bluuebunny/crossref_metadata_2025_split huggingface dataset:
Graduates’ Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study
Authors: Latessa Robyn A. , Swendiman Robert A. , Parlier Anna Beth , Galvin Shelley L. , Hirsh David A. 
Published: March 2017

Purpose
The authors explored affordances that contribute to participants’ successful learning in longitudinal integrated clerkships (LICs).

Method
This dual-institutional, mixed-methods study included electronic surveys and semistructured interviews of LIC graduates who completed their core clinical (third) year of medical school. These LIC graduates took part in LICs at Harvard Medical School from 2004 to 2013 and the University of North Carolina School of Medicine–Asheville campus from 2009 to 2013. The survey questions asked LIC graduates to rate components of LICs that they perceived as contributing to successful learning. A research assistant interviewed a subset of study participants about their learning experiences. The authors analyzed aggregate data quantitatively and performed a qualitative content analysis on interview data.

Results
The graduates reported multiple affordances that they perceive contributed to successful learning in their LIC. The most reported components included continuity and relationships with preceptors, patients, place, and peers, along with integration of and flexibility within the curriculum.

Conclusions
As LIC models grow in size and number, and their structures and processes evolve, learners’ perceptions of affordances may guide curriculum planning. Further research is needed to investigate to what degree and by what means these affordances support learning in LICs and other models of clinical education.
Nebulization of Antiinfective Agents in Invasively Mechanically Ventilated Adults
Authors: Solé-Lleonart Candela , Rouby Jean-Jacques , Blot Stijn , Poulakou Garyfallia , Chastre Jean , Palmer Lucy B. , Bassetti Matteo , Luyt Charles-Edouard , Pereira Jose M. , Riera Jordi , Felton Tim , Dhanani Jayesh , Welte Tobias , Garcia-Alamino Jose M. , Roberts Jason A. , Rello Jordi 
Published: March 2017

Abstract

Background
Nebulization of antiinfective agents is a common but unstandardized practice in critically ill patients.

Methods
A systematic review of 1,435 studies was performed in adults receiving invasive mechanical ventilation. Two different administration strategies (adjunctive and substitute) were considered clinically relevant. Inclusion was restricted to studies using jet, ultrasonic, and vibrating-mesh nebulizers. Studies involving children, colonized-but-not-infected adults, and cystic fibrosis patients were excluded.

Results
Five of the 11 studies included had a small sample size (fewer than 50 patients), and only 6 were randomized. Diversity of case-mix, dosage, and devices are sources of bias. Only a few patients had severe hypoxemia. Aminoglycosides and colistin were the most common antibiotics, being safe regarding nephrotoxicity and neurotoxicity, but increased respiratory complications in 9% (95% CI, 0.01 to 0.18; I2 = 52%), particularly when administered to hypoxemic patients. For tracheobronchitis, a significant decrease in emergence of resistance was evidenced (risk ratio, 0.18; 95% CI, 0.05 to 0.64; I2 = 0%). Similar findings were observed in pneumonia by susceptible pathogens, without improvement in mortality or ventilation duration. In pneumonia caused by resistant pathogens, higher clinical resolution (odds ratio, 1.96; 95% CI, 1.30 to 2.96; I2 = 0%) was evidenced. These findings were not consistently evidenced in the assessment of efficacy against pneumonia caused by susceptible pathogens.

Conclusions
Performance of randomized trials evaluating the impact of nebulized antibiotics with more homogeneous populations, standardized drug delivery, predetermined clinical efficacy, and safety outcomes is urgently required. Infections by resistant pathogens might potentially have higher benefit from nebulized antiinfective agents. Nebulization, without concomitant systemic administration of the drug, may reduce nephrotoxicity but may also be associated with higher risk of respiratory complications.
A Prospective Study of Chronic Pain after Thoracic Surgery
Authors: Bayman Emine Ozgur , Parekh Kalpaj R. , Keech John , Selte Atakan , Brennan Timothy J. 
Published: March 2017

Abstract

Background
The goal of this study was to detect the predictors of chronic pain at 6 months after thoracic surgery from a comprehensive evaluation of demographic, psychosocial, and surgical factors.

Methods
Thoracic surgery patients were enrolled 1 week before surgery and followed up 6 months postsurgery in this prospective, observational study. Comprehensive psychosocial measurements were assessed before surgery. The presence and severity of pain were assessed at 3 and 6 months after surgery. One hundred seven patients were assessed during the first 3 days after surgery, and 99 (30 thoracotomy and 69 video-assisted thoracoscopic surgery, thoracoscopy) patients completed the 6-month follow-up. Patients with versus without chronic pain related to thoracic surgery at 6 months were compared.

