bluuebunny/crossref_metadata_2025_split huggingface dataset:
Live Biotherapeutic Products for the Prevention of Recurrent Clostridioides difficile Infection
Authors: Pettit Natasha N. , Shaeer Kristy M. , Chahine Elias B. 
Published: March 2024

Objective: To review the efficacy, safety, and role of live biotherapeutic products (LBPs) in the prevention of recurrent Clostridioides difficile infection (rCDI). Data Sources: A literature search was performed using PubMed and Google Scholar (through February 2024) with search terms RBX2660, SER-109, and fecal microbiota. Other resources included abstracts presented at recent conferences, national clinical practice guidelines, and manufacturers’ websites. Study Selection and Data Extraction: All relevant studies, trial updates, conference abstracts, and guidelines in the English language were included. Data Synthesis: Two LBPs were recently approved by the Food and Drug Administration for the prevention of recurrence in adults following antibiotic treatment for rCDI. Fecal microbiota, live-jslm is administered rectally as a retention enema, whereas fecal microbiota spores, live-brpk is given orally after bowel preparation. Several phase 2 and phase 3 clinical trials have established the safety and efficacy of these LBPs in reducing rates of rCDI compared with placebo. Patients with severe immunosuppression and those with inflammatory bowel disease were largely excluded from these trials. Relevance to Patient Care and Clinical Practice in Comparison with Existing Drugs: Live biotherapeutic products offer a similar mechanism to conventional fecal microbiota transplant (FMT) in preventing rCDI through microbiota restoration. The primary advantages of LBPs over FMT are their standardized composition and donor stool screening processes for transmissible pathogens. Bezlotoxumab is also available for the prevention of Clostridioides difficile infection; however, there are no clinical data available to compare the efficacy of LBPs with bezlotoxumab, and the benefit of simultaneous use of these preventative therapies is unclear. Conclusions: Live biotherapeutic products provide a safe and effective option for the prevention of rCDI and represent an improvement over conventional FMT. Additional studies are needed to further determine their place in therapy relative to bezlotoxumab and in the setting of immunosuppression and inflammatory bowel disease.
Clinical and Radiographic Healing of Nonoperative and Operative Treatment of Jones Fractures
Authors: Kingery Matthew T. , Kadiyala Manasa L. , Walls Raymond , Konda Sanjit R. , Ganta Abhishek , Leucht Philipp , Rivero Steven , Egol Kenneth A. 
Published: March 2024

Background: Significant heterogeneity in the classification and treatment of zone 3 proximal fifth metatarsal base fractures (“true Jones fractures”) exists. This study compared time to clinical and radiographic healing between patients treated operatively and nonoperatively. We hypothesized that patients treated nonoperatively may demonstrate a greater time to clinical healing. Methods: This was a retrospective cohort study of patients presenting to a large, urban, academic medical center with “Jones” fractures between December 2012 and April 2022. Jones fractures were defined as fifth metatarsal base fractures occurring in the proximal metadiaphyseal region, distal to the articulation of the fourth and fifth metatarsals on the oblique radiographic view. Clinical healing was the time point at which the patient had returned to their baseline ambulatory status with no tenderness to palpation. Radiographic healing was the presence of bridging callus across at least 3 cortices. Results: A total of 2450 patients presented with fifth metatarsal fractures, and 166 fractures (6.8%) were true Jones fractures. Among patients with Jones fractures, 120 patients with 121 Jones fractures followed up at our institution and were included in the analysis (mean age 46.5 ± 18.5 years). Ninety-nine fractures (81.8%) were treated nonoperatively and 22 fractures (18.2%) operatively. There were no differences between nonoperative and operative groups in time to clinical healing (12.7 ± 7.1 vs 12.8 ± 4.8 weeks, P = .931) or radiographic healing (13.2 ± 8.1 vs 11.7 ± 5.9 weeks, P = .331). Overall healing rate was 96% for the nonoperative group compared with 96.2% for the operative group. Conclusion: In this study, nonoperative and operative treatment of true Jones fractures were associated with equivalent clinical and radiographic healing. The rate of delayed union in true Jones fractures was lower than previously described, and there was no difference in delayed union rate between nonoperative and operative management. Level of Evidence: Level III, retrospective cohort study.
Pembrolizumab induced type 1 diabetes mellitus in a patient with metastatic melanoma and literature review on steroids as a treatment option
Authors: Greene Adina , Penner Scott , Kunesh Jacqueline , Altaf Amal , McGrade William , Niu Jiaxin 
Published: March 2024

