bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urgent Chemotherapy for Life-Threatening Complications Related to Solid Neoplasms
Authors: Zerbib Yoann , Rabbat Antoine , Fartoukh Muriel , Bigé Naïke , Andréjak Claire , Mayaux Julien , De Prost Nicolas , Misset Benoît , Lemiale Virginie , Bruneel Fabrice , Maizel Julien , Ricome Sylvie , Jacobs Frédéric , Bornstain Caroline , Dupont Hervé , Baudin François , Azoulay Elie , Pène Frédéric 
Published: April 2017

Objectives:
Solid neoplasms can be directly responsible for organ failures at the time of diagnosis or relapse. The management of such specific complications relies on urgent chemotherapy and eventual instrumental or surgical procedures, combined with advanced life support. We conducted a multicenter study to address the prognosis of this condition.

Design:
A multicenter retrospective (2001–2015) chart review.

Setting:
Medical and respiratory ICUs.

Patients:
Adult patients who received urgent chemotherapy in the ICU for organ failure related to solid neoplasms were included. The modalities of chemotherapy, requirements of adjuvant instrumental or surgical procedures, and organ supports were collected. Endpoints were short- and long-term survival rates.

Interventions:
None.

Measurements and Main Results:
One hundred thirty-six patients were included. Lung cancer was the most common malignancy distributed into small cell lung cancer (n = 57) and non-small cell lung cancer (n = 33). The main reason for ICU admission was acute respiratory failure in 111 patients (81.6%), of whom 89 required invasive mechanical ventilation. Compression and tissue infiltration by tumor cells were the leading mechanisms resulting in organ involvement in 78 (57.4%) and 47 (34.6%) patients. The overall in-ICU, in-hospital, 6-month, and 1-year mortality rates were 37%, 58%, 74%, and 88%, respectively. Small cell lung cancer was identified as an independent predictor of hospital survival. However, this gain in survival was not sustained since the 1-year survival rates of small cell lung cancer, non-small cell lung cancer, and non-lung cancer patients all dropped below 20%.

Conclusions:
Urgent chemotherapy along with aggressive management of organ failures in the ICU can be lifesaving in very selected cancer patients, most especially with small cell lung cancer, although the long-term survival is hardly sustainable.
The Association Between Visiting Intensivists and ICU Outcomes*
Authors: Whitehouse Tony , Hodson James , Pemberton Philip , Veenith Tonny , Snelson Catherine , Bion Julian , Rubenfeld Gordon D. 
Published: April 2017

Objectives:
We hypothesized that intensivists unfamiliar with an ICU team and the context of that ICU would affect patient outcomes. We examined differences in mortality when ICU patients were admitted under intensivists routinely working in that ICU and compared with those admitted by intensivists familiar with an ICU elsewhere in the same hospital.

Design, Settings, and Patients:
A 5-year natural experimental crossover study involving patients admitted to four ICUs in a large U.K. teaching hospital.

Interventions:
During a period of service reconfiguration, intensivists routinely rostered to work in one ICU worked in another of the hospital’s four ICUs. “Home” intensivists were those who continued to work in their usual ICU; “visitor” intensivists were those who delivered care in an unfamiliar ICU. Patient data were obtained from electronic patient records to provide analysis on sex, age, admission Sequential Organ Failure Assessment score, date and time of admission, and admission type (elective, transfer, or unplanned).

Measurements and Main Results:
We analyzed 9,981 admissions to four separate ICUs over a 5-year period. In total, 34.5% of patients were admitted by intensivists working in nonfamiliar surroundings. Visitor intensivists admitted patients with similar age and gender distributions but with greater physiologic derangement (mean Sequential Organ Failure Assessment score, 4.1 ± 2.8 vs 3.9 ± 2.8; p < 0.001) than home intensivists. Overall ICU mortality rates were higher in visitor intensivists, albeit not significantly so (11.5% vs 10.2%; p = 0.052). However, when the ICUs were analyzed separately, visitor mortality rates were found to be significantly higher than for home intensivists in two of the four ICUs (p = 0.017, 0.006). A multivariable analysis adjusting for confounding factors and the clustering of consultants revealed that the overall mortality rate was significantly higher for visitors (odds ratio, 1.18; 95% CI, 1.02–1.37; p = 0.024). A significant interaction between the ICU and visitor status was also detected (p = 0.046), with the visitor effect remaining significant in the two ICUs identified previously (both p = 0.009).

