bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of Preoperative Consultation and Surgical Specialty in an Integrated Healthcare System
Authors: Thilen Stephan R. , Bryson Christopher L. , Reid Robert J. , Wijeysundera Duminda N. , Weaver Edward M. , Treggiari Miriam M. 
Published: March 2013

Abstract

Background:
Many patients scheduled for elective surgery are referred for a preoperative medical consultation. Only limited data are available on factors associated with preoperative consultations. The authors hypothesized that surgical specialty contributes to variation in referrals for preoperative consultations.

Methods:
This is a cohort study using data from Group Health Cooperative, an integrated healthcare system. The authors included 13,673 patients undergoing a variety of common procedures—primarily low-risk surgeries—representing six surgical specialties, in 2005–2006. The authors identified consultations by family physicians, general internists, pulmonologists, or cardiologists in the 42 days preceding surgery. Multivariable logistic regression was used to estimate the association between surgical specialty and consultation, adjusting for potential confounders including the revised cardiac risk index, age, gender, Deyo comorbidity index, number of prescription medications, and 11 medication classes.

Results:
The authors found that 3,063 (22%) of all patients had preoperative consultations, with significant variation by surgical specialty. Patients having ophthalmologic, orthopedic, or urologic surgery were more likely to have consultations compared with those having general surgery—adjusted odds ratios (95% CI) of 3.8 (3.3–4.2), 1.5 (1.3–1.7), and 2.3 (1.8–2.8), respectively. Preoperative consultations were more common in patients with lower revised cardiac risk scores.

Conclusion:
There is substantial practice variation among surgical specialties with regard to the use of preoperative consultations in this integrated healthcare system. Given the large number of consultations provided for patients with low cardiac risk and for patients presenting for low-risk surgeries, their indications, the financial burden, and cost-effectiveness of consultations deserve further study.
Evaluation of Spinal Toxicity and Long-term Spinal Reflex Function after Intrathecal Levobupivaciane in the Neonatal Rat
Authors: Hamurtekin Emre , Fitzsimmons Bethany L. , Shubayev Veronica I. , Grafe Marjorie R. , Deumens Ronald , Yaksh Tony L. , Walker Suellen M. 
Published: March 2013

AbstractBackground:Neuraxial anesthesia is utilized in children of all ages. Local anesthetics produce dose-dependent toxicity in certain adult models, but the developing spinal cord may also be susceptible to drug-induced apoptosis. In postnatal rodents, we examined the effects of intrathecal levobupivacaine on neuropathology and long-term sensorimotor outcomes.Methods:Postnatal day 3 (P3) or P7 rat pups received intrathecal levobupivacaine 2.5 mg/kg (0.5%) or saline. Mechanical withdrawal thresholds and motor block were assessed. Spinal cord tissue analysis included apoptosis counts (activated caspase-3, Fluoro-Jade C) at 24 h, glial reactivity at 7 days, and histopathology in cord and cauda equina at 24 h and 7 days. Long-term spinal function in young adults (P35) was assessed by hind limb withdrawal thresholds, electromyography responses to suprathreshold stimuli, and gait analysis.Results:Intrathecal levobupivacaine produced spinal anesthesia at P3 and P7. No increase in apoptosis or histopathological change was seen in the cord or cauda equina. In the P3 saline group, activated caspase-3 (mean ± SEM per lumbar cord section 6.1 ± 0.3) and Fluoro-Jade C (12.1 ± 1.2) counts were higher than at P7, but were not altered by levobupivacaine (P = 0.62 and P = 0.11, two-tailed Mann–Whitney test). At P35, mechanical withdrawal thresholds, thermal withdrawal latency, and electromyographic reflex responses did not differ across P3 or P7 levobupivacaine or saline groups (one way ANOVA with Bonferroni comparisons). Intrathecal bupivacaine at P3 did not alter gait.Conclusion:Single dose intrathecal levobupivacaine 0.5% did not increase apoptosis or produce spinal toxicity in neonatal rat pups. This study provides preclinical safety data relevant to neonatal use of neuraxial local anesthesia.
Juvenile Myasthenia Gravis
Authors: Castro Diana , Derisavifard Samir , Anderson Mariam , Greene Medrith , Iannaccone Susan 
Published: March 2013

Abstract

Objective:
Juvenile myasthenia gravis (JMG) is an antibody-mediated autoimmune disorder of the neuromuscular junction, at the postsynaptic end plate. JMG presents with fluctuating skeletal muscle weakness and fatigue before the age of 18 years. Very frequently JMG presents with the involvement of the oculomotor muscles, with or without generalized involvement.

