bluuebunny/crossref_metadata_2025_split huggingface dataset:
520 AN UNEXPECTED SURPRISE
Authors: Soriente Lucia , Santopietro Mario , Aliberti Chiara , Di Fonzo Rosanna , Vecchione Carmine , Di Muro Michele Roberto 
Published: December 2022

Abstract
Aortic Pseudoaneurysms often represent a complication of reconstructive surgery of the aortic valve and ascending aorta due to dehiscence of the surgical suture, especially in correspondence of reimplanted coronary ostia. We present the case of a 74-year-old patient with a recent feverish episode and positive blood cultures for Serratia marcescens, who came to our attention to perform a transesophageal echocardiogram for suspected endocarditis.
In history, previous aortic valve replacement with biological prosthesis about 6 months before, complicated by pseudoaneurysm of the ascending aorta caused by dehiscence of sutures, treated by pseudoaneurismectomy and reconstruction of aortic continuity.
Transesophageal echo showed a normopositioned bioprosthesis in the aortic location and absence of formations compatible with vegetations. During the examination, a subtle drop-out of echoes in the anterior wall of the ascending aorta was observed at approximately 2 cm from the aortic valve plane, raising suspicion of communication with a large pseudoaneurysmal sac. The Colordoppler showed a jet of discrete turbulence between the two cavities; for these reasons it was indicated to perform an urgent angioTC, which documented the presence of fissuring of the proximal ascending aorta with active overflow of contrast media with a collar of about 12 mm and considerable blood collection in the anterior mediastinum of about 51×38×60mm.
The patient underwent false lumen exclusion surgery by percutaneous amplatzer device placement. Currently, the patient is asymptomatic and in good clinical condition.
1157 WITCHING FROM DUAL ANTIPLATELET THERAPY WITH ASPIRIN PLUS A P2Y12 INHIBITOR TO DUAL PATHWAY INHIBITION WITH ASPIRIN PLUS VASCULAR-DOSE RIVAROXABAN: THE SWITCHING ANTI-PLATELET AND ANTI-COAGULANT THERAPY (SWAP-AC) STUDY
Authors: Giordano Salvatore , Ortega-paz Luis , Franchi Francesco , Rollini Fabiana , Galli Mattia , Been Latonya , Ghanem Ghussan , Shalhoub Awss , Ossi Tiffany , Rivas Andrea , Zhou Xuan , Pineda Andres M. , Suryadevara Siva , Soffer Daniel , Zenni Martin M. , Jennings Lisa K , Angiolillo Dominick J. 
Published: December 2022

Abstract

Aims
To assess the feasibility of switching from dual antiplatelet therapy (DAPT) to dual pathway inhibition (DPI) and to compare the pharmacodynamic (PD) profiles of these treatment regimens.

Methods and results
This was a prospective, randomized, PD study conducted in 90 patients with chronic coronary syndrome (CCS) on DAPT with aspirin (81 mg/qd) plus a P2Y12 inhibitor [clopidogrel (75 mg/qd; n = 30), ticagrelor (90 mg/bid; n = 30), or prasugrel (10 mg/qd; n = 30)]. Patients in each cohort were randomized to maintain DAPT or switch to DPI (aspirin 81 mg/qd plus rivaroxaban 2.5 mg/bid). PD assessments included: VerifyNow P2Y12 reaction units; light transmittance aggregometry following stimuli with adenosine diphosphate (ADP), tissue factor, and a combination of collagen, ADP, and TF (CATF, maximum platelet aggregation %); thrombelastograph coagulation analyzer; thrombin generation (TG). Assays were performed at baseline (on DAPT) and 30 days post-randomization (trough and peak). Switching from DAPT to DPI occurred without major side effects. DAPT was associated with enhanced P2Y12 inhibition, while DPI with reduced TG. Platelet-mediated global thrombogenicity (primary endpoint) showed no differences between DAPT and DPI in the ticagrelor (14.5% [0.0–63.0] vs. 20.0% [0.0–70.0]; p = 0.477) and prasugrel (20.0% [0.0–66.0] vs. 4.0% [0.0–70.0]; p = 0.482), but not clopidogrel (27.0% [0.0–68.0] vs. 53.0% [0.0–81.0]; p = 0.011), cohorts.

