bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Report: Validation of a Urine Tenofovir Immunoassay for Adherence Monitoring to PrEP and ART and Establishing the Cutoff for a Point-of-Care Test
Authors: Gandhi Monica , Bacchetti Peter , Spinelli Matthew A. , Okochi Hideaki , Baeten Jared M. , Siriprakaisil Oraphan , Klinbuayaem Virat , Rodrigues Warren C. , Wang Guohong , Vincent Michael , Cressey Tim R. , Drain Paul K. 
Published: January 2019

Background:
Current pharmacologic adherence monitoring for antiretrovirals involves expensive, labor-intensive liquid chromatography/tandem mass spectrometry (LC-MS/MS)-based methods. Antibody-based assays can monitor and support adherence in real time. We developed a tenofovir (TFV)-based immunoassay and further validated it in a directly observed therapy (DOT) study.

Design:
Pharmacologic DOT study of TFV disoproxil fumarate (TDF)/emtricitabine (FTC) administered to HIV-noninfected volunteers.

Methods:
The TARGET study provided directly observed TDF 300 mg/FTC 200 mg 7 (high adherence), 4 (moderate), and 2 doses/week (low) to 30 volunteers (10/group) in Thailand, collecting a total of 637 urine samples over 6 weeks of administration and during washout. ELISA measured urine TFV levels by the immunoassay and LC-MS/MS-based concentrations served as the gold standard. A mixed-effects regression model evaluated cutoffs for a point-of-care assay. Performance characteristics of the immunoassay were compared with LC-MS/MS at a chosen cutoff.

Results:
Median TFV levels were 12,000 ng/mL by the immunoassay 1 day after dosing; 5000 ng/mL 2 days after dosing; 1500 ng/mL 3 days after dosing; and below the lower limit of quantification thereafter (≥4 days). An immunoassay cutoff of 1500 ng/mL accurately classified 98% of patients who took a dose 24 hours ago as adherent. The specificity and sensitivity of the immunoassay compared with LC-MS/MS at the 1500 ng/mL cutoff were 99% and 94%; the correlation between TFV levels by the 2 assays was high (0.92, P < 0.00001).

Conclusions:
We have developed a novel TFV immunoassay that is highly specific, sensitive, and correlates strongly with LC-MS/MS measurements in a large DOT study. Adherence benchmarks from this DOT study will guide the development of a low-cost rapid point-of-care test for pre-exposure prophylaxis and antiretroviral treatment adherence monitoring and interventions.
Current role of oxazolidinones and lipoglycopeptides in skin and soft tissue infections
Authors: Righi Elda , Carnelutti Alessia , Bassetti Matteo 
Published: January 2019

Purpose of review
An increase of skin and soft tissue infections involving Staphylococcus aureus has been reported in community and hospital settings. Methicillin resistance in S. aureus is associated with treatment failure and increased mortality. Recently, new antimicrobials with enhanced activity against methicillin-resistant Staph. aureus have been approved for the treatment of skin and soft tissue infections. Among these, novel oxazolidinones and lipoglycopeptides represent options with favorable pharmacokinetic characteristics and safety profiles.

Recent findings
Newly approved compounds include tedizolid, characterized by the availability of both oral and intravenous formulation and once daily administration and dalbavancin, a long-acting antimicrobial allowing for weekly administration. These new molecules present advantages, such as enhanced activity against multidrug-resistant Gram-positive bacteria and favorable safety profiles.

Summary
We have reviewed the pharmacokinetic characteristics and the implications for use in skin and soft tissue infections of tedizolid and dalbavancin. Advantages associated with the use of these compounds include the possibility for early patient discharge, reduced hospital length of stay, and outpatient treatment, with potential impact on morbidity, mortality, and overall health-care costs.
Principles and practice of antibiotic stewardship in the management of diabetic foot infections
Authors: Uçkay Ilker , Berli Martin , Sendi Parham , Lipsky Benjamin A. 
Published: January 2019

Purpose of review
Systemic antibiotic therapy in persons with a diabetic foot infection (DFI) is frequent, increasing the risk of promoting resistance to common pathogens. Applying principles of antibiotic stewardship may help avoid this problem.

Recent findings
We performed a systematic review of the literature, especially seeking recently published studies, for data on the role and value of antibiotic stewardship (especially reducing the spectrum and duration of antibiotic therapy) in community and hospital populations of persons with a DFI.

