bluuebunny/crossref_metadata_2025 huggingface dataset:
Manifestations buccales de la sclérose tubéreuse de Bourneville
Authors: Lafont J. , Catherine J.H. , Lejeune M. , Ordioni U. , Lan R. , Campana F.
Published: March 2020

L’objectif de ce travail est de faire le point sur les manifestations buccales de la sclérose tubéreuse de Bourneville (STB) à travers le cas d’un jeune patient. Un jeune homme de 15 ans était adressée pour la mise en place de minivis orthodontique afin de fermer des espaces d’agénésies de 35 et 45. L’interrogatoire retrouvait une STB dont les manifestations épileptiques étaient traitées par de la lamotrigine 75mg/j et de la carbamazépine LP 200mg/j. L’examen clinique exo-buccal retrouvait des macules hypochromiques sur le membre inférieur droit, des angiofibromes faciaux et une malformation vasculaire jugale gauche. L’examen endo-buccal retrouvait de multiples lésions buccales sur les papilles interdentaires pouvant évoquer des fibromes ou des hamartomes. Une biopsie était réalisée et retrouvait un revêtement malpighien, discrètement hyperplasique et sans atypie cellulaire. Les faisceaux collagènes du conjonctif étaient mêlés à de nombreux fibroblastes aux noyaux réguliers, sans mitose visible.

Les cellules inflammatoires, essentiellement mononuclées, étaient dispersées mais tendaient à se regrouper autour de vaisseaux nombreux et hyperplasiques. L’examen concluait à un fibrome. Aucun traitement buccal n’était proposé devant l’absence de symptôme et de demande esthétique. La STB est une maladie génétique autosomique dominante avec une incidence de 1/10 000. Elle est liée à une mutation du gène TSC1 sur le chromosome 9 ou du gène TSC2 sur le chromosome 16 qui perturbe la sécrétion d’une protéine régulant la voie mTOR. C’est une maladie multisystème avec une expression clinique variable. Les principaux symptômes sont l’épilepsie, le retard mental et la présence d’adénomes sébacés, mais la maladie est associée à un polymorphisme clinique rendant le diagnostic difficile. La conférence de consensus de 2012 a ainsi défini des critères diagnostiques majeurs (lésions cutanées, oculaires, cérébrales, cardiaques, pulmonaires, rénales,..) et mineurs dont deux sont bucco-dentaires. Le diagnostic est retenu devant deux critères majeurs ou un critères majeur et deux critères mineurs. Les signes oraux sont la présence de trois ou plus puits d’émail et deux ou plus fibromes gingivaux. Les fibromes gingivaux atteindraient 50 à 70% des patients. La région antérieure maxillaire semble la plus touchée. L’exérèse est indiquée en cas de gêne esthétique ou de saignements associés. Actuellement, les inhibiteurs de mTOR représentent une option thérapeutique proposée dans la prise en charge des patients atteints de STB. La STB est une pathologie rare. La présence de lésions buccales fait partie des critères diagnostiques.
Granulomatose oro-faciale révélatrice d’une maladie de Crohn : présentation d’un cas
Authors: Ordioni U. , Labrosse G. , Campana F. , Lan R. , Catherine J.H. , Albertini A.F.
Published: March 2020

La granulomatoses oro-faciale (GOF) est une entité rare regroupant toutes les pathologies caractérisées par une inflammation granulomateuse non caséeuse de la région oro-faciale. Le diagnostic est histologique. L’étiologie n’est pas connue. L’oedème labial d’abord intermittent, pouvant s’installer de manière permanente, est un symptôme classique de la GOF. D’autres signes cliniques, extra-oraux, peuvent être associées lorsque la GOF s’inscrit dans le cadre d’une pathologie systémique : maladie de Crohn, Sarcoïdose, maladie de Wegener. Nous présentons le cas d’un patient pour qui l’exploration de sa GOF a conduit au diagnostic de maladie de Crohn (MC). Un patient de 29 ans consultait pour une tuméfaction labiale évoluant depuis an après échec de traitement locaux (dermocorticoïdes). On notait des diarrhées chroniques étiquetées maladie coeliaque et un épisode d’hyperplasie gingivale à l’âge de 14 ans (gingivectomie réalisée par un parodontiste mais sans analyse anatomopathologique). L’examen clinique montrait un oedème labial supérieur et inférieur associé à un érythème, une hyperplasie gingivale, une ulcération vestibulaire et une langue géographique associée à une langue plicaturée. On ne notait pas de paralysie faciale. Des biopsies étaient réalisées. La biopsie labiale montrait une muqueuse normokératosique, avec des remaniements spongiotiques, sans micro-abcès. Le chorion sous-jacent était oedémateux avec des vaisseaux dilatés. On observait plus en profondeur un vaisseau altéré avec un granulome lympho-épithéioïde sans cellule géante et sans nécrose. La biopsie gingivale montrait une muqueuse oedémateuse sans granulome. L’examen biologique (NFS, VS, CRP, bilan martial, dosage enzyme conversion angiotensine, sérologie VIH, VHC, VHB) et la radiologie thoracique était sans particularité. Compte tenu de la présente d’une pathologie intestinale et à la vue de ces nouvelles données, un avis gastro-entérologique était demandé. L’examen proctologique montrait des marisques anales. L’entero-IRM confirmait le diagnostic de MC. La macrochéilie a été traité par injection de triamcinolone retard 40ml. Un traitement par anti- TNF était instauré. La MC est une maladie inflammatoire chronique de l’intestin pouvant atteindre le tube digestif de la bouche à l’anus. Les manifestations oro-faciales (macrochéilie, ulcérations buccales, hyperplasie gingivale, pseudo-polypes, erythèmes muqueux, fissures gingivales ou pyostomatite végétante) de la maladie de Crohn peuvent précéder l’atteinte intestinale. Des atteintes extra-intestinales peuvent exister : érythème noueux, uvéite, arthralgie, arthrite entéropathique. Le diagnostic de GOF doit faire rechercher des signes extra-oraux afin de déterminer si elle est isolée ou associée à une MC, à une sarcoidose ou un Wegener. En cas de GOF isolé, la question du suivi de dépistage d’une MC reste non élucidée.
Therapie des fortgeschrittenen hormonrezeptor(HR)-positiven HER2-negativen Mammakarzinoms
Authors: Ditsch Nina , Schmidt Marcus
Published: March 2020

