bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistence of HIV transmission clusters among people who inject drugs
Authors: Rose Rebecca , Cross Sissy , Lamers Susanna L. , Astemborski Jacquie , Kirk Greg D. , Mehta Shruti H. , Sievers Matthew , Martens Craig , Bruno Daniel , Redd Andrew D. , Laeyendecker Oliver 
Published: August 2020

Objective:
We investigated the duration of HIV transmission clusters.

Design:
Fifty-four individuals newly infected at enrollment in the ALIVE cohort were included, all of whom had sequences at an intake visit (T1) and from a second (T2) and/or a third (T3) follow-up visit, median 2.9 and 5.4 years later, respectively.

Methods:
Sequences were generated using the 454 DNA sequencing platform for portions of HIV pol and env (HXB2 positions 2717–3230; 7941–8264). Genetic distances were calculated using tn93 and sequences were clustered over a range of thresholds (1--5%) using HIV-TRACE. Analyses were performed separately for individuals with pol sequences for T1 + T2 (n = 40, ‘Set 1’) and T1 + T3 (n = 25; ‘Set 2’), and env sequences for T1 + T2 (n = 47, ‘Set 1’), and T1 + T3 (n = 30; ‘Set 2’).

Results:
For pol, with one exception, a single cluster contained more than 75% of samples at all thresholds, and cluster composition was at least 90% concordant between time points/thresholds. For env, two major clusters (A and B) were observed at T1 and T2/T3, although cluster composition concordance between time points/thresholds was low (<60%) at lower thresholds for both sets 1 and 2. In addition, several individuals were included in clusters at T2/T3, although not at T1.

Conclusion:
Caution should be used in applying a single threshold in population studies where seroconversion dates are unknown. However, the retention of some clusters even after 5 + years is evidence for the robustness of the clustering approach in general.
Pediatric acute gastroenteritis associated with adenovirus 40/41 in low-income and middle-income countries
Authors: Lee Benjamin , Damon Christina F. , Platts-Mills James A. 
Published: August 2020

Purpose of reviewTo review the roles of enteric adenovirus types 40 and 41 and nonenteric adenoviruses in the global burden of pediatric diarrhea.Recent findingsLarge studies using highly sensitive, type-specific molecular diagnostics have demonstrated a substantial and previously under-estimated burden of pediatric diarrheal disease because of enteric infections with adenovirus types 40/41. However, the true epidemiology of adenovirus 40/41 remains incompletely understood. Similarly, additional adenovirus types may also be implicated as agents of community-acquired pediatric gastroenteritis but current data are too limited to elucidate their epidemiological role(s), if any.SummaryEfforts at global diarrhea control in low-income and middle-income countries will require combating pediatric gastroenteritis because of enteric adenovirus infections. Future research in these settings using type-specific molecular diagnostics or strain genotyping to fully characterize the epidemiology of adenovirus 40/41 infections, identify non-40/41 adenoviruses significantly associated with gastroenteritis, and develop vaccines effective at preventing adenovirus diarrhea is warranted.
Final frontiers of the polio eradication endgame
Authors: Bandyopadhyay Ananda S. , Macklin Grace R. 
Published: August 2020

Purpose of review
Focusing on the key developments since January 2019, this review aims to inform policymakers and clinical practitioners on the latest on evolving global polio epidemiology and scientific advancements to guide strategies for eradication.

Recent findings
An upsurge in wild poliovirus type 1 cases in Pakistan and Afghanistan and an expansion of type 2 circulating vaccine-derived poliovirus transmission in multiple countries threaten the remarkable progress made over past several decades by the global eradication program. These challenges have also spurred innovation on multiple fronts, including earlier detection, enhanced environmental surveillance and safer and more affordable vaccine options.

Summary
A concerted effort to adapt program strategies to address context-specific challenges and continued focus on innovations to enhance detection and response capabilities will be the key to achieve and sustain eradication of all types of polioviruses.
Drug resistance in Salmonella Typhi: implications for South Asia and travel
Authors: Radha Sneha , Murugesan Malathi , Rupali Priscilla 
Published: August 2020

Purpose of review
Recent attempts at mapping Typhoid epidemiology have revealed an enormous burden of disease in developing countries. Countries hitherto believed to have a low incidence, such as the African subcontinent, on accurate mapping were found to have a significant burden of disease. Drug resistance, because of rampant overuse of antibiotics, has driven selection pressure to extensively drug-resistant typhoid becoming a reality in the Indian subcontinent. With widespread travel, importation of this variety of typhoid to nonendemic countries is likely to lead to outbreaks in a nonimmune population.

