Helicobacter pylori Empirical and Tailored Eradication Therapy and Factors Influencing Eradication Rate: a 4-Year Single-Center Study.

BACKGROUND: The Helicobacter pylori eradication rate with standard triple therapy (STT) is continuously decreasing due to clarithromycin resistance. This study aimed to investigate the eradication rate of empirical and tailored therapy and explore various factors affecting this eradication rate using clarithromycin resistance test data for the last 4 years at a single institution in Daegu. METHODS: From August 2018 to July 2021, a total of 1,395 patients diagnosed with H. pylori infection based on rapid urea testing and histology at Keimyung University Dongsan Hospital were retrospectively examined. Participants were classified into the empirical and tailored therapy groups according to the results of the clarithromycin resistance test using the polymerase chain reaction. RESULTS: The overall eradication rate of empirical STT was 72.8%, and the eradication rate by year was 71.6% in 2018, 77.4% in 2019, 70.3% in 2020, and 70.6% in 2021; the differences were not statistically significant (p = 0.173). No significant difference was noted in the eradication rate according to gender, age, type of proton pump inhibitors, and use of probiotics. Significant differences were noted in the eradication rate according to the treat-ment period: 69.7% in the 7-day, 67.3% in the 10-day, and 81.4% in the 14-day group (p = 0.001). The eradication rate with STT was 87.4% in the non-resistant group. In the case of clarithromycin resistance, treatment was mainly with bismuth quadruple therapy (BQT), and the eradication rate was 86.1%. The eradication rate was higher with administration of BQT for 10 days or 14 days than for administration of BQT for 7 days, but with no statistical significance (p = 0.364). CONCLUSIONS: Extending the treatment period of STT helped in improving the eradication rate, and tailored therapy through clarithromycin resistance testing showed superior results when compared to empirical therapy.

Toxocara canis and Fasciola hepatica Co-Infection Leading to Hepatic Abscess: A Case Report.

Toxocariasis is a zoonotic disease caused by ingesting eggs from soil contaminated with Toxocara canis and Toxocara cati, commonly found in feces of infected dogs and cats, leading to a range of clinical symptoms including fever, abdominal pain and gastrointestinal manifestations. Fascioliasis is also a zoonotic disease caused by liver flukes Fasciola hepatica and Fasciola gigantica, which can be contracted through consumption of contaminated water or aquatic plants, leading to various clinical features. Here, we report a case of a 39-year-old woman diagnosed with a liver abscess caused by co-infection of T. canis and F. hepatica, as confirmed by serological tests. Although the existence of a pet dog and an experience of eating raw water dropwort are potential clues for diagnosis, it cannot be determined as the source of infection because the source of infection has not been clearly identified. After administrating albendazole and triclabendazole sequentially, the patient showed improvement in blood test and imaging findings. Clinicians should be aware of parasitic co-infection and take appropriate management.

Performance of digital morphology analyzer Medica EasyCell assistant.

OBJECTIVES: The EasyCell assistant (Medica, Bedford, MA, USA) is one of the state-of-the-art digital morphology analyzers. We explored the performance of EasyCell assistant in comparison with manual microscopic review and Pentra DX Nexus (Horiba ABX Diagnostics, Montpellier, France). METHODS: In a total of 225 samples (100 normal and 125 abnormal samples), white blood cell (WBC) differentials and platelet (PLT) count estimation by EasyCell assistant were compared with the results by manual microscopic review and Pentra DX Nexus. The manual microscopic review was performed according to the Clinical and Laboratory Standards Institute guidelines (H20-A2). RESULTS: WBC differentials between pre-classification by EasyCell assistant and manual counting showed moderate correlations for neutrophils (r=0.58), lymphocytes (r=0.69), and eosinophils (r=0.51) in all samples. After user verification, they showed mostly high to very high correlations for neutrophils (r=0.74), lymphocytes (r=0.78), eosinophils (r=0.88), and other cells (r=0.91). PLT count by EasyCell assistant highly correlated with that by Pentra DX Nexus (r=0.82). CONCLUSIONS: The performance of EasyCell assistant for WBC differentials and PLT count seems to be acceptable even in abnormal samples with improvement after user verification. The EasyCell assistant, with its reliable performance on WBC differentials and PLT count, would help optimize the workflow of hematology laboratories with reduced workload of manual microscopic review.

Parenting in place: Young children's living arrangement and migrants' sleep health in South Africa.

