bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of survival and prognostic factors in treatment of hepatocellular carcinoma in Spanish patients with drug-eluting bead transarterial chemoembolization
Authors: Sánchez-Delgado Jordi , Vergara Mercedes , Machlab Salvador , Lira Alba , Gómez Zaragoza Carlos , Criado Eva , Rosinach Mercè , Batista Lissette , Arau Beatriz , Roget Mercè , Ortiz Jordi , Garcia Caridad , Sort Pau , Casas Meritxell , Dalmau Blai , Forné Montserrat , Falcó Joan , Miquel Mireia 
Published: August 2018

Background and aim
Drug-eluting bead transarterial chemoembolization (DEB-TACE) improves the survival of patients with hepatocellular carcinoma (HCC), intermediate stage [i.e. Barcelona Clinic Liver Cancer-B (BCLC-B)]. The aim of our study was to analyse the overall survival (OS) and prognostic factors of patients with HCC treated with DEB-TACE.

Patients and methods
Patients’ clinical course was recorded from January 2005 to July 2014. The median OS was obtained by the Kaplan–Meier method and compared using the log-rank test. The prognosis factors associated with OS were determined by a multivariate Cox regression analysis and the accuracy of the OS prediction was determined by calculation of the assessment for retreatment with TACE score (ART score).

Results
A cohort of 147 consecutive patients treated with DEB-TACE was included. Median age of the patients was 73.4 years. Overall, 68.7% were men, and all had cirrhosis, with 68.8% being hepatisis C virus positive. Moreover, 35.2% were staged as BCLC-A and 60.2% as BCLC-B. After a median follow-up of 19.2 months, 29.3% were alive, 4.3% needed treatment with sorafenib and 56.1% underwent DEB-TACE retreatment. Median OS was 22.8 [95% confidence interval (CI)=19.6–25.9]. After censoring for ascites and more than one nodule, OS was 23.87 (95% CI =20.72–27.01) and 26.89 (95% CI =21.00–32.78), respectively. The risk of death decreased by 22.3% with the number of DEB-TACE sessions (hazard ratio=0.777) and increased by 25.9% with higher Child–Pugh score (hazard ratio=1.259). Overall, 61.2% of the cohort had an ART score between 0 and 1.5. There were no statistical differences in OS between cohort groups with ART of 0–1.5 and at least 2.5.

Conclusion
The results validate the efficacy and safety of DEB-TACE in patients with HCC and the importance of some prognostic factors for patient survival.
Acute Pancreatitis in Chronic Dialysis Patients
Authors: Barbara Mary , Tsen Adrianne , Rosenkranz Laura 
Published: August 2018

Abstract
The annual incidence of acute pancreatitis (AP) ranges from 4.9 to 73.4 cases per 100,000 worldwide. Patients with end-stage renal disease on dialysis have an increased risk for developing AP compared with patients without renal disease. In addition to the general population risk factors, there are factors related to renal insufficiency and dialysis process that might predispose to AP in this population. Clinical features and diagnosis are the same as those in patients without renal failure; however, amylase and lipase levels should be interpreted cautiously as they might be falsely elevated in renal failure. In this article, we will describe the risk factors that are exclusive to this population. In addition, we will also focus on the laboratory indices and clinical features that are unique to this population with patients with end-stage renal disease.
Germline Variants and Risk for Pancreatic Cancer
Authors: Zhan Wei , Shelton Celeste A. , Greer Phil J. , Brand Randall E. , Whitcomb David C. 
Published: August 2018

