bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanism of High-Level Daptomycin Resistance in
Corynebacterium striatum
Authors: Goldner Nicholas K. , Bulow Christopher , Cho Kevin , Wallace Meghan , Hsu Fong-Fu , Patti Gary J. , Burnham Carey-Ann , Schlesinger Paul , Dantas Gautam 
Published: August 2018

Antimicrobial resistance threatens the efficacy of antimicrobial treatment options, including last-line-of-defense drugs. Understanding how this resistance develops can help direct antimicrobial stewardship efforts and is critical to designing the next generation of antimicrobial therapies. Here we determine how
Corynebacterium striatum
, a skin commensal and opportunistic pathogen, evolved high-level resistance to a drug of last resort, daptomycin. Through a single mutation, this pathogen was able to remove the daptomycin’s target, phosphatidylglycerol (PG), from the membrane and evade daptomycin’s bactericidal activity. We found that additional compensatory changes were not necessary to support the removal of PG and replacement with phosphatidylinositol (PI). The ease with which
C. striatum
evolved high-level resistance is cause for alarm and highlights the importance of screening new antimicrobials against a wide range of clinical pathogens which may harbor unique capacities for resistance evolution.
Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients
Authors: Noubiap Jean Jacques , Nansseu Jobert Richie , Nyaga Ulrich Flore , Sime Paule Sandra , Francis Innocent , Bigna Jean Joel 
Published: August 2018

ObjectiveWe conducted the first systematic review and meta-analysis to estimate the specific prevalence of apparent treatment-resistant, pseudo-resistant and true-resistant hypertension among treated patients with hypertension globally.MethodsWe conducted a search in PubMed, EMBASE, Web of Science and Global Index Medicus to identify articles published from inception to 30 September 2017, and searched the reference list of retrieved articles. We used a random-effects model to estimate the prevalence of resistant hypertension across studies and heterogeneity was assessed via the χ² test on Cochran’s Q statistic.ResultsWe included 91 studies published between 1991 and 2017 reporting data of a pooled sample of 3 207 911 patients with hypertension on antihypertensive drugs globally. Most of the studies (n=64, 70%) only used office blood pressure (BP) measurement. In the general, population of treated patients with hypertension, the prevalence of true-resistant, apparent treatment-resistant and pseudo-resistant hypertension were 10.3% (95% CI 7.6% to 13.2%), 14.7% (95% CI 13.1% to 16.3%) and 10.3% (95% CI 6.0% to 15.5%). The prevalence of true-resistant hypertension was 22.9% (95% CI 19.1% to 27.0%), 56.0% (95% CI 52.7% to 59.3%) and 12.3% (95% CI 1.7% to 30.5%) in chronic kidney disease, renal transplant and elderly patients, respectively.ConclusionsThis study shows a high prevalence of true-resistant hypertension. This prevalence is lower than that of apparent treatment-resistant hypertension, demonstrating the importance to exclude causes of pseudo-resistant hypertension including white-coat hypertension with the use of ambulatory BP measurement. The burden of resistant hypertension is highest in patients with chronic kidney disease. New treatments for resistant hypertension are highly needed, considering the disastrous complications of the disease.
Radical Resection of Locally Recurrent Colorectal Cancer Significantly Improves Overall Survival: A Single-Center Cohort Study
Authors: Braun Rüdiger , Bruch Hans-Peter , Keck Tobias , Benecke Claudia , Hoffmann Martin 
Published: August 2018

<b><i>Background:</i></b> Despite multimodal treatment strategies, locoregional recurrence rates are still significant in colorectal carcinoma (CRC). <b><i>Methods:</i></b> Clinical, pathological, perioperative, and survival data of 203 patients with recurrent CRC enlisted in a prospective database from 1990 to 2011 were analyzed. <b><i>Results:</i></b> Median disease-free survival in our cohort of 203 patients was 23 months after resection of the primary tumor. In total, 113 of these patients had surgical therapy with resection of the recurrent tumor. The primary tumor was localized in the rectum in 63 (56%) patients and in the colon in 50 (44%) patients. A complete resection of the recurrent tumor (R0) was achieved in 69 (61%) patients. Postoperative complications occurred in 42 (37%) patients. Postoperative mortality was 2.7%. The median overall survival for R0-resected patients without distant metastasis was 91 months. Those patients had better overall survival compared to patients in whom no complete resection of the recurrent tumor was possible (<i>p</i> &#x3c; 0.001). There was no statistically significant difference (overall survival) between patients that had R0-resection with systemic metastasis and R1 (<i>p</i> = 0.794) or R2 (<i>p</i> = 0.422) resection. <b><i>Conclusion:</i></b> Surgical resection of a locally recurrent CRC leads to a substantial long-term survival rate for R0-resected patients.
Depleting wild prey compels common leopard (Panthera pardus) to sustain on livestock
Authors: Hussain Abid , Mahmood Tariq , Akrim Faraz , Andleeb Shaista , Fatima Hira , Hamid Abdul , Waseem Muhammad 
Published: August 2018

