bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergent opportunities in humans: playful kittens, an arthropod vector, and a zoonotic agent
Authors: Hanlon Cathleen A. , Dedmon Robert E. 
Published: April 2018

AbstractBartonella henselae is implicated as the main etiologic agent of Cat scratch disease (CSD, Cat-scratch fever). A majority of domestic cats may harbor the intra-erythrocytic agent for extended periods without apparent disease. In humans, B. henselae most commonly results in a subacute, bacterial infection that presents with one or more reddish papules which may progress to pustules and regional lymph node enlargement. Usual features include fever, malaise, and a granulomatous lymphadenitis on biopsy. However, atypical clinical presentations occur, albeit with infrequence, and may result in a difficult and protracted diagnostic process. The infection in susceptible hosts such as immunocompromised or elderly patients may result in endocarditis, encephalitis, fever of unknown origin, and general malaise. It is not transmitted from person to person and quarantine is not necessary. The arthropod vector, Ctenocephalides felis, or the cat flea, plays a major role in transmission among cats and to humans. The transmission risk to humans can be substantially reduced through elimination of flea infestations in companion animals. There are numerous recent reviews and case reports in the veterinary and medical literature reflecting increased recognition of this zoonotic agent. All this notwithstanding, many physicians and other providers may not be familiar with this agent and the potential spectrum of human disease; this may lead to delays in diagnosis and unnecessary diagnostic procedures. This article emphasizes the aspects of B. henselae infection, including a typical case report and a table with selected human case reports of unusual clinical manifestations from the published literature.
Hyperfibrinolysis and the risk of hemorrhage in stable cirrhotic patients
Authors: Surawong Anoree , Rojnuckarin Ponlapat , Juntiang Jumlong , Akkawat Benjaporn , Komolmit Piyawat , Intragumtornchai Tanin 
Published: April 2018

AbstractBackground: Bleeding is an important complication of cirrhosis. Currently, there is no coagulation test that can reliably predict clinical hemorrhage. However, previous studies demonstrated significant correlations between hyperfibrinolysis and following bleeding in advanced cirrhotic patients. Objectives: Estimate the prevalence of hyperfibrinolysis in cirrhotic patients at stable conditions and to assess its role in predicting subsequent hemorrhage. Methods: The prospective cohort study included 58 consecutive cirrhotic patients at the Liver Clinic, Chulalongkorn Hospital. Assays for liver functions, PT, APTT, fibrinogen, fibrin degradation products (FDPs) and euglobulin lysis time (ELT) were performed at baseline. The subjects were followed-up for 10 months to observe clinical hemorrhage and survival. Results: The mean age was 56.4 years and 47% were male. The etiologies of liver diseases were virus (62.1%), alcohol (24.1%) or unknown (8.6%). Hyperfibrinolysis as reflected by ELT<120 minutes or FDPs>10 μg/mL was present in 32.8% and 74.1%, respectively. Fibrinolytic activity was significantly correlated with platelet counts and coagulation times, but not as much with liver function tests. By 10 months, 13 cases (22.4%) showed hemorrhagic episodes and 7 (12.1%) were expired, including 2 from bleeding. The significant predictors for death were Child class B or C, presence of ascites, hyperbilirubinemia, hypoalbuminemia, and prolonged APTT. However, none of the clinical, biochemical, or hemostatic factors was associated with clinical bleeding. Conclusion: Hyperfibrinolysis is common in cirrhotic outpatients. However, it cannot predict subsequent hemorrhage or survival. Novel hemostatic tests are required to assess the probability of bleeding in this disorder.
Pasteurella multocida infections in cancer patients
Authors: Véleza Marela , Casanas Beata , Greene John N. 
Published: April 2018

