bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterization of Esophageal Motility in Infants With Congenital Diaphragmatic Hernia Using High‐resolution Manometry
Authors: Rayyan Maissa , Omari Taher , Debeer Anne , Decaluwe Herbert , Deprest Jan , Allegaert Karel , Rommel Nathalie 
Published: March 2019

ABSTRACTObjectives:The aim of the study was to characterize esophageal motility and esophagogastric junction (EGJ) function in infants who underwent repair of an isolated congenital diaphragmatic hernia (iCDH).Methods:High‐resolution manometry with impedance was used to investigate esophageal motility and EGJ function after diaphragmatic repair in 12 infants with iCDH (11 left‐sided; 9 patch repair). They had esophageal motility studies during neonatal admission (n = 12), at 6 months (n = 10) and at 12 months of life (n = 7). Swallows were analyzed using conventional esophageal pressure topography and pressure flow analysis and were compared with 11 healthy preterm born infants at near‐term age.Results:Esophageal peristaltic motor patterns in patients with iCDH were comparable to controls. EGJ end‐expiratory pressure was higher in patients with patch repair compared with controls (P = 0.050) and those without patch (P = 0.009). The difference between inspiratory and expiratory pressures at the EGJ was lower in patients with iCDH with patch (P = 0.045) compared to patients without. Patients with iCDH with patch showed increased Pressure Flow Index, resistance of bolus flow at the EGJ, compared with controls (P = 0.043).Conclusions:Normal esophageal wave patterns are present in the investigated patients with iCDH. EGJ end‐expiratory pressure seems lower in patients with iCDH without patch suggesting a decreased EGJ barrier function hence increased vulnerability to gastroesophageal reflux. Patch repair appears to increase end‐expiratory pressure at the EGJ above that of controls suggesting that patch surgery tightens the EGJ, thereby increasing flow resistance. This is in line with the increased Pressure Flow Index. In infants with a patch, the inspiration‐expiration pressure difference is lower, reflecting diminished activity of the crural diaphragm.
Women's Experiences with Tandem Breastfeeding
Authors: O'rourke Molly Patricia , Spatz Diane Lynn 
Published: March 2019

Abstract

Background:
Choosing to breastfeed is a decision with far-reaching benefits; strengthened immune systems, all-encompassing nutrition, and fostering healthy attachment. For these and other reasons, some mothers are reluctant to wean their child due to a subsequent pregnancy. Mothers may breastfeed throughout their second pregnancy, give birth to their second child, and simultaneously breastfeed two children. This practice is known as tandem breastfeeding.

Purpose:
We explore the biological and emotional considerations of tandem breastfeeding and offer practical suggestions for nurses.

Methods:
Three mothers who engaged in tandem breastfeeding were identified and interviewed. Interviews were face-to-face or over the phone. One researcher conducted all interviews using the same questions that served as the foundation and guidance for the discussion-based interview. The interviews lasted 40 to 60 minutes and were audio recorded to minimize recall issues during data analysis.

Results:
Three mothers shared their tandem breastfeeding journeys, challenges faced, and overall perspectives. This was an opportunity for mothers to share feedback on how nurses provided education and care as well as suggestions for nursing care of future mothers who choose to tandem breastfeeding.

Clinical Implications:
Through research and case-series interviews, we developed implications for nursing practice. Nurses must be informed and supportive of mothers' decisions to tandem breastfeed.
Using Lean to Improve Patient Safety and Resource Utilization After Pediatric Adenotonsillectomy
Authors: Gray Mingyang L. , Chen Sida , Kinberg Eliezer , Colley Patrick , Malkin Benjamin D. 
Published: March 2019

Objective
The objective of this quality improvement project was to decrease the rate of nonemergent use of emergency department (ED) resources in children undergoing adenotonsillectomy by 50% and/or reach a future state of 5% or less overall ED visits among all postoperative patients within 1 year. A secondary objective was to standardize the preoperative, intraoperative, and postoperative management of these patients.

Methods
The study was a quality improvement project using Lean. The target population was children younger than 18 years undergoing tonsillectomy with or without adenoidectomy. A retrospective review of adenotonsillectomy was performed for a 12-month period. Lean tools including A3 Thinking, Ishikawa “fishbone” diagram, and value stream mapping were used to analyze the problem and identify interventions. Postintervention data were collected for a 10-month period.

