bluuebunny/crossref_metadata_2025 huggingface dataset:
Expanded Dataset Reveals the Emergence and Evolution of DNA Gyrase in Archaea
Authors: Villain Paul , Catchpole Ryan , Forterre Patrick , Oberto Jacques , da Cunha Violette , Basta Tamara
Published: July 2022

DNA gyrase is a type II topoisomerase with the unique capacity to introduce negative supercoiling in DNA. In bacteria, DNA gyrase has an essential role in the homeostatic regulation of supercoiling. While ubiquitous in bacteria, DNA gyrase was previously reported to have a patchy distribution in Archaea but its emergent function and evolutionary history in this domain of life remains elusive. In this study, we used phylogenomic approaches and an up-to date sequence dataset to establish global and archaea-specific phylogenies of DNA gyrases. The most parsimonious evolutionary scenario infers that DNA gyrase was introduced into the lineage leading to Euryarchaeal group II via a single horizontal gene transfer from a bacterial donor which we identified as an ancestor of Gracilicutes and/or Terrabacteria. The archaea-focused trees indicate that DNA gyrase spread from Euryarchaeal group II to some DPANN and Asgard lineages via rare horizontal gene transfers. The analysis of successful recent transfers suggests a requirement for syntropic or symbiotic/parasitic relationship between donor and recipient organisms. We further show that the ubiquitous archaeal Topoisomerase VI may have co-evolved with DNA gyrase to allow the division of labor in the management of topological constraints. Collectively, our study reveals the evolutionary history of DNA gyrase in Archaea and provides testable hypotheses to understand the prerequisites for successful establishment of DNA gyrase in a naive archaeon and the associated adaptations in the management of topological constraints.
Expanding the strategic and clinical leadership role of accredited specialists
Authors: Parsons V , Pattani S , Gilbey A , Madan I , Harling C , Muiry R , de Bono A
Published: July 2022

Background

We sought to explore the value and benefits of accredited specialists employed in the National Health Service (NHS), and proposed strategies for expanding their role.

Aims

To explore the core characteristics of accredited specialists and to examine how their skills could be further utilized to enhance occupational health (OH) services.

Methods

Mixed methods comprising a survey and qualitative work.

Results

OH survey was completed by 65 of 128 (51%) respondents. Nine accredited specialists and 16 stakeholders contributed qualitative data. Most OH departments were located in acute NHS trusts and additionally provided externally contracted services. We found a large variation in OH staffing and OH services delivered. The COVID pandemic created unprecedented challenges and required expansion in services to meet demand. The majority of respondents described greater recognition and appreciation by others of accredited specialists and OH teams for their specialist contribution during the pandemic. From the qualitative data, we identified two overarching themes. ‘Professional credibility has currency’ (Theme 1) and ‘A visionary future’ (Theme 2). A series of sub-themes are described.

Conclusions

Accredited specialists employed in the NHS possess a core set of attributes and capabilities, and are skilful at delivering strong, influential and impactful clinical and strategic leadership across the NHS hierarchy and landscape. The COVID pandemic provided valuable opportunities for them to showcase their specialist clinical and leadership skills. The current wider reorientation of NHS clinical services offers bold new ways to expand their role beyond traditional clinical boundaries.
Nested calcium dynamics support daily cell unity and diversity in the suprachiasmatic nuclei of free-behaving mice
Authors: El Cheikh Hussein Lama , Fontanaud Pierre , Mollard Patrice , Bonnefont Xavier
Published: July 2022

The suprachiasmatic nuclei (SCN) of the anterior hypothalamus host the circadian pacemaker that synchronizes mammalian rhythms with the day–night cycle. SCN neurons are intrinsically rhythmic, thanks to a conserved cell-autonomous clock mechanism. In addition, circuit-level emergent properties confer a unique degree of precision and robustness to SCN neuronal rhythmicity. However, the multicellular functional organization of the SCN is not yet fully understood. Indeed, although SCN neurons are well-coordinated, experimental evidences indicate that some neurons oscillate out of phase in SCN explants, and possibly to a larger extent in vivo. Here, to tackle this issue we used microendoscopic Ca2+i imaging and investigated SCN rhythmicity at a single cell resolution in free-behaving mice. We found that SCN neurons in vivo exhibited fast Ca2+i spikes superimposed upon slow changes in baseline Ca2+i levels. Both spikes and baseline followed a time-of-day modulation in many neurons, but independently from each other. Daily rhythms in basal Ca2+i were highly coordinated, while spike activity from the same neurons peaked at multiple times of the light cycle, and unveiled clock-independent coactivity in neuron subsets. Hence, fast Ca2+i spikes and slow changes in baseline Ca2+i levels highlighted how multiple individual activity patterns could articulate within the temporal unity of the SCN cell network in vivo, and provided support for a multiplex neuronal code in the circadian pacemaker.
General Information
Authors: Esposito John L.
Published: July 2022