Results
Both incidence (P = 0.37) and severity (P = 0.97) of surgery-related chronic pain at 6 months were similar after thoracotomy (33%; 95% CI, 17 to 53%; 3.3 ± 2.1) and thoracoscopy (25%; 95% CI, 15 to 36%; 3.3 ± 1.7). Both frequentist and Bayesian multivariate models revealed that the severity of acute pain (numerical rating scale, 0 to 10) is the measure associated with chronic pain related to thoracic surgery. Psychosocial factors and quantitative sensory testing were not predictive.

Conclusions
There was no difference in the incidence and severity of chronic pain at 6 months in patients undergoing thoracotomy versus thoracoscopy. Unlike other postsurgical pain conditions, none of the preoperative psychosocial measurements were associated with chronic pain after thoracic surgery.
MicroRNA-182-5p Regulates Nerve Injury–induced Nociceptive Hypersensitivity by Targeting Ephrin Type-b Receptor 1
Authors: Zhou Xuelong , Zhang Chenjing , Zhang Congjuan , Peng Yunan , Wang Yin , Xu Hongjiao 
Published: March 2017

Abstract

Background
The authors and others have previously shown that the up-regulation of spinal ephrin type-b receptor 1 plays an essential role in the pathologic process of nerve injury–induced nociceptive hypersensitivity, but the regulatory mechanism remains unclear.

Methods
Radiant heat and von Frey filaments were applied to assess nociceptive behaviors. Real-time quantitative polymerase chain reaction, Western blotting, fluorescence in situ hybridization, immunofluorescence, immunohistochemistry, dual-luciferase reporter gene assays, recombinant lentivirus, and small interfering RNA were used to characterize the likely mechanisms.

Results
Periphery nerve injury induced by chronic constriction injury of the sciatic nerve significantly reduced spinal microRNA-182-5p (miR-182-5p) expression levels, which were inversely correlated with spinal ephrin type-b receptor 1 expression (R
2 = 0.90; P < 0.05; n = 8). The overexpression of miR-182-5p in the spinal cord prevented and reversed the nociceptive behaviors induced by sciatic nerve injury, accompanied by a decreased expression of spinal ephrin type-b receptor 1 (recombinant lentiviruses containing pre-microRNA-182: 1.91 ± 0.34 vs. 1.24 ± 0.31, n = 4; miR-182-5p mimic: 2.90 ± 0.48 vs. 1.51 ± 0.25, n = 4). In contrast, the down-regulation of spinal miR-182-5p facilitated the nociceptive behaviors induced by sciatic nerve injury and increased the expression of spinal ephrin type-b receptor 1 (1.0 ± 0.26 vs. 1.74 ± 0.31, n = 4). Moreover, the down-regulation of miR-182-5p and up-regulation of ephrin type-b receptor 1 caused by sciatic nerve injury were mediated by the N-methyl-d-aspartate receptor.

Conclusions
Collectively, our findings reveal that the spinal ephrin type-b receptor 1 is regulated by miR-182-5p in nerve injury–induced nociceptive hypersensitivity.
Recent developments in the management of germ cell tumors
Authors: Msaouel Pavlos , Bilen Mehmet A. , Zhang Miao , Campbell Matthew , Wang Jennifer , Tu Shi-Ming 
Published: March 2017

Purpose of review
In the present review, we summarize the recent developments in the management of germ cell tumors (GCTs).

Recent findings
Treatment-related acute and late-onset toxicity remains a key challenge in the management of GCTs. Recent data show that patients with large retroperitoneal lymph node metastases are at increased risk of venous thromboembolism and may benefit from prophylactic anticoagulation. Predictive models have been developed to identify patients with residual retroperitoneal lymph node masses who are more likely to benefit from surgical resection. However, their clinical use remains hampered by relatively low accuracy. There are currently multiple conventional-dose chemotherapy (CDCT) options for salvage therapy in patients with refractory or recurrent disease. In addition, more efficacious high-dose chemotherapy (HDCT) regimens continue to be developed. The role of salvage CDCT versus HDCT is currently being prospectively investigated.
Finally, intratumoral heterogeneity is a common finding in cancer and an obvious observation in GCTs. Despite intratumoral heterogeneity, recent studies on nonseminomatous GCT have identified distinct histological subgroups and a potentially lethal clinical phenotype. Importantly, comprehensive molecular profiling so far has not elucidated the biologic basis or the clinical underpinnings of intratumoral heterogeneity in GCTs.

