bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Acute Organ Dysfunction on Long-Term Survival in Sepsis*
Authors: Schuler Alejandro , Wulf David A. , Lu Yun , Iwashyna Theodore J. , Escobar Gabriel J. , Shah Nigam H. , Liu Vincent X. 
Published: February 2018

Objectives:
To estimate the impact of each of six types of acute organ dysfunction (hepatic, renal, coagulation, neurologic, cardiac, and respiratory) on long-term mortality after surviving sepsis hospitalization.

Design:
Multicenter, retrospective study.

Settings:
Twenty-one hospitals within an integrated healthcare delivery system in Northern California.

Patients:
Thirty thousand one hundred sixty-three sepsis patients admitted through the emergency department between 2010 and 2013, with mortality follow-up through April 2015.

Interventions:
None.

Measurements and Main Results:
Acute organ dysfunction was quantified using modified Sequential Organ Failure Assessment scores. The main outcome was long-term mortality among sepsis patients who survived hospitalization. The estimates of the impact of each type of acute organ dysfunction on long-term mortality were based on adjusted Cox proportional hazards models. Sensitivity analyses were conducted based on propensity score–matching and adjusted logistic regression. Hospital mortality was 9.4% and mortality was 31.7% at 1 year. Median follow-up time among sepsis survivors was 797 days (interquartile range: 384–1,219 d). Acute neurologic (odds ratio, 1.86; p < 0.001), respiratory (odds ratio, 1.43; p < 0.001), and cardiac (odds ratio, 1.31; p < 0.001) dysfunction were most strongly associated with short-term hospital mortality, compared with sepsis patients without these organ dysfunctions. Evaluating only patients surviving their sepsis hospitalization, acute neurologic dysfunction was also most strongly associated with long-term mortality (odds ratio, 1.52; p < 0.001) corresponding to a marginal increase in predicted 1-year mortality of 6.0% for the presence of any neurologic dysfunction (p < 0.001). Liver dysfunction was also associated with long-term mortality in all models, whereas the association for other organ dysfunction subtypes was inconsistent between models.

Conclusions:
Acute sepsis-related neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality and represents a key mediator of long-term adverse outcomes following sepsis.
Impact of Tourette Syndrome on School Measures in a Nationally Representative Sample
Authors: Claussen Angelika H. , Bitsko Rebecca H. , Holbrook Joseph R. , Bloomfield Jeanette , Giordano Kathy 
Published: February 2018

ABSTRACT:

Objective:
Children with Tourette syndrome (TS) are at risk for a variety of co-occurring conditions and learning and school problems. The purpose of this study was to determine the impact of TS and co-occurring conditions on school measures.

Methods:
Parent-reported data from the 2007–2008 and 2011–2012 National Survey of Children's Health were combined (n = 129,353 children aged 6–17 yrs). Parent report of health care provider diagnosis of TS; co-occurring mental, emotional, and behavioral conditions; learning and language conditions; and school measures were assessed. School measures included type of school, individual education plan (IEP), number of school days missed, school problems, doing well in school, doing homework, and repeating a grade. Children with TS were compared with those who never had TS on school measures accounting for co-occurring conditions.

Results:
After adjusting for demographics, compared with children without TS, children currently with TS were more likely to have an IEP, have a parent contacted about school problems, and not complete homework. After further adjusting for co-occurring conditions, only IEP status remained statistically significant. Compared with children with mild TS, children with moderate or severe TS were more likely to have an IEP, repeat a grade, encounter school problems, and not care about doing well in school.

Conclusion:
Tourette syndrome severity and co-occurring conditions are associated with school challenges and educational service needs. Awareness among health care providers, teachers and parents of the potential challenges related to both TS and co-occurring conditions would help to best support the child's education.
Efficacy of misoprostol before diagnostic hysteroscopy in postmenopausal women: a randomized clinical trial
Authors: Nakano Fabiana Y. , Yela Daniela A. , Pinto Joao P.L. , Riegas Talita , Benetti-Pinto Cristina L. , Pedro Adriana Orcesi , Paiva Lucia Helena Costa 
Published: February 2018

Abstract

Objective:
To evaluate pain and determine the efficacy of misoprostol, compared with placebo, for postmenopausal women before diagnostic hysteroscopy.

