bluuebunny/crossref_metadata_2025_split huggingface dataset:
Term Elective Cesarean Delivery and Offspring Infectious Morbidity
Authors: Wainstock Tamar , Walfisch Asnat , Shoham-Vardi Ilana , Segal Idit , Sergienko Ruslan , Landau Daniella , Sheiner Eyal 
Published: September 2018

Background:
Studies have found associations between delivery mode and offspring long-term health. We aimed to study the possible association between delivery mode and the risk for long-term infectious diseases of the offspring during a follow-up period of up of 18 years.

Methods:
A population-based cohort analysis was performed comparing different subtypes of infectious morbidity leading to hospitalization among children, based on delivery mode (vaginal vs. elective cesarean). Data on pregnancy course and outcome, delivery mode and later offspring hospitalizations were available from a single tertiary center. All singleton uncomplicated deliveries and pregnancies between the years 1991 and 2014 were included in the analysis. Kaplan–Meier and multivariable Weibull survival models were applied to adjust for differences in follow-up time between the study groups and confounders.

Results:
During the study period, 138,910 newborns met the inclusion criteria: 13,206 (9.5%) were delivered by elective cesarean delivery, and 125,704 (91.5%) were delivered vaginally. During the follow-up period (median: 10.22 years), 13,054 (9.4%) were hospitalized (at least once) with infectious morbidity: 12.0% and 9.1% among the cesarean and vaginally delivered children, respectively (Relative Risk: 1.36; 95% confidence interval: 1.28–1.43; incidence density rates for first hospitalization were 15.22/1000 person-years and 9.06/1000 person-years among cesarean and vaginally delivered children, respectively; Kaplan–Meier log rank P < 0.001). The association between cesarean delivery and long-term pediatric infectious morbidity remained significant in the multivariable model, controlling for confounding variables (adjusted hazard ratio: 1.18; 95% confidence interval: 1.11–1.25; P < 0.001).

Conclusions:
Children delivered by elective cesarean section are at an increased risk for hospitalization with pediatric infectious morbidity when compared with vaginally delivered children.
Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality
Authors: Gordon Oren , Cohen Matan J. , Gross Itai , Amit Sharon , Averbuch Dina , Engelhard Dan , Milstone Aaron M. , Moses Allon E. 
Published: September 2018

Background:

Staphylococcus aureus (SA) is a major cause of bacteremia in children. Methicillin-resistant SA (MRSA) is considered a public health threat; however, the differences in the prognosis of children with methicillin-susceptible SA (MSSA) versus MRSA bacteremia are not well defined.

Methods:
Data from all SA bacteremia events in children (0–16 years) from 2002 to 2016 in a single Israeli tertiary center were collected. Positive cultures within 48 hours of hospitalization were considered community associated (CA). Those obtained afterward or from children hospitalized within the previous year were considered health-care associated (HA).

Results:
We recorded 427 events, 284 (66%) were HA, 64 (15%) were MRSA and 9 (2%) were CA-MRSA. There was no increase in MRSA during the study period. In-hospital, 30-day and 1-year mortality were 3% (12 cases), 3.5% (16 cases), and 12% (50 cases), respectively. A multivariable analysis controlling for demographics, admitting department and prior morbidity showed an increased 1-year mortality in children with HA bacteremia (hazard ratio [HR] 4.1; 95% confidence interval [CI]: 1.3–12) and prior chronic disease (HR 3.4; 95% CI 1.2 to 9.0). MRSA was not independently associated with increased one-year mortality compared with MSSA: HR (95% CI: 1.4 [0.6–3.1]).

Conclusions:
Short-term pediatric mortality after SA bacteremia is low. HA-SA bacteremia has an increased long-term risk for mortality, particularly in children with chronic diseases. Our data suggest mortality was not increased for MRSA compared with MSSA bacteremia. The very low rate of CA-MRSA bacteremia justifies the current practice not to include glycopeptides in the empiric treatment of CA bacteremia in Israel.
Concussion Epidemiology in Athletes Who Are Deaf or Hard-of-Hearing Compared With Athletes Who Are Hearing
Authors: Brancaleone Matthew P. , Clifton Daniel R. , Onate James A. , Boucher Laura C. 
Published: September 2018

Objective:
To compare the epidemiology of concussion between athletes who are deaf or hard-of-hearing (D/HoH) and athletes who are hearing.

