GF Jooste Hospital

To analyze the outcomes of the endoscopic transcanal approach for removal of early stage middle ear paraganglioma tumors (MEPT). Cases series with chart review. Two tertiary Australian Otology centers. Adult patients with middle ear paraganglioma tumors treated with transcanal endoscopic approach from 2/2016 to 12/2019. Tumor staging was described using the Modified Fisch-Mattox (MFM). Inclusion criteria included patients with an MFM Class A or B. Exclusion criteria included higher staged or syndromic disease. All tumors were managed with transcanal endoscopic approach. Primary outcome measures included disease clearance and hearing measured according to the AAO-HNS guidelines. Secondary outcomes included complications, duration of surgery, and length of stay. Ten patients underwent totally endoscopic transcanal resection of MEPT (9 female, mean age of 45.5 years, 70% were left sided). Mean tumor size was 6.1 mm (SD 3.4 mm). Five cases (50%) were classified using the MFM system as class A1, two cases were class A2, and three cases were class B1. Three cases required canalplasty for access but were completed entirely endoscopically. Nine of the 10 cases had complete audiometric data. Pre- and postoperative mean air conduction remained stable with a decrease in mean air-bone gap of 2.84 dB. Postoperative complications include one pinhole perforation. There were no facial nerve complications. Mean follow-up period was 10 months (range 4-25 mo) with all cases having resolution of pulsatile tinnitus and no tumor recurrence. The transcanal endoscopic approach for early stage MEPT offers excellent visualization and permits safe and effective removal of disease with the advantages of a minimally invasive technique for patient recovery.

We propose a novel type of photonic-crystal (PC)-based nanostructures for efficient and tunable optically-induced spin current generation via the spin Seebeck and inverse spin Hall effects. It has been experimentally demonstrated that optical surface modes localized at the PC surface covered by ferromagnetic layer and materials with giant spin-orbit coupling (SOC) notably increase the efficiency of the optically-induced spin current generation, and provides its tunability by modifying the light wavelength or angle of incidence. Up to 100% of the incident light power can be transferred to heat within the SOC layer and, therefore, to the spin current. Importantly, the high efficiency becomes accessible even for ultra-thin SOC layers. Moreover, the surface patterning of the PC-based spintronic nanostructure allows for the local generation of spin currents at the pattern scales rather than the diameter of the laser beam.

From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2018 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,248 unique episodes of bacteraemia investigated, 93.5% were caused by either E. faecalis (54.2%) or E. faecium (39.3%). Ampicillin resistance was not detected in E. faecalis but was detected in 89.4% of E. faecium. Vancomycin non-susceptibility was not detected in E. faecalis but was reported in 45.0% of E. faecium. Overall 49.3% of E. faecium isolates harboured vanA or vanB genes. Of the vanA/vanB positive E. faecium isolates, 52.9% harboured vanA genes and 46.2% vanB genes; 0.8% harboured both vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is substantially higher than that seen in most European countries. E. faecium consisted of 59 multilocus sequence types (STs) of which 74.4% of isolates were classified into six major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. The predominant STs (ST17, ST1424, ST796, ST80, ST1421, and ST262) were found across most regions of Australia. The most predominant clone was ST17 which was identified in all regions except the Australian Capital Territory and the Northern Territory. Overall, 55.8% of isolates belonging to the six predominant STs harboured vanA or vanB genes. The AESOP 2018 study has shown that enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin-resistant vanA- or vanB-harbouring E. faecium which have limited treatment options.

Fenton-like degradation ofp-hydroxybenzoic acid by ultrafine copper nanoclusters and single sites exhibited high atom utilities and a wide working pH range.

BackgroundA small proportion of false rifampicin resistant results have previously been reported using GeneXpert MTB/RIF version G4 on sputum samples; however, this has not been investigated for urine samples in HIV-associated tuberculosis (TB).ObjectivesWe sought to determine the proportion of false rifampicin resistant results using Xpert MTB/RIF version G4 on urine samples among HIV-infected inpatients investigated for TB.MethodsHospitalised HIV-infected patients undergoing systematic TB testing from two cohorts in Cape Town, South Africa, were enrolled. All patients with ≥1 urine Xpert result available were included. Rifampicin resistant urine Xpert results were classified into three mutually exclusive groups: (1) true rifampicin resistance, (2) false rifampicin resistance or (3) unknown after review of available microbiologic and clinical data.ResultsOverall, 1171 patients were included, from whom a total of 1704 urine Xpert results were available on unconcentrated and/or concentrated urine samples. There were 416 samples positive for TB (24.4% [95% CI 22.4–26.5]), of which 43/413 (10.4% [95% CI 7.6–13.8]) were rifampicin resistant (after excluding three results that were falsely positive due to contamination). Of 43 rifampicin resistant Xpert results (among 40 patients), 30 were classified as true resistance, 11 as false resistance and 2 could not be classified. Excluding unclassifiable results, 30/41 results were confirmed as true-positive urine Xpert rifampicin resistance (positive predictive value: 73.2% [95% CI 57.1–85.8]).ConclusionUrine Xpert testing showed a high proportion of false rifampicin resistance results. Urine Xpert rifampicin resistant results should be interpreted cautiously and confirmed when possible.

