Molecular detection of spotted fever group rickettsiae in ticks from Cameroon

In western and eastern Africa, rickettsioses are one cause of fever in humans. Little is known regarding the presence of Rickettsia sp. in northern Cameroon. The present work was conducted in order to identify potential tick-borne spotted fever group Rickettsia in the Adamawa region of northern Cameroon, which may contribute filling some of the knowledge gaps of these pathogens. Ticks were collected from cattle in the municipal slaughterhouse of Ngaoundere in the Adamawa region of northern Cameroon. After morphological identification of tick species, extracted DNA was analyzed by PCR targeting the rickettsial ompB gene and the intergenic spacers dksA-xerC, mppA-purC and rpmE-tRNA^fMet_. Of the 316 adult ticks collected, 149 (47.1%) were Amblyomma variegatum, 92 (29%) Rhipicephalus spp. and 75 (23.7%) Hyalomma spp. Through the use of conventional PCR assays for the rickettsial ompB gene, rickettsial DNA was detected in 104 (32.9%) samples (85 Amblyomma sp., 14 Hyalomma spp. and 5 Rhipicephalus spp.). The ompB gene and the three intergenic were sequenced for 10 ticks in order to determine the rickettsial species. Rickettsia africae was detected in Amblyomma variegatum, Rickettsia aeschlimannii in Hyalomma rufipes and Hyalomma truncatum, Rickettsia sibirica in H. truncatum, Rickettsia massiliae in Rhipicephalus lunulatus and Candidatus Rickettsia barbariae in R. lunulatus. To the best of the author's knowledge, this report represents the first molecular evidence of rickettsial infection in ticks in the Adamawa region of northern Cameroon, which suggests a possible exposure of the human population in this region.

A prospective, randomized trial of the Ambu AuraGain™ laryngeal mask versus the LMA® protector airway in paralyzed, anesthetized adult men

BACKGROUND

We hypothesize that oropharyngeal leak pressures differ between the LMA® Protector™ and the AuraGain™, two novel supraglottic airway devices offering the possibility of intubation.

METHODS

Ninety-eight male patients ASAI-II were randomly assigned to the AuraGainTM or ProtectorTM group. Oropharyngeal leak pressure was measured by incrementing cuff volume in 10 mL steps from 10 mL to 40 mL. The primary outcome was oropharyngeal leak pressure at 40 mL cuff volume. Secondary parameters such as transdevice intubation success, intubation time, the number of intubation attempts, and resistance during advancement of the endotracheal tube were determined.

RESULTS

Mean (SD) oropharyngeal leak pressures at cuff volume of 40 mL was 30.1 (6) cmH2O for the AuraGainTM and 28.2 (7) cmH2O for the LMA ProtectorTM (P=0.142). The mean intracuff pressure for the AuraGainTM was 154 (41) cmH2O and 200 (43) cmH2O for the LMA Protector (P≤0.001). The number of attempts to insert the laryngeal mask was higher for the AuraGainTM group (P=0.002). Intubation time was lower in the AuraGainTM group (15.7 s vs. 18.5 s [ProtectorTM group]; P=0.004), and less resistance in advancing the tracheal tube through the AuraGainTM compared to LMA ProtectorTM device (P<0.001). There were no differences in fiberoptic placement of the endotracheal tube, the number of intubation attempts or postoperative morbidity between the groups.

CONCLUSIONS

Because of the higher success rate in first time insertion of the laryngeal mask and the gastric tube, respectively, as well as the lower resistance to insertion of the endotracheal tube we conclude a possible easier handling of the AuraGainTM in anesthetized male patients.

Breathing-motion-compensated robotic guided stereotactic body radiation therapy : Patterns of failure analysis

PURPOSE

We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs.

PATIENTS AND METHODS

Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1-372.0 cc). Medians of mean GTV BED_{α/β =10 Gy} (BED = biological effective dose) was 148.5 Gy₁₀ (31.5-233.3 Gy₁₀) and prescribed planning target volume (PTV) BED_{α/β =10 Gy} was 89.7 Gy₁₀ (28.8-151.2 Gy₁₀), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases).

