Clindamycin adjunctive therapy for severe Staphylococcus aureus treatment evaluation (CASSETTE)—an open-labelled pilot randomized controlled trial

Background Combination antibiotic therapy with an antitoxin agent, such as clindamycin, is included in some guidelines for severe, toxin-mediated Staphylococcus aureus infections. The evidence to support this practice is currently limited to in vitro, animal and observational human case-series data, with no previous randomized controlled trials (RCTs). Objectives This pilot RCT aimed to determine the feasibility of conducting a clinical trial to examine if adjunctive clindamycin with standard therapy has greater efficacy than standard therapy alone for S. aureus infections. Methods We performed an investigator-initiated, open-label, multicentre, pilot RCT (ACTRN12617001416381p) in adults and children with severe S. aureus infections, randomized to standard antibiotic therapy with or without clindamycin for 7 days. Results Over 28 months, across nine sites, 127 individuals were screened and 34 randomized, including 11 children (32%). The primary outcome—number of days alive and free of systemic inflammatory response syndrome ≤14 days—was similar between groups: clindamycin (3 days [IQR 1–6]) versus standard therapy (4 days [IQR 0–8]). The 90 day mortality was 0% (0/17) in the clindamycin group versus 24% (4/17) in the standard therapy group. Secondary outcomes—microbiological relapse, treatment failure or diarrhoea—were similar between groups. Conclusions As the first clinical trial assessing adjunctive clindamycin for S. aureus infections, this study indicates feasibility and that adults and children can be incorporated into one trial using harmonized endpoints, and there were no safety concerns. The CASSETTE trial will inform the definitive S. aureus Network Adaptive Platform (SNAP) trial, which includes an adjunctive clindamycin domain and participants with non-severe disease

Clinical characteristics, etiology, and initial management strategy of newly diagnosed periprosthetic joint infection: A multicenter, prospective observational cohort study of 783 patients

Background Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections. Methods The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation. Results We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and 30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%). Conclusions In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials

Adsorption of Cd, Cu, Ni and Zn in tropical soils under competitive and non-competitive systems

The adsorption of heavy metals in soils affects their behavior in the environment and their bioavailability to plants. The knowledge of the adsorption mechanisms in competitive systems allows a more realistic evaluation of the metals' behavior in the soil than the single metal adsorption. The objectives of this study were (i) to evaluate Cd, Cu, Ni, and Zn adsorption in 14 surface samples (0-0.2 m) of representative soils of the Brazilian humid-tropical region, in competitive and non-competitive systems, and (ii) to establish metal affinity sequences for each soil, based in the maximum adsorption capacity (MAC) estimated by the Langmuir model. The Rhodic Eutrudox, the Kandiudalf Eutrudox, the Arenic Hapludalf, the Arenic Hapludult and the Typic Argiudoll had the highest metals' adsorption capacity, whereas the Typic Quartzipsamment and the sandy-textured Arenic Hapludult had the lowest values. In general, the MAC values for metals were lower in the competitive than in the non-competitive system. In the non-competitive system, the most common affinity sequence was Cu > Zn > Ni > Cd, whereas the most common sequence was Cu > Cd > Zn > Ni in the competitive system. In general, the Langmuir model fitted well the adsorption data of metals on the studied soils.A adsorção de metais pesados em solos afeta seu comportamento e biodisponibilidade às plantas. O conhecimento dos mecanismos de adsorção em sistemas competitivos permite uma avaliação mais realista do comportamento dos metais no solo do que estudos com adsorção de cada metal, isoladamente. Os objetivos desse trabalho foram: (i) avaliar a adsorção de Cd, Cu, Ni e Zn em amostras superficiais (0-0,2 m) de 14 solos representativos da região tropical úmida, em sistema competitivo e não-competitivo, e (ii) estabelecer sequências de afinidade metálica para cada solo, com base nos valores de capacidade máxima de adsorção (CMA) dos metais estimados por meio do modelo de Langmuir. O Rhodic Eutrudox, o Kandiudalfic Eutrudox, o Arenic Hapludalf (Alf2), o Arenic Hapludult (Ult2) e o Typic Argiudoll apresentaram elevadas capacidades de adsorção dos metais, ocorrendo o inverso para o Typic Quartzipsamment e para o Arenic Hapludult textura arenosa. No geral, a CMA dos metais aos solos foi menor no sistema competitivo. A sequência de afinidade mais comumente encontrada no sistema não-competitivo foi Cu > Zn > Ni > Cd. No sistema competitivo, a sequência foi Cu > Cd > Zn > Ni. Em geral, o modelo de Langmuir simulou de maneira satisfatória a adsorção dos metais nas amostras de solo

