Search

Invasive pulmonary aspergillosis (IPA) is a life‐threatening complication in patients with severe fever with thrombocytopenia syndrome (SFTS), yet SFTS‐associated IPA (SAPA)'s risk factors remain undefined. A multicenter retrospective cohort study across Hubei and Anhui provinces (May 2013–September 2022) utilized least absolute shrinkage and selection operator (LASSO) regression for variable selection. Multivariable logistic regression identified independent predictors of SAPA, Cox regression highlighted mortality‐related risk factors. Of the 1775 screened SFTS patients, 1650 were included, with 169 developing IPA, leading to a 42‐day mortality rate of 26.6% among SAPA patients. Multivariable logistic regression revealed SAPA risk factors including advanced age, petechia, hemoptysis, tremor, low albumin levels, elongated activated partial thromboplastin time (APTT), intensive care unit (ICU) admission, glucocorticoid usage, intravenous immunoglobulin (IVIG) and prolonged hospital stays. Cox regression identified predictors of 42‐day mortality, including ecchymosis at venipuncture sites, absence of ICU admission, elongated prothrombin time (PT), vasopressor and glucocorticoid use, non‐antifungals. Nomograms constructed on these predictors registered concordance indexes of 0.855 (95% CI: 0.826–0.884) and 0.778 (95% CI: 0.702–0.854) for SAPA onset and 42‐day mortality, respectively. Lower survival rates for SAPA patients treated with glucocorticoids (p < 0.001) and improved 14‐day survival with antifungal therapy (p = 0.036). Improving IPA management in SFTS‐endemic areas is crucial, with effective predictive tool. [ABSTRACT FROM AUTHOR]

To evaluate the diagnostic value and clinical application of metagenomic next-generation sequencing (mNGS) for infections in critically ill patients.Methods: Comparison of diagnostic performance of mNGS and conventional microbiological testing for pathogens was analyzed in 234 patients. The differences between immunocompetent and immunocompromised individuals in mNGS-guided anti-infective treatment adjustment were also analyzed.Results: The sensitivity and specificity of mNGS for bacterial and fungal detection were 96.6% (95% confidence interval [CI], 93.5%– 99.6%) and 83.1% (95% CI, 75.2%– 91.1%), and 85.7% (95% CI, 71.9%– 99.5%) and 93.2% (95% CI, 89.7%– 96.7%), respectively. Overall, 152 viruses were detected by mNGS, but in which 28 viruses were considered causative agents. The proportion of mNGS-guided beneficial anti-infective therapy adjustments in the immunocompromised group was greater than in the immunocompetent group (48.5% vs 30.1%; P=0.008). In addition, mNGS-guided anti-infective regimens with peripheral blood and BALF specimens had the highest proportion (39.0%; 40.0%), but the proportion of patients not helpful due to peripheral blood mNGS was also as high as 22.0%.Conclusion: mNGS might be a promising technology to provide precision medicine for critically ill patients with infection. [ABSTRACT FROM AUTHOR]

The southern Bay of Bengal (BOB) cold pool (SCP) plays an important role in the regional climate fluctuation of the BOB. However, the interannual variability in the SCP is still unknown. Multisource satellite remote sensing data and assimilation have been applied to explore the interannual variability in the SCP and its relationship with El Niño–Southern Oscillation (ENSO) events for the period 1982–2020. The anomalous SST of the SCP in the summer following the peak phase (i.e., winter) of the ENSO was closely related to the ENSO events. El Niño (La Niña)-induced the warm (cold) anomaly of the SCP starting from May and persisted throughout August with a peak value appearing in June during the El Niño (La Niña) decaying years. In the El Niño decaying years, the southwest monsoon current (SMC) was weakened, forced locally by the weakening southwesterly wind and remotely by the easterly wind anomaly at the equator associated with El Niño. The El Niño-related weakening SMC and the associated less cold advection led to the warm anomaly of the SCP. In addition, El Niño-related atmospheric heating also made a comparable contribution to the evolution of the SCP's SST. In the early stage (15 May to 10 June), its contribution to the warming of the SCP was much larger than that of the SMC, whereas from mid-June to August, it reversed to have a cooling effect and partially offset the advection heating induced by the SMC on the SCP. In the La Niña decaying years, similar oceanic and atmospheric processes operated but in an opposite way. [ABSTRACT FROM AUTHOR]

