bluuebunny/crossref_metadata_2025_split huggingface dataset:
Visceral leishmaniasis in patients with lymphoma
Authors: Kalmi Galith , Vignon-Pennamen Marie-Dominique , Ram-Wolff Caroline , Battistella Maxime , Lafaurie Mathieu , Bouaziz Jean-David , Hamane Samia , Bernard Sophie , Bretagne Stéphane , Thiéblemont Catherine , Bagot Martine , de Masson Adèle 
Published: November 2020

Abstract

Introduction:
Non–HIV-related visceral leishmaniasis (VL) is becoming increasingly prevalent in nontropical countries because of the increasing number of patients with chronic diseases and the development of immune-modulating drugs.

Patient concerns:
Case 1 is a 60-year-old male patient of Senegalese origin presented with weight loss, lymphadenopathy, anemia, and elevated lactate dehydrogenases. Case 2 is a 46-year-old male patient of Algerian origin, with a negative HIV serology presented with cutaneous lesions.

Diagnosis:
Patient 1: The diagnosis of stage IV lymphocytic lymphoma (LL) was confirmed by an inguinal nodal biopsy in 2013. Patient 2: The diagnosis of T-cell lymphoma was made in 2003.

Interventions:
Patient 1 received 5 cycles of bendamustine and rituximab followed by a complete remission. Patient 2 was initially treated with >10 different treatments followed by 8 different chemotherapy regimens due to the disease progression.

Outcomes:
Patient 1: In 2017, after a follow-up of 4 years, the patient presented with fever, lymphadenopathy, splenomegaly, and pancytopenia in the setting of hemophagocytic syndrome. The initial diagnosis was a relapse of lymphoma and the patient was treated with ibrutinib. His status worsened, and Leishmania DNA was detected by polymerase chain reaction (PCR) on the blood and bone marrow aspirates. Ibrutinib was stopped. Amphotericin B treatment induced a complete clinical remission and clearance of Leishmania DNA from the blood.
Patient 2: In 2017, after a follow-up of 14 years, the patient presented with fever, lymphadenopathy, hepatosplenomegaly, pancytopenia with hemophagocytic syndrome, and an increase in the tumor skin lesions. A skin biopsy was taken from the face and the patient. A careful reexamination of the skin biopsy revealed the presence of Leishmania bodies. He was treated with 40 mg/kg liposomal amphotericin B leading to a regression of the clinical symptoms and negativation of the blood PCR.

Conclusions:
This case study shows that VL may be a diagnostic challenge in patients with lymphoma. Reactivation or primary infection should be considered in the differential diagnosis. The purpose of this study is to remind clinicians to think of VL in patients with systemic symptoms that could be misdiagnosed as a progression of the underlying lymphoma.
Primitive neuroectodermal tumor of urinary bladder
Authors: Gao Liang , Xie Wenjie , Li Kun , Huang Gaomin , Ji Yuanhai , Ou Yangkang , Chen Jie 
Published: November 2020

Abstract

Rationale:
Primitive neuroectodermal tumor (PNET) of the urinary bladder is a highly aggressive tumor with high local recurrence and distant metastasis rates in cases of incomplete excision. We report a case of a young female patient, in whom early laparoscopic radical cystectomy combined with standard lymph node dissection and a modified vincristine, doxorubicin hydrochloride, and cyclophosphamide (VAC) chemotherapy regimen was controversial. Because PNET of the urinary bladder is a rare malignancy, the standard treatment regimen has not yet been established. It is not clear whether surgery combined with postoperative chemotherapy for PNET patients may be superior to surgery alone on long term survival.

Patient concerns:
The patient was a 45-year-old Chinese woman who complained of lower urinary tract symptoms, including urgency, frequency, and difficulty in urination, for 2 months.

Diagnoses:
PNET.

Interventions:
The patient underwent laparoscopic radical cystectomy and standard lymph node dissection, combined with modified VAC chemotherapy regimens.

Outcomes:
After undergoing radical surgery in 2018, the patient completed 6 courses of adjuvant chemotherapy. Abdominal and thorax computed tomography scanning was performed 3, 6, 9, and 12 months after the surgery was completely free of tumor. The patient is still alive with no signs of recurrent disease 2 years after diagnosis.

