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2.
Simul Healthc ; 16(6): e188-e193, 2021 Dec 01.
Article in English | MEDLINE | ID: mdl-34860738

ABSTRACT

INTRODUCTION: Previous efforts used digital video to develop computer-generated assessments of surgical hand motion economy and fluidity of motion. This study tests how well previously trained assessment models match expert ratings of suturing and tying video clips recorded in a new operating room (OR) setting. METHODS: Enabled through computer vision of the hands, this study tests the applicability of assessments born out of benchtop simulations to in vivo suturing and tying tasks recorded in the OR. RESULTS: Compared with expert ratings, computer-generated assessments for fluidity of motion (slope = 0.83, intercept = 1.77, R2 = 0.55) performed better than motion economy (slope = 0.73, intercept = 2.04, R2 = 0.49), although 85% of ratings for both models were within ±2 of the expert response. Neither assessment performed as well in the OR as they did on the training data. Assessments were sensitive to changing hand postures, dropped ligatures, and poor tissue contact-features typically missing from training data. Computer-generated assessment of OR tasks was contingent on a clear, consistent view of both surgeon's hands. CONCLUSIONS: Computer-generated assessment may help provide formative feedback during deliberate practice, albeit with greater variability in the OR compared with benchtop simulations. Future work will benefit from expanded available bimanual video records.


Subject(s)
Clinical Competence , Suture Techniques , Humans , Operating Rooms
3.
J Surg Res ; 254: 255-260, 2020 10.
Article in English | MEDLINE | ID: mdl-32480069

ABSTRACT

BACKGROUND: Historically low, the proportion of female urology residents now exceeds 25% in recent years. Self-assessment is a widely used tool to track progress in medical education. However, the validity of its results and gender differences may influence interpretation. Simulation of surgical skills is increasingly common in modern residency training and standardizes certain objective tasks and skills. The objective of this study was to identify gender differences in self-assessment of surgeons and trainees when using simulation of surgical skills. METHODS: Medical students, residents, and attending and retired surgeons completed simple interrupted suturing. Assessment was self-rated using previously tested visual analog motion scales. Tasks were video recorded and rated by blinded expert surgeons using identical motion scales. Computer vision motion tracking software was used to objectively analyze the kinematics of surgical tasks. RESULTS: Proportion of female (n = 17) and male (n = 20) participants did not differ significantly by the level of training, P = 0.76. Five expert surgeons evaluated 84 video segments of simple interrupted suturing tasks (mean 3.0 segments per task per participant). Self-assessment correlated well overall with expert rating for motion economy (Pearson correlation coefficient 0.61, P < 0.001) and motion fluidity (0.55, P = 0.002). Women underrated their performance in accordance with mean individual difference of self-assessment and expert assessment scores (Δ SAS-EAS) for both economy of motion (mean ± SEM -1.1 ± 0.38, P = 0.01) and fluidity of motion (-1.3 ± 0.39, P < 0.01). On the same measures, men tended to rate themselves in accordance with experts (-0.16 ± 0.36, P = 0.63; -0.09 ± 0.41, P = 0.82, respectively). Δ SAS-EAS did not differ significantly on any rating scale across levels of training. Expert ratings did not differ significantly by gender for any domain. CONCLUSIONS: Female surgeons and trainees underrate some technical skills on self-assessment when compared with expert ratings, whereas male surgeon and trainee self-ratings and expert ratings were similar. Further work is needed to determine if these differences are accentuated across increasingly difficult tasks.


Subject(s)
Gender Identity , Self-Assessment , Students, Medical/psychology , Urologists/psychology , Clinical Competence , Female , Humans , Male , Suture Techniques
4.
Appl Ergon ; 87: 103136, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32501255

