bluuebunny/crossref_metadata_2025_split huggingface dataset:
The utility of real-time polymerase chain reaction in detecting Coccidioides immitis among clinical specimens in the Central California San Joaquin Valley
Authors: Dizon Dominic , Mitchell Marilyn , Dizon Bernadette , Libke Robert , Peterson Michael W 
Published: October 2018

AbstractCoccidioidomycosis, the fungal infection caused by dimorphic Coccidioides species, is typically diagnosed by histopathologic identification of spherules, by culture, or by serology. These tests are reliable but time-intensive, delaying diagnosis and treatment. Rapid real-time polymerase chain reaction (RT-PCR) can be performed and was validated to identify Coccidioides immitis using an in-house developed assay for the Becton Dickinson molecular instrument (BD MAXTM). These studies were performed using patient samples that had been shown to be positive on previously set up fungal cultures. To evaluate this new RT-PCR test in the clinical setting, we conducted a retrospective chart review of patients (N = 1160) who underwent Coccidioides PCR (Cocci PCR) on clinical samples between March 1, 2014, and Dec 31, 2016. We abstracted clinical, microbiologic, serologic, radiographic, treatment, and follow-up data. Specimens of cerebrospinal fluid (CSF), bronchioalveolar lavage fluid (BAL), lung tissue biopsy (LTB), sputum, and pleural fluid were evaluated to determine sensitivity and specificity. Of the 113 specimens that tested positive for Cocci PCR, all had clinical disease defined by traditional clinical criteria, yielding 100% specificity. Overall sensitivity was 74% versus 46% for fungal culture and was available in 4 hours rather than 1–2 weeks. Sensitivities varied by source material and clinical setting. CSF had a sensitivity of 59%, BAL for acute pneumonia 91%, sputum for acute pneumonia 94%, pleural fluid 86%, but LTB for lung nodules only 44%. Overall positive predictive value (PPV) was 100%, while negative predictive value (NPV) was 96%, but again this varied by specimen and clinical setting. Our experience with clinical testing of >1160 specimens over 2–3 years shows we can utilize this technology to improve our ability to diagnose disease but that the sensitivity varies by specimen source and clinical setting.
The relationship between disability and suicide: prospective evidence from the Ten to Men cohort
Authors: Milner Allison , Bollier Anne-Marie , Emerson Eric , Kavanagh Anne 
Published: October 2018

Abstract

Background
People with disabilities often face a range of social and economic adversities. Evidence suggests that these disadvantages result in poorer mental health. Some research also indicates that people with disabilities are more likely experience thoughts about suicide than people without disability, although most of this research is based on small cross-sectional samples.

Methods
We explored the relationship between self-reported disability (measured at baseline) and likelihood of reporting thoughts of suicide (measured at follow up) using a large longitudinal cohort of Australian males. A logistic regression model was conducted with thoughts of suicide within the past 12 months (yes or no) as the outcome and disability as the exposure. The models adjusted for relevant confounders, including mental health using the SF-12 MCS, and excluded males who reported thoughts of suicide at baseline.

Results
After adjustment, there was a 1.48 (95% CI: 0.98–2.23, P = 0.063) increase in the odds of thoughts of suicide among men who also reported a disability. The size of association was similar to that of being unemployed.

Conclusions
Males reporting disability may also suffer from thoughts of suicide. We speculate that discrimination may be one explanation for the observed association. More research on this topic is needed.
Cost and Hospital Resource Utilization of Staphylococcus aureus Infection Post Elective Posterior Instrumented Spinal Fusion Surgeries in U.S. Hospitals: A Retrospective Cohort Study
Authors: Rosenthal Ning A. , Heinrich Kirstin H. , Chung Jessica , Yu Holly 
Published: October 2018

Study Design.
A retrospective cohort study.

Objective.
The aim of this study was to assess hospital resource utilization and costs associated with Staphylococcus aureus infection within 180 days post elective posterior instrumented spinal fusion surgeries (index surgery) between 2010 and 2015.

Summary of Background Data.
Surgical site infections (SSIs) and blood stream infections (BSIs) post spinal fusion surgeries are associated with worse clinical outcomes and increased costs. Economic data specific to the most common pathogen of infections post spinal fusion surgeries, S. aureus, are limited.

