bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial Intelligence Applied to Gastrointestinal Diagnostics
Authors: Patel Vatsal , Khan Marium N. , Shrivastava Aman , Sadiq Kamran , Ali S. Asad , Moore Sean R. , Brown Donald E. , Syed Sana 
Published: September 2019

ABSTRACTArtificial intelligence (AI), a discipline encompassed by data science, has seen recent rapid growth in its application to healthcare and beyond, and is now an integral part of daily life. Uses of AI in gastroenterology include the automated detection of disease and differentiation of pathology subtypes and disease severity. Although a majority of AI research in gastroenterology focuses on adult applications, there are a number of pediatric pathologies that could benefit from more research. As new and improved diagnostic tools become available and more information is retrieved from them, AI could provide physicians a method to distill enormous amounts of data into enhanced decision‐making and cost saving for children with digestive disorders. This review provides a broad overview of AI and examples of its possible applications in pediatric gastroenterology.
Efficacy of Single‐ Versus Split‐dose Polyethylene Glycol for Colonic Preparation in Children
Authors: Tripathi Parijat Ram , Poddar Ujjal , Yachha Surender Kumar , Sarma Moinak Sen , Srivastava Anshu 
Published: September 2019

ABSTRACTObjectives:Polyethylene glycol (PEG) is the most effective colon‐cleansing agent but volume‐related adverse effects are common. Though split‐dose PEG is used in adults, no pediatric study so‐far has compared split‐dose with single‐dose PEG. We aimed at comparing the efficacy and tolerability of split‐dose versus single‐dose PEG for bowel preparation in children.Methods:Consecutive children (1–18 years) were randomized into either single‐dose or split‐dose PEG. Single‐dose group received 4000 mL/1.73 m2 PEG solution day before colonoscopy whereas split‐dose group received half dose day before and the remaining half on the day of colonoscopy. Effectiveness of bowel preparation was assessed on Aronchik scale, by the endoscopist who was blinded to the type of preparation. Interobserver variability was analyzed by comparing with independent scoring by the blinded trained endoscopy‐nurse. The trial was registered with Clinical Trials Registry of India (Trail number 2017/08/009303).Results:Of the 220 randomized children, 179 completed the study (split‐dose: 93, single‐dose: 86). The mean age of the study population was 11.51 (4.82) years (72.6% boys). The efficacy of bowel preparation was better with split‐dose (satisfactory preparation:76.34% vs 43.02%, P < 0.001) with almost perfect inter‐observer agreement (k = 0.803). Nausea, vomiting, and sleep disturbance were significantly less in split‐dose than single‐dose group (P < 0.05). Split‐dose patients were able to drink PEG solution faster (P = 0.002). Total sleep duration and uninterrupted sleep duration was also better in split‐dose group as compared with single‐dose (P = 0.001).Conclusions:Split‐dose PEG is more effective than single‐dose regimen for bowel preparation with better tolerability and improved sleep quality in pediatric population.
Functional Pancreatic Sphincter Dysfunction in Children
Authors: Lin Tom K. , Fishman Douglas S. , Giefer Matthew J. , Liu Quin Y. , Troendle David , Werlin Steven , Lowe Mark E. , Uc Aliye 
Published: September 2019

