Candidaemia is a serious hazard to hospitalized patients, but European epidemiological data are restricted to national studies focusing on Northern Europe, population-based surveillance programmes or ...studies conducted in distinct local areas. The aim was to provide current data on the overall burden and epidemiological development of candidaemia in Europe.
A Web of Knowledge™ search was carried out from January 2000 to February 2019. Appropriate data were collected on total cases, study duration, incidence, species distribution and/or mortality rates. Meta-analysis was performed to pool individual studies. Heterogeneity was examined using the I2 statistic. Calculations of pooled incidence and mortality rates, subgroup analysis by geographical origin, study period and scenarios were carried out. Daily candidaemia incidence and mortality rates in Europe were extrapolated. Systematic review and meta-analysis were used to determine incidence and mortality of candidaemia in the UN European region. Complete datasets were categorized into population-based and hospital-based epidemiological studies and were analysed separately. Subgroup analyses were performed for geographic distributions and time-dependent developments.
In population-based studies, 43 799 cases of candidaemia were diagnosed in 1 885 271 885 person-years, revealing an overall pooled incidence rate of 3.88/100 000. The highest pooled incidence rate was observed in intensive care units (5.5/1000 admissions, Day 30 mortality rate 37%), followed by tertiary care centres (0.96/1000 admissions, pooled Day 30 mortality rate 38%) and the mixed group of teaching and general hospitals (0.52/1000 admissions, pooled Day 30 mortality rate 37%). European incidence of candidaemia was extrapolated to approximately 79 cases per day, of which an estimated 29 patients might have fatal outcome at Day 30.
Pooled incidence rates, species distribution and outcome of candidaemia differ considerably between clinical groups, European regions and over time. We observed an increasing overall pooled incidence rate of candidaemia and a higher proportion of Candida spp. other than C. albicans in the current decade in population-based data.
Wheat-dependent exercise-induced anaphylaxis Scherf, K. A.; Brockow, K.; Biedermann, T. ...
Clinical and experimental allergy,
January 2016, Letnik:
46, Številka:
1
Journal Article
Recenzirano
Summary
Wheat‐dependent exercise‐induced anaphylaxis (WDEIA) is a rare, but potentially severe food allergy exclusively occurring when wheat ingestion is accompanied by augmenting cofactors. It is ...clinically characterized by anaphylactic reactions ranging from urticaria and angioedema to dyspnoea, hypotension, collapse, and shock. WDEIA usually develops after ingestion of wheat products followed by physical exercise. Other cofactors are acetylsalicylic acid and other non‐steroidal anti‐inflammatory drugs, alcohol, and infections. The precise mechanisms of WDEIA remain unclear; exercise and other cofactors might increase gastrointestinal allergen permeability and osmolality, redistribute blood flow, or lower the threshold for IgE‐mediated mast cell degranulation. Among wheat proteins, ω5‐gliadin and high‐molecular‐weight glutenin subunits have been reported to be the major allergens. In some patients, WDEIA has been discussed to be caused by epicutaneous sensitization with hydrolysed wheat gluten included in cosmetics. Diagnosis is made based on the patient's history in combination with allergy skin testing, determination of wheat‐specific IgE serum antibodies, basophil activation test, histamine release test, and/or exercise challenge test. Acute treatment includes application of adrenaline or antihistamines. The most reliable prophylaxis of WDEIA is a gluten‐free diet. In less severe cases, a strict limitation of wheat ingestion before exercise and avoidance of other cofactors may be sufficient.
Severe pulmonary infections are among the most common reasons for admission to intensive care units (ICU). Within the last decade, increasing reports of severe influenza pneumonia resulting in acute ...respiratory distress syndrome (ARDS) complicated by Aspergillus infection were published.
To provide a comprehensive review of management of influenza-associated pulmonary aspergillosis in patients with ARDS.
Review of the literature pertaining to severe influenza-associated pulmonary aspergillosis. PubMed database was searched for publications from the database inception to January 2019.
In patients with lower respiratory symptoms, development of respiratory insufficiency should trigger rapid and thorough clinical evaluation, in particular in cases of suspected ARDS, including electrocardiography and echocardiography to exclude cardiac dysfunction, arrhythmias and ischaemia. Bronchoalveolar lavage should obtain lower respiratory tract samples for galactomannan assay, direct microscopy, culture, and bacterial, fungal and viral PCR. In case of positive Aspergillus testing, chest CT is the imaging modality of choice. If influenza pneumonia is diagnosed, neuraminidase inhibitors are the preferred approved drugs. When invasive aspergillosis is confirmed, first-line therapy consists of isavuconazole or voriconazole. Isavuconazole is an alternative in case of intolerance to voriconazole, drug–drug interactions, renal impairment, or if a spectrum of activity including the majority of Mucorales is desired. Primary anti-mould prophylaxis with posaconazole is recommended in haematology patients at high-risk. It may be considered in newly diagnosed influenza and ARDS, but ideally in clinical trials.
