bluuebunny/crossref_metadata_2025_split huggingface dataset:
INDEX OF SUSPICION
Authors: Cron Randy , Ho Laurette , Bradford Bradley 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A previously healthy 6-month-old girl is seen at the office for evaluation of fussiness and infrequent urination. The child has not voided in the past 9 hours despite her usual fluid intake. She is afebrile, with no focus of infection found on careful physical examination. A palpable mass is felt in the suprapubic area. Her external genitalia are normal.
Renal and pelvic ultrasonography reveal an echo-free area superior to a normal lower renal ureteral segment on the left side, with a circular echo free area at the lower end of the ureter extending into and taking up about one quarter of the space within a distended bladder.
Case 2 Presentation
A 4-year-old boy is seen in your office with a 4-day history of sore throat and low-grade fever.
Trace Elements in Nutrition
Authors: Shah Heena A. 
Published: December 2021

Trace elements other than iron only recently have gained importance in infant nutrition. Zinc and copper are two of the most essential trace elements. Zinc is a constituent of more than 100 metalloenzymes and plays an important role in growth, reproduction, tissue repair, and cellular immunity. Copper is a component of several metalloenzymes and is required for oxidative metabolism.
Nutritional deficiencies of zinc now are recognized as being fairly prevalent throughout the world. Symptomatic zinc deficiency among infants can be attributed to several factors. It can be secondary to low zinc concentration in breast milk, low stores (as in prematurity), malabsorption (as in acrodermatitis enteropathica), or absence or inadequate amount in parenteral nutrition.
Leukocyte Disorders: Quantitative and Qualitative Disorders of the Neutrophil, Part 1
Authors: Boxer Laurence A. , Blackwood R. Alexander 
Published: December 2021

Introduction
Neutrophils form the first line of defense against most bacterial and fungal pathogens after disruption of the skin and mucous membranes. Once tissue is invaded by microorganisms, a variety of vasoactive and chemotactic mediators are released by the involved tissue. In response to these chemotactic peptides, neutrophils, normally found in the circulation, adhere to the inflamed endothelium and migrate to the site of infection where the phagocytes ingest and kill the invading microorganisms. Neutrophils also release a variety of cytokines that may modify the neutrophils' own responses as well as interact with other elements of the immune system. Neutrophils, therefore, are both important effectors and regulators of the host defense system. Because of the complexity of this defense system and the major role played by neutrophils, both primary and acquired defects in neutrophil number or function result in persistent as well as recurrent infections.
Primary defects in neutrophil number or function are relatively rare, but they must be considered in a child who presents with recurrent infections. Early identification and management of affected children lead to decreased morbidity and mortality. Although care predominantly has been supportive in the past through the use of prophylactic and therapeutic antibiotics, specific therapies now are becoming available to reduce the frequency of infections in some diseases.
Diaphragmatic Hernia
Authors: Cairns Anne Marie , Ewig Jeffrey M. 
Published: December 2021

Congenital diaphragmatic hernia (CDH), with an incidence of approximately 1 in 3000 births, occurs secondary to defective fusion of the pleuroperitoneal membranes during embryonic development. The most common form is the posterolateral hernia through the foramen of Bochdalek, with a left-to-right ratio of approximately 8:1.
The space-occupying effect of the bowel during pulmonary development results in hypoplasia of the ipsilateral lung. This process also may cause hypoplasia to a lesser degree of the contralateral lung, secondary to severe mediastinal shift. Bohn and co-workers assessed alveolar number by postmortem morphometric analysis of five infants who died after surgical repair for CDH. A severe reduction in alveolar number was noted in both the ipsilateral and contralateral lung, although the changes in the ipsilateral lung were more pronounced.
Hyperkalemia
Authors: Roberts Kenneth B. 
Published: December 2021

