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Cigarette smoke (CS) exposure is a risk factor for many chronic diseases including chronic obstructive pulmonary disease (COPD), however the mechanism by which smoke exposure can alter homeostasis and bring about chronic inflammation is poorly understood. Here, we showcase a novel role for smoke in regulating long noncoding RNAs (lncRNAs), showing that it activates lincRNA-Cox2, which we previously characterized as functional in inflammatory regulation. Exposing lincRNA-Cox2 murine models to smoke in vivo confirmed lincRNA-Cox2 as a regulator of inflammatory gene expression in response to smoke both systemically and within the lung. We also report that lincRNA-Cox2 negatively regulates genes in smoked bone marrow derived macrophages exposed to LPS stimulation. In addition to the effects on lncRNAs, we also report dysregulated transcription and splicing of inflammatory protein-coding genes in the bone marrow niche following CS exposure in vivo. Collectively, this work provides insights into how innate immune signaling from gene expression to splicing is altered following in vivo exposure to CS and highlights an important new role for lincRNA-Cox2 in regulating immune genes following smoke exposure.

Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease associated with cigarette smoking. Alterations in local lung and systemic iron regulation are associated with disease progression and pathogenesis. Hepcidin, an iron regulatory peptide hormone, is altered in subjects with COPD; however, the molecular role of hepcidin in COPD pathogenesis remains to be determined. In this study, using a murine model of smoke-induced COPD, we demonstrate that lung and circulating hepcidin levels are inhibited by cigarette smoke. We show that cigarette smoke exposure increases erythropoietin and bone marrow–derived erythroferrone and leads to expanded but inefficient erythropoiesis in murine bone marrow and an increase in ferroportin on alveolar macrophages (AMs). AMs from smokers and subjects with COPD display increased expression of ferroportin as well as hepcidin. Notably, murine AMs exposed to smoke fail to increase hepcidin in response to Gram-negative or Gram-positive infection. Loss of hepcidin in vivo results in blunted functional responses of AMs and exaggerated responses to Streptococcus pneumoniae infection.

Background: Hepatic steatosis is associated with increased surgical complications in patients undergoing bariatric surgery. The aim of this study was to evaluate the effect of phentermine in reducing hepatic steatosis, adipose tissue and surgical complications in patients undergoing bariatric surgery. Methods: This study is a two-arm, double-blind, randomized, controlled pilot trial of 64 adult subjects with BMI >35 kg/m2 selected for bariatric surgery randomized to phentermine 15 mg once daily for 8 week or placebo. Both groups adhered to a hypocaloric diet and individualized exercise program. The primary end point was the reduce frequency of hepatic steatosis measured by ultrasound and the reduce adipose tissue through fat mass in total kilograms or percentage. Key secondary points were the prevalence of surgical complications. Baseline and final biochemical parameters and blood pressure too were assessments. Results: Phentermine group the frequency of hepatic steatosis decreased 19%, and the percentage of patients with a normal ultrasound increased from 9% to 20% (p= 0.053). Likewise, the decrease in fat mass in kilograms was greater in the phentermine group (56.1 kg vs. 51.8 kg, p=0.02), and a significant decrease in the HOMA-IR index was observed regardless of weight loss. No differences in surgical complications were observed between groups. Phentermine was well tolerated; no differences were observed in the frequency of adverse events between the groups. Conclusions: Phentermine decreased the proportion of individuals with hepatic steatosis by 19%, promoted a greater loss of fat mass in kilograms, and decreased insulin resistance among candidates for bariatric surgery.

Immune checkpoint blockers (ICBs) have revolutionized the treatment of some solid cancers but have failed to benefit the majority of glioblastoma (GBM) patients. Two reasons underlying limited ICB benefit are: 1) immune-related adverse events, and 2) resistance conferred by the tumor microenvironment. Here, we show that ICBs induce cerebral edema in patients and GBM mouse models. This edema results from an inflammatory response to ICB treatment that disrupts the blood-tumor-barrier, as confirmed by intravital imaging, mechanistic blocking studies, and single-cell RNA sequencing. Losartan – a commonly prescribed antihypertensive agent – controls ICB-induced edema, reprograms the immunosuppressive tumor microenvironment, and improves survival under ICB therapy. In combination with a standard of care regimen in mice mimicking clinical treatment (surgical resection, chemoradiation), losartan increases the percent of long-term surviving (cured) mice under ICB therapy from 16% to 43%. Finally, a bihemispheric “resect-and-response” model to establish predictive biomarkers from the tumor microenvironment reveals that cured mice have an immunostimulatory (“hot”) immune tumor compartment prior to therapy. These results provide the basis for clinical testing of adding to losartan to ICB treatment for GBM patients.

When Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly “cot-to-cot” resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101)

Here, we present a one-dimensional, time-dependent multi-physics model of a plasma–liquid interface that encompasses both the plasma and liquid phases using the MOOSE-based drift–diffusion–reaction software, Zapdos-Crane. The model was applied to an experimental configuration comprised of a direct-current powered argon plasma formed at the surface of an aqueous, ionically conductive solution. In this system, one of the reactions that occurs is the formation of hydroxyl radicals, which subsequently produce hydrogen peroxide. We studied potential mechanisms for hydrogen peroxide production with the plasma operated as either the cathode or anode. Experiments were performed in support of modeling to characterize the plasma and measure the aqueous hydrogen peroxide, and both modeling and experimental results show that its production is substantially higher during anodic operation. In the case of the cathodic plasma, the simulations predict that solvated electrons degrade aqueous hydrogen peroxide, and in support, adding nitrate, a known electron scavenger, to the electrolyte during cathodic operation is shown to increase the production of aqueous hydrogen peroxide by an order of magnitude in experiments.

Background: Small intestinal neuroendocrine tumors (SI-NETs) are the most common neoplasms of the small bowel, accounting for 40% of all small intestinal malignancies. Previous high-throughput sequencing studies have shown that SI-NETs have a low somatic mutation rate. Loss of heterozygosity (LOH) at chromosome 18 is the most frequent genomic alteration identified, occurring in ~60% of tumors, and the only recurrent mutations reported to date are loss-of-function mutations in CDKN1B in ~10% of tumors. Most previous studies have focused on sequencing a single primary tumor from each SI-NET patient, even though up to 50% of the patients are diagnosed with multiple synchronous tumors. Thus, the mechanisms by which multifocal SI-NETs arise remain elusive. A better understanding of their tumorigenesis is essential for the optimal treatment of the patients. Materials and Methods: We performed a comprehensive genomic profiling of 75 de-identified synchronous primary tumors, 15 metastases, and 18 normal ileal mucosa and/or whole blood specimens from 13 patients with multifocal ileal NETs using whole genome sequencing. Results: We observed lack of shared somatic variation among the multifocal ileal NET patients and between the synchronous primary tumors within each patient, indicating that these tumors develop independently. Although recurrent copy-number alterations were identified, additional chromosome mapping revealed that tumors from the same patient can gain or lose different parental alleles. In addition to the previously reported CDKN1B loss-of-function mutations, we identified potential driver gene alterations in TNRC6B in a subset of ileal NETs. We also observed two different metastatic dissemination patterns among patients with multiple metastases. Metastases were either clonal or independent, originating from one or several primary tumors. Conclusions: Our study demonstrates notable genomic diversity among multifocal ileal NETs, which corroborates previous literature suggesting that these tumors originate independently. We identified potential loss-of-function mutations in TNRC6B, a candidate tumor suppressor gene in a small subset of ileal NETs. Identification of different metastatic dissemination patterns has an important clinical implication, highlighting the need to carefully remove all synchronous primary tumors of the entire jejunum and ileum at the time of surgery. Lastly, our results indicate that the tumorigenesis of multifocal ileal NETs is not exclusively driven by genomic alterations, suggesting that SI-NETs could be also driven by epigenetic mechanisms, or arise from morphologically normal small intestine as a result of field cancerization. Also, the tumor microenvironment in the ileum may play a role in the growth and development of SI-NETs. Citation Format: NETTA MÄKINEN, Meng Zhou, Zhouwei Zhang, Yosuke Kasai, Elizabeth Perez, Grace E. Kim, Chrissie Thirlwell, Eric Nakakura, Matthew Meyerson. Independent clonal origins of synchronous primary tumors in multifocal ileal neuroendocrine tumor patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 46.

