bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategy for lung parenchyma-sparing bronchial resection: a case series report
Authors: Ohsumi Akihiro , Kayawake Hidenao , Yamada Yoshito , Tanaka Satona , Yutaka Yojiro , Nakajima Daisuke , Hamaji Masatsugu , Menju Toshi , Date Hiroshi 
Published: June 2022

Abstract

Lung parenchyma-sparing bronchial resection is uncommon, and the operative procedure depends on the cause and location of the stenosis. We present 6 cases and discuss the different surgical strategies for sleeve resection of the central airway without lung resection. Bronchoplasty for the main bronchus and truncus intermedius was performed with a posterolateral approach. We resected the right main bronchus including the right lateral wall of the lower trachea and half of the carina obliquely and performed an anastomosis. The tumour in the left lobar bronchus was exposed and removed by transient division of the accompanying pulmonary artery. Although post-transplant stenosis and malacia can pose a challenge, bronchoplasty can be used as a definitive treatment in experienced centres.
A Novel Locus on 6p21.2 for Cancer Treatment–Induced Cardiac Dysfunction Among Childhood Cancer Survivors
Authors: Sapkota Yadav , Ehrhardt Matthew J , Qin Na , Wang Zhaoming , Liu Qi , Qiu Weiyu , Shelton Kyla , Shao Ying , Plyler Emily , Mulder Heather L , Easton John , Michael J Robert , Burridge Paul W , Wang Xuexia , Wilson Carmen L , Jefferies John L , Chow Eric J , Oeffinger Kevin C , Morton Lindsay M , Li Chunliang , Yang Jun J , Zhang Jinghui , Bhatia Smita , Mulrooney Daniel A , Hudson Melissa M , Robison Leslie L , Armstrong Gregory T , Yasui Yutaka 
Published: June 2022

Abstract

Background
Adult survivors of childhood cancer are at increased risk of cardiac late effects.

Methods
Using whole-genome sequencing data from 1870 survivors of European ancestry in the St. Jude Lifetime Cohort (SJLIFE) study, genetic variants were examined for association with ejection fraction (EF) and clinically assessed cancer therapy–induced cardiac dysfunction (CCD). Statistically significant findings were validated in 301 SJLIFE survivors of African ancestry and 4020 survivors of European ancestry from the Childhood Cancer Survivor Study. All statistical tests were 2-sided.

Results
A variant near KCNK17 showed genome-wide significant association with EF (rs2815063-A: EF reduction = 1.6%; P = 2.1 × 10-8) in SJLIFE survivors of European ancestry, which replicated in SJLIFE survivors of African ancestry (EF reduction = 1.5%; P = .004). The rs2815063-A also showed a 1.80-fold (P = .008) risk of severe or disabling or life-threatening CCD and replicated in 4020 Childhood Cancer Survivor Study survivors of European ancestry (odds ratio = 1.40; P = .04). Notably, rs2815063-A was specifically associated among survivors exposed to doxorubicin only, with a stronger effect on EF (3.3% EF reduction) and CCD (2.97-fold). Whole blood DNA methylation data in 1651 SJLIFE survivors of European ancestry showed statistically significant correlation of rs2815063-A with dysregulation of KCNK17 enhancers (false discovery rate &lt;5%), which replicated in 263 survivors of African ancestry. Consistently, the rs2815063-A was associated with KCNK17 downregulation based on RNA sequencing of 75 survivors.

Conclusions
Leveraging the 2 largest cohorts of childhood cancer survivors in North America and survivor-specific polygenomic functional data, we identified a novel risk locus for CCD, which showed specificity with doxorubicin-induced cardiac dysfunction and highlighted dysregulation of KCNK17 as the likely molecular mechanism underlying this genetic association.
#42 A Retrospective Study of Valganciclovir Discontinuation Due to Toxicity or Intolerance in Pediatric Solid Organ Transplant Patients
Authors: Demirhan Salih 
Published: June 2022

