bluuebunny/crossref_metadata_2025_split huggingface dataset:
Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics
Authors: Chiappini Elena , Ciarcià Martina , Bortone Barbara , Doria Mattia , Becherucci Paolo , Marseglia Gian Luigi , Motisi Marco Antonio , de Martino Maurizio , Galli Luisa , Licari Amelia , De Masi Salvatore , Lubrano Riccardo , Bettinelli Maria , Vicini Claudio , Felisati Giovanni , Villani Alberto , Marchisio Paola 
Published: December 2019

Background:
In recent years, new progress has been made regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society therefore decided to issue an update to the previous guidelines published in 2010.

Methods:
Literature searches were conducted on MEDLINE by Pubmed, including studies in children, in English or Italian, published between January 1, 2010, and December 31, 2018. The quality of the included studies was assessed using the grading of recommendations, assessment, development and evaluations (GRADE) methodology. In particular, the quality of the systematic reviews was evaluated using the AMSTAR 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts.

Results:
The diagnosis of AOM is based on acute clinical symptoms and otoscopic evidence; alternatively, the presence of otorrhea associated with spontaneous tympanic membrane perforation allows the AOM diagnosis. The diagnosis of AOM must be certain and the use of a pneumatic otoscope is of fundamental importance. As an alternative to the pneumatic otoscope, pediatricians can use a static otoscope and a tympanometer. To objectively establish the severity of the episode for the formulation of a correct treatment program, an AOM severity scoring system taking into account clinical signs and otoscopic findings was developed.

Conclusions:
The diagnosis of AOM is clinical and requires the introduction of specific medical training programs. The use of pneumatic otoscopes must be promoted, as they are not sufficiently commonly used in routine practice in Italy.
Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics
Authors: Marchisio Paola , Galli Luisa , Bortone Barbara , Ciarcià Martina , Antonio Motisi Marco , Novelli Andrea , Pinto Luciano , Bottero Sergio , Pignataro Lorenzo , Piacentini Giorgio , Mattina Roberto , Cutrera Renato , Varicchio Attilio , Luigi Marseglia Gian , Villani Alberto , Chiappini Elena 
Published: December 2019

Background:
New insights into the diagnosis, treatment and prevention of acute otitis media (AOM) have been gained in recent years. For this reason, the Italian Paediatric Society has updated its 2010 guidelines.

Methods:
A literature search was carried out on PubMed. Only pediatric studies published between January 1, 2010 and December 31, 2018 in English or Italian were included. Each included study was assessed according to the GRADE methodology. The quality of the systematic reviews was assessed using AMSTAR 2. The recommendations were formulated by a multidisciplinary panel of experts.

Results:
Prompt antibiotic treatment is recommended for children with otorrhea, intracranial complications and/or a history of recurrence and for children under the age of 6 months. For children 6 months to 2 years of age, prompt antibiotic treatment is recommended for all forms of unilateral and bilateral AOM, whether mild or severe. Prompt antibiotic treatment is also recommended for children over 2 years with severe bilateral AOM. A watchful-waiting approach can be applied to children over 2 years with mild or severe unilateral AOM or mild bilateral AOM. High doses of amoxicillin, or amoxicillin-clavulanic acid for patients with a high risk of infection by Beta-lactamase producing strains, remain the first-line antibiotics.

Conclusions:
AOM should be managed on a case-by-case basis that takes account of the child’s age, the severity of the episode and whether it is unilateral or bilateral. In patients under 2 years, prompt antibiotic treatment is always recommended.
Characterization of Circulating Clostridium difficile Strains, Host Response and Intestinal Microbiome in Hospitalized Children With Diarrhea
Authors: Lees Emily Ann , Carrol Enitan D. , Ellaby Nicholas A. F. , Roberts Paul , Corless Caroline E. , Lenzi Luca , Darby Alistair , O’Brien Sarah J. , Cunliffe Nigel A. , Turner Mark A. , Miyajima Fabio , Pirmohamed Munir 
Published: December 2019

Background:

Clostridium difficile is capable of causing severe enterocolitis in adults. The significance of toxin-producing C. difficile in children with diarrhea is unclear and practice differs on whether to institute treatment. We aimed to characterize the microbiome in relation to the presence of C. difficile and co-infection with other pathogens and to describe host response to infection.

