bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Associated with Postoperative Exacerbation of Sleep-disordered Breathing
Authors: Chung Frances , Liao Pu , Elsaid Hisham , Shapiro Colin M. , Kang Weimin 
Published: October 2013

Abstract

Introduction:
The knowledge on the mechanism of the postoperative exacerbation of sleep-disordered breathing may direct the perioperative management of patients with obstructive sleep apnea. The objective of this study is to investigate the factors associated with postoperative severity of sleep-disordered breathing.

Methods:
After obtaining approvals from Institutional Review Boards, consenting patients underwent portable polysomnography preoperatively, and on postoperative nights 1 and 3 in hospital or at home. The primary outcomes were polysomnography parameters measuring the sleep-disordered breathing. They were treated as repeated measurement variables and analyzed for associated factors by mixed models.

Results:
Three hundred seventy-six patients, 168 men and 208 women, completed polysomnography on preoperative and postoperative night 1. Age was 59 ± 12 yr (mean ± SD). Preoperative apnea–hypopnea index (AHI) was 12 (4, 26) (median [25th, 75th percentile]) events per hour. Thirty-five patients had minor surgeries, 292 intermediate surgeries, and 49 major surgeries, with 210 general anesthesia and 166 regional anesthesia. The 72-h opioid dose was 55 (14, 85) mg intravenous morphine-equivalent dose. Preoperative AHI, age, and 72-h opioid dose were associated with postoperative AHI. Preoperative central apnea index, male sex, and general anesthesia were associated with postoperative central apnea index. Slow wave sleep percentage was inversely associated with postoperative AHI and central apnea index.

Conclusions:
Patients with a higher preoperative AHI were predicted to have a higher postoperative AHI. Preoperative AHI, age, and 72-h opioid dose were positively associated with postoperative AHI. Preoperative central apnea, male sex, and general anesthesia were associated with postoperative central apnea index.
Dietary Fiber Mixture in Pediatric Patients With Controlled Chronic Constipation
Authors: Weber Thabata K. , Toporovski Mauro S. , Tahan Soraia , Neufeld Clarice B. , de Morais Mauro B. 
Published: October 2013

ABSTRACTObjectives:The aim of the study was to test the clinical efficacy and effect on colonic transit time (CTT) of a dietary fiber mixture given to children with controlled chronic constipation (CC) after the withdrawal of stool softeners and enemas.Methods:This randomized, placebo‐controlled, double‐blind clinical trial involved 54 patients aged 4 to 12 years and had CC that was controlled by the use of low‐dose stool softeners. The use of these softeners was discontinued when the patients were admitted to the clinical trial. The patients were randomized into 2 groups for the 4‐week study period. One group received a dietary fiber mixture and the other group received a placebo (maltodextrin). The primary outcome was therapeutic failure (oral stool softeners or enemas was required to prescribe during the trial). Secondary outcomes included defecation frequency, stool consistency (measured using the Bristol Stool Form Scale), and CTT.Results:Therapeutic failure was observed in 34.6% (9/26) of the patients in the dietary fiber mixture group and in 35.7% (10/28) in the control group (P = 0.933). The mean increase in daily bowel movements was 0.53 in the dietary fiber mixture group and 0.23 in the control group (P = 0.014). The patients in the dietary fiber mixture group (60.0%) passed nonhardened stools more frequently than did those in the control group (16.7%, P = 0.003). The CTT was similar for both groups.Conclusions:The fiber mixture did not prevent the suspension of stool softeners or lead to reduced CTT; however, the mixture promoted an increased frequency of defecation and an improvement in the stool consistency.
The role of serious concomitant injuries in the treatment and outcome of pediatric severe traumatic brain injury
Authors: Stewart Tanya Charyk , Alharfi Ibrahim M. , Fraser Douglas D. 
Published: October 2013

BACKGROUND
The study objective was to describe the epidemiology of serious concomitant injuries and their effects on outcome in pediatric severe traumatic brain injury (sTBI).

METHODS
A retrospective cohort of all severely injured (Injury Severity Score [ISS] ≥ 12) pediatric patients (<18 years) admitted to our pediatric intensive care unit, between 2000 and 2011, after experiencing an sTBI (Glasgow Coma Scale [GCS] score ≤ 8 and head Abbreviated Injury Scale [AIS] ≥ 4) were included. Two groups were compared based on the presence of serious concomitant injuries (maximum AIS score ≥ 3). Multivariate logistic regression was undertaken to determine variable associations with mortality.