ABSTRACT

This paper compares clinician hand motion for common suturing tasks across a range of experience levels and tissue types. Medical students (32), residents (41), attending surgeons (10), and retirees (2) were recorded on digital video while suturing on one of: foam, pig feet, or porcine bowel. Depending on time in position, each medical student, resident, and attending participant was classified as junior or senior, yielding six experience categories. This work focuses on trends associated with increasing tenure observed from those medical students (10), residents (15), and attendings (10) who sutured on foam, and draws comparison across tissue types where pertinent. Utilizing custom software, the two-dimensional location of each of the participant's hands were automatically recorded in every video frame, producing a rich spatiotemporal feature set. While suturing on foam, increasing clinician experience was associated with conserved path length per cycle of the non-dominant hand, significantly reducing from junior medical students (mean = 73.63 cm, sd = 33.21 cm) to senior residents (mean = 46.16 cm, sd = 14.03 cm, p = 0.015), and again between senior residents and senior attendings (mean = 30.84 cm, sd = 14.51 cm, p = 0.045). Despite similar maneuver rates, attendings also accelerated less with their non-dominant hand (mean = 16.27 cm/s2, sd = 81.12 cm/s2, p = 0.002) than senior residents (mean = 24.84 cm/s2, sd = 68.29 cm/s2, p = 0.002). While tying, medical students moved their dominant hands slower (mean = 4.39 cm/s, sd = 1.73 cm/s, p = 0.033) than senior residents (mean = 6.53 cm/s, sd = 2.52 cm/s). These results suggest that increased psychomotor performance during early training manifest through faster dominant hand function, while later increases are characterized by conserving energy and efficiently distributing work between hands. Incorporating this scalable video-based motion analysis into regular formative assessment routines may enable greater quality and consistency of feedback throughout a surgical career.


Subject(s)
Clinical Competence , Hand/physiology , Surgeons , Suture Techniques , Work/physiology , Adult , Biomechanical Phenomena , Female , Humans , Internship and Residency , Male , Middle Aged , Motion , Psychomotor Performance , Simulation Training , Students, Medical , Task Performance and Analysis
5.
Am J Clin Exp Urol ; 8(1): 28-37, 2020.
Article in English | MEDLINE | ID: mdl-32211451

ABSTRACT

Epidural anesthesia is used to improve pain control after major surgeries. Few data describe the impact of epidural use for bladder cancer patients treated with radical cystectomy (RC). Here, we evaluate epidural use on perioperative and long-term outcomes for patients treated with radical cystectomy for bladder cancer. Patients who received radical cystectomy for non-metastatic bladder urothelial carcinoma with epidural (n=1,748) and without epidural (n=6,109) anesthesia from 2002-2014 were identified using Surveillance, Epidemiology and End Results-Medicare data. Radical cystectomy outcomes with and without epidural anesthesia were compared using propensity score weighting. Epidural use at time of radical cystectomy was identified in 1,748 (22.2%) of 7,857 patients who met inclusion criteria. After propensity score weighted adjustment, epidural use was associated with increased 30-day readmission (29.6% vs. 26.2%, P<0.001), increased median length of stay in days (9.0, IQR 7.0-12.0 vs 8.0, IQR 6.0-12.0, P<0.01), and decreased likelihood of being discharged directly to home without need for home health or skilled nursing care (21.6% vs 29.1%, P<0.001). Post-operative MI (2.6% vs 1.3%, P<0.001) in the first 30 days after radical cystectomy was more common in the epidural group, but perioperative 30-day mortality was similar (3.3% vs 2.9%, P=0.21). Epidural use was not associated with increased cancer specific (HR 0.96, 0.90-1.02, P=0.20) or overall survival (HR 0.99, 0.95-1.04, P=0.73). Epidural use at time of radical cystectomy is associated with increased risk of perioperative complications, hospital readmission, and longer hospitalization without improving disease specific survival. Prospective studies are needed to confirm these findings.

6.
Urol Oncol ; 37(11): 811.e17-811.e21, 2019 11.
Article in English | MEDLINE | ID: mdl-31451335

ABSTRACT

INTRODUCTION: Oncocytic neoplasms are renal tumors similar to oncocytoma, but their morphologic variations preclude definitive diagnosis. This somewhat confusing diagnosis can create treatment and surveillance challenges for the treating urologist. We hypothesize that these subtle morphologic variations do not drastically affect the malignant potential of these tumors, and we sought to demonstrate this by comparing clinical outcomes of oncocytic neoplasms to those of classic oncocytoma and chromophobe. METHODS: We gathered demographic and outcomes data for patients with variant oncocytic tumors. Oncologic surveillance was conducted per institutional protocol in accordance with NCCN guidelines. Descriptive statistics were used to compare incidence of metastasis and death against those for patients with oncocytoma and chromophobe. Three hundred and fifty-one patients were analyzed: 164 patients with oncocytoma, 28 with oncocytic neoplasms, and 159 with chromophobe tumors. RESULTS: Median follow-up time for the entire cohort was 32.4 months, (interquartile range 9.2-70.0). Seventeen total patients (17/351, 4.9%) died during the course of the study. In patients with oncocytoma or oncocytic neoplasm, none were known to metastasize or die of their disease. Only chromophobe tumors >6 cm in size in our series demonstrated metastatic progression and approximately half of these metastasized tumors demonstrated sarcomatoid changes. CONCLUSION: Variant oncocytic neoplasms appear to have a natural course similar to classic oncocytoma. These tumors appear to have no metastatic potential, and oncologic surveillance may not be indicated after surgery.


