Pneumocystis pneumonia has long been recognized as a cause of morbidity and mortality in immunocompromised populations, particularly those with HIV infection. Pneumocystis colonization-that is, detection of the organism or its DNA, without signs or symptoms of pneumonia-has recently been described, and accumulating evidence suggests that it may be an important clinical phenomenon. Sensitive molecular techniques such as polymerase chain reaction are frequently used to identify Pneumocystis colonization. Low levels of Pneumocystis in the lungs may stimulate pulmonary inflammation and may play a role in the development of lung diseases such as chronic obstructive pulmonary disease. In this review, we discuss evidence for the occurrence of Pneumocystis colonization in animals as well as the epidemiology and risk factors for Pneumocystis colonization in various human populations. We also evaluate the clinical significance of Pneumocystis colonization and its relationship to lung disease.

We report a high-speed microfluidic switch capable of achieving a switching time of 10 μs. The switching mechanism is realized by exciting dynamic vapor bubbles with focused laser pulses in a microfluidic polydimethylsiloxane (PDMS) channel. The bubble expansion deforms the elastic PDMS channel wall and squeezes the adjacent sample channel to control its fluid and particle flows as captured by the time-resolved imaging system. A switching of polystyrene microspheres in a Y-shaped channel has also been demonstrated. This ultrafast laser triggered switching mechanism has the potential to advance the sorting speed of state-of-the-art microscale fluorescence activated cell sorting devices.

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Background. Despite early goal-directed therapy, sepsis mortality remains high. Statins exhibit pleiotropic effects. Objective. We sought to compare mortality outcomes among statin users versus nonusers who were hospitalized with sepsis. Methods. Retrospective cohort study of patients (age ≥18 years) during 1/1/2008–9/30/2018. Mortality was compared between statin users and nonusers and within statin users (hydrophilic versus lipophilic, fungal versus synthetic derivation, and individual statins head-to-head). Multivariable Cox regression models were used to estimate hazard ratios (HR) for 30-day and 90-day mortality. Inverse probability treatment weighting (IPTW) analysis was performed to account for indication bias. Results. Among 128,161 sepsis patients, 34,088 (26.6%) were prescribed statin drugs prior to admission. Statin users compared to nonusers had a 30-day and 90-day mortality HR (95% CI) of 0.80 (0.77–0.83) and 0.79 (0.77–0.81), respectively. Synthetic derived statin users compared to fungal derived users had a 30- and 90-day mortality HR (95% CI) of 0.86 (0.81–0.91) and 0.85 (0.81–0.89), respectively. Hydrophilic statin users compared to lipophilic users had a 30-day and 90-day mortality HR (95% CI) of 0.90 (0.81–1.01) and 0.86 (0.78–0.94), respectively. Compared to simvastatin, 30-day mortality HRs (95% CI) were 0.85 (0.66–1.10), 0.87 (0.82–0.92), 0.87 (0.76–0.98), and 1.22 (1.10–1.36) for rosuvastatin, atorvastatin, pravastatin, and lovastatin, respectively. Conclusion. Statin use was associated with lower mortality in patients hospitalized with sepsis. Hydrophilic and synthetic statins were associated with better outcomes than lipophilic and fungal-based preparations.

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The use of Vitamin C (VC) therapy in patients with septic shock has recently been explored due to its anti-oxidative and anti-inflammatory properties. However, the prevalence and impact of VC deficiency among critically-ill patients in shock is unclear. We sought to determine the prevalence of VC deficiency as well as its association on clinical outcomes. METHODS: We conducted a retrospective cohort study of patients admitted to the intensive care unit (ICU) at Kaiser Permanente Los Angeles Medical Center with a diagnosis of shock from March 1, 2018 to June 30, 2018. The study included all causes of shock defined as hypotension requiring vasopressor therapy. VC serum concentrations were collected upon admission to the ICU. Data on demographics and comorbidities were collected. We compared outcomes, including survival at 7-, 30-, and 90days, and vasopressor free days at 30-days between VC deficient and VC sufficient subjects. Logistic regression was used to estimate odds ratios (OR). Chi-square and Fisher's exact test were used to determine statistical significance for categorical variables. P-value <0.05 was considered statistically significant. RESULTS: The study examined 145 patients, of which, 51 were VC deficient. With VC sufficient subjects as reference, estimated risks of 7-day survival compared to VC deficient subjects were OR 2.1; 95% CI, 0.86-5.10, p= 0.10. VC deficient patients had an increased risk in 30-day mortality, OR 2.52; 95% CI 1.24-5.12, p= 0.01, compared to VC sufficient patients. VC deficient patients also had increased risk in 90-day mortality OR 3.06; 95% CI 1.5-6.24, p= 0.002, compared to VC sufficient patients. VC deficient subjects also averaged fewer vasopressor free days, [means (SD): 14.7 (11.96) vs 21.5 (10.36), OR 0.94; 95% CI 0.92-0.98, p= 0.0009]. Patients with chronic kidney disease (CKD) were four times more likely to be VC deficient, OR 4.06 (1.76-9.3), p= 0.0009. CONCLUSIONS: Medical ICU patients account for the majority of ICU cases. There is a small percentage of cardiogenic shock patients given the presence of a designated Coronary Care Unit. Prevalence of VC deficiency among the study population was five times higher than the US general population (35% vs 7%). VC deficiency was associated with decreased survival at 30 days and 90 days when compared to VC sufficient subjects. There was no significant difference in mortality at 7 days. VC deficiency was also associated with fewer vasopressor free days. History of CKD was the highest predictor for VC deficiency. Our findings suggest that VC deficient subjects presenting with shock are at greater risk for poor outcomes. Therefore, studies should further explore the use of VC therapy in subjects at higher risk. CLINICAL IMPLICATIONS: Literature has not explored mortality benefit in Vitamin C deficient patients. Thus, VC therapy in this subset of patients must be studied.

Venous thromboembolism (VTE) is common in the post-solid organ and bone marrow transplant population. In lung transplant patients, VTE incidence ranges from 1.78-45%. Whether its occurrence in the post-lung transplant setting jeopardizes long term allograft outcome is unclear. Our aims were to identify the prevalence and risk factors associated with VTE post-lung-transplant, and to assess survival rate after VTE. METHODS: We performed a retrospective review of 126 patients within a large urban HMO cohort who underwent lung transplantation between 2003 and 2016. Patients were followed until the end of December 2017. Patient demographic information, underlying lung disease requiring transplant, results of testing for DVT or PE and survival statistics were gathered. RESULTS: We identified 147 post lung transplant patients in the Kaiser Permanente Southern California database. 15 were excluded due to a lack of data, 4 excluded due to pre-transplant VTE, and 2 excluded due to age < 18 at time of transplant. The population was male-predominant (63.5%) with median age of 60 (range 20-75 years). 54% were non-Caucasians. Among 126 patients included, 31 were diagnosed with VTE (24.6%, 15 with pulmonary emboli, 22 with deep venous thrombosis, 6 with both). These occurred at a median of 168 days after transplant (mean 660 days, range 1-3526 days). There was no significant difference in age (p¼0.2677) or gender (p¼0.3194). VTE patients were more likely to be Caucasian (74.2% in VTE to 36.8% in non-VTE, p¼0.0003) and more likely to have COPD (27.3% in VTE to 7.1% in non-VTE, p¼0.0118). Crude hazard ratios for survival and hazard ratios adjusted for age, gender, and ethnicity were not statistically significant (1.293, p¼0.395; 1.306, p¼0.433). Similarly, there was no statistical significance in these hazard ratios at 1 year (1.