Clostridium difficile cytotoxin B in adults with diarrhea: a comparison of patients treated or not treated with antibiotics prior to infection

AbstractDepartments of Medicine and Immunology Microbiology, Pathology and Infectious Diseases, Karolinska Institute, Huddinge University Hospital, Huddinge, SwedenObjectiveTo study the detection rate of Clostridium difficile cytotoxin B in stool specimens from adults with diarrhea as related to previous antimicrobial treatment.MethodsStool specimens from 802 adult patients with diarrhea and 203 healthy controls were tested for C. dificile cytotoxin B using a cell cytotoxicity assay. Antibiotic susceptibility testing of C. difficile was performed with the E test.ResultsOf 173 patients treated with antimicrobial medication within 5 weeks of onset of diarrhea, 60 (35%) were positive for C. difficile cytotoxin B (group A) compared to only 41 (7%) of 629 untreated patients (group B) and two of the 203 (1%) healthy controls. Compared to patients in group A, patients in group B possessed characteristics not usually connected with C. difficile disease. They were generally younger (median age 40 years vs. 73 years), had been hospitalized less frequently (10% vs. 67%), had more often travelled abroad within the previous 2 weeks (46% vs. 1%), and more often had multiple enteropathogens (41% vs. 3%). Minimal inhibitory concentrations for vancomycin, metronidazole and fucidic acid to C. difficile isolates ranged from 0.5 to 4 mg/L, from 0.125 to 256 mg/L and 0.25 to 4 mg/L, respectively.ConclusionsThe detection rate of C. difficile cytotoxin B in patients with diarrhea, not associated with antibiotic treatment, is comparable to that in healthy control subjects. It probably merely reflects a carrier state without clinical significance

Impact of co-morbidity on mortality after oesophageal cancer surgery

Background: There is limited knowledge of how co-morbidities influence survival after surgery for oesophageal cancer. This population-based cohort study investigated how Charlson co-morbidity index and specific co-morbidities influenced all-cause and disease-specific mortality. Conclusion: Co-morbidity with a Charlson score of 2 or more, previous myocardial infarction and congestive heart failure were associated with increased mortality after oesophageal cancer surgery undertaken with curative intent

Towards operational remote sensing of forest carbon balance across Northern Europe

Monthly averages of ecosystem respiration (ER), gross primary production (GPP) and net ecosystem exchange (NEE) over Scandinavian forest sites were estimated using regression models driven by air temperature (AT), absorbed photosynthetically active radiation (APAR) and vegetation indices. The models were constructed and evaluated using satellite data from Terra/MODIS and measured data collected at seven flux tower sites in northern Europe. Data used for model construction was excluded from the evaluation. Relationships between ground measured variables and the independent variables were investigated. <br><br> It was found that the enhanced vegetation index (EVI) at 250 m resolution was highly noisy for the coniferous sites, and hence, 1 km EVI was used for the analysis. Linear relationships between EVI and the biophysical variables were found: correlation coefficients between EVI and GPP, NEE, and AT ranged from 0.90 to 0.79 for the deciduous data, and from 0.85 to 0.67 for the coniferous data. Due to saturation, there were no linear relationships between normalized difference vegetation index (NDVI) and the ground measured parameters found at any site. APAR correlated better with the parameters in question than the vegetation indices. Modeled GPP and ER were in good agreement with measured values, with more than 90% of the variation in measured GPP and ER being explained by the coniferous models. The site-specific respiration rate at 10°C (<i>R</i><sub>10</sub>) was needed for describing the ER variation between sites. Even though monthly NEE was modeled with less accuracy than GPP, 61% and 75% (dec. and con., respectively) of the variation in the measured time series was explained by the model. These results are important for moving towards operational remote sensing of forest carbon balance across Northern Europe

Optimization and activation of renewable durian husk for biosorption of lead (II) from a aqueous medium

Background: Biosorption of lead Pb(II) by durian husk activated carbon (DHAC) was investigated. The main aim of this work is to explore the effect of operating variables such as pH, biosorbent dose, temperature, initial metal ion concentration and contact time on the removal of Pb(II) from synthesized aqueous medium using a response surface methodology (RSM) technique. The experimentation was performed in two sets, namely set 1 and set 2. Results: For experimental set 1, pH was set to 7.0. The optimum conditions for the remaining parameters were determined to be 0.39 g DHAC dose, 60 min contact time and 100 mg L−1 of initial metal ion concentration, which yielded maximum biosorption capacity of 14.6 mg g−1. For experimental set 2, 41.27 °C, 8.95 and 99.96 mg L−1 were the optimum conditions determined for temperature, pH and initial Pb(II) concentration, respectively; which revealed a maximum adsorption capacity of 9.67 mg g−1. Characterization of the adsorbent revealed active functional groups such as hydroxyl, carboxylic, alcohol and hemicellulose. The equilibrium adsorption data obeyed the Langmuir isotherm and pseudo‐second‐order kinetic models with maximum Langmuir uptake of 36.1 mg g−1. Conclusions: The biosorbent was capable of reuse, so that the abundant durian husk could be utilized effectively for the removal of Pb(II) from polluted water

