Emergence and Persistent Dominance of SARS-CoV-2 Omicron BA.2.3.7 Variant, Taiwan

Since April 2022, waves of SARS-CoV-2 Omicron variant cases have surfaced in Taiwan and spread throughout the island. Using high-throughput sequencing of the SARS-CoV-2 genome, we analyzed 2,405 PCR-positive swab samples from 2,339 persons and identified the Omicron BA.2.3.7 variant as a major lineage within recent community outbreaks in Taiwan.

An Actinobacterial Isolate, Streptomyces sp. YX44, Produces Broad-Spectrum Antibiotics That Strongly Inhibit Staphylococcus aureus

The need for new antibiotics is increasing due to their overuse, and antibiotic resistance has become one of the major threats worldwide to public health, food safety, and clinical treatment. In this study, we describe an actinobacterial isolate, YX44, which belongs to the genus Streptomyces. This Streptomyces was isolated from a drinking pipe located in Osaka, Japan, and has the ability to inhibit Gram-positive bacteria, Gram-negative bacteria, and various fungi. YX44 fermentation broth shows strong activity against Escherichia coli and Staphylococcus aureus, as well as also inhibiting clinical isolates of multidrug-resistant Staphylococcus aureus. The YX44 antibacterial substances in the broth are relatively heat-stable, show high stability from the pH range 1 to 11, and have good solubility in both organic and non-organic solvents. Size-exclusion chromatography revealed that the YX44 antibacterial compounds are less than 1000 Da in size. LC-MS was able to identify three possible candidate molecules with molecular weights of 308, 365, 460, and 653 g/mol; none of these sizes correspond to any well-known antibiotics. Our results show that Streptomyces sp. YX44 seems to produce a number of novel antibiotics with high pH stability and good solubility that have significant activity against S. aureus, including multidrug-resistant strains.

Simulation of airfoil surface pressure due to incident turbulence using realizations of uncorrelated wall plane waves

A numerical technique is proposed for synthesizing realizations of airfoil surface pressure induced by incoming turbulence. In this approach, realization of the surface pressure field is expressed as a set of uncorrelated wall plane waves. The amplitude of these plane waves is determined from the power spectrum density function of the incoming upwash velocity fluctuation and the airfoil aeroacoustic transfer function. The auto-spectrum of the surface pressure is obtained from an ensemble average of different realizations. The numerical technique is computationally efficient as it rapidly converges using a relatively small number of realizations. The surface pressures for different airfoils excited by incoming turbulence are numerically predicted, and the results are compared with experimental data in the literature. Further, the unsteady force exerted on an airfoil due to the airfoil-turbulence interaction is also computed, and it is shown to be in very good agreement with analytical results.

Diagnosis of Arboleda-Tham syndrome by whole genome sequencing in an Asian boy with severe developmental delay

Diagnosis of a 9-month-old boy brought to our genetics clinic with chief complaints of developmental delay (DD), failure to thrive, microcephaly, trunk hypotonia and hypertonia of the extremities. Multiple congenital defects but no significant syndromes or diseases were impressed. The chromosomal analysis and array comparative genomic hybridization (aCGH) revealed no significant pathogenic changes. Whole Genome Sequencing (WGS) identified a p.Glu1139fs de novo mutation of the KAT6A gene. The patient's phenotype was consistent clinically with Arboleda-Tham syndrome (ARTHS). Reviewing the literature showed that this is the first patient in Taiwan detected by WGS and that it involves a novel mutation. Comparing the highly variable clinical presentations of this syndrome with our patient, this boy's features and severe developmental defects seem to be due to a late-truncating mutation at the carboxyl end of the KAT6A protein. Our study demonstrates the power of WGS to confirm a diagnosis within 4 weeks for this rare condition.

Oxidative Stress and Cardiovascular Risk in Type 1 Diabetes Mellitus: Insights From the DCCT/EDIC Study

Background

Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus.

Methods and Results

A random subcohort of 349 participants was selected from the DCCT / EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT , and 1 to 2 years post‐ DCCT ( EDIC years 1 and 2) were measured for markers of oxidative stress, including plasma myeloperoxidase, paraoxonase activity, urinary F 2α isoprostanes, and its metabolite, 2,3 dinor‐8 iso prostaglandin F 2α . Following adjustment for glycated hemoblobin and weighting the observations inversely proportional to the sampling selection probabilities, higher paraoxonase activity, reflective of antioxidant activity, and 2,3 dinor‐8 iso prostaglandin F 2α , an oxidative marker, were significantly associated with lower risk of cardiovascular disease (−4.5% risk for 10% higher paraoxonase, P <0.003; −5.3% risk for 10% higher 2,3 dinor‐8 iso prostaglandin F 2α , P =0.0092). In contrast, the oxidative markers myeloperoxidase and F 2α isoprostanes were not significantly associated with cardiovascular disease after adjustment for glycated hemoblobin. There were no significant differences between DCCT intensive and conventional treatment groups in the change in all biomarkers across time segments.

