bluuebunny/crossref_metadata_2025_split huggingface dataset:
Drug resistance mutations in HIV provirus are associated with defective proviral genomes with hypermutation
Authors: Li Yijia , Etemad Behzad , Dele-Oni Ruth , Sharaf Radwa , Gao Ce , Lichterfeld Mathias , Li Jonathan Z. 
Published: February 2021

Background:
HIV proviral sequencing overcomes the limit of plasma viral load requirement by detecting all the ‘archived mutations’, but the clinical relevance remains to be evaluated.

Methods:
We included 25 participants with available proviral sequences (both intact and defective sequences available) and utilized the genotypic sensitivity score (GSS) to evaluate the level of resistance in their provirus and plasma virus. Defective sequences were further categorized as sequences with and without hypermutations. Personalized GSS score and total GSS score were calculated to evaluate the level of resistance to a whole panel of antiretroviral therapies and to certain antiretroviral therapy that a participant was using. The rate of sequences with drug resistance mutations (DRMs) within each sequence compartment (intact, defective and plasma viral sequences) was calculated for each participant.

Results:
Defective proviral sequences harbored more DRMs than other sequence compartments, with a median DRM rate of 0.25 compared with intact sequences (0.0, P = 0.014) and plasma sequences (0.095, P = 0.30). Defective sequences with hypermutations were the major source of DRMs, with a median DRM rate of 1.0 compared with defective sequences without hypermutations (0.042, P < 0.001). Certain Apolipoprotein B Editing Complex 3-related DRMs including reverse transcriptase gene mutations M184I, E138K, M230I, G190E and protease gene mutations M46I, D30N were enriched in hypermutated sequences but not in intact sequences or plasma sequences. All the hypermutated sequences had premature stop codons due to Apolipoprotein B Editing Complex 3.

Conclusion:
Proviral sequencing may overestimate DRMs as a result of hypermutations. Removing hypermutated sequences is essential in the interpretation of proviral drug resistance testing.
Primary Malignant Melanoma of the Oropharynx Presented on 18F-FDG PET/CT
Authors: Xiao JingXing , Su Min , Wang Dong 
Published: February 2021

AbstractPrimary malignant melanoma in the oropharynx is extremely rare. A 49-year-old man presented with a 3-month history of progressive dysphagia. An outside CT scan of the head and neck showed a space-occupying lesion in the oropharynx. Staging with FDG PET/CT demonstrated a hypermetabolic mass in the right wall of the oropharynx. A biopsy revealed malignant melanoma. The patient underwent total resection of the tumor, with no recurrence after 6-month follow-up.
A Clinical Study on Individualized Surgical Scheme of Hydrocephalus Complicated With Skull Defect
Authors: Zhou Jian-Yun , Zhang Xin , Gao Hai-Bin , Cao Ze , Sun Wei 
Published: February 2021

Objective:
This study intends to discuss the individualized selection of surgical scheme of hydrocephalus complicated with skull defect.

Methods:
A total of 141 patients with hydrocephalus complicated with skull defect in our hospital from January 2012 to December 2018 were the main subjects of this study. Among these 141 patients, 78 patients underwent shunt and skull repair surgery in our hospital. In the present study, according to the classification of bone window tension, and combined with factors that affect the operation, different surgical schemes were selected, namely, repair surgery in the first phase and shunt surgery in the second phase, or simultaneous surgery, or shunt surgery in the first phase and repair surgery in the second phase.

Results:
The results of the present study show that an individualized surgical scheme can allow for the operation of hydrocephalus complicated with skull defect, without increasing the risk of complications, such as shunt infection, epidural hematoma, etc.