Islam is the second-largest religion in the world (after Christianity) and
will soon be the second-largest religion in America.
Muslims In The West
Authors: Esposito John L.
Published: July 2022

Muslim Americans are Americans who came here from sixty-eight different
countries as well as indigenous African Americans and converts from a
variety of ethnic backgrounds. They are one of the most diverse communities
in the world, racially, economically, and politically. Although estimates of
the Muslim American population vary widely, it is safe to say that there are
at least five to seven million, making Islam the third largest religion
(after Christianity and Judaism) in America. Many believe that in the first
half of the twenty-first century Islam will become the second-largest
religion in America.
Evidence-based management of patients with nonalcoholic fatty liver disease
Authors: Patel Minal
Published: July 2022

Over the past decade, fatty liver disease has become a forefront health issue. The clinical implication of this silent disease extends well beyond just the liver and is linked to a variety of health concerns, including cardiovascular disease, diabetes, and cancer. The prevalence of fatty liver disease in the United States is estimated to be 25% and increasing. This article reviews the pathophysiology of fatty liver disease, how clinicians can recognize contributing factors, and appropriate interventions based on the American Association for the Study of Liver Disease's guidelines.
Open Reduction Internal Fixation Versus Distal Femoral Replacement (DFR) for Treatment of OTA/AO 33C Fractures in the Elderly: A Review of Functional Outcomes and Cost Analysis
Authors: Caines Andrew , Adamczyk Andrew , Mahaffey Ryan , Pickell Michael
Published: July 2022

Objectives:

To determine the economic cost associated with the treatment of OTA/AO 33C fractures in patients older than 65 years of age using open reduction internal fixation (ORIF) or DFR and to assess the perioperative outcomes of elderly patients treated surgically following OTA/AO 33C fractures.

Design:

Retrospective cohort over a 10-year period.

Setting:

A single level-1 trauma center.

Participants and Intervention:

Thirty-nine patients 65 or older with OTA/AO 33C fractures who underwent treatment with ORIF (n = 27) or DFR (n = 12) were included.

Main Outcome Measurements:

Direct cost associated with surgical treatment along with LOS, functional outcomes, patient-reported outcomes, and all-cause reoperation.

Results:

Index procedure costs were as follows: DFR: $ 61,259 vs. ORIF: $44,490 (P = 0.056). Five (20%) ORIF patients required revision versus one (8%) in the DFR group. Total cost when including reoperation resulted in DFR being $14,805 more costly, which was not significant. Hospital LOS was similar between groups; however, convalescent LOS was longer in ORIF patients (43.2 vs. 23.1 days, P = 0.02).

Conclusion:

This study demonstrates that there is no significant difference in overall cost between ORIF and DFR when all costs are considered. A larger portion of DFR patients were able to mobilize postoperatively, with subacute length of stay being longer in ORIF patients. A multicenter trial is warranted to determine optimal treatment for this complex problem.

Level of Evidence:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
CHANGES OF OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY PARAMETERS AFTER INTERNAL LIMITING MEMBRANE PEELING COMPARED WITH NONPEELING IN EPIRETINAL MEMBRANE SURGERY
Authors: Gabriel Maximilian , Djavid Daniel , Innauer Felix , Ivastinovic Domagoj , Seidel Gerald , Mayer-Xanthaki Christoph , Ansari-Shahrezaei Siamak , Wedrich Andreas , Haas Anton
Published: July 2022

Purpose:

To prospectively compare microvascular changes of internal limiting membrane (ILM) peeled and nonpeeled eyes in patients with idiopathic epiretinal membranes using optical coherence tomography angiography.

