Examining the impact of a 9-component bundle and the INICC multidimensional approach on catheter-associated urinary tract infection rates in 32 countries across Asia, Eastern Europe, Latin America, and the Middle East.

BACKGROUND: Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. METHODS: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. RESULTS: Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). CONCLUSIONS: Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.

Allogeneic hematopoietic stem cell transplantation in patients with childhood cerebral adrenoleukodystrophy: A single-center experience "Better prognosis in earlier stage".

BACKGROUND: ALD is a rare X-linked peroxisomal metabolic disorder with many distinct phenotypes of disease that emerge on a wide scale from adrenal insufficiency to fatal cALD which progresses to a vegetative state within a few years. Currently, HSCT is the only treatment method known to stabilize disease progression in patients with cALD. In this study, we aim to report our HSCT experience in patients with cALD and the factors that determine the success of HSCT, as a single-center experience. METHODS: The study cohort involves 23 boys with cALD and three patients with ALD trait and new-onset abnormal behavior who underwent allogeneic HSCT between January 2012 and September 2019 in our transplantation center. Loes scoring, NFS, scale and MFD were performed for evaluating the severity of the cerebral disease. The study cohort was divided into two groups according to baseline NFS and Loes score: early-stage (NFS ≤ 1 and Loes score <9) and advanced stage (NFS > 1 or Loes score ≥9). RESULTS: The pretransplant stage of disease impacted both OS and MFD-free survival. The estimated OS and MFD-free survival at 3 years in patients with advanced disease were 46.1% (95% CI 19.0-73.2) and 23.1% (95% CI 0.2-46.0), respectively, and all patients with the early disease were alive (p: .004) and MFD-free (p < .001) at 3 years. CONCLUSION: This study demonstrated that early HSCT is vital in patients with cALD. The early-stage disease had a significant survival advantage and free from disease progression after HSCT.

Biomarkers for Antidepressant Efficacy of Electroconvulsive Therapy: An Exploratory Cerebrospinal Fluid Study.

BACKGROUND: No candidate biomarkers based on cerebrospinal fluid (CSF) have been identified as prognostic factors in patients with major depression treated with electroconvulsive therapy (ECT), yet. METHOD: Following different underlying hypotheses, we analysed baseline CSF levels of markers of neurodegeneration (tau proteins, ß-amyloids and neurogranin), elements of the innate immune system (interleukin [IL]-6, neopterin, soluble CD14, soluble CD163, migration inhibitory factor and monocyte chemotactic protein 1), endocannabinoids, sphingolipids and Klotho before ECT in patients with depression (n = 12) to identify possible correlations with the clinical antidepressant response to ECT. RESULTS: Correlation with the reduction of the depressive symptoms could be observed especially for markers of neurodegeneration and elements of the innate immune system. Differences for CSF levels of several markers were found between the groups of responders and non-responders at the trend level. LIMITATIONS: The sample size is small and the -distribution of responders and non-responders is uneven. CONCLUSIONS: It is this first study on CSF biomarkers for antidepressant efficacy of ECT warrants further research regarding the mechanism of ECT and personalized antidepressant therapy.

Sustained lung inflation at birth via short binasal prong in very low birth weight preterm infants: A retrospective study.

BACKGROUND AND OBJECTIVES: It is believed, that sustained lung inflation (SLI) at birth in preterm infants reduces the need for mechanical ventilation (MV) and improves respiratory outcomes. The aim of this study was to compare need for MV in preterm infants at high risk for respiratory distress syndrome (RDS) after prophylactic SLI via short binasal prongs at birth combined with early nasal continuous positive airway pressure (nCPAP) versus nCPAP alone. METHODS: Medical records of infants born at 260/7 to 296/7 weeks gestation through 2015 and 2017 were retrospectively assessed. Infants who get sustained inflations at 25 cmH2 O pressure for 15 s following delivery via binasal short prongs comprised the study group. Gestational age matched infants who was supported solely with nCPAP (6 cmH2 O PEEP) comprised the control group. Early rescue surfactant (200 mg/kg poractant alfa) was delivered using the less invasive surfactant administration technique in infants with established RDS. RESULTS: A total of 215 infants were analyzed. Fewer infants in the SLI group required MV within the first 72 h of life compared to the control group (25.7% vs 56.9%, P < 0.001). In multiple logistic regression analysis, SLI emerged as an independent factor for reduced MV need. Bronchopulmonary dysplasia (BPD) incidence including mild BPD was significantly lower in the SLI group (31.9% vs 48%, P = 0.01); however, moderate and severe BPD rates did not reach to a statistical significance (11.5% vs 20.6%, P = 0.06). CONCLUSION: Prophylactic SLI maneuver at birth for preterm infants with impending RDS reduces the need for MV with no adverse effects.