Subject(s)
Adenoma, Oxyphilic/surgery , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Adenoma, Oxyphilic/mortality , Adenoma, Oxyphilic/pathology , Adult , Aged , Carcinoma, Renal Cell/mortality , Carcinoma, Renal Cell/pathology , Disease Progression , Female , Humans , Kidney Neoplasms/mortality , Kidney Neoplasms/pathology , Male , Middle Aged , Nephrectomy , Prognosis , Survival Rate , Treatment Outcome
7.
Hum Factors ; 61(8): 1326-1339, 2019 12.
Article in English | MEDLINE | ID: mdl-31013463

ABSTRACT

OBJECTIVE: This study explores how common machine learning techniques can predict surgical maneuvers from a continuous video record of surgical benchtop simulations. BACKGROUND: Automatic computer vision recognition of surgical maneuvers (suturing, tying, and transition) could expedite video review and objective assessment of surgeries. METHOD: We recorded hand movements of 37 clinicians performing simple and running subcuticular suturing benchtop simulations, and applied three machine learning techniques (decision trees, random forests, and hidden Markov models) to classify surgical maneuvers every 2 s (60 frames) of video. RESULTS: Random forest predictions of surgical video correctly classified 74% of all video segments into suturing, tying, and transition states for a randomly selected test set. Hidden Markov model adjustments improved the random forest predictions to 79% for simple interrupted suturing on a subset of randomly selected participants. CONCLUSION: Random forest predictions aided by hidden Markov modeling provided the best prediction of surgical maneuvers. Training of models across all users improved prediction accuracy by 10% compared with a random selection of participants. APPLICATION: Marker-less video hand tracking can predict surgical maneuvers from a continuous video record with similar accuracy as robot-assisted surgical platforms, and may enable more efficient video review of surgical procedures for training and coaching.


Subject(s)
Hand , Image Interpretation, Computer-Assisted , Machine Learning , Motor Skills , Pattern Recognition, Automated , Surgical Procedures, Operative , Humans , Video Recording
8.
J Urol ; 199(3): 639, 2018 03.
Article in English | MEDLINE | ID: mdl-29227803
9.
Urology ; 112: 92-97, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29030073

ABSTRACT

OBJECTIVE: To compare oncological and procedural outcomes for renal oncocytic tumors treated with surgery, thermal ablation, or active surveillance. METHODS: Clinical and pathologic data were collected for consecutive patients with a histologic diagnosis of oncocytoma, oncocytic neoplasm, or chromophobe renal cell cancer (chRCC) from 2003 to 2016. Independent pathology and radiology reviews were performed for this study. RESULTS: Of 171 patients, tumor histology included oncocytoma (n = 122), chRCC (n = 47), and oncocytic neoplasm not otherwise specified (n = 2). At the initial diagnosis, 67, 14, and 90 patients were treated with surgery, thermal ablation, and active surveillance. In 3 of 19 patients (16%) who had biopsy and subsequent surgery, diagnosis changed from oncocytoma to chRCC. The median follow-up was 39.9 months with no difference among choices of treatment modalities (P = .33). Of 90 patients who began active surveillance, 32 (36%) switched to active treatments (19 underwent thermal ablation and 13 underwent surgery). The median linear growth rate for patients on active surveillance was 1.2 mm/y. No patients who were managed with active surveillance developed metastatic renal cell cancer (mRCC). mRCC was identified in 3 patients and was the cause of death in 2 patients. Patients who developed metastatic disease presented with symptomatic tumors of >4 cm and were treated with immediate surgery. For oncocytic masses of ≤4 cm (n = 126), the 5-year cancer-specific survival was 100%. CONCLUSION: Renal oncocytic neoplasms have favorable oncological outcomes. Active surveillance is safe and is the preferred management for small (≤4 cm) oncocytic renal tumors in selected patients.


