bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Time to Postoperative Radiation Therapy on Survival in Resected Merkel Cell Carcinoma
Authors: Shinde Ashwin , Verma Vivek , Jones Bernard L. , Li Richard , Glaser Scott , Freeman Morganna , Melstrom Laleh , Kang Robert , Parvathaneni Upendra , Modi Badri , Amini Arya 
Published: July 2019

Objectives:
Delays from surgery to adjuvant radiation therapy (aRT) are associated with poorer prognosis in multiple neoplasms. Presently, no data exist for Merkel cell carcinoma (MCC). The authors sought to assess the time interval from surgery to aRT and effect on outcomes in MCC.

Materials and Methods:
The National Cancer Database was queried for histologically confirmed nonmetastatic MCC status post resection and aRT diagnosed between 2004 and 2015 who received aRT within 24 weeks of surgery. Kaplan-Meier analysis assessed univariate overall survival (OS); multivariable Cox proportional hazards modeling assessed multivariate OS; χ2 and logistic regression assessed differences in baseline characteristics and predictors of delayed aRT.

Results:
Of 5952 patients meeting criteria, 13% commenced aRT within 4 weeks, 48% between 4 and 7 weeks, 23% between 8 and 11 weeks, 11% between 12 and 15 weeks, and 6% between 16 and 24 weeks. There were no differences in OS on the basis of the surgery-aRT interval (P=0.99). Predictors of worse OS on the multivariate analysis included advanced age, greater comorbidities, male sex, lower regional income, earlier year of diagnosis, more advanced tumor and nodal staging, positive margins, head and neck location, and treatment at community facilities (P<0.05 for all). Factors predictive of delayed aRT were identified. Subset analyses on these factors, such as receipt of chemotherapy or positive lymph nodes, did not demonstrate that the timing of aRT affected survival (P≥0.37).

Conclusion:
This study of a contemporary national database revealed that delays from resection to aRT were not associated with survival in MCC, somewhat discordant from other malignancies such as squamous cell carcinoma.
Unique Uses of SPY: An Approach to Groin Lymphatic Complications
Authors: Lu Karen B. , Erickson Cameron , Sanniec Kyle , Amirlak Bardia 
Published: July 2019

Summary:
Femoral artery reconstructive operations pose the risk of damage to the lymphatic system and leakage of lymph fluid into the groin. This leakage establishes a stagnant reservoir of protein-rich fluid, further placing the patient at risk for complications, especially a higher infection rate. The use of SPY technology (Stryker Corp/Novadaq Technologies, Kalamazoo, Mich) for lymphatic leaks have been described in previous studies. However, the management of persistent high-output lymphatic leaks addressed secondarily with SPY lymphangiography have yet to be reported. This case report describes a young male who underwent thrombectomy in the left common femoral artery, who presented several days later with a high-output chylous leak. The lymphatic leak was initially managed and failed conventional muscle flaps, and SPY lymphangiography was performed to manage the lymphatic leak during the secondary surgery. The lymphatic vessels were ligated and confirmed with SPY lymphangiography. The management of lymphatic groin complications aided by the use of SPY lymphangiography provided valuable data and allowed for better intraoperative visualization. Utilization of SPY technology allowed the surgeons to properly address all sites of leakage in an otherwise persistent lymphatic leak. Resolution of lymphatic leak was further confirmed with SPY. Lymphatic complications, particularly those in the groin area, are of significant concern to physicians. Any suspected chylous leak should be followed with SPY lymphangiography to ensure proper treatment and resolution. Prophylactic use of SPY technology in high-risk patients during lymphatic surgery of the groin may also be considered.
Infantile Hemangiomas of the Lip: Complications and Need for Surgical Intervention
Authors: Cawthorn Thomas R. , Fraulin Frankie O.G. , Harrop Alan Robertson 
Published: July 2019

Background:
Infantile lip hemangiomas are challenging to manage due to the functional and aesthetic importance of the lips. Hemangiomas in this region may lead to significant complications including ulceration, feeding difficulties, and lip contour distortion requiring surgical intervention.

