bluuebunny/crossref_metadata_2025_split huggingface dataset:
Linezolid to treat urinary tract infections caused by vancomycin-resistant Enterococcus
Authors: Pontefract Benjamin Alan , Rovelsky Suzette Amy , Madaras-Kelly Karl Joseph 
Published: November 2020

Background: Vancomycin-resistant Enterococcus can cause urinary tract infection. Linezolid possesses antimicrobial activity against vancomycin-resistant Enterococcus but has limited urinary excretion. Minimal data demonstrate efficacy of linezolid for treatment of urinary tract infections. Objective: The main aim of this study is to compare post-treatment outcomes of linezolid to other antibiotics with vancomycin-resistant Enterococcus activity in the treatment of urinary tract infection caused by vancomycin-resistant Enterococcus. Methods: A retrospective cohort of inpatients within Veterans Health Administration facilities with urinary tract infection caused by vancomycin-resistant Enterococcus was created. Patients with vancomycin-resistant Enterococcus isolated from urine cultures and chart documentation meeting criteria for urinary tract infection were identified. Demographics, comorbidity, treatments, and post-treatment outcomes were extracted from the electronic health record. Outcomes were compared between patients treated with linezolid and alternative antibiotics possessing vancomycin-resistant Enterococcus activity 14 days after treatment completion. Logistic regression adjusted for covariates associated with each outcome. Results: Of 4,683 patients with a positive vancomycin-resistant Enterococcus culture, 624 (13%) met criteria for chart review, and 92 (15%) had documentation of urinary tract infection symptoms and treatment. The primary reason for exclusion was asymptomatic bacteriuria (64%). Patients had high Charlson Comorbidity Scores (mean = 8.7; standard deviation (SD) = 3.3), and 70% were located on general medical/surgical wards on the day of culture collection. Linezolid was prescribed in 54 (59%) cases. No difference between linezolid and comparator antibiotics were observed in re-initiation of antibiotics for vancomycin-resistant Enterococcus urinary tract infection (9% and 5% respectively (p = 0.56), (adjusted odds ratio (OR) = 1.90; 95% confidence interval (CI) = 0.34–10.63)), recurrent positive vancomycin-resistant Enterococcus culture (4% and 11%, respectively (p = 0.23), (adjusted OR = 0.36; 95% CI = 0.05–2.31)), or mortality (7% and 3%, respectively (p = 0.39) (adjusted OR = 2.96; 95% CI = 0.37–41.39)). Conclusion: Most patients with vancomycin-resistant Enterococcus identified on urine culture were asymptomatic. Linezolid appears effective as comparator antibiotics for the treatment of mild vancomycin-resistant Enterococcus urinary tract infection.
Suicidal thoughts, suicidal behaviours and self-harm in daily life: A systematic review of ecological momentary assessment studies
Authors: Gee Brendan Loo , Han Jin , Benassi Helen , Batterham Philip J 
Published: November 2020

Background Ecological Momentary Assessments (EMA) offer an approach to understand the daily risk factors of suicide and self-harm of individuals through the use of self-monitoring techniques using mobile technologies. Objectives This systematic review aimed to examine the results of studies on suicidality risk factors and self-harm that used Ecological Momentary Assessments. Methods Pubmed and PsycINFO databases were searched up to April 2020. Bibliographies of eligible studies were hand-searched, and 744 abstracts were screened and double-coded for inclusion. Results The 49 studies using EMA included in the review found associations between daily affect, rumination and interpersonal interactions and daily non-suicidal self-injury (NSSI). Studies also found associations between daily negative affect and positive affect, social support, sleep, and emotions and a person’s history of suicide and self-harm. Associations between daily suicide thoughts and self-harm, and psychopathology factors measured at baseline were also observed. Conclusions Research using EMA has the potential to offer clinicians the ability to understand the daily predictors, or risk factors, of suicide and self-harm. However, there are no clear reporting standards for EMA studies on risk factors for suicide. Further research should utilise longitudinal study designs, harmonise datasets and use machine learning techniques to identify patterns of proximal risk factors for suicide behaviours.
Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?
Authors: Krych Aaron J. , LaPrade Matthew D. , Hevesi Mario , Rhodes Nicholas G. , Johnson Adam C. , Camp Christopher L. , Stuart Michael J. 
Published: November 2020

