bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed
Authors: Cohen Helen S. , Mulavara Ajitkumar P. , Stitz Jasmine , Sangi-Haghpeykar Haleh , Williams Susan P. , Peters Brian T. , Bloomberg Jacob J. 
Published: March 2019

Objectives:
Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders.

Study Design:
Case-control study.
Setting: Out-patient tertiary care.

Subjects and Methods:
Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials.

Results:
Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found.

Conclusion:
Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
The Significance of a Pale Area Via Flexible Spectral Imaging Color Enhancement in the Diagnosis of Esophageal Precancerous Lesions and Early-stage Squamous Cancer
Authors: Li Yuan , Yangjin Ciren , Shi Yanyan , Wen Yue , Jin Zhu , Cui Rongli , Zhang Hejun , Ding Shigang 
Published: March 2019

Goals:
The main aim of this study was to investigate the significance of a pale area via flexible spectral imaging color enhancement (FICE) in the diagnosis of esophageal dysplasia and cancer.

Background:
The early diagnosis of esophageal squamous cancer is challenging, and the indication of Lugol’s chromoendoscopy has not yet been well established.

Study:
The esophageal mucosa of patients at our endoscopic center were sequentially evaluated with white-light endoscopy and FICE during insertion of the endoscope, followed by staining with Lugol’s solution during withdrawal. Patients were divided into 2 groups depending on whether esophageal leukoplakia was detected by white-light endoscopy and 2 groups depending on whether a pale area was detected by FICE. We compared cases of patients with abnormal iodine staining, and cases of dysplasia or cancer in esophageal leukoplakia—or pale area—positive and negative groups.

Results:
Cases of abnormal staining in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000). Cases of esophageal dysplasia and cancer in the esophageal leukoplakia—or pale area—positive group were far more numerous than cases without esophageal leukoplakia or pale area, respectively (P=0.000).

Conclusions:
Iodine staining should be performed in patients with esophageal leukoplakia or pale areas. Esophageal dysplasia and early-stage cancer were more easily detected in those with esophageal leukoplakia or pale areas.
Does Helicobacter pylori Eradication Reduce the Incidence of Metachronous Gastric Cancer After Curative Endoscopic Resection of Early Gastric Cancer
Authors: Zhao Bochao , Zhang Jiale , Mei Di , Luo Rui , Lu Huiwen , Xu Huimian , Huang Baojun 
Published: March 2019

Background:
Whether Helicobacter pylori eradication could reduce the risk of metachronous gastric cancer remain controversial. In the present study, we performed a systematic review and meta-analysis to evaluate the preventive effect of H. pylori eradication on the occurrence of metachronous gastric cancer after curative endoscopic resection of early gastric cancer.

Methods:
The related studies were identified by searching PubMed and Embase databases. According to the H. pylori infection status and subsequent treatment, all patients were classified into H. pylori negative group, H. pylori eradication group and noneradication group. The relevant data were extracted and pooled effect size was assessed using a fixed effect model or a random effect model.

Results:
A total of 11 retrospective cohort studies and 3 randomized controlled trials were included in this meta-analysis. The results based on the cohort studies indicated that the risk of metachronous gastric cancer was significantly lower in H. pylori eradication group than in noneradication group (hazard ratios: 0.65, 95% confidence interval: 0.50-0.86, P=0.002; I
2=0%). The pooled result of 2 randomized controlled trials demonstrated that the patients receiving anti-H. pylori treatment had a lower risk of metachronous gastric cancer than those who did not receive H. pylori eradication treatment (hazard ratios: 0.43, 95% confidence interval: 0.26-0.70, P=0.001; I
2=0%). In addition, the occurrence of metachronous gastric cancer in H. pylori eradication group was not significantly different from that in H. pylori negative group.

