bluuebunny/crossref_metadata_2025_split huggingface dataset:
The survival of non-traumatic osteonecrosis of femoral head at ARCO II with ring-shaped sclerotic zone: a mid-term follow-up retrospective study
Authors: Wu Zhong-Shu , Hong Guoju , Yang Peng , Yang Fan , Chen Zhen-Qiu , He Wei , Wei Qiu-Shi 
Published: March 2021

AbstractThe sclerotic zone in the osteonecrosis of femoral head (ONFH), containing condensed trabecular bone and abundant neovascularization, is the transition area between osteonecrosis and normal tissue. Due to the prominent feature in ONFH, the characteristics of the sclerotic zone might indicate the femoral head survival of the disease. Thirty ONFH patients (41 hips) with ring-shaped sclerotic zone at Association Research Circulation Osseous-II were recruited during 1996 to 2019, and the corresponding radiographic images in their follow-up are reviewed retrospectively. Two subtypes (type A and B) are defined to discriminate different locations of ring-shaped sclerotic zone in the femoral head (center or subchondral bone plate) in accordance with the radiographic images. The natural history of the enrolled subjects was followed up for average 9 years to record and compare their collapse incidences as well as the progress of hip symptoms. Chi-square test shows that the occurrence rates of symptomatic hip of type A are significantly lower than that of type B and differences between these two groups were significant (P &lt; 0.05). Kaplan Meier survival curve analysis shows that the mean survival time of type A is 247.600 M (95% CI: 203.072 ∼ 292.128 M) and type B is 88.795 M (95% CI: 72.607 ∼ 104.984 M). The survival rate of femoral head of type A is significantly higher than that of type B (P &lt; 0.005). This study demonstrates that type A shows a more satisfactory clinical outcomes and lower femoral head collapse rate in a mid-term follow-up.
#40: Next-generation Sequencing Improves the Diagnosis of Uncommon Infection in children with Hematologic Malignancies: A Case Series Study
Authors: Zhou Mi , Xiao Peifang , He Hailong , Lu Jun , Li Jie , Hu* Shaoyan 
Published: March 2021

Abstract

Background
Children with hematological malignancies are at high risk of infection. Various kinds of pathogens may cause infection in these patients. The effect of traditional methods on these patients is not ideal.

Methods
This was a case series study. The cases of five patients with clinical symptoms of pulmonary infection. Next-generation sequencing (NGS) was used to identify pathogens in these 5 patients.

Results
Uncommon pathogens were detected in five patients. Case information are shown in Table 1.

Conclusion
NGS may serve as a promising tool for rapid and accurate etiological diagnosis, which could greatly improve the diagnosis of uncommon infection in children with hematologic malignancies.
#18: Brincidofovir for the Treatment of Disseminated Human Adenovirus Infection in Pediatric Solid-organ Transplant Recipients
Authors: Londeree Jackson , Garro Rouba , Romero Rene , George Roshan , Winterberg Pamela , Liverman Rochelle , Serluco Anastacia , Shin Stella , Yildirim Inci 
Published: March 2021

Abstract

Background
Human adenovirus (HAdV) viremia can cause significant morbidity among pediatric patients undergoing solid-organ transplantation (SOT). Currently, there are no US Food and Drug Administration (FDA)-approved treatments for HAdV infections, and historically the mainstay of treatment has been decreasing immunosuppression with antiviral therapies reserved for those with severe disease. Brincidofovir (BCV) is an investigational antiviral drug with potency against HAdV. We describe four cases of disseminated HAdV infection treated with (BCV) among pediatric SOT patients.

Methods
We retrospectively reviewed 4 cases of severe disseminated HAdV infection, which occurred between 2018 and 2019, in a tertiary pediatric transplant center. HAdV infection was defined as a positive HAdV PCR from a clinical specimen. Baseline clinical characteristics, disease course, treatment, and outcomes were reviewed.

Results
Four pediatric SOT patients (2 kidneys, 1 dual kidney/liver, and 1 liver) ranging in age from 9 months to 19 years were diagnosed with HAdV infection (Table 1). Patients presented with varied symptoms from 12 to 912 days post-transplant. Peak HAdV viral load ranged from 37,000 to &gt;1,000,000 copies/mL. All patients had disseminated disease with evidence of graft involvement and varying degrees of acute kidney injury (AKI) making them candidates for BCV therapy over cidofovir to avoid nephrotoxicity. Three out of four patients received cidofovir prior to conversion to BCV. IRB-approved compassionate use of BCV was dosed at 2 mg/kg (max 100 mg) twice weekly PO along with reduced immunosuppression. Resolution of symptoms and HAdV viremia was seen at a mean of 21.5 days (range 15–32) of therapy. All patients had resolution of AKI with a return to baseline creatinine after therapy.

