bluuebunny/crossref_metadata_2025_split huggingface dataset:
C5 (Clinical Case) Coccobacillary Meningitis and Septic Embolic Infarcts in an Ex-Preterm Infant: An Unexpected Pathogen
Authors: Burke Karina , Algain Sulwan , Abdulsatar Farah , Almutawa Fatimah , Tay Keng , Barton-Forbes Michelle 
Published: September 2023

Abstract

Introduction/Background
Pasteurella multocida causes life-threatening zoonotic invasive infections in immunocompromised individuals and those at extremes of age (neonates and elderly). Bacteremia, meningitis, and endocarditis are serious complications that are associated with up to 25-30% mortality.

Case Description
A 7-week-old ex-34-week preterm female infant presented with a one-day history of fever, irritability, and poor feeding without exposure to sick contacts. Household contacts included a constantly drooling Shi Tzu dog. Examination revealed an irritable, febrile infant with a bulging fontanelle and scant purulent eye discharge. No focal neurological deficits, skin rashes or murmurs were appreciated. Empiric antibiotics were initiated following a full work-up for sepsis.
Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis with 7608 x106L nucleated cells (95% neutrophils), protein 7360 mg/L, glucose &lt;0.2 mmol/L and gram-negative coccobacilli. Blood and CSF cultures grew Pasteurella multocida, prompting a switch to crystalline penicillin. An echogenic mitral valvular mass was identified in the absence of underlying cardiac defects. Head imaging confirmed ventriculitis with multiple small infarcts. No sequelae of abscess, hydrocephalus or hearing loss were demonstrated after the completion of 6 weeks of penicillin therapy.

Discussion
Haemophilus influenzae, serotype b, is the typical cause of coccobacillary meningitis in a 7-week-old infant. In addition to non-b serotypes, non-typeable species which cause conjunctivitis may also cause invasive disease in young infants. The resultant growth of P. multocida from cultures was, therefore, unexpected, particularly given there were no preceding animal bites or scratches. In vulnerable hosts, this pathogen can be transmitted across skin or mucous membranes after close animal contact, such as licking and sniffing. The constant drooling and spraying of saliva from the pet dog, a flat-faced breed known to have stenotic nares and chronic nasal secretions, likely provided an opportunity for mucosal contamination. This infant’s young age, prematurity, and exposure to a flat-faced dog placed her at high risk for Pasteurellosis, which manifested as complicated meningitis and endocarditis.

Conclusion
Pasteurella infections most often arise as local infections following an animal bite or scratch, are rare but important causes of life-threatening severe coccobacillary invasive infection, even without preceding trauma, in young infants. Families of at-risk individuals who own pets should have adequate education about zoonotic infections that address risk factors, including animal breed and behaviour, presenting features and preventive strategies to reduce the potential for serious morbidity and even mortality.
C6 (Clinical Case) A 5-Year-Old with Headbanging and Hemiparesis
Authors: Foulds Jessica , Morel Terra , Mailo Janette 
Published: September 2023

Abstract

Introduction/Background
A 5-year-old boy had a medical history of Phelan-McDermid syndrome; and with that associated autism spectrum disorder; severe, medication-resistant headbanging; and type 1 diabetes. He presented to community hospital with acute onset inability to walk, irritability, and vomiting.

Case Description
On examination he had left arm weakness and truncal ataxia. CT head identified a left cerebellar infarction. He was transferred to the local children’s hospital, and CT angiogram showed left PICA proximal occlusion. Due to diagnostic delay, the infarct was not amenable to endovascular intervention. Initial management was neuroprotective care, and given his history of headbanging and the risk of further trauma, only ASA monotherapy. MR brain visualized a left vertebral artery dissection, the stroke’s likely cause. Other causes were ruled out with normal echocardiogram and thrombophilia work-up, including antiphospholipid panel. Genetic analysis was negative for connective tissue diseases, bleeding or clotting disorders.
On day 5 of admission, he acutely developed worsened left arm weakness and inability to bear weight. Repeat brain imaging showed new bilateral medial thalamic infarcts and diffusion restriction within the right putamen. Given this progression, despite the risk of bleeding, heparin was initiated. On day 9, repeat CT head identified a new lacunar infarct.
On day 14, repeat MRI confirmed clinical stability, and he was switched from heparin to enoxaparin. After 27 days, he was discharged for home-based rehabilitation. His three-month follow-up MRI was stable, and anticoagulation was discontinued, while he remained on ASA only.

