Trends in Legionnaires\u27 Disease-Associated Hospitalizations, United States, 2006-2010

Background: Legionella pneumophila is a waterborne cause of both healthcare-associated and community-acquired pneumonia. Legionella pneumophila serogroup 1 is responsible for 80% of infections. There is currently limited published disease burden data on Legionnaires\u27 disease-associated hospitalization in the United States. Methods: In this study, we estimated the annual incidence of Legionnaires\u27 disease-associated hospitalizations in United States and identified demographic, temporal, and regional characteristics of individuals hospitalized for Legionnaires\u27 disease. A retrospective study was conducted using the National Hospital Discharge Survey (NHDS) data from 2006 to 2010. The NHDS is a nationally representative US survey, which includes estimates of inpatient stays in short-stay hospitals in the United States, excluding federal, military, and Veterans Administration hospitals. All discharges assigned with the Legionnaires\u27 disease International Classification of Diseases 9th Clinical Modification discharge diagnostic code (482.84) were included in this study. Results: We observed the annual incidence and number of Legionnaires\u27 disease-associated hospitalizations (per 100 000 population) in the United States by year, age, sex, race, and region. Over a 5-year period, 14 574 individuals experienced Legionnaires\u27 disease-associated hospitalizations in the United States The annual population-adjusted incidence (per 100 000 population) of Legionnaires\u27 disease-associated hospitalizations was 5.37 (95% confidence interval [CI], 5.12-5.64) in 2006, 7.06 (95% CI, 6.80-7.40) in 2007, 8.77 (95% CI, 8.44-9.11) in 2008, 17.07 (95% CI, 16.62-17.54) in 2009, and 9.66 (95% CI, 9.32-10.01) in 2010. A summer peak of Legionnaires\u27 disease-associated hospitalizations occurred from June through September in 2006, 2007, 2008, and 2010. Conclusions: Legionnaires\u27 disease-associated hospitalizations significantly increased over the 5-year study period. The increasing disease burden of Legionnaires\u27 disease suggests that large segments of the US population are at risk for exposure to this waterborne pathogen

Prognostic significance of new onset ascites in patients with pancreatic cancer

BACKGROUND: The purpose of this study was to determine risk factors for development of malignant ascites and its prognostic significance in patients with pancreatic cancer. METHODS: A prospective database was queried to identify patients with pancreatic cancer who develop ascites. Stage at presentation, size, and location of primary tumor, treatment received and length of survival after onset of ascites were determined. RESULTS: A total of 15 patients were identified. Of which 4 patients (1 stage II, 3 stage III) underwent pancreaticoduodenectomy and manifested with ascites 2, 3, 24 and 47 months after surgery (tumor size 2.9 ± 1.32 cm). All but one of the remaining 11 patients (tumor size 4.4 ± 3.38 cm) presented with metastatic disease, and all developed malignant ascites 9 months after diagnosis, dying 2 months later. Resected patients lived longer before the onset of ascites, but not after. CONCLUSION: Once diagnosed, ascites in pancreatic cancer patients heralds imminent death. Limited survival should be considered when determining the aggressiveness of further intervention

Enhanced Recovery after Surgery in a Single High-Volume Surgical Oncology Unit: Details Matter

Benefits of ERAS protocol have been well documented; however, it is unclear whether the improvement stems from the protocol or shifts in expectations. Interdisciplinary educational seminars were conducted for all health professionals. However, one test surgeon adopted the protocol. 394 patients undergoing elective abdominal surgery from June 2013 to April 2015 with a median age of 63 years were included. The implementation of ERAS protocol resulted in a decrease in the length of stay (LOS) and mortality, whereas the difference in cost was found to be insignificant. For the test surgeon, ERAS was associated with decreased LOS, cost, and mortality. For the control providers, the LOS, cost, mortality, readmission rates, and complications remained similar both before and after the implementation of ERAS. An ERAS protocol on the single high-volume surgical unit decreased the cost, LOS, and mortality

Perforated gastric corpus in a strangulated paraesophageal hernia: a case report

a case repor

The impact of obesity and timely antiviral administration on severe influenza outcomes among hospitalized adults

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141541/1/jmv24946.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141541/2/jmv24946_am.pd

