bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia
Authors: Sekar Poorani , Johnson James R. , Thurn Joseph R. , Drekonja Dimitri M. , Morrison Vicki A. , Chandrashekhar Yellapragada , Adabag Selcuk , Kuskowski Michael A. , Filice Gregory A. 
Published: February 2017

Abstract

Background
Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial.

Methods
We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making.

Results
Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P &lt; .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of 17 (94%) for TEE (P &lt; .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%).

Conclusions
Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.
Risk Factors for Surgical Site Infection After Cholecystectomy
Authors: Warren David K. , Nickel Katelin B. , Wallace Anna E. , Mines Daniel , Tian Fang , Symons William J. , Fraser Victoria J. , Olsen Margaret A. 
Published: February 2017

AbstractBackgroundThere are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.MethodsA retrospective cohort of commercially insured persons aged 18–64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI.ResultsSurgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P &lt; .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27–1.96), open approach with (HR, 4.29; 95% CI, 2.45–7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96–8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74–8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87–13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection.ConclusionsAcute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.
Sensitive Molecular Diagnostics for Cutaneous Leishmaniasis
Authors: Sagi Orli , Berkowitz Anat , Codish Shlomi , Novack Victor , Rashti Aviv , Akad Fouad , Shemer-Avni Yonat 
Published: February 2017

Abstract

Background
Rapid diagnosis of cutaneous leishmaniasis (CL) and identification of Leishmania species is highly important for the disease management. In Israel, CL is caused mainly by Leishmania major and Leishmania tropica species.

Methods
We established an easy to handle point of care lesion-swabbing, combined with a highly sensitive multiplex real time PCR (multiplex qPCR) for accurate and rapid diagnosis of Leishmania species.

Results
Using three probes: one general for: Leishmania species, and two specific for L major, and L tropica, we screened 1783 clinical samples collected during two years. Leishmania species was found in 1086 individuals, 1008 L major, and 70 L tropica. Eight samples positive for Leishmania species only, were further tested using a second set of multiplex qPCR developed, and were found positive for Leishmania braziliensis and Leishmania infantum/donovani (2 and 6 samples, concomitantly).

Conclusions
Taken together, the test enabled diagnostics and better treatment of Leishmania infections from the Old World (1078 samples) and the New World (8 samples), and the subtyping of the dominant strains in the region, as well as in returning travelers’.
Infection Rates and Treatment of Low-Velocity Extremity Gunshot Injuries
Authors: Nguyen Mai P. , Savakus Jonathan C. , O'Donnell Jeffrey A. , Prayson Nicholas F. , Reich Michael S. , Golob Joseph F. , McDonald Amy A. , Como John J. , Vallier Heather A. 
Published: February 2017

Objectives:
To determine the rates of infection in low-energy gunshot wounds (GSWs) to the extremity.

Design:
Retrospective review.

Setting:
Level I trauma center.

Patients/Participants:
Patients (N = 140) with at least 90-day follow-up for extremity-only low-energy GSW injuries from 2010–2014 were retrospectively reviewed. Treatment was recorded, including type and duration of antibiotics and details of nonoperative and operative managements.

Main Outcome Measures:
The rates of superficial and deep infections.

Results:
The overall infection rate was 15.7% (22 patients), and the deep infection rate was 3.6% (5 patients). Age, sex, and injury location were similar between the groups that did and did not receive antibiotic prophylaxis. Injury Severity Scores were higher in the group that did receive antibiotics. Regarding soft tissue-only injuries, antibiotic prophylaxis trended toward a lower rate of overall infection versus no antibiotic prophylaxis (6.1% vs. 25.9%, respectively, P = 0.07). Multiple doses of antibiotics did not reduce the rate of infection when compared with a single dose (14.6% vs. 12.5%, respectively, P = 1.00). No deep infections occurred in patients with nonoperatively treated fractures, regardless of antibiotic administration. All operatively treated fractures received antibiotic prophylaxis and demonstrated superficial and deep infection rates of 15.1% and 5.7%, respectively.