Summary
We found very few publications specifically concerning antibiotic stewardship in persons with a DFI. The case-mix of these patients is substantial and infection plays only one part among several chronic problems. As with other types of infections, attempting to prevent infections and avoiding or reducing the spectrum and duration of antibiotic therapy are perhaps the best ways to reduce antibiotic prescribing in the DFI population. The field is complex and necessitates knowledge over the current scientific literature and clinical experience. On a larger scale, clinical pathways, guidelines, and recommendations are additionally supportive.
Imaging of Moyamoya Disease and Moyamoya Syndrome: Current Status
Authors: Li Jincheng , Jin Meiyu , Sun Xiaoyan , Li Jingying , Liu Yumei , Xi Yanli , Wang Qiang , Zhao Wenzhuo , Huang Yanzhi 
Published: January 2019

Abstract
Moyamoya disease (MMD) and Moyamoya syndrome (MMS) are referring to a progressive steno-occlusive vasculopathy at terminal portions of the bilateral internal carotid arteries and their proximal branches with prominent collateral artery formation. They can be found throughout the world and cause irreversible damage to the cerebral hemodynamics due to the progressive nature. Prompt diagnosis and accurate assessment could significantly improve the prognosis of MMD and MMS. Some imaging modalities could be used for diagnosis and nonquantitative evaluation of MMD and MMS, such as conventional computed tomography (CT) and magnetic resonance imaging (MRI), digital subtraction angiography, CT angiography (CTA), and magnetic resonance angiography. Some could quantitatively evaluate the cerebral hemodynamics of MMD and MMS, such as single-photon emission CT, positron emission tomography, xenon-enhanced CT, perfusion CT, dynamic susceptibility contrast MRI, arterial spin labeling MRI, and the hemodynamic parameters measured by those imaging methods could guide treatment of MMD and MMS. All the imaging modalities have their merits and demerits, and they can play a part in certain situation. We need establish standardized protocols for preoperative and postoperative evaluation with different imaging techniques in the further science for MMD and MMS.
Radiomics for Classifying Histological Subtypes of Lung Cancer Based on Multiphasic Contrast-Enhanced Computed Tomography
Authors: E Linning , Lu Lin , Li Li , Yang Hao , Schwartz Lawrence H. , Zhao Binsheng 
Published: January 2019

Objectives
The aim of this study was to evaluate the performance of the radiomics method in classifying lung cancer histological subtypes based on multiphasic contrast-enhanced computed tomography (CT) images.

Methods
A total of 229 patients with pathologically confirmed lung cancer were retrospectively recruited. All recruited patients underwent nonenhanced and dual-phase chest contrast-enhanced CT; 1160 quantitative radiomics features were calculated to build a radiomics classification model. The performance of the classification models was evaluated by the receiver operating characteristic curve.

Results
The areas under the curve of radiomics models in classifying adenocarcinoma and squamous cell carcinoma, adenocarcinoma and small cell lung cancer, and squamous cell carcinoma and small cell lung cancer were 0.801, 0.857, and 0.657 (nonenhanced); 0.834, 0.855, and 0.619 (arterial phase); and 0.864, 0.864, and 0.664 (venous phase), respectively. Moreover, the application of contrast-enhanced CT may affect the selection of radiomics features.

Conclusions
Our study indicates that radiomics may be a promising tool for noninvasive predicting histological subtypes of lung cancer based on the multiphasic contrast-enhanced CT images.
Perinodular Vascularity Distinguishes Benign Intrapulmonary Lymph Nodes From Lung Cancer on Computed Tomography
Authors: Barnett Joseph , Pulzato Ilaria , Wilson Ryan , Padley Simon , Nicholson Andrew G. , Devaraj Anand 
Published: January 2019

Purpose:
A common diagnostic dilemma in the assessment of small pulmonary nodules on computed tomography (CT) is in distinguishing benign intrapulmonary lymph nodes (IPLNs) from small primary pulmonary malignancies. Several CT features have been described of IPLNs, including attachment to a pleural surface. We had observed that IPLNs were often connected to a pulmonary vein and sought to evaluate the utility of this sign in discriminating IPLNs from lung adenocarcinomas. The frequency of other previously described CT signs of IPLNs was also compared with lung adenocarcinomas.