Lessons:
Radical surgery and standard lymphadenectomy combined with adjuvant chemotherapy may be essential to improve the prognosis of PNET of the urinary bladder.
A Learning Health System for Pediatric Liver Transplant
Authors: Perito Emily R. , Squires James E. , Bray David , Bucuvalas John , Krise‐Confair Cassandra , Eisenberg Elizabeth , Gonzalez‐Peralta Regino P. , Gupta Nitika , Hsu Evelyn K. , Kosmach‐Park Beverly , Lobritto Steven , Logan Beth , Mohammad Saeed , Ng Vicky L. , Pillari Tony , Rasmussen Sara , Shemesh Eyal , Soltys Kyle , Szolna Jonathan , Superina Riccardo , Tunno John , Mazariegos George V. 
Published: November 2020

ABSTRACTObjective:Learning health systems (LHS) integrate research, improvement, management, and patient care, such that every child receives “the right care at the right time…every time,” that is, evidence‐based, personalized medicine. Here, we report our efforts to establish a sustainable, productive, multicenter LHS focused on pediatric liver transplantation.Methods:The Starzl Network for Excellence in Pediatric Transplantation (SNEPT) is the first multicenter effort by pediatric liver transplant families and providers to develop shared priorities and a shared agenda for innovation in clinical care. This report outlines SNEPT's structure, accomplishments, and challenges as an LHS.Results:We prioritized 4 initial projects: immunosuppression, perioperative anticoagulation, quality of life, and transition of care. We shared center protocols/management to identify areas of practice variability between centers. We prioritized actionable items that address barriers to providing “the right care at the right time” to every pediatric liver transplant recipient: facilitating transparency of practice variation and the connection of practices to patient outcomes, harnessing existing datasets to reduce the burden of tracking outcomes, incorporating patient‐reported outcomes into outcome metrics, and accelerating the implementation of knowledge into clinical practice. This has allowed us to strengthen collaborative relationships, design quality improvement projects, and collect pilot data for each of our priority projects.Conclusions:The field of pediatric liver transplantation can be advanced through application of LHS principles. Going forward, SNEPT will continue to unite patient advocacy, big data, technology, and transplant thought leaders to deliver the best care, while developing new, scalable solutions to pediatric transplantation's most challenging problems.
Low Adherence to Society Guidelines for the Management of Helicobacter Pylori Among Pediatric Gastroenterologists
Authors: Bonilla Silvana , Mitchell Paul D. , Mansuri Ishrat 
Published: November 2020

ABSTRACTBackground:The revised ESPGHAN/NASPGHAN 2016 guideline on the diagnosis and management of Helicobacter pylori (H pylori) infection discourages a “test and treat” strategy. Instead, upper endoscopy (EGD) is recommended when a valid clinical indication is present. Likewise, new treatment recommendations for first‐line therapies strongly encourage obtaining antimicrobial susceptibility before treatment. We conducted this study to assess the effect of revised guidelines on clinical practice at our center.Methods:Retrospective chart review of patients with H pylori infection diagnosis either by serology, stool antigen test, urea breath test, or EGD at Boston Children's Hospital between January 2013 and July 2019. We compared demographic and clinical data between initial guideline and 2016 revision (January 2013 to November 2016) and period after revised guideline (December 2016 to July 2019).Results:Two hundred and fifty‐six patients were included. EGD was the initial diagnostic test in 49% (50/103, prerevised guideline) and in 52% (79/153, postrevised guideline). Biopsy culture was sent in 3% of patients for both periods (3/103 and 4/153, respectively). PPI‐clarithromycin‐amoxicillin triple therapy was the most common regimen in both periods. Clarithromycin use was lower in postrevised guideline period (P = 0.003) whereas the opposite was noted for metronidazole and tetracycline (P = 0.009 and P = 0.02, respectively). There was no significant difference in eradication rate between periods (86% vs 81%).Conclusions:Low adherence to the updated H pylori guideline recommendations was observed among pediatric gastroenterologists at our center with low use of gastric biopsy culture. The guideline revision was associated with avoidance of clarithromycin use as a second‐line therapy, but no change in eradication rates. Future interventions should address the importance of obtaining gastric biopsy culture for antibiotic susceptibilities to guide therapy.
Antibiotic Prophylaxis for Percutaneous Endoscopic Gastrostomy in Children
Authors: Alessandri Francesco , Strisciuglio Caterina , Borrazzo Cristian , Cozzi Denis , Romano Claudio , Betalli Pietro , Villa Maria Pia , Parisi Pasquale , Ziparo Chiara , Rocco Monica , Evangelisti Melania , Pugliese Francesco , Di Nardo Giovanni 
Published: November 2020

