bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Study of Presepsin as an Indicator of the Severity of Community-Acquired Pneumonia in Emergency Departments: Comparison with Pneumonia Severity Index and CURB-65 Scores
Authors: Ham Ji Yeon , Song Kyung Eun
Published: February 2019

Despite widely used severity indices such as the pneumonia severity index (PSI) and CURB-65, a rapid, easy-to-detect biological marker is required for assessment of community-acquired pneumonia (CAP) severity. We aimed to investigate the ability of presepsin to differentiate between high- and low-risk patients, categorized according to PSI and CURB-65 scores. This prospective study was performed in an emergency department (ED) with 90 CAP patients. Whole blood presepsin levels were measured with a point-of-care test instrument. Using PSI and CURB-65 scores, we classified patients into outpatient (low-score group of PSI and CURB-65) and inpatient (high-score group of PSI and CURB-65) management groups. Presepsin levels were significantly higher in CAP patients with the high-score groups compared to the corresponding low-score groups. Presepsin correlated well with low- and high-score PSI (ROC AUC: presepsin, 0.726; PCT, 0.614; CRP, 0.544) and CURB-65 groups (ROC AUC: presepsin, 0.669; PCT, 0.645; CRP, 0.602). Presepsin is a valuable biomarker for assessing and classifying CAP severity.
One-year safety and efficacy of intravenous etelcalcetide in patients on hemodialysis with secondary hyperparathyroidism
Authors: Bushinsky David A , Chertow Glenn M , Cheng Sunfa , Deng Hongjie , Kopyt Nelson , Martin Kevin J , Rastogi Anjay , Ureña-Torres Pablo , Vervloet Marc , Block Geoffrey A
Published: February 2019

Background

Secondary hyperparathyroidism (sHPT), a common complication of chronic kidney disease, is characterized by elevated serum parathyroid hormone (PTH). Etelcalcetide is an intravenous calcimimetic that increases sensitivity of the calcium-sensing receptor to calcium and decreases PTH secretion. This open-label extension (OLE) trial evaluated the long-term effects of etelcalcetide for sHPT treatment in patients receiving hemodialysis.

Methods

This 52-week, multicenter, single-arm OLE enrolled patients from three parent trials: two randomized, double-blind, placebo-controlled trials and one open-label, single-arm, ‘switch’ study from cinacalcet to etelcalcetide. The primary endpoint was to investigate the nature, frequency, severity and relation to treatment of all adverse events (AEs) reported throughout the trial. Secondary endpoints included the proportion of patients with >30% reduction from baseline in PTH and the percentage change from baseline in PTH, albumin-corrected calcium (Ca), phosphate (P) and the calcium–phosphate product (Ca × P).

ClinicalTrials.gov identifier: NCT01785875; Amgen study: 20120231.

Results

Overall, 89.8% of the patients experienced one or more treatment-emergent AE. The most common were decreased blood Ca (43.3%), diarrhea (10.8%), vomiting (10.4%) and nausea (9.6%); symptomatic hypocalcemia occurred in 3.7% of the patients. Approximately 68% of patients achieved >30% reduction in PTH, and ∼56% achieved PTH ≤300 pg/mL. Mean percent changes from baseline ranged from −25.4% to −26.1% for PTH, −8.3% to −9.1% for Ca, −3.6% to −4.1% for P and −12.0% to −12.6% for Ca × P.

Conclusions

Etelcalcetide effectively lowered PTH and its effect was sustained, while no new safety concerns emerged over a 1-year treatment period.
Prevalence of Anti-HCV Antibody Among the General Population in Mainland China Between 1991 and 2015: A Systematic Review and Meta-analysis
Authors: Gao Yuhua , Yang Jun , Sun Feng , Zhan Siyan , Fang Zhongliao , Liu Xueen , Zhuang Hui
Published: February 2019

Our study aims to estimate the burden of hepatitis C virus (HCV) infection among the general population in Mainland China. We searched 4 databases for studies of the prevalence of anti-HCV antibody among the general population. Studies that met the selection criteria were included in the meta-analysis. Ninety-four studies with 10729 929 individuals were finally included. Overall, the prevalence of anti-HCV antibody among the general population in Mainland China is 0.91% (95% confidence interval, 0.81%–1.03%). The prevalence rates of anti-HCV antibody were geographically different, with a range of 0.32%–6.51%, and the East and South of China had a relatively lower prevalence. The prevalence of anti-HCV antibody increased successively from 0.16% to 3.95% with advancing age. It was noteworthy that the prevalence of anti-HCV antibody decreased continuously from 2.09% to 0.45% during 1991–2010, whereas it increased to 0.58% during 2011–2015.
Viral RNA Degradation Makes Urine a Challenging Specimen for Detection of Japanese Encephalitis Virus in Patients With Suspected CNS Infection
Authors: Bharucha Tehmina , Sengvilaipaseuth Onanong , Seephonelee Malee , Vongsouvath Malavanh , Vongsouvath Manivanh , Rattanavong Sayaphet , Piorkowski Géraldine , Lecuit Marc , Gorman Christopher , Pommier Jean-David , Garson Jeremy A , Newton Paul N , de Lamballerie Xavier , Dubot-Pérès Audrey
Published: February 2019

Background

Japanese encephalitis virus (JEV) is a leading cause of central nervous system (CNS) infections in Asia and results in significant morbidity and mortality. JEV RNA is rarely detected in serum or cerebrospinal fluid (CSF), and diagnosis of JEV infection is usually based on serological tests that are frequently difficult to interpret. Unlike serum or CSF, urine is relatively easy to obtain, but, to date, there has been minimal work on the feasibility of testing urine for JEV RNA.

