bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Cardiovascular Implantable Electronic Device Infection in Patients Presenting With Gram-Negative Bacteremia
Authors: Chesdachai Supavit , Baddour Larry M , Sohail M Rizwan , Palraj Bharath Raj , Madhavan Malini , Tabaja Hussam , Fida Madiha , Lahr Brian D , DeSimone Daniel C 
Published: August 2022

Abstract

Background
Gram-negative bacteremia (GNB) as a manifestation of cardiovascular implantable electronic device (CIED) infection is uncommon. Moreover, echocardiography may be nonspecific in its ability to differentiate whether CIED lead masses are infected. We aimed to determine the rate of CIED infection in the setting of GNB.

Methods
All patients with CIED who were hospitalized with GNB during 2012–2019 at Mayo Clinic were investigated. The definition of CIED infection was based on criteria recommended by the 2019 European Heart Rhythm Association document.

Results
A total of 126 patients with CIED developed GNB. None of them had signs of pocket infection. Twenty (15.9%) patients underwent transesophageal echocardiography. Overall, 4 (3%) patients had definite CIED infection. None of them underwent CIED extraction; 3 died within 12 weeks and 1 received long-term antibiotic suppression. Ten (8%) patients had possible CIED infection; despite no CIED extraction, no patient had relapsing GNB. We observed a higher rate of CIED infection in patients with Serratia marcescens bacteremia as compared to that in patients with other GNB.

Conclusions
The rate of CIED infection following GNB was relatively low. However, accurate classification of CIED infection among patients presenting with GNB remains challenging, in part, due to a case definition of CIED infection that is characterized by a low pretest probability in the setting of GNB. Prospective, multicenter studies are needed to determine accurate identification of CIED infection among GNB, so that only patients with true infection undergo device removal.
RADIOACTIVITY ASSESSMENT OF SURFACE SOIL IN THE VICINITY OF A URANIUM MINE IN MALAWI
Authors: Majawa Louis John , Tshivhase Victor M , Dlamini Thulani 
Published: August 2022

Abstract
The activity concentrations of 238U, 232Th and 40K in the soil of areas surrounding the Kayelekera uranium mine were assessed. This study aims to provide a comprehensive profile of soil radioactivity distribution in the area surrounding the uranium mine to determine radiological hazards associated with mining and processing activities. Soil samples were analysed using gamma-ray spectrometry with a high-purity germanium detector. Mean specific activities of 238U, 232Th and 40K were 58.3 ± 3.7, 40.3 ± 0.3 and 590.9 ± 63.9 Bq kg−1, respectively. Results from this study have indicated changes in radioactivity levels of naturally occurring radioactive materials in the area surrounding the understudied mine, with certain areas close to the mine site showing elevated levels of 238U, highlighting the need for systematic and periodic monitoring.
Standards of Diagnostic Validation: Recommendations for Reference Collections
Authors: Harmon Carrie L. , Castlebury Lisa A. , Boundy-Mills Kyria , Broders Kirk D. , Hyten Aimee M. , Jacobs Jonathan L. , Knight-Connoni Victoria K. , Mollov Dimitre , Riojas Marco A. , Sharma Poonam 
Published: August 2022

Agricultural and ecosystem biosecurity requires accurate and reliable diagnostic data provided by systems of people, technologies, and validated diagnostic assays. Biological reference collections, including living and preserved microbe culture collections, and authenticated sequence databases are essential for development and validation of robust diagnostic assays, as well as breeding for disease resistance. However, the lack of standardized requirements for long-term preservation, curation, recordkeeping, and data provenance of collections poses a significant risk to this research. Several examples of successful collections and funding models exist, but these are disparate, disconnected, and lack standards for harmonization among them. We recommend a framework for coordinated development, long-term maintenance, and accessibility of curated sets of pathogen data representing cultures and other reference material that could serve the needs of pathogen diagnostics development, population studies, and resistance breeding efforts. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Cigarette smoke promotes inflammasome‐independent activation of caspase‐1 and ‐4 leading to gasdermin D cleavage in human macrophages
Authors: Buscetta Marco , Cristaldi Marta , Cimino Maura , La Mensa Agnese , Dino Paola , Bucchieri Fabio , Rappa Francesca , Amato Santina , Aronica Tommaso Silvano , Pace Elisabetta , Bertani Alessandro , Cipollina Chiara 
Published: August 2022