Discussion
There is no known association between Phelan-McDermid syndrome and cerebrovascular diseases. However, self-injurious behaviour, such as head banging, is not uncommon in the paediatric population, particularly among neurodiverse patients. These behaviours, in and of themselves, can cause significant injury and morbidity. The case shows how severe headbanging may have caused vertebral artery dissection with thromboembolic consequences. As such, for patients who demonstrate self-injurious behaviour, it is important to counsel these patients and families on potential harms, and inform efforts to mitigate risk, where possible.
In cases of acute change to neurological status, stroke should remain on the differential diagnosis, and brain imaging should be considered. Time to central imaging affects therapeutic opportunities, as exemplified in this case where, due to delays in obtaining imaging, endovascular therapy was not an option for the patient.

Conclusion
Many children engage in self-injurious behaviour that can, as in this case, cause devastating consequences. Clinicians should remain wary of change in neurologic status and have low thresholds for central nervous system imaging, especially for patients with non-verbal communication.
R2 (Resident Advocacy Project) Reducing the Risk of ATV-related Harm in Saskatchewan Children
Authors: Zucchet Alyssa , Leis Karen 
Published: September 2023

Abstract

Rationale and Objectives
All-terrain vehicles (ATVs) are the second highest cause of transport-related hospitalizations, emergency room visits, and disabilities in Saskatchewan citizens of all ages. Saskatchewan law restricts the use of ATVs by children aged 12-16 and bans the use of ATVs by children under the age of 12 on public land. Previous CPS status reports had found this level of legislation inadequate. Clinically, we certainly see many children enter Saskatchewan hospitals for ATV-related injuries, and previous attempts at education campaigns and government lobbying have not been successful. There is limited Saskatchewan information on this issue, so we first sought to gather data to identify where social and legislative advocacy efforts should be directed.

Project Description
We partnered with the Saskatchewan Prevention Institute, a non-profit organization working to prevent injuries in children, as they have worked on ATV safety over the years with community partners as well as government. We completed a retrospective chart review to describe the prevalence and outcomes of ATV accidents in children and youth (aged 20 and under) presenting to hospitals in Saskatoon from 2016 to 2021. Armed with this data, we will be able to improve education campaigns as well as share information with key stakeholders, and hopefully effect change.

Outcomes
During the study period, 354 children presented to hospital after an ATV accident (most aged 12-16 years). Over 90% of children using dirt-bikes were wearing a helmet compared to 48% of children using four-wheeled ATVs (quads, side-by-sides, and other ATVs). Accidents involving quads resulted in an average hospital stay of 10 days, compared to 2 days for cases involving dirt-bikes. Finally, the type of injury was significantly associated with the patient’s health region of residence. For example, children living in the North and Far North Saskatchewan accounted for the highest proportion of moderate/severe head injuries (76.19%) and polytraumas (50%).

Discussion/Future Directions
This data suggests that there is a potential knowledge gap in public knowledge regarding the risks of children using ATVs; that there may be barriers to helmet use; and, most strikingly, that there is a disproportionate number of severe injuries occurring in northern Saskatchewan. New public education initiatives are now in development based on these findings. There are many stakeholders to consider, and we are aiming to share our data so that evidence-based policy decisions can be made. We are currently drafting a letter to relevant ministries, and hope to have more progress to share in the near future.
R3 (Resident Advocacy Project) Evaluation of a Novel COVID-19 Vaccine Consult Service
Authors: Gibbs Danielle , Orkin Julia , Dharmaraj Blossom , Cinq-Mars Lise , Clarke Lindsay , Russett Genevieve , Solomon Donna , Boyce Allison , Beasley Patricia 
Published: September 2023

