Vital Signs: Health Care-Associated Legionnaires' Disease Surveillance Data From 20 States and a Large Metropolitan Area-United States, 2015.

BACKGROUND: Legionnaires' disease, a severe pneumonia, is typically acquired through inhalation of aerosolized water containing Legionella bacteria. Legionella can grow in the complex water systems of buildings, including health care facilities. Effective water management programs could prevent the growth of Legionella in building water systems. METHODS: Using national surveillance data, Legionnaires' disease cases were characterized from the 21 jurisdictions (20 U.S. states and one large metropolitan area) that reported exposure information for ≥90% of 2015 Legionella infections. An assessment of whether cases were health care-associated was completed; definite health care association was defined as hospitalization or long-term care facility residence for the entire 10 days preceding symptom onset, and possible association was defined as any exposure to a health care facility for a portion of the 10 days preceding symptom onset. All other Legionnaires' disease cases were considered unrelated to health care. RESULTS: A total of 2,809 confirmed Legionnaires' disease cases were reported from the 21 jurisdictions, including 85 (3%) definite and 468 (17%) possible health care-associated cases. Among the 21 jurisdictions, 16 (76%) reported 1-21 definite health care-associated cases per jurisdiction. Among definite health care-associated cases, the majority (75, 88%) occurred in persons aged ≥60 years, and exposures occurred at 72 facilities (15 hospitals and 57 long-term care facilities). The case fatality rate was 25% for definite and 10% for possible health care-associated Legionnaires' disease. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Exposure to Legionella from health care facility water systems can result in Legionnaires' disease. The high case fatality rate of health care-associated Legionnaires' disease highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification.

Spatial Relationship of Maxillary Posterior Teeth with Maxillary Sinus Floor in Sagittal, Coronal and Axial Planes by Using Cone-Beam Computed Tomography in a Subpopulation of Central India.

Inadvertent perforation of the root apex during endodontic procedure in maxillary posterior teeth may unnecessarily invite the complications of sinusitis or inflammatory responses. This becomes even more important when performing endodontic surgical procedures. Thus, it is mandatory to have the precise knowledge of anatomic structures which are in close proximity to the apex of roots and its variations among different geographic area. This retrospective observational study was performed in the Central India to assess the spatial relationships between the maxillary second pre-molar (sPM), maxillary first molar (M1), maxillary second molar (M2) with the maxillary sinus floor using cone beam computed tomography (CBCT) in all three axial, sagittal and coronal sections from year 2016 to 2021. Three hundred and sixty teeth were examined through sixty full volumes CBCT scans of the patients in between year 2016-2021 in Indore, (MP, India). The Distances (D) between the examined roots and the sinus floor, were evaluated using CBCT in all three sections, and grouped in 7 classes. To simplify, Class 1 and 2 were grouped as Negative Configuration where apices are protruding into sinus floor, Class 3 as Zero and Class 4-7 as Positive configuration. The data were analyzed statistically using SPSS system. The prevalence of class 1 and 2 (negative configuration) was the highest for the Palatal of M1 (16.67%) followed by Distobuccal of M1 (13.34%). The prevalence of class 3 that is Zero configuration was the highest for the Mesiobuccal of M2 (63.33%). The results suggested all the three teeth roots showed closed proximity with sinus floor, closest relationship with the sinus floor was seen in palatal of M1 in this study.

Ubiquilin1 represses migration and epithelial-to-mesenchymal transition of human non-small cell lung cancer cells.

Ubiquilin1 (UBQLN1) is a ubiquitin-like domain and a ubiquitin-associated domain containing protein that has been reported to be involved in shuttling proteins to the proteasome, especially during endoplasmic reticulum-associated protein degradation. Thus, UBQLN1 function has been shown to be critical for combating a number of neurological disorders caused by protein aggregation, such as amyotrophic lateral sclerosis, Alzheimer's disease and Huntington's disease. A role for UBQLN1 in regulating processes involved in tumorigenesis has not been demonstrated. Herein, we show that loss of UBQLN1 causes increased cell migration and invasion, actin cytoskeleton reorganization and induction of epithelial-to-mesenchymal transition (EMT). Loss of UBQLN1 results in a significant decrease in the expression of epithelial markers including E-cadherin and claudin1, whereas expression of mesenchymal markers including Vimentin, Snail and ZEB1 are significantly elevated. Interestingly, we found that ZEB1 is required for induction of mesenchymal-like properties following loss of UBQLN1 and ZEB1 is capable of repressing expression of UBQLN1, suggesting a physiological, reciprocal regulation of EMT by UBQLN1 and ZEB1. Further, we find evidence for a role for UBQLN2 in also regulating EMT and cell migration. These observations have potential clinical relevance because the UBQLN1 gene is lost and underexpressed in a large percentage of human cancer cell lines, and primary human lung cancer samples and recurrent mutations in all five UBQLN family members have been identified in human lung cancers. Taken together, our results suggest for the first time a role for UBQLN family members in cancer biology.

