Search Results (1,708)

Background/Objectives: This study aimed to create a ‘carbapenem resistance score’ with the risk factors of carbapenem-resistant Gram-negative bacterial infections (GNBIs) in patients with hematological malignancies. Methods: Patients with carbapenem-resistant and susceptible GNBIs were included in this study and compared in terms of risk factors. Three models of “carbapenem resistance risk scores” were created with statistically significant variables. Results: The study included 154 patients with hospital-acquired GNBIs, of whom 64 had carbapenem-resistant GNBIs and 90 had carbapenem-susceptible GNBIs. Univariate and multivariate analyses identified several statistically significant risk factors for carbapenem resistance, including transfer from another hospital or clinic (p = 0.038), prior use of antibiotics like fluoroquinolones (p = 0.009) and carbapenems (p = 0.001), a history of carbapenem-resistant infection in the last six months (p < 0.001), rectal Klebsiella pneumoniae colonization (p < 0.001), hospitalization for ≥30 days (p = 0.001), and the presence of a urinary catheter (p = 0.002). Notably, the 14-day mortality rate was significantly higher in the carbapenem-resistant group (p < 0.001). Based on these findings, three risk-scoring models were developed. Common factors in all three models were fluoroquinolone use in the last six months, rectal K. pneumoniae colonization, and the presence of a urinary catheter. The fourth variable was transfer from another hospital (Model 1), a history of carbapenem-resistant infection (Model 2), or hospitalization for ≥30 days (Model 3). All models demonstrated strong discriminative power (AUC for Model 1: 0.830, Model 2: 0.826, Model 3: 0.831). For all three models, a cutoff value of >2.5 was adopted as the threshold to identify patients at high risk for carbapenem resistance, a value which yielded high positive and negative predictive values. Conclusions: This study successfully developed three practical risk-scoring models to predict carbapenem resistance in patients with hematological malignancies using common clinical risk factors. A cutoff score of >2.5 proved to be a reliable threshold for identifying high-risk patients across all models, providing clinicians with a valuable tool to guide appropriate empirical antibiotic therapy. Full article

Introduction: Carbapenem-resistant Klebsiella pneumoniae (CRKP) represents a critical public health threat due to its rapid nosocomial dissemination, limited therapeutic options, and elevated mortality rates. This study aimed to characterize the epidemiology, carbapenemase profiles, and antimicrobial susceptibility patterns of CRKP isolates, as well as the clinical features and outcomes observed in infected or colonized patients. Materials and Methods: We conducted a retrospective analysis of clinical and microbiological data from patients with CRKP infections or colonization admitted between January 2023 and January 2024. Descriptive statistics were used to assess prevalence, resistance patterns, and patient outcomes. Two binary logistic regression models were applied to identify independent predictors of sepsis and in-hospital mortality. Results: Among 89 CRKP isolates, 45 underwent carbapenemase typing. More than half were metallo-β-lactamase (MBL) producers, with 44.4% co-harbouring NDM and OXA-48-like enzymes. Surgical intervention was associated with a significantly lower risk of sepsis (p < 0.01) and in-hospital mortality (p = 0.045), whereas intensive care unit (ICU) stay was a strong predictor of both outcomes. ICU admission conferred a 10-fold higher risk of sepsis (95%Cl 2.4–41.0) and a 40.8-fold higher risk of in-hospital death (95% Cl 3.5–473.3). Limitations: This single-center retrospective study included a limited number of isolates in certain groups. Additionally, cefiderocol (FDC) susceptibility was assessed by disk diffusion rather than by the broth microdilution method. Conclusions: Our study underscores the increasing prevalence of metallo-beta-lactamase-producing CRKP, particularly strains harbouring dual carbapenemases. Timely recognition of high-risk patients, combined with the implementation of targeted infection control measures and the integration of novel therapeutic options, is crucial to optimize clinical management and reduce mortality associated with CRKP. Full article