AbstractMechanisms and consequences of gasdermin D (GSDMD) activation in cigarette smoke (CS)‐associated inflammation and lung disease are unknown. GSDMD is a downstream effector of caspase‐1, ‐8, and ‐4. Upon cleavage, GSDMD generates pores into cell membranes. Different degrees of GSDMD activation are associated with a range of physiological outputs ranging from cell hyperactivation to pyroptosis. We have previously reported that in human monocyte‐derived macrophages CS extract (CSE) inhibits the NLRP3 inflammasome and shifts the response to lipopolysaccharide (LPS) towards the TLR4‐TRIF axis leading to activation of caspase‐8, which, in turn, activates caspase‐1. In the present work, we investigated whether other ASC‐dependent inflammasomes could be involved in caspase activation by CSE and whether caspase activation led to GSDMD cleavage and other downstream effects. Presented results demonstrate that CSE promoted ASC‐independent activation of caspase‐1 leading to GSDMD cleavage and increased cell permeability, in the absence of cell death. GSDMD cleavage was strongly enhanced upon stimulation with LPS+CSE, suggesting a synergistic effect between the two stimuli. Noteworthy, CSE promoted LPS internalization leading to caspase‐4 activation, thus contributing to increased GSDMD cleavage. Caspase‐dependent GSDMD cleavage was associated with mitochondrial superoxide generation. Increased cleaved GSDMD was found in lung macrophages of smokers compared to ex‐smokers and non‐smoking controls. Our findings revealed that ASC‐independent activation of caspase‐1, ‐4, and ‐8 and GSDMD cleavage upon exposure to CS may contribute to macrophage dysfunction and feed the chronic inflammation observed in the smokers' lung.
Facial dermatitis in a healthy 9-year-old boy
Authors: Hiep Ashley , Gross Elissa 
Published: August 2022

ABSTRACT
This case report describes a boy who presented to the hospital with worsening facial rash and fevers. He had previously been prescribed mometasone cream for rosacea, which his mother applied daily for about 45 days. After a biopsy was performed, he was diagnosed with acneiform dermatitis likely secondary to topical corticosteroid use complicated by demodex folliculitis and a superimposed bacterial infection.
PAs in Puerto Rico
Authors: Weikel Kimberly , Juarez Laura , Irizarry Charity M. Ramsey 
Published: August 2022

ABSTRACT
As strained as Puerto Rico's healthcare infrastructure has become in recent years, the island's medical community has long resisted the idea of the physician assistant (PA). After almost 30 years of advocating for the PA profession in Puerto Rico, Law No. 71 was enacted in August 2017, recognizing the PA profession under the title of médico asistente. Eighteen months later, in February 2019, PAs were able to apply for licensure. However, the law as written severely restricts PA medical practice. This article reviews the current status of certified PAs in Puerto Rico and what steps are being taken to establish the profession to ultimately improve health outcomes and expand access to care throughout the island.
Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients
Authors: Hines Kevin , Philipp Lucas , Thalheimer Sara , Montenegro Thiago S. , Gonzalez Glenn A. , Hughes Liam P. , Leibold Adam , Mahtabfar Aria , Franco Daniel , Heller Joshua E. , Jallo Jack , Prasad Srinivas , Sharan Ashwini D. , Harrop James S. 
Published: August 2022

Study Design:
The present study design was that of a single center, retrospective cohort study to evaluate the influence of surgeon-specific factors on patient functional outcomes at 6 months following lumbar fusion. Retrospective review of a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis identified the present study population.

Objective:
This study seeks to evaluate surgeon-specific variable effects on patient-reported outcomes such as Oswestry Disability Index (ODI) and the effect of North American Spine Society (NASS) concordance on outcomes in the setting of variable surgeon characteristics.