Conclusions

Heightened antioxidant activity (rather than diminished oxidative stress markers) is associated with lower cardiovascular disease risk in type 1 diabetes mellitus, but these biomarkers did not change over time with intensification of glycemic control.

Clinical Trial Registration

URL : https://www.clinicaltrials.gov . Unique identifiers: NCT 00360815 and NCT 00360893.

Effects of a new parallel primary healthcare centre and on-campus training programme on history taking, physical examination skills and medical students' preparedness: a prospective comparative study in Taiwan

OBJECTIVES

The primary healthcarecentre (PHCC) is the first place that medical students experience patient contact. Usually, medical students are frustrated by a lack of proper skills training for on-campus history taking (HT), physical examination (PE) and self-directed learning (SDL) to prepare for their PHCC and inhospital patient contact. For pre-clerks, this study aims to compare the effectiveness of PHCC training and PHCC training in combination with on-campus HT and PE training modules (PHCC+on-campus) on their clerkship preparedness.

DESIGN

This comparative study utilised prospective, consecutive, end of pre-clerkship group objective structured clinical examination (GOSCE), beginning of clerkship OSCE and self-administered Preparation for Hospital Practice Questionnaire (PHPQ).

SETTING/PARTICIPANTS

128 pre-clinical clerk volunteers (64 each year) receiving PHCC training (7 week PHCCtraining in addition to 7 week assignment based group learning, academic year 2014, controls) and PHCC training in combination with on-campus module training (academic year 2015, 7 week PHCCtraining in addition to 7 week on-campus sessions) were sequentially assessed before the module (week 1), at the end of the module (week 14) and at the beginning of clerkship (week 25).

RESULTS

For overall HT and PE skills, both PHCC and PHCC+on-campus module trained pre-clerks performed better on OSCE than GOSCE. Additionally, the improvement was accompanied by higher self-reported PHPQ scores in 'confidence/coping' and 'SDL' domains. At the end of the pre-clerkship and the beginning of the clerkship stages, the degree of improvement in preparedness in 'confidence/coping' and 'SDL' domains was higher for those in the PHCC+on-campus group than for those in the PHCC group. Among the PHCC+on-campus module participants, a positive association was observed between high mean PHPQ-SDL scores and high OSCE scores.

CONCLUSIONS

Our study suggests that the PHCC+on-campus module, which is paired faculty led and pre-trained dyad student assisted, is effective in developing a preclinical clerk's HT and PE skills and intensifying SDL/patient management abilities to prepare for hospital practice in clerkship.

Unintentional ingestion of Cordyceps fungus-infected cicada nymphs causing ibotenic acid poisoning in Southern Vietnam

BACKGROUND

Cordyceps fungus found in infected cicada nymphs ("cicada flowers") is utilized in traditional Chinese medicine. Cordyceps fungus toxicity in humans has not been previously reported. We report 60 cases of apparent Cordyceps poisoning in Southern Vietnam.

METHODS

We retrospectively collected demographic and clinical data from the medical records (21 cases) and by telephone interview (39 cases) of patients admitted to seven hospitals in Southern Vietnam following ingestion of cicada flowers between 2008 and 2015. We also determined the species of Cordyceps present in the cicada flowers and performed a partial chemical analysis of the fungus.

RESULTS

Sixty cases of toxic effects following ingestion of cicada flowers were documented. Symptom onset occurred within 60 minutes following ingestion. Symptoms included dizziness, vomiting, salivation, mydriasis, jaw stiffness, urinary retention, seizures, agitated delirium, hallucinations, somnolence and coma. None of the patients suffered liver or kidney injury. There was one fatality. The Cordyceps fungus involved in these poisoning was identified as Ophiocordyceps heteropoda. The presence of ibotenic acid was confirmed, but musimol and muscarine were absent.

CONCLUSIONS

Cicada infected with Ophiocordyceps heteropoda in Vietnam contain ibotenic acid and are associated with a clinical syndrome consistent with its effects.

Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk's "excellence in clinical care": a pilot study

BACKGROUND

Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school's curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, "clinical excellence" program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the "clinical excellence" of new clerks.

