A parsimonious approach to predict regions affected by sewer-borne contaminants in urban aquifers.

Leaky urban drainage networks (UDNs) exfiltrating wastewater can contaminate aquifers. Detailed knowledge on spatiotemporal distributions of water-dissolved, sewer-borne contaminants in groundwater is essential to protect urban aquifers and to optimize monitoring systems. We evaluated the effect of UDN layouts on the spreading of sewer-borne contaminants in groundwater using a parsimonious approach. Due to the UDN's long-term leakage behavior and the existence of non-degradable sewer-borne contaminants (equivalent to a conservative and constant contaminant source), we employed a concept of horizontal line sources to mimic the UDN layout. This does not require the consideration of bio-degradation processes or temporal delay and effectively bypasses the vadose zone, thus reducing computational requirements associated with a full simulation of leakages. We used a set of synthetic leakage scenarios which were generated using fractals and are based on a real-world UDN layout. We investigated the effects of typical leakage rates, varying groundwater flow directions, and UDN's layouts on the shape of the contaminant plume, disregarding the resulted concentration. Leakage rates showed minimal effects on the total covered plume area, whereas 89% of the variance of the plume's geometry is explained by both the UDN's layout (e.g., length and level of complexity) and groundwater flow direction. We demonstrated the potential of applying this approach to identify possible locations of groundwater observation wells using a real UDN layout. This straightforward and parsimonious method can serve as an initial step to strategically identify optimal monitoring systems locations within urban aquifers, and to improve sewer asset management at city scale.

MiR-139 Affects Radioresistance in Esophageal Cancer by Targeting the PDK1/AKT/Cyclin D1 Signaling Pathway.

We explored the mechanism by which miR-139 modulates radioresistance of esophageal cancer (EC). The radioresistant cell line KYSE150R was obtained from the parental KYSE150 cell line by fractionated irradiation (15×2 Gy; total dose of 30 Gy). The cell cycle was assessed by flow cytometry. A gene profiling study was conducted to detect the expression of genes related to the radioresistance of EC. In the KYSE150R line, flow cytometry revealed increased number of G1-phase cells and decreased number of G2-phase cells; the expression of miR-139 increased. Knockdown of miR-139 decreased radioresistance and changed the distribution of cell cycle phases in KYSE150R cells. Western blotting showed that miR-139 knockdown increased the expression levels of cyclin D1, p-AKT, and PDK1. However, PDK1 inhibitor GSK2334470 reversed this effect for p-AKT and cyclin D1 expression. A luciferase reporter assay indicated that miR-139 directly bound to the PDK1 mRNA 3'-UTR. Analysis of the clinical data from 110 patients with EC showed an association of miR-139 expression with the TNM stage and the effect of therapy. MiR-139 expression significantly correlated with EC and progression-free survival. In conclusion, miR-139 enhances the radiosensitivity of EC by regulating the cell cycle through the PDK1/Akt/Cyclin D1 signaling pathway.

Deep-Learning-Based Parking Area and Collision Risk Area Detection Using AVM in Autonomous Parking Situation.

In this paper, I propose a bird eye view image detection method for parking areas and collision risk areas at the same time in parking situations. Deep learning algorithms using area detection and semantic segmentation were used. The main architecture of the method described in this paper is based on a harmonic densely connected network and a cross-stage partial network. The dataset used for training was calibrated to four 190° wide-angle cameras to generate around view monitor (AVM) images based on the Chungbuk National University parking lot, and an experiment was performed based on this dataset. In the experimental results, the available parking area was visualized by detecting the parking line, parking area, and available driving area in the AVM images. Furthermore, the undetected area in the semantic segmentation as a collision risk area was visualized in order to obtain the results. According to the proposed attention CSPHarDNet model, the experimental results were 81.89% mIoU and 18.36 FPS in a NVIDIA Xavier environment. The results of this experiment demonstrated that algorithms can be used in real time in a parking situation and have better performance results compared to the conventional HarDNet.

The antibiotic resistance of Helicobacter pylori to five antibiotics and influencing factors in an area of China with a high risk of gastric cancer.