Design:
Descriptive epidemiology study.

Setting:
Data were collected from 2 Division III athletic programs. One institution is the world's only university designed to be barrier-free for students who are D/HoH.

Participants:
Six hundred ninety-three athletes who are D/HoH and 1284 athletes who are hearing were included in this study. Athletes participated in collegiate athletics during the 2012 to 2013 through the 2016 to 2017 academic years.

Interventions:
Concussion data were provided by the athletic training staff at each institution.

Main Outcome Measures:
Concussion counts, concussion rate, and injury rate ratios (IRRs) with 95% confidence intervals (95% CIs).

Results:
Thirty athletes who are D/HoH and 104 athletes who are hearing suffered concussions. Athletes who are hearing had an increased injury rate compared with athletes who are D/HoH for all sports combined (IRR = 1.87, 95% CI, 1.26-2.78). Football athletes who are hearing also had an increased injury rate compared with football athletes who are D/HoH (IRR = 3.30, 95% CI, 1.71-6.37). Concussion rate was higher for male athletes who are hearing than male athletes who are D/HoH (IRR = 2.84, 95% CI, 1.62-4.97). No other significant differences regarding concussion risk were identified.

Conclusions:
Athletes who are D/HoH in sex-comparable sports may not have a higher rate of concussion than athletes who are hearing. Rate of concussion in football may be greater among athletes who are hearing compared with athletes who are D/HoH.
Comparison of Electrosurgical Devices for Cervical Conization: Novel Monopolar Scalpel (VIO) Versus Ultrasonic Scalpel
Authors: Akazawa Munetoshi , Saito Toshiaki , Okadome Masao , Ariyoshi Kazuya 
Published: September 2018

Objective
The aim of this study was to compare the outcomes associated with the use of a novel monopolar scalpel with those associated with the use of an ultrasonic scalpel for cervical conization of cervical intraepithelial neoplasia.

Materials and Methods
We conducted a retrospective cross-sectional study in patients treated in our institute between April 2010 and March 2017. We used either the VIO monopolar scalpel (VIO) or Harmonic ultrasonic scalpel (HS) for cervical conization. We analyzed operative outcomes, postoperative complications, and pathological findings associated with the use of the 2 devices.

Results
In 500 patients treated with cervical conization, VIO and HS were used in 249 and 251 patients, respectively. No significant difference in patient background was found between the groups. The mean operative time was shorter with VIO than with HS (18.2 min vs. 27.4 min). The mean estimated blood loss was greater with VIO (7.2 g vs. 3.1 g), but the postoperative bleeding rate was higher with HS (5% vs. 20%). Regarding other complications, cervical stenosis was only noted with VIO (4 cases, 1.6%). The positive margin (11% vs. 16%) and positive endocervical curettage rates (7% vs 10%) were not significantly different between the groups. No significant differences were also found in the pathological results and need for additional treatment (the rate of the additional treatment: 20% vs. 23%).

Conclusions
Considering short operating time and less postoperative bleeding, VIO was preferred to HS. However, the excessive coagulation in VIO is considered to lead to cervical stenosis.
Fact or Fiction? Adipose-Derived Stem Cells and Platelet-Rich Plasma for the Treatment of Vulvar Lichen Sclerosus
Authors: Eshtiaghi Panteha , Sadownik Leslie Ann 
Published: September 2018

Objective
The aim of the study was to summarize and review the evidence for the efficacy and safety of adipose-derived stem cells (ADSCs) and platelet-rich plasma (PRP) for the treatment of vulvar lichen sclerosus (LS).

Materials and Methods
PubMed/MEDLINE, Ovid, Web of Science, and clinicaltrials.gov were searched from inception up to May 7, 2018.

Results
Seven observational studies were identified, with a total of 98 patients. Both ADSCs and PRP were reported to improve symptoms, quality of life measures, as well as clinical and histological signs of vulvar LS. There is a strong risk of biased estimates of treatment effect.