Methods.
We analyzed hospital discharge and microbiology data from 129 U.S. hospitals in Premier Healthcare Database. Selection criteria included age ≥ 18 years; had a primary/secondary ICD-9-CM procedure code for index surgery; and had microbiology data during study period. Outcomes included total hospitalization cost, length of stay, and risk of all-cause readmission. Infection status was classified as culture-confirmed invasive (i.e., BSIs, deep or organ/space SSIs), any, and no S. aureus infection. Multivariable regression analyses were used to compare outcome variables between infection groups controlling for known confounders.

Results.
Two hundred ninety-four patients had any S. aureus infection (151 had invasive infection) and 12,918 had no infection. Compared with no infection group, invasive and any infection groups had higher total hospitalization cost (adjusted mean in 2015 U.S. dollars: $88,353 and $64,356 vs. $47,366, P < 0.001), longer length of stay (adjusted mean: 20.98 and 13.15 vs. 6.77 days, P < 0.001), and higher risk of all-cause readmission [adjusted risk ratio: 2.15 (95% confidence interval: 2.06–2.25) for invasive and 1.70 (95% confidence interval: 1.61–1.80) for any infection groups].

Conclusion.

S. aureus infections post elective posterior instrumented spinal fusion surgeries are associated with significantly higher hospitalization cost, length of stay, and 180-day risk of readmission than those with no such infection, which presents substantial burden to hospitals and patients. Reducing such infections may cut costs and hospital resource utilization.

Level of Evidence: 3
Comparative Analysis of Two Transforaminal Lumbar Interbody Fusion Techniques
Authors: Ge David H. , Stekas Nicholas D. , Varlotta Christopher G. , Fischer Charla R. , Petrizzo Anthony , Protopsaltis Themistocles S. , Passias Peter G. , Errico Thomas J. , Buckland Aaron J. 
Published: October 2018

Study Design.
A retrospective cohort study at a single institution.

Objective.
The aim of this study was to analyze the perioperative and postoperative outcomes of patients who underwent open transforaminal lumbar interbody fusion (O-TLIF) and bilateral minimally invasive surgery (MIS) Wiltse approach TLIF (Wil-TLIF).

Summary of Background Data.
Several studies have compared open TLIF to MIS TLIF; however, comparing the techniques using a large cohort of one-level TLIFs has not been fully explored.

Methods.
We reviewed the charts of patients undergoing a single-level primary posterior lumbar interbody fusion between 2012 and 2017. The cases were categorized as Open TLIF (traditional midline exposure including lateral exposure of transverse processes) or bilateral paramedian Wiltse TLIF approach. Differences between groups were assessed by t tests.

Results.
Two hundred twenty-seven patients underwent one-level primary TLIF (116 O-TLIF, 111 Wil-TLIF). There was no difference in age, gender, American Society of Anesthesiologists (ASA), or body mass index (BMI) between groups. Wil-TLIF had the lowest estimated blood loss (EBL; 197 vs. 499 mL O-TLIF, P ≤ 0.001), length of stay (LOS; 2.7 vs. 3.6 days O-TLIF, P ≤ 0.001), overall complication rate (12% vs. 24% O-TLIF, P = 0.015), minor complication rate (7% vs. 16% O-TLIF, P = 0.049), and 90-day readmission rate (1% vs. 8% O-TLIF, P = 0.012). Wil-TLIF was associated with the higher fluoroscopy time (83 vs. 24 seconds O-TLIF, P ≤ 0.001). There was not a significant difference in operative time, intraoperative or neurological complications, extubation time, reoperation rate, or infection rate.

Conclusion.
In comparing Wiltse MIS TLIF to Open TLIF, the minimally invasive paramedian Wiltse approach demonstrated the lowest EBL, LOS, readmission rates, and complications, but longer fluoroscopy times when compared with the traditional open approach.

Level of Evidence: 3
Ten-year Outcomes of Cervical Disc Replacement With the BRYAN Cervical Disc
Authors: Lavelle William F. , Riew K. Daniel , Levi Allan D. , Florman Jeffrey E. 
Published: October 2018

Study Design.
A prospective, randomized multicenter IDE trial between May 2002 and October 2004.

Objective.
The aim of this study was to report on the 10-year safety and efficacy of BRYAN cervical disc arthroplasty (CDA).

Summary of Background Data.
Cervical disc arthroplasty (CDA) is a potential alternative for anterior cervical decompression and fusion (ACDF) with the hope that maintenance of motion may decrease the likelihood of adjacent segment disease.

