bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paramedian Supracerebellar Approach in Semi-Sitting Position for Endoscopic Resection of Pineal Cyst: 2-Dimensional Operative Video
Authors: Fernandez-Miranda Juan C 
Published: October 2018

Abstract
In this video, we present the case of a 41-yr-old female with new onset of recurrent syncopal episodes. She underwent extensive evaluations and diagnostic work-up by cardiology and neurology, excluding any other cause than a large pineal cyst that was found on magnetic resonance imaging.
Surgical indications for pineal cyst resection are very limited as most pineal cyst can be treated conservatively. Recurrent drop-attacks (without loss of consciousness) or syncopal episodes (with brief loss of consciousness) have been associated with pineal cysts secondary to a possible ball valve effect with shift of position causing sudden obstruction of the ventricular system followed by rapid rising of intracranial pressure.
Several approaches, different positions, and alternative surgical techniques (microscopic vs endoscopic) have been proposed for resection of pineal region lesions. The semi-sitting position provides excellent exposure of the pineal region secondary to gravity-based retraction of the cerebellum, and carries minimal risk of air venous embolism when head elevation is reduced to 30° and lower extremities are elevated. The paramedian supracerebellar approach is less invasive and faster than midline supracerebellar approach, because it requires exposure of just 1 transverse sinus (nondominant for centered lesions) and avoids exposure of the torcula. The endoscopic technique greatly improves the ergonomics of the approach when compared to the microscope based technique, and provides excellent visualization of all the neurovascular structures in the pineal region.
Surgical resection was successfully performed with no complications and complete cyst resection. Patient was discharged on postoperative day 1 and remains free of syncopal episodes.
The patient signed informed consent including the use of photographic and video material for educational or academic purposes.
Does Opioid Tapering in Chronic Pain Patients Result in Improved Pain or Same Pain vs Increased Pain at Taper Completion? A Structured Evidence-Based Systematic Review
Authors: Fishbain David A , Pulikal Aditya 
Published: October 2018

AbstractObjectiveTo support or refute the hypothesis that opioid tapering in chronic pain patients (CPPs) improves pain or maintains the same pain level by taper completion but does not increase pain.MethodsOf 364 references, 20 fulfilled inclusion/exclusion criteria. These studies were type 3 and 4 (not controlled) but reported pre/post-taper pain levels. Characteristics of the studies were abstracted into tabular form for numerical analysis. Studies were rated independently by two reviewers for quality. The percentage of studies supporting the above hypothesis was determined.ResultsNo studies had a rejection quality score. Combining all studies, 2,109 CPPs were tapered. Eighty percent of the studies reported that by taper completion pain had improved. Of these, 81.25% demonstrated this statistically. In 15% of the studies, pain was the same by taper completion. One study reported that by taper completion, 97% of the CPPs had improved or the same pain, but CPPs had worse pain in 3%. As such, 100% of the studies supported the hypothesis. Applying the Agency for Health Care Policy and Research Levels of Evidence Guidelines to this result produced an A consistency rating.ConclusionsThere is consistent type 3 and 4 study evidence that opioid tapering in CPPs reduces pain or maintains the same level of pain. However, these studies represented lower levels of evidence and were not designed to test the hypothesis, with the evidence being marginal in quality with large amounts of missing data. These results then primarily reveal the need for controlled studies (type 2) to address this hypothesis.
Health inequalities and health equity challenges for victims of modern slavery
Authors: Dando Coral J , Brierley Robin , Saunders Karen , Mackenzie Jay-Marie 
Published: October 2018

