bluuebunny/crossref_metadata_2025_split huggingface dataset:
High Altitude Alternobaric Facial Palsy: Case Series and Systematic Review of the Literature
Authors: Cumming Benjamin , Matchett Ian , Meller Catherine , Saxby Alexander 
Published: September 2019

Background:
Alternobaric facial palsy (AFP) is a rare phenomenon which occurs in patients with Eustachian tube dysfunction, a dehiscent facial canal, and subsequent compression induced ischemic neuropraxia of the facial nerve upon exposure to atmospheric pressure changes. There are few documented cases of AFP and most relate to underwater diving. There is limited understanding in the literature of AFP in the setting of high altitude, leading to a potential for misdiagnosis and inappropriate management.

Objective:
We present two cases of transient, recurrent, unilateral facial palsy at high altitude and perform a systematic review of the available literature.

Data Sources:
Full-text articles indexed to Medline, EMBase, and PubMed, and associated reference lists.

Data Extraction:
Data was extracted into standardized data extraction forms.

Data Synthesis:
Binomial proportions and Fischer's exact test were used to analyze sex distribution and relationship between sex and side of palsy, and number of episodes experienced.

Methods:
Systematic review using PRISMA guidelines with meta-analysis.

Results:
We identified 19 cases in the literature relating to AFP in patients at high altitude and present two new cases.

Conclusion:
AFP is an uncommon but important diagnosis. We present two cases and systematically review the literature to discuss the diagnosis and management of AFP.
Drivers of Hospital Length of Stay in Medicaid and Commercially Insured Mother-Infant Pairs With a Diagnosis of Neonatal Abstinence Syndrome
Authors: Parlett Lauren , Agiro Abiy , Brown Susan , Wilt Mary , Portzline Amy , Verburg Jacqueline , Shea Karen , DeVries Andrea 
Published: September 2019

Background:
The occurrence of neonatal abstinence syndrome (NAS) mirrors the growing opioid epidemic in the United States. As Medicaid covers a majority of cases, the commercially insured population has largely been ignored for NAS risk.

Objective:
The objective of this study was to examine Medicaid and commercially insured mother-infant pairs to determine demographic and clinical characteristics associated with NAS length of stay (LOS).

Research Design:
This observational, descriptive case-series study utilized administrative claims from HealthCore Integrated Research Database to measure maternal characteristics for 6 months before delivery, and neonatal characteristics and health care service utilization for 3 months after NAS diagnosis. Bootstrapped regressions were used to model LOS.

Results:
The sample included 1807 mother-infant pairs. Most infants (79%) had Medicaid coverage (Medicaid: N=1419; Commercial: N=388). Although all infants had NAS, Medicaid-insured mothers had more prevalent drug abuse (70.8% vs. 41.0%; P<0.0001), but fewer used prescription opioids (45.3% vs. 60.8%; P<0.0001) compared with commercially insured mothers. Commercially insured infants were sicker, with a higher prevalence of complex chronic conditions, and yet Medicaid-insured infants were admitted to neonatal intensive care unit at a much higher rate (91.1% vs. 78.9%; P<0.0001). After adjustment, neonatal intensive care unit admission (+6.7 d, 95% confidence interval: 4.5–9.3) and chronic complex conditions (+5.2 d, 95% confidence interval: 3.8–6.6) contributed most to LOS.

Conclusion:
A re-evaluation of obstetrical management towards a focus on the history of possible opioid and substance use regardless of insurance type and demographic background might inform efforts to reduce LOS.
Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients
Authors: Wasfy Jason H. , Bhambhani Vijeta , Healy Emma W. , Choirat Christine , Dominici Francesca , Wadhera Rishi K. , Shen Changyu , Wang Yun , Yeh Robert W. 
Published: September 2019

Importance:
Hospitals that serve poorer populations have higher readmission rates. It is unknown whether these hospitals effectively lowered readmission rates in response to the Hospital Readmissions Reduction Program (HRRP).

Objective:
To compare pre-post differences in readmission rates among hospitals with different proportion of dual-eligible patients both generally and among the most highly penalized (ie, low performing) hospitals.

