bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoscopic banding without resection (BWR) technique for treatment of diminutive neuroendocrine tumors in the duodenum
Authors: Khara Harshit , Shovlin Gerald , Johal Amitpal , Diehl David 
Published: February 2019

AbstractEndoscopic treatment of diminutive (less than 10 mm) duodenal neuroendocrine tumors (NETs) is recommended because of the risk of metastatic potential. Endoscopic mucosal resection and endoscopic submucosal dissection are alternatives to surgical management but have significant adverse event rates. We evaluated the effectiveness, feasibility, and safety of the ‘banding without resection’ (BWR) technique and assessed outcomes for the treatment of diminutive duodenal NETs. Our study included eight patients referred for endoscopic treatment of incidentally discovered, biopsy proven, diminutive duodenal bulb NETs. Endoscopic ultrasound (EUS) in all patients showed duodenal bulb NETs located in the deep mucosa and submucosal layers without any nodal metastasis. The BWR technique was successfully performed in all patients with technical feasibility, with the assistance of submucosal saline lift in three patients when the lesion was smaller than 5 mm in size, without any immediate or delayed adverse events. Complete resection with no residual lesion was confirmed at short-term (median 2.3 months) and long-term (median 4.2 years) follow-up intervals by repeat endoscopy, biopsy, and EUS exam. The BWR technique appears to be a safe, feasible, and effective therapy for endoscopic treatment of diminutive duodenal bulb NETs in the absence of local and distant metastasis.
Supercutaneous Plating for the Treatment of Traumatic Injuries of the Appendicular Skeleton in Dogs
Authors: Longo Federico , Nicetto Tommaso 
Published: February 2019

Objectives The purpose of this study was to report the clinical outcomes of traumatic appendicular bone injuries treated with supercutaneous plating.
Methods We conducted a retrospective case series of medical records following fracture fixation using locking implants with a supercutaneous plating technique. Inclusion criteria comprised a complete clinical and radiographical follow-up until implant removal. Patient history and signalment as well as fracture configuration were recorded.
Results Five appendicular long bone fractures (3 radii, 2 tibiae) were included in the study and they were all treated using conical coupling locking plates. The patient mean age was 2.3 years (range: 0.3–5.8 years) and the mean body weight 16.5 kg (range: 3–27 kg).One major (implant failure) and minor complications (delayed bone union and iatrogenic recurvatum deformity) were detected. The removal of the plates was quick and did not require general anaesthesia. All five fractures treated healed and patients were sound at final follow-up. Neither discomfort nor pain were noticed during the postoperative patient management.
Clinical Significance The advantages related to the minimally invasive approach and implant removal could make the supercutaneous plating (SCP) an alternative to the traditional external skeletal fixation.Further clinical investigations are required before definitive treatment recommendations using this technique can be made. In consideration of some of the complications detected, the use of fluoroscopy is recommended to support the surgeon at the beginning of their SCP learning curve.
Kinetic and Kinematic Analysis of Dogs Suffering from Hip Osteoarthritis and Healthy Dogs Across Different Physical Activities
Authors: Escobar Andres , Germano Bruno , Farias Claudia , Gomes Luana , Matera Julia , Souza Alexandre 
Published: February 2019

Objective The purpose of this study was to investigate mobility performance in dogs suffering from hip osteoarthritis secondary to hip dysplasia using kinesiology.
Materials and Methods Twenty dogs with a radiographical diagnosis of bilateral hip dysplasia and hip osteoarthritis and 20 healthy dogs were submitted to kinetic and kinematic analysis while climbing upstairs, walking down a slope, sitting down, standing up, and walking. Dogs were also scored by two blind examiners using a visual analog scale (VAS).
Results Dysplastic dogs had lower peak vertical force (4% of body weight on average), increased symmetry index (12.6% difference on average) and reduced maximum hip joint extension angle and range of motion (ROM) in all tests. Mean hip joint range of motion difference was 11, 20, 25.4 and 25.2 degrees (walking, climbing upstairs, walking down a slope, sitting down and standing up exercise respectively). The VAS scores varied widely between examiners; still, healthy and dysplastic dog mobility differed across all physical test tasks.
Conclusion and Clinical Relevance Gait changes were observed in all physical tasks performed by dysplastic dogs with hip osteoarthritis, particularly in those requiring higher levels of effort. Comprehensive, quantitative assessment of dogs suffering from hip osteoarthritis across a range of physical activities is recommended.
Off-pump Revascularization with Bilateral versus Single Mammary Arteries—A Propensity Score-Matched Analysis
Authors: Puehler Thomas , Zittermann Armin , Dia Mohamad , Emmel Eric , Gercek Mustafa , Börgermann Jochen , Hakim-Meibodi Kavous , Gummert Jan 
Published: February 2019