AbstractBackgroundModern slavery is a serious organized crime, with severe consequences for the physical and mental health of victims, and so has public health implications. Anecdotally many victims of sex slavery experience difficulties accessing healthcare. Public Health England recently articulated the importance of health engagement to address modern slavery but little is known about the experiences of the survivors.MethodsWe conducted in depth interviews with Albanian female survivors of sex slavery who all displayed significant and complex health needs. Interviews were conducted between July 2017 and January 2018. Thematic analysis identified four primary themes: (i) barriers to access, (ii) negotiating access, (iii) health needs and care received and (iv) overall experience of primary care.ResultsSurvivors experienced repeated challenges accessing healthcare, for themselves and their children, and initially could not access GP services. When accompanied by an advocate they reported qualitatively and quantitatively improved experiences resulting in improved permeability. Confusion surrounding eligibility criteria and a lack of understanding of modern slavery emerged as the primary barriers, fueling biased adjudications.ConclusionsThe importance of advocates, enabling rights-based approaches, improving understanding about access to health services for vulnerable groups, and a need for education across health service settings are discussed.
Using a mobile application to detect health needs among children and adolescents who are newly arrived migrants in Europe
Authors: Rath B , Swenshon S , Haase K , Szeles T , Jung C , Jacobi F , Myles P 
Published: October 2018

Abstract

Background
Unprecedented numbers of migrants have arrived in Europe, including children and adolescents. Little is known about their unique health needs. Prospective data collection has been sparse. Mobile applications may help to facilitate global health surveillance.

Methods
A pre-validated survey instrument was converted into a mobile application covering self-reported exposures and disruptions of healthcare before/during migration, communicable and non-communicable diseases. Participation was voluntary, anonymous and confidential.

Results
Data were obtained from 405 migrant children and adolescents in Berlin, Germany, between 7 October 2015 and 15 March 2016 (median age 19 years, range: 1–24; 80.7% males) with the majority from Syria (62.5%), Afghanistan (9.1%) and Iraq (8.2%). In total, 55% were without family, 64% registered asylum-seekers with access to healthcare; 54% had seen a doctor since arrival, with colds or respiratory complaints (37.5 and 13.6%), followed by pain (26.7%) gastrointestinal (12.4%) and skin problems (11.1%). Underlying conditions were reported in 15.6%, predominantly asthma. Overall, 73% reported being up-to date on immunizations, but only 22% held a vaccination record with 46.4% having lost it during migration.

Conclusions
The lack of medical and immunization records among newly arrived migrants provides a challenge to healthcare systems. Mobile applications offer rapid screening tools in times of crisis, helping stakeholders with timely information.
Impact of Disease on Amikacin Pharmacokinetics and Dosing in Children
Authors: Liu Xiaoxi , Smits Anne , Wang Yuhuan , Renard Marleen , Wead Stephanie , Kagan Richard J. , Healy Daniel P. , De Cock Pieter , Allegaert Karel , Sherwin Catherine M.T. 
Published: October 2018

Background:
Amikacin is widely used to treat severe Gram-negative bacterial infections. Its peak concentration in plasma is associated with treatment efficacy. Amikacin pharmacokinetics (PK) is influenced by disease conditions, in addition to other patient characteristics. In this retrospective study, we evaluated the impact of clinical characteristics and disease condition on amikacin PK in children with burn injuries and those with cancer.

Methods:
Amikacin PK data from 66 children with burn injuries and 112 children with cancer were analyzed. A population PK model was developed using the nonlinear mixed-effects modeling approach. Models were developed using NONMEM 7.3 (ICON Development Solutions, LLC, Ellicott City, MD). Data processing and visualization was performed using R packages.

Results:
The amikacin PK data were best described by a 2-compartment model. The parameters were estimated with mean values (95% confidence intervals) as follows: central volume of distribution (V1), 5.70 L (4.64–6.76 L); central clearance, 2.12 L/h (1.79–2.46 L/h); peripheral volume of distribution (V2), 4.79 L (2.36–7.22 L); and distribution clearance (Q), 0.71 L/h (0.25–1.16 L/h). The final model identified the disease condition as a significant covariate and indicated 55% (28%–82%) higher central clearance and 17% (1%–34%) higher V1 in burn patients compared with cancer patients. Volume of distribution was significantly influenced by age and body weight. Clearance was significantly influenced by age, body weight, and creatinine clearance. Using the final PK model, we developed a workflow for selecting optimal dosing strategies for 3 representative pediatric patient profiles.