Conclusions:
Infections after low-energy extremity GSWs are infrequent. For soft tissue injuries without fracture, a single dose of intravenous antibiotics in the emergency department was associated with a lower rate of infection compared with no antibiotics. Operatively treated low-energy GSW fractures should receive standard perioperative antibiotics.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Anterior Intrapelvic Approach for Acetabular Fractures Using Approach-Specific Instruments and an Anatomical-Preshaped 3-Dimensional Suprapectineal Plate
Authors: Gras Florian , Marintschev Ivan , Grossterlinden Lars , Rossmann Markus , Graul Isabel , Hofmann Gunther O. , Rueger Johannes M. , Lehmann Wolfgang 
Published: February 2017

Objectives:
Anatomical acetabular plates the anterior intrapelvic approach (AIP) were recently introduced to fix acetabular fractures through the intrapelvic approach. Therefore, we asked the following: (1) Does the preshaped 3-dimensional suprapectineal plate interfere with or even impair the fracture reduction quality? (2) How often does the AIP approach need to be extended by the first (lateral) window of the ilioinguinal approach?

Design:
Observational case series.

Setting:
Two Level 1 trauma centers.

Patients/Participants:
Patients with unstable acetabular fractures in 2014.

Intervention:
Fracture fixation with anatomical-preshaped, 3-dimensional suprapectineal plates through the AIP approach ± the first window of the ilioinguinal approach.

Outcome Measurements:
Fracture reduction results were measured in computed tomography scans and graded according to the Matta quality of reduction. Intraoperative parameters and perioperative complications were recorded. Radiological results (according to Matta) and functional outcome (modified Merle d'Aubigné score) were evaluated at 1-year follow-up.

Results:
Thirty patients (9 women + 21 men; mean age ± SE: 64 ± 8 years) were included. The intrapelvic approach was solely used in 19 cases, and in 11 cases, an additional extension with the first window of the ilioinguinal approach (preferential for 2-column fractures) was performed. The mean operating time was 202 ± 59 minutes; the fluoroscopic time was 66 ± 48 seconds. Fracture gaps and steps in preoperative versus postoperative computed tomography scans were 12.4 ± 9.8 versus 2.0 ± 1.5 and 6.0 ± 5.5 versus 1.3 ± 1.7 mm, respectively. At 13.4 ± 2.9 months follow-up, the Matta grading was excellent in 50%, good in 25%, fair in 11%, and poor in 14% of cases. The modified Merle d'Aubigné score was excellent in 17%, good in 37%, fair in 33%, and poor in 13% of cases.

Conclusion:
The AIP approach using approach-specific instruments and an anatomical-preshaped, 3-dimensional suprapectineal plate became the standard procedure in our departments. Radiological and functional early results justify joint preserving surgery in most cases.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Under Pressure: The Utility of Spacers in Univalved Fiberglass Casts
Authors: Kleis Kevin , Schlechter John A. , Doan Joshua D. , Farnsworth Christine L. , Edmonds Eric W. 
Published: February 2017

Background:
Univalving fiberglass casts after fracture manipulation or extremity surgery reduces the risk of developing compartment syndrome (CS). Previous experiments have demonstrated that univalving decreases intracompartmental pressures (ICPs), but increases the risk for loss of fracture reduction due to altering the mechanical properties of the cast. The purpose of this study was to correlate cast valve width within a univalved cast model to decreasing ICP.

Methods:
Saline bags (1 L) were covered with stockinette, Webril, and fiberglass tape then connected to an arterial pressure line monitor. Resting pressure was recorded. A water column was added to simulate 2 groups (n=5 each) of clinical CS: low pressure CS (LPCS range, 28 to 31 mm Hg) and high pressure CS (HPCS, range, 64 to 68 mm Hg). After the designated pressure was reached, the fiberglass was cut (stockinette and Webril remained intact). Cast spacers were inserted into each univalve and secured with varying widths: position #1 (3 mm wide), #2 (6 mm), #3 (9 mm), and #4 (12 mm). Pressure was recorded after cutting the fiberglass and following each spacer placement.

Results:
In LPCS and HPCS groups, after univalve and placement of spacer position #1, pressure dropped by a mean of 52% and 58%, respectively. Spacer #2, decreased the pressure by a mean of 78% and 80%, respectively. Both spacer sizes significantly decreased the underlying pressure in both groups. Spacer #3 and #4 progressively reduced pressure within the cast, but not statistically significantly more than the previous spacer widths.

Conclusions:
This experimental model replicates the iatrogenic elevation in interstitial compartment pressure due to rigid cast application, not necessarily a self-sustained true CS. Increasing the univalved cast spread by ≥9 mm of the initial cast diameter will reduce pressure to a pre-CS level; however, a spread of only 6 mm can effectively reduce the pressure to <30 mm Hg depending on the initial elevated ICP. Cutting the Webril and stockinette in our model yielded a pressure decrease of 91% and 94% from the starting experimental pressure in the LPCS and the HPCS groups, respectively.

