bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in National ACGME Case Log Data for Pediatric Orthopaedic Fellowships: Are Fellow Coding Practices Responsible?
Authors: McClure Philip K. , Woiczik Marcella , Karol Lori , Sankar Wudbhav N. 
Published: March 2017

Background:
The introduction of the 80-hour work week for Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship programs initiated many efforts to optimize surgical training. One particular area of interest is on recording and tracking surgical experiences. The current standard is logging cases based on Current Procedural Terminology codes, which are primarily designed for billing. Proposed guidelines from the ACGME regarding logging exist, but their implementation is unknown, as is the variation in case volume across fellowship programs. The purpose of this study was to investigate variability in the national case log data, and explore potential sources of variation using fellow surveys.

Methods:
National ACGME case log data for pediatric orthopaedic fellowships from 2012 to 2015 were reviewed, with particular attention to the domains of spine, pelvis/hip, arthroscopy, trauma, and other (which includes clubfoot casting). To explore potential sources of case log variability, a survey on case logging behavior was distributed to all pediatric orthopaedic fellows for the academic year 2015 to 2016.

Results:
Reported experiences based on ACGME case logs varied widely between fellows with percentage difference of up to 100% in all areas. Similarly, wide variability is present in coding practices of pediatric orthopaedic fellows, who often lack formal education on the topic of appropriate coding/logging. In the survey, hypothetical case scenarios had an absolute difference in recorded codes of up to 13 and a percentage difference of up to 100%.

Conclusions:
ACGME case log data for pediatric orthopaedic fellowships demonstrates wide variability in reported surgical experiences. This variability may be due, in part, to differences in logging practices by individual fellows. This observation makes meaningful interpretation of national data on surgical volume challenging. Proposed surgical experience minimums should be interpreted in light of these data, and may not be advisable unless accompanied by standardized and specific guidelines for case log entry. Efforts to optimize training in the post 80-hour era will require accurate data to serve as a starting point for future educational efforts.
A Significant Influence of Metronidazole on Busulfan Pharmacokinetics: A Case Report of Therapeutic Drug Monitoring
Authors: Chung Hyewon , Yu Kyung-Sang , Hong Kyung Taek , Choi Jung Yoon , Hong Che Ry , Kang Hyoung Jin , Park Kyung Duk , Shin Hee Young , Lee SeungHwan 
Published: March 2017

Abstract:
Busulfan is a cytotoxic agent used in preconditioning for hematopoietic stem cell transplantation. Therapeutic drug monitoring of busulfan is necessary owing to its narrow therapeutic range. Patients undergoing preconditioning are susceptible to infection and might require coadministration of antibiotics. We present a case study of a 3-year-old girl with precursor T-cell acute lymphoblastic leukemia who received intravenous busulfan before hematopoietic stem cell transplantation. Metronidazole was coadministered before the third dose of busulfan because of Clostridium difficile infection. The daily pharmacokinetic analysis revealed that the clearance reduced to 57% of that before the coadministration. Although the underlying mechanism is unclear, a significant pharmacokinetic interaction was observed between busulfan and metronidazole, underscoring the importance of therapeutic drug monitoring.
CHANGES IN METAMORPHOPSIA AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS AFTER SUCCESSFUL RETINAL DETACHMENT SURGERY
Authors: Murakami Tomoya , Okamoto Fumiki , Sugiura Yoshimi , Okamoto Yoshifumi , Hiraoka Takahiro , Oshika Tetsuro 
Published: March 2017

Purpose:
To investigate changes in metamorphopsia after rhegmatogenous retinal detachment surgery and to evaluate the relationship between metamorphopsia and retinal microstructures assessed with optical coherence tomography.

Methods:
The study included 47 eyes of 47 patients undergoing retinal detachment surgery. We examined the severity of metamorphopsia using M-CHARTS, best-corrected visual acuity, and optical coherence tomography images. All data were recorded before and 3, 6, and 12 months after surgery, except for M-CHARTS which were recorded only postoperatively.

Results:
Metamorphopsia scores at 3, 6, and 12 months postoperatively were 0.46 ± 0.51, 0.41 ± 0.44, and 0.28 ± 0.37, respectively, with significant improvement from 3 months to 12 months after surgery. Significant metamorphopsia (score ≥0.2) was present in 49% of patients at 12 months postoperatively. Multiple regression analysis revealed that metamorphopsia score at 12 months was significantly related to the status of macula and interdigitation zone. In patients with macula-off retinal detachment, improvement of metamorphopsia scores was associated with an increase in thickness of external limiting membrane-retinal pigment epithelium.