Conclusions:
Visitor intensivists in some ICUs were associated with higher mortality. The reasons are unknown but could relate to intensivists’ practices, unfamiliarity with the patients, or the interaction with the interprofessional team.
Early Systolic Dysfunction Following Traumatic Brain Injury: A Cohort Study
Authors: Krishnamoorthy Vijay , Rowhani-Rahbar Ali , Gibbons Edward F. , Rivara Frederick P. , Temkin Nancy R. , Pontius Crystal , Luk Kevin , Graves Morgan , Lozier Danielle , Chaikittisilpa Nophanan , Kiatchai Taniga , Vavilala Monica S. 
Published: April 2017

Objective:
Prior studies have suggested that traumatic brain injury may affect cardiac function. Our study aims were to determine the frequency, longitudinal course, and admission risk factors for systolic dysfunction in patients with moderate-severe traumatic brain injury.

Design:
Prospective cohort study.

Setting:
Level 1 trauma center.

Measurements:
Transthoracic echocardiogram within 1 day and over the first week after moderate-severe traumatic brain injury; transthoracic echocardiogram within 1 day after mild traumatic brain injury (comparison group).

Measurements and Main Results:
Systolic function was assessed by transthoracic echocardiogram, and systolic dysfunction was defined as fractional shortening less than 25%. Multivariable Poisson regression models examined admission risk factors for systolic dysfunction. Systolic function in 32 patients with isolated moderate-severe traumatic brain injury and 32 patients with isolated mild traumatic brain injury (comparison group) was assessed with transthoracic echocardiogram. Seven (22%) moderate-severe traumatic brain injury and 0 (0%) mild traumatic brain injury patients had systolic dysfunction within the first day after injury (p < 0.01). All patients with early systolic dysfunction recovered in 1 week. Younger age (relative risk, 0.87; 95% CI, 0.79–0.94; for 1 yr increase in age) and lower admission Glasgow Coma Scale score (relative risk, 0.34; 95% CI, 0.20–0.58; for one unit increase in Glasgow Coma Scale) were independently associated with the development of systolic dysfunction among moderate-severe traumatic brain injury patients.

Conclusions:
Early systolic dysfunction can occur in previously healthy patients with moderate-severe traumatic brain injury, and it is reversible over the first week of hospitalization. Younger age and lower admission Glasgow Coma Scale score are independently associated with the development of systolic dysfunction after moderate-severe traumatic brain injury.
Histological Features of Methylene Blue–Induced Phototoxicity Administered in the Context of Parathyroid Surgery
Authors: Maguire Ciara A. , Sharma Anup , Alarcon Lida , Ffolkes Lorrette , Kurzepa Malgorzata , Ostlere Lucy , Samarasinghe Venura , Singh Manuraj 
Published: April 2017

Abstract:
Methylene blue is a chromophore dye known for its photosensitizing properties. It is also administered intravenously as a tracer in parathyroid surgery to identify abnormal glands. We describe 2 cases of acute methylene blue–induced phototoxicity in patients who underwent parathyroidectomy. Both patients developed an acute vesiculopustular inflammatory rash on the anterior neck corresponding to the site exposed intraoperatively to overhanging surgical lights. One of the patients also developed a bulla on her finger at the site of attachment of the oxygen probe. Biopsies were taken from both patients at different time points. The histological findings included destruction of sebaceous glands and deposition of diastase-periodic acid-Schiff–positive hyaline material around dermal blood vessels. These features are similar to those seen in skin treated with photodynamic therapy and systemic photosensitivity disorders such as the porphyrias. The wavelengths of light emitted by the surgical lights and oxygen probe overlap with the absorption spectrum of methylene blue. This resulted in excitation of the systemically administered methylene blue at exposed sites, with resultant local tissue damage and a phototoxic reaction.
Hemosiderotic Juvenile Xanthogranuloma
Authors: Fernandez-Flores Angel , Nicklaus Ina , Browne Fiona , Colmenero Isabel 
Published: April 2017

Abstract:
Juvenile xanthogranuloma is a non-Langerhans cell lesion mostly limited to the skin but occasionally presenting in extracutaneous locations or associated with systemic conditions. Lesions need to be distinguished mainly from dermatofibroma, xanthoma, Langerhans cell histiocytosis, or reticulohistiocytoma. Herein, we present a hemosiderotic variant of juvenile xanthogranuloma in a 12-year-old girl, which we have not found described in literature. The lesion presented at the back of the scalp as a slowly growing yellowish polypoid lesion showing occasional bleeding. The histopathological examination demonstrated a cellular infiltrate expanding the dermis, with a Grenz zone and with no remarkable changes in the overlying epidermis. The papule was made of mononucleated macrophages, many of which were xanthomatous. There were some Touton giant cells. The lesion was intermingled with a mild inflammatory infiltrate comprising lymphocytes, plasma cells, neutrophils, and some eosinophils. Many of the macrophages contained abundant cytoplasmic deposits of iron. The macrophages expressed CD68 and CD163, whereas they failed to express S100 protein, CD1a, and Langerin.
Rapid Homogeneous Immunoassay to Quantify Gemcitabine in Plasma for Therapeutic Drug Monitoring
Authors: Kozo Daniel , Ross Matt W. , Jarrah Justin , Barrett Michael , Harney Rebecca L. , Courtney Jodi B. , Baburina Irina , Holleran Julianne L. , Beumer Jan H. , Peters Godefridus J. , Honeywell Richard J. , Salamone Salvatore J. 
Published: April 2017

