bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systems Thinking Education in RN-BSN Programs
Authors: Stalter Ann M. , Jauch Amy 
Published: July 2018

Background
Nurses need to take a lead in reducing medical errors. Formal education of systems thinking (ST) can be a catalyst for error prevention.

Problem
Integration of ST in RN-BSN education has not been studied.

Approach
A descriptive, cross-sectional design using survey methods was used.

Outcomes
Deans of accredited RN-BSN programs across the Midwest reported on ST integration across their RN-BSN programs. Gaps in ST integration were identified as (1) a lack of evaluation tools to determine mastery of systems theory, thinking and awareness, and the application of quality and safety competencies for systems-level synthesis and (2) program outcomes emphasizing autonomy of systems-level decisions.

Conclusions
Systems thinking was integrated across curricula among most accredited RN-BSN programs in the Midwest. Recommendations are to integrate systems theory into program outcomes and to develop evaluation tools that validate ST mastery.
Resuscitation With Ringer's Lactate Compared With Normal Saline for Pediatric Diabetic Ketoacidosis
Authors: Bergmann Kelly R. , Abuzzahab M. Jennifer , Nowak Jeffrey , Arms Joe , Cutler Gretchen , Christensen Eric , Finch Mike , Kharbanda Anupam 
Published: July 2018

Objective
The aims of this study were to describe the use of Ringer's lactate (LR) or normal saline (NS) for resuscitation among children with diabetic ketoacidosis (DKA) and compare the effect of fluid type on cost, length of stay, and rate of cerebral edema (CE).

Methods
This is a retrospective study of 49,737 children aged 0 to 17 years with DKA between January 1, 2005, and September 30, 2015, using data from the Pediatric Health Information System. Treatment with LR or NS was identified. Our primary outcomes were total adjusted cost and length of stay. Our secondary outcome was CE rate per 1000 episodes.

Results
The majority of patients were treated with NS (n = 43,841 [88%]) compared with LR (n = 1762 [4%]) or both NS and LR (n = 4134 [8%]). Hospital-year–specific practice patterns were used to investigate the effect of fluid type across resuscitation fluid groups. Total adjusted cost was $1160 less (95% confidence interval, −1468 to −852), or −14.2%, for cases with any episode of LR compared with NS only. Length of stay was not different across groups. The rate of cerebral edema per 1000 episodes was 12.7 for cases with any episode of LR compared with 34.6 NS only (difference, −21.9; 95% confidence interval, −30.4 to −13.3).

Conclusions
Ringer's lactate was infrequently used for resuscitation of pediatric DKA patients. However, resuscitation with LR compared with NS was associated with lower total cost and rates of CE. Further investigation using patient-level clinical and laboratory data is needed to evaluate factors that drive cost and risk of CE development with each fluid.
Nonvisualization of Sentinel Lymph Nodes by Lymphoscintigraphy in Primary Cutaneous Melanoma: Incidence, Risk Factors, and a Review of Management Options
Authors: Pavri Sabrina Nicole , Gary Cyril , Martinez Rajendra Sawh , Kim Samuel , Han Dale , Ariyan Stephan , Narayan Deepak 
Published: July 2018

Background:
Lymphoscintigraphy is often performed before sentinel lymph node biopsy, especially in areas likely to have multiple or aberrant drainage patterns. This study aims to determine the incidence and characteristics of melanoma patients with negative lymphoscintigraphic findings and to review the management options and surgical recommendations.

Methods:
This is a retrospective study of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy between 2005 and 2016. Patients with nonvisualized lymph nodes on preoperative lymphoscintigraphy were compared in a 1:4 ratio with a randomly selected unmatched cohort drawn from all melanoma patients who underwent preoperative lymphoscintigraphy within the period of the study. Demographic, clinical, and outcome data were compared between these groups.

Results:
A negative lymphoscintigraphic scan was seen in 2.3 percent of all cases (25 of 1073). In both univariate and multivariate analyses, predictive patient- and tumor-specific factors for negative lymphoscintigraphy included older age and head and neck location. Patients with a nonvisualized sentinel lymph node had significantly worse overall survival compared with patients who had a visualized sentinel lymph node, but there was no difference in melanoma-specific survival. In 16 of the 25 cases (64 percent), at least one sentinel lymph node was found intraoperatively despite the negative lymphoscintigraphic findings.

