bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Acutely Ruptured Cerebral Aneurysms With the Woven EndoBridge Device: Experience Post-FDA Approval
Authors: Al Saiegh Fadi , Hasan David , Mouchtouris Nikolaos , Zanaty Mario , Sweid Ahmad , Khanna Omaditya , Chalouhi Nohra , Ghosh Ritam , Tjoumakaris Stavropoula , Gooch M Reid , Rosenwasser Robert , Jabbour Pascal 
Published: March 2020

Abstract

BACKGROUND
Coil embolization of ruptured bifurcation aneurysms is challenging and often necessitates adjunctive stenting, which requires antiplatelet therapy in the setting of subarachnoid hemorrhage (SAH). The Woven EndoBridge (WEB; Terumo) device is an alternative self-expanding 3D mesh that does not require antiplatelet agents. However, its use has been mostly reserved for unruptured aneurysms.

OBJECTIVE
To assess the safety and feasibility of ruptured aneurysm treatment with the WEB.

METHODS
Retrospective analysis of 9 SAH patients with 11 aneurysms that were treated with the WEB device at 2 institutions after FDA approval.

RESULTS
Hunt and Hess grades were III and IV in 4 (44%) each and V in 1 (11%). All patients were treated within 24 h of hospitalization, and a single WEB was used in all but one aneurysm. Aneurysms treated were 3 basilar tip, 2 anterior communicating artery, 2 posterior inferior cerebellarartery, 1 middle cerebral artery, 1 carotid-ophthalmic artery, 1 posterior communicating artery, and 1 vertebrobasilar junction. Mean aneurysm height and width were 6.2 ± 2.2 mm (range: 3-10) and 5.6 ± 3.0 mm (range: 3.3-14), respectively. Mean dome-to-neck ratio was 1.7 ± 0.8 (range: 1.0-3.8). There was one intraoperative rupture that occurred because of device dislodgement and was managed with embolization. There were no treatment-related mortalities and no re-rupture after securement of the aneurysms with the WEB.

CONCLUSION
Our preliminary experience indicates that the WEB device can be used safely for ruptured aneurysms of various sizes in the anterior and posterior circulation. Larger series with long-term follow-up are necessary to confirm our findings.
Operative Treatment of a Superior Cerebellar Artery Perforator Dissecting Aneurysm
Authors: Lee Jonathan J , Huang Meng , Guerrero Jaime , Desai Virendra R , Jenson Amanda , Austerman Ryan , Diaz Orlando , Britz Gavin W 
Published: March 2020

Abstract

BACKGROUND AND IMPORTANCE
Superior cerebellar artery (SCA) perforator aneurysms are extremely rare, with only one other case published in the literature. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed.

CLINICAL PRESENTATION
A 61-yr-old male presented with intraventricular hemorrhage (IVH) primarily in the posterior fossa. He was found to have a dissecting left SCA perforator aneurysm lying on the floor of the fourth ventricle. The aneurysm was not amenable to endovascular treatment, and antifibrinolytic therapy failed to spontaneously thrombose the aneurysm. We performed a suboccipital craniotomy and used a supracerebellar transvermian approach to resect the aneurysm. There was total obliteration of the aneurysm on postoperative cerebral angiogram.

CONCLUSION
SCA perforator aneurysms represent an extremely uncommon subset of intracranial aneurysms. The best therapeutic strategy has yet to be definitively proven. When pursuing surgical treatment, the supracerebellar transvermian navigated approach can be a useful and safe option, as described and illustrated in this video.
A Unified Welfare Analysis of Government Policies*
Authors: Hendren Nathaniel , Sprung-Keyser Ben 
Published: March 2020

AbstractWe conduct a comparative welfare analysis of 133 historical policy changes over the past half-century in the United States, focusing on policies in social insurance, education and job training, taxes and cash transfers, and in-kind transfers. For each policy, we use existing causal estimates to calculate the benefit that each policy provides its recipients (measured as their willingness to pay) and the policy’s net cost, inclusive of long-term effects on the government’s budget. We divide the willingness to pay by the net cost to the government to form each policy’s Marginal Value of Public Funds, or its ``MVPF''. Comparing MVPFs across policies provides a unified method of assessing their effect on social welfare. Our results suggest that direct investments in low-income children’s health and education have historically had the highest MVPFs, on average exceeding 5. Many such policies have paid for themselves as the government recouped the cost of their initial expenditures through additional taxes collected and reduced transfers. We find large MVPFs for education and health policies among children of all ages, rather than observing diminishing marginal returns throughout childhood. We find smaller MVPFs for policies targeting adults, generally between 0.5 and 2. Expenditures on adults have exceeded this MVPF range in particular if they induced large spillovers on children. We relate our estimates to existing theories of optimal government policy, and we discuss how the MVPF provides lessons for the design of future research.
Higher Serum C-Reactive Protein Levels in Catatonic Patients: A Comparison to Non-catatonic Patients and Healthy Controls
Authors: Zhou Fu-Chun , Lee Joseph W Y , Zhang Qi-Hang , Sun Zuo-Li , Bo Qijing , He Xiao-Xiao , Han Tian , Xiong Min , Li Chaohui , Wang Chuan-Yue 
Published: March 2020