Results
Compared with the baseline period, the ED visit rate after adenotonsillectomy decreased from 36.2% to 15.5% (P = 0.0095). The rate of ED visits for nonbleeding complaints decreased from 30.4% to 12.1% (P = 0.01748). There was no significant change in rate of ED visits for bleeding (decreased from 5.8% to 3.5% [P = 0.6873]). There was no significant change in the use of intraoperative dexamethasone and acetaminophen.

Conclusions
Postadenotonsillectomy patients often use emergency resources better reserved for other patients. Addressing this problem with Lean principles significantly decreased postoperative ED visit rates by more than 50%.

Implications for Practice
To our knowledge, this is the first reported use of Lean principles to decrease utilization of emergency resources in the postoperative period. Lean can be applied to other processes in our field to eliminate waste and add value to improve patient outcomes.

Level of Evidence
NA.
A Comparison of Plasma Efavirenz and Tenofovir, Dried Blood Spot Tenofovir-Diphosphate, and Self-Reported Adherence to Predict Virologic Suppression Among South African Women
Authors: Phillips Tamsin K. , Sinxadi Phumla , Abrams Elaine J. , Zerbe Allison , Orrell Catherine , Hu Nai-Chung , Brittain Kirsty , Gomba Yolanda , Norman Jennifer , Wiesner Lubbe , Myer Landon , Maartens Gary 
Published: March 2019

Background:
Tenofovir-diphosphate (TFV-DP) in dried blood spots (DBS) is an objective long-term adherence measure, but data are limited on its ability to predict virologic suppression (VS) in people on antiretroviral (ARV) treatment. There are also no data comparing DBS TFV-DP with plasma ARV concentrations as predictors of VS.

Methods:
Women who were on a first-line regimen of tenofovir, emtricitabine, and efavirenz (EFV) were enrolled in a cross-sectional study. Plasma EFV and tenofovir (TFV), DBS TFV-DP assays, and 30-day self-reported adherence were evaluated as predictors of VS (<50 copies/mL) with the area under the curve of receiver operating characteristics and logistic regression.

Results:
We enrolled 137 women; mean age of 33 years; median 4 years on antiretroviral therapy; 88 (64%) had VS. In receiver operating characteristics analyses: DBS TFV-DP [0.926 (95% CI: 0.876 to 0.976)] had a higher area under the curve than plasma TFV [0.864 (0.797 to 0.932); P = 0.006], whereas plasma EFV [0.903 (0.839–0.967)] was not significantly different from DBS TFV-DP (P = 0.138) or plasma TFV (P = 0.140); all ARV assays performed better than self-report. The association of TFV-DP in DBS with VS strengthened with increasing concentrations [reference <350 fmol/punch: 350–699 fmol/punch aOR 37 (8–178); 700–1249 fmol/punch aOR 47 (13–175); ≥1250 fmol/punch aOR 175 (20–1539)]. “White coat adherence” (defined as DBS TFV-DP <350 fmol/punch with detectable plasma TFV) was only detected in 4 women.

Conclusions:
Plasma EFV, TFV, and DBS TFV-DP were all strong predictors of VS. EFV or TFV assays have potential for development as point-of-care assays for use as objective adherence measures in resource-limited settings.
Discrimination, Medical Distrust, Stigma, Depressive Symptoms, Antiretroviral Medication Adherence, Engagement in Care, and Quality of Life Among Women Living With HIV in North Carolina: A Mediated Structural Equation Model
Authors: Relf Michael V. , Pan Wei , Edmonds Andrew , Ramirez Catalina , Amarasekara Sathya , Adimora Adaora A. 
Published: March 2019

Background:
Women represent 23% of all Americans living with HIV. By 2020, more than 70% of Americans living with HIV are expected to be 50 years and older.

Setting:
This study was conducted in the Southern United States—a geographic region with the highest number of new HIV infections and deaths.

Objective:
To explore the moderating effect of age on everyday discrimination (EVD); group-based medical (GBM) distrust; enacted, anticipated, internalized HIV stigma; depressive symptoms; HIV disclosure; engagement in care; antiretroviral medication adherence; and quality of life (QOL) among women living with HIV.

