bluuebunny/crossref_metadata_2025_split huggingface dataset:
In Vivo Angiography Quantifies Oxygen-Induced Retinopathy Vascular Recovery
Authors: Mezu-Ndubuisi Olachi J. 
Published: August 2016

ABSTRACT

Purpose
Retinopathy of prematurity (ROP) is a potentially blinding vasoproliferative disease. There is no standardized way to quantify plus disease (tortuous and dilated retinal vessels) or characterize abnormal recovery during ROP monitoring. This study objectively studies vascular features in live mice during development using noninvasive retinal imaging.

Methods
Using fluorescein angiography (FA), retinal vascular features were quantified in live mice with oxygen induced retinopathy (OIR). A total of 105 wild-type mice were exposed to 77% oxygen from postnatal day 7 (P7) till P12 (OIR mice). Also, 105 age-matched pups were raised in room air (RA mice). In vivo FA was performed at early (P16 to P20), mid (P23 to P27), late (P30 to P34), and mature (P47) phases of retinal vascular development. Retinal vascular area, retinal vein width, and retinal artery tortuosity were quantified.

Results
Retinal artery tortuosity was higher in OIR than RA mice at early (p < 0.0001), mid (p < 0.0001), late (p < 0.0001), and mature (p < 0.0001) phases. Retinal vascular area in OIR mice increased from early to mid-phase (p < 0.0001), but remained unchanged from mid to late (p = 0.23), and from late to mature phase (p = 0.98). Retinal vein width was larger in OIR mice compared to RA mice during early phase only. Arteries in OIR mice were more tortuous from early to mid-phase (p < 0.0001), but tortuosity remained stable from mid through mature phase. RA mice had an increase in retinal vascular area from early to late phase, but maintained uniform retinal vein width and retinal artery tortuosity in all phases.

Conclusions
In vivo FA distinguished arterial and venous features, similar to plus disease, and revealed aberrant recovery of OIR mice (arterial tortuosity, reduced capillary density, and absent neovascular buds) that persisted into adulthood. Retinal artery tortuosity may be a reliable, objective marker of severity of ROP. Infants with abnormal retinal vascular recovery may need extended monitoring.
Type II Macular Telangiectasia Presenting as Bilateral Retinochoroidal Anastomosis
Authors: Agarwal Aniruddha , Invernizzi Alessandro , Kumari Neha , Singh Ramandeep 
Published: August 2016

ABSTRACT

Purpose
Retinochoroidal anastamosis (RCA) is known to be associated with retinal angiomatous proliferans rather than idiopathic macular telangiectasia. The case report describes a rare association of bilateral RCA with type II idiopathic macular telangiectasia in an elderly woman.

Case Report
A 65-year-old female patient presented with decreased vision in both eyes to the ophthalmology clinic. She was diagnosed with bilateral large serous retinal pigment epithelial detachments (PED). Atypical association of PED with IMT led to additional imaging, including fluorescein angiography (FA), spectral-domain optical coherence tomography (SD-OCT), and indocyanine green angiography (ICGA). Multimodal imaging analysis revealed characteristic signs of RCA such as the so-called kissing sign on SD-OCT. The patient was not offered any treatment due to the poor prognosis associated with the condition.

Conclusions
Although more commonly associated with retinal angiomatous proliferans (type III neovascular age-related macular degeneration), RCA can present in type II IMT Stage 5.
Pulmonary Hypertension
Authors: Oishi Peter , Fineman Jeffrey R. 
Published: August 2016

Objectives:
To review the clinical classification, diagnosis, and pathophysiology of pulmonary hypertension in children, emphasizing the role of right ventricular function, ventricular interaction, and congenital heart disease in the evolution and progression of disease, as well as management strategies and therapeutic options.

Data Source:
MEDLINE, PubMed.

Conclusions:
Critically ill children with pulmonary hypertension associated with congenital heart disease are a high-risk population. Congenital cardiac defects resulting in either increased pulmonary blood flow or impaired pulmonary venous drainage predispose patients to developing structural and functional aberrations of the pulmonary vasculature. Mortality from pulmonary hypertension is most directly related to right ventricular failure.
Hemodynamic Monitoring
Authors: Bronicki Ronald A. 
Published: August 2016

Objectives:
In this review, we discuss hemodynamic monitoring modalities, including their application, the interpretation of data, limitations, and impact on outcomes.