Abstract
Catatonia is a psychomotor syndrome defined by a constellation of predominantly motor symptoms. The aim of the present study was to determine whether recently admitted psychiatric patients with catatonia exhibited higher serum C-reactive protein (hs-CRP) levels compared to non-catatonic psychiatric patients and healthy controls (HCs). Recently admitted psychiatric patients were screened and evaluated for the catatonia syndrome using the Bush-Francis Catatonia Rating Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The study sample was formed by 150 individuals (39 male and 111 female), including 51 catatonic patients, 55 non-catatonic patients, and 44 HCs. Serum hs-CRP levels were processed with the enzyme-linked immunosorbent assay. Serum levels of creatine kinase (CK), adrenocorticotropic hormone (ACTH), immunoglobulin G (IgG), complement component 3 (C3), and complement component 4 (C4) were also determined. There was a significantly higher percentage of patients with high inflammatory levels (hs-CRP &gt; 3000ng/ml) in the catatonic (43.1%) than in the non-catatonic (14.5%) or HCs group (9.1%) (χ 2 =18.9, P &lt; .001). Logistic regression showed that catatonic patients had significantly higher hs-CRP levels compared to non-catatonic patients even after controlling for other clinical and laboratory variables (OR = 3.52, P = .015, 95% CI 1.28–9.79). Multiple linear regression analysis revealed that log-transformed hs-CRP was independently predicted by body mass index and log-transformed C4, ACTH, and Cortisol in catatonic patients. Findings of the present study suggest that catatonia is specifically linked to a higher level of systemic inflammation, not merely attributable to the overall psychopathology, or alterations in the stress level and complement system.
Switchgrass Rhizosphere Metabolite Chemistry Driven by Nitrogen Availability
Authors: Smercina Darian N. , Bowsher Alan W. , Evans Sarah E. , Friesen Maren L. , Eder Elizabeth K. , Hoyt David W. , Tiemann Lisa K. 
Published: March 2020

Plants and soil microorganisms interact closely in the rhizosphere where plants may exchange carbon (C) for functional benefits from the microbial community. For example, the bioenergy crop, switchgrass (Panicum virgatum) is thought to exchange root-exuded C for nitrogen (N) fixed by diazotrophs (free-living N-fixers). However, this interaction is not well characterized and it is not known how or if switchgrass responds to diazotrophs or their activity. To explore this question, we assessed rhizosphere metabolite chemistry of switchgrass grown in a hydroponic system under two N levels and under inoculated or uninoculated conditions. Plants were grown with the inoculum Azotobacter vinelandii DJ for 3 days before harvest. We found switchgrass root exudate chemistry to be driven by N availability. Total metabolite concentrations were generally greater under high N versus low N and unaffected by inoculation. Examination of rhizosphere chemical fingerprints indicates metabolite chemistry was also driven strongly by N availability with a greater relative abundance of carbohydrates under high N and greater relative abundance of organic acids under low N. We also found evidence of changes in rhizosphere chemical fingerprints by inoculation treatment. However, we found little evidence of N treatment and inoculation interaction effects that suggests this response is not directly mediated by N availability. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Phenotypic variation of Gardnerella vaginalis subgroups in relation to virulence potential
Authors: Bulavaitė Aistė , Janulaitienė Miglė , Baranauskienė Lina , Gėgžna Vilmantas , Plečkaitytė Milda 
Published: March 2020

Background
Phenotypic and genotypic diversity of vaginal bacteria Gardnerella vaginalis resulted in its classification into genotypic subgroups. The virulence potential of these subgroups was evaluated.
Methods

G. vaginalis clinical isolates were subtyped on the basis of subgroup-specific genes by PCR. The virulence-related phenotypic characteristics of the isolates were evaluated assessing their in vitro ability to grow as biofilm on abiotic surfaces, produce the toxin vaginolysin, and express sialidase activity. Vaginolysin in the supernatant of the cultures was quantified using toxin-specific antibodies by sandwich ELISA. Sialidase activity was tested using fluorogenic substrate. Cloning and expression of the sialidase gene of G. vaginalis in E. coli was performed. Differences in the expression of phenotypic properties of the isolates were evaluated by agglomerative hierarchical clustering and principal component analysis.

