bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of the patients with adnexal torsion and outcomes of different surgical procedures
Authors: Wang Zengyan , Zhang Dan , Zhang Huanxiao , Guo Xu , Zheng Jingxuan , Xie Hongzhe 
Published: January 2019

Abstract
There is no uniform standard to assess the viability of the ovary and choose conservative surgery or radical surgery for patients with adnexal torsion. This retrospective study aims to explore the characteristics of patients with adnexal torsion and the outcomes of different surgical procedures.
A retrospective analysis of 174 cases diagnosed with adnexal torsion at our hospital between January 2005 and October 2014 was performed. Patients’ clinical characteristics, surgical procedures, and postoperative recovery were analyzed.
Of the cases, 31 (17.82%) did not have any emergent symptom; adnexal torsion were found during other surgeries. Among all 174 adnexal torsion patients, 14 cases received conservative treatment, including anti-inflammatory treatment, and 8 (58.1%) were pregnant. Of the cases, 160 underwent surgical treatment: 144 (90%) were confirmed to have ovary/ovarian cyst torsion, among whom 26 (18.1%) had their adnexa retained (group A) and 118 (81.9%) underwent adnexectomy (group B). Age, time of torsion, and rounds of torsion in group A were significantly less than in group B. None of the patients with adnexa preservation surgery had any complication, such as abdominal infection or thrombotic diseases.
Patients with ovary/ovarian cyst torsion can attempt to preserve the ovaries without serious clinical complications; there were no severe complications such as embolism after the conservative surgeries in this study.
The role of contrast-enhanced ultrasound in the diagnosis of hepatic alveolar echinococcosis
Authors: Cai Diming , Li Yongzhong , Jiang Yong , Wang Huiyao , Wang Xiaoling , Song Bin 
Published: January 2019

Abstract
To evaluate the value of contrast-enhanced ultrasound (CEUS) compared with ultrasound (US) in the diagnosis of hepatic alveolar echinococcosis (AE).
Thirty-one patients with 43 hepatic AE lesions between January 2010 and September 2017 were included in the study. All lesions which were histopathologically proven to be hepatic AE were retrospectively reviewed. Features of the lesions by CEUS were retrospectively studied.
All lesions were detected by US and CEUS in the 31 patients (17 males and 14 females) with a mean age of 38.5 ± 10.6 years (range: 16–58 years). The size of the lesions ranged from 1.5 × 0.7 cm to 15 × 18 cm. By US, 3 lesions (7%, 3/43) were hypoechoic nodules, 21 (48.8%, 21/43) were hyperechoic, and 19 lesions (44.2%, 19/43) were of mixed echogenicity type (solid-cystic). 27 lesions (62.8%, 27/43) had calcifications. Only 1 lesion was detected blood-flow signals. With CEUS, 23 lesions (53.5%, 23/43) displayed no enhancement in the arterial phase, portal phase and delayed phase on CEUS. 11 lesions (25.6%, 11/43) displayed a slight ring-like hyper-enhancement in the arterial phase and displayed hypo-enhancement in the portal and delayed phase. 6 lesions (14%, 6/43) displayed hyper-enhancement in the arterial phase and hypo-enhancement in the portal and delayed phase. 2 lesions (4.7%, 2/43) showed iso-enhancement in the arterial, portal, and delayed phase. 1 lesion (2.3%, 1/43) showed slight hypo-enhancement in the arterial, portal, and delayed phase.
CEUS is a more valid technique for diagnosing AE than US. It could be a reliable tool in the diagnosis of hepatic AE.
The impact of advanced maternal age on the outcomes of very low birth weight preterm infants
Authors: Tseng Kai-Ti , Peng Chun-Chih , Chang Jui-Hsing , Hsu Chyong-Hsin , Lin Chia-Ying , Jim Wai-Tim , Chang Hung-Yang 
Published: January 2019

