bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe Respiratory Syncytial Virus Infection in Hospitalized Children Less Than 3 Years of Age in a Temperate and Tropical Climate
Authors: Butler Jessica , Gunnarsson Ronny , Traves Aileen , Marshall Helen 
Published: April 2018

Background:
Respiratory syncytial virus (RSV) infection is a frequent cause of hospitalization in infants younger than 3 years of age. We aimed to determine the factors associated with severe RSV disease.

Methods:
Retrospective medical review of children up to 3 years of age admitted for laboratory-proven RSV infection between January 1, 2013, and December 31, 2014, was conducted at the Women’s and Children’s Hospital, Adelaide, South Australia, and the Paediatric Department at Cairns Hospital, Cairns, North Queensland. Severity of infection was determined using the validated Brisbane RSV Infection Severity Score.

Results:
Four-hundred ninety-six children (383 at Women’s and Children’s Hospital and 113 at Cairns Hospital) were included in the study, with 76, 323 and 97 patients identified as having mild, moderate or severe disease, respectively. Decreasing age [odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.90–0.99, P = 0.020), and being Indigenous, increased (OR = 2.6; 95% CI = 1.4–4.9, P = 0.002) the risk of severe RSV infection in hospitalized children. Underlying respiratory (P = 0.029, OR = 2.5; 95% CI = 1.1–5.8) or cardiac (OR = 2.7; 95% CI = 1.1–6.4, P = 0.024) conditions, as well as the presence of tachypnoea on admission (OR = 2.2; 95% CI = 1.2–4.1, P = 0.009), were also independent predictors of severe RSV infection. Seasonal variation in hospitalization was observed between temperate and tropical climates but was not associated with disease severity.

Conclusions:
Young infants, Indigenous patients and children with underlying respiratory and cardiac disease should be observed closely for signs of deterioration. Infants with tachypnoea on admission should be continuously monitored.
Vaccine Impact on Long-term Trends in Invasive Bacterial Disease in New Zealand Children
Authors: Walls Tony , Cho Vicki , Martin Natalie , Williman Jonathan , Brunton Cheryl 
Published: April 2018

Background:
Vaccines against Haemophilus influenzae type B (Hib), Neisseria meningitidis and Streptococcus pneumoniae have been serially introduced into the New Zealand national immunization schedule since the 1990s. This study aimed to describe long-term trends in the rates of these invasive bacterial infections in children from New Zealand and compare these to recent UK data.

Methods:
This population-based observational study used 2 national datasets that collect data about hospital discharges (National Minimum Dataset) and notifiable diseases (Epurv). Annual age-specific and age-standardized hospital admission rates and notification rates were analyzed for all children <15 years of age.

Results:
Hospital admissions for Hib reduced by 79% during the 2 years after the introduction of the Hib vaccine (5.94–1.24/100,000). Meningococcal disease notifications fell by 75% over 8 years after the introduction of MeNZB vaccine (26.15–2.48/100,000) and have continued to decline. Meningococcal disease rates were lower than in the United Kingdom despite the absence of an ongoing meningococcal vaccination program in New Zealand (8.16 compared with 10.37/100,000 for 2007–2011). There rates of notifications and hospital admissions for pneumococcal disease were discordant, but both reduced substantially after the introduction of pneumococcal conjugate vaccines. Maori children had the highest rates of disease and the greatest reduction in rates after the introduction of both meningococcal and pneumococcal vaccines.

Conclusions:
Vaccines have had a substantial impact on the rates of invasive bacterial disease in children from New Zealand because of Hib, pneumococcus and meningococcus. Reductions in rates of disease have been greatest in Maori children, improving longstanding disparities in disease burden.
Epidemiology of Meningitis and Encephalitis in Infants and Children in the United States, 2011–2014
Authors: Hasbun Rodrigo , Wootton Susan H. , Rosenthal Ning , Balada-Llasat Joan Miquel , Chung Jessica , Duff Steve , Bozzette Samuel , Zimmer Louise , Ginocchio Christine C. 
Published: April 2018

Background:
Large epidemiologic studies evaluating the etiologies, management decisions and outcomes of infants and children with meningitis and encephalitis in the United States are lacking.

Methods:
Children 0–17 years of age with meningitis or encephalitis as assessed by International Classification of Diseases, Ninth Revision, codes available in the Premier Healthcare Database during 2011–2014 were analyzed.