Background: Metagenomics next-generation sequencing (mNGS) is more efficient in identifying pathogens responsible for pneumonia. However, whether these patients ultimately benefit from this improvement remains unknown. Methods: In this retrospective, nested, case–control study, patients with severe hospital-acquired pneumonia (HAP) who had undergone mNGS of bronchoalveolar lavage fluid while in our intensive care unit from March 2017 to December 2020 (n = 33) were matched in a ratio of 1 to 2 (n = 66) by sex, age, comorbidities, immune status, Acute Physiology and Chronic Health Evaluation II score, severity of pulmonary infection, and use of extracorporeal life support with patients who had undergone conventional microbiological testing only. The primary outcome was 90-day mortality; secondary outcomes being length of intensive care unit stay, duration of mechanical ventilation support, 7-day and 28-day mortality, and efficacy of treatment of pulmonary infection. Results: In the CMT group, 17 patients (25.8%) had negative results, whereas only one (3.0%) had negative results in the mNGS group (P < 0.001). After receipt of microbiology results, antibiotics were altered in 23/33 patients (70.0%) in the mNGS group, but in only 29/66 (43.9%) in the CMT group (P = 0.016). Pulmonary infection-related findings improved in 20/33 patients (60.6%) in the mNGS group in the subsequent 7 days, but in only 25/66 (37.9%) in the CMT group (P = 0.032). However, the 28-day (33.3% vs 31.2%, P = 1.0) and 90-day (48.5% vs 45.5%, P = 0.78) mortality rates did not differ significantly between the two groups. These findings were supported by Cox-regression and Kaplan–Meier survival curve analyses. Conclusion: mNGS is helpful in the treatment of severe HAP but does not improve medium or long-term survival rates, especially in patients with severe comorbidities. [ABSTRACT FROM AUTHOR]

Objective : To evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) using bronchoalveolar lavage fluid (BALF) in patients with ventilator-associated pneumonia (VAP). Methods : BALF samples of 72 patients with VAP were collected from August 2018 to May 2020. The diagnostic performance of conventional testing (CT) and mNGS methods were compared based on bacterial and fungal examinations. The diagnostic value of mNGS for viral and mixed infections was also analyzed. Results : The percentage of mNGS positive samples was significantly higher than that estimated by the CT method [odds ratio (OR), 4.33; 95% confidence interval (CI), 1.78–10.53; p < 0.001]. The sensitivity and specificity of mNGS for bacterial detection were 97.1% (95% CI, 93.2–101.0%) and 42.1% (95 CI, 30.7–53.5%), respectively, whereas the positive predictive value (PPV) and the negative predictive value (NPV) were 60.0% (95% CI, 48.7–71.3%) and 94.1% (95% CI, 88.7–99.6%), respectively. A total of 38 samples were negative for bacterial detection as determined by the CT method, while 22 samples were positive as shown by the mNGS method. Conflicting results were obtained for three samples between the two methods of bacterial detection. However, no significant differences were noted between the mNGS and CT methods (OR, 1.42; 95% CI, 0.68–2.97; p = 0.46) with regard to fungal infections. The sensitivity and specificity of mNGS were 71.9% (95% CI, 61.5–82.3%) and 77.5% (95% CI, 67.9–87.1%), respectively. mNGS exhibited a PPV of 71.9% (95% CI, 61.5–82.3%) and an NPV of 77.5% (95% CI, 67.9–87.1%). A total of 9 out of 40 samples were found positive for fungi according to mNGS, whereas the CT method failed to present positive results in these samples. The mNGS and CT methods produced conflicting results with regard to fungal detection of the two samples. A total of 30 patients were virus-positive using mNGS. Furthermore, 42 patients (58.3%) were identified as pulmonary mixed infection cases. Conclusions : mNGS detection using BALF improved the sensitivity and specificity of bacterial identification in patients who developed VAP. In addition, mNGS exhibited apparent advantages in detecting viruses and identifying mixed infections. [ABSTRACT FROM AUTHOR]