Methods:
We performed a retrospective chart review of patients diagnosed with myasthenia in the pediatric neuromuscular clinics at UT Southwestern, between 1990 and 2010. Osserman classification and the response to therapy scale of Millichap and Dodge were used to compare each patient's severity of myasthenia and responsiveness to drugs before the surgery as a baseline and at the last visit, after thymectomy.

Results:
Fifty-eight patients were included; 29 (50%) were African American, and 34 (58.6%) were female. Age of onset was 11 months to 17 years, and 38 patients (65%) presented as generalized myasthenia gravis. Forty-nine patients (84%) were acetylcholine receptor antibody (AchR-Ab) positive. Of the 32 to undergo thymectomy, 19 subjects (59%) experienced an improved response to B level on the Myasthenia Scale of Millichap and Dodge (good improvement, both objective and subjective, but continuation of drug therapy required in the same or lower dosage) and 75% experienced a drop in Osserman classification by at least 1. Of the 8 individuals who did not show improvement after thymectomy, 4 subjects (50%) underwent repeat thymectomy. They had initially less invasive fluoroscopic or thoracoscopic procedure. Thymic hyperplasia was found in 7 patients (21%) and thymoma in 2.

Conclusions:
Thymectomy was well tolerated by this group of children. There was clinical improvement after thymectomy in two thirds of the AchR-Ab–positive generalized myasthenia gravis patients. Thymic pathology was seen in less than one third of the patients who underwent thymectomy, with thymic hyperplasia being common. Further studies are necessary to determine whether thymectomy is indicated for all children with generalized JMG. More information about the immunologic, genetic, and molecular differences between patients may determine the best treatment for individual patients.
Difference in Central and Peripheral Recovery in a Patient With Severe Axonal Motor Neuropathy and Central Nervous System Involvement and Review of Literature
Authors: Moody Shade’ B. , Wanchoo Ruchi J. , Kalamangalam Giridhar P. , Infante Ernesto , Sheikh Kazim A. 
Published: March 2013

Abstract
In the literature, the term fulminant Guillain–Barré syndrome is used to refer to patients with Guillain–Barré syndrome with rapidly progressive and severe weakness and/or comatose state mimicking brain death. We present the case of a 53-year-old man with fulminant Guillain–Barré syndrome with discrepancy in central nervous system and peripheral nervous system recovery. Our review of literature confirms that these patients often have good and relatively rapid recovery of central nervous system function, whereas peripheral nervous system function is relatively delayed and often incomplete.
EARLY SPONTANEOUS CLOSURE AFTER REOPENING OF A PREVIOUSLY REPAIRED MACULAR HOLE
Authors: Vahdani Kaveh , Park Jonathan C. , Raman Vasant S. 
Published: March 2013

Purpose:
To describe a case of early spontaneous closure of macular hole after reopening after previous successful surgical repair.

Methods:
A 72-year-old female patient was treated for stage 2 idiopathic macular hole in the right eye. The hole remained anatomically closed for 2 months postoperatively, before reopening 1 month later.

Results:
The patient was listed for revision surgery; however, on the day of the operation, which was 2 months after the reopening, the hole seemed to have closed spontaneously. Two years later, the macular hole remains closed with best-corrected visual acuity of 6/9.

Conclusion:
Spontaneous closure of macular holes after reopening is a rare phenomenon. The case presented here demonstrates that for early reopening of macular holes, a period of observation with serial optical coherence tomography may allow the hole to close spontaneously before proceeding with further surgical intervention.
SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY OF ROTH SPOTS
Authors: Giovinazzo Jerome , Mrejen Sarah , Freund K. Bailey 
Published: March 2013

Purpose:
To describe the retinal findings of subacute bacterial endocarditis, their evolution after treatment, and analysis with spectral-domain optical coherence tomography.

Methods:
Retrospective chart review.

Results:
A 21-year-old man presented with the sudden onset of a central scotoma in his left eye because of a sub–internal limiting membrane hemorrhage overlying the left fovea. When examined 2 weeks later, Roth spots were noted in his right eye. The patient was immediately referred to his internist and diagnosed with subacute bacterial endocarditis with cultures positive for Streptococcus viridans. He subsequently underwent aortic valve replacement surgery after 4 weeks of intravenous antibiotic therapy. When examined 4 weeks after valve replacement surgery, there was regression of the Roth spots.

