bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cerebrospinal Fluid Shunt Infections in Children: Do Hematologic and Cerebrospinal Fluid White Cells Examinations Correlate With the Type of Infection?
Authors: Buonsenso Danilo , Bianchi Federico , Scoppettuolo Giancarlo , Frassanito Paolo , Massimi Luca , Caldarelli Massimo , Salvatelli Niccolò , Ferro Valentina , Valentini Piero , Tamburrini Gianpiero 
Published: October 2021

Background:
Cerebrospinal fluid (CSF) shunt infections in children represent an increasing problem in clinical practice. However, comprehensive clinical, laboratory and microbiologic data are scarce in pediatric age.

Methods:
We conducted a 10-year retrospective study to (1) analyze clinical, laboratory and microbiologic parameters associated with infections in children; (2) analyze results according to the type of catheter (medicated or not), type of infection (first or relapses), type of hydrocephalus (acquired and congenital), presence or not of bacteriemia; (3) describe antibiotic susceptibilities and their evolution during the study period.

Results:
Eighty-seven children with shunt infection and 61 children with mechanical shunt malfunction were enrolled. Fever, vomit, leukocytosis and elevated C-reactive protein were more frequent in the infected group (P < 0.001), while neurologic symptoms developed more frequently in the noninfected group (10.3% vs. 27.87%; P = 0.006). Local signs of inflammation and abdomen distension were similarly reported in the 2 groups. Children with medicated shunts had lower cell count in the CSF (12/mm3) compared with those with nonmedicated shunts (380/mm3; P < 0.0001). Gram-negative bacteria were more common in the not-medicated catheters (90.91% vs. 50% of cultures; P = 0.04). Gram-negative bacteria were identified in 50.67% of CSF cultures, Gram-positive bacteria in 53.33% and fungi were observed in 5.33%. Sixteen children (18.4%) had also a positive blood culture. Enterococci isolation was associated with relapsed infections (37.50% vs. 15.25%; P = 0.05).

Conclusions:
Our study shows that the diagnosis and management of children with shunt infections are challenging. Prospective studies with a comprehensive approach focusing on patient, medical, microbiologic and surgical risk factors for first infection are urgently needed.
Reducing Occupational Sitting While Working From Home
Authors: Mailey Emily L. , Rosenkranz Richard , Rosenkranz Sara K. , Ablah Elizabeth , Talley Mia , Biggins Anna , Towsley Alissa , Honn Allison 
Published: October 2021

Objective:
This study examined the individual and combined effects of a height-adjustable desk and an online behavioral intervention on sedentary behavior and health among university employees working from home.

Methods:
Participants (N = 95) were randomly assigned to one of four conditions: Desk Only, Program Only, Desk + Program, or Control. Desk participants received a height-adjustable desk; program participants received a 12-week web-based intervention. Outcomes measured at baseline and post-intervention included workday sitting and cardiometabolic health outcomes.

Results:
Reductions in sitting were largest in the Desk + Program condition (−206 min/workday; d = 1.84), followed by the Desk Only condition (−122 min/workday; d = 0.98), and the Program Only condition (−96 min/workday; d = 1.13). There were no significant changes in the health outcomes assessed.

Conclusions:
Both a height-adjustable desk and an online behavioral intervention effectively reduced occupational sitting, and a combined approach was most effective.
Bad blood: ischemic conditions of the large bowel
Authors: Rizwan Rabia , Feuerstadt Paul 
Published: October 2021

Purpose of review
Colon ischemia is the most common form of intestinal ischemic injury and is seen frequently in an elderly population. This disease is usually self-limited, and many causes have been identified. The recent literature has focused on estimates of prognosis, triaging appropriate level of care, and identification of optimal treatments. In this review, we will address our current understanding of colon ischemia including epidemiology, pathophysiology, segmental distribution, presentation, diagnosis, and management.

Recent findings
Research has recently been focused on factors associated with poor outcome. The medical comorbidities identified include chronic obstructive pulmonary disease (COPD), hepatic cirrhosis, and chronic aspirin use. Serological markers are noninvasive tools that can triage severity. Recent studies have shown procalcitonin, C-reactive protein, D-dimer, and neutrophil counts can help predict those at greatest risk for poor outcome. The timing of colonoscopy relative to symptomatic onset also can help predict severity. Early colonoscopy allows for quicker identification of ischemic stigmata, reducing the chance of misdiagnosis and potentially unnecessary and harmful treatment. The treatment of colon ischemia has classically been conservative with antimicrobials reserved for those with moderate or severe disease. Recent retrospective analysis calls into question the utility of antibiotics in the treatment of colon ischemia, although the data is not convincing enough to advise against antimicrobial treatment in patients with severe and fulminant disease.

