The largest prison outbreak of TB in Western Europe investigated using whole-genome sequencing.

BACKGROUND: In March 2011, the Department of Public Health East in Ireland were notified of two cases of TB in two prisoners sharing a cell. We define the resulting outbreak and highlight the role of public health and laboratory-based molecular epidemiology in mapping and control of a prison outbreak.METHODS: Cases were identified through clinical presentation, contact tracing, case-finding exercise or enhanced laboratory surveillance. Mycobacterium tuberculosis isolates were genotyped and underwent whole-genome sequencing (WGS).RESULTS: Of the 34 cases of TB linked to the outbreak, 27 were prisoners (79%), 4 prison officers (12%) and 3 community cases (9%). M. tuberculosis was isolated from 31 cases (culture positivity: 91%). A maximum of six single-nucleotide polymorphisms separated the isolates, with 22 being identical, suggestive of a highly infectious 'super-spreader´ within the prison. Isolates belonged to the Beijing sub-lineage, and were susceptible to first-line anti-TB agents. A case-finding exercise incidentally detected a prisoner with multidrug-resistant TB. Of the 143 prison officers screened, 52% had latent TB infection. Litigation costs exceeded five million euros.CONCLUSION: This constitutes the largest prison outbreak of TB in Western Europe investigated using WGS. A robust prison entry TB screening and education programme is required to effect better TB control, and prevent future outbreaks and attendant litigation.

Níveis de flexibilidade e força muscular em mulheres praticantes e não praticantes de hidroginástica / Levels of fl exibility and muscle strength in women that are practicing and non-practicing of aqua-aerobics

O estudo se propôs comparar os níveis de fl exibilidade e força muscular em mulheres praticantes e não praticantes de hidroginástica da cidade de Guanambi/BA. Para isso, realizou-se uma pesquisa de campo de caráter quantitativo, descritivo e explicativo, composta por uma amostra de quarenta mulheres, sendo vinte mulheres praticantes e vinte mulheres não praticantes de hidroginástica, com a faixa etária dos 50 aos 77 anos de idades. A coleta dos dados foi através de três testes: "teste de sentar e alcançar", "teste de força de preensão manual" e "teste de levantar da cadeira em 30 segundos". Os dados foram tabulados e organizados no Programa da Microsoft Excel versão 2013. Em seguida, os resultados foram transpostos para a planilha do programa Graph Pad Prism 6, para comparar à média e o desvio padrão das variáveis (testes), utilizando o teste "t". Para análise estatística dos dados usou o programa Graph Pad Prism 6, que se atribui como nível de signifi cância valor de p<0,05. Após a análise dos dados notou-se que no "teste de sentar e alcançar", as praticantes de hidroginástica encontra-se na faixa recomendável e na baixa aptidão. Já no "teste de preensão manual direita e esquerda" foram classifi cadas como regular e fraca, e no "teste de levantar da cadeira em 30 segundos" encontram-se no valor de repetições recomendável....(AU)

The present study aimed to compare the levels of fl exibility and muscle strength in women from the city of Guanambi/Bahia, which were practicing and non-practicing of aqua-aerobics. For this, a fi eld research was done with 20 practicing and 20 non-practicing women of 50 to 77 years old. They were submitted to a "sit and reach test", "manual grip strength test" and "chair lift test in 30 seconds" and the quantitative, descriptive and explanatory data were obtained, transferred and tabulated in the Microsoft Excel 2013 software and in the Graph Pad Prism 6 software. The t test was used to compare the means and the standard deviations of the variables (tests) and a P value < 0.05 was considered to be statistically signifi cant. The results showed that practicing women were classifi ed in the group of recommendable range and low aptitude for the "sit-and-reach test". On the other hand, they were classifi ed as regular and weak for the "right and left hand grip test" and in the recommended repetition value for the "lift test of the chair in 30 seconds"....(AU)

Neophobia does not account for motoric self-regulation performance as measured during the detour-reaching cylinder task.

