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Introduction: Factor VII (FVII) deficiency, a rare bleeding disorder, can manifest as an autosomal recessive congenital or an acquired coagulopathy. Acquired FVII deficiency, although infrequently reported, presents unique challenges in understanding its mechanisms and identifying underlying causes. Case presentation: We present a case of acquired FVII deficiency discovered in a 23-year-old female patient with no apparent underlying disease. The patient exhibited spontaneous ecchymosis and gingival hemorrhage, along with low FVII activity and isolated prolongation of prothrombin time. Extensive laboratory investigations excluded liver dysfunction, familial deficiency, vitamin K deficiency, and inhibitory antibodies. Prompt treatment with Fresh Frozen Plasma (FFP) and bypassing agents resulted in a favorable response and resolution of hematomas. Conclusion: Acquired FVII deficiency was identified with bleeding symptoms in association with prolonged prothrombin time and a low level of FVII activity. In literature, this deficiency has been associated with various conditions such as sepsis, aplastic anemia, stem cell transplantation, and neoplasms, although approximately 14% of cases remain idiopathic. Clinical outcomes remain generally poor, with limited complete remissions reported.

Bone marrow and the central nervous system are both protected by bone. The two systems are interconnected not only structurally but also functionally. In both systems specialized cells communicate through synapses. There exists a tridirectional communication within the neuroimmune network, including the hormonal system, the immune system, and the nervous system. Bone marrow is a priming site for T cell responses to blood-borne antigens including those from the central nervous system. In cases of auto (self) antigens, the responses lead to immune tolerance while in cases of neo (non-self) antigens, the responses lead to neoantigen-specific T cell activation, immune control, and finally to the generation of neoantigen-specific immunological memory. Bone marrow has an important function in the storage and maintenance of immunological memory. It is a multifunctional and very active cell-generating organ, constantly providing hematopoiesis and osteogenesis in finely-tuned homeostasis. Clinical perspectives include mesenchymal stem cell transplantation for tissue repair within the central nervous system.

As the introduction of immune checkpoint inhibitors in the treatment of various cancers is now proven to be already acquired knowledge, so does a new challenge arise for clinicians; the understanding, diagnosis, and management of the rarest adverse effects of immunotherapy. We present a case of type-1 diabetes Mellitus (T1DM) in a patient with non-small cell lung carcinoma (NSCLC) treated with pembrolizumab. Following ten cycles of treatment, our patient was diagnosed with T1DM after being admitted for diabetic ketoacidosis and stayed hospitalized in the ICU. Later, they continued treatment with insulin, having shown disease response to pembrolizumab, and resumed immunotherapy while on insulin. Immunotherapy-induced T1DM can sometimes occur with PD1/PD-L1 blockage therapies. It has a rapid onset, is characterized by insulin deficiency due to the autoimmune destruction of beta-cells, and usually presents itself with diabetic ketoacidosis. Unlike most of the other adverse effects of immunotherapy, glucocorticoids don’t seem to be of therapeutic value, and insulin substitution is required. Regular glucose monitoring can be key to early diagnosis and prevention of hospitalization. 

Amyotrophic lateral sclerosis (ALS) disease is characterized by degeneration of motor neurons and elevation of brain oxidative stress. Previous studies demonstrated the neuroprotective effects of Telomerase reverse transcriptase (TERT) from oxidative stress. We showed that increasing TERT expression in the brain of the Tg hSOD1G93A mouse ALS model attenuated the disease pathology and increased the survival of motor neurons exposed to oxidative stress. How TERT increased the survival of motor neurons exposed to oxidative stress is not yet clear. Here we investigated the consequence of TERT depletion in motor neuron cells under normal and oxidative stress conditions and in mouse brains of TERT knockout mice, on the expression and activity of SOD1 and catalase enzymes. Depletion of mouse TERT caused mitochondrial dysfunction and impaired catalase and SOD1 activity. Compensation with hTERT restored the activity of SOD1. SOD1 expression increased in the brain of TERT KO and in ALS mice and decreased in the brain of WT mice treated with telomerase-increasing compounds. We suggest that the ability of TERT to protect neurons from oxidative stress affects the expression and activity of SOD1, in a TERT-dependent manner, and supports the notion of TERT as a therapeutic target for neurodegenerative diseases like ALS.

