bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methicillin-ResistantStaphylococcus aureusin German Intensive Care Units During 2000-2003: Data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units)
Authors: Meyer Elisabeth , Schwab Frank , Gastmeier Petra , Jonas Daniel , Rueden Henning , Daschner Franz D. 
Published: February 2006

Objectives.The objective of this study was to analyze methicillin-resistantStaphylococcus aureus(MRSA) percentages (defined as the percentage ofS. aureusisolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003).Methods.This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days.Results.From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552S. aureusisolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use (P<.05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%]). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage (P<.05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days.Conclusion.The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.
What Proportion of Hospital Patients Colonized With Methicillin-ResistantStaphylococcus aureusAre Identified by Clinical Microbiological Cultures?
Authors: Salgado Cassandra D. , Farr Barry M. 
Published: February 2006

Background.Most hospitals in the United States do not perform active surveillance cultures and, thus, rely on clinical microbiological cultures (CMCs) to identify patients colonized with methicillin-resistantStaphylococcus aureus(MRSA). We sought to determine what proportion of patients who are colonized with MRSA at admission are identified by CMCs during hospitalization.Methods.From February 1998 through November 2002, patients found to be colonized with MRSA at admission by use of active surveillance cultures were identified. The proportion of colonized patients who had a CMC that was positive for MRSA, the number of CMCs performed and their type (ie, according to the anatomical site from which specimens were obtained for culture), and the number and type of CMCs that were positive for MRSA were calculated.Results.Four hundred thirty-seven patients were found to be colonized with MRSA at admission, and 98 of 1,238 CMCs (7.9%; 95% confidence interval, 6.5%-9.6%) performed for 66 of these patients (15%; 95% confidence interval, 11.9%-18.8%) were positive for MRSA. The number of nonisolated days that would have occurred by relying on CMCs to identify MRSA-colonized patients was 3,247 (mean, 7.4 days per patient). Among the anatomical sites from which specimens were obtained for CMC, wounds demonstrated the highest sensitivity (30.2%) for identifying MRSA-colonized patients.Conclusions.CMCs failed to identify 85% of MRSA-colonized patients, because, in part, CMCs identified only a small proportion of colonized patients. Because many studies have shown a decrease in the transmission of MRSA from colonized patients for whom contact precautions, rather than standard precautions, are used, the findings of this study suggest that failure to identify colonized patients and to use contact precautions may be an important reason for the increasing rate of nosocomial MRSA infection in hospitals in the United States.
Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients
Authors: Singh Nina , Squier Cheryl , Wannstedt Cheryl , Keyes Lois , Wagener Marilyn M. , Cacciarelli Thomas V. 
Published: February 2006

Background.Methicillin-resistant Staphylococcus aureus has emerged as a leading pathogen in transplant recipients and has become endemic in many institutions where transplantation is performed. The role of active surveillance programs based on the detection of colonization in the prevention of S. aureus infection in liver transplant recipients has not been defined.Methods.A total of 47 consecutive patients who underwent liver transplantation during 1996-1999 were compared with 97 patients who received a liver transplant during 2000-2004 after implementation of an intensive intervention program that included use of surveillance cultures to detect nasal and rectal colonization, use of cohorting and contact isolation precautions, and decolonization with intranasal mupirocin therapy.Results.The rate of new acquisition of S. aureus colonization of nares after transplantation decreased from 45.6% (21 of 46 patients) during the preintervention period to 9.9% (9 of 91 patients) during the postintervention period (P< .001). An increased length of hospital stay (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P < .002) was associated with new carriage acquisition, and transplantation during the postintervention period (odds ratio, 0.21; 95% confidence interval, 0.08-0.51; P<.001) was independently protective against new carriage. The rate of infection due to S. aureus decreased from 40.4% (19 of 47 patients) during the preintervention period to 4.1% (4 of 97 patients) during the postintervention period (P<.001), and the rate of bacteremia decreased from 25.5% (12 of 47 patients) to 4.1% (4 of 97 patients), respectively (P< .001). Overall, S. aureus infections occurred more frequently among patients with new carriage than among patients who were carriers at the time of transplantation (P< .001) or patients who were noncarriers (P< .001).Conclusions.Use of active surveillance cultures to detect colonization and implementation of targeted infection control interventions proved to be effective in curtailing new acquisition of S. aureus colonization and in decreasing the rate of S. aureus infection that was endemic in our population of liver transplant recipients.
Management of Outbreaks of Methicillin-ResistantStaphylococcus aureusInfection in the Neonatal Intensive Care Unit: A Consensus Statement
Authors: Gerber Susan I. , Jones Roderick C. , Scott Mary V. , Price Joel S. , Dworkin Mark S. , Filippell Mala B. , Rearick Terri , Pur Stacy L. , McAuley James B. , Lavin Mary Alice , Welbel Sharon F. , Garcia-Houchins Sylvia , Bova Judith L. , Weber Stephen G. , Arnow Paul M. , Englund Janet A. , Gavin Patrick J. , Fisher Adrienne G. , Thomson Richard B. , Vescio Thomas , Chou Teresa , Johnson Daniel C. , Fry Mary Beth , Molloy Anne H. , Bardowski Laura , Noskin Gary A. 
Published: February 2006

