bluuebunny/crossref_metadata_2025_split huggingface dataset:
Significance of contrast-enhanced ultrasonography in differential diagnosis of thyroid nodules
Authors: Tian Qing , Zhu Haohui , Li Hui 
Published: October 2018

Abstract
The present study was aimed to compare the application values between 2-dimensional color Doppler ultrasonography (2DUS) and contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of thyroid malignant nodules.
A total of 124 patients suspectedly diagnosed with malignant thyroid nodules under conventional gray-scale ultrasonography were recruited in this study. All enrolled patients were examined by both 2DUS and CEUS.
A total of 153 nodules (94.44%) and 45 cases (90.00%) with malignant nodules were detected by the CEUS. No significant differences were noted in nodule detection rates between 2DUS and CEUS (χ2 = 1.170, P = .279; χ2 = 0.796, P = .372). The aspect ratio, microcalcification, internal echo, borderline, Vmax, resistance index, and total scores of malignant nodules were higher than those of benign nodules (all P < .05) when diagnosed by 2DUS. The peripheral/internal enhancement time, peak intensity, local enhancement, ring enhancement, and total scores of malignant nodules were significantly higher compared with those of benign nodules (all P < .05) by CEUS. Total score of malignant nodules diagnosed by 2DUS was approximately 3.5 and 2.3 points for CEUS. The diagnostic accuracy of 2DUS as observed by area under the curve was 0.821 with the cut-off value of 3.9, the sensitivity was 82.5%, and the specificity was 85.6%. The diagnostic accuracy of CEUS was 0.862 with the cut-off value of 2.8, the sensitivity was 86.7%, and the specificity was 91.3%.
Both 2DUS and CEUS are worthy of application values in the differential diagnosis from benign to malignant thyroid nodules.
The risk factors for bone metastases in patients with colorectal cancer
Authors: Li An-An , Cao Zhi-Yuan , Liu Jia-Ming , Huang Shan-Hu , Liu Zhi-Li 
Published: October 2018

Abstract
This retrospective analysis aim to evaluate the potential risk factors for bone metastases (BM) in patients who were diagnosed with colorectal cancer (CRC).
A total of 2790 patients diagnosed with CRC between January 2006 and December 2016 were collected in this study. All patients were divided into 2 groups, BM and no BM. The associations between biomarkers (including age, gender, histopathological types, alkaline phosphatase (ALP), carcinoembryonic antigen (CEA), cancer antigen 125, and so on), and BM in patients with CRC were analyzed. All the analyses were conducted by SPSS software (version 22.0, SPSS, Chicago, IL).
Of all patients, 74 (2.7%) were identified with BM. The level of serum ALP, CEA, and cancer antigen 125 in patients with BM were obviously higher than those without BM (P < .001, P = .005, and P < .001). And the cut-off values of ALP, CEA, and cancer antigen 125 were 85.5 U/L, 6.9 mmol/L, and 16.8 mmol/L, respectively.
ALP, CEA, and cancer antigen 125 were identified as the independent risk factors for BM in patients with CRC.
Association of human leukocyte antigen alleles and supertypes with immunogenicity of oral rotavirus vaccine given to infants in China
Authors: Liu Yueyue , Guo Tai , Yu Qingchuan , Zhang Haowen , Du Jialiang , Zhang Yunqi , Xia Shengli , Yang Huan , Li Qihan 
Published: October 2018

