No abstract

While sleep quality and duration have been related to cardiovascular endpoints, little is known about the association between sleep duration and incident atrial fibrillation (AF). Hence, we prospectively examined the association between sleep duration and incident AF in a cohort of 18,755 US male physicians. Self-reported sleep duration was ascertained during 2002 annual follow-up questionnaire. Incident AF was ascertained through yearly follow-up questionnaires. Cox regression was used to estimate relative risks of AF. The average age at baseline was 67.7 (+8.6) years. During a mean follow up of 6.9 (±2.1) years, 1,468 cases of AF occurred. Using 7 hours of sleep as the reference group, multivariable adjusted hazard ratios (95% CI) for AF were 1.06 (0.92–1.22), 1.0 (ref), and 1.13 (1.00–1.27) from the lowest to the highest category of sleep duration (p for trend 0.26), respectively. In a secondary analysis, there was no evidence of effect modification by adiposity (p interaction =0.69); however, prevalent sleep apnea modified the relation of sleep duration with AF (p interaction =0.01): from the highest to the lowest category of sleep duration, multivariable adjusted hazard ratios (95% CI) for AF were 2.26 (1.26–4.05), 1.0 (ref), and 1.34 (0.73–2.46) for those with prevalent sleep apnea and 1.01 (0.87–1.16), 1.0 (ref), and 1.12 (0.99–1.27) for those without sleep apnea, respectively. Our data showed a modestly elevated risk of AF with long sleep duration among US male physicians. Furthermore, shorter sleep duration was associated with a higher risk of AF in people with prevalent sleep apnea.

The potential of the Bacillus genus to antagonize phytopathogens is associated with the production of cyclic lipopeptides. Depending upon the type of lipopeptide, they may serve as biocontrol agents that are eco-friendly alternatives to chemical fertilizers. This study evaluates the biocontrol activity of surfactin-producing Bacillus (SPB) strains NH-100 and NH-217 and purified surfactin A from these strains against rice bakanae disease. Biologically active surfactin fractions were purified by HPLC, and surfactin A variants with chain lengths from C12 to C16 were confirmed by LCMS-ESI. In hemolytic assays, a positive correlation between surfactin A production and halo zone formation was observed. The purified surfactin A had strong antifungal activity against Fusarium oxysporum, F. moniliforme, F. solani, Trichoderma atroviride and T. reesei. Maximum fungal growth suppression (84%) was recorded at 2000 ppm against F. moniliforme. Surfactin A retained antifungal activity at different pH levels (5-9) and temperatures (20, 50 and 121 °C). Hydroponic and pot experiments were conducted to determine the biocontrol activity of SPB strains and the purified surfactin A from these strains on Super Basmati rice. Surfactin production in the rice rhizosphere was detected by LCMS-ESI at early growth stages in hydroponics experiments inoculated with SPB strains. However, the maximum yield was observed with a consortium of SPB strains (T4) and purified surfactin A (T5) treatments in the pot experiment. The outcomes of the present study revealed that surfactin A significantly reduced rice bakanae disease by up to 80%. These findings suggest that purified surfactin A could be an effective biocontrol agent against bakanae disease in rice and should be incorporated into strategies for disease management.

