Dalbavancin as sequential therapy for infective endocarditis due to Gram-positive organisms: a review.

Dalbavancin is a parenteral lipoglycopeptide antibiotic derived from teicoplanin, an analogue of vancomycin. It is mainly used for skin and soft tissue infections. The sustained half-life of approximately 14 days makes dalbavancin a novel option for potential use as sequential treatment in infections such as infective endocarditis, which require prolonged antibiotic courses. However, only a few studies have been reported in the literature, and the use of dalbavancin remains limited. This article is a review of the currently available literature using dalbavancin for the treatment of infective endocarditis due to Gram-positive organisms. Almost all patients received dalbavancin as sequential therapy following standard-of-care antibiotics. The overall clinical efficacy of dalbavancin was approximately 90%, and it appeared to be well tolerated.

Complications in Device Therapy: Spectrum, Prevalence, and Management.

PURPOSE OF REVIEW: Cardiac implantable electronic device implant numbers are continually increasing due to the expanding indications and ageing population. This review explores the complications associated with device therapy and discusses ways to minimise and manage such complications. RECENT FINDINGS: Complications related to device therapy contribute to mortality and morbidity. Recent publications have detailed clear guidelines for appropriate cardiac device selection, as well as consensus documents discussing care quality and optimal implantation techniques. There have also been advances in device technologies that may offer alternative options to patients at high risk of/or already having encountered a complication. Adherence to guidelines, appropriate training, and selection of device, in addition to good surgical technique are key in reducing the burden of complications and improving acceptability of device therapy.

Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic.

At the peak of the coronavirus disease 2019 (COVID-19) pandemic, hand hygiene audits indicated decreased compliance in a 12-bed critical care (CC) area with ventilated COVID-19 patients, where staff used personal protective equipment (PPE), including sessional use of long-sleeved gowns in accordance with the recommendations of Public Health England. There was also a cluster of three central venous catheter (CVC) infections along with increases in the number of patients from whom enteric Gram-negative bacteria (GNB) were isolated from sterile sites. Environmental sampling of near-patient surfaces and frequently touched sites demonstrated that 11.5% of areas were contaminated with enteric GNB in the COVID-19 CC area, compared with 2.6% and 2.7% in COVID-19 and non-COVID-19 general wards, respectively. Following a risk assessment, hospital policy was changed to replace long-sleeved gowns with short-sleeved gowns. The CC unit underwent enhanced cleaning with hypochlorite-based disinfectant and was resampled 8 days later. On resampling, no GNB were isolated from the CC unit. Following this change in PPE, hand hygiene compliance returned to baseline standards and no further CVC infections were identified. Staff reported a preference for short-sleeved gowns. No evidence currently exists that PPE beyond that recommended for pandemic influenza (respiratory protection plus standard PPE) adds to the protection of healthcare workers (HCWs) from severe acute respiratory syndrome coronavirus-2. Long-sleeved gowns prevent HCWs performing hand hygiene effectively. While it is imperative that HCWs are adequately protected, protection of patients from infection hazards is equally important. Further studies are necessary to establish risks from PPE to inform a review of current guidance.

Effects of resistance training protocols on nonlinear analysis of heart rate variability in metabolic syndrome.

Despite the various standard non-linear measurements used in autonomic modulation (AM) assessments usually being applied to long time-series, such analyses can sometimes be applied to shorter term series. To overcome this disadvantage, chaotic global methods were formulated by putting together heart rate variability (HRV) linear methods. Chaos provides information about vegetative function control related to cardiovascular risks. Applying this method can be useful to investigate the complexity of the health condition after resistance training protocols, as a therapeutic intervention in AM in metabolic syndrome individuals (MetS). This study aimed to compare the effects of two resistance training programs (conventional vs functional) in MetS using nonlinear analysis of AM. MetS subjects (n=50) of both sexes aged 40 to 60 years were randomly divided into two programs; a group of 12 people served as a control group. Both groups performed 30 sessions of training. AM was assessed in the chaos domain by chaotic global techniques. The main results showed that both resistance training, functional and conventional, increased chaos when compared to the control group, respectively, observed by chaotic forward parameter (CFP)1 (13.9±17.9 vs 12.8±14.4 vs -2.23±7.96; P≤0.05) and CFP3 (15.4±19.8 vs 21.9±13.2 vs -4.82±11.4; P≤0.05). In addition, 30 sessions of both resistance programs increased chaos, and non-linear analysis enabled discrimination of AM after interventions when compared to the control group.

