bluuebunny/crossref_metadata_2025_split huggingface dataset:
Energy Balance in Critically Ill Children With Severe Sepsis Using Indirect Calorimetry
Authors: Ismail Javed , Bansal Arun , Jayashree Muralidharan , Nallasamy Karthi , Attri Savita V. 
Published: March 2019

ABSTRACTObjectives:Energy needs in critically ill children are dynamic and variable. Data on energy balance in children with severe sepsis using indirect calorimetry (IC) is lacking. Thus, we planned to study the energy needs and balance of this cohort.Methods:Prospective observational study conducted in ventilated children aged 5 to 12 years, admitted in pediatric intensive care unit with severe sepsis from May 2016 to June 2017. Measured resting energy expenditure (mREE) was measured with IC (Quark RMR, COSMED) till 7 days or pediatric intensive care unit discharge. Predicted energy expenditure (pREE) was estimated using Schofield, Harris and Benedict, and FAO/WHO/UNU equations. Primary outcome was to study the daily energy balance. Secondary outcome was to determine nitrogen balance and agreement of mREE with pREE.Results:Forty children (24 boys) with median age of 7 (5.2, 10) years were enrolled. All received enteral nutrition; 35 (87.5%) received inotropic support. Median ventilation‐free days were 19 days and 4 children died (10%). A total of 176 IC measurements were obtained with an average of 4 per patient. The mean mREE was 51 ± 17 kcal/kg and mean respiratory quotient was 0.77 ± 0.07. There was persistent negative energy balance from days 1 to 7 and negative nitrogen balance from days 1 to 5. There was poor agreement of pREE with mREE using Bland Altman plots. None of severity of illness scores (PRISM III, daily Sequential Organ Function Assessment, daily Vasoactive Inotropic Score) showed correlation with mREE.Conclusions:Persistent negative energy and nitrogen balance exist during acute phase of severe sepsis. Predictive equations are inaccurate compared with IC as the criterion standard.
Passenger Lymphocyte Syndrome After Pediatric Liver Transplantation
Authors: Woolfson Jessica P. , Vandriel Shannon M. , Stephens Derek , Dharmaraj Blossom G. , De Angelis Maria , Cattral Mark S. , Ghanekar Anand , Grant David R. , Avitzur Yaron , Ng Vicky L. 
Published: March 2019

ABSTRACTBackground:Passenger lymphocyte syndrome (PLS) is a less known etiology of acute onset anemia following ABO‐compatible (ABO‐c) liver transplantation (LT). Available literature on PLS after pediatric LT is limited. Therefore, we evaluated the prevalence, clinical course, and risk factors of PLS in children following ABO‐c LT.Methods:A single‐center retrospective review of all children who underwent LT between 2000 and 2017 was performed. PLS was defined as a drop‐in hemoglobin >20 g/L within 30 days of LT, with positive direct antiglobulin test and 1 laboratory test confirming hemolysis. Chi square and student t tests compared variables between subjects with and without PLS.Results:Amongst 333 pediatric LT performed, 51 children received an ABO‐c graft. PLS was diagnosed in 7 (14%) subjects at a median of 10 days after LT. There were no significant differences in patient demographics, graft type, or immunosuppression between those who did and did not develop PLS. Recipient blood group A+ receiving a donor O+ graft was a risk factor for PLS (P = 0.015). All PLS subjects recovered with blood transfusions (median 2), and no additional interventions. Three subjects initially received recipient (instead of donor) blood group red cells.Conclusions:We report a 14% prevalence of PLS following pediatric ABO‐c LT. Recipient blood group A+ receiving a donor O+ graft is a risk factor for PLS. Recognition of PLS as a cause of early acute anemia in pediatric ABO‐c LT enables timely transfusion with donor (rather than recipient) blood group red cells.
Oxytocin Guidelines Associated with Compliance to National Standards
Authors: Jackson Jodi K. , Wickstrom Elizabeth , Anderson Betsi 
Published: March 2019

Abstract

Objective:
Develop a multidisciplinary, consensus-driven, evidence-based approach to oxytocin use, while adhering to national guidelines.

