bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Topical Anti-inflammatory and Oral Acetazolamide in the Treatment of Central Serous Chorioretinopathy
Authors: Wuarin Raphael , Kakkassery Vinodh , Consigli Andrea , Roquelaure Daniel , Papanastasiou Athanasios , Schutz James Scott , Thumann Gabriele , Chronopoulos Argyrios 
Published: July 2019

SIGNIFICANCE
Central serous chorioretinopathy (CSCR) is still a therapeutic challenge with no criterion standard treatment. However, anatomic changes at the level of the retinal pigment epithelium could prove of predictive value in the course of the disease for selective treatment in cases of increased risk of chronicity.

PURPOSE
This pilot study analyzes the efficacy for treating acute CSCR with combined systemic acetazolamide 250 mg twice a day and nepafenac 0.1% eye drops three times a day in comparison with an untreated control group. It also evaluates the presence a pigment epithelial detachment (PED) as a risk factor for chronic CSCR.

METHODS
Nineteen consecutive patients (group 1) with new or new onset of recurrent CSCR were treated with oral acetazolamide and nepafenac eye drops for at least 2 months. A control group of 14 patients (group 2) with new or new onset of recurrent CSCR were untreated while under regular observation for 4 months. Primary end points were central macular thickness and best-corrected visual acuity after 4 months. Secondary end points were complete regression of subretinal fluid at 3 months and association of PED at baseline with recurrent or chronic CSCR imaged by optical coherence tomography.

RESULTS
Group 1 showed significantly faster resolution of subretinal fluid with a mean central macular thickness at 4 months of 271 ± 85 μm compared with 322 ± 79 μm for group 2 (P < .05), but with no functional benefit with a best-corrected visual acuity at 4 months of 0.8 ± 0.2 for group 1 compared with 0.9 ± 0.1 for the control group (P < .05). Patients with a small flat PED were at a higher risk of developing chronic CSCR compared with patients with a dome-shaped or no PED (P < .05).

CONCLUSIONS
Central serous chorioretinopathy remains a therapeutic challenge. This pilot study shows faster resolution of subretinal fluid with treatment but without functional benefit compared with observation. The presence of small, flat PED was associated with development of chronic CSCR.
Simulation-Based Curricula for Enhanced Retention of Pediatric Resuscitation Skills
Authors: Jani Priti , Blood Angela D. , Park Yoon Soo , Xing Kuan , Mitchell Diana 
Published: July 2019

Introduction
Resuscitation skills decay as early as 4 months after course acquisition. Gaps in research remain regarding ideal educational modalities, timing, and frequency of curricula required to optimize skills retention. Our objective was to evaluate the impact on retention of resuscitation skills 8 months after the Pediatric Advanced Life Support (PALS) course when reinforced by an adjunct simulation-based curriculum 4 months after PALS certification. We hypothesized there would be improved retention in the intervention group.

Methods
This is a partial, double-blind, randomized controlled study. First-year pediatric residents were randomized to an intervention or control group. The intervention group participated in a simulation-based curriculum grounded in principles of deliberate practice and debriefing. The control group received no intervention. T-tests were used to compare mean percent scores (M) from simulation-based assessments and multiple-choice tests immediately following the PALS course and after 8 months.

Results
Intervention group (n = 12) had overall improved retention of resuscitation skills at 8 months when compared with the control group (n = 12) (mean, 0.57 ± 0.05 vs 0.52 ± 0.06; P = 0.037). No significant difference existed between individual skills stations. The intervention group had greater retention of cognitive knowledge (mean, 0.78 ± 0.09 vs 0.68 ± 0.14; P = 0.049). Residents performed 61% of assessment items correctly immediately following the PALS course.

Conclusions
Resuscitation skills acquisition from the PALS course and retention are suboptimal. These findings support the use of simulation-based curricula as course adjuncts to extend retention beyond 4 months.
Frequent Emergency Department Use by Children
Authors: Vivier Patrick M. , Rogers Michelle L. , Gjelsvik Annie , Linakis James G. , Schlichting Lauren E. , Mello Michael J. 
Published: July 2019

Objectives
Frequent use of the emergency department (ED) is often targeted as a quality improvement metric. The objective of this study was to assess ED visit frequency by the demographic and health characteristics of children who visit the ED to better understand risk factors for high ED utilization.