A new data set of observations by six cruises of ship-mounted acoustic doppler current profiler (SADCP) and three 40 d long bottom-mounted ADCPs (BADCPs) is employed to reveal the spatiotemporal variability of tidal and subtidal currents in the western Taiwan Strait (TWS) during winter season. The results confirm the existence of intense cotidal lines for M tidal current, which is located north of 25°N. In this case, no existence of an amphidromic point can be identified. It is also revealed that the counter-wind current (CWC) can extend through the whole western TWS and even occupy the entire water column during winter monsoon relaxation. However, this CWC is observed to be thoroughly overwhelmed by the downwind China coastal current (CCC) during the two big monsoon bloom events in the winter of 2007, and the CCC consequently extends southward throughout the western TWS instead. Most importantly, the variation of the spatial extent for the CWC and the CCC in the western TWS is found to be well explained by the first two modes of the vector empirical orthogonal function (VEOF) analysis, that is, it is mainly controlled by a wind-driven quasi barotropic current as the first mode and slightly modulated by a relatively weak background current with a first-order baroclinic structure as the second mode. [ABSTRACT FROM AUTHOR]

We investigated the dynamics of carbonate system which was greatly modulated by a river plume and coastal upwelling in July 2014 and July 2015 at the east coast of Hainan Island where a fringing reef distributes inshore. By using a three end-member mixing model, we semiquantitatively estimated the removal of dissolved inorganic carbon (DIC) mediated by biological production in the river plume and upwelled water to be 13 ± 17 and 15 ± 16 μmol kg−1, respectively. The enhanced organic production was mainly responsible for these DIC consumptions in both two regimes, however, nearly a half of DIC removal was attributed to biocalcification in the plume system while it was negligible in the upwelling system. Furthermore, the modeled results over reefs revealed that river plume and coastal upwelling were two major threats of acidification to coral communities at the east coast of Hainan Island during cruises. In comparison, the biological contribution to acidification was limited for balancing between organic production and biocalcification during July 2014 cruise, whereas the acidification was greatly intensified by organic degradation during July 2015 cruise. It was verified that naturally local acidification (physical and biological processes) played a major role in great pH decreases on a short-term scale, leading to coastal waters more vulnerable to anthropogenic 'ocean acidification' (uptake of atmospheric CO2) by reducing buffering capacity of waters. Finally, effects of acidification associated with other local threats on a fringing reef were further depicted with a conceptual model. [ABSTRACT FROM AUTHOR]

Mesoscale eddy effects on the wintertime vertical mixing in the formation region of the North Pacific Subtropical Mode Water (NPSTMW) are studied using hydrographic data from Argo profiling floats deployed in the Kuroshio recirculation region in February and March of 2001. Anticyclonic (warm) eddy enhances the wintertime vertical mixing and results in the deep mixed layer and the deep thermocline. Consequently, a large volumetric water mass with low potential vorticity corresponding to the prototype of NPSTMW tends to be formed. By contrast, cyclonic (cold) eddy is unfavorable for the vertical mixing process and halts the deepening of the mixed layer and thus the formation of mode water. Further analysis shows that cyclonic eddies prevail in the late 1990s in the formation region of NPSTMW, which lead to significant suppression of the wintertime vertical mixing (96-98) and thus are unfavorable for the formation of NPSTMW; while the situation is completely reversed in the early 1990s (93-95). [ABSTRACT FROM AUTHOR]

A rarely seen upwelling phenomena northwest off the Hainan Island (UNWHI) is witnessed by the in situ observation during July, 2015. Model simulation suggest that (1) the UNWHI is not a stationary phenomenon because it is the extension of upwelling west off the Hainan Island (UWHI) and located in the wake zone of the circling upwelling around the Hainan Island, (2) the generation mechanism for the UNWHI is tidal mixing and the favorable winds, where tidal mixing is the basic driving force and the local southwestly winds is the necessary condition for the UNWHI's occurrence, (3 net heat flux has limited effect on UNWHI,(4)variation of water temperature in NWHI and in WHI are highly correlated. [ABSTRACT FROM AUTHOR]