Subject(s)
Ablation Techniques , Adenoma, Oxyphilic/therapy , Carcinoma, Renal Cell/therapy , Kidney Neoplasms/therapy , Nephrectomy , Watchful Waiting , Adult , Aged , Female , Hot Temperature , Humans , Male , Middle Aged , Retrospective Studies
10.
Cell ; 154(4): 888-903, 2013 Aug 15.
Article in English | MEDLINE | ID: mdl-23953118

ABSTRACT

Cellular-state information between generations of developing cells may be propagated via regulatory regions. We report consistent patterns of gain and loss of DNase I-hypersensitive sites (DHSs) as cells progress from embryonic stem cells (ESCs) to terminal fates. DHS patterns alone convey rich information about cell fate and lineage relationships distinct from information conveyed by gene expression. Developing cells share a proportion of their DHS landscapes with ESCs; that proportion decreases continuously in each cell type as differentiation progresses, providing a quantitative benchmark of developmental maturity. Developmentally stable DHSs densely encode binding sites for transcription factors involved in autoregulatory feedback circuits. In contrast to normal cells, cancer cells extensively reactivate silenced ESC DHSs and those from developmental programs external to the cell lineage from which the malignancy derives. Our results point to changes in regulatory DNA landscapes as quantitative indicators of cell-fate transitions, lineage relationships, and dysfunction.


Subject(s)
Cell Lineage , Gene Expression Regulation, Developmental , Animals , Cell Differentiation , Cell Transformation, Neoplastic , Chromatin/metabolism , Embryonic Stem Cells/metabolism , Enhancer Elements, Genetic , Feedback , Humans , Mice , Stem Cells/metabolism
11.
Am J Prev Med ; 45(3): 297-303, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23953356

ABSTRACT

BACKGROUND: Methods of measuring influenza vaccination of healthcare personnel (HCP) vary substantially, as do the groups of HCP that are included in any given set of measurements. Thus, comparison of vaccination rates across healthcare facilities is difficult. PURPOSE: The goal of the study was to determine the feasibility of implementing a standardized measure for reporting HCP influenza vaccination data in various types of healthcare facilities. METHODS: A total of 318 facilities recruited in four U.S. jurisdictions agreed to participate in the evaluation, including hospitals, long-term care facilities, dialysis clinics, ambulatory surgery centers, and physician practices. HCP in participating facilities were categorized as employees, credentialed non-employees, or other non-employees using standard definitions. Data were gathered using cross-sectional web-based surveys completed at three intervals between October 2010 and May 2011; data were analyzed in February 2012. RESULTS: 234 facilities (74%) completed all three surveys. Most facilities could report on-site employee vaccination; almost one third could not provide complete data on HCP vaccinated outside the facility, contraindications, or declinations, primarily due to missing non-employee data. Inability to determine vaccination status of credentialed and other non-employees was cited as a major barrier to measure implementation by 24% and 27% of respondents, respectively. CONCLUSIONS: Using the measure to report employee vaccination status was feasible for most facilities; tracking non-employee HCP was more challenging. Based on evaluation findings, the measure was revised to limit the types of non-employees included. Although the revised measure is less comprehensive, it is more likely to produce valid vaccination coverage estimates. Use of this standardized measure can inform quality improvement efforts and facilitate comparison of HCP influenza vaccination among facilities.


Subject(s)
Health Personnel/statistics & numerical data , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Vaccination/statistics & numerical data , Cross-Sectional Studies , Data Collection/methods , Feasibility Studies , Health Facilities/statistics & numerical data , Humans , Internet , Pilot Projects , United States
12.
Infect Control Hosp Epidemiol ; 34(6): 631-3, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23651896

ABSTRACT

We assessed the impact of a quality improvement intervention to reduce urinary catheter use and associated urinary tract infections (UTIs) at a single hospital. After implementation, UTIs were reduced by 39% ([Formula: see text]). Additionally, we observed a slight decrease in catheter use and the number of catheters without an appropriate indication.


