bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing inflammation and its role in comorbidities among persons living with HIV
Authors: Peterson Tess E. , Baker Jason V. 
Published: November 2018

Purpose of review
This article describes the use of biomarkers in expanding our understanding of chronic non-AIDS comorbidities among persons living with HIV (PLWH) receiving antiretroviral therapy (ART).

Recent findings
We review current evidence that biomarkers of chronic immune activation and inflammation associate with a broad spectrum of end-organ diseases in PLWH. We discuss how ART may impact inflammation associated with HIV infection and the degree to which inflammation persists despite effective suppression of viral replication in plasma. We then discuss the limitations of the current literature, which lacks evidence of causality and disproportionately involves a few protein biomarkers that are unable to disentangle complex and overlapping biological pathways.

Summary
Premature end-organ disease among PLWH has been repeatedly associated with higher levels of blood biomarkers reflecting inflammation and immune activation, which, despite viral suppression and CD4+ T-cell increases after ART treatment, remain elevated relative to uninfected persons. There remain important unanswered questions with implications for the development of anti-inflammatory treatment strategies aimed at mitigating excess risk for end-organ comorbidities among PLWH.
Introduction to the Craniofacial Collaboration UK: A Developmental Screening Protocol at the United Kingdom's Four Highly Specialized Craniofacial Centers
Authors: Care Helen , Horton Jo , Kearney Anna , Kennedy-Williams Patrick , Knapp Maria , Rooney Natasha , Thomas Siân , Evans Martin , James Greg , Johnson David , Parks Chris , Wall Steven , Dalton Louise 
Published: November 2018

Abstract
The clinical psychologists at the 4 highly specialized craniofacial centers in the United Kingdom have developed a systematic, developmental screening protocol, called the Craniofacial Collaboration UK (CC-UK). Previous systematic reviews of the literature into the developmental sequelae of single-suture craniosynostosis have identified a number of methodological flaws which the CC-UK seeks to avoid. This study presents an introduction to the rationale for its development, as well as the methodology of the CC-UK.
Soft Palate Dysfunction in Children With Microtia
Authors: van Hövell tot Westerflier Claire , Bracamontes Ignacio Colin , Tahiri Youssef , Breugem Corstiaan , Reinisch John 
Published: November 2018

Background:
Speech issues in microtia patients have been historically attributed to poor hearing. However, the authors have noted that almost all patients with microtia have palatal dysfunction. The aim of this study is to determine the prevalence of soft palate dysfunction (SPD) and velopharyngeal insufficiency (VPI) in microtia patients.

Methods:
A prospective cohort study was performed on consecutive microtia patients from March to June 2017. Clinical characteristics were collected. Palate movement was rated by oral examination and degree of nasal escape by the mirror-fogging test. Correlations between clinical characteristics of microtia and SPD were determined.

Results:
Ninety-seven (40 unilateral, 27 bilateral, and 30 control) children met inclusion criteria. Among all 67 patients with microtia, 96% (64 patients) showed SPD. Twenty-four unilaterals (60%) and 23 bilaterals (85%) had observable VPI by mirror examination. Of these patients, nasality was noticeable to the examiners in 14 unilaterals (58%) and 21 bilaterals (91%). Sixteen of the 27 bilaterals (59%) showed almost no movement of the soft palate. There was a significant correlation between SPD and mirror-fogging. A less developed middle ear as determined by computed tomography scan was associated with palatal dysfunction (P = 0.007). The severity of mandibular shift (P = 0.048) and presence of a syndrome (P = 0.045) were associated with grade of VPI. The severity of the ear deformity (P = 0.007) and presence of a syndrome (P = 0.034) were also correlated with the presence of SPD.

Conclusions:
This is the first study that documents the presence of VPI due to soft palate dysfunction in patients with isolated and nonisolated microtia.
The Diffuse and Severe Traumatic Subarachnoid Hemorrhage Being Hard to Distinguish to Aneurysmal Subarachnoid Hemorrhage
Authors: Arai Nobuhiko , Mine Yutaka , Kagami Hiroshi , Inaba Makoto 
Published: November 2018

Background:
In primary intracerebral hemorrhage, several studies showed that contrast extravasation (CEV) is reported to be an indicator of delayed hematoma expansion, emergent hematoma removal and poor prognosis. On the contrary in head trauma, few researches validated the effectiveness of CEV because of other influences such as subarachnoid hemorrhage (SAH), contusion or brain swelling. The authors experienced a patient showing diffuse SAH caused by traumatic mechanism with acute subdural hematoma (ASDH). In the angiography, a notable rare image of CEV was found and emergency operation mainly to cease the bleeding points was performed.