Abstract

Rationale and Objectives
Strengthening confidence in COVID-19 vaccination in the paediatric population promotes more children getting vaccinated, leading to fewer COVID-19 illnesses, hospitalizations and deaths.
Paediatric providers play an important role in promoting dialogue on the risks and benefits of the COVID-19 vaccines for children. Caregivers who experience hesitancy toward the vaccines may lack access to quality medical information. Developed to close this gap, the SickKids COVID-19 Vaccine Consult Service (VCS) is a nurse-led, telephone consultation service for residents of Ontario with questions/concerns about COVID-19 vaccination for children. The VCS aims to address vaccine hesitancy and enhance vaccine uptake, and ensures that children and caregivers have equitable access to timely and reliable information regarding COVID-19 vaccines in a safe and judgement-free environment. The VCS has escalation pathways in place should further discussion with a physician be required. Appointments can be booked without a referral and discussions are held by telephone. The VCS supports families whose children require specialized accommodation for vaccination with appointments at SickKids and throughout Ontario.

Project Description
A retrospective review of telephone consults received by the VCS between October 1, 2021- April 1, 2022 was undertaken to evaluate the service utilizing descriptive methodology. Information was extracted from databases stored in RedCap/EPIC and was maintained by staff conducting the calls. Inductive Thematic Analysis was utilized to analyze qualitative data and codes were generated to inform themes. Feedback formation was collected via exit surveys and included details about who was calling, reasons for calling, if concerns had been addressed, and intention to vaccinate.

Outcomes
Parents were the majority of callers (96%) and 4% were patients themselves, grandparents or other. A total of 99% of the calls included general questions about the vaccine, 36% of calls were questions about children with underlying medical conditions (cardiac conditions being the most common), and 12% were allergy-related questions. 9% of calls required a consult with MD/NP. 83% of questions/concerns were resolved following the call. Further, the majority of those surveyed following the appointment expressed intent for vaccination. Safety and development, side effects, and doses/intervals were the most common reason callers described hesitancy with proceeding with vaccination.

Discussion/Future Directions
Providing caregivers with timely and reliable information regarding COVID-19 vaccines through the VCS has proven to be effective in reducing vaccine hesitancy and increasing vaccine uptake in the paediatric community. In the future, the VCS model can be utilized to provide education to caregivers on other routine childhood vaccines.
A novel chemokine biomarker to distinguish active tuberculosis from latent tuberculosis: a cohort study
Authors: Li H , Ren W , Liang Q , Zhang X , Li Q , Shang Y , Ma L , Li S , Pang Y 
Published: September 2023

Summary

Background
Interferon-γ release assays (IGRAs), which are widely used to diagnose tuberculosis (TB), cannot effectively discriminate latent TB infection (LTBI) from active TB (ATB). This study aimed to identify potential antigen-specific biomarkers for differentiating LTBI cases from ATB cases.

Methods
Ongoing recruitment was conducted of individuals meeting study inclusion criteria at Beijing Chest Hospital from May 2020 to April 2022; 208 participants were enrolled and assigned to three groups: HC (60 healthy controls), LTBI (52 subjects with LTBI) and ATB (96 ATB patients). After participants were assigned to the discovery cohort (20 or 21 subjects/group), all others were assigned to the verification cohort. Discovery cohort blood levels of 40 chemokines were measured using Luminex assays to identify chemokines that could be used to discriminate LTBI cases from ATB cases; candidate biomarkers were verified using enzyme-linked immunosorbent assay-based testing of validation cohort samples.

Results
Luminex results revealed highest ATB group levels of numerous cytokines, growth factors and chemokines. Receiving operating characteristic curve-based analysis of 40 biomarkers revealed CCL8 (AUC = 0.890) and CXCL9 (AUC = 0.883) effectively discriminated between LTBI and TB cases; greatest diagnostic efficiency was obtained using both markers together (AUC = 0.929). Interpretation of CCL8 and CXCL9 levels for validation cohort IGRA-positive subjects (based on a 0.658-ng/ml cutoff) revealed ATB group CCL8-based sensitivity and specificity rates approaching 90.79% and 100.00%, respectively.