Data Source:
MEDLINE, PubMed.

Conclusions:
One of the tenets of critical care medicine is to ensure adequate tissue oxygenation. This assessment must be timely and accurate to optimize outcomes. The clinical assessment of cardiac function, cardiac output, and tissue oxygenation based on the physical examination and standard hemodynamic variables, although an indispensable part of this exercise, has significant limitations. The use of adjunctive hemodynamic monitoring modalities provides a much more objective, accurate, and timely assessment of the patient’s hemodynamic profile and is invaluable for assessing the patient’s clinical status, clinical trajectory, and response to interventions.
Acquired and Congenital Coronary Artery Diseases
Authors: Fuller Stephanie , Ravishankar Chitra 
Published: August 2016

Objectives:
The objectives of this review are to discuss the spectrum of coronary artery anomalies and the evidence behind current treatment strategies.

Data Source:
MEDLINE and PubMed.

Conclusion:
Coronary artery anomalies exist in up to 1% of the population and most of these do not cause symptoms or ischemia and do not require any surgical intervention whereas others are potentially fatal. The type of surgical intervention is often dictated by the type of lesion, and upon the unique anatomic and physiologic variables associated with each lesion. Postoperative care can be challenging particularly after surgical repair of anomalous left coronary artery from the pulmonary artery.
Arrhythmias in Cardiac Critical Care
Authors: Smith Andrew H. 
Published: August 2016

Objectives:
Here, we characterize the frequency, mechanisms, clinical impact, and potential treatment options for several arrhythmias commonly encountered in pediatric cardiac critical care.

Data Source:
MEDLINE and PubMed.

Conclusions:
Arrhythmias among children in the cardiac critical care setting are common and clinically important, associated independently with prolonged mechanical ventilation, critical care unit stay, and an increase in mortality. The precise characterization of an arrhythmia may provide clues as to an underlying mechanism as well as serve to guide treatment. Arrhythmia therapy, pharmacologic or otherwise, is directed toward addressing the underlying mechanism, and as such may be applicable to the treatment of more than one specific rhythm disturbance. Decisions concerning therapy must call into consideration an arrhythmia’s underlying etiology, mechanism, and associated hemodynamic embarrassment, along with the potential for adverse effects of treatment.
Acute Kidney Injury and Cardiorenal Syndromes in Pediatric Cardiac Intensive Care
Authors: Cooper David S. , Kwiatkowski David M. , Goldstein Stuart L. , Krawczeski Catherine D. 
Published: August 2016

Objectives:
The objectives of this review are to discuss the definition, diagnosis, and pathophysiology of acute kidney injury and its impact on immediate, short-, and long-term outcomes. In addition, the spectrum of cardiorenal syndromes will be reviewed including the pathophysiology on this interaction and its impact on outcomes.

Data Source:
MEDLINE and PubMed.

Conclusion:
The field of cardiac intensive care continues to advance in tandem with congenital heart surgery. As mortality has become a rare occurrence, the focus of cardiac intensive care has shifted to that of morbidity reduction. Acute kidney injury adversely impact outcomes of patients following surgery for congenital heart disease as well as in those with heart failure (cardiorenal syndrome). Patients who become fluid overloaded and/or require dialysis are at a higher risk of mortality, but even minor degrees of acute kidney injury portend a significant increase in mortality and morbidity. Clinicians continue to seek methods of early diagnosis and risk stratification of acute kidney injury to prevent its adverse sequelae.
Clinical-Physiological Considerations in Patients Undergoing Staged Palliation for a Functionally Single Ventricle
Authors: Penny Daniel J. , Krishnamurthy Rajesh 
Published: August 2016

Objectives:
The objectives of this review are to discuss the pathophysiology of the circulation with a functionally univentricular heart, with a focus on the unique physiologic characteristics, which provide the underpinnings for the management of these complex patients.

Data Source:
MEDLINE and PubMed.