Background: The development of brain metastases (BM) is a relatively uncommon but significantly adverse event in the spread of colorectal cancer (CRC). Although management of CRC BM has improved with advances in imaging and systemic therapies, clinical outcomes remain poor. Methods: This retrospective cohort study used the U.S. National Cancer Database to evaluate survival outcomes, treatment patterns, and prognostic factors in CRC patients diagnosed with BM between 2010 and 2020. Patients with isolated brain-only metastases formed the primary analytic cohort, while those with additional extracranial metastases were included for descriptive comparison. Multivariable Cox proportional hazards and logistic regression models were used to assess factors associated with of survival. Proportional hazards assumptions were tested using Schoenfeld residuals. Accelerated failure time models were also employed. Results: From a cohort of 1,040,877 individuals with CRC, 795 had metastatic disease present along with relevant data, of which 296 had isolated BM. Median overall survival (mOS) in BM-only metastatic disease group was 7.82 months (95% CI: 5.82–9.66). The longest survival was observed among patients treated with stereotactic radiosurgery combined with systemic therapy (SRS+Sys), with a median OS of 23.26 months (95% CI: 17.51–41.95) and a 3-year survival rate of 35.8%. In adjusted Cox models, SRS, systemic therapy, and definitive surgery of the primary site were each independently associated with reduced hazard of death. Rectal cancer patients had longer survival than those with colon primaries (mOS: 10.35 vs. 6.08 months). Age, comorbidity burden, and insurance status were not associated with survival in adjusted analyses. Conclusions: SRS+Sys was associated with longer survival compared to other treatment strategies. However, treatment selection is highly dependent on individual clinical factors such as performance status, comorbidities, and disease extent; therefore, these findings must be interpreted with caution Future prospective studies incorporating molecular and biomarker data are warranted to better guide care in this rare and high-risk group. Full article

The 1980 eruption of Mount St. Helens (WA, USA) presented a unique opportunity to observe primary succession in a post-eruption landscape previously dominated by conifer forests. The eruption scoured soil and biological communities adjacent to the mountain, and species of conifers have generally been slow to colonize the nutrient-poor substrate surrounding the volcano. Further, different species of conifer establish and grow at different rates. The recent advancement of conifers in the post-eruption landscape has highlighted a research gap related to conifer growth patterns. We measured the height, age, and incremental growth of 472 trees representing three common conifers, Pseudotsuga menziesii, Abies procera, and Pinus contorta, on debris avalanche (80 sites) and pyroclastic flow (82 sites) disturbance zones of the 1980 eruption. We paired annual incremental growth with recent climate data. We found that height, age, and growth rates differ among species and sites. All species had higher growth rates on the debris avalanche deposit compared to the pyroclastic flow due to either climate or substrate. Climate influences were mixed, where one species increased growth with temperature, another declined, and another was unrelated. Nevertheless, more than 40 years after the eruption, we find rapid height growth in species with implications for future forests. Full article

Colorectal surgery has undergone significant advances over the past few decades, driven by the evolution of minimally invasive techniques, particularly laparoscopy and robotics. While laparoscopy is widely recognized for its short-term benefits and oncological safety, the increasing adoption of robot-assisted surgery (RAS) has generated considerable debate regarding its clinical benefits, economic implications, and overall impact on patient outcomes. This narrative review synthesizes the existing evidence, highlighting the clinical and economic aspects of RAS in colorectal surgery, while exploring areas for future research. The findings suggest that RAS offers potential technical advantages, including increased precision, three-dimensional visualization, and improved ergonomics, particularly in anatomically complex scenarios such as low rectal resections. Still, its superiority over laparoscopy remains inconclusive and current evidence is mixed. For colon cancer, meta-analyses and analyses of large cohorts suggest lower conversion rates and faster recovery with RAS, although data are mostly retrospective and lack long-term oncological endpoints. In rectal cancer, emerging evidence from randomized controlled trials demonstrates improved short-term outcomes. Additionally, the recently published three-year results of the REAL trial are the first to demonstrate enhanced oncological outcomes following RAS. However, findings remain inconsistent due to methodological heterogeneity, the absence of patient stratification, and limited data on long-term survival and cost-effectiveness. The available evidence indicates that RAS may offer advantages in selected patient populations, particularly for anatomically complex procedures. Yet, its overall utility remains uncertain. Future studies should emphasize high-quality randomized trials, stratified subgroup analyses, and standardized economic evaluations to better define the role of RAS in colorectal surgery. Full article

