The mcr-1 Gene Has No Effect on Colistin Resistance When It Coexists with Inactivated mgrB Gene in Klebsiella pneumoniae

Microbial Drug Resistance, Ahead of Print.


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A Genome-Wide Assay Specifies Only GreA as a Transcription Fidelity Factor in Escherichia coli

Although mutations are the basis for adaptation and heritable genetic change, transient errors occur during transcription at rates that are orders of magnitude higher than the mutation rate. High rates of transcription errors can be detrimental by causing the production of erroneous proteins that need to be degraded. Two transcription fidelity factors, GreA and GreB, have previously been reported to stimulate the removal of errors that occur during transcription, and a third fidelity factor, DksA, is thought to decrease the error rate through an unknown mechanism. Because the majority of transcription-error assays of these fidelity factors were performed in vitro and on individual genes, we measured the in vivo transcriptome-wide error rates in all possible combinations of mutants of the three fidelity factors. This method expands measurements of these fidelity factors to the full spectrum of errors across the entire genome. Our assay shows that GreB and DksA have no significant effect on transcription error rates, and that GreA only influences the transcription error rate by reducing G-to-A errors.

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Key Transport and Ammonia Recycling Genes Involved in Aphid Symbiosis Respond to Host-Plant Specialization

Microbes are known to influence insect-plant interactions; however, it is unclear if host-plant diet influences the regulation of nutritional insect symbioses. The pea aphid, Acyrthosiphon pisum, requires its nutritional endosymbiont, Buchnera, for the production of essential amino acids. We hypothesize that key aphid genes that regulate the nutritional symbioses respond to host-plant diet when aphids feed on a specialized (alfalfa) compared to a universal host-plant diet (fava), which vary in amino acid profiles. Using RNA-Seq and whole genome bisulfite sequencing, we measured gene expression and DNA methylation profiles for such genes when aphids fed on either their specialized or universal host-plant diets. Our results reveal that when aphids feed on their specialized host-plant they significantly up-regulate and/or hypo-methylate key aphid genes in bacteriocytes related to the amino acid metabolism, including glutamine synthetase in the GOGAT cycle that recycles ammonia into glutamine and the glutamine transporter ApGLNT1. Moreover, regardless of what host-plant aphids feed on we observed significant up-regulation and differential methylation of key genes involved in the amino acid metabolism and the glycine/serine metabolism, a metabolic program observed in proliferating cancer cells potentially to combat oxidative stress. Based on our results, we suggest that this regulatory response of key symbiosis genes in bacteriocytes allows aphids to feed on a suboptimal host-plant that they specialize on.

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Assessment of an Organ-Specific de Novo Transcriptome of the Nematode Trap-Crop, Solanum sisymbriifolium

Solanum sisymbriifolium, also known as "Litchi Tomato" or "Sticky Nightshade," is an undomesticated and poorly researched plant related to potato and tomato. Unlike the latter species, S. sisymbriifolium induces eggs of the cyst nematode, Globodera pallida, to hatch and migrate into its roots, but then arrests further nematode maturation. In order to provide researchers with a partial blueprint of its genetic make-up so that the mechanism of this response might be identified, we used single molecule real time (SMRT) sequencing to compile a high quality de novo transcriptome of 41,189 unigenes drawn from individually sequenced bud, root, stem, and leaf RNA populations. Functional annotation and BUSCO analysis showed that this transcriptome was surprisingly complete, even though it represented genes expressed at a single time point. By sequencing the 4 organ libraries separately, we found we could get a reliable snapshot of transcript distributions in each organ. A divergent site analysis of the merged transcriptome indicated that this species might have undergone a recent genome duplication and re-diploidization. Further analysis indicated that the plant then retained a disproportionate number of genes associated with photosynthesis and amino acid metabolism in comparison to genes with characteristics of R-proteins or involved in secondary metabolism. The former processes may have given S. sisymbriifolium a bigger competitive advantage than the latter did.

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Correction to: Endoscopic and surgical management of nonampullary duodenal neoplasms

Abstract

This article was updated to correct the author listing for Carlos Roberto Simons-Linares.

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Laparoscopic management is feasible for nonobstetric surgical disease in all trimesters of pregnancy

Abstract

Background

Nonobstetric surgical interventions are required in some women during pregnancy. The most common nonobstetric conditions requiring surgery during pregnancy are acute appendicitis and cholecystitis. This study aimed to evaluate pregnancy outcomes and complications following surgical procedures for presumed nonobstetric surgical interventions during pregnancy, and to compare the outcomes between the laparoscopic and open approaches.

Methods

We conducted a retrospective study of patients who underwent laparoscopic or open surgery during pregnancy for nonobstetric surgical indications at our institution between 2008 and 2016.

