bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ideal and Actual Impact of Rapid Diagnostic Testing and Antibiotic Stewardship on Antibiotic Prescribing and Clinical Outcomes in Children With Positive Blood Cultures
Authors: Reuter Caroline H. , Palac Hannah L. , Kociolek Larry K. , Zheng Xiaotian T. , Chao Yusuf Y. , Patel Rupal M. , Patel Sameer J. 
Published: May 2018

Background:
Implementing matrix-assisted laser desorption ionization–time of flight and multiplex polymerase chain reaction has been associated with decreased mortality and hospital length of stay in adults, but the impact in pediatrics is less understood.

Methods:
This pre–post quasi-experimental study compared antibiotic prescribing for positive blood cultures in patients ≤21 years of age collected in 2012 (preintervention) and in 2015 (after matrix-assisted laser desorption ionization–time of flight/multiplex polymerase chain reaction). Time to effective and optimal antimicrobial therapy was evaluated using Cox proportional hazards regression. Time to ideal optimal therapy was estimated as the earliest potential initiation of optimal therapy. Antibiotic use and clinical outcomes were measured.

Results:
There were 242 and 192 positive monomicrobial blood cultures in 2012 and 2015, respectively. Postintervention, time to optimal therapy (73.8 vs. 48.8 hours; P < 0.001) and organism identification (55.6 vs. 29.5 hours; P < 0.001) were reduced, and patients were more likely to receive optimal therapy by 7 days (hazard ratio, 1.85; P < 0.001). In the ideal scenario in 2015, there was an 8.8-hour delay in initiating optimal therapy based on the time that sufficient microbiologic data were available. Postintervention, time to effective therapy (2.8 vs. 2.7 hours; P = 0.782) and clinical outcomes did not differ. Unnecessary antibiotic duration for probable contaminants (skin flora) (43.1 vs. 29.7 hours; P = 0.027), vancomycin for methicillin-sensitive Staphylococcus aureus (54.0 vs. 41.3 hours; P = 0.008) and nonpenicillin/ampicillin antibiotics for group A Streptococcus, group B Streptococcus and Enterococcus faecalis (87.2 vs. 33.4 hours; P < 0.001) were reduced postintervention.

Conclusions:
Rapid diagnostics reduced time to optimal antimicrobial therapy and unnecessary antibiotic use without worse clinical outcomes.
NALCN channels enhance the intrinsic excitability of spinal projection neurons
Authors: Ford Neil C. , Ren Dejian , Baccei Mark L. 
Published: May 2018

Abstract
Spinal projection neurons convey nociceptive signals to multiple brain regions including the parabrachial (PB) nucleus, which contributes to the emotional valence of pain perception. Despite the clear importance of projection neurons to pain processing, our understanding of the factors that shape their intrinsic membrane excitability remains limited. Here, we investigate a potential role for the Na+ leak channel NALCN in regulating the activity of spino-PB neurons in the developing rodent. Pharmacological reduction of NALCN current (INALCN), or the genetic deletion of NALCN channels, significantly reduced the intrinsic excitability of lamina I spino-PB neurons. In addition, substance P (SP) activated INALCN in ascending projection neurons through downstream Src kinase signaling, and the knockout of NALCN prevented SP-evoked action potential discharge in this neuronal population. These results identify, for the first time, NALCN as a strong regulator of neuronal activity within central pain circuits and also elucidate an additional ionic mechanism by which SP can modulate spinal nociceptive processing. Collectively, these findings indicate that the level of NALCN conductance within spino-PB neurons tightly governs ascending nociceptive transmission to the brain and thereby potentially influences pain perception.
A Simple Tool Using AM-PAC “6-Clicks” to Measure Value Added in Acute Care Physical Therapy: The Therapy Value Quotient
Authors: Hull Brian L. , Thut M. Cathy 
Published: May 2018

Background and Purpose:
Acute physical therapy practitioners and leaders continue to search for a practical method to measure value. The purpose of this case report is to introduce the Therapy Value Quotient and its simple yet effective use of Activity Measure for Post-Acute Care Inpatient Mobility Short Form, also known as “6-Clicks,” and common payroll data to measure changes in value added to patient care.

Case Description:
Health care service value should be measured by outcomes produced divided by the cost of services to produce those outcomes. Although acute physical therapy practice continues to progress toward consistent outcome measurement, widespread application of outcomes to quantify value is rare. This lack of value measurement leaves acute care practitioners' value measured primarily in terms of how many units or visits a therapist can code in a certain number of hours worked. Unfortunately, quantities of units or visits are not synonymous with value. Acute care managers and practitioners need a viable and easy-to-use tool that requires minimal data entry and uses existing, easily accessible payroll and electronic health record data.

