bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-time Monitoring of Cerebral Blood Flow and Cerebral Oxygenation During Rapid Ventricular Pacing in Neurovascular Surgery: A Pilot Study
Authors: Saldien Vera , Schepens Tom , Vanlinthout Luc , Wildemeersch Davina , Wouters Kristien , Vercauteren Marcel , Menovsky Tomas 
Published: June 2019

Background:
Rapid ventricular pacing (RVP) can be used to produce short periods of flow arrest during dissection or rupture of a cerebral aneurysm but carries the risk of inducing cerebral ischemia. This study evaluates the intraoperative effect of RVP on local cerebral blood flow (CBF) and cerebral oxygenation during neurovascular surgery.

Materials and Methods:
Five patients undergoing elective cerebrovascular surgery were included in a single-center prospective study. RVP was applied in pacing periods of 40 seconds with 30% and 100% FiO2. Regional cerebral oxygenation was monitored using a Foresight near-infrared spectroscopy sensor. A Clark-type electrode and a thermal diffusion microprobe located in the white matter were used to monitor brain tissue pO2 and CBF, respectively.

Results:
CBF response to RVP closely followed the blood pressure pattern and resulted in a low-flow state. Unlike CBF, brain tissue pO2 and regional cerebral oxygenation showed a delayed response to RVP, decreasing beyond the pacing period and slowly recovering after RVP cessation. We found a correlation between brain tissue pO2 and regional cerebral oxygenation. Increasing the inspired oxygen concentration had a positive impact on absolute regional cerebral oxygenation and brain tissue pO2 values, but the pattern resulting from applying RVP remained unaltered.

Conclusions:
RVP reduces CBF and cerebral oxygenation. Brain tissue pO2 and regional cerebral oxygenation are correlated but unlike CBF respond to RVP in a delayed manner. Further research is required to evaluate the impact of longer RVP bursts on brain oxygenation.
Symptomatic Iliosacral Screw Removal After Pelvic Trauma—Incidence and Clinical Impact
Authors: Quade Jonathan , Busel Gennadiy , Beebe Michael , Auston Darryl , Shah Anjan R. , Infante Anthony , Maxson Benjamin , Watson David , Sanders Roy W. , Mir Hassan R. 
Published: June 2019

Objective:
To calculate the incidence of symptomatic iliosacral (SI) screw removal following pelvic trauma and to determine the clinical impact of the secondary intervention.

Design:
Retrospective chart review.

Setting:
Level 1 and Level 2 trauma centers.

Patients:
Four hundred seventy-one consecutive patients undergoing percutaneous posterior pelvic fixation over 10 years, with 7 excluded for spinopelvic fixation,and 7 excluded due to age <16 year old.

Intervention:
Implant removal.

Main Outcome Measurement:
Secondary intervention.

Results:
A total of 25/457 patients underwent screw removal (5.4%). Two patients were lost to follow-up, leaving 23 for analysis. There were 13 male patients and 10 female patients. There were 13 SI and 10 trans-sacral screws removed. Four screws were loose before removal (17%). Average time to screw removal was 10.7 months (4–26 minutes). Fifteen (83.3%) patients had subjective improvement, and 3 (16.7%) had no notable improvement.

Conclusion:
The incidence of symptomatic SI screws necessitating removal is low (5.4%). When removed, there is a high likelihood (83%) that the secondary intervention will result in subjective symptomatic improvement. Routine screw removal is unnecessary because most patients tolerate the implants without symptoms necessitating subsequent surgery.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Contained-Delivery Route and the Administration of Postoperative Steroids Following Anterior Cervical Spinal Fusion With Low-dose rhBMP-2 Reduces the Magnitude of Respiratory Compromise
Authors: Maza Noor M. , Ferrer Christopher E. , Qureshi Sheeraz A. , Cho Samuel K. , Chaudhary Saad B. , Hecht Andrew C. 
Published: June 2019

Study Design:
Retrospective chart review of patients who underwent anterior cervical discectomy and fusion (ACDF) using low-dose recombinant human bone morphogenic protein (rhBMP)-2.

Objective:
Determine whether severity and incidence of respiratory complications after ACDF surgery are decreased when using a low-dose BMP-infused sponge within a constrained carrier and postoperative IV and oral steroids.

Summary of Background Data:
Many physicians avoid using BMP in anterior cervical spine fusions because of concern for an increased incidence of dysphagia, significant prevertebral swelling, and airway edema compromise. Pilot studies have shown that the local application of steroids may decrease the incidence of postoperative airway edema and dysphagia. We performed a retrospective study to evaluate the safety of immediate postoperative tapered steroid use following low-dose rhBMP-2 completely contained inside either an allograft or PEEK cage in reducing the severity and incidence of respiratory complications following ACDF.

