The contribution of Escherichia coli from human and animal sources to the integron gene pool in coastal waters

To understand the contribution of animal- and human-derived fecal pollution sources in shaping integron prevalence and diversity in beach waters, 414 Escherichia coli strains were collected from beach waters (BW, n = 166), seagull feces (SF, n = 179), and wastewaters (WW, n = 69), on the World Biosphere Reserve of the Berlenga Island, Portugal. Statistical differences were found between the prevalence of integrons in BW (21%) and WW (10%), but not between BW and SF (19%). The majority of integrase-positive (intI (+))-strains affiliated to commensal phylogroups B1 (37%), A0 (24%), and A1 (20%). Eighteen different gene cassette arrays were detected, most of them coding for resistances to aminoglycosides, trimethoprim, chloramphenicol, and quaternary ammonia compounds. Common arrays were found among strains from different sources. Multi-resistance to three or more different classes of antibiotics was observed in 89, 82, and 57% of intI (+)-strains from BW, SF and WW, respectively. Plasmids were detected in 79% of strains (60/76) revealing a high diversity of replicons in all sources, mostly belonging to IncF (Frep, FIA, and FIB subgroups), IncI1, IncN, IncY, and IncK incompatibility groups. In 20% (15/76) of strains, integrons were successfully mobilized through conjugation to E. coli CV601. Results obtained support the existence of a diverse integron pool in the E. coli strains from this coastal environment, associated with different resistance traits and plasmid incompatibility groups, mainly shaped by animal fecal pollution inputs. These findings underscore the role of wild life in dissemination of integrons and antibiotic resistance traits in natural environments

Management of acute intracerebral haemorrhage – an update

Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefit versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage

ruvA Mutants that resolve Holliday junctions but do not reverse replication forks

RuvAB and RuvABC complexes catalyze branch migration and resolution of Holliday junctions (HJs) respectively. In addition to their action in the last steps of homologous recombination, they process HJs made by replication fork reversal, a reaction which occurs at inactivated replication forks by the annealing of blocked leading and lagging strand ends. RuvAB was recently proposed to bind replication forks and directly catalyze their conversion into HJs. We report here the isolation and characterization of two separation-of-function ruvA mutants that resolve HJs, based on their capacity to promote conjugational recombination and recombinational repair of UV and mitomycin C lesions, but have lost the capacity to reverse forks. In vivo and in vitro evidence indicate that the ruvA mutations affect DNA binding and the stimulation of RuvB helicase activity. This work shows that RuvA's actions at forks and at HJs can be genetically separated, and that RuvA mutants compromised for fork reversal remain fully capable of homologous recombination

The effectiveness and safety of antifibrinolytics in patients with acute intracranial haemorrhage: statistical analysis plan for an individual patient data meta-analysis

Introduction: The Antifibrinolytic Trialists Collaboration aims to increase knowledge about the effectiveness and safety of antifibrinolytic treatment by conducting individual patient data (IPD) meta-analyses of randomised trials. This article presents the statistical analysis plan for an IPD meta-analysis of the effects of antifibrinolytics for acute intracranial haemorrhage. Methods: The protocol for the IPD meta-analysis has been registered with PROSPERO (CRD42016052155). We will conduct an individual patient data meta-analysis of randomised controlled trials with 1000 patients or more assessing the effects of antifibrinolytics in acute intracranial haemorrhage. We will assess the effect on two co-primary outcomes: 1) death in hospital at end of trial follow-up, and 2) death in hospital or dependency at end of trial follow-up. The co-primary outcomes will be limited to patients treated within three hours of injury or stroke onset. We will report treatment effects using odds ratios and 95% confidence intervals. We use logistic regression models to examine how the effect of antifibrinolytics vary by time to treatment, severity of intracranial bleeding, and age. We will also examine the effect of antifibrinolytics on secondary outcomes including death, dependency, vascular occlusive events, seizures, and neurological outcomes. Secondary outcomes will be assessed in all patients irrespective of time of treatment. All analyses will be conducted on an intention-to-treat basis. Conclusions: This IPD meta-analysis will examine important clinical questions about the effects of antifibrinolytic treatment in patients with intracranial haemorrhage that cannot be answered using aggregate data. With IPD we can examine how effects vary by time to treatment, bleeding severity, and age, to gain better understanding of the balance of benefit and harms on which to base recommendations for practice

