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1.幽门螺杆菌感染与终末期肾病的关系:中国人群的回顾性对列研究
慢性肾病或心血管疾病患者伴幽门螺杆菌感染时,其终末期肾病的风险增加
Association between Helicobacter pylori infection and the subsequent risk of end-stage renal disease: a nationwide population-based cohort study.
Lin SY(1), Lin CL, Liu JH, Yang YF, Huang CC, Kao CH.
Int J Clin Pract. 2015 Jan 21. doi: 10.1111/ijcp.12602.
[Epub ahead of print]
Abstract
BACKGROUND & AIMS: The association between Helicobacter pylori
infection and end-stage renal disease (ESRD) events remains unknown. We assessed the
relationship between H. pylori infection requiring hospital admission and the subsequent risks of ESRD.
METHODS: This was a retrospective cohort study in which
data from the National Health Insurance system of Taiwan
was used. The H. pylori-infected cohort comprised 20,068 patients. Each participant was frequency-matched by age and sex with 4 individuals from the general population without H. pylori-infected. Cox
proportional hazards regression analysis was used to estimate
the influence of H. pylori infection on the risk of ESRD.
RESULTS: The overall incidence of ESRD was 3.72 times greater
in the H. pylori-infected cohort than in the non-infected cohort (11.1 vs. 2.96 per 1000
person-years), with an adjusted HR of 2.58 [95% confidence interval
(CI) = 2.33-2.86]. The risk of ESRD markedly increased in patients with H. pylori
infection combined with at least one of the following concomitant
comorbidities: hypertension, diabetes, hyperlipidaemia and coronary artery disease.
CONCLUSIONS: This is currently the largest nation-based study in which the risk of ESRD in H. pylori-infected patients was examined. H. pylori infection was
associated with a subsequent risk of ESRD. H. pylori-infected patients with
concomitant chronic kidney disease (CKD) or cardiovascular
disease (CVD) risk factors were at higher risk of ESRD than were those who had a single CKD or CVD
risk factor.
2.亚洲地区幽门螺杆菌感染与胃食管反流性疾病关系的Meta分析
Meta分析显示:幽门螺杆菌的根除治疗增加亚洲地区胃食管反流性疾病的风险,
但在亚洲国家,幽门螺杆菌感染在胃食管反流患者中仍然一个是不确定和重要的问题。
Helicobacter pylori Infection in Gastroesophageal Reflux Disease in the Asian Countries.
Hong SJ(1), Kim SW(2).Gastroenterol Res Pract. 2015;2015:985249.
doi: 10.1155/2015/985249. Epub 2015 Jan 6.
Abstract
Helicobacter pylori infection, a common infection in many countries,
is related to the clinical course of upper gastrointestinal diseases. Gastroesophagealreflux disease (GERD) is a common esophageal
disease in Western countries and its
prevalence is increasing in Asian countries. The pathophysiology
of GERD is multifactorial. Although no single factor has been
isolated as the cause of GERD,a negative association between
the prevalence of H. pylori and the severity of
GERD, including Barrett's esophagus, has been demonstrated
in epidemiological studies. The high prevalence of H. pylori
infection affects the incidence of GERD in Asian countries.
In the subjects with East Asian CagA-positive strains, acid
injury may be minimized by hypochlorhydria from pangastritis
and gastric atrophy.Additionally, host genetic factors may affect
the development of GERD. The interactions between genetic factors
and the virulence of H. pylori infection may be the reason for the low
prevalence of GERD in Asian countries. H. pylori eradication is not
considered pivotal in GERD exacerbation based on
evidence from Western studies. A recent meta-analysis demonstrated that eradication therapy of
H. pylori was related to a higher risk of developing
de novo GERD in Asian studies. H. pylori infection remains
an inconclusive and important issue in GERD in Asian countries.
PMCID: PMC4302361
PMID: 25642246 [PubMed]
3. 幽门螺杆菌感染与心肌梗死关系的Meta分析
Helicobacter pylori and the Risk of Myocardial Infarction: Any Missing Data
in the Meta-Analysis?