Methods:
This randomized, double-blind, placebo-controlled clinical trial included 158 postmenopausal women who received either 200 μg of misoprostol or placebo through the vaginal route before diagnostic hysteroscopy (79 women/group). The primary outcome was pain assessment (presence and intensity) during the four steps of hysteroscopy: cervical grasping with a Pozzi tenaculum forceps immediately before hysteroscopy, during hysteroscopy, during performance of the endometrial biopsy, and postprocedure. The secondary outcomes were duration of the procedure, need for additional cervical dilatation, complications, and adverse effects.

Results:
Mean ages of the women were 62 ± 8.2 years and 60 ± 7.3 years in the misoprostol and placebo groups, respectively. Abnormal bleeding (misoprostol group, 45.6%; placebo, 43%) and endometrial thickening (54.4% in the misoprostol group and 57% in the placebo group) were the most common indications for the examination in both groups (P = 0.49). There was no significant difference between groups in the pain intensity of the four steps of the procedure. The duration of hysteroscopy was similar in both groups (misoprostol group, 2.5 ± 2.7 minutes; placebo, 2.1 ± 1.6 minutes; P = 0.43). Additional cervical dilatation was needed in 11 women in the misoprostol group versus 9 in the placebo group (P = 0.63). In both groups, there was no significant difference in terms of complications. Adverse effects were reported by 25.3% of women using misoprostol (vaginal bleeding, 11.3%; cramping, 12.6%; diarrhea, 2.5%; 1 woman reported both vaginal bleeding and cramping). In the placebo group, only 2.5% of women developed adverse effects (P < 0.0001).

Conclusion:
Misoprostol does not reduce pain intensity, the duration of the procedure, or need for additional cervical dilatation, and causes more adverse effects when used in postmenopausal women before diagnostic hysteroscopy.
Two-year Follow-up of Patients With Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Undergoing Early Invasive Strategy: Predictors of Normal or Near-Normal Coronary Angiography and Mortality
Authors: Jenab Yaser , Kassaian Ebrahim , Pourhosseini Hamid Reza , Salarifar Mojtaba , Jalali Arash , Talasaz Azita Hajhossein 
Published: February 2018

Background:
Predictors of normal or near-normal coronary angiography (NONCAG) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and their importance regarding the prognosis are not understood. Accordingly, we determined these predictors as well as mortality risk factors at 2-year follow-up of UA/NSTEMI patients managed by the early invasive strategy.

Methods:
We prospectively studied consecutive patients with UA/NSTEMI managed with the early invasive strategy at Tehran Heart Center, in 1-year period. Echocardiography was performed before coronary angiography (CAG) for all the patients. Baseline characteristics, laboratory parameters, echocardiographic findings, invasive treatment modalities, and survival status after 2 years of follow-up were collected. We identified the predictors of NONCAG in the first phase of the study and then the risk factors of mortality in the second phase.

Results:
In the study period, 298 patients including 211 (71%) males, with the age of 59.31 ± 10.72 years were enrolled. The following factors were predictors of NONCAG: the female sex (P < 0.001); negative family history of CAD (P = 0.028); Thrombolysis in Myocardial Infarction (TIMI) risk score (P < 0.001); and early transmitral flow velocity/mean mitral annular velocity (E/E′mean) (P = 0.003). The following items were significant protective factors against mortality: percutaneous coronary intervention (PCI) (P = 0.012), age (P = 0.001), and E/E′mean (P = 0.020).

