Background: Volume overload is associated not only with clinical manifestations but also with poor outcomes of heart failure (HF). However, there is an unmet need for effective methods for serial monitoring of volume status during HF hospitalization. The aim of this study was to evaluate the prognostic implication of serial measurement of bioelectrical impedance analysis (BIA) in patients hospitalized with acute HF. Methods: This study is a retrospective observational study and screened 310 patients hospitalized due to acute decompensated HF between November 2021 and September 2022. Among them, 116 patients with acute HF who underwent BIA at the time of admission and at discharge were evaluated. We investigated the correlation between change of BIA parameters and the primary composite outcome (in-hospital mortality or rehospitalization for worsening HF within one month). Results: The median (interquartile range) age was 77 years (67-82 years). The mean left ventricular ejection fraction was 40.7 & PLUSMN; 14.6% and 55.8% of HF patients have HF with reduced ejection fraction. The body water composition (intracellular water [ICW], extracellular water [ECW], and total body water [TBW]) showed a statistically significant correlation with body mass index and LV chamber sizes. Furthermore, the ratio of ECW to TBW (ECW/TBW), as an edema index showed a significant correlation with natriuretic peptide levels. Notably, the change of the edema index during hospitalization (AECW/TBW) showed a significant correlation with the primary outcome. The area under the curve of AECW/TBW for predicting primary outcome was 0.71 (95% confidence interval [CI], 0.61-0.79; P = 0.006). When patients were divided into two groups based on the median value of AECW/TBW, the group of high and positive AECW/TBW (+0.3% to +5.1%) had a significantly higher risk of the primary outcome (23.2% vs. 8.3%, adjusted odds ratio, 4.8; 95% CI, 1.2-19.3; P = 0.029) than those with a low and negative AECW/TBW (-5.3% to +0.2%). Conclusion: BIA is a noninvasive and effective method to evaluate the volume status during the hospitalization of HF patients. The high and positive value of AECW/TBW during hospitalization was associated with poor outcomes in patients with HF.

Purpose: Patients with a history of radiocontrast media (RCM) hypersensitivity can be overlooked, resulting in repeated reactions.Therefore, a consultation support system for RCM hypersensitivity has been in operation at Seoul National University Bundang Hospital since December 2011.We analyzed the effect of this system on physicians' practice.Methods: A retrospective study was conducted on patients with previous RCM reactions (December 1, 2010 to November 30, 2012).The control period was December 2010 to November 2011, and the intervention period was December 2011 to November 2012.The primary outcome was the composite outcome of premedication and consultation.Premedication was defined as preventive medication prescribed by the physician who ordered RCM-enhanced computed tomography (CT) at the same time.The secondary outcome was the recurrence rate after using the consultation support system.Results: A total of 189 clinicians prescribed 913 CT scans during the control period and 225 clinicians performed 1,153 examinations during the intervention period.The odds ratio (OR) of achieving the composite outcome increased significantly after use of the consultation support system (OR, 1.54; 95% confidence interval [CI], 1.15-2.05).Clinicians in both medical (OR, 1.48; 95% CI, 1.06-2.07)and surgical (OR, 2.07; 95% CI, 1.24-3.46)departments showed significant changes in their behavior, whereas those in the emergency department did not (OR, 1.07; 95% CI, 0.41-2.78).Professors (OR, 1.47; 95% CI, 1.06-2.04)and trainees (OR, 1.97, 95% CI, 1.22-3.18)showed significant changes in their behavior toward patients with previous RCM reactions.The behavior of 86 clinicians who ordered CT scans during both the control and intervention periods was unchanged.Conclusions: The consultation support system for those with previous RCM hypersensitivity reactions changed physicians' practice patterns and decreased recurrent RCM hypersensitivity reactions as well.