RESULTS

Median follow-up was 10.4 months (2.0-59.0 months). The 2‑year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2‑year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 × 12-13 Gy) and higher average GTV dose (equivalence of 3 × 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%).

CONCLUSIONS

Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points.

Hypo-fractionated SBRT for localized prostate cancer: a German bi-center single treatment group feasibility trial

BACKGROUND

For prostate cancer treatment, treatment options with minimal side effects are desired. External beam radiation therapy (EBRT) is non-invasive, standard of care and delivered in either conventional fractionation over 8 weeks or with moderate hypo-fractionation over about 5 weeks. Recent advances in radiotherapy technology have made extreme hypo-fractionated stereotactic body radiation therapy (SBRT) of prostate cancer feasible, which has not yet been introduced as a standard treatment method in Germany. Initial results from other countries are promising, but long-term results are not yet available. The aim of this study is to investigate feasibility and effectiveness of SBRT for prostate cancer in Germany.

METHODS/DESIGN

This German bi-center single group trial (HYPOSTAT) is designed to evaluate feasibility and effectiveness, as measured by toxicity and PSA-response, respectively, of an extreme hypo-fractionated SBRT regimen with five fractions of 7 Gy in treatment of localized low and intermediate risk prostate cancer. The target volume includes the prostate with or without the base of seminal vesicles depending on risk stratification and uncertainty margins that are kept at 3-5 mm. SBRT treatment is delivered with the robotic CyberKnife system, which was recently introduced in Germany. Acute and late toxicity after one year will be evaluated according to Common Terminology Criteria for Adverse Events (CTCAE v. 4.0), Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) Scores. The quality of life will be assessed before and after treatment with the EORTC QLQ C30 questionnaire. Hypothesizing that the proportion of patients with grade 2 side effects or higher is less or equal than 2.8%, thus markedly lower than the standard EBRT percentage (17.5%), the recruitment target is 85 patients.

DISCUSSION

The HYPOSTAT trial aims at demonstrating short term feasibility of extreme hypo-fractioned SBRT for the treatment of prostate cancer and might be used as the pilot study for a multi-center multi-platform or for randomized-controlled trials comparing conventional radiotherapy with SBRT for localized prostate cancer in the future. The study concept of patient enrollment, follow up and evaluation by multiple public university clinics and actual patient treatment in dedicated private radiosurgery practices with high-tech radiation equipment is unique for clinical trials.

STUDY STATUS

The study is ongoing and currently recruiting patients.

TRIAL REGISTRATION

Registration number: NCT02635256 ( clinicaltrials.gov ). Registered 8 December 2015.

Rickettsia felis Infection in Febrile Children, Ghana

AbstractRickettsial infections are an underrecognized cause of febrile illness in sub-Saharan Africa. To evaluate the epidemiology and clinical features of rickettsial disease in pediatric patients in Ghana, we screened blood samples from febrile children aged less than 15 years presenting to an outpatient department in Ghana's Ashanti Region for the presence of rickettsial DNA. We detected Rickettsia felis in 7/470 (1.5%) blood samples, using two independent real-time polymerase chain reactions. No other Rickettsia species were found. R. felis was detected repeatedly in one patient, and coinfection with Plasmodium falciparum was found in 3/7 samples. Symptoms apart from fever included cough (6/7) and vomiting (4/7). None of the R. felis-positive patients reported a rash. This study is the first report on R. felis in Ghana and adds to the growing evidence for its widespread occurrence with and without malaria coinfection in sub-Saharan Africa.

Transfer of skills and comparison of performance between king vision® video laryngoscope and macintosh blade following an AHA airway management course

Background

To potentially optimize intubation skill teaching in an American Heart Association® Airway Management Course® for novices, we investigated the transfer of skills from video laryngoscopy to direct laryngoscopy and vice versa using King Vision® and Macintosh blade laryngoscopes respectively.