Design:
This was a quality improvement project that used the Plan Do Study Act method to create cycles of change over several years. To initiate discussion, a survey was administered at a social event for providers from divergent community practices that addressed the controversial aspects of oxytocin use. Graphic feedback was provided showing divergences between answers and the evidence. The perinatal team directed design and implementation of this project with specific involvement of a nurse quality improvement coordinator and nurse educator.

Measures:
Process, outcome, and balancing measures were used to evaluate the program. Process measure: use of a standardized order-set. Outcome measure: rate of adherence to the resultant protocol. Balancing measures: 1) maximum oxytocin dose, 2) time from oxytocin initiation to birth, 3) cesarean birth rates, and 4) Apgar scores.

Results:
An initial increase in adherence to the protocol decreased with the loss of the “paper” order-set. Adherence improved when computerized physician order entry was adjusted: 2006: 73%, 2007: 95%; 2011: 57%, 2013: 100% (p = 0.007, 2006 vs. 2007) (p < 0.001, 2006 vs. 2013). Compliance with the protocol was associated with a decrease in maximum oxytocin dose and in time between oxytocin initiation and birth (p < 0.001).

Conclusion:
Consistency and safety in patient care can be accomplished using literature-based evidence and active consensus building among members of the perinatal team. A standardization process must be integrated into the electronic medical record to become a sustained part of a practice culture.
Smartphone-Related Accidents in Children and Adolescents
Authors: Wagner Richard , Gosemann Jan-Hendrik , Sorge Ina , Hubertus Jochen , Lacher Martin , Mayer Steffi 
Published: March 2019

ObjectivesSmartphones have become an integral part of daily life, often grabbing full attention of its user. We hypothesized that smartphone-associated trauma in children and adolescents has increased in the last decade. The objective of this study was to analyze smartphone-related injuries in children at two German centers for pediatric emergency care.MethodsSmartphone-related injuries were recorded between January 2008 and March 2018 at two centers of pediatric surgery in Germany. Data were assessed for patient demography, cause of accident, type of injury, treatment, and outcome.ResultsTen children (8 girls, 2 boys; mean ± SD age, 10.6 ± 6.0 years; range, 10 weeks to 17 years) were included. Two patients were injured in 2008 to 2015, eight in 2016 to 2018, of which three required hospital admissions. Six accidents happened in public spaces, and four within domestic environments. Eight children (mean ± SD age, 13.3 ± 2.4 years; 7 girls) were injured while using their smartphone, therefore being distracted. Two children (mean ± SD age, 6.5 ± 6.4 months) were involuntarily hurt by the smartphone of their caregivers. The causes of accident and related injuries were highly variable and ranged from minor trauma (mild head injury [n = 3], abrasions [n = 2], bruises of fingers [n = 2]/hand [n = 1]/ankle [n = 2]) to major injuries requiring intensive care treatment (pelvic [n = 1] or vertebral body fractures [n = 1]).ConclusionsSmartphone-associated injuries mainly caused by distraction gain increasing importance in pediatric traumatology. The frequency is higher in females compared with their male counterparts. The prevention of these accidents should become part of educational programs for children and adolescents.
Safety, Biodistribution, and Dosimetry of 123I-6-Deoxy-6-Iodo-D-Glucose, a Tracer of Glucose Transport, in Healthy and Diabetic Volunteers
Authors: Calizzano Alex , Perret Pascale , Desruet Marie-Dominique , Ahmadi Mitra , Reboulet Ghislaine , Djaileb Loïc , Vanzetto Gérald , Fagret Daniel , Barone-Rochette Gilles , Ghezzi Catherine 
Published: March 2019

Purpose
Insulin resistance is a key feature of the metabolic syndrome and type 2 diabetes, in which noninvasive assessment is not currently allowed by any methodology. We previously validated an iodinated tracer of glucose transport (6DIG) and a new methodology for the in vivo quantification of cardiac insulin resistance in rodents. The aim of this study was to investigate the safety, biodistribution, and radiation dosimetry of this method using 123I-6DIG in 5 healthy and 6 diabetic volunteers.

