bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-Operator Ultrasound-Guided Central Venous Catheter Insertion Verifies Proper Tip Placement*
Authors: Galante Ori , Slutsky Tzachi , Fuchs Lior , Smoliakov Alexander , Mizrakli Yuval , Novack Victor , Brotfein Evgeni , Klein Moti , Frenkel Amit , Koifman Leonid , Almog Yaniv 
Published: May 2017

Objectives:
To evaluate whether a single-operator ultrasound-guided, right-sided, central venous catheter insertion verifies proper placement and shortens time to catheter utilization.

Design:
Prospective observational study with historical controls.

Setting:
Adult ICUs.

Patients:
Sixty-four consecutive patients undergoing ultrasound-assisted right-sided central venous catheterization compared with 92 serial historic controls who had unassisted central catheter insertion at the same sites.

Interventions:
Subcostal transthoracic echocardiography during catheter insertion.

Measurements and Main Results:
The primary outcome was the correct placement of the catheter tip determined by postprocedural chest radiography. The subclavian site was used in 41 patients (64%) (inserted without ultrasound guidance) in the ultrasound-assisted group and 62 (67%) in the control group, whereas the jugular vein was used in the remaining patients. The tip was accurately positioned in 59 of 68 patients (86.7%) in the ultrasound-assisted group compared with 51 of 94 (54.8%) in the control group (p < 0.001). The median time from end of the procedure to catheter utilization after chest radiography approval was 2.4 hours.

Conclusions:
A single-operator ultrasound-guided central venous catheter insertion is effective in verifying proper tip placement and shortens time to catheter utilization.
Hyperlactatemia, Lactate Kinetics and Prediction of Citrate Accumulation in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy With Regional Citrate Anticoagulation
Authors: Khadzhynov Dmytro , Dahlinger Annette , Schelter Christin , Peters Harm , Kindgen-Milles Detlef , Budde Klemens , Lehner Lukas Johannes , Halleck Fabian , Staeck Oliver , Slowinski Torsten 
Published: May 2017

Objectives:
Citrate accumulation is a major complication of regional citrate anticoagulation during continuous renal replacement therapy. We studied the prediction of citrate accumulation during continuous veno-venous hemodialysis with regional citrate anticoagulation by initial lactate concentrations and lactate kinetics.

Design:
A retrospective follow-up analysis from a cohort of critically ill patients.

Setting:
Mixed medical-surgical ICUs at a university hospital.

Patients:
All adult patients with acute kidney injury and treated with regional citrate anticoagulation-continuous veno-venous hemodialysis during a 3-year period (n = 1,070) were included in this retrospective study and screened for metabolic signs of citrate accumulation.

Interventions:
None.

Measurements and Main Results:
The frequency of citrate accumulation during the first 48 hours of therapy was 2.26%. In patients with initial normal lactate (< 2.2 mmol/L), elevated lactate (≥ 2.2 to < 4 mmol/L), or severe hyperlactatemia (≥ 4 mmol/L), the frequency of citrate accumulation was 0.77%, 2.70%, and 6.33%, respectively. Receiver operating characteristics-area under the curve of initial lactate concentration was 0.789 for the prediction of citrate accumulation. Optimal cutoff from receiver operating characteristics (2.39 mmol/L) showed strong negative prediction (99.28%), but weak positive prediction (5.21%). The slope intercept of lactate kinetics over 48 hours was positive and significantly higher in patients with citrate accumulation compared to those without (+0.2 vs –0.006 mmol/L/hr; p < 0.001). In patients with initial severe hyperlactatemia (≥ 4 mmol/L), the median calculated lactate clearance at 6, 12, and 18 hours was 24.0%, 48.1%, and 59.4% in the nonaccumulation group. These clearance rates were significantly higher at each time-point compared to patients with citrate accumulation (–9.8%, –20.5%, and 2.3%, respectively; p < 0.001 for each time-point). The highest receiver operating characteristics-area under the curve for citrate accumulation was observed for 12-hour values of lactate clearance (area under the curve = 0.839; 95% CI, 0.751–0.927) with an optimal cut-off value of 24.3%.

