bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transfer of elderly patients from health care facilities to emergency departments: Prospective observational study of the emergency department in Japan
Authors: Iwata Mitsunaga , Kuzuya Masafumi , Kitagawa Yoshimi , Ohmiya Takashi , Iguchi Akihisa 
Published: December 2003

Background:  The purpose of the present paper is to describe the current status of emergency departments (ED) that are used by health care facilities for elderly (HCFFE) residents in Japan.Methods:  The present paper is based on a prospective, observational study that was undertaken at a teaching hospital in Nagoya city over a 12‐month period. All patients transferred to the hospital ED from a regional HCFFE were analyzed. Demographic data, timing of the visit, the primary reason for transfer, diagnosis and disposition were recorded. The need for ambulance use was graded prospectively using three categories of urgency.Results:  A total of 102 HCFFE residents made 116 ED visits. Their mean age was 83.3 years (range 58–101), 68% were female. The majority of patients (93%) were transferred by ambulance. Ambulance transfer was classified as emergency (20% of patients), urgent (51%) and routine (29%). The main reasons for patients to be transferred were fever (15.5%), fall (11.2%), altered mental status (10.3%), focal neurological deficits (10.3%), and weakness (9.5%). A total of 88% of the ED visits led to admission to the hospital. After admissions, the mean length of stay was 21.4 days and the mortality rate was 13%.Conclusion:  Elderly patients staying in HCFFE are frequently transferred to an ED, and their visits are likely to lead to admission to the hospital, which is associated with prolonged lengths of stay as well as high mortality rates.
Surge Capacity for Response to Bioterrorism in Hospital Clinical Microbiology Laboratories
Authors: Shapiro Daniel S. 
Published: December 2003

ABSTRACT
Surge capacity is the ability to rapidly mobilize to meet an increased demand. While large amounts of federal funding have been allocated to public health laboratories, little federal funding has been allocated to hospital microbiology laboratories. There are concerns that hospital laboratories may have inadequate surge capacities to deal with a significant bioterrorism incident. A workflow analysis of a clinical microbiology laboratory that serves an urban medical center was performed to identify barriers to surge capacity in the setting of a bioterrorism event and to identify solutions to these problems. Barriers include a national shortage of trained medical technologists, the inability of clinical laboratories to deal with a dramatic increase in the number of blood cultures, a delay while manufacturers increase production of critical products and then transport and deliver these products to clinical laboratories, and a shortage of class II biological safety cabinets. Federal funding could remedy staffing shortages by making the salaries of medical technologists comparable to those of similarly educated health care professionals and by providing financial incentives for students to enroll in clinical laboratory science programs. Blood culture bottles, and possibly continuous-monitoring blood culture instruments, should be added to the national antibiotic stockpile. Federal support must ensure that companies that manufacture essential laboratory supplies are capable of rapidly scaling up production. Hospitals must provide increased numbers of biological safety cabinets and amounts of space dedicated to clinical microbiology laboratories. Laboratories should undertake limited cross-training of technologists, ensure that adequate packaging supplies are available, and be able to move to a 4-day blood culture protocol.
Acquisition and Duration of Vancomycin-Resistant Enterococcal Carriage in Relation to Strain Type
Authors: Mascini E. M. , Jalink K. P. , Kamp-Hopmans T. E. M. , Blok H. E. M. , Verhoef J. , Bonten M. J. M. , Troelstra A. 
Published: December 2003