Methods
The majority of pediatric ED services in Rhode Island are provided by a hospital network that includes the state's only children's hospital. Using 10 years of data (2005–2014) from this statewide hospital network, we examined ED use in this network for all children aged 0 to 17 years. Patients' home addresses were geocoded to assess their neighborhood characteristics.

Results
Between 2005 and 2014, 17,844 children visited 1 or more of the network EDs at least once. In their year of maximum use, 67.8% had only 1 ED visit, 20.1% had 2 visits, 6.9% had 3 visits, and 5.2% had 4 or more visits. In the adjusted multinomial logistic regression model, age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the ED were found to be significantly associated with increased visit frequency.

Conclusions
Risk factors for frequent ED use by children include age, race/ethnicity, language, insurance coverage, medical complexity, neighborhood risk, and distance to the hospital. To decrease frequent pediatric ED use, improved medical management of complex medical problems is needed, but it is also essential to address modifiable social determinants of health care utilization in this population.
Clinical Indicators of Pediatric Shunt Malfunction
Authors: Razmara Ashkaun , Jackson Eric M. 
Published: July 2019

Objectives
The majority of the previous literature on clinical predictors of shunt malfunction is from the neurosurgical data, looking at the symptoms of patients who had surgery. Because common childhood illnesses are filtered from these samples, the prevalence of shunt malfunction is markedly higher than it would be for the pediatrician's office or emergency department (ED). Clinical predictive values obtained from a representative population can better inform clinical judgment in these environments.

Methods
A retrospective analysis of the Nationwide Emergency Department Sample (2006–2015) was performed. International Classification of Diseases, Ninth Revision, Clinical Modification Diagnosis/Procedure Codes were used to identify pediatric (≤20 years of age) ED visits with the presence of a cerebrospinal fluid (CSF) shunt (V45.2). Shunt malfunction was defined as any condition resulting in surgical revision (02.41, 02.42, 02.43). Multivariable logistic regression was used to examine the associations between shunt malfunction, demographic factors, and clinical presentation.

Results
There were 74,552 observations for ED visits by pediatric patients with a CSF shunt between 2006 and 2015, of which 12.8% (9,560) required shunt revision. Positive predictive values for clinical indicators were reported along with the results of multivariable logistic regression.

Conclusions
We identified peritonitis, papilledema, and oculomotor palsies as the strongest clinical indicators for shunt malfunction in pediatric ED visits with a CSF shunt. We found that patients presenting with headache, nausea/vomiting, convulsions, or fever were more likely to have an etiology other than shunt malfunction. Thus, after an appropriate shunt evaluation, other sources of symptoms should be investigated.
Otherwise Healthy 15-Month-Old With Rapid-Onset Soft Tissue Swelling
Authors: Anderson Julie Jelaine , Avendano Pablo , Kaila Rahul 
Published: July 2019

Abstract
Necrotizing soft tissue infections are a serious medical emergency that involve necrosis within the soft tissue space including the dermis, subcutaneous tissue, superficial fascia, deep fascia, and muscle. Inciting factors include recent varicella infection, omphalitis, trauma, intramuscular injections, perianal trauma, and surgery. Unlike adult cases, children presenting with necrotizing soft tissue infections are more likely to be immunocompetent and without underlying chronic illnesses. Although rare in children, familiarity with the clinical manifestations of necrotizing soft tissue infections is essential for early diagnosis and surgical debridement, as significant mortality is associated with advanced disease.
Point-of-Care Ultrasound for Targeted Assessment of Shock
Authors: Weberding Nathaniel T. , Marin Jennifer R. 
Published: July 2019

