bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elevated Postmortem Vitreous Sodium and Chloride Level in a Salt Water Drowning Death During Self-Contained Underwater Breathing Apparatus Diving With Diving Mask in Place
Authors: Tse Rexson , Garland Jack , Kesha Kilak , Morrow Paul , Elstub Hannah , Cala Allan , Spark Amy , Stables Simon , Sage Martin 
Published: February 2018

Abstract
Elevation of postmortem vitreous sodium and chloride (PMVSC) levels in salt water drowning (SWD) is hypothesized to result from electrolyte changes in blood from salt water inhalation/ingestion during drowning. After approximately 1 hour after death, electrolytes may diffuse into the vitreous humor via the eye coverings. This hypothesis was based on a study where bovine eyeballs were immersed in salt water. There is no human study that could confirm that SWD would result in an initial elevation of PMVSC with no effects from immersion. We present an SWD during self-contained underwater breathing apparatus diving in which the face mask remained in its correct position while the deceased was underwater. The face mask would have prevented the orbits from being in direct contact with salt water and therefore stopped any effects of immersion on PMVSC. The PMVSC was 294 mmol/L, above control levels, and the reported cut-off of 259 mmol/L for a diagnosis SWD. The elevated PMVSC would unlikely be owing to immersion but SWD. This case report supports the observation that during SWD PMVSC would initially increase from salt water inhalation and ingestion and not from immersion.
Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality*
Authors: Ames Stefanie G. , Davis Billie S. , Angus Derek C. , Carcillo Joseph A. , Kahn Jeremy M. 
Published: February 2018

Objectives:
With continued attention to pediatric sepsis at both the clinical and policy levels, it is important to understand the quality of hospitals in terms of their pediatric sepsis mortality. We sought to develop a method to evaluate hospital pediatric sepsis performance using 30-day risk-adjusted mortality and to assess hospital variation in risk-adjusted sepsis mortality in a large state-wide sample.

Design:
Retrospective cohort study using administrative claims data.

Settings:
Acute care hospitals in the state of Pennsylvania from 2011 to 2013.

Patients:
Patients between the ages of 0–19 years admitted to a hospital with sepsis defined using validated International Classification of Diseases, Ninth revision, Clinical Modification, diagnosis and procedure codes.

Interventions:
None.

Measurements and Main Results:
During the study period, there were 9,013 pediatric sepsis encounters in 153 hospitals. After excluding repeat visits and hospitals with annual patient volumes too small to reliably assess hospital performance, there were 6,468 unique encounters in 24 hospitals. The overall unadjusted mortality rate was 6.5% (range across all hospitals: 1.5–11.9%). The median number of pediatric sepsis cases per hospital was 67 (range across all hospitals: 30–1,858). A hierarchical logistic regression model for 30-day risk-adjusted mortality controlling for patient age, gender, emergency department admission, infection source, presence of organ dysfunction at admission, and presence of chronic complex conditions showed good discrimination (C-statistic = 0.80) and calibration (slope and intercept of calibration plot: 0.95 and –0.01, respectively). The hospital-specific risk-adjusted mortality rates calculated from this model varied minimally, ranging from 6.0% to 7.4%.

Conclusions:
Although a risk-adjustment model for 30-day pediatric sepsis mortality had good performance characteristics, the use of risk-adjusted mortality rates as a hospital quality measure in pediatric sepsis is not useful due to the low volume of cases at most hospitals. Novel metrics to evaluate the quality of pediatric sepsis care are needed.
Cervical Spine Imaging and Injuries in Young Children With Non-Motor Vehicle Crash-Associated Traumatic Brain Injury
Authors: Henry M. Katherine , French Benjamin , Feudtner Chris , Zonfrillo Mark R. , Lindberg Daniel M. , Anderst James D. , Berger Rachel P. , Wood Joanne N. 
Published: February 2018

Objectives
The aim of this study was to evaluate cervical magnetic resonance imaging (MRI) and computed tomography (CT) practices and cervical spine injuries among young children with non–motor vehicle crash (MVC)–associated traumatic brain injury (TBI).

