bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced Vancomycin Susceptibility, MRSA and Treatment Failure in Pediatric Staphylococcus aureus Bloodstream Infections
Authors: Canty Ethan , Carnahan Benjamin , Curley Tara , Anususinha Emily , Hamdy Rana F. , Ericson Jessica E. 
Published: November 2020

Background:
Clinical implications of reduced vancomycin susceptibility (RVS) among pediatric Staphylococcus aureus bloodstream infections are unknown.

Methods:
We identified all children at 2 children’s hospitals with ≥1 blood culture positive for S. aureus. We compared patient and clinical factors for RVS and non-RVS infections using Wilcoxon rank-sum and chi-squared tests. Treatment failure and the duration of bacteremia for RVS versus non-RVS and for methicillin-resistant Staphylococcus aureus (MRSA) versus methicillin-susceptible Staphylococcus aureus (MSSA) infections were compared using multivariable logistic and Poisson regressions, respectively. For MRSA infections, the association of empiric vancomycin monotherapy with treatment failure was assessed using multivariable logistic regression.

Results:
RVS was present in 72% (309/426) of cases. No patient or infection characteristics, including methicillin resistance, were associated with RVS. RVS was associated with an increased duration of bacteremia compared with non-RVS infections, aIRR = 1.15 (95% confidence interval: 1.02–1.30). The odds of treatment failure was similar for RVS and non-RVS infections, aOR = 1.04 (0.62–1.74). In contrast, MRSA infections were more likely to have treatment failure than MSSA infections, aOR = 3.03 (95% confidence interval: 1.84–5.00). For MRSA infections, empiric vancomycin monotherapy was associated with an increased odds of treatment failure compared with non-vancomycin or combination anti-MRSA antibiotics, aOR = 3.23 (1.12–9.26).

Conclusions:
RVS was common and was associated with a longer duration of bacteremia but not with treatment failure. Treatment failure was more common for MRSA than for MSSA bloodstream infections. Empiric vancomycin monotherapy increased the odds of treatment failure for MRSA infections.
Descemet-stripping automated endothelial keratoplasty with intrascleral haptic–fixated intraocular lens in a sequential vs simultaneous approach
Authors: Sinha Rajesh , Shiny Hannah , Nair Sridevi , Sharma Namrata , Agarwal Tushar , Titiyal Jeewan Singh 
Published: November 2020

Purpose:
To compare the outcomes of Descemet-stripping automated endothelial keratoplasty (DSAEK) with intrascleral haptic–fixated intraocular lens (IOL) in a sequential and simultaneous approach.

Setting:
Tertiary eyecare center.

Design:
Prospective randomized comparative study.

Methods:
Patients with aphakic or complicated pseudophakic bullous keratopathy visiting a tertiary eyecare center were included in the study. A total of 40 patients were randomized into 2 groups of 20 each. Group 1 had subjects who underwent scleral-fixated IOL (SF IOL) implantation by intrascleral haptic fixation technique, followed by DSAEK (sequential procedure) with an interval of at least 3 months. Group 2 (simultaneous) had subjects who underwent DSAEK with SF IOL as a combined procedure. Graft survival, endothelial cell loss (ECL), corrected distance visual acuity (CDVA), and need for any intervention such as rebubbling were evaluated for both the groups at the end of 6 months.

Results:
At 6 months, the sequential group had significantly better CDVA of 0.62 ± 0.17 logMAR compared with 0.87 ± 0.19 logMAR in the simultaneous group (P = .002). Group 1 had significantly better overall cumulative graft survival (100% vs 60%, P = .002), significantly lower ECL (P = .006), lesser mean central corneal thickness (P = .03), and significantly thinner donor lenticule (P = .009). Rebubbling rate was significantly higher in Group 2 (P = .025). The mean hyperopic shift was significantly more in Group 2 (P = .02).

