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Esthetic smiles are an increasingly important focus of orthodontic treatment. Factors related to maxillary incisors, such as smile arc, maxillary gingival exposure, and maxillary crown torque, are related to esthetic smiles. It is very important to consider these factors during orthodontic treatment. However, with conventional orthodontic treatment using traditional anchorage, torque and vertical control of maxillary incisors, which are closely related to esthetic smile, were significant challenges, but with the introduction of temporary skeletal anchorage devices (TSADs), control of maxillary incisors has become easier to accomplish along with premolar extractions. Importantly, the various clinical applications and biomechanics of TSADs must be understood because of the variety of sites where the TSADs can be implanted. In general, the torque and vertical position of the maxillary incisors can be controlled by adjusting the line of action of force by changing the length of the lever arm and the vertical position of the TSADs. In this article, we classify TSADs for esthetic control of the maxillary incisors into anterior labial TSADs, posterior buccal TSADs, and palatal TSADs according to the implant sites, presenting various cases and discussing the biomechanics associated with them. [ABSTRACT FROM AUTHOR]

Prolonged drug efficacy to reduce the number of administrations is a key factor in the successful treatment of glaucoma through topical drug delivery to the eye. Therefore, we propose a new strategy for iontophoretic ocular delivery of drug-loaded nanoparticles. Considering safety and convenience, our strategy is involved with topical administration of the drug-loaded nanoparticles followed by their permeation into the eye tissues via noninvasive iontophoresis, using the skin-attached electrodes. Thus, those nanoparticles stayed longer in the eye, and during this period, the drug was released in a sustained manner, thereby prolonging drug exposure even with one-time treatment. The nanoparticles were made of poly(lactic-co-glycolic acid) (PLGA), which were loaded with a glaucoma drug, latanoprost. We varied the size of the nanoparticles at 100, 200, 300, and 500 nm and sought to find the optimum size under the fixed conditions for iontophoresis proposed in this work (4 mA; 30 min). Even with iontophoresis through the skin-attached electrodes, the nanoparticles were indeed deposited in the eye tissues, where with an increase in particle size, drug release was more sustained, but fewer particles could permeate into the eye tissues. Because of these two competing factors, iontophoretic delivery of the 300-nm particles exhibited the most prolonged drug efficacy in vivo for more than 7 days, and showed an approximately 23-fold increase in drug efficacy compared with that of Xalatan®, a commercially available eye drop of latanoprost developed for once-a-day administration every day. To treat glaucoma, conventional eye drops are often prescribed; however, they often require multiple daily administrations due to rapid preocular clearance. To resolve this, we suggest a noninvasive iontophoretic ocular delivery of latanoprost-loaded PLGA nanoparticles using the skin-attached electrodes. Even with iontophoresis via the skin-attached electrodes, the nanoparticles can indeed be deposited into the eye tissues. However, with an increase in particle size, fewer particles can permeate into the eye tissues, although drug release is more sustained. Therefore, the particles with a size of 300 nm show the optimal in vivo delivery profile in this work, where the drug efficacy can be extended for more than 7 days with a single administration. [Display omitted] [ABSTRACT FROM AUTHOR]

• The overall incidence of CDI after orthopedic surgery was 0.7%. • The occurrence of CDI after orthopedic surgery contributes to increased LOS. • The greatest impact of CDI on LOS occurs among elderly patients and patients with comorbidities. To identify the incidence, associated factors, and impact of hospital-acquired Clostridium difficile infection (CDI) among patients who have undergone orthopedic surgery. We retrospectively reviewed the charts of all adults patients who underwent orthopedic surgery from January 2016 through December 2017 at a tertiary hospital. Of 7,363 patients who underwent orthopedic surgical procedures, 52 (0.7%) developed hospital-acquired CDI. The independent factors associated with CDI were age ≥65 years (adjusted odds ratio [aOR], 3.4; P <.001), preoperative hospital stay ≥3 days (aOR, 3.7; P <.001), operating time ≥3 hours (aOR, 2.5; P <.005), and antibiotic use for infection treatment (aOR, 4.3; P <.001). After adjusting for the timing of CDI using a multistate model, the mean excess LOS attributable to CDI was 2.8 days (95% confidence interval [CI], 0.4-5.3). The impact of CDI on excess LOS was more evident among patients aged ≥65 years (4.4 days; 95% CI, 1.8-7.0) and those with any comorbidity (5.6 days; 95% CI, 3.0-8.1). The overall incidence of CDI after orthopedic surgery was 0.7%. The occurrence of CDI after orthopedic surgery contributes to increased LOS. The greatest impact of CDI on LOS occurs among elderly patients and patients with comorbidities. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the anatomy of the posterior palatal alveolar process, which is often used for placement of the orthodontic mini-implant (OMI), and to suggest simple guidelines for safe placement of OMI.Methods: Cone-beam computed tomography (CBCT) scans of 60 patients (30 men, 30 women; age range, 18-39 years; average age, 25.8 years) was used to measure the palatal interradicular distance, the palatal bone thickness, and the palatal soft-tissue thickness. Measurements were performed on the area from the maxillary canine to the maxillary second molar based on the vertical distance apical from the cementoenamel junction. The CBCT data were analyzed by Bonferroni correction for multiple testing and the multivariable mixed linear model.Results: The palatal interradicular distance was the widest between the second premolar and the first molar and the narrowest between the first and second premolars. The palatal bone thickness at interdental sites was the thickest between the first and second premolars and the thinnest between the first and second molars. The interdental palatal soft-tissue thickness from the canine to the second premolar was thicker than any other area. There were minor measurement differences between genders and positive correlations between vertical distance from the cementoenamel junction plane and all of the parameters.Conclusion: In this study, we evaluated the anatomy of the posterior palatal area using CBCT scans of adult patients. The data will provide guidelines to the clinicians before OMI placement in the posterior palatal alveolar process. [ABSTRACT FROM AUTHOR]