Methods:
A retrospective chart review of children with focal lip hemangiomas treated at our institution between January 2000 and December 2016 was conducted. Patient demographics, lesion characteristics, complications, treatments, and outcomes were collected. Lesions were classified based on depth (superficial, deep, or mixed depth), vermillion border involvement, and location.

Results:
One hundred and two patients with focal lip hemangiomas were identified; 45.1% were managed expectantly, 43.1% were treated medically, and 18.6% required surgery. Residual lip contour deformity following involution was the most common complication (26.5% of patients). Ulceration during the proliferation phase was reported in 14.7% of patients, leading to significant feeding difficulties in 9.8% of patients. All ulcerations occurred in lesions with a superficial component. None of the patients with superficial lesions underwent surgery; 27.1% of patients with deep or mixed depth hemangiomas required surgical treatment to restore lip contour.

Conclusions:
Lip hemangiomas have high rates of complications that seem to be related to lesion morphology and phase of growth. Ulceration occurs during the early proliferative phase and is most frequently associated with mixed depth hemangiomas. Residual lip contour deformities are identified in the involution phase; presence of a deep component is the primary factor in predicting the need for surgical intervention in these patients.
Prediction of Best-Corrected Visual Acuity With Swept-Source Optical Coherence Tomography Parameters in Keratoconus
Authors: Esaka Yuri , Kojima Takashi , Dogru Murat , Hasegawa Asato , Tamaoki Akeno , Uno Yunako , Nishida Tomoya , Nakamura Tomoaki , Hara Syuya , Ichikawa Kazuo 
Published: July 2019

Purpose:
This study aimed to predict the best-corrected visual acuity (BCVA) based on swept-source optical coherence tomography (SS-OCT) parameters in eyes with keratoconus.

Methods:
We retrospectively reviewed 135 eyes of 135 patients with keratoconus (mean age: 31.9 ± 12.4 years). The average keratometry value and BCVA (logarithm of the minimal angle of resolution [Snellen]) were 48.68 ± 5.44 diopter and 0.20 ± 0.36 (20/25), respectively. Eleven parameters were calculated using SS-OCT. Apart from the corneal height and elevation, all the other parameters were calculated from both anterior and posterior corneal OCT data. The patients were divided into 2 groups, 1 for creating the prediction equation (prediction group, 86 eyes) and another for verifying the equation (verification group, 49 eyes). In the former, individual correlations between the BCVA and SS-OCT parameters were analyzed. A stepwise multiple regression analysis was performed with the BCVA as a dependent variable and SS-OCT parameters as independent variables. After its creation, the accuracy of the prediction equation was verified in the verification group.

Results:
All the parameters, except for age and total corneal cylinder, showed statistically significant correlations with BCVA (P < 0.0001). Using the stepwise multiple regression analysis, we selected 2 explanatory variables: root mean square of anterior corneal elevation (standardized regression coefficient: 1.221; P < 0.0001) and total coma aberration (standardized regression coefficient: −0.575; P = 0.001; adjusted R2 = 0.546). The prediction was correct in 84.6% of the eyes within ±1 line of Snellen BCVA.

Conclusions:
Using the equation we derived from SS-OCT parameters is a promising method to predict visual function in patients with keratoconus.
Excluding Clinically Significant Bacteremia by 24 Hours in Otherwise Well Febrile Children Younger Than 16 Years
Authors: Theodosiou Anastasia A. , Mashumba Fari , Flatt Andrew 
Published: July 2019

Background:
In febrile children given empiric parenteral antibiotics, guidelines advise provisional reporting of negative blood cultures and antibiotic review after 36 hours incubation for neonates and 48 hours for older children. Following improvements in culture processing and childhood vaccination, we revisited this important clinical topic, assessing time to exclude clinically significant bacteremia in well-appearing febrile children with no comorbidities or features of sepsis.

Methods:
We analyzed the results of all 53,276 pediatric blood cultures taken during an 8-year period at a UK hospital.