Objective.In 2002, the Chicago Department of Public Health (CDPH; Chicago, Illinois) convened the Chicago-Area Neonatal MRSA Working Group (CANMWG) to discuss and compare approaches aimed at control of methicillin-resistantStaphylococcus aureus(MRSA) in neonatal intensive care units (NICUs). To better understand these issues on a regional level, the CDPH and the Evanston Department of Health and Human Services (EDHHS; Evanston, Illinois) began an investigation.Design.Survey to collect demographic, clinical, microbiologic, and epidemiologic data on individual cases and clusters of MRSA infection; an additional survey collected data on infection control practices.Setting.Level III NICUs at Chicago-area hospitals.Participants.Neonates and healthcare workers associated with the level III NICUs.Methods.From June 2001 through September 2002, the participating hospitals reported all clusters of MRSA infection in their respective level III NICUs to the CDPH and the EDHHS.Results.Thirteen clusters of MRSA infection were detected in level III NICUs, and 149 MRSA-positive infants were reported. Infection control surveys showed that hospitals took different approaches for controlling MRSA colonization and infection in NICUs.Conclusion.The CANMWG developed recommendations for the prevention and control of MRSA colonization and infection in the NICU and agreed that recommendations should expand to include future data generated by further studies. Continuing partnerships between hospital infection control personnel and public health professionals will be crucial in honing appropriate guidelines for effective approaches to the management and control of MRSA colonization and infection in NICUs.
Primary Treatment of Ranula With Intracystic Injection of OK‐432
Authors: Roh Jong‐Lyel 
Published: February 2006

AbstractObjective: Although surgery is the first choice of therapy for ranula, it was made a hypothesis that ranula can be primarily treated with sclerotherapy from prior evidence. This study examined the effectiveness of intracystic injection of OK‐432 for treatment of ranula.Method: This prospective clinical study comprised a total of 26 patients with ranula (19 intraoral type; seven plunging type) treated with OK‐432 sclerotherapy. Aspirated mucus of ranula was replaced with an equal volume of OK‐432 solution of 0.01 mg/mL. The size of ranula was compared before and after sclerotherapy.Results: Twenty of 26 patients (77%) showed a complete response after sclerotherapy: higher in plunging ranula (86%) than in intraoral ranula (74%). Rupture of ranula developed in seven of 19 patients (37%) with intraoral ranula within a few days after injection. The early rupture occurred more frequently in patients having a less‐than‐marked response and seemed to cause an increase in the total number of OK‐432 injections: seven ruptured cases versus 12 nonruptured cases (mean 3.6 versus 1.5, P < .001). Recurrence occurred in two patients during a median follow‐up period of 12 months (range, 9–22 mo) after the last injection. There were no major side effects, scarring, or increased morbidity to surgery of the OK‐432‐injected lesions.Conclusion: The intracystic injection of OK‐432 is highly effective as a primary treatment modality of ranula.
Morbidity After Flap Reconstruction of Hypopharyngeal Defects
Authors: Clark Jonathan R. , Gilbert Ralph , Irish Jonathan , Brown Dale , Neligan Peter , Gullane Patrick J. 
Published: February 2006

AbstractObjectives: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects.Method: A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10‐year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastro‐omental flaps. Gastric transposition and pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy.Results: The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P = .046) and flap‐related morbidity (P = .037), hypocalcemia (P < .001), late complications (P = .003), and stricture (P = .009). Gastric transposition had increased total (P = .007), flap‐related (P = .035), late complications (P = .034), and hypocalcemia (P = .001). Pharyngocutaneous fistula was increased in patients undergoing salvage pharyngectomy for radiation failure (P = .048) compared with primary surgery. On multivariate analysis, gastric transposition independently predicted for wound complications (P = .014) and fistula (P = .012). Circumferential defects predicted for flap‐related morbidity (P = .030), hypocalcemia (P = .017), and late complications (P = .042). Tracheoesophageal speech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition.Conclusion: The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were able to predict morbidity by defect extent and reconstruction type and initial treatment modality. Swallowing function is acceptable; however, less than half of the patients undergoing pharyngectomy had tracheoesophageal puncture voice restoration.
The Edwin Smith Papyrus: The Birth of Analytical Thinking in Medicine and Otolaryngology
Authors: Stiefel Marc , Shaner Arlene , Schaefer Steven D. 
Published: February 2006