Recent findings
A strain of extensively drug-resistant Salmonella Typhi isolated in Pakistan in 2016 has been responsible for multiple outbreaks in Pakistan and multiple travel-related cases all over the world in United States, UK, and Australia. This novel strain belongs to H58 lineage harbouring a plasmid encoding additional resistance elements like blaCTX-M-15 and a qnrS fluoroquinolone resistance gene. This resistance pattern has rendered many therapeutic options like Ceftriaxone and Fluoroquinolones clinically inactive impacting care in endemic and traveller populations alike.

Summary
Changing epidemiology and drug resistance in typhoid indicates that it may be prudent to vaccinate nonimmune travellers travelling to typhoid endemic areas, especially the Indian subcontinent.
Proof of Concept: Phantom Study to Ensure Quality and Safety of Portable Chest Radiography Through Glass During the COVID-19 Pandemic
Authors: Rai Archana , MacGregor Kate , Hunt Bryce , Gontar Alex , Ditkofsky Noah , Deva Djeven , Mathur Shobhit 
Published: August 2020

Background
Chest radiography is often used to detect lung involvement in patients with suspected pneumonia. Chest radiography through glass walls of an isolation room is a technique that could be immensely useful in the current COVID-19 pandemic.

Purpose
The purpose of this study was to ensure quality and radiation safety while acquiring portable chest radiographs through the glass doors of isolation rooms using an adult anthropomorphic thorax phantom.

Materials and Methods
Sixteen chest radiographs were acquired utilizing different exposure factors without glass, through the smart glass, and through regular glass. Images were scored independently by 2 radiologists for quantum mottle and sharpness of anatomical structures using a 5-point Likert scale. Statistically significant differences in Likert scale scores and entrance surface dose (ESD) between images acquired without glass and through the smart and regular glass were tested. Interreader reliability was also evaluated.

Results
Compared with conventional radiography, equal or higher mean image quality scores (mottle and anatomical structures) were observed with the smart glass using 100 kVp at 12 mAs and 20 mAs and 125 kVp at 6.3 mAs (100 kVp at 2 mAs and 125 kVp at 3.2 mAs were used for conventional radiography observations). There was no statistically significant difference in the Likert scale scores for image quality and the entrance surface dose for radiographs acquired without glass, through the smart glass, and through regular glass. Backscatter from the smart glass was minimal at a distance of 3 m and was recorded as zero at a distance of 4 m from the x-ray tube outside an isolation room.

Conclusions
Good-quality portable chest radiographs can be obtained safely through the smart glass doors of the isolation room. However, this technique does result in minor backscatter radiation. Modifications in the exposure factors (such as increasing milliampere seconds) may be required to optimize image quality while using this technique.
Multilevel Body Composition Analysis on Chest Computed Tomography Predicts Hospital Length of Stay and Complications After Lobectomy for Lung Cancer
Authors: Best Till D. , Mercaldo Sarah F. , Bryan Darren S. , Marquardt Jan Peter , Wrobel Maria M. , Bridge Christopher P. , Troschel Fabian M. , Javidan Cylen , Chung Jonathan H. , Muniappan Ashok , Bhalla Sanjeev , Meyers Bryan F. , Ferguson Mark K. , Gaissert Henning A. , Fintelmann Florian J. 
Published: August 2020

Objective:
To investigate the impact of thoracic body composition on outcomes after lobectomy for lung cancer

Summary and Background Data:
Preoperative identification of patients at risk for adverse outcomes permits treatment modification. The impact of body composition on lung resection outcomes has not been investigated in a multicenter setting.

Methods:
A total of 958 consecutive patients undergoing lobectomy for lung cancer at 3 centers from 2014 to 2017 were retrospectively analyzed. Muscle and adipose tissue cross-sectional area at the fifth, eighth, and tenth thoracic vertebral body was quantified. Prospectively collected outcomes from a national database were abstracted to characterize the association between sums of muscle and adipose tissue and hospital length of stay (LOS), number of any postoperative complications, and number of respiratory postoperative complications using multivariate regression. A priori determined covariates were forced expiratory volume in 1 second and diffusion capacity of the lungs for carbon monoxide predicted, age, sex, body mass index, race, surgical approach, smoking status, Zubrod and American Society of Anesthesiologists scores.