Methods:
We used multigroup structural equation modeling to analyze baseline data from 123 participants enrolled at the University of North Carolina at Chapel Hill site of the Women's Interagency HIV Study during October 2013–May 2015.

Results:
Although age did not moderate the pathways hypothesized, age had a direct effect on internalized stigma and QOL. EVD had a direct effect on anticipated stigma and depressive symptoms. GBM distrust had a direct effect on depressive symptoms and a mediated effect through internalized stigma. Internalized stigma was the only form of stigma directly related to disclosure. Depressive symptoms were a significant mediator between GBM, EVD, and internalized stigma reducing antiretroviral therapy medication adherence, engagement in care, and QOL.

Conclusions:
EVD, GBM, and internalized stigma adversely affect depressive symptoms, antiretroviral therapy medication adherence, and engagement in care, which collectively influence the QOL of women living with HIV.
A delicate balancing act: immunity and immunopathology in human H7N9 influenza virus infections
Authors: Karawita Anjana C. , Tong Marcus Z.W. , Short Kirsty R. 
Published: March 2019

Purpose of review
A delicate balance exists between a protective and detrimental immune response to an invading viral pathogen. Here, we review the latest advancements in our understanding of immunity and immunopathology during H7N9 influenza A virus (IAV) infections and its relevance to disease management and diagnosis.

Recent findings
Recent studies have highlighted the role of specific leukocytes in the pathogenesis of H7N9 IAV infections and potential diagnostic role that host cytokine profiles can play in forecasting disease severity. Furthermore, alterations in diet have emerged as a possible preventive measure for severe IAV infections.

Summary
The recent emergence and continued evolution of H7N9 IAVs have emphasized the threat that these avian viruses pose to human health. Understanding the role of the host immune response in both disease protection and pathogenesis is an essential first step in the creation of novel therapeutic and preventive measures for H7N9 IAV infections.
Single-Center Retrospective Analysis of Breakthrough Allergic-Like Reactions to Gadobutrol
Authors: Walker Daniel , Chakraborty Santanu , Schieda Nicola 
Published: March 2019

Objective
The purpose of this study was to assess the rate and severity of breakthrough allergic-like reactions to gadobutrol.

Materials and Methods
Under a waiver from our institutional review board, we performed a key word search of our institutional PACS (Picture Archiving and Communication System) database to identify all allergic-like reactions, which occurred in the setting of gadobutrol administration between December 2009 and August 2018, encompassing approximately 25,000 gadobutrol injections. Patients with an index allergic-like reaction who underwent a subsequent gadobutrol-enhanced magnetic resonance imaging after a standard 13-hour corticosteroid and antihistamine premedication protocol before repeat injection were identified. Patient characteristics, volume of gadobutrol injected, and severity of index and breakthrough reactions were recorded and compared by χ2 test, t test, and Spearman correlation.

Results
The index allergic-like reaction rate to gadobutrol was 0.28% (69/25000). Of the patients who had an index allergic-like reaction, 45% (31/69) had a subsequent magnetic resonance imaging with gadobutrol injection and premedication with a breakthrough reaction rate of 35% (11/31). Most index reactions were mild in severity (91% [63/69]), and most breakthrough reactions were also typically mild (91% [10/11]). One patient escalated from a mild index reaction to a moderate breakthrough reaction despite premedication. There was no correlation between volume of gadobutrol injected (ρ = −0.004, P = 0.98) or association with age (P = 0.74), although female patients had higher breakthrough reaction rates (P = 0.007).

Conclusions
Allergic-like reactions to gadobutrol are rare; however, breakthrough reactions occur with moderate frequency despite premedication, and although generally of mild severity, in our series, one breakthrough reaction escalated in severity.
Splenic Marginal Zone B-Cell Lymphoma With Splenic Infarction in a Patient With Cold Agglutinin Disease
Authors: Nakamoto Ryusuke , Okuyama Chio , Utsumi Takahiko , Yamamoto Yoshihiro 
Published: March 2019

