bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Unstable Pediatric Tibia Shaft Fractures in Finland
Authors: Stenroos Antti , Jalkanen Jenni , Sinikumpu Juha-Jaakko , Palmu Sauli , Koskimies-Virta Eeva , Laaksonen Topi , Nietosvaara Yrjänä 
Published: February 2018

Background Surgical treatment of pediatric tibia shaft fractures has gained popularity despite closed reduction and cast-immobilization providing good long-term results. There is no consensus about optimal methods and satisfactory quality of treatment.
Materials and Methods During 2010 to 2014, 226 pediatric patients were treated under anesthesia for tibia shaft fractures in Finland's five university hospitals. A total of 164 (73%) patients had closed fractures of the tibia or both tibia and fibula without other injuries (62 tibia only and 102 both tibia and fibula). Forty-one (18%) had open tibia fractures, 16 had additional fractures, and 5 (2%) had sustained a polytrauma (Injury Severity Score [ISS] > 15). Treatment methods, follow-up protocols, complications, and the outcome were analyzed.
Results A total of 143 (63%) of the tibia fractures were treated surgically: 87 (53%) closed fractures, 36 (88%) open fractures, 15 (94%) with additional fractures, and 5 (2%) polytrauma patients. The rate of surgical treatment of closed tibia fractures was significantly higher in patients older than 10 and in patients with a concomitant fibula fracture. Fasciotomy was done in 33 (15%) patients. Reoperations were performed in 13 (6%) patients because of unsatisfactory treatment (inappropriate primary reduction 6, malunion 6, and non-union 1). There were no differences between the five university hospitals in treatment or follow-up protocols.
Conclusion Internal fixation is used for the majority of tibia shaft fractures treated under anesthesia in university hospitals in Finland. Serious fracture or treatment related complications are very rare, but the percentage (6%) of re-operations because of unsatisfactory standard of treatment should be lower and could probably be improved by concentrating internal fixation to fewer hands. A prospective randomized controlled trial comparing non-operative treatment to intramedullary nailing in pediatric tibia fractures should be performed.
Anterior Knee Pain in Children and Adolescents: Overview and Management
Authors: Slotkin Steven , Thome Andrew , Ricketts Cassandra , Georgiadis Andrew , Cruz Aristides , Seeley Mark 
Published: February 2018

AbstractAnterior knee pain (AKP) is a common presenting complaint for pediatricians and orthopaedic surgeons and is often seen in young athletes. AKP is multifactorial and has a broad differential diagnosis. The growth changes, biomechanics, and anatomy around the knee add to the complexity of diagnosis and treatment of AKP. Common causes of AKP include Osgood–Schlatter's disease, patellar tendinitis, and patellofemoral instability. In the diagnosis of AKP, it is important to rule out serious and morbid causes of pain, including infection and tumor. It is crucial to complete a detailed history and physical examination and obtain appropriate imaging studies. In general, the majority of patients will respond to nonoperative measures targeted to correct neuromuscular control and kinetic chain dysfunction.
Effect of Additional Treatments Combined with Conventional Therapies in Pregnant Patients with High-Risk Antiphospholipid Syndrome: A Multicentre Study
Authors: Tonello Marta , Hoxha Ariela , Sciascia Savino , Cuadrado Maria , Latino José , Udry Sebastian , Reshetnyak Tatiana , Costedoat-Chalumeau Nathalie , Morel Nathalie , Marozio Luca , Tincani Angela , Andreoli Laura , Haladyj Ewa , Meroni Pier , Gerosa Maria , Alijotas-Reig Jaume , Tenti Sara , Mayer-Pickel Karoline , Simchen Michal , Bertero Maria , De Carolis Sara , Ramoni Véronique , Mekinian Arsène , Grandone Elvira , Maina Aldo , Serrano Fátima , Pengo Vittorio , Khamashta Munther , Ruffatti Amelia 
Published: February 2018

