bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applicability of the Calcaneal Apophysis Ossification Staging System to the Modern Pediatric Population
Authors: Li Samuel Q. , Nicholson Allen D. , Cooperman Daniel R. , Liu Raymond W. 
Published: November 2017

Background:
The calcaneal apophysis ossification staging system is a novel method for assessing skeletal maturity. However, it was created using the same historic patient population that was used to create the Greulich and Pyle atlas of the hand and wrist, predominantly white children. It is unclear if the calcaneal apophysis ossification staging system is still applicable to the modern pediatric population and to children of other races.

Methods:
We retrospectively studied 1327 benign lateral foot x-rays from modern white and black children. Calcaneal stage was determined and age, race, and sex were collected for each patient. A 2-tailed Student t test was used to compare between cohorts the differences in age for each calcaneal stage.

Results:
Mean age was 11.55±4.39 years. Modern white females graded as stage 3 and 4 were significantly delayed in their bone age (stage 3 P<0.002; stage 4 P<0.003) when compared with their historic counterparts. Skeletal maturity was consistent between modern and historic white males for stages 1 to 4. Modern black females graded as stage 1 to 4 were significantly advanced in their skeletal age when compared with modern white females (stage 1 P<0.038; stage 2 P<0.005; stage 3 P<0.002; stage 4 P<0.002). Modern black males graded as stages 1, 3, and 4 were also significantly advanced in their bone age when compared with their modern white counterparts (stage 1 P<0.003; stage 3 P<0.012; stage 4 P<0.029).

Conclusions:
Modern white females mature more slowly in the later stages when compared with their historic counterparts. No significant difference is seen between modern and historic white males. Modern black females and males were skeletally advanced compared with modern white females and males. We have shown that the calcaneal ossification staging system can be used to assess for skeletal maturity in the modern pediatric population with only mild corrections for white females and more significant adjustments for black females and males.

Level of Evidence:
Level III—retrospective chart review.
Kinetics of Urinary Cell Cycle Arrest Markers for Acute Kidney Injury Following Exposure to Potential Renal Insults
Authors: Ostermann Marlies , McCullough Peter A. , Forni Lui G. , Bagshaw Sean M. , Joannidis Michael , Shi Jing , Kashani Kianoush , Honore Patrick M. , Chawla Lakhmir S. , Kellum John A. 
Published: November 2017

Objectives:
Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 predict the development of acute kidney injury following renal insults of varied aetiology. To aid clinical interpretation, we describe the kinetics of biomarker elevations around an exposure.

Design:
In an ancillary analysis of the multicenter SAPPHIRE study, we examined the kinetics of the urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7] in association with exposure to common renal insults (major surgery, IV radiocontrast, vancomycin, nonsteroidal anti-inflammatory drugs, and piperacillin/tazobactam).

Setting:
Thirty-five sites in North America and Europe between September 2010 and June 2012.

Patients:
Seven hundred twenty-three critically ill adult patients admitted to the ICU.

Interventions:
None.

Measurements and Main Results:
We compared the urinary [tissue metalloproteinase-2]•[insulin growth factor binding protein 7] kinetics from the day prior to exposure up to 5 days after exposure in patients developing acute kidney injury stage 2–3, stage 1, or no acute kidney injury by Kidney Disease Improving Global Outcome criteria. Among the 723 patients, 679 (94%) had at least one, 70% had more than one, and 35% had three or more exposures to a known renal insult. There was a significant association between cumulative number of exposures up to study day 3 and risk of acute kidney injury (p = 0.02) but no association between the specific type of exposure and acute kidney injury (p = 0.22). With the exception of radiocontrast, patients who developed acute kidney injury stage 2–3 after one of the five exposures, had a clear rise and fall of urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7] from the day of exposure to 24–48 hours later. In patients without acute kidney injury, there was no significant elevation in urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7].

