Evaluation of filter paper as a means of transporting inactivated Gram-negative non-fermentative bacteria and Haemophilus spp. for identification using the MALDI-TOF MS system.

This study aimed to evaluate the filter paper as a means to transport inactivated Gram-negative non-fermentative (GNNF) bacteria and Haemophilus spp. for analysis using MALDI-TOF MS. A total of 133 isolates were evaluated and the analysis of each isolate was performed directly from original bacterial colony and in filter paper after the processing. To evaluate the agreement between the identification performed directly from the colony and after impregnation in filter paper, we assign the scores: >2·3 as excellent (E); 2·0 to 2·3 as very good (VG); 1·7-1·99 as good (G); <1·7 as unidentified (U). The divergences were classified as: Minor Divergence, Intermediate Divergence and Major Divergence. A total of 80 isolates transported in the filter paper disks presented full category concordance; 39 isolates presented Minor Divergence; 4 isolates present Intermediate Divergence; 4 isolates present Major Divergence and 6 isolates present better results after impregnation in filter paper. The proposed methodology of bacteria transportation presented a sensitivity of 96·9% and a specificity of 100%. The filter paper as a means to transport and storage of inactivated GNNF and Haemophilus spp. may be considered a potential tool for faster, more accurate, biosafe and less-expensive identification.

Sports-Related Cervical Spine Injuries - Background, Triage, and Prevention.

ABSTRACT: Cervical spinal injuries are a rare, but potentially devastating occurrence in sports. Although many of these injuries occur in unsupervised sports, they are also seen in organized sports - most commonly in football, wrestling, and ice hockey. Additionally, although each sport is associated with its own unique injury patterns, axial loading remains a common theme seen in cervical injuries associated with significant neurologic impairment. Regardless of the mechanism, a cautious and conservative approach should be taken with regards to evaluation, management, and return to play.

NYX-458 Improves Cognitive Performance in a Primate Parkinson's Disease Model.

BACKGROUND: NYX-458 is a N-methyl-d-aspartate receptor (NMDAR) modulator that enhances synaptic plasticity. Dopaminergic cell loss in Parkinson's disease (PD) leads to NMDAR dysregulation in the cortico-striato-pallidal-thalmo-cortical network and altered plasticity in brain regions important to cognitive function. We hypothesize that targeting the NMDAR may be an efficacious approach to treating cognitive impairment in PD. OBJECTIVES: NYX-458 was evaluated in 2 nonhuman primate models of PD. The first, a chronic low-dose 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-administration model, was used to assess the effects of NYX-458 on cognitive domains impacted early in PD including attention, working memory, executive function, and visuospatial learning. The second, a high-dose MPTP-administration model, was used to assess potential for NYX-458 induced change in motor symptoms. METHODS: NYX-458 was evaluated in the chronic low-dose MPTP model using the variable delayed response measure to assess attention and working memory and simple discrimination reversal to assess executive function. NYX-458 was also assessed in the high-dose MPTP model as a monotherapy and in combination with low-dose or high-dose levodopa to assess potential impact on motor symptoms. RESULTS: NYX-458 administration resulted in rapid and long-lasting improvement in cognitive function across the domains of attention, working memory, and executive function. Dose levels effective in improving cognitive performance had no effect on PD motor symptoms, the antiparkinsonian benefit of levodopa, or dyskinesia. CONCLUSIONS: NYX-458 provides benefit in specific domains known to be impaired in PD in a dopamine depletion model of PD-like cognitive impairment. These data support the continued evaluation of NYX-458 as a potential therapeutic for cognitive decline in PD. © 2020 International Parkinson and Movement Disorder Society.

Phonon-Induced Enhancement of Photon Entanglement in Quantum Dot-Cavity Systems.

We report on simulations of the degree of polarization entanglement of photon pairs simultaneously emitted from a quantum dot-cavity system that demand revisiting the role of phonons. Since coherence is a fundamental precondition for entanglement and phonons are known to be a major source of decoherence, it seems unavoidable that phonons can only degrade entanglement. In contrast, we demonstrate that phonons can cause a degree of entanglement that even surpasses the corresponding value for the phonon-free case. In particular, we consider the situation of comparatively small biexciton binding energies and either finite exciton or cavity mode splitting. In both cases, combinations of the splitting and the dot-cavity coupling strength are found where the entanglement exhibits a nonmonotonic temperature dependence which enables entanglement above the phonon-free level in a finite parameter range. This unusual behavior can be explained by phonon-induced renormalizations of the dot-cavity coupling g in combination with a nonmonotonic dependence of the entanglement on g that is present already without phonons.

