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1.
Medicine (Baltimore) ; 99(6): e19069, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028430

RESUMO

Nutritional assessment is feasible with computed tomography anthropometry. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, especially sarcopenia. However, studies on nutritional assessment of the brain using computed tomography are still scarce. This study aimed to investigate the applicability of the masseter muscle as a nutritional biomarker.Patients who underwent simultaneous brain and abdominopelvic computed tomography in the emergency department was retrospectively analyzed. We assessed their masseter muscle 2 cm below the zygomatic arch and abdominal muscle at L3 via computed tomography anthropometry. The skeletal muscle index, prognostic nutritional index, and other nutritional biomarkers were assessed for sarcopenia using the receiver operating characteristic curve analysis.A total of 314 patients (240 men and 72 women) were analyzed (mean age, 50.24 years; mean areas of the masseter and abdominal muscles, 1039.6 and 13478.3 mm, respectively). Masseter muscle areas significantly differed in sarcopenic, obese, and geriatric patients (P < .001). The areas under the curve of the masseter muscle in sarcopenic, geriatric, and obese patients were 0.663, 0.686, and 0.602, respectively. Multivariable linear regression analysis showed a correlation with the abdominal muscle area, weight, and age.The masseter muscle, analyzed via computed tomography anthropometry, showed a statistically significant association with systemic nutritional biomarkers, and its use as a nutritional biomarker would be feasible.


Assuntos
Músculo Masseter/diagnóstico por imagem , Estado Nutricional , Biomarcadores , Composição Corporal , Feminino , Humanos , Masculino , Músculo Masseter/anatomia & histologia , Pessoa de Meia-Idade , Avaliação Nutricional , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
2.
Clin Infect Dis ; 70(3): 464-473, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30891596

RESUMO

BACKGROUND: Endemic outbreaks of hantaviruses pose a critical public health threat worldwide. Hantaan orthohantavirus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS) in humans. Using comparative genomic analyses of partial and nearly complete sequences of HTNV from humans and rodents, we were able to localize, with limitations, the putative infection locations for HFRS patients. Partial sequences might not reflect precise phylogenetic positions over the whole-genome sequences; finer granularity of rodent sampling reflects more precisely the circulation of strains. METHODS: Five HFRS specimens were collected. Epidemiological surveys were conducted with the patients during hospitalization. We conducted active surveillance at suspected HFRS outbreak areas. We performed multiplex polymerase chain reaction-based next-generation sequencing to obtain the genomic sequence of HTNV from patients and rodents. The phylogeny of human- and rodent-derived HTNV was generated using the maximum likelihood method. For phylogeographic analyses, the tracing of HTNV genomes from HFRS patients was defined on the bases of epidemiological interviews, phylogenetic patterns of the viruses, and geographic locations of HTNV-positive rodents. RESULTS: The phylogeographic analyses demonstrated genetic clusters of HTNV strains from clinical specimens, with HTNV circulating in rodents at suspected sites of patient infections. CONCLUSIONS: This study demonstrates a major shift in molecular epidemiological surveillance of HTNV. Active targeted surveillance was performed at sites of suspected infections, allowing the high-resolution phylogeographic analysis to reveal the site of emergence of HTNV. We posit that this novel approach will make it possible to identify infectious sources, perform disease risk assessment, and implement preparedness against vector-borne viruses.