Conclusion:
After successful retinal detachment surgery, metamorphopsia gradually improved, but nearly half of the patients still exhibited metamorphopsia at 12 months postoperatively. Disruption of interdigitation zone and external limiting membrane-retinal pigment epithelium thickness was related to metamorphopsia.
INTRAVITREAL AFLIBERCEPT INJECTION FOR CHOROIDAL NEOVASCULARIZATION DUE TO PRESUMED OCULAR HISTOPLASMOSIS SYNDROME
Authors: Toussaint Brian W. , Kitchens John W. , Marcus Dennis M. , Miller Daniel M. , Kingdon Megan L. , Holcomb Diana , Ivey Ken 
Published: March 2017

Purpose:
To evaluate intravitreal aflibercept injection (IAI) in patients with presumed ocular histoplasmosis syndrome and choroidal neovascularization.

Methods:
Open-label randomized Phase I/II study of IAI in patients with presumed ocular histoplasmosis syndrome–related choroidal neovascularization. Thirty-nine eyes from 39 patients were randomized in a 1:1 ratio to 2 groups. The Sustained Group eyes (n = 19) underwent monthly IAI for 3 months, then mandatory IAI every 2 months for 12 months (with an option for monthly PRN dosing, if needed). The PRN Group eyes (n = 20) received 1 IAI at randomization, then monthly PRN IAI for 12 months.

Results:
Thirty-nine eyes (19 eyes Sustained Group and 20 eyes PRN Group) were randomized. Average age of participants was 50 years (19–75), with 16 men and 23 women. Ten, 12, and 17 eyes demonstrated extrafoveal, juxtafoveal, and subfoveal choroidal neovascularization, respectively. All eyes in both groups received IAI at baseline, with the Sustained and PRN groups receiving on an average 7.5 (5–11) and 4.6 (1–10) injections, respectively, over the 12 months. At baseline, overall average visual acuity was 68 letters (13–87 letters) with Snellen equivalent of 20/42 (20/20–20/160). At 12-month follow-up, Sustained Group's average visual acuity was 84.9 letters (74–94) and Snellen equivalent was 20/21 (20/13–20/32), indicating an average improvement of 12 letters (6 letters loss to 36 letters gain) (P < 0.01). The PRN Group's 12-month average visual acuity was 80.9 letters (60–94) and Snellen equivalent was 20/26 (20/13–20/63), indicating an average gain of 19 letters (4–75) (P < 0.01). Mean baseline central subfield thickness (CST) was 374 μm and mean 1-year CST was 260 μm (P < 0.01) among all study participants. The Sustained Group's mean baseline CST was 383 μm and mean 12-month CST was 268 μm (P < 0.01). Mean baseline CST of the PRN Group was 360.8 μm, with the final mean CST of 260.5 μm (P < 0.01). No reported endophthalmitis, retinal tears, detachments, vitreous hemorrhage, nor adverse thrombotic events were reported.

Conclusion:
Intravitreal aflibercept resulted in improved visual and anatomical outcomes with a favorable safety profile. PRN IAI dosing required less injections with similar visual and anatomical outcomes compared with sustained dosing.
Clinical Outcomes and Contact Lens Case Contamination Using a Povidone–Iodine Disinfection System
Authors: Tan Jacqueline , Datta Ananya , Wong Katherine , Willcox Mark D. P. , Vijay Ajay K. 
Published: March 2017

Objective:
To assess the incidence of adverse events during the use of a povidone–iodine disinfecting solution (cleadew) and the microbial contamination in contact lens cases.

Methods:
A prospective, single-center, open-label, controlled study evaluating the use of cleadew cleaning and disinfecting system in existing daily wear soft contact lens wearers over a 3-month period was conducted. Ocular signs and symptoms during lens wear were assessed at baseline and after 1 and 3 months of using cleadew. Contact lens cases were assessed for the frequency of microbial contamination and the types of microbes, using traditional microbial culture, followed by identification of bacteria using 16S rRNA sequencing.

