bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update in the management of the middle vault in rhinoplasty
Authors: Fedok Fred G. 
Published: May 2016

Purpose of reviewThe middle vault of the nose continues to be a topic of interest among surgeons interested in aesthetic and functional rhinoplasty. The purpose of this review is to present currently accepted concepts regarding the significance of the middle vault of the nose in rhinoplasty and to review the more frequently advocated methods to be used in the correction of deficiencies.Recent findingsSpreader grafts may be at least as effective as flaring sutures in improving the airway. Studies have shown an improvement in quality of life and nasal breathing with the use of autospreader flaps. The correlation between acoustic rhinometry and clinical symptoms of nasal obstruction, however, has fallen short of providing clear diagnostic value.SummaryThe diagnosis of middle vault collapse and nasal valve obstruction remains largely clinical. The patient's reported symptoms of nasal obstruction are diagnostically considered along with the findings of clinical examination, including the findings of a modified Cottle maneuver.The use of spreader grafts and autospreader flaps has been popularized to correct problems in the middle vault of the nose and will be presented in detail in this manuscript.
The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges
Authors: D'Souza-Li Lilia , Harris Sion Kim 
Published: May 2016

Purpose of review
Screening, brief intervention and referral to treatment (SBIRT) offers a practical, integrated model for addressing substance use in primary care settings. This review provides an update of the research on SBIRT for adolescents in primary care, examines current dissemination challenges and suggests future research directions.

Recent findings
A number of brief screening tools for adolescents have been developed and tested relative to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use disorders. Computerized previsit screening promotes standardization and is a more time-efficient alternative to provider interview. The adolescent brief intervention literature is growing, particularly with respect to technology-based tools, but is still limited, with evidence greatest for alcohol, and for motivational enhancement therapy interventions. Increasing SBIRT implementation in pediatric primary care remains a challenge. Using nonphysician behavioral health providers to deliver SBIRT, and embedding a screener and decision support tool in electronic medical record systems are strategies being investigated to promote SBIRT implementation.

Summary
Substance use begins in adolescence, and pediatric SBIRT could help to achieve a population-level reduction of substance use-related harms. With a growing number of available tools, adolescent SBIRT effectiveness and feasibility are increasing, but more studies are needed to grow its evidence base, and elucidate strategies to increase implementation.
Helicobacter pylori‐Clarithromycin Resistance in Symptomatic Pediatric Patients in a High Prevalence Country
Authors: Serrano Carolina A. , Leon Miguel A. , Palma Camila , Vera Macarena , Hernandez Caroll , Harris Paul R. 
Published: May 2016

ABSTRACTIntroduction:Failure to eradicate Helicobacter pylori despite antibiotic treatment is generally attributed to increasing clarithromycin resistance conferred by point mutations in the 23S‐rRNA gene or metronidazole resistance attributed to rdxA gene (HP0954) deletion in patients. Scarce data for pediatric population are available from developing countries.Objectives:The aim of the present study was to determine the presence of A2142G/C and A2143G mutations in the 23S‐rRNA gene and/or rdxA gene (HP0954) deletion in a group of symptomatic H pylori–infected children recruited from an area with high infection rate and risk of gastric cancer.Patients and Methods:We recruited 118 patients referred for upper endoscopy for gastrointestinal symptoms. The presence of H pylori was determined by urease test and histological staining. The rdxA gene (HP0954) deletion, and 2142G/C and A2143G mutations were determined by polymerase chain reaction–restriction fragment length polymorphism. A subgroup of infected patients received a 14‐day regimen of omeprazole, amoxicillin, and clarithromycin. The effectiveness of this regime was determined by stool antigen determination 8 weeks after treatment.Results:About 21% of the analyzed infected patients showed mutation in the 23S‐rRNA gene, with the A2143G transition as the more frequent mutation, and 2% of the patients showed rdxA gene (HP0954) deletion. After treatment, 25% of the patients continued to harbor the bacteria; of these, 67% carried the A2143G mutation.Conclusions:H pylori–infected pediatric patients from Chile show high prevalence of the mutation responsible for clarithromycin resistance. The failure to eradicate H pylori can be attributed to the presence of the A2143G mutation.
Item Generation and Reduction Toward Developing a Patient‐reported Outcome for Pediatric Ulcerative Colitis (TUMMY‐UC)
Authors: Marcovitch Liron , Nissan Anat , Mack David , Otley Anthony , Hussey Seamus , Mclean Beth , Lewis Mary , Croft Nick , Barakat Farah M. , Griffiths Anne M. , Turner Dan 
Published: May 2016

