Relation between temporal bone pneumatisation and middle-ear barotrauma in aircrew members.

OBJECTIVE: This study aimed to assess the potential role of pneumatisation of the mastoid and its communicating air cells in the development of middle-ear barotrauma in aircrew members. METHODS: Seventy-nine aircrew members (158 ears) underwent temporal computed tomography. All were assessed before flying by clinical examination and audiology evaluation, followed by post-flight examination to detect barotrauma. RESULTS: Aircrew members' ears were divided into 3 groups based on barotrauma and temporal bone pneumatisation: 33 ears with barotrauma and temporal bone pneumatisation of 71 cm3 or greater (group A); 12 ears with barotrauma and temporal bone pneumatisation of 11.2 cm3 or lower (group B); and 113 ears with no barotrauma (group C). Mean pneumatisation volumes were 91.05 cm3, 5.45 cm3 and 28.01 cm3 in groups A, B and C, respectively. A direct relationship was observed between volume of temporal bone pneumatisation of 71 cm3 or greater and barotrauma grade. CONCLUSION: Pneumatisation volume of the mastoid and its communicating air cells that ranges from 11.3 cm3 to 70.4 cm3 serves as a reliable predictor of the avoidance of middle-ear barotrauma associated with flying in aircrew members who have normal resting middle-ear pressure and good Eustachian tube function.

Spread of imipenem-resistant Acinetobacter baumannii co-expressing OXA-23 and GES-11 carbapenemases in Lebanon.

OBJECTIVES: The acquisition of carbapenemases by Acinetobacter baumannii is reported increasingly worldwide, but data from Lebanon are limited. The aims of this study were to evaluate the prevalence of imipenem-resistant A. baumannii in Lebanon, identify resistance determinants, and detect clonal relatedness. METHODS: Imipenem-resistant A. baumannii were collected from nine Lebanese hospitals during 2012. Antimicrobial susceptibility, the cloxacillin effect, and ethylenediaminetetraacetic acid (EDTA) synergy were determined. Genes encoding carbapenemases and insertion sequence ISAba1 were screened via PCR sequencing. ISAba1 position relative to genes encoding Acinetobacter-derived cephalosporinases (ADCs) and OXA-23 was studied by PCR mapping. Clonal linkage was examined by enterobacterial repetitive intergenic consensus PCR (ERIC-PCR). RESULTS: Out of 724 A. baumannii isolated in 2012, 638 (88%) were imipenem-resistant. Of these, 142 were analyzed. Clavulanic acid-imipenem synergy suggested carbapenem-hydrolyzing extended-spectrum ß-lactamase. A positive cloxacillin test indicated ADCs, while EDTA detection strips were negative. Genotyping indicated that 90% of isolates co-harbored blaOXA-23 and blaGES-11. The remaining strains had blaOXA-23, blaOXA-24, blaGES-11, or blaOXA-24 with blaGES-11. ISAba1 was located upstream of blaADC and blaOXA-23 in 97% and 100% of isolates, respectively. ERIC-PCR fingerprinting revealed 18 pulsotypes spread via horizontal gene transfer and clonal dissemination. CONCLUSION: This survey established baseline evidence of OXA-23 and GES-11-producing A. baumannii in Lebanon, indicating the need for further surveillance.

Countrywide spread of OXA-48 carbapenemase in Lebanon: surveillance and genetic characterization of carbapenem-non-susceptible Enterobacteriaceae in 10 hospitals over a one-year period.

OBJECTIVES: To detect, characterize, and assess the genetic clonality of carbapenem-non-susceptible Enterobacteriaceae in 10 Lebanese hospitals in 2012. METHODS: Selected Enterobacteriaceae isolates with reduced susceptibility to carbapenems were subject to phenotypic study including antibiotic susceptibility, cloxacillin effect, modified Hodge test, and activity of efflux pump inhibitor. Carbapenemase genes were detected using PCR; clonal relatedness was studied by pulsed field gel electrophoresis. RESULTS: Out of 8717 Enterobacteriaceae isolated in 2012, 102 (1.2%) showed reduced susceptibility to carbapenems. Thirty-one (70%) of the 44 studied clinical isolates harbored blaOXA-48, including 15 Klebsiella pneumoniae, eight Escherichia coli, four Serratia marcescens, three Enterobacter cloacae, and one Morganella morganii. The majority of OXA-48 producers co-secreted an extended-spectrum beta-lactamase, while one had an acquired AmpC of the ACC type. In the non-OXA-48 producers, carbapenem resistance was attributed to the production of acquired AmpC cephalosporinases of MOX or CIT type, outer membrane impermeability, and/or efflux pump overproduction. DNA fingerprints revealed that OXA-48 producers were different, except for clonal relatedness among four K. pneumoniae, two E. coli, two E. cloacae, and three S. marcescens. CONCLUSIONS: Nosocomial carbapenem-non-susceptible Enterobacteriaceae are moderately spread in Lebanon and the predominant mechanism is OXA-48 production.

The impact of groundwater quality on the removal of methyl tertiary-butyl ether (MTBE) using advanced oxidation technology.

In this study, the removal of methyl tertiary-butyl ether (MTBE) from contaminated groundwater using advanced oxidation technology was investigated. The UV/H(2)O(2) treatment process was applied to remove MTBE from two Saudi groundwater sources that have different quality characteristics with regard to their contents of inorganic species such as chloride, bromide, sulfates and alkalinity. MTBE was spiked into water samples collected from the two sources to a concentration level of about 250 microg/L. A 500 mL bench-scale forced-liquid circulation photoreactor was used to conduct the experiments. Two different UV lamps were utilized: 15 Watt low pressure (LP) and 150 Watt medium pressure (MP). Results of the study showed that the UV/H(2)O(2) process removed more than 90% of MTBE in 20 minutes when the MP lamp was used at an MTBE/H(2)O(2) molar ratio of 1:200. The results also showed that groundwater sources with higher levels of radical scavengers such as alkalinity, bromide, nitrate and sulfate showed lower rate of MTBE removal.

Immature thymocytes undergoing receptor rearrangements are resistant to an Atm-dependent death pathway activated in mature T cells by double-stranded DNA breaks.

Immature CD4(+)CD8(+) thymocytes rearrange their T cell receptor (TCR)-alpha gene locus to generate clonotypic alpha/beta TCR, after which a few cells expressing selectable TCR are signaled to further differentiate into mature T cells. Because of requirements for self-tolerance, immature CD4(+)CD8(+) thymocytes are programmed to die in the thymus in response to a variety of stimuli that do not induce death of mature T cells. We now demonstrate that, in contrast to all previously described stimuli, immature CD4(+)CD8(+) thymocytes are selectively more resistant than mature T cells to apoptotic death induced by DNA intercalating agents. Importantly, we demonstrate that DNA intercalating agents induce double-stranded DNA breaks in both immature thymocytes and mature T cells, but immature thymocytes tolerate these DNA breaks, whereas mature T cells are signaled to die by an Atm-dependent but p53-independent death mechanism. Thus, our results indicate that absence of an Atm-dependent but p53-independent pathway allows immature thymocytes to survive double-stranded DNA breaks. It is likely that the unique ability of immature thymocytes to survive DNA-damaging intercalating agents reflects their tolerance of double-stranded DNA breaks that occur normally during antigen receptor gene rearrangements.