Asia Western Pacific Region Research Articles

Minimum inhibitory concentrations of antifungals against invasive isolates of Cryptococcus species worldwide: Global antifungal antimicrobial testing leadership and surveillance program, 2010–2020

This study examined the geographic distribution of minimum inhibitory concentrations (MICs) of antifungals against Cryptococcus isolates. Data were collected on the MICs of specific antifungals (amphotericin B, 5-flucytosine, fluconazole, voriconazole, posaconazole, and isavuconazole) against various Cryptococcus species for the period 2010 to 2020 from the Antimicrobial Testing Leadership and Surveillance database. Cryptococcus isolates were collected from samples of blood and cerebrospinal fluid (CSF) from patients hospitalized in different regions worldwide. We applied the epidemiological cutoff values (ECVs) of antifungals against various Cryptococcus species to distinguish wild-type (WT) from non-WT Cryptococcus isolates. A total of 395 isolates of Cryptococcus species cultured from blood (n = 201) or CSF (n = 194) were analyzed. C. grubii (n = 270), C. neoformans (n = 111), and C. gattii (n = 11) were the three predominant species causing bloodstream infections (BSI) or meningitis/meningoencephalitis (MME). The proportion of MICs above the ECV (1 mg/L) for amphotericin B among C. neoformans isolates was significantly lower than that among C. gattii isolates (MICs >0.5 mg/L; P < 0.001), as evaluated using the chi-square test. For most isolates of the three predominant Cryptococcus species, the MICs of new triazoles were ≤0.25 mg/L. The MICs of fluconazole and amphotericin B in the BSI/MME-causing Cryptococcus isolates collected from patients hospitalized in the Asia-Western Pacific region and Europe were significantly lower (i.e., the distributions were more leftward) than those in North America and Latin America. Ongoing monitoring of MIC data for important antifungals against cryptococcosis is crucial.

Antifungal susceptibilities of opportunistic filamentous fungal pathogens from the Asia and Western Pacific Region: data from the SENTRY Antifungal Surveillance Program (2011\u20132019)

Antifungal surveillance is an important tool to monitor the prevalence of uncommon fungal species and increasing antifungal resistance throughout the world, but data comparing results across several different Asian countries are scarce. In this study, 372 invasive molds collected in the Asia-Western Pacific region in 2011–2019 were susceptibility tested for mold-active triazoles (isavuconazole, posaconazole, voriconazole, and itraconazole). The collection includes 318 Aspergillus spp. isolates and 53 non-Aspergillus molds. The MIC values using CLSI methods for isavuconazole versus Aspergillus fumigatus ranged from 0.25 to 2 mg l−1. Isavuconazole, itraconazole, posaconazole, and voriconazole acted similarly against A. fumigatus. The mold-active triazoles exhibited a wildtype phenotype to most of the Aspergillus spp. isolates tested (>94%), but poor activity against Fusarium solani species complex and Lomentospora prolificans. Voriconazole was most active against the Scedosporium spp. and posaconazole was most active against the Mucorales. In summary, isavuconazole displayed excellent activity against most species of Aspergillus and was comparable to other mold-active triazoles against non-Aspergillus molds.

Physiotherapists' knowledge and the implementation of COVID-19 infection prevention and control measures.

Physiotherapists are required to recognize their role in managing patients with Coronavirus Disease-19 (COVID-19), and to adopt preventive measures to limit transmission of the disease. The aim of this study was to assess the perception, knowledge, and application of the preventive measures taken by physiotherapists in managing issues with confirmed or suspected patients suffering from COVID-19. A self-administered survey comprising 15 questions was divided into four sections related to precautions when interacting with patients with COVID-19: (1) knowledge of the physiotherapy role, (2) knowledge of preventive measures to limit transmission of the virus, (3) practicing these measures, and (4) managing patients with COVID-19. A total of 456 physiotherapists from 139 countries participated in the study. Most physiotherapists were knowledgeable regarding their role in the management of COVID-19 patients (M = 94.3%; SD = 15.4) and the management of potential COVID-19 patients (M = 84.5%; SD = 20.1). The rating of knowledge and practices of preventive measures to limit transmission of COVID-19 were lower (M = 74.3%; SD = 25.7, and M = 62.5%; SD = 31.3, respectively). Participants from the European region (M = 83; SD = 15.8) had a higher score than participants from the Asia Western Pacific region (M = 78; SD = 18.49; P = 0.01). Physiotherapists are highly knowledgeable about their role in managing COVID-19 patients. Most of them are adopting preventive measures to limit the transmission of the disease. Yet, physiotherapists are required to enroll in medical education, training and infection control workshops and courses to remain updated with the recent advances in such fields.

