historical features, physical examination findings, laboratory results, and neuroimaging results were collected. Neuroimaging studies that were classified as abnormal by a neuroradiologist were further reviewed and classified by the study neurologist as clinically significant or not.

Results
The records of 141 subjects were analyzed. The most common causes of ataxia were infectious/postinfectious (36.2%) and ingestion (15.6%). Neuroimaging was performed in 104 children (73.8%). Neuroimaging was abnormal in 63 children (60.6%). However, these abnormalities were clinically significant in only 14 children (13.5%). Focal neurological findings were noted in 12 of 14 children (85.7%) with clinically significant neuroimaging.

Conclusions
Clinically significant neuroimaging was noted in a minority of children who presented with acute/subacute ataxia. The majority of patients with clinically significant neuroimaging had focal neurological findings on examination. Neuroimaging may not be required in all children presenting to the ED with acute ataxia, but further large-scale studies are needed to validate these findings and identify a subset of patients with ataxia in whom imaging can be deferred.
A rare complication of knee hematoma after genicular nerve radiofrequency ablation
Authors: Strand Natalie , Jorge Paolo , Freeman John , D'Souza Ryan S. 
Published: April 2019

Abstract

Background:
Genicular nerve radiofrequency ablation (RFA) is an intervention to treat patients with chronic knee pain who have failed previous conservative, pharmacologic, and surgical interventions. Vascular complications following interventional procedures of the knee are extremely rare. A delay in diagnosis may be detrimental for the viability of the affected limb and may ultimately require amputation.

Case Presentation:
A 76-year-old man with a history of severe bilateral knee osteoarthritis and grade 4 chondromalacia presented to our clinic with refractory, severe bilateral knee pain and received a bilateral genicular nerve RFA. He returned 4 days later with right medial thigh pain and a magnetic resonance imaging study revealing a hematoma along the anteromedial aspect of the right distal femoral diaphysis measuring 13.3 × 4.5 × 3.0 cm. After collaboration between pain medicine and orthopedic surgery services, decision was made to treat patient conservatively with rest, compression, elevation, ice application, tramadol, and gabapentin, but with close follow-up and a low threshold to intervene with diagnostic and therapeutic angiography with embolization if bleeding worsened; he reported resolution of his pain after a 4-day and 1-month follow-up.

Conclusion:
This is the first report describing iatrogenic vascular injury in the knee after a genicular RFA procedure. Pain medicine physicians should be aware of the vascular anatomy of the knee, particularly paying close attention to variations after previous surgeries. Future trials should investigate modalities that minimize vascular complications including concomitant use of ultrasonography with fluoroscopy and other forms of RFA including pulsed or cooled RFA.
Cytomegalovirus Viremia in HIV-1 Subtype C Positive Women at Delivery in Botswana and Adverse Birth/Infant Health Outcomes
Authors: Moraka Natasha O. , Moyo Sikhulile , Mayondi Gloria , Leidner Jean , Ibrahim Maryanne , Smith Christiana , Weinberg Adriana , Li Shaobing , Thami Prisca K. , Kammerer Betsy , Ajibola Gbolahan , Musonda Rosemary , Shapiro Roger , Gaseitsiwe Simani , Lockman Shahin 
Published: April 2019

Background:
We evaluated the association between maternal cytomegalovirus (CMV) viremia during pregnancy and adverse birth and infant health outcomes in HIV-infected mothers and their HIV-exposed uninfected infants.

Methods:
HIV-positive women and their infants were followed prospectively from pregnancy through 2 years postpartum in the “Tshipidi” study in Botswana. We analyzed the association between detectable CMV DNA in maternal blood at delivery and adverse birth outcomes (stillbirth, preterm delivery, small for gestational age, or birth defect), as well as infant hospitalization and mortality through 24 months.

Results:
We measured CMV DNA in blood samples from 350 (77.1%) of 454 HIV-positive women from the Tshipidi study. The median maternal CD4 count was 422 cells/mL, and median HIV-1 RNA at entry was 3.2 log10 copies/mL. Fifty-one (14.6%) women had detectable CMV DNA. In unadjusted analyses, detectable CMV DNA was associated with higher maternal HIV-1 RNA [odds ratio (OR) 1.4, 95% confidence interval (CI): 1.1 to 1.9], presence of a birth defect (OR 9.8, 95% CI: 1.6 to 60.3), and occurrence of any adverse birth outcome (OR 2.0, 95% CI: 1.04 to 3.95). In multivariable analysis, we observed a trend toward association between detectable maternal CMV DNA and occurrence of any adverse birth outcome (adjusted OR 1.9, 95% CI: 0.96 to 3.8). Maternal CMV viremia was not associated with infant hospitalization and/or death by 24 months.

Conclusions:
Approximately 1 in 6 HIV-positive women in Botswana had detectable CMV DNA in blood at delivery. The presence of maternal CMV viremia had a borderline association with adverse birth outcomes but not with 24-month morbidity or mortality in HIV-exposed uninfected children.
Understanding the Barriers to Reporting Sexual Harassment in Surgical Training
Authors: Freedman-Weiss Mollie R. , Chiu Alexander S. , Heller Danielle R. , Cutler Abigail S. , Longo Walter E. , Ahuja Nita , Yoo Peter S. 
Published: April 2019

Objective:
To investigate the occurrence, nature, and reporting of sexual harassment in surgical training and to understand why surgical trainees who experience harassment might not report it. This information will inform ways to overcome barriers to reporting sexual harassment.

Summary/ Background Data:
Sexual harassment in the workplace is a known phenomenon with reports of high frequency in the medical field. Aspects of surgical training leave trainees especially vulnerable to harassing behavior. The characteristics of sexual harassment and reasons for its underreporting have yet to be studied on the national level in this population.

Methods:
An electronic anonymous survey was distributed to general surgery trainees in participating program; all general surgery training programs nationally were invited to participate.

Results:
Sixteen general surgery training programs participated, yielding 270 completed surveys (response rate of 30%). Overall, 48.9% of all respondents and 70.8% of female respondents experienced at least 1 form of sexual harassment during their training. Of the respondents who experienced sexual harassment, 7.6% reported the incident. The most common cited reasons for nonreporting were believing that the action was harmless (62.1%) and believing reporting would be a waste of time (47.7%).

Conclusion:
Sexual harassment occurs in surgical training and is rarely reported. Many residents who are harassed question if the behavior they experienced was harassment or feel that reporting would be ineffectual—leading to frequent nonreporting. Surgical training programs should provide all-level education on sexual harassment and delineate the best mechanism for resident reporting of sexual harassment.