The rising reports of influenza-associated pulmonary aspergillosis in patients with ARDS, who are otherwise not considered at risk for fungal pneumonia demands heightened clinical awareness. Tracheobronchitis and Aspergillus in respiratory tract samples should prompt suspicion of invasive fungal infection and further work-up. The management algorithm should comprise bronchoalveolar lavage, CT imaging, sophisticated ventilator-management, rescue extracorporeal membrane oxygenation, and antifungal and antiviral therapy. To decrease the burden of influenza-related illness, vaccination is of utmost importance, specifically in patients with co-morbidities.
We provide the first demonstration that molecular-level methods based on gas kinetic theory and molecular chaos can simulate turbulence and its decay. The direct simulation Monte Carlo (DSMC) method, ...a molecular-level technique for simulating gas flows that resolves phenomena from molecular to hydrodynamic (continuum) length scales, is applied to simulate the Taylor-Green vortex flow. The DSMC simulations reproduce the Kolmogorov -5/3 law and agree well with the turbulent kinetic energy and energy dissipation rate obtained from direct numerical simulation of the Navier-Stokes equations using a spectral method. This agreement provides strong evidence that molecular-level methods for gases can be used to investigate turbulent flows quantitatively.
Nitric oxide adsorption on a Au(100) single crystal has been investigated to identify the type of adsorption, the adsorption site, and the orientation and alignment of the adsorbed NO relative to the ...surface. This was done using a combination of 3D-surface velocity map imaging, near-ambient pressure X-ray photoelectron spectroscopy, and density functional theory. NO was observed to be molecularly adsorbed on gold at ∼200 K. Very narrow angular distributions and cold rotational distributions of photodesorbed NO indicate that NO adsorbs on high-symmetry sites on the Au crystal, with the N-O bond axis close to the surface normal. Our density functional theory calculations show that NO preferentially adsorbs on the symmetric bridge (2f) site, which ensures efficient overlap of the NO π* orbital with the orbitals on the two neighbouring Au atoms, and with the N-O bond axis aligned along the surface normal, in agreement with our conclusions from the rotational state distributions. The combination of XPS, which reveals the orientation of NO on gold, with 3D-surface velocity map imaging and density functional theory thus allowed us to determine the adsorption site, orientation and alignment of nitric oxide adsorbed on Au(100).
Molecular surface geometry of adsorbents by triangulation using 3D-velocity map imaging.
The presence of a metal oxide surface can significantly alter the product yield distribution during the radiolysis of water with some metal oxides such as ZrO2 or CeO2, increasing the yield of H2 ...during the irradiation of water adsorbed on the oxide as compared to liquid water, while other oxides such as PuO2 decrease H2 yields. In this study, the γ-ray radiolysis of the ZnO/H2O system was investigated. Surprisingly, both O2 and H2 were produced in similar quantities. The production of O2 is unexpected as no, or negligible, amounts of O2 have been observed for the radiolysis of water adsorbed on other oxides. Molecular oxygen production is observed during the radiolysis of both wet and dry ZnO, indicating that the source of at least some of the O2 is the bulk oxide. The production of H2 due to the radiolysis of water adsorbed on ZnO is an order of magnitude greater than for pure water. This increase is likely due to an energy-transfer process from the oxide to the adsorbed water molecules. However, the radiolysis of aqueous suspensions of ZnO resulted in lower radiolytic H2 yields than for pure water.
In this study, we calculated the energetics of hydrogen atoms adsorbing on and diffusing into the first few layers of γ-Fe for the (100), (110) and (111) surfaces and for the non-magnetic (NM), ...ferromagnetic (FM), and antiferromagnetic single (AFM1) and double layer (AFMD) structures. These studies are relevant as they atomistically simulate the early stages of hydrogen embrittlement in steels. We employed density functional theory to establish adsorption sites and energies for each plane and the minimum energy pathways for diffusion through the first few layers with associated activation barriers. Adsorption energies for all cases vary between ∼3.7 and 4.4 eV, and the energy barriers to diffusion in the bulk region vary between ∼0.2 and 1.2 eV for the twelve cases, with the highest and lowest bulk diffusion barriers occurring in the NM(111) and the FM(100) case, respectively. We conclude that the texturing of steels in order to expose certain cleavage planes or magnetic structures can decrease the likelihood of hydrogen embrittlement.