Migration research tends to treat childrearing as a secondary role for migrants. By prioritising the economic objectives of migration, most models present migrants as either delaying childbearing or, if they have young children, not living with them. However, migration has become increasingly feminised, the types of mobility more varied, while the returns to migration remain uncertain at best. At the same time, norms around childrearing are shifting, and the capacity of kin to take care of children may be weakening. In such contexts, migrants may not want to or be able to be separated from their children. Confronting such difficult decisions and their consequences may be reflected in poor sleep health for the migrant parent. We draw on data from the Migration and Health Follow-Up Study (MHFUS) in South Africa to examine the following questions: (i) To what extent is children's coresidence associated with sleep health for migrant parents? (ii) Do effects vary by sex of migrant? and (iii) Do effects vary by location of migrant? Results from propensity score matching confirm that migrants who coreside with all their young children are more likely to experience healthy sleep compared to those who have nonresident or no young children. However, stratified analysis shows that these effects are only significant for women and those not living in Gauteng province. The value of these findings is underscored by the need for research on the well-being of migrant parents who are negotiating multiple agendas in economically precarious and physically insecure destinations.

Performance of digital morphology analyzer Vision Pro on white blood cell differentials.

OBJECTIVES: Vision Pro (West Medica, Perchtoldsdorf, Austria) is a recently developed digital morphology analyzer. We evaluated the performance of Vision Pro on white blood cell (WBC) differentials. METHODS: In a total of 200 peripheral blood smear samples (100 normal and 100 abnormal samples), WBC preclassification and reclassification by Vision Pro were evaluated and compared with manual WBC count, according to the Clinical and Laboratory Standards Institute guidelines (H20-A2). RESULTS: The overall sensitivity was high for normal WBCs and nRBCs (80.1-98.0%). The overall specificity and overall efficiency were high for all cell classes (98.1-100.0% and 97.7-99.9%, respectively). The absolute values of mean differences between Vision Pro and manual count ranged from 0.01 to 1.31. In leukopenic samples, those values ranged from 0.09 to 2.01. For normal WBCs, Vision Pro preclassification and manual count showed moderate or high correlations (r=0.52-0.88) except for basophils (r=0.34); after reclassification, the correlation between Vision Pro and manual count was improved (r=0.36-0.90). CONCLUSIONS: This is the first study that evaluated the performance of Vision Pro on WBC differentials. Vision Pro showed reliable analytical performance on WBC differentials with improvement after reclassification. Vision Pro could help improve laboratory workflow.

Performance of Platelet Counting in Thrombocytopenic Samples: Comparison between Mindray BC-6800Plus and Sysmex XN-9000.

The performance of platelet (PLT) counting in thrombocytopenic samples is crucial for transfusion decisions. We compared PLT counting and its reproducibility between Mindray BC-6800Plus (BC-6800P, Mindray, Shenzhen, China) and Sysmex XN-9000 (XN, Sysmex, Kobe, Japan), especially focused on thrombocytopenic samples. We analyzed the correlation and agreement of PLT-I channels in both analyzers and BC-6800P PLT-O mode and XN PLT-F channel in 516 samples regarding PLT counts. Ten thrombocytopenic samples (≤2.0 × 109/L by XN PLT-F) were measured 10 times to investigate the reproducibility with the desirable precision criterion, 7.6%. The correlation of BC-6800P PLT-I and XN PLT-I was arranged moderate to very high; but the correlation of BC-6800P PLT-O and XN PLT-F was arranged high to very high. Both BC-6800P PLT-I vs. XN PLT-I and BC-6800P PLT-O vs. XN PLT-F showed very good agreement (κ = 0.93 and κ = 0.94). In 41 discordant samples between BC-6800P PLT-O and XN PLT-F at transfusion thresholds, BC-6800P PLT-O showed higher PLT counts than XN-PLT-F, except the one case. BC-6800P PLT-O exceeded the precision criterion in one of 10 samples; but XN PLT-F exceeded it in six of 10 samples. BC-6800P would be a reliable option for PLT counting in thrombocytopenic samples with good reproducibility.

Control of formation of viscoelastic droplets and distribution of nano-inclusions in functional deposition for lithium-sulfur batteries.

The electrospray process produces micro/nanodroplets for various applications such as thin and uniform coatings, drug carriers and mass spectrometry. In this paper, we study the spray processes of viscoelastic jets using simulations and experiments. In discretized modeling, the jet is perturbed with axisymmetric instability and the growth of this instability causes the jet to break into droplets. For the experiments, a solution of polyvinyl alcohol in water is sprayed and is visualized using a high-speed camera. The droplet size distribution is studied from simulations with experiments for three spray cases: electrospray, air spray, and air-controlled electrospray. Our simulations and experiments reveal that the electric field is effective in reducing the droplet size, while air flow offers more jet break-ups and thus a larger number of droplets. As a result, air-controlled electrospray where these two driving forces are synergistically combined leads to a larger number of smaller droplets than electrospray or air spray. Finally, we applied three spray processes to obtain a deposition of sulfur/mesoporous carbon/graphene/polymer binder composites as a lithium sulfur battery cathode and demonstrated that air-controlled electrospray leads to a higher capacity and rate capability than other processes, exhibiting 800 mA h g-1 at 0.5C and 600 mA h g-1 at 2C.