Methods

We investigated the use of lysis buffer and a Microsep device to optimize urine storage for detection of JEV RNA by reverse transcription real-time polymerase chain reaction (RT-qPCR). The best of the studied methods was then evaluated in consecutive patients admitted to the hospital with suspected CNS infections in Laos.

Results

We demonstrated degradation of JEV RNA in urine after even short storage periods at 4°C or –80°C. Although there was no advantage in using a Microsep concentration device alone, immediate addition of lysis buffer to fresh urine improved the detection of JEV RNA at the limit of detection.

Conclusions

In 2 studies of 41 patients with acute encephalitis syndrome, 11 (27%) were positive for JEV IgM in CSF and/or serum, and 2 (4.9%) were JEV RT-qPCR positive from throat swabs. JEV RNA was not detected in any of these patients’ urine samples. However, lysis buffer was only used during a prospective study, that is, for only 17/41 (41%) patient urine samples. Our findings suggest a need for larger studies testing urine for JEV RNA, with urine collected at different times from symptom onset, and using lysis buffer, which stabilizes RNA, for storage.
Multiplier method estimates of the population of men who have sex with men: the effect of privacy protection
Authors: Jing Liwei , Cui Yuehua , Lu Qing , Yu Hongmei
Published: February 2019

Objectives

The stigmatization of men who have sex with men (MSM) has led to an underestimation of their population size. To address this, the United Nations Programme on HIV/Acquired Immunodeficiency Syndrome and World Health Organization developed a multiplier method. However, nearly all multiplier method estimates of MSM population size in China are far below national estimates. This study explores how privacy protection to address and avoid MSM stigmatization can affect reliable estimates.

Methods

Data from an MSM website, a bar, and a peer-based HIV testing were used to produce three multiplier method estimates of the MSM population size in Taiyuan, China, in 2014. The effect of privacy protection on stigmatization was explored by comparing the peer-based HIV testing with other estimates. We used a national estimate as a reference to verify potential underestimation.

Results

The website and bar estimates were 5- to 10-times and 8- to 16-times lower than the Chinese national estimate range, respectively. Conversely, the peer-based HIV testing estimate was within the national estimate range.

Conclusions

Though the multiplier method was developed to estimate the size of stigmatized populations, it might be affected by privacy protection addressing stigmatization; this should be considered when gathering data.
Variation in patent impact by organization type: An investigation of government, university, and corporate patents
Authors: Schmid Jon , Fajebe Ayodeji
Published: February 2019

This article investigates whether patents assigned to different types of organizations—firms, universities, and government research agencies—vary with regards to their effect on subsequent technological change. We find the organization type to which a patent is assigned to have significant and robust effects on the number of times a patent is cited and its generality. More precisely, we find that university patents are cited more often than corporate patents and that both university and government patents are more general than corporate ones. Additionally, university and governments patents are more likely than corporate patents to be both highly cited and highly general. The finding that university patents have a particularly deep and wide impact on subsequent technological change suggests that policies that attempt to use universities as engines for advancing technological innovation may hold promise.
Growing Your Own: Will Your Associate Degree Nursing Student Consider a Future Faculty Role?
Authors: Bond Diana K. , Swanson Melvin S. , Winters-Thornburg Carol E.
Published: February 2019

AIM

The purpose of the study was to determine the intent of associate degree in nursing (ADN) students to pursue a future nursing faculty role.

BACKGROUND

Nursing faculty shortages negatively affect the capacity to educate new nurses.

METHOD

A prospective correlational research design was used to conduct a national survey of ADN students regarding their intent for a future nursing faculty role using constructs of social cognitive career theory.

RESULTS

Twenty-nine percent of participants intended to pursue a future faculty role. The statistically significant predictors of future intent were semesters completed (OR = 2.4), interest in the activities of a faculty role (OR = 2.3), encouragement from faculty (OR = 2.0), outcome expectations-advantages (OR = 1.7), and outcome expectations-disadvantages (OR = 0.7).

CONCLUSION

Encouraging ADN students toward graduate education and a future faculty role and informing them of all aspects of the role, including advantages and disadvantages, may inspire ADN students toward such a role.
Prognostic Factors for Patients With Undifferentiated High Grade Pleomorphic Sarcoma of the Spine
Authors: Lou Yan , Wan Wei , Wu Zhipeng , Yang Jian , Xu Kehan , Huang Quan , Liu Tielong , Wei Haifeng , Yang Xinghai , Xiao Jianru
Published: February 2019

Study Design.

Retrospective survival analysis of 44 undifferentiated high grade pleomorphic sarcoma (UPS) of the spine.

Objective.

To identify factors related to overall survival (OS) and help decision making in the treatment of undifferentiated high grade pleomorphic sarcoma of the spine.

Summary of Background Data.

UPS is an aggressive malignant tumor rarely originating from the spine. Due to its scarcity, only a few studies had been reported to describe the clinical features, treatments, and outcomes of sporadic cases, devoid of evaluation on prognostic factors.

Methods.

Enrolled in this survival analysis were 44 patients who underwent surgery and adjuvant therapies from January 1999 to December 2015. Kaplan–Meier methods were applied to estimate the overall survival. A multivariate Cox algorithm was applied to recognize factors independently associated with overall survival.

Results.

