bluuebunny/crossref_metadata_2025_split huggingface dataset:
Consequences of the SARS-CoV-2 pandemic in the perinatal period
Authors: Hudak Mark L. 
Published: February 2021

Purpose of review
To provide an update on the consequences of severe acute respiratory syndrome (SARS)-CoV-2 infection on the health and perinatal outcomes of pregnant women and their infants.

Recent findings
The severity of SARS-CoV-2 infection is greater in pregnant compared to nonpregnant women as measured by rates of admission to intensive care units, mechanical ventilation, mortality, and morbidities including myocardial infarction, venous thromboembolic and other thrombotic events, preeclampsia, preterm labor, and preterm birth. The risk of transmission from mother-to-infant is relatively low (1.5–5%) as quantitated by neonatal SARS-CoV-2 testing. Infants appear to be at higher risk of testing positive for SARS-CoV-2 if the mother has tested positive within 1 week of delivery or is herself symptomatic at the time of maternity admission. The rate of positivity is not higher in infants who room in with the mother compared to infants who are initially separated and cared for in a SARS-CoV-2-free environment. Infants who test positive in the hospital have no or mild signs of disease, most of which may be attributable to prematurity, and rarely require readmission for clinical signs consistent with COVID-19.

Summary
Pregnant women should take precautions to avoid infection with SARS-CoV-2. Infants born to mothers who test positive for SARS-CoV-2 can receive normal neonatal care in-hospital with their mothers if mother and staff adhere to recommended infection control practices.
Role of the purinergic signaling network in lung ischemia-reperfusion injury
Authors: Haywood Nathan , Ta Huy Q. , Rotar Evan , Daneva Zdravka , Sonkusare Swapnil K. , Laubach Victor E. 
Published: February 2021

Purpose of review
Primary graft dysfunction (PGD) is the leading cause of early mortality following lung transplantation and is typically caused by lung ischemia-reperfusion injury (IRI). Current management of PGD is largely supportive and there are no approved therapies to prevent lung IRI after transplantation. The purinergic signaling network plays an important role in this sterile inflammatory process, and pharmacologic manipulation of said network is a promising therapeutic strategy. This review will summarize recent findings in this area.

Recent findings
In the past 18 months, our understanding of lung IRI has improved, and it is becoming clear that the purinergic signaling network plays a vital role. Recent works have identified critical components of the purinergic signaling network (Pannexin-1 channels, ectonucleotidases, purinergic P1 and P2 receptors) involved in inflammation in a number of pathologic states including lung IRI. In addition, a functionally-related calcium channel, the transient receptor potential vanilloid type 4 (TRPV4) channel, has recently been linked to purinergic signaling and has also been shown to mediate lung IRI.

Summary
Agents targeting components of the purinergic signaling network are promising potential therapeutics to limit inflammation associated with lung IRI and thus decrease the risk of developing PGD.
Intestinal transplantation
Authors: Garcia Jennifer , Selvaggi Gennaro , Tekin Akin , Vianna Rodrigo 
Published: February 2021

Purpose of review
Intestinal transplantation has evolved to be a viable treatment option for patients with intestinal failure. This review shows the most current tendencies and practices of intestinal transplant centers and an overall comparison to intestinal rehabilitation.

Recent findings
This review outlines that timing for referral and advances in preoperative and postoperative care of intestinal and multivisceral transplant candidates are crucial to achieve results comparable to intestinal rehabilitation.

Summary
Current practices have shown that intestinal transplantation continues to improve overall results and could be considered in patients with permanent home parenteral nutrition. Timing for referral and preoperative and postoperative management are crucial to optimize long-term results.
Current status: meeting the regulatory goals of your liver transplant program
Authors: Batra Ramesh K. , Mulligan David C. 
Published: February 2021

Purpose of review
The regulatory framework set by the Organ Procurement and Transplantation Network (OPTN) and Center for Medicare and Medicaid Services (CMS) for practice of liver transplantation in US is periodically updated and risk adjusted. Therefore, it is prudent for transplant centers to know the rules of engagement as it pertains to their practice.

Recent findings
OPTN besides providing the regulatory oversight for safe and continued practice of transplant centers, provides necessary tools like: advanced statistical models and technological platforms to aid, and guide transplant centers including the necessary safeguards for high-quality transplant care.
CMS regulations although had different thresholds to flag underperformance, often covered common grounds similar to the OPTN, therefore considered duplicative and unnecessary. But with much deliberation and consideration CMS undertook a major overhaul to the final rule for re-approval applications, a giant leap in the positive direction for transplant innovation and growth.