Pellicano R(1).Helicobacter. 2015 Jan 30.
doi: 10.1111/hel.12212. [Epub ahead of print]
PMID: 25640774 [PubMed - as supplied by publisher]
4. 使用多重基因分析系统(MGAS)定性和定量的检测幽门螺杆菌
MGAS在幽门螺杆菌检测中的敏感性和特异性为92.9 和 92.4%
A Creative Helicobacter pylori Diagnosis Scheme Based on Multiple Genetic Analysis System:
Qualification and Quantitation.
Zhou L(1), Zhao F, Hu B, Fang Y, Miao Y, Huang Y, Ji D,
Zhang J, Xu L, Zhang Y,Bao Z, Zhao H.Helicobacter. 2015 Jan 29.
doi: 10.1111/hel.12206. [Epub ahead of print]
Abstract
BACKGROUND: Currently, several diagnostic assays for
Helicobacter pylori (H. pylori) are available, but each has
some limitations.Further, a high-flux quantitative assay is required
to assist clinical diagnosis and monitor the
effectiveness of therapy and novel vaccine candidates.
METHODS: Three hundred and eighty-seven adult patients [nonulcer dyspepsia (NUD) 295,peptic ulcer disease (PUD)
77, gastric cancer (GC) 15] were enrolled for
gastrointestinal endoscopies. Three biopsy samples from
gastric antrum were collected for the following tests:
culture, rapid urease test (RUT),histopathology, conventional
polymerase chain reaction (PCR), and Multiple
Genetic Analysis System (MGAS). The diagnostic capability
of H. pylori for all methods was evaluated through the
receiver operating characteristic (ROC) curves.
RESULTS: Based on the gold standard, the sensitivity and
specificity of MGAS were 92.9 and 92.4%, and positive predict
value (PPV) and negative predict value (NPV)
were 96.0 and 87.1%, respectively. All the above parameters
of MGAS were higher than that of culture (except its specificity),
RUT and histopathology, and nearly closed to that of conventional
PCR.The area under curve (AUC) was 0.7575
(Culture), 0.8870 (RUT), 0.9000 (Histopathology), 0.9496 (Conventional PCR), and
0.9277 (MGAS). No significant statistical difference was observed for the
H. pylori DNA load in different disease groups (p = .067). In contrast, a
statistically significant difference in the H. pylori DNA copy number was
observed based on age (p = .043) and gender (p = .021).
CONCLUSIONS: The data showed that MGAS performed well in detecting H. pylori
infection. Furthermore, the quantitative analysis showed that the load of
H. pylori was significantly different within both age and gender groups. These
results suggested that MGAS could be a potential alternative method for clinical
detection and monitoring of the effectiveness of H. pylori therapy.
PMID: 25640660 [PubMed - as supplied by publisher]
5. 韩国C13尿素呼气试验(不含柠檬酸、高剂量)在幽门螺杆菌根除治疗后的准确性研究
目前在韩国所使用的不含柠檬酸的C13尿素呼气试验的临界值特异性差,导致假阳性。
The Diagnostic Validity of Citric Acid-Free, High Dose <sup>13</sup> C-Urea Breath Test AfterHelicobacter pylori Eradication in Korea.
Kwon YH(1), Kim N, Lee JY, Choi YJ, Yoon K, Hwang JJ, Lee HJ,
Lee A, Jeong YS, Oh S, Yoon H, Shin CM, Park YS, Lee DH.Helicobacter.
2015 Jan 29. doi: 10.1111/hel.12189. [Epub ahead of print]
Abstract
BACKGROUND: The (13) C-urea breath test ((13) C-UBT) is a noninvasive method for diagnosing Helicobacter pylori (H. pylori) infection. The aims of this study wereto evaluate the diagnostic validity of the (13) C-UBT cutoff value and to identify influencing clinical factors responsible for aberrant results.
METHODS: (13) C-UBT (UBiTkit; Otsuka Pharmaceutical, cutoff value: 2.5‰) results
in the range 2.0‰ to 10.0‰ after H. pylori eradication therapy were compared with the results of endoscopic biopsy results of the antrum and body. Factors
considered to affect test results adversely were analyzed.
