bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary Burn Progression Mitigated by an Adenosine 2A Receptor Agonist
Authors: Haywood Nathan , Byler Matthew R , Zhang Aimee , Rotar Evan P , Money Dustin , Gradecki Sarah E , Ta Huy Q , Salmon Morgan , Kron Irving L , Laubach Victor E , Mehaffey J Hunter , Roeser Mark E 
Published: March 2021

Abstract
Current burn therapy is largely supportive with limited therapies to curb secondary burn progression. Adenosine 2A receptor (A2AR) agonists have anti-inflammatory effects with decreased inflammatory cell infiltrate and release of proinflammatory mediators. Using a porcine comb burn model, we examined whether A2AR agonists could mitigate burn progression. Eight full-thickness comb burns (four prongs with three spaces per comb) per pig were generated with the following specifications: temperature 115°C, 3-kg force, and 30-second application time. In a randomized fashion, animals (four per group) were then treated with A2AR agonist (ATL-1223, 3 ng/kg/min, intravenous infusion over 6 hours) or vehicle control. Necrotic interspace development was the primary outcome and additional histologic assessments were conducted. Analysis of unburned interspaces (72 per group) revealed that ATL-1223 treatment decreased the rate of necrotic interspace development over the first 4 days following injury (p &lt; .05). Treatment significantly decreased dermal neutrophil infiltration at 48 hours following burn (14.63 ± 4.30 vs 29.71 ± 10.76 neutrophils/high-power field, p = .029). Additionally, ATL-1223 treatment was associated with fewer interspaces with evidence of microvascular thrombi through postburn day 4 (18.8% vs 56.3%, p = .002). Two weeks following insult, the depth of injury at distinct burn sites (adjacent to interspaces) was significantly reduced by ATL-1223 treatment (2.91 ± 0.47 vs 3.28 ± 0.58 mm, p = .038). This work demonstrates the ability of an A2AR agonist to mitigate burn progression through dampening local inflammatory processes. Extended dosing strategies may yield additional benefit and improve cosmetic outcome in those with severe injury.
#81: Care Process Measures and Outcomes of Percutaneous Pulmonary Valve Implantation-associated Infective Endocarditis
Authors: Rubbab B , Talluto C , Nuibe A , Levorson R 
Published: March 2021

Abstract

Background
Percutaneous pulmonary valve implantation (PPVI) is being increasingly used as a minimally invasive corrective procedure for right ventricular outflow tract (RVOT) dysfunction. Ten-year survival following PPVI is estimated at over 90% due to the durability of the various bioprosthetic valves. However, infective endocarditis (IE) remains a potential complication of such valves with significant morbidity and mortality. We evaluated the presenting symptoms, clinical features, pathogens, and outcomes of patients with IE following PPVI to identify opportunities to improve early diagnosis and management.

Methods
A convenience sample of patients at a large Pediatric Cardiology practice in Northern Virginia was queried for PPVI and IE from January 1, 2016, to June 30, 2019. Manual chart review was done to extract clinical points of interest and descriptive analyses were performed. Patients were classified as having IE per modified Duke’s criteria.

Results
We identified 14 patients who underwent PPVI. Five of these patients (36%) developed IE. All IE patients had underlying Tetralogy of Fallot and none had previous episodes of IE. 60% of patients with IE were male with a median age of 26 years old (IQR 20–30). Four IE patients had a Melody valve and 1 had a SAPIEN valve. The median elapsed time between PPVI and IE diagnosis was 128 days (IQR 32–391) with a median duration of illness prior to the diagnosis of IE of 6 days (IQR 5–9). All IE patients had to present fever. 40% of IE patients had to present chest pain and 20% had presenting musculoskeletal pain. All IE patients had an elevated initial C-reactive protein (CRP) with a median value of 13.1 mg/dL (IQR 12.5–15.2). The median initial white blood cell count was 9.3 × 103/μL (IQR 8.1–10.3). The median duration of bacteremia was 1 day (IQR 1–2). A pathogen was recovered in all five IE patients with different organisms amongst the patients: coagulase-negative Staphylococcus species were recovered in patients who developed IE within 60 days from PPVI (Staphylococcus lugdunensis and Staphylococcus epidermidis) whereas coagulase-negative Staphylococcus species and oral commensal organisms were found in IE patients beyond 60 days from PPVI (Staphylococcus sanguinis, Gamella haemolysans, and Neisseria elongata). The initial echocardiogram did not show vegetations in any of the patients and 40% went on to have sternotomy with valve replacement. There were no deaths.

