bluuebunny/crossref_metadata_2025_split huggingface dataset:
Autoimmune hepatitis and long-term disease course in children in Turkey, a single-center experience
Authors: Karakoyun Miray , Ecevit Cigdem O. , Kilicoglu Erhan , Aydogdu Sema , Yagci Rasit V. , Ozgenc Funda 
Published: June 2016

Introduction
The aim of this study is to determine clinic and laboratory features, treatment protocols, treatment responses, and long term follow-up of children with autoimmune hepatitis (AIH) in a region of Turkey followed at Ege University.

Materials and methods
The records of 47 children with AIH between 1998 and 2012 were retrospectively analyzed for clinical profiles, treatment response, relapse rate, and long-term side effects.

Results
The median age of the children was 10±4.1 years (55.3% females). A total of 29 patients presented with chronic hepatitis (61.7%). According to the autoantibody profiles, 40 (85.1%) and seven (14.9%) cases were classified as type 1 and type 2, respectively. Presentation with acute hepatitis and chronic hepatitis was significantly higher in type 1 disease. Laboratory findings at presentation was found similar among races as well as AIH types (P>0.05). The prednisolone was used for remission induction in 37 patients; 86.4% (n: 32) achieved a complete response, 2.7% (n: 1) achieved a partial response, and four patients (10.8%) showed no response. Maintenance was attained by low-dose steroid plus thiopurine and relapse in steroid responders (n: 32) was 9.4% (n: 3) at 8, 12, and 48 months. A total of 36% (n: 24) had neither acute nor chronic treatment side effects. Bone marrow suppression was observed in five patients and hyperglycemia was observed in one patient (10.6 and 2.1%), respectively.

Conclusion
AIH type 1 prevails in children in a region of Turkey during the second decade of life. Low-dose corticosteroids combined with azathioprine are found.
Safety of Bifidobacterium animalis Subsp. Lactis (B. lactis) Strain BB‐12‐Supplemented Yogurt in Healthy Children
Authors: Tan Tina P. , Ba Zhaoyong , Sanders Mary E. , D'Amico Frank J. , Roberts Robert F. , Smith Keisha H. , Merenstein Daniel J. 
Published: June 2016

ABSTRACTObjectives:Probiotics are live microorganisms that may provide health benefits to the individual when consumed in sufficient quantities. For studies conducted on health or disease endpoints on probiotics in the United States, the Food and Administration has required those studies to be conducted as investigational new drugs. This phase I, double‐blinded, randomized, controlled safety study represents the first requirement of this pathway. The purpose of the study was to determine the safety of Bifidobacterium animalis subsp. lactis (B lactis) strain BB‐12 (BB‐12)‐supplemented yogurt when consumed by a generally healthy group of children. The secondary aim was to assess the effect of BB‐12‐supplemented yogurt on the gut microbiota of the children.Methods:Sixty children ages 1 to 5 years were randomly assigned to consume 4 ounces of either BB‐12‐supplemented yogurt or nonsupplemented control yogurt daily for 10 days. The primary outcome was to assess safety and tolerability, as determined by the number of reported adverse events.Results:A total of 186 nonserious adverse events were reported, with no significant differences between the control and BB‐12 groups. No significant changes due to probiotic treatment were observed in the gut microbiota of the study cohort.Conclusions:BB‐12‐supplemented yogurt is safe and well‐tolerated when consumed by healthy children. The present study will form the basis for future randomized clinical trials investigating the potential effects of BB‐12‐supplemented yogurt in different disease states.
Assessment of the Family History of Patients With Ulcerative Colitis at a Single Center in Japan
Authors: Fujii Tohru , Sato Masamichi , Hosoi Kenji , Ohbayashi Naho , Ikuse Tamaki , Jimbo Keisuke , Aoyagi Yo , Kudo Takahiro , Ohtsuka Yoshikazu , Shimizu Toshiaki 
Published: June 2016