Methods

Ninety volunteers (medical students, residents and staff physicians) without prior intubation experience were randomized into three groups to receive intubation training with either King Vision® or Macintosh blade or both. Afterwards they attempted intubation on two human cadavers with both tools. The primary outcome was skill transfer from video laryngoscopy to direct laryngoscopy assessed by first attempt success rates within 60 s. Secondary outcomes were skill transfer in the opposite direction, the efficacy of teaching both tools, and the success rates and esophageal intubation rates of Macintosh blade versus King Vision®.

Results

Performance with the Macintosh blade was identical following training with either Macintosh blade or King Vision® (unadjusted odds ratio [OR] 1.09, 95% confidence interval [95% CI] 0.5–2.6). Performance with the King Vision® was significantly better in the group that was trained on it (OR 2.7, 95% CI 1.2–5.9). Success rate within 60 s with Macintosh blade was 48% compared to 52% with King Vision® (OR 0.85, 95% CI 0.4–2.0). Rate of esophageal intubations with Macintosh blade was significantly higher (17% versus 4%, OR 5.0, 95% CI 1.1–23).

Conclusions

We found better skill transfer from King Vision® to Macintosh blade than vice versa and fewer esophageal intubations with video laryngoscopy. For global skill improvement in an airway management course for novices, teaching only video laryngoscopy may be sufficient. However, success rates were low for both devices.

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-016-0296-9) contains supplementary material, which is available to authorized users.

Comparative evaluation of two Rickettsia typhi-specific quantitative real-time PCRs for research and diagnostic purposes

Rickettsioses are caused by intracellular bacteria of the family of Rickettsiaceae. Rickettsia (R.) typhi is the causative agent of endemic typhus. The disease occurs worldwide and is one of the most prevalent rickettsioses. Rickettsial diseases, however, are generally underdiagnosed which is mainly due to the lack of sensitive and specific methods. In addition, methods for quantitative detection of the bacteria for research purposes are rare. We established two qPCRs for the detection of R. typhi by amplification of the outer membrane protein B (ompB) and parvulin-type PPIase (prsA) genes. Both qPCRs are specific and exclusively recognize R. typhi but no other rickettsiae including the closest relative, R. prowazekii. The prsA-based qPCR revealed to be much more sensitive than the amplification of ompB and provided highly reproducible results in the detection of R. typhi in organs of infected mice. Furthermore, as a nested PCR the prsA qPCR was applicable for the detection of R. typhi in human blood samples. Collectively, the prsA-based qPCR represents a reliable method for the quantitative detection of R. typhi for research purposes and is a promising candidate for differential diagnosis.

Phonetic detail and lateralization of reading-related inner speech and of auditory and somatosensory feedback processing during overt reading

Phonetic detail and lateralization of inner speech during covert sentence reading as well as overt reading in 32 right-handed healthy participants undergoing 3T fMRI were investigated. The number of voiceless and voiced consonants in the processed sentences was systematically varied. Participants listened to sentences, read them covertly, silently mouthed them while reading, and read them overtly. Condition comparisons allowed for the study of effects of externally versus self-generated auditory input and of somatosensory feedback related to or independent of voicing. In every condition, increased voicing modulated bilateral voice-selective regions in the superior temporal sulcus without any lateralization. The enhanced temporal modulation and/or higher spectral frequencies of sentences rich in voiceless consonants induced left-lateralized activation of phonological regions in the posterior temporal lobe, regardless of condition. These results provide evidence that inner speech during reading codes detail as fine as consonant voicing. Our findings suggest that the fronto-temporal internal loops underlying inner speech target different temporal regions. These regions differ in their sensitivity to inner or overt acoustic speech features. More slowly varying acoustic parameters are represented more anteriorly and bilaterally in the temporal lobe while quickly changing acoustic features are processed in more posterior left temporal cortices. Furthermore, processing of external auditory feedback during overt sentence reading was sensitive to consonant voicing only in the left superior temporal cortex. Voicing did not modulate left-lateralized processing of somatosensory feedback during articulation or bilateral motor processing. This suggests voicing is primarily monitored in the auditory rather than in the somatosensory feedback channel. Hum Brain Mapp 38:493-508, 2017. © 2016 Wiley Periodicals, Inc.

