Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK.

BACKGROUND: Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus. AIM: To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe. METHODS: The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls. FINDINGS: In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis. CONCLUSION: The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Modular air-liquid interface aerosol exposure system (MALIES) to study toxicity of nanoparticle aerosols in 3D-cultured A549 cells in vitro.

We present a novel lung aerosol exposure system named MALIES (modular air-liquid interface exposure system), which allows three-dimensional cultivation of lung epithelial cells in alveolar-like scaffolds (MatriGrids®) and exposure to nanoparticle aerosols. MALIES consists of multiple modular units for aerosol generation, and can be rapidly assembled and commissioned. The MALIES system was proven for its ability to reliably produce a dose-dependent toxicity in A549 cells using CuSO4 aerosol. Cytotoxic effects of BaSO4- and TiO2-nanoparticles were investigated using MALIES with the human lung tumor cell line A549 cultured at the air-liquid interface. Experiments with concentrations of up to 5.93 × 105 (BaSO4) and 1.49 × 106 (TiO2) particles/cm3, resulting in deposited masses of up to 26.6 and 74.0 µg/cm2 were performed using two identical aerosol exposure systems in two different laboratories. LDH, resazurin reduction and total glutathione were measured. A549 cells grown on MatriGrids® form a ZO-1- and E-Cadherin-positive epithelial barrier and produce mucin and surfactant protein. BaSO4-NP in a deposited mass of up to 26.6 µg/cm2 resulted in mild, reversible damage (~ 10% decrease in viability) to lung epithelium 24 h after exposure. TiO2-NP in a deposited mass of up to 74.0 µg/cm2 did not induce any cytotoxicity in A549 cells 24 h and 72 h after exposure, with the exception of a 1.7 fold increase in the low exposure group in laboratory 1. These results are consistent with previous studies showing no significant damage to lung epithelium by short-term treatment with low concentrations of nanoscale BaSO4 and TiO2 in in vitro experiments.

Biomimetic reconstruction of the hematopoietic stem cell niche for in vitro amplification of human hematopoietic stem cells.

Hematopoietic stem cell transplantation is successfully applied since the late 1950s; however, its efficacy still needs to be increased. A promising strategy is to transplant high numbers of pluripotent hematopoietic stem cells (HSCs). Therefore, an improved ex vivo culture system that supports proliferation and maintains HSC pluripotency would override possible limitations in cell numbers gained from donors. To model the natural HSC niche in vitro, we optimized the HSC medium composition with a panel of cytokines and valproic acid and used an artificial 3D bone marrow-like scaffold made of polydimethylsiloxane (PDMS). This 3D scaffold offered a suitable platform to amplify human HSCs in vitro and, simultaneously, to support their viability, multipotency and ability for self-renewal. Silicon oxide-covering of PDMS structures further improved amplification of CD34+ cells, although the conservation of naïve HSCs was better on non-covered 3D PDMS. Finally, we found that HSC cultivated on non-covered 3D PDMS generated most pluripotent colonies within colony forming unit assays. In conclusion, by combining biological and biotechnological approaches, we optimized in vitro HSCs culture conditions, resulting in improved amplification, multipotency maintenance and vitality of HSCs.

Autoinfection as a cause of postpartum subdural empyema due to Mycoplasma hominis.

Mycoplasma hominis is a commensal of the genitourinary tract, which is infrequently associated with urogenital infections. Extra-urogenital infections due to M. hominis are rare. Here, we report an unusual case of M. hominis subdural empyema in a woman occurring shortly after delivery. The patient presented with symptoms suggestive of bacterial meningitis. Spinal imaging revealed a subdural empyema that required neurosurgical intervention. Cultures from intraoperatively obtained biopsies identified M. hominis as the causative pathogen. The patient was treated with oral moxifloxacin for 4 weeks resulting in the resolution of the spinal lesion. The subdural empyema was presumably caused by a contaminated epidural blood patch performed with the patient's own blood during an episode of transient M. hominis bacteremia after delivery. The blood patch was indicated for the treatment of cerebrospinal fluid leakage, which had occurred after epidural anesthesia. Our findings highlight the significance of transient M. hominis bacteremia after delivery and implicate that M. hominis should be considered as a causative agent of extra-genitourinary tract infections particularly during the postpartum period or after genitourinary manipulation.

