The Cyclodextrin Glycosyltransferase of Paenibacillus pabuli US132 Strain: Molecular Characterization and Overproduction of the Recombinant Enzyme

The gene encoding the cyclodextrin glycosyltransferase (CGTase) of Paenibacillus pabuli US132, previously described as efficient antistaling agent and good candidate for cyclodextrins production, was cloned, sequenced, and expressed in Escherichia coli. Sequence analysis showed that the mature enzyme (684 amino acids) was preceded by a signal peptide of 34 residues. The enzyme exhibited the highest identity (94%) to the β-CGTase of Bacillus circulans no. 8. The production of the recombinant CGTase, as active form, was very low (about 1 U/mL) in shake flasks at 37°C. This production reached 22 U/mL after 22 hours of induction by mainly shifting the postinduction temperature from 37 to 19°C and using 2TY instead of LB medium. High enzyme production (35 U/mL) was attained after 18 hours of induction in fermentor using the same culture conditions as in shake flask. The recombinant enzyme showed Vmax and Km values of 253 ± 36 μmol of β-cyclodextrin/mg/min and 0.36 ± 0.18 g/L, respectively

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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Diagnosis of Fucosidosis through Cutaneous Manifestations

El objetivo central de este trabajo es analizar la crítica al naturalismo formulada por la corriente denominada feminismo materialista francés (FMF). Mostraremos que la crítica que dicha corriente elabora permite desmontar tempranamente, desde principios de la década de 1970, diversos biologicismos, tanto en el campo del marxismo como del feminismo teórico. De este modo, demostraremos que el FMF provee un marco epistémico alternativo al sistema sexo/género, tal como era desarrollado por la misma época en la literatura anglófona (a partir de los trabajos de Ann Oakley y Gayle Rubin) y que permite pensar "antes del género y más allá de él" (tomamos prestada la expresión de Falquet, 2018). Esta investigación se despliega a la luz de una inquietud general: la necesidad de recuperar líneas de pensamiento que quedan ocultas bajo la sedimentación de las narrativas hegemónicas. En este caso, se trata de abordar teorías que se encuentran fuera del feminismo mainstream, con clara preeminencia estadounidense. Es por esto que en este trabajo, retomamos la propuesta benjaminiana de construir una historia a contrapelo que descubra, entre las diferentes capas o estratos del relato hegemónico, los restos de otros relatos. El feminismo materialista francés, que surge al fragor de los tumultuosos años sesenta y principios de los setenta, quedará sepultado en los años posteriores. ¿Cuáles son los motivos de esta invisibilización? ¿Por qué el FMF pasó desapercibido durante tanto tiempo, e incluso hoy, cómo es que casi no conocemos los nombres de estas autoras: Christine Delphy, Colette Guillaumin, Paola Tabet y Nicole-Claude Mathieu? Para abordar estos interrogantes, proponemos un análisis del feminismo materialista francés desde una nueva perspectiva: aquella que aportan los estudios contemporáneos sobre la división académica del conocimiento global, desde una perspectiva situada en el Sur, para contribuir tanto a los estudios feministas como al gran campo de saberes sobre la circulación internacional de teorías.Universidad Nacional de La Plat

Gestion prothétique des problèmes esthétique et biomécanique d’un édentement terminal maxillaire bordé par une incisive : à propos d’un cas clinique didactique

Résumé : Le traitement prothétique d\u27un édentement maxillaire bordé par une incisive est source de difficultés thérapeutiques du fait de sa topographie particulière génératrice de problèmes biomécanique et esthétique. Nous rapportons dans ce cas, les clés de succès de la réhabilitation prothétique par prothèse composite complexe pour répondre aux exigences esthético-fonctionnelles d’un patient présentant cette topographie particulière d’édentement. Le cas clinique a été abordé selon une approche didactique pour mettre en exergue les difficultés thérapeutiques et les différentes séquences du traitement prothétique à respecter pour garantir l’intégration de la prothèse et sa longévité. Mots clés: Edentement partiel, attachement de précision, incisive, problème esthétique, problème biomécanique Abstract The prosthetic treatment of a maxillary edentulism bordered by an incisor is a source of therapeutic difficulties due to its particular topography generating biomechanical and aesthetic problems. We here report, the keys to the success of prosthetic rehabilitation using complexe combine prosthesis to meet the aesthetic and functional requirements of a patient with this particular edentulism. The clinical case has been presented according to a didactic approach to highlight the therapeutic difficulties and the different prosthetic treatment sequences to be respected to guarantee the integration of the prosthesis and its longevity. Key words: Partial edentulism, Denture Precision Attachment, incisor, aesthetic problem, biomechanical problem

Mapping COVID-19's potential infection risk based on land use characteristics: A case study of commercial activities in two Egyptian cities

The contagious COVID-19 has recently emerged and evolved into a world-threatening pandemic outbreak. After pursuing rigorous prophylactic measures two years ago, most activities globally reopened despite the emergence of lethal genetic strains. In this context, assessing and mapping activity characteristics-based hot spot regions facilitating infectious transmission is essential. Hence, our research question is: How can the potential hotspots of COVID-19 risk be defined intra-cities based on the spatial planning of commercial activity in particular? In our research, Zayed and October cities, Egypt, characterized by various commercial activities, were selected as testbeds. First, we analyzed each activity's spatial and morphological characteristics and potential infection risk based on the Centre for Disease Control and Prevention (CDCP) criteria and the Kriging Interpolation method. Then, using Google Mobility, previous reports, and semi-structured interviews, points of interest and population flow were defined and combined with the last step as interrelated horizontal layers for determining hotspots. A validation study compared the generated activity risk map, spatial COVID-19 cases, and land use distribution using logistic regression (LR) and Pearson coefficients (rxy). Through visual analytics, our findings indicate the central areas of both cities, including incompatible and concentrated commercial activities, have high-risk peaks (LR = 0.903, rxy = 0.78) despite the medium urban density of districts, indicating that urban density alone is insufficient for public health risk reduction. Health perspective-based spatial configuration of activities is advised as a risk assessment tool along with urban density for appropriate decision-making in shaping pandemic-resilient cities

Worsening of left ventricular twist mechanics in isolated rheumatic mitral stenosis immediately after balloon mitral valvuloplasty

Background: Reportedly, left ventricular (LV) mechanics are worsened in patients with mitral stenosis (MS) compared to controls. The immediate effect of balloon mitral valvuloplasty (BMV) on LV mechanics is, however, not known. Aim: To assess the immediate effect of balloon mitral valvuloplasty on the left ventricular twist mechanics. Methods and results: We studied 39 candidates for BMV. Pressures were measured invasively before and after BMV. Speckle tracking echocardiography (STE) was done for twist mechanics (basal rotation, apical rotation, and torsion) before and immediately after BMV. Twist mechanics were also measured by STE in 15 normal subjects as control group. Mean age was 30.4 ± 7.2 years, mean BMI was 24.7 ± 3.1 and 28 patients (72%) were females. All twist mechanics apical rotation and torsion were lower post-BMV compared to pre-BMV. Left ventricular end diastolic pressure was significantly higher post compared to pre-BMV while left atrial pressure (LAP) was similar between both groups. Importantly, patients who showed an increased LVEDP post compared to pre-BMV had worse LV twist mechanics than those whose LVEDP post-BMV was similar to or lower than pre-BMV. Conclusion: LV twist mechanics are worsened in MS with a further worsening, immediately after BMV probably because of failure of the LV to adapt to the sudden increased preload