Background: The effects of subinhibitory concentrations (sub-MICs) of antibacterial agents on the biofilm-forming ability of Staphylococcus aureus require further study.Aim: To investigate the effects of sub-MICs of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates.Methods: MRSA isolates were collected from patients with bloodstream infections at a tertiary care hospital. The basal level of biofilm formation and biofilm induction by sub-MICs of chlorhexidine and mupirocin were evaluated by measuring biofilm mass stained with Crystal Violet.Findings: Of the 112 MRSA isolates tested, 63 (56.3%) and 44 (39.3%) belonged to sequence type (ST)5 and ST72 lineages, respectively, which are the predominant healthcare- and community-associated clones in South Korea. ST5 isolates were more likely to have chlorhexidine MIC ≥4 (73.0% vs 29.5%), resistance to mupirocin (23.8% vs 0%), agr dysfunction (73.0% vs 9.1%), and qacA/B gene (58.7% vs 2.3%) compared to ST72 isolates. The basal level of biofilm formation ability was frequently stronger in ST72 isolates compared to ST5 isolates (77.3% vs 12.7%). Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in 56.3% and 53.6%, respectively, of all isolates. Biofilm induction was more prevalent in ST5 isolates (85.7% for chlorhexidine, 69.8% for mupirocin) than in ST72 isolates (15.9% for chlorhexidine, 27.3% for mupirocin).Conclusion: Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in half of the clinical MRSA isolates. Our results suggest that ST5 MRSA biofilm can be induced together with some other bacterial virulent factors following exposure to chlorhexidine, which might confer a survival advantage to this clone in the healthcare environment. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract We have proposed a metal-organic framework (MOF), NH 2 -MIL-88(Fe), as a novel carrier for topical drug delivery to the eye. The NH 2 -MIL-88(Fe) particles were prepared via a solvothermal synthesis method and their structure was confirmed by powder X-ray diffraction, Fourier transform infrared analysis, thermogravimetric analysis, electron microscopy, and N 2 adsorption-desorption measurements. When brimonidine, an anti-glaucoma medicine, was encapsulated into NH 2 -MIL(Fe)-88 (i.e., NH 2 -MIL-88(Fe)/Br), the drug was loaded at 121.3 µg/mg and released in a sustained manner for up to 12 h. The NH 2 -MIL-88(Fe)/Br exhibited mucoadhesive properties and remained on rabbit eyes for a period of up to 4 h. Consequently, a high concentration of brimonidine was found in tears for a prolonged period after the administration of NH 2 -MIL-88(Fe)/Br, which resulted in a greater than two-fold increase in drug bioavailability and activity period compared with those of Alphagan P, which are brimonidine eye drops already approved for clinical use. Hence, NH 2 -MIL-88(Fe) is suggested to be a promising carrier for topical delivery to the eye that provides enhanced bioavailability of ocular drugs. Statement of Significance We suggest NH 2 -MIL(Fe)-88, a type of metal-organic frameworks (MOFs), as delivery carriers of an ophthalmic drug, brimonidine. The NH 2 -MIL(Fe)-88 particles possess a mucoadhesive property, hence prolonged retention in the preocular space when topically administered to the eye. The particles can also encapsulate the drug in their micro-pores, through which the drug can be released in a sustained manner. Therefore, when tested to rabbit eyes in vivo, the drug-loaded NH 2 -MIL(Fe)-88 particles were shown to enhance the ocular drug bioavailability, as compared with Alphagan P, the marketed eye drops of brimonidine. [ABSTRACT FROM AUTHOR]

Background The effect of decolonization on the control of methicillin-resistant Staphylococcus aureus (MRSA) may differ depending on intensive care unit (ICU) settings and the prevalence of antiseptic resistance in MRSA. Methods This study was conducted in a 14-bed surgical ICU over a 40-month period. The baseline period featured active surveillance for MRSA and institution of contact precautions. MRSA decolonization via chlorhexidine baths and intranasal mupirocin was implemented during a subsequent 20-month intervention period. Pre–post and interrupted time series analysis were used to evaluate changes in the clinical incidence of hospital-acquired MRSA colonization or infection. MRSA isolates were tested for the presence of qacA/B genes and mupirocin resistance. Results In pre–post analysis, the clinical incidence of MRSA significantly decreased by 61.6% after implementation of decolonization ( P  < .001). Meanwhile, interrupted time series analysis showed decreases in both the level (β = −0.686; P  = .210) and trend (β = −0.011; P  = .819) of clinical MRSA incidence, but these changes were not statistically significant. Of 169 MRSA isolates, 64 (37.8%) carried the qacA/B genes, and 22 (13.0%) showed either low- (n = 20) or high-level (n = 2) resistance to mupirocin. Low-level mupirocin resistance significantly increased from 0%-19.4% during the study period. Conclusion Although decolonization using antiseptic agents was helpful to decrease hospital-acquired MRSA rates, the emergence of antiseptic resistance should be monitored. [ABSTRACT FROM AUTHOR]

