An Outbreak Investigation of Vibrio parahaemolyticus Infections in the United States Linked to Crabmeat Imported from Venezuela: 2018.

Vibrio parahaemolyticus is the leading cause of seafood-related foodborne illness globally. In 2018, the U.S. federal, state, and local public health and regulatory partners investigated a multistate outbreak of V. parahaemolyticus infections linked to crabmeat that resulted in 26 ill people and nine hospitalizations. State and U.S. Food and Drug Administration (FDA) laboratories recovered V. parahaemolyticus, Salmonella spp., and Listeria monocytogenes isolates from crabmeat samples collected from various points of distribution and conducted phylogenetic analyses of whole-genome sequencing data. Federal, state, and local partners conducted traceback investigations to determine the source of crabmeat. Multiple Venezuelan processors that supplied various brands of crabmeat were identified, but a sole firm was not confirmed as the source of the outbreak. Travel restrictions between the United States and Venezuela prevented FDA officials from conducting on-site inspections of cooked crabmeat processors. Based on investigation findings, partners developed public communications advising consumers not to eat crabmeat imported from Venezuela and placed potentially implicated firms on import alerts. While some challenges limited the scope of the investigation, epidemiologic, traceback, and laboratory evidence identified the contaminated food and country of origin, and contributed to public health and regulatory actions, preventing additional illnesses. This multistate outbreak illustrates the importance of adhering to appropriate food safety practices and regulations for imported seafood.

The RAG1 Ubiquitin Ligase Domain Stimulates Recombination of TCRß and TCRα Genes and Influences Development of αß T Cell Lineages.

RAG1/RAG2 (RAG) endonuclease-mediated assembly of diverse lymphocyte Ag receptor genes by V(D)J recombination is critical for the development and immune function of T and B cells. The RAG1 protein contains a ubiquitin ligase domain that stabilizes RAG1 and stimulates RAG endonuclease activity in vitro. We report in this study that mice with a mutation that inactivates the Rag1 ubiquitin ligase in vitro exhibit decreased rearrangements and altered repertoires of TCRß and TCRα genes in thymocytes and impaired thymocyte developmental transitions that require the assembly and selection of functional TCRß and/or TCRα genes. These Rag1 mutant mice present diminished positive selection and superantigen-mediated negative selection of conventional αß T cells, decreased genesis of invariant NK T lineage αß T cells, and mature CD4+ αß T cells with elevated autoimmune potential. Our findings reveal that the Rag1 ubiquitin ligase domain functions in vivo to stimulate TCRß and TCRα gene recombination and influence differentiation of αß T lineage cells, thereby establishing replete diversity of αß TCRs and populations of αß T cells while restraining generation of potentially autoreactive conventional αß T cells.

A Descriptive Analysis of the Execution of the Expert Field Medical Badge Competition with Mitigation Measures during the COVID-19 Pandemic.

OBJECTIVE: Introduction: In September 2020, the 2nd Stryker Brigade Combat Team of the 4th Infantry Division at Fort Carson, CO, executed an Expert Field Medical Badge (EFMB) event, unique in its implementation of Coronavirus Disease 2019 (COVID-19) mitigation measures. We conducted a descriptive analysis of our experience to inform future EFMB events. METHODS: We planned and resourced the EFMB competition in accordance with the Army Medical Department Center and School Pamphlet 350-10. We additionally defined adjustments to each event based upon the installation's COVID-19 Health Protection Condition (B, B+, or C) to set conditions for us to execute training regardless of shifts in the public health posture. We further implemented mitigation measures to include a 72-hour restriction of movement for all candidates and cadre prior to competition start, strict use of face coverings, and two daily temperature and symptom screenings. We recorded numbers of candidates and cadre withdrawing from the competition each day and the reasons for withdrawal. RESULTS: Of the 66 evaluators, 179 support personnel, and 113 candidates, 2 personnel withdrew for reasons related to COVID-19 mitigation measures. A single cadre member entered a quarantine for the development of a sore throat during the competition. One candidate withdrew after disclosing failure to comply with the 72-hour restriction of movement prior to competition start. Another candidate withdrew prior to start due to an injury sustained during land navigation. Of the remaining 111 candidates, 22 (20%) earned the EFMB. Most failures occurred due to the Army Physical Fitness Test (APFT, 33) and land navigation (44). DISCUSSION: Our competition provides proof in principle that large-scale events to train individual skills such as EFMB are feasible in conjunction with COVID-19 public health measures. Our experience highlights the imperative of prior preparation of candidates in particular for the APFT and land navigation.

