Toward a Universal Unit for Quantification of Antibiotic Resistance Genes in Environmental Samples.

Surveillance of antibiotic resistance genes (ARGs) has been increasingly conducted in environmental sectors to complement the surveys in human and animal sectors under the "One-Health" framework. However, there are substantial challenges in comparing and synthesizing the results of multiple studies that employ different test methods and approaches in bioinformatic analysis. In this article, we consider the commonly used quantification units (ARG copy per cell, ARG copy per genome, ARG density, ARG copy per 16S rRNA gene, RPKM, coverage, PPM, etc.) for profiling ARGs and suggest a universal unit (ARG copy per cell) for reporting such biological measurements of samples and improving the comparability of different surveillance efforts.

Application of hybrid anaerobic reactor: Treatment of increasing cyanide containing effluents and microbial composition identification.

The study endeavors the anaerobic treatment of cyanide-containing effluents using the hybrid anaerobic reactor, with self-immobilized granules under high up-flow velocities. Comparison of one-year time-course analyses of HARs treating high strength effluents containing cyanide and control indicates the importance of wastewater characteristics in development and maintenance of microbiome. Efforts were directed towards associating process performance with microbial dynamics. Presence of cyanide results in the accumulation of intermediates paralleled with a drop in abundance of sensitive aceticlastic methanogens. HAR appear to have better resilience than other identified digesters because of shielding effects and enhanced granule-wastewater contact. The predominance of Methanobacteriales in the presence of cyanide can be linked to its tolerance. It was found that methane yield is positively correlated with abundance of aceticlastic guilds (R = 0.830, CI = 0.01). Tolerant bacterial groups were also identified. The study advances our knowledge related to less energy intensive technology with the focus on the development of efficient HAR.

Factors affecting breastfeeding practices among working women in Pakistan.

In urban areas of Pakistan, women's return to work after giving birth has frequently been found to be a main contributor to the early termination of breastfeeding. This study aimed to assess workplace breastfeeding support provided to working mothers in Pakistan. In a cross-sectional survey in 2014, mothers and employers from a representative sample of 297 workplaces were interviewed using a pre-tested questionnaire. Mothers from 36 (12.1%) sites reported receiving breastfeeding breaks, and 86% of the mothers had received 3 months paid maternity leave. Provision of a lighter job and information about breastfeeding options on return to work were reported from 15% and 5% of the workplaces, respectively. Only two sites had designated breastfeeding corners. Significantly different results were found between types of employer (government or private) and type of organization (national or multinational) with regard to breastfeeding breaks, breastfeeding corners, lighter jobs and paid maternity leave. Public and multinational companies were slightly better than private and national ones in providing breastfeeding facilities.

Achilles tendinopathy in club runners.

Ultrasound (US) changes within the Achilles tendon are present in asymptomatic Achilles individuals. We assessed the association of US signs with symptoms of Achilles tendinopathy in a study group of club level running athletes and in a control group of athletes training at least 2 times per week. The Achilles tendon was assessed in its entirety on longitudinal US scans, at the musculotendinous junction (MTJ), the calcaneal insertion site, and at a midtendon point. 25 middle distance runners, 19 males and 6 females, aged from 18 to 58, were enrolled in each group. When compared to control athletes, club level runners presented significantly increased tendon thickness (p=0.046) at the musculo-tendinous junction, and increased tendon thickness, with no statistical significance, at the other landmarks points. Although club level runners were significantly more symptomatic and predisposed to develop signs of tendinopathy than control athletes (p=<0.001), ultrasound abnormalities were not significantly associated with local symptoms complained at the US investigation time. Prospective studies on asymptomatic athletes are needed to define the predictive value of US signs of Achilles tendinopathy in the development of symptoms in the long-term.

Feasibility tests for treating shampoo and hair colorant wastewaters using anaerobic processes.

Wastes from the personal care product (PCP) industry are often high in biodegradable carbon, which makes them amenable to aerobic biological treatment, although process costs are usually high due to aeration inefficiencies, high electricity demand and production of large amounts of sludge. As such, anaerobic treatment technologies are being considered to lower net energy costs by reducing air use and increasing methane production. To assess the amenability of PCP wastes to anaerobic treatment, methane yields and rates were quantified in different anaerobic reactors treating typical PCP wastes, including wastes from shampoo and hair colorant products. Overall, shampoo wastes were more amenable to methanogenesis with almost double the methane yields compared with colour wastes. To assess relevant microbial guilds, qPCR was performed on reactor biomass samples. Methanosaetaceae abundances were always significantly higher than Methanosarcinaceae and Methanomicrobiales abundances (P < 0.05), and did not differ significantly between waste types. Although colour wastes were less amenable to anaerobic treatment than shampoo wastes, differences cannot be explained by relative microbial abundances and probably result from the presence of inhibiting compounds in hair colorants (e.g., oxidants) at higher levels. Results showed that anaerobic technologies have great potential for treating PCP wastes, but additional work is needed to establish the basis of elevated methane yields and inhibition, especially when colorant wastes are present.