Objectives: Early diagnosis and treatment of tuberculous meningitis (TBM) is essential for a positive outcome, but sensitive, specific, and rapid diagnostic tests for TBM are lacking. We evaluated the diagnostic utility of enzyme-linked immunosorbent spot (ELISPOT) assays in HIV-uninfected patients with suspected TBM.Methods: All HIV-uninfected patients with suspected TBM were prospectively enrolled at a tertiary care hospital in an intermediate TB-burden country, during a 6-year period. ELISPOT assays were performed on peripheral blood mononuclear cells (PBMC) and cerebrospinal fluid-mononuclear cells (CSF-MC).Results: Of the 276 evaluable patients, 90 (33%) were classified as having TBM (30 definite cases, 19 probable, and 41 possible), and 186 (67%) as having non-TBM. When comparing definite TBM versus non-TBM, the sensitivity and specificity of the PBMC ELISPOT assay (≥6 spots; manufacturer's recommended cut-off) for diagnosing TBM were 96% (95% CI, 82-100) and 58% (95% CI, 50-66), respectively. The CSF-MC ELISPOT assay (≥38 spots; receiver operating characteristic [ROC]-derived cut-off) was a useful rule-in test with specificity of 95% (96% CI, 90-98). Its sensitivity was 68% (95% CI, 45-86), which was superior those of AFB smear microscopy (14%; P < 0.001) and CSF Mycobacterium tuberculosis PCR (41%; P = 0.07). Combining this assay with M. tuberculosis PCR, clinical score, and both together increased sensitivity to 86%, 91%, and 95%, respectively, while retaining about 95% specificity.Conclusions: The CSF-MC ELISPOT assay appears to be a rapid and accurate rule-in test for the diagnosis of TBM and a useful adjunct for diagnosing TBM in HIV-uninfected patients. [ABSTRACT FROM AUTHOR]

This multicenter, retrospective cohort study compared the clinical characteristics and outcomes of community-acquired Klebsiella pneumoniae meningitis (CA-KPM) with those of community-acquired Streptococcus pneumoniae meningitis (CA-SPM). Eighty-three adult patients, 27 with CA-KPM and 56 with CA-SPM, were included. Diabetes mellitus (48.1% versus 21.4%; P = 0.01) and liver cirrhosis (22.2% versus 5.4%; P = 0.05) were more commonly associated with CA-KPM. Comatose mental status (40.7% versus 12.5%; P = 0.01), septic shock (44.4% versus 8.9%; P < 0.001), and concomitant extrameningeal infections (40.7% versus 7.1%; P = 0.001) were also more common in the CA-KPM group. The 28-day mortality (44.4% versus 10.7%; P < 0.001) and inhospital mortality (51.9% versus 14.3%; P < 0.001) were higher in the CA-KPM group. In conclusion, diabetes mellitus and liver cirrhosis are more common in the CA-KPM patients who were also more likely to present with severe manifestations and poor outcomes. [ABSTRACT FROM AUTHOR]

Background This study evaluated the effect of infection control interventions on the incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) in a tertiary hospital over a 6-year period. Methods Multiple interventions, including cohorting, promotion of hand hygiene, active surveillance in the intensive care units, and environmental cleaning, were implemented from 2007 through 2009 (period 1). From 2009 through 2012 (period 2), infection control programs were enhanced by the introduction of an onsite education and hand hygiene campaign in preparation for hospital accreditation. To assess the efficacy of the infection control intervention programs, the nosocomial incidence density of CRAB, consumption of alcohol-based hand gel, and consumption of antimicrobials during the study period were measured. Results The incidence density of CRAB increased from 0.35 to 0.46 per 1000 patient-days (PD) during period 1, but decreased to 0.06 per 1000 PD in period 2 ( P = .011). The consumption of alcohol-based hand gel increased from 5.6 L to 11.9 L per 1000 PD during the study period ( P < .001). There was a significant association between the incidence density of CRAB and carbapenem use ( P = .008). Conclusions Education for infection control programs, hand hygiene campaign, and the judicious use of carbapenem may decrease the nosocomial incidence of CRAB. [ABSTRACT FROM AUTHOR]

Summary: Objective: To evaluate the clinical characteristics and outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by gram-negative bacteria (GNB). Methods: We conducted a retrospective chart review of adult patients with HVO from three tertiary-care hospitals over a 7-year period. Results: Of the 313 microbiologically diagnosed HVO cases, GNB was responsible for 65 (20.8%) cases. Compared with patients with MSSA HVO, patients with GNB HVO were more likely to be female (P = 0.03) and have diabetes (P = 0.03), but less likely to have epidural abscess (P = 0.02) and paravertebral abscess (P = 0.003). Clinical outcomes were similar between the GNB and MSSA groups, including in-hospital mortality (4.6% vs. 7.8%; P = 0.53), recurrence (9.7% vs. 4.3%; P = 0.20), and sequelae (31.7% vs. 32.2%; P = 0.95). Among GNB-infected patients, recurrence rates differed according to the total duration of antibiotic treatment: 40.0% (4–6 weeks), 33.3% (6–8 weeks), and 2.1% (≥8 weeks) (P = 0.002). Conclusions: GNB HVO was responsible for 20.8% of adult cases of HVO. Despite some differences in clinical and radiological presentation, clinical outcomes were similar between GNB and MSSA HVO. Antibiotic therapy for ≥8 weeks may benefit patients with GNB HVO. [Copyright &y& Elsevier]

Abstract: The association between optic disk hemorrhage and glaucoma has been studied for many years. Recently, randomized clinical trials have confirmed that disk hemorrhage is a risk factor for development and progression of glaucoma. Disk hemorrhage is more commonly detected in open-angle glaucoma with normal tension than in open-angle glaucoma with high tension. Development of disk hemorrhage possibly is associated with the biomechanical properties of the lamina cribrosa and surrounding tissues, including the intraocular pressure (IOP)–cerebrospinal pressure gradient, arterial pressure, and venous pressure. Disk hemorrhage may be a marker of rapid glaucoma progression, in that localized subclinical structural change predisposes to disk hemorrhage, after which subsequent disease progression is accelerated, and recurrent optic disk hemorrhages are related to rapid structural progression of glaucomatous damage. IOP-lowering therapy can be helpful in halting post-hemorrhage glaucoma progression. [Copyright &y& Elsevier]

