bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Curse of the All-Star Team: A Single-Season Prospective Shoulder MRI Study of Little League Baseball Players
Authors: Holt Joshua B. , Stearns Philip H. , Bastrom Tracey P. , Dennis M. Morgan , Dwek Jerry R. , Pennock Andrew T. 
Published: April 2019

Background:
Throwing guidelines have been implemented in Little League baseball in an attempt to minimize injuries in young baseball players. We hypothesized that playing pitcher or catcher and increased innings played during the season would result in dominant shoulder magnetic resonance imaging (MRI) abnormalities.

Methods:
A prospective evaluation of Little League players aged 10 to 12 years was performed. Players recruited before the start of the season underwent bilateral preseason and dominant shoulder postseason MRI, physical examination, and questionnaires addressing their playing history and arm pain. Innings played, player position, pitch counts, and all-star team selection were recorded.

Results:
In total, 23 players were enrolled. The majority (19/23, 82.6%) were right-handed and 16 of 23 (69.6%) played at least 10 innings as pitcher or catcher. Sixteen were selected for the all-star team. Fourteen players (60.9%) had positive dominant shoulder MRI findings not present in their nondominant shoulder. Eight players (34.8%) had new or worsening postseason MRI findings. Thirteen players (81.3%) selected to the all-star team had abnormal MRI findings whereas only one (14.3%) player not selected as an all-star had MRI abnormalities (P=0.005). Year-round play (P=0.016), innings pitched (P=0.046), innings catcher (P=0.039), and number of pitches (P=0.033) were associated with any postseason MRI abnormality, but not for new or worsening MRI changes. Single sport athletes and players playing for multiple teams were significantly more likely to have abnormal MRI findings (P=0.043 and 0.040, respectively) when compared with multisport athletes playing on a single team.

Conclusions:
MRI abnormalities involving the dominant shoulder are common in Little League baseball players and often develop or worsen during the season. Contrary to our hypothesis, MRI abnormalities were not associated with player position and pitch counts. Instead, they were most closely associated with year round play, single sports participation, and all-star team selection. The increased demands required for all-star selection comes at a price to the young athlete as the majority of players selected for this honor had abnormal MRI findings in their throwing shoulder while few non all-stars demonstrated such pathology.

Level of Evidence:
Level II.
Patient and Family Centered Actionable Processes of Care and Performance Measures for Persistent and Chronic Critical Illness: A Systematic Review
Authors: Rose Louise , Istanboulian Laura , Allum Laura , Burry Lisa , Dale Craig , Hart Nicholas , Kydonaki Kalliopi , Ramsay Pam , Pattison Natalie , Connolly Bronwen 
Published: April 2019

Objectives:To identify actionable processes of care, quality indicators, or performance measures and their evidence base relevant to patients with persistent or chronic critical illness and their family members including themes relating to patient/family experience.Data Sources:Two authors independently searched electronic, systemic review, and trial registration databases (inception to November 2016).Study Selection:We included studies with an ICU length of stay of greater than or equal to 7 days as an inclusion criterion and reported actionable processes of care; quality improvement indicators, measures, or tools; or patient/family experience. We excluded case series/reports of less than 10 patients.Data Extraction:Paired authors independently extracted data and performed risk of bias assessment.Data Synthesis:We screened 13,130 references identifying 114 primary studies and 102 relevant reviews. Primary studies reported data on 24,252 participants; median (interquartile range) sample size of 70 (32–182). We identified 42 distinct actionable processes of care, the most commonly investigated related to categories of 1) weaning methods (21 studies; 27 reviews); 2) rehabilitation, mobilization, and physiotherapy (20 studies; 40 reviews); and 3) provision of information, prognosis, and family communication (14 studies; 11 reviews). Processes with limited evidence were generally more patient-centered categories such as communication, promotion of sleep, symptom management, or family support. Of the 21 randomized controlled trials, only two were considered at low risk of bias across all six domains, whereas just two cohort studies and one qualitative study were considered of high quality.Conclusions:We identified 42 distinct actionable processes of care relevant to patients with persistent or chronic critical illness and their families, with most frequently studied processes relating to weaning, rehabilitation/mobilization, and family communication. Qualitative studies highlighted the need to address psychologic needs and distressing symptoms as well as enabling patient communication. Our findings are informative for clinicians and decision-makers when planning high-quality patient and family-focused care.
Fresh Red Cells for Transfusion in Critically Ill Adults: An Economic Evaluation of the Standard Issue Transfusion Versus Fresher Red-Cell Use in Intensive Care (TRANSFUSE) Clinical Trial
Authors: Irving Adam , Higgins Alisa , Ady Bridget , Bellomo Rinaldo , Cooper D. James , French Craig , Gantner Dashiell , Harris Anthony , Irving David O. , Murray Lynne , Nichol Alistair , Petrie Dennis , McQuilten Zoe K. 
Published: April 2019

