bluuebunny/crossref_metadata_2025_split huggingface dataset:
Successful combination of local flaps for large palatal fistula closure
Authors: Perry J. , Bhopal S. , Bharadwaj G. , O'Regan B. 
Published: May 2015

AbstractThe closure of large palatal fistulae may challenge oral and maxillofacial surgeons especially when considering subsequent prosthetic requirements. Surgical procedures used to reconstruct palatal defects include prostheses, local flaps, distant flaps, bone grafting and allografts. We present a case of successful closure of a large post‐resection palatal fistula using a combination of three established techniques. Closure of the superior naso‐antral layer was completed using Fickling's inkwell technique. The resultant large defect was closed using a ‘tadpole’ rotational palatal flap combined with a buccal fat pad advancement to secure the unsupported lateral aspect of the rotation flap and remaining denuded bone of the left hard palate. The fistula remains closed four years after surgery. This report demonstrates the effective combination of three local intra‐oral flaps as a single‐stage, low‐risk method of closing a large palatal fistula.
Incidence and Predictors of Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement
Authors: MAAN ABHISHEK , REFAAT MARWAN M. , HEIST EDWIN KEVIN , PASSERI JONATHAN , INGLESSIS IGNACIO , PTASZEK LEON , VLAHAKES GUS , RUSKIN JEREMY N. , PALACIOS IGOR , SUNDT THORALF , MANSOUR MOUSSA 
Published: May 2015

BackgroundTranscatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for patients with symptomatic aortic stenosis who are at high risk for surgical aortic valve replacement. The development of conduction abnormalities is a major complication in the postprocedural period of TAVR.ObjectivesThe objective of this study was to investigate the development of postprocedural conduction abnormalities and the requirement of permanent pacemaker (PPM) implantation in patients undergoing TAVR.MethodsData from 137 consecutive patients who underwent TAVR (Edwards SAPIEN valve, Edwards Lifesciences, Irvine, CA, USA) between June 2008 and October 2012 were reviewed. Patients with prior history of PPM (n = 27) were excluded. The role of various predictors for pacemaker implantation after TAVR, including the valve index (calculated as [valve size/left ventricular outflow tract diameter] × 100) was investigated.ResultsA total of 31/110 (28.2%) patients required implantation of a PPM after TAVR. The median time to implantation of a PPM was 5 days after the procedure. The development of postprocedural complete heart block was the most common indication for implantation of a PPM (16/31; 51.6%). On multivariate analysis, the presence of preexisting right bundle branch block (RBBB) was found to be a strong predictor of PPM implantation after TAVR (adjusted odds ratio: 4.87; 95% confidence interval: 1.29–18.46, P = 0.020). Using the receiver operated curve analysis, a cut‐off value of valve index of 128 was found to be a strong predictor for PPM implantation with a sensitivity of 73% and specificity of 61% (c statistic = 0.68).ConclusionsThis study identified the presence of prior RBBB and a valve index of 128 as important risk factors for PPM implantation after TAVR. A larger implanted valve size relative to left ventricular outflow tract diameter leads to a greater compression of the intrinsic conduction system, increasing the need for pacemaker placement.
Impact of Implantable Cardioverter Defibrillators on Survival of Patients with Centrifugal Left Ventricular Assist Devices
Authors: LEE WILLIAM , TAY ANDRE , SUBBIAH RAJESH N. , WALKER BRUCE D. , KUCHAR DENNIS L. , MUTHIAH KAVITHA , MACDONALD PETER S. , KEOGH ANNE M. , KOTLYAR EUGENE , JABBOUR ANDREW , SPRATT PHILIP , JANSZ PAUL C. , GRANGER EMILY , DHITAL KUMUD , HAYWARD CHRISTOPHER S. 
Published: May 2015

BackgroundBoth implantable cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs) have a positive impact on survival in the heart failure population. We sought to determine whether these positive effects on survival are additive or whether LVAD therapy supersedes ICD therapy.MethodWe analyzed survival data of patients implanted with nonpulsatile LVADs between October 2004 and March 2013. Survival in patients with ICDs (n = 64) was compared to those without ICDs (n = 36). Patients exited the study at the time of heart transplantation or death.ResultsA total of 100 patients underwent LVAD implantation during this time. Patients had a mean follow‐up time of 364 ± 295 days. Death occurred in 15 (38%) patients in the no ICD group versus 18 (30%) in the ICD group. Univariate analysis demonstrated a marginal early survival benefit at up to 1 year post‐LVAD implant in the ICD cohort; however, at time points greater than 1 year there was no statistically significant benefit in ICD therapy in LVAD patients (P = 0.56). Multivariate analysis did not show any significant predictor of survival. There were no patients who died of sudden cardiac death. There was no significant difference in the time to heart transplantation (443 days ± 251 no ICD vs 372 days ± 277 ICD, P = 0.37).ConclusionThe benefit of ICD therapy in the setting of continuous flow LVAD therapy is uncertain. Although prolonged ventricular arrhythmias (VAs) may potentially impact on patient survival, LVAD therapy is beneficial in prevention of sudden cardiac death due to VAs.
Prognostic Value of a Very Prolonged Asystole during Head‐Up Tilt Test
Authors: CARVALHO MARIA SALOMÉ , REIS SANTOS KATYA , CARMO PEDRO , CAVACO DIOGO , PARREIRA LEONOR , MORGADO FRANCISCO , ADRAGÃO PEDRO 
Published: May 2015