RESULTS
Of the 180 patients with sTBI, 113 (63%) sustained serious concomitant injuries. Chest was the most commonly injured extracranial body region (84%), with lung being the most often injured. Patients with serious concomitant injuries had increased age, weight, and injury severity (p < 0.001) and were more likely injured in a motor vehicle collision (91% vs. 48%, p < 0.001). Those with serious concomitant injuries had worse sTBI, based on lower presedation GCS (p = 0.031), higher frequency of fixed pupils (p = 0.006), and increased imaging abnormalities (SAH and DAI, p ≤ 0.01). Non-neurosurgical operations and blood transfusions were more frequent in the serious concomitant injury group (p < 0.01). The differences in mortality for the two groups failed to reach statistical significant (p = 0.053), but patients with serious concomitant injuries had higher rates of infection and acute central diabetes insipidus, fewer ventilator-free days, and greater length of stays (p < 0.05). Multivariate analyses revealed fixed pupillary response (odd ratio [OR], 63.58; p < 0.001), presedation motor GCS (OR, 0.23; p = 0.001), blood transfusion (OR, 5.80; p = 0.008), and hypotension (OR, 4.82; p = 0.025) were associated with mortality, but serious concomitant injuries was not (p = 0.283).

CONCLUSION
Head injury is the most important prognostic factor in mortality for sTBI pediatric patients, but the presence of serious concomitant injuries does contribute to greater morbidity, including longer stays, more infections, fewer ventilator-free days, and a higher level of care required on discharge from hospital.

LEVEL OF EVIDENCE
Prognostic and epidemiologic study, level III.
Basic fibroblast growth factor/vascular endothelial growth factor in the serum from severe burn patients stimulates the proliferation of cultured human umbilical cord mesenchymal stem cells via activation of Notch signaling pathways
Authors: Liu Ling-Ying , Hou Yu-Sen , Chai Jia-Ke , Hu Quan , Duan Hong-Jie , Yu Yong-Hui , Yin Hui-Nan , Hao Dai-Feng , Feng Guang , Li Tao , Du Jun-Dong 
Published: October 2013

BACKGROUND
Mesenchymal stem cells (MSCs) are the leading cellular constituents used in regenerative medicine. MSCs repair and reconstruct wounds of acute traumata and radiation-induced burns through proliferation, differentiation, and trophic activity. However, repair effect of MSCs on severe burn wounds remain to be clarified because severe burns are much more complex traumata than radiation-induced burns. Survival and proliferation of MSCs in microenvironments affected by severe burns are very important for improving wound repair/regeneration. This study aimed to elucidate the survival and proliferation effects and the potential proliferation mechanism of serum from severe burn patients (BPS) on human umbilical cord MSCs (hUCMSCs) in vitro.

METHODS
The hUCMSCs were isolated, cultured, and identified. Next, we evaluated the effects of BPS on cell numbers, cell cycle progression, cyclin D expression, and key proteins and genes of the Notch signaling pathway. Putative mechanisms underlying the proliferation of hUCMSCs were investigated.

RESULTS
BPS markedly increased the number of hUCMSCs, and the results of the cell cycle studies indicated that BPS induced cell cycle progression into the M phase. Cyclin D expression was higher with BPS than in the control group. Moreover, Notch-1, a key determinant of hUCMSC activation and proliferation, and its target gene Hes-1 were overexpressed after BPS treatment. Proliferation numbers of hUCMSC, rate of proliferation period (G2/M+S), and the expression of cyclin D, Notch-1, and Hes-1 were markedly decreased by Notch signaling inhibitors (DAPT/GSI). In the case of BPS, basic fibroblast growth factor and vascular endothelial growth factor were the key factors that promoted hUCMSC proliferation.

CONCLUSION
This study provides novel evidence for the role of BPS in the survival and rapid proliferation of hUCMSCs and suggests that these cells could be used for cell therapy–based clinical applications for treating severe burns. Furthermore, hUCMSC proliferation was induced by basic fibroblast growth factor/vascular endothelial growth factor in BPS through activation of Notch signal.
From the barn to the operating room and back
Authors: Rogers Amelia , Horst Michael , Rogers Frederick , Lee John , Reihart Michael 
Published: October 2013

BACKGROUND
The Amish culture is known for simple living, reluctance to use modern technology, and a heavy emphasis on church and family relationships. We hypothesized that the strong work ethic and social structure of the Amish would lead to improved outcome following trauma.