ABSTRACTBackground:The Pediatric Ulcerative Colitis Activity Index (PUCAI) is a noninvasive clinician‐based index, which reflects disease severity in pediatric ulcerative colitis (UC) when no endoscopy is performed. Here, we aimed to explore signs and symptoms important to children with UC and their caregivers as the first stage of developing a patient‐reported outcome (PRO) measure for pediatric UC (ie, the TUMMY‐UC index) to supplement endoscopic assessment.Methods:Concept elicitation qualitative interviews were performed with children who have UC and their caregivers in 6 centers. Items were rank‐ordered by the interviewees according to the frequency of endorsement and importance, graded on a 1 to 5 scale.Results:A total of 46 children (ages 12.5 ± 3.3 years, range 7–18, 48% boys, 83% with pancolitis, 24% with moderate–severe disease) and 33 caregivers were interviewed (ie, 79 interviews). The following items were identified by the children, in decreasing order of weights: abdominal pain (importance × frequency weight 3.9), rectal bleeding (3.6), stool frequency (3.0), stool consistency (3.0), general well‐being/fatigue (2.9), urgency (1.9), and nocturnal stools (1.6). Two other items were scored lower: lack of appetite (1.1) and weight loss (0.6). Children 13 to 18 years comprehended adult vocabulary, children 8 to 12 years comprehended simple vocabulary, and younger children had poor understanding in completing the questions.Conclusions:In this first stage of the TUMMY‐UC development, items were generated and ranked by input from patients. These items are now being explored for optimal vocabulary and response options. The TUMMY‐UC will supplement the PUCAI in clinical trial outcome assessment.
Validity and Reliability of Turkish Version of the Functional Assessment of Cancer Therapy–Brain Questionnaire
Authors: Arli Senay K. , Gurkan Aysel 
Published: May 2016

Background:
Assessing the quality of life (QOL) of patients with brain tumors is ever more important, given increasing survivorship and the higher likelihood of developing potential morbidities associated with new therapies.

Objective:
The aim of this study was to adapt the Functional Assessment of Cancer Therapy–Brain (FACT-Br) Questionnaire for Turkish populations and test its validity and reliability.

Methods:
The questionnaire was first translated into Turkish and back-translated, adapting it to the Turkish culture. This Turkish version of the FACT-Br was administered to 500 patients. Confirmatory factor analysis was conducted to examine the scale’s construct validity. Test-retest and Cronbach’s α reliability coefficients were calculated to determine reliability of the total questionnaire and all subdimensions.

Results:
The questionnaire’s factor structure demonstrated good fit, implying that it could be applied to the Turkish population. Interclass correlation coefficients were between 0.93 and 0.99. The 5 subscales demonstrated good internal consistency, with Cronbach’s α ranging from .72 to .87. Overall, the reliability estimate for the total scale was 0.93. There was no difference between a 15-day test and retest coefficients for subscale and total scores, indicating stability.

Conclusions:
The Turkish version of the FACT-Br is a valid and reliable instrument that can be used to measure the QOL of patients with a brain tumor in Turkey.

Implications for Practice:
This assessment tool can be used in treatment evaluations and to evaluate other measures of QOL.
Reactive Stepping After Stroke: Determinants of Time to Foot Off in the Paretic and Nonparetic Limb
Authors: Inness Elizabeth L. , Mansfield Avril , Bayley Mark , McIlroy William E. 
Published: May 2016

Background and Purpose:
Impaired features of reactive stepping, specifically delays in the early time to foot off (TFO) phase, are associated with increased fall rates after stroke. This study aimed to determine differences in, and determinants of, paretic and nonparetic limb TFO, and to determine whether both paretic and nonparetic TFO were associated with perturbation-evoked falls.