Conclusion
In patients with CCS, switching from different DAPT regimens to DPI was feasible, showing enhanced P2Y12 inhibition with DAPT and reduced TG with DPI, with no differences in platelet-mediated global thrombogenicity between DPI and ticagrelor- and prasugrel, but not clopidogrel-, based DAPT.
1156 CANGRELOR IN PATIENTS WITH CORONARY ARTERY DISEASE PRE-TREATED WITH TICAGRELOR: THE SWITCHING ANTIPLATELET (SWAP)-5 STUDY
Authors: Giordano Salvatore , Franchi Francesco , Ortega-paz Luis , Rollini Fabiana , Galli Mattia , Been Latonya , Ghanem Ghussan , Shalhoub Awss , Ossi Tiffany , Rivas Andrea , Zhou Xuan , Pineda Andres M , Suryadevara Siva , Soffer Daniel , Zenni Martin M , Reiter Birgit , Jilma Bernd , Angiolillo Dominick J 
Published: December 2022

Abstract

Objectives
To rule out a drug-drug interaction (DDI) among cangrelor-treated patients who have been pre-treated with ticagrelor.

Background
There are no studies specifically designed to rule out a DDI when cangrelor is used among patients who have been pre-treated with ticagrelor.

Methods
In this prospective, randomized, double-blind, placebo-controlled, cross-over, pharmacokinetic (PK) and pharmacodynamic (PD) study, patients with coronary artery disease (n = 20) were pre-treated with a 180-mg ticagrelor loading dose (LD) and after 1 hour randomized to placebo or cangrelor (bolus and infusion for 2 hours). Patients crossed over after 1-4 weeks of washout. PK analysis included ticagrelor plasma levels and its active metabolite. PD assessments included: VerifyNow P2Y12 reaction units (PRU), light transmittance aggregometry vasodilatorstimulated phosphoprotein, and Total Thrombus-Formation Analysis System. PK/PD assessments were performed at 7-time points.

Results
Compared to placebo, adding cangrelor to patients pre-treated with ticagrelor resulted in a significant reduction in PRU at 30 min and 1 hour after starting infusion. At 2 hours after stopping cangrelor/placebo infusion, PRU was low and similar in both groups (16.9 vs. 12.6; mean difference: 4.3; 95%CI: -28.6; 37.3), meeting the non-inferiority primary endpoint (predefined non-inferiority margin 45 PRU). Consistent findings were shown with all PD assays. PK tracked PD findings with no differences between groups in plasma levels of ticagrelor and its metabolite.

Conclusions
Compared with placebo, the use of cangrelor in patients pre-treated with ticagrelor results in enhanced platelet inhibition with no differences in PK/PD profiles after discontinuation of drug infusion indicating the absence of a DDI.
A flexible RecC surface loop required for Chi hotspot control of RecBCD enzyme
Authors: Amundsen Susan K , Richardson Alex , Ha Khoi , Smith Gerald R 
Published: December 2022

Abstract
Escherichia coli RecBCD helicase–nuclease promotes vital homologous recombination-based repair of DNA double-strand breaks. The RecB nuclease domain (Nuc) is connected to the RecB helicase domain by a 19-amino-acid tether. When DNA binds to RecBCD, published evidence suggests that Nuc moves ∼50 Å from the exit of a RecC tunnel, from which the 3′-ended strand emerges during unwinding, to a distant position on RecC's surface. During subsequent ATP-dependent unwinding of DNA, Nuc nicks the 3′-ended strand near 5′-GCTGGTGG-3′ (Chi recombination hotspot). Here, we test our model of Nuc swinging on the tether from the RecC tunnel exit to the RecC distant surface and back to the RecC tunnel exit to cut at Chi. We identify positions in a flexible surface loop on RecC and on RecB Nuc with complementary charges, mutation of which strongly reduces but does not eliminate Chi hotspot activity in cells. The recC loop mutation interacts with recB mutations hypothesized to be in the Chi-activated intramolecular signal transduction pathway; the double mutants, but not the single mutants, eliminate Chi hotspot activity. A RecC amino acid near the flexible loop is also essential for full Chi activity; its alteration likewise synergizes with a signal transduction mutation to eliminate Chi activity. We infer that altering the RecC surface loop reduces coordination among the subunits, which is critical for Chi hotspot activity. We discuss other RecBCD mutants with related properties.
Interferon regulatory factor-2 is required for the establishment of the gut intraepithelial T-cell compartment
Authors: Tokumaru Shigeo , Yamamoto Yuta , Yoshizawa Kazuki , Soejima Yuji , Sanjo Hideki , Taki Shinsuke 
Published: December 2022