Conclusions:
Exposure to potential renal insults is common. In patients developing acute kidney injury stage 2–3, the kinetics of urinary [tissue inhibitor of metalloproteinase-2]•[insulin-like growth factor binding protein 7] matched the exposure except in the case of radiocontrast.
Initial Antifungal Strategy Reduces Mortality in Critically Ill Patients With Candidemia: A Propensity Score–Adjusted Analysis of a Multicenter Study*
Authors: Garnacho-Montero José , Díaz-Martín Ana , Cantón-Bulnes Luisa , Ramírez Paula , Sierra Rafael , Arias-Verdú Dolores , Rodríguez-Delgado Marina , Loza-Vázquez Ana , Rodriguez-Gomez Jesús , Gordón Mónica , Estella Ángel , García-Garmendia José Luis 
Published: November 2017

Objective:
The objective of this study was to evaluate the impact of the empirical therapy with fluconazole or an echinocandin on 30- and 90-day mortality in critically ill patients with candidemia. The outcome of patients in whom the empirical echinocandin was deescalated to fluconazole was also assessed.

Design:
Retrospective, observational multicenter study.

Setting:
Medical and surgical ICUs in nine Spanish hospitals.

Patients:
Adult patients (≥ 18 yr) with an episode of Candida bloodstream infection during ICU admission from January 2011 to April 2016.

Interventions:
Patient characteristics, infection-related variables, therapeutic interventions, and metastatic complications were reviewed. A propensity score–adjusted multivariable analysis was performed to identify the risk factors significantly associated with 30-day and 90-day mortality.

Measurements and Main Results:
A total of 294 patients were diagnosed of candidemia in the participant ICUs. Sixty patients were excluded (other antifungals in the primary therapy or the patient died without empirical antifungal therapy). The study group comprised 115 patients who received fluconazole (30-day mortality, 37.4%) and 119 patients treated empirically with an echinocandin (30-day mortality, 31.9%). The use of an echinocandin in the empirical therapy was a protective factor for 30-day (odds ratio, 0.32; 95% CI, 0.16–0.66; p = 0.002) and 90-day mortality (odds ratio, 0.50; 95% CI, 0.27–0.93; p = 0.014) in the propensity score– adjusted multivariable analysis. Deescalation of the empirical echinocandin to fluconazole was not associated with a higher mortality or the occurrence of long-term complications.

Conclusions:
Empirical use of an echinocandin in critically ill patients with documented candidemia reduces mortality at 30 and 90 days significantly. Deescalation of the empirical echinocandin to fluconazole is safe and effective in fluconazole-susceptible infections.
The history and basic science development of soy isoflavones
Authors: Setchell Kenneth D.R. 
Published: November 2017

Abstract
This review summarizes the 2016 NAMS/Pfizer—Wulf H. Utian Endowed Lecture that focused on the history and basic science of soy isoflavones. Described is a personal perspective of the background and history that led to the current interest in soy and isoflavones with a specific focus on the role that soy isoflavones play in the health of postmenopausal women. This overview covers the metabolism and physiological behavior of isoflavones, their biological properties that are of potential relevance to aging, issues related to the safety of soy isoflavones, and the role of the important intestinally derived metabolite S-(−)equol.
Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis
Authors: Poppler Louis H. , Parikh Rajiv P. , Bichanich Miles J. , Rebehn Kelsey , Bettlach Carrie R. , Mackinnon Susan E. , Moore Amy M. 
Published: November 2017

Abstract
A consensus on the optimal treatment of painful neuromas does not exist. Our objective was to identify available data and to examine the role of surgical technique on outcomes following surgical management of painful neuromas. In accordance with the PRISMA guidelines, we performed a comprehensive literature search to identify studies measuring the efficacy of the surgical treatment of painful neuromas in the extremities (excluding Morton's neuroma and compression neuropathies). Surgical treatments were categorized as excision-only, excision and transposition, excision and cap, excision and repair, or neurolysis and coverage. Data on the proportion of patients with a meaningful reduction in pain were pooled and a random-effects meta-analysis was performed. The effects of confounding, study quality, and publication bias were examined with stratified, meta-regression, and bias analysis. Fifty-four articles met the inclusion criteria, many with multiple treatment groups. Outcomes reporting varied significantly and few studies controlled for confounding. Overall, surgical treatment of neuroma pain was effective in 77% of patients [95% confidence interval: 73-81]. No significant differences were seen between surgical techniques. Among studies with a mean pain duration greater than 24 months, or median number of operations greater than 2 prior to definitive neuroma pain surgery, excision and transposition or neurolysis and coverage were significantly more likely than other operative techniques to result in a meaningful reduction in pain (P < 0.05). Standardization in the reporting of surgical techniques, outcomes, and confounding factors is needed in future studies to enable providers to make comparisons across disparate techniques in the surgical treatment of neuroma pain.
New developments in immunotherapy for pediatric solid tumors
Authors: Schultz Liora M. , Majzner Robbie , Davis Kara L. , Mackall Crystal 
Published: November 2017