Design:
Retrospective cohort study using piecewise linear model with estimated hospital-level risk-standardized readmission rates (RSRRs) as the dependent variable and a change point at HRRP passage (2010). Economic burden was assessed by proportion of dual-eligibles served.

Setting:
Acute care hospitals within the United States.

Participants:
Medicare fee-for-service beneficiaries aged 65 years or older discharged alive from January 1, 2003 to November 30, 2014 with a principal discharge diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia.

Main Outcome and Measure:
Decrease in hospital-level RSRRs in the post-law period, after controlling for the pre-law trend.

Results:
For AMI, the pre-post difference between hospitals that service high and low proportion of dual-eligibles was not significant (−65 vs. −64 risk-standardized readmissions per 10000 discharges per year, P=0.0678). For CHF, RSRRs declined more at high than low dual-eligible hospitals (−79 vs. −75 risk-standardized readmissions per 10000 discharges per year, P=0.0006). For pneumonia, RSRRs declined less at high than low dual-eligible hospitals (−44 vs. −47 risk-standardized readmissions per 10000 discharges per year, P=0.0003). Among the 742 highest penalized hospitals and all conditions, the pre-post decline in rate of change of RSRRs was less for high dual-eligible hospitals than low dual-eligible hospitals (−68 vs. −74 risk-standardized readmissions per 10000 discharges per year for AMI, −88 vs. −97 for CHF, and −47 vs. −56 for pneumonia, P<0.0001 for all).

Conclusions and Relevance:
For all hospitals, differences in pre-post trends in RSRRs varied with disease conditions. However, for the highest-penalized hospitals, the pre-post decline in RSRRs was greater for low than high dual-eligible hospitals for all penalized conditions. These results suggest that high penalty, high dual-eligible hospitals may be less able to improve performance on readmission metrics.
Platelet Transfusion Practice and Related Outcomes in Pediatric Extracorporeal Membrane Oxygenation*
Authors: Cashen Katherine , Dalton Heidi , Reeder Ron W. , Saini Arun , Zuppa Athena F. , Shanley Thomas P. , Newth Christopher J. L. , Pollack Murray M. , Wessel David , Carcillo Joseph , Harrison Rick , Dean J. Michael , Meert Kathleen L. 
Published: September 2019

Objective:
To describe factors associated with platelet transfusion during pediatric extracorporeal membrane oxygenation and the relationships among platelet transfusion, complications, and mortality.

Design:
Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.

Setting:
Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals.

Patients:
Age less than 19 years old and treated with extracorporeal membrane oxygenation.

Interventions:
None.

Measurements and Main Results:
Of 511 children, 496 (97.1%) received at least one platelet transfusion during extracorporeal membrane oxygenation. Neonatal age, venoarterial extracorporeal membrane oxygenation, and various acute and chronic diagnoses were associated with increased average daily platelet transfusion volume (milliliters per kilogram body weight). On multivariable analysis, average daily platelet transfusion volume was independently associated with mortality (per 1 mL/kg; odds ratio, 1.05; CI, 1.03–1.08; p < 0.001), whereas average daily platelet count was not (per 1 × 109/L up to 115 × 109/L; odds ratio, 1.00; CI, 0.98–1.01; p = 0.49). Variables independently associated with increased daily bleeding risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day, a primary cardiac indication for extracorporeal membrane oxygenation, adolescent age, and an acute diagnosis of congenital cardiovascular disease. Variables independently associated with increased daily thrombotic risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day and venoarterial extracorporeal membrane oxygenation. Variables independently associated with decreased daily thrombotic risk included full-term neonatal age and an acute diagnosis of airway abnormality.

