bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transcatheter Closure of Moderate to Large Perimembranous Ventricular Septal Defects in Children Weighing 10 kilograms or less
Authors: Pillai Ajith Ananthakrishna , Rangasamy Sasinthar , Balasubramonian Vidhyakar Rangaswamy 
Published: May 2019

Background: Transcatheter device closure of ventricular septal defect (VSD) is an alternative to conventional surgical closure. Device closure of moderate to large perimembranous VSD (pmVSD) is considered technically challenging in smaller children weighing ≤10 kg. Very few studies are published on the outcomes of the same. Methods: Descriptive single-center retrospective study. Data of 49 children ≤10 kg with moderate to large pmVSDs taken up for transcatheter device closure in our institute were analyzed and their follow-up details were reviewed. Results: Of the 87 patients referred for VSD closure, 49 patients qualified for the inclusion criteria. Median age was 18 months (interquartile range: 13-22). Successful device deployment was achieved in 42 (85.7%) patients. Mean VSD size by transthoracic echocardiography was 5.98 mm (range: 4-12 mm). Mean waist size of the device used was 8.26 mm (range: 4-14 mm). There was one device embolization, requiring catheter-directed retrieval from the left ventricle and subsequent surgical referral for VSD closure. Minor complications such as device-related persistent new aortic regurgitation was noted in one patient and mild tricuspid regurgitation and transient heart block occurred in two patients each. There was no mortality or complete heart block requiring permanent pacemaker implantation immediately or during midterm follow-up (mean follow-up: 20 months; range: 6-72.5 months). Conclusion: Device closure of moderate to large pmVSDs in children weighing ≤10 kg is feasible and safe with a success rate of 85.7%. Careful selection of patients and avoidance of oversizing the defect makes the immediate and midterm results acceptable.
Increasing Burden of Youth Baseball Elbow Injuries in US Emergency Departments
Authors: Trofa David P. , Obana Kyle K. , Swindell Hasani W. , Shiu Brian , Noticewala Manish S. , Popkin Charles A. , Ahmad Christopher S. 
Published: May 2019

Background: Youth athletes are starting sports earlier and training harder. Intense, year-round demands are encouraging early sports specialization under the perception that it will improve the odds of future elite performance. Unfortunately, there is growing evidence that early specialization is associated with increased risk of injury and burnout. This is especially true of pediatric and adolescent baseball players. Purpose/Hypothesis: The purpose of this investigation was to analyze national injury trends of youth baseball players. We hypothesized that while the total number of baseball injuries diagnosed over the past decade would decrease, there would be an increase in adolescent elbow injuries seen nationally. A further hypothesis was that this trend would be significantly greater than other injuries to the upper extremity and major joints. Study Design: Descriptive epidemiology study. Methods: Injury data from the National Electronic Injury Surveillance System, a United States Consumer Product Safety Commission database, were analyzed between January 1, 2006, and December 31, 2016, for baseball players aged ≤18 years. Data were collected on the location of injury, diagnosis, and mechanism of injury. Results: Between 2006 and 2016, an estimated 665,133 baseball injuries occurred nationally. The mean age of the injured players was 11.5 years. The most common injuries diagnosed included contusions (26.8%), fractures (23.6%), and strains and sprains (18.7%). Among major joints, the ankle (25.6%) was most commonly injured, followed by the knee (21.3%), wrist (19.2%), elbow (17.7%), and shoulder (16.2%). The incidence of the ankle, knee, wrist, and shoulder injuries decreased over time, while only the incidence of elbow injuries increased. A linear regression analysis demonstrated that the increasing incidence of elbow injuries was statistically significant against the decreasing trend for all baseball injury diagnoses, as well as ankle, knee, wrist, hand, and finger injuries ( P < .05). Additionally, the only elbow injury mechanism that increased substantially over time was throwing. Conclusion: The current investigation found that while the incidence of baseball injuries sustained by youth players is decreasing, elbow pathology is becoming more prevalent and is more commonly being caused by throwing. Given that the majority of elbow injuries among adolescent baseball players are overuse injuries, these findings underscore the importance of developing strategies to continue to ensure the safety of these youth athletes.
Health-related quality of life in children with autism spectrum disorders and children with developmental language disorders
Authors: Coales Catherine , Heaney Natalie , Ricketts Jessie , Dockrell Julie E , Lindsay Geoff , Palikara Olympia , Charman Tony 
Published: May 2019

