bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic Steatosis Is Prevalent Following Orthotopic Liver Transplantation in Children With Cystic Fibrosis
Authors: Cortes‐Santiago Nahir , Leung Daniel H. , Castro Eumenia , Finegold Milton , Wu Hao , Patel Kalyani R. 
Published: September 2018

ABSTRACTObjectives:Systematic study of allograft liver histology in children undergoing orthotopic liver transplantation (LT) for cystic fibrosis‐related liver disease (CFLD).Methods:Retrospective clinicopathologic review of explants and allograft liver biopsies from 13 children and adolescents with CFLD.Results:In this study, the median age at LT for CFLD was 15.7 years. Notably, 10 of 13 (77%) CF explants had >5% steatosis and 8 of 13 (61.5%) demonstrated variable fibrosis. The median age, sex, type of transplant (liver vs liver‐lung), pancreatic insufficiency status, body mass index (BMI) percentile, genotype, and prevalence of diabetes were comparable in those with and without explant steatosis. More than half of allograft biopsies showed significant steatosis (17/31, 54.8%) and lobular inflammation (16/31, 51.6%). Hepatocyte ballooning was less frequent (5/31, 16.1%). Overall, 6 patients (46.2%) had allograft steatosis that worsened over time in 2 patients (33%). None had advanced fibrosis (≥stage 3). Patients with allograft steatosis had significantly more biopsies, were more likely to be “liver only” recipients, had a shorter interval since transplant and higher body mass index percentile (although <85). Patients without explant steatosis never demonstrated allograft steatosis, whereas 60% of patients with explant steatosis (n = 6) developed varying degrees of allograft steatosis. The degree of explant steatosis did not predict its severity in allografts (P = 0.3).Conclusion:This is the first study highlighting the development of allograft steatosis in CF patients. Our findings suggest that allograft steatosis in patients with CF may be related to pre‐existing steatosis in native livers, regardless of other risk factors and may have implications on patient management and long‐term graft/patient survival.
The Relationship Between Sleep Disturbance and Disease Activity in Pediatric Patients With Inflammatory Bowel Disease
Authors: Jarasvaraparn Chaowapong , Zlomke Kimberly , Vann Noelle C. , Wang Bin , Crissinger Karen D. , Gremse David A. 
Published: September 2018

ABSTRACTObjective:The aim of this prospective cross sectional study was to assess the prevalence of sleep disturbance in children with inflammatory bowel disease (IBD), including the relationships between sleep, inflammatory markers, and disease activity of pediatric patients with IBD.Methods:Pediatric patients with IBD and parents were enrolled in the study. Patients completed the Pittsburgh Sleep Quality Index (PSQI), the Pediatric Daytime Sleepiness Scale, and the Adolescent Sleep Wake Scale (ASWS) surveys. Parents completed the Child Sleep Habits Questionnaire (CSHQ). Disease activity for Crohn disease (CD) was determined by the Pediatric Crohn Disease Activity Index and the Pediatric Ulcerative Colitis Activity Index was used to define disease activity in ulcerative colitis (UC)/indeterminate colitis patients.Results:Fifty‐three pediatric patients with IBD (38 CD, 12 UC, and 3 indeterminate colitis) participated in the study. The significant correlations between the CSHQ and Pediatric Crohn Disease Activity Index (P = 0.002) and the PSQI and Pediatric Ulcerative Colitis Activity Index (P = 0.04) were found. Youth with UC and indeterminate colitis significantly reported more sleep disturbance than patients with CD, (P = 0.03, 0.05, and 0.04; PSQI, Pediatric Daytime Sleepiness Scale, ASWS, respectively). Patients self‐reported significantly more sleep disturbance than was observed by parents (P < 0.0001). This study showed the significant correlations between CSHQ score compared to erythrocyte sedimentation rate and albumin (P = 0.001 and 0.03, respectively).Conclusions:Results suggest that increased disease activity is associated with adverse effects on sleep quality. Based on the results of this study, pediatric patients with IBD should be screened for sleep disturbance.
Drug resistance of clinical and environmental isolates of Brucella species in Iran: a meta-analysis
Authors: Khademi Farzad , Yousefi-Avarvand Arshid , Sahebkar Amirhossein , Mohammadi-Ghalehbin Behnam , Arzanlou Mohsen , Peeridogaheh Hadi 
Published: September 2018

Background:
Brucellosis is a contagious and febrile disease endemic to Iran. Increased antibiotic resistance in endemic areas may lead to increased risk of treatment failure and the risk of disease relapse. This systematic review and meta-analysis was performed to determine the antibiotic susceptibility profiles of Brucella species isolated from clinical and environmental samples in Iran.