N-Methyl-D-Aspartate Receptor Encephalitis with Psychiatric Symptoms and an Ovarian Teratoma Detected by MRI in a 17-Year-Old Girl.

N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare antibody-mediated autoimmune encephalitis often associated with an ovarian teratoma in adolescent females. Here we present a 17-year-old girl with only and unusual psychiatric symptoms as part of her NMDAR encephalitis in combination with a very small ovarian teratoma suspected by magnetic resonance (MR) imaging and finally histologically confirmed. We further review the literature of NMDAR encephalitis in combination with an ovarian teratoma and discuss the recommended radiological workup in children with a suspected ovarian tumor.

Imaging characteristics of chronic spinal cord injury identified during screening for a cell transplantation clinical trial.

OBJECTIVEIn cell transplantation trials for spinal cord injury (SCI), quantifiable imaging criteria that serve as inclusion criteria are important in trial design. The authors' institutional experience has demonstrated an overall high rate of screen failures. The authors examined the causes for trial exclusion in a phase I, open-lab clinical trial examining the role of autologous Schwann cell intramedullary transplantation. Specifically, they reviewed the imaging characteristics in people with chronic SCI that excluded applicants from the trial, as this was a common cause of screening failures in their study.METHODSThe authors reviewed MRI records from 152 people with chronic (> 1 year) SCI who volunteered for intralesional Schwann cell transplantation but were deemed ineligible by prospectively defined criteria. Rostral-caudal injury lesion length was measured along the long axis of the spinal cord in the sagittal plane on T2-weighted MRI. Other lesion characteristics, specifically those pertaining to lesion cavity structure resulting in trial exclusion, were recorded.RESULTSImaging records from 152 potential participants with chronic SCI were reviewed, 42 with thoracic-level SCI and 110 with cervical-level SCI. Twenty-three individuals (55%) with thoracic SCI and 70 (64%) with cervical SCI were not enrolled in the trial based on imaging characteristics. For potential participants with thoracic injuries who did not meet the screening criteria for enrollment, the average rostral-caudal sagittal lesion length was 50 mm (SD 41 mm). In applicants with cervical injuries who did not meet the screening criteria for enrollment, the average sagittal lesion length was 34 mm (SD 21 mm).CONCLUSIONSWhile screening people with SCI for participation in a cell transplantation clinical trial, lesion length or volume can exclude potential subjects who appear appropriate candidates based on neurological eligibility criteria. In planning future cell-based therapy trials, the limitations incurred by lesion size should be considered early due to the screening burden and impact on candidate selection.

Probing the activity of a recombinant Zn2+ -transporting P-type ATPase.

P-type ATPase proteins maintain cellular homeostasis and uphold critical concentration gradients by ATP-driven ion transport across biological membranes. Characterization of single-cycle dynamics by time-resolved X-ray scattering techniques in solution could resolve structural intermediates not amendable to for example crystallization or cryo-electron microscopy sample preparation. To pave way for such time-resolved experiments, we used biochemical activity measurements, Attenuated Total Reflectance (ATR) and time-dependent Fourier-Transform Infra-Red (FTIR) spectroscopy to identify optimal conditions for activating a Zn2+ -transporting Type-I ATPase from Shigella sonnei (ssZntA) at high protein concentration using caged ATP. The highest total activity was observed at a protein concentration of 25 mg/mL, at 310 K, pH 7, and required the presence of 20% (v/v) glycerol as stabilizing agent. Neither the presence of caged ATP nor increasing lipid-to-protein ratio affected the hydrolysis activity significantly. This work also paves way for characterization of recombinant metal-transporting (Type-I) ATPase mutants with medical relevance.

Dissemination of bla OXA-370 gene among several Enterobacteriaceae species in Brazil.

