bluuebunny/crossref_metadata_2025_split huggingface dataset:
927. Cidofovir in the Treatment of BK Virus–Associated Hemorrhagic Cystitis Following Hematopoietic Stem Cell Transplantation; A Medication Use and Safety Analysis
Authors: Nazareno Ryan , Patel Dhaval , Monday Lea M 
Published: November 2023

Abstract

Background
BK virus hemorrhagic cystitis (BKV-HC) is a complication after allogeneic hematopoietic stem cell transplant (AlloHCT) for which optimal management is uncertain. Intravenous (IV) and intravesicular (IVES) cidofovir have been used with varying degrees of success in small case series of six to 33 patients. While some series have investigated side effects, none have examined medication errors (Fig 1).

Methods
A retrospective single-center case series of AlloHCT patients with BKV-HC given IV or IVES cidofovir (CDV) from 2018 to 2022 at an urban cancer center in Detroit, MI. Our primary objective was to determine the incidence of CDV related medication errors (ME) and perform a root cause analysis (RCA) to determine factors contributing to such events. Secondary objectives were to describe the effectiveness of CDV for BKV-HC following AlloHCT.

Results
Six AlloHCT patients were treated with CDV. Patient characteristics are shown in Table 1. Median age was 48 years (range 32-63), with most being high risk for cytomegalovirus (R+) and experiencing acute graft versus host disease. CDV and BKV-HC characteristics are shown in Table 2. BKV-HC occurred a median of 53 days post Allo-HCT (range 27-179). Four patients received IV CDV only and two received it both IV and IVES. Median number of doses was 2 (range 1-10). Median BKV-HC severity grade was 2.5, and three of six patients had BK viremia (Table 2). Five of six patients had microscopic resolution of hematuria (median time to resolution 30 days, range 1-116). However, 4 of 6 had died and 1 of 6 had recurrence of BKV-HC within 90 days. The most common CDV side effects were bladder pain/spasms (n=5) and acute kidney injury (n=4). There were 2 MEs; one near miss where CDV was incorrectly ordered IV but changed to IVES by a pharmacist, and one major safety event where an IVES dose was administered IV. RCA analysis revealed multiple contributing factors including similarity in appearance of doses and an overly simplified pump library without an option for IVES administration (Fig 2).

Conclusion
In this first case series to describe medication errors in patients treated with CDV for BKV-HC, one in three patients experienced an ME. Clinicians caring for AlloHCT patients should have a high predisposition for error when cidofovir is being prescribed.

Disclosures
All Authors: No reported disclosures
Rapid assessment of changes in phage bioactivity using dynamic light scattering
Authors: Dharmaraj Tejas , Kratochvil Michael J , Pourtois Julie D , Chen Qingquan , Hajfathalian Maryam , Hargil Aviv , Lin Yung-Hao , Evans Zoe , Oromí-Bosch Agnès , Berry Joel D , McBride Robert , Haddock Naomi L , Holman Derek R , van Belleghem Jonas D , Chang Tony H , Barr Jeremy J , Lavigne Rob , Heilshorn Sarah C , Blankenberg Francis G , Bollyky Paul L 
Published: November 2023

Abstract
Extensive efforts are underway to develop bacteriophages as therapies against antibiotic-resistant bacteria. However, these efforts are confounded by the instability of phage preparations and a lack of suitable tools to assess active phage concentrations over time. In this study, we use dynamic light scattering (DLS) to measure changes in phage physical state in response to environmental factors and time, finding that phages tend to decay and form aggregates and that the degree of aggregation can be used to predict phage bioactivity. We then use DLS to optimize phage storage conditions for phages from human clinical trials, predict bioactivity in 50-y-old archival stocks, and evaluate phage samples for use in a phage therapy/wound infection model. We also provide a web application (Phage-Estimator of Lytic Function) to facilitate DLS studies of phages. We conclude that DLS provides a rapid, convenient, and nondestructive tool for quality control of phage preparations in academic and commercial settings.
Intraoperative Mechanical Power and Postoperative Pulmonary Complications in Noncardiothoracic Elective Surgery Patients: A 10-Year Retrospective Cohort Study
Authors: Elefterion Bertrand , Cirenei Cedric , Kipnis Eric , Cailliau Emeline , Bruandet Amélie , Tavernier Benoit , Lamer Antoine , Lebuffe Gilles 
Published: November 2023

Background
Postoperative pulmonary complications is a major issue that affects outcomes of surgical patients. The hypothesis was that the intraoperative ventilation parameters are associated with occurrence of postoperative pulmonary complications.