Abstract
CD8αα+ intestinal intraepithelial lymphocytes (iIELs) are known for their unique role in keeping the integrity of the intestinal epithelial barrier, but factors affecting the development of these cells have not been thoroughly understood. Here, we found that the transcriptional regulator interferon regulatory factor-2 (IRF-2) plays a cell-intrinsic, indispensable role in establishing iIEL populations. CD8αα+, but not CD8αβ+, iIELs bearing TCRαβ or TCRγδ were severely reduced in numbers in mice lacking this factor (Irf2–/– mice). Moreover, the majority of residual CD8αα+TCRαβ+ iIELs in these mice was immature as judged from their Thy1.2high phenotype and inefficient T-bet expression. Thymic IEL precursors isolated from Irf2–/– mice failed to efficiently generate CD8αα+TCRαβ+ and TCRγδ+ IELs upon transfer in vivo and CD8αα+TCRαβ+ cells in response to IL-15 in vitro. Double mutant mice lacking both interleukin-15 (IL-15) and IRF-2 showed an even more severe iIEL defect than in mice lacking IL-15 alone. Upon increasing agonistic TCR signal strength through OT-II TCR transgenesis, CD8αα+TCRαβ+ iIELs became more abundant but remained immature on the Irf2–/– background. Our current observations, thus, revealed the unique bimodal role that IRF-2 plays in promoting not only generation of IEL progenitors in the thymus but also maturation of iIELs in the periphery in IL-15-dependent and -independent manners.
Asian tropical forests assimilating carbon under dry conditions: water stress or light benefits?
Authors: Yang Lian-Yan , Yu Rui , Wu Jin , Zhang Yongjiang , Kosugi Yoshiko , Restrepo-Coupe Natalia , Huete Afredo , Zhang Jie , Liu Yu-Hai , Zhang Xiang , Liu Wen-Jie , Zhao Jun-Fu , Zeng Jiye , Song Qing-Hai , Chen Ya-Jun , Song Liang , Tan Zheng-Hong 
Published: December 2022

AbstractTropical forests are characterized by vast biomass, complex structures and mega-biodiversity. However, the adaptation processes of these forests to seasonal water availability are less understood, especially those located in the monsoonal and mountainous regions of tropical Southeast Asia. This study used four representative tropical forests spanning from 2° N to 22° N in continental Southeast Asia to address dry-condition photosynthesis at the seasonal scale. We first provided novel and reliable estimations of ecosystem photosynthesis (gross primary production; GPP) seasonality at all four sites. As expected, both evergreen and deciduous seasonal forests exhibited higher GPPs during the rainy season than during the dry season. A bimodal pattern corresponding to solar radiation occurred in the GPP of the perhumid forest. The surface conductance (Gs) was consistently lower both in the dry season and during dry spells (DSPs) than during the wet season and non-dry spells. However, this did not prevent GPP from increasing alongside increasing irradiance in the perhumid forest, suggesting that other ecosystem physiological properties, for example, the light-saturated photosynthetic rate, must have increased, thus surpassing the effect of Gs reduction. Thus, perhumid forests could be defined as light-demanding ecosystems with regard to their seasonal dynamics. Seasonal forests are water-stressed ecosystems in the dry season, as shown by the reductions in GPP, Gs and related ecosystem physiological properties. At all four forest sites, we observed a lack of consistent adaptive strategy to fit the water seasonality due to the diversity in leaf phenology, soil nutrient availability, root depth and other potential factors.
Lipid metabolism in tumor-infiltrating T cells: mechanisms and applications
Authors: Ke Xin-Yu , Zou Miaowen , Xu Chenqi 
Published: December 2022

Abstract
As an essential part of adaptive immunity, T cells coordinate the immune responses against pathogens and cancer cells. Lipid metabolism has emerged as a key regulator for the activation, differentiation, and effector functions of T cells. Therefore, uncovering the molecular mechanisms by which lipid metabolism dictates T cell biology is of vital importance. The tumor microenvironment is a hostile milieu, i.e. often characterized by nutrient restriction. In this environment, various cells, such as T cells and cancer cells, reprogram their metabolism, including their lipid metabolism, to meet their energy and functional needs. Here, we review the participation of fatty acid and cholesterol metabolism homeostasis in orchestrating T cell biology. We demonstrate how the tumor microenvironment reshapes the lipid metabolism in T cells. Importantly, we highlight the current cancer therapeutic interventions that target fatty acid and cholesterol metabolism of T cells. By offering a holistic understanding of how lipid metabolic adaption by T cells facilitates their immunosurveillance in the tumor microenvironment, we believe this review and the future studies might inspire the next-generation immunotherapies.
81. Impact of Early Post-Transplant Multidrug-Resistant Organism Detection Among Renal Transplant Recipients, 2005–2021
Authors: Babiker Ahmed , Karadkhele Geeta , Robichaux Chad , Page Alex M , Satola Sarah W , Kraft Colleen S , Larsen Christian P , Pouch Stephanie M , Woodworh Michael H 
Published: December 2022

