Changes in the preoperative ocular surface flora with an increase in patient age: A surveillance analysis of bacterial diversity and resistance to fluoroquinolone.

PURPOSE: This study analyzed the relationship between patient age and the prevalence and fluoroquinolone susceptibility of gram-positive cocci from the ocular surface flora before ophthalmic surgery. METHODS: This surveillance study included scraped samples from the conjunctival sac of 8923 eyes of 5490 patients (70.0 ± 13.7 years) without ocular infection before ophthalmologic surgery between August 2018 and December 2020. A review of microbiological records regarding patient age was used to determine the number of isolates and gram-positive species obtained, as well as their fluoroquinolone susceptibility. Fluoroquinolone susceptibility was determined using the Clinical and Laboratory Standards Institute protocols of broth microdilution. Statistical analysis was performed using a generalized additive model and a log-linear model. RESULTS: In total, 9,894 bacterial isolates obtained from scraped samples from the patients were analyzed. The detected species were Staphylococcus epidermidis (31.0%), Staphylococcus aureus (6.1%), Staphylococcus lugdunensis (3.9%), Enterococcus faecalis (5.8%), Corynebacterium species (31.7%), and Cutibacterium acnes (7.5%) and others. The number of species isolated from the ocular surface was increased at the rate of 1.018 per 10 years of age (p < 0.0001). S. epidermidis, S. lugdunensis, E. faecalis, and Corynebacterium species were isolated more often with an increase in patient age. The levofloxacin resistance ratio of methicillin-sensitive S. epidermidis and Corynebacterium species increased at the rate of 1.204 and 1.087 respectively with a 10-year increase in age (both p < 0.0001). CONCLUSION: Gram-positive bacteria in the ocular surface flora (OSF) exhibited gradual changes in diversity and fluoroquinolone resistance with an increase in patient age. It is important to monitor the OSF of the patients before ophthalmologic surgery to prevent refractory ocular postoperative infection.

Age factor in the fluoroquinolone susceptibility of gram-positive cocci isolates from bacterial keratitis cases between 2008 and 2016.

PURPOSE: To determine the relationship between fluoroquinolone susceptibility of gram-positive cocci (GPC) isolated from patients with bacterial keratitis and the age of the patients or the date of onset. METHODS: Bacterial isolates were obtained from corneal lesions of patients with infectious keratitis treated between January 2008 and December 2016. The fluoroquinolone susceptibility of GPC was assessed, and a retrospective review of microbiological records was performed. Fluoroquinolone susceptibility was measured through broth microdilution in accordance with protocols of the Clinical and Laboratory Standards Institute. Statistical analysis was performed using a generalized estimating equation and cubic spline to determine the association between fluoroquinolone susceptibility of GPC isolated from corneal lesions and patient age. RESULTS: Of the 1200 bacterial isolates, 471 GPC were identified. They included Staphylococcus epidermidis (45.6%), other coagulase-negative Staphylococcus sp. (17.8%), and Staphylococcus aureus (18.3%). Levofloxacin susceptibility of GPC exhibited a negative relationship with age and had an odds ratio of 0.893 (95% confidence interval, 0.825-0.967) for every 10 years of age. A non-adjusted cubic spline curve was well correlated with year-adjusted data in a generalized additive model, and the levofloxacin susceptibility of GPC was initially stable but gradually declined after 40 years of age, before re-stabilizing again after 70 years of age. CONCLUSION: The fluoroquinolone susceptibility of GPC isolated from corneal lesions of infectious keratitis is high in children under 15 years of age and declines with an increase in age of patients using a generalized estimating equation and cubic spline.

Long-term effects of cataract surgery with topical levofloxacin on ocular bacterial flora.

PURPOSE: To clarify the long-term effect of topical antibiotics on the ocular bacterial flora after cataract surgery. SETTING: Miyata Eye Hospital, Miyazaki, Japan. DESIGN: Prospective case series. METHODS: Patients who had cataract surgery between November 2014 and January 2015 were included. Levofloxacin 1.5% was administered 4 times a day by topical instillation from 3 days before surgery to 1 month postoperatively. The conjunctival sacs of patients were scraped before the procedure and 0, 3, 6, 9, and 12 months after the last instillation. The samples were cultured, and minimum inhibitory concentrations (MICs) of levofloxacin for Staphylococcus epidermidis and Propionibacterium acnes were evaluated using mixed-effects models. RESULTS: The study evaluated 50 patients. Diverse bacterial species, predominantly S epidermidis and P acnes, were isolated before the application of topical levofloxacin. Bacterial diversity was substantially reduced after the final topical levofloxacin application and subsequently increased after 3 months. However, the geometric mean levofloxacin MICs for S epidermidis isolates were still significantly higher at 0 months and 3 months than before treatment (P < .01 and P = .03, respectively) and reached pretreatment levels 6 months and 12 months after the last application. Propionibacterium acnes did not show significant changes in the geometric mean levofloxacin MIC over time. CONCLUSION: The restoration of the bacterial flora required more than 6 months after cataract surgery and topical levofloxacin.

Effect of the administration period of perioperative topical levofloxacin on normal conjunctival bacterial flora.