METHODS

In a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills.

RESULTS

Overtime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCE_diag and OSCE_reason scores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCE_diag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCE_reason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCE_diag and OSCE_reason scores (>400) than those with less cumulative learning hours.

CONCLUSION

Our pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot "clinical excellence" program have encouraged the formal implementation of this course as part of the clerkship curriculum.

Note. Reaction of Bacteria Associated with Fish Spoilage to Chemical and Physical Stress

A cocktail made up of six bacteria isolated from fish was subjected to various heats (30 °C and 60 °C, 20 s) and chemical preservative stresses, alone and in combination. The chemical preservatives tested were potassium sorbate (PS, 1%), trisodium phosphate (TSP, 10%) and tetrasodium pyrophosphate (TSPP, 3%). Heating the bacteria at 60 °C for 20 s resulted in an average reduction of 2.0 log cfu/mL in the total number. The results showed amarked synergistic effect of heat treatment prior to chemical additives, especially for TSPP and sorbate; no significant effect was evident when chemicals were applied alone. The effect was increased by the application of chemical preservatives, before heating, in the decreasing order TSP, TSPP and sorbate; reductions obtained were more than 5.0, 4.0 and 3.0 log cfu/mL, respectively. The synergistic effect observed was dependent on the type of chemical additives used and also on the order of the treatments. Bacteria identified as Shewanella putrefaciens and Pseudomonas putida were more resistant to heat treatment and Brochothrix thermosphacta and Lactobacillus plantarum were more resistant to TSP treatment. These bacteria in the cocktail showed high sensitivity to combined TSP/heat treatment; bacterial cells identified as Enterobacter spp. were the most resistant to this treatment.

Contemporary characteristics of blunt abdominal trauma in a regional series from the UK

INTRODUCTION Blunt abdominal trauma (BAT) is a common injury in recent trauma series. The characteristics of patients with BAT have changed following the reconfiguration of UK trauma services. The aim of this study was to build a new profile for BAT patients undergoing immediate or delayed laparotomy. METHODS All 5,401 consecutive adults presenting with major trauma between April 2012 and April 2014 in the 3 major trauma centres in the West Midlands were analysed to identify all patients with BAT. A total of 2,793 patients with a mechanism of injury or symptomatology consistent with BAT were identified (52%). Outcomes were analysed using local electronic clinical results systems and notes. RESULTS Of the 2,793 patients, 179 (6.4%) had a mesenteric or hollow viscus injury, 168 (6.0%) had a hepatobiliary injury, 149 (5.4%) had a splenic injury and 46 (1.6%) had a vascular injury. Overall, 103 patients (3.7%) underwent an early (<12 hours) laparotomy while 30 (1.1%) underwent a delayed (>12 hours) laparotomy. Twenty (66.7%) of those undergoing a delayed laparotomy had a hollow viscus injury. In total, 170 deaths occurred among the BAT patients (6.1%). In the early laparotomy group, 53 patients died (51.5%) whereas in the delayed laparotomy group, 6 patients died (20.0%). CONCLUSIONS This series has attempted to provide the characteristics of patients with BAT in a large contemporary UK cohort. BAT was found to be a common type of injury. Early and delayed laparotomy occurred in 3.7% and 1.1% of these patients respectively, mostly because of hollow viscus injury in both cases. Outcomes were comparable with those in the international literature from regions with mature trauma services.

A model of four hierarchical levels to train Chinese residents' teaching skills for "practice-based learning and improvement" competency

OBJECTIVES

The current study focused on validating a protocol for training and auditing the resident's practice-based learning and improvement (PBLI) and quality improvement (QI) competencies for primary care.

METHODS

Twelve second-year (R2), 12 first-year (R1) and 12 postgraduate year-1 residents were enrolled into group A, B and C, respectively, as trainees. After three training protocols had been completed, a writing test, self-assessed questionnaire and mini-OSTE and end-of-rotation assessment were used in auditing the PBLI competency, performance and teaching ability of trainees.

RESULTS

Baseline expert-assessed PBLI and QI knowledge application tool writing scores were low for the R1 and R2 residents. After three training protocols, PBLI and QI proficiencies, performance and teaching abilities were improved to similar levels cross the three training levels of residents based on the expert-assessed writing test-audited assessments and on the faculty and standardized clerk-assessed end-of-rotation-/mini-OSTE-audited assessments.

CONCLUSION

The different four-level hierarchical protocols used to teach group A, B and C were equally beneficial and fitted their needs; namely the different levels of the trainees. Specifically, each level was able to augment their PBLI and QI proficiency. This educational intervention helps medical institutions to train residents as PBLI instructors.

