Hiding in Plain Sight: Characterization of Aeromonas Species Isolated from a Recreational Estuary Reveals the Carriage and Putative Dissemination of Resistance Genes.

Antimicrobial resistance (AMR) has become one of the greatest challenges worldwide, hampering the treatment of a plethora of infections. Indeed, the AMR crisis poses a threat to the achievement of the United Nations' Sustainable Development Goals and, due to its multisectoral character, a holistic approach is needed to tackle this issue. Thus, the investigation of environments beyond the clinic is of utmost importance. Here, we investigated thirteen strains of antimicrobial-resistant Aeromonas isolated from an urban estuary in Brazil. Most strains carried at least one antimicrobial resistance gene and 11 carried at least one heavy metal resistance gene. Noteworthy, four (30.7%) strains carried the blaKPC gene, coding for a carbapenemase. In particular, the whole-genome sequence of Aeromonas hydrophila strain 34SFC-3 was determined, revealing not only the presence of antimicrobial and heavy metal resistance genes but also a versatile virulome repertoire. Mobile genetic elements, including insertion sequences, transposons, integrative conjugative elements, and an IncQ1 plasmid were also detected. Considering the ubiquity of Aeromonas species, their genetic promiscuity, pathogenicity, and intrinsic features to endure environmental stress, our findings reinforce the concept that A. hydrophila truly is a "Jack of all trades'' that should not be overlooked under the One Health perspective.

Positive personal resources and psychological distress during the COVID-19 pandemic: resilience, optimism, hope, courage, trait mindfulness, and self-efficacy in breast cancer patients and survivors.

PURPOSE: This study aims to understand the association between positive personal resources (i.e., optimism, hope, courage, trait mindfulness, and self-efficacy), resilience, and psychological distress (i.e., anxiety, depression, stress) in women with breast cancer and breast cancer survivors during the COVID-19 pandemic. We hypothesized that personal positive resources can directly influence resilience, which in turn prevented psychological distress. METHODS: The research sample consisted of 409 Italian women (49% patients, 51% survivors) who were administered a questionnaire to assess positive resources, resiliency, and distress. structural equation model (SEM) analysis was carried out to confirm the hypothetical-theoretical model. RESULTS: Personal positive resources had a direct positive effect on resilience, which prevented from distress. These results were observed across cancer patients and survivors, and regardless the level of direct exposure to COVID-19. CONCLUSIONS: In both patients and survivors, the relationships between positive personal resources, resilience, and psychological distress is strong enough to be not influenced by the level of exposure to COVID-19 and despite COVID-19 pandemic caused the disruption of active treatment plans and delays in routine check-ups. IMPLICATIONS FOR CANCER SURVIVORS: Implications of this study suggest the urgency to screen positive resources and to identify women with lower resilience and a potentially higher susceptibility to develop psychological distress. For these women, our findings suggest the implementation of psychological interventions that build resilience.

Effects of Circadian Phase Tailored Light Therapy on Sleep, Mood, and Cognition in Alzheimer's Disease: Preliminary Findings in a Pivotal Study.

It is shown that the circadian system is affected in patients with Alzheimer's disease (AD) even at an early stage of the disease and that such dysfunction may be detrimental to sleep, mood, and cognitive functioning. Light is a strong central modulator of the circadian rhythms and is potentially beneficial to mood and cognitive functioning via a direct effect or indirectly via its modulating effects on circadian rhythms. This study focuses on tracking the effect of light therapy on sleep quality, mood, and cognition in AD of mild/moderate severity. We performed a single-blind randomized controlled trial to investigate the effects of a light therapy treatment tailored to the individual circadian phase as measured by dim light melatonin onset (DLMO). Such a treatment induced an objective circadian phase shift consistent with the melatonin phase response curve to light exposure, led to a shortening of the phase angle DLMO-falling asleep time, and was associated with an improvement in subjective sleep quality and cognitive performance.

Colistin-associated Acute Kidney Injury in Severely Ill Patients: A Step Toward a Better Renal Care? A Prospective Cohort Study.

