bluuebunny/crossref_metadata_2025_split huggingface dataset:
2147. Human Infections due to Actinotignum Species: A 5-Year Retrospective Review at Mayo Clinic Rochester, Minnesota
Authors: Syed Sadia , Sohail Muhammad R 
Published: July 2020

Abstract

Background
We aim to investigate the incidence, clinical presentation, management, and outcome of infections due to Actinotignum species observed at Mayo Clinic Rochester over the last 5 years.

Methods
We searched the clinical microbiology laboratory database to identify isolates of Actinotignum spp. from all body sites between January 1, 2014 and December 31, 2018.

Results
Fifty-four patients with positive culture with Actinotignum were identified. Mean age was 67 years and 27 (50%) had an underlying urogenital condition. Actinotignum was isolated in 26 urine cultures, 6 blood cultures, 12 abscess fluid cultures, and 10 bone/joint tissue cultures (Table 1). Fifteen (28%) specimens were monomicrobial while 39 (72%) were polymicrobial. Recovery from urine cultures was interpreted as colonization in 11 (20%) cases. Of the 54 patients with positive cultures, 43 patients had Actinotignum-associated clinical infection; 15 (35%) with urinary tract infections (11 with cystitis and 4 with pyelonephritis), 12 (28%) with abscesses (skin, intraabdominal, and surgical site infections), 10 (23%) with bone/joint infection, and 6 (14%) with bacteremia (Table 2). Most frequently isolated species was A. schaalii (n = 40); followed by 2 cases of A. sanguinis. Susceptibility testing (n = 40) showed that all stains were susceptible to penicillin (MIC&lt; = 0.5), 36% were susceptible to clindamycin (MIC &lt; = 2) and 10% susceptible to metronidazole (MIC &lt; = 8). There was no recurrence of Actinotignum-related infections in any of the treated cases. Two patients with bone/joint infection underwent repeat surgical intervention due to worsening infection while on antibiotic treatment prior to resolution of infection. There was 1 death in a patient with bacteremia (polymicrobial) who had presented with a massive stroke (Table 3).

Conclusion
A. schaalii was most commonly associated with urinary tract infections followed by abscesses and bone/joint infections in elderly population. Majority of the infections were polymicrobial. All tested isolated were susceptible to penicillin; however, resistance was frequent for clindamycin and metronidazole. All appropriately treated patients had resolution of infection without recurrence from Actinotignum, except for one patient with bacteremia who died from massive stroke

Disclosures
All authors: No reported disclosures.
641. Evaluation of the FilmArray Pneumonia Panel and Potential Impact of Antimicrobial Use on Patients in a Trauma and Medical Intensive Care Unit
Authors: Krupinski- Shaw Kathy , Lopez Lauren , Orlinski Halle , Ozbolt Patrick , Antonara Stella 
Published: July 2020

Abstract

Background
Organisms causing infections of the lower respiratory tract in hospitalized patients can lead to high morbidity and mortality. Identification of the agents of pneumonia allows implementation of appropriate antimicrobial therapy and fast and accurate results are essential for the application of the correct antimicrobial regimen.

Methods
For 6 months results of quantitative bronchioalveolar lavage (Q-BALs) respiratory cultures, ordered as a standard of care for patients in our intensive care unit, were compared with the results obtained by a new multiplex molecular assay for the detection of lower respiratory tract pathogens, the FilmArray pneumonia panel (PP). The panel offers semi-quantitation of the bacterial targets that were compared with the quantitative results of the Q-BALs. Additionally, a retrospective chart review was performed to examine whether there would be any difference in the timing of appropriate antimicrobial therapy if the results of the panel were to be available for those patients. Appropriate antimicrobial therapy was determined according to the institution protocol for treatment of patients for ventilator-associated pneumonia based on the results of the quantitative cultures

Results
Thirty-six unique patients Q-BALs were run and of those there was 82% agreement on the detected targets between cultures and PP. Six targets were not detected by the panel (yeast, S. maltophilia, Streptococci, Salmonella spp.). M. catarrhalis, S. agalactiae and 3 viral targets were detected only by the panel. There was 100% agreement between the panel detected resistance markers and the culture isolates susceptibilities. Of the 36 patients, 12 were excluded because their medical records were not available for review. Of the 24 reviewed, 8 (33.3%) would have de-escalation in their antibiotics use at least 24h earlier due to the PP result. Eight (33.3%) would have no potential change in therapy and 8 (33.3%) could have inappropriate escalation or continuation due to reporting of potential pathogens by the PP but recorded as normal flora by cultures.