Background and aims There is a paucity of literature investigating health-related quality of life in neurodevelopmental populations including children with developmental language disorders and children with autism spectrum disorder. Health-related quality of life in these two groups remains poorly understood. Furthermore, studies have typically relied on reports from caregivers and teachers rather than using self-report measures. The aim of the current study is to compare the levels and profiles of self-reported health-related quality of life of children with developmental language disorders and children with autism spectrum disorder. Methods Participants comprised 114 7-to-13-year-old children with developmental language disorders ( n = 63) and children with autism spectrum disorder ( n = 51) attending mainstream school. Self-reported health-related quality of life was measured using the KIDSCREEN-52. We also collected standardised measures of receptive language, autism spectrum disorder symptoms, nonverbal IQ and emotional and behavioural problems. Results Children with developmental language disorders reported health-related quality of life commensurate with normative ranges, except for 2 of the 10 dimensions; the Moods and Emotions domain and the Social acceptance/bullying domain, which were below norms. Children with autism spectrum disorder reported significantly lower health-related quality of life compared to norms and the developmental language disorders group. However, when the effects of non-verbal ability and language – on which the groups were not matched – were covaried most group differences fell to non-significance or disappeared. Child characteristics showed few associations with dimensions of health-related quality of life across groups. Conclusions Children with autism spectrum disorder may be particularly vulnerable to poorer health-related quality of life and the relevant professionals need to be aware of this. Children with developmental language disorders exhibit a profile of health-related quality of life more in-line with average ranges. However, certain domains warrant monitoring and may benefit from intervention. Many of the between-group differences in self-reported health-related quality of life disappeared when non-verbal and language ability were covaried, though neither of the covariates was systematically related to scores. Other within-child factors such as emotional understanding and competence should be explored in future studies. Implications Further research into child and contextual factors may elucidate risk or protective factors for health-related quality of life in children with neurodevelopmental disorders.
Oxygen in patients with fibrotic interstitial lung disease: an international Delphi survey
Authors: Lim Rachel K. , Humphreys Christopher , Morisset Julie , Holland Anne E. , Johannson Kerri A. 
Published: May 2019

RationalePatients with fibrotic interstitial lung disease (ILD) frequently develop resting or exertional hypoxaemia. There is heterogeneity in clinical practice and a paucity of evidence guiding supplemental oxygen use in this patient population. The objectives of this study were to build international expert-based consensus on the indications and goals of supplemental oxygen from the perspective of healthcare providers, and identify potential barriers to its access.MethodsSemistructured interviews and a comprehensive literature search informed items for the Delphi survey, with items not meeting consensus included in round 2. Round 3 contained survey questions regarding regional funding coverage for oxygen therapy.A prioridefinitions of consensus were median scores of 4 (agree) to 5 (strongly agree) for “agreement”, 1 (strongly disagree) to 2 (disagree) for “disagreement” or 3 (unsure) with an interquartile range of 0–1.Results42 out of 45 (93%) experts completed all three survey rounds, representing 17 countries. 20 out of 36 items met consensus for agreement or disagreement, 10 items met consensus for unsure and four items did not meet consensus. Experts agreed that oxygen should be recommended for patients with severe resting hypoxaemia and in cases of exertional desaturation to <85–89%, particularly with attributable symptoms or exercise limitation. There are regional differences in funding coverage for oxygen, based on desaturation thresholds, clinical symptoms and testing requirements.ConclusionsExperts achieved consensus on 20 items guiding supplemental oxygen use in fibrotic ILD. These findings may inform research, clinical recommendations and funding policy.
Spirometric indices in primary ciliary dyskinesia: systematic review and meta-analysis
Authors: Halbeisen Florian S. , Jose Anu , de Jong Carmen , Nyilas Sylvia , Latzin Philipp , Kuehni Claudia E. , Goutaki Myrofora 
Published: May 2019

