bluuebunny/crossref_metadata_2025_split huggingface dataset:
#4059 MICROBIOLOGICAL ANALYSIS OF HEMODIALYSIS WATER AT THE DOUALA GENERAL HOSPITAL, CAMEROON
Authors: Gueguim Cedric , Ragon Alain , Patrice Halle Marie , Folefack Francois Jerome Kaze , Kamga Hortense Gonsu 
Published: June 2023

Abstract

Background and Aims
Rigorous control of the microbiological quality of water in hemodialysis services is important because the immune system of patients with chronic renal failure is weakened. The aims of this study was to determine the microbiological quality of water for hemodialysis in Nephrology Unit of the Douala Général Hospital in order to improve the disinfection strategy.

Method
Twelve water samples were collected each month at different sites of the hemodialysis circuits A (inlet of filters), B (Outlet of filters / inlet of Reverse Osmosis (RO) device) and C (outlet of the RO device / close to the generator) between November 2015 and February 2016 to be analyzed. The bacteria were isolated after filtration of 100 ml of water at each site through nitrocellulose membrane with 0.45 µm microporosity deposited on the surface of the Tryptone Glucose Extract Agar (TGEA) and then incubated at room temperature (20 to 22°C) for 7 days. After transplanting to different environments, pure bacterial isolates were identified by their cultural characters and marketed biochemical galleries.

Results
The colony count was well above the required international standards (˃100 CFU / ml), for the hemodialysis water with a percentage of 50% of non-compliance. Among the bacteria identified, seven (07) were Gram-negative bacilli including Pseudomonas fluorescens, and Klebsiella pneumoniae subsp ozaenae, three (03) Gram-positive bacilli all Bacillus sp and three (03) Gram-positive cocci all of coagulase-negative staphylococci. The most frequently isolated bacterial genera were Pseudomonas sp (38,5%), Staphylococcus sp (23%), Bacillus sp (23%) and Klebsiella sp (15,5%).

Conclusion
The high bacteriological contamination of the hemodialysis water with the detection of a variety of bacteria shows that the disinfection procedure of the distribution loop is not efficient and cannot prevent the development of a biofilm. A higher frequency of disinfection (almost every week), an increase of the concentration and time of contact of the chlorine disinfection product or the use of peracetic acid and a regular monitoring can contribute to improve the quality of the hemodialysis water at the Douala General Hospital to ensure a better quality of life for patients undergoing this treatment.
#5395 ASSOCIATION BETWEEN PARABEN EXPOSURE AND EARLY RENAL INJURY IN A MIDDLE-AGED ADULT IN TAIWAN
Authors: Chang Jung-Wei , Huang Yen-Hsuan , Chen Hsin-Chang , Chang Wan-Ting , Huang Po-Chin 
Published: June 2023

Abstract

Background and Aims
Parabens are a class of preservatives used in the cosmetics industry and are widely used in people's daily lives, including personal care products (PCPs), pharmaceuticals and food. Epidemiological studies concerning the relations of exposure to parabens with renal function were limited. We aimed to investigate the potential sources of paraben exposure, estimate the daily intake (DI) of four parabens based on their urinary levels and the association between urinary paraben and renal function in a middle-aged adult population in Taiwan.

Method
We recruited 591 subjects aged from ≥40 to &lt;65 years old (yrs) who have participated in Taiwan Environmental Survey for Toxicants (TEST) study from 2013-2016. Urinary parabens including methylparaben (MeP), ethylparaben (EtP), propylparaben (PrP), and butylparaben (BuP) are measured by liquid chromatography/ tandem mass spectrometry. The cross-sectional analysis of the association between urinary paraben and biomarkers of renal function have also been established.

