bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Cytomegalovirus Anterior Uveitis at a North American Tertiary Center With Oral Valganciclovir
Authors: Bhoopat Taniya , Takhar Jaskirat S. , Oldenburg Catherine E. , Keenan Jeremy D. , Gonzales John A. , Margolis Todd P. 
Published: February 2020

Purpose:
Cytomegalovirus is an increasingly recognized cause of anterior uveitis. We present clinical features of cytomegalovirus anterior uveitis (CMVAU) and outcomes of oral valganciclovir treatment at a tertiary referral center in North America.

Methods:
This is a retrospective case series review (2002–2014) of immunocompetent patients with CMVAU treated with valganciclovir 900 mg BID and subsequent maintenance dosing of ≤450 mg BID. Most patients were prescribed topical corticosteroids concurrently. Diagnostic evaluations and clinical features at baseline and follow-up were reviewed. Resolution time, maintenance of quiescence, and adverse events were assessed.

Results:
Eighteen eyes of 16 patients were included. The mean age of diagnosis was 41 years. At diagnosis, mean best-corrected visual acuity was 0.30 LogMAR and mean intraocular pressure (IOP) was 18.4 mm Hg; 14 eyes (78%) had an active anterior chamber (AC) cell, 8 (44%) had circinate keratic precipitates, and 6 (33%) had iris atrophy. The mean follow-up duration was 48 months. Fourteen eyes of 12 patients were available for the 12-month follow-up; patients demonstrated improvement in best-corrected visual acuity (difference: −0.21 LogMAR, 95% CI −0.33 to −0.09; P = 0.003), AC cell (OR = 0.10, 95% CI 0.02–0.41; P = 0.002), and IOP (difference: −4.21 mm Hg, 95% CI −7.98 to −0.44; P = 0.03) compared with baseline. One patient experienced a serious adverse event likely due to valganciclovir. Thirteen eyes experienced recurrence of inflammation: 7 (54%) on prophylactic dose of valganciclovir and 6 (46%) after stopping.

Conclusions:
Valganciclovir appears effective and safe for treating CMVAU in this retrospective case series. Long-term antiviral prophylaxis does not abolish recurrences, although it may possibly reduce their frequency when compared with no prophylaxis.
Fulminant Acanthamoeba Endophthalmitis After Cataract Surgery—A Case Report
Authors: Raghavan Anita , Veerappan Saravanan , Rangarajan Viji , Rajaraman Revathi , Salian Romit , MK Janani , L Dhanurekha , Ganesh VR Ram , Venkatapathy Narendran , Rammohan Ram 
Published: February 2020

Purpose:
To report a case of Acanthamoeba endophthalmitis after an uneventful cataract surgery.

Methods:
Description, management, and outcomes of a biopsy-proven case of Acanthamoeba endophthalmitis.

Results:
Two days after a routine cataract surgery elsewhere, the patient presented with acute endophthalmitis diagnosed as a bacterial infection based on timing and severity. When conventional methods of management failed, the patient was referred to us. Only the presence of an atypical ring infiltrate suggested Acanthamoeba as a probable cause. Subsequent diagnostic evaluations confirmed the initial suspicion. Management with topical antiamoebics and intracameral and intravitreal voriconazole was attempted. Systemic voriconazole and metronidazole were also administered. However, because of relentless disease progression, the eye had to be eviscerated. The cornea, aqueous, vitreous, and sclera were positive by culture and/or polymerase chain reaction and histopathology.

Conclusions:

Acanthamoeba usually causes a chronic smoldering keratitis and, very rarely, scleritis. This report, which is the first of its kind, emphasizes the fact that fulminant endophthalmitis with associated scleritis can occur after ocular surgery in an immunocompetent individual, with no significant ophthalmic history.
Health Care for Transgender Men: What Is Missing in OB/GYN Care?
Authors: Haseen Ben , Kahn Abigail , Belton Allyson , Roth Bayer Carey 
Published: February 2020

Objective
Transgender men (TGM) are those who identify their sex as male but were assigned female at birth who face marginalization in obstetrics and gynecology (OB/GYN) practices. The following commentary highlights recommendations for creating inclusive OB/GYN spaces and improving outcomes for TGM patients.

Methods
The commentary is written in a call to action style using previously published literature about treatment and guidelines for care of transgender patients to highlight recommendations for creating inclusive OB/GYN spaces for TGM. The GLMA Handbook on LGBT Health and The UCSF Transgender Care Web site were among the resources used to gather information on transgender patient inclusivity in health care settings.