Abstract
The association between advanced maternal age and neonatal outcomes remains controversial. This study attempted to determine the short-term and long-term outcomes of very low birth weight (VLBW, <1500 g) preterm infants, born to mothers of advanced age (≥35 years).
In this retrospective cohort study, VLBW infants were divided into the advanced maternal age group and comparison group. We compared the pregnancy complications, demographic factors, short-term morbidities, and neurodevelopmental outcomes using the Bayley Scales of Infant Development-Third Edition, at 24 months of corrected age between the 2 groups.
The study comprised of 536 VLBW infants born to 483 mothers. Mothers of advanced age had a significantly lower rate of primiparity compared to the comparison group (45.8% vs 65.2%, P < .001), and were more likely to have gestational diabetes (13.7% vs 5.5%, P = .002) and to undergo in vitro fertilization (IVF; 18.4% vs 9.9%, P = .01). No significant differences were found between the 2 groups in terms of short-term outcomes. At 2 years of corrected age, advanced maternal age was associated with a higher incidence of severe speech delay (11.3% vs 5.7%, P = .04), neurodevelopmental impairment (NDI; 28.8% vs 18.4%, P = .02), and adverse composite outcome (37.4% vs 27.3%, P = .02). However, the differences in NDI and composite adverse outcomes were not statistically significant between the groups after adjustments for potential confounders.
Advanced maternal age was not associated with major morbidities and long-term NDI among VLBW preterm infants. The association between advanced maternal age and severe speech delay in the infant needs further investigation.
Parathyroid adenoma presenting with spontaneous cervical and anterior mediastinal hemorrhage
Authors: Khan Sohini , Choe Charles C. , Shabaik Ahmed , Bouvet Michael 
Published: January 2019

Abstract

Rationale:
Spontaneous anterior cervical or mediastinal hemorrhage is a rare presentation of parathyroid adenoma.

Patient concerns:
A 69-year-old woman presented with neck hematoma and dysphagia and was found to have a soft tissue mass adjacent to her thyroid gland as seen on MRI and neck ultrasound.

Diagnosis:
Laboratory testing demonstrated elevated calcium and parathyroid hormone supporting diagnosis of parathyroid adenoma.

Interventions:
She underwent right inferior parathyroidectomy and en bloc right hemithyroidectomy due to significant fibrosis.

Outcomes:
Pathology confirmed hypercellular parathyroid and normal thyroid tissue. Postoperatively, patient's calcium and parathyroid hormone levels had normalized.

Lessons:
In conclusion, imaging may not always be specific in identifying the source of neck hematoma and so laboratory studies should be done to rule out parathyroid adenoma as the underlying etiology.
Coagulation tests and blood glucose before vaginal delivery in healthy teenage pregnant women compared with healthy adult pregnant women
Authors: Covali Roxana , Socolov Demetra , Socolov Razvan 
Published: January 2019

Abstract
The aim of this study was to compare the coagulation tests and blood glucose levels between healthy teenage pregnant patients and healthy adult pregnant patients just before vaginal delivery
In a prospective study, 208 consecutive patients, 3rd trimester healthy pregnant women, underwent blood tests to determine their glucose levels the day before vaginal delivery. Of the 208 patients, 103 also underwent blood coagulation testing performed on the same day.
The median values of the coagulation tests (APTT, prothrombin time, INR, prothrombin activity) and blood glucose were very similar in the healthy pregnant teenagers (32.6; 12.9; 1.02; 97.1; 81) compared with that in the healthy adult pregnant patients (32.45; 13.1; 1.01; 97.5; 81.2). Only the median value for fibrinogen was significantly different in healthy pregnant teenagers (348.9 mg/dL) (interquartile range 21.7) compared with that in healthy adult pregnant patients (359.1 mg/dL) (interquartile range 29.88).
Significantly different median blood glucose levels also occurred in the <20; 20–29; 30–39; >40 age groups, but the glucose levels were still within normal limits.
Even if there was variability between blood values from one age group to another, the median values for coagulation tests and blood glucose were very close in the healthy teenage pregnant patients compared with the median values of the healthy adult pregnant patients, just before vaginal delivery. With very few exceptions, the values for coagulation tests and blood glucose were within normal limits in all age groups of healthy pregnant patients.
Pathomorphological features of metastatic lymph nodes as predictors of postoperative prognosis in pancreatic cancer
Authors: Hoshikawa Mayumi , Ogata Sho , Nishikawa Makoto , Kimura Akifumi , Einama Takahiro , Noro Takuji , Aosasa Suefumi , Hase Kazuo , Tsujimoto Hironori , Ueno Hideki , Yamamoto Junji 
Published: January 2019