Objective To evaluate the impact of an electronic consultation support system on the incidence of hypersensitivity reactions to iodinated radiocontrast media (RCM).Materials and methods A retrospective observational study was conducted before and after the introduction of the consultation support system. The 1-year study period was divided into two 6-month periods: before and after 1 December 2012 (baseline and intervention periods, respectively), which was when our consultation support system was introduced. Data from examinations were collected retrospectively from the hospital information centre and problem reporting sheets in the radiology department. The primary outcome was the incidence of RCM reactions before and after the introduction of the consultation support system. Generalised estimating equations were used to account for the correlation between the same patients measured on multiple occasions.Results There were 317/20 179 (1.6%) and 186/19 873 (0.9%) hypersensitivity reactions during the baseline and intervention periods, respectively. The consultation support system significantly decreased the odds of the occurrence of a RCM reaction (OR=0.59, 95% CI 0.49 to 0.71, p<0.001) compared with baseline. There was also a twofold increase in the premedication rate after initiation of the consultation support system (OR=2.05, 95% CI 1.16 to 3.65 p=0.01). However, there was no significant difference in the recurrence rate between the periods (OR=0.97, 95% CI 0.58 to 1.65, p<0.93).Conclusions The introduction of the consultation support system reduced the incidence of hypersensitivity reactions to RCM and increased the use of premedication in patients with known hypersensitivity to RCM.

Recent studies have demonstrated differences in the intestinal microbiota between patients with irritable bowel syndrome (IBS) and healthy controls (HC), suggesting a role for the intestinal microbiota in the pathogenesis of IBS. Alterations in the microbiota have also been implicated in the pathogenesis of abdominal bloating, a commonly reported symptom in IBS. We investigated the relationship between the intestinal microbiota, abdominal bloating, and altered bowel patterns in a cohort of patients with IBS and HC. The 16S rRNA gene from fresh fecal samples was amplified and pyrosequenced by using Roche-454 Titanium chemistry. A Core Measurable Microbiome (CMM) was generated for Operational Taxonomic Unit (OTU) detected in >75% of all samples and compositional features of CMM were compared between groups by Linear Discriminant Analysis (LDA). IBS differentiated from HC by LDA using continuous variation in the species/OTUs or the CMM genera. When subcategorized based on bloating symptoms and bowel characteristics, the same subjects were also well differentiated from one another and from HC. ANOVA analysis showed quantitative species/OTU differences between the subgroups including IBS with and without bloating, and subtypes based on bowel characteristics. The clear LDA differentiation and the significant microbial taxa differences between the groups imply a significant association of the microbiota with bloating symptoms and bowel characteristics in IBS. These changes in the microbiota may serve as a biomarker for IBS and its clinical subtypes and suggest a role for the intestinal microbiota in the pathogenesis of the main symptoms of the disorder.

Fungal DNA was selectively amplified, and the ITS region sequenced, from fecal samples taken from 45 healthy human volunteers at one (21 volunteers) or two (24 volunteers) time points. Seventy-two operational taxonomic units, representing two phyla and ten classes of fungi, were recovered. Candida yeasts, notably Candida tropicalis (present in 51 samples), and yeasts in the Dipodascaceae (39 samples), dominated, while 38 OTUs were detected in a single sample each. Fungi included known human symbionts (Candida, Cryptococcus, Malassezia and Trichosporon spp.), common airborne fungi (Cladosporium sp.) and fungi known to be associated with food (Debaryomyces hansenii and high salt fermented foods; Penicillium roqueforti and blue cheese). In contrast with gut-associated bacteria, fungi occurred in much lower abundance and diversity, and fungal composition appeared unstable over time.

ABSTRACT Fresh pork sausage is produced without a microbial kill step and therefore chilled or frozen to control microbial growth. In this report, the microbiota in a chilled fresh pork sausage model produced with or without an antimicrobial combination of sodium lactate and sodium diacetate was studied using a combination of traditional microbiological methods and deep pyrosequencing of 16S rRNA gene amplicons. In the untreated system, microbial populations rose from 102 to 106 CFU/g within 15 days of storage at 4°C, peaking at nearly 108 CFU/g by day 30. Pyrosequencing revealed a complex community at day 0, with taxa belonging to the Bacilli, Gammaproteobacteria, Betaproteobacteria, Actinobacteria, Bacteroidetes, and Clostridia. During storage at 4°C, the untreated system displayed a complex succession, with species of Weissella and Leuconostoc that dominate the product at day 0 being displaced by species of Pseudomonas (P. lini and P. psychrophila) within 15 days. By day 30, a second wave of taxa (Lactobacillus graminis, Carnobacterium divergens, Buttiauxella brennerae, Yersinia mollaretti, and a taxon of Serratia) dominated the population, and this succession coincided with significant chemical changes in the matrix. Treatment with lactate-diacetate altered the dynamics dramatically, yielding a monophasic growth curve of a single species of Lactobacillus (L. graminis), followed by a uniform selective die-off of the majority of species in the population. Of the six species of Lactobacillus that were routinely detected, L. graminis became the dominant member in all samples, and its origins were traced to the spice blend used in the formulation.