Spiral ganglion neurons are protected from degeneration by GDNF gene therapy.

Perceptual benefits from the cochlear prosthesis are related to the quantity and quality of the patient's auditory nerve population. Multiple neurotrophic factors, such as glial cell line-derived neurotrophic factor (GDNF), have been shown to have important roles in the survival of inner ear auditory neurons, including protection of deafferented spiral ganglion cells (SGCs). In this study, GDNF gene therapy was tested for its ability to enhance survival of SGCs after aminoglycoside/diuretic-induced insult that eliminated the inner hair cells. The GDNF transgene was delivered by adenoviral vectors. Similar vectors with a reporter gene (lacZ) insert served as controls. Four or seven days after bilateral deafening, 5 microl of an adenoviral suspension (Ad-GDNF or Ad-lacZ) or an artificial perilymph was injected into the left scala tympani of guinea pigs. Animals were sacrificed 28 days after deafening and their inner ears prepared for SGC counts. Adenoviral-mediated GDNF transgene expression enhanced SGC survival in the left (viral-treated) deafened ears. This observation suggests that GDNF is one of the survival factors in the inner ear and may help maintain the auditory neurons after insult. Application of GDNF and other survival factors via gene therapy has great potential for inducing survival of auditory neurons following hair cell loss.

Impact of hypoxemia on the performance of cerebral oximeter in volunteer subjects.

Adverse neurological events during hypoxic episodes in high-risk patients or in patients not thought to be at risk while undergoing procedures increase morbidity and mortality. The ability to reliably monitor cerebral oxygenation could serve as an indicator for the need of therapeutic intervention and it's overall effect. This study was designed to verify the reliability of the only commercially available continuous noninvasive monitor, the INVOS 3100 (Somanetics Corp., Troy, MI), in subjects with varying levels of hypoxemia. Six adult volunteer subjects were enrolled. After placement of electrocardiogram (EKG), noninvasive blood pressure (NIBP), pulse oximeter (SpO2), cerebral oximeter (rSO2), a 20 g radial artery catheter, and a 4 F oximetric jugular bulb catheter, the subjects were given hypoxic mixtures to breathe to varying levels of desaturation. Arterial and mixed venous blood was drawn for blood-gas analysis at each level of O2 saturation. The cerebral hemoglobin saturation value from the cerebral oximeter was compared to the combined brain saturation using the formula: estimated field saturation between the light source and the detector (fSO2) = 0.25 x the arterial oxygen saturation (SaO2) + 0.75 x the jugular bulb venous oxygen saturation (SjvO2), (fSO2 = 0.25 SaO2 + 0.75 SjvO2). Statistical analysis demonstrated a correlation of 0.67 between rSO2 and fSO2 and a bias of -3.1% with a precision of 12.1%. Minimal bias of 0.38% and precision of 6.22% were calculated for transitional error. We concluded from the study that rSO2 may serve as a reliable indicator of changes in brain oxygenation induced by hypoxemia.

Procedures: do we really want to know them? An examination of the effects of procedural justice on self-esteem.

This study examined the effects of procedural justice on state-dependent self-esteem using the group-value model and attribution theory to present competing theoretical perspectives. The group-value model predicts a positive relationship between self-esteem and fair procedures. In contrast, attribution theory suggests procedural fairness interacts with outcome favorability to influence self-esteem. Thus, fair procedures will result in higher self-esteem ratings than unfair procedures when the outcome is positive but will result in lower self-esteem ratings than unfair procedures when the outcome is negative. The results of a laboratory and field study provide converging evidence to support the attribution theory predictions. The results of a 2nd laboratory study suggest that self-esteem is influenced by outcome expectancies, not actual outcomes.

Amebic pericarditis following ruptured right liver lobe abscess.

We present an unusual case of suppurative pericarditis following rupture of a solitary right lobe amebic liver abscess. The condition was treated successfully by drainage of the liver abscess alone.

Spontaneous left ventricle cavity thrombus in a patient of systemic lupus erythematosus.

A 32 year old female with systemic lupus erythematosus having circulating lupus anticoagulant developed a thrombus in the left ventricle cavity, an unusual site. She responded to standard anticoagulant regime.

Lipoid proteinosis.

A 20-year old male presented with hoarseness of voice since birth, beaded papular lesions on both eyelids, multiple hypopigmented atrophic scars on trunk and extremities and yellowish infiltrated plaques on tongue, palate and buccal mucosae. Patient was diagnosed clinically as a case of lipoid proteinosis. It was confirmed by mucosal biopsy.

Granuloma faciale.

A 40-year old woman presented with asymptomatic erythematous well-demarcated, infiltrated plaque of 8 cm x 7 cm in size on the right cheek for past four years. Histopathological study of skin biopsy revealed features of granuloma faciale. Oral dapsone and intralesional corticosteroid caused marked improvement.

