Validation of a health-related quality of life questionnaire in patients with recurrent Clostridioides difficile infection in ECOSPOR III, a Phase 3 randomized trial

alexandrossfakianakis shared this article with you from Inoreader Validation of a health-related quality of life questionnaire in patients with recurrent Clostridioides difficile infection in ECOSPOR III, a Phase 3 randomized trial via Clinical Infectious Diseases Advance Access Abstract Background Debilitating symptoms of recurrent Clostridioides difficile infection (rCDI) often lead to long-term effects on health-related quality-of-life (HRQOL). In ECOSPOR III, SER-109, an investigational oral microbiome therapeutic, was superior to placebo in reducing rCDI. We investigated the validity, reliability, and responsiveness of a 32-item, CDI-specific questionnaire (Cdiff32) across mental, physical, and social domains in patients with rCDI. Methods In this post-hoc analysis of a Phase 3 clinical trial, 182 outpatients with rCDI completed Cdiff32 and EQ-5D at baseline, 1 and 8 weeks. Cdiff32 was evaluated for item performance, internal reliability, and convergent validity. To assess known-groups validity, Cdiff32 scores were compared across recurrent versus non-recurrent patients at week 1; internal responsiveness was evaluated in non-re current patients by 8 weeks by paired t-test. Results All 182 patients (mean age 65.5 ± 16.5, 59.9% female) completed baseline Cdiff32. Confirmatory factor analysis identified 3 domains (physical, mental, and social relationships) with good item fit. High internal reliability was demonstrated (Cronbach's alpha = 0.94 with all subscales > 0.80). Convergent validity was evidenced by significant correlations between Cdiff32 subscales and EQ-5D (r range: 0.29-0.37, p < 0.001). Cdiff32 differentiated recurrent from non-recurrent patients at week 1 (effect sizes: 0.38-0.42; p < 0.05 overall), with significant improvement from baseline to week 8 in non-recurrent patients (effect sizes: 0.75-1.02; p < 0.001 overall). Conclusions Cdiff32 is a valid, reliable, and responsive disease-specific HRQOL questionnaire fit-for-purpose for interventional treatment trials. The significant improvement in non-recurrent patients by 8 weeks demonstra tes the negative impact of rCDI on HRQOL. View on Web

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Kindlin-2 loss in condylar chondrocytes causes spontaneous osteoarthritic lesions in the temporomandibular joint in mice

alexandrossfakianakis shared this article with you from Inoreader Kindlin-2 loss in condylar chondrocytes causes spontaneous osteoarthritic lesions in the temporomandibular joint in mice via International Journal of Oral Science - Issue View on Web

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Perioperative Antibiotic Stewardship in the Organ Transplant Setting

alexandrossfakianakis shared this article with you from Inoreader Perioperative Antibiotic Stewardship in the Organ Transplant Setting via Transplant Infectious Disease Abstract Background Solid organ transplant (SOT) recipients can benefit from traditional antimicrobial stewardship (AMS) activities directed to improve judicious perioperative prescribing and management, but evidence is lacking. The aim of this expert opinion review is to provide an update on the current landscape of application of AMS practices for optimization of perioperative prophylaxis (PP). Methods We reviewed the available literature on early post-operative infectious complications in SOT and PP management, on modified perioperative approaches in case of infection or colonization in recipients and donors and on AMS in transplantation PP. Results SOT recipients are at high risk for early post-operative infectious complications due to the complexity of surgical procedures, severity of end stage organ disease, net state of immunosuppression in the post-transplant period and to the high risk for multidrug resistant organism. Moreover, SOT may be exposed to preservation fluid infections and expected or unexpected donor-derived infections. We summarize main factors to take into account when prescribing transplant PP. Conclusion Creating personalized PP to avoid unwanted consequences of antimicrobials while improving outcomes is an emerging and critical aspect in SOT setting. Further studies are needed to offer best PP tailored to SOT type and to evaluate interventions efficacy and safety. This article is protected by copyright. All rights reserved View on Web

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Impact of Narrowing Perioperative Antibiotic Prophylaxis for Left Ventricular Assist Device Implantation

alexandrossfakianakis shared this article with you from Inoreader Impact of Narrowing Perioperative Antibiotic Prophylaxis for Left Ventricular Assist Device Implantation via Transplant Infectious Disease Abstract Background Although infections are a significant potential complication among patients undergoing left ventricular assist device (LVAD) implantation, standardized surgical infection prophylaxis (SIP) regimens are not well defined. At Montefiore Medical Center, a 4-drug SIP regimen containing fluconazole, ciprofloxacin, rifampin, and vancomycin was previously utilized. In January 2020, the antimicrobial stewardship program implemented a 2-drug SIP regimen of vancomycin and cefazolin to limit exposure to broad-spectrum antibiotics. This study evaluated LVAD-associated infection rates prior to and following the SIP revision. Methods A retrospective review of patients who underwent LVAD implantation from 1/2018-4/2021 was performed. Infections were classified using the International Society for Heart and Lung Transplantation definitions. Infection rates at 2 weeks, 30 days, and 90-days post-implantation in the 4-drug SIP regimen (1/2018-12/2019) and the 2-drug SIP regimen (1/2020-4/2021) were compared. Results A total of 71 patients were included. The number of patients with LVAD-associated infections (including surgical site infections) was not significantly different in either SIP group at 2 weeks (9% vs 4%, p = 0.64), 30 days (9% vs 11%, p = 0.99), or 90 days (19% vs 14%, p = 0.75). There was no statistically significant difference in 30 or 90-day mortality. LVAD-associated gram-negative (7% vs 7%; p>0.99) and fungal (5% vs 0%; p = 0.51) infections were uncommon. The most common organism isolated was Staphylococcus aureus and the most common type of infection was pneumonia in both SIP groups. Conclusion No significant difference in LVAD-associated infections or infection-related mortality was observed with de-escalation of perioperative antibiotics. Additional studies with larger sample sizes are needed to endorse the findings of this study. This article is protected by copyright. All rights reserved View on Web

