Swine farm groundwater is a hidden hotspot for antibiotic-resistant pathogenic Acinetobacter.

Acinetobacter is present in the livestock environment, but little is known about their antibiotic resistance and pathogenic species in the farm groundwater. Here we investigated antibiotic resistance of Acinetobacter in the swine farm groundwater (JZPG) and residential groundwater (JZG) of a swine farming village, in comparison to a nearby (3.5 km) non-farming village (WTG) using metagenomic and culture-based approaches. Results showed that the abundance of antibiotic resistome in some JZG and all JZPG (~3.4 copies/16S rRNA gene) was higher than that in WTG (~0.7 copies/16S rRNA gene), indicating the influence of farming activities on both groundwater types. Acinetobacter accounted for ~95.7% of the bacteria in JZG and JZPG, but only ~8.0% in WTG. They were potential hosts of ~95.6% of the resistome in farm affected groundwater, which includes 99 ARG subtypes against 23 antibiotic classes. These ARGs were associated with diverse intrinsic and acquired resistance mechanisms, and the predominant ARGs were tetracyclines and fluoroquinolones resistance genes. Metagenomic binning analysis elucidated that non-baumannii Acinetobacter including A. oleivorans, A. beijerinckii, A. seifertii, A. bereziniae and A. modestus might pose environmental risks because of multidrug resistance, pathogenicity and massive existence in the groundwater. Antibiotic susceptibility tests showed that the isolated strains were resistant to multiple antibiotics including sulfamethoxazole (resistance ratio: 96.2%), levofloxacin (42.5%), gatifloxacin (39.0%), ciprofloxacin (32.6%), tetracycline (32.0%), doxycycline (29.0%) and ampicillin (12.0%) as well as last-resort polymyxin B (31.7%), colistin (24.1%) and tigecycline (4.1%). The findings highlight potential prevalence of groundwater-borne antibiotic-resistant pathogenic Acinetobacter in the livestock environment.

Clinical application of intravesical botulinum toxin type A for overactive bladder and interstitial cystitis.

After decades of clinical and basic science research, the clinical application of botulinum toxin A (Botox) in urology has been extended to neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity, refractory overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), lower urinary tract symptoms, benign prostatic hyperplasia, and neurogenic or non-neurogenic lower urinary tract dysfunction in children. Botox selectively disrupts and modulates neurotransmission, suppresses detrusor overactivity, and modulates sensory function, inflammation, and glandular function. In addition to motor effects, Botox has been found to have sensory inhibitory effects and anti-inflammatory effects; therefore, it has been used to treat IC/BPS and OAB. Currently, Botox has been approved for the treatment of NDO and OAB. Recent clinical trials on Botox for the treatment of IC/BPS have reported promising therapeutic effects, including reduced bladder pain. Additionally, the therapeutic duration was found to be longer with repeated Botox injections than with a single injection. However, the use of Botox for IC/BPS has not been approved. This paper reviews the recent advances in intravesical Botox treatment for OAB and IC/BPS.

Precision medicine in the diagnosis and treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia.

Male lower urinary tract symptoms (LUTSs) are highly prevalent in men and the incidence increases with aging. The pathophysiology of male LUTSs might be bladder outlet dysfunctions such as bladder neck (BN) dysfunction, benign prostatic obstruction, and poor relaxation of external sphincter and bladder dysfunctions such as detrusor overactivity (DO), detrusor underactivity, DO, and inadequate contractility. Male LUTSs include voiding and storage symptoms, and precision diagnosis should not be done based on the symptoms alone. Videourodynamic study provides a thorough look at the bladder and bladder outlet and can clearly demonstrate the underlying pathophysiology when the initial medication fails to relieve LUTS. Medical treatment should be given based on the underlying pathophysiology of LUTS, and surgical intervention to remove prostate should only be performed when a definite bladder outlet obstruction due to prostatic obstruction has been confirmed by invasive urodynamic study.

High-Throughput Biochemical Fingerprinting of Oleaginous Aurantiochytrium sp. Strains by Fourier Transform Infrared Spectroscopy (FT-IR) for Lipid and Carbohydrate Productions.

The traditional biochemical methods for analyzing cellular composition of oleaginous microorganisms are time-consuming, polluting, and expensive. In the present study, an FT-IR method was used to analyze the cellular composition of the marine oleaginous protist Aurantiochytrium sp. during various research processes, such as strains screening, medium optimization, and fermentation, and was evaluated as a green, low-cost, high throughput, and accurate method compared with the traditional methods. A total of 109 Aurantiochytrium sp. strains were screened for lipid and carbohydrate production and the best results were found for the strains No. 6 and No. 32. The yields and productivities could reach up to 47.2 g/L and 0.72 g/L/h for lipid, 21.6 g/L and 0.33 g/L/h for docosahexaenoic acid (DHA) in the strain No. 6, and 15.4 g/L and 0.18 g/L/h for carbohydrate in the strain No. 32, under the optimal conditions, respectively. These results confirmed potentials of the two Aurantiochytrium sp. strains for lipid, DHA, and carbohydrate productions at industrial scales. The FT-IR method in this study will facilitate research on the oleaginous Aurantiochytrium sp., and the obtained two strains for lipid and carbohydrate productions will provide the foundations for their applications in medical, food, and feed industries.

