Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Transforming growth factor β-mediated micromechanics modulates disease progression in primary myelofibrosis.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadPrimary myelofibrosis (PMF) is a Ph-negative myeloproliferative neoplasm (MPN), characterized by advanced bone marrow fibrosis and extramedullary haematopoiesis. The bone marrow fibrosis results from excessive proliferation of fibroblasts that are influenced by several cytokines in the microenvironment, of which transforming growth factor-β (TGF-β) is the most important. Micromechanics related to the niche has not yet been elucidated. In this study, we hypothesized that mechanical stress modulates TGF-β signalling leading to further activation and subsequent proliferation and invasion of bone marrow fibroblasts, thus showing the important role of micromechanics in the development and progression of PMF, both in the bone marrow and in extramedullary sites. Using three PMF-derived fibroblast cell lines and transforming growth factor-β receptor (TGFBR) 1 and 2 knock-down PMF-derived fibroblasts, we showed that mechanical stress does stimulate the collagen synthesis by the fibroblasts in patients with myelofibrosis, through the TGFBR1, which however seems to be activated through alternative pathways, other than TGFBR2. Keywords: TGF-β; fibroblast activation; invasion; micromechanics; myelofibrosis; proliferation.School of Doctoral Studies-Iuliu Hatieganu University Romanian Government Ion Chiricuta Oncology Institute Cluj Napoca international collaborative grant of the European Economic Space between Romania and Iceland 2020-2022 1

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Extended bioreactor conditioning of mononuclear cell–seeded heart valve scaffolds

The tissue-engineered heart valve may be the ideal valve replacement option but still must overcome challenges in leaflet recellularization. This study sought to investigate the potential for leaflet matrix restoration and repopulation following mononuclear cell seeding and extended periods of bioreactor conditioning. Human aortic heart valves were seeded with mononuclear cells and conditioned in a pulsatile bioreactor for 3 days, 3 weeks, or 6 weeks. The results of this study determined that a mononuclear cell population can be readily localized within the leaflet tissue in as little as 3 days. Furthermore, as extended bioreactor condition continued to the 3- and 6-week time points, the mesenchymal stem cell subfraction proliferated and appeared to become the predominant cell phenotype. This was evident through positive expression of mesenchymal stem cell markers and no expression of mononuclear cell markers observed by immunohistochemistry in the 3- and 6-week groups. In addition, cells in the 3- and 6-week groups exhibited an up-regulation of mesenchymal stem cell–associated genes ( THY1, NT5E , and ITGB1 ) and a down-regulation of mononuclear cell–associated genes ( CD14, ICAM1 , and PECAM1 ) compared to the initial seeded cell population. However, repopulation of the leaflet interstitium was less extensive than anticipated. Valves in the 6-week time point also exhibited retracted leaflets. Thus, while the 3-week bioreactor-conditioning period used in this study may hold some promise, a bioreactor-conditioning period of 6 weeks is not a viable option for clinical translation due to the negative impact on valve performance

Growth and Characterization of Lead-free Piezoelectric Single Crystals

Lead-free piezoelectric materials attract more and more attention owing to the environmental toxicity of lead-containing materials. In this work, we review our first attempts of single crystal grown by the top-seeded solution growth method of BaTiO3 substituted with zirconium and calcium (BCTZ) and (K0.5Na0.5)NbO3 substituted with lithium, tantalum, and antimony (KNLSTN). The growth methodology is optimized in order to reach the best compositions where enhanced properties are expected. Chemical analysis and electrical characterizations are presented for both kinds of crystals. The compositionally-dependent electrical performance is investigated for a better understanding of the relationship between the composition and electrical properties. A cross-over from relaxor to ferroelectric state in BCTZ solid solution is evidenced similar to the one reported in ceramics. In KNLSTN single crystals, we observed a substantial evolution of the orthorhombic-to-tetragonal phase transition under minute composition changes

