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

Targeted gene sanger sequencing should remain the first-tier genetic test for children suspected to have the five common X-linked inborn errors of immunity

DATA AVAILABILITY STATEMENT : The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.To address inborn errors of immunity (IEI) which were underdiagnosed in resource-limited regions, our centre developed and offered free genetic testing for the most common IEI by Sanger sequencing (SS) since 2001. With the establishment of The Asian Primary Immunodeficiency (APID) Network in 2009, the awareness and definitive diagnosis of IEI were further improved with collaboration among centres caring for IEI patients from East and Southeast Asia. We also started to use whole exome sequencing (WES) for undiagnosed cases and further extended our collaboration with centres from South Asia and Africa. With the increased use of Next Generation Sequencing (NGS), we have shifted our diagnostic practice from SS to WES. However, SS was still one of the key diagnostic tools for IEI for the past two decades. Our centre has performed 2,024 IEI SS genetic tests, with in-house protocol designed specifically for 84 genes, in 1,376 patients with 744 identified to have disease-causing mutations (54.1%). The high diagnostic rate after just one round of targeted gene SS for each of the 5 common IEI (X-linked agammaglobulinemia (XLA) 77.4%, Wiskott–Aldrich syndrome (WAS) 69.2%, X-linked chronic granulomatous disease (XCGD) 59.5%, X-linked severe combined immunodeficiency (XSCID) 51.1%, and X-linked hyper-IgM syndrome (HIGM1) 58.1%) demonstrated targeted gene SS should remain the first-tier genetic test for the 5 common X-linked IEI.The Hong Kong Society for Relief of Disabled Children and Jeffrey Modell Foundation.http://www.frontiersin.org/Immunologyam2023Paediatrics and Child Healt

New insight into cervical myelopathic hand sign : a pilot study

Background: The myelopathy hand was first described by Ono et al. on the analysis of finger motion impairment caused by cervical myelopathy. The clumsiness associated with intrinsic finger weakness decreases the number of grip-and-release cycles a patient can perform within 10 seconds. However, this quantitative analysis only provides a crude representation. The purpose of this study is to perform electromyographic (EMG) analysis of this myelopathic hand sign in pre- and postoperative patients. Methods: Patients diagnosed with cervical myelopathy and planned for surgical decompression were recruited into the study. Clinical examination including the presence of myelopathy hand and modified Japanese Orthopaedic Association (mJOA) scores, and EMGs during the grip-and-release tests were performed pre- and postoperatively. Results: Ten patients were recruited into the the pilot study. Five patients had improvement of mJOA score by 2 points or more postoperatively, whereas the remaining Five had similar scores. For patients who had improved mJOA scores, there was a statistical significance in improvement in low frequency EMG amplitudes compared with preoperative during the 10 second grip-and-release tests, whereas there was no difference in high frequency amplitudes. For those who had no change in mJOA scores, EMG amplitudes did not change pre- and postoperatively in high or low frequencies. Conclusions: Improvement in low frequency EMG amplitudes may represent a sensitive method in detecting improvement in hand function post surgical decompression of cervical myelopathy. Further studies are required to determine if this will allow objective documentation and prognostication of surgical outcomes

Using EMG spectral analysis to predict modified Japanese Orthopaedic Association score in patients with cervical myelopathy

Rationale/Objectives: Modified Japanese Orthopaedic Association (mJOA) score is a widely used tool to assess the severity of cervical myelopathy. However, evaluation of mJOA score can be subjective and time consuming. The present study aimed to develop a robust and simple method to predict the mJOA score. Methods: Nine patients with cervical myelopathy (6 males and 3 females, age=64.8±14.8 years) were examined from a local hospital before and one week after decompression surgery. During each time point, two wireless EMG sensors sampling at 1,000 Hz were placed onto bilateral wrist extensor muscles. The patients were asked to perform 10-second grip-and-release test (10GRT). We conducted spectral analyses on the raw EMG data by computing the power in four preset bandwidths (1-10, 11-20, 21-30, and 31-100 Hz). A multiple regression model was used to predict the mJOA scores, which were charted by a single research nurse, with the EMG power parameters. Results: We found significant correlations between mJOA score with EMG power of higher-functioned hand and lower-functioned hand at preset bandwidths (p<0.05) A prediction equation was established with R2=0.742 and RMSE was 1.215 unit of mJOA score. Conclusions: Our findings suggest that spectral analyses of wrist extensor muscles activity can be a potential non-invasive clinical tool to predict mJOA score for patients with cervical myelopathy

Aggregation-Induced Nonlinear Optical Effects of AIEgen Nanocrystals for Ultra-Deep in Vivo Bio-Imaging