Methods
The collection of adverse effects (AEs) and medical supervision of vital parameters and biological variables allowed the safety evaluation. Biodistribution was studied by sequentially acquiring whole-body images at 1, 2, 4, 8, and 24 hours postinjection. The total number of disintegrations in each organ normalized to the injected activity was calculated as the area under the time-activity curves. Dosimetry calculations were performed using OLINDA/EXM.

Results
No major adverse events were observed. The average dose corresponding to the 2 injections of 123I-6DIG used in the protocol was 182.1 ± 7.5 MBq. A fast blood clearance of 123I-6DIG was observed. The main route of elimination was urinary, with greater than 50% of urine activity over 24 hours. No blood or urine metabolite was detected. 123I-6DIG accumulation mostly occurred in elimination organs such as kidneys and liver. Mean radiation dosimetry calculations indicated an effective whole-body absorbed dose of 3.35 ± 0.57 mSv for the whole procedure.

Conclusions

123I-6DIG was well tolerated in human with a dosimetry profile comparable to that of other commonly used iodinated tracers, thereby allowing further clinical development of the tracer.
Fabrication of Poly(l-Lactic Acid)/Chitosan Scaffolds by Solid–Liquid Phase Separation Method for Nerve Tissue Engineering: An In Vitro Study on Human Neuroblasts
Authors: Salehi Majid , Farzamfar Saeed , Bozorgzadeh Shaghayegh , Bastami Farshid 
Published: March 2019

Abstract
Polymeric scaffolds that support neural cell behaviors are attracting more attention. In the present study, solid–liquid phase separation technique is used to fabricate scaffolds made of poly(l-lactic acid) (PLLA) and chitosan (CS) blends to mimic both cellular microenvironment and anatomical structure of nerve tissue. The fabricated scaffolds favor characteristics of both natural and synthetic polymers. Different tests and assays including physical and mechanical ones (in vitro degradation rate, free radical release, hydrophilicity, and porosity measurements, microstructure observation, and mechanical tests) and cellular assays (cell attachment measurement and viability assessment) suggest that blend scaffolds prepared with this method support nerve cells for tissue engineering applications adequately and even better than scaffolds prepared with the same method but from pure PLLA or CS.
Surgical Treatment Strategy and Perioperative Analysis of Patients With Intracranial Mirror Aneurysms
Authors: Zhou Han , Cheng Jing , Liu Hengjian , Lu Donglin , Feng Yugong 
Published: March 2019

Object:
Intracranial mirror aneurysm is a type of multiple aneurysms, which is rare in clinical and literature. There is no unified conclusion on the treatment strategy of mirror aneurysms. Therefore, our study evaluated the surgical approach and prognosis of a series of mirror aneurysms, and explored the clinical features and treatment strategies of mirror aneurysms.

Methods:
This study retrospectively analyzed the clinical features, imaging data, treatment methods and post-hospital results of 67 cases of mirror aneurysms admitted to our department from December 1997 to April 2018.

Results:
There were 20 males and 47 females with an average age of 53.6 years. Mirror aneurysms are mainly located in the posterior communicating artery and middle cerebral artery. Of 67 patients, 1-stage unilateral craniotomy with bilateral aneurysms in 18 cases, 1-stage bilateral craniotomy with bilateral aneurysms in 17 cases, staged treatment of bilateral aneurysms in 13 cases, and 19 cases only treated the responsible aneurysms. 57 cases with good recovery; 7 cases were self-care; 1 case was heavy disability; 2 cases were dead. In parallel, 8 cases had different degrees of cerebral infarction, 3 cases of hydrocephalus, 3 cases of oculomotor nerve injury, 2 cases died of cerebral hernia resulted from intracranial hypertension, and the remaining 53 cases were better.