Results:
Use of cleadew was well tolerated. There was reduction in corneal staining (0.5±0.5 at 3 months of use) compared with the participant's habitual multipurpose disinfecting system (1.1±1.0); all other clinical signs were not significantly different. There were no cases of solution-induced corneal staining. There was a low adverse event rate of 0.8% per 100 participant-months. Contact lens case contamination was low, with 30% of cases having no culturable microbes. Comparison with previously published data showed that use of cleadew resulted in low frequencies of Gram-positive (49%) and fungal (8%) contamination and a low, but higher than some other disinfecting solutions, level of Gram-negative bacteria.

Conclusions:
Cleadew cleaning and disinfecting system was associated with low levels of adverse events during use. Contact lens cases were significantly less frequently contaminated than for some other types of disinfecting solutions.
Arteriovenous Lesions of the Internal Auditory Canal
Authors: Anzalone Charles L. , Lane John I. , Link Michael J. , Carlson Matthew L. 
Published: March 2017

Objective:
To describe a unique case of an asymptomatic arteriovenous lesion of the internal auditory canal (IAC) and present the associated imaging findings.

Methods:
Retrospective case report and review of the literature.

Results:
A 55-year-old man presented for further evaluation of a left-sided sudden sensorineural hearing loss that occurred 8 years earlier. Careful review of outside serial magnetic resonance (MR) imaging revealed a contralateral, ill-defined right-sided IAC mass with low T2 signal and subtle peripheral enhancement on postcontrast T1-weighted sequencing. The patient had no history of right-sided otologic symptoms.
Subsequent dedicated IAC MR imaging confirmed the presence of a space-occupying lesion adjacent to a complexity of vasculature. The presence of prominent flow voids, paucity of avid enhancement on previous studies, and marked signal within the lesion on time-of-flight MR angiography and MR venography was consistent with the diagnosis of a solitary arteriovenous lesion of the IAC. There was no radiological evidence of recent or remote parenchymal or subarachnoid hemorrhage or stroke.

Conclusion:
We report a novel case of an occult asymptomatic IAC arteriovenous lesion. Vascular anomalies confined to the IAC are rare. To date, there have been only four reports in the literature of IAC arteriovenous lesions and our case is the first to present asymptomatically. A high index of suspicion and dedicated imaging is required to identify and accurately diagnose these lesions to guide appropriate counseling and potential intervention.
Adherence to Celiac Disease and Eosinophilic Esophagitis Biopsy Guidelines Is Poor in Children
Authors: Wallach Thomas , Genta Robert M. , Lebwohl Benjamin , Green Peter H.R. , Reilly Norelle R. 
Published: March 2017

ABSTRACTObjectives:Celiac disease (CD) and eosinophilic esophagitis (EoE) are underdiagnosed gastrointestinal conditions, which adversely affect children's health. Previous studies have shown that diagnostic guidelines for CD are not consistently followed in adults. The aims of the present study are to assess the frequency with which endoscopists comply with diagnostic guidelines for CD and EoE in children, and to determine whether an association exists between adherence to biopsy guidelines and disease detection in pediatric patients.Methods:We reviewed pathology reports from 9171 children (ages 0–18) with at least 1 duodenal biopsy, and 8280 children with at least 1 esophageal biopsy, with specimens submitted to a national pathology laboratory. Frequency of adherence to diagnostic guidelines and recommendations for CD and EoE were determined, and the effect of this upon detection of CD and EoE.Results:Overall, 35% of cases were biopsied according to the 2006 American Gastroenterological Association guidelines for CD diagnosis; 8% were biopsied according to the 2007 American Gastroenterological Association EoE consensus recommendations. Detection of CD and EoE increased with the number of biopsies collected (P for trend in each <0.001). Adherence to diagnostic guidelines was particularly poor among those found to have histologically normal mucosa in both cohorts. The likelihood of CD and EoE diagnosis was significantly associated with adherence to diagnostic guidelines (odds ratio for CD 6.3, 95% confidence interval 4.4–8.9; odds ratio for EoE 2.4, 95% confidence interval 1.9–2.9).Conclusion:Adherence to established guidelines is poor, and improved guideline adherence is associated with greater disease detection rates for CD and EoE.
Management of Pediatric Nonalcoholic Fatty Liver Disease by Academic Hepatologists in Canada
Authors: Mouzaki Marialena , Ling Simon C. , Schreiber Richard A. , Kamath Binita M. 
Published: March 2017

