bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clubfoot Etiology: A Meta-Analysis and Systematic Review of Observational and Randomized Trials
Authors: Chen Cynthia , Kaushal Neil , Scher David M. , Doyle Shevaun M. , Blanco John S. , Dodwell Emily R. 
Published: June 2018

Background:Clubfoot is a common congenital anomaly with multiple potential risk factors. Identification of modifiable risk factors may minimize future incidence of clubfoot. The aim of this meta-analysis was to systematically review and analyze the best clinical evidence regarding risk factors associated with clubfoot.Methods:Medline, Embase, and Cochrane databases were systematically searched from 1967 to May 11, 2016 for studies reporting risk factors for clubfoot. Randomized trials and observational studies were eligible for inclusion, and assessed in duplicate. Study quality was assessed with the Newcastle-Ottawa Scale or Cochrane risk of bias tool; low quality studies were excluded, all randomized trials were included. Two reviewers extracted data independently. This meta-analysis was conducted in accordance with PRISMA guidelines. Pooled effect estimates for the odds of clubfoot were calculated using random or fixed-effects models based on heterogeneity.Results:Forty-two studies (28 case-control, 10 cohort, 4 randomized trials) comprising 31,844 clubfoot cases and 6,604,013 controls were included. Risk factors associated with increased odds of clubfoot included maternal smoking [odds ratio (OR)=1.65; 95% confidence interval (CI), 1.54-1.78], paternal smoking (OR=1.72; 95% CI, 1.05-2.84), maternal body mass index >30 (OR=1.46; 95% CI, 1.29-1.65), family history (OR=7.80; 95% CI, 4.04-15.04), amniocentesis (OR=2.08; 95% CI, 1.34-3.21), selective serotonin reuptake inhibitor exposure (OR=1.78; 95% CI, 1.34-2.37) maternal single status (OR=1.17; 95% CI, 1.11-1.23), gestational diabetes (OR=1.40; 95% CI, 1.13-1.72), nulliparity (OR=1.32; 95% CI, 1.19-1.45), male sex (OR=1.68; 95% CI, 1.48-1.94), and aboriginal Australian race (OR=2.35; 95% CI, 1.63-3.38).Conclusions:Smoking, maternal obesity, family history, amniocentesis, and some selective serotonin reuptake inhibitor exposures are the most clinically relevant exposures associated with increased odds of clubfoot, with family history representing the greatest risk. Recognition of modifiable risk factors may help in counseling patients, and minimizing clubfoot incidence.Level of Evidence:Level II.
Docking of the Femoral Head Following Closed Reduction for DDH: Does it Really Occur?
Authors: Talathi Nakul S. , Chauvin Nancy A. , Sankar Wudbhav N. 
Published: June 2018

Background:
It has been suggested that the femoral head can “dock” deeper into the acetabulum after initial closed reduction (CR) for developmental dysplasia of the hip (DDH). The purpose of this study was to quantify the interval change in femoral head position between immediate postoperative magnetic resonance imaging (MRI) and follow-up imaging at ~3 weeks.

Methods:
A retrospective review of 29 patients (30 hips) who underwent CR and spica casting for DDH was conducted. Immediate postoperative and average 3-week follow-up MRI scans in spica were performed on all patients. On both scans, 2 blinded reviewers measured the following indices: the distance between the femoral head and the acetabulum on midcoronal and midaxial images, the displacement of the center of femoral head from Hilgenreiner’s line in the coronal and axial plane, and the left-right displacement of the center of femoral head from Perkins line. Measurements were averaged between the 2 reviewers and the interval change in femoral head position between the immediate postoperative and follow-up scans were compared.

Results:
There were 26 female individuals and 3 male individuals in our series with a mean age of 7.6 months (range, 4 to 13 mo). Follow-up MRI scans were performed at an average of 23.8 days (range, 13 to 46 d). On the basis of the averaged measurements from both readers, the distance between the femoral head and the acetabulum decreased significantly on coronal measurement and on all 3 axial measurements between initial and follow-up MRI. In addition, the position of the femoral head became significantly more medial, more anterior, and more cranial relative to the acetabulum. The interrater correlation coefficient between both readers across all measurements was 0.731.