The aim of this study was to isolate and identify lactic acid bacteria (LAB) from a traditional fermented beverage, Boza, and to conduct an in-depth study on their fermentation and probiotic properties. The fermentation (acid production rate, acid tolerance, salt tolerance, amino acid decarboxylase activity) and probiotic properties (gastrointestinal tolerance, bile salt tolerance, hydrophobicity, self-aggregation, drug resistance, bacteriostatic properties) of the 16 isolated LAB were systematically analyzed by morphological, physiological, and biochemical tests and 16S rDNA molecular biology. This analysis utilized principal component analysis (PCA) to comprehensively evaluate the biological properties of the strains. The identified LAB included Limosilactobacillus fermentum (9 strains), Levilactobacillus brevis (2 strains), Lacticaseibacillus paracasei (2 strains), and Lactobacillus helveticus (3 strains). These strains showed strong environmental adaptation at different pH (3.5) and temperature (45 °C), with different gastrointestinal colonization, tolerance, and antioxidant properties. All the strains did not show hemolytic activity and were inhibitory to Staphylococcus aureus, and showed resistance to kanamycin, gentamicin, vancomycin, and streptomycin. Based on the integrated scoring of biological properties by principal component analysis, Limosilactobacillus fermentum S4 and S6 and Levilactobacillus brevis S5 had excellent fermentation properties and tolerance and could be used as potential functional microbial resources. Full article

As the primary biological risk threatening safe dairy production, bovine mastitis control highly relies on environmental disinfection measures. However, the mechanisms by which chemical disinfectants influence host–environment microbial interactions remain unclear. This study systematically investigated the disinfection efficacy and regulatory effects on microbial community composition and diversity of glutaraldehyde-benzalkonium chloride (BAC) and glutaraldehyde-didecyl dimethyl ammonium bromide (DAB) at recommended concentrations (2–5%), using 80 environmental samples from intensive dairy farms in Xinjiang, China. Combining 16S rDNA sequencing with culturomics, the results showed that BAC achieved a disinfection rate of 99.33%, higher than DAB’s 97.87%, and reduced the environment–gut microbiota similarity index by 23.7% via a cationic bacteriostatic film effect. Microbiome analysis revealed that BAC selectively suppressed Fusobacteriota abundance (15.67% reduction) and promoted Bifidobacterium proliferation (7.42% increase), enhancing intestinal mucosal barrier function through butyrate metabolism. In contrast, DAB induced Actinobacteria enrichment in the environment (44.71%), inhibiting pathogen colonization via bioantagonism. BAC’s long-acting bacteriostatic properties significantly reduced disinfection costs and mastitis incidence. This study first elucidated the mechanism by which quaternary ammonium compound (QAC) disinfectants regulate host health through “environment-gut” microbial interactions, providing a critical theoretical basis for developing precision disinfection protocols integrating “cost reduction-efficiency enhancement-risk mitigation.” Full article

Nitrogen (N) availability often limits primary productivity in terrestrial ecosystems, and arbuscular mycorrhizal fungi (AMF) can enhance plant N acquisition. This study investigated the interactive effects of N fertilization and AMF inoculation on N uptake, plant performance and phenolic acid content in Hyssopus officinalis L., with the aim of promoting sustainable N management in H. officinalis cultivation. A factorial randomized complete block design was employed to evaluate four AMF inoculation strategies (no inoculation, root inoculation, soil inoculation and combined root–soil inoculation) across three N application rates (0, 0.5 and 1,1 g N pot⁻¹ (7 L)) in a controlled greenhouse environment. Combined root and soil AMF inoculation alongside moderate N fertilization (0.5 mg N pot⁻¹) optimized N use efficiency, maximizing plant biomass and bioactive compound production. Compared to non-inoculated controls, this treatment combination increased N uptake by 30%, phosphorus uptake by 24% and potassium uptake by 22%. AMF colonization increased chlorophyll content and total phenolic compounds under moderate N supply. However, excessive N application (1 g N pot⁻¹) reduced AMF effectiveness and secondary metabolite accumulation. Notably, AMF inoculation without N fertilization yielded the highest levels of anthocyanin and salicylic acid, indicating differential N-dependent regulation of specific biosynthetic pathways. The interaction between AMF and N demonstrated that moderate N fertilization (0.5 g N pot⁻¹) combined with dual inoculation strategies can reduce total N input requirements by 50%, while maintaining optimal plant performance. These findings provide practical insights for developing N-efficient cultivation protocols in medicinal plant production systems, contributing to sustainable agricultural practices that minimize environmental N losses. Full article

