bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asanguineous Cardiopulmonary Bypass in Infants: Impact on Postoperative Mortality and Morbidity
Authors: Murin Peter , Boettcher Wolfgang , Ozaki Shinichi , Wloch Alexa , Cho Mi-Young , Redlin Mathias , Miera Oliver , Sinzobahamvya Nicodème , Photiadis Joachim 
Published: January 2019

Background We routinely start cardiopulmonary bypass (CPB) for pediatric congenital heart surgery without homologous blood, due to circuit miniaturization, and blood-saving measures. Blood transfusion is applied if hemoglobin concentration falls under 8 g/dL, or it is postponed to after coming off bypass or after operation. How this strategy impacts on postoperative mortality and morbidity, in infants weighing ≤ 7 kg?
Methods Six-hundred fifteen open-heart procedures performed from January 2014 to June 2018 were selected. One-hundred sixty-three patients (26.5%) were transfused on CPB (group 1), while 452 (73.5%) patients were not transfused on CPB (group 2). Operative risk and complexity were similar in both groups. Postoperative mortality and morbidity were compared. Multiple logistic regression was used to detect factors independently associated with outcome.
Results Observed mortality in nontransfused group (0.7% = 3/452) was significantly lower than expected (4.2% = 19/452): p = 0.0007, and much lower than in transfused group (6.7% = 11/163): p < 0.0001. CPB transfusion (p = 0.001) was independently associated with mortality, either acting as the sole factor or in combination with the Society of Thoracic Surgeons morbidity score (p = 0.013). Patients not transfused during CPB required less frequently vasoactive inotropic drugs (p = 0.011) and duration of their mechanical ventilation was shorter (93 ± 134 hours) than for transfused patients (142 ± 170 hours): p = 0.0003. CPB transfusion was an independent determinant factor for morbidity (p = 0.05), together with body weight (p < 0.0001), vasoactive inotropic score (p < 0.0001), CPB duration (p = 0.001), and postoperative transfusion (p = 0.009).
Conclusion The strategy of transfusion-free CPB course, feasible in most patients ≤ 7kg, was associated with improved outcome. Asanguineous priming of CPB circuit should become standard, even in neonates and infants.
Diabetics have Inferior Long-Term Survival and Quality of Life after CABG
Authors: Hokkanen Matti , Huhtala Heini , Järvinen Otso 
Published: January 2019

A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG.Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later.Thirty-day mortality was 2.7 versus 1.6 (p = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% (p = 0.287) and 63.5% versus 81.6% (p < 0.001), respectively. After 1 year, diabetics improved significantly (p < 0.005) in seven, and nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time.Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.
Kneeling after Total Knee Arthroplasty
Authors: Amin Raj M. , Vasan Vikram , Oni Julius K. 
Published: January 2019

AbstractThe ability to kneel is one of the many patient goals after total knee arthroplasty (TKA). Few studies have addressed patients' ability to kneel after TKA as a primary outcome. Given the altered biomechanics of the knee after TKA, the various implant designs, and multiple surgical approaches, there is a need to further understand the patient's kneeling ability after TKA. We evaluated the available literature on this topic to help to guide postoperative care recommendations. Biomechanical data show that the load borne by the patellofemoral joint is elevated significantly at all flexion angles, whereas tibiofemoral articulation pressures are elevated only at 90 to 120 degrees of flexion. However, these increased pressures are rarely borne by prosthetic knees because patients often avoid kneeling after TKA. In patients who do kneel after surgery, data show that increased range of motion promotes improved kneeling performance. Targeted interventions to encourage kneeling after TKA, including preoperative education, have not shown an ability to increase the frequency with which patients kneel after TKA. Reasons for patient avoidance of kneeling are multifaceted and complex. There is no biomechanical or clinical evidence contraindicating kneeling after TKA. There are insufficient data to recommend particular prosthetic designs or surgical approaches to maximize kneeling ability after surgery. Musculoskeletal health care providers should continue to promote kneeling to allow patients to achieve maximum clinical benefit after TKA.
Outcomes of Congenital Diaphragmatic Hernia in One of the Twins
Authors: Wang Weipeng , Pan Weihua , Chen Jie , Xie Wei , Liu Ming , Wang Jun 
Published: January 2019

