Clinical features of Talaromyces marneffei infection in HIV-positive and HIV-negative individuals: A retrospective study in southern China.

Talaromyces marneffei (TSM) is a temperature-dependent dimorphic fungus endemic to Southeast Asia and southern China. As the number of people at risk of TSM infection continues to increase, the clinical manifestations are becoming increasingly complex, posing challenges for clinical management. In this study, we analyzed the medical records of 99 patients (71 human immunodeficiency virus [HIV]-positive and 28 HIV-negative) diagnosed with TSM infection from January 1, 2017, to December 31, 2022, in southern China and compared the clinical manifestations in HIV-positive and HIV-negative patients. Most patients (83/99, 84%) were male. The incidence of skin and soft tissue involvement (48% vs. 21%, P = .016); disseminated infection with blood circulation, hematopoietic, lymphatic, alimentary, or central nervous system involvement (69% vs. 36%, P = .002); and gastrointestinal bleeding (33% vs. 9%, P = .023) was higher in the HIV-positive group than the HIV-negative group. The HIV-positive group also had significantly higher alanine aminotransferase (ALT) levels (31 [26-42] vs. 14 [11-16] U/l, P < .001) and ALT/aspartate transaminase ratio (1.9 [1.5-2.2] vs. 1.3 [1.1-1.6], P = .006) than the HIV-negative group. The time to diagnosis (5.5 ± 1.1 vs. 5.1 ± 1.4 days, P = .103), antifungal regimen (P = .278), case fatality rate (20% vs. 21%, P = .849), and relapse/reinfection rate (11% vs. 19%, P = .576) did not differ significantly between the HIV-positive and HIV-negative groups. Poor antiretroviral therapy adherence (OR = 26.19, 95%CI 3.26-210.70, P = .002), advanced age (OR = 1.13, 95%CI 1.03-1.23, P = .010), and Epstein-Barr virus co-infection (OR = 37.13, 95%CI 3.03-455.64, P = .005) were independent risk factors for all-cause mortality from TSM infection in HIV-positive patients. Overall, the predominant infection sites, clinical manifestations, and complications of TSM infection differed by HIV status. However, with prompt diagnosis and appropriate treatment, HIV-positive patients with TSM infection can have similar outcomes to HIV-negative patients.

There are certain differences in the clinical features, sites of infection, and associated complications of Talaromyces marneffei infection between individuals with and without human immunodeficiency virus. It is necessary to accurately identify individuals at high risk to enable prompt diagnosis and standardized treatment.

Modulated wafer-scale WS2 films based on atomic-layer-deposition for various device applications.

Tungsten disulfide (WS2) is promising for potential applications in transistors and gas sensors due to its high mobility and high adsorption of gas molecules onto edge sites. This work comprehensively studied the deposition temperature, growth mechanism, annealing conditions, and Nb doping of WS2 to prepare high-quality wafer-scale N- and P-type WS2 films by atomic layer deposition (ALD). It shows that the deposition and annealing temperature greatly influence the electronic properties and crystallinity of WS2, and insufficient annealing will seriously reduce the switch ratio and on-state current of the field effect transistors (FETs). Besides, the morphologies and carrier types of WS2 films can be controlled by adjusting the processes of ALD. The obtained WS2 films and the films with vertical structures were used to fabricate FETs and gas sensors, respectively. Among them, the Ion/Ioff ratio of N- and P-type WS2 FETs is 105 and 102, respectively, and the response of N- and P-type gas sensors is 14% and 42% under 50 ppm NH3 at room temperature, respectively. We have successfully demonstrated a controllable ALD process to modify the morphology and doping behavior of WS2 films with various device functionalities based on acquisitive characteristics.

Metagenomic next-generation sequencing for the etiological diagnosis of rabies virus in cerebrospinal fluid.

Background: Rabies is a highly fatal disease. Once symptoms develop, death usually occurs within days. Survivors were occasionally reported in the literatures. Ante-mortem diagnosis remains a challenge in most rabies endemic countries. A novel, accurate diagnostic assay is highly desirable. Methods: We used metagenomic next-generation sequencing (mNGS) to examine the cerebrospinal fluid (CSF) samples of a 49-year-old patient with rabies and validated the results by TaqMan PCR and RT-PCR/Sanger sequencing. Results: Metagenomic next-generation sequencing identified sequence reads uniquely aligned to the rabies virus (RABV). PCR confirmed the presence of the partial RABV N gene in the CSF. Phylogenetic analysis showed that the RABV grouped as an Asian clade, which is the most broadly distributed clade in China. Conclusion: Metagenomic next-generation sequencing may be a useful screening tool for the etiological diagnosis of rabies, especially in the absence of timely rabies laboratory testing or in patients with no exposure history.

Multi-Dimensional Composite Frame as Bifunctional Catalytic Medium for Ultra-Fast Charging Lithium-Sulfur Battery.