Abstract: We describe nanostructured microparticles (NMs) containing a mucoadhesive polymer for enhanced preocular retention and consider them as potential carriers of drugs to the eye. These NMs are each composed of entangled nanofibers to give an enlarged specific surface area, and thus can better adhere to the preocular mucus surface. This physical design allows the microparticles still to be composed mainly of a wall material, poly(lactic-co-glycolic acid), as required for controlled drug delivery, while the effects of an additive, mucoadhesive material, polyethylene glycol, can be synergistically improved via the nanostructured morphology. Thus, when formulated in a dry tablet dosage form, the NMs in this work show more than a 10-fold increase in preocular retention in vivo compared to conventional spherical microparticles. Therefore, we conclude that these mucoadhesive NMs can reside on the preocular surface for a prolonged period, and thus appear to be a promising system for topical drug delivery to the eye. [Copyright &y& Elsevier]

Summary: Objective: To evaluate the clinical characteristics and therapeutic outcomes of patients with hematogenous vertebral osteomyelitis (HVO) caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: We performed a cohort study of adult patients diagnosed with S. aureus HVO at a tertiary-care hospital over a 7-year period. Results: Of the 139 patients with S. aureus HVO, MRSA caused 62 (44.6%) cases. In multivariate analysis, compared with methicillin-susceptible S. aureus (MSSA), MRSA was associated with a higher risk of persistent bacteremia (≥7 days) (8.40 fold; P < 0.001) and relapse (4.83 fold; P = 0.03), and increased hospital stay (1.69 fold; P = 0.001). Among the MRSA cases, relapse rates differed according to duration of antibiotics: 41.7% (4–6 weeks), 25.0% (6–8 weeks), and 5.6% (≥8 weeks) (P = 0.007). Bacteremia was more likely to persist for ≥7 days in patients with an initial vancomycin trough <15 mg/L than in those with an initial trough ≥15 mg/L (79.3% vs. 20.0%; P = 0.001). Conclusions: MRSA HVO was associated with more frequent persistent bacteremia (≥7 days) and relapse, and longer hospital stay compared to MSSA HVO. Antibiotic therapy for ≥8 weeks and targeting a vancomycin trough of ≥15 mg/L may be benefit patients with MRSA HVO. [Copyright &y& Elsevier]

Summary: Objectives: Limited data are available regarding the incidence and outcomes of lymphadenopathy after completing tuberculosis (TB) treatment. Methods: We prospectively evaluated the incidence and outcomes of post-treatment lymphadenopathy in 154 patients with newly diagnosed lymph node TB (group 1) and in 12 patients previously treated for TB (group 2). We assessed the rates of microbiological recurrence, clinical recurrence, and post-treatment paradoxical response (PR) (defined as no microbiological recurrence with spontaneous improvement). Results: Post-treatment lymphadenopathy occurred in 24 (15.6%) patients of group 1 and in 12 patients of group 2. Re-biopsy was performed in 23 of these 36 patients. AFB stain was positive in four (17.4%) cases, and TB-PCR was positive in 11 (47.8%), but all samples were sterile (no microbiological recurrence). Granuloma was present in 12 (52.2%) histological specimens. Thirty-three (91.7%) of the 36 patients with lymphadenopathy improved spontaneously (post-treatment PR) and 3 (8.3%) were improved with retreatment (clinical recurrence). The overall incidence of post-treatment PR in patients with lymph node TB (group 1) was 8.6 per 100 person-years (95% CI, 5.8–12.7). Conclusions: Lymphadenopathy after TB treatment was more likely to be associated with post-treatment PR rather than with microbiological recurrence, and it should be monitored until PR resolve. [Copyright &y& Elsevier]

Abstract: Objectives: This study was performed to elucidate the involvement of integrin-FAK (focal adhesion kinase) pathway in compressive stress-induced mRNA expression of macrophage colony stimulating factor (M-CSF), tumour necrosis factor (TNF)-α, receptor activator of nuclear factor κB (RANKL) and osteoprotegerin (OPG) and to further confirm the role of the integrin-FAK complex as a mechanoreceptor in PDL cells. Design: Periodontal ligament (PDL) cells were obtained from patients having healthy first premolars extracted for orthodontic purposes. Cultured PDL cells were divided into three groups: the control group in which compressive stress was administered; the negative control group in which mechanical stress was administered after transfection of negative control siRNA; and FAK knockdown group in which mechanical stress was administered after FAK siRNA treatment. Compressive stress (2g/cm2) was for various time durations (0.5, 2, 6, 24, 48h). Total RNA was collected after the experiment and real-time PCR analysis was performed to determine the mRNA expression levels of M-CSF, TNF-α, RANKL and OPG. Also the supernatant was analysed with ELISA to detect the corresponding cytokine concentrations. Results: The cells of the control group and the negative control group expressed higher mRNA levels of M-CSF, TNF-α, and RANKL but a lower mRNA level of OPG compared to those of baseline. FAK knockdown cells showed lower mRNA expression levels of M-CSF, TNF-α, and RANKL but a higher mRNA expression level of OPG than that in the control. The OPG mRNA expression level in FAK knockdown cells was even higher than that of baseline. ELISA results showed similar pattern of cytokine concentration changes. Conclusions: Results of this study indicate that the integrin-FAK pathway regulates compressive stress-induced expression of M-CSF, TNF-α, RANKL and OPG and suggests that the integrin-FAK complex acts as a mechanoreceptor in PDL cells. [Copyright &y& Elsevier]

