A Rare Case of Rectal Metastasis from Sarcomatoid Variant of Urothelial Carcinoma: A Case Report

Introduction: Urothelial carcinoma of the bladder with sarcomatoid differentiation is known to display aggressive biological behaviour. To our knowledge, this is the first reported case of isolated rectal metastasis from sarcomatoid urothelial carcinoma of the bladder following curative surgery.Presentation of Case: A 72-year-old male presented with tenesmus 6 months after radical cystoprostatectomy, lymph node dissection and ileal conduit formation for pathological T1N0M0 bladder carcinoma.Digital rectal examination revealed thickening of the distal rectum with no bleeding. Computerised tomography demonstrated thickening in the rectal mucosa and submucosa with intact perirectal fat. Rectal biopsy performed via colonoscopy confirmed metastases of urothelial carcinoma origin. The patient was treated with palliative radiation.Conclusion: This case report illustrates an unusual location of urothelial carcinoma metastasis. A high clinical suspicion in patients with this aggressive variant of cancer is required

The genetic structure of Aedes aegypti populations is driven by boat traffic in the Peruvian Amazon.

In the Americas, as in much of the rest of the world, the dengue virus vector Aedes aegypti is found in close association with human habitations, often leading to high population densities of mosquitoes in urban settings. In the Peruvian Amazon, this vector has been expanding to rural communities over the last 10-15 years, but to date, the population genetic structure of Ae. aegypti in this region has not been characterized. To investigate the relationship between Ae. aegypti gene flow and human transportation networks, we characterized mosquito population structure using a panel of 8 microsatellite markers and linked results to various potential mechanisms for long-distance dispersal. Adult and immature Ae. aegypti (>20 individuals per site) were collected from Iquitos city and from six neighboring riverine communities, i.e., Nauta, Indiana, Mazan, Barrio Florida, Tamshiaco, and Aucayo. FST statistics indicate significant, but low to moderate differentiation for the majority of study site pairs. Population structure of Ae. aegypti is not correlated with the geographic distance between towns, suggesting that human transportation networks provide a reasonable explanation for the high levels of population mixing. Our results indicate that Ae. aegypti gene flow among sub-populations is greatest between locations with heavy boat traffic, such as Iquitos-Tamshiaco and Iquitos-Indiana-Mazan, and lowest between locations with little or no boat/road traffic between them such as Barrio Florida-Iquitos. Bayesian clustering analysis showed ancestral admixture among three genetic clusters; no single cluster was exclusive to any site. Our results are consistent with the hypothesis that human transportation networks, particularly riverways, are responsible for the geographic spread of Ae. aegypti in the Peruvian Amazon. Our findings are applicable to other regions of the world characterized by networks of urban islands connected by fluvial transport routes

Targeting Sedentary Behavior in Minority Populations as a Feasible Health Strategy during and beyond COVID-19: On Behalf of ACSM-EIM and HL-PIVOT

Increased sedentary behavior has been an unintended consequence of social and physical distancing restrictions needed to limit transmission of SARS-CoV-2, the novel coronavirus that causes COVID-19. Sedentary behavior is defined as any waking behavior characterized by an energy expenditure ≤1.5 METs while in a sitting, reclining, or lying posture. These restrictions negatively affect peoples’ cardiometabolic and mental health and disproportionately affect certain sectors of the population, including racial/ethnic minorities. In part, the higher risk for complications of COVID-19 could be the result of an increased prevalence of comorbid diseases. Further, regular participation and adherence to current physical activity guidelines, defined as at least 150 min·wk−1 of moderate-intensity physical activity or muscle strengthening activities on 2 or more days a week, is challenging for many and may be especially difficult to achieve during the COVID-19 pandemic. A practical strategy to promote health and well-being during COVID-19 is reducing sedentary behavior. Reducing sedentary behaviors (e.g., breaking up periods of prolonged sitting with light-intensity physical activity) may be more easily achieved than physical activity for all individuals, including individuals of racial/ethnic decent, as it does not require purchasing equipment nor require compromising the physical restrictions necessary to slow the spread of COVID-19. The purpose of this commentary is to argue that sedentary behavior is a feasible, independent target to modify during COVID-19, particularly in minority populations, and to address this behavior we need to consider individual, environmental, and policy-level factors.N/

Large-Scale Sidereal Anisotropy of Galactic Cosmic-Ray Intensity Observed by the Tibet Air Shower Array

We present the large-scale sidereal anisotropy ofgalactic cosmic-ray intensity in the multi-TeV region observed with the Tibet-IIIair shower array during the period from 1999 through 2003. The sidereal daily variation of cosmic rays observed in this experiment shows an excess of relative intensity around $4\sim7$ hours local sidereal time, as well as a deficit around 12 hours local sidereal time. While the amplitude of the excess is not significant when averaged over all declinations, the excess in individual declinaton bands becomes larger and clearer as the viewing direction moves toward the south. The maximum phase of the excess intensity changes from $\sim$7 at the northern hemisphere to $\sim$4 hours at the equatorial region. We also show that both the amplitude and the phase of the first harmonic vector of the daily variation are remarkably independent of primary energy in the multi-TeV region. This is the first result determining the energy and declination dependences of the full 24-hour profiles of the sidereal daily variation in the multi-TeV region with a single air shower experiment.Comment: 13 pages, 3 figures, 1 table. Accepted for publication in ApJ

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

How does building background knowledge influence struggling readers motivation at the secondary level

The research question addressed in this capstone was how does building background knowledge influence struggling readers motivation at the secondary level? This question came to light as a result of the lack of background knowledge and motivation students who had been identified as struggling readers possessed in relation to the Civil Rights Movement. This capstone reviews the research on struggling readers in the classroom, the importance of building background knowledge, and the significance of motivation for struggling readers. This capstone question led to a study in which struggling readers were provided a weeklong opportunity to research different genres of text, through the use of a text set on the topic of the Civil Rights Movement. The findings of this study determined that once students possessed the necessary background knowledge on the topic, they were more motivated for the unit that followed

Full Septin Alignment

Alignment of whole septin protein sequences from included species

Alicut processed septin alignment

Septin alignment after processing with Alicut using window size of 1