bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pneumococcal Serotype-specific Opsonophagocytic Activity in Interleukin-1 Receptor-associated Kinase 4-deficient Patients
Authors: Uehara Tomoko , Morino Saeko , Oishi Kazunori , Nakamura Yukitsugu , Togashi Noriko , Imaizumi Masue , Nishimura Shiho , Okada Satoshi , Yara Asao , Fukushima Hiroko , Imagawa Kazuo , Takada Hidetoshi 
Published: January 2021

Background:
The antibody response after pneumococcal vaccines and their effectiveness against invasive pneumococcal disease (IPD) in patients with interleukin-1 receptor-associated kinase 4 (IRAK4) deficiency have not been fully evaluated. Here, we evaluated pneumococcal serotype-specific opsonophagocytic activity (OPA) in IRAK4-deficient patients along with their clinical course.

Methods:
We investigated 6 IRAK4-deficient patients in Japan, whose attending physicians could be contacted. We performed OPA measurements using stored and more recent serum samples obtained from these patients.

Results:
All patients had received pneumococcal vaccination. Among the 3 patients who had IPD, 2 had an episode of pneumococcal meningitis and the other developed pneumococcal bacteremia 3 years after the occurrence of pneumococcal meningitis. Only one episode of invasive bacterial infection was caused by a Streptococcus pneumoniae vaccine-type strain. An increased opsonization index was found in the sera after vaccination for all IRAK-deficient patients, including when the 23-valent pneumococcal polysaccharide vaccine was used.

Conclusions:
A significant increase in levels of OPA against most of the pneumococcal vaccine antigens was observed for all IRAK4-deficient patients. However, IPD could not be prevented by pneumococcal vaccination alone. Therefore, adequate prophylaxis should be provided with antibiotics at least until 8 years of age, along with regular immunoglobulin therapy, particularly during the infantile period.
Application of a Pneumococcal Serotype-specific Urinary Antigen Detection Test for Identification of Pediatric Pneumonia in Burkina Faso
Authors: Bountogo Mamadou , Sanogo Bintou , Pride Michael W. , Jiang Qin , Nikièma Zakari , Njanpop-Lafourcade Berthe-Marie , Ouédraogo Abdou Salam , van der Linden Mark P. G. , Moisi Jennifer , Tall Haoua , Essoh Alima , Betsem Edouard , Gessner Bradford D. , Meda Nicolas 
Published: January 2021

Background:
Serotype-specific diagnosis of pneumococcal community-acquired pneumonia in children under age 5 years would mark a major advancement for understanding pneumococcal epidemiology and supporting vaccine decision-making.

Methods:
A Luminex technology-based multiplex urinary antigen detection (UAD) diagnostic assay was developed and subsequently validated in adults, but its applicability to children is unknown. This study aimed to set appropriate cutoffs for use of the UAD in a healthy pediatric population and apply these cutoffs in children with pneumonia in sub-Saharan Africa. The cutoffs were determined by assessing 379 urines obtained from healthy children under age 5 years from the Bobo-Dioulasso area for serotypes included in 13-valent pneumococcal conjugate vaccine (UAD-1) and the 11 other serotypes unique to 23-valent pneumococcal polysaccharide vaccine (UAD-2).

Results:
Based on the assigned cutoff values, among 108 children who met the World Health Organization consolidation endpoint criteria, UAD-1 and UAD-2 were positive in 23.3% and 8.3%, respectively; among 364 children with clinically suspected pneumonia who did not meet the World Health Organization criteria, UAD-1 and UAD-2 were positive for 6.6% and 3.6%, respectively. Pneumococcal carriage prevalence was similar among pneumonia cases (30%) versus controls (35%) as was semiquantitative carriage density.