Abstract
Background: Pasteurella multocida is a small, gram-negative coccobacillus, which most commonly causes soft tissue infections due to animal bites or scratches, mainly from cats and dogs. Immunocompromised hosts, such as cancer patients, are more likely to develop systemic complications as a result of P. multocida infections. Objective: Retrospectively analyze the medical records of four afflicted patients being managed at Moffitt Cancer Center, Tampa, USA between 1999 and 2009, and careful study for additional 32 cases of P. multocida infection among cancer patients with variegated histology found in the current medical literature. Methods: Of 36 subjects, 67% of the patients had been diagnosed with a solid organ cancer, whereas 33% had a hematologic malignancy. Clinical scenarios described fever as the most frequent initial presentation and bacteremia as the most prevalent mode of infection. Results: Forty-seven percent of the patients had experienced some sort of animal contact and 41% showed evidence of skin or soft tissue infection. The status of the white blood cell count, was available in 22 patients (of 36 patients), and 27% demonstrated neutropenia. The survival percentage of the patients with known clinical outcome was 77%. Conclusion: Medical management mostly involved antibiosis with beta-lactams. Atypical scenario of Pasteurella multocida infection may involve bites or scratches (specifically from cats or dogs) in a cancer patient presenting with sepsis and accompanied by skin or soft tissue or respiratory tract infection. A high level of suspicion for P. multocida as a possible pathogen in cancer patients would facilitate an amelioration in morbidity ameliorating, and timely initiation of specific antibiotics.
Treatment outcome of hepatocellular carcinoma patients with high-risk vascular invasion: a retrospective analysis
Authors: Suphapol Jade , Sirichindakul Boonchoo , Nonthasoot Bunthoon , Nivatvongs Supanit 
Published: April 2018

Abstract
Background: Invasion of major hepatic vessels in hepatocellular carcinoma (HCC) generally prohibits the surgical treatment. Objective: Analyze outcomes of non-surgical approaches in this group of HCC. Methods: Retrospective review of medical records of 648 HCC admitted to King Chulalongkorn Memorial Hospital between January 2003 and December 2005 was carried out to select only patients who had unresectable HCC with vascular invasion and hepatic functions-Child-Pugh class-A. Vascular invasion was defined as involvement of portal vein, inferior vena cava (IVC), or their branches identified by imaging techniques. Non-surgical treatments were either transarterial chemoembolization (TACE) or systemic chemotherapy (SCT) in addition to general supportive care. Treatment outcomes of the patients were analyzed. Results: Out of 71 unresectable HCC patients enrolled, 57patients were treated with TACE, while 14 received SCT. In the TACE group, 39 (68%), 7 (12%) and 11 (19%) patients had portal vein, IVC, and both vessels invasion, respectively. In the SCT group; 11 (78%), 1 (7%) and 2 (14%) had invasion of portal vein, IVC, and both vessels, respectively. Median overall survival in both groups was 158 days. Univariate analysis demonstrated that AFP level <1000 ng/mL, tumor size <10 cm, and SCT treatment significantly influenced survival. Additional multivariate analysis confirmed that diameters of tumor, and SCT were independent prognostic factors for good survival. A survival analysis showed longer survival in the SCT group than that of TACE (210 vs. 149 days, p=0.03) group. Conclusion: Survival of HCC patients with major vessels invasion was better when treated with SCT compared to TACE. Future prospective study in larger populations to test the hypothesis is warranted.
Thai national guidelines for the use of antiretroviral therapy in pediatric HIV infection in 2010
Authors: Puthanakit Thanyawee , Tangsathapornpong Auchara , Ananworanich Jintanat , Wongsawat Jurai , Suntrattiwong Piyarat , Wittawatmongkol Orasri , Mekmullica Jutarat , Waidab Woraman , Bhakeecheep Sorakij , Chokephaibulkit Kulkanya 
Published: April 2018