Abstract
To investigate the pathological features of metastatic lymph nodes (LN) in pancreatic ductal adenocarcinoma (PDAC) and to determine factors with prognostic implications.
Metastatic LN status is a proven significant factor for predicting postoperative prognosis in pancreatic cancer patients. However, the effective prognostic criteria regarding metastatic LNs for such disease remain unknown.
We retrospectively reviewed 98 patients with R0/1 resection for PDAC. All metastatic LNs were evaluated for the pathomorphological features of metastasis and analyzed in terms of postoperative outcomes. Various morphological patterns of metastasis were assessed in 440 positive LNs and then classified into 4 groups: common type, direct type (continuously invaded by the main tumor), scatter type (multiple tumor clusters among the normal LN tissues), and isolated tumor cell (ITC).
The pathological stage was defined as stage IIA in 10% and IIB in 90% patients. Common-type metastasis was noted in 55% positive LNs of 75% node-positive patients; direct type in 36% LNs of 69% patients; scatter type in 5% LNs of 14% patients; and ITCs in 5% LNs of 18% patients. Significant difference was noted only in recurrence-free survival (RFS) but not in overall survival (OS) in the common-type; only in OS but not in RFS for the scatter type; and neither in RFS nor OS for both direct type and ITC. Multivariate analysis revealed that only LN ratio and curability were independent predictive factors of poor.
The tumor distribution patterns in metastatic LNs are the postoperative prognostic factors in pancreatic cancer.
A randomized controlled trial comparing methohexital and propofol for induction in patients receiving angiotensin axis blockade
Authors: Bonavia Anthony , Verbeek Thomas , Adhikary Sanjib , Kunselman Allen , Budde Arne , Lyn-Sue Jerome , Mets Berend 
Published: January 2019

Abstract

Background:
Pharmacologic angiotensin axis blockade (AAB) has been associated with profound hypotension following anesthetic induction with propofol. To combat this problem, investigators have attempted to withhold angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) preoperatively, or evaluated the effects of different induction agents in conferring greater hemodynamic stability. To date, methohexital has not been compared with the most commonly used induction agent, propofol. Hence, the primary objective was to study the hypothesis that methohexital confers a better hemodynamic profile than propofol for anesthetic induction, in patients receiving AAB. The secondary objective was to investigate the postinduction levels of serum neurohormones in an attempt to explain the mechanisms involved.

Methods:
Forty-five adult, hypertensive patients taking ACEi or ARB and scheduled for elective, noncardiac surgery completed the study. Patients were randomized to receive equi-anesthetic doses of either propofol or methohexital for anesthetic induction. Hemodynamic variables were measured and blood samples were drawn before induction and for 15 minutes afterwards.

Results:
Methohexital resulted in less hypotension compared with propofol (P = .01), although the degree of refractory hypotension was similar (P = .37). The postinduction systolic blood pressure (P = .03), diastolic blood pressure (P < .001) and heart rate (P = .03) were significantly higher in the methohexital group. A nonsignificant elevation of serum norepinephrine and epinephrine levels was observed in the methohexital group, while serum arginine vasopressin and angiotensin II levels did not differ between groups.

Conclusion:
While methohexital was shown to confer greater hemodynamic stability in patients taking ACEi/ARB, the measured hormone levels could not explain the mechanism for this effect.
A risk scoring model to predict renal progression associated with postcontrast acute kidney injury in chronic kidney disease patients
Authors: Baek Seung Don , Kim So Mi , Kang Jae-Young , Han Minkyu , Lee Eun Kyoung , Chang Jai Won 
Published: January 2019