AbstractThe wide distribution of a predator can reflect its flexibility in adapting to various ecosystems. The common leopard (Panthera pardus) is “Critically Endangered” in Pakistan while the IUCN Red List categorizes it globally as “Vulnerable”. This study investigated the distribution of the common leopard and the contribution of livestock in its diet in District Sudhanoti of Azad Jammu and Kashmir. During the surveys, scats, pugmarks, prey remains, and dead bodies of the common leopard were recovered in a scanned area of approximately 262 km2. The scats were mostly found on tracks and trails in hilly terrain, and pugmarks in the riparian zone and nallas, while prey remains were found mostly in dense bushes and rocks. Dead common leopards were recovered within or around village areas. All signs of the species were found between 418 m and 2016 m elevation above sea level. Scat analysis revealed a total of ten prey species including seven domestic mammals and only three wild meso-mammals. Domestic animals were most frequently consumed while wild prey contributed significantly less. The consumption of domestic prey species was found not to differ between the summer and winter season. We conclude that the common leopard was sustaining mainly on livestock with a much smaller contribution from wild prey. This fact, along with the “Critically Endangered” status of the species in the country, demands effective conservation measures to be taken to save common leopards.
Mitigating the Risks Entailed in Shareholders’ Claims for Reflective Loss: Suggestions for Investment Treaty Reform
Authors: Kyriakou Panagiotis A. 
Published: August 2018

Abstract
This contribution identifies the systemic risks posed by the permissibility of shareholders’ claims for reflective loss in international investment law. It revisits existing investment treaty mechanisms under which shareholder recourse can be limited, and evaluates their effectiveness in the particular context of reflective loss. Drawing on ‘traditional’ and ‘new generation’ treaty language, as well as on domestic and general international law, the article then proposes new treaty language with the aim of eliminating the risks of reflective loss claims from investment treaties.
Radar-Observed Bulk Microphysics of Midlatitude Leading-Line Trailing-Stratiform Mesoscale Convective Systems
Authors: Handler Shawn L. , Homeyer Cameron R. 
Published: August 2018

AbstractIn 2013, all NEXRAD WSR-88D units in the United States were upgraded to dual polarization. Dual polarization allows for the identification of precipitation particle shape, size, orientation, and concentration. In this study, dual-polarization NEXRAD observations from 34 recent events are used to identify the bulk microphysical characteristics of a specific subset of mesoscale convective systems (MCSs), the leading-line trailing-stratiform (LLTS) MCS. NEXRAD observations are used to examine hydrometeor distributions in relative altitude to the 0°C level and as a function of storm life cycle, precipitation source (convective or stratiform), and storm environment. The analysis reveals that graupel particles are the most frequently classified hydrometeor class in a layer extending from the 0°C-level altitude to approximately 5 km above within the convective region. Below the 0°C level, rain is the most frequently classified hydrometeor, with small hail and graupel concentrations present throughout the LLTS system’s life cycle. The stratiform precipitation region contains small graupel concentrations in a shallow layer above the 0°C level, with pristine ice crystals being classified as the most frequently observed hydrometeor at higher altitudes and snow aggregates being classified as the most frequently observed hydrometeor at lower altitudes above the environmental 0°C level. Variations in most unstable convective available potential energy (MUCAPE) have the largest impact on the vertical distribution of hydrometeors, because more-unstable environments are characterized by a greater production of rimed ice.
Steroid Use for Sudden Sensorineural Hearing Loss: A CHEER Network Study
Authors: Witsell David L. , Mulder Hillary , Rauch Steven , Schulz Kristine A. , Tucci Debara L. 
Published: August 2018