The use of a simple three-level bronchoscopic assessment of inhalation injury to predict in-hospital mortality and duration of mechanical ventilation in patients with burns.

Major burn centres in Australia use bronchoscopy to assess severity of inhalation injuries despite limited evidence as to how best to classify severity of inhalational injury or its relationship to patient outcomes. All patients with burns who were admitted to the intensive care unit (ICU) at The Alfred Hospital between February 2010 and July 2014 and underwent bronchoscopy to assess inhalational injury, were reviewed. Age, total body surface area burnt, severity of illness indices and mechanisms of injury were extracted from medical histories and local ICU and burns registries. Inhalational injury was classified based on the Abbreviated Injury Score and then grouped into three categories (none/mild, moderate, or severe injury). Univariable and multivariable analyses were undertaken to examine the relationship between inhalational injury and outcomes (in-hospital mortality and duration of mechanical ventilation). One hundred and twenty-eight patients were classified as having none/mild inhalational injury, 81 moderate, and 13 severe inhalation injury. Mortality in each group was 2.3% (3/128), 7.4% (6/81) and 30.7% (4/13) respectively. Median (interquartile range) duration of mechanical ventilation in each group was 26 (11-82) hours, 84 (32-232) hours and 94 (21-146) hours respectively. After adjusting for age, total body surface area burnt and severity of illness, only the severe inhalation injury group was independently associated with increased mortality (odds ratio 20.4 [95% confidence intervals {CI} 1.74 to 239.4], P=0.016). Moderate inhalation injury was independently associated with increased duration of ventilation (odds ratio 2.25 [95% CI 1.53 to 3.31], P <0.001), but not increased mortality. This study suggests that stratification of bronchoscopically-assessed inhalational injury into three categories can provide useful prognostic information about duration of ventilation and mortality. Larger multicentre prospective studies are required to validate these findings.

Effects of resistance training protocols on nonlinear analysis of heart rate variability in metabolic syndrome

Despite the various standard non-linear measurements used in autonomic modulation (AM) assessments usually being applied to long time-series, such analyses can sometimes be applied to shorter term series. To overcome this disadvantage, chaotic global methods were formulated by putting together heart rate variability (HRV) linear methods. Chaos provides information about vegetative function control related to cardiovascular risks. Applying this method can be useful to investigate the complexity of the health condition after resistance training protocols, as a therapeutic intervention in AM in metabolic syndrome individuals (MetS). This study aimed to compare the effects of two resistance training programs (conventional vs functional) in MetS using nonlinear analysis of AM. MetS subjects (n=50) of both sexes aged 40 to 60 years were randomly divided into two programs; a group of 12 people served as a control group. Both groups performed 30 sessions of training. AM was assessed in the chaos domain by chaotic global techniques. The main results showed that both resistance training, functional and conventional, increased chaos when compared to the control group, respectively, observed by chaotic forward parameter (CFP)1 (13.9±17.9 vs 12.8±14.4 vs -2.23±7.96; P≤0.05) and CFP3 (15.4±19.8 vs 21.9±13.2 vs -4.82±11.4; P≤0.05). In addition, 30 sessions of both resistance programs increased chaos, and non-linear analysis enabled discrimination of AM after interventions when compared to the control group.

Outbreak of Stenotrophomonas maltophilia on an intensive care unit.

