bluuebunny/crossref_metadata_2025_split huggingface dataset:
Helicobacter pylori Infection May Be Related to Inflammation and Not to Iron Deficiency Anemia in Hemodialysis Patients
Authors: Ibrahim Hoda Mohamed , El Wahab Ahmed Mohammed Abd , Shahin Dina , El-Kannishy Ghada 
Published: June 2019

Introduction
Anemia develops early in the course of chronic kidney disease and is nearly universal in patients with end-stage renal disease. In the general population, observational studies have shown a link between Helicobacter pylori and iron deficiency, often resulting in iron deficiency anemia. This study was conducted to investigate the effect of H. pylori infection in hemodialysis (HD) patients on parameters of iron deficiency anemia. The relation between H. pylori infection and inflammation as well as hepcidin serum level in HD patient was also identified.

Methods
This study included 84 HD patients from dialysis unit in Talkha Central Hospital. Patients were classified into 2 groups according to presence of H. pylori antigen in stool.

Results

Helicobacter pylori stool antigen was positive in 47 patients (55.6%). There was a significant male predominance in H. pylori–infected group. Infection with H. pylori was associated with longer dialysis duration and more dyspeptic symptoms. No significant difference was found between infected and noninfected patients regarding hematocrit, hemoglobin, iron, ferritin, nor transferrin saturation. C-reactive protein was significantly higher in H. pylori–positive group. Hepcidin was also higher in the noninfected group but with no significant difference.

Conclusions
Patients with longer duration of HD, male sex, and the presence of dyspepsia had higher odds to exhibit H. pylori infection. Helicobacter pylori infection did not seem to have an influence on iron deficiency or anemia severity in HD patients and does not have relation with serum hepcidin level. However, H. pylori may to be related to inflammation in HD patients.
A Hail Mary Diagnostic Success
Authors: Dylewski Joe , Domingo Marc-Christian , Thivierge Karine 
Published: June 2019

Abstract
With the advent of newer methodologies, it has become possible to detect previously unsuspected pathogens. We wish to present a case of human granulocytic anaplasmosis that was diagnosed using 16S ribosomal RNA gene sequencing while originally investigating possible culture-negative endocarditis. This case is the first reported in humans from the province of Quebec. A brief review of means of transmission and clinical and laboratory findings as well as treatment is provided.
Acute Amebic Encephalitis in an Allogeneic Hematopoietic Stem-Cell Transplant Recipient
Authors: Molina Alfonso , Winston Drew J. , Haeri Mohammad , Khanlou Negar , Schiller Gary J. 
Published: June 2019

Abstract
Except for cerebral toxoplasmosis, parasitic central nervous system (CNS) infections are extremely rare in allogeneic hematopoietic stem-cell transplant recipients. We report an unusual case of acute amebic encephalitis in an allogeneic hematopoietic stem-cell transplant patient occurring more than 1 year after transplantation. Because the clinical presentation of amebic encephalitis can mimic other more common causes of CNS infection, the diagnosis should be considered whenever more common causes of CNS infection have been excluded.
Identification of Ureaplasma parvum as a Cause of Culture-Negative Septic Monoarthitis Using 16S rRNA Gene Sequencing
Authors: Suknuntha Kran , Lepak Alexander J. , Rehrauer William M. , Chen Derrick J. 
Published: June 2019

Abstract

Ureaplasma species primarily colonize in the human genitourinary tract and are a cause of nongonococcal urethritis. Rare cases of septic arthritis caused by these organisms have been reported in immunocompromised hosts; however, their pathogenic activity in hosts with competent immune status remains unclear. Here, we report a case of septic arthritis caused by Ureaplasma parvum in an adult immunocompetent male patient diagnosed by 16S rRNA gene sequencing.
Nutritional Status Deterioration Occurs Frequently During Children’s ICU Stay*
Authors: Valla Frédéric V. , Baudin Florent , Gaillard Le Roux Bénédicte , Ford-Chessel Carole , Gervet Elodie , Giraud Céline , Ginhoux Tiphanie , Cour-Andlauer Fleur , Javouhey Etienne , Tume Lyvonne 
Published: June 2019

Objectives:
Malnutrition and faltering growth at PICU admission have been related to suboptimal outcomes. However, little is known about nutritional status deterioration during PICU stay, as critical illness is characterized by a profound and complex metabolism shift, which affects energy requirements and protein turnover. We aim to describe faltering growth occurrence during PICU stay.

Design:
Single-center prospective observational study.