Results
The urinary MeP, EtP, PrP and BuP (median) levels were measured at 442, 42.9, 107 and 5.92 μg/L, respectively, which were also 10 times higher than those in other countries. Subjects aged from ≥55 to &lt;65 yrs had higher urinary MeP and EtP levels and DI than those aged from ≥40 to &lt;55 yrs (Fig. 1 & Fig. 2). The median of DI was higher in lotion, perfume and nail polish users than those seldom used (Fig. 3). However, there was no significant difference between DI and PCPs usage, or the cumulative usage of PCPs by gender. The median of creatinine, microalbumin, urinary protein and uric acid were significantly higher in men than in women, the albumin to creatinine ratio was significantly higher in women (3.73 mg/g) than in men (3.05 mg/g).

Conclusion
The urinary paraben concentration of middle-aged adults in Taiwan was significantly higher than those in US, Canada, and Korea. There was no significant difference among paraben levels, age and gender. PCPs usage was a source of paraben exposure.
#5657 FRAILTY AND VASCULAR ACCESS IN HEMODIALYSIS PATIENTS
Authors: Intzevidou Eleni , Loutradis Charalampos , Kougioumtzidou Ourania , Pitoulias Georgios 
Published: June 2023

Abstract

Background and Aims
Frailty is a geriatric syndrome characterized by increased vulnerability to stressors. The elderly become vulnerable and susceptible to adverse outcomes for their health and to functional restrictions. Previous guidelines suggested fistula creation as first choice for vascular access. Current guidelines suggest a more tailored approach to the patient's needs. Despite the high prevalence of frailty in hemodialysis patients, there is paucity of work investigating the relationship between frailty and vascular access failure. The aim of the study was the estimation of frailty with different scores and relationship with the choice of first vascular access, the current vascular access and vascular failures.

Method
67 patients in hemodialysis participated to the study (observational cross-sectional study). Frailty was assessed with 6 different scores,Clinical Frailty Scale (CFS), Frailty Phenotype (FP), Edmonton Frailty Scale (EFS), Groningen Frailty Index GFI), Short Physical Performance Battery (SPPB), Prisma-7 and ankle-brachial index (ABI) and hand grip were also estimated. The current vascular access, the first vascular access, the vascular access failures and the mean duration of the vascular accesses were also recorded. Finally, the levels of the hemoglobin, serum albumin, C reactive protein, cholesterol were measured for all patients and the hemodialysis adequacy (URR, sp Kt/V) was calculated from the levels of urea before and after the hemodialysis session. Finally, the levels of the hemoglobin, albumin, C reactive protein, cholesterol were measured for all patients and the hemodialysis adequacy was calculated from the levels of urea before and after the hemodialysis session.

Results
The first vascular access of hemodialysis presents statistically significant relation between frail and robust patients that start hemodialysis with central venus catheter and AVF-AVG respectively. (SPPB- tunneled CVC 85, 7%, non tunneled CVC 46,2% ρ=0,032, Prisma-7- frail tunneled CVC 100%, non tunneled CVC 76,9% ρ=0,018, Groningen FI -frail tunneled CVC 100%, non tunneled CVC 65,7% ρ=0,011, Εdmonton FS -AVF-AVG not frail 64,7%, vulnerable 20,6% ρ=0,042) (Table 1-4). ABI presented a statistically significant relationship with the current vascular access. 68,18% of the patients with normal ABI have AVF-AVG and 60,87% of patients with abnormal ABI have tunneled CVC (p=0,022). In addition, the number of vascular accesses per patient, the mean duration of the accesses and the premature failures (3 months after creation) don't present statistically significant relation with frailty.

