bluuebunny/crossref_metadata_2025_split huggingface dataset:
MICROBIOTICA AND PROBIOTICS IN PEDIATRIC IRRITABLE BOWEL SYNDROME
Authors: Staiano A. 
Published: July 2016

Irritable bowel syndrome (IBS), as described by the Rome criteria, includes abdominal pain (AP) or discomfort associated with changes in bowel patterns.Despite a still incomplete pathophysiologic understanding of this condition, IBS is generally considered a disorder of the brain‐gut axis. This bidirectional connection between the central and the enteric nervous systems links emotional and cognitive centers of the brain with intestinal motility and entero‐endocrine and immune functions, likely determining the clinical expression of most functional gastrointestinal disorders (FGIDs).Probiotics are emerging as new therapeutic tools in FGIDs, due to the recognition of the importance of gut microbiota in influencing brain‐gut interactions, and of the role played by intestinal infections in the genesis of AP‐FGIDs. Preclinical data suggest that changes in the gut microbiota can affect brain signaling systems related to pain and associated emotional behavior. Therefore, probiotics likely play a relevant role in the management of FGIDs, by affecting the gut microbiota or by altering brain function and pain perception centrally.Few randomized clinical trials (RCTs) are available in children. A meta‐analysis including 9 trials which tested different probiotics as a treatment for FGIDs in children and adolescents concluded that Lactobacillus GG, Lactobacillus reuteri DSM 17938 and VSL#3 significantly increased treatment success, particularly in children with associated bowel changes.We recently showed that, in children with IBS, a mixture of Bifidobacterium infantis M‐63®, breve M‐16V® and longum BB536® is safe and is associated with better AP control and improved QoL when compared to placebo.
PRE‐, PROBIOTICS AND SYNBIOTICS IN CONSTIPATION
Authors: Benninga M.A. 
Published: July 2016

Prevalence of childhood constipation has been estimated at 0.7% to 29.6% in the general population worldwide; most children have no obvious etiological factors. The management of constipation is essentially multifactorial and, along with medical treatment, should address the social and psychological issues that may be associated with it.This presentation focuses on the evidence of treatment with pre‐ pro‐ and synbiotics in one of the most prevalent gastrointestinal disorders in children of all ages. Namely, functional constipation.Low fiber intake is associated with constipation and, therefore, every child with or without constipation needs a normal daily fiber intake. The role of extra fiber on constipation requires further evaluation. Clinical guidelines recommend the use of polyethylene glycol (PEG) with or without electrolytes as first‐line maintenance pharmacological treatment for the functional constipation in children rather than dietary interventions alone.There are many different prebiotics and probiotic microorganisms with different effects. Currently, evidence is lacking to support use of any pre‐ or pro‐ or synbiotic strain in the treatment of constipation in children.
APPLICATION OF GAS CHROMATOGRAPHY‐MASS SPECTROMETRY FOR ASSESSMENT OF THE INTESTINAL MICROFLORA CONDITION IN CHILDREN WITH CHRONIC GASTRITIS
Authors: Gurova M. , Novikova V. 
Published: July 2016

Objectives:This study is aimed at assessing condition of intestinal microflora in children with chronic gastritis in different phases of the disease and after a course of probiotic treatment using of gas chromatography ‐ mass spectrometry (GC‐MS).Methods:This longitudinal study was conducted among 90 children aged 11–15 years with Helicobacter pylori positive morphologically proven chronic gastritis (CG). 22 healthy children matched by age and gender with the children of the main group were taken as comparison group. Children with CG have been investigated repeatedly in the period of exacerbation, 6 months after the successful eradication of Helicobacter pylori infection and after a one‐month course of probiotic medicine. As the probiotic medicine, a complex probiotic Bifiform containing at least 107 Bifidobacteriun longum and at least 107 Enterococcus faecium was used. To assess the state of intestinal microbiota we use GC‐MS – detecting species‐specific fatty acids as genetically determined structural components of the cell wall.Results:In children with chronic gastritis both in acute and remission phases in 100% of cases were revealed changes in composition of the intestinal microflora affecting not only intraluminal but parietal microflora. In phase of exacerbation, microbiota disorders were expressed by decreased number of obligate bacteria (bifidobacteria, lactobacilli). In phase of remission the revealed changes saved and characterized by decreased number not only bifidobacteria, lactobacilli but propionobacterium and increased number of such opportunistic bacteria as clostridia (Clostridium histolyticum, Clostridium propionicum, and Clostridium ramosum), streptococci, Candida fungi. Excessive proliferation of Candida albicans were found in 16.5% (95% CI 12 – 21.2) children in exacerbation phase and in 30% (95% CI 22.2 – 38.8) in phase of remission (р = 0.0412). Intensity of violations of parietal microflora were significantly associated (р < 0.05) with morphological changes of gastric mucous. After a course of probiotic treatment were found positive changes in composition of the gut microbiota characterizing by increasing number of bifidobacteria and enrecocci, and decreased number of clostridia and Candida fungi.Conclusion:Chronic gastritis in children is commonly associated with negative changes in parietal microflora in acute phase and in 6 months. Using of gas chromatography ‐ mass spectrometry for studying and evaluating the intestinal microflora in children with chronic gastritis can significantly extend the range of the defined microbiota and its possible changes in different phases in diseases.
ARE SYNBIOTICS (BIFIDOBACTERIUM LACTIS B94, INULIN) BETTER THAN PROBIOTICS (BIFIDOBACTERIUM LACTIS B94) AND PREBIOTICS (INULIN) FOR IRRITABLE BOWEL SYNDROME IN CHILDREN?
Authors: Artan R , Basturk A , Yilmaz A 
Published: July 2016