Effective Suppression of the Polysulfide Shuttle Effect in Lithium-Sulfur Batteries by Implementing rGO-PEDOT:PSS-Coated Separators via Air-Controlled Electrospray.

Lithium-sulfur (Li-S) batteries have been earning significant attention because of their high energy density and cost efficiency. Albeit these outstanding qualities, the polysulfide shuttling effect and low electrical conductivity of the sulfur active material in this battery chemistry results in poor cycling performance. In an attempt to overcome these problems, a hybrid structure of poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) and reduced graphene oxide was developed and coated on the surface of a conventional separator using air-controlled electrospray. Implementing these coated separators in Li-S batteries led to lower polarization and stymied the polysulfide shuttling effect through the combining effects of electrostatic, physical, and chemical interactions. Our results reveal that the capacity and rate capacity are drastically improved via coating the separator, leading to more than twice the capacity of over 800 mA h g-1 after 100 cycles at 0.5 C rate, when it is compared to those with the pristine separator. Overall, this hybrid coating material shows great promise in enhancing the current Li-S battery technology.

Performance of automated digital cell imaging analyzer Sysmex DI-60.

BACKGROUND: The Sysmex DI-60 system (DI-60, Sysmex, Kobe, Japan) is a new automated digital cell imaging analyzer. We explored the performance of DI-60 in comparison with Sysmex XN analyzer (XN, Sysmex) and manual count. METHODS: In a total of 276 samples (176 abnormal and 100 normal samples), white blood cell (WBC) differentials, red blood cell (RBC) classification and platelet (PLT) estimation by DI-60 were compared with the results by XN and/or manual count. RBC morphology between pre-classification and verification was compared according to the ICSH grading criteria. The manual count was performed according to the Clinical and Laboratory Standards Institute guidelines (H20-A2). RESULTS: The overall concordance between DI-60 and manual count for WBCs was 86.0%. The agreement between DI-60 pre-classification and verification was excellent (weighted κ=0.963) for WBC five-part differentials. The correlation with manual count was very strong for neutrophils (r=0.955), lymphocytes (r=0.871), immature granulocytes (r=0.820), and blasts (r=0.879). RBC grading showed notable differences between DI-60 and manual counting on the basis of the ICSH grading criteria. Platelet count by DI-60 highly correlated with that by XN (r=0.945). However, DI-60 underestimated platelet counts in samples with marked thrombocytosis. CONCLUSIONS: The performance of DI-60 for WBC differential, RBC classification, and platelet estimation seems to be acceptable even in abnormal samples with improvement after verification. DI-60 would help optimize the workflow in hematology laboratory with reduced manual workload.

Biochemical-immunological hybrid biosensor based on two-dimensional chromatography for on-site sepsis diagnosis.

A hybrid-biosensor system that can simultaneously fulfill the immunoassay for protein markers (e.g., C-reactive protein (CRP) and procalcitonin (PCT)) and the enzyme assay for metabolic substances (e.g., lactate) in the same sepsis-based sample has been devised. Such a challenge was pursued through the installation of an enzyme-reaction zone on the signal pad of the typical immuno-strip for the rapid two-dimensional (2-D)-chromatography test. To minimize the mutual interference in the hybrid assays, a pre-determined membrane site was etched in a pattern and mounted with a biochemical-reaction pad, thereby allowing a loaded sample to enter and then stay in the pad for a colored-signal production over the course of an immunoassay. By employing such a constructed system, a serum sample was analyzed according to the vertical direction flowing along the strip, which supplied lactate to the biochemical-reaction zone and then protein markers to the immunological-binding area that was pre-coated with capture antibodies. Thereafter, the enzyme-signal tracers for the immunoassay and the substrate solution were sequentially furnished using a horizontal path for the tracing of the immune complexes that were formed with CRP or PCT. The color signal that was produced from each assay was detected at a pre-determined time and quantified on a smartphone-based detector. Under the optimal conditions, the dynamic ranges for the analytes covered the respective clinical ranges, and the total coefficient of variation was between 8.6% and 13.3%. The hybrid biosensor further showed a high correlation (R2 > 0.95) with the reference systems for the target markers.

