bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ocular radiation exposure during endoscopic retrograde cholangiopancreatography: a meta-analysis of studies
Authors: Menon Shyam , Mathew Ray , Kumar Mayur 
Published: January 2019

Background
The increasing complexity involved in procedures requiring fluoroscopy such as endoscopic retrograde cholangiopancreatography (ERCP) results in heightened screening times with attendant radiation exposure during these procedures. There is increasing awareness of tissue-reactions to the lens of the eye due to radiation exposure, with evidence suggesting that threshold doses may be lower than previously considered.

Materials and methods
A literature search was performed to identify studies involving ERCP in which radiation exposure was reported. Demographic data and data on fluoroscopy time and ocular exposure were extracted. Fixed and random-effects meta-analyses were conducted.

Results
Twenty-six studies (8016 procedures) were identified, of which 10 studies (818 procedures) contained data on ocular exposure. The mean screening time per procedure was 3.9 min with a mean of three images captured per procedure. On fixed effects meta-analysis, the point estimate for the effective ocular exposure dose per procedure was 0.018 (95% confidence interval: 0.017–0.019) mSv. On random-effects meta-analysis, the effective ocular exposure dose was 0.139 (0.118–0.160) mSv (Q=2590.78, I
2=99.5, P<0.001). On comparing these point estimates to the ocular dose limit of 20 mSv/year, 1111 ERCPs (using fixed effects data) and 144 ERCPs (using random-effects data), with a mean of 627 ERCPs/individual/year, could deliver an ocular radiation dose equivalent to this dose limit.

Conclusion
Ocular radiation exposures in high-volume ERCP operators (>200 procedures/year) and operators performing complex ERCPs involving prolonged fluoroscopy, need to exercise caution in relation to ocular exposure. Shielding using lead-lined glasses may be reasonable in this group.
A 3-Year Retrospective Study of the Epidemiology of Acute Respiratory Viral Infections in Pediatric Patients With Cancer Undergoing Chemotherapy
Authors: Aydin Köker Sultan , Demirağ Bengü , Tahta Neryal , Bayram Nuri , Oymak Yeşim , Karapinar Tuba H. , Gözmen Salih , Düzgöl Mine , Erçan Bozyer Hazer , Vergin Canan , Devrim İlker 
Published: January 2019

Background:
Acute viral respiratory infections are common causes of febrile episodes in children. There are still limited data about distribution of acute viral respiratory infections in children with cancer.

Objective:
The first aim of this study was to evaluate the viral etiology and seasonality of acute viral respiratory infection in pediatric patients with cancer in a 3-year study. Our second aim was to evaluate the impact of viral infections on delaying the patients’ chemotherapy or radiotherapy.

Materials and Methods:
This cross-sectional study was conducted from January 2014 to July 2017. Nasopharyngeal aspirates were analyzed in patients younger than 21 years with acute respiratory infections. Patients were treated in the Pediatric Hematology and Oncology Department of Dr. Behçet Uz Children’s Hospital with real-time multiplex polymerase chain reaction. Data were analyzed to determine the frequency and seasonality of infections. The χ2 or the Fisher exact tests were used.

Results:
A total of 219 samples of nasopharyngeal aspirates and blood were analyzed. The mean patient age was 76.8±59.3 months, with 46.3% female and 53.7% male children in a total of 108 patients. Of this total, 55% (60/108 cases) had multiple acute respiratory infections. Acute lymphoblastic leukemia (48.1%) was the most prevalent disease. The 3 most prevalent viruses were human rhinovirus (HRV) (33.1%), parainfluenza (PI) (18.7%), and coronavirus (CoV) (14.8%). In terms of the seasonal distribution of viruses, PI was most common in winter 2014, HRV in spring 2014, HRV in fall 2014, PI in winter 2015 and summer 2015, CoV in spring 2015, HRV in fall 2015, both influenza and HRV in winter 2016, both human metapneumovirus and bocavirus in spring 2016, HRV in summer 2016, both HRV and PI in fall 2016, both respiratory syncytial virus and influenza in winter 2017, HRV in spring 2017, and both HRV and adenovirus in summer 2017. The mean duration of neutropenia for patients with viral respiratory infection was 17.1±13.8 (range: 2 to 90) days. The mean duration of symptoms of viral respiratory infection was 6.8±4.2 (range: 2 to 31) days. A delay in chemotherapy treatment owing to viral respiratory infection was detected in 73 (33.3%) patients. The mean duration of delay in chemotherapy treatment was 9.6±5.4 (range: 3 to 31) days.