Background:The etiology of irritable bowel syndrome (IBS) has not been fully elucidated. Therefore, multi‐centered studies examining the efficacy and safety of different probiotics and synbiotics for the treatment of IBS in different age groups are necessary.Aims:Our current study aimed to investigate the efficacy of synbiotics (Bifidobacterium lactis B94, Inulin), probiotics (Bifidobacterium lactis B94) and prebiotics (Inulin) for the treatment of IBS in a pediatric age group. This study was randomized, double‐blind, controlled and prospective in design.Materials and Methods:This study included 71 children between the ages of 2–18 years old who were diagnosed with IBS according to Roma III diagnostic criteria. The patients were randomly divided into three groups. The first group received synbiotic treatment [5 × 109 colony forming unit (CFU) Bifidobacterium lactis B94 (B. Lactis B94) and 900 mg inulin], the second group received probiotic treatment (5 × 109 CFU B. Lactis B94) and the third group received prebiotic treatment (900 mg inulin). The treatments for each group were administered twice daily in a double‐blind setting. All patients were evaluated at the end of a four week treatment period. Those who did not have any complaints at the end of four weeks were considered as having a full recovery. Those who had improvements in one or more of their initial complaints were considered as having improvement of their initial complaints.Results:At the end of treatment, the prebiotic group had significant improvements in belching‐abdominal fullness (p = 0.008), the probiotic group had significant improvements in abdominal fullness (p = 0.016), bloating after meals (p = 0.016) and constipation (p = 0.031), and the synbiotic group had significant improvements in belching‐abdominal fullness (p = <0.001), bloating after meals (p = 0.004), constipation (p = 0.021) and mucus in the feces (p = 0.021). The synbiotic group had a significantly higher ratio of full recovery with treatment than did the prebiotic group (39% vs. 12.5%, p = 0.036).Conclusion:In conclusion, the twice‐a‐day administration of synbiotics, probiotics and prebiotics is safe for the treatment of children with IBS. When compared to prebiotics, the administration of synbiotics and probiotics provides significant improvements in initial complaints. Furthermore, the ratio of those with full recovery in IBS symptoms was significantly higher in the synbiotic group than in the prebiotic group; the probiotic group was not significantly different.
EFFECT OF SYNBIOTICS IN CHILDREN WITH NON‐ALCOHOLIC FATTY LIVER DISEASE
Authors: Cakir Murat , Isbilen Ayse Aksel , Eyuboglu Ilker , Kaklikkaya Nese , Orem Asim 
Published: July 2016