Conclusions:
Successful H. pylori eradication may be useful for the prevention of metachronous gastric cancer after curative endoscopic resection of early gastric cancer. Thus, anti-H. pylori treatment should be considered for those patients with H. pylori infection after curative endoscopic resection.
Lower 90-day Hospital Readmission Rates for Esophageal Variceal Bleeding After TIPS
Authors: Rush Barret , Deol Navjot , Teriyaki Anour , Sey Michael , Jairath Vipul , Walley Keith R. , Celi Leo A. , Brahmania Mayur 
Published: March 2019

Objective:
Hospital readmission rates following a transjugular intrahepatic portosystemic shunt (TIPS) insertion after an episode of esophageal variceal bleeding (EVB) has not been well studied. We aimed to address this gap in knowledge on a population level.

Methods:
The Nationwide Readmission Database (NRD) was used to study the readmission rates for patients with decompensated cirrhosis who had a TIPS insertion performed for EVB. The NRD is a national database that tracks patients longitudinally for hospital readmissions. A propensity score matching model was created to match patients who received TIPS with those who did not.

Results:
A total of 42,679,001 hospital admissions from the 2012 to 2014 NRD sample were analyzed. There were 33,934 patients with EVB who met inclusion criteria for the study, of whom, 1527 (4.5%) received TIPS after EVB and were matched with 1527 patients with EVB who did not undergo TIPS. With a uniform follow-up of 3 months, patients with TIPS were less likely to be readmitted to hospital with a recurrent EVB [odds ratio (OR): 0.33, 95% confidence interval (CI): 0.24-0.47, P<0.01], although were more likely to be readmitted with hepatic encephalopathy (OR: 1.66; 95% CI: 1.31-2.11, P<0.01). At 3 months, there was no difference in all cause hospital readmission rate between the 2 groups (OR: 38.8%; 95% CI: 38.1-44.9 TIPS vs. OR: 41.5%; 95% CI: 34.1-43.3 non-TIPS: P=0.17).

Conclusions:
In this large nationally representative study, TIPS insertion after an episode of EVB was associated with a significantly lower risk of 3-month readmission for recurrent EVB compared with patients who did not receive TIPS. Although those receiving TIPS had a higher rate of hepatic encephalopathy the overall readmission remained unchanged.
Best Practices for Obtaining Genomic Consent in Pediatric Traumatic Brain Injury Research
Authors: Schnur Kaylee C. , Gill Eliana , Guerrero Alejandro , Osier Nicole , Reuter-Rice Karin 
Published: March 2019

Background
Precision health relies on large sample sizes to ensure adequate power, generalizability, and replicability; however, a critical first step to any study is the successful recruitment of participants.

Objectives
This study seeks to explore how the enrollment strategies used in a parent study contributed to the high consent rates, establish current best practices that can be used in future studies, and identify additional factors that contribute to consent into pediatric traumatic brain injury biobanks.

Methods
Retrospective secondary analysis of data from a parent study with high consent rates was examined to explore factors affecting consent into biobanking studies.

Results
Of the 76 subjects who were approached, met the eligibility criteria, and reviewed the consent form, only 16 (21.1%) declined to participate. The consented group (n = 60) represents 64.5% of those who met the eligibility criteria upon initial screening (n = 93) and 78.9% of those with confirmed eligibility (n = 76). Analysis of screening data suggested there were no major barriers to consenting individuals into this pediatric traumatic brain injury biobank.

Discussion
There were no demographic or research-related characteristics that significantly explained enrollment. Ethically, to obtain true informed consent, parents need to understand only their child’s diagnosis, prognosis, and medical care, as well as the purpose of the proposed research and its risks and benefits. Researchers need to implement best practices, including a comprehensive review of census data to identify eligible participants to approach, a prescreening protocol, and effective consenting process to obtain informed consent so that precision care initiatives can be pursued.
A Statewide Study of the Epidemiology of Emergency Medical Services' Management of Pediatric Asthma
Authors: Fishe Jennifer N. , Palmer Eugene , Finlay Erik , Smotherman Carmen , Gautam Shiva , Hendry Phyllis , Hendeles Leslie 
Published: March 2019

Objectives
Little is known about emergency medical services' (EMS') management of pediatric asthma. This study's objective was to describe the demographic, clinical, and geographic characteristics of current EMS' management of pediatric asthma in the state with the fourth-largest pediatric population.

