Characterization of Mycobacterium tuberculosis Beijing isolates from the Mediterranean area

BACKGROUND

The Beijing lineage of Mycobacterium tuberculosis is causing concern due to its global distribution and its involvement in severe outbreaks. Studies focused on this lineage are mainly restricted to geographical settings where its prevalence is high, whereas those in other areas are scarce. In this study, we analyze Beijing isolates in the Mediterranean area, where this lineage is not prevalent and is mainly associated with immigrant cases.

RESULTS

Only 1% (N = 26) of the isolates from two population-based studies in Spain corresponded to Beijing strains, most of which were pan-susceptible and from Peruvian and Ecuadorian patients. Restriction fragment length polymorphism typing with the insertion sequence IS6110 identified three small clusters (2-3 cases). Mycobacterial interspersed repetitive unit-variable number tandem repeat typing (MIRU-15) offered low discriminatory power, requiring the introduction of five additional loci. A selection of the Beijing isolates identified in the Spanish sample, together with a sample of Beijing strains from Italy, to broaden the analysis context in the Mediterranean area, were assayed in an infection model with THP-1 cells. A wide range of intracellular growth rates was observed with only two isolates showing an increased intracellular replication, in both cases associated with contained production of TNF-alpha. No correlation was observed between virulence and the Beijing phylogenetic group, clustered/orphan status, or resistance. The Beijing strain responsible for extensive spread on Gran Canaria Island was also identified in Madrid, but did not lead to secondary cases and did not show high infectivity in the infection model.

CONCLUSIONS

The Beijing lineage in our area is a non-homogeneous family, with only certain highly virulent representatives. The specific characterization of Beijing isolates in different settings could help us to accurately identify the virulent representatives before making general assumptions about this lineage.

Prevalence and molecular characterization of Streptococcus pneumoniae serotype 6C causing invasive disease in Gipuzkoa, northern Spain, 1990-2009

The recently discovered pneumococcus serotype 6C was responsible for ten of the 1,530 invasive isolates studied between 1990 and 2009. These ten isolates belonged to seven sequence types (STs) and were isolated only from adult patients: six with bacteremia, three with meningitis, and one with peritonitis. All isolates but one were fully penicillin-susceptible.

Clonal structure and 21-year evolution of Streptococcus pneumoniae serotype 1 isolates in northern Spain

This study of 135 serotype 1 pneumococcal isolates (88 invasive and 47 non-invasive), collected between 1987 and 2007, gave eight sequence types (217, 227, 228, 304, 305, 306, 3860 and 3861) that group, using eBurst, into three different lineages and one singleton. The annual incidence of serotype 1 invasive episodes per million inhabitants increased from 1.8 in 1987-1993 to 4.0 in 1994-2000, and to 25.6 in 2001-2007. ST228 was the predominant clone until 1998. ST306 first appeared in 1998 and became the most prevalent sequence type (>80%) after the introduction, in June 2001, of the heptavalent pneumococcal conjugate vaccine.

Multi-Layered Films Containing a Biomimetic Stimuli-Responsive Recombinant Protein

Electrostatic self-assembly was used to fabricate new smart multi-layer coatings, using a recombinant elastin-like polymer (ELP) and chitosan as the counterion macromolecule. The ELP was bioproduced, purified and its purity and expected molecular weight were assessed. Aggregate size measurements, obtained by light scattering of dissolved ELP, were performed as a function of temperature and pH to assess the smart properties of the polymer. The build-up of multi-layered films containing ELP and chitosan, using a layer-by-layer methodology, was followed by quartz-crystal microbalance with dissipation monitoring. Atomic force microscopy analysis permitted to demonstrate that the topography of the multi-layered films could respond to temperature. This work opens new possibilities for the use of ELPs in the fabrication of biodegradable smart coatings and films, offering new platforms in biotechnology and in the biomedical area.

Phase II study of first-line sagopilone combined with prednisone in patients with metastatic castration-resistant prostate cancer (CRPC)