Abstract

Background
Cytomegalovirus (CMV) prevention strategies in pediatric solid organ transplantation (SOT) recipients include universal prophylaxis or pre-emptive therapy with valganciclovir (VGCV) based on CMV risk stratification. However, VGCV is associated with myelosuppresion and nephrotoxicity, which may result in premature termination or dose modifications of VGCV and/or discontinuation of Pneumocystis jirovecii pneumonia (PJP) prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX), which is also myelosupressive. There are no currently approved alternatives for CMV prevention in pediatric SOT patients. Thus, the specific aims of this study were to determine the frequency with which SOT recipients receiving VGCV develop neutropenia or lymphopenia, how often VGCV or TMP-SMX are discontinued or have a dose reduction, and whether changes in CMV prophylaxis are associated with increased rates of CMV DNAemia or disease.

Method
A retrospective, observational study of pediatric SOT recipients who were &lt; 20 years old and who initiated VGCV prophylaxis, with the intent to receive at least 3 months of therapy, was conducted at 8 U.S. centers between January 2016 and December 2019. Each site abstracted demographic and clinical data for 1 year post-transplantation into a central REDCap electronic database hosted at St Jude. Patients with complete information as of December 2021 (n= 557) were included in this preliminary analysis.

Results
The cohort included 201 renal (36%), 101 cardiac (18%), 202 liver (36%), 34 lung (6%), 10 multivisceral (2%), 2 intestinal and 6 other SOT recipients. Median age at transplantation was 9.5 [IQR: 2.7- 14] years; 52% were male. VGCV was prematurely discontinued in 31 and the dose was adjusted in 168 resulting in changes in 199 (36%) recipients. TMP-SMX was discontinued prematurely in 61 and changed to an alternative therapy in 77 patients resulting in changes in 131 (24%) recipients. Seven patients discontinued both medications. No breakthrough cases of Pneumocystis pneumonia were documented. There were 119 (21%) patients with at least one episode of CMV DNAemia in the first year post-transplant, 54 (45%) of these occurred in patients who had changes to their VGCV prophylaxis.

Conclusion
Preliminary analysis of this large pediatric cohort suggests that CMV prophylaxis with VGCV is difficult to maintain and requires frequent dose adjustments and/or discontinuation of either VGCV and/or TMP-SMX for PJP prophylaxis. Despite alterations in PJP prophylaxis, no breakthrough infections were documented. These findings highlight the need to study the safety and efficacy of alternative prophylactic options for CMV in pediatric SOT recipients.
#12 Comparing Treatment of Pediatric Bronchiolitis and Upper Respiratory Infections in Primary, Tertiary, and Urgent Care Settings
Authors: Dellplain Laura 
Published: June 2022

Abstract

Background
Pediatric bronchiolitis and upper respiratory infections (URI) are almost always of viral origin and thus managed without antibiotics. Inappropriate antibiotic use for such diagnoses can contribute to antimicrobial resistance. We assessed the appropriateness of pediatric bronchiolitis and URI treatment in primary, tertiary, and urgent care settings within a large private health system in Upstate New York and compared treatment appropriateness between the three settings.

Method
We conducted a retrospective, observational chart review of patient visits in pediatric primary, pediatric tertiary, and urgent care settings where there was a presumptive diagnosis of bronchiolitis or URI between January 1 and December 31, 2019 using ICD-10 diagnostic codes. We assessed patient treatment for each visit as “appropriate,” “possibly appropriate,” or “inappropriate” based on extracted chart data. We performed simple proportion calculations for each treatment category in each care setting, and then compared proportions for each treatment category between settings using chi-square and logistic regression models.

Results
Of the 450 patient visits reviewed in each care setting, 354 primary care, 375 tertiary care, and 442 urgent care visits met the inclusion criteria. Table 1 shows the proportion of appropriate, possibly appropriate, and inappropriate visits in the primary, tertiary, and urgent care settings. The tertiary care and urgent care settings had a statistically significant proportion of possibly appropriate or inappropriate encounters at 2.4% and 4.8% respectively. In comparing odds ratios for possibly appropriate or inappropriate treatment of pediatric bronchiolitis and URIs between care settings, urgent care setting treatments were 5.77 times more likely to be inappropriate or possibly appropriate than in pediatric primary care settings (95% CI [1.71, 19.5]). Differences in treatment between primary and tertiary care settings and tertiary and urgent care settings were not statistically significant.