Methods
This was a retrospective observational study of EMS patients ages 2 to 18 years with an asthma exacerbation from 2011 to 2016. Patients from Florida's EMS Tracking and Reporting System were included if their EMS chief complaint indicated respiratory distress, if they received at least 1 albuterol treatment, and if they were transported to a hospital.

Results
A total of 11,226 patients met the inclusion criteria. The median age was 9 years, and 49% were African-American. Geospatial analysis revealed 4 rural counties with disproportionate numbers of African-American patients. In addition to albuterol, 37% of patients received ipratropium bromide and 9% received systemic corticosteroids. Adjusted logistic regression revealed that the strongest predictors of receiving systemic corticosteroids from EMS were intravenous access (odds ratio, 33.4; 95% confidence interval, 24.4–45.6) and intravenous magnesium sulfate administration (odds ratio, 5.0; 95% confidence interval, 3.4–7.3), indicating a more severe presentation.

Conclusions
This statewide study demonstrated low rates of EMS administration of ipratropium bromide and systemic corticosteroids, both evidence-based treatments for asthma exacerbations. Targeted EMS education should attempt to increase utilization of both those medications. In addition, the feasibility and efficacy of EMS administration of oral systemic corticosteroids for children should be explored.
Use of Point-of-Care Ultrasound to Assess and Guide Renal Stent Repositioning in the Pediatric Emergency Department
Authors: Garcia Angélica Marie , Riera Antonio 
Published: March 2019

Abstract
Point-of-care ultrasound can be used as an assessment tool during the evaluation of children with renal colic. We discuss the case of a 7-year-old girl presenting to the pediatric emergency department with left flank pain, vomiting, and urinary incontinence status post–left renal stent placement. Renal ultrasound revealed ureteral obstruction caused by renal stent displacement. Point-of-care ultrasound performed by pediatric emergency department physicians was used to assess renal stent location, repositioning, and confirmation of the new location by the urology team. We discuss the role of transabdominal point-of-care ultrasound for the evaluation and treatment of the symptomatic child with recent ureter stent placement.
Antibiotic Prescription Practice for Pediatric Urinary Tract Infection in a Tertiary Center
Authors: Alghounaim Mohammad , Ostrow Olivia , Timberlake Kathryn , Richardson Susan E. , Koyle Martin , Science Michelle 
Published: March 2019

Objectives
Prescribing antibiotics for suspected urinary tract infection (UTI) is common practice and may lead to unnecessary antibiotic exposure. We aimed to review UTI diagnosis and management in the emergency department and to identify targets for antimicrobial stewardship.

Methods
Single-center, retrospective cohort study of children aged 12 weeks to younger than 18 years discharged from the emergency department with a diagnosis of UTI between October and December 2016. Children with genitourinary malformations were excluded. Clinical information, urine collection method, laboratory findings, and urine culture results were gathered. The sensitivity and specificity of nitrite and leukocyte esterase for UTI diagnosis were calculated. The relationship between urinalysis characteristics and confirmed UTI was examined using logistic regression.

Results
A total of 183 children with a median (interquartile range) age of 4.2 (1.1–7.5) years were included; 82.5% were female. Almost all children were discharged home on antibiotics (n = 180, 98%) for a median (interquartile range) duration of 7 (7–10) days. A total of 85 patients (46.4%) received antibiotics despite negative urine cultures leading to 525 unnecessary antibiotic days. The presence of nitrites was the strongest predictor of UTI (odds ratio = 20.22, P < 0.001) and was highly specific.

Conclusions
Current practice in managing suspected pediatric UTIs in our ED resulted in significant and unnecessary antibiotic exposure. We identified targets to reduce unnecessary antibiotic exposure including improving the diagnostic accuracy of UTIs, a process to discontinue antibiotics for negative cultures and standardizing antimicrobial duration.
Characteristics That Distinguish Abusive From Nonabusive Causes of Sudden Unexpected Infant Deaths
Authors: Bechtel Kirsten , Derbyshire Meagan , Gaither Julie R. , Leventhal John M. 
Published: March 2019

Background
Fatal child abuse can be mistaken for sudden unexpected infant death (SUID) in the emergency department setting. It is unknown if there are characteristics that distinguish abusive from nonabusive causes of SUIDs in the emergency department.