AbstractPancreatic cancer requires many genetic mutations. Combinations of underlying germline variants and environmental factors may increase the risk of cancer and accelerate the oncogenic process. We systematically reviewed, annotated, and classified previously reported pancreatic cancer–associated germline variants in established risk genes. Variants were scored using multiple criteria and binned by evidence for pathogenicity, then annotated with published functional studies and associated biological systems/pathways. Twenty-two previously identified pancreatic cancer risk genes and 337 germline variants were identified from 97 informative studies that met our inclusion criteria. Fifteen of these genes contained 66 variants predicted to be pathogenic (APC,ATM,BRCA1,BRCA2,CDKN2A,CFTR,CHEK2,MLH1,MSH2,NBN,PALB2,PALLD,PRSS1,SPINK1,TP53). Pancreatic cancer risk genes were organized into key biological mechanisms that promote pancreatic oncogenesis within an oncogenic model. Development of precision medicine approaches requires updated variant information within the framework of an oncogenic progression model. Complex risk modeling may improve interpretation of early biomarkers and guide pathway-specific treatment for pancreatic cancer in the future. Precision medicine is within reach.
Use of Breast Milk and Other Feeding Practices Following Gastrointestinal Surgery in Infants
Authors: Varma Sanskriti , Bartlett Edward L. , Nam Lucy , Shores Darla R. 
Published: August 2018

ABSTRACTObjectives:The aim of the study was to characterize the enteral feeding practices in infants after gastrointestinal surgery.Methods:We performed a retrospective analysis of infants who underwent intestinal surgery at age <6 months who survived to be fed enterally between January 2012 and June 2017. Demographics, surgical characteristics, feeding practices, and growth‐related outcomes during hospitalization, discharge, and follow‐up (3, 6, and 12 months) were obtained from the electronic medical records. Descriptive statistics compared infants by their initial diagnosis.Results:We reviewed 111 infants: necrotizing enterocolitis (NEC) = 21, gastroschisis = 28, atresia = 27, spontaneous intestinal perforation (SIP) = 18, and other diagnoses = 17. Most infants (77%) received mother's milk (MM) as the first postoperative feed, but this differed by diagnosis (P = 0.004). Donor milk was used in 11%, most commonly in infants with NEC and SIP. Infants with NEC were least likely to continue MM in the hospital (7%, P = 0.0014) and were more likely to receive elemental formula. Only 44% of infants received MM at discharge. After 1 year, 25% were fed MM. The majority of infants were discharged with feeding tubes (nasogastric: 35%, gastric: 23%). Although all groups had acceptable weights at discharge, infants with NEC (z score: −1.8) and SIP (z score: −1.1) showed growth failure at 3 months (z scores: −3.3, −3.2, respectively, P < 0.0001), but had appropriate gain by 1 year (z scores: −1.1, −1.7, respectively).Conclusions:Despite most infants receiving MM in the early postoperative period, <50% at discharge and only 33% at 1‐year still received MM. Weight gain after discharge in infants with NEC and SIP warrants close monitoring.
Evaluation of Content on Commonly Used Web sites About Induction of Labor and Pain Management During Labor
Authors: English Cara L. , Alden Kathryn R. , Zomorodi Meg , Travers Debbie , Ross Malcolm S. 
Published: August 2018

Abstract

Purpose:
The Internet is a common source of information for women during pregnancy. A multitude of data about birth can be found on the Internet, yet there are few guidelines to direct women to credible Web sites. Providers are often unaware of the health sites their patients access. The purpose of this study was to evaluate the quality of the written content on Web sites about induction of labor and pain management during labor.

Study Design and Methods:
Descriptive study of 11 Web sites on induction of labor and pain management during labor. Searches on Google, Yahoo, and Bing were used to identify Web sites women use to seek information about labor and birth. The Web sites were evaluated using the Health Information Technology Institute (HITI) criteria, readability, and content criteria from UpToDate, an evidence-based, healthcare professional-authored clinical resource.

Results:
No Web sites met all the HITI criteria for both topics. One Web site was written at or below a seventh-grade reading level and six were written at or above a ninth-grade level. Although there was no perfect Web site, we noted government Web sites provided the highest quality information.

Clinical Implications:
Evaluation and discussion of Web sites used by pregnant women is needed. Nurses and other healthcare providers should be aware of what information exists and what Web sites women are using so they can guide women to credible, evidence-based data. Directing women to government-sponsored Web sites on childbirth topics may help them access accurate information.
Symptoms of Depression and Preterm Birth Among Black Women
Authors: Nutor Jerry John , Slaughter-Acey Jaime C. , Giurgescu Carmen , Misra Dawn P. 
Published: August 2018

Abstract

Objective:
To investigate the relationship between depressive symptoms and preterm birth (PTB) while adjusting for social support, both general and from the father of the baby.

