Case Report: pericardial and sternal wound infection following orthotopic heart transplantation.

, a genus of soil and vegetation-based fungi, is a rare cause of infections in immunocompromised individuals, including transplant recipients. In this case, we describe successful treatment of mediastinitis in the recipient of an orthotopic heart transplant. Treatment included multiple courses of combination antibiotic and antifungal therapy several surgical debridements, continuous mediastinal irrigation with antifungal agents, and staged closure with an omental flap.

A realist review of how, why, for whom and in which contexts quality improvement in healthcare impacts inequalities.

Introduction: Quality improvement (QI) is aimed at improving care. Equity is one of the six domains of healthcare quality, as defined by the Institute of Medicine. If this domain is ignored, QI projects have the potential to maintain or even worsen inequalities.

Metformin Improves Glycemic Control and Postprandial Metabolism and Enhances Postprandial Glucagon-Like Peptide 1 Secretion in Patients With Type 2 Diabetes and Heart Failure: A Randomized, Double-Blind, Placebo-Controlled Trial.

This randomized trial tested the effect of metformin on glycemic control and cardiac function in patients with heart failure (HF) and type 2 diabetes while evaluating intestinal effects on selected gut microbiome products reflected by trimethylamine-N-oxide (TMAO) and gut-derived incretins. Metformin treatment improved glycemic control and postprandial metabolism and enhanced postprandial glucagon-like peptide 1 (GLP-1) secretion but did not influence cardiac function or the TMAO levels. Metabolic effects of metformin in HF may be mediated by an improvement in intestinal endocrine function and enhanced secretion of the gut-derived incretin GLP-1.

Terminal Alkyne Activation by an Al(I)-Centered Anion: Impact on the Mechanism of Alkali Metal Identity.

The group 1 alumanyls, [{SiN}AlM] (M = K, Rb, Cs; SiN = {CHSiMeNDipp}), display a variable kinetic facility (K < Rb < Cs) toward oxidative addition of the acidic C-H bond of terminal alkynes to provide the corresponding alkali metal hydrido(alkynyl)aluminate derivatives. Theoretical analysis of the formation of these compounds through density functional theory (DFT) calculations implies that the experimentally observed changes in reaction rate are a consequence of the variable stability of the [{SiN}AlM] dimers, the integrity of which reflects the ability of M to maintain the polyhapto group 1-arene interactions necessary for dimer propagation. These observations highlight that such "on-dimer" reactivity takes place sequentially and also that the ability of each constituent Al(I) center to effect the activation of the organic substrate is kinetically differentiated.

Active learning-assisted directed evolution.

Directed evolution (DE) is a powerful tool to optimize protein fitness for a specific application. However, DE can be inefficient when mutations exhibit non-additive, or epistatic, behavior. Here, we present Active Learning-assisted Directed Evolution (ALDE), an iterative machine learning-assisted DE workflow that leverages uncertainty quantification to explore the search space of proteins more efficiently than current DE methods.