Primary ciliary dyskinesia (PCD) is a genetic, heterogeneous disease caused by dysfunction of cilia. Evidence is sparse and reports of lung function in PCD patients range from normal to severe impairment. This systematic review and meta-analysis of studies of lung function in PCD patients examines the spirometric indices of PCD patients and differences by age group and sex.We searched PubMed, Embase and Scopus for studies that described lung function in 10 or more patients with PCD. We performed meta-analyses and meta-regression to explain heterogeneity. We included 24 studies, ranging from 13 to 158 patients per study.The most commonly reported spirometric indices were forced expiratory volume in 1 s (FEV1) and forced vital capacity presented as mean and standard deviation of percent predicted values. We found considerable heterogeneity for both parameters (I2=94–96%). The heterogeneity remained when we stratified the analysis by age; however, FEV1in adult patients was lower. Even after taking into account explanatory factors, the largest part of the between-studies variance remained unexplained.Heterogeneity could be explained by genetic differences between study populations, methodological factors related to the variability of study inclusion criteria or details on the performance and evaluation of lung function measurements that we could not account for. Prospective studies therefore need to use standardised protocols and international reference values. These results underline the possibility of distinct PCD phenotypes as in other chronic respiratory diseases. Detailed characterisation of these phenotypes and related genotypes is needed in order to better understand the natural history of PCD.
Preliminary results from a legacy indicator tool for measuring climate change related impacts on built heritage
Authors: Daly Cathy 
Published: May 2019

Abstract

Background
Gradual changes in weathering rates and mechanisms are the barely visible impacts of climate change on cultural heritage. Long-term monitoring of built and archaeological heritage is therefore necessary to ascertain the nature of loss due to slow onset effects. During research at the Dublin Institute of Technology in 2011 a Legacy Indicator Tool (LegIT) for measuring the weathering of stone surfaces into the far future was developed by the author and piloted at five National Monuments in Ireland. While it is too soon to evaluate the tool in relation to long term climate change trends, this article considers the data from 5 years of exposure and provides an early assessment of the pilot study’s design and implementation.

Results
Measurements for colour, surface roughness, weight, and dimensions from the 5 year exposure of the LegIT were analysed. Comparisons between sites allows assessment of surface change under different atmospheric conditions. The indications for regional and localized weathering trends will aid managers in understanding risks and setting priorities—both for further monitoring and for conservation interventions.

Conclusions
Results from the 5 year pilot trial of the LegIT has allowed preliminary evaluation of its potential as a long term indicator for surface weathering. Recommendations have been made for modifications to the design, manufacture and implementation of the tool. The future aim is to compare results over time at each site, building a picture of surface weathering processes in relation to regional climatic change.
Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Gastric Cancer With Peritoneal Metastases (CYTO-CHIP study): A Propensity Score Analysis
Authors: Bonnot Pierre-Emmanuel , Piessen Guillaume , Kepenekian Vahan , Decullier Evelyne , Pocard Marc , Meunier Bernard , Bereder Jean-Marc , Abboud Karine , Marchal Frédéric , Quenet François , Goere Diane , Msika Simon , Arvieux Catherine , Pirro Nicolas , Wernert Romuald , Rat Patrick , Gagnière Johan , Lefevre Jeremie H. , Courvoisier Thomas , Kianmanesh Reza , Vaudoyer Delphine , Rivoire Michel , Meeus Pierre , Passot Guillaume , Glehen Olivier ,   on behalf of the FREGAT and BIG-RENAPE Networks
Published: May 2019

PURPOSE Gastric cancer (GC) with peritoneal metastases (PMs) is a poor prognostic evolution. Cytoreductive surgery (CRS) yields promising results, but the impact of hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. Here we aimed to compare outcomes between CRS-HIPEC versus CRS alone (CRSa) among patients with PMs from GC. PATIENTS AND METHODS From prospective databases, we identified 277 patients with PMs from GC who were treated with complete CRS with curative intent (no residual nodules > 2.5 mm) at 19 French centers from 1989 to 2014. Of these patients, 180 underwent CRS-HIPEC and 97 CRSa. Tumor burden was assessed using the peritoneal cancer index. A Cox proportional hazards regression model with inverse probability of treatment weighting (IPTW) based on propensity score was used to assess the effect of HIPEC and account for confounding factors. RESULTS After IPTW adjustment, the groups were similar, except that median peritoneal cancer index remained higher in the CRS-HIPEC group (6 v 2; P = .003). CRS-HIPEC improved overall survival (OS) in both crude and IPTW models. Upon IPTW analysis, in CRS-HIPEC and CRSa groups, median OS was 18.8 versus 12.1 months, 3- and 5-year OS rates were 26.21% and 19.87% versus 10.82% and 6.43% (adjusted hazard ratio, 0.60; 95% CI, 0.42 to 0.86; P = .005), and 3- and 5-year recurrence-free survival rates were 20.40% and 17.05% versus 5.87% and 3.76% ( P = .001), respectively; the groups did not differ regarding 90-day mortality (7.4% v 10.1%, respectively; P = .820) or major complication rate (53.7% v 55.3%, respectively; P = .496). CONCLUSION Compared with CRSa, CRS-HIPEC improved OS and recurrence-free survival, without additional morbidity or mortality. When complete CRS is possible, CRS-HIPEC may be considered a valuable therapy for strictly selected patients with limited PMs from GC.
Estimation of Mortality Risk in Type 2 Diabetic Patients (ENFORCE): An Inexpensive and Parsimonious Prediction Model
Authors: Copetti Massimiliano , Shah Hetal , Fontana Andrea , Scarale Maria Giovanna , Menzaghi Claudia , De Cosmo Salvatore , Garofolo Monia , Sorrentino Maria Rosaria , Lamacchia Olga , Penno Giuseppe , Doria Alessandro , Trischitta Vincenzo 
Published: May 2019