Abstract
Postcontrast acute kidney injury (AKI) occurs more frequently in patients with lower estimated glomerular filtration rate. We hypothesized that postcontrast AKI in chronic kidney disease (CKD) patients with distinct risk factors might be associated with accelerated renal progression.
We undertook this retrospective cohort study to develop and validate a risk scoring model for predicting renal progression. In a development dataset, 18,278 contrast-enhanced CT scans were performed in 9097 patients with CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2) who were not undergoing dialysis. Postcontrast AKI was observed in 5.8% (1051/18,278) of all contrast-enhanced CTs with 7.6% (689/9097) of the total CKD patients. We investigated the 1-year renal outcome in 224 eligible patients. A risk scoring model was developed with multivariate regression analysis and was assessed in external validation (independent 154 patients).
Among 224 patients, 70 (31.3%) patients had progression of renal dysfunction at 1 year (defined as reduction in estimated GFR ≥25% at 1 year). A risk score of 4, 4, 6, 6, 7, or 6 was assigned to diabetes, baseline estimated GFR < 45 mL/min/1.73 m2, hypertension, repeated contrast exposure, congestive heart failure, and persistent renal injury (defined as an elevation of serum creatinine ≥25% at 3 months), respectively. An increasing risk score was associated with renal progression. Of note, persistent renal injury was more prevalent in the progression group than in the non-progression group. The AUROC of the model in the development population was 0.765. In the validation dataset, however, the discriminative power decreased (AUROC = 0.653).
Our suggested model provided the risk of renal progression, aiding in predicting prognosis, counseling, and improving outcomes in CKD patients complicated by postcontrast AKI.
Another Useful Application of Point-of-Care Ultrasound
Authors: Mori Takaaki , Nomura Osamu , Hagiwara Yusuke 
Published: January 2019

Abstract
Foreign body ingestion is a common pediatric complaint. Esophageal foreign body (EFB) requires early diagnosis and emergency removal of the object. We report 3 cases of EFB detected by point-of-care ultrasound demonstrating characteristic sonographic findings. Point-of-care ultrasound can be a potentially useful modality for identifying EFB.
Shock Index as a Predictor of Morbidity and Mortality in Pediatric Trauma Patients
Authors: Strutt Jonathan , Flood Andrew , Kharbanda Anupam B. 
Published: January 2019

Objectives
Compared with unadjusted shock index (SI) (heart rate/systolic blood pressure), age-adjusted SI improves identification of negative outcomes after injury in pediatric patients. We aimed to further evaluate the utility of age-adjusted SI to predict negative outcomes in pediatric trauma.

Methods
We performed an analysis of patients younger than 15 years using the National Trauma Data Bank. Elevated SI was defined as high normal heart rate divided by low-normal blood pressure for age. Our primary outcome measure was mortality. Secondary outcomes included need for a blood transfusion, ventilation, any operating room/interventional radiology procedures, and intensive care unit stay. Multiple logistic regressions were performed.

Results
Twenty-eight thousand seven hundred forty-one cases met the study criteria. The overall mortality rate was 0.7%, and 1.7% had an elevated SI. Patients with an elevated SI were more likely (P < 0.001) to require blood transfusion, ventilation, an operating room/interventional radiology procedure, or an intensive care unit stay. An elevated SI was the strongest predictor for mortality (odds ratio [OR] 22.0) in pediatric trauma patients compared with hypotension (OR, 12.6) and tachycardia (OR, 2.6).

Conclusions
Elevated SI is an accurate and specific predictor of morbidity and mortality in pediatric trauma patients and is superior to tachycardia or hypotension alone for predicting mortality.
Perinatal Mental Health Treatment Needs, Preferences, and Barriers in Parents of Multiples
Authors: WENZE SUSAN J. , BATTLE CYNTHIA L. 
Published: January 2019

Purpose:
Many parents of multiples experience elevated mental health symptoms in the perinatal period. This population often presents with unique treatment needs and barriers to care; however, no tailored interventions have been developed for pregnant or postpartum mothers of multiples and/or their partners. This study involved an initial exploration of the perceived mental health treatment needs, preferences, and barriers to care in this population, as a first step toward developing such an intervention.

Methods:
Participants were 241 parents of multiples who were recruited in-person and online. They completed self-report measures assessing treatment history/preferences, barriers to care, and symptoms during the perinatal period.

Results:
Participants identified postpartum months 0 to 3 as the most difficult time. Few participants received any form of mental health treatment, although a significant percentage (approximately half) expressed interest in such treatment. Treatment interest was high for a range of clinical concerns. Participants were interested in both traditional treatment paradigms and eHealth approaches. Barriers to care were common, with the most common barrier being lack of time.

