Bacterial profiles detected in ventilator-associated pneumonia in Japan: A systematic review.

The primary objective of this study was to identify the predominant organisms associated with ventilator-associated pneumonia (VAP) in Japan. Studies on VAP conducted in Japan were systematically reviewed, and seven studies with a total of 374 cases were included. The detection rate of each bacterium and multidrug-resistant (MDR) pathogen was analyzed using the inverse variance method. Pseudomonas aeruginosa was identified as the predominant pathogen in 29.2 % of cases, followed by methicillin-resistant Staphylococcus aureus (MRSA) (12.0 %), and Klebsiella spp. (9.5 %). An integrated analysis revealed a detection rate of 57.8 % (95 % confidence interval: 48.7%-66.8 %) for MDR pathogens. This review highlights P. aeruginosa and MRSA as the predominant VAP-associated organisms in Japan, with a significant prevalence of MDR pathogens. This analysis provides valuable insights based on the regional distribution of bacteria detected in VAP, which is critical for selecting appropriate empirical therapy.

Carbapenem vs. non-carbapenem antibiotics for ventilator-associated pneumonia: A systematic review with meta-analysis.

BACKGROUND: Carbapenem is recommended as one of the first-line regimens for ventilator-associated pneumonia (VAP), but no recent systematic review has fully investigated its efficacy. This systematic review aims to evaluate the efficacy of carbapenem compared with non-carbapenem for VAP treatment. METHODS: We performed a systematic review and meta-analysis of studies comparing the efficacy and the safety between carbapenem and non-carbapenem with activity to Pseudomonas aeruginosa in the treatment for VAP. The main outcome was mortality, and the additional outcomes were the clinical cure of pneumonia, length of intensive care unit stay, recurrence, adverse effects, and the development of resistant bacteria. This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Of the initial 1,730 publications, 9 randomized control trials were enrolled. In the meta-analysis, no difference was observed between the carbapenem and non-carbapenem regimens in improving mortality (odds ratio, 0.83; 95 % confidence interval (CI) 0.67-1.02). While the carbapenem regimen was superior to the non-carbapenem regimen in studies reporting the resolution of pneumonia (odds ratio, 1.09; 95 % CI 1.01-1.17), the effectiveness of carbapenem treatment was not evident in studies assessing the other outcomes. CONCLUSIONS: Carbapenem might have no superiority in survival when treating VAP. Moreover, non-carbapenem antibiotics with activities to P. aeruginosa have a potential option to avoid inducing carbapenem-resistant pathogens.

Effects of heatwave events on the seagrass-dwelling crustacean Pandalus latirostris in a subarctic lagoon.

Heatwaves often cause mass mortality of organisms in seagrass areas, and they eventually alter some ecological functions of seagrass ecosystems. In subarctic regions, however, the effects of heatwaves on seagrass areas are still unclear. In a subarctic lagoon of northern Japan, we examined the effects of heatwaves on the Hokkai shrimp, Pandalus latirostris, a commercially exploited species distributed in seagrass areas of northern Japan and eastern Russia. A long-term survey of the surface water temperature in the lagoon clarified a gradual increase in the frequency and intensity of heatwave events since 1999. Surveys of the water temperature at a seagrass area in the lagoon during summer have also demonstrated that the maximum water temperature had been exceeding 25 °C, unusually high for this location, regardless of water depth. These results indicate that the effects of heatwaves in seagrass areas in a subarctic region had become as severe as those in tropical and temperate regions. We also experimentally evaluated the effects of this unusually high water temperature (25 °C) on the survival of P. latirostris by changing the length of exposure time. Some individuals suffered damage to their intestinal mucosal structure after exposure for 12 h or longer, and all individuals died after exposure for 120 h. Our results suggest that heatwaves possibly cause mass mortality in P. latirostris in the following sequence: heat stress, damage to the intestinal epithelial mucosal structure, degradation of nutrient absorption and immunological function of the intestine, energy deficiency and disease infection, and finally mortality. This study, conducted in subarctic closed waters, concludes that it is essential to become familiar with not only trends in heatwaves but also the intermittent occurrence of unusually high water temperature in seagrass areas in order to better understand the process of mortality of organisms that inhabit these ecosystems.

Synthesis of Submicron-Sized Spherical Silica-Coated Iron Nickel Particles with Adjustable Shell Thickness via Swirler Connector-Assisted Spray Pyrolysis.

