Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

Background: Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). Methods: This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Results: Single-room occupancy decreased from 79.7% pre-intervention to 23.6% postintervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, −0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P= 0.571) or trend (P = 0.720). Conclusion Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

BACKGROUND: Adipose-derived stem cells (ADSCs) exert immunomodulatory effects in the treatment of transplant rejection. This study aimed to evaluate the effects of ADSCs on the skin graft survival in a human-to-rat xenograft transplantation model and to compare single and multiple injections of ADSCs. METHODS: Full-thickness human skin xenografts were transplanted into the backs of Sprague–Dawley rats. The rats were injected subcutaneously on postoperative days 0, 3, and 5. The injections were as follows: triple injections of phosphate-buffered saline (PBS group), a single injection of ADSCs and double injections of PBS (ADSC 9 1 group), and triple injections of ADSCs (ADSC 9 3 group). The immunomodulatory effects of ADSCs on human skin xenografts were assessed. RESULTS: Triple injections of ADSCs considerably delayed cell-mediated xenograft rejection compared with the PBS and ADSC 9 1 groups. The vascularization and collagen type 1–3 ratios in the ADSC 9 3 group were significantly higher than those in the other groups. In addition, intragraft infiltration of CD3-, CD4-, CD8-, and CD68-positive cells was reduced in the ADSC 9 3 group. Furthermore, in the ADSC 9 3 group, the expression levels of proinflammatory cytokine interferon-gamma (IFN-c) were decreased and immunosuppressive prostaglandin E synthase (PGES) was increased in the xenograft and lymph node samples. CONCLUSION This study presented that triple injections of ADSCs appeared to be superior to a single injection in suppressing cell-mediated xenograft rejection. The immunomodulatory effects of ADSCs are associated with the downregulation of IFN-c and upregulation of PGES in skin xenografts and lymph nodes.

Fasiglifam (TAK-875) a G-protein coupled receptor 40 (GPR40) agonist, significantly improves hyperglycemia without hypoglycemia and weight gain, the major side effects of conventional anti-diabetics. Unfortunately, during multi-center Phase 3 clinical trials, unexpected liver toxicity resulted in premature termination of its development. Here, we investigated whether TAK-875 directly inflicts toxicity on hepatocytes and explored its underlying mechanism of toxicity. TAK-875 decreased viability of 2D and 3D cultures of HepG2, a human hepatocarcinoma cell line, in concentration- (>50 μM) and time-dependent manners, both of which corresponded with ROS generation. An antioxidant, N-acetylcysteine, attenuated TAK-875-mediated hepatotoxicity, which confirmed the role of ROS generation. Of note, knockdown of GPR40 using siRNA abolished the hepatotoxicity of TAK-875 and attenuated ROS generation. In contrast, TAK-875 induced no cytotoxicity in fibroblasts up to 500 μM. Supporting the hepatotoxic potential of TAK-875, exposure to TAK-875 resulted in increased mortality of zebrafish larvae at 25 μM. Histopathological examination of zebrafish exposed to TAK-875 revealed severe hepatotoxicity as manifested by degenerated hypertrophic hepatocytes with cytoplasmic vacuolation and acentric nuclei, confirming that TAK-875 may induce direct hepatotoxicity and that ROS generation may be involved in a GPR40-dependent manner.
Acetylcysteine ; Cell Line ; Cytoplasm ; Fibroblasts ; GTP-Binding Proteins ; Hepatocytes ; Humans ; Hyperglycemia ; Hypoglycemia ; Larva ; Liver ; Mortality ; Reactive Oxygen Species* ; RNA, Small Interfering ; Weight Gain ; Zebrafish

OBJECTIVE: To evaluate the laboratory and clinical manifestations of Sjögren's syndrome (SS) association with chemokine (C-X-C motif) ligand 1 (CXCL1) expression in the ductal and acinar salivary gland epithelial cells (SGEC) of the minor salivary glands. METHODS: The sociodemographic data of 106 SS patients was obtained, and the glandular and extraglandular manifestations of the disease documented. The minor salivary glands were biopsied and the laboratory findings analyzed. European League Against Rheumatism SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) scores were obtained during biopsy. An immunohistochemical approach was used to define the expression of CXCL1 in the salivary glands. RESULTS: Of 106 patients, the minor salivary glands of 22 patients (20.7%) stained positively for CXCL1. Such CXCL1-positive patients exhibited higher ESSDAI scores at the time of biopsy than the CXCL1-negative patients (3.86±2.27 vs. 2.64±1.62, p=0.015). Lymphadenopathy was more frequently observed in CXCL1-positive patients, compared with CXCL1-negative patients (31.8% vs. 9.5%, p=0.014). No differences between groups were identified in terms of sociodemographic characteristics, laboratory data, or the extent of the glandular manifestation of SS. CONCLUSION: The expression of CXCL1 within the ductal and acinar SGEC of SS patients is associated with lymphadenopathy and elevated clinical disease activity. CXCL1 may play an important role in the disease activity and prognosis of SS.
Biopsy ; Chemokine CXCL1* ; Chemokines ; Epithelial Cells ; Humans ; Lymphatic Diseases ; Prognosis ; Rheumatic Diseases ; Salivary Glands ; Salivary Glands, Minor*