Multivariate analysis suggested that age greater than or equal to 55 years (hazard ratio [HR], 3.923, P < 0.001), Eastern Cooperative Oncology Group (ECOG) score four (HR, 4.656, P < 0.001), and subtotal resection or piecemeal total resection (HR, 4.375, P < 0.001) were independently associated with poor overall survival.

Conclusion.

We identified independent prognostic factors of UPS of the spine. Subtotal resection or piecemeal total resection, age more than or equal to 55 years and ECOG score four are factors adversely affecting overall survival of patients with UPS of the spine.

Level of Evidence: 4
Hybrid Growing Rod Technique of Osteotomy With Short Fusion and Spinal Distraction
Authors: Sun Xu , Xu Liang , Chen Zhonghui , Shi Benlong , Chen Xi , Li Song , Du Changzhi , Zhou Qingshuang , Qiu Yong , Zhu Zezhang
Published: February 2019

Study Design.

Retrospective study.

Objective.

The current study aimed to evaluate the effectiveness of the hybrid growing rod (GR) technique for the treatment of young children with congenital scoliosis (CS).

Summary of Background Data.

Congenital vertebral anomalies within long-spanned kyphoscoliosis were difficult to be managed by either definitive spinal fusion or standard GR technique. Hybrid technique of one-stage posterior osteotomy with short fusion and GR distraction was proposed in previous studies. There is, however, paucity of data regarding its effectiveness.

Methods.

Thirteen patients (mean age, 5.4 ± 2.0 yr) who had undergone hybrid GR treatment were retrospectively reviewed, including 8 patients treated with single GR and 5 patients with dual GR. All of their radiographic data were measured, and surgical complications were recorded.

Results.

On average, the current cohort had 4.1 ± 1.7 lengthening procedures. After the index surgery, the major curve improved remarkably from 86.4° ± 11.9° to 37.3° ± 12.4° (P < 0.001). The global kyphosis significantly decreased from 66.8° ± 16.1° to 33.3° ± 3.5° postoperatively. Both value remained steady during follow-up. There were no significant difference between single GR and dual GR groups in terms of the coronal deformity correction, whereas correction loss of global kyphosis in single GR group was significantly higher than that in dual GR group (P = 0.039). After the index surgery, T1-S1 height averagely gained 4.4 ± 0.8 cm and it grew at an average rate of 1.31 ± 0.24 cm/yr during the follow-up. Two complications were identified in two patients, including one with rod fracture and one with proximal junctional kyphosis.

Conclusion.

The hybrid GR technique was effective in correcting spinal deformity and allowing continuous spinal growth. The optimal indications were young children with apical vertebrae anomalies and a long-spanned kyphoscoliosis.

Level of Evidence: 3
Application of a Prognostic Stratification System for High-risk Prostate Cancer to Patients Treated With Radiotherapy
Authors: Foster Benjamin , Jackson William , Foster Corey , Dess Robert , Abu-Isa Eyad , McLaughlin Patrick William , Merrick Gregory , Hearn Jason , Spratt Daniel , Liauw Stanley , Hamstra Daniel
Published: February 2019

Objectives:

We applied an established prognostic model to high-risk prostate cancer (HRPC) patients treated with radiotherapy (RT) and evaluated the influence of clinical and treatment variables on treatment outcomes.

Methods:

In total, 1075 HRPC patients undergoing definitive radiotherapy (RT) between 1995 and 2010 were retrospectively reviewed. Median follow-up was 62.3 months. Patients received either dose-escalated external beam radiotherapy (n=628, EBRT) or combined-modality radiotherapy (n=447, pelvic RT and low-dose rate brachytherapy boost, CMRT). 82.9% received androgen-deprivation therapy (ADT). A prognostic model stratified patients into predefined groups (good, intermediate, and poor). Kaplan-Meier methods and Cox proportional hazards regressions assessed biochemical failure (BF), distant metastasis (DM), prostate cancer-specific mortality (PCSM) and overall mortality (OM). C-indices analyzed predictive value.

Results:

The model was prognostic; C-indices for BF, DM, PCSM and OM were: 0.62, 0.64, 0.61, and 0.57. On multivariate analysis, CMRT and longer ADT (≥24 mo) were associated with improved BF, DM, and PCSM. Gleason score (GS) 9-10 was the strongest predictor of PCSM. C-indices for BF, DM, PCSM, and OM using a 4-compartment model incorporating GS 9-10 were: 0.62, 0.65, 0.68, and 0.56. In poor-prognosis patients (GS 8-10+additional risk factors), CMRT+LTADT (>12 mo) had 10-year PCSM (3.7%±3.6%), comparing favorably to 25.8%±9.2% with EBRT+LTADT.

Conclusions:

The model applies to high-risk RT patients; GS 9-10 remains a powerful predictor of PCSM. Comparing similar prognosis patients, CMRT is associated with improved disease-specific outcomes relative to EBRT. In poor-prognosis patients, CMRT+LTADT yields superior 10-year PCSM, potentially improving RT treatment personalization for those with HRPC.
Tobacco Treatment Programs at National Cancer Institute-designated Cancer Centers
Authors: Day Andrew T. , Tang Liyang , Karam-Hage Maher , Fakhry Carole
Published: February 2019

Objectives:

The main objectives of this study were to evaluate abstinence rates of tobacco treatment programs (TTPs) at National Cancer Institute (NCI)-designated cancer centers (DCCs) and to ascertain the number of NCI-DCCs with online references to TTPs.

