Community‐acquired,methicillin‐resistant Staphylococcus aureus isolated from children with community‐onset pneumonia in China

Community‐acquired, methicillin‐resistant Staphylococcus aureus (CA‐MRSA) has been associated with morbidity and mortality in various countries. In this study, we characterized the molecular and clinical features of pediatric CA‐MRSA pneumonia in China. Between June 2006 and February 2008, 55 previously healthy children confined in eight hospitals countrywide were found to be afflicted with CA‐MRSA pneumonia. A total of 55 strains collected from these children were analyzed by multilocus sequence typing (MLST), Staphylococcus cassette chromosome mec (SCCmec) typing, and spa typing. The Panton–Valentine leukocidin (PVL) gene was also detected. Overall, nine STs were obtained, with ST59 (40.4%) established to be the most prevalent type. We first registered the new ST1409 from a child with necrotizing pneumonia. SCCmecIVa was the most predominant type, followed by SCCmec type V. Twelve spa types were identified, of which one new spa type, t5348, was first detected and registered. One typical livestock‐associated spa type, t034, was found in a 4‐month‐old girl living in the countryside. We also found that 40% of those isolates were PVL‐positive. In addition, the median age of the children in this study was 10 months. A total of 69% (38/55) of the children with community‐acquired pneumonia (CAP) had preceding influenza or influenza‐like illness, and three ST910‐MRSA‐IV strains (PVL gene‐positive) were associated with severe necrosis. The results indicated that the recent CA‐MRSA found in Chinese children with CAP was largely associated with the spread of the ST59‐MRSA‐IV clone, and most of the PVL‐positive strains in this study did not cause necrotic cases. Pediatr Pulmonol. 2010; 45:387–394. © 2010 Wiley‐Liss, Inc.     

Spa treatments as a potential tool in the rehabilitation of people with alcohol and drug problems: a personal perspective

There is a lack of non‐pharmacological options for the treatment of people with substance misuse problems. However, service users often mention their use of steam rooms and home baths to help aid their problem of detoxification and aid relaxation of muscle cramps. These anecdotes prompted this current review, to establish whether spa bathing is used for this purpose and whether there is any evidence of its effectiveness. The review was carried out in 2003 and includes a literature review together with written and oral responses from individuals and organizations. The review provided an overview of the extent of uses of spa bathing and describes a variety of examples.     

A pragmatic randomized controlled trial on the effectiveness of low concentrated saline spa water baths followed by ultraviolet B (UVB) compared to UVB only in moderate to severe psoriasis

OBJECTIVE: To evaluate whether low concentrated saline spa water baths followed by ultraviolet B (LC-SSW-UVB) are superior to UVB alone in moderate to severe psoriasis. BACKGROUND: There is a lack of sufficiently large randomized controlled clinical trial evaluating the additional benefit of saltwater baths followed by UVB compared to UVB only in psoriasis. STUDY DESIGN: Partly evaluator blind, multicentre, pragmatic, randomized controlled trial. SETTING: Five German spa centres. SUBJECTS: One hundred and forty-three adults with stable psoriasis during the last month and a Psoriasis Area and Severity Index (PASI) of > 10 and/or an affected body surface area of > 15%. INTERVENTIONS: LC-SSW-UVB or UVB thrice a week until remission (PASI < 5) or for a maximum of 6 weeks. Sodium chloride concentrations of natural springs varied between 4.5% and 12%. Conventional UVB (broadband UVB or selective UVB phototherapy) was used as irradiation source. MAIN OUTCOME: Reduction of PASI and/or affected body surface area of 50% at the end of the intervention period (PASI-50). Only participants receiving at least one intervention were included in the primary analysis. RESULTS: Patients allocated to LC-SSP-UVB attained a statistically significantly higher rate of PASI-50 at the end of the intervention period than patients allocated to UVB [58/79 (73%) vs. 32/64 (50%); P = 0.01; NNT, 4.3, 95% CI, 2.4-18.1]. Benefit persisted until 3 months only for one of two secondary outcomes considered. CONCLUSIONS: In routine clinical practice balneophototherapy using conventional UVB is superior to conventional UVB only at the end of a 6-week treatment course.     

