Outbreak of non-tuberculous mycobacteria skin or soft tissue infections associated with handling fish - New York City, 2013-2014.

Mycobacterium marinum, a bacterium found in freshwater and saltwater, can infect persons with direct exposure to fish or aquariums. During December 2013, the New York City Department of Health and Mental Hygiene learned of four suspected or confirmed M. marinum skin or soft tissue infections (SSTIs) among persons who purchased whole fish from Chinese markets. Ninety-eight case-patients with non-tuberculous mycobacteria (NTM) SSTIs were identified with onset June 2013-March 2014. Of these, 77 (79%) were female. The median age was 62 years (range 30-91). Whole genome sequencing of clinical isolates revealed two main clusters and marked genetic diversity. Environmental samples from distributors yielded NTM though not M. marinum. We compared 56 case-patients with 185 control subjects who shopped in Chinese markets, frequency-matched by age group and sex. Risk factors for infection included skin injury to the finger or hand (odds ratio [OR]: 15·5; 95% confidence interval [CI]: 6·9-37·3), hand injury while preparing fish or seafood (OR 8·3; 95% CI 3·8-19·1), and purchasing tilapia (OR 3·6; 95% CI 1·1-13·9) or whiting (OR 2·7; 95% CI 1·1-6·6). A definitive environmental outbreak source was not identified.

Pathway to mental health recovery: a qualitative and quantitative study on the needs of Chinese psychiatric inpatients.

BACKGROUND: Exploration of the information and participation needs of psychiatric inpatients is an important step for the implementation of recovery-oriented mental health service. The objective of this study was to explore the information and participation needs of Chinese psychiatric inpatients in the largest psychiatric hospital in Hong Kong. METHODS: The study was divided into two parts. In the first part, eight focus groups with patients, patients' relatives and healthcare professionals were held to identify 22 items of information needs and 16 items of participation needs of Chinese psychiatric inpatients. Basing on the items identified in the first part of the study, a questionnaire was developed to survey on the importance of the different information and participation needs in the second part of the study. Participants were asked to rate in rank order their perceived importance of the items in the questionnaire survey. RESULTS: A hundred and eighty three Chinese psychiatric inpatients completed the questionnaire and the majority of them suffered from schizophrenia (68.3 %). For information needs, the top three needs rated by patients as the most important in descending order were: "Information on the classifications of mental illnesses, signs and symptoms and factors contributing to relapse", "Information on the criteria and arrangements for discharge", and "Information on the importance of psychiatric drug taking and its side effects". For participation needs, the top three needs rated by patients as the most important in descending order were: "Enquiring about personal needs and arrangements", "Keeping in touch with the outside world", and "Learning and practising self-management". CONCLUSIONS: This study reveals that Chinese psychiatric inpatients are concerned about information on their mental illness and its treatments as well as the criteria for discharge. On the other hand, patients are concerned about their personal needs, their self-management, as well as their keeping in touch with the outside world during their hospitalisation. Moreover, patients with different socio-demographic and clinical characteristics have different information and participation needs. The results of the present study serve as a reference for designing guidelines, strategies, and programmes to meet the information needs and participation needs of psychiatric inpatients in Hong Kong.

Combined diastematomyelia and hemivertebra: a review of the management at a single centre.

A combination of hemivertebrae and diastematomyelia is rare. We have identified 12 such patients seen during a period of 11 years in the orthopaedic, spinal and neurosurgical units in Nottingham and analysed their treatment and outcome.

Laparoscopic nephrectomy: an early experience at Queen Mary Hospital.

