bluuebunny/crossref_metadata_2025_split huggingface dataset:
Infant Human Immunodeficiency Virus–free Survival in the Era of Universal Antiretroviral Therapy for Pregnant and Breastfeeding Women
Authors: Chi Benjamin H. , Mutale Wilbroad , Winston Jennifer , Phiri Winifreda , Price Joan T. , Mwiche Angel , Ayles Helen , Stringer Jeffrey S. A. 
Published: March 2018

Background:
Lifelong antiretroviral therapy (ART) is now recommended for all human immunodeficiency virus (HIV)-infected pregnant and breastfeeding women; however, few have described overall infant outcomes in this new era for the prevention of mother-to-child HIV transmission (PMTCT).

Methods:
As part of an assessment of PMTCT program impact, we enrolled a prospective cohort study in 4 predominantly rural districts in Zambia. HIV-infected mothers and their newborns (≤30 days old) were recruited and followed at 6 weeks, 6 months and 12 months postpartum; infant specimens were tested via HIV DNA polymerase chain reaction. In Kaplan–Meier analyses, we estimated overall infant HIV-free survival and then stratified by district, community and maternal ART use. We investigated the relationship between community-level 12-month, self-reported maternal ART use and infant HIV-free survival via linear regression.

Results:
From June 2014 to November 2015, we enrolled 827 mother–infant pairs in 33 communities. At 12 months, small proportions of infants had died (2.8%), were HIV-infected (3.0%) or were lost to follow-up (4.3%). Overall, infant HIV-free survival was 99.0% [95% confidence interval (CI): 98.0%–99.5%] at 6 weeks, 97.5% (95% CI: 96.1%–98.4%) at 6 months and 96.3% (95% CI: 94.8%–97.4%) at 12 months. Women reporting ART use at enrollment had higher infant HIV-free survival than those who did not (97.4% vs. 89.0%, P = 0.01). Differences were noted at the district and site levels (P = 0.01). In community-level analysis, no relationship was observed between 12-month infant HIV-free survival and self-reported maternal ART use (P = 0.65).

Conclusion:
Although encouraging, these findings highlight the need for rigorous monitoring and evaluation of PMTCT services at the population level.
Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children
Authors: Gaensbauer James T. , Birkholz Meghan , Smit Michael A. , Garcia Roger , Todd James K. 
Published: March 2018

Introduction:
It is important for clinicians to recognize the contribution of toxic shock syndrome (TSS) to the overall burden of pediatric septic shock because the clinical features, optimal therapy and prognosis differ from non-TSS septic shock.

Methods:
We analyzed cases of pediatric septic shock reported to the Pediatric Health Information Systems database between 2009 and 2013 to define the clinical and demographic characteristics of pediatric TSS in the United States. Using a validated International Classification of Diseases, 9th revision, coding strategy, we identified patients with infectious shock among inpatients age 1–18 years and classified cases of staphylococcal and streptococcal TSS for comparison with non-TSS cases.

Results:
Of 8,226 cases of pediatric septic shock, 909 (11.1%) were classified as TSS and 562 (6.8%) were possible TSS cases. Staphylococcal TSS represented the majority (83%) of TSS cases and occurred more commonly in females and at an older age. Compared with non-TSS septic shock, TSS had significantly lower fatality rates, disease severity and length of hospital stay and was present more often at the time of admission (P < 0.001 for each). Streptococcal TSS was associated with poorer outcomes than staphylococcal TSS. Treatment for TSS differed from non-TSS septic shock in use of more clindamycin, vancomycin and Intravenous Immunoglobulin and less need for vasopressors.

Conclusions:
Results demonstrate a significant contribution of TSS to the burden of pediatric septic shock in the United States. The findings emphasize the importance of inclusion of TSS diagnostic and therapeutic considerations in sepsis treatment protocols for children.
The Influence of β-Adrenergic Receptor Kinase-1 on Stroke-induced Immunodeficiency Syndrome
Authors: Ross Amy Miner , Lee Christopher S. , Lutsep Helmi , Clark Wayne M. 
Published: March 2018

Background:
Immunodeficiency in acute ischemic stroke (AIS) is thought to be a result of norepinephrine suppression of the lymphoid tissue. The possible differences in the distribution of lymphocytes after stroke may be due to differences in responsiveness of lymphocyte β-adrenergic receptors to their kinase (BARK-1).

