BACKGROUND & AIMS: :Bovine tuberculosis (bTB) is a chronic disease of cattle that is difficult to control and eradicate in part due to the costly nature of surveillance and poor sensitivity of diagnostic tests. Like many countries, bTB prevalence in Uruguay has gradually declined to low levels due to intensive surveillance and control efforts over the past decades. In low prevalence settings, broad-based surveillance strategies based on routine testing may not be the most cost-effective way for controlling between-farm bTB transmission, while targeted surveillance aimed at high-risk farms may be more efficient for this purpose. To investigate the efficacy of targeted surveillance, we developed an integrated within- and between-farm bTB transmission model utilizing data from Uruguay's comprehensive animal movement database. A genetic algorithm was used to fit uncertain parameter values, such as the animal-level sensitivity of skin testing and slaughter inspection, to observed bTB epidemiological data. Of ten alternative surveillance strategies evaluated, a strategy based on eliminating testing in low-risk farms resulted in a 40% reduction in sampling effort without increasing bTB incidence. These results can inform the design of more cost-effective surveillance programs to detect and control bTB in Uruguay and other countries with low bTB prevalence.

背景与目标： : 牛结核病 (bTB) 是一种牛的慢性疾病，由于监测的成本高昂和诊断测试的敏感性差，很难控制和根除。与许多国家一样，由于过去几十年来的密集监测和控制工作，乌拉圭的bTB患病率逐渐下降到较低水平。在低流行率的环境中，基于常规测试的基础广泛的监测策略可能不是控制农场间bTB传播的最具成本效益的方法，而针对高风险农场的针对性监测可能为此目的更有效。为了研究目标监测的有效性，我们利用乌拉圭综合动物运动数据库中的数据开发了一个集成的农场内和农场间bTB传播模型。使用遗传算法将不确定的参数值 (例如皮肤测试和屠宰检查的动物级敏感性) 拟合到观察到的bTB流行病学数据。在评估的十种替代监测策略中，基于消除低风险农场测试的策略导致采样工作量40% 减少，而不会增加bTB发生率。这些结果可以为设计更具成本效益的监测计划提供信息，以检测和控制乌拉圭和其他bTB患病率较低的国家的bTB。

BACKGROUND & AIMS: :Influenza virus infections result in considerable morbidity and mortality both in the temperate and tropical world. Influenza surveillance over multiple years is important to determine the impact and epidemiology of influenza and to develop a national vaccine policy, especially in countries developing influenza vaccine manufacturing capacity, such as Vietnam. We conducted surveillance of influenza and influenza-like illness in Vietnam through the National Influenza Surveillance System during 2006-2010. At 15 sentinel sites, the first two patients presenting each weekday with influenza-like illness (ILI), defined as fever and cough and/or sore throat with illness onset within 3 days, were enrolled and throat specimens were collected and tested for influenza virus type and influenza A subtype by RT-PCR. De-identified demographic and provider reported subsequent hospitalization information was collected on each patient. Each site also collected information on the total number of patients with influenza-like illness evaluated per week. Of 29,804 enrolled patients presenting with influenza-like illness, 6516 (22%) were influenza positive. Of enrolled patients, 2737 (9.3%) were reported as subsequently hospitalized; of the 2737, 527 (19%) were influenza positive. Across all age groups with ILI, school-aged children had the highest percent of influenza infection (29%) and the highest percent of subsequent hospitalizations associated with influenza infection (28%). Influenza viruses co-circulated throughout most years in Vietnam during 2006-2010 and often reached peak levels multiple times during a year, when >20% of tests were influenza positive. Influenza is an important cause of all influenza-like illness and provider reported subsequent hospitalization among outpatients in Vietnam, especially among school-aged children. These findings may have important implications for influenza vaccine policy in Vietnam.