Conclusions
Though HAdV infection in pediatric SOT patients is uncommon, a subset of patients experience severe disease, morbidity, and graft loss. Currently, HAdV is not routinely monitored in pediatric SOT transplant patients. Although supportive care and decreased immunosuppression remain as the most important component of therapy, BCV was well tolerated and efficacious in our series. Further research is needed to better understand risk factors for HAdV infection and potential antiviral treatment options to improve patient outcomes.
#30: Patterns of Post-Exposure Prophylaxis for Varicella-Zoster Virus in Pediatric Patients
Authors: Sun Shan , Patel Sameer , Jhaveri Ravi 
Published: March 2021

Abstract

Background
Varicella-Zoster virus (VZV) is still a significant threat for severe illness for patients in high-risk groups. These patients are candidates for post-exposure prophylaxis (PEP), but among adult providers there is significant variation on what agents are used for PEP. There are little data on PEP practices among pediatric providers.

Objective
We sought to define patterns of PEP for VZV exposure across children’s hospitals.

Methods
Using the Pediatric Health Information Systems database, we analyzed claims data for the relevant ICD-9/10 codes for VZV exposure from 2009 to 2018. We evaluated patients for subsequent VZV disease, and we also evaluated how frequently PEP was given, how many days after the exposure or admission, and what agent was used for PEP. We analyzed annual data and institutional-level data over the study period and looked for trends over time. We performed Kruskal–Willis testing when comparing more than two independent samples of equal or different sample sizes.

Results
Over the 10 years, we identified 1726 children with VZV exposure, 1622 of them with only one exposure. Of these 1662 children, 683 (42.1%) were prescribed some form of PEP after VZV exposure, while 75 (4.6%) ultimately developed some form of symptomatic VZV. Among the agents used for VZV PEP, acyclovir along was the most frequently used overall, but its use declined over time (45% in 2009 to 30% in 2018). Immunoglobulin was the second most used option (26–43%), while a consistent percentage (4–19%) of children also received the combination of acyclovir and IG. Varicella-specific immune globulin (VariZIG) was used sparingly before 2013, but its use was more frequent from 2015 to 2018 (23–27%). Most children receiving VZV PEP had some form of malignancy, with various newborn populations comprising most of the rest of PEP recipients. Efficacy in preventing VZV was significantly different: 27/218 (12.4%) of children with acyclovir PEP ultimately had a VZV-diagnosis code, compared with 1/148 (0.7%) and 1/112 (0.9%) treated, respectively, with either IG or VariZIG (P &lt; 0.0001).

Conclusions
Increasing use of VariZIG likely corresponded to widespread US availability after a long market absence. Nonetheless, the management of VZV PEP in children with high-risk conditions varied considerably across institutions. As the CDC and AAP Red Book list VariZIG as the primary option for PEP, there is considerable room to optimize PEP practice and reduce breakthrough VZV infections.
#79: Modeling Zika Virus Tissue Tropism in Rhesus Macaques to Define the Risk of Donor-derived Transmission
Authors: Treadway Taylor A , Shepherd Phoenix M , Newman Christina M , Mohr Emma L , Dudley Dawn M , Breitbach Meghan E , Yamamoto Keisuke , Stewart Laurel M , Koenig Michelle R , Bliss Mason , Rybarczyk Sierra L , Weiler Andrea M , Semler Matthew R , Mitzey Ann , Razo Elaina , Schotzko Michele , Peterson Eric , Simmons Heather A , Mejia Andres , Golos Thaddeus G , Friedrich Thomas C , O’Connor David H 
Published: March 2021

Abstract

Background
Almost 115,000 people in the United States are currently on a transplant waitlist, which vastly exceeds the number of organ donors every year. This discrepancy emphasizes the need for retention of all possible donors. Those who have recently traveled to an area with an active outbreak of Zika virus (ZIKV) are often disqualified as a donor because immunosuppressed recipients would be at risk of a donor-derived ZIKV infection. Therefore, we define ZIKV tissue tropism and the risk of donor-derived transmission.