Conclusion
In 2019, nearly all reviewed encounters in the pediatric primary, pediatric tertiary, and urgent care settings within a large private health system in Upstate New York adhered to clinical guidelines for bronchiolitis and URI treatment. However, the urgent care setting had a significantly greater odds of possibly appropriate or inappropriate treatment of these pediatric infections, highlighting an opportunity for further education and intervention to improve guideline adherence for bronchiolitis and URI management in that setting.
#21 High Caregiver Adverse Childhood Experiences are Associated with Influenza and COVID-19 Vaccination Acceptance in One Pediatric Primary Care Site
Authors: Day Melissa E 
Published: June 2022

Abstract

Background
Vaccine hesitancy is complex, ranging from safety concerns to decisions built atop disinformation and medical mistrust. Though distrust towards healthcare providers has been described in those with adverse childhood experiences (ACEs), studies have not assessed for links between caregiver ACEs and pediatric vaccine refusal. We sought to determine the association between caregiver ACEs and caregiver decisions to immunize their child with influenza and COVID-19 vaccines.

Method
This was a cross-sectional study of caregivers of patients &gt;6 months at one pediatric primary care center. Caregivers completed a 19-question survey to determine ACE score, influenza vaccine acceptance and beliefs (adapted from a CDC-validated survey), and intention to accept the COVID-19 vaccine for their children. Demographic characteristics, social risk factors (e.g. housing and food insecurity), social work notes or medical legal partnership referrals within 3 days of a clinic visit, and vaccination data of the children present with each caregiver were extracted from the electronic medical record. Statistical analyses included chi-square tests for categorical variables and t-tests for age. The chi-square test was used to determine the association between caregiver ACEs (high versus low) and demographic, social risk factors and vaccination acceptance, and the two-sample t-test was used to test for differences in child age.

Results
A total of 234 caregivers participated, representing 276 patients (mean age of 5.9 years, 52% male). Of participating caregivers, 24% (n = 56) had high ACEs (score ≥ 4) and 38% (n = 88) accepted influenza vaccination for their child in 2021. Of those with high ACEs, 51% accepted influenza vaccination for their child compared to 34% with low ACEs (p = 0.03). Those with high ACEs also had more positive attitudes toward influenza vaccine safety and efficacy (p=0.01). Intention to vaccinate children with COVID-19 vaccine also varied by caregiver ACE score (high ACEs: 40%; low ACEs: 24%; p=0.03). Insurance type, a positive social risk screen, and social work consult were not associated with ACEs (Table 1).

Conclusion
Influenza vaccination rates and intention to vaccinate children with the COVID-19 vaccine differed between caregivers with high and low ACEs – those with more ACEs were more likely to vaccinate. Further studies assessing the role of caregiver ACEs on vaccine decision-making is warranted.
#38 The Impact of the COVID-19 Pandemic on Acute Appendicitis Presentation in Two Urban Multiethnic Community Hospitals
Authors: Mallikarjuna Priya 
Published: June 2022

Abstract

Background
Acute appendicitis (AA) is the most common abdominal surgical emergency in pediatrics. There was a precipitous drop in pediatric visits to hospitals, including the emergency department, since the United States declared COVID-19 a national emergency. Managing AA during the pandemic remains a challenge as fear of COVID exposure can lead to delays in presentation and surgery, as well as a shift to conservative management. Alvarado score (AS) is a ten-point clinical scoring system to identify AA and the American Association for the Surgery of Trauma (AAST) grading system (I-V) is a validated tool for AA diagnosis and severity. There are no studies on prevalence and severity of AA during the COVID-19 pandemic in an urban multiethnic community.

Method
This is a retrospective chart review of patients admitted to Flushing Hospital Medical Center and Jamaica Hospital Medical Center with the diagnosis of AA from March 2018 to March 2021. Charts were reviewed for demographics, clinical, imaging and surgical data to determine AS and AAST. AS grouped from 1-6 (less likely to require surgery) and 7-10 (more likely to require surgery). AAST scoring was based on most severe criteria if grading discrepancies were found between pathology, surgical and computed tomography findings. Leukocytosis was defined as white blood cell count &gt;10. G1 identified AA cases March 2018 - February 2020 and G2 March 2020 – March 2021. Data was analyzed using SPSS software, p&lt;0.05 was considered significant.