Abstract
The differential diagnosis for patients presenting in shock can be broad, making rapid diagnosis and management challenging. We present a case of a medically complex patient with presumed septic shock, diagnosed with a large pericardial effusion with evidence of tamponade using the rapid ultrasound in shock and hypotension protocol. The point-of-care ultrasound examination allowed for more timely and definitive management.
Reconstruction of Gustilo Type IIIC Injuries of the Lower Extremity
Authors: Ricci Joseph A. , Abdou Salma A. , Stranix John T. , Lee Z-Hye , Anzai Lavinia , Thanik Vishal D. , Saadeh Pierre B. , Levine Jamie P. 
Published: July 2019

Background:
Gustilo type IIIC open tibia fractures are characterized by an ischemic limb requiring immediate arterial repair. In this patient population, the decision between primary amputation and limb salvage can be challenging. This study aims to evaluate the reconstructive outcomes of patients with Gustilo type IIIC injuries.

Methods:
A single-center retrospective review of 806 lower extremity free flaps from 1976 to 2016 was performed. Flap loss and salvage rates for patients with Gustilo type IIIC injuries were determined. To determine the utility of performing salvage in this group, outcomes of the IIIC reconstructions were compared to those of similar patients with Gustilo I type IIB injuries with only a single patent vessel.

Results:
A total of 32 patients with Gustilo type IIIC injuries underwent reconstruction after traumatic injury. Ten patients (31.3 percent) experienced a perioperative complication, including seven unplanned returns to the operating room (21.9 percent), three partial flap losses (9.4 percent), and five complete flap losses (15.6 percent). When type IIIC injuries were compared with single-vessel Gustilo type IIIB injuries, no statistically significant differences were noted with respect to major perioperative complications (p = 0.527), unplanned return to the operating room (p = 0.06), partial flap loss (p = 0.209), complete flap loss (p = 0.596), or salvage rate (p = 0.368). Although this result was not statistically significant, Gustilo type IIIC injuries trended toward lower take-back rates and higher salvage rates compared with single-vessel Gustilo type IIIB injuries.

Conclusion:
Patients with Gustilo type IIIC open tibia fractures should be considered candidates for limb salvage, as flap loss and reconstruction of these injuries are comparable to those of the routinely reconstructed single-vessel runoff type IIIB injuries.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Ultrasound Time-Harmonic Elastography of the Aorta
Authors: Schaafs Lars-Arne , Tzschätzsch Heiko , Reshetnik Alexander , van der Giet Markus , Braun Jürgen , Hamm Bernd , Sack Ingolf , Elgeti Thomas 
Published: July 2019

Objectives
The aim of this study was to investigate ultrasound time-harmonic elastography for quantifying aortic stiffness in vivo in the context of aging and arterial hypertension.

Materials and Methods
Seventy-four participants (50 healthy participants and 24 participants with long-standing hypertension) were prospectively included between January 2018 and October 2018, and underwent ultrasound time-harmonic elastography of the upper abdominal aorta. Compound maps of shear-wave speed (SWS) as a surrogate of tissue stiffness were generated from multifrequency wave fields covering the full field-of-view of B-mode ultrasound. Blood pressure and pulse wave velocity were measured beforehand. Interobserver and intraobserver agreement was determined in 30 subjects. Reproducibility of time-harmonic elastography was assessed in subgroups with repeated measurements after 20 minutes and after 6 months. Linear regression analysis, with subsequent age adjustment of SWS obtained, receiver operating characteristic analysis, and intraclass correlation coefficients (ICCs) were used for statistical evaluation.

Results
Linear regression analysis revealed a significant effect of age on SWS with an increase by 0.024 m/s per year (P < 0.001). Age-adjusted SWS was significantly greater in hypertensives (0.24 m/s; interquartile range [IQR], 0.17–0.40 m/s) than in healthy participants (0.07 m/s; IQR, −0.01 to 0.06 m/s; P < 0.001). A cutoff value of 0.15 m/s was found to differentiate best between groups (area under the receiver operating characteristic curve, 0.966; 95% confidence interval, 0.93–1.0; P < 0.001; 83% sensitivity and 98% specificity). Interobserver and intraobserver variability was excellent (ICC, 0.987 and 0.937, respectively). Reproducibility was excellent in the short term (ICC, 0.968; confidence interval, 0.878–0.992) and good in the long term (ICC, 0.844; confidence interval, 0.491–0.959).

