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Objectives/hypothesis To examine the pathogenic bacterial spectra and prognosis of deep neck infection (DNI) in end-stage renal disease (ESRD) patients. Study design Retrospective study. Methods Patients diagnosed with DNI between 2004 and 2015 in Chang Gung Memorial Hospital were enrolled and divided into three groups, namely ESRD-DNI, chronic kidney disease (CKD)-DNI, and non-CKD-DNI. Differences in pathogenic bacteria, treatment, and prognosis were compared across the three groups. Results The bacterial spectra differed among the three groups. The main three facultative anaerobic or aerobic bacteria causing ESRD-DNIs were methicillin-resistant Staphylococcus aureus (MRSA; 25.4%), methicillin-susceptible S. aureus (MSSA; 14.1%), and Klebsiella pneumoniae (KP; 12.7%). For CKD-DNIs, they were KP (23.5%), Viridans streptococci (VS; 23.5%), and MSSA (14.7%). For non-CKD-DNIs, they were VS (31.7%), KP (17.2%), and coagulase-negative staphylococci (8.0%). Compared with the other groups, the ESRD-DNI group had higher white blood cell and C-reactive protein levels, longer hospital stays, more frequent admissions to the intensive care unit, more mediastinal complications, and a significantly higher mortality rate. Conclusions The ESRD-DNI group exhibited more severe disease activity and higher mortality compared with those of the CKD-DNI and non-CKD-DNI groups. MRSA was the leading pathogen for patients with ESRD-DNI. Physicians must implement strategies for the early detection of MRSA to accurately prescribe antibiotics and prevent nosocomial transmission. Level of evidence 4 Laryngoscope, 2021.

Retrospective review for conducted for four years (period I, without an ID physician, December 2001 to December 2005) and 15 years (period II, with an ID physician, January 2006 to March 2021). In period II, the hospital-wide computerized antimicrobial approval system (HCAAS) was also implemented. A pretest-posttest time series analysis compared the two periods. Differences in clinical outcomes, demographics, comorbidities, signs and symptoms, laboratory findings,There were 19 patients in period I and 53 patients in period II. Patients had a lower rate of amputation or mortality in period II (35.8%) compared with period I (63.2%). Forty-four patients (61.1%) had polymicrobial infections. In the emergency room, the rate of misdiagnosis decreased from 47.4% in period I to 28.3% in period II, while effective empiric antibiotic usage increased from 21.1% in period I to 66.0% in period II. After the ID physician's adjustment, 69.4% received monotherapy in period II compared to 33.3% in period I.Because

The roundhouse kick is one of the most widely applied techniques in a taekwondo competition. Because the scoring system of taekwondo has been changed, the skill of roundhouse kick has been affected. Therefore, coaches and athletes are attempting to better understand how to control the movement of the kick to gain points more effectively. The aim of this study was to investigate the differences in the biomechanical characteristics between the roundhouse kicks with higher and lower impact magnitude using an electronic body protector. Eighteen elite college Taekwondo athletes participated in this study. A motion capture system measured the kinematics data of the kicking leg. The results indicated that elite athletes can obtain a high-impact index of the electrical body protector through increasing the peak linear velocity of shank, even with the same foot velocity level. In regard to kinetic skills, the roundhouse kicks a high impact. The velocity of proximal kicking limb could predominantly contribute to the powerful roundhouse kicks to achieve the high-impact force for electrical body protector. Moreover, when the kick cannot be effectively scored during the game, coaches and masters should consider adjusting to increase the velocity of proximal kicking.

Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. The formation of hemorrhagic bullae is a special skin sign of NF. The purposes of this study were to investigate the incidence of hemorrhagic bullae formation and bacteremia associated with different organisms, to appraise the appropriate use of ceftriaxone, and to compare the clinical and laboratory risk indicators of NF patients with Gram-positive and Gram-negative infections on the initial examination. Methods: From March 2018 to December 2020, there were seventy-four NF patients with positive monomicrobial bacterial cultures enrolled based on surgical confirmation, and were categorized into two groups: the Gram-positive group and the Gram-negative group. Ceftriaxone susceptibility tests were carried out using the standard disk diffusion technique. Data, such as demographics, clinical outcomes, microbiological results, presentations of hemorrhagic bullae, and laboratory findings, were compared among these two groups. Results: The Gram-negative group included 52 patients, of whom 6 patients died, resulting in a mortality rate of 11.5%. The Gram-positive group included 22 patients and none died. Patients with bacteremia, hemorrhagic bullae, shock, fever, higher segmented forms and banded forms, and lower platelet counts constituted higher proportions in the Gram-negative group than in the Gram-positive group. The multivariate analysis identified six variables for the differentiation of Gram-negative and Gram-positive NF: the presentation of bacteremia, hemorrhagic bullae, shock at first consultation, fever with body temperature > 38.5 °C, band forms > 0%, and segmented forms ≦ 74%. A total of 66 isolates (89.2%) was susceptible to ceftriaxone. Conclusions: Gram-negative NF patients were significantly associated with hemorrhagic bullae presentation, blood stream infection, and mortality. Physicians should be alert to NF patients with the appearance of bacteremia, shock, fever, higher WBC banded and segmented forms, and lower platelet counts at the emergency department, with patients revealed to more likely have Gram-negative infections. Ceftriaxone with/without other appropriate antibiotics under the supervision of infectious doctors appeared to be clinically effective for the treatment of NF and blood stream infections.

