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Study design: retrospective case series. Objective: the presenting clinical symptoms of spinal infections are often nonspecific and a delay in diagnosis can lead to adverse patient outcomes. The morbidity and mortality of patients with multifocal spinal infections is significantly higher compared to unifocal infections. The purpose of the current study was to analyse the risk factors for multifocal spinal infections. Methods: we conducted a retrospective review of all pyogenic non-tuberculous spinal infections treated surgically at a single tertiary care medical center from 2006-2020. The medical records, imaging studies, and laboratory data of 43 patients during this time period were reviewed and analysed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection. Results: 15 patients (35 %) had multifocal infections. In univariate analysis, there was a significant association with chronic kidney disease ( p = 0.040 ), gender ( p = 0.003 ), a white blood cell count ( p = 0.011 ), and cervical ( p < 0.001 ) or thoracic ( p < 0 .001) involvement. In multivariate analysis, both cervical and thoracic involvement remained statistically significant ( p = 0.001 and p < 0.001 , respectively). Conclusions: patients with infections in the thoracic or cervical region are more likely to have a multifocal infection. Multifocal pyogenic spinal infections remain a common entity and a total spine MRI should be performed to aid in prompt diagnosis.

Study design: retrospective case series. Objective: the presenting clinical symptoms of spinal infections are often nonspecific and a delay in diagnosis can lead to adverse patient outcomes. The morbidity and mortality of patients with multifocal spinal infections is significantly higher compared to unifocal infections. The purpose of the current study was to analyse the risk factors for multifocal spinal infections. Methods: we conducted a retrospective review of all pyogenic non-tuberculous spinal infections treated surgically at a single tertiary care medical center from 2006–2020. The medical records, imaging studies, and laboratory data of 43 patients during this time period were reviewed and analysed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection. Results: 15 patients (35 %) had multifocal infections. In univariate analysis, there was a significant association with chronic kidney disease (p=0.040), gender (p=0.003), a white blood cell count (p=0.011), and cervical (p) or thoracic (p.001) involvement. In multivariate analysis, both cervical and thoracic involvement remained statistically significant (p=0.001 and p, respectively). Conclusions: patients with infections in the thoracic or cervical region are more likely to have a multifocal infection. Multifocal pyogenic spinal infections remain a common entity and a total spine MRI should be performed to aid in prompt diagnosis.

Objective: The study explores caregiver perceptions of home programs for clients with acquired brain injury based on current clinical care after transition to the community. Design: A qualitative descriptive study. Setting: Within the community, post inpatient rehabilitation. Participants: A convenience sample of eight caregivers of clients with acquired brain injury from one clinical site. All participants spoke English, were between the ages of 18 and 85 years, had no neurodegenerative disorders, and self-identified as caregivers. Procedures: Two nested semi-structured interviews were completed post-discharge from an inpatient rehabilitation facility. All interviews were audio recorded and transcribed. Qualitative data analysis was performed utilizing MAXQDA© software, consensus coding, and abstraction of themes. Results: Two themes with subsequent subthemes were identified: (1) Systems, Roles, and Responsibilities Influenced Caregivers' Perceptions of Home Program and Recovery Outlook and (2) Caregivers' Home Program Experience. The first theme addresses topics of caregiver roles and responsibilities, system supports and barriers, and their general outlook on recovery. Within the second theme, results provide a chronological description of home program training, use, and modification. Conclusions: A caregiver's outlook on the care receiver's recovery and home program implementation is influenced by the burden of responsibilities, and system-level supports and barriers. The home program experience of the caregivers was reported to involve limited but satisfactory training. Caregivers saw the value in home programs and advised others to engage in them. Future programs should encourage healthcare providers to provide explicit instruction to the caregiver about their intrinsic value to home program implementation and adherence. [ABSTRACT FROM AUTHOR]