Introduction:Synbiotics have beneficial effect on intestinal inflammation and permeability (1, 2, 3). We aimed to analyze the effect of long term (4 months) synbiotic treatment on non‐alcoholic fatty liver disease (NAFLD) in obese children.Patients and Methods:The study included the 28 children with NAFLD (12.2 ± 2.2 years and 64.3% male) based on the clinical and liver ultrasound (US) findings (severe fatty liver in 25%, moderate in 57% and mild in 18%) and 28 age‐and sex matched healthy children. At baseline, patients and control group underwent anthropometric measurements including body mass index (BMI) and laboratory evaluation including liver function tests, serum lipids, HOMA‐IR, cytokeratin‐18 (CK‐18), ethanol, tumor necrosis factor alpha (TNF‐α), oxidant (TOS) and anti‐oxidant (TAS) and zonulin levels and stool calprotectin level. All the patients with NAFLD were treated with synbiotics including Bifidobacterium lactis, Lactobacillus acidophilus and Lactobacillus casei (7 million CFU/day) plus inulin 100 mg (Maflor plus capsules®), 1 capsules per day for 4 months. Clinical and laboratory analysis was repeated in patients 4 months after synbiotic treatment and the results were compared with baseline and control group.Results:Apart from anthropometric measurements; liver function tests and lipid profile, serum ethanol (4.9 ± 3.9 vs. 0.6 ± 0.8 mg/dl, p = 0.001), TNF‐α (9.9 ± 7.4 vs. 6.1 ± 4.6 pg/mL, p = 0.03), and stool calprotectin level (14.1 ± 17.4 vs. 7.2 ± 0.8 ng/mL, p = 0.01) were significantly high in patients with NAFLD compared to healthy children. After treatment, improvement in anthropometric parameters was seen in all patients. Significant decrease was found in liver function tests, serum ethanol (4.9 ± 3.9 vs. 0.9 ± 1.4 mg/dl, p = 0.001) and TNF‐α (9.9 ± 7.4 vs. 8.4 ± 7.4 pg/mL, p = 0.01) levels and stool calprotectin level (14.1 ± 17.4 vs. 7.9 ± 1.5 ng/mL, p = 0.04) after treatment, whereas serum TAS levels (1.4 ± 0.3 vs. 1.8 ± 0.4 mmol trolox Eq/L, p = 0.02) were significantly increased. Liver US revealed severe fatty liver in 14.3%, moderate in 39.2%, mild in 39.2% and normal in 14.3% of the patients. Liver US findings were improved in 19 patients (67.8%) when compared to baseline US findings. It was found that ethanol (5.3 ± 4 vs. 0.9 ± 1.47 mg/dl, p = 0.001), TNF‐α (9.6 ± 7.1 vs. 5.5 ± 3 pg/mL, p = 0.026) levels, BMI (30.5 ± 6.6 vs. 28.6 ± 6.1 kg/m2, p = 0.001) were significantly decreased and TAS levels (1.4 ± 0.3 vs. 1.8 ± 0.3 mmol trolox Eq/L, p = 0.03) were significantly increased compared to baseline findings in the US improved group (n = 19), whereas significant differences were observed in only ethanol (5.8 ± 4 vs. 1.1 ± 1.3 mg/dl, p = 0.01) and TAS (1.2 ± 0.3 vs. 2.2 ± 0.4 mmol trolox Eq/L, p = 0.02) levels in patients without any US improvement (n = 9).Conclusion:Synbiotics are effective for the treatment of NAFLD in children, and it may be related with the effect of synbiotics on inflammation (decrease in TNF‐α level) and BMI.
Effects of Probiotics on Some Blood Parameters and Serum IgG in Broilers
Authors: Yalçin Sakine , Eser Handan , Yalçin Suzan , Yalçin S. Songül 
Published: July 2016

Introduction:Probiotics as a live microbial feed supplement affects the host by improving its gut microbial balance. Probiotics may have positive effects on broiler performance, improve microbial balance, synthesize vitamins of B complex, decrease pH in the intestine, stimulate of intestinal mucosa immunity, reduce blood cholesterol and increase protection against toxins produced by pathogenic microorganisms. Blood serum parameters may provide useful information about the evaluation of the health status of broilers. This study was aimed to determine the effects of dietary probiotics on some blood parameters and serum IgG in broilers.Methods:A total of 300 Ross 308 broiler male chicks aged one day were divided into one control group and two treatment groups each group containing 100 chicks. Each group was divided into 5 replicates, as subgroups, each comprising 20 chicks. The experimental period lasted 39 days. Basal diet was supplemented with the probiotics (Nafoil forte, Bacillus subtilis, Lactobacillus plantarum, Saccharomyces cerevisiae, Biotem Ltd Company). Probiotics were added at 0.1 and 0.2% to the first and second treatment groups, respectively. At the end of the experiment (d 39) blood samples were collected from 10 fed broilers randomly chosen from each group (2 from each replicate) and centrifuged. Serum was separated. Levels of ALT, AST, ALP and total protein, uric acid, cholesterol and triglyceride were determined by an autoanalyser using their accompanying commercial kits. Serum IgG levels were determined by ELISA.Results:Dietary supplementation of probiotics containing Bacillus subtilis, Lactobacillus plantarum, Saccharomyces cerevisiae didn't affect blood serum protein, uric acid, triglyceride and the levels of ALT, AST and ALP. Probiotics supplementation decreased serum cholesterol concentration linearly (P = 0.001). Serum IgG concentration linearly increased (P = 0.014) with dietary probiotics supplementation.Discussion:Dietary probiotics supplementation decreased serum cholesterol and increased serum IgG concentration in broilers. Therefore this probiotics seems to be the perfect feed additive for lowering cholesterol in the gastrointestinal tract and enhancing humoral immune response.
A Framework for Understanding Lapses in Professionalism Among Medical Students: Applying the Theory of Planned Behavior to Fitness to Practice Cases
Authors: Jha Vikram , Brockbank Susannah , Roberts Trudie 
Published: July 2016