Conclusions:
These findings provide evidence that femoral head position within the acetabulum improves even over a short time period following initial CR for DDH, suggesting that the “docking” phenomenon may in fact occur.

Level of Evidence:
Level IV—therapeutic study.
Anxiety, depressive symptoms, and cardiac autonomic function in perimenopausal and postmenopausal women with hot flashes: a brief report
Authors: Fu Polly , Gibson Carolyn J. , Mendes Wendy Berry , Schembri Michael , Huang Alison J. 
Published: June 2018

AbstractObjective:The aim of the study was to examine whether anxiety and depressive symptoms are associated with an adverse cardiac autonomic profile among midlife women with hot flashes.Methods:Anxiety and depressive symptoms were evaluated by validated self-administered questionnaires among peri- and postmenopausal women in a randomized trial of slow-paced respiration for hot flashes. Pre-ejection period (PEP), a marker of sympathetic activation, and respiratory sinus arrhythmia (RSA), a marker of parasympathetic activation, were measured at baseline and 12 weeks using impedance cardiography and electocardiography. Multivariable repeated measures linear regression models examined associations between anxiety and depression symptoms and autonomic markers, corrected for multiple comparisons with Benjamini–Hochberg procedure, and adjusted for age and body mass index.Results:Among the 121 participants, greater state anxiety was associated with shorter PEP, reflecting higher sympathetic activity (β = −0.24,P = 0.02). Greater trait anxiety and cognitive anxiety were associated with lower RSA, reflecting decreased parasympathetic activity (β = −0.03,P < 0.01 for Spielberger Trait Anxiety;β = −0.06,P = 0.02 for Hospital Anxiety and Depression Scale [HADS] Anxiety Subscale). Greater depressive symptoms were associated with lower RSA (β = −0.06,P = 0.03 for HADS Depression Subscale;β = −0.03,P = 0.04 for Beck Depression Inventory).Conclusions:Among peri- and postmenopausal women with hot flashes, greater self-reported anxiety and depressive symptoms were associated with lower levels of resting cardiac parasympathetic activity, and greater state anxiety was associated with higher levels of cardiac sympathetic activity. Findings suggest that midlife women with increased anxiety and depressive symptoms may have an unfavorable cardiac autonomic profile with potential implications for their overall cardiovascular risk.
Treatment Delay Impact on Open Reduction Internal Fixation of Mandibular Fractures: A Systematic Review
Authors: Stone Nicholas , Corneman Alex , Sandre Anthony R. , Farrokhyar Forough , Thoma Achilleas , Cooper Michael J. 
Published: June 2018

Background:
The impact of mandible fracture treatment delay has been contested in the literature for decades, with conventional wisdom favoring earlier surgical treatment to prevent postoperative complications, primarily infection. Through a systematic review of all available evidence, this study aims to determine whether delay to open reduction and internal fixation of traumatic mandibular fractures influences outcomes.

Methods:
MEDLINE, EMBASE, CINAHL, and Web of Science were systematically searched for English language literature pertaining to the above research question and screened in duplicate. Methodological quality scoring was performed using MINORS criteria. Qualitative and quantitative findings from relevant studies are presented.

Results:
Twenty eligible studies including 2,671 patients had open reduction internal fixation, with or without adjunct mandibulomaxillary fixation. All studies were observational cohort or case-control studies of low methodological quality with a mean MINORS score of 6.5 of 16 (40.6%) for noncomparative studies and 11.2 of 24 (46.7%) for comparative studies. Only 5 of 20 (25%) studies recommended earlier treatment. Due to insufficient reporting of data and study heterogeneity, the impact of treatment delay on complications could not be quantitatively analyzed.

Conclusions:
There is substantial heterogeneity and no consensus on the definition of “early” versus “delayed” surgical treatment for patients with traumatic mandibular fractures. The majority of included studies do not make a recommendation for earlier treatment. Future, well-designed prospective studies are essential to determine if there is an optimal surgical treatment delay of mandibular fractures that mitigates the risk of infectious and noninfectious complications.
Acute Glaucoma Following Cyanoacrylate Glue Patch for Corneal Perforation
Authors: Vasquez-Perez Alfonso , Matarazzo Francesco , Mandal Niraj , Tuft Stephen 
Published: June 2018

Purpose:
To describe a case of acute glaucoma after cyanoacrylate gluing for a nontraumatic central corneal perforation.