Conclusions:
Older patients with head and neck melanomas are more likely to experience nodal nonvisualization on lymphoscintigraphy. In patients who have nodal nonvisualization, the surgeon should attempt sentinel lymph node biopsy at the time of excision of the primary lesion because a sentinel lymph node can still be found in a majority of cases, and it offers prognostic information.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Anatomical Basis of the Gastroepiploic Vascularized Lymph Node Transfer: A Radiographic Evaluation Using Computed Tomographic Angiography
Authors: Howell Anna C. , Gould Daniel J. , Mayfield Cory , Samakar Kamran , Hassani Cameron , Patel Ketan M. 
Published: July 2018

Background:
The omentum, nourished by the gastroepiploic vessels, has gained popularity as an option for vascularized lymph node transfer. The anatomy of the gastroepiploic vessels, omentum, and lymph nodes has not been investigated. The purpose of this article is to describe the right gastroepiploic artery and related structures by using computed tomographic angiography.

Methods:
A retrospective analysis was conducted on 34 patients who underwent computed tomographic angiography. Statistical models were applied to identify right gastroepiploic artery and lymph node anatomical characteristics.

Results:
The right gastroepiploic artery was identified in 33 of 34 patients. It was found to have a diameter of 2.49 ± 0.66 mm at its origin. The gastroduodenal artery length before right gastroepiploic artery takeoff was 3.09 ± 1.31 cm. Twenty-five patients had lymph nodes in the right gastroepiploic artery lymphosome. There were 2.7 ± 2.12 lymph nodes identified per patient. The distance from the right gastroepiploic artery origin to the most proximal lymph node was 3.99 ± 2.21 cm. The distance from the gastroepiploic artery origin to the third lymph node was 9.12 ± 5.06 cm. Each lymph node was within 7.00 ± 6.2 mm of the right gastroepiploic artery.

Conclusions:
When using the right gastroepiploic artery donor site for vascularized lymph node transfer, the plastic surgeon should anticipate using a pedicle length of 4 cm, a total flap length of 9 cm, and 3 cm of surrounding tissue to obtain at least three lymph nodes for transfer. Computed tomographic angiography is an effective imaging modality that can be used for patient-specific surgical navigation before vascularized lymph node transfer.
Sphenoid Dysplasia in Neurofibromatosis: Patterns of Presentation and Outcomes of Treatment
Authors: Naran Sanjay , Swanson Jordan W. , Ligh Cassandra A. , Shubinets Val , Taylor Jesse A. , Bartlett Scott P. 
Published: July 2018

Background:
Sphenoid wing dysplasia in patients with neurofibromatosis type 1 may result in challenging and significant changes, including ultimately vision loss. The authors describe the radiographic patterns of sphenoid dysmorphology with time and age, and the impact of surgical intervention on preservation of vision.

Methods:
A retrospective study was performed at a single pediatric hospital, identifying subjects with neurofibromatosis type 1. Records were reviewed in their entirety for each subject, with attention to ophthalmologic evaluation. Radiographic images were digitally analyzed and scored for sphenoid transformations on a grade of 0 to 3.

Results:
Fifty-two subjects were identified. On initial imaging, 42.31 percent had a normal sphenoid (grade 0), 32.69 percent had an abnormal contour (grade 1), 11.54 percent had thinning (grade 2), and 13.46 percent had a gross defect (grade 3). Among the 45 subjects with serial imaging, 55.56 percent demonstrated progression of the deformity of at least one grade. Deformity progression correlated with length of imaging interval. Enucleation was noted to occur more often in subjects with a gross sphenoid defect (p < 0.0001). Of subjects identified as having a gross sphenoid defect, 26.7 percent were managed using orbitosphenoid reconstruction with titanium mesh and cranial bone graft, and 33.3 percent were managed with soft-tissue debulking and canthopexy only. Vision was more likely to be preserved with early orbitosphenoid reconstruction (p < 0.05).