3.
Sci Rep ; 9(1): 16631, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31719616

RESUMO

Orthohantaviruses, negative-sense single-strand tripartite RNA viruses, are a global public health threat. In humans, orthohantavirus infection causes hemorrhagic fever with renal syndrome or hantavirus cardiopulmonary syndrome. Whole-genome sequencing of the virus helps in identification and characterization of emerging or re-emerging viruses. Next-generation sequencing (NGS) is a potent method to sequence the viral genome, using molecular enrichment methods, from clinical specimens containing low virus titers. Hence, a comparative study on the target enrichment NGS methods is required for whole-genome sequencing of orthohantavirus in clinical samples. In this study, we used the sequence-independent, single-primer amplification, target capture, and amplicon NGS for whole-genome sequencing of Hantaan orthohantavirus (HTNV) from rodent specimens. We analyzed the coverage of the HTNV genome based on the viral RNA copy number, which is quantified by real-time quantitative PCR. Target capture and amplicon NGS demonstrated a high coverage rate of HTNV in Apodemus agrarius lung tissues containing up to 103-104 copies/µL of HTNV RNA. Furthermore, the amplicon NGS showed a 10-fold (102 copies/µL) higher sensitivity than the target capture NGS. This report provides useful insights into target enrichment NGS for whole-genome sequencing of orthohantaviruses without cultivating the viruses.

4.
Transfus Apher Sci ; : 102631, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31585831

RESUMO

BACKGROUND: Massive transfusion protocol (MTP) has been used to provide plasma and packed red blood cells (pRBCs) rapidly. MTP also has been adapted for non-traumatic patients. The effects of hospital-wide MTP implementation on clinical outcomes were reviewed. METHODS: This was a retrospective study of patients who received massive transfusion before and after MTP implementation, between August 2010 and May 2018. Massive transfusion was defined as 10 or more units of pRBCs within 24 h. Recipients of massive transfusion were divided into periods before and after MTP implementation. The 24 -h death rate, thirty-day death rate and several laboratory findings were investigated. RESULTS: Eighty patients whose massive transfusion occurred before MTP implementation and 63 patients whose massive transfusion occurred after MTP implementation were compared. No statistically significant difference was found in 24 -h death rate (15.0% vs. 23.8%, p = 0.181), or 30-day death rate (43.8% vs. 36.5%, p = 0.381). Use of an anti-fibrinolytic agent was more frequent in patients after the MTP implementation (31.3% vs. 55.6%, p = 0.003). A statistically significant difference was found in the lowest body temperature of the two groups during the 24 -h period (34.7 °C vs. 35.6 °C, p < 0.001). Transfusion ratio of plasma to pRBC was numerically improved after the MTP implementation (1:1.91 vs. 1:1.58, p = 0.173). Earlier initiation of pRBC transfusion was achieved after implementation (51 min vs. 40 min, p = 0.042). CONCLUSIONS: MTP implementation showed improved coagulation profiles, but did not show a statistically significant death-rate reduction in non-traumatic patients.

5.
PLoS One ; 14(6): e0218196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167000

RESUMO

[This corrects the article DOI: 10.1371/journal.pone.0211240.].

6.
PLoS One ; 14(1): e0211240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30677085

RESUMO

BACKGROUND: Intensive care unit (ICU) readmission is generally associated with increased hospital stays and increased mortality. However, there are limited data on ICU readmission in critically ill cancer patients. METHOD: We conducted a retrospective cohort study based on the prospective registry of all critically ill cancer patients admitted to the oncology medical ICU between January 2012 and December 2013. After excluding patients who were discharged to another hospital or decided to end-of-life care, we divided the enrolled patients into four groups according to the time period from ICU discharge to unexpected events (ICU readmission or ward death) as follows: no (without ICU readmission or death, n = 456), early (within 2 days, n = 42), intermediate (between 2 and 7 days, n = 64), and late event groups (after 7 days of index ICU discharge, n = 129). The independent risk factors associated with ICU readmission or unexpected death after ICU discharge were also analyzed using multinomial logistic regression model. RESULTS: There were no differences in the reasons for ICU readmission across the groups. ICU mortality did not differ among the groups, but hospital mortality was significantly higher in the late event group than in the early event group. Mechanical ventilation during ICU stay, tachycardia, decreased mental status, and thrombocytopenia on the day of index ICU discharge increased the risk of early ICU readmission or unexpected ward death, while admission through the emergency room and sepsis and respiratory failure as the reasons for index ICU admission were associated with increased risk of late readmission or unexpected ward death. Interestingly, recent chemotherapy within 4 weeks before index ICU admission was inversely associated with the risk of late readmission or unexpected ward death. CONCLUSION: In critically ill cancer patients, patient characteristics predicting ICU readmission or unexpected ward death were different according to the time period between index ICU discharge and the events.


