Diagnostic Accuracy of Lipopolysaccharide-Binding Protein as Biomarker for Sepsis in Adult Patients: A Systematic Review and Meta-Analysis

IntroductionLipopolysaccharide-binding protein (LBP) is widely reported as a biomarker to differentiate infected from non-infected patients. The diagnostic use of LBP for sepsis remains a matter of debate. We aimed to perform a systematic review and meta-analysis to assess the diagnostic accuracy of serum LBP for sepsis in adult patients.MethodsWe performed a systematic review and meta-analysis to assess the accuracy of LBP for sepsis diagnosis. A systematic search in PubMed and EMBASE for studies that evaluated the diagnostic role of LBP for sepsis through December 2015 was conducted. We searched these databases for original, English language, research articles that studied the diagnostic accuracy between septic and non-septic adult patients. Sensitivity, specificity, and other measures of accuracy, such as diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUC) of LBP were pooled using the Hierarchical Summary Receiver Operating Characteristic (HSROC) method.ResultsOur search returned 53 reports, of which 8 fulfilled the inclusion criteria, accounting for 1684 patients. The pooled sensitivity and specificity of LBP for diagnosis of sepsis by the HSROC method were 0.64 (95% CI: 0.56–0.72) and 0.63 (95% CI: 0.53–0.73), respectively. The value of the DOR was 3.0 (95% CI: 2.0–4.0) and the AUC was 0.68 (95% CI: 0.64–0.72). Meta-regression analysis revealed that cut-off values accounted for the heterogeneity of sensitivity and sample size (> = 150) accounted for the heterogeneity of specificity.ConclusionsBased on the results of our meta-analysis, LBP had weak sensitivity and specificity in the detection of sepsis. LBP may not be practically recommended for clinical utilization as a single biomarker.     

Phylogeny and phylogeography of the genus Geothelphusa (Crustacea: Decapoda, Brachyura, Potamidae) in southwestern Taiwan based on two mitochondrial genes

Eleven species of Geothelphusa have been reported from southwestern Taiwan (Tainan, Kaohsiung and the northern part of Pingtung counties): G. albogilva Shy, Ng, and Yu, 1994; G. ancylophallus Shy, Ng, and Yu, 1994; G. caesia Shy, Ng, and Yu, 1994; G. lili Chen, Cheng, and Shy, 2005; G. nanhsi Shy, Ng, and Yu, 1994; G. neipu Chen, Cheng, and Shy, 1998; G. olea Shy, Ng, and Yu, 1994; G. pingtung Tan and Liu, 1998; G. shernshan Chen, Cheng, and Shy, 2005; G. tsayae Shy, Ng, and Yu, 1994 and G. wutai Shy, Ng, and Yu, 1994. Comparisons of DNA sequences encoding parts of the mitochondrial large subunit (16S) rRNA and cytochrome oxidase subunit I (COI) genes revealed three major clades, of which one is the species G. ancylophallus, and the other two are species groups here referred to as the G. olea and G. pingtung clades. Geothelphusa ancylophallus is geographically restricted and adapted to an ecologically challenging habitat with an unstable water supply and uneven topology. The G. olea clade (G. olea, G. caesia, G. nanhsi, G. tsayae, and G. wutai) is widely distributed throughout central-western and southwestern Taiwan. The G. pingtung clade (G. pingtung, G. neipu and G. shernshan) is confined to southwestern Taiwan between the previously defined southernmost clades of G. tawu, G. albogilva, and G. ferruginea, and the G. olea clade to the north. It includes an isolated population on distant Chaishan Mountain near Taiwan Strait, which probably dispersed from the peripheral hills of the Central Range during the early Pleistocene. The available genetic evidence indicates that the differential coloration observed in members of the G. olea and G. pingtung clades is not reflected in mtDNA, appears to be dependent on environmental conditions, food, etc., and has little value as a taxonomic character. Possible geological events and climatic factors responsible for the historic isolation of the different freshwater crab clades in southwestern Taiwan are discussed in detail.     

The millipede family Polydesmidae in Taiwan, with descriptions of five new species (Polydesmida, Diplopoda)

Polydesmidae are represented in Taiwan by seven species in two genera. Neither of the genera is endemic to Taiwan, but six of the species are, including five new: Nipponesmus minorsp. n., Epanerchodus bispinosussp. n., Epanerchodus curtigonopussp. n., Epanerchodus flagellifersp. n. and Epanerchodus pinguissp. n. In addition, the diagnosis of the hitherto enigmatic genus Nipponesmus Chamberlin & Wang, 1953 is refined vis-à-vis the especially similar, Central Asian, Siberian and Eastern European genus Schizoturanius Verhoeff, 1931, chiefly based on new material of the type-species Nipponesmus shirinensis Chamberlin & Wang, 1953; this species is adequately redescribed and represents still another Taiwanese endemic. A key to all three currently known species of Nipponesmus Chamberlin & Wang, 1953 is given. The highly speciose Central to East Asian genus Epanerchodus Attems, 1901 is represented in Taiwan by five species, all keyed, including Epanerchodus orientalis Attems, 1901, which is long known to be highly variable in Japan and found particularly polymorphous and apparently allochthonous in Taiwan. The following synonymy is formalized: Epanerchodus orientalis orientalis Attems, 1901 = Epanerchodus orientalis takakuwai Verhoeff, 1913, syn. n. The genus Usbekodesmus Lohmander, 1932 is formally synonymized with Epanerchodus Attems, 1901, syn. n., resulting in the following new formal transfers: Epanerchodus redikorzevi (Lohmander, 1932), Epanerchodus swatensis (Golovatch, 1991), Epanerchodus varius (Geoffroy & Golovatch, 2004), Epanerchodus anachoretus (Golovatch, 1986), Epanerchodus buddhis (Golovatch, 1986), Epanerchodus occultus (Golovatch, 1986), Epanerchodus sacer (Golovatch, 1987), Epanerchodus theocraticus (Golovatch, 1990) and Epanerchodus theosophicus (Golovatch, 1986), all comb. n. ex Usbekodesmus. The distributions of all seven species of Polydesmidae occurring in Taiwan are mapped and discussed.     

