bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hematoma extradural espinhal espontâneo: Relato de caso
Authors: Araújo Dias Luiz Antonio , Pereira Carlos Umberto , Plastina Fernando Eduardo , Dezena Roberto Alexandre , Dias Junior Luiz Antonio Araújo , Dias Clicie Araújo 
Published: January 2018

ResumoO hematoma extradural espinhal espontâneo é considerado raro. Tem sido associado com hipertensão arterial e coagulopatias. O exame de escolha para diagnóstico é a ressonância nuclear magnética. O tratamento de escolha é drenagem cirúrgica do hematoma. O prognóstico está relacionado com a etiologia, intervalo entre icto e diagnóstico e o grau de déficits neurológicos. Os autores relatam um caso de hematoma extradural espinhal espontâneo, localizado na região torácica, com quadro de choque medular, sendo submetido a tratamento cirúrgico, que evoluiu para óbito.
Plötzlicher Herztod bei 17-jährigem Mädchen – ein Fallbericht
Authors: Huscher Stefan , Trägner Peter , Jacobi Sindy , Frank Mark , Gäßler Michael , Nowak Andreas 
Published: January 2018

Zusammenfassung
Falldarstellung Eine 17-jährige Gymnasiastin betätigte sich in einer Freizeitsportgruppe körperlich moderat. Wenige Sekunden nach einem leichten abdominellen Anprall eines Balles bricht sie bewusstlos zusammen. Bei fehlender Atmung werden durch Laien sofort Maßnahmen der Basisreanimation durchgeführt. Ein Team aus boden- und luftgebundenen Rettungskräften konnte nach insgesamt 50 Minuten Reanimation einen Return of Spontaneous Circulation (ROSC) registrieren. Unter kontinuierlicher Noradrenalininjektion erfolgte der luftgebundene Transport in die Klinik. Die Patientin verstarb jedoch am 3. Tag nach dem Ereignis an dem in der Folge des Kreislaufstillstands aufgetretenen Hirnödem. In der Sektion und den sich anschließenden Zusatzuntersuchungen wurden ein hypoxischer Hirnschaden sowie Zeichen eines Schockgeschehens an lebenswichtigen Organen festgestellt. Außerdem fanden sich Hinweise der kardialen Manifestation einer Infektion mit Parvovirus B19 (PVB19).
Schlussfolgerungen Der plötzliche Herztod im Rahmen körperlicher Belastung, wie bspw. bei Sportveranstaltungen, ist ein extrem seltenes Ereignis. Die Anwendung der im professionellen Sportbereich üblichen umfangreichen medizinischen Betreuung wäre im Breitensport mit hohem Aufwand verbunden. Einer symptomatischen Therapie während medizinischer Notfallsituationen in diesem Bereich kommt damit große Bedeutung zu. Das Hauptaugenmerk sollte dabei auf einer funktionierenden Rettungskette mit qualitativ hochwertig ausgeführten Erst- und Folgemaßnahmen sowie einer durch die aufnehmende Rettungsleitstelle telefonisch unterstützten Laienreanimation liegen.
Dermatoskopische Muster bei Kindern mit Dermatomykosen des behaarten Kopfes oder Alopecia areata
Authors: Ufimtseva М. , Antonova S. 
Published: January 2018

Zusammenfassung
Ziel: Bewertung der diagnostischen Effektivität der Dermatoskopie mit zehnfacher Vergrößerung für die Differenzialdiagnose von Mykosen des behaarten Kopfes oder Alopecia areata bei Kindern. Derartige Erkrankungen kommen bei Kindern häufig vor und werden gelegentlich nicht oder erst spät erkannt. Hier werden Ergebnisse eigener Untersuchungen und Literaturangaben zum Thema besprochen.
Material und Methoden: Es wurden dermatoskopische Untersuchungen an 78 erkrankten Kindern durchgeführt und im Vergleich mit publizierten Studien ausgewertet.
Ergebnisse: Bei 49 (93 %) der Kinder mit einer Mykose waren eines oder mehrere der folgenden dermatoskopischen Muster vorhanden: kommaartige Haare bei 30 (57 %), zickzackförmige Haare bei 31 (59 %; p < 0,05).Zudem wurden die für von Mikrosporie befallenen Haare typischen weißen, horizontalen Streifen in der Haarschaftstruktur bei 17 Kindern (60,7 %) beobachtet, die für die von Trichophytie befallenen korkenzieherartigen Haare bei 8 (32 %; p < 0,05). Es waren bei 24 (96 %) der an Alopecia areata erkrankten Kinder eines oder mehrere der folgenden dermatoskopischen Muster vorhanden: gelbe Punkte bei 22 (88 %), schwarze Punkte (kadaverisierte Haare) bei 9 (36 %), ausrufezeichenartige Haare bei 12 (48 %) und miniaturisierte, pigmentlose Haare (Vellushärchen) bei 19 (76 %).Es wurden bei den Kindern mit Mykosen des behaarten Kopfes keine für Alopecia areata typischen Zeichen beobachtet.
List composition effect on cognate and non-cognate word acquisition in children
Authors: Comesaña Montserrat , Moreira Ana J. , Valente Daniela , Hernández-Cabrera Juan A. , Soares Ana Paula 
Published: January 2018

