bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intergenerational influences on childhood anaemia
Authors: Onyeneho Nkechi G. , Corsi Daniel J. , Kurpad Anura , Subramanian SV 
Published: September 2018

AbstractPrior research on assessing intergenerational influences on child anaemia has largely approached it from purely maternal perspective. Although there is much merit to focus on that, it is an extremely limited/reductionist view of understanding intergenerational influences. We expanded the intergenerational influences to include the fathers and overall of intergenerational household transfers. We analysed a sample of 19,619 mother–father‐offspring trios from the 2015–2016 Indian National Fertility and Health Survey with available data on haemoglobin (Hb). Multinomial logistic regression models were used to establish associations between parent anaemia, household characteristics, and categories of offspring anaemia. Maternal and paternal Hb was measured as in children using a finger prick blood sample. The primary outcome was child's Hb level (in g/dl) and grades of anaemia defined as mild (10–10.9 g/dl), moderate (7–9.9 g/dl), and severe (<7 g/dl). Mean Hb was 10.1 g/dl for children, 14.2 g/dl among fathers, and 11.4 g/dl among mothers. Hb correlation was 0.1 between fathers and offspring and 0.2 between mothers and offspring (P < 0.001 for all correlations). Maternal–paternal Hb correlations were consistent across quintiles of wealth index. Maternal anaemia was associated with odds ratio of 1.3 (95% CI [1.1, 1.4]) and 1.6 (95% CI [1.4, 1.7]) for childhood mild and moderate/severe anaemia, respectively. Paternal mild anaemia was associated with an odds ratio of 1.1 (95% CI [0.9, 1.4]) and 1.4 (95% CI [1.2, 1.7]) for child moderate/severe anaemia. The clustering of poor circumstances suggests that public health strategies target social deprivation at the household level. A comprehensive perspective will provide holistic interventions to control childhood anaemia.
Rapid palatal expansion (RPE): Meta‐analysis of long‐term effects
Authors: Cannavale Rosangela , Chiodini Paolo , Perillo Letizia , Piancino Maria Grazia 
Published: September 2018

AbstractObjectsRapid palatal expansion (RPE) is a widespread orthopaedic procedure used in several clinical situations. The aim of the study was to provide a systematic review and meta‐analysis of transverse intercanine and intermolar width changes after RPE and long‐term effects.Setting and Sample PopulationA systematic literature search was conducted until January 2018 on original studies with RPE treatment.Material and MethodsIntercanine and intermolar distance were measured at the start of RPE (T1, median age 9.2 years) and at the end of treatment (T2). The long‐term evaluation was conducted on a subset of articles with 5‐year follow‐up (T3).ResultsEighteen studies T1‐T2 and 5 studies T3 were selected. Regarding the intercanine distance, the RPE resulted in a gain of space T1‐T2 of 3.73 mm with a significant heterogeneity (P < 0.0001; I2 = 94.21%) and a relapse T2‐T3 of −0.81 mm with a significant heterogeneity (P < 0.0001; I2 = 95.8%); the overall gain of space was 2.91 mm. Regarding the intermolar distance, the RPE resulted in a gain of space T1‐T2 of 4.85 mm with a significant heterogeneity (P < 0.0001; I2 = 92.41%) and a relapse T2‐T3 of −0.47 mm with a significant heterogeneity (P < 0.0001; I2 = 87.5%); the overall gain of space was 4.38 mm. Meta‐regression analysis showed that at younger age, the amount of anterior expansion is similar to posterior. With increasing age, the anterior opening diminishes significantly more than the posterior, being half of the posterior at 15 years.ConclusionBecause long‐term results were obtained with simultaneously fixed appliances and long upper retention, RPE should be carefully considered before using.
Ultrasound assessment of the prevalence of increased gastric contents and volume in elective pediatric patients: A prospective cohort study
Authors: Bouvet Lionel , Bellier Nicolas , Gagey‐Riegel Anne‐Charlotte , Desgranges François‐Pierrick , Chassard Dominique , De Queiroz Siqueira Mathilde 
Published: September 2018

