bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unintentional Opioid Ingestions Presenting to a Pediatric Emergency Department
Authors: Ghosh Pallavi , Pruitt Christopher , Shah Nipam , Kulkarni Abhay , Slattery Ann , Nichols Michele 
Published: January 2019

Objectives
The purpose of this study was to describe unintentional opioid exposures in young children, including demographics, medical interventions, and clinical outcomes.

Methods
This was a retrospective, cross-sectional study of children 0 to 6 years of age with possible opioid exposure over a 3-year period (July 2010 to June 2013). Data collected included sex, age, specific drug, whether they were referred to the emergency department (ED) by the Regional Poison Control Center, presence of symptoms, therapeutic interventions, ED disposition, and clinical outcomes for admitted patients.

Results
Median age of patients included in the study was 2 years, and 64% of these children were male. The most common drug of exposure was buprenorphine/naloxone. Of the 429 charts screened, 140 patients were reported to be symptomatic and referred to the ED, of which 113 patients actually presented to the ED. An additional 122 patients presented to the ED without Regional Poison Control Center referral. Of the total 235 patients presenting to ED, 76 (32%) received a therapeutic intervention. Of 231 total opioid exposures, 31 exposures were administered naloxone. Three children underwent endotracheal intubation. Sixty-five patients were hospitalized, with a median length of stay of 1 day. Although there were no fatalities, 1 child suffered severe morbidity (anoxic brain injury).

Conclusions
While opioid exposures in young children are a common and potentially life-threatening problem, most children remain asymptomatic. The majority of patients are able to be discharged from the ED after observation, and of those who are admitted, most have favorable outcomes and brief hospital stays. A small number of these patients require considerable medical interventions.
Patterned Bruises From Abusive Squeezing
Authors: Petska Hillary W. , Frasier Lori D. , Livingston Nina , Moles Rebecca , Sheets Lynn K. 
Published: January 2019

Abstract
Bruising is the most common presentation of child physical abuse. Many patterns of abusive bruising result in positive or negative imprints of the implement used (eg, fingertips in “grab mark” contusions or hand in slap injury). However, bruising may also form along the lines of greatest anatomical stress (eg, gluteal cleft or pinna bruising). Bruising due to abusive squeezing also forms along lines of greatest anatomical stress, resulting in a negative imprint of the flexural folds of the hand. Four cases of children with this unique pattern of bruising due to abusive squeezing are presented. Recognition of these bruises as inflicted represents an opportunity for early identification and intervention in cases of child physical abuse.
Delayed Subaponeurotic Fluid Collections
Authors: Stephan Alexander M. , Feldman Kenneth W. , Otjen Jeffrey P. , Metz James B. 
Published: January 2019

Abstract
Delayed subaponeurotic fluid collections (DSFCs) are a recently described cause of idiopathic scalp swelling in young infants. Associated with traumatic birth and the use of vacuum-assisted devices or fetal scalp electrodes, DSFCs can be differentiated from similar causes of neonatal scalp swelling based on characteristic history and physical examination findings. In this article, we highlight 2 cases of young infants presenting to a pediatric emergency department with large, fluctuant scalp swellings, which were appropriately diagnosed as DSFCs; clinical data on an additional eight cases are presented in table format. In cases of isolated DSFCs in otherwise well-appearing infants, further laboratory work, imaging, subspecialty consultation, and child abuse investigation is not necessary. Recommendations for the diagnosis and management of DSFCs presented reflect the clinical experience of the authors in conjunction with a review of the available medical literature on this topic.
Craniocervical Dissociation in Pediatric Patients
Authors: Hazboun Rajaie , Muñoz Amanda , Krafft Paul R. , Harder Sheri , Vannix Rosemary , Zouros Alexander , Kim Paggie , Baerg Joanne 
Published: January 2019

Aims
The aims of this study were to document the injury pattern in pediatric traumatic craniocervical dissociation (CCD) and identify features of survivors.

