Incidence and Outcomes Associated With Clostridium difficile Infections: A Systematic Review and Meta-analysis

Importance: An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. Objective: To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. Data Sources: MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. Study Selection: Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. Data Extraction and Synthesis: Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I2 value. Data analysis was performed in February 2019. Main Outcomes and Measures: Incidence of CDI and CDI-associated hospital LOS in the United States. Results: When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). Conclusions and Relevance: Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions

X-linked hyper-IgM syndrome with CD40LG mutation: Two case reports and literature review in Taiwanese patients

Hyper-IgM syndrome (HIGM) is a rare primary immunodeficiency disorder characterized by elevated or normal serum IgM and decreased IgG, IgA, and IgE due to defective immunoglobulin class switching. X-linked HIGM (XHIGM, HIGM1) is the most frequent type, is caused by mutations in the CD40 ligand gene, and is regarded as a combined T and B immunodeficiency. We report an 18-year-old male who was diagnosed initially with hypogammaglobulinemia in infancy, but developed repeated pneumonia, sepsis, cellulitis, perianal abscess, pericarditis, and bronchiectasis despite regular intravenous immunoglobulin replacement therapy. The patient died at age 18 years due to pneumonia and tension pneumothorax. Mutation analysis revealed CD40L gene mutation within Exon 5 at nucleotide position 476 (cDNA 476G > A). This nonsense mutation predicted a tryptophan codon (TGG) change to a stop codon (TGA) at position 140 (W140X), preventing CD40L protein expression. Sequence analysis in the family confirmed a de novo mutation. The second case of 6-month-old male infant presented as Pneumocystis jiroveci pneumonia and acute respiratory distress syndrome. Gene analysis of the CD40L gene revealed G to C substitution in Intron 4 (c.409 + 5G > C) and mother was a carrier. Hematopoietic stem cell transplantation, the only cure for XHIGM, was arranged in the second case

Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

Information about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more). VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections

Specific requirement of NMDA receptors for long-term memory consolidation in Drosophila ellipsoid body

In humans and many other animals, memory consolidation occurs through multiple temporal phases and usually involves more than one neuroanatomical brain system. Genetic dissection of Pavlovian olfactory learning in Drosophila melanogaster has revealed multiple memory phases, but the predominant view holds that all memory phases occur in mushroom body neurons. Here, we demonstrate an acute requirement for NMDA receptors (NMDARs) outside of the mushroom body during long-term memory (LTM) consolidation. Targeted dsRNA-mediated silencing of Nmdar1 and Nmdar2 (also known as dNR1 or dNR2, respectively) in cholinergic R4m-subtype large-field neurons of the ellipsoid body specifically disrupted LTM consolidation, but not retrieval. Similar silencing of functional NMDARs in the mushroom body disrupted an earlier memory phase, leaving LTM intact. Our results clearly establish an anatomical site outside of the mushroom body involved with LTM consolidation, thus revealing both a distributed brain system subserving olfactory memory formation and the existence of a system-level memory consolidation in Drosophila

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

A Study on the Ancient Flying Fairies of Dunhuang Murals and An Explanation of Artworks About Flying Fairies Which Chiang, Yin-Hsiu Innovated

[[abstract]]The main topics of this thesis include “ the Flying Fairies of Dunhuang ” and “Ancient Classic and Innovation”, which are the creative, thematic objectives of Chiang Yin-Hsiu’s artworks. The Flying Fairies images from the various dynasties of Dunhuang Murals have high value for artistic research. The Flying Fairies are commonly referred to as “Fei Tian” in Mandarin. The 　　　Dunhuang Flying Fairies originated in India and are otherwise known as Gandharva. Dunhuang Murals are bright and splendid legends in the deserts of China! Dunhuang is located in the western end of the Hexi Corridor, and is an important location on the “Silk Road”. It has historically been referred to as “the cosmopolitan area between Chinese and foreigners.” It is where Buddhist culture first came to China, and is where Chinese, Indian, Greek, and Islamic culture converged. Due to its unique historical background, a multicultural society resulted in its colorful uniqueness! The Northern Liang (one of the Sixteen Kingdoms) and the Northern Wei periods employed “Buddhist ideology in governance” . They actively dug more grottoes and created additional Buddhist images. The mural paintings of the Dunhuang Caves' mineral colors are still radiant after a thousand years: these murals are infused with diverse aesthetics, and at the height of the Sui and Tang Dynasties. Profound, glamorous, solemn, and heavenly colored art still provides an astounding sight. “Fei Tian”images are full of complex artistic vitality! At least ten dynasties of Dunhuang murals contain images of Flying Fairies and Sky Palace Musicians--the images of these different dynasties are all unique. The research scope of this thesis ranges from the Northern Lian through the Northern Wei, Western Wei, Northern Zhou, to the height of Sui and Tang Dynasties . The research content includes: the origin and meaning of the Flying Fairies (“Fei Tian”); their gender; capabilities; musical instruments and dance. The content additionally includes: stylistic influences; Sinicization; and features of the Dunhuang Flying Fairies during different dynasties. “Ancient, Classic and Innovation”: this involves the collection and analysis of literary data, plus personal experience of the vast beauty of the Silk Road and the Gobi Desert. I have personally entered some of the Mogao Caves and got to stand on the floor with lotus patterns. I sensed the ancient mysterious atmosphere. I was fascinated by the splendor and magnificence of the Dunhuang murals. I saw the Sky Palace Musicians of the Dunhuang murals which were painted in the Northern Wei dynasty . This engendered Remote ancientness : I was moved by the traditional, beautiful and ancient murals and have come to understand the experiences accumulated by the nameless artists over the dynasties. The beauty of the Flying Fairies murals manifests in different ways through Gouache Painting-- (made from mineral pigments with glue) , or colored ink , underglaze , or mixing other media ! Innovation : to understand these artworks of Contemporary ink-wash or colored ink paintings in relation to Contemporary Art theories. We can use Postmodern artistic thought to comprehend the innovations seen in Flying Fairies --“Fei Tian”!