Silica-coated iron nickel (FeNi@SiO2) particles have attracted significant attention because of their potential applications in electronic devices. In this work, submicron-sized spherical FeNi@SiO2 particles with precisely controllable shell thickness were successfully synthesized for the first time using a swirler connector-assisted spray pyrolysis system, comprising a preheater, specific connector, and main heater. The results indicated that the thickness of the SiO2 shell can be tuned from 3 to 23 nm by adjusting the parameter conditions (i.e., preheater temperature, SiO2 supplied amount). Furthermore, our fabrication method consistently yielded a high coating ratio of more than 94%, indicating an excellent quality of the synthesized particles. Especially, to gain an in-depth understanding of the particle formation process of the FeNi@SiO2 particles, a plausible mechanism was also investigated. These findings highlight the importance of controlling the preheater and SiO2 supplied amount to obtain FeNi@SiO2 particles with desirable morphology and high coating quality.

Clinical results of 30 consecutive patients of carotid artery stenosis treated with CASPER stent placement: 1-year follow-up and in-stent findings on intravascular ultrasound examination immediately and 6 months after treatment.

BACKGROUND: The CASPER stent is expected to reduce periprocedural ischemic complications, but there is concern about restenosis in the early period. One-year follow-up results of CASPER stenting and findings on intravascular ultrasound (IVUS) immediately and 6 months after treatment are evaluated. METHODS: Thirty consecutive patients were treated with CASPER stents for carotid artery stenosis. IVUS was performed immediately after stenting, and MRI and carotid ultrasonography were performed the next day, at 1 week, at 2 weeks, and then every 3 months. One-year follow-up results were evaluated. Twenty-five patients underwent follow-up angiography and IVUS after 6 months and their findings were investigated. RESULTS: All patients were treated without complications during the intraoperative and periprocedural periods. After 6 months, all 25 patients with follow-up angiography and IVUS showed various degrees of intimal formation on IVUS and 8 of them had ≥50% stenosis on angiography. Three of the 30 patients required retreatment within 6 months because of severe restenosis. In these patients, the inner layer of the stent was deformed toward the inside due to intimal hyperplasia on follow-up IVUS, and there was dissociation between the inner and outer layers. All but the 3 of 30 patients with 1-year follow-up did not lead to symptomatic cerebrovascular events or retreatment. CONCLUSIONS: The CASPER stent appears to be effective for preventing periprocedural ischemic complications. IVUS showed various degrees of intimal formation within 6 months after treatment, and it is possible that the CASPER stent is structurally prone to intimal formation or hyperplasia.

Mechanisms that can cause population decline under heavily skewed male-biased adult sex ratios.

While adult sex ratio (ASR) is a crucial component for population management, there is still a limited understanding of how its fluctuation affects population dynamics. To demonstrate mechanisms that hinder population growth under a biased ASR, we examined changes in reproductive success with ASR using a decapod crustacean exposed to female-selective harvesting. We examined the effect of ASR on the spawning success of females. A laboratory experiment showed that the number of eggs carried by females decreased as the proportion of males in the mating groups increased. Although the same result was not observed in data collected over 25 years in the wild, the negative effect of ASR was suggested when success in carrying eggs was considered as a spawning success. These results indicate that a surplus of males results in females failing to carry eggs, probably due to sexual coercion, and the negative effect of ASR can be detected at the population level only when the bias increases because failure in spawning success occurs in part of population. We experimentally examined how male-biased sex ratios affected the maintenance of genetic diversity in a population. The diversity of paternity in a clutch increased with the number of candidate fathers. However, over 50% of a clutch was fertilised by a single male regardless of the sex ratio, and the degree of diversity was less than half of the highest diversity expected in each mating group. We also experimentally examined the mating ability of males during the breeding season. The experiment showed that multiple mating by males could not compensate for the risk that their genotypes would be lost when multiple males competed for one female. These results suggest that a male-biased ASR could trigger a decline of genetic diversity in a population. We show that ASR skewed by female-selective harvesting decreases reproductive success not only of males that have few mating opportunities but also of females. We discuss that we may still underestimate the significance of ASR on population persistence due to the difficulty of revealing the effect of ASR.

Lung Injury Induced by Crizotinib and Entrectinib in a Patient with ROS1-rearranged Non-small-cell Lung Cancer.

We herein report the first case of c-ros oncogene 1 (ROS1)-rearranged advanced non-small-cell lung cancer (NSCLC) in which lung injury was induced by crizotinib and entrectinib. Crizotinib was administered as first-line chemotherapy in a woman in her early 70s with stage IV NSCLC showing ROS1 rearrangement. This resulted in the development of drug-induced organizing pneumonia, which was alleviated by discontinuing drug administration and giving corticosteroids. Following second-line chemotherapy with entrectinib, a similar lung injury was noted. In cases of crizotinib-induced lung injury, physicians must be alert for drug-induced lung injury in subsequent treatment with entrectinib.

