bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concurrent Meniscal and Chondral Injuries in Pediatric and Adolescent Patients Undergoing ACL Reconstruction
Authors: Vavken Patrick , Tepolt Frances A. , Kocher Mininder S. 
Published: May 2016

Background/Purpose:
The aim of this study is to assess the prevalence of and risk factors for concurrent meniscal and articular cartilage injury in children and adolescents undergoing anterior cruciate ligament (ACL) reconstruction.

Methods:
Medical records of pediatric patients (below 18 y old) undergoing ACL surgery during the 2013 to 2014 academic year at a tertiary care children’s hospital were reviewed for clinical or radiographic documentation of meniscal or chondral injury. Prevalence of concurrent injury was regressed on the basis of age, sex, body mass index (BMI), and time between injury and surgery. Skeletally immature patients were analyzed as a separate subgroup.

Results:
Medical records of 208 patients with a mean age of 15±2 years were reviewed. Overall, 117 patients (56%) were found to have had at least 1 concurrent injury; 66 patients (32%) had a medial meniscus tear, 72 patients (35%) had a lateral meniscus tear, and 10 patients (5%) had a chondral lesion. Both BMI and time duration between injury and ACL reconstruction surgery were significant predictors for meniscal or chondral injury, with increase in injury prevalence of approximately 10% per point BMI and 6% per month delay to surgery.

Conclusions:
More than half of the children and the adolescents treated for ACL tear have concurrent meniscal or chondral injury. Risk factors for concurrent injury are BMI and time duration between injury and surgery. The prevalence of concurrent injury and associated risk factors should be considered when counseling a pediatric patient and family regarding operative versus nonoperative management in the setting of an ACL tear.

Level of Evidence:
Level IV—case series.
SPONTANEOUS BILATERAL HEMORRHAGIC CHOROIDAL DETACHMENTS ASSOCIATED WITH MALIGNANT HYPERTENSION
Authors: Cheung Albert Y. , David James A. , Ober Michael D. 
Published: May 2016

Purpose:
To report the details of a patient with bilateral spontaneous suprachoroidal hemorrhages related to malignant hypertension.

Methods:
Observational case report with review of relevant literature.

Results:
A 62-year-old man with a history of hypertension was referred secondary to bilateral temporal scotomas and persistent headache for 3 days. Symptoms began during an inpatient admission for malignant hypertension. Examination revealed bilateral 360° hemorrhagic choroidal detachments without retinal hemorrhage or detachment. Choroidal hemorrhages underwent prompt resolution with blood pressure control.

Conclusion:
Spontaneous suprachoroidal hemorrhage is a rare event and should prompt a focused systemic workup including the evaluation of blood pressure.
Idarucizumab for Reversing Dabigatran-Induced Anticoagulation: A Systematic Review
Authors: Thibault Nathan , Morrill Amanda M. , Willett Kristine C. 
Published: May 2016

Background:
The approval of the oral direct thrombin inhibitor, dabigatran etexilate, gave patients an alternative to oral anticoagulation with warfarin. Like all anticoagulants, the primary adverse event (AE) associated with dabigatran is bleeding. Until the FDA approval of idarucizumab, there had been no reversal agent for dabigatran-induced anticoagulation in patients with life-threatening or uncontrollable bleeding, or those requiring emergent procedures.

Areas of Uncertainty:
The primary purpose of this review is to summarize the safety and efficacy of idarucizumab, a monoclonal antibody fragment, and its use as a reversal agent for dabigatran.

Data Sources:
A literature search was conducted through MEDLINE (1946 to November week 1 2015) and Embase (1980–2015 week 46) using the search term idarucizumab. Clinicaltrials.gov was consulted for a comprehensive list of ongoing and completed studies. Additional studies were identified through bibliographical citations. Clinical trials in animals and humans published in English evaluating the safety and efficacy of idarucizumab for reversal of anticoagulant treatment with dabigatran were included for review.

Results:
Idarucizumab has been shown to significantly reverse the anticoagulant effects of dabigatran in both healthy volunteers and patients requiring a reversal agent because of either overt bleeding or an emergency surgery or invasive procedure. The most common AEs were headache, nasopharyngitis, back pain, skin irritation, hypokalemia, delirium, constipation, pyrexia, and pneumonia. Deaths reported in idarucizumab studies were attributed to either the index event or a preexisting comorbidity. Most adverse effects were minor, but 21 serious AEs have been reported in the published data including thrombotic events.

