bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centrifugal Pump Generates Superior Hemodynamic Performance Compared to a new Diagonal Blood Pump in Neonatal and Pediatric ECMO Circuits
Authors: Patel Krishna , Ündar Akif 
Published: March 2022

Purpose With newer generation diagonal and centrifugal blood pumps gaining popularity, the objective of this study was to compare the DP3-i-cor diagonal and RotaFlow centrifugal pumps in terms of hemodynamic performance using simulated neonatal and pediatric extracorporeal membrane oxygenation (ECMO) circuits. Description The DP3-i-cor diagonal pump is a part of the newly FDA-approved NovaLung system. The experimental circuit consisted of either the DP3-i-cor diagonal or RotaFlow centrifugal pump, a polymethylpentene membrane oxygenator, neonatal and pediatric arterial/venous cannulae, and 1/4-inch ID tubing. Three circuits were tested using combinations of either the DP3-i-cor or RotaFlow pump and varying arterial/venous cannulae sizes. Real-time pressure and flow data were collected. Evaluation The new DP3-i-cor diagonal pump exhibited lower flow rate and pressure head when compared to the RotaFlow centrifugal pump at similar rotational speeds and identical experimental conditions. Large-caliber arterial cannulae expectedly generated higher flow rates and pressures. Conclusions The RotaFlow centrifugal pump demonstrated superior hemodynamic performance when compared to the DP3-i-cor diagonal pump in simulated neonatal and pediatric ECMO circuits. Translational research of all ECMO components is crucial.
Outcomes Following Aortic Valve Replacement in Children With Conotruncal Anomalies
Authors: Alsoufi Bahaaldin , Knight Jessica H. , St. Louis James , Raghuveer Geetha , Kochilas Lazaros 
Published: March 2022

Objective Conotruncal anomalies can develop aortopathy and/or aortic valve (AV) disease and AV replacement (AVR) is occasionally needed. We report long-term results and examine factors affecting survival following AVR in this group. Methods We queried the Pediatric Cardiac Care Consortium (PCCC, US database for interventions for congenital heart diseases) to identify patients with repaired conotruncal anomalies and AVR. Long-term outcomes were provided by the PCCC, the US National Death Index, and Organ Procurement and Transplantation Network. Competing risks analysis examined outcomes following AVR (death/transplantation, reoperation) and multivariable regression analysis assessed significant factors. Results One hundred six children with repaired conotruncal anomalies underwent AVR (1982-2003). Underlying anomaly was truncus (n = 40), d-transposition (n = 22), type-B interrupted arch (n = 16), double-outlet right ventricle (n = 12), pulmonary atresia with ventricular septal defect (n = 9), tetralogy of Fallot (n = 6), corrected transposition (n = 1). 18 (17%) had prior aortic valvuloplasty (surgical = 12, percutaneous = 6). Median age at AVR was 6.9 years (interquartile range = 2.5-12.4). AV pathophysiology was regurgitation (n = 83, 78%), stenosis (n = 9, 9%), and mixed (n = 14, 15%). AVR type was mechanical (n = 72, 68%), homograft (n = 21, 20%), and Ross (n = 13, 12%). Operative mortality was 13(12%). Infant age at AVR was risk factor (odds ratio = 55, 95% confidence interval [CI] = 6-539, P = .0006). On competing risks analysis, five years after AVR, 6% died or received transplantation, 20% had reoperation. Twenty-five years transplant-free survival was 53%. Factors associated with death after hospital discharge included mitral surgery (hazards ratio [HR] = 11, 95% CI = 3-39, P = .0002), underlying defect (HR = 2, 95% CI = 1-5, P = .446). Twenty years transplant-free survival in conotruncal anomalies group was inferior to matched children undergoing AVR for congenital non-conotruncal disease (61% vs 82%, P = .0012). Conclusions Long-term survival following AVR in children with conotruncal anomalies is inferior to that of isolated congenital AV disease and is linked to an underlying cardiac defect. Although valve type was not associated with survival, infant age was a risk factor for operative mortality. Continuous attrition and high reoperation warrant vigilant monitoring.
Stent Angioplasty for Post-Operative Coronary Artery Stenosis in Infants
Authors: Chaszczewski Kasey J. , Nicholson George T. , Shahanavaz Shabana , Dori Yoav , Gillespie Matthew J. , O’Byrne Michael L. , Rome Jonathan J. , Glatz Andrew C. 
Published: March 2022