Abstract

Background
Understanding the impact of multi-drug resistant organism (MDRO) acquisition on renal transplant recipients (RTR) mortality and allograft function is paramount to mitigating deleterious outcomes. Prior studies have been limited by lack of control groups and sample sizes. We aimed to the assess whether the detection of an MDRO or a susceptible organism during the early post-transplant period was associated with increased mortality and allograft failure among RTRs.

Methods
We performed a retrospective cohort study of RTRs at the Emory University Transplant Center between 2005–2022. Early post-transplant culture positivity was defined as a positive culture within 30 days of renal transplant. The primary outcome was a combined composite of one year- allograft loss and/or mortality following renal transplant. A Kaplan–Meier survival analysis was performed, and differences between survival curves for RTRs with an early post-transplant positive culture (stratified by susceptibility status) and negative control RTRs were assessed using the log-rank test. Multivariable cox proportional hazard and a competing risk analysis were performed.

Results
Among 3,233 RTRs, 259 (8%) had a susceptible organism detected and 35 (1%) had an MDRO detected (Figure 1). Demographic and microbiology characteristics are summarized in Table 1 & 2. One hundred and forty-nine (5%) RTRs experienced the composite outcome, this was experienced more frequently among RTRs with an MDRO detected (14%, 5/35) compared to RTRs with a susceptible organism defected (8%, 21/259) and negative controls (4%, 123/2,939) (Table 3). Significant difference between time from transplantation to the composite outcome when comparing negative controls, MDRO and susceptible organisms RTRs was observed (log rank p &lt; 0.001) (Figure 2). Early post-transplant culture positivity (aHR 1.98 [1.30, 3.04]) and MDRO detection (aHR: 3.20 [1.30, 7.84]) were significantly associated with the composite outcome (Table 4).

Conclusion
MDRO as well as susceptible organism acquisition during the early post-transplant period was associated with increased mortality and allograft loss highlighting the need for increased infection prevention efforts within this vulnerable population.

Disclosures
All Authors: No reported disclosures.
735. Contribution of the Oral Cavity and Gastrointestinal Microbiome on Bloodstream Infections inLeukemia Patients
Authors: McMahon Stephanie , Microbiology B S , Galloway-Peña Jessica , Sahasrabhojane Pranoti V , Shelburne Samuel A 
Published: December 2022

Abstract

Background
Blood stream infections (BSI) are a common cause of morbidity and mortality in immunocompromised patients. It was previously reported that intestinal domination (defined as occupation of ≥ 30% of the microbiota by a single bacterial taxon) by
Enterococcus and Proteobacteria often preceded enterococcal and gram-negative BSI.

Methods
16s rRNA sequencing was used to analyze the saliva and stool of 73 acute leukemia patients with BSIs to determine the correlation between the taxa present ( &gt; 0% relative abundance), colonizing ( &gt; 3%) or dominating ( &gt; 30%) a patient’s microbiome and the BSI agent. Species level confirmation of these findings was performed via digital droplet PCR (ddPCR) and LEfSe analysis was used to determine enrichment of infectious taxa at either collection site. Whole genome sequencing and antimicrobial susceptibilities on all BSI isolates.

Results
We collected simultaneous patient stool and blood isolates from 11 Pseudomonas aeruginosa, 14 Escherichia coli, 4 Klebsiella sp., 8 Enterococcus sp., 18 viridans group streptococci (VGS), 13 Staphylococcus epidermidis, and 5 Staphylococcus aureus BSIs. Mann-Whitney testing confirmed that individuals with P. aeruginosa (oral P =.004, stool P &lt; .001), E. coli (stool P &lt; .001), and VGS infections (oral P =.001) had significantly higher relative abundance of those respective genera compared to other BSI patients, and this appeared to be site specific. LEfSe analysis confirmed enrichment of Pseudomonas in the saliva and stool, Escherichia in the stool, and Streptococcus in the saliva of respective infections. However, while 64 patients showed presence of the infectious genera in the stool and/or saliva at time of BSI, only 7 exhibited domination. ddPCR was used to confirm not only species specificity, but the detection of those antibiotic resistance determinants (CTX-14, CTX-15, Van A and CfrA) found in the BSI isolates within concurrent stool samples.