Factors Associated with Extended-spectrum ß-lactamase-producing Enterobacteria Isolated from Respiratory Samples.

Objective Although extended-spectrum ß-lactamase (ESBL)-producing bacteria are a global threat, as they may cause respiratory infection, the factors associated with the isolation of these bacteria from sputum remain unclear. We therefore explored the factors related to ESBL-producing Klebsiella pneumoniae and Escherichia coli isolated from sputum samples. Methods This study included consecutive patients admitted to our department from 2010 to 2021 with K. pneumoniae or E. coli isolated from their sputum. The patients were categorized into ESBL-producing and non-ESBL-producing groups, and the factors associated with ESBL-producing bacteria isolation were assessed using a binomial logistic regression analysis. Results We included 82 patients, and ESBL-producing pathogens were isolated from 23 (28%). The usage rates of cephem [odds ratio (OR) 4.000, 95% confidence interval (CI) 1.402-11.409, p=0.010], quinolone (OR 2.961, 95% CI 1.097-7.996, p=0.032), and macrolide (OR 4.273, 95% CI 1.518-12.028, p=0.006) in the past year were significantly higher in the ESBL-producing group than in the non-ESBL-producing group. The multivariate analysis revealed that the applications of cephem (adjusted OR: 4.130, 95% CI: 1.233-13.830, p=0.021) and macrolide (adjusted OR: 6.365, 95% CI: 1.922-21.077, p=0.002) was independently associated with the isolation of ESBL-producing bacteria. Conclusion A history of cephem and macrolide use can be considered a risk factor for ESBL-producing bacteria isolation from sputum samples. Physicians need to consider these risk factors when determining antibiotics for the treatment of patients with respiratory infections.

Factors related to insufficient hemostasis using the EXOSEAL vascular closure device with five-minutes compression for femoral artery punctures after neuro-endovascular therapy: A retrospective, single-center experience.

OBJECTIVES: The aim was to identify the factors related to inadequate hemostasis with five minutes of manual compression using the EXOSEAL vascular closure device (VCD), and to evaluate the optimal time to hemostasis (TTH). METHODS: A total of 119 consecutive patients who underwent neuro-endovascular therapy via common femoral arterial puncture between February 2019 and August 2021 were included. These patients underwent hemostasis using an EXOSEAL with manual compression for five minutes. In this retrospective study, the 119 patients were divided into two groups: (1) achieved hemostasis with five minutes (n = 76); and (2) required more than five minutes to achieve hemostasis (n = 43, Add group). In both groups, patient's characteristics, endovascular procedures, and closure procedures were assessed. RESULTS: On univariable analysis, activated clotting time (ACT), multiple antiplatelets, closure with an under-sized EXOSEAL VCD (U-VCD), endovascular procedure, and use of a 7Fr. VCD were significantly associated with additional compression (p < 0.05). On multivariate logistic regression analysis, the following three factors were found to be associated with additional compression: pre-closure ACT (adjusted OR, 0.136; 95% CI, 1.017-1.056; p < 0.001); multiple antithrombotics (adjusted OR, 12.843; 95% CI, 3.458-47.693; p < 0.001); and closure with a U-VCD (adjusted OR, 5.653; 95% CI, 1.751-18.151; p = 0.004). On the receiver-operating characteristic curve analysis for prediction of the need for additional compression, the cutoff point for pre-closure ACT was calculated to be 268 s. In the Add group, mean TTH was 9.8 ± 1.5 min. CONCLUSION: Multiple antiplatelets and closure with a U-VCD may increase the risk of insufficient hemostasis with five-minutes compression using an EXOSEAL VCD for femoral puncture sites if the pre-closure ACT is greater than 268 s. In these patients, mean TTH was 9.8 ± 1.5 min.

Cerebral Aneurysm Coil Embolization with a Coil-Assisted Technique Using a Small-Diameter Helical Coil.

Objective: We introduce a coil-assisted technique using a small diameter helical coil to preserve a branch artery in the aneurysm neck or dome during coil embolization of a cerebral aneurysm. Case Presentations: We report three cases that were treated with the coil-assisted technique. Using this method, the branch artery was preserved with a small diameter helical coil that was placed to support another frame coil. The first case was a ruptured internal carotid artery-posterior communicating artery (IC-Pcom) aneurysm, the second case was a ruptured anterior communicating artery aneurysm, and the third case was an unruptured IC-Pcom aneurysm, with branching of the Pcom, A2, and Pcom, respectively, from the neck or dome of the aneurysm. We were able to preserve the branch artery in all cases. Conclusion: This technique is feasible and safe for coil embolization of intracranial branch-incorporated aneurysms. The technique is especially useful for preserving branch arteries that are difficult to preserve by conventional techniques.