Introduction While frequently performed in the adult population, percutaneous coronary artery stent angioplasty (CSA) in infants is rare. CSA in infants is challenging because of limited options in terms of appropriately sized (length and diameter) stents, concern about stenting vessels with significant growth potential and limited data regarding durability of benefit. We report a multicenter case series of infants who underwent CSA. Methods A multicenter, retrospective case series of infants who underwent percutaneous CSA to treat post-operative coronary artery stenoses was performed. Results Six infants from 3 institutions who underwent post-operative CSA were identified. The anatomic diagnoses were d-transposition of the great arteries in 3 cases, anomalous left coronary artery from the pulmonary artery in 2 and supravalvar aortic stenosis in 1. All infants were critically ill at the time of CSA. Diameters of coronary artery stents used ranged from 2.25 to 2.75 mm. There were no procedural complications. All stents were patent immediately after placement and the clinical condition improved or stabilized in all patients. Follow-up angiography was available for 3 patients at 4 to 16 months post-CSA, at which time 67% (2/3) remained patent. Conclusion CSA is a feasible and effective therapy for critically ill infants with post-surgical coronary obstruction. Treatment appears to allow at least short-term reperfusion to facilitate recovery of ventricular function and potential development of collateral circulation when longer-term stent patency is not achieved. Longer-term stent patency and coronary artery health remain unanswered questions.
The Impacts of Autoimmune Polyendocrinopathy-Candidiasis-Ectodermal Dysplasia (APECED) on the Oral Health of Children and Young People: A Review and Case Report
Authors: Graham Anna , Javidi Hanieh , Stern Melanie , Rogers Helen J. 
Published: March 2022

Aim: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare, highly variable disease with significant oral health impacts. The aim of the study is to examine the existing evidence base surrounding the oral health impacts of APECED and consider the wider clinical significance of the condition relevant to the provision of pediatric dental care. Materials and Methods: The evidence surrounding APECED and the oral health impacts obtained from a review of multiple databases was qualitatively summarized in the form of a literature review. A case study was used to illustrate the relevance of literature in caring patients with APECED. Results: The literature describes a broad range of impacts from APECED, although it is characterized by chronic candidal infection, autoimmune hypoparathyroidism, and Addison’s disease. Oral manifestations of APECED appear frequently and can present early. Developmental defects of the teeth affect a large proportion of patients with APECED and together with candidiasis, characterize the key oral manifestations of the disease. An enhanced preventive and minimally invasive approach to oral health care is recommended for these patients in light of the complexities of their medical condition. Conclusion: Patients with APECED require careful multidisciplinary care to ensure that the optimal oral health outcomes are achieved.
Lessons Learned from the Preimplementation Phase of an Oral Health Care Project
Authors: Murray J. , Hunter S.C. , Splawinski Z. , Conroy T. 
Published: March 2022

Implementation research aims to improve uptake of evidence-based interventions into health care practice and policy, but conducting such research can be complex. This brief report discusses the intentions of the research team versus the reality faced when conducting the preimplementation phase of a project aiming to improve adherence to best-practice oral health care in a hospital geriatric unit. Using our project as an example, our aim is to provide researchers with an insight into potential hurdles they may also face and strategies that could be employed to overcome these. During the preimplementation stage, it is important to take sufficient time to ensure that the local site is ready and motivated for the proposed change and committed to the shared goal. Explicit delineation of roles of facilitators is needed. Contextual circumstances will always change, and additional support or resources might be required to navigate them. A flexible mind-set is required as goals and strategies may need to be renegotiated along the way. The success and effectiveness of implementation projects are often built from the time and relationship building invested in the preimplementation phase. Knowledge Transfer Statement: This commentary highlights that effective implementation of best-practice oral health care in acute geriatric units is built on the time and relationship building invested in the preimplementation phase.
Medical Student Portfolios: A Systematic Scoping Review
Authors: Tan Rei , Qi Ting Jacquelin Jia , Zhihao Hong Daniel , Sing Lim Annabelle Jia , Ong Yun Ting , Pisupati Anushka , Xin Chong Eleanor Jia , Chiam Min , Inn Lee Alexia Sze , Shuen Tan Laura Hui , Chew Chin Annelissa Mien , Wijaya Limin , Fong Warren , Radha Krishna Lalit Kumar 
Published: March 2022