Methods
Pediatric traumatic CCDs, diagnosed between January 2004 and July 2016, were reviewed. Survivors and nonsurvivors were compared. Categorical and continuous variables were analyzed with Fisher exact and t tests, respectively.

Results
Twenty-seven children were identified; 10 died (37%). The median age was 60 months (ranges, 6–109 months [survivors], 2–98 months [nonsurvivors]). For survivors, the median follow-up was 13.4 months (range, 1–109 months). The median time to mortality was 1.5 days (range, 1–7 days). The injury modality was motor vehicle collision in 18 (67%), pedestrian struck in 8 (30%), and 1 shaken infant (3%). For nonsurvivors, CCD was equally diagnosed by plain radiograph and head/cervical spine computed tomography scan. For survivors, CCD was diagnosed by computed tomography in 7 (41%), magnetic resonance imaging in 10 (59%), and none by radiograph. Seven diagnosed by magnetic resonance imaging (41%) had nondiagnostic initial imaging but persistent neck pain. Magnetic resonance imaging was obtained and was diagnostic of CCD in all 7 (P < 0.01). Survivors required significantly less cardiopulmonary resuscitation (P < 0.01), had lower Injury Severity Scores (P < 0.01), higher Glasgow Coma Scale scores (P < 0.01), and shorter transport times (P < 0.01). Significantly more involved in motor vehicle collisions survived (P = 0.04). Nine (53%) had no disability at follow-up evaluation.

Conclusions
In pediatric CCD, high-velocity mechanism, cardiac arrest, high Injury Severity Score, and low Glasgow Coma Scale score are associated with mortality. If CCD is correctly managed in the absence of cardiac arrest or traumatic brain or spinal cord injury, children may survive intact.
A Frosty Challenge
Authors: Bréhin Camille , Cortey Caroline , Claudet Isabelle 
Published: January 2019

Background
We report a case of geometrical skin lesions in a teenage patient.

Case
A previously healthy 14-year-old boy presented in our pediatric emergency department with unusual skin lesions on his left forearm. The patient said the lesions started 2 weeks earlier following a spider bite. His physical examination revealed an otherwise healthy child with no medical history with raised square lesions of the left forearm. The lesions were in different stages of healing and resembled second-degree burns. Examination showed no other lesions. Vital signs were normal. The patient was discharged after the lesions were dressed with antibiotic ointment. A follow-up consultation was scheduled a week later, but the patient did not attend the follow-up consultation. A senior emergency physician called the family and learned that the lesions were progressively healing and no other lesions appeared. The teen admitted he played the “salt and ice challenge.”

Discussion
The salt and ice challenge involves putting salt on the skin and then applying and/or pressing ice cubes on top of the salt. The challenge is to resist the pain consecutive to frostbite for as long as possible. The result is often second-degree burns and possible partial third-degree burns.

Conclusions
Because of the current popularity of this practice, emergency or family physicians, pediatricians, dermatologists, and burn or orthopedic surgery units might encounter these injuries. When young patients present with geometrical burn injuries and unexplained or bizarre circumstances, self-inflicted burn “challenges” should be considered.
Trends in Emergent Head Computed Tomography Utilization for Minor Head Trauma After Implementation of a Clinical Pathway
Authors: Corwin Daniel J. , Durbin Dennis R. , Hayes Katie L. , Zonfrillo Mark R. 
Published: January 2019

Objective
The aims of this study were to evaluate trends over time in computed tomography (CT) scan utilization after implementation of a clinical pathway in a tertiary care children's hospital emergency department (ED), to determine how ED throughput differs by CT utilization, and to determine provider reasoning for obtaining head CT in low-risk patients.

Methods
This was a retrospective cohort study of patients 21 years or younger discharged from our ED with head trauma (Glasgow Coma Scale score ≥13 and a head trauma International Classification of Diseases code) over a 5-year period, starting 1 year after pathway implementation (January 2012 to December 2016). A manual chart review of 10% of patients who received a CT was performed to determine reasoning for CT utilization and guideline compliance.