Objective:
The objective was to quantify the influence of lymphocyte BARK-1 on stroke-induced immunodeficiency in AIS patients.

Methods:
A prospective clinical cohort study was conducted (N = 44). Measures included age, gender, race, risk factors for stroke, stroke severity, comorbidities, presence of infection, white blood cell counts and differential proportions, and lymphocyte BARK-1. Student t tests, effect sizes, and linear and logistic regressions were conducted to test the study objective. The study was approved by the Oregon Health & Science University Institutional Review Board.

Results:
There were significant changes in all white blood cells and differential proportions and in the National Institutes of Health Stroke Scale from admission to 48 hours after onset of stroke deficits. Higher BARK-1 influenced the lower lymphocyte proportion at 48 hours, independent of age, P < .0001. Furthermore, BARK-1 also was associated with an increase in the likelihood of having sustained or stroke-induced immunodeficiency at 48 hours: odds ratio, 2.41; 95% confidence interval, 1.10–5.25; P = .027, and odds ratio, 2.79; 95% confidence interval, 1.03–7.52; P = .043, respectively. In all backward stepwise selection of factors, BARK-1 was the only factor consistently retained in the models.

Conclusions:
β-Adrenergic receptor kinase-1 has a significant quantifiable influence on lymphocyte proportion at 48 hours and on the classification of sustained stroke-induced immunodeficiency.

Clinical Implications:
β-Adrenergic stimulation influences immunodeficiency in AIS.
Seasonal Work and Cardiovascular Risk Factors in Farmers
Authors: Schulz Paula S. , Zimmerman Lani , Johansson Patrik 
Published: March 2018

Background:
Cardiovascular disease is the leading cause of death and hospitalization in the rural United States. Midwestern farmers are integral to rural communities, but little is known about the effect of occupational variability of seasonal work and technology use on their cardiovascular disease risk.

Aims:
This study describes the relationships of health behaviors and cardiovascular disease risk in 40 Midwestern farmers during peak and off-peak farming seasons.

Methods:
Objectively measured physical activity and self-report of demographics, diet, and health-related quality of life were collected during each farming season.

Results and Conclusions:
Farmers in this study were physically active, ate consistent diets, and reported high health status ratings throughout the year. Cardiovascular disease risk was positively correlated with age and body mass index (P < .01), and half of young and middle-age farmers reported anxiety and depression problems. Cardiovascular disease risk reduction interventions for farmers should address both physical and emotional aspects of farming.
Low Bone Mineral Density in Elite Female Athletes With a History of Secondary Amenorrhea in Their Teens
Authors: Nose-Ogura Sayaka , Yoshino Osamu , Dohi Michiko , Kigawa Mika , Harada Miyuki , Kawahara Takashi , Osuga Yutaka , Saito Shigeru 
Published: March 2018

Objective:
To determine whether secondary amenorrhea during teenage years influences bone mineral density (BMD) in female athletes in their 20s.

Design:
Original research.

Setting:
Japan Institute of Sports Sciences.

Participants:
Two hundred ten elite female athletes older than 20 years were included in the study.

Main Outcome Measures:
Information on the participants' past (ie, during their teenage years) and current menstrual cycle, training time, history of stress fractures, and blood tests for hormones received was obtained. Bone mineral density of the lumbar spine was evaluated by dual-energy x-ray absorptiometry; low BMD was defined as a Z-score ≤−1. We investigated the correlation factors for low BMD in athletes in their 20s by univariable and multivariable logistic regression analysis.

Results:
A total of 39 (18.6%) female athletes had low BMD. Secondary amenorrhea in their teens [odds ratio (OR), 7.11, 95% confidence interval (CI), 2.38-21.24; P < 0.001] and present body mass index (BMI) (OR, 0.56, 95% CI, 0.42-0.73; P < 0.001) were independent correlation factors for low BMD in the multivariable logistic regression analysis. The average Z-score for those with secondary amenorrhea in their teens and 20s, secondary amenorrhea in their 20s only, and regular menstruation was −1.56 ± 1.00, −0.45 ± 1.21, and 0.82 ± 1.11 g/cm2, respectively.