Abstract
Background Coronary artery bypass grafting is the first-line therapy for severe multivessel coronary artery disease. We aimed to investigate the clinical outcome in patients undergoing isolated off-pump surgery with the single or bilateral internal mammary artery (SIMA or BIMA) approach.
Methods We performed a propensity score-matched analysis in 1,852 consecutive patients, aged 50 to 70 years, who underwent myocardial revascularization at our institution between July 2009 and August 2016. Primary end point was the probability of survival.
Results Mean follow-up was 36.3 (range: 0.1–89.6) months. The probability of survival in the SIMA and BIMA groups was 98.6 and 99.0% at year 1, 92.0 and 92.5% at year 5, and 85.6 and 81.6% at year 7, respectively, with a hazard ratio (HR) of mortality for the BIMA group versus the SIMA group of 0.98 (95% confidence interval[CI]: 0.64–1.52; p = 0.94). There was evidence for interaction between diabetes and study group on mortality risk (HR = 2.59, 95% CI: 1.07–6.23; p = 0.034). Freedom from mediastinitis/wound infection was higher in the SIMA group than in the BIMA group (99.5 and 96.9%, respectively; HR of an event = 6.39, 95% CI: 2.88–14.18; p < 0.001). The corresponding values in the subgroups of diabetic patients were 98.6 and 90.9%, respectively (HR = 6.45, 95% CI: 2.24–18.58; p = 0.001). Mediastinitis/wound infection was associated with increased mortality risk (HR = 2.96, 95% CI: 1.29–6.78; p = 0.010).
Conclusion Overall, our data indicate similar probability of survival up to a maximum follow-up of 7 years by off-pump surgery with the SIMA or BIMA approach. However, in diabetic patients, the clinical outcome indicates caution regarding the use of the BIMA approach.
Total Correction of Tetralogy of Fallot in the First 60 Days of Life in Symptomatic Infants: Is It The Gold Standard?
Authors: Menaissy Yasser , Omar Ihab , Mofreh Basem , Alassal Mohamed 
Published: February 2019

Background The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes.
Patients and Methods We retrospectively reviewed 152 patients with TOF who were ≤60 days of age when they underwent total correction of TOF. All patients had either duct-dependent pulmonary blood flow or arterial blood oxygen saturation less than 65% on room air requiring urgent surgical correction. Exclusion criteria included TOF with pulmonary atresia, TOF with nonconfluent pulmonary arteries, TOF with multiple aortopulmonary collateral arteries, and associated complete atrioventricular septal defects.
Results The mean age at repair was 34 ± 19 days, and the mean weight was 3.8 ± 0.9 kg. Before surgery, 96 patients received an infusion of prostaglandin, 45 were mechanically ventilated, and 32 required inotropic support. Right ventricular outflow tract obstruction was managed with a transannular patch in 112 patients, and all the others had a main pulmonary artery patch. Cardiopulmonary bypass (CPB) with moderate hypothermia was the standard, and the CPB time averaged 48 ± 21 minutes. The postoperative intensive care unit stay was 5.7 ± 6 days, with 2.8 ± 4 days of mechanical ventilation. Early mortality was 4.6% (7 of 152), and actuarial survival rates were 95% at 1 year and 92% at 5 years. Univariable and multivariable analyses of the patients' demographics, anatomical characteristics, and operative techniques revealed the presence of small pulmonary arteries and low body weight to be the only independent risk factors for death.
Conclusion Early total correction of TOF during the first 60 days of life can be performed with low mortality and good intermediate-term survival and, from our point of view, “should be the gold standard for TOFs.”
Do Life History Traits Influence Patterns of Maternal Immune Elements in New World Blackbirds (Icteridae)?
Authors: Fassbinder-Orth C A , Igl L D , Hahn D C , Watts K M , Wilcoxen T E , Ramos-Álvarez K R 
Published: February 2019

