A clinical prediction rule for fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection

Data from a case-control study were used to derive and internally validate a prediction rule for identifying fluoroquinolone resistance in healthcare-acquired gram-negative urinary tract infection. This prediction rule has an excellent sensitivity and specificity (C-statistic, 0.816). External validation is necessary before implementing this rule to optimize empirical antibiotic use in clinical practice.     

Strategies towards simpler configuration and higher peak capacity with comprehensive multidimensional gas chromatography

Experimental and data analysis approaches in multidimensional gas chromatography (MDGC) comprising comprehensive multiple heart-cut (H/C) and comprehensive two dimensional GC (GC × GC) were developed with an example application illustrated for analysis of a technical glycol precursor sample. The GC × GC system employed a long ¹D (30 m) and a short ²D (5 m) column with a flow modulator and a Deans switch (DS) as a splitter; meanwhile. The H/C system was applied solely as a DS located between long ¹D (30 m) and ²D (60 m) columns without use of cryogenic trapping devices. The effects of injection time and ²D column flow in GC × GC and the impacts of H/C window and number of injections (total analysis time) in H/C analysis were investigated. The analysis performance for each condition was evaluated according to peak capacity and number of separated compounds. The continuum between the two techniques was then established via the relationship between analysis time and analysis performance. The separation performances were improved with longer analysis time so that the suitable condition was selected within this compromise. Under the selected conditions, volatile compounds in the technical glycol precursor sample were identified according to the match between the experimental MS spectra and first dimensional retention indices (¹I) with that from the NIST2014 database and literature. An hour analysis with GC × GC resulted in a total peak capacity of 798, number of separated peaks of 61 and average MS match score of 887 ± 35; meanwhile, the corresponding numbers were improved to be 9198, 107 and 898 ± 24, respectively, with the 25 h comprehensive H/C analysis.

Experimental and data analysis approaches in MDGC comprising comprehensive H/C and GC × GC were developed with an example application illustrated for analysis of a technical glycol precursor sample.     

Sleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes

ObjectiveThe objective of the present study was to investigate the relationship between sleep insufficiency and sleep duration, particularly regarding negative cardiometabolic health outcomes already considered to be affected by reduced sleep time.MethodsA total of N = 30,934 participants from the 2009 Behavioural Risk Factor Surveillance System (BRFSS) answered questions about their sleep duration as well as subjective feelings of sleep insufficiency. Outcomes included body mass index (BMI), obesity (BMI ? 30 kg m^?2) and history of hypertension, diabetes, hypercholesterolaemia, heart attack and stroke. Linear and logistic regression models examined whether cardiometabolic outcomes were associated with (1) sleep duration alone, (2) sleep insufficiency alone and (3) the combined effect of sleep duration and sleep insufficiency.ResultsResults indicated that, when examined alone, sleep duration <5 h (versus 7 h) was related to BMI (B = 2.716, p < 0.01), obesity (B = 2.080, p < 0.000001), diabetes (B = 3.162, p < 0.000001), hypertension (B = 2.703, p < 0.000001), hypercholesterolaemia (B = 1.922, p < 0.00001), heart attack (B = 4.704, p < 0.000001) and stroke (B = 4.558, p < 0.000001), and sleep insufficiency (days per week, continuous) was related to BMI (B = 0.181, p < 0.01), obesity (B = 1.061, p < 0.000001) and hypercholesterolaemia (B = 1.025, p < 0.01). All of these relationships remained significant after adjustment for covariates, except for diabetes and sleep duration. Also, after adjustment, a significant relationship between insufficient sleep and hypertension emerged (B = 1.039, p < 0.001). When evaluated together, after adjustment for covariates, significant relationships remained between sleep duration <5 h (versus 7 h) and BMI (B = 1.266, p < 0.05), obesity (B = 1.389, p < 0.05), hypertension (B = 1.555, p < 0.01), heart attack (B = 2.513, p < 0.01) and stroke (B = 1.807, p < 0.05). It should be noted that relationships between sleep duration >9 h (versus 7 h) were seen for heart attack (B = 1.863, p < 0.001) and stroke (B = 1.816, p < 0.01). In these models, sleep insufficiency was associated with hypercholesterolaemia (B = 1.031, p < 0.01) and hypertension (B = 1.027, p < 0.05).ConclusionsThese analyses show that both sleep duration and insufficiency are related to cardiometabolic health outcomes, and that when evaluated together, both variables demonstrate unique effects.     

Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: A split‐scar,evaluator‐blinded study

Background/Objectives

Despite precise surgical technique, some postoperative facial scars will depress and widen over time, likely due to weakened or inadequately replaced collagen fibers in the underlying dermis. The purpose of this study is to evaluate whether a 10,600 nm ablative carbon dioxide (CO₂) fractional laser used early in the post‐surgical setting results in improved postoperative facial scars after a single treatment session.

Study Design

A prospective randomized, comparative split‐scar study was conducted on 20 subjects between the ages of 20–90. Subjects underwent Mohs surgery for nonmelanoma skin cancer of the face. Subsequent to tumor removal, subjects with a linear scar of 4 cm or greater were enrolled. On the day of suture removal, all subjects had one‐half of their scar randomly selected and treated with a 10,600 nm CO₂ fractional laser (energy = 10 mJ; density = 10%; spot size = 7 mm; pulse = 1). The untreated scar half served as a control. Scars were re‐evaluated 12 weeks later. An independent blinded observer graded the scar halves with the Vancouver scar scale (VSS) immediately prior to treatment and 12 weeks after treatment. Subjects completed a visual analog scale (VAS) at the same time points.

Results

Three months after laser treatment, a significant decrease in VSS and 3 of the 4 of its individual parameters were detected in both control and treated halves of the scar. When comparing the laser group versus the control group, a statistically significant difference was not noted in VSS (P = 0.31) but a statistically significant difference in patient VAS was detected (P = 0.002). No side effects of the laser treatment were noted.

Conclusion

Facial wounds sutured in a layered manner heal well. Patients prefer early fractional CO₂ lasing of surgical scars, though use of the VSS failed to detect an objective difference between laser and control halves of scars. Conservative laser settings, a single session treatment, and VSS insensitivity for surgical scars may influence these findings. Lasers Surg. Med. 47:1–5, 2015. © 2015 Wiley Periodicals, Inc.