bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Anidulafungin for Fungal Infection in Patients With Liver Dysfunction or Multiorgan Failure
Authors: Verma Anita , Auzinger Georg , Kantecki Michal , Campling James , Spurden Dean , Percival Fran , Heaton Nigel 
Published: November 2016

Abstract

Background
The objective of this study was to review our clinical experience on the safety and efficacy of anidulafungin, an echinocandin antifungal, in the treatment of invasive fungal infections (IFIs) in patients with moderate to severe abnormal liver function tests or multiorgan failure and IFI, in a large United Kingdom Liver Centre.

Methods
The clinical records of the first 50 consecutive patients treated for IFI with anidulafungin between January 7, 2009 and March 2, 2011 were analyzed. Data were collected on demographics, underlying disease, disease characteristics, hematological and biochemical parameters, IFI, concomitant bacterial and viral infections, response to anidulafungin, and anidulafungin-related adverse events.

Results
The patients’ median age was 54.3 years (range, 19.6–75.9); 60% were male. Twenty-two (44%) patients were liver transplant recipients. Others had hepatopancreaticobiliary disease (n = 15, 30%) or chronic liver disease (n = 11, 22%). Invasive fungal infection (predominantly Candida spp) was proven in 36 (72%) patients, probable in 14 (28%). Of 46 evaluable patients, 35 (76%) had a favorable anidulafungin treatment outcome. Forty-nine (98%) had abnormal liver function tests (LFTs) pretreatment; 31 (62%) had ≥1 LFT raised to ≥2× baseline during anidulafungin treatment.

Conclusions
In this highly specialized group of patients, anidulafungin treatment was efficacious and well tolerated by those with decompensated liver disease, multiorgan failure, and high-risk liver transplant with proven or probable IFI.
Closed Reduction for Developmental Dysplasia of the Hip: Early-term Results From a Prospective, Multicenter Cohort
Authors: Sankar Wudbhav N. , Gornitzky Alex L. , Clarke Nicholas M.P. , Herrera-Soto José A. , Kelley Simon P. , Matheney Travis , Mulpuri Kishore , Schaeffer Emily K. , Upasani Vidyadhar V. , Williams Nicole , Price Charles T. 
Published: November 2016

Background:
Closed reduction (CR) is a common treatment for infantile developmental dysplasia of the hip. The purpose of this observational, prospective, multicenter study was to determine the early outcomes following CR.

Methods:
Prospectively collected data from an international multicenter study group was analyzed for patients treated from 2010 to 2014. Baseline demographics, clinical exam, radiographic/ultrasonographic data, and history of previous orthotic treatment were assessed. At minimum 1-year follow-up, failure was defined as an IHDI grade 3 or 4 hip and/or need for open reduction. The incidence of avascular necrosis (AVN), residual dysplasia, and need for further surgery was assessed.

Results:
A total of 78 patients undergoing CR for 87 hips were evaluated with a median age at initial reduction of 8 months (range, 1 to 20 mo). Of these, 8 hips (9%) were unable to be closed reduced initially. At most recent follow-up (median 22 mo; range, 12 to 36 mo), 72/79 initially successful CRs (91%) remained stable. The likelihood of failure was unaffected by initial clinical reducibility of the hip (P=0.434), age at initial CR (P=0.897), or previous treatment in brace (P=0.222). Excluding those hips that failed initial CR, 18/72 hips (25%) developed AVN, and the risk of osteonecrosis was unaffected by prereduction reducibility of the hip (P=0.586), age at CR (P=0.745), presence of an ossific nucleus (P=0.496), or previous treatment in brace (P=0.662). Mean acetabular index on most recent radiographs was 25 degrees (±6 degrees), and was also unaffected by any of the above variables. During the follow-up period, 8/72 successfully closed reduced hips (11%) underwent acetabular and/or femoral osteotomy for residual dysplasia.