Viral oncolysis is considered a promising cancer treatment method because of its good tolerability and durable anti-tumor effects. Compared with other oncolytic viruses, Newcastle disease virus (NDV) has some distinct advantages. As an RNA virus, NDV does not recombine with the host genome, making it safer compared with DNA viruses and retroviruses; NDV can induce syncytium formation, allowing the virus to spread among cells without exposure to host neutralizing antibodies; and its genome adheres to the hexamer genetic code rule (genome length as a multiple of six nucleotides), ensuring accurate replication, low recombination rates, and high genetic stability. Although wild-type NDV has a killing effect on various tumor cells, its oncolytic effect and working mechanism are diverse, increasing the complexity of generating engineered oncolytic viruses with NDV. This study aims to employ whole-genome CRISPR-Cas9 knockout screening and RNA sequencing to identify putative key regulatory factors involved in the interaction between NDV and human colon cancer HCT116 cells and map their global interaction networks. The results suggests that NDV infection disrupts cellular homeostasis, thereby exerting oncolytic effects by inhibiting cell metabolism and proliferation. Meanwhile, the antiviral immune response triggered by NDV infection, along with the activation of anti-apoptotic signaling pathways, may be responsible for the limited oncolytic efficacy of NDV against HCT116 cells. These findings not only enhance our understanding of the oncolytic mechanism of NDV against colonic carcinoma but also provide potential strategies and targets for the development of NDV-based engineered oncolytic viruses. Full article

Water buffalo (Bubalus bubalis) are a primary source of milk in Pakistan, where bovine mastitis is a significant health issue among cattle, leading to substantial economic losses. Staphylococcus aureus is a predominant pathogen associated with mastitis; however, a detailed molecular characterization of the strains in the country remains limited. We previously characterized mastitis strains from the Hazara division of Khyber Pakhtunkhwa, Pakistan. In this study, we investigated mastitis cases in the Peshawar division, including samples from both animals and human farm workers for comparison. Higher rates of mastitis (67.27% of animals) and sub-clinical mastitis (91.03% of positive animals) were identified in Peshawar than for those (34.55% and 75.31%, respectively) previously observed in Hazara. Methicillin-susceptible S. aureus (MSSA) belonging to clonal complex 9 (ST2454) were predominant. Methicillin-resistant S. aureus (MRSA) belonging to ST22 and ST8 were also detected in the Nowshera district. While no S. aureus colonization was observed among animal handlers, evidence of hand contamination suggests a potential route for pathogen spread. Low levels of antibiotic resistance were noted amongst isolates, but higher rates were seen in MRSA. This study presents only the second comprehensive molecular investigation of S. aureus isolated from buffalo mastitis in Pakistan and indicates a concerning rise in mastitis within the province. Full article

Infections with multidrug-resistant (MDR) organisms remain a significant cause of morbidity and mortality among liver transplant recipients, despite advances in surgical techniques and immunosuppressive therapy. This prospective observational study aimed to evaluate the impact of targeted perioperative antibiotic prophylaxis against MDR Gram-negative bacteria on postoperative infections and mortality in liver transplant recipients. Seventy-nine adult patients who underwent liver transplantation and were admitted to the ICU for more than 24 h postoperatively were included. Demographics, disease severity scores, comorbidities, and lengths of ICU and hospital stay were recorded. Colonization with carbapenem-resistant Gram-negative bacteria was assessed via preoperative and postoperative cultures from the blood, urine, rectum, and tracheal secretions. Patients were divided into two groups: those with MDR colonization or infection who received targeted prophylaxis and controls who received standard prophylaxis. Infectious complications (30.4%) occurred significantly less frequently than non-infectious ones (62.0%, p = 0.005). The most common infections were bacteremia (22.7%), pneumonia (17.7%), and surgical site infections (2.5%), with most events occurring within 15 days post-transplant. MDR pathogens isolated included Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Although overall complication and mortality rates at 30 days and 3 months did not differ significantly between groups, the targeted prophylaxis group had fewer infectious complications (22.8% vs. 68.5%, p = 0.008), particularly bacteremia (p = 0.007). Infection-related mortality was also significantly reduced in this group (p = 0.039). These findings suggest that identification of MDR colonization and administration of targeted perioperative antibiotics may reduce septic complications in liver transplant patients. Further prospective studies are warranted to confirm benefits on outcomes and resource utilization. Full article

