bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interhospital Transport of Critically Ill Children to PICUs in the United Kingdom and Republic of Ireland: Analysis of an International Dataset*
Authors: Ramnarayan Padmanabhan , Dimitriades Konstantinos , Freeburn Lynsey , Kashyap Aravind , Dixon Michaela , Barry Peter W. , Claydon-Smith Kathryn , Wardhaugh Allan , Lamming Caroline R. , Draper Elizabeth S. 
Published: February 2018

Objectives:
International data on characteristics and outcomes of children transported from general hospitals to PICUs are scarce. We aimed to 1) describe the development of a common transport dataset in the United Kingdom and Ireland and 2) analyze transport data from a recent 2-year period.

Design:
Retrospective analysis of prospectively collected data.

Setting:
Specialist pediatric critical care transport teams and PICUs in the United Kingdom and Ireland.

Patients:
Critically ill children less than 16 years old transported by pediatric critical care transport teams to PICUs in the United Kingdom and Ireland.

Interventions:
None.

Measurements and Main Results:
A common transport dataset was developed as part of the Paediatric Intensive Care Audit Network, and standardized data were collected from all PICUs and pediatric critical care transport teams from 2012. Anonymized data on transports (and linked PICU admissions) from a 2-year period (2014–2015) were analyzed to describe patient and transport characteristics, and in uni- and multivariate analyses, to study the association between key transport factors and PICU mortality. A total of 8,167 records were analyzed. Transported children were severely ill (median predicted mortality risk 4.4%) with around half being infants (4,226/8,167; 51.7%) and nearly half presenting with respiratory illnesses (3,619/8,167; 44.3%). The majority of transports were led by physicians (78.4%; consultants: 3,059/8,167, fellows: 3,344/8,167). The median time for a pediatric critical care transport team to arrive at the patient’s bedside from referral was 85 minutes (interquartile range, 58–135 min). Adverse events occurred in 369 transports (4.5%). There were considerable variations in how transports were organized and delivered across pediatric critical care transport teams. In multivariate analyses, consultant team leader and transport from an intensive care area were associated with PICU mortality (p = 0.006).

Conclusions:
Variations exist in United Kingdom and Ireland services for critically ill children needing interhospital transport. Future studies should assess the impact of these variations on long-term patient outcomes taking into account treatment provided prior to transport.
Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms
Authors: Schwindt Eva M. , Hoffmann Florian , Deindl Philipp , Waldhoer Thomas J. , Schwindt Jens C. 
Published: February 2018

Objectives:
To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation.

Design:
Retrospective analysis of audio-video recorded neonatal simulation training.

Settings:
Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany). Equipment was prepared the same way as for real clinical events.

Subjects:
Medical teams of four to five persons with birth-related background (midwives, nurses, neonatologists, and anesthesiologists) in a realistic team composition.

Interventions:
Audio-video recorded mannequin-based simulated resuscitation of an asphyxiated newborn including the establishment of either umbilical venous catheter or intraosseous access.

Measurements and Main Results:
The duration of access establishment (time from decision to first flush/aspiration), preparation (decision to start of procedure), and the procedure itself (start to first flush/aspiration) was significantly longer for umbilical venous catheter than for intraosseous access (overall duration 199 vs 86 s). Delaying factors for umbilical venous catheter establishment were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in intraosseous access establishment were handling of the unfamiliar material and absence of an intraosseous access kit in the resuscitation room. There was no significant difference between the required duration for access establishment between large centers and small hospitals, but a trend was observed that duration for umbilical venous catheter was longer in small hospitals than in centers. Duration for intraosseous access was similar in both hospital types.

Conclusions:
Vascular access establishment in neonatal resuscitation could be accelerated by infrastructural improvements and specific training of medical teams. In simulated in situ neonatal resuscitation, intraosseous access is faster to establish than umbilical venous catheter. Future studies are required to assess efficacy and safety of both approaches in real resuscitation settings.
Optimizing Pulmonary Embolism Computed Tomography in the Age of Individualized Medicine
Authors: Hendriks Babs M.F. , Eijsvoogel Nienke G. , Kok Madeleine , Martens Bibi , Wildberger Joachim E. , Das Marco 
Published: February 2018

Purpose
The aim of the study was to simultaneously optimize contrast media (CM) injection and scan parameters for the individual patient during computed tomography pulmonary angiography (CTPA).