Objectives:
Trials comparing the effects of transfusing RBC units of different storage durations have considered mortality or morbidity as outcomes. We perform the first economic evaluation alongside a full age of blood clinical trial with a large population assessing the impact of RBC storage duration on quality-of-life and costs in critically ill adults.

Design:
Quality-of-life was measured at 6 months post randomization using the EuroQol 5-dimension 3-level instrument. The economic evaluation considers quality-adjusted life year and cost implications from randomization to 6 months. A generalized linear model was used to estimate incremental costs (2016 U.S. dollars) and quality-adjusted life years, respectively while adjusting for baseline characteristics.

Setting:
Fifty-nine ICUs in five countries.

Patients:
Adults with an anticipated ICU stay of at least 24 hours when the decision had been made to transfuse at least one RBC unit.

Interventions:
Patients were randomized to receive either the freshest or oldest available compatible RBC units (standard practice) in the hospital transfusion service.

Measurements and Main Results:
EuroQol 5-dimension 3-level utility scores were similar at 6 months—0.65 in the short-term and 0.63 in the long-term storage group (difference, 0.02; 95% CI, –0.00 to 0.04; p = 0.10). There were no significant differences in resource use between the two groups apart from 3.0 fewer hospital readmission days (95% CI, –5.3 to –0.8; p = 0.01) during follow-up in the short-term storage group. There were no significant differences in adjusted total costs or quality-adjusted life years between the short- and long-term storage groups (incremental costs, –$2,358; 95% CI, –$5,586 to $711) and incremental quality-adjusted life years: 0.003 quality-adjusted life years (95% CI, –0.003 to 0.008).

Conclusions:
Without considering the additional supply cost of implementing a freshest available RBC strategy for critical care patients, there is no evidence to suggest that the policy improves quality-of-life or reduces other costs compared with standard transfusion practice.
A Double-Blind, Placebo-Controlled, Phase 3b Study of ATX-101 for Reduction of Mild or Extreme Submental Fat
Authors: Glogau Richard G. , Glaser Dee Anna , Callender Valerie D. , Yoelin Steve , Dover Jeffrey S. , Green Jeremy B. , Breshears Laura , Bowen Beta 
Published: April 2019

BACKGROUND
ATX-101 (deoxycholic acid injection) is approved for reduction of moderate or severe submental fat (SMF).

OBJECTIVE
To evaluate the efficacy and safety of ATX-101 in subjects with mild or extreme SMF.

PATIENTS AND METHODS
Adults with mild or extreme SMF (based on clinician assessment) were randomized to receive ≤6 treatments with ATX-101 or placebo. Efficacy end points, evaluated at 12 weeks after last treatment, included percentage of subjects who achieved ≥1-grade improvement in SMF from baseline based on both clinician and patient assessment (composite CR-1/PR-1 response) as well as multiple subject-reported outcomes. Safety end points included change in skin laxity and incidence of adverse events.

RESULTS
Overall, 61.3% of ATX-101–treated subjects versus 6.7% of placebo-treated subjects with mild SMF and 89.3% versus 13.3% of subjects, respectively, with extreme SMF achieved a composite CR-1/PR-1 response (p < .001 for both). ATX-101–treated subjects also reported higher levels of satisfaction and greater reductions in the psychological impact of SMF versus placebo-treated subjects regardless of baseline SMF severity. Skin laxity was unchanged or improved in most of the subjects. Adverse events were mainly mild/moderate, transient, and associated with the injection site.

CONCLUSION
ATX-101 was efficacious and well tolerated for reduction of mild or extreme SMF.
Vestibular Aqueduct Morphology Correlates With Endolymphatic Sac Pathologies in Menière's Disease—A Correlative Histology and Computed Tomography Study
Authors: Bächinger David , Luu Ngoc-Nhi , Kempfle Judith S. , Barber Samuel , Zürrer Daniel , Lee Daniel J. , Curtin Hugh D. , Rauch Steven D. , Nadol Joseph B. , Adams Joe C. , Eckhard Andreas H. 
Published: April 2019

Hypothesis:
The vestibular aqueduct (VA) in Menière's disease (MD) exhibits different angular trajectories depending on the presenting endolymphatic sac (ES) pathology, i.e., 1) ES hypoplasia or 2) ES degeneration.

