bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Etiology of Pancreatitis Matter? Differences in Outcomes Among Patients With Post–Endoscopic Retrograde Cholangiopancreatography, Acute Biliary, and Alcoholic Pancreatitis
Authors: Kamal Ayesha , Akshintala Venkata S. , Kamal Muhammad M. , El Zein Mohammad , Besharati Sepideh , Kumbhari Vivek , Ngamruengphong Saowonee , Shin Eun Ji , Singh Vikesh K. , Kalloo Anthony N. , Khashab Mouen A. 
Published: April 2019

Objectives
We compared outcomes of acute alcoholic pancreatitis (AAP), acute biliary pancreatitis (ABP), and post–endoscopic retrograde cholangiopancreatography pancreatitis (PEP).

Methods
This was a retrospective cohort study conducted at a tertiary care center between June 2007 and June 2012.

Results
A total of 300 (68%) patients were diagnosed with AAP, 88 (20%) with ABP, and 55 (12%) with PEP. Longer length of hospital stay (LOHS) was more common in ABP (23%) as compared with AAP (10%) and PEP (7%, P = 0.025). Pseudocyst (P = 0.048), organ failure (OF) (P = 0.01), need for interventions (P ≤ 0.001), and mortality (P = 0.002) occurred more in ABP as compared with other groups. Systemic inflammatory response syndrome was associated with LOHS of more than 10 days (P = 0.01) and multi-OF (P = 0.05). Chronic pancreatitis was associated more with pseudocyst (P < 0.001) and mortality (P = 0.03). Serum urea nitrogen of greater than 25 g/dL predicted LOHS of more than 10 days (P = 0.02), OF (P < 0.001), multi-OF (P < 0.001), and persistent OF (P < 0.001).

Conclusions
Acute biliary pancreatitis is a more severe disease compared with PEP and AAP. Chronic pancreatitis, systemic inflammatory response syndrome, and high serum urea nitrogen are important predictors of morbidity.
Systems Thinking for Transitions of Care
Authors: Phillips Janet M. , Stalter Ann M. , Ruggiero Jeanne S. , Bonnett Pamela L. , Brodhead Josette , Merriam Deborah H. , Scardaville Debra L. , Wiggs Carol M. , Winegardner Sherri 
Published: April 2019

Purpose:
The purpose of this study was to develop a standardized rubric for systems thinking across transitions of care for clinical nurse specialists.

Design:
The design was a mixed-methods study using the Systems Awareness Model as a framework for bridging theory to practice.

Methods:
Content validity was determined using a content validity index. Reliability was established using statistical analysis with Cronbach’s α and intraclass correlation coefficient. Usability of the rubric was established using content analysis from focus group discussions about their experiences in using the rubric.

Results:
Content validity was established with a content validity ratio of 1.0. Statistical analysis showed a high interrater reliability (α = 0.99), and sections of the rubric showed a strong degree of reliability with α’s ranging from 0.88 to 1.00. Content analysis revealed several overall themes for usability of the rubric: clarity, objectivity, and detail. The area for improvement included adding more detail in the scholarly writing section.

Conclusion:
The research team recommends using the rubric to reflect application of systems thinking across transitions of care.
Polycystic Ovary Syndrome: Impact of Lipotoxicity on Metabolic and Reproductive Health
Authors: Brennan Kathleen M. , Kroener Lindsay L. , Chazenbalk Gregorio D. , Dumesic Daniel A. 
Published: April 2019

ImportancePolycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. Women with PCOS are at increased risk of developing several metabolic and reproductive abnormalities, including metabolic syndrome. Underlying the combined metabolic and reproductive dysfunction is lipotoxicity, defined as the ectopic deposition of lipid in nonadipose tissue where it induces oxidative stress linked with insulin resistance and inflammation.ObjectiveTo examine what metabolic components underlie insulin resistance in PCOS, how lipotoxicity through insulin resistance impairs metabolism and reproduction in these women, and why evidence-based, individualized management is essential for their care.Evidence AcquisitionPubMed search was performed using relevant terms to identify journal articles related to the subject. Relevant textbook chapters were also used.ResultsPolycystic ovary syndrome by Rotterdam criteria represents a complex syndrome of heterogeneous expression with variable adverse metabolic and reproductive implications. Women with classic PCOS are often insulin resistant and at greatest risk of developing metabolic syndrome with preferential fat accumulation and weight gain. Moreover, PCOS women may also have an altered capacity to properly store fat, causing ectopic lipid accumulation in nonadipose tissue, including the ovaries, where it can perpetuate insulin resistance and inflammation and harm the oocyte.Conclusions and RelevanceA personalized approach to managing PCOS is essential to improve the health of all PCOS women through cost-effective prevention and/or treatment, to minimize the risk of pregnancy complications in those individuals wishing to conceive, and to optimize the long-term health of PCOS women and their offspring.Target AudienceObstetricians and gynecologists, family physiciansLearning ObjectivesAfter completing this activity, the learner should be better able to explain the phenotypic variants of PCOS; describe how obesity, preferential abdominal fat accumulation, and lipotoxicity adversely affect the health of PCOS women; and propose a preconception management plan for overweight and obese PCOS women wishing to conceive.
Posterior malleolus exposure
Authors: Meulenkamp Brad , Louati Hakim , Morellato John , Papp Steve , Lalonde Karl Andre 
Published: April 2019