Methods:

Literature searches of Pubmed, EMBASE, Web of Science, and Scopus were performed from their inception through January 2018 using keywords including cancer patients, cancer survivors, tobacco, smoking, cessation, and program. In total, 4094 articles were identified, 1450 duplicates were removed, 2644 candidate titles and abstracts were screened, and 210 selected full-text articles were independently reviewed by 2 authors. Three retrospective, single-institution cohort studies describing system-wide TTPs at 3 NCI-DCCs met inclusion criteria. Secondarily, online website audits of each NCI-DCC were performed to identify institutions with online evidence of a system-wide TTP servicing cancer patients.

Results:

Among 62 NCI-DCCs, only 3 reported system-wide TTP outcomes. Abstinence rates ranged from 15% to 47%. Online website audit identified 47 NCI-DCCs maintaining system-wide TTPs. Seventeen TTPs were housed within the cancer center and 30 TTPs were offered by the primary affiliated institution; among the latter group, only 13 TTPs were identifiable via the NCI-DCC webpage.

Conclusions:

Most NCI-DCCs offer tobacco treatment services to cancer patients but very few have reported their results. Increased NCI-DCC TTP outcome publication and online presence are needed.
Elevated Pretreatment CEA and CA19-9 Levels are Related to Early Treatment Failure in Esophageal Adenocarcinoma
Authors: van der Kaaij Rosa T. , Voncken Francine E.M. , van Dieren Jolanda M. , Snaebjornsson Petur , Korse Catharina M. , Grootscholten Cecile , Aleman Berthe M.P. , van Sandick Johanna W.
Published: February 2019

Introduction:

Chemoradiotherapy and surgery are the basis of the potentially curative treatment for esophageal cancer. Approximately 1 in 5 patients, however, do not benefit from this intensive treatment due to early treatment failure. The aim of this study was to evaluate levels of carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 at diagnosis, in relation to survival and early treatment failure (disease recurrence or death within 1 year after surgery).

Methods:

Patients with esophageal adenocarcinoma scheduled for chemoradiotherapy followed by surgery between 1998 and 2014 were selected from a retrospectively collected database if both CEA and CA19-9 levels were measured before the start of treatment.

Results:

Pretreatment CEA and CA19-9 levels were known in 102 patients. Median overall survival differed (P<0.001) between patients with normal levels of both CEA and CA19-9 (n=59; 51 mo), patients with elevated CEA only (n=13; 43 mo), patients with elevated CA19-9 only (n=19; 24 mo), and those with elevated levels of both CEA and CA19-9 (n=11; 11 mo). Elevation of both CEA and CA19-9 was associated with early treatment failure (odds ratio: 10.4; 95% confidence interval: 2.4-45.5, P=0.002). Median time to tumor recurrence was 34 months in patients with normal CEA and CA19-9 levels, and 7 months in those with elevated levels of both (P=0.003).

Conclusions:

Pretreatment elevated CEA and CA19-9 levels were significantly associated with early treatment failure and decreased overall survival in this esophageal adenocarcinoma patient cohort treated with curative intent. Until prospective validation, CEA and CA19-9 might play a role in identifying high-risk patients before the start of intensive locoregional therapy.
Celecoxib potentiates the antianxiety and anticompulsive-like activity of fluoxetine against chronic unpredictable mild stress in experimental animals
Authors: Garabadu Debapriya , Kumar Vivek
Published: February 2019

Obsessive–compulsive disorder (OCD) is considered a heterogeneous anxiety disorder that includes compulsions. Celecoxib is considered an adjuvant to fluoxetine in the management of OCD in a clinical study. However, the experimental evidence is yet to be established. Therefore, the antianxiety and anticompulsive-like activity of celecoxib (20 mg/kg, orally) was evaluated in the presence or absence of fluoxetine (20 mg/kg, orally) in mice who were exposed to chronic unpredictable mild stress (CUMS) for 14 consecutive days. Seven-day treatment of celecoxib significantly attenuated the CUMS-induced anxiety in open-field, hole-board, elevated plus maze tests, and compulsion in the marble-burying test. Celecoxib significantly reversed the CUMS-induced decrease and increase in the levels of serotonin (5-HT) and its metabolite (5-hydroxyindole acetic acid) in the prefrontal cortex, and attenuated the CUMS-induced increase in the levels of inflammatory markers such as interleukin-6 and tumor necrosis factor-α, and apoptosis marker caspase-3 in the prefrontal cortex. Celecoxib also potentiated the anxiolytic, anticompulsive, serotonergic, anti-inflammatory, and antiapoptotic activity of 7-day treatment with fluoxetine in CUMS-challenged animals compared with their monotherapy. Thus, it can be speculated that the combination of an anti-inflammatory agent with selective serotonin reuptake inhibitor could be a better therapeutic option in the management of stress-related disorders including selective serotonin reuptake inhibitor-resistant OCD.
Role of AMPA receptor stimulation and TrkB signaling in the antidepressant-like effect of ketamine co-administered with a group II mGlu receptor antagonist, LY341495, in the forced swim test in rats
Authors: Agnieszka Pałucha-Poniewiera , Karolina Podkowa , Andrzej Pilc
Published: February 2019