ABSTRACTBackground:The literature on the optimal clinical management of pediatric patients with nonalcoholic fatty liver disease (NAFLD) is limited. The objective of this study was to identify discrepancies in the care provided to patients with NAFLD by hepatologists practicing in academic centers across Canada.Methods:A nationwide survey was distributed electronically to all pediatric hepatologists practicing in university‐affiliated hospitals using the infrastructure of the Canadian Pediatric Hepatology Research Group. The responses were anonymous.Results:The response rate to the survey was 79%. Everyone reported diagnosing NAFLD based on a combination of elevated transaminases and imaging suggestive of steatosis in the context of an otherwise negative workup for other liver diseases. Only 14% use liver biopsy to confirm the diagnosis. There are significant discrepancies in the frequency of screening for other comorbidities (eg, hypertension, sleep apnea, etc) and in the frequency of laboratory investigations (eg, lipid profile, transaminases, international normalized ratio, etc). Frequency of outpatient clinic follow‐up varies significantly. Treatment is consistently based on lifestyle modifications; however, reported patient outcomes in terms of body mass index improvements are poor.Conclusions:There are significant discrepancies in the care provided to children with NAFLD by hepatologists practicing in academic centers across Canada.
Classification of Acute Pancreatitis in the Pediatric Population
Authors: Abu‐El‐Haija Maisam , Kumar Soma , Szabo Flora , Werlin Steven , Conwell Darwin , Banks Peter , Morinville Veronique D. ,   NASPGHAN Pancreas Committee
Published: March 2017

ABSTRACTIntroduction:Acute pancreatitis (AP) is an emerging problem in pediatrics, with most cases resolving spontaneously. Approximately 10% to 30%, however, are believed to develop “severe acute pancreatitis” (SAP).Methods:This consensus statement on the classification of AP in pediatrics was developed through a working group that performed an evidence‐based search for classification of AP in adult pancreatitis, definitions and criteria of systemic inflammatory response syndrome, and organ failure in pediatrics.Results and Discussion:Severity in pediatric AP is classified as mild, moderately severe, or severe. Mild AP is defined by AP without organ failure, local or systemic complications, and usually resolves in the first week. Moderately SAP is defined by the presence of transient organ failure that resolves in no >48 hours, or local complications or exacerbation of co‐morbid disease. SAP is defined by persistent organ failure that lasts <48 hours. The presence of systemic inflammatory response syndrome is associated with increased risk for persistent organ dysfunction. Criteria to define organ failure must be pediatric‐ and age‐based.Conclusions:Classifying AP in pediatrics in a uniform fashion will help define outcomes and encourage the development of future studies in the field of pediatric pancreatitis.
High-Quality Randomized Controlled Trials in Pediatric Critical Care: A Survey of Barriers and Facilitators*
Authors: Duffett Mark , Choong Karen , Foster Jennifer , Meade Maureen , Menon Kusum , Parker Melissa , Cook Deborah J. 
Published: March 2017

Objectives:
High-quality, adequately powered, randomized controlled trials are needed to inform the care of critically ill children. Unfortunately, such evidence is not always available. Our objective was to identify barriers and facilitators of conducting high-quality randomized controlled trials in pediatric critical care, from the perspective of trialists in this field.

Design:
Self-administered online survey. Respondents rated the importance of barriers and effectiveness of facilitators on seven-point scales.

Setting:
Authors of 294 pediatric critical care randomized controlled trials (published 1986 to June 2015).

Subjects:
One hundred sixteen researchers from 25 countries participated.

Interventions:
None.

Measurements and Main Results:
Respondents reported a median (Q1, Q3) of 21 years (15, 26 yr) of experience and 41 (36%) had authored more than one randomized controlled trial. More survey respondents, compared with nonrespondents, had published more than one trial (35% vs 26%; p = 0.002) and their trials were more often cited (median citations/yr, 2.4 vs 1.5; p < 0.001). Of the barriers listed, the five most important were primarily related to lack of funding. The five facilitators perceived as most effective were protected time for research, ability to recruit participants 24 hours per day/7 days per week, conducting randomized controlled trials in collaboration with a research network, funding from government agencies specifically for randomized controlled trials in critically ill children, and academic department support for conducting randomized controlled trials. Respondent experience and country income level were associated with differences in importance ratings for eight of 41 barriers. There were fewer such differences for facilitators.