Methods
Using a matched case-control design, we reviewed the medical examiner records of deaths of infants younger than 12 months who were found unresponsive at a residence, required cardiopulmonary resuscitation, and had a complete forensic autopsy between 2009 and 2015. Infants with a manner of death as homicide were cases; controls were those with the manner of death as accident, natural, or undetermined. Each case was matched with 5 controls based on age (months). Differences between cases and controls were evaluated with respect to demographic, parental, and household characteristics and clinical outcomes.

Results
We identified 12 cases (homicides) and 169 controls (nonhomicides), of which 60 were selected for the matched analysis. We found no significant differences between cases and controls with respect to age, race, sex, maternal substance use, Child Protective Services involvement prior to death, presence of male head of household, surviving siblings, or emergency medical services transport. Cases were more likely to have Child Protective Services involvement at the time of death (83% vs 38%; P = 0.01), sentinel injuries (odds ratio, 9.67; 95% confidence interval, 1.30–122.43), and return of spontaneous circulation (odds ratio, 29.99; 95% confidence interval, 3.70–241.30).

Conclusions
Child Protective Services agency involvement at time of death, sentinel injury, and return of spontaneous circulation were more often associated with abusive causes of SUID. Further study is needed to confirm these findings.
A Short History of Medical Expert Guidelines and How They Pertain to Tracheostomy Tubes and Physical Medicine and Rehabilitation
Authors: Bach John R. 
Published: March 2019

Abstract
Continuous noninvasive ventilatory support (CNVS) and mechanical insufflation-exsufflation have been used since 1953 to spare patients with ventilatory pump failure from ever-requiring tracheostomy tubes for ventilatory support or secretion management. Today there are patients with spinal muscular atrophy type 1 who are 25 yrs old and CNVS dependent since 4 months or age, postpolio survivors CNVS dependent for 64 yrs, Duchenne muscular dystrophy patients over age 45 CNVS dependent for over 25 yrs, high-level spinal cord injured patients CNVS dependent for over 20 yrs, and even lung disease patients dependent on CNVS. All these patients, although unweanable from ventilatory support and with little or no measurable vital capacity, can also be extubated to CNVS and mechanical insufflation-exsufflation when necessary to continue CNVS. No patients want tracheostomy tubes. However, for various reasons, this is not cited in academic society expert guidelines. This article considers the extent of the damage being caused by this.
Reconstruction of Large Facial Malignant Tumor Defects Using Local Angular Perforator Flap
Authors: Weng Xiao-Juan , Li Xiao-Jing 
Published: March 2019

Objective:
To investigate the 1-stage repair for postoperative wound of large facial malignant tumors.

Materials and Methods:
The angular perforator flap of the face and neck was used for 1-stage rotary advancement repair of the large skin wound following tumor resection.

Results:
After using the angular perforator flap for 1-stage wound repair, the flap was completely preserved, and the donor incision site healed well. The suture was removed after some 7 to 9 days, and the flap color was similar to that of the surrounding skin. After 12 months follow-up, there was no obvious scar growth observed.

Conclusion:
The design of the neck and face angular perforator flap was flexible with a good blood supply, and thus can be used for 1-stage repair of the large defect wound after facial malignant tumor resection. Also, the observed prognosis was good.
Utilization of Intermaxilar Fixation Screws as Anchors in the Treatment of the Mandible Recurrent Dislocation
Authors: Pessoa Petros Fernandes , de Brito Silva Lucas Nunes , de Souza André Lustosa , de Carvalho Nogueira Emerson Filipe , Brainer Diogo Luiz Bastos 
Published: March 2019

Propose:
This paper aims to describe a modification of the Wolford technique by replacing the Mitek anchors with bone screws.