Abstract
Previous studies on second language (L2) vocabulary acquisition with children showed that the use of a picture learning method favours the
creation of direct links between the semantic system and new lexical representations at early stages of L2 acquisition (Comesaña et al., 2009). However, recent studies found that this influence seems to vary according to
the cognate status of the words being learned (Comesaña et al., 2012), raising the question of how the type of words involved can modulate
the lexical-semantic connections between the words of both languages in the bilingual memory. The main goal of the present study was to
explore list composition effects in the establishment of L2 word-to-concept connections in Portuguese children by using a picture-based
method. Results showed no influence of list composition in the establishment of L2 lexical-semantic connections when cognates have to be
learned. Findings are discussed in light of relevant models of bilingual memory.
Reducing eutrophication increases spatial extent of communities supporting commercial fisheries: a model case study
Authors: Bauer Barbara , Meier H E Markus , Casini Michele , Hoff Ayoe , Margoński Piotr , Orio Alessandro , Saraiva Sofia , Steenbeek Jeroen , Tomczak Maciej T 
Published: January 2018

AbstractIn this study we investigate if eutrophication management has the potential to substantially affect which areas are going to be most suitable for commercial fishing in the future. We use a spatial ecosystem model, forced by a coupled physical-biogeochemical model, to simulate the spatial distribution of functional groups within a marine ecosystem, which depends on their respective tolerances to abiotic factors, trophic interactions, and fishing. We simulate the future long-term spatial developments of the community composition and their potential implications for fisheries under three different nutrient management scenarios and changing climate. The three nutrient management scenarios result in contrasting developments of bottom oxygen concentrations and phytoplankton abundance, with substantial effects on fish production. Nutrient load reduction increases the spatial extent of the areas suitable for the commercially most valuable demersal fish predator and all types of fisheries. This suggests that strategic planning of fishery management strategies could benefit from considering future changes in species distributions due to changes in eutrophication. We show that combining approaches from climate research, physical oceanography, biogeochemistry, biogeography, and trophic ecology with economical information provides a strong foundation to produce scientific knowledge that can support a multisectoral management of ecosystems.
Cadential Syntax and Tonal Expectation in Late Sixteenth-Century Homophony
Authors: Long Megan Kaes 
Published: January 2018

AbstractThis article explores the emergence of tonal languages in late-sixteenth-century homophony by considering the ways in which phrase structure, meter, and cadential rhetoric produce trajectories of expectation. Focusing on the English ballett and the French air de cour, two homophonic, secular, vernacular genres produced according to wildly different aesthetic criteria, it demonstrates how composers’ regulation of harmony and syntax transformed contrapuntal languages into tonal ones. Early tonal languages are thus defined here by the trajectories of expectation that such regulation establishes.
Superficial Inferior Epigastric Artery Flap Salvage Technique Using Deep Inferior Epigastric Artery Graft
Authors: Garza Rebecca M. , Shenaq Deana , Song David H. , Park Julie E. 
Published: January 2018

