"Primer shot" fractionation with an early treatment break is theoretically superior to consecutive weekday fractionation schemes for early-stage non-small cell lung cancer.

PURPOSE: Radiotherapy is traditionally given in equally spaced weekday fractions. We hypothesize that heterogeneous interfraction intervals can increase radiosensitivity via reoxygenation. Through modeling, we investigate whether this minimizes local failures and toxicity for early-stage non-small cell lung cancer (NSCLC). METHODS: Previously, a tumor dose-response model based on resource competition and cell-cycle-dependent radiosensitivity accurately predicted local failure rates for early-stage NSCLC cohorts. Here, the model mathematically determined non-uniform inter-fraction intervals minimizing local failures at similar normal tissue toxicity risk, i.e., iso-BED3 (iso-NTCP) for fractionation schemes 18Gyx3, 12Gyx4, 10Gyx5, 7.5Gyx8, 5Gyx12, 4Gyx15. Next, we used these optimized schedules to reduce toxicity risk (BED3) while maintaining stable local failures (TCP). RESULTS: Optimal schedules consistently favored a "primer shot" fraction followed by a 2-week break, allowing tumor reoxygenation. Increasing or decreasing the assumed baseline hypoxia extended or shortened this optimal break by up to one week. Fraction sizes of 7.5 Gy and up required a single primer shot, while smaller fractions needed one or two extra fractions for full reoxygenation. The optimized schedules, versus consecutive weekday fractionation, predicted absolute LF reductions of 4.6%-7.4%, except for the already optimal LF rate seen for 18Gyx3. Primer shot schedules could also reduce BED3 at iso-TCP with the biggest improvements for the shortest schedules (94.6Gy reduction for 18Gyx3). CONCLUSION: A validated simulation model clearly supports non-standard "primer shot" fractionation, reducing the impact of hypoxia-induced radioresistance. A limitation of this study is that primer-shot fractionation is outside prior clinical experience and therefore will require clinical studies for definitive testing.

Increased salivary syndecan-1 level is associated with salivary gland function and inflammation in patients with Sjögren's syndrome.

OBJECTIVE: Syndecan-1 (SDC-1), a transmembrane heparin sulphate proteoglycan predominantly expressed on epithelial cells, also exists in a soluble form through ectodomain shedding. SDC-1 expression and shedding may be modulated in the inflammatory milieu of primary Sjögren's syndrome (SS). We investigated SDC-1 expression in minor salivary glands (MSGs) and analysed the association between salivary or plasma levels of SDC-1 and clinical parameters in SS. METHOD: We measured salivary and plasma SDC-1 levels via an enzyme-linked immunosorbent assay and assessed the salivary flow rates (SFRs) in 70 patients with SS and 35 healthy subjects. Disease activity indices, serological markers, salivary gland scintigraphy, and MSG biopsy were evaluated in patients with SS. RESULTS: SDC-1 expression was upregulated on ductal epithelial cells in inflamed salivary glands. Salivary SDC-1 levels in patients significantly exceeded those in healthy subjects [median (interquartile range) 49.0 (20.7-79.1) vs 3.7 (1.7-6.3) ng/mL, p < 0.001] and inversely correlated with SFRs (r = -0.358, p = 0.032) and ejection fractions of the parotid (r = -0.363, p = 0.027) and submandibular (r = -0.485, p = 0.002) glands in salivary gland scintigraphy. Plasma SDC-1 levels were significantly correlated with the EULAR Sjögren's Syndrome Disease Activity Index (r = 0.507, p < 0.001) and EULAR Sjögren's Syndrome Patient Reported Index (r = 0.267, p = 0.033). Focus scores were correlated with salivary SDC-1 levels (r = 0.551, p = 0.004). CONCLUSIONS: Salivary and plasma SDC-1 levels may constitute potential biomarkers for salivary gland function and disease activity, respectively, in SS.

Incidence and Distribution of the Pathogens Causing Central Nervous System Infections at the University Hospital of Korea.