A systematic review of diabetes self-management education interventions for people with type 2 diabetes mellitus in the Asian Western Pacific (AWP) region.

Aims and objectivesTo assess the effectiveness of educational and/or psychological diabetes self‐management education (DSME) intervention for people with type 2 diabetes (T2DM) in the Asian Western Pacific (AWP) region.BackgroundTranslational research indicates that DSME is effective; therefore, it is important to look at the AWP region to see what has been implemented and what the potential barriers are for the low integration of DSME. The need for DSME is present, and programmes are being developed. Therefore, focusing a systematic review of DSME research in the AWP region would give a better understanding of which intervention approaches are associated with better clinical outcomes and are culturally acceptable.DesignA systematic review.MethodsA review of randomized controlled trials (RCTs) and comparative studies to evaluate the effectiveness of face‐to‐face delivery reporting educational and/or psychological interventions for people with T2DM was implemented. We conducted searches using MEDLINE, EMBASE, CINAHL, PubMed and ASSIA databases between January 1990–June 2018. Studies published in English and non‐English were included. Two reviewers independently extracted data on participant and intervention characteristics. The quality of evidence was rated on predetermined criteria. Main outcomes included glycaemic control (reduction in HbA1c level).ResultsWe included 21 DSME programmes (17 RCTs), while 15 were group‐based approaches. Twelve studies (60%) were categorized as high quality. Three studies (25%) had a moderate (good) effect. Eight trials were effective in improving glycaemic control and reported statistically significant improvements in HbA1c levels. 50% of these were high‐intensity group‐based programmes.

Panaxadiol saponins treatment caused the subtle variations in the global transcriptional state of Asiatic corn borer, Ostrinia furnacalis

BackgroundThe lepidopteran Asiatic corn borer (ACB), Ostriniafurnacalis (Guenee), has caused huge economic losses throughout the Asian-Western Pacific region. Usually, chemical pesticides are used for the control, but excessive use of pesticides has caused great harm. Therefore, the inartificial ecotypic pesticides to ACB are extremely essential. In our previous study, we found that panaxadiol saponins (PDS) can effectively reduce the harm of ACB by causing antifeedant activity. Therefore, it is necessary to reveal the biological molecular changes in ACB and the functionary mechanism of PDS. MethodsWe analyzed the global transcription of ACB with different PDS concentration treatment (5 mg/mL, 10 mg/mL, and 25 mg/mL) by high-throughput sequencing and de novo transcriptome assembly method. ResultsPDS treatment could cause the changes of many gene expressions which regulate its signal pathways. The genes in peroxisome proliferator–activated receptor (PPAR) signaling pathway were significantly downregulated, and then, the downstream fatty acid degradation pathway had also been greatly affected. ConclusionThrough this experiment, we hypothesized that the occurrence of antifeedant action of ACB is because the PDS brought about the downregulation of FATP and FABP, the key regulators in the PPAR, and the downregulation of FATP and FABP exerts further effects on the expression of SCD-1, ACBP, LPL, SCP-X, and ACO, which leads to the disorder of PPAR signaling pathway and the fatty acid degradation pathway. Not only that, PDS treatment leads to enzyme activity decrease by inhibiting the expression of genes associated with catalytic activity, such as cytochrome P450 and other similar genes.

Direct and indirect ENSO modulation of winter temperature over the Asian-Pacific-American region.