Conclusions
Ultrasound time-harmonic elastography of the upper abdominal aorta allows quantification of aortic wall stiffness in vivo and shows significantly higher values in patients with arterial hypertension.
Nasoplatine Island Advancement Flap for Closure of Anterior Palatal Fistula in Patient With Isolated Cleft Palate
Authors: Rahpeyma Amin , DDS Saeedeh Khajehahmadi 
Published: July 2019

Abstract
Palatal fistula is common in cleft patients. Palatal fistula repair is difficult, and there is 10% to 30% recurrence rate. Application of nasopalatine Island advancement flap for easy closure of medium size anterior palatal fistula in isolated cleft patient is demonstrated. Anatomic basis, advantages, and limitations of this new flap are explained. Nasopalatine Island advancement flap is a useful aid for easy closure of medium size anterior palatal fistula in isolated cleft patient.
Evaluation of the Spatial Position and Correlation of Mandibular Ramus in Skeletal Class III Patients With Mandibular Asymmetry
Authors: Qu Guan-Lin , Xu Jing , Zhou Qing 
Published: July 2019

Purpose:
To evaluate the position and bilateral difference of mandibular ramus region, specifically the condyle, sigmoid notch, and mandibular angle in skeletal class III patients with mandibular asymmetry.

Materials and Methods:
3D-CT images were performed in 50 patients with skeletal class III malocclusion. According to the severity of mandibular asymmetry, 22 cases were included in the control group and 28 cases were included in the symmetry group. The 3D landmarks were measured relative to 6 reference planes and the outcomes among different groups were compared.

Results:
There are significant differences in the position of mandibular ramus region between both sides in the asymmetry group. The position of condyle was more posterior and internal on the deviated side; and the positions of sigmoid notch and gonion were more posterior, superior, and lateral on the deviated side. Furthermore, the degree of mandibular asymmetry was more highly correlated with the height of ramus and the position of mandibular angle than it was with the height of condyle and the position of sigmoid notch.

Conclusion:
When evaluating mandibular asymmetry and making surgical plans, the position of mandibular ramus should be taken into consideration.
The Upper Third in Facial Gender Confirmation Surgery: Forehead and Hairline
Authors: Capitán Luis , Simon Daniel , Bailón Carlos , Bellinga Raúl J. , Gutiérrez-Santamaría Javier , Tenório Thiago , Capitán-Cañadas Fermín 
Published: July 2019

Abstract
The upper third of the face contains 2 features that are particularly important for facial gender recognition: the frontonasoorbital region and the hairline. The supraorbital ridge, which determines the position and exposure of the eyebrows, is almost invariably more developed in the male than in the female. Surgical modification of the frontonasoorbital complex, considered a standard procedure in facial feminization, is reliable and predictable, and also delivers satisfactory results that are stable over time.
A prototypical male hairline has an M-shaped pattern compared to the more rounded shape often seen in female hairlines. Feminization of the hairline requires minimizing the temples as well as rounding out the overall shape, optimizing hair density, and occasionally changing the height of the hairline.
This article provides an update on our forehead reconstruction technique and our experience in the treatment of hairline redefinition.
Artifacts That Can Be Misinterpreted as Interictal Discharges
Authors: Mathias Sally V. , Bensalem-Owen Meriem 
Published: July 2019

Summary:
It is presumed that the EEG records only cerebral activity. However, frequently it can include other electrical activities, referred to as noise or artifact, which are not of cerebral origin. In the last few decades, evolution in digital technology has greatly improved the ability to record and display interpretable EEG. With the widespread availability of prolonged EEG recording, new artifacts have been described. The addition of concomitant video with audio during recordings has allowed in most instances to determine the source of certain artifacts. One of the challenges of interpreting EEGs consists of identifying artifacts correctly. Some of the EEG artifacts are so distinctive in appearance that the experienced reader can readily identify them. It is not uncommon for normal EEGs to be overinterpreted, especially by inexperienced readers. Failing to identify artifacts correctly can lead to “over reading” a study and doing so can result in misdiagnosis of epilepsy. This in turn can result in inappropriate treatments that ultimately can have serious clinical implications. This review will provide a description of the most commonly encountered artifacts that mimic spike or sharp waves, also referred to as interictal epileptiform discharges. In addition, we will describe troubleshooting approaches to eliminate these artifacts whenever possible. Artifacts that mimic ictal discharges will be reviewed in a different section.
Normal Variants Are Commonly Overread as Interictal Epileptiform Abnormalities
Authors: Kang Joon Y. , Krauss Gregory L. 
Published: July 2019