Abstract

Objectives:
Posterior malleolus (PM) fractures are common in rotational ankle injuries, tibial plafond fractures, and distal third tibia fractures. Surgical indications continue to evolve as we improve our understanding of ankle and syndesmotic stability. These fractures remain technically challenging with respect to both exposure and fixation. Our biomechanical cadaveric study compared posterolateral versus modified posteromedial surgical approaches to define the following: maximal surface area exposed, and maximal screw trajectory obtainable for fixation.

Methods:
Twelve fresh-frozen cadaver limbs were thawed at room temperature. Posterolateral and modified posteromedial approaches were performed on each limb. Margins of exposure were marked. A 2.5 mm drill was advanced at the extreme medial and lateral extents of each exposure, standardized at 1 cm proximal to the joint line and perpendicular to the bone. Computed tomography (CT) scans were performed to identify the maximal trajectory. Limbs were stripped of soft tissue, and the exposed bony surface area was measured using a validated laser surface-scanning technique.

Results:
The modified posteromedial approach allowed for a larger exposed surface area compared to the posterolateral exposure (median 99% vs 64%, respectively; P < .05). The modified posteromedial approach allowed for instrumentation of up to a median of 77% of the posterior distal tibia as opposed to 46% through the posterolateral approach (P < .05).

Conclusion:
The modified posteromedial approach allowed for increased exposure and wider access for instrumentation of the PM when compared to the posterolateral approach. We advocate use of this approach when addressing complex PM fractures, in particular the Haraguchi type 2 fracture pattern.
Ultrasound-Guided Femoral Arterial Cannulation in Neonates Undergoing Cardiac Surgery or Catheterization: Comparison of 0.014-Inch Floppy Versus 0.019-Inch Straight Guidewire
Authors: Polat Tugcin Bora 
Published: April 2019

Objectives:
Percutaneous femoral artery cannulation can be technically challenging in small infants.

Design:
We designed a prospective randomized trial to compare the use of two different guidewires for femoral arterial cannulation in neonates undergoing cardiac surgery or catheterization.

Settings:
Cardiac ICU in a university hospital.

Patients:
One-hundred twenty-four children were enrolled in this prospective study, with 64 being randomized to the 0.019-inch straight guidewire group and 60 to the 0.014-inch floppy guidewire group.

Interventions:
Femoral artery cannulation.

Measurements and Main Results:
The study period was limited to 10 minutes at the first site of arterial puncture. The time to complete cannulation, number of successful cannulation on first attempt, number of attempts, and number of successful cannulations were compared. The number of successful cannulations and successful cannulations on first attempt were higher in 0.014-inch floppy guidewire group (p = 0.001; p = 0.002, respectively). The time to complete cannulation was significantly shorter, and the number of attempts was lower in 0.014-inch floppy guidewire group (p = 0.001). Among the neonates less than 2000g, the number of attempts and time to complete cannulation were significantly lower (p < 0.001), and number of successful cannulation on first attempt and number of successful cannulations were significantly higher (p < 0.028; p < 0.001, respectively) in the 0.014-inch floppy guidewire

Conclusions:
Using 0.014-inch floppy guidewire for femoral arterial cannulation in particularly very small neonates provides significant improvement in first attempt success, number of successful cannulations, number of attempts, time to complete cannulation.
PICU-Based Rehabilitation and Outcomes Assessment: A Survey of Pediatric Critical Care Physicians*
Authors: Treble-Barna Amery , Beers Sue R. , Houtrow Amy J. , Ortiz-Aguayo Roberto , Valenta Cynthia , Stanger Meg , Chrisman Maddie , Orringer Maxine , Smith Craig M. , Pollon Dorothy , Duffett Mark , Choong Karen , Watson R. Scott , Kochanek Patrick M. , Fink Ericka L. 
Published: April 2019

Objectives:
Characterize current practices for PICU-based rehabilitation, and physician perceptions and attitudes, barriers, resources, and outcome assessment in contemporary PICU settings.

