bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Case Report and Literature Review of Scrub Typhus With Acute Abdomen and Septic Shock in a Child—The Role of Leukocytoclastic Vasculitis and Granulysin
Authors: Chang Po-Hsiung , Cheng Yu-Pin , Chang Po-Sheng , Lo Chiao-Wei , Lin Lung-Huang , Lu Chin-Fang , Chung Wen-Hung 
Published: April 2018

Scrub typhus is becoming a clinically important cause of acute undifferentiated febrile illness in Taiwan. The incubation period is between 6 and 21 days after exposure. It is transmitted by chiggers (larva of trombiculid mite) in long grasses and in dirt-floor homes, with infection characterized by a flu-like illness of fever, headache, and myalgia lasting approximately 1 week. It has various systemic manifestations, including GI symptoms. In some, the illness progresses to multiorgan dysfunction syndrome and death. We report on a 13-year-old boy who lived in Taipei City and who had initially tentative diagnosis of acute pyrexia of unknown origin with high fever up to 40.3°C for 1 week, but later had thrombocytopenia and diffuse abdominal pain with peritoneal sign suspected acute appendicitis. During the clinical course, septic shock and disseminated intravascular coagulopathy (DIC) were noted. There were skin rash in his trunk and extremities and an eschar with black crust surrounded by a scaling erythematous rim on his right buttock. In addition, we got the information of his travel history in Green Island and Orchid Island for 10 days.
With the correct antibiotics, vancomycin, meropenem, and doxycycline, the patient was getting better and corresponding with high level of granulysin and tumor necrosis factor-alpha. The diagnosis of scrub typhus was confirmed by the biopsy of eschar and high quantitative real-time polymerase chain reaction values of Orientia tsutsugamushi (16sRNA and 56 kDa) tested by Centers for Disease Control and Prevention, Taiwan. Histopathological findings of the eschar revealed the leukocytoclastic vasculitis, crust and thrombus formation with many gram-negative microorganisms, O. tsutsugamushi demonstrated by 47 kDa monoclonal antibody immunohistochemical stain and electromicroscopy.

Outcomes:
After the careful selection of appropriate antibiotics including meropenem, vancomycin, and doxycycline, he recovered and was subsequently discharged 7 days after admission.

Lesson subsections:
This case highlights that scrub typhus infection can mimic acute abdomen and septic shock with DIC. This rare presentation of acute abdomen and septic shock with thrombocytopenia and DIC caused by scrub typhus should remind physicians to be alert to the possibility of acute abdomen and febrile illness resulting from scrub typhus.
Tranilast Blunts the Hypertrophic and Fibrotic Response to Increased Afterload Independent of Cardiomyocyte Transient Receptor Potential Vanilloid 2 Channels
Authors: Koch Sheryl E. , Nieman Michelle L. , Robbins Nathan , Slone Samuel , Worley Mariah , Green Lisa C. , Chen Yamei , Barlow Alexandria , Tranter Michael , Wang HongSheng , Lorenz John N. , Rubinstein Jack 
Published: April 2018

Abstract:
Tranilast is clinically indicated for the treatment of allergic disorders and is also a nonselective blocker of the transient receptor potential vanilloid 2 (TRPV2) channel. Previous studies have found that it has protective effects in various animal models of cardiac disease. Our laboratory has found that genetic deletion of TRPV2 results in a blunted hypertrophic response to increased afterload; thus, this study tested the hypothesis that tranilast through cardiomyocyte TRPV2 blockade can inhibit the hypertrophic response to pressure overload in vivo through transverse aortic constriction and ex vivo through isolated myocyte studies. The in vivo studies demonstrated that tranilast blunted the fibrotic response to increased afterload and, to a lesser extent, the hypertrophic response. After 4 weeks, this blunting was associated with improved cardiac function, although at 8 weeks, the cardiac function deteriorated similarly to the control group. Finally, the in vitro studies demonstrated that tranilast was not inhibiting these responses at the cardiomyocyte level. In conclusion, we demonstrated that tranilast blunting of the fibrotic and hypertrophic response occurs independently of cardiac TRPV2 channels and may be cardioprotective in the short term but not after prolonged administration.
Estimating Fluoroscopic Peak Skin Dose Using Manual Calculations
Authors: Berry Kendall Elizabeth 
Published: April 2018