AbstractThe effect of additional treatments combined with conventional therapy on pregnancy outcomes was examined in high-risk primary antiphospholipid syndrome (PAPS) patients to identify the most effective treatment strategy. The study's inclusion criteria were (1) positivity to lupus anticoagulant alone or associated with anticardiolipin and/or anti-β2 glycoprotein I antibodies; (2) a history of severe maternal–foetal complications (Group I) or a history of one or more pregnancies refractory to conventional therapy leading to unexplained foetal deaths not associated with severe maternal–foetal complications (Group II). Two different additional treatments were considered: oral—low-dose steroids (10–20 mg prednisone daily) and/or 200 to 400 mg daily doses of hydroxychloroquine and parenteral—intravenous immunoglobulins at 2 g/kg per month and/or plasma exchange. The study's primary outcomes were live birth rates and pregnancy complications. A total of 194 pregnant PAPS patients attending 20 tertiary centres were retrospectively enrolled. Hydroxychloroquine was found to be linked to a significantly higher live birth rate with respect to the other oral treatments in the Group II patients. The high (400 mg) versus low (200 mg) doses of hydroxychloroquine (p = 0.036) and its administration before versus during pregnancy (p = 0.021) were associated with a significantly higher live birth rate. Hydroxychloroquine therapy appeared particularly efficacious in the PAPS patients without previous thrombosis. Parenteral treatments were associated with a significantly higher live birth rate with respect to the oral ones (p = 0.037), particularly in the Group I patients. In conclusion, some additional treatments were found to be safe and efficacious in high-risk PAPS pregnant women.
Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers
Authors: Mullassery Dhanya , Chhabra Sumita , Babu Ashik , Iacona Roberta , Blackburn Simon , Cross Kate , De Coppi Paolo , Baillie Colin , Kenny Simon , Curry Joe 
Published: February 2018

Aim Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers.
Materials and Methods This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups.
Results From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18–48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B (p = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B (p = 0.48).
Conclusion The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.
The Association between Cervical Exam after Ripening with Foley Balloon Catheter and Outcomes of Nulliparous Labor Induction
Authors: Palatnik Anna , Peress Danielle , Grobman William , Battarbee Ashley 
Published: February 2018

Objective Evaluate the association between cervical examination after ripening with Foley catheter and labor induction outcomes.
Materials and Methods In this retrospective cohort, nulliparous women with singleton, viable gestation undergoing cervical ripening with Foley catheter were compared based on cervical status after catheter removal or expulsion: favorable (modified Bishop score ≥ 5) or unfavorable (score < 5). Bivariable and multivariable analyses were performed to determine whether cervical examination postripening was associated with time to delivery and chance of vaginal delivery.
Results A total of 774 women were eligible. Women with favorable examination postripening had lower body mass index (BMI) and more favorable admission cervical examination. The frequency of vaginal delivery was higher in women with favorable cervical examination postripening (57.9% versus 46.8%, p < 0.01). Median durations from Foley removal or expulsion to complete dilation (8.6 h versus 11.5 h) and vaginal delivery (10.4 h versus 13.2 h) were shorter for women with favorable cervical examination postripening (p < 0.001). In multivariable analysis, favorable examination postripening remained associated with vaginal delivery (adjusted odds ratio 1.39, 95% confidence interval 1.04–1.87), and time to vaginal delivery (adjusted hazard ratio 1.39, 95% confidence interval 1.13–1.70).
Conclusion A favorable modified Bishop score after cervical ripening with Foley balloon catheter is associated with higher chance of vaginal delivery and shorter labor duration.
Die Aufmerksamkeitsdefizit- und Hyperaktivitätsstörung (ADHS) in der Erwachsenenpsychiatrie: Erfassung der ADHS-12-Monatsprävalenz, der Risikofaktoren und Komorbidität bei ADHS
Authors: Miesch Matthias , Deister Arno 
Published: February 2018