Treatment strategies of space-occupying intradural metastases of the cauda equina of nonneurogenic origin.

BACKGROUND: Compressive intradural metastases of the cauda equina are a rare site of metastatic spread in systemic cancer. So far, only few reports have been published with conflicting statements concerning a surgical versus nonsurgical approach. METHOD: Five patients with symptomatic space-occupying intradural metastases of the cauda equina were analyzed retrospectively, focusing on the influence of surgical intervention on pain relief, neurological outcome and thus the patients' quality of life. FINDINGS: At the time of diagnosis, all patients were in an advanced metastatic state. Surgical resection was the primary treatment in four patients and radiotherapy in one. Despite infiltration of the cauda rootlets, gross total tumour resection could be achieved in two of the four patients treated surgically. Functional outcome was beneficial in these patients with marked and immediate relief of pain and improvement of motor function even following incomplete tumour resection. CONCLUSIONS: Surgical treatment of compressive intradural metastases of the cauda equina seems to be feasible with low operative risk and with the potential benefit of an immediate relief of pain and improvement in motor function and thus an increase in quality of life.

The identification of a chlorinated MDMA.

The abuse of the designer amphetamines such as 3,4-methylenedioxymethamphetamine (MDMA) is increasing throughout the world. They have become popular drugs at all night techno dance parties, and their detection is an important issue. The objective of the presented study was to identify an unknown compound detected by thin-layer chromatography (TLC) in the urine of an illicit drug abuser. The compound was isolated by TLC and analyzed by gas chromatography-mass spectrometry (GC-MS) in electron ionization (EI) and positive ion chemical ionization (PICI) mode to elucidate its chemical structure. Based on EI-MS and PICI-MS mass spectral data, the unknown compound was indicated to be a structure similar to MDMA, substituted by a single chlorine atom-a chlorinated MDMA (Cl-MDMA). To confirm the Cl-MDMA structure, the unknown compound was silylated, trifluoroacetylated, acetylated, heptafluorobutyrylated, and analyzed by GC-MS. The position of the chlorine atom cannot be assigned exactly from the mass spectral data presented here; however, we believe that the unknown compound could be 6-Cl-MDMA.

Variability in infectivity of primary cell cultures of human brain tumors with HSV-1 amplicon vectors.

We investigated the variability in infectivity of cells in primary brain tumor samples from different patients using an HSV-1 amplicon vector. We studied the infectivity of HSV-1 amplicon vectors in tumor samples derived from neurosurgical resections of 20 patients. Cells were infected with a definite amount of HSV-1 amplicon vector HSV-GFP. Transduction efficiency in primary tumor cell cultures was compared to an established human glioma line. Moreover, duration of transgene expression was monitored in different tumor cell types. All primary cell cultures were infectable with HSV-GFP with variable transduction efficiencies ranging between 3.0 and 42.4% from reference human Gli36 Delta EGFR glioma cells. Transduction efficiency was significantly greater in anaplastic gliomas and meningiomas (26.7+/-17.4%) compared to more malignant tumor types (glioblastomas, metastases; 11.2+/-8.5%; P=0.05). To further investigate the possible underlying mechanism of this variability, nectin-1/HevC expression was analyzed and was found to contribute, at least in part, to this variability in infectability. The tumor cells expressed the exogenous gene for 7 to 61 days with significant shorter expression in glioblastomas (18+/-13 d) compared to anaplastic gliomas (42+/-24 d; P<0.05). Interindividual variability of infectivity by HSV-1 virions might explain, at least in part, why some patients enrolled in gene therapy for glioblastoma in the past exhibited a sustained response to HSV-1-based gene- and virus therapy. Infectivity of primary tumor samples from respective patients should be tested to enable the development of efficient and safe herpes vector-based gene and virus therapy for clinical application.