Design:
Retrospective study design.

Setting:
Participants of the Life-course Influences of Fetal Environments (LIFE) study were recruited from a suburban hospital in Metropolitan Detroit, Michigan.

Participants:
The LIFE data consisted of 1,410 self-identified Black women age 18 to 45 years; 1,207 women were included in this analysis.

Methods:
Women were interviewed using a structured questionnaire administered 24 to 48 hours after birth during their postpartum hospitalization. Data on the newborns and their mothers' health were collected through medical record abstraction. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure symptoms of depression. The CES-D scores ≥23 were considered severe symptoms of depression. Modified Poisson regression models were built using a stepwise approach to assess association between symptoms of depression and PTB.

Results:
Approximately, 17% of women had a PTB and 20% of women in the sample had a CES-D scores ≥23. Women who had CES-D score ≥23 were about 70% more likely to have a PTB compared with women with CES-D scores <23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support.

Conclusion:
Women with CES-D scores ≥23 were almost twice more likely to have PTB compared with women with CES-D scores <23. Referrals for mental healthcare providers might benefit women with symptoms of depression and improve birth outcomes. Nurses should encourage women to seek support beyond the father of the baby.
Hepatobiliary Dysfunction and Disseminated Intravascular Coagulation Increase Risk of Mortality in Pediatric Hemophagocytic Lymphohistiocytosis*
Authors: Goldman Jordana , Desai Moreshwar S. , McClain Kenneth L. , Tcharmtchi M. Hossein , Kennedy Curtis E. , Thompson Kathleen , Lam Fong , Bashir Dalia A. , Chinn Ivan K. , Goldberg Baruch R. , Allen Carl E. , Nguyen Trung C. 
Published: August 2018

Objectives:
Hemophagocytic lymphohistiocytosis poses significant challenges due to limited tools to guide clinical decisions in a population at high risk of death. We sought to assess whether disseminated intravascular coagulation and hepatobiliary dysfunction, significant comorbidities seen in critical care settings, would identify hemophagocytic lymphohistiocytosis patients with increased risk of mortality.

Design:
Retrospective chart review.

Setting:
Single-center PICU.

Patients:
All patients admitted to a tertiary care children’s hospital diagnosed with hemophagocytic lymphohistiocytosis from 2005 to 2012.

Interventions:
None.

Measurements and Main Results:
Forty-three patients were diagnosed with hemophagocytic lymphohistiocytosis with median age of 61 months. The 5-year overall survival was 51% (22/43). Univariate analyses revealed ferritin levels greater than 10,000 (ng/mL), international normalized ratio greater than 1.5, or platelet counts less than 100,000/µL at initiation of dexamethasone were individually associated with mortality. Development of disseminated intravascular coagulation, hepatobiliary dysfunction, or both increased the likelihood of death in hemophagocytic lymphohistiocytosis patients (relative risk; 95% CI) (6; 1.4–34; p < 0.05), (4.1; 1.8–10; p < 0.05), and (7.5; 1.8–42; p < 0.05). Of 12 autopsies performed, 75% had at least one active infection, 66% had chronic lymphopenia, 50% had lymphocyte depletion in the spleen, thymus, or bone marrow, 42% had evidence of microvascular thrombosis, and 92% had evidence of hepatocellular injury.

Conclusions:
Hemophagocytic lymphohistiocytosis continues to have high mortality with hemophagocytic lymphohistiocytosis-1994/2004 (dexamethasone/etoposide), the current standard of care for all children with hemophagocytic lymphohistiocytosis. Hemophagocytic lymphohistiocytosis patients who developed disseminated intravascular coagulation, hepatobiliary dysfunction, or both had higher risk of death with mortalities of 60%, 77%, and 77%, respectively. Phenotypic classifications are urgently needed to guide individualized treatment strategies to improve outcomes for children with hemophagocytic lymphohistiocytosis.
Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey*
Authors: Conlon Thomas W. , Kantor David B. , Su Erik R. , Basu Sonali , Boyer Donald L. , Haileselassie Bereketeab , Petersen Tara L. , Su Felice , Nishisaki Akira 
Published: August 2018

Objectives:
To assess current diagnostic bedside ultrasound program core element (training, credentialing, image storage, documentation, and quality assurance) implementation across pediatric critical care medicine divisions in the United States.

