Epidemiologic characteristics of Klebsiella pneumoniae isolates in ventilator-associated pneumonia in intensive care units

Klebsiella pneumoniae is a common pathogen that causes ventilator associated pneumonia (VAP) in intensive care units (ICUs). Strain typing is a useful tool in tracking the spread of these infections. Primary objective was to study different strains causing VAP in Anesthesia ICUs. Secondary objective was to determine role of health-care workers (HCWs) and ICU environment in the transmission of these strains. Endotracheal aspirates of 60 VAP patients, surveillance samples from the HCWs (18 )and the ICU environment (193)were collected. Antibiogram typing and enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) were used for comparison of the isolates from VAP patients and surveillance samples. Antibiogram showed 5 antibiotic susceptibility patterns that were designated A1-A5. ERIC-PCR yielded 1 to 5 amplification bands. All the isolates were typable by ERIC-PCR. Eight ERIC patterns were obtained ERIC(I)-ERIC(VIII). ERIC-PCR typing method gave higher discriminatory index (D) (0.7557) than antibiogram (0.6035). There was sharing of certain ERIC patterns among patient and HCWs or environmental sources. In Conclusion: K.pneumoniae is the most dominant pathogen in anesthesia ICUs. Throats and hands of HCWs are possible sources of pathogen transmission to patients. Surfaces with hand contact of the medical staff are often contaminated and may serve as vectors for cross transmission.Keywords: Ventilator-associated pneumonia, ICU environment, health-care workers, Klebsiella pneumoniae, antibiogram typing, ERIC-PC

The TAL1 complex targets the FBXW7 tumor suppressor by activating miR-223 in human T cell acute lymphoblastic leukemia

The oncogenic transcription factor TAL1/SCL is aberrantly expressed in 60% of cases of human T cell acute lymphoblastic leukemia (T-ALL) and initiates T-ALL in mouse models. By performing global microRNA (miRNA) expression profiling after depletion of TAL1, together with genome-wide analysis of TAL1 occupancy by chromatin immunoprecipitation coupled to massively parallel DNA sequencing, we identified the miRNA genes directly controlled by TAL1 and its regulatory partners HEB, E2A, LMO1/2, GATA3, and RUNX1. The most dynamically regulated miRNA was miR-223, which is bound at its promoter and up-regulated by the TAL1 complex. miR-223 expression mirrors TAL1 levels during thymic development, with high expression in early thymocytes and marked down-regulation after the double-negative-2 stage of maturation. We demonstrate that aberrant miR-223 up-regulation by TAL1 is important for optimal growth of TAL1-positive T-ALL cells and that sustained expression of miR-223 partially rescues T-ALL cells after TAL1 knockdown. Overexpression of miR-223 also leads to marked down-regulation of FBXW7 protein expression, whereas knockdown of TAL1 leads to up-regulation of FBXW7 protein levels, with a marked reduction of its substrates MYC, MYB, NOTCH1, and CYCLIN E. We conclude that TAL1-mediated up-regulation of miR-223 promotes the malignant phenotype in T-ALL through repression of the FBXW7 tumor suppressor

The TAL1 complex targets the FBXW7 tumor suppressor by activating miR-223 in human T cell acute lymphoblastic leukemia

The oncogenic transcription factor TAL1/SCL is aberrantly expressed in 60% of cases of human T cell acute lymphoblastic leukemia (T-ALL) and initiates T-ALL in mouse models. By performing global microRNA (miRNA) expression profiling after depletion of TAL1, together with genome-wide analysis of TAL1 occupancy by chromatin immunoprecipitation coupled to massively parallel DNA sequencing, we identified the miRNA genes directly controlled by TAL1 and its regulatory partners HEB, E2A, LMO1/2, GATA3, and RUNX1. The most dynamically regulated miRNA was miR-223, which is bound at its promoter and up-regulated by the TAL1 complex. miR-223 expression mirrors TAL1 levels during thymic development, with high expression in early thymocytes and marked down-regulation after the double-negative-2 stage of maturation. We demonstrate that aberrant miR-223 up-regulation by TAL1 is important for optimal growth of TAL1-positive T-ALL cells and that sustained expression of miR-223 partially rescues T-ALL cells after TAL1 knockdown. Overexpression of miR-223 also leads to marked down-regulation of FBXW7 protein expression, whereas knockdown of TAL1 leads to up-regulation of FBXW7 protein levels, with a marked reduction of its substrates MYC, MYB, NOTCH1, and CYCLIN E. We conclude that TAL1-mediated up-regulation of miR-223 promotes the malignant phenotype in T-ALL through repression of the FBXW7 tumor suppressor.National Cancer Institute (U.S.) (5P01CA109901)National Cancer Institute (U.S.) (5P01CA68484)National Cancer Institute (U.S.) (1K99CA157951)National Institutes of Health (U.S.). Intramural Research ProgramCenter for Cancer Research (National Cancer Institute (U.S.)