Background: Meniscus root tears are increasingly being recognized. Meniscal extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscal restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. Purpose: To better understand the association between MT ligament competence, medial meniscal extrusion, and medial meniscus posterior root tears (MMPRTs) as well as to determine the progression of meniscal extrusion over time. Study Design: Case series; Level of evidence, 4. Methods: Serial magnetic resonance imaging (MRI) scans were reviewed for patients who showed evidence of medial meniscal extrusion and MMPRTs on at least 1 of ≥2 available MRI scans. All patients were symptomatic at the time of diagnosis. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscal extrusion, and MMPRTs were recorded for each MRI scan. The time between MRI scans, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated. Results: Overall, 27 knees in 26 patients were included in this study, with a total of 63 MRI scans analyzed (21 knees with 2 MRI scans, 3 with 3 MRI scans, and 3 with 4 MRI scans). All patients demonstrated clear medial meniscal extrusion and MT ligament disruption before the subsequent development of MMPRTs ( P < .001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT ( P < .001). The mean time between initial MRI and the first identification of an MMPRT on later MRI was 1.7 ± 1.6 years. Conclusion: In a sample of 27 symptomatic knees with serial MRI scans both before and after an MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscal extrusion before the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscal extrusion represent early and predisposing events contributing to MMPRTs. Therefore, this provides a possible explanation of why meniscal extrusion is not corrected with medial meniscus root repair.
Culture-Negative C acnes Endophthalmitis Following Implantation of a Phakic Implantable Collamer Lens
Authors: Robbins Calvin C. , Sobrin Lucia , Ma Kevin K. , Brouillette Kathryn M. , Moore Jeffrey K. 
Published: November 2020

Purpose: This work describes a case of Cutibacterium acnes (formerly Propionibacterium acnes) endophthalmitis following a posterior-chamber, phakic, Implantable Collamer Lens (ICL) surgery. Methods: A 34-year-old previously healthy woman presented with chronic unilateral iritis 8 months after bilateral ICL surgery. Original testing revealed no cause for the iritis with normal culture, serology, and autoimmune testing results. Results: Follow-up revealed C acnes by polymerase chain reaction on vitrectomy samples. Complete resolution of symptoms was achieved following removal of the implant, lensectomy, and intravitreal antibiotics. Conclusions: We believe this is the first reported case of postphakic ICL C acnes endophthalmitis. It highlights the utility of polymerase chain reaction in cases of chronic uveitis.
Does Practicing with a Virtual Reality Driving Simulator Improve Spatial Cognition in Older Adults? A Pilot Study
Authors: Masoumzadeh Sogol , Moussavi Zahra 
Published: November 2020

Memory, cognition, executive functioning, and spatial cognition loss are prevalent in the normal aging process, but these impairments are observed more extensively in individuals with dementia, specifically Alzheimer’s disease. To improve the impaired functions, serious games targeting the lost functions are commonly developed and used in training programs. In this study, we designed a virtual reality driving simulator (VRDS) as a serious game with different difficulty levels for improving the spatial cognition; we evaluated it on 11 participants with different levels of dementia for two weeks, every day except weekends (10 sessions of practice in total) and 30 min/day. We assessed the participants’ spatial cognition before and after the intervention by an independent assessment (the VR replica of Morris Water test) and also by their performance playing the VRDS during the intervention. We also assessed the participants’ mood by a standard depression scale as well as their plausible experience of simulation sickness. The results showed significant improvement in Morris water test. The participants’ normalized correct trajectory (to find the target) was improved significantly by 44.4% at post-intervention with respect to baseline. Furthermore, on average, the participants progressed to higher (more challenging) levels of the game, and their spatial learning score increased throughout the sessions. Their mood also showed improvement with respect to baseline. Overall, the results hold promise for the designed VRDS as a mood-lifting and enhancing spatial skills serious game for older adults if it is played regularly. Trial Registry name: Investigating the Effect of Training with a Virtual Reality Driving Simulator URL: https://clinicaltrials.gov/ct2/show/NCT04074655 Clinical Trials.gov ID: NCT04074655
Predicting Thrombosis Recurrence in Children: The Role of Thrombophilia Testing
Authors: Allahyani Bader , Ljung Rolf 
Published: November 2020