Design:
Cross-sectional questionnaire-based needs assessment survey.

Setting:
Pediatric critical care medicine divisions with an Accreditation Council of Graduate Medical Education-accredited fellowship.

Respondents:
Divisional leaders in education and/or bedside ultrasound training.

Interventions:
None.

Measurements and Main Results:
Fifty-five of 67 pediatric critical care medicine divisions (82%) with an Accreditation Council of Graduate Medical Education-accredited fellowship provided responses. Overall, 63% of responding divisions (34/54) were clinically performing diagnostic bedside ultrasound studies with no difference between divisions with large versus small units. Diagnostic bedside ultrasound training is available for pediatric critical care medicine fellows within 67% of divisions (35/52) with no difference in availability between divisions with large versus small units. Other core elements were present in less than 25% of all divisions performing clinical studies, with a statistically significant increase in credentialing and documentation among divisions with large units (p = 0.048 and 0.01, respectively). All core elements were perceived to have not only high impact in program development but also high effort in implementation. Assuming that all structural elements could be effectively implemented within their division, 83% of respondents (43/52) agreed that diagnostic bedside ultrasound should be a core curricular component of fellowship education.

Conclusions:
Diagnostic bedside ultrasound is increasingly prevalent in training and clinical use across the pediatric critical care medicine landscape despite frequently absent core programmatic infrastructural elements. These core elements are perceived as important to program development, regardless of division unit size. Shared standardized resources may assist in reducing the effort in core element implementation and allow us to measure important educational and clinical outcomes.
The Association Between the Functional Status Scale and the Pediatric Functional Independence Measure in Children Who Survive Traumatic Brain Injury*
Authors: Maddux Aline B. , Cox-Martin Matthew , Dichiaro Michael , Bennett Tellen D. 
Published: August 2018

Objectives:
To determine the association between the Functional Status Scale and Pediatric Functional Independence Measure scores during the rehabilitation stay in children who survive traumatic brain injury.

Design:
Secondary analysis of a prospective observational cohort study.

Setting:
Tertiary care children’s hospital with a level 1 trauma center and inpatient rehabilitation service.

Patients:
Sixty-five children less than 18 years old admitted to an ICU with acute traumatic brain injury and subsequently transferred to the inpatient rehabilitation service.

Interventions:
Not applicable.

Measurements and Main Results:
Functional Status Scale and Pediatric Functional Independence Measure at transfer to rehabilitation and Pediatric Functional Independence Measure at discharge from rehabilitation. The median age of the cohort was 7.1 years (interquartile range, 0.8–12.3 yr), and 29% were female. Nearly all of the children were healthy prior to the traumatic brain injury: six patients (9.2%) had a baseline Functional Status Scale score greater than 6. At the time of transfer to inpatient rehabilitation, total Functional Status Scale and Pediatric Functional Independence Measure scores had the expected negative correlation due to increasing disability resulting in lower scores in Pediatric Functional Independence Measure and higher scores in Functional Status Scale (r = –0.49; 95% CI, –0.62 to –0.35). Among subjects with less disability as measured by lower total Functional Status Scale scores, we found substantial variability in the total Pediatric Functional Independence Measure scores. In contrast, Pediatric Functional Independence Measure scores were consistently low among subjects with a wide range of higher total Functional Status Scale scores (more disability).

