Evaluation of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Molecular Typing of Acinetobacter baumannii in Comparison with Orthogonal Methods

Colonization and subsequent health care-associated infection (HCAI) with Acinetobacter baumannii are a concern for vulnerable patient groups within the hospital setting. Outbreaks involving multidrug-resistant strains are associated with increased patient morbidity and mortality and poorer overall outcomes. Reliable molecular typing methods can help to trace transmission routes and manage outbreaks. In addition to methods deployed by reference laboratories, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) may assist by making initial in-house judgments on strain relatedness. However, limited studies on method reproducibility exist for this application. We applied MALDI-TOF MS typing to A. baumannii isolates associated with a nosocomial outbreak and evaluated different methods for data analysis. In addition, we compared MALDI-TOF MS with whole-genome sequencing (WGS) and Fourier transform infrared spectroscopy (FTIR) as orthogonal methods to further explore their resolution for bacterial strain typing. A related subgroup of isolates consistently clustered separately from the main outbreak group by all investigated methods. This finding, combined with epidemiological data from the outbreak, indicates that these methods identified a separate transmission event unrelated to the main outbreak. However, the MALDI-TOF MS upstream approach introduced measurement variability impacting method reproducibility and limiting its reliability as a standalone typing method. Availability of in-house typing methods with well-characterized sources of measurement uncertainty could assist with rapid and dependable confirmation (or denial) of suspected transmission events. This work highlights some of the steps to be improved before such tools can be fully integrated into routine diagnostic service workflows for strain typing. IMPORTANCE Managing the transmission of antimicrobial resistance necessitates reliable methods for tracking outbreaks. We compared the performance of MALDI-TOF MS with orthogonal approaches for strain typing, including WGS and FTIR, for Acinetobacter baumannii isolates correlated with a health care-associated infection (HCAI) event. Combined with epidemiological data, all methods investigated identified a group of isolates that were temporally and spatially linked to the outbreak, yet potentially attributed to a separate transmission event. This may have implications for guiding infection control strategies during an outbreak. However, the technical reproducibility of MALDI-TOF MS needs to be improved for it to be employed as a standalone typing method, as different stages of the experimental workflow introduced bias influencing interpretation of biomarker peak data. Availability of in-house methods for strain typing of bacteria could improve infection control practices following increased reports of outbreaks of antimicrobial-resistant organisms during the COVID-19 pandemic, related to sessional usage of personal protective equipment (PPE)

Overcoming challenges in designing and implementing a phase II randomized controlled trial using a presurgical model to test a dietary intervention in prostate cancer

BackgroundThe time between the diagnosis of cancer and a planned definitive surgical procedure offers a strong and direct approach for assessing the impact of interventions (including lifestyle interventions) on the biology of the target tissue and the tumor. Despite the many strengths of presurgical models, there are practical issues and challenges that arise when using this approach.Purpose/MethodsWe recently completed an NIH-funded phase II trial that utilized a presurgical model in testing the comparative effects of flaxseed supplementation and/or dietary fat restriction on the biology and biomarkers associated with prostatic carcinoma. Herein, we report the rationale for our original design, discuss modifications in strategy, and relay experiences in implementing this trial related to the following topics: (1) subject accrual; (2) subject retention; (3) intervention delivery; and (4) retrieval and completion rates regarding the collection of paraffin-embedded and fresh frozen prostate tissue, blood, urine, ejaculate, anthropometric measures and survey data.ResultsThis trial achieved its accrual target, i.e., a racially-representative (70% white, 30% minority) sample of 161 participants, low rates of attrition (7%); and collection rates that exceeded 90% for almost all biospecimens and survey data. While the experience gained from pilot studies was invaluable in designing this trial, the complexity introduced by the collection of several biospecimens, inclusion of a team of pathologists (to provide validated readings), and shifts in practice patterns related to prostatectomy, made it necessary to revise our protocol; lessons from our experiences are offered within this article.ConclusionsWhile our experience specifically relates to the implementation of a presurgical model-based trial in prostate cancer aimed at testing flaxseed-supplemented and fat-restricted diets, many of the lessons learned have broad application to trials that utilize a presurgical model or dietary modification within various cancer populations

Why are saccades influenced by the Brentano illusion?

In the Brentano version of the Müller-Lyer illusion one part looks longer and the other looks shorter than it really is. We asked participants to make saccadic eye movements along these parts of the figure and between positions on the figure and a position outside the illusion. By showing that saccades from outside the figure are not influenced by the illusion, we demonstrate that the reason that saccades along the figure are influenced is that the incorrectly judged length is used to plan the amplitude of the saccade. This finding contradicts several current views on the use of visual information for action. We conclude that actions are influenced by visual illusions, but that such influences are only apparent if the action is guided by the attribute that is fooled by the illusion. © 2006 Springer-Verlag

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Degradation and lifetime of self-healing thermal barrier coatings containing MoSi2 as self-healing particles in thermo-cycling testing

Yttria-stabilized zirconia (YSZ) is the state-of-the-art top coat material for thermal barrier coatings (TBCs) applied on highly loaded gas turbine parts. During operation at high temperatures, stresses are induced by the thermal expansion coefficient mismatch between the ceramic TBC and the metallic substrate. As a consequence cracks can grow, propagate and finally lead to a spallation of the top coat. Using atmospheric plasma spraying (APS), so-called self-healing MoSi2 particles can be incorporated into the YSZ matrix to mitigate the propagation of cracks leading to a lifetime gain and possibly higher temperature capability of the TBC. In the present work, the healing process is realized by the oxidation of the self-healing particles, which introduces a volume expansion by a formation of reaction products, which can seal the cracks. The self-healing particles were introduced within the first 150 μm of the YSZ coating matrix immediately on top of the bond coat. The degradation and lifetime of such systems were studied in furnace cycling and in burner rig tests, in which a temperature gradient through the sample was applied. The lifetime of the self-healing coatings was then compared to the lifetime of an YSZ coating without self-healing particles. In burner rig tests a clear lifetime extension of the self-healing TBCs was observed. The origin of this different behavior was investigated by microstructural analysis in scanning electron microscopy. A further insight into the failure mechanisms was gained by the analysis of a self-healing TBC cycled in a furnace cycling test only for about 55% of its expected lifetime

Efeito da exposição à fumaça do cigarro sobre parâmetros comportamentais e peroxidação lipídica em camundongos

O tabagismo é um dos principais fatores de risco para o desenvolvimento de várias doenças, dentre elas o câncer. Ao inalar a fumaça de cigarro, o organismo recebe, além da nicotina, capaz de promover alterações comportamentais, elevadas quantidades de substâncias reativas de oxigênio, capazes de promover o estresse oxidativo. Este trabalho examinou as alterações comportamentais em camundongos expostos à fumaça de cigarro em um padrão de exposição que simula a exposição humana em locais fechados, como bares e boates. Também foi avaliado o índice de peroxidação lipídica no fígado, cérebro e pulmão desses animais. Os resultados obtidos permitem verificar que ocorreu alteração comportamental no grupo de camundongos exposto à fumaça do cigarro, que se tornou mais ansioso e teve elevação da atividade exploratória. Essa modificação comportamental foi acompanhada de elevação do índice de peroxidação lipídica no cérebro desses animais. Conclui-se que a exposição de camundongos a fumaça do cigarro, mesmo por curto período de tempo, é capaz de produzir alterações comportamentais e induzir a degradação do tecido cerebral através da peroxidação lipídica, tornando-se um fator de risco para o desenvolvimento de câncer e de doenças degenerativas