Conclusions:
Following an initially successful CR, 9% of hips failed reduction and 25% developed radiographic AVN at early-term follow-up. History of femoral head reducibility, previous orthotic bracing, and age at CR did not correlate with success or chances of developing AVN. Further follow-up of this prospective, multicenter cohort will be necessary to establish definitive success and complication rates following CR for infantile developmental dysplasia of the hip.

Level of Evidence:
Level II—prospective observational cohort.
Usefulness of the Clavien–Dindo Classification in Understanding the Limitations and Indications of Larynx-preserving Esophageal Reconstruction
Authors: Umezawa Hiroki , Nakao Junichi , Matsutani Takeshi , Kuwahara Hiroaki , Taga Marie , Ogawa Rei 
Published: November 2016

Background:
The Clavien–Dindo (CD) classification is used to evaluate the severity of surgical complications. However, its usefulness in esophageal reconstruction has not been reported. To address this, this case series study used the CD classification to evaluate the complications after cervical esophageal reconstruction with free jejunum transfer or supercharged pedicled intestinal transfer.

Methods:
All consecutive patients who underwent esophageal cancer surgery with larynx-preserving free jejunum or pedicled ileocolic transfer in June 2012–December 2015 were identified. The postoperative complications were classified using the CD classification.

Results:
In total, 22 patients (20 men and 2 women; mean age, 63.3 years) underwent esophageal cancer reconstruction with larynx-preserving free jejunum transfer (n = 9) and supercharged pedicled intestinal transfer (n = 13). Seven patients underwent prophylactic tracheotomy. Four patients underwent emergent tracheotomy 1 or 5 days after surgery. The most frequent complication was recurrent nerve paralysis (RNP) (n = 8). Of these 8 RNP cases, 6 and 2 were classified as CD I and III complications, respectively. Pneumonia was the next most common complication (n = 7). Of these 7 pneumonia cases, 5 and 2 were classified as CD II and III, respectively. There were 2 cases of intestinal anastomosis leakage (CD II and III). On average, patients were able to start oral alimentation 15.1 (9–35) days after surgery.

Conclusions:
Our analysis with the CD classification suggested that vascularized free jejunum transfer or supercharge-drainage pedicled ileocolic transfer prevents postoperative intestinal anastomosis leakage and that prophylactic tracheotomy is especially indicated in cases with significant surgical damage in the cervical region.
A Novel Pretreatment Regimen for Breakthrough Radiocontrast Media Anaphylaxis in Cardiac Patients
Authors: Montandon Shari V. , Petrov Andrej A. , Fajt Merritt L. 
Published: November 2016

Background:
Radiocontrast media allergy is a severe and potentially life-threatening condition. This creates a clinical dilemma for cardiac patients who require urgent interventions with radiocontrast media. Several pretreatment regimens have been suggested for patients with prior immediate hypersensitivity reactions to radiocontrast media. Despite using pretreatment regimens, breakthrough reactions have been reported in 2.1%–18% of patients with radiocontrast media allergy. Little is known about management of patients with a history of breakthrough radiocontrast media anaphylaxis who require urgent lifesaving procedures.

Methods:
We report a retrospective analysis of 2 cardiac cases with a history of breakthrough radiocontrast media anaphylaxis despite standard pretreatment. These patients required urgent cardiac intervention with the use of radiocontrast media.

Results:
We present a novel pretreatment regimen for high-risk cardiac patients with breakthrough radiocontrast media anaphylaxis despite prior pretreatment who need urgent coronary interventions.

Conclusion:
This protocol is both safe and effective in mitigating anaphylaxis in cardiac patients.
Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit
Authors: Wang Hao , Watson Katherine , Robinson Richard D. , Domanski Kristina H. , Umejiego Johnbosco , Hamblin Layton , Overstreet Sterling E. , Akin Amanda M. , Hoang Steven , Shrivastav Meena , Collyer Michael , Krech Ryan N. , Schrader Chet D. , Zenarosa Nestor R. 
Published: November 2016

Objective:
To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography.