Methods:
Participants were children with acute diarrhea, 0–16 years of age, from whom stool samples had been submitted to the hospital laboratory for routine microbiology/virology. Convenience sampling was used for 50 prospective and 150 retrospective samples. No participants were treated for C. difficile. Rates of culture positivity for C. difficile, presence of toxin and PCR-ribotype were compared between age groups. Presence of other potential pathogens, comorbidities and complications were recorded. Microbiotal diversity was measured by 16S profiling.

Results:
Nineteen of 77 (25%) children <2 years of age and 13 of 119 (11%) children >2 years of age were C. difficile positive, of whom 10 (53%) and 9 (69%), respectively, carried toxigenic strains. Increased Shannon diversity was seen in children carrying C. difficile, with altered milieu. Presence of C. difficile was not associated with adverse clinical outcomes. In stools containing both Norovirus and C. difficile, there was increased relative abundance of verrucomicrobia.

Conclusions:
Children with diarrhea regularly carried toxigenic and non-toxigenic strains of C. difficile, demonstrating enhanced microbiotal diversity, and change in milieu, without apparent morbidity. This unexpected finding is contrary to that seen in adults with C. difficile disease.
Middle Ear Effusion in Children With Congenital Cytomegalovirus Infection
Authors: Chung Winnie , Leung Jessica , Lanzieri Tatiana M. , Blum Peggy , Demmler-Harrison Gail ,   for the Congenital Cytomegalovirus Longitudinal Study Group
Published: December 2019

Background:
Sensorineural hearing loss (SNHL) is well described in children with congenital cytomegalovirus (CMV) infection, but limited data are available on middle ear effusion (MEE) occurrence in this population. We assessed the prevalence of MEE and the degree of transient hearing change associated with MEE among children with congenital CMV infection.

Methods:
Children with congenital CMV infection enrolled in a longitudinal study received hearing and tympanometric testing during scheduled follow-up visits annually up to 6 years of age. We used a generalized linear mixed-effect logistic regression model to compare the odds of MEE, defined as type B tympanogram (normal ear canal volume with little tympanic membrane movement) among patients categorized as symptomatic or asymptomatic based on the presence of congenital CMV-associated signs in the newborn period.

Results:
Forty-four (61%) of 72 symptomatic and 24 (28%) of 87 asymptomatic patients had ≥1 visit with MEE. After controlling for the number of visits, symptomatic patients had significantly higher odds of MEE (odds ratio: 2.09; 95% confidence interval: 1.39–3.14) than asymptomatic patients. Transient hearing decrease associated with a type B tympanogram ranged from 10 to 40 dB, as measured by audiometric air-bone gap in 11 patients.

Conclusions:
Among children with congenital CMV, MEE can result in transient hearing decrease, which can reduce the efficacy of a hearing aid in those with SNHL. It is warranted that children with congenital CMV infection and SNHL receive routine audiologic and tympanometric testing to better manage hearing aid amplification levels.
Predictive Value of Serum Angiotensin-Converting Enzyme Titers in Sarcoid-Like Dacryoadenitis
Authors: Vahdani Kaveh , Rose Geoffrey E. 
Published: December 2019

Purpose:
To compare serum angiotensin-converting enzyme (sACE) titers in patients with newly diagnosed sarcoid-like dacryoadenitis and nongranulomatous dacryoadenitis.

Study Design:
Retrospective comparative case series.

Patients and Methods:
Clinical details and presenting sACE titers were reviewed for patients with newly diagnosed sarcoid-like dacryoadenitis (SLD) and nongranulomatous dacryoadenitis (NGD). All sACE titers were expressed as a percentage of the upper end of normal range (“normalized”). Using Student t test, sACE titers for patients with unilateral SLD were compared with unilateral NGD and the sensitivity and specificity of sACE as a predictor for SLD calculated; this was repeated for patients with bilateral dacryoadenitis. The proportion of patients with raised sACE were compared in each group (Fisher exact test), and the mean sACE titers compared for these selected patients.