BACKGROUND: H. pylori exhibits antibiotic resistance with regional differences. In this paper, we explored antibiotic resistance of H. pylori to five antibiotics in an area with a high risk of gastric cancer. RESULTS: H. pylori resistance rates to metronidazole, levofloxacin, clarithromycin, amoxicillin, and tetracycline were 78.0, 56.0, 31.0, 9.0, and 15.0%, respectively. Double, triple, quadruple, and quintuple resistance rates were 23, 20, 6, and 4%, respectively. The clarithromycin and multidrug resistance rates were significantly higher in males than females (clarithromycin: 44.4% vs 15.2%, respectively, P = 0.002; multidrug: 75.5% vs 37.2%, respectively; P < 0.001). During the three periods of 1998-1999, 2002-2004 and 2016-2017, the resistance rates to levofloxacin and amoxicillin were increasing (OR: 2.089, 95%CI: 1.142-3.821, P = 0.017; and OR: 5.035, 95%CI: 1.327-19.105, P = 0.018, respectively). The antibiotic resistance rates were unassociated with the host disease state. Metronidazole resistance was lower in the vacAs1m1/m2 group than the vacAs1m1m2 group (65% vs 85.7%, respectively; P = 0.026). As for levofloxacin resistance, it was higher with cagA + than cagA- (60.9% vs 23.1%, respectively; P = 0.020) but lower with slyD+ than slyD- (41.4% vs 68.5%, respectively; P = 0.009). Clarithromycin had a lower resistance rate with iceA++ than iceA-+ (19.7% vs 52.4%, respectively; P = 0.017). For amoxicillin, the iceA++ group had a lower resistance rate than the iceA-- group (1.6% vs 27.8%, respectively; P = 0.009). CONCLUSIONS: The total resistance rates of H. pylori to metronidazole, levofloxacin, clarithromycin, amoxicillin, and tetracycline were high in Zhuanghe. The resistanc rates to levofloxacin and amoxicillin increased over time. Clarithromycin resistance was associated with male and iceA. The resistance of metronidazole was related to vacA. Levofloxacin resistance was concerned with cagA and slyD and amoxicillin resistance was concerned with iceA. While, the antibiotic resistance of H. pylori had nothing to do with the status of gastric disease.

Determining of risk areas due to exposure to heavy metals in the Toluca Valley using epiphytic mosses as a biomonitor.

The work aim is to identify the risk areas by exposure to Cr, Cu, Pb and Zn in the Metropolitan Zone of Toluca Valley (MZTV) using the mosses Fabriona cilaris and Leskea angustata as a biomonitors, geostatistical interpolation and multi-criteria evaluation by analytical hierarchy process. The results from the estimation of the enrichment factors (EF) showed that Pb is the heavy metal with the highest values, followed by the Zn, Cu and Cr. The EF obtained for all heavy metals show that there is a moderate to high anthropogenic enrichment. The above indicates that in the MZTV there are emission sources that contribute (significantly) in the amount of Cr, Cu, Pb and Zn accumulated in the biomonitor. Combustion processes, vehicle emissions, biomass burning, brick kiln emissions, agricultural and livestock activities, manufacturing industry and re-deposition by the action of the wind, were identified as the main heavy metals sources in the MZTV. Risk maps showed the high and medium risk areas are located in sites with poor urban vegetation coverage and close to highways and industrial parks. Low risk areas are located in sites with high urban vegetation coverage. The method used for identifying risk areas is a rapid and low-cost evaluation tool can allow local government environmental agencies to define public policies on air pollution control.

Updated incidence rates and risk factors of esophageal cancer in Nan'ao Island, a coastal high-risk area in southern China.