Ketamine has been shown to induce a rapid antidepressant effect on patients with depression. In many animal models, both rapid and sustained antidepressant activities were also found in response to an antagonist of group II metabotropic glutamate receptors, LY341495, and its mechanism of action seemed to be similar in many ways to the action of ketamine. It has also been found that LY341495 enhanced the antidepressant-like activity of sub-effective doses of ketamine in rats without inducing adverse effects. Here, we investigated the role of AMPA receptor and TrkB receptor activation in the antidepressant-like effects of ketamine (3 mg/kg) co-administered with LY341495 (0.1 mg/kg), in the forced swim test in rats, at three time points (40 min, 3 h and 24 h) after joint administration of the tested compounds. It was found that the AMPA receptor antagonist NBQX (10 mg/kg) reversed the antidepressant effect of ketamine co-administered with LY341495 at all tested time points, whereas the TrkB receptor antagonist ANA-12 contributed to blockade of the effect of ketamine and LY341495 3 h after their joint administration. These results indicate that activation of AMPA receptor and BDNF-related signaling may play a role in the mechanism of antidepressant action of ketamine co-administered with LY341495.
Epidemiology of Perinatal HIV Transmission in the United States in the Era of Its Elimination
Authors: Nesheim Steven R. , FitzHarris Lauren F. , Mahle Gray Kristen , Lampe Margaret A.
Published: February 2019

The number of infants born with HIV in the United States has decreased for years, approaching the Centers for Disease Control and Prevention’s incidence goal for eliminating perinatal HIV transmission. We reviewed recent literature on perinatal HIV transmission in the United States. Among perinatally HIV-exposed infants (whose mothers have HIV, without regard to infants’ HIV diagnosis), prenatal and natal antiretroviral use has increased, maternal HIV infection is more frequently diagnosed before pregnancy and breast-feeding is uncommon. In contrast, mothers of infants with HIV are tested at a lower rate for HIV, receive prenatal care less often, receive antiretrovirals (prenatal and natal) less often and breastfeed more often. The incidence of perinatal HIV remains 5 times as high among black than white infants. The annual number of births to women with HIV was estimated last for 2006 (8700) but has likely decreased. The numbers of women of childbearing age living with HIV and HIV diagnoses have decreased. The estimated time from HIV infection to diagnosis remains long among women and men who acquired HIV heterosexually. It is important to review the epidemiology and to continue monitoring outcomes and other health indicators for reproductive age adults living with HIV and their infants.
Curious Case of a Year-Long History of Cold Subcutaneous Abscesses
Authors: Frani Ian Adrian F. , Asad Shadaba
Published: February 2019

Cold subcutaneous abscess (CSA) is an abscess lacking classic inflammatory signs. This is a case of a 27-year-old incarcerated African American man who presented with 1-year history of soft, painless, mobile, masses on his limbs. Chest computed tomography scan showed diffuse reticulonodular infiltrates with right lower lobe mass. Computed tomography scan of the right upper extremity showed fluid density with no deep tissue involvement. Coccidioides complement fixation titers are 1:64, IgG 1.315, and IgM 0.242. Lung biopsy and CSA aspiration showed thick walled black spherules with endospores consistent with disseminated coccidioidomycosis (DCM). Cold subcutaneous abscess is a rarely reported manifestation of DCM. Defective cell-mediated immunity and inhibition of inflammation were thought to play a role in DCM and CSA pathogenesis. Cold subcutaneous abscess can remain unnoticed because of lack of inflammation. Our patient has longest time a CSA lasted without other symptoms of DCM. It is important to recognize it early to uncover a potentially dangerous disease.
Risk Factors and Outcomes of Vancomycin-Resistant Versus Vancomycin-Sensitive Enterococcal Bloodstream Infections in Patients With Acute Myeloid Leukemia
Authors: Hackney Noah , Addisu Anteneh , Nanjappa Sowmya , Greene John
Published: February 2019

Background

Studies have shown increased mortality from vancomycin-resistant enterococcal (VRE) bloodstream infections (BSI) in neutropenic patients. Whether these mortality differences pertain to acute myeloid leukemia (AML) patients is unknown. We compared risk factors and outcomes between VRE and vancomycin-sensitive enterococcal (VSE) BSIs in AML patients.

Methods

We conducted a single-center, 5-year, retrospective cohort study of AML patients with enterococcal BSI. Neutropenia duration, Enterococcus species, vancomycin exposure, VRE colonization, 7- and 30-day mortality, age, sex, length of stay, and central line status were compared and analyzed.

Results

There were a total of 77 AML patients with enterococcal BSI, 54.5% had VRE. Enterococcus faecalis and Enterococcus faecium accounted for 28.5% and 62.3% of BSI, respectively. The E. faecalis isolates were more likely to be VSE (91% vs 9%, P < 0.001) and E. faecium isolates to be VRE (71% vs 29%, P < 0.001). Duration of neutropenia was significantly longer (27.3 days vs 2.7 days, P < 0.005) among VRE patients. Recent vancomycin use and VRE colonization were associated with VRE BSI. There were no differences in bacteremia duration, length of stay, or 7- and 30-day mortality between VRE and VSE BSI.

Conclusion

Enterococcal infections among AML patients are more likely to be caused by vancomycin-resistant E. faecium. The risk is increased by VRE colonization and vancomycin exposure. In a relatively homogenous group of patients, treatment-related factors may affect outcome more than species type or susceptibility of bacterial isolates. This finding is important for future development of patient education, preventive, and treatment protocols.
Twenty-Four–Hour Measures of Heart Rate–Corrected QT Interval, Peak-to-End of the T-Wave, and Peak-to-End of the T-Wave/Corrected QT Interval Ratio During Antipsychotic Treatment
Authors: Tümüklü Mevhibe N. , Tümüklü Mustafa M. , Nesterenko Vladislav , Jayathilake Karu , Beasley Charles M. , Meltzer Herbert Y.
Published: February 2019

Purpose/Background

Prolonged ventricular repolarization, measured by heart rate–corrected QT interval (QTc) prolongation, might be a biomarker for risk of torsade de pointes (TdP) and sudden cardiac death. However, the predictive value of QTc has been challenged, and a component of QTc, peak-to-end of the T-wave (Tpe), and a high Tpe/QT ratio might be superior biomarkers because they better reflect increased transmural dispersion of ventricular myocyte repolarization, which can lead to TDP. The purpose of this pilot study was to provide the first measurements of heart rate, QTc, Tpe, Tpe/QTc, and their variability over 24 hours in medication-free patients with schizophrenia, during treatment with ziprasidone or other antipsychotic drugs, and healthy controls.