Yemen with its diverse climatic regions represents a rich resource for bioactive compounds obtained from microorganisms. This study was designed to screen fungal isolates obtained from the Microbiology branch, Biological Sciences Department, Faculty of Science, Sana’a University for their ability to produce L-asparaginase enzyme. In preliminary screening for L-asparaginase, among 77 fungal isolates about 29 fungal isolates representing 37.66% were high producers of L-asparaginase. These fungal isolates belonged to the genera Aspergillus, Eupenicillium, Fusarium, Penicillium, and Stachyobotrys. These 29 fungal isolates were screened for their ability to produce L-asparaginase using the agar well diffusion method. 12 fungal isolates out of 29 showed the ability to produce extracellular L-asparaginase. These isolates belonged to 8 species which were: A. sulphurs, A. ustus, F. sacchari, P. chrysogenum, P. citrinum, P. corylophilum, P. melinii, and P. subturcoseum. Only 5 isolates were obtained for the determination of enzymatic activity, among them P. chrysogenum showed the highest activity (279.8696U ml-1) followed by A. ustus (170.9435U ml-1). This finding is the first report on the L-asparaginase production from filamentous fungi in Yemen.

Background: CPTs are rare intraventricular papillary neoplasms derived from the choroid plexus epithelium. Anti-collagenase and extracellular matrix which have not been expressed in brain tumors. Objective: The purpose of this study was to investigate the expression levels of collagen type VI, anti-collagenase, laminin, MM9, claudins 1 and 5, N and E cadherins, and collagen VII, tejido, and collagen degradation enzyme complexes in choroid plexus tumors.Materials and methods: We studied the expression of adhesion molecules, extracellular matrix, and anticollagenase with an immunohistochemistry approach and electron microscopy analysis in 42 choroid plexus tumors. Results: 28(67%) were choroid plexus papillomas, 8 (19%) were atypical choroid plexus papillomas and 6 (14%) were choroid plexus carcinomas. The Ki67-li and MVD increased from CPC to ACPP, being the highest in malignant tumors as well as a strong immunoexpression of anti-collagenase and were inverse correlation with claudin 5, E, and N cadherin and collagen IV immunoexpressions which added further significant information to the prognosis and varied according to the histologic classification. By ultrastructure, the loss of basal membrane and cilia, disorganization, and proliferation of ECM were observed in CPC. Cerebral homeostasis largely results from the ability of both the Blood–Brain Barrier (BBB) at the brain microvascular endothelium and the Blood–Cerebrospinal Fluid Barrier (BCSFB) at the epithelium of the Choroid Plexuses (CPs), to control the composition of the CSF and cerebral extracellular fluid. Under expression of the tight junction proteins occludin, claudin-1 and claudin-5 are key molecular abnormalities responsible for the increased permeability of tumor endothelial tight junctions. Conclusion: The loss of basement membrane and ECM overexpression could be considered as a poor prognosis predictor in CPT. Anti-collagenase and MMP9 overexpression could be related to basal membrane and BBB plasticity in CPTs.

This review article deals with quantum biology, the new tool that helps traditional biology unravel some mysteries concerning life and living organisms on Earth. We use Einstein’s famous equation to explain how an unknown energy realm creates the material universe. We demonstrate how material existence precedes living existence and elucidate how non-living atoms transition to living molecules, Francis Crick’s faded dream that comes to reality. Finally, we expose the two types of Information available inside a cell to sustain life in living organisms and elaborate on a new formulation of the biogenesis theory.

The Masquelet technique has become increasingly popular in reconstruction scenarios such as osteomyelitis, cancer, and nonunions. The procedure is a two-staged approach: first, a polymethylmethacrylate (PMMA) cement spacer is inserted to fill a bone void. The spacer induces a membrane to form around it, and 6-9 weeks later, the second stage involves carefully extracting the spacer and filling the membrane with bone graft. Most of the current literature has published either femoral or tibial involvement for Masquelet studies, with limited published data on foot reconstruction. Here, the authors used the procedure for the fourth metatarsal. Despite complications, this case proves a more excellent utility and warrants further investigation into Masquelet techniques in the foot.

