bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic characterization of small colonic polyps: baseline performance of experienced endoscopists is no different to that of medical students
Authors: Basford Peter , Brown James , Cooper Sarah , Bhandari Pradeep 
Published: March 2019

Abstract
Background Studies examining the impact of training modules on characterization of diminutive colonic polyps (DCP) show varying results.
Aim We aimed to assess the impact of a novel web-based training module on the accuracy of in vivo characterization of DCPs using different imaging modalities. Differences between groups with varying degrees of endoscopic experience were also assessed.
Methods In total, 90 images of 30 DCPs viewed with high definition white light (HDWL), i-Scan, and indigo carmine chromoendoscopy were included in an online test module. Testing was undertaken before and after completing a novel web-based in vivo characterization training module. In total, 21 subjects (medical students (MS), gastroenterology trainees (GT), and gastroenterology consultants (GC)) undertook the tests and training module.
Results No statistically significant difference in overall accuracy was found between the three groups either pre- (MS 59.1 %, GR 65.7 %, GC 62.4 %, P = ns for all three comparisons) or post-training (MS 69.2 %, GR 71.1 %, GC 71.3 %, P = ns for all three comparisons). Accuracy improved significantly for all three groups post-training (P < 0.001) as did interobserver agreement. No significant differences in accuracy between modalities were found pre-training (HDWL 64.8 %, i-Scan 60.0 %, chromoendoscopy 62.2 %, P = ns). Post-training accuracy with HDWL and chromoendoscopy was better than with i-Scan (HDWL 72.9 % vs i-Scan 65.1 %, P = 0.002; i-Scan 65.1 % vs chromoendoscopy 73.7 %, P < 0.001). The proportion of high confidence predictions increased from 25.7 % to 41.5 %, with a high confidence prediction accuracy of 81.7 %.
Conclusions Skills for in vivo characterization of DCPs are not acquired through endoscopic experience alone. A novel web-based training intervention results in modest improvements in accuracy with further improvements likely to require more prolonged training.
Visuelle Lebensqualität bei starker Sehbehinderung – Messung und Messinstrumente
Authors: Terheyden Jan , Finger Robert 
Published: March 2019

ZusammenfassungPatientenberichtete Endpunkte wie die Lebensqualität werden zunehmend häufiger in klinischen Studien eingesetzt, um patientenrelevante Aspekte einer Intervention oder eine Funktionsbeeinträchtigung zu messen. Bei Sehverlust erfasst z. B. die visuelle Lebensqualität die individuelle Beeinträchtigung im Alltag. Wichtig bei der Verwendung von Messinstrumenten zu patientenberichteten Endpunkten wie der Lebensqualität sind psychometrische Parameter wie die Reliabilität, Validität und Änderungssensitivität, um sicher sein zu können, dass die mit den jeweiligen Instrumenten erhobenen Daten robust sind. Zur visuellen Lebensqualität existieren zahlreiche allgemeine wie auch erkrankungsspezifische bzw. funktionsspezifische Fragebögen; nicht alle sind jedoch für Patienten mit schwerer Sehbeeinträchtigung geeignet. Zu empfehlen ist derzeit etwa der IVI- oder der NEI-VFQ-Fragebogen, die in einer validierten deutschen Übersetzung vorliegen. Zur breiteren Evaluation dieser Messinstrumente und ggf. der Neuentwicklung von besseren Instrumenten sind jedoch weitere Studien nötig, damit z. B. auch das wachsende Interesse am Einsatz von Patientenfragebögen als Endpunkte in der klinischen Forschung gedeckt werden kann.
Das phänotypische Spektrum der Augenveränderungen bei CEP290-Sequenzvariationen
Authors: Preising Markus , Schneider Ute , Friedburg Christoph , Gruber Hildegard , Lindner Susanne , Lorenz Birgit 
Published: March 2019