Results:
Mean patient age was 67 years, body mass index 27.4 kg/m2 and 65% had stage i disease. Sixty-three percent underwent minimally invasive lobectomy. Median LOS was 4 days and 34% of patients experienced complications. Muscle (using 30 cm2 increments) was an independent predictor of LOS (adjusted coefficient 0.972; P = 0.002), any postoperative complications (odds ratio 0.897; P = 0.007) and postoperative respiratory complications (odds ratio 0.860; P = 0.010). Sarcopenic obesity was also associated with LOS and adverse outcomes.

Conclusions:
Body composition on preoperative chest computed tomography is an independent predictor of LOS and postoperative complications after lobectomy for lung cancer.
Hyperthyroidism Symptoms, Management, and Outcomes in Children and Adults Seeking Definitive Surgical Treatment
Authors: Chung Sebastian K. , Asban Ammar , Hur Jinwoo , Iyer Pallavi , Chen Herbert 
Published: August 2020

Objective:
To identify the difference in presentation, time to treatment, and outcomes between hyperthyroid adults and children referred to surgical evaluation.

Background:
There is little data on differences in presenting symptoms, time to treatment, and outcomes between adults and children presenting for thyroidectomy for Graves’ disease.

Methods:
We retrospectively reviewed records of patients with hyperthyroidism referred for thyroidectomy between January 2016 and April 2017. We divided our cohort into 2 groups based on age, children (age ≤18 years), and adults (age >18), and evaluated the difference in prevalence of symptoms, time from diagnosis, and initiation of antithyroid medications to surgery, and outcomes.

Results:
We identified 38 patients (27 adults and 11 children) with data on hyperthyroidism symptoms referred for thyroidectomy. Relative to hyperthyroid adults, children with hyperthyroidism were more likely to present with hoarseness (55% vs 15%, P = 0.01) and difficulty concentrating (45% vs 7%, P = 0.01) at initial presentation. There was no statistically significant difference in prevalence of vision changes, exophthalmos, pretibial myxedema, palpitations, fatigue, temperature intolerance, dysphagia, tremors, or constitutional symptoms. A median of 15 months elapsed from diagnosis to thyroidectomy among adult and 6 months among pediatric patients. Adult and pediatric patients waited a median of 13 and 6 months from initiation of antithyroid medications to thyroidectomy, respectively. There was no significant difference in outcomes.

Conclusions:
Children with hyperthyroidism were more likely to present with hoarseness and difficulty concentrating than adults. Concentration and communication are critical skills in developing children, and early intervention with definitive therapy may improve such symptoms.
Superior Survival Outcomes of a Polyethylene Glycol-20k Based Resuscitation Solution in a Preclinical Porcine Model of Lethal Hemorrhagic Shock
Authors: Khoraki Jad , Wickramaratne Niluka , Kang Hae Sung , Xu Haoxuan , Archambault Caitlin , Blocher Charles , Li Ru , Liebrecht Loren , Aboutanos Michel , Mangino Martin J. 
Published: August 2020

Objective:
To compare early outcomes and 24-hour survival after LVR with the novel polyethylene glycol-20k-based crystalloid (PEG-20k), WB, or hextend in a preclinical model of lethal HS.

Background:
Posttraumatic HS is a major cause of preventable death. current resuscitation strategies focus on restoring oxygen-carrying capacity (OCC) and coagulation with blood products. Our lab shows that PEG-20k is an effective non-sanguineous, LVR solution in acute models of HS through mechanisms targeting cell swelling-induced microcirculatory failure.

Methods:
Male pigs underwent splenectomy followed by controlled hemorrhage until lactate reached 7.5–8.5 mmol/L. They were randomized to receive LVR with PEG-20k, WB, or Hextend. Surviving animals were recovered 4 hours post-LVR. Outcomes included 24-hour survival rates, mean arterial pressure, lactate, hemoglobin, and estimated intravascular volume changes.

Results:
Twenty-four-hour survival rates were 100%, 16.7%, and 0% in the PEG-20k, WB, and Hextend groups, respectively (P
= 0.001). PEG-20k significantly restored mean arterial press, intravascular volume, and capillary perfusion to baseline, compared to other groups. This caused complete lactate clearance despite decreased OCC. Neurological function was normal after next-day recovery in PEG-20k resuscitated pigs.