BackgroundClinical significance and prognosis of a cardioinhibitory response to head‐up tilt (HUT) test with a very prolonged asystole (≥30 seconds) is poorly studied. Our aim was to evaluate the treatment (including pacemaker implantation) and prognosis (syncope recurrence, syncope‐related trauma, and overall mortality) of patients with a very prolonged asystole on a HUT test.Methods and ResultsA retrospective study was conducted in two centers between January 2003 and December 2013 and included a total of 2,263 consecutive HUT tests (sensitized with isosorbide dinitrate) performed in 2,247 patients with syncope of unknown etiology. Cardioinhibitory response with asystole was observed in 149 (6.6%) of these tests (44.3% women, mean age 37 ± 18 years old, 16.1% in the nonpharmacological phase), with a median duration of asystole of 10 (6–19) seconds. Very prolonged asystole (≥30 seconds) was documented in 11 (0.5%) patients (45% women; mean age 40 ± 19 years; only one in the nonpharmacological phase, 9 minutes after HUT). The longest pause lasted 63 seconds. In all patients, avoidance of triggering factors and physical counterpressure maneuvers were recommended. Telephone follow‐up was performed: in one patient, fludrocortisone was started; tilt training was conducted in one patient and none received a pacemaker. After a median follow‐up of 42 (30–76) months, four patients (36%) had syncopal recurrences, one patient had a syncope‐related injury (scalp laceration), and no patient died.
Anesthesia and organic aciduria: is the use of lactated Ringer's solution absolutely contraindicated?
Authors: Ruzkova Katerina , Weingarten Toby N. , Larson Kelly J. , Friedhoff Robert J. , Gavrilov Dimitar K. , Sprung Juraj 
Published: May 2015

SummaryBackgroundOrganic acidurias (OAs) are rare inborn errors of metabolism that can present with various neurologic manifestations, propensity for acute metabolic decompensation with anion‐gap metabolic acidosis, developmental delay, poor feeding, and failure to thrive.ObjectiveIn this case series, we outline the anesthetic management and perioperative outcomes of OA patients.MethodsWe reviewed demographic characteristics, comorbidities, and perioperative course of patients with four different OAs who underwent anesthetic care at our institution between January 1, 2000, and December 31, 2013.ResultsEleven patients with OA underwent 19 anesthetic procedures, of which 13 were <2 h in duration and seven were outpatient procedures. One patient with methylmalonic acidemia developed metabolic acidosis during a 10‐h procedure with substantial blood loss but lacked evidence that this acidosis could be attributed to his underlying metabolic disease. The patients who received hydration with lactated Ringer's solution and/or nitrous oxide anesthetic had a perioperative course free of metabolic complication. Two patients died within 30 days of surgery from causes likely to be unrelated to anesthetic exposure.ConclusionsOur patients with various forms of metabolically compensated OAs tolerated anesthetics for surgical procedures without metabolic decompensation, even when lactated Ringer's solution was used for hydration. Measures to prevent protein catabolism and intraoperative events that may precipitate metabolic acidosis, in addition to close monitoring of acid‐base status during more extensive procedures, must be part of perioperative treatment of these patients.
The Relationship Between Volume Overload in End‐Stage Renal Disease and Obstructive Sleep Apnea
Authors: Roumelioti Maria‐Eleni , Brown Lee K. , Unruh Mark L. 
Published: May 2015