Purpose of review
Building upon preclinical advances, we are uncovering immunotherapy strategies that are translating into improved outcomes in tumor subsets. Advanced pediatric solid tumors carry poor prognoses and resultant robust efforts to apply immunotherapy advances to pediatric solid tumors are in progress. Here, we discuss recent developments in the field using mAb and mAb-based therapies including checkpoint blockade and chimeric antigen receptors (CARs).

Recent findings
The pediatric solid tumor mAb experience targeting the diganglioside, GD2, for patients with neuroblastoma has been the most compelling to date. GD2 and alternative antigen-specific mAbs are now being incorporated into antibody–drug conjugates, bispecific antibodies and CARs for treatment of solid tumors. CARs in pediatric solid tumors have not yet achieved comparative responses to the hematologic CAR experience; however, novel strategies such as bispecific targeting, intratumoral administration and improved understanding of T-cell biology may yield enhanced CAR-efficacy. Therapeutic effect using single-agent checkpoint blocking antibodies in pediatric solid tumors also remains limited to date. Combinatorial strategies continue to hold promise and the clinical effect in tumor subsets with high antigenic burden is being explored.

Summary
Pediatric immunotherapy remains at early stages of translation, yet we anticipate that with advanced technology, we will achieve widespread, efficacious use of immunotherapy for pediatric solid tumors.
Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis*
Authors: Cigarroa Claire L. , van den Bosch Sarah J. , Tang Xiaoqi , Gauvreau Kimberlee , Baird Christopher W. , DiNardo James A. , Kheir John Nagi 
Published: November 2017

Objectives:
Increased alveolar dead space fraction has been associated with prolonged mechanical ventilation and increased mortality in pediatric patients with respiratory failure. The association of alveolar dead space fraction with clinical outcomes in patients undergoing bidirectional cavopulmonary anastomosis for single ventricle congenital heart disease has not been reported. We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis.

Design:
In a retrospective case-control study, we examined for associations between alveolar dead space fraction ([Paco
2 – end-tidal Co
2]/Paco
2), arterial oxyhemoglobin saturation, and transpulmonary gradient upon postoperative ICU admission with a composite primary outcome (requirement for surgical or catheter-based intervention, death, or transplant prior to hospital discharge, defining cases) and several secondary endpoints in infants following bidirectional cavopulmonary anastomosis.

Settings:
Cardiac ICU in a tertiary care pediatric hospital.

Patients:
Patients undergoing bidirectional cavopulmonary anastomosis at our institution between 2011 and 2016.

Interventions:
None.

Measurements and Main Results:
Of 191 patients undergoing bidirectional cavopulmonary anastomosis, 28 patients were cases and 163 were controls. Alveolar dead space fraction was significantly higher in the case (0.26 ± 0.09) versus control group (0.17 ± 0.09; p < 0.001); alveolar dead space fraction at admission was less than 0.12 in 0% of cases and was greater than 0.28 in 35% of cases. Admission arterial oxyhemoglobin saturation was significantly lower in the case (77% ± 12%) versus control group (83% ± 9%; p < 0.05). Sensitivity and specificity for future case versus control assignment was best when prebidirectional cavopulmonary anastomosis risk factors, admission alveolar dead space fraction (AUC, 0.74), and arterial oxyhemoglobin saturation (AUC, 0.65) were combined in a summarial model (AUC, 0.83). For a given arterial oxyhemoglobin saturation, the odds of becoming a case increased on average by 181% for every 0.1 unit increase in alveolar dead space fraction. Admission alveolar dead space fraction and arterial oxyhemoglobin saturation were linearly associated with prolonged ICU length of stay, hospital length of stay, duration of mechanical ventilation, and duration of thoracic drainage (p < 0.001 for all).