背景与目标： : 在温带和热带地区，流感病毒会导致相当大的发病率和死亡率。多年的流感监测对于确定流感的影响和流行病学以及制定国家疫苗政策非常重要，特别是在越南等发展流感疫苗生产能力的国家。我们在2006-2010年期间通过国家流感监测系统对越南的流感和流感样疾病进行了监测。在15个哨点，招募了每个工作日出现流感样疾病 (ILI) 的前两名患者，这些疾病定义为发热，咳嗽和/或喉咙痛，并在3天内发病，并收集了喉咙标本，并通过rt-pcr检测了流感病毒类型和a型流感亚型。取消身份的人口统计学和提供者报告的后续住院信息收集了每位患者。每个站点还收集了每周评估的流感样疾病患者总数的信息。在29,804名出现流感样疾病的患者中，6516 (22%) 为流感阳性。在登记的患者中，2737 (9.3%) 被报告为随后住院; 2737中，527 (19%) 为流感阳性。在ILI的所有年龄组中，学龄儿童的流感感染率最高 (29%)，随后与流感感染相关的住院率最高 (28%)。在2006-2010年期间，流感病毒在越南的大多数年份中共同传播，并且在一年中经常多次达到峰值水平，当> 20% 的测试为流感阳性时。流感是所有流感样疾病的重要原因，提供者报告说越南门诊患者随后住院，尤其是学龄儿童。这些发现可能对越南的流感疫苗政策具有重要意义。

BACKGROUND & AIMS: :We compared serotype distributions of Streptococcus pneumoniae isolates from patients aged <5 and o5 years with invasive pneumococcal disease in New South Wales, Australia, and antibiotic susceptibilities of isolates from the <5 years age group only, before (2002–2004) and after(2005–2009) introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Overall, there were significant decreases in the mean annual number of referred isolates (770 vs. 515) and the proportion belonging to PCV7 serotypes (74% vs. 38%), but non-PCV7 serotypes, particularly 19A, increased (5% vs. 18%). All changes were more marked in the <5 years age group.Susceptibility testing of isolates from the <5 years age group showed variation in resistance between serotypes, but significant overall increases in penicillin non-susceptibility (23% vs. 31%),ceftriaxone resistance (2% vs. 12%) and multidrug resistance (4% vs. 7%) rates ; erythromycin resistance fell (32% vs. 25%). Continued surveillance is needed to monitor changes following the introduction of 13-valent PCV in 2012.

背景与目标： : 我们比较了澳大利亚新南威尔士州 <5岁和o5岁侵袭性肺炎球菌疾病患者肺炎链球菌分离株的血清型分布，以及 <5岁年龄组分离株的抗生素敏感性，在 (2002-2004) 和 (2005-2009) 引入7价肺炎球菌结合疫苗 (PCV7) 之前。总体而言，平均年转诊分离株数 (770对515) 和属于PCV7血清型的比例显著下降 (74% 对38%)，但non-PCV7血清型，特别是19A，增加 (5% 对18%)。所有变化在 <5岁年龄组中更为明显。来自 <5岁年龄组的分离株的药敏试验显示血清型之间的耐药性差异，但青霉素非药敏总体显着增加 (23% 对31%)，头孢曲松耐药率 (2% 对12%) 和多药耐药率 (4% 对7%); 红霉素耐药率下降 (32% 对25%)。在引入13价PCV 2012年后，需要持续监测以监测变化。