The ability to restrain a prepotent response in favor of a more adaptive behavior, or to exert inhibitory control, has been used as a measure of a species' cognitive abilities. Inhibitory control defines a spectrum of behaviors varying in complexity, ranging from self-control to motoric self-regulation. Several factors underlying inhibitory control have been identified, however, the influence of neophobia (i.e., aversion to novelty) on inhibitory control has not received much attention. Neophobia is known to affect complex cognitive abilities, but whether neophobia also influences more basic cognitive abilities, such as motoric self-regulation, has received less attention. Further, it remains unclear whether an individual's response to novelty is consistent across different paradigms purported to assess neophobia. We tested two North American corvid species, black-billed magpies (Pica hudsonia) and California scrub jays (Aphelocoma californica) using two well-established neophobia paradigms to assess response stability between contexts. We then evaluated neophobia scores against the number of trials needed to learn a motoric self-regulation task, as well as subsequent task performance. Neophobia scores did not correlate across paradigms, nor did the responses during either paradigm account for motoric self-regulation performance.

Comparative approaches to same/different abstract-concept learning.

Martinho and Kacelnik (2016) imprinted newly hatched ducklings (Anas platyrhynchos domestica) with a moving pair of either same or different objects, and following only one session, the ducklings accurately transferred the same/different relationship to novel object pairs that maintained the training relationship. This rapid learning and transfer of the concepts same and different far outstrips the more gradual learning of these basic concepts by animals in associative-learning tasks in which reinforcement is given for correct responses.

Adenosine Increases Hepatic Artery Flow in Liver Transplant Recipients: A Pilot Study.

BACKGROUND: The aim of this study was to assess the effect of low-dose adenosine on hepatic artery flow (HAF) when administered intraoperatively by continuous infusion. MATERIALS AND METHODS: Between January 2009 and August 2009, 74 patients underwent orthotopic liver transplantation (OLT). Ten patients were enrolled for adenosine treatment, and 64 non-study patients served as controls. After arterial reperfusion, a 16-G central venous catheter was placed in the gastroduodenal artery, and adenosine was continuously infused at doses ranging from 0.7 to 2.8 µg/kg/min for 30 min. HAF and portal vein flow were measured using a transit time flow meter before adenosine infusion, during infusion, and 10 min after infusion. Liver function tests were monitored routinely, duplex ultrasonography was performed on postoperative day 1, and the hepatic artery resistive index measured. The patients were followed for 1 year. RESULTS: Adenosine significantly increased HAF at doses from 0.7 to 2.8 µg/kg/min. The smallest increase in HAF was 24% above the baseline; in 80% of patients, the increase in HAF was >50% of the baseline values. In 2 patients, HAF was increased by >300%. The dosing started at 0.7 µg/kg/min, and 6 of 10 patients responded. Three patients required an increase to 1.4 µg/kg/min. Doses >2.8 µg/kg/min did not further increase HAF. One patient showed a minimal response regardless of the dose. There were no differences between the adenosine group and control group with respect to liver function (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and International Normalized Ratio), platelet count on POD2, hepatic artery resistive index, and post-transplant length of stay, intensive care days, or 1-year patient survival rates. CONCLUSIONS: This pilot study established that adenosine administered directly into the hepatic artery produces a similar effect on HAF in cadaveric liver transplant recipients to that found in the laboratory without producing systemic side effects.

Inhibition in Clark's nutcrackers (Nucifraga columbiana): results of a detour-reaching test.

