A Physiological and Molecular Focus on the Resistance of "Filippo Ceo" Almond Tree to Xylella fastidiosa

The impact of Xylella fastidiosa (Xf) subsp. pauca on the environment and economy of Southern Italy has been devastating. To restore the landscape and support the local economy, introducing new crops is crucial for restoring destroyed olive groves, and the almond tree (Prunus dulcis Mill. D. A. Webb) could be a promising candidate. This work focused on the resistance of the cultivar "Filippo Ceo" to Xf and evaluated its physiological and molecular responses to individual stresses (drought or pathogen stress) and combined stress factors under field conditions over three seasons. Filippo Ceo showed a low pathogen concentration (≈103 CFU mL-1) and a lack of almond leaf scorch symptoms. Physiologically, an excellent plant water status was observed (RWC 82-89%) regardless of the stress conditions, which was associated with an increased proline content compared to that of the control plants, particularly in response to Xf stress (≈8-fold). The plant's response did not lead to a gene modulation that was specific to different stress factors but seemed more indistinct: upregulation of the LEA and DHN gene transcripts by Xf was observed, while the PR transcript was upregulated by drought stress. In addition, the genes encoding the transcription factors (TFs) were differentially induced by stress conditions. Filippo Ceo could be an excellent cultivar for coexistence with Xf subps. pauca, confirming its resistance to both water stress and the pathogen, although this similar health status was achieved differently due to transcriptional reprogramming that results in the modulation of genes directly or indirectly involved in defence strategies.

An ancestral molecular response to nanomaterial particulates

The varied transcriptomic response to nanoparticles has hampered the understanding of the mechanism of action. Here, by performing a meta-analysis of a large collection of transcriptomics data from various engineered nanoparticle exposure studies, we identify common patterns of gene regulation that impact the transcriptomic response. Analysis identifies deregulation of immune functions as a prominent response across different exposure studies. Looking at the promoter regions of these genes, a set of binding sites for zinc finger transcription factors C2H2, involved in cell stress responses, protein misfolding and chromatin remodelling and immunomodulation, is identified. The model can be used to explain the outcomes of mechanism of action and is observed across a range of species indicating this is a conserved part of the innate immune system.

Xylem Embolism and Pathogens: Can the Vessel Anatomy of Woody Plants Contribute to X. fastidiosa Resistance?

The maintenance of an intact water column in the xylem lumen several meters above the ground is essential for woody plant viability. In fact, abiotic and biotic factors can lead to the formation of emboli in the xylem, interrupting sap flow and causing consequences on the health status of the plant. Anyway, the tendency of plants to develop emboli depends on the intrinsic features of the xylem, while the cyto-histological structure of the xylem plays a role in resistance to vascular pathogens, as in the case of the pathogenic bacterium Xylella fastidiosa. Analysis of the scientific literature suggests that on grapevine and olive, some xylem features can determine plant tolerance to vascular pathogens. However, the same trend was not reported in citrus, indicating that X. fastidiosa interactions with host plants differ by species. Unfortunately, studies in this area are still limited, with few explaining inter-cultivar insights. Thus, in a global context seriously threatened by X. fastidiosa, a deeper understanding of the relationship between the physical and mechanical characteristics of the xylem and resistance to stresses can be useful for selecting cultivars that may be more resistant to environmental changes, such as drought and vascular pathogens, as a way to preserve agricultural productions and ecosystems.

"Ectomosphere": Insects and Microorganism Interactions

This study focuses on interacting with insects and their ectosymbiont (lato sensu) microorganisms for environmentally safe plant production and protection. Some cases help compare ectosymbiont microorganisms that are insect-borne, -driven, or -spread relevant to endosymbionts' behaviour. Ectosymbiotic bacteria can interact with insects by allowing them to improve the value of their pabula. In addition, some bacteria are essential for creating ecological niches that can host the development of pests. Insect-borne plant pathogens include bacteria, viruses, and fungi. These pathogens interact with their vectors to enhance reciprocal fitness. Knowing vector-phoront interaction could considerably increase chances for outbreak management, notably when sustained by quarantine vector ectosymbiont pathogens, such as the actual Xylella fastidiosa Mediterranean invasion episode. Insect pathogenic viruses have a close evolutionary relationship with their hosts, also being highly specific and obligate parasites. Sixteen virus families have been reported to infect insects and may be involved in the biological control of specific pests, including some economic weevils. Insects and fungi are among the most widespread organisms in nature and interact with each other, establishing symbiotic relationships ranging from mutualism to antagonism. The associations can influence the extent to which interacting organisms can exert their effects on plants and the proper management practices. Sustainable pest management also relies on entomopathogenic fungi; research on these species starts from their isolation from insect carcasses, followed by identification using conventional light or electron microscopy techniques. Thanks to the development of omics sciences, it is possible to identify entomopathogenic fungi with evolutionary histories that are less-shared with the target insect and can be proposed as pest antagonists. Many interesting omics can help detect the presence of entomopathogens in different natural matrices, such as soil or plants. The same techniques will help localize ectosymbionts, localization of recesses, or specialized morphological adaptation, greatly supporting the robust interpretation of the symbiont role. The manipulation and modulation of ectosymbionts could be a more promising way to counteract pests and borne pathogens, mitigating the impact of formulates and reducing food insecurity due to the lesser impact of direct damage and diseases. The promise has a preventive intent for more manageable and broader implications for pests, comparing what we can obtain using simpler, less-specific techniques and a less comprehensive approach to Integrated Pest Management (IPM).