Phenomenon Medical Student Portfolios (MSP)s allow medical students to reflect and better appreciate their clinical, research and academic experiences which promotes their individual personal and professional development. However, differences in adoption rate, content design and practice setting create significant variability in their employ. With MSPs increasingly used to evaluate professional competencies and the student's professional identity formation (PIF), this has become an area of concern. Approach We adopt Krishna’s Systematic Evidence-Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on MSPs. The structured search process of six databases, concurrent use of thematic and content analysis in the Split Approach and comparisons of the themes and categories with the tabulated summaries of included articles in the Jigsaw Perspective and Funnelling Process offers enhanced transparency and reproducibility to this review. Findings The research team retrieved 14501 abstracts, reviewed 779 full-text articles and included 96 articles. Similarities between the themes, categories and tabulated summaries allowed the identification of the following funnelled domains: Purpose of MSPs, Content and structure of MSPs, Strengths and limitations of MSPs, Methods to improve MSPs, and Use of E-portfolios. Insights Variability in the employ of MSPs arise as a result of a failure to recognise its different roles and uses. Here we propose additional roles of MSPs, in particular, building on a consistent set of content materials and assessments of milestones called micro-competencies. Whislt generalised micro-competencies assess achievement of general milestones expected of all medical students, personalised micro-competencies record attainment of particular skills, knowledge and attitudes balanced against the medical student’s abilities, context and needs. This combination of micro-competencies in a consistent framework promises a holistic, authentic and longitudinal perspective of the medical student’s development and maturing PIF.
Metal-Free Fixation for Free Bone-Block Reconstruction of Chronic Anteroinferior Shoulder Instability
Authors: Scheibel M. , Lorenz C. J. 
Published: March 2022

Background: Anterior shoulder instability is common and may cause a considerable effect on quality of life. For cases with glenoid bone loss, there is still a controversial discussion regarding the optimal treatment. Most of the recent methods are using metal implants to attach the needed graft to the glenoid with reported disadvantages such as metal impingement, damage to the humeral head, cartilage destruction, and premature arthritis. Indications: (1) Erosion-type defects with significant bone loss (>15%-20%); (2) chronic fragment-type defects if the size of the fragment is not large enough for an anatomical reconstruction; and (3) non-reconstructible, multifragmented acute fragment type of lesions. Technique Description: After placing the patient in a lateral decubitus position and fixing the arm in a traction devise, 3 arthroscopic entries are established: a posterior portal, an anterosuperior portal, and an anteroinferior portal. A harvested tricortical iliac crest bone graft is provided with 2 drilling holes which match the drilling holes through the glenoid. The tapes are then placed from the posterior to the anterior side of the glenoid, and then the graft is passed from the anterior to the posterior side, thus compressing the cancellous side of the bone block onto the glenoid defect. A following interconnection of the sutures creates a continuous loop. The end of the tapes was loaded into a pretied racking hitch knot system, which creates sliding knots between the 2 pair of tapes, whereon the knots can be reduced to the glenoid in a symmetrical fashion. Finally, the reconstruction of the anterosuperior labrum can be done, to cover the bone block with enough soft tissue. Results: First short-term results show radiographic consolidation after 3 months and an increased median glenoid estimated surface area at 12 months. The functional scores showed good outcomes, and there were no serious complications reported. Discussion/Conclusion: The presented arthroscopic reconstruction of the glenoid using a tricortical bone graft and high-strength fiber tapes provides a metal-free technique which results in a high primary stability of the construct and should therefore be considered when treating anterior shoulder instability with significant bone loss.
The effects of the probiotic cocktail on modulation of the NF-kB and JAK/STAT signaling pathways involved in the inflammatory response in bowel disease model
Authors: Aghamohammad Shadi , Sepehr Amin , Miri Seyedeh Tina , Najafi Saeideh , Rohani Mahdi , Pourshafiea Mohammad R. 
Published: March 2022