Methods:

Forty-two patients with epiretinal membranes underwent vitrectomy with (n = 22) or without ILM peeling (n = 20). The mean superficial capillary plexus foveal avascular zone area change between preoperative and three-month postoperative readings served as the main outcome measure. Secondary outcome parameters included mean changes in superficial capillary plexus parafoveal vessel density, central foveal thickness, retinal volume, and best-corrected visual acuity.

Results:

Mean superficial capillary plexus foveal avascular zone area change (μm2) was 59 ± 74 in the ILM nonpeeling group compared with −12 ± 86 in the ILM peeling group (P = 0.007). Similarly, mean superficial capillary plexus parafoveal vessel density change (%) was higher in the ILM nonpeeling group (ILM nonpeeling 4 ± 4, ILM peeling −2 ± 6, P = 0.003). The mean retinal volume reduction was higher in the ILM peeling group, and this difference also reached statistical significance (P = 0.036). There were no intergroup differences in mean central foveal thickness change and mean best-corrected visual acuity change (P = 0.409 and P = 0.440, respectively). Epiretinal membrane/ILM separation was achieved in 23 of 51 patients.

Conclusion:

The macular microvasculature demonstrated more remodeling in the ILM nonpeeling group after three months.
Tanner Stages and Pubertal Development
Authors: Hamlin Amy , Robertson Michelle , Wilson Debra Rose
Published: July 2022

Puberty typically follows a predictable pattern that can be assessed using the Tanner stages or Sexual Maturity Rating scale. Clinicians can use this tool to evaluate and monitor progress in female and male puberty. The timing and sequence of puberty are important indicators of the growth and development of pediatric patients. Stages of puberty and normal findings must be known before variations can be identified. Pubertal changes that fall outside the normal timeline or trajectory are considered abnormal and must be investigated. Treatments for abnormal variations are based on pathologic versus idiopathic causes. Nurses, as members of the interprofessional collaborative team, serve an important role by obtaining data, monitoring progress, providing health education, performing ongoing assessment/evaluation, and ensuring continuity of care when needed.
Timing Is Everything! Fertility Preservation Process From Patient Cancer Diagnosis Through Ovarian Tissue Cryopreservation to the Start of Treatment
Authors: Erickson Laura L. , Tsui Elizabeth L. , Laronda Monica M.
Published: July 2022

Children diagnosed with cancer today can expect a greater than 80% chance of 5-year survival. Childhood cancer survivors are significantly more likely to be infertile or have difficulty getting pregnant than their siblings. Studies have shown that infertility is one of the primary concerns of cancer survivors. Fertility preservation (FP) completed before treatment starts gives the patient the best fertility potential for a biological child in the future. Infertility is a significant risk factor for those treated with gonadotoxic therapy for cancer in childhood or adolescence. Infertility risk counseling and FP procedures may have the greatest success of fertility and hormone restoration if performed before the initiation of gonadotoxic therapy.

A single-institution retrospective chart review was completed of patients enrolled in an institutional-review-board-approved ovarian tissue cryopreservation protocol from 2011 to 2019. Data collected include demographics and the timing of various stages of the FP process. One hundred five patients were included in this chart review (58 prepubertal and 47 postpubertal).

Most consult requests were from the solid tumor diagnosis group. The time from diagnosis to consultation was 18 days, the time from consult to ovarian tissue cryopreservation surgery was 7 days, and the time from surgery to treatment was 5 days. Further investigation of time to consult revealed timing was justified in most patient situations.

Workflow, education, and outreach were established. Future analyses will include defining the incidents and efficiencies in providing fertility and hormone consultations in female and male patients who do not undergo FP procedures.
The Effect of On-Site Visits From the Physical Therapy Clinical Instructor Perspective: A Mixed-Methods Approach
Authors: Palmer R. Joe , Rapport Mary Jane
Published: July 2022

Introduction and Review of the Literature.

Strong academic–clinical partnerships are necessary to conduct effective, sustainable clinical education for entry-level physical therapy students. On-site visits are conducted by the entry-level physical therapist education program at affiliated clinical sites with identified clinical instructors. The purpose of this mixed-methods study was to explore the experience and impact on-site visits have on the academic–clinical partnership as perceived by physical therapy clinical instructors.