Design:
International, self-administered, quantitative, cross-sectional survey.

Setting:
Online survey distributed from March 2017 to April 2017.

Patients or Subjects:
Pediatric critical care physicians who subscribed to email distribution lists of the Pediatric Acute Lung Injury and Sepsis Investigators, the Pediatric Neurocritical Care Research Group, or the Prevalence of Acute Critical Neurological Disease in Children: A Global Epidemiological Assessment study group, and visitors to the World Federation of Pediatric Intensive and Critical Care Societies website.

Interventions:
None.

Measurements and Main Results:
Of the 170 subjects who began the survey, 148 completed it. Of those who completed the optional respondent information, most reported working in an academic medical setting and were located in the United States. The main findings were 1) a large majority of PICU physicians reported working in institutions with no guidelines for PICU-based rehabilitation, but expressed interest in developing and implementing such guidelines; 2) despite this lack of guidelines, an overwhelming majority of respondents reported that their current practices would involve consultation of multiple rehabilitation services for each case example provided; 3) PICU physicians believed that additional research evidence is needed to determine efficacy and optimal implementation of PICU-based rehabilitation; 4) PICU physicians reported significant barriers to implementation of PICU-based rehabilitation across centers; and 5) low routine assessment of long-term functional outcomes of PICU patients, although some centers have developed multidisciplinary follow-up programs.

Conclusions:
Physicians lack PICU-based rehabilitation guidelines despite great interest and current practices involving a high degree of PICU-based rehabilitation consultation. Data are needed to identify best practices and necessary resources in the delivery of ICU-based multidisciplinary rehabilitation and long-term functional outcomes assessment to optimize recovery of children and families affected by critical illness.
Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment
Authors: Scarella Timothy M. , Boland Robert J. , Barsky Arthur J. 
Published: April 2019

ABSTRACT
Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.
Simultaneous Multislice Echo Planar Imaging for Accelerated Diffusion-Weighted Imaging of Malignant and Benign Breast Lesions
Authors: Ohlmeyer Sabine , Laun Frederik Bernd , Palm Theresa , Janka Rolf , Weiland Elisabeth , Uder Michael , Wenkel Evelyn 
Published: April 2019

Objectives
Comparison of the diagnostic value of simultaneous multislice (SMS) accelerated diffusion-weighted echo planar imaging (EPI) of malignant and benign lesions of the breast compared with a reference EPI sequence.

Materials and Methods
The study was approved by the institutional ethics committee. Sixty-eight patients were examined with a diffusion-weighted EPI (reference EPI; TE = 54 milliseconds; TR = 9000 milliseconds; TA, 3:27 minutes) and a diffusion-weighted SMS accelerated EPI (SMS EPI; acceleration factor 2; TE = 58 milliseconds; TR = 4300 milliseconds; TA, 1:53 minutes) in addition to the standard magnetic resonance imaging (MRI) protocol. Further acquisition parameters were as follows: 3 T MAGNETOM Skyra (Siemens Healthcare, Erlangen, Germany), 2.5-mm isotropic resolution, field of view = 185 to 190 × 350 mm2, 62 slices, b = 50 and 800 s/mm2 with 1 and 4 averages, respectively. A dedicated 16-channel bilateral breast coil was used for imaging. Image quality was evaluated with respect to the presence of artifacts, signal voids, and quality of fat suppression. These parameters were rated using a 5-point Likert scale (1 = very strong to 5 = negligible). The apparent diffusion coefficient (ADC) was measured in 72 focal lesions (46 breast carcinomas and 26 benign lesions), and the diagnostic value of the 2 datasets was statistically evaluated and compared. The evaluation was performed a second time excluding cysts.