RESULTS: Among patients with a positive (13) C-UBT result (2.5‰ to 10.0‰,
n = 223) or a negative (13) C-UBT result (2.0‰ to < 2.5‰, n = 66) after H. pylori
eradication, 73 patients (34.0%) were false positive, and one (1.5%) was false
negative as determined by endoscopic biopsy. The sensitivity, specificity,
false-positive rate, and false-negative rate for a cutoff value of 2.5‰ were
99.3%, 47.1%, 52.9%, and 0.7%, respectively, and positive and negative predictive
values of the (13) C-UBT were 67.3% and 98.5%, respectively. Multivariate
analysis showed that a history of two or more previous H. pylori eradication
therapies (OR = 2.455, 95%CI = 1.299-4.641) and moderate to severe gastric
intestinal metaplasia (OR = 3.359, 95%CI = 1.572-7.178) were associated with a
false-positive (13) C-UBT result.
CONCLUSION: The (13) C-UBT cutoff value currently used has poor specificity for
confirming H. pylori status after eradication, and this lack of specificity is
exacerbated in patients that have undergone multiple prior eradication therapies
and in patients with moderate to severe gastric intestinal metaplasia. In
addition, the citric-free (13) C-UBT would increase a false-positive (13) C-UBT
result.
PMID: 25640474 [PubMed - as supplied by publisher]
6. 幽门螺杆菌的分子致病机理
综述文章:从幽门螺杆菌黏附、入侵胃黏膜上皮细胞、细胞内炎症通路的激活、到表观遗传修饰来进行阐述。
Molecular Mechanisms of Helicobacter Pylori Pathogenesis.
De Falco M(1), Lucariello A, Iaquinto S, Esposito V, Guerra G, De Luca A.J Cell Physiol. 2015 Jan 29. doi: 10.1002/jcp.24933. [Epub ahead of print]
Abstract
Helicobacter pylori infects 50% of mankind. The vast majority of H. pylori
infection occurs in the developing countries where up to 80% of the middle-aged
adults may be infected. Bacterial infection causes an inflammatory response that
proceeds through a series of intermediated stages of precancerous lesions
(gastritis, atrophy, intestinal metaplasia and dysplasia). Among infected
individuals, approximately 10% develops severe gastric lesions such as peptic
ulcer disease, 1-3% progresses to gastric cancer (GC) with a low 5 year survival
rate, and 0.1% develops mucosa-associated lymphoid tissue (MALT). GC is one of
the most common cancer and the third leading cause of cancer-related deaths
worldwide. In this review we have summarized the most recent papers about
molecular mechanisms of Helicobacter pylori pathogenesis. The main important
steps of H. pylori infection such as adhesion, entry in epithelial gastric cells,
activation of intracellular pathways until epigenetic modifications have been
described. This article is protected by copyright. All rights reserved.
PMID: 25639461 [PubMed - as supplied by publisher]
7. 新加坡研究,幽门螺杆菌一线治疗方案的比较:标准三联方案vs序贯疗法vs伴同疗法(疗程10天)
ITT方案分析时,三种方案的根除率均大于80%;MITT和PP方案分析时,三种方案的根除率均大于90%。抗生素双重耐药和依从性差可以预测根除治疗的失败。
Ten-day triple therapy versus sequential therapy versus concomitant therapy as first line treatment for Helicobacter pylori infection.
Ang TL(1), Fock KM, Song M, Ang D, Kwek AB, Ong J, Tan J, Teo EK, Dhamodaran S.J Gastroenterol Hepatol. 2015 Jan 16. doi: 10.1111/jgh.12892. [Epub ahead of
print]
Abstract
BACKGROUND AND AIM: Clarithromycin-based triple therapy (TT) is the first line
treatment for H. pylori infection in Singapore. There is awareness that TT may no
longer be effective due to increased clarithromycin resistance rates. Sequential
therapy (ST) and concomitant therapy (CT) are alternative treatment regimens. The
study aimed to compare the efficacy of 10-day TT, ST and CT as first line
treatment for H. pylori infection.
METHODS: A randomized study conducted in a teaching hospital. Patients aged 21
years and older with newly diagnosed H. pylori infection were randomized to
10-day TT, ST or CT. Treatment outcome was assessed by 13-carbon urea breath test at least 4 weeks after therapy. Intention to treat (ITT), modified ITT (MITT) and
per protocol (PP) analysis of the eradication rates were performed.