ObjectiveThe objective of this study was to describe patterns of corticosteroid treatment for sudden sensorineural hearing loss and to evaluate effectiveness based on delivery mode (oral vs intratympanic vs both).Study DesignCross‐sectional repeated measures.SettingPatients were recruited from practices within the Creating Healthcare Excellence through Education and Research (CHEER) Network. CHEER is a National Institutes of Health–funded nationwide network of 30 community and academic otolaryngology practice sites.Subjects and MethodsA subset of 117 patients who had been treated with steroids for sudden sensorineural hearing loss were recruited from within a larger initial CHEER Network study on clinical practice guideline compliance. Outcomes included audiometric and speech scores and patient‐perceived improvement. Descriptive analyses, Wilcoxon rank‐sum tests, and Fisher exact tests were run.ResultsTwo categories (oral and simultaneous oral + intratympanic) had adequate sample sizes to support statistical comparison of treatment results. Improvements were seen in both audiometry and speech testing scores; 57% of patients self‐reported improvement perceived as either minor or major. There were no significant differences in degree of improvement between these treatment groups.ConclusionsWe observed that a majority of steroid‐treated patients demonstrated hearing improvement, but this improvement did not meet criteria for statistical significance. As in other studies on this topic, the relatively small sample size may have prevented differentiation of effectiveness among steroid treatments. We propose that the use of alternative approaches, such as pragmatic clinical trials and multidisciplinary electronic health record systems and megadatabases, may hold the most promise for an approach to best practice development.
The Difficult Airway after Endoscopic Endonasal Skull Base Surgery: A Case Series and Management Algorithm
Authors: Chou Courtney , Snyderman Carl , Phillips Dennis , Darby Joseph 
Published: August 2018

ObjectivesTo analyze difficult airway situations affecting patients after endoscopic endonasal surgery (EES) for skull base tumors and to develop an airway management algorithm.Study DesignCase series with chart review.SettingSingle tertiary care center.Subjects and MethodsEleven difficult airway events occurred among patients after EES for skull base tumors, as identified through a retrospective review of our institutional Difficult Airway Management Team registry from January 2008 to March 2016. Data from these events included patient demographics, event characteristics, airway management techniques, and outcomes. Results were used to design a difficult airway protocol.ResultsThe majority of patients were obese (63.6%) and had a dural defect (90.9%), each of which was repaired with a vascularized flap. The most common reasons for the difficult airway call were concern for using mask ventilation in a patient with a dural defect (27.3%) and difficult airway anatomy (27.3%). Two patients did not require airway intervention; 8 were intubated; and 1 underwent cricothyroidotomy. Videolaryngoscopy was the most common first‐attempt intubation technique, followed by conventional direct laryngoscopy. Effective adjunctive techniques included intubation through a laryngeal mask airway and bougie‐guided intubation. As compared with simple mask ventilation, laryngeal mask airway–assisted ventilation was associated with a decreased incidence of postevent cerebrospinal fluid leak. There were no incidences of postevent pneumocephalus, cardiopulmonary arrest, or mortality.ConclusionsWe propose a difficult airway algorithm for patients following EES of the skull base, with sequential recommendations for airway management methods and commentary on adjunctive techniques.
Intraoperative Corticosteroids for Voice Outcomes among Patients Undergoing Thyroidectomy: A Systematic Review and Meta‐analysis
Authors: Noel Julia E. , Kligerman Maxwell P. , Megwalu Uchechukwu C. 
Published: August 2018