OBJECTIVE: To report our early experience of laparoscopic nephrectomy. DESIGN: Prospective data collection. SETTING: Queen Mary Hospital, Hong Kong. PATIENTS: Transperitoneal laparoscopic nephrectomies were performed on 40 patients between July 1997 and December 2002. MAIN OUTCOME MEASURES: Demographic and perioperative data including operating time, blood loss, postoperative pain score, analgesic requirement, complications, time to resume oral intake, ambulatory state, and length of hospital stay. RESULTS: Laparoscopic nephrectomy was performed for 21 solid renal masses, five transitional cell carcinomas, and 14 non-functioning kidneys. Seven (17.5%) patients had previous abdominal surgery. The mean body mass index of the patients was 23.9 kg/m(2) and the mean operating time was 229 minutes. The mean estimated blood loss was 370 mL, and two patients required conversion to open surgery because of intra-operative bleeding. Other complications include diaphragmatic injury, port-site bleeding, chyle leakage, bleeding peptic ulcer, and myocardial ischaemia. The postoperative mean analgesic requirement was 26 mg of morphine sulphate equivalent. The mean time for patients to resume oral diet and full ambulation was 1.3 and 2.8 days, respectively, and the mean length of hospital stay was 6.7 days. The mean diameter of the solid renal tumour was 4.1 cm and the surgical margins of all resected specimen for malignant tumours were negative. CONCLUSION: Laparoscopic nephrectomy is a safe and efficacious approach for resection of benign non-functioning kidneys and malignant renal tumours.

Effects of biochanin A on the growth and differentiation of myeloid leukemia WEHI-3B (JCS) cells.

The effects of biochanin A on the growth and differentiation of a recently characterized myeloid leukemia cell line WEHI-3B (JCS) were investigated. Biochanin A not only inhibited the growth of JCS cells in a dose-dependent manner (0 - 200 microM) but also induced the morphological differentiation of JCS cells. The phagocytic activity of biochanin A-treated JCS cells was also increased. Flow cytometric analysis showed that the expression of macrophage differentiation markers Mac-1 and F4/80 was up-regulated in biochanin A-treated JCS cells. The expression level of Mac-1 was higher than that of F4/80. The expression of cytokine genes was studied by reverse transcription-polymerase chain reaction (RT-PCR) and cycle titration. mRNA levels of IL-1alpha, IL-1beta and IL-4 were found to be up-regulated at 46 hours after incubation of JCS cells with biochanin A. Although the expression of LIF was also up-regulated, the LIF receptor gene was not expressed in the uninduced or induced JCS cells. Our results suggest that IL-1alpha, IL-1beta and IL-4 may act on the later stage of biochanin A-mediated differentiation of JCS cells.

Isolation of anti-leukemia compounds from Citrus reticulata.

In vitro effects of medicinal plant extracts from the pericarpium of Citrus reticulata (cv Jiao Gan) (PCRJ) on the growth and differentiation of a recently characterized murine myeloid leukemic cell clone WEHI 3B (JCS) were investigated. Extracts of PCRJ not only inhibited the proliferation of JCS cells in a dose dependent manner, but also induced differentiation of JCS cells into macrophages and granulocytes. Morphological differentiation of PCRJ treated JCS cells was associated with an increase in phagocytic activity of the cells. Furthermore, both in vitro clonogenicity and in vivo growth of PCRJ treated JCS leukemic cells in syngeneic BALB/c mice were significantly reduced. The survival rate of mice receiving PCRJ treated JCS tumour cells was also increased. Using 1H-NMR, 13C-NMR, and GC/MS, two active components isolated from PCRJ were identified as nobiletin and tangeretin.

Protein-losing enteropathy in congestive heart failure: diagnosis by means of a simple method.

Protein-losing enteropathy is frequently overlooked in patients suffering from congestive heart failure. Although textbooks often quote heart failure as one of the causes of protein-losing enteropathy, this association has not been clearly documented in the literature. Furthermore, conventional diagnostic techniques for protein-losing enteropathy are both cumbersome and time-consuming. We report the first case of protein-losing enteropathy of a 79 year-old lady who suffered from dilated cardiomyopathy. The profound hypoalbuminemia could not be explained by urinary loss or impaired hepatic synthesis. Protein-losing enteropathy was confirmed by means of Technetium-99m- (99mTc) labelled human serum albumin scintigraphy which showed diffuse activity in the entire colon. The use of this simple and non-invasive diagnostic technique in protein-losing enteropathy is discussed.