The high cost of mushroom spawn remains a critical constraint to economically viable mushroom cultivation, particularly for small-scale farmers. This study investigated four spawn types, including stick (giant mimosa stalks, GMS), sawdust, sorghum, and liquid culture as inoculum sources for 10 edible mushroom species. The results indicated that GMS stick spawn provides excellent conditions for the mycelial growth of seven species, outperforming other spawn types in terms of colonization rate and pinhead formation. Mushrooms grown on GMS substrate demonstrated rapid development, with full colonization occurring within 11 to 26 days and pinhead initiation between 18 and 47 days, depending on the species. Among the mushroom species tested, Schizophyllum commune exhibited the fastest growth, reaching full colonization in 11 days and forming pinheads after 18 days of inoculation. In comparison, Auricularia polytricha showed the slowest development. Economically, GMS spawn was the most cost-effective at 0.074 USD per unit, significantly lower than sawdust (0.24 USD), sorghum (0.29 USD), and potato dextrose broth (PDB; 2.80 USD). The conversion from PDB with GMS could reduce industrial inoculum costs from 35,000 USD to 600 USD annually. These findings demonstrate the potential of GMS as an effective, low-cost, and sustainable spawn option that can enhance mycelial growth and support eco-friendly farming practices. Full article

Background: The number of women veterans has been rising steadily since the Gulf War and many assume the functions of their male counterparts. Women face unique obstacles in their service, and it is imperative that differences in physiology not be overlooked so as to provide better and appropriate care to our women in uniform. Despite this influx and incorporation of female talent, dedicated reports contrasting female and male veterans are rare, outside of specific psychological studies. We therefore attempt to contrast gut constituents, absorption, innate immune system, and nutritional differences to provide a comprehensive account of similarities and differences between female and male veterans, from our single-center perspective, as this has not been carried out previously. Herein, we obtained a detailed roster of commonly used biomedical tests and some novel entities to detect differences between female and male veterans. The objective of this study was to detect differences in the innate immune system and other ancillary test results to seek differences that may impact the health of female and male veterans differently. Methods: To contrast biochemical and sociomedical parameters in female and male veterans, we studied the data collected on 450 female veterans and contrasted them to a group of approximately 1642 males, sequentially from 1995 to 2022, all selected because of above-average risk for CRC. As part of this colorectal cancer (CRC) screening cross-sectional and longitudinal study, we also collected stool, urine, saliva, and serum specimens. We used ELISA testing to detect stool p87 shedding by the Adnab-9 monoclonal and urinary organ-specific antigen using the BAC18.1 monoclonal. We used the FERAD ratio (blood ferritin/fecal p87), a measure of the innate immune system to gauge the activity of the innate immune system (InImS) by dividing the denominator p87 (10% N-linked glycoprotein detected by ELISA) into the ferritin level (the enumerator, a common lab test to assess anemia). FERAD ratios have not been performed elsewhere despite past Adnab-9 commercial availability so we have had to auto-cite our published data where appropriate. Results: Many differences between female and males were detected. The most impressive differences were those of the InImS where males clearly had the higher numbers (54,957 ± 120,095) in contrast to a much lower level in females (28,621 ± 66,869), which was highly significantly different (p < 0.004). Mortality was higher in males than females (49.4% vs. 24.1%; OR 3.08 [2.40–3.94]; p < 0.0001). Stool p87, which is secreted by Paneth cells and may have a protective function, was lower in males (0.044 ± 0.083) but higher in females (0.063 ± 0.116; p < 0.031). Immunohistochemistry of the Paneth cell-fixed p87 antigen was also higher in females (in the descending colon and rectum). In contrast, male ferritin levels were significantly higher (206.3 ± 255.9 vs. 141.1 ± 211.00 ng/mL; p < 0.0006). Females were less likely to be diabetic (29.4 vs. 37.3%; OR 0.7 [0.55–0.90]; p < 0.006). Females were also more likely to use NSAIDs (14.7 vs. 10.7%, OR 1.08 [1.08–2.00]; p < 0.015). Females also had borderline less GI bleeding by fecal immune tests (FITs), with 13.2% as opposed to 18.2% in males (OR 0.68 [0.46–1.01]; p = 0.057), but were less inclined to have available flexible sigmoidoscopy (OR 0.68 [0.53–0.89]; p < 0.004). Females also had more GI symptomatology, a higher rate of smoking, and were significantly younger than their male counterparts. Conclusions: This study shows significant differences with multiple parameters in female and male veterans. Full article

