bluuebunny/crossref_metadata_2025_split huggingface dataset:
Empiric Antibiotic Therapy in 1402 Children With Parapneumonic Effusion/Pleural Empyema in Germany: A Long-term Surveillance Study
Authors: Forster Johannes , Piazza Giuseppina , Goettler David , Tanzberger Eva-Lotta , Kenntner Simone , Schoen Christoph , Streng Andrea , Liese Johannes G. 
Published: May 2024

Objective:
This study investigated empiric antibiotic treatment (EAT), guideline adherence, antibiotic streamlining and clinical outcomes in 1402 hospitalized children with pediatric parapneumonic effusion/pleural empyema (PPE/PE).

Methods:
A nationwide surveillance study collected data on EAT, clinical course/outcome, pathogens, susceptibility testing and antibiotic streamlining of children with PPE/PE in Germany between 2010 and 2018. Subgroups were compared using χ
2 test/Fisher exact test, Mann–Whitney U test and linear regression analysis adjusting for patient age where appropriate.

Results:
Complete data on EAT were available for 1402 children. In children with monotherapy (n = 567) and in children with combination therapy of 2 antibiotics (n = 589), the most commonly used antibiotics were aminopenicillin/beta-lactamase inhibitor [138/567 (24.3%) and 102/589 (17.3%)] and cefuroxime [291/567 (51.3%) and 294/589 (49.9%)]. The most common combinations with these beta-lactams were macrolides, aminoglycosides and clindamycin. We observed no difference in clinical severity/outcome between EAT with aminopenicillin/beta-lactamase inhibitor and cefuroxime, neither when used in monotherapy nor when used in combination therapy of 2 antibiotics. Species diagnosis of Streptococcus pneumoniae (n = 192), Streptococcus pyogenes (n = 111) or Staphylococcus aureus (n = 38) in polymerase chain reaction or culture from pleural fluid or blood resulted in a switch to an appropriate narrow-spectrum beta-lactam therapy in 9.4%, 18.9 % and 5.2% of children. In a subset of children with reported bacterial susceptibility testing, penicillin resistance was reported in 3/63 (4.8%) of S. pneumoniae and methicillin resistance in S. aureus was reported in 10/32 (31.3%) of children.

Conclusion:
This study points to antibiotic overtreatment in children with PPE/PE, particularly the frequent use of combinations of antibiotics. Children receiving combinations of antibiotics did not show differences in clinical outcomes. The low rate of children with streamlined antibiotic therapy even upon pathogen detection indicates a necessity for antibiotic stewardship measures in PPE/PE and the need of investigating other potential therapeutic strategies as anti-inflammatory therapy.
Evaluation of Pediatric HIV Postexposure Prophylaxis Guideline Following Child Sexual Assault in Western Australia
Authors: Combs Momoko , Johnson Alice , Abbotsford Joanne , Bowen Asha C. , McLeod Charlie , Foley David A. 
Published: May 2024

Background:
HIV postexposure prophylaxis (PEP) following child sexual assault (CSA) is recommended in select cases. High rates of poor adherence to PEP are reported. We evaluated adherence to the recommended management of children following CSA at the tertiary pediatric facility in Western Australia and compared our approach with international guidelines.

Methods:
Medical records were reviewed for all children <16 years old assessed at Perth Children’s Hospital between October 1, 2016 and November 30, 2020 following alleged CSA. Data, including exposure type, PEP adherence and follow-up, were collected. A review of contemporary national and international PEP guidelines was undertaken in parallel.

Results:
There were 511 alleged CSA events over the study period; 62/511 (12%) were appropriately risk-assessed as requiring PEP by the treating clinician. PEP was not prescribed in 8/62 (13%) events, with a reason documented for 6/8 (75%). Overall, less than half of children who were eligible for PEP were adherent to the 28-day regimen (23/54, 43%). Gastrointestinal upset contributed to early cessation in 5/54 (9%). Final 3-month blood-borne virus serology results were available in less than one in 3 children. A review of international clinical practice revealed significant heterogeneity of criteria for the provision of PEP and a paucity of pediatric-specific data.