BACKGROUND & AIMS: BACKGROUND:Many studies on migrant health have focused on aspects of morbidity and mortality, but very few approach the relevant issues of migrants' health considering behavioral risk factors. Previous studies have often been limited methodologically because of sample size or lack of information on migrant country of origin. Information about risk factors is fundamental to direct any intervention, particularly with regard to non-communicable diseases that are leading causes of death and disease. Thus, the main focus of our analysis is the influence of country of origin and the assimilation process. METHOD:Utilizing a surveillance system that has been collecting over 30,000 interviews a year in Italy since 2008, we have studied migrants' attitudes and behaviors by country of origin and by length of stay. Given 6 years of observation, we have obtained and analyzed 228,201 interviews of which over 9000 were migrants. RESULTS:While migrants overall present similar conditions to native-born Italians, major differences appear when country of origin or length of stay is considered. Subgroups of migrants present substantially different behaviors, some much better than native-born Italians, some worse. However, integration processes generally produce a convergence towards the behavioral prevalence observed for native-born Italians. CONCLUSIONS:Health programs should consider the diversity of the growing migrant population: data and analyses are needed to support appropriate policies. Many migrants' subgroups arrive with healthier behaviors than those of their adopted country. However, they are likely to have a less favorable social position in their destination countries that could lead to a change towards less healthy behaviors. Interventions capable of identifying this tendency could produce significant better health for this important part of the future (multicultural) populations.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Peripheral arterial disease (PAD) indicates generalized atherosclerosis but is still underdiagnosed and undertreated. METHODS:Data were collected from patients with PAD from the Department of Cardiology and Angiology, University of Heidelberg, Germany. The prevalence of cardiovascular risk factors and medication were documented. RESULTS:Atherogenic risk factors, cardiovascular disease, and cerebrovascular disease were highly prevalent. By continuous care at the university clinic, in addition to family medicine treatment, the use of platelet inhibitors, antihypertensives, and lipid-lowering therapy was increased. Ankle-brachial index and walking distance improved. CONCLUSION:Long-term treatment at the university clinic had positive effects on atherogenic risk factors. The regular use of secondary preventive medication was improved. Still, this patient population remained undertreated and showed a high incidence of vascular event rates and a need for vascular interventions. This study implies the importance of both specialists and general practitioners in the care of these individuals.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Using smokeless tobacco and smoking are behaviors that increase the risk of developing oral cancer, soft-tissue lesions, caries, periodontal disease and other oral conditions. The author conducted a study to examine use of smokeless tobacco and smoking by adolescents. METHODS:The study was a cross-sectional analysis of participants with complete data regarding smoking, smokeless tobacco use and other variables of interest from the 2011 national Youth Risk Behavior Surveillance System survey (n = 9,655). The author performed descriptive analysis and multivariable logistic regression analyses. RESULTS:The unadjusted odds ratio for smokeless tobacco use and smoking was 9.68 (95 percent confidence interval [CI], 7.72-12.13; P < .0001), and the adjusted odds ratio was 3.92 (95 percent CI, 2.89-5.31; P < .0001). Adolescents who used smokeless tobacco were more likely to be male, to smoke and to have engaged in binge drinking. CONCLUSION:Adolescents who were using smokeless tobacco were more likely to be engaging in concomitant smoking and to be participating in other risk-taking behaviors. Practical Implications. Dentists are involved in helping patients with tobacco-use cessation. The association of smoking with using smokeless tobacco needs to be considered in the design of tobacco-use cessation programs for adolescents.

背景与目标：

BACKGROUND & AIMS: :NK cells are highly efficient at preventing cancer metastasis but are infrequently found in the core of primary tumors. Here, have we demonstrated that freshly isolated mouse and human NK cells express low levels of the endo-β-D-glucuronidase heparanase that increase upon NK cell activation. Heparanase deficiency did not affect development, differentiation, or tissue localization of NK cells under steady-state conditions. However, mice lacking heparanase specifically in NK cells (Hpsefl/fl NKp46-iCre mice) were highly tumor prone when challenged with the carcinogen methylcholanthrene (MCA). Hpsefl/fl NKp46-iCre mice were also more susceptible to tumor growth than were their littermate controls when challenged with the established mouse lymphoma cell line RMA-S-RAE-1β, which overexpresses the NK cell group 2D (NKG2D) ligand RAE-1β, or when inoculated with metastatic melanoma, prostate carcinoma, or mammary carcinoma cell lines. NK cell invasion of primary tumors and recruitment to the site of metastasis were strictly dependent on the presence of heparanase. Cytokine and immune checkpoint blockade immunotherapy for metastases was compromised when NK cells lacked heparanase. Our data suggest that heparanase plays a critical role in NK cell invasion into tumors and thereby tumor progression and metastases. This should be considered when systemically treating cancer patients with heparanase inhibitors, since the potential adverse effect on NK cell infiltration might limit the antitumor activity of the inhibitors.