Methods
We performed a retrospective study of a stratified, systematic random sample of 328 children younger than 2 years with non-MVC-associated TBI at 4 urban children's hospitals from 2008 to 2012. We defined TBI etiology as accidental, indeterminate, or abuse. We reported the proportion, by etiology, who underwent cervical MRI or CT, and had cervical abnormalities identified.

Results
Of children with non-MVC-associated TBI, 39.4% had abusive head trauma (AHT), 52.2% had accidental TBI, and in 8.4% the etiology was indeterminate. Advanced cervical imaging (CT and/or MRI) was obtained in 19.1% of all children with TBI, with 9.3% undergoing MRI and 11.7% undergoing CT. Cervical MRI or CT was performed in 30.9% of children with AHT, in 11.7% of accidental TBI, and in 10.7% of indeterminate-cause TBI. Among children imaged by MRI or CT, abnormal cervical findings were found in 22.1%, including 31.3% of children with AHT, 7.1% of children with accidental TBI, and 0% of children with indeterminate-cause TBI. Children with more severe head injuries who underwent cervical imaging were more likely to have cervical injuries.

Conclusions
Abusive head trauma victims appear to be at increased risk of cervical injuries. Prospective studies are needed to define the risk of cervical injury in children with TBI concerning for AHT and to inform development of imaging guidelines.
Toll-Like Receptor 4 Signaling Licenses the Cytosolic Transport of Lipopolysaccharide From Bacterial Outer Membrane Vesicles
Authors: Gu Lan , Meng Ran , Tang Yiting , Zhao Kai , Liang Fang , Zhang Rui , Xue Qianqian , Chen Fangping , Xiao Xianzhong , Wang Huadong , Wang Haichao , Billiar Timothy R. , Lu Ben 
Published: February 2018

ABSTRACT
Outer membrane vesicles (OMVs), released by variety of bacteria, are membrane-enclosed entities enriched in microbial components, toxins, and virulent factors. OMVs could deliver lipopolysaccharide (LPS) into the cytosol of host cells and subsequently activate caspase-11, which critically orchestrates immune responses and mediates septic shock. Although it is known that caspase-11 is activated by intracellular LPS, how OMVs deliver LPS into the cytosol remains largely unknown. Here we show that the activation of toll-like receptor 4 (TLR4), a LPS receptor on the cytoplasmic membrane, licenses macrophages to transport LPS from OMVs into the cytosol through TIR domain-containing adaptor-inducing interferon-β (TRIF). TRIF-mediated cytosolic delivery of LPS from OMVs depends on the production of type 1 interferon and the expression of guanylate-binding proteins (GBPs). Deletion of TRIF or GBPs prevents pyroptosis and lethality induced by OMVs or OMVs-releasing Escherichia coli. Together, these findings provide novel insight into how host coordinates extracellular and intracellular LPS sensing to orchestrate immune responses during gram-negative bacterial infection.
Davydov Procedure for Augmenting Vaginal Length in a Postsurgical Male-to-Female Transgender Patient
Authors: Jalalizadeh Mehrsa , Shobeiri S. Abbas 
Published: February 2018

Abstract
Male-to-female gender reassignment surgery may lead to unsatisfactory vaginal length. No standard approaches are established to treat these patients. We present a case of vaginoplasty using the laparoscopic Davydov technique performed on a male-to-female transgender patient. Our case provides a novel approach to treating this rare condition and introduces Davydov procedure as a potentially effective and safe treatment. Preoperative endovaginal and endoanal 3-dimensional ultrasounds and a pelvic magnetic resonance imaging of the case are presented to provide details of this patient's unique anatomy.
Tourniquet usage in prehospital care and resuscitation of pediatric trauma patients—Pediatric Trauma Society position statement
Authors: Cunningham Aaron , Auerbach Marc , Cicero Mark , Jafri Mubeen 
Published: February 2018

BACKGROUND
Recent mass casualty events in the United States have highlighted the need for public preparedness to prevent death from uncontrolled hemorrhage. The Pediatric Trauma Society (PTS) reviewed the literature regarding pediatric tourniquet usage with the aim to provide recommendations about the utility of this adjunct for hemorrhage control in children.