Methods

Subjects included 12 patients treated with ziprasidone, 30 treated with other antipsychotic drugs, 3 unmedicated patients, and 15 normal controls. Subjects underwent 24-hour analog Holter recording, and the recordings were digitized. A cardiologist blind to treatment selected multiple 10-cycle segments throughout each recording and measured the electrocardiogram metrics.

Results

Variability in QTc, Tpe, and Tpe/QTc over the 24 hours was present in all groups; 91.1% of patients and 100% of controls had 1 or more QTc values of 450 milliseconds or greater. Mean QTc length was significantly greater in the ziprasidone-treated than the non–ziprasidone-treated patients (P= 0.02). Mean Tpe was not elevated in the ziprasidone patients, whereas mean Tpe/QTc was lower (P< 0.01).

Conclusions

The large variability in QTc, Tpe, and Tpe/QTc observed supports the need for 24-hour electrocardiogram recordings to provide an accurate assessment of risk of TdP. Heart rate–corrected QT interval alone does not capture the risk of TdP.
Fluoroscopy and Dynamic Pressure-Based Foot Orthoses for Children With Flatfoot
Authors: Liu Xue-Cheng , Rizza Robert , Van Valin Scott , Al-Ramahi Jehad , Lyon Roger , Thometz John
Published: February 2019

Introduction

The current nonsurgical treatment for pediatric flatfoot includes shoe modification, inserts, and foot orthoses (FOs). However, these methods do not affect the course of flatfoot in children and have only limited evidence of correction of foot pronation. The goals of this study are 1) to describe how to design novel customized FOs using plantar pressure and fluoroscopic measurements; and 2) to assess kinematics and kinetics of the foot and ankle joint and functional outcomes at baseline and 12-month follow-up.

Materials and Methods

One child with bilateral flatfeet received trio-pressure measurements, including dynamic plantar pressure, single sensor pressures on the lateral calcaneus, and medial talar head. The two-dimensional (2D) foot motion in the sagittal plane during the stance phase using single gantry fluoroscopy was recorded. Three-dimensional (3D) surface images of the entire foot and distal lower limb were registered.

Results

A total of 14 pressure metrics and three-dimensional (3D) foot and ankle topography were used to design the new orthoses and generate a computer-aided design model. Data from the fluoroscopic images were used to evaluate the orthotic design. Finally, two orthoses were designed and manufactured with a rapid prototype system (SLS).

Discussion

The gait-based software was successfully developed to design the new orthoses. Features included use of navicular height, talar and calcaneal alignment, pressure metrics, and foot geometry. This case study had 12-month follow-up and showed that the new FOs reduced pain and improved functional outcomes.

Conclusions

Use of gait-based software allows a further approach directly into the rapid prototype systems for orthoses designed to address pes valgus deformity.
Organ dysfunction in cirrhosis: a mechanism involving the microcirculation
Authors: Brito-Azevedo Anderson , Perez Renata M. , Maranhão Priscila A. , Coelho Henrique S. , Fernandes Eduardo S.M. , Castiglione Raquel C. , de Souza Maria D. , Villela-Nogueira Cristiane A. , Bouskela Eliete
Published: February 2019

Introduction

Microcirculation is essential for adequate tissue perfusion and organ function. Microcirculatory changes may occur in cirrhosis, inducing loss of multiorgan function. The aim was to evaluate preliver transplantation and postliver transplantation aspects of multiorgan function, microcirculation, inflammatory, and endothelial biomarkers and survival in a controlled study including cirrhotic outpatients.

Patients and methods

We accessed functional capillary density (FCD) and red blood cell acceleration (RBCA) by nailfold videocapillaroscopy. Inflammatory and endothelial biomarkers [interleukin-6 (IL-6), soluble intercellular adhesion molecule-1, endothelin-1, and tumor necrosis factor-α] were analyzed. Cerebral and renal functions were assessed to represent organ dysfunction and regression analyses were carried out. Receiver operating characteristic curves were constructed and survival Kaplan–Meier analysis was carried out.

Results

Fifty-four patients and 18 controls were included. Inflammatory and endothelial markers increased in advanced disease. FCD was reduced and RBCA was progressively lower according to disease severity. RBCA correlated inversely with inflammatory and endothelial biomarkers, and directly with renal function. The presence of hepatic encephalopathy correlated inversely with RBCA and directly with IL-6 and endothelin-1. In multivariate analysis, RBCA was an independent factor for organ dysfunction. The area under the receiver operating chartacteristic curve for IL-6 for survival was 0.74 (0.59–0.89), P=0.05. Transplant-free survival was 97.5% for values under 5.78 ng/ml (IL-6 best cutoff) and 83.9% above 5.78 ng/ml, log-rank=0.018. Eleven patients underwent transplantation, with an overall improvement in microcirculatory function.

