MALDI-TOF mass spectrometry rapid pathogen identification and outcomes of patients with bloodstream infection: A systematic review and meta-analysis.

There was inconsistent evidence regarding the use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for microorganism identification with/without antibiotic stewardship team (AST) and the clinical outcome of patients with bloodstream infections (BSI). In a systematic review and meta-analysis, we evaluated the effectiveness of rapid microbial identification by MALDI-TOF MS with and without AST on clinical outcomes. We searched PubMed and EMBASE databases from inception to 1 February 2022 to identify pre-post and parallel comparative studies that evaluated the use of MALDI-TOF MS for microorganism identification. Pooled effect estimates were derived using the random-effects model. Twenty-one studies with 14,515 patients were meta-analysed. Compared with conventional phenotypic methods, MALDI-TOF MS was associated with a 23% reduction in mortality (RR = 0.77; 95% CI: 0.66; 0.90; I2  = 35.9%; 13 studies); 5.07-h reduction in time to effective antibiotic therapy (95% CI: -5.83; -4.31; I2  = 95.7%); 22.86-h reduction in time to identify microorganisms (95% CI: -23.99; -21.74; I2  = 91.6%); 0.73-day reduction in hospital stay (95% CI: -1.30; -0.16; I2  = 53.1%); and US$4140 saving in direct hospitalization cost (95% CI: $-8166.75; $-113.60; I2  = 66.1%). No significant heterogeneity sources were found, and no statistical evidence for publication bias was found. Rapid pathogen identification by MALDI-TOF MS with or without AST was associated with reduced mortality and improved outcomes of BSI, and may be cost-effective among patients with BSI.

Epidemiology of dermatologic disease in Palau: a cross-sectional study in the national public and community health service.

BACKGROUND: Dermatologic disease is a neglected public health challenge that disproportionately affects resource-poor settings. Globally, dermatologic disease contributes the fourth highest burden of nonfatal disability with the most acute impact in the Oceanic region, including the Republic of Palau. Efforts to address the dermatologic health inequality are hindered without the necessary epidemiologic evidence to guide health policy in the resource-poor setting of Palau. METHODS: We conducted a 4-year cross-sectional study of all Dermatology Service patients in the Belau National Hospital and outreach community health centers from 2015 to 2018. No other specialized dermatology service was available. Skin disease was classified by both diagnosis and Global Burden of Disease criteria and analyzed by age, gender, region, and surrounding Oceanic nations. RESULTS: The study enrolled 494 patients comprising 179 males and 315 females between 2015 and 2018. The most prevalent diseases were eczema (48.8%), superficial fungal infection (24.5%), and pruritus (22.7%). The neglected tropical disease of scabies was detected in four patients. Males were significantly more likely to present with cellulitis, keratinocyte carcinoma, stasis dermatitis, wounds, marine-related dermatitis, viral skin disease, tinea faciei, verruca, and xerosis and females with melasma and hyperpigmentation. CONCLUSION: This study presents the first primary epidemiologic data describing the prevalence of dermatologic disease in the Palauan adult population. The significant burden of disease in Palau compared with other Oceanic nations validates ongoing dermatology services and informs public health implications for resource allocation and disease management to achieve health equality in the resource-poor nation.

Mangosteen Concentrate Drink Supplementation Promotes Antioxidant Status and Lactate Clearance in Rats after Exercise.

High-strength or long-duration exercise can lead to significant fatigue, oxidative stress, and muscle damage. The purpose of this study was to examine the effect of mangosteen concentrate drink (MCD) supplementation on antioxidant capacity and lactate clearance in rats after running exercise. Forty rats were divided into five groups: N, non-treatment; C, control; or supplemented with MCD, including M1, M5, and M10 (0.9, 4.5, and 9 mL/day) for 6 weeks. The rats were subjected to 30 min running and exhaustive-running tests using a treadmill. The blood lactate; triglyceride; cholesterol and glucose levels; hepatic and muscular malonaldehyde (MDA) levels; and antioxidant enzymes, including superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT), were analyzed. The results of this study demonstrated that MCD supplementation can increase GPx and CAT activities, alleviate oxidative stress in muscle, and increase lactate clearance, and is thereby beneficial to reduced muscle fatigue after exercise.

A systematic review: comparative analysis of the effects of propofol and sevoflurane on postoperative cognitive function in elderly patients with lung cancer.