Results
In total, 6.3% (95% confidence interval [CI], 5.9%–6.6%) of 21,129 discharged patients received a head CT, decreasing annually by an average of 0.9%. Pediatricians were more likely to obtain a CT than pediatric emergency medicine physicians after adjusting for acuity (odds ratio, 1.37; 95% CI, 1.02–1.82). Those who received a CT stayed 90 minutes longer (95% CI, 79–101 minutes) than those who did not after propensity score matching. Thirty percent of patients who received a CT in our manual chart review met low-risk Pediatric Emergency Care Applied Research Network criteria.

Conclusions
Head CT rates in patients with minor head trauma consistently decreased each year after guideline implementation. Children who received head CT did not have prolonged lengths of stay compared with those who did not. A minority of patients who received a CT and were discharged met low-risk criteria by standardized guidelines.
Clinical Features and Biomarkers Suggestive of Bloodstream Infection in Pediatric Patients With Intestinal Failure and Central Venous Lines for Parenteral Nutrition
Authors: Fischer Jason B. , Sturza Julie , Kim Zio , Lopez M. James , Rogers Alexander J. 
Published: January 2019

Objectives
This study aimed to describe demographic, clinical, and laboratory values in febrile pediatric intestinal failure patients with indwelling central venous catheters presenting to the emergency department to determine if there are low-risk features predictive of negative blood cultures that could help identify a subset that do not need hospitalization and/or broad-spectrum antibiotics.

Methods
We conducted a retrospective cohort study of febrile patients younger than 18 years with diagnosis of intestinal failure requiring a central venous catheter for home parenteral nutrition to identify factors associated with normal blood cultures to identify a low-risk subset.

Results
Of 119 encounters, 46% had a bloodstream infection. Children with a bloodstream infection were older than those without. A normal lactate and heart rate were associated with negative blood cultures.

Conclusion
Pediatric intestinal failure patients with a central venous catheter for home parenteral nutrition presenting to the emergency department with fever and found to have a normal lactate and heart rates had lower rates of bloodstream infection. Although we were unable to create a highly sensitive clinical decision-making rule to identify a low-risk cohort because of the low number of patients meeting both criteria, the promising candidate variables identified merit for future multicenter studies.
Degree of Agreement between Electrodiagnostic Testing and Magnetic Resonance Imaging in the Evaluation of Brachial Plexopathy
Authors: Kang Seok , Yoon Joon Shik , Hong Suk-Joo , Yang Seung Nam 
Published: January 2019

Objective
Electrodiagnostic study (EDX) and magnetic resonance imaging (MRI) are commonly used in the diagnosis of brachial plexopathy, but the agreement between these 2 studies is unknown. The aim of this study was to evaluate the agreement of EDX and MRI in patients with brachial plexopathy.

Design
The records of 69 patients with symptoms of brachial plexopathy who underwent EDX and MRI were reviewed. Based on the degree of agreement of EDX and MRI results, patients were classified as a “complete match,” “partial match,” or “mismatch.”

Results
Both studies yielded similar results for the majority of patients (63.2%). Among the enrolled patients, 26.4% were classified as a “complete match,” 36.8% as “partial match,” and 36.8% as “mismatch.” However, only 1 test, either EDX or MRI, revealed abnormal findings in 21.1% of patients.

