bluuebunny/crossref_metadata_2025_split huggingface dataset:
How much is enough? An investigation of the relationship between haemodialysis adequacy and quality of life of elderly patients
Authors: Zimbudzi Edward , Samlero Reggie , Kerr Peter G , Zoungas Sophia 
Published: September 2015

AbstractAimThe average age of patients requiring haemodialysis is on the rise and has resulted in an increase in the number of elderly people receiving dialysis. While haemodialysis is one of the treatment options for this patient group, questions about its effectiveness have been raised. A second question centres on how much haemodialysis is actually needed to maintain quality of life (QoL). This study examined the relationship between dialysis adequacy and the QoL of elderly patients on haemodialysis.MethodA prospective cohort of 40 haemodialysis patients aged 75 years and above was recruited and studied over 3 months. Quality of life was assessed with the European Quality of Life‐5 Dimensions questionnaire and dialysis adequacy with the urea reduction ratio (URR), and the relationship between the two examined using a simple linear regression model.ResultsThe average age of the participants was 79.8 ± (3.9 years; 45% were women, and diabetes was the main cause of kidney disease (42.5%). The mean URR, visual analogue scale, European Quality of Life‐5 Dimensions indices score and Charlson comorbidity index scores were 78.1 ± (5.5)%, 65.4 ± (13.7)%, 0.7 ± (0.27) and 6.3 ± (2.15), respectively. There was no clear relationship between dialysis adequacy and QoL, r = 0.093. Dialysis adequacy did not significantly predict QoL (P = 0.09).ConclusionThere was no evidence for an association between haemodialysis adequacy and QoL in elderly patients receiving haemodialysis across a URR range of 64.0% to 88.9%. Attempts to improve dialysis adequacy beyond these levels may not be necessary for maintaining the QoL of elderly patients on dialysis.Key messageModern therapy should embrace the concept of quality of life and focus more on symptom relief and optimization of self‐management skills to improve the well‐being of the elderly patients with ESKD.
Pulmonary hypertension is an independent predictor of cardiovascular events and mortality in haemodialysis patients
Authors: Reque Javier , Quiroga Borja , Ruiz Caridad , Villaverde Maria Teresa , Vega Almudena , Abad Soraya , Panizo Nayara , López‐Gómez J. Manuel 
Published: September 2015

AbstractAimThe evidence about prevalence, associated factors of pulmonary hypertension (PH) and its impact on patient's outcomes is limited.MethodsWe included 211 haemodialysis patients, we estimated the systolic pulmonary artery pressure (SPAP) by 2D Doppler echocardiography defining PH as a SPAP above 35 mmHg, the median follow‐up was 39 (19–56) moths, and the primary endpoints were all cause mortality and cardiovascular events.ResultsWe found PH in 91 patients (43.9%). Independent determinants of PH were age, previous cardiovascular disease, the Nt‐pro‐BNP level hs‐TnT, the systolic dysfunction, diastolic dysfunction and left ventricular hypertrophy. Over the follow‐up 94 cardiovascular events occurred, variables associated were: PH, age, history cardiovascular disease, dyslipidaemia, elevated concentration of Nt‐pro‐BNP and hs‐TnT, systolic and diastolic dysfunction, in a multivariate model, the PH maintained its independent association. Mortality data: 88 patients died (41.7%); 35 (29.5%) in the no PH group and 53 (58.5%) in the PH group (P < 0.001). In the Cox survival analysis, we found an association between mortality and age, previous cardiovascular disease, history of peripheral vascular disease, Nt‐pro‐BNP levels. In a multivariate model the PH remains as independent predictor of mortality.ConclusionsPulmonary hypertension is a common finding in HD patients and a valuable predictor of mortality and cardiovascular events. Prospective studies are needed to assess the effect of intervention on risk factors in improving patient's outcomes.
U‐shaped relationship between uric acid and residual renal function decline in continuous ambulatory peritoneal dialysis patients
Authors: Hsieh Yao‐Peng , Yang Yu , Chang Chia‐Chu , Kor Chew‐Teng , Wen Yao‐Ko , Chiu Ping‐Fang , Lin Chi‐Chen 
Published: September 2015