Results
Thirty-five clinical isolates of G. vaginalis were subtyped into three subgroups 1, 2 and 4. Analysis of sialidase activity indicated statistically significant differences among the subgroups. All isolates were grouped into three clusters by the methods of statistical analysis. The distinct profile of each cluster was based on the phenotypic characteristics of isolates. Subgroup 4 was the most homogenous group, as all isolates were found in the same cluster, which was characterized by the low production of all studied virulence factors. Subgroup 2 isolates were mainly distributed between two clusters, whereas subgroup 1 isolates were found in all three clusters.

Conclusion
G. vaginalis subgroups with different virulence potential might play distinct roles in vaginal microbiota.
Is hand surface coverage a good measure of hand hygiene effectiveness?
Authors: Gozdzielewska Lucyna , Price Lesley , McAloney Kareena , Lang Sue , Reilly Jacqui 
Published: March 2020

Background: Effective hand hygiene (HH) is fundamental to the prevention of healthcare-associated infections. One of the commonly used ways for assessing the effectiveness of HH procedure is measuring the extent of hand surface coverage with alcohol-based handrub (ABHR).
Methods: In this Latin square design study, handrubbing with ABHR was performed seven times by each of the 35 volunteers. Volunteers’ hands were contaminated with the Escherichia coli K12 strain as per EN 1500 guidelines. Glove juice samples were collected from their hands before and after each ABHR application and surface coverage was measured using Hand-in-Scan® scanner. The relationship between the bacterial log10 reduction and percent surface coverage was analysed using Spearman’s Rank Order Correlation and simple linear regression.
Results: Surface coverage ranged from 49.38% to 100% (N= 208, Mdn: 97,33%, IQR= 83.52 – 99.93), while the E. coli reduction ranged from 0.96 to 5.92 log10 (N= 221, M: 3.07, SD= 0.94). The Spearman’s Rank Order Correlation results showed no significant correlation between percent hand surface coverage and E. coli log10 reduction [r= -0.009, n= 198, p= 0.905]. The lack of correlation was further confirmed by the linear regression.
Conclusions: These findings suggest that the rate of surface coverage does not correlate with reduction in bacterial load on hands following HH. Although visual feedback on surface coverage can be a good approach to teaching the correct HH technique, these findings suggest that surface coverage alone is not a reliable measure of HH effectiveness.
Doxycycline for the empiric treatment of low-severity hospital acquired pneumonia
Authors: Cevik Muge , Russell Clark , Evans Morgan , Mackintosh Claire 
Published: March 2020

Background
In the U.K., doxycycline is widely recommended as first-line empiric treatment for mild HAP, however this practice is based on expert opinion and we are aware of no data describing the outcomes of patients treated with doxycycline. Here we describe the outcomes of non-ICU patients treated empirically with doxycycline for low-severity HAP.
Methods
1680 inpatient chest x-rays were manually screened to identify cases of HAP. HAP was defined as new or progressive CXR consolidation occurring ³48 hours after admission, combined with compatible symptoms or signs. Treatment failure was defined as requirement for antimicrobial escalation, HAP recurrence or mortality attributed to HAP. We compared groups according to treatment outcome using the Kruskal-Wallis test and receiver operator characteristic (ROC) analysis.

Results
Forty-nine patients who received doxycycline were included in the analysis. The median age was 78 years and 63% had >2 co-morbidities. Hypoxia was common (57%) but extra-pulmonary organ dysfunction was uncommon. 71% of patients were successfully treated with doxycycline as first-line empiric therapy. Treatment failure was associated with increased duration of hospitalisation prior to HAP onset (median 21.5 vs. 10 days, p=0.03) and higher neutrophil count (10.1 vs. 6.1 x109L-1, p=0.04). ROC analysis identified HAP onset >14 days after admission as the optimum cut-off for predicting treatment failure.
Conclusions
In this cohort, the majority of patients with low-severity HAP were successfully treated with doxycycline. Treatment failure was associated with prolonged hospitalisation prior to HAP onset with 14d identified as a potential surrogate marker for patients requiring antimicrobials against Gram-negative organisms.
Post-influenza meningitis in an immunosuppressed man
Authors: Senanayake Rashantha , Burns Daniel , Canning Benjamin , Dedicoat Martin , Moran Ed 
Published: March 2020

Background:
We report a case of post-influenza invasive aspergillosis causing ventriculitis in a patient immunosuppressed on methotrexate for rheumatoid arthritis.