Background:
The role of inherited thrombophilia testing in predicting a recurrence of deep vein thrombosis (DVT) after an incident of the first DVT in children remains unclear
Objectives:
To investigate the association between inherited thrombophilia and DVT recurrence.
Design/Method:
We conducted a retrospective regional study of all consecutive ICD10 codes of venous thromboembolism (VTE) in children over 15 years (January 1, 2000, to December 31, 2015) in a regional catchment area of southern Sweden using an electronic diagnosis registry. Eligible subjects were children aged 1-18 years presenting with DVT diagnosed with imaging and having undergone complete inherited thrombophilia workup after the first DVT event. Of the 174 patients diagnosed with DVTs, 139 were eligible for inclusion. Data regarding subject demographics and medical history, location of DVT and imaging method, coagulation studies at primary investigation including at least plasma concentrations of protein C, protein S, antithrombin, resistance to activated protein C, and the genotypes FVG1691A and FIIG20210A. Also, plasma values for coagulation factors, VIII and XI, D-dimer, INR, and cardiolipin antibodies, were analyzed.
Results:
A total of 139 patients had inherited thrombophilia workup after the incident of the first DVT. Inherited thrombophilia was found in 30 % of patients, the prevalence of minor thrombophilia among these 139 patients was 23 % (n = 32), whereas major thrombophilia accounted for 7 % (n = 10) of abnormal results. Anticoagulants as treatment were administered in 92 % of the first DVT. The majority of the cohort treated with anticoagulation therapy for 12 weeks. Patients with minor inherited thrombophilia treated for at least 24 weeks, whereas the patients with major inherited thrombophilia were continued on anticoagulation therapy for the long term. The incidence rate of recurrent thromboembolic events was 6.5 % (n = 9) of patients after their incident of the first thrombotic event. Recurrent thrombosis in patients with spontaneous DVT and proven inherited thrombophilia found in only 1 %.
Conclusion:
Inherited thrombophilia was not predictive of recurrent DVT among our cohort patients. Our findings suggest that Inherited thrombophilia testing may not predict risk for the recurrence of DVT, although it may help for adjustment of the duration of the anticoagulation therapy.
Figure

Disclosures
No relevant conflicts of interest to declare.
Prevalence of Thrombophilia in Transient Ischemic Attack and Ischemic Stroke Patients
Authors: Raslan Omar , Tran Christopher , Al-Ani Fatimah , Sposato Luciano , Lazo-Langner Alejandro 
Published: November 2020

Introduction. Screening for inherited thrombophilia has been recommended in patients with cryptogenic ischemic strokes and anticoagulant therapy is frequently indicated based on these results. However, current evidence suggests that thrombophilia screening is over utilized in stroke patients and may provide more risks than benefits.
Patients and Methods.We conducted a retrospective cohort study in patients with transient ischemic attack (TIA) or ischemic stroke who had a thrombophilia screen and determined the proportions of each thrombophilia trait, and the proportion of high risk thrombophilia in this population. Pre-specified subgroup analyses were conducted for patients with ischemic stroke and transient ischemic attacks, and for patients with patent foramen ovale.
Results.We included 412 patients (152 male and 260 female). The prevalence of thrombophilia was 7.52% (95% CI 5.35-10.48). The proportion of major thrombophilia was 2.18 (95% CI=1.15 - 4.09). The proportion of thrombophilia traits in ischemic stroke patients was lower 4.92% (95% CI 2.61 - 9.08) than that in patients with transient ischemic attacks 9.57% (95% CI = 6.41 - 14.06); Only 2 individuals had both a positive thrombophilia screen and a patent foramen ovale.
Discussion. In this study the prevalence of thrombophilia traits in patients with ischemic stroke or transient ischemic attack was low, including high risk thrombophilic traits. Further studies are needed to determine if thrombophilia screening exposes these patients to additional risks without any benefits.