Assuntos
Mortalidade Hospitalar/tendências , Unidades de Terapia Intensiva , Neoplasias/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Idoso , Estudos de Coortes , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Alta do Paciente , Estudos Retrospectivos , Fatores de Risco
7.
Ann Surg Treat Res ; 96(1): 1-7, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30603627

RESUMO

Purpose: A task force appointed by the Korean Society of Acute Care Surgery reviewed previously published guidelines on antibiotic use in patients with abdominal injuries and adapted guidelines for Korea. Methods: Four guidelines were assessed using the Appraisal of Guidelines for Research and Evaluation II instrument. Five topics were considered: indication for antibiotics, time until first antibiotic use, antibiotic therapy duration, appropriate antibiotics, and antibiotic use in abdominal trauma patients with hemorrhagic shock. Results: Patients requiring surgery need preoperative prophylactic antibiotics. Patients who do not require surgery do not need antibiotics. Antibiotics should be administered as soon as possible after injury. In the absence of hollow viscus injury, no additional antibiotic doses are needed. If hollow viscus injury is repaired within 12 hours, antibiotics should be continued for ≤ 24 hours. If hollow viscus injury is repaired after 12 hours, antibiotics should be limited to 7 days. Antibiotics can be administered for ≥7 days if hollow viscus injury is incompletely repaired or clinical signs persist. Broad-spectrum aerobic and anaerobic coverage antibiotics are preferred as the initial antibiotics. Second-generation cephalosporins are the recommended initial antibiotics. Third-generation cephalosporins are alternative choices. For hemorrhagic shock, the antibiotic dose may be increased twofold or threefold and repeated after transfusion of every 10 units of blood until there is no further blood loss. Conclusion: Although this guideline was drafted through adaptation of other guidelines, it may be meaningful in that it provides a consensus on the use of antibiotics in abdominal trauma patients in Korea.

8.
Medicine (Baltimore) ; 97(49): e13150, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30544375

RESUMO

Benign paroxysmal positional vertigo (BPPV) is a comorbid condition prevalent in patients recovering from trauma. Due to the paucity of studies investigating the etiology of this condition, the present study sought to analyze the high-risk group of BPPV patients following trauma.Trauma patients visiting the emergency department from January to December 2016 were enrolled. The study excluded patients with minor superficial injuries, those who were dead, and those discharged within 2 days after their visit. The medical records were reviewed, and every abbreviated injury score, injury severity score, and other clinical characteristics, such as age and sex, were gathered. A diagnosis of BPPV was reached only after a provocation test was administered by an otolaryngologist. The correlation was statistically analyzed.A total of 2219 trauma patients were analyzed. The mean age of the patients was 52.6 years, and the mean injury severity score (ISS) was 7.9. About 70% of the patients were men. Additional BPPV patients were identified among patients with injuries to head and neck, chest, and abdomen, and those with external injuries. However, patients with head and neck (odds ratio [OR] (95% confidence interval [CI]) = 10.556 (1.029-108.262), and abdominal injury (OR [95% CI] = 78.576 [1.263-4888.523]) showed statistically significant correlation with BPPV in the logistic regression analysis. Patients-not only those with head and neck injuries but those with abdominal injuries-who complain of dizziness need to be evaluated for BPPV using provocation tests. Further studies investigating traumatic BPPV are needed.