AbstractObstructive sleep apnea (OSA) is common, underdiagnosed, and undertreated among patients with end‐stage renal disease (ESRD). As in all cases, pathogenesis of OSA is related to repeated upper airway (UA) occlusion or narrowing, but in ESRD, additional contributory factors likely include uremic destabilization of central respiratory control and anatomic changes in the UA related to fluid status. Pulmonary congestion is common in acute and chronic kidney failure and is a consequence of cardiomyopathy and fluid overload, two potentially reversible risk factors. Emerging evidence suggests that volume overload also reduces the UA caliber. The diminution in UA area as well as destabilization of ventilatory control in ESRD have been postulated as causes of increased OSA prevalence and severity in these patients, and creates a vicious cycle wherein OSA exacerbates fluid overload disorders such as in congestive heart failure (CHF) and ESRD, which then further worsen OSA. Dialysis modalities may differ in their effects on volume status, the accumulation of uremic toxins, and acid–base status, and as a consequence, on the emergence and severity of OSA. Given the contribution of excess fluid to both the severity of nocturnal hypoxia and UA narrowing, establishing and maintaining dry weight is of particular importance when managing OSA in ESRD. Clinical trials to determine the extent to which more aggressive fluid removal in ESRD patients may alleviate OSA are needed.
From Official Supervision to Self‐monitoring: Privatizing Supervision of Private Social Care Services in Finland
Authors: Kotkas Toomas 
Published: May 2015

AbstractIn October 2011, a new Act on Private Social Care Services came into force in Finland. The Act included a provision on a ‘self‐monitoring plan’. According to the provision, providers of private social care services are required to draw up a self‐monitoring plan and to follow its realization. The plan must be kept publicly on view so that clients and their relatives can also keep an eye on the realization of self‐monitoring. In this article, self‐monitoring is first explained and then briefly analyzed against the background of a wider theoretical discussion on accountability. It is argued that the introduction of client involvement in the supervision of private social care services represents a new mechanism of accountability that is typical of the Post‐Keynesian welfare state. Because public authorities are no longer able to supervise the growing number of private social care service providers, the responsibility has been partly shifted to service providers themselves as well as to clients. However, it is argued that the idea of self‐monitoring lends itself poorly to ‘delegated’ private social care services, i.e. to services that are outsourced to private service suppliers. Supervision of private social care service providers should not be too eagerly delegated to service providers themselves, or to clients, because we are here dealing with the constitutional right to adequate social care services. Client involvement also involves numerous practical problems, as shown at the end of the article.
Effects of Surotomycin on Clostridium difficile Viability and Toxin Production
In Vitro
Authors: Bouillaut Laurent , McBride Shonna , Sorg Joseph A. , Schmidt Diane J. , Suarez José M. , Tzipori Saul , Mascio Carmela , Chesnel Laurent , Sonenshein A. L. 
Published: May 2015

ABSTRACT

The increasing incidence and severity of infection by
Clostridium difficile
have stimulated attempts to develop new antimicrobial therapies. We report here the relative abilities of two antibiotics (metronidazole and vancomycin) in current use for treating
C. difficile
infection and of a third antimicrobial, surotomycin, to kill
C. difficile
cells at various stages of development and to inhibit the production of the toxin proteins that are the major virulence factors. The results indicate that none of the drugs affects the viability of spores at 8× MIC or 80× MIC and that all of the drugs kill exponential-phase cells when provided at 8× MIC. In contrast, none of the drugs killed stationary-phase cells or inhibited toxin production when provided at 8× MIC and neither vancomycin nor metronidazole killed stationary-phase cells when provided at 80× MIC. Surotomycin, on the other hand, did kill stationary-phase cells when provided at 80× MIC but did so without inducing lysis.
Direct Administration in the Respiratory Tract Improves Efficacy of Broadly Neutralizing Anti-Influenza Virus Monoclonal Antibodies
Authors: Leyva-Grado Victor H. , Tan Gene S. , Leon Paul E. , Yondola Mark , Palese Peter 
Published: May 2015

ABSTRACTThe emergence of influenza virus strains resistant to approved neuraminidase inhibitors and the time constrains after infection when these drugs can be effective constitute major drawbacks for this class of drugs. This highlights a critical need to discover new therapeutic agents that can be used for the treatment of influenza virus-infected patients. The use of broadly neutralizing anti-influenza monoclonal antibodies (MAbs) has been sought as an alternative immunotherapy against influenza infection. Here, we tested in mice previously characterized broadly neutralizing anti-hemagglutinin (HA) stalk MAbs prophylactically and therapeutically using different routes of administration. The efficacy of treatment against an influenza H1N1 pandemic virus challenge was compared between two systemic routes of administration, intraperitoneal (i.p.) and intravenous (i.v.), and two local routes, intranasal (i.n.) and aerosol (a.e.). The dose of MAb required for prophylactic protection was reduced by 10-fold in animals treated locally (i.n. or a.e.) compared with those treated systemically (i.p. or i.v.). Improved therapeutic protection was observed in animals treated i.n. on day 5 postinfection (60% survival) compared with those treated via the i.p. route (20% survival). An increase in therapeutic efficacy against other influenza virus subtypes (H5N1) was also observed when a local route of administration was used. Our findings demonstrate that local administration significantly decreases the amount of broadly neutralizing monoclonal antibody required for protection against influenza, which highlights the potential use of MAbs as a therapeutic agent for influenza-associated disease.
Inhibition of Aminoglycoside Acetyltransferase Resistance Enzymes by Metal Salts
Authors: Li Yijia , Green Keith D. , Johnson Brooke R. , Garneau-Tsodikova Sylvie 
Published: May 2015