Materials and Methods:
We retrospectively identified histopathologically proven benign IPLNs (n=62) and small (<15 mm) adenocarcinomas (n=61). CTs were reviewed to assess the number and type of pulmonary blood vessels arising from, or terminating within, these nodules, as well as other CT features of IPLNs (shape, location, and outline).

Results:
The termination of a pulmonary artery within a nodule was strongly associated with primary lung adenocarcinoma (55.7%), and this was never seen in isolation in IPLNs (0%) (P<0.001). IPLNs were more frequently associated with pulmonary venous connections (93.5%) compared with lung adenocarcinomas (21.3%) (P<0.001). The connection to a pleural surface was observed in both IPLNs (38.7%) and lung adenocarcinomas (37.7%) (P=1.0).

Conclusions:
We describe a novel imaging marker that can help to differentiate between benign and malignant pulmonary nodules. However, attachment of a nodule to a pleural surface should not be used in isolation to distinguish IPLNs from lung malignancy.
A National Contemporary Analysis of Perioperative Outcomes for Vaginal Vault Prolapse: Minimally Invasive Sacrocolpopexy Versus Nonmesh Vaginal Surgery
Authors: Linder Brian J. , Gershman Boris , Bews Katherine A. , Glasgow Amy E. , Occhino John A. 
Published: January 2019

Objective
The aim of this study was to compare the perioperative morbidity of minimally invasive sacrocolpopexy (MISC) and nonmesh apical vaginal surgeries for repair of vaginal vault prolapse using data from a contemporary nationwide cohort.

Methods
The American College of Surgeons' National Surgical Quality Improvement Program database was used to identify women who underwent apical prolapse surgery via vaginal approach or MISC from 2010 to 2016. Those undergoing concomitant hysterectomy or transvaginal mesh placement were excluded. Associations of surgical approach with 30-day complications, prolonged hospitalization, and reoperation were evaluated using logistic regression. Readmission within 30 days was calculated using the person-years method and Cox proportional hazards models.

Results
Overall, 6390 women underwent surgery, including 3852 (60%) via vaginal approach and 2538 (40%) via MISC. Patients undergoing MISC were younger (P < 0.0001) and less likely to have hypertension (P = 0.04) or chronic obstructive pulmonary disease (P = 0.008), with lower American Society of Anesthesiologists scores (P < 0.0001) and higher preoperative hematocrit (P = 0.009). The MISC cohort had a lower unadjusted rates of minor complications (3.9% vs 5.6%; P = 0.004), urinary tract infection (3.3% vs 4.8%; P = 0.004), and prolonged hospitalization (5.2% vs 7.9%; P < 0.0001), with a higher rate of nephrologic (P = 0.01) complications. On multivariable analysis, there were no significant associations of MISC with the risk of 30-day complications (odds ratio [OR], 1.51; 95% confidence interval [CI], 0.92–2.51; P = 0.11), prolonged hospitalization (OR, 0.96; 95% CI, 0.76–1.21; P = 0.72), readmission (HR 1.03; 95% CI, 0.71–1.49;P = 0.88), or reoperation (OR, 0.95; 95% CI, 0.57–1.60; P = 0.86).

Conclusions
Minimally invasive sacrocolpopexy is associated with similar rates of 30-day complications, prolonged hospitalization, readmission, and reoperation compared with nonmesh vaginal surgeries for apical prolapse.
Predictors and timing of amputations in military lower extremity trauma with arterial injury
Authors: Kauvar David S. , Thomas Sarah B. , Schechtman David W. , Walters Thomas J. 
Published: January 2019

INTRODUCTION
Military lower extremity arterial injuries present threats to life and limb. These injuries are common and limb salvage is a trauma system priority. Understanding the timing and predictors of amputation through the phases of casualty evacuation can help inform future limb salvage efforts. This study characterizes limbs undergoing amputation at different operationally relevant time points.

METHODS
A retrospective cohort study of casualties with lower extremity arterial injuries undergoing initial vascular limb salvage in Iraq and Afghanistan was undertaken. Amputations were grouped as having been performed early (in theater at Role 2 or 3) or late (after evacuation to Role 4 or 5). Further distinction was made between late and delayed (after discharge from initial hospitalization) amputations.