Conclusions:
In conclusion, we report our 3-year experience about the frequency and seasonality of respiratory viruses in children with cancer.
Birth Tourism Among Chinese Women
Authors: Jaramillo Juanita , Goyal Deepika , Lung Carmen 
Published: January 2019

Abstract

Purpose:
To explore the reasons why some Chinese women travel to the United States on a tourist visa specifically to give birth, also known as birth tourism.

Study Design:
Qualitative, exploratory design.

Methods:
Using convenience and snowball sampling, Chinese women were recruited from the waiting rooms of obstetricians known to care for birth tourists. Participants completed demographic data and provided answers to questions about their reasons for traveling to give birth and their birth experience while in the United States. Qualitative content analysis methods were used to extract themes from participant narratives.

Results:
Twelve married, college-educated women, aged between 26 and 39 years, self-identifying as birth tourists from China participated in this study. Content analysis revealed two themes: (1) positive perceptions of childbirth in the United States; and (2) securing a future for their child.

Clinical Implications:
Study findings suggest Chinese birth tourists come to the United States for a better childbirth experience, and to secure future opportunities for their children. Nurses should be aware of the current political climate on immigration and birth tourism in order to promote a safe and judgment-free environment when providing care to this unique population of women.
Association Between Lactation and Postpartum Blood Pressure in Women with Preeclampsia
Authors: Burgess Adriane , McDowell Wendy , Ebersold Stacie 
Published: January 2019

Abstract

Purpose:
Preeclampsia affects 3% to 8% of all pregnancies. There are two distinct subtypes; early- (<34 weeks) and late-onset (≥34 weeks). Each subtype is associated with increased risk of cardiovascular disease. Lactation has been shown to improve cardiovascular outcomes. The purpose of this study was to describe lactation practices among women with each subtype of preeclampsia and determine the association between lactation and blood pressure at the initial postpartum visit.

Study Design and Methods:
This retrospective cohort study included 246 subjects; 120 early- and 126 with late-onset preeclampsia who gave birth to live singleton newborns at a large suburban tertiary referral center in south central Pennsylvania between January 2012 and June 2016. Electronic health records were reviewed and data abstracted. Univariate and bivariate analyses were conducted.

Results:
There was a significant difference in breastfeeding intent (p = .004) as well as rate of breastfeeding at maternal hospital discharge (p< .001) by preeclampsia subtype. However, there was no difference in rate of breastfeeding at the initial postpartum visit (p = .21) between subtypes. There was a significant difference in systolic (p = .03) and diastolic (p = .04) blood pressure between those breastfeeding and those who were not breastfeeding at the initial postpartum visit.

Clinical Implications:
Healthcare providers should provide women with preeclampsia clear and consistent messaging about importance of breastfeeding during pregnancy and the postpartum period on its association with improved neonatal outcomes, and specifically education on the cardioprotective benefit of sustained lactogenesis.
Neural Responses to Faces of Attachment Figures and Unfamiliar Faces
Authors: Petrowski Katja , Wintermann Gloria-Beatrice , Hübner Thomas , Smolka Michael N. , Donix Markus 
Published: January 2019