Abstract
Rotavirus (RV) vaccines show distinct immunogenicity in dozens of clinical trials, which is associated with multiple host and environmental factors. Previous research has demonstrated that the highly polymorphic human leukocyte antigen (HLA) system plays an essential role in regulating immune response to a variety of vaccines. This study aims to investigate the relationship between HLA polymorphisms and immunogenicity of RV vaccine.
A nested case-control study was carried out among infants enrolled in phase III clinical trial of trivalent human-lamb reassortant vaccine (RV3) in Henan province, China. Serum RV specific immunoglobulin A (RV-IgA) was detected before and after a 3-dose vaccination series, followed by calculation of seroconversion rates. Seroconversion was defined as a 4-fold or greater increase in RV-IgA titers between pre-vaccination and 1-month post-dose 3 vaccination. The infants who seroconverted were defined as responders, and the others without seroconversion were considered as non-responders. Their HLA genotypes were obtained by using the sequence-based typing method. The HLA allele and supertype frequencies of 2 groups were analyzed statistically.
Eighty-three of 133 infants seroconverted after vaccination. Twenty-one HLA-A, 45 HLA-B, 24 HLA-Cw, 29 HLA-DRB1 and 16 HLA-DQB1 distinct alleles were detected. The frequency of HLA-B∗4001 (corrected P = .01, adjusted OR = 0.152, 95% CI = 0.048–0.475) in non-responder group was significantly higher than that in responder group. Furthermore, significant association was found between HLA-B44 supertype (corrected P = .02, adjusted OR = 0.414, 95% CI = 0.225–0.763) and RV non-response.
Certain HLA allele (HLA-B∗4001) and supertype (HLA-B44) are potentially associated with non-response after immunization with the novel RV3 vaccine in Chinese infants.
Evidence supporting FDA approval and CMS national coverage determinations for novel medical products, 2005 through 2016
Authors: Roginiel Aliya C. , Dhruva Sanket S. , Ross Joseph S. 
Published: October 2018

Abstract
Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) rely on evidence from clinical trials when approving a therapeutic for marketing and insurance coverage in the US, respectively. No study has compared the quality and quantity of evidence examined by these agencies.
To characterize evidence used by FDA and CMS to support marketing approval and National Coverage Determinations (NCDs), respectively, of novel therapeutics reviewed for CMS coverage from 2005 through 2016.
A cross-sectional study of clinical trials described in FDA approval documents and CMS NCD memoranda. We compared the number of clinical trials used by each agency as well as the following characteristics among original clinical trials: study size, randomization, double-blinding, and control arm.
Twelve medical products met our inclusion criteria. FDA approvals of these products were based on 22 pivotal trials. CMS NCDs were based on 27 original clinical trials; 14 clinical trials were used by both agencies. Between FDA pivotal and CMS original clinical trials, there was no significant difference in study size (P = .53), use of randomization (P = .75), double-blinding (P = .55), or control arm (P = .54). There was no statistically significant difference in median age between participants in trials reviewed by CMS versus those reviewed by FDA (62 vs 59 years, P = .26). The median time from FDA approval to publication of CMS NCD memorandum was 17 (interquartile range, 13–36) months.
FDA approvals and CMS NCDs are based on a similar number and quality of trials, although trial participants are not reflective of the Medicare population, and the process of finalizing coverage determinations requires an additional 17 months.
Vitamin D supplementation to prevent vitamin D deficiency for children with epilepsy
Authors: Khalifah Reem Al , Hudairi Abrar , Homyani Doua Al , Hamad Muddathir H. , Bashiri Fahad A. 
Published: October 2018

Abstract

Background
: Vitamin D deficiency is highly prevalent among children with epilepsy. Lack of high-quality evidence led to variability among scientific societies recommendations. Therefore, we aim to determine the efficacy of different common doses used in the pediatric practice to maintain optimal 25-hydroxy vitamin D (25 [OH] vitamin D) level in children with epilepsy and normal baseline 25 (OH) vitamin D level over 6 months of supplementation.

Methods
: This is a protocol for phase IV pragmatic randomized superiority controlled open-label trial at King Saud University Medical City in Riyadh. Children with epilepsy and receiving chronic antiepliptic medication and normal baseline 25 (OH) vitamin D level will be randomly assigned to receive Cholecalciferol 400 IU/day versus 1000 IU/day for 6 months. Our primary outcome is the proportion of children with vitamin D insufficiency (25 (OH) vitamin D level < 75nmol/L) at 6 months. Secondary outcomes include seizure treatment failure, seizure frequency, parathyroid hormone (PTH) levels, bone mineral density, and safety.

Discussion: Our trial is set out to evaluate the efficacy of common different vitamin D maintenance doses on 25 (OH) vitamin D level, seizure control, and bone health for children with epilepsy. The results of our study will possibly help in shaping current vitamin D guidelines for vitamin D supplementation in children with epilepsy and provide a link between 25 (OH) vitamin D level and seizure control.
Organizational Factors Associated With Technical Efficiency of Nursing Care in US Intensive Care Units
Authors: Min Ari , Scott Linda D. , Park Chang , Vincent Catherine , Ryan Catherine J. 
Published: October 2018

Background:
Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs).