AbstractWith better knowledge and availability of antiretroviral treatments, the Thai National HIV Guidelines Working Group has issued treatment guidelines for children in Thailand in March 2010. The most important aspects of these new guidelines are detailed below. ART should be initiated in infants less than 12 months of age at any CD4 level regardless of symptoms and in all children at CDC clinical stage B and C or WHO clinical stages 3 and 4. For children with no or mild symptoms consider CD4-guided thresholds of CD4 <25% (children aged one to five years) or CD4 <350 cells/mm3(children 5 years or older). The preferred first-line regimen in children aged < 3 years is AZT+3TC+NVP. For children >3 years of age the preferred regimen is AZT+3TC+EFV. If an infant has previously been exposed to NVP perinatally, use AZT+3TC+LPV/r as empirical first regimen. In adolescents, consider TDF+3TC+EFV. The preferred ARV treatment in children who failed first line regimens of 2NRTI+NNRTI (Salvage treatment) comprises 2NRTI (guided by genotype) +LPV/r, and an alternative regimen is 2NRTI (guided by genotype) +ATV/ r (use in cases with dyslipidemia who are six years or older). In cases with extensive NRTI resistance with no effective NRTI option available, double boosted PI with LPV/r+SQV or LPV/r+IDV can be considered. Consultation with an expert is recommended. Laboratory monitoring is recommended for CD4 and every six months. Viral load at least at 6 and 12 months after initiation or change of regimen, then yearly thereafter. More frequent viral load monitoring is advised for cases with unsuccessful virologic response, infants, children with imperfect adherence, or those using of third line regimens. Toxicity monitoring depends on the drug received, at least every six months, and more often as clinically indicated. These include, but are not limited to, complete blood count, renal function tests, liver function tests, urinanalysis, and lipid profiles. Therapeutic drug monitoring is recommended in cases that have ARV-related toxicity, receiving non-standard dosing or regimens, using double boosted PI, and in those with renal or hepatic impairment.
Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2010
Authors: Sungkanuparph Somnuek , Techasathit Wichai , Utaipiboon Chitlada , Chasombat Sanchai , Bhakeecheep Sorakij , Leechawengwongs Manoon , Ruxrungtham Kiat , Phanuphak Praphan 
Published: April 2018

AbstractIn Thailand, more than 150,000 patients are currently treated with antiretroviral drugs under the support of the National AIDS Program (NAP). The appointed Adults and Adolescents Committee consisted of 28 members who are experts in HIV research, patient care or health care policy. Relevant published literature, guidelines, and the most recent relevant clinical trials presented internationally were reviewed. Several peer review and clinical studies conducted in Thailand were included in the review process. Special considerations for patients with co-infection of tuberculosis or hepatitis B were incorporated. Appropriate cut-off of CD4+ T-cell counts when to commence ART among Thai patients have been considered. It is now recommended to start ART at CD4+ T-cell count <350 cells/mm3. For treatment-naive patients, the preferred initial therapy is a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen containing lamivudine plus zidovudine or tenofovir. Stavudine will be phased out in a two-year plan at the national program level. Viral load and CD4+ T-cell counts should be monitored at least once and twice a year. To achieve long-term treatment success, enhancing adherence together with the proper management of antiretroviral-related toxicity is critical. In summary, the major changes from the Thai 2008 guidelines include commencing ART earlier. ART is recommended regardless of CD4+ T cell count if patients have an indication to treat their HBV co-infection. Preferred first regimen uses AZT or TDF, not d4T as the NRTI-backbone. Furthermore, efavirenz is now considered a preferred NNRTI, along with nevirapine.
Chest radiographic findings in children with asplenia syndrome
Authors: Trinavarat Panruethai , Tantiprawan Kullana , Khongphatthanayothin Apichai 
Published: April 2018

AbstractBackground: Early diagnosis of asplenia syndrome is important because prophylactic antibiotic and proper vaccination will prevent serious infection. Most children with asplenia syndrome present with symptoms of congenital heart disease. Chest X-ray is usually the first line imaging modality. Objective: Define useful findings in chest radiograph that could suggest the diagnosis of asplenia syndrome. Methods: Chest radiographs of pediatric patients who had asplenia syndrome diagnosed between January 1, 2002 and June 30, 2008 in a single institute were retrospectively reviewed for the positions of the visceral organs in the chest and abdomen. Results: Three hundred seventy one chest radiographs of 30 patients were reviewed. The mean age at diagnosis was 3 years old. Asplenia was diagnosed by ultrasound in 27 patients, by CT scan in two patients, and by damaged red blood cell scintigraphy in one patient. Six important findings detected from chest radiographs were, 1) bilateral minor fissures, 16 cases (53%), 2) bilateral eparterial bronchi, 16 cases (53%), 3) ipsilateral side of stomach and liver, 12 cases (40%), 4) ipsilateral side of minor fissure or eparterial bronchus and stomach, 10 cases (33%), 5) symmetrical transverse lie of the liver, nine cases (30%), and 6) contralateral side of minor fissure or eparterial bronchus and the liver in seven cases (23%). All except two patients (93%) had at least one of the above findings. All patients had congenital heart diseases. Most of the heart diseases were pulmonary atresia or pulmonary stenosis (88%) and single ventricle (85%). Conclusion: Chest radiographs have high sensitivity in suggesting the diagnosis of asplenia syndrome, when detecting one or more of the above findings, particular in patients with congenital heart disease and decreased pulmonary vasculature.
Second line antiretroviral therapy for treatment of HIV in Asia
Authors: Elliott Julian H. 
Published: April 2018