Summary
The duplicative regulatory framework of OPTN and CMS has although achieved the goal of improving 1-year patient outcomes, it has proven costly in terms of slowing innovation, increasing organ discard and stunting growth of transplant volume. But the new updates in effect and also in the pipeline are a long-awaited opportunity for waiting transplant patients.
Nutritional Management of the Critically Ill Neonate
Authors: Moltu Sissel Jennifer , Bronsky Jiri , Embleton Nicholas , Gerasimidis Konstantinos , Indrio Flavia , Köglmeier Jutta , de Koning Barbara , Lapillonne Alexandre , Norsa Lorenzo , Verduci Elvira , Domellöf Magnus ,   ESPGHAN Committee on Nutrition
Published: February 2021

ABSTRACTObjectives:The nutritional management of critically ill term neonates and preterm infants varies widely, and controversies exist in regard to when to initiate nutrition, mode of feeding, energy requirements, and composition of enteral and parenteral feeds. Recommendations for nutritional support in critical illness are needed.Methods:The ESPGHAN Committee on Nutrition (ESPGHAN‐CoN) conducted a systematic literature search on nutritional support in critically ill neonates, including studies on basic metabolism. The Medline database and the Cochrane Library were used in the search for relevant publications. The quality of evidence was reviewed and discussed before voting on recommendations, and a consensus of 90% or more was required for the final approval. Important research gaps were also identified.Results:This position paper provides clinical recommendations on nutritional support during different phases of critical illness in preterm and term neonates based on available literature and expert opinion.Conclusion:Basic research along with adequately powered trials are urgently needed to resolve key uncertainties on metabolism and nutrient requirements in this heterogeneous patient population.
Clinical Characterization of Pediatric Gastroparesis Using a Four‐hour Gastric Emptying Scintigraphy Standard
Authors: Wolfson Sharon , Wilhelm Zoe , Opekun Antone R. , Orth Robert , Shulman Robert J. , Chumpitazi Bruno P. 
Published: February 2021

ABSTRACTObjectives:Four‐hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4‐hour GES evaluation.Methods:We performed a retrospective chart review of pediatric patients diagnosed with GP by 4‐hour GES (>10% retention at 4 hours). Demographics, body mass index, GP‐related symptoms, comorbidities, etiologies, therapies (eg, medications), healthcare utilization, and response to therapy were captured systematically. Symptoms were compared from the initial versus last gastroenterology visit. Outcomes were categorized as no improvement; improvement (resolution of at least 1 symptom while remaining on therapy); and complete resolution of symptoms.Results:A total of 239 subjects (12.1 ± 4.1 years [mean ± standard deviation], 70% girls) were included. The identified characteristics of childhood GP were broad with idiopathic GP being the most common etiology. Outcomes over a median of 22 months (25%–75%: 9.0–45.5 months) were 34.8% no improvement, 34.8% some improvement, and 30.3% with complete symptom resolution. Compared to younger children, adolescents had a higher female predominance (P < 0.01) and were more likely to have nausea (P = 0.006). Girls were more likely to have abdominal pain (P = 0.001), nausea (P = 0.03), and a documented diagnosis of dysautonomia (P = 0.03). Boys were more likely to have regurgitation (P = 0.006), gastroesophageal reflux disease (P = 0.02), and rumination (P = 0.02).Conclusions:Using the 4‐hour GES standard, childhood GP has broad clinical characteristics and outcomes. There are several significant age‐ and sex‐based differences in childhood GP.
Clinical and Esophagogastroduodenoscopy Findings in Pediatric Patients With Severe Obesity Evaluated Before Bariatric Surgery
Authors: Sivan Rachel Frenklak , Bar Lev Michal Rozenfeld , Silbermintz Ari , Mozer‐Glassberg Yael , Seguier‐Lipzyc Emmanuelle , Shalitin Shlomit , Stafler Patrick , Tiroler Simona , Shamir Raanan , Waisbourd‐Zinman Orith 
Published: February 2021