Alterations in the intestinal microbiota have been implicated in the pathogenesis of irritable bowel syndrome (IBS). Recent studies using advanced molecular biology techniques have demonstratedmicrobiota compositional differences between IBS patients and healthy controls (HC). Many of these studies, however, are confounded by the fact that the study populations comprise a mixed group of patients with IBS or a specific subtype of IBS. Thus, there is a need for systematic comparison of microbiota composition between subjects with clinicallyrelevant subtypes of IBS. Aim: To investigate the differences in composition of the intestinal microbiota between clinically-relevant, well-defined subgroups of patients with IBS and HC using deep pyrosequencing of the 16S rRNA gene. Methods: DNA was isolated from fecal samples from 60 IBS patients (Rome III: C-IBS, D-IBS, M-IBS; n=20 per group) and 20 HC. The V1-V2 variable regions of the 16S rRNA gene were amplified using bar-coded fusion primers and pyrosequenced using Roche-454 Titanium chemistry. Sequences were processed through the Multi-CLASSIFIER algorithm for taxonomic assignment. Classified reads were assigned to a species/OTU-level status using BLAST pipeline. Unclassified readswere clustered into OTUs at 97% using CD-Hit. A Core Measurable Microbiome (CMM) was generated for OTUs detected in ≥75% of all samples. Compositional features of CMM were compared using Linear Discriminant Analysis (LDA). Quantitative differences in species/OTUs and taxonomic groups were tested by ANOVA with the Tukey correction for multiple testing. Results: Subjects with IBS differentiated from HC by LDA using continuous variation in the species/OTUs or the CMM genera as variables. When further subcategorized based on bowel characteristics, the same subjects were also well-differentiated from one another and from HC. ANOVA analysis showed quantitative species/OTUs differences between the study subgroups: I. a significant increase in members of the Actinobacteria phyla (in particular the genus Collinsiella) in the C-IBS subgroup compared to all other groups, II. a significant decrease in members of Firmicutes phyla ( Oscillibacter, Anaerovorax, Incertae sedis XIII, Streptococcus and Eubacteriaceae) in D-IBS and M-IBS compared to HC and C-IBS, and III. a significant lower levels of Lactobacillus in HC compared to C-IBS and D-IBS. Conclusion: We demonstrated clear differences in the intestinal microbiota between patients with clinically-relevant subtypes of IBS. While differences in many individual taxa were identified, there was little difference in the relative abundances of major taxonomic groups (e.g., ratio of Bacteriodetes;Firmicutes:Proteobacteria). Our results provide a rationale for further investigation of the causality and the role of these microbiota compositional alterations in the pathogenesis of IBS.

