GR13-type plasmids in Acinetobacter potentiate the accumulation and horizontal transfer of diverse accessory genes

Carbapenem resistance and other antibiotic resistance genes (ARGs) can be found in plasmids in Acinetobacter, but many plasmid types in this genus have not been well-characterised. Here we describe the distribution, diversity and evolutionary capacity of rep group 13 (GR13) plasmids that are found in Acinetobacter species from diverse environments. Our investigation was prompted by the discovery of two GR13 plasmids in A. baumannii isolated in an intensive care unit (ICU). The plasmids harbour distinct accessory genes: pDETAB5 contains blaNDM-1 and genes that confer resistance to four further antibiotic classes, while pDETAB13 carries putative alcohol tolerance determinants. Both plasmids contain multiple dif modules, which are flanked by pdif sites recognised by XerC/XerD tyrosine recombinases. The ARG-containing dif modules in pDETAB5 are almost identical to those found in pDETAB2, a GR34 plasmid from an unrelated A. baumannii isolated in the same ICU a month prior. Examination of a further 41 complete, publicly available plasmid sequences revealed that the GR13 pangenome consists of just four core but 1086 accessory genes, 123 in the shell and 1063 in the cloud, reflecting substantial capacity for diversification. The GR13 core genome includes genes for replication and partitioning, and for a putative tyrosine recombinase. Accessory segments encode proteins with diverse putative functions, including for metabolism, antibiotic/heavy metal/alcohol tolerance, restriction-modification, an anti-phage system and multiple toxin-antitoxin systems. The movement of dif modules and actions of insertion sequences play an important role in generating diversity in GR13 plasmids. Discrete GR13 plasmid lineages are internationally disseminated and found in multiple Acinetobacter species, which suggests they are important platforms for the accumulation, horizontal transmission and persistence of accessory genes in this genus.

Idiopathic Macular Hole without Vitreomacular Separation

Purpose: To investigate the clinical features and treatment outcomes of idiopathic full thickness macular hole (FTMH) without vitreomacular separation (VMS). Methods: Consecutive cases of idiopathic FTMH at one tertiary center from January 2013 to April 2020 was retrospectively recruited. They were separated into two groups according to the findings in optical coherence tomography (OCT): FTMH with VMS and FTMH without VMS. Ophthalmic examinations and OCT were performed pre and postoperatively. The clinical findings were compared between two groups. Results: Of the total 124 cases, 15 (12.1 %) were noted as FTMH without VMS with the presence of an attached posterior hyaloid (PH) at macula. The macular hole (MH) size was smaller (276.06 ± 170.10 µm) compared to those with VMS (492.83 ± 209.31 µm) (P < 0.001). The incidence of lamellar hole associated epiretinal proliferation (LHEP) was much higher in this group (13/15, 86.7%), compared to FTMH with VMS (11/109, 10.1%) (P < 0.001). A higher rate of spontaneous closure of MH (13.3%) was also noted in FMTH without VMS (13.3% vs 0.9% in FTMH with VMS, P = 0.040). After operation, the MH closure rate was 93.3%. The postoperative best-corrected visual acuity was not significantly different between two groups (P = 0.098). Conclusions: A small percentage (12.1% in this series) of idiopathic FTMH had no VMS. The completely attached PH along with the high incidence of LHEP implied a tangential traction in FTMH without VMS. The MH size was usually small, and the postoperative outcomes was similar to those of conventional FTMH with VMS.

Heavier group 13/15 multiple bond systems: Synthesis, Structure and Chemical Bond Activation

Heavier group 13/15 multiple bonds have been under investigation since the late 80s and to date, several examples have been published, which shows the obsoleteness of the so-called double bond...

Prevalence of Allergy Symptoms in Schoolchildren of Chechen Republic (ISAAC Questionnaire Results)

Background. Rising prevalence of allergic diseases is a major medical and social problem.Objective. The aim of the study is to study the prevalence of allergy symptoms in schoolchildren of Chechen Republic according to the ISAAC (International Study of Asthma and Allergy in Childhood) questionnaire.Methods. We have surveyed 3,398 schoolchildren from 26 randomly chosen schools located in 2 urban and 2 rural areas of Chechen Republic. The first age group (7–8 years old) included 1331 first graders, the second group (13-14 years old) — 2067 eighth graders.Results. The prevalence of allergic diseases symptoms according to the questionnaire was the following: bronchial asthma (BA) — 18.4% (625 children), allergic rhinitis (AR) — 16.6% (565 children), atopic dermatitis (AD) — 4.7% (160 children), while medically verified diagnosis was established in dramatically less cases. Analysis of BA, AR, AD symptoms prevalence has revealed significant correlation between studied parameters and age. Symptoms of BA, AR prevailed in the older age group, AD in the younger one. There were no gender differences identified. Higher prevalence of BA and AR symptoms was recorded in urban residents, while the prevalence of AD in urban and rural areas was quite the same. Moreover, estimation of allergy symptoms prevalence revealed mild course of these diseases in schoolchildren of Chechen Republic.Conclusion. The study, conducted with ISAAC questionnaire, demonstrates high prevalence of allergy symptoms in schoolchildren of Chechen Republic, exceeding the official statistics. It requires particular attention from the healthcare system and improved diagnostic methods for allergies.