Inhibition (i.e. the ability to restrain ineffective responses to a given stimulus) is a good indicator of complex cognitive abilities in animals. Inhibition has been demonstrated in a broad range of mammals with foraging style and social group size identified as potential influences of this ability. Whether these ecological factors also apply to birds has not been well studied. Corvids, a family of birds well known for being able to accomplish difficult cognitive tasks often requiring inhibition, are a good model for studying inhibitory control. During this study, we measured the ability of Clark's nutcrackers (Nucifraga columbiana), a relatively non-social, food specialist corvid to exercise inhibitory control during a detour-reaching test. Individuals had to retrieve a pine nut inserted into a transparent tube through one of the side openings without pecking directly at the nut from the front of the tube. Overall, nutcrackers were able to inhibit pecking directly at the food (i.e. prepotent response), instead detouring to the side to retrieve the reward. However, the nutcrackers first required a learning period before showing inhibitory control. The nutcrackers' ability to inhibit was lower than other corvids studied to date, and we discuss the implications of this result for the role of sociality and dietary breadth for the evolution of inhibitory control.

Testosterone and obesity.

Testosterone is a key hormone in the pathology of metabolic diseases such as obesity. Low testosterone levels are associated with increased fat mass (particularly central adiposity) and reduced lean mass in males. These morphological features are linked to metabolic dysfunction, and testosterone deficiency is associated with energy imbalance, impaired glucose control, reduced insulin sensitivity and dyslipidaemia. A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels. Androgenic effects on enzymatic pathways of fatty acid metabolism, glucose control and energy utilization are apparent and often tissue specific with differential effects noted in different regional fat depots, muscle and liver to potentially explain the mechanisms of testosterone action. Testosterone replacement therapy demonstrates beneficial effects on measures of obesity that are partially explained by both direct metabolic actions on adipose and muscle and also potentially by increasing motivation, vigour and energy allowing obese individuals to engage in more active lifestyles. The degree of these beneficial effects may be dependent on the treatment modality with longer term administration often achieving greater improvements. Testosterone replacement may therefore potentially be an effective adjunctive treatment for weight management in obese men with concomitant hypogonadism.

Tendency to overestimate the explicit time interval in relation to aging and cognitive decline.

Age-related deficits in explicit time perception has been reported by some studies. However, the findings are inconsistent about the preference of older adults to over/underestimate the observed interval as well as the relationship between the time estimation and the participant's cognitive status. In this study, we used a verbal estimation task for the rotation time of a virtual building (40 seconds) to assess the explicit interval timing of participants. The performance of a cohort of 250 cognitively-healthy adults and 10 Alzheimer's patients was analyzed in relation to their age and cognitive scale, measured by Montreal Cognitive Assessment (MoCA) score. The participants' performances were evaluated based on three measurements: Coefficient of variation (CV) for measuring stability, Absolute Error (AE) for measuring accuracy and Directional Error (DE) for measuring the degree of over/under-estimation. A significant difference was observed between the participants who overestimated the interval and those who underestimated it in terms of age, cognitive status and Absolute Error. We also found a significant effect of time estimation, with underestimation by cognitively healthy participants to mild over-estimation by 70+ year old and low-MoCA (MoCA score <; 26) participants as well as severe overestimation by Alzheimer's disease patients. The result of regression analysis for predicting MoCA score based on the dependent variables (AE, DE and CV) support the superiority of Directional Error to Absolute Error and Coefficient of Variation that are commonly used in the time perception studies.

Split liver transplantation using Hemiliver graft in the MELD era: a single center experience in the United States.

Under the "sickest first" Model for End-Stage Liver Disease (MELD) allocation, livers amenable to splitting are most often allocated to patients unsuitable for split liver transplantation (SLT). Our experience with SLT using hemilivers was reviewed. From April 2004 to June 2012, we used 25 lobar grafts (10 left lobes and 15 right lobes) for adult-sized recipients. Twelve recipients were transplanted with primary offers, and 13 were transplanted with leftover grafts. Six grafts were shared with other centers. The data were compared with matched whole liver grafts (n = 121). In 92% of donors, the livers were split in situ. Hemiliver recipients with severe portal hypertension had a greater graft-to-recipient weight ratio than those without severe portal hypertension (1.96% vs. 1.40%, p < 0.05). Hemiliver recipients experienced biliary complications more frequently (32.0% vs. 10.7%, p = 0.01); however, the 5-year graft survival for hemilivers was comparable to whole livers (80.0% vs. 81.5%, p = 0.43). The secondary recipients with leftover grafts did not have increased incidences of graft failure (p = 0.99) or surgical complications (p = 0.43) compared to the primary recipients. In conclusion, while routine application is still controversial due to various challenges, hemiliver SLT can achieve excellent outcomes under the MELD allocation.