Conclusions:
Platelet transfusion was common in this multisite pediatric extracorporeal membrane oxygenation cohort. Platelet transfusion volume was associated with increased risk of mortality, bleeding, and thrombosis.
A Multicenter Network Assessment of Three Inflammation Phenotypes in Pediatric Sepsis-Induced Multiple Organ Failure
Authors: Carcillo Joseph A. , Berg Robert A. , Wessel David , Pollack Murray , Meert Kathleen , Hall Mark , Newth Christopher , Lin John C. , Doctor Allan , Shanley Tom , Cornell Tim , Harrison Rick E. , Zuppa Athena F. , Reeder Ron W. , Banks Russell , Kellum John A. , Holubkov Richard , Notterman Daniel A. , Dean J. Michael 
Published: September 2019

Objectives:
Ongoing adult sepsis clinical trials are assessing therapies that target three inflammation phenotypes including 1) immunoparalysis associated, 2) thrombotic microangiopathy driven thrombocytopenia associated, and 3) sequential liver failure associated multiple organ failure. These three phenotypes have not been assessed in the pediatric multicenter setting. We tested the hypothesis that these phenotypes are associated with increased macrophage activation syndrome and mortality in pediatric sepsis.

Design:
Prospective severe sepsis cohort study comparing children with multiple organ failure and any of these phenotypes to children with multiple organ failure without these phenotypes and children with single organ failure.

Setting:
Nine PICUs in the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.

Patients:
Children with severe sepsis and indwelling arterial or central venous catheters.

Interventions:
Clinical data collection and twice weekly blood sampling until PICU day 28 or discharge.

Measurements and Main Results:
Of 401 severe sepsis cases enrolled, 112 (28%) developed single organ failure (0% macrophage activation syndrome 0/112; < 1% mortality 1/112), whereas 289 (72%) developed multiple organ failure (9% macrophage activation syndrome 24/289; 15% mortality 43/289). Overall mortality was higher in children with multiple organ and the phenotypes (24/101 vs 20/300; relative risk, 3.56; 95% CI, 2.06–6.17). Compared to the 188 multiple organ failure patients without these inflammation phenotypes, the 101 multiple organ failure patients with these phenotypes had both increased macrophage activation syndrome (19% vs 3%; relative risk, 7.07; 95% CI, 2.72–18.38) and mortality (24% vs 10%; relative risk, 2.35; 95% CI, 1.35–4.08).

Conclusions:
These three inflammation phenotypes were associated with increased macrophage activation syndrome and mortality in pediatric sepsis-induced multiple organ failure. This study provides an impetus and essential baseline data for planning multicenter clinical trials targeting these inflammation phenotypes in children.
Parental Conflict, Regret, and Short-term Impact on Quality of Life in Tracheostomy Decision-Making
Authors: October Tessie W. , Jones Amy H. , Greenlick Michals Hannah , Hebert Lauren M. , Jiang Jiji , Wang Jichuan 
Published: September 2019

Objectives:
The prevalence of tracheostomy-dependence in critically ill children is increasing in the United States. We do not know the impact of this decision on parental outcomes. We aimed to determine the prevalence of decisional conflict and regret and explore the impact on quality of life among parents considering tracheostomy placement for their child.

Subjects:
Parents facing tracheostomy decision for their child.

Design:
Prospective, mixed-methods longitudinal study.

Setting:
PICU, cardiac ICU, and neonatal ICU of a single quaternary medical center.

Interventions:
None.

Measurements and Main Results:
Parents completed a decisional conflict survey at the time of tracheostomy decision and decisional regret and quality of life surveys at 2 weeks and 3 months after the decision regarding tracheostomy placement was made. We enrolled 39 parents, of which 25 completed surveys at all three time points. Thirty-five of 39 (89.7%) reported at least some decisional conflict, most commonly from feeling uninformed and pressured to make a decision. At 2 weeks, 13 of 25 parents (52%) reported regret, which increased to 18 of 25 participants (72%) at 3 months. Regret stemmed from feeling uninformed, ill-chosen timing of placement, and perceptions of inadequate medical care. At 2 weeks, the quality of life score was in the mid-range, 78.8 (sd 13.8) and decreased to 75.5 (sd 14.2) at 3 months. Quality of life was impacted by the overwhelming medical care and complexity of caring for a child with a tracheostomy, financial burden, and effect on parent’s psychosocial health.