Objective Congenital diaphragmatic hernia (CDH) occurred in one of the twins is rarely seen. This study aims to describe the clinical features and outcomes of this special CDH.
Study Design The medical records of all CDH neonates treated in our institution between 2010 and 2016 were retrospectively reviewed. Data were analyzed using parametric and nonparametric tests, appropriately. Association between the twin pregnancy and outcomes was assessed.
Results Eighty-nine patients met the inclusion criteria. In the multivariate analysis, liver herniation, observed/expected lung-to-head circumference ratio, and lower birth weight were independently related to the survival rate of CDH. Eleven patients were identified with CDH occurred in only one of the twins. Among them, seven patients (63.6%) were premature and six (54.5%) were found with low birth weight. Compared with CDH patients with singleton pregnancy, they had significantly higher rates of prematurity (p < 0.001) and lower birth weight (p < 0.001). Additionally, they had worse outcomes with a shorter duration of mechanical ventilation (p = 0.015) and lower survival rate at discharge (p = 0.024).
Conclusion Preterm birth and low birth weight are more common in CDH patients with twin pregnancy, which may lead to worse outcomes.
Combined Volar T-Plate and Dorsal Pi-Plate for Distal Radius Fractures: A Consecutive Series of 80 AO type C2 and C3 Cases
Authors: Sagerfors Marcus , Bjorling Patrik , Niklasson Johan , Pettersson Kurt 
Published: January 2019

Background The distal radius fracture (DRF) is the most common fracture among adults. In recent years, there has been a shift toward volar locking plates in the treatment of DRFs, and this shift has taken place with a low degree of evidence.
Question/purposes Can combined volar T-plating and dorsal pi-plating of AO type C fractures yield a good functional and radiographic outcome 1 year postoperatively?
Patients and Methods In a retrospective cohort study, we evaluated 102 consecutive patients operated with combined dorsal and volar plating, of whom 80 completed the 1-year follow-up. The DRFs were operated between 2012 and 2013. All cases were AO type C2 and C3 fractures. The primary outcome was functional scoring including radiographic examination. Secondary outcome measures included range of motion, visual analog scale (VAS) pain scores, and hand grip strength.
Results The median Batra radiographic score was 84.5. Wrist extension was 74% of the uninjured side, flexion was 70%, pronation was 94%, and supination was 90%. The Patient-Rated Wrist Evaluation score was 21 points, and the Disabilities of the Arm, Shoulder, and Hand score was 19.4 points. VAS pain scores were 0 at rest and 3 during activity. Hand grip strength was 80% of the uninjured side. Radiographic outcome did not correspond to a patient-reported outcome. Hardware removal was performed in 15/80 cases.
Conclusions We conclude that a good outcome can be expected after combined dorsal and volar plating of DRFs. Radiographic outcome is not necessarily associated with functional outcome 1 year postoperatively. The rate of hardware removal was acceptable.
Level of Evidence III
Possible Role of Heat Shock Protein 70 in Childhood Seizures
Authors: Kamel Magdy Mostafa , Mounir Samir Mohammed , Okaily Nagwa Ismail , Abdelzaher Mohammed Hosny , Hassan Mohammed Hosny 
Published: January 2019

