bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of Gut Microbiome After Traumatic Brain Injury
Authors: Mahajan Charu , Khurana Surbhi , Kapoor Indu , Sokhal Suman , Kumar Subodh , Prabhakar Hemanshu , Mathur Purva , Mani Kalaivani 
Published: July 2021

Background:
Preclinical studies have reported significant changes in the gut microbiome after traumatic brain injury (TBI). We hypothesized that TBI induces the growth of Proteobacteria in the human gut. Our primary outcome was to study the profile of the human fecal microbiome after TBI and the secondary outcome was to identify colonization with colistin-resistant and multidrug-resistant pathogens.

Methods:
Consecutive patients with moderate-severe TBI admitted to the neurotrauma-intensive care unit within 48 hours of injury were enrolled into this observational study. Samples from rectal swabs obtained on days 0, 3, and 7 after admission were assessed for microbial growth and antibiotic resistance. Demographic data and variables such as hypotension, blood transfusion, surgery, start of nasogastric feeding, use of antibiotics, length of hospital stay and mortality were noted.

Results:
One hundred one patients were enrolled into this study; 57 (56.4%) underwent surgery, 80 (79.2%) required blood transfusion, 15 (14.9%) had an episode of hypotension, 37 (36.6%) received enteral feed within the first 3 days, and 79 (78.2%) received antibiotics. Rectal microbiological samples were collected from 101, 95, and 85 patients on days 0, 3, and 7, respectively. All organisms isolated at the 3 time-points belonged to the Proteobacteria phylum, with Enterobacteriaceae forming the largest group. Colistin-resistant organisms were found in 17 (16.8%) of 101 patients and multidrug-resistant organisms in 25 (64.1%) of the 39 patients in whom isolates were tested against the entire panel of antimicrobials.

Conclusion:
TBI is associated with widespread colonization with Proteobacteria as early as 48 hours after injury. Colonization with colistin and multidrug-resistant organisms highlights the importance of the judicious use of antibiotics.
The use of modular total knee prostheses in femoral defects in traumatic and revision patients: a prospective case series
Authors: Rady Ahmed Emad , Abdelazim Haytham , Hashem Mohammed H. , El Ghazawy Ahmed K. 
Published: July 2021

Background:
Management of distal femoral bone defects represents a great challenge, whether these defects are caused by failed total knee arthroplasties or trauma. One method of management is the use of modular hinged total knee implants with distal femoral replacement, depending on the present defects. Such prostheses can be used in revision surgery, acute comminuted distal femoral fracture, or distal femoral fracture with nonunion. This study aimed to analyze the functional outcome and possible complications of the use of modular total knee prostheses in revision surgery or traumatic injuries in patients with femoral defects.

Methods:
This study was a prospective case series of nononcologic femoral endoprosthetic reconstructions for either revision total knee arthroplasty (TKA) or traumatic femoral defects in eight patients (n=8) from 2015 to 2020. Patient cases were categorized as failed TKA (n=4) or traumatic (n=4). Traumatic patient cases were either distal femoral fractures with nonunion (n=2) or periprosthetic fractures (n=2). Mean follow-up was 2.75 yr (range from 6 mo to 4 yr). Clinical outcomes and ambulatory status (able to walk or not) were assessed. Knee Society Scores (KSS) were calculated, and the range of motion (ROM) was assessed.

Results:
In this group of patients, modular endoprosthetic replacement provided immediate pain relief, early mobilization, and weightbearing. KSS was improved in all patients. ROM was 70 to 90 degrees in four patients, and 90 to 110 degrees in four patients. None of the patients developed soft-tissue infection or implant loosening during the follow-up period.

Conclusions:
Short-term clinical outcomes for the use of modular endoprosthetic total knee implants in the management of distal femoral defects in either traumatic injury or revision surgery result in good functional outcome and patient satisfaction.

Level of Evidence:
Level III.
Adult reconstruction call and prosthetic joint infection (PJI) management patterns across the United States: a cross-sectional study
Authors: Vajapey Sravya P. , Li Mengnai , Glassman Andrew H. 
Published: July 2021

Background:
Patients with prosthetic joint infection (PJI) impose a significant burden in total costs, resources consumed, complication rates, and readmission risk. We sought to determine how patients with PJI who were transferred from other hospitals were initially triaged and managed by medical centers across the country.

Methods:
An online survey was sent to fellowship program directors or chiefs of adult reconstruction (AR) divisions at academic medical centers. The survey consisted of 11 multiple-choice questions regarding initial management and disposition of patients with PJI who were transferred from other hospitals. Statistical analysis was performed.