Esophageal cancer (EC) is one of the most common cancers in China. The purpose of this study was to investigate the updated incidence rates and risk factors of EC in Nan'ao Island, where the EC incidence rate was chronically the highest in southern China. To calculate the annual incidence rate, data on 338 EC cases from Nan'ao Cancer Registry system diagnosed during 2005-2011 were collected. A case-control study was conducted to explore the EC risk factors. One hundred twenty-five alive EC patients diagnosed during 2005-2011 and 250 controls were enrolled into the case-control study. A pre-test questionnaire on demography, dietary factors, drinking water treatment, and behavioral factors was applied to collect information of all participants. The average EC incidence rates during 2005-2011 were 66.09/105, 94.62/105, 36.83/105 for both genders, males and females, respectively, in Nan'ao Island. The EC incidence rate in males was 2.40- to 4.55-fold higher than that in females in the period from 2006 to 2011 (P < 0.05). Considering the onset age, males tend to be much younger than females and reached peak incidence rate at a younger age (P < 0.05). Drinking water treatment by filter (odds ratio [OR] = 0.28, 95% confidence interval [95% CI] = 0.13-0.58) and fruit consumption (OR = 0.55, 95% CI = 0.32-0.94) reduced the risk for EC. On the contrary, the pickled vegetables consumption (OR = 2.64, 95% CI = 1.46-4.76) and liquor drinking (OR = 2.32, 95% CI = 1.21-4.44) increased the risk for EC. These results may be of importance for future research on EC etiology and prevention strategies.

Sheep and goats as indicator animals for the circulation of CCHFV in the environment.

Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus, which causes a serious illness with case-fatality rates of up to 80% in humans. CCHFV is endemic in many countries of Africa, Asia and Southeastern Europe. Next to the countries with endemic areas, the distribution of CCHFV is unknown in Southeastern Europe. As the antibody prevalence in animals is a good indicator for the presence or absence of the virus in a region, seroepidemiological studies can be used for the definition of risk areas for CCHFV. The aim of the present study was to reveal which ruminant species is best suited as indicator for the detection of a CCHFV circulation in an area. Therefore, the prevalence rates in sheep, goats and cattle in different regions of Albania and Former Yugoslav Republic of Macedonia were investigated. As there are no commercial tests available for the detection of CCHFV-specific antibodies in animals, two commercial tests for testing human sera were adapted for the investigation of sera from sheep and goats, and new in-house ELISAs were developed. The investigation of serum samples with these highly sensitive and specific assays (94-100%) resulted in an overall prevalence rate of 23% for Albania and of 49% for Former Yugoslav Republic of Macedonia. Significant lower seroprevalence rates for CCHFV were found in cattle than in small ruminants in given areas. These results indicate that small ruminants are more suitable indicator animals for CCHFV infections and should therefore be tested preferentially, when risk areas are to be identified.

Survey data on socioeconomic demographics of drug-free families living in high-risk drug environments in East Coast States of Peninsular Malaysia.

The dataset represents the socioeconomic demographic of drug-free families living in a high-risk drug environment in East Coast states of Peninsular Malaysia. The purposive sampling technique was used to choose among drug free families living in high drug environment, have children aged between 13 and 17 and none of the family members involved in any substance abuse cases via face-to-face interview questionnaires between 3rd April 2021 and 8th April 2021, gathering a total of 200 responses. The survey assessing socioeconomic demographic information (14 items) and involvement in drug prevention programs (8 items). The survey data was analyzed using descriptive analysis through frequencies and percentages. The data will assist the government, policymakers, and researchers to improve the content and delivery of family-based drug prevention programs and improve family awareness on risk and protective factors towards preventing drug abuse among youths.

Ecological Requirements for Abundance and Dispersion of Brazilian Yellow Fever Vectors in Tropical Areas.

In the Americas, wild yellow fever (WYF) is an infectious disease that is highly lethal for some non-human primate species and non-vaccinated people. Specifically, in the Brazilian Atlantic Forest, Haemagogus leucocelaenus and Haemagogus janthinomys mosquitoes act as the major vectors. Despite transmission risk being related to vector densities, little is known about how landscape structure affects vector abundance and movement. To fill these gaps, we used vector abundance data and a model-selection approach to assess how landscape structure affects vector abundance, aiming to identify connecting elements for virus dispersion in the state of São Paulo, Brazil. Our findings show that Hg. leucocelaenus and Hg. janthinomys abundances, in highly degraded and fragmented landscapes, are mainly affected by increases in forest cover at scales of 2.0 and 2.5 km, respectively. Fragmented landscapes provide ecological corridors for vector dispersion, which, along with high vector abundance, promotes the creation of risk areas for WYF virus spread, especially along the border with Minas Gerais state, the upper edges of the Serra do Mar, in the Serra da Cantareira, and in areas of the metropolitan regions of São Paulo and Campinas.