COT-31 Risk Factors for the Development of Skin Rash with Levetiracetam and Lacosamide in Patients with Glioma

Introduction: Seizure control of in glioma patients is essential for quality of life. The new generation anti-seizure drug (ASD) is represented by lacosamide (LCM) and levetiracetam (LEV), and is said to have few side effects of eruption. We retrospectively analyzed the incidence of rash and related factors of the ASD, evaluated the safety of patients with glioma, and conducted a comparison with the evaluation of patients with meningioma. Method: We calculated the incidence of rash in patients who underwent glioma resection at our Hospital from January 2017 to December 2019 and were prescribed LEV or LCM, and compared it with the same incidence in meningioma patients. Multivariate logistic regression analysis was used to analyze the risk factors for the ASD-related eruption. Result: The subjects were 353 gliomas and 125 meningiomas who received LEV or LCM.The median ages are 44 ± 14.8 and 58 ± 13.2, respectively, and the male-female ratio is 203/150 and 53/72. There was no difference in the incidence of eruptions between the two groups, LEV and LCM, and the incidence of ASD-related eruptions was 11% (39/353) for gliomas, significantly higher than 1.6% (2/125) for meningiomas (p = 0.006). The incidence of ASD-related eruptions in glioma patients was not significantly different between the LEV group (10% (21/216)) and the LCM group (13% (20/154)) (p = 0.53). In a multivariate analysis of risk factors for eruption, chemoradiotherapy (p = 0.01), history of drug allergy (p = 0.039) was significantly higher. Conclusion: The incidence of LEV and LCM eruptions in glioma patients was higher than that in meningioma patients, and it was speculated that the treatment course specificity was more important than the disease-specific factors. Patients with glioma, especially those who have undergone chemoradiotherapy or have a history of drug allergies, require careful confirmation of the eruption.

Influence of complex treatment on the functional state of the hepatobiliary system in patients with diabetes mellitus

Liver damage in diabetes mellitus is of particular interest, since this factor significantly affects the course of the disease, the level of compensation and prognosis of the underlying disease. The aim. To study the effect of complex treatment using ursosan on the functional state of the hepatobiliary system in patients with diabetes mellitus. Materials and methods. The study included 30 patients with type 1 diabetes mellitus and 48 patients with type 2 diabetes. According to the duration of diabetes, patients were divided into three subgroups: a) up to five years; b) 5–10 years; c) more than 10 years. The number of patients was: 1a group – 13, 1b group – 10, 1c group – 7 people; Group 2a – 23, 2b group – 13, 2c group – 10 people. The control group consisted of 23 apparently healthy people. Ursosan was prescribed at a dose of 10-12 mg per 1 kg of body per day for 6 months. Clinical laboratory and instrumental research methods were used to study the functional state of the liver and gallbladder. Research results. After the course of treatment with Ursosan, patients with diabetes mellitus showed normalization of protein, pigment, enzymatic metabolism and, to a lesser extent, lipid metabolism in the liver, which led to an improvement in cellular metabolism and redox processes, providing a stable course of diabetes. Conclusions. A 6-month course of treatment with Ursosan in diabetic patients promotes long-term diabetes compensation. Patients during treatment have a decrease in cytolysis syndrome indicators (alanine aminotransferase (AlAT), aspartate aminotransferase (AsAT), lactate dehydrogenesis (LDH)) by about 1.5 times in all 3 indicators compared to the indicators before treatment. The same trend was observed in terms of gamma-glutamine transferase (GGT) and alkaline phosphatase (ALP)

Monte Carlo Algorithm-Based Multimodal Magnetic Resonance Imaging Prognosis Prediction in Analysis of Rehabilitation Effect of Exercise Learning on Stroke Patients and Influencing Factors of Memory Function

Based on Monte Carlo algorithm and multimodal MRI diagnosis, the effect of motor learning on motor memory function recovery in stroke patients was investigated in this research. A total of 26 stroke patients with hemiplegia treated in hospital in the past three years were recruited. Patients were rolled into routine group (13 cases) and experimental group (13 cases) according to different follow-up rehabilitation methods. All patients were treated with intravenous thrombolysis. After treatment, the conventional group received conventional rehabilitation therapy and the experimental group received restraint induced exercise therapy (CIMT). Then, T1-weighted imaging, T2-weighted imaging, 3D anatomical imaging, and resting state examinations were performed on the patients before and after treatment. All image data and image processing were performed by the Monte Carlo algorithm. Before treatment and six weeks after rehabilitation treatment, the patients’ mental state and memory function were tested using Addenbrooke’s Cognitive Examination (ACE-III) and Montreal Cognitive Assessment (MoCA). In addition, the Fugl-Meyer motor assessment, the simple test for evaluating hand function, and the modified Barthel index were used to evaluate the patient’s ability of daily living. After processing, the quality of multimode MRI image was improved obviously, and the lesion was more prominent. The fractional amplitude of low frequency fluctuation of supplement motor area in stroke patients increased after treatment combined with exercise rehabilitation ( P < 0.05 ) and ReHo decreased compared with that before treatment. The connection function of the left and right hippocampus was enhanced. The difference in ACE-III (experimental group: 16 versus 21; control group: 17.1 versus 19) scores between the two groups after treatment and before treatment was remarkable ( P < 0.05 ), but the score of patients in experimental group improved better. The MoCA (experimental group: 24.38 versus 26.47; control group: 23.13 versus 23.37) scores of the two groups of patients changed greatly from those before treatment ( P < 0.05 ), and the MoCA score ratio between the two groups was also statistically different (26.47 versus 23.37; P < 0.05 ). There was a statistical difference in the living ability of the two groups of patients before and after treatment ( P < 0.05 ). The Monte Carlo algorithm had a good processing effect on multimodal MRI images. The recovery of the experimental group was evidently better, and the difference between the two groups was substantial ( P < 0.05 ). CIMT had a good effect on the recovery of exercise rehabilitation and memory function of patients with ischemic stroke.