ABSTRACTObjectives:Severe obesity in the pediatric population has lifelong consequences. Bariatric surgery has been suggested for selected adolescents with severe obesity after careful evaluation. The indications for preoperative esophagogastroduodenoscopy (EGD) in this age group are not clear, despite its established usefulness in adults. We aimed to assess the usefulness of EGD before bariatric surgery in pediatric patients with severe obesity and metabolic comorbidities.Methods:We conducted a retrospective chart review in a single tertiary pediatric medical center of adolescents treated during 2011 to 2018. Data collected from electronic medical records included patient demographics, endoscopic findings, and laboratory parameters.Results:A total of 80 patients (40 boys) underwent evaluation. Macroscopic abnormalities were detected in 54% of the endoscopies, including gastritis, esophagitis, and duodenitis in 46%, 16%, and 13%, respectively. Forty‐nine percentage of the biopsies showed histological abnormalities; in 35 (44%) patients, Helicobacter pylori was detected. Thirty‐three patients (41%) received medical treatment and 2 (2.5%) required a second EGD. Metabolic comorbidities included hypertriglyceridemia (38% of the patients), low high‐density lipoprotein (23%), and prediabetic (16%) or diabetic levels of HbA1C (4%). Fifty‐five percentage of the cohort had elevated alanine aminotransferase (ALT), suggestive of nonalcoholic fatty liver disease (NAFLD).Conclusions:Endoscopies performed before bariatric surgeries suggest a higher prevalence of clinically significant findings, many of which required treatment. These findings support incorporating an EGD into the preoperative evaluation of this patient population.
Comparison of Total Body Irradiation–based Versus Chemotherapy-based Conditionings for Early Complications of Allogeneic Hematopoietic Stem Cell Transplantation in Children With ALL
Authors: Yalcin Koray , Pehlivan Berrin , Celen Suna , Bas Elif Gulsah , Kabakci Canan , Pashayev Dayanat , Daloglu Hayriye , Zhumatayev Suleyman , Uygun Vedat , Karasu Gulsun Tezcan , Hazar Volkan , Yesilipek Akif 
Published: February 2021

Background:
Total body irradiation (TBI) is the cornerstone of conditioning regimens in pediatric hematopoietic stem cell transplantation for acute lymphoblastic leukemia. As the late effects and survival comparison between TBI and chemotherapy were well analyzed before, in this study, we aim to focus on the first 100 days and early complications of transplantation.

Methods:
This retrospective study involves 72 pediatric patients (0 to 18 y) underwent first hematopoietic stem cell transplantation for acute lymphoblastic leukemia between October 2015 and May 2019. Patients are divided into 2 groups regarding conditioning regimens. Conditionings includes either TBI 1200 cGy/6 fractions/3 days and etoposide phosphate or busulfan, fludarabine, and thiotepa. Busulfan was administered IV and according to body weight.

Results:
The incidences of acute graft versus host disease grade 2 to 4, veno-occlusive disease, capillary leakage syndrome, thrombotic microangiopathy, blood stream infection, hemorrhagic cystitis and posterior reversible encephalopathy syndrome before day 100 were similar for both conditioning regimens; however, patients received TBI-based conditioning had significantly longer neutrophil engraftment time (17.5 vs. 13 d, P=0.001) and tended to have more engraftment syndrome (ES) (45.5% for TBI vs. 24.0% for chemotherapy, P=0.069). Multivariate analysis showed that TBI-based conditioning was associated with a longer neutrophil engraftment time (hazard ratio [HR]=1.20, P=0.006), more cytomegalovirus (CMV) reactivation (HR=3.65, P=0.038) and more ES (HR=3.18, P=0.078).

Conclusions:
Our findings support chemotherapy-based regimens with early neutrophil engraftment, less ES and CMV reactivation compared with TBI. Although there is no impact on survival rates, increased incidence of ES and CMV reactivation should be considered in TBI-based regimens.
Challenges in the Management of Childhood Intracranial Germ Cell Tumors in Middle-Income Countries: A 20-Year Retrospective Review From a Single Tertiary Center in Malaysia
Authors: Rajagopal Revathi , Leong Sheng Hoay , Jawin Vida , Foo Jen Chun , Ahmad Bahuri Nor Faizal , Mun Kein Seong , Azman Raja Rizal , Loh Jasmin , Yap Tsiao Yi , Ariffin Hany , Moreira Daniel C. , Gottardo Nicholas G. , Bouffet Eric , Ganesan Dharmendra 
Published: February 2021

Background:
A higher incidence of pediatric intracranial germ cell tumors (iGCTs) in Asian countries compared with Western countries has been reported. In Malaysia, the literature regarding pediatric iGCTs have been nonexistent. The aim of this study was to review the management, survival, and long-term outcomes of pediatric iGCTs at a single tertiary center in Malaysia.

