Recent studies have highlighted the close relationship between the kidney and the gastrointestinal (GI) tract--frequently referred to as the kidney--gut axis--in patients with chronic kidney disease ...(CKD). In this regard, two important pathophysiological concepts have evolved: (i) production and accumulation of toxic end-products derived from increased bacterial fermentation of protein and other nitrogen-containing substances in the GI tract, (ii) translocation of endotoxins and live bacteria from gut lumen into the bloodstream, due to damage of the intestinal epithelial barrier and quantitative/qualitative alterations of the intestinal microbiota associated with the uraemic milieu. In both cases, these gut-centred alterations may have relevant systemic consequences in CKD patients, since they are able to trigger chronic inflammation, increase cardiovascular risk and worsen uraemic toxicity. The present review is thus focused on the kidney-gut axis in CKD, with special attention to the alterations of the intestinal barrier and the local microbiota (i.e. the collection of microorganisms living in a symbiotic coexistence with their host in the intestinal lumen) and their relationships to inflammation and uraemic toxicity in CKD. Moreover, we will summarize the most important clinical data suggesting the potential for nutritional modulation of gut-related inflammation and intestinal production of noxious by-products contributing to uraemic toxicity in CKD patients.
The Escherichia coli strain causing a large outbreak of haemolytic uraemic syndrome and bloody diarrhoea in Germany in May and June 2011 possesses an unusual combination of pathogenic features ...typical of enteroaggregative E. coli together with the capacity to produce Shiga toxin. Through rapid national and international exchange of information and strains the known occurrence in humans was quickly assessed.We describe simple diagnostic screening tools to detect the outbreak strain in clinical specimens and a novel real-time PCR for its detection in foods.
The interest in the development of nanoscale plasmonic technologies has dramatically increased in recent years. The photonic properties of plasmonic nanopatterns can be controlled and tuned via their ...size, shape, or the arrangement of their constituents. In this work, we propose a 2D hybrid metallic polymeric nanostructure based on the octupolar framework with enhanced sensing property. We analyze its plasmonic features both numerically and experimentally, demonstrating the higher values of their relevant figures of merit: we estimated a surface-enhanced Raman spectroscopy (SERS) enhancement factor of 9 × 107 and a SPR bulk sensitivity of 430 nm/RIU. In addition, our nanostructure exhibits a dual resonance in the visible and near-infrared region, enabling our system toward multispectral plasmonic analysis. Finally, we illustrate our design engineering strategy as enabled by electron beam lithography by the outstanding performance of a SERS-based biosensor that targets the Shiga toxin 2a, a clinically relevant bacterial toxin. To the best of our knowledge, this is the first time that a SERS fingerprint of this toxin has been evidenced.
Subtilase (SubAB) is a cytotoxin elaborated by some Shiga Toxin (Stx)-producing Escherichia coli (STEC) strains usually lacking the locus of enterocyte effacement (LEE). Two variants of SubAB coding ...genes have been described: subAB1, located on the plasmid of the STEC O113 98NK2 strain, and subAB2, located on a pathogenicity island (PAI) together with the tia gene, encoding an invasion determinant described in enterotoxigenic E. coli. In the present study, we determined the entire nucleotide sequence of the PAI containing the subAB2 operon, termed Subtilase-Encoding PAI (SE-PAI), and identified its integration site in the pheV tRNA locus. In addition, a PCR strategy for discriminating the two subAB allelic variants was developed and used to investigate their presence in E. coli strains belonging to different pathotypes and in a large collection of LEE-negative STEC of human and ovine origin. The results confirmed that subAB genes are carried predominantly by STEC and showed their presence in 72% and 86% of the LEE-negative strains from human cases of diarrhoea and from healthy sheep respectively. Most of the subAB-positive strains (98%) identified possessed the subAB2 allelic variant and were also positive for tia, suggesting the presence of SE-PAI. Altogether, our observations indicate that subAB2 is the prevalent SubAB-coding operon in LEE-negative STEC circulating in European countries, and that sheep may represent an important reservoir for human infections with these strains. Further studies are needed to assess the role of tia and/or other genes carried by SE-PAI in the colonization of the host intestinal mucosa.
Summary Background & aims Abnormalities of blood glucose (BG) concentration (hyper- and hypoglycemia), now referred to with the cumulative term of dysglycemia, are frequently observed in critically ...ill patients, and significantly affect their clinical outcome. Acute kidney injury (AKI) may further complicate glycemic control in the same clinical setting. This narrative review was aimed at describing the pathogenesis of hyper- and hypoglycemia in the intensive care unit (ICU), with special regard to patients with AKI. Moreover, the complex relationship between AKI, glycemic control, hypoglycemic risk, and outcomes was analyzed. Methods An extensive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, treatment and outcome of hypo- and hyperglycemia in critically ill patients with AKI. Results and conclusion Patients with AKI are at increased risk of both hyper-and hypoglycemia. The available evidence does not support a protective effect on the kidney by glycemic control protocols employing Intensive Insulin Treatment (IIT), i.e. those aimed at maintaining normal BG concentrations (80–110 mg/dl). Recent guidelines taking into account the high risk for hypoglycemia associated with IIT protocols in critically ill patients, now suggest higher BG concentration targets (<180 mg/dl or 140–180 mg/dl) than those previously recommended (80–110 mg/dl). Notwithstanding the limited evidence available, it seems reasonable to extend these indications also to ICU patients with AKI.