Conclusion
The use of PP would lead to a reduction of unnecessary antimicrobial therapy in 1/3 of the patients examined. However, quantification of organisms otherwise reported as normal flora may lead to unnecessary treatment and requires education of staff to understand the results of the assay.

Disclosures
All authors: No reported disclosures.
667. Preclinical Pharmacokinetic and Pharmacodynamic Characterization of EDP-938, a Novel and Potent NonFusion Replication Inhibitor of Respiratory Syncytial Virus
Authors: Jiang Li-Juan , Xu Lisha , Huang Meng , Zhang Shucha , Li Yang , Zang Indy , Kibel Jonathan , Adams Madison , Labrecque Noelle , Rhodin Michael , McAllister Nicole , Lin Kai , Jong Kim In , Sun Or Yat 
Published: July 2020

Abstract

Background
Respiratory syncytial virus (RSV) infection presents a significant health challenge in young children, elderly and immunocompromised patients. To date, there are no effective treatments available. EDP-938 was designed to meet this unmet medical need and is currently in Phase 2 clinical trials. Herein we report its preclinical pharmacokinetic (PK) and pharmacodynamic (PD) properties.

Methods
The pharmacokinetics of EDP-938 following single intravenous and oral doses were determined in mice, rats, dogs, and monkeys. In vitro cellular permeability and metabolic stability were assayed using Caco-2 cells and human liver microsomes, respectively. In vivo pharmacodynamic efficacy of EDP-938 was conducted in the African green monkey model, in which animals experimentally challenged with RSV were orally dosed twice daily with 100 mg/kg EDP-938 for 6 days starting 24 hours prior to infection.

Results
EDP-938 was well absorbed in the preclinical species with oral bioavailability values ranging from 27.1% in dogs, 35.4% in mice, 35.7% in rats, and 39.5% in monkeys, after a single oral dose when formulated in 0.5% methylcellulose. EDP-938 showed a moderate in vitro permeability of 3.6 x 10–6 cm/sec in Caco-2 cells. Based on the outcome of these absorption studies, EDP-938 was projected to have good oral absorption in humans. EDP-938 had low intrinsic clearance of 5 mL/minute/mg in human liver microsomes. Moreover, EDP-938 demonstrated potent antiviral efficacy in an African green monkey model of RSV infection. In untreated monkeys the RSV RNA viral load in the bronchoalveolar lavage fluid peaked at 106 copies/mL on day 5 post-infection, by comparison in animals treated with EDP-938 the viral load was below the limit of detection by day 3 post-infection. The PK/PD modeling suggested that plasma trough concentrations ≥10 × EC90 led to &gt;4-log viral load reduction in EDP-938 treated monkeys.

Conclusion
The favorable preclinical PK and PD properties of EDP-938 support its further clinical development as a novel treatment for RSV infection.

Disclosures
All authors: No reported disclosures.
0264 Childhood Adversity And Adult Sleep: The Role Of Deprivation And Threat
Authors: Cribbet Matthew R , Williams Paula G , Tinajero Ruben , Rau Holly K 
Published: July 2020

Abstract

Introduction
There are robust associations between childhood adversity (CA) and poor physical health in adulthood. Sleep is a possible mechanism linking CA to adult health. The prevailing approach for testing associations between CA and adult sleep offers little insight into which aspects of CA are related to specific sleep outcomes. To better understand associations between CA and adult sleep outcomes, we tested a conceptual model that distinguishes between threat (e.g. physical, emotional and sexual abuse), and deprivation (e.g. emotional and physical neglect).