Conclusion:
The sequential procedure of SF IOL followed by DSAEK has better visual outcomes and graft survival when compared with simultaneous procedure in cases of aphakic or complicated pseudophakic bullous keratopathy.
Type II antithrombin deficiency caused by a novel missense mutation (p.Leu417Gln) in a Chinese family
Authors: Liu Siqi , Wang Huanhuan , Xu Qiyu , Luo Shasha , Jin Yanhui , Yang Lihong , Wang Mingshan 
Published: November 2020

The aim of the report was t
o explore the phenotype and genotype of a hereditary antithrombin deficient Chinese family. Functional and molecular analysis of the proband and his family members was performed. Online bioinformatics software was used to predict the pathogenicity of the novel mutation. ClustalX-2.1-win and PyMol software were applied to conservative analysis and generate molecular graphic images, respectively. Functional analysis had shown that the antithrombin (AT):A of the proband was reduced to 32% whereas AT:Ag was normal. Molecular analysis revealed a heterozygous missense mutation p. Leu417Gln in exon 7 of SERPINC1 gene. Bioinformatics and model analysis indicated that this mutation could affect the integrity of local intermolecular structures, resulting in a mild type of antithrombin deficiency but when combined with other genetic or acquired thrombophilic factors, patients may develop venous thrombosis. The p.Leu417Gln mutation was responsible for the decrease of AT:A in this family and caused type II antithrombin deficiency.
Lipid profile as a strong indicator of coronary plaques: noninvasive assessment by multislice computerized tomography
Authors: Regev-Avraham Zipi , Halabi Majdi , Israeli Zeev , Hussein Osamah , Sharabi-Nov Adi , Rosenfeld Ina 
Published: November 2020

Background
Most acute coronary syndrome disorders occur as a consequence of atherosclerotic plaque rupture. Lipids are involved in atherosclerotic plaque buildup. Advances in image quality of coronary computed tomography have enabled improved characterization of coronary plaques. The aim of our study was to evaluate the association between lipid profile and coronary plaque presence in general and soft plaques in particular.

Methods
In this cross-sectional survey, 258 consecutive patients presenting with chest pain either or both with low-to-moderate risk for coronary artery disease, were included. All patients were tested for lipid profile prior to cardiac imaging on a 64-slice computer tomography. Multivariate logistic regression models were used to assess the odds ratios (ORs) and 95% confidence interval (CI) for the relationship between blood lipid levels and prevalence of coronary plaques.

Results
Age, total cholesterol levels, hypertension, hyperlipidemia (dichotomous) and risk factor index, all were independently associated with prevalence all kind of plaques, especially with soft plaques. No significant relationships were detected among BMI, current smoking, diabetes or triglycerides levels. In a multivariate logistic regression, hyperlipidemia was associated with presence of coronary plaque risk with adjusted OR of 2.28 (95% CI 1.30–4.01), total cholesterol with adjusted OR = 1.05 (95% CI 1.01–1.06), and risk factor index (1–6) with adjusted OR = 2.23 (95% CI 1.40–3.55).

Conclusion
Hyperlipidemia is strongly associated with prevalence of coronary plaques (P < 0.001) in individuals with low-to-intermediate risk for coronary artery disease, based on cardiac CT. Cardiac CT may serve as a noninvasive alternative for the early diagnosis of CAD in such individuals.
Early repolarization in the inferolateral leads predicts the presence of vasospastic angina: a novel predictor in patients with resting angina
Authors: Ikeda Hiroyuki , Hasegawa Kanae , Uzui Hiroyasu , Fukuoka Yoshitomo , Shiomi Yuichiro , Tama Naoto , Miyazaki Shinsuke , Ishida Kentaro , Tada Hiroshi 
Published: November 2020

Background
An association between early repolarization and ventricular fibrillation has recently been reported in patients with vasospastic angina (VSA). However, no studies have clarified whether the presence of early repolarization can predict VSA.

Methods
Participants comprised 286 patients (136 males) with clinically suspected VSA who underwent intracoronary provocation tests using acetylcholine or ergonovine. Patients were divided into a VSA group [n = 94, positive provocation test as induction of coronary arterial spasm (>90% stenosis)] and a non-VSA group (n = 192). Detailed early repolarization data were compared between groups.