Use of tissue plasminogen activator in liver transplantation from donation after cardiac death donors.

Ischemic-type biliary stricture (ITBS) occurs in up to 50% after liver transplantation (LT) from donation after cardiac death (DCD) donors. Thrombus formation in the peribiliary microcirculation is a postulated mechanism. The aim was to describe our experience of tissue plasminogen activator (TPA) administration in DCD-LT. TPA was injected into the donor hepatic artery on the backtable (n = 22). Two recipients developed ITBS including one graft failure. Although excessive postreperfusion bleeding was seen in 14 recipients, the amount of TPA was comparable between those with and without excessive bleeding (6.4 ± 2.8 vs. 6.6 ± 2.8 mg, p = 0.78). However, donor age (41 ± 12 vs. 29 ± 9 years, p = 0.02), donor BMI (26.3 ± 5.5 vs. 21.7 ± 3.6 kg/m(2) , p = 0.03), previous laparotomy (50% vs. 0%, p = 0.02) and lactate after portal reperfusion (6.3 ± 4.6 vs. 2.8 ± 0.9 mmol/L, p = 0.005) were significantly greater in recipients with excessive bleeding. In conclusion, the use of TPA may lower the risk of ITBS-related graft failure in DCD-LT. Excessive bleeding may be related to poor graft quality and previous laparotomy rather than the amount of TPA. Further studies are needed in larger population.

Use of a geometric rule or absolute vectors: landmark use by Clark's nutcrackers (Nucifraga columbiana).

Clark's nutcrackers (Nucifraga columbiana) were trained to search for a hidden goal located in the center of a four-landmark array. Upon completion of training, the nutcrackers were presented with tests that expanded the landmark array in the east-west direction, north-south direction and in both directions simultaneously. Although the birds learned to search accurately at the center of the landmark array during training, this search pattern did not transfer to the expansion tests. The nutcrackers searched at locations defined by absolute distance and/or direction relationships with landmarks in the training array. These results contrast with those from experiments with nutcrackers in which an abstract geometric rule was learned. This difference appears due to differences in the experimental paradigms used during training.

Allometric analysis reveals relatively little variation in nitrogen versus biomass accrual in four plant species exposed to varying light, nutrients, water and CO2.

Nitrogen concentrations in plant tissues can vary as a function of resource availability. Altered rates of plant growth and development under varying resource availabilities were examined to determine their effects on changes in whole-plant N use efficiency (NUE). Three species of old-field annuals were grown at broadly varying light, nutrient and water levels, and four species at varying atmospheric concentrations of CO2. Study results show highly variable N accrual rates when expressed as a function of plant age or size, but similar patterns of whole-plant N versus non-N biomass accrual over a wide range of environmental conditions. However, severely light-limited plants showed increased N versus biomass accrual for two of three species, and severely nutrient-limited plants had decreased N versus biomass accrual for all species. Whole-plant N accrual versus age and N versus biomass accrual increased under saturating water for two of three species. A marginally significant, modest decrease in N versus biomass accrual was found at high CO2 levels for two of four species. Physiological adjustments in NUE, expressed as N versus biomass accrual, were limited to environments with severely limited or overabundant resources.

High-resolution CT using MDCT: comparison of degree of motion artifact between volumetric and axial methods.

OBJECTIVE: The purpose of this study was to compare the degree of motion artifact on high-resolution CT images obtained using volumetric and axial (nonvolumetric) CT methods. CONCLUSION: Volumetric high-resolution CT is associated with significantly greater motion artifact compared with axial noncontiguous high-resolution imaging.