Xylella fastidiosa and Drought Stress in Olive Trees: A Complex Relationship Mediated by Soluble Sugars

Simple Summary

Carbohydrates play important roles in tolerance to both biotic and abiotic stressors. Xylella fastidiosa, the causal agent of “Olive Quick Decline Syndrome”, is a quarantine pathogen that induces drought stress in the host, aggravated by eventual water shortage, which is a frequent environmental condition in Mediterranean olive groves. At present, the resistance mechanisms shown by few resistant olive cultivars (e.g., cv Leccino) are not completely known; therefore, the aim of this research is to understand whether sugar metabolism is involved in the cross-talk mechanisms of biotic and abiotic responses. The results show that drought stress response induces effects beneficial to resistance of Xylella fastidiosa in cv Leccino. In the current context of global climate change, this study supports the importance of investigating the complex drought–disease interaction to detect resistance traits and thus find ways to counter the threat of this pathogen in the future.

Abstract

Xylella fastidiosa (Xf) subsp. pauca “De Donno” is the etiological agent of “Olive Quick Decline Syndrome” (OQDS) on olive trees (Olea europaea L.); the presence of the bacterium causes xylem vessel occlusions inducing a drought stress and the development of leaf scorch symptoms, which may be worsened by water shortage in summer. In order to evaluate how the two stress factors overlap each other, the carbohydrate content and the expression patterns of genes related to carbohydrate metabolism have been evaluated in two olive cvs trees (Cellina di Nardò, susceptible to Xf, and Leccino, resistant to Xf) reporting transcriptional dynamics elicited by Xf infection, drought, or combined stress (drought/Xf). In the Xf-susceptible Cellina di Nardò plants, Xf and its combination with drought significantly decrease total sugars compared to control (−27.0% and −25.7%, respectively). In contrast, the Xf-resistant Leccino plants show a more limited reduction in sugar content in Xf-positive conditions (−20.1%) and combined stresses (−11.1%). Furthermore, while the amount of glucose decreases significantly in stressed Cellina di Nardò plants (≈18%), an increase was observed in Leccino plants under drought/Xf combined stresses (+11.2%). An opposite behavior among cvs was also observed for sucrose, as an accumulation of the disaccharide was recorded in stressed Leccino plants (≈37%). The different response to combined stress by Xf-resistant plants was confirmed considering genes coding for the sucrose or monosaccharide transporter (OeSUT1, OeMST2), the cell wall or vacuolar invertase (OeINV-CW, OeINV-V), the granule-bound starch synthase I (OeGBSSI) and sucrose synthase (OeSUSY), with a higher expression than at least one single stress (e.g., ≈1-fold higher or more than Xf for OeMST2, OeINV-CW, OeINV-V, OeGBSSI). It is probable that the pathways involved in drought stress response induce positive effects useful for pathogen resistance in cv Leccino, confirming the importance of investigating the mechanisms of cross-talk of biotic and abiotic responses.

Skills needed to communicate adequately COVID-19 risk indicators to citizens and policy-makers

Risk communication is a sustained communication process established with a diverse audience about the likelihood of the health outcomes of specific conditions or actions. Individuals are influenced by risk information in complex and unpredictable ways and communicating effectively risk during a pandemic event requires a set of different skills: 1) analysis skills, to be able to gather and assess the information; 2) communication skills, to deliver information that is understandable, through the right channels for the specific audience; 3) coordination and leadership skills, to be able to align partners at local, regional, national, international level to meet common goals. In this presentation, challenges of communicating COVID-19 risk indicators such as the risk of infection, risk of being hospitalised, risk of death, risk of long-term consequences, and risk of adverse events from vaccination will be presented. In particular, through case studies we will examine local, national and international risk communication strategies on: 1) risk of death in the vulnerable population; 2) risk of transmission in the home setting; 3) risk of long-term consequences of COVID-19 (“long COVID”). The strengths and weaknesses of the communication strategies in these examples will be pointed out and opportunities to improve them will be covered.