Objective: To investigate whether a topographic correlation exists between β-zone parapapillary atrophy (PPA) and retinal nerve fiber layer (RNFL) defect. The location and extent of the β-zone were examined. Design: Retrospective, cross-sectional study. Participants: One hundred twenty-eight eyes from 128 consecutive patients with primary open-angle glaucoma (POAG) and a single localized RNFL defect were included. Methods: Digital optic disc photographs of the enrolled eyes were reviewed and eyes with β-zone PPA were identified. The topographic parameters of β-zone PPA and RNFL defect were measured on optic disc photographs and digital red-free RNFL photographs. The association between these parameters was examined statistically. Main Outcome Measures: Angular location and angular extent of β-zone PPA and RNFL defect, angular location of point of maximum radial extent (PMRE) of β-zone PPA, and β-zone PPA-to-disc area ratio. Results: Eighty-two (64.1%) of the 128 eyes with a single localized RNFL defect had β-zone PPA. Patients with β-zone PPA were younger (by 6.6 years) than those without β-zone PPA (P = 0.001). β-Zone PPA was located most commonly inferotemporally (65.9%). The RNFL defect was located in the same hemifield as the β-zone PPA in 76% of eyes and was located in the same hemifield as PMRE in 88% of eyes. The angular location of the RNFL defect showed a linear correlation with those of β-zone PPA (r = 0.390; P<0.001) and PMRE (r = 0.558; P<0.001). The angular extent of RNFL defect was not correlated significantly with that of β-zone PPA (P = 0.106), but it was associated weakly with β-zone PPA-to-disc area ratio (r = 0.197; P = 0.026). The angular extent of the RNFL defect also was correlated with the cup-to-disc ratio (r = 0.322; P<0.001) and the cup-to-disc area ratio (r = 0.337; P = 0.002). Conclusions: In POAG, a localized RNFL defect is correlated spatially with β-zone PPA. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Summary: Objective: We evaluated the efficacy of linezolid-based salvage therapy compared with glycopeptide-based therapy in patients with persistent (≥7 days) methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B). Methods: All patients with MRSA-B during 2-year period at a tertiary-care hospital were prospectively enrolled. Linezolid-based salvage therapy was classified if patients switched glycopeptides to linezolid with/without carbapenem due to persistent MRSA-B. Covariate adjustment using the propensity score and inverse probability of treatment weighting (IPTW) using the propensity score were performed to control for bias in treatment assignment. Results: Of 377 patients with MRSA-B, 90 with persistent MRSA-B were included. Of these, 38 (42%) were classified as linezolid-based salvage group and the remaining 52 (58%) as glycopeptide-based therapy group. The duration of persistent bacteremia (median 16 days vs. 10 days; P = 0.008) was longer in linezolid-based salvage group than in the comparator. However, the 30-day mortality (11% vs. 25%; P = 0.08) had a trend toward being lower in linezolid-based salvage group than those in the comparator. Logistic regression models with covariate adjustment and IPTW using propensity scores also revealed that linezolid-based salvage showed a trend toward having better outcome than the comparator, although this did not reach any statistically significance (OR 0.31; 95% CI 0.03–2.95 and OR 0.19; 95% CI 0.01–3.39, respectively). Conclusions: While having worse prognostic factors compared with glycopeptide-based therapy, linezolid-based salvage therapy revealed a trend toward better outcomes than the comparator. Our data suggest that linezolid-based salvage therapy would be considered in patients with persistent MRSA-B despite the use of glycopeptides therapy. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The clinical significance of polymicrobial Staphylococcus aureus bacteremia (SAB) remains unclear. We therefore compared the clinical features and outcomes of polymicrobial and monomicrobial SAB. Methods: A prospective cohort study of patients with SAB was performed during a 20-months. Polymicrobial SAB was defined as the simultaneous isolation of S. aureus and other microorganisms from blood cultures. However, Corynebacterium spp., Bacillus spp., and coagulase-negative staphylococci were considered contaminants unless they were related to device infection and grew in two or more blood cultures. Results: During the study period, 44 (10%) patients had polymicrobial and 412 (90%) had monomicrobial SAB. A total of 54 microorganisms were isolated from the former, with Enterococcus spp. (22%) being the most common. Independent risk factors for polymicrobial SAB included neutropenia (odds ratio [OR] 3.5, p = 0.02), biliary tract catheters (OR 5.0, p = 0.001), and intra-abdominal infection (OR 10.3, p < 0.001). Clinical outcomes were significantly worse among patients with polymicrobial than monomicrobial SAB, including bacteremia-related and 7-day mortality rates. Independent predictors of bacteremia-related mortality were solid tumors (HR 2.0, p = 0.03) and polymicrobial SAB (HR 2.8, p = 0.007). Conclusions: Polymicrobial SAB is associated with more severe illness than monomicrobial SAB, with neutropenia, biliary tract catheters and intra-abdominal infection being significant risk factors for polymicrobial SAB. [ABSTRACT FROM AUTHOR]

