Abstract
A nationwide tuberculosis outbreak linked to a viable bone allograft product contaminated with Mycobacterium tuberculosis was identified in June 2021. Our subsequent investigation identified ...73 healthcare personnel with new latent tuberculosis infection following exposure to the contaminated product, product recipients, surgical instruments, or medical waste.
Little is known about co-occurring tuberculosis (TB) and COVID-19 in low TB incidence settings. We obtained a cross-section of 333 persons in the United States co-diagnosed with TB and COVID-19 ...within 180 days and compared them to 4,433 persons with TB only in 2020 and 18,898 persons with TB during 2017‒2019. Across both comparison groups, a higher proportion of persons with TB–COVID-19 were Hispanic, were long-term care facility residents, and had diabetes. When adjusted for age, underlying conditions, and TB severity, COVID-19 co-infection was not statistically associated with death compared with TB infection only in 2020 (adjusted prevalence ratio 1.0 95% CI 0.8‒1.4). Among TB–COVID-19 patients, death was associated with a shorter interval between TB and COVID-19 diagnoses, older age, and being immunocompromised (non-HIV). TB–COVID-19 deaths in the United States appear to be concentrated in subgroups sharing characteristics known to increase risk for death from either disease alone.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live ...cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
: We report a multicentered randomized controlled trial across Australia and New Zealand comparing laparoscopic-assisted colon resection (LCR) with open colon resection (OCR) for colon cancer.
: ...Colon cancer is a significant worldwide health issue. This trial investigated whether the short-term benefits associated with LCR for colon cancer could be achieved safely, without survival disadvantages, in our region.
: A total of 601 patients with potentially curable colon cancer were randomized to receive LCR or OCR. Primary endpoints were 5-year overall survival, recurrence-free survival, and freedom from recurrence rates, compared using an intention-to-treat analysis.
: On April 5, 2010, 587 eligible patients were followed for a median of 5.2 years (range, 1 week-11.4 years) with 5-year confirmed follow-up data for survival and recurrence on 567 (96.6%). Significant differences between the 2 trial groups were as follows: LCR patients were older at randomization, and their pathology specimens showed smaller distal resection margins; OCR patients had some worse pathology parameters, but there were no differences in disease stages. There were no significant differences between the LCR and OCR groups in 5-year follow-up of overall survival (77.7% vs 76.0%, P = 0.64), recurrence-free survival (72.7% vs 71.2%, P = 0.70), or freedom from recurrence (86.2% vs 85.6%, P = 0.85).
: In spite of some differences in short-term surrogate oncological markers, LCR was not inferior to OCR in direct measures of survival and disease recurrence. These findings emphasize the importance of long-term data in formulating evidence-based practice guidelines.
The oil and gas (O&G) sector is a significant source
of methane (CH4) emissions. Quantifying these emissions remains
challenging, with many studies highlighting discrepancies between
measurements and ...inventory-based estimates. In this study, we present
CH4 emission fluxes from 21 offshore O&G facilities collected in 10
O&G fields over two regions of the Norwegian continental shelf in 2019.
Emissions of CH4 derived from measurements during 13 aircraft surveys
were found to range from 2.6 to 1200 t yr−1 (with a mean of 211 t yr−1 across all 21 facilities). Comparing this with aggregated
operator-reported facility emissions for 2019, we found excellent agreement
(within 1σ uncertainty), with mean aircraft-measured fluxes only
16 % lower than those reported by operators. We also compared
aircraft-derived fluxes with facility fluxes extracted from a global gridded
fossil fuel CH4 emission inventory compiled for 2016. We found that the
measured emissions were 42 % larger than the inventory for the area
covered by this study, for the 21 facilities surveyed (in aggregate). We
interpret this large discrepancy not to reflect a systematic error in the
operator-reported emissions, which agree with measurements, but rather the
representativity of the global inventory due to the methodology used to
construct it and the fact that the inventory was compiled for 2016 (and thus
not representative of emissions in 2019). This highlights the need for
timely and up-to-date inventories for use in research and policy. The
variable nature of CH4 emissions from individual facilities requires
knowledge of facility operational status during measurements for data to be
useful in prioritising targeted emission mitigation solutions. Future
surveys of individual facilities would benefit from knowledge of facility
operational status over time. Field-specific aggregated emissions (and
uncertainty statistics), as presented here for the Norwegian Sea, can be
meaningfully estimated from intensive aircraft surveys. However,
field-specific estimates cannot be reliably extrapolated to other production
fields without their own tailored surveys, which would need to capture a
range of facility designs, oil and gas production volumes, and facility
ages. For year-on-year comparison to annually updated inventories and
regulatory emission reporting, analogous annual surveys would be needed for
meaningful top-down validation. In summary, this study demonstrates the
importance and accuracy of detailed, facility-level emission accounting and
reporting by operators and the use of airborne measurement approaches to
validate bottom-up accounting.