AbstractAimThere is little information on the relationship between uric acid (UA) and residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD). The aim of this research is to study the influence of UA on RRF decline in CAPD patients.MethodsA retrospective observational cohort study of 304 patients who started CAPD without anuria between 2001 and 2010 was conducted at a single medical center. The outcomes measured in the study included the rate of RRF decline and anuria. A multiple ordinal logistic regression model with backward elimination was conducted to determine the independent factors of the slope of RRF decline. A Cox proportional hazard model was conducted to determine the independent variables of time to anuria.ResultsThe average rate of RRF decline was −0.12 ± 0.22 mL/min per month. Multivariate analysis showed that lower UA group (<0.372 mmol/L), higher UA group (≧0.421 mmol/L), male gender, diabetes mellitus (DM), the use of calcium channel blocker (CCB), and RRF at baseline were linked positively with the rate of RRF decline; on the other hand, independence in dialysate exchanges and BUN were negatively associated with the risk of RRF decline. In addition, male gender, DM, diuretics, and CCB were associated with a higher risk of progression to anuria, whereas 24‐h urine amount at baseline conferred a protective role in the development of anuria.ConclusionsA U‐shaped relationship was found between UA levels and the rate of RRF decline in patients on CAPD, with a faster decline rate in those of higher and lower UA groups.
A pilot and feasibility study of the plasma and tissue pharmacokinetics of cefazolin in an immature porcine model of pediatric cardiac surgery
Authors: Kilbaugh Todd J. , Himebauch Adam S. , Zaoutis Theoklis , Jobes David , Greeley William J. , Nicolson Susan C. , Zuppa Athena F. 
Published: September 2015

SummaryBackgroundSurgical site infection (SSI) prevention for children with congenital heart disease is imperative and methods to assess and evaluate the tissue concentrations of prophylactic antibiotics are important to help maximize these efforts.AimThe purposes of this study were to determine the plasma and tissue concentrations with standard of care, perioperative cefazolin dosing in an immature porcine model of pediatric cardiac surgery, and to determine the feasibility of this model.MethodsPiglets (3–5 days old) underwent either median sternotomy (MS) or cardiopulmonary bypass with deep hypothermic circulatory arrest (CPB + DHCA) and received standard of care prophylactic cefazolin for the procedures. Serial plasma and microdialysis sampling of the skeletal muscle and subcutaneous tissue adjacent to the surgical site was performed. Cefazolin concentrations were measured, noncompartmental pharmacokinetic analyses were performed, and tissue penetration of cefazolin was assessed.ResultsFollowing the first intravenous dose, maximal cefazolin concentrations in the subcutaneous tissue and skeletal muscle were similar between groups with peak tissue concentrations 15–30 min after administration. After the second cefazolin dose given with the initiation of CPB, total plasma cefazolin concentrations remained relatively constant until the end of DHCA and then decreased while muscle‐ and subcutaneous‐unbound cefazolin concentrations showed a second peak during or after rewarming. For the MS group, 60–67% of the intraoperative time showed subcutaneous and skeletal muscle concentrations of cefazolin >16 μg·ml−1 while this percentage was 78–79% for the CPB + DHCA group. There was less tissue penetration of cefazolin in the group that underwent CBP + DHCA (P = 0.03).ConclusionsThe cefazolin dosing used in this study achieves plasma and tissue concentrations that should be effective against methicillin‐sensitive Staphylococcus aureus but may not be effective against some gram‐negative pathogens. The timing of the cefazolin administration prior to incision and a second dose given during cardiopulmonary bypass may be important factors for achieving goal tissue concentrations.
Calibration of EBT2 film using a red‐channel PDD method in combination with a modified three‐channel technique
Authors: Chang Liyun , Ho Sheng‐Yow , Lee Tsair‐Fwu , Yeh Shyh‐An , Ding Hueisch‐Jy , Chen Pang‐Yu 
Published: September 2015