Results:
Of 96 programs queried, 34 institutions responded. All participating programs performed revision arthroplasties. Thirty-three (97.5%) of the 34 programs accepted transfer of patients with PJI, even if the index arthroplasty procedure was done elsewhere. Twenty-eight (82.4%) responded that a fellowship-trained AR surgeon provides initial treatment to transferred patients with PJI, provided patients are not septic or critically ill. If a patient was septic or critically ill, 12 (35.3%) programs responded that the surgeon on call for general orthopaedics would provide the initial treatment for PJI, usually with irrigation and debridement with retention of components and that, once the patient is medically stabilized, a fellowship-trained AR surgeon would assume care. Roughly 44% of the programs that participated in the survey had a dedicated AR call pool.

Conclusions:
There were a variety of models used by academic medical centers for triaging and management of PJI transfer patients. There does not seem to be one single algorithm universally accepted as optimum for initial management of patients.

Level of Evidence:
Level III.
Future of women orthopaedists: signs of optimism in a 3-year follow-up survey
Authors: Fuchs Lee , Oron Amir 
Published: July 2021

Background:
Gender diversity in medicine can improve physician-patient interactions. Although the number of female medical students has risen to almost 50%, the relative number of female orthopaedic residents remains low. The reason for so few female applicants to orthopaedic programs remains in question.

Methods:
A web survey was distributed to medical students and interns in Israel in 2015 and again in 2018. The survey included demographic data and a questionnaire. The questionnaire explored reasons for not choosing orthopaedics as a specialty and exposure to musculoskeletal medicine in medical school.

Results:
A total of 371 responses were received, 143 in 2015 and 228 in 2018. The distribution of gender, marital status, student status, and medical schools were similar. Men were more inclined to choose orthopaedics in both years (P=0.004, P=0.044). The major reason for not choosing orthopaedics was “it’s just not interesting.” However, in 2018, there were a significant number of male responders who wanted a more balanced work-life profession (P=0.047).

Conclusions:
Women have given many possible reasons for not choosing orthopaedic surgery, such as wanting a better work-life balance, perceptions of physical strength needed, a closed “boy’s club,” not enough exposure, and lack of female role models, yet most of them replied the field is “just not interesting.” The authors suggest in concordance to the literature that having more opportunity for exposure and more female role models would increase gender diversity in orthopaedics.

Level of Evidence:
Level IV.
Effect of Joint Exposure to Psychosocial and Physical Work Factors on the Incidence of Workplace Injuries
Authors: Colin Régis , Wild Pascal , Paris Christophe , Boini Stéphanie 
Published: July 2021

Objective:
To analyze the interaction between physical and psychosocial work factors regarding the workplace injuries incidence among 6900 workers out of a longitudinal survey.

Methods:
Based on responses to questionnaires, we obtained exposure groups respectively for physical factors and for psychosocial factors using hierarchical clustering. We performed multiple Poisson regression model with the workplace injuries incidence during 4 years of follow-up as the outcome and the clusters as the independent variables of interest.

Results:
High psychosocial exposure had a deleterious effect on workplace injuries incidence, which was no longer significant when adjusting for physical factors. The difference in model-based workplace injuries rates between high and low psychosocial exposures seemed to increase (non-significantly) with increasing physical exposure.

Conclusions:
The risk of workplace injuries was highest among workers with high physical exposures regardless of the psychosocial exposures.
Comparison Between Transimpedance Matrix (TIM) Measurement and X-ray Fluoroscopy for Intraoperative Electrode Array Tip Fold-Over Detection
Authors: Klabbers Tim M. , Huinck Wendy J. , Mylanus Emmanuel A. M. 
Published: July 2021

Objective:
The aim of this study was to compare Transimpedance Matrix (TIM-) measurement and X-ray fluoroscopy for the intraoperative detection of electrode array tip fold-over in cochlear implant recipients.

Study design:
Retrospective agreement study.

Setting:
Tertiary referral hospital.

Patients:
Forty-two patients (47 ears) consecutively implanted with the Slim Modiolar Electrode.

Interventions:
Five raters, with different levels of clinical experience, individually retrospectively evaluated the TIM-heatmaps and X-ray fluoroscopy images of all patients included in this study for electrode array tip fold-over.

Main Outcome Measures:
Agreement between raters’ individual evaluation and the diagnosis given during clinical intraoperative evaluation for both modalities, as well as the inter-method agreement between TIM-measurement and fluoroscopy, and the inter-rater agreement for both modalities.