AbstractWe report a case of splenic marginal zone B-cell lymphoma discovered in a 73-year-old man with cold agglutinin disease. PET/CT revealed splenomegaly with focally intense uptake of18F-FDG and diffusely increased bone marrow uptake, which was considered to be secondary to hemolytic anemia. Splenectomy was performed. The histopathology of the spleen showed splenic marginal zone B-cell lymphoma with partial splenic infarction, which correlated with the area of focal intense FDG uptake. Depending on the time since onset, splenic infarctions can present as focal FDG accumulation.
The Prognostic Value of Baseline 18F-FDG PET/CT in Human Papillomavirus–Positive Versus Human Papillomavirus–Negative Patients With Oropharyngeal Cancer
Authors: Gouw Zeno A. R. , La Fontaine Matthew D. , van Kranen Simon , van de Kamer Jeroen B. , Vogel Wouter V. , van Werkhoven Erik , Sonke Jan-Jakob , Al-Mamgani Abrahim 
Published: March 2019

Purpose
Oropharynx cancer (OPC) is heterogeneous; human papillomavirus (HPV)–positive and HPV− tumors represent 2 disease entities with a different prognosis. Earlier studies investigating the prognostic value of pretreatment 18F-FDG PET in OPC are small or included patients with unknown HPV status. This study assessed the prognostic value of PET variables, in a large cohort with balanced HPV status.

Methods
Retrospectively, primary tumor SUVmax, SUVpeak, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were extracted from baseline FDG PET/CT of patients with OPC treated with (chemo)radiation. The Pearson correlation between the PET variables was calculated. With linear regression, the correlation between the PET variables and HPV status, age, smoking status, T stage, N stage, and American Joint Committee on Cancer stage was calculated. Univariable and multivariable Cox models analyzed local control, overall survival, and disease-free survival (DFS).

Results
Of 201 patients, 109 were HPV+. Metabolic tumor volume and TLG correlated (r = 0.96), as did SUVpeak and SUVmax (r = 0.97). The PET variables correlated strongest with HPV status and T stage. These two accounted for 40% of the variance of MTV and 33% of TLG. Human papillomavirus–negative tumors had a significantly higher SUVmax, SUVpeak, MTV, and TLG. In univariable analysis, all PET variables were significantly associated with local control, overall survival, and DFS. In multivariable analysis, TLG was significantly associated to DFS in patients with HPV− OPC (hazard ratio, 1.005; 95% confidence interval, 1.001–1.010; P = 0.03). However, we did not observe this in HPV+ patients.

Conclusions
Increased baseline TLG is associated with worse DFS in HPV− OPC and might be used as biomarker for risk stratification in these patients. Interestingly, we could not identify this association in HPV+ patients.
Quality and Safety in Healthcare, Part LIII
Authors: Harolds Jay A. 
Published: March 2019

Abstract
There is overlap between the symptoms of depression and burnout. Many of those with burnout are also depressed. If the depression is significant, the individual should be referred for therapy. However, many articles on therapy for those with burnout are flawed, and the best type of therapy for burnout is controversial. However, cognitive behavior therapy is usually helpful for the emotional exhaustion component of burnout. Counseling and/or coaching may be helpful for those having burnout without significant depression. There are lessons from positive psychology that may be utilized to help counsel those with burnout.
Car Accident With Airbag Deployment Trauma Showed Special Pattern in Bone Scan
Authors: Chuang Tzyy-Ling , Hsu Ta-Wen , Chou Shih-Chin , Wang Yuh-Feng 
Published: March 2019

Abstract
A 72-year-old man had rectal adenocarcinoma with partial obstruction with liver and lung metastases. Bone scan showed special pattern with bony destructions to the lateral aspect of the left first to fourth and right first to 10th ribs (in a row in continuous vertical alignment), the costal end of the left second rib, the left sternoclavicular junction, and sternum. Patient recalled a car traffic accident with airbag deployment trauma to the anterior aspect of the chest about 2 months prior. Chest CT confirmed that the bone lesions were all fractures.
Orbital Paraganglioma
Authors: Zhu Binbin , Yan Jianhua 
Published: March 2019

Background:
Paragangliomas are groups of neuroendocrine neoplasms originating from neural crest cells throughout the body, but are rarely observed within the orbit.

