pinecone/core-2020-05-10-deduplication huggingface dataset:
Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program

BACKGROUND: The Assistance Publique-Hôpitaux de Paris (AP-HP) institution administers 38 teaching hospitals (23 acute care and 15 rehabilitation and long-term care hospitals; total, 23 000 beds) scattered across Paris and surrounding suburbs in France. In the late 1980s, the proportion of methicillin resistance among clinical strains of Staphylococcus aureus (MRSA) reached approximately 40% at AP-HP.METHODS: A program aimed at curbing the MRSA burden was launched in 1993, based on passive and active surveillance, barrier precautions, training, and feedback. This program, supported by the strong commitment of the institution, was reinforced in 2001 by a campaign promoting the use of alcohol-based hand-rub solutions. An observational study on MRSA rate was prospectively carried out from 1993 onwards. RESULTS: There was a significant progressive decrease in MRSA burden (-35%) from 1993 to 2007, whether recorded as the proportion (expressed as percentage) of MRSA among S aureus strains (41.0% down to 26.6% overall; 45.3% to 24.2% in blood cultures) or incidence of MRSA cases (0.86 down to 0.56 per 1000 hospital days). The MRSA burden decreased more markedly in intensive care units (-59%) than in surgical (-44%) and medical (-32%) wards. The use of ABHR solutions (in liters per 1000 hospital days) increased steadily from 2 L to 21 L (to 26 L in acute care hospitals and to 10 L in rehabilitation and long-term care hospitals) following the campaign. CONCLUSION: A sustained reduction of MRSA burden can be obtained at the scale of a large hospital institution with high endemic MRSA rates, providing that an intensive program is maintained for a long period
Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients

Background: Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness. Methods: We prospectively studied 600 consecutive patients 65 years or older who were admitted with acute illness to a university teaching hospital over a 4-month interval. Potentially inappropriate medicines were defined by both Beers and STOPP criteria. Adverse drug events were defined by World Health Organization- Uppsala Monitoring Centre criteria and verified by a local expert consensus panel, which also assessed whether ADEs were causal or contributory to current hospitalization. Hallas criteria defined ADE avoidability. We compared the proportions of patients taking Beers criteria PIMs and STOPP criteria PIMs with avoidable ADEs that were causal or contributory to admission. Results: A total of 329 ADEs were detected in 158 of 600 patients (26.3%); 219 of 329 ADEs (66.6%) were considered causal or contributory to admission. Of the 219 ADEs, 151(68.9%) considered causal or contributory to admission were avoidable or potentially avoidable. After adjusting for age, sex, comorbidity, dementia, baseline activities of daily living function, and number of medications, the likelihood of a serious avoidable ADE increased significantly when STOPP PIMs were prescribed (odds ratio, 1.847; 95% confidence interval [CI], 1.506-2.264;P<.001);prescription of Beers criteria PIMs did not significantly increase ADE risk (odds ratio, 1.276; 95% CI, 0.945-1.722; P=.11). Conclusion: STOPP criteria PIMs, unlike Beers criteria PIMs, are significantly associated with avoidable ADEs in older people that cause or contribute to urgent hospitalization
Subclinical hyperthyroidism and the risk of coronary heart disease and mortality.