BACKGROUND: The potential risk for cognitive impairment following surgery and anesthesia is a common concern, especially in the elderly and more fragile patients. The risk for various neurocognitive effects is thus an area of importance. The independent impact of surgery and anesthesia is still not known. Likewise, the independent effect of different drugs used during anesthesia is a matter of debate, as is the number and amounts of drugs used and the "depth of anesthesia." So, understanding the drug-related phenomenon and mechanisms for postoperative cognitive impairment is essential. This meta-analysis aims to compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function in elderly patients with lung cancer. METHODS: This study is a systematic review and meta-analysis for controlled clinical studies. Public-available online databases were searched to identify eligible randomized placebo-controlled trials or prospective cohort studies concerning the effects of propofol and sevoflurane on postoperative cognitive function. The primary endpoints are postoperative mini-mental state examination (MMSE) scores at various time points; the secondary endpoint is the serum S100beta concentration 24 h after surgery. Standard mean differences (SMDs) along with 95% confidence intervals (CIs) were extracted and analyzed using random or fixed-effects models. Analyses regarding heterogeneity, risk of bias assessment, and sensitivity were performed. RESULTS: We searched 1626 eligible publications and 14 studies of 1404 patients were included in the final analysis. The majority of included studies had been undertaken in Asian populations. Results suggested that propofol has a greater adverse effect on cognitive function in the elderly patients with lung cancer than sevoflurane. There were significant differences in issues of MMSE 6 h (11 studies; SMD -1.391, 95% CI -2.024, - 0.757; p < 0.001), MMSE 24 h (14 studies; SMD -1.106, 95% CI -1.588, - 0.624; p < 0.001), MMSE 3d (11 studies; SMD -1.065, 95% CI -1.564, - 0.566; p < 0.001), MMSE 7d (10 studies; SMD -0.422, 95% CI -0.549, - 0.295; p < 0.001), and serum S100beta concentration at 1 day after surgery (13 studies; SMD 0.746, 95% CI 0.475, 1.017; p < 0.001). CONCLUSION: Propofol has a more significant adverse effect on postoperative cognitive function in elderly patients with lung cancer than sevoflurane.

Rapid, large-scale species discovery in hyperdiverse taxa using 1D MinION sequencing.

BACKGROUND: More than 80% of all animal species remain unknown to science. Most of these species live in the tropics and belong to animal taxa that combine small body size with high specimen abundance and large species richness. For such clades, using morphology for species discovery is slow because large numbers of specimens must be sorted based on detailed microscopic investigations. Fortunately, species discovery could be greatly accelerated if DNA sequences could be used for sorting specimens to species. Morphological verification of such "molecular operational taxonomic units" (mOTUs) could then be based on dissection of a small subset of specimens. However, this approach requires cost-effective and low-tech DNA barcoding techniques because well-equipped, well-funded molecular laboratories are not readily available in many biodiverse countries. RESULTS: We here document how MinION sequencing can be used for large-scale species discovery in a specimen- and species-rich taxon like the hyperdiverse fly family Phoridae (Diptera). We sequenced 7059 specimens collected in a single Malaise trap in Kibale National Park, Uganda, over the short period of 8 weeks. We discovered > 650 species which exceeds the number of phorid species currently described for the entire Afrotropical region. The barcodes were obtained using an improved low-cost MinION pipeline that increased the barcoding capacity sevenfold from 500 to 3500 barcodes per flowcell. This was achieved by adopting 1D sequencing, resequencing weak amplicons on a used flowcell, and improving demultiplexing. Comparison with Illumina data revealed that the MinION barcodes were very accurate (99.99% accuracy, 0.46% Ns) and thus yielded very similar species units (match ratio 0.991). Morphological examination of 100 mOTUs also confirmed good congruence with morphology (93% of mOTUs; > 99% of specimens) and revealed that 90% of the putative species belong to the neglected, megadiverse genus Megaselia. We demonstrate for one Megaselia species how the molecular data can guide the description of a new species (Megaselia sepsioides sp. nov.). CONCLUSIONS: We document that one field site in Africa can be home to an estimated 1000 species of phorids and speculate that the Afrotropical diversity could exceed 200,000 species. We furthermore conclude that low-cost MinION sequencers are very suitable for reliable, rapid, and large-scale species discovery in hyperdiverse taxa. MinION sequencing could quickly reveal the extent of the unknown diversity and is especially suitable for biodiverse countries with limited access to capital-intensive sequencing facilities.

Black sea cucumber (Holothuria atra Jaeger, 1833) rescues Pseudomonas aeruginosa-infected Caenorhabditis elegans via reduction of pathogen virulence factors and enhancement of host immunity.

A strategy to circumvent the problem of multidrug resistant pathogens is the discovery of anti-infectives targeting bacterial virulence or host immunity. Black sea cucumber (Holothuria atra) is a tropical sea cucumber species traditionally consumed as a remedy for many ailments. There is a paucity of knowledge on the anti-infective capacity of H. atra and the underlying mechanisms involved. The objective of this study is to utilize the Caenorhabditis elegans-P. aeruginosa infection model to elucidate the anti-infective properties of H. atra. A bioactive H. atra extract and subsequently its fraction were shown to have the capability of promoting the survival of C. elegans during a customarily lethal P. aeruginosa infection. The same entities also attenuate the production of elastase, protease, pyocyanin and biofilm in P. aeruginosa. The treatment of infected transgenic lys-7::GFP worms with this H. atra fraction restores the repressed expression of the defense enzyme lys-7, indicating an improved host immunity. QTOF-LCMS analysis revealed the presence of aspidospermatidine, an indole alkaloid, and inosine in this fraction. Collectively, our findings show that H. atra possesses anti-infective properties against P. aeruginosa infection, by inhibiting pathogen virulence and, eventually, reinstating host lys-7 expression.

