Current features of infective endocarditis in elderly patients: results of the International Collaboration on Endocarditis Prospective Cohort Study.

BACKGROUND: Elderly patients are emerging as a population at high risk for infective endocarditis (IE). However, adequately sized prospective studies on the features of IE in elderly patients are lacking. METHODS: In this multinational, prospective, observational cohort study within the International Collaboration on Endocarditis, 2759 consecutive patients were enrolled from June 15, 2000, to December 1, 2005; 1056 patients with IE 65 years or older were compared with 1703 patients younger than 65 years. Risk factors, predisposing conditions, origin, clinical features, course, and outcome of IE were comprehensively analyzed. RESULTS: Elderly patients reported more frequently a hospitalization or an invasive procedure before IE onset. Diabetes mellitus and genitourinary and gastrointestinal cancer were the major predisposing conditions. Blood culture yield was higher among elderly patients with IE. The leading causative organism was Staphylococcus aureus, with a higher rate of methicillin resistance. Streptococcus bovis and enterococci were also significantly more prevalent. The clinical presentation of elderly patients with IE was remarkable for lower rates of embolism, immune-mediated phenomena, or septic complications. At both echocardiography and surgery, fewer vegetations and more abscesses were found, and the gain in the diagnostic yield of transesophageal echocardiography was significantly larger. Significantly fewer elderly patients underwent cardiac surgery (38.9% vs 53.5%; P < .001). Elderly patients with IE showed a higher rate of in-hospital death (24.9% vs 12.8%; P < .001), and age older than 65 years was an independent predictor of mortality. CONCLUSIONS: In this large prospective study, increasing age emerges as a major determinant of the clinical characteristics of IE. Lower rates of surgical treatment and high mortality are the most prominent features of elderly patients with IE. Efforts should be made to prevent health care-associated acquisition and improve outcomes in this major subgroup of patients with IE.

Simulation of growth and development of irrigated cowpea in Piauí State by CROPGRO model

The objective of this work was to adapt the CROPGRO model, which is part of the DSSAT system, for simulating the cowpea (Vigna unguiculata) growth and development under soil and climate conditions of the Baixo Parnaíba region, Piauí State, Brazil. In the CROPGRO, only input parameters that define crop species, cultivars, and ecotype were changed in order to characterize the cowpea crop. Soil and climate files were created for the considered site. Field experiments without water deficit were used to calibrate the model. In these experiments, dry matter (DM), leaf area index (LAI), yield components and grain yield of cowpea (cv. BR 14 Mulato) were evaluated. The results showed good fit for DM and LAI estimates. The medium values of R² and medium absolute error (MAE) were, respectively, 0.95 and 264.9 kg ha-1 for DM, and 0.97 and 0.22 for LAI. The difference between observed and simulated values of plant phenology varied from 0 to 3 days. The model also presented good performance for yield components simulation, excluding 100-grain weight, for which the error ranged from 20.9% to 34.3%. Considering the medium values of crop yield in two years, the model presented an error from 5.6%.

Photosynthetic responses of young cashew plants to varying environmental conditions

The aim of this study was to characterize gas exchange responses of young cashew plants to varying photosynthetic photon flux density (PPFD), temperature, vapor-pressure deficit (VPD), and intercellular CO2 concentration (Ci), under controlled conditions. Daily courses of gas exchange and chlorophyll a fluorescence parameters were measured under natural conditions. Maximum CO2 assimilation rates, under optimal controlled conditions, were about 13 mmol m-2 s-1 , with light saturation around 1,000 mmol m-2 s-1. Leaf temperatures between 25ºC and 35ºC were optimal for photosynthesis. Stomata showed sensitivity to CO2, and a closing response with increasing Ci. Increasing VPD had a small effect on CO2 assimilation rates, with a small decrease above 2.5 kPa. Stomata, however, were strongly affected by VPD, exhibiting gradual closure above 1.5 kPa. The reduced stomatal conductances at high VPD were efficient in restricting water losses by transpiration, demonstrating the species adaptability to dry environments. Under natural irradiance, CO2 assimilation rates were saturated in early morning, following thereafter the PPFD changes. Transient Fv/Fm decreases were registered around 11h, indicating the occurrence of photoinhibition. Decreases of excitation capture efficiency, decreases of effective quantum yield of photosystem II, and increases in non-photochemical quenching were consistent with the occurrence of photoprotection under excessive irradiance levels.

Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation.

Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.

New diagnoses of dementia among older patients admitted to postacute care.

Objectives: To determine the prevalence of dementia and the proportion of undiagnosed dementia in elderly patients admitted to postacute care, and to identify patients' characteristics associated with undiagnosed dementia. Design: Cross-sectional study. Setting: Academic postacute rehabilitation facility in Lausanne, Switzerland. Participants: Patients (N = 1764) aged 70 years and older. Measurements: Data on socio-demographic, medical, functional, and affective status were collected upon admission. Data on cognitive performance (Mini-Mental State Exam [MMSE]), and cognition-related discharge diagnoses were abstracted through a structured review of discharge summaries. Results: Overall, 24.1% (425/1764) patients had a diagnosis of dementia, most frequently secondary to Alzheimer's disease (260/425, 61.2%). Among dementia cases, 70.8% (301/425) were newly diagnosed during postacute stay. This proportion was lower among patients referred from internal medicine than from orthopedic/surgery services (65.8% versus 74.8%, P = .042). Compared to patients with already diagnosed dementia, those newly diagnosed were older, lived alone more frequently, and had better functional status and MMSE score at admission (all P < .05). In multivariate analysis, previously undetected dementia remained associated with older age (OR = 2.4 for age 85 years and older, 95% CI 1.5-4.0, P = .001) and normal MMSE at admission (OR = 5.9, 95% CI 2.7-12.7, P < .001). Conclusion: Dementia was present in almost a fourth of elderly patients referred to postacute care, but was diagnosed in less than a third before admission. Oldest old patients appear especially at risk for underrecognition. These results emphasize the high diagnostic yield of systematic cognitive assessment in the postacute care setting to improve these patients' management and quality of life.

Agronomic performance, chromosomal stability and resistance to velvetbean caterpillar of transgenic soybean expressing cry1Ac gene

The objective of this work was to analyze the agronomic performance and chromosomal stability of transgenic homozygous progenies of soybean [Glycine max (L.) Merrill.], and to confirm the resistance of these plants against Anticarsia gemmatalis. Eleven progenies expressing cry1Ac, hpt and gusA genes were evaluated for agronomic characteristics in relation to the nontransformed parent IAS 5 cultivar. Cytogenetical analysis was carried out on transgenic and nontransgenic plants. Two out of the 11 transgenic progenies were also evaluated, in vitro and in vivo, for resistance to A. gemmatalis. Two negative controls were used in resistance bioassays: a transgenic homozygous line, containing only the gusA reporter gene, and nontransgenic 'IAS 5' plants. The presence of cry1Ac transgene affected neither the development nor the yield of plants. Cytogenetical analysis showed that transgenic plants presented normal karyotype. In detached-leaf bioassay, cry1Ac plants exhibited complete efficacy against A. gemmatalis, whereas negative controls were significantly damaged. Whole-plant feeding assay confirmed a very high protection of cry1Ac against velvetbean caterpillar, while nontransgenic 'IAS 5' plants and homozygous gusA line exhibited 56.5 and 71.5% defoliation, respectively. The presence of cry1Ac transgene doesn't affect the majority of agronomic traits (including yield) of soybean and grants high protection against A. gemmatalis.