Setting:
Twenty-three-bed general PICU, Lyon, France.

Patients:
All critically ill children 0–18 years old with length of stay longer than 5 days were included (September 2013–December 2015).

Interventions:
Weight and height/length were measured at admission, and weight was monitored during PICU stay, in order to calculate body mass index for age z score. Faltering growth was defined as body mass index z score decline over PICU stay. Children admitted during the first year of the study and who presented with faltering growth were followed after PICU discharge for 3 months.

Measurements and Main Results:
We analyzed 579 admissions. Of them, 10.2% presented a body mass index z score decline greater than 1 sd and 27.8% greater than 0.5. Admission severity risk scores and prolonged PICU stay accounted for 4% of the variability in nutritional status deterioration. Follow-up of post-PICU discharge nutritional status showed recovery within 3 months in most patients.

Conclusions:
Nutritional deterioration is frequent and often intense in critically ill children with length of stay greater than 5 days. Future research should focus on how targeted nutritional therapies can minimize PICU faltering growth and improve post-PICU rehabilitation.
Temporal Variability in the Sampling of Vital Sign Data Limits the Accuracy of Patient State Estimation*
Authors: Eytan Danny , Jegatheeswaran Anusha , Mazwi Mjaye L. , Assadi Azadeh , Goodwin Andrew J. , Greer Robert W. , Goodfellow Sebastian D. , Laussen Peter C. 
Published: June 2019

Objectives:
Physiologic signals are typically measured continuously in the critical care unit, but only recorded at intermittent time intervals in the patient health record. Low frequency data collection may not accurately reflect the variability and complexity of these signals or the patient’s clinical state. We aimed to characterize how increasing the temporal window size of observation from seconds to hours modifies the measured variability and complexity of basic vital signs.

Design:
Retrospective analysis of signal data acquired between April 1, 2013, and September 30, 2015.

Setting:
Critical care unit at The Hospital for Sick Children, Toronto.

Patients:
Seven hundred forty-seven patients less than or equal to 18 years old (63,814,869 data values), within seven diagnostic/surgical groups.

Interventions:
None.

Measurements and Main Results:
Measures of variability (sd and the absolute differences) and signal complexity (multiscale sample entropy and detrended fluctuation analysis [expressed as the scaling component α]) were calculated for systolic blood pressure, heart rate, and oxygen saturation. The variability of all vital signs increases as the window size increases from seconds to hours at the patient and diagnostic/surgical group level. Significant differences in the magnitude of variability for all time scales within and between groups was demonstrated (p < 0.0001). Variability correlated negatively with patient age for heart rate and oxygen saturation, but positively with systolic blood pressure. Changes in variability and complexity of heart rate and systolic blood pressure from time of admission to discharge were found.

Conclusions:
In critically ill children, the temporal variability of physiologic signals supports higher frequency data capture, and this variability should be accounted for in models of patient state estimation.
Nonenhancing Component of Clear Cell Renal Cell Carcinoma on Computed Tomography Correlates With Tumor Necrosis and Stage and Serves as a Size-Independent Prognostic Biomarker
Authors: Ahmed Firas S. , Akin Oguz , Shaish Hiram , Luk Lyndon , Guo Xiaotao , Yang Hao , Zabor Emily , Ostrovnaya Irina , Hakimi A. Ari , Zhao Binsheng , Schwartz Lawrence H. 
Published: June 2019

Objectives
This study aimed to quantify nonenhancing tumor (NT) component in clear cell renal cell carcinoma (ccRCC) and assess its association with histologically defined tumor necrosis, stage, and survival outcomes.

Methods
Among 183 patients with ccRCC, multi-institutional changes in computed tomography attenuation of tumor voxels were used to quantify percent of NT. Associations of NT with histologic tumor necrosis and tumor stage/grade were tested using Wilcoxon signed rank test and with survival outcomes using Kaplan-Meier curves/Cox regression analysis.

Results
Nonenhancing tumor was higher in ccRCC with tumor necrosis (11% vs 7%; P = 0.040) and higher pathological stage (P = 0.042 and P < 0.001, respectively). Patients with greater NT had higher incidence of cancer recurrence after resection (P < 0.001) and cancer-specific mortality (P < 0.001).