PURA syndrome : clinical delineation and genotype-phenotype study in 32 individuals with review of published literature

Background De novo mutations in PURA have recently been described to cause PURA syndrome, a neurodevelopmental disorder characterised by severe intellectual disability (ID), epilepsy, feeding difficulties and neonatal hypotonia. Objectives T o delineate the clinical spectrum of PURA syndrome and study genotype-phenotype correlations. Methods Diagnostic or research-based exome or Sanger sequencing was performed in individuals with ID. We systematically collected clinical and mutation data on newly ascertained PURA syndrome individuals, evaluated data of previously reported individuals and performed a computational analysis of photographs. We classified mutations based on predicted effect using 3D in silico models of crystal structures of Drosophila-derived Pur-alpha homologues. Finally, we explored genotypephenotype correlations by analysis of both recurrent mutations as well as mutation classes. Results We report mutations in PURA (purine-rich element binding protein A) in 32 individuals, the largest cohort described so far. Evaluation of clinical data, including 22 previously published cases, revealed that all have moderate to severe ID and neonatal-onset symptoms, including hypotonia (96%), respiratory problems (57%), feeding difficulties (77%), exaggerated startle response (44%), hypersomnolence (66%) and hypothermia (35%). Epilepsy (54%) and gastrointestinal (69%), ophthalmological (51%) and endocrine problems (42%) were observed frequently. Computational analysis of facial photographs showed subtle facial dysmorphism. No strong genotype-phenotype correlation was identified by subgrouping mutations into functional classes. Conclusion We delineate the clinical spectrum of PURA syndrome with the identification of 32 additional individuals. The identification of one individual through targeted Sanger sequencing points towards the clinical recognisability of the syndrome. Genotype-phenotype analysis showed no significant correlation between mutation classes and disease severity.Peer reviewe

A parametric study on the dynamic response of planar multibody systems with multiple clearance joints

A general methodology for dynamic modeling and analysis of multibody systems with multiple clearance joints is presented and discussed in this paper. The joint components that constitute a real joint are modeled as colliding bodies, being their behavior influenced by geometric and physical properties of the contacting surfaces. A continuous contact force model, based on the elastic Hertz theory together with a dissipative term, is used to evaluate the intra-joint contact forces. Furthermore, the incorporation of the friction phenomenon, based on the classical Coulomb’s friction law, is also discussed. The suitable contact-impact force models are embedded into the dynamics of multibody systems methodologies. An elementary mechanical system is used to demonstrate the accuracy and efficiency of the presented approach, and to discuss the main assumptions and procedures adopted. Different test scenarios are considered with the purpose of performing a parametric study for quantifying the influence of the clearance size, input crank speed and number of clearance joints on the dynamic response of multibody systems with multiple clearance joints. Additionally, the total computation time consumed in each simulation is evaluated in order to test the computational accuracy and efficiency of the presented approach. From the main results obtained in this study, it can be drawn that clearance size and the operating conditions play a crucial role in predicting accurately the dynamic responses of multibody systems.Fundação para a Ciência e a Tecnologia (FCT

Descriptors of Posidonia oceanica meadows: Use and application

The conservation of the coastal marine environment requires the possession of information that enables the global quality of the environment to be evaluated reliably and relatively quickly. The use of biological indicators is often an appropriate method. Seagrasses in general, and Posidonia oceanica meadows in particular, are considered to be appropriate for biomonitoring because of their wide distribution, reasonable size, sedentary habit, easy collection and abundance and sensitivity to modifications of littoral zone. Reasoned management, on the scale of the whole Mediterranean basin, requires standardized methods of study, to be applied by both researchers and administrators, enabling comparable results to be obtained. This paper synthesises the existing methods applied to monitor P. oceanica meadows, identifies the most suitable techniques and suggests future research directions. From the results of a questionnaire, distributed to all the identified laboratories working on this topic, a list of the most commonly used descriptors was drawn up, together with the related research techniques (e.g. standardization, interest and limits, valuation of the results). It seems that the techniques used to study meadows are rather similar, but rarely identical, even though the various teams often refer to previously published works. This paper shows the interest of a practical guide that describes, in a standardized way, the most useful techniques enabling P. oceanica meadows to be used as an environmental descriptor. Indeed, it constitutes the first stage in the process. (c) 2005 Elsevier Ltd. All rights reserved.Peer reviewe

Global impact of COVID-19 on stroke care and IV thrombolysis

Objective To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. Methods We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months.Paroxysmal Cerebral Disorder

Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018

Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations.Peer reviewe

Measurement of the View the tt production cross-section using eμ events with b-tagged jets in pp collisions at √s = 13 TeV with the ATLAS detector

This paper describes a measurement of the inclusive top quark pair production cross-section (σtt¯) with a data sample of 3.2 fb−1 of proton–proton collisions at a centre-of-mass energy of √s = 13 TeV, collected in 2015 by the ATLAS detector at the LHC. This measurement uses events with an opposite-charge electron–muon pair in the final state. Jets containing b-quarks are tagged using an algorithm based on track impact parameters and reconstructed secondary vertices. The numbers of events with exactly one and exactly two b-tagged jets are counted and used to determine simultaneously σtt¯ and the efficiency to reconstruct and b-tag a jet from a top quark decay, thereby minimising the associated systematic uncertainties. The cross-section is measured to be: σtt¯ = 818 ± 8 (stat) ± 27 (syst) ± 19 (lumi) ± 12 (beam) pb, where the four uncertainties arise from data statistics, experimental and theoretical systematic effects, the integrated luminosity and the LHC beam energy, giving a total relative uncertainty of 4.4%. The result is consistent with theoretical QCD calculations at next-to-next-to-leading order. A fiducial measurement corresponding to the experimental acceptance of the leptons is also presented