Practical points in the medical treatment of overactive bladder and nocturia in the elderly.

The prevalence of overactive bladder (OAB) increases with age. Degeneration of the central nervous system in the elderly has been proposed as one of the pathogenic factors of OAB. Antimuscarinic therapy is effective in the treatment of OAB; however, intolerable systemic adverse events and cognitive dysfunction during treatment with nonselective antimuscarinic agents is of growing concern in elderly patients. The newly developed beta-3 adrenoceptor agonist mirabegron does not adversely affect flow rate and detrusor pressure, and its therapeutic efficacy and tolerability are similar in patients aged > 65 years and > 75 years, suggesting it might be the therapeutic choice in older patients with OAB. Nocturia can cause sleep deprivation at night and increase daytime sleepiness and loss of energy in the elderly. Desmopressin add-on therapy is effective in improving nocturia and storage symptoms. However, elderly patients with a baseline serum sodium level below the normal range are at high risk of developing significant hyponatremia.

Methylation of P16 in exhaled breath condensate for diagnosis of non-small cell lung cancer.

BACKGROUND: Non-small cell lung cancer is the most frequently cause of cancer-related death in the world. To explore the technical feasibility, we detected aberrant promoter methylation of P16 in exhaled breath condensate which was a new, non-invasive tool for diagnosis and screening program of NSCLC. METHODS: We analyzed aberrant promoter methylation of P16 in 180 samples from 60 individuals, including 30 NSCLC patients (cancer tissues, adjacent normal lung tissues, blood plasma, and EBC), and 30 healthy controls (blood plasma and EBC) by fluorescent quantitative methylation-specific polymerase chain reaction (F-MSP). RESULTS: The positive rate of aberrant promoter methylation of P16 was 26 of 30 (86.66%) in tumor tissues, 15 of 30 (50%) in blood plasma, and 12 of 30 (40%) in EBC, we have not observed the positive methylation of P16 in the adjacent normal lung tissues, or in EBC or blood plasma from the healthy control group. CONCLUSION: We found that detected promoter methylation of P16 in EBC was feasibility, it should be an useful biomarker for diagnosis of NSCLC, it have potential prospect that detected the gene molecular in EBC because of noninvasive, specificity, convenient and repeatable.

The identification of a spontaneous 47, XX, +21/46, XY chimeric fetus with male genitalia.

BACKGROUND: Approximately 30 sex-chromosome discordant chimera cases have been reported to date, of which only four cases carried trisomy 21. Here, we present an additional case, an aborted fetus with a karyotype of 47,XX, +21/46,XY. CASE PRESENTATION: Autopsy demonstrated that this fetus was normally developed and had male genitalia. Major characteristics of Down syndrome were not observed except an enlarged gap between the first and second toes. Karyotyping of tissues cultured from the fetus revealed the same chimeric chromosomal composition detected in the amniotic fluid but with a different ratio of [47,XX,+21] to [46,XY]. Further short tandem repeat analysis indicated a double paternal contribution and single maternal contribution to the fetus, with the additional chromosome 21 in the [47,XX,+21] cell lineage originating from the paternal side. CONCLUSION: We thus propose that this chimeric fetus was formed via the dispermic fertilization of a parthenogenetic ovum with one (Y) sperm and one (X,+21) sperm.

Reduction of cystometric bladder capacity and bladder compliance with time in patients with end-stage renal disease.

BACKGROUND/PURPOSE: Reduced bladder capacity and compliance in patients with end-stage renal disease (ESRD) may affect storage and voiding function after kidney transplantation. This study evaluated the bladder capacity, compliance, and lower urinary tract dysfunction in ESRD patients with duration after dialysis and anuria. MATERIALS AND METHODS: Adults with ESRD on kidney transplantation waiting list were consecutively enrolled. The survey items included videourodynamic study (VUDS), renal ultrasound, and cystoscopy. The analytical variables assessed included the duration of dialysis, the duration of anuria, cystometric bladder capacity and bladder compliance, voiding phases in VUDS, and cystoscopic findings. RESULTS: A total of 62 patients with a mean dialysis duration of 58.9 ± 6.3 months were enrolled. The mean cystometric bladder capacity was 178 ± 14 mL and decreased significantly with duration of dialysis (p < 0.001). Anuria was diagnosed in 26 patients, and the mean cystometric bladder capacity decreased significantly with the duration of anuria (p = 0.002). Among the 26 patients with anuria, 16 had a poor bladder compliance. VUDS revealed abnormal storage function in 44 (71.0%) patients and bladder outlet obstruction due to bladder neck dysfunction or urethral narrowing in the voiding phase in 32 (51.6%). Abnormal cystoscopic findings were also noted in 30 (48.4%) patients. CONCLUSION: Cystometric bladder capacity and bladder compliance decreased with longer duration of dialysis, and the presence of anuria contributed to further decreases in cystometric bladder capacity and bladder compliance. More than two-thirds of patients with ESRD had abnormal findings on VUDS.