Descriptive Analysis of Casualties Rapidly Returned to the Fight after Injury: Reverse Triage Implications for Large Scale Combat Operations.

BACKGROUND: During large scale combat operations, rising numbers of casualties will likely outstrip in-theater US military medical hospitalization assets. This highlights the importance of identifying those casualties who can return to the fight in order to minimize further medical resource depletion. We describe specific characteristics of casualties returned to duty without requiring evacuation from theater during recent major combat operations. MATERIALS AND METHODS: We conducted a secondary analysis of previously published data from the Department of Defense Trauma Registry during 01 January 2007 through 17 March 2020. We included all adult US military casualties. We categorized casualties according to documented disposition, namely, return to duty within 72 hours without evacuation from theater, return to duty greater than 72 hours without evacuation from theater, and all other casualties. RESULTS: Of 10,182 adult US military casualties, 3,856 (37.9%) returned to duty within 72 hours without evacuation from theater and 220 (2.2%) returned to duty in greater than 72 hours without evacuation from theater. The cohort that rapidly returned to duty had a lower median injury severity score (2) than casualties returning to duty in greater than 72 hours (4) and those evacuated from theater (11). Notably higher proportions of casualties evacuated from theater sustained injuries to the face, thorax, abdomen, and extremities. Modes of transportation were similar across all three groups, though casualties undergoing evacuation from theater were more likely to undergo air transportation during the spectrum of their medical care. CONCLUSIONS: Most combat casualties returning to duty without evacuation from theater did so within 72 hours of hospitalization. Casualties not requiring evacuation from theater were less likely to sustain injuries to the face, thorax, abdomen, and extremities.

Effects of Farm Location on Vibrio parahaemolyticus and Vibrio vulnificus Levels in Oysters after Desiccation and Resubmersion in the Northern Gulf of Mexico.

ABSTRACT: Desiccation is a routine farming practice used in off-bottom oyster aquaculture to reduce biofouling organisms and improve shell quality. This practice can increase Vibrio parahaemolyticus and Vibrio vulnificus levels, leading to increased risk of illness for raw oyster consumers. Previous resubmersion studies were performed in geographic proximity to one another, so to better understand the broader applicability of resubmersion, the next step was to perform concurrent studies in multiple geographic locations within a region. This study evaluated the effect of variations in geographic location on the recovery time needed for elevated vibrio levels to return to ambient levels in desiccated oysters after resubmersion at Gulf Coast farms. Two trials were performed between May and August 2019 at sites spanning ∼100 km: three in Alabama and one in Florida. Oysters were deployed in OysterGro cages at each location, 2 weeks before each trial, and then either were desiccated for 24 h or remained submersed as controls. Triplicate samples were taken before and immediately following the desiccation period, as well as 7 and 14 days after resubmersion. Total and pathogenic V. parahaemolyticus and V. vulnificus levels were determined using most-probable-number (MPN) real-time PCR. Vibrio levels increased by 0.23 to 3.50 log MPN/g after desiccation. Recovery times varied among geographic locations by trial and Vibrio spp., with all vibrio counts recovering to levels not significantly higher than those in control oysters within 7 to 14 days of resubmersion (P ≥ 0.06). These results suggest a 14-day resubmersion period of cultured oysters allowed vibrio levels, elevated because of routine handling, to return to ambient levels at all farm sites studied.

