Carbapenemase-producing klebsiella pneumoniae colonization and infection in solid organ transplant recipients: A single-center, retrospective study

Carbapenemase-KPC producing Klebsiella pneumoniae (CP-Kp) infection represents a serious threat to solid organ transplant (SOT). All patients admitted between 1 May 2011 and 31 August 2014 undergoing SOT were included in the retrospective study. The primary outcomes included a description of the association of enteric colonization and invasive infections by CP-Kp with one-year mortality. Secondary outcomes were the study of risk factors for colonization and invasive infections by CP-Kp. Results: A total of 5.4% (45/828) of SOT recipients had at least one positive rectal swab for CP-Kp, with most (88.9%) occurring after transplantation. 4.5% (35/828) of patients developed a CP-Kp-related invasive infection, with 68.6% (24/35) being previously colonized. The 1-year mortality was 31.1% in patients with enteric colonization with CP-Kp and, it was 51.4% among patients with CP-Kp-related invasive infections. At univariate analysis, colonization, invasive infections, sepsis, severe sepsis, and septic shock were significantly associated with 1-year mortality. At multivariate analysis, only invasive infections and the combination of sepsis, severe sepsis, or septic shock were significantly associated with 1-year mortality, whereas gastrointestinal colonization was significantly associated with survival. In this population, the 1-year mortality was significantly associated with invasive infections; otherwise, gastrointestinal colonization was not associated with increased 1-year mortality

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded results on VMS, insomnia, circadian rhythm disorders, obstructive sleep apnea (OSA) and restless leg syndrome (RLS). Overall, the studies show that menopausal hormone therapy (MHT) improves VMS, insomnia, and mood. Several antidepressants can improve insomnia, either on their own or in association with MHT; these include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and mirtazapine. Long-term benefits for postmenopausal insomnia may also be achieved with non-drug strategies such as cognitive behavioral therapy (CBT) and aerobic exercise. Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) both reduce blood pressure and cortisol levels in postmenopausal women suffering from OSA. However, the data regarding MHT on postmenopausal restless legs syndrome are conflicting

The Open Universe survey of Swift-XRT GRB fields: a complete sample of HBL blazars

We have analysed all the X-ray images centred on Gamma Ray Bursts generated by Swift over the last 15 years using automatic tools that do not require any expertise in X-ray astronomy, producing results in excellent agreement with previous findings. This work, besides presenting the largest medium-deep survey of the X-ray sky and a complete sample of blazars, wishes to be a step in the direction of achieving the ultimate goal of the Open Universe Initiative, that is to enable non expert people to fully benefit of space science data, possibly extending the potential for scientific discovery, currently confined within a small number of highly specialised teams, to a much larger population. We have used the Swift_deepsky Docker container encapsulated pipeline to build the largest existing flux-limited and unbiased sample of serendipitous X-ray sources. Swift_deepsky runs on any laptop or desktop computer with a modern operating system. The tool automatically downloads the data and the calibration files from the archives, runs the official Swift analysis software and produces a number of results including images, the list of detected sources, X-ray fluxes, SED data, and spectral slope estimations. We used our source list to build the LogN-LogS of extra-galactic sources, which perfectly matches that estimated by other satellites. Combining our survey with multi-frequency data we selected a complete radio flux-density limited sample of High Energy Peaked (HBL) blazars.Comment: Accepted for publication in A&A. 8 pages, 7 figure

Expanding the phenotype associated to KMT2A variants: overlapping clinical signs between Wiedemann–Steiner and Rubinstein–Taybi syndromes

Lysine-specific methyltransferase 2A (KMT2A) is responsible for methylation of histone H3 (K4H3me) and contributes to chromatin remodeling, acting as \u201cwriter\u201d of the epigenetic machinery. Mutations in KMT2A were first reported in Wiedemann\u2013Steiner syndrome (WDSTS). More recently, KMT2A variants have been described in probands with a specific clinical diagnosis comprised in the so-called chromatinopathies. Such conditions, including WDSTS, are a group of overlapping disorders caused by mutations in genes coding for the epigenetic machinery. Among them, Rubinstein\u2013Taybi syndrome (RSTS) is mainly caused by heterozygous pathogenic variants in CREBBP or EP300. In this work, we used next generation sequencing (either by custom-made panel or by whole exome) to identify alternative causative genes in individuals with a RSTS-like phenotype negative to CREBBP and EP300 mutational screening. In six patients we identified different novel unreported variants in KMT2A gene. The identified variants are de novo in at least four out of six tested individuals and all of them display some typical RSTS phenotypic features but also WDSTS specific signs. This study reinforces the concept that germline variants affecting the epigenetic machinery lead to a shared molecular effect (alteration of the chromatin state) determining superimposable clinical conditions

Open Universe for Blazars: A new generation of astronomical products based on 14 years of Swift -XRT data