Conclusions:
Given the increased use of direct oral anticoagulants, such as dabigatran, a need for specific reversal agents exists. Idarucizumab has been shown to be safe and effective in the reversal of dabigatran-induced anticoagulation in patients requiring emergent or urgent surgery or in patients with severe bleeding.
Treatment of Metastatic, Refractory Alveolar Soft Part Sarcoma: Case Reports and Literature Review of Treatment Options in the Era of Targeted Therapy
Authors: Kuo Dennis J. , Menell Jill S. , Glade Bender Julia L. 
Published: May 2016

Background:
Alveolar soft part sarcoma is a rare soft tissue sarcoma that is characterized by a pattern of slow growth with metastases to the lung, bone, and brain that is not responsive to conventional cytotoxic chemotherapy.

Observations:
We describe 2 patients, with a combined 19 years of treatment experience including multiple different chemotherapeutic and targeted therapy regimens, surgery, and radiotherapy. We also present a review of the literature regarding treatment options to highlight recent findings.

Conclusions:
Alveolar soft part sarcoma is an indolent, but persistently progressive disease. Novel therapeutic agents hold promise in its management.
Results of Therapy for Wilms Tumor and Other Malignant Kidney Tumors: A Report From the Chilean Pediatric National Cancer Program (PINDA)
Authors: Joannon Pilar , Becker Ana , Kabalan Paola , Concha Emma , Beresi Victoria , Salgado Carmen , Martínez Pilar , Olate Paola , Arriagada Mónica , Espinoza Felipe , Varas Mónica , Benavides Pablo , Valero Miguel , Reyes Mauricio 
Published: May 2016

Objective:
The aim of this study was to analyze the survival of children with Wilms tumor and other malignant renal tumors treated with the TWPINDA-99 protocol.

Materials and Methods:
Between January 1999 and December 2013, 226 patients were registered on this trial, based on National Wilms Tumor Study-5. Patient characteristics and survival were evaluated.

Results:
Two hundred seven patients were diagnosed with Wilms tumor, which represented 91.6% of renal tumors. The male to female ratio was 0.7:1. The median age at diagnosis was 3.3 years. Stage III was the most frequent (39.2%). Metastatic disease was present in 16.7% of the cases. Synchronous bilateral disease was observed in 9.3% of the cases. Favorable histology was diagnosed in 93.6% and anaplastic histology in 6.4% of the patients. Median follow-up was 7.5 years. Ten-year event-free survival and overall survival (OS) for assessable patients with Wilms tumor (n=192) were 82.0% and 89.9%, respectively. OS for patients with stage I was 100% (n=36), stage II: 97.1% (n=35), stage III: 88.6% (n=71), stage IV: 77.9% (n=32), and stage V: 80.8% (n=18). OS for favorable histology (n=180) and anaplastic histology tumors (n=12) were 91.0% and 72.9%, respectively. Other malignant renal tumors had a poorer survival.

Conclusion:
Prognosis for patients with Wilms tumor treated on TWPINDA-99 seems to be better than previous national trials and is similar to developed countries.
Safety and Effectiveness of Intravenous Pentamidine for Prophylaxis of Pneumocystis jirovecii Pneumonia in Pediatric Hematology/Oncology Patients
Authors: Solodokin Loriel J. , Klejmont Liana M. , Scipione Marco R. , Dubrovskaya Yanina , Lighter-Fisher Jennifer , Papadopoulos John 
Published: May 2016

Background:

Pneumocystis jirovecii pneumonia (PCP) is an opportunistic infection that can lead to significant morbidity and mortality in immunocompromised pediatric hematology/oncology patients. Trimethoprim/sulfamethoxazole is the gold standard for prophylaxis. Intravenous (IV) pentamidine is the preferred second-line agent for PCP prophylaxis at our institution and is used first-line under certain circumstances. The purpose of this study is to evaluate the effectiveness and safety of IV pentamidine for PCP prophylaxis in pediatric hematology/oncology patients.