ABSTRACT

In May 2000, the first outbreak of vancomycin-resistant
Enterococcus faecium
(VREF) was detected in the University Medical Center Utrecht in the nephrology ward. The question arose why some VREF strains spread among hospitalized patients, whereas other strains do not. Thirty patients who were found to be colonized with VREF between May and November 2000 were included in the study. Molecular typing confirmed that 19 of them carried an identical epidemic strain which harbored the
esp
gene while 11 were colonized by nonepidemic strains that were all
esp
negative. Acquisition of the outbreak strain was significantly associated with diabetes mellitus, renal transplantation, and extensive use of antibiotics, especially cephalosporins, in the 2-month period before the first isolation of VREF. To establish the duration of colonization, prospective surveillance of VREF carriage for a 6-month period starting from the first isolation of VREF was realized for 20 patients. After 6 months, VREF was still recovered from 60% of carriers of the outbreak strain versus 20% of carriers of nonepidemic strains (
P
< 0.01). However, antibiotic use during the follow-up period was significantly higher by carriers of the outbreak strain than by carriers of nonepidemic strains. The fact that the outbreak strain was recovered for a longer period of time than nonepidemic strains may facilitate dissemination of the strain. The results support a careful restrictive antibiotic policy for wards at risk for spread of VREF and implementation of isolation precautions for patients who are colonized with
esp
-positive outbreak strains.
Growth of
Helicobacter pylori
in Medium Supplemented with Cyanobacterial Extract
Authors: Vega Alba E. , Cortiñas Teresa I. , Mattana Claudia M. , Silva Humberto J. , Puig de Centorbi Olga 
Published: December 2003

ABSTRACT

Solid and liquid media supplemented only with a cyanobacterial extract (CE) and free of fetal calf serum (FCS), blood, and its derivatives support the growth of
Helicobacter pylori
. A total of 11 strains of
H. pylori
isolated from gastric biopsy samples were successfully subcultured in Mueller-Hinton agar supplemented with 0.4% CE. When this medium was used for primary isolation of
H. pylori
, a low isolation rate (30%) was observed because of the abundant growth of contaminants. The growth kinetics of eight isolates and
H. pylori
reference strain NCTC 11638 in Mueller-Hinton broth (MHB) supplemented with 0.7% CE were estimated by use of growth parameters, and the results were compared with those obtained with MHB-5% FCS. For four strains the cellular concentrations obtained with CE were statistically higher (
P
< 0.05) than those obtained with FCS, and in some cases these values were similar to the highest values reported in the literature. Depending on the strain, the specific growth rates obtained with CE were similar to or increased compared with those obtained with FCS. The replacement of FCS by CE in
H. pylori
cultures would facilitate the retrieval of cultures with high cellular densities as a source of cellular and extracellular proteins free of serum. Also, CE has advantages over conventional supplements, such as easier conservation and compliance with the pressing tendency at present to avoid the use of products derived from animals.
Multilocus Variable-Number Tandem Repeat AnalysisDistinguishes Outbreak and SporadicEscherichia coliO157:H7Isolates
Authors: Noller Anna C. , McEllistrem M. Catherine , Pacheco Antonio G. F. , Boxrud David J. , Harrison Lee H. 
Published: December 2003

ABSTRACTEscherichia coliO157:H7 is a major cause of food-borne illness in the United States. Outbreak detection involves traditional epidemiological methods and routine molecular subtyping by pulsed-field gel electrophoresis (PFGE). PFGE is labor-intensive, and the results are difficult to analyze and not easily transferable between laboratories. Multilocus variable-number tandem repeat (VNTR) analysis (MLVA) is a fast, portable method that analyzes multiple VNTR loci, which are areas of the bacterial genome that evolve quickly. Eighty isolates, including 21 isolates from five epidemiologically well-characterized outbreaks from Pennsylvania and Minnesota, were analyzed by PFGE and MLVA. Strains in PFGE clusters were defined as strains that differed by less than or equal to one band by usingXbaI and the confirmatory enzymeSpeI. MLVA was performed by comparing the number of tandem repeats at seven loci. From 6 to 30 alleles were found at the seven loci, resulting in 64 MLVA types among the 80 isolates. MLVA correctly identified the isolates from all five outbreaks if only a single-locus variant was allowed. MLVA differentiated strains with unique PFGE types. Additionally, MLVA discriminated strains within PFGE-defined clusters that were not known to be part of an outbreak. In addition to being a simple and validated method forE. coliO157:H7 outbreak detection, MLVA appears to have a sensitivity equal to that of PFGE and a specificity superior to that of PFGE.
Evolution ofsfbIEncoding Streptococcal Fibronectin-Binding Protein I: Horizontal Genetic Transfer and Gene Mosaic Structure
Authors: Towers Rebecca J. , Fagan Peter K. , Talay Susanne R. , Currie Bart J. , Sriprakash Kadaba S. , Walker Mark J. , Chhatwal Gursharan S. 
Published: December 2003