Assuntos
Vertigem Posicional Paroxística Benigna/complicações , Vertigem Posicional Paroxística Benigna/epidemiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
9.
PLoS One ; 13(3): e0192841, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29570715

RESUMO

Delirium is a common complication of vascular surgery. The protective effect of preoperative statins on delirium after vascular surgery is controversial. The authors hypothesized that preoperative statin administration would decrease the incidence of delirium after vascular surgery. From May 2010 to May 2015, 1,132 patients underwent vascular surgery. Postoperative delirium was diagnosed from patients' medical records. The incidence of delirium was 11.5%. The preoperative statin exposure was not associated with reduced delirium in the univariate analysis. After adjusting for covariates, preoperative statin exposure was associated with reduced delirium (OR, 0.54; 95% CI, 0.33-0.87; p = 0.011). This favor effect of statin for delirium was observed after propensity matching (OR, 0.59; 95% CI, 0.34-1.02; p = 0.060). However, the median hospital lengths of stay and in-hospital mortality were not statistically different between the two groups. CRP(C-reactive protein) levels in the unmatched population were lower in the preoperative statin group compared with the other group (p<0.001), however, there was only numerically different without statistical difference after matching (p = 0.083). Preoperative statin use was associated with a decreased incidence of postoperative delirium in patients who underwent vascular surgery. However, preoperative statin did not reduce mortality rate and hospital stay.


Assuntos
Delírio/mortalidade , Delírio/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Idoso , Proteína C-Reativa/metabolismo , Delírio/sangue , Delírio/etiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Estudos Retrospectivos
10.
Front Immunol ; 9: 55, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29434590

RESUMO

Short-chain fatty acids (SCFAs), such as acetate, butyrate, and propionate, modulate immune responses in the gut. However, the effect of SCFAs on mucosal vaccine-induced immune cell migration is poorly understood. Here, we investigated whether SCFAs modulate chemokine expression induced by the killed whole-cell oral cholera vaccine, Shanchol™, in human intestinal epithelial cells. Shanchol™ induced expression of CCL2, CCL5, CCL20, and CXCL10 at the mRNA level, but not at the protein level. Interestingly, CCL20 secretion was substantially increased by co-stimulation with Shanchol™ and butyrate, while neither acetate nor propionate showed such effect. Enhanced CCL20 secretion was associated with GPR109A activation, and histone deacetylase (HDAC) inhibition. In addition, co-treatment with Shanchol™ and butyrate synergistically increased the secretion of adenosine triphosphate (ATP). Moreover, CCL20 secretion was decreased by inhibiting the extracellular ATP receptor P2X7. However, neither inflammasomes nor caspases were involved in CCL20 production. The culture supernatant of cells treated with Shanchol™ and butyrate augmented human immature dendritic cell migration. Collectively, these results suggest that butyrate enhances Shanchol™-induced CCL20 production in human intestinal epithelial cells via HDAC inhibition and ATP-P2X7 signaling by activating GPR109A. These effects potentially enhance the mucosal immune responses in the gut induced by this oral cholera vaccine.


Assuntos
Butiratos/metabolismo , Quimiocina CCL20/biossíntese , Vacinas contra Cólera/imunologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/metabolismo , Vacinas de Produtos Inativados/imunologia , Trifosfato de Adenosina/metabolismo , Administração Oral , Linhagem Celular Tumoral , Quimiotaxia/imunologia , Cólera/imunologia , Cólera/metabolismo , Cólera/prevenção & controle , Vacinas contra Cólera/administração & dosagem , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/imunologia , Células Dendríticas/metabolismo , Ácidos Graxos Voláteis/metabolismo , Inibidores de Histona Desacetilases/farmacologia , Humanos , Mucosa Intestinal/efeitos dos fármacos , Modelos Biológicos , RNA Mensageiro/genética , Receptores Purinérgicos P2X7/metabolismo , Transdução de Sinais , Vacinas de Produtos Inativados/administração & dosagem , Vibrio cholerae/imunologia
11.
Emerg Infect Dis ; 24(2): 249-257, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29350137