BACKGROUND: The pathogens involved in central nervous system (CNS) infections are various, such as viruses, bacteria, and fungi, so a syndromic approach can be required. In addition, since their rapid and accurate detection is very crucial, molecular diagnostics using cerebrospinal fluid is becoming the emerging standard method. METHODS: The study was conducted retrospectively to identify the incidence and distribution patterns of the pathogens according to gender, age, season, and month and to analyze their codetection from August 2017 to July 2020. It was also conducted to investigate turn-around times (TATs) according to the detection method. The detection methods were FilmArray® Meningitis/Encephalitis (M/E) method (FilmArray), Cepheid® Xpert EV assay (Xpert), and Multiplex PCR method for five species of bacteria. RESULTS: The overall incidence for at least one pathogen was 13.9% (346/2,496). The highest incidence was shown in age group 4 (3 - 6 years), with 27.4%. The detection rates by FilmArray, Xpert, and Multiplex PCR method were 39.8%, 41.7%, and 0.4%, respectively. Enterovirus (EV) showed the highest incidence rate, which accounted for 37.0%. The distribution of the pathogens according to the age groups were the highest in age group 4, with 47.5% (168/354), followed by 27.4% (97/354) in age group 5. Of the ten cases in which bacteria were detected, S. agalactiae accounted for 60.0% (6/10), most of which occurred in age group 1. E. coli K1, L. monocytogenes, and N. meningitidis were not detected. In the viral distribution, EV accounted for the highest proportion in all age groups. The overall proportion of EV accounted for 87.6% (310/354), followed by human parechovirus with 2.8% (10/354). The most commonly detected season was summer, comprising 75.1%. A total of eight cases of co-detection with two pathogens accounted for 1.6% (8/507) in FilmArray. In FilmArray, all TATs were found to be shorter than Xpert. CONCLUSIONS: The information on the incidence and distribution patterns of the pathogens causing CNS infections and their rapid detection are critically important to clinicians in the management of immunocompromised patients, elderly, and children. The expeditious molecular diagnostics for these pathogens would be valuable in medical decisions by clinicians.

Animal Welfare Worldwide, the Opinion of Practicing Veterinarians.

The objective of this study was to investigate the animal welfare issues considered the most important by companion animal veterinarians worldwide. For this purpose, a global survey of several potential animal welfare issues was distributed via SurveyMonkey® in multiple languages. The distribution of survey responses differed by region. The main animal welfare concern reported worldwide was obesity, although there were differences across regions, possibly due to cultural and socioeconomic factors. Anthropomorphism (attributing human qualities or characteristics to an animal) was an issue in western countries but less so in Asia, Africa, and Oceania. There were significant differences between Asia and Europe, Africa, and Oceania in the importance and prevalence of convenience euthanasia. There were also age and sex differences in participant responses, with older veterinarians reporting fewer welfare problems than younger veterinarians, and female veterinarians reporting more welfare issues than their male counterparts.

Incidence and Distribution of Respiratory Microorganisms Causing Acute Respiratory Infections at the University Hospital of Korea.

BACKGROUND: Acute respiratory infection caused by respiratory microorganisms including various kinds of viruses and bacteria is the most common infectious disease. When managing patients, it is crucial to detect these microorganisms rapidly and monitor their occurrence and tendency. Recently, the methods of detecting them have been implemented by molecular diagnostics. The authors intended to investigate their incidence and distribution and identify the significance of the molecular diagnosis for their detection. METHODS: The retrospective study was conducted to investigate the incidence and distribution of respiratory microorganisms according to the age, gender, month, season, and the detection method and to analyze their co-infections from July 2016 to December 2019. In addition, the four types of turn-around time (TAT) for each detec-tion method were also analyzed. RESULTS: The overall incidence for at least one respiratory microorganism was 23.1% (3,645/15,808). The highest incidence was identified in age group 2 (1 - 3 months), 38.5%. The incidence rates by multiplex PCR using Anyplex and Allplex, FilmArray method, and influenza virus (flu) antigen detection test were 44.2% (718/1,625), 63.1% (1,198/1,899), and 14.1% (1,729/12,284), respectively. The overall incidence between male and female patients showed no statistically significant difference (p = 0.980), except for the flu antigen detection test (p = 0.000). Influenza A viruses (flu A) accounted for the highest percentage (34.9%), followed by rhinovirus/enterovirus (20.5%), RSV (12.8%), flu B (8.3%), and adenovirus (7.6%). These microorganisms showed characteristic distribution patterns according to season and month. Flu A and flu B predominated in winter and accounted for an increasing proportion as age increased according to the age groups. The overall co-infection rate was 22.5% (432/1,916). The average TATs of the FilmArray method were significantly much faster than multiplex PCR using Anyplex and Allplex (p = 0.000). CONCLUSIONS: The information on the incidence and distribution of respiratory microorganisms and their expeditious detection are considered critical to the management of the elderly, immunocompromised patients, and children. The rapid molecular-based diagnosis of respiratory infections would be beneficial in medical decision and prevention of their propagation.