ABSTRACTStreptococcal fibronectin-binding protein is an important virulence factor involved in colonization and invasion of epithelial cells and tissues byStreptococcus pyogenes. In order to investigate the mechanisms involved in the evolution ofsfbI, thesfbIgenes from 54 strains were sequenced. Thirty-four distinct alleles were identified. Three principal mechanisms appear to have been involved in the evolution ofsfbI. The amino-terminal aromatic amino acid-rich domain is the most variable region and is apparently generated by intergenic recombination of horizontally acquired DNA cassettes, resulting in a genetic mosaic in this region. Two distinct and divergent sequence types that shared only 61 to 70% identity were identified in the central proline-rich region, while variation at the 3′ end of the gene is due to deletion or duplication of defined repeat units. Potential antigenic and functional variabilities in SfbI imply significant selective pressure in vivo with direct implications for the microbial pathogenesis ofS. pyogenes.
PCR Typing of Genetic Determinants for Metallo-β-Lactamases and Integrases Carried by Gram-Negative Bacteria Isolated in Japan, with Focus on the Class 3 Integron
Authors: Shibata Naohiro , Doi Yohei , Yamane Kunikazu , Yagi Tetsuya , Kurokawa Hiroshi , Shibayama Keigo , Kato Haru , Kai Kumiko , Arakawa Yoshichika 
Published: December 2003

ABSTRACT

From January 2001 to December 2002, 587 strains of gram-negative bacterial isolates demonstrating resistance to ceftazidime and a combination of sulbactam and cefoperazone were subjected to a disk diffusion screening test using sodium mercaptoacetic acid; 431 strains (73.4%) appeared to produce metallo-β-lactamase (MBL). Of these 431 strains, 357 were found by PCR to carry genes for IMP-1 type MBL (
bla
IMP-1
), while only 7 and 67 strains carried the IMP-2 gene (
bla
IMP-2
) and the VIM-2 gene (
bla
VIM-2
), respectively. Neither VIM-1 nor SPM-1 type MBL genes were found among the strains tested. Of 431 strains, 427 carried the
intI1
gene, and 4 strains carrying both the
intI1
and
intI3
genes were reidentified as
Pseudomonas putida
harboring
bla
IMP-1
. Of these four
P. putida
strains, three strains and one strain, respectively, were separately isolated from two hospitals located in the same prefecture, and the three strains showed very similar pulsed-field gel electrophoresis patterns. Of 357
bla
IMP-1
carriers, 116, 53, 51, 47, and 30 strains were identified as
Pseudomonas aeruginosa
,
Alcaligenes xylosoxidans
,
P. putida/fluorescens
,
Serratia marcescens
, and
Acinetobacter baumannii
, respectively. Four strains carrying
bla
IMP-2
were reidentified as
P. putida
. Sixty-three
P. aeruginosa
strains and four
P. putida
strains carried
bla
VIM-2
. Of 427
intI1
-positive strains, 180, 53, 51, 47, and 35 were identified as
P. aeruginosa
,
A. xylosoxidans
,
P. putida/fluorescens
,
S. marcescens
, and
A. baumannii
, respectively. In the present study, it was confirmed that strains carrying
bla
IMP-1
with a class 1 integron are the most prevalent type in Japan, although several
intI3
carriers have also been identified sporadically in this country.
Use of an Immunoglobulin G Avidity Assay Based on Recombinant Antigens for Diagnosis of PrimaryToxoplasma gondiiInfection during Pregnancy
Authors: Beghetto Elisa , Buffolano Wilma , Spadoni Andrea , Del Pezzo Mariassunta , Di Cristina Manlio , Minenkova Olga , Petersen Eskild , Felici Franco , Gargano Nicola 
Published: December 2003