Summary:
Superficial inferior epigastric artery (SIEA) flap salvage remains challenging, particularly in cases of arterial insufficiency due to vessel spasm, pedicle kinking, or thrombosis. The already small, short SIEA pedicle, in addition to its inherent tendency toward spasm, renders the SIEA flap more difficult to manage when anastomotic revision is required. Furthermore, arterial thrombosis will cause dilation of the internal mammary artery, exacerbating vessel mismatch. In our previously published experience with 145 SIEA flaps, no flap with postoperative arterial thrombosis was salvageable. Following this experience, a new salvage technique using deep inferior epigastric artery grafts has been utilized and is described here.
Innovative Use of Thighplasty to Improve Prosthesis Fit and Function in a Transfemoral Amputee
Authors: Kuiken Todd A. , Fey Nicholas P. , Reissman Timothy , Finucane Suzanne B. , Dumanian Gregory A. 
Published: January 2018

Background:
Excess residual limb fat is a common problem that can impair prosthesis control and negatively impact gait. In the general population, thighplasty and liposuction are commonly performed for cosmetic reasons but not specifically to improve function in amputees. The objective of this study was to determine if these procedures could enhance prosthesis fit and function in an overweight above-knee amputee.

Methods:
We evaluated the use of these techniques on a 50-year-old transfemoral amputee who was overweight. The patient underwent presurgical imaging and tests to measure her residual limb tissue distribution, socket-limb interface stiffness, residual femur orientation, lower-extremity function, and prosthesis satisfaction. A medial thighplasty procedure with circumferential liposuction was performed, during which 2,812 g (6.2 lbs.) of subcutaneous fat and skin was removed from her residual limb. Imaging was repeated 5 months postsurgery; functional assessments were repeated 9 months postsurgery.

Results:
The patient demonstrated notable improvements in socket fit and in performing most functional and walking tests. Her comfortable walking speed increased 13.3%, and her scores for the Sit-to-Stand and Four Square Step tests improved over 20%. Femur alignment in her socket changed from 8.13 to 4.14 degrees, and analysis showed a marked increase in the socket-limb interface stiffness.

Conclusions:
This study demonstrates the potential of using a routine plastic surgery procedure to modify the intrinsic properties of the limb and to improve functional outcomes in overweight or obese transfemoral amputees. This technique is a potentially attractive option compared with multiple reiterations of sockets, which can be time-consuming and costly.
Clinical Significance of Interleukin-6 in the Diagnosis of Sepsis and Discriminating Sepsis Induced by Gram-negative Bacteria
Authors: Shao Wen-xia , Yu Dao-jun , Zhang Wei-ying , Wang Xian-jun 
Published: January 2018

Background:
To discuss the clinical significance of interleukin (IL)-6 in the differential diagnosis of sepsis and its capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria.

Methods:
A total of 379 children with sepsis were involved in this study to form the case group, and their C-reactive protein (CRP), procalcitonin (PCT) and IL-6 levels before antibiotics and after recovery were checked. Receiver operating characteristic curve was applied to evaluate the significance of CRP, PCT and IL-6 in the differential diagnosis of sepsis and their capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria.

Results:
When these 3 indicators were applied to the differential diagnosis of sepsis, the area under the curve (AUC) of IL-6, PCT and CRP was 0.881, 0.877 and 0.754, respectively. The combination of IL-6 and PCT presented highest diagnostic efficiency. CRP, PCT and IL-6 levels in children with sepsis induced by Gram-negative bacteria were significantly higher than those in children with sepsis induced by Gram-positive bacteria.

Conclusions:
CRP, IL-6 and PCT are applicable to the differential diagnosis of sepsis and differentiating the sepsis induced by Gram-negative bacteria from Gram-positive bacteria. Appropriate combinations of these indicators are capable of increasing differential diagnosis efficiency. These indicators can be used as markers of antibiotics usage, but whether they can be used as markers to withdraw antibiotics is still needed to be observed.
Reversal of Intestinal Failure in Children With Tufting Enteropathy Supported With Parenteral Nutrition at Home
Authors: Ashworth Iona , Wilson Alexander , Aquilina Samuel , Parascandalo Raymond , Mercieca Victor , Gerada Jurgen , Macdonald Sarah , Simchowitz Venetia , Hill Susan 
Published: January 2018

