bluuebunny/crossref_metadata_2025_split huggingface dataset:
Twenty-nine Cases of Enterovirus-D68–associated Acute Flaccid Myelitis in Europe 2016
Authors: Knoester Marjolein , Helfferich Jelte , Poelman Randy , Van Leer-Buter Coretta , Brouwer Oebele F. , Niesters Hubert G. M. ,   on Behalf of the 2016 EV-D68 AFM Working Group
Published: September 2018

Background:
Enterovirus-D68 (EV-D68) is a respiratory virus within the genus Enterovirus and the family of Picornaviridae. Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM).

Methods:
In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68–associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV testing was collected for the period between March and October 2016.

Results:
Twenty-nine cases of EV-D68–associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n = 27), feces (n = 8) and/or cerebrospinal fluid (n = 2). Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n = 3), and 2 patients died. The epidemiologic data from 16 European laboratories showed that of all EV-D68–positive samples, 99% was detected in a respiratory specimen.

Conclusions:
For 2016, 29 EV-D68–related AFM cases were identified in mostly Western Europe. This is likely an underestimation, because case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples and the capability of laboratories to type EVs.
Streptococcal Serology in Acute Rheumatic Fever Patients
Authors: Jack Susan , Moreland Nicole J. , Meagher Jess , Fittock Marea , Galloway Yvonne , Ralph Anna P. 
Published: September 2018

Background:
Globally, there is wide variation in streptococcal titer upper limits of normal (ULN) for antistreptolysin O (ASO) and anti-deoxyribonuclease B (ADB) used as an evidence of recent group A streptococcal infection to diagnose acute rheumatic fever (ARF).

Methods:
We audited ASO and ADB titers among individuals with ARF in New Zealand (NZ) and in Australia’s Northern Territory. We summarized streptococcal titers by different ARF clinical manifestations, assessed application of locally recommended serology guidelines where NZ uses high ULN cut-offs and calculated the proportion of cases fulfilling alternative serologic diagnostic criteria.

Results:
From January 2013 to December 2015, group A streptococcal serology results were available for 350 patients diagnosed with ARF in NZ and 182 patients in Northern Territory. Median peak streptococcal titers were similar in both settings. Among NZ cases, 267/350 (76.3%) met NZ serologic diagnostic criteria, whereas 329/350 (94.0%) met Australian criteria. By applying Australian ULN titer cut-off criteria to NZ cases, excluding chorea, ARF definite cases would increase by 17.6% representing 47 cases.

Conclusions:
ASO and ADB values were similar in these settings. Use of high ULN cut-offs potentially undercounts definite and probable ARF diagnoses. We recommend NZ and other high-burden settings to use globally accepted, age-specific, lower serologic cut-offs to avoid misclassification of ARF.
Two Randomized Trials of the Effect of the Russian Strain of Bacillus Calmette-Guérin Alone or With Oral Polio Vaccine on Neonatal Mortality in Infants Weighing <2000 g in India
Authors: Jayaraman Kumutha , Adhisivam Bethou , Nallasivan Saravanan , Krishnan R. Gokul , Kamalarathnam Chinnathambi , Bharathi Mangala , McSharry Brent , Namachivayam Siva P. , Shann Frank , Boopalan Sasireka I , David Ponrani , Bhat B. Vishnu 
Published: September 2018

Background:
In randomized trials in Guinea-Bissau, the Danish strain of Bacillus Calmette-Guérin (BCG) reduces neonatal mortality, primarily by reducing deaths from pneumonia and sepsis. Because World Health Organization–prequalified BCG-Denmark was not available in India, we conducted 2 randomized trials to test whether BCG-Russia alone or with oral polio vaccine (OPV) has similar effects to BCG-Denmark.

Methods:
We randomized neonates weighing <2000 g to a control group that was not vaccinated before 28 days of age or to receive either BCG-Russia alone (first trial) or BCG-Russia with OPV (second trial) soon after birth. We performed intention-to-treat analysis using Cox hazards models with age as the underlying time and adjusted for weight, sex and inborn versus outborn status.

