Role of a single noncoding nucleotide in the evolution of an epidemic African clade of Salmonella

Salmonella enterica serovar Typhimurium ST313 is a relatively newly emerged sequence type that is causing a devastating epidemic of bloodstream infections across sub-Saharan Africa. Analysis of hundreds ofSalmonellagenomes has revealed that ST313 is closely related to the ST19 group ofSTyphimurium that cause gastroenteritis across the world. The core genomes of ST313 and ST19 vary by only ∼1,000 SNPs. We hypothesized that the phenotypic differences that distinguish AfricanSalmonellafrom ST19 are caused by certain SNPs that directly modulate the transcription of virulence genes. Here we identified 3,597 transcriptional start sites of the ST313 strain D23580, and searched for a gene-expression signature linked to pathogenesis ofSalmonellaWe identified a SNP in the promoter of thepgtEgene that caused high expression of the PgtE virulence factor in AfricanS.Typhimurium, increased the degradation of the factor B component of human complement, contributed to serum resistance, and modulated virulence in the chicken infection model. We propose that high levels of PgtE expression by AfricanSTyphimurium ST313 promote bacterial survival and dissemination during human infection. Our finding of a functional role for an extragenic SNP shows that approaches used to deduce the evolution of virulence in bacterial pathogens should include a focus on noncoding regions of the genome

Scapular winging: anatomical review, diagnosis, and treatments

Scapular winging is a rare debilitating condition that leads to limited functional activity of the upper extremity. It is the result of numerous causes, including traumatic, iatrogenic, and idiopathic processes that most often result in nerve injury and paralysis of either the serratus anterior, trapezius, or rhomboid muscles. Diagnosis is easily made upon visible inspection of the scapula, with serratus anterior paralysis resulting in medial winging of the scapula. This is in contrast to the lateral winging generated by trapezius and rhomboid paralysis. Most cases of serratus anterior paralysis spontaneously resolve within 24 months, while conservative treatment of trapezius paralysis is less effective. A conservative course of treatment is usually followed for rhomboid paralysis. To allow time for spontaneous recovery, a 6–24 month course of conservative treatment is often recommended, after which if there is no recovery, patients become candidates for corrective surgery

Probing photoinduced rearrangements in the NdNiO3 magnetic spiral with polarization-sensitive ultrafast resonant soft x-ray scattering

We use resonant soft x-ray diffraction to track the photoinduced dynamics of the antiferromagnetic structure in a NdNiO3 thin film. Femtosecond laser pulses with a photon energy of 0.61 eV, resonant with electron transfer between long-bond and short-bond nickel sites, are used to excite the material and drive an ultrafast insulator-metal transition. Polarization-sensitive soft x-ray diffraction, resonant to the nickel L3 edge, then probes the evolution of the underlying magnetic spiral as a function of time delay with 80 ps time resolution. By modeling the azimuthal dependence of the scattered intensity for different linear x-ray polarizations, we benchmark the changes of the local magnetic moments and the spin alignment. The measured changes are consistent with a reduction of the long-bond site magnetic moments and an alignment of the spins towards a more collinear structure at early time delays

Cost-Effectiveness Analysis of Breast Reconstruction Options in the Setting of Postmastectomy Radiotherapy Using the BREAST-Q.