Conclusion:
Patients’ baseline characteristics as well as echocardiographic data could help in predicting those with NONCAG and PCI can be considered as the treatment of strategy with the most protection against mortality.
Clinical Outcomes of Transferred Versus Onsite Primary Percutaneous Coronary Intervention for Patients With STEMI: Time to Look Beyond Door to Balloon Time
Authors: Mallidi Jaya , Visintainer Paul , Pallekonda Indupriya , Fisher Daniel , Barringhaus Kurt , Kugelmass Aaron , Lotfi Amir 
Published: February 2018

Background:
It is currently unknown if the delay due to practical aspects associated with transfer of patients from a non-percutaneous coronary intervention (PCI) facility to a primary PCI facility is associated with adverse outcomes.

Methods:
We conducted a retrospective cohort study of all patients who presented with ST-segment elevation myocardial infarction (STEMI) and underwent primary PCI in 2 large regional STEMI centers in Massachusetts between January 2005 and June 2009. The cohort was divided into onsite patients who presented directly to the primary PCI center and transferred patients referred from another facility. The primary outcome was a composite of in-hospital major cardiovascular events (death, myocardial infarction, and stroke). Secondary outcomes were the individual components of the composite endpoint and bleeding complications.

Results:
The cohort included a total of 1236 patients. Among them, 426 (34%) patients were transferred patients and 810 (66%) were onsite patients. The median door to balloon time was significantly higher at for transferred patients (124 vs. 71 minutes). There was no significant difference in primary composite endpoint between the 2 groups (onsite 3.8% vs. transfer 5.3%, odds ratio 1.50, 95% confidence interval 0.79–2.84; P = 0.21). Adjusted risk estimates did not show a statistical difference in all-cause bleeding rates between the groups (onsite 10.1% vs. transfer 7.3%, odds ratio 0.68, 95% confidence interval 0.41–1.14; P = 0.14).

Conclusions:
This study confirms that well-established and integrated regional STEMI programs provide equivalent care to transferred patients and onsite patients. Parameters beyond door to balloon times should be investigated for their contributions to improve patient outcomes.
ECG-to-Decision Time Impact on 30-Day Mortality and Reperfusion Times for STEMI Care
Authors: Mullvain Richard , Saman Daniel M. , Rostvedt Ashlee , Landgren Pauline 
Published: February 2018

Objectives:
Little data are published on the unique care performance metric of electrocardiogram-to-decision time (E2Decide) for primary percutaneous coronary intervention (PCI) treatment of ST-elevation myocardial infarction (STEMI). The objective of this study is to evaluate E2Decide time on mortality and delayed reperfusion.

Methods:
This was a retrospective study of STEMI activations treated with primary PCI at 2 PCI-capable hospitals located in Duluth, Minnesota, and Fargo, North Dakota, originating in 3 different settings: (1) primary PCI-capable hospital emergency departments, (2) non-PCI facilities, and (3) in the field by emergency medical services. Analysis of variance, generalized linear modeling, and logistic regression models were used in this study.

Results:
There were 289 (96 females) STEMI patients included in our analyses. Non significant differences were observed in E2Decide time between male and female patients (9.7 vs. 11.1 min, respectively). Generalized linear modeling revealed that only non-PCI facilities significantly affected E2Decide time [β = 6.29; P = 0.007; 95% confidence interval (CI), 1.7–10.9] relative to PCI-capable hospitals. We found that E2Decide time was significantly associated with the metric decision-to-PCI, and that for every additional E2Decide minute, the decision-to-PCI increased by another 1.21 minutes (P < 0.001; 95% CI, 0.873–1.56). We also found a 20.3% increased odds of 30-day mortality for every 5-minute increase in E2Decide time (estimated odds ratio = 1.20; 95% CI, 1.04–1.38).

Conclusions:
We observed that a delay in E2Decide time was significantly associated with a subsequent delay in decision-to-PCI time. E2Decide time was significantly associated with increased odds in 30-day mortality. This study demonstrates the potential value of the metric E2Decide time.
Economic Evaluation of Selective Neonatal Bacillus Calmette-Guérin Vaccination of High-risk Infants in Ireland
Authors: Teljeur Conor , Moran Patrick S. , Harrington Patricia , Butler Karina , Corcoran Brenda , O’Donnell Joan , Usher Cara , O’Flanagan Darina , Connolly Kevin , Ryan Máirín 
Published: February 2018

Background:
In Western Europe, currently only Ireland and Portugal continue to provide universal neonatal bacillus Calmette-Guérin (BCG) vaccination programs, despite not being considered as high tuberculosis (TB) incidence countries. Other European countries only vaccinate infants considered at high risk of contracting TB. We evaluated the cost-effectiveness of selective BCG vaccination compared with strategies of universal and no vaccination.