Conclusions:
The surgical scheme for hydrocephalus complicated with skull defect differs in clinic.
Uncertain Clinical Effect of Polymyxin B Hemoperfusion in Patients with Septic Acute Kidney Injury Requiring Continuous Renal Replacement Therapy
Authors: Lee Jong Min , Baek Seung Don , Kim Tae Hyun , Jeon Hwa Ran , Han Jin Hee , Chang Jai Won 
Published: February 2021

ABSTRACT
Polymyxin B hemoperfusion (PMX-HP) may improve the clinical outcomes of patients with sepsis and gram-negative bacteremia by reducing endotoxin levels. However, the recent studies with the variable degree of renal support have shown that the improvement of survival rate by PMX-HP remains unclear in such patients. Therefore, we investigated whether the addition of PMX-HP to continuous renal replacement therapy (CRRT) could improve the survival rate than CRRT alone. This study included 231 patients with sepsis undergoing CRRT alone or PMX-HP with CRRT. Primary outcomes were 28-day and 90-day all-cause mortality. Urine output, ventilator support, and Sequential Organ Failure Assessment (SOFA) score were not significantly different between the two groups. Crude 28-day and 90-day mortality rates were higher in the PMX-HP with CRRT group than in the CRRT-alone group. To correct for disease severity, propensity score (PS) matching was performed with acute respiratory distress syndrome, mechanical ventilation support, extracorporeal membrane oxygenation, infection source (abdomen), age, inotropic score, SOFA score, C-reactive protein, and procalcitonin levels. Sixty-six PS-matched pairs revealed significantly higher 28-day and 90-day mortality rates in the PMX-HP with CRRT group than in the CRRT-alone group. Considering the mortality rates after PS matching, the additional use of PMX-HP does not improve the clinical outcomes of patients with sepsis and acute kidney injury requiring CRRT.
A Discrete Event Simulation-Based Model to Optimally Design and Dimension Mobile COVID-19 Saliva-Based Testing Stations
Authors: Saidani Michael , Kim Harrison 
Published: February 2021

Summary Statement
The present COVID-19 brief report addresses: (1) the problem of optimal design and resource allocation to mobile testing stations to ensure rapid results to the persons getting tested; (2) the proposed solution through a newly developed discrete event simulation model, experienced in on-campus saliva-based testing stations at the University of Illinois at Urbana-Champaign; and (3) the lessons learned on how 10,000 samples (from noninvasive polymerase chain reaction COVID-19 tests) can be processed per day on campus, as well as how the model could be reused or adapted to other contexts by site managers and decision makers.
Vaginal Estrogen as First-Line Therapy for Recurrent Urinary Tract Infections in Postmenopausal Women and Risk Factors for Needing Additional Therapy
Authors: Chang Eric , Kent Laura , Prieto Isabel , Eggers Erica , Tanner Jean Paul , Bassaly Renee , Wyman Allison , Greene Kristie 
Published: February 2021

Objectives
This retrospective cohort study aims to determine the proportion of postmenopausal women with recurrent urinary tract infections (rUTIs) who improve with vaginal estrogen cream alone and to identify risk factors for those who go on to require additional therapies.

Methods
Postmenopausal women presenting with rUTIs seen at a single institution over a 29-month period were identified. Patients who had not undergone previous treatment and were started on vaginal estrogen cream alone as first-line therapy were included in the study. Descriptive statistics were used to compare demographic and clinical characteristics between therapy groups. Log-binomial regression was used to explore the association between treatment failure (ie, the need for additional therapy for rUTIs) and patient sociodemographic and clinical characteristics.

Results
During the study period, 167 patients with rUTIs met inclusion criteria. Of these, 67.7% noted improvement or resolution in their symptoms with vaginal estrogen cream alone. Women with a concomitant diagnosis of urinary incontinence, as defined as subjective report of bothersome stress or urgency urinary incontinence, were 2.3 times more likely to need additional therapy compared with women not reporting urinary incontinence (relative risk, 2.28; 95% confidence interval, 1.06-4.90).

Conclusions
Sixty-eight percent of postmenopausal women with rUTIs treated with vaginal estrogen alone did not go on to receive additional therapy. A risk factor for needing additional therapy in our study population is the presence of urinary incontinence.
Association Between Hemoglobin A1 c and Midurethral Sling Complications in Diabetic Women: A Cohort Study
Authors: Ortega Marcus V. , Bangura Marie , Ayati Elnaz , James Kaitlyn , Mitchell Caroline , Weinstein Milena M. , Von Bargen Emily 
Published: February 2021

Objective
We aimed to evaluate the association between hemoglobin A1
c (HbA1
c) levels and midurethral sling (MUS) complications.