Purpose:
To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care.

Methods:
A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency.

Results:
Nurse-to-patient ratio showed the strongest positive correlation with technical efficiency. Units in non-Magnet and small-size hospitals had higher technical efficiency than those in Magnet and medium- or large-size hospitals.

Conclusions:
A higher nurse-to-patient ratio greatly improved technical efficiency of nursing care in ICUs and the effect differed between hospitals. Administrators and policy makers can translate the study findings into management strategies to provide efficient nursing care in ICUs.
A Comparison of the Nulliparous-Term-Singleton-Vertex and Society of Maternal-Fetal Medicine Cesarean Birth Metrics Based on Hospital Size
Authors: Shields Laurence E. , Walker Suzan , Hedriana Herman L. , Wiesner Suzanne , Pelletreau Barbara , Hitti Jane , Benedetti Thomas J. 
Published: October 2018

(Abstracted from Am J Perinatol 2018;35:390–396)
Cesarean delivery rate is a commonly used health care metric to evaluate quality of care. Some states have proposed using it to select hospitals to provide care to pregnant women paid for by state-funded health care exchanges.
Association of Prenatal Ultrasonography and Autism Spectrum Disorder
Authors: Rosman N. Paul , Vassar Rachel , Doros Gheorghe , DeRosa James , Froman Allison , DiMauro Audrey , Santiago Sherry , Abbott Jodi 
Published: October 2018

(Abstracted from JAMA Pediatr 2018;172(4):336–344)
The prevalence of autism spectrum disorder (ASD) has increased over the past several decades. Despite ongoing identification of genetic causes, there exists mounting evidence that environmental exposures may account for a significant amount of this increase in incidence.
Germline De Novo Mutation Clusters Arise During Oocyte Aging in Genomic Regions With High Double-Strand-Break Incidence
Authors: Goldmann Jakob M. , Seplyarskiy Vladimir B. , Wong Wendy S. W. , Vilboux Thierry , Neerincx Pieter B. , Bodian Dale L. , Solomon Benjamin D. , Veltman Joris A. , Deeken John F. , Gilissen Christian , Niederhuber John E. 
Published: October 2018

(Abstracted from Nat Genet 2018;50:487–492)
Germline de novo mutations (DNMs) arise spontaneously in parental gametes and are both drivers of evolution and a common cause of sporadic disorders. The total number of DNMs is highly correlated with paternal age and with maternal age to a lesser extent.
Development of Silicone Hydrogel Antimicrobial Contact Lenses with Mel4 Peptide Coating
Authors: Dutta Debarun , Kamphuis Bjorn , Ozcelik Berkay , Thissen Helmut , Pinarbasi Rasim , Kumar Naresh , Willcox Mark D. P. 
Published: October 2018

SIGNIFICANCE
This study investigated the development of an antimicrobial coating on silicone hydrogel contact lenses that may have the capacity to reduce contact lens–related infection and inflammatory events.

PURPOSE
The purpose of this study was to develop an effective antimicrobial coating for silicone hydrogel contact lenses by attachment of Mel4 peptide.

METHODS
Lotrafilcon A, comfilcon A, somofilcon A, senofilcon A, and lotrafilcon B silicone hydrogel contact lenses were plasma coated with acrylic acid followed by Mel4 antimicrobial peptide immobilization by covalent coupling. Peptide immobilization was quantified by x-ray electron spectroscopy. Contact lens diameter, base curve, center thickness, and lens surface wettability were measured by captive-bubble contact-angle technique. Antimicrobial activity of the lenses was determined against Pseudomonas aeruginosa and Staphylococcus aureus by viable plate count and also after soaking with artificial tears solution for 1 day. In vivo safety and biocompatibility were determined in an animal model for 1 week.

RESULTS
Mel4 peptide–coated silicone hydrogel contact lenses were associated with high antimicrobial inhibition (>2 log), except for lotrafilcon B and senofilcon A. Lotrafilcon B did not exhibit any activity, whereas senofilcon A showed 1.4- and 0.7-log inhibition against P. aeruginosa and S. aureus, respectively. X-ray electron spectroscopy revealed significant increases in the lens surface–bound amide nitrogen in all contact lenses except for lotrafilcon B. All contact lens parameters remained unchanged except for the base curve and center thickness for senofilcon A. Mel4 immobilization was associated with a decrease in contact angle. Mel4-coated contact lens wear was not associated with any signs or symptoms of ocular irritation in a rabbit model study. Reduced antimicrobial activity was observed with all the lenses after soaking with artificial tears solution or rabbit wear.