BACKGROUND: Data from prospective cohort studies regarding the association between subclinical hyperthyroidism and cardiovascular outcomes are conflicting.We aimed to assess the risks of total and coronary heart disease (CHD) mortality, CHD events, and atrial fibrillation (AF) associated with endogenous subclinical hyperthyroidism among all available large prospective cohorts.
METHODS: Individual data on 52 674 participants were pooled from 10 cohorts. Coronary heart disease events were analyzed in 22 437 participants from 6 cohorts with available data, and incident AF was analyzed in 8711 participants from 5 cohorts. Euthyroidism was defined as thyrotropin level between 0.45 and 4.49 mIU/L and endogenous subclinical hyperthyroidism as thyrotropin level lower than 0.45 mIU/L with normal free thyroxine levels, after excluding those receiving thyroid-altering medications.
RESULTS: Of 52 674 participants, 2188 (4.2%) had subclinical hyperthyroidism. During follow-up, 8527 participants died (including 1896 from CHD), 3653 of 22 437 had CHD events, and 785 of 8711 developed AF. In age- and sex-adjusted analyses, subclinical hyperthyroidism was associated with increased total mortality (hazard ratio[HR], 1.24, 95% CI, 1.06-1.46), CHD mortality (HR,1.29; 95% CI, 1.02-1.62), CHD events (HR, 1.21; 95%CI, 0.99-1.46), and AF (HR, 1.68; 95% CI, 1.16-2.43).Risks did not differ significantly by age, sex, or preexisting cardiovascular disease and were similar after further adjustment for cardiovascular risk factors, with attributable risk of 14.5% for total mortality to 41.5% forAF in those with subclinical hyperthyroidism. Risks for CHD mortality and AF (but not other outcomes) were higher for thyrotropin level lower than 0.10 mIU/L compared with thyrotropin level between 0.10 and 0.44 mIU/L(for both, P value for trend, .03).
CONCLUSION: Endogenous subclinical hyperthyroidism is associated with increased risks of total, CHD mortality, and incident AF, with highest risks of CHD mortality and AF when thyrotropin level is lower than 0.10 mIU/L
Attention and fluctuating attention in patients with dementia with lewy bodies and alzheimer disease

Background: Attentional deficits are described in the consensus clinical criteria for the operationalized diagnosis of dementia with Lewy bodies (DLB) as characteristic of the condition. In addition, preliminary studies have indicated that both attentional impairments and fluctuation of attentional impairments are more marked in patients with DLB than in patients with Alzheimer disease (AD), although neuropsychological function has not previously been examined in a large prospective cohort with confirmed diagnostic accuracy against postmortem diagnosis. Methods: A detailed evaluation of attention and fluctuating attention was undertaken in 155 patients with dementia (85 with DLB and 80 with AD) from a representative hospital dementia case register and 35 elderly controls using the Cognitive Drug Research Computerized Assessment System for Dementia Patients computerized neuropsychological battery. Operationalized clinical diagnosis was made using the consensus criteria for DLB and the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD. High levels of sensitivity and specificity have been achieved for the first 50 cases undergoing postmortem examination. Results: The groups were well matched for severity of cognitive impairments, bur the AD patients were older (mean age, 80 vs 78 years) and more likely to be female (55 vs 40). Patients with DLB were significantly more impaired than patients with AD on all measures of attention and fluctuating attention (for all comparisons, t â�¥ 2.5, P<.001), and patients from both dementia groups were significantly more impaired than elderly controls for all comparisons other than cognitive reaction time, which was significantly more impaired in DLB patients than controls but was comparable in controls and AD patients. There were, however, significant associations between the severity of cognitive impairment and the severity of both attentional deficits and fluctuations in attention. Conclusions: This large prospective study confirms that slowing of cognitive processing, attention, and fluctuations of attention are significantly more pronounced in DLB and AD patients, although fluctuating attention is common in patients with moderate-to-severe AD. Deficits of cognitive reaction rime appear to be specific to DLB, except in severe dementia. A detailed evaluation of attentional performance could make an important contribution to differential diagnosis, although the results need to be interpreted within the context of the overall severity of cognitive deficits
Clinical and pathological continuum of multisystem TDP-43 proteinopathies

OBJECTIVE: To determine the extent of transactivation response DNA-binding protein with a molecular weight of 43 kDa (TDP-43) pathology in the central nervous system of patients with clinically and autopsy-confirmed diagnoses of frontotemporal lobar degeneration with and without motor neuron disease and amyotrophic lateral sclerosis with and without cognitive impairment. DESIGN: Performance of immunohistochemical whole-central nervous system scans for evidence of pathological TDP-43 and retrospective clinical medical record review. SETTING: An academic medical center. PARTICIPANTS: We included 64 patients with clinically and pathologically confirmed frontotemporal lobar degeneration with ubiquitinated inclusions with or without motor neuron disease and amyotrophic lateral sclerosis with or without cognitive impairment. MAIN OUTCOME MEASURE: Neuronal and glial TDP-43 pathology. RESULTS: We found evidence of neuronal and glial TDP-43 pathology in all disease groups throughout the neuraxis, albeit with variations in the frequency, morphology, and distribution of TDP-43 lesions. Moreover, the major clinical manifestations (eg, cognitive impairments, motor neuron signs, extrapyramidal symptoms, neuropsychiatric features) were reflected by the predominant distribution and burden of TDP-43 pathology. CONCLUSION: These findings strongly suggest that amyotrophic lateral sclerosis, frontotemporal lobar degeneration with amyotrophic lateral sclerosis or motor neuron disease, and frontotemporal lobar degeneration with ubiquitinated inclusions are different manifestations of a multiple-system TDP-43 proteinopathy linked to similar mechanisms of neurodegeneration
The spectrum of mutations in progranulin: a collaborative study screening 545 cases of neurodegeneration