Clinical characteristics and outcomes of primary antibody deficiency: A 20-year follow-up study

Primary antibody deficiency is the most common disorder among primary immunodeficiencies. Recurrent infection and chronic lung change often lead to mortality and morbidity. Methods: This study focused on the clinical presentation, molecular diagnosis, and outcomes of primary antibody deficiency in Taiwan pediatric group. Medical records of patients with primary antibody deficiency during the period 1990–2010 were retrospectively reviewed in one medical center. Results: Among the 34 patients evaluated, X-linked agammaglobulinemia (XLA) (29.4%) and common variable immunodeficiency diseases (CVIDs) (29.4%) were the most common disorders presented with respiratory and skin infections. Some genotype/phenotype discordance was found in one family. Patients with XLA, CVID, and hyper-IgM syndrome without complications had higher trough and initial IgG levels, and shorter delays in diagnosis. Patients with trough IgG levels >700 mg/dL had less occurrence of bronchiectasis. Conclusion: These results summarized clinical manifestations of primary antibody deficiency in pediatric group in Taiwan. Clinicians should strive to shorten delays in diagnosis and maintain higher trough IgG levels to decrease subsequent mortality and morbidity

In Vitro and In Vivo Studies on Protective Action of N-Phenethyl Caffeamide against Photodamage of Skin.

In our previous study, N-phenethyl caffeamide (K36) was proved to act as an antioxidant and an antiphotoaging agent by inhibiting type I procollagen degradation and stimulating collagen synthesis in human skin fibroblasts. In the present study, in vitro and in vivo experiments were conducted to investigate the mechanism of action and the antiinflammatory and antiphotoaging activity of K36. K36 reduced UVB-induced cyclooxygenase-2 (COX-2) and inducible nitric oxide synthases (iNOS) expression by regulating IκB and p-IκB expression. K36 also inhibited the nuclear translocation of NF-κB. Furthermore, the inhibition of mitogen-activated protein (MAP) kinases by K36 was attributed to the downregulation of COX-2. Topically applying K36 led to efficient antiwrinkle formation and reduced UVB-induced erythema and thickness of epidermis in hairless mice. In addition, K36 penetrated into the skin of hairless mice. Our findings show that K36 has significant beneficial effects on antioxidant, antiinflammatory, and antiphotoaging activity and suggest that K36 can be developed as an antiaging agent for cosmetic and skin care products

Strontium ion can significantly decrease enamel demineralization and prevent the enamel surface hardness loss in acidic environment

Background/purpose: Strontium ion may play a role similar to calcium ion in enamel remineralization. The aim of this study was to investigate the effect of strontium ion concentration gradient on the demineralization of enamel. Methods: Citric acid and sodium citrate were used to prepare 16 different experimental acidic solutions with four different pH values (2.5, 3.5, 4.5, and 5.5) and four different strontium ion concentrations (0 M, 10−4 M, 10−3 M, and 10−2 M). Forty-eight human enamel samples were divided into 16 groups (n = 3) and immersed into the 16 different acidic solutions for 3 min. The phosphorus ion concentrations in 16 different acidic solutions were measured and compared. The enamel surface hardness was measured with a Vickers hardness tester. The energy dispersive spectrometer was used to detect the strontium ion content in the enamel surface. Results: Addition the strontium ions to the acidic solution could reduce the dissolution of the enamel. At pH 3.5 and pH 5.5, significantly lower phosphorus ion concentrations were detected in the acidic solutions with the addition of 10−2 M strontium ions. There was a less reduction of enamel surface hardness, while the strontium ion concentration increased in the acidic solution. At pH 2.5, the addition of 10−4 M, 10−3 M, or 10−2 M strontium ions to the acidic solution resulted in a significant increase in the strontium ion content in the enamel surface. Conclusion: Strontium ion can decrease the dissolution of the enamel and prevent the enamel surface hardness loss in acidic environment. Keywords: Enamel demineralization, Strontium ion, Enamel surface hardnes