Primary mesenteric gastrointestinal stromal tumour

Primary mesenteric gastrointestinal stromal tumours (GISTs) are rare tumours and can be included as a differential for an expanding intraabdominal mass. We present the case, in our institution, of a 72-year-old male who presented with non-specific symptoms and was diagnosed with a primary mesenteric GIST following resection. We report his follow-up and discuss the current theories as to the origins of these rare tumours and current treatment modalities.

Copy Number Change of the NDM-1 sequence in a multidrug-resistant Klebsiella pneumoniae clinical isolate

The genetic features of the antimicrobial resistance of a multidrug resistant Klebsiella pneumoniae strain harboring bla_NDM-1 were investigated to increase our understanding of the evolution of NDM-1. The strain, KPX, came from a Taiwanese patient with a hospitalization history in New Delhi. Complete DNA sequencing was performed; and the genes responsible for antimicrobial resistance were systematically examined and isolated by library screening. KPX harbored two resistance plasmids, pKPX-1 and pKPX-2, which are 250-kb and 141-kb in size, respectively, with bla_NDM-1 present on pKPX-1. The plasmid pKPX-1 contained genes associated with the IncR and IncF groups, while pKPX-2 belonged to the IncF family. Each plasmid carried multiple antimicrobial resistance genetic determinants. The gene responsible for resistance to carbapenems was found on pKPX-1 and that for resistance to aztreonam was found on pKPX-2. To our surprise, we discovered that bla_NDM-1 exists on pKPX-1 as multiple copies in the form of tandem repeats. Amplification of bla_NDM-1 was found to occur by duplication of an 8.6-kb unit, with the copy number of the repeat varying from colony to colony. This repeat sequence is identical to that of the pNDM-MAR except for two base substitutions. The copy number of bla_NDM-1 of colonies under different conditions was assessed by Southern blotting and quantitative PCR. The bla_NDM-1 sequence was maintained in the presence of the antimicrobial selection; however, removal of antimicrobial selection led to the emergence of susceptible bacterial populations with a reduced copy number or even the complete loss of the bla_NDM-1 sequence. The dynamic nature of the NDM-1 sequence provides a strong argument for judicious use of the broad-spectrum antimicrobials in order to reduce the development and spread of antimicrobial resistance among pathogens.

Draft Genome Sequence of the Oxytetracycline-Producing Bacterium Streptomyces rimosus ATCC 10970

We report the draft genome of Streptomyces rimosus (ATCC 10970), a soil isolate that produces oxytetracycline, a commercially important and clinically useful antibiotic.

The quantitative assessment of the role played by basic amino acid clusters in the nuclear uptake of human ribosomal protein L7

In this study, we used a multiple copy (EGFP)(3) reporter system to establish a numeric nuclear index system to assess the degree of nuclear import. The system was first validated by a FRAP assay, and then was applied to evaluate the essential and multifaceted nature of basic amino acid clusters during the nuclear import of ribosomal protein L7. The results indicate that the sequence context of the basic cluster determines the degree of nuclear import, and that the number of basic residues in the cluster is irrelevant; rather the position of the pertinent basic residues is crucial. Moreover, it also found that the type of carrier protein used by basic cluster has a great impact on the degree of nuclear import. In case of L7, importin β2 or importin β3 are preferentially used by clusters with a high import efficiency, notwithstanding that other importins are also used by clusters with a weaker level of nuclear import. Such a preferential usage of multiple basic clusters and importins to gain nuclear entry would seem to be a common practice among ribosomal proteins in order to ensure their full participation in high rate ribosome synthesis.

Breast cancer after prophylactic mastectomy for Lobular Carcinoma-In-Situ (LCIS) - an unusual case

Bilateral risk reducing mastectomy results in the greatest breast cancer risk reduction but is an irreversible intervention. Total mastectomy can never remove all breast tissue and there is always a small risk of breast cancer. Regular follow up and surveillance is beneficial. We present the case of a 47-year-old woman who presented with axillary lymph node metastatic breast cancer after risk reducing mastectomy in which only Lobular Carcinoma-in-Situ (LCIS) was present on histopathology.

Elective right hemicolectomy: a twenty-year retrospective analysis of a single general surgeon's practice

AIM

Changes in working practices implemented over the last decade particularly with respect to subspecialisation have changed the working practices of the traditional general surgeon. The majority of non-colorectal specialists who wish to continue abdominal surgery have been limited to pursue right sided colorectal pathology only. The aim of this study was to assess the outcomes of colorectal procedures performed by one non-colorectal specialist general surgeon who commenced consultant practice in 1991 and compare these outcomes against the outcomes recorded in the literature for low and high volume caseload surgeons.