BACKGROUND: Stenotrophomonas maltophilia causes opportunistic infections and remains a problem pathogen on intensive care unit (ICU) due to its multidrug resistance. AIM: An outbreak of S. maltophilia on ICU is described in order to highlight the risk from contaminated devices for supply of drinking water. METHODS: The outbreak was investigated by a combination of epidemiology, environmental sampling and molecular typing. FINDINGS: From 2009 to 2011 isolates of S. maltophilia from 23 patients were found to belong to only two genotypes by contrast with isolates from 52 other patients during this period, which represented distinct strains. The monthly incidence for all S. maltophilia strains ranged from 0 to 11% and for the two outbreak strains from 0 to 9%. Admission and weekly pharyngeal screening on ICU showed that the outbreak strains were acquired on ICU (range: 3-90 days). The majority of isolates (74%) were from the respiratory tract. Only two of 12 (17%) colonized intubated patients developed pneumonia. Environmental sampling found the two outbreak strains in two sinks and in the drinking water of the cooling unit in the ICU kitchen. S. maltophilia had formed a biofilm in the flexible tube from the carbon filter to the chiller and from the latter to the tap at the kitchen sink. This cooled water was used for providing drinking water and mouth care to ICU patients. The outbreak strains disappeared after removal of the water-cooler and the monthly incidence fell to <2% of ICU admissions. CONCLUSION: This outbreak report highlights the risk from biofilms in devices that supply drinking water for ICU patients.

Hoechst 33342: the dye that enabled differentiation of living X-and Y-chromosome bearing mammalian sperm.

Hoechst 33342 is the fluorophore used routinely to measure DNA in X- and Y-chromosome-bearing mammalian sperm so they can be separated by flow sorting. A difference of <3% in DNA mass can be detected. This synthetic dye consists of two adjacent benzimidazole rings with N-methyl-piperazine and phenolic groups at the ends. The molecule permeates the cell membrane of living cells and binds selectively to A-T base pairs exposed in the minor-groove of double stranded DNA. Capability to distinguish and separate X- and Y-chromosome-bearing sperm has led to artificial insemination of somewhere around a million female mammals. Offspring with obvious abnormalities are no more frequent than after insemination of unsorted sperm into cows, horses, humans, pigs, sheep, rabbits, dolphins and other mammals. There is no apparent genotoxic effect from exposure of sperm to Hoechst 33342, although information on cellular toxicity or development of embryos resulting from Hoechst 33342-stained sperm is less reassuring. Little is known about the fate of sperm-delivered Hoechst dye in the female reproductive tract or on progeny of resultant offspring.

Investigation and management of an outbreak of mucormycosis in a paediatric oncology unit.

Mucormycosis is an aggressive and often fatal infection, despite conventional methods of treatment, which predominantly affects immunocompromised patients. This report describes an outbreak of rhinocerebral mucormycosis in a university hospital paediatric oncology department secondary to water damage in a linen store and parents' shower room. The source of the outbreak was successfully determined using simple environmental sampling techniques. Sampling allowed timely and successful implementation of infection control measures to contain the source and protect patients. Two cases were treated with posaconazole and made a complete recovery, with no discernible impact on the management of their cancer. Fifteen other children identified as having a high risk of developing infection were given posaconazole prophylaxis. None of the children, including one that was only five years old, experienced any adverse events from taking posaconazole.

History of commercializing sexed semen for cattle.

Although the basic principles controlling the sex of mammalian offspring have been known for a relatively long time, recent application of certain modern cellular methodologies has led to development of a flow cytometric system capable of differentiating and separating living X- and Y-chromosome-bearing sperm in amounts suitable for AI and therefore, commercialization of this sexing technology. After a very long history of unsuccessful attempts to differentiate between mammalian sperm that produce males from those that produce females, a breakthrough came in 1981 when it was demonstrated that precise DNA content could be measured. Although these initial measurements of DNA content killed the sperm in the process, they led to the ultimate development of a sperm sorting system that was capable, not only of differentiating between live X- and Y-sperm, but of sorting them into relatively pure X- and Y-sperm populations without obvious cellular damage. Initial efforts to predetermine the sex of mammalian offspring in 1989 required surgical insemination, but later enhancements provided sex-sorted sperm in quantities suitable for use with IVF. Subsequent advances in flow sorting provided minimal numbers of sperm sufficient for use in AI. It was not until the flow cytometric sorting system was improved greatly and successful cryopreservation of sex-sorted bull sperm was developed that efficacious approaches to commercialization of sexed semen could be implemented worldwide in cattle. A number of companies now offer sex-sorted bovine sperm. Innovative approaches by a diverse group of scientists along with advances in computer science, biophysics, cell biology, instrumentation, and applied reproductive physiology provided the basis for commercializing sexed semen in cattle.

