Modern lineages of Mycobacterium tuberculosis were recently introduced in western India and demonstrate increased transmissibility

Background: Mycobacterium tuberculosis (Mtb) transmissibility may vary between lineages (or variants) and this may contribute to the slow decline of tuberculosis (TB) incidence. The objective of our study was to compare transmissibility across four major lineages (L1-4) of Mtb among participants from two cohort studies in Pune, India. Methods: We performed whole-genome sequencing (WGS) of Mtb sputum culture-positive isolates from participants in two prospective cohort studies of adults with pulmonary TB seeking care at public treatment centers in Pune, Maharashtra. We performed genotypic susceptibility prediction for both first- and second-line drugs using a previously validated random forest model. We used single nucleotide substitutions (SNS) and maximum likelihood estimation to build isolate phylogenies by lineage. We used Bayesian molecular dating to estimate ancestral node ages and compared tree characteristics using a two-sample Kolmogorov-Smirnov (KS) test. Results: Of the 642 isolates from distinct study participants that underwent WGS, 612 met sequence quality criteria. The median age of the 612 participants was 31 years (IQR 24.4-44.2), the majority were male (64.7%) and sputum smear-positive (83.3%), and 6.7% had co-infection with HIV. Most isolates belonged to L3 (44.6%). The majority (61.1%) of multidrug-resistant isolates (MDR, resistant to isoniazid and rifampin) belonged to L2 (P < 0.001 [Fisher's Exact]). There was no significant difference in host characteristics between participants infected with the four major lineages. In phylogenetic analysis, we measured shorter terminal branch lengths in the L2 tree compared to L1 and L3 trees indicating less time elapsing between transmission and sampling and higher transmissibility (median branch lengths: L2 - 3.3, L3 - 7.8, p <0.001). Branching times for L2 and L4 were more recent than L1 and L3 indicating recent introduction into the region (p < 0.01 [KS test]). Conclusion: Modern Mtb lineages (L2 and L4) were more recently introduced in western India, compared to older lineages (L1 and L3). L2 shows a higher frequency of drug-resistance and higher transmissibility. Our findings highlight the need for contact tracing around cases of TB due to L2, and heightened surveillance of TB antibiotic resistance in India.

Understanding drivers of phylogenetic clustering and terminal branch lengths distribution in epidemics of Mycobacterium tuberculosis

Detecting factors associated with transmission is important to understand disease epidemics, and to design effective public health measures. Clustering and terminal branch lengths (TBL) analyses are commonly applied to genomic data sets of Mycobacterium tuberculosis (MTB) to identify sub-populations with increased transmission. Here, I used a simulation-based approach to investigate what epidemiological processes influence the results of clustering and TBL analyses, and whether difference in transmission can be detected with these methods. I simulated MTB epidemics with different dynamics (latency, infectious period, transmission rate, basic reproductive number R0, sampling proportion, and molecular clock), and found that all these factors, except the length of the infectious period and R0, affect the results of clustering and TBL distributions. I show that standard interpretations of this type of analyses ignore two main caveats: 1) clustering results and TBL depend on many factors that have nothing to do with transmission, 2) clustering results and TBL do not tell anything about whether the epidemic is stable, growing, or shrinking. An important consequence is that the optimal SNP threshold for clustering depends on the epidemiological conditions, and that sub-populations with different epidemiological characteristics should not be analyzed with the same threshold. Finally, these results suggest that different clustering rates and TBL distributions, that are found consistently between different MTB lineages, are probably due to intrinsic bacterial factors, and do not indicate necessarily differences in transmission or evolutionary success.