Subjects.

Participants were licensed physical therapists who have acted as a clinical instructor for at least 1 student from the study program. Ninety-five participants completed an anonymous survey and 14 participated in concurrent semi-structured interviews during the survey period.

Methods.

A concurrent, triangulation mixed-methods design was used to integrate quantitative and qualitative approaches in data analysis. A validated, novel survey was developed to assess perspectives of partnership using ordinary linear regression equations. A transcendental phenomenological approach explored perspectives of partnership after an on-site visit. The Partnership Success theoretical framework was used to define and frame the concept of partnership within this study.

Results.

Key findings showed that on-site visits demonstrated a statistically significant increase in perceptions of commitment among participants. On-site visits also appear to improve communication, result in stronger connections between the clinical site and physical therapist education program, and enhance resource sharing based on clinical instructor's interviews. Additionally, program alums demonstrate higher perceptions of trust and communication behaviors as compared with nonalums.

Discussion and Conclusion.

On-site visits are viewed favorably by clinical instructors who felt the visits positively contribute to the academic–clinical partnership and contribute to elements of the academic–clinical partnership, particularly in the area of perceived commitment. Program alums have different perceptions of partnership than nonalums.
Validation of a Very Brief Assessment of Interprofessional Collaborative Practice Skill Gains: ICCAS-Q21
Authors: Ohtake Patricia J. , Kruger Daniel J. , Kruger Jessica S.
Published: July 2022

Introduction.

Assessing interprofessional education (IPE) learning experience effectiveness for developing interprofessional collaborative practice (IPCP) skill ability is important; however, current assessment measures pose considerable time burdens to respondents and learning experience logistics.

Review of Literature.

The Interprofessional Collaborative Competencies Attainment Survey (ICCAS) is a frequently used measure for self-assessed IPCP skill ability. The ICCAS instrument is administered after an interprofessional learning experience and uses a retrospective pretest/posttest design to assess 20 items and includes one additional item assessing overall skill gain (ICCAS-Q21). Although the total ICCAS score can reveal changes in IPCP abilities after an IPE learning experience, a brief measure may facilitate assessment with greater efficiency. The purpose of this investigation was to determine if the ICCAS-Q21 has the psychometric properties to serve as a stand-alone assessment instrument of self-assessed change in ability to perform the IPEC core competency skills.

Subjects.

Complete ICCAS scores were analyzed from 1,480 students from 12 different health professions programs (Fall 2019 [n = 807] and Spring 2020 [n = 673]).

Methods.

The ICCAS was completed after 2 in-person IPE forums. Total ICCAS pretest, posttest, and pretest–posttest difference (gain) scores were determined. Interprofessional Collaborative Competencies Attainment Survey interitem reliabilities were assessed, and Pearson correlations were conducted with ICCAS-Q21 and the total ICCAS pretest, posttest, and gain scores.

Results.

Total ICCAS scores increased after each IPE forum (P < .001). High internal consistency was observed among all items of the ICCAS. Interprofessional Collaborative Competencies Attainment Survey-Q21 was highly correlated with ICCAS gain scores (Fall r = .431, Spring r = .468; P < .001).

Discussion and Conclusion.

Interprofessional Collaborative Competencies Attainment Survey-Q21, a single-item assessment instrument, has psychometric properties that warrant its use to evaluate the self-assessed change in IPE core competency skill ability and is a good proxy for the full ICCAS instrument. This brief assessment instrument provides additional flexibility in assessment techniques for IPCP learning experiences.
Early recruitable coronary collaterals preserve miocardial viability in late presentation infarctions
Authors: Gutiérrez-Barrios Alejandro , Alarcón de la Lastra Inara , Cañadas-Pruaño Lola , Delgado William , Alba-Sáchez Miguel , Gamaza-Chulián Sergio , Díaz-Retamino Enrique , Zayas-Rueda Ricardo , Calle-Pérez Germán , Vázquez-García Rafael , Toro Rocio
Published: July 2022

Background

Previous studies showed conflicting results regarding the contribution of coronary collateral circulation (CCC) to myocardial perfusion and function in the setting of myocardial infarction (MI). In the primary angioplasty era, the role of CCC in these studies may have been influenced by the effect of early reperfusion. The true impact of CCC could be clarified by studying its effect on nonreperfused patients. The aim of our study was to evaluate the effect of CCC on myocardial viability of late presentation MI.