In this study, the direct and indirect atmospheric responses over the Asian–Pacific–American region to the El Niño–Southern Oscillation (ENSO) are documented. Since ENSO is likely to induce the northward displacement of the East Asian trough (NDEAT), some of the influence of ENSO on the Asian–Pacific–American region is possibly indirect and acts by inducing NDEAT. To separate corresponding influences of ENSO and NDEAT, partial regression is utilized. It is noted that temperature variations in the East Asian–Western Pacific region are controlled mainly by NDEAT. In contrast, ENSO demonstrates a weak direct relation to the temperature variation over the East Asian–Western Pacific region. This suggests that the influence of ENSO on this region is indirect, through modulation of NDEAT. On the other hand, temperature variation over the tropical eastern Pacific is dominated by ENSO forcing. Finally, temperature variation over the eastern North American–Western Pacific region is controlled by both ENSO and NDEAT. Nevertheless, their influences on temperature and circulation over this region tend to offset each other. This implies that temperature variation is controlled by their relative strengths.

Use of the Physiotherapy Evidence Database (PEDro) in Japan.

The Physiotherapy Evidence Database (PEDro) may help users to overcome some obstacles to evidence-based physiotherapy. Understanding the extent to which Japanese physiotherapists access research evidence via the PEDro website may suggest strategies to enhance evidence-based physiotherapy in Japan. To quantify usage of PEDro in Japan, to compare this to usage in other countries, and to examine variations in PEDro usage within Japan. An observational study of PEDro usage with geographic analysis. Data about visits to the home-page and searches of the database were recorded for 4 years. These data were analysed by each region of the World Confederation for Physical Therapy, each country in the Asia Western Pacific region, and each prefecture in Japan. From 2010 to 2013, users of PEDro made 2.27 million visits to the home-page and ran 6.28 million searches. Usage (ie, number of searches normalised by population) was highest in Europe, followed by North America Carribean, South America, Asia Western Pacific, and Africa. Within the Asia Western Pacific region, population-normalised usage was highest in Australia, then New Zealand and Singapore. Japan ranked 10 among the 26 countries in the region. Within Japan, the highest population-normalised usage was in the Nagano, Kumamoto and Aomori prefectures, which was ten-fold higher usage than in some other prefectures. Although Japan has higher PEDro usage than many other countries in the Asia Western Pacific region, some prefectures had very low usage, suggesting that evidence-based practice may not be being adopted uniformly across Japan.

Genotypic Characterization of Methicillin-Resistant Staphylococcus aureus Recovered at Baseline from Phase 3 Pneumonia Clinical Trials for Ceftobiprole.

Baseline methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients with nosocomial and community-acquired pneumonia collected during Phase 3 trials for ceftobiprole were characterized. Eighty-four unique isolates from patients enrolled in Europe (50.0%), Asia-Western Pacific region (APAC; 20.2%), North America (19.0%), Latin America (8.3%), and South Africa (2.4%) were included. Antimicrobial susceptibility testing was performed by broth microdilution and isolates screened for Panton-Valentine leukocidin. SCCmec and agr types were determined. Strains were subjected to pulsed-field gel electrophoresis and spa typing. Clonal complexes (CCs) were assigned based on spa and/or multilocus sequence typing. Most isolates were CC5-MRSA-I/II/IV (44.0%; 37/84), followed by CC8-MRSA-IV (22.6%; 19/84) and CC239-MRSA-III (21.4%; 18/84). Other MRSA formed seven clonal clusters. Isolates from North America were associated with USA100, while those from South America belonged to the Cordobes/Chilean CC. A greater clonal diversity was observed in Europe; however, each country had CC5, CC8, or CC239 as prevalent lineages. Isolates from APAC were CC5-MRSA-II (47.1%; 8/17) or CC239-MRSA-III (47.1%; 8/17). Isolates carrying SCCmec I and III had ceftobiprole MIC50 values of 2 μg/ml, while those isolates with SCCmec II and IV had MIC50 values of 1 μg/ml. Ceftobiprole inhibited 96% and 100.0% of the isolates at ≤2 and ≤4 μg/ml, respectively. These isolates represented common circulating MRSA clones. Ceftobiprole demonstrated in vitro activity with a slight variation of minimum inhibitory concentrations (MICs) according to SCCmec or clonal type.

Antifungal susceptibilities of Candida, Cryptococcus neoformans and Aspergillus fumigatus from the Asia and Western Pacific region: data from the SENTRY antifungal surveillance program (2010-2012).