Patient Presentation:
A 70-year-old man was found being comatose and brought to emergency room. Computed tomography (CT) revealed diffuse SAH with left ASDH. Computed tomography angiography (CTA) also did not clarify any abnormal vessel structure except for slightly dilatation at the part of internal carotid artery, suggesting tiny ruptured aneurysm. The authors performed a cerebral angiography and resulted in no aneurysm or arteriovenous shunt detection but revealed the extravasation from middle cerebral artery and middle meningeal artery. Follow-up CT revealed increased left ASDH though 5 hours have already elapsed. The authors performed surgical intervention to halt the bleeding.

Conclusion:
The authors experienced a notably rare image of the extravasation from middle cerebral artery and middle meningeal artery in the cerebral angiography. When an obscure arterial abnormality is suspected on CTA for the unknown origin SAH with ASDH, the authors may have an affirmative attitude toward performing conventional cerebral angiography, which is most promising modality to detect the source of bleeding including CEV.
Mandibular Regeneration With Autologous Human Bone Marrow Derived Mesenchymal Stem Cells to Treat Unicystic Ameloblastoma: A Clinical Report
Authors: Son Jeong Wan , Kim Bong Chul , Yoon Jung Hoon , Jun Lee  , Lim Hun Jun 
Published: November 2018

Abstract
Ameloblastoma is a rare, benign tumor found in the jaw. These tumors have a tendency for locally aggressive expansion, and thus require surgical removal. For the previous 3 decades, autologous bone grafting and free flap surgeries have been most commonly used to correct bone defects after surgical removal of the lesion. In this report, the authors describe a case of unicystic ameloblastoma in a 14-year-old girl who was successfully treated with mandibular regeneration, attained by autologous human bone marrow mesenchymal stem cells without any autologous bone graft and free flap transfer. This case shows that autologous human bone marrow mesenchymal stem cells can be used as an alternative method to autologous bone graft and free flap transfer in a large bone defect of the jaw.
Assessment of Bioabsorbable Hydroxyapatite for Cranial Defect in Children
Authors: Sakamoto Yoshiaki , Miwa Tomoru , Yoshida Kazunari , Kishi Kazuo 
Published: November 2018

Purpose:
To evaluate the utility and efficacy of bioabsorbable hydroxyapatite and collagen complex (HA/Col) for cranioplasty repair of cranial bone defects in children.

Methods:
Two patients (a 6-year-old male and 11-year-old female) with Treacher Collins syndrome received zygoma and orbital floor reconstruction using a full thickness of parietal bone. The bone grafts were taken from each patient's parietal cranium. The right parietal cranial defect was repaired with autologous bone dust, and the left side was repaired with HA/Col in each patient. Computed tomography scans were taken immediately after and at 12 months following surgery. The osteosynthesis areas and thicknesses were measured using computer-aided engineering.

Results:
Both patients experienced no complications, including infection. In the 6- and 11-year-old patients, the extent of osteosynthesis for HA/Col was 92.2% and 89.4%, respectively; and for the autologous bone dust was 78.5% and 53.2%, respectively. Because of the small sample size, a significant difference could not be calculated; however, the percentage of osteosynthesis for HA/Col was higher than for the autologous bone dust.

Conclusion:
This study showed that HA/Col can be effectively used in cranial defects and can be considered an alternative graft material for cranial reconstruction.
Gingival Neurofibroma With Teardrop-Shaped Defects of the Interdental Alveolar Bone: An Unusual Oral Manifestation of Neurofibromatosis Type 1
Authors: Kubota Seiko , Imai Tomoaki , Iwai Soichi , Nakazawa Mitsuhiro , Uzawa Narikazu 
Published: November 2018