ObjectiveTo determine if a preoperative dose of intravenous corticosteroids reduces the risk of postoperative recurrent laryngeal nerve palsy and improves subjective voice outcomes among patients undergoing thyroidectomy.Data SourcesPubMed, Cochrane database, and EMBASE.Review MethodsRandomized controlled trials comparing corticosteroids with placebo on voice outcomes in thyroid surgery were extracted with standardized search criteria. Systematic review and meta‐analysis were performed. With random effects models, trial data were pooled to determine the overall rate of recurrent laryngeal nerve palsy as well as secondary outcomes of adverse events, including wound infection and hyperglycemia.ResultsFour studies with a total of 517 patients met inclusion criteria. The overall rate of recurrent laryngeal nerve palsy was 5.78%. There was no difference in the rate of palsy between the corticosteroid and placebo groups (risk ratio, 0.70; 95% CI, 0.34‐1.44). There was also no difference between the groups in regard to wound infection, healing, or hyperglycemia.ConclusionsPreoperative corticosteroids do not appear to reduce the risk of recurrent laryngeal nerve palsy following thyroid surgery. There is insufficient evidence to assess its effect on subjective voice outcomes. More robust randomized controlled trials are needed to assess the effectiveness of perioperative steroids in improving voice outcomes after thyroidectomy.
Correlation analysis between JAK2, MPL, and CALR mutations in patients with myeloproliferative neoplasms of Chinese Uygur and Han nationality and their clinical characteristics
Authors: Lang Tao , Nie Yuling , Wang Zengsheng , Huang Qin , An Li , Wang Yichun , Wufuer Guzailinuer , Maimaiti Aziguli , Fu Ling , Li Yan , Zhang Xiaoyan , Aisimutula Aihemaitijiang , Wang Xiaomin , Zhu Lin , Liu Hong , Mao Min 
Published: August 2018

Background Genetic factors play a role in the etiology of BCR-ABL-negative myeloproliferative neoplasms (MPNs). This study explored the relationship between mutations in the Janus kinase 2 gene ( JAK2), MPL, and the calreticulin gene ( CALR) in Uygur and Han Chinese patients with BCR-ABL fusion gene-negative MPN and corresponding clinical features. Methods A total of 492 BCR-ABL-negative MPN patients treated in our hospital from May 2013 to August 2016 were enrolled. Genomic DNA was extracted from peripheral blood and used for PCR amplification and DNA sequencing. Mutations including JAK2 V617F, MPL W515L/K, and those in JAK2 exon 12 and CALR were analyzed and compared with patient clinical characteristics. Results Of the 492 MPN patients, 169 were Uygur and 323 were Han. In these two patient groups, JAK2 mutations were detected in 39.64% and 52.63%, respectively, CALR mutations were detected in 10.06% and 20.43%, respectively, and MPL mutations were detected in 0.93% of Han patients. The age, white blood cell count, platelet levels, and hemoglobin levels in JAK2 in Han patients were higher than those in Uygur patients. Conclusion Han MPN patients harboring JAK2 mutations had higher level of age, WBC, PLT, and Hb than Uyghur patients with the same mutations.
Trattamento antibiotico empirico, mirato o ragionato? Dalla pratica clinica alle Linee Guida EAU 2017
Authors: Cai Tommaso 
Published: August 2018

Empirical antibiotic treatment of urinary tract infections: from everyday clinical practice to EAU guidelines 2017 Recent epidemiological data confirm the increasing problem of antimicrobial resistance not only for hospitalized, healthcare-associated patients but also for outpatients. In particular, the progressive increase in resistance to broad-spectrum antibiotics, such as third-generation cephalosporins, fluoroquinolones, or carbapenems in Enterobacteriaceae, is an alarming situation for all urologists and general practitioners. The management of uncomplicated urinary tract infections are an important step in antibiotic stewardship achievement: a new approach is urgently required. All international Guidelines on urological infections suggest to take into account the following parameters for choosing antimicrobial therapy: spectrum and susceptibility patterns of the aetiological pathogens; efficacy for the particular indication in clinical studies; tolerability and adverse reactions; adverse ecological effects; costs and availability. In other words, an accurate evaluation of all patients and bacteria-related factors should be performed, along with the consideration of local data of bacterial resistance rate. According to these principles and the available susceptibility patterns in Italy, fosfomycin trometamol 3 g single dose and nitrofurantoin, are considered as drugs of first choice.
Sodium Nitrite–Mediated Cardioprotection in Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Cost-Effectiveness Analysis
Authors: Jones Daniel A. , Whittaker Peter , Rathod Krishnaraj S. , Richards Amy J. , Andiapen Mervyn , Antoniou Sotiris , Mathur Anthony , Ahluwalia Amrita 
Published: August 2018