Purpose:Ashland Inc. EBT2 and EBT3 films are widely used in quality assurance for radiation therapy; however, there remains a relatively high degree of uncertainty [B. Hartmann, M. Martisikova, and O. Jakel, “Homogeneity of Gafchromic EBT2 film,” Med. Phys. 37, 1753–1756 (2010)]. Micke et al. (2011) recently improved the spatial homogeneity using all color channels of a flatbed scanner; however, van Hoof et al. (2012) pointed out that the corrected nonuniformity still requires further investigation for larger fields. To reduce the calibration errors and the uncertainty, the authors propose a new red‐channel percentage‐depth‐dose method in combination with a modified three‐channel technique.Methods:For the ease of comparison, the EBT2 film image used in the authors’ previous study (2012) was reanalyzed using different approaches. Photon beams of 6‐MV were delivered to two different films at two different beam on times, resulting in the absorption doses of ranging from approximately 30 to 300 cGy at the vertical midline of the film, which was set to be coincident with the central axis of the beam. The film was tightly sandwiched in a 303‐cm3 polystyrene phantom, and the pixel values for red, green, and blue channels were extracted from 234 points on the central axis of the beam and compared with the corresponding depth doses. The film was first calibrated using the multichannel method proposed by Micke et al. (2010), accounting for nonuniformities in the scanner. After eliminating the scanner and dose‐independent nonuniformities, the film was recalibrated via the dose‐dependent optical density of the red channel and fitted to a power function. This calibration was verified via comparisons of the dose profiles extracted from the films, where three were exposed to a 60° physical wedge field and three were exposed to composite fields, and all of which were measured in a water phantom. A correction for optical attenuation was implemented, and treatment plans of intensity modulated radiation therapy and volumetric modulated arc therapy were evaluated.Results:The method described here demonstrated improved accuracy with reduced uncertainty. The relative error compared with the measurements of a water phantom was less than 1%, and the overall calibration uncertainty was less than 2%. Verification tests revealed that the results were close to those of the authors’ previous study, and all differences were within 3%, except those with a high‐dose gradient. The gamma pass rates (2%/2 mm) of the treatment plan evaluated using the method described here were greater than 99%, and no obvious stripe patterns were observed in the dose‐difference maps.Conclusions:Spatial homogeneity was significantly improved via the calibration method described here. This technique is both convenient and time‐efficient because it does not require cutting the film, and only two exposures are necessary.
Clinical Appraisal of Fosfomycin in the Era of Antimicrobial Resistance
Authors: Sastry Sangeeta , Clarke Lloyd G. , Alrowais Hind , Querry Ashley M. , Shutt Kathleen A. , Doi Yohei 
Published: September 2015

ABSTRACT

Fosfomycin is recommended as one of the first-line agents for treatment of urinary tract infections (UTIs) in the latest guidelines endorsed by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID). We evaluated the use of fosfomycin among inpatients at a tertiary care hospital between 2009 and 2013. UTI cases were defined using physician diagnosis and the National Healthcare Safety Network (NHSN) surveillance definitions. The number of patients treated with fosfomycin increased from none in 2009 to 391 in 2013. Among 537 patients who received fosfomycin for any indication during this period, UTI was the most common indication (74%), followed by asymptomatic bacteriuria (10%). All except 19 patients received a single dose of fosfomycin.
Escherichia coli
was the most common organism involved (52%). For 119 patients with UTIs, after exclusion of those with negative urine culture results, negative urinalysis results, receipt of additional agents, or indeterminate clinical outcomes, the clinical success rate at 48 h was 74.8%. Of 89 patients who met the criteria for NHSN-defined UTIs, 89.9% had successful outcomes. Recurrent infections occurred in 4.3% of cases, and mild adverse events were observed in 2.0%. All 100 randomly selected extended-spectrum β-lactamase (ESBL)-producing
E. coli
clinical isolates from this period were susceptible to fosfomycin. In conclusion, the use of fosfomycin has increased substantially since implementation of the updated guidelines at this hospital. Fosfomycin was used mainly for the treatment of physician-diagnosed UTIs, and the clinical outcomes were generally favorable. Fosfomycin maintained activity against
E. coli
despite the increased use of the agent.
Deletion of
liaR
Reverses Daptomycin Resistance in Enterococcus faecium Independent of the Genetic Background
Authors: Panesso Diana , Reyes Jinnethe , Gaston Elizabeth P. , Deal Morgan , Londoño Alejandra , Nigo Masayuki , Munita Jose M. , Miller William R. , Shamoo Yousif , Tran Truc T. , Arias Cesar A. 
Published: September 2015