Methods.
This is an analysis of a US Food and Drug Administration (FDA) investigation comparing CDA with ACDF for single-level patients. Eligible patients were ≥ 21 years of age with symptomatic cervical disc disease who had failed conservative care. Patients were followed at regular intervals with the current data set at > 10 years. Protocol for overall success: ≥ 15-point improvement in NDI scores, maintenance or improvement in neurologic status, no serious adverse events related to implant or implant/surgical procedure, and no subsequent surgery or intervention classified as “failure.”

Results.
At 10-year follow-up, 128 (CDA) and 104 (ACDF) patients were available for evaluation. Overall success rate was significantly higher for CDA group (81.3% vs. 66.3%; P = 0.005). The rate of second surgeries at adjacent levels was lower for CDA group (9.7% vs. 15.8%; P = 0.146). NDI scores improved significantly in CDA group (Δ38.3 vs. Δ31.1; P = 0.010). Visual Analog Scale (VAS) neck and arm improved in the CDA group (Δ54.3 vs. Δ49.2; P = 0.119), (Δ58.1 vs. Δ51.6; P = 0.0.60) respectively. About 4.1% of CDA patients and 4.9% of ACDF patients had serious adverse events related to study device. Mean angular motions at index level for BRYAN disc and ACDF were 8.69° and 0.60°, respectively.

Conclusion.
CDA can preserve and maintain motion in the long term compared with ACDF. There was a trend toward fewer adjacent segment surgeries for BRYAN disc that did not reach significance. Significant improvement in CDA NDI scores may suggest better long-term success for CDA as compared to fusion.

Level of Evidence: 2
Tick Bite–Associated Morphea: A Case Report
Authors: George Eva , Nielson Colton B. , Vincek Vladimir 
Published: October 2018

Abstract:

Borrelia burgdorferi, the causative organism of Lyme disease, has been linked to the development of scleroatrophic skin conditions including morphea, although this association remains controversial. The possibility that tick bite with or without concurrent Borrelia infection instigates that morphea development is important to recognize because this could prompt further workup for Lyme disease, or other tick-borne illness, which, when untreated, can have devastating consequences. Here, we report a case of a woman with a history of previous tick bite in the location of morphea. This prompted further workup, including serologies that were negative for borrelia. The patient declined empiric treatment with doxycycline. It is important to be aware that morphea may represent a consequence of tick bite because this can alter patient management.
Concurrent Microbial Keratitis and Nasolacrimal Duct Obstruction: Concordance, Etiopathogenesis, and Outcome
Authors: Nayak Arpita , Mitra Basu Sanchita , De Anuria , Mallick Aparajita , Das Sujata , Rath Suryasnata 
Published: October 2018

Purpose:
Nasolacrimal duct obstruction (NLDO) is believed to be a risk factor for microbial keratitis (MK). The primary objective of this study was to look at microbiological concordance between corneal scraping and lacrimal sac flora in patients with concurrent MK and NLDO. The secondary objective was to compare microbiological isolates from MK and NLDO, MK alone, NLDO alone, and healthy subjects.

Methods:
A prospective comparative study of 146 subjects with standard microbiological analyses was performed between February 2014 and October 2017.

Results:
Of the 146 subjects, 35 had concurrent MK and NLDO, 35 had MK, 41 had NLDO, and 35 were healthy subjects. Overall, mean age and sex distribution among groups were similar. In the MK and NLDO group, coagulase-negative staphylococci (CNS) were the most common isolates from the corneal scraping (n = 12/35, 34%) and lacrimal sac (n = 10/35, 29%) with 58% concordance. CNS were also the most common isolates from the NLDO group and healthy subjects, fungus being the most common isolate in the MK group. Anatomical success was achieved in 31 patients (89%) after dacryocystorhinostomy (DCR) in the MK and NLDO group. The difference between the number of patients who had successful DCR surgery but failure of medical therapy for MK (1/31) versus those who failed DCR and medical therapy for MK (3/4) was statistically significant (P = 0.002, Fisher exact test).