Conclusion

Our results suggest a mechanism of organ damage in cirrhosis, where microcirculatory dysfunction could be correlated to inflammatory and endothelial biomarkers, and loss of multiorgan function. IL-6 seems to be an important survival marker of inflammation. Liver transplantation improved microcirculatory dysfunction, corroborating this hypothesis.
Can l-carnitine supplementation and exercise improve muscle complications in patients with liver cirrhosis who receive branched-chain amino acid supplementation?
Authors: Hiraoka Atsushi , Kiguchi Daisuke , Ninomiya Tomoyuki , Hirooka Masashi , Abe Masanori , Matsuura Bunzo , Hiasa Yoichi , Michitaka Kojiro
Published: February 2019

Background

The aim of this study was to elucidate the efficacy of the combination of l-carnitine and exercise, reported to prevent muscle wasting, for muscle complications (function, volume, and cramping) in patients with liver cirrhosis (LC) who received branched-chain amino acid supplementation.

Materials and methods

From December 2017 to April 2018, 18 patients with LC who had been given branched-chain amino acid granule supplementation (12.45 g/day) were enrolled (mean age 68.4±10.8 years; 10 males and eight females; Child–Pugh A : B=9 : 9). After evaluating the average number of daily steps, oral l-carnitine supplementation (1000 mg/day) and additional exercise (plus 2000 steps/day) were added for 6 months. Every 4 weeks, a pedometer, a hand dynamometer, ergometer, and bioelectrical impedance analysis were used to evaluate daily steps, muscle function and muscle volume, and muscle cramps were recorded using a numerical rating scale.

Results

Average steps and serum levels of total and free carnitine were increased from before treatment to the final measurement (1883.5±1211.6 vs. 3165.1±1800.0/day, 62.6±16.5 vs. 110.9±28.6 μmol/l, and 47.7±15.2 vs. 83.2±21.5 μmol/l, respectively; P<0.01), whereas there were no significant changes in the ratios of handgrip strength, leg strength, and muscle volume after 6 months [1.00±0.13 (P=0.991), 1.07±0.13 (P=0.073), and 0.992±0.036 (P=0.390), respectively]. However, the frequency of complaints of muscle cramping was reduced as compared with the start of therapy (baseline, 3 months, and 6 months: 6.3±4.8, 3.1±3.3, and 2.1±2.0, respectively) (P=0.025, Holm’s method), whereas numerical rating scale did not show any significant improvement.

Conclusion

l-Carnitine may have an important role for prevention of muscle wasting and reducing the frequency of muscle cramping.
The promising role of probiotic and synbiotic therapy in aminotransferase levels and inflammatory markers in patients with nonalcoholic fatty liver disease – a systematic review and meta-analysis
Authors: Khan Muhammad Y. , Mihali Albana B. , Rawala Muhammad S. , Aslam Aysha , Siddiqui Waqas J.
Published: February 2019

Background

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide. The pathogenesis of NAFLD is complex and multifactorial. There is growing evidence that altered gut microbiota plays a key role in NAFLD progression. Probiotics/synbiotics, by modifying gut microbiota, may be a promising treatment choice for NAFLD management.

Aim

The aim of this study was to study the effect of probiotics/synbiotics on various laboratory and radiographic parameters in NAFLD management.

Materials and methods

A systematic review and meta-analysis were carried out according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We searched PubMed, Medline, and Google Scholar for randomized-controlled trials that studied the role of probiotics/synbiotics in NAFLD. The primary outcome was change in baseline alanine aminotransferase and aspartate aminotransferase in the treatment arm. We used a random-effects model and inverse variance for the continuous data to estimate the mean difference (MD) and the standard mean difference (SMD) in RevMan Version 5.3.

Results

We included 12 randomized-controlled trials for analysis. The intervention arm, which comprised of the probiotic and/or the synbiotic arm, showed a significant improvement in alanine aminotransferase levels, MD=–13.93, confidence interval (CI)=–20.20 to –7.66, P value of less than 0.0001, I
2=92% and aspartate aminotransferase levels MD=−11.45, CI=−15.15 to −7.74, P value of less than 0.00001, I
2=91%. There was a reduction in high-sensitivity C-reactive protein levels in the intervention arm, SMD=–0.68, CI=–1.10 to –0.26, P value of 0.001, I
2=0%. The liver fibrosis score improved in the intervention arm, MD=–0.71, CI=–0.81 to –0.61, P value less than 0.00001, I
2=0%.

Conclusion

Probiotic/synbiotic use improves aminotransaminase levels and reduces proinflammatory marker high-sensitivity C-reactive protein and liver fibrosis in NAFLD patients.
Clinical relevance of human papillomavirus outside of oropharynx
Authors: Klozar Jan
Published: February 2019

Purpose of review

The role of HPV in oropharyngeal cancer is well recognized. HPV DNA is also found in a fraction of head and neck tumors outside of oropharynx but its clinical importance is unknown. The purpose of this review is to sum up the present knowledge about the prevalence and possible impact of HPV presence in head and neck tumors in nonoropharyngeal sites.

Recent findings

The data demonstrating prevalence of HPV presence in tumors outside of oropharynx are inconsistent. However, it can be stated that it is substantially lower than in oropharynx. Most articles report the HPV DNA presence only but very few prove also the transcriptionally active viral presence. The fraction of really HPV-induced tumors is probably very small. The majority of literature shows no impact of HPV on prognosis in nonoropharyngeal locations. Also the role of high-risk HPV in malignant transformation of lesions potentially linked to malignancy like inverted papillomas, recurrent respiratory papillomatosis or laryngeal dysplasia was up to date not demonstrated.