Methods:
A 55-year-old woman with history of rheumatoid arthritis and severe dry eye presented to emergency with a right central corneal perforation. She was treated successfully with the use cyanoacrylate glue patch but iridocorneal adhesions remained. The next day she presented with ocular pain, headaches, and vomiting. On examination she had shallow anterior chamber (AC) with no aqueous leakage but her intraocular pressure (IOP) was 56 mm Hg measured with rebound tonometry. An anterior segment optical coherence tomography scan showed a 360 degrees central iris adhesion with shallow AC. Topical and oral treatment for acute glaucoma was given that decreased her IOP. She then underwent urgent surgery to release the iridocorneal adhesions and restore aqueous flow that was achieved without replacing the glue patch.

Results:
One day postoperatively her right eye was comfortable and her IOP measurement remained within normal limits. The AC was deep with no iridocorneal adhesions.

Conclusions:
Close monitoring of the IOP is recommendable in central corneal perforations with iris adhesions managed with cyanoacrylate glue due to the potential developing of aqueous blockage.
A Systematic Review and Meta-Analysis on Outcomes and Complications of Percutaneous Endoscopic Versus Radiologic Gastrostomy for Enteral Feeding
Authors: Strijbos Denise , Keszthelyi Daniel , Bogie Roel M.M. , Gilissen Lennard P.L. , Lacko Martin , Hoeijmakers Janneke G.J. , van der Leij Christiaan , de Ridder Rogier , de Haan Michiel W. , Masclee Ad A.M. 
Published: June 2018

Background:
The optimal technique for long-term enteral feeding has not yet been established. Both percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are widely used. Aim was to extensively review outcomes of PEG and PRG.

Materials and Methods:
A systematic review using Medline, Embase, and Cochrane was performed, using standardized tools for assessing bias. Main outcomes were infectious and tube-related complications, procedure related and 30-day mortality. Pooled risk differences (RDs) with corresponding 95% confidence intervals (95% CIs) were calculated using random effects. Arcsine transformations were applied.

Results:
In total, 344 studies were identified, of which 16 were included, reporting on 934 PEGs and 1093 PRGs. No differences were found for infectious complications [RD, 0.03 (−0.05 to 0.11)], procedure-related mortality [RD, 0.01 (−0.04 to 0.06)], or 30-day mortality [RD, 0.06 (−0.01 to 0.13)]. Tube-related complications were higher in PRG [RD, 0.16 (0.06-0.26)]. Subgroup analysis was performed for head and neck cancer (HNC) and motor neuron disease. In HNC, this revealed significantly lower tube-related complications and procedure-related mortality after PEG. In motor neuron disease, no differences were seen. The level of evidence appears sufficient considering the low degree of heterogeneity.

Conclusions:
No differences were found with regard to mortality or infectious complications. PEG showed lower risk of tube-related complications. Subgroup analysis revealed PEG to be favorable in HNC based on lower rates of procedure-related mortality and tube-related complications. Local experience and availability should be taken into account in the decision process.
Non-alcoholic fatty liver disease and hypertension: coprevalent or correlated?
Authors: Oikonomou Dimitrios , Georgiopoulos Georgios , Katsi Vassiliki , Kourek Chris , Tsioufis Constantinos , Alexopoulou Alexendra , Koutli Evaggelia , Tousoulis Dimitrios 
Published: June 2018

Objective
To provide a comprehensive review summarizing the existing evidence on the association between nonalcoholic fatty liver disease (NAFLD) and hypertension (HT) independent of other components of metabolic syndrome.

Methods
We searched the literature through Medline and the Cochrane Library for studies evaluating the relationship between hypertension and fatty liver disease.