METHODS

The patient records of 131 patients who underwent right hemicolectomy by a single surgeon between March 1991 and December 2010 were retrieved and retrospectively analysed. All patients underwent midline laparotomy with two-layer handsewn end-end or end-side ileocolonic anastomoses. Complications of interest were postoperative deaths and clinically relevant anastomotic leaks as well as clinically diagnosed medical complications.

RESULTS

The mean age of patients was 61.5 years (range 17-83). A total of 92 patients were operated upon for colorectal malignancy and 39 patients for crohn's disease. No anastomotic leaks occurred. There was only a single inpatient death secondary to acute myocardial infarction.

CONCLUSION

Our small study of a single surgeon's career long practice for elective right hemicolectomies demonstrates that high standards in terms of anastomotic leak rates and operative mortality can be achieved in clinical practice by the non-specialist General Surgeon. However, prospective data collection would be required to apply this to the broader non-colorectal specialist community.

A persistent level of Cisd2 extends healthy lifespan and delays aging in mice

The CISD2 gene, which is an evolutionarily conserved novel gene, encodes a transmembrane protein primarily associated with the mitochondrial outer membrane. Significantly, the CISD2 gene is located within the candidate region on chromosome 4q where a genetic component for human longevity has been mapped. Previously, we have shown that Cisd2 deficiency shortens lifespan resulting in premature aging in mice. Additionally, an age-dependent decrease in Cisd2 expression has been detected during normal aging. In this study, we demonstrate that a persistent level of Cisd2 achieved by transgenic expression in mice extends their median and maximum lifespan without any apparent deleterious side effects. Cisd2 also ameliorates age-associated degeneration of the skin, skeletal muscles and neurons. Moreover, Cisd2 protects mitochondria from age-associated damage and functional decline as well as attenuating the age-associated reduction in whole-body energy metabolism. These results suggest that Cisd2 is a fundamentally important regulator of lifespan and provide an experimental basis for exploring the candidacy of CISD2 in human longevity.

Deactivating chemical agents using enzyme-coated nanofibers formed by electrospinning

The coaxial electrospinning technique was investigated as a novel method to create stabilized, enzyme-containing fibers that have the potential to provide enhanced protection from chemical agents. Electrospinning is a versatile technique for the fabrication of polymer fibers with large length (cm to km): diameter (nm to μm) aspect ratios. The large surface to volume ratios, along with the biofriendly nature of this technique, enables the fabrication of fiber mats with high enzyme concentrations, which amplify the catalytic activity per unit volume of membrane. Blended composite (single-source) fibers incorporate enzyme throughout the fiber, which may limit substrate accessibility to the enzyme. In contrast, core/sheath fibers can be produced by coaxial electrospinning with very high enzyme loading (>80%) in the sheath without noticeable loss of enzymatic activity. Several core-sheath combinations have been explored with the toxin-mitigating enzyme DFPase in order to achieve fibers with optimum properties. The concentration of fluoride released, normalized for the amount of protein incorporated into the sheath, was used as a measure of the enzyme activity versus time. The coaxial core/sheath combination of PEO and DFPase produced the highest activity (~7.3 mM/mg).

Chromosome diversity and similarity within the Actinomycetales

Many chromosomes from Actinomycetales, an order within the Actinobacteria, have been sequenced over the last 10 years and the pace is increasing. This group of Gram-positive and high G+C% bacteria is economically and medically important. However, this group of organisms also is just about the only order in the kingdom Bacteria to have a relatively high proportion of linear chromosomes. Chromosome topology varies within the order according to the genera. Streptomyces, Kitasatospora and Rhodococcus, at least as chromosome sequencing stands at present, have a very high proportion of linear chromosomes, whereas most other genera seem to have circular chromosomes. This review examines chromosome topology across the Actinomycetales and how this affects our concepts of chromosome evolution.