SummaryBackgroundThough pulmonary aspiration of gastric contents occurs mainly in the setting of emergency surgery, it may also occur in children scheduled for elective surgery without any obvious clinical risk factor. Increased gastric content volume is one the predisposing factors for pulmonary aspiration that could affect such children and may be identified using ultrasound examination of the gastric antrum.AimsWe aimed to assess the prevalence of “at‐risk stomach” defined by ultrasound visualization of any solid content in the antrum and/or by calculated gastric fluid volume > 1.25 mL/kg, in children scheduled for elective surgery.MethodsChildren scheduled for elective surgery were consecutively included into this prospective cohort study. Preoperative ultrasound examination of the antrum was performed in both the supine and the right lateral decubitus positions. Gastric fluid content was assessed using a 0‐2 qualitative grading scale. The antral cross‐sectional area was also measured in both the supine and the right lateral decubitus positions, allowing the calculation of the gastric fluid volume according to a formula previously described.ResultsWe analyzed 200 elective children. Median duration of fasting was 4 hours for liquids and >13 hours for solids. None of the children included in this study had evidence of solid content. Six (3%) children had a Grade 2 antrum (fluid content seen in both the supine and the right lateral decubitus positions). Two children had a gastric fluid volume >1.25 mL/kg. The prevalence of “at‐risk stomach” was 1% (95% confidence interval: 0.2%‐3.9%).ConclusionAccording to our results, only 1% of elective children had potentially increased risk for pulmonary aspiration. Further studies should be performed in order to define the target population of elective children for which ultrasound assessment of gastric content should be performed prior to general anesthesia.
Oral manifestations of Langerhans cell histiocytosis: A case series
Authors: Neves‐Silva Rodrigo , Fernandes Diego Tetzner , Fonseca Felipe Paiva , Rebelo Pontes Helder Antonio , Brasileiro Bernardo Ferreira , Santos‐Silva Alan Roger , Vargas Pablo Agustin , Lopes Marcio Ajudarte 
Published: September 2018

AbstractAimLangerhans cell histiocytosis (LCH) is an unusual proliferative disorder of bone marrow‐derived histiocytes (Langerhans cells) that can produce focal or systemic manifestations. Oral manifestations of LCH can present as single or multiple lesions and can be a challenge in clinical practice. The aim of this paper is to present the clinicopathological features of a series of nine patients with oral involvement.Methods and resultsThe patient's age ranged from 2 to 63 years being five males and four females. The most common oral site involvement was the hard‐palate mucosa. Ulceration was the main clinical feature. Only two patients showed clearly jawbone involvement. In eight out of nine patients, the diagnosis of LCH was established because of the oral manifestations.ConclusionThe recognition of the clinical features of LCH oral manifestation is important to avoid misdiagnosis and to the establishment of the correct treatment. Thus, dentists can play a vital role in the diagnosis of LCH since oral lesions may be the earliest manifestation and sometimes the only sign of the disease. Furthermore, oral lesions may be the early signs of disease reactivation or a multisystem disease indication.
Aid for trade and export diversification in recipient‐countries
Authors: Gnangnon Sèna Kimm 
Published: September 2018

AbstractThe Aid‐for‐Trade (AfT) Initiative was launched by the Members of the World Trade Organization (WTO) with a view to helping developing countries and the least‐developed countries (LDCs) expand their trade. The current paper contributes to the literature on AfT effectiveness by examining how AfT affects recipient‐countries' export product diversification. The analysis has been carried out on a sample of 104 AfT recipient‐countries over the period 2002–2015 and uses the two‐step system generalised methods of moments (GMM) approach. Results show that AfT flows are conducive to export product diversification in recipient‐countries. In addition, the analysis has shown a positive impact of the cumulative AfT flows on the export product diversification path of these countries. These results apply as well to the subsamples of LDCs and other developing countries. One policy implication of these results is that a scale‐up of AfT would help recipient‐countries to diversify their export products baskets and hence facilitate their greater integration into the global trading system.
Handover training for medical students: a controlled educational trial of a pilot curriculum in Germany
Authors: Thaeter Laura , Schröder Hanna , Henze Lina , Butte Jennifer , Henn Patrick , Rossaint Rolf , Sopka Saša 
Published: September 2018