Conclusions:
Secondary amenorrhea for at least 1 year during teenage years in female athletes and BMI at present was strongly associated with low BMD in their 20s.
Test–Retest Reliability and the Effects of Exercise on the King-Devick Test
Authors: Eddy Ryan , Goetschius John , Hertel Jay , Resch Jacob 
Published: March 2018

Objective:To determine the test–retest reliability and the influence of exercise on King-Devick (K-D) test performance.Design:Crossover study design.Setting:Controlled laboratory.Participants:Participants consisted of 63 (39 women and 24 men) healthy, recreationally active college students who were 21.0 + 1.5 years of age.Independent Variables:Participants completed the K-D test using a 2-week, test–retest interval. The K-D test was administered before and after a counterbalanced exercise or rest intervention. Reliability was assessed using testing visits (visit 1 and visit 2) as the independent variables. Exercise or rest and time (baseline, postintervention) were used as independent variables to examine the influence of exercise.Main Outcome Measures:Intraclass correlation (ICC) coefficients with 95% confidence intervals were calculated between visits to assess reliability of K-D test completion time. A repeated-measure 2 x 2 analysis of variance (intervention × time) with post hoc pairedttests was used to assess the influence of exercise on K-D test performance.Results:The K-D test was observed to have strong test–retest reliability [ICC2,1= 0.90 (0.71, 0.96)] over time. No significant intervention-by-time interaction (P= 0.55) or intervention main effects (P= 0.68) on K-D time were observed. Mean differences of −1.5 and −1.7 seconds (P< 0.001) were observed between baseline and rest and exercise interventions for K-D test performance, respectively. Up to 32% (20/63) of participants were observed to have a false-positive K-D test performance before and after each intervention.Conclusions:Although strong test–retest reliability coefficients were observed using clinically relevant time points, a high false-positive rate warrants caution when interpreting the K-D test.
Pediatric Collagenous Gastritis and Colitis
Authors: Matta Judy , Alex George , Cameron Donald J.S. , Chow Chung W. , Hardikar Winita , Heine Ralf G. 
Published: March 2018

ABSTRACTIntroduction:Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands. Two phenotypes of the disease have been described: a pediatric‐onset and an adult‐onset type. The adult‐onset form is associated with collagenous colitis and autoimmune disorders. No effective treatment has been identified to date.Objective:We aim to describe the clinical features and outcomes of patients in our cohort and provide a summary of published pediatric cases with collagenous gastritis and colitis reported to date to gather information that will contribute to improved knowledge of this rare condition.Methods:A retrospective chart review of all patients with collagenous gastritis and/or colitis who were treated at the Royal Children's Hospital, Melbourne, was performed. A literature review was also conducted.Results:A total of 12 cases of collagenous gastritis were reviewed. Three of 12 (25%) patients had associated collagenous colitis. The most common clinical presentation was iron deficiency anemia. Nine (75%) patients were followed up, and repeat endoscopies were performed in 8 (67%). Iron deficiency anemia resolved in all patients on oral iron supplementation. Histologic improvement was only identified in one patient with the adult phenotype who had been treated with oral corticosteroids and azathioprine.Conclusions:Collagenous gastritis is a rare condition in children. A small proportion of children develop features of the “‘adult” phenotype at a very young age. Patients with collagenous gastritis require long‐term follow‐up and monitoring of their disease. Further randomized clinical trials are needed to establish an effective therapeutic strategy.
Multivariate Model for the Prediction of Severity of Acute Pancreatitis in Children
Authors: Izquierdo Yojhan E. , Fonseca Eileen V. , Moreno Luz Á. , Montoya Rubén D. , Guerrero Rafael 
Published: March 2018