Materials and Methods:
A retrospective analysis of pediatric hematology/oncology patients (N=121) who received ≥1 dose of IV pentamidine between January 2009 and July 2014 was conducted. Electronic health records were reviewed to determine baseline characteristics, rate of breakthrough PCP infection, characteristics of IV pentamidine use, and adverse events. The follow-up period was 6 months after the last reported IV pentamidine dose or the last recorded clinic visit/hospital admission.

Results:
No patients developed PCP during the entirety of their IV pentamidine course or during the follow-up period. Nineteen patients (16%) experienced adverse events and 5 of the 19 patients required discontinuation of IV pentamidine.

Conclusions:
IV pentamidine is a safe, tolerable, and effective agent for PCP prophylaxis in pediatric hematology/oncology patients and may be considered a reasonable therapeutic alternative when trimethoprim/sulfamethoxazole cannot be used for PCP prophylaxis.
Improving Communication During Cardiac ICU Multidisciplinary Rounds Through Visual Display of Patient Daily Goals*
Authors: Justice Lindsey B. , Cooper David S. , Henderson Carla , Brown James , Simon Katherine , Clark Lindsey , Fleckenstein Elizabeth , Benscoter Alexis , Nelson David P. 
Published: May 2016

Objectives:
To improve communication during daily cardiac ICU multidisciplinary rounds.

Design:
Quality improvement methodology.

Setting:
Twenty-five–bed cardiac ICUs in an academic free-standing pediatric hospital.

Patients:
All patients admitted to the cardiac ICU.

Interventions:
Implementation of visual display of patient daily goals through a write-down and read-back process.

Measurements and Main Results:
The Rounds Effectiveness Assessment and Communication Tool was developed based on the previously validated Patient Knowledge Assessment Tool to evaluate comprehension of patient daily goals. Rounds were assessed for each patient by the bedside nurse, nurse practitioner or fellow, and attending physician, and answers were compared to determine percent agreement per day. At baseline, percent agreement for patient goals was only 62%. After initial implementation of the daily goal write-down/read-back process, which was written on paper by the bedside nurse, the Rounds Effectiveness Assessment and Communication Tool survey revealed no improvement. With adaptation of the intervention so goals were written on whiteboards for visual display during rounds, the percent agreement improved to 85%. Families were also asked to complete a survey (1–6 Likert scale) of their satisfaction with rounds and understanding of daily goals before and after the intervention. Family survey results improved from a mean of 4.6–5.7. Parent selection of the best possible score for each question was 19% at baseline and 75% after the intervention.

Conclusions:
Visual display of patient daily goals via a write-down/read-back process improves comprehension of goals by all team members and improves parent satisfaction. The daily goal whiteboard facilitates consistent development of a comprehensive plan of care for each patient, fosters goal-directed care, and provides a checklist for providers and parents to review throughout the day.
Clinical Symptoms and Adverse Effects Associated With Energy Drink Consumption in Adolescents
Authors: Bashir Dalia , Reed-Schrader Essie , Olympia Robert P. , Brady Jodi , Rivera Ruby , Serra Theresa , Weber Christopher 
Published: May 2016

Objective
The aims of the study were to determine the prevalence of energy drink consumption by adolescents, to identify associated clinical symptoms and adverse effects, and to gain an understanding to the motivation behind its consumption.

Methods
A prospective, questionnaire-based study was conducted at 2 emergency departments from June 2011 to June 2013. The questionnaire was distributed to a convenience sample of adolescents aged 12 to 18 years. Stratification was performed on the basis of frequency of consumption: frequent consumption (at least once a month) and infrequent consumption (less frequent than once a month).

Results
Data analysis was performed on 612 completed questionnaires. Two hundred two responders (33%) were considered frequent energy drink consumers. Frequent consumers were more likely to be involved in high-risk behaviors and more likely to consume other caffeinated drinks. In the previous 6 months, frequent energy drink consumers were more likely to report headache (76%), anger (47%), and increased urination (24%) and were more likely to require medical evaluation for headache (41%) and difficulty breathing (22%). Frequent energy drink consumers were more likely to believe that energy drinks “help me do better in school” (12%), “help me do better in sports” (35%), “are just for fun” (46%), “help me stay up at night” (67%), and “make me concentrate/focus better” (34%).