Significant elevation of free itraconazole concentration at onset of adverse effects: A case report.

Free itraconazole and hydroxyitraconazole concentrations were markedly elevated despite almost no changes in total concentrations when itraconazole was discontinued due to adverse effects. Elevated free itraconazole concentration may have a causal relationship with the development of adverse effects.

Detection of hydroacoustic signals on a fiber-optic submarine cable.

A ship-based seismic survey was conducted close to a fiber-optic submarine cable, and 50 km-long distributed acoustic sensing (DAS) recordings with air-gun shots were obtained for the first time. We examine the acquired DAS dataset together with the co-located hydrophones to investigate the detection capability of underwater acoustic (hydroacoustic) signals. Here, we show the hydroacoustic signals identified by the DAS measurement characterizing in frequency-time space. The DAS measurement can be sensitive for hydroacoustic signals in a frequency range from [Formula: see text] to a few tens of Hz which is similar to the hydrophones. The observed phases of hydroacoustic signals are coherent within a few kilometers along the submarine cable, suggesting the DAS is suitable for applying correlation analysis using hydroacoustic signals. Although our study suggests that virtual sensor's self-noise of the present DAS measurement is relatively high compared to the conventional in-situ hydroacoustic sensors above a few Hz, the DAS identifies the ocean microseismic background noise along the entire submarine cable except for some cable sections de-coupled from the seafloor.

Renal Artery Injury Caused by a 0.035-Inch Guidewire in Navigating a Guiding Sheath during Coil Embolization: A Case Report of Rescue Embolization with n-Butyl-2-Cianoacrylate.

Objective: We report renal artery injury by a guidewire during coil embolization of a cerebral artery aneurysm, which was successfully treated by transarterial embolization using n-butyl-2-cianoacrylate (NBCA). Case Presentation: A 65-year-old woman underwent coil embolization for an unruptured cerebral aneurysm, resulting in its complete occlusion. However, her blood pressure decreased during embolization and postoperative abdominal computed tomography (CT) revealed a retroperitoneal hematoma. Intraoperative video revealed that the 0.035-inch guidewire had passed deeply into the right renal artery when the guiding sheath was navigated into the abdominal aorta, suggesting renal artery perforation. Transarterial embolization using NBCA was performed immediately, which resulted in hemostasis. Conclusion: Although renal artery perforation with a guidewire is a rare complication, it can have severe consequences. Early diagnosis with prompt and definitive hemostasis is important.

Clinical Evaluations of the Ischemic Core in Acute Ischemic Stroke Using Modified Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores by Ischemic Reversibility Using the Signal Intensity.

Objective: Early recanalization of acute stroke caused by large vessel occlusion (LVO) may improve high signal intensity (HSI) on diffusion-weighted imaging (DWI). In this study, we investigated whether subtraction of reversible ischemic lesions (RIL) from the HSI lesions on DWI improves the diagnostic accuracy for the ischemic core. Methods: A total of 35 patients from April 2013 and December 2019 were included in this study. These patients presented acute ischemic stroke due to anterior circulation LVO and underwent thrombectomy. All patients underwent DWI within 48 hours after thrombectomy. HSI ratios were calculated, and compared between ischemic lesions and contralateral normal tissue. Ischemic lesions with improvement in the HSI ratio from initial to postoperative DWI were defined as RIL. Based on a receiver operating characteristic (ROC) curve analysis that compared the HSI ratio of all ischemic lesions, the cutoff value of HSI ratio of RILs was calculated. Results: In all, 127 ischemic lesions were identified in 35 patients. HSI ratios of RILs were significantly lower than those of irreversible ischemic lesions (IILs) (p <0.0001). Based on a ROC curve analysis that compared the HSI ratio of all 127 lesions, the cutoff value of the HSI ratio of RILs was 1.4. After applying this cutoff value to the 127 ischemic lesions of the 35 patients, 20 patients (57%) were identified as having RILs with a HSI ratio of <1.4. In this 20 patients, the postoperative National Institutes of Health Stroke Scale (NIHSS) score at 24 hours was significantly lower (p = 0.007) and improvement in the NIHSS score was significantly higher (p = 0.018) than in the other patients. Conclusion: A HSI ratio of <1.4 on preoperative DWI may reflect ischemic reversibility. In this study, the HSI ratio correlated with clinical findings associated with cerebral ischemia, and our method may be useful in assessing ischemic cores.