Methods:
An economic model was used to simulate a cohort from birth to life expectancy, taking the perspective of the publicly funded healthcare system. BCG protection was modeled to last 15 years. International vaccine efficacy data were combined with Irish epidemiologic and cost data. The model took into account long-term sequelae associated with TB meningitis and severe adverse reactions relating to the BCG vaccine. A fully probabilistic model was used to incorporate uncertainty across all parameters.

Results:
At €139,557 per quality-adjusted life year, selective vaccination was not cost-effective relative to a program of no vaccination. The incremental cost-effectiveness of universal vaccination was €2.55 million per quality-adjusted life year relative to selective vaccination. There was substantial uncertainty regarding the effectiveness of BCG vaccination. The cost-effectiveness of selective vaccination could be substantially improved by reducing the cost of administering the vaccine.

Conclusions:
In the absence of changes to other aspects of TB control, a switch to selective vaccination will result in increased cases of childhood TB. Although not considered cost-effective, selective vaccination may be preferable to no vaccination until other changes to TB control may be implemented to reduce the risk of TB in children.
Reducing morbidity and complications after major head and neck cancer surgery: the (future) role of enhanced recovery after surgery protocols
Authors: Huber Gerhard F. , Dort Joseph C. 
Published: February 2018

Purpose of review
To review the development and the benefits of enhanced recovery after surgery (ERAS) protocols in non-head and neck disciplines and to describe early implementation efforts in major head and neck surgeries.

Recent findings
Several groups have adopted ERAS protocols for major head and neck surgery and demonstrated its feasibility and effectiveness.

Summary
There is growing evidence that clinical and financial outcomes for patients undergoing major head and neck surgery rehabilitation can be significantly improved by standardizing preoperative, intraoperative, and postoperative treatment protocols. Current experience is limited to single centers. A future goal is to broaden the adoption of ERAS in head and neck surgical oncology to include national and international collaboration, data sharing, and learning.
Prematurity and future kidney health: the growing risk of chronic kidney disease
Authors: Starr Michelle C. , Hingorani Sangeeta R. 
Published: February 2018

Purpose of review
The purpose of this review is to describe the role prematurity plays in the development of chronic kidney disease (CKD) and to discuss potential reasons for this association including decreased nephron mass, as well as postnatal insults such as neonatal acute kidney injury (nAKI).

Recent findings
New observational studies in humans and experimental studies in animal models have strengthened the association between prematurity, low birth weight and CKD. Growing evidence suggests increased susceptibility to CKD is caused by decreased nephron mass at birth. Beginning with a low nephron count may cause only subtle abnormalities during childhood, however may result in CKD, hypertension and albuminuria in adolescence or adulthood. Recent studies in premature infants reveal a high incidence of nAKI, which may also contribute to ongoing CKD risk.

Summary
Children born at low birth weights (both due to prematurity and/or intrauterine growth restriction) show increased risk of kidney dysfunction during adulthood. A better understanding of the modulators of nephron mass in premature infants as well as the effects of the extrauterine environment is essential. Additionally, improved awareness of at-risk infants is important as is early evaluation and detection of kidney dysfunction, allowing interventions to slow the progression to CKD.
Neutrophil Extracellular Traps in Children With Meningococcal Sepsis
Authors: Hoppenbrouwers Tamara , Boeddha Navin P. , Ekinci Ebru , Emonts Marieke , Hazelzet Jan A. , Driessen Gertjan J. , de Maat Moniek P. 
Published: February 2018

Objectives:
Children with meningococcal sepsis are highly at risk for fulminant disease, multiple organ failure, and death. Recently, neutrophil extracellular traps levels have been indicated as a marker for severity in different kinds of sepsis. Our aim was to study the role of neutrophil extracellular traposis in meninogococcal sepsis in children.