Summary: Background: The clinical manifestations of extrapulmonary tuberculosis (E-TB) vary according to site of disease, so we tested the hypothesis that IFN-γ producing T-cell responses also vary in parallel. Therefore we conducted a prospective, blinded, observational study to evaluate the diagnostic performance of blood T-SPOT.TB according to the various sites of E-TB. Methods: From April 2008 to August 2010, all patients with suspected E-TB were enrolled at a tertiary hospital in an intermediate TB-burden country. Final diagnosis in patients with suspected E-TB was classified by clinical category. Results: A total of 368 patients with suspected E-TB were enrolled; 196 (53%) were classified as having TB, including 119 (32%) with confirmed TB, 34 (9%) probable TB, and 43 (12%) possible TB; the remaining 172 (47%) were classified as not having TB. After excluding patients with possible TB, the T-SPOT.TB was more sensitive in patients with chronic forms of E-TB such as lymph node or osteoarticular TB (93%, 95% CI 83%–97%) than in patients with acute forms of E-TB such as TB meningitis or miliary TB (79%, 95% CI 66%–87%, P = 0.03). Conclusions: The diagnostic performance of the blood T-SPOT.TB differs among patients with various clinical manifestations of E-TB. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The utility of a newly-developed Mycobacterium tuberculosis-specific enzyme-linked immunosorbent spot (ELISPOT) assay for diagnosis of tuberculous peritonitis (TBP) has not been fully assessed. Methods: All patients with suspected TBP in a tertiary care hospital in an intermediate TB burden country were prospectively enrolled over a 30-month period. ELISPOT assays were performed on peripheral mononuclear cells (PBMC) and mononuclear cells from peritoneal fluid (PF-MC). Results: Sixty-four patients with suspected TBP were enrolled. Of these, 30 (47%) were classified as having TBP (27 confirmed and 3 probable cases), and 25 (39%) were classified as not having active tuberculosis. The remaining 9 (14%) with possible TBP were excluded from the final analysis. Five (8%) of the total 64 patients gave indeterminate PBMC ELISPOT results and 7 (18%) of 39 patients who underwent PF-MC ELISPOT assay revealed indeterminate PF-MC ELISPOT results. The sensitivity and specificity, respectively, of the tested methods for diagnosing TBP were as follows: PBMC ELISPOT (≥6 spots), 86% and 67%; PF-MC ELISPOT (≥14spots), 92% and 86%; PF-MC ELISPOT/PBMC ELISPOT ratio (≥ 2), 75% and 93%; and PF ADA levels (≥38IU/L), 95% and 100%. The areas under the receiver operating characteristics curves were as follows: PF-MC ELISPOT, 0.96; PF ADA, 0.96; PBMC ELISPOT, 0.88; and PF-MC ELISPOT/PBMC ELISPOT ratio, 0.87, respectively. Conclusions: Although the ELISPOT assay does not outperform PF ADA, the ELISPOT assay using PBMC and PF-MC is a useful adjunct for diagnosing TBP, especially for a rule-in test when PF/MC/PBMC ELISPOT ratio (≥2) is used. However, the relatively high proportion of indeterminate results limits test utility, so further studies are needed to develop an optimized assay prototype. [ABSTRACT FROM AUTHOR]

Abstract: There are limited data on the incidence of subsequent bloodstream infection (BSI) and the effect of systemic antibiotics in patients who had positive catheter-drawn blood cultures (CBC) and negative peripheral blood cultures (PBC). We retrospectively reviewed all paired blood cultures from patients with Hickman catheter in the hematology–oncology ward between January 1997 and December 2008. There were 112 episodes with positive CBC and negative PBC. Nine episodes (8.0%; 95% CI, 3.0–13.1%) led to subsequent BSI within 28 days. Subsequent BSI developed in 6 of 31 episodes (19%) where empiric antibiotics were inappropriate but in 3 of 81 episodes (4%) where empiric antibiotics were appropriate (P = 0.01). Subsequent candidemia (50%, 2 of 4) was more common than subsequent bacteremia (6%, 7 of 108) (P = 0.03). In conclusion, for patients with positive CBC and negative PBC, the overall incidence of subsequent BSI was 8.0%, and inappropriate empiric antibiotics was associated with subsequent BSI. [Copyright &y& Elsevier]

Abstract: In orthodontics, the surface roughnesses of orthodontic archwire and brackets affect the effectiveness of arch-guided tooth movement, corrosion behavior, and the aesthetics of orthodontic components. Atomic force microscopy (AFM) measurements were used to provide quantitative information on the surface roughness of the orthodontic material. In this study, the changes in surface roughness of various orthodontic bracket slots before and after sliding movement of archwire in vitro and in vivo were observed through the utilization of AFM. Firstly, we characterized the surface of four types of brackets slots as follows: conventional stainless steel (Succes®), conventional ceramic (Perfect®), self-ligating stainless steel (Damon®) and self-ligating ceramic (Clippy-C®) brackets. Succes® and Damon® brackets showed relatively smooth surfaces, while Perfect® had the roughest surface among the four types of brackets used. Secondly, after in vitro sliding test with beta titanium wire in two conventional brackets (Succes® and Perfect®), there were significant increases in only stainless steel bracket, Succes®. Thirdly, after clinical orthodontic treatment for a maximum of 2 years, the self-ligating stainless steel bracket, Damon®, showed a significant increase in surface roughness. But self-ligating ceramic brackets, Clippy-C®, represented less significant changes in roughness parameters than self-ligating stainless steel ones. Based on the results of the AFM measurements, it is suggested that the self-ligating ceramic bracket has great possibility to exhibit less friction and better biocompatibility than the other tested brackets. This implies that these bracket slots will aid in the effectiveness of arch-guided tooth movement. [ABSTRACT FROM AUTHOR]