Background: Some radiocontrast media (RCM) hypersensitivity reactions may have underlying IgE-or T-cellemediated mechanisms. RCM skin testing may be useful for predicting future reactions.Objective: To investigate the clinical value of RCM skin testing before computed tomography and after RCM hypersensitivity reactions.Methods: Patients who underwent RCM skin testing were a prospective sample of convenience at a single medical center and were tested just before their pending nonionic RCM-enhanced computed tomogram. In addition, skin test data of patients who were referred to the allergy clinic because of their previous RCM hypersensitivity reactions were reviewed retrospectively.Results: A total of 1048 patients enrolled in the study prospectively. Of these, 672 (64.1%) had never been exposed to RCM. Of the 376 previously exposed to RCM, 61 ( 16.2%) had a history of at least one mild RCMassociated reaction, 56 ( 91.8%) had immediate reactions, and 5 had no-immediate reactions. There was only 1 positive immediate hypersensitivity RCM skin test result (0.09%). There were 51 mild immediate reactions (4.9%), 1 moderate immediate reaction (0.09%), 8 mild nonimmediate reactions (0.76%), and 1 moderate nonimmediate reaction (0.09%). There was only 1 positive delayed hypersensitivity skin test result (0.09%), retrospectively determined, in 1 (11.1%) of the nonimmediate RCM-associated reactions. Sensitivity of RCM skin testing was significantly higher with severe immediate reactions (57.1%) than mild reactions (12.9%) and moderate reactions (25.0%) in the retrospective review of diagnostic skin test data (P.03).Conclusion: RCM skin testing for screening is of no clinical utility in predicting hypersensitivity reactions. RCM skin testing may have modest utility in retrospectively evaluating severe adverse reactions. (C) 2013 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Radiocontrast media (RCM) hypersensitivity can cause life-threatening consequences. Yet, RCM hypersensitivity can be overlooked in the busy clinical settings. We developed an electronic medical record-embedded consultation support system for iodinated radiocontrast media (RCM) hypersensitivity prevention (ECO-Prevention). An observational study was conducted from June, 2011 to May, 2012 in Seoul National University Bundang Hospital. The one-year study period was divided into 2 periods of 6 months each, before and after the initiation of ECO-Prevention – control and intervention. Primary endpoint was the difference in the incidence of RCM hypersensitivity and secondary endpoints were the difference in the rate of premedication and the recurrence rates of RCM hypersensitivity among patients with previous history between 2 periods. Of 43,030 examinations that were prescribed and underwent during study period, there were 995 reports on RCM hypersensitivity: 555 and 440 during control and intervention periods, respectively. Total numbers of adverse reaction to RCM were significantly reduced during intervention period (n = 317 (1.5%) in control vs. n = 186 (0.9%) in intervention; OR 0.6 [95% CI, 0.50-0.71]). Of the scans given to the patients with previous history, 86.9% during control vs. 93.3% during intervention were executed after premedication (p = .02, OR 2.1 [95% CI, 1.16-3.75]). The rates of recurrence were 11.2% during control and 10.2% during intervention (p= .72, OR 0.91 [95% CI, 0.53-1.56]). ECO-Prevention might help manage hypersensitivity reactions to iodinated radiocontrast media through consultation to allergy specialist and increasing the level of awareness of medical personnel about RCM hypersensitivity.

The crown and rhizome transcriptome of an upland tetraploid switchgrass cultivar cv Summer well adapted to the upper Midwest was investigated using the Roche 454-FLX pyrosequencing platform. Overall, approximately one million reads consisting of 216 million bases were assembled into 27,687 contigs and 43,094 singletons. Analyses of these sequences revealed minor contamination with non-plant sequences (< 0.5%), indicating that a majority were for transcripts coded by the switchgrass genome. Blast2Gos comparisons resulted in the annotation of ~65% of the contig sequences and ~40% of the singleton sequences. Contig sequences were mostly homologous to other plant sequences, dominated by matches to Sorghum bicolor genome. Singleton sequences, while displaying significant matches to S. bicolor, also contained sequences matching non-plant species. Comparisons of the 454 dataset to existing EST collections resulted in the identification of 30,177 new sequences. These new sequences coded for a number of different proteins and a selective analysis of two categories, namely, peroxidases and transcription factors, resulted in the identification of specific peroxidases and a number of low-abundance transcription factors expected to be involved in chromatin remodeling. KEGG maps for glycolysis and sugar metabolism showed high levels of transcript coding for enzymes involved in primary metabolism. The assembly provided significant insights into the status of these tissues and broadly indicated that there was active metabolism taking place in the crown and rhizomes at post-anthesis, the seed maturation stage of plant development.