Results:
For unilateral SLD the mean sACE was 97%, compared with 57% in NGD (p=0.0010), and the sensitivity of sACE titer was 42%, specificity 92%, positive predictive value 75%, and negative predictive value 73%. Area under curve from receiver operating characteristic analysis for unilateral dacryoadenitis was 0.78 (p=0.0040). In contrast, there was no significant difference for bilateral disease (SLD 148%, NGD 82%; p=0.33), and somewhat lower positive predictive value (54%), negative predictive value (71%) and area under curve (0.71; p=0.070). Although not significantly so with bilateral disease, the proportion of patients with raised sACE was consistently greater in SLD as compared to NGD—being highest with bilateral SLD (7/12 patients; 58%) and lowest in unilateral NGD (2/26; 8%). Seventeen of the 27 patients with SLD were later found to have systemic involvement: where systemic disease was present, the mean sACE levels were significantly different in unilateral (102%) and bilateral dacryoadenitis (209%; p=0.029) disease, whereas there was no difference in the absence of systemic involvement (sACE with unilateral dacryoadenitis = 86%, bilateral = 75%; p=0.72).

Conclusions:
Normalized serum titers of ACE are minimally predictive for SLD, whether unilateral or bilateral, with some false negatives and false positives in all groups. However, with unilateral dacryoadenitis, an sACE of >125% maximum range appears absolutely predictive for SLD, and >150% maximum range for bilateral disease.
Conjunctival Pediatric Follicular Lymphoma: Case Report and Literature Review
Authors: AlSemari Mohammad A. , Maktabi Azza , AlSamnan Mazen S. , Alrajeh Mohammed S. , Strianese Diego 
Published: December 2019

Follicular lymphoma (FL) is the second most commonly reported B-cell lymphoma and accounts for 6% of all orbital lymphomas. FL presentation in the pediatric population is rare. This study reported an 18-year-old male with a pink elevated lesion in the conjunctiva of the left eye and normal ocular parameters. Following a complete excisional biopsy, the lesion was oval and smooth grossly and showed dense proliferation with a high nuclear–cytoplasmic ratio microscopically. Immunohistochemical studies revealed positive CD20 and bcl-6 while bcl-2 was negative, which is a common feature for pediatric FL in contrast to bcl-2 positivity found by immunohistochemistry in FL occurring in adult patient population. No signs of recurrence were observed over 2 years of follow-up. This study adds a new case to the existing few reports. Interestingly, all reported cases were males including the patient, mean duration of onset was 5 months, and mean duration of follow-up was 18.4 months. The authors emphasize that total surgical excision with close monitoring is reasonable management of such clinical entity.
Follicular lymphoma (FL) is a rare entity in pediatric patients. Six cases have been reported with conjunctival FL in the literature (age between 6 and 21 years). Interestingly, all of them were male including the patient.
Unilateral Frontalis Suspension With Silicone Sling Without Levator Extirpation in Congenital Ptosis With Marcus Gunn Jaw Winking Synkinesis
Authors: Shah Gaurav , Khurana Deepika , Das Sima , Tiple Sweety , Honavar Santosh G. 
Published: December 2019

Purpose:
To evaluate the efficacy of unilateral tarso-frontalis silicone sling without levator extirpation or disinsertion in dampening the jaw wink in patients with congenital ptosis associated with Marcus Gunn Jaw Winking synkinesis phenomenon.

Methods:
Retrospective review of medical records of all patients of congenital ptosis with moderate to severe Marcus Gunn jaw winking synkinesis who underwent unilateral tarsofrontal silicone sling surgery without extirpation of the levator muscle were retrospectively reviewed. Data were collected about the pre- and the postoperative severity of the ptosis and the amount of Marcus Gunn jaw winking excursion.