Nonlinear optical microscopy has become a powerful tool in bioimaging research due to its unique capabilities of deep optical sectioning, high spatial resolution imaging and three-dimensional reconstruction of biological specimens. Developing organic fluorescent probes with strong nonlinear optical effects, in particular third-harmonic generation (THG), is promising for exploiting nonlinear microscopic imaging for biomedical applications. Herein, we succesfully demonstrate a simple method for preparing organic nanocrystals based on an aggregation-induced emission (AIE) luminogen (DCCN) with bright near-infrared emission. Under femtosecond laser excitation, the high-order nonlinear optical effects of DCCN were studied in three distinct systems, including monomolecules in solution, amorphous nanopaticles, and crystaline nanopaticles. Results revealed aggregation-induced nonlinear optical (AINLO) effects, including two-photon fluorescence (2PF), three-photon fluorescence (3PF) and THG, of DCCN in nanopaticles, especially for the crystaline nanopaticles. Taking advantage of the strong 2PF and THG properties, the nanocrystals of DCCN have been successfully applied for 2PF microscopy at 1040 nm NIR-II excitation and THG microscopy at 1560 nm NIR-II excitation, respectively, to reconstruct the 3D vasculature of the mouse cerebral vasculature. Impressively, the THG microscopy could provide much higher spatial resolution and brightness than the 2PF microscopy and could visualize small vessels with diameters of ~2.7 μm at deepest depth of 800 μm in mouse brain, which is among the largest penetration depth and best spatial resolution of in vivo THG vasculature imaging. Thus, this is expected to inspire new insights into development of advanced AIE materials with multiple nonlinearity, in particular THG, for multimodal nonlinear optical microscopy.</p

Bioinspired Simultaneous Changes in Fluorescence Color, Brightness and Shape of Hydrogels Enabled by AIEgens

Development of stimuli-responsive materials with complex practical functions is significant for achieving bioinspired artificial intelligence. It is challenging to fabricate stimuli-responsive hydrogels showing simultaneous changes in fluorescence color, brightness and shape in response to one stimulus. Herein a bilayer hydrogel strategy was designed by utilizing an aggregation-induced emission luminogen (AIEgen) tetra-(4-pyridylphenyl)ethylene (TPE-4Py) to fabricate hydrogels with the above capabilities. Bilayer hydrogel actuators with ionomer of poly(acrylamide-r-sodium 4-styrenesulfonate) (PAS) as matrix of both active and passive layers and TPE-4Py as the core function element in the active layer were prepared. At acidic pH, the protonation of TPE-4Py led to fluorescence color and brightness changes of the actuators and the electrostatic interactions between the protonated TPE-4Py and benzenesulfonate groups of PAS chains in the active layer caused the actuators to deform. The proposed TPE-4Py/PAS-based bilayer hydrogel actuators with such responsiveness to stimulus provide pregnant insights in the design of intelligent systems and are highly attractive material candidates in fields of 3D/4D printing, soft robots and smart wearable devices

Efficient Regioselective Photogeneration of a Five-Membered Azaheterocyclic AIEgen for Cancer Cell Differentiation with Unusual Photoamplification Effect

Five-membered azaheterocycles, mostly suffered from various synthetic problems, hold a special status in pharmaceutical chemistry and life science. Here, based on green chemistry, a highly efficient and remarkably regioselective photoreaction was developed under mild conditions for constructing fused five-membered azaheterocycles with aggregation-induced emission (AIE) characteristics. After the photoreaction, one of the most noteworthy optical features is the abruptly increased emission induced by UV irradiation. Making use of this, fluorescent photopatterns were readily fabricated in solution and solid support with improved signal-to-background ratio. Due to the excellent biocompatibility and unique chemical structure of the azaheterocycles, selective mitochondria-targeted cancer cell recognition was realized at an ultralow dye concentration. Notably, an unusual photoamplification effect and an exceptional anti-photobleaching phenomenon were observed thanks to the occurrence of the photoreaction. It is not only the first time that fused five-membered azaheterocyclic AIE luminogen was synthesized quantitatively via an unconventionally yet highly regioselective photoreaction, but also the first attempt to combat photobleaching problem by the photoamplification effect

A Versatile AIE Fluorogen with Selective Reactivity to Primary Amines for Monitoring Amination, Protein Labeling and Mitochondrial Staining

Specific bioconjugation for native primary amines is highly valuable for both chemistry and biomedical research. Despite all the efforts, scientists lack a proper strategy to achieve high selectivity for primary amines, not to mention the requirement of fast response for real applications. Herein, in this work, we report a chromone-based aggregation-induced emission (AIE) fluorogen called CMVMN as a self-reporting bioconjugation reagent for selective primary amine identification, and its applications for monitoring bioprocesses of amination and protein labeling. CMVMN is AIE-active and is capable of solid-state sensing. Thus, its electrospun films are manufactured for visualization of amine diffusion and leakage process. CMVMN also shows good biocompatibility and potential mitochondria-staining ability, which provides new insight for organelle-staining probe design. Combined with its facile synthesis and good reversibility, CMVMN not only shows wide potential applications in biology, but also offers new possibilities for molecular engineering

Association between meteorological variations and activities of influenza A and B across different climate zones: a multi-region modelling analysis across the globe

To elucidate the effects of meteorological variations on the activity of influenza A and B in 11 sites across different climate regions.Daily numbers of laboratory-confirmed influenza A and B cases from 2011-2015 were collected from study sites where the corresponding daily mean temperature, relative humidity, wind speed and daily precipitation amount were used for boosted regression trees analysis on the marginal associations and the interaction effects.Cold temperature was a major determinant that favored both influenza A and B in temperate and subtropical sites. Temperature-to-influenza A, but not influenza B, exhibited a U-shape association in subtropical and tropical sites. High relative humidity was also associated with influenza activities but were less consistent with influenza B activity. Compared with relative humidity, absolute humidity had a stronger association - it was negatively associated with influenza B activity in temperate zones, but was positively associated with both influenza A and B in subtropical and tropical zones.The association between meteorological factors and with influenza activity is virus type specific and climate dependent. The heavy influence of temperature on influenza activity across climate zones implies that global warming is likely to have an impact on the influenza burden