Decreased mortality in coronavirus disease 2019 associated mucormycosis with aspirin use: a retrospective cohort study.

OBJECTIVE: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. METHOD: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. RESULTS: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan-Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). CONCLUSION: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.

Proceedings from the Inaugural Conference of the Society of Women in Maxillofacial Surgery, 18th May 2019, Bristol.

The number of women studying in medical schools is increasing, and the relative proportion of female consultants in surgical and leadership roles is lagging behind, relatively, and so a new drive for promoting and supporting women in surgery has evolved. A part of this was the creation of the Society of Women in Oral and Maxillofacial Surgery. This short communication gives proceedings of the inaugural conference of SWiMS and discusses the need for greater promotion of women in the speciality (and the profession at large) and how the society has addressed the need for resilience and community in surgical training and beyond.

Aseptic meningitis and abducens nerve palsy as a serious side effect of high dose intravenous immunoglobulin used in a patient with renal transplantation.

Immune globulin intravenous (human) (IGIV) is effective in the treatment of various autoimmune and inflammatory disorders. Recently, high-dose IGIV 2 g/kg has been utilized in the treatment of antibody-mediated rejection in solid organ transplantation. We report a renal transplant recipient who developed aseptic meningitis and diplopia from abducens nerve (cranial nerve VI) palsy following IGIV administration for antibody-mediated rejection. Potential mechanisms of the IGIV-related aseptic meningitis are elaborated. Clinicians should be aware of aseptic meningitis and cranial nerve palsy as an adverse reaction to IGIV exposure and monitor for its signs and symptoms.

Effect of electrode surface properties on enhanced electron transfer activity in microbial fuel cells.

The influence of electrode surface chemistry over biofilm growth was evaluated for photo-bioelectrocatalytic fuel cell. A consortium of photosynthetic bacteria was grown onto different electrodes designed with polyethylenimine (PEI) and multiwall carbon nanotubes as hydrophilic and hydrophobic modifier, respectively. The designed electrodes were loaded with 0.08, 0.17, and 0.33 µg/cm2 of PEI to change the hydrophilicity. However, 0.56, 0.72, and 0.83 mg/cm2 of multiwall carbon nanotubes were used to alter the hydrophobicity of the electrodes. The surface chemistry of electrode and bio-interaction was evaluated as a function of contact angle and biofilm formation. The results were compared with those obtained with a carbon paper electrode. The contact angle on the untreated electrode (carbon paper) was 118°, whereas for hydrophobic and hydrophilic electrodes, the maximum and minimum contact angles were 170° and 0°, respectively. Interestingly, the maximum biofilm growth (0.2275 g, wet basis) was observed on highly hydrophobic surface; however, the maximum electrochemical performance (246 mV) was shown by the most hydrophilic electrode surface. PEI-based electrode with good biofilm formation showed comparatively higher electrogenic activity.

Two-week wait false alarms? A prospective investigation of 2WW head and neck cancer referrals.

Objectives i) To prospectively explore patients' experience through the two-week wait (2WW) referral process; ii) To compare the relative true malignancy diagnostic rate between general medical practitioners (GMPs) and general dental practitioners (GDPs) over a six-month period; iii) To compare management of 2WW referral cases between GMPs and GDPs before the referral and during the 2 weeks in regards to symptomatic support, investigations in primary care, and information communicated to patients and secondary care clinicians; iv) To investigate the benign conditions that comprise 2WW referrals by finding out the final diagnoses of all cases included in the study.Method The patient inclusion criteria were all 2WW referral patients who attended consultation clinics during the six-month study period in Royal Cornwall Hospital NHS Trust. We prospectively distributed patient questionnaires and clinician's referral assessment forms. We obtained the final diagnoses of all participants electronically, and also identified all malignancies diagnosed via routine referral route during the study period from the cancer services team.Results Two hundred and twenty patients referred via 2WW pathway participated in the study. Of these, 148 referrals were from GMPs and 72 from GDPs. The overall malignancy diagnostic yield was 6.2%; markedly higher from GMPs (9.5%) than GDPs (1.4%), and higher number than those from routine pathway. The GMPs and GDPs showed similar levels of clinical management and information exchange judging from the participants' responses. We also identified the top nine most commonly urgently referred benign conditions.Conclusion We reiterate the need for improved communication between clinicians and patients and between clinicians. We also suggest more focus on education in commonly encountered conditions as well as malignant lesions. The number of 2WW referrals we received from GMPs was nearly twice as many as those from GDPs, highlighting the importance of delivering oral medicine education to medical students, trainees and GMPs.