Objective We report a case of a 77-year-old male with metastatic melanoma who developed immune-checkpoint-inhibitor (ICI) induced type 1 diabetes mellitus (T1DM) after seven months of pembrolizumab treatment and required life-long insulin use. This prompted a literature review of best practice guidelines for long-term management of checkpoint-inhibitor induced T1DM including oral steroids as a treatment option similar to other ICI adverse effects. Data Sources and Summary A literature search on PubMed was conducted to evaluate the efficacy of steroid treatment ICI-induced T1DM in any cancer type. Search terms consisted of “ipilimumab” OR “nivolumab” OR & “pembrolizumab” OR “immune checkpoint” AND “diabetes” OR “type 1 diabetes” AND “cancer” OR “melanoma” OR “carcinoma OR “sarcoma”. Inclusion criteria were case reports published after 2015 in which the patient was diagnosed with ICI-induced T1DM or diabetic ketoacidosis where oral steroids were part of the treatment. Exclusion criteria included oral steroids not used as a treatment modality for T1DM, multiple endocrine comorbidities, no response recorded, and previous history of T1DM. 284 abstracts were found with these search terms of which 33 full-text articles were concluded to be eligible and screened and from which 8 records were included. From these 8 articles, there were 12 cases included. Conclusion This literature search suggests that ICI-induced T1DM cannot be reversed by steroids and that insulin must be used permanently for treatment management.
Novel compound heterozygous variants in LTBP2 associated with relative anterior microphthalmos
Authors: Lin Peimin , Xu Jie , Miao Ao , Lu Yi , Jiang Yongxiang , Zheng Tianyu 
Published: March 2024

Purpose Relative anterior microphthalmos (RAM) is a rare congenital defect associated with severe vision impairment that is primarily caused by genetic alterations. The purpose of this study was to identify the causative genetic variants in two Chinese families with RAM with an autosomal recessive inheritance pattern. Methods DNA samples were obtained from two probands and their family members. Targeted next-generation sequencing (NGS) was used to screen 425 genes associated with inherited eye diseases to identify possible disease-causing variants in the two patients. Sanger sequencing was subsequently used to validate the results in both families. Results The targeted NGS panel identified potentially causative novel variants of the latent transforming growth factor beta binding protein 2 ( LTBP2) gene in the two RAM families: a missense variant (c.2771C > T; p.Ala924Val) and an intronic variant (c.4582 + 9A > G) in Family A and a different missense variant (c.5239C > A; p.Arg1747Ser) and a synonymous variant (c.951G > A; p.Pro317Pro) in Family B. These four novel variants all cosegregated with the disease phenotype. Conclusion To our knowledge, this is the first study to report novel LTBP2 gene variants related to RAM. Considering the importance of LTBP2 in ocular development, we provide initial insights into the potential pathogenic mechanisms of LTBP2 in RAM.
Evaluating the outcome of a bundle with 11 components and the INICC multidimensional approach in decreasing rates of central line-associated bloodstream infections across nine Asian countries
Authors: Rosenthal Victor Daniel , Yin Ruijie , Myatra Sheila Nainan , Divatia Jigeeshu Vasishth , Biswas Sanjay K , Shrivastava Anjana Mahesh , Perez Valentina , Wang Qi Yuee , Todi Subhash Kumar , Tang Swee Fong , Tai Chian Wern , Lee Pei-Chuen , Sengupta Deep , Sarma Smita , Sandhu Kavita , Rodrigues Camilla , Nag Bikas , Mohd-Basri Mat Nor , Mehta Yatin , Kharbanda Mohit , Kansal Sudha , Jain Aakanksha Chawla , Davaadagva Narangarav , Chuah Soo Lin , Low Michelle Siu Yee , Gan Chin Seng , Bt Madzlan Kushairi Marissa , Bhattacharyya Mahuya , Bhakta Arpita , Begzjav Tsolmon , Bat-Erdene Batsuren , Bali Roseleen Kaur , Badyal Binesh , Arora Ankush , Arjun Rajalakshmi , Tao Lili , Jin Zhilin , Chawla Rajesh 
Published: March 2024