Loss of BRCA2 correlates with reduced long-term survival of sporadic breast cancer patients.

BACKGROUND: The present study was undertaken to analyze the prognostic value of loss of heterozygosity (LOH) at 13q12-13, 17q21 and 17p13, harboring BRCA2, BRCA1 and p53 to predict the clinical course of sporadic breast cancer patients. MATERIALS AND METHODS: LOH analysis was performed by PCR amplification of genomic DNA using nine microsatellite markers. Fifty-three sporadic breast cancer patients were followed clinically for a median of 55 months. Disease-free and overall survival was documented as the endpoint for statistical evaluation. RESULTS: Patients presenting with LOH in their tumor samples at at least one of the loci examined were found to have a reduced overall survival time compared to those retaining heterozygosity (61% versus 48%). Focusing on the three target regions, patients with LOH at the BRCA2 locus died earlier compared to patients retaining heterozygosity (69% versus 50%) and, in addition, BRCA2 LOH-positive patients showed a shorter metastasis-free interval (30 versus 37 months). In a multivariate analysis, LOH at the 13q12-13 locus was found to be a significant predictor for reduced long-term survival (risk ratio 2.33, 95% C.I., 1.0-5.3; p<0.05) and earlier metastases manifestation (risk ratio 2.32, 95% C.I., 1.0-5.3, p<0.05). CONCLUSION: Allelic loss at the BRCA2 locus may be of use as a negative predictor for metastases-free and overall survival.

Some basic parameters of microspheres fabricated from a branched oligoester by a rapid procedure.

Microspheres were prepared from a branched copolymer of DL-lactic acid with mannitol containing native albumin and albumin labelled with fluorescein isothiocyanate, using a rapid method of distribution of methylformate as the solvent of the copolymer from the intermediate phase of the multiple w/o/w emulsion. The primary w/o emulsion was prepared by the method of homogenization with a turbine or, alternatively, by the method of dispersion with ultrasound in modified vessels. Different additives in the external aqueous phase, such as polyvinyl alcohol or the gelatin hydrolyzate as emulsifiers were tested. Ammonium sulphate, methylformate or ethyl acetate were used as moderators of solidification of microspheres. The effect of these selected formulation parameters on the size, encapsulation efficiency, yield of microspheres and on the course of the BSA and FITC-BSA release in vitro conditions were examined.

Rifampin-impregnated silicone catheters: a potential tool for prevention and treatment of CSF shunt infections.

BACKGROUND: Infection continues to be one of the major complications of cerebro-spinal fluid shunting procedures. Recent insights in the pathophysiological mechanism of these foreign body infections have elucidated the difficulty of achieving successful treatment without device removal. The development of a rifampin-impregnated silicone catheter yielded excellent results in infection prevention and treatment in vitro as well as in an animal model. PATIENTS AND METHODS: Here, we describe the application of this device in two patients with a complicated course of shunt infection. RESULTS: In one patient the rifampin-impregnated shunt system was implanted after external drainage to prevent further infection. The shunt infection of the second patient was treated by replacement of the infected shunt system with a rifampin-impregnated device. Both patients recovered immediately without any signs of adverse effects and the two shunt systems have now been working properly for more than 36 and 21 months, respectively. CONCLUSION: These results suggest that rifampin-impregnated silicone catheters could become a valuable tool in the treatment and prevention of shunt infections.

Snacking patterns influence energy and nutrient intakes but not body mass index.