Kidney transplantation is the therapy of choice for patients with end-stage kidney disease (ESKD). Nevertheless, the main limitation for long-term graft survival is immune-mediated rejection. Some authors have proposed that differences in immune effector mechanisms are influenced by underlying molecular mechanisms; thereby, the identification of differentially expressed genes in acute or chronic rejection in non-invasive samples such as urine may be essential for the identification of potential biomarkers and biological processes associated with allograft outcomes. Our aim was to explore differences in gene expression and functional categories associated with acute and chronic kidney rejection in blood, biopsy, and urine of kidney transplant patients using RNA-Seq. RNA was isolated and sequenced implementing standard protocols. Analyses were addressed to identify differentially expressed genes (DEGs) and Functional Categories of Gene Ontology comparing between samples. Then we focused on immune genes and pathways to identify their association with the allograft. We identified a significant transcriptional similarity between biopsy and urine, in comparison with blood in acute and chronic rejection. Functional analyses suggested an enrichment of immune processes such as antigen processing and presentation, and regulation of B cell receptor signaling pathway in blood of acute and chronic rejection, respectively. Additionally, we observed an increase in expression of chemokines in biopsy and urine of both outcomes along with an increase in chemokine receptors in blood. Our findings suggest that urine is suitable for identifying potential biomarkers and biological processes related to renal allograft rejection, as it shares a significant number of regulated genes with biopsy.

A very unusual, interesting, and challenging case of a 24-year-old female who was born with three openings in the neck. The patient had chronic abdominal gaseous distention, recurrent abdominal pain, and constipation since early infancy. The patient presented in emergency with acute painful red, hot, and tender swelling in the left upper cervical area. Laboratory studies showed high inflammatory markers and a provisional diagnosis of abscess with a sinus was made. The patient underwent an emergency incision and drainage. Sinus recurred and a sinogram showed it to be a residual cyst in the left submandibular salivary gland. The total cyst excision was attempted with resultant recurrence and grade IV facial nerve palsy. Post-operatively recurrent infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) required several courses of oral and intravenous broad-spectrum antibiotics with several hospital admissions with no resolution in sight. Subsequent ultrasound and magnetic resonance imaging showed a residual infected cyst, cutaneous sinus, and a fistula opening in the left ear canal. A diagnosis of branchial cyst type II of the first brachial cleft remnant with a fistula was established with bilateral branchial fistulas of the second branchial remnants and the associated colorectal hypoganglionosis based on radiological studies. The patient refused any further operative interventions. Therefore, the option of conservative treatment of hypoganglionosis with holobiotics consisting of prebiotics, probiotics and postbiotics, laxatives, dietary changes, lifestyle modifications, and dietary supplements started. All antibiotics were stopped. These therapies resulted in the resolution of residual first branchial remnants and recurrent MRSA infections with the improvement in the facial nerve palsy from grade V to grade III-IV together with an excellent cosmetic and functional result. The patient is doing well at follow-ups being infection-free for 18 months and repeat contrast-enhanced computed tomogram (CECT) has shown complete resolution of the residual cyst, sinus, and fistula with fibrosis.

With the increase in incidence and prevalence of myeloid neoplasms in India, it has become a necessity to understand its molecular mechanisms, acquisition of genomic alterations, and understand its primary and secondary resistance pathways which ultimately impact the decision of therapeutics. The objective of this review is to investigate the molecular aspects of this disease type and identify the biomarkers that help with diagnosis, risk assessment, prognosis, and selecting the best line of treatment for a specific myeloid neoplasm. Advancements and innovations in molecular technologies from simplest Real-Time PCR to high throughput next-generation sequencing have played a vital role in screening the most common mutations and fusions to the novel and rare. Molecular technologies have helped to enumerate the genomic landscape of myeloid malignancies. The understanding of both- the mechanisms and the technology is a strong combination as it has helped revolutionize precision oncology and helped in giving better therapeutic choices with better clinical outcomes. The importance of cellular morphology, clinical symptoms, and molecular pathology in assessing the risk of myeloid malignancies is emphasized and summarized in the review. The review concludes that understanding molecular pathogenesis can be improved by using clinical-pathological-molecular strategies for diagnosis and therapy decision-making.