Methods:
Using national and international databases and extracted keywords from the MeSH database, a fully computerized search was done until 11 June 2018. Of 385 collected studies on the prevalence of drug resistance of Brucella species isolated in Iran, six articles were included in the meta-analysis using predefined eligibility criteria.

Results:
Overall resistance rates of Brucella species to different antibiotics in Iran were as follows: doxycycline: 0%, tigecycline: 5.1%, trimethoprim/sulfamethoxazole: 5.7%, ciprofloxacin: 2.7%, streptomycin: 5%, rifampin: 9.5%, tetracycline: 4.6%, gentamicin: 3.9%, moxifloxacin: 0%, erythromycin: 33.3%, azithromycin: 5.8% and ceftriaxone: 6.3%.

Conclusion:
Our study revealed that the prevalence of drug resistance of Brucella species isolated from clinical and environmental samples in Iran was acceptable and low. However, care should be exercised in the use of common antibiotics for the treatment of brucellosis to prevent the spread of drug resistance.
What Has Happened to Hysteria?
Authors: Cramer Phebe 
Published: September 2018

Abstract
This article traces the history of the diagnosis of hysteria from the earliest medical formulations in the 17th century to the present, including the presence of this diagnosis in the five iterations of the Diagnostic Statistical Manual (DSM) of the American Psychiatric Association. Several different types of hysteria are discussed, with alternative causal explanations. Research focusing on this disorder is summarized.
Updating Apathy: Using Research Domain Criteria to Inform Clinical Assessment and Diagnosis of Disorders of Motivation
Authors: Thant Thida , Yager Joel 
Published: September 2018

Abstract
Clinical observations regarding apathy and motivation derived from many psychiatric and neurological conditions have generated divergent descriptions of apathy-related syndromes. Stimulated by complex cases presenting with prominent apathy, uses of the term “apathy” and “related phenomena” in the Diagnostic and Statistical Manual of Mental Disorders, diagnostic proposals for apathy as a syndrome and disorder of motivation, Research Domain Criteria (RDoC) systems governing motivational processes, and their clinical intersections are reviewed. Clinical apathy and associated dysfunctions can be addressed using constructs suggested by the RDoC domain of Positive Valence Systems, including approach motivation and component processes of reward valuation, effort valuation/willingness to work, expectancy/reward prediction error, and responses to reward and reward learning. Although apathy syndromes have been validated, defining potentially distinct disorders of motivation (not simply subordinated to mood, psychotic, cognitive, or substance use disorders) will require additional research to better delineate etiology and pathogenesis, predictive validators, reliable diagnostic methods, treatments, and demonstrations of use for these diagnostic proposals.
Acute Polymorphic Psychotic Disorder
Authors: Castagnini Augusto , Foldager Leslie , Berrios German E. 
Published: September 2018

Abstract
The ICD-11 International Classification of Diseases and Related Health Problems will move toward a narrower concept of “acute and transient psychotic disorders” (ATPD) characterized by the remnant “polymorphic psychotic disorder” (APPD) of the current ICD-10 category, also including schizophrenic and predominantly delusional subtypes. To assess the validity of APPD, relevant articles published between January 1993 and September 2017 were found through searches in PubMed and Web of Science. APPD is a rare mental disorder and affects significantly more women than men in early-middle adulthood. Its diagnostic reliability is relatively low, and its consistency reaches just 53.8% on average over 8.8 years, but is significantly greater than either of ATPD subtypes, which are more likely to progress to schizophrenia and related disorders. Although APPD has distinctive features and higher predictive power, its rarity and the fleeting and polymorphic nature of its symptoms could reduce its usefulness in clinical practice and discourage research.
Association of CTRP13 With Liver Enzymes and Cognitive Symptoms in Nonalcoholic Fatty Liver Disease
Authors: An Kyungeh , Starkweather Angela , Sturgill Jamie , Salyer Jeanne , Sterling Richard K. 
Published: September 2018

Background
Nonalcoholic fatty liver disease (NAFLD) is a chronic liver disease in which patients present with metabolic dysregulation and obesity as well as fat accumulation in the liver. Those with NAFLD frequently have symptoms of fatigue, sleep disturbance, depression, and cognitive dysfunction. C1q/TNF-related protein 13 (CTRP13) regulates glucose metabolism and obesity in mice, yet the role of CTRP13 in human NAFLD has not been elucidated.