Outcomes:
The goal of this project was to create a value calculation with commonly used systems (payroll, electronic health record) data and Activity Measure for Post-Acute Care Inpatient Mobility Short Form data to quantify value. Minimizing manual data entry decreases errors and improves real-time calculations. The purposely minimized design of the equation allows clinicians and managers freedom to create highest-value processes that achieve the maximal value added.

Discussion:
The Therapy Value Quotient can help managers and clinicians investigate and measure value-adding tactics while improving care delivery and efficiency instead of simply increasing the number of procedures per hour worked.
Structural brain abnormalities in Cushing's syndrome
Authors: Bauduin Stephanie E.E.C. , van der Wee Nic J.A. , van der Werff Steven J.A. 
Published: May 2018

Purpose of reviewAlongside various physical symptoms, patients with Cushing's disease and Cushing's syndrome display a wide variety of neuropsychiatric and cognitive symptoms, which are indicative of involvement of the central nervous system. The aim of this review is to provide an overview of the structural brain abnormalities that are associated with Cushing's disease and Cushing's syndrome and their relation to behavioral and cognitive symptomatology.Recent findingsIn this review, we discuss the gray matter structural abnormalities found in patients with active Cushing's disease and Cushing's syndrome, the reversibility and persistence of these changes and the white matter structural changes related to Cushing's syndrome. Recent findings are of particular interest because they provide more detailed information on localization of the structural changes as well as possible insights into the underlying biological processes.SummaryActive Cushing's disease and Cushing's syndrome is related to volume reductions of the hippocampus and in a prefrontal region involving the anterior cingulate cortex (ACC) and medial frontal gyrus (MFG). Whilst there are indications that the reductions in hippocampal volume are partially reversible, the changes in the ACC and MFG appear to be more persistent. In contrast to the volumetric findings, changes in white matter connectivity are typically widespread involving multiple tracts.
Prevalence and incidence of hepatitis delta in patients with chronic hepatitis B in Spain
Authors: Aguilera Antonio , Trastoy Rocio , Rodríguez-Calviño Javier , Manso Tamara , de Mendoza Carmen , Soriano Vicente 
Published: May 2018

Background
Hepatitis delta virus (HDV) is a defective agent that only replicates in the presence of the hepatitis B virus. Accordingly, HDV acquisition may occur as superinfection of HBsAg+ carriers or following acute dual HDV and hepatitis B virus exposure. Herein, we examined the global and incident rates of HDV infections in Spain.

Patients and methods
The presence of anti-HDV antibody and new HDV superinfections was examined in all HBsAg+ patients who attended one large tertiary outclinic in Spain since year 2000. Anti-HDV antibodies were tested repeatedly every 5 years in those previously negative.

Results
During a median follow-up of 12 years, 478 individuals were diagnosed as HBsAg+. Overall, 64.4% were male, median age was 55 years, 88.1% were native Spaniards, 6.5% were coinfected with HIV, and 7.3% were reactive for hepatitis C virus (HCV) antibodies.
A total of 19 (4%) patients had anti-HDV antibody at first diagnosis. There were no further HDV seroconversions. Most anti-HDV+ patients were male (n=12), former injection drug users (n=13), and native Spaniards (n=16). Coinfection with HIV was found in six, and 12 had HCV antibodies. Interestingly, three of seven women with delta hepatitis were foreigners (Asian or African), denied injection drug use, were younger than 40 years old, and negative for both HCV and HIV.

Conclusion
The prevalence of chronic hepatitis delta is currently very low (<5%) among chronic HBsAg+ carriers in Spain, with lower rates in recent years. Moreover, new incident HDV infections were not seen in 478 chronic hepatitis B carriers since year 2000, following drastic declines in injection drug use.
Recommendations for Diagnosis and Management of Autoimmune Pancreatitis in Childhood
Authors: Scheers Isabelle , Palermo Joseph J. , Freedman Steven , Wilschanski Michael , Shah Uzma , Abu‐El‐Haija Maisam , Barth Bradley , Fishman Douglas S. , Gariepy Cheryl , Giefer Matthew J. , Heyman Melvin B. , Himes Ryan W. , Husain Sohail Z. , Lin Tom K. , Liu Quin , Lowe Mark , Mascarenhas Maria , Morinville Veronique , Ooi Chee Y. , Perito Emily R. , Piccoli David A. , Pohl John F. , Schwarzenberg Sarah J. , Troendle David , Werlin Steven , Zimmerman Bridget , Uc Aliye , Gonska Tanja 
Published: May 2018