ABSTRACTObjectives:Paediatric studies on the role of antibiotic prophylaxis in the prevention of postoperative infections in children undergoing percutaneous endoscopic gastrostomy (PEG) are lacking. The aim of this study was to assess if a single dose of co‐amoxiclav before PEG can decrease the rate of peristomal wound and systemic infection in children.Methods:In this prospective, randomised, double‐blind, multicentre trial, children undergoing PEG were randomized to antibiotic prophylaxis with co‐amoxiclav versus placebo and the rate of local and systemic infections were assessed.Results:Of the 106 patients considered for inclusion, 49 patients were randomized. In the per‐protocol analysis, the occurrence of wound infection was 5% (1/20) in the antibiotic group and 21% (4/19) in the placebo group (P = 0.13, 16% difference in proportions, odds ratio [OR] 0.19, 95% confidence interval [CI] 0.02–1.9). The occurrence of systemic infection was 9% (2/22) in the antibiotic group and 27.2% (6/25) in the placebo group [P = 0.17, 18% difference in proportions, OR 0.32, 95% CI 0.06%–1.80%]. Similar results were obtained in intention‐to‐treat analysis. Interestingly, the overall infection rate was significantly higher in the placebo group as compared with the antibiotic group (40% vs 13.6%; P = 0.04) and the duration of hospital stay was significantly longer in the placebo group as compared with the antibiotic group (4.4 ± 1.6 vs 3.5 ± 1.05; P = 0.02). The number‐needed‐to‐treat (NTT) to prevent 1 peristomal infection on average are 6.7 patients.Conclusions:A preoperative dose of co‐amoxiclav reduces the overall infection rate and the duration of hospital stay. Our data suggest that antibiotic prophylaxis should be recommended in every children undergoing PEG placement.
Disentangling cause and consequence: Genetic dissection of theDANGEROUS MIX2risk locus, and activation of the DM2h NLR in autoimmunity
Authors: Ordon Jana , Martin Patrick , Erickson Jessica Lee , Ferik Filiz , Balcke Gerd , Bonas Ulla , Stuttmann Johannes 
Published: November 2020

AbstractNucleotide-binding domain–leucine-rich repeat-type immune receptors (NLRs) protect plants against pathogenic microbes through intracellular detection of effector proteins. However, this comes at a cost, as NLRs can also induce detrimental autoimmunity in genetic interactions with foreign alleles. This may occur when independently evolved genomes are combined in inter- or intraspecific crosses, or when foreign alleles are introduced by mutagenesis or transgenesis. Most autoimmunity-inducing NLRs are encoded within highly variableNLRgene clusters with no known immune functions, which were termed autoimmune risk loci. Whether risk NLRs differ from sensor NLRs operating in natural pathogen resistance and how risk NLRs are activated in autoimmunity is unknown. Here, we analyzed theDANGEROUS MIX2risk locus, a major autoimmunity hotspot inArabidopsis thaliana. By gene editing and heterologous expression, we show that a single gene,DM2h, is necessary and sufficient for autoimmune induction in three independent cases of autoimmunity in accession Landsbergerecta. We focus on autoimmunity provoked by an EDS1-YFPNLSfusion protein to functionally characterize DM2h and determine features of EDS1-YFPNLSactivating the immune receptor. Our data suggest that risk NLRs function reminiscent of sensor NLRs, while autoimmunity-inducing properties of EDS1-YFPNLSare in this context unrelated to the protein’s functions as immune regulator. We propose that autoimmunity may, at least in some cases, be caused by spurious, stochastic interactions of foreign alleles with co-incidentally matching risk NLRs.
Benefits and risks of zinc for adults during covid-19: rapid systematic review and meta-analysis of randomised controlled trials
Authors: Hunter Jennifer , Arentz Susan , Goldenberg Joshua , Yang Guoyan , Beardsley Jennifer , Myers Stephen P , Mertz Dominik , Leeder Stephen 
Published: November 2020