背景与目标： : NK细胞在预防癌症转移方面非常有效，但在原发性肿瘤的核心中很少发现。在这里，我们已经证明了新鲜分离的小鼠和人NK细胞表达低水平的内切-β-D-葡萄糖醛酸苷酶乙酰肝素酶，该酶在NK细胞活化后会增加。在稳态条件下，乙酰肝素酶缺乏症不会影响NK细胞的发育，分化或组织定位。然而，在NK细胞中特异性缺乏乙酰肝素酶的小鼠 (Hpsefl/fl NKp46-iCre小鼠) 在被致癌物甲基胆蒽 (MCA) 攻击时高度容易发生肿瘤。当用已建立的小鼠淋巴瘤细胞系RMA-S-RAE-1β (其过表达NK细胞组2D (NKG2D) 配体RAE-1β) 或接种转移性黑色素瘤、前列腺癌或乳腺癌细胞系时，Hpsefl/fl NKp46-iCre小鼠也比其同窝对照更容易肿瘤生长。NK细胞对原发性肿瘤的侵袭和向转移部位的募集严格取决于乙酰肝素酶的存在。当NK细胞缺乏乙酰肝素酶时，细胞因子和免疫检查点阻断对转移灶的免疫疗法受到损害。我们的数据表明，乙酰肝素酶在NK细胞侵袭肿瘤，从而肿瘤进展和转移中起关键作用。当用乙酰肝素酶抑制剂全身治疗癌症患者时，应考虑这一点，因为对NK细胞浸润的潜在不良影响可能会限制抑制剂的抗肿瘤活性。

BACKGROUND & AIMS: :Much of the mammalian genome is transcribed, generating long non-coding RNAs (lncRNAs) that can undergo post-transcriptional surveillance whereby only a subset of the non-coding transcripts is allowed to attain sufficient stability to persist in the cellular milieu and control various cellular functions. Paralleling protein turnover by the proteasome complex, lncRNAs are also likely to exist in a dynamic equilibrium that is maintained through constant monitoring by the RNA surveillance machinery. In this Review, we describe the RNA surveillance factors and discuss the vital role of lncRNA surveillance in orchestrating various biological processes, including the protection of genome integrity, maintenance of pluripotency of embryonic stem cells, antibody-gene diversification, coordination of immune cell activation and regulation of heterochromatin formation. We also discuss examples of human diseases and developmental defects associated with the failure of RNA surveillance mechanisms, further highlighting the importance of lncRNA surveillance in maintaining cell and organism functions and health.

背景与目标： : 许多哺乳动物基因组被转录，产生长的非编码rna (lncrna)，可以进行转录后监测，因此仅允许非编码转录本的子集获得足够的稳定性，以在细胞环境中持续存在并控制各种细胞功能。与蛋白酶体复合物平行的蛋白质转换，lncrna也可能以动态平衡存在，该动态平衡通过RNA监视机制的持续监测得以维持。在这篇综述中，我们描述了RNA监测因素，并讨论了lncRNA监测在协调各种生物过程中的重要作用，包括保护基因组完整性，维持胚胎干细胞的多能性，抗体-基因多样化，免疫细胞激活的协调和异染色质形成的调节。我们还讨论了与RNA监视机制失败相关的人类疾病和发育缺陷的例子，进一步强调了lncRNA监视在维持细胞和生物功能以及健康方面的重要性。