Characterization of a new potential virulence factor of Microsporum canis, the secreted subtilisin Sub6

Background: Microsporum canis is a dermatophyte responsible for cutaneous superficial mycoses in domestic carnivores and humans. The pathogenesis of dermatophytoses, including M. canis infections, remains poorly understood. Secreted proteases including members of the subtilisin family are thought to be involved in the infection process. In particular the subtilisin Sub6 could represent a major virulence factor.Objective: The aim of this work was to (i) isolate the M. canis SUB6 genomic DNA and cDNA (ii) produce Sub6 as a recombinant protease (rSub6) and (iii) produce a specific anti-Sub6 polyclonal serum. Material and methods: Genomic SUB6 was amplified by PCR using specific primers and M. canis IHEM 21239 DNA as a target. The SUB6 cDNA was obtained by reverse transcriptase (RT)-PCR using total RNA extracted from the same M. canis strain grown in liquid medium containing feline keratin as unique nitrogen source. Both SUB6 cDNA and genomic DNA were sequenced. The SUB6 cDNA was cloned in pPICZA to produce recombinant Sub6 (rSub6) in Pichia pastoris KM71. This protease rSub6 was produced in methanol medium at a yield of 30 mg ml)1 and purified by anion exchange chromatography using a DEAE-sepharose column. Polyclonal antibodies against purified rSub6 were produced in a rabbit using a standard immunization procedure with saponin as the adjuvant. Seventy days after the first immunization, serum was collected and IgG were purified by affinity chromatography.Results: The coding sequence for M. canis SUB6 from genomic DNA contains 1410 bp and 3 introns, while the cDNA contains a 1221 bp open reading frame. Deduced amino acid sequence analysis revealed that Sub6 is synthesized as a 406 amino acids preproprotein. The predicted catalytic domain has 286 amino acids, a molecular mass of 29.1 kDa and five potential N-glycosylation sites. SDS-PAGE of rSub6 revealed a single polypeptide chain with an apparent molecular mass of 37 kDa. Purified rabbit IgG were shown to be specific for Sub6 using ELISA.Conclusion: We have characterized for the first time Sub6 from a dermatophyte species as a recombinant secreted active enzyme and purified it until homogeneity. Active rSub6 and Sub6 specific antiserum will be used to further study the role of M. canis Sub6 protease in pathogenesis, notably the pattern of in vivo Sub6 secretion in different host species.

Cell size in trays for the production of strawberry plug transplants

The objective of this work was to evaluate the influence of cell sizes used for strawberry plug production in trays compared to bare root transplants, regarding initial plant size, harvest timing, and total strawberry fruit yield. Plug transplants were produced from runner tips rooted in trays with cell sizes of 26.5, 50, 100 and 150 cm³ filled with Plantmax HA organic substrate. Bare root transplants (control) were produced in a closed soilless system using sand as substrate. A randomized block design was used, with four replicates with 16 plants per plot. Bare root transplants and plug transplants from 100-cm³ cells had larger crown and higher leaf and root dry mass. Early fruit yield was higher in plants propagated from plugs than in those propagated from bare root transplants. Spring and total fruit yield did not differ among treatments, with an average yield of 435 and 874 g per plant, respectively. Earlier strawberry fruit yield was obtained by using plug transplants, even from trays with small cells of 26.5 or 50 cm³.

Impact of direct seeding mulch-based cropping systems on soil nematodes in a long-term experiment in Madagascar

The objective of this work was to assess the effects of conventional tillage and of different direct seeding mulch-based cropping systems (DMC) on soil nematofauna characteristics. The long-term field experiment was carried out in the highlands of Madagascar on an andic Dystrustept soil. Soil samples were taken once a year during three successive years (14 to 16 years after installation of the treatments) from a 0-5-cm soil layer of a conventional tillage system and of three kinds of DMC: direct seeding on mulch from rotation soybean-maize residues; direct seeding of maize-maize rotation on living mulch of silverleaf (Desmodium uncinatum); direct seeding of bean (Phaseolus vulgaris)-soybean rotation on living mulch of kikuyu grass (Pennisetum clandestinum). The samples were compared with samples from natural fallows. The soil nematofauna, characterized by the abundance of different trophic groups and indices (MI, maturity index; EI and SI, enrichment and structure indices), allowed the discrimination of the different cropping systems. The different DMC treatments had a more complex soil food web than the tillage treatment: SI and MI were significantly greater in DMC systems. Moreover, DMC with dead mulch had a lower density of free-living nematodes than DMC with living mulch, which suggested a lower microbial activity.