BACKGROUND: Mutation in the progranulin gene (GRN) can cause frontotemporal dementia (FTD). However, it is unclear whether some rare FTD-related GRN variants are pathogenic and whether neurodegenerative disorders other than FTD can also be caused by GRN mutations.\ud
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OBJECTIVES: To delineate the range of clinical presentations associated with GRN mutations and to define pathogenic candidacy of rare GRN variants.\ud
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DESIGN: Case-control study.\ud
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SETTING: Clinical and neuropathology dementia research studies at 8 academic centers.\ud
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PARTICIPANTS: Four hundred thirty-four patients with FTD, including primary progressive aphasia, semantic dementia, FTD/amyotrophic lateral sclerosis (ALS), FTD/motor neuron disease, corticobasal syndrome/corticobasal degeneration, progressive supranuclear palsy, Pick disease, dementia lacking distinctive histopathology, and pathologically confirmed cases of frontotemporal lobar degeneration with ubiquitin-positive inclusions (FTLD-U); and 111 non-FTD cases (controls) in which TDP-43 deposits were a prominent neuropathological feature, including subjects with ALS, Guam ALS and/or parkinsonism dementia complex, Guam dementia, Alzheimer disease, multiple system atrophy, and argyrophilic grain disease.\ud
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MAIN OUTCOME MEASURES: Variants detected on sequencing of all 13 GRN exons and at least 80 base pairs of flanking introns, and their pathogenic candidacy determined by in silico and ex vivo splicing assays.\ud
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RESULTS: We identified 58 genetic variants that included 26 previously unknown changes. Twenty-four variants appeared to be pathogenic, including 8 novel mutations. The frequency of GRN mutations was 6.9% (30 of 434) of all FTD-spectrum cases, 21.4% (9 of 42) of cases with a pathological diagnosis of FTLD-U, 16.0% (28 of 175) of FTD-spectrum cases with a family history of a similar neurodegenerative disease, and 56.2% (9 of 16) of cases of FTLD-U with a family history.\ud
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CONCLUSIONS: Pathogenic mutations were found only in FTD-spectrum cases and not in other related neurodegenerative diseases. Haploinsufficiency of GRN is the predominant mechanism leading to FTD
Fine-needle aspiration biopsy: its Use in orbital tumors

Fifteen orbital tumors have been evaluated with the fine-needle aspiration biopsy (FNAB) technique. The best indication for FNAB is supposed malignant orbital disease. The technique has not been helpful in tumors or inflammatory disease with a high fibrous content. Lesions that are suspected of being pseudotumors are not recommended for FNAB since, even in histologic sections, they are notoriously difficult to distinguish from well-differentiated lymphocytic malignant lymphoma. Benign encapsulated tumors should not be subjected to FNAB
Sideways displacement and curved path of recti eye muscles

We investigated the sideways displacement of recti muscles with the eye in various gaze-positions by making computed tomographic (CT) scans in a plane perpendicular to the muscle cone, posterior to the globe. We found no consistent sideways displacement of the horizontal recti in the up or down gaze or the vertical recti in the left or right gaze. We found a substantial displacement, however, of the contracting and relaxing muscles. Consequently, we made CT scans in a horizontal plane through medial and lateral recti and found that, with the eye in primary position, the recti muscles follow a curved path. The curvature of the path increased following muscle relaxation and decreased following muscle contraction
Intraoperative length and tension curves of human eye muscles. Including stiffness in passive horizontal eye movement in awake volunteers

