Risk factors for community-associated Clostridioides difficile infection in young children.

The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case-control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014-February 2016. Case-patients were defined as children aged 1-5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18-17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.

Reptile-associated salmonellosis in Minnesota, 1996-2011.

Reptile-associated salmonellosis (RAS) occurs when Salmonella is transmitted from a reptile to a human. This study describes the epidemiology of RAS in Minnesota during 1996-2011. All Minnesotans with confirmed Salmonella infections are reported to the Minnesota Department of Health (MDH). Case patients are interviewed about illness characteristics and risk factors, including foods eaten, drinking and recreational water exposures, contact with ill people, and animal contact. Willing RAS case patients can submit stool from the reptile for culture. Serotype and pulsed-field gel electrophoresis (PFGE) subtype of Salmonella isolates from reptiles and case patients are compared. Of 8389 sporadic (not associated with an outbreak) non-typhoidal salmonellosis case patients in Minnesotans during 1996-2011, 290 (3.5%) reported reptile exposure. The median age of case patients with reptile exposure was 11 years, 31% were under the age of 5 years and 67% were under the age of 20 years; 50% were female. The median illness duration was 8 days; 23% required hospitalization. The most commonly reported reptile exposures were lizard (47%), snake (20%), turtle (19%) and a combination of reptile types (14%). Eighty-four per cent of isolates from case patients who reported reptile exposure were Salmonella enterica subspecies I. The three most common serotypes were Typhimurium (15%), Enteritidis (7%) and subspecies IV serotypes (7%). Of 60 reptiles testing positive for Salmonella, 36 (60%) yielded the same Salmonella serotype as the human isolate. Twenty-six of 27 reptile isolates that were subtyped by PFGE were indistinguishable from the human isolate. Of these, 88% were subspecies I; the most common serotypes were Enteritidis (12%), Typhimurium (8%), and Bareilly (8%). RAS accounts for approximately 3.5% of salmonellosis cases in Minnesota, primarily affecting children. The majority of isolates from case patients and reptiles belonged to Salmonella subspecies I, suggesting that reptiles are a source of human infection with serotypes not traditionally considered to be reptile-associated.

Image-guided core biopsy has advantages over needle localization biopsy for the diagnosis of nonpalpable breast cancer.

Image-guided core biopsy (IGCB) of nonpalpable mammographic abnormalities has gained attention as an alternative to needle-localized breast biopsy (NLB). This study evaluated IGCB in the diagnostic workup of patients with nonpalpable mammographic lesions suspicious for cancer. Eighty-six patients who underwent IGCB were compared to 85 patients who underwent NLB for the diagnosis of mammographic lesions suspicious for cancer. The incidence of positive margins was less in patients who subsequently underwent needle-localized resection in the IGCB group than in the NLB group (29 and 65%; P < 0.0001). The volume of excision was greater for patients in the IGCB group than for the NLB group (106 cm3 and 52 cm3; P < 0.0001). Patients in the IGCB group averaged 1.1 operative procedures compared with patients in the NLB group, who required an average of 1.9 operative procedures. The mean charge for an IGCB was $1011 compared to $2975 for a NLB. Subset analysis of 32 spiculated masses from the IGCB group and 21 from the NLB group showed similar advantages of IGCB over NLB. The preoperative use of IGCB for mammographically suspicious lesions can reduce the incidence of positive surgical margins and the number of surgical procedures required. The use of IGCB allows for a more efficient diagnostic workup and less expense to the patient.

Axillary lymph node metastasis in stage T1a breast cancer: a pathologic review of 82 patients.

The recent shift toward the diagnosis of smaller breast cancers has led to the reevaluation of their treatment. Because of the low incidence of nodal involvement, recent studies have recommended selective axillary lymph node dissection (AxLND) for early breast cancer. The incidence of nodal involvement is a critical factor in defining the role of AxLND. Large series based on cancer registry data report the incidence of nodal positivity in stage T1a cancer to be 16 to 23 per cent. In contrast, data that include only pathologically reviewed cases report the incidence to be 0 to 6 per cent. We reviewed the medical records of 148 stage T1a breast cancer patients from 1987 through 1994 in two community hospitals as identified by the local tumor registry. After chart review, 115 cases with AxLND underwent pathologic review; 82 were confirmed as stage T1a. Only 3 of 82 (4%) patients were node positive. All three node-positive tumors were of infiltrating ductal histology. No tumor characteristic was predictive of nodal metastasis. Data from the tumor registry and from pathology reports overstated the incidence of nodal involvement (5 and 9%, respectively). In light of the limited clinical benefit and associated cost and morbidity of AxLND, selected informed patients may be spared AxLND.

Identification of the hepatitis B virus factor that inhibits expression of the beta interferon gene.

The identity of the trans-acting factor encoded by the 1,828-bp BamHI DNA fragment of hepatitis B virus (HBV) that suppresses the transcription of the human beta interferon gene was investigated. Each complete and partial open reading frame (ORF) present within the 1,828-bp BamHI HBV DNA fragment was cloned into a simian virus 40 expression vector, and the resulting gene products were assayed for their ability to inhibit the activity of the regulatory DNA region that governs the expression of the beta interferon gene. Only the proteins encoded by the C ORF inhibited the activity of the beta interferon regulatory DNA region; putative proteins encoded by the partial X, P, and S ORFs present in the 1,828-bp BamHI HBV DNA fragment had no effect. A plasmid encoding only the native HBV core antigen, but not one coding for a truncated core antigen, possessed this inhibitory activity. The inhibition by the core antigen was specific for the regulatory elements of the beta interferon gene; none of a variety of viral transcriptional elements was inhibited.

An internal domain of the hepatitis B virus X antigen is necessary for transactivating activity.

A number of deletion mutants of the hepatitis B viral X antigen had been constructed and assayed for their ability to transactivate heterologous viral regulatory elements. Neither the N-terminal nor the C-terminal amino acid residues were required for transactivating activity. Transactivating activity that resided within amino acid residues 32 to 148 of the X antigen did not show any target DNA sequence or cell line specificity.

A phylogeny of gibbons (Hylobates spp.) based on morphological and behavioural characters.

A new estimate of the phylogenetic relationships among the nine gibbon taxa is presented, based on a compatibility analysis of 55 morphological and behavioural characters. The phylogeny presented here differs somewhat from those of other studies, but there appears to be a basic consensus that: the siamang and concolor gibbons represent the earliest forms to speciate; the agile, lar, moloch, Müller's, and pileated gibbons represent the lates forms to speciate; with the Kloss and hoolock gibbons representing intermediate forms. Although the hypotheses regarding the evolutionary direction of these characters remain subjective due to the lack of gibbons in the fossil record, the method used is totally objective in its approach and is repeatable when further data become available.