Conclusions:
We identified several areas of our PEP management that required strengthening, with limited direction available in current international guidelines. We have adopted a broader use of fixed drug combinations and implemented a multifaceted follow-up program. It will be essential to review the impact of these changes.
Prospective randomized clinical trial evaluating efficacy and safety of a new ophthalmic viscosurgical device in patients undergoing cataract surgery
Authors: De Rosa Luigi , Furiosi Luca , Pellegrini Marco , Yu Angeli Christy , Scorcia Vincenzo , Busin Massimo 
Published: May 2024

Purpose:
To evaluate the efficacy and safety of Bio-Hyalur LVD compared with Viscoat ophthalmic viscosurgical device (OVD) in patients undergoing routine cataract surgery.

Setting:
2 tertiary eyecare hospitals in Italy.

Design:
Prospective randomized clinical trial.

Methods:
This study compared the outcomes of Bio-Hyalur LVD vs Viscoat OVD in patients undergoing standard cataract surgery with phacoemulsification and intraocular lens implantation from January 2021 to April 2022. The primary outcome was mean change in IOP at 6 hours. Secondary outcomes included 1-day, 7-day, 30-day, and 90-day mean intraocular pressure (IOP); 7-day, 30-day, and 90-day corrected distance visual acuity; endothelial cell density (ECD); change in central corneal thickness (CCT); and complications including intraocular inflammation.

Results:
84 eyes of 84 patients (n = 41 in the Bio-Hyalur LVD group and n = 43 in the Viscoat group) were screened, enrolled, randomized, and included in the analysis. Mean change in IOP was significantly higher in the Viscoat group than in the Bio-Hyalur LVD group 6 hours (P = .034), 7 days (P < .001), 30 days (P < .001), and 90 days (P = .003) postoperatively. Mean change in uncorrected distance visual acuity and corrected distance visual acuity was significantly higher in the Bio-Hyalur LVD group 30 and 90 days postoperatively. No significant differences in ECD, CCT, and complication rates were observed between groups at any timepoint.

Conclusions:
Bio-Hyalur LVD OVD was safe and effective in patients undergoing routine cataract surgery. Bio-Hyalur LVD OVD did not confer a higher risk of postoperative increase in IOP.
Comparison of corneal endothelial cell loss in FLACS: impact on endothelial cells in different regions
Authors: Altansukh Altantsetseg , Ma Kathleen Sheng-Chuan , Doyodmaa Adiyabazar , Hung Ning , Kang Eugene Yu-Chuan , Quan Wuyong , Ma David Hui-Kang 
Published: May 2024

Purpose:
To compare changes in corneal endothelial parameters after femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) in different corneal regions.

Setting:
Chang Gung Memorial Hospital, Linkou, Taiwan.

Design:
Single-center, retrospective.

Methods:
Before and 1, 3, and 6 months postoperatively, specular microscopy was performed to measure endothelial cell density (ECD), corneal thickness, hexagonal cell rate (Hex), and coefficient of variation (CoV). Position 1 referred to the central cornea, position 2 was nearest to the main wound, and position 3 was at the peripheral zone diagonal to the main wound.

Results:
This study analyzed 96 eyes in the FLACS group and 110 eyes in the CPS group. Preoperatively, position 1 had lower ECD and CoV and higher Hex compared with the peripheral regions. FLACS patients had a significantly less phacoemulsification time and cumulative dissipated energy. At 1 month, FLACS patients showed a significantly smaller increase in corneal thickness at positions 1 and 2. At 3 months, FLACS patients had lower endothelial cell loss (ECL) at positions 1 and 3. ECL remained lower in FLACS patients at 6 months. The highest ECL was observed at position 2 in both groups and was progressive up to 6 months.

Conclusions:
After phacoemulsification, ECL varied in different corneal regions. At 3 months, the FLACS group exhibited significantly less ECL at the central cornea; however, the continued ECL at 6 months near the main wound suggested ongoing endothelial remodeling in the region.
Pain reflects the informational value of nociceptive inputs
Authors: Coll Michel-Pierre , Walden Zoey , Bourgoin Pierre-Alexandre , Taylor Veronique , Rainville Pierre , Robert Manon , Nguyen Dang Khoa , Jolicoeur Pierre , Roy Mathieu 
Published: May 2024