Conclusion:
Superior early and 24-hour outcomes were observed with PEG-20k LVR compared to WB and Hextend in a preclinical porcine model of lethal HS, despite decreased OCC from substantial volume-expansion. These findings demonstrate the importance of enhancing microcirculatory perfusion in early resuscitation strategies.
Influence of the Retrocolic Versus Antecolic Route for Alimentary Tract Reconstruction on Delayed Gastric Emptying After Pancreatoduodenectomy
Authors: Toyama Hirochika , Matsumoto Ippei , Mizumoto Takuya , Fujita Hirofumi , Tsuchida Shinobu , Kanbara Yoshihiro , Kadowaki Yoshihiko , Maeda Hiromi , Okano Keiichi , Fukuoka Masato , Takase Shiro , Shirakawa Sachiyo , Terai Sachio , Mukubo Hideyo , Ishida Jun , Yamashita Hironori , Ueno Kimihiko , Tanaka Motofumi , Kido Masahiro , Ajiki Tetsuo , Murakami Sae , Nishimura Kunihiro , Fukumoto Takumi 
Published: August 2020

Objective:
This study aimed to determine whether retrocolic alimentary tract reconstruction is noninferior to antecolic reconstruction in terms of DGE incidence after pancreatoduodenectomy (PD) and investigated patients’ postoperative nutritional status.

Summary of Background Data:
The influence of the route of alimentary tract reconstruction on DGE after PD is controversial.

Methods:
Patients from 9 participating institutions scheduled for PD were randomly allocated to the retrocolic or antecolic reconstruction groups. The primary outcome was incidence of DGE, defined according to the 2007 version of the International Study Group for Pancreatic Surgery definition. Noninferiority would be indicated if the incidence of DGE in the retrocolic group did not exceed that in the antecolic group by a margin of 10%. Patients’ postoperative nutrition data were compared as secondary outcomes.

Results:
Total, 109 and 103 patients were allocated to the retrocolic and antecolic reconstruction group, respectively (n = 212). Baseline characteristics were similar between both groups. DGE occurred in 17 (15.6%) and 13 (12.6%) patients in the retrocolic and antecolic group, respectively (risk difference; 2.97%, 95% confidence interval; −6.3% to 12.6%, which exceeded the specified margin of 10%). There were no differences in the incidence of other postoperative complications and in the duration of hospitalization. Postoperative nutritional indices were similar between both groups.

Conclusions:
This trial could not demonstrate the noninferiority of retrocolic to antecolic alimentary tract reconstruction in terms of DGE incidence. The alimentary tract should not be reconstructed via the retrocolic route after PD, to prevent DGE.
The Comparative Efficacy of Chlorhexidine Gluconate and Povidone-iodine Antiseptics for the Prevention of Infection in Clean Surgery
Authors: Wade Ryckie G. , Burr Nicholas E. , McCauley Gordon , Bourke Grainne , Efthimiou Orestis 
Published: August 2020

Objective:
There is uncertainty around preoperative skin antisepsis in clean surgery. Network meta-analysis provides more precise estimates than standard pairwise meta-analysis and can rank interventions by efficacy, to better inform clinical decisions.

Background:
Infection is the most common and costly complication of surgery. The relative efficacy of CHG and PVI based skin antiseptics in clean surgery remains unclear.

Methods:
We searched for randomized or nonrandomized studies comparing the effect of different preparations of CHG and PVI on the dichotomous outcome of surgical site infection. We included studies of adults undergoing clean surgery. We excluded studies concerning indwelling vascular catheters, blood sampling, combination antiseptics or sequential applications of different antiseptics. We performed a network meta-analysis to estimate the relative efficacy of interventions using relative risks (RR).

Results:
We included 17 studies comparing 5 antiseptics in 14,593 individuals. The overall rate of surgical site infection was 3%. Alcoholic CHG 4%–5% was ranked as the most effective antiseptic as it halved the risk of surgical site infection when compared to aqueous PVI [RR 0.49 (95% confidence interval 0.24, 1.02)] and also to alcoholic PVI, although uncertainty was larger [RR 0.51 (95% confidence interval 0.21, 1.27)]. Adverse events related to antiseptic application were only observed with patients exposed to PVI.

Conclusions:
Alcoholic formulations of 4%–5% CHG seem to be safe and twice as effective as PVI (alcoholic or aqueous solutions) in preventing infection after clean surgery in adults. Our findings concur with the literature on contaminated and clean-contaminated surgery, and endorse guidelines worldwide which advocate the use of alcoholic CHG for preoperative skin antisepsis.