Conclusions:
The treatment of the mirror aneurysm should be based on the location, size, shape of the aneurysm, the patient's clinical manifestations and the surgeon's experience to choose a personalized treatment.
Morphometric Analysis of Sphenoid Sinus in Patients With Nasal Septum Deviation
Authors: Orhan Israfil , Ormeci Tugrul , Bilal Nagihan , Sagiroglu Saime , Doganer Adem 
Published: March 2019

Abstract
This retrospective study aimed to assess the association of the volume and types of the sphenoid sinus with deviated nasal septum by analyzing multislice computed tomography images. A total of 93 patients with a deviated nasal septum and 70 healthy controls were included in the study. Patients with sinonasal morbidities other than deviation were excluded. Three-dimensionally reconstructed computed tomography images of the study participants were acquired. A total of 326 sphenoid sinus volumes from the patient and control groups were obtained and compared between the groups. Sphenoid sinus volumes and the angle of the deviation were measured for standardization and assessment of the severity. Deviated nasal septum was found on the right in 49.5% (n = 46) and on the left in 50.5% (n = 47) of the study participants. Deviation angles were in the range from 7.2° to 22.4° and the mean value was 13.2° ± 5.0°. The measured volumes were in the range from 1.8 cm3 to 9.6 cm3 with a mean of 4.8 ± 1.5 cm3. In the control group, the median values for the sphenoid sinus volumes were 4.40 cm3 (0.80–8.90 cm3) on the right and 4.20 cm3 (0.90–8.70 cm3) on the left. In the study group, sphenoid sinus volumes were found to be statistically significantly different between those on the ipsilateral and contralateral side of the septal deviation. Sphenoid sinus volumes were significantly smaller on the same side with septal deviation compared with those on the contralateral side. There was no statistical relationship between the presence of septal deviation, age and gender, and the type of sphenoid sinus.
In Situ Hinge Technique for the Frontal Bandeau for the Correction of Metopic Craniosynostosis Reduces Operative Time
Authors: Magoon Katie , Azzolini Anthony , Yang Robin , Taylor Jesse 
Published: March 2019

Background and Purpose:
Treatment of metopic craniosynostosis often involves bitemporal expansion of the anterior cranium. This report compares perioperative variables of a surgical technique in which the fronto-orbital bandeau is bent in situ to traditional fronto-orbital advancement and remodeling (FOAR).

Method/Description:
Six patients undergoing the hinge technique were compared to the senior author's 6 most recent conventional FOARs. Study and control cohorts were reasonably well matched for age and sex; only those with nonsyndromic, single-suture metopic synostosis were included. Perioperative variables such as OR time, blood loss, hardware costs, length of stay, and perioperative complications were compared between groups using unpaired t tests.

Results:
Operative time was significantly decreased when the hinge technique was utilized, with a mean operative time of 159 ± 14.0 minutes for hinge patients and 193 ± 33.8 minutes for nonhinge patients (P = 0.049). Hardware was also significantly decreased from an average of 2.2 ± 1.0 plates and 35 ± 13.8 screws in nonhinge patients to 1 plate and 20 screws in each hinge patient (P < 0.02), for an average hardware saving of $2990 per hinge surgery (P = 0.019). Estimated blood loss, length of stay, and perioperative complications were not significantly different between groups. All patients in both groups had Whitaker 1 outcomes in short-term follow-up.

Conclusions:
The hinge technique for the treatment of metopic synostosis is associated with a statistically significant decrease in operative time, hardware utilization, and hardware cost. Perioperative outcomes were similar between the hinge technique and traditional FOAR in the short term, and additional follow-up is needed to determine whether the 2 have similar long-term outcomes.
Measurements and Clinical Application of Anatomical Space for Transfrontal Pituitary Surgery Through Magnetic Resonance Imaging Reconstruction
Authors: Sun Jialiang , Yu Zhentao , Cheng Kailiang , Wang Honglei , Han Yingying , Li Youqiong 
Published: March 2019

Objective:
This study aims to clarify the relative position of the normal important structures and anatomical spaces formed by the structures passed through during the transfrontal pituitary surgery, and discuss how to avoid some eloquent structures.

Methods:
A total of 120 cases of magnetic resonance imaging images from normal adult brains were selected as the object of study and divided into male and female groups. The important adjacent structures of the pituitary passed through during the transfrontal pituitary surgery were marked on the reconstructed images. In all planes of the spaces passing through successively during the pituitary surgery, the morphological parameters such as the size, boundary, structure, and spatial extent of the spaces were measured.