Pigeons encode relative geometry.

Pigeons were trained to search for hidden food in a rectangular environment designed to eliminate any external cues. Following training, the authors administered unreinforced test trials in which the geometric properties of the apparatus were manipulated. During tests that preserved the relative geometry but altered the absolute geometry of the environment, the pigeons continued to choose the geometrically correct corners, indicating that they encoded the relative geometry of the enclosure. When tested in a square enclosure, which distorted both the absolute and relative geometry, the pigeons randomly chose among the 4 corners, indicating that their choices were not based on cues external to the apparatus. This study provides new insight into how metric properties of an environment are encoded by pigeons.

Detection of glass patterns by pigeons and humans: implications for differences in higher-level processing.

Glass patterns have been used to examine mechanisms underlying form perception. The current investigation compared detection of Glass patterns by pigeons and humans and provides evidence for substantial species differences in global form perception. Subjects were required to discriminate, on a simultaneous display, a random dot pattern from a Glass pattern. Four different randomly presented Glass patterns were used (concentric, radial, parallel-vertical, and parallel-horizontal). Detection thresholds were measured by degrading the Glass patterns through the addition of random noise. For both humans and pigeons, discrimination decreased systematically with the addition of noise. Humans showed detection differences among the four patterns, with lowest thresholds to radial and concentric patterns and highest thresholds to the parallel-horiZontal pattern. Pigeons did not show a detection difference across the four patterns. Implications for differences in neural processing of complex forms are discussed.

Pulmonary lymphangitis carcinomatosa and acute pancreatitis: a rare presentation of choledochal cyst.

Pulmonary lymphangitis carcinomatosa is an unusual cause of death in a young adult. This case describes an apparently healthy young woman who presented with severe acute pancreatitis, which is a recognized complication of a choledochal cyst. Autopsy examination revealed advanced malignancy with poorly differentiated adenocarcinoma penetrating the wall of the choledochal cyst and metastatic adenocarcinoma in the lymph nodes, lungs and kidneys. This case emphasises the unusual presentation of a choledochal cyst with acute pancreatitis and the aggressive nature of malignancy associated with this congenital anomaly.

Liver transplant recipients are not at increased risk for nonlymphoid solid organ tumors.

BACKGROUND: Organ transplant recipients are at higher risk for developing lymphoid tumors, skin carcinomas, and sarcomas. Whether liver transplant recipients are at higher risk for developing more common cancers is unclear. METHODS: All patients with a history of malignancy prior to liver transplantation and those who developed malignancy, either de novo or recurrent, after transplantation were identified retrospectively. The following parameters were examined: age at diagnosis; indication for transplant; interval from transplant to tumor diagnosis; tumor treatment received; predisposing factors for the development of cancer; immunosuppression regimen, including the use of OKT3; number and treatment of rejection episodes; and survival. RESULTS: Of 888 patients, 29 (3.2%) had 31 previous malignancies; of these 29 patients, 4 developed a recurrence in the posttransplant period. Thirty-nine patients (4.3%) developed 43 de novo nonlymphoid malignancies. Alcoholic cirrhotic patients had a significantly higher incidence of de novo carcinomas. Except for skin carcinomas, tumors did not occur with greater frequency than in the general population, and recurrent tumors were not more aggressive than reported for that disease. One patient had an unrecognized renal cell carcinoma at the time of transplant that progressed rapidly; this patient died 64 days after transplantation. CONCLUSIONS: With current immunosuppressive regimens, liver transplant patients do not appear to be at an increased risk for developing nonlymphoid solid organ tumors. However, longer follow-up will be necessary to confirm these results.

Spontaneous rupture of a malignant rhabdoid tumour of the liver.

Malignant rhabdoid tumours (MRT) of the liver are rare. The criteria for pathological diagnosis are clearly defined, but the clinical behaviour of these tumours is still emerging. We report a MRT of the liver with the rare clinical presentation of spontaneous rupture.