No abstract

Pulmonary arterial hypertension (PAH) associated with portal hypertension [portopulmonary hypertension (PPHTN)] occurs in 2% to 10% of patients with advanced liver disease and carries a very poor prognosis without treatment. Most hepatic transplantation centers consider moderate to severe PPHTN to be a contraindication to liver transplantation because of the high rate of perioperative complications. We present 3 patients with PPHTN who were managed with intravenous prostacyclin therapy followed by living donor liver transplantation (LDLT). These individuals demonstrated subsequent resolution of their pulmonary hypertension and were weaned off all PAH-specific medical therapy. We present their demographics, clinical courses, and hemodynamics. We discuss the potential indications for LDLT and risks with respect to this patient population. Pulmonary arterial hypertension (PAH) associated with portal hypertension (with or without cirrhosis) has been termed portopulmonary hypertension (PPHTN). 1 PPHTN occurs in 2% to 10% of patients with advanced liver disease, with about 1% of patients demonstrating clinically severe pulmonary hypertension. 2,3Diagnostic criteria for PPHTN include (1) the presence of clinical portal hypertension, (2) a mean pulmonary artery pressure (mPAP) greater than 25 mm Hg, (3) a pulmonary artery occlusion pressure (PAOP) less than 15 mm Hg, and (4) Liver transplantation (LT) is a potential option for patients with PPHTN; however, patients with moderate to severe PPHTN (mPAP ! 35 mm Hg) and a PVR greater than 250 dyne Á second/cm 5 have a particularly poor prognosis and unacceptably high posttransplant mortality.5 As a result, most LT centers consider Abbreviations: DDLT, deceased donor liver transplantation; DLCO/VA, diffusing capacity for carbon monoxide corrected for alveolar volume; FEV1, forced expiratory volume in the first second; FVC, forced vital capacity; LDLT, living donor liver transplantation; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; MESSAGE, MELD Exceptional Case Study Group; mPAP, mean pulmonary artery pressure; PAH, pulmonary arterial hypertension; PAOP, pulmonary artery occlusion pressure; PAP, pulmonary artery pressure; PPHTN, portopulmonary hypertension; PVR, pulmonary vascular resistance; RAP, right atrial pressure; RHC, right heart catheterization; RV, right ventricular; RVSP, right ventricular systolic pressure.The current address for Richard B. Freeman is

Potato is prone to many drastic diseases like potato common scab (CS). As no highly effective methods exist for managing CS, this study explored the possibility of using biological control. Ten bacterial strains were isolated from CS-infected potato tubers from four different locations of Punjab, Pakistan, and identified based on biochemical and molecular analysis. Analysis of 16s rDNA sequences amplified by PCR revealed the isolated bacterial strains to be Streptomyces scabies, S. turgidiscabies and S. stelliscabiei. Pathogenic islands were also confirmed among the isolates after identification of txtAB, nec1, and tomA genes with PCR amplification. One strain isolated from soil was antagonistic to the pathogenic Streptomyces spp., and determined to be Streptomyces A1RT on the basis of 16s rRNA sequencing. A methanolic extract of Streptomyces A1RT contained Isatropolone C, which was purified and structurally determined by 1H- and 13C-NMR, 1H/1H-COSY, HMQC, and HMBC techniques. Streptomyces A1RT also produced the plant growth hormone indole-3-acetic acid (IAA) with a titer of 26 μg ml-1 as confirmed by spectrophotometry and HPLC. In a greenhouse assay, disease severity index was established from 0 to 500. Average disease severity indexes were recorded as 63, 130.5, and 78 for Streptomyces scabies, S. turgidiscabies and S. stelliscabiei, respectively. When Streptomyces A1RT was applied in soil that contained one of these pathogenic isolates, the average disease severity indexes were significantly (P < 0.05) reduced to 11.1, 5.6 and 8.4, respectively. A significant increase in tuber weight and shoot development was also observed with the tubers treated with Streptomyces A1RT. The use of the plant growth-promoting Streptomyces A1RT against potato CS thus provides an alternative strategy to control the disease without affecting environmental, plants, animals and human health.

The clinical characteristics of VAP and VAT are similar and include fever, leukocytosis, and purulent sputum. An infiltrate on chest radiograph is consistent with VAP but lacks diagnostic precision, so it is not a criterion in the proposed surveillance definition and should be interpreted cautiously by clinicians. Microbiologically, quantitative and semiquantitative endotracheal aspirate cultures may be employed to diagnose VAP and VAT. Positive bronchoalveolar lavage and protected specimen brush cultures are useful only for the diagnosis of VAP. Experts should collaborate to develop consensus definitions for VAP and VAT that can be applied in practice.

Ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is a leading healthcare-associated infection in mechanically ventilated patients. The incidence of VAP due to MDR pathogens has increased significantly in the last decade. Risk factors for VAP due to MDR organisms include advanced age, immunosuppression, broad-spectrum antibiotic exposure, increased severity of illness, previous hospitalization or residence in a chronic care facility and prolonged duration of invasive mechanical ventilation. Methicillin-resistant Staphylococcus aureus and several different species of Gram-negative bacteria can cause MDR VAP. Especially difficult Gram-negative bacteria include Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenemase-producing Enterobacteraciae and extended-spectrum β-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antiimicrobial sensitivity data. Evidence-based strategies to prevent VAP that incorporate multidisciplinary staff education and collaboration are essential to reduce the burden of this disease and associated healthcare costs.