Background: Central line-associated bloodstream infection (CLABSI) rates in intensive care units (ICUs) across Latin America exceed those in high-income countries significantly. Methods: We implemented the INICC multidimensional approach, incorporating an 11-component bundle, in 122 ICUs spanning nine Asian countries. We computed the CLABSI rate using the CDC/NSHN definition and criteria. The CLABSI rate per 1000 CL-days was calculated at baseline and throughout different phases of the intervention, including the 2nd month, 3rd month, 4–16 month, and 17–29 month periods. A two-sample t-test was employed to compare baseline CLABSI rates with intervention rates. Additionally, we utilized a generalized linear mixed model with a Poisson distribution to analyze the association between exposure and outcome. Results: A total of 124,946 patients were hospitalized over 717,270 patient-days, with 238,595 central line (CL)-days recorded. The rates of CLABSI per 1000 CL-days significantly decreased from 16.64 during the baseline period to 6.51 in the 2nd month (RR = 0.39; 95% CI = 0.36–0.42; p < 0.001), 3.71 in the 3rd month (RR = 0.22; 95% CI = 0.21–0.25; p < 0.001), 2.80 in the 4–16 month (RR = 0.17; 95% CI = 0.15–0.19; p < 0.001), and 2.18 in the 17–29 month (RR = 0.13; 95% CI = 0.11–0.15; p < 0.001) intervals. A multilevel Poisson regression model demonstrated a sustained, continuous, and statistically significant decrease in ratios of incidence rates, reaching 0.35 ( p < 0.0001) during the 17–29 month period. Moreover, the all-cause in-ICU mortality rate significantly decreased from 13.23% to 10.96% ( p = 0.0001) during the 17–29 month period. Conclusions: Our intervention led to an 87% reduction in CLABSI rates, with a 29-month follow-up.
Determinants and Magnitude of Neonatal Sepsis at Hiwot Fana Comprehensive Specialized University Hospital, in Eastern Ethiopia: A Cross-Sectional Study
Authors: Alemayehu Astawus , Yusuf Mohammed , Demissie Abebaw , Muleta Mekuria Edae 
Published: March 2024

Background: Neonatal sepsis is a serious blood bacterial infection in neonates at the age of equal to or less than 28 days of life, and it’s still the major significant cause of death and long-term morbidity in developing countries. Objective: This study aimed to assess the prevalence and related factors with neonatal sepsis among newborns admitted to the neonatal intensive care unit at Hiwot Fana Comprehensive Specialized University Hospital, Harar, Ethiopia. Methods: An institutional-based retrospective cross-sectional study design was conducted among 386 neonates admitted to Neonatal Intensive Care Unit from September 2017 to August 2019. A systematic random sampling method was used. Data were analyzed using SPSS V.26. Descriptive summary statistics were done. Bivariate regression and multivariate analysis were computed. Variables with P-value <.05 were declared as having a statistically significant association. Result: The prevalence of neonatal sepsis was 53.1%. Among the total neonates who had sepsis, 67.8% had early neonatal sepsis. Among neonatal factors, preterm neonates (AOR: 8.1, 95%CI: 2.1, 31.2), birth asphyxia (AOR: 4.7, 95%CI: 1.6, 13.6); and among maternal factors, urban residence (AOR: 0.26, 95%CI: 0.1, 0.5), antenatal care attendance (AOR: 0.32, 95%CI: 0.2, 0.6), spontaneous vaginal delivery (AOR: 0.047, 95%CI: 0.01, 0.2), and maternal antibiotic use (AOR: 0.39; 95%CI: 0.2, 0.8) were found to have significant association with neonatal sepsis. Conclusion: Overall, the magnitude of neonatal sepsis was high. Provision of neonatal and obstetrics care as per standard during prenatal, intranatal, and postnatal periods is needed. Training of health professionals on infection prevention and safe delivery practice should be provided.
Interface debonding defect detection for CFST columns based on EMI measurements: Experiment, numerical simulation and blind inspection in practice
Authors: Liu Qian , Xu Bin , Xia Zongjun , Chen Zhifei , Yao Yudi , Wang Jiang 
Published: March 2024