ABSTRACTObjective:Functional pancreatic sphincter dysfunction (FPSD), previously characterized as pancreatic sphincter of Oddi dysfunction, is a rarely described cause of pancreatitis. Most studies are reported in adults with alcohol or smoking as confounders, which are uncommon risk factors in children. There are no tests to reliably diagnose FPSD in pediatrics and it is unclear to what degree this disorder contributes to childhood pancreatitis.Methods:We conducted a literature review of the diagnostic and treatment approaches for FPSD, including unique challenges applicable to pediatrics. We identified best practices in the management of children with suspected FPSD and formed a consensus expert opinion.Results:In children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP), we recommend that other risk factors, specifically obstructive factors, be ruled out before considering FPSD as the underlying etiology. In children with ARP/CP, FPSD may be the etiology behind a persistently dilated pancreatic duct in the absence of an alternative obstructive process. Endoscopic retrograde cholangiopancreatography with sphincterotomy should be considered in a select group of children with ARP/CP when FPSD is highly suspected and other etiologies have been effectively ruled out. The family and patient should be thoroughly counseled regarding the risks and advantages of endoscopic intervention. Endoscopic retrograde cholangiopancreatography for suspected FPSD should be considered with caution in children with ARP/CP when pancreatic ductal dilatation is absent.Conclusions:Our consensus expert guidelines provide a uniform approach to the diagnosis and treatment of pediatric FPSD. Further research is necessary to determine the full contribution of FPSD to pediatric pancreatitis.
High Rates of Biomarker-Confirmed Alcohol Use Among Pregnant Women Living With HIV in South Africa and Uganda
Authors: Raggio Greer A. , Psaros Christina , Fatch Robin , Goodman Georgia , Matthews Lynn T. , Magidson Jessica F. , Amanyire Gideon , Cross Anna , Asiimwe Stephen , Hahn Judith A. , Haberer Jessica E. ,   on behalf of the META team
Published: September 2019

Background:
Alcohol use is common among people living with HIV and particularly harmful during pregnancy. However, objective data on alcohol use in pregnant women living with HIV (WLWH) are lacking. In areas with high levels of alcohol use generally, such as South Africa and Uganda, these data are needed to inform interventions.

Methods:
Pregnant and nonpregnant, antiretroviral therapy-naive WLWH were recruited from outpatient clinics in South Africa and Uganda. Women provided self-report data on previous three-month alcohol use and potential mental health correlates of alcohol use (depression and stigma). Blood samples were used to measure phosphatidylethanol (PEth), an objective biomarker of recent alcohol intake. We analyzed any alcohol use (ie, any self-reported use or PEth-positive [≥8 ng/mL]) and under-reporting of alcohol use (ie, no self-reported use with concurrent PEth-positive).

Results:
Among pregnant WLWH (n = 163, median age was 26 [interquartile range: 23–29], median gestational age was 20 weeks [interquartile range: 16–26]), 40% were using alcohol and 16% under-reported alcohol use. Neither any alcohol use nor under-reporting of alcohol use differed significantly between pregnant and nonpregnant women or by country (P > 0.05). Greater depression (but not greater stigma) was significantly associated with any alcohol use (adjusted odds ratio = 1.41, 95% confidence interval: [1.01 to 1.99]; P = 0.045).

Conclusions:
Alcohol use was prevalent and under-reported among pregnant WLWH in South Africa and Uganda, similar to nonpregnant participants, and associated with depression. General health care and antenatal clinic settings present opportunities to provide integrated alcohol-based counseling and depression treatment.
Human herpesvirus 6 in transplant recipients: an update on diagnostic and treatment strategies
Authors: Hill Joshua A. 
Published: September 2019

Purpose of review
The current review article focuses on recent advances in the approach to the diagnosis and treatment of human herpesvirus 6B (HHV-6B) in hematopoietic cell and solid organ transplant recipients.

Recent findings
Over the past few years, key studies have broadened our understanding of best practices for the prevention and treatment of HHV-6B encephalitis after transplantation. Moreover, important data have been reported that support a potential role of HHV-6B reactivation in the development of acute graft-versus-host disease and lower respiratory tract disease in transplant recipients. Finally, increasing recognition of inherited chromosomally integrated HHV-6 (iciHHV-6) and an expanding array of diagnostic tools have increased our understanding of the potential for complications related to viral reactivation originating from iciHHV-6 in donors or recipients.

Summary
Recent advances in diagnostic tools, disease associations, and potential treatments for HHV-6B present abundant opportunities for improving our understanding and management of this complex virus in transplant recipients.
Primary immunodeficiencies and invasive fungal infection: when to suspect and how to diagnose and manage
Authors: Lionakis Michail S. 
Published: September 2019

Purpose of review
Invasive fungal infections (IFIs) most often occur secondary to acquired immunodeficiency states such as transplantation, AIDS or immune-modulatory treatment for neoplastic and autoimmune disorders. Apart from these acquired conditions, several primary immunodeficiency disorders (PIDs) can present with IFIs in the absence of iatrogenic immunosuppression. This review highlights recent advances in our understanding of PIDs that cause IFIs, which may help clinicians in the diagnosis and management of such infections.