Abstract
Pain perception and its modulation are fundamental to human learning and adaptive behavior. This study investigated the hypothesis that pain perception is tied to pain's learning function. Thirty-one participants performed a threat conditioning task where certain cues were associated with a possibility of receiving a painful electric shock. The cues that signaled potential pain or safety were regularly changed, requiring participants to continually establish new associations. Using computational models, we quantified participants' pain expectations and prediction errors throughout the task and assessed their relationship with pain perception and electrophysiological responses. Our findings suggest that subjective pain perception increases with prediction error, that is, when pain was unexpected. Prediction errors were also related to physiological nociceptive responses, including the amplitude of nociceptive flexion reflex and electroencephalography markers of cortical nociceptive processing (N1-P2–evoked potential and gamma-band power). In addition, higher pain expectations were related to increased late event-related potential responses and alpha/beta decreases in amplitude during cue presentation. These results further strengthen the idea of a crucial link between pain and learning and suggest that understanding the influence of learning mechanisms in pain modulation could help us understand when and why pain perception is modulated in health and disease.
Cancer drugs and acute kidney injury: new therapies and new challenges
Authors: Gork Ittamar , Xiong Fei , Kitchlu Abhijat 
Published: May 2024

Purpose of review
Cancer therapies continue to evolve at a rapid pace and although novel treatments, including immunotherapies and targeted therapies have allowed for substantial improvements in cancer survival, they carry associated risks of acute kidney injury (AKI). We aim to summarize the existing literature on AKI associated with the spectrum of systemic cancer treatments, including conventional chemotherapies, newer immunotherapies, and the growing number of targeted cancer therapies, which may be associated with both AKI and ‘pseudo-AKI’.

Recent findings
Conventional cytotoxic chemotherapies (e.g. cisplatin and other platinum-based agents, methotrexate, pemetrexed, ifosfamide, etc.) with well recognized nephrotoxicities (predominantly tubulointerstitial injury) remain in widespread use. Immunotherapies (e.g., immune checkpoint inhibitors and CAR-T therapies) may be associated with kidney immune-related adverse events, most often acute interstitial nephritis, and rarely, glomerular disease. Recently, multiple targeted cancer therapies have been associated with reduced renal tubular secretion of creatinine, causing elevations in serum creatinine and apparent ‘pseudo-AKI’. To complicate matters further, these agents have had biopsy-proven, ‘true’ kidney injury attributed to them in numerous case reports.

Summary
Clinicians in nephrology and oncology must be aware of the various potential kidney risks with these agents and recognize those with clinically meaningful impact on both cancer and kidney outcomes.
Digital Pathology is a Fast and Effective Platform for Providing Head and Neck Pathology Consultations
Authors: Liu Bella L. , Haghighi Mehrvash , Westra William H. 
Published: May 2024

Surgical pathology of the head and neck is one of the more challenging areas in all of diagnostic pathology. Its unparalleled diversity and complexity renders it highly vulnerable to diagnostic error compelling unconstrained access to specialized diagnostic expertise. Digital pathology (DP) is a state-of-the-art tool that could facilitate access to specialized expertise, but it is relatively untested in the context of pathology consultations. In a collaboration between Labcorp Dianon and a large academic hospital with subspecialized surgical pathology, DP was implemented to provide the pathology community access to head and neck pathology expertise. From this collaborative experience, glass slides from consecutive consult cases that had been previously diagnosed using DP were reviewed by an expert consultant in a blinded manner following an extended wash-out period. The intraobserver discrepancy rate was recorded. Major discrepancies were defined as those resulting in significant impact on clinical management and/or prognosis, whereas minor discrepancies were those with no impact on care or prognosis. Slides from 57 cases were available for review. The average wash-out period was 19 months. Five discrepancies were recorded (intraobserver concordance rate of 91%). All discrepancies were minor (major discrepancy rate, 0%; minor discrepancy rate, 9%). On appraisal of the discrepant cases, discordant diagnoses were attributed to subjective differences in interpretation rather than objective differences related to the inferiority of DP. DP decreased the median turnaround time by 97% (from 70 h 26 min to 2 h 25 min). DP provides efficient and fast access to expert consultants. The speed of case delivery does not compromise diagnostic precision. Discrepancies are uncommon, minor, and reflect subjective interpretative differences inherent to difficult and ambiguous head and neck cases, and not the inferiority of DP as a diagnostic platform. High concordance can be achieved even for those difficult and complex cases that are concentrated in the consultation practice. This observation carries profound implications regarding universal health care access to specialized diagnostic expertise.
Bivalirudin Monitoring in Pediatric Ventricular Assist Device and Extracorporeal Membrane Oxygenation: Analysis of Single-Center Retrospective Cohort Data 2018–2022
Authors: Engel Elissa R. , Perry Tanya , Block Mary , Palumbo Joseph S. , Lorts Angela , Luchtman-Jones Lori 
Published: May 2024