AbstractLimited access to virological monitoring has led to a high prevalence of resistance to nucleoside reverse transcriptase inhibitors (NRTIs) at the time of first line failure in most studies from low- and middle-income countries (LMIC). Nevertheless, the current standard of care is to include NRTIs in second line regimens. The activity of tenofovir/emtricitabine following failure of stavudine/lamivudine or zidovudine/lamivudine is dependent on the sensitivity of the monitoring strategy used during first line therapy and the threshold for switching, whereas these factors are less important if the opposite sequencing strategy is used. Boosted protease inhibitors (PIs) are the foundation of effective second-line therapy with demonstrated efficacy in early salvage regimens and high barrier to resistance. Lopinavir/ritonavir and ritonavir-boosted atazanavir have recently been described by the World Health Organization as preferred boosted PIs for use in LMIC. Alternative approaches currently under investigation include boosted PI monotherapy, dual boosted PIs, and the combination of raltegravir (an HIV integrase inhibitor) and a boosted PI.
HIV-vaccines: lessons learned and the way forward
Authors: Excler Jean-Louis 
Published: April 2018

Abstract
A safe and efficacious preventive HIV vaccine, as part of a comprehensive prevention program, remains among the highest public health priorities. It would be the best tool that could reduce the spread of HIV significantly in the long run. Current AIDS vaccine candidates are unable to induce neutralizing antibodies against primary HIV isolates or only to a very limited and narrow extent, representing a major obstacle in the development of an efficacious HIV vaccine. Clinical efforts have mainly focused on T-cell vaccines such as DNA and various recombinant vectors alone or in prime-boost regimens. The Merck Ad5 vaccine not only failed to show efficacy but also was associated with increased risk of HIV acquisition in vaccinees in a Phase IIb trial. While gp120 alone was not efficacious, the ALVAC prime and gp120 boost regimen showed 31% efficacy in a Phase III trial in Thailand. These contrasting results illustrate the limitations of available laboratory assays to assess the vaccine-induced immune responses and the lack of understanding of immune correlates of protection. Efforts should therefore focus on developing vaccine candidates inducing broadly neutralizing antibodies. Similarly, new vector strategies such as replicating vectors should be explored to induce strong and broad T-cell responses in the systemic and mucosal compartments. Innovation in immune assay development and testing algorithms is critically needed. The standardization of more relevant and predictive non-human primate models for immunogenicity and efficacy studies will contribute to better and faster vaccine assessment. HIV vaccine development requires innovative ideas and a sustained long-term commitment of the scientific community, civil society, politicians, and donors and participants for clinical research.
Sexual life and contraception in people living with HIV
Authors: Landolt Nadia Kancheva , Phanuphak Nittaya , Chaithongwongwatthana Surasith , Ananworanich Jintanat 
Published: April 2018

Abstract
As people living with HIV (PLH) are living longer and healthier lives in the era of highly active antiretroviral therapy, common reproductive health issues are becoming more important. According to WHO, PLH should be offered routine counselling on sexual and reproductive health, so that they can implement informed, healthy, and appropriate decisions. PLH need special attention with regard to the use of contraceptive methods that provide dual protection against HIV/sexually transmitted infection transmission and unintended pregnancies. This article includes literature review on sexual life and contraception in the context of HIV infection including barrier methods, natural methods, sterilization, hormonal contraception, intrauterine device, spermicides/ microbicides and emergency contraception. To date, there is no perfect method that provides both protection against HIV transmission and unintended pregnancy. Although male condom remains the principal contraceptive method, its male-controlled usage is its most important obstacle. This article describes the pros and cons of each method for PLH as well as the interaction between hormonal contraceptives and antiretroviral drugs. Many questions remain to be answered. It is therefore important that studies of different methods of contraception in PLH continue.
Hepatocyte steatosis increases the expression of adhesion molecules in endothelial cells
Authors: Lin Gang , Duan Xiaoyan , Cai Xiaobo , Tian Liyan , Xu Zhengjie , Fan Jiangao 
Published: April 2018