Methods
This was a multihospital, retrospective cohort study from 2010 to 2020. We included all women with diabetes mellitus who underwent a synthetic mesh MUS procedure and had a preoperative HbA1
c within 3 months of surgery. The primary outcome was a composite of complications, including MUS mesh exposure, surgical site granulation tissue or infection, urinary tract infection, surgical site pain beyond 6 weeks postoperatively, and MUS failure. A sensitivity analysis analyzing MUS failure alone was performed.

Results
During the study period, 109 women met the inclusion criteria. Most were White (52.2%) and had a median body mass index of 31.2 kg/m2, and 84.9% were postmenopausal. Median HbA1
c was 7.2% (interquartile range, 6.3%–7.7%). Urinary tract infection was the most common complication in 12 (11.0%) women. Mesh exposure was diagnosed in 7 (6.4%) women. Seventeen (15.6%) had MUS failure. On univariate regression analysis, a higher HbA1
c was associated with increased odds of composite complications (odds ratio, 1.67; 95% confidence interval, 1.20–2.32; P = 0.002) and MUS failure (odds ratio, 1.81, 95% confidence interval, 1.26–2.60; P = 0.001). On multivariate analysis, higher HbA1
c levels were associated with a composite of complications and failure (P < 0.05). Based on the receiver operating characteristic curve, HbA1
c greater than 8% demonstrated a specificity of 85.7% and a sensitivity of 50% for MUS failure.

Conclusions
In diabetic patients, a higher HbA1c was associated with a higher risk of MUS complications and failure. Obtaining an HbA1
c within 3 months of surgery may help with risk stratification.
Autologous Fascia Lata for Combined Sacrocolpopexy and Rectopexy
Authors: Shaw Jonathan S. , Wilson Lauren R. , Wilson Matthew Z. , Ivatury S. Joga , Strohbehn Kris 
Published: February 2021

Abstract
We present a case series and video of our technique using autologous fascia lata for combined sacrocolpopexy and rectopexy, with or without resection.
Is Rapid Molecular Testing enough In Screening Resistant Tuberculosis In Community
Authors: Ashok Dhaker , Ashish Bahal , Vishal Mangal , Arun K Yadav , Anuj Singhal , Anoushka Gupta 
Published: March 2021

AbstractBackgroundThe study aimed to compare the sensitivity and specificity of cartridge based nucleic acid amplification test (CBNAAT) for diagnosis of Drug-Resistant tuberculosis (DRTB) with culture sensitivity assays.MethodsPatients with cough symptoms for more than two weeks with any one symptom such as night sweats, fever, and unintentional weight loss were enrolled. Cases where Mycobacterium Tuberculosis was detected on sputum CBNAAT, were included in the study. Demographic variables, clinical features, and chest radiographs were collected. Each sputum sample was divided into three aliquots: smear microscopy, culture, and genotypic drug sensitivity testing (DST). Results of all three diagnostic modalities were compared with CBNAAT.ResultsOut of 236 patients with sputum positive CBNAAT, 49.4 % (117/236) were rifampicin-resistant while 50. 6 % (119/236) were Rifampicin sensitive. The genotypic DST assays carried out on all enrolled patients showed that 76. 3 % (181/236) patients were resistant to one or more first-line or second-line antitubercular (ATT) drugs, while 23.7 % (55/236) patients were sensitive to all ATT drugs. On concordant analysis of CB NAAT with DST assays, we found that among 119 CB NAAT rifampicin sensitive patients, 66 patients were resistant to first-line or second-line antitubercular drugs.ConclusionThis study found that the screening of DRTB with CBNAAT at the community level is suboptimal compared to the gold standard. Although CBNAAT’s sensitivity in detecting DRTB is significantly higher, the specificity is lower in that population who have received ATT earlier.
Epidemiology and costs of post-sepsis morbidity, nursing care dependency, and mortality in Germany
Authors: Fleischmann-Struzek Carolin , Rose Norman , Freytag Antje , Spoden Melissa , Prescott Hallie C. , Schettler Anna , Wedekind Lisa , Ditscheid Bianka , Storch Josephine , Born Sebastian , Schlattmann Peter , Günster Christian , Reinhart Konrad , Hartog Christiane S. 
Published: March 2021