Hemangioblastomas (HBs) are highly vascular tumors of the Central Nervous System that are commonly associated with the familial von Hippel-Lindau (VHL) disease and contribute significantly to the morbidity and mortality of VHL patients. They are characterized by high heterogeneity but the cell origin of HB tumors is still unclear, and the genomic landscape and signaling pathways underlying the tumor formation are unknown. We performed single-cell and single-nuclei RNA sequencing of cerebellar and spinal HBs surgically removed from VHL patients, in order to identify the lineage of the tumor cells and to profile the tumor microenvironment (TME). The percentage of VHL-/- tumor cells ranges from 8-80% of the cell population; the TME is reactive, contributing to a high percentage of the total tumor volume and playing a critical role in HB development. Single-cell and single-nuclei HB analysis provided significant insights into the cell of origin as well as the oncogenic pathways that drive the growth of HB. Whole exome sequencing (WES) in a cohort of HB patients revealed that biallelic VHL inactivation is necessary for the tumor formation of VHL disease-related HBs. Citation Format: Eumorphia Konstantakou, Elizabeth Perez, Alex Barbera, Nicholas Haradhvala, Marcello Stanzione, Fred Barker, Brian Nahed, Anat Stemmer-Rachamimov, Nick Dyson, Gad Getz, Mario Suva, Othon Iliopoulos. Dissecting the heterogeneity of central nervous system hemangioblastomas by single-cell and single-nuclei RNA sequencing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2287.

Background information The COVID-19 pandemic has influenced the global health care system. The institutional guidelines indicate that all surgical procedures require a negative COVID test within four days of surgery. Operating room (OR) delays/cancellations related to pending COVID results can lead to unnecessary waste of PPE resources. Additionally, it can cause undue emotional distress for the patient and family, which affects the patient experience. Objectives of Project The objective of this project was to reduce OR delays/cancellations related to COVID-19 testing. Process of implementation Perioperative guidelines and workflow on testing for COVID-19 prior to surgery was developed utilizing the institutional guidelines, based on Centers for Disease Control and Prevention (CDC) recommendations. A tracking tool was created to enter COVID-19 test information, starting from 6/15/2020. This data included information regarding test status, delays and cancellations. Testing appointments and pending results were reviewed throughout the day to ensure timely identification and interventions if the patients fell outside the COVID testing criteria. Communication to surgical and leadership teams were also completed to ensure proper follow up and escalation of processes. Statement of Successful Practice The development of a COVID-19 test tracking tool data indicates significant reduction of OR delay or cancellation. The overall data from June to August 2020 shows that COVID-19 pending tests have improved significantly from 6.8% to 0.2%. Of the pending results, the delay of surgical cases improved from 2.9% to 0.2%; and the cancellations of cases improved from 0.7% to 0.07%. Implications for perianesthesia nurses and future research Having a tracking tool provides perianesthesia nurses an opportunity to quickly identify COVID testing needs. This can have a positive impact on the patient experience during a pandemic and eliminate the waste of PPE, helping the organization to be financially responsible. The development of the perioperative guidelines is important in managing practice changes during a global pandemic.

In previous studies it was found that thymulin 5cH (thymic hormone) can modulate immune processes in several diseases. Additionally, the Antimonium crudum has used in dogs bearing leishmaniosis, according to the similia principle. We studied the inflammatory and immune modulation by thymulin 5CH and Antimonium crudum 30CH treatment in mice experimentally inoculated with Leishmania (L.) amazonensis. Male adult Balb/c mice were inoculated with Leishmania (2x105 promastigotes) into the footpad to induce inflammatory response and peritoneum and spleen cells were evaluated by flow cytometry after 60 days. Animals were divided in 3 groups (n=10): thymulin 5cH, Antimonium crudum 30cH and vehicle /control. Treatment was made in blind, daily, in water/alcohol 30% diluted 1:2500 in drinking water, during all experimental period. CD11b (activated phagocytes and B1 cells), CD19 (B1 cells and B2), CD4 and CD8 (effective T lymphocytes) markers were used to identify immune cells subsets in peritoneal washing fluid and spleen cell suspension. Mice treated with thymulin 5cH presented increase in peritoneal and spleen B1 stem cells (X2=0.0001) and higher CD8+/CD4+ ratio in spleen, regarding to the control. Also, Antimonium crudum 30CH induced a mild increase in B1 cells in peritoneum and spleen ( both X2, p=0.0001). Further histological analysis of the primary lesion will be done in the next step, to elucidate the impact of these findings in the disease evolution. The results show that both treatments stimulate B1 stem cell proliferation and suggest the cooperation of T spleen lymphocytes in the process.

