bluuebunny/crossref_metadata_2025_split huggingface dataset:
BASELINE STUDIES ON RADIONUCLIDE CONCENTRATION IN FOOD MATERIALS AND ESTIMATION OF THE COMMITTED RADIATION DOSE AROUND THE PHOSPHATE INDUSTRIAL AREA OF SOUTH TUNISIA
Authors: Machraoui Sonia , Mohan M P , Naregundi Karunakara , Labidi Salam 
Published: November 2018

Abstract
The activity concentration of natural and anthropogenic radionuclides was determined in different vegetable samples, and foods derived from animal origin, from different locations in the four cities of Southern Tunisia, where large-scale phosphate industries are operating. The aim of the studies was to establish a baseline database on radionuclide concentration in food materials and to evaluate the radiation dose to the general population due to its ingestion through the food chain. The activity concentrations of 40K, 210Pb, 226Ra, 228Ra and 137Cs was determined by gamma spectrometry using a HPGe detector, and from the measured activity concentrations, the doses were estimated using the dose coefficients given by the ICRP. The dose due to intake of radionuclides through mineral water was also determined. The total annual effective doses were found to be 2.2, 1.4, and 0.7 mSv y−1 for 1 y, 5–15 y and adult (>17 y) age groups, respectively. Among the radionuclides studied, 210Po was the highest contributor to the total dose, followed by 210Pb.
The Use of Ultrasonography for Verifying Gastric Tube Placement in Newborns
Authors: Dias Fla'via de Souza Barbosa , Alvares Beatriz Regina , Jales Rodrigo Menezes , Franco Aline Patricia Vicente , Silva Jessica Emile Fabri da , Fabene Suelen Mara Silva , Caldas Jamil Pedro de Siqueira , Carmona Elenice Valentim 
Published: November 2018

Background:
The use of gastric tubes in newborns admitted to a neonatal intensive care unit is fairly high, and there is a risk of serious complications related to this procedure.

Purpose:
Considering the need to find a method that does not involve the patient's exposure to radiation, this study aimed to evaluate the diagnostic accuracy of ultrasonography for verifying gastric tube placement in newborns.

Methods:
This was a prospective, double-blind, observational study performed in a neonatal intensive care unit, in which 159 infants had gastric intubation using ultrasound examination and radiological imaging, to verify positioning. Results were analyzed in terms of diagnostic accuracy.

Results:
The tubes were correctly positioned in 157 cases (98.7%), according to radiological images, and in 156 cases (98.1%), according to ultrasound. The sensitivity analysis was 0.98 and the positive predictive value was 0.99. It was not possible to perform a specificity analysis, as there were not enough negative cases in the sample.

Implications for Practice:
The use of ultrasonography to identify correct positioning of gastric tubes in infants and newborns shows good sensitivity.

Implications for Research:
It was not possible to evaluate the ultrasonography specificity; further studies with greater samples are probably necessary, so that this objective can be achieved.

Video Abstract available at
https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=29&autoPlay=true.
A Changing Spectrum of Colorectal Cancer Biology With Age: Implications for the Young Patient
Authors: Chouhan Hanumant , Ferrandon Sylvain , DeVecchio Jennifer , Kalady Matthew F. , Church James M. 
Published: November 2018

BACKGROUND:
The methylator pathway of colorectal carcinogenesis, characterized by CpG island hypermethylation and BRAF mutations, accounts for ≈25% of colorectal cancers. Because these cancers tend to be right sided and because DNA methylation in the right colon increases with age, we expect an increasing proportion of right-sided cancer over time. Conversely, we expect young patients (age <50 y) to have less methylated and fewer right-sided cancers

OBJECTIVE:
The purpose of this study was to analyze the distribution and genetic traits of colorectal cancer from different age groups.

DESIGN:
This was a retrospective cohort study.

SETTING:
The study was conducted at a high-volume tertiary referral center.

PATIENTS:
Patient samples included those from our colorectal cancer biobank of resected colorectal cancer specimens.

MAIN OUTCOME MEASURES:
Tumor CpG island hypermethylation, microsatellite instability, and mutations in KRAS and BRAF oncogenes were analyzed in resected specimens and stratified by age and tumor location. Comparisons included age >50 or <50 years and decade of diagnosis (≤50, 51–60, 61–70, 71–80, and >81 y). Patients with IBD or hereditary syndromes were excluded.