Results:
Six thousand six hundred sixty-five patients with meningitis or encephalitis were identified; 3030 (45.5%) were younger than 1 year of age, 295 (4.4%) were 1–2 years of age, 1460 (21.9%) were 3–9 years of age, and 1880 (28.2%) were 10–17 years of age. Etiologies included enterovirus (58.4%), unknown (23.7%), bacterial (13.0%), noninfectious (3.1%), herpes simplex virus (1.5%), other viruses (0.7%), arboviruses (0.5%) and fungal (0.04%). The majority of patients were male [3847 (57.7%)] and healthy [6094 (91.4%)] with no reported underlying conditions. Most underwent a lumbar puncture in the emergency department [5363 (80%)] and were admitted to the hospital [5363 (83.1%)]. Antibiotic therapy was frequent (92.2%) with children younger than 1 year of age with the highest rates (97.7%). Antiviral therapy was less common (31.1%). Only 539 (8.1%) of 6665 of patients received steroids. Early administration of adjunctive steroids was not associated with a reduction in mortality (P = 0.266). The overall median length of stay was 2 days. Overall mortality rate (0.5%) and readmission rates (<1%) was low for both groups.

Conclusion:
Meningitis and encephalitis in infants and children in the United States are more commonly caused by viruses and are treated empirically with antibiotic therapy and antiviral therapy in a significant proportion of cases. Adjunctive steroids are used infrequently and are not associated with a benefit in mortality.
Mycobacterium abscessus Soft Tissue Disease of the Abdominal Wall
Authors: Rodriguez Vivian Vega , Oehler Richard L. 
Published: April 2018

Abstract
Rapidly growing mycobacteria (RGM) are widely distributed in nature and known to be able to withstand extremes of temperature and nutritionally austere environments. They have been isolated from soil, dust, water, terrestrial and aquatic animals, hospital environments, and contaminated reagents and pharmaceuticals. The Mycobacterium abscessus complex group is considered the most significant set of human pathogens among the RGM. M. abscessus complex includes 3 subspecies: M. abscessus subspecies abscessus, M. abscessus subspecies massiliense, and M. abscessus subspecies bolletii. M. abscessus complex can cause a wide range of clinical manifestations and is responsible for most lung infections associated with the rapid growers. Extrapulmonary manifestations have included infections of the skin and soft tissue, prosthetic devices, surgical site infections, and disseminated disease associated with profound immunosuppression.
In this report, we present a case of intra-abdominal M. abscessus presenting as an enlarging mass in a patient on chronic corticosteroid therapy. Cases of intra-abdominal M. abscessus complex infections are limited in the published literature, and the treatment approach for these infections has not been consistent. Furthermore, M. abscessus complex has acquired the reputation of being the most virulent and chemotherapy-resistant member of the RGM group. As a result, the management of such infections is complicated and lacks specific guidance.
Evaluation of serum procollagen C-proteinase enhancer 1 level as a fibrosis marker in patients with chronic hepatitis B
Authors: Gokce Onur , Ozenirler Seren , Atak Yucel Aysegul , Oruklu Nihan , Yilmaz Esendagli Guldal , Karahan Sevilay 
Published: April 2018

Aim
Although liver biopsy has long been considered the gold standard for staging fibrosis, because of the disadvantages and risks of biopsy, several noninvasive processes such as serum biomarkers have been introduced for the assessment of liver fibrosis. The aim of this study was to assess the diagnostic value of serum procollagen C-proteinase enhancer 1 (PCPE-1) as a noninvasive fibrosis marker in treatment-naive chronic hepatitis B patients.

Patients and methods
This study included 126 patients with biopsy-proven hepatitis B and 50 healthy controls. Fibrosis stage was determined using the Ishak scoring system. The PCPE-1 level was measured using the enzyme-linked immunosorbent assay assay, and the aspartate aminotransferase to platelet ratio index and the FIB-4 index were calculated using the formulas described in Appendix 1 (Supplemental digital content 1,
http://links.lww.com/EJGH/A277
).

Results
Serum PCPE-1 levels of chronic hepatitis B patients were found to be significantly lower than those of the healthy control group (4.49±2.74 vs. 42.9±59.6 pg/ml, respectively, P<0.001). There was a statistically significant negative correlation between serum PCPE-1 level and fibrosis stage (P=0.011; r=−0.226). A statistically significant negative correlation was found between serum PCPE-1 level and necroinflammatory activity (P=0.030; r=−0.194). PCPE-1 levels of patients with liver fibrosis scores of F1–2 were statistically significantly lower than those of the healthy control group (P<0.001) (area under the receiver operating characteristic: 0.955). The area under the receiver operating characteristic of the PCPE-1 level was 0.615 for the prediction of fibrosis (F0 vs. F1–6) (P=0.039).