Conclusion
The frailty score could be used as a tool for the choice of vascular access in hemodialysis patients. Further studies, in a larger number of patients, are required to define a reliable and easy to use frailty tool, which is best suited to dialysis access selection.
Passively Acquired Constant Region 5–Specific Antibodies Associated With Improved Survival in Infants Who Acquire Human Immunodeficiency Virus
Authors: Yaffe Zak A , Sung Kevin , Bosire Rose , Farquhar Carey , Ngacha Dorothy Mbori , Lohman-Payne Barbara , Nduati Ruth , John-Stewart Grace , Matsen Frederick A , Overbaugh Julie 
Published: June 2023

Abstract
Studying vertical human immunodeficiency virus (HIV) transmission enables the impact of passively transferred antibodies on HIV transmission and pathogenesis to be examined. Using phage display of HIV envelope peptides and peptide enzyme-linked immunosorbent assay (ELISA), we found that, in infants who acquired HIV, passive antibody responses to constant region 5 (C5) were associated with improved survival in 2 cohorts. In a combined analysis, C5 peptide ELISA activity was correlated directly with survival and estimated infection time and inversely with set point viral load. These results suggest that preexisting C5-specific antibodies may be correlated with the survival of infants living with HIV, motivating additional research into their protective potential.
Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation
Authors: Herms Emma N , Bolbecker Amanda R , Wisner Krista M 
Published: June 2023

Abstract

Background and Hypothesis
Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships.

Study Design
In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter’s Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma.

Study Results
Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences.

Conclusions
These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.
Hanging on and digging deep: comparative forelimb myology of the koala (Phascolarctos cinereus) and common wombat (Vombatus ursinus)
Authors: Richards Hazel L , Adams Justin W , Evans Alistair R 
Published: June 2023

Abstract
Establishing relationships between soft tissues and bones in living species can inform our understanding of functional adaptations in their extinct kin in the absence of direct data on habitual behaviours. The koala and the wombats are the only surviving species of the vombatiform suborder, and represent the extant phylogenetic bracket for dozens of fossil marsupial species across nine families. Here we present the first quantitative architectural data on the forelimb myology of the koala and common wombat, alongside redescriptions based on physical and digital dissections. Despite obvious contrasts in how their forelimbs are used in arboreal (koala) and fossorial (wombat) functional contexts, overall they showed only minor differences in qualitative and quantitative measures of myology. When the architectural properties of antagonistic pairs of muscle groups crossing each joint were compared, the greatest contrasts were seen in muscles crossing the elbow, where the wombat exhibited greater relative emphasis on forceful elbow extension than the koala, indicative of adaptations for digging. Our findings reinforce the importance of the elbow as a useful system to explore when seeking discrimination between habitual patterns of forelimb use in extinct vombatiform species.
Local anaesthetic adjuncts for peripheral nerve blockade
Authors: Desai Neel , Albrecht Eric 
Published: June 2023

Purpose of review
Moderate-to-severe pain is common and remains a significant problem. Compared with opioid analgesia alone, single-shot peripheral nerve blockade has been associated with improved pain relief and the potential of decreased side effects. Single-shot nerve blockade, however, is limited by its relatively short duration of action. In this review, we aim to summarize the evidence related to local anaesthetic adjuncts for peripheral nerve blockade.

Recent findings
Dexamethasone and dexmedetomidine exhibit characteristics that most closely resemble the ideal local anaesthetic adjunct. In upper limb block, dexamethasone has been demonstrated to be superior to dexmedetomidine regardless of administration route for the duration of sensory and motor blockade as well as the duration of analgesia. No clinically significant differences between intravenous and perineural dexamethasone were found. Perineural and intravenous dexamethasone have the potential to prolong sensory blockade to a greater extent than motor blockade. The evidence indicates that the mechanism of action of perineural dexamethasone in upper limb block is systemic in nature. Unlike perineural dexmedetomidine, intravenous dexmedetomidine has not been shown to result in differences in the characteristics of regional blockade compared with local anaesthetic alone.

