Impact of control measures including decolonization and hand hygiene for orthopaedic surgical site infection caused by MRSA at a Japanese tertiary-care hospital.

BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen in orthopaedic surgical site infections (SSIs). However, few studies have investigated the transmission process of orthopaedic MRSA SSI. AIM: To investigate the transmission process of orthopaedic MRSA SSI using epidemiological and molecular analyses and to determine a method to prevent MRSA SSI in nosocomial orthopaedic surgery. METHODS: Active MRSA surveillance, preoperative decolonization and contact precautions for MRSA-positive cases was performed at our institution. Changes in epidemic strains were evaluated and the possibility of transmission from patients in an orthopaedic ward of a Japanese tertiary-care hospital was assessed by genotyping stored MRSA strains. In addition, data on the prevalence of MRSA SSI, MRSA colonization, and use of an alcohol antiseptic agent (mL/patient-days) during 2005-2022 were retrospectively assessed. FINDINGS: SCCmec type II strain in the SSI group decreased over time, associated with fewer outbreaks. Even during a period of high infection rates, no cases of transmission-induced SSI from nasal MRSA carriers were identified. The infection rate correlated negatively with the use of an alcohol antiseptic agent (r = -0.82; P < 0.0001). Two cases among five nasal carriers developed MRSA SSI caused by strains different from those related to nasal colonization. CONCLUSION: The infection control measures for transmission from the hospital reservoirs including strict adherence to hand hygiene and decolonization of carriers is likely to be important for the prevention of orthopaedic MRSA SSI. However, the need for contact precautions for decolonized nasal carriers might be low.

Nicotine pouch product awareness, interest and ever use among US adults who smoke, 2021.

BACKGROUND: Tobacco-free nicotine pouches are one of the fastest growing tobacco product categories in the US market. However, data on awareness, appeal or ever use of these products in the USA are limited. METHODS: We surveyed a population-based sample of US adults who smoked (n=1018) between January and February 2021 about awareness, ever use of or interest in nicotine pouches. Multivariable logistic regression models explored the relationship between nicotine pouch variables and demographic and tobacco use characteristics. RESULTS: In early 2021, 29.2% of adults who smoked had ever seen or heard of nicotine pouches, 5.6% had ever tried pouches and 16.8% reported interest in using pouches in the next 6 months. Adults who smoked aged 18-44 years and those who had ever used smokeless tobacco (SLT) were more likely to be aware of nicotine pouches. Interest in using nicotine pouches was more prevalent among adult smokers who planned to quit within 6 months, attempted to quit before using counselling or another tobacco product and had ever used pouches. Among adults who smoked, those with more education had lower odds of ever using nicotine pouches while those who had attempted to quit before using traditional methods or ever used SLT had higher odds of ever use. CONCLUSION: Levels of awareness, appeal and trial of nicotine pouches among US adults who smoke were modest, with variation by age, education, quit plans and quit attempt methods. Continued surveillance is warranted, including among naïve users and users of other tobacco and nicotine products.

Perceived effectiveness of cancer screening among family medicine and internal medicine physicians in the United States.

Family and internal medicine physicians play an important role in cancer screening, yet there are limited data on their beliefs regarding effectiveness of screening tests, which may affect physicians' likelihood to recommend such tests. The study purpose was to assess current beliefs among family medicine and internal medicine physicians regarding effectiveness of various types of cancer screening. A national sample of 582 physicians from the American Medical Association's Physician Masterfile were surveyed. Participants were asked about their perceived effectiveness of screening for colon, lung, breast, prostate, and cervical cancer among average, healthy individuals. Chi-square tests were conducted to assess relationships between perceiving screening tests to be 'very effective in reducing cancer-related mortality' and demographic characteristics. A substantial majority of physicians perceived colonoscopy (83.8%) and Pap smear (82.9%) to be very effective. Perceiving low-dose computed tomography (LDCT), Pap smear, and prostate-specific antigen (PSA) as 'very effective' differed by gender, with females less likely to endorse LDCT and Pap smear but more likely to endorse PSA. Perceiving PSA as 'very effective' differed by age and graduation year, with younger or more recently graduated physicians being less likely to perceive PSA as 'very effective'. Non-Hispanic Black/African-American physicians were more likely to perceive mammography as 'very effective' than other groups. Physicians' perceived effectiveness about cancer screening tests varies widely and may influence their recommendations or usage of these tests. Understanding physicians' beliefs can help in improving uptake of evidence-based screening tests by providers and patients to promote early detection and successful treatment.