ABSTRACT

Aminoglycosides (AGs) are clinically relevant antibiotics used to treat infections caused by both Gram-negative and Gram-positive bacteria, as well as
Mycobacteria
. As with all current antibacterial agents, resistance to AGs is an increasing problem. The most common mechanism of resistance to AGs is the presence of AG-modifying enzymes (AMEs) in bacterial cells, with AG acetyltransferases (AACs) being the most prevalent. Recently, it was discovered that Zn
2+
metal ions displayed an inhibitory effect on the resistance enzyme AAC(6′)-Ib in
Acinetobacter baumannii
and
Escherichia coli
. In this study, we explore a wide array of metal salts (Mg
2+
, Cr
3+
, Cr
6+
, Mn
2+
, Co
2+
, Ni
2+
, Cu
2+
, Zn
2+
, Cd
2+
, and Au
3+
with different counter ions) and their inhibitory effect on a large repertoire of AACs [AAC(2′)-Ic, AAC(3)-Ia, AAC(3)-Ib, AAC(3)-IV, AAC(6′)-Ib′, AAC(6′)-Ie, AAC(6′)-IId, and Eis]. In addition, we determine the MIC values for amikacin and tobramycin in combination with a zinc pyrithione complex in clinical isolates of various bacterial strains (two strains of
A. baumannii
, three of
Enterobacter cloacae
, and four of
Klebsiella pneumoniae
) and one representative of each species purchased from the American Type Culture Collection.
Development of Gendine-Coated Cannula for Continuous Subcutaneous Insulin Infusion for Extended Use
Authors: Jamal Mohamed A. , Garoge Kumait , Rosenblatt Joel S. , Hachem Ray Y. , Raad Issam I. 
Published: May 2015

ABSTRACT

Continuous subcutaneous insulin infusion (CSII) using pumps is a widely used method for insulin therapy in patients with diabetes mellitus. Among the major factors that usually lead to the discontinuation of CSII are CSII set-related issues, including infection at the infusion site. The American Diabetic Association currently recommends rotating sites every 2 to 3 days. This recommendation adds cost and creates inconvenience. Therefore, in order to prevent infections and extend the duration between insertion site changes, we developed a Teflon cannula coated with a combination of gentian violet and chlorhexidine (gendine) and tested its antimicrobial efficacy against different pathogens. The cannulas were coated with gendine on the exterior surface and dried. The efficacy and durability of gendine-coated cannulas were determined against methicillin-resistant
Staphylococcus aureus
,
Staphylococcus epidermidis
, methicillin-susceptible
S. aureus
,
Streptococcus pyogenes
, vancomycin-resistant enterococci,
Escherichia coli
,
Pseudomonas aeruginosa
,
Candida albicans
, and
Candida glabrata
using a biofilm colonization method. The cytotoxicity of gendine was assessed against mouse fibroblast cell lines. The gendine-coated cannulas showed complete prevention of biofilm colonization of all organisms tested for up to 2 weeks (
P
< 0.0001) compared to that with the uncoated control. A gendine-coated catheter against mouse fibroblast cells was shown to be noncytotoxic. Our
in vitro
results show that a novel gendine cannula is highly effective in completely inhibiting the biofilm of multidrug-resistant pathogens for up to 2 weeks and may have potential clinical applications, such as prolonged use, cost reduction, and lower infection rate.
Mutational Analysis of the Chlamydia muridarum Plasticity Zone
Authors: Rajaram Krithika , Giebel Amanda M. , Toh Evelyn , Hu Shuai , Newman Jasmine H. , Morrison Sandra G. , Kari Laszlo , Morrison Richard P. , Nelson David E. 
Published: May 2015