Abstract
Background: Non-alcoholic fatty liver disease is considered a hepatic manifestation of the metabolic syndrome. It is associated with endothelial dysfunction as an early event of generalized atherosclerosis. However, it is unclear whether steatotic hepatocytes influence endothelial function directly. Objective: Explore the influence of hepatocyte steatosis on the function of endothelial cells. Methods: Oleic and palmitic acid (2:1 mixture, final concentration: 1 mM for 24 hours) was used to induce a normal adult hepatocyte strain (L-02) for transformation into steatosis cells. This was followed by oil red O staining and transmission electron microscopy (TEM) for verification. The culture solution of steatotic L-02 cells was filtered and collected, and added into the culture substrate of human umbilical vein endothelial cells (HUVECs). The expression of vascular cellular adhesion molecule -1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin in HUVECs was detected by real-time polymerase chain reaction and Western blot assays. The apoptosis and proliferation of HUVECs was determined using flow cytometry. The experimental results were compared with the controls. Results: Oil red O staining and microscopic observation showed that the cytoplasm of induced L-02 cells contained a large amount of red lipid droplets. TEM results showed that the cytoplasm had lipid accumulation, swelling mitochondria, fewer cristae, and reduced number of rough endoplasmic reticula accompanied with degranulation. However, these changes were not observed in normal L-02 cells. As to the group of HUVECs treated by the filtrate of steatosis L-02 cells, the mRNA and protein expression of VCAM-1, ICAM-1, and E-selectin was higher than that in the control group. The difference was statistically significant (p <0.01). No significant difference was found when HUVECs apoptosis and proliferation were assessed by flow cytometry. Conclusion: Secretion from steatotic hepatocytes could boost the expression of VCAM-1, ICAM-1, and E-selectin in endothelial cells, indicating that hepatocyte steatosis could induce endothelial cell dysfunction. The proliferation and apoptosis of endothelial cells did not change, suggesting that hepatocyte steatosis had no influence on the viability of endothelial cells under this condition.
Thai parental perception of the etiology of autism spectrum disorders with an emphasis on genetics
Authors: Chirdkiatgumchai Vilawan , Ruangdaraganon Nichara , Roongpraiwan Rawiwan , Sombuntham Tasnawat , Rojmahamongkol Pat , Prasertchai Rungtip 
Published: April 2018

Abstract
Background: More than 90% of cases of autism spectrum disorders (ASDs) are idiopathic and are multi-factorial inheritant in etiology. Although parental perceptions of ASDs etiologies including genetics have been investigated well in western countries, there is no study regarding Asian parental perspectives on the genetic etiology of ASDs. Objectives: Examine what Thai parents perceived to be the etiology of ASDs with particular focus on the role of genetics, and analyze the correlation between demographics of parents and the perception of genetics as an etiology of ASDs. Methods: Children diagnosed with an ASD at Ramathibodi Hospital were recruited, and 328 questionnaires were mailed to their parents between February 1 and March 31, 2008. Based on 252 answers received, the perception of genetics as an etiology of ASDs was evaluated using univariate and multivariate analysis. Results: Among 252 parents, 44.0% cited genetics, 52% cited other prenatal and perinatal factors such as stress and chemical exposure during pregnancy, 33% cited postnatal factors such as child rearing, child’s viewing of television, and playing computer game as etiologies of ASDs. Parents’ education, positive family history of ASDs, and positive family history of speech delay were all significantly associated with the perception of genetics as an etiology of ASDs. Conclusions: Less than half of Thai parents cited genetics as an etiology of ASDs. This finding alerts medical professionals to spend more time and effort to educate and counsel parents.
Increasing the remnant liver volume using portal vein embolization
Authors: Saksirinukul Thanis , Kosolbhand Permyot , Tanpowpong Natthaporn 
Published: April 2018

Abstract
Background: Portal vein embolization (PVE) is a common procedure to induce hypertrophy of the remnant liver (RL) before major hepatectomy. Objective: Evaluate increased RL volume after PVE based on CT volumetric measurement. Methods: Multi-detector computed tomography (MDCT) was used to measure hepatic volumetric measurement, including total liver volume and RL volumes of pre- and post-PVE. Complications were recorded from PVE and from three-month after post-extended hepatectomy liver dysfunction. Result and conclusion: There was a 10% increase in RL volume. Mean days between CT and PVE were 20 days. No major complications from PVE were observed.