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

Hijacking ZIP codes: posttanscriptional regulation of CCN2 by nucleophosmin

CCN2 (connective tissue growth factor [CTGF]/hypertrophic chondrocyte-specific gene product 24 [Hcs24]) is regulated at the transcriptional and posttranscriptional level. For example, an element in the its 3′ untranslated region (3′-UTR) of the CCN2 mRNA controls message stability in chondrocytes. In a recent study, Mukudai et al. (Mol Cell Biol 28:6134-6147, 2008) purified and identified a trans-factor protein binding to the minimal repressive cis element in the 3′-UTR of ccn2 mRNA and identify this protein as the multifunctional nucleolar phosphoprotein nucleophosmin (NPM) This commentary summarizes these observations

Using virtual experiences of older age: exploring pedagogical and psychological experiences of students

Fostering intergenerational empathy is vital for creating an age-friendly society and an important aim for Sport and Exercise Science (SES) degree programmes given that graduates are increasingly entering the healthcare workforce supporting older adults (British Association of Sport and Exercise Sciences; BASES, 2018). Interventions to challenge negative stereotypes of ageing, generate empathy for older adults, and help University students gain experience of ‘being’ an older person have demonstrated mixed success (e.g., Prior & Sargent-Cox, 2014). Recent studies indicate the promise of virtual reality in this context but do not present conclusive evidence for this effect (e.g., Banakou, Kishore, & Slater, 2018). Thus this study explored SES students’ responses to virtual experiences of being an older person in a workshop. Participants completed the “Become Victor” module of the FrailtySIM© application, based on real life experience of an older person in their home, and, a University-developed immersive experience of being an older person in a social situation. Fifty-two students completed questionnaires about their experience of “Become Victor” and 15 students were interviewed (12 in 2 focus groups, 3 individually) about their experiences of both simulations. Data indicated that “Become Victor” offered students insight into being an older person that was “eye-opening” and realistic but frustrating and stressful. The social situation effectively simulated the isolation felt by some older people to an extent, but needed to be more interactive. Students felt that the simulations were important for contextualising previously delivered lecture material on older adults. Future workshop iterations will integrate lecture and virtual experiences using opportunities for student reflection on their experiences

Dynamic moisture loss explored through quantitative super-resolution microscopy, spatial micro-viscosity and macroscopic analyses in acid milk gels

Molecular interactions and dynamic changes at a range of length scales affect the structuring of food materials, as such it is essential to explore structure at a range of different length scales. Herein, four acid milk gel samples are produced from either fresh or reconstituted skim milk that either had no heat treatment or had undergone heat treatment at 85 °C for 10 min. Milk acid gels demonstrate complex structure on a range of length scales of interest in colloidal materials and exhibit different macroscopic and water binding properties. A method is presented to measure the dynamic moisture loss in these samples, without applying external force. Super-resolution microscopy images are quantitatively analysed to describe the gel microstructure with precise features. Fluorescent Lifetime Imaging Microscopy is used to spatially resolve differences in molecular confinement across the sample's microstructure, which is quantified for each sample. Moisture loss and microstructural analyses are correlated to bulk and macroscopic properties determined through rheological and texture analysis, pH and conductivity measurements. More severe thermal and processing treatments leads to a reduction in moisture loss over time. Differences in moisture loss and mechanical properties relate to different thermal processing histories, but are not fully explained by levels of denatured whey proteins, and appear related to changes in mineral balance. The methods presented provide a comprehensive and complementary overview of material properties across relevant length scales and relevant sample conditions

SCA8 CAG/CTG Expansions, a Tale of Two TOXICities: A Unique or Common Case?

International audienc

Macrocyclic colibactin induces DNA double-strand breaks via copper-mediated oxidative cleavage.

Colibactin is an assumed human gut bacterial genotoxin, whose biosynthesis is linked to the clb genomic island that has a widespread distribution in pathogenic and commensal human enterobacteria. Colibactin-producing gut microbes promote colon tumour formation and enhance the progression of colorectal cancer via cellular senescence and death induced by DNA double-strand breaks (DSBs); however, the chemical basis that contributes to the pathogenesis at the molecular level has not been fully characterized. Here, we report the discovery of colibactin-645, a macrocyclic colibactin metabolite that recapitulates the previously assumed genotoxicity and cytotoxicity. Colibactin-645 shows strong DNA DSB activity in vitro and in human cell cultures via a unique copper-mediated oxidative mechanism. We also delineate a complete biosynthetic model for colibactin-645, which highlights a unique fate of the aminomalonate-building monomer in forming the C-terminal 5-hydroxy-4-oxazolecarboxylic acid moiety through the activities of both the polyketide synthase ClbO and the amidase ClbL. This work thus provides a molecular basis for colibactin's DNA DSB activity and facilitates further mechanistic study of colibactin-related colorectal cancer incidence and prevention