bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Routine Colonic Biopsies in Pediatric Colonoscopic Polypectomy for Benign Juvenile Hamartomatous Polyps
Authors: Malandra Michael , Kaur Sunpreet , Chogle Ashish 
Published: June 2016

ABSTRACTIntroduction:Benign juvenile hamartomatous polyps are common in pediatric gastrointestinal practice. We hypothesize that in the absence of gross mucosal abnormalities, the likelihood of histologic abnormalities from routine random colonic biopsies is low.Methods:We performed a retrospective chart review identifying patients ages 1 to 18 years who underwent complete colonoscopy and polypectomy for suspected colorectal polyps from January 1, 2004 to July 1, 2014. Indication, age, number of polyps, gross and histologic findings, and any management changes resulting from endoscopy were recorded. Exclusion criteria included history of polyposis syndrome, >5 polyps on colonoscopy, inflammatory bowel disease, and incomplete documentation. Practice patterns were assessed by online survey distributed via Pediatric Gastroenterology listserv.Results:A total of 141 patients underwent colonoscopy with anticipated polypectomy. Seventy‐two (63% male) were included. Mean age was 6.5 years. Indication was hematochezia in 71. Findings other than polyps were found in 7 (10%). Juvenile hamartomatous polyps were documented by histologic examination in 68 patients (94%). Routine colonic biopsies were performed in 55 patients (76%). In 8 (15%), histologic abnormalities were seen that did not result in management changes. Seventy‐three providers responded to the online survey; 56% reported not taking ileocolonic biopsies in the absence of other mucosal abnormalities; 45% routinely biopsied from the terminal ileum and/or colon. None would biopsy the terminal ileum only.Conclusions:In children with benign juvenile hamartomatous polyps, routine colonic biopsies are not required in the absence of mucosal abnormalities. Overuse of pathology services, increased procedural time, risk, and cost can be avoided.
Symptoms and Mucosal Changes Stable During Rapid Increase of Pediatric Celiac Disease in Norway
Authors: Beitnes Ann‐Christin R. , Vikskjold Florin B. , Jóhannesdóttir Gróa B. , Perminow Gøri , Olbjørn Christine , Andersen Solveig N. , Bentsen Beint S. , Rugtveit Jarle , Størdal Ketil 
Published: June 2016

ABSTRACTObjectives:We aimed to study whether the incidence of pediatric celiac disease (CD) in South‐Eastern Norway changed from 2000 to 2010. We also examined whether there was a change in symptoms and histopathological morphology in the duodenal biopsies during the same period.Methods:In 3 hospitals in South‐Eastern Norway, records from pediatric patients (0–14.9 years) diagnosed with CD during two 3‐year periods (2000–2002 and 2008–2010) were reviewed. Only cases with a duodenal biopsy diagnosis of CD classified as Marsh grade 2 and 3a−c were included. Frequencies of symptoms, anthropometric data, and laboratory results were compared, in addition to re‐examinations of histological sections from one of the hospitals.Results:A total of 400 cases were diagnosed with a female to male ratio of 1.5:1. The incidence rate for 2000 to 2002 was 15.9 cases per 100,000 person‐years (95% confidence interval 12.8–19.4), compared with 45.5 cases per 100,000 person‐years during 2008 to 2010 (95% confidence interval 40.5–50.9), P < 0.001. The relative frequencies of symptoms and the distribution of histopathological changes were similar in the 2 periods, whereas weight z scores and hemoglobin levels were significantly lower in the first period.Conclusions:We found a 3‐fold increase in the incidence rate for CD in the Norwegian pediatric population during the decade 2000 to 2010. Slightly higher weight and hemoglobin levels at diagnosis in the latter period may be due to improved CD awareness. Unaltered relative frequencies of symptoms and histopathological changes in the gut, however, suggest a true increase of CD in Norwegian children.
Subcortical DNET in a Patient With an Enzymatic Deficiency: A Rare Case and Review of the Literature
Authors: Infinger Libby K. , Karia Samir R. , Kinsman Stephen L. , Kosnik Edward J. , Welsh Cynthia T. , Roberts Donna R. , Bredlau Amy-Lee 
Published: June 2016

Purpose:
This case report describes a toddler with a medical history of biotinidase deficiency who presented with atypical seizures due to a brain tumor.

