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Early replacement of a new central venous catheter (CVC) may pose a risk of persistent or recurrent infection in patients with a catheter-related bloodstream infection (CRBSI). We evaluated the clinical impact of early CVC reinsertion after catheter removal in patients with CRBSIs.
We conducted a retrospective chart review of adult patients with confirmed CRBSIs in 2 tertiary-care hospitals over a 7-year period.
To treat their infections, 316 patients with CRBSIs underwent CVC removal. Among them, 130 (41.1%) underwent early CVC reinsertion (≤3 days after CVC removal), 39 (12.4%) underwent delayed reinsertion (>3 days), and 147 (46.5%) did not undergo CVC reinsertion. There were no differences in baseline characteristics among the 3 groups, except for nontunneled CVC, presence of septic shock, and reason for CVC reinsertion. The rate of persistent CRBSI in the early CVC reinsertion group (22.3%) was higher than that in the no CVC reinsertion group (7.5%; P = .002) but was similar to that in the delayed CVC reinsertion group (17.9%; P > .99). The other clinical outcomes did not differ among the 3 groups, including rates of 30-day mortality, complicated infection, and recurrence. After controlling for several confounding factors, early CVC reinsertion was not significantly associated with persistent CRBSI (OR, 1.59; P = .35) or 30-day mortality compared with delayed CVC reinsertion (OR, 0.81; P = .68).
Early CVC reinsertion in the setting of CRBSI may be safe. Replacement of a new CVC should not be delayed in patients who still require a CVC for ongoing management.
Several life-threatening diseases of the kidney have their origins in mutational events that occur during embryonic development. In this study, we investigate the role of the Wolffian duct (WD), the earliest embryonic epithelial progenitor of renal tubules, in the etiology of autosomal dominant polycystic kidney disease (ADPKD). ADPKD is associated with a germline mutation of one of the two Pkd1 alleles. For the disease to occur, a second event that disrupts the expression of the other inherited Pkd1 allele must occur. We postulated that this secondary event can occur in the pronephric WD. Using Cre-Lox recombination, mice with WD-specific deletion of one or both Pkd1 alleles were generated. Homozygous Pkd1-targeted deletion in WD-derived tissues resulted in mice with large cystic kidneys and serologic evidence of renal failure. In contrast, heterozygous deletion of Pkd1 in the WD led to kidneys that were phenotypically indistinguishable from control in the early postnatal period. High-throughput sequencing, however, revealed underlying gene and microRNA (miRNA) changes in these heterozygous mutant kidneys that suggest a strong predisposition toward developing ADPKD. Bioinformatic analysis of this data demonstrated an upregulation of several miRNAs that have been previously associated with PKD; pathway analysis further demonstrated that the differentially expressed genes in the heterozygous mutant kidneys were overrepresented in signaling pathways associated with maintenance and function of the renal tubular epithelium. These results suggest that the WD may be an early epithelial target for the genetic or molecular signals that can lead to cyst formation in ADPKD.
Residents of Hong Kong have undergone a dietary transition from a traditional Chinese diet that is high in seafood to a more Western diet. This may have affected the nutritional composition of breast milk of Hong Kong mothers. The present study aims to investigate the relationship between the dietary pattern and the fatty acid profile of the breast milk of lactating women in Hong Kong. Seventy-three volunteering healthy Hong Kong lactating mothers participated in the study. Their dietary intakes were assessed by using a 3-d dietary record and FFQ. The mean n-3 fatty acid levels were approximately 0·4 % (EPA) and 0·9 % (DHA) of total fatty acids in the breast milk of lactating mothers who had exclusively breastfed their infants aged 2–6 months. Maternal dietary intakes of n-3 fatty acids were positively associated with their levels in the breast milk. The levels of maternal intakes of freshwater and saltwater fish, especially the consumption of salmon, croaker and mandarin, were significantly correlated with the content of DHA in breast milk. The present study is among the very few in the literature to determine the fatty acid profile of breast milk in Hong Kong populations and verify certain dietary factors that influence this profile. High levels of n-3 PUFA, especially DHA, were observed in the breast milk of Hong Kong lactating women. The findings may serve as a dietary reference for lactating mothers to optimise the fatty acid profile of their breast milk.
Recent analyses of Lee et al. (2018, 2019) have confirmed that Galactic bulge consists of stellar populations originated from Milky Way globular clusters (MWGCs). Motivated by this, here we present the evolutionary population synthesis (EPS) for the Galactic bulge and early-type galaxies (ETGs) with the realistic treatment of individual variations in light elements observed in the MWGCs. We have utilized our model with GC-origin populations to explain the CN spread observed in ETGs, and the results show remarkable matches with the observations. We further employ our model to estimate the age of ETGs, which are considered as good analogs for the MW bulge. We find that, without the effect of our new treatments, EPS models will almost always underestimate the true age of ETGs. Our analysis indicates that the EPS with GC-origin populations is an essential constraint in determining the ETG formation epoch and is closely related to understanding the evolution of the Universe.