METHODS
Search terms “pediatric” and “tourniquet” were used to query the US National Library of Medicine National Institutes of Health for pertinent literature. Exclusion criteria include not involving children, not involving the use of an extremity tourniquet, primary outcomes not related to hemorrhage control, tourniquet use to prevent snake envenomation, single case reports, and only foreign language formats available. Bibliographies of remaining studies reviewed to identify additional pertinent research. Four physician members of the PTS Guidelines Committee reviewed identified studies.

RESULTS
One hundred thirty-four studies were identified. One hundred twenty-three studies were excluded. Seven additional studies were identified through bibliography review. Eighteen pertinent studies were reviewed. Seven articles evaluated physiologic response to tourniquet use in operating room settings. Six articles were generated from combat experience in conflicts in Afghanistan and Iraq. Four articles discussed technical details of tourniquet usage. One article evaluated the use of tourniquets during the Boston Marathon bombing in 2015.

CONCLUSION
Despite limited data of limited quality regarding their use, the PTS supports the usage of tourniquets in the prehospital setting and during the resuscitation of children suffering from exsanguinating hemorrhage from severe extremity trauma. Expedited, definitive care must be sought, and tourniquet pressure and time should be limited to the least amount possible. The Society supports the ACS “Stop the Bleed” campaign and encourages further investigation of tourniquet use in children.

LEVEL OF EVIDENCE
Guidelines/algorithm study, level IIIa.
Emergency sternal intraosseous access for warm fresh whole blood transfusion in damage control resuscitation
Authors: Bjerkvig Christopher Kalhagen , Fosse Theodor Kaurin , Apelseth Torunn Oveland , Sivertsen Joar , Braathen Hanne , Eliassen Håkon Skogrand , Guttormsen Anne Berit , Cap Andrew P. , Strandenes Geir 
Published: February 2018

BACKGROUND
Intraosseous (IO) vascular access is increasingly used as an emergency tool for achieving access to the systemic circulation in critically ill patients. The role of IO transfusion of blood in damage control resuscitation is however questionable due to possible inadequate flow rate and hemolysis. Some experts claim that IO transfusion is contraindicated. In this study, we have challenged this statement by looking at flow rates of autologous fresh whole blood reinfusion and hemolysis using two of the commonly used Food and Drug Administration–approved and Conformité Européenne (CE)-marked sternal needles. Additionally, the success rate of sternal access between the two devices is evaluated.

METHODS
Volunteer professional military personnel, were enrolled prospectively in a nonrandomized observational study design. We collected 450 mL of autologous whole blood from each participant. Participants were divided into the following three groups of 10: Tactically Advanced Lifesaving IO Needle (T.A.L.O.N.) IO, FAST1 IO, and intravenous group. The reinfusion was done by gravity only. Blood sampling was performed before blood collection and 30 minutes after reinfusion. Investigation of hemolysis was performed by measurements of haptoglobin and lactate dehydrogenase. Success rate was evaluated by correct aspiration of bone marrow.

RESULTS
Median reinfusion rate was 46.2 mL/min in the FAST1 group, 32.4 mL/min in the T.A.L.O.N. group, and 74.1 mL/min in the intravenous group. Blood samples from all participants were within normal ranges. There was no statistically significant difference in haptoglobin and lactate dehydrogenase between the groups. In the FAST1 group, 1 (9%) of 11 procedures failed. In the T.A.L.O.N. group, 4 (29%) of 14 procedures failed.

CONCLUSION
Although preferable, achieving peripheral venous access in the bleeding patient is a major problem. Our findings suggest that fresh whole-blood transfusion through the IO route is safe, reliable, and provide sufficient flow for resuscitation.

