Notes

Import of multidrug-resistant germs through in foreign countries via interhospital transactions, Finland, 2010-2019.
Pelvic hematoma is a common finding following hysterectomy which at times may become infected causing substantial morbidity. The aim of this study was to describe the incidence, clinical manifestation and identify risk factors for infected pelvic hematoma. We also attempted to identify specific bacterial pathogens which may cause this phenomenon.

We conducted a retrospective cohort study at a tertiary university teaching hospital. Included were all women who underwent hysterectomy and were diagnosed with a pelvic hematoma following surgery from 2013 to 2018. In an attempt to assess possible risk factors for infected pelvic hematoma women with asymptomatic pelvic hematoma were compared to women with an infected pelvic hematoma.

During the study period 648 women underwent hysterectomy at our medical center. Pelvic hematoma was diagnosed by imaging in 50 women (7.7%) including 41 women who underwent vaginal hysterectomy and 9 women who underwent abdominal hysterectomy. selleck chemical In 14 (2.2%) cases the hematoma became infected resulting in need for readmission and further treatment. Women who underwent vaginal surgery were more likely to return with infected pelvic hematoma compared to women who underwent open abdominal or laparoscopic surgery (4.5% vs. 1.1%, p < 0.05). In 8 women bacterial growth from hematoma culture was noted. Enterococcus faecalis, was the most abundant pathogen to be isolated in this sub-group.

Vaginal route of hysterectomy is a risk factor for infected pelvic hematoma following hysterectomy. link2 Most of these infections were caused by anaerobic bacteria which may not be sufficiently covered by current antibiotic prophylactic regimens.
Vaginal route of hysterectomy is a risk factor for infected pelvic hematoma following hysterectomy. Most of these infections were caused by anaerobic bacteria which may not be sufficiently covered by current antibiotic prophylactic regimens.
Over the last 20years, society's perception of the ideal female body size in Western cultures has changed from thin to athletic, and many women practice sports to achieve well-toned bodies. However, to date, no study has investigated whether Muslim women who live in a Western country and veil their bodies strive for lean or muscular bodies too. The current cross-sectional survey therefore addressed this question.

Veiled Muslim women (n = 70), unveiled Muslim women (n = 50), Christian women (n = 79), and atheist women (n = 68) living in Germany answered several questionnaires assessing engagement in sports, body appreciation, and drive for leanness and muscularity. Univariate and multivariate analyses were conducted to compare the four groups.

The results of univariate and multivariate analyses showed that Muslim women engaged less in sports and veiled Muslim women reported higher body appreciation than did Christian and atheist women. Although the groups did not differ significantly in drive for muscularity, Muslim women showed lower levels of drive for leanness than did Christian and atheist women.

Given that Muslim women engaged less in sports and strived less for a lean body compared to Christian and atheist women, a well-toned body might be less important for them. Nevertheless, as being active is beneficial for general health, barriers that prevent Muslim women from engaging in sports should be diminished.
Given that Muslim women engaged less in sports and strived less for a lean body compared to Christian and atheist women, a well-toned body might be less important for them. Nevertheless, as being active is beneficial for general health, barriers that prevent Muslim women from engaging in sports should be diminished.
Data are scarce regarding intravesical maintenance therapy (MT) with the low-dose bacillus Calmette-Guérin (BCG) Tokyo strain. We investigated the efficacy and safety of MT with a half dose of the Tokyo strain for patients following transurethral resection of nonmuscle invasive bladder cancer (NMIBC).

This study retrospectively reviewed clinical data on 78 patients diagnosed with intermediate or high-risk NMIBC followed by either MT (n = 38) or IT alone (n = 40) between January 2012 and March 2018. Statistical analysis was performed to compare recurrence-free survival (RFS) and adverse effects between the two groups. BCG was instilled once weekly for 6weeks as IT, then once weekly in 2-week for a total of 20 instillations over 3years.

Kaplan-Meier analyses showed that patients undergoing MT had significantly better RFS than did those undergoing IT alone (hazard ratio (HR)0.32, 95% confidence interval (CI)0.12-0.89, P = 0.02). The 3-year RFS was 65.0% in the IT group and 89.5% in the MT group. Multivariate analysis showed that MT was associated with a reduced risk of recurrence (HR 0.32, 95% CI0.11-0.93, P = 0.03). One MT patient (2.6%) exhibited progression.

The BCG Tokyo strain showed acceptable efficacy and safety in patients undergoing MT; thus, it is a potential treatment for preventing bladder cancer recurrence.
The BCG Tokyo strain showed acceptable efficacy and safety in patients undergoing MT; thus, it is a potential treatment for preventing bladder cancer recurrence.
Soil and microbial biomass stoichiometry plays an important role in understanding nutrient cycling in terrestrial ecosystems. However, studies on soil and microbial biomass stoichiometry in forests are rare. This study investigated the effect of tree species and topographic factors on the ecological stoichiometry of soil and soil microbial biomass.