Diseases Caused by Xylella fastidiosa in Prunus Genus: An Overview of the Research on an Increasingly Widespread Pathogen

Cultivated plants belonging to the genus Prunus are globally widespread and for some countries, are economically important crops; and they play a key role in the composition of a landscape. Xylella fastidiosa is a key threat to plant health, and several Prunus species are heavily stressed by this pathogen, such as almond, peach, and plum; many strain types of different subspecies can cause severe diseases. This review highlights different approaches to managing epidemic events related to X. fastidiosa in stone fruit plants. In fact, in most new European and Asian outbreaks, almond is the main and very common host and peach, plum, apricot, and cherry are widespread and profitable crops for the involved areas. Various diseases associated with stone fruit plants show different degrees of severity in relation to cultivar, although investigations are still limited. The development and selection of tolerant and resistant cultivars and the study of resistance mechanisms activated by the plant against X. fastidiosa infections seem to be the best way to find long-term solutions aimed at making affected areas recover. In addition, observations in orchards severely affected by the disease can be essential for collecting tolerant or resistant materials within the local germplasm. In areas where the bacterium is not yet present, a qualitative-quantitative study on entomofauna is also important for the timely identification of potential vectors and for developing effective control strategies.

Feature set optimization in biomarker discovery from genome-scale data

MOTIVATION

Omics technologies have the potential to facilitate the discovery of new biomarkers. However, only few omics-derived biomarkers have been successfully translated into clinical applications to date. Feature selection is a crucial step in this process that identifies small sets of features with high predictive power. Models consisting of a limited number of features are not only more robust in analytical terms, but also ensure cost effectiveness and clinical translatability of new biomarker panels. Here we introduce GARBO, a novel multi-island adaptive genetic algorithm to simultaneously optimize accuracy and set size in omics-driven biomarker discovery problems.

RESULTS

Compared to existing methods, GARBO enables the identification of biomarker sets that best optimize the trade-off between classification accuracy and number of biomarkers. We tested GARBO and six alternative selection methods with two high relevant topics in precision medicine: cancer patient stratification and drug sensitivity prediction. We found multivariate biomarker models from different omics data types such as mRNA, miRNA, copy number variation, mutation and DNA methylation. The top performing models were evaluated by using two different strategies: the Pareto-based selection, and the weighted sum between accuracy and set size (w = 0.5). Pareto-based preferences show the ability of the proposed algorithm to search minimal subsets of relevant features that can be used to model accurate random forest-based classification systems. Moreover, GARBO systematically identified, on larger omics data types, such as gene expression and DNA methylation, biomarker panels exhibiting higher classification accuracy or employing a number of features much lower than those discovered with other methods. These results were confirmed on independent datasets.

AVAILABILITY AND IMPLEMENTATION

github.com/Greco-Lab/GARBO.

CONTACT

dario.greco@tuni.fi.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Structural brain anomalies in Cri-du-Chat syndrome: MRI findings in 14 patients and possible genotype-phenotype correlations

INTRODUCTION

Cri-du-Chat Syndrome (CdCS) is a genetic condition due to deletions showing different breakpoints encompassing a critical region on the short arm of chromosome 5, located between p15.2 and p15.3, first defined by Niebuhr in 1978. The classic phenotype includes a characteristic cry, peculiar facies, microcephaly, growth retardation, hypotonia, speech and psychomotor delay and intellectual disability. A wide spectrum of clinical manifestations can be attributed to differences in size and localization of the 5p deletion. Several critical regions related to some of the main features (such as cry, peculiar facies, developmental delay) have been identified. The aim of this study is to further define the genotype-phenotype correlations in CdCS with particular regards to the specific neuroradiological findings.

PATIENTS AND METHODS

Fourteen patients with 5p deletions have been included in the present study. Neuroimaging studies were conducted using brain Magnetic Resonance Imaging (MRI). Genetic testing was performed by means of comparative genomic hybridization (CGH) array at 130 kb resolution.

RESULTS

MRI analyses showed that isolated pontine hypoplasia is the most common finding, followed by vermian hypoplasia, ventricular anomalies, abnormal basal angle, widening of cavum sellae, increased signal of white matter, corpus callosum anomalies, and anomalies of cortical development. Chromosomal microarray analysis identified deletions ranging in size from 11,6 to 33,8 Mb on the short arm of chromosome 5. Then, we took into consideration the overlapping and non-overlapping deleted regions. The goal was to establish a correlation between the deleted segments and the neuroradiological features of our patients.

CONCLUSIONS

Performing MRI on all the patients in our cohort, allowed us to expand the neuroradiological phenotype in CdCS. Moreover, possible critical regions associated to characteristic MRI findings have been identified.