Conclusions
Clarifying common misconceptions associated with energy drink consumption, especially in high-risk adolescents and frequent energy drink consumers, may decrease the frequency of symptoms experienced by adolescents, such as headache and difficulty breathing, requiring medical evaluation.
Emergency and Disaster Preparedness of School Transportation Staff and School Buses in the United States: Compliance With Recommendations for School Transportation Safety
Authors: Olympia Robert P. , Weber Christopher , Brady Jodi , Ho Susana 
Published: May 2016

Objective
The aim of the study was to determine the compliance of school transportation staff and school buses with recommendations for the safe transportation of children to and from school and school-related activities.

Methods
An electronic questionnaire was distributed to school transportation staff represented by the International Brotherhood of Teamsters during the 2013–2014 academic year.

Results
Analysis was performed on 558 completed questionnaires (13% usable response rate). Responders had previous training in first aid (89%), basic life support (28%), and cardiopulmonary resuscitation (52%). Seventy-eight percent of school buses in our sample had restraint devices and 87% had seat belt cutters. Responders reported the immediate availability of the following on their bus: communication devices (81%), first aid kits (97%), fire extinguishers (89%), automated external defibrillators (1%), and epinephrine autoinjectors (2%). Thirty percent of responders have had no previous training in the management of emergencies such as trouble breathing, severe allergic reaction, seizures, cardiac arrest or unresponsiveness, and head, neck, or extremity trauma. Thirteen percent of responders are unfamiliar with or have had no previous training on protocols regarding emergency shelters and community evacuation plans in the event of a disaster.

Conclusions
Variability exists in the compliance of school transportation staff and school buses with recommendations for the safe transportation of children. Areas for improvement were identified, such as educating school transportation staff in the recognition and initial management of pediatric emergencies, ensuring the presence of restraint devices, increasing the immediate availability of certain emergency medications and equipment, and familiarizing school transportation staff with designated emergency shelters and community evacuation plans.
The Validity of the Pediatric Assessment Triangle as the First Step in the Triage Process in a Pediatric Emergency Department
Authors: Fernández Ana , Ares Maria Isabel , Garcia Sara , Martinez-Indart Lorea , Mintegi Santiago , Benito Javier 
Published: May 2016

Objective
This study aimed to assess the association between pediatric assessment triangle (PAT) findings during triage and markers of severity in a pediatric emergency department (PED).

Methods
During the study period, patients arriving to the PED were classified by trained nurses with the Pediatric Canadian Triage and Acuity Scale using a computer system, from which data were obtained and analyzed retrospectively. The primary outcome measure was the percentage of children hospitalized related with PAT findings. The secondary outcome measures were the admission to the intensive care unit (%), PED length of stay, and performance of blood tests (%).

Results
Among the 302,103 episodes included, there were abnormal PAT findings in 24,120 cases (7.9%). Multivariate analysis adjusted for age confirmed that PAT findings and triage level were independent risk factors for admission (odds ratio [OR], 2.21; 95% confidence interval [CI], 2.13–2.29; OR, 6.01; 95% CI, 5.79–6.24, respectively). Abnormal findings in appearance or in more than 1 PAT component were even more strongly associated with admission (3.99; 95% CI, 3.63–4.38; 14.99, 95% CI, 11.99–18.74, respectively). When adjusted for triage level and age, abnormal PAT findings were also an independent risk factor for intensive care unit admission (OR, 4.44; 95% CI, 3.77–5.24) and a longer stay in the PED (OR, 1.78; 95% CI, 1.72–1.84).

Conclusions
Abnormal findings in the PAT applied by trained nurses at triage identify patients with a higher risk of hospitalization. The PAT seems to be a valid tool for identifying the most severe patients as a first step in the triage process.
Relative Effectiveness of Dopamine Antagonists for Pediatric Migraine in the Emergency Department
Authors: Sheridan David C. , Laurie Amber , Pacheco Stephanie , Fu Rongwei , Hansen Matthew L. , Ma O. John , Meckler Garth D. 
Published: May 2016

Objective
Migraine headaches are common in the pediatric emergency department. The mainstay of abortive treatment consists of nonsteroidal anti-inflammatories and dopamine antagonists. The objective of this study was to compare the effectiveness of 3 commonly used dopamine antagonists to abort pediatric migraine.