The impact of repeat FNA in non-diagnostic and indeterminate thyroid nodules: A 5-year single-centre experience.

INTRODUCTION: FNA is a well-established method for the preoperative diagnosis of thyroid nodules, but limitations still reside among non-diagnostic and indeterminate samples. The objective of the present study was to assess the impact of repeat FNA in thyroid nodules primarily classified as non-diagnostic and indeterminate, with the evaluation of the diagnostic resolution rate after the reassessment of the nodule. METHODS: We retrospectively collected all cases of thyroid FNA at our institution in the last 5 years that had one or more repeat aspirations of the same nodule, calculating the percentage of samples with change in the diagnostic category. Additional collected data included sex, age and interval between the repeat aspirations. RESULTS: One hundred and seventy-eight specimens from 167 patients (140 female, 27 male) with a median age of 56 years (range 11-90) were included in the study. Among the 86 cases primarily classified as non-diagnostic, 25 (29.1%) remained in the same category after the first reassessment and only 18 (20.9%) after the second repeat aspiration. Among the 40 indeterminate cases, only 10 (25%) retained their status after the second aspiration, with no change after the third assessment. CONCLUSION: Repeat aspiration of non-diagnostic and indeterminate thyroid nodules had a positive impact in both groups, with diagnostic resolution rates of 80% and 75%, respectively. The present study therefore endorses the use of such strategy for the initial follow-up of nodules with no definite diagnosis, especially in low-resource centres with limited access to modern molecular technologies.

What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan.

PURPOSE: The diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) is able to diagnose DIC accurately and promptly. The aim of this retrospective study is to evaluate the degree of association between each parameter of JAAM DIC criteria and the diagnosis of trauma induced DIC (T-DIC) utilizing thromboelastometry (ROTEM). METHODS: Trauma patients transported to our hospital with ROTEM performed in the emergency department between January 2013 and December 2015 were enrolled in this study. We evaluated (1) the characteristics of T-DIC, (2) the relationships between T-DIC and each parameter of the JAAM DIC criteria and (3) the diagnostic accuracies of each parameter for T-DIC by statistical measurement. RESULTS: All 72 patients (21 T-DIC and 51 control) were included in primary analysis. T-DIC was significantly related to younger age, more severe trauma scores, more cases of massive transfusions, and remarkable coagulation abnormality detected by standard coagulation tests. In the cases of T-DIC, ROTEM showed longer clotting time, lower acceleration, lower clot firmness, and inhibited fibrinolysis in EXTEM/INTEM. Within the JAAM DIC score, PT-INR ≥1.2 was the most accurate factor for T-DIC diagnosis; sensitivity 60.0%, specificity 100.0%, and accuracy 88.7%. PT-INR ≥1.2 was statistically correlated with the JAAM DIC score (p < 0.001, r = 0.709). The univariate analysis based on 1.2 of PT-INR indicated statistical differences in most categories of ROTEM, which is similar to analysis performed for the presence and absence of T-DIC. CONCLUSIONS: Among JAAM DIC criteria, the PT-INR ≥1.2 was the most accurate factor for both the diagnosis of T-DIC and the evaluation of its severity.

Deciphering the DNA repair protein, Rad23 from kuruma shrimp Marsupenaeus japonicus: full-length cDNA cloning and characterization.

AIMS: Lesions of DNA are removed by nucleotide excision repair (NER) process in the living systems. NER process-related host factors are believed to aid recovery steps during viral integration. Here, we report identification and characterization of a DNA repair molecule Rad23 from kuruma shrimp Marsupenaeus japonicus. METHODS AND RESULTS: The full-length cDNA of M. japonicus Rad23 gene (MjRad23) has 1149 bp coding for a putative protein of 382 amino acids with a 5' untranslated region (UTR) of 92 bp and 3' UTR region of 1116 bp. Quantitative expression analysis revealed MjRad23 is constitutively expressed in all the organs of healthy shrimp, whereas with high level in muscle tissue. Although MjRad23 expression is observed in every haemolymph samplings to post-white spot syndrome virus infection, high expression is recorded at 2 h post infection (h.p.i.). MjRad23 consists of putative functional domains including one ubiquitin domain (UBQ), two ubiquitin-associated domains (UBA) and one heat-shock chaperonin-binding motif (STI1). Multiple alignment of MjRad23 with Rad23 of other species showed highly significant identity ranging from 37 to 53%; however, high homology is observed with Rad23 of Bombyx mori (BmRad23). UBQ domain region alignment revealed maximum of 66% homology with Rad23 of Apis melifera (AmRad23). MjRad23 clustered with invertebrate sector along with insect species in evolution analysis. Three-dimensional structural analyses demonstrated the highest identity between MjRad23 and human Rad23A (hHR23A). CONCLUSIONS: The present work revealed the presence of MjRad23 gene, which is essential in DNA repair process. Further studies are required to clarify the involvement of MjRad23 in NER process. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report on identification and characterization of DNA repair protein in crustaceans, which will lead to further investigation to explore the molecular mechanisms behind the NER process.