Conclusion
Serum PCPE-1 might be used as a noninvasive marker of liver fibrosis. Further animal and human studies are needed to assess the utility of this marker.
Diagnostic Accuracy of Preoperative Imaging for Differentiation of Branch Duct Versus Mixed Duct Intraductal Papillary Mucinous Neoplasms
Authors: Ugbarugba Emmanuel E. , Grieco Carmen , Hart Phil A. , Li Feng , Sklaw Brett , Cronley Kevin , Oza Veeral M. , Swanson Benjamin J. , Walker Jon P. , El-dika Samer , Conwell Darwin L. , Krishna Somashekar G. 
Published: April 2018

Objective
The aim of this study is to determine the diagnostic accuracy of preoperative evaluation to detect main pancreatic duct involvement in pancreatic cystic lesions thus differentiating mixed intraductal papillary mucinous neoplasm (IPMN) from branch duct (BD)–IPMN.

Methods
The pathology database of pancreatic resections from 2000 to 2014 was reviewed. Main pancreatic duct-IPMNs and IPMNs with intracystic mass/nodules were excluded. The preoperative test characteristics were analyzed using surgical histopathology as the “gold standard.”

Results
Sixty BD-IPMNs and 23 mixed-IPMNs were identified. Mixed-IPMNs were larger (mean [standard deviation], 4.14 [2.9] vs 2.74 [1.9] mm; P = 0.03) and demonstrated frequent high-grade dysplasia/adenocarcinoma (43% vs 12%, P = 0.004) than BD-IPMNs. Endoscopic ultrasound (EUS) (sensitivity, 80%; specificity, 78%; accuracy, 79%) had the best diagnostic accuracy, whereas magnetic resonance imaging (MRI) (sensitivity, 83%; specificity, 63%; accuracy, 68%) had the highest sensitivity for the diagnosis of mixed-IPMN. A combination of EUS and MRI reached maximum sensitivity but with decreased accuracy (sensitivity, 100%; specificity, 64%; accuracy, 67%). The area under the curve for receiver operation curve was 0.71 whereas the optimal cyst size to detect main duct involvement was 3 cm.

Conclusions
For preoperative evaluation of pancreatic cystic lesions without evidence of intracystic nodules, a combination of MRI and EUS should be considered for improved detection of main duct involvement.
Impact of Improved HIV Care and Treatment on PrEP Effectiveness in the United States, 2016–2020
Authors: Khurana Nidhi , Yaylali Emine , Farnham Paul G. , Hicks Katherine A. , Allaire Benjamin T. , Jacobson Evin , Sansom Stephanie L. 
Published: April 2018

Background:
The effect of improving diagnosis, care, and treatment of persons living with HIV (PLWH) on pre-exposure prophylaxis (PrEP) effectiveness in the United States has not been well established.

Methods:
We used a dynamic, compartmental model that simulates the sexually active US population. We investigated the change in cumulative HIV incidence from 2016 to 2020 for 3 HIV care-continuum levels and the marginal benefit of PrEP compared with each. We also explored the marginal benefit of PrEP for individual risk groups, and as PrEP adherence, coverage and dropout rates varied.

Results:
Delivering PrEP in 2016 to persons at high risk of acquiring HIV resulted in an 18.1% reduction in new HIV infections from 2016 to 2020 under current care-continuum levels. Achieving HIV national goals of 90% of PLWH with diagnosed infection, 85% of newly diagnosed PLWH linked to care at diagnosis, and 80% of diagnosed PLWH virally suppressed reduced cumulative incidence by 34.4%. Delivery of PrEP in addition to this scenario resulted in a marginal benefit of 11.1% additional infections prevented. When national goals were reached, PrEP prevented an additional 15.2% cases among men who have sex with men, 3.9% among heterosexuals, and 3.8% among persons who inject drugs.

Conclusions:
The marginal benefit of PrEP was larger when current HIV-care-continuum percentages were maintained but continued to be substantial even when national care goals were met. The high-risk men who have sex with men population was the chief beneficiary of PrEP.
A Spatiotemporal Analysis of HIV-Associated Mortality in Rural Western Kenya 2011–2015
Authors: Sifuna Peter , Otieno Lucas , Andagalu Ben , Oyieko Janet , Ogutu Bernhards , Singoei Valentine , Owuoth John , Ogwang Sheila , Cowden Jessica , Otieno Walter 
Published: April 2018

Background:
Reliable data on the HIV epidemic is critical for the measurement of the impact of HIV response and for the implementation of further interventions.