Summary of Background Data:
Lumbar fusion is one of the fastest growing procedures performed in the United States. Although the impact of surgeon-specific factors on patient-reported outcomes has been contested, studies examining these effects are limited.

Methods:
This is a single center, retrospective cohort study analyzing a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis by 1 of 5 neurosurgery fellowship trained spine surgeons. The primary outcome was improvement of ODI at 6 months postoperative follow-up compared with preoperative ODI.

Results:
A total of 307 patients were identified for analysis. Overall, 62% of the study population achieved minimum clinically important difference (MCID) in ODI score at 6 months. Years in practice and volume of lumbar fusions were statistically significant independent predictors of MCID ODI on multivariable logistic regression (P=0.0340 and P=0.0343, respectively). Concordance with evidence-based criteria conferred a 3.16 (95% CI: 1.03, 9.65) times greater odds of achieving MCID.

Conclusion:
This study demonstrates that traditional surgeon-specific variables predicting surgical morbidity such as experience and procedural volume are also predictors of achieving MCID 6 months postoperatively from lumbar fusion. Independent of surgeon factors, however, adhering to evidence-based guidelines can lead to improved outcomes.
Lumbar Radiculopathy due to Iliacus Abscess: Diagnosis, Treatment, and Review of the Literature
Authors: Morrow Dillon , Read Connor , Powell Charles , Dunlap Burton , Colon Felipe , Miller Joseph , Cunningham Bryce 
Published: August 2022

Background:
An iliopsoas abscess is a type of deep pelvic infection that presents as an uncommon cause of back pain. Patients generally present with vague and ambiguous symptoms that pose diagnostic difficulty. This case report describes a 19-year-old female who initially presented with low back pain and lower extremity lumbar radiculopathy secondary to complex iliacus deep pelvic infection. This is the second documented case of lumbar radiculopathy as the presenting symptom for iliopsoas abscess. The patient underwent surgical drainage and debridement and was prescribed intravenous culture-tailored antibiotic therapy for 6 weeks.
Enhancing Clinical Teaching in Critical Thinking, High-Value Care, and Health Care Equity
Authors: Sullivan Amy M. , Beltran Christine P. , Ranchoff Brittany L. , Hayes Margaret M. , Atkins K. Meredith , Tibbles Carrie D. , Cohen Amy P. , Cohen David A. , Huang Grace C. , Schwartzstein Richard M. ,   the Clinician Educator Research Group
Published: August 2022

Introduction:
Faculty development in the clinical setting is challenging to implement and assess. This study evaluated an intervention (IG) to enhance bedside teaching in three content areas: critical thinking (CT), high-value care (HVC), and health care equity (HCE).

Methods:
The Communities of Practice model and Theoretical Domains Framework informed IG development. Three multidepartmental working groups (WGs) (CT, HVC, HCE) developed three 2-hour sessions delivered over three months. Evaluation addressed faculty satisfaction, knowledge acquisition, and behavior change. Data collection included surveys and observations of teaching during patient care. Primary analyses compared counts of post-IG teaching behaviors per hour across intervention group (IG), comparison group (CG), and WG groups. Statistical analyses of counts were modeled with generalized linear models using the Poisson distribution.

Results:
Eighty-seven faculty members participated (IG n = 30, CG n = 28, WG n = 29). Sixty-eight (IG n = 28, CG n = 23, WG n = 17) were observed, with a median of 3 observation sessions and 5.2 hours each. Postintervention comparison of teaching (average counts/hour) showed statistically significant differences across groups: CT CG = 4.1, IG = 4.8, WG = 8.2; HVC CG = 0.6, IG = 0.9, WG = 1.6; and HCE CG = 0.2, IG = 0.4, WG = 1.4 (P < .001).