ABSTRACTObjectives:The prevalence of ulcerative colitis (UC) differs by country, which is likely due to differences in genetic factors among ethnicities. Moreover, the prevalence of pediatric UC with a family history (FH) is 4.1% in Japanese patients; its clinical course begins at an early age and is more severe. Recently, a genome‐wide association study identified 3 new susceptibility loci for adult Japanese patients with UC.Methods:To assess the effects of FH in patients with UC, 60 children were enrolled. Age at diagnosis, clinical features of the initial symptoms, and family structure were assessed in patients with and without an FH. The 3 new loci were examined in patients who provided informed consent.Results:Of the patients with UC, 10 (16.7%) had an FH involving first‐degree relatives, including 7 mothers, 1 father, and 2 sisters. There was a trend toward a younger age at onset in the positive FH group. There were, however, no significant differences in the clinical characteristics of the patients regardless of FH. From the genomic analyses, there were significant differences in the polymorphisms of the solute carrier family 26, member 3 (SLC26A3) between those with and without an FH.Conclusions:Although the etiology of UC remains unknown, there were no observed relation between clinical symptoms and FH. SLC26A3 may, however, contribute to the pathogenesis of UC in Japanese individuals with an FH.
Pilot Study of Parent Psychophysiologic Outcomes in Pediatric Hematopoietic Stem Cell Transplantation
Authors: Ward Jessica , Swanson Barbara , Fogg Louis , Rodgers Cheryl 
Published: June 2016

Background:
Parents of children undergoing hematopoietic stem cell transplantation (HSCT) are at risk for psychological distress. This distress may result in aberrant immune, inflammatory, or endocrine effects. These physiologic outcomes have not been reported previously.

Main Objective:
The aim of this study is to examine the feasibility of longitudinal testing of psychophysiological parameters of stress in parents of children undergoing HSCT.

Methods:
This pilot study was conducted at a large children’s hospital in the Midwest and included parents of children who received autologous or allogeneic HSCT. Time points included before the start of HSCT conditioning and day +30, +60, and +100. Outcome variables included parent-perceived stress, lymphocyte subsets, C-reactive protein (CRP), proinflammatory cytokines, salivary cortisol, and salivary amylase. Effect sizes were calculated for each outcome.

Results:
Twelve parent-child dyads were enrolled (10 mothers, 2 fathers). Missing data were minimal. Parent-perceived stress significantly increased from pre-HSCT through day +100, and parent CD3+ T-lymphocyte counts decreased from pre-HSCT through day +100. No significant effects were observed for salivary studies, CRP, or proinflammatory cytokines. Effect sizes ranged from 1.23 (perceived stress) to 0.07 (CRP).

Conclusion:
The results of this study suggest that it is feasible longitudinally measure parent psychophysiologic outcomes in the pediatric HSCT setting. In addition, parent-perceived stress increased linearly from start of conditioning through day +100, whereas parent T-lymphocyte counts decreased concurrently.

Implications for Practice:
Routine psychological and physical health screening of parents of children undergoing HSCT is needed. Multidisciplinary psychosocial support services should be offered to parents at regular intervals during their child’s HSCT.
Dual-Polymer Drops, Contact Lens Comfort, and Lid Wiper Epitheliopathy
Authors: Nichols Jason J. , Lievens Christopher W. , Bloomenstein Marc R. , Liu Haixia , Simmons Peter , Vehige Joseph 
Published: June 2016

ABSTRACT

Purpose
This study compared a new contact lens rewetting drop containing both carboxymethylcellulose and hyaluronic acid (CMC-HA) with a standard drop containing carboxymethylcellulose only (CMC). Symptoms of discomfort typical in lens wear and lid wiper epitheliopathy (LWE) were assessed over a 3-month period in a diverse sample of contact lens wearers.

Methods
Adapted daily-wear contact lens subjects using hydrogel, silicone hydrogel, or rigid gas permeable lenses were enrolled in this prospective, randomized, double-masked, parallel-group, 90-day study conducted at 15 clinical sites. Subjects were randomized 2:1 to CMC-HA (n = 244) or CMC alone (n = 121) with dosage at least four times per day, along with their habitual lens care system. At baseline and at days 7, 30, 60, and 90, subject-completed questionnaires, bulbar conjunctival staining, LWE, contact lens distance visual acuity (CLDVA), and standard safety measures were assessed.

Results
At day 90, CMC-HA performed significantly better than CMC in ocular symptoms including dryness throughout the day (p = 0.006), and burning/stinging throughout the day (p = 0.02) and at the end of the day (p < 0.001). CMC-HA also performed numerically better for dryness at the end of day (p = 0.06). LWE staining was improved in the CMC-HA group at day 90 whereas it increased slightly in the CMC alone group, with a significant between-group difference (p = 0.009). CMC-HA also demonstrated greater reduction in conjunctival staining compared with CMC alone at day 90 (p = 0.08). No differences in CLDVA, contact lens wear time, acceptability, and product use were observed, and safety outcomes were similar between groups.