Future land use simulation model-based landscape ecological risk prediction under the localized shared socioeconomic pathways in the Xiangjiang River Basin, China.

Landscape ecological risk (LER) is an effective index to identify regional ecological risk and measure regional ecological security. The localized shared socioeconomic pathways (LSSPs) can provide multi-scenario parameters of social and economic development for LER research. The research of LER under LSSPs is of scientific significance and practical value in curbing the breeding and spread of LER risk areas. In this study, land-cover raster files from 2010 to 2020 were used as the foundational data. Future land use simulation (FLUS), regression, and Markov chain models were used to predict the land cover patterns under the five LSSP scenarios in the Xiangjiang River Basin (XJRB) in 2030. Thus, an evaluation model was established, and the LER of the watershed was evaluated. We found that the rate of land cover change (LCC) in the XJRB between 2010 and 2020 had a higher intensity (increasing at an average of 18.89% per decade) than that projected under the LSSPs for 2020-2030 (averaging an increase of 8.58% per decade). Among the growth rates of all land use types in the XJRB, that of urban land was the highest (33.3%). From 2010 to 2030, the LER in the XJRB was classified as lower risk (33.73%), lowest risk (33.11%), and moderate risk (24.13%) for each decade. Finally, the LER exhibited significant heterogeneity among different scenarios. Specifically, the percentages of regions characterized by the highest (9.77%) and higher LER (9.75%) were notably higher than those in the remaining scenarios. The higher-level risk area under the localized SSP1 demonstrated a clear spatial reduction compared to those of the other four scenarios. In addition, in order to facilitate the differential management and control of LER by relevant departments, risk zoning was carried out at the county level according to the prediction results of LER. And we got three types of risk management regions for the XJRB under the LSSPs.

[Structured patient handover in high-risk areas : Evidence and recommendations for the practical implementation]. / Strukturierte Patientenübergabe in Hochrisikobereichen : Evidenz und Empfehlungen für die praktische Implementierung.

The perioperative setting is a high-risk environment which is particularly susceptible to communication deficits and errors. The situation, background, assessment, recommendation (SBAR) approach provides an intuitive guideline for team communication, which is associated with an improved quality of the handover. The German Society for Anaesthesiology and Intensive Care Medicine (DGAI) has updated its recommendations in March 2022 and continues to endorse the use of the SBAR template. The impact of tools used for structured communication during patient handover are often studied in the context of a larger bundle of measures. The SBAR template is one option for establishing structured communication in clinical practice. Successful implementation is supported by clearly defined standard workflows to promote consistent use. This standardization identifies common communication barriers and assists in resolving them in a high-risk environment. A common understanding of the inherent values, and a shared interest in learning, applying, and training these techniques are paramount in establishing a culture of patient safety. This can only be reached through excellent interprofessional teamwork and supportive leadership.

Pollution threshold assessment and risk area delineation of heavy metals in soils through the finite mixture distribution model and Bayesian maximum entropy theory.

Pollution threshold and high-risk area determination for heavy metals is important for effectively developing pollution control strategies. Based on heavy metal contents in 3627 dense samples, an integrated framework combining the finite mixture distribution model and Bayesian maximum entropy (BME) theory was proposed to assess pollution thresholds, contamination levels and risk areas in an uncertain environment for soil heavy metals. The results showed that the average heavy metal contents were in the order Zn > Cr > Pb > Cu > Ni > As > Cd > Hg, with strong/moderate variation, and the corresponding pollution thresholds were 158.39, 84.29, 47.84, 49.75, 28.95, 18.01, 0.49 and 0.16 mg/kg, respectively. The thresholds were consistently greater than the Zhejiang Province backgrounds but lower than the national risk screening values, except for Cd. Approximately 27.9% of the samples were classified as contaminated at various levels, and they were distributed in the northern, northwestern and eastern regions of the study area. Additionally, 3.73%, 5.34% and 8.22% of the total area were classified as at-risk areas under confidence levels of 95%, 90% and 75%, respectively, through BME theory. The findings provide a reasonable classification system and suggestions for heavy metal pollution management and control.

