This study was conducted to investigate the adherence to clinical practice guidelines (CPGs) for
Clostridium difficile
infection (CDI). A retrospective multicenter observational study was conducted ...via chart review at four teaching hospitals in Japan from April 2012 through September 2013. CDI was diagnosed based on positive identification of CD toxin by enzyme immunoassay testing. CDI patients were divided into non-severe and severe groups according to the severity criteria of four published guidelines (SHEA/IDSA 2010, ACG 2013, ESCMID 2009, HPA/DH 2008). Three parameters were assessed in association with disease severity: adherence to treatment guidelines, prognosis, and relapse rate. In total, 170 patients were diagnosed with CDI (1.04 cases per 10,000 patient-days). The 30-day all-cause mortality and recurrence rates were 13% and 14%, respectively. CPGs adherence ranged from 52% to 70% in the non-severe group and from 8.5 to 23% in the severe group (
P
< 0.01). Among severe CDI patients, no significant difference in mortality or recurrence was found between the patients whose treatments adhered and did not adhere to the CPGs. CPGs adherence was low, especially for patients with severe CDI. Improved guideline adherence and more accurate definitions of severity based on prognosis are needed for appropriate CDI management.
In the phosphorelay-mediated cytokinin signal transduction of Arabidopsis thaliana, certain members of the type-B authentic response regulator (ARR) family are implicated in the regulatory networks ...that are primarily propagated by the cytokinin-receptors authentic histidine kinases (AHKs). Clarification of the involvement of each type-B ARR transcription factor in cytokinin-responsive phenomena is still at a very early stage. Here we analyzed the redundant function of two type-B ARR genes, ARR10 and ARR12, by constructing an arr10/arr12 double mutant. The resulting mutant plants showed stronger phenotypes with special reference to the cytokinin action in roots (e.g. inhibition of root elongation, green callus formation from root explants) than those for each single mutant, suggesting that ARR10 and ARR12 redundantly play an important role in the cytokinin signaling in roots. This idea was further supported by results from root-specific microarray analyses with the double mutant plant. We also showed that ARR10 and ARR12 are involved in the AHK-dependent signaling pathway that negatively regulates protoxylem specification in root vascular tissues. When the double mutant is combined with an arr1 allele, the resultant arr1/arr10/arr12 triple mutant showed phenotypes displaying a very poor growth, quite similar to those of the wooden leg (wol) mutant that virtually lacks cytokinin receptor activities in plants. In this triple arr mutant, the specification of root vascular tissues is also affected as severely as in wol. Taken together, we propose that ARR10 and ARR12, together with ARR1, redundantly play pivotal roles in the AHK-dependent phosphorelay signaling in response to cytokinin in roots.
We experimentally revealed that a direct current (DC) biased excitation method can reduce the noise in parallel fluxgate magnetometers composed of a permalloy ring core. The noise suppression was ...achieved by decreasing the Barkhausen noise and increasing the open-loop sensitivity using the nonlinearity of the B-H curve with the DC-biased excitation. The noise performance depends on the excitation parameters: frequency, amplitude, and DC-bias. We proposed that the parameters should be determined based on the evaluation of the sensitivity and noise level in both open-loop and closed-loop modes. Specifically, a contour map of the closed-loop noise is useful for understanding the noise decrease with different values of the amplitude and DC-bias. We also demonstrated the effectiveness of the DC-biased excitation method using a commercially available fluxgate magnetometer (APS520A, Applied Physics Systems). Using the DC-biased excitation method, the noise level was approximately one-fourth compared to that of the original electronics.
Background
To enhance the sensitivity and specificity of the clinical diagnosis of progressive supranuclear palsy (PSP), neuroradiological parameters established in pathologically proven cases are ...needed.
Methods
We examined brainstem atrophy in five pathologically confirmed PSP patients (three men, mean age at death 77 years, range 64–84 years). Time interval between symptom onset and MRI ranged from 1 to 5 years, and between MRI and death from 33 to 52 months. Only one patient had clinical diagnosis of PSP at the time of MRI. Control group consisted of 19 age- and gendermatched healthy subjects. Seventeen morphometric parameters of the midbrain and pons were measured on T1-weighted midsagittal and T2-weighted axial MRI scans with Image Analyzer. Measurements of superior cerebellar peduncle (SCP) width were performed on PSP autopsy specimens.