Metabolic and psychological changes during refeeding in anorexia nervosa.

OBJECTIVE: This study aimed to examine resting metabolic rate (RMR) and psychological changes during refeeding in 10 women with anorexia nervosa participating in a partial hospitalization eating disorder program. RESULTS: Participants' admission RMRs, as assessed by the MedGem Analyzer, were below their RMRs predicted by the Harris- Benedict equation, t(1,9)=5.77, p<0.01. Correlational analyses revealed a trend toward smaller increases in RMR being associated with higher admission BMI (r=-0.49, p=0.08), but not with highest lifetime BMI. Over the course of treatment, RMR per pound of Fat-Free Mass (FFM) increased from the beginning to the middle, t(1,9)=-3.02, p<0.05, and to the end stage of treatment, t(1,9)=-2.53, p<0.05. Scores on the Eating Attitudes Test-26, Eating Disorder Inventory-2, Brief Symptom Inventory (BSI), BSI Depression subscale, and Mizes Anorectic Cognitions scale significantly improved throughout treatment (all p<0.05); however, body dissatisfaction did not improve. DISCUSSION: Results suggest that weight restoration programs for anorexia nervosa cannot rely on FFM or standard formulas to predict caloric needs throughout refeeding, and that admission BMI is one factor to be considered in predicting caloric needs during refeeding. Furthermore, ways to improve body dissatisfaction during refeeding needs to be more of a treatment focus.

Fluoroscopy and Paget's disease of the breast.

A case report concerning a 36-year-old woman having developed Paget's disease of the breast subsequent to multiple fluoroscopies as a child for the investigation of Fallot's anomaly/pulmonary atresia is presented. This case is discussed with a brief review of the relevant literature regarding current theories as to the pathogenesis of Paget's disease of the breast, ionizing radiation and its role in dysplastic breast disease and their possible interrelation.

Nuclear texture features for classifying benign vs. dysplastic or malignant squamous epithelium of the larynx.

OBJECTIVE: To search for nuclear features and feature combinations able to assess malignancy and premalignant changes on tissue sections of laryngeal squamous epithelium. STUDY DESIGN: A total of 139 lesions of benign changes (BC) (n = 44), epithelial dysplasias (ED) (n = 50) and invasive laryngeal cancer (LC) (n = 45) were retrieved from archival pathology specimens. The goal of this study was to identify the best features or feature combinations that discriminate BC from LC and also reflect the degree of ED. In order to verify the results on independent data, the groups were split into two separate subgroups, one for training and one for testing. RESULTS: On the test set of slides, the overall correct classification of BC vs. LC cases was 82% using only one feature, fractal2_area. This classification rate could be increased to 91% when a discriminant function based on 10 features was used. However, this gain was not significant. CONCLUSION: Fractal texture features can be used to assess malignancy on tissue sections as an alternative to DNA measurement. In this study feature combinations did not significantly improve classification rates.

Sex-Sorting mammalian sperm: concept to application in animals.

Sperm sexing can be used to produce sexed offspring with 85%-95% accuracy (Amann, 1999; Johnson and Seidel, 1999; Seidel et al 1999a). On September 1, 2000, the sale of sexed bovine sperm commented in the United Kingdom. It will be interesting to see to what degree sexed sperm penetrate the semen market. This verified sexed product sets the stage for commercialization around the world in major animal producing countries. This commercialization of sexed sperm occurred nearly 20 years after technology for accurately determining the proportion of X and Y sperm in semen was first developed at Lawrence Livermore National Laboratory. It came about due to advances in both the hardware and the software componenets of computer science, biophysic, cell biology and applied reproductive physiology plus efforts of innovative scientist. Many individuals have contributed in making semen sexing in animals a commercial reality since the research team of Bart Gledhill, Dan Pinkel, Duane Garner, Susan Lake, and Larry Johnson began following up on the first flow cytometric studies on human sperm by Friedrich Otto, Wolfgang Göhde, and Marvin Meistrich. There was also major input from personnel at USDA Beltsville Agricultural Research Center as well as scientists at Cambridge University, Atlantic Breeders Cooperative, Colorado State University and XY Inc. These include Chuck Allen, Rupert Amann, David Cran, Patrick Doyle, Mike Evans, Lisa Herickhoff, Mervyn Jacobson, Kehuan Lu, Chris Polge, Wim Rens, John Schenk, George Seidel, Glenn Welch, and many others.