Forced moves and chosen moves: residential mobility in Ankara, Turkey

This thesis presents an analysis of residential mobility in Ankara, Turkey. The principal question posed is whether the household adjustment model, in which residential mobility is defined as a mechanism enabling households to meet their housing needs, is applicable. The thesis examines the previous literature on residential mobility, describes the economic and social context of housing decisions in Ankara, and then presents a detailed analysis of a survey of a representative sample of Ankara households. The critical review of previous writing on residential mobility leads us to set out a conceptual framework which includes household decision making and the context in which such decisions are made. It is shown that in Ankara this context includes economic liberalisation policy, declining average real wages and housing costs rising faster than inflation. The scene is set for an examination of the relative value of the household adjustment model and a 'forced mobility' model in which households are strongly constrained by land and housing market actors. The analyses of the survey distinguishes four types of area (high, medium and low income authorised and unauthorised) and two types of tenure category (owners and tenants). Unlike most of the few previous residential mobility studies in third world cities our sample covers the whole population rather than migrants only. Path models and logit models are developed of past residential mobility, planned residential mobility and housing satisfaction. It is shown that owner-occupiers are highly immobile compared with tenants. These analyses reveal that the household adjustment model has only limited value in explaining residential mobility. It is relevant in the high income areas and t osome extent in the middle income areas but has only limited relevance in the low income area types. The models of satisfaction are used to show that residential mobility in low income areas does not lead to greater housing satisfaction, or to better housing as measured by an objective index. Further support for the applicability of the forced mobility model was provided by qualitative follow-up interviews with tenants who had moved. These revealed the importance of landlords pressures on their housing decisions. An exception to the above statements concerns owner-occupiers in unauthorised areas who are relatively happy with their situation, possibly due to the speculative potential of land in many such areas. It is therefore concluded that the household adjustment model cannot be applied as a general model of residential mobility in Ankara. Rather, the further one moves from the high-income type of area to the low-income and unauthorised type of area, the greater the relevance of the forced mobility model. It is thus argued that the main difference between third world cities and advanced capitalist cities affecting the character of residential mobility lies in the contexts within which mobility decisions are made rather than in households' housing needs

The influence of the accessory genome on bacterial pathogen evolution

Bacterial pathogens exhibit significant variation in their genomic content of virulence factors. This reflects the abundance of strategies pathogens evolved to infect host organisms by suppressing host immunity. Molecular arms-races have been a strong driving force for the evolution of pathogenicity, with pathogens often encoding overlapping or redundant functions, such as type III protein secretion effectors and hosts encoding ever more sophisticated immune systems. The pathogens’ frequent exposure to other microbes, either in their host or in the environment, provides opportunities for the acquisition or interchange of mobile genetic elements. These DNA elements accessorise the core genome and can play major roles in shaping genome structure and altering the complement of virulence factors. Here, we review the different mobile genetic elements focusing on the more recent discoveries and highlighting their role in shaping bacterial pathogen evolution

Unusual Ectopic Eruption of a Permanent Central Incisor Following an Intrusion Injury to the Primary Tooth

Intrusive luxation of primary teeth carries a high risk of damage to underlying permanent tooth germs. Ectopic eruption of permanent incisors is an unusual outcome of traumatic injury to their predecessors. In this case report, we describe the multidisciplinary management of the consequences of a primary tooth intrusion that led to severe ectopic eruption of the permanent left central incisor in a horizontal position at the level of the labial sulcus

Positive selection inhibits gene mobilization and transfer in soil bacterial communities

Horizontal gene transfer (HGT) between bacterial lineages is a fundamental evolutionary process that accelerates adaptation. Sequence analyses show that conjugative plasmids are principal agents of HGT in natural communities. However, we lack understanding of how the ecology of bacterial communities and their environments affect the dynamics of plasmid-mediated gene mobilization and transfer. Here we show, in simple experimental soil bacterial communities containing a conjugative mercury resistance plasmid, the repeated, independent mobilization of transposon-borne genes from chromosome to plasmid, plasmid to chromosome and, in the absence of mercury selection, interspecific gene transfers from the chromosome of one species to the other via the plasmid. By reducing conjugation, positive selection for plasmid-encoded traits, like mercury resistance, can consequently inhibit HGT. Our results suggest that interspecific plasmid-mediated gene mobilization is most likely to occur in environments where plasmids are infectious, parasitic elements rather than those where plasmids are positively selected, beneficial elements