Results:
1308 (2.5%) cultures were positive, of which 333 (25.5%) grew pathogens typically associated with clinically significant bacteremia. The remaining 975 (74.5%) grew organisms associated with contaminated culture, or with opportunistic infection only in children with relevant risk factors. Time to positivity (TTP) from incubation was significantly shorter for the 333 definite pathogens than the 975 contaminating/opportunistic organisms, with 92% of definite pathogens identified by 24 hours incubation. Only 3 of all definite pathogens were identified after 24 hours in children otherwise eligible for discharge at 24 hours. There was no significant difference in TTP for definite pathogens between neonates and older children. Median time from specimen collection to incubation was 3 hours.

Conclusions:
Clinically significant bacteremia can be excluded by 24 hours incubation in well-appearing febrile children with no comorbidities or features of sepsis. This is the largest dataset of its kind, and the second to compare neonates and older children. Our findings may inform future guidelines, facilitating earlier antibiotic review and discharge.
Recommendations for photoprotection in pediatric rheumatology patients
Authors: Dayrit-Castro Carmela , Tantuco Kimberly , Lara-Corrales Irene 
Published: July 2019

Purpose of review
Patients seen at pediatric rheumatology are at increased risk of immediate and long-term consequences from sun exposure. The objective of this review is to build awareness of the need of sun protection in pediatric rheumatology patients.

Recent findings
Sun exposure can lead to disease exacerbations in many rheumatic diseases. There is well documented literature linking the chronic use of immunosuppressants with long-term risk of skin cancer. Although there is a lack of literature in pediatric rheumatology addressing the need of sun protection in this patient population, the young age of patients, the nature of their disease and the treatments they receive, make them a high-risk population for the effects of the sun.

Summary
Sun protection recommendations are outlined in the following manuscript, backed up by the rationale and biology of why it is important for pediatric rheumatology patients to be protected from the sun. The information reviewed in this article should be part of the education that all pediatric rheumatology patients should receive as part of their care.
Experiences of Women with Postpartum Depression Participating in a Support Group Led by Mental Health Providers
Authors: Cook Carolyn , Goyal Deepika , Allen Monica 
Published: July 2019

Abstract

Purpose:
The purpose of this study was to explore experiences of women currently with or at high risk for developing postpartum depression (PPD) who were participating in a postpartum support group facilitated by mental health providers.

Study Design and Methods:
Using a qualitative design, women ≥18 years of age, who had given birth within the past 2 years, and who were currently attending, or had attended the PPD support group within the past year were invited to participate. The women provided demographic data and participated in a semistructured face-to-face interview. Data were analyzed using qualitative content analysis.

Results:
Seven women between 27 and 38 years of age participated. Most were married and college educated. At time of the interviews, participants were between 5 months and 2 years postpartum and all reported taking antidepressant medications for their symptoms. Qualitative content analysis revealed three overall themes: attendance, impact, and medication adherence, with associated subthemes.

Clinical Implications:
Women attending a PPD support group facilitated by mental health providers felt supported, were more likely to disclose their symptoms to other women in the same situation, and were able to share their feelings without fear of judgment. Having concerns about antidepressant medication addressed at each meeting promoted medication adherence. Nurses working with childbearing women should be aware of community support services available for women at risk for developing PPD.
Chemotherapy supply chain safety: current data from public oncology centers in Morocco
Authors: Ouasrhir Abdelali , Rahhali Rabie , Boukhatem Noureddine 
Published: July 2019

Abstract

Introduction:
Since 2006, Morocco has been involved in care development for cancer patients, through regionalization of oncology centers, setting up of a program for cancer prevention, control, and treatment, finally by ensuring the quality of treatment. Chemotherapy is a risk-complexed process because of involving many health professionals. Our objective is to focus on the current state of public oncology hospitals and evaluate the chemotherapy process.

Methods:
An anonymous questionnaire was sent to 12 public centers by e-mails. It contains 4 items that establish chemotherapy process starting by receiving and storage of anticancer drugs, pharmaceutical validation of therapeutic protocols, until the administration of chemotherapy as well as the management of medical waste and expired medications.