Summary Background The purpose of this study was to determine the species distribution and to monitor the antifungal susceptibility profiles of clinical Candida isolates collected in China from 2009 to 2013. Methods The antifungal susceptibilities of 952 Candida isolates were tested. Results Candida albicans was the most common species, accounting for 65.7% of the total isolates. The most frequently isolated non-albicans Candida species in this study was Candida glabrata (193, 20.3%). Nearly 7.6%, 3.2%, 1.8%, and 1.1% of the 952 isolates exhibited decreased susceptibility to fluconazole, voriconazole, itraconazole, and flucytosine, respectively. Moreover, seven C. albicans and one Candida krusei had an amphotericin B minimum inhibitory concentration (MIC) of 2 μg/ml. Conclusions The distribution of species and the prevalence of antifungal resistance in Candida isolates varied among different areas in China. Continuous monitoring of resistance patterns is necessary to control the spread of resistance in clinical isolates of Candida species. [ABSTRACT FROM AUTHOR]

Abstract A new dataset based on in-situ observations and a numerical model are employed to reveal the spatio-temporal variation and driving mechanism of counter-wind current (CWC) in the western Taiwan Strait (TWS) during the winter monsoon. Our results confirm the existence of the CWC in the western TWS during the months of strong northeasterly wind, which is well supported by a rarely observed through-flow pattern recorded by a Lagrangian drifter, during which the average wind speed was 11 m/s. Moreover, both the synchronous ADCP observations and model results demonstrate that the CWC acted as an episodic local event when the winter monsoon went into transient relaxation. By examining the model results, the momentum budget and the time-dependent dynamics, we further revealed that the wind relaxation mechanism is crucial in explaining the existence of the CWC, which acted as a short-lived local event in the form of a return current that lied in the downstream of a significant along-strait sea-level set-up in the northern Taiwan Bank when the prevailing strong wind experienced a short transient relaxation. Last but not least, the large-scale pressure gradient related to the open-ocean forcing was found to play a predominant role in driving a stable CWC in the frame of geostrophy when the winter-monsoon wind gradually relaxed. Highlights • We confirm the existence of the CWC in the western TWS during the months of strong northeasterly wind. • The wind relaxation mechanism was crucial in explaining the existence of the CWC. • The CWC acted as a short-lived local event when the prevailing strong wind experienced a short transient relaxation. • The large-scale pressure gradient plays a predominant role in driving a stable CWC when the winter-monsoon wind gradually relaxed. [ABSTRACT FROM AUTHOR]

Coastal upwelling that brings to the surface both CO 2 - and nutrient-rich deep seawater is related to acidification and intense biological productivities in surface waters. However, the impact of biological activities on upwelling-induced acidification from nearshore to offshore areas in an upwelling zone remains insufficiently known. In this paper, we present daily records of high-resolution profiles of carbonate chemistry and hydrographic parameters from the nearshore to the offshore upwelling zone off the east coast of Hainan Island (ECH) in July 2014 (summer season). A three end-member mixing model was adopted to discriminate biological processes from physical mixing and to further semiquantitatively diagnose biological contribution to the upwelling-induced acidification. The results show divergent responses in pH, aragonite saturation state (Ω Ar) and biomediated nonconservative dissolved inorganic carbon (ΔDIC) at depths of 10 m–30 m between nearshore and offshore regimes under the on-going coastal upwelling, which were attributed to the distinct roles of biological activities in mediating acidification in the upper 30 m across the ECH. Specifically, in the offshore regime, enhanced photosynthesis reduced the upwelling-induced acidification by 40% (i.e., type C: relief role), whereas aerobic respiration increased acidification in the subsurface waters of the nearshore regime by 15% (i.e., type B: aggravation role). This led to the pH and Ω Ar minimum in upwelled waters along the transect from the nearshore to the offshore. In contrast, the biological contribution was almost negligible over surface waters in the nearshore regime because of the balance between net community productivity and net community calcification (i.e., type A: limited or minor role). • Three types of biological contribution to upwelling-induced acidification are quantitatively revealed at the east coast of Hainan Island. • Behaviors of carbonate chemistry and dissolved oxygen in upwelled waters are distinct between the nearshore and offshore regimes. • Aerobic respiration intensifies acidification in the subsurface of the nearshore area during a coastal upwelling. [ABSTRACT FROM AUTHOR]