Results
Of 239 patients with AA over 3 years, G1 totaled 184 (77%) in 2 years pre-pandemic and G2 had 55 (23%) during first year pandemic. Mean age, gender and ethnicity were similar for G1 and G2. AS and AAST were compared for G1 and G2, Table 1. G2 had significantly greater overall AS of &gt;7 (p=0.038) and higher AAST (p=0.016). Only three patients tested positive for SARS-CoV-2 and 9 (16%) of G2 were transferred to a tertiary care center.

Conclusion
Although there was a decline in number of AA evaluated in our emergency department, the severity of AA was heightened during the pandemic. Healthcare providers need to have a high index of suspicion of increased severity with AA complications.
#48 Stenotropomonas maltophilia infection in the Neonatal Intensive Care Unit: A retrospective study of risk factors and outcome in a tertiary hospital in New York.
Authors: Khan Sana Irfan 
Published: June 2022

Abstract

Background
Stenotrophomonas maltophilia (S maltophilia) remains an important nosocomial gram-negative bacillus on the rise with limited studies in the neonatal population. The aim of the present study was to review the risk factors and outcomes of S maltophilia infections in the level 3 neonatal intensive care unit (NICU) of a tertiary hospital in Brooklyn, New York City.

Method
A retrospective review and analysis of electronic medical records of patients admitted to NICU with culture positive S maltophilia and matched controls in a period of 12 years from 2008-2020 was carried out. The JMP 10.0 (SAS Institute Inc., Cary, NC, USA) software package was used for data analyses. T-test was used to determine if there was a significant difference between the data of interest among cases and controls. Values of p &lt;0.05 were considered statistically significant.

Results
Twenty-one cases of S maltophilia were compared with 42 controls in the study (case control ratio of 1:2). Of the 21 patients with S maltophilia infections, 13 (70%) were females and 8 (30%) were males. The median birth weight of neonates with S maltophilia infection was 705g versus 770.5g in the control group. The median length of NICU stay in culture positive cases was 134 days while the median duration in control was 92 days (p&lt;0.01). The median duration of total parenteral nutrition (TPN) was 113.5 days in cases while it was 19.5 days in control (p&lt;0.001). The median duration of mechanical ventilation in cases was 54 days versus 20.5 days in control (&lt;0.01). The median duration of antibiotic use was 67.5 days in cases while it was 23 days in the control group (p&lt;0.01). Six patients in the cases group underwent abdominal surgery and the overall mortality rate in the case group was 28.5%.

Conclusion
This study demonstrated that invasive interventions such as mechanical ventilation and TPN are associated with S maltophilia infection. In addition, long hospital stays and extended antibiotic use are risk factors. Efforts to reduce exposure to the identified risk factors are essential to prevent infections in this population given the high mortality. In particular, antimicrobial stewardship programs have the potential to reduce number of days on antibiotics and other risk factors as well as provide guidance on diagnosis and treatment in infected neonates.
#49 Nasal microbiota differences in young infants are associated with early childhood irritability
Authors: Mithal Leena 
Published: June 2022

Abstract

Background
The etiology and pathophysiology of childhood mental health are poorly understood. Early childhood irritability is a transdiagnostic marker that portends significant risk for subsequent mental health problems. Robust evidence demonstrates irritability can be quantified early in infancy. The early life microbiome is implicated in defining health trajectories including neurodevelopment. In contrast to the gut microbiome, however, a relationship between the infant nasal microbiome and early childhood irritability remains undefined. We sought to investigate associations between the nasal microbiota of infants &lt;60 days of age and early childhood irritability.