Thyroid cancer, characterized by the development of malignant tumors in the cells of the thyroid gland, impacts the quality of life and well-being of diagnosed patients. This article explores different aspects of this type of cancer, including everything from its typologies, incidence, causes, and risk factors to symptoms, diagnostic methods, and treatment options. Furthermore, the impact on Health-Related Quality of Life (HRQoL) is addressed, highlighting that, although the prognosis is generally favorable, patients can experience significant negative repercussions. Therefore, the need for further investigation into the priorities of psychological intervention with the population with this problem is emphasized.

The city of Santo Amaro (Bahia, Brazil) gained visibility among the scientific community due to the contamination of the Subaé River by lead and cadmium from the PLUMBUM Mineração e Metalurgia Ltda industry, on the banks of the river in 1956, which produced lead ingots The present work aimed to investigate the adsorption capacity of heavy metals (Pb and Cd) of EPS produced by bacterial species from the Subaé River, for possible future application of these biopolymers in bioremediation processes in areas impacted by the aforementioned heavy metals. Subaé river water was collected for physical-chemical analysis and bacterial isolation. It was verified that all isolated bacteria produced an expressive amount of Exopolysaccharide (EPS). Thus, the optimization of this production in different sugars (sucrose, glucose, and mannitol) and in three different pHs: 5.5; 6.5, and 7.5. All bacteria produced EPS in large quantities and the best sugar was sucrose at pH 7.5. In order to use the EPS for the bioremediation area, the adsorption test of lead and cadmium was carried out by the isolated EPS. 0.5 g of the EPS was dissolved in 50 ml of deionized water, then the solutions of metals, lead acetate, and cadmium sulfate (procedure performed separately) were incubated at 28 °C for 16 h after that period, and were centrifuged. Samples were filtered to separate the insoluble EPS and the filtrates obtained were used in the quantification of the metals by atomic absorption (FAAS- Flame Atomic Absorption Spectrometry). Bacillus spp., Bacillus cereus, Staphylococcus spp., and Serratiamarcescens, all showed tolerance to the tested metals, due to the efficiency in the adsorption capacity of the EPS, and it was possible to distinguish seven genera, Klebsiella pneumonia, Pseudomonas aeruginosa, Lysinibacillus spp. to be used in the bioremediation of environments contaminated with heavy metals.

Background: The age-dependent sporadic form of PD is characterized by the degeneration of dopaminergic (DA) neurons in the Substantia Nigra (SN), gliosis, and vascular changes. Vascular changes may contribute to the onset of the disease and exacerbate the neurodegenerative process, as some vascular changes occur before the onset of neuronal loss. To demonstrate the anti-neuroinflammatory efficacy of a new compound, a water-soluble form of dihydroquercetin (DHQ-WF), we studied the structural changes of microcirculatory vasculature, astroglial GFAP, and vascular endothelial growth factor –A (VEGF-A) mRNA expression in the SN of young and old rats after unilateral nigral treatment by lipopolysaccharide (LPS) and oral administration of DHQ-WF.Materials and methods: The experiments were performed on 18 young (8 weeks - 10 weeks old; 250 g - 320 g) and 18 old (18 months - 19 months old; 390 g - 450 g) male Vistar rats. Young and adult rats from the experimental groups were stereotactically injected with 2 μL LPS solution (LPS from Escherichia coli; 0,01 μL/mL) into one side of the SN. Control young and old rats were similarly injected with 2 μL sterile saline. Half of the animals in both the control and experimental groups (6 animals in each group) received a 2 ml solution containing DHQ-WF at a concentration of 3 mg/ml orally every day. After 8 weeks, brains were harvested and serial cryostat sections were prepared for histochemical (FITC-labeled tomato lectin), immunohistochemical (anti-GFAP Antibody, Cy3 Conjugate) staining, and real-time PCR (mRNA VEGF-A).Results: Eight weeks after LPS injection into the SN, a significant excess of areas occupied by cell bodies and processes of astroglial cells, the density of microcirculatory vessels, and mRNA VEGF-A expression was observed in old animals compared to control old animals and young LPS-treated rats.  Oral administration of DHQ-WF to LPS-treated rats resulted in a significant reduction of these parameters in old animals.Conclusion: Injection of LPS into rat SN induces neuroinflammation and vascular angiogenesis, maximally expressed in old animals.  Administration of DHQ-WF for 8 weeks significantly reduces these LPS-induced changes. DHQ-WF may be an effective treatment for reducing the effects of neuroinflammation in the aging brain.