Summary
It is an exciting time for research focused on colon ischemia. With an improved knowledge, awareness of associated risk factors and predictors of severity, clinicians now have enhanced clinical tools to diagnose and triage patients earlier in the disease. This should help institute prompt and appropriate therapies ultimately improving outcomes.
Driving Pressure Is Associated With Outcome in Pediatric Acute Respiratory Failure
Authors: van Schelven Patrick , Koopman Alette A. , Burgerhof Johannes G. M. , Markhorst Dick G. , Blokpoel Robert G. T. , Kneyber Martin C. J. 
Published: October 2021

OBJECTIVES:
Driving pressure (ratio of tidal volume over respiratory system compliance) is associated with mortality in acute respiratory distress syndrome. We sought to evaluate if such association could be identified in critically ill children.

DESIGN:
We studied the association between driving pressure on day 1 of mechanical ventilation and ventilator-free days at day 28 through secondary analyses of prospectively collected physiology data.

SETTING:
Medical-surgical university hospital PICU.

PATIENTS:
Children younger than 18 years (stratified by Pediatric Mechanical Ventilation Consensus Conference clinical phenotype definitions) without evidence of spontaneous respiration.

INTERVENTIONS:
Inspiratory hold maneuvers.

MEASUREMENTS AND MAIN RESULTS:
Data of 222 patients with median age 11 months (2–51 mo) were analyzed. Sixty-five patients (29.3%) met Pediatric Mechanical Ventilation Consensus Conference criteria for restrictive and 78 patients (35.1%) for mixed lung disease, and 10.4% of all patients had acute respiratory distress syndrome. Driving pressure calculated by the ratio of tidal volume over respiratory system compliance for the whole cohort was 16 cm H2O (12–21 cm H2O) and correlated with the static airway pressure gradient (plateau pressure minus positive end-expiratory pressure) (Spearman correlation coefficient = 0.797; p < 0.001). Bland-Altman analysis showed that the dynamic pressure gradient (peak inspiratory pressure minus positive end-expiratory pressure) overestimated driving pressure (levels of agreement –2.295 to 7.268). Rematching the cohort through a double stratification procedure (obtaining subgroups of patients with matched mean levels for one variable but different mean levels for another ranking variable) showed a reduction in ventilator-free days at day 28 with increasing driving pressure in patients ventilated for a direct pulmonary indication. Competing risk regression analysis showed that increasing driving pressure remained independently associated with increased time to extubation (p < 0.001) after adjusting for Pediatric Risk of Mortality III 24-hour score, presence of direct pulmonary indication jury, and oxygenation index.

CONCLUSIONS:
Higher driving pressure was independently associated with increased time to extubation in mechanically ventilated children. Dynamic assessments of driving pressure should be cautiously interpreted.
Myocarditis Following mRNA COVID-19 Vaccine
Authors: Visclosky Timothy , Theyyunni Nik , Klekowski Nicole , Bradin Stuart 
Published: October 2021

Abstract
A growing number of adolescents are being diagnosed with acute myocarditis following mRNA COVID-19 vaccinations. This case describes an adolescent who presented to the emergency department with chest pain and tachycardia following the Pfizer-BioNTech COVID-19 vaccination. Point-of-care ultrasound was performed prior to the return of laboratory studies and revealed depressed left ventricular systolic function. Point-of-care ultrasound may be a tool used to rapidly diagnose or risk stratify patients with potential post–COVID-19 vaccine myocarditis.
Gram-negative bacteria as a cause of mediastinitis after cardiac surgery
Authors: Peghin Maddalena , Pompei Esmeralda , Vendramin Igor , Tascini Carlo 
Published: October 2021

Purpose of review
Poststernotomy mediastinitis (PSM) remains a serious infection and is significantly associated with high morbidity, short-term and long-term mortality. Gram-negative bacteria (GNB) are an underestimated cause of PSM, and there is little information on the risk factors, prevention, diagnosis and management of GNB PSM.

