Clinical predictors of methicillin-resistance and their impact on mortality associated with Staphylococcus aureus bacteraemia.

We investigated the clinical predictors of methicillin-resistance and their impact on mortality in 371 patients with Staphylococcus aureus bacteraemia identified from two prospective multi-centre studies. Methicillin resistant S. aureus (MRSA) accounted for 42.2% of community-onset and 74.5% of hospital-onset cases. No significant clinical difference was found between patients infected with MRSA vs. methicillin-sensitive S. aureus (MSSA), except that the former were more likely to have had hospital-onset bacteraemia and received antibiotics in the preceding 90 days. After stratifying according to the acquisition site, prior antibiotic use was the only independent predictor of having MRSA in both community-onset and hospital-onset cases. The frequency of inappropriate empirical antibiotic therapy was higher in patients with MRSA than in those with MSSA bacteraemia. However, methicillin resistance was not a predictor of mortality in patients and the clinical characteristics and outcomes of both MRSA and MSSA bacteraemia were similar. This study indicates that there are no definitive clinical or epidemiological risk factors which could distinguish MRSA from MSSA cases with the exception of the previous use of antibiotics for having MRSA bacteraemia, which emphasises the prudent use of glycopeptide treatment of patients at risk for invasive MRSA infections.

Tunable quad-band transmission response, based on single-layer metamaterials.

We investigated the electromagnetically induced transparency (EIT)-like effects in planar metamaterials (MMs) at microwave (GHz) frequencies. The specific MMs that were used in this study consist of cut-wire resonator/ring resonator, which achieved the dual EIT-like effects in a single-layer through the bright- and quasi-dark-mode coupling and the lattice mode coupling. In addition, by varying the distance between the two resonators, the quad-band EIT spectral response in the microwave region was obtained, and the group refractive index at the EIT-like resonance of proposed design reached up to 4,000. This study provides the design approach to the multispectral EIT-like effects and might suggest potential applications in a variety of fields, for example, low-loss slow-light device, multiple switching sensor, and other sensing devices.

Switching and extension of transmission response, based on bending metamaterials.

The electromagnetically-induced transparency (EIT)-like effects in planar and non-planar metamaterials (MMs) were investigated for microwave (GHz) frequencies. The specific MMs used in this study consisted of a cut-wire resonator and a ring resonator, where were placed on the top and the bottom layers, respectively. A transmission window was produced, due to the interference between bright- and bright-mode coupling. Using the numerical and the experimental results, we demonstrate that the bending of MM leads to enhanced transmission and bandwidth, as well as an additional EIT-like peak. This provides an effective way of realizing the tunable devices, including the switching sensors.

Surveillance of the Middle East respiratory syndrome (MERS) coronavirus (CoV) infection in healthcare workers after contact with confirmed MERS patients: incidence and risk factors of MERS-CoV seropositivity.

Given the mode of transmission of Middle East respiratory syndrome (MERS), healthcare workers (HCWs) in contact with MERS patients are expected to be at risk of MERS infections. We evaluated the prevalence of MERS coronavirus (CoV) immunoglobulin (Ig) G in HCWs exposed to MERS patients and calculated the incidence of MERS-affected cases in HCWs. We enrolled HCWs from hospitals where confirmed MERS patients had visited. Serum was collected 4 to 6 weeks after the last contact with a confirmed MERS patient. We performed an enzyme-linked immunosorbent assay (ELISA) to screen for the presence of MERS-CoV IgG and an indirect immunofluorescence test (IIFT) to confirm MERS-CoV IgG. We used a questionnaire to collect information regarding the exposure. We calculated the incidence of MERS-affected cases by dividing the sum of PCR-confirmed and serology-confirmed cases by the number of exposed HCWs in participating hospitals. In total, 1169 HCWs in 31 hospitals had contact with 114 MERS patients, and among the HCWs, 15 were PCR-confirmed MERS cases in study hospitals. Serologic analysis was performed for 737 participants. ELISA was positive in five participants and borderline for seven. IIFT was positive for two (0.3%) of these 12 participants. Among the participants who did not use appropriate personal protective equipment (PPE), seropositivity was 0.7% (2/294) compared to 0% (0/443) in cases with appropriate PPE use. The incidence of MERS infection in HCWs was 1.5% (17/1169). The seroprevalence of MERS-CoV IgG among HCWs was higher among participants who did not use appropriate PPE.

Comparison of surgical performance and short-term clinical outcomes between laparoscopic and robotic surgery in distal gastric cancer.