Abstract
The neural response to faces of attachment figures compared with unfamiliar faces still remains elusive. In particular, the modulation of the neural response by the organized (secure, insecure) compared with disorganized attachment representation of the subject investigated is unknown. For the present study, 38 healthy participants (age range, 21–71 years) were recruited. Three attachment groups (secure, n = 14; insecure, n = 15; disorganized, n = 9) were assessed using the Adult Attachment Projective. The participants were shown pictures of the faces of attachment figures (romantic partner/parents) and unfamiliar faces in a blocked factorial design, using functional magnetic resonance imaging. Showing pictures of attachment figures activated parts of a neural social judgment network, important for inferring others' affective and cognitive mental states (e.g., inferior parietal lobe/superior temporal gyrus) in securely attached healthy individuals. In contrast, disorganized attached individuals with the experience of unresolved attachment trauma in their biography showed deactivations in these areas.
Poly D,L-Lactide-Co-Glycolic Acid Grafting Material in Sinus Lift
Authors: Mastrangelo Filiberto , Quaresima Raimondo , Sebastianelli Ilaria , Dedola Alberto , Kuperman Shiri , Azzi Lorenzo , Mortellaro Carmen , Muttini Aurelio , Mijiritsky Eitan 
Published: January 2019

Abstract
The poly D,L-lactide-co-glycolic acid (PLGA) is a copolymer used in many therapeutic devices for its high rates of biodegradability and biocompatibility. The principal aim of the research was to evaluate the new bone formation, after 16 (T1) and 28 weeks (T2), in sheep maxillary sinus lift in vivo model using PLGA.
Computerized tomography analysis, X-ray microanalysis, and scanning electron microscope analysis of secondary electrons (SE) and the backscattered electrons (BSE) of the samples were detected.
After 28 weeks, the computed tomography analysis showed a 22% increase of UH density in the grafting areas. The X-ray microanalysis of the samples showed calcium and phosphorus increase at T1 and T2 follow-up period and the carbon and oxygen concentration decrease. The SE evaluation showed a rapid superficial resorption of the biomaterials at T1 and a completely bone reorganization of biomaterial at T2. The BSE analysis confirmed the SE data and showed the direct and intimate contact between bone and PLGA with a higher calcification in T2 compared to T1.
Certainly, still other experiments and a larger number of samples will be necessary to be analyzed to determine the behavior of the PLGA in the bone regeneration; however, the PLGA used in maxillary sinus lift animal model, seem to promote new bone formation that continues increase at 28 weeks after grafting.
Importance of Three-Dimensional Modeling in Cranioplasty
Authors: Aydin Hasan Emre , Kaya Ismail , Aydin Nevin , Kizmazoglu Ceren , Karakoc Feridun , Yurt Hidayet , Hüsemoglu Resit Bugra 
Published: January 2019

Abstract
Cranioplasty is a reconstruction operation made to protect intracranial structures. It is applied for the closure of bone defects occurring due to causes such as trauma, tumor, infection, and infarct. Many different products changing from autologous bone grafts to synthetic materials are used for cranioplasty. Three-dimensional printers that are among the popular innovations of today are used gradually more in medical area as in every field of life and they make the surgical operation easier. When customizable materials are combined with technology, the authors come across successful results and less complications. The aim of the authors’ study was to show a 3-dimensional modeling method in 2 patients the authors applied cranioplasty and the advantages provided by this method for the surgeon and the patient.
Ischemic Time in Free-Flap Surgery With Arteriovenous Bundle Interposition Graft: Comparison of Two Anastomosis Sequences
Authors: Kim Yong-Ha , Kim Jae-Won , Kim Tae-gon , Lee Jun-Ho , Chung Kyu Jin , Yeo Chi-Ho 
Published: January 2019

Background:
During free-tissue transfer for scalp reconstruction, pedicle lengthening may be required when finding a recipient vessel is difficult because of defects from previous surgery. Arteriovenous (AV) bundle interposition grafting is a good option. This study compared 2 sequences of AV bundle interposition grafting when flap pedicle lengthening is needed.

Methods:
Two anastomosis methods were used. In the recipient lengthening type (R type), the flap was harvested and the AV bundle was harvested from a donor vessel for lengthening. In the flap lengthening type (F type), the flap was harvested first. Next, in contrast to that in the R type method, the authors performed anastomosis with a flap pedicle and bundle before the AV bundle was harvested.