ABSTRACT

We have shown previously that changes in LiaFSR, a three-component regulatory system predicted to orchestrate the cell membrane stress response, are important mediators of daptomycin (DAP) resistance in enterococci. Indeed, deletion of the gene encoding the response regulator LiaR in a clinical strain of
Enterococcus faecalis
reversed DAP resistance (DAP-R) and produced a strain hypersusceptible to antimicrobial peptides. Since LiaFSR is conserved in
Enterococcus faecium
, we investigated the role of LiaR in a variety of clinical
E. faecium
strains representing the most common DAP-R genetic backgrounds. Deletion of
liaR
in DAP-R
E. faecium
R446F (DAP MIC of 16 μg/ml) and R497F (MIC of 24 μg/ml; harboring changes in LiaRS) strains fully reversed resistance (DAP MICs decreasing to 0.25 and 0.094 μg/ml, respectively). Moreover, DAP at concentrations of 13 μg/ml (achieved with human doses of 12 mg/kg body weight) retained bactericidal activity against the mutants. Furthermore, the
liaR
deletion derivatives of these two DAP-R strains exhibited increased binding of boron-dipyrromethene difluoride (BODIPY)-daptomycin, suggesting that high-level DAP-R mediated by LiaR in
E. faecium
involves repulsion of the calcium-DAP complex from the cell surface. In DAP-tolerant strains HOU503F and HOU515F (DAP MICs within the susceptible range but bacteria not killed by DAP concentrations of 5× the MIC), deletion of
liaR
not only markedly decreased the DAP MICs (0.064 and 0.047 μg/ml, respectively) but also restored the bactericidal activity of DAP at concentrations as low as 4 μg/ml (achieved with human doses of 4 mg/kg). Our results suggest that LiaR plays a relevant role in the enterococcal cell membrane adaptive response to antimicrobial peptides independent of the genetic background and emerges as an attractive target to restore the activity of DAP against multidrug-resistant strains.
In Vitro
Susceptibility Profiles of Eight Antifungal Drugs against Clinical and Environmental Strains of Phaeoacremonium
Authors: Badali Hamid , Khodavaisy Sadegh , Fakhim Hamed , de Hoog G. Sybren , Meis Jacques F. , Chowdhary Anuradha 
Published: September 2015

ABSTRACT

In vitro
susceptibilities of a worldwide collection of molecularly identified
Phaeoacremonium
strains (
n
= 43) belonging to seven species and originating from human and environmental sources were determined for eight antifungal drugs. Voriconazole had the lowest geometric mean MIC (0.35 μg/ml), followed by posaconazole (0.37 μg/ml), amphotericin B (0.4 μg/ml), and isavuconazole (1.16 μg/ml). Caspofungin, anidulafungin, fluconazole, and itraconazole had no activity.
Outcomes of Aminopenicillin Therapy for Vancomycin-Resistant Enterococcal Urinary Tract Infections
Authors: Cole Kelli A. , Kenney Rachel M. , Perri Mary Beth , Dumkow Lisa E. , Samuel Linoj P. , Zervos Marcus J. , Davis Susan L. 
Published: September 2015

ABSTRACT

Vancomycin-resistant urinary tract infections are often challenging to treat. This retrospective cohort study compared outcomes between patients treated for vancomycin-resistant enterococcal urinary tract infection with an aminopenicillin and those treated with a non-β-lactam antibiotic. Inpatients treated with an enterococcus-active agent for their first symptomatic vancomycin-resistant enterococcal urinary tract infection between 1 January 2012 and 31 December 2013 were considered for inclusion. Patients with colonization, on hospice, or receiving comfort care only were excluded. The primary endpoint of clinical cure was defined as resolution of clinical symptoms, or symptom improvement to the extent that no additional antibacterial drug therapy was necessary, and lack of microbiologic persistence. Secondary endpoints of 30-day readmission or retreatment and 30-day all-cause mortality were also compared. A total of 316 urinary isolates were screened, and 61 patients with symptomatic urinary tract infection were included. Twenty (35%) of the 57 isolates tested were ampicillin susceptible. Thirty-one patients received an aminopenicillin, and 30 received a non-β-lactam. Rates of clinical cure for aminopenicillin versus non-β-lactam treatment were 26/31 (83.9%) and 22/30 (73.3%) (
P
= 0.315), respectively. Rates of 30-day readmission (6/31, or 19.4%, versus 9/30, or 30%, respectively;
P
= 0.334), 30-day retreatment (4/31, or 12.9%, versus 4/30, 13.3%, respectively;
P
= 0.960), and 30-day all-cause mortality (2/31, or 6.5%, versus 1/30, or 3.3%, respectively;
P
= 0.573) were also not significantly different between groups. Aminopenicillins may be a viable option for treating vancomycin-resistant urinary tract infection regardless of the organism's ampicillin susceptibility. Prospective validation with larger cohorts of patients should be considered.
Activation of Antibiotic Production in Bacillus spp. by Cumulative Drug Resistance Mutations
Authors: Tojo Shigeo , Tanaka Yukinori , Ochi Kozo 
Published: September 2015