ABSTRACTObjectives:Autoimmune pancreatitis (AIP) represents a complex immune‐mediated pancreas disorder. Pediatric AIP (P‐AIP) is rare. We have recently summarized the characteristic features of P‐AIP. We now aim to develop recommendation statements to standardize the diagnostic and therapeutic approach to P‐AIP and facilitate future research in the field.Methods:A panel of pediatric gastroenterologists participating in the International Study Group of Pediatric Pancreatitis: In search for a cuRE was formed to discuss and then vote on 15 recommendation statements. A consensus of at least 80% was obtained following 3 voting rounds and revision of the statements.Results:We have now generated 15 statements to help standardize the approach to diagnosis and management of P‐AIP.Conclusions:The first P‐AIP recommendation statements developed by the International Study Group of Pediatric Pancreatitis: In search for a cuRE group are intended to bring standardization to the diagnosis and treatment of this rare childhood disorder. These statements may help guide a uniform approach to patient care and facilitate future research studies.
Cognitive Profile of Children With Intracranial Germ Cell Tumor According to Tumor Location
Authors: Coutinho Virginie , Dellatolas Georges , Castaignede-Lalande Clemence , Longaud-Vales Audrey , Kieffer Virginie , Guerrini-Rousseau Lea , Grill Jacques , Valteau-Couanet Dominique , Dufour Christelle 
Published: May 2018

Purpose:
The purpose of this study was to evaluate the long-term cognitive sequelae and to describe the neuropsychological profile of patients with intracranial germ cell tumors according to tumor location (pineal or suprasellar site).

Patients and Methods:
Forty-five children treated at Gustave Roussy between 1991 and 2010 were assessed with neuropsychological tests to measure IQ, memory, visuospatial, motor, and executive skills at a mean delay of 4.2 years after diagnosis. All patients have received chemotherapy associated with surgery in 17 cases. Thirty-nine patients received, radiotherapy (focal 27, focal plus ventricles 8, craniospinal 4). Twenty-three patients had 2 IQ assessments with a mean delay of 4.1 years between the first and second.

Results:
Full scale IQ was preserved, with higher verbal IQ than other IQ indexes. Visuospatial, fine-motor, and executive difficulties were present in a significant proportion of patients. Visuospatial and fine-motor deficits were significantly associated with oculomotor difficulties, more present in the pineal than in the suprasellar group. No cognitive decline was observed between the first and the second IQ assessment.

Conclusions:
Overall cognitive abilities were preserved in children treated for central nervous system germ cell tumor.
Hemophagocytic Lymphohystiocytosis Associated With Type Ia Glycogen Storage Disease
Authors: Düzenli Kar Yeter , Özdemir Zeynep C. , Kiral Eylem , Kiliç Yildirim Gonca , Dinleyici Ener Ç. , Bör Özcan 
Published: May 2018

Background:
Hemophagocytic lymphohystiocytosis (HLH) is characterized by fever, splenomegaly, pancytopenia, and elevated levels of triglycerides and ferritin. These signs and symptoms are common to other metabolic diseases.

Observation:
A 5-month-old female infant, who presented with fever, respiratory distress, massive hepatomegaly, and bicytopenia, was diagnosed as having HLH and chemotherapy was initiated. The patient was negative for familial HLH gene mutations. Respiratory distress and laboratory findings improved rapidly after starting chemotherapy. However, there was no improvement in the massive hepatomegaly and she experienced hypoglycemic episodes. In addition, her family history included a cousin with glycogen storage disease (GSD). On the basis of the findings, the patient was diagnosed as having type Ia GSD. There are no previous reports of HLH secondary to GSD type Ia in the literature.

Conclusions:
Congenital metabolic diseases should be considered in the differential diagnosis of children with HLH.
Adherence to American Cancer Society Guidelines on Nutrition and Physical Activity in Female Cancer Survivors
Authors: Park So-Hyun , Knobf M. Tish , Kerstetter Jane , Jeon Sangchoon 
Published: May 2018

Background
The American Cancer Society (ACS) publishes guidelines on nutrition and physical activity to minimize health risks in cancer patients and survivors. Studies show that high adherence to such guidelines is associated with a decrease in overall cancer incidence and mortality. However, there are sparse data on adherence to the ACS guidelines in cancer survivors.

Objective
The aim of this study was to describe adherence to the ACS guidelines in female cancer survivors who participated in an exercise intervention trial for 1 year.