Registration:
PROSPERO ID CRD42018113001.
The Clinical Utility of Molecular Testing in the Management of Thyroid Follicular Neoplasms (Bethesda IV Nodules)
Authors: Carty Sally E. , Ohori N. Paul , Hilko Dane A. , McCoy Kelly L. , French Esra K. , Manroa Pooja , Morariu Elena , Sridharan Shaum , Seethala Raja R. , Yip Linwah 
Published: August 2020

Objective:
FN present a management quandary as they are often benign but may also be aggressive TC. Consensus recommendations have historically advised thyroidectomy for definitive diagnosis. Although MT have robust benefit in hypothetical cost analyses, under current management guidelines a real-time study of their clinical utility in FN is awaited. We investigate if MT use for FN directs appropriate thyroidectomy for TC while triaging to surveillance nodules that are likely benign.

Methods:
Data were analyzed for 389 consecutive patients managed from 11/14 to 9/19 for 405 FN, excluding oncocytic neoplasms. TC was defined as same-nodule histologic malignancy. When obtained, MT was performed using ThyroSeq (TS) v2 or 3.

Results:
With a mean nodule size of 2.7 ± 1.3 cm, MT was used in 89% and was positive in 39%. When MT was positive, thyroidectomy was more often utilized (91% v. MT− 27%; P < 0.001) and more likely for histologic TC (70% vs 16%, P < 0.001). With preoperative MT, all American Thyroid Association intermediate, high-risk, and medullary TC were positive whereas all MT− malignancies were low-risk. With TSv3, ultrasound surveillance was more likely for MT− FN (90% vs TSv2 65%, P < 0.001), and occurred for a total of 174 MT− FN. With mean follow-up of 24.6 months, 82% remained stable in size.

Conclusions:
MT use for FN increased the surgical yield of cancer by 4-fold, identified all potentially aggressive malignancies, and allowed apparently safe nonoperative surveillance for >80% of MT-negative patients. Thyroid nodule MT optimizes patient outcomes sufficiently to justify its incorporation into routine practice.
Chronic axonal idiopathic polyneuropathy: is it really benign
Authors: Samuelsson Kristin , Press Rayomand 
Published: August 2020

Purpose of reviewChronic idiopathic axonal polyneuropathy (CIAP), a common neurological condition, is considered to be a benign neurological condition with a small risk of disability. However, many studies have shown a reduced quality of life and a nonnegligible affection of daily activities in patients with CIAP. Here we summarize recent data about CIAP.Recent findingsWe discuss some of the latest articles regarding risk factors, comorbidities, and possible pathogenic factors regarding CIAP. Patients with chronic polyneuropathy have impaired walking capacity, disturbed balance, and an increased risk of falls. Idiopathic polyneuropathy has a negative impact on activities of daily living. Patients with CIAP may develop plantar ulcers and neuropathic arthropathy. Small fiber involvement may occur, and two recent studies indicate that neuropathic pain is present in about two thirds of the CIAP group. Furthermore, patients with CIAP with neuropathic pain have increased fatigue and poorer emotional well being.SummaryDespite the relatively mild motor impairment seen in most patients with CIAP, the condition causes limitations in life with decreased mobility, pain, and affection of basal daily activities. Because the pathogenesis of CIAP in unclear, there is no disease modifying treatment. Further studies regarding pathogenesis, and randomized controlled clinical trials regarding possible treatment options are needed.
The constantly evolving spectrum of phenotypes in titinopathies – will it ever stop?
Authors: Udd Bjarne 
Published: August 2020

Purpose of review
The last few years have confirmed previous assumptions of an enormous impact of the titin gene (TTN) on the occurrence of muscle disease, cardiomyopathy, or both together. The reason for this rather late understanding of its importance is because of the huge size which prevented sequencing of the whole gene by the previous Sanger technique in the individual cases. An update of the advances in diagnosing titinopathies is the main focus of this review.

Recent findings
High throughput methods are now widely available for TTN sequencing and a corresponding explosion of different types of identified titinopathies is observed and published in the literature, although final confirmation is lacking in many cases with recessive missense variants.

Summary
The implications of these findings for clinical practice are easy to understand: patients with previously undiagnosed muscle disease can now have a correct diagnosis and subsequently receive a likely prognosis, can have accurate genetic counseling for the whole family and early treatment for predictable complications from the heart and respiratory muscles. In addition not to forget, they can avoid wrong diagnoses leading to wrong treatments.