OBJECTIVE: To study dietary intake and body mass index (BMI) patterns among US adults, stratified by snacking patterns. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) provided the study sample. Snacking episodes were defined as a 'food and/or beverage break', and subjects were classified as morning, afternoon, evening, multiple or never snackers. SUBJECTS/SETTING: Our study included data from 1756 men and 1511 women who provided two nonconsecutive, multiple-pass 24-h dietary recalls. STATISTICAL ANALYSES: Mean values of each subject's two 24-h recalls were used for analyses, and data were analysed using the Statistical Package for the Social Sciences (SPSS) for Windows and SUDAAN. RESULTS: Compared with women, men were more likely to be evening, multiple or never snackers. Male multiple snackers had significantly higher energy intakes than did afternoon and never snackers, whereas female multiple snackers had higher energy intakes than did morning, evening and never snackers. At the same time, male and female multiple snackers had more prudent energy-adjusted intakes of protein, cholesterol, calcium and sodium. Coffee, cola, milk, ice cream and fruits were among the most frequently consumed snacks by men and women. The BMI did not differ significantly across snacker categories. CONCLUSIONS: These data indicate that snacking patterns have some effects on energy and nutrient intakes but not on BMI. Snack food choices remain a concern, especially beverages, including those that are sweetened. Vegetables and fruits as snacks should be encouraged.

Antigenic and adjuvant activities of branched aliphatic oligoester (M-DL-LA) microspheres with incorporated bovine rotavirus.

Branched aliphatic oligoester microspheres (msp) with incorporated rotavirus were used to induce the production of systemic and mucosal antibodies in mice. The msp with a mean diameter of 7.4 microm were prepared by the w/o/w technique. The mice were immunized intraperitoneally or orally. High ELISA titres of systemic and local IgG and IgA antibodies were indicative of rotavirus incorporation and of the adjuvant activity of msp. Oral immunization with a split dose administered on three consecutive days, resulted in the production of systemic IgG and IgA antibodies, but failed to induce the production of mucosal antibodies even if the immunization dose was increased threefold. Specific antibodies were detectable in faeces of orally immunized mice only after another triple administration of the same dose in the fourth week of the experiment. Reactions of blood serum IgG with the structural viral proteins VP4, VP6, and VP7 were demonstrated by western blotting. Both systemic, and faecal IgA antibodies were specific for the VP6 protein and the dimeric form of the glycoprotein VP4.

Differences in dietary patterns of nonsmoking adults married to smokers vs. nonsmokers.

PURPOSE: To compare dietary intakes of nonsmoking adults married to smokers or nonsmokers. DESIGN: Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals (CSFII), 1994 to 1996 (response rate = 76.1% for 2 days of dietary intake). Nonsmoking adults aged 18 and older were grouped according to the smoking status of their spouse. SETTING: In-home interviews in all 50 states and Washington, D.C. SUBJECTS: The selected sample included 757 men and 754 women who were married to nonsmokers, and 197 men and 262 women who were married to smokers. MEASURES: Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared using chi 2 and analysis of covariance. RESULTS: Men and women married to smokers had greater (p < or = .025) energy-adjusted intakes of total and saturated fat but significantly lower (p < or = .05) energy-adjusted intakes of fiber and vitamin A. Men married to smokers consumed significantly more (p < .025) energy-adjusted cholesterol and ethanol but significantly less calcium (p = .026); women married to smokers consumed significantly less (p = .014) energy-adjusted folate. Men married to smokers consumed significantly more (p < or = .05) alcoholic beverages, coffee, and soft drinks; women married to smokers consumed significantly less water (p = .014) but more cheese and table sweeteners (p < or = .05). CONCLUSIONS: Nonsmoking men and women who were married to smokers had compromised dietary intakes. Nonsmoking men whose wives smoked, in particular, had unhealthy diets due to elevated intakes of fat and cholesterol and low intakes of vitamin A, calcium, and fiber. Health professionals should continue to provide tobacco cessation instruction and dietary guidance, but also be aware of at-risk patients' immediate family members who likely share an increased risk of disease because of poor diet quality and exposure to environmental tobacco smoke.