Discussion:
A faculty development intervention focused on teaching in the context of providing clinical care resulted in more frequent teaching of CT, HVC, and HCE in the intervention group compared with controls. WG faculty demonstrated highest teaching counts and provide benchmarks to assess future interventions. With the creation of durable teaching materials and a cadre of trained faculty, this project sets a foundation for infusing substantive content into clinical teaching.
Perioperative Management of Ulcerative Colitis: A Systematic Review
Authors: Lee Kate E. , Faye Adam S. , Vermeire Séverine , Shen Bo 
Published: August 2022

BACKGROUND:
Patients with ulcerative colitis may require colectomy for severe disease unresponsive or refractory to pharmacological therapy. Managing ulcerative colitis is complicated as there are many factors at play, including patient optimization and treatment; the guidance varies on the ideal perioperative use of corticosteroids, immunomodulators, biologics, and small molecule agents.

OBJECTIVE:
A systematic literature review was performed to describe the current status of perioperative management of ulcerative colitis.

DATA SOURCES:
PubMed and Cochrane databases were used.

STUDY SELECTION:
Studies between January 2000 and January 2022, in any language, were included. Articles regarding pediatric or endoscopic management were excluded.

INTERVENTIONS:
Perioperative management of ulcerative colitis was included.

MAIN OUTCOME MEASURES:
Successful management, including reducing surgical complication rates, was measured.

RESULTS:
A total of 121 studies were included in this review, including 23 meta-analyses or systematic reviews, 25 reviews, and 51 cohort studies.

LIMITATIONS:
Qualitative review including all study types. The varied nature of study types precludes quantitative comparison.

CONCLUSION:
Indications for colectomy in UC include severe disease unresponsive to medical treatment and colitis-associated neoplasia. Urgent colectomy has a higher mortality rate than elective colectomy. Corticosteroids are associated with postsurgical infectious complications and should be stopped or weaned before surgery. Biologics are not associated with adverse postoperative effects and do not necessarily need to be stopped preoperatively. Additionally, the clinician must assess individuals’ comorbidities, nutrition status, and risk of venous thromboembolism. Nutritional imbalance should be corrected, ideally at preoperative period. Postoperatively, corticosteroids can be tapered based on the length of preoperative corticosteroid use.
Component blood transfusion used to treat massive postoperative hemorrhage after resection of a thoracic tumor: a case report
Authors: Zou Bin , Fan Haiyin , Guo Changying 
Published: August 2022

Introduction and importance:
Perioperative bleeding is a common complication of thoracic surgery. Massive bleeding after thoracic surgery usually requires secondary thoracotomy to achieve hemostasis. We report a patient who developed massive hemorrhage after resection of a large thoracic tumor. Such a massive hemorrhage has not been performed with secondary thoracotomy, which has not been reported yet.

Case presentation:
A 76-year-old man was suffering from chest pain for 3 weeks. Chest computed tomography showed a large thoracic tumor with a maximum diameter of ~160 mm. Tumor puncture cytology showed no cancer cells, but histopathologic examination revealed large amount of necrotic tissue. After detailed preoperative evaluation, the patient underwent tumor resection and pleural peeling. The patient developed massive thoracic hemorrhage after the surgery. This postoperative intrathoracic hemorrhage was controlled by infusion of large amounts of cryoprecipitate and other blood products.

Conclusions:
Our experience with this patient suggests that massive hemorrhage in such cases can be managed by blood transfusion instead of secondary thoracotomy. The key point is determining whether the hemorrhage is due to oozing from surgical wound or an active vascular bleed.
Two Independent Capsules Surrounding a Single Textured Implant in Ehlers-Danlos Syndrome
Authors: Padmanabhan Jagannath , Liu Farrah C. , Sivaraj Dharshan , Henn Dominic , Chen Kellen , Simon Devorah R. , Barrera Janos A. , Gurtner Geoffrey C. 
Published: August 2022