AbstractAvian immunology developed originally by investigating domesticated poultry species (Galliformes), but in recent decades eco-immunological studies of wild bird species have revealed that avian immune systems are more diverse than initially assumed. This study compares six immunological elements in eggs of six species within the same family, the New World blackbirds (Icteridae),whose members differ most notably in two life history parameters, brood parasitism and body size. We measured the maternal immune investment of passive immune components in both yolk and albumen: lysozyme, ovotransferrin, and immunoglobulins (Igs), and LPS-specific Igs. We predicted that brood parasites would have higher levels of immune activity for both innate and adaptive immunity compared with non-brood parasites, and that increased body size could increase microbial exposure of larger animals, resulting in an increase in some adaptive immune responses, such as LPS-specific Igs. We found that brood parasites had significantly higher levels of Igs and lysozyme levels in albumen, but significantly lower levels of Igs in yolk compared with non-brood parasites. Igs in yolk scaled according to body size, with the smallest organisms (the brood parasites) having the lowest levels, and the largest organism (common grackle) having the highest. Our results confirm the findings of other studies of comparative immunity among species in a single taxon that (1) similarities in immune investment cannot be assumed among closely related species and (2) single measures of immune defense cannot be assumed to be indicators of a species’ overall immune strategy, as life history traits can differentially affect immune responses.
The Development of Integration in Marsupial and Placental Limbs
Authors: Kelly E M , Marcot J D , Selwood L , Sears K E 
Published: February 2019

AbstractThe morphological interdependence of traits, or their integration, is commonly thought to influence their evolution. As such, study of morphological integration and the factors responsible for its generation form an important branch of the field of morphological evolution. However, most research to date on post-cranial morphological integration has focused on adult patterns of integration. This study investigates patterns of correlation (i.e., morphological integration) among skeletal elements of the fore- and hind limbs of developing marsupial and placental mammals. The goals of this study are to establish how patterns of limb integration vary over development in marsupials and placentals, and identify factors that are likely responsible for their generation. Our results indicate that although the overall pattern of correlation among limb elements is consistent with adult integration throughout mammalian development, correlations vary at the level of the individual element and stage. As a result, the relative integration among fore- and hind limb elements varies dynamically between stages during development in both marsupial and placental mammals. Therefore, adult integration studies of the limbs may not be indicative of developmental integration. Results are also consistent with integration during early limb development being more heavily influenced by genetic and developmental factors, and later by function. Additionally, results are generally consistent with a constraint on marsupial forelimb evolution caused by the functional requirements of the crawl to the teat that operates by limiting morphological variation before and at the time of birth, and not after.
Epidemic Clostridioides difficile Ribotype 027 Lineages: Comparisons of Texas Versus Worldwide Strains
Authors: Endres Bradley T , Begum Khurshida , Sun Hua , Walk Seth T , Memariani Ali , Lancaster Chris , Gonzales-Luna Anne J , Dotson Kierra M , Bassères Eugénie , Offiong Charlene , Tupy Shawn , Kuper Kristi , Septimus Edward , Arafat Raouf , Alam M Jahangir , Zhao Zhongming , Hurdle Julian G , Savidge Tor C , Garey Kevin W 
Published: February 2019

Abstract

Background
The epidemic Clostridioides difficile ribotype 027 strain resulted from the dissemination of 2 separate fluoroquinolone-resistant lineages: FQR1 and FQR2. Both lineages were reported to originate in North America; however, confirmatory large-scale investigations of C difficile ribotype 027 epidemiology using whole genome sequencing has not been undertaken in the United States.