Conclusion
Nonenhancing tumor on preoperative computed tomographic scans in patients with ccRCC correlates with tumor necrosis and stage and may serve as an independent imaging prognostic biomarker for cancer recurrence and cancer-specific survival.
Usefulness of Diffusion-Weighted Magnetic Resonance Imaging Using Apparent Diffusion Coefficient Values for Diagnosis of Infantile Hemangioma
Authors: Saito Mioko , Kitami Masahiro , Takase Kei 
Published: June 2019

Objective
The objective of this study was to determine whether apparent diffusion coefficient (ADC) values obtained from diffusion-weighted imaging allow differentiation between infantile hemangiomas (IHs) and malignant soft tissue tumors.

Methods
A retrospective review was performed on magnetic resonance images of pediatric patients with IHs and malignant soft tissue tumors from January 2014 to December 2016, which comprised 7 patients with 8 IHs and 6 patients with 6 malignant soft tissue tumors. We calculated and compared the ADC values of each lesion. Receiver operating characteristic curve analysis was performed to determine a cutoff value for the ADC.

Results
There was a statistically significant difference between the ADC values of IHs and those of malignant soft tissue tumors (1.32 [1.27–1.72] × 10−3 mm2/s vs 0.67 [0.57–0.79] × 10−3 mm2/s; P < 0.001), with no overlap between the 2 groups.

Conclusions
The ADC values obtained from diffusion-weighted imaging were useful in differentiating IHs from malignant soft tissue tumors in pediatric patients.
Incidental Detection of Adenocarcinoma in the Neck of the Pancreas by FDG PET Imaging When a Cystic Lesion in the Body of Pancreas Was Evaluated
Authors: Xing Haiqun , Hu Ya , Hou Bo , Huo Li , Zhao Yupei 
Published: June 2019

Abstract
FDG PET/CT and PET/MRI were performed to evaluate a cystic lesion in the body of the pancreas in a 65-year-old man. Neither studies showed abnormally increased activity in the cystic lesion in the body of the pancreas. However, both studies revealed abnormal activity in the neck of the pancreas, which did not show anatomical abnormality and was not suspected prior to the PET imaging. Pathological examination demonstrated that the lesion in the body of the pancreas was a benign duct dilation, whereas the abnormal FDG activity in the neck of the pancreas was due to pancreatic adenocarcinoma.
Ankylosis of the Temporomandibular Joint in Pediatric Patients
Authors: Rozanski Collin , Wood Kasey , Sanati-Mehrizy Paymon , Xu Hope , Taub Peter J. 
Published: June 2019

Introduction:
While surgical interventions for temporomandibular joint (TMJ) ankylosis are well-documented, there is lack of consensus regarding the ideal approach in pediatric patients. Surgical interventions include gap arthroplasty, interpositional arthroplasty, or total joint reconstruction.

Methods:
A systematic review of PubMed (Jan 1, 1990–Jan 1, 2017) and Scopus (Jan 1, 1990–Jan 1, 2017) was performed and included studies in English with at least one patient under the age of 18 diagnosed with TMJ ankylosis who underwent surgical correction. Primary outcomes of interest included surgical modality, preoperative maximum interincisal opening (MIO) (MIOpreop), postoperative MIO (MIOpostop), ΔMIO (ΔMIO = MIOpostop – MIOpreop), and complications.

Results:
Twenty-four case series/reports with 176 patients and 227 joints were included. By independent sample t tests MIOpostop (mm) was greater for gap arthroplasty (30.18) compared to reconstruction (27.47) (t = 4.9, P = 0.043), interpositional arthroplasty (32.87) compared to reconstruction (t = 3.25, P = 0.002), but not for gap compared to interpositional (t = −1.9, P = 0.054). ΔMIO (mm) was greater for gap arthroplasty (28.67) compared to reconstruction (22.24) (t = 4.2, P = 0.001), interpositional arthroplasty (28.33) compared to reconstruction (t = 3.27, P = 0.002), but not for interpositional compared to gap (t = 0.29, P = 0.33). Weighted-average follow-up time was 28.37 months (N = 164). 4 of 176 (2.27%) patients reported development of re-ankylosis. There was no significant difference in occurrence of re-ankylosis between interventions.

Conclusions:
Given the technical ease of gap arthroplasty and nonsignificant differences in ΔMIO, MIOpostop, or occurrence of re-ankylosis between gap and interpositional arthroplasty, gap arthroplasty should be considered for primary ankylosis repair in pediatric patients, with emphasis on postoperative physiotherapy to prevent recurrent-ankylosis.
High-Sensitivity Troponin T Predicts Postoperative Cardiogenic Shock Requiring Mechanical Circulatory Support in Patients With Valve Disease
Authors: Duchnowski Piotr , Hryniewiecki Tomasz , Kuśmierczyk Mariusz , Szymański Piotr 
Published: June 2019

ABSTRACT

Background:
Cardiogenic shock is a very serious postoperative complication in patients undergoing heart valve surgery. Mechanical circulatory support is a recognized method of treating patients with this complication. The aim of the presented study was to assess the usefulness of selected biomarkers in predicting the occurrence of postoperative cardiogenic shock requiring mechanical circulatory support.