RESUMO

Seoul virus (SEOV) poses a worldwide public health threat. This virus, which is harbored by Rattus norvegicus and R. rattus rats, is the causative agent of hemorrhagic fever with renal syndrome (HFRS) in humans, which has been reported in Asia, Europe, the Americas, and Africa. Defining SEOV genome sequences plays a critical role in development of preventive and therapeutic strategies against the unique worldwide hantavirus. We applied multiplex PCR-based next-generation sequencing to obtain SEOV genome sequences from clinical and reservoir host specimens. Epidemiologic surveillance of R. norvegicus rats in South Korea during 2000-2016 demonstrated that the serologic prevalence of enzootic SEOV infections was not significant on the basis of sex, weight (age), and season. Viral loads of SEOV in rats showed wide dissemination in tissues and dynamic circulation among populations. Phylogenetic analyses showed the global diversity of SEOV and possible genomic configuration of genetic exchanges.


Assuntos
Variação Genética , Febre Hemorrágica com Síndrome Renal/virologia , Reação em Cadeia da Polimerase Multiplex , Vírus Seoul/genética , Animais , Genoma Viral , Saúde Global , Febre Hemorrágica com Síndrome Renal/epidemiologia , Humanos , Filogeografia , RNA Viral/genética , Ratos , República da Coreia/epidemiologia , Estudos Retrospectivos , Estações do Ano , Testes Sorológicos
12.
Virus Genes ; 53(6): 918-921, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28795266

RESUMO

Zika virus (ZIKV) (genus Flavivirus, family Flaviviridae) is an emerging pathogen associated with microcephaly and Guillain-Barré syndrome. The rapid spread of ZIKV disease in over 60 countries and the large numbers of travel-associated cases have caused worldwide concern. Thus, intensified surveillance of cases among immigrants and tourists from ZIKV-endemic areas is important for disease control and prevention. In this study, using Next Generation Sequencing, we reported the first whole-genome sequence of ZIKV strain AFMC-U, amplified from the urine of a traveler returning to Korea from the Philippines. Phylogenetic analysis showed geographic-specific clustering. Our results underscore the importance of examining urine in the diagnosis of ZIKV infection.


Assuntos
Infecção por Zika virus/virologia , Humanos , Filipinas , Filogenia , República da Coreia , Viagem , Sequenciamento Completo do Genoma/métodos , Zika virus/genética
13.
Emerg Infect Dis ; 23(6): 1016-1020, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28518038

RESUMO

An outbreak of febrile respiratory illness associated with human adenovirus (HAdV) occurred in the South Korea military during the 2014-15 influenza season and thereafter. Molecular typing and phylogenetic analysis of patient samples identified HAdV type 55 as the causative agent. Emergence of this novel HAdV necessitates continued surveillance in military and civilian populations.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Adenovírus Humanos/genética , Surtos de Doenças , Genes Virais , Infecções Respiratórias/epidemiologia , Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/classificação , Adenovírus Humanos/isolamento & purificação , Adulto , Humanos , Militares , Tipagem Molecular , Filogenia , República da Coreia/epidemiologia , Infecções Respiratórias/virologia , Estações do Ano
14.
PLoS One ; 12(4): e0176143, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28423065

RESUMO

BACKGROUND: Obesity might be associated with disturbance of cannulation in situation of extracorporeal cardiopulmonary resuscitation (ECPR). However, limited data are available on obesity in the setting of ECPR. Therefore, we investigated the association between body mass index (BMI) and clinical outcome in patients underwent ECPR. METHODS: From January 2004 to December 2013, in-hospital cardiac arrest patients who had ECPR were enrolled from a single-center registry. We divided patients into four group according to BMI defined with the WHO classification (underweight, BMI < 18.5, n = 14; normal weight, BMI = 18.5-24.9, n = 118; overweight, BMI = 25.0-29.9, n = 53; obese, BMI ≥ 30, n = 15). The primary outcome was survival to hospital discharge. RESULTS: Analysis was carried out for a total of 200 adult patients (39.5% females). Their median BMI was 23.20 (interquartile range, 20.93-25.80). The rate of survival to hospital discharge was 31.0%. There was no significant difference in survival to hospital discharge among the four groups (underweight, 35.7%; normal, 31.4%; overweight, 30.2%; obese, 26.7%, p = 0.958). Neurologic outcomes (p = 0.85) and procedural complications (p = 0.40) were not significantly different among the four groups either. SOFA score, initial arrest rhythm, and CPR to extracorporeal membrane oxygenation (ECMO) pump on time were significant predictors for survival to discharge, but not BMI. CONCLUSION: BMI was not associated with in-hospital mortality who underwent ECPR. Neurologic outcomes at discharge or procedural complications following ECPR were not related with BMI either.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea , Parada Cardíaca/diagnóstico , Obesidade/diagnóstico , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/mortalidade , Parada Cardíaca/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/mortalidade , Obesidade/cirurgia , Alta do Paciente/estatística & dados numéricos , República da Coreia , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
15.
Eur Spine J ; 26(9): 2333-2339, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28447274