ABSTRACTThe objective of this work was to develop an antibody-specific immunoglobulin G (IgG) avidity assay to discriminate between acute and latent phases ofToxoplasma gondiiinfection by using recombinant antigens. One hundred twenty-one serum samples from women who developed IgG antibodies againstToxoplasmaduring pregnancy were used. The IgG avidities of antibodies directed against epitopes carried by fragments of GRA3, GRA7, MIC3, and SAG1 antigens were measured by performing parallel enzyme immunoassays. The avidity index forToxoplasma-specific antibodies against a homogeneous mixture of recombinant GRA3, GRA7, MIC3, and SAG1 antigens correlated closely with the IgG avidity of antibodies against lysed whole-cellT. gondiiantigen. The avidity assay performed with the recombinant MIC3 antigen highlighted the presence of avidity low-antibodies IgG exclusively in sera collected within 2 months after primary infection. The presence ofT. gondii-specific, low-avidity IgG antibodies against recombinant MIC3 antigen can be used to determine the point of infection withT. gondiiwithin a 2-month time frame after infection.
Molecular Parameters for Precise Diagnosis of Asymptomatic Epstein-Barr Virus Reactivation in Healthy Carriers
Authors: Maurmann Susanne , Fricke Lutz , Wagner Hans-Joachim , Schlenke Peter , Hennig Holger , Steinhoff Jürgen , Jabs Wolfram J. 
Published: December 2003

ABSTRACTAsymptomatic Epstein-Barr virus (EBV) reactivations periodically occur in oral mucosa-associated lymphoid tissues. Until now, EBV reactivation has been diagnosed by serologic profiles that suggest virus replication. Serologic responses, however, are delayed and do not necessarily indicate ongoing replicative activity. The aim of the present study was to establish in healthy carriers parameters for a molecular diagnosis of reactivated EBV infection. Recent studies emphasized the association of an increase in peripheral-B-cell viral load with replicative activity at remote sites. Therefore, real-time PCR was used to quantitate EBV genomes in the peripheral blood mononuclear cells (PBMC) (viral load) and plasma samples (viremia) of 22 healthy EBV-seropositive blood donors over a period of 15 months. Furthermore, transcription of the immediate-early gene encoding BZLF1 was investigated in the PBMC of all volunteers. Serology suggested reactivation in nine donors, of whom all but one showed at least once a significant increase in viral load. Another five individuals also exhibited significant changes in viral load but no serologic response. Of the 13 volunteers with significant increases in viral load, 6 had a period of viremia accompanying the rise in viral load. A stable viral load without viremia and negative serology was seen in eight adults. BZLF1 mRNA was undetectable throughout. We conclude that for healthy subjects serology underestimates the frequency of asymptomatic EBV reactivations. Prospective examination of peripheral viral load and viremia is suitable for the exact diagnosis of EBV reactivation, which might be of advantage for immunocompromised patients in whom EBV reactivations are considerably harmful.
Changes in Gene Cassettes of Class 1 Integrons among
Escherichia coli
Isolates from Urine Specimens Collected in Korea during the Last Two Decades
Authors: Yu Hak Sun , Lee Je Chul , Kang Hee Young , Ro Dong Woo , Chung Jae Young , Jeong Young Sook , Tae Seong Ho , Choi Chul Hee , Lee Eun Young , Seol Sung Yong , Lee Yoo Chul , Cho Dong Taek 
Published: December 2003