Conclusions
The addition of HA to a standard CMC rewetting drop improves clinical performance. In this comparison of rewetting drop efficacy in contact lens wearers, LWE was a useful clinical sign for differentiating clinical performance.
Demographic Factors Affect Ocular Comfort Ratings During Contact Lens Wear
Authors: Naduvilath Thomas , Papas Eric B. , Lazon de la Jara Percy 
Published: June 2016

ABSTRACT

Purpose
To determine if rating of ocular comfort during soft contact lens wear is affected by demographic factors.

Methods
Retrospective analysis of ocular comfort ratings during soft contact lens wear extracted from 44 nonrandomized similar clinical trials (n = 986). Subjects wore one of seven daily wear silicone hydrogels (SiHy) in combination with one of nine lens care products (LCP), and two daily disposables lenses. The effects on comfort rating of demographic factors were examined after adjusting for lens and LCP effects using general linear model.

Results
Males reported lower comfort on insertion than females (7.9 ± 1.6 vs. 8.1 ± 1.6, p = 0.001). Over 45 years old had higher comfort ratings than those between 26 and 45 or <26 years old at insertion (8.7 ± 1.3 vs. 8.1 ± 1.6 vs. 7.8 ± 1.6, p < 0.001), during the day (8.6 ± 1.2 vs. 8.0 ± 1.6 vs. 8.2 ± 1.2, p < 0.001), and end of day (7.7 ± 1.6 vs. 6.8 ± 2.0 vs. 7.0 ± 1.6, p < 0.001). Neophytes reported lower comfort on insertion (7.3 ± 1.6 vs. 8.2 ± 1.5, p < 0.001) and during day (8.0 ± 1.3 vs. 8.3 ± 1.3, p = 0.020) than experienced wearers. Participants with Rx ≥−3.50D had higher comfort ratings than those with ≤−3.50D on insertion (8.3 ± 1.4 vs. 7.8 ± 1.6, p < 0.001), during the day (8.4 ± 1.3 vs. 8.1 ± 1.3, p = 0.010), and end of day (7.2 ± 1.7 vs. 6.9 ± 1.8, p = 0.046). Comfort during the day was different between participants of different ethnic origin (p = 0.024) with Asians reporting the lowest (8.1 ± 1.3).

Conclusions
Demographic factors such as age, gender, lens wear experience, ethnicity, and refractive status can influence the rating of ocular comfort in clinical studies. The confounding effects of such demographic factors can be controlled by implementing randomization and appropriate multivariable statistical analysis.
Outcomes After Pediatric Out-of-Hospital Cardiopulmonary Interventions
Authors: Lo Jennifer Y. , Tani Lloyd Y. , Christensen Miles , Sheng Xiaoming , Clawson Jason , Menon Shaji C. 
Published: June 2016

Objective
The aim of the study was to evaluate outcomes after pediatric out-of-hospital cardiopulmonary interventions (CPIs) by emergency medical services (EMS).

Methods
Children (age, ≤18 years) who received CPI by EMS from 2001 to 2008 were identified from the Utah Department of Health. Cardiopulmonary intervention was defined as oxygenation, ventilation or CPR, and transport to a hospital by EMS. Univariate and multivariable regression analyses evaluated associations between potential predictors and outcomes (death and new neurologic dysfunction).

Results
A total of 464 patients (58% male) received EMS attention. For the 71% patients (327) who were alive on EMS arrival, 63% (205) received CPI without CPR. Of note, 6% (12) of these patients died after arrival to the hospital and new neurologic dysfunction was diagnosed in 6% (13). Among the 12 patients who died, 50% (6) were younger than 1 year.
On multivariable regression analysis, factors associated with increased risk of death before and in-hospital are the following: age younger than 1 year (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.17–0.39), shorter EMS transport time (OR, 0.94; 95% CI, 0.89–0.99), and longer EMS dispatch time (OR, 1.23; 95% CI, 1.08–1.40). Factors associated with increased risk of new neurologic dysfunction are the following: lack of pulse (OR, 0.14; 95% CI, 0.04–0.53), requiring CPR (OR, 6.15; 95% CI, 1.48–25.6), and CPR duration (OR, 1.20; 95% CI, 1.05–1.37).