Revision of the Taiwanese millipede genus Chamberlinius Wang, 1956, with descriptions of two new species and a reclassification of the tribe Chamberlinini (Diplopoda, Polydesmida, Paradoxosomatidae, Paradoxosomatinae)

The millipede genus Chamberlinius is basically confined to Taiwan, with only one of the four known species presumably introduced to southern Japan. Both previously known species are redescribed, based on new material: Chamberlinius hualienensis Wang, 1956 (the type species) and Chamberlinius piceofasciatus (Gressitt, 1941), the latter being a new subjective senior synonym of Chamberlinius shengmui Wang, 1957, syn. n. Two further congeners are described as new: Chamberlinius pessior sp. n. and Chamberlinius sublaevus sp. n. The genus is re-diagnosed, all of its four species are keyed, and their distributions mapped. The tribe Chamberlinini is reclassified and, based on gonopod traits, shown to comprise the following five genera: Chamberlinius Wang, 1956, Haplogonosoma Brölemann, 1916, Riukiupeltis Verhoeff, 1939, Aponedyopus Verhoeff, 1939 and Geniculodesmus Chen, Golovatch and Chang, 2008.     

Revision of the endemic Taiwanese millipede genus Aponedyopus Verhoeff, 1939, with descriptions of two new species (Diplopoda, Polydesmida, Paradoxosomatidae). Advances in the systematica of Diplopoda III

The millipede genus Aponedyopus is endemic to Taiwan and contains three species. All previously described nominal species are considered to represent one species: Aponedyopus montanus Verhoeff, 1939 (the type species), including Aponedyopus reesi (Wang, 1957) and Aponedyopus maculatus Takakuwa, 1942, syn. n. Two further species are described as new: Aponedyopus similissp. n. and Aponedyopus latilobatussp. n. The genus is re-diagnosed, all of its three species are keyed, and their distributions mapped.     

Innate immune response after acute myocardial infarction and pharmacomodulatory action of tacrolimus in reducing infarct size and preserving myocardial integrity

Background

This study investigated the association between innate immune reaction and myocardial damage after acute myocardial infarction (AMI) and anti-inflammatory role of tacrolimus in reducing infarct size. Male mini-pigs (n=18) were equally categorized into sham control (SC), untreated AMI (by ligation of left anterior descending coronary artery), and AMI-Tacrolimus (AMI-Tac) (0.5 mg intra-coronary injection 30 minutes post-AMI). Cardiac magnetic resonance imaging (MRI) was performed at post-AMI days 2, 5 and 21 before sacrificing the animals.

Results

By post-AMI day 21, left ventricular ejection fraction (LVEF) was lowest in untreated AMI animals, significantly higher in SC than in AMI-Tac group (all p<0.003). Infarct areas at basal, middle, and apical levels, numbers of CD14+ and iNOS+ cells in infarct area (IA) and peri-IA, and protein expression of CD14, CD68, and Ly6g from circulating inflammatory cells showed an opposite pattern compared with that of LVEF in all groups (all p<0.005). Protein expressions of MCP-1, MIP-1, TNF-α, NF-κB, iNOS, and IL-12 in IA and peri-IA exhibited an identical pattern compared to that of CD14, CD68, and Ly6g from circulating inflammatory cells (all p<0.01). Expressions of myocardial damage biomarkers in IA and peri-IA [γ-H2AX, β-myosin heavy chain (MHC), Smad3, TGF-β] were highest in AMI and higher in AMI-Tac than in SC, whereas expressions of myocardial integrity biomarkers (connexin43, mitochondrial cytochrome-C, α-MHC, BMP-2, Smad1/5) were opposite to those of damage biomarkers (all p<0.001).

Conclusion

Innate immune responses were markedly augmented and LVEF was significantly reduced after AMI but were remarkably improved after tacrolimus treatment.     