Antidepressant efficacy of electroconvulsive therapy is associated with a reduction of the innate cellular immune activity in the cerebrospinal fluid in patients with depression.

OBJECTIVES: A bidirectional link between the antidepressant effects of electroconvulsive therapy (ECT) and the modulation of the immune system has been proposed. To elucidate the interplay between antidepressant treatment and macrophage/microglia activation in humans, we performed a study on the effects of the antidepressant treatment by ECT on markers of macrophage/microglia activation in patients with depression. METHODS: We measured six different markers (IL-6, neopterin, sCD14, sCD163 MIF and MCP1) of macrophage/microglia activation in the cerebrospinal fluid (CSF) and blood of 12 patients with a severe, treatment-resistant depressive episode before and after a course of ECT. RESULTS: Some markers in the CSF of remitters were reduced after the ECT course and differed from non-remitters, but no differences were found before and after ECT independently from the antidepressant efficacy. CSF baseline levels of some markers could predict the reduction of depressive psychopathology during ECT. Higher CSF levels indicating increased macrophage/microglia activation at baseline predicted a better treatment response to ECT. CONCLUSIONS: Although the sample size was small, our data suggest that macrophages/microglia are involved in the pathophysiology of major depression and that antidepressant efficacy by ECT might be partly explained by the modulation of the innate immune system within the brain.

Utilizing Infant Cry Acoustics to Determine Gestational Age.

OBJECTIVES/HYPOTHESIS: The date of last menstruation period and ultrasonography are the most commonly used methods to determine gestational age (GA). However, if these data are not clear, some scoring systems performed after birth can be used. New Ballard Score (NBS) is a commonly used method in estimation of GA. Cry sound may reflect the developmental integrity of the infant. The aim of this study was to evaluate the connection between the infants' GA and some acoustic parameters of the infant cry. STUDY DESIGN: A prospective single-blind study was carried out. METHODS: In this prospective study, medically stable infants without any congenital craniofacial anomalies were evaluated. During routine blood sampling, cry sounds were recorded and acoustic analysis was performed. Step-by-step multiple linear regression analysis was performed. RESULTS: The data of 116 infants (57 female, 59 male) with the known GA (34.6 ± 3.8 weeks) were evaluated and with Apgar score of higher than 5. The real GA was significantly and well correlated with the estimated GA according to the NBS, F0, Int, Jitt, and latency parameters. The obtained stepwise linear regression analysis model was formulized as GA=(31.169) - (0.020 × F0)+(0.286 × GA according to NBS) - (0.003 × Latency)+(0.108 × Int) - (0.367 × Jitt). The real GA could be determined with a ratio of 91.7% using this model. CONCLUSIONS: We have determined that after addition of F0, Int, Jitt, and latency to NBS, the power of GA estimation would be increased. This simple formula can be used to determine GA in clinical practice but validity of such prediction formulas needs to be further tested.

Dealing with pandemic influenza A during postpartum and early neonatal period in a busy family-centered neonatal intensive care unit.

Although most infections with the current pandemic H1N1 virus have been self-limited, the risk of influenza complications is higher in some subpopulations. Pregnant women had an increased risk of influenza complications in two past epidemics (1918-1919 and 1957-1958). Since neonates do not have a well-developed immune system, they are also vulnerable to viral infections and its complications. This article reports the interventions and health care planning strategies for pandemic influenza A, and its seasonal results in a tertiary perinatal care center with annually 20,000 deliveries.

Spermatogenic disturbance induced by di-(2-ethylhexyl) phthalate is significantly prevented by treatment with antioxidant vitamins in the rat.

