Spatio-temporal variability in the distribution of ground-dwelling riparian spiders and their potential role in water-to-land energy transfer along Hong Kong forest streams

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Identification by 16S ribosomal RNA gene sequencing of an Enterobacteriaceae species with ambiguous biochemical profile from a renal transplant recipient

Traditional ways of identification of bacteria by phenotypic characteristics cannot be used for non-cultivable organisms and organisms with unusual biochemical profiles. In this study, an Enterobacteriaceae was isolated in pure growth from the mid-stream urine of a 67-year old renal transplant recipient with urinary tract infection. Conventional biochemical tests did not reveal a pattern resembling any known member of the Enterobacteriaceae family. The Vitek system (GNI+) showed that it was 18% Leclercia adecarboxylata and 55% Klebsiella ozaenae; whereas the API system (20E) showed that it was 99.8% Rahnella aquatilis. 16S ribosomal RNA gene sequencing showed that there was 7 base differences between the isolate and Enterobacter cloacae, 18 base differences between the isolate and Enterobacter asburiae, 17 base differences between the isolate and Enterobacter cancerogenus, 35 base differences between the isolate and K. ozaenae, 27 base differences between the isolate and L. adecarboxylata, and 72 base differences between the isolate and R. aquatilis, indicating that the isolate most closely resembled a strain of E. cloacae. Identification of the organism in this study is important, as the choice of antibiotics would be radically different. In this case, cephalosporins should be avoided regardless of in-vitro susceptibility as cephalosporins are well-known to select for AmpC derepressed mutants in Enterobacter, and previous administration of third-generation cephalosporins is more likely to be associated with multidrug resistant Enterobacter isolates than is administration of antibiotics that do not include a third-generation cephalosporin. © 2001 Elsevier Science Inc.link_to_subscribed_fulltex

Relatively alcohol-resistant mycobacteria are emerging pathogens in patients receiving acupuncture treatment

Acupuncture has been gaining popularity as a form of alternative medicine. In the past, only blood-borne viruses and anecdotal reports of bacterial infections have been associated with acupuncture. We report on four patients with mycobacterial infections complicating acupuncture who were encountered in a 2-year period. All had clinical and/or radiological lesions at acupuncture point- and meridian-specific locations. There was no other history of trauma or other clinical foci of infections, and the chest radiographs were normal. Histological studies of biopsy specimens of all four patients showed changes compatible with chronic inflammation, with granulomatous inflammation present in three patients and acid-fast bacilli present in two. Conventional biochemical tests and whole-cell fatty acid analysis for identification were inconclusive for all four nonpigmented mycobacteria recovered from tissue biopsies. 16S rRNA gene sequencing showed that the strains from two patients were Mycobacterium chelonae and that those from the other two were Mycobacterium nonchromogenicum. Alcohol resistance assay using the quantitative suspension test revealed that all four strains showed prolonged survival in 75% alcohol compared to other skin flora. Mycobacterial infections transmitted by acupuncture are an emerging problem. A high index of suspicion is essential to recognize this clinical syndrome, and strict implementation of proper infection control guidelines for acupuncture is mandatory.published_or_final_versio

Circulating fibroblast growth factor 21 level predicts the progression of diabetic nephropathy in patients with type 2 diabetes

Session: OR23-The Beta Cell and Diabetes Complications: Basic and Clinical Aspects Clinical/Translational: no. OR23-4Oral PresentationObjective: Fibroblast Growth Factor 21 (FGF21) is a metabolic hormone produced by the liver, but also expressed in the other tissues including the adipose tissues, pancreas and kidney. Beneficial effects on body weight, carbohydrate and lipids metabolism have been observed in animals treated with recombinant FGF21. However, paradoxical increases in circulating FGF21 levels are found in obesity and diabetes. Elevated levels are also found in patients with impaired renal function. Its correlation with urinary albumin excretion in patients with diabetic nephropathy, even in the stage of microalbuminuria, suggests it to be an early indicator of subclinical diabetic nephropathy. Here we investigate whether serum FGF21 level can be usefully employed in the prediction of disease progression in patients with diabetic nephropathy. Research Design and Methods: Baseline plasma FGF21 levels were measured with an ELISA in type 2 diabetic subjects, recruited from the Hong Kong West Diabetes Registry. The role of FGF21 in predicting chronic kidney disease (CKD) over a median follow-up of 4 years was analyzed using Cox regression analysis. CKD progression was defined as a deterioration in CKD staging and a 25% or greater drop in estimated glomerular filtration rate (eGFR) from baseline, as defined by International Society of Nephrology statements. Results: At baseline, serum FGF21 levels increased progressively with CKD staging (P for trend <0.001; n=1136). Amongst 1071 subjects with baseline CKD stage ≤ 3, serum FGF21 levels were significantly higher in those with CKD progression (n=171) during follow-up than those with no progression (n=900) (P<0.001). On multivariable Cox regression analysis, serum FG21 was independently associated with CKD progression (hazard ratio [HR]: 1.24; 95% CI: 1.05-1.47; P=0.012), after adjustment for age, duration of diabetes, hypertension, C-reactive protein and eGFR. Serum FGF21 remained an independent predictor of CKD progression in a subgroup of subjects with normoalbuminuria and CKD stage 1 or 2 at baseline (HR 1.4; 95% CI 1.04-1.88; p=0.028; n=559) Conclusions: Elevated FGF21 levels may represent a compensatory change to the metabolic derangement and renal injury in diabetic patients with renal disease and appear to be a useful biomarker for predicting disease progression in type 2 diabetic patients at early stages of diabetic nephropathy. Supported by: the Hong Kong Research Grant Council (CRF HKU 02/12R)link_to_OA_fulltex