Conclusions:
Risk of citrate accumulation during regional citrate anticoagulation in a well-selected cohort of patients is low even in case of initial severe hyperlactatemia. Lactate kinetics rather than initially elevated lactate concentration should be considered in assessing the risk of citrate accumulation.
Nonlinear Imputation of Pao 2/Fio 2 From Spo 2/Fio 2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study
Authors: Brown Samuel M. , Duggal Abhijit , Hou Peter C. , Tidswell Mark , Khan Akram , Exline Matthew , Park Pauline K. , Schoenfeld David A. , Liu Ming , Grissom Colin K. , Moss Marc , Rice Todd W. , Hough Catherine L. , Rivers Emanuel , Thompson B. Taylor , Brower Roy G. 
Published: May 2017

Objectives:
In the contemporary ICU, mechanically ventilated patients may not have arterial blood gas measurements available at relevant timepoints. Severity criteria often depend on arterial blood gas results. Retrospective studies suggest that nonlinear imputation of Pao
2/Fio
2 from Spo
2/Fio
2 is accurate, but this has not been established prospectively among mechanically ventilated ICU patients. The objective was to validate the superiority of nonlinear imputation of Pao
2/Fio
2 among mechanically ventilated patients and understand what factors influence the accuracy of imputation.

Design:
Simultaneous Spo
2, oximeter characteristics, receipt of vasopressors, and skin pigmentation were recorded at the time of a clinical arterial blood gas. Acute respiratory distress syndrome criteria were recorded. For each imputation method, we calculated both imputation error and the area under the curve for patients meeting criteria for acute respiratory distress syndrome (Pao
2/Fio
2 ≤ 300) and moderate-severe acute respiratory distress syndrome (Pao
2/Fio
2 ≤ 150).

Setting:
Nine hospitals within the Prevention and Early Treatment of Acute Lung Injury network.

Patients:
We prospectively enrolled 703 mechanically ventilated patients admitted to the emergency departments or ICUs of participating study hospitals.

Interventions:
None.

Measurements and Main Results:
We studied 1,034 arterial blood gases from 703 patients; 650 arterial blood gases were associated with Spo
2 less than or equal to 96%. Nonlinear imputation had consistently lower error than other techniques. Among all patients, nonlinear had a lower error (p < 0.001) and higher (p < 0.001) area under the curve (0.87; 95% CI, 0.85–0.90) for Pao
2/Fio
2 less than or equal to 300 than linear/log-linear (0.80; 95% CI, 0.76–0.83) imputation. All imputation methods better identified moderate-severe acute respiratory distress syndrome (Pao
2/Fio
2 ≤ 150); nonlinear imputation remained superior (p < 0.001). For Pao
2/Fio
2 less than or equal to 150, the sensitivity and specificity for nonlinear imputation were 0.87 (95% CI, 0.83–0.90) and 0.91 (95% CI, 0.88–0.93), respectively. Skin pigmentation and receipt of vasopressors were not associated with imputation accuracy.

Conclusions:
In mechanically ventilated patients, nonlinear imputation of Pao
2/Fio
2 from Spo
2/Fio
2 seems accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputations cannot be recommended.
General Pediatrician-Staffed Behavioral/Developmental Access Clinic Decreases Time to Evaluation of Early Childhood Developmental Disorders
Authors: Harrison Meghan , Jones Persephone , Sharif Iman , Di Guglielmo Matthew D. 
Published: May 2017

ABSTRACT:

Objective:
To describe and evaluate the effectiveness of a quality improvement project to decrease wait time to evaluation for children referred to Developmental Behavioral Pediatricians (DBPs).

Methods:
The authors created a Behavioral/Developmental Access Clinic (BDAC) staffed by a general pediatrician (GP) and pediatric psychologist. Clinicians in the BDAC provided comprehensive developmental evaluations for children in a discrete age range (<5 yr old). We describe the establishment of the BDAC along with referrals, diagnoses, and recommended follow-up for patients seen by the GP. We used 2-tailed t tests to compare the mean time with initial evaluation for patients seen in BDAC versus a DBP.