ABSTRACTObjectives:The aim of the study was to review long‐term outcome of intestinal epithelial dysplasia (IED)/tufting enteropathy (TE) patients treated with parenteral nutrition (PN) at home managed by an intestinal failure (IF) rehabilitation service.Methods:Infants presenting from 1986 to 2010 with IF, and TE histology were retrospectively reviewed for up to 30 years. Data collected included outcome, presentation, nutrition (parenteral/enteral), country of residence, race, EpCAM gene, growth, bone age, and occupation.Results:Thirteen patients (6 boys) in Malta and the UK with TE histology were established on home PN. Survival was 100% for UK children and 92% overall (1 death aged 13 months). Six patients (50% of the surviving 12) weaned off PN. Overall PN requirements reduced with increasing age and <7 infusions/week were needed by 10/12, 83% by 10 years, 6/8, 75% who had reached 15 years, 5/7, 71% who had reached 20, and all 4, 100% >25 years. Two of 12 cases weaned from PN by 10 years, 1 of 8 by 15 years, 3 of 7 by 20 years, and 3 of 4 or 75% >25 years. Seven Maltese patients homozygous for the same EPCAM gene abnormality had a similar outcome to the other cases. Weight, height, bone mineralization, bone age, and insulin‐like growth factor‐1 (IGF‐1) levels were low, but improved with age. Patients achieved educational levels of parents and were employed.Conclusions:IED cases should have >92% chance of long‐term survival and >50% chance of enteral autonomy by/in early adult life and 75% by 25 years. Even if PN dependent s/he can gain employment. Patients with IED managed on PN at home by an IF rehabilitation service should avoid intestinal transplant.
Not a Straight Line—Patients’ Experiences of Prostate Cancer and Their Journey Through the Healthcare System
Authors: Schildmeijer Kristina , Frykholm Oscar , Kneck Åsa , Ekstedt Mirjam 
Published: January 2018

Background
Cancer and its treatment can severely impact quality of life, giving rise to complex needs with respect to follow-up care. To support patient needs and increase efficiency of care with limited resources, the Swedish government has launched national reforms to redesign cancer care pathways.

Objective
The aim of this study was to explore how prostate cancer patients experience their journey through the healthcare system when their care is provided according to the standardized care pathway, as described in healthcare policy documents.

Methods
A qualitative, descriptive approach with individual interviews was used. A template of a standardized prostate cancer pathway, created together with healthcare professionals, was used during interviews. Fourteen interviews were conducted with prostate cancer patients all operated on at a midsized hospital in southeast Sweden between October 2015 and April 2016. The interviews were analyzed with qualitative content analysis and illustrated in a patient journey map.

Results
We identified an overall theme, “walking a tightrope,” consisting of 4 categories: “waiting,” “becoming familiar with a troublesome body,” “adjusting to a different life,” and “information challenges.”

Conclusions
The clinical implementation of the standardized care pathway is described as a straight path through care, but patients described their experiences as walking a tightrope. Lack of information, especially about cancer treatment and its adverse effects, was the most common experience.

Implications for Practice
Our findings indicate areas where further healthcare tools could improve patient experiences of cancer treatment. This could include offering individualized information and tools to increase patient empowerment, as well as patient/caregiver collaboration (co-care).
The Systemic-immune-inflammation Index Independently Predicts Survival and Recurrence in Resectable Pancreatic Cancer and its Prognostic Value Depends on Bilirubin Levels
Authors: Aziz Mohammad Hosein , Sideras Kostandinos , Aziz Nasir Ahmad , Mauff Katya , Haen Roel , Roos Daphne , Saida Lawlaw , Suker Mustafa , van der Harst Erwin , Mieog Jan Sven , Bonsing Bert A. , Klaver Yarne , Koerkamp Bas Groot , van Eijck Casper H. 
Published: January 2018

Objective:
Our aim was to determine the prognostic significance of the systemic-immune-inflammation index (SIII) in patients with resectable pancreatic cancer, using cancer-specific survival as the primary outcome.

Background:
Pancreatic cancer is associated with a dysfunctional immune system and poor prognosis. We examined the prognostic significance of the SIII in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and the effects of bilirubin on this index.

Methods:
We retrospectively assessed all pancreatic resections performed between 2004 and 2015 at 4 tertiary referral centers to identify pathologically confirmed PDAC patients. Baseline clinicopathologic characteristics, preoperative laboratory values such as absolute neutrophil, lymphocyte, and platelet counts, C-reactive protein, albumin, bilirubin, and CA19-9 levels, and also follow-up information, were collected. The associations of the calculated inflammatory indices with outcome were both internally and externally validated.