Abstract
Background There has been a long interest in investigating the relationship between heat shock protein (HSP) expression and the evidence of neuronal damage in the most susceptible brain areas after seizures. So, the present study aimed to assess heat shock protein (HSP70) in children with seizures (febrile seizures and epilepsy), and to find out the cutoff point of this marker that may help in confirming epilepsy diagnosis. The present study has been conducted to evaluate serum levels of HSP70 in children with epileptic and febrile seizures and to compare these results to that of healthy children.
Materials and Methods A prospective study included 85 children (32 females and 53 males) in Children and Maternity Unit, Minia University Hospital, Minia, Egypt. Children were subdivided into three groups, group (I) included 30 children with epilepsy, group (II) included 30 children with febrile seizures, and group (III) included 25 healthy children that served as a control group. HSP70 assay was performed for all included children using the enzyme-linked immunosorbent assay technique.
Results The overall results revealed significant high serum HSP70 levels in epilepsy and febrile seizures groups when compared with control group (p < 0.001). Also, HSP70 serum levels were significantly higher in epilepsy group than in febrile seizures group (p < 0.001). Serum HSP70 level at a cutoff point > 170 ng/L showed 60% sensitivity and specificity equal to 83.3% in prediction of epilepsy.
Conclusion HSP70 level was significantly higher in epileptic and febrile seizures children than normal healthy children, and HSP70 may be beneficial in confirming the diagnosis of epilepsy.
Haemostatic Profiles are Similar across All Aetiologies of Cirrhosis
Authors: Bos Sarah , van den Boom Bente , Kamphuisen Pieter , Adelmeijer Jelle , Blokzijl Hans , Schreuder Tim , Lisman Ton 
Published: January 2019

Background and Aim Patients with cirrhosis may acquire profound changes in haemostasis. Although haemostatic changes in cirrhosis have been extensively studied, most studies were performed in groups of patients with mixed aetiology. As thrombotic events appear more common in some aetiologies of disease, notably non-alcoholic steatohepatitis (NASH) and cholestatic disease, we hypothesized that haemostatic changes might be different across aetiologies.
Patients and Methods We studied 109 patients with cirrhosis (31 cholestatic liver disease, 23 NASH, 37 alcoholic liver disease [ALD], 18 viral hepatitis) and 44 healthy controls. Patients with malignancy were excluded. Routine diagnostic tests of haemostasis, thrombin generation assays, fibrin permeability assays and a plasma-based fibrinolytic assay were performed.
Results All patients had comparable severity of disease according to their Model for End-Stage Liver Disease score (9 [7–11]). Plasma levels of von Willebrand factor were substantially elevated across all aetiologies, with a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 levels comparable to controls. Thrombin generation capacity was elevated in all aetiologies, most profoundly in ALD. Fibrin permeability was decreased in all aetiologies, which was accompanied by elevated fibrinogen levels. Clot lysis times were prolonged in NASH and cholestatic disease. Plasma levels of individual proteins were similarly altered in all aetiologies.
Conclusion Our in-depth haemostatic profiling of primary, secondary and tertiary haemostasis in a group of patients with Childs–Turcotte–Pugh A/B cirrhosis showed no large differences between aetiologies, and was consistent with a general hypercoagulable profile in patients with mild cirrhosis. These results suggest that patients with cirrhosis have an increased risk of thrombosis, irrespective of their aetiology.
Primary and Posttraumatic Knee Osteoarthritis in the Military
Authors: Garcia E'Stephan , Dickens Jon , Rodriguez Marina 
Published: January 2019

AbstractOsteoarthritis is a particularly burdensome and career-limiting condition for military service members. The daily demands of military service place the service members at a baseline increased risk of developing primary OA as well as increased risk of acute knee injuries that further predispose to developing posttraumatic OA. There are multiple treatment options available for primary and posttraumatic OA from osteotomy to arthroplasty.
Combination Therapy Involving Ear Cartilage Transfer and Suture-Button Suspension Arthroplasty for Symptomatic Thumb Carpometacarpal Joint Arthritis
Authors: Usami Satoshi , Inami Kohei 
Published: January 2019

AbstractWe describe the short-term outcomes of combination therapy involving ear cartilage transfer and suture-button suspension arthroplasty for the treatment of symptomatic thumb carpometacarpal joint arthritis. The concept is to reduce joint arthritis by separate independent approaches, which are renewing the damaged joint surface of the trapezium and first metacarpal bone suspension. Autologous ear cartilage is a desirable material for joint resurfacing arthroplasty without postoperative synovitis or infection, and it is expected to prevent bone impingement or recurrent joint arthritis when postoperative suture-button slack or failure unfortunately occurs.
Electromagnetic Navigation Bronchoscopy Triple Contrast Dye Marking for Lung Nodule Localization
Authors: Ng Calvin S.H. , Zhao Zerui , Long Hao , Lau Rainbow W.H. 
Published: January 2019

