bluuebunny/crossref_metadata_2025_split huggingface dataset:
Current Trends in Aortic Root Surgery
Authors: Abjigitova Djamila , Panagopoulos Georgia , Orlov Oleg , Shah Vishal , Plestis Konstadinos A. 
Published: April 2018

Objective The mini-sternotomy approach is becoming a widespread technique for aortic valve surgery. However, its safety for aortic root replacement has yet to be established. The aim of the present study was to compare the operative outcomes of patients who underwent aortic root replacement via upper mini-sternotomy (mini-Bentall) to patients who underwent Bentall procedure via median sternotomy (full-sternotomy Bentall). Methods Between November 1998 and November 2016, 91 consecutive patients underwent full-sternotomy Bentall procedure and 26 patients underwent mini-Bentall procedure. The mini-Bentall procedure was performed via an upper hemisternotomy incision extending to the right fourth intercostal space. Patients with concomitant procedures and those who underwent deep hypothermic circulatory arrest were excluded from the analysis. Outcome variables were operative mortality and major surgical complications, including prolonged length of hospital stay, transfusion rates, reoperation for bleeding, and prolonged ventilatory support. Results No significant differences were observed on the preoperative, operative, and postoperative characteristics between the two treatment groups. The median cardiopulmonary bypass and aortic cross-clamp times were 169 minutes (interquartile range = 156.0–188.5) and 148 minutes (interquartile range = 131.3–160.3) in the mini-Bentall group, respectively. The median duration of hospitalization in the mini-Bentall group was 6.5 days (interquartile range = 5.0–11.0 days). In-hospital mortality and new renal insufficiency occurred at a frequency of 1.1% and reoperation for bleeding at 6.6% in the group of patients who underwent the conventional Bentall procedure compared with 0% for all these measures in the mini-Bentall group ( P > 0.33). There was no significant difference in intraoperative red blood cell transfusion and other major postoperative complications. No strokes were observed in either group, and there were no conversions to median sternotomy in the mini-Bentall group. Conclusions An upper hemisternotomy is a feasible technique in patients undergoing elective aortic root replacement surgery. However, future prospective studies are required before these procedures become the standard of care.
Slowly Evolving Brain Abscess Caused by Nocardia beijingensis in a Kidney Transplant Patient
Authors: Nasser Roni , Korytny Alexander , Geffen Yuval , Andraous Maisa , Paul Mical , Braun Eyal 
Published: April 2018

Abstract
A 71-year-old actively working farmer was admitted because of progressive weakness of the left hand and leg starting 5 weeks before admission. He has been suffering from headaches in the last 4 years. He has undergone kidney transplantation 14 years before admission. Brain magnetic resonance imaging (MRI) revealed a right frontoparietal hypodense lesion measuring 22 × 34 × 17 mm, causing edema, suspected to represent an abscess. Reviewing 2 brain MRI scans performed 4 years 10 months before admission showed a gradually worsening pathological process in the same region. Open surgery revealed an abscess, and drainage was performed. Gram stain and culture from the pus were negative, but panbacterial polymerase chain reaction was positive for Nocardia beijingensis. The patient was treated with ceftriaxone and linezolid for 3 months followed by trimethoprim-sulfamethoxazole. Repeated MRI 2 weeks after drainage showed reduction in abscess size. Brain computed tomography 3 months later showed further improvement. The patient has never recovered and died 8 months later.
Bladder Versus Enteric Drainage of Exocrine Secretions in Pancreas Transplantation
Authors: Siskind Eric J. , Amodu Leo I. , Pinto Sonia , Akerman Meredith , Jonsson Johann , Molmenti Ernesto P. , Ortiz Jorge 
Published: April 2018

Objectives
The method for drainage of exocrine secretions in pancreas transplantation remains a matter of debate. Different methods have evolved over time. Most data on these methods are from single-center studies with small sample sizes. Larger studies have yielded conflicting results.

Methods
Data from the United Network for Organ Sharing database on all adult subjects who received pancreas and kidney-pancreas transplants between 1996 and 2012 were analyzed (n = 19,934). Subjects were divided into 3 groups: enteric drainage with Roux-en-Y (n = 4308), enteric drainage without Roux-en-Y (n = 11,145), and bladder drainage (n = 4481). Primary end points were patient and graft survival at 1, 3, 5, 10, and 15 years.

Results
There was a patient and graft survival advantage with enteric drainage without Roux-en-Y reconstruction compared with the other methods. This was consistent at 1, 3, 5, 10, and 15 years.