Abstract
Gingival enlargement, although frequently encountered in clinical settings, is rarely associated with systemic diseases or syndromes. Among the diverse pathological conditions of neurofibromatosis type 1 (NF-1), minor manifestations in the orofacial region are occasionally overlooked. Herein, the authors present an unusual case of gingival neurofibroma in a patient with NF-1 associated with characteristic osseous defects in the alveolus in the long-term course of 17 years from the first examination.
A 5-year-old boy with NF-1 was referred for the evaluation of gingival enlargement in the posterior left maxilla. An incisal biopsy led to the diagnosis of neurofibroma. At 22 years of age, the patient was referred again with a complaint of bleeding and pain in the same region refractory to periodontal therapy. The gingiva and tuberosity were swollen, and the second molar was affected by the tumor. Radiography revealed a low level of the interdental septum beneath the tumor with a relatively intact periodontal cortical bone, exhibiting a teardrop-shaped bone defect. The lesion was completely resected with the periosteum.
Gingival neurofibroma in NF-1 may be associated with osseous and dental abnormalities and can be mistaken for periodontitis. Raising awareness of this clinical entity can lead to proper management of the esthetic and functional problems in the oral and maxillofacial region.
Reliability of Ultrasound-Guided One-Point Fixation for Zygomaticomaxillary Complex Fractures
Authors: Sato Akimitsu , Imai Yoshimichi , Muraki Kenji , Tachi Masahiro 
Published: November 2018

Abstract
This study aimed to analyze the precision and postoperative stability of ultrasound guided 1-point fixation on the zygomaticomaxillary buttress for the treatment of zygomaticomaxillary complex (ZMC) fractures. The authors analyzed 24 consecutive patients who underwent ultrasound-guided 1-point fixation for ZMC fractures without separation of the fracture at the frontal process of the zygomatic bone. The authors used titanium plates in the first 6 cases, and biodegradable plates in the remaining 18 cases. The authors obtained computed tomography images preoperatively, and again the first day after surgery (T1) and 6 months after the surgery (T2). The authors calculated vertical change (VC) and horizontal change (HC) of the zygoma on computed tomography. Precision was evaluated with T1 images. Stability was evaluated from T1 to T2, and titanium and biodegradable plates were compared. From T1 images, the mean VC and HC was 0.22° (range, 1.60°–1.08°) and 0.33° (range, 1.86°–1.03°), respectively. From T1 to T2, the mean VC and HC was 0.08° and 0.28°, respectively. Comparing the types of plates, the mean HC in the biodegradable plate group was 0.39°, which was significantly greater than that in the titanium plate group (mean −0.10°). However, as the degree of change was relatively small, this did not pose any clinical problems. Our findings suggest that ultrasound-guided 1-point fixation on the zygomaticomaxillary buttress provides accurate reduction on ZMC fractures without the separation of the frontal process of the zygomatic bone fracture. Sufficient stability was obtained, even with the use of biodegradable plates.
Change in functional status among children treated in the intensive care unit after injury
Authors: Ahmed Omar Z. , Holubkov Richard , Dean J. Michael , Bennett Tellen D. , Meert Kathleen L. , Berg Robert A. , Newth Christopher J.L. , Carcillo Joseph A. , Burd Randall S. , Pollack Murray M. 
Published: November 2018

BACKGROUND
Because pediatric trauma-related mortality continues to decline, metrics assessing morbidity are needed to evaluate the impact of treatment after injury. Based on its value for assessing children with traumatic brain injuries and other critical illnesses, Functional Status Scale (FSS), a tool that measures function in six domains (communication, feeding, mental, motor, sensory, and respiratory), was evaluated as an outcome measure for the overall population of injured children.

METHODS
Children with at least one injury (Abbreviated Injury Scale [AIS] severity ≥1) surviving to discharge between December 2011 and April 2013 were identified in a previous study of intensive care unit admissions. Morbidity was defined as additional morbidity in any domain (domain FSS change ≥2 or "new domain morbidity") and additional overall morbidity (total FSS change ≥3) between preinjury status and discharge. Associations between injury profiles and the development of morbidity were analyzed.

RESULTS
We identified 553 injured children, with a mean of 2.0 ± 1.9 injuries. New domain and overall morbidity were observed in 17.0% and 11.0% of patients, respectively. New domain morbidity was associated with an increasing number of body regions with an injury with AIS ≥ 2 (p < 0.001), with severe (AIS ≥ 4) head (p = 0.04) and spine (p = 0.01) injuries and with at moderately severe (AIS ≥ 2) lower extremity injuries (p = 0.01). New domain morbidity was more common among patients with severe spine and lower extremity injuries (55.6% and 48.7%, respectively), with greatest impact in the motor domain (55.6% and 43.6%, respectively). New domain morbidity was associated with increasing injury severity score, number of moderately severe injuries and number of body regions with more than a moderately severe injury (p < 0.001 for all).