AbstractSmall pulmonary lesions can be difficult to localize during video-assisted thoracoscopic surgery. Electromagnetic navigation bronchoscopy (ENB) dye marking of the lesion, particularly when guided by cone beam computed tomography in the hybrid operating room (HOR), is an emerging approach. However, issues with confirmation of dye injection and intraoperative visualization of the colored dye can be unpredictable and challenging. To address these uncertainties, we present our technique of ENB dye marking localization of lung nodule using the triple-contrast dye method in the HOR.
Neurodevelopmental Outcomes in Neonates with Mild Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia
Authors: Rao Rakesh , Trivedi Shamik , Distler Amy , Liao Steve , Vesoulis Zachary , Smyser Christopher , Mathur Amit M. 
Published: January 2019

Objective To review developmental outcomes of neonates with mild hypoxic-ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH).
Study Design Neonates ≥35 weeks' gestation with mild HIE/TH (TH group, n = 30) were matched with healthy term-born infants (control group, n = 30) and reviewed for the presence and severity of magnetic resonance imaging (MRI)-detected neurological injury. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant Development (BSID).
Results MRI injury was present in 13/30 (43.3%) neonates (11 mild, 1 moderate, and 1 severe injuries) in the TH group. The mean (standard deviation [SD]) corrected age at BSID III was 29.3 (3.9) months in the controls compared with 14.7 (3.9) months in the TH group (p < 0.01). The mean (SD) cognitive, language, and motor composite scores in neonates in the TH group (n = 16, 53.3%) and control groups (n = 30, 100%) were 99.4 (17.1) versus 93.0 (12.3), (p = 0.15), 89.5 (15.5) versus 100.2 (18.4), (p = 0.054), and 93.1 (15.4) versus 100.8 (16.3) (p = 0.13), respectively.
Conclusion Developmental outcomes of neonates with mild HIE/TH were similar to healthy, term-born neonates.
The Effect of Distraction during Labor Induction on Timing of Analgesia Request: A Randomized Clinical Trial
Authors: Dixon C. Luke , Monsivais Luis , Chamseddine Petra , Olson Gayle , Pacheco Luis D. , Saade George R. , Costantine Maged M. 
Published: January 2019

Objective To assess whether distraction using music and/or video games influences timing of analgesia request and improves pain outcomes in women undergoing labor induction.
Study Design A total of 219 pregnant women with singleton gestation undergoing labor induction with a Foley bulb (FB) at term were randomized to distraction with music and video games via iPod (n = 109) or no iPod (n = 110). The primary outcome was the time from FB placement to request for pain medication. Secondary outcomes included number of patients requesting pain medication within 6 and 12 hours, type of pain medication received, pain visual analog scale scores, and patient satisfaction. Mann–Whitney's, chi-square, Kaplan–Meier's curves, and Pearson's product moment correlation were used for statistical analysis (significance: p < 0.05).
Results Baseline characteristics were similar between the two groups. There was no difference in the time from FB placement until pain medication request between the groups. There were no significant differences in secondary outcomes. Increased per cent time of iPod use correlated with a longer time until pain medication request (R
2 = 0.22, p = 0.03).
Conclusion We were not able to show that distraction using music and video games delays timing of analgesia request or improve pain outcomes in pregnant women undergoing mechanical labor induction at term.
Epidemiology of Blood Culture Utilization in a Cohort of Critically Ill Children
Authors: Tran Christine Anh-Thu , Zschaebitz Jenna Verena , Spaeder Michael Campbell 
Published: January 2019

AbstractBlood culture acquisition is integral in the assessment of patients with sepsis, though there exists a lack of clarity relating to clinical states that warrant acquisition. We investigated the clinical status of critically ill children in the timeframe proximate to acquisition of blood cultures. The associated rates of systemic inflammatory response syndrome (72%) and sepsis (57%) with blood culture acquisition were relatively low suggesting a potential overutilization of blood cultures. Efforts are needed to improve decision making at the time that acquisition of blood cultures is under consideration and promote percutaneous blood draws over indwelling lines.
Petrous Apex Meningioma with Extension into Meckel's Cave: Resection using a Retrosigmoid Intradural Suprameatal Approach
Authors: Munich Stephan A. , Morcos Jacques J. 
Published: January 2019