Results:
The size, boundary, structure, and spatial extent of the space between the 2 optic nerves, the space between the optic nerves and the pituitary stalk, and the space between the tuber cinereum and the interal carotid artery in the plane of the pituitary stalk were measured, the anterior part and the posterior part in male were shorter than those in female (P = 0.021; P = 0.029); no statistically significant difference was found in the measurements of the lengths and angles of these spaces.

Conclusions:
The authors’ findings provide the surgeons with the detailed anatomical data and help to provide a morphological basis for intraoperative protection of the pituitary and vital adjacent structures and surgical approach.
Evaluating Postoperative Morbidity in Patients Undergoing Pelvic Reconstructive Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator
Authors: Boyd Sarah S. , O’Sullivan David M. , Lasala Christine 
Published: March 2019

Objective
The aim of this study was to evaluate the ability of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator to predict surgical morbidity in patients undergoing pelvic reconstructive surgery.

Methods
This was a retrospective study of patients who underwent pelvic reconstructive surgery from 2014 to 2017. Preoperative risk factors were abstracted from medical records and entered into the ACS NSQIP surgical risk calculator. The Current Procedural Terminology code that produced the largest risk was used and compared with actual patient outcomes. Demographic, clinical, and surgical characteristics were analyzed descriptively. Logistic regression evaluated significant factors associated with each outcome; prediction capability of the risk calculator was assessed.

Results
Seven hundred thirty-one surgical cases were reviewed. The cohort was predominantly younger than 65 years (58.7%), white (77.4%), multiparous (81.1%), and overweight (64.7%); 76.3% were American Society of Anesthesiologists class 2, and 70.2% had vaginal surgery. There was no difference in median risk scores between those with and without postoperative event. Two hundred twenty-one (30.3%) experienced “any serious complication,” with 89% of these due to urinary tract infection. Incidence of urinary tract infection was 27%; readmission was 3.2%, and 3.6% returned to the operating room. Decreasing age was predictive of return to the operating room (P < 0.001), and increasingly worse functional status predicted discharge to nursing or skilled rehabilitation facility (P < 0.001).

Conclusions
The ACS NSQIP surgical risk calculator is an overall poor predictor of actual outcomes in a sample of patients who underwent pelvic reconstructive surgery, perhaps because of low prevalence of serious events. A more accurate surgical risk calculator is needed for this patient population.
Identification of risk factors for arterial repair failures and lessons learned: Experiences from managing 129 combat vascular extremity wounds in the Sri Lankan War
Authors: Ratnayake Amila Sanjiva , Bala Miklosh , Howard Robert , Rajapakse Kavinda , Samarasinghe Bandula , Worlton Tamara Jean 
Published: March 2019

BACKGROUND
In extremity vascular trauma, early complications occur at a rate of 13% to 44%. The most common of which are infection, dehiscence, thrombosis, and stenosis. Failure of the arterial repair, also called arterial blowout, has the potential for exsanguinating hemorrhage and poses a considerable challenge for the surgeon to save limb and life.

METHOD
All adults with extremity vascular injuries admitted in 8-month period were prospectively recorded and retrospectively analyzed. Extremity vascular injuries in this group include those in which limb salvage attempted. 5 arterial blowouts in a recorded 87 arterial repairs were analyzed for demographics, presentation, management and outcome in the context of identifying most probable causative factors.

RESULT
5 arterial blowouts occurred out of 87 arterial repairs for a rate of 5.75%. These occurred at a mean of 14 days post-operatively. All patients were male with the majority of the injuries, 80%, resulting from gunshot wounds. All injuries were associated with severe soft tissue injury and clinical evidence of bacterial infection. Technical error, inadequate debridement, prolonged exposed vessel and unstable skeletal injury were noted as causative factors in addition to the commonly reported causes of repair failure. At a mean follow-up of 17 days, the arterial blowout cohort had 80% limb survival rate.

CONCLUSION
Ischemic, damaged and contaminated military wounds lead to infections of varied degree. Delay in closure due to tight distal muscle compartments or severe persistent soft tissue infections, necessitating serial irrigation and debridement (I&D) of wounds, is the common chain noted leading to arterial blowout. To break this chain of events the authors suggest early identification of at risk limbs and aggressive soft tissue cover of the newly constructed repair.

LEVEL OF EVIDENCE
Case series, level IV.