Conclusions
With an increase in PPVI, clinicians should have a high index of suspicion for IE in patients with underlying Tetralogy of Fallot who present with fever and elevated CRP, regardless of elapsed time from PPVI or valve type. Empiric antimicrobial therapy for suspected IE following PPVI should remain broad with other possible pathogens beyond coagulase-negative Staphylococcus species.
#3: A Historical Perspective to US Syphilis Reporting and the Recent Rise of Risky Behaviors Among Women with Syphilis
Authors: Quintana G 
Published: March 2021

Abstract

Background
Congenital syphilis is a vertically transmitted infectious disease with devastating consequences during the perinatal period, including stillbirth. On October 8, 2019, the CDC published a press release stating the urgent action needed to break the cycle of STD increases, including syphilis. The purpose of this study was to provide a brief historical perspective of syphilis coding, reporting, and monitoring system changes since 1992, discuss US syphilis incidence and trends, and assess risky behaviors among women with primary or secondary syphilis.

Methods
Quantitative data were obtained from CDC AtlasPlus, STD Surveillance 2018 report, and CDC Syphilis Surveillance Supplement 2013–2017.

Results
The possible association between risky sexual behaviors among reproductive-age women, such as the use of phone applications like Tinder, and increased rates of congenital syphilis have come into question. In 2017, risky behaviors reported by American women with syphilis were having sex while intoxicated (36.7%), having sex with an anonymous partner (21.8%), use of methamphetamine (16.6%), and having met a sex partner through the internet (11.6%). Women aged 35–39 were most likely to report of having sex while intoxicated (45.3%) followed by ages 25–34 (41.3%). Women aged 15–19 were most likely to meet a sex partner on the internet (16.7%). 22.6% of women reported the use of “other drug,” not categorized under “crack”, “poppers”, “cocaine,” “heroin,” “methamphetamine,” “injection drugs.” Furthermore, younger individuals were more likely to report the use of an “other drug” with increasing annual trends since 2013.

Conclusion
The highest reported risky behavior among women with syphilis was having sex while intoxicated. Unexpectedly, having met a sex partner on the internet was not among the highest reported risky behavior. Clarification of “other drugs” may be beneficial in understanding the risky behaviors among young women with syphilis. The correlation between risky sexual behaviors and drug use among reproductive-age women and increasing congenital syphilis rates warrants further investigation. A causal relationship between these two variables cannot be excluded until linked data are available, including further stratification of “other drug” categories.
#36: Can Astrovirus VA1, a Novel Human Astrovirus, Cause Diseases of the Central Nervous and Cardiovascular Systems?
Authors: Janowski A B , Dudley H , Feehley T , Ingle H , Baldridge M T , Virgin H W , Klein R S , Wang D 
Published: March 2021

Abstract

Background
Since their original isolation from human stool samples in 1975, astroviruses have been assumed to be pathogens exclusive to the gastrointestinal tract. However, astroviruses have been recently identified from brain tissue of humans and other mammals suffering from neurological diseases, suggesting that members of this family of viruses have a previously unrecognized neurotropism. One human astrovirus genotype, astrovirus VA1/HMO-C (VA1) is the most frequently identified astrovirus from cases of human encephalitis. We previously described the ability of several cell lines, including Caco-2, A549, and HEK293, to support VA1 growth in cell culture. Our goals were to develop cell culture and animal models to study the pathogenic potential of VA1.

Methods
VA1 was inoculated into primary astrocytes, primary neurons, and SK-N-SH cells in tissue culture. Viral RNA was measured in multistep growth curves by qRT-PCR, capsid was detected by immunofluorescence, and infectious titer was measured by a TCID50 assay. For development of an in vivo model of infection, mice were inoculated with VA1 with simultaneous intracranial, intraperitoneal, intravenous, and oral gavage inoculations with a VA1 stock. Mice were sacrificed 7 days after inoculation, RNA extracted from tissues, and viral load quantified by qRT-PCR. Tissue was also processed for histology and staining with hematoxylin and eosin. Primary human cardiac endothelial and myocytes were also inoculated with VA1 and viral RNA was measured in multistep growth curves by qRT-PCR.