Hypoxia, a hallmark of solid tumors, determines the selection of invasive and aggressive malignant clones displaying resistance to radiotherapy, conventional chemotherapy or targeted therapy. The recent introduction of immunotherapy, based on immune checkpoint inhibitors (ICPIs) and chimeric antigen receptor (CAR) T-cells, has markedly transformed the prognosis in some tumors but also revealed the existence of intrinsic or acquired drug resistance. In the current review we highlight hypoxia as a culprit of immunotherapy failure. Indeed, multiple metabolic cross talks between tumor and stromal cells determine the prevalence of immunosuppressive populations within the hypoxic tumor microenvironment and confer upon tumor cells resistance to ICPIs and CAR T-cells. Notably, hypoxia-triggered angiogenesis causes immunosuppression, adding another piece to the puzzle of hypoxia-induced immunoresistance. If these factors concurrently contribute to the resistance to immunotherapy, they also unveil an unexpected Achille’s heel of hypoxic tumors, providing the basis for innovative combination therapies that may rescue the efficacy of ICPIs and CAR T-cells. Although these treatments reveal both a bright side and a dark side in terms of efficacy and safety in clinical trials, they represent the future solution to enhance the efficacy of immunotherapy against hypoxic and therapy-resistant solid tumors., CR unit receives funding from the Italian Association of Cancer Research (AIRC; IG21408). ABSR unit is supported by Foundation for Science and Technology (FCT), Portugal (UID/NEU/04539/2019, UIDB/ 04539/2020 and UIDP/04539/2020). J.D.L.R. unit is funded by Fondo de Investigación Sanitaria—Instituto de Salud Carlos III (FIS—ISCIII, Ministry of Health of Spain; PI18/00591 and PT17/0009/0008) and by the FEDER European Union’s program. J.D.L.R. and C. R. are Vice-Chair and Chair of the COST-Action STRATAGEM (CA17104). All authors are members of STRATAGEM (CA17104).

Cancer is the second leading cause of death worldwide, with breast cancer one of the tumors with the highest incidence in Brazil, with an estimated 57,120 new cases in 2014. Several forms of treatment and control of cancer symptoms has been studied, among them homeopathy. In the Banerji clinic in India, doctors have used a protocol consisting of 4 homeopathic medicines with relevant results that motivated this study. In our research the Ehrlich tumor was used, a transplantable tumor cell, whose features are similar a breast carcinoma, as discovered in 1905 by Paul Ehrlich. Objective: To analyze the clinical and immunomodulatory Ehrlich tumor in mice treated with the homeopathic medications found in the Banerji Protocol and with thymulin 5CH. Methodology: The project was approved under protocol 158/13 of the Paulista University Ethics Committee. BALB / c mice between 6 and 9 weeks old were used. Each mouse was inoculated with 1x10 7 tumor cells into the peritoneum cavity, to obtain the ascitic form of tumor. Mice were divided in 5 groups (N=6 animals per group), being the following treatments: control treated with sterile water, Conium maculatum 200CH, Thuja occidentalis 200CH, Phytolacca decandra 200CH, Carcinosinum 200CH, every day being 0.1mL/10g body weight. The animals were weighed and the consumption of water and feed was measured daily. Clinical signals and body temperature were also registered daily. The survival of each group was also analyzed. Results: All groups presented reduction of body temperature one day before death. The peak of clinical symptoms in the majority of groups was in the D18, while Carcinosinum treated group had its peak in D29. The observed clinical symptoms were apathy, prostration, cyanosis, priapism, tachydyspnea, genital edema and secretion, decreased general activity, hair bristling and trembling. The control group had loose stools as unique symptom, seen in 20% of mice; the Carcinosinum treated group showed trembling as the sole symptom, that affected 20% of mice. The group treated with Conium maculatum showed higher incidence of clinical symptoms, involving up to 80% of mice, while the group treated with Carcinosinum showed lower incidence of clinical symptoms, affecting no more than 40% of mice, with weight reduction (reduction of ascites) and longer survival, when compared to the other groups. Conclusion: The results of the pilot study directed us to the second stage of the research, in which the histopathological and immunohistochemical observation will be assessed, being Carcinosinum the treatment chosen to this next step.