Patients and Methods:
We retrospectively reviewed data from patients below 18 years of age with iGCTs treated at the University Malaya Medical Center (UMMC) from 1998 to 2017.

Results:
Thirty-four patients were identified, with a median follow-up of 3.54 years. Sixteen (47%) patients had pure germinoma tumors (PGs), and the remaining patients had nongerminomatous germ cell tumors (NGGCTs). The median age was 12 years, with a male:female ratio of 4.7:1. Abnormal vision, headache with vomiting, and diabetes insipidus were the commonest presenting symptoms. Twenty-eight patients received initial surgical interventions, 24 were treated with chemotherapy, and 28 received radiotherapy. Eight patients experienced relapses. The 5- and 10-year event-free survival rates were similar at 61.1%±12.6% and 42.9%±12.1% for PG and NGGCT, respectively. The 5- and 10-year overall survival rates were the same at 75.5%±10.8% and 53.3%±12.3% for PG and NGGCT, respectively. Four patients died of treatment-related toxicity. Most of the survivors experienced good quality of life with satisfactory neurologic status.

Conclusions:
The survival rate of childhood iGCTs in UMMC was inferior to that reported in developed countries. Late diagnosis, poor adherence to treatment, and treatment-related complications were the contributing factors. Although these results highlight a single institution experience, they most likely reflect similar treatment patterns, outcomes, and challenges in other centers in Malaysia.
HIV Prevention and Treatment Cascades Among Female Sex Workers in Benin, West Africa
Authors: Morin Laurianne , Béhanzin Luc , Guédou Fernand A. , Kêkê René Kpèmahouton , Bushman Lane , Anderson Peter L. , Gangbo Flore , Diabaté Souleymane , Nagot Nicolas , Alary Michel 
Published: February 2021

Background
Benin has a long-standing history of HIV prevention programs aimed at female sex workers (FSWs). We used data from a national survey among FSWs (2017) to assess the prevention and care cascades in this population.

Methods
Female sex workers were recruited through cluster sampling of sex work sites. A questionnaire was administered, and HIV tested. HIV-positive participants were asked to provide dried blood spots and were tested for antiretroviral and viral load. We assessed 2 prevention cascades (HIV testing and safer sex) and the treatment cascade, using a combination of self-reported and biological variables.

Results
Mean age of the 1086 FSWs was 30 years. Half of them were Beninese, and two-thirds had a primary school education level or less. Almost all FSWs had ever heard of HIV/AIDS. More than half (79.1%) had ever been tested, and 84.1% of the latter had been tested in the last year. In the previous 6 months, 90.1% were exposed to prevention messages. Women exposed to any HIV prevention message reported a higher level of consistent condom use in the last month (69.0%) than those who were not (48.5%, P < 0.0001). HIV prevalence was 7.7%. Among HIV-positive women, 60.6% knew their status; among those, 90.5% were on antiretroviral and 81.8% of them had a suppressed viral load.

Conclusions
Despite long-standing HIV prevention programs for FSWs, the prevention indicators were often low. Linkage to care was good, viral suppression was suboptimal, but knowledge of HIV-positive status was low. Exposing women to prevention messages is necessary, as to increase HIV testing.
Evaluation of Polymerase Chain Reaction over Routine Microbial Diagnosis for the Diagnosis of Fungal Keratitis
Authors: Behera Himanshu Sekhara , Srigyan Deepankar 
Published: February 2021

SIGNIFICANCE
The significance of the study is that, although conventional culture remains the criterion standard for identifying the causative fungal pathogens, polymerase chain reaction (PCR) may serve as a powerful and high-throughput tool for the early and definitive diagnosis of high-risk patients with mycotic keratitis owing to high sensitivity and specificity.

PURPOSE
This study was focused on comparing the results of PCR with traditional microbial studies for the detection and identification of fungal pathogens in patients with clinically suspected fungal keratitis.

