bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and risk factors for myopia and other refractive errors in an adult population in southern India
Authors: Joseph Sanil , Krishnan Tiruvengada , Ravindran Ravilla D. , Maraini Giovanni , Camparini Monica , Chakravarthy Usha , Ravilla Thulasiraj D. , Hutchings Andrew , Fletcher Astrid E.
Published: March 2018

Purpose

To investigate prevalence and risk factors for myopia, hyperopia and astigmatism in southern India.

Methods

Randomly sampled villages were enumerated to identify people aged ≥40 years. Participants were interviewed for socioeconomic and lifestyle factors and attended a hospital‐based ophthalmic examination including visual acuity measurement and objective and subjective measurement of refractive status. Myopia was defined as spherical equivalent (SE) worse than −0.75 dioptres (D), hyperopia as SE ≥+1D and astigmatism as cylinder <−0.5.

Results

The age‐standardised prevalences of myopia, hyperopia and astigmatism were 35.6% (95% CI: 34.7–36.6), 17.0% (95% CI: 16.3–17.8) and 32.6 (29.3–36.1), respectively. Of those with myopia (n = 1490), 70% had advanced cataract. Of these, 79% had presenting visual acuity (VA) less than 6/18 and after best correction, 44% of these improved to 6/12 or better and 27% remained with VA less than 6/18. In multivariable analyses (excluding patients with advanced cataract), increasing nuclear opacity score, current tobacco use, and increasing height were associated with higher odds of myopia. Higher levels of education were associated with increased odds of myopia in younger people and decreased odds in older people. Increasing time outdoors was associated with myopia only in older people. Increasing age and female gender were associated with hyperopia, and nuclear opacity score, increasing time outdoors, rural residence and current tobacco use with lower odds of hyperopia. After controlling for myopia, factors associated with higher odds of astigmatism were age, rural residence, and increasing nuclear opacity score and increasing education with lower odds.

Conclusions

In contrast to high‐income settings and in agreement with studies from low‐income settings, we found a rise in myopia with increasing age reflecting the high prevalence of advanced cataract.
Mechanical bacterial lysate administration prevents exacerbation in allergic asthmatic children—The EOLIA study
Authors: Emeryk Andrzej , Bartkowiak‐Emeryk Malgorzata , Raus Zbigniew , Braido Fulvio , Ferlazzo Guido , Melioli Giovanni
Published: March 2018

Background

Despite progress in asthma management, prevention of asthma exacerbation remains challenging in school‐aged children with allergic asthma. New therapeutic approaches are needed. Previously, a chemical bacterial lysate has been successfully used in preschool children to reduce wheezing attacks. We assessed the effect of Polyvalent Mechanical Bacterial Lysate (PMBL®) Tablet on asthma clinical course and control in 6‐ to 16‐year‐old children with partly controlled or uncontrolled allergic asthma.

Methods

A randomized, double‐blind, placebo‐controlled, parallel‐group study was performed in 152 patients exhibiting allergic asthma assigned to receive Placebo or PMBL®. Eligible patients underwent four visits during the 9‐month study. Asthma control level was assessed by ACT/C‐ACT score.

Results

The main criterion was not achieved as ACT/C‐ACT changes were similar in both groups at the end of the 3‐month treatment period. However, the mean number (±SD) of asthma exacerbations was significantly lower with PMBL® Tablet than with Placebo at Week 12 (0.3 ± 0.6 vs 0.8 ± 1.1, P = .009) and over the total study period (1.1 ± 1.3 vs 1.9 ± 2.0, P = .01). Consistently, the mean number of days with exacerbation per patient was significantly lower with PMBL® Tablet (13.3 ± 11.2 vs 19.8 ± 15.7 over the whole study, P = .009). Treatment with PMBL® Tablet prolonged the time to second exacerbation by 55% (Hazard Ratio [HR]=0.45; 95% Confidence Interval [CI] 0.27 to 0.77, P = .002) and to third exacerbation by 74% (HR=0.26; 95% CI 0.12 to 0.58, P < .001). No serious adverse event related to PMBL® Tablet administration was recorded.

Conclusion

Administration of PMBL® Tablet represents a safe and effective means for significantly reducing the rate of exacerbations in school‐aged allergic asthmatic children. (EudraCT 2013‐000737‐12 and NCT02541331)
Increasing specific immunoglobulin E levels correlate with the risk of anaphylaxis during an oral food challenge
Authors: Yanagida Noriyuki , Sato Sakura , Takahashi Kyohei , Nagakura Ken‐ichi , Asaumi Tomoyuki , Ogura Kiyotake , Ebisawa Motohiro
Published: March 2018

Background

Oral food challenges (OFCs) are necessary to diagnose food allergies; however, these tests can cause anaphylaxis. Higher specific immunoglobulin E (sIgE) levels to causative food have been associated with a positive OFC. To date, no data have been found to indicate the factors associated with severe symptoms or anaphylaxis among challenge‐positive patients. This study aimed to clarify the association of sIgE with causative foods and anaphylaxis during OFC among the whole study population and challenge‐positive patients.

Methods

This cross‐sectional study collected symptom and severity data between June 2012 and December 2016 during an open OFC to diagnose food allergy or confirm tolerance acquisition. We analyzed the risk factors for anaphylaxis during OFC.