Conclusions:
UAD-1 and UAD-2 were able to distinguish community controls from children with pneumonia, particularly pneumonia with consolidation. Future studies are needed to confirm these results and more fully assess the contribution of pneumococcal carriage and concurrent viral infection.
Multisystem Inflammatory Syndrome in an Adult With COVID-19
Authors: Brown Leah M. , Semler Matthew W. , Hansen Megan , Person Anna K. , Kelly Sean G. 
Published: January 2021

Abstract
Multisystem inflammatory syndrome (MIS) in children is a severe illness characterized by fever, laboratory evidence of inflammation, and multisystem organ dysfunction resulting from severe acute respiratory syndrome coronavirus 2 infection in a patient younger than 21 years. We present the case of a 39-year-old man with evidence of prior COVID-19 who seemed to meet all non–age-related criteria for MIS in children as well as criteria for the working definition of MIS in adults, and who improved after treatment with aspirin, corticosteroids, and intravenous immunoglobulin. Clinicians should be aware of this new inflammatory illness, not only in children but potentially also in adults with antecedent or concurrent COVID-19.
A Case Report of the Hospital-Acquired Coronavirus Disease 2019 Pneumonia
Authors: Adedeji Adekola , Riffle Lori , Charoenpong Prangthip , Mohammed Alam 
Published: January 2021

Abstract
This study presented a case of coronavirus disease 2019 pneumonia in a patient in isolation for 103 days. Severe acute respiratory syndrome coronavirus 2 was positive in her last 4 days. Despite policies of temperature checks for employees and visitors, and employees facing patients wearing a mask, the transmission of severe acute respiratory syndrome coronavirus 2 from an asymptomatic carrier was inevitable.
Defining the nocturnal period in 24-h ambulatory blood pressure monitoring: a comparison of three methods
Authors: Slusniene Anzela , Navickas Petras , Stankus Albinas , Lauceviciene Ieva , Ryliskyte Ligita , Laucevicius Aleksandras 
Published: January 2021

Objectives
The purpose of our study was to compare three definitions of ambulatory blood pressure (BP) nocturnal period and to assess their agreement in determining nocturnal BP dipping patterns.

Methods
We investigated 69 subjects with metabolic syndrome, aged 50–55 years. In all subjects, we assessed 24-h BP monitoring, electrocardiogram and actigraphy profiles. The nocturnal period was defined in three ways: as a fixed narrow nighttime period from 01:00 to 06:00, as a self-reported sleeping period and as a disappearance and onset of physical activity recorded by the actigraph.

Results
Our study revealed a significant discrepancy between the self-reported and actigraphy-based nocturnal periods (P < 0.001). In addition, different definitions of the nighttime yielded significant differences in determining nondipping, extreme dipping and dipping BP patterns, the identification of the latter being affected the most. The actigraphy-based approach best aligned with the fixed-time determination of the nocturnal period: Cohen’s kappa coefficient for the nondipping pattern was 0.78 (0.58–1), for the dipping pattern 0.75 (0.59–0.91) and for the extreme dipping pattern 0.81 (0.65–0.97). In comparison to the self-reported determination of the nocturnal period, using the actigraphy-based approach resulted in reclassifying the nocturnal BP pattern in 20.3% of subjects.

Conclusions
The lack of agreement between fixed-time, self-reported and actigraphy-based determinations of the nighttime period affects the identification of the nocturnal BP patterns. In comparison to the self-reported nocturnal period estimation, the actigraphy-based approach results in the reclassification of BP dipping status in every fifth subject.
Comparison of a tonometric with an oscillometric blood pressure monitoring device over 24 hours of ambulatory use
Authors: Miranda Hurtado Martin , Reyes Vasquez Javiera , Rodriguez-Fernandez Maria 
Published: January 2021

Purpose
Multiple devices capable of measuring ambulatory blood pressure without cuffs have been recently developed and it is required that they offer high-accuracy measurements. The purpose of this prospective study was to compare the performance of a tonometric blood pressure monitor with that of an oscillometric cuff-based device used as a reference in healthy and hypertensive subjects over 24 hours of ambulatory use.

Materials and methods
Conventional oscillometric cuff-based device (Oscar 2; Sun Tech Medical) was placed in the left arm of 33 subjects, and a watch-type device based on the tonometric method (Bpro; HealthSTATS International, Singapore) was positioned in the right wrist. Both devices were synchronized to measure simultaneously over 24 hours.

Results
The difference between the means over 24 hours of the oscillometric and the tonometric devices was −0.9 mmHg for SBP and −4.5 mmHg for DBP; the standard deviations were 14.7 and 12.2 mmHg, respectively. Greater differences in bias and dispersion were observed overnight than during the daytime. The accuracy of the tonometric device for diagnosing hypertension was 75% and for detecting the non-dipper profile, 48%.