Engaging policy makers: how to make the message pass?

Vaccination remains a serious matter of concern from a relevant part of the population, therefore a quite delicate issue for policy-makers. The paradox between vaccination success and vaccination hesitancy is a current issue: the more vaccination has been successful in eliminating or reducing the incidence of diseases the lower the perception of risk among younger parents' cohorts that never saw diseases for which their children are requested to be vaccinated.

This hesitancy is reflected in the politicians' space, as they are quite reluctant to impose measures that will target the mass of healthy young children potentially raising negative reaction from the parent's population.

Financial issues are not a concern in the rich world: vaccination global budget is a small fraction of the running health expenditures; money is still a problem in developing countries, but there population and politicians do accept happily donation for new vaccination campaigns.

But the situation is quickly changing: in the northern hemisphere, despite the growth of vaccination hesitancy seven new vaccines have been successfully introduced in the last decade (e.g. Chickenpox, HPV, Rotavirus) and new ones are close to introduction (e.g. Herpes Zoster, Gonorrhea, Norovirus, RSV).

Are policy-maker changing the traditional reluctant attitude against new vaccines? Few factors have been underlined in the last decade: Vaccination cost-benefit analysis offer politicians a good argument to show they are working for the population health.Mathematical models are becoming frequently used tools to show the economic gain of vaccination.The consequences of fake news and antivaccine narrative are warning politicians for more respect for science.Newly emerging epidemic diseases are increasing population confidence for public health interventions.

Those factors are influencing health communication and could become useful tools to complement policy-makers' strategies.

Vitamin D replacement ameliorates serum lipoprotein functions, adipokine profile and subclinical atherosclerosis in pre-menopausal women

BACKGROUND AND AIMS

Low vitamin D (vitD) has been linked to increased cardiovascular (CV) risk, but the effects of vitD supplementation are not clarified. We evaluated the impact of vitD normalization on HDL cholesterol efflux capacity (CEC), which inversely correlates with CV risk, the proatherogenic serum cholesterol loading capacity (CLC), adipokine profile and subclinical atherosclerosis.

METHODS AND RESULTS

Healthy premenopausal women with vitD deficiency (n = 31) underwent supplementation. Subclinical atherosclerosis was evaluated by flow-mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AIx), measured with standard techniques. HDL CEC and serum CLC were measured by a radioisotopic and fluorimetric assay, respectively. Malondialdehyde (MDA) in HDL was quantified by the TBARS assay. Pre-β HDL was assessed by 2D-electrophoresis. Serum adipokines were measured by ELISA. VitD replacement restored normal levels of serum 25-hydroxyvitamin D (25OHD) and significantly improved FMD (+4%; p < 0.001), PWV (-4.1%: p < 0.001) and AIx (-16.1%; p < 0.001). Total CEC was significantly improved (+19.5%; p = 0.003), with a specific increase in the ABCA1-mediated CEC (+70.8%; p < 0.001). HDL-MDA slightly but significantly decreased (-9.6%; p = 0.027), while no difference was detected in pre-β HDL. No change was observed in aqueous diffusion nor in the ABCG1-mediated CEC. Serum CLC was significantly reduced (-13.3%; p = 0.026). Levels of adiponectin were increased (+50.6%; p < 0.0001) and resistin levels were decreased (-24.3%; p < 0.0001). After vitD replacement, an inverse relationship was found linking the ABCA1-mediated CEC with pre-β HDL (r² = 0.346; p < 0.001) and resistin (r² = 0.220; p = 0.009).

CONCLUSION

Our data support vitD supplementation for CV risk prevention.

Nasal mucosa and blood cell transcriptome profiles do not reflect respiratory symptoms associated with moisture damage

Upper and lower respiratory symptoms and asthma are adverse health effects associated with moisture-damaged buildings. Quantitative measures to detect adverse health effects related to exposure to dampness and mold are needed. Here, we investigate differences in gene expression between occupants of moisture-damaged and reference buildings. Moisture-damaged (N = 11) and control (N = 5) buildings were evaluated for dampness and mold by trained inspectors. The transcriptomics cohort consisted of nasal brushings and peripheral blood mononuclear cells (PBMCs) from 86 teachers, with/without self-perceived respiratory symptoms. Subject categories comprised reference (R) and damaged (D) buildings with (S) or without (NS) symptoms, that is, R-S, R-NS, DS, and D-NS. Component analyses and k-means clustering of transcriptome profiles did not distinguish building status (R/D) or presence of respiratory symptoms (S/NS). Only one nasal mucosa gene (YBX3P1) exhibited a significant change in expression between D-S and D-NS. Nine other nasal mucosa genes were differentially expressed between R-S and D-S teachers. No differentially expressed genes were identified in PBMCs. We conclude that the observed mRNA differences provide very weak biological evidence for adverse health effects associated with subject occupancy of the specified moisture-damaged buildings. This emphasizes the need to evaluate all potential factors (including those not related to toxicity) influencing perceived/self-reported ill health in moisture-damaged buildings.