Demonstration of the appearance of the paraspinal musculoligamentous structures of the cervical spine using ultrasound.

The application of ultrasound in the imaging of the neck has primarily focussed on anterior structures (e.g., thyroid gland). Structures located on the posterior aspect of the neck have received little attention. This study illustrates the capability of modern ultrasound equipment in visualising the musculoligamentous structures of the neck, particularly the paraspinal musculature. Ten healthy adult volunteers (6 female; 4 male) underwent ultrasound examination of the cervical spine. A standardised technique for transducer placement was adopted and successive images of the neck of each subject were obtained. Spatial compound (extended field of view) images were obtained in subjects using one of two different ultrasound systems. Images of structures produced by ultrasound were compared to those achieved with magnetic resonance imaging in three subjects. Identification of key landmarks aided orientation and identification of structures. The internal architecture of the musculoligamentous structures of the cervical spine, especially the posterior neck muscles, was demonstrated well using ultrasound. Our study showed that modern ultrasound equipment is capable of producing clear images of the posterior cervical spine musculature and certain bony features.

Transcatheter closure of the patent ductus arteriosus using an Amplatzer duct occluder in adults.

Patent ductus arteriosus (PDA) is a congenital heart disease that frequently escapes detection until the patient reaches adulthood. Percutaneous closure of the PDA has been established as a safe alternative to surgery, the Amplatzer duct occluder (ADO) is a new device that has been recently reported in paediatric patients. Our initial experience with an of ADO in an adult population appears to be encouraging and as good as in paediatric patients.

A prospective randomized controlled trial on ureteral stenting after ureteroscopic holmium laser lithotripsy.

PURPOSE: A prospective randomized controlled trial was conducted to evaluate whether postoperative ureteral stenting is necessary after ureteroscopic laser lithotripsy. MATERIALS AND METHODS: A total of 58 patients with unilateral ureteral stones were randomized into either stented or unstented groups. Ureteroscopic laser lithotripsy was performed using a semirigid ureteroscope (6.5/7Fr) and holmium laser without ureteral orifice dilation. There were no selection criteria regarding stone size, location, preoperative ureteral obstruction and hydronephrosis. Endoscopic evidence of stone impaction or mucosal edema/damage did not exclude a patient from the study. Ureteral perforation on completion retrograde pyelogram was the only intraoperative criterion for study exclusion. Postoperative pain scores and symptoms were recorded. Excretory urography was performed to document stone-free status and stricture formation. Radionuclide scan was performed selectively to exclude functional obstruction when ureteral narrowing was found on excretory urogram. RESULTS: Mean stone size +/- SD was 9.7 +/- 4.0 mm. (range 4 to 27). Proximal ureteral stones accounted for 43% of all stones. Stented and unstented groups were comparable with respect to demographic data, stone parameters, preoperative obstruction and hydronephrosis. There was no significant difference in operating time, laser energy used, stone impaction and mucosal edema/damage between the 2 groups. Postoperative pain and symptoms were more severe and frequent (p <0.05) in the stented group. However, there was no difference in the incidence of postoperative sepsis and unplanned medical visits. The stone-free and stricture formation rates showed no statistical difference between the 2 groups. CONCLUSIONS: Ureteral stenting is not necessary after uncomplicated ureteroscopic laser lithotripsy for ureteral stones. Ureteral stent increases the incidence of pain and urinary symptoms but does not prevent postoperative urinary sepsis and unplanned medical visits. Severity of preoperative obstruction and intraoperative ureteral trauma were not shown to be determining factors for stenting.

Prospective study on ultrasonography plus plain radiography in predicting residual obstruction after extracorporeal shock wave lithotripsy for ureteral stones.