Conclusion
The test device presented a high disagreement (especially during the night) compared to the oscillometric cuff-based device against which it was initially calibrated. This disagreement resulted in limited accuracy for diagnosing patients with suspected arterial hypertension and detecting non-dipper profiles.
Identification of an Infected Urachal Cyst Using Point-of-Care Ultrasound
Authors: Austin Samuel , Jersey Candice , Soltis Michael , Chicaiza Henry 
Published: January 2021

Abstract
This case describes a 6-year-old girl who presented to the pediatric emergency department with 3 days of fever and suprapubic pain in the setting of 1 month of worsening, dull abdominal pain. On presentation, she had a tender, erythematous, and fluctuant mass on her lower abdomen. Point-of-care ultrasound was used to identify an abnormal fluid collection anterior to her bladder, suspicious for an infected urachal cyst. In this case, point-of-care ultrasound helped identify this uncommon finding in a timely fashion, which expedited definitive care and prevented unnecessary exposure to ionizing radiation.
Local Treatment of Triple-Negative Breast Cancer
Authors: Machiels Melanie , Kaidar-Person Orit , Rubio Isabel T. , Poortmans Philip 
Published: January 2021

Abstract
Triple-negative breast cancer, compared with other molecular subtypes, poses particular challenges for optimizing the timing and the extent of locoregional treatments. In the past, the combination of increased rates of both locoregional and distant recurrences led to a preference of radical surgery and extensive radiation therapy; however, since the introduction of more effective chemotherapy, a sharp de-escalation in the extent of locoregional treatments followed. Current evidence confirms that less aggressive surgery in combination with tailored radiation therapy offers improved oncological outcomes combined with better quality of life. However, further research is required to optimize locoregional treatments, considering the significant heterogeneity in biological behavior and tumor response to systemic treatments.
Ultrasound Evaluation of the Axilla in the Breast Imaging Setting
Authors: Teichgraeber Davis C. , Perez Frances , Guirguis Mary S. , Kapoor Megha M. , Whitman Gary J. 
Published: January 2021

Abstract
Ultrasound evaluation of the axilla plays a critical role in the setting of newly diagnosed breast cancer as surgical management evolves toward more targeted axillary nodal resection. Regional nodal involvement by metastatic carcinoma is one of most important prognostic factors in breast cancer and guides local, regional, and systemic treatment. Ultrasound also evaluates response to neoadjuvant chemotherapy. This article will review ultrasound techniques and the anatomy and the morphology of axillary lymph nodes. Lymph node staging in breast cancer will also be discussed. Ultrasound-guided interventions and localizations and emerging technologies of elastography and contrast-enhanced ultrasound will be discussed. In addition, this article will discuss the role of ultrasound as it applies to management of the axilla since the American College of Surgeons Oncology Group Z011 and Z1071 trials. Finally, other causes of benign and malignant axillary lymphadenopathy, not related to breast cancer, are discussed.
Breast Reconstruction and Nipple-Sparing Mastectomy
Authors: Pestana Ivo A. , Jones V. Morgan , Velazquez Christine 
Published: January 2021

Background
Superior aesthetic outcomes can be achieved with mastectomy techniques that maximize breast envelope preservation and maintain the nipple-areolar complex. This is the impetus for the popularization of the nipple-sparing mastectomy (NSM). Nipple-sparing mastectomy is a challenging procedure due to potential ischemia of the mastectomy flap (which includes the nipple-areolar complex) and the risk of incomplete oncologic resection. We review our experience with NSM, identify technique modifications used over time, and evaluate reconstructive outcomes of NSM and its modifications.

Methods
A retrospective review of consecutive patients with NSM and breast reconstruction over an 8-year period was completed.

Results
Fifty-five patients underwent 95 NSMs. Indications included invasive and in situ cancer, atypical ductal hyperplasia, and risk reduction. In the first 4 years of experience, the most frequently used NSM incision was radial (lateral) whereas use of a variety of incision patterns was noted in the second 4 years. Overall NSM and breast reconstruction complication rate for the entire study period was 50.9% and included a full-thickness mastectomy skin flap necrosis/nipple necrosis rate of 8.4%. In situ cancer of the nipple was identified in 3.2% of the patients, and 1 patient had locoregional recurrence. Overall complication rate was lower in the second 4 years of experience with NSM and reconstruction. One third of the patients underwent intraoperative fluorescent angiography (FA) to assess mastectomy skin perfusion before reconstruction start. Of the patients who had FA due to perfusion concerns, more than 70% of studies demonstrated poor perfusion and 83.3% of these patients had reconstruction delayed based on these results. Immediate, implant-based reconstruction was performed most commonly. An average of 2.66 procedures were required to achieve reconstruction completion, and 92.4% of the patients who sought reconstruction achieved completion.