RESULTS
Four hundred fifty-five casualties met inclusion criteria with 103 amputations (23%). Twenty-one (20%) were performed in theater and 82 (80%) were performed following overseas evacuation. Twenty-one (26% of late amputations) were delayed, a median of 359 days from injury (interquartile range, 176–582). Most amputations were performed in the first 4 days following injury. Amputation incidence was highest in popliteal injuries (28%). Overall, amputation was predicted by higher incidence of blast mechanism and fracture and greater limb and casualty injury severity. Early amputations had higher limb injury severity than late amputations. Delayed amputations had greater incidence of motor and sensory loss and contracture than early amputations.

CONCLUSION
Casualty and limb injury severity predict predictors and timing of amputation in military lower extremity arterial injury. Amputation following overseas evacuation was more common than in-theater amputation, and functional loss is associated with delayed amputation. Future limb salvage efforts should focus on postevacuation and rehabilitative care.

LEVEL OF EVIDENCE
Epidemiologic study, level III.
Extrahepatic bile duct injury in blunt trauma: A systematic review
Authors: Pereira Ryan , Vo Tovi , Slater Kellee 
Published: January 2019

BACKGROUND
Extrahepatic bile duct injuries (EHBDIs) are a rare consequence of blunt abdominal trauma. The purpose of this study was to establish mechanisms of injury, clinical indicators of EHBDI following blunt trauma (both with investigative modalities and intraoperatively), method and timing of injury detection, and definitive treatment options.

METHODS
A systematic review was performed to gather data on patients with an EHBDI secondary to blunt trauma. Three databases (MEDLINE, PubMed, and EMBASE) were searched to July 19, 2018.

RESULTS
Our systematic review included 51 studies, compromising a study population of 66 patients with EHBDIs sustained from blunt trauma. The three most common injuries included complete transection of the suprapancreatic common bile duct (29%, n = 19), complete transection of the intrapancreatic common bile duct (23%, n = 15) and partial laceration of the left hepatic duct (20%, n = 13). Of the hemodynamically stable group managed nonoperatively (n = 23), mean timing postinjury to diagnosis of EHBDI was 11 days. An EHBDI was recognized at initial laparotomy in 87% (n = 13) of hemodynamically stable patients. An EHBDI was recognized at initial laparotomy in 57% (n = 8) of hemodynamically unstable patients.

CONCLUSION
The EHBDIs are a rare yet serious consequence of blunt trauma. To establish a timely diagnosis and limit complications of missed injuries, a heightened awareness is required by the attending surgeon with particular attention to subtle yet important clinical indicators. These vary depending on the hemodynamic stability of the patient and decision to manage injuries conservatively or surgically on presentation.

LEVEL OF EVIDENCE
Systematic review, level III.
Hormone replacement therapy in brain-dead organ donors: a comprehensive review with an emphasis on traumatic brain injury
Authors: Turco Lauren M. , Glorsky Steven L. , Winfield Robert D. 
Published: January 2019

BACKGROUND
Organ shortage is an ongoing problem in the United States. Most donor organs are procured following brain death and a significant portion of brain-dead donors result from devastating brain injury. Without a standard practice for hormone replacement therapy (HRT) in the setting of brain death, a comprehensive review of the literature was deemed necessary.

METHODS
A search of published literature was conducted with terms “TBI” or “brain injury” or “head injury” AND “hormone” or “management” AND “organ” AND “donor” or “donation.” Abstracts and full texts were screened for relevance and inclusion of information on HRT. Additional studies were selected from references cited within these. Excluded studies were non-English, nonhuman based, or had small sample size, (i.e., case reports or series with fewer than five subjects).

RESULTS
Fifteen studies were selected for inclusion and contained Level III or Level IV evidence. Combinations of thyroid hormone, insulin, and corticosteroids were the most commonly cited HRT. Ninety-three percent of studies found a significant increase in organ procurement rate among donors who received HRT. Hormone replacement therapy was administered after brain death declaration in eight studies. Only two studies specifically explored the effects of starting HRT earlier and identified even greater procurement rates. Four studies were specific to traumatic brain injury (TBI); the remaining 11 studies involved TBI in 22% to 89% of the sample.

CONCLUSION
Organ shortage remains a growing problem in the United States. Donor management including HRT has been proposed to combat the endocrine derangement associated with brain death and, in particular, TBI. While the existing literature reported compelling outcomes using HRT, there remains a need for further Level I and Level II evidence studies to define optimal practice.