Asymmetric intra- and interhemispheric interactions during covert and overt sentence reading

Covert and overt sentence reading evoke lateralized activations in overall bihemispheric networks. We assumed that the study of functional connectivity may reveal underlying principles of functional lateralization. Left-lateralized activations could relate to stronger reading-related modulation of intrahemispheric functional connectivity in the left than the right hemisphere. Alternatively, left-lateralization could result from suppression of contralateral processing and thus reflect asymmetric interhemispheric interactions. To address this issue, this functional MRI study investigated the regional lateralization of covert and overt German sentence reading in 39 healthy participants. Further, it revealed the modulation of the lateralized brain regions' functional connectivity and their contralateral homotopes by covert and overt reading (psychophysiological interactions). Left-lateralization during covert reading was associated with stronger intrahemispheric coupling particularly in the left dorsal stream rather than with suppression of contralateral processing. Lateralization during overt sentence reading instead went along with additional recruitment of right perisylvian cortices involved in articulation by asymmetric positive heterotopic interhemispheric interactions. Given the paucity of interhemispheric anti-correlations with homotopic regions, functional lateralization is likely a consequence of a task-dependent interplay between asymmetric positive intra- and interhemispheric coupling.

Silicon alleviates Cd stress of wheat seedlings (Triticum turgidum L. cv. Claudio) grown in hydroponics

We investigated the potential role of silicon in improving tolerance and decreasing cadmium (Cd) toxicity in durum wheat (Triticum turgidum L. durum) either through a reduced Cd uptake or exclusion/sequestration in non-metabolic tissues. For this, plants were grown in hydroponic conditions for 10 days either in presence or absence of 1 mM Si and for 11 additional days in various Cd concentrations (0, 0.5, 5.0 and 50 μM). After harvesting, morphological and physiological parameters as well as elemental concentrations were recorded. Cadmium caused reduction in growth parameters, photosynthetic pigments and mineral nutrient concentrations both in shoots and roots. Shoot and root contents of malate, citrate and aconitate increased, while contents of phosphate, nitrate and sulphate decreased with increasing Cd concentrations in plants. Addition of Si to the nutrient solution mitigated these adverse effects: Cd concentration in shoots decreased while concentration of Cd adsorbed at the root cell apoplasmic level increased together with Zn uptake by roots. Overall, total Cd uptake decreased in presence of Si. There was no co-localisation of Cd and Si either at the shoot or at the root levels. No Cd was detected in leaf phytoliths. In roots, Cd was mainly detected in the cortical parenchyma and Si at the endodermis level, while analysis of the outer thin root surface of the plants grown in the 50 μM Cd + 1 mM Si treatment highlighted non-homogeneous Cd and Si enrichments. These data strongly suggest the existence of a root localised protection mechanism consisting in armoring the root surface by Si- and Cd-bearing compounds and in limiting root-shoot translocation.

Tick (Amblyomma chabaudi) infestation of endemic tortoises in southwest Madagascar and investigation of tick-borne pathogens

Little is known about the role of endemic ticks as vectors for bacterial and protozoan pathogens for animals and humans in Madagascar and their interaction in anthropogenic habitats where humans, their livestock and native Malagasy species (vectors and hosts) come into more frequent contact than in natural forest ecosystems. The aims of the study were (1) to test whether habitat degradation is associated with increased infestation of tortoises by ticks and (2) to investigate whether ticks carried Babesia, Borrelia or Rickettsia species that might be pathogenic for humans and livestock. We studied hard ticks of two endemic Malagasy tortoises, Astrochelys radiata and Pyxis arachnoides in March and April 2013 in southwest Madagascar. Two tortoise habitats were compared, the National Park of Tsimanampetsotsa and the adjacent degraded pasture and agricultural land at the end of the wet season. Ticks were screened for protozoan and bacterial pathogens via PCR on DNA isolated from ticks using genus-specific primers. Only one out of 42 A. radiata collected from both habitats had ticks. The low prevalence did not allow further analyses of the effect of habitat degradation. Forty-two P. arachnoides were found in the anthropogenic habitat and 36 individuals in the national park. Tick infestation rates of P. arachnoides differed significantly between the two study sites. Tortoises inside the park had lower tick prevalence than outside (8 of 36 (22%) versus 32 of 42 individuals (76%)) and infected animals tended to have fewer ticks inside than outside the park. All ticks collected in both habitats were adults of the ixodid tick Amblyomma chabaudi, which is supposed to be a host-specific tick of P. arachnoides. Screening for Borrelia sp. and Babesia sp. was negative in all ticks. But all A. chabaudi ticks were infected with Rickettsia africae, known to cause spotted fever in humans. Thus, habitat degradation seems to be linked to higher infestation of tortoises with ticks with possible consequences for humans and their livestock.