Summary
Remaining challenges to be addressed include minimizing therapeutic toxicity and improving outcomes in patients with refractory/recurrent GCTs or malignant transformation of teratomas.
Clinical Characteristics of Arteriovenous Malformations of the Head and Neck
Authors: Kim Jae Bong , Lee Jeong Woo , Choi Kang Young , Yang Jung Dug , Cho Byung Chae , Lee Seok-Jong , Kim Yong-Sun , Lee Jong Min , Huh Seung , Chung Ho Yun 
Published: March 2017

BACKGROUND
Arteriovenous malformation (AVM) of the head and neck regions show low incidence; hence, studies regarding the causative factors of onset, diagnostic criteria, clinical aspects, treatment methods, and outcomes remain lacking.

OBJECTIVE
To share the diagnostic and treatment experiences at the center and to understand the treatments' effect through a retrospective analysis of cases in the past 15 years.

MATERIALS AND METHODS
The authors included 60 patients with AVM in the head and neck area between January 1999 and September 2014 to investigate diagnostic methods, distributions and locations of lesions, clinical stage, and treatment methods by retrospective evaluation.

RESULTS
In all, 3.7% were diagnosed with AVMs of the head and neck. No sex-related differences were observed, and the mean age at diagnosis was 27.6 ± 14.24 years. The left (26 patients, 43%) and V2 sections (33 patients, 55%) of the head and neck were the most frequent locations. Stage II (28 patients, 47%) had the largest distribution. Forty-four patients (73%) showed improvement after sclerotherapy, embolization, and surgical resection.

CONCLUSION
The diagnosis and treatment of AVMs should be approached on a case-by-case basis by gathering opinions from specialists in each department using medical history, physical examination, and imaging results.
Autonomic Nervous System Function After a Skin-to-Skin Contact Intervention in Infants With Congenital Heart Disease
Authors: Harrison Tondi M. , Brown Roger 
Published: March 2017

Background:Infants with complex congenital heart disease (CCHD) demonstrate impaired autonomic nervous system (ANS) regulation, which may contribute to commonly observed impairments in feeding, growth, and development. Close mother-infant physical contact improves ANS function in other high-risk infant populations.Objective:Our purposes were to examine feasibility of a 2-week daily skin-to-skin contact (SSC) intervention and to describe change in ANS function in response to the intervention.Methods:Feasibility was assessed by recruitment and retention rates, safety, and acceptability. Autonomic nervous system function was measured with linear and nonlinear measures of heart rate variability (HRV) during a feeding before the 14-day SSC intervention and 3 times during a 4-week follow-up.Results:Recruitment rate was 72%; retention rate was 55.5%. Mothers were universally positive about SSC. Ten mothers and infants completed a daily mean of 77.05 minutes of SSC during the 14-day intervention with no adverse events. Baseline high-frequency HRV, reactivity to challenge, and recovery after challenge improved during the 6-week study. Nonlinear measures demonstrated abnormally high sympathetic activity, especially after feeding, in most infants.Conclusions:Skin-to-skin contact is feasible in infants with CCHD. Linear measures of HRV suggested improvements in ANS function with this intervention. This article is one of the first to describe nonlinear HRV measures in infants with CCHD. Additional research is needed to identify variations in linear and nonlinear effects based on specific cardiac conditions and with varying intervention doses and timing. This low-cost, low-risk intervention has the potential to improve outcomes in infants with CCHD.
Epidemiology and Outcomes of Pediatric Multiple Organ Dysfunction Syndrome
Authors: Watson R. Scott , Crow Sheri S. , Hartman Mary E. , Lacroix Jacques , Odetola Folafoluwa O. 
Published: March 2017

Objective:
To summarize the epidemiology and outcomes of children with multiple organ dysfunction syndrome as part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development multiple organ dysfunction syndrome workshop (March 26–27, 2015).

Data Sources:
Literature review, research data, and expert opinion.

Study Selection:
Not applicable.

Data Extraction:
Moderated by an experienced expert from the field, issues relevant to the epidemiology and outcomes of children with multiple organ dysfunction syndrome were presented, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:
Summary of presentations and discussion supported and supplemented by the relevant literature.