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Glioblastoma multiforme (GBM) is a poor prognosis type of tumour due to its resistance to chemo and radiotherapy. SOCS1 and SOCS3 have been associated with tumour progression and response to treatments in different kinds of cancers, including GBM. In this study, cell lines of IDH-wildtype GBM from primary cultures were obtained, and the role of SOCS1 and SOCS3 in the radiotherapy response was analysed. Fifty-two brain aspirates from GBM patients were processed, and six new cell lines of IDH-wildtype GBM were established. These new cell lines were characterized according to the WHO classification of CNS tumours. SOCS1 and SOCS3 expression levels were determined, at mRNA level by Q-PCR, at protein level by immunocytochemistry, and Western blot analysis. The results showed that SOCS1 and SOCS3 are overexpressed in GBM, as compared to a non-tumoral brain RNA pool. SOCS1 and SOCS3 expression were reduced by siRNA, and it was found that SOCS3 inhibition increases radioresistance in GBM cell lines, suggesting a key role of SOCS3 in radioresistant acquisition. In addition, radioresistant clonal populations obtained by selective pressure on these cell cultures also showed a significant decrease in SOCS3 expression, while SOCS1 remained unchanged. Furthermore, the induction of SOCS3 expression, under a heterologous promoter, in a radiotherapy resistant GBM cell line increased its radiosensitivity, supporting an important implication of SOCS3 in radiotherapy resistance acquisition. Finally, the treatment with TSA in the most radioresistant established cell line produced an increase in the effect of radiotherapy, that correlated with an increase in the expression of SOCS3. These effects of TSA disappeared if the increase in the expression of SOCS3 prevented with an siRNA against SOCS3. Thus, SOCS3 signal transduction pathway (JAK/STAT) could be useful to unmask new putative targets to improve radiotherapy response in GBM. This article has been funded by a grant from “Instituto de Salud Carlos III” (Grant PI012/02025), co-supported by FEDER funds, to M. Saceda; “Fundación ERESA” small project to M.Saceda, FISABIO grant (UGP-15-237) to V. M. Barberá, and a donation from AFECANCER to M.Saceda.

Los contratos inteligentes representan un aspecto importante de las cadenas de bloques. Su objetivo es complementar alos contratos tradicionales que implican modificaciones sobre los datos almacenados en la cadena. En este artículo sedefine una metodología para el diseño de contratos inteligentes y se ilustra su uso con un caso de estudio.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) can be associated with coagulopathy and a high incidence of thromboembolic events These events were associated with worse clinical outcomes, especially in critically ill patients Our study investigated the safety of full dose anticoagulation (AC), in ventilated, predominantly Black patients with COVID-19 infection METHODS: This is a retrospective observational study based on a chart review of patients admitted to the University Hospital of Brooklyn in New York City from March 23rd through April 23rd, 2020 Inclusion criteria included age ≥ 18 years, confirmed COVID-19 infection, and need for mechanical ventilation The variables collected included demographics, comorbidities, laboratory results, type of anticoagulation, and Sepsis- Induced Coagulopathy (SIC) score RESULTS: A total of 48 hospitalized patients met the inclusion criteria 41 (85 4%) were Black, 26 (54%) were males, 22 (46%) were females, and the average age was 68 years Average days on mechanical ventilation was 13 6 days D-Dimer was elevated in all patients, with an average of 5 8 mcg/ml Almost all patients (47/48) had elevated SIC score, defined as SIC score of 2 or above AC agent used was Heparin in 13 patients (27 1%), low molecular weight heparin (LMWH) in 12 (25%), direct oral anticoagulants (DOAC) in 8 (16 7%), and multiple AC agents in 15 (31 3%) AC was stopped because of major bleed in 5 patients Overall mortality was 62 5% AC discontinuation was not associated with increased overall mortality (Pearson Chi-Square= 0 228;p=0 633) CONCLUSIONS: Our study showed that full dose anticoagulation was administered in high risk ICU patients with COVID-19 infection, and significantly elevated D-Dimer level and SIC score Most patients received heparin or LMWH, or a combination of heparin products with transition to DOAC However only 5 patients had a major bleed, that was not a significant contributor to overall mortality Based on our results, administration of full dose anticoagulation in ventilated predominantly black patients with COVID-19 infection, was overall safe and well tolerated