Electrochemical Investigation of the OER Activity for Nickel Phosphite-Based Compositions and Its Morphology-Dependent Fluorescence Properties

Herein, we present the investigation of catalytical and fluorescence properties for Ni11(HPO3)8(OH)6 materials obtained through a hydrothermal approach. As part of the constant search for new materials that are both cost effective and electrocatalytically active for the oxygen evolution reaction (OER) in alkaline medium, the present study involves several graphite electrodes modified with Ni11(HPO3)8(OH)6 mixed with reduced graphene oxide (rGO) and carbon black. The experimental results obtained in 0.1 mol L&ndash;1 KOH electrolyte solution show the electrode modified with rGO, 5 mg carbon black and 1 mg nickel phosphite as displaying the highest current density. This performance can be attributed to the synergistic effect between nickel phosphite and the carbon materials. Investigation of the electrode&rsquo;s OER performance in 0.1 mol L&ndash;1 KOH solution revealed a Tafel slope value of just 46 mV dec&ndash;1. By increasing the concentration to 0.5 and 1 mol L&ndash;1, this value increased as well, but there was a significant decrease in overpotential. Fluorescence properties were analyzed for the first time at the excitation length of 344 nm, and the observed strong and multiple emissions are described

Electrochemical Investigation of the OER Activity for Nickel Phosphite-Based Compositions and Its Morphology-Dependent Fluorescence Properties

Herein, we present the investigation of catalytical and fluorescence properties for Ni11(HPO3)8(OH)6 materials obtained through a hydrothermal approach. As part of the constant search for new materials that are both cost effective and electrocatalytically active for the oxygen evolution reaction (OER) in alkaline medium, the present study involves several graphite electrodes modified with Ni11(HPO3)8(OH)6 mixed with reduced graphene oxide (rGO) and carbon black. The experimental results obtained in 0.1 mol L–1 KOH electrolyte solution show the electrode modified with rGO, 5 mg carbon black and 1 mg nickel phosphite as displaying the highest current density. This performance can be attributed to the synergistic effect between nickel phosphite and the carbon materials. Investigation of the electrode’s OER performance in 0.1 mol L–1 KOH solution revealed a Tafel slope value of just 46 mV dec–1. By increasing the concentration to 0.5 and 1 mol L–1, this value increased as well, but there was a significant decrease in overpotential. Fluorescence properties were analyzed for the first time at the excitation length of 344 nm, and the observed strong and multiple emissions are described

IMAGING DIAGNOSIS OF NONALCOHOLIC STEATOHEPATITIS

Non-alcoholic fatty liver comprises several clinical entities, starting from hepatic steatosis and reaching steatohepatitis, fibrosis and liver cirrhosis; it is currently considered a major public health issue. The most important risk factors for non-alcoholic fatty liver are obesity, type II diabetes and dyslipidaemia. At present, it is of great importance the study of non-invasive diagnostic methods to identify imaging techniques that correlate with steatohepatitis and liver fibrosis and to establish clear indications of liver biopsy in patients with non-alcoholic fatty liver

Laser demonstration with highly doped Yb:Gd2O3 and Yb:Y2O3 crystals grown by an original flux method

We present, to the best of our knowledge, the first laser demonstration of an Yb-doped Gd2O3 cubic crystal. This crystal was obtained by the flux method using an original borate-based solvent, which was particularly well suited to the growth of rare earth sesquioxide crystals at half the working temperature of classical growth techniques. This flux method is a very interesting alternative for the production of laser sesquioxide crystals, not only because it provides access to new matrices of the cubic polymorph, but also because it permits high Yb3+-doping levels for these crystals. The first laser results of two highly Yb3+-doped sesquioxides, namely Gd2O3 and Y2O3, grown by this flux method are presented here, including the Ti:sapphire and diode pumping configurations. Laser efficiencies and emission spectra for these two crystals were studied and compared