Sarcina ventriculi, also known as Zymosarcina ventriculi and, incorrectly, as Clostridium ventriculi, is rarely encountered in clinical settings. A patient with a complicated gastrointestinal (GI) history, who was acutely presenting with small-bowel obstruction, was found to be colonized by S. ventriculi. The distinctive morphology of this species, with large Gram-variable cocci (up to 3 µm) arranged in two-by-two cuboid clusters reaching up to 20 µm, was key in identifying this bacterium in a stomach biopsy specimen. Sarcina ventriculi appears to be ubiquitously found in nature, and related bacterial species can cause GI-related disease in various animals. Clinical manifestations in humans are broad and often related to other underlying comorbidities. Isolation of S. ventriculi in the laboratory requires anaerobic culture on select media but its absence from standard MALDI-TOF databases complicates identification. Susceptibility data do not exist, so empiric treatment is the only option for this rare pathogen.

Promoting land use planning through ecosystem service (ES) protection is a crucial approach for maintaining landscape sustainability. Identifying ES bundles to serve landscape functional zoning can provide a new perspective for sustainable land use planning. Taking the Beijing metropolitan region as a study area, we quantitatively assessed the spatiotemporal distributions of multiple ESs, from 1980 to 2017, based on land use changes. By combining ES patterns and comprehensive ecosystem service (CES), distinct ES bundles were identified through the clustering method. Based on the ES bundles, landscape functional zones were then established. We further developed improved land use scenarios to conserve ESs in selected towns of different functional zones by exploring dominant factors influencing ESs. Results showed that most of ESs decreased due to the expansion of developed lands. According to the classification of ES bundles, Beijing can be classified into three landscape functional zones at town level: the ecological conservation region (ECR), food production region (FPR), and urban development region (UDR). For each landscape functional zone, the town with the greatest decline in CES value was selected. Associated with the influencing factors of ESs, local land use patterns, and ecological protection policies, corresponding multi-step improved land use scenarios were designed. These scenarios were demonstrated to be effective in conserving ESs in the selected towns: (1) the agricultural expansion scenario, which enhanced food provision services in the ECR; (2) the forest conservation scenario, which enhanced habitat and recreational services in the FPR; and (3) the developed land optimization scenario, which enhanced a range of regulating services in the UDR. Overall, this study used landscape functional zoning as a nexus to connect ES patterns and land use management. The optimized land use strategies can provide references for conserving ESs and enhancing landscape sustainability in Beijing and other similar metropolitan areas worldwide.

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of a new three-component \'bundle\' for insertion and management of centrally inserted central catheters (CICCs), designed to minimize catheter-related bloodstream infections (CRBSIs) in critically ill children.
METHODS: Our \'bundle\' has three components: insertion, management, and education. Insertion and management recommendations include: skin antisepsis with 2% chlorhexidine; maximal barrier precautions; ultrasound-guided venipuncture; tunneling of the catheter when a long indwelling time is expected; glue on the exit site; sutureless securement; use of transparent dressing; chlorhexidine sponge dressing on the 7th day; neutral displacement needle-free connectors. All CICCs were inserted by appropriately trained physicians proficient in a standardized simulation training program.
RESULTS: We compared CRBSI rate per 1000 catheters-days of CICCs inserted before adoption of our new bundle with that of CICCs inserted after implementation of the bundle. CICCs inserted after adoption of the bundle remained in place for a mean of 2.2 days longer than those inserted before. We found a drop in CRBSI rate to 10%, from 15 per 1000 catheters-days to 1.5.
CONCLUSIONS: Our data suggest that a bundle aimed at minimizing CR-BSI in critically ill children should incorporate four practices: (1) ultrasound guidance, which minimizes contamination by reducing the number of attempts and possible break-down of aseptic technique; (2) tunneling the catheter to obtain exit site in the infra-clavicular area with reduced bacterial colonization; (3) glue, which seals and protects the exit site; (4) simulation-based education of the staff.