AbstractThe Edwin Smith Papyrus, discovered in 1862 outside of Luxor, Egypt, is the oldest known surgical text in the history of civilization. The surviving scroll, a copy of an earlier text from around 3,000 B.C., gives us remarkable insight into the medical practice of ancient Egyptians in the Nile River bed during the dawn of civilization. The Papyrus is divided into 48 cases, most of which describe traumatic injuries. The text instructs the physician to examine the patient and look for revealing physical signs that may indicate the outcome of the injury. Although in modern medicine we take for granted that the use of physical examination and rational thinking lead to an accurate conclusion, 5,000 years ago, this was extraordinary. The Edwin Smith Papyrus cast aside the prevailing magic and mysticism of that time in favor of logic and deductive reasoning. As Egyptian civilization declined during the next millennium, the teachings of the Papyrus would be lost. It would not be until 300 B.C. when Hippocrates and his disciples in ancient Greece would once again revive logic in medical thinking and teaching. It is believed that the ancient Greeks had knowledge of the contents of the Edwin Smith Papyrus and its teachings and used them as the basis for their writings. As Europe entered the Dark Ages, so did medicine yet again, reverting to spells and prayers instead of judgment and reason. Although Hippocrates teachings were recognized by some scholars during the Middle Ages, they did not make up the basis for mainstream medical knowledge. With the dawn of the Renaissance, medicine would finally purge itself of its past supernatural foundation. Hippocratic teachings were used to form the basis of modern medicine, and medical pioneers in the 17th century studied the ancient Greek texts as the origin for their ideas. Many of the concepts physicians and patients today take as common knowledge originated in the Edwin Smith Papyrus. The authors attempt to uncover some of these fundamental ideas and trace them through time until their incorporation in our modern medical knowledge base. It is the rational, logical, and advanced thinking exhibited in the Edwin Smith Papyrus that mandates its respect from modern otolaryngologists and all physicians alike.
Signaling Pathways in Interleukin‐1β‐Mediated Middle Ear Mucin Secretion
Authors: Kerschner Joseph E. , Yang Chris , Burrows Amy , Cioffi Joseph A. 
Published: February 2006

AbstractObjectives: The objectives of this study were to investigate the role of the phosphatidylcholine‐specific phospholipase C (PC‐PLC), protein kinase C (PKC), and nitric oxide synthase (NOS) pathways during upregulation of mucin secretion by middle ear epithelium after exposure to interleukin‐1β and to examine the ability of a specific interleukin‐1 receptor antagonist (IL‐1βra) to block this increased secretion.Materials and Methods: Primary chinchilla middle ear epithelial cultures were established and exposed to IL‐1β. Specific inhibitors of calmodulin, PC‐PLC, PKC, and NOS pathways were used to investigate the potential role of these pathways leading to increased epithelial mucin secretion after exposure to IL‐1β. Mucin secretion was characterized by exclusion chromatography and liquid scintillation.Results: Epithelial cultures exposed to IL‐1β demonstrate an increase in mucin secretion that is blocked by specific inhibitors of PC‐PLC, PKC, and NOS, but not by inhibitors of calmodulin. In addition, mucin secretion stimulated by IL‐1β was reversible with use of a specific IL‐1βra.Conclusions: IL‐1β stimulates mucin secretion from middle ear epithelium and its effects can be reversed by IL‐1βra. PC‐PLC, PKC, and NOS pathways play a role in the increased secretion of mucin in middle ear epithelial cells after exposure to IL‐1β.
Cranial Bone Regeneration Using a Composite Scaffold of Beta‐Tricalcium Phosphate, Collagen, and Autologous Bone Fragments
Authors: Kishimoto Masanao , Kanemaru Shin‐ichi , Yamashita Masaru , Nakamura Tatsuo , Tamura Yoshihiro , Tamaki Hisanobu , Omori Koichi , Ito Juichi 
Published: February 2006