Conclusions
Our study demonstrated increased graft and patient survival when comparing enteric drainage of the transplanted pancreas without Roux-en-Y reconstruction to enteric drainage with Roux-en-Y and bladder drainage at 1, 3, 5, 10, and 15 years. Based on this study, we recommend enteric drainage without Roux-en-Y reconstruction as the method of choice in pancreas transplantation.
Pancreatic Neuroendocrine Tumors and Intraductal Papillary Mucinous Neoplasm of the Pancreas
Authors: Manuel-Vazquez Alba , Ramia José Manuel , Latorre-Fragua Raquel , Valle-Rubio Ainhoa , Arteaga-Peralta Vladimir , Ramiro-Pérez Carmen , de la Plaza-Llamas Roberto 
Published: April 2018

Objectives
This study aimed to identify factors that explain the association of intraductal papillary mucinous neoplasms-pancreatic neuroendocrine tumors (IPMNs-PNETs), radiological characteristics, and factors that might guide therapy.

Methods
We performed a systematic review of the literature to search for articles on concurrent IPMN-PNET, mixed endocrine-exocrine pancreatic tumors, and/or PNET with an intraductal growth pattern.

Results
A review of the literature suggests that there is some confusion about association of IPMNs-PNETs. Regarding this association, the studies collected data from 32 patients. Eleven patients presented concurrent tumors, 9 mixed endocrine-exocrine tumors, and no data were available in the remaining 7. In addition, the relationship IPMN-PNET focuses not only on the coexistence of the 2 lesions, but also on the possibility of the intraductal growth of the endocrine lesion. In the literature, in 4 cases, the preoperative radiological diagnosis had been IPMN.

Conclusions
Intraductal papillary mucinous neoplasms and PNETs may be associated in a number of scenarios. The association may be due to the concurrent existence of independent lesions, may be a mixed endocrine-exocrine tumor, or may be due to intraductal growth of the endocrine lesion. But the literature is confusing. It is not known whether the association is accidental or whether there is an etiological reason. Further studies are needed to investigate this scenario.
SLCO1B1 Polymorphisms are Associated With Drug Intolerance in Childhood Leukemia Maintenance Therapy
Authors: Eldem İrem , Yavuz Duygu , Cumaoğullari Özge , İleri Talia , Ünal İnce Elif , Ertem Mehmet , Doğanay Erdoğan Beyza , Bindak Recep , Özdağ Hilal , Şatiroğlu-Tufan N. Lale , Uysal L. Zümrüt 
Published: April 2018

Background:
Therapy discontinuations and toxicities occur because of significant interindividual variations in 6-mercaptopurine (6-MP) and methotrexate (MTX) response during maintenance therapy of childhood acute lymphoblastic leukemia (ALL). 6-MP/MTX intolerance in some of the patients cannot be explained by thiopurine S-methyl transferase (TPMT) gene variants. In this study, we aimed to investigate candidate pharmacogenetic determinants of 6-MP and MTX intolerance in Turkish ALL children.

Methods:
In total, 48 children with ALL who had completed or were receiving maintenance therapy according to Children’s Oncology Group (COG) protocols were enrolled. Fifteen single-nucleotide polymorphisms in 8 candidate genes that were related to drug toxicity or had a role in the 6-MP/MTX metabolism (TPMT, ITPA, MTHFR, IMPDH2, PACSIN2, SLCO1B1, ABCC4, and PYGL) were genotyped by competitive allele-specific PCR (KASP). Drug doses during maintenance therapy were modified according to the protocol.

Results:
The median drug dose intensity was 50% (28% to 92%) for 6-MP and 58% (27% to 99%) for MTX in the first year of maintenance therapy, which were lower than that scheduled in all patients. Among the analyzed polymorphisms, variant alleles in SLCO1B1 rs4149056 and rs11045879 were found to be associated with lower 6-MP/MTX tolerance.

Conclusions:

SLCO1B1 rs4149056 and rs11045879 polymorphisms may be important genetic markers to individualize 6-MP/MTX doses.
Rasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer
Authors: Wu Tzu-Yi , Chen Cheng-Te , Huang Yi-Jing , Hou Wen-Hsuan , Wang Jung-Der , Hsieh Ching-Lin 
Published: April 2018

