Can industrial laundry remove Bacillus cereus from hospital linen?

Contaminated hospital linen has caused some cases of Bacillus cereus bacteremia in Japan. We analyzed the disinfection efficacy of industrial washing of hospital towels and sheets by counting the number of B. cereus on linen before and after washing. That before washing averaged 7.6 cells/cm2 on unwashed sheets, decreasing to 1.2 cells/cm2 after washing. That on unwashed towels, however, averaged 10(6) cells/cm2 before washing and 1096 cells/cm2 after washing, which was very high and suggested the possibility of causing nosocomial infection.     

In vivo study of myocardial elastography under graded ischemia conditions

The capability of currently available echocardiography-based strain estimation techniques to fully map myocardial abnormality at early stages of myocardial ischemia is yet to be investigated. In this study, myocardial elastography (ME), a radio-frequency (RF)-based strain imaging technique that maps the full 2D transmural angle-independent strain tensor in standard echocardiographic views at both high spatial and temporal resolution is presented. The objectives were to (1) evaluate the performance of ME on mapping the onset, extent and progression of myocardial ischemia at graded coronary constriction levels (from partial to complete coronary flow reduction), and (2) validate the accuracy of the strain estimates against sonomicrometry (SM) measurements. A non-survival canine ischemic model (n = 5) was performed by gradually constricting the left anterior descending (LAD) coronary blood flow from 0% (baseline blood flow) to 100% (zero blood flow) at 20% increments. An open-architecture ultrasound system was used to acquire RF echocardiograms in a standard full short-axis view at the frame rate of 211 fps, at least twice higher than what is typically used in conventional echocardiographic systems, using a previously developed, fully automated composite technique. Myocardial deformation was estimated by ME and validated against sonomicrometry. ME estimates and maps transmural (1) 2D displacements using RF cross-correlation and recorrelation; and (2) 2D polar (radial and circumferential) strains, derived from 2D (i.e. both lateral and axial) displacement components, at high accuracy. Full-view strain images were shown and found to reliably depict decreased myocardial function in the region at risk at increased levels of coronary flow reduction. The ME radial strain was deemed to be a more sensitive, quantitative, regional measure of myocardial ischemia as a result of coronary flow reduction when compared to the conventional wall motion score index and ejection fraction. Good agreement (0.22% strain bias, 95% limits of agreement) using Bland-Altman analysis and good correlation (r = 0.84) were found between the ME and SM measurements. These findings demonstrate for the first time that ME could map angle-independent strains to non-invasively detect, localize and characterize the early onset of myocardial ischemia, i.e. at 40%, and possibly as low as 20%, LAD flow reduction, which could be further associated with the severity of coronary stenosis.     

Dried culture spots for Xpert MTB/RIF external quality assessment: results of a phase 1 pilot study in South Africa

Implementation of Xpert MTB/RIF requires quality assessment. A pilot program using dried culture spots (DCSs) of inactivated Mycobacterium tuberculosis is described. Of 274 DCS results received, 2.19% generated errors; the remainder yielded 100% correct Mycobacterium tuberculosis detection. The probe A cycle threshold (C(T)) variability of three DCS batches was ≤ 3.47. The study of longer-term DCS stability is ongoing.     

Successful utilization of coronary covered stents to treat a common hepatic artery pseudoaneurysm secondary to pancreatic fistula after Whipple’s procedure: Report of a case

A 73-year-old man underwent a pylorus-preserving Whipple’s procedure for distal cholangiocarcinoma. His postoperative course was complicated by the formation of a pancreatic fistula, which was initially managed conservatively. On postoperative day (POD) 86, he lost 100 ml of blood from the site of the pancreatic fistula. Contrast-enhanced computed tomography (CT) showed a pseudoaneurysm, 12 mm in diameter, in the common hepatic artery. The diameter of the pseudoaneurysm increased to 15 mm on POD 89, so we implanted coronary covered stents to prevent massive bleeding from rupture and to retain hepatic arterial flow. Six days after implantation, computed tomography findings confirmed a thrombosed pseudoaneurysm as well as patent hepatic arterial flow. Follow-up CT 18 months after surgery showed patent hepatic arterial flow. There have been no signs of rebleeding or abnormal liver function.     