Conclusions:
Following bidirectional cavopulmonary anastomosis, alveolar dead space fraction in excess of 0.28 or arterial oxyhemoglobin saturation less than 78% upon ICU admission indicates an increased likelihood of requiring intervention prior to hospital discharge. Increasing alveolar dead space fraction and decreasing arterial oxyhemoglobin saturation are associated with increased lengths of stay.
Management of Pediatric Isolated Skull Fractures
Authors: Williams Daniel C. , Russell W. Scott , Andrews Annie L. , Simpson Kit N. , Basco William T. , Teufel Ronald J. 
Published: November 2017

Objective
Pediatric isolated skull fractures (ISFs) are common injuries that represent challenging disposition decisions for clinicians. The purpose of this study is to use a decision analysis to compare the clinical and cost-effectiveness of 3 emergency department (ED)–based disposition scenarios for a pediatric patient presenting with ISF.

Methods
We conducted a cost-effectiveness analysis comparing ED disposition scenarios that included current practice, increased at-home surveillance, and observation unit utilization. Current rates of admission, deterioration after initial diagnosis, and ED return after discharge, as well as cost of observation-only status, were obtained through literature review. Cost calculations using Healthcare Cost and Utilization Project data included total ED cost, admission without complication, and admission with deterioration.

Results
In current practice, 76% of subjects with ISF are admitted and 2.5% of those develop persistent or new symptoms. No patient diagnosed with ISF required neurosurgical intervention. Of those discharged home from the ED, 2.8% return with a new concern with 7.4% having new findings on imaging leading to admission. Total cost per 100 patients by current practice was US $583,587. Increasing at-home surveillance by 20% resulted in a total cost saving of US $113,176 per 100 patients while increasing returns to the ED from less than 1% to 1.1%. Admitting at the current rate to an observation unit resulted in a US $205,395 cost saving per 100 patients.

Conclusions
Decreased inpatient utilization through home surveillance or observation unit use reduced cost associated with pediatric ISF management without increasing clinical risk owing to the low probability of clinical deterioration after initial diagnosis.
Fast and Sensitive
Authors: Malia Laurie , Strumph Kaitlin , Smith Sharon , Brancato John , Johnson Stephanie T. , Chicaiza Henry 
Published: November 2017

Objective
Point-of-care (POC) urine dipstick is a highly used test in the pediatric emergency department (PED) owing to its fast turn-around time and inexpensive cost. Past studies have shown hand-held urine dipsticks and automated urinalysis in children younger than 48 months to be sensitive predictors for urinary tract infection (UTI). It is hypothesized that POC dip testing is as accurate as laboratory urinalysis in the diagnosis of UTI.

Methods
A retrospective chart review was conducted on patients (aged birth through 18 years) presenting to a PED between January 2015 and December 2015. Eligible subjects included those that had a POC dip, laboratory urinalysis (lab UA), and urine culture performed during their PED visit. Subjects were selected, using a random number generator; 334 charts were selected. A positive POC dip was defined as having a positive leukocyte esterase or the presence of nitrites. A positive lab UA was defined as having a positive leukocyte esterase, nitrites, or greater than 10 white blood cells per high-power field. Urine culture was used as the criterion standard for comparison.

Results
A total of 334 subjects' charts were reviewed. Sensitivity and specificity of the POC dip were 91.4% (95% confidence interval [CI], 76.9%–98.2%) and 63.9% (95% CI, 57.2%–69.3%); lab UA, 91.4% (95% CI, 76.9%–98.2%) and 63.9% (95% CI, 58.2%–69.3%); and lab dip, 88.6% (95% CI, 73.3%–96.8%) and 65.6% (95% CI, 59.9%–70.9%).

Conclusions
Point-of-care dips are as sensitive in detecting UTI as the lab UA. A prospective study could allow for further demographic evaluation of POC dip diagnosed UTI.
Lactotripeptides Supplementations Alleviate the Decrease in Maximal Isometric Force After High-Intensity Eccentric Exercise
Authors: Tagawa Kaname , Ra Song-Gyu , Choi Youngju , Maeda Seiji 
Published: November 2017