Aims
Our aims were to examine whether the plasma levels of CTRP13 are (a) increased in patients with NAFLD; (b) associated with metabolic dysregulation, obesity, liver enzymes, and dyslipidemia; and (c) associated with putative symptoms of NAFLD.

Methods
An observational study was conducted with 23 adults with confirmed NAFLD. Plasma levels of CTRP13, insulin resistance, insulin sensitivity, HbA1C, lipid profile, and liver enzymes were collected. Anthropometric analysis (body mass index, waist–hip circumference ratio) and bioelectrical impedance analysis of body composition were used to assess obesity. Symptom questionnaires were used to assess putative symptoms of NAFLD. Plasma levels of CTRP13 were measured in 21 age- and sex-matched control samples from a biobank. Paired t test was used for comparison of the CTRP13 between NAFLD and controls. Pearson’s correlation coefficients were used to examine associations among variables.

Results
Plasma levels of CTRP13 were significantly higher in patients with NAFLD than in normal controls (p < .001), were associated with higher levels of aspartate aminotransferase, alanine aminotransferase (both p < .05), triglycerides (p < .001), and poorer cognitive function, particularly visuospatial memory (p < .001).

Conclusions
CTRP13 may be a surrogate biomarker of NAFLD symptoms and associated with hepatocellular damage, dyslipidemia, and cognitive dysfunction.
Antimicrobial Susceptibility of Neisseria gonorrhoeae Isolates in Yaoundé, Cameroon From 2009 to 2014
Authors: Tayimetha Carolle Y. , Unemo Magnus 
Published: September 2018

Abstract
We investigated the antimicrobial resistance in gonococci 2009 to 2014 in Yaoundé, Cameroon, and recommend revisions of the Cameroonian treatment guideline. We observed a high resistance to ciprofloxacin (17.6%) but no ceftriaxone resistance. Ceftriaxone should replace ciprofloxacin as the recommended first-line treatment for urethral/vaginal discharge. Enhanced resistance surveillance in Africa is essential.
Pediatric Ventilator-Associated Events: Analysis of the Pediatric Ventilator-Associated Infection Data
Authors: Willson Douglas F. , Hall Mark , Beardsley Andrew , Hoot Michelle , Kirby Aileen , Hays Spencer , Erickson Simon , Truemper Edward , Khemani Robinder 
Published: September 2018

Objectives:
To compare the prevalence of infection applying the proposed pediatric ventilator-associated events criteria versus clinician-diagnosed ventilator-associated infection to subjects in the pediatric ventilator-associated infection study.

Design:
Analysis of prospectively collected data from the pediatric ventilator-associated infection study.

Setting:
PICUs of 47 hospitals in the United States, Canada, and Australia.

Patients:
Two-hundred twenty-nine children ventilated for greater than 48 hours who had respiratory secretion cultures performed to evaluate for suspected ventilator-associated infection.

Interventions:
None.

Measurements and Main Results:
Applying the proposed pediatric ventilator-associated event criteria, 15 of 229 subjects in the ventilator-associated infection study qualified as “ventilator-associated condition” and five of 229 (2%) met criteria for “infection-related ventilator-associated complication.” This was compared with 89 of 229 (39%) diagnosed as clinical ventilator-associated infection (Kappa = 0.068). Ten of 15 subjects identified as ventilator-associated condition did not meet criteria for infection-related ventilator-associated complication primarily because they did not receive 4 days of antibiotics. Ventilator-associated condition subjects were similar demographically to nonventilator-associated condition subjects and had similar mortality (13% vs 10%), PICU-free days (6.9 ± 7.7; interquartile range, 0–14 vs 9.8 ± 9.6; interquartile range, 0–19; p = 0.25), but fewer ventilator-free days (6.6 ± 9.3; interquartile range, 1–15 vs 12.4 ± 10.7; interquartile range, 0–22; p = 0.04). The clinical ventilator-associated infection diagnosis in the ventilator-associated infection study was associated with fewer PICU-free days but no difference in mortality or ventilator-free days.