OBJECTIVES:
The activated partial thromboplastin time (aPTT) is the most frequently used monitoring assay for bivalirudin in children and young adults on mechanical circulatory support including ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO). However, intrinsic variability of the aPTT complicates management and risks bleeding or thrombotic complications. We evaluated the utility and reliability of a bivalirudin-calibrated dilute thrombin time (Bival dTT) assay for bivalirudin monitoring in this population.

DESIGN:
Retrospective analysis of clinical data (including aPTT, dilute thrombin time [dTT]) and results of residual plasma samples from VAD patients were assessed in two drug-calibrated experimental assays. One assay (Bival dTT) was validated for clinical use in VAD patients, and subsequently used by clinicians in ECMO patients. Pearson correlation and simple linear regression were used to determine R
2 correlation coefficients between the different laboratory parameters using Statistical Package for Social Sciences (Armonk, NY).

SETTING:
ICUs at Cincinnati Children’s Hospital Medical Center.

SUBJECTS:
Children on VAD or ECMO support anticoagulated with bivalirudin.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
One hundred fifteen plasma samples from 11 VAD patients were analyzed. Both drug-calibrated experimental assays (anti-IIa and Bival dTT) showed excellent correlation with each other (R
2 = 0.94) and with the dTT (R
2 = 0.87), but poor correlation with aPTT (R
2 = 0.1). Bival dTT was selected for validation in VAD patients. Subsequently, clinically ordered results (105) from 11 ECMO patients demonstrated excellent correlation between the Bival dTT and the standard dTT (R
2 = 0.86) but very poor correlation with aPTT (R
2 = 0.004).

CONCLUSIONS:
APTT is unreliable and correlates poorly with bivalirudin’s anticoagulant effect in ECMO and VAD patients. A drug-calibrated Bival dTT offers superior reliability and opportunity to standardize results across institutions. Additional studies are needed to determine an appropriate therapeutic range and correlation with clinical outcomes.
Ultrasound in Cardiopulmonary Arrest and Resuscitation
Authors: Loscalzo Steven M. , White Lauren J. , Rosenblatt Samuel , Woods-Hill Charlotte Z. , Teran Felipe , Wolfe Heather , Himebauch Adam S. , Glau Christie , Nishisaki Akira , Conlon Thomas W. 
Published: May 2024

Objectives
Information obtained from point-of-care ultrasound during cardiopulmonary arrest and resuscitation (POCUS-CA) can be used to identify underlying pathophysiology and provide life-sustaining interventions. However, integration of POCUS-CA into resuscitation care is inconsistent. We used expert consensus building methodology to help identify discrete barriers to clinical integration. We subsequently applied implementation science frameworks to generate generalizable strategies to overcome these barriers.

Measures and Main Results
Two multidisciplinary expert working groups used KJ Reverse-Merlin consensus building method to identify and characterize barriers contributing to failed POCUS-CA utilization in a hypothetical future state. Identified barriers were organized into affinity groups. The Center for Implementation Research (CFIR) framework and Expert Recommendations for Implementing Change (CFIR-ERIC) tool were used to identify strategies to guide POCUS-US implementation.

Results
Sixteen multidisciplinary resuscitation content experts participated in the working groups and identified individual barriers, consolidated into 19 unique affinity groups that mapped 12 separate CFIR constructs, representing all 5 CFIR domains. The CFIR-ERIC tool identified the following strategies as most impactful to address barriers described in the affinity groups: identify and prepare champions, conduct local needs assessment, conduct local consensus discussions, and conduct educational meetings.