Conclusions:
The circulation of the patient with a functionally univentricular heart displays unique physiologic characteristics, which are quite different from those of the normal biventricular circulation. There are profound differences within the heart itself in terms of ventricular function, interventricular interactions, and myocardial architecture, which are likely to have significant implications for the efficiency of ventricular ejection and metabolism. The coupling between the systemic ventricle and the aorta also displays unique features. The 3D orientation of the Fontan anastomosis itself can profoundly impact cardiac output, although the “portal” pulmonary arterial bed is a crucial determinant of overall cardiovascular function. As a result, disease-specific approaches to improve cardiovascular function are required at all stages during the care of these complex patients.
Shunt Lesions Part II: Anomalous Pulmonary Venous Connections and Truncus Arteriosus
Authors: Martin Billie-Jean , Karamlou Tara B. , Tabbutt Sarah 
Published: August 2016

Objectives:
The objectives of this review are to describe the anatomy, pathophysiology, perioperative therapeutic strategies, and operative procedures for patients with anomalous pulmonary venous connections and truncus arteriosus.

Data Source:
MEDLINE and PubMed.

Conclusions:
An understanding of the anatomy and pathophysiology of anomalous pulmonary venous connections and truncus arteriosus is essential for the optimal perioperative management of these complex and challenging congenital lesions.
L-Transposition of the Great Arteries
Authors: Ravishankar Chitra 
Published: August 2016

Objectives:
To describe the various surgical options, perioperative management strategies, and outcomes for this complex lesion.

Data Source:
MEDLINE and PubMed.

Conclusions:
L-transposition of the great arteries is a relatively rare defect, comprising less than 1% of all congenital heart defects. There is considerable heterogeneity in clinical presentation depending on the presence of associated defects. Surgery for this rare and complex defect has evolved from “physiologic” repair in which the right ventricle remains in the systemic position to the “anatomic” repair, which restores the left ventricle as the systemic ventricle. There has been a great interest in performing the anatomic repair or “double switch” operation, a rather complex operation that presents unique challenges in the postoperative period.
Aortic and Mitral Valve Disease and Left Ventricular Dysfunction in Children
Authors: Maher Kevin O. , Tweddell James S. 
Published: August 2016

Objectives:
In this review, we will discuss aortic stenosis, aortic regurgitation, mitral regurgitation, and mitral stenosis. We will review the etiology, anatomy, pathophysiology, presentation, and treatment of aortic and mitral valve disease. Age and lesion specific treatments are outlined based on the severity of valve disease with an aim at long-term preservation of left ventricular function.

Data Source:
MEDLINE and PubMed.

Conclusions:
Mitral and aortic valve disease leads to unique hemodynamic burdens that can impact left ventricular function, quality of life, and longevity. The primary challenge in the management of mitral and aortic valve disease is to apply appropriate medical management and identify that point in time at which the surgery is necessary. Although guidelines have been established for the management of aortic and mitral valve disease in adults, the challenges of early presentation, maintenance of growth potential, and apparent increased tolerance of hemodynamic burden in children makes decision making challenging.
Clinical Impact of Accurate Point-of-Care Glucose Monitoring for Tight Glycemic Control in Severely Burned Children*
Authors: Tran Nam K. , Godwin Zachary R. , Steele Amanda N. , Wolf Steven E. , Palmieri Tina L. 
Published: August 2016

Objectives:
The goal of this study was to retrospectively evaluate the clinical impact of an accurate autocorrecting blood glucose monitoring system in children with severe burns. Blood glucose monitoring system accuracy is essential for providing appropriate intensive insulin therapy and achieving tight glycemic control in critically ill patients. Unfortunately, few comparison studies have been performed to evaluate the clinical impact of accurate blood glucose monitoring system monitoring in the high-risk pediatric burn population.

Design:
Retrospective analysis of an electronic health record system.

Setting:
Pediatric burn ICU at an academic medical center.

Patients:
Children (aged < 18 yr) with severe burns (≥ 20% total body surface area) receiving intensive insulin therapy guided by either a noncorrecting (blood glucose monitoring system-1) or an autocorrecting blood glucose monitoring system (blood glucose monitoring system-2).