Summary:
Electroencephalographers may misclassify benign variant EEG patterns as epileptiform discharges, resulting in delays in the diagnosis and appropriate treatment of other paroxysmal disorders, such as psychogenic nonepileptic seizures, anxiety/panic disorders, and near syncope. These benign variant patterns include wicket spikes, small sharp spikes, and rhythmic mid-temporal theta of drowsiness. Cautious interpretations of semi-rhythmic sharp transients, usually gradually rising from the EEG background in drowsiness, can help avoid misdiagnosing patients as having seizures. Viewing the EEG as confirmatory for a clear clinical diagnosis is also helpful—elderly patients with syncope, for example, often have microvascular disease and EEG wicket rhythms in drowsiness—a careful review of the clinical history and the paroxysmal EEG pattern usually help distinguish normal variant patterns from interictal sharp waves and spikes and avoid misdiagnosing epilepsy.
Phased diploid genome assemblies for three strains ofCandida albicansfrom oak trees
Authors: Hamlin Jennafer A. P. , Dias Guilherme , Bergman Casey M. , Bensasson Douda 
Published: July 2019

ABSTRACTAlthough normally a harmless commensal,Candida albicanshas the potential to generate a wide range of infections including systemic candidaemia, making it the most common cause of bloodstream infections worldwide with a high rate of mortality.C. albicanshas long been considered an obligate commensal, however, recent studies suggest it can live outside animal hosts. Here, we have generated PacBio sequencing and phased genome assemblies for threeC. albicansstrains from oak trees in the United Kingdom (NCYC 4144, NCYC 4145, and NCYC 4146). Our results provide phasedde novodiploid assemblies forC. albicansand provide a framework to study patterns of genomic variation within and among strains of an important fungal pathogen.
Inflammasome-mediated antagonism of type I interferon enhancesRickettsiapathogenesis
Authors: Burke Thomas P. , Engström Patrik , Chavez Roberto A. , Fonbuena Joshua A. , Vance Russell E. , Welch Matthew D. 
Published: July 2019

SummaryInflammasomes and interferons constitute two critical arms of innate immunity. Most facultative bacterial pathogens that inhabit the host cell cytosol avoid activating inflammasomes and are often resistant to killing by type I interferon (IFN-I). We report that the human pathogenRickettsia parkeri,an obligate intracellular pathogen that resides in the cytosol, is sensitive to IFN-I. The mechanism of IFN-I-dependent restriction requires the transcription factor IRF5, which upregulates anti-rickettsial factors including guanylate-binding proteins and iNOS. However,R. parkericurtails cGAS-dependent IFN-I production by causing caspase-11-dependent pyroptosis.In vivo, inflammasome activation antagonizes IFN-I production, enhancingR. parkeriabundance in the spleen. Mice lacking either IFN-I or IFN-γ signaling are resistant to infection, but mice lacking both rapidly succumb, revealing that both interferons are required to controlR. parkeri. This study illuminates how an obligate cytosolic pathogen exploits the intrinsic trade-off between cell death and cytokine production to escape killing by innate immunity.HighlightsRickettsiakilled by GBPs activates caspase-11 and GSDMD, promoting pyroptosisRickettsiaexploits pyroptosis to avoid cGAS-dependent type I interferonIRF5, GBPs, and iNOS contribute to controllingR. parkeriinfectionIfnar-/-Ifngr-/-mice succumb to infection, uncovering a mouse model to studyR. parkeri