Summary
Intravenous dexamethasone is the local anaesthetic adjunct of choice, increasing the duration of sensory and motor blockade as well as the duration of analgesia by 477, 289 and 478 min, respectively. In view of this, we recommend consideration of the intravenous administration of dexamethasone at a dose of 0.1–0.2 mg/kg for all patients undergoing surgery whatever the level of postoperative pain, mild, moderate or severe. Further research should focus on the potential synergism of action between intravenous dexamethasone and perineural dexmedetomidine.
Clarifying the grey space of sugammadex induced bradycardia
Authors: Johnson Ken B. , Chacin Rebeca 
Published: June 2023

Purpose of review
This review describes recent prospective and retrospective work exploring the incidence and clinical consequence of sugammadex-induced bradycardia and an update of recent evidence and adverse event reports to the United States Food and Drug Administration regarding the incidence of sugammadex induced bradycardia.

Recent findings
This work suggests that the incidence of sugammadex-induced bradycardia can range from 1 to 7% depending on the definition to reverse moderate to deep neuromuscular blockade. For most instances, the bradycardia is inconsequential. For those instances that have hemodynamic instability, the adverse physiology is easily treated with appropriate vasoactive agents. One study demonstrated that the incidence of bradycardia from sugammadex is less than with neostigmine. There are several case reports that describe marked bradycardia with cardiac arrest from reversal with sugammadex. The incidence of this type of reaction to sugammadex appears to be very rare. Data from the United States Food and Drug Administration's Adverse Event Reporting System public dashboard corroborates this presence of this rare finding.

Summary
Sugammadex-induced bradycardia is common and, in most instances, of minimal clinical consequence. Nevertheless, anesthesia providers should maintain proper monitoring and vigilance to treat hemodynamical instability with each administration of sugammadex.
Flow-Sizing Critical Care Resources*
Authors: Nates Joseph L. , Oropello John M. , Badjatia Neeraj , Beilman Gregory , Coopersmith Craig M. , Halpern Neil A. , Herr Daniel L. , Jacobi Judith , Kahn Roozehra , Leung Sharon , Puri Nitin , Sen Ayan , Pastores Stephen M. ,   for the Academic Leaders in Critical Care Task Force (ALCCM) of the Society of Critical Care Medicine
Published: June 2023

OBJECTIVES:To describe the factors affecting critical care capacity and how critical care organizations (CCOs) within academic centers in the U.S. flow-size critical care resources under normal operations, strain, and surge conditions.DATA SOURCES:PubMed, federal agency and American Hospital Association reports, and previous CCO survey results were reviewed.STUDY SELECTION:Studies and reports of critical care bed capacity and utilization within CCOs and in the United States were selected.DATA EXTRACTION:The Academic Leaders in the Critical Care Medicine Task Force established regular conference calls to reach a consensus on the approach of CCOs to “flow-sizing” critical care services.DATA SYNTHESIS:The approach of CCOs to “flow-sizing” critical care is outlined. The vertical (relation to institutional resources, e.g., space allocation, equipment, personnel redistribution) and horizontal (interdepartmental, e.g., emergency department, operating room, inpatient floors) integration of critical care delivery (ICUs, rapid response) for healthcare organizations and the methods by which CCOs flow-size critical care during normal operations, strain, and surge conditions are described. The advantages, barriers, and recommendations for the rapid and efficient scaling of critical care operations via a CCO structure are explained. Comprehensive guidance and resources for the development of “flow-sizing” capability by a CCO within a healthcare organization are provided.CONCLUSIONS:We identified and summarized the fundamental principles affecting critical care capacity. The taskforce highlighted the advantages of the CCO governance model to achieve rapid and cost-effective “flow-sizing” of critical care services and provide recommendations and resources to facilitate this capability. The relevance of a comprehensive approach to “flow-sizing” has become particularly relevant in the wake of the latest COVID-19 pandemic. In light of the growing risks of another extreme epidemic, planning for adequate capacity to confront the next critical care crisis is urgent.
Early MDO with a Virtually Planned Distractor in a Neonate with Pierre Robin Sequence
Authors: Lutz Rainer , Olmos Manuel , Schmidt Joachim , Morhart Patrick , Nobis Christopher , Möst Tobias , Kesting Marco , Weber Manuel 
Published: June 2023