Results
The VSA group showed a higher frequency of smokers (28.7%) than the non-VSA group (17.2%; P = 0.02). On baseline 12-lead ECG, early repolarization (defined as a J-point elevation ≥0.1 mV from baseline in both or either of inferolateral leads) was found in 39 patients (inferior leads, n = 27; inferolateral leads, n = 12). Early repolarization was found more frequently in the VSA group (28.7%) than in the non-VSA group (6.2%, P < 0.01). Multivariate analysis revealed early repolarization as an independent predictor of VSA (odds ratio, 5.22; 95% confidence interval, 2.41–11.2; P < 0.01). Early repolarization pattern features including inferior lead, higher amplitude, notched type and horizontal/descending ST segments were associated with increased risk of VSA.

Conclusion
In patients with resting chest pain, early repolarization was a predictor of VSA that could be particularly related to the inferior lead, higher amplitude, notched type and horizontal/descending ST segment.
Safety and efficacy of coronary laser ablation as an adjunctive therapy in percutaneous coronary intervention: a single-centre experience
Authors: Mohandes Mohsen , Fernández Laura , Rojas Sergio , Moreno Cristina , Fuertes Mónica , Fernández Francisco , Pernigotti Alberto , Gonzalez-del-Hoyo Maribel , Guarinos Jordi , Sanz Esther , Bardají Alfredo 
Published: November 2020

Background
Coronary laser is a long-established coadjuvant therapy in interventional cardiology. This study aimed to present our experience regarding the safety and efficacy of laser assistance to percutaneous coronary intervention (PCI) in different scenarios of coronary artery disease.

Methods
We used coronary laser as an adjunctive therapy for PCI between May 2014 and March 2020. The safety of laser ablation was evaluated by studying any complication associated with the laser application. Besides, the laser contribution to PCI and 1 year of follow-up for adverse cardiac events was studied.

Results
Coronary laser was performed in 81 lesions and 75 patients in different scenarios to assist PCI. The average age was 66 ± 11.7 years and 72 (88.9%) were men. Coronary laser was used in 30 (37%) cases for in-stent-material debulking; 26 (32.1%) in primary angioplasty, 19 (23.4%) in chronic total occlusion and 5 (6.2%) in saphenous vein grafts. Procedural success was achieved in 77 (95.1%) with 1 (1.2%) type III coronary perforation. One year of follow-up for combined adverse cardiac events consisting of death due to any cause, myocardial infarction or target vessel failure showed an event-free rate of 0.82 (95% confidence interval, 0.72–0.91).

Conclusions
Our preliminary experience reveals the safety and efficacy of the current modality of coronary laser as a coadjuvant therapy in PCI with a low rate of adverse cardiac events in 1-year of follow-up. Further studies are needed to establish more precisely the contribution of laser application in different contexts of coronary artery disease.
Building a hemodiafiltration system from readily available components for continuous renal replacement therapy under disasters and pandemics: preparing for an acute kidney injury surge during COVID-19
Authors: Hanna Ramy M. , Ferrey Antoney , Rhee Connie M. , Sam Ramin , Pearce David , Kalantar-Zadeh Kamyar , Don Burl R. 
Published: November 2020

Purpose of review
The novel corona virus (SARS-CoV2) has been demonstrated to cause acute kidney injury due to direct cellular toxicity as well as due to a variety of autoimmune glomerular diseases. The concept of a surge of infected patients resulting in an overwhelming number of critical patients has been a central concern in healthcare planning during the COVID-19 era.

Recent findings
One crucial question remains as to how to manage patients with end stage renal disease and acute kidney injury in case of a massive surge of critically ill infected patients. Some publications address practical and ingenious solutions for just such a surge of need for renal replacement therapy. We present a plan for using a blood pump, readily available dialysis filter, and a prefilter and postfilter replacement fluid set up. This is in conjunction with multiple intravenous pumps to develop a simple hemofiltration apparatus.

Summary
The current set up may be a readily available option for use in critical situations where the need for renal replacement therapy outstrips the capacity of traditional hemodialysis services in a hospital or region.
Novel management of diabetes in kidney transplantation
Authors: Ong Song C. , Rhee Connie M. 
Published: November 2020

Purpose of review
Posttransplant diabetes mellitus (PTDM) is a prevalent complication in kidney transplant recipients, and has been associated with worse short-term and long-term outcomes.