Risk of Gastric Cancer is Highly Dependent on Type of First-Degree Family Member Affected by Cancer: Lessons from a High-Risk Population in Iran.

Background: Family history of gastric cancer (GC) in first-degree relatives may increase the risk of GC. This study aimed to assess how family history of GC in first-degree relatives really affects the risk of GC in an extremely high-risk population. Methods: A large population-based case-control study was carried out on 1222 incident GC cases and 1235 controls in Ardabil Province-a high-risk area in North-West Iran-to assess the associations of GC family history in first-degree relatives with the risk of GC (2003-2017). Results: GC family history did not significantly associate with the risk of GC overall (ORadj=1.09, 95% CI: 0.80-1.47, P=0.589). It found no significant association of GC family history in a parent, and in a father, mother, and sister separately, with the risk of GC. However, GC risk was significantly associated with a history of GC in a sibling (ORadj=1.61, 95% CI: 1.11-2.35, P=0.013), especially brother (ORadj=2.24, 95% CI: 1.41-3.64, P=0.0008). The risk was greatly increased in subjects with two or more affected brothers (ORadj =5.56, 95% CI: 2.33-14.20, P=0.0002). Conclusion: We did not find a familial tendency to cardia GC and non-cardia GC as well as histopathologic features. Determining the type of first-degree relationships with GC may, therefore, be more important than assessing family history alone for predicting the risk of GC in this high-risk area.

No Excess of Mortality from Lung Cancer during the COVID-19 Pandemic in an Area at Environmental Risk: Results of an Explorative Analysis.

BACKGROUND: The COVID-19 pandemic and the restrictive measures associated with it placed enormous pressure on health facilities and may have caused delays in the treatment of other diseases, leading to increases in mortality compared to the expected rates. Areas with high levels of air pollution already have a high risk of death from cancer, so we aimed to evaluate the possible indirect effects of the pandemic on mortality from lung cancer compared to the pre-pandemic period in the province of Taranto, a polluted site of national interest for environmental risk in the south of Italy. METHODS: We carried out a retrospective observational study on lung cancer data (ICD-10: C34) from the Registry of Mortality (ReMo) for municipalities in Taranto Province over the period of 1 January 2011 to 31 December 2021. Seasonal exponential smoothing, Holt-Winters additive, Holt-Winters multiplicative, and auto-regressive integrated moving average (ARIMA) models were used to forecast the number of deaths during the pandemic period. Data were standardized by sex and age via an indirect method and shown as monthly mortality rates (MRs), standardized mortality ratios (SMRs), and adjusted mortality rates (AMRs). RESULTS: In Taranto Province, 3108 deaths from lung cancer were recorded between 2011 and 2021. In the province of Taranto, almost all of the adjusted monthly mortality rates during the pandemic were within the confidence interval of the predicted rates, with the exception of significant excesses in March (+1.82, 95% CI 0.11-3.08) and August 2020 (+2.09, 95% CI 0.20-3.44). In the municipality of Taranto, the only significant excess rate was in August 2020 (+3.51, 95% CI 0.33-6.69). However, in total, in 2020 and 2021, the excess deaths from lung cancer were not significant both for the province of Taranto (+30 (95% CI -77; +106) for 2020 and +28 (95% CI -130; +133) for 2021) and for the municipality of Taranto alone (+14 (95% CI -47; +74) for 2020 and -2 (95% CI -86; +76) for 2021). CONCLUSIONS: This study shows that there was no excess mortality from lung cancer as a result of the COVID-19 pandemic in the province of Taranto. The strategies applied by the local oncological services during the pandemic were probably effective in minimizing the possible interruption of cancer treatment. Strategies for accessing care in future health emergencies should take into account the results of continuous monitoring of disease trends.

Defining a risk area for tick-borne encephalitis (TBE) in a country where TBE is emerging, the Netherlands, July 2016-October 2020.