Results

A total of 2272 cases were analyzed (median age: 3.5 years; egg: 1166 cases; milk: 589 cases; wheat: 388 cases; and peanut: 129 cases). Among 979 challenge‐positive patients, anaphylactic reactions were observed in 334 cases. A statistically significant association was observed between anaphylaxis during OFC and higher sIgE levels to causative foods (odds ratio: 2.71, 95% confidence interval: 1.94‐3.78, for the third compared to the first tertile, P‐value for trend <.001). Only gastrointestinal, respiratory, cardiovascular, and neurological symptoms were also statistically significantly associated with higher sIgE levels to causative foods.

Conclusions

The risk of all symptoms, except skin symptoms, during OFCs increased with increasing sIgE levels, and this consequently increased anaphylaxis during OFCs. The mechanism of how sIgE affects the prevalence of gastrointestinal, respiratory, cardiovascular, and neurological symptoms or anaphylaxis is unknown; thus, further study is required.
Lung ultrasound reclassification of chest X‐ray data after pediatric cardiac surgery
Authors: Cantinotti Massimiliano , Ait Ali Lamia , Scalese Marco , Giordano Raffaele , Melo Manuel , Remoli Ettore , Franchi Eliana , Clemente Alberto , Moschetti Riccardo , Festa Pierluigi , Haxiademi Dorela , Gargani Luna
Published: March 2018

Introduction

Lung ultrasound is gaining consensus for the diagnosis of some pulmonary conditions. Pulmonary complications are common in pediatric cardiac surgery. However, its use remains limited in this setting. Our aim was to test the feasibility of lung ultrasound following pediatric cardiac surgery and to compare lung ultrasound and chest X‐ray findings, assessing whether lung ultrasound may provide additional information.

Methods

One hundred and thirty‐eight lung ultrasound examinations were performed in 79 children (median age 9.3 months) at different time points after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) have been evaluated in the upper and lower halves of the chest (for a total of 6 scanning sites per side). Pleural effusion, atelectasis, and the number of B‐lines were investigated.

Results

Lung ultrasound was feasible in all cases in at least 1 of the 3 areas. Feasibility was different for the lateral, posterior, and anterior areas (100%, 90%, and 78%, respectively). The posterior areas were more sensitive than anterior and lateral ones in the diagnosis of effusion/atelectasis. In 81 cases, lung ultrasound allowed reclassification of chest X‐ray findings, including 40 new diagnoses (diagnosis of effusion/atelectasis with negative chest X‐ray reports) and 41 changes in diagnosis (effusions reclassified as atelectasis/severe congestion or vice versa). Although new diagnosis of small‐to‐moderate effusion/atelectasis was of limited clinical value, in 29 cases the new diagnosis changed the therapeutic approach.

Conclusion

Lung ultrasound is feasible and accurate for the diagnosis of common pulmonary conditions after pediatric cardiac surgery, allowing reclassification of chest X‐ray findings in a significant number of patients.
Perioperative management of children with glycogen storage disease type II—Pompe disease
Authors: Bosman Linelot , Hoeks Sanne E. , González Candel Antonia , van den Hout Hannerieke J. M. , van der Ploeg Ans T. , Staals Lonneke M.
Published: March 2018

Background

Pompe disease is a rare metabolic disorder caused by a deficiency of the lysosomal enzyme acid α‐glucosidase. Glycogen accumulation damages skeletal, cardiac, and smooth muscles, causing a progressive and debilitating muscle weakness and cardiomyopathy. As life expectancy has much improved since the introduction of enzyme replacement therapy an increasing number of patients are referred for surgical procedures. Due to the potential cardiopulmonary complications, these patients form a high‐risk group for the anesthesiologist.

Aims

In this study, we investigated the incidence of perioperative complications in children with Pompe disease treated in our hospital since the introduction of enzyme replacement therapy.

Methods

Anesthetic and perioperative data of children with Pompe disease treated between 1999 and 2015 in the Erasmus MC—Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands, were collected, retrospectively.

Results

Of the 65 children with Pompe disease, 34 patients underwent in total 77, mostly low‐risk, surgical procedures. Twenty‐one children had the classic infantile form and 13 had a nonclassic presentation of Pompe disease. In 13 (16.8%) procedures, 1 or more perioperative complications occurred. Perioperative desaturation was the main complication (12.9%), followed by arrhythmia (3.8%) and heart failure requiring diuretic treatment (2.6%). One child died 2 days postoperatively, but this was considered unrelated to the procedure.

Conclusion

Despite the potentially high anesthetic risk for children with Pompe disease under enzyme replacement therapy, the incidence of perioperative complications in our study was relatively low. Our data suggest that with proper precautionary measures and a critical choice of timing of the operation, general anesthesia in children with Pompe disease could be relatively safe nowadays.
The impact of Narcotrend™ EEG‐guided propofol administration on the speed of recovery from pediatric procedural sedation—A randomized controlled trial
Authors: Weber Frank , Walhout Laurence C. , Escher Johanna C.
Published: March 2018

Background

Propofol is often used for procedural sedation in children undergoing gastrointestinal endoscopy. Reliable assessment of the depth of hypnosis during the endoscopic procedure is challenging. Processed electroencephalography using the Narcotrend Index can help titrating propofol to a predefined sedation level.

Aims

The aim of this trial was to investigate the impact of Narcotrend Index‐guided titration of propofol delivery on the speed of recovery.