Subject(s)
Hospitals, Veterans/standards , Urinary Catheterization/standards , Urinary Catheters/statistics & numerical data , Urinary Tract Infections/epidemiology , Urinary Tract Infections/prevention & control , Humans , Incidence , Organizational Policy , Practice Guidelines as Topic , Quality Improvement , United States/epidemiology , Urinary Catheterization/adverse effects , Urinary Catheterization/trends , Urinary Catheters/adverse effects , Urinary Tract Infections/etiology
13.
Clin Infect Dis ; 53(11): 1051-9, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22045954

ABSTRACT

BACKGROUND: Many health professional organizations now endorse influenza vaccination as a condition of employment in healthcare settings. Our objective was to describe institutional requirements for influenza vaccination of healthcare personnel (HCP) among US hospitals during the 2010-2011 influenza season. METHODS: A survey was mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as "a policy that requires HCP to receive or decline influenza vaccination, with or without consequences for vaccine refusal." A weighted analysis included univariate analyses and logistic regression. RESULTS: Of responding hospitals (n = 808; 81.0%), 440 (55.6%) reported institutional requirements for influenza vaccination. Although employees were uniformly subject to requirements, nonemployees often were not. The proportion of requirements with consequences for vaccine refusal was 44.4% (n = 194); where consequences were imposed, nonmedical exemptions were often granted (69.3%). Wearing a mask was the most common consequence (74.2% of 194 requirements); by contrast, 29 hospitals (14.4%) terminated unvaccinated HCP. After adjustment for demographic factors, the following characteristics remained significantly associated with requirements: location in a state requiring HCP to receive or decline influenza vaccine, caring for inpatients that are potentially vulnerable to influenza, use of ≥9 Advisory Committee on Immunization Practices-recommended, evidence-based influenza vaccination campaign strategies, and for-profit ownership. CONCLUSIONS: Influenza vaccination requirements were prevalent among hospitals of varying size and location. However, few policies were as stringent or as comprehensive as those endorsed by health professional organizations. Because influenza vaccination requirements are a viable alternative for hospitals unable to achieve high coverage through voluntary policies, there is still substantial room for improvement.


Subject(s)
Health Personnel , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Organizational Policy , Cross Infection/prevention & control , Hospitals , Humans , Occupational Diseases/prevention & control , Surveys and Questionnaires , United States
14.
Infect Control Hosp Epidemiol ; 32(12): 1209-12, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22080660

ABSTRACT

In 2011, institutional requirements for pertussis vaccination of healthcare personnel were reported by nearly one-third of surveyed US hospitals. Requirements often applied to personnel with certain clinical responsibilities, such as those caring for infants. Healthcare personnel who were not on an institution's payroll were rarely subject to pertussis vaccination requirements.


Subject(s)
Diphtheria-Tetanus-acellular Pertussis Vaccines/therapeutic use , Guideline Adherence/statistics & numerical data , Personnel, Hospital/statistics & numerical data , American Hospital Association , Databases, Factual , Diphtheria-Tetanus-acellular Pertussis Vaccines/administration & dosage , Health Care Surveys , Health Policy , Hospitals/statistics & numerical data , Humans , Practice Guidelines as Topic , United States
15.
Vaccine ; 29(50): 9398-403, 2011 Nov 21.
Article in English | MEDLINE | ID: mdl-21945495

ABSTRACT

BACKGROUND: Institutional requirements for influenza vaccination, ranging from policies that mandate declinations to those terminating unvaccinated healthcare personnel (HCP), are increasingly common in the U.S. Our objective was to determine HCP vaccine uptake following requirements for influenza vaccination at U.S. hospitals. METHODS: Survey mailed in 2011 to a nationally representative sample of 998 acute care hospitals. An institutional requirement was defined as an institutional policy that requires receipt or declination of influenza vaccination, with or without consequences for vaccine refusal. Respondents reported institutional-level, seasonal influenza vaccination coverage, if known, during two consecutive influenza seasons: the season prior to (i.e., pre-requirement), and the first season of requirement (i.e., post-requirement). Weighted univariate and multivariate analyses accounted for sampling design and non-response. RESULTS: 808 (81.0%) hospitals responded. Of hospitals with institutional requirements for influenza vaccination (n=440), 228 hospitals met analytic inclusion criteria. Overall, mean reported institutional-level influenza vaccination coverage among HCP rose from 62.0% in the pre-requirement season to 76.6% in the post-requirement season, representing a single-season increase of 14.7 (95% CI: 12.6-16.7) percentage points. After adjusting for potential confounders, single-season increases in influenza vaccination uptake remained greater among hospitals that imposed consequences for vaccine refusal, and among hospitals with lower pre-requirement vaccination coverage. Institutional characteristics were not associated with vaccination increases of differential magnitude. CONCLUSION: Hospitals that are unable to improve suboptimal influenza vaccination coverage through multi-faceted, voluntary vaccination campaigns may consider institutional requirements for influenza vaccination. Rapid and measurable increases in vaccination coverage followed institutional requirements at hospitals of varying demographic characteristics.