AbstractContextWe previously developed and validated an inexpensive and parsimonious prediction model of 2-year all-cause mortality in real-life patients with type 2 diabetes.ObjectiveThis model, now named ENFORCE (EstimatioN oF mORtality risk in type 2 diabetiC patiEnts), was investigated in terms of (i) prediction performance at 6 years, a more clinically useful time-horizon; (ii) further validation in an independent sample; and (iii) performance comparison in a real-life vs a clinical trial setting.DesignObservational prospective randomized clinical trial.SettingWhite patients with type 2 diabetes.PatientsGargano Mortality Study (GMS; n = 1019), Foggia Mortality Study (FMS; n = 1045), and Pisa Mortality Study (PMS; n = 972) as real-life samples and the standard glycemic arm of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) clinical trial (n = 3150).Main Outcome MeasureThe endpoint was all-cause mortality. Prediction accuracy and calibration were estimated to assess the model's performances.ResultsENFORCE yielded 6-year mortality C-statistics of 0.79, 0.78, and 0.75 in GMS, FMS, and PMS, respectively (P heterogeneity = 0.71). Pooling the three cohorts showed a 6-year mortality C-statistic of 0.80. In the ACCORD trial, ENFORCE achieved a C-statistic of 0.68, a value significantly lower than that obtained in the pooled real-life samples (P < 0.0001). This difference resembles that observed with other models comparing real-life vs clinical trial settings, thus suggesting it is a true, replicable phenomenon.ConclusionsThe time horizon of ENFORCE has been extended to 6 years and validated in three independent samples. ENFORCE is a free and user-friendly risk calculator of all-cause mortality in white patients with type 2 diabetes from a real-life setting.
Why We Should Still Treat by Neurosurgery Patients With Cushing Disease and a Normal or Inconclusive Pituitary MRI
Authors: Cristante Justine , Lefournier Virginie , Sturm Nathalie , Passagia Jean Guy , Gauchez Anne Sophie , Tahon Florence , Cantin Stéphane , Chabre Olivier , Gay Emmanuel 
Published: May 2019

Abstract

Context
In patients with Cushing disease (CD) and a typical image of adenoma at MRI, transsphenoidal surgery is consensual. However, when MRI is inconclusive or normal, some authors now advocate medical treatment instead. The implicit assumption is that modern MRI should miss only very small microadenomas that are too difficult to visualize at surgery.

Objective
To analyze the evolution with time of the performances of MRI and the outcomes of surgery in patients with CD with a typical image of adenoma vs an inconclusive or normal MRI.

Design and Patients
Retrospective single center study of 195 patients with CD treated by transsphenoidal surgery between 1992 and 2018, using first a translabial microscopic and then a transnasal endoscopic approach. Patients with inconclusive or normal MRI were explored by bilateral inferior petrosal sinus sampling. Four MRI groups were defined: microadenomas (n = 89), macroadenomas (n = 18), or MRI either inconclusive (n = 44) or normal (n = 44).

Results
The proportion of inconclusive/normal MRI decreased with time, from 60% (21/35) in 1992 to 1996 to 27% (14/51) in 2012 to 2018 (P = 0.037). In the four MRI groups, the per-operatory adenoma visualization rate was only slightly lower when MRI was normal (95%, 100%, 86%, 79%; P = 0.012) and postoperative remission rates were not different (85%, 94%, 73%, 75%; P = 0.11).