Methods

Children, aged 12‐17 years, undergoing gastrointestinal endoscopy under procedural sedation, had propofol delivered via target controlled infusion either based on Narcotrend Index guidance (group NI) or standard clinical parameters (group C). Sedation was augmented with remifentanil in both study groups. The primary endpoint of this study was to compare the speed of fulfilling discharge criteria from the operating room between study groups. Major secondary endpoints were propofol consumption, discharge readiness from the recovery room, hypnotic depth as measured by the Narcotrend Index, and adverse events.

Results

Of the 40 children included, data were obtainable from 37. The time until discharge readiness from the operating room was shorter in group NI than in group C, with a difference between medians of 4.76 minutes [95%CI 2.6 to 7.4 minutes]. The same accounts for recovery room discharge times; difference between medians 4.03 minutes [95%CI 0.81 to 7.61 minutes]. Propofol consumption and the percentage of EEG traces indicating oversedation were higher in group C than in group NI. There were no significant adverse events in either study group.

Conclusion

Narcotrend Index guidance of propofol delivery for deep sedation in children aged 12‐17 years, underdoing gastrointestinal endoscopy results in faster recovery, less drug consumption, and fewer episodes of oversedation than dosing propofol according to clinical surrogate parameters of depth of hypnosis. The results of this study provide additional evidence in favor of the safety profile of propofol/remifentanil for procedural sedation in adequately selected pediatric patients.
Severe postintubation tracheobronchial rupture
Authors: Vedovati Sergio , Consonni Francesco , Nacoti Mirco , Bonanomi Ezio
Published: March 2018

Tracheal injury is a rare complication after pediatric intubation. The choice of treatment depends on the size of the lesion and on the underlying disease. We present a complex case of severe tracheal injury treated with success with tracheal stent positioning.
A red cell preservation strategy reduces postoperative transfusions in pediatric heart surgery patients
Authors: Nathan Meena , Tishler Brielle , Gauvreau Kimberlee , Matte Gregory S. , Howe Robert J. , Durham Linda , Boyle Sharon , Mathieu Derek , Fynn‐Thompson Francis , DiNardo James A. , Ibla Juan C.
Published: March 2018

Background

Blood transfusion has well‐documented adverse effects. As part of a blood conservation initiative at our center, we began routine use of cell saver for all congenital heart surgery performed on cardiopulmonary bypass since 2014.

Aims

This study aimed to compare transfusion rates prior to, and in the first and second year after this initiative. We hypothesized that cell saver use would decrease transfusion requirements in second year after use of the cell saver compared to the pre cell saver group.

Methods

Consecutive patients under 18 years undergoing congenital heart surgery on cardiopulmonary bypass were retrospectively analyzed as 3 one‐year cohorts defined above. We excluded patients who required mechanical support or reoperation at index admission. Baseline characteristics, and use of blood intraoperatively and postoperatively were compared between groups.

Results

The 3 groups had similar baseline characteristics. Blood use was significantly lower in year 2 after cell saver initiation as compared to the pre cell saver group both intra‐ and postoperatively. The median difference in volume of intraoperative blood transfusion was lower by 138 mL/m2 (−266, −10 mL/m2) in year 2 when compared to the pre cell saver group. Similarly, the proportion of subjects requiring red blood cell transfusion postoperatively on day of surgery was lower by 10% (−15%, −6%).

Conclusion

Standardized use of cell saver significantly decreased perioperative blood use in children undergoing cardiac surgery at our center. A risk‐adjusted transfusion threshold for children undergoing heart surgery needs to be developed to further decrease exposure to blood products and associated costs.
Butler's Stone
Authors: Tilley John J.
Published: March 2018

In the eleventh of Joseph Butler's Fifteen Sermons we find his best‐known argument against psychological hedonism. Elliott Sober calls that argument Butler's stone, and famously challenges it. I consider whether Butler's stone has value. In doing so I examine, and reject, two possible responses to Sober's objection. This involves, in part, discussing Lord Kames's version of the stone argument, which has hitherto escaped scholarly attention. Finally, I explain an important value of Butler's stone, which I have not found previously discussed. Butler's stone blocks an inference, persuasive to many people, which purports to show that we intrinsically desire only pleasure.
Narrative insight in psychosis: The relationship with spiritual and religious explanatory frameworks
Authors: Marriott Michael R. , Thompson Andrew R. , Cockshutt Graham , Rowse Georgina
Published: March 2018

Objective

When considering psychosis, the concept of narrative insight has been offered as an alternative to clinical insight in determining individuals’ responses to their difficulties, as it allows for a more holistic and person‐centred framework to be embraced within professional practice. This study aims to explore the validity of the narrative insight construct within a group of people who have experienced psychosis.

Design

Inductive qualitative methods were used to explore how eight participants utilized spiritual or religious explanatory frameworks for their experiences of psychosis and to consider these in relation to the construct of narrative insight.

Methods

Semi‐structured interviews were undertaken with individuals who identified themselves as interested in spiritual or religious ideas and whose self‐reported experiences which were identified as akin to psychosis by experienced academic clinicians. Transcriptions from these interviews were subject to interpretative phenomenological analysis within a broader research question; a selection of themes and data from the resultant phenomenological structure are explored here for their relevance to narrative insight.