Abstract
Background
Probiotics positively affect inflammatory responses, in part, through Janus kinase/signal transduction and activator of transcription (JAK/STAT) and inflammatory signaling pathways. To evaluate the precise effects of probiotics as protective treatment, we aimed to investigate the effectiveness of Lactobacillus spp., Bifidobacterium spp., and a mixture of these probiotics in modulating the JAK/STAT and inflammatory signaling pathways.

Methods
A quantitative real-time polymerase chain reaction (qPCR) assay was used to analyze the expression of JAK/STAT and inflammatory genes (TIRAP, IRAK4, NEMO, and RIP) following HT-29 cell line treatment with sonicated pathogens Lactobacillus spp., Bifidobacterium spp., and a mixed cocktail. A cytokine assay was also used to evaluate the IL-6 and IL-1β production following the probiotic treatment.

Results
The probiotic cocktail downregulated the JAK genes and TIRAP, IRAK4, NEMO, and RIP genes in the NF-kB pathway compared to sonicate pathogen treatment cells. The expression of STAT genes was variable following probiotic treatment. The IL-6 and IL-1β production decreased after probiotic treatment.

Conclusions
Our probiotic cocktail showed anti-inflammatory effects on HT-29 cells by modulating JAK/STAT and NF-kB pathways. Therefore, Lactobacillus spp. and Bifidobacterium spp. probiotics as nutritional supplements may reduce inflammation-associated diseases such as inflammatory bowel disease (IBD).
A competing risk analysis of colorectal cancer recurrence after curative surgery
Authors: Schellenberg Angela E. , Moravan Veronika , Christian Francis 
Published: March 2022

Abstract
Background
This study examines the effect of prognostic patient and disease characteristics on colorectal cancer (CRC) recurrence after curative resection. We used competing risk analysis with death as a competing risk. This method provides the clinician a perspective into a patient’s actual risk of experiencing a recurrence.

Methods
A retrospective cohort study of patients diagnosed with CRC who underwent curative resection for CRC from 2003–2007 at the Royal University Hospital in Saskatoon was completed. The outcome of interest was the first CRC recurrence, either local or distant metastasis. Demographic data, tumor characteristics, adjuvant treatment and follow-up data, date of local recurrence or metastasis were recorded from the medical record. Univariate analysis was completed to look at the relationship between each of the prognostic indicators and recurrence. Multivariable modelling (subdistribution regression modelling) was done to identify the main risk factors in determining recurrence.

Results
Of 148 patients, 38 (25.7%) experienced a recurrence, 16 (10.8%) died without evidence of recurrence, and 94 (63.5%) experienced neither outcome. The median follow-up was 30.5 months (interquartile range 10.6–50). In univariable subdistribution regression, T-stage, N-stage, vascular invasion and positive margins were all predictive of cancer recurrence, with p ≤ 0.001, with subdistribution hazard ratios for T4 stage at 11.93, T3 stage at 2.46, N2 stage at 10.58, and presence of vascular invasion at 4.27. N-stage remained as the sole predictor in multivariable regression. Cumulative incidence function (CIF) of recurrence at 48 months after surgery was 15%, 27% and 90% for N1/2, N3 and N4 respectively.