Potassium is the major intracellular cation; only a very small fraction of total body potassium is in the intravascular space. Increased potassium concentration in serum is infrequent in pediatrics, but it can be life-threatening because of its effect on membrane potentials, particularly of heart muscle.
The serum potassium concentration is affected primarily by the kidney. Potassium is filtered by the glomerulus, then reabsorbed and secreted by the tubule. Processes that interfere with filtration or secretion (eg, acute on chronic glomerulonephritis, interstitial nephritis) may cause hyperkalemia; processes that interfere with reabsorption may cause hypokalemia.
The most common cause of an increased serum potassium is "pseudohyperkalemia" due to hemolysis or to tissue hypoxia distal to the placement of a tourniquet.
The Biological Aspects of Puberty
Authors: Kulin Howard E. , Müller Jørn 
Published: December 2021

Normal Pubertal Development
SOMATIC CHANGES
Puberty is characterized by an increase in growth rate and the appearance of striking somatic sex differences. The onset of these changes actually antedates the appearance of secondary sex characteristics by a few years. Thus, sexual maturation is a considerably longer process than the period of visible changes induced by marked incremental increases in gonadal hormones. Unlike boys, girls augment their body fat noticeably at 7 years of age; by 16 years of age girls have twice as much fat as boys.
Total body water reflects lean body mass, which is made up primarily of muscle and skeletal tissues. At 9 years of age, total body water increases significantly in boys and signals the onset of more rapid growth in lean body mass. Muscle mass in boys doubles between the ages of 10 and 17 years, and skeletal mass doubles between ages 12 and 16 years. During adolescence boys exceed girls in all body measurements except hip width and body fat.
The changes in body constituents during puberty are reflected more impressively by increases in height and weight. The initiation of the adolescent growth spurt precedes the onset of secondary sex characteristics by approximately 1 year in boys and girls.
Sleep Problems Among Infants and Young Children
Authors: Blum Nathan J. , Carey William B. 
Published: December 2021

Parental concerns about their young children's sleep are among the most frequent behavior problems discussed with pediatricians. In view of this high prevalence, it is important to review the origins of these problems and emerging information about how best to manage them.
Definition
Sleep disorders among children can be classified as dyssomnias, parasomnias, and disruptions secondary to other conditions. The dyssomnias are disturbances in the amount or timing of the sleep. They include intrinsic sleep disorders such as narcolepsy and sleep apnea, interactional sleep disorders such as excessive night waking, and sleep phase disorders, when the time the parents assign for sleep and the child's period of needing it are not synchronous. Parasomnias, on the other hand, are abnormal behaviors that occur during sleep, such as night terrors, nightmares, sleep walking, and sleep talking. Sleep also can be disturbed as the result of various mental and physical conditions, including asthma, epilepsy, and anxiety disorders.
The dyssomnias (sleep refusal and night waking) and parasomnias (night terrors and nightmares) of infancy and early childhood are the most common complaints of parents to pediatricians. Sometimes, however, parents may not seek help for these problems; at other times, they may be concerned by what actually is normal sleep behavior.
INDEX OF SUSPICION
Authors: Edwards Whitney C. , Khalak Rubia , Gadawski Robert , Babl Franz E. , Hyams Jeffrey S. , Justinich Christopher J. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 7-year-old boy is seen in the pediatric clinic. He has been ill for 3 weeks with fever, pharyngitis, and rash. Diagnosed as having streptococal pharyngitis and scarlet fever, he was treated with antibiotics without relief. Ten days ago, he developed vomiting, diarrhea, and right-sided abdominal pain. When given paregoric, his vomiting worsened. Six days ago he was admitted to a community hospital for treatment of dehydration. During his 3-day admission, his white blood cell count and his liver enzymes were elevated. At the time of discharge, he was no longer vomiting, but he had blisters on his hands and feet.
Two days ago, the vomiting, diarrhea, and abdominal pain recurred. Findings on abdominal ultrasonography were normal.
Wilson's Disease
Authors: Riely Caroline A. 
Published: December 2021