Results
Artifacts and signal voids were negligible in both sequences (mean on Likert scale for reference EPI 4.68 vs SMS EPI 4.65, P = 0.52, and mean on Likert scale for reference EPI 4.85 vs SMS EPI 4.77, P = 0.14). Fat suppression was significantly better in SMS EPI (mean on Likert scale 3.28 vs 2.97, P < 0.001, Pearson r = 0.49). For benign lesions, the mean ADC in both EPI sequences was 1.86 · 10−3 mm2/s. For malignant lesions, a mean ADC of 0.90 · 10−3 mm2/s for the reference EPI and 0.89 · 10−3 mm2/s for the SMS EPI was found. No significant difference between the EPI sequences was observed for ADC values (P = 0.75) and for the area under the curve (SMS, 0.985; no SMS, 0.975). The cutoff for differentiation of benign and malignant lesions was at ADC = 1.42 · 10−3 mm2/s for SMS EPI (sensitivity, 1; specificity, 0.88) and at 1.23 · 10−3 mm2/s for the reference EPI (sensitivity, 1; specificity, 0.92). Excluding the cysts, the cutoff for differentiation of benign and malignant lesions was at ADC = 1.11 · 10−3 mm2/s for SMS EPI (sensitivity, 0.89; specificity, 0.93) and at 1.23 · 10−3 mm2/s for the reference EPI (sensitivity, 1; specificity, 0.87).

Conclusions
Our data indicate that SMS acceleration can be used for diffusion imaging in breast MRI in clinical practice. Simultaneous multislice EPI achieved the same diagnostic accuracy in breast MRI, but in a substantially reduced scan time.
Physicochemical and Pharmacokinetic Profiles of Gadopiclenol
Authors: Robic Caroline , Port Marc , Rousseaux Olivier , Louguet Stéphanie , Fretellier Nathalie , Catoen Sarah , Factor Cécile , Le Greneur Soizic , Medina Christelle , Bourrinet Philippe , Raynal Isabelle , Idée Jean-Marc , Corot Claire 
Published: April 2019

Abstract

Objectives
We aimed to evaluate gadopiclenol, a newly developed extracellular nonspecific macrocyclic gadolinium-based contrast agent (GBCA) having high relaxivity properties, which was designed to increase lesion detection and characterization by magnetic resonance imaging.

Methods
We described the molecular structure of gadopiclenol and measured the r1 and r2 relaxivity properties at fields of 0.47 and 1.41 T in water and human serum. Nuclear magnetic relaxation dispersion profile measurements were performed from 0.24 mT to 7 T. Protonation and complexation constants were determined using pH-metric measurements, and we investigated the acid-assisted dissociation of gadopiclenol, gadodiamide, gadobutrol, and gadoterate at 37°C and pH 1.2. Applying the relaxometry technique (37°C, 0.47 T), we investigated the risk of dechelation of gadopiclenol, gadoterate, and gadodiamide in the presence of ZnCl2 (2.5 mM) and a phosphate buffer (335 mM). Pharmacokinetics studies of radiolabeled 153Gd-gadopiclenol were performed in Beagle dogs, and protein binding was measured in rats, dogs, and humans plasma and red blood cells.

Results
Gadopiclenol [gadolinium chelate of 2,2′,2″-(3,6,9-triaza-1(2,6)-pyridinacyclodecaphane-3,6,9-triyl)tris(5-((2,3-dihydroxypropyl)amino)-5-oxopentanoic acid); registry number 933983-75-6] is based on a pyclen macrocyclic structure. Gadopiclenol exhibited a very high relaxivity in water (r1 = 12.2 mM−1·s−1 at 1.41 T), and the r1 value in human serum at 37°C did not markedly change with increasing field (r1 = 12.8 mM−1·s−1 at 1.41 T and 11.6 mM−1·s−1 at 3 T). The relaxivity data in human serum did not indicate protein binding. The nuclear magnetic relaxation dispersion profile of gadopiclenol exhibited a high and stable relaxivity in a strong magnetic field. Gadopiclenol showed high kinetic inertness under acidic conditions, with a dissociation half-life of 20 ± 3 days compared with 4 ± 0.5 days for gadoterate, 18 hours for gadobutrol, and less than 5 seconds for gadodiamide and gadopentetate. The pharmacokinetic profile in dogs was typical of extracellular nonspecific GBCAs, showing distribution in the extracellular compartment and no metabolism. No protein binding was found in rats, dogs, and humans.