Case report:
Two patients, a 4-year-old male and 27-year-old female, presented with a slow-growing proptosis. Well-defined masses were located in the superomedial (male) and temporal (female) portion of the right orbit and involved the entire bodies of either the superior (male) or lateral (female) rectus muscles. B-mode ultrasound scan revealed a homogeneous, well-defined, hypoechoic mass, with rich blood flow signals inside the mass on CDI. CT scans indicated a well-defined, homogeneous mass with moderate enhancement, while MRI showed a well-defined mass with a salt and pepper appearance due to the prominence of blood vessels in the form of flow-void areas. Anterior orbitotomy and total tumor excision were performed on both patients. Subsequent histological and immunohistochemistry assays confirmed the diagnosis of orbital paraganglioma. The male patient is currently at 14 years of follow-up without recurrence or metastasis. The female patient developed recurrence at 3 months post-surgery. After a second surgery and local radiotherapy, there were no signs of the recurrence as assessed at 13 years of follow-up in this female patient.

Conclusion:
Orbital paraganglioma is an extremely rare benign tumor. The salt-and-pepper appearance as observed with MRI scan represents a relatively salient characteristic of this condition. Total excision of the lesion by orbitotomy is the treatment of choice and the possibility of tumor recurrence warrants diligent consideration. Radiotherapy is useful in patients with tumor recurrence or subtotal surgical excision.
Ventriculoperitoneal Shunting in Alobar Holoprosencephaly: Does it Work Even When Patient Has No Sign of Raised Intracranial Pressure?
Authors: Akpinar Elif , Gürbüz Mehmet Sabri , Okutan Mehmet Özerk , Beşkonakli Ethem 
Published: March 2019

Abstract
Holoprosencephaly (HPE) is a developmental anomaly of forebrain characterized by a failure of division of the embryonic forebrain into hemispheres. It is associated with a set of facial anomalies at a rate of 80%. Survival rate, particularly in alobar HPE, is quite low. Alobar HPE is usually associated with a large dorsal cyst which might eventually lead to hydrocephalus and raised intracranial pressure. Placement of ventriculoperitoneal (VP) shunt has been reported to be beneficial in symptomatic hydrocephalus accompanying HPE. Here we report a preterm infant born with alobar HPE and undergoing VP shunt placement although there was no sign of raised intracranial pressure. She is 12 months old now having near-normal developmental progress. This case has revealed that the placement of VP shunt, particularly inserting the catheter tip into dorsal cyst of HPE, might be beneficial and contribute to the survival and further brain development even in the absence of the signs of raised intracranial pressure.
Median Perforating Canal in Human Mandible
Authors: Marzook Hamdy A. , El-Gendy Abeer A. , Darweesh Fawzy R.S. 
Published: March 2019

Abstract
Surgical interventions in the anterior region of the human mandible are associated with many complications. Some anatomical structures like the median perforating canal were discovered in mammals. Such canals may be a cause of concern that needs attention in human mandible. The purpose of the present study was to evaluate the occurrence, location, and course of median perforating canal and its associated extensions in the anterior segment of the human mandible in cone beam computed tomography scans (CBCT). Data were collected from 160 CBCT scans, and evaluated. The incidence was 23.75% for median perforating canal with wide anatomical variations concerning the related lingual and labial extensions. Median perforating canal and their associated lingual and labial foramina are frequently seen in human mandible. A thorough investigation of the symphyseal region using CBCT must be taken into account when targeting surgical intervention in this area.
Extranasopharyngeal Angiofibroma of the Frontal Sinus
Authors: Kim Jong Seung , Kwon Sam Hyun , Kim Jung Soo , Jung Ji Yun , Heo Sung Jae 
Published: March 2019

Abstract
Angiofibroma is a rare tumor that accounts for about 0.05% of all head and neck tumors; it mainly occurs in the region of the nasopharynx. To date, no study originating in the frontal sinus has been reported. The authors report a report of an 18-year-old male complaining of severe pain in the right periocular area, forehead, and temporal area for 1 week. Endoscopic sinus surgery in combination with trephination was used to remove the tumor and the tumor was diagnosed as angiofibroma from histopathologic examination. It is hard to consider a tumor as being angiofibroma when it is not located in the nasopharynx. In particular, although extranasopharyngeal angiofibroma can occur in all head and neck regions, a tumor which has developed in the frontal sinus is more difficult to diagnose as angiofibroma because no patients have been reported until now. With this study, surgeons now need to be aware of the possibility of occurrence of angiofibroma in the frontal sinus.