METHODS
Trauma registry was queried for all patients from years 2000 to 2010. Patients separated into Amish versus non-Amish. Groups were compared using univariate logistic regression, with the first outcome variable being mortality and the second being hospital length of stay (LOS) greater than 5 days. Factors significant on univariate analysis were included in the multivariate models for the same dependent variables.

RESULTS
From 2000 to 2010, our Level II trauma center admitted 18,337 trauma patients, 802 (4.4%) of whom were Amish. When adjusted for age of 65 years or older, Injury Severity Score (ISS) of 16 or greater, and the occurrence of at least one complication, the Amish are at 96% lower odds for having an overall hospital LOS greater than 5 days (odds ratio, 0.51; 95% confidence interval, 0.40–0.66; p < 0.001). The Amish have a 72% lower odds of dying following trauma, when controlling for age of 65 years or older, Glasgow Coma Scale (GCS) score of 13 or less, ISS of 16 or greater, and Revised Trauma Score (RTS) of 7 or less (odds ratio, 0.58; 95% confidence interval, 0.33–0.96; p = 0.036). The hospital LOS model had a receiver operating characteristic curve of 0.77, and the mortality model had a receiver operating characteristic curve of 0.88.

CONCLUSION
When adjusted for injury severity, age, and physiology, the Amish have a 72% lower odds of dying following trauma than their non-Amish counterparts. When adjusted for injury severity, age, physiology, and complications, the Amish have a 96% lower odds of having an extended hospital LOS than their non-Amish counterparts. Understanding the unique social structure of the Amish population may allow scarce social services’ resources to be shifted to more underserved areas.

LEVEL OF EVIDENCE
Epidemiologic, level III.
The value of digital rectal examination in assessing for pelvic fracture–associated urethral injury
Authors: Johnson Michael H. , Chang Andrew , Brandes Steven B. 
Published: October 2013

BACKGROUND
The Advanced Trauma Life Support Manual (8th ed.) recommend a digital rectal examination (DRE) as part of the initial evaluation of all trauma patients. A “high-riding” or “nonpalpable” prostate is a contraindication to urethral catheterization and an indication for urethrography. However, there are no published guidelines on, definitions of, or predictive values for high riding. Moreover, prostate evaluation can be difficult in the supine/trauma position.

METHODS
A total of 100 patients underwent DRE in lateral decubitus position. Prostate size and distance from anal verge to the prostate apex were recorded. DRE in the supine position was then performed, noting the most proximal part of the prostate that was palpable. High-riding prostate was defined as the apex being one or more SDs farther from the anal verge than the mean. Fifty index finger lengths were measured to ensure that DRE findings were applicable to the average examiner.

RESULTS
A total of 100 prostates were evaluated. Mean (SD) distance from the anal verge to the prostate apex in patients with palpable prostates was 4.86 (1.38) cm (range, 2.5–8 cm). The prostate was nonpalpable in the decubitus position in 8 of the 100 patients and in the supine position in 42 of the 100 patients. Mean (SD) body mass index in the nonpalpable group was 32.6 (5.8) kg/m2 versus palpable group with 28.1 (5.7) kg/m2 (p < 0.01). Of the 100 patients, 26 had prostates that were “high riding” (defined as >6.2 cm from the anal verge), 2 of which were palpable in the supine position. Palpable prostates were closer to the anal verge at 4.13 cm compared with nonpalpable at 6.15 cm (p < 0.01). Mean (SD) index finger length is 7.3 (0.60) cm.

CONCLUSION
DRE in the pelvic fracture trauma setting to evaluate for urethral disruption is unreliable. Patients with a larger body mass index were less likely to have a palpable prostate. The use of the criteria of “nonpalpable” prostate has a high false-positive rate. Our objective definition of high-riding prostate should be incorporated into all trauma protocols.

LEVEL OF EVIDENCE
Epidemiologic study, level V.
Surgical management of traumatic isolated sternal fracture and manubriosternal dislocation
Authors: Divisi Duilio , Di Leonardo Gabriella , Crisci Roberto 
Published: October 2013

BACKGROUND
The aim of this study was to evaluate the surgical procedures of osteosynthesis and the respective costs in isolated sternal fractures and manubriosternal dislocations.