Zusammenfassung
Anliegen und Methodik Die ADHS-12-Monats-Prävalenz, Risikofaktoren und Komorbidität wurden an einem Kollektiv vollstationärer psychiatrischer Patienten erfasst.
Ergebnisse Es fanden sich eine ADHS-12 Monats-Prävalenz von 59,0 % (schwere Ausprägung bei 33,1 %), gehäuft komorbide Störungen (Depressionen: 92,9 %, bipolare Störungen: 5,1 %, Angststörungen: 28,6 %, emotional-instabile Persönlichkeitsstörungen: 30,6 %, ängstliche Persönlichkeitsstörungen: 31,6 %, abhängige Persönlichkeitsstörungen: 18,4 %, kombinierte Persönlichkeitsstörungen: 25,5 %, zwanghafte Persönlichkeitsstörungen: 10,2 %, PTBS: 26,5 %, Restless-legs Syndrome: 25,5 %, Adipositas: 24,5 %, Essstörungen: 11,2 %, Teilleistungsstörungen: 45,9 %, Nikotinabhängigkeiten: 51,0 %, Alkoholabhängigkeiten: 4,1 % und Substanzabhängigkeiten: 7,1 %), Risikofaktoren für ADHS, eine hohe genetische Belastung (72,4 %) und Probleme in der psychosozialen Anpassung.
Schlussfolgerungen Aufgrund der erhöhten Prävalenz der ADHS bei stationären psychiatrischen Patienten sollten diese auf das Vorliegen einer ADHS-Diagnose mittels Fragebögen überprüft und komorbide Störungen miterfasst werden.
Chirurgische und metabolische Komplikationen nach bariatrischen Operationen – Ernährungsempfehlungen
Authors: Weimann Arved , Oberänder Nadine , Hösel Jana 
Published: February 2018

ZusammenfassungDer Artikel gibt eine Übersicht chirurgischer und metabolischer Komplikationen nach bariatrischer Chirurgie, deren Behandlung nur interdisziplinär erfolgen kann. Schwere chirurgische Komplikationen sind selten und die Mortalität sehr niedrig. Es liegen jedoch auch Fallberichte mit Mangelernährung durch Kurzdarmsyndrom und Indikation zur parenteralen Ernährung vor. Die chirurgische Induktion eines Gewichtsverlustes bedeutet eine veränderte Nahrungspassage und -absorption. Bereits präoperativ bestehende Ernährungsdefizite müssen einkalkuliert werden. Die Prävention einer Osteoporose oder Wernicke-Enzephalopathie erfordert frühzeitige postoperative Verlaufskontrollen mit Ernährungsberatung und lebenslanger Supplementierung mit Vitaminen und Spurenelementen.
A sharp 𝑘-plane Strichartz inequality for the Schrödinger equation
Authors: Bennett Jonathan , Bez Neal , Flock Taryn , Gutiérrez Susana , Iliopoulou Marina 
Published: February 2018

We prove that

‖
X
(

|

u

|

2

)

‖

L

t
,
ℓ

3

≤
C
‖
f

‖

L
2

(

R

2

)

2

,

\begin{equation*} \|X(|u|^2)\|_{L^3_{t,\ell }}\leq C\|f\|_{L^2(\mathbb {R}^2)}^2, \end{equation*}

where

u
(
x
,
t
)

u(x,t)

is the solution to the linear time-dependent Schrödinger equation on

R

2

\mathbb {R}^2

with initial datum

f
f

and

X
X

is the (spatial) X-ray transform on

R

2

\mathbb {R}^2

. In particular, we identify the best constant

C
C

and show that a datum

f
f

is an extremiser if and only if it is a gaussian. We also establish bounds of this type in higher dimensions

d
d

, where the X-ray transform is replaced by the

k
k

-plane transform for any

1
≤
k
≤
d
−
1

1\leq k\leq d-1

. In the process we obtain sharp

L
2

(
μ
)

L^2(\mu )

bounds on Fourier extension operators associated with certain high-dimensional spheres involving measures

μ
\mu

supported on natural “co-

k
k

-planarity” sets.
MIRA: an R package for DNA methylation-based inference of regulatory activity
Authors: Lawson John T , Tomazou Eleni M , Bock Christoph , Sheffield Nathan C 
Published: February 2018

Abstract

Summary
DNA methylation contains information about the regulatory state of the cell. MIRA aggregates genome-scale DNA methylation data into a DNA methylation profile for a given region set with shared biological annotation. Using this profile, MIRA infers and scores the collective regulatory activity for the region set. MIRA facilitates regulatory analysis in situations where classical regulatory assays would be difficult and allows public sources of region sets to be leveraged for novel insight into the regulatory state of DNA methylation datasets.