The shuttle effect of soluble lithium polysulfides (LiPSs) between electrodes and slow reaction kinetics lead to extreme inefficiency and poor high current cycling stability, which limits the commercial application of Li-S batteries. Herein, the multi-dimensional composite frame has been proposed as the modified separator (MCCoS/PP) of Li-S battery, which is composed of CoS2 nanoparticles on alkali-treated MXene nanosheets and carbon nanotubes. Both experiments and theoretical calculations show that bifunctional catalytic activity can be achieved on the MCCoS/PP separator. It can not only promote the liquid-solid conversion in the reduction process, but also accelerate the decomposition of insoluble Li2S in the oxidation process. In addition, LiPSs shuttle effect has been inhibited without a decrease in lithium-ion transference numbers. Simultaneously, the MCCoS/PP separator with good LiPSs adsorption capability arouses redistribution and fixing of active substances, which is also beneficial to the rate performance and cycling stability. The Li-S batteries with the MCCoS/PP separator have a specific capacity of 368.6 mAh g-1 at 20C, and the capacity decay per cycle is only 0.033% in 1000 cycles at 7C. Also, high area capacity (6.34 mAh cm-2) with a high sulfur loading (7.7 mg cm-2) and a low electrolyte/sulfur ratio (7.5 µL mg-1) is achieved.

Combined procalcitonin and hemogram parameters contribute to early differential diagnosis of Gram-negative/Gram-positive bloodstream infections.

BACKGROUND: Hemogram parameters and procalcitonin (PCT) play auxiliary roles in the diagnosis and outcome of sepsis. However, it is not clear whether these indicators can quickly distinguish bacterial classification or guide the choice of empirical antibiotics. METHODS: We retrospectively enrolled 381 patients with bloodstream infections (BSI), divided into Gram-positive bloodstream infections (GP-BSI) and Gram-negative bloodstream infections (GN-BSI). Demographic parameters, hemogram parameters, and PCT were recorded and compared between the two groups. RESULTS: The mean platelet volume (MPV), platelet distribution width (PDW), and PCT in the GN-BSI group were significantly higher than those in the GP-BSI group, while the platelet count (PLT), plateletcrit, platelet count-to-white blood cell count ratio (PWR), platelet count-to-neutrophil count ratio (PNR), platelet count-to-PCT ratio (PLT/PCT), and mean platelet volume-to-PCT ratio (MPV/PCT) were significantly lower in the GN-BSI group. Multivariate stepwise logistic regression analysis revealed that the independent predictors of GN-BSI were MPV, PWR, and PCT. The areas under the curve (AUC) for this prediction model was 0.79, with sensitivity =0.75 and specificity =0.71. CONCLUSIONS: There were significant differences in terms of PCT, platelet parameters, and platelet-related index-PCT ratio between GN-BSI and GP-BSI. Combined PCT and hemogram parameters are more conducive to the early differential diagnosis of bacterial classification of BSI.

Preoperative false-negative transthoracic echocardiographic results in native valve infective endocarditis patients: a retrospective study from 2001 to 2018.

BACKGROUND: Infective endocarditis (IE) is a lethal disease that is difficult to diagnosis early. Although echocardiography is one of the most widely used diagnostic technique, it has limited sensitivity. This study surveyed the clinical features of IE patients who underwent surgery and compared transthoracic echocardiography and histological findings to explore the factors related to false-negative echocardiographic results. METHODS: Medical records were extracted from IE patients consecutively hospitalized between June 2001 and June 2018. RESULTS: A total of 182 patients with native valve IE who underwent surgery were included. Compared to the non-surgery group, the surgery group was more likely to have pre-existing valvular lesions and more serious cardiac conditions and a relative lack of signs of infection and cerebrovascular events, leading to a lower proportion of "definite cases" before surgery. The false-negative rate of echocardiography was 14.5%. Echocardiography has significant disadvantages in diagnosing perivalvular abscesses, valve perforations, and left-sided endocarditis, especially for subjects with both aortic and mitral valve infections. The multivariate analysis identified congenital heart disease and small vegetations (< 10 mm) as independent predictors of false-negative echocardiography results. Conversely, fever and heart murmurs on admission served as protective factors. CONCLUSIONS: Under some circumstances, echocardiography provides inconsistent results compared with surgical findings, and negative echocardiography results do not rule out IE. The diagnosis of IE depends on comprehensive evaluations using multiple methods.

A highly stable and sensitive ethanol sensor based on Ru-decorated 1D WO3 nanowires.