Methods
We subcutaneously inoculated 15 Indian-origin rhesus macaques (RM) with a Puerto Rican isolate of ZIKV (PRVABC59). All RMs were inoculated in mid to early gestation. We inoculated during pregnancy because plasma viremia is typically prolonged in pregnancy and we wanted to model tissue tropism for donor-derived transmission in the worst scenario of prolonged viremia. At 30, 65, and 105 days post-infection (dpi), the animals were euthanized and comprehensive necropsies were performed, which evaluated a minimum of 60 tissues per animal. ZIKV RNA was quantified in tissues via qRT-PCR.

Results
Plasma viremia duration was &gt;10 days in 13 of 15 RMs. ZIKV RNA was most commonly detected in lymph nodes, with 19/45 lymph nodes that were vRNA positive in 5 RMs at 30 dpi. There were 15/45 vRNA positive lymph nodes at 60 dpi and 8/38 at 105 dpi. Reproductive and maternal fetal-interface (MFI) tissues were the second most commonly positive tissues. Twenty-five MFI tissues, including the amniotic/chorionic membrane, decidua, placenta, uterus, and placental bed, were positive, with 10/53 positive at 30 dpi, 14/24 positive at 60 dpi and 1/47 positive at 105 dpi. Other vRNA positive tissues included the primary bronchus, femoral vein, kidney, thyroid, lung, colon, mammary gland, pericardium, hand nerve, and sciatic nerve in 1–2 RMs at one of the three timepoints.

Conclusions
We found ZIKV RNA most frequently within lymph nodes. Lymph nodes are included in lung and small bowel transplants, indicating that these transplants could pose a risk of donor-derived ZIKV transmission. Virus detection within other commonly transplanted tissues, such as the kidney and blood vessels was much less common. We did not determine what fraction of vRNA comes from replication-competent virus in each tissue; some tissues with vRNA might not contain virions that could initiate new infections. Donor-derived Zika virus transmission from other commonly transplanted organs, such as the liver, seems unlikely since no viral RNA was detected in this organ.
#87: Association Between Healthcare-Associated Respiratory Viral Infections and Length of Stay at a Pediatric Hospital
Authors: Most Zachary , Sebert Michael , Jackson Patricia , Perl Trish M 
Published: March 2021

Abstract

Background
Healthcare-associated infections (HAI) are major preventable causes of morbidity and mortality. While there are fewer overall HAI in children, there is a greater potential impact in disability-adjusted life years. Healthcare-associated respiratory viral infections (HARVI) are not frequently tracked within institutions, yet the risk for such infections in pediatric hospitals is very high. Recent data demonstrate large inter-hospital variability of HARVI incidence that may depend on various factors including the number of immunocompromised patients in the hospital and the presence of shared rooms. We hypothesize that the burden of healthcare-associated respiratory viral infections and their impact on the length of stay (LOS) is substantial at a large urban pediatric hospital.

Methods
A cohort of all children with any HARVI admitted to a large urban pediatric hospital between July 2017 and June 2018 were included after obtaining IRB approval. We defined a HARVI as a respiratory infection with an onset of symptoms while the patient was hospitalized meeting three criteria: A positive microbiologic test for one of 8 viruses, presence of symptoms of a respiratory infection, and onset of symptoms after admission beyond the minimum incubation period for each virus. Infections with symptom onset after admission beyond the maximum incubation period were considered definite hospital onset whereas others were considered possible hospital onset. The electronic medical record provided data on demographics, underlying medical conditions, hospital length of stay prior to infection and hospital unit of infection, and consequences and outcome of HARVI. The at-risk population for calculation of the incidence of HARVI was all admitted patient-days at the hospital over this time period.

Results
Between July 2017 and June 2018 the incidence of HARVI (definite or possible hospital onset) was 1.2 infections per 1,000 admitted patient-days (60% due to rhinovirus/enterovirus, 12% due to respiratory syncytial virus, and 9% due to influenza). Overall, 48% of patients were under 2 years of age, 18% were between 2 and 5 years of age, and 34% were over 5 years of age. Twenty-one percent were immunocompromised and 35% had underlying lung disease. The median length of stay prior to symptom onset was 11 days (IQR 5–36 days) and the median total length of stay was 30 days (IQR 15–82.5 days). Eight individuals had more than one HARVI over this time period. Nineteen percent were transferred to the intensive care unit and 7% died during their hospital admission