Conclusion
TB-specific chemokines hold promise as ATB diagnostic biomarkers. Additional laboratory confirmation is needed to establish whether CCL8-based assays can differentiate between ATB and LTBI cases, especially for bacteriologically unconfirmed TB cases.
Inhaled toxicants and pulmonary lipid metabolism: biological consequences and therapeutic interventions
Authors: Lovins Hannah B , Bathon Brooke E , Shaikh Saame Raza , Gowdy Kymberly M 
Published: September 2023

Abstract
Inhaled toxicants drive the onset of and exacerbate preexisting chronic pulmonary diseases, however, the biological mechanisms by which this occurs are largely unknown. Exposure to inhaled toxicants, both environmental and occupational, drives pulmonary inflammation and injury. Upon activation of the inflammatory response, polyunsaturated fatty acids (PUFAs) are metabolized into predominately proinflammatory lipid mediators termed eicosanoids which recruit immune cells to the site of injury, perpetuating inflammation to clear the exposed toxicants. Following inflammation, lipid mediator class-switching occurs, a process that leads to increased metabolism of hydroxylated derivates of PUFAs. These mediators, which include mono-hydroxylated PUFA derivatives and specialized proresolving lipid mediators, initiate an active process of inflammation resolution by inhibiting the inflammatory response and activating resolution pathways to return the tissue to homeostasis. Exposure to inhaled toxicants leads to alterations in the synthesis of these proinflammatory and proresolving lipid mediator pathways, resulting in greater pulmonary inflammation and injury, and increasing the risk for the onset of chronic lung diseases. Recent studies have begun utilizing supplementation of PUFAs and their metabolites as potential therapeutics for toxicant-induced pulmonary inflammation and injury. Here we will review the current understanding of the lipid mediators in pulmonary inflammation and resolution as well as the impact of dietary fatty acid supplementation on lipid mediator-driven inflammation following air pollution exposure.
Comprehensive analysis of JAZ family members in Ginkgo biloba reveals the regulatory role of the GbCOI1/GbJAZs/GbMYC2 module in ginkgolide biosynthesis
Authors: Du Jin-fa , Zhao Zhen , Xu Wen-bo , Wang Qiao-lei , Li Ping , Lu Xu 
Published: September 2023

Abstract
Ginkgo biloba L., an ancient relict plant known as a ‘living fossil’, has a high medicinal and nutritional value in its kernels and leaves. Ginkgolides are unique diterpene lactone compounds in G. biloba, with favorable therapeutic effects on cardiovascular and cerebrovascular diseases. Thus, it is essential to study the biosynthesis and regulatory mechanism of ginkgolide, which will contribute to quality improvement and medication requirements. In this study, the regulatory roles of the JAZ gene family and GbCOI1/GbJAZs/GbMYC2 module in ginkgolide biosynthesis were explored based on genome and methyl jasmonate-induced transcriptome. Firstly, 18 JAZ proteins were identified from G. biloba, and the gene characteristics and expansion patterns along with evolutionary relationships of these GbJAZs were analyzed systematically. Expression patterns analysis indicated that most GbJAZs expressed highly in the fibrous root and were induced significantly by methyl jasmonate. Mechanistically, yeast two-hybrid assays suggested that GbJAZ3/11 interacted with both GbMYC2 and GbCOI1, and several GbJAZ proteins could form homodimers or heterodimers between the GbJAZ family. Moreover, GbMYC2 is directly bound to the G-box element in the promoter of GbLPS, to regulate the biosynthesis of ginkgolide. Collectively, these results systematically characterized the JAZ gene family in G. biloba and demonstrated that the GbCOI1/GbJAZs/GbMYC2 module could regulate ginkgolides biosynthesis, which provides a novel insight for studying the mechanism of JA regulating ginkgolide biosynthesis.
The “Atypical Glandular Cells” Papanicolaou Test: Recent Updates
Authors: Li Zaibo , Zhao Chengquan 
Published: September 2023

AbstractAtypical glandular cells are gynecologic cytology abnormalities representing glandular cells with morphologic changes that exceed obvious reactive/reparative changes, but fall short of an interpretation of adenocarcinoma either quantitatively or qualitatively. This cytological diagnosis occurs in less than 1% of the results of gynecologic cytology tests (0.2%–0.8%) but potentially reflects a wide range of conditions, from benign changes and cervical squamous/glandular precursor lesions, to invasive cervical or other gynecologic cancers. In this article, we aim at reviewing different subcategories, potential ancillary studies, histological follow-up results, and clinical management of atypical glandular cells.
Changes and Clarifications in the Eighth Edition of the AJCC Cancer Staging System for Breast Cancer
Authors: Sanders Mary Ann , Wong Stephanie M. , Iorgulescu Julian Bryan , Lester Susan C. 
Published: September 2023