Methods:
This prospective study was conducted on a group of 712 patients undergoing heart valve surgery. The primary end-point at the intrahospital follow-up was postoperative cardiogenic shock requiring mechanical circulatory support.

Results:
The postoperative cardiogenic shock requiring mechanical circulatory support occurred in 20 patients. At multivariate analysis high-sensitivity Troponin T measured immediately after surgery (OR 1.006; 95% CI 1.002–1.013; P 0.009) remained independent predictor of the primary end point.

Conclusions:
The postoperative hs-TnT can be used to predict a postoperative cardiogenic shock requiring mechanical circulatory support.
Can Surgeons Identify Appendicitis Macroscopically? Results From a Multicentre Prospective Study
Authors: Thong Da Wei , Crouch Stephen , Morgan Samuel , Arthur Thomas 
Published: June 2019

Purpose:
The primary outcome was to investigate the accuracy of intraoperative macroscopic diagnosis by the operating surgeon with the results of the subsequent histopathologic examination. The secondary outcome was to identify the predictors of discrepancies between these 2 groups.

Materials and Methods:
A multicentre, prospective, observational study was conducted over a period of 2 months with a 30-day follow-up period. Patients who underwent surgery with the intention of appendicectomy were recruited in the study.

Results:
A total of 1169 patients were recruited. False negatives (FNs) were defined as a normal macroscopic diagnosis but histopathologically appendicitis, whereas false positive otherwise. Overall, FN rates were 22.4%, whereas false positive rates were 8.2%. The seniority of the operating surgeons did not affect the ability to accurately diagnose appendicitis macroscopically (P=0.069). However, consultant surgeons had the lowest FN rate of 15.6%. Females and preoperative ultrasound scan increased odds of FN, whereas preoperative computed tomography decreased the odds of FN appendicectomy.

Conclusion:
Macroscopic identification intraoperatively is inaccurate with a FN rate of 22%.
Removal of retrievable inferior vena cava filters before discharge: Is it associated with increased incidence of pulmonary embolism?
Authors: Robbins Justin M. , Garwe Tabitha , McCarthy Cullen K. , Sarwar Zoona , Gonzalez Robert A. , Zander Tyler L. , Jalla Aditi N. , Conner Keri S. , Stewart Kenneth E. , Albrecht Roxie M. 
Published: June 2019

BACKGROUND
Severely injured trauma patients are at high risk of developing deep venous thrombosis and pulmonary emboli (PE), and may have contraindications to prophylactic or therapeutic anticoagulation. Retrievable inferior vena cava filters (rIVCFs) are used to act as a mechanical obstruction to prevent PE in high risk populations and those with deep venous thrombosis who cannot be anticoagulated. The removal rate of rIVCFs is variable in trauma centers, including our previous published rate of 50% to 89%/year. Indwelling filters carry a risk of significant morbidity and the success of retrieval decreases as the dwell time increases. We hypothesized that once patients could receive appropriate prophylactic or therapeutic anticoagulation, rIVCF could be removed before hospital discharge without impact on occurrence or recurrence of PE.

METHODS
All trauma patients with rIVCF placed and removed between January 2006 and August 2018 were reviewed. We collected data from record review from admission to 6 months postfilter removal, including demographics, filter indication, filter type, dwell time, placement and removal complications, antithrombosis medications, location of venous thromboembolism, complications, and discharge disposition. Exposure of interest was timing of filter removal: before (BEF) or after hospital discharge (AFT). The outcome of interest was whether the patient had a documented PE within 6 months of filter removal.

RESULTS
A total of 281 rIVCFs were placed, 218 were eligible for removal, 72.4% (158/218) were retrieved with 63% (100/158) removed before discharge. Mean filter duration was 26 days and 103 days for the before and after groups, respectively. No differences (p > 0.05) were noted in the distribution of demographic and clinical factors except for filter indication (venous thromboembolism indication, 95% in AFT vs. 74% in BEF, p = 0.0043). Postremoval PE rates were 0% BEF and 1% AFT (Fisher's exact test, p = 1.000).