Methods
In this study (NCT02611115), 235 consecutive patients suspected of having pulmonary embolism were prospectively enrolled. Automated kV selection software on a third-generation multidetector computed tomography adapted tube voltage to the individual patient, based on scout scans. The contrast injection protocol was adapted to both patient body weight and kV-setting selection via a predefined formula, based on previous research. Injection data were collected from a contrast media and radiation dose monitoring software. Attenuation was measured in Hounsfield units (HU) in the pulmonary trunk (PT); attenuation values 200 HU or greater were considered diagnostic. Subjective image quality was assessed by using a 4-point Likert scale at the level of the PT, lobar, segmental, and subsegmental arteries. Results between groups were reported as mean ± SD.

Results
Two hundred twenty-two patients (94%) were scanned at a kV setting below 100 kV: n = 108 for 70 kV, n = 82 for 80 kV, and n = 32 for 90 kV. Mean CM bolus volume (in milliliters) and total iodine load (in grams of iodine) for 70 to 90 kV were as follows: 24 ± 3 mL and 7 ± 1 g I, 29 ± 4 mL and 9 ± 2 g I, and 38 ± 4 mL and 11 ± 1 g I, respectively. Mean flow rates (in milliliters per second) and iodine delivery rates (in grams of iodine per second) were 3.0 ± 0.4 mL/s and 0.9 ± 0.1 g I/s (70 kV), 3.6 ± 0.4 mL/s and 1.0 ± 0.1 g I/s (80 kV), and 4.7 ± 0.5 mL/s and 1.3 ± 0.1 g I/s (90 kV). Mean radiation doses were 1.3 ± 0.3 mSv at 70 kV, 1.7 ± 0.4 mSv at 80 kV, and 2.2 ± 0.6 mSv at 90 kV. Mean vascular attenuation in the PT for each kV group was as follows: 397 ± 101 HU for 70 kV, 398 ± 96 HU for 80 kV, and 378 ± 100 HU for 90 kV, P = 0.59. Forty-six patients (21%) showed pulmonary embolism on the CTPA. One scan (90 kV) showed nondiagnostic segmental pulmonary arteries, and 5% of subsegmental arteries were of nondiagnostic image quality. All other segments were considered diagnostic-excellent subjective image quality.

Conclusions
Simultaneously optimizing both CM injections and kV settings to the individual patient in CTPA results in diagnostic attenuation with on average 24 to 38 mL of CM volume and a low radiation dose for most patients. This individualized protocol may help overcome attenuation-variation problems between patients and kV settings in CTPA.
Clinical Impact of Radioguided Localization in the Treatment of Solitary Pulmonary Nodule
Authors: Manca Gianpiero , Davini Federico , Tardelli Elisa , De Liperi Annalisa , Falaschi Fabio , Melfi Franca , Colletti Patrick M. , Rubello Domenico , Volterrani Duccio , Boni Giuseppe 
Published: February 2018

Purpose
Incidental solitary pulmonary nodules (SPNs) have become an increasingly common CT finding worldwide. Although there are currently many imaging strategies for evaluating SPNs, the differential diagnosis and management of SPNs remains complex because of overlap between benign and malignant processes. Moreover, transbronchial or percutaneous CT-guided biopsies do not always allow definitive diagnoses. In such cases, video-assisted thoracic surgery (VATS) has become the preferred surgical procedure for diagnosis and, in selected cases, for treatment of indeterminate SPNs. The difficulties in localizing smaller, deeper, and ground-glass nodules have been approached with different techniques. The aim of this study was to report 20 years of experience with radioguided thoracoscopic resection of SPNs at the Regional Centre of Nuclear Medicine of Pisa.

Methods
Three hundred ninety-five patients with SPNs less than 2 cm and deeper than 5 mm below the visceral pleura underwent CT-guided injection of a suspension composed of 0.1 to 0.2 mL 99mTc-labeled human albumin macroaggregates (99mTc-MAA) and of 0.2 to 0.3 mL of nonionic contrast medium into or adjacent to the SPN. During VATS, the pulmonary area with the highest target/background ratio identified by an 11-mm-diameter collimated thoracoscopic gamma probe was resected.

