An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis

Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies.We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested.25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV1 % predicted was 60 %, and mean BMI was 19.5 kg/m(2). The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 %) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection.Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection.James B. Geake, David W. Reid, Bart J. Currie, Scott C. Bell, and MelioidCF Investigator

Similar or Different? The Role of the Ventrolateral Prefrontal Cortex in Similarity Detection

Patients with frontal lobe syndrome can exhibit two types of abnormal behaviour when asked to place a banana and an orange in a single category: some patients categorize them at a concrete level (e.g., “both have peel”), while others continue to look for differences between these objects (e.g., “one is yellow, the other is orange”). These observations raise the question of whether abstraction and similarity detection are distinct processes involved in abstract categorization, and that depend on separate areas of the prefrontal cortex (PFC). We designed an original experimental paradigm for a functional magnetic resonance imaging (fMRI) study involving healthy subjects, confirming the existence of two distinct processes relying on different prefrontal areas, and thus explaining the behavioural dissociation in frontal lesion patients. We showed that: 1) Similarity detection involves the anterior ventrolateral PFC bilaterally with a right-left asymmetry: the right anterior ventrolateral PFC is only engaged in detecting physical similarities; 2) Abstraction per se activates the left dorsolateral PFC

A Biocultural Analysis of Mortuary Practices in the Later Anglo-Saxon to Anglo-Norman Black Gate Cemetery, Newcastle-upon-Tyne, England

The lack of grave goods in cemeteries from later Anglo‐Saxon England (eighth to 11th century AD) has in the past been interpreted as reflecting standardisation of burial rites dictated by Christian doctrine. This study employed a biocultural approach to investigate whether variations in mortuary practices such as burial location, grave form, and body disposition within the eighth to 12th‐century Black Gate Cemetery, Newcastle‐upon‐Tyne represented alternative mediums of social display.Skeletal markers commonly associated with early life stress (cribra orbitalia and linear enamel hypoplasia), non‐specific stress (tibial periosteal lesions and maxillary sinusitis), oral health (calculus, caries, abscesses, and ante‐mortem tooth loss), and biomechanical stress (appendicular and spinal degenerative joint disease and trauma) were examined macroscopically on the skeletal remains of 643 individuals. The aim of the analysis was to investigate whether patterns in age, sex, and biological stress in the different burial locations, burial types, and body positions evidenced social status or sociocultural relationships between the different mortuary practices.Demographic and biocultural analysis revealed the inclusion of males, females, non‐adults, and the elderly in all of the mortuary practices, and no evidence for marked inequalities in biological stress between those afforded the different burial practices. The dominant influence for non‐significant trends in the stress data was variation in age‐structure between different areas of burial. However, non‐significant but consistently higher frequencies of stress indicators were observed in graves containing stone inclusions (pillow stones, head‐cists, and earmuffs) compared with those constructed from stone (cists and rubble cists) and plain burials, all burial practices with a similar mortality profile.The distribution of age and stress indicators between the mortuary practices placed in the wider sociocultural context provided a deeper insight into the complex contribution of social relationships, life‐course, pragmatism, regional and temporal trends, and cultural and religious beliefs upon treatment of the deceased