Concrete-filled steel tube (CFST) members have been widely used in skyscrapers and long-span bridges. Non-uniformly distributed hydration heat during curing, inadequate compaction during construction and unavoidable shrinkage and creep of mass concrete in service most likely lead to interface debonding defects between concrete core and steel tube, which has been a common concern. The development of effective non-destructive inspection methods for interface bonding condition of existing CFST members is critical. In this study, an interface debonding defect detection method based on electromechanical impedance (EMI) measurement using surface-mounted piezoelectric-lead-zirconate-titanate (PZT) sensors is proposed at first. Then, experimental study on the feasibility of the proposed approach is carried out with scaled CFST specimens with artificially mimicked interface debonding defects. EMI of surface-mounted PZT sensors at different frequency bands are measured and compared to verify the detectability of the proposed approach for the mimicked interface debonding defects. Thirdly, a multi-physics CFST-PZT coupling finite element model (FEM) with interface debonding defects is established, and EMI of surface-mounted PZT sensors at different locations is simulated. The influence of interface debonding defects on EMI measurements is illustrated. Finally, a blind inspection on the interface bonding condition of selected CFST columns in an existing skyscraper in service using the proposed approach is carried out. Both bonding and debonding defect in the tested CFST columns are detected correctly and validated with drilling hole observation. Experimental, numerical and engineering application results show the proposed approach is effective for interface debonding detection of CFST members and sensitive to minor debonding defect of 0.3 mm in CFST members.
Self-report instruments measuring aspects of self for people living with dementia: A systematic literature review of psychosocial interventions
Authors: Baggaley Jessica , Wolverson Emma , Clarke Chris 
Published: March 2024

Objective A positive sense of self may be a key domain of psychological well-being for people living with dementia and therefore a legitimate target for psychosocial interventions in dementia care. Determining the effectiveness of such interventions often requires valid self-report instruments. This review aimed to investigate what aspects of self have been measured using self-report instruments in evaluating psychosocial interventions for people living with dementia and to explore the effectiveness of these interventions in terms of positive outcomes related to aspects of self. Method A systematic search of the literature using five electronic databases and one register (CENTRAL) was conducted. A narrative synthesis and methodological quality assessment was completed for the included studies. Results A total of 24 studies were included in the review. Seven aspects of self were measured using a range of self-report instruments, many of which have not been validated for dementia. Aspects of self were; self-esteem, self-efficacy, self-compassion, self-growth, self-acceptance, self-management, and self-identity. Studies included a variety of interventions; however, the effectiveness of these interventions for these aspects of self was mixed. Conclusion There is some evidence that psychosocial interventions improve specific aspects of self in dementia but further research to improve this evidence base is needed. Future research should also investigate and confirm the validity and reliability of existing self-report instruments that aim to measure aspects of self in dementia. Limitations and implications of the review are discussed.
Outcome of Endovascular and Open Treated Penetrating Aortic Ulcers
Authors: Kapalla Marvin , Kröger Joselyn , Choubey Rahul , Busch Albert , Hoffmann Ralf-Thorsten , Reeps Christian , Wolk Steffen 
Published: March 2024

Purpose: Penetrating aortic ulcer (PAU) is a rare etiology of acute aortic syndrome. Few studies exist regarding the perioperative outcome. The aim was to analyze clinical outcome and risk factors of mortality in this treatment population. Methods: Retrospective, monocentric study from 2010 to 2021. Clinical data of endovascular or open treated PAU were analyzed. In-hospital mortality was selected as the primary study endpoint. Angio-morphologies were analyzed and risk factors for mortality were identified by using univariate analysis. Results: Overall, 133 patients were identified. 29% (n=38) of patients presented symptomatically. In 64% (n=85), the PAU was localized in the thoracic aorta. On average, PAUs had a depth of 15.4±10.1 mm and a width of 17.9±9.6 mm. The patients had a median of 2 (95% confidence interval [CI]=2-3) high-risk features (HRF) as PAU depth >10 mm, PAU width >20 mm, aortic diameter >40 mm, symptomatic, intramural hematoma (IMH), pleural effusion. Significantly more HRF were observed in symptomatic patients (p=0.01). 53% (n=71) of patients were treated with thoracic endovascular aortic repair (TEVAR), 41% (n=54) by endovascular aortic repair (EVAR), and 6% (n=8) by open surgery. A hybrid procedure with cervical debranching was performed in 16% (n=21) and complex endovascular repair with fenestrated or branched endografts in 15% (n=20). Overall, complications greater than grade II according to the Clavien-Dindo classification occurred in 19% (n=25) and of the patients. In-hospital mortality manifested in 6% (n=8). Factors associated with increased mortality were the diameter of the aorta >40 mm (88% vs 39%, p=0.03), as well as symptomatic patients (63% vs 26%, p=0.04), coincident IMHs (38% vs 10%, p=0.05), and complex endovascular procedures (50% vs 50% p<0.01). Penetrating aortic ulcer width >20 mm tended to show higher mortality (75% vs 40%, p=0.06). Routine follow-up was available for 89% (n=117) for a median of 39 months (95% CI=25-42). One-year and 5-year survival were 83% and 60%, respectively, with 1 aortic pathology-related death. Conclusions: Treatment of PAU is associated with an acceptable perioperative morbidity and mortality. Risk factors associated with increased mortality are an elevated aortic diameter, the presence of IMHs, clinical symptomatology at presentation, and complex endovascular procedures.
Developing a Diabetes Discharge Order Set for Patients With Diabetes on Insulin
Authors: Miles Elizabeth , McKnight Melissa , Schmitz Claire C. , McElroy Chelsea R. , Wardian Jana L. , Shostrom Valerie , Polavarapu Preethi 
Published: March 2024