Results
Studies testing this association are limited, but agree that HT and fatty liver disease are inter-related independent of other components of the metabolic syndrome such as obesity and diabetes mellitus. Clinical evidence shows that NAFLD is associated with new-onset HT, whereas increased blood pressure is related to the development of fatty liver disease and the possible subsequent progression to liver fibrosis. Insulin resistance and activation of the renin–angiotensin–aldosterone system (RAAS) might provide potential pathophysiologic links between these clinical entities. Until further evidence is available, patients with HT should be meticulously evaluated and treated for fatty liver disease and vice versa. RAAS inhibitors have been tested in NAFLD, presenting a favorable profile by decreasing insulin resistance and fibrosis progression.

Conclusion
NAFLD and HT are associated independent of traditional cardiovascular risk factors. Insulin resistance appears to be the main linking mechanism. Although RAAS inhibitors are the most beneficial treatment option for HT in patients with NAFLD, randomized studies on the administration of these agents in HT patients with NAFDL are warranted to provide optimal treatment options in these high cardiovascular risk individuals.
Comparison of Clinical Methods With the Faecal Gluten Immunogenic Peptide to Assess Gluten Intake in Coeliac Disease
Authors: Gerasimidis Konstantinos , Zafeiropoulou Konstantina , Mackinder Mary , Ijaz Umer Z , Duncan Hazel , Buchanan Elaine , Cardigan Tracey , Edwards Christine A. , McGrogan Paraic , Russell Richard K. 
Published: June 2018

ABSTRACTObjectives:Detection of faecal gluten immunogenic peptides (GIP) is a biomarker of recent gluten consumption. GIP levels can be used to monitor gluten intake and compliment clinical methods to evaluate compliance to gluten‐free diet (GFD). In the present study, recent gluten intake was measured by GIP in children with coeliac disease (CD) and compared to routine clinical measures to evaluate GFD compliance.Methods:GIP was measured in 90 samples from 63 CD children (44 previously and 19 newly diagnosed with follow‐up samples at 6 and 12 months on GFD). Compliance to GFD was evaluated based on clinical assessment, tissue transglutaminase (tTG) levels, and Biagi score.Results:GIP was detectable in 16% of patients with previous CD diagnosis on GFD. Body mass index z score (P = 0.774), height z score (P = 0.723), haemoglobin concentration (P = 0.233), age (P = 0.448), sex (P = 0.734), or disease duration (P = 0.488) did not differ between those with detectable and nondetectable GIP. In newly diagnosed patients, on gluten‐containing diet, GIP was detectable in 95% of them. Following GFD initiation, GIP decreased (P < 0.001); 17% and 27% had detectable levels at 6 and 12 months, respectively. Compared to GIP, the Biagi score, tTG, and clinical assessment presented sensitivity of 17%, 42%, and 17%, respectively. Likewise, GIP was detectable in 16%, 16%, and 14% of patients evaluated as GFD compliant according to the Biagi score, tTG, and clinical assessment, respectively. A combination of methods did not improve identification of patients who were noncompliant.Conclusions:Inclusion of faecal GIP measurements is likely to improve identification of GFD recent noncompliance in CD management and could be incorporated into current follow‐up strategies.
Interruptions During Senior Nurse Handover in the Intensive Care Unit
Authors: Spooner Amy J. , Chaboyer Wendy , Aitken Leanne M. 
Published: June 2018

Background:Interruptions during handover may compromise continuity of care and patient safety.Local Problem:Interruptions occur frequently during handovers in the intensive care unit.Methods:A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention.Interventions:The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback.Results:Forty handovers were audiotaped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention.Conclusions:Further work is required to reduce interruptions that do not benefit patient care.
Spontaneous Pneumomediastinum in Connective Tissue Diseases
Authors: De Giacomi Federica , Baqir Misbah , Cox Christian W. , Moua Teng , Matteson Eric L. , Ryu Jay H. 
Published: June 2018