Wilson's disease (hepatolenticular degeneration) is a relatively rare cause of illness in the pediatric age group. But, as a chronic life-threatening disease that is treatable, even "curable," its investigation should be thoroughly pursued by the pediatrician. The recognition of Wilson's disease provides the opportunity to prevent this illness in presymptomatic family members. Therefore, Wilson's disease should be included in the differential diagnosis of all forms of liver disease in pediatrics and appropriately excluded.
The clinical findings that are compatible with a diagnosis of Wilson's disease are protean, and confirming or denying this diagnosis is often difficult. In order to appreciate these problems, it is necessary first to understand the normal physiology of copper in the body and the derangements in this homeostasis that characterize Wilson's disease (Fig 1).
COPPER HOMEOSTASIS
Normal
Copper is absorbed from the diet in excess of the body's requirement for it. Many foods contain copper, but chocolate, nuts, mushrooms, liver, and shellfish are particularly rich sources. Once absorbed, copper is transported free in the blood to the liver. Here, a certain fraction is incorporated in an irreversible fashion into ceruloplasmin. This copper-containing protein separates in the α2-globulins, can be an acute-phase reactant, increasing in concentration in response to stress. Alternatively, in the presence of hepatic failure with decrerased protein synthesis, its concentration in blood decreases. Ceruloplasmin is an oxidative enzyme used in a variety of pathways, including the oxidation of ferrous to ferric ions.
Metabolic Bone Diseases
Authors: Chesney Russell W. 
Published: December 2021

Upon viewing a skeleton, one thinks of bone as an inert framework upon which the remainder of the body is constructed. Nothing could be more incorrect, since bone is a dynamic living organ which is capable of constant turnover, weight-bearing, and sustaining the remarkable stresses incurred in running, jumping, and other daily activities. Bone is constantly being formed and reformed (modeled and remodeled), is continuously serving as a reservoir of the divalent minerals (calcium, phosphate, and magnesium), and, in children, is constantly undergoing growth. In this article, the disorders that affect bone will be reviewed. These conditions fall under the general rubric metabolic bone disease and generally comprise a group of disorders in which impaired formation, enhanced resorption, or altered turnover of bone prevails (Table 1).
The human skeleton is composed of a collagen-containing (and noncollagen protein-containing) matrix, or osteoid, upon which is deposited a crystalline mineral phase. This mineral component of bone contains calcium and phosphate in various inorganic chemical compounds, the major one being hydroxyapatite. However, this hydroxyapatite is deep within bone trabeculae and ordinarily inaccessible. The rapidly exchangeable pool and accessible mineral phase of bone is composed of newly formed, but incomplete, hydroxyapatite crystals and amorphous calcium phosphate.1
Kaznodzieja, coach czy influencer? Kogo preferuje współczesny odbiorca medialny?
Authors: Ostafiński Witold 
Published: December 2021

Powszechność Internetu, innowacyjność technologiczna w publikowaniu treści audio i video w sieci internetowej to nowa rzeczywistość medialna i społeczna, która domaga się zrewidowania sposobu głoszenia słowa Bożego we współczesnym świecie. Nowe technologie stwarzają nowe szanse i większe możliwości wpływu na odbiorców poszukujących odpowiedzi nie tylko na egzystencjalne, ale także na duchowe, religijne i transcendentalne pytania. Większa obecność głosicieli słowa Bożego w Internecie oraz poszerzenie ich kompetencji o umiejętności coachingowe i influencerskie stwarza szanse do efektywniejszej ewangelizacji i skuteczniejszej prezentacji treści ewangelicznych.
Factors associated with long-term adverse cardiovascular events in patients with type 2 diabetes
Authors: Demin A. A. , Bondar I. A. , Grazhdankina D. V. 
Published: December 2021