The SENTRY Antifungal Surveillance Program monitors global susceptibility rates of newer and established antifungal agents. We report the in vitro activity of seven antifungal agents against 496 contemporary clinical isolates of yeasts and molds. The isolates were obtained from 20 laboratories in the Asia-Western Pacific (APAC) region during 2010 through 2012. Anidulafungin, caspofungin, micafungin, fluconazole, itraconazole, posaconazole and voriconazole were susceptibility tested using CLSI methods and species-specific interpretive criteria. Sequencing of fks hot spots was performed for echinocandin-resistant strains. Isolates included 13 species of Candida (n=460), 5 species of non-Candida yeasts (21), 5 species of Aspergillus (11) and 4 other molds. Echinocandin resistance was uncommon among eight species of Candida and was only detected in three isolates of Candida glabrata, two from Australia harboring mutations in fks1 (F625S) and fks2 (S663P). Resistance to the azoles was much more common and was observed among all species with the exception of Candida dubliniensis. Fluconazole resistance rates observed with C. glabrata (6.8%) was comparable to that seen with Candida parapsilosis (5.7%) and Candida tropicalis (3.6%). Cross resistance among the triazoles was seen with each of these three species. The mold-active azoles and the echinocandins were all active against isolates of Aspergillus fumigatus. Azole resistance was not detected among the isolates of Cryptococcus neoformans. Antifungal resistance is uncommon among isolates of fungi causing invasive fungal infections in the APAC region. As in other regions of the world, emerging resistance to the echinocandins among invasive isolates of C. glabrata bears close monitoring.

The in vitro evaluation of tigecycline tested against pathogens isolated in eight countries in the Asia-Western Pacific region (2008)

To determine the in vitro activity of tigecycline and comparator common use antimicrobial agents tested against contemporary bacterial pathogens from the Asia-Western Pacific region. As part of the SENTRY Antimicrobial Surveillance Program, a total of 5759 Gram-positive and Gram-negative isolates were collected from 28 medical centers in eight Asia-Western Pacific countries during 2008. Minimum inhibitory concentrations (MICs) were determined using Clinical and Laboratory Standards Institute (CLSI) broth microdilution method and interpreted using CLSI breakpoints. United States Food and Drug Administration (US-FDA) breakpoints were used to interpret tigecycline susceptibility. Antimicrobial resistance was found to be widespread and prevalence varied considerably between the eight countries. Against pathogens for which breakpoints were available, >98% of all isolates were susceptible to tigecycline. Against all Gram-positive isolates, including methicillin (oxacillin)-resistant Staphylococcus aureus, penicillin- and multidrug-resistant pneumococci, and vancomycin-resistant enterococci, the highest tigecycline MIC found was 1 microg/ml. Against all Enterobacteriaceae, including extended-spectrum beta-lactamase phenotypes, tigecycline susceptibility was 97.5%. Tigecycline had good activity against Acinetobacter spp. but was much less active against Pseudomonas aeruginosa. Tigecycline demonstrated excellent sustained in vitro activity against a wide spectrum of contemporary Gram-positive and -negative pathogens from Asia-Western Pacific countries.

Impact of Atmosphere–Ocean Coupling on the Predictability of Monsoon Intraseasonal Oscillations*

Abstract The impact of air–sea coupling on the predictability of monsoon intraseasonal oscillations (MISO) has been investigated with an atmosphere–ocean coupled model and its atmospheric component. From a 15-yr coupled control run, 20 MISO events are selected. A series of twin perturbation experiments have been conducted for all the selected events using both the coupled model and the atmosphere-only model. Two complementary measures are used to quantify the MISO predictability: (i) the ratio of signal-to-forecast error and (ii) the spatial anomaly correlation coefficient (ACC). In the coupled model, the MISO predictability is generally higher over the Indian sector than that over the western Pacific with a maximum of 35 days in the eastern equatorial Indian Ocean. Air–sea coupling significantly improves the predictability in almost the entire Asian–western Pacific region. The mean predictability of the MISO-related rainfall over its active area (10°S–30°N, 60°–160°E) reaches about 24 days in the coupled model and is about 17 days in the atmosphere-only model. This result suggests that including an interactive ocean allows the MISO predictability of an atmosphere-only model to be extended by about a week. The extended predictability is primarily due to the coupled model capturing the two-way interactions between the MISO and underlying sea surface. The MISO forces a coherent intraseasonal SST response in underlying ocean that in return exerts an external control on the future evolutions of the MISO. The break phase of the MISO is more predictable than the active phase in both the atmosphere-only model and the coupled model as revealed in the observations. Air–sea coupling appears to extend the MISO predictability uniformly regardless of the active or break phases.