Subject(s)
Health Personnel/statistics & numerical data , Hospitals , Influenza Vaccines/administration & dosage , Influenza, Human/prevention & control , Vaccination/statistics & numerical data , Data Collection , Health Policy , Humans , Mandatory Programs , United States
16.
Infect Control Hosp Epidemiol ; 32(9): 908-11, 2011 Sep.
Article in English | MEDLINE | ID: mdl-21828972

ABSTRACT

US health professional schools with student immunity requirements for recommended vaccines frequently accept evidence of immunity other than vaccination but vary widely on the types of evidence that are accepted. Exemptions for nonmedical reasons and, to a lesser extent, medical reasons are often obtainable by a student-written document.


Subject(s)
Guideline Adherence , Organizational Policy , Schools, Medical/standards , Schools, Nursing/standards , Vaccination/standards , Guidelines as Topic , Humans , Schools, Medical/organization & administration , Schools, Nursing/organization & administration , United States
17.
Vaccine ; 29(22): 3850-6, 2011 May 17.
Article in English | MEDLINE | ID: mdl-21459173

ABSTRACT

BACKGROUND: The tetanus, diphtheria and acellular pertussis vaccine (Tdap) was recommended by the Advisory Committee on Immunization Practices (ACIP) for U.S. adults in 2005. Our objective was to identify barriers to early uptake of Tdap among adult populations. METHODS: The 2007 National Immunization Survey (NIS)-Adult was a telephone survey sponsored by the Centers for Disease Control and Prevention (CDC). Immunization information was collected for persons aged ≥18 years on all ACIP-recommended vaccines. A weighted analysis accounted for the complex survey design and non-response. RESULTS: Overall, 3.6% of adults aged 18-64 years reported receipt of a Tdap vaccination. Of unvaccinated respondents, 18.8% had heard of Tdap, of which 9.4% reported that a healthcare provider had recommended it. A low perceived risk of contracting pertussis was the single most common reason for either not vaccinating with Tdap or being unwilling to do so (44.7%). Most unvaccinated respondents (81.8%) indicated a willingness to receive Tdap if it was recommended by a provider. CONCLUSIONS: During the first two years of availability, Tdap uptake was likely inhibited by a low collective awareness of Tdap and a low perceived risk of contracting pertussis among U.S. adults, as well as a paucity of provider-to-patient vaccination recommendations. Significant potential exists for improved coverage, as many adults were receptive to vaccination.


Subject(s)
Diphtheria-Tetanus-acellular Pertussis Vaccines/administration & dosage , Patient Acceptance of Health Care/statistics & numerical data , Vaccination/statistics & numerical data , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Interviews as Topic , Male , Middle Aged , United States , Young Adult
18.
Microb Drug Resist ; 17(1): 121-4, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21166574

ABSTRACT

Our objective was to characterize 46 unique, erythromycin-sensitive, and clindamycin-resistant Streptococcus agalactiae strains from S. Korea that displayed a novel phenotype in double-disk diffusion assay. We used polymerase chain reaction to determine presence of erythromycin and clindamycin resistance genes, disc diffusion assays to determine resistance phenotype, and microbroth dilution to determine minimal inhibitory concentration. We detected a novel phenotype in the double-disk diffusion assay for inducible resistance among 46 S. agalactiae strains that were both erythromycin sensitive and clindamycin resistant. Thirty-two strains with the novel phenotype tested positive for erm(B) by DNA-DNA hybridization; sequencing of the erm(B) gene revealed mutations in the ribosomal binding site region in the erm(B) open reading frame, which is consistent with a lack of erythromycin resistance phenotype. Although identified from patients at multiple hospitals, genotyping suggested that the strains are closely related. The new phenotype shows increased sensitivity to clindamycin in the presence of erythromycin.