Results

Participants discussed spiritual and biological explanations for their experiences and were able to hold alternative potential explanations alongside each other. They were reflective regarding the origins of their explanations and would describe a process of testing and proof in relation to them.

Conclusions

These findings suggest that the narrative insight construct has the potential to be a valid approach to understanding experiences of psychosis, and challenge the dominance of the clinical insight construct within clinical practice.

Practitioner points

Clinicians should value the explanatory framework for experiences which are provided by individuals experiencing psychosis, and encourage them to develop a framework which is coherent to their own world view rather than predominantly pursuing a biomedical explanation.

Assessments of psychosis should be adapted to include an understanding of the cohesiveness of the individual's explanatory framework and personal value to them, with a reduced focus on their acceptance of biomedical models of ‘illness’.

Care and care research for individuals experiencing psychosis should consider the value of narrative insight within future developments.
Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive–compulsive disorder, major depressive disorder, or borderline personality disorder
Authors: Didonna Fabrizio , Rossi Roberta , Ferrari Clarissa , Iani Luca , Pedrini Laura , Rossi Nicoletta , Xodo Erica , Lanfredi Mariangela
Published: March 2018

Objectives

To explore differences in mindfulness facets among patients with a diagnosis of either obsessive–compulsive disorder (OCD), major depressive disorder (MDD), or borderline personality disorder (BPD), and healthy controls (HC), and their associations with clinical features.

Design and method

One hundred and fifty‐three patients and 50 HC underwent a clinical assessment including measures of mindfulness (Five Facets Mindfulness Questionnaire – FFMQ), psychopathological symptoms (Symptom Check List‐90‐R), dissociation (Dissociative Experience Scale), alexithymia (Alexithymia Scale 20), and depression (Beck Depression Inventory‐II). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were performed to assess differences in mindfulness scores and their associations with clinical features.

Results

The three diagnostic groups scored lower on all mindfulness facets (apart from FFMQobserving) compared to the HC group. OCD group had a significant higher FFMQ total score (FFMQ‐TS) and FFMQacting with awareness compared to the BPD group, and scored higher on FFMQdescribing compared to BPD and MDD groups. The scores in non‐judging facet were significantly lower in all the three diagnostic groups compared to the HC group. Interestingly, higher FFMQ‐TS was inversely related to all psychological measures, regardless of diagnostic group.

Conclusions

Deficits in mindfulness skills were present in all diagnostic groups. Furthermore, we found disease‐specific relationships between some mindfulness facets and specific psychological variables. Clinical implications are discussed.

Practitioner points

The study showed deficits in mindfulness scores in all diagnostic groups compared to a healthy control group.

Overall, mindfulness construct has a significantly negative association with indexes of global distress, dissociative symptoms, alexithymia, and depression.

Mindfulness‐based interventions in clinical settings should take into account different patterns of mindfulness skills and their impact on disease‐specific maladaptive cognitive strategies or symptomatology.
Quantitative trait loci mapping of forage stover quality traits in six mapping populations derived from European elite maize germplasm
Authors: Leng Pengfei , Ouzunova Milena , Landbeck Matthias , Wenzel Gerhard , Eder Joachim , Darnhofer Birte , Lübberstedt Thomas
Published: March 2018

Four forage maize stover quality traits were analysed including in vitro digestibility of organic matter (IVDOM), neutral detergent fibre (NDF), water‐soluble carbohydrates (WSC) and digestibility of NDF (DNDF). We mapped quantitative trait loci (QTL) in three DH (doubled haploid) populations (totally 250–720 DH lines): one RIL population (358 lines) and two testcross (TC) populations, based on field phenotyping at multiple locations and years for each. High phenotypic and genotypic correlations were found for all traits and significant (p < .01) at two locations, and NDF was negatively correlated with the other traits. QTL analyses were conducted by composite interval mapping. A total of 33, 23, 32 and 25 QTL were identified for IVDOM, NDF, WSC and DNDF, respectively, with three, four, five and two major QTL for each. Few consistent QTL for IVDOM, WSC and DNDF were detected in more than two populations. This study contributed to the identification of key QTL associated with forage maize digestibility traits and is beneficial for marker‐assisted breeding and fine mapping of candidate genes associated with forage maize quality.
Reduced root cortical burden improves growth and grain yield under low phosphorus availability in maize
Authors: Galindo‐Castañeda Tania , Brown Kathleen M. , Lynch Jonathan P.
Published: March 2018

Root phenes and phene states that reduce the metabolic cost of soil exploration may improve plant growth under low phosphorus availability. We tested the hypothesis that under low phosphorus, reduced living cortical area (LCA) would increase soil exploration, phosphorus capture, biomass, and grain yield. Maize genotypes contrasting in LCA were grown in the field and in greenhouse mesocosms under optimal and suboptimal phosphorus regimes. Percent LCA in nodal roots ranged from 25% to 67%. Plants with 0.2 mm2 less LCA under low phosphorus had 75% less root segment respiration, 54% less root phosphorus content, rooted 20 cm deeper, allocated up to four times more roots between 60 and 120 cm depth, had between 20% and 150% more biomass, 35–40% greater leaf phosphorus content, and 60% greater grain yield compared with plants with high LCA. Low‐LCA plants had up to 55% less arbuscular mycorrhizal colonization in axial roots, but this decrease was not correlated with biomass or phosphorus content. The LCA components cortical cell file number and cortical cell size were important for biomass and phosphorus content under low phosphorus. These results are consistent with the hypothesis that root phenes that decrease the metabolic cost of soil exploration are adaptive under phosphorus stress.
Arabidopsis thaliana Raf22 protein kinase maintains growth capacity during postgerminative growth arrest under stress
Authors: Hwang Jae‐Ung , Yim Sojeong , Do Thanh Ha Thi , Kang Joohyun , Lee Youngsook
Published: March 2018

