Recurrent and consecutive non-arteritic optic neuropathy in a patient with protein S deficiency

A 50-year-old man with a history of protein S deficiency treated by long-term warfarin presented with right non-arteritic optic neuropathy. Following successful augmentation of warfarin to minimise the effect of thrombophilia, he had a recurrence in the right eye and involvement of the left eye 11 days after the initial onset. Further investigation showed a marginal blood lipid profile, which was treated with lipid-lowering agents. A combination of aetiologies was seen in this patient. Other unique factors, such as the short duration to recurrence and involvement of the fellow eye, are discussed.published_or_final_versio

DISCOVERY: A Photo-Identification Data Management System

Session: Monitoring animals and plantspublished_or_final_versio

Evaluation of dose prediction error and optimization convergence error in four-dimensional inverse planning of robotic stereotactic lung radiotherapy

Inverse optimization of robotic stereotactic lung radiotherapy is typically performed using relatively simple dose calculation algorithm on a single instance of breathing geometry. Variations of patient geometry and tissue density during respiration could reduce the dose accuracy of these 3D optimized plans. To quantify the potential benefits of direct four-dimensional (4D) optimization in robotic lung radiosurgery, 4D optimizations using 1) ray-tracing algorithm with equivalent path-length heterogeneity correction (4EPL(opt)), and 2) Monte Carlo (MC) algorithm (4MC(opt)), were performed in 25 patients. The 4EPL(opt) plans were recalculated using MC algorithm (4MC(recal)) to quantify the dose prediction errors (DPEs). Optimization convergence errors (OCEs) were evaluated by comparing the 4MC(recal) and 4MC(opt) dose results. The results were analyzed by dose-volume histogram indices for selected organs. Statistical equivalence tests were performed to determine the clinical significance of the DPEs and OCEs, compared with a 3% tolerance. Statistical equivalence tests indicated that the DPE and the OCE are significant predominately in GTV D98%. The DPEs in V20 of lung, and D2% of cord, trachea, and esophagus are within 1.2%, while the OCEs are within 10.4% in lung V20 and within 3.5% in trachea D2%. The marked DPE and OCE suggest that 4D MC optimization is important to improve the dosimetric accuracy in robotic-based stereotactic body radiotherapy, despite the longer computation time.published_or_final_versio

Secretin facilitates GABA transmission in the cerebellum

Secretin was the first hormone discovered in human history, and yet, its function as a neuropeptide has been overlooked in the past. The recent discovery of the potential use of secretin in treating autistic patients, together with the conflicting reports on its effectiveness, urges an in-depth investigation of this issue. We show here that in the rat cerebellar cortex, mRNAs encoding secretin are localized in the Purkinje cells, whereas those of its receptor are found in both Purkinje cells and GABAergic interneurons. Immunoreactivity for secretin is localized in the soma and dendrites of Purkinje cells. In addition, secretin facilitates evoked, spontaneous, and miniature IPSCs recorded from Purkinje cells. We propose that secretin is released from the somatodendritic region of Purkinje cells and serves as a retrograde messenger modulating GABAergic afferent activity.published_or_final_versio

Comparative analysis of patients with chronic pulmonary aspergillosis and invasive pulmonary aspergillosis: a ten-year retrospective study

Poster Presentation: e-POSTER VIEWING: Mycology: paper no. EV0981postprin

Infection Control Preparedness for Human Infection With Influenza A H7N9 in Hong Kong

Objective. To assess the effectiveness of infection control preparedness for human infection with influenza A H7N9 in Hong Kong Design. A descriptive study of responses to the emergence of influenza A H7N9 Setting. A university-affiliated teaching hospital Participants. Healthcare workers (HCWs) with unprotected exposure (not wearing N95 respirator during aerosol-generating procedure) to a patient with influenza A H7N9 Methods. A bundle approach including active and enhanced surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and extensive contact tracing for HCWs with unprotected exposure was implemented. Seventy HCWs with unprotected exposure to an index case were interviewed especially regarding their patient care activities Results. From April 1, 2013, through May 31, 2014, a total of 126 (0.08%) of 163,456 admitted patients were tested for the H7 gene by reverse transcription-polymerase chain reaction per protocol. Two confirmed cases were identified. Seventy (53.8%) of 130 HCWs had unprotected exposure to an index case, whereas 41 (58.6%) and 58 (82.9%) of 70 HCWs wore surgical masks and practiced hand hygiene after patient care, respectively. Sixteen (22.9%) of 70 HCWs were involved in high-risk patient contacts. More HCWs with high-risk patient contacts received oseltamivir prophylaxis (P= 0.088) and significantly more had paired sera collected for H7 antibody testing (P<0.001). Ten (14.3%) of 70 HCWs developed influenza-like illness during medical surveillance, but none had positive results by reverse transcriptionpolymerase chain reaction. Paired sera was available from 33 of 70 HCWs with unprotected exposure, and none showed seroconversion against H7N9 Conclusions. Despite the delay in airborne precautions implementation, no patient-to-HCW transmission of influenza A H7N9 was demonstrated. © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved.published_or_final_versio