An evaluation of the effects of cloud parameterization in the R42L9 GCM

Cloud is one of the uncertainty factors influencing the performance of a general circulation model (GCM). Recently, the State Key Laboratory of Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics (LASG/IAP) has developed a new version of a GCM (R42L9). In this work, roles of cloud parameterization in the R42L9 are evaluated through a comparison between two 20-year simulations using different cloud schemes. One scheme is that the cloud in the model is diagnosed from relative humidity and vertical velocity, and the other one is that diagnostic cloud is replaced by retrieved cloud amount from the International Satellite Cloud Climatology Project (ISCCP), combined with the amounts of high-, middle-, and low-cloud and heights of the cloud base and top from the NCEP. The boreal winter and summer seasonal means, as well as the annual mean, of the simulated top-of-atmosphere shortwave radiative flux, surface energy fluxes, and precipitation are analyzed in comparison with the observational estimates and NCEP reanalysis data. The results show that the scheme of diagnostic cloud parameterization greatly contributes to model biases of radiative budget and precipitation. When our derived cloud fractions are used to replace the diagnostic cloud amount, the top-of-atmosphere and surface radiation fields are better estimated as well as the spatial pattern of precipitation. The simulations of the regional precipitation, especially over the equatorial Indian Ocean in winter and the Asia-western Pacific region in summer, are obviously improved.

Intercomparison of the climatological variations of Asian summer monsoon precipitation simulated by 10 GCMs

We assesses the overall performance of state-of-the-art atmospheric GCMs in simulating the climatological variations of summer monsoon rainfall over the Asian-Western Pacific region and the systematic errors that are common to a group of GCMs. The GCM data utilized are obtained from 10 GCM groups participated in the CLIVAR/Monsoon GCM Intercomparison Project. The model composite shows that the overall spatial pattern of summer monsoon rainfall is similar to the observed, although the western Pacific rainfall is relatively weak. For the simulated precipitation over the western Pacific, the models can be classified into two categories. The first category of models simulates the precipitation more confined to the equatorial region and weaker precipitation in the subtropical western Pacific compared to the observed. The second category of models simulates large precipitation in the subtropical western Pacific but the region is shifted to the north by 5–10°. None of the models realistically reproduce the observed Mei-yu rain band in the region from the East China Sea to the mid Pacific. Most of the models produce a rain band along the continental side of East Asia. The climatological variations of simulated summer rainfall are examined in terms of their amplitude and their principal EOF modes. All models simulate larger amplitudes of the climatological seasonal variation of Indian summer monsoon than the observed, though most models simulate smaller amplitudes in the western Pacific. The ten model composite produces four leading EOF modes over the Asian-western Pacific region, which are remarkably similar to the observed counterparts. The first and second eigenmodes, respectively, represent the smoothed seasonal march of broad-scale monsoon and the onsets of the Indian and East Asian summer monsoon. The third and fourth modes relate to the climatological intraseasonal oscillation (CISO). In contrast to the model composite, several models fail to reproduce the first principal mode, and most models do not reproduce the observed modes higher than the second. The CISO of precipitation is also examined over the Indian monsoon and the East Asia-western Pacific monsoon regions separately.

Pathogen occurrence and antimicrobial resistance trends among urinary tract infection isolates in the Asia-Western Pacific Region: report from the SENTRY Antimicrobial Surveillance Program, 1998–1999