Results:
Results showed that public regional centers represent 58.4% of participating centers, and university hospital centers represent 41.6%. Three quarters (73.3%) of hospital pharmacies have enough and appropriate receiving space. Sixty percent of pharmacist did not do any training to receive anticancer drugs. Oncology treatment protocols received in 53.3% of hospitals are not computerized. Biological data for pharmaceutical validation are not available on chemotherapy protocol in 73% of cases. All participating centers in the study confirmed that they have subcontracting contracts with companies specialized in the management of expired anticancer drugs and chemotherapy waste.

Conclusion:
Our study has shown that much effort has been made concerning the provision of oncology centers in several regions of the kingdom, anticancer drugs compounding centralization, and establishment-quality procedures that accompanied the chemotherapy process.
Specific Viral Etiologies Are Associated With Outcomes in Pediatric Acute Respiratory Distress Syndrome*
Authors: Roberts Anna L. , Sammons Julia S. , Mourani Peter M. , Thomas Neal J. , Yehya Nadir 
Published: July 2019

Objectives:
Infectious pneumonia is the most common cause of acute respiratory distress syndrome, with viruses frequently implicated as causative. However, the significance of viruses in pediatric acute respiratory distress syndrome is unknown. We aimed to characterize the epidemiology of viral pneumonia in pediatric acute respiratory distress syndrome and compare characteristics and outcomes between pneumonia subjects with and without viruses. Secondarily, we examined the association between specific viruses and outcomes.

Design:
We performed a secondary analysis of a prospectively enrolled pediatric acute respiratory distress syndrome cohort. Subjects with pneumonia acute respiratory distress syndrome underwent testing of respiratory secretions for viruses and culture for bacteria and fungi and were stratified according to presence or absence of a virus.

Setting:
Tertiary care children’s hospital.

Patients:
Children with acute respiratory distress syndrome.

Interventions:
None.

Measurements and Main Results:
Of 544 children with acute respiratory distress syndrome, 282 (52%) had pneumonia as their inciting etiology, of whom 212 were virus-positive. In 141 of 282 (50%) pneumonia acute respiratory distress syndrome cases, a virus was the sole pathogen identified. Virus-positive pneumonia had fewer organ failures but worse oxygenation, relative to virus-negative pneumonia, with no differences in antibiotic use, ventilator duration, or mortality. Subjects with respiratory syncytial virus-associated acute respiratory distress syndrome had lower mortality (0%), and subjects with influenza-associated acute respiratory distress syndrome had shorter ventilator duration, relative to other viral acute respiratory distress syndrome. Nonadeno herpesviruses, tested for exclusively in immunocompromised subjects, had greater than 80% mortality.

Conclusions:
Pneumonia was the most common cause of pediatric acute respiratory distress syndrome, and viruses were commonly isolated as the sole pathogen. Respiratory syncytial virus and influenza were associated with better outcomes relative to other viral etiologies. Viral pneumonias in immunocompromised subjects, particularly nonadeno herpesviruses, drove the mortality rate for pneumonia acute respiratory distress syndrome. Specific viral etiologies are associated with differential outcomes in pediatric acute respiratory distress syndrome and should be accounted for in future studies.
Acquired von Willebrand Syndrome in Pediatric Extracorporeal Membrane Oxygenation Patients: A Single Institution’s Experience*
Authors: Ruth Amanda , Meador Marcie , Hui Rocky , Loftis Laura , Teruya Jun 
Published: July 2019

Objectives:
1) Describe the prevalence of acquired von Willebrand syndrome in pediatric patients undergoing extracorporeal membrane oxygenation deemed to be at increased risk for the disease in our institution, 2) discuss the challenges of testing for acquired von Willebrand syndrome diagnosis, 3) describe the characteristics of the patient population found to have acquired von Willebrand syndrome and their outcomes, and 4) discuss the potential implications of acquired von Willebrand syndrome on bleeding complications.