BACKGROUND: A consensus is lacking on a uniform reconstructive algorithm for patients with locally advanced breast cancer who require postmastectomy radiotherapy. Both delayed autologous and immediate prosthetic techniques have inherent advantages and complications. The study hypothesis is that implants are more cost effective than autologous reconstruction in the setting of postmastectomy radiotherapy because of immediate restoration of the breast mound. METHODS: A cost-effectiveness analysis model using the payer perspective was created comparing delayed autologous and immediate prosthetic techniques against the do-nothing option of mastectomy without reconstruction. Costs were obtained from the 2010 Nationwide Inpatient Sample database. Effectiveness was determined using the BREAST-Q patient-reported outcome measure. A breast quality-adjusted life-year value was considered 1 year of perfect breast health-related quality of life. The incremental cost-effectiveness ratio was calculated for both treatments compared with the do-nothing option. RESULTS: BREAST-Q scores were obtained from patients who underwent immediate prosthetic reconstruction (n = 196), delayed autologous reconstruction (n = 76), and mastectomy alone (n = 71). The incremental cost-effectiveness ratios for immediate prosthetic and delayed autologous reconstruction compared with mastectomy alone were $57,906 and$102,509, respectively. Sensitivity analysis showed that the incremental cost-effectiveness ratio for both treatment options decreased with increasing life expectancy. CONCLUSIONS: For patients with advanced breast cancer who require postmastectomy radiotherapy, immediate prosthetic-based breast reconstruction is a cost-effective approach. Despite high complication rates, implant use can be rationalized based on low cost and health-related quality-of-life benefit derived from early breast mound restoration. If greater life expectancy is anticipated, autologous transfer is cost effective as well and may be a superior option

The Impact of Travel Distance on Breast Reconstruction in the United States.

BACKGROUND: Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women\u27s Health and Cancer Rights Act. It remains unclear whether all patients interested in breast reconstruction undergo this procedure. The aim of this study was to determine whether geographic disparities are present that limit the rate and method of postmastectomy reconstruction. METHODS: Travel distance in miles between the patient\u27s residence and the hospital reporting the case was used as a quantitative measure of geographic disparities. The American College of Surgeons National Cancer Database was queried for mastectomy with or without reconstruction performed from 1998 to 2011. Reconstructive procedures were categorized as implant or autologous techniques. Standard statistical tests including linear regression were performed. RESULTS: Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (p \u3c 0.01). A linear correlation was demonstrated between travel distance and reconstruction rates (p \u3c 0.01). The mean distances traveled by patients who underwent reconstruction at community, comprehensive community, or academic programs were 10.3, 19.9, and 26.2 miles, respectively (p \u3c 0.01). Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction. CONCLUSIONS: Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States, the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates, but are located farther from patients\u27 residences. Increasing the number of plastics surgeons, especially in community centers, would be one method of addressing this inequality

The effects of carbohydrate loading on repetitive jump squat power performance

The beneficial role of carbohydrate (CHO) supplementation in endurance exercise is well documented. However, only few data are available on the effects of CHO loading on resistance exercise performance. Because of the repetitive use of high-threshold motor units, it was hypothesized that the power output (power-endurance) of multiple sets of jump squats would be enhanced following a high-CHO (6.5 g CHO kg body mass) diet compared to a moderate-CHO (4.4 g CHO kg body mass) diet. Eight healthy men (mean ± SD: age 26.3 ± 2.6 years; weight 73.0 ± 6.3 kg; body fat 13.4 ± 5.0%; height 178.2 ± 6.1 cm) participated in 2 randomly assigned counterbalanced supplementation periods of 4 days after having their free-living habitual diet monitored. The resistance exercise test consisted of 4 sets of 12 repetitions of maximal-effort jump squats using a Plyometric Power System unit and a load of 30% of 1 repetition maximum (1RM). A 2-minute rest period was used between sets. Immediately before and after the exercise test, a blood sample was obtained to determine the serum glucose and blood lactate concentrations. No significant difference in power performance existed between the 2 diets. As expected, there was a significant (p ≤ 0.05) decrease in power performance between the repetitions in every set. Blood lactate concentrations were significantly higher postexercise with both the high-CHO and the moderate- or lower-CHO diet, but there were no differences between conditions. The results indicated that the power output during multiple sets of maximal jump squats was not enhanced following a higher-CHO diet compared to a moderate- or lower-CHO diet. These data show that elevated carbohydrate intake is not needed to optimize a repetitive power-endurance performance when it is done as the first exercise in a workout