PURPOSE: To assess the long-term and short-term effects of post-cataract surgery antibiotic therapy on the drug-resistance profile of normal conjunctival bacterial flora. SETTING: Miyata Eye Hospital, Miyazaki, Japan. DESIGN: Randomized prospective clinical trial. METHODS: Patients aged 20 years or older who had cataract surgery between May and September 2015 were given levofloxacin 1.5% ophthalmic solution for 3 days preoperatively. The patients were randomly assigned to a 1-week postoperative group or a 1-month postoperative group according to postoperative administration duration. Conjunctival sacs were scraped for bacterial culturing before administration, 1 week postoperatively, at the completion of administration, and 1, 3, and 6 months after administration completion. The bacterial culture growth and minimum inhibitory concentrations (MICs) of levofloxacin against recovered strains of Staphylococcus epidermidis were assessed. RESULTS: The study enrolled 104 patients. The MICs of levofloxacin against S epidermidis increased during levofloxacin administration compared with before administration in both groups and then declined after administration completion. However, by 3 months, the MICs in the 1-month group were approximately twice those in the 1-week group. Antibiotic susceptibility before administration, at completion of administration, and at 3 months was 73.6%, 20.2%, and 38.5%, respectively, in the 1-week group and 63.0%, 0.0%, and 19.3%, respectively, in the 1-month group. The results indicate that from completion of administration to 3 months, the susceptible strains were approximately 20% lower in the 1-month postoperative group than in the 1-week postoperative group. CONCLUSION: Administration duration of perioperative levofloxacin 1.5% influenced the MICs and susceptibility of S epidermidis isolated from the conjunctival sac.

[Effect of ambient light variations on luminance ratio of CRT monitor and image contrast in ultrasonography].

Variation in the luminance ratio of a cathode ray tube(CRT)monitor and the ultrasonographic images at different levels of ambient light(0-150 lux)was investigated to obtain optimum ambient light in the ultrasonography suite. The maximum and minimum luminances of test patterns and ultrasonographic images were measured after three technicians independently optimized the brightness and contrast of the CRT monitor and ultrasonographic images at different levels of ambient light. Furthermore, the luminance ratio was calculated from the maximum luminance divided by the minimum luminance. When ambient light increased, it was difficult for the technicians to optimize the brightness and contrast settings of the CRT monitor to maintain a high luminance ratio at 0 lux. The luminance ratio decreased rapidly as ambient light increased up to 20 lux. However, the luminance ratio decreased gradually when ambient light was higher than 20 lux. It is necessary to take into consideration the ambient light to maintain a high luminance ratio of ultrasonographic images.

Identification of novel type III secretion effectors in Xanthomonas oryzae pv. oryzae.

Many gram-negative bacteria secrete so-called effector proteins via a type III secretion (T3S) system. Through genome screening for genes encoding potential T3S effectors, 60 candidates were selected from rice pathogen Xanthomonas oryzae pv. oryzae MAFF311018 using these criteria: i) homologs of known T3S effectors in plant-pathogenic bacteria, ii) genes with expression regulated by hrp regulatory protein HrpX, or iii) proteins with N-terminal amino acid patterns associated with T3S substrates of Pseudomonas syringae. Of effector candidates tested with the Bordetella pertussis calmodulin-dependent adenylate cyclase reporter for translocation into plant cells, 16 proteins were translocated in a T3S system-dependent manner. Of these 16 proteins, nine were homologs of known effectors in other plant-pathogenic bacteria and seven were not. Most of the effectors were widely conserved in Xanthomonas spp.; however, some were specific to X. oryzae. Interestingly, all these effectors were expressed in an HrpX-dependent manner, suggesting coregulation of effectors and the T3S system. In X. campestris pv. vesicatoria, HpaB and HpaC (HpaP in X. oryzae pv. oryzae) have a central role in recruiting T3S substrates to the secretion apparatus. Secretion of all but one effector was reduced in both HpaB() and HpaP() mutant strains, indicating that HpaB and HpaP are widely involved in efficient secretion of the effectors.

Uterine cervical cancer: a holistic approach to mental health and it's socio-psychological implications.

This correlation study investigated outpatients with early stage uterine cervical cancer. The subjects' mental health and its' relationship with demographic characteristics, clinical characteristics, and quality of life were examined. One hundred and seventy six patients from three major hospitals in the Fukuoka area were surveyed with a structured questionnaire. The status of mental health measured by CES-D (Center for Epidemiologic Studies Depression Scale) indicated an average score of 13+/-8 (mean+/-SD). No clinical parameters were found to have significant correlation to CES-D. However, increased pain (p< 0.001) and the absence of a husband or a partner (p < 0 .01) had greater CES-D score which indicated worse mental health outcome. The QOL (Quality of Life) scale developed for this study consists of the four domains: "Feel satisfied with life" (r = -.526, p < 0. 01), "Find life worth living" (r= -.485, p < 0.01), "Feel no hindrance in daily life" (r= -.319, p<0.01), and "Feel no anxiety with illness" (r= -. 578, p < 0.01) all which have statistically significant correlations with CES-D scores respectively. Upon examination using the multi-regression model, a strong relationship between CES-D scores and "Feel no anxiety with illness" (r= -.331, p<0.001) was evident. This showed to be the strongest indicator affecting the depression outcome, followed by "Strong pain" (r= .231, p<0.01). Clinical parameters, such as performance status, clinical stage, and medical treatment did not show any correlation to CES-D scores. The research suggests that the mental health of outpatients with uterine cervical cancer was influenced by pain and quality of life, rather than the clinical parameters. The presence of a husband or a partner played the role as social support to reduce the level of depression. In order to provide complete care of patients, pain management, anxiety management, and spousal involvement are crucial to patients' mental health, especially in the ongoing care of uterine cervical cancer.

Photoregulation of deacylation rate of acyl trypsin derived from photoresponsive inverse substrate.

The acyl trypsin was prepared by use of an inverse substrate, which is comprise of a photoresponsive 4-phenylazobenzoyl moiety. The acyl group in acyl trypsin has been shown to isomerize from trans-form (4t-trypsin) to cis-form (4c-trypsin)/from cis-form to trans-form by irradiation of UV-vis light. The deacylation rate of the cis-form (4c-trypsin) has been shown to be 18.6 times faster than that of the trans-form (4t-trypsin).