Methods:
Retrospective chart review of 105 individuals with stroke was performed within an inpatient rehabilitation setting; each had received a standardized assessment of reactive balance control (in response to a perturbation) at time of discharge.

Results:
There were no significant differences in paretic (351 ms) and nonparetic (365 ms) TFO. The capacity to maximally load the nonparetic limb, the amplitude of the perturbation, and the capacity to load the paretic limb were all negatively associated with paretic step TFO, explaining 23.8% of the variance. The amplitude of the perturbation and the preperturbation load under the nonparetic stepping limb were, respectively, negatively and positively associated with nonparetic step TFO, explaining 22.7% of the variance. The likelihood of a perturbation-evoked fall was associated with mean nonparetic limb TFO but not paretic limb TFO.

Discussion and Conclusions:
Unique stroke-related impairments of dynamic balance control and limb-load asymmetry may differentially influence paretic and nonparetic reactive step TFO, in response to a loss of balance. The amplitude of the perturbation influences reactive step TFO in both limbs. The results of the current study have implications for the future development of standardized clinical assessment methodologies and training strategies to evaluate and remediate reactive stepping and reduce fall risk.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A133).
Pulmonary Physical Therapy Techniques to Enhance Survival in Amyotrophic Lateral Sclerosis: A Systematic Review
Authors: Macpherson Chelsea E. , Bassile Clare C. 
Published: May 2016

Background and Purpose:
Respiratory insufficiency is the primary cause of morbidity and mortality in individuals with amyotrophic lateral sclerosis (ALS). Although mechanical interventions are effective in prolonging survival through respiratory support, pulmonary physical therapy interventions are being investigated. The purpose of this systematic review was to examine the effectiveness of pulmonary physical therapy interventions across the progressive stages of ALS.

Methods:
Six databases were searched for articles from inception to December 2014 investigating pulmonary physical therapy interventions in the ALS population. The search strategy followed Cochrane Collaboration guidelines with replication per database. Effect sizes (ES) were calculated for primary outcome measures: forced vital capacity (FVC) and peak cough expiratory flow (PCEF).

Results:
Seven studies met inclusion criteria. Four studies used control groups whereas the remainder used repeated measures. With the exception of diaphragmatic breathing, pulmonary physical therapy interventions were effective in improving multiple respiratory outcome measures in this population. Inspiratory muscle training (IMT) was shown to prolong respiratory muscle strength with a strong effect size (ES = 1.48) for FVC. In addition, mean length of survival increased by 12 months. Lung volume recruitment training (LVRT) strongly enhanced immediate cough efficacy with improved FVC (ES = 1.02) and PCEF (ES = 1.82). Manually assisted cough (MAC) only improved PCEF by a small amount (ES = 0.15, bulbar ALS; ES = 0.16, classical ALS groups).

Discussion and Conclusions:
Specific pulmonary physical therapy interventions (IMT, LVRT, and MAC) have effectiveness in improving respiratory outcome measures and increasing survival. These should be routinely incorporated into the comprehensive management of individuals with ALS. More rigorous methodological investigations should be performed to replicate these findings.

Video abstract available with brief technique demonstration of IMT and LVRT (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A136).
Hemodynamic Effects of Phenylephrine, Vasopressin, and Epinephrine in Children With Pulmonary Hypertension: A Pilot Study*
Authors: Siehr Stephanie L. , Feinstein Jeffrey A. , Yang Weiguang , Peng Lynn F. , Ogawa Michelle T. , Ramamoorthy Chandra 
Published: May 2016

Objectives:
During a pulmonary hypertensive crisis, the marked increase in pulmonary vascular resistance can result in acute right ventricular failure and death. Currently, there are no therapeutic guidelines for managing an acute crisis. This pilot study examined the hemodynamic effects of phenylephrine, arginine vasopressin, and epinephrine in pediatric patients with pulmonary hypertension.

Design:
In this prospective, open-label, nonrandomized pilot study, we enrolled pediatric patients previously diagnosed with pulmonary hypertensive who were scheduled electively for cardiac catheterization. Primary outcome was a change in the ratio of pulmonary-to-systemic vascular resistance. Baseline hemodynamic data were collected before and after the study drug was administered.