Methods
Participants (N= 79; Mage = 27.48(SD=6.53); 68% Female) were screened for insomnia disorder, mental health conditions and physical illnesses. Participants completed demographic and depressive symptom measures, along with the Childhood Trauma Questionnaire, a self-report retrospective measure that captures dimensions of threat and deprivation. Sleep duration, latency, efficiency, wake after sleep onset (WASO), and secondary sleep onset latency (SSOL) were averaged across 3 consecutive days of wrist actigraphy and sleep diaries. Daily ratings of sleep-quality, non-restorative sleep, alcohol use and current stress were averaged across 3 days. Structural equation modeling (SEM) was used to account for missing data. All SEM models included correlated measures of deprivation and threat along with age, sex, BMI, alcohol use, daily stress, and depressive symptoms.

Results
In SEM models, threat was significantly positively associated with non-restorative sleep (b = .046, p &lt;.001) and sleep quality (b=.025, p=.008), but unrelated to all other diary-based and actigraphy-based sleep measures (ps &gt; .05). Deprivation was significantly negatively associated with diary-based WASO (b = -.076, p = .003) and SSOL, but unrelated to all other diary-based and actigraphy-based sleep measures (ps &gt; .05).

Conclusion
These results begin to clarify associations between related, but distinct forms of CA and specific adult sleep outcomes. Identifying specific pathways linking CA and adult health is critical for developing interventions and mitigating future health risk.

Support (If Any)
This study was funded by a Funding Incentive Seed Grant from the University of Utah, the Mind and Life Institute, and Division 38 of the American Psychological Association.
Cowan v Scargill and the fiduciary duty of investment: has the nature of the investment duty changed and what is currently driving “socially responsible investing” in pension schemes?
Authors: Brown Lloyd 
Published: July 2020

Abstract
This article examines the fiduciary duty of investment. It is particularly interested in how this duty may be exercised by pension trusts in support of the “socially responsible investing” (SRI) movement. An analysis of the case of Cowan v Scargill is provided to better understand whether this duty has changed over the past two decades. It finds that the above-named case shows that, intrinsically, this duty has not changed. In light of that finding, the article stipulates that external stimuli, in the form of increased regulation and societal appreciation of SRI, are driving improvements in this area.
Familial cerebral cavernous malformation presenting with epilepsy caused by mutation in the CCM2 gene
Authors: Ishii Kazuhiro , Tozaka Naoki , Tsutsumi Satoshi , Muroi Ai , Tamaoka Akira 
Published: July 2020

Abstract

Rationale:
Cerebral cavernous malformation (CCM) of the familial type is caused by abnormalities in the CCM1, CCM2, and CCM3 genes. These 3 proteins forming a complex associate with the maintenance of vascular endothelial cell-cell junctions. Dysfunction of these proteins results in the development of hemangiomas and abnormal intercellular junctions.

Patient concerns:
We report a 68-year-old man with familial cerebral cavernous malformation with initial presentation as convulsions at an advanced age. Brain magnetic resonance imaging revealed multiple cavernous hemangiomas in the right occipital lobe. The convulsions were considered to be induced by hemorrhage from cavernous hemangioma in the right occipital lobe.

Diagnoses:
Genetic screening of the CCM1, CCM2, and CCM3 genes revealed a novel mutation in the CCM2 gene (exon4 c: 359 T>A, p: V120D). No abnormalities were found in CCM1 or CCM3. Therefore, we diagnosed the patient with familial CCM caused by a CCM2 mutation.

Interventions:
This patient was treated with the administration of levetiracetam at a dosage of 1000 mg/day.

Outcomes:
No seizures have been observed since the antiepileptic drug was administered. We performed brain magnetic resonance imaging (MRI) regularly to follow-up on appearance of new cerebral hemorrhages and cavernous hemangiomas.