Methods:
A prospective observational single center study was conducted from January 2014 through June 2015. EDOU chest pain patients were included. HEART, GRACE, and TIMI scores were categorized as low (HEART ≤ 3, GRACE ≤ 108, and TIMI ≤1) versus elevated based on thresholds suggested in prior studies. Patients were followed for 6 months postdischarge. The results of emergent cardiac imaging tests, EDOU length of stay (LOS), and MACE occurrences were compared. Student t test was used to compare groups with continuous data, and χ2 testing was used for categorical data analysis.

Results:
Of 986 patients, emergent cardiac imaging tests were performed on 62%. A majority of patients were scored as low risk by all tools (85% by HEART, 81% by GRACE, and 80% by TIMI, P < 0.05). The low-risk patients had few abnormal cardiac imaging test results as compared with patients scored as intermediate to high risk (1% vs. 11% in HEART, 1% vs. 9% in TIMI, and 2% vs. 4% in GRACE, P < 0.05). The average LOS was 33 hours for patients with emergent cardiac imaging tests performed and 25 hours for patients without (P < 0.05). MACE occurrence rate demonstrated no significant difference regardless of whether tests were performed emergently (0.31% vs. 0.97% in HEART, 0.27% vs. 0.95% in TIMI, and 0% vs. 0.81% in GRACE, P > 0.05).

Conclusions:
Chest pain risk stratification via clinical decision tool scores can minimize the need for emergent cardiac imaging tests with less than 1% MACE occurrence, especially when the HEART score is used.
Novel Emergency Department Risk Score Discriminates Acute Coronary Syndrome Among Chest Pain Patients With Known Coronary Artery Disease
Authors: Crim Matthew T. , Berkowitz Scott A. , Saheed Mustapha , Miller Jason , Deutschendorf Amy , Gerstenblith Gary , Hill Peter , Korley Frederick K. 
Published: November 2016

Background:
Patients with known coronary artery disease presenting to the emergency department (ED) with chest pain are often admitted, yet may not be having an acute coronary syndrome (ACS).

Methods:
We assessed whether the use of a novel risk score and a modified thrombolysis in myocardial infarction risk score obtained in the ED could discriminate which of these high-risk patients have ACS. Chart review was performed on a cohort of 285 patients with known coronary artery disease presenting to the ED with chest pain thought to be of ischemic origin and admitted to the hospital. The ED variables were assessed with logistic regression for their association with eventual ACS diagnosis at hospital discharge. ACS was diagnosed in 74 (26%) of the patients.

Results:
Non-ACS patients had a 2-day median length of stay and $6875 median inpatient (post ED) hospital charges (not including physician fees), totaling 566 hospital bed days and $1,871,250 for the 211 (74%) non-ACS patients. A novel risk score, including (1) history of prior revascularization, (2) comorbid chronic kidney disease, (3) onset of chest discomfort at rest, (4) dynamic electrocardiogram changes in the ED, (5) elevated troponin I (>0.05 ng/mL) in the ED, and (6) associated illness at presentation, discriminated ACS and non-ACS with a c statistic of 0.767; the c statistic for a modified thrombolysis in myocardial infarction risk score was 0.712.

Conclusions:
Application of these risk scores may reduce the number of potentially avoidable admissions and their associated hazards and costs.
Association Between Hospital Practices and Door-in-door-out Time in ST-segment Elevation Myocardial Infarction
Authors: Mumma Bryn E. , Eggert James , Mahler Simon A. , Kontos Michael C. , Diercks Deborah B. 
Published: November 2016

Background:
Current guidelines suggest a “door-in-door-out” (DIDO) time of 30 minutes or shorter for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a STEMI referral hospital and are transferred to a STEMI-receiving center for primary percutaneous coronary intervention. Experts previously identified 18 system practices as critical for reducing DIDO times. The objective of this study was to describe how frequently these critical practices are used and to determine whether their use was associated with shorter DIDO times.