Conclusion:
The present case demonstrates the importance of a funduscopic examination in the early diagnosis and management of subacute bacterial endocarditis. The analysis of Roth spots with spectral-domain optical coherence tomography suggested that they were septic emboli.
Delayed Small Bowel Transit in Children With Cystic Fibrosis and Pancreatic Insufficiency
Authors: Rovner Alisha J. , Schall Joan I. , Mondick John T. , Zhuang Hongming , Mascarenhas Maria R. 
Published: March 2013

ABSTRACTObjective:Gastrointestinal disturbances are common in people with cystic fibrosis (CF); however, motility studies in this population have yielded inconsistent results. This study examined gastric emptying (GE) and small bowel transit (SBT) time in children with CF and pancreatic insufficiency compared with a healthy adult reference group.Methods:Participants consumed an 8‐ounce liquid test meal (approximately 550 calories, 32 g of fat) labeled with 300 μCi 99m technetium (Tc) sulfur colloid. Subjects with CF received a standard dose of pancreatic enzymes before consuming the test meal. GE and SBT were measured using a standard nuclear medicine scan. GE was determined after correcting for 99mTc decay in both anterior and posterior images. SBT was determined by following the movement of the tracer from the stomach to the cecum. The percentage arrival of total small bowel activity at the terminal ileum and cecum/ascending colon at 6 hours was used as an index of SBT. A 1‐way analysis of covariance was performed for comparisons between groups after adjustment for age, sex, and body mass index.Results:Subjects with CF (n = 16) had similar GE compared with the healthy reference group (n = 12); however, subjects with CF had significantly prolonged SBT time. At 6 hours, 37.2% ± 25.4% (95% CI 23.7–50.7) of the tracer reached the terminal ileum and colon compared with 68.6% ± 13.1% (95% CI 60.2–76.9) for the reference group (P < 0.001). After controlling for sex, age, and body mass index, this difference remained statistically significant (F = 12.06, adjusted R2 = 0.44, P < 0.002).Conclusions:Children with CF and pancreatic insufficiency had unaltered GE but delayed SBT time when taking pancreatic enzymes.
A Multidisciplinary Clinical Program Is Effective in Stabilizing BMI and Reducing Transaminase Levels in Pediatric Patients With NAFLD
Authors: DeVore Stephanie , Kohli Rohit , Lake Kathleen , Nicholas Lynda , Dietrich Kim , Balistreri William F. , Xanthakos Stavra A. 
Published: March 2013

ABSTRACTBackground and Aim:Weight loss is an effective treatment for children with nonalcoholic fatty liver disease (NAFLD), but it is extremely difficult to achieve outside of an intensive weight management program. We hypothesized that one can achieve success in improving NAFLD and weight‐related outcomes in a structured and focused multidisciplinary clinical program feasible to implement in a gastroenterology clinic.Methods:We prospectively tracked the clinical status of our patients enrolled in a multidisciplinary program of dietary and exercise advice through an institutional review board–approved NAFLD registry. Each patient met with a gastroenterologist and dietitian every 3 months for 30 minutes to set individualized goals and monitor progress.Results:A total of 108 children have been enrolled in the registry, and of the 83 that were eligible for 1‐year follow‐up and included in the analysis, 39 patients returned, resulting in a 47% follow‐up rate. These 39 patients showed statistically significant improvements in mean BMI z score (−0.1 U, P < 0.05), total (−11 mg/dL, P < 0.05) and low‐density lipoprotein (9 mg/dL, P < 0.05) cholesterol, and serum alanine aminotransferase levels (−36 U/L) and aspartate aminotransferase levels (−22 U/L) levels.Conclusions:A clinically feasible multidisciplinary program for obese pediatric patients with NAFLD stabilized BMI z score and significantly improved aminotransferase levels at 1‐year follow‐up.
Early Life Exposures as Risk Factors for Pediatric Eosinophilic Esophagitis
Authors: Jensen Elizabeth T. , Kappelman Michael D. , Kim Hannah P. , Ringel‐Kulka Tamar , Dellon Evan S. 
Published: March 2013