Conclusion
The diagnostic performances of MRI have improved but remain inferior to the eye of an expert neurosurgeon, best assisted by endoscopy. We propose that patients with CD and an inconclusive/normal MRI be addressed by an expert neurosurgeon for transsphenoidal surgery rather than being treated medically.
Long-Acting and Selective Oxytocin Peptide Analogs Show Antidiabetic and Antiobesity Effects in Male Mice
Authors: Snider Brandy , Geiser Andrea , Yu Xiao-peng , Beebe Emily Cathleen , Willency Jill Amanda , Qing Keyun , Guo Lili , Lu Jianliang , Wang Xiaojun , Yang Qian , Efanov Alexander , Adams Andrew Charles , Coskun Tamer , Emmerson Paul Joseph , Alsina-Fernandez Jorge , Ai Minrong 
Published: May 2019

AbstractOxytocin (OXT) has been shown to suppress appetite, induce weight loss, and improve glycemic control and lipid metabolism in several species, including humans, monkeys, and rodents. However, OXT’s short half-life in circulation and lack of receptor selectivity limit its application and efficacy. In this study, we report an OXT peptide analog (OXTGly) that is potent and selective for the OXT receptor (OXTR). OXT, but not OXTGly, activated vasopressin receptors in vitro and acutely increased blood pressure in vivo when administered IP. OXT suppressed food intake in mice, whereas OXTGly had a moderate effect on food intake when administered IP or intracerebroventricularly. Both OXT (IP) and OXTGly (IP) improved glycemic control in glucose tolerance tests. Additionally, both OXT (IP) and OXTGly (IP) stimulated insulin, glucagon-like peptide 1, and glucagon secretion in mice. We generated lipid-conjugated OXT (acylated-OXT) and OXTGly (acylated-OXTGly) and demonstrated that these molecules have significantly extended half-lives in vivo. Compared with OXT, 2-week treatment of diet-induced obese mice with acylated-OXT [subcutaneous(ly) (SC)] resulted in enhanced body weight reduction, an improved lipid profile, and gene expression changes consistent with increased lipolysis and decreased gluconeogenesis. Treatment with acylated-OXTGly (SC) also resulted in a statistically significant weight loss, albeit to a lesser degree compared with acylated-OXT treatment. In conclusion, we demonstrate that selective activation of the OXTR pathway results in both acute and chronic metabolic benefits, whereas potential activation of vasopressin receptors by nonselective OXT analogs causes physiological stress that contributes to additional weight loss.
Inequitable Long-Term Outcomes for an Indigenous Population After Definitive Treatment of Patients With Graves Disease
Authors: Tamatea Jade A U , Tu'akoi Kelson , Meyer-Rochow Goswin Y , Conaglen John V , Elston Marianne S 
Published: May 2019

Abstract

Background
Māori, the indigenous people of Aotearoa/New Zealand, have an increased incidence of Graves disease and often require more than one radioiodine (RAI) dose, raising the question as to whether surgery may be preferable in this population. However, there is a lack of outcome data after definitive therapy in an indigenous population.

Aim
To assess ethnic differences in thyroid status after definitive therapy for Graves disease.

Methods
Single-center retrospective review of patients treated by RAI or thyroidectomy from 1 December 2001 to 31 March 2013. TSH levels at 1, 2, 5, and 10 years after treatment were recorded.

Results
A total of 798 patients were included: 589 received RAI, and 209 underwent surgery. Overall, 48% of patients were euthyroid at 1 year after definitive treatment, and 63.5% were euthyroid by 10 years. Māori were less likely to be euthyroid when compared with Europeans at all time points (e.g., 29.7% vs 57.3% at 1 year and 52.2% vs 70.9% at 10 years, P < 0.0005). Māori were more likely to receive more than one dose of RAI compared with Europeans (30.2% vs 14.2%, P < 0.0005). Persistent thyrotoxicosis at 1 year after RAI was seen in 25.8% of Māori compared with 8.3% of Europeans (P < 0.0005).

Conclusions
Māori have lower rates of optimal thyroid levels than their European counterparts at all time points studied. Early disparity was associated with a higher RAI failure rate. Late differences were due to higher rates of untreated hypothyroidism. Overall, euthyroid rates were low, indicating the need for improvement in care, particularly for indigenous peoples.