Methods:
This is a case report.

Results:
Electroencephalogram revealed a frontal lobe mass, with magnetic resonance imaging confirmation of a mass extending from the frontal lobe into the genu and anterior corpus callosum. She underwent a near-total resection, and pathology identified a dysembryoplastic neuroepithelial tumor. The patient is now seizure free and clinically doing well.

Conclusions:
Children with biotinidase deficiency and atypical seizures should receive a full electroencephalogram evaluation, as brain tumors continue to be on the differential for seizures in this patient population.
Clinicoepidemiological Profile and Outcome of Children With Wilms Tumor in a Developing Country
Authors: Verma Nishant , Kumar Archana 
Published: June 2016

Background:
Outcome of children with Wilms tumor (WT) has improved remarkably because of the advancements in Pediatric Oncology. However, in most developing countries survival rates are still poor. There is a paucity of data regarding the clinical profile and outcome of children with WT in India.

Methods:
Children with WT who were treated at our center between 2005 and 2014 were retrospectively analyzed.

Results:
Over the 10-year study period, 108 children with WT were treated in our unit. The median age at presentation was 30 months (male:female ratio of 4:1). Abdominal mass was the most common presenting feature (91%). The majority of children had stage 2 (30%) or stage 3 (35%) disease. Fifty-nine children had large or bilateral tumors requiring preoperative chemotherapy. Of the total 108 children, 11 died during primary treatment and 14 relapsed after completion of treatment. The projected 5-year overall survival is 74%, whereas the event-free survival is 73%.

Conclusions:
Children with WT in our setting present late with advanced disease and large tumors, which are technically difficult to deliver at surgery. With a multidisciplinary approach, reasonably good survival rates were achieved even in the resource-limited Indian scenario.
Care Coordination Challenges Among High-Needs, High-Costs Older Adults in a Medigap Plan
Authors: Wells Timothy S. , Bhattarai Gandhi R. , Hawkins Kevin , Cheng Yan , Ruiz Joann , Barnowski Cynthia A. , Spivack Barney , Yeh Charlotte S. 
Published: June 2016

Purpose of the Study:
Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges.

Primary Practice Setting:
Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York).

Methodology and Sample:
The three groups included the highest needs, highest costs (the “highest group”), the high needs, high costs (the “high group”), and the “all other group.” Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes.

Results:
The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures. On average, the highest group had $102,798 in yearly health care expenditures, compared with $34,610 and $7,634 for the high and all other groups, respectively. Fifty-seven percent of the highest group saw 16 or more different providers annually, compared with 21% and 2% of the high and all other groups, respectively. Finally, 28% of the highest group had prescriptions from at least seven different providers, compared with 20% and 5% of the high and all other groups, respectively.

Implications for Case Management Practice:
Individuals with high health care needs and costs have visits to numerous health care providers and receive multiple prescriptions for pharmacotherapy. As a result, these individuals can become overwhelmed trying to manage and coordinate their health care needs. Care coordination programs may help these individuals coordinate their care.
Mechanically Isolated Stromal Vascular Fraction Provides a Valid and Useful Collagenase-Free Alternative Technique: A Comparative Study
Authors: Chaput Benoit , Bertheuil Nicolas , Escubes Marina , Grolleau Jean-Louis , Garrido Ignacio , Laloze Jérôme , Espagnolle Nicolas , Casteilla Louis , Sensebé Luc , Varin Audrey 
Published: June 2016

Background:
The use of stromal vascular fraction and adipose-derived stromal cells in tissue regeneration is now being increasingly investigated, and studies have demonstrated that adipose-derived stromal cells present differentiation and immunomodulatory capacities. The development of a rapid, inexpensive, and enzyme-free technique to isolate adipose-derived stromal cell–enriched stromal vascular fraction is a major goal for stem cell therapy. Therefore, the authors compared innovative mechanical procedures to the gold standard technique, collagenase digestion.