Results:
A tip fold-over was found in three of the forty-seven implantations (6.4%) included in this study. The average agreement between raters’ evaluation and the intraoperative evaluation was 88% (Cohens κ = 0.378) for fluoroscopy and 99% (Cohens κ = 0.915) for TIM-measurement. Two raters misdiagnosed at least one tip fold-over as being correctly positioned when evaluating the fluoroscopy images (1/3 and 3/3, respectively). Each of the raters correctly detected all three tip fold-overs using the TIM-heatmaps. The inter-rater agreement for fluoroscopy was classified as “fair” (Fleiss’ κ = 0.286), while the inter-rater agreement for TIM-measurement was classified as “near-perfect” (Fleiss’ κ = 0.850).

Conclusions:
TIM-measurement has a high potential to replace X-ray fluoroscopy for intraoperatively detecting electrode array tip fold-over in cochlear implantation, especially in patients implanted with flexible, precurved arrays.
Polyethylene Glycol 3350 Changes Stool Consistency and the Microbiome but not Behavior of CD1 Mice
Authors: Salman Salman S. , Williams Kent C. , Marte-Ortiz Pedro , Rumpf Wolfgang , Mashburn-Warren Lauren , Lauber Christian L. , Bailey Michael T. , Maltz Ross M. 
Published: July 2021

ABSTRACT

Objectives:
Polyethylene Glycol 3350 (PEG3350) is a laxative commonly used to treat constipation in children. The Food and Drug Administration has received reports of increased anxiety, aggression, and obsessive--compulsive behaviors in children administered PEG3350. Thus, we assessed whether daily administration of PEG3350 leads to anxiety-like behavior in mice.

Methods:
Outbred CD-1 IGS mice were administered either a high or a low dose of PEG3350 via daily oral gavage for 2 weeks. As a laxative comparison and control, additional mice were given a high or low dose of magnesium citrate or vehicle (water). Weight and stool consistency were assessed after each gavage to determine laxative effectiveness. Anxiety-like behaviors were assessed using light/dark, open field, and elevated plus maze (EPM) tests at baseline, after 2 weeks of daily gavage, and after a 2 week washout in experiment 1, and after 2 weeks of daily gavage in experiment 2. Stool samples were collected for microbiome analysis in experiment 2 at baseline, after 2 weeks of daily gavage, and after 2 weeks washout.

Results:
PEG3350 and magnesium citrate significantly changed stool consistency, as well as microbiome alpha and beta diversity. Anxiety-like behaviors were not, however, different in mice administered low or high doses of PEG3350 or magnesium citrate.

Conclusions:
Although changes in stool consistency and the gut microbiome occurred, administration of PEG3350 did not alter anxiety-like behaviors.
Brief Report: Frailty in Aging People Living With HIV: A Matched Controlled Study
Authors: Lellouche Lionel , Gutierrez Laure-Anne , Leclercq Pascale , Zaegel-Faucher Olivia , Bernard Louis , Vassallo Matteo , Barbuat Claudine , Ozguler Anna , Zins Marie , Nailler Laura , Reynes Jacques , Berr Claudine , Makinson Alain 
Published: July 2021

Background:
We compared the prevalence of frailty among aging people living with HIV (PLHIV) with people without HIV from the ANS EP58 HAND 55–70 Study.

Methods:
Cross-sectional multicentric study which consecutively included 200 PLHIV and 1000 people without HIV from the French national CONSTANCES cohort, matched on age, sex, and education level. PLHIV were aged 55–70 years, with a HIV viral load < 50 copies/mL and a lymphocyte T-CD4 level > 200 cells/µL for the last 24 and 12 months, respectively. We measured frailty (>2 items) and prefrailty (one or 2 items) using a proxy of the 5-item Fried score. Multivariate logistic regression was performed to assess the association between HIV and frailty/prefrailty, adjusting for demographic, social, behavioral, and comorbidity confounders.

Results:
Outcome measures were available for 192 PLHIV and 822 people without HIV. The median age was 62 years, and 84.9% were men. Among PLHIV, the median CD4 cell count was 645.5 cells/µL. Prevalence of frailty/prefrailty was 5.73%/57.3% in PLHIV vs. 1.73%/52.2% in people without HIV, respectively. HIV was associated with prefrailty/frailty [odds ratio = 1.89; 95% confidence interval = 1.37 to 2.61), but after adjusting for social and behavioral factors and comorbidities, HIV was not significantly associated with prefrailty/frailty (odds ratio = 1.24; 95% confidence interval: = 0.84 to 1.81). In PLHIV only, frailty/prefrailty was associated with depressive symptomatology, kidney disease, and time since HIV infection.