Exploring the Penicillium marneffei genome

Penicillium marneffei is a dimorphic fungus that intracellularly infects the reticuloendothelial system of humans and bamboo rats. Endemic in Southeast Asia, it infects 10% of AIDS patients in this region. The absence of a sexual stage and the highly infectious nature of the mould-phase conidia have impaired studies on thermal dimorphic switching and host-microbe interactions. Genomic analysis, therefore, could provide crucial information. Pulsed-field gel electrophoresis of genomic DNA of P. marneffei revealed three or more chromosomes (5.0, 4.0, and 2.2 Mb). Telomeric fingerprinting revealed 6-12 bands, suggesting that there were chromosomes of similar sizes. The genome size of P. marneffei was hence about 17.8-26.2 Mb. G+C content of the genome is 48:8 mol%. Random exploration of the genome of P. marneffei yielded 2303 random sequence tags (RSTs), corresponding to 9% of the genome, with 11.7, 6.3, and 17.4% of the RSTs having sequence similarity to yeast-specific sequences, non-yeast fungus sequences, and both (common sequences), respectively. Analysis of the RSTs revealed genes for information transfer (ribosomal protein genes, tRNA synthetase subunits, translation initiation, and elongation factors), metabolism, and compartmentalization, including several multi-drug-resistance protein genes and homologues of fluconazole-resistance gene. Furthermore, the presence of genes encoding pheromone homologues and ankyrin repeat-containing proteins of other fungi and algae strongly suggests the presence of a sexual stage that presumably exists in the environment.link_to_subscribed_fulltex

Protocol driven assessment programme effectively shortens new case waiting time

Service Priorities and Programmes Free Papers: SPP4.6 Quality and Safety in Healthcare 1Conference Theme: Consolidating Health Care - 固本培員, 健行不息Introduction: The waiting time for new cases in endocrine clinic has been rising due to increasing demand. The average waiting time has increased to 26.3 ± 5.5 weeks in February 2012. To improve the situation, a protocol driven assessment (PDA) programme has been established and incorporated into the triage pathway starting from April 2012. Objectives: (1) To shorten the waiting time of new case at the Endocrine Clinic; and (2) to enhance efficient work flow of triage system and improve patient care. Methodology: Protocols for endocrine diseases including obesity, hyperprolactinaemia, hypercalcaemia, hypopituitarism and hypogonadism were developed. Patients referred for such conditions were triaged to the PDA programme in which history taking, assessments, investigations and early interventions were carried out according to the protocols set by an endocrine nurse and subsequently followed by endocrinologists. Results: 225 referrals were screened from May 2012 to December 2012. 64 patients were triaged to the programme. The referralto-nurse and referral-to-endocrinologist times for the programme were 5.9 ± 4.9 and 9.8 ± 5.3 weeks respectively. This showed a significant improvement when compared with their original referral-to-endocrinologist time (26.6 ± 5.7 weeks, p<0.05). Referral-to-endocrinologist time for patients not recruited into the programme also showed significant improvement (10.3 ± 9.0 vs. 26.2 ± 5.4 weeks, p< 0.05) and the PDA programme was one of the measures that contributed to this success. Early intervention has been initiated during the initial nursing assessment of the programme. 18 obese patients received prompt referrals to relevant allied health disciplines before assessments by specialists. Four patients, referred for hyperprolactinaemia, had normal serum prolactin level after re-checked by endocrine nurse under a controlled non-stressed condition. They could be discharged from clinic at the first specialist assessment. More urgent conditions, such as visual field defects and high blood pressure, had also been detected early in the nursing assessment stage and resulted in prompt treatment action. The establishment of PDA programme, conducted by an experienced nurse, not only shortens waiting time but also provides patients with a more streamlined, timely and efficient model of care