Results:
Twenty-three patients were included in the study. Mean postoperative follow up duration was 31.2 (range 6–208) weeks. The severity of the preoperative jaw wink was mild (<2 mm excursion) in 0 patient, moderate (2–5mm) in 15 (65%) patients, and severe (>5 mm eyelid excursion) in 8 (35%) patients. Postoperatively, 20 (87%) patients had mild residual jaw wink, 3 (13%) patients had moderate jaw wink and none of the patient had severe residual jaw wink.

Conclusion:
Unilateral tarsofrontal silicone sling without disinsertion or extirpation of the levator can reduce the severity of the jaw wink excursion in patients with congenital ptosis with moderate to severe preoperative Marcus Gunn jaw winking synkinesis.
Electrocardiographic and Echocardiographic Findings in Elite Ghanaian Male Soccer Players
Authors: Pambo Prince , Adu-Adadey Martin , Agbodzakey Hope , Scharhag Jürgen 
Published: December 2019

Objective:
To analyze the athlete's heart of adult and adolescent elite male soccer players by electrocardiography (ECG) and echocardiography (ECHO) and to describe typical ECG and ECHO findings in this cohort (West African elite soccer players).

Design:
A cross-sectional study of ECGs and ECHOs conducted as part of precompetition medical assessment for national male soccer teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016 and 2017.

Setting:
Ghana National Football Association.

Participants:
One hundred fifty-nine players playing for the National male soccer teams preparing for tournaments in 2016 and 2017.

Interventions:
Precompetition medical assessment using ECGs and ECHOs.

Main Outcome Measures:
Number of athletes with abnormal ECGs and ECHO findings.

Results:
Twenty-three percent of the players had abnormal ECGs. Nine percent of the participants had T-wave inversions in lateral leads (V5–V6). Sokolow–Lyon criteria for left ventricular hypertrophy were present in 64% of participants. Thirty-six (23%) players had left ventricular wall thickness (LVWT) ≥13 mm, with no player exceeding 16 mm. Four percent of players had left ventricular cavity dimension greater than 60 mm. Relative wall thickness >0.42 was present in 44% of the players.

Conclusions:
Uncommon ECG changes seem to be more common in elite Ghanaian soccer players compared with previously reported results for Caucasians and even mixed populations of black athletes. Although ST elevation, T-wave inversions, and LVWT up to 15 mm are common, ST depression, deep T-waves in lateral leads, and LVWT ≥16 mm always warrant further clinical and scientific investigations.
Phase II study of vincristine, actinomycin-D, cyclophosphamide and irinotecan for patients with newly diagnosed low-risk subset B rhabdomyosarcoma
Authors: Miyachi Mitsuru , Tsuchiya Kunihiko , Hosono Ako , Ogawa Atsushi , Koh Katsuyoshi , Kikuta Atsushi , Hara Junichi , Teramukai Satoshi , Hosoi Hajime 
Published: December 2019

Abstract

Background:
Approximately 80% to 90% of patients with low-risk rhabdomyosarcoma can be cured. However, cured patients often face long-term complications associated with the treatment. An important factor in the treatment plan is the dose of cyclophosphamide administered because the dose can have both acute and long-term side effects. It is therefore essential to investigate whether the dose can be reduced without a negative effect on treatment outcome. The ARST0331 trial revealed that drastically reducing the cyclophosphamide dose to 4.8 g/m2 negatively affected treatment outcomes. The current study aims to determine whether reducing the cyclophosphamide dose to 10.8 g/m2 while introducing a new drug, irinotecan, can prevent the negative effect on treatment outcome. We also aim to investigate whether the reduced cyclophosphamide dose results in a decrease in infertility, one of the long-term complications of this treatment.

Methods:
The subjects are patients with stage 1 group III rhabdomyosarcoma (excluding those with orbital group III N0 and NX) or patients with stage 3 group I and II low-risk subset B embryonal rhabdomyosarcoma who will alternately undergo VAC 1.2 treatment (vincristine, actinomycin D, cyclophosphamide 1.2 g/m2) and VI treatment (vincristine, irinotecan). The effectiveness and safety of this treatment regimen will be assessed. Data will be presented at international conferences and will be published in peer-reviewed journals.