We investigated potential nosocomial aerosol transmission of severe fever with thrombocytopenia syndrome virus (SFTSV) with droplet precautions. During aerosol generating procedures, SFTSV was be transmitted from person to person through aerosols. Thus, airborne precautions should be added to standard precautions to avoid direct contact and droplet transmission.
Palaeoenvironmental history is reconstructed from diatoms in two sediment cores, GC01-PW02 and GC03-PW02, recovered from Powell Basin, Antarctica. A total of 43 species belonging to 21 genera are identified from GC01-PW02. A total of 61 species belonging to 27 genera are identified from GC03-PW02. The number of diatom valves g-1 of dry sediment ranges from 0.1–48.3 × 106 valves g-1. Based on diatom abundance, six assemblage zones were identified from GC01-PW02, and five diatom zones were identified from GC03-PW02. Barren intervals represent glacial periods, while intervals with higher diatom abundances were deposited during interglacial periods and reduced sea ice cover. The occurrence of Rouxia leventerae only within the deepest zone of each of the cores indicates that the core sediments were deposited since marine isotope stage (MIS) 6.
Jatropha curcas L. is a potential bioenergy crop but has a lack of improved cultivars with high yields and oil content. Therefore, increasing our understanding of J. curcas germplasm is important for designing breeding strategies. This study was performed to investigate the genetic diversity and population structure of Indonesian J. curcas populations from six different islands. To construct a reference, we de novo assembled the scaffolds (N50 = 355.5 kb) using 182 Gb Illumina HiSeq sequencing data from Thai J. curcas variety Chai Nat. Genetic diversity analysis among 52 Indonesian J. curcas accessions was conducted based on yield traits and single nucleotide polymorphism (SNP) markers detected by mapping genotyping-by-sequencing reads from Indonesian population to Chai Nat scaffolds. Strong variation in yield traits was detected among accessions. Using J. integerrima as an outgroup, 13,916 SNPs were detected. Among J. curcas accessions, including accessions from other countries (Thailand, the Philippines and China), 856 SNPs were detected, but only 297 SNPs were detected among Indonesian J. curcas populations, representing low genetic diversity. Through phylogenetic and structural analysis, the populations were clustered into two major groups. Group one consists of populations from Bangka and Sulawesi in the northern part of Indonesia, which are located at a distance of 1572.59 km. Group two contains populations from islands in the southern part: Java, Lombok-Sumbawa, Flores and Timor. These results indicate that introduction of diverse J. curcas germplasms is necessary for the improvement of the genetic variation in the Indonesian collections.
The aim of this study is to develop predictive models to predict organ at risk (OAR) complication level, classification of OAR dose-volume and combination of this function with our in-house developed treatment decision support system.
Materials and methods
We analysed the support vector machine and decision tree algorithm for predicting OAR complication level and toxicity in order to integrate this function into our in-house radiation treatment planning decision support system. A total of 12 TomoTherapyTM treatment plans for prostate cancer were established, and a hundred modelled plans were generated to analyse the toxicity prediction for bladder and rectum.
The toxicity prediction algorithm analysis showed 91·0% accuracy in the training process. A scatter plot for bladder and rectum was obtained by 100 modelled plans and classification result derived. OAR complication level was analysed and risk factor for 25% bladder and 50% rectum was detected by decision tree. Therefore, it was shown that complication prediction of patients using big data-based clinical information is possible.
We verified the accuracy of the tested algorithm using prostate cancer cases. Side effects can be minimised by applying this predictive modelling algorithm with the planning decision support system for patient-specific radiotherapy planning.
This study aimed to investigate the relationship between the unemployment experience and depressive symptoms among mid-aged (ages 45–59) and elderly (ages 60 or above) persons and to examine further the effects of unemployment insurance, industrial accident compensation insurance (IACI) and national pension on the stated relationship. Data were used from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012. A total of 1,536 individuals employed at the 2006 baseline were followed. The association between employment status change during 2006 to 2008, 2008 to 2010 or 2010 to 2012 and depressive symptoms in years 2008, 2010 or 2012 were analysed using a generalised estimating equation model. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale (CES-D 10) scale. The results showed that the ‘employed to unemployed’ group had statistically significant increases in depression scores in the mid-aged (β = 0.4884, p = 0.0038) and elderly (β = 0.8275, p ⩽ 0.0001) categories, compared to the ‘employed to employed’ group. Findings were maintained in groups without a social safety net. Contrastingly, the ‘employed to unemployed’ groups with unemployment insurance and IACI did not show statistically significant increases in depression scores. The ‘employed to unemployed’ category of individuals enrolled in the national pension system exhibited a lower increase of depression. Therefore, an enhanced focus on the mental health of unemployed individuals is required, in addition to the provision of a reliable social safety net.