Methods
Perimenopausal and early postmenopausal female cancer survivors (n = 154) participated in a randomized controlled trial that examined the efficacy of an aerobic-resistance exercise intervention. In addition to body mass index and alcohol, diet and physical activity data were collected with 4-day diet records and the International Physical Activity Questionnaire. A scoring system was used to determine adherence to the ACS guidelines, with scores ranging from 0 (no adherence) to 8 (highest adherence).

Results
Mean total adherence scores for ACS guidelines for all intervention and control condition participants, most of whom had breast or gynecological cancers, were 4.2 (baseline), 4.9 (6 months), and 4.8 (12 months), suggesting moderate adherence. Physical activity levels improved in both groups; however, no significant change was observed for adherence to weight, dietary, or alcohol intake guidelines for either group.

Conclusion
Findings indicate only partial adherence to the ACS guidelines, even for motivated cancer survivors participating in an exercise intervention study.

Implications for Practice
Further research is needed regarding strategies and interventions to improve adherence to ACS guidelines.
Management and Outcome of Pediatric Patients With Transient Small Bowel–Small Bowel Intussusception
Authors: Melvin Jennifer E. , Zuckerbraun Noel S. , Nworgu Chijindu R. , Mollen Kevin P. , Furtado Andre D. , Manole Mioara D. 
Published: May 2018

Objective
The aim of this study was to assess the management and outcomes of healthy pediatric patients diagnosed radiologically with transient and benign small bowel–small bowel intussusception (SB-SBI).

Methods
Retrospective cohort study of healthy patients 0 to 18 years of age who presented to a children's hospital emergency department from January 1, 2005, to June 30, 2015, and had transient and benign SB-SBI characterized by spontaneous resolution (ie, transient), diameter of less than 2.5 cm, no lead point, normal bowel wall thickness, nondilated proximal small bowel, and no colonic involvement (ie, benign radiographic features). Charts were reviewed for demographics, clinical presentation, radiologic studies obtained, outcomes, and further management. Medical and radiologic records were also reviewed for 1 year after presentation for any subsequent pathologic diagnoses.

Results
Sixty-eight patients were included in our study, with a total of 87 episodes of transient and benign SB-SBI on initial or follow-up examination. Overall, 39 patients (57%) were admitted to the hospital, and 38 patients (56%) had a surgical consultation. Twenty-four patients (35%) had further radiologic studies obtained, including computed tomography scans, esophagogastroduodenoscopy, Meckel’s scan, barium swallow studies, and magnetic resonance imaging. All studies were negative for concerning pathology including apparent lead points. None of the patients required surgical intervention or had any complications.

Conclusions
Transient and benign SB-SBIs with reassuring radiologic and clinical features diagnosed in healthy pediatric patients are likely incidentally found and are unlikely to be associated with a pathologic lead point.
Augmented Reality–Guided Lumbar Facet Joint Injections
Authors: Agten Christoph A. , Dennler Cyrill , Rosskopf Andrea B. , Jaberg Laurenz , Pfirrmann Christian W.A. , Farshad Mazda 
Published: May 2018

Objectives
The aim of this study was to assess feasibility and accuracy of augmented reality–guided lumbar facet joint injections.

Materials and Methods
A spine phantom completely embedded in hardened opaque agar with 3 ring markers was built. A 3-dimensional model of the phantom was uploaded to an augmented reality headset (Microsoft HoloLens). Two radiologists independently performed 20 augmented reality–guided and 20 computed tomography (CT)–guided facet joint injections each: for each augmented reality–guided injection, the hologram was manually aligned with the phantom container using the ring markers. The radiologists targeted the virtual facet joint and tried to place the needle tip in the holographic joint space. Computed tomography was performed after each needle placement to document final needle tip position. Time needed from grabbing the needle to final needle placement was measured for each simulated injection. An independent radiologist rated images of all needle placements in a randomized order blinded to modality (augmented reality vs CT) and performer as perfect, acceptable, incorrect, or unsafe. Accuracy and time to place needles were compared between augmented reality–guided and CT-guided facet joint injections.

Results
In total, 39/40 (97.5%) of augmented reality–guided needle placements were either perfect or acceptable compared with 40/40 (100%) CT-guided needle placements (P = 0.5). One augmented reality–guided injection missed the facet joint space by 2 mm. No unsafe needle placements occurred. Time to final needle placement was substantially faster with augmented reality guidance (mean 14 ± 6 seconds vs 39 ± 15 seconds, P < 0.001 for both readers).