Measurements and Main Results:
Patient demographics, insulin rates, and blood glucose monitoring system measurements were collected. The frequency of hypoglycemia and glycemic variability was compared between the two blood glucose monitoring system groups. A total of 122 patient charts from 2001 to 2014 were reviewed. Sixty-three patients received intensive insulin therapy using blood glucose monitoring system-1 and 59 via blood glucose monitoring system-2. Patient demographics were similar between the two groups. Mean insulin infusion rates (5.1 ± 3.8 U/hr; n = 535 paired measurements vs 2.4 ± 1.3 U/hr; n = 511 paired measurements; p < 0.001), glycemic variability, and frequency of hypoglycemic events (90 vs 12; p < 0.001) were significantly higher in blood glucose monitoring system-1–treated patients. Compared with laboratory measurements, blood glucose monitoring system-2 yielded the most accurate results (mean ± sd bias: –1.7 ± 6.9 mg/dL [–0.09 ± 0.4 mmol/L] vs 7.4 ± 13.5 mg/dL [0.4 ± 0.7 mmol/L]). Blood glucose monitoring system-2 patients achieve glycemic control more quickly (5.7 ± 4.3 vs 13.1 ± 6.9 hr; p< 0.001) and stayed within the target glycemic control range longer compared with blood glucose monitoring system-1 patients (85.2% ± 13.9% vs 57.9% ± 29.1%; p < 0.001).

Conclusions:
Accurate autocorrecting blood glucose monitoring system optimizes intensive insulin therapy, improves tight glycemic control, and reduces the risk of hypoglycemia and glycemic variability. The use of an autocorrecting blood glucose monitoring system for intensive insulin therapy may improve glycemic control in severely burned children.
Platelet Transfusions in Pediatric Intensive Care*
Authors: Du Pont-Thibodeau Geneviève , Tucci Marisa , Robitaille Nancy , Ducruet Thierry , Lacroix Jacques 
Published: August 2016

Objectives:
To characterize the determinants of platelet transfusion in a PICU and determine whether there exists an association between platelet transfusion and adverse outcomes.

Design:
Prospective observational single center study, combined with a self-administered survey.

Setting:
PICU of Sainte-Justine Hospital, a university-affiliated tertiary care institution.

Patients:
All children admitted to the PICU from April 2009 to April 2010.

Intervention:
None.

Measurements and Main Results:
Among 842 consecutive PICU admissions, 60 patients (7.1%) received at least one platelet transfusion while in PICU. In the univariate analysis, significant determinants for platelet transfusion were admission Pediatric Risk of Mortality Score greater than 10 (odds ratio, 6.80; 95% CI, 2.5–18.3; p < 0.01) and Pediatric Logistic Organ Dysfunction scores greater than 20 (odds ratio, 26.9; 95% CI, 8.88–81.5; p < 0.01), history of malignancy (odds ratio, 5.08; 95% CI, 2.43–10.68; p < 0.01), thrombocytopenia (platelet count, < 50 × 109/L or < 50,000/mm3) (odds ratio, 141; 95% CI, 50.4–394.5; p < 0.01), use of heparin (odds ratio, 3.03; 95% CI, 1.40–6.37; p < 0.01), shock (odds ratio, 5.73; 95% CI, 2.85–11.5; p < 0.01), and multiple organ dysfunction syndrome (odds ratio, 10.41; 95% CI, 5.89–10.40; p < 0.01). In the multivariate analysis, platelet count less than 50 × 109/L (odds ratio, 138; 95% CI, 42.6–449; p < 0.01) and age less than 12 months (odds ratio, 3.06; 95% CI, 1.03–9.10; p = 0.02) remained statistically significant determinants. The attending physicians were asked why they gave a platelet transfusion; the most frequent justification was prophylactic platelet transfusion in presence of thrombocytopenia with an average pretransfusion platelet count of 32 ± 27 × 109/L (median, 21), followed by active bleeding with an average pretransfusion platelet count of 76 ± 39 × 109/L (median, 72). Platelet transfusions were associated with the subsequent development of multiple organ dysfunction syndrome (odds ratio, 2.53; 95% CI, 1.18–5.43; p = 0.03) and mortality (odds ratio, 10.1; 95% CI, 4.48–22.7; p < 0.01).

Conclusions:
Among children, 7.1% received at least one platelet transfusion while in PICU. Thrombocytopenia and active bleeding were significant determinants of platelet transfusion. Platelet transfusions were associated with the development of multiple organ dysfunction syndrome and increased mortality.
Refractory Status Epilepticus in Children: Intention to Treat With Continuous Infusions of Midazolam and Pentobarbital*
Authors: Tasker Robert C. , Goodkin Howard P. , Sánchez Fernández Iván , Chapman Kevin E. , Abend Nicholas S. , Arya Ravindra , Brenton James N. , Carpenter Jessica L. , Gaillard William D. , Glauser Tracy A. , Goldstein Joshua , Helseth Ashley R. , Jackson Michele C. , Kapur Kush , Mikati Mohamad A. , Peariso Katrina , Wainwright Mark S. , Wilfong Angus A. , Williams Korwyn , Loddenkemper Tobias 
Published: August 2016

Objective:
To describe pediatric patients with convulsive refractory status epilepticus in whom there is intention to use an IV anesthetic for seizure control.