Recent findings
A growing number of PIDs that cause varying combinations of invasive infections by commensal Candida, inhaled molds (primarily Aspergillus), Cryptococcus, Pneumocystis, endemic dimorphic fungi, dermatophytes, and/or agents of phaeohyphomycosis has uncovered the organ- and fungus-specific requirements for effective antifungal host defense in humans. Employing certain diagnostic algorithms tailored to the infecting fungus can facilitate the genetic diagnosis of the underlying PID, which has implications for the optimal management of affected patients.

Summary
Heightened clinical suspicion is required for the diagnosis of underlying genetic defects in patients who develop IFIs in the absence of acquired immunodeficiency. Early initiation of antifungal therapy followed by long-term secondary prophylaxis is typically needed to achieve remission, but hematopoietic stem-cell transplantation may sometimes be necessary to promote immune restoration and infection control.
Anaerobic resistance: should we be worried?
Authors: Cooley Louise , Teng Jasmine 
Published: September 2019

Purpose of review
Anaerobic bacteria are implicated in a broad range of infections and can cause significant morbidity and mortality. As such, development of antimicrobial resistance (AMR) increases the risk of worse clinical outcomes and death.

Recent findings
Anaerobe AMR is highly variable according to region and species included in the survey. The overall trend is to increasing resistance, particularly in Europe and Asia, and in the Bacteroides fragilis group and Clostridium sp. Conversely, with the decline in RT027, resistance in Clostridiodes difficile is decreasing. Resistance to moxifloxacin and clindamycin has reached 30–50%, whereas prevalence of metronidazole and carbapenem resistance is generally low. Infections due to multidrug anaerobes have been increasingly reported, with clinical studies demonstrating adverse clinical outcomes, including higher mortality, with anaerobic resistance or inappropriate therapy. The role of antimicrobial stewardship in the setting of increasing anaerobe resistance is yet to be fully elucidated.

Summary
These findings highlight the importance of continuous surveillance in monitoring emerging trends in anaerobe AMR. Mean inhibitory concentrations should be reported due to variable susceptibility breakpoints and for detection of isolates with reduced susceptibility. At a local level, the clinical microbiology laboratory has a key role in identifying and undertaking susceptibility testing to inform individual patient management, develop local antibiograms and liaise with antimicrobial stewardship teams. A greater understanding of the clinical impact of anaerobic resistance and the role of antimicrobial stewardship in preventing resistance is required.
An overview of guidelines for the management of hospital-acquired and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria
Authors: Cillóniz Catia , Dominedò Cristina , Torres Antoni 
Published: September 2019

Purpose of review
Multidrug-resistant (MDR) Gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are associated with poor clinical outcomes. These pathogens represent a global threat with few therapeutic options. In this review, we discuss current guidelines for the empiric management of HAP/VAP caused by MDR Gram-negative pathogens.

Recent findings
The incidence of MDR Gram-negative bacteria is rising among cases of nosocomial pneumonia, such that it is now becoming a significant challenge for clinicians. Adherence to international guidelines may ensure early and adequate antimicrobial therapy, guided by local microbiological data and awareness of the risk factors for MDR bacteria.

Summary
Due to the increasing prevalence of HAP/VAP caused by MDR Gram-negative pathogens, management should be guided by the local ecology and the patient's risk factors for MDR pathogens. The main risk factors are prior hospitalization for at least 5 days, prior use of broad-spectrum antibiotics, prior colonization with resistant pathogens, admission to hospital settings with high rates of MDR pathogens, and septic shock at the time of diagnosis with nosocomial pneumonia.
The role of fosfomycin for multidrug-resistant gram-negative infections
Authors: Bassetti Matteo , Graziano Elena , Berruti Marco , Giacobbe Daniele Roberto 
Published: September 2019