PTTG induces EMT through integrin αVß3-focal adhesion kinase signaling in lung cancer cells.

Pituitary tumor transforming gene (PTTG) is a well-studied oncogene for its role in tumorigenesis and serves as a marker of malignancy in several cancer types including lung. In the present study, we defined the role of PTTG in actin cytoskeleton remodeling, cell migration and induction of epithelial mesenchymal transition (EMT) through the regulation of integrin α(V)ß(3)-FAK (focal adhesion kinase) signaling pathway. Overexpression of PTTG through an adenovirus vector resulted in a significant increase in the expression of integrins α(V) and ß(3), a process that was reversed with the downregulation of PTTG expression through the use of an adenovirus expressing PTTG-specific small interfering RNA (siRNA). Western blot analysis of cells infected with adenovirus PTTG cDNA resulted in increased FAK and enhanced expression of adhesion complex molecules paxillin, metavincullin, and talin. Furthermore, downstream signaling genes Rac1, RhoA, Cdc42 and DOCK180 showed upregulation upon PTTG overexpression. This process was dependent on integrin α(V), as blockage by antagonist echistatin (RGD peptide) or α(V)-specific siRNA resulted in a decrease in FAK and subsequent adhesion molecules. Actin cytoskeleton disruption was detected as a result of integrin-FAK signaling by PTTG as well as enhanced cell motility. Taken together, our results suggest for the first time an important role of PTTG in regulation of integrins α(V) and ß(3) and adhesion-complex proteins leading to induction of EMT.

The induction of obesity in rodents by means of monosodium glutamate.

1. Monosodium glutamate (MSG) was administered by various methods to mice and rats of various ages and the incidence of obesity was later measured. 2. Newborn mice were injected subcutaneously with 3 mg MSG/g body-weight at 1, 2, 3, 6, 7, and 8 d of age; 16% died before weaning. Of the survivors, 90% or more became markedly obese. Mean carcass lipid content was increased by about 120% in both sexes at 20-30 weeks old. In male mice, MSG treatment increased body-weight and epididymal fat pad weight, and greatly decreased adrenaline-stimulated lipolysis in isolated fat cells. Body-eright of females was not increased significantly. Food intake was not increased in either sex from weeks 13 to 15. Blood glucose level was not generally increased by MSG but some of the male mice had abnormally high values. 3. Obesity was not detected in the offspring of female mice that had received 100 g MSG/kg diet, either from 3 weeks before mating until weaning, or from the 14th day of pregnancy until weaning. 4. Intraperitoneal injection of 10 mg MSG/g body-weight (in two doses) at weaning increased carcass lipid content in female mice by 34% by 23 weeks of age, but female rats were not affected. 5. The addition of 20 g MSG/l to the drinking-water from weaning onwards did not increase carcass lipid content in female rats or mice. 6. The addition of 20 g MSG/kg diet from weaning onwards did not alter body-weight or carcass lipid content in male and female rats by 14 weeks of age. 7. The obesity induced in mice by MSG was not associated with hyperphagia, unlike genetic obesity and obesity induced by gold thioglucose (GTG). 8. All types of mouse studied, obese and lean, had essentially the same linear relationship between carcass water content and carcass lipid content. 9. Although MSG-obese mice could not readily be differentiated from normal mice by the increase in body-weight, which was only about 10% compared to 50-120% for genetic and GTG-induced obesity, the proposed schedule of injections in the newborn was almost 100% reliable in inducing a high extent of adiposity.

Sonographic findings in gastrointestinal and peritoneal tuberculosis.

The various ultrasound (US) findings in 90 patients with abdominal (gastrointestinal, peritoneal, mesenteric and lymph node) tuberculosis (TB) studied in an area of high incidence of TB over a 1 year period were analysed. The lesions encountered were intestinal (n = 31), extraintestinal (n = 39), or a combination (n = 20). The extraintestinal lesions included free and loculated ascites (n = 36), localized ascites ('Club Sandwich sign') (n = 4), adhesions (n = 14), peritoneal thickening (n = 14), peritoneal nodules (n = 3), lymphadenopathy (n = 23) and cold abscesses (n = 10)-of these, the presence of fine fibrinous strands in the ascetic fluid, localized ascites and caseous or calcified lymph nodes were highly suspicious of a diagnosis of TB in appropriate clinical settings. The bowel lesions were characterized by concentric bowel wall thickening (n = 31) with ulceration in six. Bowel thickening, when present in the ileocaecal junction and especially when situated in the subhepatic position, was suggestive of a tuberculous etiology. Complex masses in the abdomen pointed to an advanced stage of the disease. US is a useful imaging modality in patients clinically suspected of having abdominal TB for diagnosis and follow-up, although in a few cases differentiation of it from metastatic disease is difficult. When bowel involvement is suspected, barium studies should be performed.