RESULTS: A total of 462 patients were enrolled (ST: 154; TT 155; CT 153). Patient
demographics were similar. Eradication rates for ST vs. TT vs. CT: ITT analysis:
84.4% vs. 83.2% vs. 81.7% (p= NS); MITT analysis: 90.3% vs. 92.1% vs. 94.7% (p =
NS); PP analysis: 94.1% vs. 92.8% vs. 95.4% (p = NS). Antibiotic resistance rates
for amoxicillin, clarithromycin and metronidazole were 4.7%, 17.9% and 48.1%
respectively. Dual clarithromycin and metronidazole resistance occurred in 7.5%.
Dual resistance and lack of compliance were predictors of treatment failure.
CONCLUSIONS: TT, ST and CT all achieved eradication rates above 80% on ITT and above 90% on MITT and PP analyses. Dual resistance and lack of compliance were predictors of treatment failure. ClinicalTrials.gov: NCT02092506.
PMID: 25639278 [PubMed - as supplied by publisher]
8.儿童幽门螺杆菌感染三联疗法根除方案中雷贝拉唑的剂量
儿童(≥1岁,<16岁)推荐按公斤体重计算(每日两次):
6-10公斤:10毫克;
10-30公斤:15毫克;
大于等于30公斤:20毫克
Helicobacter pylori Treatment in Children: Defining a Dose for Rabeprazole as a Part of a Triple Therapy Regimen.
Kimko H(1), Thyssen A, Mould DR, Mannaert E, Treem WR. J Clin Pharmacol. 2015 Jan 5. doi: 10.1002/jcph.457. [Epub ahead of print]
Abstract
The proton pump inhibitor, rabeprazole, has been studied in children for the
treatment of gastroesophageal reflux disease (GERD). In adults, rabeprazole is
indicated for Helicobacter pylori eradication in combination with amoxicillin and
clarithromycin. Nonlinear mixed effects modeling was conducted to estimate
pharmacokinetic (PK) parameters for rabeprazole and its thioether metabolite from
336 subjects, 35% of whom were children 1-11 years with GERD from phase I and III
studies. A 2-compartment disposition model with a transit absorption model
provided the best fit for rabeprazole PK. The steady-state area under the
concentration-time curves given several candidate doses were simulated to
identify a dose per each body weight group that is comparable to a 20 mg
twice-daily dose in adults, which is the recommended dose for treatment of H.
pylori in adults. Simulations provided the following recommended twice-daily
weight-based doses for children ≥1 year and <16 years: 10 mg for 6-10 kg, 15 mg for 10-30 kg, and 20 mg for ≥30 kg.
PMID: 25639255 [PubMed - as supplied by publisher]
9. Satureja bachtiarica Bung植物精油的抗幽门螺杆菌作用,以及其化学成分
Satureja bachtiarica Bung植物精油的主要成分为香芹酚(45.5%)和麝香草酚(27.9%),其在体外对幽门螺杆菌具有一定的抗菌活性,还有待于进一步的研究和探索。
Chemical composition and anti-Helicobacter pylori effect of Satureja bachtiarica Bunge essential oil.
Falsafi T(1), Moradi P(1), Mahboubi M(2), Rahimi E(3), Momtaz H(4), Hamedi B(5).Phytomedicine. 2015 Jan 15;22(1):173-7. doi: 10.1016/j.phymed.2014.11.012. Epub2014 Nov 26.
Abstract
Resistance of H. pylori strains to common antibiotics has been developed in
different parts of the world and continues to increase. It is important to
investigate the novel and efficient anti-H. pylori drugs, among which the plants
would be suitable sources. Satureja bachtiarica Bunge is traditionally used as
antimicrobial agent. In this study, we evaluated the antibacterial activity of S.
bachtiarica Bunge essential oil against 10 clinical isolates of Helicobacter
pylori by disc diffusion and agar dilution methods. The chemical composition of
essential oil was analyzed by GC and GC-MS. Carvacrol (45.5%) and thymol (27.9%)
were the primary constituents of oil, followed by p-cymene (4.4%), and
γ-terpinene (4.0%). S. bachtiarica essential oil showed strong antibacterial
activity against clinical isolates of H. pylori (17.6 ± 1.1 mm and
0.035 ± 0.13 μl/ml). Carvacrol, as the first main component, had a significant
role in this effect, whereas in the presence of thymol, the antibacterial effect
of carvacrol was reduced. Therefore, S. bachtiarica essential oil can be applied
as an alternative agent for treatment of H. pylori infections. More studies would
be required to better clarify its mechanism of action on H. pylori.