Results
We detected the completion of the full VA1 lifecycle in primary astrocytes and SK-N-SH cells with &gt;100-fold increase in viral RNA in a multistep growth curve, detection of intracellular viral capsid, and a &gt;100-fold increase in the infectious titer. These results support the neurotropic potential of VA1. In the development of a mouse model of VA1 infection, we detected the virus in the brain tissue of mice 7 days after inoculation. Unexpectedly, we detected the highest titer of VA1 in heart tissue, which was associated with histological evidence of myocarditis. Furthermore, we demonstrated VA1 can replicate in primary human cardiac endothelial cells but not in primary human cardiac myocytes.

Conclusions
Our data demonstrate that astroviruses have tissue tropisms outside of the gastrointestinal tract. We provide the first demonstration that cultured neural-derived cells can support infection and replication of astroviruses, providing a model for studying the neuropathogenic potential of VA1. Furthermore, we have identified a novel cardiotropism for VA1, raising the possibility that VA1 may contribute to human cardiac diseases currently without an ascribed etiology.
#16: Use of a Multiplex PCR Panel for Diagnosis of Complicated Pneumonia in Pediatrics
Authors: Armas Elisa A , Melgar M , Juárez J , Vidal M , Eguizábal J , Gordillo R 
Published: March 2021

Abstract

Background
Pleural fluid cultures performed in the period from April 2015 to April 2017 (prior to having the test) were reviewed, 120 cultures were found, of which 7.5% were positive.

Methods
Descriptive study in patients from 0 to 12 years old, from April 2017 to April 2019, at Roosevelt Hospital, Guatemala City, June 2019

Results
In the period from April 2017 to April 2019, pleural fluids were evaluated in which multiplex PCR was performed, obtaining 41 results, 24 positive PCR for pneumonia producing bacteria in the community, of which only 1 positive culture was found, which, if correlated, which means 25 times more detection capacity, than the Gold standard of culture. Forty-one cultures of pleural fluids were evaluated, of which 58% were detected by FilmArray® The most frequently isolated microorganisms were Streptococcus pneumoniae 42%, Streptococcus sp. 3% Haemophilus influenzae 13% and Pseudomonas aeruginosa 3%

Conclusion
The use of Multiplex PCR in pleural fluid allowed the identification of a high percentage of microorganisms in the pleural fluid. Although the test is not valid for this use, its use could mean a great advantage for the etiological diagnosis.
#60: Knowledge of Diagnosis and Management of Chagas-related Heart Disease Among Pediatric Cardiologists in the United States
Authors: Malhotra Sanchi , Masood Imran , Giglio Noberto , Pruetz Jay , Pannaraj Pia 
Published: March 2021

Abstract

Background
Chagas disease is a highly pathogenic infection with a prevalence of approximately 5.7 million cases worldwide and greater than 300,000 cases in the United States. Up to 40% of immigrants to the United States are from highly endemic Latin American countries. An estimated 40,000 women of childbearing age in the United States are infected, with a 1–5% risk of vertical transmission. The impact of this disease is extensive, often life-long, and difficult to eradicate. The purpose of our study was to better understand current knowledge and experience among pediatric cardiologists in the United States with the cardiac presentations of Chagas disease to determine where to focus educational programs and critical content.

Methods
We prospectively disseminated a 19-question survey to pediatric cardiologists via the PediHeart, WSOPC, and Pediatric CHF listservs three times between September and November 2019. The survey included demographic, multiple-choice and Likert-scale questions. We used Qualtrics to ensure anonymity. Respondents outside of the United States were excluded.