RESUMO

PURPOSE: In patients with cervical spinal cord injury (CSCI), respiratory compromise and the need for tracheostomy are common. The purpose of this study was to identify common risk factors for tracheostomy following traumatic CSCI and develop a decision tree for tracheostomy in traumatic CSCI patients without pulmonary function test. METHODS: Data of 105 trauma patients with CSCI admitted in our institution from April, 2008 to February, 2014 were retrospectively analyzed. Patients who underwent tracheostomy were compared to those who did not. Stepwise logistic regression analysis and classification and regression tree model were used to predict the risk factors for tracheostomy. RESULTS: Tracheostomy was performed in 20% of patients with traumatic CSCI on median hospital day 4. Patients who underwent tracheostomy tended to be more severely injured (higher Injury Severity Score, lower Glasgow Coma Score, and lower systolic blood pressure on admission) which required more frequent intubation in the emergency room (ER) with a higher rate of complete CSCI compared to those who did not. Upon multiple logistic analysis, Age ≥ 55 years (OR: 6.86, p = 0.037), Car accident (OR: 5.8, p = 0.049), injury above C5 (OR: 28.95, p = 0.009), ISS ≥ 16 (OR: 12.6, p = 0.004), intubation in the ER (OR: 23.87, p = 0.001), and complete CSCI (OR: 62.14, p < 0.001) were significant predictors for the need of tracheostomy after CSCI. These factors can predict whether a new patient needs future tracheostomy with 91.4% accuracy. CONCLUSIONS: Age ≥ 55 years, injury above C5, ISS ≥ 16, Car accident, intubation in the ER, and complete CSCI were independently associated with tracheostomy after CSCI. CART analysis may provide an intuitive decision tree for tracheostomy.


Assuntos
Medula Cervical/lesões , Árvores de Decisões , Traumatismos da Medula Espinal/complicações , Traqueostomia , Acidentes de Trânsito , Adulto , Fatores Etários , Idoso , Vértebras Cervicais/lesões , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco
16.
Appl Environ Microbiol ; 83(9)2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28258144

RESUMO

For a surrogate bacterium to be used in outdoor studies, it is important to consider environmental and human safety and ease of detection. Recently, Bacillus thuringiensis, a popular bioinsecticide bacterium, has been gaining attention as a surrogate bacterium for use in biodefense. In this study, we constructed simulant strains of B. thuringiensis with enhanced characteristics for environmental studies. Through transposon mutagenesis, pigment genes were inserted into the chromosome, producing yellow-colored colonies for easy detection. To prevent persistence of spores in the environment, a genetic circuit was designed to produce a spore without sporulation capability. Two loxP sites were inserted, one on each side of the spo0A gene, which encodes a sporulation master regulator, and a sporulation-dependent Cre expression cassette was inserted into the chromosome. This genetic circuit successfully deleted spo0A during sporulation, producing spores that lacked the spo0A gene. In addition, two major α/ß-type small acid-soluble spore protein (SASP) genes, predicted by synteny analysis, were deleted. The spores of the mutant strain showed increased UV-C sensitivity and quickly lost viability when tested in a solar simulator. When the spores of the mutant strain were administered to the lungs of BALB/c mice, cells were quickly removed from the body, suggesting enhanced in vivo safety. All strains constructed in this study contain no antibiotic resistance markers and all heterologous genes were inserted into the chromosome, which are useful features for simulants to be released into the environment.IMPORTANCEB. thuringiensis has recently been receiving increasing attention as a good spore simulant in biodefense research. However, few studies were done to properly address many important features of B. thuringiensis as a simulant in environmental studies. Since spores can persist in the environment for years after release, environmental contamination is a big problem, especially when genetically engineered strains are used. To solve these problems, we report here the development of B. thuringiensis simulant strains that are capable of forming yellow colonies for easy detection, incapable of forming spores more than once due to a genetic circuit, and lacking in two major SASP genes. The genetic circuit to produce a spore without sporulation capability, together with the deletion of SASP genes, ensures the environmental and human safety of the simulant strains developed in this study. All of these features will allow wider use of B. thuringiensis as a simulant for Bacillus anthracis in environmental release studies.