PMID: 25636887 [PubMed - in process]
10. 评估Exalenz Bioscience公司的13C尿素呼气试验产品BreathID(®)
Evaluation of Exalenz Bioscience's Breath ID for Helicobacter pylori detection.
Broide E(1), Shirin H.Expert Rev Mol Diagn. 2015 Jan 29:1-14. [Epub ahead of print]
Abstract
Carbon-labeled urea breath tests, which have high sensitivity and specificity,
are the preferred method used in epidemiological studies, screening dyspeptic
patients and assessing eradication or recurrence of Helicobacter pylori
infection. The principle of the (13)C-urea breath test relies upon the ability of
the H. pylori urease to hydrolyze the orally administered (13)C-urea. The
BreathID(®) (Exalenz Bioscience Inc., Union, NJ, USA) provides a competitive
solution for breath testing, including unique features such as automatic
continuous breath collection and analysis. This is an unattended convenient test,
with no human error as the correct part of the breath is collected and patients'
assistance is not required. The test results are available in real time at the
point of care and enable shortened breath testing procedures. Additionally,
several studies showing expanded utility of the BreathID in pediatrics, after
therapy and during proton pump inhibitors intake, further support the safety and
performance of the BreathID in the diagnosis of H. pylori.
PMID: 25634297 [PubMed - as supplied by publisher]
11.日本患者幽门螺杆菌感染和非甾体抗炎药引起消化性溃疡出血的时间变化趋势
在过去10年里,日本患者消化性溃疡出血的主要原因已不再是幽门螺杆菌感染,而是非甾体抗炎药的使用
Time Trends of the Impact of Helicobacter pylori Infection and Nonsteroidal Anti-Inflammatory Drugs on Peptic Ulcer Bleeding in Japanese Patients.
Nagasue T(1), Nakamura S, Kochi S, Kurahara K, Yaita H, Kawasaki K, Fuchigami T.Digestion. 2015;91(1):37-41. doi: 10.1159/000368810. Epub 2015 Jan 20.
Abstract
BACKGROUND/AIMS: Helicobacter pylori infection and the use of nonsteroidal
anti-inflammatory drugs (NSAIDs) are the main causes of peptic ulcers. The
purpose of the present study was to elucidate the time trends of the impact of H.
pylori infection and use of NSAIDs and/or antithrombotic agents on peptic ulcer
bleeding (PUB) in Japanese patients.
METHODS: We retrospectively reviewed 719 patients who had received endoscopic
hemostasis for PUB between 2002 and 2013. Subjects were divided into either the
first-half group (2002-2007, n = 363) or the second-half group (2008-2013, n =
356). The clinical characteristics of the patients, including the prevalence of
H. pylori infection and use of NSAIDs and antithrombotic agents, were compared
between the two groups.
RESULTS: Compared to the first-half group, patients in the second-half group were
characterized by older age (proportion of the patients above 60 years old, 63.9
vs. 76.7%, p = 0.0002), less frequent H. pylori infection (71.6 vs. 57.9%, p <
0.001) and more frequent NSAID intake (39.9 vs. 48.6%, p = 0.02). No significant
difference was observed regarding the use of antithrombotic agents between the
two groups (18.6 vs. 23.3%, p = 0.13). The prevalence of H. pylori infection and
proportion of patients above 60 years old were significantly different between
the two groups in a multivariate analysis.
CONCLUSION: The main cause of PUB has clearly shifted from H. pylori infection to
the use of NSAIDs over the last decade. © 2015 S. Karger AG, Basel.
PMID: 25632915 [PubMed - in process]
12.幽门螺杆菌感染的粪抗原检测的临床应用指南和成本效益
综述文章
Stool Antigen Tests for <i>Helicobacter pylori</i> Infection: A Review of Clinical and Cost-Effectiveness and Guidelines [Internet].
Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2015 Jan.
CADTH Rapid Response Reports.