The purpose of this prospective study was to investigate the different micro-organisms associated with mortality, to evaluate the bullous skin sign, and to identify the positive predictive factors for differentiating necrotizing fasciitis from cellulitis on initial onset at emergency department.This prospective study was conducted in 145 consecutive NF patients and 159 cellulitis patients. Age, gender, comorbidities, infection site, microbiological results, condition of skin lesions, laboratory findings, vital signs, and clinical outcomes were compared between the two groups at the time of admission to emergency room.Fifteen patients of NF group and two patients of cellulitis group died, resulting in a mortality rate of 10.3% and 1.3% respectively. NF group had a significantly higher incidence of white blood cell (WBC) counts, band form neutrophil, and C-reactive protein (CRP) than the patients of cellulitis group. Hemorrhagic bullae presentation appeared to have significantly associated with the necrotizing fasciitis and death.THE FOLLOWING DIAGNOSTIC INDICATORS: : presence of hemorrhagic bullae, WBC counts11000 cells/mm

Monomicrobial necrotizing fasciitis caused by Pseudomonas species is a rare infection. This study aimed to elucidate the specific characteristics and clinical outcomes of necrotizing fasciitis caused by Pseudomonas aeruginosa and Pseudomonas fluorescens. Ten patients with monomicrobial necrotizing fasciitis caused by Pseudomonas species were retrospectively reviewed in an 8-year period. Differences in mortality, patient characteristics, clinical presentation, laboratory data, and clinical outcomes were compared between the death and survival groups. Two patients died, showing a mortality rate of 20%. P. aeruginosa was the causative agent in nine patients and P. fluorescens in one patient. The most common comorbidity was type 2 diabetes (n = 5). We found that patients who died had lower albumin levels and higher leukocyte counts than those who survived. Monomicrobial necrotizing fasciitis caused by Pseudomonas species needs emergent surgical intervention and aggressive intensive care due to the high mortality rate. We report the first case of monomicrobial necrotizing fasciitis caused by P. fluorescens. Severe hypoalbuminemia and high leukocyte counts in initial laboratory examinations can be considered poor prognostic factors.

Based on incredibly increasing applications in modern optoelectronic devices, the demand for securing a superior conductive transparent electrode (TCE) candidate becomes significant and urgent. However, boosting both transmittance and conductance simultaneously is an intrinsic limitation. In this work, we present silver nanoscale plasmonic wires (Ag NPWs) to function as TCEs in the visible light region by lowering their corresponding plasma frequencies. By carefully designing geometric dimensions of the Ag NPWs, we also optimize the performance for red, green, and blue colors, respectively. The demonstrated figure of merits for RGB colors appeared respectively 443.29, 459.46, and 133.78 in simulation and 302.75, 344.11, and 348.02 in experiments. Evidently, our Ag NPWs offer much greater FoMs beyond conventional TCEs that are most frequently comprised of indium tin oxide and show further advantages of flexibility and less Moire effect for the applications of flexible and high-resolution optoelectronic devices.

Study objective Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. Bullae are special skin manifestations of NF. This study was conducted to analyze the differences between different types of bullae of limbs with NF for providing the information to emergency treatment. Methods From April 2015 to August 2018, patients were initially enrolled based on surgical confirmation of limbs with NF. According to the presence of different bullae types, patients were divided into no bullae group (Group N), serous-filled bullae group (Group S), and hemorrhagic bullae group (Group H). Data such as demographics, clinical outcomes, microbiological results, presenting symptoms/signs, and laboratory findings were compared among these groups. Results In total, 187 patients were collected, with 111 (59.4%) patients in Group N, 35 (18.7%) in Group S, and 41 (21.9%) in Group H. Group H had the highest incidence of amputation, required intensive care unit care, and most patients infected with Vibrio species. In Group N, more patients were infected with Staphylococcus spp. than Group H. In Group S, more patients were infected with β-hemolytic Streptococcus than Group H. Patients with bacteremia, shock, skin necrosis, anemia, and longer prothrombin time constituted higher proportions in Group H and S than in Group N. Conclusions In southern Taiwan, patients with NF accompanied by hemorrhagic bullae appear to have more bacteremia, Vibrio infection, septic shock, and risk for amputation. If the physicians at the emergency department can detect for the early signs of NF as soon as possible, and more patient’s life and limbs may be saved.

Background Sexual problems are common in male lung cancer survivors. However, the development of erectile dysfunction (ED) in lung cancer patients after surgery has been rarely explored. In this study, we aimed to explore the incidence and risk factors of ED after lung cancer surgery. Methods From 2000 to 2012, 6025 and 24,100 male patients were included in each matched cohort of lung cancer and non-lung cancer patients, respectively. Poisson regression analysis was used to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). Results The incidence of ED was higher in the lung cancer cohort compared to the non-lung cancer cohort (38.47 vs 28.28 per 10,000 person-years) with an adjusted IRR (aIRR) of 1.34 (95% CI: 1.06-1.70, p=0.014) after the confounders were adjusted for. An increased incidence of ED was observed in the lung cancer cohort aged 40-54 years (aIRR: 5.44, 95% CI: 2.25-13.15, p

Nematode-trapping fungi (NTF) are a group of specialized microbial predators that consume nematodes when food sources are limited. Predation is initiated when conserved nematode ascaroside pheromones are sensed, followed by the development of complex trapping devices. To gain insights into the coevolution of this interkingdom predator–prey relationship, we investigated natural populations of nematodes and NTF that we found to be ubiquitous in soils. Arthrobotrys species were sympatric with various nematode species and behaved as generalist predators. The ability to sense prey among wild isolates of Arthrobotrys oligospora varied greatly, as determined by the number of traps after exposure to Caenorhabditis elegans . While some strains were highly sensitive to C. elegans and the nematode pheromone ascarosides, others responded only weakly. Furthermore, strains that were highly sensitive to the nematode prey also developed traps faster. The polymorphic nature of trap formation correlated with competency in prey killing, as well as with the phylogeny of A. oligospora natural strains, calculated after assembly and annotation of the genomes of 20 isolates. A chromosome-level genome assembly and annotation were established for one of the most sensitive wild isolates, and deletion of the only G-protein β-subunit–encoding gene of A. oligospora nearly abolished trap formation. In summary, our study establishes a highly responsive A. oligospora wild isolate as a model strain for the study of fungus–nematode interactions and demonstrates that trap formation is a fitness character in generalist predators of the nematode-trapping fungus family.