Conclusions
At our institution, NSM use is increasing, NSM incision pattern types used are expanding, and complication rates are decreasing. Immediate, implant-based reconstruction is most commonly used in combination with NSM at our institution. Fluorescent angiography is used to assess mastectomy skin perfusion and likely limits mastectomy complication effects on reconstruction. Despite the occurrence of complications, most patients will complete the breast reconstruction process.
Association Between Postoperative Complications and Long-term Survival After Non-cardiac Surgery Among Veterans
Authors: Portuondo Jorge I. , Itani Kamal M. F. , Massarweh Nader N. 
Published: January 2021

Objective:
To evaluate the relationship between postoperative complications and long-term survival.

Summary and Background:
Postoperative complications remain a significant driver of healthcare costs and are associated with increased perioperative mortality, yet the extent to which they are associated with long-term survival is unclear.

Methods:
National cohort study of Veterans who underwent non-cardiac surgery using data from the Veterans Affairs Surgical Quality Improvement Program (2011–2016). Patients were classified as having undergone outpatient, low-risk inpatient, or high-risk inpatient surgery. Patients were categorized based on number and type of complications. The association between the number of complications (or the specific type of complication) and risk of death was evaluated using multivariable Cox regression with robust standard errors using a 90-day survival landmark.

Results:
Among 699,002 patients, complication rates were 3.0%, 6.1%, and 18.3% for outpatient, low-risk inpatient, and high-risk inpatient surgery, respectively. There was a dose-response relationship between an increasing number of complications and overall risk of death in all operative settings [outpatient surgery: no complications (ref); one—hazard ratio (HR) 1.30 (1.23 – 1.38); multiple—HR 1.61 (1.46 – 1.78); low-risk inpatient surgery: one—HR 1.34 (1.26 – 1.41); multiple—HR 1.69 (1.55 – 1.85); high-risk inpatient surgery: one—HR 1.14 (1.10 – 1.18); multiple—HR 1.42 (1.36 – 1.48)]. All complication types were associated with risk of death in at least 1 operative setting, and pulmonary complications, sepsis, and clostridium difficile colitis were associated with higher risk of death across all settings. Conclusions: Postoperative complications have an adverse impact on patients’ long-term survival beyond the immediate postoperative period. Although most research and quality improvement initiatives primarily focus on the perioperative impact of complications, these data suggest they also have important longer-term implications that merit further investigation.
Long-term Metabolic Morbidity and Steatohepatosis Following Standard Pancreatic Resections and Parenchyma-sparing, Local Extirpations for Benign Tumor
Authors: Beger Hans G. , Mayer Benjamin , Vasilescu Catalin , Poch Bertram 
Published: January 2021

Objective:
To assess metabolic dysfunctions and steatohepatosis after standard and local pancreatic resections for benign and premalignant neoplasms.

Summary of Background Data:
Duodenopancreatectomy, hemipancreatectomy, and parenchyma-sparing, limited pancreatic resections are currently in use for nonmalignant tumors.

Methods:
Medline, Embase, and Cochrane libraries were searched for studies reporting measured data of metabolic functions following PD, pancreatic left resection (PLR), duodenum-sparing pancreatic head resection (DPPHR), pancreatic middle segment resection (PMSR), and tumor enucleation (TEN). Forty cohort studies comprising data of 2729 patients were eligible.