我国猪源甲氧西林耐药金黄色葡萄球菌的分离与分子分型研究

目的:近期研究发现,养殖生猪是甲氧西林耐药金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)的重要宿主,本研究旨在阐明MRSA在我国养殖生猪中的分布和遗传学特征。方法:从我国河北、陕西、湖北和四川的生猪养殖场或屠宰场采集生猪鼻咽部拭子进行MRSA分离和鉴定,并对分离株进行了表型和基因型的分析。结果:从569份生猪鼻咽部拭子中分离出58株MRSA,这些菌株的耐药表型主要有2种:CIP-CLI-ERY-FOX-GEN-TET-CHL和CIP-CLI-ERY-FOX-GEN-TET;所有菌株均属于spa t899和SCCmecⅢ型,未检出PVL基因。经多位点测序分型分析后发现,我国猪源MRSA菌株以ST9型为主;脉冲场电泳(Pulssed Gel Electrophoresis,PFGE)分型分析显示,猪源MRSA菌株中存在优势的PFGE基因型和基因簇。结论:在我国养殖生猪中广泛存在ST9-spa899-SCCmecⅢ型MRSA菌株,这些菌株可能成为社区MRSA感染的新来源。     

Mortality and Cancer Incidence in Misasa, Japan, a Spa Area with Elevated Radon Levels

A historical cohort study was conducted in Misasa town, Tottori prefecture, Japan, where radon spas have been operating for a long time. Misasa town was divided into an elevated radon level area and a control area, with mean indoor radon levels of about 60 and 20 Bq/m³, respectively. In total, 3,083 subjects in the elevated radon level area and 1,248 in the control area, all aged 40 or older on January 1, 1976, were followed up until December 31, 1993, for a mean period of 14 years. The mortality rates from all causes exhibited no difference between the elevated radon level area and the control area for both sexes. No difference was observed in the incidence of all-site cancers (age, period-adjusted rate ratios by Poisson regression, RR=1.06, 95% confidence interval (CI) 0.79–1.42 for males, RR=0.90, 95% CI 0.65–1.24 for females), while stomach cancer incidence seemed to decrease for both sexes (RR=0.70, 95% CI 0.44–1.11 for male, RR=0.58, 95% CI 0.34–1.00 for female) and lung cancer incidence for males only seemed to increase (RR=1.65, 95% CI 0.83–3.30 for male, RR=1.07, 95% CI 0.28–4.14 for female) in the elevated radon level area. Caution is needed in the interpretation of these findings, however, since the individual exposure level was not measured and major confounding factors, such as smoking and diet, could not be controlled in this study.     

Transient neuromotor phenotype in transgenic spastic mice expressing low levels of glycine receptor beta-subunit: an animal model of startle disease

Startle disease or hereditary hyperekplexia has been shown to result from mutations in the alpha1-subunit gene of the inhibitory glycine receptor (GlyR). In hyperekplexia patients, neuromotor symptoms generally become apparent at birth, improve with age, and often disappear in adulthood. Loss-of-function mutations of GlyR alpha or beta-subunits in mice show rather severe neuromotor phenotypes. Here, we generated mutant mice with a transient neuromotor deficiency by introducing a GlyR beta transgene into the spastic mouse (spa/spa), a recessive mutant carrying a transposon insertion within the GlyR beta-subunit gene. In spa/spa TG456 mice, one of three strains generated with this construct, which expressed very low levels of GlyR beta transgene-dependent mRNA and protein, the spastic phenotype was found to depend upon the transgene copy number. Notably, mice carrying two copies of the transgene showed an age-dependent sensitivity to tremor induction, which peaked at approximately 3-4 weeks postnatally. This closely resembles the development of symptoms in human hyperekplexia patients, where motor coordination significantly improves after adolescence. The spa/spa TG456 line thus may serve as an animal model of human startle disease.     