ABSTRACT

Bacillus subtilis
strains produce a wide range of antibiotics, including ribosomal and nonribosomal peptide antibiotics, as well as bacilysocin and neotrehalosadiamine. Mutations in
B. subtilis
strain 168 that conferred resistance to drugs such as streptomycin and rifampin resulted in overproduction of the dipeptide antibiotic bacilysin. Cumulative drug resistance mutations, such as mutations in the
mthA
and
rpsL
genes, which confer low- and high-level resistance, respectively, to streptomycin, and mutations in
rpoB
, which confer resistance to rifampin, resulted in cells that overproduced bacilysin. Transcriptional analysis demonstrated that the enhanced transcription of biosynthesis genes was responsible for the overproduction of bacilysin. This approach was effective also in activating the cryptic genes of
Bacillus amyloliquefaciens
, leading to actual production of antibiotic(s).
Biochemical Characterization of VIM-39, a VIM-1-Like Metallo-β-Lactamase Variant from a Multidrug-Resistant Klebsiella pneumoniae Isolate from Greece
Authors: Papagiannitsis Costas C. , Pollini Simona , De Luca Filomena , Rossolini Gian Maria , Docquier Jean-Denis , Hrabák Jaroslav 
Published: September 2015

ABSTRACT

VIM-39, a VIM-1-like metallo-β-lactamase variant (VIM-1 Thr33Ala His224Leu) was identified in a clinical isolate of
Klebsiella pneumoniae
belonging to sequence type 147. VIM-39 hydrolyzed ampicillin, cephalothin, and imipenem more efficiently than did VIM-1 and VIM-26 (a VIM-1 variant with the His224Leu substitution) because of higher turnover rates.
(A)Historical Science
Authors: Casadevall Arturo , Fang Ferric C. 
Published: September 2015

ABSTRACTIn contrast to many other human endeavors, science pays little attention to its history. Fundamental scientific discoveries are often considered to be timeless and independent of how they were made. Science and the history of science are regarded as independent academic disciplines. Although most scientists are aware of great discoveries in their fields and their association with the names of individual scientists, few know the detailed stories behind the discoveries. Indeed, the history of scientific discovery is sometimes recorded only in informal accounts that may be inaccurate or biased for self-serving reasons. Scientific papers are generally written in a formulaic style that bears no relationship to the actual process of discovery. Here we examine why scientists should care more about the history of science. A better understanding of history can illuminate social influences on the scientific process, allow scientists to learn from previous errors, and provide a greater appreciation for the importance of serendipity in scientific discovery. Moreover, history can help to assign credit where it is due and call attention to evolving ethical standards in science. History can make science better.
How do general practitioners manage patients with cancer symptoms? A video-vignette study
Authors: Jiwa Moyez , Meng Xingqiong , O'Shea Carolyn , Magin Parker , Dadich Ann , Pillai Vinita 
Published: September 2015

ObjectivesDetermine how general practitioners (GPs) manage patients with cancer symptoms.DesignGPs reviewed 24 video-vignettes and case notes on patients with cancer symptoms and indicated whether they would refer the patient and/or prescribe medication, and/or undertake further investigation. According to available guidelines, all cases warranted a referral to a specialist or further investigations.SettingAustralian primary care sector.Participants102 practising GPs participated in this study, including trainees.InterventionsThe research was part of a larger randomised controlled trial testing a referral pro forma; however, this paper reports on management decisions made throughout the study.Primary and secondary outcome measuresThis paper reports on how the participants would manage the patients depicted in each vignette.ResultsIn more than one-in-eight cases, the patient was not investigated or referred. Patient management varied significantly by cancer type (p<0.001). For two key reasons, colorectal cancer was the chosen referent category. First, it represents a prevalent type of cancer. Second, in this study, colorectal cancer symptoms were managed in a similar proportion of options—that is, prescription, referral or investigation. Compared with vignettes featuring colorectal cancer participants were less likely to manage breast, bladder, endometrial, and lung cancers with a ‘prescription only’ or ‘referral only’ option. They were less likely to manage prostate cancer with a ‘prescription only’, yet more likely to manage it with a ‘referral with investigation’. With regard to pancreatic and cervical cancers, participants were more likely to manage these with a ‘referral only’ or a ‘referral with investigation’.ConclusionsSome patients may receive a delayed cancer diagnosis, even when they present with typical cancer symptoms to a GP who can access relevant diagnostic tests.Trial registration numberACTRN12611000760976.