ABSTRACT

Gene cassettes of class 1 integrons in
Escherichia coli
isolates from urine specimens collected in Korea during the last 2 decades were characterized.
intI1
was detected in 54% of the isolates, yet gene cassette regions were amplified in only 43% of the isolates.
intI2
was detected in 29 (5%) isolates, and no
intI3
was detected in this study. Twenty-one different genes, including genes encoding resistance to antibiotics, an alcohol dehydrogenase gene (
adhE
), and unknown genes, were detected. The genes most commonly found in class 1 integrons were those for aminoglycoside and trimethoprim resistance. The occurrence of aminoglycoside resistance genes in class 1 integrons decreased, and the presence of
dfr
genes increased rapidly, during the last 2 decades. Single-gene cassettes were predominant during the 1980s, while multigene cassettes predominated from the 1990s on. The
aadA1
,
aadA2
, and
blaP1-aadA2
gene cassettes were frequently found in isolates from the 1980s but were not detected in isolates recovered since 2000.
dfrA12-aadA2
and
dfrA17-aadA5
were the most prevalent gene cassettes among isolates recovered from the 1990s on. In conclusion, class 1 integrons would appear to be responsible for resistance to antibiotics commonly used to treat urinary tract infections, and selection of a specific gene cassette was found to occur over the course of time.
Culture and Phenotypic Characterization of a
Wolbachia pipientis
Isolate
Authors: Fenollar Florence , La Scola Bernard , Inokuma Hisashi , Dumler J. Stephen , Taylor Mark J. , Raoult Didier 
Published: December 2003

ABSTRACT

The recent isolation of
Wolbachia pipientis
in the continuous cell line Aa23, established from eggs of a strain of the Asian tiger mosquito
Aedes albopictus
, allowed us to perform extensive characterization of the isolate. Bacterial growth could be obtained in C6/36, another
A. albopictus
cell line, at 28°C and in a human embryonic lung fibroblast monolayer at 28 and 37°C, confirming that its host cell range is broader than was initially thought. The bacteria were best visualized by Diff-Quik and May-Grünwald-Giemsa staining. Proteins from 213 to 18 kDa with two major protein bands of 65 and 25 kDa were observed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. By Western blotting with specific polyclonal mouse and rabbit antisera, dominant immunoreactive antigens were found at approximately 100, 80, and 30 kDa. The genome size was calculated to be 1,790 ± 17 kb by pulsed-field gel electrophoresis. The sequence of the citrate synthase gene (
gltA
) of
W. pipientis
was determined by gene walking. Its position in the phylogenetic tree constructed with
gltA
confirmed that found in a phylogenetic tree constructed with 16S rRNA genes and that it belongs in the α subgroup of the class
Proteobacteria
and that it is closely related to but independent from the genera
Ehrlichia
,
Anaplasma
, and
Neorickettsia
.
Typing of Methicillin-Resistant
Staphylococcus aureus
in a University Hospital Setting by Using Novel Software for
spa
Repeat Determination and Database Management
Authors: Harmsen Dag , Claus Heike , Witte Wolfgang , Rothgänger Jörg , Claus Hermann , Turnwald Doris , Vogel Ulrich 
Published: December 2003