Methods:
We surveyed 18 STEMI referral hospitals for 4 STEMI-receiving centers regarding their use of these 18 practices. The median number used was 14 practices (interquartile range 12–15). We then evaluated their association with DIDO times in all patients (n = 93) transferred from these STEMI referral hospitals to the 4 STEMI-receiving centers for primary percutaneous coronary intervention.

Results:
In univariate linear regression analyses, system-wide quality improvement programs with leaders in the emergency medical services agencies and STEMI referral hospitals were associated with shorter DIDO times (P < 0.001 for all). Overall use of system practices was not associated with DIDO times (P = 0.143). The majority (76%, 95% confidence interval: 66%–85%) of DIDO times did not meet the 30-minute goal.

Conclusions:
These findings highlight the difficulty in achieving the 30-minute DIDO goal and the need for continued focus on strategies for reducing DIDO time, including system-wide quality improvement programs.
Optic Nerve Head Histopathology in High Axial Myopia
Authors: Jonas Jost B. , Ohno-Matsui Kyoko , Panda-Jonas Songhomitra 
Published: November 2016

Purpose:
To describe particularities of the optic nerve head of axially highly myopic eyes.

Methods:
Measurements were obtained from enucleated globes and from population-based studies.

Results:
Morphologic optic disc particularities in high axial myopia included enlarged disc size (secondary macrodisc), widening and temporal translocation of the papillary Bruch’s membrane (BM) opening, parapapillary gamma and delta zone, elongation and thinning of lamina cribrosa and peripapillary scleral flange, steeper translamina cribrosa pressure gradient, decreased peripapillary choroid thickness, longer distance between peripapillary arterial circle and optic disc, optic cup flattening, presumably a stretching of the lamina cribrosa pores, and peripapillary intrachoroidal cavitations. These changes may be explained by growth of new BM in the retroequatorial region in the process of emmetropization or myopization as “overshooting” of the emmetropization process.

Conclusions:
The intrapapillary and parapapillary changes in the highly myopic optic nerve head may be reason for the increased susceptibility for glaucomatous optic nerve damage in high axial myopia. The widening of the papillary BM opening and the potential shift of the optic nerve head’s 3 layer into temporal direction, both potentially leading to the development of parapapillary gamma zone may be of interest for elucidating the process of emmetropization/myopization.
Linkage to Primary Care and Survival After Hospital Discharge for HIV-Infected Adults in Tanzania: A Prospective Cohort Study
Authors: Peck Robert N. , Wang Richard J. , Mtui Graham , Smart Luke , Yango Missana , Elchaki Rim , Wajanga Bahati , Downs Jennifer A. , Mteta Kien , Fitzgerald Daniel W. 
Published: November 2016

Introduction:
Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, posthospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality.

Methods:
In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at 1, 3, 6, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital.

Results:
We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in hospital vs. 104/494 (21.1%) of the HIV-uninfected adults. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Posthospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected adults (adjusted P = 0.006). The 66/105 (62.9%) HIV-infected adults who attended clinic within 1 month after discharge had significantly lower mortality than the other HIV-infected adults [adjusted hazards ratio = 0.17 (0.07–0.39), P < 0.001]. Adults admitted to a nearby government hospital had similar high rates of posthospital mortality.

Conclusions:
Posthospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The posthospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing posthospital linkage to primary HIV care.
Single-Incision Laparoscopic Appendectomy by Surgical Trainees
Authors: Suh Sang Gyun , Sohn Hee Joo , Kim Beom Gyu , Park Joong-Min , Choi Yoo-Shin , Park Yong Keum , Lee Seung Eun 
Published: November 2016

Background:
Single-incision laparoscopic appendectomy (SILA) is one of the most commonly performed single port surgeries in the world. However, there are few publications documenting a young resident’s experience. The purpose of this study is to investigate clinical outcomes of SILA performed by a surgical trainee and to evaluate its feasibility and safety compared with conventional three-port laparoscopic appendectomy (TPLA) when performed by a surgical trainee and SILA by surgical staff.