Methods
Whole genome sequencing and single-nucleotide polymorphism (SNP) analysis was performed on 76 clinical ribotype 027 isolates obtained from hospitalized patients in Texas with C difficile infection and compared with 32 previously sequenced worldwide strains. Maximum-likelihood phylogeny based on a set of core genome SNPs was used to construct phylogenetic trees investigating strain macro- and microevolution. Bayesian phylogenetic and phylogeographic analyses were used to incorporate temporal and geographic variables with the SNP strain analysis.

Results
Whole genome sequence analysis identified 2841 SNPs including 900 nonsynonymous mutations, 1404 synonymous substitutions, and 537 intergenic changes. Phylogenetic analysis separated the strains into 2 prominent groups, which grossly differed by 28 SNPs: the FQR1 and FQR2 lineages. Five isolates were identified as pre-epidemic strains. Phylogeny demonstrated unique clustering and resistance genes in Texas strains indicating that spatiotemporal bias has defined the microevolution of ribotype 027 genetics.

Conclusions
Clostridioides difficile ribotype 027 lineages emerged earlier than previously reported, coinciding with increased use of fluoroquinolones. Both FQR1 and FQR2 ribotype 027 epidemic lineages are present in Texas, but they have evolved geographically to represent region-specific public health threats.
Dirofilaria repens Infection Mimicking Lung Melanoma Metastasis
Authors: Oliva A , Gabrielli S , Pernazza A , Pagini A , Daralioti T , Mantovani S , Mattiucci S , D’Amati G , Mastroianni C M 
Published: February 2019

Abstract
We describe a rare case of Dirofilaria repens infection presenting as peripheral lung nodules and mimicking a metastatic focus from a previously diagnosed cutaneous melanoma. To avoid invasive investigations before arriving at the correct diagnosis, dirofilariasis should be included as a part of the diagnostic process in subjects with lung nodules who live in (or have traveled to) endemic regions.
Preparation for and Management of “Failed” Laryngoscopy and/or Intubation
Authors: Cooper Richard M. 
Published: February 2019

Abstract
An airway manager’s primary objective is to provide a path to oxygenation. This can be achieved by means of a facemask, a supraglottic airway, or a tracheal tube. If one method fails, an alternative approach may avert hypoxia. We cannot always predict the difficulties with each of the methods, but these difficulties may be overcome by an alternative technique. Each unsuccessful attempt to maintain oxygenation is time lost and may incrementally increase the risk of hypoxia, trauma, and airway obstruction necessitating a surgical airway. We should strive to optimize each effort. Differentiation between failed laryngoscopy and failed intubation is important because the solutions differ. Failed facemask ventilation may be easily managed with an supraglottic airway or alternatively tracheal intubation. When alveolar ventilation cannot be achieved by facemask, supraglottic airway, or tracheal intubation, every anesthesiologist should be prepared to perform an emergency surgical airway to avert disaster.
Differences in the Majeed Pelvic Score Between Injured and Uninjured Patients
Authors: Brouwers Lars , Wouter Lansink Koen Willem , van Delft-Schreurs Katinka , Cornelia de Jongh Mariska Adriana 
Published: February 2019

Objectives:
To investigate the differences in the Majeed Pelvic Score (MPS) between injured and uninjured patients. Discriminative power and applicability of the MPS in elderly are also investigated, and a norm score for the MPS in the Netherlands is provided.

Design:
Cross-sectional cohort study.

Setting:
Urban level 1 trauma center.

Patients/Participants:
One hundred ninety-five patients with pelvic ring disruptions; 101 61A, 67 61B, and 27 61C (OTA/AO classification; 6%, 27%, and 82% surgically treated, respectively); mean follow-up 29 months (range 6–61); 554 adults from the Longitudinal Internet Studies for the Social Sciences panel (control group). Participants were divided into 2 age groups: <65 and ≥65 years (respectively, maximum MPS: 100 and 80 points).

Main Outcome Measurements:
Majeed Pelvic Score.

Results:
Patients <65 years of age (81.6) scored lower on the MPS when compared with the control group (88.3, P < 0.001). Patients ≥65 years of age (68.1) scored lower on the MPS when compared with the control group (72.0, P = 0.006). In the <65 group, the patient group scored worse on the sexual function, work, and standing dimensions (P < 0.001). In the ≥65 group, the patient group scored worse on the dimensions sitting (P = 0.03) and standing (P < 0.001) and better on the dimension pain (P = 0.001).