Zusammenfassung
Einleitung Eine häufige Ursache erblicher Netzhautdegenerationen sind Mutationen in Genen, die für den Aufbau des verbindenden Ziliums der Photorezeptoren und den interflagellaren Transport codieren. Diese Erkrankungen werden als Ziliopathien zusammengefasst. Eines der häufigsten Ziliopathiegene ist das CEP290, in dem die tief-intronische Splice-Mutation c.2991+1655A>G dominiert. Eine Übersicht über das ophthalmologische Spektrum verschiedener Mutationen des CEP290-Gens wird in dieser Studie dargestellt.
Methoden Patienten mit ursächlichen Mutationen im CEP290-Gen wurden in einer umfassenden ophthalmologischen Diagnostik dokumentiert. Zusätzlich zur Sehschärfe und Refraktion wurde die Sehfunktion elektrophysiologisch erfasst. Bei ausreichender Kooperation erfolgte eine Dokumentation mit psychophysischen Methoden, des Augenhintergrundes und der Netzhautschichtung.
Ergebnisse 30 Patienten im Alter zwischen 1 Monat und 84 Jahren (Median der ersten Vorstellung 0,6 Jahre) wurden in einem Zeitraum zwischen 5 Monaten und 25,7 Jahren (Median 4,8 Jahre) erfasst. Bei 23 Patienten lag c.2991+1655A>G vor (30/60 Allele, 7 homozygot). Die zweithäufigste Mutation war p.K1575* (9/60 Allele). Im Ganzfeld-Elektroretinogramm fanden sich bei wenigen Patienten initial noch Restpotenziale. Im weiteren Verlauf waren bei allen Patienten keine Potenziale mehr nachweisbar. Die Sehschärfe war seit Geburt stark reduziert. Bei 8 Patienten lag ein quantifizierbarer Visus (logMAR 2 – 0,3) vor. Eine fehlende Fixation wurde bei 15 Patienten während der ersten Lebensmonate berichtet. Für 10 dieser Patienten fand keine Verbesserung statt. Die übrigen Patienten entwickelten Lichtscheinwahrnehmung (LSP) oder Erkennen von Handbewegungen. Eine bessere Sehschärfe war nicht auf Patienten mit c.2991+1655A>G-Mutation beschränkt. Der Augenhintergrund zeigte degenerative Veränderungen in der gesamten Fläche mit paramakulär ringförmig erhöhter Fundusautofluoreszenz (FAF) und punktförmig erhöhter FAF in der Peripherie (9/30 Patienten). Die Netzhautschichtung (6/30 Patienten) war im Bereich der Photorezeptoren (OPL bis OS) stark verdünnt bei erhaltener Dicke der inneren retinalen Schichten (RNFL bis INL). Die Schichtung der zentralen Netzhaut oder der Genotyp ließen keine Rückschlüsse auf die Sehschärfe zu.
Schlussfolgerungen
CEP290-Mutationen gehören zu den häufigsten Ursachen erblicher Netzhautdegenerationen. Von den 30 Patienten in dieser Studie hatten nur 33% keine Lichtwahrnehmung. Von den übrigen 67%, die zumindest LSP entwickelten, erreichten 26% einen quantifizierbaren Visus zwischen logMAR 2 und 0,3. Zusammen mit einem guten Erhalt der Ganglienzellschicht und der Nervenfaserschicht erscheint eine erfolgreiche Anwendung therapeutischer Verfahren möglich.
Entwicklung von cGMP-Analoga zur pharmakologischen Behandlung von neurodegenerativen Netzhauterkrankungen
Authors: Fischer Dominik , Paquet-Durand François 
Published: March 2019