ABSTRACTObjectives:Few etiologic studies of eosinophilic esophagitis (EoE) have been conducted. Early life exposures have been shown to predispose to other allergic disease, but their role has not been assessed in EoE. The present study sought to explore early life exposures as possible risk factors for developing EoE in the pediatric population.Methods:This was a 2‐phase case‐control study conducted at the University of North Carolina. The first phase consisted of survey development for early life exposures via cognitive interview. In the second phase, a telephone‐based questionnaire was administered to cases with EoE (n = 31) and 2 sets of controls, patients with gastroesophageal reflux disease, and siblings of nonsyndromic cleft lip/palate patients (n = 26 in each). Different controls were explored to identify controls reflective of the source population of the cases. Siblings of cleft lip/palate patients were identified as the more suitable control population. Odds ratios were calculated to evaluate the association between early life exposures and the development of pediatric EoE.Results:Early life exposures were associated with increased odds of developing pediatric‐onset EoE. Antibiotic use in infancy was associated with 6 times the odds of having EoE (95% confidence interval 1.7–20.8). Cesarean delivery, preterm birth, and formula‐only or mixed (infant formula and breast milk) feeding also have trends toward increased odds for developing EoE.Conclusions:A number of early life exposures may be associated with the development of EoE. These are potentially modifiable risk factors that if confirmed would have implications for improved understanding of EoE pathogenesis and disease prevention.
Bone Deficits in Parenteral Nutrition–Dependent Infants and Children With Intestinal Failure Are Attenuated When Accounting for Slower Growth
Authors: Appleman Stephanie S. , Kalkwarf Heidi J. , Dwivedi Alok , Heubi James E. 
Published: March 2013

ABSTRACTObjective:The aim of the present study was to determine whether bone mineral content (BMC) and density (BMD) of infants and children with parenteral nutrition (PN)–dependent intestinal failure (IF) is lower than healthy controls, and investigate potential causes of lower BMC and BMD.Methods:We performed a cross‐sectional study comparing infants and children with PN‐dependent IF with duos of age‐, sex‐, and race‐matched controls. Lumbar spine BMC and BMD were measured by dual‐energy x‐ray absorptiometry, and serum cytokines, aluminum, insulin‐like growth factor‐1 (IGF‐1), IGF‐binding protein 3 (IGF‐BP3), parathyroid hormone, 25‐hydroxy vitamin D, and 1,25‐dihydroxy vitamin D were measured. Generalized estimating equation models accounting for matching were used for comparisons.Results:BMC was 15% and BMD was 12% lower in IF participants than in controls (P ≤ 0.004). Group differences were attenuated to 3% and 7% and were not statistically significant (P = 0.40 and P = 0.07) when adjusted for length and weight; length‐ and weight‐for‐age were lower in IF than in control participants (12.5% vs 63%; 29.5% vs 54%, P ≤ 0.03). IF participants had higher serum aluminum (23 vs 7 μg/L, P < 0.0001), IGF‐1 (97 vs 64 ng/mL, P = 0.04), and 25‐hydroxy vitamin D concentrations (40 vs 30 ng/mL, P = 0.0005), and lower IGF‐BP3 (1418 vs 1812 ng/mL, P < 0.0001) and parathyroid hormone concentrations (51 vs 98 pg/mL, P = 0.0002) than controls. There was no difference in serum cytokine concentrations (P ≥ 0.09).Conclusions:Growth retardation is a significant problem for patients with PN‐dependent IF. Additional investigation is needed to elucidate the cause and its effect on bone mass and density, especially the role of IGF‐1 resistance and aluminum toxicity.
Efficacy of Different Probiotic Combinations on Death and Necrotizing Enterocolitis in a Premature Rat Model
Authors: Wu Shu‐Fen , Chiu Hsiao‐Yu , Chen An‐Chyi , Lin Hsiang‐Yu , Lin Hung‐Chih , Caplan Michael 
Published: March 2013