ABSTRACTThis study aimed to develop a severity prediction system for pediatric patients with acute pancreatitis (AP) based on clinical and laboratory parameters recorded at disease onset. A retrospective cohort study including 130 patients with AP, aged 0 to 18 years, was conducted. Correlations between severe AP (SAP) and clinical and laboratory data were established. Parameters with a significant statistical correlation (P ⩽ 0.05) were incorporated in logistic regression models, and receiver operating characteristic curves were generated. The best‐performance cutoff points were calculated to propose a severity prediction score, for which sensitivity and specificity were determined. Thirty‐eight cases (29.2%) were consistent with SAP. A value of ≥1 point yielded a sensitivity of 81.5% and specificity of 64.1% for SAP prediction, when using a score including blood urea nitrogen ≥12.5 mg/dL (1 point) or hemoglobin <13 mg/dL (1 point) as variables. The proposed severity score showed good performance in predicting SAP.
Use of Oral Fluid With a Rapid Treponemal Test for Syphilis Evaluation
Authors: Bristow Claire C. , Shannon Chelsea , Herbst de Cortina Sasha , Klausner Jeffrey D. 
Published: March 2018

Abstract
We aimed to determine if rapid treponemal tests intended for whole-blood specimens could be used to detect treponemal antibody in oral fluid. We found a high sensitivity of oral fluid rapid testing, which increased with increasing rapid plasma reagin titer, suggesting potential for the development of accurate rapid oral syphilis tests.
Chikungunya in a Pediatric Traveler
Authors: Thomas Vanessa A. , Murray Kristy O. , Crouse Heather L. 
Published: March 2018

Abstract
Chikungunya is a mosquito-transmitted virus found primarily in Africa and Asia. In late 2013, chikungunya virus emerged in the Western hemisphere, spreading from the Caribbean to South, Central, and North America (MMWR Morb Mortal Wkly Rep. 2014;63:1121–1128). Symptoms can be similar to nonspecific viral presentations including fever, joint pain, joint swelling, and rash. The diagnosis of infectious tropical diseases in the emergency department often requires a high index of suspicion, given the nonspecific early findings that characterize many of these tropical diseases. This report presents a case of chikungunya in a pediatric patient traveling from Guatemala to the United States. Proper recognition of infection and diagnosis are vital from a public health perspective. Considering patients will remain viremic for up to a week and potentially expose local mosquitoes to infection, it is important to educate the patient on mosquito bite prevention in geographic areas of the United States where competent mosquito vectors exist as a means of avoiding further spread.
Extracellular Vesicles in Cancer
Authors: Clancy James , D’Souza-Schorey Crislyn 
Published: March 2018

Abstract
Extracellular vesicles refer collectively to a heterogeneous group of membrane-bound vesicles released from cells and loaded with bioactive proteins, nucleic acids, and lipids. The concept of extracellular vesicles has rapidly evolved from once being viewed as cellular debris to their recognition as packets of cellular information with considerable promise for clinical applications as biomarker platforms and therapeutic vehicles. These shed vesicles have emerged as critical mediators of intercellular communication in both local and distant microenvironments during normal physiological processes, as well as in orchestrating systemic pathophysiological events in disease. This mode of cellular crosstalk is particularly relevant to modulating the tumor microenvironment and orchestrating paths of least resistance during metastases. Here, we describe recent advances for the roles of extracellular vesicles in tumor progression and their potential as disease biomarkers.
Molecular Profiling of Liquid Biopsy Samples for Precision Medicine
Authors: Campos Camila D.M. , Jackson Joshua M. , Witek Małgorzata A. , Soper Steven A. 
Published: March 2018

Abstract
In the context of oncology, liquid biopsies consist of harvesting cancer biomarkers, such as circulating tumor cells, tumor-derived cell-free DNA, and extracellular vesicles, from bodily fluids. These biomarkers provide a source of clinically actionable molecular information that can enable precision medicine. Herein, we review technologies for the molecular profiling of liquid biopsy markers with special emphasis on the analysis of low abundant markers from mixed populations.
Mechanosensitive Ion Channels
Authors: Hope Jacob M. , Greenlee Joshua D. , King Michael R. 
Published: March 2018