Salvage Low Dose Rate Brachytherapy For Recurrent Prostate Cancer After External Beam Radiotherapy: Results From A Single Institution With Focus On Toxicity And Functional Outcomes

Background/aim:

Low dose rate brachytherapy has been used as salvage therapy for locally recurrent prostate cancer (PC) after primary external beam radiation therapy (EBRT), along with surgery and cryotherapy. All these techniques, in particular, when applied to the whole gland, involve a relatively high risk of toxicity and may worsen the patient’s quality of life. Our aim is to evaluate the results of whole-gland salvage brachytherapy (SBT) after primary EBRT in terms of toxicity, functional outcomes, and efficacy.

Materials and methods:

We retrospectively reviewed clinical data on 19 patients consecutively treated with SBT at our institution between June 2012 and November 2015. Local recurrences were identified with 11C-choline positron emission tomography/computed tomography and pelvic magnetic resonance imaging after biochemical recurrence according to Phoenix criteria (prostate-specific antigen nadir + 2). Low dose rate brachytherapy was performed by ¹²⁵I permanent seeds implantation to the whole prostate gland, with a prescription dose of 130 Gy. At the time of SBT, only 2 patients were receiving androgen deprivation therapy. Acute and late toxicities were recorded using the CTCAE 4.0 scoring system. Quality of life was assessed using IPSS (International Prostate Symptoms Score) and IIEF (International Index of Erectile Function) questionnaires at baseline and 6, 12, and 24 months after SBT, and the respective mean values were compared using Student t test. Biochemical relapse-free survival (BRFS) was also calculated.

Results:

Median follow-up after SBT was 24 months. Of 19 patients, 2 patients experienced a G3 cystitis (10.2%) and 1 patient experienced a G4 proctitis (5.3%), respectively. Mean pre-SBT IPSS scores and 6, 12, and 24 months after SBT were 5.84, 10.22, 15.72, and 8.10, respectively. Mean pre-SBT IIEF scores and 6, 12, and 24 months after SBT were 8.42, 3.55, 7.89, and 6.40, respectively. At the time of analysis, only 2 patients showed a biochemical relapse (3-year BRFS 85.2%). The Student t test demonstrated a worsening of functional outcome 6 months and 1 year after treatment but a subsequent improvement 2 years after SBT.

Conclusions:

Salvage brachytherapy for recurrent PC after primary EBRT seems to be a feasible treatment for selected patients. Our series revealed a severe toxicity peak 6 months and 1 year after local re-treatment and then they decrease. Early BRFS rates are good. However, these are very preliminary results so further patient accrual, long-term follow-up, and prospective trials are needed in the future.

Normal pregnancy outcome after first-trimester exposure to liraglutide in a woman with Type 2 diabetes

BACKGROUND

Data from animal studies suggest that glucagon-like peptide-1 analogues should not be used in pregnancy, but there have been no reports to date of their effects in human pregnancy. The aim of the present report was to describe a case of exposure to liraglutide during the first trimester of pregnancy in a patient with Type 2 diabetes mellitus.

CASE REPORT

A 37-year-old woman with Type 2 diabetes mellitus who had been taking liraglutide for 2 years was admitted in the 13(th) week of gestation. Liraglutide was immediately discontinued and intensive insulin therapy instituted. The woman gave birth to a healthy child after completing an uneventful gestation period.

CONCLUSION

Although the present normal pregnancy outcome does not mean that glucagon-like peptide-1 analogues are safe to use in pregnancy, this report contributes to the limited knowledge regarding human exposure to these drugs during pregnancy in women with diabetes.