A developmental study of the structural integrity of white matter in autism

Diffusion tensor imaging was used to examine developmental changes in the organization of white matter in a large sample of male participants with autism and controls between the ages of 10 and 35 years. Participants with autism had lower fractional anisotropy in areas within and near the corpus callosum and in the right retrolenticular portion of the internal capsule. Only one area, in the posterior limb of the right internal capsule, showed an interaction between age and group. The findings suggest that reductions in the structural integrity of white matter in autism persist into adulthood. These reductions may underlie the behavioral pattern observed in autism, as well as findings of reduced functional connectivity in functional magnetic resonance imaging signal between activating cortical areas.     

Effect of pharmaceutical wastewater as nitrogen source on the optimization of simultaneous saccharification and fermentation hydrogen production from paper mill sludge

This study modeled and optimized a novel simultaneous saccharification and fermentation (SSF) dark fermentative hydrogen production system using pharmaceutical wastewater (PW) as a nitrogen source to obtain a suitable C/N for paper mill sludge (PMS). Optimized hydrogen yields of 54.8, 53.6 and 39.3 mL/g PMS were obtained using PW, yeast extract and ammonium nitrate as the nitrogen source, respectively, using the developed models. The process kinetics were evaluated against yeast extract and ammonium nitrate, using the modified Gompertz model. SSF production generated a slightly lower hydrogen yield than yeast extract, of 54.8 mL/g PMS, and a peak hydrogen gas fraction of 45.6% when using PW. Optimized processes showed that PW gave comparable kinetic data, shown in a 3.3 h variation in process lag time between PW and yeast extract and an 8.7% increase in maximum potential hydrogen production rate when PW was used in place of ammonium nitrate. Implications from this study suggest that using waste to enhance the beneficiation and treatment of waste PMS could significantly reduce the time and costs associated with its valorization.     

Theory of Mind disruption and recruitment of the right hemisphere during narrative comprehension in autism

The intersection of Theory of Mind (ToM) processing and complex narrative comprehension in high functioning autism was examined by comparing cortical activation during the reading of passages that required inferences based on either intentions, emotional states, or physical causality. Right hemisphere activation was substantially greater for all sentences in the autism group than in a matched control group suggesting decreased LH capacity in autism resulting in a spillover of processing to RH homologs. Moreover, the ToM network was disrupted. The autism group showed similar activation for all inference types in the right temporo-parietal component of the ToM network whereas the control participants selectively activated this network only when appropriate. The autism group had lower functional connectivity within the ToM network and also between the ToM and a left hemisphere language network. Furthermore, the within-network functional connectivity in autism was correlated with the size of the anterior portion of the corpus callosum.     

Endoscopy-assisted subcutaneous mastectomy and immediate breast reconstruction for breast cancer: advantage of the posterior approach

In the past few years, endoscopic surgery has been applied to breast surgery to minimize the wound. We have performed endoscopic-assisted subcutaneous mastectomy and immediate breast reconstruction (EASM-IBR) since 2002. In later cases of EASM-IBR, we used a posterior approach to the breast tissue. EASM-IBR was performed in 21 cases. Ten patients underwent EASM by the advanced skin flap method, and 11 patients underwent EASM by the posterior approach. Surgical duration was 251 and 216 minutes, respectively. Intraoperative blood loss was 294 and 238 ml, respectively. Surgical duration tended to be shorter, and there was less bleeding with the posterior approach than with the advanced skin flap method. In the posterior approach, breast tissue is fully retracted through the wound as the dissection advances. It is a useful method for video-assisted surgery.