Discussion:
This study is significant because it aims to establish that the use of irinotecan in patients with low-risk subset B embryonal rhabdomyosarcoma (aged 30 or younger) allows the dose of cyclophosphamide to be reduced and is associated with few short-term adverse effects and long-term complications. The open-label and single-arm design of this study may be a limitation.

Trial registration and ethical approval:
The trial registration number is jRCTs051180200 (Japan Registry of Clinical Trials). The study protocol was approved by the institutional review board at each of the participating centers and the data will be presented at international conferences and published in peer-reviewed journals.
Systematic review and meta-analysis of whether cesarean section contributes to the incidence of allergic diseases in children
Authors: Gu Li , Zhang Weijian , Yang Wenhao , Liu Hanmin 
Published: December 2019

Abstract

Background:
As abundant evidence shows the composition of gut flora in children born by caesarean section is different from that of vaginal delivery children, studies on whether caesarean section would increase the offspring's risk of developing allergic disease attract extensive attention. However, the results of different researches are inconsistent. Therefore we conduct a systematic review and meta-analysis to explore the relationship between caesarean section and childhood allergic disease.

Methods:
The protocol followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Cohort studies for investigating the relationship between caesarean section and the risk of childhood allergic disease will be searched in 4 main databases (PubMed, EMBASE, the Cochrane Library, and the web of science). In addition, a manual search of the references of relevant published studies will also be considered. Four common allergic outcomes will be included: asthma, allergic rhinitis, food allergy, and atopic dermatitis. Studies selection, data extraction, and risk of bias assessment will be conducted by 2 independent reviewers. The primary outcome is the incidence of 4 allergic diseases.

Results:
The results will provide useful information on whether caesarean section contributes to the increase of allergic disease in children.

Conclusion:
The findings of this study will be published in a peer-reviewed journal.

PROSPERO registration number:
CRD42019135196.
Anaplastic lymphoma kinase-negative pulmonary inflammatory myofibroblastic tumor with multiple metastases and its treatment by Apatinib
Authors: Liu Qiuxia , Wei Jianguo , Liu Xizhong , Wang Jianfang 
Published: December 2019

AbstractRationale:Primary pulmonary inflammatory myofibroblastic tumor (IMT) with distant metastasis is extremely rare. Moreover, metastasis of pulmonary IMT to bone marrow has never been reported in previous studies. Therapeutic approaches for anaplastic lymphoma kinase (ALK)-negative pulmonary IMT with metastasis are limited. Yet there is no report on the treatment of advanced IMT cases with anti-angiogenesis drugs.Patient concerns:We described a patient with a complaint of fatigue, with the chest computed tomography (CT) scan revealing 2 masses in bilateral lung.Diagnoses:The CT-guided lung biopsy examined 1 lesion in the right lung, and the post-operative pathological diagnosis of ALK-negative pulmonary IMT was recommended. However, the lung lesions were found significantly enlarged during the subsequent visit 8 months later, along with multiple metastases to the bone and abdominal cavity. A bone marrow biopsy revealed bone marrow infiltration by spindle cells.Interventions:The patient began to take Celecoxib due to the rapid progression of IMT, however, resulting in the aggravated gastric ulcer. He stopped taking the medicine 1 month later, with no remarkable change in the lesions by CT. Apatinib was administrated instead of Celecoxib.Outcomes:After the 5-month treatment of Apatinib, the mass in the abdominal cavity significantly shrank and the lung lesions slightly decreased in size. With the 9-month administration of Apatinib, the lung lesions and the abdominal mass kept stable, compared with the situation in the 5-month follow-up.Lessons:Although pulmonary IMT shows the potential of metastasis, its metastasizing to bone marrow is a highly unusual event. Apatinib is effective for pulmonary IMT, and should be taken into consideration for the treatment of inoperable pulmonary IMT patients who lack ALK rearrangement.