Conclusions:
Disease condition was significant in influencing amikacin PK in children. To reach the same target concentrations (64 mg/L peak concentration) with a daily-dose plan, burn patients need higher doses than cancer patients. Future investigations are needed to explore the impact of other diseases on amikacin disposition in children, and to prospectively validate the proposed dosing strategy.
Pharmacokinetic Characteristics and Limited Sampling Strategies for Therapeutic Drug Monitoring of Colistin in Patients With Multidrug-Resistant Gram-Negative Bacterial Infections
Authors: Kim Eun Jung , Oh Jaeseong , Lee Kyounghoon , Yu Kyung-Sang , Chung Jae-Yong , Hwang Joo-Hee , Nam Eun Young , Kim Hyoung Sook , Kim Moonsuk , Park Jeong Su , Song Kyoung-Ho , Kim Eu Suk , Song Junghan , Kim Hong Bin 
Published: October 2018

Background:
Colistin is increasingly used as the last therapeutic option for the treatment of multidrug-resistant, Gram-negative bacterial infections. To ensure safe and efficacious use of colistin, therapeutic drug monitoring (TDM) is needed due to its narrow therapeutic window. This study aimed to evaluate the pharmacokinetic (PK) characteristics of colistin and to guide TDM in colistin-treated patients in Korea.

Methods:
In a prospective study, we analyzed PK characteristics in 15 patients who intravenously received colistin methanesulfonate twice per day. Colistin methanesulfonate doses were adjusted based on renal function of the subjects. The appropriate blood sampling points for TDM were evaluated by analyzing the correlations between the PK parameters and the plasma concentrations at each time point.

Results:
The mean values for the minimum, maximum, and average concentrations (Cmin, Cmax, and Caverage) of colistin at steady state were 2.29, 5.5, and 3.38 mg/L, respectively. The dose-normalized Cmin, Cmax, Caverage, and area under the plasma concentration–time curve from 0 to the last measurable concentration (AUClast) showed negative correlations with the creatinine clearance. The combination of the 0- and 2-hour post-dose plasma concentrations was evaluated as the appropriate sampling point for TDM. Two patients reported nephrotoxic adverse events during colistin administration.

Conclusions:
Our study clarifies the PK characteristics of successful colistin treatment using TDM. Further evaluations in a larger patient population are needed to confirm the clinical usefulness of colistin TDM.
Whipple's disease and Tropheryma whipplei infections: when to suspect them and how to diagnose and treat them
Authors: Lagier Jean-Christophe , Raoult Didier 
Published: October 2018

Purpose of review
The delay between first clinical signs and diagnosis of Whipple's disease and Tropheryma whipplei infections is more than 6 years, and relapses are frequently observed, resulting in a need for clinicians to be aware of this infection.

Recent findings
18 FDG-PET is useful in the diagnosis and the follow-up of patients (particularly in case of neurological involvement). Histological involvement remains the goldstandard for classic Whipple's disease diagnosis. PCR performed on biopsies of fluid is the main tool for the diagnosis of localized chronic infections. PCR performed on urine samples should become an important role of noninvasive diagnostic strategies, while T. whipplei PCR performed on saliva and stool lack specificity. Because of lifetime susceptibility to T. whipplei and in-vitro susceptibility data, a 1-year course of doxycycline and hydroxychloroquine followed by a lifelong treatment by doxycycline is recommended for Whipple's disease, localized endocarditis and encephalitis.

Summary
Clinical involvement of the different T. whipplei infections is well described, as well as the treatment of Whipple's disease, endocarditis and encephalitis. The place of PCR performed on urine remains to be clarified for diagnosis of localized T. whipplei infections and acute infections as well as the optimal treatment for arthritis and acute infections.
Invasive fungal disease and cytomegalovirus infection: is there an association?
Authors: Yong Michelle K. , Slavin Monica A. , Kontoyiannis Dimitrios P. 
Published: October 2018