A fast and effective alternative to a high-ethanol disinfectant: Low concentrations of fermented ethanol, caprylic acid, and citric acid synergistically eradicate biofilm-embedded methicillin-resistant Staphylococcus aureus.

BACKGROUND: There is a growing need to develop a powerful bactericidal method with low ethanol concentrations due to the frequent ineffectiveness of traditional antibiotics against biofilms and the side effect of a high ethanol concentration. OBJECTIVES: This study aims to develop a novel synergistic technique replacing a high-ethanol disinfectant. METHODS: Low concentrations of fermented ethanol (FE, 10-20%) with naturally derived antimicrobials, citric acid (CTA, 0.5-1.0%) and caprylic acid (CAP, 0.05-0.15%), were examined against a methicillin-resistant S. aureus (MRSA) biofilm formed on silicone coupons (catheter materials). RESULTS: CTA and CAP were identified as effective antimicrobials that exhibited a synergistic interaction with FE. Complete eradication of MRSA biofilms (>7 log reduction) was obtained within 5 min after treatment with 20% FE plus 1.0% CTA and 0.15% CAP at both 22 and 37 °C, while individual treatments with each material showed negligible bactericidal effects (<1 log reduction except 0.15% CAP treatment at 37 °C). No bacteria were recovered from the surface after the combined treatment (five enrichment tests). The developed compounds were able to disinfect surfaces with more than 5 log-reduction within only 1 min at 22 °C. Confocal microscopy images showed that the combination of all three materials resulted in remarkable membrane damage and cell detachment from the silicone surface. DISCUSSON: Application of FE plus CTA and CAP, therefore, can be a valuable decontamination technique for medical devices or can work as a surface disinfectant, reducing the concerns regarding undesirable high ethanol concentrations in disinfectants.

Fluoroquinolone resistance in Haemophilus influenzae from nursing home residents in Taiwan: correlation of MICs and mutations in QRDRs.

AIMS: To study the association between number and positions of mutations with MICs of fluoroquinolone non-susceptible Haemophilus influenzae. METHODS AND RESULTS: More than 40% of 48 H. influenzae isolated from nursing home residents were not susceptible to fluoroquinolone. Amino acid changes in the quinolone resistance determining regions, and correlation with MICs and inhibition zone diameters were analysed. All isolates with reduced susceptibility to fluoroquinolones (MIC ≥0·125 µg ml-1 ) had at least one mutation in gyrA at position 84 and were resistant to nalidixic acid. Compared to isolates with reduced susceptibility, resistant isolates were associated with mutations in gyrA at positions 88 and 134, and in parC at position 88 (P < 0·001). Inhibition zone diameter for nalidixic acid disk ≥23 mm may detect susceptible isolates. CONCLUSIONS: Reduced susceptibility to fluoroquinolones was associated with mutations at position 84 in gyrA. A further increase in fluoroquinolone MIC was associated with mutations in gyrA at positions 88 and 134, and parC at position 88. SIGNIFICANCE AND IMPACT OF THE STUDY: Due to limited resistant H. influenzae strains, prior studies on association between positions of mutations and fluoroquinolone MICs were inconclusive. The comparison of mutations between isolates with susceptibility, reduced susceptibility and high resistance supported the importance of the present study.

Types and Frequencies of Pre-Analytical Errors in the Clinical Laboratory at the University Hospital of Korea.