Conclusions
Augmented reality–guided facet joint injections are feasible and accurate without potentially harmful needle placement in an experimental setting.
Falciform Ligament Artery Uptake on 99mTc MAA Planning Scan Before 90Y SIRT Confirmed by Retrospective SPECT/MRI Fusion
Authors: Große Hokamp Nils , Kobe Carsten , O’Donnell James K. , Gupta Amit 
Published: May 2018

Abstract
Selective internal radiation therapy using 90Y spheres is a treatment option for patients with primary or secondary liver cancer. To avoid complications, screening using 99mTc macroaggregated albumin is performed to identify lung shunting and extrahepatic depositions. For the latter, deposition after the anterior abdominal wall is frequently attributed to a patent falciform artery, although the vessel itself is rarely visible on SPECT/CT scans. We demonstrate that retrospective SPECT/MRI fusion clearly attributes the nuclide accumulation to a patent falciform artery. During selective internal radiation therapy, ice packs were placed on the anterior abdominal wall, resulting in a complication-free treatment.
Elongated Appearance of Meckel’s Diverticulum on 99mTcO4 Scintigraphy
Authors: Wu Ha , Zhao Ruifang , Song Zai , Kung B.T. , Zhao Xiaofei 
Published: May 2018

Abstract
A Meckel’s scintigraphy using 99mTcO4 was performed in a 9-year-old boy. The images revealed an elongated abnormal radiotracer accumulation in the right abdomen, which was confirmed as Meckel diverticulum combined with an omphalomesenteric cyst.
Chemokine Receptor CXCR4−Targeted PET/CT With 68Ga-Pentixafor Shows Superiority to 18F-FDG in a Patient With Waldenström Macroglobulinemia
Authors: Luo Yaping , Pan Qingqing , Feng Jun , Cao Xinxin , Li Fang 
Published: May 2018

Abstract
A 69-year-old woman diagnosed with Waldenström macroglobulinemia (WM) was referred for 18F-FDG and 68Ga-Pentixafor PET/CT for evaluation of the disease. Extensive involvement of WM with intense radioactivity in the bone marrow and lymph nodes was found in 68Ga-Pentixafor PET/CT. However, in 18F-FDG PET/CT, the lesions showed significantly lower tracer uptake. Given the superiority of 68Ga-Pentixafor in detecting WM lesions to 18F-FDG in this patient, 68Ga-Pentixafor PET/CT might be a promising imaging modality in assessment of tumor burden of WM in future studies.
Effects of End-Tidal Carbon Dioxide-Guided Fluid Resuscitation on Outcomes in a Cecal Ligation and Puncture Induced Rat Model of Sepsis
Authors: Xu Jing , Zheng Guanghui , Wu Liangliang , Fang Xiangshao , Wang Yue , Jiang Longyuan , Ling Qin , Yang Zhengfei , Tang Wanchun 
Published: May 2018

ABSTRACT
Cecal ligation and puncture (CLP) was used to cause severe sepsis in male Sprague–Dawley rats. There are four groups in this study: sham (n = 5), CLP (n = 10), end-tidal carbon dioxide (ETCO2) (n = 10), and mean arterial pressure (MAP) (n = 10). In ETCO2 group, fluid resuscitation (FR) began when ETCO2 at most 25 mmHg. In MAP group, FR began when MAP at most 100 mmHg. Electrocardiogram, aortic pressure, core temperature, and ETCO2 values were recorded at baseline, 2, 4, 6, 8, 10, and 12 h post-CLP. Lactate level, cardiac output (CO), perfused small vessel density (PSVD), and microvascular flow index (MFI) were assessed at the same time points as above. The results showed that MAP, CO, and ETCO2 gradually decreased after CLP. After FR, MAP, ETCO2, and CO in the ETCO2 group increased compared with the MAP group 12 h after CLP (all P < 0.05). Lactate level remains high in MAP group while decreasing in the ETCO2 group 8 h post-CLP. Both PSVD and MFI deteriorated after CLP in CLP group, though significantly improved in the ETCO2 group 8 h post-CLP. The average survival time in the ETCO2 group was significantly greater than MAP group (14.95 ± 3.90 h vs. 11.15 ± 1.76 h; t = 2.804, P = 0.012). Moreover, ETCO2 showed a negative correlation with lactic acid levels and a positive correlation with CO, PSVD, and MFI. In conclusion, ETCO2 can guide FR implement and improve outcomes of severe sepsis in CLP-inducted rat model. ETCO2 might be a potential index to guiding early FR in severe sepsis.