ABSTRACTPathogenically diverseChlamydiaspp. can have surprisingly similar genomes.Chlamydia trachomatisisolates that cause trachoma, sexually transmitted genital tract infections (chlamydia), and invasive lymphogranuloma venereum (LGV) and the murine strainChlamydia muridarumshare 99% of their gene content. A region of high genomic diversity betweenChlamydiaspp. termed the plasticity zone (PZ) may encode niche-specific virulence determinants that dictate pathogenic diversity. We hypothesized that PZ genes might mediate the greater virulence and gamma interferon (IFN-γ) resistance ofC. muridarumcompared toC. trachomatisin the murine genital tract. To test this hypothesis, we isolated and characterized a series ofC. muridarumPZ nonsense mutants. Strains with nonsense mutations in chlamydial cytotoxins,guaBA-add, and a phospholipase D homolog developed normally in cell culture. Two of the cytotoxin mutants were less cytotoxic than the wild type, suggesting that the cytotoxins may be functional. However, none of the PZ nonsense mutants exhibited increased IFN-γ sensitivity in cell culture or were profoundly attenuated in a murine genital tract infection model. Our results suggest thatC. muridarumPZ genes are transcribed—and some may produce functional proteins—but are dispensable for infection of the murine genital tract.
Proteomic Analyses of Intracellular Salmonella enterica Serovar Typhimurium Reveal Extensive Bacterial Adaptations to Infected Host Epithelial Cells
Authors: Liu Yanhua , Zhang Qiufeng , Hu Mo , Yu Kaiwen , Fu Jiaqi , Zhou Fan , Liu Xiaoyun 
Published: May 2015

ABSTRACT

Salmonella
species can gain access into nonphagocytic cells, where the bacterium proliferates in a unique membrane-bounded compartment. In order to reveal bacterial adaptations to their intracellular niche, here we conducted the first comprehensive proteomic survey of
Salmonella
isolated from infected epithelial cells. Among ∼3,300 identified bacterial proteins, we found that about 100 proteins were significantly altered at the onset of
Salmonella
intracellular replication. In addition to substantially increased iron-uptake capacities, bacterial high-affinity manganese and zinc transporters were also upregulated, suggesting an overall limitation of metal ions in host epithelial cells. We also found that
Salmonella
induced multiple phosphate utilization pathways. Furthermore, our data suggested upregulation of the two-component PhoPQ system as well as of many downstream virulence factors under its regulation. Our survey also revealed that intracellular
Salmonella
has increased needs for certain amino acids and biotin. In contrast,
Salmonella
downregulated glycerol and maltose utilization as well as chemotaxis pathways.
Synergistic Costimulatory Effect of Chlamydia pneumoniae with Carbon Nanoparticles on NLRP3 Inflammasome-Mediated Interleukin-1β Secretion in Macrophages
Authors: Matsuo Junji , Nakamura Shinji , Takeda Seiji , Ishida Kasumi , Yamazaki Tomohiro , Yoshida Mitsutaka , Chiba Hitoshi , Hui Shu-Ping , Yamaguchi Hiroyuki 
Published: May 2015

ABSTRACT

The obligate intracellular bacterium
Chlamydia pneumoniae
is not only a causative agent of community-acquired pneumonia but is also associated with a more serious chronic disease, asthma, which might be exacerbated by air pollution containing carbon nanoparticles. Although a detailed mechanism of exacerbation remains unknown, the proinflammatory cytokine interleukin-1β (IL-1β) is a critical player in the pathogenesis of asthma.
C. pneumoniae
induces IL-1β in macrophages via NACHT, LRR, and PYD domain-containing protein 3 (NLRP3) inflammasome activation and Toll-like receptor 2/4 (TLR2/4) stimulation. Carbon nanoparticles, such as carbon nanotubes (CNTs), can also evoke the NLRP3 inflammasome to trigger IL-1β secretion from lipopolysaccharide-primed macrophages. This study assessed whether costimulation of
C. pneumoniae
with CNTs synergistically enhanced IL-1β secretion from macrophages, and determined the molecular mechanism involved. Enhanced IL-1β secretion from
C. pneumoniae
-infected macrophages by CNTs was dose and time dependent. Transmission electron microscopy revealed that
C. pneumoniae
and CNTs were engulfed concurrently by macrophages. Inhibitors of actin polymerization or caspase-1, a component of the inflammasome, significantly blocked IL-1β secretion. Gene silencing using small interfering RNA (siRNA) targeting the NLRP3 gene also abolished IL-1β secretion. Other inhibitors (K
+
efflux inhibitor, cathepsin B inhibitor, and reactive oxygen species-generating inhibitor) also blocked IL-1β secretion. Taken together, these findings demonstrated that CNTs synergistically enhanced IL-1β secretion from
C. pneumoniae
-infected macrophages via the NLRP3 inflammasome and caspase-1 activation, providing novel insight into our understanding of how
C. pneumoniae
infection can exacerbate asthma.