Balneotherapy for chronic plaque psoriasis at Comano spa in Trentino, Italy

ABSTRACT:  Thermal therapy is used worldwide in the treatment of psoriasis but few controlled studies have evaluated its efficacy and safety. We studied the efficacy and safety of balneotherapy compared to photobalneotherapy performed at Comano spa in Trentino, Italy, in chronic plaque psoriasis in a prospective, nonrandomized, open study. Three hundred adult patients with mild to severe chronic plaque psoriasis were assigned to either balneotherapy or photobalneotherapy with daily narrow-band ultraviolet B for a mean period of 1 or 2 weeks, reflecting the times that most patients can dedicate to thermal therapy. Patients were evaluated at baseline and end of treatment for psoriasis area and severity index (PASI) and body surface area; self-administered PASI (SAPASI) and Skindex-29 were evaluated at the same times, and also at 4 months by a mailed questionnaire. One-week balneotherapy or photobalneotherapy resulted in a significant reduction in PASI score (11.54% ± 2.76 and 12.76% ± 3.79, respectively; mean ± standard deviation; p  < 0.001). Two-week therapy induced a greater response with photobalneotherapy than with balneotherapy alone, with PASI reduction of 19.8% ± 24.5 and 13.5% ± 23.1 ( p <  0.005), respectively. These results were confirmed by SAPASI and Skindex-29 evaluation. The therapy was well tolerated. Skin improvement was mostly lost after 4 months. Short-term balneotherapy and photobalneotherapy could thus be offered to patients willing to temporarily discontinue pharmacologic therapy or as adjuvant therapy.     

Molecular characterization of Staphylococcus aureus isolates from skin and soft tissue infections samples and healthy carriers in the Central Slovenia region

Staphylococcus aureus is among the most important human pathogens. It is associated with different infections and is a major cause of skin and soft tissue infections (SSTIs). The aim of our study was to compare S. aureus isolates associated with SSTIs with isolates obtained from healthy carriers in the Central Slovenia region in terms of antimicrobial susceptibility, genetic diversity by clonal complex (CC)/sequence type, spa type, and by toxin gene profiling. In total, 274 S. aureus isolates were collected prospectively by culturing wound samples from 461 SSTI patients and nasal samples from 451 healthy carriers. We have demonstrated high heterogeneity in terms of CCs and spa type in both groups of isolates. The main clone among SSTI strains was Panton–Valentine leukocidin gene (pvl) positive CC121, whereas the main clone among carrier strains was CC45 carrying a large range of toxin genes. The main spa type in both groups was t091. Pvl was more frequently present in SSTI strains (31.2% SSTI vs 3.6% carrier strains) and staphylococcal enterotoxin C was more frequently present in carrier strains (1.6% SSTI vs 17.0% carrier strains). We have also demonstrated that methicillin‐resistant S. aureus was a rare cause (2.8%) of SSTIs in our region.     

Modulation of the peripheral immune system after low-dose radon spa therapy: Detailed longitudinal immune monitoring of patients within the RAD-ON01 study

The pain-relieving effects of low-dose radon therapies on patients suffering from chronic painful inflammatory diseases have been described for centuries. Even though it has been suggested that low doses of radiation may attenuate chronic inflammation, the underlying mechanisms remain elusive. Thus, the RAD-ON01 study was initiated to examine the effects of radon spa therapy and its low doses of alpha radiation on the human immune system. In addition to an evaluation of pain parameters, blood was drawn from 100 patients suffering from chronic painful degenerative musculoskeletal diseases before as well as 6, 12, 18, and 30 weeks after the start of therapy. We verified significant long-term pain reduction for the majority of patients which was accompanied by modulations of the peripheral immune cells. Detailed immune monitoring was performed using a multicolor flow cytometry-based whole blood assay. After therapy, the major immune cells were only marginally affected. Nevertheless, a small but long-lasting increase in T cells and monocytes was observed. Moreover, neutrophils, eosinophils and, in particular, dendritic cells were temporarily modulated after therapy. Regarding the immune cell subsets, cytotoxic T and NK cells, in particular, were altered. However, the most prominent effects were identified in a strong reduction of the activation marker CD69 on T, B, and NK cells. Simultaneously, the percentage of HLA-DR⁺ T cells was elevated after therapy. The RAD-ON01 study showed for the first time a modulation of the peripheral immune cells following standard radon spa therapy. These modulations are in line with attenuation of inflammation.