Methods:
We used mortality data from the Kombewa health and demographic surveillance systems (HDSS) from January 1, 2011 to December 31, 2015 to examine the space–time pattern of HIV-associated mortality. HIV mortality rate was calculated per 1000 persons living with HIV (for comparison with regional and national averages) and per 1000 person-years (p-y) for comparison with data from other HDSS sites. We used the Optimized Hot Spot Analysis to examine whether HIV-associated deaths would form statistically significant local aggregation in the 5-year period. P-value of <0.05 and <0.01 was considered significant.

Results:
The HIV-associated mortality rate over the 5-year period was 9.8 per 1000 persons living with HIV (PLHIV). Mortality declined from 11.6 per 1000 PLHIV in 2011 to 7.3 per 1000 PLHIV by the end of 2015. The rates of HIV were highest among infants [hazard ratio (HR) = 2.39 (<0.001)]. Tuberculosis mortality rates were highest in the age group 5–14 years [HR = 2.29 (0.002)] and the age group 50–64 years [HR = 1.18 (0.531)]. The overall trend in HIV-associated mortality showed a decline from 1.8 per 1000 p-y in 2011 to 1.3 per 1000 p-y by the end of 2015. The hotspot analysis showed that 20.0% of the study area (72 km2) was detected as hotspots (Z = 2.382–3.143, P ≤ 0.001) and 4.2% of the study area as cold spots (15 km2).

Conclusions:
HIV attributable death in the HDSS population is substantial, although it is lower than both the national and the regional estimates.
Pulmonary Ultrasound
Authors: Ñamendys-Silva Silvio A. , Garrido-Aguirre Eduardo , Romero-González Juan P. , Mena-Arceo Roger G. , Rojo del Moral Oscar , González-Chon Octavio 
Published: April 2018

Abstract
Pulmonary ultrasonography is a complementary study that is easy to perform at the patient bedside with no need to transfer the patient to special areas. The technique provides information with high sensitivity and specificity for different pathologies. Pulmonary ultrasonography is a very important diagnostic tool in the assessment of lung, pleural, and chest wall diseases. Pulmonary ultrasound provides low-cost analysis, easy real-time reproduction, and safety, all of which have made it a beneficial tool in the diagnostic arsenal available to medical personnel. The purpose of this review was to describe the usefulness of pulmonary ultrasound in critical areas.
Alterations of Vascular Endothelial Growth Factor A Expression and Microvessel Density Associated With Polypropylene Vaginal Mesh
Authors: Kowalski Joseph T. , Goodheart Michael J. , Genadry Rene , Bhattarai Ava , Bradley Catherine S. 
Published: April 2018

Objective
Vaginal mesh exposure is the most common complication from mesh use in prolapse and incontinence surgery. Angiogenesis is an essential component of tissue healing, and defective angiogenesis plays a role in chronic wounds. We hypothesized that patients with exposures will have impaired angiogenesis as evidenced by altered tissue vascular endothelial growth factor A (VEGFA) expression and microvessel density. The study objective was to compare angiogenesis in women with vaginal mesh exposures, those with vaginal mesh without exposures, and in women who were mesh-naive.

Methods
Patients undergoing polypropylene mesh removal and patients without mesh undergoing urinary incontinence or prolapse surgery were recruited. Full-thickness vaginal epithelial biopsies were obtained. The relative abundance of VEGFA RNA was measured with reverse transcription-polymerase chain reaction. The VEGFA and CD31 immunohistochemistry were also performed.

Results
Ninety-two subjects were enrolled and biopsied. Mean age (SD) was 57.2 (12.8) years, 16 (17.4%) were smokers, and 68 (73.9%) were postmenopausal.
The VEGFA RNA expression did not differ between subjects with mesh exposure and with mesh but no exposure (P = 0.89). However, compared with subjects with no mesh, vaginal VEGFA expression was decreased in subjects with any implanted mesh (relative expression, 0.72; P = 0.02). Microvessel density was increased in subjects with mesh exposure compared with subjects with no mesh (P < 0.01). The VEGFA expression by immunohistochemistry was significantly lower in postmenopausal subjects without estrogen treatment compared with premenopausal and postmenopausal subjects being treated with estrogen (P = 0.02).