Conclusions
Age younger than 1 year, shorter transport time, and longer dispatch time were associated with increased risk of death. Being pulseless upon discovery and receiving CPR were associated with new neurologic dysfunction. Maximizing EMS transport interventions for patients younger than 1 year requiring CPI may improve patient outcomes.
Acute Disseminated Encephalomyelitis
Authors: Gray Matthew Philip , Gorelick Marc H. 
Published: June 2016

Abstract
Acute disseminated encephalomyelitis is a primarily pediatric, immune-mediated disease characterized by demyelination and polyfocal neurologic symptoms that typically occur after a preceding viral infection or recent immunization. This article presents the pathophysiology, diagnostic criteria, and magnetic resonance imaging characteristics of acute disseminated encephalomyelitis. We also present evaluation and management strategies.
Brief Report: HIV-1 Infection Impairs CD16 and CD35 Mediated Opsonophagocytosis of Mycobacterium tuberculosis by Human Neutrophils
Authors: Bangani Nonzwakazi , Nakiwala Justine , Martineau Adrian R. , Wilkinson Robert J. , Wilkinson Katalin A. , Lowe David M. 
Published: June 2016

Abstract:
Using a flow cytometric assay, we investigated neutrophil–Mycobacterium tuberculosis opsonophagocytosis and the impact of HIV-1–infected serum on this process. The mean (±SD) percentage of neutrophils internalizing bacilli after 30 minutes incubation was significantly reduced by pretreatment with anti-CD16 (18.2% ± 8.1%, P < 0.001) or anti-CD35 antibody (23.2% ± 10.6%, P < 0.05) versus anti-CD4 controls (29.9% ± 8.1%). Blocking CD88 or CD11a did not affect internalization. Using heat-inactivated serum, maximal internalization was lower using HIV-1–infected serum versus HIV-1–uninfected. Using non–heat-inactivated serum, internalization decreased more rapidly with sequential dilutions of HIV-1–infected versus HIV-1–uninfected serum. CD16 and CD35 are important for neutrophil internalization of M. tuberculosis, whereas HIV-1 infection adversely affects opsonophagocytosis.
More Than One Way to Debrief
Authors: Sawyer Taylor , Eppich Walter , Brett-Fleegler Marisa , Grant Vincent , Cheng Adam 
Published: June 2016

Summary Statement
Debriefing is a critical component in the process of learning through healthcare simulation. This critical review examines the timing, facilitation, conversational structures, and process elements used in healthcare simulation debriefing. Debriefing occurs either after (postevent) or during (within-event) the simulation. The debriefing conversation can be guided by either a facilitator (facilitator-guided) or the simulation participants themselves (self-guided). Postevent facilitator-guided debriefing may incorporate several conversational structures. These conversational structures break the debriefing discussion into a series of 3 or more phases to help organize the debriefing and ensure the conversation proceeds in an orderly manner. Debriefing process elements are an array of techniques to optimize reflective experience and maximize the impact of debriefing. These are divided here into the following 3 categories: essential elements, conversational techniques/educational strategies, and debriefing adjuncts. This review provides both novice and advanced simulation educators with an overview of various methods of conducting healthcare simulation debriefing. Future research will investigate which debriefing methods are best for which contexts and for whom, and also explore how lessons from simulation debriefing translate to debriefing in clinical practice.
Recent advances in genetics of chorea
Authors: Mencacci Niccolò E. , Carecchio Miryam 
Published: June 2016

Purpose of review
Chorea presenting in childhood and adulthood encompasses several neurological disorders, both degenerative and nonprogressive, often with a genetic basis. In this review, we discuss how modern genomic technologies are expanding our knowledge of monogenic choreic syndromes and advancing our insight into the molecular mechanisms responsible for chorea.

Recent findings
A genome-wide association study in Huntington's disease identified genetic disease modifiers involved in controlling DNA repair mechanisms and stability of the HTT trinucleotide repeat expansion. Chorea is the cardinal feature of newly recognized genetic entities, ADCY5 and PDE10A-related choreas, with onset in infancy and childhood. A phenotypic overlap between chorea, ataxia, epilepsy, and neurodevelopmental disorders is becoming increasingly evident.

Summary
The differential diagnosis of genetic conditions presenting with chorea has considerably widened, permitting a molecular diagnosis and an improved prognostic definition in an expanding number of cases. The identification of Huntington's disease genetic modifiers and new chorea-causing gene mutations has allowed the initial recognition of converging molecular pathways underlying medium spiny neurons degeneration and dysregulation of normal development and activity of basal ganglia circuits. Signalling downstream of dopamine receptors and control of cAMP levels represent a very promising target for the development of new aetiology-based treatments for chorea and other hyperkinetic disorders.
Fibre break failure processes in unidirectional composites: evaluation of critical damage states
Authors: Thionnet A. , Bunsell A. R. 
Published: May 2016