LEVEL OF EVIDENCE
Therapeutic/Care management study, level III.
Physician training in critical care in the United States: Update 2018
Authors: Napolitano Lena M. , Rajajee Venkatakrishna , Gunnerson Kyle J. , Maile Michael D. , Quasney Michael , Hyzy Robert C. 
Published: February 2018

ABSTRACT
Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001–2017). The number of critical care fellowship training programs has increased 22.6%, with a 49.4% increase in the number of on-duty residents annually, over the last 16 years. This is in contrast to the period of 1995 to 2000 when the number of physicians enrolled in critical care fellowship programs had decreased or remained unchanged. Although more than 80% of intensivists in the US train in internal medicine critical care Accreditation Council for Graduate Medical Education–approved fellowships, there has been a significant increase in the number of residents from surgery, anesthesiology, pediatrics, emergency medicine, and other specialties who complete specialty fellowship training and certification in critical care. Matriculation in neurocritical care fellowships is rapidly rising with 60 programs and over 1,200 neurocritical care diplomates. Critical care is now an increasingly popular fellowship in all specialties. This rapid growth of all critical care specialties highlights the magnitude of the heterogeneity that will exist between intensivists in the future.
Prognosis of diffuse axonal injury with traumatic brain injury
Authors: Humble Stephen S. , Wilson Laura D. , Wang Li , Long Drew A. , Smith Miya A. , Siktberg Jonathan C. , Mirhoseini Mina F. , Bhatia Aashim , Pruthi Sumit , Day Matthew A. , Muehlschlegel Susanne , Patel Mayur B. 
Published: February 2018

BACKGROUND
Determine the prognostic impact of magnetic resonance imaging (MRI)-defined diffuse axonal injury (DAI) after traumatic brain injury (TBI) on functional outcomes, quality of life, and 3-year mortality.

METHODS
This retrospective single center cohort included adult trauma patients (age > 17 years) admitted from 2006 to 2012 with TBI. Inclusion criteria were positive head computed tomography with brain MRI within 2 weeks of admission. Exclusion criteria included penetrating TBI or prior neurologic condition. Separate ordinal logistic models assessed DAI's prognostic value for the following scores: (1) hospital-discharge Functional Independence Measure, (2) long-term Glasgow Outcome Scale-Extended, and (3) long-term Quality of Life after Brain Injury-Overall Scale. Cox proportional hazards modeling assessed DAI's prognostic value for 3-year survival. Covariates included age, sex, race, insurance status, Injury Severity Score, admission Glasgow Coma Scale Score, Marshall Head computed tomography Class, clinical DAI on MRI (Y/N), research-level anatomic DAI Grades I-III (I, cortical; II, corpus callosum; III, brainstem), ventilator days, time to follow commands, and time to long-term follow-up (for logistic models).

RESULTS
Eligibility criteria was met by 311 patients, who had a median age of 40 years (interquartile range [IQR], 23–57 years), Injury Severity Score of 29 (IQR, 22–38), intensive care unit stay of 6 days (IQR, 2–11 days), and follow-up of 5 years (IQR, 3–6 years). Clinical DAI was present on 47% of MRIs. Among 300 readable MRIs, 56% of MRIs had anatomic DAI (25% Grade I, 18% Grade II, 13% Grade III). On regression, only clinical (not anatomic) DAI was predictive of a lower Functional Independence Measure score (odds ratio, 2.5; 95% confidence interval, 1.28–4.76], p = 0.007). Neither clinical nor anatomic DAI were related to survival, Glasgow Outcome Scale-Extended, or Quality of Life after Brain Injury-Overall Scale scores.

CONCLUSION
In this longitudinal cohort, clinical evidence of DAI on MRI may only be useful for predicting short-term in-hospital functional outcome. Given no association of DAI and long-term TBI outcomes, providers should be cautious in attributing DAI to future neurologic function, quality of life, and/or survival.

LEVEL OF EVIDENCE
Epidemiological, level III; Therapeutic, level IV.
Evaluation of the management of severe trauma kidney injury and long-term renal function in children
Authors: Overs Camille , Teklali Youssef , Boillot Bernard , Poncet Delphine , Rabattu Pierre-Yves , Robert Yohan , Piolat Christian 
Published: February 2018

BACKGROUND
To evaluate the management and long-term renal function with DMSA scintigraphy in pediatric severe traumatic kidney injury grade IV and V at the trauma center of Grenoble Teaching Hospital.