Conclusions:
The decision to pursue tracheostomy among parents of critically ill children is fraught with conflict with worsening regret and quality of life over time. Strategies to reduce contributing factors may improve parental outcomes after this life-changing decision.
Apneic Oxygenation As a Quality Improvement Intervention in an Academic PICU*
Authors: Napolitano Natalie , Laverriere Elizabeth K. , Craig Nancy , Snyder Megan , Thompson Allison , Davis Daniela , Nett Sholeen , Branca Aline , Harwayne-Gidansky Ilana , Sanders Ron , Shults Justine , Nadkarni Vinay , Nishisaki Akira 
Published: September 2019

Objectives:
To evaluate if the use of apneic oxygenation during tracheal intubation in children is feasible and would decrease the occurrence of oxygen desaturation.

Design:
Prospective pre/post observational study.

Setting:
A large single-center noncardiac PICU in North America.

Patients:
All patients less than 18 years old who underwent primary tracheal intubation from August 1, 2014, to September 30, 2018.

Interventions:
Implementation of apneic oxygenation for all primary tracheal intubation as quality improvement.

Measurements and Main Results:
Total of 1,373 tracheal intubations (661 preimplementation and 712 postimplementation) took place during study period. Within 2 months, apneic oxygenation use reached to predefined adherence threshold (> 80% of primary tracheal intubations) after implementation and sustained at greater than 70% level throughout the postimplementation. Between the preimplementation and postimplementation, no significant differences were observed in patient demographics, difficult airway features, or providers. Respiratory and procedural indications were more common during preintervention. Video laryngoscopy devices were used more often during the postimplementation (pre 5% vs post 75%; p < 0.001). Moderate oxygen desaturation less than 80% were observed in fewer tracheal intubations after apneic oxygenation implementation (pre 15.4% vs post 11.8%; p = 0.049); severe oxygen desaturation less than 70% was also observed in fewer tracheal intubations after implementation (pre 10.4% vs post 7.2%; p = 0.032). Hemodynamic tracheal intubation associated events (i.e., cardiac arrests, hypotension, dysrhythmia) were unchanged (pre 3.2% vs post 2.0%; p = 0.155). Multivariable analyses showed apneic oxygenation implementation was significantly associated with a decrease in moderate desaturation less than 80% (adjusted odds ratio, 0.55; 95% CI, 0.34–0.88) and with severe desaturation less than 70% (adjusted odds ratio, 0.54; 95% CI, 0.31–0.96) while adjusting for tracheal intubation indications and device.

Conclusions:
Implementation of apneic oxygenation in PICU was feasible, and was associated with significant reduction in moderate and severe oxygen desaturation. Use of apneic oxygenation should be considered when intubating critically ill children.
Laparoscopic Versus Open Left Lateral Segmentectomy for Large Hepatocellular Carcinoma: A Propensity Score–Matched Analysis
Authors: Fu Xiu-Tao , Tang Zheng , Shi Ying-Hong , Zhou Jian , Liu Wei-Ren , Gao Qiang , Ding Guang-Yu , Chen Jia-Feng , Song Kang , Wang Xiao-Ying , Fan Jia , Ding Zhen-Bin 
Published: September 2019

Background:
With the advancement of endoscopic technology, laparoscopic liver resection has become the standard procedure for left lateral segmentectomy. The aim of this study was to compare perioperative and oncological outcomes between laparoscopic and open left lateral segmentectomy for hepatocellular carcinoma (HCC) >5 cm.

Patients and Methods:
A total of 66 patients underwent left lateral segmentectomy for HCC (>5 cm) during the period spanning between 2013 and 2015. To overcome selection bias, 1:3 match using propensity score–matched analysis was performed between laparoscopic and open liver resection.

Results:
Relatively smaller tumor size (6.0 vs. 7.0 cm; P=0.030) and more frequent incidence of complete tumor capsule (93.3% vs. 58.8%; P=0.013) were observed in the laparoscopic group compared with the open group before matching. Although the longer operation time (195 vs. 150 min; P=0.022) was consumed in the laparoscopic procedure after matching, the laparoscopic group had shorter postoperative hospital stay (6 vs. 7 d; P=0.002) and less blood loss volume (50 vs. 100 mL; P=0.022). The Pringle maneuver for hepatic inflow occlusion was more likely to be applied in patients who underwent open surgery. The incidence of postoperative complication seemed to be lower in the laparoscopic group (6.7%) compared with that in the open group (11.8%) before matching. On the basis of propensity score–matched analysis, the complication rates were comparable between the 2 groups (7.1% vs. 6.7%, P=0.953). No difference in the 1-year and 3-year overall and recurrence-free survival rates was found between the laparoscopic and open groups.