BACKGROUND: The results of laboratory tests play a critical role in patient management, so the clinical laboratory is obligated to report accurate results. However, the pre-analytical phase, in which human factors are mainly involved, is clearly a vulnerable part of the laboratory process. This study was conducted to investigate and analyze pre-analytical errors. The author intended to reduce these errors by some measures in order to enhance the credibility of the laboratory. METHODS: A retrospective study was conducted to identify the rates and the types and frequencies of pre-analytical errors in the laboratory and analyze them according to the departments of patients, the sections of the laboratory, and the wards of the hospital. The reasons for these errors were persistently identified and analyzed in order to make efforts to reduce the errors. The activities for quality improvement including education and training programs on the phlebotomy teams were also accomplished to reduce these errors. RESULTS: The overall rate of pre-analytical errors was 0.40%. The rate of these errors significantly decreased from 0.44% in 2017 to 0.36% in 2018. In particular, the proportion of improper volume decreased from 46.1% in 2017 to 36.4% in 2018. The most common pre-analytical error was 'improper volume' (41.5%), followed by 'undue clotting' (32.8%). These errors were overwhelmingly more common in inpatients than in outpatients. The rate of these errors was the highest in stat section (1.95%). CONCLUSIONS: Clinical laboratory should make efforts to reduce pre-analytical errors in order to report accurate and expeditious results. Reduction of these errors can be achieved through analyzing and correcting the reasons for them and education and training on the phlebotomy teams and, as a result, the credibility of the laboratory may also be enhanced.

Nanoporous anodic aluminum oxide internalized with gold nanoparticles for on-chip PCR and direct detection by surface-enhanced Raman scattering.

Nanoporous anodic aluminum oxide internalized with gold nanoparticles was utilized as an integrated platform miniaturized for consecutively performing on-chip PCR and downstream detection of the amplified product of a 183 bp eaeA gene fragment from Escherichia coli O157:H7 using surface-enhanced Raman scattering (SERS).

TGF-ß triggers rapid fibrillogenesis via a novel TßRII-dependent fibronectin-trafficking mechanism.

Fibronectin (FN) is a critical regulator of extracellular matrix (ECM) remodeling through its availability and stepwise polymerization for fibrillogenesis. Availability of FN is regulated by its synthesis and turnover, and fibrillogenesis is a multistep, integrin-dependent process essential for cell migration, proliferation, and tissue function. Transforming growth factor ß (TGF-ß) is an established regulator of ECM remodeling via transcriptional control of ECM proteins. Here we show that TGF-ß, through increased FN trafficking in a transcription- and SMAD-independent manner, is a direct and rapid inducer of the fibrillogenesis required for TGF-ß-induced cell migration. Whereas TGF-ß signaling is dispensable for rapid fibrillogenesis, stable interactions between the cytoplasmic domain of the type II TGF-ß receptor (TßRII) and the FN receptor (α5ß1 integrin) are required. We find that, in response to TGF-ß, cell surface-internalized FN is not degraded by the lysosome but instead undergoes recycling and incorporation into fibrils, a process dependent on TßRII. These findings are the first to show direct use of trafficked and recycled FN for fibrillogenesis, with a striking role for TGF-ß in this process. Given the significant physiological consequences associated with FN availability and polymerization, our findings provide new insights into the regulation of fibrillogenesis for cellular homeostasis.

Liquid culture enhances diagnosis of patients with milder forms of non-tuberculous mycobacterial lung disease.

OBJECTIVE: To evaluate the proportion and clinical characteristics of patients with non-tuberculous mycobacteria (NTM) lung disease diagnosed based on positive culture results in liquid medium only. METHODS: We reviewed the medical records of 978 patients diagnosed with NTM lung disease. All clinical samples were cultured in both solid and liquid media. RESULTS: Of the 978 patients, 111 (11.3%) were culture-positive in liquid medium only (liquid culture group), and 867 (88.7%) (solid culture group) on solid medium, regardless of the culture results in liquid medium. At the time of diagnosis, the liquid culture group was less likely than the solid culture group to have haemoptysis (11.7% vs. 20.0%, P = 0.04), positive sputum smear for acid-fast bacilli (14.4% vs. 50.2%, P < 0.001) or the fibrocavitary form of NTM lung disease (3.6% vs. 14.6%, P = 0.001). During the median follow-up period of 28.9 months (interquartile range 19.1-41.6), the proportion of patients requiring antibiotic treatment was lower in the liquid culture group than in the solid culture group (44.1% vs. 61.6%, P < 0.001). CONCLUSIONS: Liquid media culture is helpful in the diagnosis of patients with less severe forms of NTM lung disease.

Empirical combination of a ß-lactam to vancomycin may not improve outcomes of methicillin-susceptible Staphylococcus aureus bacteremia, compared to vancomycin monotherapy.