Thrombotic thrombocytopenic purpura: brain CT and MRI findings in 12 patients.

Clinical-neuroimaging analysis of 12 thrombotic thrombocytopenic purpura (TTP) patients revealed a variety of brain lesions. These included reversible cerebral edema lesions with MRI features of reversible posterior leukoencephalopathy syndrome (RPLS). Most of the RPLS patients had hypertension and renal dysfunction, suggesting RPLS due to hypertensive encephalopathy. Prompt treatment usually led to neurologic recovery and disappearance of edematous lesions. Those with infarcts or hematomas had a poorer outcome. TTP should be added to the expanding spectrum of RPLS and hypertensive encephalopathy.

Fatigue in multiple sclerosis: cross-sectional correlation with brain MRI findings in 71 patients.

Fatigue is an unexplained but common and disabling symptom in MS. We assessed fatigue in 71 patients with MS and identified MS-fatigue (MSF) and MS-nonfatigue (MSNF) groups. Fatigue severity did not correlate with regional or global MRI plaque load or atrophy assessed by conventional sequences. No significant differences were noted in any MRI measures between MSF and MSNF groups. We suggest that brain MRI disease topography or severity does not explain fatigue in MS and that fatigue is likely due to mechanisms poorly characterized by conventional MRI.

Differences in the uptake of cadmium and mercury by rat hepatocyte primary cultures. Role of a sulfhydryl carrier.

Studies measuring the uptake of cadmium or mercury in isolated hepatocytes demonstrated that hepatocytes accumulated more cadmium than mercury in serum-containing medium, serum-free medium, or balanced salt solution. The preferential hepatocellular accumulation of cadmium, independent of medium composition, suggested that the uptake mechanism for cadmium and mercury might be different in hepatocytes. Pretreatment of hepatocytes with 50 microM N-ethylmaleimide decreased cadmium uptake by 23% while having no effect on the uptake of mercury was inhibited in a concentration-dependent manner. The uptake of cadmium was maximally inhibited (80%) with 75 microM parachloromercuribenzenesulfonate or 20 microM mercury respectively. Cadmium had no effect on mercury. Hepatocytes treated with parachloromercuribenzenesulfonate or mercury accumulated cadmium at a rate closely resembling the rate of mercury uptake in untreated hepatocytes. These results suggested that an SH-containing carrier may be operative in the uptake of cadmium by hepatocytes. Mercury can interact with this carrier to inhibit cadmium uptake; however, this carrier does not appear to facilitate mercury uptake.

Sex differences in hepatic and renal cadmium accumulation and metallothionein induction. Role of estradiol.

The role of estradiol in sex differences in hepatic and renal cadmium accumulation and metallothionein (MT) induction was investigated. Male and female rats and castrated males pretreated with estradiol were injected either i.v. or s.c. with 10 mumol CdCl2/kg. Sex differences in cadmium accumulation and MT induction were apparent after s.c. but not i.v. administration. The female rats accumulated a significantly greater concentration of cadmium in their liver than did the males, as early as 1 hr after the s.c. injection. The elevated levels of cadmium in the females were maintained for at least 10 days. Pretreatment of castrated males with estradiol caused a similarly greater accumulation of cadmium in the liver. Hepatic MT levels peaked in the females at 24 hr and in males 48-72 hr after the cadmium injection and then declined to lower levels. This superinduction of MT occurred only after the s.c. administration of cadmium. MT levels in both sexes plateaued 5 days after the s.c. injection to the levels that were similar to those seen in male and female rats 24 hr after an i.v. injection. In animals injected s.c. with cadmium the renal cadmium levels continued to rise for 5-10 days; however, in animals injected i.v. the levels stabilized within 2 hr. The renal MT levels in the females were significantly higher than in the males. Estradiol pretreatment induced renal MT but did not affect renal cadmium accumulation. Thus, the sex differences in hepatic cadmium accumulation and MT induction are affected by the route and time after the administration of cadmium. Furthermore, estradiol causes a more rapid uptake of cadmium by the liver and also an enhanced induction of MT in both the liver and kidney.