Methods
A single-center retrospective cohort study was conducted at the Lille University Hospital, France. The study included 33,701 adults undergoing noncardiac, nonthoracic elective surgery requiring general anesthesia with tracheal intubation between January 2010 and December 2019. Intraoperative ventilation parameters were compared between patients with and without one or more postoperative pulmonary complications (respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis) within 7 days of surgery.

Results
Among 33,701 patients, 2,033 (6.0%) had one or more postoperative pulmonary complications. The lower tidal volume to predicted body weight ratio (odds ratio per −1 ml·kgPBW
−1, 1.08; 95% CI, 1.02 to 1.14; P < 0.001), higher mechanical power (odds ratio per 4 J·min−1, 1.37; 95% CI, 1.26 to 1.49; P < 0.001), dynamic respiratory system compliance less than 30 ml·cm H2O (1.30; 95% CI, 1.15 to 1.46; P < 0.001), oxygen saturation measured by pulse oximetry less than 96% (odds ratio, 2.42; 95% CI, 1.97 to 2.96; P < 0.001), and lower end-tidal carbon dioxide (odds ratio per –3 mmHg, 1.06; 95% CI, 1.00 to 1.13; P = 0.023) were independently associated with postoperative pulmonary complications. Patients with postoperative pulmonary complications were more likely to be admitted to the intensive care unit (odds ratio, 12.5; 95% CI, 6.6 to 10.1; P < 0.001), had longer hospital length of stay (subhazard ratio, 0.43; 95% CI, 0.40 to 0.45), and higher in-hospital (subhazard ratio, 6.0; 95% CI, 4.1 to 9.0; P < 0.001) and 1-yr mortality (subhazard ratio, 2.65; 95% CI, 2.33 to 3.02; P < 0.001).

Conclusions
In the study’s population, decreased rather than increased tidal volume, decreased compliance, increased mechanical power, and decreased end-tidal carbon dioxide were independently associated with postoperative pulmonary complications.

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Agreement between Patient-reported Pain Medication Use and Electronic Medical Record Data in Surgical Amputation Patients
Authors: Kubiak Carrie A. , Lee Jennifer C. , Hamill Jennifer B. , Kim H. Myra , Roth Randy S. , Cederna Paul S. , Geisser Michael E. , Kung Theodore A. , Kemp Stephen W. P. 
Published: November 2023

Background:
Opioid misuse after surgery remains a public health crisis in the United States. Recent efforts have focused on tracking pain medication use in surgical populations. However, accurate interpretations of medication use remain quite challenging given inconsistent usage of different datasets. The purpose of this study was to investigate the agreement between electronic medical records (EMR) versus patient self-reported use of pain medications in a surgical amputation population.

Methods:
Patients undergoing major lower extremity amputation or amputation-related procedures were included in this study. Both self-reported and EMR data for pain medication intake were obtained for each patient at three time points (preoperatively, 4 months postoperatively, and 12 months postoperatively). Percentage agreement and the kappa statistic were calculated for both usage (yes/no) and dose categories.

Results:
Forty-five patients were included in this study, resulting in 108 pairs of self-reported and EMR datasets. Substantial levels of agreement (>70% agreement, kappa >0.61) for opioid use was seen at preoperative and 12 months postoperative. However, agreement dropped at 4 months postoperatively. Anticonvulsant medication showed high levels, whereas acetaminophen showed lower levels of agreements at all time points.

Conclusions:
Either self-reported or EMR data may be used in research and clinical settings for preoperative or 12-month postoperative patients with little concern for discrepancies. However, at time points immediately following the expected end of acute surgical pain, self-reported data may be needed for more accurate medication reporting. With these findings in mind, usage of datasets should be driven by study objectives and the dataset’s strength (eg, accuracy, ease, lack of bias).
Coronal, Sagittal, and Horizontal Classification of the Chest Shape and Its Role in Selection of Proper Implants
Authors: Kolasiński Jerzy , Santanelli di Pompeo Weronika , Remlein Agnieszka , Pieszko Karolina 
Published: November 2023

Background:
The number of female breast correction procedures has been steadily increasing. Despite extensive literature being available on these procedures, few authors have discussed the role of preoperative chest wall analysis in relation to postoperative outcomes. To date, no comprehensive classification of chest shape has been introduced in the literature. The aim of this study was to present a novel classification of chest shapes, based on three basic planes: coronal (C), sagittal (S), and horizontal (H), hence the proposed name “CSH classification.”