Aims. Open Universe for Blazars is a set of high-transparency multi-frequency data products for blazar science, and the tools designed to generate them. Blazars are drawing growing interest following the consolidation of their position as the most abundant type of source in the extragalactic very high-energy γ-ray sky, and because of their status as prime candidate sources in the nascent field of multi-messenger astrophysics. As such, blazar astrophysics is becoming increasingly data driven, depending on the integration and combined analysis of large quantities of data from the entire span of observational astrophysics techniques. The project was therefore chosen as one of the pilot activities within the United Nations Open Universe Initiative, whose objective is to stimulate a large increase in the accessibility and ease of utilisation of space science data for the worldwide benefit of scientific research, education, capacity building, and citizen science. Methods. Our aim is to deliver innovative data science tools for multi-messenger astrophysics. In this work we report on a data analysis pipeline called Swift-DeepSky based on the Swift XRTDAS software and the XIMAGE package, encapsulated into a Docker container. Swift-DeepSky downloads and reads low-level data, generates higher level products, detects X-ray sources, and estimates several intensity and spectral parameters for each detection, thus facilitating the generation of complete and up-to-date science-ready catalogues from an entire space-mission data set. Results. As a first application of our innovative approach, we present the results of a detailed X-ray image analysis based on Swift-DeepSky that was run on all Swift-XRT observations including a known blazar, carried out during the first 14 years of operations of the Neil Gehrels Swift Observatory. Short exposures executed within one week of each other have been added to increase sensitivity, which ranges between ∼1 × 10-12 and ∼1 × 10-14 erg cm-2 s-1 (0.3-10.0 keV). After cleaning for problematic fields, the resulting database includes over 27 000 images integrated in different X-ray bands, and a catalogue, called 1OUSXB, that provides intensity and spectral information for 33 396 X-ray sources, 8896 of which are single or multiple detections of 2308 distinct blazars. All the results can be accessed online in a variety of ways, from the Open Universe portal through Virtual Observatory services, via the VOU-Blazar tool and the SSDC SED builder. One of the most innovative aspects of this work is that the results can be easily reproduced and extended by anyone using the Docker version of the Swift-DeepSky pipeline, which runs on Linux, Mac, and Windows machines, and does not require any specific experience in X-ray data analysis.Fil: Giommi, Paolo. Università di Roma; Italia. International Center For Relativistic Astrophysics; Italia. Universitat Technical Zu Munich; AlemaniaFil: Brandt, C. H.. International Center For Relativistic Astrophysics; Italia. Jacobs University; AlemaniaFil: Barres de Almeida, U.. International Center For Relativistic Astrophysics; Italia. Centro Brasileiro de Pesquisas Físicas; BrasilFil: Pollock, A. M. T.. University of Sheffield; Reino UnidoFil: Arneodo, F.. New York University Abu Dhabi; Arabia SauditaFil: Chang, Y. L.. International Center For Relativistic Astrophysics; ItaliaFil: Civitarese, Enrique Osvaldo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Física La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Física La Plata; ArgentinaFil: de Angelis, Maria Cruz. Università di Roma; ItaliaFil: D'Elia, V.. Space Science Data Center; Italia. Osservatorio Astronomico di Roma; ItaliaFil: Del Rio Vera, J.. United Nations Office for Outer Space Affairs; AustraliaFil: Di Pippo, S.. United Nations Office for Outer Space Affairs; AustraliaFil: Middei, Riccardo. Università di Roma; ItaliaFil: Penacchioni, Ana Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Física La Plata. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Física La Plata; ArgentinaFil: Perri, M.. Osservatorio Astronomico di Roma; Italia. Space Science Data Center; ItaliaFil: Ruffini, Remo. International Center For Relativistic Astrophysics; ItaliaFil: Sahakyan, Narek. International Centre For Relativistic Astrophysics Network; ArmeniaFil: Turriziani, Sara. Computational Astrophysics Laboratory; Japó

Multiwavelength observations of 3C 454.3 II. The AGILE 2007 December campaign

We report on the second AGILE multiwavelength campaign of the blazar 3C 454.3 during the first half of December 2007. This campaign involved AGILE, Spitzer, Swift,Suzaku,the WEBT consortium,the REM and MITSuME telescopes,offering a broad band coverage that allowed for a simultaneous sampling of the synchrotron and inverse Compton (IC) emissions.The 2-week AGILE monitoring was accompanied by radio to optical monitoring by WEBT and REM and by sparse observations in mid-Infrared and soft/hard X-ray energy bands performed by means of Target of Opportunity observations by Spitzer, Swift and Suzaku, respectively.The source was detected with an average flux of~250x10^{-8}ph cm^-2s^-1 above 100 MeV,typical of its flaring states.The simultaneous optical and gamma-ray monitoring allowed us to study the time-lag associated with the variability in the two energy bands, resulting in a possible ~1-day delay of the gamma-ray emission with respect to the optical one. From the simultaneous optical and gamma-ray fast flare detected on December 12, we can constrain the delay between the gamma-ray and optical emissions within 12 hours. Moreover, we obtain three Spectral Energy Distributions (SEDs) with simultaneous data for 2007 December 5, 13, 15, characterized by the widest multifrequency coverage. We found that a model with an external Compton on seed photons by a standard disk and reprocessed by the Broad Line Regions does not describe in a satisfactory way the SEDs of 2007 December 5, 13 and 15. An additional contribution, possibly from the hot corona with T=10^6 K surrounding the jet, is required to account simultaneously for the softness of the synchrotron and the hardness of the inverse Compton emissions during those epochs.Comment: 13 pages, 8 figures, 2 tables, Accepted for publication in Ap