p39R861-4, a type 2 A/C2 plasmid carrying a segment from the A/C1 RA1

The largest plasmid in the strain 39R861, which is used as a plasmid size standard, was recovered by conjugation and sequenced to determine its exact size. Plasmid p39R861-4 transferred at high frequency. Though reported to be the A/C1 plasmid RA1, p39R861-4 is a 155794 bp Type 2 A/C2 plasmid in which a 39 kb segment derived from RA1 that includes a relative of the RA1 resistance island replaces 26.5 kb of the Type 2 backbone. p39R861-4 includes a single copy of IS10 and two resistance islands with a CR2-sul2 region in each of them. The 84 kb of backbone between the resistance islands is inverted relative to other known A/C plasmids and this inversion has arisen via recombination between the CR2-sul2 regions that are inversely oriented. The resistance islands prior to inversion were one related to but longer than that found in RA1, and a form of the ARI-B island identical to one found in the A/C2 plasmid R55. They contain genes conferring resistance to tetracycline (tetA(D)), sulphonamides (sul2) and florfenicol and chloramphenicol (floR). The tet(D) determinant is flanked by two IS26 in a transposon-like structure named Tntet(D). Both resistance islands contain remnants of the two ends of the integrative element GIsul2, consistent with the sul2 gene being mobilized by GIsul2 rather than by CR2

Mediastinal abscess after endobronchial ultrasound with transbronchial needle aspiration: a case report

Endobronchial ultrasound (EBUS) with transbronchial needle aspiration is now becoming widely accepted as a preferred staging technique. It has been perceived as a non-invasive and well tolerated procedure with minimal complications. We report the development and treatment of a severe complication that developed 2 weeks after the initial procedure in the form of a complex mediastinal abscess. EBUS although useful in its non-invasive application for diagnosing mediastinal or hilar disease, must be regarded with caution since the potential exists to develop severe complications

Genomic landscape of lung adenocarcinoma in East Asians

Lung cancer is the world’s leading cause of cancer death and shows strong ancestry disparities. By sequencing and assembling a large genomic and transcriptomic dataset of lung adenocarcinoma (LUAD) in individuals of East Asian ancestry (EAS; n = 305), we found that East Asian LUADs had more stable genomes characterized by fewer mutations and fewer copy number alterations than LUADs from individuals of European ancestry. This difference is much stronger in smokers as compared to nonsmokers. Transcriptomic clustering identified a new EAS-specific LUAD subgroup with a less complex genomic profile and upregulated immune-related genes, allowing the possibility of immunotherapy-based approaches. Integrative analysis across clinical and molecular features showed the importance of molecular phenotypes in patient prognostic stratification. EAS LUADs had better prediction accuracy than those of European ancestry, potentially due to their less complex genomic architecture. This study elucidated a comprehensive genomic landscape of EAS LUADs and highlighted important ancestry differences between the two cohorts

P288 The Desensitisation Effect Of Graphic Health Warning Labels And Cross-cultural Differences In The Awareness Of Smoking Related Consequences: Comparing A London And Singapore Cohort

Introduction and objectives Graphic Health Warning Labels (GHWL) assist in primary and secondary smoking prevention. A lack of evidence exists regarding their desensitisation with increased exposure. Investigating knowledge and attitudes around GHWL may allow better implementation of future public health policies. Singapore introduced GHWL in 2004, five years before they were introduced in the UK; this study aims to investigate any potential desensitisation effect by direct comparison. Methods Data were collected from 266 smokers and non-smokers, 163 from London (54.6% smokers, 54.0% male, mean age 52.4 (17.8)) and 103 from Singapore (47.6% smokers, 77.7% male, mean age 57.7 (14.5)) between 2011 and 2013. A structured interview with fifty items, showing ten different GHWL, recorded demographics, smoking history, plans to quit and knowledge about the health-related consequences of smoking, as well as the emotional response, processing and impact of GHWL on behaviour. Participants further ranked hypothetical conditions that they could develop in terms of prevention and treatment. Results The London cohort experienced significantly higher levels of ‘disgust’ when viewing GHWL than their Singapore counterparts (smokers 74.1% vs 49.0%, p = 0.003; non-smokers 83.8% vs 57.4%, p < 0.001), and felt GHWLs were a sufficient deterrent (smokers 33.7% vs 16.3%, p = 0.029; non-smokers 71.6% vs 50.0%, p = 0.013). London non-smokers had a higher awareness of heart disease (82.4% vs 32.0%, p = 0.007), stroke (72.3% vs 28.2%, p = 0.02), mouth and throat cancer (95.6% vs 35.0%, p < 0.001) and lung cancer (98.7% vs 35.0%, p < 0.001) as smoking-related diseases. London smokers reported an increased motivation to quit if they hypothetically developed smoking-related disease (85.2% vs 72.7%, p = 0.001). Blindness was the least well-known consequence overall (27.8%), despite provoking the highest levels of fear amongst Singaporeans. Conclusion A desensitisation effect of GHWL is observed in cohorts with an increased length of exposure, both in smokers and non-smokers. The socio-cultural background needs to be considered when running public health campaigns due to differences in perception and responses to GHWL. Investigating the awareness of risks such as blindness, that have a low knowledge score but a high deterring impact, provides the chance to create a tailored approach when addressing this desensitisation