Method:
In this study, a retrospective analysis of 1000 randomly selected chest and breast images was conducted by three independent nonmedical evaluators, using standardized digital images captured with the Vectra 3D body scanner. All examined patients were qualified for breast augmentation surgery.

Results:
Among 1000 randomly examined patients, 923 were classified in the coronal plane, 920 in the sagittal plane, and 627 in the horizontal plane. Other patients were excluded from the study due to insufficient quality of the images. A notable 43.2% of women have shoulder height asymmetries. A relationship between shoulder height asymmetry and chest width was confirmed by the chi-square Pearson test (P = 0.04), indicating that a higher shoulder is associated with a greater chest width on the same side. Furthermore, 84.7% of women displayed excessive upper chest projection, whereas 28.4% showed excessive lower chest projection. Additionally, 84.4% of women had chest projection asymmetries.

Conclusions:
The vast majority of the women had natural asymmetries of the breast or and chest wall. The CSH classification allows systematizing the chest shape assessment. The chest shape has a significant impact on breast implant selection and the choice of the breast surgery technique.
Congenital Nostril Stenosis with a Horseshoe-like Shape
Authors: Ueda Koichi , Sugita Naoya , Akamatsu Jun , Kawase Hiroyo , Umeda Chizuru 
Published: November 2023

Summary:
We report a rare case of congenital nostril stenosis because it is very interesting from the perspective of human embryo development. As we were not able to find a similar congenital case in the literature, we would like to describe it here. The patient is a 36-year-old woman who had bilateral congenital stenotic nostrils with horseshoe-like shape. Particularly, the bilateral medial crura protruded prominently. When she inhaled strongly, she could not breathe further because the action was analogous to the closure of a valve. Her elder sister had similar stenosis in the right nostril only, and parents did not have any stenotic nostrils. During the surgery, the prominent webs of the bilateral medial crura were resected, and Y-V advancement flap was inserted bilaterally to avoid restenosis. Histopathological examination revealed that the resected tissue contained cartilaginous and muscular tissue. A Koken retainer was worn throughout each entire day without washing the face or taking a bath for 3 months after surgery and was washed for keeping hygiene many times every day. After surgery, the patient can breathe well when she inhales strongly and is very satisfied with the operative results. Stenosis has not recurred 6 months after operation. Pathogenesis of this case is thought to occur at the early phase of embryo development when the medial and lateral nasal placodes form a downward-facing “horseshoe.”
Lactobacillus induced by irbesartan on spontaneously hypertensive rat contribute to its antihypertensive effect
Authors: Xiong Yanling , He Yanping , Chen Zhi , Wu Tianyuan , Xiong Yalan , Peng Yilei , Yang Xuechun , Liu Yujie , Zhou Jian , Zhou Honghao , Zhang Wei , Shu Yan , Li Xiong , Li Qing 
Published: November 2023

Objective:
Hypertension is linked to gut dysbiosis. Here, the impact of the angiotensin receptor antagonist irbesartan on the gut microbiota of spontaneously hypertensive rats (SHR) were investigated. In addition, we assessed their contribution to its antihypertensive effect.

Methods:
Eight-week-old Wistar–Kyoto (WKY) rats and SHR were administered irbesartan for 8 weeks. Fecal microbiota transplantation (FMT) was performed from SHR treated with irbesartan or untreated SHR to recipient untreated SHR. The preventive effect of Lactobacillus on hypertension in SHR was evaluated. Blood pressure (BP) was calculated using a tail-sleeve sphygmomanometer. To better assess the composition of the gut microbiota, the V3–V4 region of the 16S rRNA gene was amplified while short-chain fatty acids (SCFAs) in feces were tested by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS).

Results:
Irbesartan restored gut dysbiosis, increased the abundance of Lactobacillus, and improved anti-inflammatory ability, antioxidative ability, intestinal integrity, and intestinal inflammation in SHR. The microbiota in SHR-treated irbesartan could reduce BP and improve antioxidative ability and gut integrity in SHR. Lactobacillus johnsonii (L. johnsonii) and Lactobacillus reuteri (L. reuteri) reduced BP, restored gut dysbiosis and improved anti-inflammatory ability, antioxidative ability, intestinal integrity in SHR. Most notably, irbesartan, L. johnsonii, and L. reuteri can significantly increase SCFA content in SHR feces.