Fitness to practice decisions are often based on a student’s digression from the regulations, with limited exploration of the reasoning behind the student’s behavior. However, behavior is underpinned by complex, “hidden” variables, including an individual’s attitudes and social norms. Examining hidden determinants of professionalism, such as context, interpersonal relationships, social norms, and local cultures, then allows medical educators to develop a richer understanding of unprofessional behavior.
In this article, the authors propose the use of the theory of planned behavior (TPB) as a framework to help evaluate unprofessional behavior in students. The TPB is a deliberative processing model that explains how an individual’s behavior is underpinned by his or her cognitions, with behavior being primarily dependent on the intention to perform the behavior (behavioral intention). Intention, in turn, is determined by three variables: attitude, subjective norm, and perceived behavioral control.
To understand the practical use of the TPB, the authors present four complex, anonymized case studies in which they employed the TPB to help deal with serious professionalism lapses among medical students. The outcomes of these cases as well as the student and program director perspectives, all explained via the TPB variables, are presented. The strengths and limitations of the TPB are discussed.
Modifying the Primary Care Exception Rule to Require Competency-Based Assessment
Authors: Tobin Daniel G. , Doolittle Benjamin R. , Ellman Matthew S. , Ruser Christopher B. , Brienza Rebecca S. , Genao Inginia 
Published: July 2016

Teaching residents to practice independently is a core objective of graduate medical education (GME). However, billing rules established by the Centers for Medicare and Medicaid Services (CMS) require that teaching physicians physically be present in the examination room for the care they bill, unless the training program qualifies for the Primary Care Exception Rule (PCER). Teaching physicians in programs that use this exception can bill for indirectly supervised ambulatory care once the resident who provides that care has completed six months of training. However, CMS does not mandate that programs assess or attest to residents’ clinical competence before using this rule. By requiring this six-month probationary period, the implication is that residents are adequately prepared for indirectly supervised practice by this time. As residents’ skill development varies, this may or may not be true. The PCER makes no attempt to delineate how residents’ competence should be assessed, nor does the GME community have a standard for how and when to make this assessment specifically for the purpose of determining residents’ readiness for indirectly supervised primary care practice.
In this Perspective, the authors review the history and current requirements of the PCER, explore its limitations, and offer suggestions for how to modify the teaching physician billing requirements to mandate the evaluation of residents’ competence using the existing milestones framework. They also recommend strategies to standardize this process of evaluation and to develop benchmarks across training programs.
Methodologic Considerations for Collecting Patient-reported Outcomes from Unselected Surgical Patients
Authors: Helsten Daniel L. , Ben Abdallah Arbi , Avidan Michael S. , Wildes Troy S. , Winter Anke , McKinnon Sherry , Bollini Mara , Candelario Penny , Burnside Beth A. , Sharma Anshuman 
Published: July 2016

Abstract

Background
The impact of surgery on health is only appreciated long after hospital discharge. Furthermore, patients’ perceptions of postoperative health are not routinely ascertained. The authors instituted the Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys (SATISFY-SOS) registry to evaluate patients’ postoperative health based on patient-reported outcomes (PROs).

Methods
This article describes the methods of establishing the SATISFY-SOS registry from an unselected surgical population, combining perioperative PROs with information from electronic medical records. Patients enrolled during their preoperative visit were surveyed at enrollment, 30 days, and 1-yr postoperatively. Information on PROs, including quality of life, return to work, pain, functional status, medical complications, and cognition, was obtained from online, mail, or telephone surveys.