Conclusions
The agreement between EDX and MRI was high in patients with brachial plexopathy. However, only one of these tests, not both, revealed abnormal findings in several cases. Although both EDX and MRI were in accord with the diagnosis of brachial plexopathy in majority of cases, these 2 studies remain complementary diagnostic modalities for evaluating brachial plexopathies.
Latin American and Caribbean consensus on noninvasive central nervous system neuromodulation for chronic pain management (LAC2-NIN-CP)
Authors: Baptista Abrahão Fontes , Fernandes Ana Mércia B.L. , Sá Katia Nunes , Okano Alexandre Hideki , Brunoni André Russowsky , Lara-Solares Argelia , Jreige Iskandar Aziza , Guerrero Carlos , Amescua-García César , Kraychete Durval Campos , Caparelli-Daquer Egas , Atencio Elias , Piedimonte Fabián , Colimon Frantz , Hazime Fuad Ahmed , Garcia João Batista S. , Hernández-Castro John Jairo , Cantisani José Alberto Flores , Karina do Monte-Silva Kátia , Lemos Correia Luis Claudio , Gallegos Manuel Sempértegui , Marcolin Marco Antonio , Ricco María Antonieta , Cook María Berenguel , Bonilla Patricia , Schestatsky Pedro , Galhardoni Ricardo , Silva Valquíria , Delgado Barrera William , Caumo Wolnei , Bouhassira Didier , Chipchase Lucy S. , Lefaucheur Jean-Pascal , Teixeira Manoel Jacobsen , de Andrade Daniel Ciampi 
Published: January 2019

Abstract

Introduction:
Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP.

Objective:
To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice.

Methods:
Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study.

Results:
The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain.

Conclusion:
Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.
Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care
Authors: Péculo-Carrasco Juan-Antonio , Rodríguez-Bouza Mónica , Casal-Sánchez María-del-Mar , de-la-Fuente-Rodríguez José-Manuel , Puerta-Córdoba Antonio , Rodríguez-Ruiz Hugo-José , Sánchez-Almagro César-Pedro , Failde Inmaculada 
Published: January 2019

Objective
The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the “061” phone number.

Methods
This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. A questionnaire was designed after focus groups with patients, witnesses, and professionals. It consisted of 10 items, with Likert-type answers, and a range of 0 to 50 points. In addition to basic criteria (frequency of endorsement and ability to discriminate between groups), their validity (content and construct) and reliability (stability and homogeneity) were evaluated. Stability was evaluated by test-retest and homogeneity by means of two properties: internal consistency of items (corrected item-scale correlation coefficient) and internal consistency of the scale (Cronbach α coefficient).

Results
A total of 849 questionnaires were obtained, with scores between 0 and 50 points, with an average of 47.31 (median of 50). The exploratory factor analysis detected a component that explained 61.1% of the total variance. The intraclass correlation coefficient was 0.933 with 95% confidence interval between 0.900 and 0.954. The corrected item-scale correlation coefficient was greater than 0.596, and the Cronbach α coefficient was 0.927 (95% confidence interval, 0.919–0.934).

Conclusions
The ESPT10 Witness Perceived Safety Scale is valid and reliable for quantifying the safety perception of witnesses of emergency assistance and transfers.
Prosthetic joint infections: clinical management, diagnosis, and treatment
Authors: Bassetti Matteo , Castaldo Nadia , Cadeo Barbara , Carnelutti Alessia 
Published: January 2019

Purpose of review
Prosthetic joint infections (PJIs) represent one of the most disastrous complications in prosthetic surgery, requiring long hospitalization, prolonged antimicrobial treatment and repeated surgical interventions. No gold standard test to formulate diagnosis exist. A combination of high index of suspicion, physical examination, microbiological and biohumoral investigations is required. Therapeutical approach should be based on a multidisciplinary team. In our center, a two-stage approach is preferred. As regards the choice of the empirical antibiotic backbone, individual risk factors for multiple-drug resistant (MDR) pathogens should be considered. Several studies enhance the possibility to shorten the length of antibiotic couses.

Recent findings
Some interesting improvements have been made in the setting of PJIs management. As regards diagnosis, novel biomarkers and nuclear imaging are acquiring more importance. Molecular biology techniques also offer the possibility to formulate rapid microbiological identification. The pattern of PJIs is evolving towards higher rates of MDR causes. During the last decade, a number of new antibiotic molecules with activity against MDRs have been approved. Some of them are also available either in oral formulation or as long-acting compounds, offering the opportunity for early patient's discharge, with expected healthcare costs saving.