Methods
This was a retrospective cohort study of all patients who presented to the pediatric emergency department at a tertiary care pediatric hospital between January 2010 and December 2013. Patients were treated for a migraine headache with a combination of ketorolac and one of the following dopamine antagonists: prochlorperazine, metoclopramide, or promethazine. The primary outcome was treatment failure and receiving non–evidence-based treatment defined by the need for opioids. Secondary outcomes included pain score reduction and return visit within 48 hours.

Results
There were 57 patients during this period with 67 visits that met inclusion criteria: 27 (40.3%) visits in which patients were treated with prochlorperazine, 23 (34.3%) visits in which patients were treated with metoclopramide, and 17 (25.4%) visits in which patients were treated with promethazine. Across visits, the mean age was 14.5 years, and 63% were women. Opioids were given for treatment failure in 8.7% of visits in which patients received prochlorperazine, 25% in which patients received metoclopramide, and 42.8% in which patients received promethazine. Patients treated with promethazine had significantly higher odds of needing opioids and experiencing less than 50% reduction in pain score compared with prochlorperazine after adjusting for patient characteristics.

Conclusions
This study suggests variable efficacy among 3 commonly used dopamine antagonists for pediatric migraine headache. Promethazine seems least effective and results in higher use of opioids compared with other available dopamine antagonists.
Pediatric Exposures to Bombina Toads Reported to Poison Centers
Authors: Forrester Mathias B. 
Published: May 2016

Objectives
Fire-bellied toads (genus Bombina) secrete toxins from their skin that may cause problems to humans, particularly if they get in the eye. This study aimed to describe pediatric exposures to fire-bellied toads reported to a large poison center system.

Methods
Cases were fire-bellied toad exposures among patients aged 13 years or younger reported to Texas poison centers during 2000–2014. The distribution by various demographic and clinical factors was determined.

Results
Of 20 total exposures, the mean patient age was 5.8 years (range, 2–13 years); 70% of the patients were boys. The exposure route was ocular (70%), dermal (55%), and ingestion (20%). Eighty-five percent of the exposures occurred at the patient's own residence. Sixty percent of the patients were managed onsite, and 40% were already at or en route to a health care facility. The medical outcome was as follows: minor effects (45%), moderate effects (5%), and not followed but judged to have minimal clinical effects (50%). The most common reported symptoms were ocular irritation/pain (65%), dermal irritation/pain (30%), and red eye (20%). Decontamination by dilution/irrigation/wash was reported in 95% of the patients.

Conclusions
Few pediatric exposures to fire-bellied toads were reported. Those that were reported were most likely to involve ocular followed by dermal routes. The exposures tended not to be serious and could be managed outside of a health care facility.
Proteasome dysfunction triggers activation of SKN-1A/Nrf1 by the aspartic protease DDI-1
Authors: Lehrbach Nicolas J. , Ruvkun Gary 
Published: May 2016

ABSTRACTProteasomes are essential for protein homeostasis in eukaryotes. To preserve cellular function, transcription of proteasome subunit genes is induced in response to proteasome dysfunction caused by pathogen attacks or proteasome inhibitor drugs. In Caenorhabditis elegans, this response requires SKN-1, a transcription factor related to mammalian Nrf1/2. Here, we use comprehensive genetic analyses to identify the pathway required for C. elegans to detect proteasome dysfunction and activate SKN-1. Genes required for SKN-1 activation encode regulators of ER traffic, a peptide N-glycanase, and DDI-1, a conserved aspartic protease. DDI-1 expression is induced by proteasome dysfunction, and we show that DDI-1 is required to cleave and activate an ER-associated isoform of SKN-1. Mammalian Nrf1 is also ER-associated and subject to proteolytic cleavage, suggesting a conserved mechanism of proteasome surveillance. Targeting mammalian DDI1 protease could mitigate effects of proteasome dysfunction in aging and protein aggregation disorders, or increase effectiveness of proteasome inhibitor cancer chemotherapies.