Background:
Gemcitabine (2′,2′-difluoro-2′-deoxycytidine) is a nucleoside analog used as a single agent and in combination regimens for the treatment of a variety of solid tumors. Several studies have shown a relationship between gemcitabine peak plasma concentration (Cmax) and hematological toxicity. An immunoassay for gemcitabine in plasma was developed and validated to facilitate therapeutic drug monitoring (TDM) by providing an economical, robust method for automated chemistry analyzers.

Methods:
A monoclonal antibody was coated on nanoparticles to develop a homogenous agglutination inhibition assay. To prevent ex vivo degradation of gemcitabine in blood, tetrahydrouridine was used as a sample stabilizer. Validation was conducted for precision, recovery, cross-reactivity, and linearity on a Beckman Coulter AU480. Verification was performed on an AU5800 in a hospital laboratory. A method comparison was performed with (LC-MS/MS) liquid chromatography tandem mass spectrometry using clinical samples. Selectivity was demonstrated by testing cross-reactivity of the major metabolite, 2′,2′-difluorodeoxyuridine.

Results:
Coefficients of variation for repeatability and within-laboratory precision were <8%. The deviation between measured and assigned values was <3%. Linear range was from 0.40 to 33.02 μ/mL (1.5–125.5 μM). Correlation with validated LC-MS/MS methods was R2 = 0.977. The assay was specific for gemcitabine: there was no cross-reactivity to 2′,2′-difluorodeoxyuridine, chemotherapeutics, concomitant, or common medications tested. Tetrahydrouridine was packaged in single-use syringes. Gemcitabine stability in whole blood was extended to 8 hours (at room temperature) and in plasma to 8 days (2–8°C).

Conclusions:
The assay demonstrated the selectivity, test range, precision, and linearity to perform reliable measurements of gemcitabine in plasma. The addition of stabilizer improved the sample handling. Using general clinical chemistry analyzers, gemcitabine could be measured for TDM.
Rotavirus Vaccination and the Risk of Celiac Disease or Type 1 Diabetes in Finnish Children at Early Life
Authors: Vaarala Outi , Jokinen Jukka , Lahdenkari Mika , Leino Tuija 
Published: April 2017

Background:
Rotavirus infection has been suggested as a trigger of type 1 diabetes (T1D)-related autoimmunity and celiac disease (CD)-related autoimmunity.

Methods:
We carried out a nationwide, population-based cohort study evaluating whether prevention of rotavirus infection with vaccination affects the risk of CD and T1D diagnosed during 2009–2014 in Finnish children by comparing vaccinated and unvaccinated children in a cohort born in 2009–2010. Nationwide rotavirus vaccination records were collected from healthcare databases during 2009–2011 and validated for a sample of 495 children born from July 2009 to December 2009. Incident diagnoses of CD and T1D during 2009–2014 in the cohort were identified in the National Care Register.

Results:
The adjusted relative risks (with 95% confidence intervals) were 0.91 (0.69–1.20) for T1D and 0.87 (0.65–1.17) for CD in vaccinated children compared with unvaccinated, suggesting that oral rotavirus vaccination does not alter the risk of CD or T1D during 4–6 years follow-up after vaccination.

Conclusions:
Our results suggest that oral rotavirus vaccination is considered safe in the individuals at risk of CD and T1D.
Pneumococcal Immune Response in Infants Whose Mothers Received Tetanus, Diphtheria and Acellular Pertussis Vaccination During Pregnancy
Authors: Maertens Kirsten , Burbidge Polly , Van Damme Pierre , Goldblatt David , Leuridan Elke 
Published: April 2017

Background:
Maternal immunization with a tetanus, diphtheria and acellular pertussis (Tdap) vaccine may blunt infant pneumococcal immune responses after a primary series of vaccines.