Conclusion:
The current study demonstrated that irbesartan treatment ameliorated gut dysbiosis in SHR. Irbesartan induced alterations in gut microbiota, with increased prevalence of Lactobacillus.
FOXO3 longevity genotype attenuates the impact of hypertension on cerebral microinfarct risk
Authors: Nakagawa Kazuma , Chen Randi , Ross G. Webster , Donlon Timothy A. , Allsopp Richard C. , Willcox D. Craig , Morris Brian J. , Willcox Bradley J. , Masaki Kamal H. 
Published: November 2023

Objective:
The G-allele of FOXO3 SNP rs2802292, which is associated with human resilience and longevity, has been shown to attenuate the impact of hypertension on the risk of intracerebral hemorrhage (ICH). We sought to determine whether the FOXO3 G-allele similarly attenuates the impact of hypertension on the risk of cerebral microinfarcts (CMI).

Methods:
From a prospective population-based cohort of American men of Japanese ancestry from the Kuakini Honolulu Heart Program (KHHP) and Kuakini Honolulu-Asia Aging Study (KHAAS) that had brain autopsy data, age-adjusted prevalence of any CMI on brain autopsy was assessed. Logistic regression models, adjusted for age at death, cardiovascular risk factors, FOXO3 and APOE-ε4 genotypes, were utilized to determine the predictors of any CMI. Interaction of FOXO3 genotype and hypertension was analyzed.

Results:
Among 809 men with complete data, 511 (63.2%) participants had evidence of CMI. A full multivariable model demonstrated that BMI [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01–1.14, P = 0.015) was the only predictor of CMI, while hypertension was a borderline predictor (OR 1.44, 95% CI 1.00–2.08, P = 0.052). However, a significant interaction between FOXO3 G-allele carriage and hypertension was observed (P = 0.020). In the stratified analyses, among the participants without the longevity-associated FOXO3 G-allele, hypertension was a strong predictor of CMI (OR 2.25, 95% CI 1.34–3.77, P = 0.002), while among those with the longevity-associated FOXO3 G-allele, hypertension was not a predictor of CMI (OR 0.88, 95% CI 0.51–1.54, P = 0.66).

Conclusion:
The longevity-associated FOXO3 G-allele mitigates the impact of hypertension on the risk of CMI.
Evaluation of Deuterium Oxide Deposition Velocity Over a Forest Environment
Authors: Viner Brian J. , Swindle Ashlee , Angelette Lucas , Langan Candace J. , Kuhne Wendy W. 
Published: November 2023

Abstract
Field experiments were performed to evaluate the deposition velocity of tritium oxide within a forest environment at the Savannah River Site near Aiken, SC. Field releases were designed to guide selection of deposition velocity values for use in safety-basis modeling. Six releases of deuterium oxide were conducted in 2020 and 2021 with corresponding air samples during and following each release. Samples were analyzed to determine the deuterium-to-hydrogen ratio in water and converted to concentrations of deuterium in the air during the experiment. Measurements were compared to prior model simulations to evaluate model performance and deposition velocity estimates. Field releases demonstrated vertical and horizontal mixing of a plume in a forest. Predicted deposition velocities ranged from 2.4 to 5.4 cm s−1 on average. In all cases, model simulations underpredicted deuterium concentration by 1 to 2 orders of magnitude, indicating the model does not sufficiently mix the plume into the forest. While the model underestimated the transfer of material downward through the forest, it does suggest that the model’s estimates are conservative for making downwind dose estimates because of lower plume depletion, leading to higher concentration and dose estimates. While the field releases do not cover all possible meteorological conditions, we conclude it is appropriate to use a non-zero deposition velocity when performing safety-basis modeling of tritium oxide based on conservatism within the model. A recommendation of 1.0 cm s−1 as a deposition velocity is made, which is beyond the 95th percentile value estimated from the prior modeling study.
Safety of Cidofovir Treatment for Suspected or Confirmed Adenovirus Infection in Immunocompetent Pediatric Population
Authors: Zalcman Jonatan , Pasternak Yehonatan , Kenan Dana , Dotan Miri , Gueta Itai , Kadmon Gili , Peled Orit , Bilavsky-Yarden Havatzelet 
Published: November 2023

Background:
Cidofovir (CDV), a nucleoside phosphonate analogue, exhibits activity against severe cytomegalovirus and adenoviral (ADV) infection. Nevertheless, reports of elevated nephrotoxicity rates limited its use to highly vulnerable cases, mainly immunocompromised children with fulminant infection. Limited data exists regarding CDV safety in immunocompetent children.

Objective:
To evaluate CDV-related toxicity, mainly nephrotoxicity, in immunocompetent children with severe ADV/cytomegalovirus infection.