Conclusions:
A full understanding the epidemiology and outcome of multiple organ dysfunction syndrome in children is limited by inconsistent definitions and populations studied. Nonetheless, pediatric multiple organ dysfunction syndrome is common among PICU patients, occurring in up to 57% depending on the population studied; sepsis remains its leading cause. Pediatric multiple organ dysfunction syndrome leads to considerable short-term morbidity and mortality. Long-term outcomes of multiple organ dysfunction syndrome in children have not been well studied; however, studies of adults and children with other critical illnesses suggest that the risk of long-term adverse sequelae is high. Characterization of the long-term outcomes of pediatric multiple organ dysfunction syndrome is crucial to identify opportunities for improved treatment and recovery strategies that will improve the quality of life of critically ill children and their families. The workshop identified important knowledge gaps and research priorities intended to promote the development of standard definitions and the identification of modifiable factors related to its occurrence and outcome.
Pathophysiology of Pediatric Multiple Organ Dysfunction Syndrome
Authors: Carcillo Joseph A. , Podd Bradley , Aneja Rajesh , Weiss Scott L. , Hall Mark W. , Cornell Timothy T. , Shanley Thomas P. , Doughty Lesley A. , Nguyen Trung C. 
Published: March 2017

Objective:
To describe the pathophysiology associated with multiple organ dysfunction syndrome in children.

Data Sources:
Literature review, research data, and expert opinion.

Study Selection:
Not applicable.

Data Extraction:
Moderated by an experienced expert from the field, pathophysiologic processes associated with multiple organ dysfunction syndrome in children were described, discussed, and debated with a focus on identifying knowledge gaps and research priorities.

Data Synthesis:
Summary of presentations and discussion supported and supplemented by relevant literature.

Conclusions:
Experiment modeling suggests that persistent macrophage activation may be a pathophysiologic basis for multiple organ dysfunction syndrome. Children with multiple organ dysfunction syndrome have 1) reduced cytochrome P450 metabolism inversely proportional to inflammation; 2) increased circulating damage-associated molecular pattern molecules from injured tissues; 3) increased circulating pathogen-associated molecular pattern molecules from infection or endogenous microbiome; and 4) cytokine-driven epithelial, endothelial, mitochondrial, and immune cell dysfunction. Cytochrome P450s metabolize endogenous compounds and xenobiotics, many of which ameliorate inflammation, whereas damage-associated molecular pattern molecules and pathogen-associated molecular pattern molecules alone and together amplify the cytokine production leading to the inflammatory multiple organ dysfunction syndrome response. Genetic and environmental factors can impede inflammation resolution in children with a spectrum of multiple organ dysfunction syndrome pathobiology phenotypes. Thrombocytopenia-associated multiple organ dysfunction syndrome patients have extensive endothelial activation and thrombotic microangiopathy with associated oligogenic deficiencies in inhibitory complement and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13. Sequential multiple organ dysfunction syndrome patients have soluble Fas ligand-Fas–mediated hepatic failure with associated oligogenic deficiencies in perforin and granzyme signaling. Immunoparalysis-associated multiple organ dysfunction syndrome patients have impaired ability to resolve infection and have associated environmental causes of lymphocyte apoptosis. These inflammation phenotypes can lead to macrophage activation syndrome. Resolution of multiple organ dysfunction syndrome requires elimination of the source of inflammation. Full recovery of organ functions is noted 6–18 weeks later when epithelial, endothelial, mitochondrial, and immune cell regeneration and reprogramming is completed.
Diagnosis of an Intraventricular Cyst Using Point-of-Care Cranial Ultrasound in the Pediatric Emergency Department
Authors: Doctor Kaynan , Cohen Joanna S. 
Published: March 2017

Abstract
A 2-month-old previously healthy male infant presents with 2 days of unusual eye movements and increased fatigue. During evaluation in the pediatric emergency department, point-of-care cranial ultrasound identified a cyst-like mass. Subsequent magnetic resonance imaging confirmed the presence of a cyst within the third ventricle causing obstructive hydrocephalus.
High Concentration of C-Reactive Protein Is Associated With Serious Bacterial Infection in Previously Healthy Children Aged 3 to 36 Months With Fever and Extreme Leukocytosis
Authors: Kim Jung Heon , Lee Jeong-Yong , Cho Hyung-Rae , Lee Jong Seung , Ryu Jeong-Min , Lee Jina 
Published: March 2017

Objectives
The aim of the study was to investigate the diagnostic efficacy of C-reactive protein (CRP) in predicting serious bacterial infection (SBI) in febrile children aged 3 to 36 months with extreme leukocytosis (EL), defined as a peripheral white blood cell count of 25,000 to 49,999/mm3.