Design:
Retrospective chart review.

Setting:
PICU and cardiovascular ICU in a single institution.

Patients:
All PICU and cardiovascular ICU extracorporeal membrane oxygenation patients 0–18 years old who underwent screening for acquired von Willebrand syndrome between January 2014 and December 2016.

Interventions:
Humate P administration to a small subset of acquired von Willebrand syndrome positive subjects.

Measurements and Main Results:
Laboratory data of identified patients were analyzed. The diagnosis of acquired von Willebrand syndrome was made based on decreased ristocetin cofactor activity to von Willebrand factor antigen ratio and/or abnormal multimer analysis. Clinical data were extracted from the chart and through the Pediatric Extracorporeal Membrane Oxygenation Outcome Registry to describe the demographics, comorbidities, and outcomes of this patient population. In the 2 years, 29 patients had laboratory testing performed for surveillance and in cases of clinical bleeding. Of these, 23 (79%) were positive by criteria. No significant difference in mortality rate was found between patients with acquired von Willebrand syndrome versus without. We also did not find a significant difference in the blood product utilization or bleeding complications between patients with acquired von Willebrand syndrome versus without. Humate P was administered in 39% of patients (9/23) who were positive for acquired von Willebrand syndrome, but no significant difference was seen in blood product utilization or bleeding complications between acquired von Willebrand syndrome patients receiving Humate P versus those who did not.

Conclusions:
Acquired von Willebrand syndrome is a common but under recognized disorder in pediatric extracorporeal membrane oxygenation patients. The clinical implications of this disorder on bleeding and its potential treatments are still unclear.
Epidemiology of Clinically Relevant Bleeding in Critically Ill Adolescents*
Authors: Pinto Matthew G. , Shabanova Veronika , Li Simon , Trakas Erin , Miksa Michael , Gertz Shira , Polikoff Lee A. , Tala Joana A. , Faustino Edward Vincent S. 
Published: July 2019

Objectives:
The epidemiology of clinically relevant bleeding in critically ill adolescents, particularly those who are at high risk of venous thromboembolism, is unclear. In preparation for a randomized clinical trial of pharmacologic prophylaxis against venous thromboembolism, we characterized the epidemiology of clinically relevant bleeding in critically ill adolescents.

Design:
Post hoc analysis of data from a pediatric multicenter observational study of venous thromboembolism.

Setting:
Six PICUs.

Patients:
Adolescents 13–17 years old who received cardiac or pulmonary support for at least 48 hours were eligible. Those admitted with venous thromboembolism or receiving therapeutic anticoagulation were excluded.

Interventions:
None.

Measurements and Main Results:
Adolescents (n = 88) were followed daily for the development of any bleeding event. The severity of the event was categorized based on the definitions by the International Society on Thrombosis and Haemostasis. The frequency of clinically relevant bleeding was 29.5% (95% CI, 20.3–40.2%) or 3.7 events (95% CI, 2.5–5.4 events) per 100 patient-days. Adolescents with venous thromboembolism were more likely to develop clinically relevant bleeding (hazard ratio, 2.06; 95% CI, 1.08–3.94). Age was negatively associated with clinically relevant bleeding (hazard ratio for every 1-year increase in age: 0.68; 95% CI, 0.58–0.79). In contrast, predicted risk of mortality (hazard ratio for every 0.10 increase in risk: 1.35; 95% CI, 1.05–1.74) and admission for trauma or surgery (hazard ratio: 2.04; 95% CI, 1.21–3.44) were positively associated with clinically relevant bleeding. The association of clinically relevant bleeding with medications, interventions, or laboratory tests, including mechanical ventilation and pharmacologic prophylaxis with anticoagulation, did not reach statistical significance. Adolescents with clinically relevant bleeding stayed in the hospital longer than those without clinically relevant bleeding.

Conclusions:
Clinically relevant bleeding is common in critically ill adolescents who are at high risk of venous thromboembolism. Admission for trauma or surgery can be used to stratify the risk of clinically relevant bleeding in these adolescents.