Recent findings
While hyperglycemia is frequently seen in the early posttransplant period because of surgical stress, infection, and use of high-dose steroids, the diagnosis of PTDM should be established after patients are clinically stable and on stable maintenance immunosuppression. In the early posttransplant period, hyperglycemia is typically treated with insulin, and pilot data have suggested potential benefit of lower vs. higher glycemic targets in this setting. Growing data indicate lifestyle modifications, including dietary interventions, physical activity, and mitigation of obesity, are associated with improved posttransplant outcomes. While there are limited data to support a first-line antidiabetic medication for PTDM, more established pharmacotherapies such as sulfonylureas, meglitinides, and dipetidyl peptidase IV inhibitors are commonly used. Given recent trials showing the benefits of sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists upon kidney outcomes in nontransplant patients, further study of these agents specifically in kidney transplant recipients are urgently needed.

Summary
Increasing evidence supports a multidisciplinary approach, including lifestyle modification, obesity treatment, judicious immunosuppression selection, and careful utilization of novel antidiabetic therapies in PTDM patients.
Novel therapeutic approaches for COVID-19 in chronic kidney disease and transplant
Authors: Ferrey Antoney J. , Hanna Ramy , Reddy Uttam G. , Tantisattamo Ekamol , Kalantar-Zadeh Kamyar , Amin Alpesh N. 
Published: November 2020

Purpose of review
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the novel virus responsible for the current worldwide pandemic. The scientific and healthcare communities have made every effort to discover and implement treatment options at a historic pace. Patients with kidney disease are uniquely vulnerable to an infectious pandemic because of their need to be in frequent contact with the healthcare system for life-sustaining renal replacement therapy whether it be by dialysis or transplant.

Recent findings
The use of targeted viral therapies, extracorporeal therapies, immunosuppressive therapy and public health interventions are important in the management of patients with COVID-19 but require special consideration in patients with kidney disease because of the complexity of their condition.

Summary
Here, we discuss some of the major efforts made to prevent spread and emerging treatment options for this virus, as they pertain to patients with kidney disease.
Genetic heterogeneity and clonal evolution in acute myeloid leukemia
Authors: Romer-Seibert Jennifer S. , Meyer Sara E. 
Published: November 2020

Purpose of review
Clonal heterogeneity is a significant obstacle to successful treatment of patients with acute myeloid leukemia (AML). Here, we review new advances in the understanding of genetic heterogeneity in AML using single-cell DNA-sequencing technology.

Recent findings
New genomics and immunologic discovery tools have provided single-cell resolution maps of the clonal architecture of AML. The use of these technologies reveals the mutational landscape of AML at diagnosis, during treatment, and at relapse has an enormous degree of clonal complexity and diversity that is poised to adapt and evolve under environmental pressures.

Summary
AML is a complex ecosystem of competing and cooperating clones undergoing constant evolution and selection.
Recent advances in percutaneous lithotripsy techniques
Authors: De Sio Marco , Manfredi Celeste , Fusco Ferdinando , Creta Massimiliano , Mirone Vincenzo , Arcaniolo Davide 
Published: November 2020

Purpose of review
To describe and critically discuss the most recent evidence regarding the percutaneous nephrolithotomy (PCNL) techniques.

Recent findings
Three-dimensional printing and virtual reality are promising tools to improve surgeon experience and operative performance. Totally ultrasound-guided PCNL is feasible and can reduce the radiological risk. Growing evidence highlights the safety and advantages of the use of miniaturized instrumentations, although some related limitations place the mini PCNL (mPCNL) in direct challenge with the retrograde intrarenal surgery. LithoClast Trilogy and ClearPetra system can improve the stone clearance. Thulium laser is a new source of energy with growing expectations and promising in-vitro results.