When seeds are exposed to drought and salinity during germination, newly germinated embryos stop growth and enter a quiescent state called postgerminative growth (PGG) arrest. PGG arrest protects embryos from the stress, but it is not known how PGG is restored from the arrest when stress is eased. In this study, we show that under stress‐ or abscisic acid‐induced PGG arrest conditions, Arabidopsis thaliana Raf‐type protein kinase 22 (AtRaf22) overexpression accelerated photoautotrophic seedling establishment, whereas atraf22 knockout mutations enhanced the arrest. Furthermore, when the stress intensity was reduced subsequently, AtRaf22 overexpression plants resumed growth and accomplished photoautotrophic transition much faster than the knockout or wild‐type plants. These results suggest that AtRaf22 activity is important for maintaining growth capacity during stress‐induced PGG arrest, which is most likely critical for competitive growth when the stress subsides and plants resume growth. Such a factor has not been reported before.
Burnlike scars: A sign suggestive of KLHL24‐related epidermolysis bullosa simplex
Authors: Alkhalifah Azzam , Chiaverini Christine , Charlesworth Alexandra , Has Cristina , Lacour Jean‐Philippe
Published: March 2018

Epidermolysis bullosa simplex is a group of inherited disorders with allelic and locus heterogeneity in which skin fragility and blistering within the skin occur. Mutations in KRT5 and KRT14 underlie the majority of reported cases. Mutations in KLHL24, a gene that encodes KLHL24 protein, have been reported recently to cause a generalized subtype of epidermolysis bullosa simplex, presumably by increasing the degradation of keratin 14. We describe a case of KLHL24‐related epidermolysis bullosa simplex and highlight the burn‐like pattern of scars.
Familial papular epidermal nevus with “skyline” basal cell layer
Authors: Beteta‐Gorriti Valia , de Dios‐Velázquez Álvaro , Yuste Manuela , Santos‐Briz Ángel , Román‐Curto Concepción , Cañueto Javier
Published: March 2018

Papular epidermal nevus with “skyline” basal cell layer is a variant of keratinocytic nevus that usually occurs sporadically but may affect different family members. We report on the fourth family with papular epidermal nevus with “skyline” basal cell layer affecting a 3‐month‐old girl and her father.
Use of a disposable ear speculum: An alternative technique for molluscum contagiosum curettage
Authors: Kelly Virginie , Coulombe Jerome , Lavoie Isabelle
Published: March 2018

Molluscum contagiosum is a common contagious disease in children characterized by small skin‐colored umbilicated papules. Although spontaneous resolution is common, many parents and patients seek treatment. Multiple therapeutic modalities have been described. We present an easy, safe, caregiver‐friendly, modified curettage technique using an ear speculum.
Exogenous Cushing syndrome from an unexpected source of systemic steroids
Authors: O'Brien Kathleen F. , DeKlotz Cynthia Marie Carver , Silverman Robert A.
Published: March 2018

A 12‐year‐old Hispanic boy with chronic atopic dermatitis and cushingoid features presented to our institution. He was being treated with an unknown quantity of oral prednisolone 15 mg/5 mL, equivalent to 70 mg/m2/d of oral prednisone, purchased over the counter in El Salvador. Systemic corticosteroids are not recommended for chronic therapy of atopic dermatitis because of their significant adverse effects. Foreign‐sourced pharmaceuticals account for almost half of the drugs consumed in the United States, which means that, to protect our patients, medical providers must inquire about and report unsafe medications deemed legal outside the United States to the Food and Drug Administration.
Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application: A treatment option for pediatric cutaneous leishmaniasis
Authors: Hilerowicz Yuval , Koren Amir , Mashiah Jacob , Katz Oren , Sprecher Eli , Artzi Ofir
Published: March 2018

Background

Leishmaniasis is a protozoan zoonotic parasitic infection with cutaneous, mucocutaneous, and visceral manifestations. Israel is endemic for cutaneous leishmaniasis, which is a self‐limited disease but is associated with scarring, which is often a source of psychological and social burden for patients. Scars can be especially devastating for children and teenagers. A wide range of physical and medical approaches is used to treat cutaneous leishmaniasis, among which intralesional injections of sodium stibogluconate rank among the most frequently used. Unfortunately, despite being effective, this therapeutic modality can be very painful. Fractional ablative laser creates a controlled mesh‐like pattern of tissue ablation in the skin that promotes dermal remodeling and collagen production while at the same time facilitating enhanced delivery of topically applied medications.

Methods

Patients were treated with fractional ablative carbon dioxide laser followed by immediate topical application of sodium stibogluconate. All children were diagnosed with cutaneous leishmaniasis prior to treatment initiation..

Results

Ten children were treated. One leishmania tropica‐positive girl failed to respond. The other nine patients achieved clinical cure and demonstrated good to excellent final cosmesis. Self‐rated patient satisfaction and tolerance were high No adverse effects were observed or reported during treatment.