Background:
Hypoplasia or degeneration of the ES was consistently found in inner ears affected by MD. The two etiologically distinct ES pathologies presumably represent two disease “endotypes,” which may be associated with different clinical traits (“phenotypes”) of MD. Recognizing these endotypes in the clinical setting requires a diagnostic tool.

Methods:
1) Defining the angular trajectory of the VA (ATVA) in the axial plane. 2) Measuring age-dependent normative data for the ATVA in postmortem temporal bone histology material from normal adults and fetuses. 3) Validating ATVA measurements from normative CT imaging data. 4) Correlating the ATVA with different ES pathologies in histological materials and CT imaging data from MD patients.

Results:
1) The ATVA differed significantly between normal adults and MD cases with ES degeneration, as well as between fetuses and MD cases with ES hypoplasia; 2) a strong correlation between ATVA measurements in histological sections and CT imaging data was found; 3) a correlation between the ATVA, in particular its axial trajectory in the opercular region (angle α
exit), with degenerative (α
exit < 120°) and hypoplastic ES pathology (α
exit > 140°) was demonstrated.

Conclusion:
We established the ATVA as a radiographic surrogate marker for ES pathologies. CT-imaging-based determination of the ATVA enables endotyping of MD patients according to ES pathology. Future studies will apply this method to investigate whether ES endotypes distinguish clinically meaningful subgroups of MD patients.
Primary Petrous Apex Epidermoids With Skull Base Erosion
Authors: Casazza Geoffrey C. , McCrary Hilary C. , Shelton Clough , Gurgel Richard K. 
Published: April 2019

Objective:
To describe the clinical course and treatment outcomes for patients with petrous apex epidermoid with skull base erosion.

Study Design:
Retrospective case series.

Setting:
Tertiary-care academic center.

Patients:
Patients surgically managed for petrous apex epidermoids at a single-tertiary care institution from 2001 to 2017.

Interventions:
Surgical management of primary petrous apex epidermoids.

Main Outcome Measures:
The presenting symptoms, imaging, pre- and postoperative clinical course, and complications were reviewed.

Results:
Seven patients were identified. The most common presenting symptoms included: sudden sensorineural hearing loss (n = 3), headaches (n = 1), vertigo (n = 2), and facial paralysis/paresis (n = 2). An epidermoid was discovered in two patients as an incidental finding after a head trauma and one patient after admission for altered mental status and meningitis. Two patients presented with complete facial paralysis (House–Brackmann 6/6). Preoperative normal hearing (pure-tone average < 25 db) was identified in three patients and serviceable hearing (pure-tone average 25–60 dB) in one patient. Three patients with nonserviceable hearing underwent a transcochlear or transotic approach. The remaining four patients underwent an attempted hearing preservation approach. Postoperatively, one patient developed delayed facial paralysis, improving within 3 months. Hearing was preserved in three patients. Two patients developed recurrence of disease within 4 and 7 years respectively.

Conclusions:
Surgical management of aggressive petrous apex epidermoid is effective to preserve facial function and prevent recurrence. In our series different surgical approaches were used with variable outcomes.
Clusters of Psychological Symptoms in Breast Cancer
Authors: Guimond Anne-Josée , Ivers Hans , Savard Josée 
Published: April 2019

Background
Breast cancer patients tend to experience numerous concurrent psychological symptoms that form clusters. It has been proposed that a common psychological mechanism may underlie the membership of symptoms in a given cluster, but this hypothesis has never been investigated. Maladaptive emotion regulation (ER) is one possible common mechanism.

Objective
This study examined cross-sectional and prospective relationships between subjective (experiential avoidance, expressive suppression, and cognitive reappraisal) and objective (high-frequency heart rate variability) measures of ER and clusters of psychological symptoms among women receiving radiation therapy for breast cancer.

Method
A total of 81 women completed a battery of self-report scales before (T1) and after (T2) radiotherapy, including measures of anxiety, depression, fear of cancer recurrence, insomnia, fatigue, pain, and cognitive impairments. Resting high-frequency heart rate variability was measured at T1.