A role for the CISD2 gene in lifespan control and human disease

CISD2, the causative gene for Wolfram syndrome 2 (WFS2), is an evolutionarily conserved novel gene. Recently, we have demonstrated that CISD2 is involved in mammalian lifespan control; this work also establishes WFS2 as a mitochondria-mediated disorder and effectively links CISD2 gene function, mitochondrial integrity, and aging in mammals. In wild-type mice, the expression levels of CISD2 decrease in an age-dependent manner during the naturally aging process; this correlates with mitochondrial breakdown and parallels the development of an aged phenotype. Future work will examine how the CISD2 knockout mouse helps us to understand WFS2 pathogenesis, as well as exploring the potential effects of increased CISD2 expression. In addition, it will be of great interest to compare gene activity and/or protein function between normal human populations and long-lived centenarian groups. Together, human and mouse genetic studies should provide evidence as to whether CISD2 is a "master gene" for extreme old age.

Brain imaging findings in dyslexia

Dyslexia is a brain-based disorder that has been intensively studied in the Western world for more than a century because of its social burden. However, affected individuals in Chinese communities are neither recognized nor formally diagnosed. Previous studies have concentrated on the disadvantages of reading deficits, and few have addressed non-linguistic skills, which are included in the symptoms. In addition, certain dyslexics possess visual spatial talents that have usually been ignored. In this review, we discuss the available information regarding brain imaging studies of dyslexia based on studies in Caucasian subjects. Gray matter deficits have been demonstrated in dyslexics using structural magnetic resonance imaging. Reduced neural activities in the left temporal and left parietal cortices, and diffuse widespread activation patterns in the cerebellum could be detected using functional magnetic resonance imaging. Changes in lactate levels, N-acetylaspartate/choline-containing compounds and N-acetylaspartate/creatine ratios, and phosphomonoester peak area were detected in magnetic resonance spectroscopy studies. Lower fractional anisotropy values in bilateral white matter tracts have been demonstrated by diffusion tensor imaging. Abnormal Broca's area activation was found using positron emission tomography imaging. Increased activities in the right frontal and temporal brain regions were detected using electroencephalography. Reduced hemispheric asymmetry and increased left inferior frontal activation were reported following magnetoencephalography. Although these imaging modalities are not currently diagnostic or prognostic, they are able to provide information on the causes of dyslexia beyond what was previously provided by behavioral or cognition studies.

Distribution, transport and exchanges of fine sediment, with tidal power implications: Severn Estuary, UK

The Severn, a hypertidal, high turbidity estuary, has a bed largely stripped of unconsolidated sediment. Its inter-tidal zone is mainly mudflats, the universal erosional trend of which is now proven. These are a source for sub-tidal mud accumulations in Newport Deep, much of Bridgwater Bay, less so in Bristol Deep and Cardiff Roads. The main estuary turbidity maximum is dominated by its exceptional turbidity and the cycling of this on two tidal timescales. It is the means to exchange fines between sources and sinks. It shows discontinuities in three planes - lutoclines, suspended sediment fronts and slug flow. Much of the estuary is verging on or actually barren. It has been designated under EU legislation for its fine sediment-induced naturally-depauperate nature. This is invalid as it is complicated by large scale ecosystem collapse due to climate change. Building a Cardiff-Weston barrage would induce a large rise in faunal abundance and biodiversity.

Clinical presentation and initial management of black men and white men with prostate cancer in the United Kingdom: the PROCESS cohort study

Background:

In the United States, Black men have a higher risk of prostate cancer and worse survival than do White men, but it is unclear whether this is because of differences in diagnosis and management. We re-examined these differences in the United Kingdom, where health care is free and unlikely to vary by socioeconomic status.

Methods:

This study is a population-based retrospective cohort study of men diagnosed with prostate cancer with data on ethnicity, prognostic factors, and clinical care. A Delphi panel considered the appropriateness of investigations and treatments received.

Results:

At diagnosis, Black men had similar clinical stage and Gleason scores but higher age-adjusted prostate-specific antigen levels (geometric mean ratio 1.41, 95% confidence interval (95% CI): 1.15–1.73). Black men underwent more investigations and were more likely to undergo radical treatment, although this was largely explained by their younger age. Even after age adjustment, Black men were more likely to undergo a bone scan (odds ratio 1.37, 95% CI: 1.05–1.80). The Delphi analysis did not suggest differential management by ethnicity.

Conclusions:

This UK-based study comparing Black men with White men found no evidence of differences in disease characteristics at the time of prostate cancer diagnosis, nor of under-investigation or under-treatment in Black men.

Cisd2 mediates mitochondrial integrity and life span in mammals

CISD2, the causative gene for Wolfram syndrome 2 (WFS2), is a previously uncharacterized novel gene. Using a mouse genetic approach, this work demonstrated for the first time that Cisd2 is involved in mammalian life span control. Cisd2 deficiency in mice leads to mitochondrial breakdown and dysfunction; this is accompanied by cell death with autophagic features and these events precede the two earliest manifestations of nerve and muscle degeneration. Together, they lead to a panel of phenotypic features suggestive of premature aging. This work effectively links Cisd2 gene function, mitochondrial integrity and aging in mammals.