METHODS
Corneal scrapings were collected from 59 patients with clinically suspected fungal keratitis for routine culture, staining, and seminested PCR assay for fungal pathogen identification. The results of PCR were compared with a conventional microbial workup (smear and culture). The samples that were unidentified by culture but were amplified by PCR were further identified by nucleotide sequencing.

RESULTS
Of the 59 patients with suspected fungal keratitis, 38 (64.40%) were found to be positive by PCR assay, 24 (40.67%) by culture, 18 (20.3%) by potassium hydroxide wet mount, and 8 (13.5%) by Gram stains for fungal pathogens. All the 24 isolates found positive with culture were also positive with PCR, so they had not been sequenced for molecular identification. The remaining 14 isolates that were positive with PCR but negative with culture were further identified as Cladosporium cladosporioides, Simplicillium species, Fusarium solani, Alternaria tenuissima, Chaetomium globosum, Penicillium citrinum, and Rhizopus microsporus by sequencing up to the species level.

CONCLUSIONS
The PCR was able to detect the presence of fungal pathogens in a high proportion of culture-negative cases. This study suggests that PCR may serve as a rapid, important complement to traditional culture with high-throughput means of fungal pathogen identification in patients with clinically suspected fungal keratitis.
Case Report: Crying Blood
Authors: Idowu Oluwatobi O. , Kaidonis Georgia , Husain Sameera , Winn Bryan J. 
Published: February 2021

ABSTRACT

SIGNIFICANCE
Hemolacria (bloody tears) is a rare clinical presentation with varied underlying etiologies. Thorough clinical evaluation is essential to diagnosis and management.

PURPOSE
This study aimed to report unilateral hemolacria in a known contact lens wearer with an occult, palpebral, conjunctival pyogenic granuloma and review the literature.

CASE REPORT
A 21-year-old female contact lens wearer presented to the clinic after three episodes of sudden painless bloody tears from the right eye. She was referred to the oculoplastic clinic for evaluation. On everting her right upper lid, a fleshy, nontender, ovoid, pedunculated mass was found attached to the palpebral conjunctiva of the right, nasal, upper tarsus. Surgical excision was performed in the office, and pathological examination of the lesion was consistent with pyogenic granuloma.

CONCLUSIONS
Unilateral hemolacria should raise clinical suspicion for a hidden conjunctival lesion such as pyogenic granuloma, although other more sinister causes of hemolacria must also be considered. Thorough evaluation including eyelid eversion is critical in identifying and managing occult conjunctival lesions.
GPBAR1 Promotes Proliferation of Serous Ovarian Cancer by Inducing Smad4 Ubiquitination
Authors: Li Haixia , Zhao Juanhong , Shi Xiaoyan 
Published: February 2021

Background:
Ovarian cancer (OC) is the most lethal malignancy of all female cancers and lacks an effective prognostic biomarker. Serous ovarian cancer (SOC) is the most common OC histologic type. The expression and function of bile acid receptor, G-protein-coupled bile acid receptor-1 (GPBAR1), in tumor progression remains controversial, and its clinical significance in SOC is unclear.

Materials and Methods:
In our study, we detected the expression of GPBAR1 in SOCs and normal ovarian tissues with quantitative real-time polymerase chain reaction and immunohistochemistry to detect its expression pattern. Moreover, the prognostic significance of GPBAR1 was investigated with univariate and multivariate analyses. The function of GPBAR1 in regulating SOC proliferation was studied and the underlying mechanism was investigated with experiments in vitro.

Results:
GPBAR1 was overexpressed in SOCs compared with the normal ovarian tissues. In the 166 SOCs, subsets with low and high GPBAR1 accounted for 57.23% and 42.77%, respectively. Moreover, our results suggested that GPBAR1 expression was significantly associated with poor prognosis and can be considered as an independent prognostic biomarker. With experiments in vitro, we suggested that GPBAR1 promoted SOC proliferation by increasing Smad4 ubiquitination, which required the involvement of GPBAR1-induced ERK phosphorylation.

Conclusions:
GPBAR1 was overexpressed in SOC and predicted the poor prognosis of SOC. We showed that GPBAR1 promoted SOC proliferation by activating ERK and ubiquitining Smad4. Our results suggested that GPBAR1 was a supplement to better classify SOC on the basis of the molecular profile and that GPBAR1 may be a potential drug target of SOC.