To evaluate the appropriateness of the screening strategy for healthcare personnel (HCP) during a hospital-associated Middle East Respiratory Syndrome (MERS) outbreak, we performed a serologic investigation in 189 rRT-PCR–negative HCP exposed and assigned to MERS patients. Although 20%–25% of HCP experienced MERS-like symptoms, none of them showed seroconversion by plaque reduction neutralization test (PRNT).
Catenipora is one of the most common tabulate coral genera occurring in various lithofacies in the Upper Ordovician Xiazhen Formation at Zhuzhai in South China. A combination of traditional multivariate analysis and geometric morphometrics is applied to a large number of specimens to distinguish and identify species. Based on three major principal components extracted from 11 morphological characters, three major groups as determined by the cluster-analysis dendrogram are considered to be morphospecies. Their validity and distinctiveness are confirmed by discriminant analysis, descriptive statistics, and bivariate plots. Tabularium area and common wall thickness are the most meaningful characters to distinguish the three morphospecies. Geometric morphometrics is adopted to compare the morphospecies with types and/or figured specimens of species previously reported from the vicinity of Zhuzhai. Despite discrepancies in corallite size, principal component analysis and discriminant analysis, as well as consideration of overall morphological characteristics, indicate that the morphospecies represent C. zhejiangensis Yu in Yu et al., 1963, C. shiyangensis Lin and Chow, 1977, and C. dianbiancunensis Lin and Chow, 1977.
Catenipora occurs in seven stratigraphic intervals in the Xiazhen Formation at Zhuzhai, representing a variety of heterogeneous environments. The coralla preservation is variable due to differential compaction; coralla preserved in limestones are commonly intact and in growth position, whereas those in shales are mostly crushed or fragmentary. The size and shape of corallites are considered primarily to be species-specific characters, but are also related to the depositional environments. In all species, morphological characters, including corallite size, septal development, and shape and size of lacunae, show high variability in accordance with lithofacies and stratigraphic position. The intraspecific differences in corallite size at various localities in the Zhuzhai area may indicate responses to local environmental factors, but may also reflect genetic differences if there was limited connection among populations.
To examine the hypothesis that the association between vitamin D deficiency and depressive symptoms is dependent upon total cholesterol level in a representative national sample of the South Korean population.
This was a population-based cross-sectional study.
The Fifth Korean National Health and Nutrition Examination Survey (KNHANES V, 2010–2012).
We included 7198 adults aged 20–88 years.
The incidence of depressive symptoms in individuals with vitamin D deficiency (serum 25-hydroxyvitamin D<20 ng/ml) was 1·54-fold (95 % CI 1·20, 1·98) greater than in individuals without vitamin D deficiency (serum 25-hydroxyvitamin D ≥20 ng/ml). The relationship was stronger in individuals with normal-to-borderline serum total cholesterol (serum total cholesterol<240 mg/dl; OR=1·60; 95 % CI 1·23, 2·08) and non-significant in individuals with high serum total cholesterol (OR=0·97; 95 % CI 0·52, 1·81) after adjustment for confounding variables (age, sex, BMI, alcohol consumption, smoking status, regular exercise, income level, education level, marital status, changes in body weight, perceived body shape, season of examination date and cholesterol profiles).
The association between vitamin D deficiency and depressive symptoms was weakened by high serum total cholesterol status. These findings suggest that both vitamin D and total cholesterol are important targets for the prevention and treatment of depression.
This study evaluated the impacts of earlier traumatic events on the mental health of older adults, in terms of mental disorders and mental well-being, according to sociodemographic variables, trauma-related characteristics, and personality traits in a nationally representative sample of older Koreans.
A total of 1,621 subjects aged 60 to 74 years from a Korean national epidemiological survey of mental disorders responded face-to-face interviews. The Korean Composite International Diagnostic Interview was used to investigate lifetime trauma exposure (LTE) and psychiatric diagnoses. The EuroQol health classification system and life satisfaction scale were used to assess quality of life (QoL), and the Big Five Inventory-10 (BFI-10) to measure personality traits.