Methods:
Between September 2014 and August 2015, clinical data were retrospectively collected for SILA and TPLA cases performed at Chung-Ang University Hospital. Three surgical residents who have assisted at least 50 cases of TPLA and 30 cases of SILA performed by gastrointestinal surgery specialists performed the surgeries. The indication of SILA by surgical trainees was noncomplicated appendicitis with no comorbidity.

Results:
In total, 47 patients underwent SILA by surgical residents, 98 patients underwent TPLA by surgical residents and 137 patients underwent SILA by surgical staff. In comparing SILA and TPLA performed by surgical residents, the mean age was younger (26 vs. 41 y, P<0.005) in the SILA group, the operative time (47.2 vs. 61.5 min, P<0.010) and hospital stay (2.3 vs. 2.7 d, P=0.003) were shorter in SILA group. In the SILA group, 2 cases of postoperative fluid collection (5.7%) occurred, necessitating antibiotic treatment. In TPLA group, 1 postoperative abscess occurred, requiring drainage. When comparing SILA performed by surgical residents and SILA performed by surgical staff, there were no significant differences in operation time, and postoperative complications.

Conclusion:
Surgical residents safely performed SILA with good postoperative outcomes after short learning curve.
Cause for pause before leaping to conclusions about stepping
Authors: Zylberberg Ariel , Shadlen Michael N. 
Published: November 2016

AbstractMany neurons in parietal and prefrontal association cortex undergo gradual changes in firing rate during the formation of some perceptual decisions. These dynamics are often ramp-like increases or decreases depending on the sign and strength of the sensory evidence and are thus hypothesized to represent the accumulation of noisy samples of evidence, analogous to biased diffusion. This idea was challenged recently. An analysis of sequences of action potentials recorded from neurons in the lateral intraparietal cortex (area LIP) suggests that the spikes on single trials are explained by rates that undergo a discrete step from an intermediate rate to either a low or high rate at a random time during deliberation. The average of such steps, like the average of biased diffusion, is consistent with the ramp-like firing rates observed in LIP, but a Bayesian model comparison deemed stepping superior. Here we show that a shortcoming in the mathematical depiction of drift-diffusion led to a severe bias in the model comparison. We conclude that at present there is no compelling evidence that favors the stepping account.
Self-destructive altruism in a synthetic developmental program enables complex feedstock utilization
Authors: Egbert Robert , Brettner Leandra , Zong David , Klavins Eric 
Published: November 2016

AbstractCooperation through division of labor underpins biological complexity for organisms and communities. In microbes, stochastic differentiation coupled to programmed cell death drives diverse altruistic behaviors that promote cooperation. Utilizing cell death for developmental multicellular programs requires control over differentiation rate to balance cell proliferation against the utility of sacrifice. However, these behaviors are often controlled by complex regulatory networks and have yet to be demonstrated from first principles. Here we engineered a synthetic developmental gene network that couples stochastic differentiation with programmed cell death to implement a two-member division of labor. Progenitor consumer cells were engineered to grow on cellobiose and differentiate at a controlled rate into self-destructive altruists that release an otherwise sequestered cellulase payload through autolysis. This circuit produces a developmentalEscherichia coliconsortium that utilizes cellulose for growth. We used an experimentally parameterized model of task switching, payload delivery and nutrient release to set key parameters to achieve overall population growth, liberating 14-23% of the available carbon. An inevitable consequence of engineering self-destructive altruism is the emergence of cheaters that undermine cooperation. We observed cheater phenotypes for consumers and altruists, identified mutational hotspots and developed a predictive model of circuit longeivity. This work introduces the altruistic developmental program as a tool for synthetic biology, demonstrates the utility of population dynamics models to engineer multicellular behaviors and provides a testbed for probing the evolutionary biology of self-destructive altruism.