Conclusions
Current evidence is weak for ADSCs and/or PRP as treatment for vulvar LS. Further research is needed before recommending this therapy.
Has Rotavirus Vaccination Decreased the Prevalence of Biliary Atresia?
Authors: Danial Elizabeth , Fleck-Derderian Shannon , Rosenthal Philip 
Published: September 2018

Objectives:
Biliary atresia (BA) is a rare neonatal liver disease that causes cholestasis and is the leading indication for pediatric liver transplantation. Although the exact etiology of BA remains unknown, evidence from murine models supports the role of rotavirus infection in the development of BA. In 2006, universal rotavirus vaccination was implemented in the United States. The goal of this study was to determine if the prevalence of BA correlated with the number of annual rotavirus infections.

Methods:
We utilized data from the 1997 to 2012 Kids’ Inpatient Database and the 1988 to 2015 Organ Procurement and Transplantation Network to determine the annual number of infant discharges with a primary diagnosis of BA and the number of infants with BA who received a liver transplant, respectively. We obtained the number of annual rotavirus infections from the National Respiratory and Enteric Virus Surveillance System and examined whether trends existed between the data from these 3 sources over time.

Results:
From 1997 to 2006, the number of positive rotavirus antigen tests remained steady, however a rapid decrease was observed from 2006 to 2012 (8774 to 1277), coinciding with the uptake of rotavirus immunizations nationwide. The number of BA discharges doubled from 1997 to 2003 and again increased from 2006 to 2012 (67 to 137 and 117 to 156), while the number of liver transplants for BA changed very little from 1997 to 2012.

Conclusions:
The recent implementation of rotavirus vaccination has not had any substantial influence on the prevalence of BA in the United States.
Insurance Coverage and Utilization Improve for Latino Youth but Disparities by Heritage Group Persist Following the ACA
Authors: Kemmick Pintor Jessie , Chen Jie , Alcalá Héctor E. , Langellier Brent A. , McKenna Ryan M. , Roby Dylan H. , Ortega Alexander N. 
Published: September 2018

Objective:
Latino youth experience worse access to and utilization of health care compared with non-Latino “white” youth, with inequities persisting following the implementation of the Affordable Care Act (ACA). To better understand these disparities, we examine changes in youth’s access and utilization associated with the ACA for different Latino heritage groups relative to whites.

Study Design:
We use 6 years (2011–2016) of National Health Interview Survey data to examine Latino youth’s insurance coverage and health care utilization by heritage group, nativity, and parental language. The dependent measures of utilization included well-child, emergency department, and physician visits. We used multivariable logistic regression models to estimate the odds of each dependent measure and interacted heritage group and time period [2011–2013 (pre-ACA) versus 2014–2016 (post-ACA)] to examine how changes associated with the ACA varied by group.

Results:
Insurance coverage and well-child visits improved among youth overall following implementation of the ACA. Although Mexican and Central or South American youth experienced the largest absolute increase in coverage, they still had high levels of uninsurance post-ACA (9.9% and 9.1%, respectively). Disparities in coverage between Puerto Rican and white youth improved, while disparities in well-child visits between Mexican and white youth worsened. Little to no movement was observed in disparities by nativity and parental language.

Conclusions:
Most disparities in insurance and utilization across Latino heritage groups and white youth persisted post-ACA despite significant gains within groups. Although disparities for Puerto Rican youth have improved, Mexican and Central or South American youth continue to experience disparities.
The Prevalence of Culture Change Practice in US Nursing Homes
Authors: Miller Susan C. , Schwartz Margot L. , Lima Julie C. , Shield Renée R. , Tyler Denise A. , Berridge Clara W. , Gozalo Pedro L. , Lepore Michael J. , Clark Melissa A. 
Published: September 2018

Background and Objectives:
Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/2017 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence.

Research Design and Methods:
We administered a nationwide survey to 2142 NH Administrators at NHs previously responding to a 2009/2010 survey. Seventy-four percent of administrators (1583) responded (with no detectable nonresponse bias) enabling us to generalize (weighted) findings to US NHs. From responses, we created index scores for practice domains of resident-centered care, staff empowerment, physical environment, leadership, and family and community engagement. Facility-level covariate data came from the survey and the Certification and Survey Provider Enhanced Reporting system. Ordered logistic regression identified the factors associated with higher index scores.

Results:
Eighty-eight percent of administrators reported some facility-level involvement in NH culture change, with higher reported involvement consistently associated with higher domain index scores. NHs performed the best (82.6/100 weighted points) on the standardized resident-centered care practices index, and had the lowest scores (54.8) on the family and community engagement index. Multivariable results indicate higher index scores in NHs with higher leadership scores and in states having Medicaid pay-for-performance with culture change-related quality measures.