A novel psittacine adenovirus identified during an outbreak of avian chlamydiosis and human psittacosis: zoonosis associated with virus-bacterium coinfection in birds

Chlamydophila psittaci is found worldwide, but is particularly common among psittacine birds in tropical and subtropical regions. While investigating a human psittacosis outbreak that was associated with avian chlamydiosis in Hong Kong, we identified a novel adenovirus in epidemiologically linked Mealy Parrots, which was not present in healthy birds unrelated to the outbreak or in other animals. The novel adenovirus (tentatively named Psittacine adenovirus HKU1) was most closely related to Duck adenovirus A in the Atadenovirus genus. Sequencing showed that the Psittacine adenovirus HKU1 genome consists of 31,735 nucleotides. Comparative genome analysis showed that the Psittacine adenovirus HKU1 genome contains 23 open reading frames (ORFs) with sequence similarity to known adenoviral genes, and six additional ORFs at the 3′ end of the genome. Similar to Duck adenovirus A, the novel adenovirus lacks LH1, LH2 and LH3, which distinguishes it from other viruses in the Atadenovirus genus. Notably, fiber-2 protein, which is present in Aviadenovirus but not Atadenovirus, is also present in Psittacine adenovirus HKU1. Psittacine adenovirus HKU1 had pairwise amino acid sequence identities of 50.3–54.0% for the DNA polymerase, 64.6–70.7% for the penton protein, and 66.1–74.0% for the hexon protein with other Atadenovirus. The C. psittaci bacterial load was positively correlated with adenovirus viral load in the lung. Immunostaining for fiber protein expression was positive in lung and liver tissue cells of affected parrots, confirming active viral replication. No other viruses were found. This is the first documentation of an adenovirus-C. psittaci co-infection in an avian species that was associated with a human outbreak of psittacosis. Viral-bacterial co-infection often increases disease severity in both humans and animals. The role of viral-bacterial co-infection in animal-to-human transmission of infectious agents has not received sufficient attention and should be emphasized in the investigation of disease outbreaks in human and animals. © 2014 To et al.published_or_final_versio

Emergence of Carbapenem-Resistant Acinetobacter baumannii in Nursing Homes With High Background Rates of MRSA Colonization

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Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature

Background: Prolonged asymptomatic carriage of vancomycin-resistant enterococci (VRE) in the gastrointestinal tract and the lack of effective decolonization regimen perpetuate the endemicity of VRE in the healthcare settings.Case presentation: We report a regimen for decolonization of gastrointestinal carriage of VRE by a combination of environmental disinfection, patient isolation, bowel preparation to wash-out the fecal bacterial population using polyethylene glycol, a five-day course of oral absorbable linezolid and non-absorbable daptomycin to suppress any remaining VRE, and subsequent oral Lactobacillus rhamnosus GG to maintain the colonization resistance in four patients, including two patients with end-stage liver cirrhosis, one patient with complication post liver transplant, and one patient with complicated infective endocarditis. All patients had clearance of VRE immediately after decolonization, and 3 of them remained VRE-free for 23 to 137 days of hospitalization, despite subsequent use of intravenous broad-spectrum antibiotics without anti-VRE activity.Conclusion: This strategy should be further studied in settings of low VRE endemicity with limited isolation facilities. © 2014 Cheng et al.; licensee BioMed Central Ltd.published_or_final_versio

Minimal intervention for controlling nosocomial transmission of Methicillin-Resistant Staphylococcus aureus in resource limited setting with high endemicity

Objective: To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity. Methods: Three phases of infection control interventions were implemented in a University-affiliated hospital between 1- January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per- 1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored. Results: During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospitalacquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000- MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3). Conclusions: Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broadspectrum antibiotics. © 2014 Cheng et al.published_or_final_versio