Population structure, biogeography and transmissibility of Mycobacterium tuberculosis

Mycobacterium tuberculosis is a clonal pathogen proposed to have co-evolved with its human host for millennia, yet our understanding of its genomic diversity and biogeography remains incomplete. Here we use a combination of phylogenetics and dimensionality reduction to reevaluate the population structure of M. tuberculosis, providing an in-depth analysis of the ancient Indo-Oceanic Lineage 1 and the modern Central Asian Lineage 3, and expanding our understanding of Lineages 2 and 4. We assess sub-lineages using genomic sequences from 4939 pan-susceptible strains, and find 30 new genetically distinct clades that we validate in a dataset of 4645 independent isolates. We find a consistent geographically restricted or unrestricted pattern for 20 groups, including three groups of Lineage 1. The distribution of terminal branch lengths across the M. tuberculosis phylogeny supports the hypothesis of a higher transmissibility of Lineages 2 and 4, in comparison with Lineages 3 and 1, on a global scale. We define an expanded barcode of 95 single nucleotide substitutions that allows rapid identification of 69 M. tuberculosis sub-lineages and 26 additional internal groups. Our results paint a higher resolution picture of the M. tuberculosis phylogeny and biogeography.

Musculocutaneous nerve as a branch from median nerve: A case report

The brachial plexus is the most variable part of the peripheral nervous system. The Musculocutaneous nerve is a terminal branch of the lateral cord of the brachial plexus in a normal individual. It is not uncommon for variations in the origin, branching termination, and connection patterns. During routine dissection in the Anatomy Department, College of Medicine, King Saud University, we found the lateral cord after giving a small branch to the coracobrachialis muscle join the medial root of the medial cord to form the median nerve. Knowledge of these variations is essential for anatomists, orthopedics, neurologists, and anesthesiologists.

Cadaveric Study of the Mode of Termination of the Sciatic Nerve in a Malian Population: Cases of Trifurcation and Hexafurcation

Background: The sciatic nerve is the largest nerve in body. It is the only terminal branch of the sacral plexus. It emerges under the piriformis muscle, descends into the gluteal region, then into the posterior compartment of the thigh. It ends in the popliteal fossa by dividing into the tibial and common peroneal nerve. It is the most frequently injured nerve. The aim of this work was to study the mode of termination of the sciatic nerve by cadaveric dissection in a Malian population.Materials and methods: This was a cross-sectional study, carried out at the anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako, ranging from December 2019 to April 2021. The sciatic nerve was dissected 74 times in 37 cadaveric subjects (29 men and 8 women).Results: The classic termination mode (the sciatic nerve terminates giving the tibial nerve and common peroneal nerve) was most frequently encountered with a prevalence of 82.43%. Anatomical variations were noted in 17.57%. Among these variations, trifurcation (termination in three branches) of the sciatic nerve was observed in 16.22%. Hexafurcation (six-branch termination) of the sciatic nerve was observed in 1.35%. The termination mode showed a significant difference being more frequently bilateral than unilateral (P˂0.05)Conclusion: Anatomical variations in the mode of termination of the sciatic nerve are not uncommon. The most common of these variations is the trifurcation in which the sciatic nerve ends up giving the tibial nerve, the common peroneal nerve and a third branch which is variable. Knowledge of these variations is important for surgeons when treating popliteal artery aneurysm, popliteal vessel fistula and popliteal fossa cysts.

Yet Another Mitochondrial Genome of the Pacific Cupped Oyster: The Published Mitogenome of Alectryonella plicatula (Ostreinae) Is Based on a Misidentified Magallana gigas (Crassostreinae)

The recently published mitochondrial genome of the fingerprint oyster Alectryonella plicatula (Gmelin, 1791) with GenBank accession number MW143047 was resolved in an unexpected phylogenetic position, as sister to the Pacific cupped oyster Magallana gigas (Thunberg, 1793) and share with this species three typical gene duplications that represent robust synapomorphies of the Magallana clade. In this study, we verified the identity of MW143047 using direct comparisons of single gene sequences, DNA barcoding and phylogenetic analyses. BLAST searches using as query each of the 12 protein coding genes (PCGs) and rRNA genes extracted from MW143047 retrieved M. gigas as best hit with 100% sequence identity for all genes. MW143047 is nested within the clade formed by M. gigas sequences, with virtually zero-length terminal branch, both in the cox1 gene tree (based on 3639 sequences) and in the 16S gene tree (based on 1839 sequences), as well as in the Maximum Likelihood mitogenomic tree based on concatenated sequence of 12 PCGs. Our findings suggest that the original specimen used for mitogenome sequencing was misidentified and represents an individual of M. gigas. This study reinforces the notion that morphological shell analysis alone is not sufficient for oyster identification, not even at high taxonomic ranks such as subfamilies. While it is well established that morphological identification of oysters should be validated by molecular data, this study emphasizes that also molecular data should be taxonomically verified by means of DNA barcoding and phylogenetic analyses. The implications of the publication of taxonomically misidentified sequences and mitogenomes are discussed.