Objectives
To describe multidetector CT and ultrasonographic characteristics of abdominal arterial pseudoaneurysms (segmental dilatations of an artery with a ruptured tunica intima) arising secondary ...to systemic mycosis in dogs.
Materials and Methods
Retrospective study on dogs with confirmed histological diagnosis of a fungal pseudoaneurysm and the availability of multidetector CT or ultrasound images.
Results
At the time of admission, the three dogs included in this study demonstrated segmental arterial dilation, irregular arterial wall thickening, and increased echogenicity or attenuation within the local perivascular fat on ultrasound and multidetector CT images. Follow‐up examinations revealed progressive increase in arterial wall thickening and saccular dilation with formation of a pseudoaneurysm in affected vessels of two dogs.
Clinical Significance
Multidetector CT and ultrasonography can be useful imaging modalities in the diagnosis and monitoring of abdominal arterial pseudoaneurysms caused by systemic mycosis.
Prevention and preparedness to health threats pose several challenges: to identify multifactorial drivers, to detect and evaluate risks as early as possible, to involve multiple actors and ...stakeholders and to make information and data transversely and transparently accessible.
One Health (OH) can provide a strategic scientific support if OH strategies are integrated in prevention and preparedness plans at national and international level and OH-based Conceptual Frameworks (OHCF) could facilitate this integration.
We conducted a scoping review to identify aspects in existing prevention and preparedness plans that could benefit of OH strategies and developed a OH based Conceptual Framework (OHCF).
Enhancing prevention and early detection capacity to reduce the societal costs of a pandemic, considering integrated drivers for epidemic/pandemic preparedness, involving the multiplicity of the actors, stakeholders, disciplines and related interests, ensuring prompt access and share of information and data are among the priorities to address which could be supported by One Health strategies.
A OHCF has been developed with a multidisciplinary effort to facilitate detection of threats at the human-animal-environment interface, assess risks for pandemic, support evaluation of possible impacts and provide input for prevention. The OHCF aims at guiding the relevant national sectors towards harmonised and context driven OH strategies in prevention and preparedness and identifies priority actions for Governance, Data collection and analysis and Capacity building, both at national and international level.
At present, stand-alone national One Health plans are often developed, while the effort, in order to benefit from One Health approaches, should be to appropriately integrate One Health strategies into relevant national and international plans.
It is therefore necessary to develop adequate frameworks and identify procedures that allow this integration and effective implementation of comprehensive prevention and preparedness strategies.
The adoption of the proposed OHCF would facilitate the development of intersectoral data sharing and analysis platforms and support decision-making based on early signals which contemplate possible uncertainties.
The OHCF will facilitate operationalisation of OH in prevention and preparedness and will guide assessment of the multiple potential risk factors involved before they became a threat.
We describe a foodborne outbreak in Italy caused by enteroinvasive Escherichia coli (EIEC), an enteric pathogen uncommon in industrialized countries. On 14 April 2012 a number of employees of the ...city of Milan Fire Brigade (FB) were admitted to hospital with severe diarrhoea after attending their canteen. Thirty-two patients were hospitalized and a total of 109 cases were identified. A case-control study conducted on 83 cases and 32 controls attending the canteen without having symptoms identified cooked vegetables to be significantly associated with the disease. Stool samples collected from 62 subjects were screened for enteric pathogens using PCR-based commercial kits: 17 cases and two asymptomatic kitchen-workers were positive for the Shigella marker gene ipaH; an ipaH-positive EIEC strain O96:H19 was isolated from six cases. EIEC may cause serious dysentery-like outbreaks even in Western European countries. Microbiologists should be aware of microbiological procedures to detect EIEC, to be applied especially when no common enteric pathogens are identified.
We present an “event stratigraphy” framework built for the last 23
cal
ka marine record in the southern offshore of Ischia Island based on AMS
14C dating and tephrostratigraphic analysis of 11 ...gravity cores. Two collapse events have been recovered in the record: a) the Ischia submarine debris avalanche/debris flow (DA/DF), dated between ~
3
ka
B.P. and 2.4
ka
B.P. and possibly between 2.7
ka
B.P. and 2.4
ka
B.P. (event DF1); b) a former, pre-Holocene, DA/DF older than 23
cal
ka
B.P. (event DF2). The Ischia DA, with an estimated volume of 1.5
km
3, incorporates thousands of blocks that are still detectable on the sea-floor until 45–50
km far from the island. Our results indicate an age of emplacement younger than previously thought and support the hypothesis that a major catastrophic event occurred when the island was already inhabited by Greek settlers (i.e. after the 7th century BC). Three ash layers have been recognised in the post-DF1 avalanche sequence and correlated with Ischian eruptions occurred between Middle Ages and Roman times. Two tephras recovered in the pre-DF1 succession have been correlated with explosive activity occurred on Ischia and Procida islands from ~
23
ka to ~
17.5
ka
B.P. The results presented here improve the chronostratigraphic reconstruction of the main eruptive and collapse events that affected Ischia volcano during Late Pleistocene–Holocene and their dispersal at sea. The occurrence of at least two major collapsing events in the past 23
kyr confirms the close genetic relationship between gravity failures and Mt. Epomeo uplift.
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