Artificial intelligence: a key to relieve China's insufficient and unequally-distributed medical resources.

In this manuscript, we firstly reviewed the challenges faced by China in its health care reform. Though Chinese governments have made tremendous efforts, problems like the difficulties and high expense in medical care and the nervous doctor-patient relationship have been reported a lot, whose key problem is the insufficiency of high-quality medical resource and the supply-demand imbalance. Presently, it's almost old news: artificial intelligence will overturn the existing medical model. Artificial intelligence technology will transform the medical sector and trigger an estimated $147 billion market during the next 20 years. We hereby pointed out the strengths of medical artificial intelligence and its potentials to relieve China's insufficient and unequally-distributed medical resources. Also, we analyzed China's advantages in developing medical AI due to its huge medical big data and China government's powerful promotion policy. Finally, we put forward some challenges for China to practice this.

Do parents and children agree on rating a child's HRQOL? A systematic review and Meta-analysis of comparisons between children with attention deficit hyperactivity disorder and children with typical development using the PedsQLTM.

PURPOSE: This meta-analysis was conducted to assess differences in a child's health-related quality of life (HRQOL) as reported by the child and their parents using the Pediatric Quality of Life InventoryTM, and the effects in both children with attention deficit hyperactivity disorder (ADHD) and those with typical development. METHODS: Eight studies encompassing 16 independent groups met the inclusion criteria and were combined and compared in this meta-analysis. Fixed effect analysis was applied in the subgroup analysis to compare differences between children with ADHD and those with typical development. RESULTS: Small to moderate magnitudes of parent-child discrepancies were found in the ratings of the children's HRQOL both in those with ADHD (g = -0.23 [-0.33, -0.13], p < 0.001, physical HRQOL; g = -0.60 [-0.71, -0.48], p < 0.001, psychosocial HRQOL) and in those with typical development (g = -0.27 [-0.31, -0.23], p < 0.001, physical HRQOL; g = -0.29 [-0.33, -0.25], p < 0.001, psychosocial HRQOL) except for emotional HRQOL in children with typical development (g = 0.003 [-0.04, 0.04], p = 0.90). The parent-child discrepancy in rating the child's psychosocial HRQOL was significantly larger in the children with ADHD than in those with typical development. CONCLUSIONS AND IMPLICATIONS: This meta-analysis suggests that a child's HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports. Parent-child discrepancies, especially in psychosocial HRQOL, and sources of discrepancy need to be addressed when assessing the child's HRQOL and planning interventions in children with ADHD. Implications for Rehabilitation Parents reported a significantly worse health-related quality of life of their children than both the children with attention deficit hyperactivity disorder and those with typical development. A child's health-related quality of life needs to be assessed both by parent proxy and self-reports of the children. Children with attention deficit hyperactivity disorder and those with typical development differed significantly in parent-child discrepancy in child's psychosocial health-related quality of life, but not in physical health-related quality of life. Parent-child discrepancies, especially in psychosocial health-related quality of life, and sources of discrepancy (e.g., child, parent or family characteristics) need to be addressed when assessing the child's health-related quality of life and planning interventions in children with attention deficit hyperactivity disorder.

Meta-analysis of quality of life in children and adolescents with ADHD: By both parent proxy-report and child self-report using PedsQL™.

Attention deficit hyperactivity disorder (ADHD) is a prevalent developmental disorder that seriously and negatively impacts a child's health-related quality of life (HRQOL). However, no meta-analysis has been conducted to examine the magnitude of impact, domains affected and factors moderating the impact. This review included nine studies that compared HRQOL of children or adolescents with ADHD with those with typical development using both child self-reports and parent proxy-reports. Seven among nine studies were meta-analytically synthesized to examine the degree of impact of ADHD on children and adolescents, parent-child discrepancy, and the moderators. The results indicate that ADHD impact a child's or adolescent's HRQOL negatively with a moderate effect in physical and a severe effect in psychosocial (i.e., emotional, social, and school) domains. Parental ratings of overall HRQOL in children or adolescents with ADHD were not significantly different from child's ratings when compared with typically developing children and adolescents. Age was negatively associated with all domains of HRQOL in children and adolescents with ADHD both by parent- and child-ratings, and the strongest effect was found in parental ratings of child's emotional HRQOL, with a moderate correlation. This meta-analysis suggests that HRQOL may be assessed in children and adolescents with ADHD both by parent proxy- and child self-reports, and that interventions may be planned accordingly. Future meta-analysis may explore how measures of HRQOL and other factors including child, parental, familiar and school characteristics influence the impact of ADHD and the parent-child agreement in children and adolescents.