Conclusions
Gadopiclenol is a new extracellular and macrocyclic Gd chelate that exhibited high relaxivity, no protein binding, and high kinetic inertness. Its pharmacokinetic profile in dogs was similar to that of other extracellular nonspecific GBCAs.
Construction of Bony-Cartilaginous Defects of the Nose
Authors: Çelik Muzaffer , Aktan Erkan 
Published: April 2019

Abstract
Bony and cartilage defects of the nose should be reconstructed for both esthetic and functional purposes. In the past, autogenous bones, such as rib bones, cranial bones, and other bone grafts, have been used to reconstruct bony defects of the nose. Rib and ear cartilage have been used to reconstruct cartilage defects of the nose. A congenital subtotal bony-cartilaginous defect of the nose was reconstructed using cranial bone for the nasal bony defect, ear cartilage for the tip cartilage deficiency, and rib cartilage for the septal defect, in the present patient.
Three-Dimensional Pharyngeal Airway Changes After 2-Jaw Orthognathic Surgery With Segmentation in Dento-Skeletal Class III Patients
Authors: Tan Su Keng , Tang Alexander T.H. , Leung Wai Keung , Zwahlen Roger A. 
Published: April 2019

Purpose:
To investigate short- and long-term three-dimensional changes of pharyngeal airway morphology and hyoid bone position in dento-skeletal class III deformity patients after 2-jaw orthognathic surgery with segmentation.

Methods:
A retrospective analysis has been performed on patients with dento-skeletal class III deformity who had undergone orthognathic 2-jaw surgery with segmentations, presenting both pre- and post-surgical cone-beam computed tomographys. Three-dimensional skeletal movements, pharyngeal airway changes and hyoid bone position were measured and correlated.

Results:
The mean short term postsurgical review period for all included 47 patients was 5.8 ± 2.2 months. Thirteen patients among them provided a mean long term period of 26.4 ± 3.4 months. The mean postsurgical maxillary movement was 2.29 ± 2.49 mm in vertical, 2.02 ± 3.45 mm in horizontal direction, respectively, while the mandibular movement was 6.49 ± 4.58 mm in vertical, and −5.85 ± 6.13 mm in horizontal direction. In short-term, the vertical length of nasopharynx was found to be reduced (P = 0.005) but increased for the oropharynx (P < 0.001). Furthermore, the oropharyngeal minimum cross-sectional area has decreased significantly (P = 0.013). The hyoid bone moved posterosuperiorly, however, with only its horizontal movement found to be significant (P = 0.043). No significant result was detected in long-term analyses, neither in postsurgical pharyngeal airway changes nor the hyoid bone movement. There were no significant differences in pharyngeal airway measurements (P > 0.05) detected between patients with and without genioplasty advancement.

Conclusion:
Two-jaw orthognathic surgery in dento-skeletal class III patients led to a statistically non-significant reduction of the post-surgical airway volume in both short- and long-term. Although the post-surgical oropharyneal minimum cross-sectional area was decreased significantly in the short term, this finding did not persist in the long term.
Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation
Authors: São Julião Guilherme P. , Karagkounis Georgios , Fernandez Laura M. , Habr-Gama Angelita , Vailati Bruna B. , Dattani Mit , Kalady Matthew F. , Perez Rodrigo O. 
Published: April 2019

Objective:
Analyze conditional recurrence-free survival (cRFS) for rectal cancer patients with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) managed nonoperatively after each year without recurrence.

Summary Background Data:
Select patients with cCR after nCRT have been managed nonoperatively. Risk factors for local recurrence, the need for prolonged follow-up, and the risk of recurrence over time are not well defined.

Methods:
Retrospective review of patients with rectal cancer cT2-4N0-2M0 treated with nCRT. Mean follow-up was 64 months. Patients who achieved cCR were managed nonoperatively. cRFS was used to investigate the evolution of recurrence-odds, as patients remain recurrence-free after completion of nCRT. Three-year cRFS was estimated at “x” years after completion of nCRT based on the formula cRFS3 = RFS(x+3)/RFS(x).

Results:
One hundred ninety-seven patients with cCR after nCRT were included. Overall survival and recurrence-free survival (RFS) at 5 years were 81.9% (95% CI 74.0%–87.6%) and 60.4% (95% CI 52.5%–67.4%) respectively. Using cRFS estimates, the probability of remaining disease-free for an additional 3 years if the patient survived without disease at 1, 3, and 5 years, was 77.4% (95% CI 68.8%–83.8%), 91.0% (95% CI 81.9%–95.7%), and 94.3% (95% CI 82.9%–98.2%), respectively. In contrast, actuarial RFS rates for similar intervals were 79.1% (95% CI 72.5%–84.2%), 64.2% (95% CI 56.5%–70.8%), and 60.4% (95% CI 52.5%–67.4%). After 2 years disease-free, 3 year cRFS became similar for T2 and T3 cancers. In contrast, patients undergoing extended nCRT became less likely to develop recurrences only after initial 2 years of successful organ-preservation.

Conclusions:
Conditional survival suggests that patients have significantly lower risks (≤10%) of developing recurrences after 2 years of achieving cCR following nCRT.