Conclusions:
The relatively higher resident-centered care scores (compared with other domain scores) suggest an emphasis on person-centered care in many US NHs. Findings also support pay-for-performance as a potential mechanism to incentivize preferred NH practice.
Retinitis pigmentosa: recent advances and future directions in diagnosis and management
Authors: Fahim Abigail 
Published: September 2018

Purpose of review
Retinitis pigmentosa is a group of genetically diverse inherited blinding disorders for which there are no treatments. Owing to recent advances in imaging technology, DNA sequencing, gene therapy, and stem cell biology, clinical trials have multiplied and the landscape is rapidly changing. This review provides a relevant and timely update of current trends and future directions for the diagnosis and management of this disease.

Recent findings
This review will highlight the use of retinal imaging to measure progression of disease, next-generation sequencing for genetic diagnosis, the use of electronic retinal implants as well as noninvasive digital low-vision aids, and the current state of preclinical and clinical research with gene therapy and cell-based therapies.

Summary
Retinitis pigmentosa has historically been an untreatable condition. Recent advances have allowed for limited improvement in visual outcomes for select patients. Retinal degenerative disease is on the cutting edge of regenerative medicine. Gene therapy and stem cell therapeutic strategies are currently under investigation and are expected to radically impact management of inherited retinal disease in the coming years.

Video abstract

http://links.lww.com/MOP/A33.
The overlap between allergy and immunodeficiency
Authors: Sokol Kristin , Milner Joshua D. 
Published: September 2018

Purpose of review
The mechanisms underlying the overlap of, and relationship between, atopy and immunodeficiency are just beginning to be recognized, through the identification of novel genetic conditions and the reexamination of well known primary immunodeficiencies. The present review seeks both to frame the topic and to highlight the most recent literature combining allergy in the context of immunodeficiency.

Recent findings
The true prevalence of atopic disorders in the setting of primary immunodeficiency as a whole is difficult to pinpoint, however there have been recent attempts to measure prevalence. Individual immunodeficiency disorders have been more carefully dissected for atopic disease and the mechanisms underlying the atopic phenotypic, whereas several newly described immune deficiencies because of single gene mutations are highly associated with atopic phenotypes. Finally, a number of novel genetic conditions with atopy being the primary feature, even in the absence of overt immune deficiency, have been described, providing instrumental clues into the diagnostic dilemmas these syndromes create.

Summary
Defining and examining diseases with primary features of atopy and infection allow for a better understanding of the interplay between the two in rare disease, and hopefully sheds light on fundamental pathways involved in atopy and host defense in the general population.
Interleukin 9 Alters Epithelial Barrier and E‐cadherin in Eosinophilic Esophagitis
Authors: Doshi Ashmi , Khamishon Rebecca , Rawson Renee , Duong Loan , Dohil Lucas , Myers Stephen J. , Bell Braxton , Dohil Ranjan , Newbury Robert O. , Barrett Kim E. , Kurten Richard C. , Aceves Seema S. 
Published: September 2018

ABSTRACTBackground:Eosinophilic esophagitis (EoE) is a chronic TH2‐assocated inflammatory condition accompanied by substantial impairments in epithelial barrier function and increased numbers of interleukin 9 (IL‐9) expressing inflammatory cells. While IL‐9 is known to affect barrier function in the intestine, the functional effects of IL‐9 on the esophagus are unclear. Herein we aimed to understand the expression of the IL‐9 receptor and effects of IL‐9 on the epithelium in EoE.Methods:We used esophageal biopsies from pediatric EoE patients with active and inactive disease to analyze the expression of the IL‐9 receptor, the adherens junction protein E‐cadherin and the tight junction protein claudin‐1. We treated primary human esophageal epithelial cells with IL‐9 to understand its effects on E‐cadherin expression and function.Results:Active EoE subjects had increased epithelial expression of IL‐9 receptor mRNA and protein (P < 0.05) and decreased membrane bound E‐cadherin (P < 0.01) and claudin‐1 (P < 0.05) expression. IL‐9 receptor expression and mislocalized claudin‐1 positively correlated and while membrane bound E‐cadherin expression negatively correlated with the degree of histologic epithelial remodeling (P < 0.05). IL‐9 decreased epithelial resistance in stratified primary human esophageal epithelial cells (P < 0.01) and membrane bound E‐cadherin in epithelial cell monolayers (P < 0.01).Conclusions:These data suggest that IL‐9, its receptor, and its effects on E‐cadherin may be important mechanisms for epithelial barrier disruption in EoE.
Lower 6‐MMP/6‐TG Ratio May Be a Therapeutic Target in Pediatric Autoimmune Hepatitis
Authors: Bolia Rishi , Rajanayagam Jeremy , Hardikar Winita 
Published: September 2018