Worldwide surveillance of antimicrobial resistance among urinary tract pathogens is useful to determine important trends and geographical variation for common Gram-positive and -negative species. The most common causative uropathogens often have intrinsic or acquired resistance mechanisms which include ESBL production among enteric bacilli, multi-drug resistant staphylococci and non-fermentative Gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter spp. and vancomycin-resistant Enterococcus spp. This study evaluates pathogen frequency and the resistance rates among urinary tract infection (UTI) pathogens in 14 medical centres in the Asia-Pacific region between 1998 and 1999. The isolates were referred to a central monitor for reference NCCLS broth microdilution testing, identification confirmation and patient demographic analysis. Over 50% of the 958 pathogens were Escherichia coli and Klebsiella spp. followed by P. aeruginosa, Enterococcus spp. and Enterobacter spp. Susceptibility for the three enteric bacilli was high for carbapenems (100%), ‘fourth-generation’ cephalosporins (cefepime 94.9–98.6%) and amikacin (≥93.0%). Beta-lactamase inhibitor compounds were more active against E. coli (piperacillin/tazobactam; >90% susceptible) than the other two enteric species and all other tested agents had a narrower spectra of activity. The rank order of anti-pseudomonal agents was amikacin (91.5% susceptible)>imipenem>piperacillin/tazobactam>tobramycin>ceftazidime and cefepime (77.4 and 76.4% susceptible, respectively). Susceptibility to quinolones for the P. aeruginosa isolates was only 63.2–67.0%. Only one vancomycin-intermediate Enterococcus spp. ( van C phenotype) was detected among the 103 strains tested. Newer fluoroquinolones (gatifloxacin; MIC 50, mg/l) were more potent against enterococci than ciprofloxacin (MIC 50, 2 mg/l) and high-level resistance to aminoglycosides was common (41.7%). The data presented are compared to studies of similar design from other areas which are part of the SENTRY surveillance network.

Paleobiogeographical extinction patterns of Permian brachiopods in the Asian–western Pacific region

Spatial and temporal variations in biological diversity are critical in understanding the role of biogeographical regulation (if any) on mass extinctions. An analysis based on a latest database of the stratigraphic ranges of 89 Permian brachiopod families, 422 genera, and 2059 species within the Boreal, Paleoequatorial, and Gondwanan Realms in the Asian–western Pacific region suggests two discrete mass extinctions, each possibly with different causes. Using species/family rarefaction analysis, we constructed diversity curves for late Artinskian–Kungurian, Roadian–Wordian, Capitanian, and Wuchiapingian intervals for filtering out uneven sampling intensities. The end-Changhsingian (latest Permian) extinction eliminated 87–90% of genera and 94–96% of species of Brachiopoda. The timing of the end-Changhsingian extinction of brachiopods in the carbonate settings of South China and southern Tibet indicates that brachiopods suffered a rapid extinction within a short interval just below the Permian/Triassic boundary.In comparison, the end-Guadalupian/late Guadalupian extinction is less profound and varies temporally in different realms. Brachiopods in the western Pacific sector of the Boreal Realm nearly disappeared by the end-Guadalupian but experienced a relatively long-term press extinction spanning the entire Guadalupian in the Gondwanan Realm. The end-Guadalupian brachiopod diversity fall is not well reflected at the timescale used here in the Paleoequatorial Realm because the life-depleted early Wuchiapingian was overlapped by a rapid radiation phase in the late Wuchiapingian. The Guadalupian fall appears to be related to the dramatic reduction of habitat area for the brachiopods, which itself is associated with the withdrawal of seawater from continental Pangea and the closure of the Sino-Mongolian seaway by the end-Guadalupian.

Summation: β-lactam resistance surveillance in the Asia–Western Pacific Region

The in vitro antimicrobial resistance surveillance studies presented in this series of symposium publications offer unique country-based information, and establish the opportunity to compare rates of susceptibility or resistance among commonly used broadspectrum b-lactam agents. A series of tables have been prepared that summarize important resistance mechanism rates for the Asia–Western Pacific nations (this symposium) and the results from the same study design applied to clinical isolates from the United States (Jones et al., 1997b), Latin America (Colombian Antimicrobial Resistance Study [CARS] Group et al., 1997; Puerto Rico Antimicrobial Resistance Study [PRARS] Group et al., 1998; Sader et al., 1997; Venezuelan Antimicrobial Resistance Study [VARS] Group et al., 1998), Turkey (Turkish Antimicrobial Resistance Study [TARS] Group et al., 1999), and China (Xu et al., 1999). The quality assurance performed in each study resulted in the disqualification of a number of participant’s data in each geographic region, and only data from control-qualified or monitor-confirmed resistant strains were forwarded for publication. All results were interpreted by the criteria published by the National Committee for Clinical Laboratory Standards (NCCLS) and the utilized method has been validated versus NCCLS (1997) procedures (NCCLS, 1999). b-Lactam Activity Against P. aeruginosa