Phthalate esters, now regarded as endocrine disruptors, are widely used in the plastics industry. In particular, di-(2-ethylhexyl) phthalate (DEHP) is produced in large quantities, and is used in blood storage bags, catheters and haemodialysis instruments. Previous studies have demonstrated that treatment of rats with DEHP induces testicular atrophy with liver enlargement, although the precise nature and mechanism of the action of DEHP on these organs remains unclear. In the present study, we produced an experimental model of DEHP-induced spermatogenic disturbance in rats by feeding them a DEHP-containing diet. Liver enlargement occurred in rats fed either a 1 or 2% DEHP-containing diet. However, testicular atrophy accompanied by aspermatogenesis was induced by feeding with the 2% but not with the 1% DEHP-containing diet. This suggests that the critical DEHP dose for gonadotoxicity is higher than that for hepatotoxicity. Using the 2% DEHP-dose, the effect of simultaneous administration of antioxidant vitamins (= vitamins C and E) was next examined. It was found that the vitamin supplementation significantly prevented the testicular injury. The results suggest that antioxidant vitamins can protect the testes from DEHP-toxicity.

Analysis of beta3 adrenergic receptor gene polymorphism using noninvasive samples obtained at scheduled infant health checkups.

Obesity is a risk factor for life-style-related diseases, and is based on three factors: genetic, environmental, and life-style. In adults, it is difficult to achieve and maintain normal body weight, so it is more effective to intervene from infancy to establish weight control. Legally required health checkups in infants of 18 and 36 months present important opportunities for obesity prevention. We consider genetic analysis to be a very important factor for obesity prevention in infancy. However, since health checkups don't involve the collection of blood, genetic analysis is considered difficult. In this study, we attempted the typing of beta3 adrenergic receptor gene polymorphism as a genetic factor from non-invasively obtained samples, buccal mucosa, hair and cerumen in 96 infants at their 18- and 36-month health checkups. Sampling buccal mucosa, hair and cerumen instead of blood caused almost no anxiety to the child or parent, so 94.1% cooperation with sampling was obtained. From buccal mucosa, about 76% of the samples could be used for the typing of polymorphism (81% by enzyme method, 59% by kit method). From hair, about 44% of the samples permitted typing of polymorphism, but from cerumen only about 4% of the samples could be used. Results from buccal mucosa and hair typed about 90% of infant polymorphism. These results suggest that this method would be practical at periodic health checkups, and would probably be applicable to mass screenings for genetic factor analysis for other diseases.

Tissue concentrations of chlordanes in mice after long-term exposures to technical grade chlordane at indoor air levels.

We determined concentrations of chlordanes (5 chlordane compounds and 2 metabolites) in tissues and organs of mice following a prolonged exposure to Chlordane (technical grade chlordane) at levels as low as those in indoor air.After exposure to 4.22-11.36 µ g/m(3) Chlordane (total of 5 compounds) in the air for 1-6 months, 6.44-13.00 ppm chlordanes (total of 7 compounds) were detected in mice (2 tissues and 6 organs). The adipose tissue among the 2 tissues / 6 organs examined contained the highest chlordanes. The ratio of the adipose tissue chlordanes to the liver chlordanes was approximately 5.6 times, followed by the muscle (0.9), lungs (0.4), kidneys (0.4), heart (0.3), spleen (0.2) and brain (0.1). In addition, trans-nonachlor, oxychlordane and heptachlorepoxide in chlordanes were at a high level.The level of Chlordane exposure (dose) and the level of chlordanes accumulation in each tissue or organ of the mice except for the heart were closely correlated (r=0.9388-0.7130), and showed a linear relationship. The tendency of chlordanes accumulation in light of the linear relationship was adipose ≫ liver ≥ muscle.Thus, even with a low level of Chlordane in indoor air, chlordanes may be steadily accumulated in the bodies of human residents with prolonged exposure similarly. The present findings suggest that it is necessary to investigate die risk of organochlorine chemicals contamination in indoor air at prolonged exposure.

Study on biological monitoring of fenpropathrin exposure in application by utilizing urinary 3-phenoxybenzoic acid level.