Summary:
Textured breast implants are associated with prolonged inflammation leading to increased risk for complications such as the development of anaplastic large cell lymphoma. The underlying molecular mechanisms that drive increased inflammation toward textured implants (compared with smooth implants) remain poorly understood. Here, we present the first known case of a patient with Ehlers-Danlos syndrome (EDS) who developed two independent fibrotic capsules around a single textured silicone implant. The patient was found to have one internal capsule tightly adherent to the implant and a second external capsule that was attached to the surrounding tissue. We observed that the internal implant-adherent capsule was composed of a highly aligned and dense collagen network, completely atypical for EDS and indicative of a high mechanical stress environment. In contrast, the external nonadherent capsule, which primarily interacted with the smooth surface of the internal capsule, displayed disorganized collagen fibers with no discernible alignment, classic for EDS. Remarkably, we found that the internal capsule displayed high activation of monocyte chemoattractant protein-1, a mechanoresponsive inflammatory mediator that was not elevated in the disorganized external capsule. Taken together, these findings demonstrate that the tight adhesion between the textured implant surface and the internal capsule creates a high mechanical stress environment, which is responsible for the increased local inflammation observed in the internal capsule. This unique case demonstrates that mechanical stress is able to override genetic defects locally in collagen organization and directly connects the textured surface of implants to prolonged inflammation.
AGGREGATIBACTER ENDOPHTHALMITIS IN A PATIENT WITH DENTOPHOBIA
Authors: Mejaddam Assem , Pircher Achmed 
Published: August 2022

Purpose:
To describe a rare case of unilateral, endogenous endophthalmitis caused by Aggregatibacter aphrophilus (HACEK group) confirmed in vitreous and blood cultures, in a patient with dentophobia.

Methods:
Case report.

Patients:
A seventy-five-year-old male patient with Type 2 diabetes, previous myocardial infarction, and pacemaker implantation.

Results:
Patient was observed with sudden loss of vision at the Department of Ophthalmology, Uppsala University. Initial diagnosis was posterior vitreous detachment and anterior uveitis, but progression of disease led to vitrectomy, which actually demonstrated endophthalmitis and growth of A. aphrophilus of the HACEK group. Aggregatibacter bacteremia and pacemaker endocarditis were also identified and dental examination confirmed growth of Aggregatibacter in the oral cavity. Intravitreal treatment with ceftazidime and vancomycin according to Endophthalmitis Vitrectomy Study protocol was administered with quick resolution of endophthalmitis.

Conclusion:
Aggregatibacter endophthalmitis is a rare, but devastating cause of vision loss where immediate diagnosis may be delayed. Prompt diagnosis may be facilitated by a thorough medical history and early vitreous biopsy. Systemic investigation by an infectious disease specialist and multidisciplinary assessment are mandatory. Ophthalmologic treatment is effective with intravitreal injections of ceftazidime and vancomycin.
The Case Against Stapedectomy as a Core Competency for General Practice: A Study of Care Patterns in the Department of Defense
Authors: Adams Jason K. , Malka Ronit E. , Marinelli John P. , Esquivel Carlos R. , Newberry Travis R. , Spear Samuel A. , Erbele Isaac D. 
Published: August 2022

Objective
Stapedectomy remains a key indicator case reportable to the Accreditation Council of Graduate Medical Education despite the decline in the incidence of otosclerosis over the last half century. This study compared the rates of stapedectomy performed by otolaryngologists at academic and nonacademic centers.

Study Design
Retrospective review.

Setting
Tertiary referral academic centers, nonacademic centers, and civilian purchased-care across the Department of Defense between 2015 and 2020.

Patients
Department of Defense beneficiaries with otosclerosis near a military treatment facility with an otolaryngologist.

Interventions
Stapedectomy (Current Procedural Terminology codes 69,660, 69,661, and 69,662).

Main Outcome Measures
Number of stapedectomies performed by setting.

Results
From 2015 to 2020, 426 stapedectomies were performed at or near a military treatment facility with an otolaryngologist (274 directly by military otolaryngologists, 152 by community providers). Military providers performed 94% of stapedectomies at or near military academic centers, versus only 30% at or near nonacademic centers (p < 0.0001). Among the 60 stapedectomies performed at nonacademic centers, only 30 were performed by general otolaryngologists (7% of all stapedectomies performed; 11% of procedures by military providers) while the rest were performed by fellowship-trained otologist or neurotologist.

Conclusions
Low stapes surgical volume by military general otolaryngologists reinforces recent epidemiologic trends and suggests that few general otolaryngologists graduate residency with sufficient competency to pursue independently performing stapedectomy or have difficulty maintaining competency after graduation.