Conclusion
HARVI occurs frequently in a pediatric hospital and often in patients with underlying comorbidities. The risk for HARVI increases substantially with increased length of stay. Such data support the need for tracking HARVI in high-risk institutions.
#8: Survival Analysis in Childhood Acute Myeloblastic Leukemia: Do Infection and Lymphocyte-Mediated Immune Response Play a Role?
Authors: Ardianto Bambang ,   Christine, Triasih Rina , Supriyadi Eddy , Widjajanto Pudjo Hagung , Mulatsih Sri , Pangarso Alexandra Widita Swipratami , Armytasari Inggar , Purwanto Ignatius ,   Sutaryo
Published: March 2021

Abstract

Background
Acute myeloblastic leukemia (AML) is the second most prevalent cancer among Indonesian children. In contrast, to those of acute lymphoblastic leukemia (ALL), a number of studies reported unfavorable outcomes following the initiation of cytostatic protocols for childhood AML. In addition, our previous study showed that Gram-negative bacterial infection constitutes the major cause of treatment-related mortality in children with AML. These findings raised a question on the prognostic role of diagnostic lymphopenia, which represents the immunosuppressive state, as demonstrated in adult patients with solid tumors.

Methods
A retrospective cohort study, which involved children younger than 18 years of age with the newly diagnosed, non-M3 AML, was conducted. These children were admitted to Dr. Sardjito General Hospital, Yogyakarta, Indonesia, during the period of 2011–2019 and received National Pilot Protocol (2011–2016), Pediatric AML Protocol (2016–2018), and International Society of Pediatric Oncology (SIOP) Pediatric Oncology in Developing Countries (PODC) Protocol with prephase (2018–2019). One-year overall survival (OS) was analyzed, using diagnostic absolute lymphocyte counts (ALC0) of more than 4.5 × 109/L and less than 4.5 × 109/L as the determinants, in accordance with those reported in a number of studies on adult AML.

Results
Sixty-five children, which consisted of 41 (63%) children with ALC0 of more than 4.5 × 109/L and 24 (37%) children with ALC0 of less than 4.5 × 109/L, were eligible for this study. Of these 65 children, 56 (86%) children received Cytosine arabinoside in the first week of treatment (National Pilot Protocol and Pediatric AML Protocol), while 9 (14%) children did not (SIOP PODC Protocol with prephase). OS analysis showed that 44% and 19% of children with ALC0 of more than 4.5 × 109/L and ALC0 of less than 4.5×109/L, respectively, were alive within the first year of treatment. Cox-regression analysis, however, failed to reach statistical significance [hazard ratio (HR), 0.63; 95% confidence interval (95% CI), 0.33–1.18; P = 0.15].

Conclusion
Despite lacked statistical significance, our study showed the superior one-year OS in children with ALC0 of more than 4.5 × 109/L. Our findings, therefore, might indicate the prognostic role of infection and lymphocyte-mediated immune response in childhood AML.
#33: A Tale of Two Pneumos: the Impact of HIV Exposure or Infection Status on Pediatric Carriage of Streptococcus pneumoniae and Pneumocystis jirovecii, a Nested Case–control Analysis from the Pneumonia Etiology Research in Child Health (PERCH) study in Zambia
Authors: Camelo I , Mwananyanda L M , Thea D M , Seidenberg P , Gill C J , Weinstein J R 
Published: March 2021

Abstract

Background
Most pediatric HIV cases in Africa reflect maternal to child transmission (MTCT). The persistently high seroprevalence of HIV in pregnant women (16.6%) and the low rates of mother to child HIV transmission (~2%) have resulted in a high number of children who are HIV exposed but uninfected (HEU). HIV exposed but uninfected (HEU) children have increased rates of morbidity and mortality vs. HIV unexposed and uninfected (HUU).

Methods
To explore the mechanisms behind this phenomenon, each case and control was sampled using a nasopharyngeal NP swab and an oropharyngeal (OP). A multiplex real-time polymerase chain reaction (PCR) assay was used to determine the presence of Streptococcus pneumoniae and Pneumocystis jirovecii in the NP/OP specimens. We compared nasopharyngeal carriage rates of S. pneumoniae and P. jirovecii between HIV-infected, HEU, or HUU case (pneumonia) and control (without pneumonia) children. In bivariate analyses, using carriage as a dichotomous outcome, proportions we compared using chi-square or odds ratios with 95% confidence intervals. In multivariate models, we created logistic and linear regression models adjusting for nutritional status as possible mediators of carriage status.