Abstract
Not all healthcare providers can afford to purchase commercially available programs that can quickly and easily provide peak skin dose estimations for patients undergoing diagnostic and international fluoroscopic procedures. The air kerma reference point exposure, Ka,r, available on all equipment manufactured after 2006, may over or under estimate the patient's peak skin dose. The total air kerma reference point exposure provided at the end of a case might be on the order of 20 Gy for a patient, indicating that a Joint Commission "sentinel event" may have occurred. An investigation to determine whether a sentinel event has occurred becomes necessary. This article will introduce information available to the investigating health physicist for data mining, how to process that information, and then how best to interpret the results. I have used this system of data mining and analysis to effectively influence how physicians performing diagnostic and interventional fluoroscopic procedures use fluoroscopic equipment. Arriving at an answer is not simple; it is time consuming, and the methodologies are imperfect. Your effort can result in improved utilization of fluoroscopic equipment at your institution which in turn will lower patient and staff doses.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN PATIENTS WITH NONOCULAR BEHÇET DISEASE
Authors: Raafat Karim A. , Allam Riham S. H. M. , Medhat Basma M. 
Published: April 2018

Purpose:
To describe the optical coherence tomography angiography findings in nonocular Behçet disease.

Methods:
The superficial capillary plexus (SCP) and deep capillary plexus (DCP) and outer retinal and choroidal flow were evaluated using optical coherence tomography angiography. Perimetry was performed to correlate any microvascular and functional changes.

Results:
Capillary nonperfusion areas were found in the superficial capillary plexus in 16/20 eyes (80%) and in the DCP in 17/20 eyes (85%). Perifoveal capillary arcade disruption and vessel rarefaction were present in both plexuses in all cases. Capillary telangiectasia was present in the superficial capillary plexus in five eyes (25%) and in the DCP in all eyes. Telangiectasia of the parafoveal capillaries was present in the DCP in all eyes. The mean area of the foveal avascular zone was not significantly different from that in 20 normal eyes (P = 0.68). However, mean and central subfield capillary density values were significantly lower (P < 0.001 and P < 0.005, respectively) in the Behçet disease group. Perimetry revealed central scotomata on the pattern deviation plot in 12 eyes (60%).

Conclusion:
Telangiectasia of the parafoveal capillaries was detected in the DCP in all cases. Microvascular changes in the superficial capillary plexus and DCP in nonocular Behçet disease can be detected by optical coherence tomography angiography.
Significantly Elevated C-Reactive Protein Levels after Epicardial Clipping of the Left Atrial Appendage
Authors: Verberkmoes Niels J. , Akca Ferdi , Vandevenne Ann-Sofie , Jacobs Luuk , Hamad Mohamed A. Soliman , van Straten Albert H.M. 
Published: April 2018

Objective Besides mechanical and anatomical changes of the left atrium, epicardial closure of the left atrial appendage has also possible homeostatic effects. The aim of this study was to assess whether epicardial clipping of the left atrial appendage has different biochemical effects compared with complete removal of the left atrial appendage. Methods Eighty-two patients were included and underwent a totally thoracoscopic AF ablation procedure. As part of the procedure, the left atrial appendage was excluded with an epicardial clip (n = 57) or the left atrial appendage was fully amputated with an endoscopic vascular stapler (n = 25). From all patients’ preprocedural and postprocedural blood pressure, electrolytes and inflammatory parameters were collected. Results The mean age and left atrial volume index were comparable between the epicardial clip and stapler group (64 ± 8 years vs. 60 ± 9 years, P = non-significant; 44 ±15 mL/m2 vs. 40 ± 13 mL/m2, P = nonsignificant). Patients receiving left atrial appendage clipping had significantly elevated C-reactive protein levels compared with patients who had left atrial appendage stapling at the second, third, and fourth postoperative day (225 ± 84 mg/L vs. 149 ± 76 mg/L, P = 0.002, 244 ± 78 vs. 167 ± 76, P = 0.004, 190 ± 74vs. 105 ± 48, P < 0.001, respectively). Patients had a significant decrease in sodium levels, systolic, and diastolic blood pressure at 24 and 72 hours after left atrial appendage closure. However, this was comparable for both the left atrial appendage clipping and stapling group. Conclusions Increased activation of the inflammatory response was observed after left atrial appendage clipping compared with left atrial appendage stapling. Furthermore, a significant decrease in blood pressure was observed after surgical removal of the left atrial appendage. Whether the inflammatory response affects the outcome of arrhythmia surgery needs to be further evaluated.
“A Drop in the Ocean”: A Reflection on the Application of Cognitive Analytic Therapy Within a Prison Setting
Authors: Roper Louise 
Published: April 2018