Methods:
As part of a prospective controlled cohort trial of Tdap (Boostrix; GSK Biologicals, Rixensart, Belgium) vaccination in pregnancy, infants born to vaccinated mothers and controls were immunized at 8 and 16 weeks and 12 months of age with 13-valent pneumococcal conjugate vaccine (Prevenar13; Pfizer, Wyeth, United States). Sera were tested for pneumococcal antibody concentrations against vaccine serotypes following primary and booster immunization.

Results:
Geometric mean concentration of antibodies to serotypes 1, 3, 4, 5, 6A, 7F, 9V, 14 and 19A was significantly lower after 2 doses of Prevenar13 vaccine in the offspring of the mothers vaccinated in pregnancy. This blunting effect disappeared after a booster dose at 12 months of age, except for serotypes 1 and 4. Despite this blunting, the percentage of children achieving the threshold of protection of 0.35 µg/mL was comparable in the vaccine and the control group both after primary and booster vaccination with only a significant lower rate of seroprotection in the vaccine group for serotype 3 after primary vaccination. After booster vaccination, seroprotection rates increased further for serotypes 3, 5, 6B, 9V and 23F.

Conclusions:
The present results indicate a blunting effect after primary vaccination for some serotypes resolving after booster vaccination. Seroprotection rates were comparable both after primary and booster vaccination, except for serotype 3 with a significant lower seroprotection rate in the vaccine group after primary vaccination.
A Comparison of Hospital Versus Outpatient Parenteral Antibiotic Therapy at Home for Pyelonephritis and Meningitis
Authors: Hensey Conor C. , Sett Arun , Connell Tom G. , Bryant Penelope A. 
Published: April 2017

Background:
Despite the benefits of home treatment with outpatient parenteral antimicrobial therapy (OPAT), children with pyelonephritis and meningitis are rarely included. We aimed to compare clinical characteristics and outcomes between hospital and home treatment for these conditions and to identify factors influencing home treatment.

Methods:
Children admitted to the hospital with pyelonephritis or proven and presumed bacterial meningitis from January 1, 2012, to December 31, 2013 were identified retrospectively. Patients who received any OPAT (home group) received daily visits via our Hospital-in-the-Home (HITH) program; inpatients (hospital group) received standard care. Clinical and demographic features, length of stay, readmission rate and cost were compared between hospital and home groups.

Results:
One hundred thirty-nine children with pyelonephritis and 70 with meningitis were identified, of which 127 and 44 were potentially suitable for OPAT, respectively. Of these, 12 (9%) with pyelonephritis received OPAT, contrasting with 29 (66%) with meningitis. Clinical features did not differ between hospital- and home-treated patients for either condition. Patients with meningitis in the hospital group were younger than those transferred to HITH (1 vs. 2 months; P = 0.01). All patients were afebrile before transfer to HITH. Admissions for pyelonephritis were brief with inpatients having a shorter length of stay than home patients (median: 3 vs. 4.5 days; P = 0.002). Unplanned readmission rates were comparable across all groups. Transfer to HITH resulted in a saving of AU$178,180.

Conclusions:
Children with pyelonephritis and meningitis can feasibly receive OPAT. Age, treatment duration and fever influence this decision. None of these should be barriers to OPAT, and the cost savings support change in practice.
The Nasopharyngeal Microbiota of Children With Respiratory Infections in Botswana
Authors: Kelly Matthew S. , Surette Michael G. , Smieja Marek , Pernica Jeffrey M. , Rossi Laura , Luinstra Kathy , Steenhoff Andrew P. , Feemster Kristen A. , Goldfarb David M. , Arscott-Mills Tonya , Boiditswe Sefelani , Rulaganyang Ikanyeng , Muthoga Charles , Gaofiwe Letang , Mazhani Tiny , Rawls John F. , Cunningham Coleen K. , Shah Samir S. , Seed Patrick C. 
Published: April 2017

Background:
Nearly half of child pneumonia deaths occur in sub-Saharan Africa. Microbial communities in the nasopharynx are a reservoir for pneumonia pathogens and remain poorly described in African children.

Methods:
Nasopharyngeal swabs were collected from children with pneumonia (N = 204), children with upper respiratory infection symptoms (N = 55) and healthy children (N = 60) in Botswana between April 2012 and April 2014. We sequenced the V3 region of the bacterial 16S ribosomal RNA gene and used partitioning around medoids to cluster samples into microbiota biotypes. We then used multivariable logistic regression to examine whether microbiota biotypes were associated with pneumonia and upper respiratory infection symptoms.