Decorating materials with noble metal catalysts is an effective method for optimizing the sensing performance of sensors based on tungsten trioxide (WO3) nanowires. Ruthenium (Ru) exhibits excellent catalytic activity for oxygen adsorption/desorption and chemical reactions between gases and adsorbed oxygen. Herein, small Ru nanoparticles were uniformly distributed on the surface of one-dimensional WO3 nanowires. The nanowires were prepared by the electrospinning method through an ultraviolet (UV) irradiation process, and decoration with Ru did not change their morphology. A sensor based on 4% Ru nanowires (NWs) shows the highest response (∼120) to 100 ppm ethanol, which was increased around 47 times, and the lowest ethanol detection limit (221 ppb) at a lower temperature (200 °C) displays outstanding repeatability and stability even after 45 days or in higher-humidity conditions. Moreover, it also has faster response-recovery features. The improvement in the sensing performance was attributed to the stable morphology of the nanowires, the sensitization effect of Ru, the catalytic effect of RuO2 and the optimal atomic utilization efficiency. This work offers an effective and promising strategy for promoting the ethanol sensing performance of WO3.

Patients with tuberculous meningitis and hepatitis B co-infection have increased risk for antituberculosis drug-induced liver injury and poor outcomes.

BACKGROUND: Tuberculous meningitis (TBM) is one of the most severe forms of tuberculosis. Previous studies reported that hepatitis B virus (HBV) infection could increase the risk of antituberculosis drug-induced liver injury (ATB-DILI) in pulmonary tuberculosis patients. To date, only a few studies exist on the effect of HBV on TBM. METHODS: This inpatient study retrospectively analyzed the medical records of patients who were diagnosed with TBM between June 2002 and June 2018. Statistical analysis was used to reveal the difference between the HBV and non-HBV groups. Univariate analysis and multivariate regression analysis were performed on data to determine the prognostic factors of TBM. RESULTS: A total of 386 patients were enrolled in our study, 57 of whom were included in the HBV group and 329 in the non-HBV group. The HBV group showed a higher frequency of ATB-DILI (HBV group: 14.0% versus non-HBV group: 3.3%, p < .001) and a higher risk of poor outcomes (i.e. death during inpatient period or neurological deficit at discharge, HBV group: 31.6% versus non-HBV group: 19.8%, p = .045) than the non-HBV group. The multivariate regression analysis identified ATB-DILI, scores of 3-8 on the Glasgow Coma Scale and hydrocephalus as independent predictors of poor outcomes in TBM patients. CONCLUSIONS: Our study demonstrated that HBV co-infection could increase the incidence of ATB-DILI and the risk of poor outcomes as identified by three predictors in TBM patients.

Insufficient knowledge and inappropriate practices of emergency doctors towards tetanus prevention in trauma patients: a pilot survey.

China has a shocking number of tetanus cases in the world, but little research has investigated doctors' knowledge of and practices in tetanus prophylaxis, especially tetanus vaccination. To this end, we conducted a pilot study on 197 emergency doctors using a mixed method of web-based (163; 82.8%) and paper-based (34; 17.2%) surveys. There was no difference between the two groups except for the percentage of doctors receiving a tetanus booster in the past 10 years and the responses to question 11. Surprisingly, only 28.9% of doctors had received formal training on tetanus immunization and only 21.3% had themselves received a tetanus vaccine booster in the past 10 years. Furthermore, only 14.2% of the respondents confirmed the availability of the tetanus vaccine in their respective institutions. Finally, the correct rates and Tetanus-immune-globulin (TIG)-only option rates for questions 11-15 were unsatisfactory. Our results showed that most emergency doctors' knowledge and practices strayed from the recommendations of Advisory Committee on Immunization Practices (ACIP): 1) TIG alone for most trauma patients instead of vaccine was an overused treatment approach. 2) Most of the emergency doctors lacked formal training on and knowledge of tetanus vaccination. 3) Even the emergency doctors themselves were not properly vaccinated. 4) The tetanus vaccine was only available in a small number of the respondents' institutions. The findings of this study suggest an urgent need to improve this dire situation.

Logic Gate Functions Built with Nonvolatile Resistive Switching and Thermoresponsive Memory Based on Biologic Proteins.

Logic gate functions built with nonvolatile resistive switching and thermoresponsive memory based on biologic proteins were investigated. The "NAND" and "NOR" functions of logic gates in soya protein devices have been built at room temperature by their nonvolatile ternary WORM resistive switching behaviors. Furthermore, heating the devices from room temperature to 358 K results in a switch from tristable state to bistable state WORM resistive switching behavior, indicating that the thermoresponsiveness can be efficiently memorized. The biologic transient nonvolatile memory device consisting of soya protein is illustrated. This device exhibits a long data retention time (104 s) and significant HRS/LRS ratio (∼105); the transient response of the current to voltage of an as-fabricated device is also explored. The soya protein based memory device on a gelatin film substrate is also assessed to validate the feasibility of degradation and biological compatibility for the implantable biological electronic device, that is, innoxious and avirulent to the human body. This can offer alternative avenues for exploring prospective bioelectronic devices.

A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018.

BACKGROUND: Infective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years. METHODS: Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018. RESULTS: A Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality. CONCLUSIONS: Our study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.