Materials and Methods:
Forty-seven patients between 33 and 74 years of age, undergoing 1-, 2-, 3-, or 4-level ACDFs augmented with a fraction of a small sponge of rhBMP-2 (0.525 mg/level) within an allograft or PEEK cage and prescribed IV and oral postoperative steroids between January 1, 2008 and November 1, 2016. The incidence of complications such as dyspnea, dysphagia, airway issues, edema ectopic bone osteolysis, radiculitis, and nonunion were collected using medical charts. Additional data regarding length of hospital stay and readmissions were also recorded.

Results:
No life-threatening respiratory events, such as prolonged intubation, re-intubation, or readmission for labored breathing, were observed. No complications referable to steroids such as delayed healing, uncontrollable blood sugar, or diabetes were encountered in this series.

Conclusions:
This study provides evidence that a tapered dose of steroids and a contained delivery route significantly decreases postoperative respiratory compromise incidence and magnitude following anterior cervical spine fusion using low-dose rhBMP-2.
Sagittal Balance in Adolescent Idiopathic Scoliosis Managed With Intraoperative Skull Femoral Traction
Authors: Peiro-Garcia Alejandro , Brown Garielle E. , Earp Madalene A. , Parsons David , Ferri-de-Barros Fabio 
Published: June 2019

Study Design:
This is a retrospective cohort, single-center quality improvement study.

Objectives:
To evaluate the effect of the intraoperative skull femoral traction (IOSFT) on sagittal balance in posterior spinal instrumentation (PSI) to manage scoliosis.

Summary of Background Data:
IOSFT has been used routinely as an adjunct technique for facilitating PSI to manage scoliosis in our institution since 2010. Previous studies have raised concerns regarding the negative effect of IOSFT on lumbar lordosis.

Materials and Methods:
The medical records and radiographs of 113 patients with adolescent idiopathic scoliosis managed with single stage PSI were reviewed. Eighty-five patients were operated with IOSFT (traction group) and 28 patients were operated without traction (nontraction group). Patients who had double (anterior-posterior) approaches or nonidiopathic scoliosis were excluded. Sagittal balance and pelvic parameters at 2 years of postoperative follow-up were the primary outcome measures. Statistical analysis was done with R for statistical computing. Median values and interquartile range were compared between groups using Wilcoxon rank sum, Fischer exact, and Welch t tests. P-values of <0.05 were considered statistically significant.

Results:
No significant differences were found comparing postoperative lumbar lordosis in the nontraction group (54 degrees) with the traction group (53 degrees) (P=0.4953). No significant differences were found in postoperative sagittal vertical axis medians comparing both groups, with 17 mm in the nontraction group and 18 mm in the traction group (P=0.3994). No significant differences were found in postoperative pelvic parameters. The median pelvic incidence was 52 degrees in the nontraction group and 50 degrees in the traction group (P=0.2711).

Conclusions:
According to our results, the use of IOSFT as an adjunct to facilitate PSI for managing adolescent idiopathic scoliosis had no measurable negative impact on sagittal balance in our IOSFT cohort.
Primary Sternal Osteomyelitis: A Case Report and Review
Authors: Lopez Christopher D. , Hill J. Bradford , Stavropoulos Christos , Lerman Oren Z. 
Published: June 2019

Summary:
Primary sternal osteomyelitis (PSO) remains a rare but morbid and challenging condition. Due to the limited reports of PSO in the literature, management of this disease continues to lack consensus. We present a case report highlighting how PSO remained, in our experience, refractory to medical management, and how operative intervention provided resolution, and a review of the literature.
A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder
Authors: Daros Alexander R. , Williams Gregory E. 
Published: June 2019

Abstract
Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross’s extended process model of ER and Linehan’s updated theoretical account on the development of emotion dysregulation.
Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country
Authors: Lempinen Laura , Karppinen Mariia , Pelkonen Tuula , Laulajainen-Hongisto Anu , Aarnisalo Antti A. , Sinkkonen Saku T. , Bernardino Luis , Peltola Heikki , Pitkäranta Anne , Jero Jussi 
Published: June 2019

Background:Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.Methods:Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM, and according to their age, ≤12 month old and >12 month old. Prospectively collected clinical data, laboratory test results and outcome for these groups were assessed.Results:Sixty-two children (12%) had OM-associated BM, of whom 39 had otorrhea. Ear discharge was more common in older children (median age 45 months old vs. 12 months old;P< 0.001). Children with OM often showed an additional infectious focus (n = 20, 32% vs. n = 82, 18%;P= 0.016), were dehydrated (n = 16, 26% vs. n = 66, 15%;P= 0.04), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004–5.15,P= 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.Conclusions:Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical course and showing a higher risk of complicated or fatal outcome. HIV infection and malnutrition were common in children with otorrhea, which was also associated with low socioeconomic status.
Pneumococcal-related Hemolytic Uremic Syndrome in the United Kingdom
Authors: Makwana Ashley , Sheppard Carmen , Fry Norman K. , Ladhani Shamez N. 
Published: June 2019

Background:
children <5 years of age since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2006 and its replacement with the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 in the United Kingdom.