High detection rate of Rickettsia africae in Amblyomma variegatum but low prevalence of anti-rickettsial antibodies in healthy pregnant women in Madagascar

Tick-borne spotted fever group (SFG) rickettsioses are emerging infectious diseases in Sub-Saharan Africa. In Madagascar, the endemicity of tick-borne rickettsiae and their vectors has been incompletely studied. The first part of the present study was conducted in 2011 and 2012 to identify potential anthropophilic tick vectors for SFG rickettsiae on cattle from seven Malagasy regions, and to detect and characterize rickettsiae in these ticks. Amblyomma variegatum was the only anthropophilic tick species found on 262 cattle. Using a novel ompB-specific qPCR, screening for rickettsial DNA was performed on 111 A. variegatum ticks. Rickettsial DNA was detected in 96 of 111 ticks studied (86.5%). Rickettsia africae was identified as the only infecting rickettsia using phylogenetic analysis of ompA and ompB gene sequences and three variable intergenic spacers from 11 ticks. The second part of the study was a cross-sectional survey for antibodies against SFG rickettsiae in plasma samples taken from healthy, pregnant women at six locations in Madagascar, two at sea level and four between 450 and 1300m altitude. An indirect fluorescent antibody test with Rickettsia conorii as surrogate SFG rickettsial antigen was used. We found R. conorii-seropositives at all altitudes with prevalences between 0.5% and 3.1%. Our results suggest that A. variegatum ticks highly infected with R. africae are the most prevalent cattle-associated tick vectors for SFG rickettsiosis in Madagascar. Transmission of SFG rickettsiosis to humans occurs at different altitudes in Madagascar and should be considered as a relevant cause of febrile diseases.

Effect of silicon on wheat seedlings (Triticum turgidum L.) grown in hydroponics and exposed to 0 to 30 µM Cu

Aqueous Si limits Cu uptake by a Si-accumulating plant via physicochemical mechanisms occurring at the root level. Sufficient Si supply may alleviate Cu toxicity in Cu-contaminated soils. Little information is available on the role of silicon (Si) in copper (Cu) tolerance while Cu toxicity is widespread in crops grown on Cu-contaminated soils. A hydroponic study was set up to investigate the influence of Si on Cu tolerance in durum wheat (Triticum turgidum L.) grown in 0, 0.7, 7.0 and 30 µM Cu without and with 1.0 mM Si, and to identify the mechanisms involved in mitigation of Cu toxicity. Si supply alleviated Cu toxicity in durum wheat at 30 µM Cu, while Cu significantly increased Si concentration in roots. Root length, photosynthetic pigments concentrations, macroelements, and organic anions (malate, acetate and aconitate) in roots, were also increased. Desorption experiments, XPS analysis of the outer thin root surface (≤100 Å) and µXRF analyses showed that Si increased adsorption of Cu at the root surface as well as Cu accumulation in the epidermis while Cu was localised in the central cylinder when Si was not applied. Copper was not detected in phytoliths. This study provides evidences for Si-mediated alleviation of Cu toxicity in durum wheat. It also shows that Si supplementation to plants exposed to increasing levels of Cu in solution induces non-simultaneous changes in physiological parameters. We propose a three-step mechanism occurring mainly at the root level and limiting Cu uptake and translocation to shoots: (i) increased Cu adsorption onto the outer thin layer root surface and immobilisation in the vicinity of root epidermis, (ii) increased Cu complexation by both inorganic and organic anions such as aconitate and, (iii) limitation of translocation through an enhanced thickening of a Si-loaded endodermis.