Low-income populations are disproportionately affected by hepatitis C virus (HCV) infection. Thus, implementing baby boomer screening (born 1945-1965) for HCV may be a high priority for safety net hospitals. We report the prevalence and predictors of HCV infection and advanced fibrosis or cirrhosis based on the Fibrosis-4 score plus imaging for a baby boomer cohort admitted to a safety net hospital over a 21-month interval with >9 months of follow-up. Anti-HCV antibody testing was performed for 4582, or 90%, of all never-screened patients, of whom 312 (6.7%) tested positive. Adjusted odds ratios of testing anti-HCV-positive were 2.66 for men versus women (P

BACKGROUND/OBJECTIVE The US Preventive Services Task Force recommends 1-time hepatitis C virus (HCV) screening of all baby boomers (born 1945–1965). However, little is known about optimal ways to implement HCV screening, counseling, and linkage to care. We developed strategies following approaches used for HIV to implement baby boomer HCV screening in a hospital setting and report results as well as costs. DESIGN/PATIENTS Prospective cohort of 6140 baby boomers admitted to a safety-net hospital in South Texas from December 1, 2012 to January 31, 2014 and followed to December 10, 2014. PROCEDURES/MEASUREMENTS The HCV screening program included clinician/staff education, electronic medical record algorithm for eligibility and order entry, opt-out consent, anti-HCV antibody test with reflex HCV RNA, personalized inpatient counseling, and outpatient case management. Outcomes were anti-HCV antibody-positive and HCV RNA–positive results. RESULTS Of 3168 eligible patients, 240 (7.6%) were anti-HCV positive, which was more likely (P 80% to follow-up care. Yet access to therapy is challenging for largely uninsured populations, and most programmatic costs of the program are not currently covered. Journal of Hospital Medicine 2015;10:510–516. © 2015 Society of Hospital Medicine

Microorganisms may colonize needleless connectors (NCs) on intravascular catheters, forming biofilms and predisposing patients to catheter-associated infection (CAI). Standard and silver-coated NCs were collected from catheterized intensive care unit patients to characterize biofilm formation using culture-dependent and culture-independent methods and to investigate the associations between NC usage and biofilm characteristics. Viable microorganisms were detected by plate counts from 46% of standard NCs and 59% of silver-coated NCs ( P = 0.11). There were no significant associations ( P > 0.05, chi-square test) between catheter type, side of catheter placement, number of catheter lumens, site of catheter placement, or NC placement duration and positive NC findings. There was an association ( P = 0.04, chi-square test) between infusion type and positive findings for standard NCs. Viable microorganisms exhibiting intracellular esterase activity were detected on >90% of both NC types ( P = 0.751), suggesting that a large percentage of organisms were not culturable using the conditions provided in this study. Amplification of the 16S rRNA gene from selected NCs provided a substantially larger number of operational taxonomic units per NC than did plate counts (26 to 43 versus 1 to 4 operational taxonomic units/NC, respectively), suggesting that culture-dependent methods may substantially underestimate microbial diversity on NCs. NC bacterial communities were clustered by patient and venous access type and may reflect the composition of the patient's local microbiome but also may contain organisms from the health care environment. NCs provide a portal of entry for a wide diversity of opportunistic pathogens to colonize the catheter lumen, forming a biofilm and increasing the potential for CAI, highlighting the importance of catheter maintenance practices to reduce microbial contamination.

Clostridium difficile is a challenging infection that can be difficult to treat with antibiotic therapy. This chapter outlines the processing material for fecal microbiota transplantation (FMT), also known as stool transplant. Fecal transplantations are effective in treating recurrent C. difficile infection (CDI). FMT uses a stool sample collected from a healthy, screened donor to restore healthy microbiota in the colon of a patient with CDI for symptom resolution. Here, we describe a rapid method for FMT preparation that uses inexpensive and disposable materials.