Methods:
Public Health England conducts enhanced national surveillance of invasive pneumococcal disease in England. Confirmed invasive pneumococcal disease cases diagnosed between September 1, 2006, and March 31, 2016, with hemolytic uremic syndrome reported as a complication were included in the analysis.

Results:
There were 54 cases of pHUS during the surveillance period, with a median age of 17 months. The incidence of pHUS was 0.25/100,000 during the PCV7 period and 0.08/100,000 during the PCV13 period (incidence rate ratio: 0.31; 95% confidence interval: 0.16–0.57; P < 0.0001). Twelve children (22%) had an underlying comorbidity before disease onset. Overall, 31 (57%) presented with lower respiratory tract infection, 14 (25%) with meningitis, 8 (15%) with bacteremia and 1 (2%) with septic arthritis. An empyema was reported in 26/31 children (84%) with lower respiratory tract infection and cerebral abscess in 5/14 children (36%) with meningitis. The main responsible serotypes were 19A (n = 20), 3 (n = 6), 7F (n = 5) and 33F (n = 4). Eight children (15%) died, including 6 with meningitis.

Conclusions:
pHUS continues to be associated with significant morbidity and mortality. The incidence of pHUS was significantly lower after PCV13 replaced PCV7 in the childhood immunization program. Currently, most cases are due to non-PCV13 serotypes.
Validation of the British Thoracic Society Severity Criteria for Pediatric Community-acquired Pneumonia
Authors: Ambroggio Lilliam , Brokamp Cole , Mantyla Rachel , DePaoli Bradley , Ruddy Richard M. , Shah Samir S. , Florin Todd A. 
Published: June 2019

Background:
The British Thoracic Society (BTS) guideline for pediatric community-acquired pneumonia (CAP) outlines severity criteria to guide clinical decision-making. Our objective was to examine the predictive performance of the criteria on the need for hospitalization (NFH) and disposition.

Methods:
This was a retrospective cohort study of children 3 months–18 years of age diagnosed with CAP in an urban, pediatric emergency department (ED) in the United States from September 2014 to August 2015. Children with chronic medical conditions, recent ED visits, and ED transfers were excluded. The main outcomes were interventions or diagnoses that necessitate hospitalization (ie, NFH) and disposition (eg, admit vs. discharge). Test characteristics, stratified by age, were calculated for each outcome.

Results:
Of 518 eligible children, 56.6% (n = 293) were discharged from the ED with 372 children meeting at least 1 BTS criterion. Overall BTS criteria were specific but not sensitive for NFH nor for disposition. For children <1 year of age sensitive criteria included not feeding and temperature for NFH and tachycardia, cyanosis and not feeding for disposition. For children ≥1 year of age, tachycardia had a sensitivity of >0.60 for both outcomes. The areas under the receiver operator characteristic curves for predicting any BTS criteria was 0.57 for NFH and 0.84 for disposition.

Conclusions:
The BTS CAP severity criteria had fair to excellent ability to predict NFH and disposition, respectively. Although specific, the low sensitivity and poor discriminatory ability for NFH of these criteria suggest a need for improved prognostic tools for children with CAP.
Antimicrobial Use in a Swedish Pediatric Hospital
Authors: Luthander Joachim , Bennet Rutger , Nilsson Anna , Eriksson Margareta 
Published: June 2019

Background:
Antimicrobial resistance is increasing, and data on antimicrobial use in Swedish children are limited. We evaluated trends in antimicrobial use and attempted to identify targets for improving the quality of antimicrobial prescribing in a tertiary care center.

Methods:
One-day hospital-wide point prevalence surveys were conducted 8 times during 2003–2017 at Astrid Lindgren Children’s Hospital. Children <17 years old were included. Medical records were evaluated for risk factors, indications for treatment, and antibiotic agents used.