TBE is an emerging infectious disease in the Netherlands since July 2016, and risk areas have not been defined yet. Until October 2020 twelve autochthonous cases of TBE have been identified. In six of these cases transmission of TBE virus likely occurred in the Twente region, which therefore is the region with the highest case number and risk of contracting the disease. Here we summarize the Twente cases so far and discuss if the Twente region should be considered a risk-area using criteria of traditional TBE endemic countries, and the public health measures that may accompany such designation.

Identification of risk areas for Orobanche cumana and Phelipanche aegyptiaca in China, based on the major host plant and CMIP6 climate scenarios.

Parasitic broomrape of the genus Orobanche poses a formidable threat to producing many crops in Europe, Africa, and Asia. Orobanche cumana and Phelipanche aegyptiaca are two of China's most destructive root parasitic plants, causing extreme sunflower, tomato, melon, and tobacco damage. However, the potentially suitable areas of O. cumana and P. aegyptiaca in China have not been predicted, and little is known about the important environmental factors that affect their extension. Due to their invasiveness and economic importance, studying how climate change and host plants may affect broomrapes' distribution is necessary. In the study, we first predicted the potentially suitable areas of the invasive weeds (O. cumana and P. aegyptiaca) and their susceptible host plants (Helianthus annuus and Solanum lycopersicon) using MaxEnt. Then, the risk zones and distribution shifts of two broomrapes under different climate conditions were identified by incorporating the distribution of their susceptible host plants. The results highlighted that the potential middle- and high-risk zones for O. cumana and P. aegyptiaca amounted to 197.88 × 104 km2 and 12.90 × 104 km2, respectively. Notably, Xinjiang and Inner Mongolia were the highest-risk areas within the distribution and establishment of O. cumana and P. aegyptiaca. Elevation and topsoil pH were the decisive factors for shaping O. cumana distribution; precipitation seasonality and annual precipitation were the dominant bioclimatic variables limiting the spread of P. aegyptiaca. The potentially suitable areas and risk zones of O. cumana would decrease significantly, and those of P. aegyptiaca would fluctuate slightly under future climate change scenarios. Overall, our study suggested that the two broomrapes' risk zones will significantly northward to higher latitudes. The results will provide suggestions for preventing O. cumana and P. aegyptiaca.

Identification and uncertainty analysis of high-risk areas of heavy metals in sediments of the Yangtze River estuary, China.

In this study, ordinary kriging (OK) and indicator kriging (IK) were used to analyze the uncertainty associated with high-risk areas of seven heavy metals (As, Cd, Cr, Cu, Hg, Pb, and Zn) in sediments of the Yangtze River estuary during four seasons. The OK results showed that the high-risk areas of Cd, Cr, Cu, Hg, and Pb had a high proportion, with the highest corresponding to Cr pollution (up to 60%). Predictions based on IK revealed that the proportion of high-risk areas of Cr, Cd, and Hg pollution were high, especially that of Cr was higher than 90%. However, there were uncertainties between the OK and IK results. The uncertainty results revealed that the uncertainty areas of Cr pollution were relatively large, accounting for about 30%, while those of Cd, Cu, and Hg pollution were lower than 10%.

Asymmetric distribution of pathogenic low wall shear stress of the bilateral subclavian arteries: two case reports.

The effects of increasing blood flow on the pathogenic wall shear stress (pWSS) of subclavian arteries (SAs) are currently unclear. Patient-specific models of the SA were constructed based on computed tomographic images from two patients. Using the Ansys Fluent 19.0 transient laminar flow solver, the finite volume method was chosen to solve the Navier-Stokes equation governing fluid behavior. The time-averaged wall shear stress, ratio of risk area, cumulative ratio of risk area (P¯), ratio of risk time, and ratio contour of risk time were calculated to describe the temporal and spatial distributions of pWSS. Virtually all pWSS occurred during the diastolic phase. The P¯ was 2.3 and 1.29 times higher on the left than on the right in Patients 1 (P1) and 2 (P2), respectively. Increasing the blood flow volume of the left SA by 20%, 40%, and 60% led to a 9.27%, 15.10%, and 20.99% decrease in P¯ for P1 and a 5.74%, 11.55%, and 17.14% decrease in P¯ for P2, respectively, compared with baseline values. In conclusion, the left SA showed greater diastolic pWSS than the right SA, and increasing the blood flow volume reduced the pWSS in the left SA.