Periprosthetic joint infection (PJI) is a troublesome clinical issue in total joint arthroplasty (TJA). Although methicillin-resistant

Background This retrospective study analyzed the clinical characteristics and outcomes of patients with anaerobic spondylodiscitis. Methods From a total of 382 patients with infectious spondylodiscitis, nine patients (2.4%; two male and seven female with an average age of 67 years) with anaerobic spondylodiscitis between March 2003 and March 2017 were analyzed. Results Most of the patients (77.8%) initially presented with afebrile back pain. Hematogenous spread occurred in seven patients and postoperative infection in two patients. Bacteroid fragilis was the most common pathogen isolated from three patients. Atypical radiographic characteristics, including a vertebral fracture with the preservation of disk height or coexisting spondylolytic spondylolisthesis, occurred in four patients with hematogenous anaerobic spondylodiscitis. The eradication rate of anaerobic infection was significantly higher in the patients with hematogenous infection than in those with postoperative infection (100% vs. 0%, p = 0.0476). Anaerobic spondylodiscitis accounted for 2.4% of cases of infectious spondylodiscitis and predominantly affected the female patients. Conclusions Diagnostic delay may occur because of atypical spinal radiographs if the patient reports only back pain but no fever. Anaerobic infection following elective spinal instrumentation has a higher recurrence rate.

Background. Aeromonas necrotizing fasciitis (NF) causes high rates of amputation and mortality, even after aggressive surgical debridement and antibacterial therapy. This study investigated the effects of rational use of antibiotics and education by infectious disease (ID) physicians on Aeromonas NF treatment outcomes. Methods. Retrospective review for conducted for four years (period I, without an ID physician, December 2001 to December 2005) and 15 years (period II, with an ID physician, January 2006 to March 2021). In period II, the hospital-wide computerized antimicrobial approval system (HCAAS) was also implemented. A pretest-posttest time series analysis compared the two periods. Differences in clinical outcomes, demographics, comorbidities, signs and symptoms, laboratory findings, Aeromonas antibiotic susceptibility, and antibiotic regimens were compared between the two periods. Results. There were 19 patients in period I and 53 patients in period II. Patients had a lower rate of amputation or mortality in period II (35.8%) compared with period I (63.2%). Forty-four patients (61.1%) had polymicrobial infections. In the emergency room, the rate of misdiagnosis decreased from 47.4% in period I to 28.3% in period II, while effective empiric antibiotic usage increased from 21.1% in period I to 66.0% in period II. After the ID physician’s adjustment, 69.4% received monotherapy in period II compared to 33.3% in period I. Conclusions. Because Aeromonas NF had a high mortality rate and was often polymicrobial, choosing an antibiotic regimen was difficult. Using the HCAAS by an experienced ID physician can improve rational antibiotic usage and clinical outcomes in Aeromonas NF.

Better sensitivity of a biosensor could boost up the detection limit of analytes, thus a must in the fields of bio-sensing and bio-detection. To further enhance the sensitivity of a biosensor, in this work, we design an oblique-flat-sheet metamaterial perfect absorber (MPA) to concentrate the hot spots within air between the oblique flat sheet and the continuous ground metal, thus enabling fully interaction between analytes and hot spots. The corresponding field distributions in simulation corroborated our assumption and its sensitivity could be up to 1049 nm/RIU. Then, we fabricated the sample by e-beam lithography process for a seed layer and simply tilting the sample during deposition to obtain oblique flat sheets. When considering the stochastic nature of the deposited multiple oblique flat sheets, we modified the metallic upper resonator of the MPA from the single oblique-flat-sheet into randomly distributed oblique-wire-bundle (OWB) and in simulation, its sensitivity is boosted up to 3319 nm/RIU. In experiments, the measured sensitivity is 1329 nm/RIU under different concentrations of glucose solutions that is four times larger than the 330 nm/RIU of the planar MPA. The higher sensitivity was attributed to that the OWB MPA could provide hot spots within air not only between OWB and grounded metal but also among wires. Moreover, the OWB could also trap and concentrate the analytes locally.

Background Vibrio vulnificus has been reported as the leading causative pathogen of necrotizing fasciitis (NF) and related fatality in the coastal area. Necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and V. vulnificus have high mortality rates. The purpose of this prospective study was to clarify the clinical characteristics between death and survival NF patients, to investigate bacteriologic profile and mortality of NF patients, and to compare risk indicators of MRSA and V. vulnificus NF patients. Methods This prospective study was conducted in 184 consecutive NF patients over a period of three years in a tertiary coastal hospital. Differences in mortality, laboratory findings, microbiology and clinical outcomes were compared between the death and survival groups, and the V. vulnificus and MRSA subgroups. Results Twenty patients died, resulting in a mortality rate of 10.9%, and there were 108 patients with a monomicrobial infection (58.7%). The death group had a significantly higher incidence of shock at emergency room and bacteremia than did the survival group. Vibrio species (40 cases) and S. aureus (31 cases) were the two major pathogens. Significant differences with respect to hepatic dysfunction, shock, the event with seawater or seafood contact, bacteremia, C-reactive protein, mean platelet counts, and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score were observes between V. vulnificus and MRSA groups. Conclusions NF patients with both hepatic dysfunction and diabetes mellitus, bacteremia and shock have significantly higher mortality. We should be aware of the increasing incidence of monomicrobial NF and higher mortality rates of Gram-negative pathogens in the warm coastal area. LRINEC score is not a suitable diagnostic indicator for V. vulnificus NF, which is more rapidly progressive and fulminant than MRSA NF. NF needed team works by early suspicion, immediate surgical intervention and aggressive care, which can successfully decrease mortality.