Methods:
Stromal vascular fraction was prepared from 21 liposuctions using either enzymatic digestion or two different mechanical methods: high vortexing/centrifugation and dissociation by intersyringe processing. The effects of tissue processing on cell count, viability, proliferation, clonogenic enrichment, and the phenotypes of the different native cell were determined. Adipose-derived stromal cell phenotypes from the different protocols, and their differentiation and immunosuppressive potential, were compared.

Results:
Enzymatic digestion isolated more viable cells than dissociation by intersyringe processing and vortexing/centrifugation. The expansion rate and clonogenic enrichment were higher for stromal vascular fraction isolated with collagenase. The proportion of adipose-derived stromal cells was higher in stromal vascular fraction extracted with dissociation than with enzymatic digestion and vortexing/centrifugation (p < 0.01). Interestingly, all cultured adipose-derived stromal cells displayed similar differentiation and immunosuppressive capacities.

Conclusions:
Enzymatic digestion extracts more adipose-derived stromal cells, but intersyringe dissociation enables the rapid extraction of adipose-derived stromal cell–enriched stromal vascular fraction. Moreover, mechanical methods enable adipose-derived stromal cell isolation with stemness and immunosuppressive properties, similar to enzymatic digestion. Such mechanical procedures could allow easier and more rapid isolation of adipose-derived stromal cell–enriched stromal vascular fraction for practitioners.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Long-Term Results of a One-Stage Secondary Debulking Procedure after Flap Reconstruction of the Foot
Authors: Lin Tsan-Shiun , Quing Richard 
Published: June 2016

Background:
Free or local flaps that are used to reconstruct the foot are often associated with a multitude of problems, most with regard to poor aesthetic and functional outcomes. This is because of the bulkiness of the flap and its difference from the native glabrous skin of the weight-bearing region of the foot. Although these can be improved using various debulking procedures, the results are not satisfactory.

Methods:
From January of 2002 to July of 2014, one-stage debulking procedures were performed for 42 feet after flap reconstructions. Twelve patients (28.6 percent) had bulky flaps over the weight-bearing area of the foot compared with 30 (71.4 percent) on the non–weight-bearing area. The functional and cosmetic outcomes were reviewed after 12-month follow-up.

Results:
The overall mean follow-up time was 20 months. All the grafted skin took well, except for partial superficial skin necrosis, which healed by secondary intention, and one skin loss that needed further skin grafting. The patients were able to dress in their preinjury shoes without any difficulty and with ease of ambulation because of improvement in skin stability. The skin sensation and texture of the reconstructed feet matched the normal sides well. No long-term ulceration was noted. All of the patients were satisfied with the results.

Conclusion:
A one-stage debulking procedure can provide long-term constant, reliable, thin skin coverage for the feet after free flap or local flap reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Cancer Care Index: A Novel Metric to Assess Overall Performance of a Pediatric Oncology Program
Authors: Olshefski Randal , Vaughan Michele , YoungSaleme Tammi , Barr Daniel , Frost Randall , Nuss Kathryn E. , Wheeler T. Arthur , Brady Michael , Davis John Terrance , Bibart Mindy , Cripe Timothy , Brilli Richard J. 
Published: June 2016

Objective
Childhood cancer metrics are currently primarily focused on survival rates and late effects of therapy. Our objectives were to design and test a metric that reflected overall quality and safety performance, across all cancer types, of an oncology–bone marrow transplant service line and to use the metric to drive improvement.

Method
The Cancer Care Index (CCI) aggregates adverse safety events and missed opportunities for best practices into a composite score that reflects overall program performance without regard to cancer type or patient outcome. Fifteen domains were selected in 3 areas as follows: (1) treatment-related quality and safety, (2) provision of a harm-free environment, and (3) psychosocial support. The CCI is the aggregate number of adverse events or missed opportunities to provide quality care in a given time frame. A lower CCI reflects better care and improved overall system performance. Multidisciplinary microsystem-based teams addressed specific aims for each domain. The CCI was widely followed by all team members, particularly frontline providers.