Intraoperative continuous-registration length and tension curves of attached and detached eye muscles were made in 18 strabismic patients under general anesthesia. For relaxed eye muscles, we found an exponential relation between length and tension. An increased stiffness was quantified in Duane's syndrome, Graves' disease, orbital-floor fracture, and superior oblique palsy. The stiffnesses of agonist and antagonist were remarkably similar, not only in uncomplicated squint, but also when only one of the two had initially become stiffer. After intravenous administration of succinylcholine chloride, the eye muscles contracted, and the exponential length and tension curve changed into a set of straight, parallel lines. In addition, we measured stiffness in passive horizontal eye movement in awake volunteers and found 0.52 to 1.26 g/degrees (other eye in 5° of adduction), confirming other published results
Treatment of Partly Accommodative Esotropia With a High Accommodative Convergence-Accommodation Ratio

In the June 1987 issue of the Archives, the results were published of a study by Kushner et al1 on the treatment of accommodative convergence excess, with bilateral medial rectus recessions or recessions with 14-mm posterior fixation sutures. Posterior fixation surgery was considered an unsatisfactory technique in this study, a conclusion based mainly on the frequent occurrence of overcorrections, although large undercorrections also occurred in the recession with posterior fixation suture group. Mims,2 in a letter to the editor in the September 1987 issue of the Archives, reached a similar conclusion: six overcorrections in a group of 30 patients.We think that at least some of these overcorrections were caused by adding a large, uniform-dose posterior fixation operation to a recession that, by itself, was appropriate for the angle measured at distance fixation
Pterygium and Associated Ocular Surface Squamous Neoplasia

Objective: To measure the rate of histopathologically identified ocular surface squamous neoplasia (OSSN) in pterygium specimens. Methods: All pterygium specimens collected from consecutive patients between April 8, 2003, and February 6, 2008, were submitted for histopathologic examination, and the rate of OSSN was calculated. Results: The rate of OSSN was 9.8% (52 of 533) in sequential pterygium specimens. Conclusions: This rate of unsuspected OSSN suggests that all specimens of pterygium should be submitted for histopathologic examination and that patients in whom OSSN is noted should be examined at more frequent intervals so any clinical OSSN that develops can be identified at an early stage
Ultra-High-Resolution Optical Coherence Tomographic Findings in Commotio Retinae

Commotio retinae is a self-limited opacification of the retina secondary to direct blunt ocular trauma. Histologic studies of monkeys and humans relate this clinical observation to damaged photoreceptor outer segments and receptor cell bodies.[superscript 1 - 3] Reports using time-domain optical coherence tomography (OCT) and spectral-domain OCT support the involvement of the photoreceptor layer, but these techniques lack the resolution necessary to confirm results of histologic analysis.[superscript 4 - 6] Prototype high-speed ultra–high-resolution OCT (hs-UHR-OCT) images demonstrate these anatomical changes in a patient with acute commotio retinae.National Institutes of Health (U.S.) (Contract Number RO1-EY11289-23)National Institutes of Health (U.S.) (Contract Number R01-EY13178-07)United States. Air Force Office of Scientific Research (Grant Number FA9550-07-1-0101)United States. Air Force Office of Scientific Research (Grant Number FA9550-07-1-0014
Prognostic Indicators and Outcome Measures for Surgical Removal of Symptomatic Nonadvanced Cataract