Conclusions:
The ventilator-associated event criteria appear to be insensitive to the clinical diagnosis of ventilator-associated infection. Differentiation between ventilator-associated condition and infection-related ventilator-associated complication was primarily determined by the clinician decision to treat with antibiotics rather than clinical signs and symptoms. The utility of the proposed pediatric ventilator-associated event criteria as a surrogate for ventilator-associated infection criteria is unclear.
External Validation of the “Quick” Pediatric Logistic Organ Dysfunction-2 Score Using a Large North American Cohort of Critically Ill Children With Suspected Infection
Authors: Görges Matthias , Peters Cheryl , Murthy Srinivas , Pi Shanshan , Kissoon Niranjan 
Published: September 2018

Objectives:
A quick Pediatric Logistic Organ Dysfunction 2 score on day 1, consisting of tachycardia, hypotension, and altered mentation, was shown to predict mortality with an area under the receiver operating characteristic curve of 82% (95% CI, 76–87%) in children admitted to a PICU with suspected infection. We performed an external validation of the quick Pediatric Logistic Organ Dysfunction 2, including its performance in predicting mortality in specific age groups.

Design:
Analysis of retrospective data obtained from the Virtual Pediatric Systems PICU registry.

Setting:
Prospectively collected clinical records from 130 participating PICUs in North America.

Patients:
Children admitted between January 2009 and December 2014, with a diagnosis of infection at discharge, for whom all required data were available.

Interventions:
None.

Measurements and Main Results:
Systolic blood pressures, heart rates, and Glasgow Coma Scale scores were used to evaluate the quick Pediatric Logistic Organ Dysfunction 2 using area under the receiver operating characteristic curve analysis. Performance was compared with Pediatric Risk of Mortality 3 and Pediatric Index of Mortality 2 risk scores. Data from 42,196 children with complete data were analyzed, with median age 2.7 years (interquartile range, 0.7–8.8 yr; range 0–18 yr) and a 4.27% mortality rate. Mortality was 13.4% for quick Pediatric Logistic Organ Dysfunction 2 greater than or equal to 2 and 2.5% for quick Pediatric Logistic Organ Dysfunction 2 less than 2, representing a false-negative rate of 49.5%. Also 311 children (17%) who died had a quick Pediatric Logistic Organ Dysfunction 2 score of 0. The area under the receiver operating characteristic curve was 72.6% (95% CI, 71.4–73.8%) for quick Pediatric Logistic Organ Dysfunction 2, compared with 85.0% (95% CI, 84.0–86.0%) for Pediatric Risk of Mortality 3 and 81.5% (95% CI, 80.5–82.5%) for Pediatric Index of Mortality 2. Performance of quick Pediatric Logistic Organ Dysfunction 2 was worst in the greater than 12 years age group (area under the receiver operating characteristic curve, 67.8%; 95% CI, 65–70.5) and best in the less than 1 month age group (area under the receiver operating characteristic curve, 78.9%; 95% CI, 75.3–82.4).

Conclusions:
Quick Pediatric Logistic Organ Dysfunction 2 performed markedly worse in our cohort, compared with the original study, and the high rate of false negatives limits its clinical utility in our population. Further work is needed to develop a robust quick pediatric sepsis diagnostic tool for both research and clinical care.
Prevalence and Prognostic Value of Abnormal Liver Test Results in Critically Ill Children and the Impact of Delaying Parenteral Nutrition*
Authors: Jenniskens Marc , Güiza Fabian , Haghedooren Renata , Verbruggen Sascha , Joosten Koen , Langouche Lies , Van den Berghe Greet 
Published: September 2018

Objectives:
In the Early versus Late Parenteral Nutrition in the Pediatric ICU randomized controlled trial, delaying parenteral nutrition to beyond day 7 (late parenteral nutrition) was clinically superior to supplemental parenteral nutrition initiated within 24 hours (early parenteral nutrition), but resulted in a higher rise in bilirubin. We aimed to document prevalence and prognostic value of abnormal liver tests in the PICU and the impact hereon of withholding early parenteral nutrition.