ABSTRACTBackground:Azathioprine (AZA) is the mainstay of maintenance therapy in pediatric autoimmune hepatitis (AIH). The use of thiopurines metabolites to individualize therapy and avoid toxicity has not, however, been clearly defined.Methods:Retrospective analysis of children ⩽18 years diagnosed with AIH between January 2001 and 2016. Standard definitions were used for treatment response and disease flare. Thiopurine metabolite levels were correlated with the corresponding liver function test.Results:A total of 56 children (32 girls) were diagnosed with AIH at a median age of 11 years (interquartile range [IQR] 9). No difference in 6‐thioguanine‐nucleotide (6‐TG) levels (271[IQR 251] pmol/8 × 108 red blood cell vs 224 [IQR 147] pmol/8 × 108 red blood cell, P = 0.06) was observed in children in remission when compared with those who were not in remission. No correlation was observed between the 6‐TG and alanine aminotransferase levels (r = −0.179, P = 0.109) or between 6‐methyl‐mercaptopurine (6‐MMP) and alanine aminotransferase levels (r = 0.139, P = 0.213). The 6‐MMP/6‐TG ratio was significantly lower in patients who were in remission (2[7] vs 5 (10), P = 0.04). Using a quartile analysis, we found that having a ratio of <4 was significantly associated with being in remission with OR 2.50 (95% confidence interval 1.02–6.10), P = 0.047. Use of allopurinol with low‐dose AZA in 6 children with preferential 6‐MMP production brought about remission in 5/6 (83.3%).Conclusions:Thiopurine metabolite levels should be measured in patients with AIH who have experienced a loss of remission. A 6‐MMP/6‐TG ratio of <4 with the addition of allopurinol could be considered in these patients.
Chronic Acalculous Cholecystitis in Children With Biliary Symptoms
Authors: Kwatra Neha S. , Nurko Samuel , Stamoulis Catherine , Falone Anthony E. , Grant Frederick D. , Treves S. Ted 
Published: September 2018

ABSTRACTObjectives:Chronic acalculous cholecystitis (CAC) increasingly is being diagnosed as a cause of recurring biliary symptoms in children, but its clinical diagnosis remains challenging. The primary objective was to evaluate the utility of hepatocholescintigraphy in pediatric patients with suspected CAC. A secondary objective was to describe their clinical follow‐up after diagnosis.Methods:Medical records of patients (aged 9–20 years) who underwent hepatocholescintigraphy from February 2008 to January 2012 were reviewed. Patients with gallstones, and with ⩽1 year of clinical follow‐up, and studies without gallbladder (GB) stimulation were excluded. GB ejection fraction (GBEF) of <35% after sincalide or fatty meal (Lipomul) stimulation were considered abnormal. Diagnosis of CAC was based on histopathology after cholecystectomy. Patients with negative GB pathology, or complete resolution of symptoms without surgery, or alternative diagnoses for persistent symptoms were considered to not have CAC.Results:Eighty‐three patients formed the study group (median age 14.9 years), of which 81.9% were girls. Median duration of symptoms and clinical follow‐up were 6 months and 2.9 years, respectively. Fifty‐two patients had at least 1 study with sincalide and 36 patients had at least 1 study with Lipomul. Initial cholescintigraphy was 95.0% sensitive and 73.0% specific in diagnosing CAC, with a negative predictive value of 97.9%. Of the 31 patients with abnormal GBEF, 22 underwent cholecystectomy with improvement in pain in 72.7%, whereas all of the 9 without surgery improved.Conclusions:Hepatocholescintigraphy is useful for excluding CAC, although the clinical implications of an abnormal GBEF need to be further defined.