Conclusions:
Sphenoid dysplasia is a progressive disease. Loss of vision is associated with a gross defect, and appears to be better preserved with early orbitosphenoid reconstruction with titanium mesh and cranial bone graft.
Comparison of Pediatric Intercalary Allograft Reconstructions with and without a Free Vascularized Fibula
Authors: Houdek Matthew T. , Rose Peter S. , Milbrandt Todd A. , Stans Anthony A. , Moran Steven L. , Sim Franklin H. 
Published: July 2018

Background:
Lower extremity intercalary allograft reconstruction has traditionally been used to facilitate limb salvage. Combining the allograft with a free vascularized fibula graft has been described; however, there is a paucity of data comparing the outcome of these reconstructions.

Methods:
Twenty-nine pediatric patients (15 boys and 14 girls) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12 years. The most common diagnosis was osteosarcoma (n = 18). Patients underwent reconstruction with an allograft alone (n = 11) or supplemented with a free vascularized fibula graft (n = 18).

Results:
The mean time to union of the allograft was 11 months, with 10 patients requiring additional bone grafting. There was no difference in the need for an additional bone graft (OR, 0.87; p = 1.0) between patients with a free vascularized fibula graft and those without. The allograft was revised in three patients because of fracture (n = 2) and fracture and infection (n = 1). In all of these patients, the allograft was not supplemented with a free vascularized fibula graft (p < 0.001). Five patients underwent an amputation, most commonly for disease recurrence. At last follow-up, the mean Mankin and Musculoskeletal Tumor Society rating was 90 percent, with 19 patients (66 percent) who achieved a “good” or “excellent” outcome according to the Mankin score.

Conclusion:
Use of an intercalary allograft to reconstruct a lower extremity provides a durable means of reconstruction; however, supplementation with a free vascularized fibula graft reduces the risk of allograft revision.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
Ambulatory Blood Pressure Reactivity as a Moderator in the Association Between Daily Life Psychosocial Stress and Carotid Artery Atherosclerosis
Authors: Kamarck Thomas W. , Li Xingyuan , Wright Aidan G.C. , Muldoon Matthew F. , Manuck Stephen B. 
Published: July 2018

ABSTRACT

Objective
We examined whether associations between daily psychosocial stressor exposures and carotid artery intima-medial thickness (IMT) may be stronger among those showing larger stress-related cardiovascular reactivity (CVR) during the course of daily living.

Methods
A total of 474 healthy working adults (ages 30–54 years) collected ambulatory blood pressure and recorded their daily experiences, using electronic diaries, during two 2-day periods for a week. Measures of mean momentary task strain and social conflict were used as indices of stressor exposure, and partial regression coefficients linking momentary strain and conflict with ambulatory blood pressure fluctuations were used as measures of CVR. IMT was assessed in the carotid arteries using B-mode ultrasound.

Results
After covariate adjustment, associations between mean task strain exposure and IMT were significant among those high in CVR to strain (for systolic blood pressure, p = .006, for diastolic blood pressure, p = .011) but not among those low in strain CVR. Similarly, associations involving mean conflict exposure were significant among those high in CVR to social conflict (p < .001 for systolic blood pressure, p = .001 for diastolic blood pressure) but not among low social conflict reactors. Significant moderation effects were more consistently shown for task strain than for social conflict, but the overall pattern of results was robust across two different types of statistical modeling procedures.

Conclusions
Individual differences in CVR may moderate the effects of daily psychosocial stress on subclinical CVD among healthy employed adults. Using ecological momentary assessment to measure stress exposure as well as stress reactivity may facilitate our ability to detect these effects.
Automated Early Identification of an Excessive Air-in-Oil X-ray Tube Artifact That Mimics Acute Cerebral Infarct
Authors: Jaffe Tracy A. , Winslow James , Zhang Yakun , Allen Brian C. , Choudhury Kingshuk R. , Samei Ehsan 
Published: July 2018

Purpose
This study aimed to develop an automated, quantitative method to increase the likelihood of identifying and preventing such air-in-oil (AIO) artifact.