Abstract
There are two types of stool antigen tests for the diagnosis of H. pylori
infection, one based on enzyme immunoassay (EIA) and the other based on
immunochromatography (ICA). Both types of tests can be operated using either
monoclonal antibody or polyclonal antibodies. Although both are highly sensitive
and specific, the EIA-based tests appears to be more accurate than the ICA-based
tests. However, the ICA-based tests do not required specialized equipment, are
easy to use, and are useful for rapid diagnosis of H. pylori infection. The aim
of this report is to review the diagnostic accuracy, clinical effectiveness,
cost-effectiveness, and guidelines of stool antigen tests for H. pylori
infection.
PMID: 25632493 [PubMed]
13. 幽门螺杆菌感染是否增加冠心病的风险
Helicobacter pylori: Does it add to risk of coronary artery disease.
Sharma V(1), Aggarwal A(1).World J Cardiol. 2015 Jan 26;7(1):19-25. doi: 10.4330/wjc.v7.i1.19.
Abstract
Helicobacter pylori (H. pylori) is a known pathogen implicated in genesis of
gastritis, peptic ulcer disease, gastric carcinoma and gastric lymphoma. Beyond
the stomach, the organism has also been implicated in the causation of immune
thrombocytopenia and iron deficiency anemia. Although an area of active clinical
research, the role of this gram negative organism in causation of atherosclerosis
and coronary artery disease (CAD) remains enigmatic. CAD is a multifactorial
disease which results from the atherosclerosis involving coronary arteries. The
major risk factors include age, diabetes mellitus, smoking, hypertension and
dyslipidemia. The risk of CAD is believed to increase with chronic inflammation.
Various organisms like Chlamydia and Helicobacter have been suspected to have a
role in genesis of atherosclerosis via causation of chronic inflammation. This
paper focuses on available evidence to ascertain if the role of H. pylori in CAD
causation has been proven beyond doubt and if eradication may reduce the risk of
CAD or improve outcomes in these patients.
PMCID: PMC4306202 PMID: 25632315 [PubMed]
14.幽门螺杆菌尿素呼气试验准确性的Meta分析,对于消化不良患者采用UBT检测幽门螺杆菌的准确性高。
Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis.
Ferwana M(1), Abdulmajeed I(1), Alhajiahmed A(1), Madani W(1), Firwana B(1),
Hasan R(1), Altayar O(1), Limburg PJ(1), Murad MH(1), Knawy B(1). World J Gastroenterol. 2015 Jan 28;21(4):1305-14. doi: 10.3748/wjg.v21.i4.1305.
Abstract
AIM: To quantitatively summarize and appraise the available evidence of urea
breath test (UBT) use to diagnose Helicobacter pylori (H. pylori) infection in
patients with dyspepsia and provide pooled diagnostic accuracy measures.
METHODS: We searched MEDLINE, EMBASE, Cochrane library and other databases for studies addressing the value of UBT in the diagnosis of H. pylori infection. We included cross-sectional studies that evaluated the diagnostic accuracy of UBT in adult patients with dyspeptic symptoms. Risk of bias was assessed using QUADAS (Quality Assessment of Diagnostic Accuracy Studies)-2 tool. Diagnostic accuracy measures were pooled using the random-effects model. Subgroup analysis was conducted by UBT type ((13)C vs (14)C) and by measurement technique (Infrared spectrometry vs Isotope Ratio Mass Spectrometry).
RESULTS: Out of 1380 studies identified, only 23 met the eligibility criteria.
Fourteen studies (61%) evaluated (13)C UBT and 9 studies (39%) evaluated (14)C
UBT. There was significant variation in the type of reference standard tests used
across studies.Pooled sensitivity was 0.96 (95%CI: 0.95-0.97) andpooled
specificity was 0.93 (95%CI: 0.91-0.94). Likelihood ratio for a positive test was
12 and for a negative test was 0.05 with an area under thecurve of 0.985.
Meta-analyses were associated with a significant statistical heterogeneity that
remained unexplained after subgroup analysis. The included studies had a moderate
risk of bias.
CONCLUSION: UBT has high diagnostic accuracy for detecting H. pylori infection in
patients with dyspepsia. The reliability of diagnostic meta-analytic estimates
however is limited by significant heterogeneity.
PMCID: PMC4306177
PMID: 25632206 [PubMed - in process]
15. 也门症状儿童幽门螺杆菌和寄生虫的感染率
Prevalence of Helicobacter pylori and parasites in symptomatic children examined for
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