Background: Patients with acute and chronic leukemia presenting with hyperleukocytosis are at risk of developing leukostasis which has serious and life-threatening complications. Leukapheresis is usually performed to reduce the complications of leukostasis in patients presenting with hyperleukocytosis and clinical manifestations compatible with leukostasis. Methods and materials: A retrospective study of patients with acute and chronic leukemia who received leukapheresis for hyperleukocytosis between the 1st of January 2013 and the 31st of December 2023 at King Fahad Specialist Hospital (KFSH) in Dammam, Saudi Arabia was performed. Results: Over a period of 11 years, a total of 50 patients with acute and chronic leukemia presenting with hyperleukocytosis and clinical manifestations of leukostasis; 32 patients with acute leukemia (AL) and 18 patients with chronic myeloid leukemia (CML); received leukapheresis at our institution. Among the 32 patients with AL who received leukapheresis, 24 patients (75%) had acute myeloid leukemia (AML), 7 patients (21.88%) had acute lymphoblastic leukemia (ALL) and 1 patient (3.13%) had bilineage acute leukemia (BAL). At presentation of their AL: 3 patients (9.38%) had fever, 9 patients (28.13%) had infections, 4 patients (12.5%) had palpable spleen or liver, 6 patients (18.75%) had palpable external lymph nodes, and 9 patients (28.13%) had extramedullary disease (EMD). After receiving induction and consolidation cycles of chemotherapy, 11 patients (34.38%) of AL patients received allogeneic hematopoietic stem cell transplantation (HSCT). At the end of the follow-up, 17 patients (53.1%) with AL were alive while 15 patients (46.9%) were dead. The 8-year overall survival (OS) for all patients with AL subjected to leukapheresis was 47%. The 5 years OS for patients with AL who subsequently received HSCT and those who did not receive allogeneic HSCT were 70% and 40% respectively. The mean white blood cell (WBC) count of CML patients subjected to leukapheresis was 465.5 × 109/L, 11 patients (61.11%) had clear signs of leukostasis, and 8 patients (44.44%) had splenomegaly at presentation. Regarding the disease stage at presentation, 14 CML patients (77.78%) had chronic phase (CP), 2 patients (11.11%) had accelerated phase (AP) and 2 patients (11.11%) had blast phase (BP). Regarding the fate of CML patients at the end of the study were: 15 (83.33%) were alive, 1 (5.56%) dead, and 2 (11.11%) were unknown as they lost follow-up. However, the 10-year OS of patients with CML subjected to leukapheresis was 90%. Conclusion: Patients with acute or chronic leukemia presenting with hyperleukocytosis and either ongoing or impending leukostasis should have urgent cytoreductive chemotherapy and leukapheresis to prevent life-threatening complications. Although the outcome of AL patients presenting with leukostasis is generally poor, prompt cytoreductive therapy and leukapheresis, followed by induction chemotherapy and allogeneic HSCT may improve the outcome. Also, urgent cytoreduction including leukapheresis improves the outcome of patients with CML presenting with hyperleukocytosis and leukostasis.

Inflammation is a natural response of the body to defend itself against potential threats and can be reduced through physical activity, proper nutrition, and the use of herbal medicines, which are medicinal plants. In the study, we aim to examine the anti-inflammatory effects of the volatile and ethanolic fractions of two commonly used medicinal plants, Equisetum arvense, and Baccharis trimera. The essential oils were obtained by hydrodistillation of the fresh leaves of the plants, while the ethanolic extracts were obtained using classical methodologies. All fractions were tested for anti-inflammatory activity, evaluating their ability to stabilize the red blood cell membrane and inhibit the spreading, and phagocytosis by macrophages, at concentrations varying from 200 to 600 µg mL-1. The results of the experiments suggest that the ethanolic fraction of B. trimera shows promising results compared to the positive controls. Our investigations thus contribute to the specialized literature on the use of herbal medicines around nutrition, providing guidance for future studies on these fractions.