Magnetic Field Amplification in Galaxy Clusters and its Simulation

We review the present theoretical and numerical understanding of magnetic field amplification in cosmic large-scale structure, on length scales of galaxy clusters and beyond. Structure formation drives compression and turbulence, which amplify tiny magnetic seed fields to the microGauss values that are observed in the intracluster medium. This process is intimately connected to the properties of turbulence and the microphysics of the intra-cluster medium. Additional roles are played by merger induced shocks that sweep through the intra-cluster medium and motions induced by sloshing cool cores. The accurate simulation of magnetic field amplification in clusters still poses a serious challenge for simulations of cosmological structure formation. We review the current literature on cosmological simulations that include magnetic fields and outline theoretical as well as numerical challenges.Comment: 60 pages, 19 Figure

An integrated map of structural variation in 2,504 human genomes

Structural variants are implicated in numerous diseases and make up the majority of varying nucleotides among human genomes. Here we describe an integrated set of eight structural variant classes comprising both balanced and unbalanced variants, which we constructed using short-read DNA sequencing data and statistically phased onto haplotype blocks in 26 human populations. Analysing this set, we identify numerous gene-intersecting structural variants exhibiting population stratification and describe naturally occurring homozygous gene knockouts that suggest the dispensability of a variety of human genes. We demonstrate that structural variants are enriched on haplotypes identified by genome-wide association studies and exhibit enrichment for expression quantitative trait loci. Additionally, we uncover appreciable levels of structural variant complexity at different scales, including genic loci subject to clusters of repeated rearrangement and complex structural variants with multiple breakpoints likely to have formed through individual mutational events. Our catalogue will enhance future studies into structural variant demography, functional impact and disease association. © 2015 Macmillan Publishers Limited. All rights reserved

The European Solar Telescope

The European Solar Telescope (EST) is a project aimed at studying the magnetic connectivity of the solar atmosphere, from the deep photosphere to the upper chromosphere. Its design combines the knowledge and expertise gathered by the European solar physics community during the construction and operation of state-of-the-art solar telescopes operating in visible and near-infrared wavelengths: the Swedish 1m Solar Telescope, the German Vacuum Tower Telescope and GREGOR, the French Télescope Héliographique pour l'Étude du Magnétisme et des Instabilités Solaires, and the Dutch Open Telescope. With its 4.2 m primary mirror and an open configuration, EST will become the most powerful European ground-based facility to study the Sun in the coming decades in the visible and near-infrared bands. EST uses the most innovative technological advances: the first adaptive secondary mirror ever used in a solar telescope, a complex multi-conjugate adaptive optics with deformable mirrors that form part of the optical design in a natural way, a polarimetrically compensated telescope design that eliminates the complex temporal variation and wavelength dependence of the telescope Mueller matrix, and an instrument suite containing several (etalon-based) tunable imaging spectropolarimeters and several integral field unit spectropolarimeters. This publication summarises some fundamental science questions that can be addressed with the telescope, together with a complete description of its major subsystems

Otimização da análise da atividade da redutase do nitrato e sua caracterização em folhas de cana-de-açúcar

O objetivo deste trabalho foi padronizar e caracterizar as condições para determinação da atividade da redutase do nitrato em tecido foliar de cana-de-açúcar, com uso do método in vivo. Amostras foliares foram coletadas de uma lavoura de primeira soqueira da cultivar IACSP 933046, com idade de seis meses. Foram estudadas diferentes condições de preparo das amostras foliares e do meio de incubação. O material que possibilitou a maior atividade da redutase do nitrato foi obtido pela amostragem de 25 discos de 1 cm de diâmetro, coletados às 13h, do centro da folha do tipo +1 sem nervura. O meio de incubação otimizado para a determinação da atividade dessa enzima em folhas de cana-de-açúcar deve ser composto por: 2,5 mL de KNO3 300 mmol L-1; 2,5 mL de tampão fosfato 285 mmol L-1 pH 7,3; 1,0 mL de Tween 20 a 0,6% (v/v); e 4,0 mL de água deionizada. A maior atividade da redutase do nitrato é obtida pela incubação das amostras por 90 min, a 32ºC, no escuro; é observada em plantas jovens formadas pela brotação da soqueira; e alcança o valor mínimo na fase de maturação das plantas