METHODS
This is a single-center observational retrospective study between 2004 and 2014. All children younger than 15 years and managed at the Grenoble teaching Hospital for a severe trauma kidney injury grade IV or V were included. The trauma grade was radiologically diagnosed on arrival at hospital, using the classification of the American Association for Surgery of Trauma. The management followed the algorithm in effect in the establishment. The assessment of the renal function was performed by a DMSA scintigraphy after at least 6 months from the injury.

RESULTS
Twenty-one children were managed for a severe renal trauma (16 IV and 5 V). The diagnosis was initially made by an ultrasonography (eight cases) or a computed tomography scan (13 cases). A child with a severe renal trauma IV underwent nephrectomy on day 6 of the trauma. Eleven children needed a therapeutic procedure (three embolizations, four double J stents, one arterial stent, one peritoneal lavage for a splenic hemoperitoneum, four pleural drainages). A DMSA scintigraphy was performed in 15 patients to assess the function of the injured kidney: 11 of 16 severe renal trauma IV with an average of 39.4%, and 17% in 4 of 5 severe renal trauma V analyzed.

CONCLUSION
Among the 21 children managed for a severe kidney trauma injury IV or V, 11 required a therapeutic procedure, one of them a nephrectomy. The DMSA scintigraphy performed after at least 6 months from the trauma found an injured renal function at 39.4% in 11 of 16 severe renal trauma IV analyzed, and 17% in 4 of 5 severe renal trauma V analyzed, which confirms the currently conservative management.

LEVEL OF EVIDENCE
Type of study: original article, retrospective observational study, level IV.
The Sibship Index can’t discriminates Half-Sibs from Full-Sibs; a new algorithm, including maternal genotype, can do it
Authors: Cardillo Giuseppe 
Published: February 2018

AbstractSibship DNA testing is conducted in order to determine if two subjects share one or both biological parents: Full-sibs have both parents in common, whereas Half-sibs have one parent in common, either the mother or the father. When an alleged father is not available for a paternity test, sibship testing is one way to determine family relationships. Results of a sibship test have also been accepted as proof in Social Security benefit and other inheritance claims. To analyze the possibility that the siblings share two common parents versus only one common parent, the ratio of the full sibship index versus half sibship index is computed: a sibship index less than 1, provides genetic evidence which does not favor a full-sibling relationship. In this paper we will demonstrate that the actually used Sibship Index is unable to distinguish Full-sibs from Half-Sibs and the only way to distinguish them is to use a new Index including the genotype of the Mother, that, usually, is the known common parent.HighlightsUsually used Sibship Index (SI) greatly overestimates likelihood ratios;Rising up the number of investigated STR, all Half-Sibs are declared Full-Sibs;The only way to avoid this overestimate is to use a Sibship Index Corrected by the common parent genotype, that usually is the mother (SICMG); all likelihood ratio formulas can be reconducted to five scenarios;For both SI and SICMG there is a better cut-off than 1 to discriminate Half-Sibs: this cut-off is computed for all commercial available forensic STR kit.
A stainless-steel mortar, pestle and sleeve design for the efficient fragmentation of ancient bone
Authors: Gondek Agata T , Boessenkool Sanne , Star Bastiaan 
Published: February 2018

AbstractAncient DNA (aDNA) bone extraction protocols routinely require the fragmentation of larger bone pieces into smaller pieces or powder prior to DNA extraction. To achieve this goal, different types of equipment such as oscillating ball mills, freezer mills, mortar and pestle, or drills can be used. Although all these approaches are suitable, practical drawbacks are associated with each method. Here, we present the design for a stainless-steel mortar and pestle, with a removable sleeve to contain bone material. The tool readily comes apart for ease of cleaning and its simplicity allows university workshops equipped with a lathe, boring tools and milling machine to make these components at local expense. We find that this design allows for the controlled fragmentation of ancient bone and that it significantly improves our sample throughput. We recommend this design as a useful, economical addition to existing laboratory equipment for the efficient handling of ancient bone.