Results
SP carriage rates were similar between cases and controls. However, density was increased among HIV-infected children vs. HEU or HUU children (15.8 vs. 4.7 vs. 3.6 × 105 copies/mL, respectively). Among cases, PJ carriage among HIV positive, HEU and HUU children was 31%, 15% and 10%,, respectively, (P &lt; 0.05) and carriage density was 63.9, 20.9, and 4.8 × 103 copies/mL, respectively (P &lt; 0.05). In adjusted logistic regression models, HIV-infected cases were slightly more likely to be an S. pneumoniae carrier compared with HUU cases (aOR = 1.1; 95% CI: 0.57–2.14). In contrast, all other case/exposure combinations were less likely to be S. pneumoniae carriers with the lowest adjusted odds among HIV-infected controls children (aOR = 0.34; 95% CI: 0.17–0.71). The odds of being a PJ carrier was almost 6 times higher in HIV-infected cases than in HIV unexposed cases (aOR = 6.63; 95% CI: 3.24–13.54).

Conclusions
We demonstrate that HIV infection and HIV exposure without infection each have an impact on carriage rates and density for S. pneumoniae and P. jirovecii, though the magnitude and nature of these effects differs substantially between the two pathogens. This may be explained in part by differences in immune responses to these two different pathogens. Our analysis provides further evidence of fundamental differences in immune function among HIV exposed but uninfected infants compared with HIV unexposed, uninfected infants.
#66: An Educational Needs Assessment of Oral Health Knowledge, Attitude and Practices Among Graduates of St. Jude Global Infectious Diseases Training Programs
Authors: Pardasani S , Homsi M , Mzayek F , Nolan V G , Caniza M 
Published: March 2021

Abstract

Background
Chemotherapy and radiotherapy for oncologic diseases can cause oral complications during therapy or thereafter. These oral complications and their consequences may interfere with cancer treatment, prolong hospital stay, and increase overall treatment costs. Therefore, oral examination of children with cancer by healthcare providers must be part of routine clinical examination. According to published literature, oral examination and recommendations of best oral care in children with cancer might not be routinely practiced and varies among providers. We suspect that personal knowledge, attitude and practice may play an important role in the routine practice of healthcare professionals and that the introduction of an oral health curriculum may complement existing practice. To tailor oral health training, we must know the healthcare professional’s educational needs and their attitude toward oral health.

Methods
Steps followed to build the needs assessment of our targeted learners included: (1) literature review of published surveys; (2) reviews of oral healthcare policies; (3) key-informant interviews with practicing healthcare providers regarding oral health training; (4) selection of essential survey items; (5) face validity; and (6) pilot testing. We used the ©2019Qualtrics® software to build this survey. Face validity was evaluated and approved by five subject matter and survey experts. Graduates of the St. Jude Global Infectious Disease training served as pilot testing subjects.

Results
Interviews indicated that information about oral health examination is often contained in institutional policies; training in oral health is cursory. Surveys published in the literature have assessed knowledge related to oral complications such as oral mucositis and dental caries. We have added gingival conditions to our survey, which is also one of the most prevalent oral manifestation in pediatric cancer patients. Our 31-item survey is comprised of multiple choice and Likert scale questions distributed in seven sections, namely: (1) demographics; (2) clinical settings; (3) participant’s view of own oral healthcare; (4) knowledge and practice on oral infections; (5) knowledge, attitude and practice of oral examination; (6)attitude and practice of oral healthcare preventive measures, and; (7) continuing education. Validity testing indicated two questions that required modifications—the definition of plaque, its causes, and oral infections and manifestations. The final survey tool will take participants approximately 15 minutes to complete.

Conclusion
We developed a 31-item survey tool that will be used for assessing the needs of global healthcare providers, from which we can develop targeted and appropriate educational programs.
An ontology of masters of the Babylonian Talmud
Authors: Giovannetti Emiliano , Albanesi Davide , Bellandi Andrea , Dattilo David , Del Grosso Angelo Mario , Marchi Simone 
Published: March 2021

Abstract
The purpose of this research is to build an ontology of the masters appearing in the Babylonian Talmud (BT). The ontology built so far has been shared as a Linked Open Data and it will be linked to existing vocabularies. This work has been developed in the context of the Babylonian Talmud Translation Project, where more than eighty Talmudists are working together, since 2012, at the translation (comprehensive of explicative notes and glossaries) of the Talmud into Italian. The construction of the resource has involved the application of tools leveraging on computational linguistics approaches. The ontology, already describing more than 500 masters, constitutes the first portion of a more comprehensive Talmudic Knowledge Base where the text itself, the terminology, the entities, and the concepts constituting the BT will be formalized and linked to each other.