Helicobacter pylori, one of the most common bacterial pathogens of humans, colonizes the gastric mucosa, where it appears to persist throughout the host's life unless the patient is treated. Colonization induces chronic gastric inflammation which can progress to a variety of diseases, ranging in severity from superficial gastritis and peptic ulcer to gastric cancer and mucosal-associated lymphoma. Strain-specific genetic diversity has been proposed to be involved in the organism's ability to cause different diseases or even be beneficial to the infected host and to participate in the lifelong chronicity of infection. Here we compare the complete genomic sequences of two unrelated H. pylori isolates. This is, to our knowledge, the first such genomic comparison. H. pylori was believed to exhibit a large degree of genomic and allelic diversity, but we find that the overall genomic organization, gene order and predicted proteomes (sets of proteins encoded by the genomes) of the two strains are quite similar. Between 6 to 7% of the genes are specific to each strain, with almost half of these genes being clustered in a single hypervariable region.

Sirolimus has antineoplastic effects and may reduce skin cancer rates in kidney transplant patients. This prospective, multicenter, randomized, open-label, controlled trial randomized 86 kidney transplant recipients (≥1 year posttransplant) with history of nonmelanoma skin cancer (NMSC) to continue calcineurin inhibitor (CNI) or convert to sirolimus. Patients were stratified by number of NMSC lesions (0-5, 6-20) in previous year. Primary end point was number of biopsy-confirmed new NMSC lesions per patient-year. Yearly NMSC rate was significantly lower with sirolimus (1.31 vs. 2.48 lesions/patient-year; p = 0.022). Squamous cell carcinoma occurred at a lower rate in the sirolimus versus CNI group (p = 0.038); basal cell carcinoma rate was similar in both. A lower proportion of patients receiving sirolimus developed new or recurrent NMSC (56.4% vs. 80.9%; p = 0.015) or new squamous cell carcinoma (41.0% vs. 70.2%; p = 0.006). No sirolimus patients and one CNI continuation patient experienced acute rejection. Incidence of treatment-emergent adverse events was similar between groups; however, discontinuation rates related to adverse events were significantly higher with sirolimus (46.2% vs. 0%; p < 0.001). In kidney transplant recipients with history of NMSC, conversion from CNI to sirolimus reduced rates of NMSC, without increasing acute rejection risk.

In this study, we systematically examined in vitro frequencies and spectra of the spontaneous mutations in Helicobacter pylori that confer resistance to clarithromycin (Cla r Antibiotic resistance is an increasing problem for the treatment of infectious diseases. Bacteria have evolved diverse mechanisms (pathways) of resistance to antimicrobial agents, including control of uptake and efflux of drugs, modification and detoxification of drugs, alteration and protection of the target sites, and acquisition of heterologous resistance genes from external sources. In Helicobacter pylori, the etiological agent of a wide range of gastric diseases, genetic determinants for resistance to several antibiotics, including clarithromycin, metronidazole, ciprofloxacin, and rifampin, have been determined. Remarkably, the known mechanisms of antibiotic resistance in H. pylori are all due to mutations in chromosomal genes. Clarithromycin resistance is associated with mutations in the 23S rRNA gene (22,25), which inhibit the binding of clarithromycin to the ribosome. Ciprofloxacin resistance is due to mutations in the gyrA gene, which encodes the A subunit of DNA gyrase (16), and rifampin resistance results from mutations in the rpoB gene, encoding the ␤ subunit of RNA polymerase (7). For metronidazole resistance, although several different mechanisms may exist, the predominant determinant has been shown to be the mutational inactivation of the rdxA gene that encodes an oxygen-insensitive NADPH nitroreductase (4, 9, 10, 13, 21).)The importance of de novo mutation in developing antibiotic resistance prompted us to ask how mutations occur in H. pylori (28). The first step in elucidating the mechanisms of mutagenesis is to define the background of frequency and specificity of spontaneous mutations. From the pioneering works of Luria and Delbruck (14) and recent developments in determining mutation rates of bacterial populations, it is known that determination of mutation rates is not simple (15,17), and determination of mutation spectra is particularly tedious. In this study we systematically examined the in vitro frequencies and spectra of spontaneous mutations in H. pylori that confer resistance to clarithromycin, metronidazole, amoxicillin, ciprofloxacin, and rifampin. MATERIALS AND METHODSH. pylori strains, growth medium, and antibiotics. H. pylori reference strains 26695, NCTC11639, and UA802 (26), as well as some isolates from University of Alberta Hospital, were used; all are susceptible to the antibiotics tested in this study. H. pylori strains were grown on BHI-YE broth (3.7% brain heart infusion with 0.3% yeast extract and 5% animal serum) or agar plates at 37°C under microaerobic conditions (5% CO 2 , 5% H 2 , and 90% N 2 ). Antibiotics used in this study include clarithromycin (Bayer), metronidazole (Sigma), ciprofloxacin (Bayer), rifampin (Sigma), and amoxicillin (Sigma).MIC test. H. pylori cells were grown for 2 days and suspended in sterile BHI-YE liquid medium, and the turbidity of the suspensions was adjusted to that...

Our study demonstrated real-world, direct effectiveness of 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia following introduction into a routine immunization program among adults aged ≥65 years, many of whom had immunocompromising and chronic medical conditions.