BackgroundSpontaneous pneumomediastinum (SP) is an uncommon disorder but has been described in cases with connective tissue diseases (CTDs), most commonly dermatomyositis and polymyositis. We aimed to explore this relationship by analyzing the characteristics of CTD patients with SP.MethodsUsing a computer-assisted search, we identified 25 patients with CTD and SP evaluated between January 1997 and December 2016 at our institution. Clinicoradiologic characteristics, treatment, and outcomes were extracted and chest computed tomography studies analyzed.ResultsWe identified 25 patients with CTD and SP. Median (range) age at SP occurrence was 55 (18–82) years, and 60% of the patients were women. Smoking history was present in 37%. Spontaneous pneumomediastinum was symptomatic in 56% of patients. Eighteen patients (72%) had a known CTD diagnosis, and 20 patients (80%) manifested radiologic evidence of interstitial lung disease. Spontaneous pneumomediastinum diagnosis was achieved with chest radiography in 20% of cases and chest computed tomography in the other cases. Spontaneous pneumomediastinum was managed with expectant observation alone in 22 cases (88%). Four patients (16%) had concomitant pneumothorax, 1 of whom required chest tube drainage. There were no deaths attributable to SP during the median (range) follow-up of 13 (0–174) months. Cumulative survival was 52% at 1 year and 40% at 2 years.ConclusionsSpontaneous pneumomediastinum is an uncommon manifestation of CTD and usually occurs in the presence of interstitial lung disease. Although SP seems to be associated with a relatively benign short-term course, occurrence of SP in CTD patients may be a poor prognostic factor.
Pediatric 131I-MIBG Therapy for Neuroblastoma
Authors: Willegaignon José , Crema Karin Paola , Oliveira Nathaliê Canhameiro , Pelissoni Rogério Alexandre , Coura-Filho George Barberio , Sapienza Marcelo Tatit , Buchpiguel Carlos Alberto 
Published: June 2018

Purpose

131I-metaiodobenzylguanidine (131I-MIBG) has been used in the diagnosis and therapy of neuroblastoma in adult and pediatric patients for many years. In this study, we evaluated whole-body 131I-MIBG clearance and radiation doses received by patients, family caregivers, and medical staff to establish appropriate radiation safety measures to be used in therapy applications.

Methods
Research was focused on 23 children and adolescents with metastatic neuroblastoma, with ages ranging from 1.8 to 13 years, being treated with 131I-MIBG. Based on measured external dose rates from patients, dosimetric data to patients, family members, and others were calculated.

Results
The mean ± SD 131I-MIBG activity administered was 8.55 ± 1.69 GBq. Percent whole-body retention rates of 131I-MIBG at 24, 48, and 72 hours after administration were 48% ± 7%, 23% ± 7%, and 12% ± 6%, with a whole-body 131I-MIBG effective half-life of 23 ± 5 hours for all patients. The mean doses for patients were 0.234 ± 0.096 mGy·MBq−1 to red-marrow and 0.251 ± 0.101 mGy·MBq−1 to whole body. The maximum potential radiation doses transmitted by patients to others at 1.0 m was estimated to be 11.9 ± 3.4 mSv, with 97% of this dose occurring over 120 hours after therapy administration. Measured mean dose received by the 22 family caregivers was 1.88 ± 1.85 mSv, and that received by the 19 pediatric physicians was 43 ± 51 μSv.

Conclusion
In this study, we evaluated the whole-body clearance of 131I-MIBG in 23 pediatric patients, and the radiation doses received by family caregivers and medical staff during these therapy procedures, thus facilitating the establishment of radiation safety measures to be applied in pediatric therapy.
Uterine Corpus Metastasis From Rectal Adenocarcinoma Detected Using 18F-FDG PET/CT
Authors: Wang Hongxi , Su Minggang , Cui Futao , Wu Xia , Tian Rong 
Published: June 2018

Abstract
We report an unusual case of uterine corpus metastasis from rectal adenocarcinoma detected using 18F-FDG PET/CT. A 47-year-old woman was diagnosed with rectal adenocarcinoma and treated with surgery and radiochemotherapy 3 years ago. During follow-up, she presented with lower abdomen pain and elevated tumor markers, but ultrasonography findings were unremarkable. We performed an 18F-FDG PET/CT scan, which showed intense 18F-FDG avidity in the myometrium of the uterine corpus. Uterine corpus metastasis was suspected, and complementary MRI and diagnostic curettage histopathology confirmed uterine metastasis from rectal adenocarcinoma.