Results

A total of 62 consecutive patients who underwent surgical intervention due to nonobstetric causes during pregnancy were included in our study. Of these, 35 (56.5%) were managed with laparoscopy and 27 (43.5%) with the open approach. Patients who underwent laparoscopy had a significantly shorter hospital stay and lower pain score on postoperative day 2 than those who underwent open surgery (5.5 vs. 7.2 days, p = 0.03 and 1.4 vs. 2.4, p < 0.01, respectively). There were no significant differences in operative complications between both groups. In advanced pregnancy (gestational age ≥ 23 weeks), 7 patients (41.2%) were managed with laparoscopy and 10 (58.8%) with the open approach. No differences in surgical complications were found between both groups in advanced pregnancy as well.

Conclusions

In our study, laparoscopic surgery was found to be feasible and safe in the late second and third trimesters as well as in the first and early second trimesters without adverse effects on pregnancy.

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Pathological outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a systematic review with meta-analysis

Abstract

Background

Since 2010, comparative studies on transanal and laparoscopic total mesorectal excision (TME) have been published and it remains unclear about the oncological benefit from transanal total mesorectal excision (taTME).

Methods

We have searched English databases to identify all taTME studies published between January 2010 and August 2017. Pathological outcomes included circumferential resection margin (CRM), positive CRM (< 1 M), length of distal resection margin (DRM), positive DRM, quality of mesorectum (complete mesorectum), harvested lymph node, and length of the specimen. Odds ratios (ORs) were calculated for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes.

Results

We have included ten studies comprising of 762 patients. Compared with laparoscopic TME, taTME had a longer CRM (WMD, 0.833; 95% CI 0.366–1.299; P < 0.001), a lower positive rate of CRM (OR, 0.505; 95% CI 0.258–0.991; P = 0.047), and a longer DRM (WMD, 6.261; 95% CI 1.049–11.472; P = 0.019). There were no significant differences in other pathological outcomes. Both cumulative meta-analysis and sensitivity analysis were unable to detect potential sources of the heterogeneity in DRM. There was no evidence of publication bias.

Conclusions

This meta-analysis revealed that taTME had more advantages on positive CRM, CRM, and DRM compared with laparoscopic TME. Compared with laparoscopic TME, more benefits of taTME on pathological outcomes remained undetected. The current findings are all based on observational studies, RCTs with adequate power are required.

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National moment of silence to be held to honor fallen EMS providers

The National EMS Memorial Service Board is requesting that agencies observe 10 to 30 seconds of radio silence on May 19

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Reliability, validity and discriminant ability of the instrumental indices provided by a novel planar robotic device for upper limb rehabilitation

In the last few years, there has been an increasing interest in the use of robotic devices to objectively quantify motor performance of patients after brain damage. Although these robot-derived measures can po...

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Rehabilitation technologies and interventions for individuals with spinal cord injury: translational potential of current trends

In the past, neurorehabilitation for individuals with neurological damage, such as spinal cord injury (SCI), was focused on learning compensatory movements to regain function. Presently, the focus of neuroreha...

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FDNY unveils EMS Week 2018 poster

Fire Commissioner Daniel Nigro unveiled the poster, which promotes this year's "Stronger Together" theme

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Influences to ADHD Problem Recognition: Mixed-Method Investigation and Recommendations to Reduce Disparities for Latino Youth

Abstract

ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification. Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.

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Paramedic Instructor - Garden City Community College

Garden City Community College is currently seeking a full-time dynamic Paramedic Instructor to help lead our 12-month paramedic program. The program includes a very progressive and innovative classroom setting that simulates on-the-job training. The program also utilizes the latest and most innovative equipment to promote realism through simulation in locations around campus. This position involves ...

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Boy saves grandma who collapsed thanks to 'Smart 911' system

Dispatchers were able to quickly figure out exactly where Joshua's grandmother was thanks to a new system

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Paramedic gifts AED to Lowe's after father suffers cardiac arrest

Mark Greczkowski presented an AED to Lowe's after his father, who works at the store, went into cardiac arrest while on the job

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Association of colonoscopy adenoma findings with long-term colorectal cancer incidence

JAMA

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Pregnancy outcome in women undergoing liver biopsy during pregnancy: A nationwide population-based cohort study

Hepatology

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Hepatitis B virus screening and reactivation in a National VA Cohort of patients with inflammatory bowel disease treated with tumor necrosis factor antagonists

Digestive Diseases and Sciences

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Serum HBV RNA as a predictor of peginterferon alfa-2a (40KD) response in patients with HBeAg-positive chronic hepatitis B

The Journal of Infectious Diseases

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Elevated liver stiffness is linked to increased biomarkers of inflammation and immune activation in HIV/hepatitis C virus-coinfected patients

AIDS

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Effects of virologic response to treatment on short- and long-term outcomes of patients with chronic HBV infection and decompensated cirrhosis