Conclusion
The highest CIF of recurrence was associated with T4 stage, N2 stage, and vascular invasion. Patient’s age, tumour location, type, or histological grade were not found to have a significant effect on the success of CRC surgery in precluding a recurrence.
Endoscopic ultrasound avoids adverse events in high probability choledocholithiasis patients with a negative computed tomography
Authors: Lin Meng-Ying , Lee Chun-Te , Hsieh Ming-Tsung , Ou Ming-Ching , Wang Yao-Shen , Lee Meng-Chieh , Chang Wei-Lun , Sheu Bor-Shyang 
Published: March 2022

Abstract
Background
The current guideline recommends patients who meet high probability criteria for choledocholithiasis to receive endoscopic retrograde cholangiopancreatography (ERCP). However, adverse events can occur during ERCP. Our goal is to determine whether endoscopic ultrasound (EUS) before ERCP can avoid unnecessary ERCP complications, especially in patients with a negative CT scan.

Methods
A total of 604 patients with high probability of choledocholithiasis were screened and 104 patients were prospectively enrolled. Patients with malignant biliary obstruction, altered GI anatomy, and choledocholithiasis on CT scan were excluded. Among them, 44 patients received EUS first, and ERCP if choledocholithiasis present (EUS-first group). The other 60 patients received ERCP directly (ERCP-first group). The baseline characteristics, presence of choledocholithiasis, and complications were compared between groups. All patients were followed for 3 months to determine the difference in recurrent biliary event rate. Cost-effectiveness was compared between the two strategies.

Results
There was no marked difference in age, sex, laboratory data, presenting with pancreatitis, and risk factors for choledocholithiasis. Overall, 51 patients (49.0%) had choledocholithiasis, which did not justify the risk of direct ERCP. In the EUS-first group, 27 (61.4%) ERCP procedures were prevented. The overall complication rate was significantly lower in the EUS-first group compared to the ERCP-fist group (6.8% vs. 21.7%, P = 0.04). The number-needed-to-treat to avoid one unnecessary adverse event was 6.71. After a 3-month follow-up, the cumulative recurrence biliary event rates were similar (13.6% vs. 15.0%, P = 0.803). EUS-first strategy was more cost-effective than the ERCP-first strategy (mean cost 2322.89$ vs. 3175.63$, P = 0.002).

Conclusions
In high-probability choledocholithiasis patients with a negative CT, the EUS-first strategy is cost-effective, which can prevent unnecessary ERCP procedures and their complications.
The mediation role of sleep quality in the relationship between cognitive decline and depression
Authors: Liu Xiaolei , Xia Xin , Hu Fengjuan , Hao Qiukui , Hou Lisha , Sun Xuelian , Zhang Gongchang , Yue Jirong , Dong Birong 
Published: March 2022

Abstract
Objectives
Associations between cognitive decline and depression have been inconclusive. We examined 1) whether sleep quality mediates these relationships and 2) which factor of sleep quality mediates these relationships.

Methods
This study utilized baseline data from the 2018 West China Health and Aging Trend study (WCHAT), a large cohort data-set that including participants aged over 50 years old. We defined depression using the 15-item Geriatric Depression Scale (GDS-15). Cognitive status was measured using the Short Portable Mental Status Questionnaire (SPMSQ) and sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Direct relationships between cognitive decline, sleep quality and depression were assessed using multiple linear regression. Mediation models and structural equation model (SEM) pathway analysis were used to test the mediating role of specific aspects of sleep (e.g., quality, duration) in the relationship between cognitive decline and depression.

Results
Of 6828 participants aged 50 years old or older, the proportion of depression was 17.4%. Regression analysis indicated a total association between cognitive scores (β = 0.251, 95% CI 0.211 to 0.290, p < 0.001) and depression status. After adjusted PSQI scores, the association between cognitive scores and depression status was still significant (β = 0.242, 95% CI 0.203 to 0.281, p < 0.001), indicating a partial mediation effect of sleep quality. Mediation analysis verified sleep quality partially mediate the associations between cognitive decline and depression (indirect effect estimate = 0.0308, bootstrap 95% CI 0.023 to 0.040; direct effect estimate = 0.3124, bootstrap 95% CI 0.269 to 0.350). And daytime dysfunction had a highest mediation effect with a proportion of mediation up to 14.6%.

Conclusions
Sleep quality partially mediated the relationship between cognitive decline and depression. Daytime dysfunction had a highest mediation effect. Further research is necessary to examine the effects of sleep quality on the relationship of cognitive decline and depression.