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Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5066 Patients in the National Database of Hospital-based Cancer Registries in Japan

alexandrossfakianakis shared this article with you from Inoreader Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5066 Patients in the National Database of Hospital-based Cancer Registries in Japan via Annals of Surgery - Most Popular Articles Objective: To determine whether esophagectomy provides a survival advantage in octogenarians with resectable thoracic esophageal cancer. Summary Background Data: Elderly patients with thoracic esophageal cancer do not always receive the full standard treatment; however, advanced age alone should not preclude the use of effective treatment that could meaningfully improve survival. Methods: We retrieved the 2008 to 2011 data from the National Database of Hospital-based Cancer Registries from the National Cancer Centerin Japan, divided the patients into a ≥75 group (75–79 years; n = 2935) and a ≥80 group (80 years or older; n = 2131), and then compared the patient backgrounds and survival curves. A multivariable Cox proportional hazards regression model was developed to compare the effects of esophagectomy and chemoradiotherapy in the 2 groups. Results: A significantly greater percentage of patients were treated with esoph-agectomy in the ≥75 group (34.6%) than the ≥80 group (18.4%). Among patients who received esophagectomy, the 3-year survival rate was 51.1% in the ≥ 75 group and 39.0% in the ≥80 group (P View on Web

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Fastigial nuclei surgical damage and focal midbrain disruption implicate PAG survival circuits in cerebellar mutism syndrome

alexandrossfakianakis shared this article with you from Inoreader Fastigial nuclei surgical damage and focal midbrain disruption implicate PAG survival circuits in cerebellar mutism syndrome via Neuro-Oncology Advance Access Abstract Background Pediatric postoperative cerebellar mutism syndrome (CMS) is a rare but well-known complication of medulloblastoma (Mb) resection with devastating effects on expressive language, mobility, cognition, and emotional regulation that diminishes quality of life for many Mb survivors. The specific anatomical and neuronal basis of CMS remains obscure. We address this issue by identifying patterns of surgical damage and secondary axonal degeneration in Mb survivors with CMS. Methods Children with Mb deemed high-risk for CMS based on intraventricular location of the tumor had T1 images analyzed for location(s) of surgical damage using a specially developed algorithm. We used three complementary methods of spatial analysis to identify surgical damage linked to CMS diagnosis. Magnetization transfer ratio (MTR) images were analyzed for evidence of demyelination in anatomic regions downstream of the cerebellum, indicating neuronal dysfunction. Results Spatial analyses highlighted damage to the fastigial nuclei and their associated cerebellar cortices as the strongest predictors of CMS. CMS-related MTR decrease was greatest in the ventral periaqueductal grey area (PAG) and highly consistent in the left red nucleus. Conclusion Our evidence points to disruption of output from the fastigial nuclei as a likely causal trigger for CMS. We propose that core CMS symptoms result from a disruption in the triggering of survival behaviors regulated by the PAG, including the gating of vocalization and volitional movement. The fastigial nuclei provide the densest output to the PAG from the cerebellum, thus sparing these structures may provide a greater likelihood of CMS prevention. View on Web

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Habitual Exercise, Air Pollution, and Pneumonia Mortality: A Longitudinal Cohort Study of Approximately 0.4 Million Adults

alexandrossfakianakis shared this article with you from Inoreader Habitual Exercise, Air Pollution, and Pneumonia Mortality: A Longitudinal Cohort Study of Approximately 0.4 Million Adults via American Journal of Epidemiology - Advance Access Abstract This study aims to examine the combined associations of PM2.5 and exercise with deaths from pneumonia. We included 384,130 participants with an age of ≥18 years from Taiwan during 2001-2016. The adults were followed up until 31 May 2019 to obtain the vital status. We performed a time-dependent Cox regression model for statistical analysis. We found that the risk of pneumonia mortality reduced 55% [hazard ratio (HR): 0.45 (95% confidence intervals, CI: 0.36–0.55)] and 36% [0.64 (95%CI: 0.52–0.80)] in participants who took high-/moderate-level of exercise, respectively, as compared to the inactive. By contrast, every 10μg/m3 increase in chronic exposure to PM2.5 was associated with a 30% [1.30 (95%CI: 1.17–1.45)] higher risk of pneumonia mortality. The risk of pneumonia mortality decreased 72% (95%CI: 59%–80%) for the adults who took high-level exercise and simultaneously exposed to low-level PM2.5. A lower risk of pneumonia mortality was associated with both higher exercise and lower PM2.5 air pollution. For adults exposed to different levels of PM2.5, exercise benefits remained. Our findings suggest taking exercise is a safe and effective strategy to alleviate the burden of pneumonia mortality even for people who reside in a moderately-polluted area. View on Web

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