Five-hundred and seventy-seven subjects (35.6%) reported a history of LTE (mean age at trauma, 30.8 years old). Current mental disorders were more prevalent in elderly people with LTE, while better current QoL was more frequent in those without LTE. Among older people with LTE, lower extraversion and higher neuroticism increased the risk of current mood or anxiety disorders, whereas higher extraversion increased the probability of experiencing mental well-being after adjusting for sociodemographic and trauma-related variables.
Personality traits, especially extraversion, and neuroticism, may be useful for predicting the mental health outcomes of LTE in older adults. Further longitudinal studies investigating the relationship between traumatic events and mental health outcomes are needed.
During the past decade, carbapenemase-producing Enterobacteriaceae (CPE) has emerged and spread across the world.1 The major carbapenemase enzymes currently being reported are KPC, NDM-1, VIM, IMP, and OXA.2 Because carbapenemase can be effectively transmitted via mobile genetic elements, and current therapeutic options for CPE infections are extremely limited, CPE may be one of the most serious contemporary threats to public health. However, very little is known about the characteristics of CPE carriage during hospitalization. The aims of this study were to investigate the clearance rate of CPE carriage and determine the number of consecutive negative cultures required to confirm CPE clearance. We also examined CPE transmission among hospitalized patients.
Infect. Control Hosp. Epidemiol. 2015;36(11):1361–1362
Next-generation sequencing is a new technique for plant genome sequencing at a large scale that is faster and cheaper than previous sequencing technologies. The present work reports the development of new polymorphic simple sequence repeat (SSR) markers in oil palm (Elaeis guineensis Jacq.) using Illumina HiSeq sequencing data. More than 39 Gb (total 39,086,646,904 bases) was generated from the selected oil palm clone, D4. After de novo assembly, a total of 130,840 potential SSRs were identified. For SSR validation, 144 out of 762 SSR primer pairs were designed, including tri-nucleotide motifs, from the D4 contigs. Using 11 lines from three different clones of oil palm, 61 SSR primers revealed polymorphic alleles and high average polymorphic information content (PIC) values. Cluster analysis separated all oil palm plants into three clusters: clones A, B and C. These identified genome-wide SSR markers will enrich current genomic resources of the oil palm crop.
Describe the epidemiology of healthcare-related (ie, healthcare-associated and hospital-acquired) pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) among hospitalized patients in community hospitals.
Retrospective cohort study.
Twenty-four community hospitals in the southeastern United States affiliated with the Duke Infection Control Outreach Network (median size, 211 beds; range, 103–658 beds).
Adult patients with healthcare-related MRSA pneumonia admitted to study hospitals from January 1, 2008, to December 31, 2012, were identified using surveillance data. Seasonal and annual incidence rates (cases per 100,000 patient-days) were estimated using generalized estimating equation models. Characteristics of community-onset and hospital-onset cases were compared.
A total of 1,048 cases of healthcare-related pneumonia due to MRSA were observed during 5,863,941 patient-days. The annual incidence rate of healthcare-related MRSA pneumonia increased from 11.3 cases per 100,000 patient-days (95% confidence interval [CI], 6.8–18.7) in 2008 to 15.5 cases per 100,000 patient-days (95% CI, 8.4–28.5) in 2012 (P = .055). The incidence rate was highest in winter months and lowest in summer months (15.4 vs 11.1 cases per 100,000 patient-days; incidence rate ratio, 1.39 [95% CI, 1.06–1.82]; P = .016). A total of 814 cases (77.7%) were community-onset healthcare-associated pneumonia cases; only 49 cases (4.7%) were ventilator-associated cases. Of 811 patients whose disposition was known, 240 (29.6%) died during hospitalization or were discharged to hospice.
From 2008 through 2012, the incidence of healthcare-related MRSA pneumonia among patients who were admitted to a large network of community hospitals increased, despite the decreasing incidence of invasive MRSA infections nationwide. Additional study is warranted to evaluate trends in this important and potentially modifiable public health problem.
Infect Control Hosp Epidemiol 2014;35(12):1452–1457
The thickness dependence of the electrical stability under monotonic and cyclic tensile loading is investigated for Cu films on polymer substrates. As for monotonic tensile deformation, thicker films show better stability than thinner films due to their higher ductility and the larger capability of strain accommodation. For the fatigue resistance, however, a more complex behavior was observed depending on the amount of the applied strain. For low strain amplitude in the high cycle fatigue (HCF) regime, thinner films exhibit longer fatigue life because the larger strength of thinner films suppresses dislocation movement and damage nucleation. However, for high strain amplitudes in the low cycle fatigue (LCF) regime, the fatigue life for thinner films is drastically reduced compared to thicker films. It is shown that fatigue coefficients in the LCF regime can be obtained when applying the Coffin–Manson relationship.