c Rapid identification of microorganisms causing bloodstream infections directly from a positive blood culture would decrease the time to directed antimicrobial therapy and greatly improve patient care. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) is a fast and reliable method for identifying microorganisms from positive culture. This study evaluates the performance of a novel filtration-based method for processing positive-blood-culture broth for immediate identification of microorganisms by MALDI-TOF with a Vitek MS research-use-only system (VMS). BacT/Alert non-charcoal-based blood culture bottles that were flagged positive by the BacT/Alert 3D system were included. An aliquot of positiveblood-culture broth was incubated with lysis buffer for 2 to 4 min at room temperature, the resulting lysate was filtered through a membrane, and harvested microorganisms were identified by VMS. Of the 259 bottles included in the study, VMS identified the organisms in 189 (73%) cultures to the species level and 51 (19.7%) gave no identification (ID), while 6 (2.3%) gave identifications that were considered incorrect. Among 131 monomicrobic isolates from positive-blood-culture bottles with one spot having a score of 99.9%, the IDs for 131 (100%) were correct to the species level. In 202 bottles where VMS was able to generate an ID, the IDs for 189 (93.6%) were correct to the species level, whereas the IDs provided for 7 isolates (3.5%) were incorrect. In conclusion, this method does not require centrifugation and produces a clean spectrum for VMS analysis in less than 15 min. This study demonstrates the effectiveness of the new lysis-filtration method for identifying microorganisms directly from positive-blood-culture bottles in a clinical setting. R ecently, new mass spectrometry (MS) technology has been introduced as a way to quickly and accurately identify bacteria. Compared to standard phenotypic identification, this technology is rapid, requires reagents that are inexpensive (after initial purchase of the instrument), and could provide accurate results comparable to those provided by 16S rRNA sequencing (1). Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) MS has been shown to accurately identify bacteria grown on solid medium to the species level (2-4) and has the potential to serve as a fast and reliable method for identifying microorganisms directly from blood.Rapid identification of organisms causing bloodstream infections after a blood culture turns positive has the potential to improve patient care, and protocols have been developed for use with MALDI-TOF instrumentation. Previously published studies have explored a variety of approaches to accomplish this task, generally using a series of washes, centrifugations, protein extraction, and analysis using dedicated databases (e.g., BioTyper and SARAMIS) (1,3,(5)(6)(7)(8)(9)(10)(11).The Vitek MS research-use-only (RUO) system (VMS) with the SARAMIS database by bioMérieux (Durham, NC) is a research-us...

Background and Purpose-Transient ischemic attacks are a frequent diagnosis in the emergency department setting, yet expert opinion as to the proper follow-up and need for hospitalization differs widely. Recently, an effort has been made to risk-stratify patients presenting with transient ischemic attacks through scoring systems such as the ABCD and ABCD2 scales. The aim of our study was to independently validate these scores using a population-based cohort. Methods-Using the data from the Rochester Stroke and Transient Ischemic Attack Registry and resources of the Rochester Epidemiology Project, medical records of all residents of Rochester, Minn, with a diagnosis of incident transient ischemic attack from 1985 through 1994 were examined (Nϭ284). Patients were scored on the ABCD and ABCD2 scales and new scores were created by adding hyperglycemia and a history of hypertension. The end points of stroke and death were collected previously and were verified through the Rochester Epidemiology Project data. Results-Although our study did find that scores Ͼ4 had a statistically significant predictive value for future stroke, a substantial proportion of strokes within 7 days (9 of 36 cases [25%]) occurred in patients with low or intermediate risk scores (Յ4) on the ABCD2 scale. Including history of hypertension and hyperglycemia on presentation increased the sensitivity of the score to identify patients who had a stroke within 7 days. Conclusions-Reliance on the ABCD and ABCD2 scores misses some patients who will have a stroke within 7 days of a transient ischemic attack. Adding hyperglycemia and a history of hypertension to the predictive model could be useful, but the value of these additions need to be evaluated further.

It is unclear whether cancer and its treatments increase the risk of adverse pregnancy outcomes. Our aim was to examine whether cancer survivors have higher risks of poor outcomes in pregnancies conceived after diagnosis than women without cancer, and whether these risks differ by cancer type and race. Diagnoses from cancer registries were linked to pregnancy outcomes from birth certificates in three U.S. states. Analyses were limited to the first, live singleton birth conceived after diagnosis. Births to women without a previous cancer diagnosis in the registry were matched to cancer survivors on age at delivery, parity, race/ethnicity, and education. Log-binomial regression was used to estimate risk ratios. Cervical cancer survivors had higher risks of preterm birth (Risk ratio=2.8, 95% Confidence interval: 2.1, 3.7), as did survivors of invasive breast cancer (RR=1.3, 95% CI: 1.1, 1.7) and leukemia (RR=2.1, 95% CI: 1.3, 3.5). We observed a higher risk of small for gestational age (SGA) infants (<10% of weight for age based on a national distribution) in survivors of brain cancer (RR=1.7, 95% CI: 1.1, 2.8) and extranodal non-Hodgkin lymphoma (RR=2.3, 95% CI: 1.5, 3.6). We did not see an increased risk of infants born preterm, low birth weight, or SGA in pregnancies conceived after ductal carcinoma in situ, thyroid cancer, melanoma, or Hodgkin lymphoma. While our results are reassuring for survivors of many cancers, some will need closer monitoring during pregnancy.

Objective To determine if tamoxifen use is associated with decreased ovarian reserve and decreased likelihood of having a child following breast cancer diagnosis. Design Furthering Understanding of Cancer, Health, and Survivorship in Adult (FUCHSIA) Women Study–a population-based cohort study Setting Not applicable. Patients Three hundred ninety-seven female breast cancer survivors aged 22–45 years who were diagnosed between ages 20–35 years and were at least 2 years post-diagnosis; 108 survivors also participated in a clinic visit. Intervention(s) None Main Outcome Measure(s) Time to first child after cancer diagnosis, clinical measures of ovarian reserve (anti-Müllerian hormone [AMH] and antral follicle count [AFC]) after cancer Results Women who ever used tamoxifen were substantially less likely to have a child following breast cancer diagnosis (hazard ratio [HR]=0.29, 95% confidence interval [CI]: 0.16, 0.54) than women who had never used tamoxifen. After adjusting for age at diagnosis, exposure to an alkylating agent, and race, the HR was 0.25 (95% CI: 0.14, 0.47). However, after adjusting for potential confounders, women who had used tamoxifen had an estimated geometric mean AMH level 2.47 (95% CI: 1.08, 5.65) times higher than women who had never taken tamoxifen. AFC was also higher in the tamoxifen group compared to tamoxifen non-users when adjusted for the same variables (risk ratio=1.21, 95% CI: 0.84, 1.73). Conclusion Breast cancer survivors who used tamoxifen were less likely to have a child following cancer diagnosis compared to survivors who never used tamoxifen. However, tamoxifen users did not have decreased ovarian reserve compared to tamoxifen non-users.

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