BACKGROUND: Critically ill patients with severe sepsis or septic shock may need relatively high colistin daily doses for efficacy against multidrug-resistant and extensively drug-resistant gram-negative rods. However, acute kidney injury (AKI) may represent a major dose-limiting adverse effect of colistin. We sought to determine AKI occurrence and to identify factors influencing AKI risk in severely ill patients receiving colistin according to a recently proposed dosing strategy. METHODS: A prospective, observational, cohort study involving patients with severe sepsis or septic shock who received colistin was performed. AKI was defined according to Acute Kidney Injury Network criteria. Colistin administration was driven by a modified pharmacokinetics-pharmacodynamics (PK/PD)-based dosing approach. RESULTS: Of 70 patients who received colistin at a median daily dose of 9 million IU (MIU; interquartile range, 5.87-11.1 MIU), 31 (44%) developed AKI. In univariate analysis, age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA), score and baseline renal impairment were significantly associated with AKI. Moreover, patients with AKI were less frequently treated with adjuvant ascorbic acid (P = .003). In multivariate analysis, independent predictors of AKI were baseline renal impairment (adjusted hazard ratio, 4.15; 95% confidence interval, 1.9-9.2; P < .001) and age (1.03; 1.0-1.05; P = .028), whereas a strong independent renal-protective role emerged for ascorbic acid (0.27; .12-.57; P < .001). CONCLUSIONS: In severely ill patients receiving colistin according to a PK/PD-driven dosing approach, baseline renal impairment and older age strongly predict AKI occurrence, but concomitant administration of ascorbic acid markedly reduces AKI risk, allowing safer use of colistin.

Ramirez's abdominoplasty technique combined with intraperitoneal chemohyperthermia after surgical cytoreductive procedures for the treatment of advanced intraperitoneal cancer in patients with ventral hernia.

Patients affected by peritoneal carcinomatosis are frequently submitted to repeated laparotomies to reduce intra-abdominal bulky lesions and to enhance the systemic chemotherapeutic action. Aim of our study is to evaluate feasibility and results of cytoreductive surgery and intraperitoneal chemohypertermic (IPCH) perfusion combined with Ramirez's abdominoplastic technique in selected patients with voluminous ventral hernias.At the same time, we support the hypothesis that Ramirez' technique would allow a normal intra-abdominal pressure leading to an optimal capability of penetration of chemotherapeutic agents in IPCH.From January 1998 to December 2003, 30 patients were submitted to a surgical debulking and IPCH through a laparotomic approach involving a ventral hernia. After extensive cytoreductive surgery, we closed the large abdominal wall damage with Ramirez's abdominoplasty technique, followed by IPCH. The technique described by Ramirez uses bilateral muscle flap complexes transposed medially to reconstruct the central abdominal wall without using meshes to supply or reinforce the abdominal reconstruction.A total of 23 patients (76.7%) were completely cytoreducted and subjected to IPCH. Postoperative mortality was 1/30 (3.3%). Major morbidity was 5/30 (16.7%). After a mean follow-up of 3 years, no sign of recurrent ventral hernia was noted in the survivors.This study suggests that surgical debulking combined with IPCH is feasible in patients with a previously large abdominal wall defect using the functional Ramirez's abdominoplasty technique. The reconstructive technique allows a regular IPCH procedure without recurrence of the ventral hernia confirmed by clinical examination and abdominal computed tomography.

Cytoreductive surgery combined with intraperitoneal chemohyperthermia for the treatment of advanced colon cancer.

BACKGROUND: Chemohyperthermic peritoneal perfusion (CHPP) after extensive cytoreductive surgery is a possible choice as a regional treatment for peritoneal carcinomatosis (PC). The multicentric France EVOCAPE 1 study demonstrated that the median overall survival of patients with colon peritoneal carcinomatosis subjected to conventional surgical and/or chemotherapeutic treatment was 5.2 months. Historically, mitomycin C is the drug of choice in the treatment of intraperitoneal carcinomatosis from colon cancer. METHODS: Twenty-five patients affected by stage IV colon cancer with only peritoneal involvement and a prior completion of at least a partial first cycle of systemic chemotherapeutic and/or surgical treatment (24 patients) were enrolled. Immediately following extensive cytoreductive surgery, early postoperative closed abdomen CHPP was performed. RESULTS: Complete surgical cytoreduction (CC0-CC1) was obtained in 22 patients. Postoperative mortality was 1 out of 25 (4%). Major postoperative morbidity was 6 out of 25 (24%). Median overall survival estimated by Kaplan-Meier curve was 30.3 months. Locoregional progression-free survival was 17.3 months. Of all the patients 64% and 40% were alive after 1 and 2 years respectively. CONCLUSIONS: In referral centers CHPP after optimal surgical debulking is a safe procedure for peritoneal carcinomatosis from colonic cancer. Locoregional control was obtained in the majority of the pretreated patients and 1-year survival was statistically improved. A closed abdomen CHPP procedure lasting 1 hour and standard mitomycin C at a dosage of 15 mg/m(2) is probably as efficacious as other hyperthermic procedures, using higher mitomycin C dosages, with a comparable or lower number of cases of side effects. These results, as in other published phase II studies, justify future randomized trials to assess definitively the role of CHPP in the treatment of locally advanced colon neoplasms in western countries.