Der Artikel gibt einen Überblick über die aktuellen Therapieoptionen des metastasierten hormonrezeptorpositiven und HER2-negativen Mammakarzinoms. Im Fokus stehen Kombinationstherapien z. B. mit CDK4/6-Inhibition im Vergleich zu rein endokrin basierten Therapien in Prä- und Postmenopause mit Darlegung der neuesten Studienergebnisse. Die Hinzunahme eines CDK4/6-Inhibitors zu einer endokrin basierten Therapie mit Aromataseinhibitor oder Fulvestrant führt zu einer deutlichen Verbesserung des progressionsfreien Überlebens und ist vorteilhaft unabhängig davon, ob es sich um Palbociclib, Ribociclib oder Abemaciclib handelt. Der daher besondere klinische Stellenwert der Inhibition cyclinabhängiger Kinasen spricht für den Einsatz in der Erstlinienbehandlung von Frauen mit metastasiertem, hormonrezeptorpositivem und HER2-negativem Mammakarzinom im Vergleich zu den verfügbaren rein endokrin basierten Therapien.
Population-Based Estimation of the Preterm Birth Rate in Lilongwe, Malawi: Making Every Birth Count
Authors: Antony Kathleen M. , Kazembe Peter N. , Pace Ryan M. , Levison Judy , Phiri Henry , Chiudzu Grace , Harris Ronald Alan , Chirwa Rose , Nyondo Mary , Marko Ellina , Chigayo Andrew , Nanthuru Debora , Banda Bertha , Twyman Nicholas , Ramin Susan M. , Raine Susan P. , Belfort Michael A. , Aagaard Kjersti M.
Published: March 2020

Objective The objective of this study was to perform a population-based estimation of the preterm birth (PTB) rate in regions surrounding Lilongwe, Malawi.

Study Design We partnered with obstetrician specialists, community health workers, local midwives, and clinicians in a 50 km region surrounding Lilongwe, Malawi, to perform a population-based estimation of the PTB rate during the study period from December 1, 2012 to May 19, 2015.

Results Of the 14,792 births captured, 19.3% of births were preterm, including preterm early neonatal deaths. Additional PTB risk factors were similarly prevalent including domestic violence, HIV, malaria, anemia, and malnutrition.

Conclusion When performing a population-based estimation of the rate of PTB, including women without antenatal care and women delivering at home, the 19.3% rate of PTB is among the highest recorded globally. This is accompanied by a high rate of risk factors and comorbid conditions.
Surface pressure modification driven by a dielectric-barrier-discharge plasma actuator: Performance dependence on airfoil shape
Authors: Goyagi Rena , Komuro Atsushi , Kawate Rio , Sato Wakana , Suzuki Kento , Ando Akira
Published: March 2020

Optimization of the airfoil shape and flow-control device is critical for optimal performance of fluid devices, such as wind turbines and aircraft. In this study, the combined effects of an airfoil and a dielectric-barrier-discharge plasma actuator (DBD-PA), utilized as the flow-control device, were evaluated through surface pressure measurements in a wind-tunnel experiment using three types of airfoils: Göttingen 387, SG6043, and the NASA Common Research Model (NASA-CRM). Our experimental results demonstrated that combining the DBD-PA with either the SG6043 or NASA-CRM foil improved the maximum lift of the airfoil; the DBD-PA with the Göttingen 387 foil maintained lift even after the stall angle. These results indicate that the flow-control performance of a DBD-PA varies not only with the Reynolds number but also with the shape of the airfoil.
Application of exogenous enzymes: is digestibility an appropriate response variable?
Authors: Walk C. L. , Bedford M. R.
Published: March 2020

The use of digestible nutrient values for feedstuffs and non-ruminant diets has resulted in significant improvements in ingredient utilisation, pig and poultry performance and efficiency, and reduced feed costs and environmental waste. The use of exogenous enzymes such as carbohydrases, phytases and proteases in non-ruminant diets has also had a profound effect on meat production, feed efficiency and reduced environmental waste through an improvement in nutrient digestibility. However, the use of nutrient digestibility in the absence of animal growth or efficiency, on individual feed ingredients or complete diets, as an estimate of exogenous enzyme efficacy requires careful consideration. Numerous studies have highlighted a range of factors that will influence the estimated digestibility coefficients. These include but are not limited to: differences in methods employed, the use of a point-in-time measure of nutrient digestion versus growth over the lifetime of the chicken or pig, adjustment (or not) for endogenous losses, age of the animal, production status and nutritional status of the diet. These factors can also be influenced by or have an influence on exogenous enzyme efficacy to yield positive, negative, non-significant, or inconclusive effects on nutrient digestion. In addition, exogenous enzyme supplementation of diets has resulted in improvements in nutrient digestibility in the absence of an effect on productivity or efficiency or vice versa. Therefore, the use of nutrient digestibility as a response variable for exogenous enzyme efficacy is informative but only in the presence of growth performance, intake, or meat yield.
Transliterating Cities: The Interdiscursive Ethnohistory of a Tamil Francophonie
Authors: Das Sonia N.
Published: March 2020