Conclusion
It appears that GI domination by the infecting organism was not present at the time of most BSIs. However, in scenarios where the etiological agent was detectable in the saliva or stool, so were the antibiotic resistant determinants. Furthermore, certain infections exhibited a significant difference in oral or stool presence by the same bacteria they were infected with.

Disclosures
All Authors: No reported disclosures.
740. Does Natural Language Processing Improve Identification of Hospitalized People Who Use Drugs?
Authors: Sato Taisuke , Murphy Meghan , Miller Robert , Wurcel Alysse Gail 
Published: December 2022

Abstract

Background
In the absence of substance use disorder treatment and harm reduction tools, people who use drugs (PWUD) are at increased risk for severe injection-related infections (SIRI). Health services research characterizing the scope and trends of hospitalizations for SIRI often requires administrative billing records, urine toxicology, and medications to treat opioid use disorder, often supplemented with manual chart review. The goal of this research was to examine the feasibility of using natural language processing (NLP) to augment traditional systems of PWUD. We explored the practicality of using Natural Language Processing as a tool to accurately identify PWUD in electronic medical records (EMR).

Methods
We worked with information technology/computer science specialists to create a cohort of all people hospitalized at Tufts Medical Center from January 1, 2020, to April 1, 2022. Patients entered this cohort through the presence of any of these criteria: ICD10 codes for substance use disorder, positive urine toxicology results for drugs (including opiates, cocaine, amphetamine), prescriptions for medications to treat substance use disorder (at admission, during hospitalization or discharge) and the presence of NLP keywords. The NLP keyword list was created through iterative meetings with IT specialists (Table 1).

Results
There were 3102 patients with 3501 hospitalizations. The Venn Diagram (Figure 1) displays the overlap of the 4 criteria. Only 55 people were identified by NLP terms only. The most frequent criteria filled for cohort entry was the toxicology screen. Only 4.1% of the group had all 4 criteria.

Conclusion
Identifying PWUD using an NLP algorithm was possible, but there was a small number of people who were added to the cohort only on NLP criteria. Improved methodologies of identifying PWUD with medical needs are necessary to better identify gaps in healthcare, facilitate benchmarking of quality care, and improve the lives of PWUD.

Disclosures
All Authors: No reported disclosures.
742. Identification of Barriers to Shifting Management of Diabetic Foot Infections from the Hospital Setting to a Multidisciplinary Wound Clinic
Authors: Lee Michelle , Dillman Nicholas O , Petty Lindsay A , Zhou Shiwei , Nagel Jerod 
Published: December 2022

Abstract

Background
Hospitalized patients with diabetic foot infections (DFI) are commonly stable upon admission and lack signs of sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Patients are admitted for key components of DFI care: non-urgent procedures for source control; radiographic imaging; cultures; consultation with infectious diseases (ID), podiatry, or vascular surgery; and peripherally inserted central catheter (PICC) access. We aimed to identify the proportion of patients with low acuity DFI who were hospitalized and to characterize potential barriers to outpatient management.

Methods
Between 2020 and 2021, data from the medical record were abstracted for adult patients admitted to Michigan Medicine with an ICD-10 admission diagnosis of DFI. Patients were categorized into low and high acuity cohorts. High acuity was defined as sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Low acuity was defined as clinical stability (≤ 1 systemic inflammatory response syndrome (SIRS) criteria) and without high acuity criteria. The primary outcome was the prevalence of low acuity DFIs admitted to the hospital, duration of hospitalization, and associated costs. Secondary outcomes included 30-day all-cause mortality, DFI recurrence, DFI readmission, and time from clinical stability to completion of DFI care (non-urgent procedures; radiographic imaging; cultures; consultation to ID, podiatry, or vascular surgery; and PICC access).

Results
Of 64 hospitalized DFI patients, 37 (58%) were low acuity and 27 (42%) high acuity. All low acuity patients were clinically stable on admission with a median hospitalization length of 6.3 days. Figure 1 shows the time to completion of key components of DFI care from clinical stability. Low acuity group had DFI recurrence of 5.4%; readmission with DFI of 10.8%; and all-cause mortality of 5.4%. The median hospitalization cost for low-acuity DFI was $55,500 per patient.

Conclusion
More than half of hospitalized DFI patients are low acuity, and could have avoided hospitalization. These patients had a median hospitalization length of 6.3 days and total cost of $55,500. Developing a coordinated process to manage low acuity patients outpatient may avoid unnecessary hospitalizations and reduce healthcare cost.

Disclosures
All Authors: No reported disclosures.