Conclusions:
Compared with the general population, patients with pelvic ring disruption in both age groups perceived some health problems in almost all MPS domains. The MPS discriminates well enough to provide information about the mobility of elderly patients.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Treatment of Peritrochanteric Femur Fractures With Proximal Femur Locked Plating
Authors: Medda Suman , Sullivan Rashad J. , Marquez-Lara Alejandro , Araiza Edgar T. , Pilson Holly T. , Halvorson Jason J. , Carroll Eben A. 
Published: February 2019

Objectives:
To report on our results using a proximal femoral locking plate for the treatment of peritrochanteric femur fractures.

Design:
Retrospective study.

Setting:
Level I Academic Medical Center.

Patients:
Sixty-eight patients with 68 fractures.

Intervention:
Demographics, fracture morphology, preoperative imaging, rationale against nailing, and outcomes were collected.

Main Outcome Measurements:
Outcomes were grouped into no complication, minor complication, or major complication. Minor complications included healed fractures with implant failure or change in alignment from immediate postoperative radiographs, which did not require intervention or elective implant removal. Major complications included any case that required revision for nonunion or implant failure.

Results:
Nine patients were lost to follow-up. Of the 59 fractures, 16 had complications (27%): 9 minor and 7 major. Active tobacco use (P = 0.020) and fractures with an associated intracapsular femoral neck component (P = 0.006) correlated with complications.

Conclusions:
Proximal femoral locking plates continue to be associated with a high complication rate. However, based on our experience, proximal femoral locking plates may be considered in highly selected cases when absolutely no other implant is deemed appropriate, based on the degree of comminution and the complexity of the fracture pattern. Patients must be informed about the possibility of revision surgery based on the inherent limitations of these devices.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Effect of Mechanical Ventilation on Peripheral Perfusion Index and Its Association With the Prognosis of Critically Ill Patients
Authors: Su Longxiang , Zhang Ruiming , Zhang Qing , Xu Qun , Zhou Xiang , Cui Na , Wang Hao , Wang Xiaoting , Chai Wenzhao , Rui Xi , Liu Dawei , Long Yun 
Published: February 2019

Objectives:
This study aimed to explore the relationship between the variables of mechanical ventilation and circulatory perfusion and its association with ICU mortality during the first day of mechanical ventilation.

Design:
Retrospective cohort study.

Setting:
The Department of Critical Care Medicine, Peking Union Medical College Hospital.

Patients:
Patients who have undergone mechanical ventilation.

Interventions:
None.

Measurements and Main Results:
This study used the main clinical data obtained from the real-time bedside messaging systems of mechanically ventilated patients during their first day in the ICU from May 2013 to May 2016, including data on the variables of mechanical ventilation and circulatory perfusion. An analysis was then performed on the association of the above data with the patient’s in-ICU mortality. There were 5,103 patients who received mechanical ventilation during this period, and of these, 309 patients died during their ICU treatment. Peak airway pressure, mean airway pressure, respiratory rate, heart rate, mean arterial pressure, Fio
2, blood oxygen saturation, Po
2, peripheral perfusion index, and lactate level were correlated with patient outcomes. A Cox logistic regression analysis suggested that mean airway pressure and perfusion index were the most independent risk and protective factors, respectively, for patient ICU mortality. The areas under the curve for a poor prognosis for mean airway pressure and perfusion index were 0.799 (95% CI, 0.77–0.829) and 0.759 (95% CI, 0.729–0.789), respectively. Further, mean airway pressure and perfusion index exhibited a causal interaction. The relative excess risk due to interaction was 2.061 (–0.691 to 4.814), the attributable proportion due to interaction was 0.210 (–0.027 to 0.447), and the synergy index was 1.306 (0.930–1.833).

Conclusions:
A higher mean airway pressure and lower perfusion index provided a worse prognosis in mechanically ventilated patients, and it appears that these two variables have a casual interaction.