Results:
The mean flap pedicle length was 8.75 cm (range, 5–11 cm). The AV bundle had a mean length of 9.25 cm (range, 6–13 cm), meaning that 13 cm of additional pedicle length can be added. The mean length of the extended vascular pedicle was 18 cm (range, 14–23 cm).

Conclusion:
This study compared the results of F type and R type AV bundle interposition grafting. The F type allowed easy monitoring of the anastomosis of the flap pedicle and ensured flap stability by reducing continuous ischemic time. Finally, this study confirmed the efficacy and safety of the AV bundle interposition graft in scalp reconstruction.
Predictors of Adverse Outcomes in the Management of Mandibular Fractures
Authors: Daar David A. , Kantar Rami S. , Cammarata Michael J. , Rifkin William J. , Alfonso Allyson R. , Wilson Stelios C. , Rodriguez Eduardo D. 
Published: January 2019

Background:
Mandibular fractures are the most common isolated facial fractures in the United States. Various risk factors have been associated with increased rates of postoperative complications. However, national outcome reports are limited and data are conflicting. Using a national multi-institutional database, the authors sought to analyze 30-day outcomes after mandibular fracture repair and determine risk factors for complications, readmission, and reoperation.

Methods:
Retrospective review of the American College of Surgeons National Surgical Quality Improvement database was performed to identify patients undergoing surgical treatment of mandibular fractures between 2010 and 2015 using current procedural terminology codes. Primary outcomes included: wound complications, overall complications, as well as readmission and reoperation rates. Multivariate regression analysis was performed to adjust for confounders.

Results:
A total of 953 patients were eligible for analysis. Mean patient age was 34.5 years, 84% were males, and 50% were active smokers. Wound complications, overall complications, 30-day reoperation, and readmission occurred in 4.0%, 7.9%, 2.2%, and 33% of patients, respectively. Age was a significant risk factor for 30-day readmission (odds ratio [OR] = 1.06, P = 0.01), reoperation (OR = 1.05, P = 0.01), and overall complications (OR = 1.03, P = 0.02) on multivariate analysis, and smoking was a significant risk factor for 30-day reoperation (OR = 4.86, P = 0.03).

Conclusion:
The analysis identified age as an independent risk factor for readmission, reoperation, and overall complications. Smokers were also nearly 5 times as likely to undergo additional surgery. This is particularly important given that over half of patients were active smokers, highlighting the importance of perioperative patient education and smoking cessation within this population.
An Unreported Complication After Fetoscopic Myelomeningocele Closure
Authors: Ewing Donald C. , Dempsey Robert , Belfort Michael A. , Olutoye Oluyinka O. , Whitehead William E. , Hollier Larry H. , Buchanan Edward P. 
Published: January 2019

Abstract
Myelomeningocele (MMC) is a type of open neural tube defect characterized by exposure of the spinal cord through a defect in the skin and posterior hindbrain herniation through the foramen magnum. Outcomes vary but common morbidities include paraplegia, hydrocephalus, neurogenic bladder, scoliosis, and tethered cord. Fetal surgery, although not a cure, has been shown to decrease the risk of associated morbidity.
A study of a neonate born at 39 5/7 weeks gestation status-post in utero fetoscopic MMC repair at 24 weeks gestation was presented in this study along with a concise review of the literature. Fasciocutaneous advancement flaps were made in utero to facilitate a tension-free midline closure and were left to heal secondarily. The neonate underwent uncomplicated spontaneous vaginal delivery but was noted to have a right flank hernia through the relaxing incision in addition to delayed healing of the left relaxing incision. According to authors, iatrogenic flank hernia following fetoscopic MMC repair has not been previously reported in the literature. Both defects were repaired primarily in layers with undermining and retroperitoneal domain was reestablished with imbrication of the overlying muscle on the right side. The authors report their experience to contribute to the scarce literature describing postnatal complications arising from this novel procedure.
Successful Reconstruction of Agnathia by Intraoral Expansion and Free Vascularized Fibula Flap
Authors: Ishida Kunihiro 
Published: January 2019