Results:
In all, 590 patients with resectable PDAC were included. The discovery and validation cohort included 170 and 420 patients, respectively. SIII >900 [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.55–3.48], lymph node ratio (HR 3.75, 95% CI 2.08–6.76), and CA19.9 >200 kU/L (HR 1.62, 95% CI 1.07–2.46) were identified as independent predictors of cancer-specific survival. Separate model analysis confirmed that preoperative SIII contributed significantly to prognostication. However, SIII appeared to lose its prognostic significance in patients with bilirubin levels above 200 μmol/L.

Conclusions:
SIII is an independent predictor of cancer-specific survival and recurrence in patients with resectable PDAC. SIII may lose its prognostic significance in patients with high bilirubin levels. Properly designed prospective studies are needed to further confirm this hypothesis.
Validating the Electronic Cardiac Arrest Risk Triage (eCART) Score for Risk Stratification of Surgical Inpatients in the Postoperative Setting
Authors: Bartkowiak Bartlomiej , Snyder Ashley M. , Benjamin Andrew , Schneider Andrew , Twu Nicole M. , Churpek Matthew M. , Roggin Kevin K. , Edelson Dana P. 
Published: January 2018

Objective:
Assess the accuracy of 3 early warning scores for predicting severe adverse events in postoperative inpatients.

Summary of Background Data:
Postoperative clinical deterioration on inpatient hospital services is associated with increased morbidity, mortality, and cost. Early warning scores have been developed to detect inpatient clinical deterioration and trigger rapid response activation, but knowledge regarding the application of early warning scores to postoperative inpatients is limited.

Methods:
This was a retrospective cohort study of adult patients hospitalized on the wards after surgical procedures at an urban academic medical center from November, 2008 to January, 2016. The accuracies of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and the electronic cardiac arrest risk triage (eCART) score were compared in predicting severe adverse events (ICU transfer, ward cardiac arrest, or ward death) in the postoperative period using the area under the receiver operating characteristic curve (AUC).

Results:
Of the 32,537 patient admissions included in the study, 3.8% (n = 1243) experienced a severe adverse outcome after the procedure. The accuracy for predicting the composite outcome was highest for eCART [AUC 0.79 (95% CI: 0.78–0.81)], followed by NEWS [AUC 0.76 (95% CI: 0.75–0.78)], and MEWS [AUC 0.75 (95% CI: 0.73–0.76)]. Of the individual vital signs and labs, maximum respiratory rate was the most predictive (AUC 0.67) and maximum temperature was an inverse predictor (AUC 0.46).

Conclusion:
Early warning scores are predictive of severe adverse events in postoperative patients. eCART is significantly more accurate in this patient population than both NEWS and MEWS.
Proposed Modification of the 8th Edition of the AJCC Staging System for Pancreatic Ductal Adenocarcinoma
Authors: Shi Si , Hua Jie , Liang Chen , Meng Qingcai , Liang Dingkong , Xu Jin , Ni Quanxing , Yu Xianjun 
Published: January 2018

Objective:
The aim of this study was to improve the 8th edition (8th) of the American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC).

Background:
The new 8th AJCC staging system for PDAC was released in October, 2016, and will be applied in clinical practice in 2018.

Methods:
Two large cohorts were included in this analysis. One consisted of 45,856 PDAC patients in the Surveillance, Epidemiology, and End Results (SEER) database (2004–2014), and the other consisted of 3166 PDAC patients in the Fudan University Shanghai Cancer Center (FUSCC) database (2005–2015).

Results:
Using the 8th AJCC staging system, the median overall survival of the patients in the same stage varied widely among the different substages. We proposed a modified staging system based on median OS in which we maintained the T, N, and M definitions, but regrouped the substages. In the SEER cohort, the concordance index was higher for local disease with the modified staging system [0.637; 95% confidence interval (CI) 0.631–0.642] than with the 8th AJCC staging system (0.620, 95% CI 0.615–0.626). Similar findings were also observed in the FUSCC cohort. In addition, we verified the reliability of the modified staging system in an analysis of patients with different examined lymph node counts (≥15 or 1–14).

Conclusions:
The modified 8th AJCC staging system for PDAC proposed in this study provides improvements and may be evaluated for potential adoption in the next edition.