ZusammenfassungErbliche Netzhautdegenerationen sind Erkrankungen der Photorezeptoren und/oder des Pigmentepithels, die zu einem weitgehenden Sehverlust bis hin zur vollständigen Erblindung führen. Bis heute sind diese seltenen Erkrankungen der Netzhaut zumeist nicht behandelbar und stellen eine erhebliche Belastung für die Betroffenen und ihre Angehörigen dar. Dieser Übersichtsartikel zeigt einige der Herausforderungen auf, die bei der Entwicklung von neuen Therapien für erbliche Netzhautdegenerationen auftreten, insbesondere wird auf das Problem der enormen genetischen Heterogenität dieser Erkrankungen eingegangen und die Frage, wie neue Behandlungsformen über die Blut-Netzhaut-Schranke zu den Nervenzellen der Netzhaut gebracht werden können. In diesem Rahmen wird die zentrale Rolle des Botenstoffs zyklisches Guanosinmonophosphat (cGMP) im Photorezeptor erklärt und wie dessen Funktion genutzt werden kann, um mutationsunabhängige Therapien zu entwickeln. Dies wird am Beispiel des DRUGSFORD-Projektes weiter ausgeführt, wobei auch darauf eingegangen wird, wie neue Medikamente formuliert werden können, um die Blut-Netzhaut-Schranke zu überwinden. Darüber hinaus werden weitere Schwierigkeiten diskutiert, die entstehen, wenn positive Ergebnisse aus der anwendungsbezogenen Forschung in die klinische Entwicklung überführt werden sollen. Hier wird zum einen auf Lücken und mangelnde Interdisziplinarität in der Ausbildung von Naturwissenschaftlern und Medizinern hingewiesen, zum anderen behindert aber auch das Fehlen von Verlaufsdaten und geeigneten Biomarkern die klinische Entwicklung.
Vom Röntgen zum PET/MRT, und dann? – Zukunftsweisende Bildgebung in der Kinderradiologie
Authors: Staatz Gundula , Daldrup-Link Heike , Herrmann Jochen , Hirsch Franz , Schäfer Jürgen , Seehofnerova Anna , Sorantin Erich , Theruvath Ashok , Lollert André 
Published: March 2019

Die Kinderradiologie steht heute vor weitreichenden Veränderungen. Basismodalitäten wie Röntgen und Ultraschall werden zunehmend durch neuere, moderne Techniken ergänzt. Dieser Übersichtsartikel stellt Fortschritte in der Kinderradiologie sowie technische Innovationen vor, welche in Zukunft noch größere Bedeutung erlangen könnten. Hierzu werden CT-Dosisreduktionstechniken inklusive der Anwendung künstlicher Intelligenz sowie Fortschritte in den Gebieten der Magnetresonanztomografie und molekularen Bildgebung dargestellt.
Kernaussagen
Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis
Authors: Vestito Amanda , Marasco Giovanni , Maconi Giovanni , Festi Davide , Bazzoli Franco , Zagari Rocco Maurizio 
Published: March 2019

Abstract
Purpose To perform a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn’s disease.
Materials and Methods MEDLINE via the PubMed, Ovid Embase, Scopus and Cochrane Library databases, and abstracts of international conference proceedings were searched up to March 31, 2018. Studies were included if they assessed the performance of abdominal ultrasound elastography in detecting fibrotic bowel strictures in patients with Crohn’s disease using histology or the need for surgery after medical treatment as a reference standard. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies.
Results 6 studies including a total of 217 patients with Crohn’s disease and 231 bowel segments, of which 76 were bowel segments with fibrotic stricture, were selected. Three studies used strain ratio and three studies used strain value as parameters of bowel stiffness. Both the pooled standardized mean strain ratio and the pooled standardized mean strain value were higher in bowel segments with fibrotic strictures than in those without fibrotic strictures with a standardized mean difference of 0.85 (95 % confidence level [CI]: 0 to 1.71; p = 0.05) and 1.0 (95 % CI: –0.11 to 2.10; p = 0.08), respectively. There was a high heterogeneity between studies. All studies were at “high risk” or “unclear risk” of bias.
Conclusion Ultrasound elastography could be able to detect fibrotic bowel strictures in patients with Crohn’s disease. Well-designed high quality diagnostic studies with a large sample size are needed.
The Impact of Interdisciplinary Education on Skills and Attitudes of Surgery and Emergency Medicine Residents
Authors: Kunac Anastasia , King Neil , Ostrovsky Ilya , Rytzarev David , Merchant Aziz , Murano Tiffany 
Published: March 2019