Abstract
A successful surgical reconstruction case of a 9-year-old boy with agnathia is presented. The reconstruction was preceded by intraoral expansion of the oral lining and submandibular skin. Four months after initiation of the expansion, the mandible was reconstructed by free vascularized fibula osteocutaneous flap. The 14.5 cm segment of harvested fibula was osteotomized in 4 places to build a replica of the mandible with 3 cm ascending ramus, 3.5 cm body and 1.5 cm symphysis, fixated by titanium micro plating system. The reconstructed mandible was placed between the expanded oral lining and the submandibular skin, with its condylar head placed under the glenoid fossa. After reconstruction, he looked more natural with a chin projection, which he never had. His mother was very happy to see his son being able to show his feeling with facial expression. At last follow-up, he is 14 years and 10 months old, 5 years and 2 months after surgery leading a happy life with his family.
Use of Continuous EEG Monitoring in Children Presenting With Encephalopathy Following Convulsive Status Epilepticus
Authors: Yuliati Asri , Weber Amanda R. B. 
Published: January 2019

Purpose:
The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society recommends continuous EEG (cEEG) monitoring in patients with persistent encephalopathy following convulsive status epilepticus. This recommendation is based on data, which correlates prolonged nonconvulsive seizures and nonconvulsive status epilepticus with worse neurologic outcomes. Compliance with these recommendations may be limited by barriers such as inadequate resource and staff availability. We surveyed members of the Child Neurology Society to determine the barriers that prevent them from appropriately using cEEG, and how they have successfully overcome such obstacles.

Methods:
A survey was electronically distributed to Child Neurology Society members, which assessed demographics, current clinical practices, and cEEG utilization in critically ill children, with an emphasis on resource availability and strategies to overcome resource limitations.

Results:
One hundred forty-six physicians from Child Neurology Society completed the survey. Fifty-three (39.8%) respondents use cEEG to detect nonconvulsive seizures/nonconvulsive status epilepticus in most (>90%) of their pediatric patients who present with persistent encephalopathy following convulsive status epilepticus. Forty-four respondents (34.4%) perceive barriers to performing cEEG monitoring, and 107 (84.9%) of the respondents are implementing changes to overcome barriers. The two most commonly reported barriers included inadequate availability of technicians and EEG machines. The most common changes included hiring new EEG technologists and purchasing new machines. Other barriers included identification of appropriate patients and availability of remote EEG monitoring capabilities.

Conclusions:
Barriers, such as resource limitations, prevent compliance with the American Clinical Neurophysiology Society cEEG monitoring recommendations. Recognizing common limitations and learning from each other about successful strategies to overcome these barriers may improve care.
Characterizing the Dynamical Complexity underlying Meditation
Authors: Escrichs Anira , Sanjuan Ana , Atasoy Selen , López-González Ane , Garrido César , Càmara Estela , Deco Gustavo 
Published: January 2019

AbstractOver the past 2,500 years, contemplative traditions have explored the nature of the mind using meditation. More recently, neuroimaging research on meditation has revealed differences in brain function and structure in meditators. Nevertheless, the underlying neural mechanisms are still unclear. In order to understand how meditation shapes global activity through the brain, we investigated the spatiotemporal dynamics across the whole-brain functional network using the Intrinsic Ignition Framework. Recent neuroimaging studies have demonstrated that different states of consciousness differ in their underlying dynamical complexity, i.e., how the broadness of communication is elicited and distributed through the brain over time and space. In this work, controls and experienced meditators were scanned using functional magnetic resonance imaging (fMRI) during resting-state and meditation (focused attention on breathing). Our results evidenced that the dynamical complexity underlying meditation shows less complexity than during resting-state in the meditator group but not in the control group. Furthermore, we report that during resting-state, the brain activity of experienced meditators showed higher metastability (i.e., a wider dynamical regime over time) than the one observed in the control group. Overall, these results indicate that the meditation state operates in a different dynamical regime than the resting-state.