Results
Supporting literature was collected that reinstates the need to include framing questions specific to the TGM population during history-taking, creating inclusive clinic settings, and enhancing health care provider training in TGM care.

Conclusions
It is important for TGM who have a vagina, cervix, and/or uterus to have routine gynecological screenings. However, the lack of gender inclusive care in OB/GYN clinics presents a barrier for many TGM and the recommendations emphasized in this commentary will increase sensitivity for the TGM patient population and decrease their marginalization in health care settings.
Fractionated CO2 Laser as Therapy in Recalcitrant Lichen Sclerosus
Authors: Balchander Divya , Nyirjesy Paul 
Published: February 2020

Objectives
The aim of this study was to evaluate the efficacy of the fractionated CO2 laser in treating recalcitrant lichen sclerosus (LS).

Materials and Methods
The study population was 40 women diagnosed with LS who were symptomatic despite medical treatment. Patients had at least 2 or more laser sessions with a 2-month follow-up visit at the Drexel Vaginitis Center. A fractionated CO2 laser was used on affected areas at mild or standard power settings. Analyses were performed of changes in symptom rating scales, verbal reports, and physical examination findings.

Results
In the LS cohort of 40 patients, 22 women (55%) experienced symptoms that had persisted longer than 5 years before treatment. After the appropriate laser sessions, 72.5% of women described their improvement as significant or more than 66% improvement. In addition, there was a statistically significant reduction in vaginal pain, itching, dyspareunia, and dysuria. The presence of white epithelium decreased 20% after treatment. Furthermore, the mean corticosteroid use declined from 4.28 times per week to 2.04 times per week, indicating a resolution of many symptoms.

Conclusions
The fractionated CO2 laser may be a helpful approach for managing LS that is unresponsive to traditional treatment options.
Brain death: optimizing support of the traumatic brain injury patient awaiting organ procurement
Authors: Souter Michael J. , Kirschen Matthew 
Published: February 2020

Purpose of review
Increasing numbers of deaths on the transplant waiting list is associated with an expanding supply–demand deficit in transplantable organs. There is consequent interest in reviewing both donor eligibility after death from traumatic brain injury, and subsequent management, to minimize perimortem insult to donatable organs.

Recent findings
Recipient outcomes are not worsened when transplanting organs from donors who were declared dead after traumatic brain injury. Protocolized donor management improves overall organ procurement rates and subsequent organ function. Longer periods of active management (up to 48 h) are associated with improved outcomes in renal, lung, and heart transplantation. Several empirically derived interventions have been shown to be ineffective, but there are increasing numbers of structured trials being performed, offering the possibility of improving transplant numbers and recipient outcomes.

Summary
New studies have questioned previous considerations of donor eligibility, demonstrating the ability to use donated organs from a wider pool of possible donors, with less exclusion for associated injury or comorbid conditions. There are identifiable benefits from improved donor resuscitation and bundled treatment approaches, provoking systematic assessments of effect and new clinical trials in previously overlooked areas of clinical intervention.
New biomarkers for respiratory infections
Authors: Póvoa Pedro , Coelho Luís , Bos Lieuwe D.J. 
Published: February 2020

Purpose of review
Although pneumonia, either community or hospital-acquired, is the most frequent severe respiratory infection, it is an infection difficult to diagnose. At present, the diagnosis of pneumonia relies on a combination of clinical, radiologic, and microbiologic criteria. However, these criteria are far from perfect leading to uncertainty in the diagnosis, risk stratification, and choice of antibiotic therapy. Biomarkers have been used to bring additional information in this setting.

Recent findings
The aim of this review is to provide a clear overview of the current evidence for biomarkers to distinguish between patients in several clinical scenarios: to exclude pneumonia in order to withhold antibiotics, to identify the causative pathogen to target antimicrobial treatment, to identify phenotypes of inflammatory response to facilitate adjunctive treatments, to stratify the risk of severe pneumonia and provide the adequate level of care, and to monitor treatment response and de-escalate antibiotic therapy.

Summary
In recent years the number of new biomarkers increased markedly in different areas like pathogen identification or host response. Although far from the ideal, there are several promising areas that could represent true evolutions in the management of pneumonia, in the near future.
Validation set analysis to predict postoperative outcomes by technetium-99m galactosyl serum albumin scintigraphy for hepatectomy
Authors: Nanashima Atsushi , Hiyoshi Masahide , Imamura Naoya , Yano Koichi , Hamada Takeomi , Wada Takashi , Nishimuta Masato , Shimizu Ikko , Mizutani Yoichi 
Published: February 2020

Background
The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy.

Methods
We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of 99mTc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction.

Results
The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications.