BACKGROUND & AIMS: BACKGROUND:Resistance to anti-malarial drugs hinders malaria elimination. Monitoring the molecular markers of drug resistance helps improve malaria treatment policies. This study aimed to assess the distribution of molecular markers of imported Plasmodium falciparum infections. METHODS:In total, 485 P. falciparum cases imported from Africa, Southeast Asia, and Oceania into Zhejiang province, China, from 2016 to 2018 were investigated. Most were imported from Africa, and only a few cases originated in Asia and Oceania. Blood samples were collected from each patient. Plasmodium falciparum chloroquine resistance transporter (Pfcrt) at residues 72-76 and Kelch13-propeller (k13) were determined by nested PCR and DNA sequence. RESULTS:Wild-type Pfcrt at residues 72-76 was predominant (72.61%), but mutant and mixed alleles were also detected, of which CVIET (22.72%) was the most common. Mutant Pfcrt haplotypes were more frequent in patients from West Africa (26.92%), North Africa (25%), and Central Africa (21.93%). The number of cases of P. falciparum infections was small in Southeast Asia and Oceania, and these cases involved Pfcrt mutant type. For the k13 propeller gene, 26 samples presented 19 different point mutations, including eight nonsynonymous mutations (P441S, D464E, K503E, R561H, A578S, R622I, V650F, N694K). In addition, R561H, one of the validated SNPs in k13, was detected in one patient from Myanmar and one patient from Rwanda. A578S, although common in Africa, was found in only one patient from Cameroon. R622I was detected in one sample from Mozambique and one sample from Somalia. The genetic diversity of k13 was low in most regions of Africa and purifying selection was suggested by Tajima's D test. CONCLUSIONS:The frequency and spatial distributions of Pfcrt and k13 mutations associated with drug resistance were determined. Wild-type Pfcrt was dominant in Africa. Among k13 mutations correlated with delayed parasite clearance, only the R561H mutation was found in one case from Rwanda in Africa. Both Pfcrt and k13 mutations were detected in patients from Southeast Asia and Oceania. These findings provide insights into the molecular epidemiological profile of drug resistance markers in the study region.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The association of ADV-36 infection and obesity has been reported in children. The objective of this study was to examine the hypothesis that the association between ADV-36 infection and adiposity may be mediated by sub-optimal vitamin D status of the host. METHODS:Ninety one apparently healthy children in different weight categories (normal weight: 33, overweight: 33, obesity: 25) aged 5-18 years were randomly selected from the registered population at National Food and Nutrition Surveillance Program (NFNS). The groups were matched based on age and sex. Anthropometric, biochemical and serological assessments were performed. RESULTS:The amount of anti-ADV36-Ab increased whereas circulating concentrations of 25(OH) D decreased across BMI categories with higher amounts in children with normal weight than in children with overweight and obesity (31.0 ± 16.4, 22.5 ± 10.5 and 21.9 ± 9.8 nmol/L, respectively, p = 0.004). Logistic regression analysis revealed that for each unit increment of anti-ADV36-Ab, the chance of increase in weight was 8.5 times (OR: 8.5, p = 0.029). Interestingly, when 25(OH) D was introduced into the model, anti-ADV36-Ab was no longer the predictor of weight increment and the chance of increase in weight reduced 5% for each unit increase in 25(OH) D concentration (OR: 0.95, p = 0.012). CONCLUSION:It is suggested that ADV36-induced lipogenesis may be mediated by vitamin D deficiency in children with obesity.

背景与目标：

BACKGROUND & AIMS: :GPs with training in occupational medicine report cases of work-related ill health and sickness absence to The Health and Occupation Reporting network in General Practice (THOR-GP) using an online webform. This report describes the data reported in 2006 and 2007. GPs mainly reported musculoskeletal disorders and mental ill-health. A much larger proportion of the mental ill-health cases were sickness-absence certified, making up 55.9% of the total days certified. Musculoskeletal disorders are the most frequently reported diagnoses of work-related ill health, but mental ill-health is responsible for most work-related sickness absence.