Preliminary assessment of reproductive technologies in wood bison (Bison bison athabascae): implications for preserving genetic diversity.

Since the high prevalence of bovine tuberculosis and brucellosis in free-ranging wood bison in the Canadian north poses a threat to nearby healthy bison populations, commercial bison and cattle ranches, and potentially to humans, there is considerable impetus to salvage the genetics of infected bison and maintain a disease-free herd. In that regard, there is a great need to develop appropriate reproductive technologies. Therefore, the objective of this study was to develop protocols to produce and cryopreserve wood bison embryos (based on protocols used for cattle). Cumulus oocyte complexes (COC) aspirated from ovaries recovered after slaughter were matured in vitro, and fertilized with either frozen-thawed semen or chilled epididymal spermatozoa. Although both sources of spermatozoa resulted in acceptable rates of fertilization (64.4%, n=45; 89.2%, n=28, respectively) and cleavage (75.0%, n=40; 92.5%, n=40), production of morulae (7.5%, n=40; 25.0%, n=40) and blastocysts (7.5%, n=40; 10.0%, n=40) was low. Morulae- and blastocyst-stage embryos were frozen-stored by vitrification. To our knowledge, this is the first report regarding the in vitro production and cryopreservation of bison embryos for genetic recovery of diseased wood bison. These techniques have substantial potential for conserving and managing the genetic diversity of wild bison, and may also have important management implications for genetic salvage of diseased bison populations in North America.

Emergency response planning for anthrax outbreaks in bison herds of northern Canada: a balance between policy and science.

Anthrax outbreaks in northern Canada have implications for ongoing recovery efforts for the threatened wood bison and may pose a health risk to humans, other wildlife, and domestic livestock. RWED and WBNP maintain Anthrax Emergency Response Plans (AERPs) for their respective jurisdictions. An AERP is a pre-planned logistical framework for responding effectively and rapidly to an outbreak so as to minimize spread of the disease, reduce environmental load of spores available for future outbreaks, and minimize risk to public health. In this paper, we describe the main components of an AERP and outline areas for future research.

Implications of agricultural and wildlife policy on management and eradication of bovine tuberculosis and brucellosis in free-ranging wood bison of northern Canada.

Although disease is often an important factor in the population dynamics of wild ungulates, it is largely the threat-both real and perceived-that sylvatic disease reservoirs pose to the health status of commercial livestock or game farm industry that has led governments to establish policy and legislation for disease management, trade, and movement. With respect to bovine tuberculosis and brucellosis in wildlife, policies are largely borrowed from the existing regulatory framework for domestic livestock. In this paper, we review how general policy goals for managing these reportable diseases in domestic livestock have also affected conservation and management of bison in Canada. We argue that there is a need to better integrate conservation biology with agricultural livestock policy to develop management options and better address the unique conservation challenges that diseased free-ranging bison populations present.

The Hook Lake Wood Bison Recovery Project: can a disease-free captive wood bison herd be recovered from a wild population infected with bovine tuberculosis and brucellosis?

The Hook Lake Wood Bison Recovery Project (HLWBRP) is a wildlife conservation project aimed at recovering a captive, disease-free herd of wood bison (Bison bison athabascae) from a wild herd infected with bovine tuberculosis (Mycobacterium bovis) and brucellosis (Brucella abortus). The disease eradication protocol that we have used involves a combination of techniques, including (1) orphaning of newborn wild-caught calves to minimize exposure to B. abortus and M. bovis, (2) testing calves for maternal antibodies to brucellosis in the field prior to inclusion in the project, (3) isolating calves in pairs to prevent potential spread of disease, (4) prophylactic treatment using antimycobacterial and anti-Brucella drugs, and (5) an intensive whole-herd testing program for both diseases and removal of reactors. From 1996 to 1998, we captured a total of 62 calves; presently, 58 individuals comprise the founder herd. The captive-born cohorts consist of 7 two-year-olds, 21 yearlings, and 22 calves. To date, there have been no cases of bovine tuberculosis or brucellosis in the captive herd.

A simple method for evaluating abnormal lengthening of the QT interval during the face immersion test.