Emerging Role of Immune Checkpoint Blockade in Pancreatic Cancer

Immune checkpoint blockade (ICB) with programmed cell death protein-1(PD-1)/programmed death ligand -1(PD-L1) antibodies has revolutionized the management of several cancers, especially non-small cell lung cancer, melanoma, urothelial, and renal cancer. Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive cancers associated with high morbidity and mortality. Based on available data, it’s obvious that ICB has limited success in PDACs, which can be explained by the low immunogenicity and immunosuppressive tumor microenvironment of these tumors. In this review article, we focus on PD-L1 expression and microsatellite instability (MSI) in PDAC, and their roles as prognostic and predictive markers. We also discuss data supporting combination therapies to augment cancer immunity cycle. Combining anti-PD-1/PD-L1 agents with other modalities such as vaccines, chemotherapy, and radiation could potentially overcome resistance patterns and increase immune responsiveness in PDA

The nitridation of ZnO nanowires

ZnO nanowires (NWs) with diameters of 50 to 250 nm and lengths of several micrometres have been grown by reactive vapour transport via the reaction of Zn with oxygen on 1 nm Au/Si(001) at 550°C under an inert flow of Ar. These exhibited clear peaks in the X-ray diffraction corresponding to the hexagonal wurtzite crystal structure of ZnO and a photoluminescence spectrum with a peak at 3.3 eV corresponding to band edge emission close to 3.2 eV determined from the abrupt onset in the absorption-transmission through ZnO NWs grown on 0.5 nm Au/quartz. We find that the post growth nitridation of ZnO NWs under a steady flow of NH3 at temperatures ≤600°C promotes the formation of a ZnO/Zn3N2 core-shell structure as suggested by the suppression of the peaks related to ZnO and the emergence of new ones corresponding to the cubic crystal structure of Zn3N2 while maintaining their integrity. Higher temperatures lead to the complete elimination of the ZnO NWs. We discuss the effect of nitridation time, flow of NH3, ramp rate and hydrogen on the conversion and propose a mechanism for the nitridation

Viscosity solutions of systems of PDEs with interconnected obstacles and Multi modes switching problems

This paper deals with existence and uniqueness, in viscosity sense, of a solution for a system of m variational partial differential inequalities with inter-connected obstacles. A particular case of this system is the deterministic version of the Verification Theorem of the Markovian optimal m-states switching problem. The switching cost functions are arbitrary. This problem is connected with the valuation of a power plant in the energy market. The main tool is the notion of systems of reflected BSDEs with oblique reflection.Comment: 36 page

Time to Clinical Stability in Patients with Ventilator-Associated Pneumonia due to Methicillin-Resistant Staphylococcus aureus Treated with Linezolid versus Vancomycin: Results from the IMPACT-HAP Study

Background: Time to clinical stability is a well-defined early clinical outcome in hospitalized patients with community-acquired pneumonia, but it has not been evaluated in patients with ventilator-associated pneumonia (VAP). The objective of this study was to compare time to clinical stability in patients with MRSA VAP treated with linezolid versus vancomycin. Methods: This was a secondary analysis of the IMPACT-HAP study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. A patient was considered to reach clinical stability the day that the following four criteria were met: 1) Afebrile for 24 hours, 2) Decrease in WBC \u3e10% or WBC within normal range, 3) Improving of PaO2/FiO2 ratio of \u3e 20%, or PaO2/FiO2 ratio \u3e 250, or extubation, or FiO2 ≤ 30% if extubated, and 4) Systolic blood pressure \u3e90 mmHg. Time to clinical stability for linezolid and vancomycin were compared using the Chi-Squared and Student’s t-tests. Results: A total of 89 patients treated with linezolid and 75 patients treated with vancomycin met study criteria. From the population of linezolid treated patients, 79% reached clinical stability, compared to 75% of the population of vancomycin treated patients (P=0.463). Median time to clinical stability was 6 days (IQR 8) for patients treated with linezolid, versus 7 days (IQR 12) for patients treated with vancomycin (P=0.490). Conclusions: This study failed to demonstrate a statistically significant difference in time to clinical stability in patients with MRSA VAP treated with linezolid or vancomycin. The number of days for patients to reach clinical stability can be used as an early clinical outcome in patients with VAP