RESULTS:
A total of 497 colorectal cancers were analyzed (266 men and 231 women); 57 patients (11.5%) were ≤50 years of age. No young cancers (0/57) were hypermethylated compared with 97 (22%) of 440 cancers of patients aged >50 years (p < 0.001). An increasing percentage of tumors were CpG island phenotype high with each decade of age at diagnosis. No cancers in patients <50 years of age were microsatellite unstable compared with 91 (23.6%) of 346 for those >50 years of age. No young cancers contained a BRAF mutation compared with 46 (10.6%) of 434 in older cancers (p < 0.001). KRAS mutations were less common in young cancers compared with older cancers (13/57 (22.8%) vs 126/410 (30.7%); p < 0.01). Eleven (19.3%) of 57 young cancers were proximal compared with 228 (51.8%) of 440 (p < 0.001) older cancers.

LIMITATIONS:
This study was limited by its retrospective design.

CONCLUSIONS:
The lack of CpG island methylator phenotype tumors in young patients is consistent with the dominant left-sided cancer distribution seen in the young and focuses efforts to understand and prevent cancer in this age group on causes of chromosomal instability. See Video Abstract at http://links.lww.com/DCR/A709.
Consequences of Increasing Complexity in Anorectal Surgery Performed at an Academic Center
Authors: Hiller David J. , Chadi Sami A. , Rosen Lester , Wexner Steven D. 
Published: November 2018

BACKGROUND:
Anorectal surgery encompasses a wide range of procedures with varying complexity. The Accreditation Council for Graduate Medical Education Review Committee for Colon and Rectal Surgery recommends minimum case numbers (60) for 1-year specialty trainees in 6 categories of anorectal surgery, with definitions for procedural complexity.

OBJECTIVE:
The purpose of this study was to assess the scope of anorectal procedures and propose a stratification of procedures based on a consensus of levels of difficulty, as well as to identify a predictive charge cutoff suggestive of procedural complexity.

DESIGN:
This was a retrospective review.

SETTINGS:
The study was conducted at a tertiary academic center.

PATIENTS:
Patients undergoing anorectal procedures between January 2011 and December 2014 identified by Current Procedural Terminology coding were entered into 6 categories. Codes were stratified as routine or complex based on an assessment of perioperative care and technical expertise required. Patients with an abdominal portion to any procedure were excluded.

MAIN OUTCOMES MEASURES:
The study measured distribution of complexity in anorectal surgical procedures and procedural charge associated with differentiating routine from complex procedures.

RESULTS:
Seven colorectal surgeons performed 2483 anorectal procedures (mean = 620 per year). Mean age was 48 ± 16 years. Forty six (64%) of 71 procedures were classified as routine and 25 (36%) of 71 as complex. Most disease processes had subsets with routine or complex procedures, whereas all of the procedures performed for fecal incontinence or advanced anorectal techniques were considered complex. Fistula procedures and transanal excisions were most heterogeneous, with a high procedural complexity rate (37% and 50%). After a procedural complexity rating, intraclass correlation by 6 surgeons was 0.70, demonstrating good correlation. Receiver operating curve assessments of consensus categorization according to billing codes revealed $553 as the optimal cutoff between routine and complex procedures.

LIMITATIONS:
This was a single-institution retrospective review.

CONCLUSIONS:
Colorectal residents may benefit from anorectal case stratification, because it serves as a dialogue for those interested in complex anorectal surgery during training. Surgeon categorization of procedures correlates well with a charge-based model of complexity. See Video Abstract at http://links.lww.com/DCR/A806.
Hemodynamic Impact of Oxygen Desaturation During Tracheal Intubation Among Critically Ill Children With Cyanotic and Noncyanotic Heart Disease*
Authors: Mokhateb-Rafii Tanya , Bakar Adnan , Gangadharan Sandeep , Gradidge Eleanor A. , Tellez David , Ruppe Michael , Tallent Sarah , Bird Geoffrey , Lavin Natasha , Lee Anthony , Napolitano Natalie , Nadkarni Vinay , Shults Justine , Nishisaki Akira 
Published: November 2018

Objectives:
To determine a level of oxygen desaturation from baseline that is associated with increased risk of tracheal intubation associated events in children with cyanotic and noncyanotic heart disease.