Genetic diversity of capsular polysaccharide biosynthesis in Klebsiella pneumoniae clinical isolates

Klebsiella pneumoniae is an enteric pathogen causing community-acquired and hospital-acquired infections in humans. Epidemiological studies have revealed significant diversity in capsular polysaccharide (CPS) type and clinical manifestation of K. pneumoniae infection in different geographical areas of the world. We have sequenced the capsular polysaccharide synthesis (cps) region of seven clinical isolates and compared the sequences with the publicly available cps sequence data of five strains: NTUH-K2044 (K1 serotype), Chedid (K2 serotype), MGH78578 (K52 serotype), A1142 (K57 serotype) and A1517. Among all strains, six genes at the 5' end of the cps clusters that encode proteins for CPS transportation and processing at the bacterial surface are highly similar to each other. The central region of the cps gene clusters, which encodes proteins for polymerization and assembly of the CPS subunits, is highly divergent. Based on the collected sequence, we found that either the wbaP gene or the wcaJ gene exists in a given K. pneumoniae strain, suggesting that there is a major difference in the CPS biosynthesis pathway and that the K. pneumoniae strains can be classified into at least two distinct groups. All isolates contain gnd, encoding gluconate-6-phosphate dehydrogenase, at the 3' end of the cps gene clusters. The rmlBADC genes were found in CPS K9-positive, K14-positive and K52-positive strains, while manC and manB were found in K1, K2, K5, K14, K62 and two undefined strains. Our data indicate that, while overall genomic organization is similar between different pathogenic K. pneumoniae strains, the genetic variation of the sugar moiety and polysaccharide linkage generate the diversity in CPS molecules that could help evade host immune attack.

A multidrug efflux system is involved in colony growth in Streptomyces lividans

Multidrug resistance (MDR) genes are abundant in Streptomyces genomes, and yet these bacteria are generally drug sensitive under routine laboratory conditions, indicating low or no expression of these genes. Drug-resistant mutations have been isolated that lie in regulatory genes adjacent to the MDR genes, suggesting that resistance arises by derepression. This study identified a divergently oriented pair consisting of a TetR-family regulator (ebrS) and a major facilitator-family MDR pump (ebrC) gene in Streptomyces lividans, which is widely conserved in Streptomyces species. EbrS represses transcription of ebrC as well as its own transcription. Deletion of ebrS causes overexpression of ebrC, resulting in elevated resistance to many drugs. The ebrS and ebrC promoters were used in a reporter system to test inducibility by various chemicals. Among the 15 compounds (including five EbrC target drugs) tested, none induced ebrC transcription. On the other hand, the ebrS promoter was induced by rifampicin and high concentrations of calcium and magnesium. Deletion of ebrS-ebrC did not change rifampicin sensitivity, indicating that the EbrC pump is not involved in rifampicin efflux. Moreover, deletion of ebrC caused retardation of colony growth on selected media, and the defect could be suppressed by supplementation with high concentrations of Ca(2+), Mg(2+), Na(+) or K(+). Based on these results, it is proposed that the primary biological role of most MDR systems in Streptomyces species is not removal of extrinsic drugs, but rather export of specific toxic compounds endogenously synthesized during growth.

Comparative genomics of Streptomyces avermitilis, Streptomyces cattleya, Streptomyces maritimus and Kitasatospora aureofaciens using a Streptomyces coelicolor microarray system

DNA/DNA microarray hybridization was used to compare the genome content of Streptomyces avermitilis, Streptomyces cattleya, Streptomyces maritimus and Kitasatospora aureofaciens with that of Streptomyces coelicolor A3(2). The array data showed an about 93% agreement with the genome sequence data available for S. avermitilis and also showed a number of trends in the genome structure for Streptomyces and closely related Kitasatospora. A core central region was well conserved, which might be predicted from previous research and this was linked to a low degree of gene conservation in the terminal regions of the linear chromosome across all four species. Between these regions there are two areas of intermediate gene conservation by microarray analysis where gene synteny is still detectable in S. avermitilis. Nonetheless, a range of conserved genes could be identified within the terminal regions. Variation in the genes involved in differentiation, transcription, DNA replication, etc. provides interesting insights into which genes in these categories are generally conserved and which are not. The results also provide target priorities for possible gene knockouts in a group of bacteria with a very large numbers of genes with unknown functions compared to most bacterial species.