A High-Performance Fluorescence Immunoassay Based on the Relaxation of Quenching, Exemplified by Detection of Cardiac Troponin I.

The intramolecular fluorescence self-quenching phenomenon is a major drawback in developing high-performance fluorometric biosensors which use common fluorophores as signal generators. We propose two strategies involving liberation of the fluorescent molecules by means of enzymatic fragmentation of protein or dehybridization of double-stranded DNA. In the former, bovine serum albumin (BSA) was coupled with the fluorescent BODIPY dye (Red BSA), and then immobilized on a solid surface. When the insolubilized Red BSA was treated with proteinase K (10 units/mL) for 30 min, the fluorescent signal was significantly increased (3.5-fold) compared to the untreated control. In the second case, fluorophore-tagged DNA probes were linked to gold nanoparticles by hybridization with capture DNA strands densely immobilized on the surface. The quenched fluorescence signal was recovered (3.7-fold) by thermal dehybridization, which was induced with light of a specific wavelength (e.g., 530 nm) for less than 1 min. We next applied the Red BSA self-quenching relaxation technique employing enzymatic fragmentation to a high-performance immunoassay of cardiac troponin I (cTnI) in a microtiter plate format. The detection limit was 0.19 ng/mL cTnI, and the fluorescent signal was enhanced approximately 4.1-fold compared with the conventional method of direct measurement of the fluorescent signal from a non-fragmented fluorophore-labeled antibody.

A fluorescent immunosensor for high-sensitivity cardiac troponin I using a spatially-controlled polymeric, nano-scale tracer to prevent quenching.

For detection of high-sensitivity cardiac troponin I (hs-cTnI<0.01ng/mL), signal amplification was attained using a rapid immunosensor with a fluorescently-labeled, polymeric detection antibody. As fluorescent molecules tend to quench when they are less than 10nm apart, a synthetic scheme for the labeled antibody was devised to control the molecular distance and so minimize the quenching effect in a single conjugate unit. To this end, we first performed novel polymerization of fluorophore-coupled streptavidin (FL-SA) with biotinylated detection antibody (b-Ab) in a stepwise manner by adding FL-SA to b-Ab five times sequentially. Relative spatial positions of the fluorophore molecules in the polymer were then distally fixed using di-biotinylated oligonucleotides and passed through a 0.45µm filter to obtain a polymer of uniform size (i.e., ~400nm in diameter). We produced polymeric tracers using two different inexpensive fluorophores, Dylight 650 and Alexa 647, and applied it to the detection of hs-cTnI spiked in human serum using a two-dimensional chromatography-based immunosensor. The tracers showed a limit of detection of 0.002ng/mL for Dylight 650 and 0.007ng/mL for Alexa 647. The standard curves linearized via log-logit transformation exhibited regression lines with correlation coefficients (R(2))>0.97. The total coefficient of variation for the overall standard curve was 3.4±3.3% for the Dylight fluorophore and 5.9±1.5% for the Alexa dye. Such performances were comparable to those of the reference systems employing sophisticated technologies, Pathfast (Mitsubishi, Japan) and i-STAT (Abbott, US), with a strong correlation (R(2)>0.91) for the concentration range <100pg/mL.

Chemiluminometric Immunosensor for High-Sensitivity Cardiac Troponin I Employing a Polymerized Enzyme Conjugate as a Tracer.

To detect high-sensitivity cardiac troponin I (hs-cTnI; <0.01 ng/mL) at points of care, we developed a rapid immunosensor by using horseradish peroxidase polymerized in 20 molecules on average (Poly-HRP) as a tracer conjugated with streptavidin (SA-Poly-HRP). As shown in the conventional system, enhanced sensitivity could be achieved by using a sequential binding scheme for the complex formation to contain the huge molecular tracer. We used a 2-dimensional chromatographic technology to carry out the sequential bindings in cross-flow directions. After the complex formation of antigen-antibody with analyte in a vertical direction, SA-Poly-HRP was horizontally supplied across the membrane strip for additional binding via a biotin-SA linkage. The HRP substrate was subsequently supplied along the same direction to produce a chemiluminometric signal, which was measured by a cooled charge-coupled device. Hs-cTnI analysis was completed in this format within 25 min, and the results showed a high correlation with those of the CentaurXP® reference system (R(2) > 0.99). The detection limit of the rapid immunosensor was 0.003 ± 0.001 ng/mL cTnI, corresponding to a 10-fold improvement compared to results using the plain enzyme tracer. This demonstrated the measurement of hs-cTnI in a much more cost-effective manner compared to the automated versions currently available.