Recent findings
The pathogenesis of PSM is the result of a complex and multifactorial interplay between intraoperative wound contamination, host-related and surgical host factors but GNB are probably mostly translocated from other host site infections. GNB are frequent cause of PSM (18–38% of cases) and GNB PSM have shown to more frequently polymicrobial (20–44%). GNG PSM has shown to occur earlier than Gram-positive PSM. Early diagnosis is crucial to successful treatment. The management of PSM needs a combination of culture-directed antimicrobial therapy and an early extensive surgical debridement with either immediate or delayed closure of the sternal space. Antibiotic treatment choice and duration should be based on clinical evaluation, evolution of inflammatory markers, microbiological tests and imaging studies. Mortality has shown to be significantly higher with GNB PSM compared with other causes and the inappropriateness of initial antibiotic therapy may explain the worse outcome of GNB PSM.

Summary
GNB PSM is usually undervalued in the setting of PSM and have shown to be a frequent cause of inappropriate treatment with adverse prognostic potential. There is a need for efforts to improve knowledge to prevent and adequately treat GNB PSM.
Clinical Management of End-Stage Renal Disease Patients on Dialysis Receiving Radioactive Iodine Treatment
Authors: AlSadi Rahaf , Aziz Landon C. , Bohan Michael , Dewji Shaheen , Bouhali Othmane , Djekidel Mehdi 
Published: October 2021

PurposeRadioactive iodine (RAI) is used to treat thyroid cancer patients with a clear paradigm for most patients. End-stage renal disease (ESRD) patients pose several challenges when undergoing RAI treatment, primarily due to the lack of renal clearance. We retrospectively report our experience with RAI treatment in a cohort of patients with ESRD and provide a set of recommendations on aspects such as the need for adjusted dose activity, balancing scheduling between RAI therapy and dialysis, and radiation safety precautions.Patients and MethodsIn this study, we report on 5 patients (6 cases), with ESRD on dialysis, treated with RAI for thyroid cancer. Retention measurements to determine individual biological clearance of RAI from the patient’s body before and after dialysis sessions were assessed using external exposure dose rates measured at 1 m.ResultsDelayed biological clearance of RAI, after the first hemodialysis session, resulted in a longer RAI effective half-life as a consequence of longer retention periods, consistent with observations reported in scientific literature. To achieve a much closer radiation exposure compared with a nondialysis patient, one would recommend administering ~20%–30% of the dose activity normally administered to a thyroid cancer patient based on their medical history, histopathology, and uptake with the appropriate dialysis schedule.ConclusionsSpecial precautions should be taken with the administration of RAI in ESRD patients by adjusting the prescribed dose activity, dialysis sessions, and paying special attention to wastes. Pooling data from multiple centers may be useful to build a consensus and substantiated recommendations.
Diagnostic Test Accuracy of 18F-FDG PET or PET/CT for Characterization of Histologic Type of Thymic Epithelial Tumor
Authors: Kim Keunyoung , Jeong Joon-Hoon , Kim Seong-Jang 
Published: October 2021

PurposeThis study investigated diagnostic accuracies of18F-FDG PET or PET/CT for characterization of histologic type of thymic epithelial tumors (TETs) through a systematic review and meta-analysis.Patients and MethodsThe PubMed, Cochrane database, and EMBASE database, from the earliest available date of indexing through August 31, 2020, were searched for studies evaluating diagnostic performance of18F-FDG PET or PET/CT for characterization of TET. We determined the sensitivities and specificities, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves.ResultsThe pooled sensitivity of18F-FDG PET or PET/CT was 0.89 (95% confidence interval [CI], 0.80–0.95), and the pooled specificity was 0.77 (95% CI, 0.63–0.87) for differentiation between thymic cancer and thymoma. Likelihood ratio syntheses gave an overall positive likelihood ratio (LR+) of 3.9 and negative likelihood ratio (LR−) of 0.14. The pooled diagnostic odds ratio was 28 (95% CI, 13–63). The pooled sensitivity was 0.90 (95% CI, 0.75–0.96), and the pooled specificity was 0.81 (95% CI, 0.68–0.89) for differential diagnosis of a low-risk or high-risk TET. LR+ was 4.7 and LR− was 0.12. The pooled diagnostic odds ratio was 38 (95% CI, 12–121). In meta-regression analysis, no variable was the source of the study heterogeneity.Conclusions18F-FDG PET or PET/CT has excellent diagnostic performances for characterization of TET. Further large multicenter studies would be necessary to establish the diagnostic accuracy of18F-FDG PET or PET/CT for differentiation of histologic type of TET.
Subdiaphragmatic Lymph Nodes Uptake on 18F-FDG PET/CT After COVID-19 Vaccination in the Thigh
Authors: Quak Elske , Morel Adeline , Faudemer Julie , Levy Christelle , Ciappuccini Renaud 
Published: October 2021