Eating concerns in East Asian immigrants: relationships between acculturation, self-construal, ethnic identity, gender, psychological functioning and eating concerns.

OBJECTIVE: Eating concerns in East Asian immigrants were assessed and their association with acculturation status, self-construal, ethnic identity, gender and psychological functioning was examined. METHOD: One-hundred and fifty non-clinical East Asian immigrants (75 males, 75 females) were administered a battery of psychometrically established measures with satisfactory reliability and validity. RESULTS: Females were more prone to eating concerns and these were positively related to symptoms of psychological distress. Acculturation, self-construal, ethnic identity and psychological functioning were not related to desire to be thinner, feeling guilt after eating, fear of being overweight nor preoccupation with the thought of having fat on one's body. Collective self-esteem and symptoms of psychological distress were positively related to feeling discomfort after eating sweets, while interdependent self-construal and assimilation were negatively related. DISCUSSION: Culturally relevant variables, namely acculturation, self-construal and ethnic identity, were related to only certain facets of eating concerns. The findings suggest the importance of assessing discrete, psychologically-relevant facets of culture rather than more global constructs such as westernization when examining eating concerns in immigrant populations.

Seminal plasma addition attenuates the dilution effect in bovine sperm.

Dilution of semen to low cell numbers/dose can result in a bull-dependent reduction in the post-thaw viability of cryopreserved bovine spermatozoa. It is possible that essential seminal plasma components are lacking at the greater dilution rates, thereby contributing to the deleterious effects of semen dilution. Ejaculates of 6 Holstein bulls were diluted to 120 x 10(6) sperm/mL in an egg yolk citrate extender (EYC). Split samples were further diluted to 80, 40, 20 and 4 x 10(6) sperm/mL in EYC extender with (+SP) and without (-SP) the addition of frozen/thawed seminal plasma previously obtained from a vasectomized bull. Serial dilutions for the +SP treatments were calculated and performed such that each dilution contained a volume of seminal plasma equal to the original 120 x 10(6) sperm/mL dilution. Samples were then loaded into 0.5-mL French straws yielding final sperm concentrations of 30, 20, 10, 5 and 1 x 10(6)/dose. Straws from each dilution were analyzed using 2 stain combinations: the sperm viability stain, SYBR-14 and propidium iodide (PI); or the mitochondrial-specific, membrane potential-dependent stain JC-1 along with PI. Split-plot analysis of variance indicated that within bulls, there were greater proportions of viable spermatozoa in aliquots containing added seminal plasma than in aliquots without added seminal plasma (P < 0.05). Contrast analyses showed that sperm viability significantly decreased as sperm concentration decreased in the -SP samples. Although the dilution effect was also observed in the +SP samples, the magnitude of the effect was less than in the -SP samples. At most sperm concentrations, the proportions of spermatozoa that stained with JC-1 were correlated (r > 0.84; P < 0.05) with the percentages of SYBR- 14 stained spermatozoa. Furthermore, the proportions of JC-1-stained spermatozoa were greater in the +SP aliquots than in the -SP samples at a concentration of 10 x 10(6) sperm/0.5 mL. These results suggest that the addition of seminal plasma can be beneficial to sperm viability when semen is diluted to low cell numbers/dose.

Fluorescent probes and flow cytometry to assess rat sperm integrity and mitochondrial function.

Fluorescent assessment of cellular integrity and mitochondrial function by flow cytometry can provide a rapid and precise means of determining the functional status of large numbers of spermatozoa. In the present study, rat sperm viability was assessed with SYBR-14 and PI and sperm mitochondria were differentially labeled with JC-1. Sperm samples of variable viability were prepared using varying proportions of fresh and frozen spermatozoa. SYBR-14 stained sperm correlated well with expected sperm viability (r = 0.98). Motile sperm stained with JC-1 appeared orange in the midpiece indicating a high mitochondrial membrane potential whereas immotile sperm with a low membrane potential stained green. The percentage of spermatozoa staining orange was highly correlated (r = 0.99) with expected sperm viability. Flow cytometry using specific fluorescent probes is a useful technique for detecting changes in rat sperm plasma membrane integrity and mitochondrial function in large numbers of spermatozoa.