Clinical Gastroenterology and Hepatology

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Accurate determination of energy requirements in hospitalised patients with parenteral nutrition

Journal of Human Nutrition and Dietetics

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No association between consumption of sweetened beverages and later risk of Crohn's disease or ulcerative colitis

Clinical Gastroenterology and Hepatology

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Association of sugar sweetened beverages consumption with non-alcoholic fatty liver disease: A systematic review and meta-analysis

European Journal of Nutrition

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Safety and efficacy of combination treatment with calcineurin inhibitors and vedolizumab in patients with refractory inflammatory bowel disease

Clinical Gastroenterology and Hepatology

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Comparison of small vs large volume split dose preparation for colonoscopy: A study of colonoscopy outcomes

Digestive Diseases and Sciences

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Central adiposity markers, plasma lipid profile and cardiometabolic risk prediction in overweight-obese individuals

Clinical Nutrition

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Incidence and risk factors of advanced neoplasia after endoscopic mucosal resection of colonic laterally spreading lesions

International Journal of Colorectal Disease

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The novel cutoff points for the FIB4 index categorized by age increase the diagnostic accuracy in NAFLD: A multi-center study

Journal of Gastroenterology

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Risk factors for acute pancreatitis in patients with accidental hypothermia

The American Journal of Emergency Medicine

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Medic Mindset Podcast: The patient's perspective

Learn what it means to be "someone's someone" with Noah Galloway, author of "Living With No Excuses," and Ashley Liebig

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Evaluating the methods used for measuring cerebral blood flow at rest and during exercise in humans

Abstract

The first accounts of measuring cerebral blood flow (CBF) in humans were made by Angelo Mosso in ~1880, who recorded brain pulsations in patients with skull defects. In 1890, Charles Roy and Charles Sherrington determined in animals that brain pulsations—assessed via a similar method used by Mosso—were altered during a variety of stimuli including sensory nerve stimulation, asphyxia, and pharmacological interventions. Between 1880 and 1944, measurements for CBF were typically relied on skull abnormalities in humans. Thereafter, Kety and Schmidt introduced a new methodological approach in 1945 that involved nitrous oxide dilution combined with serial arterial and jugular venous blood sampling. Less than a decade later (1950's), several research groups employed the Kety-Schmidt technique to assess the effects of exercise on global CBF and metabolism; these studies demonstrated an uncoupling of CBF and metabolism during exercise, which was contrary to early hypotheses. However, there were several limitations to this technique related to low temporal resolution and the inability to measure regional CBF. These limitations were overcome in the 1960's when transcranial Doppler ultrasound (TCD) was developed as a method to measure beat-by-beat cerebral blood velocity. Between 1990 and 2010, TCD further progressed our understanding of CBF regulation and allowed for insight into other mechanistic factors, independent of local metabolism, involved in regulating CBF during exercise. Recently, it was discovered that TCD may not be accurate under several physiological conditions. Other measures of indexing CBF such as Duplex ultrasound and magnetic resonance imaging, although not without some limitations, may be more applicable for future investigations.

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StatPearls

Related Articles

StatPearls

Book. 2018 01

Authors:

Abstract
Nasotracheal intubation (NTI) involves passing an endotracheal tube through the naris into the nasopharynx and the trachea; most commonly after induction of general anesthesia in the operating room. The use of NTI permits administration of anesthetic gases without obfuscation of intraoral anatomy and is commonly used for procedures including dental, oropharyngeal and maxillofacial operations. NTI is an essential skill for anesthesia providers.  Due to the potential complications in performing NTI, it is recommended that NTI not be attempted by anyone who is not skilled at orotracheal intubation as well.

PMID: 29763142

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Prospective short‐term feasibility study of perioperative suprapubic catheters in laparoscopic colectomy

Asian Journal of Endoscopic Surgery, EarlyView.


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Understanding Physical Activity through Interactions Between the Built Environment and Social Cognition: A Systematic Review

Abstract

Background

Few people in most developed nations engage in regular physical activity (PA), despite its well-established health benefits. Socioecological models highlight the potential interaction of multiple factors from policy and the built environment to individual social cognition in explaining PA.

Objective

The purpose of this review was to appraise this interaction tenet of the socioecological model between the built environment and social cognition to predict PA.

Methods

Eligible studies had to have been published in peer-reviewed journals in the English language, and included any tests of interaction between social cognition and the built environment with PA. Literature searches, concluded in October 2017, used five common databases. Findings were grouped by type of PA outcomes (leisure, transportation, total PA and total moderate–vigorous PA [MVPA]), then grouped by the type of interactions between social cognitive and built environment constructs.