Abstract
Since worldwide COVID-19 vaccination, 18F-FDG uptake in reactive axillary lymph nodes has been frequently observed in PET/CT studies. We describe a patient with breast cancer who underwent 18F-FDG PET/CT 7 days after receiving COVID-19 vaccination in the right thigh. 18F-FDG uptake was observed in nonenlarged right-sided inguinal, iliac, and para-aortic lymph nodes. As the thigh can be used as an alternate site for COVID-19 vaccine injection in case of lymphedema in both arms or for adequate axillary staging in patients with breast cancer, physicians should be aware of such 18F-FDG uptake pattern.
Vertical Comitance of Hypertropia in Congenital and Acquired Superior Oblique Palsy
Authors: Demer Joseph L. 
Published: October 2021

Background:
Ivanir and Trobe have claimed that hypertropia (HT) that is greater in upgaze than downgaze, or equal to it, is characteristic of decompensated congenital superior oblique (SO) palsy and never present in ischemic, traumatic, or tumorous SO palsy. The reliability of this claim was tested in patients with SO palsy confirmed by MRI demonstration of subnormal ipsilesional SO size.

Methods:
Quasi-coronal, surface coil MRI was performed in target-controlled central gaze to identify patients with a unilateral reduction in SO cross section indicative of palsy. Nine patients gave an unequivocal history or had markedly increased vertical fusional amplitudes indicative of congenital onset (mean age 38 ± 16 years, SD). Seven patients had unequivocal acquired onset (age 47 ± 14 years and symptom duration 5.4 ± 4.8 years), including 2 with demonstrated trochlear Schwannoma and 5 with onset after severe head trauma. Fifteen patients had gradually progressive onset unequivocally not congenital yet not associated with any identifiable precipitating event (age 52 ± 20 years and symptom duration 13 ± 14 years).

Results:
Maximum SO cross section averaged 8.6 ± 3.9 mm2 in congenital palsy, not significantly different from 11.3 ± 3.5 mm2 in acquired palsy (P = 0.08) either unequivocally or progressively acquired, but significantly less than about 19 mm2 contralesionally in SO palsy (P < 10−4). Although mean central gaze HT was greater at 20.6 ± 8.0Δ in 9 cases of congenital than that in 22 acquired cases at 11.4 ± 6.8Δ (P = 0.002), HT was 8.4 ± 16.3Δ less in upgaze than downgaze in congenital SO palsy and 3.7 ± 11.2Δ less in acquired SO palsy. In congenital palsy, 33% of patients had HT greater in upgaze than downgaze while in 67% HT was greater in downgaze (by up to 42Δ). In acquired SO palsy, HT was greater in upgaze than downgaze or equal to it in 8 cases (36%, P = 0.87, X2). In acquired SO palsy, HT was greater in upgaze than downgaze in 37% and greater in downgaze than upgaze in 59% of cases. The HT was equal in upgaze and centralgaze in no congenital and 3 acquired cases of SO palsy. Trends were similar in unequivocal acquired and progressive acquired (noncongenital) SO palsy (P > 0.4).

Conclusions:
Hypertropia is not characteristically greater in upgaze than downgaze in congenital SO palsy proven by SO atrophy on MRI. In fact, average HT is greater in downgaze than upgaze in both acquired and congenital palsy, sometimes strikingly so in the latter. The finding of HT greater in upgaze than downgaze, or equal to it, does not reliably indicate that SO palsy is congenital, nor does maximum SO cross section.
SARS-COV-2 γ variant acquires spike P681H or P681R for improved viral fitness
Authors: Yang Xiang-Jiao 
Published: October 2021