Methods
A 1-dimensional radial representation of the 2-dimensional noise power spectrum (NPS) was calculated from AIO artifact images and compared with artifact-free images. A quality control (QC) software program was modified to include measurements of NPS average frequency within the water section of daily phantom scans. Threshold values for each CT system were incorporated into daily QC.

Results
Noise power spectrum for AIO artifact images included a large low-frequency peak compared with artifact-free images; NPS average frequencies were 0.197 and 0.319 line pairs per millimeter for AIO artifact and artifact-free images, respectively. Automated QC successfully identified 3 AIO artifacts before detrimental clinical effect occurred.

Conclusions
Serious clinical problems associated with AIO artifact can be detected and avoided by incorporating NPS average frequency measurements of daily phantom images into an automated QC program.
Unusual and Diffuse Hypermetabolism in Routine 18F-FDG PET/CT of the Supra-aortic Vessels in Biopsy-Positive Giant Cell Arteritis
Authors: Flaus Anthime , Granjon Denise , Habouzit Vincent , Gaultier Jean-Baptiste , Prevot-Bitot Nathalie 
Published: July 2018

Abstract

18F-FDG PET-CT used to lack of resolution to detect vasculitis in the superficial cranial and cervical arteries. Very few cases, for which some of these arteries were visualized, are published, and the images were acquired using a dedicated PET protocol. We present a case, acquired using a routine whole-body protocol, with increased tracer uptake detected in vertebral arteries, internal and external carotid arteries, superficial temporal arteries, occipital arteries, maxillary arteries, facial arteries, and lingual arteries. It underlines the potential for newer-generation PET-CT system to assess vasculitis. 18F-FDG PET-CT may have an important role to detect and follow vasculitis in the future.
Analysis of Intramaxillary and Mid-Face Skeletal Asymmetry in a Three-Dimensional Model With Complete Unilateral Cleft Lip and Palate
Authors: Harikrishnan Pandurangan , Balakumaran Vasudevan 
Published: July 2018

Abstract
Cleft lip and palate is the commonest congenital craniofacial anomaly and also affects the facial bones. In a unilateral cleft lip and palate (UCLP), there is asymmetry in the mid-face and also within the maxilla between the cleft and non-cleft sides. The aim of this study is to develop a 3-dimensional model of an UCLP skull from a patient's cone-beam computed tomography and measure the asymmetry. The model is constructed with manual segmentation of all regions using MIMICS v14.0 and measurements were done by 3-matic software. Measurements in the mid-face and maxilla were carried out in all planes of interest. Asymmetry was present not only in the maxilla but extends to the orbital, zygomatic, and frontal bones. Through this methodology and model, asymmetric variations <0.5 mm could be assessed precisely thus having potential applications in treatment planning of craniofacial deformities.
The Outcome of Sling Retraction Technique in Microvascular Decompression for Hemifacial Spasm
Authors: Yang Debao , Tao Cheng , Zhou Shijun , Wang Zhimin 
Published: July 2018

Objective:
This study explored the technical characteristics and effectiveness of sling retraction technique in microvascular decompression for hemifacial spasm.

Methods:
Between January 2008 and May 2016, 158 patients affected by hemifacial spasm underwent microvascular decompression. Among them, the traditional technique was performed in 86 patients (A Group) and the sling retraction technique was used in 72 patients (B Group). The authors conducted a retrospective study and compared the surgical outcome of the 2 groups. The authors measured cure rate at 3 months and 5 years after microvascular decompression.

Results:
In the traditional technique group, the cure rate of microvascular decompression was 94.2% and 83.3%. While in the sling retraction technique group, the cure rate of microvascular decompression was 95.8% and 94.4%. Facial nerve palsy, hearing loss, meningitis, and ataxia were frequent complications in both 2 groups.

Conclusions:
The sling technique using biomedical glue is an effective and safe option for patients of hemifacial spasm. During the long-term follow-up, the sling retraction technique of microvascular decompression was more effective than the traditional technique, while there were no significant differences in the incidences of complications.
Malignant hyperthermia: still an issue for neuromuscular diseases?
Authors: De Wel Bram , Claeys Kristl G. 
Published: July 2018

Purpose of review
We will give an overview of neuromuscular disorders that can be linked with malignant hyperthermia or malignant hyperthermia-like reactions, and suggest an appropriate approach to interpret the risks.