Results:
Sixty-three children were seen in BDAC over 6 months. Referrals from the BDAC included: physical/occupational/speech therapy (71%), psychology (35%), audiology (25%), genetics (14%), and neurology (8%). Five patients (8%) were diagnosed with autism spectrum disorder (ASD). Compared with time to appointment with a DBP (327 d), mean time to developmental assessment was shorter for the 45 patients who accepted earlier appointments in the BDAC (159 d), and for the 18 children seen in the BDAC as new referrals (11 d), p < .001. Follow-up with a DBP was recommended for 9 (50%) of the new patient referrals evaluated in BDAC.

Conclusion:
The BDAC allowed for earlier developmental assessment of young children, with potential for earlier diagnosis and treatment of developmental disorders, including ASD. Opportunity for initial evaluation in BDAC decreased the number of patients requiring evaluation by DBPs, improving access to this subspecialty in our institution.
Efficacy of Cyclosporine After Autologous Noncultured Melanocyte Transplantation in Localized Stable Vitiligo—A Pilot, Open Label, Comparative Study
Authors: Mutalik Sharad , Shah Swapnil , Sidwadkar Varsha , Khoja Meenaz 
Published: May 2017

BACKGROUND
Understanding the pathogenesis of vitiligo has lead to innovation of new drugs and new uses of the existing drugs to enhance treatment outcome.

OBJECTIVE
The aim of this observational pilot study was to assess the role of cyclosporine (CsA) to tackle the commonest aesthetic problem “perilesional halo” after autologous noncultured melanocyte–keratinocyte cell transplant (NCMKT) for localized, stable vitiligo.

MATERIALS AND METHODS
Of the total 50 enrolled patients who underwent NCMKT for stable/resistant vitiligo, aged 12 to 68 years (mean 29.92 years), 18 were male and 32 were female. Group I (n = 25) patients did not receive any postoperative treatment. Group II (n = 25) patients received CsA postoperatively at 3 mg·kg−1·d−1 for 3 weeks followed by 1.5 mg·kg−1·d−1 for 6 weeks.

RESULTS
In Group I, results were as follows: 28% (n = 7) achieved >75% repigmentation, 16% (n = 4) achieved 50% to 75% repigmentation, 52% (n = 13) achieved 25% to 50% repigmentation, and 4% (n = 1) achieved <25% repigmentation. In Group II, 100% (n = 25) achieved >75% (median 90.7%) repigmentation post-NCMKT at the end of 6 months.

CONCLUSION
This new drug regimen using CsA resulted in rapid and uniform repigmentation without leaving any perilesional halo in Group II patients after NCMKT.
Psychometric properties of the Finnish version of the Women's Health Questionnaire
Authors: Katainen Riina E. , Engblom Janne R. , Vahlberg Tero J. , Polo-Kantola Päivi 
Published: May 2017

Abstract

Objective:
The Women's Health Questionnaire (WHQ) is a validated and commonly used instrument for measuring climacteric-related symptoms. A revised version was previously developed. However, validation in a Finnish population is lacking. As it is important to use qualified instruments, we performed a validation study of the WHQ in a Finnish population.

Methods:
In all, 3,421 women, aged 41 to 54 years, formed the study population. In the original 36-item WHQ, the items were rated on a 1 to 4 scale and on a binary scale (0-1). The scaling of the revised 23-item WHQ was 0 to 100. We evaluated the psychometric properties (internal consistency, correlations between the symptom domains, factor structure, and sampling adequacy) in all three versions.

Results:
For the 1 to 4 scale and on the revised version of the WHQ, the internal consistency was acceptable (the Cronbach's α coefficients >0.70) for most of the domains. On the binary scale, the majority of the coefficient values were below the acceptable level. The original symptom domains, especially those on the revised version, were recognizable from the factors in the exploratory factor analysis, but there were some limitations. The Kaiser-Meyer-Olkin values were high.

Conclusions:
The WHQ is a valid instrument for measuring climacteric-related symptoms in Finnish middle-aged women. The psychometric properties of the revised 23-item WHQ were as good or even better than those of the original 36-item WHQ. Thus, we encourage use of the revised version.
Foreign Body Response to Silicone in Cochlear Implant Electrodes in the Human
Authors: O’Malley Jennifer T. , Burgess Barbara J. , Galler Donald , Nadol Joseph B. 
Published: May 2017

Hypothesis:
Silicone as part of a cochlear implant electrode may be responsible for a foreign body response in the human.