Background Interdisciplinary education (IDE) has been proposed as a means to improve patient safety by enhancing the performance of diverse health care teams. The improved camaraderie between members of different specialties may enhance communication and can foster a more supportive and positive work environment.
Objective This study was aimed to assess the effect of IDE on the procedural skills of general surgery (GS) and emergency medicine (EM), as well as the perceptions that GS and EM residents have of one another.
Methods EM and GS residents participated in two separate IDE sessions (4 months apart) designed to teach extended focused assessment with sonography in trauma (e-FAST), tube thoracostomy, and complex wound closure. Surveys were administered to determine the effects that IDE had on confidence in performing bedside procedures, perceptions of IDE, and perceptions of one another's specialty. Survey responses were recorded using a 5-point Likert's scale.
Results Nine GS residents and 10 EM residents participated in the entire study. Significant improvements in the confidence levels of performing bedside procedures were noted among both groups of residents. We also report a significant improvement in the perceived respect and communication between EM and GS residents.
Conclusions Although further studies with a larger sample size are required, we have shown that IDE can improve the confidence levels of EM and GS residents in performing tube thoracostomy, e-FAST, and complex wound closure. These IDE sessions also improve the perceptions that the residents have of one another. IDE is a useful tool and may translate into improved consultation, collaboration, and patient care.
Duration of Operative Vaginal Delivery and Adverse Obstetric Outcomes
Authors: Miller Emily S. , Lai Yinglei , Bailit Jennifer , Reddy Uma M. , Wapner Ronald J. , Varner Michael W. , Thorp John M. , Leveno Kenneth J. , Caritis Steve N. , Prasad Mona , Tita Alan T. N. , Saade George R. , Sorokin Yoram , Rouse Dwight J. , Blackwell Sean C. , Tolosa Jorge E. ,   for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network*
Published: March 2019

Abstract
Objective This study aimed to evaluate whether the number of vacuum pop-offs, the number of forceps pulls, or the duration of operative vaginal delivery (OVD) is associated with adverse maternal and perinatal outcomes.
Study Design This is a secondary analysis of a multicenter observational cohort of women who underwent an attempted OVD. Women were stratified by the duration of OVD and the number of pop-offs (vacuum) or pulls (forceps) attempted. Severe perineal lacerations, failed OVD, and a composite adverse neonatal outcome were compared by the duration of OVD and number of pop-offs or pulls.
Results Of the 115,502 women in the primary cohort, 5,325 (4.6%) underwent an attempt at OVD: 3,594 (67.5%) with vacuum and 1,731 (32.5%) with forceps. After adjusting for potential confounders, an increasing number of pop-offs was associated with an increased odds of the composite adverse neonatal outcome. However, an increasing duration of vacuum exhibited a stronger association with the composite adverse neonatal outcome. Similarly, the number of forceps pulls was less strongly associated with the composite adverse neonatal outcome compared with the duration of forceps application.
Conclusion The duration of OVD may be more associated with adverse neonatal outcomes than the number of pop-offs or pulls.
Prevalence and Risk Factors for New-Onset Hypertension in Labor
Authors: Ankumah Nana-Ama E. , Alrais Mesk A. , Amro Farah H. , Wiley Rachel L. , Sibai Baha M. 
Published: March 2019