AIMS: The authors aimed to compare the surgical performance and the short-term clinical outcomes of robotic assisted laparoscopic distal gastrectomy (RADG) with laparoscopy-assisted distal gastrectomy (LADG) in distal gastric cancer patients. METHOD: From April 2009 to August 2010, 62 patients underwent LADG and 30 patients underwent RADG for preoperative stage I distal gastric cancer by one surgeon at the National Cancer Center, Korea. Surgical performance was measured using lymph node (LN) dissection time and number of retrieved LNs, which were viewed as surrogates of technical ease and oncologic quality. RESULTS: In clinicopathologic characteristics, mean age, depth of invasion and stage were significantly different between the LADG and RADG group. Mean dissection time at each LN station was greater in the RADG group, but no significant intergroup difference was found for numbers of retrieved LNs. Furthermore, proximal resection margins were smaller, and hospital costs were higher in the RADG group. In terms of the RADG learning curve, mean LN dissection time was smaller in the late RADG group (n = 15) than in the early RADG group (n = 15) for 4sb/4d, 5, 7-12a stations, but numbers of retrieved LNs per station were similar. CONCLUSION: With the exception of operating time and cost, the numbers of retrieved LNs and the short-term clinical outcomes of RADG were found to be comparable to those of LADG, despite the surgeon's familiarity with LADG and lack of RADG experience. Further studies are needed to evaluate objectively ergonomic comfort and to quantify the patient benefits conferred by robotic surgery.

Clinical usefulness of plasma quantitative polymerase chain reaction assay: diagnosis of cytomegalovirus infection in kidney transplant recipients.

BACKGROUND: Preemptive therapy is used to prevent cytomegalovirus (CMV) disease in transplant recipients. The CMV antigenemia assay, which has been commonly used as a predictive marker for preemptive therapy, requires intensive labor and immediate processing. We compared the cutoff value of plasma CMV polymerase chain reaction (PCR) with CMV antigenemia in kidney transplant recipients. METHODS: We compared two diagnostic methods for CMV infection in kidney transplant recipients: quantitative PCR (qPCR) versus antigenemia. We evaluated the optimal cutoff value of plasma CMV qPCR by using receiver-operating characteristic curves for specific antigenemia values. All kidney transplant recipients from January 2004 to January 2005 were enrolled and followed with CMV antigenemia and plasma CMV qPCR. RESULTS: The analyses were performed on 899 samples collected from 111 patients in the early posttransplant period, matching 84.1% of patients for the results of CMV antigenemia and plasma CMV qPCR. For patients with symptomatic CMV infection and disease, who showed ≥25 positive cells in the antigenemia assay, the cutoff value for qPCR was 17.8 copies/µL with a sensitivity of 97.1%, a specificity of 89.1%, and a positive predictive value of 26.6%. CONCLUSIONS: Diagnostic assays for CMV such as CMV antigenemia and quantitative plasma PCR, showed similar diagnostic values. They are the methods of choice for the diagnosis and monitoring of active CMV infection after kidney transplantation. However, because of the relatively low positive predictive value of qPCR, this test may lead to unnecessary preemptive treatment in kidney transplant recipients.

The impact of variation in donation after cardiac death policies among donor hospitals: a regional analysis.

The Joint Commission requires all hospitals have a policy regarding donation after cardiac death. To this date however, a quantitative analysis of adult hospital donation after cardiac death (DCD) policies and its impact on transplantation outcomes has not been reported. Specific characteristics for DCD polices were identified from 90 of the 164 (54.9%) hospitals within the New England Organ Bank's donor service area. Forty-five policies (50.0%) allow family members to be present during withdrawal of life-sustaining therapy (WLST) whereas eight (8.9%) prohibit this. Seventeen policies (18.9%) require WLST to occur in the operating room (OR); 20 (22.2%) specify a location outside of the OR. Fifty-six (62.2%) policies fail to state the method of determining death; however, some require arterial line (15 policies, 16.6%) and/or EKG (10 policies, 11.1%). These variables were not associated with organ recovery, utilization or donor ischemia time. Our regional analysis highlights the high degree of variability of hospital DCD policies, which may contribute to misunderstanding and confusion among providers and patients that may influence acceptance of this mode of donation.

Characterization of the withdrawal phase in a porcine donation after the cardiac death model.