Disclosures
Sposato: Western University:Other: Kathleen and Dr. Henry Barnett Chair in Stroke Research;Boehringer Ingelheim:Honoraria, Research Funding;Pfizer:Honoraria, Research Funding;Gore:Honoraria, Research Funding;Bayer:Honoraria, Research Funding.
The New ASH ITP-Guideline Recommendations - Marching Separately, Beating Together
Authors: Matzdorff Axel , Meyer Oliver 
Published: November 2020

Background:Immune thrombocytopenia (ITP) is rare. The 1996 American Society of Hematology (ASH) ITP-Guideline for many years set the standards of ITP-care. In 2019 ASH published a new ITP guideline. We wanted to assess the acceptance of these new guideline recommendations by German physicians.
Methods:This is a cross-sectional survey presenting ten recommendations on adult ITP from the new ASH ITP guideline to German hematologist, internists and other specialists at 4 medical educational activities on ITP between September 2019 and January 2020. We asked the physicians to express their preference for each recommendation on a 5-point scale. Numeric values were assigned to the degrees of agreement or disagreement. The numeric values of the responses were summed and divided by the number of respondents to create an average score. This was compared with the degree of support ASH experts expressed for each of their recommendation.
Results:One hundred thirty questionnaires were distributed and 56 were retrieved (43%). There was consensus in 7 of 10 management issues but there were obvious differences in 3. (1) German physicians were less likely to give corticosteroids in newly diagnosed but asymptomatic or only mildly symptomatic patients, but (2) in case corticosteroids were given, German physicians were more likely to prescribe longer corticosteroid treatment, and (3) German physicians clearly prefer 2nd line thrombopoietin receptor agonists (TPO-RAs) over splenectomy. The different approach may be explained by easier access to medical care for patients (higher hospital- and physician-density than in the US), universal coverage in a publicly funded health care system, and a less developed medicolegal network pushing malpractice claims in Germany.
Conclusion: The example of the recent ASH ITP guideline shows that recommendations must not be separated from the context in which they are produced. They cannot define a universal standard of care. Instead they need to be adapted and individualized, respecting the traditions of each health care system, physicians' experiences, patients' preferences, and health literacy. Guideline recommendations do not define a 'best treatment' or any universal standard of care, all they do is providing guidance to the physician in daily practice. Th. Jefferson's sentence still holds that all human beings are created equal, but this does not mean that all patients must be treated equally.

Disclosures
Matzdorff: UCB Biopharma SRL:Consultancy, Other: Honoraria paid to institution;Swedish Orphan Biovitrium GmbH:Consultancy, Other: Honoraria paid to institution;Grifols Deutschland GmbH:Consultancy, Other: Honoraria paid to institution;Amgen GmbH:Consultancy, Other: Honoraria paid to institution;Novartis Oncology:Consultancy, Other: Honoraria paid to institution;Roche Pharma AG:Other: Family stockownership.Meyer:Novartis Pharma GmbH:Honoraria;Amgen GmbH:Honoraria;Grifols Germany:Consultancy, Honoraria.
Does Upfront Autologous Stem Cell Transplant at First Relapse Improve Outcome in Transplant Eligible Follicular Lymphoma Patients Who Relapse within 24 Months
Authors: Yahya Ayel Omar Q , MacDonald David , Radhwi Osman 
Published: November 2020