Results:
Administration of BCG-Russia alone had no effect on neonatal mortality (to 28 days of age): 15.6% of 1537 infants died in the BCG-Russia group and 16.1% of 1535 died in the control group; the adjusted hazard ratio was 0.95 [95% confidence interval (CI): 0.80–1.13]. Administration of BCG-Russia with OPV also had no effect on neonatal mortality: 18.0% of 1103 infants died in the BCG-OPV group and 17.6% of 1104 died in the control group; the adjusted hazard ratio was 1.01 (95% CI: 0.83–1.23). The adjusted hazard ratio for the 2 trials combined was 0.98 (95% CI: 0.85–1.11).

Conclusions:
BCG-Russia with or without OPV had no effect on neonatal mortality. It is important to determine which strains of BCG have the greatest specific effects (on tuberculosis) and nonspecific effects (on infections other than tuberculosis) in high-mortality regions.
When the Patient Is Not an “Ideal” Candidate. The Importance of Early Physical Therapy Intervention Pre- and Post–Lung Transplant: A Case Report
Authors: Bello Romina 
Published: September 2018

Purpose:
Each year thousands of patients are placed on lung transplant waiting lists. Despite evidence of the importance of pulmonary rehabilitation programs for this population, minimal literature regarding physical therapy (PT) for the candidate that is admitted to the hospital to await surgery exists. This case report describes a successful rehabilitation approach for this patient population.

Case Presentation:
A 59-year-old male patient with a diagnosis of idiopathic pulmonary fibrosis was admitted to the intensive care unit to await lung transplant. The inability to manage the patient's high oxygen requirements in his home environment, as well as the progression of his disease, prompted the need for constant medical management in an intensive care setting. His presurgical comorbidities classified him as a less than “ideal” transplant candidate. He received early and frequent PT both pre- and posttransplant, with focus on strengthening and gait training activities to improve his functional capacity. Subjective improvements in quality of life and function after bilateral lung transplant were achieved despite potential for a complicated postoperative course related to his medical history.

Conclusion:
Early and frequent PT may be important for patients admitted to the intensive care unit while awaiting transplantation and can play an even greater role for the less than “ideal” transplant candidate. The PT interventions can be provided safely for this population in the hospital setting. A rehabilitation approach focused on maximizing a patient's functional capacity with strength and gait training activities may facilitate improved outcomes for lung transplant recipients deemed less than optimal candidates.
Concussion History, Reporting Behaviors, Attitudes, and Knowledge in Jockeys
Authors: O'Connor Siobhán , Warrington Giles , Whelan Grainne , McGoldrick Adrian , Cullen SarahJane 
Published: September 2018

Objective:
To examine concussion history, knowledge, and attitudes among Irish professional and amateur jockeys.

Design:
Cross-sectional survey.

Setting:
Questionnaire was distributed through e-mails sent to all licensed jockeys, over social media and during professional and amateur race meetings.

Participants:
An average of 23.6% (12%-44%) Irish professional and amateur jockeys (n = 119) holding a license in 2017.

Main Outcome Measures:
Jockeys reported their previous concussion history, actions after their most recent concussion and responded to questions examining their knowledge and attitudes toward concussion.

Results:
Amateur (32.4%) and professional (19.6%) jockeys, who were never medically diagnosed over their career, suspected that they had sustained a concussion. Jockeys displayed good knowledge of concussion signs and symptoms; yet, one in 2 jockeys would continue to ride out the same day if they suspected they had a concussion. They were less likely if they had a race that day. Reasons for continuing to ride include not considering a concussion as serious (85.7%); risk of losing the ride (84.0%); not wanting to let anyone down (77.8%); and considered it a sign of weakness (74.1%). Risky behavior was more common after a suspected concussion than a medically diagnosed concussion.