ABSTRACTObjectiveTo evaluate the benefits and risks of any type of zinc intervention to prevent or treat SARS-CoV-2.DesignA living, systematic review and meta-analysis, incorporating rapid review methods.Data sources17 English and Chinese databases and clinical trial registries were searched in April/May 2020, with additional covid-19 focused searches in June and August 2020.Eligibilitycriteria and analysisRandomized control trials (RCTs) published in any language comparing zinc to a control to prevent or treat SARS-CoV-2. Other viral respiratory tract infections (RTIs) were included, but the certainty of evidence downgraded twice for indirectness. Screening, data extraction, risk of bias appraisal (RoB-2 tool) and verification was performed by calibrated, single reviewers. RCTs with adult populations were prioritised for analysis.Results123 RCTs were identified. None were specific to SARS-CoV-2 nor other coronaviruses. 28 RCTs evaluated oral (15-45mg daily), sublingual (45-300mg daily), or topical nasal (0.09-2.6 mg daily) zinc to prevent or treat nonspecific viral RTIs in 3,597 adults without zinc deficiency. Compared to placebo, zinc prevented 5 mild to moderate RTIs per 100 person-months, including in older adults (95% confidence interval 1 to 9) (number needed to treat (NTT)=20). There was no significant difference in the rates of non-serious adverse events (AE). For RTI treatment, a clinically important reduction in peak symptom severity scores was found for zinc compared to placebo (mean difference 1.2 points, 0.7 to 1.7), but not average daily symptom severity (standardised mean difference 0.2, 0.1 to 0.4). 19 fewer per 100 adults were at risk of remaining symptomatic over the first 7 days (2 to 38, NNT=5) and the mean duration of symptoms was 2 days shorter (0.2 to 3.5), however, there was substantial heterogeneity (I2 = 82% and 97%). 14 more per 100 experienced a non-serious AE (4 to 16, NNT=7) such as nausea, or mouth or nasal irritation. No differences in illness duration nor AE were found when zinc was compared to active controls. No serious AE, including copper deficiency, were reported by any RCT. Quality of life outcomes were not assessed. Confidence in these findings for SARS-CoV-2 is very low due to serious indirectness and some concerns about bias for most outcomes.ConclusionsZinc is a potential therapeutic candidate for preventing and treating SARS-CoV-2, including older adults and adults without zinc deficiency (very low certainty). Zinc may also help to prevent other viral RTIs during the pandemic (moderate certainty) and reduce the severity and duration of symptoms (very low certainty). The pending results from seven RCTs evaluating zinc for SARS-CoV-2 will be tracked.Systematic review registrationPROSPERO CRD42020182044
Data driven mathematical model of colon cancer progression
Authors: Kirshtein Arkadz , Akbarinejad Shaya , Hao Wenrui , Le Trang , Aronow Rachel A. , Shahriyari Leili 
Published: November 2020

AbstractEvery colon cancer has its own unique characteristics, and therefore may respond differently to identical treatments. Here, we develop a data driven mathematical model for the interaction network of key components of immune microenvironment in colon cancer. We estimate the relative abundance of each immune cell from gene expression profiles of tumors, and group patients based on their immune patterns. Then we compare the tumor sensitivity and progression in each of these groups of patients, and observe differences in the patterns of tumor growth between the groups. For instance, in tumors with a smaller density of naive macrophages than activated macrophages, a higher activation rate of macrophages leads to an increase in cancer cell density, demonstrating a negative effect of macrophages. Other tumors however, exhibit an opposite trend, showing a positive effect of macrophages in controlling tumor size. Although the results indicate that for all patients, the size of the tumor is sensitive to the parameters related to macrophages such as their activation and death rate, this research demonstrates that no single biomarker could predict the dynamics of tumors.
Spirometric classifications of COPD severity as predictive markers for clinical outcomes: the HUNT Study
Authors: Bhatta Laxmi , Leivseth Linda , Mai Xiao-Mei , Henriksen Anne Hildur , Carslake David , Chen Yue , Martinez-Camblor Pablo , Langhammer Arnulf , Brumpton Ben Michael 
Published: November 2020