AbstractPurposeTo quantify the frequency and co-occurrence of new diagnoses consistent with post-sepsis morbidity, mortality, new nursing care dependency, and total healthcare costs after sepsis.MethodsPopulation-based cohort study using healthcare claims data from 23 million beneficiaries of a German health insurance provider. We included adult patients with incident hospital-treated sepsis identified by ICD-10 codes in 2013-2014. New medical, psychological and cognitive diagnoses associated with post-sepsis morbidity; mortality; dependency on nursing care; and total health care costs in survivors were assessed to 3 years after hospital discharge.ResultsAmong 116,507 sepsis patients who survived hospitalization for sepsis, 74.3% had a new medical, psychological or cognitive diagnosis in the first year after discharge. 20.6% and 3.8% had new diagnoses in two and three domains, respectively. 31.5% were newly dependent on nursing care, and 30.7% died within the first year. In the second and third year, 65.8% and 59.4% of survivors had new diagnoses, respectively. Healthcare costs totaled an average 36,585 Euro/patient in three years, including index hospitalization costs. Occurrence of new diagnoses in predefined subgroups was: 73.7% (survivors of non-severe sepsis), 75.6% (severe sepsis), 78.3% (ICU-treated sepsis), 72.8% (non-ICU treated sepsis) and 68.5% (survivors without prior diagnoses).ConclusionsNew medical, psychological and cognitive diagnoses consistent with post-sepsis morbidity are common after sepsis, including among patients with less severe sepsis, no prior diagnoses, and younger age. This calls for more efforts to elucidate the underlying mechanisms, define optimal screening for common new diagnoses, and test interventions to prevent and treat post-sepsis morbidity.Trial RegistrationDRKS00016340Take home messageThis large population-based cohort of over 100,000 survivors of hospital-treated sepsis found high rates and a broad spectrum of new diagnoses consistent with post-sepsis morbidity, frequent new nursing care dependency, and high long-term mortality 1-3 years post sepsis. Post-sepsis morbidity was not limited to the oldest survivors or those with the most severe illness, but also affected younger survivors and those without pre-existing diagnoses.
Unwelcome memento mori or best clinical practice? Community end-of-life anticipatory medication prescribing practice: a mixed methods observational study
Authors: Bowers Ben , Pollock Kristian , Barclay Stephen 
Published: March 2021

AbstractBackgroundAnticipatory medications are injectable drugs prescribed ahead of possible need for administration if distressing symptoms arise in the final days of life. Little is known about how they are prescribed in primary care.AimTo investigate the frequency, timing and recorded circumstances of anticipatory medications prescribing for patients living at home and in residential care.DesignRetrospective mixed methods observational study using General Practitioner and community nursing clinical records.Setting/participants329 deceased adult patients registered with Eleven General Practitioner practices and two associated community nursing services in Hertfordshire and Cambridgeshire, England (30 most recent deaths per practice). Patients died from any cause except trauma, sudden death or suicide, between 4 March 2017 and 25 September 2019.ResultsAnticipatory medications were prescribed for 167/329 (50.8%) of the deceased patients, between 0 and 1212 days before death (median 17 days). The likelihood of prescribing was significantly higher for patients with a recorded preferred place of death (odds ratio [OR] 34; 95% CI 15-77; p < 0.001) and specialist palliative care involvement (OR 7; 95% CI 3-19; p < 0.001). For 66.5% of patients (111/167) anticipatory medications were recorded as being prescribed as part of a single end of-life planning intervention.ConclusionThe variability in the timing of prescriptions highlights the challenges in diagnosing the end-of-life phase and the potential risks of prescribing far in advance of possible need. Patient and family preferences for involvement in anticipatory medications prescribing decision-making and their experiences of care warrant urgent investigation.Summary BoxWhat is already known on this topicThe prescribing of injectable anticipatory medications to provide symptom relief in the last days of life care is recommended and widespread practice in a number of counties.There is limited research concerning the frequency, timing and context of prescriptions.What this paper addsHalf (50.8%) of 319 patients whose deaths were potentially predictable deaths were prescribed anticipatory medications, the timing of prescriptions ranging from 0 to 1212 days before death (median 17 days).Anticipatory medications were frequently prescribed as standardised drugs and doses, and often as part of a single end-of-life care planning intervention.The extent to which patients and family carers were involved in prescribing decisions was unclear.Implications for practice, theory or policyPatient and family preferences for involvement in anticipatory medications prescribing decision-making and their experiences of care warrant urgent investigation.The presence of anticipatory medications for long periods of time may compromise patient safety unless robust systems are in place to review their continued appropriateness and safe use.
Opening schools and trends in SARS-CoV-2 transmission in European countries
Authors: Buja Alessandra , Paganini Matteo , Cristofori Vittorio , Baldovin Tatjana , Fusinato Riccardo , Boccuzzo Giovanna , Cocchio Silvia , Coretti Silvia , Rebba Vincenzo , Parpinel Maria 
Published: March 2021