CONCLUSIONS
Mel4 antimicrobial coating may be an effective option for development of antimicrobial silicone hydrogel contact lenses.
Management of Wheezy Preschoolers in the Emergency Department
Authors: Currie Gillian , Crotts Jennifer , Nettel-Aguirre Alberto , Johnson David , Stang Antonia 
Published: October 2018

Objectives
This study aimed to elicit pediatric emergency physician's treatment choices for preschool-aged children with wheeze, determine the characteristics of the presenting child that influence treatment choices, and determine whether there is clinical equipoise by eliciting physician willingness to enroll these children in a placebo-controlled trial of corticosteroids.

Methods
Discrete choice experiments varying the characteristics of the presenting child were designed to elicit Canadian emergency physician's treatment choices, both in the emergency department (ED) and at discharge, for young children presenting with wheeze and their willingness to enroll in a randomized controlled trial (RCT).

Results
Most physicians chose to treat children with albuterol both in the ED and at discharge for all clinical scenarios. The proportion of physicians who chose to treat children with oral corticosteroids both in the ED and at discharge varied widely (from 12% to 81%) across all scenarios. Physician preference whether preschool children with wheeze should be treated with corticosteroids varied depending on the child's age, history of atopy, and previous and continuous wheeze. Between 73% and 86% of physicians were willing to enroll these children in an RCT indicating clinical equipoise.

Conclusions
Physician treatment choices varied widely indicating clinical equipoise as to the effectiveness of corticosteroids in this population of patients. Management choices with respect to albuterol and corticosteroids were not consistent with published national and international guidelines. In line with this finding, physician's considerable willingness to enroll these children in an RCT may suggest that they are seeking guidance on how to manage these patients.
Prehospital Analgesic Administration by Parents for Pain Relief in Children
Authors: Conrad Christina , Soni Parita , Coorg Vasanth , Thompson Benjamin , Muenzer Jared , Timmons Zebulon , Bulloch Blake 
Published: October 2018

Purpose
Undertreatment of pain by caregivers before presentation to the pediatric emergency department (ED) has been well documented. What has yet to be elucidated are the reasons why caregivers fail to adequately treat pain before arrival in the ED and whether there are differences based on ethnic background or age of the child. The objectives of this study were to determine the barriers to giving pain medication for injuries before ED arrival and to determine if there are any ethnic- or age-related variations to giving pain relief at home.

Methods
This prospective descriptive study was conducted in the ED at a tertiary care, freestanding children's hospital with a current annual census of approximately 80,000. An anonymous prospective questionnaire was given to caregivers of children between 2 and 17 years of age presenting to the ED between August 2013 and September, 2014. The study population was obtained as a convenience sample. All were self-referred with chief complaints of head, ear, or extremity pain. The questionnaire asked about pain medications and doses given at home as well as the reasons parents gave medication or refused to give pain medication before arrival. Charts were then abstracted to obtain demographic information and care received in the ED.

Results
A total of 154 (45.6%) of the 338 patients enrolled did not receive pain relief before coming to the ED. There were no differences in pain medication received at home based on ethnicity (P = 0.423) or age (P = 0.580). Parents could choose from a list of multiple reasons as to why pain medications were given and/or free text their own answer. The main reasons given by parents were that the accident did not happen at home (28.6%) and that they did not have time to give pain relief before coming to the ED (13%). Other common answers were “had no pain relievers at home” (12.4%) or “afraid it would be wrong/harmful/did not want to mask symptoms” (9.2%). Seventeen parents responded that their child did not complain of pain. Overall, only 28.1% of participants stated lack of pain medications at home.