ABSTRACT
This article reflects on the application of cognitive analytic therapy (CAT) with prisoners referred to a mental health in-reach team within a U.K. prison based on the author's experience as a clinical psychologist. The extent of mental health problems in the prison population and the provision of mental health services within prisons are summarized to highlight the extent of mental health need within this setting. The central concepts and tools of CAT that provided the framework within which this author's work was undertaken within the prison are detailed, namely, reciprocal roles and reciprocal role procedures. Personal reflections on the utility of CAT within a prison setting are presented, including how CAT informed understanding of risk. The application of CAT to the role of forensic nurses within mental health in-reach teams is also considered.
Clinical and Microbiological Effect of a Multispecies Probiotic Supplementation in Celiac Patients With Persistent IBS-type Symptoms
Authors: Francavilla Ruggiero , Piccolo Maria , Francavilla Antonio , Polimeno Lorenzo , Semeraro Francesco , Cristofori Fernanda , Castellaneta Stefania , Barone Michele , Indrio Flavia , Gobbetti Marco , De Angelis Maria 
Published: April 2018

Goals:
The goals of this study were to evaluate the efficacy and safety of a probiotic mixture in patients with celiac disease (CD) with irritable bowel syndrome (IBS)-type symptoms despite a strict gluten-free diet (GFD).

Background:
About 30% of patients with CD adherent to a GFD suffer from IBS-type symptoms; a possible cause resides in the imbalances of the intestinal microbiota in CD. Probiotics may represent a potential treatment.

Study:
CD patients with IBS-type symptoms entered a prospective, double-blind, randomized placebo-controlled study. A 6-week treatment period was preceded by a 2-week run-in and followed by a 6-week follow-up phase. Clinical data were monitored throughout the study by validated questionnaires: IBS Severity Scoring System (IBS-SSS); Gastrointestinal Symptom Rating Scale (GSRS); Bristol Stool Form Scale (BSFS); and IBS Quality of Life Questionnaire (IBS-QOL). The fecal microbiota were assayed using plate counts and 16S rRNA gene-based analysis.

Results:
In total, 109 patients were randomized to probiotics (n=54) or placebo (n=55). IBS-SSS and GSRS decreased significantly in probiotics, as compared with placebo [(−15.9%±14.8% vs. 8.2%±25.9%; P<0.001) and (−19.8%±16.6% vs. 12.9%±31.6%; P<0.001)], respectively. Treatment success was significantly higher in patients receiving probiotics, as compared with placebo (15.3% vs. 3.8%; P<0.04). Presumptive lactic acid bacteria, Staphylococcus and Bifidobacterium, increased in patients receiving probiotic treatment. No adverse events were reported.

Conclusions:
A 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms, in CD patients on strict GFD, and is associated with a modification of gut microbiota, characterized by an increase of bifidobacteria.
Gastrointestinal Bleeding With Left Ventricular Assist Devices (LVAD)
Authors: Malik Sarah , Malik Shahbaz A. , Ulmer Laura L. , Jha Lokesh K. , Strupp Michael S. , Raichlin Eugenia , Lyden Elizabeth R. , Hewlett Alexander T. 
Published: April 2018

Background and Goals:
Gastrointestinal bleeding (GIB) is a significant complication following left ventricular assist device (LVAD) implantation. We evaluated the incidence, predictors, endoscopic findings, and outcomes of GIB in LVAD recipients.

Study:
Retrospective review of 205 adult patients undergoing HeartMate II LVAD implantation from January 2012 to June 2016. Patients were reviewed and separated into GIB (n=57; 28%) and non-GIB (n=148; 72%) groups.