Transcription of mtDNA and dyslipidemia are ameliorated by aerobic exercise in type 2 diabetes.

Physical inactivity and unhealthy food intake are strongly associated with the growing prevalence of type 2 diabetes (T2D). Dyslipidemia, a characteristic of T2D patient, contributes to an increase in intra-myocellular lipid accumulation and mitochondria dysfunction, in skeletal muscle cells and further to insulin resistance. The aim of this study was to evaluate the effect of aerobic exercise on dyslipidemia, mitochondrial homeostasis and mitochondrial DNA (mtDNA) transcription in T2D- induced animals. Wistar rats (8 weeks old) were fed a diet containing 60% fat over 9 weeks, at day 14 a single injection of STZ (25 mg/kg) was administered (T2D-induced). At week 3 of the experiment half of the animals started on an aerobic exercise 5-days/week. Blood and soleus muscle were collected at 9th experimental week. Abdominal fat, blood glucose, triglyceride, low-density-lipoprotein and high-density lipoprotein (HDL), and cellular mtDNA copy number, cytochrome b (cytb) mRNA and 8-isoprostane were measured. T2D-induced animals exhibited changes in blood glucose, weight gain, abdominal fat, LDL and muscular 8-isoprostane, mtDNA copy number and cytb mRNA. Aerobic exercise attenuated the increase in weight gain and abdominal fat and the decreased cytb mRNA, and increased HDL. Our results suggest that aerobic exercise might not affect all characteristics related to the development of T2D in the same way. However, since T2D is a multifactorial disease, improvement in parameters such as HDL levels, abdominal fat and weight gain induced by aerobic exercise might delay or inhibit the onset of T2D.

Multiple Myeloma: The Case of the Disappearing Band.

This case study presents a patient with multiple myeloma whose serum specimen exhibits 2 distinct bands in serum protein electrophoresis but only one band in immunofixation electrophoresis. This latter, single band corresponds to the M-spike. An investigation is presented to determine the identity of this disappearing or phantom band. Furthermore, this case is used as a teaching point to explain the criteria used for staging multiple myeloma, how a cell can become a myeloma propagating cell, methods that can be used to identify unexpected bands in serum protein electrophoresis, possible explanations for bands in the beta region, the usual treatment regimens in multiple myeloma and finally specimen collecting and handling procedures for serum protein electrophoresis.

Toxigenic Vibrio cholerae O1 in water and seafood, Haiti.

During the 2010 cholera outbreak in Haiti, water and seafood samples were collected to detect Vibrio cholerae. The outbreak strain of toxigenic V. cholerae O1 serotype Ogawa was isolated from freshwater and seafood samples. The cholera toxin gene was detected in harbor water samples.

Proteinuria in cystic fibrosis: a possible correlation between genotype and renal phenotype.

OBJECTIVE: To assess proteinuria in patients with cystic fibrosis (CF), and to correlate proteinuria with genotype, CF-related diabetes and disease severity. METHODS: A prospective study was carried out over a six-month period and involving 22 CF patients. After the collection and analysis of 24-h urine samples, the patients were divided into two subgroups: protein excretion < 150 mg/day (low-proteinuria); and protein excretion > 150 mg/day (highproteinuria). Patient charts were reviewed to obtain data on genotype and CF-related diabetes. Disease severity was assessed based on acute exacerbations in the last six months and FEV1 measured during the study period. To assess the correlation between genotype and proteinuria, the two main mutations (DeltaF508 and R334W) were evaluated. Due to the existence of genotype DeltaF508/R334W, two categories were created to enable statistical analysis, DeltaF508 being evaluated in category 1 and R334W being evaluated in category 2. RESULTS: The DeltaF508 mutation tended to be associated with normal protein excretion: 100% of the low-proteinuria subgroup patients were considered DeltaF508 in category 1, compared with 86.7% in category 2. Protein excretion tended to be higher in patients with the R334W mutation: 60.0% of the high-proteinuria subgroup patients were considered R334W in category 1, compared with 80.0% in category 2 (p = 0.009 and p = 0.014, respectively). No significant association was found for any of the other variables. CONCLUSIONS: The results suggest that genotype is associated with renal phenotype, depending on the mechanism by which the genotype alters the function of the cystic fibrosis transmembrane conductance regulator gene.