CONCLUSIONS
Higher morbidity measured by the FSS is associated with increasing injury severity. These findings support the use of the FSS as a metric for assessing outcome after pediatric injury.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic, level III.
Near hangings: Epidemiology, injuries, and investigations
Authors: Schellenberg Morgan , Inaba Kenji , Warriner Zachary , Alfson Daniel , Roman Jordan , Van Velsen Valery , Lam Lydia , Demetriades Demetrios 
Published: November 2018

BACKGROUND
Near hangings are an infrequent cause of trauma, and the optimal workup for these patients is unclear. The study objectives were to define the epidemiology, injury patterns, and use of investigations, including computed tomographic angiography (CTA) neck, after near hangings.

METHODS
All patients presenting to LAC+USC Medical Center (2008–2015) after near hanging (International Classification of Diseases, Ninth Revision, code of E913.8, E953.0, E963, or E983.0) were screened for inclusion. Transferred patients were excluded. Patient demographics, clinical data, injury data, investigations performed, and outcomes were collected.

RESULTS
Over the study period, 71 patients were identified. Median age was 32 years (interquartile range [IQR], 24-44), and 85% (n=64) were male. Median Glasgow Coma Scale was 12 [IQR 5-15], and median Injury Severity Score was 1 [IQR 1-2]. Mortality rate was 14% (n = 10). The most common finding on physical examination was a ligature mark (n = 38, 54%). Cervical injuries after near hangings occurred infrequently (five injuries in four patients [6%]: 3 [4%] arterial injuries and 2 [3%] laryngotracheal injuries). Only one patient (1%) required surgical and/or endovascular intervention. Two (3%) arrived in cardiac arrest, underwent resuscitative thoracotomy, and were pronounced dead. All others (n = 69, 97%) underwent CTA of the neck. No patient in this series manifested signs or symptoms of cervical injury during hospitalization after a normal CTA neck on presentation.

CONCLUSION
Near hangings infrequently result in cervical injury, and intervention is rarely needed. When injuries are sustained, they occur to critical structures such as the larynx, trachea, and cervical vasculature. Therefore, effective injury screening is important. We recommend CTA of the neck as the optimal initial imaging investigation after near hangings.

LEVEL OF EVIDENCE
Epidemiologic, level IV; therapeutic/care management, level IV.
Analysis of over 2 decades of colon injuries identifies optimal method of diversion: Does an end justify the means?
Authors: Manley Nathan R. , Sharpe John P. , Lewis Richard H. , Iltis Mark S. , Chaudhuri Rishi , Fabian Timothy C. , Croce Martin A. , Magnotti Louis J. 
Published: November 2018

INTRODUCTION
Conflicting evidence exists regarding the definitive management of destructive colon injuries. Although diversion with an end ostomy can theoretically decrease initial complications, it mandates a more extensive reversal procedure. Conversely, anastomosis with proximal loop ostomy diversion, while simplifying the reversal, increases the number of suture lines and potential initial morbidity. Thus, the purpose of this study was to evaluate the impact of diversion technique on morbidity and mortality in patients with destructive colon injuries.

METHODS
Consecutive patients with destructive colon injuries managed with diversion from 1996 to 2016 were stratified by demographics, severity of shock and injury, operative management, and timing of reversal. Outcomes, including ostomy complications (obstruction, ischemia, readmission) and reversal complications (obstruction, abscess, suture line failure, fascial dehiscence), were compared between patients managed with a loop versus end colostomy. Patients with rectal injuries and who died within 24 hours were excluded.

RESULTS
A total of 115 patients were identified: 80 with end colostomy and 35 with loop ostomy. Ostomy complications occurred in 22 patients (19%), and 11 patients (10%) suffered reversal complications. There was no difference in ostomy-related (2.9% vs. 3.8%, p = 0.99) mortality. For patients without a planned ventral hernia (PVH), there was no difference in ostomy complications between patients managed with a loop versus end colostomy (12% vs. 18%, p = 0.72). However, patients managed with a loop ostomy had a shorter reversal operative time (95 vs. 245 minutes, p = 0.002) and reversal length of stay (6 vs. 10, p = 0.03) with fewer reversal complications (0% vs. 36%, p = 0.02). For patients with a PVH, there was no difference in outcomes between patients managed with a loop versus end colostomy.