Mapping the essential structures of human ribosomal protein L7 for nuclear entry, ribosome assembly and function

Human large subunit protein L7 carries multiple nuclear localization signals (NLS) in its structure: there are three monobasic partite NLSs at the NH2-region of the first 54 amino acid residues and a bipartite in the middle section at position of 156-167. The C-region of the last 50 amino acid residues displays membrane binding nature, and might involve in forming a nuclear microbody for pre-nucleolar ribosome assembly. The middle section covers 144 amino acid residues which are essential for the structure and function of ribosome. This is evident from findings that truncated L7 without the NH2-region or the C-region, or missing both regions, is capable of reaching nucleolus and incorporating in ribosome, however, only ribosomes bearing truncated L7 without the NH2-region is capable of engaging in polysome formation. Combining with the phylogenic findings from homologous sequence alignment, the NH2-region of L7, besides being as a eukaryotic expansion segment, can be excluded from building a functional eukaryotic ribosome.

What drives variation in habitat use by Anolis lizards: habitat availability or selectivity?

Geographic variation in habitat availability may drive geographic variation in a species’ habitat use; alternatively, species adapted to particular habitat characteristics may use a habitat regardless of its availability within an environment. In this study, we investigated habitat use of two sympatric species of Anolis lizards that are morphologically specialized to use different microhabitats. We examined variation in microhabitat use and availability among four distinct forest types. In each forest type, we quantified available microhabitats (i.e., perch diameter, angle of inclination, and visibility), as well as microhabitats actually used by each species. We found that species consistently differed in microhabitat use, corresponding to each species’ morphological specializations. However, microhabitat use of both species varied among sites. This variation in Anolis gundlachi Peters, 1876 reflected differences in microhabitat availability, while the variation in Anolis krugi Peters, 1876 resulted from differential microhabitat selectivity. These results indicate that both habitat availability and habitat preferences must be examined in multiple localities for a species to understand the causes of variation in its habitat use.

Comparison of sevoflurane and isoflurane in domestic ferrets (Mustela putorius furo)

Isoflurane anesthesia is commonly used in ferrets for routine examinations and diagnostics. Sevoflurane is now being used as well, but there have been no studies to date directly comparing these agents in domestic ferrets. A prospective study was designed to evaluate the quality and speed of anesthetic induction and recovery using isoflurane and sevoflurane in ferrets. In addition effects on heart rate, blood pressure and packed cell volume were also recorded. No significant differences were noted between anesthetic agents.

Subthreshold rTMS over pre-motor cortex has no effect on tics in patients with Gilles de la Tourette syndrome

OBJECTIVE

A previous study showed no effect of 1Hz repetitive transcranial magnetic stimulation (rTMS) on tics in Gilles de la Tourette Syndrome (GTS). We modified the rTMS protocol in order to investigate some of the possible methodological reasons for the negative outcome in that study.

METHODS

In a single blinded placebo-controlled cross-over study in five GTS patients without obsessive compulsive disorder we probed whether longer trains (1800 stimuli) of 1 Hz pre-motor cortex rTMS at 80% of active motor threshold and application to both hemispheres can improve tics in GTS. This was measured with the Yale Global Tic severity rating scale, the MOVES self-rating scale and video analysis.

RESULTS

We found no significant effect of either left pre-motor cortex stimulation alone, or left pre-motor followed by right pre-motor cortex stimulation.

CONCLUSIONS

These results suggest that the rTMS protocol used in this study is not useful for the treatment of tics in GTS.

SIGNIFICANCE

rTMS protocols need to be modified substantially in order to explore their potential for the treatment of tics in GTS.

Stillbirth: a review

Stillbirth occurs in nearly 1% of all births in the USA, and is one of the most common but least studied adverse pregnancy outcomes. The many risk factors for and causes of stillbirth are presented. Over the past several decades, the rate of stillbirth has been substantially reduced, with the reduction most apparent in those stillbirths previously occurring at term and/or in labor. Reductions have occurred because of reductions in risk factors (i.e. prevention of Rh disease and better control of diabetes), better antepartum monitoring of those with risk factors followed by early delivery for those fetuses found to be at risk (i.e. growth restriction, maternal pre-eclampsia), better intrapartum fetal monitoring, increases in Cesarean section for those at risk, and early detection of congenital anomalies followed by termination prior to the time that these early fetal deaths are classified as stillbirths. Finally, the value of using fetal autopsy and placental examination to determine the cause of death accurately, both for research purposes and for patient counseling in future pregnancies, is explored.