Purpose of reviewIn the last decade, an increasing interest in using fosfomycin for the treatment of multidrug-resistant gram-negative (MDR-GNB) infections have been registered, especially when none or only a few other active alternatives remained available.Recent findingsFosfomycin may remain active against a considerable proportion of MDR-GNB. In observational studies, a possible curative effect of oral fosfomycin monotherapy has been described for uncomplicated urinary tract infections (UTI) and bacterial prostatitis caused by MDR-GNB, whereas intravenous fosfomycin has been mostly used in combination with other agents for various type of severe MDR-GNB infections. The ZEUS randomized controlled trial (RCT) has started to provide high-level evidence about the possible use of fosfomycin for complicated UTI caused by extended-spectrum β-lactamase-producing GNB, but no results of large RCT are currently available to firmly guide the use of fosfomycin for carbapenem-resistant GNB.SummaryFosfomycin is an important therapeutic option for MDR-GNB infections. Further pharmacokinetic/pharmacodynamic and clinical research is needed to optimize its use.
Pharmacologic optimization of antibiotics for Gram-negative infections
Authors: Gill Christian M. , Nicolau David P. 
Published: September 2019

Purpose of review
Antimicrobial resistance among Gram-negative organisms is a rapidly escalating global challenge. Pharmacologic dose optimization based on pharmacokinetic/pharmacodynamic principles is essential for managing Gram-negative infections. High-risk patient populations may receive nonoptimized antimicrobial dosing because pf physiologic changes in acute illness and/or medical interventions. The purpose of this review is to discuss opportunities for pharmacologic optimization of new agents and highlight patient populations that are often associated with poor drug exposure profiles.

Recent findings
Dose optimization of the novel β-lactam-β-lactamase inhibitor combinations has been evaluated through optimizing exposure at the site of infection, evaluating target attainment of both the β-lactam and the β-lactamase-inhibitor in critically ill patients, and evaluating drug exposure to prevent the development of resistance. Plazomicin, a novel aminoglycoside, has pharmacodynamic optimization potential via therapeutic drug monitoring and nomogram-based dosing. Recent studies have evaluated the adequacy of dosing in varying degrees of renal function specifically acute kidney injury, continuous renal replacement therapy (CRRT), and augmented renal clearance (ARC).

Summary
The application of fundamental pharmacokinetic/pharmacodynamic principles is required to optimize new antimicrobials in the treatment of serious Gram-negative infections. Exposure at the site of infection, pharmacokinetics in critically ill patients, and exposures to prevent resistance are all considerations to improve microbiologic and clinical outcomes. Therapeutic drug monitoring may be needed for high-risk patients.
BK polyomavirus-specific antibody and T-cell responses in kidney transplantation: update
Authors: Kaur Amandeep , Wilhelm Maud , Wilk Sabrina , Hirsch Hans H. 
Published: September 2019

Purpose of review
BK polyomavirus (BKPyV) has emerged as a significant cause of premature graft failure after kidney transplantation. Without effective antiviral drugs, treatment is based on reducing immunosuppression to regain immune control over BKPyV replication. The paradigm of high-level viruria/decoy cells, BKPyV-DNAemia, and proven nephropathy permits early interventions. Here, we review recent findings about BKPyV-specific antibody and T-cell responses and their potential role in risk stratification, immune monitoring, and therapy.

Recent finding
Kidney transplant recipients having low or undetectable BKPyV-specific IgG immunoglobulin G (IgG) are higher risk for developing BKPyV-DNAemia if the donor has high BKPyV-specific IgG. This observation has been extended to neutralizing antibodies. Immunosuppression, impaired activation, proliferation, and exhaustion of BKPyV-specific T cells may increase the risk of developing BKPyV-DNAemia and nephropathy. Clearance of BKPyV-DNAemia was correlated with high CD8 T cell responses to human leukocyte antigen (HLA)-types presenting BKPyV-encoded immunodominant 9mers. For clinical translation, these data need to be assessed in appropriately designed clinical studies, as outlined in recent guidelines on BKPyV in kidney transplantation.