This article is made available in accordance with the publisher's public repositories policy.Objectives To report changes in perceived visual functioning after surgery for symptomatic cataract with preoperative corrected distance visual acuity [CDVA] of 0.4 logMAR or better (Snellen equivalent, 20/50) and to investigate the relationship between any observed changes and preoperative physical characteristics and psychophysical consequences of the lens opacity and any changes in psychophysical findings after the procedure.\ud
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Methods Eighty-five patients with cataract completed a validated questionnaire concerning functional vision satisfaction and a series of visual performance assessments before and 2 months after cataract surgery. The lens optical density and Lens Opacities Classification System III score of the cataract were recorded. Correlations between changes in the Rasch-analyzed questionnaire score and changes in visual performance after cataract surgery, as well as preoperative psychophysical measures, lens optical density, and Lens Opacities Classification System III score, were determined.\ud
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Results The mean (SD) questionnaire score improved from 2.15 (0.36) to 1.54 (0.41) (P < .001). The preoperative questionnaire score (r = −0.44), preoperative mesopic glare disability [GD] (at 1.5 cycles per degree [cpd] [r = 0.34] and 3.0 cpd [r = 0.27]), and preoperative photopic GD (at 1.5 cpd [r = 0.24] and 3.0 cpd [r = 0.30]) showed statistically significant correlations with perceived improvements in visual functioning after surgery (P < .05). Changes in perceived visual functioning correlated significantly with changes in mesopic GD (at 1.5 cpd [r = −0.43] and 3.0 cpd [r = −0.28]; P < .05) and photopic GD (at 1.5 cpd [r = −0.24] and 3.0 cpd [r = −0.39]; P < .05). Neither preoperative CDVA nor change in CDVA after surgery correlated significantly with perceived improvement in visual functioning after the procedure (P >> .05 for both).\ud
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Conclusion Psychophysical tests alternative to CDVA better represent improvements in self-reported visual functioning following removal of symptomatic nonadvanced cataract
Subjective Quality of Vision Before and After Cataract Surgery

This article is made available in accordance with the publisher's public repositories policy.Objective To investigate the effect of cataract surgery on subjective quality of vision.\ud
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Methods The Quality of Vision (QoV) questionnaire (Italian translation) was completed before and 3 months after cataract surgery in 4 groups of patients recruited from September through December 2010: first eye with ocular comorbidity, first eye without ocular comorbidity, second eye with ocular comorbidity, and second eye without ocular comorbidity. The questionnaire measures 3 aspects of quality of vision: frequency, severity, and bothersome nature of symptoms. The Lens Opacities Classification System (LOCS) III was used for cataract grading. Friedman and Kruskal-Wallis H tests were performed to compare QoV scores within and between groups. Spearman rank correlations (rs) were calculated to investigate the correlation between LOCS III and QoV symptoms.\ud
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Results Two hundred twelve patients (mean [SD] age, 74.2 [8.7] years) were recruited, and 212 eyes were included in the study. Improvements in QoV scores were found in all 4 groups (P < .05). There were no statistically significant (P > .05) differences among the 4 groups in the improvement in QoV scores or in the preoperative or postoperative scores. Blurred vision was correlated with posterior subcapsular cataract (rs = 0.420, P = .04).\ud
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Conclusions Cataract in one or both eyes causes a similar loss in subjective quality of vision, which is also irrespective of the presence of ocular comorbidity. Posterior subcapsular cataract causes the specific symptom “blurred vision.” Cataract surgery resulted in a large and comparable improvement in subjective quality of vision, regardless of ocular comorbidity and first or second eye surgery
Relationship among CFH and ARMS2 genotypes, macular pigment optical density, and neuroretinal function in persons without age-related macular degeneration

Purpose: To determine whether there is a difference in neuroretinal function and in macular pigment optical density between persons with high- and low-risk gene variants for age-related macular degeneration (AMD) and no ophthalmoscopic signs of AMD, and to compare the results on neuroretinal function to patients with manifest early AMD.\ud
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Methods and Participants: Neuroretinal function was assessed with the multifocal electroretinogram (mfERG) for 32 participants (22 healthy persons with no AMD and 10 early AMD patients). The 22 healthy participants with no AMD had high- or low-risk genotypes for either CFH (rs380390) and/or ARMS2 (rs10490924). Trough-to-peak response densities and peak-implicit times were analyzed in 5 concentric rings. Macular pigment optical densitometry was assessed by customized heterochromatic flicker photometry.\ud
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Results: Trough-to-peak response densities for concentric rings 1 to 3 were, on average, significantly greater in participants with high-risk genotypes than in participants with low-risk genotypes and in persons with early AMD after correction for age and smoking (p<0.05). The group peak- implicit times for ring 1 were, on average, delayed in the patients with early AMD compared with the participants with high- or low-risk genotypes, although these differences were not significant. There was no significant correlation between genotypes and macular pigment optical density.\ud
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Conclusion: Increased neuroretinal activity in persons who carry high-risk AMD genotypes may be due to genetically determined subclinical inflammatory and/or histological changes in the retina. Neuroretinal function in healthy persons genetically susceptible to AMD may be a useful additional early biomarker (in combination with genetics) before there is clinical manifestation