OXA-370 is a recently described OXA-48 variant that has only been described in a few Enterobacter spp. and Klebsiella pneumoniae isolates. The purpose of this study is to assess the prevalence of OXA-370-producing isolates in carbapenem-nonsusceptible Enterobacteriaceae recovered from 28 hospitals from Brazil. Real-time PCR was used to determine the presence of bla NDM-1, bla KPC-2, bla VIM-type, bla GES-type, bla OXA-48-like, and bla IMP-type genes. A total of 4,451 Enterobacteriaceae were screened. The gene bla OXA-48-like was detected in 74 (2.5%) isolates, mostly of Enterobacter spp. (44.6% E. cloacae and 2.7% E. aerogenes) and Klebsiella spp. (31.1% K. pneumoniae and 6.7% K. oxytoca), followed by Escherichia coli, (6.7%), Morganella morganii, (2.7%), Citrobacter freundii (1.3%), Proteus mirabilis (1.3%), Providencia stuartii (1.3%), and Serratia spp. (1.3%). These isolates were from five hospitals, 67 (90.5%) from the hospital where the bla OXA-370 was first described. Sequencing of bla OXA-48-like was performed in 52 isolates, including E. cloacae, E. aerogenes, K. pneumoniae, K. oxytoca, E. coli, and C. freundii; all presenting 100% identity with bla OXA-370. PFGE revealed the presence of distinct clones among K. pneumoniae, E. cloacae, K. oxytoca, and E. coli. Susceptibility rates to meropenem, imipenem, and ertapenem among OXA-370-producing isolates were 92.3%, 78.8%, 7.7% respectively; the MIC50 /MIC90 were 0.38/2 mg/L and 1/3 mg/L for meropenem and imipenem respectively. Overall, antimicrobial susceptibility analysis suggests that OXA-370 lacks carbapenemase activity. Our study demonstrated that the bla OXA-370 gene is disseminated among several Enterobacteriaceae species and clones, indicating a high potential for dissemination.

The novel video-assisted intubating laryngeal mask Totaltrack compared to the intubating laryngeal mask Fastrach - a controlled randomized manikin study.

BACKGROUND: The novel Totaltrack combines a supraglottic airway device with video laryngoscopic tracheal intubation. The intubation laryngeal mask Fastrach is an established device without visual control of intubation. We hypothesized that supraglottic ventilation success with Totaltrack would be similar to Fastrach, but intubation would be performed faster due to visual control of the procedure. METHODS: Fifty-five anaesthesiologists were randomized into one of two study arms: Fastrach Totaltrack. After a standardized introduction, six consecutive attempts of supraglottic ventilation and intubation attempts with each of one of the devices were performed on an airway manikin. The combined primary outcome was: time to supraglottic ventilation and time to ventilation after intubation. Additionally, success rate and learning curves were evaluated. RESULTS: Supraglottic time to ventilation was shorter when using the Fastrach compared to the Totaltrack (median: 7.8 s [confidence interval [CI]: 7.0-8.6 s] vs. 11 s [CI: 7.8-14.2 s], P < 0.001). Intubation was faster using the Fastrach compared to Totaltrack (median: 12.5 s, [CI: 10.1-14.9 s] vs. 23.3 s [CI: 21.5-25.1 s], P < 0.001). Success rate for supraglottic ventilation was comparable between Fastrach and Totaltrack (86-96%). Successful intubation via the device was 100% in Fastrach and ranged from 61% to 93% in Totaltrack, with a higher probability of successful intubation after four applications. CONCLUSION: In this manikin-based study the novel Totaltrack did not prove superior to Fastrach despite a similar design. Video laryngoscopic control of supraglottic ventilation and endotracheal intubation was prolonged using the Totaltrack. Clinical trials are mandatory to evaluate the role of the Totaltrack in airway management.

pH influences hydrolysis of sodium polyphosphate in dairy matrices and the structure of processed cheese.