Subject(s)
Anti-Bacterial Agents/pharmacology , Streptococcal Infections/drug therapy , Streptococcus agalactiae/drug effects , Clindamycin/pharmacology , Drug Resistance, Bacterial , Erythromycin/pharmacology , Female , Humans , Microbial Sensitivity Tests , Mutation , Open Reading Frames , Phenotype , Polymerase Chain Reaction , Pregnancy , Republic of Korea/epidemiology , Streptococcal Infections/microbiology , Streptococcus agalactiae/genetics , Streptococcus agalactiae/isolation & purification
19.
J Korean Med Sci ; 25(6): 817-23, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20514299

ABSTRACT

The prevalence of group B streptococcus (GBS) among pregnant women and disease burdens in neonates and adults are increasing in Korea. Colonizing isolates, collected by screening pregnant women (n=196), and clinical isolates collected from clinical patients throughout Korea (n=234), were serotyped and screened for antibiotic resistance. Serotype III (29.8%) and V (27.7%) predominated, followed by Ia (17.0%). Antibiotic resistance was higher among clinical than colonizing isolates for erythromycin (35.1% and 26.9%; P=0.10) and for clindamycin (49.4% and 42.1%; P=0.17). erm(B) occurred in 91.9% of erythromycin resistant isolates, and 84.0% of isolates resistant to clindamycin. Only five isolates (4.2%) resistant to erythromycin were susceptible to clindamycin; by contrast, and unique to Korea, 34% of isolates resistant to clindamycin were erythromycin susceptible. Among these 60 erythromycin-susceptible & clindamycin-resistant isolates, 88% was serotype III, and lnu(B) was found in 89% of strains. Four fifths of the serotype V isolates were resistant to both erythromycin and clindamycin. Further characterization of the genetic assembly of these resistance conferring genes, erm(B) and lnu(B), will be useful to establish the clonal lineages of multiple resistance genes carrying strains.


Subject(s)
Pregnancy Complications, Infectious/microbiology , Streptococcal Infections/epidemiology , Streptococcus agalactiae/isolation & purification , Adult , Anti-Bacterial Agents/pharmacology , Clindamycin/pharmacology , Drug Resistance, Multiple, Bacterial , Erythromycin/pharmacology , Female , Genotype , Humans , Microbial Sensitivity Tests , Middle Aged , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Republic of Korea/epidemiology , Serotyping , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Streptococcus agalactiae/drug effects , Streptococcus agalactiae/genetics
20.
PLoS One ; 5(3): e9466, 2010 Mar 01.
Article in English | MEDLINE | ID: mdl-20209125

ABSTRACT

BACKGROUND: Acute myeloid leukemia (AML) is a heterogeneous disease with an overall poor prognosis. Gene expression profiling studies of patients with AML has provided key insights into disease pathogenesis while exposing potential diagnostic and prognostic markers and therapeutic targets. A systematic comparison of the large body of gene expression profiling studies in AML has the potential to test the extensibility of conclusions based on single studies and provide further insights into AML. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we systematically compared 25 published reports of gene expression profiling in AML. There were a total of 4,918 reported genes of which one third were reported in more than one study. We found that only a minority of reported prognostically-associated genes (9.6%) were replicated in at least one other study. In a combined analysis, we comprehensively identified both gene sets and functional gene categories and pathways that exhibited significant differential regulation in distinct prognostic categories, including many previously unreported associations. CONCLUSIONS/SIGNIFICANCE: We developed a novel approach for granular, cross-study analysis of gene-by-gene data and their relationships with established prognostic features and patient outcome. We identified many robust novel prognostic molecular features in AML that were undetected in prior studies, and which provide insights into AML pathogenesis with potential diagnostic, prognostic, and therapeutic implications. Our database and integrative analysis are available online (http://gat.stamlab.org).


Subject(s)
Gene Expression Regulation, Leukemic , Leukemia, Myeloid, Acute/genetics , Leukemia, Myeloid, Acute/metabolism , Chromosome Mapping , Cluster Analysis , Cytogenetics , Databases, Genetic , Gene Expression Profiling , Humans , Prognosis
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