To evaluate effect of empirical combination of a ß-lactam to vancomycin and vancomycin monotherapy in Staphylococcus aureus bacteremia (MSSA-B), we conducted a retrospective cohort study. Electronic medical records of individuals who were diagnosed with MSSA-B between January 2005 and February 2015 at a tertiary care center were reviewed. Patients were classified into three groups according to empirical antibiotic regimen (BL group, ß-lactam; VAN group, vancomycin; BV group, combination of ß-lactam and vancomycin), and 30-day all-cause mortality of each group was compared. During the study period, 561 patients with MSSA-B were identified. After exclusion of 198 patients (36 with poly-microbial infection, 114 expired within 2 days, and 48 already received parenteral antibiotics) and a matching process, 46 patients for each group were included. Baseline characteristics were similar except for severity and comorbidity scores. The 30-day mortality for all three groups were not significantly different (BL 4.3%, VAN 6.5%, BV 8.7%; P = 0.909). In a multivariate analysis, type of empirical antibiotic regimen was not statistically associated with 30-day all-cause mortality. In comparison with the VAN group, the BV group yielded a HR of 0.579 (95% CI = 0.086-3.890, P = 0.574). Pitt bacteremia score was the only significant factor for mortality. The empirical combination of a ß-lactam to vancomycin was not associated with lower mortality in treating MSSA-B, compared to vancomycin monotherapy.

Thermally robust and biomolecule-friendly room-temperature bonding for the fabrication of elastomer-plastic hybrid microdevices.

Here, we introduce a simple and fast method for bonding a poly(dimethylsiloxane) (PDMS) silicone elastomer to different plastics. In this technique, surface modification and subsequent bonding processes are performed at room temperature. Furthermore, only one chemical is needed, and no surface oxidation step is necessary prior to bonding. This bonding method is particularly suitable for encapsulating biomolecules that are sensitive to external stimuli, such as heat or plasma treatment, and for embedding fracturable materials prior to the bonding step. Microchannel-fabricated PDMS was first oxidized by plasma treatment and reacted with aminosilane by forming strong siloxane bonds (Si-O-Si) at room temperature. Without the surface oxidation of the amine-terminated PDMS and plastic, the two heterogeneous substrates were brought into intimate physical contact and left at room temperature. Subsequently, aminolysis occurred, leading to the generation of a permanent seal via the formation of robust urethane bonds after only 5 min of assembling. Using this method, large-area (10 × 10 cm) bonding was successfully realized. The surface was characterized by contact angle measurements and X-ray photoelectron spectroscopy (XPS) analyses, and the bonding strength was analyzed by performing peel, delamination, leak, and burst tests. The bond strength of the PDMS-polycarbonate (PC) assembly was approximately 409 ± 6.6 kPa, and the assembly withstood the injection of a tremendous amount of liquid with the per-minute injection volume exceeding 2000 times its total internal volume. The thermal stability of the bonded microdevice was confirmed by performing a chamber-type multiplex polymerase chain reaction (PCR) of two major foodborne pathogens - Escherichia coli O157:H7 and Salmonella typhimurium - and assessing the possibility for on-site direct detection of PCR amplicons. This bonding method demonstrated high potential for the stable construction of closed microfluidic systems socketed with biomolecule-immobilized surfaces such as DNA, antibody, enzyme, peptide, and protein microarrays.

Sequence type 72 community-associated meticillin-resistant Staphylococcus aureus emerged as a predominant clone of nasal colonization in newly admitted patients.

Current knowledge of community-associated (CA) meticillin-resistant Staphylococcus aureus (MRSA) carriage in hospitalized patients is incomplete. Genotypic characteristics of 637 nasal MRSA isolates from newly admitted patients in South Korea were investigated. Sequence type (ST) 72 accounted for 52.1%, 46.3%, and 52.8% of the isolates during the periods of 2007-2008, 2009-2010, and 2013-2014, respectively. Instead of classic MRSA clones responsible for healthcare-associated infections, including ST5 and ST239, MRSA with community genotype ST72 was the predominant strain in newly admitted patients regardless of age and home province of the patients. Active strategies are needed to prevent healthcare-associated infection by CA-MRSA.

Changes in the Microbial Composition of Microbrewed Beer during the Process in the Actual Manufacturing Line.