Tick-borne encephalitis virus (TBEV) prevalence in field-collected ticks (Ixodes ricinus) and phylogenetic, structural and virulence analysis in a TBE high-risk endemic area in southwestern Germany.

BACKGROUND: Tick-borne encephalitis (TBE) is the most common viral CNS infection with incidences much higher than all other virus infections together in many risk areas of central and eastern Europe. The Odenwald Hill region (OWH) in southwestern Germany is classified as a TBE risk region and frequent case numbers but also more severe infections have been reported within the past decade. The objective of the present study was to survey the prevalence of tick-borne encephalitis virus (TBEV) in Ixodes ricinus and to associate TBEV genetic findings with TBE infections in the OWH. METHODS: Ticks were collected by the flagging methods supported by a crowdsourcing project implementing the interested public as collectors to cover completely and collect randomly a 3532 km2 area of the OWH TBE risk region. Prevalence of TBEV in I. ricinus was analysed by reversed transcription quantitative real-time PCR. Phylogeographic analysis was performed to classify OWH TBEV isolates within a European network of known TBEV strains. Mutational sequence analysis including 3D modelling of envelope protein pE was performed and based on a clinical database, a spatial association of TBE case frequency and severity was undertaken. RESULTS: Using the crowd sourcing approach we could analyse a total of 17,893 ticks. The prevalence of TBEV in I. ricinus in the OWH varied, depending on analysed districts from 0.12% to 0% (mean 0.04%). Calculated minimum infection rate (MIR) was one decimal power higher. All TBEV isolates belonged to the European subtype. Sequence analysis revealed a discontinuous segregation pattern of OWH isolates with two putative different lineages and a spatial association of two isolates with increased TBE case numbers as well as exceptional severe to fatal infection courses. CONCLUSIONS: TBEV prevalence within the OWH risk regions is comparatively low which is probably due to our methodological approach and may more likely reflect prevalence of natural TBEV foci. As for other European regions, TBEV genetics show a discontinuous phylogeny indicating among others an association with bird migration. Mutations within the pE gene are associated with more frequent, severe and fatal TBE infections in the OWH risk region.

Which genotype of Helicobacter pylori-cagA or cagE-Is better associated with gastric Cancer risk? Lessons from an extremely high-risk area in Iran.

The association of the H. pylori cagA- /cagE-positive genotypes with the risk of gastric cancer (GC) in Ardabil-a high-risk area in North-West Iran-was assessed. Genotyping was performed in DNA from fresh gastric biopsies (N = 218). Occurrence of H. pylori infection was 85.32% (186/218). The total frequency of the cagA+vs. cagA-, cagE+vs. cagE-, cagA+/cagE-vs. AGCs (all genotype combinations), cagA-/cagE+vs. AGCs, cagA-/cagE-vs. AGCs, cagA+/cagE+vs. AGCs, cagA+/cagE-vs. cagA-/cagE+, and cagA+/cagE+vs. cagA-/cagE- genotypes was 102/186 (54.8%), 89/186 (47.8%), 38/186 (20.4%), 25/186 (13.4), 59/186 (31.7%), 64/186 (34.4%), 38/63 (38.63%), and 64/123 (52.0%), respectively. The cagE+vs. cagE- (59.6% (65/109) in GC vs. 31.2% (24/77) in non-atrophic gastritis, NAG) and the cagA+/cagE+vs. cagA-/cagE- genotypes (66.7% (40/60) in GC vs. 38.1% (24/63) in NAG) showed an increased association with the risk of GC in Ardabil (odds ratio [OR] = 3.262, 95% confidence interval [CI]: 1.763-6.038, p = .0001 and OR = 3.250; 95% CI: 1.552-6.808, p = .002, respectively). We propose that the H. pylori cagE+ but not cagA+ genotype significantly increased the risk of GC in this extremely high-risk population. Therefore, it may play a significant role in determining H. pylori-related clinical outcome.