ObjectiveThe aim of the study was to investigate whether lactotripeptides supplementations alleviate the decrease in the maximal isometric force, an indirect marker of muscle damage, after eccentric exercise (ECC).DesignTwenty-two young men performed 50 ECC of the elbow flexors using an isokinetic dynamometer. The subjects were randomly assigned to either the placebo or lactotripeptides group and were each given a 4.5 mg/d placebo or lactotripeptides thrice on the exercise day and the day after. Maximal isometric force and brachial arterial diameter were assessed before and 2 days after the ECC.ResultsThe interaction of time and group on maximal isometric force was significant (P< 0.05); maximal isometric force was significantly decreased in both groups after ECC (P< 0.005). The interaction of brachial arterial diameter was significant (P< 0.05); brachial arterial diameter was significantly increased in only the lactotripeptides group (P< 0.005). In addition, the change in maximal isometric force was significantly related to the change in brachial arterial diameter after adjusting for body weight and change in range of motion (P< 0.05).ConclusionsThe present results suggest that lactotripeptides supplementation alleviates the decrease in the maximal isometric force via an increase in brachial arterial diameter after ECC.
Evidence that dry eye is a comorbid pain condition in a U.S. veteran population
Authors: Lee Charity J. , Levitt Roy C. , Felix Elizabeth R. , Sarantopoulos Constantine D. , Galor Anat 
Published: November 2017

Abstract

Introduction:
Recent evidence suggests that dry eye (DE) may be comorbid with other chronic pain conditions.

Objectives:
To evaluate DE as a comorbid condition in the U.S. veteran population.

Methods:
Retrospective review of veterans seen in the Veterans Administration Healthcare System (Veteran Affairs) between January 1, 2010, and December 31, 2014. Dry eye and nonocular pain disorders were ascertained by International Classification of Diseases, Ninth Revision (ICD-9) codes. Dry eye was further separated into ICD-9 codes representing tear film dysfunction or ocular pain. χ2 and logistic regression analyses were used to examine frequency and risk of DE, ocular pain, and tear film dysfunction by pain disorders.

Results:
Of 3,265,894 veterans, 959,881 had a DE diagnosis (29.4%). Dry eye frequency increased with the number of pain conditions reported (P < 0.0005). Ocular pain was most strongly associated with headache (odds ratio [OR] 2.98; 95% confidence interval [CI] 2.95–3.01), tension headache (OR 2.64; 95% CI 2.58–2.71), migraine (OR 2.58; 95% CI 2.54–2.61), temporomandibular joint dysfunction (OR 2.39; 95% CI 2.34–2.44), pelvic pain (OR 2.30; 95% CI 2.24–2.37), central pain syndrome (OR 2.24; 95% CI 1.94–2.60), and fibromyalgia/muscle pain (OR 2.23; 95% CI 2.20–2.26), all P < 0.0005. Tear film dysfunction was most closely associated with osteoarthritis (OR 1.97; 95% CI 1.96–1.98) and postherpetic neuralgia (OR 1.95; 95% CI 1.90–2.00), both P < 0.0005.

Conclusions:
Dry eye, including both ocular pain and tear film dysfunction, is comorbid with pain conditions in this nationwide population, implying common mechanisms.
Navigation-Assisted Nasal Bone Osteotomy for Malunited Fracture
Authors: Ogino Akihiro , Onishi Kiyoshi , Nakamichi Miho , Okaneya Tetsuya 
Published: November 2017

Background:
Nasal bone osteotomy subjectively judges the position for osteotomy by visual inspection and by manual feel using the fingertip. Therefore, the outcome depends on the surgeon's experience and mastery of the procedure is technically challenging.

Methods:
The authors applied a navigation system for the intraoperative evaluation of the osteotomy line and reduction position in 5 patients with malunited nasal bone fracture. The authors performed the operation with a temporal bone post developed for otologic surgery using Stealth Station S7 System (Medtronic, Minneapolis, MN). The suretrack is attached to the bone chisel. The authors performed the osteotomies while visualizing the tip of the chisel on the monitor.
In addition, evaluation of the reduction position was performed by insertion of a 23G needle syringe with the suretrack to the nasal bone surface.

Results:
The tip of the bone chisel was visible on the monitor, and the authors could perform osteotomies while confirming the position and direction of osteotomy. In addition, the reduction position could be visualized clearly on the monitor.

Conclusion:
Navigation systems can confirm the 3-dimensional spatial relationship around the fracture site in real time, requiring only comparatively simple preoperative preparation and intraoperative operation without radiation exposure. Therefore, the advantage is that even an inexperienced surgeon can perform an accurate evaluation. This would be useful as a guide for young doctors and medical students as it would be possible to perform safe and accurate osteotomy for old nasal bone fractures.