Results
Latent profile analyses identified between 2 and 3 clusters of patients with similar levels of symptoms at T1 and T2 and with a similar profile of symptom changes between T1 and T2. Discriminant analyses showed that higher levels of avoidance and suppression predicted membership in symptom clusters that included more severe symptoms cross-sectionally at T1 and at T2 (both P values < .0001). However, ER at T1 did not significantly predict membership in clusters of symptom changes between T1 and T2 (P = .15).

Conclusion
Maladaptive ER strategies, more particularly suppression and avoidance, are a possible psychological mechanism underlying clusters of cancer-related psychological symptoms.

Implications for Practice
Psychological interventions targeting maladaptive ER strategies have the potential to treat several psychological symptoms simultaneously.
Increased Testing and Health Care Costs for Pediatric Cannabis Exposures
Authors: Bashqoy Ferras , Heizer Justin W. , Reiter Pamela D. , Wang George S. , Borgelt Laura M. 
Published: April 2019

Objectives
This study aimed to evaluate the process of identifying marijuana exposure in a children's hospital emergency department and compare the cost of diagnostic testing and procedures.

Methods
A retrospective chart review was performed on patients 31 days to 20 years old with a positive marijuana toxicology screen result between November 2009 and December 2014. Primary outcomes included time to provider recognition of marijuana exposure, number of diagnostic tests and procedures performed, and length of hospital stay. Patients were analyzed based on time of exposure recognition (forthcoming compared with not forthcoming of marijuana exposure) and age (children <12 years compared with adolescents >12 years).

Results
There were 37 children and 38 adolescents included. Mean time to exposure recognition was 2.3 ± 4.3 hours in children compared with 0.4 ± 0.9 hours in adolescents (P = 0.02). Patients who were not forthcoming of marijuana exposure experienced more than twice as many diagnostic tests or procedures compared with children who were forthcoming of marijuana exposure (mean, 8.91 vs 4 tests, P < 0.0001) and more than a 4-fold higher cost of potentially avoidable diagnostic tests/procedures. Length of hospital stay was significantly longer in children (18.34 ± 2.39 hours) compared with adolescents (4.22 ± 0.52 hours; P ≤ 0.0001). Few parents or guardians were able to disclose characteristics of the marijuana product.

Conclusion
Delay in recognition of marijuana exposure is associated with high resource utilization, unnecessary medical costs, and prolonged length of stay.
Dental Infection Cause of Flap Loss in Cleft Palate Repair
Authors: Jagtap Rasika , Deshpande Gaurav 
Published: April 2019

Abstract
Flap necrosis is a very common complication encountered after cleft palate repair, especially in uni-pedicled flaps. Many causes have been attributed to this complication but very limited data is available in the literature on dental infection as the cause of flap necrosis. This report of a case describes loss of flap caused due to a periapical granuloma of dental origin impinging on the pedicle causing suspected thrombosis of the pedicle resulting in flap necrosis. Since this is an important cause that can be easily prevented, it is reported.
Surgical Treatment Strategy for Severe Rhinophyma With Bilateral Pedicled Nasolabial Flaps
Authors: Cui Meng-Ying , Guo Shu , Wang Chen-Chao , Lv Meng-Zhu , Jin Shi-Feng 
Published: April 2019

Background:
Rhinophyma is a rare disease characterized by chronic inflammation and hypertrophy of sebaceous glands, blood vessels, and fibrous tissue, associated with end-stage severe acne rosacea. There are multiple approaches to treatment and repair, including dermal shaving, secondary intention healing, free skin graft, and skin flaps. However, these methods have various disadvantages, such as prolonged healing, obvious scarring, and skin texture mismatch. Therefore, the authors adopted surgical excision with bilateral pedicled nasolabial flaps, which have better color, texture, thickness, and symmetry.

Methods:
The authors present a case of severe nasal tip rhinophyma successfully treated by excision and repair with bilateral pedicled nasolabial flaps. This procedure combines deep excision of the focal lesion and coverage with bilateral nasolabial flaps.

Results:
The bilateral pedicled nasolabial flaps were used for severe rhinophyma in a patient. After the operation, the flaps survived uneventfully in this study. Both functional and aesthetic results were satisfactory at 3 months.