Conclusion:
Laparoscopic left lateral segmentectomy for large HCC patients showed better perioperative outcomes and equivalent oncologic outcomes as the open procedure, providing evidence for considering as a standard laparoscopic practice through careful selection.
Association Between Colonic Diverticulosis and Colorectal Polyps, Advanced Neoplastic Lesions, and Colorectal Carcinomas: A Cross-Sectional, Retrospective Study
Authors: Tomaoglu Kamer 
Published: September 2019

Purpose:
The aim of the present study was to evaluate the association of diverticulosis with colorectal polyps, advanced neoplastic lesions (ANLs), and colorectal cancers (CRCs).

Methods:
The first-time colonoscopy records of 3496 patients were evaluated in this retrospective, cross-sectional cohort study. Data on clinical indications, presence of diverticulosis and diverticulitis, location of diverticula and polps, the size and number of polyps, and results of histopathologic examinations of polypectomies were noted. Categorical data were analyzed with χ2 test or the Fisher exact probability. P-values <0.05 (2 sided) were considered statistically significant. Statistical analyses were conducted with SPSS, version 18.

Results:
Of the 3496 patients, 1691 were male individuals (48.4%) and 1805 (51.6%) were female individuals. Diverticulosis was present in 12.6% of patients. A total of 870 polyps were detected in 716 patients. A total of 170 polyps (19.5%) were classified as ANLs. CRC was diagnosed in 112 (3.2%) patients. A significant relationship between diverticulosis and colorectal polyps (odds ratio: 1.99; 95% confidence interval: 1.59-0.2.48, P<0.001) was found. Similarly, adenomas and ANLs were more frequent in diverticulosis (P<0.05). There was no significant relationship between diverticulosis and CRCs (P=0.243).

Conclusions:
Adenomatous polyps and ANLs were more frequently observed in patients with diverticulosis, but no significant relationship was found between CRC and diverticulosis. The results of this retrospective cross-sectional study need to be confirmed by longitudinal prospective cohort studies.
Catechol-O-methyltransferase gene expression in stress-induced and non-stress induced schizophrenia
Authors: Aghamaleki-Sarvestani Ziba , Vousooghi Nasim , Tabrizi Mina , Alipour Mohammad Esmaeil , Alaghband-Rad Javad , Mostafavi-Abdolmaleky Hamid , Zarindast Mohammad Reza 
Published: September 2019

Introduction
As schizophrenia is a complex mental disorder and the outcome of gene-gene-environmental interactions, there are different possible pathophysiological mechanisms in different schizophrenia subtypes corresponding to various risk factors. This study was aimed at examining the impact of one of the most likely interactions, that is, ‘dopamine and stress’, in schizophrenia pathogenesis.

Methods
Here, we investigated the interaction between ‘war-related psychological trauma’ without brain trauma and catechol-O-methyltransferase gene. Using real-time PCR analysis we measured catechol-O-methyltransferase gene expression level in the blood cells of 66 male subjects in four groups, namely veteran schizophrenia patients as ‘stress-exposed schizophrenia’ (S-schizophrenia), their healthy brothers as ‘their genetically closest relatives’ (S-siblings), schizophrenia patients without any history of significant stress as ‘non-stress-exposed schizophrenia’ (NoS-schizophrenia), and the control group. The results were analyzed by Relative Expression Software Tool 2009 software.

Results
The catechol-O-methyltransferase gene expression was not significantly different between the S-schizophrenia and NoS-schizophrenia groups. However, compared to the control group, the catechol-O-methyltransferase expression was significantly decreased in three groups of S-schizophrenia, their healthy siblings, and NoS-schizophrenia patients.

Conclusion
This data supports that reduced blood catechol-O-methyltransferase expression, which may be associated with higher dopamine level, is involved both in stress-induced and non-stress–induced schizophrenia.