Conclusions:
CNS are the most common organisms in concurrent MK and NLDO (58% concordance), in patients with NLDO alone, and as commensals in healthy subjects. Persistence of NLDO may be responsible for a poorer outcome of MK in a concurrent setting.
Outcomes and costs of treating hepatitis C patients with second-generation direct-acting antivirals: results from the German Hepatitis C-Registry
Authors: Krüger Kathrin , Krauth Christian , Rossol Siegbert , Mauss Stefan , Boeker Klaus H.W. , Müller Tobias , Klinker Hartwig , Pathil Anita , Heyne Renate , Stahmeyer Jona T. 
Published: October 2018

Objective
Chronic hepatitis C virus infection is associated with a significant health burden. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of direct-acting antivirals (DAA) has led to an increase in sustained virologic response rates (SVR), but is accompanied by higher treatment costs. The aim of this study was to assess the outcomes and costs of treating hepatitis C virus infected patients with DAAs in clinical practice in Germany.

Patients and methods
Data were derived from a noninterventional study including a pharmacoeconomic subset of 2673 patients with genotypes 1 and 3 who initiated and completed treatment between February 2014 and February 2017. Sociodemographic and clinical parameters as well as resource utilization were collected using a web-based data recording system. Costs were calculated using official remuneration schemes.

Results
The mean age of the patients was 54.6 years; 48% were men. 93.5% of all patients achieved an SVR. The average total treatment costs were €67 979 (€67 131 medication costs, €824 ambulatory care, €24 hospital costs). The average costs per SVR of €72 705 were calculated. Differences in SVR and costs according to genotype, treatment regimen, treatment experience, and cirrhosis were observed. Quality-of-life data showed no or a minimal decrease during treatment.

Conclusion
This analysis confirms high SVR rates for newly introduced DAAs in a real-world setting. Costs per SVR estimated are comparable to first-generation DAA. Given the fact that the costs for the currently used treatment regimens have declined, it can be assumed that the costs per SVR have also decreased. Our insight into real-world outcomes and costs can serve as a basis for a comparison with the mentioned newly introduced treatment regimens.
Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer
Authors: Serrano Jose , Andersen Dana K. , Forsmark Christopher E. , Pandol Stephen J. , Feng Ziding , Srivastava Sudhir , Rinaudo Jo Ann S. 
Published: October 2018

Abstract
Research progress in diseases of the exocrine pancreas [chronic pancreatitis (CP), pancreatogenic diabetes mellitus, and pancreatic cancer] has been hampered by the disorders' heterogeneity, the limitations of previous small cross-sectional studies, the inability to safely obtain pancreatic tissue for study, and the lack of structured epidemiology tools, genetic testing, and biomarker development. Mechanism-based research of these diseases has suffered from the lack of systematically collected clinical measures in longitudinal cohort studies linked with biospecimens. Given the increasing incidence and prevalence of CP and its association to the development of pancreatic cancer, its complications, high mortality rate, and associated health care cost, the National Institute for Diabetes and Digestive and Kidney Diseases and the National Cancer Institute funded the Consortium for the Study of Chronic Pancreatitis, Diabetes and Pancreatic Cancer to identify research gaps and foster multidisciplinary collaborations to better diagnose, characterize, and manage CP and its sequelae. The CPDPC structure, governance, and research objectives are described in this article. Studies undertaken by the CPDPC are described in other articles in this journal's issue.
Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis—Knowledge Gaps and Research Opportunities
Authors: Uc Aliye , Andersen Dana K. , Borowitz Drucy , Glesby Marshall J. , Mayerle Julia , Sutton Robert , Pandol Stephen J. 
Published: October 2018

Abstract
A workshop was sponsored by the Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, on July 25, 2018, in Pittsburgh, Penn. The workshop was designed to bring together a multidisciplinary group of experts to accelerate the development of therapeutics for clinical application in inflammatory diseases of the exocrine pancreas. Three separate working groups (acute pancreatitis, recurrent acute pancreatitis, and chronic pancreatitis) were formed to address the needs, gaps, and opportunities. The working groups included patients with pancreatic diseases, pharmaceutical company leaders, basic scientists, clinical researchers, and representatives from the US Food and Drug Administration to assist with regulatory considerations and to identify the unmet needs, research targets, and opportunities to provide direction for successful development of therapeutic agents in these diseases. This article represents the summary of the overview presentations at the National Institute of Diabetes and Digestive and Kidney Diseases workshop including an ongoing drug trial in acute pancreatitis; a successful drug development network developed by the Cystic Fibrosis Foundation; and considerations for subject selection in drug trials, incorporating Food and Drug Administration guidelines on clinical trial design and clinical outcome measures. The summaries of each working group follow separately in accompanying articles.
Chromogranin A in the Follow-up of Gastroenteropancreatic Neuroendocrine Neoplasms
Authors: Rossi Roberta Elisa , Ciafardini Clorinda , Sciola Valentina , Conte Dario , Massironi Sara 
Published: October 2018

Objectives
Little is known about chromogranin A (CgA) during follow-up of gastroenteropancreatic neuroendocrine neoplasms. We hypothesized that serial CgA monitoring might be useful for the assessment of tumor progression, and we performed a systematic review of the literature and meta-analysis.