Abstract
Objective Little is known about prevalence, risk factors, rate of treatment, or adverse outcomes associated with intrapartum hypertension. Thus, our objective was to describe these findings.
Study Design This was a retrospective study of laboring term gestations with no history of hypertensive disorders. Intrapartum blood pressures were reviewed, and women were subdivided based on blood pressures: normal (<140 mm Hg systolic and <90 mm Hg diastolic), mild hypertension (140–159 or 90–109), and severe hypertension (≥ 160 or ≥ 110). Groups were compared using chi-square test and analysis of variance.
Results A total of 724 women were studied during 4 months: 248 (34%) had mild and 69 (10%) had severe hypertension. Severe hypertensives were more likely to be nulliparous, obese, or have received an epidural or oxytocin. There were no cases of eclampsia, stroke, or pulmonary edema in severe hypertensives (95% confidence interval, 0–5). Despite severely elevated pressures, only 4/69 (6%) patients received intravenous antihypertensive therapy, and 3 (4%) required medications at discharge.
Conclusion One in 3 women exhibits mild hypertension and 1 in 10 develop severe hypertension in labor. Only 6% of patients received treatment for severe blood pressures. This study highlights lack of treatment of hypertension in labor and further investigation into causes and outcomes of intrapartum elevations of blood pressures.
Osificación heterotópica de cadera asociada a pancreatitis aguda severa – reporte de un caso
Authors: Palma C José , Parra A Samuel , Saavedra B Yocelin , Martín L Cristian San , Muñoz C Francisco , Padilla M Fabián 
Published: March 2019

La osificación heterotópica (OH), es la formación anormal de hueso maduro dentro de tejidos blandos extra esqueléticos donde normalmente no existe tejido óseo. Varias formas de OH han sido descritas de acuerdo a su presentación clínica, localización y ocurrencia progresiva o aislada. Su presentación en pacientes sometidos a inmovilización prolongada en el contexto de coma farmacológicamente inducido, en ausencia de lesiones del sistema nervioso central, es poco habitual. Presentamos el caso de una paciente de 40 años, sexo femenino, sin antecedentes mórbidos, que presenta episodio de pancreatitis aguda grave, manejada en UCI. Producto de lo anterior, requiere coma farmacológicamente inducido por 3 meses y hospitalizaciones reiteradas y prolongadas durante los 10 meses siguientes. Durante 3 años desde la resolución de su cuadro inicial evoluciona con alteración progresiva de la marcha y rigidez de la extremidad inferior derecha, sin eventos traumáticos durante ese período. Se objetiva mediante radiografía y TAC foco de OH coxofemoral derecha. Se resuelve de forma quirúrgica y biopsia de pieza operatoria confirma el diagnóstico. La paciente logra buena recuperación posterior.
Nivel de evidencia IV
Perinatal Outcomes Associated with Early Diabetes Testing in Pregnancies Complicated by Obesity
Authors: Mission John F. , Catov Janet , Comer Diane , Abebe Kaleab Z. , Deihl Tiffany E. , Feghali Maisa , Scifres Christina M. 
Published: March 2019

Abstract
Objective This study aimed to determine whether early diabetes testing is associated with differences in perinatal outcomes among pregnant women with obesity (body mass index ≥30 kg/m2).
Study Design We conducted a retrospective cohort study of singleton pregnancies from 2012 to 2014 at a large academic medical center which examined the association of diabetes testing (HBA1c, 50 g glucose challenge test, or 100 g oral glucose tolerance test) before 24 weeks with perinatal outcomes using propensity score modeling and logistic regression.
Results Among women with obesity, 790 out of 2,698 (29.3%) underwent early diabetes testing. Propensity score modeling demonstrated that early testing was associated with higher rates of diabetes diagnosis (odds ratio [OR]: 1.62, 95% confidence interval [CI]: 1.10–2.37, p = 0.01) and a trend toward small for gestational age birth weight (OR: 1.38, 95% CI: 1.00–1.90, p = 0.05) and neonatal composite morbidity (OR: 1.25, 95% CI: 1.00–1.57, p = 0.05) compared with routine testing. Women with inadequate weight gain were more likely a small for gestational age (SGA) infant if they underwent early testing compared with those with routine testing alone (19.8 vs. 11.6%, p = 0.01).
Conclusion Early testing targets higher risk women and yields a higher diabetes diagnosis rate, but inadequate weight gain in these women may increase risk SGA birth weight and neonatal morbidity. Randomized clinical trials are urgently needed to assess whether early diabetes testing improves outcomes in women with obesity.
Utilizing Video versus Direct Laryngoscopy to Intubate Simulated Newborns while Contained within the Incubator: A Randomized Crossover Study
Authors: Ozawa Yuri , Takahashi Shigehiro , Miyahara Humiko , Hosoi Kenichiro , Miura Mazumi , Morisaki Naho , Ito Yushi , Isayama Tetsuya 
Published: March 2019