The retrosigmoid intradural suprameatal approach was first introduced in 1983 by Samii et al, as a modification of the classic retrosigmoid approach intended to open Meckel's cave, exposing the trigeminal nerve and access the middle fossa.1 The area of bone resected in this approach is similar to that removed in a Kawase's approach.2 Whereas the direction of drilling in a Kawase's approach is from anterior and superior, it is from posterior and inferior in the retrosigmoid intradural suprameatal approach. Seoane and Rhoton quantified the exposure of Meckel's cave, finding that this approach allowed access, on average, to the posterior 10.3 mm of Meckel's cave.3 This was confirmed by Chanda and Nanda who found that suprameatal drilling resulted in a mean gain of exposure of the trigeminal nerve of 10.7 mm.4 In this video, we present the case of a patient when an enlarging petrous apex meningioma with extension into Meckel's cave (Fig. 1). The patient underwent a retrosigmoid intradural suprameatal approach to achieve a Simpson's grade II resection. This approach was ideally suited for this case to obtain access to tumor located at the petrous apex and within Meckel's cave (Fig. 2). Without access to Meckel's cave provided in this approach a significant portion of tumor would have remained in situ.The link to the video can be found at: https://youtu.be/eNldkF4a_OI.
Microsurgical Reconstruction of the Plantar Foot: Long-Term Functional Outcomes and Quality of Life
Authors: Heidekrueger Paul , Ehrl Denis , Prantl Lukas , Thiha Aung , Weinschenk Fabian , Forte Antonio , Ninkovic Milomir , Broer P. 
Published: January 2019

Background When faced with plantar defects, reconstruction of the weight-bearing areas presents unique surgical challenges. Several free flap modalities have been described in this respect, but there remains debate regarding the best-suited flap modality. Aim of this study was to compare free muscle and non-neurotized fasciocutaneous flaps for plantar reconstruction with respect to long-term functional outcomes.
Methods Overall, 89 patients received 100 free flaps (anterolateral thigh [ALT] n = 46; gracilis n = 54) for plantar reconstruction. The data were screened for patients' demographics, as well as perioperative details. Postoperative complications were accounted for and the two groups compared accordingly. All patients were contacted for a long-term follow-up examination.
Results There were no significant differences between the two groups regarding major (24 vs. 17%; p = 0.366) and minor surgical complications (61 vs. 70%; p = 0.318). However, the ALT group showed a significantly higher need for secondary surgeries (39 vs. 19%; p = 0.022). Sixty-eight patients (76%) returned for long-term follow-up evaluation (mean: 51.2 months, range: 13–71 months). The ALT group showed significantly less pain at the recipient (p = 0.0004) and donor (p = 0.010) sites, and scar assessment revealed significantly better results (p < 0.001). Additionally, the ALT group showed better depth (p = 0.017) and superficial (p = 0.007) sensation and enabled better shoe provision (p = 0.014).
Conclusion Both the free ALT and gracilis flaps are well suited for plantar reconstruction, yielding overall similar functional outcomes. However, the ALT flap produces less scarring and pain, while showing better recovery of sensation and enabling better shoe provision. The ALT flap thus presents our preferred option.
Online-Schlafberatung für Schichtarbeitende
Authors: Peter Lukas , Reindl Richard , Zauter Sigrid , Richter Kneginja 
Published: January 2019

Zusammenfassung
Jeder sechste deutsche Beschäftigte ist in Schichtarbeit tätig. Angebote für die spezifische Problematik von Schichtarbeitenden sind dennoch selten. Eine kompakte Online-Schlafberatung wurde daher entwickelt, durchgeführt und evaluiert. Es zeigen sich signifikante Verbesserungen bezüglich Insomniesymptomen und Wohlbefinden.