Results
Of 140 responses received, 120 cardiologists treated pediatric patients in the United States. Over half (62.5%) of respondents served a &gt;10% Latin American patient population. Most providers (87%) had not seen a case of Chagas disease in their practice; however, most (72%) also had never tested for Chagas. In response to the statement: “I feel comfortable recognizing cardiac presentations of Chagas disease in children”, (85%) of respondents disagreed. Most respondents selected that they would not include Chagas on their differential diagnosis for cardiac presentations that included conduction anomalies, myocarditis, and/or apical aneurysms (Figure 1). However, when considering patients who recently immigrated from Latin American nations, inclusion of Chagas in the differential diagnosis increased. In response to the statement: “If I was offered a lecture on Chagas-related heart disease, I would be likely to attend,” 87% of respondents agreed.

Conclusions
In our sample of pediatric cardiologists, very few had seen cases of Chagas disease, albeit very few tested for it or included it in their differential diagnosis. However, most individuals agreed that education on Chagas disease would be worth-while. Education could help ensure these cases are not missed in pediatrics. Future analysis should focus on changes in provider knowledge and/or testing as the incidence grows, or as educational programs are implemented.
#6: Varicella Outbreak Investigation in a Cancer Hospital
Authors: Vishnu Kaniyarakkal , Najna Edakuneri , Ambili Pottammal , Kavitha Dinesh 
Published: March 2021

Abstract

Background
Primary varicella infection is usually self-limited in immunocompetent hosts, whereas it can be quite severe in immunocompromised hosts. Atypical presentations of varicella in immunocompromised hosts can be diagnostically challenging, without laboratory testing. Varicella is an occupational hazard for susceptible healthcare providers (HCP). It assumes importance in infection prevention and control, due to the possibility of spread to other susceptible coworkers and patients.

Methods
This outbreak investigation report is from a 300-bed cancer care hospital in South India. A 62-year-old male patient with lymphoplasmacytic non-Hodgkin’s lymphoma was admitted on October 1 with features of bronchopneumonia and extensive skin lesions, 2 months after his last chemotherapy cycle. The patient was received in the emergency department (ED) and later shifted to the intensive care unit (ICU) due to worsening clinical condition. The clinical picture was more in favor of Stevens–Johnson syndrome, but oral acyclovir therapy was given considering a differential diagnosis of varicella. His condition deteriorated further requiring ventilator support and on the 19th day of admission, the patient succumbed to his illness and passed away. From October 14 to 19, eight HCP presented with vesicular eruptions and fever, clinically diagnosed as having varicella. This aroused the suspicion of an outbreak. An emergency outbreak control group meeting was convened to assess and address the situation.

Results
All outbreak cases were confirmed as varicella, clinically. Contacts, including patients assigned to HCP involved in the outbreak were traced, and their varicella immune status was assessed. Nonimmune contacts were given oral acyclovir prophylaxis as per CDC recommendations. Other HCP in the hospital were offered first dose of varicella vaccine based on their varicella immune status. With these infection prevention and control measures in place, no additional cases were identified.
Being a hospital in low- to middle-income country, it was not routine practice to vaccinate susceptible HCP, after screening of varicella immune status at the time of recruitment. In the wake of the outbreak, assessment of immunity against varicella, and vaccination of susceptible HCP, is being followed up meticulously.

Conclusion
Varicella can present with atypical symptoms, especially in the immunocompromised host. Suspected cases should be isolated until sensitive PCR studies are done. Varicella immune status of HCP should be assessed at recruitment and vaccination should be offered to susceptible individuals. Implementation and infection prevention and control measures can help prevent and mitigate varicella outbreaks within healthcare facilities.
#34: Measles Outbreak in Pediatric Oncology Patients in Hue Central Hospital, Vietnam
Authors: Hoa Nguyen Thi Kim , Hao Tran Kiem , Van Ha Chau 
Published: March 2021

Abstract

Background
Measles outbreaks in immunocompromised populations present a significant challenge, and to interrupt endemic transmission can be difficult. This study aimed to investigate measles in pediatric oncology patients at Hue Central Hospital, Vietnam to describe demographic, epidemiological, and clinical features.

Methods
Potential measles infections among children with cancer were prospectively identified between April 20 to July 10, 2019 at Hue Central Hospital. Measles diagnoses were based on both clinical features and IgM laboratory evaluation. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA).