Results
Mean SCP width on MRI in PSP (2.7 ± 0.8 mm, 95%CI: 2.1–3.3) was smaller than in controls (3.7 ± 0.5 mm, 95%CI: 3.5–3.9). Mean SCP width at autopsy was 8% smaller than mean SCP width on MRI. Midsagittal midbrain area in PSP (99.1 ± 6.9 mm
2
, 95%CI: 90.5–107.6) was smaller than in controls (141.0 ± 18.1 mm
2
, 95%CI: 132.2–149.7). Midbrain/pons area ratio in PSP was 1:5 and in controls was 1:4 (p < 0.01). Repeat MRI 17 months later in one PSP case revealed 30% decrease of SCP width.
Conclusions
MR imaging with quantitative analysis may be useful in the diagnosis of early PSP and in monitoring disease course.
In Arabidopsis thaliana, Histidine-to-Aspartate (His→ Asp) phosphorelay is a paradigm of a signaling system that is considered to be involved in response to plant hormones, including ethylene and ...cytokinin. In the current framework of His→Asp phosphorelay in this higher plant, the type-B ARR (response regulator) family members appear to act as DNA-binding transcriptional regulators. Although Arabidopsis thaliana has 11 type-B ARR family members, except for ARR1 and ARR2, no biological information is available with regard to others. As the main objective of this study, we characterized another example, ARR11, in terms of not only its in vitro biochemical properties, but also its biological activity in plants. In plants, the ARR11 gene was expressed predominantly in roots. In vitro, ARR11 showed the ability to acquire a phosphoryl group from a histidine-containing phosphotransfer intermediate (AHP), and also it showed the ability to recognize a specific nucleotide sequence, GGATT. These in vitro results supported the view that ARR11 is indeed a DNA-binding transcription factor, the ability of which is most likely modulated by phosphorylation in its receiver domain. In vivo, when a C-terminal DNA-binding domain lacking the N-terminal phospho-accepting (or receiver) domain was aberrantly expressed, the resulting transgenic plants showed characteristic anomalies during development of apical parts. The observed anomalies included “unusual proliferation of tissues in cotyledons” and “outgrowth of adventitious shoots near cotyledons”. These results with regard to the functions of ARR11 are mainly discussed in comparison with those of the previously characterized type-B response regulators.
Between April 1992 and December 2000, 167 patients with pancreatic carcinoma were evaluated and treated in our department. One hundred eight patients (64.7%) with pancreatic carcinoma underwent ...pancreatectomy. Of these patients, 94 had histologically proven ductal adenocarcinoma. The overall postoperative mortality rate was 3.2% (3 patients), and the morbidity rate was 35.1% (33 patients). The estimated 1-, 2-, 3-, and 5-year survival rates were 43.6%, 28.7%, 21.8%, and 12.9%, respectively. There were only six long-term survivors who survived >5 years after surgery. METHODOLOGY AND AIMS: Institutional experience with 94 consecutive patients with ductal adenocarcinoma who underwent pancreatectomy was reviewed to clarify the influence of 29 prognostic factors (5 host, 17 tumor, and 7 treatment factors). Special reference was made to determine whether these significant factors have an effect on long-term survival. Univariate and multivariate models were used to analyze the effect of prognostic factors on survival.
Univariate analysis indicated that blood loss, operative time, postoperative complications, histopathologic lymphatic and venous permeation, lymph node metastasis, conclusive stage, conclusive curability, resection margins, serosal invasion, size of tumor, retroperitoneal invasion, major arterial invasion, and mode of histologic infiltration were associated with significantly longer survival (p < 0.05). By Cox proportional hazards survival analysis, the most powerful predictors of outcome were venous permeation, lymph node metastasis, tumor diameter, and conclusive curability. The longest-term survivor had the most advanced stage (stage IV(b)) of disease and curability C. No long-term survivors had all of the good prognostic factors (according to multivariate analysis).
The prognosis after surgical resection of pancreatic carcinoma mostly depends on tumor factors. In this study, it was difficult to identify the determinants of long-term survival in patients with resectable tumors.
1. An animal-pollinated plant living on a slope should orientate its flowers down-slope towards the more open space if by doing so it receives more pollinator visits and thereby achieves increased ...reproductive success. 2. We measured flower orientation relative to slope direction on individuals of 10 species of forest-floor herbs in cool temperate forests in Japan. For one of these species, Erythronium japonicum, we also manipulated flower orientation to test experimentally for its effects on both male and female reproductive function. 3. In all 10 species, flowers were preferentially orientated down-slope. This pattern was more pronounced in plants growing on steeper slopes. 4. Our manipulative field experiment in Erythronium japonicum demonstrated that pollen dispatch was highest in flowers orientated down-slope. Additionally, flowers orientated up-slope may have achieved a lower seed set on steep slopes. 5. We conclude that down-slope orientation of flowers was a general phenomenon among the species that we studied, and that this behaviour was adaptive in enhancing plant fitness through pollination.
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