Whooping cough, twenty years from acellular vaccines introduction

Clinical pertussis resulting from infection with B. pertussis is a significant medical and public health problem, despite the huge success of vaccination that has greatly reduced its incidence. The whole cell vaccine had an undeniable success over the last 50 years, but its acceptance was strongly inhibited by fear, only partially justified, of severe side effects, but also, in the Western world, by the difficulty to enter in combination with other vaccines: today multi-vaccine formulations are essential to maintain a high vaccination coverage. The advent of acellular vaccines was greeted with enthusiasm by the public health world: in the Nineties, several controlled vaccine trials were carried out: they demonstrated a high safety and good efficacy of new vaccines. In fact, in the Western world, the acellular vaccines completely replaced the whole cells ones. In the last years, ample evidence on the variety of protection of these vaccines linked to the presence of different antigens of Bordetella pertussis was collected. It also became clear that the protection provided, on average around 80%, leaves every year a significant cohort of vaccinated susceptible even in countries with a vaccination coverage of 95%, such as Italy. Finally, it was shown that, as for the pertussis disease, protection decreases over time, to leave a proportion of adolescents and adults unprotected. Waiting for improved pertussis vaccines, the disease control today requires a different strategy that includes a booster at 5 years for infants, but also boosters for teenagers and young adults, re-vaccination of health care personnel, and possibly of pregnant women and of those who are in contact with infants (cocooning). Finally, the quest for better vaccines inevitably tends towards pertussis acellular vaccines with at least three components, which have demonstrated superior effectiveness and have been largely in use in Italy for fifteen years.

The oxysterol receptor LXRβ protects against DSS- and TNBS-induced colitis in mice

We examined the function of the oxysterol receptors (LXRs) in inflammatory bowel disease (IBD) through studying dextran sodium sulfate (DSS)- and 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in mice and by elucidating molecular mechanisms underlying their anti-inflammatory action. We observed that Lxr-deficient mice are more susceptible to colitis. Clinical indicators of colitis including weight loss, diarrhea and blood in feces appeared earlier and were more severe in Lxr-deficient mice and particularly LXRβ protected against symptoms of colitis. Addition of an LXR agonist led to faster recovery and increased survival. In contrast, Lxr-deficient mice showed slower recovery and decreased survival. In Lxr-deficient mice, inflammatory cytokines and chemokines were increased together with increased infiltration of immune cells in the colon epithelium. Activation of LXRs strongly suppressed expression of inflammatory mediators including TNFα. While LXRα had anti-inflammatory effects in CD11b(+) immune cell populations, LXRβ in addition had anti-inflammatory effects in colon epithelial cells. Lack of LXRβ also induced CD4(+)/CD3(+) immune cell recruitment to the inflamed colon. Expression of both LXRA and LXRB was significantly suppressed in inflamed colon from subjects with IBD compared with non-inflamed colon. Taken together, our observations suggest that the LXRs could provide interesting targets to reduce the inflammatory responses in IBD.

Neuropeptide S receptor 1 (NPSR1) activates cancer-related pathways and is widely expressed in neuroendocrine tumors

Neuroendocrine tumors (NETs) arise from disseminated neuroendocrine cells and express general and specific neuroendocrine markers. Neuropeptide S receptor 1 (NPSR1) is expressed in neuroendocrine cells and its ligand neuropeptide S (NPS) affects cell proliferation. Our aim was to study whether NPS/NPSR1 could be used as a biomarker for neuroendocrine neoplasms and to identify the gene pathways affected by NPS/NPSR1. We collected a cohort of NETs comprised of 91 samples from endocrine glands, digestive tract, skin, and lung. Tumor type was validated by immunostaining of chromogranin-A and synaptophysin expression and tumor grade was analyzed by Ki-67 proliferation index. NPS and NPSR1 expression was quantified by immunohistochemistry using polyclonal antibodies against NPS and monoclonal antibodies against the amino-terminus and carboxy-terminus of NPSR1 isoform A (NPSR1-A). The effects of NPS on downstream signaling were studied in a human SH-SY5Y neuroblastoma cell line which overexpresses NPSR1-A and is of neuroendocrine origin. NPSR1 and NPS were expressed in most NET tissues, with the exception of adrenal pheochromocytomas in which NPS/NPSR1 immunoreactivity was very low. Transcriptome analysis of NPSR1-A overexpressing cells revealed that mitogen-activated protein kinase (MAPK) pathways, circadian activity, focal adhesion, transforming growth factor beta, and cytokine-cytokine interactions were the most altered gene pathways after NPS stimulation. Our results show that NETs are a source of NPS and NPSR1, and that NPS affects cancer-related pathways.

Prevalence of hospital-associated infections can be decreased effectively in developing countries

BACKGROUND

Hospital-acquired infections (HAI) are an important public health problem worldwide. Little information is available from African countries, but published data show that the burden of HAI is greater in Africa than in developed countries. In 2002, the World Health Organization (WHO) published guidelines for preventing HAI.

AIM

To evaluate the impact of a hospital infection control programme on the prevalence of HAI among patients in a large Ugandan hospital.

METHODS

A one-day cross-sectional prevalence survey and a ward procedure survey were performed in Lacor Hospital in March 2010 using standardized questionnaires. All patients admitted to hospital not less than two days before the survey were eligible to participate in the prevalence survey. Modified WHO criteria for HAI were used. The ward procedure survey examined the procedures to prevent HAI. Several hospital infection control measures were subsequently implemented, in accordance with WHO infection control guidelines, starting in October 2010. The prevalence survey and ward procedure survey were repeated in October 2011.