Summary
Evaluation of BKPyV-specific immune responses in recipient and donor may help to stratify the risk of BKPyV-DNAemia, nephropathy, and graft loss. Future efforts need to evaluate clinical translation, vaccines, and immunotherapy to control BKPyV replication.
Povidone-iodine Irrigation for Pediatric Perforated Appendicitis May Be Protective
Authors: Anderson Kathryn Tinsley , Putnam Luke Randall , Bartz-Kurycki Marisa Angeline , Hamilton Emma Catherine , Yafi Michael , Pedroza Claudia , Austin Mary Thomas , Kawaguchi Akemi Lorraine , Kao Lillian Shiow-Yu , Lally Kevin Patrick , Tsao KuoJen 
Published: September 2019

Objectives:
A randomized controlled trial was conducted to test the hypothesis that povidone-iodine (PVI) irrigation versus no irrigation (NI) reduces postoperative intra-abdominal abscess (IAA) in children with perforated appendicitis.

Methods:
A 100 patient pilot randomized controlled trial was conducted. Consecutive patients with acute perforated appendicitis were randomized (1:1) to PVI or NI from April 2016 to March 2017 and followed for 1 year. Patients and postoperative providers were blinded to allocation. The primary endpoint was 30-day image-confirmed IAA. Secondary outcomes included initial and total 30-day length of stay (LOS), emergency department (ED) visits, and readmissions. Intention-to-treat analyses were performed to estimate the probability of clinical benefit using Bayesian regression models (an optimistic prior for the primary outcome and neutral priors for secondary outcomes). Frequentist statistics were also used.

Results:
Baseline characteristics were similar between treatment arms. The PVI arm had 12% postoperative IAA versus 16% in the NI arm (relative risk 0.72, 95% credible interval 0.38–1.23). Bayesian analysis estimates 89% probability that PVI reduces IAA. High probability of benefit was seen in all secondary outcomes for the PVI arm: fewer ED visits and readmissions, and shorter initial and total 30-day LOS. The probability of benefit in reduction of total 30-day LOS in PVI patients was 96% and was significant (P = 0.05) on frequentist analysis.

Conclusions:
PVI irrigation for perforated appendicitis in children demonstrated a strong probability of reduction in postoperative IAA with a high probability of decreased LOS. With the favorable probability of benefit in all outcomes, this pilot study serves as evidence to continue a definitive trial.
Live Confocal Tissue Assessment With SYTO16/PI and WGA Staining Visualizes Acute Organ Damage and Predicts Delayed Graft Function in Kidney Transplantation
Authors: Weissenbacher Annemarie , Oberhuber Rupert , Hermann Martin , Soleiman Afshin , Ulmer Hanno , Mayer Gert , Margreiter Christian , Maglione Manuel , Bösmüller Claudia , Messner Franka , Resch Thomas , Cardini Benno , Troppmair Jakob , Margreiter Raimund , Öfner Dietmar , Schneeberger Stefan 
Published: September 2019

Objective:
The aim of our prospective clinical trial was to test a tissue staining technique (real-time confocal analysis [RTCA]) as a rapid assessment tool for donor kidney quality and function in human kidney transplantation.

Summary Background Data:
Tools for objective graft tissue viability assessment before kidney transplantation are lacking. RTCA has recently been established and tested in a pilot study using rodent kidneys.

Methods:
RTCA was performed in kidney biopsies stained with SYTO16/PI and WGA. A score between −3 (100% nonviable) and +3 (100% viable) describes the sum of viable cells divided by the number of nonviable cells per examined area (glomerulus, proximal, and distal tubules). The primary study endpoint was the delayed graft function (DGF).

Results:
Seventy-one kidney transplant recipients were transplanted. The median recipient and donor age were 58.5 and 57 years, respectively. Cold ischemia time was 13.6 ± 4.7 hours; anastomosis time was 30.8 ± 8.7 minutes (mean ± SD). Overall, 23 (33.8%) patients developed DGF. The RTCA score was significantly lower in kidneys developing DGF −0.43 ± 1.78 versus no DGF 0.91 ± 2.17, P = 0.01. The Remuzzi score did not differ between DGF and no DGF, P = 0.13. Remuzzi score and RTCA score correlate inversely significantly; P = 0.004. In the multivariate analysis, solely RTCA score was revealed as a significant independent factor predicting DGF; P = 0.015, Wald = 5.95, odds ratio = 0.72, 95% confidence interval = 0.55 to 0.94.

Conclusions:
Our data demonstrate that RTCA is feasible and clinically meaningful. The RTCA score predicts DGF and is a valid option to be applied in renal transplantation.