Summary
Significant advances have recently been recorded in PCNL techniques. Thulium fiber laser, LithoClast Trilogy, new suction devices, and the development of novel technologies for teaching and planning procedures may overcome mPCNL drawbacks. Further studies are needed to confirm the promising preliminary results available on the topic.
The experiences of caregivers of Indigenous cancer survivors in Australia, Canada, New Zealand, and the United States: a systematic review
Authors: Masa Adam J. , Martinez-Bredeck Helena , Butler Tamara L. , Anderson Kate , Girgis Afaf , Aoun Samar M. , Cunningham Joan , Wakefield Claire E. , Shahid Shaouli , Smith Allan B. , Garvey Gail 
Published: November 2020

Abstract

Background:
Caregivers of Indigenous cancer survivors provide critical unpaid support to survivors, yet they rarely receive information or training for this role and may themselves benefit from support services. Little is documented about the experiences of caregivers of Indigenous cancer survivors. The aim of this systematic review was to identify and aggregate qualitative research describing the experiences of caregivers of Indigenous cancer survivors in Australia, New Zealand, Canada and the United States.

Methods:
We systematically searched PsycINFO, PubMed, CINAHL, Embase, Scopus and Web of Science using keywords relating to Indigenous populations; caregivers; and cancer. Data were extracted from original qualitative research articles published up to March 2020.

Results:
From 24 full-text articles, 14 articles from 13 studies were analyzed using meta-aggregation. This highlighted key caregiver experiences relating to: the need for information about cancer and services; providing and receiving support; communication challenges and responsibilities; balancing caregiver roles and emotions; and culturally unsafe health systems and settings. Caregivers of Indigenous cancer survivors often act as mediator between Western biomedical approaches to cancer care and Indigenous peoples’ holistic and family-focused views of health and wellbeing, aiming to ensure that both health professionals and the cancer survivors understand each other's perspectives and preferences for care. Caregivers expressed preferences for family-focussed rather than patient-focussed care. Culturally unsafe health care systems created barriers to optimal care.

Conclusions:
The findings reveal caregivers’ unique experiences of caring for an Indigenous cancer survivor, and identifies several unmet needs which should be appropriately and systematically addressed. Caregivers should be regarded as co-clients with their own needs as well as co-workers with health professionals providing cancer care. Ultimately supporting caregivers will contribute to improving health outcomes for Indigenous cancer survivors.
Simulating HIV Breakthrough and Resistance Development During Variable Adherence to Antiretroviral Treatment
Authors: Mulato Andrew , Acosta Rima , Chang Silvia , Martin Ross , Yant Stephen R. , Cihlar Tomas , White Kirsten 
Published: November 2020

Background:
Barriers to lifelong HIV-1 suppression by antiretrovirals include poor adherence and drug resistance; regimens with higher tolerance to missed doses (forgiveness) would be beneficial to patients. To model short-term nonadherence, in vitro experiments monitoring viral breakthrough (VB) and resistance development were conducted.

Methods:
HIV breakthrough experiments simulated drug exposures at full adherence or suboptimal adherence to bictegravir+emtricitabine+tenofovir alafenamide (BIC+FTC+TAF) or dolutegravir + lamivudine (DTG+3TC). MT-2 cells were infected with wild-type or low frequency M184V HIV-1, exposed to drug combinations, monitored for VB, and rebound virus was deep sequenced. Drug concentrations were determined using human plasma–free adjusted clinical trough concentrations (Cmin), at simulated Cmin after missing 1 to 3 consecutive doses (Cmin − 1 or Cmin − 2, and Cmin − 3) based on drug or active metabolite half-lives.

Results:
Cultures infected with wild-type or low frequency M184V HIV-1 showed no VB with BIC+FTC+TAF at drug concentrations corresponding to Cmin, Cmin − 1, or Cmin − 2 but breakthrough did occur in 26 of 36 cultures at Cmin − 3, where the M184V variant emerged in one culture. Experiments using DTG + 3TC prevented most breakthrough at Cmin concentrations (9/60 had breakthrough) but showed more breakthroughs as drug concentrations decreased (up to 36/36) and variants associated with resistance to both drugs emerged in some cases.

Conclusions:
These in vitro VB results suggest that the high potency, long half-lives, and antiviral synergy provided by the BIC/FTC/TAF triple therapy regimen may protect from viral rebound and resistance development after short-term lapses in drug adherence.