Activity and weight loss in relation to solar radiation in the polymorphic land snail Cepaea nemoralis

Shell spectral reflectance, activity and weight loss in the land snail Cepaea nemoralis were examined to test whether solar radiation has different effects on the behavioural and physiological responses of different morphs. A uniform area from the empty shells of different morphs was cut and a spectrophotometer was used to measure the spectral reflectance at wavelengths from 220 nm to 800 nm. Snails were put into cages made of mesh hardware cloth, and their activities were observed from dawn onwards on two hot, dry days. Weight loss of snails under shade and under direct sunlight was also measured.
The results show that unbanded morphs reflect more light than five-banded ones, but the yellow morphs reflect only a little more than pink morphs. Five-banded morphs became inactive more quickly than unbanded ones from dawn onwards, but the differences in activity patterns were not significant between pink and yellow morphs. There are significant differences in percent weight loss between snails placed under direct sunlight and under shade. The weight loss of different morphs under shade was not statistically different. But when exposed to sunlight, five-banded morphs lost more weight than pink and yellow unbanded morphs.
Because of their lower reflectance of solar radiation, the five-banded morphs are, in a hot, arid climate, at a selective disadvantage compared to unbanded morphs. However, they can avoid such selective disadvantage by actively seeking a shaded area, as all other morphs do in the field. Such behavioural habitat selection could help the maintenance of genetic polymorphisms in natural populations.     

Seasonal variation of microhabitat distribution of the polymorphic land snail Cepaea nemoralis

We studied the seasonal variation of microhabitat distribution of the land snail Cepaea nemoralis over a 3-year period in a population at Dansville, New York. Stratified random quadrat sampling was used to determine snail densities and environmental variables in each month. The plant cover of each quadrat was estimated by a modified Daubenmire measure. Canonical correlation analysis was used to investigate the relationship between the morph density and the environmental variables. Significant relations existed between snail morphs and environmental variables in 8 of the 13 months analyzed. Temperature and rainfall are two important factors affecting such relations. In hot and dry summer months, morphs had a stronger canonical correlation with the environmental variables than in cool and wet months. Food and shelter were important in determining distribution over habitats of the snail. Food was primarily responsible for snail distribution over habitats in the early summer. As the weather became hot and dry, the importance of shelter became more evident. Both banded and unbanded morphs tended to be associated strongly with sheltered microhabitats in hot dry seasons.     

Cordyceps sinensis protects against renal ischemia/reperfusion injury in rats

Cordyceps sinensis (CS) is an entomogenous fungus used as a tonic food and Chinese medicine to replenish health. This study investigated the protective effects of CS in rats post-renal ischemia–reperfusion (I/R) sequence by analyzing the influence on stromal cell-derived factor-1α (SDF-1α and chemokine (C-X-C motif) receptor 4 (CXCR4) expressions and senescence during recovery. Chemokine SDF-1 [now called chemokine C-X-C motif ligand 12 (CXCL12)] and its receptor CXCR4 are crucial in kidney repair after ischemic acute renal failure. CS treatment significantly alleviated I/R-induced renal damage assessed by creatinine levels (p < 0.05) and abated renal tubular damages assessed by periodic acid-Schiff with diastase (PASD) staining. CS induced early SDF-1α expression and increased CXCR4 expression 1–6 h post-reperfusion. Histology studies have revealed that CS induced SDF-1α in squamous cells of Bowman’s capsule, mesangial cells, distal convoluted tubules (DCT), and proximal convoluted tubules (PCT). CS also improved renal repair in I/R-induced injury by increasing Ki-67 staining. I/R induced renal senescence after 3 and 6 h of reperfusion. However, CS alleviated I/R-induced senescence at early stage (1 and 3 h). We conclude that CS protects against I/R injury via the SDF-1/CXCR4-signaling axis and alleviates senescence.     

The Impact of Inadequate Terminal Disinfection on an Outbreak of Imipenem-Resistant Acinetobacter baumannii in an Intensive Care Unit

Background

This study was conducted to investigate an outbreak caused by imipenem-resistant Acinetobacter baumannii (IRAB) in a medical intensive care unit (ICU) in a regional hospital.

Methods

In response to an IRAB outbreak from October 2012 to February 2013, we developed several infection control measures, including an extensive review process of environmental cleaning and disinfection, and used molecular methods to identify each clinical and environmental IRAB isolate.

Results

During this five-month period, 22 patients were colonized with IRAB and 18 patients had IRAB infections. The in-hospital mortality rate was significantly higher among patients with infections rather than colonizations (44.4% vs 9.1%, p = 0.028). Additionally, nine environmental specimens, including five specimens collected after terminal disinfection, were positive for IRAB. 12 environmental isolates and 28 of 36 available clinical isolates belonged to one unique pulsotype A, which was confirmed by molecular methods. We found the concentration of disinfectant, 0.08% sodium hypochlorite, was inadequate. After correcting the environmental cleansing methods, the surveillance study showed no further IRAB isolates on the control panel surfaces of the medical equipment or in patients in the ICU. Additionally, an in vitro study of IRAB immersed in different concentrations of sodium hypochlorite showed that 0.5% sodium hypochlorite eradicates IRAB after 30 seconds of inoculation, but 0.08% sodium hypochlorite only reduces the bacterial load.

Conclusions

This study highlights the importance of the preparation of disinfectants to adequately achieve environmental disinfection in the control of IRAB outbreaks in the ICU.