Clinical Relevance:
Although the utility of splitting fiberglass casts has been previously demonstrated, we present evidence highlighting the benefit of spacing the split by at least 6 to 9 mm.
Gross Motor Skills in Children With Idiopathic Clubfoot and the Association Between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion
Authors: Lööf Elin , Andriesse Hanneke , André Marie , Böhm Stephanie , Iversen Maura D. , Broström Eva W. 
Published: February 2017

Background:
Little is known regarding gross motor skills (GMS) in children with idiopathic clubfoot (IC). This study describes GMS, specifically foot involvement and asymmetries, and analyses the association between GMS, gait, and foot status in children with IC.

Methods:
Gross motor tasks and gait were analyzed in children with IC and typically developed (TD) children. GMS were assessed using videotapes and the Clubfoot Assessment Protocol (CAP). The Gait Deviation Index (GDI) and GDI-Kinetic were calculated from gait analyses. Children were divided into bilateral, unilateral clubfoot, or TD groups. To analyze asymmetries, feet within each group were further classified into superior or inferior foot, depending on their CAP scores. Correlations identified associations between CAP and GDI, GDI-Kinetic, passive foot motion, and Dimeglio Classification Scores at birth in the clubfeet.

Results:
In total, 75 children (mean age, 5 years) were enrolled (bilateral n=22, unilateral clubfoot n=25, TD=28). Children with clubfeet demonstrated significantly lower GMS, gait, and foot motion compared with TD children. One leg standing and hopping deviated in 84% and 91%, respectively, in at least one foot in children with clubfoot. Gross motor asymmetries were evident in both children with bilateral and unilateral involvement. In children with unilateral clubfoot, contralateral feet showed few deviations in GMS compared with TD; however, differences existed in gait and foot motion. The association between GMS and gait, foot motion, and initial foot status varied between poor and moderate.

Conclusions:
Gross motor deficits and asymmetries are present in children with both bilateral and unilateral IC. Development of GMS of the contralateral foot mirrors that of TD children, but modifies to the clubfoot in gait and foot motion. The weak association with gait, foot motion, and initial clubfoot severity indicates that gross motor measurements represent a different outcome entity in clubfoot treatment. We therefore, recommend gross motor task evaluation for children with IC.

Level of Evidence:
Level II—prognostic studies.
Paraspinal Muscle Passive Stiffness Remodels in Direct Response to Spine Stiffness
Authors: Gsell Kelsey Y. , Zwambag Derek P. , Fournier Dale E. , Séguin Cheryle A. , Brown Stephen H.M. 
Published: February 2017

Study Design.
Basic science study of the relationship between the structural properties of the spine and its surrounding musculature.

Objective.
To determine whether an increase in spine stiffness causes an inverse compensatory change in the passive stiffness of the adjacent paraspinal muscles.

Summary of Background Data.
Intervertebral disc degeneration causes an increase in multifidus passive stiffness; this was hypothesized to compensate for a decrease in spine stiffness associated with disc degeneration. Mice lacking equilibrative nucleoside transporter 1 (ENT1) develop progressive ectopic calcification of the fibrous connective tissues of the spine, which affects the lumbar spine by 6 months of age and likely creates a mechanically stiffer spine.

Methods.
Experiments were conducted on four groups of mice (n = 8 mice/group): wild-type (WT) and ENT1 knockout (KO) at 2 or 8 months of age. Lumbar spines were removed and tested in cyclic axial compression to determine neutral zone length and stiffness. Single muscle fibers and bundles of fibers were isolated from lumbar multifidus and erector spinae, as well as tibialis anterior (a non–spine-related control) and tested to determine elastic modulus (passive stiffness).

Results.
At 2 months of age, neither spine nor muscle stiffness was different between KO and WT. At 8 months of age, compared with WT the lumbar spines of ENT1 KO mice had a stiffer and shorter neutral zone, and the paraspinal muscle fibers were less stiff; however, fiber bundles were not different. In addition, tibialis anterior was not different between KO and WT.

Conclusion.
This work has confirmed that calcification of spinal connective tissues in the ENT1 KO mouse results in a stiffened spine, whereas the concurrent decrease in muscle fiber elastic modulus in the adjacent paraspinal muscles suggests a direct compensatory relationship between the stiffness of the spine and the muscles that are attached to it.