Breastfeeding-related onset, flare, and relapse of rheumatoid arthritis.

The beneficial effects of pregnancy on rheumatoid arthritis have been known for decades. Only recently, however, have lactation and prolactin been targeted as predictors of onset, flare, or relapse of arthritis. Among genetically susceptible women, breastfeeding is associated with an increased risk of rheumatoid arthritis, particularly after the first pregnancy. Dietary interventions may reduce symptoms experienced by arthritic women.

Upconverting phosphor reporters in immunochromatographic assays.

Immunochromatographic assays have become popular diagnostic tools in a variety of settings because they are sensitive, fast, and easy to use. Here, we describe the use of a novel reporter, upconverting phosphors (UCP), in this assay format. UCP are submicron-sized, inorganic crystals that are excited with infrared light and that emit photons in the visible range depending on the ion composition of the crystal. Using human chorionic gonadotropin (hCG) as a model analyte to describe the properties of phosphors in immunochromatographic assays, a detection limit of 10 pg hCG in a 100-microl sample has been achieved on a regular basis, with occasional detection of 1 pg hCG. This represents at least a 10-fold improvement over conventional reporter systems such as colloidal gold or colored latex beads. Quantitation of analytes is possible over at least 3 orders of magnitude. Furthermore, an example is given of how UCP can be used for analyte multiplexing using a two-plexed wick for the detection of mouse IgG and ovalbumin. Thus, UCP lateral flow assays can be used for applications that are currently limited by assay sensitivity, and they can increase the probability of a diagnosis by verifying the presence of several analytes in the same sample.

More Americans are eating "5 a day" but intakes of dark green and cruciferous vegetables remain low.

Epidemiological investigations repeatedly show that the regular consumption of dark green and cruciferous vegetables, tomatoes and citrus fruits in particular is related to reduced cancer risk. We used the 1994-1996 Continuing Survey of Food Intakes by Individuals to examine the types of fruits and vegetables consumed by Americans. The analytic sample population, which consisted of 4806 men and women (25-75 y old) who completed two nonconsecutive 24-h recalls, consumed 3.6 +/- 2.3 servings of vegetables and 1.6 +/- 2.0 servings of fruit daily. Iceberg lettuce, tomatoes, French fried potatoes, bananas and orange juice were the most commonly consumed fruits and vegetables, accounting for nearly 30% of all fruits and vegetables consumed. The most popular items, lettuce and tomatoes, were consumed by 39-42% of the sample population during the reporting period. Fewer respondents (16-24%) consumed French fried potatoes, bananas or orange juice. Only 3% of the sample consumed broccoli during the reporting period. White potato consumption averaged 1.1 servings daily, with French fried potatoes representing 0.4 serving. Tomato product consumption averaged 0.5 serving daily, dark green vegetable consumption averaged 0.2 serving daily and citrus, berries or melon consumption amounted to nearly 0.8 serving daily. These data indicate that Americans are consuming more fruits and vegetables but that dark green and cruciferous vegetable intake is low.

Branched oligoester microspheres fabricated by a rapid emulsion solvent extraction method.

Methyl formate was used as the solvent of biodegradable oligoesters for the fabrication of microspheres with encapsulated bovine serum albumin (BSA). The procedure of dispersion of the double emulsion of the w/o/w type and its dilution and solvent extraction is very rapid, taking only several minutes. A higher yield and better encapsulation efficiency were obtained with copolymers of DL-lactic acid with mannitol than with pure linear poly DL-lactic acid. The procedure was accelerated, and yields and encapsulation efficacy were enhanced by the addition of 5% methyl formate to the external water phase. The microspheres were smaller than 100 microm. No benefits were obtained from the addition of wetting agents or other additives to the intermediate (oligoesteric) phase. Further development should concentrate particularly on hydrodynamic conditions and optimization of the composition of the external phase.