Conclusions
In this study, approximately half of all children receive an analgesic for their painful condition before coming to the ED. Continued education regarding pain relief before coming to the ED is needed. Future studies will focus on educating parents to provide analgesia at home.
Unique aspects of clinical trials of invasive therapies for chronic pain
Authors: Cohen Steven P. , Wallace Mark , Rauck Richard L. , Stacey Brett R. 
Published: October 2018

Abstract
Nearly all who review the literature conclude that the role of invasive procedures to treat chronic pain is poorly characterized because of the lack of “definitive” studies. The overt nature of invasive treatments, along with the risks, technical skills, and costs involved create challenges to study them. However, these challenges do not completely preclude evaluating invasive procedure effectiveness and safety using well-designed methods. This article reviews the challenges of studying outcomes of invasive therapies to treat pain and discuss possible solutions. Although the following discussion can apply to most invasive therapies to treat chronic pain, it is beyond the scope of the article to individually cover every invasive therapy used. Therefore, most of the examples focus on injection therapies to treat spine pain, spinal cord stimulation, and intrathecal drug therapies.
Comparison of Abdominal Computed Tomographic Enhancement and Organ Lesion Depiction Between Weight-Based Scanner Software Contrast Dosing and a Fixed-Dose Protocol in a Tertiary Care Oncologic Center
Authors: Jensen Corey T. , Blair Katherine J. , Wagner-Bartak Nicolaus A. , Vu Lan N. , Carter Brett W. , Sun Jia , Bathala Tharakeswara K. , Gupta Shiva 
Published: October 2018

Objective
This study aimed to evaluate the quality of enhancement and solid-organ lesion depiction using weight-based intravenous (IV) contrast dosing calculated by injector software versus fixed IV contrast dose in oncologic abdominal computed tomographic (CT) examinations.

Methods
This institutional review board–exempt retrospective cohort study included 134 patients who underwent single-phase abdominal CT before and after implementation of weight-based IV contrast injector software. Patient weight, height, body mass index, and body surface area were determined. Two radiologists qualitatively assessed examinations (4 indicating markedly superior to −4 indicating markedly inferior), and Hounsfield unit measurements were performed.

Results
Enhancement (estimated mean, −0.05; 95% confidence interval [CI], −0.19 to 0.09; P = 0.46) and lesion depiction (estimated mean, −0.01; 95% CI, −0.10 to 0.07; P = 0.79) scores did not differ between CT examinations using weight-based IV contrast versus fixed IV contrast dosing when a minimum of 38.5 g of iodine was used. However, the scores using weight-based IV contrast dosing were lower when the injector software calculated and delivered less than 38.5 g of iodine (estimated mean, −0.81; 95% CI, −1.06 to −0.56; P < 0.0001). There were no significant differences in measured Hounsfield units between the CT examinations using weight-based IV contrast dosing versus fixed IV contrast dosing.

Conclusions
Oncologic CT image quality was maintained or improved with weight-based IV contrast dosing using injector software when using a minimum amount of 38.5 g of iodine.
CT Window Blending for Evaluation of Multicompartmental Thoracic Pathology
Authors: Hammer Mark M. , Mandell Jacob C. 
Published: October 2018

Abstract
Standard computed tomography windows are limited in the thorax because they can only display 1 tissue at a time. Computed tomography window blending allows for simultaneous viewing of all 3 tissues in a single image, which may improve evaluation of diseases that contiguously affect multiple compartments. In this article, we use examples to illustrate the utility of window blending in aggressive infections, metastatic cancer, and penetrating trauma.
Free Latissimus Dorsi Myocutaneous Flap in a 6-Month-Old Child for Reconstruction of a Temporal Fossa Defect After Teratoma Resection
Authors: Fried Frederik W. , Beier Justus P. , Bohr Christopher , Iro Heinrich , Horch Raymund E. , Arkudas Andreas 
Published: October 2018

Abstract
Although free flap reconstruction has already gained widespread acceptance in pediatric patients, little is known about the outcome of free tissue transfer in head and neck reconstruction in pediatric patients. We present a case of a 6-month-old boy with a large volume deficit in the right temporal fossa after resection of a teratoma. This led to a large volume deficit with widely undermined skin margins. Therefore, we provided volume augmentation by microsurgical free latissimus dorsi myocutaneous flap transplantation. Intraoperative use of laser-assisted indocyanine green angiography indicated excellent flap perfusion. Postoperative magnetic resonance imaging showed adequate flap perfusion with no signs of flap necrosis. To our best knowledge, this case presents the youngest patient who underwent free flap transplantation in the head and neck region. Our case demonstrates that microvascular surgery can play an important role in particular cases in pediatric oncology, even in very young patients.