Results
From 1997 to 2016, approximately 395 patients with SPN underwent VATS wedge resection using the radioguided technique. Mean SPN size was 13 mm (range, 5–20 mm) with mean distance of 15 mm (range, 6–39 mm) from the visceral pleura. Mean VATS procedural time was 40 minutes (range, 20–90 minutes), with an average time of 3 minutes (range, 1–5 minutes) to localize the nodule. Neither mortality nor major perioperative complication was reported. The success rate of VATS with radioguidance in our series was 99%. Histological examination revealed 206 benign lesions (52%), 59 primary lung tumors (15%), and 130 metastatic nodules (33%).

Conclusions
This study demonstrates that radioguided SPN localization by VATS is a feasible, safe, and rapid procedure with highly successful rate of SPN resection.
18F-FDG PET/CT Findings in a Patient With IgG4-Related Sclerosing Mesenteritis
Authors: Fu Zhanli , Chen Guoqian , Liu Meng , Li Ziao , Li Qian 
Published: February 2018

Abstract
A large mass in the abdomen was revealed by ultrasonography on a 68-year-old woman presenting with abdominal pain and weight loss. To exclude the malignancy, an 18F-FDG PET/CT was performed, which showed a solitary soft tissue mass with heterogeneous 18F-FDG avidity at the root of small bowel mesentery. Because of the elevation of inflammatory markers and serum IgG4 level, IgG4-related sclerosing mesenteritis was suspected, which was proved by the subsequent biopsy. The mass gradually shrunk and ultimately disappeared in 6 months after a low-dose steroid therapy.
Does Periosteal Graft Combined With Platelet-Rich Plasma Enhance the Healing of Bone Defect?
Authors: Türkseven Arzu , Özçelik Derya , Çaliş Mert , Celik Hakan Hamdi , Yilmaz Fahri , Önbaş Ömer , Vatansever Alper , Toplu Gaye 
Published: February 2018

Introduction:
This study investigated the effect of periosteal graft + platelet-rich plasma (PRP) combination on facial bone defect healing.

Methods:
Five-millimeter critical sized defects in zygomatic arches of 12 adult New Zealand rabbits were created. Rabbits were randomly divided into 3 groups: First group (control group): bone defects of left zygomatic arches of 6 rabbits were wrapped with a silicone tube. Second group (periosteal graft group): bone defects of left zygomatic arches of 6 rabbits were wrapped with periosteal graft. Third group (experimental group): bone defects of right zygomatic arches of 12 rabbits were wrapped with periosteal graft–PRP combination. New bone formation was evaluated at 8th and 16th weeks. One rabbit was sacrificed at 8th week. Remaining 11 rabbits were imaged with 3-dimensional computed tomography (CT) at 16th week; then, zygomatic arches were removed for micro-CT and histologic examinations.

Results:
Three-dimensional CT analysis at 16th week revealed no significant difference between groups regarding new bone formation (P = 0.232). Micro-CT analysis of new regenerated bone at 16th week displayed significant differences between groups 1 and 3 regarding mean bone volume (BV, mm3) (P = 0.028) and mean bone mineral density (BMD, mm2) (P = 0.001). There was no difference between groups 2 and 3 or between groups 1 and 2, regarding BV or BMD. Histological Bone Regeneration Scorings at 16th week displayed significant difference between groups (P = 0.015). Negative correlation between 3-dimensional CT and histologic results (r = 0.120); positive correlations between BV/BMD values in micro-CT and histologic results (r = 0.524 and r = 0.456) were found.

Conclusions:
By enhancing bone formation capacity of periosteal grafts, periosteal graft–PRP combination provided bone formation having more volume and density comparing with silicone tube application.
Surgical Outcome After Less “Rigid” Fixation in Open Cranial Vault Remodeling for Craniosynostosis
Authors: Koh Khai Luen , Zain Ali 
Published: February 2018

Open cranial vault remodeling techniques require rigid fixation with hardware such as plates and screws; however, complications can occur. The purpose of this study was to assess the surgical outcome after open reconstruction for craniosynostosis with less rigid fixation using nonabsorbable suture.

Methods:
Retrospective review of patients who underwent open craniofacial reconstruction for craniosynostosis at the Hospital Kuala Lumpur between January 2011 and December 2016 were performed. Demographic data, surgical complications, and postoperative aesthetic outcomes and reoperations were evaluated using Whitaker classification. Statistical analyses were performed using SPSS.