Cells have emerged as highly promising vehicles for delivering drugs due to their unique advantages. They have the ability to bypass immune recognition, navigate biological barriers, and reach difficult-to-access tissues through sensing and active movement. Over the past couple of decades, extensive research has been conducted to understand how cell carriers can overcome biological barriers and influence drug effectiveness. This has resulted in the development of engineered cells for targeted drug delivery to specific tissues. Despite the presence of exciting developments, a comprehensive understanding of the challenges and potential strategies is necessary for the effective clinical application of cell-based drug carriers. This review provides an overview of recent progress and novel concepts in cell-based drug carriers, as well as their potential for translation into clinical practice. Additionally, we delve into important factors and emerging strategies for designing the next generation of cell-based delivery technologies, with a particular emphasis on achieving greater accuracy and targeted drug administration.

Spinal muscular atrophy is an autosomal recessive neuromuscular disorder characterized by progressive muscle weakness and atrophy. It is one of the most common single-gene disorders with an incidence rate of approximately 1 in 10,000 live births. The clinical manifestations are progressive hypotonia and muscle weakness due to the degeneration of alpha neurons in the anterior horn cells of the spinal cord and motor nuclei in the lower brain stem. Depending on the severity of the symptoms, SMA has five subtypes. Supportive measures can be offered for respiratory, gastrointestinal, and musculoskeletal complications. Carrier testing for all couples is recommended and this can be done by Multiplex Ligation-dependent Probe Amplification (MLPA). Prenatal diagnosis can be offered to carrier couples. Therapies must be given within the newborn period for maximum benefit and before the loss of motor neurons. It is achieved by identifying the SMA babies through Newborn screening. Several new FDA-approved drugs can reduce the progression of symptoms in SMA. However, they cannot offer a definite cure. Clinical follow-up and Neurological assessment demonstrate that SMA children can attain developmental milestones after receiving treatment, which is never normally attained in untreated cases. In utero SMA treatment with Zolgensma would enhance the survival rate and favorable neurological outcomes in the future. Base editing and Gene editing with CRISPR-Cas technologies to target the mutations and restore functional and stable SMN protein levels are the future hopes for a permanent cure of SMA.

Background: Bile duct injuries have been substantially increased after the introduction of laparoscopic cholecystectomy (LC). These are accompanied by major morbidity and mortality. Studies have shown varying degrees of success in the reduction of bile duct injury (BDI) using the Critical View of Safety (CVS) technique. The aim of this study was to see the efficacy of the CVS technique as the sole method of dissection in laparoscopic cholecystectomy. Methods: 1647 cases of LC were done between January 2012 and January 2022 for a period of 10 years in two hospitals. All were operated by the CVS dissection technique and none by the infundibular technique. Cases included acute cholecystitis, chronic cholecystitis, gangrenous cholecystitis, empyema, and Gallbladder (GB) polyp. Results: The average operating time was 42 minutes and the range was 13 to 80 minutes. In 92% of cases, all 3 criteria of CVS were achieved. In the remaining 8% cases were either converted to open or operated by a division of GB or subtotal cholecystectomy was done. There was only one case of cystic duct stump leak requiring drainage and common bile duct stenting.Conclusion: The excellent outcome of our study suggests that the CVS method will be the gold standard technique in the dissection of the gallbladder in LC. Further dissemination of the technique is necessary to improve safety in LC.

Essential oils (EO) are extracted from different plant species and can be present in different plant organs. Rosemary-pepper EO is composed of around 50% to 70% thymol, a phenolic compound proven to be active against fungi and bacteria. The active components present in these compounds can affect the vital functionality of bacterial cells, leading to protein denaturation and cell lysis. Therefore, the present study aims to evaluate in vitro the antibacterial potential of Lippia origanoides EO against gram-negative bacteria. This is an exploratory study, with a technical-experimental procedure, with a quantitative approach, carried out at the Federal University of Campina Grande. The strains used were Pseudomonas aeruginosa ATCC 27853, Proteus mirabilis ATCC 25933, and Escherichia coli ATCC 25922, using concentrations of 1024, 512, 256, and 128 μg/ml using the disc diffusion method in triplicate. After the incubation period, the formation of halos of bacterial growth inhibition was not observed. There are possible causes for the lack of antibacterial activity of the EO concerning the strains of gram-negative bacteria used in the study, including the possibility of not containing components with antibacterial properties in concentrations sufficient for the expected activity at the concentrations tested. Based on the results obtained, the Rosemary-Pepper EO (Lippia organoids) did not demonstrate antimicrobial activity against the gram-negative bacteria used in the study. Therefore, the development of new research with Lippia origanoides essential oil with gram-positive bacteria is suggested.