ABSTRACT

The
spa
gene of
Staphylococcus aureus
encodes protein A and is used for typing of methicillin-resistant
Staphylococcus aureus
(MRSA). We used sequence typing of the
spa
gene repeat region to study the epidemiology of MRSA at a German university hospital. One hundred seven and 84 strains were studied during two periods of 10 and 4 months, respectively. Repeats and
spa
types were determined by Ridom StaphType, a novel software tool allowing rapid repeat determination, data management and retrieval, and Internet-based assignment of new
spa
types following automatic quality control of DNA sequence chromatograms. Isolates representative of the most abundant
spa
types were subjected to multilocus sequence typing and pulsed-field gel electrophoresis. One of two predominant
spa
types was replaced by a clonally related variant in the second study period. Ten unique
spa
types, which were equally distributed in both study periods, were recovered. The data show a rapid dynamics of clone circulation in a university hospital setting.
spa
typing was valuable for tracking of epidemic isolates. The data show that disproval of epidemiologically suggested transmissions of MRSA is one of the main objectives of
spa
typing in departments with a high incidence of MRSA.
High Prevalence of Hepatitis B Virus Pre-S Mutant in Countries Where It Is Endemic and Its Relationship with Genotype and Chronicity
Authors: Huy Tran Thien-Tuan , Ushijima Hiroshi , Win Khin Maung , Luengrojanakul Pairoj , Shrestha Pradeep Krishna , Zhong Zhao-Hua , Smirnov Andrei V. , Taltavull Teresa Casanovas , Sata Tetsutaro , Abe Kenji 
Published: December 2003

ABSTRACT

It has been reported that hepatitis B virus (HBV) mutants carrying mutations in the pre-S region can be found in infected patients. In this study, we investigated the prevalence of the HBV variant with the pre-S mutant in different geographic regions, including countries with low and high levels of endemic HBV infection, and analyzed the correlation with clinical findings. We examined 387 HBV DNA-positive serum samples from individuals among 12 countries, consisting of Vietnam, Myanmar, Thailand, China, Korea, Nepal, Japan, Russia, Spain, United States, Bolivia, and Ghana. HBV pre-S mutants were detected in 71 (18.3%) of 387 serum samples tested. This mutant was the most prevalent in Vietnam (36%), followed by Nepal (27.3%), Myanmar (23.3%), China (22.4%), Korea (14.3%), Thailand (10.5%), Japan (7.7%), and Ghana (4.3%). In contrast, no case with this mutation was found in Russia, Spain, United States, and Bolivia. Among the HBV deletion mutations, 15.5% (11 of 71) occurred in the pre-S1 and 46.5% (33 of 71) in the pre-S2 regions. Eight (11.3%) cases had a mutation in both the pre-S1 and pre-S2 regions. In addition, a point mutation at the pre-S2 starting codon was observed in 19 (26.7%) cases. The detection rate of the HBV mutant in patients with hepatocellular carcinoma was significantly higher than in other patients (
P
< 0.05). Furthermore, these mutants were found more frequently in genotype B (25%) and genotype C (24.5%) than in the other genotypes (
P
< 0.05). Our results indicated that there was a high prevalence of HBV pre-S mutation in regions of endemic HBV infection in Asia. Furthermore, the pre-S mutation appeared to be correlated with hepatocellular carcinoma and HBV genotypes.
Evaluation of a PCR Assay for Quantitation of
Rickettsia rickettsii
and Closely Related Spotted Fever Group Rickettsiae
Authors: Eremeeva Marina E. , Dasch Gregory A. , Silverman David J. 
Published: December 2003

ABSTRACT

A spotted fever rickettsia quantitative PCR assay (SQ-PCR) was developed for the detection and enumeration of
Rickettsia rickettsii
and other closely related spotted fever group rickettsiae. The assay is based on fluorescence detection of SYBR Green dye intercalation in a 154-bp fragment of the rOmpA gene during amplification by PCR. As few as 5 copies of the rOmpA gene of
R. rickettsii
can be detected. SQ-PCR is suitable for quantitation of
R. rickettsii
and 10 other genotypes of spotted fever group rickettsiae but not for
R. akari
,
R. australis
,
R. bellii
, or typhus group rickettsiae. The sensitivity of SQ-PCR was comparable to that of a plaque assay using centrifugation for inoculation. The SQ-PCR assay was applied successfully to the characterization of rickettsial stock cultures, the replication of rickettsiae in cell culture, the recovery of rickettsial DNA following different methods of extraction, and the quantitation of rickettsial loads in infected animal tissues, clinical samples, and ticks.