36 research outputs found

    Evidence for Induction of Integron-Based Antibiotic Resistance by the SOS Response in a Clinical Setting

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    Bacterial resistance to β-lactams may rely on acquired β-lactamases encoded by class 1 integron-borne genes. Rearrangement of integron cassette arrays is mediated by the integrase IntI1. It has been previously established that integrase expression can be activated by the SOS response in vitro, leading to speculation that this is an important clinical mechanism of acquiring resistance. Here we report the first in vivo evidence of the impact of SOS response activated by the antibiotic treatment given to a patient and its output in terms of resistance development. We identified a new mechanism of modulation of antibiotic resistance in integrons, based on the insertion of a genetic element, the gcuF1 cassette, upstream of the integron-borne cassette blaOXA-28 encoding an extended spectrum β-lactamase. This insertion creates the fused protein GCUF1-OXA-28 and modulates the transcription, the translation, and the secretion of the β-lactamase in a Pseudomonas aeruginosa isolate (S-Pae) susceptible to the third generation cephalosporin ceftazidime. We found that the metronidazole, not an anti-pseudomonal antibiotic given to the first patient infected with S-Pae, triggered the SOS response that subsequently activated the integrase IntI1 expression. This resulted in the rearrangement of the integron gene cassette array, through excision of the gcuF1 cassette, and the full expression the β-lactamase in an isolate (R-Pae) highly resistant to ceftazidime, which further spread to other patients within our hospital. Our results demonstrate that in human hosts, the antibiotic-induced SOS response in pathogens could play a pivotal role in adaptation process of the bacteria

    Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

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    <p>Abstract</p> <p>Background</p> <p>Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously.</p> <p>Case presentation</p> <p>A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature.</p> <p>Conclusion</p> <p>This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis.</p

    Control Position Strategy, Cultural Distance, Conflict Resolution Strategies and Performance of International Joint Ventures

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    Facing fierce global competition, firms often establish international joint ventures (IJVs) with foreign firms (Kwon, 2013). However, researchers notice a high rate of IJV failure (e.g. Hennart, Kim and Zeng, 1998). One of the key reasons is that firms often have different goals and ways of communications. Another reason is that inter-partner conflicts often lead to dissolution of partnership (Fey and Beamish, 1999; Pajunen and Fang, 2013). Thus, understanding conflict is crucial to organisations (Boonsathorn, 2007, Das and Kumar, 2010; Krone and Steimel, 2013) since conflict resolution strategies of parent firms affect IJV performance (Fey and Bearmish, 1999; Lu, 2006; Yavas, et al., 1994). Lin and Germain, 1998) suggest that foreign parent firms differ in their choice of conflict resolution strategies (CRS). Wang, Lin, Chang and Shi (2005) notice that conflict handling styles of partner firms becomes an important topic in IJV research, and White III, Joplin and Salama (2007) maintain that conflict resolution strategy is an underexplored area in the international business and management literature.</p
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