The interdiscursive ethnohistory of outdoor signs and other transliterated graphic artifacts from four urban neighborhoods in Puducherry, Paris, and Montreal is based on linguistic, ethnographic, and archival analyses of disparate sociohistorical contexts in which businesses and organizations promote or devalorize printing in Tamil and Roman scripts. Signs that project the image of a Tamil francophonie depend on structures of addressivity that animate graphic artifacts and potentially lead to new encounters between francophone Tamils. Thus, transliterations into Tamil, French, or English recalibrate the chronotopes of francophone Tamil settlements. Embodying the present, Paris provides the grounds for reproducing the linguistic community through adherence to International French, despite its paucity of transliterations. Montreal’s transliterations embody the diaspora’s future, emphasizing vibrant entrepreneurial activities in grassroots literacy, whereas signs in Puducherry featuring ornamental displays of French offer opportunities to connect with a past in which Tamil and French once coexisted in colonial handbooks and streets.
Spatial filter and its application in three-dimensional single molecule localization microscopy
Authors: Fan Xiaoming , Hendriks Johnny , Comini Maddalena , Katranidis Alexandros , Büldt Georg , Gensch Thomas
Published: March 2020

Single molecule localization microscopy (SMLM) allows the imaging of cellular structures with resolutions five to ten times below the diffraction limit of optical microscopy. It was originally introduced as a two-dimensional technique based on the localization of single emitters as projection onto the x-y imaging plane. The determination of the axial position of a fluorescent emitter is only possible by additional information. Here we report a method (spatial filter SMLM (SFSMLM)) that allows to determine the axial positions of fluorescent molecules and nanoparticles on the nanometer scale by the usage of two spatial filters, which are placed in two otherwise identical emission detection channels. SFSMLM allows axial localization in a range of ca. 1.5 μm with a localization precision of 15 - 30 nm in axial direction. The technique was utilized for localizing and imaging small cellular structures - e.g. actin filaments, vesicles and mitochondria - in three dimensions.
What Does Native American and Indigenous Studies (NAIS) Do?
Authors: O’Brien Jean M.
Published: March 2020

David Silverman offers a critical appraisal of two prizewinning works in Native American and Indigenous studies (NAIS), Our Beloved Kin: A New History of King Philip’s War, by Lisa Brooks, and Memory Lands: King Philip’s War and the Place of Violence in the Northeast, by Christine M. DeLucia. Silverman’s review treats the methodology associated with NAIS with some skepticism, offering the opportunity for a lively discussion about the merits and perils of community-engaged history scholarship. Four scholars of Native American history, including DeLucia, respond, defending new approaches to Indigenous history represented by these recent works.
Interpretable and accurate prediction models for metagenomics data
Authors: Prifti Edi , Chevaleyre Yann , Hanczar Blaise , Belda Eugeni , Danchin Antoine , Clément Karine , Zucker Jean-Daniel
Published: March 2020

Background

Microbiome biomarker discovery for patient diagnosis, prognosis, and risk evaluation is attracting broad interest. Selected groups of microbial features provide signatures that characterize host disease states such as cancer or cardio-metabolic diseases. Yet, the current predictive models stemming from machine learning still behave as black boxes and seldom generalize well. Their interpretation is challenging for physicians and biologists, which makes them difficult to trust and use routinely in the physician–patient decision-making process. Novel methods that provide interpretability and biological insight are needed. Here, we introduce “predomics”, an original machine learning approach inspired by microbial ecosystem interactions that is tailored for metagenomics data. It discovers accurate predictive signatures and provides unprecedented interpretability. The decision provided by the predictive model is based on a simple, yet powerful score computed by adding, subtracting, or dividing cumulative abundance of microbiome measurements.

Results

Tested on >100 datasets, we demonstrate that predomics models are simple and highly interpretable. Even with such simplicity, they are at least as accurate as state-of-the-art methods. The family of best models, discovered during the learning process, offers the ability to distil biological information and to decipher the predictability signatures of the studied condition. In a proof-of-concept experiment, we successfully predicted body corpulence and metabolic improvement after bariatric surgery using pre-surgery microbiome data.