FINDINGS

The prevalence of HAI was 34% in 2010 and 17% in 2011. The prevalence of infected patients reduced from 28% to 14%. The prevalence of HAI was lower in all age groups and for all types of HAI except urinary tract infections following the implementation of infection control activities.

CONCLUSION

This study showed that HAI is an important problem in this large African hospital, and that the prevalence of HAI can be reduced effectively following the adoption of basic infection control procedures.

The prevalence and antibiotics susceptibility pattern of Neisseria gonorrhoeae in patients attending OPD clinics at St. Mary's Hospital Lacor Uganda

INTRODUCTION

Gonorrhea is one of the most common sexually transmitted infections (STls) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhoea. Periodical determination of the prevalence and monitoring of antimicrobial susceptibility of N. gonorrhoeae is essential for the early detection of emergence of drug resistance.

METHODS

A total of 640 consecutive patients who attended the Outpatient Department (OPD) Clinics at St. Mary's Hospital Lacor between Jan 2007-Dec 2011, with gonococcal urethriris symptoms and whose urethral swabs and high vagina swabs (HVS) were cultured, were involved in the study. Two hundred and fifty six (256) patients had positive pus swab culture, of which 151 (23.6%) showed growth of Neisseria gonorrhoeae. All the isolates were tested for antimicrobial susceptibility using the Kirby Bauer-disc diffusion techniques.

RESULTS

Gonococcal isolates showed rapid decrease in susceptibility to the antimicrobials especially to ampicillin, tetracycline and erythomycin, ciprofloxacin, and intermediate to chloramphenicol, however, gentamicin and cefotaxime have remained as a single dose sensitive treatment for Neisseria gonorrhoeae. Sensitization on drug use and adopting preventive measures and continuous education on safer sexual behavior through health care authorities would lead to reduction in the prevalence of Neisseria gonorrhoeae and resistance to antimicrobial.

DISCUSSION

Gonorrhea is one of the most common sexually transmitted infections (STIs) in developing countries, and the emergence of resistance to antimicrobial agents in Neisseria gonorrhoeae is a major obstacle in the control of gonorrhea. Periodical monitoring of antimicrobial susceptibility of N. gonorrhea is essential for the early detection of emergence of drug resistance.

Clinical characteristics and associated comorbidities in diabetic patients with cranial nerve palsies

BACKGROUND

Cranial mononeuropathy is one of the not so common forms of diabetic neuropathy that often appears to be a serious problem from a diagnostic and therapeutic point of view.

AIM

Objective of this study was to determine the incidence, the clinical characteristics, and risk factors associated with cranial nerve palsies among persons with diabetes.

METHODS

We have performed a retrospective study of all diabetic patients with cranial nerve palsies who were hospitalized in a metabolic department over a 12-yr period.

RESULTS

During the period of the survey, a total of 8150 diabetic subjects were hospitalized and cranial nerve palsies were identified in 61 patients (0.75%). Isolated III nerve palsies accounted for the majority of patients (0.35%), with VII nerve palsies (0.21%) occurring more frequently than VI (0.15%) and multiple palsies (0.04%). Peripheral neuropathy was present in only 24% of patients. Patients with VII nerve palsies showed a tendency toward a lower coexistence of diabetic complications and cardiovascular risk factors than those with III and VI nerve palsies.

CONCLUSIONS

Cranial nerve palsies are a not common problem among patients with diabetes; diagnosis of diabetic mononeuropathy should be considered even in the absence of peripheral neuropathy; the oculomotor nerve was most frequently affected in our case report. The coexistence of diabetic complications and cardiovascular risk factors was slightly lower in patients with VII nerve palsy: this fact is compatible with the hypotesis that this event is less closely related to diabetes and metabolic factors in its pathogenesis.

Hospital acquired infections in a large north Ugandan hospital

INTRODUCTION

Hospital care is a precious gift in Uganda, therefore little concern is given to hospital safety and very seldom Hospital Acquired Infection (HAI) risk is evaluated. Within a quality improvement hospital program the Board of Lacor Hospital, a large Missionary Hospital of north Uganda, ordered an HAI control program to be established. The first step of this program was an HAI prevalence survey whose results are presented in this paper.

METHODS

A one day prevalence survey was performed on patients admitted at least 48 hours before the survey: short training was offered to qualified nurses and hospital doctors. Lacking a suitable microbiological diagnostic service, clinical definitions of HAI were adopted. Questionnaires were completed by the nurses and data were analyzed and presented to the hospital personnel four days after the survey. A HAI control program was agreed and started soon after.