Results

The initial search yielded 308 hits, which was reduced to 22 independent studies of primarily high- to medium-quality after screening for eligibility criteria. The interaction tenet of the socioecological model was not supported for overall MVPA and total PA. By contrast, while there was heterogeneity of findings for leisure-time PA, environmental accessibility/convenience interacted with intention, and environmental aesthetics interacted with affective judgments, to predict leisure-time PA. Interactions between the built environment and social cognition in PA for transport are limited, with current results failing to support an effect.

Conclusions

The results provide some support for interactive aspects of the built environment and social cognition in leisure-time PA, and thus highlight potential areas for integrated intervention of individual and environmental change.

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Speculation as to why the Frequency of Eosinophilic Esophagitis Is Increasing

Abstract

Purpose of review

The frequency of eosinophilic esophagitis (EoE), an immune/antigen-mediated disorder first described in 1993, has been increasing rapidly. The purpose of this review is to consider hypotheses proposed to explain this increase and to speculate on their validity.

Recent findings

The hygiene hypothesis attributes the rise of EoE to modern hygienic conditions resulting in fewer childhood infections with microbes that might have protected against allergy development. Microbial dysbiosis, a change in the microbiome's composition and diversity caused by a modern affluent lifestyle, also might contribute to allergic conditions. Environmental factors including modern chemicals contaminating crops, livestock treated with hormones and antibiotics, food additives and processing changes, and pollutants in the air and water conceivably might predispose to EoE. One intriguing hypothesis attributes increasing EoE to increasing use of acid-suppressive medications like proton pump inhibitors, which might prevent peptic digestion of food allergens, increase gastric permeability, and alter the microbiome to favor food allergy development. In a recent pediatric case-control study, use of acid suppressants in infancy was by far the single strongest risk factor identified for later development of EoE.

Summary

It remains unclear which, if any, of the above factors underlies the rising frequency of EoE. These factors need not be mutually exclusive, and the cause of EoE may well be multifactorial.

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Strategies for Effective Discontinuation of Proton Pump Inhibitors

Abstract

Purpose of Review

Proton pump inhibitors (PPIs) are effective for many conditions but are often overprescribed. Recent concerns about long-term risks have made patients re-evaluate their need to take PPIs chronically, though these population-based studies have methodological weaknesses. The goal of this review is to provide evidenced-based strategies for discontinuation of PPI therapy.

Recent Findings

Given that some patients experience rebound symptoms when abruptly stopping continuous PPI therapy due to its effect on hypergastrinemia, strategies focus on avoiding rebound. Tapering the PPI and then initiating a "step-down" approach with the use of alternative medications may be effective. "On-demand therapy" provides patients with the option to take intermittent PPI courses, reducing overall use and cost while preserving patient satisfaction. It is important for providers to consider ambulatory pH or pH/impedance testing to rule out diagnoses that may require alternative medications like neuromodulators.

Summary

A number of studies reviewed here can provide guidance in counseling patients on PPI discontinuation. It is important for the provider to obtain a baseline needs assessment for PPI therapy and to elucidate predictors of difficulty in discontinuation prior to initiating a strategy.

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Inverse relationship between changes of maximal aerobic capacity and changes in walking economy after weight loss

Abstract

Purpose

The aims of this study were to: (1) determine the relationships between maximum oxygen uptake ( \(\dot {V}\) O_2max) and walking economy during non-graded and graded walking among overweight women and (2) examine potential differences in \(\dot {V}\) O_2max and walking economy before and after weight loss.

Methods

One-hundred and twenty-four premenopausal women with a body mass index (BMI) between 27 and 30 kg/m² were randomly assigned to one of three groups: (a) diet only; (b) diet and aerobic exercise training; and (c) diet and resistance exercise training. All were furnished with standard, very-low calorie diet to reduce BMI to < 25 kg/m². \(\dot {V}\) O_2max was measured using a modified-Bruce protocol while walking economy (1-net \(\dot {V}\) O₂) was obtained during fixed-speed (4.8 k·h⁻¹), steady-state treadmill walking at 0% grade and 2.5% grade. Assessments were conducted before and after achieving target BMI.

Results

Prior to weight loss, \(\dot {V}\) O_2max was inversely related (P < 0.05) with non-graded and graded walking economy (r = − 0.28 to − 0.35). Similar results were also observed following weight loss (r = − 0.22 to − 0.28). Additionally, we also detected a significant inverse relationship (P < 0.05) between the changes (∆, after weight loss) in ∆ \(\dot {V}\) O_2max, adjusted for fat-free mass, with non-graded and graded ∆walking economy (r = − 0.37 to − 0.41).

Conclusions

Our results demonstrate \(\dot {V}\) O_2max and walking economy are inversely related (cross-sectional) before and after weight loss. Importantly though, ∆ \(\dot {V}\) O_2max and ∆walking economy were also found to be inversely related, suggesting a strong synchrony between maximal aerobic capacity and metabolic cost of exercise.

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