Availability and implementation
http://bioconductor.org/packages/MIRA.
Flucytosine resistance in Cryptococcus gattii is indirectly mediated by the FCY2-FCY1-FUR1 pathway
Authors: Vu Kiem , Thompson George R , Roe Chandler C , Sykes Jane E , Dreibe Elizabeth M , Lockhart Shawn R , Meyer Wieland , Engelthaler David M , Gelli Angie 
Published: February 2018

Abstract
Cryptococcosis is an opportunistic fungal infection caused by members of the two sibling species complexes: Cryptococcus neoformans and Cryptococcus gattii. Flucytosine (5FC) is one of the most widely used antifungals against Cryptococcus spp., yet very few studies have looked at the molecular mechanisms responsible for 5FC resistance in this pathogen. In this study, we examined 11 C. gattii clinical isolates of the major molecular type VGIII based on differential 5FC susceptibility and asked whether there were genomic changes in the key genes involved in flucytosine metabolism. Susceptibility assays and sequencing analysis revealed an association between a point mutation in the cytosine deaminase gene (FCY1) and 5FC resistance in two of the studied 5FC resistant C. gattii VGIII clinical isolates, B9322 and JS5. This mutation results in the replacement of arginine for histidine at position 29 and occurs within a variable stretch of amino acids. Heterologous expression of FCY1 and spot sensitivity assays, however, demonstrated that this point mutation did not have any effect on FCY1 activities and was not responsible for 5FC resistance. Comparative sequence analysis further showed that no changes in the amino acid sequence and no genomic alterations were observed within 1 kb of the upstream and downstream sequences of either cytosine permeases (FCY2-4) or uracil phosphoribosyltransferase (FUR1) genes in 5FC resistant and 5FC susceptible C. gattii VGIII isolates. The herein obtained results suggest that the observed 5FC resistance in the isolates B9322 and JS5 is due to changes in unknown protein(s) or pathway(s) that regulate flucytosine metabolism.
Learning in Practice: A Valuation of Context in Time-Variable Medical Training
Authors: Teunissen Pim W. , Kogan Jennifer R. , ten Cate Olle , Gruppen Larry D. , Lingard Lorelei A. 
Published: February 2018

The logical consequence of implementing competency-based education is moving to time-variable training. Competency-based, time-variable training (CBTVT) requires an understanding of how learners interact with their learning context and how that leads to competence. In this article, the authors discuss this relationship. They first explain that the time required to achieve competence in clinical practice depends on the availability of clinical experiences that are conducive to ongoing competence development. This requires both curricular flexibility in light of the differences in individual learners’ development and a balance between longitudinal placements and transitions to different environments.
Along with the deliberate use of the opportunities that learning environments offer, there is value for learners in spending ample time-in-context. For instance, guided independence is possible when trainees do not progress immediately after meeting curricular learning objectives. Next, the potential implications of CBTVT can be illustrated by two learning perspectives—Sfard’s acquisition and participation metaphors—which leads to the assertion that competence is both an individual characteristic and a quality that emerges from a purposeful social interaction between individuals and their context. This theory recognizes that the deliberate use of context could be used to approach learning as acquiring collective competence.
Based on this relationship between learner, context, and competence, the authors propose an approach to CBTVT that recognizes that all learners will have to meet a number of standard preset learning targets in their workplace, while still having room for further context-specific competence development and personal growth within strategically organized learning environments.
Competency-Based, Time-Variable Education in the Health Professions: Crossroads
Authors: Lucey Catherine R. , Thibault George E. , ten Cate Olle 
Published: February 2018

Health care systems around the world are transforming to align with the needs of 21st-century patients and populations. Transformation must also occur in the educational systems that prepare the health professionals who deliver care, advance discovery, and educate the next generation of physicians in these evolving systems. Competency-based, time-variable education, a comprehensive educational strategy guided by the roles and responsibilities that health professionals must assume to meet the needs of contemporary patients and communities, has the potential to catalyze optimization of educational and health care delivery systems. By designing educational and assessment programs that require learners to meet specific competencies before transitioning between the stages of formal education and into practice, this framework assures the public that every physician is capable of providing high-quality care. By engaging learners as partners in assessment, competency-based, time-variable education prepares graduates for careers as lifelong learners. While the medical education community has embraced the notion of competencies as a guiding framework for educational institutions, the structure and conduct of formal educational programs remain more aligned with a time-based, competency-variable paradigm.
The authors outline the rationale behind this recommended shift to a competency-based, time-variable education system. They then introduce the other articles included in this supplement to Academic Medicine, which summarize the history of, theories behind, examples demonstrating, and challenges associated with competency-based, time-variable education in the health professions.
Influence of Cardiac Output on the Pharmacokinetics of Sufentanil in Anesthetized Pigs
Authors: Birkholz Torsten , Leuthold Christian , Schmidt Joachim , Ihmsen Harald , Schüttler Jürgen , Jeleazcov Christian 
Published: February 2018

Abstract

Background
Sufentanil is used for general anesthesia and analgesia. The study aim was to determine the effect of pharmacologically induced changes in cardiac output on the pharmacokinetics of sufentanil in anesthetized pigs.