Purpose of reviewInvasive fungal disease (IFD) and cytomegalovirus (CMV) infections occur frequently, either concomitantly or sequentially in immune-compromised hosts. Although there is extensive knowledge of the risk factors for these infections as single entities, the inter-relationship between opportunistic fungii and CMV has not been comprehensively explored.Recent findingsBoth solid organ and stem cell transplant recipients who develop CMV invasive organ disease are at an increased risk of developing IFD, particularly aspergillosis and Pneumocystis pneumonia (PCP). Moreover, CMV viremia and recipient CMV serostatus also increased the risk of both early and late-onset IFD. Treatment-related factors, such as ganciclovir-induced neutropenia and host genetic Toll-like receptor (TLR) polymorphisms are likely to be contributory. Less is known about the relationship between CMV and IFD outside transplantation, such as in patients with hematological cancers or other chronic immunosuppressive conditions. Finally, few studies report on the relationship between CMV-specific treatments or the viral/antigen kinetics and its influence on IFD management.SummaryCMV infection is associated with increased risk of IFD in posttransplant recipients because of a number of overlapping and virus-specific risk factors. Better understanding of how CMV virus, its related treatment, CMV-induced immunosuppression and host genetic factors impact on IFD is warranted.
Invasive pulmonary aspergillosis complicating severe influenza: epidemiology, diagnosis and treatment
Authors: Vanderbeke Lore , Spriet Isabel , Breynaert Christine , Rijnders Bart J.A. , Verweij Paul E. , Wauters Joost 
Published: October 2018

Purpose of reviewBacterial super-infection of critically ill influenza patients is well known, but in recent years, more and more reports describe invasive aspergillosis as a frequent complication as well. This review summarizes the available literature on the association of invasive pulmonary aspergillosis (IPA) with severe influenza [influenza-associated aspergillosis (IAA)], including epidemiology, diagnostic approaches and treatment options.Recent findingsThough IPA typically develops in immunodeficient patients, non-classically immunocompromised patients such as critically ill influenza patients are at high-risk for IPA as well. The morbidity and mortality of IPA in these patients is high, and in the majority of them, the onset occurs early after ICU admission. At present, standard of care (SOC) consists of close follow-up of these critically ill influenza patients with high diagnostic awareness for IPA. As soon as there is clinical, mycological or radiological suspicion for IAA, antifungal azole-based therapy (e.g. voriconazole) is initiated, in combination with therapeutic drug monitoring (TDM). Antifungal treatment regimens should reflect local epidemiology of azole-resistantAspergillusspecies and should be adjusted to clinical evolution. TDM is necessary as azoles like voriconazole are characterized by nonlinear pharmacokinetics, especially in critically ill patients.SummaryIn light of the frequency, morbidity and mortality associated with influenza-associated aspergillosis in the ICU, a high awareness of the diagnosis and prompt initiation of antifungal therapy is required. Further studies are needed to evaluate the incidence of IAA in a prospective multicentric manner, to elucidate contributing host-derived factors to the pathogenesis of this super-infection, to further delineate the population at risk, and to identify the preferred diagnostic and management strategy, and also the role of prophylaxis.
Rational approach in the management of Pseudomonas aeruginosa infections
Authors: Bassetti Matteo , Vena Antonio , Russo Alessandro , Croxatto Antony , Calandra Thierry , Guery Benoit 
Published: October 2018

Purpose of review
This review details the management of Pseudomonas aeruginosa infections covering both current and future treatment options that are and may be available for the clinicians.

Recent findings

Pseudomonas aeruginosa infections are a great concern in hospital-acquired infections with very limited therapeutic options. The increasing antibiotic resistance has led to a need for different treatment choices that range from the use of new antibiotics to new nonantibiotic alternative agents to kill or disarm the pathogen.