5059

Background: Epothilones comprise a new class of microtubule stabilizing agents, and sagopilone is a novel, fully synthetic epothilone that has shown significant activity against a broad range of tumor models. Methods: Chemotherapy-naïve metastatic CRPC patients received sagopilone 16 mg/m2 IV over 3 hours every 21 days and prednisone 5 mg PO BID. The primary efficacy evaluation was based on PSA decline (≥50% PSA reduction confirmed at least 28 days apart). The Simon 2-Stage design required 3 responders among the first 13 evaluable patients and 13 responders among the first 46 evaluable patients to declare the agent of interest for further investigation. Results: Between August 2006 and May 2008, 53 patients were enrolled and treated. Sites of metastases were: bones, lymph nodes, and viscera in 72%, 68%, and 25% patients, respectively. Median PSA was 107.5 (6.2–1727) ng/ml. A median of 5 (2–12) cycles were delivered. The median dose delivered per cycle was 13.3 mg/m2. Two patients did not meet all eligibility criteria and were excluded from efficacy analyses; 3 additional patients were excluded from PSA decline and progression-free survival analyses due to missing baseline PSA assessment. Twenty of 48 patients (42%; 80% CI: 32%-52%) had a confirmed PSA decline in excess of 50% and 30 (63%; 95% CI: 47%-76%) had a 30% reduction in PSA within 3 months of enrollment. Of 39 patients with measurable disease by RECIST, 1 had a complete, 9 had a partial confirmed response (26%; 95% CI: 13%-42%). The median PFS was 6.4 months (95% CI: 4.7 to 10.2). All 53 patients are evaluable for safety. Toxicities occurring in ≥ 20% patients included peripheral neuropathy 74% (19% grade 3), fatigue 40% (6% grade 3, 2% grade 4), extremity pain 36% (6% grade 3), arthralgia 23% (no grade 3, 4), and constipation 21% (no grade 3, 4). Conclusions: Sagopilone is active in metastatic chemotherapy-naïve CRPC patients, with probability of PSA decline, measurable disease responses, and PFS approximating the current standard of docetaxel + prednisone. Neuropathy and fatigue are the most common toxicities, while hematologic toxicity is rare. Further evaluation of this agent in prostate cancer is warranted.

[Table: see text]

The effect of type I collagen on osteochondrogenic differentiation in adipose-derived stromal cells in vivo

BACKGROUND

Recent studies have demonstrated that adipose-derived adult stromal cells (ADASCs) offer great promise for cell-based therapies due to their ability to differentiate towards bone, cartilage and fat [corrected] The objective of this study was to investigate whether type I collagen would elicit in vivo bone formation of passaged rat adipose-derived adult stromal cells (ADASC) placed extraskeletally.

METHODS

After expansion for 1-4 passages (P), cells were incubated in osteogenic medium containing dexamethasone, ascorbic acid and beta-glycerol phosphate for 2-4 weeks. Undifferentiated cells were maintained in Dulbecco's modified Eagle's medium (DMEM) with 10% fetal bovine serum (FBS). Osteogenic differentiation was evaluated by alkaline phosphatase (ALP) and von Kossa staining as well as by gene expression of ALP, osteopontin (OP), osteonectin (ON), osteocalcin (OC), collagen I (colI), collagen II (colII), bone sialoprotein (BSP), periostin (Postn), runx2, osterix (Osx), sox9, msx1 and msx2. Diffusion chambers were filled with 1x10(6) cells mixed with or without type I collagen gel and implanted subcutaneously into rats. Controls included chambers exposed to (1) undifferentiated cells (with or without collagen, (2) collagen without cells and (3) empty chambers (n=5 per group).

RESULTS

Four weeks after implantation, in vivo bone and cartilage formation was demonstrated in implants containing 4-week osteo-induced P1 and P4 cells wrapped in the collagen gel, as confirmed by Goldner's trichrome and Alcian blue staining, respectively. Newly formed bone stained positive for type I collagen. Control implants had no bone or cartilage and were primarily filled with fibrous tissue at that time interval.

DISCUSSION

Recent studies have demonstrated that ADASC offer great promise for cell-based therapies because of their ability to differentiate toward bone, cartilage and fat. However, the influence of different matrices on the in vivo osteogenic capability of ADASC is not fully understood. These findings suggest that type I collagen may support the survival and expression of osteogenic and chondrogenic phenotypes in passaged rat ADASC in vivo.

[Factors associated with survival in liver resection for metastatic colorectal carcinoma]

BACKGROUND

The liver is the organ in which often metastasize primary tumors. Knowledge of the etiology and forms of presentation of metastatic disease is key to deciding on the different treatment options.

OBJECTIVE

Describe the surgical management of liver metastases in colorectal cancer and factors that affect the survival of patients.

PATIENTS AND METHODS

We reviewed 43 cases of patients with metastatic liver cancer of the colon or rectum, who underwent liver surgery, attended January 1990 to December 2007. We analyzed demographic variables and perioperative associated with the survival of patients. There was the course and type of postoperative complications as well as the direct causes of mortality.