Three types of forest stands (Quercus variabilis, Larix principis-ruprechtii, and Cotinus coggygria Scop.) in the Beiru River basin of Funiu Mountain were analyzed in September 2018. Six slope positions (sunny bottom slope, sunny middle slope, sunny top slope, shady bottom slope, shady middle slope, and shady top slope) were selected, and the total number of sampling plots was 108. The stoichiometric indices of soil and microbial biomass were determined.

At a depth of 0-10cm, the soil organic C contents in different stands followed the order of C. coggygria (27.7 ± 5.2g/kg) > Q. variabilis (24.5 ± 4.9g/kg) > L. principis-ruprechtii (20.8 ± 4.3g/kg) (P < 0.05). The soil organic C contents at depths of 0-10cm with different slope aspects and at different slope positions also showed significant differences (P < 0.05). The highest MBC content was observed at the slope bottom (1002 ± 157mg/kg), whereas the lowest was observed at the slope top (641 ± 98.3mg/kg). Redundancy analysis showed that the contribution of tree species to these differences was 57.1%, whereas that of topographical factors was 36.2%.

Tree species more significantly affected soil nutrients and microbial biomass C, N and P than did topographic factors.
Tree species more significantly affected soil nutrients and microbial biomass C, N and P than did topographic factors.
Faculty development is important for advancing teaching practice in health professions education. However, little is known regarding how faculty development outcomes are achieved and how change in practice may happen through these activities. In this study, we explored how clinical educators integrated educational innovations, developed within a faculty development programme, into their clinical workplaces. Thus, the study seeks to widen the understanding of how change following faculty development unfolds in clinical systems.

The study was inspired by case study design and used a longitudinal faculty development programme as a case offering an opportunity to study how participants in faculty development work with change in practice. The study applied activity theory and its concept of activity systems in a thematic analysis of focus group interviews with 14 programme attendees. Participants represented two teaching hospitals, five clinical departments and five different health professions.

We present tcing our ability to make faculty development reach its full potential in bringing educational change in practice.
The study depicts the complexities of how educational change is brought about in the workplace after faculty development. Based on our findings and the activity theoretical concept of knotworking, we suggest that these complex processes may be understood as collaborative knotworking between faculty development participants and workplace staff through which both the output from faculty development and the workplace practices are transformed. Increasing our awareness of these intricate processes is important for enhancing our ability to make faculty development reach its full potential in bringing educational change in practice.
Exposure to carbon monoxide (CO) remains a leading occupational hazard in firefighters, but cigarette and waterpipe smoking likely contributes to the other sources of CO in such workers. The aim of this study was to estimate the contribution of self-reported active cigarette smoking, waterpipe use, and potential job-related sources of CO to the level of exhaled CO in firefighters.

We surveyed the personnel of 18 fire stations (N = 842), median age 28 years, who participated at an annual screening not timed to coincide with recent firefighting. We surveyed smoking and waterpipe history, exposure to secondhand smoke (SHS), use of coal for health and biomass for cooking and time since last exposure to firefighting in the workplace. We measured exhaled CO with an instantaneous reading device (piCO Smokerlyzer). We used multivariable regression models to test the association of time since last smoked cigarette (≤12 h) and waterpipe (≤12 h) and time since last fire (≤6 h) with exhaled CO.

In analysis limited to exhaled CO when measured at an annual screening, but an age interaction was manifested.
Increases in the levels of serum C-reactive protein (CRP) and creatinine (Cr) and decreases in those of albumin (Alb) are commonly observed in acute pancreatitis (AP). We aimed to evaluate the efficacy of the Cr/Alb and CRP/Alb ratios in the prediction of surgical treatment effect in AP patients.

This study retrospectively analyzed clinical data obtained from 140 AP patients who underwent debridement from January 2008 to November 2018 in Shanghai Ruijin Hospital. The Cr/Alb and CRP/Alb ratios at admission and before surgery were assessed in the analysis of clinical statistics, prediction of prognoses, and logistic regression analysis.

The admission Cr/Alb had the best predictive value of the four ratios. This value was significantly higher in patients with re-operation and those who died (P < 0.05) and was correlated with the Acute Physiology and Chronic Health Evaluation (APACHE II) score, admission CRP/Alb, preoperative Cr/Alb, and post-operative complications. link3 The admission Cr/Alb could predict the risk of AP-related re-operation and mortality with sensitivities, specificities and areas under the curve of 86.3%, 61.7% and 0.824, and 73.4%, 81.3% and 0.794, respectively. At a cut-off value of 3.43, admission Cr/Alb values were indicative of a worse clinical state, including impaired laboratory test values, APACHE II scores, rates of post-operative complications and re-operation, and mortality (P < 0.05). In the logistic regression analysis, admission Cr/Alb values were independently related to the APACHE II score, post-operative renal failure, and mortality.

Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.
Cr/Alb is a novel but promising, easy-to-measure, reproducible, non-invasive prognostic score for the prediction of the effect of debridement in AP patients.
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