The Importance of Sacral Neuroanatomy in Pain Syndromes and Procedures

: The neural plexus exists in different parts of the body. The sacral plexus is the lowest neural network in the body that is responsible for sensory and motor innervation to a large part of the body. The sacral plexus or sacral nerve roots may be damaged by diseases, such as disc herniation, spinal canal stenosis, and cancer or iatrogenic injuries during surgery or interventional pain procedures (open spinal surgeries, hip surgeries, percutaneous endoscopic disc decompression, trans-sacral epiduroscopic laser decompression, …). Patients with sacral nerve damage may experience a variety of symptoms, including low back pain radiating to the legs, sensory disturbance in the buttocks or legs, motor weakness in the legs, bladder or bowel dysfunction (urinary retention/incontinence, defecation’s problems), or sexual dysfunction. Therefore, complete familiarity with the anatomy of the sacral plexus is very important. In this article, we tried to review the anatomy of the sacral plexus and sensory or motor innervations of each terminal branch of the sacral plexus. Also, the clinical importance of these nerves in the development of pain syndromes and diagnostic and therapeutic methods for damage to the terminal branches of the sacral plexus were investigated.

Service Quality And Service User Satisfaction At PT. Pelabuhan Indonesia IV, Makassar Container Terminal Branch

PT. Pelabuhan Indonesia IV (Persero) is a state-owned company (BUMN) engaged in port services that provides port facilities and infrastructure in order to support the smooth flow of ships, passenger transportation, and delivery of goods. This study aims to determine the effect of Service Quality on Service User Satisfaction at PT. Pelabuhan Indonesia IV, Makassar Container Terminal Branch. The population in the study at PT. Pelabuhan Indonesia IV (Persero) Makassar Container Terminal Branch 220 Espedisi, namely from the many expeditions that use the services of PT Pelabuhan Indonesia IV (Persero) Makassar Container Terminal Branch. The number of samples is 69 from the existing population. Determination of the number of samples in this study using the Sloving formula. Multiple Linear Regression Analysis Method with a quantitative approach. The results showed that reliability, responsiveness, assurance, empathy, tangible, simultaneously affect service user satisfaction. Meanwhile, through partial, reliability, responsiveness, assurance, empathy, tangible all have a positive effect, but only responsiveness and empathy have a significant effect.

Do root modules still exist after they die?

Background The terminal branch orders of plant root systems are increasingly known as an ephemeral module. This concept is crucial to recognize belowground processes. However, it is unknown if root modules still exist after they die? Methods The decomposition patterns of the first five root orders were observed for 3 years using a branch-order classification, a litter-bag method and sequential sampling in a common subalpine tree species (Picea asperata) of southwestern China. Results Two root modules were observed during the 3-year incubation. Among the first five branch orders, the first three order roots exhibited temporal patterns of mass loss, nutrients and stoichiometry distinct from their woody mother roots throughout the experimental period. This study, for the first time, reported the decomposition pattern of each individual root order and found a similar decomposition dynamic among ephemeral root branches in a forest tree species. Conclusions Results from this study suggest that root modules may also exist after death, while more data are needed for confirmation. The findings may further advance our understanding of architecture-associated functional heterogeneity in the fine-root system and also improve our ability to predict belowground processes.