Earlier work which successfully modelled the kinetics of fibre breakage in unidirectional composites under monotonic tensile loading has been extended to quantify the kinetics of fibre failure during both monotonic and sustained tensile loading. In both cases, failure was seen to occur when a critical density of large clusters (more than 16 fibres are broken within the representative volume element) of fibre breaks developed. However, in monotonic loading failure occurred very quickly after the first development of these large clusters, whereas under sustained loading the composite could accommodate greater levels of large clusters because of the lower applied load.
This article is part of the themed issue ‘Multiscale modelling of the structural integrity of composite materials’.
Environmental degradation of composites for marine structures: new materials and new applications
Authors: Davies Peter 
Published: May 2016

This paper describes the influence of seawater ageing on composites used in a range of marine structures, from boats to tidal turbines. Accounting for environmental degradation is an essential element in the multi-scale modelling of composite materials but it requires reliable test data input. The traditional approach to account for ageing effects, based on testing samples after immersion for different periods, is evolving towards coupled studies involving strong interactions between water diffusion and mechanical loading. These can provide a more realistic estimation of long-term behaviour but still require some form of acceleration if useful data, for 20 year lifetimes or more, are to be obtained in a reasonable time. In order to validate extrapolations from short to long times, it is essential to understand the degradation mechanisms, so both physico-chemical and mechanical test data are required. Examples of results from some current studies on more environmentally friendly materials including bio-sourced composites will be described first. Then a case study for renewable marine energy applications will be discussed. In both cases, studies were performed first on coupons at the material level, then during structural testing and analysis of large components, in order to evaluate their long-term behaviour.
This article is part of the themed issue ‘Multiscale modelling of the structural integrity of composite materials’.
Prediction of failure in notched carbon-fibre-reinforced-polymer laminates under multi-axial loading
Authors: Tan J. L. Y. , Deshpande V. S. , Fleck N. A. 
Published: May 2016

A damage-based finite-element model is used to predict the fracture behaviour of centre-notched quasi-isotropic carbon-fibre-reinforced-polymer laminates under multi-axial loading. Damage within each ply is associated with fibre tension, fibre compression, matrix tension and matrix compression. Inter-ply delamination is modelled by cohesive interfaces using a traction-separation law. Failure envelopes for a notch and a circular hole are predicted for in-plane multi-axial loading and are in good agreement with the observed failure envelopes from a parallel experimental study. The ply-by-ply (and inter-ply) damage evolution and the critical mechanisms of ultimate failure also agree with the observed damage evolution. It is demonstrated that accurate predictions of notched compressive strength are obtained upon employing the band broadening stress for microbuckling, highlighting the importance of this damage mode in compression.
This article is part of the themed issue ‘Multiscale modelling of the structural integrity of composite materials’.
From matrix nano- and micro-phase tougheners to composite macro-properties
Authors: Kinloch A. J. , Taylor A. C. , Techapaitoon M. , Teo W. S. , Sprenger S. 
Published: May 2016

In this paper, firstly, the morphology and toughness of a range of bulk epoxy polymers, which incorporate a second phase of well-dispersed silica nanoparticles and/or rubber microparticles, have been determined. Secondly, the macro-properties of natural-fibre reinforced-plastic (NFRP) composites based upon these epoxy polymers have been ascertained, using (i) unidirectional flax fibres or (ii) regenerated-cellulose fibres in the architecture of a plain-woven fabric. Thirdly, the toughening mechanisms which are induced in these materials by the presence of the silica nanoparticles, the rubber microparticles and the natural fibres have been identified. Finally, the values of the toughness of the bulk epoxy polymers and corresponding NFRPs have been quantitatively modelled. The increased toughness recorded for the bulk epoxy polymer due to the presence of the silica nanoparticles and/or rubber microparticles was indeed typically transferred to the NFRP composites when using such epoxies as the matrices for the fibres. Thus, the important role that may be played by modifications to the epoxy matrices in order to increase the toughness of the composites was very clearly demonstrated by these results. However, notwithstanding, the toughening mechanisms induced by the fibres were essentially responsible for the very high toughnesses of the NFRP composites, compared with the bulk epoxy polymers. The modelling studies successfully predicted the values of toughness of the bulk epoxy polymers and of the NFRP composites. These studies also quantified the extent to which each toughening mechanism, induced by the second-phase nano- and microparticles and the natural fibres, contributed to the overall values of toughness of the materials.
This article is part of the themed issue ‘Multiscale modelling of the structural integrity of composite materials’.