Conclusion

Fractional ablative carbon dioxide laser followed by topical sodium stibogluconate application appears to be a safe and promising treatment for cutaneous leishmaniasis infection in children. Future controlled studies are required to validate these findings and compare this technique with traditional approaches.
Mohs micrographic surgery for cutaneous malignancies: A focus review of its indications in pediatric age groups
Authors: Le Stephanie T. , Kamal Heba Y. , Khachemoune Amor
Published: March 2018

Mohs micrographic surgery (MMS) is a highly specialized technique that has been successful in the treatment of a variety of skin tumors. The technique can be performed as an outpatient procedure and encompasses surgical excision and intraoperative assessment of tumor margins in one setting by the same physician. The process ensures precise margin control with maximal preservation of healthy tissues. Mohs micrographic surgery has been practiced worldwide, including in the United States, Europe (United Kingdom, Germany, Spain, Netherlands, Switzerland), and Australia. Although it is commonly performed in adults with greater success, it has been discussed less frequently in children. In this article, we describe several cutaneous tumors in children and the role of Mohs micrographic surgery in their management. A PubMed search was conducted to review the most common cutaneous tumors in children treated using Mohs micrographic surgery. In this review, we discuss indications for Mohs micrographic surgery and pertinent studies examining success rates in children. Mohs micrographic surgery has been used to treat several tumors in children and offers the advantage of high cure rates and tissue conservation. This report emphasizes the benefits of Mohs micrographic surgery in children and highlights several cutaneous tumors for which it has been used to treat successfully.
Planar xanthomas secondary to post‐transplantation cholangiopathy in a 16‐month‐old boy
Authors: Patel Nirali , Norberg Adam , Hogeling Marcia
Published: March 2018

Planar xanthomas in children represent rare dermatologic findings associated with abnormalities in lipid metabolism. While planar xanthomas in Alagille's syndrome have been well described in the literature, there have been no cases reported of eruptive xanthomas in pediatric liver transplant patients. Herein we report a case of a 16‐month‐old boy status post–liver transplantation who presents with planar xanthomas secondary to cholangiopathy. A brief review of xanthomas and the related literature is also provided.
Neutrophilic urticarial dermatosis as a presenting feature of systemic juvenile idiopathic arthritis
Authors: Stringer Thomas , Gittler Julia , Meehan Shane , Kahn Philip , Oza Vikash S.
Published: March 2018

This report describes a case of chronic neutrophilic urticarial dermatosis as a presenting feature of systemic juvenile idiopathic arthritis. When encountered in children, neutrophilic urticarial dermatosis should raise suspicion of autoimmune or autoinflammatory disease.
Hidradenitis suppurativa in children: The Henry Ford experience
Authors: Braunberger Taylor L. , Nicholson Cynthia L. , Gold Lauren , Nahhas Amanda F. , Jacobsen Gordon , Parks‐Miller Angela , Hamzavi Iltefat H.
Published: March 2018

Background

Although recent hidradenitis suppurativa studies have shown that early‐onset disease is associated with a positive family history and more widespread disease, research in pediatric hidradenitis suppurativa is limited.

Methods

Thirty‐three children diagnosed with hidradenitis suppurativa during an 18‐month period were included in this institutional review board–approved, retrospective chart review. Information on demographic characteristic, family history, and timing of onset (prepubescent vs postpubescent) was extracted. The Fisher exact test, Cochran‐Armitage exact trend test, and chi‐square test were used to examine the association between prepubescent or postpubescent onset of hidradenitis suppurativa and sex, disease severity, and family history.

Results

A significantly higher percentage of patients with postpubescent onset were female (85.7%) than male (14.3%), whereas those with prepubescent onset were more likely to be male (58.3%) than female (41.7%; P = .02). Associations between disease onset and positive family history of hidradenitis suppurativa (P = .47) or higher Hurley stage of disease (P = .15) were not statistically significant.

Conclusion

Boys are more likely to have prepubescent onset of hidradenitis suppurativa and girls to have postpubescent onset. This shift in sex distribution is unexplained, but we hypothesize that, whereas the role of ovarian hormones in the pathogenesis of HS may underlie much of adult‐onset disease, it is less important in prepubescent disease.
Unilateral hypertrophy of the labia minora: A case series
Authors: Boulos Scarlett , Rubin Adam I. , Yan Albert C. , McMahon Patrick J. , Perman Marissa J.
Published: March 2018

Asymmetric hypertrophy of the labia minora is a variant of normal anatomy that has not been described in the pediatric dermatology literature. Although often asymptomatic, in some cases, it can cause functional, emotional, and psychological problems. We report the clinical characteristics and outcomes of four children who presented with unilateral labium minus hypertrophy. This case series aims to establish awareness of this condition among pediatric dermatologists and provide recommendations regarding management.
Maximum QTc on Holter electrocardiography in children
Authors: Ogawa Yoshiharu , Tanaka Toshikatsu , Kido Sachiko
Published: March 2018

Background

Corrected QT interval (QTc) on electrocardiography (ECG) at rest and after exercise in a short daytime recording period may be insufficient for the diagnosis and management of long QT syndrome (LQTS), especially for LQTS type 2 and 3. Therefore, examination of QTc on Holter ECG is important. We designed a method of analyzing QTc on Holter ECG that can be performed in daily clinical practice by combining automatic and manual measurements.