Results:
Thirty-four (n = 34) cases were included in this review consisting of 16 males and 18 females (ratio 1:1.25). Sixteen patients were syndromic with multiple suture synostoses: Apert syndrome (n = 8), Crouzon syndrome (n = 6), and Muenke's syndrome (n = 2). Eighteen patients were nonsyndromic: isolated single-suture craniosynostosis (n = 12) and multiple suture involvement (n = 6). Mean age of presentation was 17.4 months (4–16 months) with mean age of surgery of 23.8 months (6–68 months). Mean length of surgery was 6.1 hours (range 3–10 hours) and mean length of hospital stay was 10 days (mean 7–20 days). Mean duration of follow-up was 2.2 years (6 month–4 years). There were a total of 9 complications postoperatively: massive blood loss (n = 4), seroma (n = 2), exposure keratitis (n = 1), hand extravasation (n = 1), and occipital sore (n = 1). Analysis showed multiple suture craniosynostoses were associated with longer operative times (4.3 hours vs 6.5 hours, P = 0.0082 < 0.05) and higher blood transfusion (170 mL vs 275 mL, P = 0.0274 < 0.05). Older age was also associated with higher blood transfusion (135.5 mL; <12 months vs 250.2 mL; 12–24 months vs 302.1 mL; >24 months of age, P = 0.00059). Patients were categorized as 88.2% (n = 30) Whitaker I and II and 11.8% (n = 4) Whitaker III and IV. Reoperation rates were 2.9% (n = 1). Whitaker III and IV class were higher among patients with syndromic synostosis, unicoronal and multiple suture synostoses.

Conclusions:
Our technique of open cranial reconstruction with nonabsorbable suture nylon 2/0 as sole method of fixation has resulted in good aesthetic outcome with low reoperations and complications rate. Longer follow-up is needed to ascertain our long-term results.
Seasonal Variation of Epistaxis in Germany
Authors: Seidel David Ulrich , Sesterhenn Andreas M. , Kostev Karel 
Published: February 2018

Aim:
The goal of the present study was to analyze the seasonal variation of epistaxis in ear, nose, and throat (ENT) practices in Germany in 2016.

Methods:
The present study sample included patients who received a first epistaxis diagnosis from physicians in 114 ENT practices in Germany between January 2016 and December 2016. The number of epistaxis patients per practice was calculated for each month. A logistic regression model, adjusted for age and sex, was used to calculate the association between epistaxis diagnosis and the month.

Results:
The authors found a total of 15,523 patients with epistaxis in 114 ENT practices. Of these patients, 55.9% were men and the mean age was 47.8 ± 27.6 years. The highest number of epistaxis patients was found in February (14.89 patients per practice) and the lowest in August (7.22 patients per practice). The age- and sex-adjusted risk of epistaxis was significantly higher in the months of February (OR = 1.32), March (OR = 1.37), April (OR = 1.34), May (OR = 1.35), and December (OR = 1.33) compared with August.

Conclusions:
The presentation of patients with epistaxis at German ENT practices shows a marked seasonal variation with a low in the summer, an increase in fall and winter, and a peak in February, March, and April.
A Review of Phytoestrogens and Their Association With Pelvic Floor Conditions
Authors: Cardenas-Trowers Olivia , Meyer Isuzu , Markland Alayne D. , Richter Holly E. , Addis Ilana 
Published: February 2018

Introduction
Urinary incontinence, pelvic organ prolapse, and fecal incontinence are pelvic floor disorders (PFDs) disproportionately experienced by postmenopausal women. Limited data exist suggesting that phytoestrogens may have an impact on the pathophysiology and symptom of PFDs.

Purpose of Review
The aim of the study was to review the current literature addressing the role of phytoestrogens on PFDs, including the pathophysiology, symptom, treatment, and possible prevention.

Findings
Qualifying literature spans from 2003 to 2017 and included 14 studies ranging from in vitro, animal, and observational studies to randomized clinical trials.