Urinary metallothionein as an indicator of cadmium body burden and of cadmium-induced nephrotoxicity.

There is a need to identify specific biological indicator(s) of cadmium exposure so that the renal damage can be prevented. Towards this end, we have examined the usefulness of urinary metallothionein as an indicator of cadmium body burden. It is found that, in both animals and humans, urinary metallothionein level is related to the hepatic and renal cadmium burdens. Significant correlations are also found between the urinary metallothionein and urinary cadmium and beta 2-microglobulin. Furthermore, it is noted that cadmium-exposed individuals with renal dysfunction excrete significantly more metallothionein than those with normal renal function. Thus it appears that there is merit to include metallothionein among the clinical parameters monitored in cadmium-exposed individuals. More tests are needed to define a critical concentration of metallothionein in urine which is related to the onset of renal dysfunction.

Metallothionein in the extracellular fluids as an index of cadmium toxicity.

In rats injected with 5 micron mole CdCl2/kg, 5 days/week, metallothionein was detected in plasma by gel filtration chromatography as early as four weeks. The mean renal concentration of cadmium was 80 microgram/g. The excretion of cadmium in urine at this time was rather low and amounted to 0.01% of the total dose. The amount of metallothionein in plasma, as determined by 109Cd-binding to the 10,000 molecular weight fraction, increased markedly during week 14. Its excretion in urine, however, did not start until about 10 weeks, when the cadmium concentration in kidney approached a mean value of 212 microgram/g. Signs of renal toxicity were evident from glucosuria and proteinuria which became severe during the next four weeks. The excretion of cadmium in urine increased markedly and the majority of it was in the form of metallothionein. It is suggested that the appearance of metallothionein in plasma and urine can be used as specific indices of cadmium poisoning and that the assay of the protein in these fluids may be useful in screening for excessive cadmium exposure.

Metal transport in cells: cadmium uptake by rat hepatocytes and renal cortical epithelial cells.

The toxic metals appear to use the transport pathways that exist for biologically essential metals. In this regard interactions between the toxic and essential metals are possible. This report summarizes recent findings on the transport of cadmium in rat hepatocytes and renal cortical epithelial cells in the presence or absence of certain essential metals. The transport of cadmium in hepatocytes does not require energy and, therefore, is not an active process. It occurs primarily (80%) by temperature-sensitive processes, i.e., ion channels and carriers, that involve interaction with sulfhydryl groups. These processes apparently exist for the transport of essential metals like copper, zinc and calcium. The remaining 20% of the cadmium in hepatocytes is transported via a temperature-insensitive process, possibly by diffusion. In comparison with the hepatocytes, a smaller fraction (30%) of the cadmium transport through the basolateral membrane and none from the apical membrane of the renal cortical epithelial cells is temperature-sensitive. Total accumulation through the basolateral membrane is about twice that through the apical membrane. A majority of the cadmium transport in the renal cells is by diffusion. As in hepatocytes, copper, zinc and mercury antagonize cadmium transport through the apical membranes of the renal cells. The relative antagonism by copper is the same (25%); however, the antagonism by zinc (16%) and mercury (10%) is 4- to 6-fold lower than in hepatocytes. It appears that the relative contribution of various transport pathways available for cadmium uptake is different in each cell type and apparently depends on the morphological and functional differences between the cell membranes.

MRI T2 shortening ('black T2') in multiple sclerosis: frequency, location, and clinical correlation.

Abnormal iron deposition occurs in the brains of patients with multiple sclerosis (MS) and may cause MRI T2 shortening ('black T2'; BT2). The frequency, distribution and clinical significance of BT2 in MS is unknown. Analysis of brain MRI scans of 114 MS patients showed BT2 in thalamus (n = 65; 57%), putamen (n = 48; 42%), caudate (n = 27; 24%) and Rolandic cortex (n = 9; 8%). BT2 was significantly related to longer disease duration and advancing neurological disability. Wheelchair-bound patients had worse BT2 in thalamus (p < 0.05), putamen (p < 0.001) and Rolandic cortex (p < 0.05). Patients with secondary progressive disease (n = 34) had worse BT2 in thalamus, putamen and caudate (all p < 0.05) than those with relapsing remitting disease (n = 80). BT2 is proposed as a clinically relevant finding relating to neuronal degeneration in MS.