ObjectiveThe aim of this study was to implement and evaluate a newly developed standardised handover curriculum for medical students. We sought to assess its effect on students’ awareness, confidence and knowledge regarding handover.DesignA controlled educational research study.SettingThe pilot handover training curriculum was integrated into a curriculum led by the Departments of Anesthesiology and Intensive Care (AI) at the University Hospital. It consisted of three modules integrated into a 4-week course of AI. Multiple types of handover settings namely end-of-shift, operating room/postanaesthesia recovery unit, intensive care unit, telephone and discharge were addressed.ParticipantsA total of n=147 fourth-year medical students participated in this study, who received either the current standard existing curriculum (no teaching of handover, n=78) or the curriculum that incorporated the pilot handover training (n=69).Outcome measuresPaper-based questionnaires regarding attitude, confidence and knowledge towards handover and patient safety were used for pre-assessment and post-assessment.ResultsStudents showed a significant increase in knowledge (p<0.01) and self-confidence for the use of standardised handover tools (p<0.01) as well as accurate handover performance (p<0.01) among the pilot group.ConclusionWe implemented and evaluated a pilot curriculum for undergraduate handover training. Students displayed a significant increase in knowledge and self-confidence for the use of standardised handover tools and accuracy in handover performance. Further studies should evaluate whether the observed effect is sustained across time and is associated with patient benefit.
Coronary artery bypass graft versus percutaneous coronary intervention in acute heart failure
Authors: Lee Sang Eun , Lee Hae-Young , Cho Hyun-Jai , Choe Won-Seok , Kim Hokon , Choi Jin Oh , Jeon Eun-Seok , Kim Min-Seok , Hwang Kyung-Kuk , Chae Shung Chull , Baek Sang Hong , Kang Seok-Min , Choi Dong-Ju , Yoo Byung-Su , Kim Kye Hun , Cho Myeong-Chan , Kim Jae-Joong , Oh Byung-Hee 
Published: September 2018

ObjectiveMyocardial ischaemia is a leading cause of acute heart failure (AHF). However, optimal revascularisation strategies in AHF are unclear. We aimed to compare two revascularisation strategies, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI), in patients with AHF.MethodsAmong 5625 consecutive patients enrolled prospectively in the Korean Acute Heart Failure registry from March 2011 to February 2014, 717 patients who received CABG or PCI during the index hospitalisation for AHF were included in this analysis. We compared adverse outcomes (death, rehospitalisation for HF aggravation or cardiovascular causes, ischaemic stroke and a composite outcome of death and rehospitalisation for HF aggravation or cardiovascular causes) with the use of propensity score matching.ResultsFor the propensity score-matched cohort with 190 patients, CABG had a lower risk of all-cause mortality than PCI (83 vs 147 deaths per 1000 patient-years; HR 0.57, 95% CI 0.34 to 0.96, p=0.033) during the median follow-up of 4 years. There was also a trend towards lower rates of rehospitalisation due to cardiovascular events or HF aggravation. Subgroup analysis revealed that the adverse outcomes were significantly lower in the CABG group than in PCI group, especially in patients with old age, three-vessel diseases, significant proximal left anterior descending artery disease and those without left main vessel disease or chronic total occlusion.ConclusionsCompared with PCI, CABG is associated with significant lower all-cause mortality in patients with AHF. Further studies should evaluate proper revascularisation strategies in AHF.Clinical trial registrationNCT01389843; Results.
Discharge against medical advice after hospitalisation for acute myocardial infarction
Authors: Kwok Chun Shing , Walsh Mary Norine , Volgman Annabelle , Alasnag Mirvat , Martin Glen Philip , Barker Diane , Patwala Ashish , Bagur Rodrigo , Fischman David L , Mamas Mamas A 
Published: September 2018