Immediate countershock versus cardiopulmonary resuscitation before countershock in a 5-minute swine model of ventricular fibrillation arrest.

STUDY OBJECTIVE: Prior laboratory and clinical studies demonstrate that cardiopulmonary resuscitation (CPR) preceding countershock of prolonged ventricular fibrillation (VF) increases the likelihood of successful cardiac resuscitation. The lower limit of VF duration at which time preshock CPR provides no benefit has not been specifically studied. The purpose of this study was to compare countershock and cardiac resuscitation outcome between immediate countershock of VF of 5-minute duration and CPR without drug therapy before countershock in a swine model. METHODS: VF was induced in anesthetized and instrumented swine. After 5 minutes of VF, animals received 1 of 2 treatments. Animals in group 1, a "historical" control group (n=20), received immediate countershock followed by CPR and repeated shocks if needed. Group 2 animals (n=11) received CPR for 90 seconds preceding countershock, then continued CPR and repeated countershock if necessary. Drugs were not administered to either group, and resuscitation efforts were discontinued if a perfusing rhythm was not restored within 10 minutes of the first countershock. First shock success rate (defined as termination of VF), the number of shocks required to terminate VF, and the cardiac resuscitation rate were compared between groups. RESULTS: The first shock terminated VF in 13 of 20 group 1 animals and 2 of 11 group 2 animals (P =.023). All but 1 animal in group 1 developed pulseless electrical activity after countershock. All but 1 animal in group 1 were eventually successfully resuscitated with CPR and repeated shocks if necessary. Four group 2 animals could not be resuscitated (P =.042). CONCLUSION: Although effective in improving outcome of prolonged VF, CPR preceding countershock of VF of 5-minute duration does not improve the response to the first shock, decrease the incidence of postshock pulseless electrical activity, or the rate of return of circulation. In this study, CPR preceding countershock resulted in a significantly lower cardiac resuscitation rate.

Monophasic versus biphasic transthoracic countershock after prolonged ventricular fibrillation in a swine model.

OBJECTIVE: We sought to compare the defibrillation efficacy of a low-energy biphasic truncated exponential (BTE) waveform and a conventional higher-energy monophasic truncated exponential (MTE) waveform after prolonged ventricular fibrillation (VF). BACKGROUND: Low energy biphasic countershocks have been shown to be effective after brief episodes of VF (15 to 30 s) and to produce few postshock electrocardiogram abnormalities. METHODS: Swine were randomized to MTE (n = 18) or BTE (n = 20) after 5 min of VF. The first MTE shock dose was 200 J, and first BTE dose 150 J. If required, up to two additional shocks were administered (300, 360 J MTE; 150, 150 J BTE). If VF persisted manual cardiopulmonary resuscitation (CPR) was begun, and shocks were administered until VF was terminated. Successful defibrillation was defined as termination of VF regardless of postshock rhythm. If countershock terminated VF but was followed by a nonperfusing rhythm, CPR was performed until a perfusing rhythm developed. Arterial pressure, left ventricular (LV) pressure, first derivative of LV pressure and cardiac output were measured at intervals for 60 min postresuscitation. RESULTS: The odds ratio of first-shock success with BTE versus MTE was 0.67 (p = 0.55). The rate of termination of VF with the second or third shocks was similar between groups, as was the incidence of postshock pulseless electrical activity (15/18 MTE, 18/20 BTE) and CPR time for those animals that were resuscitated. Hemodynamic variables were not significantly different between groups at 15, 30 and 60 min after resuscitation. CONCLUSIONS: Monophasic and biphasic waveforms were equally effective in terminating prolonged VF with the first shock, and there was no apparent clinical disadvantage of subsequent low-energy biphasic shocks compared with progressive energy monophasic shocks. Lower-energy shocks were not associated with less postresuscitation myocardial dysfunction.