Infected aortic aneurysm is a rare but life-threatening condition. Intimal injury, especially in arteries with atherosclerotic plaques, is vulnerable to Salmonella species. In this study, THP-1 macrophage-derived foam cells were used to mimic the atherosclerotic plaques. We investigated the role of different Salmonella serotype infections in foam cell autophagy and inflammatory response. Three different serotypes of Salmonella enterica-Typhimurium, Enteritidis, and Choleraesuis - with or without a virulence plasmid were used in this study. The foam cell model was established and observed under confocal microscopy. The expression of autophagy and inflammasome-related proteins after Salmonella infection was detected by Western blotting, and the secretion of the proinflammatory cytokines interleukin-1β and IL-18 was detected using ELISA. The plasmid-bearing S. enteritidis OU7130- and plasmid-less S. choleraesuis OU7266-infected foam cells both showed a lower expression of beclin-1 at 0.5 h post-infection (hpi) and p62 at 2 hpi as well as a higher expression of caspase-1 at 2 hpi than other infected cells. Moreover, infection of OU7266 induced the highest IL-1β and IL-18 production among the tested strains. In conclusion, the virulence plasmid of S. enteritidis OU7130 induced foam cell inflammatory responses, whereas that of S. choleraesuis played an opposite role. The different serotype of Salmonella may impact the infected aortic aneurysms through regulating inflammatory balance of the macrophage and foam cells in the atherosclerotic plaque.

Necrotizing fasciitis is a severe soft-tissue infection with a high mortality rate. There is little literature on the relationship between the ultrasonographic finding of fluid accumulation along the deep fascia and the diagnosis and prognosis of necrotizing fasciitis. This retrospective study showed that when fluid accumulation was present along the deep fascia, patients with clinically suspected necrotizing fasciitis had a higher probability of having necrotizing fasciitis. The ultrasonographic finding of fluid accumulation with a cutoff point of more than 2 mm of depth had the best accuracy (72.7%) for diagnosing necrotizing fasciitis. In regard to the prognosis of necrotizing fasciitis, when fluid accumulation was present along the deep fascia, patients with necrotizing fasciitis had a longer length of hospital stay and were at risk of amputation or mortality. Ultrasonography is a point-of-care imaging tool that facilitates the diagnosis and prognosis of necrotizing fasciitis.

Background: Genitourinary tuberculosis (GUTB) is rare but fatal if not diagnosed early. The purpose of this study was to investigate the outcomes of GUTB in Taiwan. Methods: We retrospectively reviewed medical records of 57 patients who were diagnosed as GUTB from January 2002 to December 2016, over a 15-year period. Demographic data and clinical manifestations were recorded for analysis. Results: There were 37 males and 20 females with a median age of 71 years. Kidney (24.6%) was the most involved organ. Fever (56.1%) was the major presentation. Sixteen (28.1%) patients presented unfavorable outcome. Compared with the favorable outcome group, the unfavorable outcome group had more malignancy (p = 0.013), fever (p = 0.020), anemia (p = 0007), thrombocytopenia (p = 0.003), and hypoalbuminemia (p = 0.015). In a multivariate analysis, fever (odds ratio: 42.716, 95% confidence interval: 1.032–1767.569; p = 0.048) was identified as prognostic factors for unfavorable outcome. Conclusion: GUTB is often in advanced stages with a high mortality in Taiwan. Establishing a diagnosis is difficult and requires thorough investigation. Fever is associated with unfavorable outcome. Keywords: Genitourinary tuberculosis, Genitourinary tract surgery, Anemia

We demonstrate the successful fabrication of all-solid-state flexible micro-supercapacitors (μSCs) on commercial polyethylene terephthalate (PET) sheet using a commercial laser printer. The interdigitated in-planar electrodes of the μSC are fabricated by commercial toner cartridge and their self-aligned stacking configurations are made by depositing Pt thin films and hydrous ruthenium oxide (RuO·xH2O, hRuO2) layers on the PET sheets using a post-low-temperature annealing process. The μSC cells can be combined in parallel or series by an arbitrary printing process operated on a personal computer, thereby avoiding unnecessary external connections and improving the capacitive behavior. The fabricated hRuO2-based μSCs exhibit excellent electrochemical-energy storage, along with ultrahigh volumetric power density (73460 mW cm−3) and energy density (24.9 mWh cm−3). This facile and simplified strategy constructs μSCs with tailored self-aligned electrodes of arbitrary design, excellent mechanical stability, and high flexibility. Therefore, it offers a high-productivity, low-cost, photolithography-free microfabrication of μSCs for microscale supercapacitor applications.