This study investigated changes in the microbial composition of microbrewed beer during the manufacturing processes and identified potential microbial hazards, effective critical quality control points, and potential contamination routes. Comprehensive quantitative (aerobic plate count, lactic acid bacteria, fungi, acetic acid bacteria, coliforms, and Bacillus cereus) and qualitative (Escherichia coli and eight foodborne pathogens) microbiological analyses were performed using samples of raw materials (malt and manufacturing water), semiprocessed products (saccharified wort, boiled wort, and samples taken during the fermentation and maturation process), and the final product obtained from three plants. The initial aerobic plate count and lactic acid bacteria counts in malt were 5.2 and 4.3 log CFU/g, respectively. These counts were reduced to undetectable levels by boiling but were present at 2.9 and 0.9 log CFU/ml in the final product. Fungi were initially present at 3.6 log CFU/g, although again, the microbes were eliminated by boiling; however, the level in the final product was 4.6 log CFU/ml. No E. coli or foodborne pathogens (except B. cereus) were detected. B. cereus was detected at all stages, although it was not present in the water or boiled wort (total detection rate » 16.4%). Results suggest that boiling of the wort is an effective microbial control measure, but careful management of raw materials and implementation of effective control measures after boiling are needed to prevent contamination of the product after the boiling step. The results of this study may constitute useful and comprehensive information regarding the microbiological quality of microbrewed beer.

Optimization of low-temperature blanching combined with calcium treatment to inactivate Escherichia coli O157:H7 on fresh-cut spinach.

AIMS: To develop a mild blanching method with calcium salts to ensure microbiological safety and quality of fresh-cut spinach. METHODS AND RESULTS: The antimicrobial efficacy of eight calcium salts was evaluated on Escherichia coli O157:H7 at 45-65°C and calcium hydroxide (Ca(OH)2 ) showed the greatest synergistic antimicrobial effect with heat. Combinations of low temperature treatments (45, 55, 65°C), time (20, 40, 60 s) and Ca(OH)2 (0·25, 0·50, 0·75%) were applied for E. coli O157:H7 disinfection on fresh-cut spinach to develop a predictive model using a Box-Behnken experimental design. A suitable quadratic model was produced (R(2) = 0·98, P < 0·001) and the optimum condition (64·9°C with 0·52% Ca(OH)2 for 42·4 s) was drawn by reducing 6·6 log CFU g(-1) of E. coli O157:H7 on fresh-cut spinach. Blanching at 61·9°C with 0·52% Ca(OH)2 for 41·7 s can inactivate E. coli O157:H7 on spinach by 5·4 log CFU g(-1) . The new method was comparable to the CDC recommendation for safe spinach cooking (71·1°C, 15 s; 5·0 log CFU g(-1) reduction) with lower levels of weight loss of the spinach (P < 0·05). CONCLUSIONS: This study suggests an efficient spinach blanching method for E. coli O157:H7 disinfection. SIGNIFICANCE AND IMPACT OF THE STUDY: This blanching method will enhance microbiological safety of fresh-cut produce while minimizing the use of energy and chemicals.

Comparison of diagnostic methods for onychomycosis, and proposal of a diagnostic algorithm.

BACKGROUND: Traditionally, the gold standard for diagnosis of onychomycosis has been the combination of direct microscopy with potassium hydroxide (KOH) staining and fungal culture. However, several studies have suggested that periodic-acid-Schiff (PAS) staining of nail-plate clippings may be a very sensitive method for the diagnosis of onychomycosis. AIM: To compare the sensitivities of direct microscopy with KOH, fungal culture and PAS staining of nail-plate clippings, and to define an efficient, high-yield and cost-effective diagnostic strategy for the diagnosis of onychomycosis in the clinical setting. METHODS: We evaluated a total of 493 patients with clinically suspected onychomycosis. Group A comprised 400 patient samples, evaluated using fungal culture and PAS stain, while group B comprised 93 patient samples evaluated using KOH, fungal culture and PAS. Diagnosis of onychomycosis was defined as clinical morphology plus at least one positive test result. RESULTS: In group A, sensitivities of fungal culture and PAS were 49.5% and 93.1% (P < 0.005), respectively. In group B, the most sensitive single test was PAS (88.2%) followed by KOH (55.9%) and fungal culture (29.4%). The combination of fungal culture and PAS (94.1%) was significantly (P < 0.001) more sensitive than that of KOH and culture (72.1%). CONCLUSION: PAS staining of nail clippings is much more sensitive than KOH and fungal culture for the diagnosis of onychomycosis. Based on our results, we propose a diagnostic algorithm for onychomycosis that takes into consideration the sensitivity, cost-effectiveness and necessary time for each test.