Seed priming and sulfur effects on soybean cell membrane stability and yield in saline soil

The objective of this work was to determine the effects of seed priming and sulfur application on cell membrane characteristics, seedling emergence, chlorophyll content and grain yield of soybean (Glycine max) in saline soil. A complete-block design in 4x3 factorial arrangement with three replicates was used to test four types of seed priming (water, auxin, gibberellin and non-priming) and three levels of sulfate availability (0, 70 and 140 kg ha-1 K2SO4). The soil had a silty loam texture with an electrical conductivity of 3.61 ds m-1, a pH of 8.2 and a saturation percentage of about 46%. Seed priming had significant effects on mean emergence rate (MER), emergence percentage, relative water content (RWC) of leaves, relative chlorophyll content, time of maturity, shoot length and grain yield. The highest values for these variables were observed in the priming treatments, except for the time of maturity. Sulfur application had significant effects on MER, shoot length, RWC, membrane injury index and grain yield. Priming treatments provide greater emergence rates and grain yields and interact sinergicaly with sulfur rates.

Mobilization of hemopoietic stem cells with high-dose methotrexate plus granulocyte-colony-stimulating factor in patients with primary central nervous system lymphoma.

BACKGROUND: High-dose therapy with autologous stem cell support after standard dose induction is a promising approach for therapy of primary central nervous system lymphoma (PCNSL). High-dose methotrexate (HD-MTX) is a standard drug for induction of PCNSL; however, data about the capacity of HD-MTX plus granulocyte-colony-stimulating factor (G-CSF) to mobilize hemopoietic progenitors are lacking. STUDY DESIGN AND METHODS: This investigation describes the data from stem cell mobilization and apheresis procedures after one or two cycles of HD-MTX for induction of PCNSL within the East German Study Group for Haematology and Oncology 053 trial. Eligible patients proceeded to high-dose busulfan/thiotepa after induction therapy and mobilization. RESULTS: Data were available from nine patients with a median age of 58 years. The maximal CD34+ cell count per microL of blood after the first course of HD-MTX was 13.89 (median). Determination was repeated in six patients after the second course with a significantly higher median CD34+ cell count of 33.69 per microL. Five patients required two apheresis procedures and in four patients a single procedure was sufficient. The total yield of CD34+ cells per kg of body weight harvested by one or two leukapheresis procedures was 6.60 x 10(6) (median; range, 2.68 x 10(6)-15.80 x 10(6)). The yield of CD34+ cells exceeded the commonly accepted lower threshold of 3 x 10(6) cells per kg of body weight in eight of nine cases. Even in the ninth, hemopoietic recovery after stem cell reinfusion was rapid and safe. CONCLUSION: HD-MTX plus G-CSF is a powerful combination for stem cell mobilization in patients with PCNSL and permits safe conduction of time-condensed and dose-intense protocols with high-dose therapy followed by stem cell reinfusion after HD-MTX induction.

Diagnostic and prognostic value of antibodies against chimeric fibrin/filaggrin citrullinated synthetic peptides in rheumatoid arthritis

Introduction: Evidence suggests that citrullinated fibrin(ogen) may be a potential in vivo target of anticitrullinated protein/peptide antibodies (ACPA) in rheumatoid arthritis (RA). We compared the diagnostic yield of three enzyme-linked immunosorbent assay (ELISA) tests by using chimeric fibrin/filaggrin citrullinated synthetic peptides (CFFCP1, CFFCP2, CFFCP3) with a commercial CCP2-based test in RA and analyzed their prognostic values in early RA. Methods: Samples from 307 blood donors and patients with RA (322), psoriatic arthritis (133), systemic lupus erythematosus (119), and hepatitis C infection (84) were assayed by using CFFCP- and CCP2-based tests. Autoantibodies also were analyzed at baseline and during a 2-year follow-up in 98 early RA patients to determine their prognostic value. Results: With cutoffs giving 98% specificity for RA versus blood donors, the sensitivity was 72.1% for CFFCP1, 78.0% for CFFCP2, 71.4% for CFFCP3, and 73.9% for CCP2, with positive predictive values greater than 97% in all cases. CFFCP sensitivity in RA increased to 80.4% without losing specificity when positivity was considered as any positive anti-CFFCP status. Specificity of the three CFFCP tests versus other rheumatic populations was high (> 90%) and similar to those for the CCP2. In early RA, CFFCP1 best identified patients with a poor radiographic outcome. Radiographic progression was faster in the small subgroup of CCP2-negative and CFFCP1-positive patients than in those negative for both autoantibodies. CFFCP antibodies decreased after 1 year, but without any correlation with changes in disease activity. Conclusions: CFFCP-based assays are highly sensitive and specific for RA. Early RA patients with anti-CFFCP1 antibodies, including CCP2-negative patients, show greater radiographic progression.