Conclusion:
The authors offer an effective method for surgical treatment of rhinophyma. Excision of hypertrophic nasal tissue is an acknowledged effective treatment for patients with severe rhinophyma. After excision, reconstruction with nasolabial flaps results in satisfactory outcomes both functionally and aesthetically. Therefore, this approach should be considered an appropriate alternative in cases of severe rhinophyma.
TUDCA Ameliorates Liver Injury Via Activation of SIRT1–FXR Signaling in a Rat Hemorrhagic Shock Model
Authors: Sun Silei , Zhao Bing , Qi Mengzhi , Yao Yi , Xu Lili , Ji Ran , Chen Weiwei , Wang Jinlong , Huang Shunwei , Ma Li , Chen Ying , Yang Zhitao , Sheng Huiqiu , Fei Jian , Chen Erzhen , Mao Enqiang 
Published: April 2019

ABSTRACT

Objective:
The aim of this study was to investigate the changes of bile acids in the liver during hemorrhagic shock (HS) and their potential to attenuate liver injury via activation of SIRT1 (sirtuin 1)–FXR (farnesoid X receptor) signaling.

Methods:
A Sprague–Dawley (SD) rat HS model was established, whereas HepG2 cells were hypoxically cultured to simulate HS in vitro. Liver bile acids (BA) were profiled with ultraperformance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). FXR expression was detected by western blot and immunohistochemistry. The mRNA levels of SIRT1 and FXR were detected by polymerase chain reaction. Protein expression of SIRT1, FoxM1, NF-κB, acetyl-NF-κB, p53, and acetyl-p53 was analyzed by western blot. Hepatocyte apoptosis and proliferation were measured by TUNEL assay and Ki-67 staining, respectively. Serum and supernatant cytokines were analyzed using ELISA assays. Liver injury was also assessed. To investigate the possible mechanisms, SIRT1 agonist (SRT1720), SIRT1 inhibitor (EX527), and FXR inhibitor (Z-guggulsterone) were used.

Results:
Tauroursodeoxycholic acid (TUDCA) in the liver decreased significantly after HS. SIRT1 and FXR expression was time-dependently downregulated by HS or hypoxia condition. TUDCA upregulated SIRT1–FXR activity, which inhibited expression and acetylation of NF-κB and p53 and increased FoxM1 expression, leading to decreased inflammatory response and apoptosis and increased proliferative capacity in hepatocytes, and attenuation of liver injury. EX527 pretreatment reversed the protective effect of TUDCA. Moreover, Z-guggulsterone supplementation decreased the protective effect of TUDCA in vitro.

Conclusion:
TUDCA in the liver decreased during HS. TUDCA supplementation might attenuate HS-induced liver injury by upregulating SIRT1–FXR signaling.
Preliminary Studies of the Impact of CXCL12 on the Foreign Body Reaction to Pancreatic Islets Microencapsulated in Alginate in Nonhuman Primates
Authors: Sremac Marinko , Lei Ji , Penson Madeline F.E. , Schuetz Christian , Lakey Jonathan R.T. , Papas Klearchos K. , Varde Pushkar S. , Hering Bernhard , de Vos Paul , Brauns Timothy , Markmann James , Poznansky Mark C. 
Published: April 2019

Background.
We previously demonstrated that the incorporation of the chemokine CXCL12 into alginate microbeads supported long-term survival of microencapsulated auto-, allo-, and xenogeneic islets in murine models of diabetes without systemic immune suppression. The purpose of this study was to test whether CXCL12 could abrogate foreign body responses (FBRs) against alginate microbeads which were empty or contained autologous islets in healthy nonhuman primates (NHPs; n = 4).

Methods.
Two NHPs received intraperitoneal implants of 400 000 alginate microbeads with or without CXCL12, and postimplantation immunological and histopathological changes were evaluated up to 6 months postimplantation. A similar evaluation of autologous islets in CXCL12-containing alginate microbeads was performed in NHPs (n = 2).

Results.
CXCL12-containing alginate microbeads were associated with a markedly reduced FBR to microbeads. Host responses to microbead implants were minimal, as assessed by clinical observations, blood counts, and chemistry. Evaluation of encapsulated islets was limited by the development of necrotizing pancreatitis after hemipancreatectomy in 1 NHP. A limited number of functioning islets were detectable at 6 months posttransplantation in the second NHP. In general, empty microbeads or islet-containing beads were found to be evenly distributed through the intraperitoneal cavity and did not accumulate in the Pouch of Douglas.

Conclusions.
Inclusion of CXCL12 in alginate microbeads minimized localized FBR. The NHP autologous islet implant model had limited utility for excluding inflammatory/immune responses to implanted islets because of the complexity of pancreatic surgery (hemipancreatectomy) before transplantation and the need to microencapsulate and transplant encapsulated autologous islets immediately after pancreatectomy and islet isolation.