AbstractBackgroundIt is important to understand the role of schools in the community transmission of SARS-CoV-2, bearing in mind that children and adolescents can spread the infection within families, even when their own symptoms are mild. The aim of this study was to examine the trends of contagion before and after schools reopened across 27 countries in the European Union.MethodsAll data on the number of people testing positive for COVID-19 in each European country were collected from 20 days before schools reopened to 45 days afterwards. The Joinpoint regression method was used to detect single change points on the trend of contagion. The Bayesian Information Criterion (BIC) was used for model selection purposes.ResultsWe calculated 27 linear regression models for the daily case numbers of SARS-CoV-2 infection in the 27 countries from 20 days before schools reopened to 45 days afterwards. A significant increase in the number of daily infections was seen for 21 countries after a change point in the linear regression lines. The change points in different countries varied, ranging from 10 to 42 days after schools reopened, with the majority occurring beyond the 21st day.ConclusionThis study analysed the trend of SARS-CoV-2 transmission before and after schools reopened in Europe. We observed a significant increase in the number of new daily cases in most countries. This issue poses a public health problem that needs to be taken into account in deciding strategies to contain the spread of COVID-19.
Factors Associated with Serious Psychological Distress during the COVID-19 Pandemic in Japan
Authors: Yoshioka Takashi , Okubo Ryo , Tabuchi Takahiro , Odani Satomi , Shinozaki Tomohiro , Tsugawa Yusuke 
Published: March 2021

AbstractImportanceThe coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on mental health of the population, leading to higher suicide rates, in many countries. However, little is known about risk factors associated with worsened mental health during the COVID-19 pandemic.ObjectiveTo investigate the factors associated with serious psychological distress (SPD) during the COVID-19 pandemic in Japan.Design, Setting, and ParticipantsA cross-sectional study using a large-scale internet survey conducted between August 25 and September 30, 2020, in Japan.ExposuresDemographics (age, gender, marital status, family composition, and caregiving burden), socio-economic status (income level, employment type, educational attainment), the experience of domestic violence (DV), the state of emergency, fear of COVID-19, and stigma related to COVID-19.Main Outcomes and MeasuresPrevalence of SPD, defined as Kessler 6 scale score ≥13.ResultsAmong 25,482 individuals included in this study, 2,556 (10%) met the criteria of SPD. Overall, women (adjusted odds ratio [aOR] 1.59; 95%CI, 1.17–2.16; P=0.003), ages 15–29 (aOR compared with ages 45–59, 2.35; 95%CI, 1.64–3.38; P<0.001), low income (aOR compared with intermediate income, 1.70; 95%CI, 1.16–2.49; P=0.007), providing caregiving to family members (aOR, 5.48; 95%CI, 3.51–8.56; P<0.001), experiencing DV (aOR, 5.72; 95%CI, 3.81–8.59; P<0.001), and fear of COVID-19 (aOR, 1.96; 95%CI, 1.55–2.48; P<0.001) were associated with a higher rate of SPD. Among women aged 15–29 years, who experienced the highest rate of SPD, caregiving, DV, fear of COVID-19, and COVID-19-related stigma were associated with a higher rate of SPD; whereas economic situation (income level and employment type) and social isolation (marital status) were not associated with the prevalence of SPD.Conclusions and RelevanceEconomic situation, caregiving burden, DV, and fear of COVID-19 were independently associated with SPD during the COVID-19 pandemic. Among young women—who have a higher risk of suicide during the COVID-19 pandemic in Japan—similar factors, except economic situation, were associated with a higher rate of SPD. Targeted interventions based on age and gender may be more effective in mitigating the negative impact of the COVID-19 pandemic on the population’s mental health.