Summary
New molecules such as ceftolozane–tazobactam, ceftazidime–avibactam, and imipenem–relebactam have shown an adequate activity against P. aeruginosa, especially against multidrug resistance strains. Other nonantibiotic alternative treatments, such as antibodies, bacteriocins or phage therapy, have shown promising results, but future clinical studies are needed.
Nitrate inhibition of nodule formation in Medicago truncatula is mediated by ACC SYNTHASE 10
Authors: Zeijl Arjan van , Guhl Kerstin , Xiao Ting Ting , Shen Defeng , Geurts René , Kohlen Wouter 
Published: October 2018

ABSTRACTLegumes form a mutualistic endosymbiosis with nitrogen-fixing rhizobia. These rhizobia are housed intracellularly in specialised lateral root organs, called nodules. Initiation of these nodules is triggered by bacterial derived signalling molecules, lipochitooligosaccharides (LCO). The process of nitrogen fixation is highly energy-demanding and therefore nodule initiation is tightly regulated. Nitrate is a potent inhibitor of nodulation. However, the precise mechanisms by which nitrate inhibits nodulation is poorly understood. Here, we demonstrate that in Medicago truncatula nitrate interferes with the transcriptional regulation of the ethylene biosynthesis gene ACC SYNTHASE 10. ACSs commit the rate limiting step in ethylene biosynthesis and in M. truncatula ACS10 is highly expressed in the zone of the root where nodulation occurs. Our results show that a reduction in ACS10 expression in response to LCO exposure correlates with the ability to form nodules. In addition, RNAi-mediated knockdown of ACS10 confers nodulation ability under otherwise inhibitory nitrate conditions. This discovery sheds new light on how ethylene is involved in the inhibition of nodulation by nitrate, bringing us one step closer to understanding how plants regulate their susceptibility towards rhizobia.
Yersiniabactin, Colibactin and Wider Resistome Contribute to Enhanced Virulence and Persistence of KPC-2-Producing Klebsiella pneumoniae CG258 in South America
Authors: Cerdeira Louise T. , Esposito Fernanda , Lam Margaret M. C. , Wyres Kelly L. , Wick Ryan R. , Judd Louise M. , Cunha Marcos V. , Knöbl Terezinha , Araújo Bruna F. , Ribas Rosineide M. , Cifuentes Sebastian , Tamariz Jesus , Bueno Maria F. C. , Francisco Gabriela R. , Garcia Doroti O. , Gonzalez-Rocha Gerardo , Gutkind Gabriel , Holt Kathryn E. , Lincopan Nilton 
Published: October 2018

AbstractThe emergence and dissemination of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) is a worrisome public health issue compromising the treatment and outcome of infections caused by this pathogen. We performed a detailed virulome and resistome analysis of representative KPC- and/or CTX-M-producing K. pneumoniae belonging to clonal group (CG) 258 (sequence types ST11, ST258, ST340, ST437), circulating in Argentina, Brazil, Chile, Colombia and Peru; with further evaluation of the virulence behavior using the Galleria mellonella infection model. Genomic analysis of K. pneumoniae strains recovered from the human-animal-environment interface revealed a wide resistome characterized by the presence of genes and mutations conferring resistance to human and veterinary antibiotics, quaternary ammonium compounds (QACs) and heavy metals. Plasmid Inc typing revealed the presence of a wide diversity of replicon types with IncF, IncN, IncR and Col-like being frequently detected. Moreover, KPC-2-producing K. pneumoniae belonging to ST11 (KL-64 andKL-105) and ST340 (KL-15) carried multiple variants of distinct yersiniabactin siderophore (ybt) and/or genotoxic colibactin (clb) genes. In this regard, ICEKp3, ICEKp4 and ICEKp12 were identified in strains belonging to ST11 and ST340, recovered from Argentina, Brazil, Chile and Colombia; whereas ybt 17 and a novel ybt sequence type (YbST346) were identified together with clb in ICEKp10 structures from ST11 and ST258, from Brazil and Colombia, respectively. K. pneumoniae ST11 (ICEKp10/YbST346 and ICEKp4/ybt 10) strains killed 100% of wax moth larvae, in a similar way to hypervirulent K1/ST23 strain (ybt- and clb-negative) carrying the pLVPK-like plasmid, indicating enhanced virulence. In summary, our results indicate that yersiniabactin, colibactin and an expanded resistome have contributed to enhanced virulence and persistence of KPC-2-producing K. pneumoniae CG258 in South America. Therefore, active surveillance of hospital-associated lineages of K. pneumoniae should not only focus on clonal origin and antimicrobial resistance, but also on the virulence factors ybt and clb.