Aim. To identify factors associated with long-term adverse cardiovascular events (CVEs) in patients with type 2 diabetes (T2D).Material and methods. The study included 94 T2D patients aged 40 to 65 years with or without early symptoms of heart failure (HF). Patients underwent clinical and laboratory investigations, 6-minute walk test (6MWT), and echocardiography. Concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. After 8,8±0,72 years of follow-up, the prevalence of following CVEs among patients were assessed: any-cause death, myocardial infarction, stroke, emergency myocardial revascularization, hospitalization due to decompensated HF. We assessed the relationship between the development of long-term CVEs in T2D patients and the initial characteristics using logistic regression model.Results. Over a period of 8,8±0,72 years, CVEs occurred in 34 out of 88 (38,6%) patients with T2D. The baseline 6MWT values were lower in patients with CVEs (391,8±56,2 m vs 418,8±53,9 m, p=0,04). Stable coronary artery disease (55,9% vs 27,8%, p=0,008), early-stage HF (61,8% vs 27,8%; p=0,0016) were more common among patients with CVEs. Patients with CVEs had higher median initial NT-proBNP (46,9 pg/ml vs 24,2 pg/ml, p=0,01) and mean left atrial (LA) size (4,5±0,6 cm vs 4,19±0,5 cm, p=0,04) levels. The logistic regression established following factors associated with long-term CVEs in patients with T2D: NT-proBNP level (p=0,05), LA size (p=0,01), and 6MWT results (p=0,002).Conclusion. The development of long-term CVEs in middle-aged T2D patients with or without early-stage HF is associated with an initially increased NT-proBNP levels, an increase in left atrial size, and a decrease in 6MWT values. Further prospective studies with larger samples are needed to identify other factors affecting outcome in patients with early signs of HF.
Role of biomarkers of myocardial injury and inflammation in predicting ischemia-reperfusion injury in patients with ST-segment elevation acute coronary syndrome undergoing endovascular revascularization
Authors: Rusak T. V. , Gelis L. G. , Medvedeva E. A. , Russkikh I. I. , Shibeko N. A. , Kurganovich S. A. , Gevorkyan T. T. 
Published: December 2021

Aim. To evaluate the informative value of biomarkers (cardiac troponin l (cTnl), high-sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NTproBNP), stimulating growth factor (ST2)) as laboratory markers of myocardial ischemia-reperfusion injury in patients with ST-segment elevation acute coronary syndrome (STEACS) undergoing endovascular revascularization.Material and methods. The study included 115 patients with STEACS who underwent endovascular myocardial revascularization. To identify the informative value of biomarkers, the levels of cTnl, NTproBNP, hsCRP, sST2 were analyzed at baseline, as well as after reperfusion therapy on the 2nd (cTnl) and 5th (sST2, hsCRP, NTproBNP) days. Contrast-enhanced cardiac magnetic resonance imaging was performed 5 days after endovascular intervention.Results. Microvascular obstruction was detected in 54 patients (47%), of which 24 (44%) patients had a combination of microvascular obstruction and myocardial hemorrhage. ln 61 cases (53%), no microvascular damage was registered. lt was found that with an increase in the threshold initial NTproBNP levels >590 pg/ml, the odds ratio (OR) of myocardial reperfusion injury was 12,2 (95% confidence interval (CI), 4,81-30,92, p<0,001). In addition, we analyzed biomarker levels in the early period after myocardial infarction, at which threshold values of reperfusion injury parameters were established as follows: for cTnI >8,1 ng/ml, OR=7,17 (95% CI, 3,11-16,53, p=0,001); for hsCRP >14 mg/L, OR=12,71 (95% CI, 5,03-32,08, p=0,001); for NTproBNP >334 pg/ml, OR=11,8 (95% CI, 4,88-28,59, p=0,001); for sST2 >41 ng/ml, OR=7,17 (95% CI, 3,11-16,53, p=0,001). According to multivariate analysis, predictors of microvascular injury were the initial NTproBNP values, as well as the cTnI, hsCRP, and sST2 values in the early postinfarction period (sensitivity — 89,5%, specificity — 83,3%).Conclusion. Thus, the initial NTproBNP, as well as cTnI, hsCRP, sST2 values after percutaneous coronary intervention are more informative for assessing the risk of microvascular damage.
Predictive value of global longitudinal strain and geometry of left ventricle in patients with noncompaction cardiomyopathy
Authors: Komissarova S. M. , Krasko O. V. , Rineyskaya N. M. , Efimova A. A. 
Published: December 2021