Conclusions:
Prevalence of frailty is increased in aging PLHIV with well-controlled HIV disease, but other factors than HIV are predominant, particularly depression and comorbidities.
Detection of Diffuse Peritoneal and Omental Metastases From Prostate Cancer With 18F-PSMA-1007 PET/CT
Authors: Ji Xiaowei , Wang Ling , Lin Jie , Tang Kun 
Published: July 2021

Abstract
Diffuse peritoneal and omental infiltration of prostate cancer detected by 18F-PSMA-1007 PET/CT was rarely reported. We report a case of an 80-year-old man who was suspected of prostate carcinoma metastasis and underwent 18F-PSMA-1007 PET/CT for restaging the disease. PET/CT imaging presented intense tracer uptake in the prostate gland, multiple lymph nodes, and bones. Interestingly, we found extremely increased radioactive uptake of diffuse peritoneum and omentum on 18F-PSMA-1007 PET/CT images, which are very rare metastatic sites for prostate cancer.
Secondary Raised Intracranial Pressure After Cranial Vault Remodeling for Isolated Sagittal Craniosynostosis
Authors: Moore Mark H. , Chaisrisawadisuk Sarut , Prasad Vani , Santoreneos Stephen , Molloy Cindy J. 
Published: July 2021

Abstract
The management of sagittal craniosynostosis has evolved over the decades as teams seek to refine their surgical approaches to idealize head shape with the least possible morbidity. Here, the authors identify the incidence of raised intracranial pressure (ICP) and its risk factors, requiring secondary surgical intervention after cranial vault remodeling (CVR) procedure at a single tertiary referral craniofacial unit. A retrospective case-control study was performed on the patients with isolated non-syndromic sagittal craniosynostosis. All patients who underwent CVR in our unit and had a minimum of 1.5 years follow-up were included. One hundred and eighty-four patients (134 male and 50 female) who underwent primary CVR surgery for isolated sagittal craniosynostosis were included. Thirteen patients (7.07%) had clinical evidence of late raised ICP resulting in repeat CVR procedures. Higher incidence of raised ICP in patients who had primary surgery before 6 months than after or at 6 months of age (P = 0.001). There were 23.5%, 5.6%, 3.2%, and 1.9% of secondary raised ICP patients who underwent the primary surgery between 1999–2004, 2005–2010, 2011–2015 and 2016–2018, respectively (P = 0.024). The risk of secondary raised ICP was higher in patients with isolated sagittal craniosynostosis whose primary surgery occurred before the age of 6 months (two times more likely). More extensive CVR can be performed safely in sagittal synostosis with promising outcomes. The late presentation with raised ICP reinforces the importance of long-term multidisciplinary protocol-based follow-up.
Incidence, Clinical Characteristics and Outcomes of Early Hyperbilirubinemia in Critically Ill Patients: Insights From the MARS Study
Authors: Juschten Jenny , Bos Lieuwe D. J. , de Grooth Harm-Jan , Beuers Ulrich , Girbes Armand R. J. , Juffermans Nicole P. , Loer Stephan A. , van der Poll Tom , Cremer Olaf L. , Bonten Marc J. M. , Schultz Marcus J. , Tuinman Pieter Roel ,   for the MARS∗ consortium
Published: July 2021

ABSTRACT

Objective:
To investigate the incidence, clinical characteristics and outcomes of early hyperbilirubinemia in critically ill patients.

Design and Setting:
This is a post hoc analysis of a prospective multicenter cohort study.

Patients:
Patients with measured bilirubin levels within the first 2 days after ICU admission were eligible. Patients with liver cirrhosis were excluded.

Endpoints:
The primary endpoint was the incidence of early hyperbilirubinemia, defined as bilirubin ≥33 μmol/L within 2 days after ICU admission. Secondary endpoints included clinical characteristics of patients with versus patients without early hyperbilirubinemia, and outcomes up to day 30.

Results:
Of 4,836 patients, 559 (11.6%) patients had early hyperbilirubinemia. Compared to patients without early hyperbilirubinemia, patients with early hyperbilirubinemia presented with higher severity of illness scores, and higher incidences of sepsis and organ failure. After adjustment for confounding variables, early hyperbilirubinemia remained associated with mortality at day 30 (odds ratio, 1.31 [95%–confidence interval 1.06–1.60]; P = 0.018). Patients with early hyperbilirubinemia and thrombocytopenia (interaction P-value = 0.005) had a higher likelihood of death within 30 days (odds ratio, 2.61 [95%–confidence interval 2.08–3.27]; P < 0.001) than patients with early hyperbilirubinemia and a normal platelet count (odds ratio, 1.09 [95%–confidence interval 0.75–1.55]; P = 0.655).