Conclusions

Predomics is a new algorithm that helps in providing reliable and trustworthy diagnostic decisions in the microbiome field. Predomics is in accord with societal and legal requirements that plead for an explainable artificial intelligence approach in the medical field.
Low Spontaneous Mutation Rate and Pleistocene Radiation of Pea Aphids
Authors: Fazalova Varvara , Nevado Bruno
Published: March 2020

Accurate estimates of divergence times are essential to understand the evolutionary history of species. It allows linking evolutionary histories of the diverging lineages with past geological, climatic, and other changes in environment and shed light on the processes involved in speciation. The pea aphid radiation includes multiple host races adapted to different legume host plants. It is thought that diversification in this system occurred very recently, over the past 8,000–16,000 years. This young age estimate was used to link diversification in pea aphids to the onset of human agriculture, and led to the establishment of the pea aphid radiation as a model system in the study of speciation with gene flow. Here, we re-examine the age of the pea aphid radiation, by combining a mutation accumulation experiment with a genome-wide estimate of divergence between distantly related pea aphid host races. We estimate the spontaneous mutation rate for pea aphids as 2.7×10-10 per haploid genome per parthenogenic generation. Using this estimate of mutation rate and the genome-wide genetic differentiation observed between pea aphid host races, we show that the pea aphid radiation is much more ancient than assumed previously, predating Neolithic agriculture by several hundreds of thousands of years. Our results rule out human agriculture as the driver of diversification of the pea aphid radiation, and call for re-assessment of the role of allopatric isolation during Pleistocene climatic oscillations in divergence of the pea aphid complex.
Effectiveness of glucocorticoid therapy in patients with severe coronavirus disease 2019: protocol of a randomized controlled trial
Authors: Qin Yuan-Yuan , Zhou Yi-Hong , Lu Yan-Qiu , Sun Feng , Yang Sen , Harypursat Vijay , Chen Yao-Kai
Published: March 2020

Background:

At the end of 2019, a novel coronavirus outbreak causative organism has been subsequently designated the 2019 novel coronavirus (2019-nCoV). The effectiveness of adjunctive glucocorticoid therapy in the management of 2019-nCoV-infected patients with severe lower respiratory tract infections is not clear, and warrants further investigation.

Methods:

The present study will be conducted as an open-labeled, randomized, controlled trial. We will enrol 48 subjects from Chongqing Public Health Medical Center. Each eligible subject will be assigned to an intervention group (methylprednisolone via intravenous injection at a dose of 1–2 mg/kg/day for 3 days) or a control group (no glucocorticoid use) randomly, at a 1:1 ratio. Subjects in both groups will be invited for 28 days of follow-up which will be scheduled at four consecutive visit points. We will use the clinical improvement rate as our primary endpoint. Secondary endpoints include the timing of clinical improvement after intervention, duration of mechanical ventilation, duration of hospitalization, overall incidence of adverse events, as well as rate of adverse events at each visit, and mortality at 2 and 4 weeks.

Discussion:

The present coronavirus outbreak is the third serious global coronavirus outbreak in the past two decades. Oral and parenteral glucocorticoids have been used in the management of severe respiratory symptoms in coronavirus-infected patients in the past. However, there remains no definitive evidence in the literature for or against the utilization of systemic glucocorticoids in seriously ill patients with coronavirus-related severe respiratory disease, or indeed in other types of severe respiratory disease. In this study, we hope to discover evidence either supporting or opposing the systemic therapeutic administration of glucocorticoids in patients with severe coronavirus disease 2019.

Trial registration:

ClinicalTrials.gov, ChiCTR2000029386, http://www.chictr.org.cn/showproj.aspx?proj=48777.
The Impact of the Theory of Nursing for the Whole Person on the Professional Practice of Nursing School Graduates
Authors: Ward Emma , Swanson Cheryl
Published: March 2020

The Theory of Nursing for the Whole Person (TNWP) is a wholistic theory that focuses on the integration of body, mind, spirit, individual, family, and community. A qualitative descriptive research study explored Oral Roberts University graduates' perceptions of their use of the TNWP in practice. Analysis revealed six major themes. Respondents felt that the TNWP was a necessary tool to truly care for patients.
Biblical Counseling
Authors: Ogorek Denise , Isaacson Janalee
Published: March 2020

Despite use of current standards of care—antidepressant medications and psychotherapy—to treat depressive symptoms, results experienced by patients and reported in the literature have been inconsistent. Religiously integrated cognitive behavioral therapy (RCBT) is an evidence-based alternative to cognitive behavioral therapy. A type of RCBT, biblical counseling is a viable option for patients experiencing depressive symptoms. Nurses need an awareness of biblical counseling as a therapeutic option for patients who are open to spiritually based care for depression.
Preferences to Receive Information about Palliative Care for Adult Patients
Authors: Pittroff Gail , Hendricks-Ferguson Verna
Published: March 2020

This research study aimed to describe preferences about factors related to receiving information regarding medical treatments and palliative care (PC) options for adult patients with a poor prognosis and/or their primary decision maker. A single-group descriptive study design and content analysis were utilized. Seven trained registered nurse (RN) study team members conducted interviews to obtain narrative data. All study participants preferred to learn PC services earlier in the illness trajectory and desired to learn about this service from nurses. Most reported a desire to have spouses and family involved in decisions about PC. Nearly all wanted to understand PC options ahead of time should treatment not go as planned.
CTNNB1 (β-CATENIN) VITREORETINOPATHY: IMAGING CHARACTERISTICS AND SURGICAL MANAGEMENT
Authors: Tipsuriyaporn Boontip , Ammar Michael J. , Yonekawa Yoshihiro
Published: March 2020

Purpose:

We report a patient with CTNNB1-associated vitreoretinopathy. We discuss imaging findings and surgical management.

Methods:

Case report.

Results:

An 18-month-old girl with microcephaly, failure to thrive, developmental delay, and chronic rhinitis presented with bilateral central and peripheral tractional retinal detachments and an anomalous retinal vasculature. She underwent multimodal imaging and genetic testing, and we discuss successful surgical management.