Aim. To assess the prognostic role of a decrease in longitudinal strain and an increase in the left ventricular sphericity index as predictors of NYHA class III heart failure (HF) progression, requiring hospitalization in a cohort of patients with noncompaction cardiomyopathy (NCM) in combination with dilated cardiomyopathy (DCM).Material and methods. We examined 90 patients with a combination of NCM and DCM aged 18 to 72 years (median age, 41 years; men — 73; women — 17), who, in addition to conventional echocardiographic and magnetic resonance imaging (MRI) characteristics, were studied for two-dimensional strain and global longitudinal strain (GLS) parameters and left ventricular sphericity index (SI) using cardiac MRI. The endpoints included NYHA class III HF progression, requiring hospitalization.Results. During the follow-up period (median follow-up, 36 (6; 152) months) in 59 of 90 (65,5%) patients with NCM in combination with DCM, symptoms progressed to NYHA class III HF, requiring hospitalization. Multivariate analysis showed following independent risk factors for HF-related hospitalization: a decrease in GLS <10% (hazard ratio (HR), 5,1; 95% confidence interval (CI), 1,6-16,7, p<0,007) and an increase in SI >0,5 (HR, 9,0; 95% CI, 2,2-37,8, p<0,003) .The 3-year event-free survival rate for patients with one risk factor (GLS, %<10 and SI <0,5; GLS, %>10 and SI >0,5) was 79,2±16,9% and 64,4±24,6%, respectively, while for the group with two risk factors (GLS, %<10 and SI>0,5) — 12,3%.Conclusion. Global longitudinal strain characteristics according to 2D Strain echocardiography and SI according to cardiac MRI are associated with adverse events in NCM and DCM combination and can be used to identify patients with a high risk of HF progression to NYHA class III, requiring hospitalization.
Effect of diabetes mellitus on levels of insulin-like growth factors and their carrier proteins in Guerin’s carcinoma and it’s perifocal tissue in rats
Authors: Frantsiyants E. M. , Bandovkina V. A. , Kaplieva I. V. , Surikova E. I. , Neskubina I. V. , Pogorelova Yu. A. , Cheryarina N. D. , Kachesova P. S. , Nemashkalova L. A. 
Published: December 2021

Purpose of the study. Diabetes mellitus (DM) is considered an independent risk factor for higher cancer incidence and death rates. The system of insulin-like growth factors and their carrier proteins (IGF and IGFBP) and hyperglycemia create favorable conditions for the proliferation and metastasis of cancer cells.Materials and methods. Outbred male and female rats were divided into groups (n = 8 each): controls - with Guerin's carcinoma; main group - Guerin's carcinoma growing in presence of DM. Experimental DM was reproduces in animals by the single intraperitoneal alloxan injection (150 mg/kg body weight). After 10 days of the carcinoma growth, levels of IGF and IGFBP in the tumor and in it's perifocal area were measured using ELISA.Results. DM in females upregulated levels of glucose both in the tumor and in perifocal tissues by 1.8 (p < 0.05) and 8.1 times, respectively, but caused opposite changes in IGF-I - it's increase by 6.3 times in the tumor and decrease by 3.2 times in the perifocal area; as a result, such tumors with small primary nodes were more "aggressive" and actively metastasized. In males, induced DM downregulated levels of glucose, IGF-II and IGFBP2 in the carcinoma by 8.4, 3.1 and 1.7 (p < 0.05) times, respectively, and increased levels of IGF-I and IGFBP2 by 1.4 and 1.3 times (p < 0.05) in the perifocal area without changing glucose levels; as a result, tumor volumes exceeded the values in the standard growth, without metastasizing into visceral organs.Conclusion. We revealed gender differences in changing levels of glucose and IGF both in the tumor and in it's perifocal tissue in rats with Guerin's carcinoma growing in presence of DM; these differences could determine different tumor growth dynamics in male and female rats.