ABSTRACTSevere acute respiratory syndrome coronavirus 2 (SARS-COV-2) evolves and generates different variants through a continuously branching model. Four variants of concern have been the major pandemic drivers around the world. One important question is how they may evolve and generate subvariants, some of which may be even more virulent and drive the pandemic further. While investigating how γ (or P.1) variant has been evolving, I noticed the spike substitution P681H in a group of genomes encoding a new subvariant, which has been designated P.1.7. This subvariant has become the dominant P.1 sublineage in Brazil, Italy, Spain and Peru, supporting that P681H confers evolutionary advantage to P.1.7. In Brazil and Peru, P.1.7 was still responsible for ~30% and ~40% cases, respectively, in August 2021. However, it has been competed out by δ1 (a δ subvariant) in both countries, Italy and Spain, suggesting that P.1.7 is not as virulent as δ1. In addition, 160 P.1 genomes possess a related substitution, P681R, and 120 of them encode a new subvariant, designated P.1.8. This P.1 subvariant carries two additional spike substitutions, T470N and C1235F, located at the receptor-binding pocket and cytoplasmic tail of spike protein, respectively. More P.1.8 genomes have been identified than P.1 genomes that encode P681R but not T470N and C1235F, suggesting that these two substitutions improve virulence of P.1.8 subvariant. Some P.1 genomes carry other substitutions (such as N679K, V687L and C1250F) that affect the furin cleavage site or cytoplasmic tail of spike protein. Thus, to improve viral fitness and expand its evolutionary cage, γ variant acquires mutations to finetune the furin cleavage site and cytoplasmic tail of spike protein.
The effect of circulating zinc, selenium, copper and vitamin K1on COVID-19 outcomes: a Mendelian randomization study
Authors: Sobczyk Maria K. , Gaunt Tom R. 
Published: October 2021

ABSTRACTBackgroundPrevious results from observational, interventional studies and in vitro experiments suggest that certain micronutrients have anti-viral and immunomodulatory activities. In particular, it has been hypothesized that zinc, selenium, copper and vitamin K1have strong potential for prophylaxis and treatment of COVID-19.ObjectivesWe aimed to test whether genetically predicted Zn, Se, Cu or vitamin K1levels have a causal effect on COVID-19 related outcomes: risk of infection, hospitalization and critical illness.MethodsWe employed two-sample Mendelian Randomization (MR) analysis. Our genetic variants derived from European-ancestry GWAS reflected circulating levels of Zn, Cu, Se in red blood cells as well as Se and vitamin K1in serum/plasma. For the COVID-19 outcome GWAS, we used infection, hospitalization or critical illness. Our inverse-variance weighted (IVW) MR analysis was complemented by sensitivity analyses: more liberal selection of variants at genome-wide subsignificant threshold, MR-Egger and weighted median/mode tests.ResultsCirculating micronutrient levels show limited evidence of association with COVID-19 infection with odds ratio [OR] ranging from 0.97 (95% CI: 0.87-1.08,p-value=0.55) for zinc to 1.07 (95% CI: 1.00-1.14,p-value=0.06) – ie. no beneficial effect for copper, per 1 SD increase in exposure. Similarly minimal evidence was obtained for the hospitalization and critical illness outcomes with OR from 0.98 (95% CI: 0.87-1.09,p-value=0.66) for vitamin K1 to 1.07 (95% CI: 0.88-1.29,p-value=0.49) for copper, and from 0.93 (95% CI: 0.72-1.19,p-value=0.55) for vitamin K1to 1.21 (95% CI: 0.79-1.86,p-value=0.39) for zinc, respectively.ConclusionsThis study does not provide evidence that supplementation with zinc, selenium, copper or vitamin K1can prevent SARS-CoV-2 infection, critical illness or hospitalization for COVID-19.
Post-transcriptionally regulated genes are essential for pluripotent stem cell survival
Authors: Iwasaki Mio , Kawahara Yuka , Tabata Tsuyoshi , Nishi Yohei , Narita Megumi , Ohta Akira , Saito Hirohide , Yamamoto Takuya , Nakagawa Masato , Yamanaka Shinya , Takahashi Kazutoshi 
Published: October 2021

SummaryThe effects of transcription factors on the maintenance and differentiation of pluripotent stem cells (PSCs) have been well studied. However, the importance of post-transcriptional regulatory mechanisms, which cause the quantitative dissociation of mRNA and protein expression, has not been explored in detail. Here, by combining transcriptome and proteome profiling, we identified 228 post-transcriptionally regulated genes with strict upregulation of the protein level in PSCs. Among them, we found that 84 genes were vital for the survival of PSCs and HDFs, including 20 genes that were specifically necessary for the survival of PSCs. These 20 proteins were upregulated only in PSCs and not in differentiated cells derived from the three germ layers. Subcellular fractionation of the mRNA showed that the expression of most of the 20 proteins was regulated at the mRNA localization stage from the nucleus to the cytoplasm, but their translation efficiency was constant. Together, these results revealed that post-transcriptionally regulated genes have a crucial role in PSC survival.