Summary:
A 63-year-old male with a positive H1N1 throat swab presented with increasing dyspnoea and pyrexia that failed to improve despite broad-spectrum antibiotics and zanamivir. Imaging of his chest showed cavitating lung disease and a possible post influenza fungal infection. He was initiated on antifungal treatment that was stopped after 10 days following a negative bronchoalveolar lavage and serum galactomann test. Respiratory symptoms and inflammatory markers improved but he developed confusion and falls. Computed tomography of the head showed hydrocephalus but there was no papilloedema. Examination of the cerebrospinal fluid (CSF) showed lymphocytosis with elevated proteins but negative initial investigations. Subsequent magnetic resonance imaging of the head with contrast showed obstructing hydrocephalus with ventriculitis. He underwent an urgent ventriculostomy by the neurosurgeons which demonstrated purulent CSF. CSF testing was strongly positive for beta-D glucan, a positive PCR result for aspergillus in CSF was received from the initial lumbar puncture and histology from operative samples showed fungal hyphae. Dual antifungal treatment was recommenced but the patient’s conditioned worsened, and he died on ITU.

Conclusion:
Whilst invasive pulmonary aspergillosis is a recognised complication of influenza, extrapulmonary infection is less well documented. This is the first case in the literature in which ventriculitis due to aspergillus is described as a sequel to infection with influenza. Clinicians should remain vigilant for fungal infection in patients with influenza who are immunosuppressed.
Developing a quality assurance system for the use of stimulan beads in a diabetic foot clinic
Authors: Burns Phillipa , Adams Kate , Hajjawi Mark , Wearmouth Deborah 
Published: March 2020

Background
Diabetic foot infections are an increasing healthcare issue and managing these infections can be difficult. A recent innovation in the way they are managed in the Hull clinic is the use of antibiotic impregnated (generally Gentamicin and Vancomycin) STIMULAN beads. Often only a couple of beads can be used in a foot wound making it a very uneconomical strategy if the beads can’t be stored and used on other wounds. There is no recommended quality assurance method provided by the manufacturers to validate this practice leading to this study.
Methods
Five beads were removed from a batch; at 1, 4, 8 and 12 week intervals for testing:
Bacterial Challenge: a 10mL spot of bead suspension was placed on Mueller Hinton seeded with Staphylococcus aureus ATCC 29213 and E. coli ATCC 25922 and incubated in Air, at 35±1ºC for 18±2hrs; zones of inhibition were read and recorded.
TDM: Vancomycin and Gentamicin levels present in each bead was established by analysing 50mL of suspension (1:5 DF) using a therapeutic drug monitoring assay.

Results
Beads were microbiologically active for 12 weeks with no notable loss of potency.
Bacterial challenge: Staphylococcus aureus range 17-23mm, av. 20.4mm and E. coli range 11-20mm, av. 17.5mm.
TDM Assay: Vancomycin range 62.01 – 110.18 Av. 88.88mg/L, Gentamicin range 20.38 – 27.41 Av.23.20mg/L.

Conclusion
Quality assurance of the STIMULAN beads can be established using standard TDM assays and microbiological activity, enabling a kit to be used for up to 12 weeks with clinical confidence.
Is prior antibiotic exposure a risk factor for the development of bacteraemia in bone marrow transplant patients?
Authors: Hills George , Dulobdas Vaishali , Perera Nelun 
Published: March 2020

Background: Bone marrow transplantation (BMT) is a unique immunosuppressed state, and the consequences of infection are often severe. We hypothesized that disruption of the faecal microbiota (such as with use of broad spectrum antibiotics) may predispose to gastrointestinal related sepsis post bone marrow transplantation.
Methods: We reviewed the laboratory data from all BMT patients between January 2016 and August 2018 and recorded the presence of bacteraemia. We matched these patients to controls with no recorded bacteraemia. We then recorded antibiotic exposure in the immediate pre-transplant period.
Results: 238 records were reviewed (81 allografts, 157 autografts). We identified 28 patients with bacteraemia from gastrointestinal related pathogens. 28 controls with no positive blood cultures were matched according to the type of BMT. In both groups there were 18 allografts, 12 of which were matched unrelated donors. In the bacteraemic group there were a total of 12 antibiotic episodes (60 days) pre-transplant, compared with 6 (41 days) in the control group. The most common antibiotics used were meropenem (47 days in the bacteraemic group, 24 control) and piperacillin/tazobactan (13 days in the bacteraemic group, 3 control).
Conclusion: Our results support the hypothesis that broad spectrum antibiotics pre-transplant may predispose to post-transplant sepsis. Although the small population size limits this study, further studies are necessary to confirm this finding, and to investigate which components of the faecal microbiota are the most important to preserve prior to BMT. This may open the door to novel therapeutics in this patient group, such as faecal microbiota transplant.
Pharmacokinetics of TKM-130803 in Ebola virus disease in Sierra Leonean subjects
Authors: Scott Janet , Sharma Raman , Meredith Luke , Dunning Jake , Moore Catrin , Sahr Foday , Ward Steve , Goodfellow Ian , Horby Peter , team RAPIDE-TKM trial 
Published: March 2020