Summary
Although the literature is limited, most studies on phytoestrogens and PFDs support associations with pathophysiologic mechanisms, symptoms, and treatment for urinary incontinence and pelvic organ prolapse, but not fecal incontinence. Less is known regarding the prevention of PFDs with phytoestrogen intake over time. Overall, the potential influence of phytoestrogens on PFDs is not well understood, and more research is needed.
Calcitonin-gene-related peptide pathway mAbs and migraine prevention
Authors: Paemeleire Koen , MaassenVanDenBrink Antoinette 
Published: February 2018

Purpose of review
Monoclonal antibodies (mAbs) targeting the calcitonin-gene-related peptide (CGRP) pathway have been developed for episodic and chronic migraine prevention, either through binding the CGRP ligand (eptinezumab, fremanezumab, galcanezumab) or the CGRP receptor (erenumab). We provide an update on published Phase 2 and Phase 3 trials, safety/tolerability data, pharmacokinetics and mechanism of action of these biologicals.

Recent findings
The efficacy data from Phase 2 trials are corroborated by those from published Phase 3 trials, with a multitude of publications expected in 2018. Review of safety data concluded there was no difference in total adverse events or main adverse events (including upper respiratory tract infection, nasopharyngitis, nausea, injection-site pain and back pain) between the mAbs and placebo injections except apparently for dizziness. The site of action of these mAbs is not fully elucidated but current insight is that their effect resides in the periphery; a contribution of central effect(s) can however not be excluded at present.

Summary
Although efficacy of all four drugs is modest over placebo in episodic and chronic migraine prevention and overall comparable with available oral preventive treatments, current tolerability and (short-term) safety data of this new treatment approach certainly promise a major step forward for migraine patients.
A Well-Tolerated and Effective Antiepileptic Drug for Patients With Myasthenia Gravis at Last?
Authors: Sánchez-Villalobos José Manuel , Villegas-Martínez Irene , Pérez-Vicente José Antonio 
Published: February 2018

Abstract
Antiepileptic drugs have been known to worsen myasthenia gravis (MG) symptoms, and therefore, in patients who suffer both conditions (myasthenia and epilepsy), treatment selection is difficult. We report 2 cases of patients with MG who were safely treated with lacosamide. Evidence about antiepileptic drug treatment and adverse effects in MG is reviewed.
Effect of Concomitant Medications on the Safety and Efficacy of Extended-Release Carbidopa-Levodopa (IPX066) in Patients With Advanced Parkinson Disease: A Post Hoc Analysis
Authors: LeWitt Peter A. , Verhagen Metman Leo , Rubens Robert , Khanna Sarita , Kell Sherron , Gupta Suneel 
Published: February 2018

Objectives
Extended-release (ER) carbidopa-levodopa (CD-LD) (IPX066/RYTARY/NUMIENT) produces improvements in “off” time, “on” time without troublesome dyskinesia, and Unified Parkinson Disease Rating Scale scores compared with immediate-release (IR) CD-LD or IR CD-LD plus entacapone (CLE). Post hoc analyses of 2 ER CD-LD phase 3 trials evaluated whether the efficacy and safety of ER CD-LD relative to the respective active comparators were altered by concomitant medications (dopaminergic agonists, monoamine oxidase B [MAO-B] inhibitors, or amantadine).

Methods
ADVANCE-PD (n = 393) assessed safety and efficacy of ER CD-LD versus IR CD-LD. ASCEND-PD (n = 91) evaluated ER CD-LD versus CLE. In both studies, IR- and CLE-experienced patients underwent a 6-week, open-label dose-conversion period to ER CD-LD prior to randomization. For analysis, the randomized population was divided into 3 subgroups: dopaminergic agonists, rasagiline or selegiline, and amantadine. For each subgroup, changes from baseline in PD diary measures (“off” time and “on” time with and without troublesome dyskinesia), Unified Parkinson Disease Rating Scale Parts II + III scores, and adverse events were analyzed, comparing ER CD-LD with the active comparator.

Results and Conclusions
Concomitant dopaminergic agonist or MAO-B inhibitor use did not diminish the efficacy (improvement in “off” time and “on” time without troublesome dyskinesia) of ER CD-LD compared with IR CD-LD or CLE, whereas the improvement with concomitant amantadine failed to reach significance. Safety and tolerability were similar among the subgroups, and ER CD-LD did not increase troublesome dyskinesia. For patients on oral LD regimens and taking a dopaminergic agonist, and/or a MAO-B inhibitor, changing from an IR to an ER CD-LD formulation provides approximately an additional hour of “good” on time.