Methods
A bibliographical search was performed in PubMed using “chromogranin A” and “neuroendocrine tumors” and “follow-up” and “biomarker” to identify all pertinent articles published in the last 10 years.

Results
Eight studies were included in current meta-analysis. Chromogranin A as a follow-up marker shows sensitivity between 46% and 100% and specificity between 68% and 90%. The meta-analysis results showed an overall accuracy of 84% (95% confidence interval [CI], 81–86.6), a cumulative sensitivity of 74.6% (95% CI, 61.9–85.4), and a cumulative specificity of 84.7% (95% CI, 81.3–87.7). These data indicate that circulating CgA has a better overall accuracy in the follow-up setting; it can be used to rule the diagnosis of recurrence/progression in, rather than to rule it out.

Conclusions
Chromogranin A is more reliable when used to monitor disease progression and response to treatment and for the early detection of recurrence after treatment rather than in the diagnostic setting. It is more sensible to use this marker in those cases where the initial values were impaired.
Mediastinal Duplication Cyst on 99mTc Pertechnetate Scan
Authors: Gupta Vanshika , Verma Ritu , Belho Ethel , Seniaray Nikhil 
Published: October 2018

Abstract
A 3-year-old boy presented with intermittent abdominal pain, melena, and anemia since 2 months. Upper gastrointestinal endoscopy did not reveal any significant abnormality. The child was then referred for 99mTc-pertechnetate scan to rule out the presence of ectopic functioning gastric mucosa. 99mTc-pertechnetate scan revealed abnormal tracer accumulation in the thoracic region, which persisted in the delayed images, suspicious for being ectopic gastric mucosa. Subsequently, ultrasound and contrast-enhanced CT (CECT) scans of the chest revealed a large multiseptate cystic lesion in the retrocardiac region, corresponding to the site of increased tracer uptake on 99mTc-pertechnetate scan.
Does Mesh Weight Affect Time to Failure After Robotic-Assisted Laparoscopic Sacrocolpopexy?
Authors: Askew Amy L. , Visco Anthony G. , Weidner Alison C. , Truong Tracy , Siddiqui Nazema Y. , Bradley Megan S. 
Published: October 2018

Objective
The objective of this study was to compare time to anatomic failure after robotic sacrocolpopexy with use of ultralightweight versus heavier weight mesh types.

Methods
We performed a retrospective cohort study of women who underwent robotic sacrocolpopexy, from January 2012 to September 2016. We compared (1) sacrocolpopexy with ultralightweight mesh (≤20 g/m2) versus (2) sacrocolpopexy with heavier weight mesh (≤35 g/m2). Our primary outcome was time to anatomic failure, defined as recurrent prolapse beyond the hymen, or retreatment for prolapse with surgery or pessary. Secondary outcomes were compartment of failure and mesh exposure. Cox proportional hazards modeling was used to estimate the hazard of failure based on mesh type.

Results
Of 461 patients, 248 (53.8%) underwent sacrocolpopexy with ultralightweight mesh and 213 (46.2%) with heavier weight mesh. Failures occurred in 37 women, with 21 in the ultralightweight mesh group and 16 in the heavier weight mesh group. Time to failure was statistically significant between groups (P = 0.03). Ultralightweight mesh had twice the hazard of failure within 3 years compared with heavier weight mesh (hazard ratio, 2.15; 95% confidence interval, 1.10–4.21; P = 0.03). Among failures, use of ultralightweight mesh was associated with almost 5 times the hazard of anterior compartment failure (hazard ratio, 4.46; 95% confidence interval, 1.39–14.27; P = 0.01). There was no difference in time to posterior failure. Of 17 mesh exposures, there were fewer in the ultralightweight mesh group, although this group was followed for less time (1.6% ultralightweight vs 6.0% heavier weight, P = 0.01).

Conclusions
Women receiving ultralightweight mesh are more likely to experience earlier anatomic failure in the anterior compartment.