Laparoscopy has revolutionized many abdominal surgical procedures. Laparoscopic colectomy has become increasingly popular. The short- and long-term benefits and satisfactory surgical oncological ...treatment of colorectal cancer by laparoscopic-assisted resection remain topical. The long-term outcomes of all international randomized controlled trials are still awaited, and short-term outcomes are important in the interim.
Between January 1998 and April 2005, a multicenter, prospective, randomized clinical trial in patients with colon cancer was conducted. Six hundred and one eligible patients were recruited by 33 surgeons from 31 Australian and New Zealand centers. Patients were allocated to colectomy by either laparoscopic-assisted surgery (n = 294) or open surgery (n = 298). Patient demographics and secondary end-points, such as operative and postoperative complications, length of hospital stay, and histopathological data, will be presented in this article. Analysis was by intention-to-treat. Survival will be reported only as the study matures.
Histopathological parameters were similar between the two groups, except in regard to distal resection margins. There was no statistically significant difference found in postoperative complications, reoperation rate, or perioperative mortality. Statistically significant differences in quicker return of gastrointestinal function and shorter hospital stay were identified in favor of laparoscopic-assisted resection. A statistically significant increased rate of infective complications was seen in cases converted from laparoscopic-assisted to open procedures but with no difference in reoperation or in-hospital mortality.
Laparoscopic-assisted colonic resection gives significant improvements in return of gastrointestinal function and length of stay, with an increased operative time and no difference in the postoperative complication rate.
Chronic obstructive pulmonary disease (COPD) is the leading cause of respiratory mortality worldwide. Genetic risk loci provide new insights into disease pathogenesis. We performed a genome-wide ...association study in 35,735 cases and 222,076 controls from the UK Biobank and additional studies from the International COPD Genetics Consortium. We identified 82 loci associated with P < 5 × 10
; 47 of these were previously described in association with either COPD or population-based measures of lung function. Of the remaining 35 new loci, 13 were associated with lung function in 79,055 individuals from the SpiroMeta consortium. Using gene expression and regulation data, we identified functional enrichment of COPD risk loci in lung tissue, smooth muscle, and several lung cell types. We found 14 COPD loci shared with either asthma or pulmonary fibrosis. COPD genetic risk loci clustered into groups based on associations with quantitative imaging features and comorbidities. Our analyses provide further support for the genetic susceptibility and heterogeneity of COPD.
We investigate feedbacks between subsurface continental shelf ocean temperatures and Antarctic glacial melt using a coupled climate model. The model was forced with SSP5‐8.5 and an uncoupled ...projection of basal melt and calving fluxes. SSP5‐8.5 forcing with fixed pre‐industrial glacial melt warms all continental shelves, such that historically “cool” and “fresh” shelves transition to “warm.” Additional glacial melt, added at depth, cools the Eastern Ross, Amundsen, and Bellingshausen seas, suggesting a negative feedback on basal melt—a novel result for a coarse resolution coupled model. From the Weddell Sea, along East Antarctica, and into the western Ross Sea—where continental shelves transition to a “warm” state—additional glacial melt increases temperatures at the continental shelf sea floor, suggesting a positive feedback. The sign of the glacial melt–subsurface temperature feedback is critically dependent on continental shelf properties, climate state, and the vertical distribution of glacial melt inputs.