Conclusions:
There is a large, unmet need for mental health treatment in parents of multiples in the perinatal period, especially the early postpartum months. eHealth strategies seem particularly feasible and acceptable in this population and may help circumvent common barriers to care. Clinical recommendations and considerations in treatment development are discussed.
Symptom Dimensions and Trajectories of Functioning Among Bipolar Youth: A Cluster Analysis
Authors: PETERS AMY T. , WEINSTEIN SALLY M. , ISAIA ASHLEY , VAN METER ANNA , ZULAUF COURTNEY A. , WEST AMY E. 
Published: January 2019

Background:
Accurate assessment of pediatric bipolar disorder (BD) is important for allocating appropriate treatment, but it is complicated by significant heterogeneity in symptom presentation and high rates of comorbidity. Investigating clinical subtypes of the disorder may help to clarify diagnostic boundaries and inform targeted treatment. This study used a full diagnostic instrument to examine symptom patterns among youth with BD.

Method:
Trained interviewers completed the Washington University Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) with 71 children (7 to 13 y of age) and families as part of the baseline assessment for a randomized clinical trial of Child- and Family-focused Cognitive-Behavioral Therapy (CFF-CBT) compared with treatment as usual (TAU) for pediatric BD. All participants met DSM-IV-TR criteria for a bipolar spectrum disorder. Hierarchical and K-means cluster analyses were performed. Resultant clusters were compared on symptom severity and psychosocial functioning at baseline and across treatment.

Results:
Two distinct symptom profiles emerged: “dysregulated/defiant” and “classic presentation.” The dysregulated/defiant cluster was characterized by more externalizing and disruptive behaviors, whereas the classic cluster presented with more severe depression, hallmark manic symptoms, anxiety, and inattention. CFF-CBT consistently promoted psychosocial coping skills, such as problem solving and self-control, for the dysregulated/defiant cluster. TAU also promoted these skills among the individuals in the classic presentation group but not those with symptoms in the dysregulated/defiant cluster.

Discussion:
Pediatric BD may be characterized by distinct phenotypes with unique etiologies and pathways to impairment. The use of a parametric approach to classify the diverse symptom presentations helped yield valuable insights into how to promote the best prognosis for improved functional outcomes in CFF-CBT versus TAU for youth with pediatric BD.
Religious Activity, Psychotic Features, and Suicidality in 688 Acute Psychiatric Inpatients
Authors: ABDEL GAWAD NOHA , DESAI PRATIKKUMAR , ALI TAHA , LEWIS KIMBERLY K. , POLO ROBERT , ENGSTROM ALLISON , ALLEN MELISSA , PIGOTT TERESA 
Published: January 2019

Background:
Religiosity has been linked to mental health outcomes for decades. This study examined the potential relationship between religiosity and demographic and clinical variables in a sample of psychiatric inpatients.

Methods:
In total, 688 adults admitted to an acute psychiatric facility with a primary mood or psychotic disorder completed the Duke University Religion Index (DUREL). The DUREL measures religious activity in 3 domains: organizational religious activity (ORA), nonorganizational religious activity (NORA), and intrinsic (or subjective) religiosity (IR). We categorized scores into high and low religiosity. Bivariate analyses with χ2 and independent sample t tests were used to examine the association between the DUREL subscales and demographic, clinical, and outcome measures. A generalized linear model was used to identify predictors of suicidality, psychosis, and 30-day rehospitalization.

Results:
Elevated religious activity was common in the inpatient sample, with 58% categorized as high IR, 43% as high NORA, and 36% as high ORA. For all 3 DUREL subscales, high religiosity scores were associated with significantly more psychosis (P<0.05) and significantly less suicidal ideation (P<0.001). High ORA (P=0.001) and high IR (P=0.01) were associated with significantly fewer suicide attempts. High ORA scores were also associated with an increased length of stay (P<0.05) and more frequent 30-day readmission rates (P=0.01). In the generalized linear model, predictors of lower levels of suicidality were high ORA, high IR, and a diagnosis of schizophrenia, schizoaffective disorder, or other psychotic disorder, whereas a diagnosis of depressive disorder was associated with greater suicidality. Predictors of psychosis were high IR and Hispanic ethnicity, whereas a diagnosis of depressive disorder was associated with lower rates of psychosis. Female inpatients were more likely than male inpatients to score high on the ORA (P<0.05), NORA (P<0.05), and IR (P<0.0001) subscales. In addition, a significant relationship was detected between age and high IR scores (P<0.005), with increasing age associated with higher IR scores.

Conclusions:
Although preliminary, these results suggest that a brief measure of religiosity may provide important information concerning clinical features and acute outcomes in patients hospitalized with serious mental illness.