Results:
Median time to GIB was 55 (range, 3 to 730) days. The GIB group patients were older (61±12 vs. 56±13, P=0.0042), more often underwent concomitant tricuspid valve (TV) repair (16% vs. 4%, P=0.007), and a higher percentage were assigned for destination therapy (75% vs. 55%, P=0.01). Angioectasia (33%) was the most common identified cause of GIB. Median time to endoscopic intervention was 1 day. The total number of hospital readmissions after LVAD was higher in the GIB group (median of 5 vs. 3, P=0.001), as was the total number of blood products transfused after LVAD (29 vs. 13, P≤0.0001). GIB was associated with an increased risk of death (hazard ratio, 1.94; 95% confidence interval, 1.16-3.25; P=0.01) and the mortality rate during hospitalization for GIB was 11% (P=0.0004). Receiving a heart transplant was associated with a decreased hazard of death (hazard ratio, 0.40; 95% confidence interval, 0.19-0.85; P=0.016).

Conclusions:
Older age and destination therapy as implant strategy were found to be associated with an increased risk of GIB, consistent with previous studies. A unique finding in our study is the association of TV repair with a higher incidence of GIB. Further studies are needed to investigate possible mechanisms by which TV repair increases the incidence of GIB.
Safety and efficacy of encapsulated fecal microbiota transplantation for recurrent Clostridium difficile infection: a systematic review
Authors: Iqbal Umair , Anwar Hafsa , Karim Muhammad A. 
Published: April 2018

Background and aims
Fecal microbial transplantation (FMT) has been shown to be effective for the treatment of recurrent clostridium difficile infection (CDI). The efficacy and safety of freeze-dried encapsulated FMT for the treatment of recurrent CDI is unclear. We performed a systematic review to evaluate and analyze the current evidence in this respect.

Materials and methods
A systematic literature search was performed using the PubMed, Embase, and Medline databases until December 2017 to identify all original studies that investigated the role of administration of encapsulated FMT in recurrent CDI. The study included patients of all ages. Two independent reviewers extracted data and assessed the quality of publications; a third investigator resolved any discrepancies.

Results
A total of six studies, five case series and one randomized-controlled trial, were included in this review. Overall, 341 patients completed treatment with encapsulated FMT. Only three major adverse events were reported and no deaths occurred directly related to FMT. In all, 285 patients responded to the first treatment, with no recurrence during the specified follow-up period set to meet the primary endpoint. Forty-two patients underwent a second treatment, with resolution of symptoms in 28 patients. At least five patients were reported to undergo a third treatment, with resolution in three of them. Only one patient was reported to have received four treatments without long-term resolution of symptoms.

Conclusion
Low-quality to moderate-quality evidence showed that encapsulated FMT is safe and cost-effective for the treatment and prevention of recurrent CDI. Its efficacy is not inferior to FMT performed through the nonoral route. Randomized-controlled trials are necessary to compare its efficacy with oral antimicrobial drugs and also to evaluate the potential adverse effects associated with the treatment.
Socioeconomic Vulnerability and Sexually Transmitted Infection Among Pregnant Haitian Women
Authors: Scheidell Joy D. , Beau De Rochars Valery Madsen , Séraphin Marie Nancy , Hobbs Marcia M. , Morris John Glenn , Célestin Joseph Pierre , Cottler Linda B. , Khan Maria R. 
Published: April 2018

Background
Despite evidence that education and poverty act through distinct pathways to influence sexually transmitted infection (STI), few studies have examined the unique, independent associations of these socioeconomic vulnerabilities with sexual risk behaviors and STI among women.

Methods
From August to October 2013, women at an antenatal clinic in Gressier, Haiti, were interviewed and tested for chlamydial infection, gonorrhea, and trichomoniasis (N = 200). We measured low educational attainment as less than 9 years of schooling and currently living in poverty based on crowding, defined as more than 2 people sleeping in one room. We used logistic regression to estimate independent associations between each socioeconomic indicator and outcomes of sexual behaviors and STI.

Results
Approximately 29% of the sample had a current STI (chlamydia, 8.0%; gonorrhea, 3.0%; trichomoniasis, 20.5%), with 2.5% testing positive for more than 1 STI. Forty percent of the sample reported low educational attainment and 40% reported current poverty. Low educational attainment was associated with early risk behaviors, including twice the odds of earlier sexual debut (adjusted odds ratio [AOR], 2.09; 95% confidence interval [CI],: 1.14–3.84). Poverty was associated with reporting the current main sexual partner to be nonmonogamous (AOR, 2.01; 95% CI, 1.00–4.01) and current STI (AOR, 2.50; 95% CI, 1.26–4.98).