Conclusion:

CTNNB1 mutations can cause a vision-threatening vitreoretinopathy. We recommend CTNNB1 to be considered as part of the workup of patients presenting with familial exudative vitreoretinopathy–like clinical findings, especially if there are systemic manifestations.
Learning mechanisms in nocebo hyperalgesia: the role of conditioning and extinction processes
Authors: Thomaidou Mia Athina , Veldhuijzen Dieuwke Swaantje , Peerdeman Kaya Joanne , Wiebing Naomi Zoë Sifra , Blythe Joseph Sullivan , Evers Andrea Walbruga Maria
Published: March 2020

Nocebo hyperalgesia is a clinically relevant phenomenon and may be formed as a result of associative learning, implemented by classical conditioning. This study explored for the first time distinct nocebo conditioning methods and their consequences for nocebo attenuation methods. Healthy participants (N = 140) were recruited and randomized to the following nocebo hyperalgesia induction groups: conditioning with continuous reinforcement (CRF), conditioning with partial reinforcement (PRF), and a sham-conditioning control group. In the attenuation phase, counterconditioning was compared with extinction. During induction, participants experienced increased thermal pain in 100% of nocebo trials in the CRF groups, while in only 70% of nocebo trials in the PRF groups. During evocation, pain stimulation was equivalent across all trials. During attenuation, pain stimulation was decreased on nocebo trials relative to control trials for the counterconditioning groups, while pain remained equivalent across all trials for the extinction groups. Results showed that both PRF and CRF significantly induced nocebo hyperalgesia, but CRF was a more potent nocebo induction method, as compared to PRF. Counterconditioning was more effective than extinction in attenuating nocebo hyperalgesia. Neither CRF nor PRF resulted in resistance to extinction. However, compared with CRF, conditioning with PRF resulted in more resistance to counterconditioning. These findings demonstrate that the more ambiguous learning method of PRF can induce nocebo hyperalgesia and may potentially explain the treatment resistance and chronification seen in clinical practice. Further research is required to establish whether attenuation with counterconditioning is generalizable to clinical settings.
Relationship between infectious screening and early unconjugated hyperbilirubinemia in well-appearing neonates
Authors: Lo Yu-Cheng , Tsai Wan-Jung , Tsao Pei-Chen , Lee Yu-Sheng
Published: March 2020

Background:

Neonatal hyperbilirubinemia (NH) may be the initial and solitary sign of infectious condition in neonates. This retrospective cohort study aims to evaluate the risk of sepsis or urinary tract infection in well-appearing infants with NH below 7 days old.

Methods:

All neonates (n = 8779) born in Taipei Veterans General Hospital from 2013 to 2017 were evaluated retrospectively. A total of 2523 initially well-appearing babies were admitted because of NH. After being hospitalized, patients were categorized into two groups according to the initial transcutaneous bilirubin (TCB) level. Infectious screening results, which include C-reactive protein (CRP), differential count, blood culture, urinalysis, and urine culture, were analyzed.

Results:

Regarding CRP, 2.7% (18/667) of neonates with NH had elevated CRP (≥1 mg/dL). Among 547 blood cultures, eight were positive, with 0.4% (2/547) non–coagulase-negative staphylococcus (CoNS) bacteremia and 1.1% (6/547) CoNS bacteremia. In urinalysis, 16.6% (182/1094) of NH neonates had pyuria, and 6.7% (25/372) had positive urine cultures. NH with a higher initial TCB level was related to an increased chance of elevated CRP (4.7% vs. 1.5%, odds ratio: 3.29, p = 0.024) and pyuria (20.6% vs. 12.6%, odds ratio: 1.79, p < 0.001). The rate of positive urine culture between the higher and lower TCB groups had no significant difference (6.6% vs. 6.9%, p > 0.99). Significant bacteriuria was more common in NH neonates admitted at later age (>2 days) (4.9% vs. 11.5%, p = 0.035).

Conclusion:

In well-appearing neonates below 7 days old, NH with a higher initial TCB is associated with an increased rate in pyuria and abnormal CRP. No difference was found in the rate of positive urine culture between higher and lower TCB levels. Significant bacteriuria was more common in older NH neonates. Septicemia is rare among well-appearing neonates with NH.
Pneumococcal virulence factors in community-acquired pneumonia
Authors: Feldman Charles , Anderson Ronald
Published: March 2020

Purpose of review

This manuscript reviews the recent literature related to new developments in the understanding of existing and novel virulence factors of the pneumococcus that are of potential importance in the development of novel preventive and therapeutic strategies.

Recent findings

The pneumococcal capsule and pneumolysin have long been recognized as being two of the most prominent virulence factors, with much recent research having revealed previously unrecognized mechanisms by which they contribute to the pathogenesis of infection. Although the pneumococcal capsule has been considered a sine qua non for virulence, the emergence of pathogenic nonencapsulated strains with newly recognized virulence determinants has also been described. Not unexpectedly, but of concern, nonencapsulated strains are unaffected by current pneumococcal vaccines. This, together with the finding of novel virulence factors, as well as new mechanisms of pathogenicity of established virulence determinants, underscores the resilience of the pneumococcus in confronting challenges in its environment, most importantly those posed by antibiotics and vaccines.