ABSTRACTRationaleGOLD grades based on percent-predicted FEV1 poorly predicts mortality. Studies have recommended alternative expressions of FEV1 for the classification of COPD severity and they warrant investigation.ObjectiveTo compare the predictive abilities of ppFEV1 (ppFEV1 quartiles, GOLD grades, ATS/ERS grades), FEV1 z-score (FEV1 z-score quartiles, FEV1 z-score grades), FEV1.Ht-2 (FEV1.Ht-2 quartiles, FEV1.Ht-2 grades), FEV1.Ht-3 (FEV1.Ht-3 quartiles), and FEV1Q (FEV1Q quartiles) to predict clinical outcomes.MethodsPeople aged ≥40 years with COPD (n=890) who participated in the HUNT Study (1995-1997) were followed for 5 years (short-term) and up to 20.4 years (long-term). Survival analysis and time-dependent area under curve (AUC) were used to compare the predictive abilities. A regression tree approach was applied to obtain optimal cut-offs of different expressions of FEV1. The UK Biobank (n=6495) was used as a replication cohort with a 5-year follow-up.ResultsAs a continuous variable, FEV1Q had the highest AUCs for all-cause mortality (short-term 70.2, long-term 68.3), respiratory mortality (short-term 68.4, long-term 67.7), cardiovascular mortality (short-term 63.1, long-term 62.3), COPD hospitalization (short-term 71.3, long-term 70.9), and pneumonia hospitalization (short-term 67.8, long-term 66.6), followed by FEV1.Ht-2 or FEV1.Ht-3. Generally, similar results were observed for FEV1Q quartiles. The optimal cut-offs of FEV1Q had higher AUCs compared to GOLD grades for predicting short-term and long-term clinical outcomes. Similar results were found in UK Biobank.ConclusionsFEV1Q best predicted the clinical outcomes and could improve the classification of COPD severity.
An international survey on the impact of COVID-19 in individuals with Down syndrome
Authors: Hüls Anke , Costa Alberto C. S. , Dierssen Mara , Baksh R. Asaad , Bargagna Stefania , Baumer Nicole T. , Brandão Ana Claudia , Carfi Angelo , Carmona-Iragui Maria , Chicoine Brain Allen , Ghosh Sujay , Lakhanpaul Monica , Manso Coral , Mayer Miguel-Angel , del Carmen Ortega Maria , de Asua Diego Real , Rebillat Anne-Sophie , Russell Lauren Ashley , Sgandurra Giuseppina , Valentini Diletta , Sherman Stephanie L , Strydom Andre 
Published: November 2020

ABSTRACTBackgroundHealth conditions and immune dysfunction associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19 once infected by SARS-CoV-2.MethodsThe T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers/family members on patients with COVID-19 and DS (N=1046). De-identified survey data collected between April and October 2020 were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS. COVID-19 patients with DS from the ISARIC4C survey (ISARIC4C DS cases=100) were matched to a random set of patients without DS (ISARIC4C controls=400) and hospitalized DS cases in the T21RS survey (T21RS DS cases=100) based on age, gender, and ethnicity.FindingThe mean age in the T21RS survey was 29 years (SD=18), 73% lived with their family. Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Pain and nausea were reported less frequently (p<0.01), whereas altered consciousness/confusion were reported more frequently (p<0.01). Risk factors for hospitalization and mortality were similar to the general population (age, male gender, diabetes, obesity, dementia) with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher than for controls (T21RS DS versus controls: risk ratio (RR)=3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus controls: RR=2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality.InterpretationLeading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of mortality, especially from age 40.FundingDown Syndrome Affiliates in Action, Down Syndrome Medical Interest Group-USA, GiGi’s Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, Matthews Foundation, National Down Syndrome Society, National Task Group on Intellectual Disabilities and Dementia Practices.
Using Capture-Recapture Methods to Estimate Influenza Hospitalization Incidence Rates
Authors: Balasubramani GK , Nowalk Mary Patricia , Clarke Lloyd G. , Dauer Klancie , Silveira Fernanda , Middleton Donald B. , Yassin Mohamed , Zimmerman Richard K. 
Published: November 2020

AbstractBackgroundAccurate population estimates of disease incidence and burden are needed to set appropriate public health policy. The capture-recapture (C-R) method combines data from multiple sources to provide better estimates than is possible using single sources.MethodsData were derived from clinical virology test results and from an influenza vaccine effectiveness study from seasons 2016-2017 to 2018-2019. The Petersen C-R method was used to estimate the population size of influenza cases; these estimates were then used to calculate adult influenza hospitalization burden using a Centers for Disease Control and Prevention (CDC) multiplier method.ResultsOver all seasons, 343 influenza cases were reported in the clinical database and 313 in the research database. Fifty-nine cases (17%) reported in the clinical database were not captured in the research database, and 29 (9%) cases in the research database were not captured in the clinical database. Influenza hospitalizations were higher among vaccinated (58%) than the unvaccinated (35%) in the current season and were similar among unvaccinated (51%) and vaccinated (49%) in the previous year. Completeness of the influenza hospitalization capture was estimated to be 76%. The incidence rates for influenza hospitalizations varied by age and season and averaged 307-309 cases/100,000 adult population annually.ConclusionUsing Capture-Recapture methods with more than one database, along with a multiplier method with adjustments improves the population estimates of influenza disease burden compared with relying on a single data source.