Skippermedina4419

ation in patients with Gerstmann-Sträussler-Scheinker disease and implies that the C-terminus of PrPSc is dispensable for infectivity and strain features for this prion strain, uncovering the central PrP domain as the minimal molecular component able to encode infectious prions. These findings are consistent with the hypothesis that non-fibrillar prion particles are highly efficient propagators of disease and provide new molecular and morphological constraints on the structure of infectious prions. © The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.OBJECTIVES This study aims to evaluate differences in proximal aorta geometry and identify specific anatomical predictors of type B aortic dissection (TBAD). METHODS We evaluated computed tomographic angiograms of controls (n = 185) and patients with acute TBAD (n = 173). Using propensity score matching, we created 2 groups of 127 patients. 3mensio Vascular software was used to analyse the computed tomographic angiograms and measure the diameter, length, tortuosity index and angulation of the proximal aorta (divided into ascending aorta and aortic arch). Tortuosity index was calculated by dividing the centre lumen line length of the aortic segment by its shortest length. Angulation was measured by the centre lumen line 'tangent line angle'. Two independent multivariable models identified significant anatomical associations regarding the tortuosity and angulation geometry. RESULTS Aortic diameter and ascending aorta and aortic arch lengths in TBAD increased significantly. The aortic arch tortuosity was significantly higher in the TBAD group (P  less then  0.001), with no difference regarding the ascending aorta (P = 0.11). Ascending aorta and aortic arch angulation were significantly higher in the TBAD group (P = 0.01, P  less then  0.001, respectively). Multivariable analyses showed that increased aortic arch tortuosity and angulation were significant predictors of the development of TBAD [odds ratio (OR) 1.91, 95% confidence interval (CI) 1.40-2.59; P  less then  0.001 and OR 1.08, 95% CI 1.04-1.12; P  less then  0.001], respectively. CONCLUSIONS In addition to proximal aorta dilation and elongation, we identified increased aortic arch tortuosity and angulation as possible specific predictors of TBAD. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.Adult congenital diaphragmatic hernia (CDH) with an absent pericardium and liver heterotopia is extremely rare, and had only been described in 1 patient. Here, we present another case of left-sided central CDH in a 40-year-old Chinese woman. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.OBJECTIVES Bacterial population kinetics of strains harbouring drug resistance-conferring mutations within a patient often show cryptic resistance in clinical practice. We report a case that showed emergence and dominance of Mycobacterium tuberculosis with uncommon rpoB and gyrA mutations, followed by an rpoC compensatory mutation, during treatment. METHODS A pre-XDR-TB patient showed heteroresistance to rifampicin and levofloxacin during treatment as a result of intermittent self-cessation. WGS was applied to investigate intra-host strain composition using five pairs of isolates from sputum samples. RESULTS The subclone in this study possessed rare mutations conferring resistance to rifampicin (rpoB V170F) and levofloxacin (gyrA S91P) and it rapidly outcompeted other subclones during treatment that included levofloxacin but not rifampicin ( less then 7 days). The high-probability compensatory mutation rpoC V483A also emerged and became dominant subsequent to the rpoB V170F mutation. check details CONCLUSIONS To the best of our knowledge, this is the first case showing the emergence of such a rare variant that dominated the population within a patient during treatment of TB. © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email journals.permissions@oup.com.OBJECTIVES Transfusion of blood products has been associated with increased risk of post-pneumonectomy respiratory failure. It is unclear whether intraoperative or postoperative transfusions confer a higher risk of respiratory failure. Our objective was to assess the role of transfusions in developing post-pneumonectomy respiratory failure. METHODS We performed a retrospective cohort study using prospectively collected data on consecutive pneumonectomies between 2005 and 2015. Patient records were reviewed for intraoperative/postoperative exposures. Univariable and multivariable analyses were performed. RESULTS Of the 251 pneumonectomies performed during the study period, 24 (9.6%) patients suffered respiratory failure. Ninety-day mortality was 5.6% (n = 14) and was more likely in patients with respiratory failure (7/24 vs 7/227, P  less then  0.001). Intraoperative and postoperative transfusions occurred in 42.2% (n = 106) and 44.6% (n = 112) of patients, respectively and were predominantly red blood cells. ratory failure. Intraoperative transfusion may be in reaction to active/unpredictable blood loss and may not be easily modifiable. However, postoperative transfusion may be modifiable and potentially avoidable. Transfusion thresholds should be assessed in light of potential cost-benefit trade-offs. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.BACKGROUND Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in low-/middle-income countries during the last decade. OBJECTIVES To estimate the prevalence of pre-treatment HIVDR and acquired HIVDR among persons living with HIV (PLHIV) on ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48) in Honduras. PATIENTS AND METHODS A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from October 2016 to November 2017. Twenty-two of 54 total ART clinics representing >90% of the national cohort of adults on ART were included. HIVDR was assessed for protease and reverse transcriptase Sanger sequences using the Stanford HIVdb tool. RESULTS A total of 729 PLHIV were enrolled; 26.3% (95% CI 20.1%-33.5%) ART initiators reported prior exposure to antiretrovirals. Pre-treatment HIVDR prevalence was 26.9% (95% CI 20.2%-34.9%) to any antiretroviral and 25.9% (19.2%-33.9%) to NNRTIs. NNRTI pre-treatment HIVDR was higher in ART initiators with prior exposure to antiretrovirals (P = 0.