Herein, we demonstrate that iron oxide modified MnO2 (FeOx-MnO2) catalyzed micromotors can be fabricated via electrochemical co-reduction and exhibit exceptional high performance at an extremely low hydrogen peroxide (H2O2) fuel concentration. We observed that graphene/FeOx-MnO2 microtubes could show motion behaviors at fuel concentration as low as 0.03% H2O2, which is nearly one order of magnitude lower than Pt-based micromotors (normally at above 0.2% H2O2). Moreover, the micromotors exhibit higher speeds than any other reported catalytic micro/nanomotors (MNMs) at low peroxide levels. The FeOx-MnO2 systems are better catalytic MNMs, due to their excellent catalytic activity, easy fabrication, robust structure and movement, as well as low-cost, biocompatible and abundance nature, showing great potential for future applications.

Introduction. Earlier antiretroviral therapy (ART) initiation in cryptococcal meningitis resulted in higher mortality compared with deferred ART initiation (1–2 weeks vs 5 weeks postmeningitis diagnosis). We hypothesized this was due to ART-associated immune pathology, without clinically recognized immune reconstitution inflammatory syndrome.Methods. Three macrophage activation markers and 19 cytokines/chemokines were measured from cryopreserved cerebrospinal fluid (CSF) and serum during the Cryptococcal Optimal ART Timing (COAT) trial. Comparisons were made between trial arms (early vs deferred) at 1, 8, 14, and 21 days following meningitis diagnosis.Results. More participants with early ART initiation had CSF white cell count (WCC) ≥5/µL at day 14 (58% vs 40%; P = .047), after a median of 6-days ART. Differences were mainly driven by participants with CSF WCC <5/µL at meningitis diagnosis: 28% (10/36) of such persons in the early ART group had CSF WCC ≥5/µL by day 14, compared with 0% (0/27) in the deferred arm (P = .002). Furthermore, Kampala participants (the largest site) receiving early ART had higher day-14 CSF levels of interleukin-13 (P = .04), sCD14 (P = .04), sCD163 (P = .02), and CCL3/MIP-1α (P = .02), suggesting increased macrophage/microglial activation.Conclusions. Early ART initiation in cryptococcal meningitis increased CSF cellular infiltrate, macrophage/microglial activation, and T helper 2 responses within the central nervous system. This suggests that increased mortality from early ART in the COAT trial was immunologically mediated.

Background: The pathogenesis of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. It has been hypothesized that an inflammatory response in the subarachnoid space and microthrombosis contribute to DCI. Previous studies showed that plasma levels of complement factors are associated with DCI and functional outcome after aSAH. We performed an autopsy study to investigate the relationship between complement activation, microthrombosis and DCI. Methods: In autopsy material from 7 patients who died from DCI, we isolated 9 areas of cerebral infarction and 15 areas without infarction. From autopsy material of 5 controls (myocardial infarction: n=3; heart failure: n=1; pulmonary embolism: n=1) we isolated 15 corresponding areas. We performed immunohistochemistry to investigate the presence of C1q, C3c, and fibrin(ogen) (which is strongly correlated with microthrombosis). Optical density measurements were used for quantitative assessments. Optical density values were compared between areas with infarction, without infarction, and controls, and analyzed with a Mann-Whitney U test. Spearman correlation tests were performed to investigate the relationships of C1q and C3c with fibrin(ogen). Results: Optical density values of C1q, C3c, and fibrin(ogen) were higher in areas of infarction than in areas without infarction or controls (Table 1, p&lt;0.001 for all comparisons). Correlations were found between C1q and fibrin(ogen) (r=0.73, p&lt;0.001) and C3c with fibrin(ogen) (r=0.74, p&lt;0.001). Conclusion: Our results show that areas of cerebral infarction in patients with aSAH have more complement activation and microthrombosis than areas without infarction or control brains. A strong correlation was found between complement activation and microthrombosis. Future studies are needed to investigate if drugs targeting complement activation decrease the risk of DCI and improve outcome after aSAH.

The singlet fission in pentacene–C60 solar cells is verified by comparing the experimental and calculated EQE based on the distribution (f1(x)) and the diffusion probability (f2(x)) of excitons.

Experimentally determine the RC-constant in ns-TPC measurements on OSCs.