Objectives: In the follow-up of patients in a trial of intracoronary sodium nitrite given during primary percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI), we found a reduction in the incidence of major adverse cardiac events (MACEs). Specifically, MACE rates were 5.2% versus 25.0% with placebo at 3 years ( P = .013). Such MACE reductions should also be associated with economic benefit. Thus, we assessed the cost utility of sodium nitrite therapy versus standard primary PCI only. Methods and Results: We developed a model to simulate costs and quality-adjusted life years (QALYs) over the first 36 months after ST-Segment Elevation Myocardial Infarction (STEMI). Decision tree analysis was used to assess different potential cardiovascular outcomes after STEMI for patients in both treatment groups. Model inputs were derived from the NITRITE-AMI study. Cost of comparative treatments and follow-up in relation to cardiovascular events was calculated from the United Kingdom National Health Service perspective. Higher procedural costs for nitrite treatment were offset by lower costs for repeat revascularization, myocardial infarction, and hospitalization for heart failure compared to primary PCI plus placebo. Nitrite treatment was associated with higher utility values (0.91 ± 0.19 vs 0.82 ± 0.30, P = .041). The calculated incremental cost-effectiveness ratio of £2177 per QALY indicates a cost-effective strategy. Furthermore, positive results were maintained when input parameters varied, indicating the robustness of our model. In fact, based on the difference in utility values, the cost of nitrite could increase by 4-fold (£2006 per vial) and remain cost-effective. Conclusion: This first analysis of sodium nitrite as a cardioprotective treatment demonstrates cost-effectiveness. Although more comparative analysis and assessment of longer follow-up times are required, our data indicate the considerable potential of nitrite-mediated cardioprotection.
Influence of the Local Food Environment on Hispanics’ Perceptions of Healthy Food Access in New York City
Authors: Co Manuel C. , Bakken Suzanne 
Published: August 2018

Introduction: Studies have characterized food environments and documented its impact on access and consumption of healthy foods as well as diet-related health conditions. This study aims to characterize the local food environment in New York City’s Washington Heights and Inwood community and to examine its influence on Hispanics’ perceptions of healthy food access. Methods: Person-level local food environments were created by spatially modeling food retailers selling fresh fruits and vegetables or low-fat products within a participant’s 400- and 800-m residential radius buffers. Data were analyzed using multivariate binary logistic regression. Results: Fruit/vegetable markets significantly increased participants’ odds of perceiving the availability of a large selection as well as the high quality of fresh fruits and vegetables in their neighborhood. Medium-/large-size supermarkets/groceries within 400-m radius significantly increased participants’ odds of perceiving the high quality of fresh fruits and vegetables in their neighborhood, whereas meat markets significantly lowered the odds. Fruit/vegetable markets and medium-/large-size supermarkets/groceries significantly increased participants’ odds of perceiving the availability of a large selection of low-fat products in their neighborhood. Conclusion: Study findings advance our understanding of the relationships between local food environment and perceived healthy food access among urban Hispanics.
Myocardial protection in on-pump coronary artery bypass grafting surgery: analysis of the effectiveness of the use of retrograde Celsior®
Authors: López-Menéndez José , Miguelena Javier , Morales Carlos , Callejo Francisco , Silva Jacobo 
Published: August 2018

Background: We analyzed the adequacy of the myocardial protection achieved with a single dose of retrograde crystalloid Celsior®, compared with an accepted standard (microplegia), in on-pump coronary artery bypass grafting surgery (CABG). Methods: This was a retrospective comparative clinical study conducted in a single institution that included all the patients operated on who had elective isolated on-pump CABG, from March 2006 to June 2014. We evaluated maximum postoperative troponin T (TnT) as a marker of myocardial damage, adjusted for possible confounders using propensity score matching. We also analyzed markers of recovery of myocardial function, and the safety of the intravenous use of Celsior®. Results: During the study period, 261 patients were included, divided in two groups: (a) continuous retrograde blood-based microplegia (114 patients); (b) retrograde single-dose crystalloid Celsior® (147 patients). The propensity score adjusted maximum TnT was significantly lower in the Celsior group [average treatment effect = −0.55 ng/dl; 95% confidence interval (CI) −1.10 to −0.1 ng/dl; p = 0.048]. There were no differences in the postoperative use of intra-aortic balloon of counterpulsation or in the requirements of high-dose inotropic medications. In-hospital mortality was equivalent in both study groups ( p = 0.73); surgical re-exploration because of bleeding was equivalent ( p = 0.37). There were no differences in prolonged mechanical ventilation ( p = 0.65) and intensive care unit length of stay ( p = 0.87). Conclusion: An isolated single dose of retrograde Celsior® may be an effective and safe myocardial protection strategy in on-pump CABG.