SUMMARY Post-operative increases in circulating bile acids have been suggested to contribute to the metabolic benefits of bariatric surgery; however, their mechanistic contributions remain undefined. We have previously reported that ileal interposition (IT) surgery delays the onset of type 2 diabetes in UCD-T2DM rats and increases circulating bile acids, independently of effects on energy intake or body weight. Therefore, we investigated potential mechanisms by which post-operative increases in circulating bile acids improve glucose homeostasis after IT surgery. IT, sham or no surgery was performed on 2-month-old weight-matched male UCD-T2DM rats. Animals underwent an oral fat tolerance test (OFTT) and serial oral glucose tolerance tests (OGTT). Tissues were collected at 1.5 and 4.5 months after surgery. Cell culture models were used to investigate interactions between bile acids and ER stress. IT-operated animals exhibited marked improvements in glucose and lipid metabolism, with concurrent increases in postprandial glucagon-like peptide-1 (GLP-1) secretion during the OFTT and OGTTs, independently of food intake and body weight. Measurement of circulating bile acid profiles revealed increases in circulating total bile acids in IT-operated animals, with a preferential increase in circulating cholic acid concentrations. Gut microbial populations were assessed as potential contributors to the increases in circulating bile acid concentrations, which revealed proportional increases in Gammaproteobacteria in IT-operated animals. Furthermore, IT surgery decreased all three sub-arms of ER stress signaling in liver, adipose and pancreas tissues. Amelioration of ER stress coincided with improved insulin signaling and preservation of β-cell mass in IT-operated animals. Incubation of hepatocyte, adipocyte and β-cell lines with cholic acid decreased ER stress. These results suggest that postoperative increases in circulating cholic acid concentration contribute to improvements in glucose homeostasis after IT surgery by ameliorating ER stress.

Recent research has provided mechanistic insight into the important contributions of the gut microbiota to vertebrate biology, but questions remain about the evolutionary processes that have shaped this symbiosis. In the present study, we showed in experiments with gnotobiotic mice that the evolution of Lactobacillus reuteri with rodents resulted in the emergence of host specialization. To identify genomic events marking adaptations to the murine host, we compared the genome of the rodent isolate L. reuteri 100-23 with that of the human isolate L. reuteri F275, and we identified hundreds of genes that were specific to each strain. In order to differentiate true host-specific genome content from strain-level differences, comparative genome hybridizations were performed to query 57 L. reuteri strains originating from six different vertebrate hosts in combination with genome sequence comparisons of nine strains encompassing five phylogenetic lineages of the species. This approach revealed that rodent strains, although showing a high degree of genomic plasticity, possessed a specific genome inventory that was rare or absent in strains from other vertebrate hosts. The distinct genome content of L. reuteri lineages reflected the niche characteristics in the gastrointestinal tracts of their respective hosts, and inactivation of seven out of eight representative rodent-specific genes in L. reuteri 100-23 resulted in impaired ecological performance in the gut of mice. The comparative genomic analyses suggested fundamentally different trends of genome evolution in rodent and human L. reuteri populations, with the former possessing a large and adaptable pan-genome while the latter being subjected to a process of reductive evolution. In conclusion, this study provided experimental evidence and a molecular basis for the evolution of host specificity in a vertebrate gut symbiont, and it identified genomic events that have shaped this process.

Background: To systematically develop dietary strategies based on resistant starch (RS) that modulate the human gut microbiome, detailed in vivo studies that evaluate the effects of different forms of RS on the community structure and population dynamics of the gut microbiota are necessary. The aim of the present study was to gain a community wide perspective of the effects of RS types 2 (RS2) and 4 (RS4) on the fecal microbiota in human individuals.Methods and Findings: Ten human subjects consumed crackers for three weeks each containing either RS2, RS4, or native starch in a double-blind, crossover design. Multiplex sequencing of 16S rRNA tags revealed that both types of RS induced several significant compositional alterations in the fecal microbial populations, with differential effects on community structure. RS4 but not RS2 induced phylum-level changes, significantly increasing Actinobacteria and Bacteroidetes while decreasing Firmicutes. At the species level, the changes evoked by RS4 were increases in Bifidobacterium adolescentis and Parabacteroides distasonis, while RS2 significantly raised the proportions of Ruminococcus bromii and Eubacterium rectale when compared to RS4. The population shifts caused by RS4 were numerically substantial for several taxa, leading for example, to a ten-fold increase in bifidobacteria in three of the subjects, enriching them to 18-30% of the fecal microbial community. The responses to RS and their magnitudes varied between individuals, and they were reversible and tightly associated with the consumption of RS.Conclusion: Our results demonstrate that RS2 and RS4 show functional differences in their effect on human fecal microbiota composition, indicating that the chemical structure of RS determines its accessibility by groups of colonic bacteria. The findings imply that specific bacterial populations could be selectively targeted by well designed functional carbohydrates, but the inter-subject variations in the response to RS indicates that such strategies might benefit from more personalized approaches.