Results
From April 20 to July 10 in 2019, a total of 11 patients with malignancies were identified as having measles, with a median age of 4.0 years (range: 1 years to 9 years). Of these 11 patients, 2 (18.2%) had not received any dose of measles vaccine, 4 (36.4%) had received 1 dose of measles vaccine, and 5 (45.5%) had received the recommended 2 doses. All patients had fever with the median temperature of 39 degrees Celsius (range: 38.5–39.5), and median fever duration of 7 days. All patients had cough and rash, while 3 (27.3%) were complicated by pneumonia, and 2 (18.2%) had elevated liver transaminases. All patients had hospital visits or were hospitalized before measles onset, with the median length of stay of 10 days (range: 7–24 days). All patients were likely to exposed each other. 100% of these patients recovered.

Conclusions
Children with cancer are at extra risk of measles infection due to their immunocompromised status. Getting vaccinated is the best way to prevent measles, and improved infection control is critical for the prevention of measles in patients with malignancies. Following this measles outbreak, a designated outpatient area was established to separate the inpatient unit and limit hospital transmission.
Diachronic delta: A computational method for analysing periods of accelerated change in literary datasets
Authors: Beausang Chris 
Published: March 2021

Abstract
In his recently published book Distant Horizons (2019), Ted Underwood argues that literary change takes place incrementally. By analysing a dataset of English language fiction obtained from the digital research library HathiTrust, Underwood demonstrates that from the early 18th to the 21st century, literature written in English evinces a steady increase in words associated with physical description, concrete nouns as well as sensory perception and that this increase is accompanied by a proportional decrease in words associated with politics, economics as well as religion (Underwood 25). This article represents an effort to test Underwood’s incremental hypothesis by operationalizing Peter W.H. Smith and W. Aldridge’s cosine distance-based emendation to John Burrows’ ‘Delta’ method (Smith, P. W. H. and Aldridge, W. (2011). Improving authorship attribution: optimising burrows’ delta method. Journal of Quantitative Linguistics 18(1): 63–88). By applying cosine Delta across time rather than as it is conventionally applied, across text (Evert, Stefan et al. Understanding and Explaining Delta Measures for Authorship Attribution. Digital Scholarship in the Humanities 32 (suppl_2) (2017): ii4–ii16), we can identify particular years as being associated with extensive amounts of ‘novelty’ (which years introduce the most amount of distance from their predecessors) and also possess extensive amounts of ‘resonance’ (are relatively proximate to their successors). According to Alexander T.J. Barron et al.’s method for analysing the parliamentary debates of the French revolution, agents within a dataset which have high amounts of novelty and high amounts of resonance are both innovative and influential, as they are significantly different from the years which come before and relatively similar to the years which come after. We might refer to these years as ‘breaks’ and contrast their behaviour with the longue-durée approach otherwise prevalent within the computational literary studies discourse. Though, as this article demonstrates, Underwood’s hypothesis of incremental change remains robust when considering the changes which come over the novel from the mid-18th to the early 20th century, applying this method to poetic and dramatic production over the same period of time, thereby examining the distinct ways in which novelty and resonance behave, allow us to modulate Underwood’s hypothesis and to understand literary history within a more conjunctural framework.
Mechanism of REST/NRSF regulation of clustered protocadherin α genes
Authors: Tang Yuanxiao , Jia Zhilian , Xu Honglin , Da Lin-tai , Wu Qiang 
Published: March 2021

Abstract
Repressor element-1 silencing transcription factor (REST) or neuron-restrictive silencer factor (NRSF) is a zinc-finger (ZF) containing transcriptional repressor that recognizes thousands of neuron-restrictive silencer elements (NRSEs) in mammalian genomes. How REST/NRSF regulates gene expression remains incompletely understood. Here, we investigate the binding pattern and regulation mechanism of REST/NRSF in the clustered protocadherin (PCDH) genes. We find that REST/NRSF directionally forms base-specific interactions with NRSEs via tandem ZFs in an anti-parallel manner but with striking conformational changes. In addition, REST/NRSF recruitment to the HS5–1 enhancer leads to the decrease of long-range enhancer-promoter interactions and downregulation of the clustered PCDHα genes. Thus, REST/NRSF represses PCDHα gene expression through directional binding to a repertoire of NRSEs within the distal enhancer and variable target genes.