Results of surgical management of acute thromboembolic lower extremity ischemia

ObjectiveAcute lower extremity ischemia secondary to arterial thromboembolism is a common problem. Contemporary data regarding this problem are sparse. This report examines a 10-year single-center experience and describes the surgical management and outcomes observed.MethodsProcedural codes were used to identify consecutive patients treated surgically for acute lower extremity embolization from January 2002 to September 2012. Patients presenting >7 days after onset of symptoms, occlusion of grafts/stents, and cases secondary to trauma or iatrogenic injury were excluded. Data collected included demographics, medical comorbidities, presenting clinical characteristics, procedural specifics, and postoperative outcomes. Results were evaluated using descriptive statistics, product-limit survival analysis, and logistic regression multivariable modeling.ResultsThe study sample included 170 patients (47% female). Mean age was 69.1 ± 16.0 years. Of these, 82 patients (49%) had a previous history of atrial fibrillation, and four (2%) were therapeutically anticoagulated (international normalized ratio ≥2.0) at presentation. Presentation for 83% was >6 hours after symptom onset, and 9% presented with a concurrent acute stroke. Femoral artery exploration with embolectomy was the most common procedural management and was used for aortic, iliac, and infrainguinal occlusion. Ten patients (6%) required bypass for limb salvage during the initial operation. Local instillation of thrombolytic agents as an adjunct to embolectomy was used in 16%, fasciotomies were performed in 39%, and unexpected return to the operating room occurred in 24%. Ninety-day amputation above or below the knee was required during the index hospitalization in 26 patients (15%). In-hospital or 30-day mortality was 18%. Median (interquartile range) length of stay was 8 days (4, 16 days), and 36% of patients were discharged to a nursing facility. Recurrent extremity embolization occurred in 23 patients (14%) at a median interval of 1.6 months. The 5-year amputation freedom and survival estimates were 80% and 41%, respectively. Predictors of 90-day amputation included prior vascular surgery, gangrene, and fasciotomy. Predictors of 30-day mortality included age, history of coronary artery disease, prior vascular surgery, and concurrent stroke.ConclusionsDespite advances in contemporary medical care, lower extremity arterial embolization remains a condition that is associated with significant morbidity and mortality. Furthermore, the condition is resource-intensive to treat and is likely preventable (initially or in recurrence) in a substantial subset of patients

Orbifold projection in supersymmetric QCD at N_f\leq N_c

Supersymmetric orbifold projection of N=1 SQCD with relatively small number of flavors (not larger than the number of colors) is considered. The purpose is to check whether orbifolding commutes with the infrared limit. On the one hand, one considers the orbifold projection of SQCD and obtains the low-energy description of the resulting theory. On the other hand, one starts with the low-energy effective theory of the original SQCD, and only then perfoms orbifolding. It is shown that at finite N_c the two low-energy theories obtained in these ways are different. However, in the case of stabilized run-away vacuum these two theories are shown to coincide in the large N_c limit. In the case of quantum modified moduli space, topological solitons carrying baryonic charges are present in the orbifolded low-energy theory. These solitons may restore the correspondence between the two theories provided that the soliton mass tends to zero in the large N_c limit.Comment: 10 pages; misprint corrected, reference adde

First identification of excited states in the Tz_z = 1/2 nucleus 93^{93}Pd

The first experimental information about excited states in the N = Z + 1 nucleus 93Pd is presented. The experiment was performed using a 205 MeV 58Ni beam from the Vivitron accelerator at IReS, Strasbourg, impinging on a bismuth-backed 40Ca target. Gamma-rays, neutrons and charged particles emitted in the reactions were detected using the Ge detector array Euroball, the Neutron Wall liquid-scintillator array and the Euclides Si charged-particle detector system. The experimental level scheme is compared with the results of new shell model calculations which predict a coupling scheme with aligned neutron-proton pairs to greatly influence the level structure of $N\approx Z$ nuclei at low excitation energies