Conclusions
KJ Reverse-Merlin consensus building identified multiple barriers to implementing POCUS-CA. Implementation science methodologies identified and prioritized strategies to overcome barriers and guide POCUS-CA implementation across diverse clinical settings.
MELATONIN ATTENUATES RENAL ISCHEMIA-REPERFUSION INJURY BY REGULATING MITOCHONDRIAL DYNAMICS AND AUTOPHAGY THROUGH AMPK/DRP1
Authors: Wang Huabin , Li Yi , Cao Xichao , Niu Heping , Li Xiaoran , Wang Jirong , Yang Jianwei , Xu Changhong , Wang Hailong , Wan Shun , Li Kunpeng , Fu Shengjun , Yang Li 
Published: May 2024

ABSTRACTIschemia-reperfusion injury (IRI) often stems from an imbalance between mitochondrial dynamics and autophagy. Melatonin mitigates IRI by regulating mitochondrial dynamics. However, the precise molecular mechanism underlying the role of melatonin in reducing IRI through modulating mitochondrial dynamics remains elusive. The objective of this study was to investigate whether pretreatment with melatonin before IRI confers protective effects by modulating mitochondrial dynamics and mitophagy. Melatonin pretreatment was administered to HK-2 cells and live rats before subjecting them to hypoxia-reoxygenation or IRI, respectively. Cells and rat kidney models were evaluated for markers of oxidative stress, autophagy, mitochondrial dynamics, and the expression of adenosine 5′-monophosphate (AMP)-activated protein kinase (AMPK) and phospho-AMPKα (P-AMPK). After renal IRI, increased mitochondrial fission and autophagy were observed, accompanied by exacerbated cellular oxidative stress injury and aggravated mitochondrial dysfunction. Nevertheless, melatonin pretreatment inhibited mitochondrial fission, promoted mitochondrial fusion, and attenuated autophagy levels. This intervention was correlated with a notable reduction in oxidative stress injury and remarkable restoration of mitochondrial functionality. Ischemia-reperfusion injury led to a decline in P-AMPK levels, whereas melatonin pretreatment increased the level of P-AMPK levels. Silencing AMPK with small interfering RNA exacerbated mitochondrial damage, and in this context, melatonin pretreatment did not alleviate mitochondrial fission or autophagy levels but resulted in sustained oxidative stress damage. Collectively, these findings indicate that melatonin pretreatment shields the kidneys from IRI by mitigating excessive mitochondrial fission, moderating autophagy levels, and preserving appropriate mitochondrial fission, all in an AMPK-dependent manner.
HBV and HCV prevalence and treatment eligibility assessment at a primary health facility in Ghana
Authors: Madison Adanusa , Adjei George , Agyeman Seth , Banson Cecil , Nyane Benjamin , Arthur Rudolf Aaron , Amoah Samuel , Halm-Lai Faustina , Boadi Dennis , Hagan Oheneba Charles Kofi 
Published: May 2024

AbstractBackgroundViral hepatitis continues to be of global public health importance, especially hepatitis B and C. Hepatitis B and C account for most of the mortality and morbidity attributable to these viral infections. There is lack of accessibility to diagnostic tools, assessment for the eligibility for treatment and treatment in most LMICs, including Ghana. Assessment for HBV treatment is expensive and not widely available throughout Ghana. TREAT-B, a new, affordable and widely available assessment tool for HBV treatment eligibility, offers a cost-effective alternative to the international and local guidelines currently in use.AimTo determine the prevalence of HBV and HCV in a cohort of patients and to assess the HBV infected for treatment eligibility.Materials and methodsA cross-sectional study of individuals diagnosed with hepatitis B infection was undertaken to assess their eligibility for treatment using local and international treatment guidelines. An additional retrospective review of records of patients screened for hepatitis B and C viruses over the period was undertaken. Questionnaires on socio-demographic were self-administered. Blood was taken for haematological analysis, liver function test, hepatitis B serological tests and DNA extraction for hepatitis B genotyping and drug sensitivity determination.ResultsFrom the retrospective review, 3358 individuals had complete data for further analysis. Prevalence for HBV and HCV was estimated at 4.3% and 1.9% respectively. Males were 3 times more likely to be HBV positive compared to females (AOR=2.8, 95% CI: 1.8-4.2,p-value < 0.001). Those who were born after the introduction of after the UCVHB had higher odds of having HBV compared to those who were born before (AOR=3.6, 95% CI: 2.5-5.3,p-value < 0.001). Assessment of 74 HBV positive patients found, 20%, 9.5%, 4.7% and 4.7% were eligible for treatment according to the TREAT-B, the WHO simplified, Ghanaian and AASLD guidelines respectively.ConclusionThe burden of HBV and HCV infections remain high in Ghana and policies must be implemented to treat individuals eligible.