TKM-130803 is a specific anti-EBOV therapeutic comprising of two small interfering RNAs (siRNA) siLpol-2 and siVP35-2. The pharmacokinetics (PK) of these siRNAs was defined in Ebola virus disease (EVD) patients. The relationship between PK and patient survival was explored.
Plasma concentration of siRNA was compared to survival at 14 days for seven subjects with EVD in Sierra Leone who received 0.3 mg/kg of TKM-130803 by intravenous infusion over 2 hours daily for up to 7 days. PKdatawere fitted to two-compartment models then Monte Carlo simulated PK profiles were compared to ET (Cmax 0.04-0.57 ng/mL and mean concentration 1.43 ng/mL), and TT (3000 ng/mL).
siRNA was in quantitative excess of virus genomes throughout treatment, but the 95% percentile exceeded TT. Plasma concentration of both siRNAs were higher in subjects who died compared to subjects who survived (p<0.025 both siRNAs).The maximum AUC for which the 95% percentile remained under TT was a continuous infusion of 0.15mg/kg/day.
TKM-130803 was circulating at sufficient concentrations, considered needed for efficacy but given extremely high viral loads it seems likely that the patients died because they were physiologically beyond the point of no return. Subjects who died exhibited some indication of impaired drug clearance, justifying caution in dosing strategies for such patients. This analysis has given a useful insight into the pharmacokinetics of the siRNA in the disease state andillustrates the valueof designing PKPD studies into future clinical trials in epidemic situations.
Case-control study of recurrent Extended-Spectrum Beta Lactamase Enterobacteriaceae Urinary Tract Infections (ESBL UTIs): the management challenges
Authors: Ghani Rohma , Mullish Benjamin , Thursz Mark , Marchesi Julian , Ghazy Anan , Davies Frances 
Published: March 2020

Recurrent UTIs are associated with increased hospitalisation and antibiotic use. We investigated patients with recurrent ESBL versus non-ESBL UTIs to identify risk factors and potential treatments.
A30 month retrospective case-control study was performed in patients with recurrent EBSL versus non-ESBL UTI. Definition :1) > three in a year (>two weeks apart) or 2) > two in six months (>one week apart) with the same profile. 3) ESBL UTIs were Enterobacteriaceae resistant to cefalexin AND ceftazadime/ceftriaxone.
281/1449 “recurrent UTI” patients were ESBLs. Patients were more likely to be older, male, with associated bacteraemia, colonisation with carbapenemase-producing Enterobacteriaceae (CPE) and higher resistance rates to non beta-lactam antibiotics. 75% of renal patients were transplant cases, 81% of urology patients had a tube insertion.
Recurrent ESBL UTIRecurrent non-ESBL UTIp value
Number (%)Number (%)(Chi-squared test)
Patients 281 1168
Organism Klebsiella spp (%)42 (14.9) 10 (0.8) <0.001
E coli (%)199 (70.8)811 (69.4)0.665
Demographics Age (mean, SD)64.1, 19 58.7, 22 <0.001
Male 137 (48.8)328 (28) <0.001
Associations Gram negative bacteraemia 35 (12.4) 37 (3.1) 0.001
Colonisation with CPE 21 (7.5) 31 (2.7) <0.001
Speciality Renal 84 (30.0) 196 (16.8)<0.001
Urology 47 (16.7) 104 (8.9) <0.001
Resistance Trimethoprim 219 (77.9)354 (30.3)<0.001
Ciprofloxacin 214 (76.2)160 (13.7)<0.001
Gentamicin135 (48). 64 (5.5) <0.001
ESBL infection is associated with worse outcomes and significant premorbid conditions. The oral crossover resistance prevented long term prophylaxis.
Options are needed to reduce colonisation burden of resistant organisms such as faecal microbiota transplantation.