Plain Language Summary
Antarctic ice shelves lose mass as freshwater—primarily from melting at their base and when icebergs break off. We know that the rate at which Antarctic ice shelves are losing mass is increasing and we expect this freshwater input into the ocean to increase further in a warmer world. Most climate models do not include a representation of this changing freshwater input, and its climatic impacts are uncertain. One particularly important climate impact is how the additional freshwater changes the subsurface ocean temperature. If freshwater warms/cools the coastal ocean it could increase/decrease melt in a positive/negative feedback loop. But existing studies disagree about this effect and even about the sign of the feedback. We added a timeseries of freshwater input to a climate model and ran experiments with strong climate warming to investigate this feedback. The sign of the feedback varies by region. Where climate change drives a cold coastal ocean to transition to a new warmer state, we find that freshwater causes a strong additional warming (a positive feedback). Where the coastal ocean is already warm in the present day and warms in future, freshwater reduces this warming (a negative feedback). To achieve the negative feedback freshwater must be added at depth.
Key Points
A glacial melt projection is added to a 1° coupled climate model under SSP5‐8.5 to investigate ocean temperature feedbacks
Additional glacial melt cools the Eastern Ross, Amundsen, and Bellingshausen seas at depth, but warms elsewhere
The addition of glacial melt at depth is necessary to generate the cooling response
Green plants (Viridiplantae) include around 450,000-500,000 species
of great diversity and have important roles in terrestrial and aquatic ecosystems. Here, as part of the One Thousand Plant ...Transcriptomes Initiative, we sequenced the vegetative transcriptomes of 1,124 species that span the diversity of plants in a broad sense (Archaeplastida), including green plants (Viridiplantae), glaucophytes (Glaucophyta) and red algae (Rhodophyta). Our analysis provides a robust phylogenomic framework for examining the evolution of green plants. Most inferred species relationships are well supported across multiple species tree and supermatrix analyses, but discordance among plastid and nuclear gene trees at a few important nodes highlights the complexity of plant genome evolution, including polyploidy, periods of rapid speciation, and extinction. Incomplete sorting of ancestral variation, polyploidization and massive expansions of gene families punctuate the evolutionary history of green plants. Notably, we find that large expansions of gene families preceded the origins of green plants, land plants and vascular plants, whereas whole-genome duplications are inferred to have occurred repeatedly throughout the evolution of flowering plants and ferns. The increasing availability of high-quality plant genome sequences and advances in functional genomics are enabling research on genome evolution across the green tree of life.
Perfluorodicarbonyl (PFDC) compounds may be emitted directly into the atmosphere or formed in the atmospheric degradation of trace fluorinated gases, such as unsaturated perfluoro cyclic compounds. A ...potential atmospheric removal process for PFDCs is UV photolysis, which is presently not well-characterized. In this work, UV and infrared absorption spectra of FC(O)C(O)F, FC(O)CF2C(O)F, and FC(O)CF2CF2C(O)F (three of the simplest PFDCs) and their 248 nm photolysis products are reported. UV spectra were measured at 296 K between 190 and 320 nm using single wavelength and broadband diode array spectroscopic measurement techniques. Infrared absorption spectra were measured at 296 K using Fourier transform infrared spectroscopy between 500 and 4000 cm–1. The PFDCs are shown to be potent greenhouse gases with radiative efficiencies (well-mixed) of 0.142, 0.218, and 0.293 W m–2 ppb–1 for FC(O)C(O)F, FC(O)CF2C(O)F, and FC(O)CF2CF2C(O)F, respectively. Photolysis product yields (248 nm) were measured using pulsed laser photolysis combined with infrared absorption detection of radical products scavenged to stable bromides by reaction with Br2. BrC(O)F was identified as a major stable end product in all systems with a yield greater than ∼90%. The infrared spectrum of BrC(O)F is reported as part of this study. FC(O)CBrF2 and FC(O)CF2CBrF2 were also identified as products in the photolysis of FC(O)CF2C(O)F and FC(O)CF2CF2C(O)F, respectively, by comparison with theoretically calculated infrared absorption spectra. A carbonyl difluoride (CF2O) primary photolysis yield of ∼10% was measured in the photolysis of FC(O)C(O)F.
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