RESULTS

The hospital has 44.000 admissions yearly with 482 beds and main hospital specialties, 410 patients were surveyed Overall HAI prevalence was 28%, more in surgery (47%) and less in pediatrics (21%). Blood stream infections were the most frequent, followed by surgical wound infections and Urinary Tract infections, several lower respiratory tract infections and few gastrointestinal one. HAI prevalence was associated with length of stay in hospital, intravenous cannulas, urinary catheters and emergency surgery. Patients with severe low nutrition status, anemia and complications of the main disease bringing them to hospital experienced higher HAI prevalence.

DISCUSSION

This paper shows that HAI can be measured also in absence of microbiological service and that Hospital staff are ready to evaluate this problem. This high HAI prevalence was not expected by the staff and has been a starting point for an hospital HAI control plan.

Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008-2009

In 2009 the second cross-sectional web-based survey was undertaken by the Vaccine European New Integrated Collaboration Effort (VENICE) project across 27 European Union (EU) member states (MS), Norway and Iceland (n=29) to determine changes in official national seasonal influenza vaccination policies since a survey undertaken in 2008 and to compare the estimates of vaccination coverage between countries using data obtained from both surveys. Of 27 responding countries, all recommended vaccination against seasonal influenza to the older adult population. Six countries recommended vaccination of children aged between six months and <18 years old. Most countries recommended influenza vaccination for those individuals with chronic medical conditions. Recommendations for vaccination of healthcare workers (HCW) in various settings existed in most, but not all countries. Staff in hospitals and long-term care facilities were recommended vaccination in 23 countries, and staff in out-patient clinics in 22 countries. In the 2009 survey, the reported national estimates on vaccine coverage varied by country and risk group, ranging from 1.1% - 82.6% for the older adult population; to between 32.9% -71.7% for clinical risk groups; and from 13.4% -89.4% for HCW. Many countries that recommend the influenza vaccination do not monitor the coverage in risk groups. In 2008 and 2009 most countries recommended influenza vaccination for the main risk groups. Hovewer, despite general consensus and recommendations for vaccination of high risk groups many countries do not achieve high coverage in these groups. The reported vaccination coverage still needs to be improved in order to achieve EU and World Health Organization goals.

PERFIDI filters to suppress and/or quantify relaxation time components in multi-component systems: an example for fat-water systems

Parametrically Enabled Relaxation FIlters with Double and multiple Inversion (PERFIDI) is an experimental NMR/MRI technique devised to analyze samples/voxels characterized by multi-exponential longitudinal relaxation. It is based on a linear combination of NMR sequences with suitable preambles composed of inversion pulses. Given any standard NMR/MRI sequence, it permits one to modify it in a way which will attenuate, in a predictable manner and before data acquisition, signals arising from components with different r rates (r=1/T1). Consequently, it is possible to define relatively simple protocols to suppress and/or to quantify signals of different components. This article describes a simple way to construct low-pass, high-pass and band-pass PERFIDI filters. Experimental data are presented in which the method has been used to separate fat and water proton signals. We also present a novel protocol for very fast determination of the ratio between the fat signal and the total signal which avoids any time-consuming magnetization recovery multi-array data acquisition. The method has been validated also for MRI, producing well T1-contrasted images.

Severe hypoglycaemia leading to hospital admission in type 2 diabetic patients aged 80 years or older

AIM

Evidence is mounting that hypoglycaemia among elderly diabetic patients is a very real and costly concern. Objective of this study was to determine the incidence and risk factors for developing severe hypoglycaemia leading to hospital admission, among type 2 diabetic subjects aged 80 years or older.

METHODS

Hypoglycaemia was defined as a symptomatic event requiring treatment with i. v. glucose and confirmed by a blood glucose determination <50 mg/dl.

RESULTS

During a eight-year period severe hypoglycaemia was identified in 99 subjects. These patients were found to have a reduced cognitive ability, a heavy burden of comorbid disease and a HbA1c values of 5.9%. Of the hypoglycaemic episodes, 76 occurred in patients taking glibenclamide. Diabetes therapy was prescribed by general practitioners in 85 of them. Only 26 patients performed regular home blood glucose self-monitoring.

CONCLUSION

Severe hypoglycaemia is a serious and not uncommon metabolic emergency among patients with type 2 diabetes aged 80 years or older; it is more frequent in patients with considerable comorbidity undergoing aggressive diabetes management and in users of a long-acting sulphonylurea. In elderly subject, each patient's risk for hypoglycaemia should be considered and therapy should be individualized accordingly; in our opinion, a great number of episodes may be avoided by teaching the principles of blood glucose monitoring and involving general practitioners in outpatients management of diabetes mellitus.