Conclusions:
Underreporting of concussions is proposed as a serious concern, and concussion understanding and attitudes can impact reporting. To address the issue of underreporting of concussions in Irish horseracing, there is a need to educate jockeys and the wider racing community on the importance of timely concussion assessments and access to appropriate management systems.
A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males
Authors: Leddy John J. , Haider Mohammad N. , Hinds Andrea L. , Darling Scott , Willer Barry S. 
Published: September 2018

Objective:
To study the effect of early prescribed aerobic exercise versus relative rest on rate of recovery in male adolescents acutely after sport-related concussion (SRC).

Design:
Quasi-experimental design.

Setting:
University sports medicine centers.

Participants:
Exercise group (EG, n = 24, 15.13 ± 1.4 years, 4.75 ± 2.5 days from injury) and rest group (RG, n = 30, 15.33 ± 1.4 years, 4.50 ± 2.1 days from injury).

Interventions:
Exercise group performed a progressive program of at least 20 minutes of daily subthreshold aerobic exercise. Rest group was prescribed relative rest (no structured exercise). Both groups completed daily online symptom reports (Postconcussion Symptom Scale) for 14 days.

Main Outcome Measures:
Days to recovery after treatment prescription. Recovery was defined as return to baseline symptoms, exercise tolerant, and judged recovered by physician examination.

Results:
Recovery time from initial visit was significantly shorter in EG (8.29 ± 3.9 days vs 23.93 ± 41.7 days, P = 0.048). Mixed-effects linear models showed that all symptom clusters decreased with time and that there was no significant interaction between treatment group and time. No EG participants experienced delayed recovery (>30 days), whereas 13% (4/30) of RG participants experienced delayed recovery.

Conclusions:
These preliminary data suggest that early subthreshold aerobic exercise prescribed to symptomatic adolescent males within 1 week of SRC hastens recovery and has the potential to prevent delayed recovery.
Fecal calprotectin is significantly linked to azathioprine metabolite concentrations in Crohn’s disease
Authors: Essmann Julian , Keil Carsten , Unruh Olesya , Otte Anita , Manns Michael P. , Bachmann Oliver 
Published: September 2018

Background
The value of therapeutic drug monitoring during azathioprine (AZA) therapy with respect to clinical outcomes has been convincingly demonstrated in recent meta-analyses. However, the association between AZA metabolites and the mucosal state in inflammatory bowel disease is largely unclear.

Aims
We investigated the association between AZA’s active metabolite 6-thioguanine nucleotides (6-TGN) and fecal calprotectin (FC) as a well-validated surrogate marker of mucosal inflammation in patients with Crohn’s disease (CD) on AZA monotherapy.

Patients and methods
Of 443 6-TGN measurements, 140 values from 88 patients with CD on AZA monotherapy visiting the inflammatory bowel disease outpatient clinic between 2009 and 2016 were retrospectively analyzed. In a subcohort with serial 6-TGN measurements, longitudinal FC measurements in patients with versus without intervention (dose increase, allopurinol, and education) were assessed.

Results
In patients with 6-TGN concentrations within a predefined range (250–450 pmol/8×108 red blood cells), FC was significantly lower (median: 119.5 vs. 327.2 mg/kg, P=0.003), and hemoglobin as well as serum protein concentrations were significantly higher than in patients with 6-TGN outside of this range. C-reactive protein and transferrin saturation were not different. In the longitudinal cohort, 6-TGN increased in the intervention group, but only a minority reached the defined range; no significant change in FC was observed.

Conclusion
This study is the first to show that in patients with CD receiving AZA monotherapy, 6-TGN concentrations within a defined range (250–450 pmol/8×108 red blood cells) are associated with significantly lower FC. A treat-to-target concept directed by 6-TGN to reach mucosal healing may thus be a promising approach (DRKS00013246).
Marijuana is not associated with progression of hepatic fibrosis in liver disease: a systematic review and meta-analysis
Authors: Farooqui Muhammad T. , Khan Muhammad A. , Cholankeril George , Khan Zubair , Mohammed Abdul Mubeen K. , Li Andrew A. , Shah Neha , Wu Lin , Haq Khwaja , Solanki Shantanu , Kim Donghee , Ahmed Aijaz 
Published: September 2018

Background
An estimated 22 million adults use marijuana in the USA. The role of marijuana in the progression of hepatic fibrosis remains unclear.