Conclusions:
Although proprietary and more time-intensive, the Pediatric Functional Independence Measure has advantages relative to the Functional Status Scale for less severely injured patients and task-specific measurements. The Functional Status Scale may have advantages relative to the Pediatric Functional Independence Measure for more severely injured patients. Further investigations are needed to characterize changes in the Functional Status Scale during the rehabilitation stay and after discharge.
Pulmonary Alveolar Proteinosis in Hereditary and Autoimmune Forms With 2 Cases
Authors: Sirin Kose Seda , Asilsoy Suna , Uzuner Nevin , Karaman Ozkan , Ozer Erdener , Anal Ozden 
Published: August 2018

AbstractPulmonary alveolar proteinosis (PAP) is a respiratory pathology characterized by the accumulation and increase of surfactant-derived material in the lungs. In clinical practice, PAP may present as the primary form, which includes autoimmune and hereditary PAP, or as the secondary form. Diffuse alveolar radiopacities on chest x-ray and the crazy-paving pattern on high-resolution computed tomography are important, although not specific findings for PAP. Bronchoalveolar lavage biopsy is a diagnostic method, and whole-lung lavage remains the criterion standard for the treatment of PAP. Evidence is required regarding treatment with exogenous anti–granulocyte/macrophage colony-stimulating factor.Here, we present a 13-year-old male patient with hereditary PAP and a 15-year-old female patient with autoimmune PAP who presented with complaints of easy fatigability and weakness to emphasize the importance of keeping in mind PAP as a differential diagnosis in patients with respiratory failure findings.
Hypothermia
Authors: Kasmire Kathryn E. , Vega Carolina , Bennett Nicholas J. , Laurich V. Matt 
Published: August 2018

Objectives
Diagnosis of sepsis in young infants can be challenging due to the nonspecific signs, which can include hypothermia. Whether the presence of hypothermia in young infants should prompt evaluation for serious infection is unclear. The objectives were to measure the prevalence of serious infection among infants ≤60 days of age with hypothermia in the emergency department (ED) and determine other clinical features of hypothermic infants who have serious infection.

Methods
This is a retrospective analysis of all infants ≤60 days seen in a children's hospital ED from April 2014 to February 2017. Primary outcome was presence of serious infection, defined as urinary tract infection, bacteremia, meningitis, pneumonia, or herpes virus infection. Hypothermia was defined as a rectal temperature of 36.0°C or less.

Results
Of 4797 infants ≤60 days of age seen in the ED, 116 had hypothermia. The prevalence of serious infection was 2.6% (3/116) in hypothermic infants compared with 15.2% (61/401) in febrile infants (P < 0.01). Hypothermic infants with serious infections were more likely to have a history of prematurity, apnea, poor feeding, lethargy, ill-appearance, and respiratory signs than hypothermic infants without serious infection. All 3 hypothermic infants with serious infection had other concerning features.

Conclusions
The prevalence of serious infection in hypothermic young infants in the ED is low. Serious infection is unlikely in infants with isolated hypothermia.
Combined Carpal Tunnel Release and Palmar Fasciectomy for Dupuytren’s Contracture Does Not Increase the Risk for Complex Regional Pain Syndrome
Authors: Loewenstein Scott N. , Duquette Stephen P. , Adkinson Joshua M. 
Published: August 2018

Background:
Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome and Dupuytren’s contracture results in an increased incidence of complex regional pain syndrome. As a result, many surgeons do not perform surgery for the two conditions concurrently. The authors’ goal was to determine the extent of this association.

Methods:
The authors identified all patients undergoing surgical treatment for carpal tunnel syndrome, Dupuytren’s contracture, or both between April of 1982 and March of 2017 using the Indiana Network for Patient Care, a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year postoperative incidence of complex regional pain syndrome were recorded.

Results:
A total of 51,739 patients (95.6 percent) underwent carpal tunnel release only, 2103 (3.9 percent) underwent palmar fasciectomy only, and 305 (0.6 percent) underwent concurrent carpal tunnel release and palmar fasciectomy. There was no difference in the likelihood of developing complex regional pain syndrome (p = 0.163) between groups. Independent risk factors for developing complex regional pain syndrome were younger age; anxiety; depression; epilepsy; gout; and history of fracture of the radius, ulna, or carpus.

Conclusions:
Concurrent carpal tunnel release and palmar fasciectomy is not associated with an increased risk for developing complex regional pain syndrome. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of complex regional pain syndrome after surgery and should be discussed preoperatively as potential risk factors.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.