Methods
Twenty-four pigs were randomly assigned to low, high, and control cardiac output groups. Cardiac output was decreased or increased from baseline by at least 40%, or maintained within ± 10% of baseline, respectively. Sufentanil was administered as a bolus followed by a continuous infusion for 120 min. Timed arterial samples were drawn for sufentanil concentration measurements.

Results
Data from 20 animals were analyzed. The cardiac outputs (means ± SD) were 2.9 ± 0.7, 5.4 ± 0.7, and 9.6 ± 1.6 l/min in the low, control, and high cardiac output groups, respectively. The parameters of the two-compartment pharmacokinetic model for these cardiac outputs were: CL1: 0.9, 1.2, and 1.7 l/min; CL2: 0.9, 3.1, and 6.9 l/min; V1: 1.6, 2.9, and 5.2 l; and V2: 27.5, 47.0, and 79.8 l, respectively. Simulated sufentanil doses to maintain a target plasma concentration of 0.5 ng/ml for 3 h were 99.5, 128.6, and 157.6 μg for cardiac outputs of 3, 5, and 7 l/min, respectively. The context-sensitive half-times for these cardiac outputs increased from 3.1 to 19.9 and 25.9 min, respectively.

Conclusions
Cardiac output influences the pharmacokinetics of sufentanil. Simulations suggest that in the case of increased cardiac output, the dose should be increased to avoid inadequate drug effect at the expense of prolonged recovery, whereas for low cardiac output the dose should be reduced, and a faster recovery may be expected.
Survival and Safety Outcomes of ICU Patients Discharged Directly Home—A Direct From ICU Sent Home Study*
Authors: Lau Vincent I. , Lam Joyce N. H. , Basmaji John , Priestap Fran A. , Ball Ian M. 
Published: February 2018

Objectives:
Evaluate outcomes (mortality, morbidity, unplanned return visits) of patients who are discharged directly to home from the ICU.

Design:
Prospective cohort study.

Setting:
Two tertiary care medical-surgical-trauma ICUs at Canadian hospitals over 1 year (February 2016–2017).

Subjects:
All adult patients who were either discharged directly to home (Recruited and Nonrecruited cohorts) from ICU or discharged home within 24 hours after ward transfer (Ward Transfer cohort).

Interventions:
Direct discharge home from ICU or discharge home within 24 hours of ward transfer from ICU.

Measurements and Main Results:
One-hundred ninety-eight patients were in the study, 100 patients in the discharged directly to home Recruited arm, 37 patients in the discharged directly to home Nonrecruited arm, and 61 patients in the Ward cohort. All three patient cohorts had 0% mortality at 8 weeks post discharge. The unplanned return visit rate for the Recruited cohort was 24% (emergency department 18%, Ward 4%, ICU 1%), whereas the rate for the Nonrecruited cohort was 52% (emergency department 34%, Ward 14%, ICU 3%) and the Ward Transfer cohort was 46% (emergency department 17%, Ward 26%, ICU 3%) (p = 0.005). No home support was available for 7% of the discharged directly to home Recruited cohort. Twenty-four percent of patients had funded home care nursing, but the majority of patients (81%) relied on help from friends/family.

Conclusions:
Recruited discharged directly to home patients experienced very good 8-week postdischarge outcomes with 0% mortality and a low rate of ICU readmission (1%) or ward readmission (4%), but not an insignificant rate of emergency department visits (18%). Recruited discharged directly to home patients had better outcomes compared with nonrecruited discharged directly to home patients and patients transferred briefly to the ward prior to discharge home. Future work should include derivation of a clinical prediction tool to identify patient characteristics that make discharged directly to home safe and a randomized control trial to compare discharged directly to home with short stay ward transfers.