Conclusion
The modified parameters of 99mTc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.
Novel lecithin:cholesterol acyltransferase-based therapeutic approaches
Authors: Freeman Lita A. , Karathanasis Sotirios K. , Remaley Alan T. 
Published: February 2020

Purpose of review
To review recent lecithin:cholesterol acyltransferas (LCAT)-based therapeutic approaches for atherosclerosis, acute coronary syndrome, and LCAT deficiency disorders.

Recent findings
A wide variety of approaches to using LCAT as a novel therapeutic target have been proposed. Enzyme replacement therapy with recombinant human LCAT is the most clinically advanced therapy for atherosclerosis and familial LCAT deficiency (FLD), with Phase I and Phase 2A clinical trials recently completed. Liver-directed LCAT gene therapy and engineered cell therapies are also another promising approach. Peptide and small molecule activators have shown efficacy in early-stage preclinical studies. Finally, lifestyle modifications, such as fat-restricted diets, cessation of cigarette smoking, and a diet rich in antioxidants may potentially suppress lipoprotein abnormalities in FLD patients and help preserve LCAT activity and renal function but have not been adequately tested.

Summary
Preclinical and early-stage clinical trials demonstrate the promise of novel LCAT therapies as HDL-raising agents that may be used to treat not only FLD but potentially also atherosclerosis and other disorders with low or dysfunctional HDL.
Dietary risk factors for urinary stones in children
Authors: Sas David J. 
Published: February 2020

Purpose of review
As the incidence of urinary stone disease in children is increasing, identifying dietary risk factors becomes vitally important, especially in the context of targeting interventions to reduce risk for stone formation. Indiscriminant dietary restrictions are not appropriate for paediatric patients.

Recent findings
Although large, prospective studies are still needed to better quantify dietary risk factors for paediatric stone formers, a number of smaller studies provide data to identify common risk factors to help prevent stone formation, while minimizing inappropriate dietary restrictions.

Summary
Interpretation of 24-h urine samples to identify individualized dietary risk factors is crucial for implementing a strategy for prevention of further urinary stone formation in children. Clinicians should avoid generalized dietary restrictions in stone-forming children uninformed by laboratory data.
The evolving role of regulatory reporting on patient and donor selection in organ transplantation
Authors: Schold Jesse D. 
Published: February 2020

Purpose of review
To describe the historical and evolving role of quality oversight in the field of transplantation. The review highlights of the prior use and effects of oversight of solid organ transplant centers and discusses potential ramifications of changes for the field.

Recent findings
There have been a number of studies illustrating unintended consequences associated with regulatory oversight. Although the intent of oversight to ensure safety and high quality of care, research highlights the potential deleterious effects of policies that do not consider the complexities and effects on practice, patient selection and utilization of donor organs in this field. Recent amendment of policy by the Center for Medicare and Medicaid Services (CMS) highlight the recognition and prominence of these concerns and potentially expand opportunities for transplantation prospectively.

Summary
The historical development and implementation of regulatory reporting in transplantation is unique and the oversight imposed on transplant organizations is particularly high compared with other healthcare contexts. The effects of recent CMS policy changes and any related developments from other regulators and payers will be important to evaluate in the years to come.
Instituting a New Central Line Policy to Decrease Central Line-associated Blood Stream Infection Rates During Induction Therapy in Pediatric Acute Lymphoblastic Leukemia Patients
Authors: Berger Rebecca , Messina Allison F. , Chandler Nicole M. , Amankwah Ernest K. , Shaw Peter H. 
Published: February 2020

Background:
Children with acute lymphoblastic leukemia (ALL) require central lines to facilitate their care. Peripherally inserted central catheters (PICCs) may have lower rates of central line-associated bloodstream infections (CLABSIs) versus other central lines.

Objectives:
The objective of this study was to compare the CLABSI rate in the first month of therapy after initiating a policy to place PICCs in new patients with severe neutropenia (SN) and Mediports in those with moderate-to-no neutropenia. We also examined thrombosis rates.

Design/Method:
We prospectively gathered data on new patients for 2.5 years following the policy change and retrospectively for the 2 years prior and compared rates of CLABSIs and thrombosis.

Results:
CLABSIs decreased in SN patients from 7.52/1000 to 3.11/1000 line days (P=0.33). The CLABSI rate for all patients with SN who had a Mediport was 13.39/1000 versus 4.08/1000 line days for those that received PICCs (P=0.15). The thrombosis rate for Mediport patients was 3.13 clots/1000 versus 7.65/1000 line days for PICC patients, but the difference was not significant (P= 0.11).