Design:
We measured myeloperoxidase-DNA, a marker for neutrophil extracellular traps, in serum of meningococcal sepsis patients upon admission to PICU, at 24 hours, and at 1 month and studied the association with clinical outcome. Subsequently, we tested whether Neisseria meningitidis, isolated from children with meningococcal sepsis, were able to induce neutrophil extracellular traposis, using confocal microscopy live imaging.

Setting:
We used enzyme-linked immunosorbent assays to measure myeloperoxidase-DNA in patient serum. We also included inflammatory markers that were previously measured in this group.

Patients:
We included exclusively children with meningococcal sepsis.

Interventions:
From each patient, serum was collected for analysis.

Measurements and Main Results:
Myeloperoxidase-DNA levels at admission (n = 35; median, 0.21 AU/mL; interquartile range, 0.12–0.27) and at 24 hours (n = 39; median, 0.14 AU/mL; interquartile range, 0.09–0.25) were significantly higher than the myeloperoxidase-DNA levels after 1 month (controls: n = 36; median, 0.07 AU/mL; interquartile range, 0.05–0.09; p < 0.001). We did not observe a correlation between myeloperoxidase-DNA levels and mortality, cell-free DNA, or other inflammatory markers. In addition, N. meningitidis are fast and strong inducers of neutrophil extracellular traposis.

Conclusions:
Children admitted to PICU for meningococcal sepsis have higher neutrophil extracellular traps levels at admission and after 24 hours than controls. Neutrophil extracellular traps levels were not associated with outcome, cell-free DNA, or other inflammatory markers. These neutrophil extracellular traps may be induced by N. meningitidis, since these are strong neutrophil extracellular traposis inducers.
Comparison of Transplant Waitlist Outcomes for Pediatric Candidates Supported by Ventricular Assist Devices Versus Medical Therapy
Authors: Law Sabrina P. , Oron Assaf P. , Kemna Mariska S. , Albers Erin L. , McMullan D. Michael , Chen Jonathan M. , Law Yuk M. 
Published: February 2018

Objectives:
Ventricular assist devices have gained popularity in the management of refractory heart failure in children listed for heart transplantation. Our primary aim was to compare the composite endpoint of all-cause pretransplant mortality and loss of transplant eligibility in children who were treated with a ventricular assist device versus a medically managed cohort.

Design:
This was a retrospective cohort analysis.

Settings:
Data were obtained from the Scientific Registry of Transplant Recipients.

Patients:
The at-risk population (n = 1,380) was less than 18 years old, either on a ventricular assist device (605 cases) or an equivalent-severity, intensively medically treated group (referred to as MED, 775 cases).

Interventions:
None.

Measurements and Main Results:
The impact of ventricular assist devices was estimated via Cox proportional hazards regression (hazard ratio), dichotomizing 1-year outcomes to “poor” (22%: 193 deaths, 114 too sick) versus all others (940 successful transplants, 41 too healthy, 90 censored), while adjusting for conventional risk factors. Among children 0–12 months old, ventricular assist device was associated with a higher risk of poor outcomes (hazard ratio, 2.1; 95% CI, 1.5–3.0; p < 0.001). By contrast, ventricular assist device was associated with improved outcomes for ages 12–18 (hazard ratio, 0.3; 95% CI, 0.1–0.7; p = 0.003). For candidates 1–5 and 6–11 years old, there were no differences in outcomes between the ventricular assist device and MED groups (hazard ratio, 0.8 and 1.0, p = 0.43 and 0.9). The interaction between ventricular assist devices and age group was strongly significant (p < 0.001).

Conclusions:
This is a comparative study of ventricular assist devices versus medical therapy in children. Age is a significant modulator of waitlist outcomes for children with end-stage heart failure supported by ventricular assist device, with the impact of ventricular assist devices being more beneficial in adolescents.