Results
Using structured query language, 44,081 patients were identified in the electronic medical records as having visited the Center for Preoperative Assessment and Planning for preoperative assessment between July 16, 2012, and June 15, 2014, and 20,719 patients (47%) consented to participate in SATISFY-SOS. Baseline characteristics and health status were similar between enrolled and not enrolled patients. The response rate for the 30-day survey was 62% (8% e-mail, 73% mail, and 19% telephone) and for the 1-yr survey was 71% (13% e-mail, 78% mail, and 8% telephone).

Conclusions
SATISFY-SOS demonstrates the feasibility of establishing a PRO registry reflective of a busy preoperative assessment center population, without disrupting clinical workflow. Our experience suggests that patient engagement, including informed consent and multiple survey modalities, enhances PROs collection from a large cohort of unselected surgical patients. Initiatives like SATISFY-SOS could promote quality improvement, enable efficient perioperative research, and facilitate outcomes that matter to surgical patients.
Results and complications in elderly patients with acetabular fractures
Authors: Scarcella Nicholas , Schnaser Erik , Vallier Heather A. 
Published: July 2016

Background:
The frequency of acetabular fractures in elderly patients is rising over time. The group presents with underlying challenges including osteoporosis, medical comorbidities, and varying levels of baseline physical and cognitive function. The purposes of this study were to characterize such patients and to determine rates of complications and secondary operations. We propose to identify injury and treatment features associated with optimal recovery.

Methods:
One hundred and ninety-three patients over the age of 60 with acute acetabular fractures were retrospectively reviewed over 12 yr. Complications, mortality, and secondary operations were documented for 171 patients with complete records and mean 18.5 mo follow-up. Ninety-one were treated operatively.

Results:
Patients who underwent open reduction and internal fixation had a mean age of 73 yr (vs. 69 yr, P=0.0003) and mean Injury Severity Score of 28.4 (vs. 15.7, P=0.001), consistent with higher-energy injuries and unstable fracture patterns compared to patients treated nonoperatively. Twenty-two percent developed early complications, with a trend toward a higher rate in patients treated surgically (27% compared to 16%, P=0.057). After open reduction and internal fixation, posttraumatic arthrosis and conversion to total hip arthroplasty occurred in 18% and 14%, respectively, compared to 3.8% of patients who had nonoperative care (both P<0.02). Mortality at 1 yr was 9.9% and at 5 yr was 29.5%, increasing with greater age.

Conclusions:
Additional research into efforts to expedite open reduction and internal fixation in stable patients with unstable fracture patterns may minimize complications by promoting mobility from bed. Further study to define patients better suited for nonoperative management is needed, as is investigation into the role of acute total hip arthroplasty or minimally invasive methods of reduction and fixation.
Second Place Award Immediate versus delayed operative treatment of low-energy tibial plateau fractures
Authors: Ellsworth Harold Scott , Dubin Jonathan R. , Shaw Christopher M. , Alongi Sadie M. , Cil Akin 
Published: July 2016

Background:
Current management of tibial plateau fractures requires careful soft-tissue management. Often a staged approach with temporary external fixation followed by delayed internal fixation is recommended. While proven in high-energy injuries, its relevance in treating low-energy fractures has not been investigated. The goal of the current study was to assess the short-term complication rates in low-energy tibial plateau fractures treated early (<48 hr). As a secondary aim, we investigated whether surgical approach would affect rates of wound complications.

Methods:
This is a retrospective analysis of patients treated operatively for low-energy tibial plateau fractures at a level-1 urban trauma center between January 1, 2000 and January 1, 2010. Schatzker type 1-3 fractures were considered “low-energy,” despite stated mechanism. Statistical analysis was performed using chi-square and Fischer’s exact tests.

Results:
We analyzed 49 patients. From these, 29 received early (<48 hr) definitive surgery, while 20 had surgery delayed (>48 hr). The early treatment group had an infection rate of 3.4% and total complication rate of 20.6%. The delayed treatment group had an infection rate of 5.0% and total complication rate of 25%. There was no significant difference with respect to superficial infection (P=1.0), deep infection (P=0.48), or total complications (P=0.74) Additionally, infection rates did not differ between surgical approaches (P=1.0, 1.0).

Conclusions:
Early surgical fixation (<48 hr) of low-energy tibial plateau fractures can be performed safely. Additionally, a midline approach did not increase soft-tissue complications and could be utilized in a patient with a prior midline incision, or one who will soon require a knee arthroplasty.