The slope of the relation between the unadjusted QT interval and heart rate during the face immersion test has been reported to be useful as an index for predicting an abnormal lengthening of the QT interval for children with nonfamilial long QT syndrome. Our goals were to determine whether we can replace the slope of the QT/heart rate relation calculated from all data with that calculated from fewer data and to determine whether we can replace the slope with the corrected QT value by heart rate (QTc value) at the minimum heart rate. We studied 19 children with a prolonged QT interval and 54 control children by using statistical analysis. The slope calculated from the selected data points (at least four) was in agreement with the slope calculated from all data, and the relationship between the slope and the QTc value at the minimum heart rate showed a high correlation. It was determined that we can replace the slope calculated from all data with that calculated from at least four data points and replace the slope with the QTc value at the minimum heart rate as an index for predicting an abnormal lengthening of the QT interval.

Hyperoxia-induced acute lung injury using a pig model: correlation between MR imaging and histologic results.

PURPOSE: To correlate MR imaging findings with pathology in experimental hyperoxia-induced acute lung injury, which has similar pathology to diffuse alveolar damage (DAD). MATERIALS AND METHODS: Seventeen Yorkshire pigs were studied. These animals were exposed to more than 80% oxygen for 24, 48, 72, and 96 hours in a sealed cage. The lungs were removed and inflated with air infused through the trachea, and then examined by both MRI and high-resolution CT (HRCT). T1-weighted spin-echo (T1WSE), T2-weighted fast (T2WFSE), and half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences were performed. RESULTS: Severity in MR findings and signal-to-noise ratios (SNR) on MR images were well correlated with pathological scores. CT values were also correlated well with pathologic scores. Abnormal SNR values were obtained from a pathological score of 5, whereas abnormal CT values were obtained from a pathological score of 15. Furthermore, significant differences in SNR were observed in each histopathological phase. CONCLUSION: SNRs on MR images were superior to CT values in detecting early pathologic changes in DAD. MR study also is potentially useful for evaluation of the histopathological phases in acute lung injury.

Phantom evaluation of scatter and attenuation correction in thallium-201/technetium-99m acquisition in myocardial perfusion single-photon emission computed tomography.

PURPOSE: This phantom study was carried out to evaluate the usefulness of scatter correction combined with transmission-based attenuation correction in separate and simultaneous 201Tl/99mTc myocardial SPECT. METHODS: An anthropomorphic torso phantom was used in this study. We used the triple-energy-window (TEW) method for scatter correction and transmission computed tomography (TCT) images for attenuation correction. Images without corrections (UC) and images with corrections (SAC) for scatter and attenuation were reconstructed for the evaluation. RESULTS: The differences in defect size between 99mTc and 201Tl UC images led to interpretation errors in separate (separate protocol) and simultaneous dual-isotope studies (simultaneous protocol). These errors were more prominent in the infero-posterior wall in the simultaneous protocol. Improvement for overestimation in object size and underestimation in defect contrast was visually obtained, and increased contrast was also shown by the myocardium-to-defect count (MD) ratios on SAC images in the separate and simultaneous protocols. However, 201Tl SAC images in the simultaneous protocol still had less defect contrast than the corresponding 201Tl SAC images in the separate protocol. CONCLUSIONS: From the results of our phantom experiment, separate rest 201Tl/stress 99mTc-sestamibi acquisitions may be recommended in clinical practice. Further clinical and phantom studies will be needed to validate the method using scatter correction combined with transmission-based attenuation correction.

Risk factors for persistence of pulmonary arterial branch stenosis in neonates and young infants.

BACKGROUND: Pulmonary arterial branch stenosis (PBS) in neonates is considered to be transient. However, PBS has been found not only in neonates, but also in young infants. Among these patients, we encountered several patients whose PBS was still present after the age of 1 year. METHODS: To clarify the natural history of PBS in neonates and young infants, we retrospectively reviewed the records of 103 patients diagnosed with PBS in the neonatal period and early infancy. RESULTS: The PBS findings were improved in all patients. Pulmonary arterial branch stenosis disappeared in 94 patients by the age of 1 year (group A), but persisted after I year of age in nine patients (group B). Group B patients had a significantly lower mean birth weight and greater deltavelocity (the difference in the peak flow velocity between the main pulmonary artery and stenotic branch) at diagnosis than group A patients. Incidences of low birth weight (< 2,500 g) and deltavelocity above 1.2 m/s were significantly higher in group B than group A patients. There was no significant difference in the frequency of premature infants (gestational age < 36 weeks) between the groups, suggesting that intrauterine growth retardation may be related to developmental abnormalities of the pulmonary arterial branch. CONCLUSIONS: All cases of PBS in neonates and young infants were improved. However, PBS persisted in some patients after the age of 1 year. Low birth weight and deltavelocity above 1.2 m/s are risk factors for persistent PBS. Pulmonary arterial branch stenosis was not present after the age of 1 year in 62 of 63 patients without either of these risk factors.