We investigated the effect of pH (5.2 to 6.8) on the hydrolysis of a sodium polyphosphate in water, milk, calcium caseinate, and spreadable processed cheese, as well as the effect of pH on the cheese structure. Monitoring of the hydrolysis in water and the different milk matrices was carried out using 31P nuclear magnetic resonance technique. In general, the decrease in pH increased the hydrolysis of polyphosphates in all matrices. The presence of calcium in milk increased the rate of hydrolysis. Hydrolysis in milk was higher than in calcium caseinate, probably due to lower molecular mobility in concentrated systems with high viscosity. Increasing the pH decreased the hardness and adhesiveness of the cheeses. At low pH (5.2 and 5.6), the cheeses presented a granular structure, although, at more neutral pH (6.0 to 6.8), the structure was continuous, homogeneous, and more fluid. These results highlight the importance of precise pH control in the manufacture of processed cheeses.

Phonon-assisted population inversion of a single InGaAs/GaAs quantum dot by pulsed laser excitation.

We demonstrate a new method to realize the population inversion of a single InGaAs/GaAs quantum dot excited by a laser pulse tuned within the neutral exciton phonon sideband. In contrast to the conventional method of inverting a two-level system by performing coherent Rabi oscillation, the inversion is achieved by rapid thermalization of the optically dressed states via incoherent phonon-assisted relaxation. A maximum exciton population of 0.67±0.06 is measured for a laser tuned 0.83 meV to higher energy. Furthermore, the phonon sideband is mapped using a two-color pump-probe technique, with its spectral form and magnitude in very good agreement with the result of path-integral calculations.

Project Medishare's Historic Haitian Earthquake Response.

This article describes the immediate large-scale medical and surgical response of Project Medishare to the 2010 Haitian earthquake. It summarizes the rapid evolution of critical care and trauma capacity in a developing nation after earthquake and discusses the transition from acute trauma treatment to interdisciplinary health care sector building.

The Challenges of Establishing and Sustaining an Overseas Enterprise: One Haitian NGO's Perspective.

This article describes the creation of Project Medishare for Haiti, Inc, a US 501(c)3 nonprofit organization and its counterpart in Haiti, Project Medishare in Haiti, a nongovernmental organization that provides health care resources and training and education in Haiti. It summarizes the strategy for fundraising and sustaining such an enterprise in a developing country and discusses the lessons learned and goals achieved during the last 20 years.

PCR to detect Mycobacterium tuberculosis in respiratory tract samples: evaluation of clinical data.

Tuberculosis (TB) remains as an important public health problem worldwide. Therefore, the rapid detection of M. tuberculosis is of primary importance to effectively reduce transmission in patients. The aims of this study were to evaluate two in-house molecular tests: nested PCR (nPCR) and real-time PCR (rtPCR) to detect M. tuberculosis complex directly from clinical samples. The results were compared to the culture results and to the culture results plus clinical data of patients. The rtPCR and nPCR presented high sensitivity (Se) and specificity (Sp) (rtPCR 97·6% and 91·5%, nPCR 85·7% and 92·7%, respectively) compared to culture. When the results of the molecular tests were compared to the culture plus clinical data the Se and Sp were 90·2% and 97·3% for rtPCR and 80·4% and 98·6% for the nPCR, respectively. The results demonstrated that molecular assays of M. tuberculosis can provide a sensitive and rapid diagnostic of TB, and when used in addition to the clinical data of TB patients will help to improve the Sp of the diagnosis of pulmonary TB.

Proposed robust and high-fidelity preparation of excitons and biexcitons in semiconductor quantum dots making active use of phonons.

It is demonstrated how the exciton and the biexciton state of a quantum dot can be prepared with high fidelity on a picosecond time scale by driving the dot with a strong laser pulse that is tuned above the exciton resonance for exciton preparation and in resonance with the exciton transition for biexciton preparation. The proposed protocols make use of the phonon-induced relaxation towards photon dressed states in optically driven quantum dots and combine the simplicity of traditional Rabi oscillation schemes with the robustness of adiabatic rapid passage schemes. Our protocols allow for an on-demand, fast, and almost perfect state preparation even at strong carrier-phonon interaction where other schemes fail. In fact, the performance of the presented protocols is shown to be better the stronger the carrier-phonon interaction is.

Carbapenem-susceptible Acinetobacter baumannii carrying the ISAba1 upstream blaOXA-51-like gene in Porto Alegre, southern Brazil.