Technical description:
Two intermaxillary fixation screws locking screws, with 2.0 mm in diameter and 8 mm in length, are used in each temporomandibular joint, one of which is fixed to the root of the zygomatic arch and another to the lateral pole of the mandibular condyle. Ethibond 2-0 thread is passed through the holes in the 2 ipsilateral screws, thus acting as an artificial ligament limiting the range of the mouth opening.

Conclusion:
The technique described was effective in preventing mandibular dislocation while allowing satisfactory mouth opening range. This technique has easy handling and low cost.
Histological Evaluation of the Effects of Growth Factors in a Fibrin Network on Bone Regeneration
Authors: Cakir Sevki , Gultekin B. Alper , Karabagli Murat , Yilmaz Tugba Ekiz , Cakir Esra , Guzel E. Elif , Yalcin Serdar , Mortellaro Carmen , Mijiritsky Eitan 
Published: March 2019

Objective:
The aim of this study was to evaluate the effect of mineralized plasmatic matrix (MPM), comprising a combination of synthetic graft and platelet concentrates, on bone regeneration.

Methods:
Critical size defects of 6-mm diameter were created on the tibias of 6 male sheep, with the animals subsequently assigned into 2 groups. Of the 5 bone defects generated per animal, 4 were randomly filled with MPM, beta-tricalcium phosphate graft (β-TCP), platelet-rich fibrin (PRF) + β-TCP, and autogenous graft. One defect was left empty as a control group. Animals were killed at 3 weeks (early healing group) and 6 weeks (late healing group). The specimens underwent histologic and histomorphometric analysis to evaluate new bone formation.

Results:
In both healing periods, new bone formation from autogenous bone was observed significantly more often than from biomaterials or the empty defect. The degree of new bone formation for MPM was significantly higher than that of the control group at all healing periods. In addition, it was significantly higher in both healing periods than that of β-TCP albeit only in the late healing period than that of the PRF + β-TCP combination. In all biomaterial groups, residual graft ratios decreased from early to late healing periods.

Conclusion:
The results indicated that MPM, representing growth factors in a fibrin network, increases new bone formation in surgically created defects in sheep tibia as confirmed by histologic assessment.
Population-Specific Metabolic Alterations in Professional Antigen-Presenting Cells Contribute to Sepsis-Associated Immunosuppression
Authors: Schenz Judith , Tamulyte Sandra , Nusshag Christian , Brenner Thorsten , Poschet Gernot , Weigand Markus A. , Uhle Florian 
Published: March 2019

ABSTRACT
Sepsis is a complex host response triggered by an infection, with the patient's immune system between hyper- and hypo-responsiveness being the main reason for the syndromes’ development and propagation. Studies conducted in peripheral blood mononuclear cells uncovered an association between an impaired immunometabolism and the severity and outcome of the disease. With this prospective observational study, we aimed to evaluate the immunometabolic phenotype of monocytes and B cells and its association with the cell function.
Monocytes and B cells were isolated from patients with sepsis (n = 10; onset, days 4 and 8) and healthy volunteers (n = 10) and subsequently analyzed for metabolic changes and human leukocyte antigen-DR (HLA-DR) expression. Contemporaneously, immune checkpoints on monocytes and the ex vivo cytokine responses (interleukins 6 and 8) upon lipopolysaccharide or zymosan stimulation were analyzed. The distribution of B cell subsets was assessed, and plasma levels of immunoglobulins and tricarboxylic acid cycle intermediates were quantified.
Both monocytes and B cells exhibited decreased HLA-DR expression in patients with sepsis. Monocytes displayed a stable upregulated glycolysis while B cells augmented glycolysis and respiration over time. The monocytes’ ability to respond to stimulation was stimuli-dependently reduced but recovered over time. The B cell compartment shifted toward antibody-producing subsets and elevated immunoglobulins within the first days.
Our results provide evidence for the induction of a state of trained immunity in monocytes and an early but transient immunosuppressive phenotype accounting for peripheral sepsis-induced vulnerability to infections. B cells exhibit an unsustainable activation contributing to adaptive immunosuppression.