Assuntos
Bacillus thuringiensis/crescimento & desenvolvimento , Bacillus thuringiensis/genética , Microbiologia Ambiental , Mutagênese Insercional , Recombinação Genética , Esporos Bacterianos/crescimento & desenvolvimento , Esporos Bacterianos/genética , Animais , Elementos de DNA Transponíveis , Modelos Animais de Doenças , Deleção de Genes , Genes Reporter , Infecções por Bactérias Gram-Positivas/imunologia , Infecções por Bactérias Gram-Positivas/microbiologia , Camundongos Endogâmicos BALB C , Viabilidade Microbiana/efeitos da radiação , Pigmentos Biológicos/genética , Pigmentos Biológicos/metabolismo , Raios Ultravioleta , Virulência
17.
Genome Announc ; 5(10)2017 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-28280019

RESUMO

Human adenovirus (HAdV) (genus Mastadenovirus; family Adenoviridae) serotype 55 is a reemerging pathogen associated with acute respiratory disease. Here, we report the complete genome sequence of HAdV-55 strain AFMC 16-0011, isolated from a military recruit, using next-generation sequencing technology.

18.
Asia Pac J Clin Nutr ; 26(1): 27-35, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28049258

RESUMO

BACKGROUND AND OBJECTIVES: The optimal delivery of enteral nutrition (EN) may improve clinical outcomes in critically ill patients; thus, optimal EN protocols should be developed. The purpose of this study was to evaluate the impact of implementing an EN protocol on the improvement of EN practices and on the clinical outcomes of critically ill patients. METHODS AND STUDY DESIGN: This was a retrospective study with prospectively collected data. Multidisciplinary working group developed an evidence-based EN protocol based on an extensive review of literature and existing guidelines. Subjects included patients consecutively admitted to the ICU who received EN for more than 24 hours. EN practices and clinical outcomes were compared before and after implementation of the protocol. RESULTS: A total of 270 patients were included, 134 patients before implementation and 136 after implementation of the protocol. EN was initiated earlier (35.8 vs 87.1 hours, p=0.001) and more patients received EN within 24 hours (59.6% vs 41.0%, p=0.002) after implementation of the protocol. The interval between starting EN and reaching the caloric goal was not different, but more patients reached the caloric goal after implementation (52.2% vs 38.3%, p=0.037). The post-implementation group was given more prokinetics and less parenteral nutrition. The incidences of diarrhea and gastrointestinal bleeding significantly decreased following implementation of the protocol. There was no difference in clinical outcomes including in-hospital mortality and length of hospital and ICU stay. CONCLUSION: The implementation of the EN protocol significantly improved the practices of EN and decreased complications in critically ill patients. Clinical outcomes were not different before and after implementation.