BackgroundShared decision making (SDM) is a best practice to help patients make optimal decisions by a process of healthcare, especially for women diagnosed with breast cancer and having heavy burden in long-term treatments. To promote successful SDM, it is crucial to assess the level of perceived involvement in SDM in women with breast cancer.ObjectiveThe aims of this study were to apply Rasch analysis to examine the construct validity and person reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in women with breast cancer.MethodsThe construct validity of SDM-Q-9 was confirmed when the items fit the Rasch model's assumptions of unidimensionality: (1) infit and outfit mean square ranged from 0.6 to 1.4; (2) the unexplained variance of the first dimension of the principal component analysis was less than 20%. Person reliability was calculated.ResultsA total of 212 participants were recruited in this study. Item 1 did not fit the model's assumptions and was deleted. The unidimensionality of the remaining 8 items (SDM-Q-8) was supported with good item fit (infit and outfit mean square ranging from 0.6 to 1.3) and very low unexplained variance of the first dimension (5.3%) of the principal component analysis. The person reliability of the SDM-Q-8 was 0.90.ConclusionsThe SDM-Q-8 was unidimensional and had good person reliability in women with breast cancer.Implications for PracticeThe SDM-Q-8 has shown its potential for assessing the level of perceived involvement in SDM in women with breast cancer for both research and clinical purposes.
Integrating Team Training in the Pediatric Life Support Program
Authors: Fagan Mary J. , Connelly Cynthia D. , Williams Brian S. , Fisher Erin Stucky 
Published: April 2018

OBJECTIVE
The aim of this study was to examine the feasibility of integrating teamwork training into an established Pediatric Advanced Life Support (PALS) program to assess the effect on teamwork and collaboration among interprofessionals.

BACKGROUND
Lack of teamwork and ineffective communication are common contributors to hospital sentinel events. Interprofessional teamwork training to support a culture of patient safety is advocated; however, training methods and related expenses vary widely.

METHODS
This study used a descriptive design. All participants received PALS recertification training; the intervention group received an additional 2-hour TeamSTEPPS (R) 2.0 Essentials curriculum with didactic and video critique including role-play on error, communication behaviors, and standard terms. Data were collected on perceptions of teamwork and collaboration. χ2, Mann-Whitney U, and t tests were used.

RESULTS
The intervention group reported significantly higher perceptions of teamwork and collaboration, situational awareness, and ability to help a team make decisions.

CONCLUSIONS
Results suggest that integrating brief team training into an existing PALS program is a feasible, cost-effective, and sustainable method to provide interprofessional team training and positively influence the culture of safety.
Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery*
Authors: Flores Saul , Cooper David S. , Opoka Amy M. , Iliopoulos Ilias , Pluckebaum Sarah , Alder Matthew N. , Krallman Kelli A. , Sahay Rashmi D. , Fei Lin , Wong Hector R. 
Published: April 2018

Objectives:Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction.Design:Prospective observational cohort study.Setting:Large, tertiary pediatric cardiac center.Subjects:Children undergoing corrective or palliative cardiac surgery.Interventions:None.Measurements and Main Results:A prospective observational cohort study was conducted in 83 children with congenital heart disease. Total glucocorticoid receptor levels were measured in the peripheral WBCs using flow cytometry. In addition, blood samples were collected for total cortisol levels. The primary outcome studied was the time to being inotrope free. An increase in glucocorticoid receptor level from postoperative day 1 to postoperative day 3 was associated with a longer time to being inotrope free (hazard ratio, 0.49 [0.29–0.81];p= 0.01) in the univariate analysis. This association remained significant after adjusting for age, weight, cardiopulmonary bypass time, cross clamp time, Risk Adjustment for Congenital Heart Surgery-1 score, and postoperative steroid use (hazard ratio, 0.53 [0.29–0.99];p= 0.05). Postoperative day 3 glucocorticoid receptor level showed a trend to have longer time to being inotrope free (hazard ratio, 0.66 [0.42–1.02];p= 0.0.06). The cortisol levels minimally increased during the study duration and did not correlate with glucocorticoid receptor levels.Conclusions:Increasing glucocorticoid receptor levels in peripheral WBCs of children undergoing cardiac surgery are associated with a longer time to being inotrope free. Cortisol levels minimally increased during the study duration. These results suggest that exposure to high-dose perioperative corticosteroids may suppress the hypothalamic-pituitary-adrenal axis leading to increase in glucocorticoid receptor levels in response to a low cortisol environment. Further studies are required to better delineate the interplay between glucocorticoid receptor levels, cortisol levels, corticosteroid exposure, and postoperative inotropic requirements.
Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance
Authors: Wolfe Jonathan D. , Domenico Henry J. , Hickson Gerald B. , Wang Deede , Dubree Marilyn , Feistritzer Nancye , Wells Nancy , Talbot Thomas R. 
Published: April 2018

Objectives
Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics.

Methods
Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model.

Results
In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R
2 = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant.

Conclusions
Uptake of an HH program was associated with factors related to a unit’s safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.
Risk of Nephrotoxicity in Patients With Drug-Resistant Tuberculosis Treated With Kanamycin/Capreomycin With or Without Concomitant Use of Tenofovir-Containing Antiretroviral Therapy
Authors: Perumal Rubeshan , Abdelghani Neveen , Naidu Naressa , Yende-Zuma Nonhlanhla , Dawood Halima , Naidoo Kogieleum , Singh Nalini , Padayatchi Nesri 
Published: April 2018

Background:
The intersection of HIV and drug-resistant (DR) tuberculosis (TB) presents the challenge of managing convergent drug toxicities.