Results
The CCI was easy to calculate and deploy and well accepted by the staff. The annual CCI progressively decreased from 278 in 2012 to 160 in 2014, a 42% reduction. Improvements in care were realized across most index domains. Multiple new initiatives were successfully implemented.

Conclusions
The CCI is a useful metric to document performance improvement across a broad range of domains, regardless of cancer type. By the use of quality improvement science, progressive reduction in CCI has occurred over a 3-year period.
Antiviral resistance in herpes simplex virus and varicella-zoster virus infections: diagnosis and management
Authors: Piret Jocelyne , Boivin Guy 
Published: June 2016

Purpose of review
Aciclovir (ACV) is the first-line drug for the management of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections. Long-term administration of ACV for the treatment of severe infections in immunocompromised patients can lead to the development of drug resistance. Furthermore, the emergence of isolates resistant to ACV is increasingly recognized in immunocompetent individuals with herpetic keratitis. This review describes the mechanisms involved in drug resistance for HSV and VZV, the laboratory diagnosis and management of patients with infections refractory to ACV therapy.

Recent findings
Genotypic testing is more frequently performed for the diagnosis of infections caused by drug-resistant HSV or VZV isolates. Molecular biology-based systems for the generation of recombinant viruses have been developed to link unknown mutations with their drug phenotypes. Fast and sensitive methods based on next-generation sequencing will improve the detection of heterogeneous viral populations of drug-resistant viruses and their temporal changes during antiviral therapy, which could allow better patient management. Novel promising compounds acting on targets that differ from the viral DNA polymerase are under clinical development.

Summary
Antiviral drug resistance monitoring for HSV and VZV is required for a rational use of antiviral therapy in high-risk populations.
Impact of Impaired Renal Function on Gadolinium Retention After Administration of Gadolinium-Based Contrast Agents in a Mouse Model
Authors: Kartamihardja A. Adhipatria P. , Nakajima Takahito , Kameo Satomi , Koyama Hiroshi , Tsushima Yoshito 
Published: June 2016

Objectives
The aim of this study was to investigate the impact of impaired renal function on gadolinium (Gd) retention in various organs after Gd-based contrast agent injection.

Materials and Methods
After local animal care and review committee approval, 23 normal mice and 26 with renal failure were divided into 4 treatment groups (Gd-DTPA-BMA, 5 mmol/kg; Gd-DOTA, 5 mmol/kg; GdCl3, 0.02 mmol/kg; and saline, 250 μL). Each agent was intravenously administered on weekdays for 4 weeks. Samples were collected on days 3 (short-term) and 45 (long-term) after the last injection. Gadolinium concentrations were quantified by inductively coupled plasma-mass spectrometry.

Results
Three mice with renal failure and 2 normal mice in the GdCl3 group and 1 mouse with renal failure in the Gd-DTPA-BMA group died. In the Gd-DTPA-BMA group, impaired renal function increased short-term Gd retention in the liver, bone, spleen, skin, and kidney (P < 0.01) but did not affect long-term Gd retention. Gd-DTPA-BMA showed higher Gd retention than Gd-DOTA. Although Gd retention in the Gd-DOTA group was generally low, impaired renal function increased only long-term hepatic Gd retention. Hepatic and splenic Gd retentions were significantly higher than other organs' Gd retention in the GdCl3 group (P < 0.01). Renal function did not affect brain Gd retention, regardless of the Gd compound used.