Recent advances in the understanding of pneumococcal virulence factors provide potential opportunities for the development of novel putative therapeutic or preventive strategies.
Brain abscess in a patient with psoriatic arthritis treated with adalimumab
Authors: Lo Yu-Pei , Desale Snehal , Wu Po-Yuan
Published: March 2020

Rationale:

In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin.

Patient concerns:

A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra).

Diagnosis:

Brain abscess with odontogenic infection.

Interventions:

The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone.

Outcomes:

A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition.

Lessons:

To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.
The efficacy and toxicity of induction chemotherapy plus concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma
Authors: Wang Peirong , Zhang Mingwei , Ke Chunlin , Cai Chuanshu
Published: March 2020

Background:

A systemic review and meta-analysis of randomized controlled trials (RCTs) was performed to compare the efficacy, toxicity and safety of concurrent chemoradiotherapy (CCRT) with or without induction chemotherapy (IC) for locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods:

Research searching was performed in Web of Science, PubMed, The Cochrane Library, Embase, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, Chongqing VIP Database for Chinese Technical Periodicals and Wanfang Database. RCTs including patients diagnosed with locoregionally advanced NPC without metastasis and randomly treated with IC plus CCRT and CCRT alone were included. Survival and outcome data were extracted and meta-analysis was performed using the Revman 5.3.0 software.

Results:

Ten RCTs (2280 patients) were selected and used for pooled meta-analysis. In comparison with CCRT, IC plus CCRT treatment significantly improved the overall survival (OS; HR = 0.70, 95%CI 0.56–0.87, P = .002), progression-free survival (PFS; HR = 0.75, 95%CI 0.65–0.87, P < .0001), distant metastasis failure-free survival (DMFS; HR = 0.71, 95%CI 0.58–0.85, P = .0003) and loco-regional failure-free survival (LFES; HR = 0.72, 95%CI 0.59–0.88, P = .002) of patients with locoregionally advanced NPC. Patients treated with IC and CCRT had higher incidence of grade 3–4 leucopenia and thrombocytopenia than patients treated with CCRT alone (P < .0001). No significant difference in other grade 3–4 adverse events and radiation toxicity was observed between the two groups. IC combined with CCRT improved the survival of patients with locoregionally advanced NPC.

Conclusions:

Combined IC and CCRT therapy was an efficacy treatment regimen for locoregionally advanced NPC.
Predictive effects of the intercondylar notch morphology on anterior cruciate ligament injury in males
Authors: Huang Mengquan , Li Yubiao , Li Hedan , Liao Chunlai , Xu Haitao , Luo Xiaowei
Published: March 2020

The effects of the intercondylar notch morphology on predicting anterior crucaite ligament (ACL) injury in males were unknown. We aimed to determine the risk factors of the intercondylar notch on ACL injury, and evaluate the predictive effects of the morphological parameters on ACL injury in males. Sixty-one patients with ACL injury and seventy-eight patients with intact ACLs were assigned to the case group and control group respectively. The notch width (NW), bicondylar width, notch width index (NWI), notch height (NH), notch cross-sectional area (CSA), notch angle (NA) and notch shape were obtained from the magnetic resonance images of male patients. Comparisons were performed between the case and control groups. Logistic regression model and the receiver operating characteristic curve were used to assess the predictive effects of these parameters on ACL injury. The NW, NWI, NH, CSA and NA in the case group were significantly smaller than those in the control group on the coronal magnetic resonance images. The NW and NWI were significantly smaller, while no significant differences of the NH and CSA were found between the 2 groups on the axial images. There was no significant difference in the notch shape between the 2 groups. The maximum value of area under the curve calculated by combining all relevant morphological parameters was 0.966. The ACL injury in males was associated with NW, NH, NWI, CSA, and NA. These were good indicators for predicting ACL injury in males.
Predictors of Lymph Node Metastasis and Differences Between Pure and Mixed Histologic Types of Early Gastric Signet-ring Cell Carcinomas
Authors: Chu Yuning , Mao Tao , Li Xiaoyu , Jing Xue , Ren Minghan , Huang Zhen , Zhou Xiao-Bin , Chen Yunqing , Tian Zibin
Published: March 2020

The aim of this study was to investigate predictors of lymph node metastasis (LNM) in early gastric signet-ring cell carcinoma (SRCC) and determine clinicopathologic and prognostic differences of different histologic subtypes. We retrospectively analyzed 13,661 gastric cancer patients; 231 were eligible for inclusion. Data for clinical, endoscopic, and histopathologic characteristics and prognoses were collected. Patients were followed up regarding postresection survival; overall and disease-specific survival rates were estimated by the Kaplan-Meier method with a log-rank test, and prognostic factors were evaluated by Cox regression. LNM incidence in early SRCC was 16.0% (37/231) overall: 6.9% (8/116) and 25.2% (29/115) in patients with pure and mixed SRCC, respectively. Univariate and multivariate analyses revealed SM2 invasion (odds ratio [OR]=5.070, P=0.003), lymphovascular invasion (LVI) (OR=14.876, P<0.001), pathologic pattern of mixed SRCC (OR=3.226, P=0.026), ulcer presence (OR=3.340, P=0.019) and lesion size over 20 mm (OR=2.823, P=0.015) as independent risk factors for LNM. Compared with pure SRCC, the mixed subtype was associated with older age, larger lesion size, higher LVI frequency, more frequent perineural invasion, and most importantly, higher LNM incidence. Patients with pure SRCC showed significantly longer overall survival (P=0.004) and disease-specific survival (P=0.002) than mixed SRCC patients. Pathologic subtype (hazard ratio [HR]=3.682; P=0.047), age (HR=5.246; P=0.001), SM1 invasion (HR=6.192; P=0.023), SM2 invasion (HR=7.529; P=0.021) and LNM (HR=5.352; P<0.001) were independent prognostic factors. Independent risk factors for LNM in early gastric SRCC were SM2 invasion, LVI, pathologic pattern, ulcer presence and lesion size over 20 mm. Early SRCC should be further classified by the purity of the SRC component.
Nonaxial Traction Mechanisms of Nursemaid's Elbow
Authors: Li Natasha , Khoo Bryant , Brown Lance , Young Tim
Published: March 2020