[Signal transduction pathway in liver fibrosis regulated by human hepatocyte growth factor].

OBJECTIVE: To explore the changes in the gene expression profiles in HepG2 cells transfected by human hepatocyte growth factor (hHGF) and analyze the signal transduction pathway in liver fibrosis regulated by hHGF. METHOD: A 20,000 gene cDNA microarray (Affymetrix) was used to examine the gene expressions in the HepG2 cells transfected by hHGF. The differentially expressed genes were identified and some genes with possible contribution to hepatic fibrosis were subjected to real-time PCR analysis. RESULT: The differentially expressed genes were mostly transcription regulatory molecules, cytokines, signal transduction, glucose metabolism, lipid metabolism. The results of real-time PCR showed up-regulated STAT1 and MAPK1 expression in the cells as were consistent with genechip analysis results. CONCLUSION: hHGF gene transfection results in the gene expression profile changes in HepG2 cells. HGF may regulate liver fibrosis via the JAK/STAT and MAPK pathways.

Botulinum toxin A injection to the bladder neck and urethra for medically refractory lower urinary tract symptoms in men without prostatic obstruction.

BACKGROUND/PURPOSE: Lower urinary tract symptoms (LUTS) in men with small benign prostatic hyperplasia (BPH) might not result from prostatic compression. Instead, bladder neck and urethral dysfunction could play an important role. We investigated the effect of botulinum toxin A (BoNT-A) injection to the bladder neck and urethra of men with small BPH and LUTS that were refractory to medical treatment. METHODS: We enrolled 30 men with a total prostate volume (TPV) of < 40 mL, International Prostate Symptom Score (IPSS) > 12, and maximum urinary flow rate (Qmax) < 15 mL/second, who were refractory to medical treatment. None had bladder outlet obstruction upon videourodynamic study. One hundred units of BoNT-A dissolved in 10 mL normal saline was injected at 10 sites at the trigone, bladder neck, proximal urethra, distal urethra and external sphincter. The values for IPSS, quality of life (QoL) index, Qmax, bladder capacity, post-void residual (PVR), TPV and global satisfaction at 1, 3 and 6 months after injection were compared with baseline. RESULTS: Significant improvements in empty and total IPSS were found at 1 and 3 months but not 6 months after treatment. Qmax significantly increased at 1 month and was still improved at 6 months. Bladder capacity increased and PVR decreased at 1 and 3 months but not at 6 months after treatment. QoL index and global satisfaction were improved significantly at all time points after treatment. CONCLUSION: Bladder neck and urethral BoNT-A injections improved LUTS and increased Qmax in men with a small prostate. Our findings suggest that bladder neck and urethral dysfunction may play a role in LUTS in men without BPH.

Long-term outcomes of augmentation enterocystoplasty with an ileal segment in patients with spinal cord injury.

BACKGROUND/PURPOSE: Neurogenic bladder has been considered a relative contraindication for augmentation enterocystoplasty (AE), but neurogenic voiding dysfunction has become a common indication for AE. We evaluated long-term outcomes in patients with spinal cord injury (SCI) who underwent AE with an ileal segment. METHODS: We reviewed retrospectively 40 consecutive adults with SCI who underwent AE. The outcomes assessed included bladder capacity and compliance, incidence of stone formation, upper urinary tract status, urinary tract infection (UTI), need for intermittent catheterization, urinary incontinence, postoperative morbidity, persistent loose stools, and metabolic malabsorption. RESULTS: Four women and 36 men aged 20-56 years (mean, 36.3 +/- 8.8 years), with a mean follow-up period of 7.8 +/- 0.6 years were included. Twenty-nine (72.5%) patients had detrusor overactivity and the other 11 had detrusor underactivity. Simple AE was performed in 27 patients, AE with ureteral reimplantation in seven, and continent diversion by enterocystoplasty with an abdominal stoma in six. The mean bladder capacity increased from 115 +/- 16.3 to 513 +/- 31.4 mL after the operation. Four patients (10%) could void spontaneously and 29 (72.5%) had to perform clean intermittent catheterization to empty their bladders. Twenty-six patients (65%) had episodes of UTI. Three patients (7.5%) experienced de novo diarrhea that required antispasmodics. Long-term complications included urinary incontinence in four (10%) patients, reservoir calculi in 13 (32.5%) and new-onset upper tract stones in nine (22.5%). CONCLUSION: AE with an ileal segment provides effective and safe therapeutic outcomes in SCI patients. However, problems with UTI, reservoir calculi and new-onset upper tract urolithiasis still need to be solved.

Malignant mesothelioma of the tunica vaginalis testis: a case report and literature review.

Malignant mesothelioma of the tunica vaginalis testis is a rare but often fatal malignancy. Here, we report one patient with locally advanced disease who has a history of asbestos exposure. We review the literature concerning current management strategies of the disease. Radical surgery plus adjuvant radiotherapy seems to provide the best results.