Background: Total hip arthroplasty (THA) is a widely used and successfully performed orthopedic procedure for treating severe hip osteoarthritis, rheumatoid arthritis, and avascular necrosis. However, periprosthetic joint infection (PJI) after THA is a devastating complication for patients and orthopedic surgeons. Although surgical technology has been advanced and antibiotic-loaded cemented spacers or beads have developed, the treatment failure rate of one- or two-stage exchange arthroplasty for PJI is reported to be high, with >10% rate of incidence. Therefore, determining the possible pathogenesis and increasing the treatment success rate is a clinically important and urgent issue. Methods: A total of 256 patients with PJI who had undergone THA from 2005 to 2015 were included in this retrospective review. Seven patients required combined ilioinguinal and anterlateoal approach for debridement of iliac fossa abscess and infected hip lesion, included five patients with intraoperative pus leakage from the acetabular inner wall and the other two patients who underwent pre-operative pelvic computed tomography (CT) because of repeat PJI treatment failure. All available data from the medical records from all patients were retrospectively analyzed.Results: Of the 256 patients, seven (3.1%) patients was combined iliac fossa abscess in our cohort. For the microbiologic analysis, a total of thirteen pathogens were isolated from seven recurrent PJI patients with iliac fossa abscess, and Staphylococus aureus was the most commomly pathogen (4 out of 7 cases). The serum white blood cell (WBC) count was decreased significantly two weeks after debridement with combined the ilioinguinal and anterolateral approach compared to the day before surgery (11840/μL vs. 7370/μL; pConclusion: This result suggests that pre-operative pelvic CT and cautious identification of uncertain pus leakage from the inner wall of the acetabulum is essential for the diagnosis of recurrent PJI. Radical debridement with combined ilioinguinal and anterlateoal approach may aviod treatment failure in recurrent PJI with iliac fossa abscess.

Nematode-trapping fungi (NTF) are carnivorous fungi that prey on nematodes under nutrient-poor conditions via specialized hyphae that function as traps. The molecular mechanisms involved in the interactions between nematode-trapping fungi and their nematode prey are largely unknown. In this study, we conducted forward genetic screens to identify potential genes and pathways that are involved in trap morphogenesis and predation in the NTF Arthrobotrys oligospora. Using Ethyl methanesulfonate and UV as the mutagens, we generated 5552 randomly-mutagenized A. oligospora strains and identified 15 mutants with strong defects in trap morphogenesis. Whole genome sequencing and bioinformatic analyses revealed mutations in genes with roles in signaling, transcription or membrane transport that may contribute to the defects of trap morphogenesis in these mutants. We further conducted functional analyses on a candidate gene, YBP-1, and demonstrate that mutation of that gene was causative of the phenotypes observed in one of the mutants. The methods established in this study might provide helpful insights for establishing forward genetic screening methods for other non-model fungal species.

Backgroud: Monomicrobial necrotizing fasciitis (NF) caused by Vibrio vulnificus, Aeromonas hydrophila and Aeromonas sobria are often associated with high mortality rates. The purpose of this study was to compare the independent predictors related to outcomes between of Vibrio vulnificus and Aeromonas spp. necrotizing fasciitis. We also investigated the risk factors association with mortality in patients with monomicrobial Aeromonas necrotizing fasciitis. Methods: Monomicrobial necrotizing fasciitis caused by Vibrio vulnificus (60 patients) and Aeromonas species (31 patients) over an 11-year period were retrospectively reviewed. Differences in mortality, patient characteristics, clinical presentations, and laboratory data were compared between the Vibrio vulnificus and Aeromonas species groups, and between the death and the survival subgroups Aeromonas patients. Results: Six patients in the Vibrio vulnificus group (10%) and eleven in the Aeromonas group (32.3%) died. Vibrio vulnificus patients had a significant higher incidence of bacteremia; however, the proportion of Aeromonas patients presenting bacteremia associated with death was significantly higher than that of Vibrio vulnificus group (p = 0.0002). Aeromonas isolates had a significant higher incidience of antibiotics resistance (p = 0.0001). The death subgroup of Aeromonas NF patients had a significantly higher incidence of bacteremia (p = 0.001), higher counts of banded leukocytes (p = 0.026), lower platelet counts (p = 0.043), lower total lymphocyte counts (p = 0.013), and lower serum albumin level (p = 0.019) than the survival subgroup. Conclusion: Monomicrobial necrotizing fasciitis caused by Aeromonas spp. was characterized more fulminating and higher mortality than that of the Vibrio vulnificus infection even after early fasciotomy and third-generation cephalosporin antibiotic therapy. The death patients of Aeromonas group have a significantly higher proportion of antibiotics resistance and bacteremia, higher incidence of shock, lower lymphocyte counts, and lower albumin levels than the Vibrio patients who died. Level of Evidence: Therapeutic level III.

After a product has undergone a manufacturing process, it usually has several important quality characteristics. When the process quality of all quality characteristics meets the requirements of the quality level, the process quality of the product can be guaranteed to satisfy customers’ needs. A large number of studies have pointed out that good process quality can raise product yield and product value; at the same time, it can reduce the ratio of rework and scrap, achieve the effect of energy saving and waste reduction, and contribute to the sustainable operation of enterprises as well the environment. Since the six sigma method combines the statistical analysis method of manufacturing cost and production data, it is a useful tool for process improvement and process quality enhancement. Therefore, this paper adopted the six sigma-define, measure, analyze, improve and control (DMAIC) improvement process to lift the manufacturing process quality of multi-characteristic products. Besides, the Taguchi process capability index is one of the commonly used tools for quality assessment in the industry. Not only can it reflect the process loss, but it also can ensure the process yield when the index value is large enough. Consequently, this paper discussed the relationship between the Taguchi process capability index and the six sigma quality level. Meanwhile, the entire six sigma DMAIC improvement process was built on the basis of the process capability index and developed by the method of statistical quality control. Hence, the proposed method is very convenient for process engineers to apply, as well as is helpful for enterprises to move toward the goal of smart manufacturing and sustainability.