Methods

We reviewed the charts of healthy children (n = 210) and LQTS patients (n = 35) aged <16 years and analyzed QTc at rest and after exercise, and the maximum QTc on Holter ECG.

Results

The QTc (Fridericia's correction) of most controls and LQTS patients reached the maximum at night or early in the morning. QTc differed according to sex and age. In the control group, QTc on ECG of all three types tended to lengthen with age. QTc after exercise was slightly longer than QTc at rest, and the maximum QTc on Holter ECG was much longer than both, reaching >450 ms in boys and 500 ms in girls. In most LQTS type 1 patients, QTc after exercise and that on Holter ECG tended to be long. In most LQTS type 2 and 3 patients, QTc at rest and that after exercise was long, and that on Holter ECG tended to be much longer.

Conclusions

The present method of analyzing QTc on Holter ECG, in which automatic and manual measurements are combined, is practical and may be useful for diagnosis and risk stratification of LQTS.
Prolonged T‐wave peak–end interval in Down syndrome patients with congenitally normal hearts
Authors: Küçük Mehmet , Karadeniz Cem , Ozdemir Rahmi , Meşe Timur
Published: March 2018

Background

Heterogeneity of ventricular repolarization has been assessed using the QT dispersion in Down syndrome (DS) patients with congenitally normal hearts. Novel repolarization indexes, that is, T‐wave peak–end (Tp‐e) interval and Tp‐e/QT ratio, however, have not previously been evaluated in these patients. The aim of this study was therefore to evaluate the Tp‐e interval and Tp‐e/QT ratio in DS patients without congenital heart defects.

Methods

Tp‐e interval, Tp‐e dispersion, and Tp‐e/QT ratio were compared between 160 DS patients and 110 age‐ and sex‐matched healthy controls on 12‐lead surface electrocardiogram.

Results

Heart rate, Tp‐e interval, Tp‐e dispersion, Tp‐e/QT and Tp‐e/QTc ratios were significantly higher in the DS group than the control group.

Conclusion

Myocardial repolarization indexes in DS patients with congenitally normal hearts were found to be prolonged compared with those in normal controls. Further evaluation is warranted to elucidate the relationship between prolonged repolarization indexes and arrhythmic events in these patients.
Long‐term renal tubular damage in intrauterine growth‐restricted rats
Authors: Murano Yayoi , Shoji Hiromichi , Hara Taichi , Ikeda Naho , Endo Amane , Nishizaki Naoto , Shimizu Toshiaki
Published: March 2018

Background

Intrauterine growth restriction (IUGR) has been shown to be associated with increased risk of renal disease or hypertension in later life. Glomerular dysfunction, however, has mainly been reported, and limited information is available to link IUGR with renal tubular damage. The aim of this study was therefore to investigate urinary markers of tubular damage in a rat model of IUGR induced by bilateral uterine artery ligation.

Methods

Pregnant Sprague–Dawley rats underwent bilateral uterine artery ligation, while the control group underwent sham surgery.

Results

Birthweight was reduced, and urinary β2‐microglobulin (β2‐MG)‐, cystatin C (Cys‐C)‐, and calbindin‐to‐creatinine ratios were significantly higher at weeks 4 and 8 in the IUGR group compared with the control group. These urinary markers were not significantly different at week 16 between the two groups. Increased excretion of urinary β2‐MG, Cys‐C, and calbindin was observed in IUGR rats at ≥8 weeks of age.

Conclusion

Children born with IUGR are at increased risk for renal tubular damage.
Physical activity experiences in children post–liver transplant: Developing a foundation for rehabilitation interventions
Authors: Patterson Catherine , So Stephanie , DeAngelis Maria , Ghent Emily , Southmayd Degen , Carpenter Christine
Published: March 2018

Physical Activity (PA) plays an important role in the physical and psychosocial health of children and is beneficial in the treatment and prevention of comorbidities associated with transplantation. Despite this, PA participation in pediatric liver transplant recipients remains low compared to healthy peers. This qualitative‐focused mixed‐methods study explored the PA experiences and parental perception of these experiences, including perceived facilitators and barriers to PA in children post–liver transplant. Eighteen participants (9 children [median age 10.8 years] and 9 parents) took part in semi‐structured interviews and completed the PedsQL Multidimensional Fatigue Scale and PAQ. Most children reported they were physically active (PAQ median 3.08 [IQR] 2.60‐3.51), participating in PA for its enjoyment, regardless of their level of motor proficiency. Levels of fatigue (median 65.28 [IQR] 56.25‐90.97) were higher than healthy norms and impacted PA participation in some children. Children and parents perceived PA as central to post‐transplant recovery and valued its social and mental health benefits; however, parents struggled with ongoing uncertainty and perceived physical vulnerability of their child. This study indicates the need for continuing PA support and education and provides valuable information for family‐centered interventions to increase PA and improve health outcomes in children post‐transplant.
Phylogenetic clustering of wingbeat frequency and flight‐associated morphometrics across insect orders
Authors: Tercel Maximillian P. T. G. , Veronesi Fabio , Pope Tom W.
Published: March 2018