Conclusion:
The differences observed suggest that placing PICCs versus Mediports in new ALL patients with SN may result in a lower incidence of CLABSIs in the first month of therapy without a significant increase in thrombosis.
Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach
Authors: Crippa Jacopo , Grass Fabian , Dozois Eric J. , Mathis Kellie L. , Merchea Amit , Colibaseanu Dorin T. , Kelley Scott R. , Larson David W. 
Published: February 2020

Objective:
To compare short term outcomes of patients undergoing laparoscopic or robotic rectal cancer surgery.

Background:
Significant benefits of robotic rectal cancer surgery over laparoscopy have yet to be demonstrated. Operative time and direct institutional cost seem in favor of the laparoscopic approach.

Methods:
We performed a retrospective review of consecutive patients operated on for rectal cancer with a mini-invasive approach at Mayo Clinic from 2005 to 2018. The primary aim of this study was to investigate the difference in postoperative morbidity between the laparoscopic and robotic approach. Multivariable models for odds to complications and prolonged (≥6 days) length of stay were built.

Results:
A total of 600 patients were included in the analysis. The number of patients undergoing robotic surgery was 317 (52.8%). The 2 groups were similar in respect to age, sex, and body mass index. Laparoscopic surgery was correlated to shorter operative time (214 vs 324 minutes; P < 0.001). Patients undergoing robotic surgery had a lower overall complications rate (37.2% vs 51.2%; P < 0.001). Robotic surgery was found to be the most protective factor [odds ratio (OR) 0.485; P = 0.006] for odds to complications. The event of a complication (OR 9.33; P < 0.001) and conversion to open surgery (OR 3.095; P = 0.002) were identified as risk factors for prolonged length of stay whereas robotic surgery (OR 0.62; P = 0.027) was the only independent protective factor.

Conclusions:
Robotic rectal cancer surgery is strongly associated with better short-term outcomes over laparoscopic surgery.
Antipsychotics and the microbiota
Authors: Chen Anderson , Park Tae Yang , Li Kevin J. , DeLisi Lynn E. 
Published: February 2020

Purpose of review
The gut microbiota has been speculated to underpin metabolic changes associated with chronic antipsychotic use. The change in the gut microbiota can also cause abnormal absorbtion from the gut into the blood stream (leaky gut syndrome) that can lead to inflammatory reactions, and thus, secondary damage to the brain and central nervous system. Our article aims to highlight relevant research on antipsychotic's effect on the microbiota and to point out future directions.

Recent findings
Antipsychtoic use can result in specific microbiota changes, and it is important to differentiate this from the innate microbiota of the patient. It is important to treat these microbiota changes, as they are correlated with obesity, which is a negative contributor to the cardiovascular health of those suffering with schizophrenia. Ways to prevent antipsychotic-induced side-effects include antibiotic treatment, histamine 3 receptor blockade and metformin use.

Summary
Given the dearth of current literature, more research is needed, however, to determine, which comes first in people with schizophrenia--an abnormal gut microbiota that elevates one's risk for schizophrenia or psychopharmacologic treatment of schizophrenia leading to secondary microbiota abnormalities or the negative symptoms of schizophrenia leading to obesity and its associated microbiota changes.
Evaluating the operational resilience of small and medium-sized enterprises to flooding using a computational modelling and simulation approach: a case study of the 2007 flood in Tewkesbury
Authors: Coates Graham , Alharbi Meshal , Li Chunhui , Ahilan Sangaralingam , Wright Nigel 
Published: February 2020

The resilience of small and medium-sized enterprises (SMEs) to disruptive events is significant as this highly prevalent category of business forms the economic backbone in developed countries. This article provides an overview of the application of a computational modelling and simulation approach to evaluate SMEs' operational resilience to flooding based on combinations of structural and procedural mitigation measures that may be implemented to improve their premises' resistance to flooding and safeguard their business continuity. The approach integrates flood modelling and simulation with agent-based modelling and simulation (ABMS) within a modelled geographical environment. SMEs are modelled as agents based on findings of semi-structured interviews with SMEs that have experienced flooding or are at risk of flooding. In this paper, the ABMS has been applied to a new case study of the major flood event of 2007 in Tewkesbury. Furthermore, to enable an evaluation of the operational resilience of manufacturing SMEs in terms of the relative effectiveness of flood mitigation measures, a new coefficient based on production loss is introduced. Results indicate structural mitigation measures are more effective than procedural measures. While this result is intuitive, the approach provides a means of evaluating the relative effectiveness of combinations of mitigation measures that SMEs may implement to enhance their operational resilience to flooding.
This article is part of the theme issue ‘Urban flood resilience’.