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.
Decrease in exhaled hydrogen as marker of congestive heart failure
Authors: Shibata Atsushi , Sugano Yasuo , Shimouchi Akito , Yokokawa Tetsuro , Jinno Naoya , Kanzaki Hideaki , Ohta-Ogo Keiko , Ikeda Yoshihiko , Okada Hideshi , Aiba Takeshi , Kusano Kengo , Shirai Mikiyasu , Ishibashi-Ueda Hatsue , Yasuda Satoshi , Ogawa Hisao , Anzai Toshihisa 
Published: September 2018

Objective Hydrogen excretion is thought to be related to systemic antioxidation activity. H2selectively reduces the hydroxyl radical of free hydrogen (·OH), a highly cytotoxic form of reactive oxygen species, in cultured cells.MethodsWe investigated whether exhaled H2decreased during night sleep, reflected ·OH production and was associated with heart failure severity. We enrolled 108 patients with chronic heart failure (CHF) and 15 control participants without CHF. H2concentration was measured by gas chromatography in exhaled breath collected before sleep and in the morning after overnight fasting. Overnight change in H2concentration (ΔH2) was calculated. Mitochondrial morphology evaluated by transmission electron microscopy in endomyocardial biopsies collected from 18 patients with dilated cardiomyopathy.ResultsΔH2was significantly lower in patients with CHF compared with controls (−4.3±1.0 vs 2.0±2.1 ppm, p=0.030) and was positively correlated with cardiac index (CI; r = −0.285, p=0.003). Patients with a ΔH2<0 ppm had a significantly lower CI compared with those who had a ΔH2>0 ppm (2.85±0.61 vs 3.24±0.65 L/min/m2, p=0.005). ΔH2was negatively correlated with both the percentage of vacuole-containing mitochondria and indices of cristae remodelling (r = −0.61, p=0.007).ConclusionsDecrease in exhaled H2during night sleep was associated with CHF severity. ΔH2warrants investigation as marker of CHF severity.
Prognostic relevance of the right ventricular myo-mechanical index (RV-MMI) in patients with precapillary pulmonary hypertension
Authors: Greiner Sebastian , Goppelt Ferdinand , Aurich Matthias , Katus Hugo A , Mereles Derliz 
Published: September 2018

ObjectiveThe aim of the prospective New-RV study was to evaluate a parameter for non-invasive quantification of right ventricular (RV) dysfunction in patients with precapillary pulmonary hypertension (PH) that yields prognostic information and is applicable in daily clinical routine.MethodsSixty-five consecutive patients with precapillary PH under guideline conform therapy (43 women, 22 men) underwent clinical assessment, serological testing, as well as a comprehensive transthoracic echocardiography including strain imaging and a detailed assessment of RV haemodynamics.ResultsThe mean follow-up time was 844 days. Sixteen patients died during clinical follow-up. Right ventricular myo-mechanical index (RV-MMI) was calculated by right atrial size, mean RV pressure gradient and strain imaging of the RV free wall, and was measurable in all examinations. RV-MMI was tested for its diagnostic accuracy (sensitivity of 88% and specificity of 73% for an optimal cut-off value of ≤0.31 mm Hg*%; area under the curve=0.85), as well as its predictive value (HR=3.3, 95% CI 1.6 to 7.0, p<0.001), and was compared in detail with established parameters. RV-MMI and N-terminal pro-brain natriuretic peptide (NTproBNP)were independent predictors of survival (HR=2.9, 95% CI 1.4 to 6.2, p=0.006; and HR=2.6, 95% CI 1.5 to 4.6, p=0.001, respectively).ConclusionIn a cohort of patients with precapillary PH, the RV-MMI differentiates the outcome of patients better than other available non-invasive parameters of RV function by preload and afterload adjusted quantification.Trial registration numberNCT01230294.
Utility of current thrombophilia screening in young patients with stroke and TIA
Authors: Alakbarzade Vafa , Taylor Alice , Scully Marie , Simister Robert , Chandratheva Arvind 
Published: September 2018