Methods:
We conducted a retrospective study of adult patients with DR-TB treated with a kanamycin/capreomycin-based (KM) regimen, with or without concomitant antiretroviral therapy (ART). We estimated the incidence of nephrotoxicity (defined as an increase in serum creatinine greater than 26.5 µmol, or an increase in serum creatinine to 1.5 times the baseline value, or a decline in glomerular filtration rate to less than 60 mL/min/1.73 m2), and evaluated the association between reported drug use and nephrotoxicity using Kaplan–Meier plots.

Results:
A total of 215 patients with DR-TB were treated with a kanamycin/capreomycin-based regimen, with or without concomitant ART. The incidence rate of nephrotoxicity was 3.6 [95% confidence interval (CI): 1.4 to 7.3], 6.9 (95% CI: 5.2 to 9.0), and 12 (95% CI: 3.3 to 30.9) cases per 100 person-months of follow-up in the KM only group (n = 42), the KM + TDF (tenofovir disoproxil fumarate) group (n = 163), and the KM + Other ART group (n = 10), respectively. Using the KM only group as a reference, the hazard ratio was 2.06 (95% CI: 0.92 to 4.63) in the KM + TDF group, and 4.09 (95% CI: 1.17 to 14.25) in the KM + Other ART group. Advancing age was an independent predictor of nephrotoxicity (adjusted hazard ratio 1.29, 95% CI: 1.14 to 1.46).

Conclusions:
Our findings provide evidence of a significant risk of nephrotoxicity during treatment with a kanamycin/capreomycin-based DR-TB regimen, with or without concurrent treatment with ART. This study lends further support to calls for the substitution of TDF during the intensive phase of DR-TB treatment and for close monitoring of renal function during DR-TB treatment, especially in settings where the use of kanamycin/capreomycin is unavoidable.
EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest
Authors: Hsu Cindy H. , Haac Bryce E. , Drake Mack , Bernard Andrew C. , Aiolfi Alberto , Inaba Kenji , Hinson Holly E. , Agarwal Chinar , Galante Joseph , Tibbits Emily M. , Johnson Nicholas J. , Carlbom David , Mirhoseini Mina F. , Patel Mayur B. , O'Bosky Karen R. , Chan Christian , Udekwu Pascal O. , Farrell Megan , Wild Jeffrey L. , Young Katelyn A. , Cullinane Daniel C. , Gojmerac Deborah J. , Weissman Alexandra , Callaway Clifton , Perman Sarah M. , Guerrero Mariana , Aisiku Imoigele P. , Seethala Raghu R. , Co Ivan N. , Madhok Debbie Y. , Darger Bryan , Kim Dennis Y. , Spence Lara , Scalea Thomas M. , Stein Deborah M. 
Published: April 2018

BACKGROUND
We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study.

METHODS
We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome.

RESULTS
A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy.

CONCLUSION
Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models.

LEVEL OF EVIDENCE
Therapeutic study, level IV; prognostic study, level III.
Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement
Authors: Perito Emily R. , Roll Garrett , Dodge Jennifer L. , Rhee Sue , Roberts John P. 
Published: April 2018

Background.
In the United States, 1 in 10 infants and 1 in 20 older children die on the liver transplant waiting list. Increasing split liver transplantation could increase organ availability for these children, without decreasing transplants in adults.

Methods.
Using United Network for Organ Sharing Standard Transplant Analysis and Research data, we identified livers transplanted 2010 to 2015 that could potentially have been used for split transplant, based on strict criteria. Livers not suitable for pediatric patients or allocated to high-risk recipients were excluded. Number and distribution of potentially “split-able” livers were compared to pediatric waitlist deaths in each region.

Results.
Of 37 333 deceased donor livers transplanted, 6.3% met our strict criteria for utilization in split liver transplant. Only 3.8% of these were actually utilized for split liver transplantation. 96% were used for a single adult recipient. Of the 2253 transplanted as whole livers, 82% of their recipients were listed as willing to accept a segmental liver, and only 3% were listed as requiring a cold ischemia time less than 6 hours. Over the same 5 years, 299 children died on the waitlist. In every United Network for Organ Sharing region, there were more potentially “split-able” livers than pediatric waitlist deaths. Thirty-seven percent of pediatric waitlist deaths occurred at transplant centers that averaged 1 or less pediatric split liver transplantation annually during the study period.

Conclusions.
This comparison, although not conclusive, suggests that we might be missing opportunities to reduce pediatric waitlist mortality without decreasing access for adults—using split liver transplant. Barriers are significant, but further work on strategies to increase split liver transplant is warranted.