A 31-year-old man who had been prescribed etanercept over a 3-year period for treatment of ankylosing spondylitis presented with newly developed dry cough, chills, myalgia, and weight loss. Chest computed tomography showed multiple reticulonodular pulmonary infiltrates and bilateral mediastinal, hilar, and peribronchial lymphadenopathy. Biopsy of a paratracheal lymph node revealed chronic granulomatous inflammation without necrosis, and the serum angiotensin-converting enzyme level was elevated. Sarcoidosis was diagnosed. His laboratory and radiological findings, and clinical symptoms improved only after discontinuation of etanercept without treatment. Although etanercept-induced sarcoidosis is rare, this case report suggests that sarcoidosis should be considered in the differential diagnosis of patients treated with the tumor necrosis factor inhibitor.
Adult ; Biopsy ; Chills ; Cough ; Diagnosis, Differential ; Etanercept* ; Humans ; Inflammation ; Lymph Nodes ; Lymphatic Diseases ; Myalgia ; Necrosis ; Sarcoidosis* ; Spondylitis, Ankylosing ; Thorax ; Tumor Necrosis Factor-alpha ; Weight Loss

We investigated the clinical and biological significance of germinal centers (GC) present in the minor salivary glands of patients with Sjogren's syndrome (SS). Minor salivary gland tissue biopsies from 93 patients with SS were used to identify GC-like structures, which were confirmed by CD21-positive follicular dendritic cell networks. Patients were compared based upon sociodemographics, glandular and extraglandular manifestations, and laboratory findings including autoantibody profiles, complement, and immunoglobulin levels; EULAR SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) were also measured. GC-like structures were observed in 28 of 93 SS patients (30.1%). Mean focus scores and CRP levels were significantly higher in GC-positive patients than in GC-negative patients; GC-positive patients also exhibit a higher prevalence of rheumatoid factor and anti-SS-A/Ro antibodies compared to GC-negative patients. No differences in glandular or extra-glandular manifestations were evident between groups. In conclusion, SS patients with GC-like structures in the minor salivary glands exhibited laboratory profiles significantly different from those of their GC-negative counterparts. Long-term follow-up of these patients will be necessary to determine whether these laboratory abnormalities are predictive of clinical outcomes.
Adult ; Autoantibodies/blood ; C-Reactive Protein/analysis ; Demography ; Female ; Germinal Center/*pathology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Receptors, Complement 3d/metabolism ; Retrospective Studies ; Salivary Glands, Minor/*pathology ; Sjogren's Syndrome/immunology/metabolism/*pathology

We investigated the clinical and biological significance of germinal centers (GC) present in the minor salivary glands of patients with Sjogren's syndrome (SS). Minor salivary gland tissue biopsies from 93 patients with SS were used to identify GC-like structures, which were confirmed by CD21-positive follicular dendritic cell networks. Patients were compared based upon sociodemographics, glandular and extraglandular manifestations, and laboratory findings including autoantibody profiles, complement, and immunoglobulin levels; EULAR SS disease activity index (ESSDAI) and SS disease damage index (SSDDI) were also measured. GC-like structures were observed in 28 of 93 SS patients (30.1%). Mean focus scores and CRP levels were significantly higher in GC-positive patients than in GC-negative patients; GC-positive patients also exhibit a higher prevalence of rheumatoid factor and anti-SS-A/Ro antibodies compared to GC-negative patients. No differences in glandular or extra-glandular manifestations were evident between groups. In conclusion, SS patients with GC-like structures in the minor salivary glands exhibited laboratory profiles significantly different from those of their GC-negative counterparts. Long-term follow-up of these patients will be necessary to determine whether these laboratory abnormalities are predictive of clinical outcomes.
Adult ; Autoantibodies/blood ; C-Reactive Protein/analysis ; Demography ; Female ; Germinal Center/*pathology ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Receptors, Complement 3d/metabolism ; Retrospective Studies ; Salivary Glands, Minor/*pathology ; Sjogren's Syndrome/immunology/metabolism/*pathology