Design:
Two-year prospective observational study evaluating patients (age range, 1 mo to 21 yr) with refractory status epilepticus not responding to two antiepileptic drug classes and treated with continuous infusion of anesthetic agent.

Setting:
Nine pediatric hospitals in the United States.

Patients:
In a cohort of 111 patients with refractory status epilepticus (median age, 3.7 yr; 50% male), 54 (49%) underwent continuous infusion of anesthetic treatment.

Main Results:
The median (interquartile range) ICU length of stay was 10 (3–20) days. Up to four “cycles” of serial anesthetic therapy were used, and seizure termination was achieved in 94% by the second cycle. Seizure duration in controlled patients was 5.9 (1.9–34) hours for the first cycle and longer when a second cycle was required (30 [4–120] hr; p = 0.048). Midazolam was the most frequent first-line anesthetic agent (78%); pentobarbital was the most frequently used second-line agent after midazolam failure (82%). An electroencephalographic endpoint was used in over half of the patients; higher midazolam dosing was used with a burst suppression endpoint. In midazolam nonresponders, transition to a second agent occurred after a median of 1 day. Most patients (94%) experienced seizure termination with these two therapies.

Conclusions:
Midazolam and pentobarbital remain the mainstay of continuous infusion therapy for refractory status epilepticus in the pediatric patient. The majority of patients experience seizure termination within a median of 30 hours. These data have implications for the design and feasibility of future intervention trials. That is, testing a new anesthetic anticonvulsant after failure of both midazolam and pentobarbital is unlikely to be feasible in a pediatric study, whereas a decision to test an alternative to pentobarbital, after midazolam failure, may be possible in a multicenter multinational study.
Diagnosis of Cystic Teratoma Facilitated by Point-of-Care Ultrasonography
Authors: Horner Kimberly Bogard , Marin Jennifer R. 
Published: August 2016

Abstract
Abdominal pain and constipation are common chief complaints in the pediatric emergency department. We present a case of a child with pain, abdominal distention, and constipation ultimately diagnosed with an ovarian teratoma and the role of point-of-care ultrasonography in the evaluation.
Tobacco User Characteristics and Outcomes Related to Intensity of Quitline Program Use: Results From Minnesota and Pennsylvania
Authors: Lien Rebecca K. , Schillo Barbara A. , Mast Jay L. , Lukowski Amy V. , Greenseid Lija O. , Keith Jennifer D. , Keller Paula A. 
Published: August 2016

Context:
Tobacco users in all 50 states have access to quitline telephone counseling and cessation medications. While studies show multiple calls relate to quit success, most participants do not complete a full call series. To date, quitline program use studies have analyzed single factors—such as number of calls or counseling minutes.

Objective:
This study combines multiple factors of quitline program use across 2 states to describe how participants use a 5-call program; assess whether intensity of program use is associated with participant subgroups; and assess whether key outcomes (quitting, satisfaction) are associated with intensity.

Design, Setting, and Participants:
This observational study examines data for quitline participants in Minnesota (n = 2844) and Pennsylvania (n = 14 359) in 2011 and 2012. A subset of participants was surveyed 7 months after registration to assess key outcomes (response rates: Minnesota 65%; Pennsylvania 60%).

Main Outcome Measures:
Quitline utilization data were used to identify program use variables: nicotine replacement therapy provision, number of counseling calls, number of counseling minutes, days from first to last counseling call, and days from registration to first counseling call. Ten program use groups were created using all 5 program use variables, from lowest (1) to highest (10) intensity.

Results:
Results were similar for both states. Only 11% of Minnesota and 8% of Pennsylvania participants completed all 5 calls. Intensity of quitline program use was associated with several participant characteristics including health conditions and age. Both quit status and program satisfaction were associated with program use intensity. Quit rates peaked in group 9, participants who received the full 5-call program.

Conclusions:
Quitlines should focus on engaging participants in multiple calls to improve quit outcomes. In addition, it is important to leverage multiple program use factors for a fuller understanding of how quitline participants use a program.