Abstract
Cancer metastasis is the second leading cause of death in the United States. Despite its morbidity, metastasis is an inefficient process that few cells can survive. However, cancer cells can overcome these metastatic barriers via cellular responses to microenvironmental cues, such as through mechanotransduction. This review focuses on the mechanosensitive ion channels TRPV4 and P2X7, and their roles in metastasis, as both channels have been shown to significantly affect tumor cell dissemination. Upon activation, these channels help form tumor neovasculature, promote transendothelial migration, and increase cell motility. Conversely, they have also been linked to forms of cancer cell death dependent upon levels of activation, implying the complex functionality of mechanosensitive ion channels. Understanding the roles of TRPV4, P2X7 and other mechanosensitive ion channels in these processes may reveal new possible drug targets that modify channel function to reduce a tumor’s metastatic potential.
Breast Cancer following Augmentation Mammaplasty: A Case-Control Study
Authors: Sosin Michael , Devulapalli Chaitan , Fehring Charles , Hammond Edward R. , Willey Shawna C. , Tousimis Eleni A. , Spear Scott L. , Nahabedian Maurice Y. , Feldman Elizabeth D. 
Published: March 2018

Background:The purpose of this study was to determine whether augmentation mammaplasty, implant type, and implant location affect breast cancer detection, stage, and treatment.Methods:An institutional case-control study was performed of patients with prior breast augmentation undergoing breast cancer treatment from 2000 to 2013. Controls were propensity matched and randomized, and data were retrospectively reviewed.Results:Forty-eight cases and 302 controls were analyzed. Palpable lesions were detected at a smaller size in augmentation patients (1.6 cm versus 2.3 cm;p< 0.001). Fewer lesions in augmented patients were detected by screening mammography (77.8 percent of cases versus 90.7 percent of controls;p= 0.010). Patients with implants were more likely to undergo an excisional biopsy for diagnosis (20.5 percent versus 4.4 percent;p< 0.001), rather than image-guided core needle biopsy (77.3 percent versus 95.3 percent;p< 0.001). Earlier staging in augmented patients approached but did not reach statistical significance (p= 0.073). Augmented patients had higher mastectomy rates (74.5 percent versus 57.0 percent) and lower rates of breast-conservation therapy (25.5 percent versus 43 percent;p= 0.023). Neither implant fill type nor anatomic location affected method of diagnosis, stage, or treatment.Conclusions:Palpable detection of breast cancer is more likely at a smaller size in augmented patients, yet it is less likely on screening mammography than in controls. Augmentation breast cancer patients have a comparable disease stage and are more likely to undergo mastectomy rather than lumpectomy. Both silicone and saline implants, whether placed submuscularly or subglandularly, have comparable effects on breast imaging, biopsy modality, and surgical intervention.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, III.
5000 Free Flaps and Counting: A 10-Year Review of a Single Academic Institution’s Microsurgical Development and Outcomes
Authors: Carney Martin J. , Weissler Jason M. , Tecce Michael G. , Mirzabeigi Michael N. , Wes Ari M. , Koltz Peter F. , Kanchwala Suhail K. , Low David W. , Kovach Stephen J. , Wu Liza C. , Serletti Joseph M. , Fosnot Joshua 
Published: March 2018

Background:
The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity.

Methods:
A 10-year retrospective institutional review was performed from fiscal years 2006 to 2016. Microsurgical flap type and operative volume were measured across all microsurgery faculty and participating hospitals. Microvascular compromise and flap salvage rates were noted for the six highest volume surgeons. Univariate and multivariable predictors of flap salvage were determined.

Results:
The 5000th flap was performed in December of 2015 within this institutional study period. Looking at the six highest volume surgeons, free flaps were examined for microvascular compromise, with an institutional mean take-back rate of 1.53 percent and flap loss rate of 0.55 percent across all participating hospitals. Overall, 74.4 percent of cases were breast flaps, and the remaining cases were extremity and head and neck flaps.

Conclusions:
Focused faculty and trainee recruitment has resulted in an academically and clinically productive practice. Collaboration among faculty, staff, and residents contributes to continual learning, innovation, and quality patient care. This established framework, constructed based on experience, offers a workable and reproducible model for other academic plastic surgery institutions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.