Methods:
We conducted a retrospective review of medical records for all immunocompetent children under 18 years of age treated with intravenous CDV from January 2005 to December 2019.

Results:
Among the 23 patients identified, 21 were diagnosed with severe ADV infection. Median age was 15 months. Twenty-one (91%) children were admitted to the pediatric intensive care unit. Eighteen patients (78%) received standard CDV protocol (5 mg/kg CDV weekly for 2 weeks), 4 (17%) according to nephroprotective low-dose protocol and 1 patient transitioned. The median duration of CDV treatment was 14 days (range: 1–21 days). All patients received hyperhydration and probenecid with each infusion. Acute kidney injury was recorded in 1 patient (with concurrent septic shock) during CDV treatment. Two children exhibited acute kidney injury before CDV initiation, but renal function normalized during CDV treatment. One patient developed transient neutropenia (600 cells/L), apparently as a result of sepsis. No other major adverse effects were noted. Mortality rate was 3/23 (13%), unrelated to CDV toxicity.

Conclusions:
Our findings suggest that CDV-related nephrotoxicity rate in immunocompetent children may be lower than previously reported, perhaps lower than in the severely immunocompromised population.
Efficacy and Safety of Risperidone in Patients With Delirium
Authors: Nguyen Patrick Viet-Quoc , Vu Thien Tuong Minh 
Published: November 2023

Abstract

Background
The cornerstone treatment of delirium is to assess and treat its underlying causes and prevent further complications. Drug therapy may be necessary to control agitation and behavioral symptoms associated with delirium. The aim of this pilot study was to evaluate the feasibility of a randomized placebo controlled trial to evaluate the efficacy and safety of risperidone in the treatment of delirium.

Methods
This was a randomized double-blinded placebo-controlled trial. Patients were enrolled in the study if they were hospitalized and 65 years or older and had a diagnosis of delirium. Delirium Rating Scale revised 98 was used to determine delirium and motor agitation.

Results
A total of 14 participants with 57% being men and having a mean age of 86 years were included. There were no statistically significant differences between the risperidone and placebo group for the Delirium Rating Scale revised 98 score. There were no severe adverse reactions reported in the study, and no patients discontinued the study for adverse reactions.

Conclusions
Risperidone at low doses (1 mg daily or less) was well tolerated for the treatment of delirium. Future large-scale trials are needed to evaluate the safety and efficacy of risperidone in the treatment of delirium. This pilot study taught us that the phase 2 RIsperDone DELirium trial will need a multicenter design with more research personnel to increase the number of participants enrolled.
COVID-19 Pandemic Effects on Clinical Outcomes of Hip Fractures Among Pediatric and Adult Patients
Authors: Roskam Justin S. , Hauser Kristine M. , DiFazio Louis T. , Rolandelli Rolando H. , Nemecz Amanda K. , Nemeth Zoltan H. 
Published: November 2023

BACKGROUND:
Little is known about the distribution and outcomes of hip fractures in pediatric patients during the COVID-19 pandemic.

OBJECTIVE:
To study the clinical outcomes of both pediatric and adult patients who underwent hip fracture surgeries and determine the effects of changes surrounding the COVID-19 pandemic.

METHODS:
Both pediatric and adult surgical hip fracture cases were analyzed from the pandemic year (2020) and the control year (2019) using the American College of Surgeons National Surgical Quality Improvement Program database.

RESULTS:
Between the prepandemic (control) and pandemic years, a total of 2,438 pediatric and 28,180 adult cases were compared. Pediatric patients had similar perioperative characteristics and outcomes between the two years. Significantly fewer hip fractures were reported among adults during the pandemic (p < .001). Preoperatively, more adult patients had ventilator dependence (p = .020), transfusions (p = .029), and systemic inflammatory response syndrome (p < .001) in 2020. Adult operations were more likely to be emergent in 2020 (p < .001) and adults had more severe disease states. Length of stay (p < .001) and the time from operation to discharge (p < .001) were significantly longer for the adult cohort in 2020. Mortality was also higher for adults during the first year of the pandemic (p = .003), and superficial surgical site infections became more common (p = .036).

CONCLUSION:
Pediatric hip fracture patients had similar clinical outcomes between 2019 and 2020. Adults with hip fractures presented in more serious clinical conditions, which resulted in higher mortality in 2020. Further studies could better clarify the reasons as to why adult hip fracture patients had markedly worse clinical course during the COVID year than pediatric patients.