Objective: Gut dysbiosis has been implicated in the pathology of inflammatory bowel disease (IBD). There is some evidence to suggest that the use of antibiotic treatment can incite an early clinical response or remission when used in conjunction with standard-of-care (SOC) therapy to treat IBD-related flares. Furthermore, antibiotics have been historically investigated for use as a bridge when initiating biologic therapy while waiting for peak biologic treatment effect to occur. This study investigated and compared the time to clinical response when treated with combination antibiotics, metronidazole monotherapy, or SOC therapy in pediatric patients with an active IBD flare. Methods: This study was a retrospective, Institution Review Board-approved, single-centered cohort study which included patients who were less than 18 years of age with a confirmed diagnosis of IBD who received conventional treatment alone or with either combination antibiotic therapy or metronidazole monotherapy to treat an active IBD flare between March 2013 and January 2024. Patients were excluded if they received antibiotic therapy to treat an active infection, had positive stool cultures or enteric pathogen polymerase chain reaction panel, or had colonic disease limited to the rectum. Results: Fifty-nine patients were included and divided into metronidazole monotherapy (n = 18), SOC therapy (n = 20), and combination antibiotics (n = 21). The primary outcome of days to clinical response was not significantly different across all groups; however, patients who received combination antibiotics achieved the fastest time to clinical response (median (IRQ))—4 days (1, 65), compared to 7.5 days (1, 119) for the SOC group and 9 days (2, 217) for the metronidazole group. Secondary outcomes of achievement of clinical response, remission, or failure were determined to be non-significant between all groups. Conclusions: There is no significant difference in time to clinical response, attaining clinical response or remission, or treatment failure rate for patients treated with combination antibiotics, metronidazole monotherapy, or SOC. However, results of this study suggest that the use of combination antibiotics plus SOC may lead to a faster time to clinical response and remission compared to SOC therapy alone. Further studies are warranted to elucidate the role of antimicrobial therapy in management of pediatric IBD. Full article

The colonization of Legionella spp. in engineered water systems constitutes a major public health threat. In this study, a six-year environmental surveillance (2020–2025) of Legionella colonization in five different types of facilities in Crete, Greece is presented, including hotels, passenger ships, primary healthcare facilities, public hospitals, and private clinics. A total of 1081 water samples were collected and analyzed, and the overall positivity was calculated using culture-based methods. Only 16.46% of the samples exceeded the regulatory limit (>10³ CFU/L) in the total sample, with 44.59% overall Legionella positivity. Colonization by facility category showed the highest rates in primary healthcare facilities with 85.96%, followed by public hospitals (46.36%), passenger ships with 36.93%, hotels with 38.08%, and finally private clinics (21.42%). The association of environmental risk factors with Legionella positivity revealed a strong effect at hot water temperatures < 50 °C (RR = 2.05) and free chlorine residuals < 0.2 mg/L (RR = 2.22) (p < 0.0001). Serotyping analysis revealed the overall dominance of Serogroups 2–15 of L. pneumophila; nevertheless, Serogroup 1 was particularly prevalent in hospitals, passenger ships, and hotels. Based on these findings, the requirement for continuous environmental monitoring and risk management plans with preventive thermochemical controls tailored to each facility is highlighted. Finally, operational disruptions, such as those experienced during the COVID-19 pandemic, especially in primary care facilities and marine systems, require special attention. Full article