Epsin-mediated degradation of IP3R1 fuels atherosclerosis.

The epsin family of endocytic adapter proteins are widely expressed, and interact with both proteins and lipids to regulate a variety of cell functions. However, the role of epsins in atherosclerosis is poorly understood. Here, we show that deletion of endothelial epsin proteins reduces inflammation and attenuates atherosclerosis using both cell culture and mouse models of this disease. In atherogenic cholesterol-treated murine aortic endothelial cells, epsins interact with the ubiquitinated endoplasmic reticulum protein inositol 1,4,5-trisphosphate receptor type 1 (IP3R1), which triggers proteasomal degradation of this calcium release channel. Epsins potentiate its degradation via this interaction. Genetic reduction of endothelial IP3R1 accelerates atherosclerosis, whereas deletion of endothelial epsins stabilizes IP3R1 and mitigates inflammation. Reduction of IP3R1 in epsin-deficient mice restores atherosclerotic progression. Taken together, epsin-mediated degradation of IP3R1 represents a previously undiscovered biological role for epsin proteins and may provide new therapeutic targets for the treatment of atherosclerosis and other diseases.

Successful Outcome in an Adult Patient with Influenza-associated Hemorrhagic Shock and Encephalopathy Syndrome.

A 50-year-old woman presented with coma and hemorrhagic shock. A rapid influenza antigen test revealed influenza A infection; other laboratory examinations ruled out any other suspected infections. She was diagnosed with hemorrhagic shock and encephalopathy syndrome (HSES) induced by influenza A. She was administered methylprednisolone pulse therapy and peramivir. Subsequently, she was discharged without any sequelae. Only a few cases of influenza-induced HSES have been reported, and the clinical outcomes were very poor. We herein report a successfully treated adult case of influenza-induced HSES and review this rare syndrome.

Simple and Reproducible Microcatheter Shaping Method for Coil Embolization of Medially-directed Paraclinoid Internal Carotid Artery Aneurysms.

Objective: It is important to guarantee intra-aneurysmal stability of microcatheters during coil embolization. We developed a simple and reproducible microcatheter shaping method for medially-directed paraclinoid internal carotid artery aneurysms. Methods: An injection needle cap was used to make a smooth curve on the mandrel, which was first wound around the back end of the cap to create a primary curve. Next, a secondary curve was created using near the tip of the cap. Thus, a two-dimensional (2D), pigtail-shaped mandrel with a two-stage curve was created. The pigtail-shaped mandrel was inserted from the tip of a straight microcatheter and heat-shaped using a heat gun. Lastly, a microcatheter having a curve whose tip was approximately 6 mm longer than that of the preshaped J was created. We evaluated the ease of navigating the microcatheter into the aneurysm and its stability during coil embolization. Results: In all, 34 consecutive medially-directed paraclinoid internal carotid artery aneurysms were treated using the shaped catheters. It took 50-300 seconds (intermediate value: 90 seconds) from inserting the microcatheter with a microguide wire to navigate and place it into an aneurysm. There were no cases that required reshaping of the microcatheters during navigation into the aneurysm. There were no cases that resulted in kickback of the microcatheters from the aneurysm during coil placement, and microcatheter stability was good until the end of the procedure. In all, 12 cases required the balloon-assisted technique and three cases required stent-assisted coiling. The angiographic outcomes immediately after embolization were as follows: 25 cases (73.5%) with complete occlusion; 3 cases (8.8%) with dome filling; and 6 cases (17.6%) with a neck remnant. There were no perioperative complications. Conclusion: The shaping method with a pigtail-shaped mandrel using an injection needle cap is simple and reproducible, and is useful for medially-directed paraclinoid internal carotid artery aneurysms.

Mycobacterium abscessus subsp. abscessus empyema complicated with subcutaneous abscess.

There have been no case reports of thoracic subcutaneous abscess after surgery for Mycobacterium abscessus complex associated empyema. We herein report a case of Mycobacterium abscessus subsp. abscessus (M. abscessus subsp. abscessus) induced subcutaneous abscesses following surgical treatment for concurrent M. abscessus subsp. abscessus -associated empyema and pneumothorax. A 75-year-old woman had M. abscessus subsp. abscessus -associated empyema and pneumothorax. She underwent surgical treatment of decortication and fistulectomy and suffered from M. abscessus subsp. abscessus -associated subcutaneous abscesses after thoracentesis/drainage. A multidisciplinary approach combined with surgical care, thermal therapy, and multidrug chemotherapy contributed to a successful result. An early multidisciplinary approach is believed to be important in cases of M. abscessus subsp. abscessus -associated empyema and subcutaneous abscess.