Clinical characteristics of Raoultella ornithinolytica bacteremia.

PURPOSE: Raoultella ornithinolytica is not well known as a clinical pathogen. We performed a retrospective review of R. ornithinolytica bacteremia to investigate its clinical features, antimicrobial susceptibility, and overall patient outcomes. METHODS: R. ornithinolytica bacteremia cases were collected from an electronic database of all cases of bacteremia over a 10-year period. Medical records were retrospectively reviewed. Demographic data, clinical information, the presence of underlying comorbidities, the results of antimicrobial susceptibility testing, and the antimicrobial regimen administered were investigated. RESULTS: R. ornithinolytica was isolated from blood culture specimens in 16 cases. The majority of these patients had an underlying malignant condition of advanced stage (15 patients, 94 %). Seven of these patients had a solid tumor with lesions or metastases that extended to the bile duct or biliary tract. Neutropenic fever following hematologic stem cell transplantation was found in three cases. No resistance to piperacillin/tazobactam or imipenem was found. Four cases showed resistance to cefoxitin, while one of these cases showed resistance to multiple cephalosporins. In overall outcomes, seven patients (44 %) did not recover from the infection and subsequently expired. CONCLUSIONS: R. ornithinolytica bacteremia occurs mainly in patients with underlying malignancies. The overall outcome was not favorable, despite favorable antimicrobial susceptibility test results. The findings of this study contradict those of other studies that demonstrated that infection from Raoultella species have good prognoses.

Low virulence? Clinical characteristics of Raoultella planticola bacteremia.

PURPOSE: Numerous case reports regarding Raoultella planticola infection have accumulated in the literature; however, its significance as a clinical pathogen remains unknown. We performed a retrospective review of R. planticola bacteremia to characterize its clinical features, antimicrobial susceptibility, and patient outcome. METHODS: Raoultella planticola bacteremia cases were culled from an electronic database of all bacteremia cases occurring over a 4-year-period. Medical records were retrospectively reviewed and demographic data, clinical findings, presence of underlying disease, results of antimicrobial susceptibility testing, and the antibiotic regimens administered during the treatment were evaluated. RESULTS: Raoultella planticola was isolated from blood culture specimens in 20 cases. The majority of these patients had underlying malignant conditions (17 patients, 85%). The most prevalent causes of malignancy were adenocarcinoma involving the gallbladder or bile duct (7 patients) and hematologic malignancies (6 patients). No cases with resistance to carbapenem or third generation cephalosporins were found. All 14 patients with R. planticola as the sole microbial isolate recovered with the use of empirical antibiotics. Of the six patients with polymicrobial infection, three did not recover and subsequently expired. CONCLUSIONS: Raoultella planticola bacteremia seemed to occur mainly in immunocompromised patients, and was also frequently found in patients with lesions involving the gallbladder or bile duct. The overall outcome was favorable when R. planticola was treated with administration of empirical antibiotics. Mixed outcomes were found when blood cultures yielded multiple species of microbes.

Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer.

Cytomegalovirus (CMV) gastrointestinal (GI) disease has been noticed frequently in cancer patients, causing abdominal pain, diarrhea, and GI bleeding. However, little is known about its actual incidence, clinical presentation, and the risk factors for its development among cancer patients. To answer these questions, we analyzed all cases that occurred during an 18-year period at our center. A case-control study was performed to identify risk factors for CMV GI disease. Electronic medical records were reviewed from individuals who were admitted and diagnosed with CMV GI disease during the period of January 1995 through March 2013 at a tertiary care center. Two CMV disease-free cancer patients were matched as controls. A total of 98 episodes of CMV GI disease were included in this study, and the overall incidence rate was 52.5 per 100,000 cancer patients, with an increasing trend throughout the study period. According to multivariate analysis, male sex, low body mass index, lymphopenia, hematological malignancy, and steroid use and red blood cell transfusion within 1 month prior to the CMV disease were identified to be independent risk factors. Among these factors, RBC transfusion showed the highest odds ratio (OR = 5.09). Male sex, low body mass index, lymphopenia, hematological malignancy, steroid use, and red blood cell transfusion within 1 month prior to the CMV disease diagnosis were independent risk factors for the development of CMV GI disease in adult patients with cancer.