Lessons:
This report reviews cases of familial cerebral cavernous malformations caused by abnormalities in the CCM2 gene. This mutation site mediates interactions with CCM1 and CCM3. The mutation occurs in the phosphotyrosine binding (PTB) site, which is considered functionally important to CCM2.
Efficacy of transconjunctival approach for the treatment of orbital fractures
Authors: Qi Yan-Xiu , Li Si-ying , Wang Dong-lan , Zhou Ping-ping 
Published: July 2020

Abstract

Background:
This study aims to assess the efficacy of transconjunctival approach (TCA) for the treatment of orbital fractures (OF) comprehensively and systematically.

Methods:
In this study, we plan to search electronic databases of Cochrane Library, MEDLINE, EMBASE, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and for relevant randomized controlled trials. All these databases will be searched from inception to the March 1, 2020 without limitations of language and publication status. Two independent authors will carry out study selection, data collection, and study quality assessment. Any disagreements will be resolved by discussion with another author if necessary. The study quality will be assessed using Cochrane risk of bias tool. Statistical analysis will be conducted using RevMan 5.3 software.

Results:
This study will be the first 1 to exert direct evidence to evaluate the efficacy of TCA for the treatment of OF.

Conclusions:
The findings of this study will provide an exhaustive view of TCA for the treatment of OF.

Study registration number:
INPLASY202040154.
Clinical efficacy of Duyiwei capsule in treating gingivitis
Authors: Liu Hai-Ying , Fan Jing-Hui , Lin Na , Zhao Zhi-Xuan 
Published: July 2020

Abstract

Background:
This study will investigate the clinical efficacy of Duyiwei capsule (DYWC) for the treatment of gingivitis.

Methods:
Relevant studies will be searched in PUBMED, EMBASE, Cochrane Library, WANGFANG, VIP, CBM, and CNKI from inception to the March 31, 2020 without limitations of language and publication time. All potential randomized controlled trials on the clinical efficacy of DYWC for the treatment of gingivitis will be considered. Two authors will independently perform literature selection, data collection, and study quality assessment. Any disagreements will be solved by a third author through discussion. We will utilize RevMan 5.3 software for statistical analysis.

Results:
This study will summarize present randomized controlled trials on the efficacy and safety of DYWC for the treatment of gingivitis.

Conclusion:
The findings of this study will provide evidence to show whether DYWC is effective and safety for gingivitis.

Systematic review registration: INPLASY202040199.
Acupotomy therapy for cervical vertigo
Authors: Xie Rongfang , You Jianyu , Liu Liting , Huang Chunhua , Liang Yu 
Published: July 2020

Abstract

Background:
Acupotomy has been widely used to relieve cervical vertigo (CV). However, the efficacy of acupotomy for CV is uncertain. The purpose of this study is to evaluate the efficacy and safety of the acupotomy for CV.

Methods:
The following electronic databases will be searched to identify relevant randomized controlled trials (RCTs) for inclusion in the review from inception to April 2020: PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Periodical Database, and Chinese Biomedical Literature Database. Two researchers will independently select studies, collect data, and assess the methodology quality by the Cochrane risk of bias tool. Meta-analysis will be completed by RevMan V.5.3 software.

Results:
This systematic review will provide an assessment of the current state of acupotomy for CV, aiming to assess the efficacy and safety of acupotomy for Patients with CV.

Conclusion:
This systematic review will provide a credible Evidence-based for the clinical treatment of CV with acupotomy.
PROSPERO registration number: CRD42019134712.
Healthcare access for autistic adults
Authors: Calleja Shenae , Islam Fakir M. Amirul , Kingsley Jonathan , McDonald Rachael 
Published: July 2020