Design:
Preplanned secondary analysis of the Early versus Late Parenteral Nutrition in the Pediatric ICU randomized controlled trial. Total bilirubin, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase plasma concentrations were measured systematically in PICU. Liver test analyses were adjusted for baseline characteristics including severity of illness.

Setting:
Three PICUs in Belgium, the Netherlands, and Canada.

Patients:
As neonatal jaundice was considered a confounder, only the 1,231 of the 1,440 Early versus Late Parenteral Nutrition in the Pediatric ICU-patients 28 days to 17 years old were included.

Interventions:
Late parenteral nutrition as compared with early parenteral nutrition.

Measurements and Main Results:
During the first seven PICU days, the prevalence of cholestasis (> 2 mg/dL [34.2 μmol/L] bilirubin) ranged between 3.8% and 4.9% and of hypoxic hepatitis (≥ 20-fold upper limit of normality for alanine aminotransferase and aspartate aminotransferase) between 0.8% and 2.2%, both unaffected by the use of parenteral nutrition. Throughout the first week in PICU plasma bilirubin concentrations were higher in late parenteral nutrition patients (p < 0.05), but became comparable to early parenteral nutrition patients as soon as parenteral nutrition was started on day 8. Plasma concentrations of gamma-glutamyl transpeptidase, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase were unaffected by parenteral nutrition. High day 1 plasma concentrations of gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase (p ≤ 0.01), but not alkaline phosphatase, were independent risk factors for PICU mortality. Day 1 plasma bilirubin concentrations displayed a U-shaped association with PICU mortality, with higher mortality associated with bilirubin less than 0.20 mg/dL and greater than 0.76 mg/dL (< 3.42 μmol/L and > 13 μmol/L) (p ≤ 0.01).

Conclusions:
Overt cholestasis and hypoxic hepatitis were rare and unrelated to the nutritional strategy. However, withholding parenteral nutrition up to 1 week in PICU increased plasma bilirubin. A mild elevation of bilirubin on the first PICU day was associated with lower risk of death and may reflect a stress response, rather than true cholestasis.
PICU Autopsies: Rates, Patient Characteristics, and the Role of the Medical Examiner*
Authors: Basu Sonali , Holubkov Richard , Dean J. Michael , Meert Kathleen L. , Berg Robert A. , Carcillo Joseph , Newth Christopher J. L. , Harrison Rick E. , Pollack Murray M. 
Published: September 2018

Objectives:
Autopsy rates in North American Children’s hospitals have not been recently evaluated. Our objectives were 1) to determine the autopsy rates from patients cared for in PICUs during a portion of their hospital stay, 2) to identify patient characteristics associated with autopsies, and 3) to understand the relative role of medical examiner cases.

Design:
Secondary analysis of data prospectively collected from a sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 2011 and April 2013.

Setting:
Eight quaternary care PICUs.

Patients:
Patients in the primary study were less than 18 years old, admitted to a PICU and not moribund on PICU admission. Patients included in this analysis were those who died during their hospital stay.

Interventions:
None.

Measurements and Main Results:
Sociodemographic, clinical, hospital, and PICU data were compared between patients who had autopsies conducted and those who did not and between medical examiner and nonmedical examiner autopsies. Of 10,078 patients, 275 died of which 36% (n = 100) had an autopsy performed. Patients with cancer who died were less likely to receive autopsies (p = 0.005), whereas those who died after trauma or cardiac arrest had autopsies performed more often (p < 0.01). Autopsies were more common in patients with greater physiologic instability at admission (p < 0.001), and those who received more aggressive PICU care. Medical examiner cases comprised nearly half of all autopsies (n = 47; 47%) were conducted in patients presenting with greater physiologic instability (p < 0.001) and more commonly after catastrophic events such as cardiac arrest or trauma (p < 0.001).

Conclusions:
In this first multicenter analysis of autopsy rates in children, 36% of deaths had autopsies conducted, of which nearly half were conducted by the medical examiner. Deaths with autopsy are more likely to be previously healthy children that had catastrophic events prior to admission.