Aims
We carried out a systematic review and meta-analysis to evaluate the impact of marijuana on prevalence and progression of hepatic fibrosis in chronic liver disease.

Patients and methods
We searched several databases from inception through 10 November 2017 to identify studies evaluating the role of marijuana in chronic liver disease. Our main outcome of interest was prevalence/progression of hepatic fibrosis. Adjusted odds ratios (ORs) and hazards ratios (HRs) were pooled and analyzed using random-effects model.

Results
Nine studies with 5 976 026 patients were included in this meta-analysis. Prevalence of hepatic fibrosis was evaluated in nonalcoholic fatty liver disease (NAFLD), hepatitis C virus (HCV), and hepatitis C and HIV coinfection by two, four, and one studies. Progression of hepatic fibrosis was evaluated by two studies. Pooled OR for prevalence of fibrosis was 0.91 (0.72–1.15), I
2=75%. On subgroup analysis, pooled OR among NAFLD patients was 0.80 (0.75–0.86), I
2=0% and pooled OR among HCV patients was 1.96 (0.78–4.92), I
2=77%. Among studies evaluating HR, pooled HR for progression of fibrosis in HCV–HIV co-infected patients was 1.03 (0.96–1.11), I
2=0%.

Conclusion
Marijuana use did not increase the prevalence or progression of hepatic fibrosis in HCV and HCV–HIV-coinfected patients. On the contrary, we noted a reduction in the prevalence of NAFLD in marijuana users. Future studies are needed to further understand the therapeutic impact of cannabidiol-based formulations in the management of NAFLD.
Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy
Authors: Young-Wolff Kelly C. , Adams Sara R. , Klebaner Daniella , Adams Alyce S. , Campbell Cynthia I. , Satre Derek D. , Prochaska Judith J. 
Published: September 2018

Objectives:
We examined the impact of the Affordable Care Act–mandated elimination of tobacco cessation pharmacotherapy (TCP) copayments on patient use of TCP, overall and by income.

Methods:
Electronic health record data captured any and combination (eg, nicotine gum plus patch) TCP use among adult smokers newly enrolled in Kaiser Permanente Northern California (KPNC). KPNC eliminated TCP copayments in 2015. We included current smokers newly enrolled in the first 6 months of 2014 (before copayment elimination, N=16,199) or 2015 (after elimination, N=16,469). Multivariable models estimated 1-year changes in rates of any TCP fill, and of combination TCP fill, and tested for differences by income (<$50k, $50≥75k, ≥$75k). Through telephone surveys in 2016 with a subset of smokers newly enrolled in 2014 (n=306), we assessed barriers to TCP use, with results stratified by income.

Results:
Smokers enrolled in KPNC in 2015 versus 2014 were more likely to have a TCP fill (9.1% vs. 8.2%; relative risk, 1.19; 95% confidence interval, 1.11–1.27), and combination TCP fill, among those with any fill (42.3% vs. 37.9%; relative risk, 1.12; 95% confidence interval, 1.02–1.23); findings were stronger for low-income smokers. Low-income patients (<$50k) were less likely to report that clinicians discussed smoking treatments with them (58%) compared with higher income smokers ($50≥75k, 67%; ≥$75k, 83%), and were less aware that TCP was free (40% vs. 53% and 69%, respectively, P-values<0.05).