CONCLUSION
For patients without PVH, anastomosis with proximal loop ostomy reduced reversal-related complications, operative time, LOS, and hospital charges without compromising initial morbidity. Therefore, loop ostomy should be the preferred method of diversion, if required, following destructive colon injury.

LEVEL OF EVIDENCE
Therapeutic, level IV.
The impact of hypothermia on outcomes in massively transfused patients
Authors: Lester Erica Louise Walsh , Fox Erin E. , Holcomb John B. , Brasel Karen J. , Bulger Eileen M. , Cohen Mitchell J. , Cotton Bryan A. , Fabian Timothy C. , Kerby Jeffery D. , O'Keefe Terrence , Rizoli Sandro B. , Scalea Thomas M. , Schreiber Martin A. , Inaba Kenji 
Published: November 2018

BACKGROUND
Hypothermia is associated with poor outcomes after injury. The relationship between hypothermia during contemporary large volume resuscitation and blood product consumption is unknown. We evaluated this association, and the predictive value of hypothermia on mortality.

METHODS
Patients predicted to receive massive transfusion at 12 level 1 trauma centers were randomized in the Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial and were grouped into those who were hypothermic (<36°C) or normothermic (36–38.5°C) within the first 6 hours of emergency department arrival. The impact of hypothermia or normothermia on the volume of blood product required during the first 24 hours was determined via negative binomial regression, adjusting for treatment arm, injury severity score, mechanism, demographics, pre–emergency department fluid volume, blood administered before becoming hypothermic, pulse and systolic blood pressure on arrival, and the time exposed to hypothermic or normothermic temperatures.

RESULTS
Of 680 patients, 590 had a temperature measured during the first 6 hours in hospital, and 399 experienced hypothermia. The mean number of red blood cell (RBC) units given to all patients in the first 24 hours of admission was 8.8 (95% confidence interval [CI], 7.9–9.6). In multivariable analysis, every 1°C decrease in temperature below 36.0°C was associated with a 10% increase (incidence rate ratio, 0.90; 95% CI, 0.89–0.92; p < 0.00) in consumption of RBCs during the first 24 hours of admission. There was no association between RBC administration and a temperature above 36°C. Hypothermia on arrival was an independent predictor of mortality, with an adjusted odds ratio of 2.7 (95% CI, 1.7–4.5; p < 0.00) for 24-hour mortality and 1.8 (95% CI, 1.3–2.4; p < 0.00) for 30-day mortality.

CONCLUSION
Hypothermia is associated with increase in blood product consumption and mortality. These findings support the maintenance of normothermia in trauma patients and suggest that further investigation on the impact of cooling or rewarming during massive transfusion is warranted.

LEVEL OF EVIDENCE
Prognostic, level III.
Reevaluation of the Kidney Donor Risk Index
Authors: Zhong Yingchao , Schaubel Douglas E. , Kalbfleisch John D. , Ashby Valarie B. , Rao Panduranga S. , Sung Randall S. 
Published: November 2018

Background.The Kidney Donor Risk Index (KDRI) is a score applicable to deceased kidney donors which reflects relative graft failure risk associated with deceased donor characteristics. The KDRI is widely used in kidney transplant outcomes research. Moreover, an abbreviated version of KDRI is the basis, for allocation purposes, of the “top 20%” designation for deceased donor kidneys. Data upon which the KDRI model was based used kidney transplants performed between 1995 and 2005. Our purpose in this report was to evaluate the need to update the coefficients in the KDRI formula, with the objective of either (a) proposing new coefficients or (b) endorsing continued used of the existing formula.Methods.Using data obtained from the Scientific Registry of Transplant Recipients, we analyzed n = 156069 deceased donor adult kidney transplants occurring from 2000 to 2016. Cox regression was used to model the risk of graft failure. We then tested for differences between the original and updated regression coefficients and compared the performance of the original and updated KDRI formulas with respect to discrimination and predictive accuracy.Results.In testing for equality between the original and updated KDRIs, few coefficients were significantly different. Moreover, the original and updated KDRI yielded very similar risk discrimination and predictive accuracy.Conclusions.Overall, our results indicate that the original KDRI is robust and is not meaningfully improved by an update derived through modeling analogous to that originally employed.