AbstractObjective: The aim of our study was to examine the tissue response and new bone formation induced by β‐tricalcium phosphate (β‐TCP), collagen, and autologous bone fragments with fibrin glue implanted into a cranial bone defect.Materials and Methods: Granulated β‐TCP and collagen from porcine skin were mixed and freeze‐dried. The weight ratio of both materials was 98:2. The composite scaffold for bone regeneration was composed of this artificial material and autologous bone fragments. Five adult beagle dogs were used. A cranial bone defect (2 cm × 2 cm) was created in each dog. The animals were divided into two groups. In group 1 (n = 3), the cranial bone defect was closed by replacing the original free bone flap, and the residual fissure and burr holes were filled with the composite scaffold with fibrin glue. In group 2 (n = 2), the bone defect was closed only by replacing the original free bone flap. Three months after the treatment, computed tomography and histologic examinations were done in all animals.Results: In all dogs in group 1, the defects were almost closed by new bone; whereas in group 2, the defects were filled with fibrous tissues instead of bone.Conclusion: This study showed that the composite scaffold made of β‐TCP, collagen, and autologous bone fragments with fibrin glue enabled reconstruction of cranial bone defects without the usual fixation materials.
Incidence of Inverted Papilloma in Recurrent Nasal Polyposis
Authors: Garavello Werner , Gaini Renato Maria 
Published: February 2006

AbstractObjectives: A diagnosis of inverted papilloma in apparently normal bilateral polyps is a possible albeit rare event. The frequency of this diagnosis varies between 0.00% and 0.92%. There are no studies evaluating whether this possibility is significantly different in patients operated for recurrence when compared with those undergoing first surgery. The aim of this study is to evaluate the frequency of inverted papilloma in a series of histologic specimens obtained from patients undergoing surgery for recurrent nasal polyposis.Methods: The authors conducted a retrospective chart and pathologic review of data from 1887 surgical interventions for removal of unremarkable bilateral nasal polyps. Frequency of inverted papilloma was assessed.Results: Five cases of inverted papilloma were identified. The incidence of this diagnosis was thus 0.26% (95% confidence interval, 0.08–0.62%). Age, gender, and number of recurrences did not influence the frequency of this diagnosis.Conclusions: The occurrence of inverted papilloma in unremarkable recurrent cases of nasal polyps is rare. This rate is similar to the one observed in patients undergoing first surgery.
Comparative Proteomics Analysis of the Proteins Associated With Laryngeal Carcinoma‐Related Gene 1
Authors: Zhang Xiaopeng , Xiao Zhiqiang , Chen Zhuchu , Li Cui , Li Jianling , Yanhui Yu , Yang Fang , Yang YiXuan , Oyang Yongmei 
Published: February 2006

AbstractObjectives: A novel gene, laryngeal carcinoma‐related gene 1 (LCRG1), had the characteristics of tumor‐suppressor genes. It was cloned in our laboratory. The objective was to find and characterize the proteins related to LCRG1 and to elucidate the molecular mechanism of LCRG1.Study Design: We used the established cell lines of Hep‐2/LCRG1 (Hep‐2 cells transfected by recombinant plasmid pcDNA3.1[+]/LCRG1) and Hep‐2/pcDNA3.1(+) (Hep‐2 cells transfected by control vector pcDNA3.1[+]) as cell models.Methods: Two‐dimensional gel electrophoresis (2‐DE) technology was performed to separate the proteins of Hep‐2/LCRG1 and Hep‐2/pcDNA3.1(+) cell lines, respectively. The differential protein spots were analyzed by software analysis, subject to in‐gel digestion, and identified by Matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF‐MS) and electrospray ionization–quadruple time‐of‐flight MS/MS (ESI‐Q‐TOF MS/MS). Then the differential expression levels of partial identified proteins were determined by Western blotting analysis and quantitative real‐time reverse transcriptase–polymerase chain reaction.Results: The results showed the attained 2‐DE patterns of the two cell lines were well‐resolved and reproducible. There were 1075 ± 43 and 1027 ± 23 protein spots observed in Hep‐2/LCRG1 and Hep‐2/pcDNA3.1(+) cell lines, respectively. The average matching rate of the two cell lines was 91%. Twenty‐six differentially expressed protein spots were identified (twenty spots for MALDI‐TOF‐MS, six spots for ESI‐Q‐TOF MS/MS). Most of the characterized proteins were characterized as the members of enzymes (phosphoglycerate mutase, manganese superoxide dismutase, and so on), transcription proteins (rho gdp dissociation inhibitor), and so on. Those identified proteins might contribute to the tumor‐suppressive function of LCRG1. The differential expression levels of the partial proteins were confirmed by real‐time polymerase chain reaction and Western blotting.Conclusions: We tentatively proposed those differentially expressed proteins were involved in the tumor‐suppressive process related to LCRG1. These data will be helpful to elucidate the molecular mechanism of LCRG1.