IntroductionApproximately 40% of strokes in young adults are cryptogenic. The diagnostic yield of thrombophilia screening remains controversial. We aimed to determine utility of current thrombophilia testing for young patients with stroke and transient ischaemic attack (TIA).MethodsWe present a retrospective review of all patients with stroke and TIA ≤60 years presenting to University College London Hospital stroke unit and daily TIA clinic from 1 January 2015 to 1 August 2016. Consecutive clinical records and thrombophilia tests, including factor V Leiden (FVL), prothrombin G20210A mutation (PGM), antiphospholipid antibody (APA), and protein S, C and antithrombin (AT) levels, were reviewed.ResultsThe mean age of 628 patients with stroke and TIA was 49.1 years (SD 9.2). Thrombophilia testing was performed in 360 (57%) patients, including 171 with stroke and 189 with TIA. Positive tests were found in 50 (14%) patients, of whom 24 patients were <50 years. Positive results were found in 36 (10%) with acute ischaemic stroke, 4 (1%) with haemorrhagic stroke and 10 (3%) with TIA. Thirteen patients (4%) had homozygous/heterozygous FVL or PGM, and 27 (7.5%) had positive APA (anticardiolipin antibody, anti-β2 glycoprotein antibody or lupus anticoagulant). Of 27 (7.5%) patients with protein C, S or AT deficiency, 10 (2.8%) had primary deficiency, presumed hereditary with other secondary causes excluded. 9% of patients with protein C, S or AT and 27% with APA were followed by confirmatory testing.ConclusionThrombophilia testing was positive in only 14% of cases overall. Thrombophilia mutations and protein C, S or AT abnormalities were found rarely and were very uncommon in patients with TIA. Follow-up of abnormal results was generally poor for all groups, which further limited the impact of the thrombophilia testing policy.
Accuracy and precision of transcutaneous carbon dioxide monitoring: a systematic review and meta-analysis
Authors: Conway Aaron , Tipton Elizabeth , Liu Wei-Hong , Conway Zachary , Soalheira Kathleen , Sutherland Joanna , Fingleton James 
Published: September 2018

BackgroundTranscutaneous carbon dioxide (TcCO2) monitoring is a non-invasive alternative to arterial blood sampling. The aim of this review was to determine the accuracy and precision of TcCO2 measurements.MethodsMedline and EMBASE (2000–2016) were searched for studies that reported on a measurement of PaCO2 that coincided with a measurement of TcCO2. Study selection and quality assessment (using the revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2)) were performed independently. The Grading Quality of Evidence and Strength of Recommendation approach was used to summarise the strength of the body of evidence. Pooled estimates of the mean bias between TcCO2 and PaCO2 and limits of agreement with outer 95% CIs (termed population limits of agreement) were calculated.ResultsThe mean bias was −0.1 mm Hg and the population limits of agreement were −15 to 15 mm Hg for 7021 paired measurements taken from 2817 participants in 73 studies, which was outside of the clinically acceptable range (7.5 mm Hg). The lowest PaCO2 reported in the studies was 18 mm Hg and the highest was 103 mm Hg. The major sources of inconsistency were sensor location and temperature. The population limits of agreement were within the clinically acceptable range across 3974 paired measurements from 1786 participants in 44 studies that applied the sensor to the earlobe using the TOSCA and Sentec devices (−6 to 6 mm Hg).ConclusionThere are substantial differences between TcCO2 and PaCO2 depending on the context in which this technology is used. TcCO2 sensors should preferentially be applied to the earlobe and users should consider setting the temperature of the sensor higher than 42°C when monitoring at other sites.Systematic review registration numberPROSPERO; CRD42017057450.