Conclusions:
Early hyperbilirubinemia occurs frequently in the critically ill, and these patients present with higher disease severity and more often with sepsis and organ failures. Early hyperbilirubinemia has an association with mortality, albeit this association was only found in patients with concomitant thrombocytopenia.
Cross-sectional cycle threshold values reflect epidemic dynamics of COVID-19 in Madagascar
Authors: Andriamandimby Soa Fy , Brook Cara E. , Razanazatovo Norosoa , Rakotondramanga Jean-Marius , Rasambainarivo Fidisoa , Raharimanga Vaomalala , Razanajatovo Iony Manitra , Mangahasimbola Reziky , Razafindratsimandresy Richter , Randrianarisoa Santatra , Bernardson Barivola , Rabarison Joelinotahiana Hasina , Randrianarisoa Mirella , Nasolo Frédérick Stanley , Rabetombosoa Roger Mario , Randremanana Rindra , Héraud Jean-Michel , Dussart Philippe 
Published: July 2021

AbstractAs the national reference laboratory for febrile illness in Madagascar, we processed samples from the first epidemic wave of COVID-19, between March and September 2020. We fit generalized additive models to cycle threshold (Ct) value data from our RT-qPCR platform, demonstrating a peak in high viral load, low-Ctvalue infections temporally coincident with peak epidemic growth rates estimated in real time from publicly-reported incidence data and retrospectively from our own laboratory testing data across three administrative regions. We additionally demonstrate a statistically significant effect of duration of time since infection onset on Ctvalue, suggesting that Ctvalue can be used as a biomarker of the stage at which an individual is sampled in the course of an infection trajectory. As an extension, the population-level Ctdistribution at a given timepoint can be used to estimate population-level epidemiological dynamics. We illustrate this concept by adopting a recently-developed, nested modeling approach, embedding a within-host viral kinetics model within a population-level Susceptible-Exposed-Infectious-Recovered (SEIR) framework, to mechanistically estimate epidemic growth rates from cross-sectional Ctdistributions across three regions in Madagascar. We find that Ct-derived epidemic growth estimates slightly precede those derived from incidence data across the first epidemic wave, suggesting delays in surveillance and case reporting. Our findings indicate that public reporting of Ctvalues could offer an important resource for epidemiological inference in low surveillance settings, enabling forecasts of impending incidence peaks in regions with limited case reporting.
Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii strains in Belgian acute-care hospitals
Authors: Valcek Adam , Bogaerts Pierre , Denis Olivier , Huang Te-Din , Van der Henst Charles 
Published: July 2021

SynopsisObjectivesTo describe the genotypic epidemiological distribution and the antibiotic resistance mechanisms of recent carbapenem-resistant Acinetobacter baumannii (CRAb) strains recovered from clinical samples in Belgium.MethodsA total of 40 clinical isolates of CRAb collected by the national reference center from 19 acute-care hospitals through national microbiological surveillance in 2014 and 2017 were analysed in this study. The isolates were tested for antimicrobial susceptibility by broth microdilution and determined for carbapenemase-encoding genes by multiplex PCR targeting major carbapenemases families. Isolates were subjected to whole-genome sequencing (WGS) with Illumina technology and the complete chromosomal sequences were de novo assembled. Genome analysis was performed to identify intrinsic and acquired resistance determinants and to characterize clonal lineage according to the sequence type (ST).ResultsAll 40 isolates were resistant to carbapenems and exhibited extensively drug-resistant phenotype with blaOXA-23 (n=29) being the most abundant detected acquired AMR gene with 38 isolates encoding at least two different types of OXA enzymes. The majority of the isolates were globally disseminated clones of ST2 (n=25) while less frequent sequence types such as ST636 (n=6), ST1 (n=3), ST85 (n=2) and per one isolate from ST604, ST215, ST158 and ST78 were also detected.ConclusionsWe have detected extensively drug-resistant globally occurring clones of A. baumannii ST1 and ST2 throughout Belgium as well as other sporadic ST including ST636 causing local outbreaks. Our results show the presence of high-risk clones of A. baumannii with common travel importation and the crucial need of constant surveillance.