Recent findings
An increasing number of neuromuscular phenotypes have been linked to malignant hyperthermia susceptibility (MHS). This is for an important part due to the highly variable phenotype associated with mutations in the ryanodine receptor 1 gene (RYR1), the gene most frequently associated with MHS. A RYR1-mutation or a clinical RYR1-phenotype does not automatically translate in MHS, but precautions should be taken nonetheless. In addition, several other genes and phenotypes are now considered to be associated with MHS. In contrast, several neuromuscular diseases that were long thought to be linked to MHS are now known to cause malignant hyperthermia-like reactions instead of malignant hyperthermia. This is highly relevant as not only the given preoperative advice differs, but also acute treatment.

Summary
This review provides a summary of current evidence linking certain neuromuscular diseases to malignant hyperthermia or malignant hyperthermia-like reactions. We provide a guide for the clinician, to determine which patients are at risk of malignant hyperthermia or malignant hyperthermia-like reactions perioperatively, and to ensure adequate treatment in case such a severe acute complication occurs.
Unfavorable Structural and Functional Outcomes in Myelin Oligodendrocyte Glycoprotein Antibody–Associated Optic Neuritis
Authors: Jelcic Ilijas , Hanson James V. M. , Lukas Sebastian , Weber Konrad P. , Landau Klara , Pless Misha , Reindl Markus , Weller Michael , Martin Roland , Lutterotti Andreas , Schippling Sven 
Published: July 2018

Background:
Recurrent optic neuritis (rON) associated with myelin oligodendrocyte glycoprotein (MOG)-specific antibodies has been initially reported to show a better clinical outcome than aquaporin-4 (AQP4)-seropositive ON in neuromyelitis optica spectrum disorder (NMOSD). Here, we characterize clinical and neuroimaging findings in severe cases of MOG antibody–positive and AQP4 antibody–negative bilateral rON.

Methods:
Three male adults with rON (ages 18, 44, and 63 years) were evaluated with optical coherence tomography (OCT), MRI, cerebrospinal fluid (CSF), and serological studies.

Results:
All patients experienced >7 relapses of ON with severe reduction of visual acuity and partial response to steroid treatment. Optic nerves were affected bilaterally, although unilateral relapses were more frequent than simultaneous bilateral recurrences. Patients were MOG-seropositive but repeatedly tested negative for AQP4 antibodies. OCT showed severe thinning of the peripapillary retinal nerve fiber layer. On MRI, contrast-enhancing lesions extended over more than half the length of the optic nerve. CSF analyses during ON episodes were normal. Severe visual deficits accumulated over time in 2 of 3 patients, despite immunosuppressive therapy.

Conclusions:
MOG-seropositive and AQP4-seronegative rON may be associated with an aggressive disease course and poor functional and structural outcomes. In contrast to previous reports, the severity and pattern of retinal and optic nerve damage closely resembled phenotypes commonly observed in AQP4-seropositive rON without fulfilling current diagnostic criteria for NMOSD.
High-resolution mapping of cancer cell networks using co-functional interactions
Authors: Boyle Evan A. , Pritchard Jonathan K. , Greenleaf William J. 
Published: July 2018

AbstractPowerful new technologies for perturbing genetic elements have expanded the study of genetic interactions in model systems ranging from yeast to human cell lines. However, technical artifacts can confound signal across genetic screens and limit the immense potential of parallel screening approaches. To address this problem, we devised a novel PCA-based method for eliminating these artifacts and bolstering sensitivity and specificity for detection of genetic interactions. Applying this strategy to a set of >300 whole genome CRISPR screens, we report ~1 million pairs of correlated “co-functional” genes that provide finer-scale information about cell compartments, biological pathways, and protein complexes than traditional gene sets. Lastly, we employed a gene community detection approach to implicate core genes for cancer growth and compress signal from functionally related genes in the same community into a single score. This work establishes new algorithms for probing cancer cell networks and motivates the acquisition of further CRISPR screen data across diverse genotypes and cell types to further resolve the complexity of cell signaling processes.