Conclusions:
The Affordable Care Act’s copayment elimination was associated with a modest increase in TCP use and a greater effect among low-income smokers. Uptake may have been enhanced if promoted to patients directly and via providers.
Innovations in Occupational Health Care Delivery Can Prevent Entry into Permanent Disability
Authors: Wickizer Thomas M. , Franklin Gary M. , Fulton-Kehoe Deborah 
Published: September 2018

Background:
Long-term work disability is known to have an adverse effect on the nation’s labor force participation rate. To reduce long-term work disability, the Washington State Department of Labor and Industries established a quality improvement initiative that created 2 pilot Centers of Occupational Health and Education (COHE).

Objectives:
To document the level of work disability in a sample of injured workers with musculoskeletal injuries and to examine (8-y) work disability outcomes associated with the COHE health care model.

Research Design:
Prospective nonrandomized intervention study with nonequivalent comparison group using difference-in-difference regression models.

Subjects:
Intervention group represents 18,790 workers with musculoskeletal injuries treated by COHE providers. Comparison group represents 20,992 workers with similar injuries treated within the COHE catchment area by non-COHE providers.

Measures:
Long-term disability outcomes include: (1) on disability 5 years after injury; (2) received a state pension for total permanent disability; (3) received total disability income support through the Social Security Disability Insurance program; or (4) a combined measure including any one of the 3 prior measures.

Results:
COHE patients had a 30% reduction in the risk of experiencing long-term work disability (odds ratio=0.70, P=0.02). The disability rate (disability days per 1000 persons) over the 8-year follow-up for the intervention and comparison groups, respectively, was 49,476 disability days and 75,832 disability days.

Conclusions:
Preventing long-term work disability is possible by reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury. Such interventions may have promising beneficial effects on reversing the nation’s progressively worsening labor force participation rate.
Migraine in children: presentation, disability and response to treatment
Authors: Slater Shalonda K. , Powers Scott W. , O’Brien Hope L. 
Published: September 2018

Purpose of review
The current review presents findings from investigations of migraine in children. The presentation of pediatric migraine, related consequences, and medication treatments are reviewed.

Recent findings
A number of advancements have been made in the study of the presentation, disability, and treatments for migraine in children. However, recent research suggests that not all approaches are equally effective in the treatment of migraine in children. Specifically, a recent study comparing pharmacological interventions found that preventive medications were not statistically more effective than placebo in children. Consistent findings showing clinically meaningful placebo response rates, shorter duration of headaches and other characteristic features (e.g. frontal, bilateral location) have been barriers to the design of randomized clinical trials in children and adolescents with migraine. Better understanding of treatment mechanisms for medication interventions is needed.

Summary
Several migraine treatments have determined to be effective for use in children but few controlled studies have evaluated the effectiveness of medication treatments. Recent research suggests that preventive medications may not be more effective than placebo. Additional research is needed to evaluate the effectiveness of medication treatment in migraine headache care.
Recent progress in porcine islet isolation, culture and engraftment strategies for xenotransplantation
Authors: Kemter Elisabeth , Wolf Eckhard 
Published: September 2018

Purpose of review
Xenotransplantation of porcine islets is a realistic option to restore β-cell function in type 1 diabetic patients. Among other factors, such as islet donor age (fetal, neonatal and adult) and genotype (wild type and genetically modified), choice of the transplantation site, and immune protection of the islets, efficient strategies for islet isolation, culture and engraftment are critical for the success of islet xenotransplantation.

Recent findings
Neonatal porcine islets (NPIs) are immature at isolation and need to be matured in vitro or in vivo before they become fully functional. Recent developments include a scalable protocol for isolation of clinically relevant batches of NPIs and a stepwise differentiation protocol for directed maturation of NPIs. In addition, different sources of mesenchymal stem cells were shown to support survival and functional maturation of NPIs in vitro and in various transplantation models in vivo.

Summary
A plethora of different culture media and supplements have been tested; however, a unique best culture system for NPIs is still missing. New insights, for example from single-cell analyses of islets or from stem cell differentiation toward β cells may help to optimize culture of porcine islets for xenotransplantation in an evidence-based manner.