Summary
Management of PJIs still represents a major threat for clinicians. Improvements in surgical techniques and antibiotic pipeline promise to revolutionize the approach in next years. Despite data from our experience confirm the efficacy of shorter antibiotic courses and the value of new molecules, randomized clinical trials are lacking. More data are needed in order to modify the routine clinical practice.
The evolving burden of viruses in pneumonia
Authors: Brenner Nicole R. , Shorr Andrew F. 
Published: January 2019

Purpose of review
To describe the evolving microbiology of various forms of pneumonia and the importance of viruses as etiologic causes of pneumonia.

Recent findings
Multiple studies utilizing novel diagnostic modalities demonstrate that the prevalence of viruses as causes for pneumonia varies from approximately 10–30% depending on the specific pneumonia type evaluated. Viral pneumonias appear similar in presentation and severity of illness to bacterial causes of pulmonary infection. Clinical criteria do not reliably allow the differentiation of viral from bacterial causes in pneumonia.

Summary
Viruses represent a pool of important culprit organisms in pneumonia and identification of a viral pathogen may facilitate attempts at antibiotic stewardship.
Longitudinal Visualization of Viable Cancer Cell Intratumoral Distribution in Mouse Models Using Oatp1a1-Enhanced Magnetic Resonance Imaging
Authors: Nyström Nivin N. , Hamilton Amanda M. , Xia Wenyao , Liu Shirley , Scholl Timothy J. , Ronald John A. 
Published: January 2019

Objectives
Multimodality reporter gene imaging provides valuable, noninvasive information on the fate of engineered cell populations. To complement magnetic resonance imaging (MRI) measures of tumor volume and 2-dimensional reporter-based optical measures of cell viability, reporter-based MRI may offer 3-dimensional information on the distribution of viable cancer cells in deep tissues.

Materials and Methods
Here, we engineered human and murine triple-negative breast cancer cells with lentivirus encoding tdTomato and firefly luciferase for fluorescence imaging and bioluminescence imaging (BLI). A subset of these cells was additionally engineered with lentivirus encoding organic anion transporting polypeptide 1a1 (Oatp1a1) for MRI. Oatp1a1 operates by transporting gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) into cells, and it concomitantly improves BLI substrate uptake. After orthotopic implantation of engineered cells expressing or not expressing Oatp1a1, longitudinal fluorescence imaging, BLI, and 3-Tesla MRI were performed.

Results

Oatp1a1-expressing tumors displayed significantly increased BLI signals relative to control tumors at all time points (P < 0.05). On MRI, post–Gd-EOB-DTPA T
1-weighted images of Oatp1a1-expressing tumors exhibited significantly increased contrast-to-noise ratios compared with control tumors and precontrast images (P < 0.05). At endpoint, tumors expressing Oatp1a1 displayed intratumoral MR signal heterogeneity not present at earlier time points. Pixel-based analysis of matched in vivo MR and ex vivo fluorescence microscopy images revealed a strong, positive correlation between MR intensity and tdTomato intensity for Oatp1a1-expressing tumors (P < 0.05), but not control tumors.

Conclusions
These results characterize Oatp1a1 as a sensitive, quantitative, positive contrast MRI reporter gene for 3-dimensional assessment of viable cancer cell intratumoral distribution and concomitant BLI enhancement. This multimodality reporter gene system can provide new insights into the influence of viable cancer cell intratumoral distribution on tumor progression and metastasis, as well as improved assessments of anticancer therapies.
FDG PET/CT Findings of a Synovial Sarcoma in a Renal Transplant
Authors: Yang Xu , Wang Wei , Kan Ying , Liu Jie , Yang Jigang 
Published: January 2019

Abstract
A 48-year old man who underwent renal transplantation 2 years ago due to chronic renal failure underwent FDG PET/CT to determine the etiology of multiple lesions in the renal transplant incidentally found on routine examination. The images demonstrated several foci of the abnormally increased activity in the transplanted kidney with SUVmax of 7.5. Surgical pathology demonstrated multiple synovial sarcoma in the transplanted kidney.