背景与目标： : 具有职业医学培训的全科医生使用在线网络表格向一般实践中的健康与职业报告网络 (THOR-GP) 报告与工作有关的不良健康和疾病的案例。本报告描述了2006年和2007报告的数据。全科医生主要报告肌肉骨骼疾病和精神疾病。在精神疾病病例中，有很大一部分是通过疾病认证的，占认证总天数的55.9%。肌肉骨骼疾病是最常报告的与工作有关的疾病的诊断，但精神疾病是大多数与工作有关的疾病的原因。

BACKGROUND & AIMS: :A 62 year old man with longstanding ulcerative colitis and previous endoscopic excision of two dysplasia associated lesions or masses (DALMs) was admitted to our endoscopy unit for evaluation and resection of other possible DALMs. He had previously been offered and refused colectomy because of comorbidity from Parkinson's disease. He had multiple polypoid and sessile lesions which were assessed using a third generation prototype narrow band imaging (NBI) colonoscope with magnification. Selected lesions were either biopsied or resected with a combination of endoscopic submucosal dissection and endoscopic mucosal resection techniques. We correlated the pit pattern and vascular pattern intensity seen with magnification NBI with histology of both inflammatory and dysplastic lesions. Dysplastic areas showed Kudo pit patterns II, IIIL, and IV and high vascular pattern intensity. Non-dysplastic and dysplastic areas of recurrence immediately adjacent to the scar from a previous endoscopic mucosal resection site were also assessed. This is the first case report where NBI has been shown to help in DALM detection and to distinguish dysplastic from non-dysplastic mucosa in ulcerative colitis.

背景与目标： : 一名患有长期溃疡性结肠炎且先前内镜下切除了两个不典型增生相关病变或肿块 (dalm) 的62岁男子被送入我们的内窥镜检查单元，以评估和切除其他可能的dalm。由于帕金森氏病的合并症，他以前曾被提供并拒绝进行结肠切除术。他有多个息肉样和无柄病变，使用第三代放大原型窄带成像 (NBI) 结肠镜进行评估。结合内镜粘膜下剥离术和内镜粘膜切除术技术对选定的病变进行活检或切除。我们将放大NBI的凹坑模式和血管模式强度与炎性和增生性病变的组织学相关联。发育不良的区域显示Kudo pit模式II，IIIL和IV以及高血管模式强度。还评估了与先前内窥镜粘膜切除部位的疤痕紧邻的非增生和增生复发区域。这是第一个病例报告，其中NBI已被证明有助于DALM检测并区分溃疡性结肠炎中发育不良和非发育不良的粘膜。

BACKGROUND & AIMS: :Objectives: To present a patient material of renal angiomyolipoma (AML) with focus on the risk of bleeding during active surveillance (AS).Methods: Medical records, 1999-2014, were studied and 98 patients (80 female, 18 men) with renal AML were identified. Eleven patients had tuberous sclerosis complex (TSC). Mean age was 54 (13-89) years.Results: Sixty patients (61%) were asymptomatic at presentation, 33 (34%) presented with flank pain and five (5%) with hematuria. Retroperitoneal bleeding or hematuria was diagnosed in 20 patients with a mean AML size of 74 mm (25-200 mm). Twenty-one patients were treated with angioembolization at time of diagnosis and 25 had surgery. Forty-five patients with sporadic AML (mean size 34 mm) and six with TSC (mean size 120 mm) were selected for AS. Only one patient with sporadic AML (46 mm) had a bleeding, whereas two of the six TSC patients had bleedings from three kidneys (AML 70-300 mm). In 25 patients (49%), the AML-size increased with 2.7 mm/year in sporadic and 5.4 mm/year in TSC-associated AML. Thirteen patients were treated with AE (including all six TSC-patients) and five with surgery in 22 kidneys due to AML-size in 16, bleeding in four and suspicion of cancer in two.Conclusion: Bleeding occurred in 20% of AML at presentation. In patients selected for AS, we found a very low risk of bleeding in sporadic AML justifying our cut off size of 50 mm to trigger intervention. In TSC-associated AML individually tailored follow-up is needed due to a higher intervention rate.