Background: Insulin, a high-risk medication, is prone to prescribing errors. Patients with diabetes experience higher hospitalization rates and extended hospital stays. Prescription errors, such as missing orders, inappropriate insulin type, missing instructions, and lack of appropriate intensification of insulin regimens are common issues. This project explored the use of system-based interventions and educational tools to minimize errors and improve the quality of insulin discharge regimens. Methods: A needs assessment and baseline chart review were conducted before adapting a diabetes order set obtained from the University of California, San Diego. Subsequent beta testing and broader implementation were followed by repeat chart reviews to assess the impact. Results: Providers strongly desired an insulin discharge order set, with 98% of those surveyed expressing this preference. Those who were high utilizers of the order set showed increased rates of ordering all supplies (55%), compared with pre-intervention rates (27%). However, no change was observed in the practice of intensifying insulin regimens in patients with uncontrolled diabetes upon discharge. Discussion: Insulin prescribing is prone to error. A diabetes discharge order set may improve the percentage of patients who receive necessary insulin supplies at discharge and provide educational resources to encourage appropriate insulin regimens at hospital discharge.
Antibacterial Profiling of Zanthoxylum armatum Extracts: A Comprehensive Computational and Experimental Study
Authors: Mukhtar Mamuna , Khan Haris Ahmed , Naz Shumaila 
Published: March 2024

Objectives The current study was conducted to evaluate the antibacterial potential of leaf and fruit extracts of Zanthoxylum armatum against two pathogenic bacterial isolates, Staphylococcus aureus and Staphylococcus epidermidis. Methods Twelve commercially available antibiotics were tested S. aureus and S. epidermidis by antimicrobial susceptibility test (AST). Qualitative analysis of phytochemicals was performed to evaluate the presence of certain secondary metabolites. The activity of Z. armatum extracts against S. aureus and S. epidermidis was measured as a maximum zone of inhibition exhibited by each leaf and fruit extract. An in-silico study was conducted on flavonoids and alkaloids to show their binding affinity with the PBP2a receptor protein of S. aureus and TcaR of S. epidermidis. Results The AST revealed that S. aureus was resistant to Penicillin, Ampicillin, Clindamycin, Vancomycin, Rifampicin, Novobiocin, and Oxacillin, whereas S. epidermidis was resistant to Streptomycin, Oxacillin, Tetracycline, and Novobiocin. Qualitative analysis of phytochemicals resulted in the presence of Saponins, fixed oils, flavonoids, alkaloids, starch, and fatty acids in both leaf and fruit extracts. The maximum zone of inhibition against S. aureus was produced by methanolic leaf extracts of Z. armatum and chloroform fruit extracts. For S. epidermidis, the best activity was exhibited by benzene leaf extracts and methanolic fruit extracts. An in-silico study showed that flavonoids Nitidine and Nevadensin exhibited binding affinity with the PBP2a receptor protein higher than selected antibiotics, ie, Penicillin, Chloramphenicol, and Oxacillin. TcaR of S. epidermidis interacted with Tambuletin, followed by Nitidine and Kaempferol. Conclusion After in vitro testing, in silico analysis advised extracting and purifying the bioactive components from Z. armatum extracts that showed significant interaction with bacterial virulence proteins for use as natural antibiotics against antibiotic-resistant bacteria.