Summary: Background: Although diagnosing osteoarticular tuberculosis (TB) remains a challenge, a recently developed Mycobacterium tuberculosis-specific ELISPOT assay for diagnosing TB infection has shown promising results. We performed a prospective, blinded, observational study to compare its diagnostic usefulness with those of conventional tests in patients with suspected osteoarticular TB. Methods: All patients presenting at a tertiary hospital between April 2008 and September 2009 with suspected osteoarticular TB were enrolled. In addition to conventional tests for TB, we used ELISPOT assays to measure the IFN-γ response to ESAT-6 and CFP-10 in T-cells in samples of peripheral blood mononuclear cells (PBMC). Patients with suspected osteoarticular TB were classified by diagnostic category. Results: Of the 65 patients with suspected osteoarticular TB, 5 (8%) were excluded due to inconclusive diagnoses. Of the remaining 60 patients, 23 (38%) were classified as having confirmed TB, 3 (5%) as having probable TB, 2 (3%) as having possible TB, and 32 (53%) as not having active TB. Five (8%) patients with probable or possible TB were excluded from the final analysis. Of the 23 patients with confirmed osteoarticular TB, 15 (65%) had TB spondylitis, 4 (17%) had TB arthritis, 2 (9%) had prosthetic joint infection, and 2 (9%) had extra-spinal TB. The sensitivities of the tuberculin skin test (≥10 mm) and the ELISPOT assay for active osteoarticular TB were 80% (95% confidence interval [CI], 58%–92%) and 100% (95% CI, 85%–100%) (P = 0.04), respectively and their specificities were 68% (95% CI, 51%–81%) and 58% (95% CI, 41%–74%) (P = 0.60), respectively. Conclusion: A negative ELISPOT assay using PBMC may be a useful test for excluding a diagnosis of active osteoarticular TB. [ABSTRACT FROM AUTHOR]

Abstract: We compared the characteristics and outcomes of 172 Enterobacter cloacae bacteremia and 67 Enterobacter aerogenes bacteremia (EAB) cases. Antimicrobial resistance rates to E. cloacae were higher than those to E. aerogenes. However, EAB more frequently presented as septic shock and was associated with poorer outcomes. [Copyright &y& Elsevier]

Summary: Objectives: We evaluated the clinical characteristics and risk factors for the paradoxical response (PR) in non-HIV-infected patients with peripheral lymph node tuberculosis (TB). Methods: Medical records of non-HIV-infected patients aged ≥16 years with peripheral lymph node TB treated in a tertiary hospital between January 1997 and August 2007 were analysed. PR was defined as clinical or radiological worsening of pre-existing TB lesions, or development of new lesions in a patient who had received anti-TB therapy for at least 2 weeks. Results: Three hundred patients with lymph node TB were included. Of these, 235 patients (78%) had confirmed TB; the remaining 65 (22%) had probable TB and were excluded from the final analysis. Among the 235 study patients, their mean age (±standard deviation) was 37.6 (±13.9) years and 175 (75%) were female. PR occurred in 54 (23%; 95% confidence interval 18–28%) patients, at a median onset time of 8 weeks (interquartile range, 4–14 weeks) after starting anti-TB medication. In multivariate analysis, younger age (OR 0.96), male gender (OR 2.60), and the presence of local tenderness at the time of diagnosis (OR 2.90) were independently associated with PR. Conclusion: PR was relatively common, occurring in one-fifth of non-HIV-infected patients with peripheral lymph node TB, and was associated with younger age, male gender, and the presence of local tenderness. [Copyright &y& Elsevier]

Purpose: To evaluate quantitatively the structural damage of the peripapillary retinal nerve fiber layer (RNFL) in eyes with disc hemorrhage (DH). Design: Prospective cross-sectional study. Participants: Seventy patients with DH (70 eyes; mean age ± standard deviation, 60.0±11.8 years) and 100 healthy control subjects (100 eyes; mean age ± standard deviation, 57.7±8.0 years) were enrolled from the Glaucoma Clinic of Seoul National University Hospital. Methods: Normal eyes without DH (group 1: normal control group) served as controls. Eyes with DH were divided into the following groups: (1) eyes with a DH, accompanied by no visible RNFL defect according to red-free fundus photography and normal visual fields (group 2: DH only group); (2) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by normal visual fields (group 3: DH-preperimetric group); and (3) eyes with a DH and a localized RNFL defect in the same quadrant, accompanied by glaucomatous visual field defect in the corresponding hemifield location (group 4: DH-perimetric group). Optical coherence tomography (OCT)-measured RNFL thicknesses were compared. Main Outcome Measures: Average and segmental (4 quadrants and 12 clock-hours) OCT-measured RNFL thicknesses. Results: The number of eyes in groups 1, 2, 3, and 4 was 100, 25, 22, and 23 eyes, respectively. The OCT-measured RNFL thickness was significantly different among the 4 groups in average RNFL thickness and in inferior, superior, and nasal quadrants (P<0.01, 1-way analysis of variance). On post hoc analysis, the eyes of groups 2 and 3 showed thinner average RNFL thickness than those of group 1, and the average RNFL thickness of group 4 was significantly lower than that of groups 2 and 3 (P<0.001, 1-way analysis of variance and Tukey''s test). The OCT-measured RNFL thickness revealed a topographic relationship with the DH location. Conclusions: Significant RNFL loss was already present in the DH only eyes with apparently normal RNFL configuration by red-free fundus photography, indicating that preperimetric changes of the RNFL are already present. These results suggest that OCT has the potential to detect subclinical or preperimetric RNFL loss in the eyes with DH. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. [Copyright &y& Elsevier]

Abstract: The CXC chemokine receptor CXCR4 and its unique ligand SDF-1 (stromal-derived factor-1) play critical roles for the retention of hematopoietic cells within the bone marrow (BM) and for their mobilization into the circulation. Lithium often produces neutrophilia in psychiatric patients, but the mechanism of mobilization related to neutrophilia has not been fully clarified. We showed here that lithium dose-dependently reduces the levels of surface CXCR4 protein and mRNA in neutrophils, but not in lymphocytes. The chemotactic migration of neutrophils in response to SDF-1 was reduced after a pre-incubation with lithium. We provide evidence that lithium down-regulates the CXCR4 expression of neutrophils and it attenuates their responsiveness to SDF-1. Our studies support the concept that down-regulation of CXCR4 is one of the mechanisms by which causes neutrophilia. [Copyright &y& Elsevier]