背景与目标： 目的: 介绍一种肾血管平滑肌脂肪瘤 (AML) 患者材料，重点关注主动监测 (AS) 期间的出血风险。方法: 研究了1999-2014年的病历，并确定了98例肾AML患者 (80例女性，18例男性)。11例患者患有结节性硬化症 (TSC)。结果: 60例患者 (61% 例) 无症状，33例 (34% 例) 侧腹疼痛，5例 (5% 例) 血尿。20例AML平均大小为74  mm (25-200  mm) 的患者诊断为腹膜后出血或血尿。21例患者在诊断时接受了血管栓塞治疗，其中25例接受了手术。选择了45例散发性AML (平均大小34 mm) 和6例TSC (平均大小120  mm) 的AS患者。只有一名散发性AML (46  mm) 患者出血，而六名TSC患者中有两名从三个肾脏 (AML 70-300  mm) 出血。在25例患者 (49%) 中，散发性AML的AML大小增加2.7  mm/年，TSC相关AML增加5.4  mm/年。13例患者接受AE治疗 (包括所有6例TSC患者)，5例因AML大小16例，22例肾脏接受手术治疗，4例出血，2例怀疑癌症。结论: 出现时，AML 20% 发生出血。在选择AS的患者中，我们发现散发性AML出血的风险非常低，这证明我们的截断尺寸为50 mm以触发干预。在TSC相关的AML中，由于较高的干预率，需要进行个性化的随访。

BACKGROUND & AIMS: BACKGROUND:Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extended-spectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. METHODS:We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. RESULTS:K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 K-loci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae. CONCLUSIONS:K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.

背景与目标：

BACKGROUND & AIMS: :Despite advances in endovascular strategies, surgical infrainguinal lower limb revascularization remains the gold standard treatment for critical lower limb ischemia and disabling claudication. Maintaining patency of infrainguinal vein bypass grafts has been a challenging task for vascular surgeons as they are prone to developing stenoses which may precipitate failure of the bypass. Duplex ultrasound scanning has evolved as the investigation of choice to identify vein graft lesions but graft surveillance programs using this technique remain controversial. The rationale for graft surveillance is that intervention in a patent but failing graft results in improved long-term patency and limb salvage rates compared to rescue of an occluded graft. The six-week postoperative Duplex ultrasound scan is important in identifying flow abnormalities that can predict the natural history of a vein graft and the outlook for the limb in the medium term. There are multiple factors influencing vein graft failure, which means guidelines should be flexible in terms of when and which type of intervention to the graft is optimum. Patency and durability favour open surgical revision over endovascular intervention but this must be counter balanced by the increased morbidity associated with surgical revision.

背景与目标： : 尽管血管内治疗策略取得了进展，但手术腹股沟下下肢血管重建仍然是严重下肢缺血和致残性跛行的金标准治疗方法。对于血管外科医生来说，保持腹股沟下静脉旁路移植物的通畅一直是一项艰巨的任务，因为它们容易出现狭窄，这可能导致旁路失败。双工超声扫描已成为确定静脉移植物病变的首选研究，但使用该技术的移植物监视程序仍存在争议。进行移植物监测的基本原理是，与挽救闭塞的移植物相比，对专利进行干预但失败的移植物可提高长期通畅性和肢体挽救率。术后六周的双工超声扫描对于识别血流异常非常重要，该血流异常可以预测静脉移植物的自然史和中期肢体的前景。有多种因素影响静脉移植失败，这意味着指南应在何时以及哪种类型的最佳干预下灵活选择。通畅性和持久性比血管内介入治疗更有利于开放性手术翻修，但这必须与手术翻修相关的发病率增加相抵消。