SUMMARY Over the last decade, Acinetobacter baumannii resistant to carbapenems has emerged in many medical centres and is commonly associated with high morbidity and mortality. We investigated potential mechanisms contributing to antimicrobial resistance of 58 clinical isolates of A. baumannii collected during a prolonged city-wide outbreak in five different hospitals in southern Brazil. The integrase gene was detected in 51 (87·9%) isolates of which 36 harboured class 2 integrons alone and 14 had both class 1 and 2 integrons; all carbapenem-resistant isolates displayed class 2 integrons. ISAba1 was found upstream of bla OXA-23-like only in isolates resistant to carbapenems; however, ISAba1 upstream of blaOXA-51-like was present in both susceptible and resistant isolates. This is the first report of a high prevalence of class 2 integrons in A. baumannii in southern Brazil. Moreover, our study suggests that ISAba1/blaOXA-51-like alone is insufficient to confer resistance to carbapenems.

Molecular cytogenetics of nucleolar organizer regions in Phyllomedusa and Phasmahyla species (Hylidae, Phyllomedusinae): a cytotaxonomic contribution.

Chromosome numbers, morphology, and nucleolus organizer region (NOR) locations are useful cytological characters for taxonomic and evolutionary studies. In this study, we provide the first cytogenetic analysis of Phyllomedusa bahiana and Phasmahyla spectabilis, and report new cytogenetic data on variation in NOR numbers and positions in Phyllomedusa rohdei and Phyllomedusa nordestina using conventional staining, AgNOR-banding, and 45S rDNA fluorescence in situ hybridization. All 4 species showed 2n = 26 chromosomes. P. spectabilis and P. bahiana had only 1 pair of NOR-carrying chromosomes. P. bahiana showed an NOR length polymorphism, and a rare homomorphic self-compatibility for both NOR lengths in anurans. Variation in the number of NOR-bearing chromosomes was found between the sampled populations of P. nordestina, ranging from 3 to 4. This study also clarified previous conflicting results concerning the occurrence of inter- and intra-population NOR variation in P. rohdei. The variation, confirmed by 45S rDNA fluorescence in situ hybridization analysis, was congruent with results obtained from AgNOR-banding in all species.

Anconeus epitrochlearis muscle (epitrochlearisanconeus muscle; Musculus epitrochleoanconeus) with cubital tunnel syndrome - a rare but relevant clinical entity.

BACKGROUND: Compression of the ulnar nerve at the elbow within the cubital tunnel is related to the anatomical structures and is generally believed to be caused by Osborne's ligament (also known as the cubital retinaculum). However, in rare cases an anatomical variation of the developmental peculiarity of a remaining anconeus epitrochlearis muscle may be responsible for the disease. METHODS: We present a series of five cases in which an anconeus epitrochlearis muscle was found as the cause of illness. RESULTS: All patients presented with typical symptoms of numbness and tingling in the hand and ulnar fingers, and recurring pain as well as weakness of the ulnar innervated muscles. With neurophysiologically confirmed diminished nerve conduction velocity and unsuccessful conservative treatment, surgical decompression revealed an anconeus epitrochlearis muscle as the reason of compression. Full symptom relief was achieved immediately after the procedure in all cases. CONCLUSIONS: This article strives to call attention to this entity when diagnosing ulnar nerve compression. Myectomy and medial epicondylectomy is the preferred treatment option in such cases.

Evaluation of an adapted method of relative growth to determine the susceptibility of Enterobacterales to polymyxin B by MALDI-TOF MS.

Polymyxin B resistance is an emerging problem worldwide. The reference method to determine susceptibility to polymyxins is broth microdilution (BMD). As BMD is time consuming, it is necessary to develop new methodologies to provide faster evaluation of polymyxin susceptibility. This study aimed to evaluate polymyxin B susceptibility of Enterobacterales using an adapted methodology of relative growth (RG) by Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). A total of 60 isolates of Enterobacterales (22 resistant and 38 susceptible to polymyxin B by BMD) were evaluated. The adapted RG technique presented categorical agreement of 96.7% with only 2 major errors (3.3%) in comparison to BMD. Our findings demonstrate a high agreement between BMD and adapted RG, indicating that this methodology is promising for differentiating polymyxin B-susceptible isolates from polymyxin B-resistant isolates and could be implemented routinely in microbiology laboratories that already use the MALDI-TOF MS to identify bacteria.