Wingbeat frequency in insects is an important variable in aerodynamic and energetic analyses of insect flight and often is studied on a family‐ or species‐level basis. Meta‐analyses of these studies report order‐level patterns suggesting that flight strategy is moderately well conserved phylogenetically. Studies incorporated into these meta‐analyses, however, use variable methodologies across different temperatures, which may confound results and phylogenetic patterns. In the present study, a high‐speed camera is used to measure wingbeat frequency in a wide variety of species (n = 102) under controlled conditions aiming (i) to determine the validity of previous meta‐analyses showing phylogenetic clustering of flight strategy and (ii) to identify new evolutionary patterns between wingbeat frequency, body mass, wing area, wing length and wing loading at the order level. All flight‐associated morphometrics significantly affect wingbeat frequency. Linear models show that wing area explains the most amount of variation in wingbeat frequency (r2 = 0.59, P ≤ 0.001), whereas body mass explains the least (r2 = 0.09, P ≤ 0.01). A multiple regression model incorporating both body mass and wing area is the best overall predictor of wingbeat frequency (r2 = 0.84, P ≤ 0.001). Order‐level phylogenetic patterns across relationships are consistent with previous studies. Thus, the present study provides experimental validation of previous meta‐analyses and provides new insights into phylogenetically conserved flight strategies across insect orders.
Comparison of pre‐ and post‐transplant sun‐safe behavior of kidney transplant recipients: What is needed to improve?
Authors: Gellén Emese , Papp Bence G. , Janka Eszter A. , Gáll Tibor , Paragh György , Emri Gabriella , Nemes Balázs , Remenyik Éva
Published: March 2018

Background

The role of sun exposure in the development of melanoma and nonmelanoma skin cancers is known; however, there are limited data on the contribution of pretransplantation total sun burden (TSB) to the increased skin cancer risk in organ transplant recipients (OTRs). The importance of patient education about sun‐safe behaviors is understood, but educations are often unsuccessful in OTRs.

Methods

A questionnaire‐based cross‐sectional study was performed with kidney transplant patients at a single academic center to assess the pre‐ and post‐transplant sun exposure, sun protection habits, and skin cancers.

Results

Two hundred and twenty‐one patients participated in the study. 13.1% developed at least one skin cancer. High total sun burden before transplantation was reported by 58.4%, and 65.2% reported education about increased skin cancer risk at the time of transplantation. However, that education did not lead to less sun exposure or better sun protection methods after transplantation. Overall, OTR related but not sun protection‐guided lifestyle changes affecting OTRs after transplantation led to reduction in sun exposure.

Conclusion

Our findings highlight the need for more tailored, population‐specific education programmes, even for patients who expect to receive a transplant in the future, and suggest the importance of pretransplantation TSB in determining the post‐transplant skin cancer risk.
Modulation of human dendritic cell activity by Giardia and helminth antigens
Authors: Summan A. , Nejsum P. , Williams A. R.
Published: March 2018

Giardia duodenalis is a common intestinal protozoan parasite known to modulate host immune responses, including dendritic cell (DC) function. Coinfections of intestinal pathogens are common, and thus, DCs may be concurrently exposed to antigens from multiple parasites. Here, we investigated the effects of G. duodenalis products on human monocyte‐derived DC function independently and in combination with helminth antigens (Ascaris suum and Trichuris suis). All antigens individually induced an anti‐inflammatory phenotype in DCs, reducing lipopolysaccharide (LPS)‐induced interleukin (IL)‐6, IL‐12p70 and tumour necrosis factor (TNF)‐α secretion. G. duodenalis and T. suis products also consistently upregulated IL‐10 production. Despite a similar modulation of cytokine secretion, additive effects between Giardia and helminth products were not observed, indicating a dominant effect of a single parasite stimulus and limited interactive effects on DC function. G. duodenalis trophozoites induced rapid apoptosis in DCs, which was not observed with the helminth antigens suggesting that the modulatory effects of G. duodenalis may override that of A. suum and T. suis. Thus, G. duodenalis modulates DC activity by modulating cytokine secretion and/or inducing apoptosis, which may be a parasite‐driven mechanism to dampen host immunity and establish chronic infections. The differential mechanisms of DC modulation by intestinal parasites warrant further attention.
A lesion categorized between ghost cell odontogenic carcinoma and dentinogenic ghost cell tumor with CTNNB1 mutation
Authors: Ohata Yae , Kayamori Kou , Yukimori Akane , Sumikura Kanako , Ohsako Toshimitsu , Harada Hiroyuki , Sakamoto Kei , Ikeda Tohru
Published: March 2018

Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm characterized by the presence of ghost cells. It is considered to arise either de novo or from a preexisting benign precursor, calcifying odontogenic cyst (COC), or dentinogenic ghost cell tumor (DGCT). We report a case of a 44‐year‐old Japanese male with a left maxillary tumor. The patient received treatment to resect the left maxillary cyst 25 years prior; however, the details were uncertain. The tumor was resected with clear margins. Taken together with the results of histological and immunohistochemical examinations, the tumor was categorized between GCOC and DGCT, and we diagnosed the tumor as GCOC suggesting similarity to DGCT. Further, we focused on CTNNB1, which encodes β‐catenin and is frequently mutated in COCs. In this tumor, we identified CTNNB1 Ser33Cys, one of the mutations typically found in COCs. This finding suggests that CTNNB1 is a common target for the pathogenesis of tumors accompanied by ghost cells.