Methods
The presence of SBI was reviewed in previously healthy children aged 3 to 36 months with a fever of 39°C or higher and EL, who visited a tertiary care hospital emergency department between September 2010 and August 2015. We measured cutoff values of CRP with corresponding likelihood ratios (LRs) and posttest probabilities (PPs).

Results
Of 9989 febrile children, 4252 (42.6%) underwent assays for white blood cell and CRP. Of 233 (5.5%) children with EL, 133 (3.1%) were enrolled, of whom 43 (32.3%; 95% confidence interval [CI], 25.0%–40.7%) had SBI, including 33 pyelonephritis, 5 deep abscesses, 3 lobar pneumonia, and 2 soft tissue infections. With the cutoff of 7.8 mg/dL, the sensitivity of CRP in predicting SBI was 81.4% (95% CI, 67.4%–90.3%); the specificity, 80.0% (95% CI, 70.6%–87.0%); the positive predictive value, 66.0% (95% CI, 52.6%–77.3%); the negative predictive value, 90.0% (95% CI, 81.5%–94.9%); the positive LR, 4.1; and the PP, 66.0% (95% CI, 55.6%–75.0%). A CRP concentration of 16.1 mg/dL or higher yielded an LR of 11.2 and a PP of 84.2% (95% CI, 62.1%–94.5%). A CRP concentration of lower than 3.4 mg/dL yielded an LR of 0.05 and a PP of 2.4% (95% CI, 0.3%–14.6%).

Conclusions
High concentration of CRP is strongly associated with the presence of SBI in febrile children with EL.
Ewings Sarcoma
Authors: Wells Jordee M. , Spencer Sandra P. 
Published: March 2017

Abstract
The Ewing sarcoma family of tumors typically appears in the second decade of life with regional pain and swelling of a long bone. The following case presents a pediatric patient, aged 4 years, given a diagnosis of Ewing sarcoma of the rib with the initial presentation of respiratory distress, hypoxia, and pleural effusion. Respiratory distress accounts for a large majority of emergency department visits annually, so it is the distinct responsibility of the emergency department physician to avoid premature closure in attributing the most common diagnoses to account for the presenting symptoms. In this case, the careful study of the initial radiographic findings led to further identification and characterization of the mass through thoracic computed tomography to suggest Ewing sarcoma, despite the patient's unlikely demographics and presentation.
Evaluation of the Relationship Between Serum Uric Acid Levels and Cardiovascular Events in Patients With Gout
Authors: Essex Margaret Noyes , Hopps Markay , Bienen E. Jay , Udall Margarita , Mardekian Jack , Makinson Geoffrey T. 
Published: March 2017

ObjectivesThe aim of this study was to evaluate relationships between serum uric acid (SUA) and newly emergent acute myocardial infarction (AMI), congestive heart failure (CHF), coronary artery disease (CAD), composite cardiovascular (CV) events (AMI, CHF, CAD), hypertension, hyperlipidemia, and renal disease in gout patients.MethodsRetrospective analysis of electronic medical records from Humedica identified adults (≥18 years) with 2 or moreInternational Classification of Diseases, Ninth Revision, Clinical Modificationcodes for gout 30 days or more apart (first diagnosis = index event) having 1 or more SUA assessment on or after the index date, and at least 6 months preindex and at least 12 months postindex enrollment. Outcomes were measured during 12 months postindex; patients with preindex events were excluded from analysis of those events. The SUA level (0.01–4.00 mg/dL, 4.01–6.00 mg/dL, 6.01–8.00 mg/dL, and ≥8.01 mg/dL) was determined using the closest laboratory assessment before or on the date of the CV event. Tukey-Kramer comparisons were performed for pairs of SUA strata and Cox proportional model estimated hazard ratios.ResultsA significantly higher incidence of AMI, CHF, and renal disease was observed for patients with 8.01 mg/dL or greater relative to other SUA levels (P< 0.0001), and a significantly higher incidence of composite CV events (AMI, CHF, and CAD) was observed for hypouricemia (SUA, 0.01–4.00 mg/dL) compared with other SUA levels (P< 0.0001). Cox models confirmed the increased risk associated with SUA 8.01 mg/dL or greater; hazard ratios ranged from 1.16 for hypertension to 2.04 for renal disease. Hyperlipidemia and hypertension were diagnosed concurrently with gout in 24% and 28% of patients, respectively.ConclusionsHyperuricemia and hypouricemia were associated with an increased risk of CV events.