Conclusions
The tendency of Gd retention varied according to the agent, regardless of renal function. Although renal impairment increased short-term Gd retention after Gd-DTPA-BMA administration, long-term Gd retention for Gd-based contrast agents was almost unaffected by renal function, suggesting that the chemical structures of retained Gd may not be consistent and some Gd is slowly eliminated after initially being retained.
Cationic liposome–nucleic acid nanoparticle assemblies with applications in gene delivery and gene silencing
Authors: Majzoub Ramsey N. , Ewert Kai K. , Safinya Cyrus R. 
Published: June 2016

Cationic liposomes (CLs) are synthetic carriers of nucleic acids in gene delivery and gene silencing therapeutics. The introduction will describe the structures of distinct liquid crystalline phases of CL–nucleic acid complexes, which were revealed in earlier synchrotron small-angle X-ray scattering experiments. When mixed with plasmid DNA, CLs containing lipids with distinct shapes spontaneously undergo topological transitions into self-assembled lamellar, inverse hexagonal, and hexagonal CL–DNA phases. CLs containing cubic phase lipids are observed to readily mix with short interfering RNA (siRNA) molecules creating double gyroid CL–siRNA phases for gene silencing. Custom synthesis of multivalent lipids and a range of novel polyethylene glycol (PEG)-lipids with attached targeting ligands and hydrolysable moieties have led to functionalized equilibrium nanoparticles (NPs) optimized for cell targeting, uptake or endosomal escape. Very recent experiments are described with surface-functionalized PEGylated CL–DNA NPs, including fluorescence microscopy colocalization with members of the Rab family of GTPases, which directly reveal interactions with cell membranes and NP pathways.In vitrooptimization of CL–DNA and CL–siRNA NPs with relevant primary cancer cells is expected to impact nucleic acid therapeuticsin vivo.This article is part of the themed issue ‘Soft interfacial materials: from fundamentals to formulation’.
Lipid self-assembled structures for reactivity control in food
Authors: Sagalowicz L. , Moccand C. , Davidek T. , Ghanbari R. , Martiel I. , Negrini R. , Mezzenga R. , Leser M. E. , Blank I. , Michel M. 
Published: June 2016

Lipid self-assembled structures (SASs) have recently gained considerable interest for their potential applications, especially for sustained nutrient release and protein crystallization. An additional property, which is underexploited, is their ability to control chemical reactions in food products. Here, we concentrate on SASs formed by phospholipids (PLs) and monoglycerides (MGs), those compounds being the most natural surfactants and therefore, the best compatible with food products, in view of providing new functionalities through the formation of SASs. In this work, the phase behaviour of these amphiphiles when mixed with oil and water is described and compared. Subsequently, we address the influence of these structures to the oxidation and Maillard-type reactions. Finally, we show that SASs formed by MGs can strongly increase the yield of key aroma impact compounds generated by Maillard-type reactions when compared with the reaction performed in aqueous precursor solutions. Various SASs are compared. In particular, addition of oil to a reversed bicontinuous structure formed by MG leads to a reversed microemulsion, which, considering its low viscosity, is particularly suitable for food products and act as a very efficient reactor system. The influence of oil and precursors on phase behaviour is discussed and related to the efficiency of the Maillard reactions.
This article is part of the themed issue ‘Soft interfacial materials: from fundamentals to formulation’.
Physical basis of some membrane shaping mechanisms
Authors: Simunovic Mijo , Prévost Coline , Callan-Jones Andrew , Bassereau Patricia 
Published: June 2016

In vesicular transport pathways, membrane proteins and lipids are internalized, externalized or transported within cells, not by bulk diffusion of single molecules, but embedded in the membrane of small vesicles or thin tubules. The formation of these ‘transport carriers’ follows sequential events: membrane bending, fission from the donor compartment, transport and eventually fusion with the acceptor membrane. A similar sequence is involved during the internalization of drug or gene carriers inside cells. These membrane-shaping events are generally mediated by proteins binding to membranes. The mechanisms behind these biological processes are actively studied both in the context of cell biology and biophysics. Bin/amphiphysin/Rvs (BAR) domain proteins are ideally suited for illustrating how simple soft matter principles can account for membrane deformation by proteins. We review here some experimental methods and corresponding theoretical models to measure how these proteins affect the mechanics and the shape of membranes. In more detail, we show how an experimental method employing optical tweezers to pull a tube from a giant vesicle may give important quantitative insights into the mechanism by which proteins sense and generate membrane curvature and the mechanism of membrane scission.
This article is part of the themed issue ‘Soft interfacial materials: from fundamentals to formulation’.