Design:
Retrospective analysis of prospectively collected data from the National Emergency Airway Registry for Children, an international multicenter quality improvement collaborative for airway management in critically ill children.

Setting:
Thirty-eight PICUs from July 2012 to December 2016.

Patients:
Children with cyanotic and noncyanotic heart disease who underwent tracheal intubation in a pediatric or cardiac ICU.

Interventions:
None.

Measurements and Main Results:
Our exposure of interest was oxygen desaturation measured by a fall in pulse oximetry from baseline after preoxygenation. Primary outcome was the occurrence of hemodynamic tracheal intubation associated events defined as cardiac arrest, hypotension or dysrhythmia. One-thousand nine-hundred ten children (cyanotic, 999; noncyanotic, 911) were included. Patients with cyanotic heart disease who underwent tracheal intubations were younger (p < 0.001) with higher Pediatric Index of Mortality 2 scores (p < 0.001), more likely to have a cardiac surgical diagnosis (p < 0.001), and less likely to have hemodynamic instability (p = 0.009) or neurologic failure as an indication (p = 0.008). Oxygen desaturation was observed more often in children with cyanotic versus noncyanotic heart disease (desaturation of 15% to < 30%: 23% vs 16%, desaturation ≥ 30%: 23% vs 17%; p < 0.001), with no significant difference in occurrence of hemodynamic tracheal intubation associated events (7.5% vs 6.9%; p = 0.618). After adjusting for confounders, oxygen desaturation by 30% or more is associated with increased odds for adverse hemodynamic events (odds ratio, 4.03; 95% CI, 2.12–7.67) for children with cyanotic heart disease and (odds ratio, 3.80; 95% CI, 1.96–7.37) for children with noncyanotic heart disease.

Conclusions:
Oxygen desaturation was more commonly observed during tracheal intubation in children with cyanotic versus noncyanotic heart disease. However, hemodynamic tracheal intubation associated event rates were similar. In both groups, oxygen desaturation greater than or equal to 30% was significantly associated with increased occurrence of hemodynamic tracheal intubation associated events.
A Pilot Study of the Association of Amino-Terminal Pro-B-Type Natriuretic Peptide and Severity of Illness in Pediatric Septic Shock*
Authors: Melendez Elliot , Whitney Jane E. , Norton Jackson S. , Silverman Melanie , Monuteaux Michael C. , Bachur Richard G. 
Published: November 2018

Objectives:
Biomarkers that can measure illness severity and predict the risk of delayed recovery may be useful in guiding pediatric septic shock. Amino-terminal pro-B-type natriuretic peptide has not been assessed in pediatric septic patients at the time of presentation to the emergency department prior to any interventions. The primary aim was to assess if emergency department amino-terminal pro-B-type natriuretic peptide is associated with worse outcomes and severity of illness.

Design:
Prospective observational pilot study.

Settings:
Tertiary free-standing children’s hospital.

Patients:
Children 0–17 years old with a diagnosis of septic shock were enrolled. Patients with preexisting cardiac and renal dysfunction were excluded.

Interventions:
None.

Measurements and Main Results:
Amino-terminal pro-B-type natriuretic peptide analysis was performed on samples obtained in the emergency department prior to any intervention. The association between biomarkers and clinical outcomes and illness severity using Pediatric RISk of Mortality 3 were assessed. Eighty-two patients with septic shock underwent analysis. The median (interquartile range) amino-terminal pro-B-type natriuretic peptide levels was 394 pg/mL (102–1,392 pg/mL). Each decile change increase in amino-terminal pro-B-type natriuretic peptide was associated with a change in ICU length of stay by 8.7%, (95% CI, 2.4–15.5), hospital length of stay by 5.7% (95% CI, 0.4–11.2), organ dysfunction by 5.1% (95% CI, 1.8–8.5), a higher inotropic score at 12, 24, and 36 hours, and longer time requiring vasoactive agents. There was a significant correlation between baseline amino-terminal pro-B-type natriuretic peptide and the Pediatric RISk of Mortality 3 score (Spearman rho = 0.247; p = 0.029).