Abstract
Objective The use of video laryngoscopy for intubating neonates in ergonomically challenging settings has not been studied well. We aimed to assess the usefulness of video laryngoscopy for experienced neonatologists to intubate neonatal manikins in incubators via side hand ports or head window.
Study Design In this randomized crossover trial at three neonatal intensive care units in Japan, 27 neonatologists were randomized into two groups, namely, those intubating neonatal simulators using video laryngoscopy and then using direct laryngoscopy, or vice versa. The intubations were performed via hand ports or head window without opening top and side walls in incubators in two manikin positions (rotated 90° or unrotated). Glottis visualization (0–100%), success rate, intubation time, and ease of laryngoscopy (from 1 [very difficult] to 10 [very easy]) were compared between video laryngoscopy and direct laryngoscopy. Generalized linear models were used for the analyses.
Results This study assessed 108 intubations performed by 27 neonatologists. The use of video laryngoscopy improved the glottis visualization by 14% (95% confidence interval, 7.4–20%; p < 0.01) and easiness scores of laryngoscopy by 0.8 (0.2–1.4; p < 0.01), but did not reduce the intubation time.
Conclusion Video laryngoscopy is useful for experienced neonatologists for intubating neonatal manikins in incubators without opening the top or side walls.
Correlation between Invasive and Noninvasive Blood Pressure Measurements in Extremely Low Gestational Age Newborns
Authors: Umapathi Krishna Kishore , Mhanna Maroun J. 
Published: March 2019

Abstract
Objective This work aimed to study the correlation between invasive blood pressure (IBP) and non-IBP (NIBP) in extremely low gestational age newborns (ELGANs) during their first 72 hours of life.
Study Design In a retrospective cohort study, IBP and simultaneous NIBP measurements during the first 72 hours of life were recorded in ELGANs. Medical records were reviewed for potential risk factors that affect BP. The % difference in mean arterial BP (% Diff-BP) measurements was calculated as (IBP–NIBP)/IBP. Hypotension was defined as mean arterial Bp < gestational age (GA).
Results In total, 236 infants and 1,340 paired IBP–NIBP measurements were studied. Infants had a (mean ± standard deviation) GA of 25.4 ± 21.6 weeks and a birth weight of 810 ± 249 g. Overall, there was a significant correlation between IBP and NIBP of 0.887 (Spearman Rho; p < 0.001). However, the agreement between IBP and NIBP was poor, with a mean difference (95% limits of agreement) of 0.20 (–5.48; 5.89). The mean % Diff-BP (±standard deviation) was 0.39 ± 8.25%. In hypotensive infants, NIBP overestimated IBP measurements, with an agreement of –0.67 (–4.17; 2.83).
Conclusion Mean arterial NIBP correlates with IBP in ELGANs. However, there is a poor agreement between methods. In hypotensive infants, NIBP overestimates IBP measurements.
Identity construction and negotiation in Chinese political discourse
Authors: Liu Lihua 
Published: March 2019

Abstract
Based on identity theory and previous studies of crisis discourse, this paper systematically analyzes the process of identity construction and negotiation between political discourse and social discourse representing the event of a fire at Xinjian Village, Daxing District in the southern suburb of Beijing. It is found that in the first phase, the political discourse focuses on the meta-discourse of “for Renmin’s sake, we carry out a campaign of thorough inspection, cleaning-up and rectification to eliminate safety hazards.” In the second phase of the event the Renmin category is then represented concretely as “residents”, “migrant workers”, “people who need help” and so on. These discursive practices have constructed a relatively acknowledged identification with the social groups concerned, and thus positively affect the governance and management of this crisis event.