Background:
Clinical evidence of a foreign body response to a cochlear implant has been reported. In a previous study, particulate material found within the fibrous sheath and within macrophages surrounding a cochlear implant has been identified as being consistent with platinum. However, to date, there has been no histologic evidence of a role for silicone in this cellular immune response.

Methods:
A total of 44 temporal bone specimens from 36 patients were reviewed by light microscopy for evidence of presumed platinum and/or silicone foreign bodies in an extracellular or intracellular location. Identification of cell type involved in phagocytosis of foreign body material was accomplished using CD163 immunostaining. The identity and source of the foreign body material was confirmed using energy-dispersive X-ray spectroscopy and scanning electron microscopy.

Results:
Evidence for both platinum and silicone was found in all 44 specimens. In three patients, anti-CD 163 immunostaining demonstrated phagocytized platinum and silicone foreign bodies. In five specimens, energy-dispersive X-ray spectroscopy demonstrated that the birefringent foreign bodies were consistent with silicone. Scanning electron microscopy of two electrodes removed from temporal bones demonstrated small cracks, fragmentation, and small circular defects in the silicone carrier.

Conclusion:
Histologic evidence of a foreign body response to the presence of platinum and silicone in a cochlear implant has been demonstrated and may be responsible for some reported delayed failures or extrusion.
Surgical orthodontics
Authors: Strohl Alexis M. , Vitkus Lauren 
Published: May 2017

Purpose of review
The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient.

Recent findings
Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of ‘surgery first’ orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes.

Summary
A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.
The Effect of Maternal Milk on Tolerance and Growth in Premature Infants
Authors: Hogewind‐Schoonenboom Jacomine E. , Rövekamp‐Abels Lyanne W.W. , de Wijs‐Meijler Daphne P.M. , Maduro Margaux D. , Jansen‐van der Weide Marijke C. , van Goudoever Johannes B. , Hulst Jessie M. 
Published: May 2017

ABSTRACTObjective:Early growth rates and feeding advancement rates of preterm infants are thought to influence later health. Feeding advancement is often difficult because of feeding intolerance. Exclusive human milk feeding improves tolerance, but can result in a lower weight gain rate. The addition of human milk fortifier has advantages for growth, but there are concerns that it may nullify the beneficial effect of human milk on tolerance. Therefore, the objective of the present study was to evaluate the relation between the amount of fortified human milk or formula and feeding tolerance and growth in preterm infants.Methods:Patients (n = 174) participating in the TOL trial and born with a gestational age 30 weeks or younger were divided into tertiles according to the amount of human milk received during feeding advancement. Data on feeding tolerance during the advancement phase of enteral nutrition and anthropometrics were analysed.Results:The infants (n = 59) receiving the lowest percentage of their enteral intake as human milk (0%–57%) had the lowest amount of gastric residuals (P = 0.034) compared with the other 2 tertiles. Time to reach full enteral feeding and other tolerance parameters were not different among the groups. There was no dose response effect of the amount of human milk consumed on growth.Conclusions:In preterm infants, an association between type of feeding (human milk vs infant formula) and time to achieve full enteral feeding or short‐term growth was not found. Future prospective trials are needed to verify our results and focus on means to improve tolerance further.
An Airway Risk Assessment Score for Unplanned Extubation in Intensive Care Pediatric Patients*
Authors: Vats Atul , Hopkins Clara , Hatfield Kelly M. , Yan Jia , Palmer Robert , Keskinocak Pinar 
Published: May 2017

Objective:
As a result of a workshop to identify common causes of unplanned extubation, Children’s Healthcare of Atlanta developed a scoring tool (Risk Assessment Score) to stratify patients into groups of low, moderate, high, and extreme risk. This tool could be used to institute appropriate monitoring or interventions for patients with high risks of unplanned extubation to enhance safety. The objective of this study is to test the hypothesis that the Risk Assessment Score will correlate with the occurrence rate of unplanned extubation in pediatric patients.

Design:
Retrospective review of 2,811 patients at five ICUs conducted between December 2012 and July 2014.

Setting:
Five ICUs at two freestanding pediatric hospitals within a large children’s healthcare system in the United States.

Patients:
All intubated pediatric patients.