Objective

This study aims to better describe those patients who present with nonaxial traction mechanisms for nursemaid's elbow.

Methods

A retrospective review on patients with the International Statistical Classification of Diseases, Ninth/Tenth Revision, code for nursemaid's elbow was performed. Patients with the classic axial traction mechanism and unknown mechanism were excluded. Demographic information and mechanism of injury were collected, and statistical analysis on this data was performed.

Results

Sixty-nine subjects with a median age of 2.4 years (interquartile range, 1.5–3.6 years) were enrolled. There was no difference in sex or sidedness. The most common mechanisms of injury were fall (57%), direct hit to the elbow (16%), and rolling over (7%). An x-ray was obtained 49% of the time. Reduction was spontaneous 12% of the time and was successfully reduced on the first attempt 87% of the time.

Conclusions

Nursemaid's elbow can occur in children with a reported nonaxial traction mechanism. They may present with history of other trauma, such as a fall, a direct blow to the elbow, or rolling over. For toddlers without the classic axial traction mechanism who refuse to move the elbow but do not have an examination consistent with fracture, it is still reasonable to suspect a nursemaid's elbow.
Point-of-Care Ultrasound for Undifferentiated Abdominal Pain in a Pediatric Patient
Authors: Leviter Julie , Constantine Erika
Published: March 2020

Abdominal pain is a common presentation in the pediatric emergency department and may pose a diagnostic challenge to the physician. Although most abdominal pain is benign, the presence of abdominal pain may represent a surgical emergency. We present an atypical presentation of perforated appendicitis in a child with 2 weeks of abdominal pain, in whom point-of-care ultrasound expedited diagnosis and patient disposition. We then recommend a diagnostic approach for using point-of-care ultrasound in a pediatric patient with undifferentiated abdominal pain.
Amitriptyline Intoxication in Children
Authors: Kamasak Tülay , Kader Şebnem , Mutlu Mehmet , Özkaya Kagan , Erduran Erol , Orhan Fazıl , Dilber Embiya , Kalyoncu Mukaddes , Karagüzel Gülay , Cakır Murat , Bahat Elif , Cansu Ali
Published: March 2020

Background

Amitriptyline ingestion is an important cause of poisoning morbidity and mortality in Turkey and other countries. In contrast to adults, data concerning amitriptyline intoxication in children are limited. The purpose of this study was to investigate amitriptyline intoxication findings in the pediatric population, based on age groups and reported dosages.

Methods

The medical records of 192 patients admitted to the Karadeniz Technical University Medical Faculty Farabi Hospital Pediatric Emergency Department, Turkey, due to amitriptyline intoxication in 1997–2017 were examined retrospectively. Patients were divided into 6 groups based on amitriptyline doses and 4 groups based on age. Complete blood count, blood glucose, serum electrolytes, renal and liver function tests, coagulation tests (prothrombin time and partial thromboplastin time), and blood gas analysis were studied in all patients. Electrocardiography was performed on all children, and chest radiography and electroencephalography on those with respiratory or central nervous system symptoms.

Results

Amitriptyline intoxication was most frequently observed between the ages of 1 and 4 years. The most common signs and symptoms observed at time of hospital admission were lethargy and drowsiness (45.3%), sinus tachycardia (19.2%), and nausea and vomiting (13%). The most common laboratory finding was hyperglycemia (17.7). Six patients were intubated because of respiratory failure, and mechanical ventilation was initiated in these cases. One patient with amitriptyline overdose had persistent supraventricular tachycardia. Four children died due to amitriptyline intoxication.

Conclusions

Tricyclic antidepressant intoxication is a leading cause of mortality and morbidity in children. It is therefore particularly important to identify the clinical and laboratory findings that develop with high-dose consumption.
Impact of Guidelines Regarding Brief Resolved Unexplained Events on Care of Patients in a Pediatric Emergency Department
Authors: Sethi Anchal , Baxi Kesha , Cheng Daphne , Laffey Steven , Hartman Neal , Heller Kayla
Published: March 2020

Objectives

This study aimed to determine if the 2016 clinical practice guidelines regarding brief resolved unexplained events (BRUE) impacted our institutional approach to infants with BRUE. We sought to determine the statement's impact on admission rates, emergency department (ED) length of stay, and return ED visits or readmissions.

Methods

We conducted a retrospective chart review of patients who presented to the ED at a tertiary pediatric hospital from January 2014 to June 2019. Diagnostic workup (laboratory testing, imaging, monitoring) in the ED was recorded. Cohorts of patients presenting pre- and post-2016 guideline were compared using χ2 and t tests. Subanalysis of higher-risk and lower-risk infant groups was also performed.