Level of Evidence: N/A
Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncologic Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial*
Authors: Bergamin Fabricio S. , Almeida Juliano P. , Landoni Giovanni , Galas Filomena R. B. G. , Fukushima Julia T. , Fominskiy Evgeny , Park Clarice H. L. , Osawa Eduardo A. , Diz Maria P. E. , Oliveira Gisele Q. , Franco Rafael A. , Nakamura Rosana E. , Almeida Elisangela M. , Abdala Edson , Freire Maristela P. , Filho Roberto K. , Auler Jose Otavio C. , Hajjar Ludhmila A. 
Published: February 2017

Objective:
To assess whether a restrictive strategy of RBC transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock.

Design:
Single center, randomized, double-blind controlled trial.

Setting:
Teaching hospital.

Patients:
Adult cancer patients with septic shock in the first 6 hours of ICU admission.

Interventions:
Patients were randomized to the liberal (hemoglobin threshold, < 9 g/dL) or to the restrictive strategy (hemoglobin threshold, < 7 g/dL) of RBC transfusion during ICU stay.

Measurements and Main Results:
Patients were randomized to the liberal (n = 149) or to the restrictive transfusion strategy (n = 151) group. Patients in the liberal group received more RBC units than patients in the restrictive group (1 [0–3] vs 0 [0–2] unit; p < 0.001). At 28 days after randomization, mortality rate in the liberal group (primary endpoint of the study) was 45% (67 patients) versus 56% (84 patients) in the restrictive group (hazard ratio, 0.74; 95% CI, 0.53–1.04; p = 0.08) with no differences in ICU and hospital length of stay. At 90 days after randomization, mortality rate in the liberal group was lower (59% vs 70%) than in the restrictive group (hazard ratio, 0.72; 95% CI, 0.53–0.97; p = 0.03).

Conclusions:
We observed a survival trend favoring a liberal transfusion strategy in patients with septic shock when compared with the restrictive strategy. These results went in the opposite direction of the a priori hypothesis and of other trials in the field and need to be confirmed.
Randomized Clinical Trial of a Combination of an Inhaled Corticosteroid and Beta Agonist in Patients at Risk of Developing the Acute Respiratory Distress Syndrome*
Authors: Festic Emir , Carr Gordon E. , Cartin-Ceba Rodrigo , Hinds Richard F. , Banner-Goodspeed Valerie , Bansal Vikas , Asuni Adijat T. , Talmor Daniel , Rajagopalan Govindarajan , Frank Ryan D. , Gajic Ognjen , Matthay Michael A. , Levitt Joseph E. 
Published: February 2017

Objectives:
Effective pharmacologic treatments directly targeting lung injury in patients with the acute respiratory distress syndrome are lacking. Early treatment with inhaled corticosteroids and beta agonists may reduce progression to acute respiratory distress syndrome by reducing lung inflammation and enhancing alveolar fluid clearance.

Design:
Double-blind, randomized clinical trial (ClinicalTrials.gov: NCT01783821). The primary outcome was longitudinal change in oxygen saturation divided by the Fio
2 (S/F) through day 5. We also analyzed categorical change in S/F by greater than 20%. Other outcomes included need for mechanical ventilation and development of acute respiratory distress syndrome.

Setting:
Five academic centers in the United States.

Patients:
Adult patients admitted through the emergency department at risk for acute respiratory distress syndrome.

Interventions:
Aerosolized budesonide/formoterol versus placebo bid for up to 5 days.

Measurements and Main Results:
Sixty-one patients were enrolled from September 3, 2013, to June 9, 2015. Median time from presentation to first study drug was less than 9 hours. More patients in the control group had shock at enrollment (14 vs 3 patients). The longitudinal increase in S/F was greater in the treatment group (p = 0.02) and independent of shock (p = 0.04). Categorical change in S/F improved (p = 0.01) but not after adjustment for shock (p = 0.15). More patients in the placebo group developed acute respiratory distress syndrome (7 vs 0) and required mechanical ventilation (53% vs 21%).

Conclusions:
Early treatment with inhaled budesonide/formoterol in patients at risk for acute respiratory distress syndrome is feasible and improved oxygenation as assessed by S/F. These results support further study to test the efficacy of inhaled corticosteroids and beta agonists for prevention of acute respiratory distress syndrome.