Patients:
Eleven of 15 participants were women, median age was 9.2 years (range, 1.7–14.9 yr), and median weight was 26.8 kg (range, 8.5–55.2 kg). Baseline mean pulmonary artery pressure was 49 ± 19 mm Hg, and mean indexed pulmonary vascular resistance was 10 ± 5.4 Wood units. Etiology of pulmonary hypertensive varied, and all were on systemic pulmonary hypertensive medications.

Interventions:
Patients 1–5 received phenylephrine 1 μg/kg; patients 6–10 received arginine vasopressin 0.03 U/kg; and patients 11–15 received epinephrine 1 μg/kg. Hemodynamics was measured continuously for up to 10 minutes following study drug administration.

Measurements and Main Results:
After study drug administration, the ratio of pulmonary-to-systemic vascular resistance decreased in three of five patients receiving phenylephrine, five of five patients receiving arginine vasopressin, and three of five patients receiving epinephrine. Although all three medications resulted in an increase in aortic pressure, only arginine vasopressin consistently resulted in a decrease in the ratio of systolic pulmonary artery-to-aortic pressure.

Conclusions:
This prospective pilot study of phenylephrine, arginine vasopressin, and epinephrine in pediatric patients with pulmonary hypertensive showed an increase in aortic pressure with all drugs although only vasopressin resulted in a consistent decrease in the ratio of pulmonary-to-systemic vascular resistance. Studies with more subjects are warranted to define optimal dosing strategies of these medications in an acute pulmonary hypertensive crisis.
Early Electroencephalographic Findings Correlate With Neurologic Outcome in Children Following Cardiac Arrest
Authors: Ostendorf Adam P. , Hartman Mary E. , Friess Stuart H. 
Published: May 2016

Objectives:
To determine the clinical and electroencephalographic findings associated with prognosis in nonneonate children following cardiac arrest.

Design:
Retrospective observational study.

Setting:
PICU and cardiac ICU.

Patients:
Nonneonate children with a history of cardiac arrest more than 2 minutes.

Interventions:
Electroencephalographic monitoring within 72 hours of return of spontaneous circulation.

Measurements and Main Results:
Clinical and features, neurophysiologic data, and Pediatric Cerebral Performance Category scores were collected. Electroencephalographic traces were reviewed in a blinded manner, all seizures and electroencephalographic findings noted, and the electroencephalography was scored at 1 hour, 24 hours, and continuous electroencephalographic end. Discrete data regarding specific characteristics of the electroencephalographic background and seizures were studied. Univariate and multivariate analyses were performed to identify associations between clinical variables, electroencephalographic findings, and Pediatric Cerebral Performance Category score at hospital discharge. Multivariate analysis of 73 children revealed duration of cardiac arrest less than 20 minutes or continuous electroencephalographic background activity within 12 hours postreturn of spontaneous circulation were associated with good short term neurologic outcome. Change in electroencephalographic background score over time and electroencephalographic data collected after the initial hour were not associated with outcome.

Conclusions:
Following pediatric cardiac arrest, an initially normal electroencephalography or generalized slowing of the electroencephalographic background was associated with good neurologic outcome at hospital discharge.
Using HIV Viral Load From Surveillance to Estimate the Timing of Antiretroviral Therapy Initiation
Authors: Braunstein Sarah L. , Robertson McKaylee M. , Myers Julie , Nash Denis 
Published: May 2016

Introduction:
HIV surveillance programs do not typically collect comprehensive data on antiretroviral therapy (ART). We validated a population-based measure of ART initiation that uses HIV viral load (VL) results in the absence of data on ART.

Methods:
We used CD4/VL data reported to NYC HIV Surveillance for persons aged ≥13 years and diagnosed with HIV from 2006 to 2012 to validate estimates of ART initiation date based on 3 ART initiation definitions: (1) ≥1-log decline in copies per milliliter between 2 VLs over 3 months; (2) ≥2-log decline in copies per milliliter between 2 VLs over 3 months; and (3) the earliest of either a ≥1-log decline in VL over 3 months, or a change from detectable VL to undetectable VL (<400 copies/mL) over any interval. We plotted median CD4 counts by quarter before and after ART initiation to compare estimated initiation date with nadir of the CD4 trajectory.