OBJECTIVES: To compare ultrasonography (US) and plain radiography with intravenous urography (IVU) in predicting ureteral obstruction after in situ extracorporeal shock wave lithotripsy (ESWL) for ureteral stones. METHODS: From April 1998 to September 2000, 100 consecutive patients with solitary ureteral stones were treated by primary in situ ESWL. ESWL failures were salvaged by ureteroscopic lithotripsy. Ninety-three patients completed the follow-up assessment. US and IVU were performed when plain radiography showed no residual stone. The occurrence of hydronephrosis on US was compared with IVU, the reference standard for ureteral obstruction. RESULTS: Of the 93 patients, 72 were men and 21 women (mean age 52 years; mean stone size 11.2 mm). ESWL successfully treated 70 ureteral stones (75%), and the 23 failures were treated by ureteroscopic lithotripsy. Sixty-nine patients without hydronephrosis on US had no ureteral obstruction on IVU. Of the 24 patients who had hydronephrosis on US, 8 had ureteral obstruction on IVU. Of the 85 patients who had no ureteral obstruction on IVU, 69 patients showed no evidence of hydronephrosis on US. However, all patients with ureteral obstruction on IVU demonstrated hydronephrosis on US. The sensitivity, specificity, and positive and negative predictive value concerning sonographic hydronephrosis in the prediction of ureteral obstruction was 100%, 81%, 33%, and 100%, respectively. US alone could not define the cause of ureteral obstruction. CONCLUSIONS: Plain abdominal radiography plus US is highly sensitive for screening ureteral obstruction after primary in situ ESWL for ureteral calculi. It can save up to 74% of patients from the potential risk of IVU. The detection of the cause of obstruction by IVU is only necessary when sonographic evidence of hydronephrosis is present.

Outpatient ureteroscopy: predictive factors for postoperative events.

OBJECTIVES: To identify risk factors that can predict the postoperative events of outpatient ureteroscopy. METHODS: The data of 329 consecutive patients who underwent outpatient ureteroscopy from January 1996 to July 2000 were analyzed. Patient selection for outpatient surgery was based solely on their general medical status and social factors. Eighty-three percent of the procedures were therapeutic ureteroscopy. The reported postoperative events included sleep disturbances, postoperative pain score, emesis, unplanned admission, and other complications. These were compared with the various patient and operative factors. Multivariate analysis was performed to identify the predictive factors for different postoperative events. RESULTS: The overall success rate of ureteroscopic access to the pathologic site was 99.7%. Most of the therapeutic ureteroscopy performed was ureteroscopic lithotripsy (93%), with a stone-free rate of 91%. Ninety-seven percent of the operations were completed within 90 minutes, and 98% of patients were fit for discharge within 5 hours. Female patients reported more symptoms on the way home (25.8% versus 16%, P = 0.047) and more postoperative emesis (14.4% versus 2.1%, P <0.001). The postoperative pain score on day 1 was higher if the operation had lasted more than 60 minutes (2.4 versus 1.5, P = 0.002). Patients who received postoperative stenting had a higher postoperative pain score on day 3 (1.1 versus 0.4, P <0.001) and a higher complication rate compared with those who required no postoperative stenting (16.8% versus 4%, P <0.001). No predictive factors for unplanned admission were identified. CONCLUSIONS: Ureteroscopy can be successfully performed in an outpatient setting. Although the early postoperative pain was associated with nature of the operation (which could not be changed), the subsequent postoperative pain and complications were associated with ureteral stenting, which could be reduced by selective stenting. Unplanned admissions could not be predicted.

Production of α-galactosidase by Monascus grown on soybean and sugarcane wastes.

Extracts of both sugarcane and soybean wastes supported the growth of Monascus but sugarcane waste was superior for the production of α-galactosidase. An aqueous extract prepared from 5% (w/v) soybean waste and 7% (w/v) sugarcane waste gave the best result and was superior to the standard peptone/glucose/yeast extract medium. Liquid-solid mixtures were slightly less effective. Enzyme production could be enhanced by adding raffinose. Enzymatic hydrolysis of p-nitrophenyl-α-D-galactoside was optimal at pH 4.5. Raffinose and stachyose were hydrolysed to sucrose and galactose.