METHODS
Between January 2006 and July 2011, we treated 47 patients with an isolated fracture and 18 patients with a dislocation of the sternum surgically. In case of sternal fracture, the titanium plate was used in 30 (64%), steel plate in 12 (25%), and steel wire in 5 patients (11%). The stabilization after traumatic luxation was obtained with steel wire in 4 patients (22%) and titanium plate associated with demineralized bone matrix in 14 patients (78%). The quality adjusted life years (QALYs) was analyzed, as well as the incremental cost-effectiveness ratio based on QALYs.

RESULTS
In the sternal fractures, titanium plate showed a decreased time of intervention (30 [2] minutes), length of stay (3 [1] days), and total cost (€2,277.10) compared with steel plate (€2,667.70) and steel wire (€2,801.60) procedures, displaying an excellent difference in QALYs (0.825 and 1.615, respectively). In the sternal dislocation, steel wire technique highlighted a poor QALYs, although this approach was less expensive than titanium plate with demineralized bone matrix (€3,553.60 vs. €6,047.80). Incremental cost-effectiveness ratio revealed that the titanium plate costs were €623.55 more than the steel wire per QALYs gained.

CONCLUSION
The rigid titanium plate application ensured a safe and easy management of traumatic sternal lesions with a good prognosis of patients, justified by the improved QALYs compared with other methods.

LEVEL OF EVIDENCE
Therapeutic study, level IV; economic analysis, level IV.
Spinal cord injury without radiologic abnormality in children imaged with magnetic resonance imaging
Authors: Mahajan Prashant , Jaffe David M. , Olsen Cody S. , Leonard Jeffrey R. , Nigrovic Lise E. , Rogers Alexander J. , Kuppermann Nathan , Leonard Julie C. 
Published: October 2013

BACKGROUND
This study aimed to compare children diagnosed with cervical spinal cord injury without radiographic abnormality (SCIWORA) relative to whether there is evidence of cervical spinal cord abnormalities on magnetic resonance imaging (MRI).

METHODS
We conducted a planned subanalysis of a cohort of children younger than 16 years with blunt cervical spine injury presenting to Pediatric Emergency Care Applied Research Network centers from January 2000 to December 2004 who underwent cervical MRI and did not have bony or ligamentous injury identified on neuroimaging. We defined SCIWORA with normal MRI finding as children with clinical evidence of cervical cord injury and a normal MRI finding and compared them with children with SCIWORA who had cervical cord signal changes on MRI (abnormal MRI finding).

RESULTS
Of the children diagnosed with cervical spine injury, 55% (297 of 540) were imaged with MRI; 69 had no bony or ligamentous injuries and were diagnosed with SCIWORA by clinical evaluation; 54 (78%) had normal MRI finding, and 15 (22%) had cervical cord signal changes on MRI (abnormal MRI finding). Children with abnormal MRI findings were more likely to receive operative stabilization (0% normal MRI finding vs. 20% abnormal MRI finding) and have persistent neurologic deficits at initial hospital discharge (6% normal MRI finding vs. 67% abnormal MRI finding).

CONCLUSION
Children diagnosed with SCIWORA but with normal MRI finding in our cohort presented differently and had substantially more favorable clinical outcomes than those with cervical cord abnormalities on MRI.

LEVEL OF EVIDENCE
Epidemiologic study, level III.
Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement
Authors: Glazer Evan S. , Kulvatunyou Narong , Green Donald J. , Gries Lynn , Joseph Bellal , O’Keeffe Terence , Tang Andrew L. , Wynne Julie L. , Friese Randall S. , Rhee Peter M. 
Published: October 2013

BACKGROUND
As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role.

METHODS
For our retrospective study, we queried our tertiary Level I trauma center’s prospectively maintained ACS database for PEG tube placement. Our study period was from July 1, 2010, through June 30, 2012. We excluded patients who underwent “push” PEG placement, an outpatient PEG tube placement, or an open or laparoscopic gastrostomy tube operation. We conducted a multivariate logistic regression analysis of factors contributing to complications.