Abstract
In the eighth edition of the American Joint Committee on Cancer staging system for breast cancer, the definitions for T (tumor), N (nodes), and M (metastases) remain substantially unchanged but with clarifications for certain categories that may have been problematic for pathologists and clinicians. The principal change is the decision to exclude lobular carcinoma in situ from T classification. In contrast, there is a major change in how stage is determined by introducing a new clinical prognostic stage and a new pathological prognostic stage. These prognostic stages incorporate information about grade, estrogen receptor expression, progesterone receptor expression, human epidermal growth factor receptor 2 expression, and, in some cases, the Oncotype Dx Recurrence Score, in addition to T, N, and M, to create groups of cancers predicted to have a similar survival at 3 years based on information from the National Cancer Database. This review highlights the changes and notable clarifications to the TNM system and how these relate to standard pathology reporting.
The American Joint Committee on Cancer Eighth Edition: Changes in Thyroid Carcinoma Staging and an Update on Reporting
Authors: Berg Aaron N. , Seethala Raja R. 
Published: September 2023

Abstract
The AJCC Cancer Staging Manual, Eighth Edition (AJCC 8th edition) contains a number of significant changes, many of which affect the reporting of clinicopathologic parameters in thyroid cancers. The first key change is the separation of medullary thyroid carcinoma into its own chapter. Within differentiated and anaplastic thyroid carcinomas, anaplastic carcinomas are now assigned a T stage similar to differentiated thyroid carcinomas. However, this is largely cosmetic because these are still assigned stage group IV. Perhaps the most significant alteration from a reporting standpoint is revision of extrathyroidal extension (ETE) in terms of T staging. Pathologic stage pT3 is now subdivided into pT3a (by size) and pT3b (by ETE). Under AJCC 8th edition, pT3b is now defined by gross (clinical, radiologic, and/or macroscopic) ETE. Other key changes are the inclusion of level VII (anterior mediastinal) lymph nodes as N1a and changes in stage groupings, particularly with a new age cutoff of 55 years, and a downshift in several stage groups. In medullary thyroid carcinoma, the potential prognostic value of nonanatomic factors (ie, serum calcitonin, carcinoembryonic antigen, RET mutation status) is officially recognized, although not yet part of staging. The advent of the new terminology noninvasive follicular thyroid neoplasm with papillary-like nuclear features will remove a subset of tumors that qualify for this new designation from formal AJCC staging altogether.
Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: Pearls and Potential
Authors: Jiang Xiaoyin “Sara” , Foo Wen-Chi 
Published: September 2023

AbstractThyroid nodules are a commonplace clinical problem. Ultrasound-guided fine-needle aspiration biopsy is often the first step in the diagnosis and management of these nodules. We provide a review of technical considerations, performance, and techniques for thyroid nodule ultrasound-guided biopsy.
Indeterminate Thyroid Cytology and Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Features on Preoperative Diagnosis
Authors: Elsheikh Tarik M. 
Published: September 2023

Abstract
Since the introduction of “noninvasive follicular thyroid neoplasm with papillary-like features” terminology, there has been much discussion and debate on how to best accommodate this new classification and its anticipated effect on cytologic preoperative risk of malignancy. Noninvasive follicular thyroid neoplasm with papillary-like features is a recently proposed terminology that was applied to a subset of noninvasive follicular variant of papillary thyroid carcinomas to avoid the label of “cancer.” In this review, the impact of noninvasive follicular thyroid neoplasm with papillary-like features on thyroid FNA diagnosis and risk of malignancy is discussed, as well as its impact on the 2017 updates to the Thyroid Bethesda system classification. Minimal cytologic criteria for establishing a definitive diagnosis of papillary thyroid carcinoma are discussed, as well as detailed diagnostic criteria of the indeterminate thyroid categories, which include atypia/follicular lesion of undetermined significance, follicular neoplasm/suspicious for follicular neoplasm, and suspicious for malignancy. The role of molecular testing in management is briefly visited.