Method
This case-control study included infants with archived respiratory nasal samples collected for routine clinical care at ≤60 days of age from an emergency department visit (1/2016-5/2019). Parents completed an online survey when children were 14-42 months of age that included questions about medical history, development, and irritability (Multidimensional Assessment of Preschool Disruptive Behavior, MAP-DB). The upper quartile of the MAP-DB Temper Loss Score was classified as high dysregulation. Additional clinical data were collected from the electronic health record. DNA extracted from archived viral media specimens were subjected to 16S rRNA gene (V3-V4 region) next generation sequencing (NGS). Ecological diversity and differential taxon analysis were performed.

Results
Seventy-two children were initially included, with 16 categorized as high dysregulation. The median age at nasal sample collection was 30 days (IQR 14-44), and age at parent survey was 28 months (IQR 19-31). Fifty-weight percent of the cohort was white, 6% Black, 6% Asian, 20% other, and 25% identified as Lantine ethnicity. The infants were 49% female sex, 77% were born by vaginal delivery, and 43% had a virus identified at time of nasal sample. After removal of extraction/PCR contaminants, taxa present only or at higher levels in media, and samples with &lt;80 sequences, the final microbiota comparison dataset was n=33 children, 7 with high dysregulation. Alpha-diversity (Shannon index) was lower in the high dysregulation group (p=0.0031 pre-background taxa removal, p=0.1288 post-correction, Figure 1A-B). Of the 18 taxa that were compared, Haemophilus, Streptococcus, Staphylococcus, and Gardnerella were significantly less abundant in the high dysregulation group (false discovery corrected significance q&lt;0.005, Figure 1C). Parasutterella was more abundant in a subset of the high dysregulation group.

Conclusion
Differences in the nasal microbiota of infants, decreased diversity and abundance of certain respiratory bacteria, are associated with early childhood irritability, a marker of mental health risk. Further study may provide mechanistic insights and potentially guide new risk assessment or treatment options.
#62 Resolution of thrombocytopenia during treatment for symptomatic congenital cytomegalovirus disease
Authors: Walcott Shelby 
Published: June 2022

Abstract

Background
Congenital cytomegalovirus (cCMV) is the most common congenital viral infection in the United States (4.5 per 1000 live births) and is the leading non-genetic cause of sensorineural hearing loss and developmental disabilities in children worldwide. However, reliable estimates of time to resolution for manifestations of cCMV disease have not been fully elucidated. A better understanding of the resolution of laboratory abnormalities for cCMV is needed to guide decisions about frequency of platelet assessments following diagnosis and potentially optimize antiviral therapy.

Method
Data from 243 infants with symptomatic cCMV were retrospectively analyzed from four studies conducted by the NIH-funded Collaborative Antiviral Study Group over the years 1989-2011. Individuals were compared based on baseline platelet value, utilizing Division of AIDS Toxicity Scale categorization, and treatment received. Kinetics of the trend in platelets over time were compared between groups using Kaplan-Meier plots and binomial assessments of abnormal vs. normal. All analyses were conducted over the 6-week (45 day) time period.

Results
Predicted curves showed that the interaction between antiviral therapy and platelet value over time was found to be significant (p=0.0106) for individuals with normal baseline platelet counts (Grade 0, defined as ≥ 125,000). For individuals with Grades 1-4 thrombocytopenia at baseline, probability curves showed that both baseline grade (p=0.0006) and time (p&lt;.0001) correlated with rate of resolution of thrombocytopenia, but antiviral treatment did not (p=0.1964). Kaplan-Meier plots of time to platelet count of ≥ 125,000 demonstrated that baseline platelet grade was significantly (p=0.0003) correlated with time to resolution of thrombocytopenia. Kaplan-Meier plots of time to platelet count of ≥ 100,000 demonstrated that baseline platelet grade was significantly (p=0.0056) correlated with time to Grade 1 thrombocytopenia.

Conclusion
For neonates with baseline thrombocytopenia from cCMV, antiviral therapy does not hasten time to resolution of thrombocytopenia. For neonates with normal baseline platelet values, antiviral therapy correlated with increasing platelet counts. Degree of baseline thrombocytopenia correlated with time to normalization of platelet count. Further understanding of the kinetics of resolution of laboratory abnormalities for symptomatic cCMV is needed to directly inform patient management decisions.