Results:
Mean ages of children with pneumonia, children with upper respiratory infection symptoms and healthy children were 8.2, 11.4 and 8.0 months, respectively. Clustering of nasopharyngeal microbiota identified 5 distinct biotypes: Corynebacterium/Dolosigranulum-dominant (23%), Haemophilus-dominant (11%), Moraxella-dominant (24%), Staphylococcus-dominant (13%) and Streptococcus-dominant (28%). The Haemophilus-dominant [odds ratio (OR): 13.55; 95% confidence interval (CI): 2.10–87.26], the Staphylococcus-dominant (OR: 8.27; 95% CI: 2.13–32.14) and the Streptococcus-dominant (OR: 39.97; 95% CI: 6.63–241.00) biotypes were associated with pneumonia. The Moraxella-dominant (OR: 3.71; 95% CI: 1.09–12.64) and Streptococcus-dominant (OR: 12.26; 95% CI: 1.81–83.06) biotypes were associated with upper respiratory infection symptoms. In children with pneumonia, HIV infection was associated with a lower relative abundance of Dolosigranulum (P = 0.03).

Conclusions:
Pneumonia and upper respiratory infection symptoms are associated with distinct nasopharyngeal microbiota biotypes in African children. A lower abundance of the commensal genus Dolosigranulum may contribute to the higher pneumonia risk of HIV-infected children.
Seizures, Systemic Inflammatory Response, and Rhabdomyolysis Associated With Laboratory-Confirmed 2C-I and 25-I Exposure
Authors: Thornton Stephen L. , Hoehn Sarah , Gerona Roy R. 
Published: April 2017

Abstract
The 2C drugs are hallucinogenic phenethylamines. They and their n-benzyloxymethyl analogs have become popular as “legal highs,” and significant toxicity has been attributed to their use. We report on a case of seizures, systemic inflammatory response, and rhabdomyolysis associated with laboratory-confirmed 4-iodo-2,5-dimethoxyphenethylamine and 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl) phenethylamine exposure. A 17-year-old male teenager developed seizures after taking “2 strips of acid.” The seizures resolved with midazolam, but he became apneic and was intubated. His head computed tomography was unremarkable. Initial creatinine level was 1.5 mg/dL, with a creatine kinase of 112 U/L. His urine immunoassay drug screen was negative. He was extubated within 12 hours but had elevated temperatures for 48 hours. He was treated with antibiotics, but no source of infection was identified. His creatinine level peaked at 2.46 mg/dL. His creatine kinase peaked 72 hours later at 14579 U/L. He was treated with intravenous fluids and did not require renal replacement therapy. He recovered fully and was discharged after 5 days. Serum and urine samples were tested using liquid chromatography time-of-flight mass spectrometry. We detected 4-iodo-2,5-dimethoxyphenethylamine and 4-iodo-2,5-dimethoxy-N-(2-methoxybenzyl) phenethylamine in both serum and urine. No other substances were detected. The 2C drugs and their n-benzyloxymethyl analogs are potent serotonergic agents. Their use has been associated with multiple adverse effects including seizures, rhabdomyolysis, and death. They should be considered in differential diagnosis for drug-induced seizures and as a cause for systemic inflammatory response. This case highlights the significant toxicity seen with these compounds.
The Season of Hoverboards
Authors: Donnally Chester J. , Lawrie Charles M. , Rush Augustus J. , Baitner Avi C. 
Published: April 2017

Objective
The aim of this study was to identify the types of pediatric orthopedic extremity fractures that are sustained as a result of hoverboard (self-balancing, self-propelling, 2-wheeled boards) use.

Methods
We performed a retrospective review of all orthopedic consultations from the emergency department at our institution from December 1 to 31, 2015. Data was collected on the injury mechanism, fracture location, management, and patient characteristics including sex, age, and hand dominance.

Results
A total of 307 patients with acute extremity injuries were evaluated for a 31-day period. Hoverboard use was identified as the mechanism of injury in 36 patients with 36 fractures (11.7%). The mean age of these 36 patients was 11 years (range, 4–17 y), with most being male (69.4%). There were 35 upper extremity fractures and 1 lower extremity fracture. Eight (22.9%) of the 36 hoverboard patients required closed reduction in the emergency department either under conscious sedation or hematoma block performed with local anesthetic. Four patients (11.1%) required operative treatment.

Conclusions
The overall incidence of extremity fractures due to hoverboard riding seen in our emergency department during the holiday season was relatively high compared with other common childhood activities. The vast majority of these fractures involved the upper extremities. A moderate percentage of these injuries required closed reduction in the emergency department or surgical treatment. Additional studies examining the use of protective equipment while riding hoverboards, time from initial hoverboard use to injury, supervision, and the cost of treating these injuries should be conducted to further elucidate the nature of these injuries and work toward prevention.