Results:
A total of 24,348 persons were diagnosed with HIV in NYC from 2006 to 2012. In all, 12,123 persons had probable ART initiation based on ≥2-log decline, 12,719 based on ≥1-log decline, and 14,311 based on ≥1-log decline or detectable–undetectable change. Lowest median CD4 count occurred at the estimated ART initiation date for all 3 definitions. The definition based on a ≥1-log VL decline or a change from detectable to undetectable VL captured more ART initiations and identified earlier initiation dates.

Conclusions:
Serial VL measures are a valid source for estimating ART initiation. A definition that includes a ≥1-log VL decline or a change from detectable to undetectable VL performed best.
Implementation and Operational Research: Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda
Authors: Roy Monika , Muyindike Winnie , Vijayan Tara , Kanyesigye Michael , Bwana Mwebesa , Wenger Megan , Martin Jeffrey , Geng Elvin 
Published: May 2016

Background:
The uptake of intensified active TB case-finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB pulmonary “diagnostic cascade” to understand real-world barriers to active TB case detection.

Methods:
We conducted a cohort analysis of new, antiretroviral therapy–naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012—September 30, 2013). We used medical records to extract date of completion of each step in the diagnostic cascade: symptom screen, order, collection, processing, and result. Factors associated with lack of sputum order were evaluated using multivariate Poisson regression and chart review of 50 screen-positive patients.

Results:
Of 2613 patients, 2439 (93%) were screened for TB and 682 (28%) screened positive. Only 90 (13.2%) had a sputum order. Of this group, 83% completed the diagnostic cascade, 13% were diagnosed with TB, and 50% had a sputum result within 1 day of their visit. Sputum ordering was associated with WHO stage 3 or 4 HIV disease and greater number of symptoms. The main identifiable reasons for lack of sputum order in chart review were treatment of presumed malaria (51%) or bacterial infection (43%).

Conclusions:
The majority of newly enrolled HIV-infected patients who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more symptoms and advanced HIV disease. Further evaluation of provider behavior in the management of screen-positive patients could improve active TB case detection rates.
Identification of a Specific miRNA Profile in HIV-Exposed Seronegative Individuals
Authors: Yahyaei Sara , Biasin Mara , Saulle Irma , Gnudi Federica , De Luca Mariacristina , Tasca Karen I. , Trabattoni Daria , Lo Caputo Sergio , Mazzotta Francesco , Clerici Mario 
Published: May 2016

Objective:
MicroRNAs (miRNAs) are small noncoding RNAs involved in the posttranscriptional regulation of gene expression that play important roles in viral infections. Alterations of specific miRNAs are described in HIV infection, suggesting a role for miRNAs in pathogenesis of this disease. We verified whether a particular miRNA signature could be identified in natural resistance to HIV-1.

Methods:
Expression level of 84 miRNAs was analyzed by RT-qPCR in plasma and unstimulated peripheral blood mononuclear cell (PBMC) of 30 seronegative individuals repeatedly exposed to HIV-1 (HESN), 30 HIV seropositive subjects (HIV+), and 30 healthy controls (HC). Results were confirmed by individual RT-qPCR in in vitro HIV-1-infected PBMC and in their cell culture medium. Dicer and Drosha expression was analyzed in basal PBMC.

Results:
Whereas Dicer and Drosha expression was comparable in HESN, HIV+ and HC, several miRNAs were upregulated both in HESN and HIV+ compared with HC. Furthermore, miRNA-29a and miR-223 were upregulated in both unstimulated PBMC and plasma of HESN alone; their expression was reduced upon in vitro HIV-1 infection of HESN PBMC indicating that, upon infection, they are secreted in the extracellular milieu. These results were confirmed by individual qPCR.

Conclusions:
Our studies demonstrate that HIV-1 exposure modifies miRNAs expression even in the absence of productive infection. Because those miRNAs that are specifically increased only in HESN have been known to reduce HIV-1 replication, their modulation could represent an important mechanism in resistance to HIV-1 infection.