Production of annual winter forage sown before and after soybean harvest under different nitrogen fertilization levels

The objective of this work was to evaluate the effect on forage yield of sowing winter forage species before and after soybean harvest, at different nitrogen application levels. The experiment was set out in a randomized block design with a strip-split plot arrangement, and three replicates. Sowing methods (18 days before soybean harvest and six days after soybean harvest) were allocated in the main plots, and the combination among forage species (Avena strigosa cv. IAPAR 61 + Lolium multiflorum; A. strigosa cv. Comum + L. multiflorum; A. strigosa cv. Comum + L. multiflorum + Vicia villosa; A. strigosa cv. Comum + L. multiflorum + Raphanus sativus; and L. multiflorum) and nitrogen levels (0, 140, 280 and 420 kg ha-1) in the plots and subplots, respectively. Forage sowing before the soybean harvest made it possible to anticipate first grazing by 14 days, with satisfactory establishment of forage species without affecting forage production. This method permitted a longer grazing period, preventing the need for soil disking, besides allowing the use of no-tillage system. The mixture of forage species enables higher forage yield for pasture in relation to single species pastures, with response to nitrogen fertilization up to 360 kg ha-1.

Different methods to assess yield temporal stability in rubber

The objective of this work was to assess, during six years, the temporal stability of natural rubber yield of 25 superior Hevea brasiliensis genotypes, using the Wricke, Eberhart & Russell, Lin & Binns, additive main effect and multiplicative interaction (AMMI) analysis, and harmonic mean of the relative performance of the genetic values (HMRPGV) methods. The IAC 40 and IAC 300 genotypes were identified as stable and high yielding by the Eberhart & Russell, Lin & Binns, HMRPGV, and AMMI Biplot methods. The ranking of the other more stable genotypes identified by these analyses was altered. The observed results in the AMMI Biplot agreed with those observed in the Wricke method for identifying stable, but lower yielding genotypes. The simultaneous use of different methods allows a more accurate indication of stable genotypes. Stability analyses based on different principles show agreement in indicating stable genotypes.

Mass and energy balance of the carbonization of babassu nutshell as affected by temperature

The objective of this work was to evaluate the carbonization yield of babassu nutshell as affected by final temperature, as well as the energy losses involved in the process. Three layers constituting the babassu nut, that is, the epicarp, mesocarp and endocarp, were used together. The material was carbonized, considering the following final temperatures: 450, 550, 650, 750, and 850ºC. The following were evaluated: energy and charcoal yields, pyroligneous liquid, non-condensable gases, and fixed carbon. The use of babassu nutshell can be highly feasible for charcoal production. The yield of charcoal from babassu nutshell carbonization was higher than that reported in the literature for Eucalyptus wood carbonization, considering the final temperature of 450ºC. Charcoal and energy yields decreased more sharply at lower temperatures, with a tendency to stabilize at higher temperatures. The energy yields obtained can be considered satisfactory, with losses between 45 and 52% (based on higher heating value) and between 43 and 49% (based on lower heating value) at temperatures ranging from 450 to 850ºC, respectively. Yields in fixed carbon and pyroligneous liquid are not affected by the final carbonization temperature.