Currently, the problem of the development of resistance to drugs among microorganisms that colonize the urogenital system is becoming especially relevant due to broadly distributed dysbiotic conditions of the reproductive system of men and women. Therefore, there should be constant monitoring of the qualitative and quantitative composition of microbiota of the urogential tract and determination of the levels of antibiotic-resistance of strains of conditionally pathogenic microorganisms in the reproductive system of various layers of the population. We monitored 774,375 people of various age and sex – patients of the independent diagnostic laboratory INVITRO in the city Dnipro in 2017–2019. Among the examined people, 640,783 of the patients were diagnosed with the development of dysbiotic disorders, accounting for 82.7% of the total amount of the applications for medical help. According to the results of identification of the range of dysbiotic conditions of the urogenital system of patients of different ages and sexes, we determined the dominating role of facultative anaerobes in the development of dysbiotic impairments caused by colonizations by large numbers of conditionally-pathogenic microorganisms: in women, Gardnerella accounted for 86.1%, Staphylococcus – 63.2%, Streptococcus – 54.1%, Candida – 69.3%; in men, Streptococcus were found in 83.0%, Staphylococcus – 79.4%, Corynebacterium – 54.2% and Candida – 37.6% of the cases. Share of obligate anaerobes was also quite large: women were diagnosed with Prevotella in 59.7%, Peptostreptococcus in 53.2%, Fusobacterium in 45.4% of the cases cases; men were observed to have Peptostreptococcus 62.4%, Clostridium in 54.3%, Bacteroides in 32.5% of the cases. We determined high parameters of frequency of diagnosing antibiotic-resistant isolates of conditionally pathogenic microorganisms that circulate in the urogenital tract of patients with dysbiotic impairments, belonging to the following families: Mycoplasmataceae – 78.6%, Enterobacteriaceae – 56.0% and genera – Staphylococcus – 76.1%, Gardnerella – 24.3%, Corynebacterium – 21.2%. The research revealed increase in the frequency of detection of strains of urapathogenic bacteria resistant to the applied antibiotic preparations in 2018–2019 compared with the data of 2017: increases of 10.3% and 6.4% in representatives of family Mycoplasmataceae resistant to ciprofloxacin and ofloxacin respectively, 4.8% and 4.0% in Enterobacteriaceae resistant to chloramphenicol and ampicillin respectively, and 8.9% in the genus Staphylococcus resistant to vancomycin.

This article presents an evidence-based strategy to assist academic fieldwork coordinators and capstone coordinators with meeting the Accreditation Council for Occupational Therapy Education standards of experiential learning components in an entry-level doctoral occupational therapy curriculum. The S.E.L.F. approach core methods for pedagogical framework and manual development are based on systems theory and educational learning theories. To optimize fieldwork and capstone delivery, the recommended process should include organizational analysis, program development, manual writing, and implementation of practical learning experience. Objectives of the fieldwork and capstone experiences can effectively connect to the overall curriculum design while addressing integral credentialing standards through an evidence-based approach. The applied learning theories are pertinent for educators to objectively deliver beneficial experiential pedagogical outcomes for student professional growth. This article provides a logical fieldwork and capstone framework for pedagogical and manual development. The S.E.L.F. approach transforms learning to meet objectives of the occupational therapy program, students, and other potential audience stakeholders.

Adhesion is the major stage of interaction of microorganisms with macroorganism, important factor with the help of which microflora colonizes different biotypes of macroorganism, thus providing colonization resistance, preventing adhesion and pathogenic invasion. In our study data about adhesive features of Aerococcus viridans autophytes of rats, mice and human are presented. Aerococcus viridans autosymbionts have higher performances of adhesion in the condition of heteroadhesion. Among performance of homoadhesionthe highest microorganisms adhesive index (MAI) was in human autosymbionts – 5,78±0,04, in rats – 4,49±0,06 and mice – 4,29±0,04. On the account of greater adhesive features, using of autosymbionts of Aerococcus viridans theoretically can be justified for correction of disbiotic conditions of a human and animals, this requires further study.

Adhesion is the major stage of interaction of microorganisms with macroorganism, important factor with the help of which microflora colonizes different biotypes of macroorganism, thus providing colonization resistance, preventing adhesion and pathogenic invasion. In our study data about adhesive features of Aerococcus viridans autophytes of rats, mice and human are presented. Aerococcus viridans autosymbionts have higher performances of adhesion in the condition of heteroadhesion. Among performance of homoadhesion the highest microorganisms adhesive index (MAI) was in human autosymbionts – 5,78±0,04, in rats – 4,49±0,06 and mice – 4,29±0,04. On the account of greater adhesive features, using of autosymbionts of Aerococcus viridans theoretically can be justified for correction of disbiotic conditions of a human and animals, this requires further study.

Author(s): Luciano G Martelotto [1]; Timour Baslan [2, 3]; Jude Kendall [2]; Felipe C Geyer [1]; Kathleen A Burke [1]; Lee Spraggon [1]; Salvatore Piscuoglio [1]; Kalyani Chadalavada [4]; Gouri [...], A substantial proportion of tumors consist of genotypically distinct subpopulations of cancer cells. This intratumor genetic heterogeneity poses a substantial challenge for the implementation of precision medicine. Single-cell genomics constitutes a powerful approach to resolve complex mixtures of cancer cells by tracing cell lineages and discovering cryptic genetic variations that would otherwise be obscured in tumor bulk analyses. Because of the chemical alterations that result from formalin fixation, single-cell genomic approaches have largely remained limited to fresh or rapidly frozen specimens. Here we describe the development and validation of a robust and accurate methodology to perform whole-genome copy-number profiling of single nuclei obtained from formalin-fixed paraffin-embedded clinical tumor samples. We applied the single-cell sequencing approach described here to study the progression from in situ to invasive breast cancer, which revealed that ductal carcinomas in situ show intratumor genetic heterogeneity at diagnosis and that these lesions may progress to invasive breast cancer through a variety of evolutionary processes.

Infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) are on a constant rise and are a noted cause of outbreaks in neonatal intensive care units (NICUs). We used whole genome sequencing (WGS) to investigate the epidemiology of consecutive and overlapping outbreaks caused by ESBL-KP in NICUs in three hospitals in close proximity. Clonality of 43 ESBL-KP isolates from 40 patients was determined by BOX-PCR. Short-read sequencing was performed on representative isolates from each clone. The dominant clones from each NICU were sequenced using long-read sequencing. Bioinformatics methods were used to define multilocus sequence type (MLST), analyze plasmid content, resistomes, and virulence factors. In each NICU, we found a unique dominant clone (ST985, ST37, and ST35), each belonging to a distinct sequence type (ST), as well as satellite clones. A satellite strain in NICU-2 (ST35) was the dominant strain in NICU-3, where it was isolated four weeks later, suggesting transmission. NICU-1- and NICU-2-dominant strains had blaCTX-M-15 carried on a similar transposable element (Tn3-ISEcp1) but at different locations: on a plasmid and on the chromosome, respectively. We concluded that the overlapping ESBL-KP outbreaks were a combination of clonal transmission within NICUs, possible transposable element transmission between NICUs, and repeated importation of ESBL-KP from the community.

In this research the data on examination of antagonist qualities of bioassotiantes A. viridans and strain B. subtilis 3 towards pathogenic and opportunistic pathogenic microflora isolated from oropharynx and nasopharynx of children who were in contact with patients with pulmonary tuberculosis (MBT +) are submitted. The expressed antagonist activity of autosimbionts A. viridans towards pathogenic and opportunistic pathogenic microflora was shown. Common antagonist activity of A. viridans (k) N 1 and B. subtilis 3 towards diverse strains of test-cultures is 1,5-2 times higher, than separate antagonist activity of A. viridans (k) №1 and B. subtilis 3. Received research data showed the possibility of continuing work on development of probiotic associations, that contain representatives of normal microflora - bioassociants A. viridans and probiotic strains B. subtilis 3 with broadspectrum of antagonistic activity in relation to the various groups of bacterium.

In this research the data on examination of antagonist qualities of bioassotiantes A. viridans and strain B. subtilis 3 towards pathogenic and opportunistic pathogenic microflora isolated from oropharynx and nasopharynx of children who were in contact with patients with pulmonary tuberculosis (MBT +) are submitted. The expressed antagonist activity of autosimbionts A. viridans towards pathogenic and opportunistic pathogenic microflora was shown. Common antagonist activity of A. viridans (k) N 1 and B. subtilis 3 towards diverse strains of test-cultures is 1,5-2 times higher, than separate antagonist activity of A. viridans (k) №1 and B. subtilis 3. Received research data showed the possibility of continuing work on development of probiotic associations, that contain representatives of normal microflora - bioassociants A. viridans and probiotic strains B. subtilis 3 with broadspectrum of antagonistic activity in relation to the various groups of bacterium.

Dysbioses of the gastrointestinal tract are common among people of all ages and genders. Development of this pathology is associated with a number of complications, from indigestion to occurrence of malignant disease. Therefore, there is a need in development of measures of their prevention and correction. Probiotics are used as drugs against dysbiosis. Most of the presently known probiotics contain bacterial cells of one species, although combination preparations feature higher efficiency. At the same time, there are difficulties in construction of these drugs, primarily due to incompatibility of physiological properties of microorganisms and mutually antagonistic action of their components. The aim was to examine the compatibility of Bacillus subtilis and Aerococcus viridans in a single preparation, their antagonistic activity against different strains of test-cultures and general antagonism directed on different groups of bacteria for subsequent formation of associative probiotic complex. Properties of aerococci strains were studied and A. viridans 167 strain was selected for inclusion into the probiotic preparation. The tested strain showed the highest indicators of production of hydrogen peroxide, which is one of the mechanisms of antagonistic effect against opportunistic pathogens. General study of biological properties of aerococci strains showed that producing of hydrogen peroxide and superoxide radical in them was conditioned by functioning of NAD-independent lactatoxidase. It has been determined that antioxidant defense of aerococci from the action of endogenous and active excretable forms of oxygen was provided by activity of superoxide-dismutase and GSH-peroxidase. The method of deferred antagonism found no depressing mutual action between probiotic strains of B. subtilis 3 and A. viridans 167 at their joint cultivation. Inhibition of growth at the joint application of A. viridans 167 and B. subtilis 3 strains was recorded for both museum and clinical strains of test-cultures Escherichia coli, Proteus vulgaris, Klebsiella ozaenae, Citrobacter freundii, Pseudomonas aeruginosa, Staphylococcus aureus, S. epidermidis, Candida albicans. Separate application of A. viridans 167 or B. subtilis 3 against strains of these opportunistic pathogens was characterized by relatively less antagonistic effect of each of strains under study. The results allow us to recommend the studied strains of B. subtilis 3 and A. viridans 167 for use as the components to construct a new associative probiotic preparation.