ABSTRACTObjective:The aim of the present study was to investigate the most effective probiotic combinations to prevent death and necrotizing enterocolitis (NEC) in a premature rat model.Methods:One hundred fifty‐eight premature Sprague‐Dawley premature rats were enrolled. Probiotic strains Bifidobacterium bifidum, B longum, Lactobacillus acidophilus, L plantarum, and B breve were fed as a single strain or mixture with 2 or 3 strains for a total of 9 study groups; control groups received no exogenous probiotic supplement. Fecal samples were collected for 72 hours to detect probiotic strains and pathologic strains by real‐time polymerase chain reaction. Colony counts of probiotic strains Escherichia coli and Klebsiella were compared between groups before and after 36 hours of the study period. The incidence of death and NEC were compared via Fisher exact test between groups.Results:The results demonstrated that L plantarum alone (P = 0.0026) and B bifidum with B longum together (P = 0.0017) were more effective in reducing NEC as compared with the control group. All of the study groups except B breve and B bifidum with B breve definitely prevented death compared with controls. B bifidum and B longum together had significantly lower mortality than the control group (P < 0.0001). Colony counts of E coli and Klebsiella in stool samples were significantly decreased in the B bifidum, B longum, and L plantarum group compared with the other study and control groups after 36 hours.Conclusions:Administration of a mixture of probiotic strains with B bifidum and B longum was most effective in preventing death and NEC in this animal model, and these observations provide an evidence‐based strategy for designing further neonatal clinical trials.
Absence of Effect of Nasal Continuous Positive Airway Pressure on the Esophageal Phase of Nutritive Swallowing in Newborn Lambs
Authors: Djeddi Djamal , Cantin Danny , Samson Nathalie , Tian Hao , Praud Jean‐Paul 
Published: March 2013

ABSTRACTObjectives:It is presently recommended that oral feeding be started in premature infants as soon as possible, often at an age at which nasal continuous positive airway pressure (nCPAP) is still required for ventilatory support. Our previous data showed that application of nCPAP up to 10 cmH2O in full‐term lambs had no deleterious effect on cardiorespiratory safety, feeding efficiency, or on nutritive swallowing–breathing coordination. Besides fear of swallowing–breathing coordination disturbances, esophageal motility disruption by nCPAP could be a reason to delay oral feeding. To our knowledge, no study has focused on the effects of nCPAP on esophageal motility in the neonatal period. The aim of the present study was therefore to further assess the effects of nCPAP on oral feeding by assessing its effects on the esophageal phase of nutritive swallowing (nutritive esophagodeglutition).Methods:Six full‐term lambs, ages 2 to 3 days, underwent esophageal multichannel intraluminal impedance‐pH monitoring. Lambs were bottle‐fed under 2 randomized conditions, namely spontaneous breathing and nCPAP 6 cmH2O.Results:Beyond confirmation of unaltered feeding efficiency, analysis of multiple variables measured by impedance monitoring revealed that nCPAP 6 does not alter nutritive esophagodeglutition in any way (nCPAP vs spontaneous breathing, P > 0.1 for all variables).Conclusions:offering further support to neonatologists pleading for initiation of oral feeding in infants still on nCPAP, the present results set the foundations for similar clinical studies in preterm human infants to confirm the absence of effects of nCPAP on nutritive swallowing.
Amputations and foot ulcers in patients newly diagnosed with Type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co‐morbidity
Authors: Bruun C. , Siersma V. , Guassora A. D. , Holstein P. , de Fine Olivarius N. 
Published: March 2013

AbstractAimsTo determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co‐morbidities.MethodsFrom the Diabetes Care in General Practice study, 1381 patients were included and examined at diabetes diagnosis, at 6 years and at 14 years after diagnosis. Register‐based follow‐up was for 19 years. Foot ulcers and amputations were related to gender, age and co‐morbidities by odds and hazard ratios from logistic and Cox regression models, respectively.ResultsThe incidence of any amputation and major amputation was 400 (95% CI 307–512) and 279 (95% CI 203–375) per 100 000 patient‐years, respectively. At the three observation points, the foot ulcer prevalences were 2.76% (95% CI 1.89–3.63), 2.93% (95% CI 1.86–4.00) and 4.96% (95% CI 3.10–6.82). Multivariate analyses showed associations between foot ulcers and peripheral neuropathy, peripheral arterial disease, male gender, retinopathy and myocardial infarction. After multivariate adjustment, significant predictors (hazard ratio; 95% CI) of any amputation were peripheral neuropathy (hazard ratio 2.09; 95% CI 1.19–3.69), peripheral arterial disease (hazard ratio 3.43; 95% CI 1.65–7.12), microalbuminuria (hazard ratio 2.11; 95% CI 1.21–3.67), retinopathy (hazard ratio 6.42; 95% CI 2.59–15.90), impaired vision (hazard ratio 6.92; 95% CI 2.35–20.38) and male gender (hazard ratio 2.40; 95% CI 1.31–4.41). For women, the risk of amputation increased with age, but for men the risk was higher when diagnosed with diabetes at a younger age.ConclusionsDespite improved treatment regimens, the incidence of amputations is still high in this population‐based patient sample. Men diagnosed with diabetes before age 65 years and patients with diabetes‐related co‐morbidities are at particularly high risk of foot ulcers and amputations.