AbstractBackground:People with autism spectrum disorder (ASD) have an increased susceptibility for many chronic health conditions compared with their peers. An increasing number of adolescents are transitioning from pediatric to adult healthcare services. Thus, being able to access appropriate healthcare services that can not only address specific needs of the person but enable them to better manage healthcare conditions and decrease the development of preventable disease is necessary. A systematic review was conducted to identify barriers and enablers of healthcare access for autistic adults.Methods:The studies included in the review were quantitative and qualitative and were published between 2003 and 2019. The participants for the review are considered to be adults (over 18 years of age) with a primary diagnosis of ASD.Results:In total, 1290 studies were initially identified and 13 studies were included based on the inclusion and exclusion criteria outlined in a previous protocol paper. The analysis of these studies identified areas of concern to access appropriate healthcare, such as clinician knowledge, the environment, and life events.Conclusion:Identifying the barriers to healthcare, highlights ways healthcare services can regulate scope of practice, the physical environment, and the process of managing health conditions, thus, autistic adults can strive for optimal health. This review contributes to peer-reviewed evidence for future research and up-to-date information when developing and piloting health interventions for autistic adults.Ethics and dissemination:There are no human participants, data, or tissue being directly studied for the purposes of the review; therefore, ethics approval and consent to participate is not applicable.Registration and Status:PROSPERO 2018 CRD42018116093
Presence of red flags in patients with cerebral venous sinus thrombosis admitted to the emergency department because of headache
Authors: García-Azorín David , Monje Mariana H.G. , González-García Nuria , Guerrero Ángel L. , Porta-Etessam Jesús 
Published: July 2020

Abstract
Cerebral venous sinus thrombosis (CVST) is a cause of secondary headache with substantial morbimortality. Headache dominates the clinical presentation, but no typical phenotype has been described. We aim to evaluate the presence of red flags in headache in patients with confirmed CVST at the moment of emergency department (ED) presentation.
Retrospective STROBE compliant cohort study including patients with confirmed CVST that consulted because of headache at the ED. We analyzed presence and type of red flags at the moment of consult. We evaluated whether CVST was suspected at the moment of imaging request and analyzed delay in the diagnosis.
Nineteen patients fulfilled inclusion and exclusion criteria. Mean age was 48.5 years, 47.4% were female. All the studied patients exhibited at least 1 red flag, being abnormal neurological examination the most frequent (79%), followed by the presence of other neurological symptoms (68%), alarm data related with headache phenotype (63%), or risk factors concerning prior medical history (47%). Temporal pattern of the headache was acute in 42.1%, thunderclap in 31.6%, and subacute in 26.3%. In none patient CVST was the specific suspicion when imaging was requested. Median time since headache onset and ED presentation was 84 hours, being different in patients with associated symptoms (48 hours) when compared with isolated headache patients (168 hours). Time since ED presentation and the diagnosis also differed between the 2 groups, being more prolonged in patients with an isolated headache at presentation.
Headache attributed with CVST did not exhibit any distinctive phenotype, but all the patients presented some red flag, being abnormal neurological examination the most frequent.
Schwannoma in the hepatoduodenal ligament with portal vein invasion
Authors: Wang Jun-Ke , Wu Qian , Wu Zhen-Ru , Liu Fei , Ran Cong-Dun , Yin Chang-Hao , Li Fu-Yu 
Published: July 2020

Abstract

Rationale:
Schwannomas are mesenchymal tumors with low malignant potential that originate from Schwann cells. They can occur in most parts of the body, such as the head, neck, and extremities. Schwannoma in the hepatoduodenal ligament is extremely rare, and only four cases have been reported in the literature.

Patient concerns:
Herein, we describe a 58-year-old female who presented with right epigastric pain for 10 days. Preoperative computed tomographic (CT) revealed a 4.5 cm × 3.8 cm tumor in the hepatic hilar area.

Diagnoses:
Schwannoma in the hepatoduodenal ligament with portal vein invasion.

Interventions:
Intraoperative findings revealed that the tumor was identified in the hepatoduodenal ligament, and the left branch of the portal vein was compressed. Complete tumor resection with reparation of the portal vein was performed for the patient. Postoperative pathological examination confirmed the final diagnosis of benign schwannoma, characterized by abundant spindle-shaped cells and positive reactivity for S-100 protein.

Outcomes:
The patient had a good prognosis and had no recurrence after 37 months of follow-up.

Lessons:
Our case of schwannoma in the hepatoduodenal ligament is unique owing to the portal vein invasion, aimed at helping recognize the difficulty of preoperative diagnosis.