Results:
PD for benign tumor was associated in 46 of 327 patients (14.1%) with postoperative new onset of diabetes mellitus (pNODM) and in 109 of 243 patients (44.9%) with postoperative new onset of pancreatic exocrine insufficiency measured after a mean follow-up of 32 months. The meta-analysis displayed pNODM following PD in 32 of 204 patients (15.7%) and in 10 of 200 patients (5%) after DPPHR [P < 0.01; OR: 0.33; (95%-CI: 0.15–0.22)]. PEI was found in 77 of 174 patients following PD (44.3%) and in 7 of 104 patients (6.7%) following DPPHR (P < 0.01;OR: 0.15; 95%-CI: 0.07–0.32). pNODM following PLR was reported in 107 of 459 patients (23.3%) and following PMSR 23 of 412 patients (5.6%) (P < 0.01; OR: 0.20; 95%-CI: 0.12–0.32). Postoperative new onset of pancreatic exocrine insufficiency was found in 17% following PLR and in 8% following PMSR (P < 0.01). pNODM following PPPD and tumor enucleation was observed in 19.7% and 5.7% (P < 0.03) of patients, respectively. Following PD/PPPD, 145 of 608 patients (23.8%) developed a nonalcoholic fatty liver disease after a mean follow-up of 30.4 months. Steatohepatosis following DPPHR developed in 2 of 66 (3%) significantly lower than following PPPD (P < 0.01).

Conclusion:
Standard pancreatic resections for benign tumor carry a considerable high risk for a new onset of diabetes, pancreatic exocrine insufficiency and following PD for steatohepatosis. Parenchyma-sparing, local resections are associated with low grade metabolic dysfunctions.
Palliative and end-of-life care for the older adult with cancer
Authors: Huynh Lise , Moore Jennifer 
Published: January 2021

Purpose of review
Despite established benefits of palliative care in the oncology population, it remains an underutilized resource particularly among older adults. The illness trajectory and needs of an older adult with cancer are unique. The purpose of this paper is to review the current literature on providing comprehensive palliative and end-of-life care for the older adult with cancer.

Recent findings
Though the difficulties of applying traditional palliative care principles in the older patients with cancer have been discussed, this review reveals a clear gap in the literature in discussing the provision of comprehensive palliative and end-of-life care in this population. Very few articles have been published in this domain with even fewer published within the past 18 months.

Summary
As such, this article reviews key aspects of palliative and geriatric medicine that need to be considered and integrated in order to provide comprehensive palliative care to the older adult with cancer. This includes a discussion of proper pain and symptoms assessment, performance status assessment, advance care planning, and end-of-life care while considering the nuances of geriatric syndromes.
Docosahexaenoic acid decreased inflammatory gene expression, but not 18-kDa translocator protein binding, in rat pup brain after controlled cortical impact
Authors: Schober Michelle Elena , Requena Daniela F. , Ohde Joshua W. , Maves Sydney , Pauly James R. 
Published: January 2021

BACKGROUND
Traumatic brain injury is the leading cause of acquired neurologic disability in children. In our model of pediatric traumatic brain injury, controlled cortical impact (CCI) in rat pups, docosahexaenoic acid (DHA) improved lesion volume and cognitive testing as late as postinjury day (PID) 50. Docosahexaenoic acid decreased proinflammatory messenger RNA (mRNA) in microglia and macrophages at PIDs 3 and 7, but not 30. We hypothesized that DHA affected inflammatory markers differentially relative to impact proximity, early and persistently after CCI.

METHODS
To provide a temporal snapshot of regional neuroinflammation, we measured 18-kDa translocator protein (TSPO) binding using whole brain autoradiography at PIDs 3, 7, 30, and 50. Guided by TSPO results, we measured mRNA levels in contused cortex and underlying hippocampus for genes associated with proinflammatory and inflammation-resolving states at PIDs 2 and 3.

RESULTS
Controlled cortical impact increased TSPO binding at all time points, most markedly at PID 3 and in regions closest to impact, not blunted by DHA. Controlled cortical impact increased cortical and hippocampal mRNA proinflammatory markers, blunted by DHA at PID 2 in hippocampus.

CONCLUSION
Controlled cortical impact increased TSPO binding in the immature brain in a persistent manner more intensely with more severe injury, not altered by DHA. Controlled cortical impact increased PIDs 2 and 3 mRNA levels of proinflammatory and inflammation-resolving genes. Docosahexaenoic acid decreased proinflammatory markers associated with inflammasome activation at PID 2. We speculate that DHA’s salutary effects on long-term outcomes result from early effects on the inflammasome. Future studies will examine functional effects of DHA on microglia both early and late after CCI.