To estimate pesticide exposure faced by applicators, an investigation of exposure-absorption was conducted on two applicators under routine working conditions and using regular procedures during pesticide spraying of greenhouse strawberries with fenpropathrin. The authors hypothesized that 3-phenoxybenzoic acid (3-PBA) is a urinary excreted metabolite of fenpropathrin, a synthetic pyrethroid pesticide with 3-phenoxybenzyl moiety, and its determination would help to improve the assessment of fenpropathrin exposure-absorption in applicators. The extent of exposure-absorption was evaluated by the determination of urinary level of 3-PBA (biological monitoring), the amount of the chemical adhered to clothes and permeated to the skin surface, and its concentration in the air of the greenhouse. The results showed that the fenpropathrin concentration in the air was less than 0.1 µg/m(3). The amount of adhesion was less than 0.001 to 10.25 µg/cm(2), and there was very little permeation. However, the urinary 3-PBA concentration by biological monitoring appeared to be approximately twice that of pre-exposure levels in both applicators. This finding demonstrates that the applicators were exposed to fenpropathrin and absorbed it during spraying. We conclude that the fenpropathrin exposure-absorption in application could be estimated by the determination of urinary 3-PBA. This method of biological monitoring may be more useful indicator to accurately evaluate the working conditions in application.

A study on urine cotinine for the evaluation of smoking cessation.

Two branch offices of enterprise T in the same city engaged in service and sales were selected at random for this study on the evaluation of smoking cessation education using the urine cotinine concentration (U-Cot) measured by ion pair reversed-phase high performance liquid chromatography (IP-R-HPLC). Branch A conducted a smoking cessation education program; branch B did not. By comparison of the results obtained from questionnaires and U-Cot analyses at both the offices, we investigated the validity of evaluation by U-Cot. The results were as follows: I. Smokers 1. At branch A, a self-reported 20-year-old female non-smoker was confirmed to smoke about 5 cigarettes per day by her high concentration (292.8) of U-Cot at pre-education. 2. At branch A, the self-reported average number of cigarettes smoked daily (ANCSD) at 6 months post-education showed a significant decrease in comparison with that at pre-education. 3. At branch A, U-Cot at post-education showed a significant decrease in comparison with those at 2 weeks, 2 months, and 6 months pre-education in descending order. 4. Two male subjects who were strongly suspected to have submitted a false number of cigarettes smoked prior to urine sampling (NCSPU)/ANCSD self-reports at 6 months post-education were confirmed to have done so by the U-Cot values at the fourth period, which were in excess of 500, and the discrepancy between the ratio ([value at post-education in 6 months] divided by [value at pre-education]) of U-Cot (1.52, 1.47, respectively) and that of NCSPU/ANCSD, (0.00)/0.00). 5. At branch A, discrepancies between the success rate of quitting smoking in self-reported NCSPU/ANCSD at 6 months (17.0%) and in U-Cot (12.2%) were observed. At branch B, no such discrepancies were observed. 6. At branch A, office workers at 6 months post-education who had, but not those who had not, previously considered the health damage caused by smoking showed a significant decrease in NCSPU/ANCSD, and also in U-Cot at 2 weeks, 2 months and 6 months post-education. At branch B, no such differences were observed. 7. At branch A, office workers at 6 months post-education who had previously considered quitting smoking showed a significant decrease in NCSPU/ANCSD, and also in U-Cot at 2 weeks, 2 months and 6 months post-education. Those who had not previously considered quitting showed a significant decrease in ANCSD, but not in NCSPU or U-Cot.(ABSTRACT TRUNCATED AT 400 WORDS)

[Chlordane accumulations in adipose tissue of mice chronically exposed to chlordanes in indoor air].

Chlordane concentrations were analyzed in the adipose tissue of mice after prolonged inhalation of low levels of chlordanes in indoor air. After inhalation of 4.22-11.36 micrograms/m3 chlordanes (total of 5 compounds) in air for 1-6 months, high levels of chlordanes (4.19-11.63 ppm, total of 5 compounds and 2 metabolites) were found in the adipose tissue. Transnanochlor, which accounted for only 14% of the total chlordane in the inhaled air, showed a high percentage (50%) in the adipose tissue, followed by 2 metabolites, i.e., oxychlordane (25%) and heptachlorepoxide (22%). Little transchlordane, cis-chlordane, or heptachlor, which accounted for high percentages of the total chlordane inhaled, was detected in the adipose tissue. A low level of cis-nonachlor was observed in the adipose tissue, and its percentage was similar to that in the air (2%). The level of chlordane exposure and the adipose tissue chlordane concentration was closely correlated (r = 0.9077, p < 0.01), showed a dose-effect relationship. These findings suggest that chlordanes such as trans-nonachlor, oxychlordane, and heptachlorepoxide may accumulate in the adipose tissue of people living in an environment containing even low levels of chlordanes and that there is a risk from indoor air contamination by chlordanes.