Results

The demographics of the 2 cohorts were not significantly different. Comparison showed significant reductions in invasive testing after the guideline, both overall (P = 0.005), and specifically regarding comprehensive metabolic panel, blood culture, urine culture, and chest x-ray. Infants meeting higher-risk criteria also showed decreases in invasive testing (P = 0.02). Admission to the hospital and ED lengths of stay decreased in the post–American Academy of Pediatrics statement cohort (P < 0.001 and P = 0.007, respectively). There were no increases in readmissions or repeat ED visits.

Conclusions

This study revealed significant reduction in invasive testing, shorter lengths of ED stays, and lower admission rates at a tertiary care children's hospital after the release of the American Academy of Pediatrics BRUE guideline with no increase in return ED visits or readmissions.
18F-FDG Uptake in a T2 Hypointense Paraspinal Mass
Authors: Singhal Aparna , Adhikari Narendra , de Idiaquez Bakula Diego A. , Sotoudeh Houman
Published: March 2020

We present a paraspinal amyloidoma found incidentally in a 77-year-old man during lymphoma workup by 18F-FDG PET/CT. A solitary FDG-avid paraspinal lesion was seen at T11–T12. MRI showed T2 hypointensity and enhancement. Lymphoma was considered the primary differential due to FDG uptake, but biopsy revealed nodules of extracellular acellular homogeneous material with apple-green birefringence on Congo red stain consistent with amyloidoma. Spinal amyloidoma is rare with few cases reported so far in literature.
Eye Symptoms in a Patient With Prostate Cancer
Authors: Kairemo Kalevi , Kangasmäki Aki , Joensuu Timo , Seregard Stefan
Published: March 2020

A 66-year-old man with castration-resistant prostate cancer was evaluated with 18F–prostate-specific membrane antigen (PSMA) 1007 PET/CT, which revealed extensive PSMA-positive skeletal metastases in the skull, thorax, spine, pelvis, and extremities. He was then treated 177Lu-PSMA-617 therapy. Twenty-four-hour SPECT/CT revealed additional activity not seen with 18F-PSMA adjacent to his left eye. The lesion was biopsied after the first cycle due to pain. This activity was not visible on SPECT/CT after the second treatment cycle, and his eye pain has resolved.
Ectopic Gallbladder Mimicking Choledochal Cyst on Hepatobiliary Scintigraphy
Authors: Zhang Lin , Gaballah Marian , Wen Zhe , Zhuang Hongming
Published: March 2020

The gallbladder is generally located at the anterolaterally situated gallbladder fossa on the undersurface of the liver, whereas choledochal cyst, as a dilation of the common bile duct, is located more posteromedially. We reported an ectopically located gallbladder, which appeared to be a choledochal cyst on hepatobiliary scintigraphy in a 10-year-old girl.
68Ga-FAPI PET/CT Improves Therapeutic Strategy by Detecting a Second Primary Malignancy in a Patient With Rectal Cancer
Authors: Chen Haojun , Zhao Liang , Ruan Dan , Sun Long , Lin Qin
Published: March 2020

A 71-year-old man with pathologically confirmed rectal cancer underwent 18F-FDG PET/CT before radical operation, which showed multiple nodules with low uptake in bilateral pleura and 1 solitary pulmonary nodule with slight uptake in left lung. The subpleural nodule was diagnosed as benign lesion through the biopsy. 68Ga-labeled fibroblast-activation-protein inhibitor PET/CT was performed for further evaluation, which showed low uptake in bilateral subpleural nodules but focally increased uptake in the nodule of left lung. This nodule was found to be a primary lung adenocarcinoma by the CT-guided biopsy. A diagnosis of rectum and lung double primary malignancies was finally made.
Prediction of Conservative Treatment Failure for Isolated Unilateral Mandibular Condylar Fractures Using Quantitative Measures
Authors: Mo Young Woong , Lee Dong Lark
Published: March 2020

Background

Interest in the treatment of mandibular condyle fracture in cases of maxillofacial trauma has been a huge concern for decades because of a diversity of opinions on the topic and the relatively few studies conducted on individuals treated by physiotherapy or rehabilitation with or without intermaxillary fixation (IMF).

Methods

We measured fracture gaps between bone ends over an 8-year period from 2012 to 2019. The study cohort was composed of only conservatively treated patients. This retrospective study was conducted to identify factors that influence treatment failure by comparing a functional treatment (physiotherapy) group with an IMF group in terms of fracture gaps and other variables. In addition, an algorithm was devised to enable clinicians to determine promptly whether IMF is needed for mandibular condylar fractures.

Results

Significant correlations were observed between several parameters and malocclusion. Multiple regression analysis resulted in the following coefficients: 0.072 for fracture gap (P = 0.006) and 0.006 for age (P < 0.05) in functional treatment group. However, in the IMF group, correlations with malocclusion were 0.063 for fracture gap (P = 0.000) and 0.003 for age (P = 0.083).

Conclusions

We proposed a diagnostic algorithm for isolated unilateral mandibular condyle fractures that provides guidance regarding surgical correction. If indications for surgical correction, as regards anatomical location, fracture level, fracture gap between bone ends, and patient cooperability, are not satisfied, clinicians should select IMF or functional treatment (rehabilitation). If the fracture gap is less than 6 mm and the patient is cooperative, functional rehabilitation would be more suitable than IMF.