Objective: To compare the clinical characteristics and progression rates of glaucoma in patients with recurrent and single disc hemorrhages (DHs). Design: Retrospective comparative case series. Participants: Patients with DH. Methods: The medical records of 57 eyes of 54 patients with DH were reviewed retrospectively. These patients had been regularly followed up at 1- to 3-month intervals, between 1991 and 2003, for at least 1 year after the initial DH. The recurrent DH group was composed of patients who had experienced ≥2 episodes of hemorrhage, whereas the single DH group was composed of those who had experienced a single DH episode. These 2 patient groups were compared with respect to clinical courses after initial DH and their clinical characteristics. Main Outcome Measures: Progression of optic disc and visual field (VF) deterioration. Results: Twenty-six of the eyes in this study (45.6%) exhibited recurrent DH, and 31 eyes (54.4%) single DH. The average total follow-up period in the recurrent DH group was 67.5 months, whereas single DH patients were followed up for an average of 54.7 months. There were no differences between the groups with regard to age, diagnosis, follow-up period, associated disease, or mean deviation in automated perimetry. Normal-tension glaucoma was the most commonly encountered glaucoma type, and the inferotemporal area was the most common location of DH in both groups. The cumulative probability of optic disc deterioration, including retinal nerve fiber layer change after DH, was found to be significantly greater in patients with recurrent DH (P = 0.004, log rank test). However, no significant differences were found between the 2 groups with regard to rate of VF deterioration (P = 0.10, log rank test). Conclusions: No differences were found between the recurrent and single DH groups in terms of clinical characteristics. Recurrent DH in cases of glaucoma may reflect more rapid optic nerve head damage progression than single DH. [Copyright &y& Elsevier]

Purpose: To evaluate the diagnostic ability of third-generation optical coherence tomography (Stratus OCT) with a normative database to detect localized retinal nerve fiber layer (RNFL) defects. Design: Cross-sectional study. Participants: One eye of each of 55 subjects (43 normal-tension glaucoma and 12 primary open-angle glaucoma subjects) with localized, wedge-shaped RNFL defects by red-free RNFL photographs and corresponding visual field defects (mean deviation, −6.77±3.54; range, −1.25 to −9.20 dB). Methods: The segments of the borderline and outside normal limits in the RNFL thickness profile of OCT were considered to be significant RNFL defects by OCT and by comparison with their corresponding red-free RNFL photographs. The angular locations and widths of RNFL defects by OCT were compared with those of RNFL defects by red-free RNFL photographs. Main Outcome Measures: Sensitivity and specificity of OCT with a normative database to detect the localized RNFL defects. Results: The mean age of the patients was 57.9±10.6 years (range, 25–78 years). The overall sensitivity and specificity of the OCT with a normative database for detecting localized RNFL defects were 85.9% and 97.4%, respectively. The OCT with a normative database showed good diagnostic agreement with red-free RNFL photographs (overall κ value = 0.79). The angular locations and widths of RNFL defects by OCT were highly correlated with those of RNFL defects by red-free RNFL photographs (Pearson correlation coefficient [r] = 0.996 and 0.725, respectively). Conclusions: The OCT with a normative database can detect localized RNFL defects with moderate sensitivity and high specificity, and shows good diagnostic agreement with red-free RNFL photographs. [Copyright &y& Elsevier]

We have identified a family of ancillary subunits of K+ channels in Caenorhabditis elegans. MPS-1 and its related members MPS-2, MPS-3, and MPS-4 are detected in the nervous system of the nematode. Electrophysiological analysis in ASE neurons and mammalian cells and epigenetic inactivation by double-stranded RNA interference (RNAi) in vivo show that each MPS can associate with and functionally endow the voltage-gated K+ channel KVS-1. In the chemosensory neuron ADF, three different MPS subunits combine with KVS-1 to form both binary (MPS-1·KVS-1) and ternary (MPS-2·MPS-3KVS-1) complexes. RNAi of mps-2, mps-3, or both, enhance the taste of the animal for sodium without altering the susceptibility to other attractants. When sodium is introduced in the test plate as background or as antagonist attractant, the nematode loses the ability to recognize a second attractant. Thus, it appears that the chemosensory apparatus of C. elegans uses sensory thresholds and that a voltage-gated K+ channel is specifically required for this mechanism. [ABSTRACT FROM AUTHOR]

: PurposeTo report four cases of normal-tension glaucoma with disk hemorrhage in one eye and branch retinal vein occlusion in the contralateral eye.: DesignObservational case series.: MethodsFour cases of normal-tension glaucoma with disk hemorrhage in one eye and branch retinal vein occlusion in the contralateral eye were detected within a 1-year period.: ResultsMean patient age was 57 ± 10 years. Three patients had systemic hypertension, two bilateral normal-tension glaucoma, and all four bilateral peripapillary atrophy. There was no significant difference in intraocular pressure between the disk hemorrhage eyes and the contralateral eyes with branch retinal vein occlusion.: ConclusionSome normal-tension glaucoma patients with disk hemorrhage may have a pathogenic mechanism in combination with branch retinal vein occlusion. [Copyright &y& Elsevier]

When decommissioning nuclear power plants, it is necessary that various types of radioactive wastes are to be estimated and be analyzed accurately. The first decommissioning process of the commercial light water reactor (LWR) is expected to start soon in South Korea, however, lots of processes are still under development for CANada Deuterium Uranium (CANDU) reactor. Unlike the LWR type reactor, the CANDU has complicated and different shapes of components in the reactor, which makes it difficult to carry out activation analysis considering region-wise different irradiation histories. In this study, a coupled module has been developed with Monte Carlo full core analysis and the region-wise depletion analysis by equipped automatic input generation. Furthermore, the levels of radioactive wastes are determined for transportation including estimation of cask contents based on the coupled module results. [ABSTRACT FROM AUTHOR]