BackgroundsTwo SNPs in melatonin receptor 1B gene, rs10830963 and rs1387153 showed significant associations with fasting plasma glucose levels and the risk of Type 2 Diabetes Mellitus (T2DM) in previous studies. Since T2DM and gestational diabetes mellitus (GDM) share similar characteristics, we suspected that the two genetic polymorphisms in MTNR1B may be associated with GDM, and conducted association studies between the polymorphisms and the disease. Furthermore, we also examined genetic effects of the two polymorphisms with various diabetes-related phenotypes.MethodsA total of 1,918 subjects (928 GDM patients and 990 controls) were used for the study. Two MTNR1B polymorphisms were genotyped using TaqMan assay. The allele distributions of SNPs were evaluated by x2 models calculating odds ratios (ORs), 95% confidence intervals (CIs), and corresponding P values. Multiple regressions were used for association analyses of GDM-related traits. Finally, conditional analyses were also performed.ResultsWe found significant associations between the two genetic variants and GDM, rs10830963, with a corrected P value of 0.0001, and rs1387153, with the corrected P value of 0.0008. In addition, we also found that the two SNPs were associated with various phenotypes such as homeostasis model assessment of beta-cell function and fasting glucose levels. Further conditional analyses results suggested that rs10830963 might be more likely functional in case/control analysis, although not clear in GDM-related phenotype analyses.ConclusionThere have been studies that found associations between genetic variants of other genes and GDM, this is the first study that found significant associations between SNPs of MTNR1B and GDM. The genetic effects of two SNPs identified in this study would be helpful in understanding the insight of GDM and other diabetes-related disorders.

Burkholderia cenocepacia is an opportunistic bacterial species capable of causing life-threatening respiratory tract infection in persons with cystic fibrosis (CF). Unlike most other pathogens in CF, which typically remain confined to the endobronchial spaces, B. cenocepacia can traverse airway epithelium to cause bacteremia and sepsis. The mechanisms by which this occurs, however, are unknown. We examined the transmigration of B. cenocepacia through polarized respiratory epithelium. Representatives of three "epidemic" lineages common among CF patients in North America were able to traverse polarized 16HBE14o ؊ cells in vitro. Transmigration of bacteria was associated with significant perturbations in epithelial permeability, as measured by a loss of transepithelial electrical resistance and increased flux of bovine serum albumin across the cell layer. Terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling and trypan blue exclusion assays, as well as lactate dehydrogenase levels, did not indicate excessive cytotoxicity or cell death in infected cell layers. Rather, confocal fluorescence microscopy demonstrated the loss of occludin from tight junctions. In contrast, zonula occludens 1 was well preserved along intercellular borders. Western blot analysis showed a shift in the major occludin isoforms from high-to low-phosphorylation states during infection. These observations suggest that B. cenocepacia traverses polarized respiratory epithelium by the dephosphorylation and dissociation of occludin from the tight-junction complex.

An 8-month-old boy developed a necrotic lung mass from which Burkholderia glumae was recovered, leading to the diagnosis of chronic granulomatous disease (CGD). While other Burkholderia species have been identified as important pathogens in persons with CGD, B. glumae has not been previously reported to cause human infection. CASE REPORTAn 8-month-old boy presented to his pediatrician with a 3-day history of fevers in the absence of other symptoms. History and physical examination provided no obvious source for the fevers. Laboratory evaluation revealed a white blood cell count of 29,000 per l (49% neutrophils, 16% bands, and 29% lymphocytes), a hematocrit of 29% and a platelet count of 451,000 per l. Blood cultures obtained at this visit were negative. He continued to have fevers during the next 4 days, after which time a chest radiograph revealed bilateral perihilar infiltrates. Treatment with oral amoxicillin-clavulanate was initiated, but treatment was switched to intramuscular ceftriaxone after 4 days. After 2 days of ceftriaxone, therapy was changed to oral cefdinir, which the patient received for 8 days. Throughout this time he continued to have daily fevers as high as 105°F. A repeat chest radiograph again demonstrated bilateral infiltrates. Therapy with azithromycin was initiated, and the patient was referred to a pediatric pulmonology clinic for further evaluation.In the clinic, the patient's physical examination was significant for decreased breath sounds in the middle left and upper right lung fields. A chest radiograph showed heterogeneous, multifocal, and somewhat nodular opacities that were most confluent in the right upper and left lower lobes. Computerized tomography (CT) of the chest, abdomen, and pelvis revealed a large (3.9 by 4.4 cm) mass within the left lower lobe and numerous nodules, the largest of which measured 2.2 by 2.1 cm, distributed diffusely throughout the lungs (Fig. 1). Enlarged cervical lymph nodes and diffuse mediastinal lymphadenopathy were present. The patient was admitted to the hospital, and an open biopsy of the left lung revealed a necrotic, exophytic tumor involving the majority of the lower lobe. Several specimens were obtained from the main mass, and a wedge biopsy specimen containing two small nodules was obtained from the apical segment of the left upper lobe. A peripheral nodule in the left lower lobe was also resected. There was no evidence of pleura-based disease. Initial gram stains of the surgical specimens revealed no organisms and rare white blood cells. Histopathology revealed a diffuse pattern of acute pneumonia, with focal areas of necrosis and areas of organization and coalescence into poorly formed granulomata. The cellular composition of the inflammation was polymorphous; no malignant cells were identified. These findings were deemed most consistent with an acute infectious etiology; however, no bacteria, fungi, or mycobacteria were identified on special histochemical stains (periodic acid-Schiff, Gomori methenamine silver, and Brown Brenn) performed on...

Background Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) are associated with high mortality rates. We evaluated the efficacy and safety of tedizolid (administered as tedizolid phosphate) for treatment of gram-positive ventilated HABP/VABP. Methods In this randomized, noninferiority, double-blind, double-dummy, global phase 3 trial, patients were randomized 1:1 to receive intravenous tedizolid phosphate 200 mg once daily for 7 days or intravenous linezolid 600 mg every 12 hours for 10 days. Treatment was 14 days in patients with concurrent gram-positive bacteremia. The primary efficacy end points were day 28 all-cause mortality (ACM; noninferiority margin, 10%) and investigator-assessed clinical response at test of cure (TOC; noninferiority margin, 12.5%) in the intention-to-treat population. Results Overall, 726 patients were randomized (tedizolid, n = 366; linezolid, n = 360). Baseline characteristics, including incidence of methicillin-resistant Staphylococcus aureus (31.3% overall), were well balanced. Tedizolid was noninferior to linezolid for day 28 ACM rate: 28.1% and 26.4%, respectively (difference, –1.8%; 95% confidence interval [CI]: –8.2 to 4.7). Noninferiority of tedizolid was not demonstrated for investigator-assessed clinical cure at TOC (tedizolid, 56.3% vs linezolid, 63.9%; difference, –7.6%; 97.5% CI: –15.7 to 0.5). In post hoc analyses, no single factor accounted for the difference in clinical response between treatment groups. Drug-related adverse events occurred in 8.1% and 11.9% of patients who received tedizolid and linezolid, respectively. Conclusions Tedizolid was noninferior to linezolid for day 28 ACM in the treatment of gram-positive ventilated HABP/VABP. Noninferiority of tedizolid for investigator-assessed clinical response at TOC was not demonstrated. Both drugs were well tolerated. Clinical Trials Registration NCT02019420.

In vertically acquired HIV-1 infected children, HAART elevates the risk of hypercholesterolemia. NRTI/PI increased risk of TC levels threefold, while NRTI/NNRTI increased risk twofold over No MED.