Conclusions:
Lack of funding and time are major barriers to conducting pediatric critical care randomized controlled trials worldwide. Although barriers varied among country income levels, the facilitators of such trials were more consistent. In addition to increased funding, respondents identified other strategies such as research networks that are within the purview of the pediatric critical care research community, to facilitate the conduct of rigorous randomized controlled trials.
Proteasome inhibitor-induced gastrointestinal toxicity
Authors: Stansborough Romany L. , Gibson Rachel J. 
Published: March 2017

Purpose of review
Gastrointestinal toxicities are commonly reported following treatment with proteasome inhibitors. The first-generation proteasome inhibitor, bortezomib, induces significant gastrointestinal side effects including nausea, vomiting, diarrhoea, and constipation, occurring in up to 84% of patients. Despite the development of safer proteasome inhibitors, such as carfilzomib, gastrointestinal toxicities remain some of the most common side effects. This review aims to summarize the previous literature on proteasome inhibitor-induced gastrointestinal toxicities, report on recent updates in the field, and investigate possible mechanisms of this toxicity.

Recent findings
Updates in the literature have included a direct comparison of the safety of approved proteasome inhibitors, bortezomib and carfilzomib, reporting less neurotoxicity and similar gastrointestinal toxicity, from carfilzomib when compared with bortezomib. Many recent studies have investigated the safety of orally bioavailable proteasome inhibitors, such as ixazomib and oprozomib. However, little progress has been made in understanding the possible mechanisms of proteasome inhibitor-induced gastrointestinal toxicities.

Summary
Although recent studies have continued to report gastrointestinal toxicities resulting from proteasome inhibitor treatment, particularly when combined with other agents or when administered orally, the mechanisms of proteasome inhibitor-induced gut toxicity remain largely unexplored. Further studies are needed to investigate the pathophysiology of this toxicity to improve the safety of existing and novel proteasome inhibitors.
LncATLAS database for subcellular localisation of long noncoding RNAs
Authors: Mas-Ponte David , Carlevaro-Fita Joana , Palumbo Emilio , Hermoso Toni , Guigo Roderic , Johnson Rory 
Published: March 2017

AbstractBackgroundThe subcellular localisation of long noncoding RNAs (lncRNAs) holds valuable clues to their molecular function. However, measuring localisation of newly-discovered lncRNAs involves time-consuming and costly experimental methods.ResultsWe have created “LncATLAS”, a comprehensive resource of lncRNA localisation in human cells based on RNA-sequencing datasets. Altogether, 6768 GENCODE-annotated lncRNAs are represented across various compartments of 15 cell lines. We introduce “Relative concentration index” (RCI) as a useful measure of localisation derived from ensemble RNAseq measurements. LncATLAS is accessible through an intuitive and informative webserver, from which lncRNAs of interest are accessed using identifiers or names. Localisation is presented across cell types and organelles, and may be compared to the distribution of all other genes. Publication-quality figures and raw data tables are automatically generated with each query, and the entire dataset is also available to download.ConclusionsLncATLAS makes lncRNA subcellular localisation data available to the widest possible number of researchers. It is available at lncATLAS.crg.eu.
Comprehensive mapping of HIV-1 escape from a broadly neutralizing antibody
Authors: Dingens Adam S. , Haddox Hugh K. , Overbaugh Julie , Bloom Jesse D. 
Published: March 2017

SummaryPrecisely defining how viral mutations affect HIV’s sensitivity to antibodies is vital to the development and evaluation of vaccines and antibody immunotherapeutics. But despite great effort, a full map of escape mutants has not yet been delineated for even a single anti-HIV antibody. Here we describe a massively parallel experimental approach to quantify how all single amino-acid mutations to Envelope (Env) affect HIV’s sensitivity to a neutralizing antibody. We applied this approach to PGT151 and identified novel sites of escape in addition to those previously defined by structural and functional studies, such as glycans at sites 611 and 637, residue 647, and sites in the fusion peptide. Evaluating the effect of each amino acid at each site lends insight into the biochemical basis of escape throughout the epitope. Thus, comprehensive mapping of HIV antibody escape gives a quantitative, mutation-level view of the ways that Env can evade neutralization.