BGLF2 is a tegument protein of the Epstein–Barr virus (EBV). This study finds that BGLF2 is expressed in the late stage of the EBV lytic cycle. Microscopic investigations reveal that BGLF2 is present in both the nucleus and the cytoplasm and colocalized with BBLF1 and gp350 at juxtanuclear regions in the cytoplasm. This study also finds that the basic KKK69 motif of BGLF2 and acidic DYEE31 motif of BBLF1 are crucial for the interaction between BGLF2 and BBLF1, which is required for the recruitment of BGLF2 to the BBLF1 that is anchored on the trans-Golgi-network (TGN). In addition, BGLF2 in a density gradient is co-sedimented with un-enveloped capsids, revealing that BGLF2 associates with the EBV capsid before the final envelopment. The knockout of BGLF2 expression is demonstrated to reduce the numbers of infectious virions that are released into the culture medium, but they do not affect the expression of lytic proteins and viral DNA replication. The production of infectious viral particles by a BGLF2-knockout mutant can be rescued by exogenously expressed BGLF2 but only partially rescued by BGLF2-3KA, which is a mutant with reduced ability to interact with BBLF1 but does not affect its ability to activate the MAPK pathway and the expression of the EBV lytic proteins, suggesting that the interaction of BGLF2 with BBLF1 is important to the efficient production of infectious viral particles during the maturation. The results of this study improve our understanding of how BGLF2 promotes EBV viral production.

Nematode-trapping fungi (NTF) are a group of specialized microbial predators that consume nematodes when food sources are limited. Predation is initiated when conserved nematode ascaroside pheromones are sensed, followed by the development of complex trapping devices. To gain insights into the co-evolution of this inter-kingdom predator-prey relationship, we investigated natural populations of nematodes and NTF, that we found to be ubiquitous in soils.Arthrobotrysspecies were sympatric with various nematode species and behaved as generalist predators. The ability to sense prey amongst wild isolates ofA. oligosporavaried greatly, as determined by the number of traps after exposure toCaenorhabditis elegans. While some strains were highly sensitive toC. elegansand the nematode pheromone ascarosides, others responded only weakly. Furthermore, strains that were highly sensitive to the nematode prey also developed traps faster. The polymorphic nature of trap formation correlated with competency in prey killing, as well as with the phylogeny ofA. oligosporanatural strains, calculated after assembly and annotation of the genomes of twenty isolates. A chromosome level genome assembly and annotation was established for one of the most sensitive wild isolate, and deletion of the only G proteinβsubunit-encoding gene ofA. oligosporanearly abolished trap formation, implicating G protein signaling in predation. In summary, our study establishes a highly responsiveA. oligosporawild isolate as a novel model strain for the study of fungal-nematode interactions and demonstrates that trap formation is a fitness character in generalist predators of the NTF family.Significance statementNematode-trapping fungi (NTF) are carnivorous microbes that hold potential to be used as biological control agents due to their ability to consume nematodes. In this work we show that NTF are ubiquitous generalist predators found in sympatry with their prey in soil samples. Wild isolates of NTF displayed a naturally diverse ability to execute their predatory lifestyle. We generated a large whole genome sequencing dataset for many of the fungal isolates that will serve as the basis of future projects isolates. In particular, we establish TWF154, a highly responsive strain ofArthrobotrys oligospora, as a model strain to study the genetics of NTF. Lastly, we provide evidence that G-protein signaling is necessary for trap induction in NTF.

Background Vibrio cholerae non-O1 is a virulent pathogen that causes significant morbidity and mortality in humans. Herein, we report a case of corneal ulcer caused by this pathogen. Case presentation A 59-year-old fisherman with no systemic history was struck in the right eye by a marine shrimp and developed keratitis. Corneal scrapping culture revealed the presence of the V. cholerae non-O1, and its identification was confirmed by Analytical Profile Index 20E system and polymerase chain reaction. He was successfully treated with topical levofloxacin (0.3%) and fortified amikacin (12.5 mg/mL) for 2 weeks. The visual acuity recovered to 20/25 after treatment without complications. Conclusions This is the first case report of keratitis caused by V. cholerae non-O1 strain. Ocular injury by marine creatures and contaminated seawater can contribute to severe corneal ulcer. Early diagnosis can be achieved by meticulous history taking and a comprehensive laboratory workup. Simultaneously, an effective antibiotic therapy can lead to a positive outcome.