Conclusions:
This pilot study shows an association between emergency department amino-terminal pro-B-type natriuretic peptide on presentation and worse septic shock outcomes and amino-terminal pro-B-type natriuretic peptide levels correlates with an ICU severity score.
Efficacy and Safety of Pediatric Critical Care Physician Telemedicine Involvement in Rapid Response Team and Code Response in a Satellite Facility*
Authors: Berrens Zachary J. , Gosdin Craig H. , Brady Patrick W. , Tegtmeyer Ken 
Published: November 2018

Objectives:
Satellite inpatient facilities of larger children’s hospitals often do not have on-site intensivist support. In-house rapid response teams and code teams may be difficult to operationalize in such facilities. We developed a system using telemedicine to provide pediatric intensivist involvement in rapid response team and code teams at the satellite facility of our children’s hospital. Herein, we compare this model with our in-person model at our main campus.

Design:
Cross-sectional.

Setting:
A tertiary pediatric center and its satellite facility.

Patients:
Patients admitted to the satellite facility.

Interventions:
Implementation of a rapid response team and code team model at a satellite facility using telemedicine to provide intensivist support.

Measurements and Main Results:
We evaluated the success of the telemedicine model through three a priori outcomes: 1) reliability: involvement of intensivist on telemedicine rapid response teams and codes, 2) efficiency: time from rapid response team and code call until intensivist response, and 3) outcomes: disposition of telemedicine rapid response team or code calls. We compared each metric from our telemedicine model with our established main campus model.

Main Results:
Critical care was involved in satellite campus rapid response team activations reliably (94.6% of the time). The process was efficient (median response time 7 min; mean 8.44 min) and effective (54.5 % patients transferred to PICU, similar to the 45–55% monthly rate at main campus). For code activations, the critical care telemedicine response rate was 100% (6/6), with a fast response time (median 1.5 min). We found no additional risk to patients, with no patients transferred from the satellite campus requiring a rapid escalation of care defined as initiation of vasoactive support, greater than 60 mL/kg in fluid resuscitation, or endotracheal intubation.

Conclusions:
Telemedicine can provide reliable, timely, and effective critical care involvement in rapid response team and Code Teams at satellite facilities.
Median Arcuate Ligament Syndrome Related to Bodybuilding
Authors: Ulualp Kenan , Masnyj Stephen V. , Lee Cheong J. , Gould Jon C. 
Published: November 2018

Background:
Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is characterized by postprandial abdominal pain and weight loss thought to be secondary to compression of the celiac artery ganglia by the median arcuate ligament (MAL).

Methods:
A young female powerlifter presented with a 3-month history of postprandial epigastric pain and involuntary weight loss following the start of a vigorous weightlifting program. The diagnosis of MALS was established after excluding other possibilities and by detailed evaluation including magnetic resonance imaging and celiac plexus block. She was treated by laparoscopic MAL release.

Results:
The patient experienced immediate and complete cessation of her pain. She has continued to be asymptomatic at 6 months after surgery.

Conclusions:
Heavy weightlifting may potentially lead to MALS. The laparoscopic approach to MAL release can be utilized to treat this condition with favorable results.
Show the model – A Harrell plot combines a forest plot of effects and uncertainty with a dot plot of the data
Authors: Walker Jeffrey A. 
Published: November 2018

AbstractSeveral high profile editorials and articles have advocated replacing the ubiquitous, but not especially informative, bar plot with dot plots or box plots which show the data or some summary of the data distribution. I argue that the biggest deficiency of bar plots (and other mean-and-error plots) is that they fail to directly communicate modeled effects and uncertainty, and dot and box plots do not address this deficiency. A Harrell plot combines a forest plot of modeled treatment effects and uncertainty, a dot plot of raw data, and a box plot of the distribution of the raw data into a single, two-part graph. A Harrell plot encourages best practices such as communication of the distribution of the data and a focus on effect size and uncertainty, while discouraging poor practices such as hiding distributions and focusing onp-values.
A New Family of Similarity Measures for Scoring Confidence of Protein Interactions using Gene Ontology
Authors: Paul Madhusudan , Anand Ashish 
Published: November 2018