[CT and MRI in the diagnosis of cardiomyopathy].

Two new noninvasive imaging modalities, electron beam computed tomography (EBCT) and magnetic resonance imaging(MRI), have emerged in recent years and have provided images of the heart with high temporal and spatial resolution. They provides accurate information of myocardial thickness, ventricular shape and volume, wall motion, and ventricular function in patients with cardiomyopathy. In addition, myocardial damage can be evaluated using contrast media. They can give unique diagnostic information above and beyond that of more traditional noninvasive modalities such as two-dimensional echocardiography, left ventriculography and radionuclide technique because both modalities acquire images in three dimensions. They have a possibility to become an alternative modality of the left ventriculography in the diagnosis of cardiomyopathy.

Increased expression of vascular endothelial growth factor (VEGF) in Castleman's disease: proposed pathomechanism of vascular proliferation in the affected lymph node.

Castleman's disease is a lymphoproliferative disorder of unknown etiology characterized by enlarged hyperplastic lymph nodes with marked vascular proliferation. To evaluate the possible involvement of vascular endothelial growth factor (VEGF) in the pathogenesis of Castleman's disease, we studied VEGF expression in sera and lymph nodes from four patients with either the plasma-cell type or mixed type of Castleman's disease. Clinically, one patient had the multicentric type and the others the localized type. The VEGF levels of the sera and the supernatants of the cultured lymph nodes were higher than those of normal controls. VEGF was strongly expressed in plasma cells in the interfollicular region of the lymph nodes, but rarely in normal lymph nodes. The disregulated IL-6 gene expression is considered to be a primary event that could be related to the etiology of this disease. Recently, Kaposi's sarcoma virus/human herpes virus 8 (KSHV/HHV-8) has been reported to be associated with a subset of the multicentric type of Castleman's disease, and a viral homologue of IL-6 (vIL-6) encoded by KSHV/HHV-8 has been shown to induce VEGF expression. Human IL-6 produced in the affected lymph nodes of Castleman's disease may induce paracrine VEGF-production by plasma cells and vascular proliferation in the lymph node. The confirmation of the role of VEGF in the pathogenesis of Castleman's disease may provide a therapeutic strategy.

Bilateral coronary artery dilatation in a child with Noonan syndrome.

A rare case of a child with Noonan syndrome who had huge bilateral coronary artery dilatation is presented. Noonan syndrome is one of the most common nonchromosomal syndromes seen in children with cardiovascular abnormalities. Coronary artery abnormality should be considered in Noonan syndrome, because this syndrome may be associated with a higher incidence of coronary anomalies than previously thought.

Inhibition of thrombin-induced neuronal cell death by recombinant thrombomodulin and E5510, a synthetic thrombin receptor signaling inhibitor.

Thrombin, a serine protease generated by the activation of the blood coagulation cascade following vessel injury, converts fibrinogen to fibrin, activates platelets and several coagulation factors, and plays a pivotal role in thrombosis and haemostasis. Thrombin acts as a mitogen and apoptosis inducer in a dose-dependent fashion. We have previously shown that thrombin caused proliferation of vascular smooth muscle cells (VSMCs). Here, we show that a low concentration of thrombin caused proliferation of mouse neuroblastoma (Neuro-2a) and human neuroblastoma (NB-1) cells, while higher concentrations affected cell viability in a time-dependent manner. Similar effects were observed when thrombin receptor agonist peptide (SFLLRNPNDKYEPF, TRAP) was applied. The dying cells showed nuclear condensation and fragmentation, suggesting that cell death occurred by apoptosis. The extent to which thrombin induced cell death was significantly attenuated by recombinant thrombomodulin (rTM), or by a minimum functional domain of TM, termed E456. Furthermore, a synthetic compound that inhibits signaling from the thrombin receptor, 4-cyano-5,5-bis (4-methoxyphenyl)-4-pentanoic acid (E5510), and the antioxidant N-acetyl L-cysteine (NAC), efficiently prevented thrombin-induced Neuro-2a cell death. Thus, thrombin inhibitors and antioxidant appear to neutralize thrombin toxicity.