RESULTS

Were conducted mostly metastasectomies (n = 25), followed by right hepatectomy (n = 9),and left hepatectomy (n = 9). Surgical mortality was 4.6% (n = 2). The survival rate at 1, 3 and 5 year were 45% (18 patients), 42.5% (18 patients)and 12.5% (5 patients), respectively. The presence of a single metastatic lesion (p = 0.006), size of the lesion larger than 5 cm (p = 0.003), positive lymph nodes (p = 0.002), synchronous tumor (p = 0.04),presence of extra hepatic disease (p = 0.01), positive margin (p = 0.001) and blood loss >2000 mL were significantly associated with a lower survival rate.

CONCLUSION

After hepatic resection for metastatic colorectal cancer the presence of more than one tumor, > of 5 cm, with presence of synchronous tumor, nodes and positive margins, extra hepatic disease, as well blood loss > 2000 mL are factors associated with a worse survival.

Selection and induction of rat skeletal muscle-derived cells to the chondro-osteogenic lineage

Bone marrow (BM) has been long established as the main source of pluripotential mesenchymal stem cells (MSCs), and has been so far the main recognized source of osteoprogenitor cells that contribute to the turnover of the skeletal scaffold. The existence of an osteoprogenitor cell in other connective tissues such as skeletal muscle has been reported. In light of its availability and because of the relative ease of muscle cell isolation, skeletal muscle is an attractive source of cells for use in tissue engineering applications. The aim of this study was to explore the potential to differentiate into the chondro--osteoblastic lineage of a plastic adhering cell population, referred t as skeletal muscle-derived cells (SMDCs), obtained from biopsies of rat skeletal muscle. SMDCs displayed a fibroblast-like morphology. Our study revealed that the isolated cell population had a mesenchymal origin as indicated by abundant expression of STRO-1 and CD166. Osteogenic markers like osteocalcin (OC), bone sialoprotein (BSP) and osteopontin (OP) gene expressions were detected by RT-PCR. When these cells were cultured in the presence of an osteo-inductive culture medium, positive staining for alkaline phosphatase (ALP) and formation of mineralized matrix were increased. Furthermore SMDCs formed bone and cartilage tissues in vivo when placed inside of diffusion chambers and in demineralized bone matrix (DBM) cylinders, implanted subdermically into the backs of rat for 28 days. In conclusion, this experimental procedure is capable of selecting a cell population obtained from the skeletal muscle that is able to complete the differentiation pathway leading to the formation of cartilage and bone. In this respect SMDCs resemble BM stromal cells (BMSCs) and have demonstrated a potential application for cartilage and bone tissue engineering.

Process for capturing CO2 arising from the calcination of the CaCO3 used in cement manufacture

This paper outlines a new CaCO3 calcination method for producing a stream of CO2 (suitable for permanent geological storage after purification and compression). The process is based on the use of very hot CaO particles (T >1000 degrees C) to transfer heat from a circulating fluidized bed combustor (CFBC) to a calciner (fluidized with CO2 and/or steam). Since the fluidized bed combustor and calciner have separate atmospheres, the CO2 resulting from the decomposition of CaCO3 can be captured, while the CO2 generated in the combustion of the fuel in air is emitted to the atmosphere. We demonstrate that with this system it is possible to reduce the CO2 emissions of a cement plant by around 60%. Furthermore, since the key pieces of equipment are similar to the commercial CFBCs used in power generation plants, it is possible to establish the additional investment required for the system and to estimate the cost per ton of CO2 avoided for this process to be about 19 $/tCO2 avoided.

[Antimicrobial drugs errors: the silent epidemic in patient safety]

INTRODUCTION

Prescribed drugs and the mistakes in the administration to patient is the first cause of adverse events in the hospitals. The aim of this study has been to evaluate antimicrobial drug mistakes in one of our hospital wards in a two year period 2005 and 2006.

METHODS

All the errors were reported through the National Health Service IR2 form (England) on a voluntary basis and classified by means of process, type of errors, their causes and contributory factors, as well as the severity. We analyzed the economic costs.

RESULTS

. A 1.3% of the inpatients had an antimicrobial error in the administration to the patient (0.84 by 1,000 prescribing orders). Classified by processes, the administration (32.4%) and dispensation (44.1%) were the most frequent errors. By type of error: the erroneous medication (32.4%), the main root cause the human factors (58.8 %) and the contribution factor due to design of tasks (55.9 %). The 5.9% of errors were severe events, mainly in the group of the betalactamic drugs, and mainly by parenteral administration (50%). Conclusions. Antimicrobial drug errors, frequent and sometimes severe, suppose a silent epidemic not being detected without the patient safety methodology. They represent a high cost for a hospital.