Assuntos
Estado Terminal/terapia , Nutrição Enteral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Cuidados Críticos/métodos , Diarreia/epidemiologia , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Feminino , Hemorragia Gastrointestinal/epidemiologia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Estudos Retrospectivos , Resultado do Tratamento
19.
Am J Trop Med Hyg ; 96(2): 389-394, 2017 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-27895275

RESUMO

Hantaan virus (HTNV), identified in the striped field mouse (Apodemus agrarius), belongs to the genus Hantavirus of the family Bunyaviridae and contains tripartite RNA genomes, small (S), medium (M), and large (L) segments. HTNV is a major causative for hemorrhagic fever with renal syndrome (HFRS) with fatality rates ranging from 1% to 15% in the Republic of Korea (ROK) and China. Defining of HTNV whole-genome sequences and isolation of the infectious particle play a critical role in the characterization and preventive and therapeutic strategies of hantavirus outbreaks. Next-generation sequencing (NGS) provides an advanced tool for massive genomic sequencing of viruses. However, the isolation of viral infectious particles is a huge obstacle to investigate and develop anti-virals for hantaviruses. Here, we report 12 HTNV isolates from lung tissues of the striped field mouse in the highly HFRS-endemic areas. Sequence-independent, single-primer amplification (SISPA) NGS was attempted to recover the genomic sequences of HTNV isolates. The nucleotide sequence of HTNV S, M, and L segments were covered up to 99.4-100%, 97.5-100%, and 95.6-99.8%, respectively, based on the full length of the prototype HTNV 76-118. The whole-genome sequencing of HTNV isolates was accomplished by additional reverse transcription polymerase chain reaction (RT-PCR) and rapid amplification cDNA ends (RACE) PCR. In conclusion, this study will lead to the attempt and usage of SISPA NGS technologies to delineate the whole-genome sequence of hantaviruses, providing a new era of viral genomics for the surveillance, trace, and disease risk management of HFRS incidents.


Assuntos
Variação Genética , Genoma Viral , Vírus Hantaan/genética , Febre Hemorrágica com Síndrome Renal/virologia , Análise de Sequência de DNA , Animais , Sequência de Bases , Primers do DNA , Estudo de Associação Genômica Ampla , Camundongos , Murinae/virologia , Filogenia , República da Coreia
20.
BMC Anesthesiol ; 16(1): 122, 2016 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-27938349

RESUMO

BACKGROUND: It is not rare for a small-bore feeding tube to be inserted incorrectly into the respiratory system in critically ill patients. Thus, monitoring is necessary to prevent respiratory malplacement of the tube. We investigated the utility of capnographic monitoring to prevent respiratory complications due to feeding tube mispositioning in critically ill patients. METHODS: This study was a pre and post-interventional study, including 445 feeding tube placements events studied retrospectively in the medical and surgical intensive care units of the Samsung Medical Center. We compared outcomes between time periods before and after capnographic monitoring and documented any respiratory complications. RESULTS: Feeding tubes were inserted in 275 cases without capnographic monitoring. Capnographic monitoring was performed in 170 cases. Sixteen patients (4%) had respiratory complications of all tube placements. Feeding tube was inserted into the trachea in 11 (2%) patients and for a pneumothorax in five (1%) patients. Fourteen cases of respiratory complications were detected in the control group (14/275, 5%, 10 tracheal insertions and four pneumothoraxes). Two respiratory complications were detected in the capnographic monitoring group (2/170, 1%, one tracheal insertion and one pneumothorax). Respiratory complications were detected less frequently in the capnographic monitoring group than that in the control group (P = 0.035). CONCLUSIONS: Capnographic monitoring is simple, easy to learn, and may be useful to prevent respiratory complications when placing a feeding tube in a critically ill patient.


Assuntos
Capnografia , Estado Terminal , Nutrição Enteral/efeitos adversos , Intubação Gastrointestinal/métodos , Lesão Pulmonar/prevenção & controle , Monitorização Fisiológica , Idoso , Feminino , Humanos , Intubação Gastrointestinal/efeitos adversos , Intubação Gastrointestinal/estatística & dados numéricos , Lesão Pulmonar/epidemiologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos
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