CONCLUSION
Our results suggest that removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates.

LEVEL OF EVIDENCE
Therapeutic, level V.
Single-lateral cervical radiograph in pediatric trauma is equivalent to multiple views
Authors: Lindholm Erika B. , Malik Archana , Parikh Darshan , Mamdouhi Tara , Alper Lauren , Nanassy Autumn , Ciullo Sean , Arthur L. Grier , Prasad Rajeev , Herman Martin , Grewal Harsh 
Published: June 2019

BACKGROUND
Cervical spine injuries (CSI) are rare within the pediatric population. Due to the significant consequences of missed CSI, children are often imaged excessively. In an attempt to decrease imaging of the cervical spine in children, we reviewed abnormal cervical radiographs (XR) to determine if the diagnosis of CSI could be made using a single-lateral cervical radiograph (LAT). Furthermore, we reviewed cervical computed tomography (CT) and magnetic resonance imaging (MRI) to ensure there were no missed CSI.

METHODS
Electronic medical records of trauma patients treated at a Level I Pediatric Trauma Center with abnormal XR findings followed by confirmatory CT or MRI between 2012 and 2017 were reviewed. All abnormal imaging on XR was compared with the LAT. In addition, all abnormal CTs and MRIs were reviewed to ensure there were no false negative XR.

RESULTS
A total of 3,735 XR were performed with 26 abnormal interpretations. All bony CSI were visualized on LAT. Confirmatory imaging found 13 (50%) were false positive and 13 (50%) were true positive. Secondary analysis of CT identified 12 injuries with prior XR; 8 of 12 LAT identifying the injury and 4 of 12 false positive on CT. Secondary analysis of MRI identified nine injuries with prior XR; 5 of 9 LAT identifying the injury. The four false-negative reads on MRI were ligamentous injuries.

CONCLUSION
Radiographs are commonly performed when evaluating CSI. In our population, initial assessment with a single LAT was equivalent to a multiple view XR. On secondary review, the only false-negative LAT reports were due to ligamentous injuries. This data suggests limiting exposure to LAT would accomplish the goal of reducing imaging without missing bony CSI and when ligamentous injury is suspected MRI should be the confirmatory study rather than CT.

LEVEL OF EVIDENCE
Diagnostic Test, level III.
Effect of mass shootings on gun sales—A 20-year perspective
Authors: Callcut Rachael A. , Robles Anamaria M. , Kornblith Lucy Z. , Plevin Rebecca E. , Mell Matthew W. 
Published: June 2019

BACKGROUND
Granular data on gun sales has been historically difficult to obtain. In 2016, California (CA) made monthly data from 1996 to 2015 publically available. Control charts are a method to analyze how a process changes over time in response to nonroutine events. We utilized this technique to study the impact of US mass shootings on CA gun sales.

METHODS
Monthly gun sales were provided by the CA Department of Justice and monthly fatalities from the CDC Wonder Death Certificate Registry. Mass shooting events were obtained from after-action reports, news media, and court proceedings. Time-ordered data were analyzed with control charts with 95% confidence intervals (upper control limit, lower control limit) using QiMacros.

RESULTS
Individual gun sales of 9,917,811 occurred in CA with a median monthly rate of 41,324 (range, 20,057–132,903). A median of 263 people lost their lives monthly from firearms (124 homicides, 128 suicides), totaling 53,975 fatalities from 1999 to 2015. Fifteen of 21 current deadliest mass shootings occurred during this study period with 40% from 2012 to 2015. Also, 36 school shootings occurred during the study (mean, 5 deaths; range, 0–33; 6 injuries; range, 0–23) with 31% in 2012 to 2015 at rate of 3 events/year versus 1.4 events/year in the 17 prior years (p < 0.05). Sales were generally consistent from 1996 to 2011 (except post-Columbine, Col). Starting in 2011, sales exceeded the 95% predicted upper control limit every single month. Before October 2011, there was no statistically significant sustained effect of mass shootings on sales (except Col); however, since a statistically significant proportional spike in sales occurred in the months immediately following every single deadliest mass shooting event. Every year since 2012, CA has strengthened gun laws in response to mass shootings yet sales have risen immediately preceding enactment of these laws each January.

CONCLUSION
Gun sales are more frequent since 2012, with an additional increase following both mass shootings and legislative changes enacted in response to these shootings.

LEVEL OF EVIDENCE
Epidemiology, level III.