LEVEL OF EVIDENCE
Review article, level IV.
Observing pneumothoraces: The 35-millimeter rule is safe for both blunt and penetrating chest trauma
Authors: Bou Zein Eddine Savo , Boyle Kelly A. , Dodgion Christopher M. , Davis Christopher S. , Webb Travis P. , Juern Jeremy S. , Milia David J. , Carver Thomas W. , Beckman Marshall A. , Codner Panna A. , Trevino Colleen , de Moya Marc A. 
Published: January 2019

BACKGROUND
As more pneumothoraxes (PTX) are being identified on chest computed tomography (CT), the empiric trigger for tube thoracostomy (TT) versus observation remains unclear. We hypothesized that PTX measuring 35 mm or less on chest CT can be safely observed in both penetrating and blunt trauma mechanisms.

METHODS
A retrospective review was conducted of all patients diagnosed with PTX by chest CT between January 2011 and December 2016. Patients were excluded if they had an associated hemothorax, an immediate TT (TT placed before the initial chest CT), or if they were on mechanical ventilation. Size of PTX was quantified by measuring the radial distance between the parietal and visceral pleura/mediastinum in a line perpendicular to the chest wall on axial imaging of the largest air pocket. Based on previous work, a cutoff of 35 mm on the initial CT was used to dichotomize the groups. Failure of observation was defined as the need for a delayed TT during the first week. A univariate analysis was performed to identify predictors of failure in both groups, and multivariate analysis was constructed to assess the independent impact of PTX measurement on the failure of observation while controlling for demographics and chest injuries.

RESULTS
Of the 1,767 chest trauma patients screened, 832 (47%) had PTX, and of those meeting inclusion criteria, 257 (89.0%) were successfully observed until discharge. Of those successfully observed, 247 (96%) patients had a measurement of 35 mm or less. The positive predictive value for 35 mm as a cutoff was 90.8% to predict successful observation. In the univariant analyses, rib fractures (p = 0.048), Glasgow Coma Scale (p = 0.012), and size of the PTX (≤35 mm or >35 mm) (P < 0.0001) were associated with failed observation. In multivariate analysis, PTX measuring 35 mm or less was an independent predictor of successful observation (odds ratio, 0.142; 95% confidence interval, 0.047–0.428)] for the combined blunt and penetrating trauma patients.

CONCLUSION
A 35-mm cutoff is safe as a general guide with only 9% of stable patients failing initial observation regardless of mechanism.

LEVEL OF EVIDENCE
Therapeutic, level III.
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults
Authors: Newgard Craig D. , Lin Amber , Eckstrom Elizabeth , Caughey Aaron , Malveau Susan , Griffiths Denise , Zive Dana , Bulger Eileen 
Published: January 2019

BACKGROUND
Comorbid conditions and anticoagulants have been considered as field triage criteria to raise the sensitivity for identifying seriously injured older adults, but research is sparse. We evaluated the utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting.

METHODS
This was a cohort study of injured adults 65 years or older transported by 44 emergency medical services agencies to 51 trauma and nontrauma hospitals in seven Oregon and Washington counties from January 1, 2011, to December 31, 2011. Out-of-hospital predictors included current field triage criteria, 13 comorbidities, preinjury anticoagulant use, and previously developed geriatric specific physiologic measures. The primary outcome (high-risk patients) was Injury Severity Score of 16 or greater or need for major nonorthopedic surgical intervention. We used binary recursive partitioning to develop a clinical decision rule with a target sensitivity of 95% or greater.

RESULTS
There were 5,021 older adults, of which 320 (6.4%) had Injury Severity Score of 16 or greater or required major nonorthopedic surgery. Of the 2,639 patients with preinjury medication history available, 400 (15.2%) were taking an anticoagulant. Current field triage practices were 36.6% sensitive (95% confidence interval [CI], 31.2%–42.0%) and 90.1% specific (95% CI, 89.2%–91.0%) for high-risk patients. Recursive partitioning identified (in order): any current field triage criteria, Glasgow Coma Scale score of 14 or less, geriatric-specific vital signs, and comorbidity count of 2 or more. Anticoagulant use was not identified as a predictor variable. The new criteria were 90.3% sensitive (95% CI, 86.8%–93.7%) and 17.0% specific (95% CI, 15.8%–18.1%).

CONCLUSIONS
The current field triage guidelines have poor sensitivity for high-risk older adults. Adding comorbidity information and geriatric-specific physiologic measures improved sensitivity, with a decrement in specificity.

LEVEL OF EVIDENCE
Prognostic/Epidemiologic, level II.