Despite of the unknown role of HPV and lack of evidence regarding any clinical use of HPV knowledge in other than oropharyngeal tumors, further research is warranted.
Photodynamic therapy in head and neck cancer: indications, outcomes, and future prospects
Authors: Meulemans Jeroen , Delaere Pierre , Vander Poorten Vincent
Published: February 2019

Purpose of review

To identify and review the recent literature on clinical applications, outcome, and new developments in photodynamic therapy (PDT) for the treatment of head and neck cancer.

Recent findings

Although PDT and surgery have a similar local control and recurrence rate, the gold standard of treatment for early-stage oral cavity cancer remains local surgery with, on indication, concurrent treatment of the neck. PDT proves its value in treatment of patients with field cancerization and patients with superficial recurrence after previous surgery and/or radiation, in whom surgical salvage would entail important morbidity. PDT is also promising as an adjuvant treatment after surgery in the presence of macroscopic or microscopic involved margins, in patients where reresection or reirradiation would imply an unacceptable risk. Recent progress in the field of PDT focuses on development and clinical application of new photosensitizing agents, photochemical internalization, and photoimmunotherapy.

The value of PDT in specific well-selected head and neck cancer clinical scenarios is well established. The basic research field is rapidly evolving and experimental findings are promising, maybe eventually leading to optimized results, less side-effects, and more indications.
Resistance-related determinants in clinically relevant Staphylococcus aureus isolated from teaching therapeutic centers, Tehran, Iran
Authors: Solgi Sana , Razavi Shabnam , Nateghian Alireza , Irajian Gholamreza , Pournajaf Abazar , Hasannejad-Bibalan Meysam , Rahmani Sara
Published: February 2019

Objectives:

The purpose of this study was to determine the antimicrobial resistance-related genes in Staphylococcus aureus isolated from patients referred to 14 teaching hospitals, Tehran, Iran.

Methods:

A total of 225 S. aureus were obtained from clinical samples in a period of 12 months. Antimicrobial resistance, minimum inhibitory concentration minimal inhibitory concentration and Inducible resistance phenotypes were determined based on the Clinical laboratory standard institute (CLSI) guidelines. PCR was performed for amplification of mecA/B/C, iles-2, ermA/B/C and ereA/B genes.

Results:

39.5 and 40.8% of isolates were resistant to oxacillin and cefoxitin (FOX), respectively. The frequency of constitutive macrolide-lincosamide-streptograminB, inducible macrolide-lincosamide-streptograminB and MS phenotypes were 55.3, 28.6 and 16.1%, respectively. 40.8, 4, 7.5, 6.2, 16 and 3.1% of strains harbored the mecA, ileS-2, ermA, ermB, ermC and ereA genes, respectively.

Conclusion:

The frequency of methicillin-resistant S. aureus isolates in our hospitals was high and disk diffusion testing using FOX or oxacillin and/or FOX minimal inhibitory concentration E test as an alternative to PCR for identification of methicillin-resistant S. aureus is suggested. This study highlights the hypothesis that rapid testing plays an important role in antibiotic stewardship by getting patients on targeted therapy faster.
Relation between the amount of daily activity and gait quality in transfemoral amputees
Authors: Müßig Janina A. , Brauner Torsten , Kröger Inga , Varady Patrick A. , Brand Andreas , Klöpfer-Krämer Isabella , Simmel Stefan , Horstmann Thomas , Augat Peter
Published: February 2019

Gait variability is often associated with reduced coordination and increased instability during walking. Especially for patients with musculoskeletal conditions, variability in gait might be associated with the level of daily activity. Therefore, this study examines kinematic variability during walking and the association with daily activity in patients with transfemoral amputation. Therefore, 15 transfemoral amputees, using the C-leg prosthesis of Otto Bock, between 18 and 65 years were recruited during their hospital stay. All patients were able to walk without crutches in everyday life and were familiar with walking using the C-leg system. Gait parameters and data of variability were captured during walking in a gait laboratory by eight infrared cameras (Vicon). Daily activity was assessed using a three-dimensional acceleration sensor of VitaMove. Patients showed variability from 0.84° up to 1.96° in frontal pelvis motion and from 0.9° up to 4.02° in trunk obliquity. The results show a significant correlation between activity and variability in trunk (r = −0.58; P  ≤ 0.05) and pelvis (r = −0.63; P ≤ 0.01) as well as gait velocity (r = 0.6; P  ≤ 0.05). However, kinematic variability and gait velocity are not related to each other. In conclusion, the results show that kinematic gait variability is associated with the extent of activity and therefore presents an important parameter for assessing amputees’ gait quality and daily activity.
High-Intensity Interval Training in Panic Disorder Patients
Authors: Plag Jens , Ergec Deniz-Levent , Fydrich Thomas , Ströhle Andreas
Published: February 2019

High-intensity interval training (HIIT) may produce strong physiological but also psychological effects within a short period. However, it is questionable if this type of training is applicable and effective in patients with panic disorder (PD) because they are more vulnerable to the adverse effects of exercise. Twelve PD patients performed a 12-day HIIT trial. Every second day, patients performed 10 high-intensive 1-minute intervals at 77% to 95% of their maximum heart rate separated by 1-minute intervals with moderate to low intensity. All patients completed the 12-day training period. PD severity, agoraphobia, depression, general disorder severity, and endurance performance improved substantially with moderate to large effects sizes. Moreover, the increase in endurance performance was correlated with the reduction of depression and agoraphobia. HIIT was well tolerated by patients with PD and may induce rapid and strong therapeutic effects. A randomized controlled clinical trial is needed to verify our findings.