Conclusions
Education and poverty seem to independently influence STI behaviors and infection, with low education associated with early sexual risk and poverty associated with current risk and infection. Improving women's educational attainment may be important in improving risk awareness, thereby reducing risky sexual behaviors and preventing a trajectory of STI risk.
A Relationship Between Clinical and Laboratory Characteristics in Children With Severe Scorpion Envenomation in Çukurova, Turkey
Authors: S. Gökay Sinem , Yılmaz Hayri L. , Yıldızdaş Rıza D. , Çelik Tuğçe , Ekinci Faruk , T. Kendir Özlem , Horoz Özden Ö. 
Published: April 2018

Objective
Scorpion stings are an important health problem in many parts of the world. The aim of this study was to retrospectively examine cases of scorpion stings to evaluate their epidemiological, clinical, and laboratory features and to determine strategies that can reduce morbidity and mortality in these cases.

Methods
Scorpion stings experienced by children between 2007 and 2013 were retrospectively reviewed. The patients were categorized into groups based on severities of toxicities, and demographic, clinical, and laboratory features were compared between the groups.

Results
The mean ± SD age of the 189 patients with scorpion stings was 83.43 ± 59.62 months. There was a significant difference between the clinical stages and the age distribution of the cases (P < 0.05). White blood cell counts differed significantly between the groups (P < 0.05). There was not a significant difference in mean platelet volume and platelet distribution width between the groups, but plateletcrit and low platelet count were significantly different between stage 1 and stage 3 cases (P < 0.05). Glucose, creatinine kinase-myoglobin binding, and troponin I were also significantly different (P < 0.05). The mortality rate was 0%.

Conclusions
People living in regions where scorpion stings are frequent should be informed about preventive measures against these stings, cases of scorpion stings should be monitored in appropriate centers, and staff offering care to these cases should be educated about treatment methods. In addition, treatment protocols should be determined in accordance with regions where the stings occur and studies should be performed to describe prognostic indicators.
The Effect of an Observation Unit on Pediatric Minor Head Injury
Authors: Hagiwara Yusuke , Inoue Nobuaki 
Published: April 2018

Objective
The aim of this study was to evaluate the effect of an observation unit (OU) in an emergency department on reducing unnecessary use of computed tomography (CT) for minor blunt head trauma.

Methods
This study was a retrospective before-and-after study of pediatric patients 18 years or younger with minor blunt head trauma. Patients with a Glasgow Coma Scale score of 14 or 15 who presented to the emergency department were included in the analysis. The rates of head CT use in the period before and after the institution of the OU were compared.

Results
In total, 4706 patients were analyzed (2344 from the period before and 2362 from period after OU institution). The median age of the patients was 3 years, and 64% were male in each period. The rates of CT use were 5.7% (95% confidence interval [CI], 4.8%–6.7%) in the period before and 4.0% (95% CI, 3.3%–4.9%) in the period after OU institution (P = 0.01). The relative risk reduction was 0.70 (95% CI, 0.54–0.91).

Conclusions
The rate of CT use decreased by 30% as a result of OU institution. The OU was an effective means of avoiding an unnecessary head CT for pediatric minor head injuries.
68Ga-Labeled PSMA Uptake in Nonprostatic Malignancies
Authors: Malik Dharmender , Kumar Rajender , Mittal Bhagwant Rai , Singh Harmandeep , Bhattacharya Anish , Singh Shrawan Kumar 
Published: April 2018

Abstract
PET/CT with 68Ga-labeled prostate-specific membrane antigen (PSMA) is increasingly recognized as the best imaging modality for disease staging and detection of recurrent prostate cancer. Despite its name, PSMA expression has been reported in a number of nonprostatic benign and malignant pathologies. Apparently, angioneogenesis is the mechanism attributed to increased 68Ga-PSMA uptake at these sites. Here we illustrate the utility of 68Ga-PSMA in 5 nonprostatic malignancies that could open up new possibilities for diagnostics and theranostic concepts with PSMA labeled radioligands in nonprostate tumor entities.