Interventions:
Data of intubations and Risk Assessment Score were collected. Extubation outcomes and severity levels were compared across demographic groups and with the maximum Risk Assessment Score of each intubation.

Measurements and Main Results:
Out of 4,566 intubations, 244 were unplanned extubations (5.3%). The occurrence rates of unplanned extubations in those less than 1, 1–6, and more than 6 years old were 6.7%, 3.6%, and 2.7%, respectively, corresponding to a rate of 0.59, 0.53, and 0.58 unplanned extubation every 100 ventilator days. The occurrence rates were 13.6% for patients weighing less than 1 kg (0.59 unplanned extubation per 100 ventilation days) and 3.8% for patients weighing greater than or equal to 1 kg (0.58 unplanned extubation per 100 ventilation days). For intubations with maximum risk score falling in risk categories of low, moderate, high, and extreme, the occurrence rates were 4.7%, 7.7%, 12.0%, and 8.3%, respectively, which corresponded to rates of 0.54, 0.62, 0.95, and 0.92 unplanned extubation per 100 ventilator days.

Conclusions:
Higher Risk Assessment Scores are associated with occurrence rates of unplanned extubation.
The ACA and Cancer Screening and Diagnosis
Authors: Sabik Lindsay M. , Adunlin Georges 
Published: May 2017

Abstract
The Patient Protection and Affordable Care Act (ACA) included multiple provisions expected to increase cancer screening and subsequently early diagnosis of cancer. Key provisions included new coverage options for low-income adults and young adults, as well as elimination of cost sharing for recommended preventive services across most health insurance plans. This article reviews relevant quantitative studies published since the ACA’s passage to assess whether the goal of increasing access to preventive services has been met. Because of lags in data availability, most studies examined only a short period post-ACA. Findings on changes in screening in the general population were mixed, although impacts were greatest among those with lower education and income, as well as groups that previously faced the highest cost barriers to screening. Furthermore, multiple studies found evidence of increases in early-stage diagnoses for certain cancers. Thus, certain targeted populations appear to have better access to cancer screening after the ACA.
Ultrasonography for Preoperative Diagnosis of Retroperitoneal Fibrosis
Authors: Chen Sheng-Jiang , Qin Ling , Xie Yu-Juan , Zhu Jian-Ping , Zhang Qiang , Chen Mei 
Published: May 2017

Abstract
This study aimed to assess the application of ultrasonography for preoperative diagnosis of retroperitoneal fibrosis (RPF). A total of 51 patients with clinically suspected RPF underwent transabdominal ultrasonography and ultrasound-guided histopathologic biopsy (tAU-UGHB). Retroperitoneal fibrosis was diagnosed in 35 patients; of these, 31 cases (88.6%) received a diagnosis using tAU-UGHB. The ultrasonographic images mainly showed solid, irregular isoechoic masses, which were present behind the retroperitoneum and surrounded the abdominal aorta, inferior vena cava, and ureters and had clear borders with the encapsulated structures. Compared with other retroperitoneal lesions, RPF lesions were mainly located below the initial level of the renal artery, and their internal flow signals were not rich (P < 0.05). Retroperitoneal fibrosis had characteristic ultrasonographic features, and color Doppler ultrasound-guided biopsy could be positioned accurately, safely, and efficiently; therefore, tAU-UGHB can be used as an effective modality for preoperative diagnosis of RPF.
Sonographic and Magnetic Resonance Imaging Characteristics of Juvenile Papillomatosis
Authors: Yilmaz Ravza , Bayramoglu Zuhal , Bicen Fuat , Kayhan Arda , Yesil Semen , Acunas Gulden 
Published: May 2017

Abstract
Juvenile papillomatosis (JP) is an infrequently seen benign proliferative lesion in women younger than 30 years. Herein, we present different clinical manifestations of histopathologically proven JP of the breast, in addition to magnetic resonance and sonographic imaging features of these cases. Patient 1 exhibited nipple discharge and papillary carcinoma accompanied after the operation. Patient 2 presented with a giant mass with cystic and numerous solid nodular components that filled the entire right breast. Patient 3 exhibited cystic areas in a well-circumscribed hypoechoic solid mass besides ahypoechoic mass with indistinct borders, which was evaluated as multifocal JP.