In Canadian adults, Follicular lymphoma (FL) is the most common subtype of NHL, Approximately 20% of patients with FL experience progression of disease (POD) within 2 years of first line chemoimmunotherapy. Those patients have an expected overall survival of less than 5 years.The optimal second-line treatment for these high-risk patients is unclear. We analyzed data from the blood and bone marrow transplantation Center at the Ottawa Hospital (TOH) to determine whether autologous hematopoietic cell transplant (ASCT) as upfront therapy for first relapse can improve outcomes in this high-risk FL subgroup. We identified 17 patients who underwent upfront ASCT between February 2012 and February 2019. All of them had relapsed within 24 months after their 1st Rituximab-based chemotherapy. The OS at 2-year and 5-year was 86.2% (95% CI: 55-96) and 71.8% (95% CI: 31-91) respectively. The PFS at 2 year and 5 year was 62.6% (95% CI: 35-81) and 53.6% (95% CI: 25-75) respectively. We demonstrate improved OS when receiving autologous hematopoietic stem cell transplant as up front at first relapse in transplant eligible follicular lymphoma who relapse within 24 months of first line therapy. However; the sample size considerably small but the results look promising. Combining other center experience the confidence intervals are wide, indicating that the sample size was too small. Considering a single center, the result looks promising, but the data need to be replicated with a larger sample size.

Disclosures
MacDonald: Roche Canada: Consultancy, Honoraria; Janssen: Honoraria; AstraZeneca: Honoraria.
Establishing the Velocity of M-Protein Decline (VMD) Value in Response to Multiple Myeloma Therapy That Best Predicts M-Protein of Zero
Authors: Haddad Philip A , Ganey Nowell 
Published: November 2020

Introduction:
Serum M-protein levels, measured by serum immunoelectrophoresis, have been one of the major tests that determine the type of response to therapy in Multiple Myeloma. Achieving an M-protein of zero is one of the criteria determining complete remission which in turn translates into longer progression-free survival and overall survival. Triplet therapy tends to be the standard therapeutic approach in younger, fit, and transplant candidates. However, in older non-fit patients many oncologists start with doublets and only escalate to triplet combinations upon less optimal response. The predictive value of the velocity of the M-spike decline (VMD) has not been adequately studied. We conducted this study to find the optimal VMD that predicts a serum M-protein of zero.
Methods:
A sample of mostly non-fit older Multiple Myeloma patients was identified. All patients had regular serum protein electrophoresis with M-protein levels documented every 4-8 weeks until they achieved M-protein levels of zero, plateauing without attaining the target of zero, or rebounding with progression. Best-fit line or curve was constructed and the slope of the decline was calculated. VMD was defined as the slope of the best fit-curve/line. VMD values corresponding to the binary outcomes of achieving or failing to achieve an M-protein value of zero were collected. A ROC curve was constructed to determine the cut-off VMD value that best predicts the outcome of M-protein of zero.
Results:
A total of 47 patients of mostly non-fit older Multiple Myeloma patients were included in our final sample. The median age of the sample was 71 years. Thirteen percent had triplet therapy. Thirty four percent had proteasome inhibitor based combinations while 64% had IMiD based combinations. Fifty seven percent achieved the target M-protein level of zero while 43% failed. The area under the ROC curve, AUC, was 0.98 (p&lt;0.0001). The cut-off VMD value (the slope of the best fit M-protein curve/line) which best predicts an outcome of M-protein of zero was &lt; -0.276 with a corresponding sensitivity of 89% and specificity of 100%.
Conclusions:
This exploratory study established the VMD value that best predicts the outcome of M-protein of zero in response to Multiple Myeloma therapy. This may be potentially used by oncologists to make early decisions regarding the need for further optimization or intensification of their therapeutic combinations as they treat their older non-fit Multiple Myeloma patients.

Disclosures
No relevant conflicts of interest to declare.