Filamentous fungi are ubiquitous in nature and serve as important biological models in various scientific fields including genetics, cell biology, ecology, evolution, and chemistry. A significant obstacle in studying filamentous fungi is the lack of tools for characterizing their growth and morphology in an efficient and quantitative manner. Consequently, assessments of the growth of filamentous fungi are often subjective and imprecise. In order to remedy this problem, we developed Fungal Feature Tracker (FFT), a user-friendly software comprised of different image analysis tools to automatically quantify different fungal characteristics, such as spore number, spore morphology, and measurements of total length, number of hyphal tips and the area covered by the mycelium. In addition, FFT can recognize and quantify specialized structures such as the traps generated by nematode-trapping fungi, which could be tuned to quantify other distinctive fungal structures in different fungi. We present a detailed characterization and comparison of a few fungal species as a case study to demonstrate the capabilities and potential of our software. Using FFT, we were able to quantify various features at strain and species level, such as mycelial growth over time and the length and width of spores, which would be difficult to track using classical approaches. In summary, FFT is a powerful tool that enables quantitative measurements of fungal features and growth, allowing objective and precise characterization of fungal phenotypes., Author summary One of the main obstacles to study filamentous fungi is the lack of tools for characterizing fungal phenotypes in an efficient and quantitative manner. Assessment of cell growth and numbers rely on tedious manual techniques that often result in subjective and imprecise measurements. In response to those limitations, we developed Fungal Feature Tracker (FFT), a user-friendly software that allows researchers to characterize different phenotypic features of filamentous fungi such as sporulation, spore morphology and mycelial growth. In addition, FFT can recognize and quantify other fungal structures including the fungal traps developed by nematode-trapping fungi. In order to show the capabilities and potential of our software, we conducted a detailed characterization and comparison of different fungal species. Our comparison relies on a series of experimental set-ups using standard and easily accessible equipment to ensure reproducibility in other laboratories. In summary, FFT is an easy to use and powerful tool that can quantitatively characterize fungal morphology, cell number and quantitatively measures the filamentous growth, which will advance our understanding of the growth and biology of filamentous fungi.

Periprosthetic joint infections (PJIs) caused by Staphylococcus aureus infection are difficult to treat due to antibiotic resistance. It is known that the biofilms from methicillin-resistant S. aureus (MRSA) promote expansion of myeloid-derived suppressor cells (MDSCs) to suppress T-cell proliferation and benefit bacterial infections. This study finds that GMI, a fungal immunomodulatory peptide isolated from Ganoderma microsporum, suppresses MDSC expansion to promote the proliferation of cytotoxic T cells. The enhancement is likely attributed to increased expression of IL-6 and TNF-α and reduction in ROS expression. Similar beneficial effects of GMI on the suppression of MDSC expansion and IL-6 expression are also observed in the whole blood and reduces the accumulation of MDSCs in the infected bone region in a mouse PJI infection model. This study shows that GMI is potentially useful for treating S. aureus-induced PJIs.

Burkholderia cepacia complex (BCC) is a group of closely related bacteria with widespread environmental distribution. BCC bacteria are opportunistic pathogens that cause nosocomial infections in patients, especially cystic fibrosis (CF). Multilocus sequence typing (MLST) is used nowadays to differentiate species within the BCC complex. This study collected 41 BCC isolates from vascular access infections (VAIs) and other clinical infections between 2014 and 2020. We preliminarily identified bacterial isolates using standard biochemical procedures and further conducted recA gene sequencing and MLST for species identification. We determined genetic diversity indices using bioinformatics software. We studied 14 isolates retrieved from patients with VAIs and observed that Burkholderia cepacia was the predominant bacterial species, and B. contaminans followed by B. cenocepacia were mainly retrieved from patients with other infections. According to MLST data, we identified that all B. contaminans isolates belonged to ST102, while a wide variety of sequence types (STs) were found in B. cenocepacia isolates. In summary, the high diversity and easy transmission of BCC increase BCC infections, which provides insights into their potential clinical effects in non-CF infections.

BACKGROUND/PURPOSE: Postoperative infection is the most disastrous complication of penetrating keratoplasty (PK). Corneoscleral rim culture provided information regarding subsequent infections. Our aims were to identify the incidence of microbial contamination in donor corneas and to report the recovery of bacteria with two culture methods, i.e., conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (Fastidious Antibiotic Neutralization [FAN]). MATERIALS AND METHODS: A total of 118 patients underwent PK. Corneoscleral rim cultures were performed using aerobic/anaerobic culture cotton swabs (Transystem™, COPAN, Italia) with subsequent convention media and blood culture media (FAN bottle, BD BACTEC™, USA). The results of the different methods were reported and analyzed. RESULTS: Microorganisms were recovered from 24 in total 118 cases (20.3%, n = 118), 14 from blood culture media (FAN) (11.8%, n = 118), 9 from conventional culture media after aerobic/anaerobic cotton swabs (7.63%, n = 118), and 2 from fungus culture (1.69%, n = 118). The most commonly identified pathogen was coagulase-negative Staphylococcus (CoNS) (n = 13, 54.2%), and more isolates of CoNS and staphylococcus aureus were recovered from blood culture media (FAN) than those from conventional culture media after aerobic/anaerobic cotton swabs (13 vs. 4, P = 0.05). Conversely, more nonfermentative Gram-negative bacilli were recovered from conventional culture media after aerobic/anaerobic cotton swabs. None of the 24 cases with positive corneoscleral rim cultures reported ocular infection for the recipients in at least 6 months’ follow-up. CONCLUSION: The conventional culture media after aerobic/anaerobic cotton swabs and blood culture media (FAN) did not yield identical isolates of bacteria. The blood culture media (FAN) could further yield Gram-positive bacteria in addition to those recovered from convention media. It seemed adding gentamicin and streptomycin could achieve bacteriostatic effect instead of the bactericidal effect. The administration of postoperative antibiotic in the recipient was suggested.

Transformation optics has brought a wave of fanaticism among researchers to realize the first-ever invisible cloak over the past decade. Several relevant devices, including internal cloaks, external cloaks, and mantle cloaks, have already been proposed, with a few being experimentally demonstrated. Still, the proposed cloaks possess their insufficiencies to realize a reciprocal cloak. To better illustrate the cloak, here we report, a new approach to a transformation-optics-based reciprocal cloak with designed dielectric-annulus-based metamaterials. Our results indicate we can easily control the anisotropic constitutive parameters at will. In addition, the as-fabricated cloak enables concurrent vision and movements of a hidden object, evidenced by both simulated and measured the field distributions. More importantly, the cloak demands no bespoke design and is applicable to arbitrary electric-large objects. We affirm that we provide a method to developing the first-ever reciprocal cloak in experiments, and believe that the cloak could be further operated at visible ranges through the methodology we introduced, paving a route toward future applications in the fields of optics, physics, materials science, etc.