Results:
Among 946 admitted patients, 36% (336/946) received antimicrobial treatment. The total number of prescriptions increased (P = 0.031), but the proportion of patients treated remained unchanged. The proportion of patients receiving prophylactic treatment increased from 11% to 43% (P = 0.005). The rate of hospital-acquired infections remained unchanged. The primary indication for antimicrobial therapy was sepsis, fever of unknown origin, or fever in neutropenia, followed by intra-abdominal infections and pneumonia. The most frequently used antibiotics were cephalosporins, but consumption decreased, and in 2017 piperacillin-tazobactam was the most frequently used. Antimicrobial use was generally appropriate, although guidelines were often missing. The number of pediatric hospital beds decreased, and the bed occupancy was 71% (101/142) in 2003 and 121% (110/91) in 2017. The patient mix changed toward more patients with underlying risk factors for infectious diseases.

Conclusions:
Antimicrobial use changed during the study period, mainly due to increased prophylactic use in at-risk patients. Antimicrobial stewardship programs including infection control interventions and increasing the availability of guidelines may reduce and improve antimicrobial therapy.
The Economic Burden of Pediatric Postconcussive Syndrome
Authors: Corwin Daniel J. , Master Christina L. , Grady Matthew F. , Zonfrillo Mark R. 
Published: June 2019

Objective:
To estimate the direct costs of pediatric postconcussive syndrome (PCS).

Design:
Retrospective cohort study.

Setting:
Subspecialty sports medicine clinics of a large pediatric tertiary care network in the United States.

Patients:
One hundred fifty-four patients aged 5 to 18 years with PCS, evaluated between 2010 and 2011.

Assessment of Independent Variables:
Direct costs included visits to sports medicine clinic, visio-vestibular therapy, homebound education, subspecialist referral, and prescription-only medications (amantadine and amitriptyline), all measured beginning at 28 days after injury.

Main Outcome Measures:
Postconcussive syndrome was defined as persistence beyond 28 days from injury.

Results:
The cost incurred by each PCS patient for sports medicine visits was $1575, for visio-vestibular therapy was $985, for homebound tutoring was $55, for prescription medications was $22, and for subspecialist referral was $120, totaling $3557 per patient, with a 95% confidence interval range of $2886 to $4257.

Conclusions:
Given the high economic costs of PCS determined in this study, therapies that mitigate this syndrome may have the potential to be cost-effective and even cost saving.
Non-HDL cholesterol should not generally replace LDL cholesterol in the management of hyperlipidaemia
Authors: Soran Handrean , Ho Jan H. , Adam Safwaan , Durrington Paul N. 
Published: June 2019

Purpose of review
Non-HDL cholesterol was originally conceived as a therapeutic target for statin treatment in hypertriglyceridaemia when apolipoprotein B100 assays were not widely available. Recently non-HDL cholesterol has been recommended to replace LDL cholesterol in the clinical management of dyslipidaemia routinely in general medical practice. This is misguided.

Recent findings
Non-HDL cholesterol is heterogeneous, constituting a mixture of triglyceride-rich VLDL, intermediate density lipoprotein and LDL in which small dense LDL is poorly represented and to which VLDL cholesterol contributes increasingly as triglyceride levels rise. This makes it unsuitable as a goal of lipid-lowering treatment or as an arbiter of who should receive such treatment. Results of trials designed to lower LDL cholesterol are not easily translated to non-HDL cholesterol. Fasting is no longer thought essential for screening the general population for raised LDL cholesterol. ApoB100 measurement also does not require fasting even in rarer more extreme lipoprotein disorders encountered in the Lipid Clinic, provides greater precision and specificity and overcomes the problems posed by LDL and non-HDL cholesterol. It is more easily interpreted both in diagnosis and as a therapeutic goal and it includes SD-LDL.

Summary
If we are to discourage use of LDL cholesterol, it should be in favour of apoB100 not non-HDL cholesterol.
Emergency Management of Acute Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children
Authors: Yuan Miao , Li Fei , Xu Chang , Fan Xia , Yang Gang , Xiang Bo , Huang Lugang 
Published: June 2019

Objectives
Acute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH.

Methods
A retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted.

Results
A total of 22 patients were included in this study. All the patients presented with respiratory symptoms. Chest x-ray revealed swollen stomach and mediastinal shift. After nasogastric tube placement, fluid infusion, and nasal oxygen breathing, the symptoms in 8 patients ameliorated, and 14 patients had no signs of obvious relief. Three patients underwent the bedside percutaneous puncture of distensible stomach, and 1 patient died in the process of emergent management for critical condition. The remaining 21 patients underwent emergency surgery. Five thoracotomies and 16 thoracoscopies were performed. Five thoracoscopies that were converted to thoracotomies were required for the difficult reduction of herniated stomach. At follow-up, all patients improved their condition.

Conclusions
Acute late-presenting CDH is a clinical emergency that can be fatal. The sudden and progressive expansion of the stomach is mainly responsible for this emergent condition. The prompt and effective management is key to decrease the mortality and achieve favorable prognosis.