AbstractThe large-scale protein-protein interaction (PPI) data has the potential to play a significant role in the endeavor of understanding cellular processes. However, the presence of a considerable fraction of false positives is a bottleneck in realizing this potential. There have been continuous efforts to utilize complementary resources for scoring confidence of PPIs in a manner that false positive interactions get a low confidence score. Gene Ontology (GO), a taxonomy of biological terms to represent the properties of gene products and their relations, has been widely used for this purpose. We utilize GO to introduce a new set of specificity measures: Relative Depth Specificity (RDS), Relative Node-based Specificity (RNS), and Relative Edge-based Specificity (RES), leading to a new family of similarity measures. We use these similarity measures to obtain a confidence score for each PPI. We evaluate the new measures using four different benchmarks. We show that all the three measures are quite effective. Notably, RNS and RES more effectively distinguish true PPIs from false positives than the existing alternatives. RES also shows a robust set-discriminating power and can be useful for protein functional clustering as well.
To CRUNCH or not to CRUNCH: Task Difficulty Affects Functional Brain Reorganisation during Visuospatial Working Memory Performance in Premanifest Huntington’s Disease
Authors: Soloveva Maria V. , Jamadar Sharna D. , Velakoulis Dennis , Poudel Govinda , Georgiou Karistianis Nellie 
Published: November 2018

AbstractPresymptomatic Huntington’s disease (pre-HD) individuals tend to increase functional brain activity to compensate for HD-related brain anomalies. We used a quantitative model of compensation, known as the CRUNCH (Compensation-Related Utilization of Neural Circuits Hypothesis) to explicitly characterise compensation in pre-HD. We acquired functionalmagnetic resonance imaging (fMRI) data (n = 15 pre-HD; n = 15 controls) during performance of an 18-minute fMRI visuospatial working memory task with low, intermediate-1, intermediate-2, and high memory loads. Consistent with the CRUNCH prediction, pre-HD individuals showed decreased fMRI activity in left intraparietal sulcus at high memory load, compared to healthy controls who showed increased fMRI activity in left intraparietal sulcus at high memory load. Contrary to the other CRUNCH prediction, the pre-HD group did not show compensatory increase in fMRI activity at lower levels of memory loads in left intraparietal sulcus. Our findings provide partial support for the validity of CRUNCH in pre-HD.HighlightsVisuospatial working memory deficits in pre-HD occur 25 years prior to predicted disease onsetTask demands differentially affect fMRI activity in left intraparietal sulcusCRUNCH can partially apply in Huntington’s disease
Detection of enterovirus protein and RNA in multiple tissues from nPOD organ donors with type 1 diabetes
Authors: Oikarinen Maarit , Laiho Jutta E , Oikarinen Sami , Richardson Sarah J , Kusmartseva Irina , Campbell-Thompson Martha , Morgan Noel G , Pugliese Alberto , Tauriainen Sisko , Toniolo Antonio , Hyöty Heikki ,   the nPOD-V study group
Published: November 2018

AbstractEpidemiological studies have shown an association between enterovirus (EV) infections and type 1 diabetes (T1D), and EV protein has been detected in the pancreatic islets of T1D patients. Here we correlated the detection of EVs in lymphoid tissues (spleen and pancreatic lymph nodes) and small intestinal mucosa to the virus detection in the pancreas of T1D, autoantibody-positive (aab+) and non-diabetic control organ donors of the Network for Pancreatic Organ Donors with Diabetes (nPOD) study. Formalin-fixed paraffin-embedded tissue samples were screened for insulin and EV protein using immunohistochemistry, and frozen tissue for EV genome using RT-PCR. The presence of EV protein in the pancreatic islets correlated with the presence of insulin-positive cells. Altogether 62 % of T1D and aab+ donors were positive for EV protein in pancreatic islets (only insulin-positive donors included), 40 % in duodenum and 32 % in spleen, compared to 33 %, 14 %, and 27 % of non-diabetic controls. Pancreatic lymph nodes were positive for EV protein in 60 % of T1D and aab+ cases. T1D and aab+ donors were more frequently VP1-positive in multiple organs than control donors (39 % vs. 11 %; including only insulin-positive donors). EV RNA was found in selected donors and from multiple tissue types except for duodenum, and individual T1D and aab+ donors were EV RNA-positive in multiple organs. The role of extra-pancreatic organs and their interplay with EV in T1D pathogenesis remains to be solved, but we hypothesize that these organs may serve as a reservoir for the virus which may reside in these tissues in a slow-replicating persistent form.