Summary:
Pierre Robin sequence (PRS) is characterized by mandibular micrognathia, glossoptosis, and airway obstruction. We report a case of a female infant with PRS in combination with deletion of chromosome 4q and cardiac insufficiency due to an atrioventricular septum defect. The child was transferred to our center from a peripheral hospital with respiratory insufficiency. Initially, respiration was ensured using a continuous positive airway pressure (CPAP) device because a Tuebingen plate was not tolerated. After a pediatric cardiac surgery intervention, CPAP ventilation proved to be insufficient, and the young patient had to be resuscitated and endotracheal intubation was required for recurrent severe respiratory failure. To avoid tracheostomy, an interdisciplinary decision was made to perform an early mandibular distraction. In the fifth week of life, two patient-specific internal distractors were implanted after prior virtual surgery planning. This approach allows for shorter surgical time through preoperative vector planning and fabrication of a patient-specific distractor, in combination with reduced morbidity through maximum protection of adjacent structures such as the tooth follicles and inferior alveolar nerves. An advancement of the mandible by 15 mm could be achieved within 2 weeks. Thereafter, the small patient could be extubated successfully, and there was no further episode of major respiratory insufficiency. We demonstrate that mandibular early distraction with a patient-specific distractor is a successful method to treat severe respiratory insufficiency in PRS, and it can prevent the necessity for tracheostomy with the resulting disadvantages. We provide details concerning our therapeutic algorithm, metric analyses, and a discussion of relevant literature.
External Ear Melanoma Treated with Auricular Reconstruction Using Four Different Tissues in a 16-Year-Old Patient
Authors: Takasu Hiroyuki , Yagi Sasagu , Taguchi Sawa , Furukawa Soichi , Ono Nao , Nakahama Miyako , Shimomura Yutaka 
Published: June 2023

Summary:
The auricular region is a common site of cutaneous malignancies, most of which are nonmelanoma skin cancers, such as basal cell carcinoma and squamous cell carcinoma, in older patients. They are often treated with limited surgery that can be performed under local anesthesia. We report the case of a young patient with external ear melanoma who underwent reconstruction for defects of more than one-half of the helix and concha using four types of tissues: a rib cartilage graft, temporoparietal fascia flap, full-thickness skin graft, and retroauricular flap. Extending the retroauricular flap posteriorly to the entire hairless area allowed us to cover the anterior surface of the rib cartilage framework, which helped effectively achieve aesthetics. In auricle reconstruction, it is crucial to determine how well the anterior surface of the auricle is created.
Breast Implant-associated Squamous Cell Carcinoma: Initial Review and Early Recommendations
Authors: Glasberg Scot B. , Sommers Catherine A. , McClure Gina T. 
Published: June 2023

Background:
The purpose of this study is to identify and describe all published cases of breast implant-associated squamous cell carcinoma (BIA-SCC) to gain a greater understanding of the incidence, presentation, diagnosis, treatment, and prognosis and to support development of recommendations that promote prompt diagnosis and management in clinical practice.

Methods:
A scoping review of PubMed and social media sites was performed in August and September 2022 to identify published cases of SCC arising in the breast capsule. No limits were set on search results. Additional data review was begun on deidentified cases reported directly to American Society of Plastic Surgeons.

Results:
Twelve articles met inclusion criteria and reported data on 16 total cases. Mean age of patients was 55.56 years (range, 40–81 years). Mean duration from initial implant placement to presentation was 23.56 years (range, 11–40 years). Cases occurred with silicone, saline, textured, and smooth implants. At the time of case publication or reporting, seven patients were alive, five were deceased and/or presumed deceased, and four were unreported.

Conclusions:
BIA‐SCC seems to be a rare complication of breast implantation that can result in significant morbidity and mortality. Physicians should be aware of the presentation of BIA-SCC to promote prompt diagnosis and treatment. BIA-SCC should be discussed with all patients considering breast implantation as part of the informed-consent process.