Cytoreductive surgery and intraperitoneal chemohyperthermia for recurrent peritoneal carcinomatosis from ovarian cancer.

Aggressive surgical cytoreduction has been shown to have a positive impact on survival of patients with ovarian cancer. After first-line chemotherapy, 47% of patients relapse within 5 years, and median survival after second line chemotherapy is 10-15 months. Adding intraperitoneal chemohyperthermia (IPCH) to surgical cytoreduction could further control ceolomic spread of disease. The aim of this study was to determine morbidity and mortality, regional relapse-free survival and, preliminarily, overall survival after combining cytoreductive surgery with IPCH for the treatment of peritoneal carcinomatosis from ovarian epithelial cancer relapsed after prior chemotherapy. Thirty women affected with such a relapse were included. Patients underwent extensive cytoreductive surgery including tumor resections and peritonectomy, followed by intraoperative IPCH with cisplatin. Complete surgical cytoreduction down to nodules less than 2.5 mm (CC0-CC1) was obtained in 23 patients (77%). One patient died postoperatively from a pulmonary embolism. Major postoperative morbidity was 5/30 (16.7%). We registered one case of anastomotic leakage, a spontaneous ileum perforation, a postoperative cholecystitis, a hydrothorax, and one patient with bone marrow toxicity. Kaplan-Meier estimates of median locoregional relapse-free survival and median overall survival were 17.1 months and 28.1 months, respectively. Patients with CC0-CC1 had locoregional relapse-free and overall survival rates of 24.4 and 37.8 months, whereas the remainder had survival rates of 4.1 and 11.0 months. We concluded that cytoreductive surgery combined with IPCH is feasible with acceptable morbidity and mortality and seems to promise good results in selected patients affected with peritoneal carcinomatosis from ovarian cancer.

Intraoperative hyperthermic tissue ablation in pulmonary metastases: a case report.

AIMS AND BACKGROUND: The surgical removal of lung metastases is controversial: some authors have reported good results in terms of prognosis and disease-free interval in patients affected by multiple metastases. Recently, percutaneous hyperthermic tissue ablation (HTA) has been used under CT guidance in solitary peripheral pulmonary tumors attached or close to the parietal pleura. METHODS AND STUDY DESIGN: We report the first intraoperative HTA of a lung metastasis from colorectal carcinoma, which might pave the way for possible future application of the procedure in patients with multiple pulmonary metastases. A 64-year-old patient affected by a rectal cancer was treated by abdominal perineal amputation followed by two lines of chemotherapy. After two years two lesions appeared in the lower left pulmonary lobe and another in the lower right lobe. The patient was monitored by three-monthly thoracic and abdominal CT. The lesions were stable for one year, but in the last two months one of the suspected metastases in the left lung increased from 1 to 2 cm. This was an indication for surgical removal. A mini posterolateral thoracotomy was performed. Thanks to complete collapse of the lung with manual squeezing of the parenchyma, ultrasonography provided satisfactory visualization of the two lesions. A frozen biopsy of the larger lesion was obtained which confirmed its metastatic nature. Ultrasound-guided HTA of the larger metastasis (2 cm) was performed. Final US demonstrated the change in the metastatic pattern. The two lesions were eventually removed by wedge resection using a TA 90 stapler. Histological examination of the two lesions confirmed the coagulative necrosis of the treated metastasis. No morbidity or pulmonary problems were recorded.