Transplantation of donation after cardiac death (DCD) livers has higher rates of organ failure and complications, specifically ischemic biliary injuries. Reported large animal DCD models all employ active means to halt circulation, contrary to human DCD protocol. We report a DCD porcine model in which the animal passively progresses to cardiac death, thereby more closely mimicking human DCD scenario. Sixteen Yorkshire pigs (10 females, 6 males, 30-45 kg) had a mean time of 26:19 min ± 14:14 from withdrawal of ventilatory support (WVS) to circulatory arrest and 44:38 min ± 16:37 from WVS to electrical standstill. Cessation of hepatic flow (HF) occurred well before electrical standstill (22:15 min ± 10:09), previously not described in human or animal DCD. Histologically comparing livers from our DCD model demonstrated a dramatic increase in hepatocyte vacuolization, disorganization of endoplasmic reticulum, formation of mitochondrial inclusions and apoptosis compared with control specimens. Subtle changes were also evident in biliary epithelial cells (BEC). This results in severe cellular changes before reperfusion. Early histologic evidence suggests that there is severe hepatocyte and biliary cell disruption in our DCD model. Further research using this model may provide a deeper understanding of the pathophysiology of the DCD liver.

Growth performance, meat quality, and gut microflora of broiler chickens fed with cranberry extract.

Cranberry fruit components have been reported to have antimicrobial activities against a variety of pathogenic bacteria and to be beneficial for human health. Studies on their effects are very limited in animals and especially in chickens. This study investigated the effect of feed supplementation with a commercial cranberry fruit extract (CFE) on the performance, breast meat quality, and intestinal integrity of broiler chickens. Twelve hundred male 1-d-old broiler chicks were allocated randomly to CFE treatments at 0, 40, 80, or 160 mg/kg of feed from d 0 to 35. Cloacal and cecal samples were collected weekly to evaluate the influence of treatments on the intestinal population of generic Escherichia coli, Clostridium perfringens, Enterococcus spp., and Lactobacillus spp. At d 35, BW were 1.62, 1.60, 1.61, and 1.64 kg for the control birds and birds fed 40, 80, and 160 mg of CFE/kg of feed, respectively. Feed intake ranged from 2.7 to 2.8 kg and feed efficiency from 1.8 to 1.9 g of feed/g of BW. However, the treatment effects on bird performance were not statistically significant (P > 0.05). The mortality rate tended to be lower (P = 0.09) in birds fed 40 mg of CFE/kg of feed. Feed supplementation with CFE did not significantly alter any broiler meat properties evaluated when compared with the control diet (P > 0.05). At d 28, the populations of Enterococcus spp. in cecal and cloacal samples were significantly lower (P < 0.05) in birds receiving CFE at 160 mg/kg of feed than the other groups. No significant differences were noted between the control and the treatment groups for general health and intestinal integrity (P > 0.05). These findings suggest that more studies are needed to investigate potential beneficial effects of CFE or its derivatives in broiler production.

Changing etiology of community-acquired bacterial meningitis in adults: a nationwide multicenter study in Korea.

Epidemiologic data on the etiologic organisms is important for appropriate empirical antibiotic treatment of bacterial meningitis. We identified the etiologies of community-acquired bacterial meningitis in Korean adults and the associated epidemiological factors. A retrospective, multicenter nationwide study was carried out. Patients 18 years of age or older with community-acquired bacterial meningitis with a confirmed pathogen were enrolled. Demographic, clinical, and microbiological data were collected. One hundred and ninety-five cases were collected. Streptococcus pneumoniae was the most common pathogen (50.8%), followed by Staphylococcus aureus (10.3%), Klebsiella pneumoniae (7.7%), Listeria monocytogenes (6.7%), and group B Streptococcus (3.1%). The penicillin resistance rate of the S. pneumoniae was 60.3%; 40.0% of the organisms were not susceptible to third-generation cephalosporins. The combination of third-generation cephalosporin with vancomycin was used in 76.3% of cases. Steroids were given before or with the first dose of antibiotics in 37.4% of patients. The 30-day mortality rate was 20.5% and neurological sequelae developed in 15.6% of cases. S. pneumoniae was the most common organism identified in community-acquired bacterial meningitis among Korean adults. S. aureus, K. pneumoniae, L. monocytogenes, and group B Streptococcus were also common. S. pneumoniae had high rates of resistance to penicillin and third-generation cephalosporins.

Magneto-optical enhancement through gyrotropic gratings.

Diffracted magneto-optical (MO) effects are numerically investigated for one-dimensional lossy gyrotropic gratings in the zeroth and the first orders for the polar magnetization by utilizing the rigorous coupled-wave approach implemented as an Airy-like internal-reflection series. The simulated Kerr spectra agree well with the experimental ones. The dependence of the MO Kerr enhancement on the grating depth in the first-order diffraction, compared with that in the zeroth one, is illustrated, and the diffracted MO Faraday effect is theoretically investigated as well. Such a MO enhancement through the gyrotropic gratings is superior to the conventional MO devices and magneto-photonic crystals. The potential applications are also suggested.