Conclusions
The presence of polypropylene mesh and hormonal status are associated with evidence of altered angiogenesis.
Changes in Pediatric Heart Transplant Hospitalization Costs Over Time
Authors: Godown Justin , Thurm Cary , Hall Matt , Soslow Jonathan H. , Feingold Brian , Mettler Bret A. , Smith Andrew H. , Bearl David W. , Dodd Debra A. 
Published: April 2018

Background
Despite significant changes in the past decade for children undergoing heart transplantation, including the evolution of mechanical circulatory support and increasing patient complexity, costs and resource utilization have not been reassessed. We sought to use a novel linkage of clinical-registry and administrative data to examine changes in hospitalization costs over time in this population.

Methods
We identified all pediatric heart transplant recipients in a unique linked Pediatric Health Information System/Scientific Registry of Transplant Recipients data set (2002-2016). Hospital costs were estimated from charges using cost-to-charge ratios, inflated to 2016 dollars. Severity-adjusted costs were calculated using generalized linear mixed-effects models. Costs were compared across 3 eras (era 1, 2002-2006; era 2, 2007-2011; and era 3, 2012-2016).

Results
A total of 2896 pediatric heart transplant recipients were included: era 1, 649 (22.4%); era 2, 1028 (35.5%); and era 3, 1219 (42.1%). Extracorporeal membrane oxygenation support at transplant decreased over time, concurrent with an increase in ventricular assist device–supported patients. Between era 1 and era 2, there was an increase in pretransplant hospitalization costs (US $343 692 vs US $435 554; P < 0.001). However, between era 2 and era 3, there was a decline in total (US $906 454 vs US $767 221; P < 0.001), pretransplant (US $435 554 vs US $353 364; P < 0.001), and posttransplant (US $586 133 vs US $508 719; P = 0.002) hospitalization costs.

Conclusions
Concurrent with the increase in utilization of ventricular assist device support, there has been an increase in pretransplant costs associated with pediatric heart transplantation. However, in the most recent era, costs have declined. These findings suggest the evolution of more cost-effective management strategies, which may be related to shifts in the approach to pediatric mechanical circulatory support.
Frailty, Inflammatory Markers, and Waitlist Mortality Among Patients With End-stage Renal Disease in a Prospective Cohort Study
Authors: McAdams-DeMarco Mara A. , Ying Hao , Thomas Alvin G. , Warsame Fatima , Shaffer Ashton A. , Haugen Christine E. , Garonzik-Wang Jacqueline M. , Desai Niraj M. , Varadhan Ravi , Walston Jeremy , Norman Silas P. , Segev Dorry L. 
Published: April 2018

Background
Among community-dwelling older adults, frailty is associated with heightened markers of inflammation and subsequent mortality. Although frailty is common among end-stage renal disease (ESRD) patients, the role of frailty and markers of inflammation in this population remains unclear. We quantified these associations in patients on the kidney transplant waitlist and tested whether frailty and/or markers of inflammation improve waitlist mortality risk prediction.

Methods
We studied 1975 ESRD patients on the kidney transplant waitlist (November 1, 2009, to February 28, 2017) in a multi-center cohort study of frailty. Serum inflammatory markers (interleukin-6 [IL-6], soluble tumor necrosis factor-α receptor-1 [sTNFR1], and C-reactive protein [CRP]) were analyzed in 605 of these participants; we calculated the inflammatory index score using IL-6 and sTNFR1. We compared the C-statistic of an established registry-based prediction model for waitlist mortality adding frailty and/or inflammatory markers (1 SD change in log IL-6, sTNFR1, CRP, or inflammatory index).

Results
The registry-based model had moderate predictive ability (c-statistic = 0.655). Frailty was associated with increased mortality (2.19; 95% confidence interval [CI], 1.26-3.79) but did not improve risk prediction (c-statistic = 0.646; P = 0.65). Like frailty, IL-6 (2.13; 95% CI, 1.41-3.22), sTNFR1 (1.70; 95% CI, 1.12-2.59), CRP (1.68; 95% CI, 1.06-2.67), and the inflammatory index (2.09; 95% CI, 1.38-3.16) were associated with increased mortality risk; unlike frailty, adding IL-6 (c-statistic = 0.777; P = 0.02), CRP (c-statistic = 0.728; P = 0.02), or inflammatory index (c-statistic = 0.777; P = 0.02) substantially improved mortality risk prediction.

Conclusions
Frailty and markers of inflammation were associated with increased waitlist mortality risk, but only markers of inflammation significantly improved ESRD risk prediction. These findings help clarify the accelerated aging physiology of ESRD and highlight easy-to-measure markers of increased waitlist mortality risk.