A strong turnover premium exists such that stocks with lower turnover have higher future returns in the 5 years following their formation than those with higher turnover. This turnover premium cannot be explained by existing asset-pricing models, a risk-based liquidity factor, or anomalies such as size, book-to-market ratio, or momentum. Further analysis indicates that the turnover premium is greater for stocks with higher idiosyncratic volatility, higher transaction costs, lower institutional ownership, and lower investor sophistication, which implies it is consistent with the mispricing explanation based on arbitrage risk.

To conquer Ohmic losses from metal and enhance pump absorption efficiency of a nanolaser based on surface plasmon polariton, we theoretically calculate the first magnetic and electric scattering coefficient of a dielectric sphere under a plane wave excitation with a dielectric constant of around 12. From this calculation, we could retrieve both negative effective permittivity and permeability of the sphere simultaneously at frequencies around 153 THz in the aids of Lewin’s theory and the power distribution clearly demonstrate the expected negative Goos-Hanchen effect, which usually occurred in a negative refractive waveguide, thus creating two energy vortices to trap incident energy and then promoting the pump absorption efficiency. Meanwhile, a magnetic lasing mode at 167.3 THz is demonstrated and reveals a magnetic dipole resonance mode and a circulating energy flow within the dielectric sphere, providing a possible stopped light feedback mechanism to enable the all-dielectric nanolaser. More importantly, the corresponding mode volume is reduced to 0.01λ3 and a gain threshold of 5.1×103 is obtained. To validate our design of all-dielectric nanolaser, we employ finite-difference-time-domain simulation software to examine the behavior of the nanolaser. From simulation, we could obtain a pinned-down population inversion of 0.001 and a lasing peak at around 166.5 THz, which is very consistent with the prediction of Mie theory. Finally, according to Mie theory, we can regard the all-dielectric nanolaser as the excitation of material polariton and thus could make an analogue between lasing modes of the dielectric and metallic nanoparticles.

Purpose No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF. Methods Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated. Results Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia. Conclusions Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

The major issue regarding magnetic response in nature—“negative values for the permeability μ of material parameters, especially in terahertz or optical region” makes the electromagnetic properties of natural materials asymmetric. Recently, research in metamaterials has grown in significance because these artificial materials can demonstrate special and, indeed, extraordinary electromagnetic phenomena such as the inverse of Snell’s law and novel applications. A critical topic in metamaterials is the artificial negative magnetic response, which can be designed in the higher frequency regime (from microwave to optical range). Artificial magnetism illustrates new physics and new applications, which have been demonstrated over the past few years. In this review, we present recent developments in research on artificial magnetic metamaterials including split-ring resonator structures, sandwich structures, and high permittivity-based dielectric composites. Engineering applications such as invisibility cloaking, negative refractive index medium, and slowing light fall into this category. We also discuss the possibility that metamaterials can be suitable for realizing new and exotic electromagnetic properties.

We conducted a retrospective study to investigate the effect of femoral bowing on the placement of components in total knee replacement (TKR), with regard to its effect on reestablishing the correct mechanical axis, as we hypothesised that computer-assisted total knee replacement (CAS-TKR) would produce more accurate alignment than conventional TKR. Between January 2006 and December 2009, 212 patients (306 knees) underwent TKR. The conventional TKR was compared with CAS-TKR for accuracy of placement of the components and post-operative alignment, as determined by five radiological measurements. There were significant differences in the reconstructed mechanical axes between the bowed and the non-bowed group after conventional TKR (176.2° (sd 3.4) vs 179.3° (sd 2.1), p < 0.001). For patients with significant femoral bowing, the reconstructed mechanical axes were significantly closer to normal in the CAS group than in the conventional group (179.2° (sd 1.9) vs 176.2° (sd 3.4), p < 0.001). Femoral bowing resulted in inaccuracy when a conventional technique was used. CAS-TKR provides an effective method of restoring the mechanical axis in the presence of significant femoral bowing.

By enabling both cavity modes and plasmonic resonance together in the designed two-handed metamaterial, we demonstrate a square-wave-like (SWL) bandpass fllter with high-ratio bandwidth (HRB). Our results show that this metamaterial-based bandpass fllter possesses high-ratio bandwidth of 30GHz centered at 92GHz, excellent transmittance beyond 87.5%, sharp transition within 1.0GHz from i3dB to i20dB as upper and lower band edge transitions, and dual- band behavior. Such an HRBSWL bandpass fllter can be scalable and readily applicable for the commercialized unlicensed 60GHz spectra with a bandwidth exceeding 7GHz, solving the challenge of conventional passive bandpass fllters to allow wide bandwidths and great quality factors simultaneously.

We design a double-sided perfect absorber at 2.4 THz within the terahertz gap to enable light absorption at the bidirectional directions, which is impossible for the traditional metamaterial-based perfect absorbers due to the employment of a metallic ground plane dedicated to reduce transmission. Here, the double-sided perfect absorber is fabricated on a λ 0 /6-thick polyethylene terephthalate (PET) substrate of e r = 3.05×(1+0.08i) sandwiched by the two identical randomized metallic patterns, which provide equalized permittivity and permeability to match the impedance of free space and enormous imaginary part of refractive index to trap the light, evidenced by the retrieval method.