Dependence of the distance between cut-wire-pair layers on resonance frequencies.

We studied both experimentally and theoretically the influence of the distance between adjacent cut-wire-pair layers on the magnetic and the electric resonances in the microwave-frequency regime. Besides the dependence on the separation between cut-wire pairs, along the electric-field direction, the electric resonance strongly depends on the distance between cut-wire-pair layers, while the magnetic resonance is almost unchanged. This contrast can be understood by the difference in the distribution of induced-charge density and in the direction of the induced current between the electric and magnetic resonances. A simple model is proposed to simulate our experimental results and the simulation results are in good agreement with the experiment. This result provides important information in obtaining left-handed behavior when the cut-wire pairs are combined with the continuous wire.

Impaired heart rate variability and altered cardiac sympathovagal balance after antidepressant overdose.

PURPOSE: Antidepressant overdose may be associated with significant cardiotoxicity, and recent data have shown that acute toxic effects are associated with impaired heart rate variability. This study was designed to examine the feasibility of non-invasive heart rate variability recording in patients that present to hospital after deliberate antidepressant ingestion. METHODS: This was a prospective study of 72 consecutive patients attending the Emergency Department after deliberate antidepressant overdose and 72 age-matched patients that ingested paracetamol, as a control group. Single time-point continuous electrocardiographic recordings were used to allow spectral analyses of heart rate variability determined in low-frequency (LF) and high-frequency (HF) domains. The LF:HF ratio was used to represent overall sympathovagal cardiac activity. RESULTS: Antidepressant overdose was associated with reduced overall heart rate variability: 1329 vs. 2018 ms(2) (P = 0.0239 by Mann-Whitney test). Variability in the LF domain was higher (64.8 vs. 49.8, P = 0.0006), whereas that in the HF domain was lower (24.3 vs. 36.4, P = 0.0001), and the LF:HF ratio was higher in the antidepressant group (2.4 vs. 1.2, P = 0.0003). CONCLUSIONS: Antidepressant overdose is associated with impaired heart rate variability in a pattern consistent with excess cardiac sympathetic activity. Further work is required to establish the significance of these findings and to explore whether the impairment of heart rate variability may be used to predict the development of arrhythmia in this patient group.

Dependence of the magnetic-resonance frequency on the cut-wire width of cut-wire pair medium.

We investigated some magnetic metamaterials based on cut-wire pairs instead of split-ring resonators to quest for the possibility of a negative magnetic permeability. Several periodic structures of cut-wire pairs were designed and fabricated, and their transmission spectra were measured in the microwave-frequency regime. The width dependence of magnetic-resonance frequency was studied both theoretically and experimentally for the periodic structures of cut-wire pairs. It was found that, besides the length dependence, the magnetic-resonance frequency also depends significantly on the width of cut-wire pair. A simple equivalent-circuit model proposed by Zhou et al. [Opt. Lett. 31, 3620-3622 (2006)] was employed to elucidate this interesting phenomenon and to simulate the width dependence. In the simulation the magnetic and the electric energies of the cut-wire pair were directly calculated to obtain the magnetic-resonance frequency. The theoretical results are in good agreement with the experimental ones. It reveals that there is a rather easy way to manipulate the magnetic-resonance frequency of magnetic-magnetic metamaterials.

Realization of a large magnetic moment in the ferromagnetic CoPt bulk phase.

Changes in the magnetic moment and other physical properties of a CoPt alloy induced by a new type of ion-beam mixing in an external magnetic field were investigated. This process induces the formation of a metastable phase through extremely rapid quenching from well above the ordering temperature. The measured magnetic moment per Co atom was 2.63 mu(B), larger by 55% and 35% than that of the bulk Co and stable CoPt film, respectively, which is one of the highest values ever observed in the ferromagnetic bulk phase.

Characterization and intracellular localization of the Rok1 protein involved in yeast cell division.

The ROK1 gene is essential for the cell cycle progression in Saccharomyces cerevisiae. ROK1 has been predicted to encode an ATP-dependent RNA helicase of the DEAD-box family. We have analyzed the ROK1 gene expression both at the protein and RNA levels. Polyclonal antibodies were raised against trpE::rok1 hybrid proteins and were affinity purified by using lacZ::rok1 hybrid proteins. Western blot experiments using anti-Rok1 antibodies revealed a single protein band of 64 kDa which is an expected size from the Rok1 amino acid sequence. Indirect immuno-fluorescence showed that the Rok1 protein is localized predominantly to the cytoplasm of the vegetatively growing cells. We have detected immunocross-reactive homologs of Rok1p in Candida albicans and Drosophila melanogaster.