In vertebrates, including humans, individuals harbor gut microbial communities whose species composition and relative proportions of dominant microbial groups are tremendously varied. Although external and stochastic factors clearly contribute to the individuality of the microbiota, the fundamental principles dictating how environmental factors and host genetic factors combine to shape this complex ecosystem are largely unknown and require systematic study. Here we examined factors that affect microbiota composition in a large (n = 645) mouse advanced intercross line originating from a cross between C57BL/6J and an ICR-derived outbred line (HR). Quantitative pyrosequencing of the microbiota defined a core measurable microbiota (CMM) of 64 conserved taxonomic groups that varied quantitatively across most animals in the population. Although some of this variation can be explained by litter and cohort effects, individual host genotype had a measurable contribution. Testing of the CMM abundances for cosegregation with 530 fully informative SNP markers identified 18 host quantitative trait loci (QTL) that show significant or suggestive genomewide linkage with relative abundances of specific microbial taxa. These QTL affect microbiota composition in three ways; some loci control individual microbial species, some control groups of related taxa, and some have putative pleiotropic effects on groups of distantly related organisms. These data provide clear evidence for the importance of host genetic control in shaping individual microbiome diversity in mammals, a key step toward understanding the factors that govern the assemblages of gut microbiota associated with complex diseases.

The LEE pathogenicity island has been acquired on multiple occasions within the different lineages of enteropathogenic and enterohemorrhagic Escherichia coli. In each lineage, LEE expression is regulated by complex networks of pathways, including core pathways shared by all lineages and lineage-specific pathways. Within the O157:H7 lineage of enterohemorrhagic E. coli, strain-to-strain variation in LEE expression has been observed, implying that expression patterns can diversify even within highly related subpopulations. Using comparative genomics of E. coli O157: H7 subpopulations, we have identified one source of strain-level variation affecting LEE expression. The variation occurs in prophage-dense regions of the genome that lie immediately adjacent to the late regions of the pch prophage carrying pchA, pchB, pchC, and a newly identified pch gene, pchX. Genomic segments extending from the holin S region to the pchA, pchB, pchC, and pchX genes of their respective prophage are highly conserved but are nonetheless embedded within adjacent genomic segments that are extraordinarily variable, termed pch adjacent genomic regions (pch AGR). Despite the remarkable degree of variation, the pattern of variation in pch AGR is highly correlated with the distribution of phylogenetic markers on the backbone of the genome. Quantitative analysis of transcription from the LEE1 promoter further revealed that variation in the pch AGR has substantial effects on absolute levels and patterns of LEE1 transcription. Variation in the pch AGR therefore serves as a mechanism to diversify LEE expression patterns, and the lineage-specific pattern of pch AGR variation could ultimately influence ecological or virulence characteristics of subpopulations within each lineage.

Electrical impedance tomography (EIT) reconstructs internal resistivity distribution using the various reconstruction methods. In reconstruction methods for EIT, the modified Newton-Raphson (mNR) method is known as nonlinear least-square method which has relatively good performance. But mNR does not obtain a satisfactory image due to ill-conditioning of Hessian matrix. To solve this problem, many methods have been developed and researched. This paper proposes a new mNR, which improves a reconstruction image in point of shape and resistivity, using assumed value and region of interest (ROI).

This work presents a boundary estimation approach for binary mixture fields based on a modified multi-layered neural network and front point approach. The boundary shape of anomaly is expressed with front points and the unknown front points are estimated with the proposed multi-layered neural network. Numerical experiments show that the proposed approach has a good possibility for the application in the visualization of a binary mixture boundary for real-time monitoring and has enhanced performances.

The work presents the image reconstruction algorithm for EIT that can enhance the speed of image reconstruction and the quality of reconstructed image. The main idea of the proposed algorithm is weighting matrices, which are obtained by the interpolation of the stream lines. Numerical experiments demonstrate that proposed algorithm provides improved reconstruction performance in terms of computational time and image quality