Calculations of adsorption and diffusion energies of hydrogen on and through iron relevant to hydrogen embrittlement.
ABSTRACT
Einkorn (Triticum monococcum L.), emmer (T. dicoccum L.), and spelt (T. spelta L.) are old‐world hulled wheat crops currently receiving renewed interest of consumers, bakers, millers, and ...farmers. Our objectives were to (i) compare einkorn, emmer, and spelt with bread (T. aestivum L.) and durum wheat (T. durum L.) regarding their main agronomic and quality traits, (ii) elaborate the heritability and correlation among these traits across the wheat species, and (iii) draw conclusions about optimized farming and processing practices for einkorn, emmer, and spelt. For this purpose, field trials were conducted at four diverse German locations, where 15 recent varieties were grown for each wheat species. Mean grain yields of spelt, emmer, and einkorn were 37, 55, and 62% lower than that of bread wheat. Furthermore, einkorn, emmer, and spelt plants were 30 cm taller than bread and durum wheat. Consequently, to avoid lodging, farmers should aim at reducing the plant height of hulled wheats. Despite their high protein content, the protein quality of hulled wheat determined as sedimentation volume was low from a classical bread wheat point of view. However, adapting classical baking procedures enables the production of high quality breads from einkorn, emmer, and spelt in addition to the development of alternative products like breakfast cereals or excellent specialty breads.
The Device for Indirect Capture Experiments on Radionuclides (DICER) is a new instrument that is being developed at the Los Alamos Neutron Science Center (LANSCE) to study neutron capture reactions ...on short-lived radionuclides. To achieve that, DICER is using an indirect technique based on measuring the neutron transmission through very small samples (0.12-1.2mm in diameter, μg-mg in mass). The main detection system of DICER consists of two dual photomultiplier (PMT) based detectors which are sensitive to the scintillation light produced when neutrons interact with 6 Li glass disks. DICER is developing a new collimation system that includes a 0.1 mm collimator. In such small sizes, the need for neutron beam imaging is crucial and necessary to confirm the appropriate alignment between the irradiated sample and the neutron detectors. The Large Area Picosecond Photodetector (LAPPD) is a multichannel plate (MCP) based photodetector, with picosecond level timing, single photon detection capabilities and spatial resolution of the order of 1 mm. Coupling the LAPPD with a 6 Li glass scintillator, results in a neutron imaging detector. The first irradiation of the LAPPD at DICER, indicated that apart from imaging the beam, the LAPPD can be used as the main neutron detection system. These results were proof of principle measurements demonstrating the capabilities of the beamline and the challenge with small samples will be addressed in the future. The first efforts and developments, including irradiations of the LAPPD and the first beam images, will be presented.
Pneumocystis jirovecii pneumonia (PCP) incidence is increasing in patients without HIV infection. In contrast to PCP in patients infected with HIV, diagnosis is often delayed and illness is ...associated with increased mortality.
To provide a comprehensive review of clinical presentation, risk factors, diagnostic strategies, and treatment options for PCP in patients without HIV infection.
Web-based literature review on PCP for trials, meta-analyses, and systematic reviews using PubMed. The restriction to the English language was applied.
Common underlying conditions in patients without HIV infection having PCP are haematological malignancies, autoimmune and inflammatory diseases, solid organ or haematopoietic stem cell transplant, and previous corticosteroid exposure. New risk groups include patients receiving monoclonal antibodies and immunomodulating therapies. Patients without HIV infection who have PCP present with rapid onset and progression of pneumonia, increased duration of hospitalization and a significantly higher mortality rate than patients infected with HIV. PCP is diagnosed by a combination of clinical symptoms and radiological as well as mycological features. Results of immunofluorescence microscopy from bronchoalveolar lavage, PCR testing, and computed tomography imaging as well as the evaluation of clinical presentation are required. The established treatment regime consists of trimethoprim and sulfamethoxazole.
Although the number of patients with immunosuppression due to causes different from HIV is increasing, a simultaneous rise in PCP incidence is observed. In the group of patients without HIV infection, rapid onset of symptoms, a more complex course, and a high mortality rate are recorded. Therefore, the time to diagnosis must be as short as possible to initiate effective therapy promptly. This review aims to raise awareness of PCP in an increasingly affected at-risk group and provides clinicians with a practical guide for efficient diagnosis and targeted therapy. Furthermore, it intends to display current inadequacies in research on the topic of PCP.
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