RESULTS
During our 24-month study period, of 184 patients, 133 underwent “pull” PEG tube placement with sufficient data for analysis. The mean (SD) age was 56 (22) years; 66% were male. Overall, 33 (25%) experienced complications: 13 (10%) were major and 20 (15%) were minor complications. In our multivariate logistic regression analysis, we found that an extreme bumper height (<2 or >5 cm) (odds ratio, 1.57; 95% confidence interval, 1.14–2.16) and upper aerodigestive tract malignancy as the operative indication (odds ratio, 1.54; 95% confidence interval, 1.06–2.26) were significantly associated with complications.

CONCLUSION
Although pull PEG tube placement is typically a straightforward procedure, morbidity can be significant. Bumper height is an easily modifiable variable; obtaining the proper height for each patient could decrease complications after PEG tube placement.

LEVEL OF EVIDENCE
Therapeutic study, level IV.
Extracorporeal life support in patients with multiple injuries and severe respiratory failure
Authors: Biderman Philippe , Einav Sharon , Fainblut Michael , Stein Michael , Singer Pierre , Medalion Benjamin 
Published: October 2013

BACKGROUND
The use of extracorporeal life support in trauma casualties is limited by concerns regarding hemorrhage, particularly in the presence of traumatic brain injury (TBI). We report the use of extracorporeal membrane oxygenation (ECMO)/interventional lung assist (iLA) as salvage therapy in trauma patients. High-flow technique without anticoagulation was used in patients with coagulopathy or TBI.

METHODS
Data were collected from all adult trauma patients referred to one center for ECMO/iLA treatment owing to severe hypoxemic respiratory failure.

RESULTS
Ten casualties had a mean (SD) Injury Severity Score (ISS) of 50.3 (10.5) (mean [SD] age, 29.8 [7.7] years; 60% male) and were supported 9.5 (4.5) days on ECMO (n = 5) and 7.6 (6.5) days on iLA (n = 5). All experienced blunt injury with severe chest injuries, including one cardiac perforation. Most were coagulopathic before initiation of ECMO/iLA support. Among the seven patients with TBI, four had active intracranial hemorrhage. Complications directly related to support therapy were not lethal; these included hemorrhage from a cannulation site (n = 1), accidental removal of a cannula (n = 1), and pressure sores (n = 3). Deaths occurred owing to septic (n = 2) and cardiogenic shock (n = 1). Survival rates were 60% and 80% on ECMO and iLA, respectively. Follow-up of survivors detected no neurologic deterioration.

CONCLUSION
ECMO/iLA therapy can be used as a rescue therapy in adult trauma patients with severe hypoxemic respiratory failure, even in the presence of coagulopathy and/or brain injury. The benefits of rewarming, acid-base correction, oxygenation, and circulatory support must be weighed individually against the risk of hemorrhage. Further research should determine whether ECMO therapy also confers survival benefit.

LEVEL OF EVIDENCE
Therapeutic study, level V.
Predicting surgical exploration in renal trauma
Authors: Shoobridge Jennifer J. , Bultitude Matthew F. , Koukounaras Jim , Royce Peter L. , Corcoran Niall M. 
Published: October 2013

BACKGROUND
This study aimed to externally validate a previously described nomogram that predicts the need for renal exploration in the trauma setting.

METHODS
The predicted probability of nephrectomy was manually calculated using prospectively collected data from consecutive patients with renal trauma who presented to our institution between May 2001 and January 2010. To assess nomogram performance, receiver operating characteristic curves against the observed exploration rate were generated, and areas under the curve were calculated. Calibration curves were generated to assess performance across the range of predicted probabilities. Logistic regression modeling was used to determine clinical factors predicting exploration in a contemporary setting, and a nomogram was derived and internally validated using bootstrapping.

RESULTS
The established nomogram was applied to the 320 patients who presented during the 9-year period. The global performance of the established nomogram was very high, with an area under the curve of 0.95. However, the model performance was poor for higher predicted probabilities, thus lacking predictive ability in the population where the model has the greatest potential utility. A clinical tool was generated to better predict trauma nephrectomy in our contemporary population, using platelet transfusion within the first 24 hours, blood urea nitrogen, hemoglobin, and heart rate on admission. The global accuracy for the new model was similar to the previous nomogram, but it was significantly better calibrated for patients with higher probabilities of nephrectomy, with good predictive accuracy even in patients with Grade 5 injuries.

CONCLUSION
Older nomogram fails to accurately predict renal exploration in high-grade injuries in the contemporary setting. A new nomogram that more accurately predicts the need for exploration is presented.

LEVEL OF EVIDENCE
Therapeutic study, level IV; prognostic study, level III.