Proteinuria in cystic fibrosis: a possible correlation between genotype and renal phenotype / Proteinúria na fibrose cística: possível correlação entre genótipo e fenótipo renal

Objective: To assess proteinuria in patients with cystic fibrosis (CF), and to correlate proteinuria with genotype, CF-related diabetes and disease severity. Methods: A prospective study was carried out over a six-month period and involving 22 CF patients. After the collection and analysis of 24-h urine samples, the patients were divided into two subgroups: protein excretion < 150 mg/day (low-proteinuria); and protein excretion ≥ 150 mg/day (highproteinuria). Patient charts were reviewed to obtain data on genotype and CF-related diabetes. Disease severity was assessed based on acute exacerbations in the last six months and FEV1 measured during the study period. To assess the correlation between genotype and proteinuria, the two main mutations (ΔF508 and R334W) were evaluated. Due to the existence of genotype ΔF508/R334W, two categories were created to enable statistical analysis, ΔF508 being evaluated in category 1 and R334W being evaluated in category 2. Results: The ΔF508 mutation tended to be associated with normal protein excretion: 100% of the low-proteinuria subgroup patients were consideredΔF508 in category 1, compared with 86.7% in category 2. Protein excretion tended to be higher in patients withthe R334W mutation: 60.0% of the high-proteinuria subgroup patients were considered R334W in category 1, compared with 80.0% in category 2 (p = 0.009 and p = 0.014, respectively). No significant association was foundfor any of the other variables. Conclusions: The results suggest that genotype is associated with renal phenotype, depending on the mechanism by which the genotype alters the function of the cystic fibrosis transmembrane conductance regulator gene.

Objetivo: Avaliar a proteinúria em pacientes com fibrose cística (FC) e correlacioná-la com o genótipo, com adiabetes relacionada à FC e com a gravidade da doença. Métodos: Estudo prospectivo realizado num período deseis meses com 22 pacientes com FC. Efetuada proteinúria de 24 h com a divisão dos pacientes em dois subgrupos:proteinúria < 150 mg/dia (proteinúria-baixa); e proteinúria ≥ 150 mg/dia (proteinúria-alta). Revisamos os prontuários clínicos para a coleta de informações sobre o genótipo e a presença de diabetes relacionada à FC. A gravidade da doença foi avaliada pelas exacerbações agudas no último semestre e pelo VEF1 durante o período de estudo. Para avaliar a correlação entre genótipo e proteinúria, consideraram-se as duas principais mutações, ΔF508 e R334W. Dada a existência do genótipo ΔF508/R334W, foram criadas duas categorias para se proceder à avaliação estatística, sendo esse genótipo considerado ΔF508 na categoria 1 e R334W na categoria 2. Resultados: A mutação ΔF508 se associou com valores normais de proteinúria: 100% dos pacientes do subgrupo proteinúria-baixa foram considerados ΔF508 na categoria 1, comparados a 86,7% na categoria 2. Em pacientes com a mutação R334W, osvalores de proteinuria foram mais elevados: 60,0% dos pacientes do subgrupo proteinúria-alta foram considerados R334W na categoria 1, comparados a 80,0% na categoria 2 (p = 0,009 e p = 0,014, respectivamente). Para as outras variáveis, não houve associação significativa. Conclusões: Os resultados sugerem que há uma associação entre o genótipo e o fenótipo renal, dependendo do mecanismo pelo qual o genótipo altera a função do generegulador de condutância transmembrana da fibrose cística.