Methods and results

Between 2008 and 2019, we included 167 patients with a late presentation MI who had a complete angiographic occlusion in a major coronary artery in which myocardial viability of the culprit territory was assessed. Patients were divided according to the presence of angiographic early recruited CCC (ERCC) (Rentrop 2–3) or poor CCC (PCC) (Rentrop 0–1). A lower left ventricular ejection function (LVEF) at discharge (54.2 ± 9 vs. 47.9 ± 12; <0.01) and a more severe left ventricular wall motion abnormalities in the culprit territory were observed in PCC patients. The presence of ERCC was the main independent predictor of myocardial viability in late presentation MI (hazard ratio, 4.24; 95% confidence interval, 1.68–10.6; P < 0.001). At follow-up, wall motion score increased significantly (2.05 ± 0.16; P = 0.02) in patients with ERCC but not in PCC patients (0.07 ± 0.16; P = 0.4), and LVEF improvement was significantly higher in ERCC than in PCC patients (9.7 ± 2.6 vs. 3.8 ± 4.2; P = 0.02).

Conclusion

The presence of ERCC was the main independent predictor of myocardial viability in late presentation MI.
Successful visible thrombus aspiration in ST-segment elevation myocardial infarction: associated factors and the clinical impact
Authors: Watanabe Tomomi , Akasaka Toshihiko , Kobara Satoshi , Yamamoto Kazuhiro
Published: July 2022

Background

Thrombus aspiration (TA) has been considered a procedure for controlling distal emboli and improving microvascular perfusion. However, current guidelines classify routine TA as class III recommendation, and it has been reported that the efficacy of TA is limited because of the relatively high incidence of failure in retrieval of thrombotic material. The aim of this study was to explore patient characteristics and procedural factors associated with successful TA in ST-elevation myocardial infarction (STEMI) and to assess the clinical impact of successful TA.

Methods

This single-center retrospective study enrolled 158 STEMI patients who underwent TA as initial recanalization. Factors associated with successful TA, which was defined as retrieving any visible material by aspiration catheter, were explored, and angiographical and short-term outcomes were assessed.

Results

In 146 cases (92.4%), the aspiration catheter reached the culprit lesion. Successful TA was achieved in 72 cases (45.6%). The single angiographical characteristic of successful TA was a higher Thrombolysis in Myocardial Infarction grade before TA. Among the procedural characteristics, the rate of successful TA was higher with a 7-French aspiration catheter compared with the rate with a 6-French catheter (57.1% vs. 29.9%, P = 0.01). Thrombolysis in Myocardial Infarction grade 3 flow was more frequent in patients with successful TA immediately after TA (36.1% vs. 16.3%, P = 0.006) and at final angiography (91.7% vs 79.1%, P = 0.04) compared with the grade in patients without successful TA, respectively.

Conclusions

The use of a larger aspiration catheter may be effective in retrieving visible thrombus material, and successful TA led to better angiographical results.
Atherogenic index of plasma predicts coronary artery disease severity and major adverse cardiac events in absence of conventional risk factors
Authors: Mangalesh Sridhar , Yadav Paras , Dudani Sharmila , Mahesh Nalin Kumar
Published: July 2022

Background

Various overlapping risk factors lead to coronary artery disease (CAD). The atherogenic index of plasma (AIP) is a marker for CAD severity and progression. However, little is known about its contribution to the residual risk of CAD observed in the absence of all typical risk factors.

Methods

A prospective cohort study of 366 Indian patients undergoing coronary computed tomography (CT) angiography and diagnosed with stable CAD. Diabetes, hypertension, hypercholesterolemia, smoking, previous CAD, alcohol or lipid-lowering medication intake, renal, liver or thyroid dysfunction were exclusion criteria. Coronary stenosis was graded using the CAD-reporting and data system (CAD-RADS™) system. Lipid profile, HbA1c, uric acid, highly sensitive C-reactive protein (hsCRP) and anthropometric measurements were taken. AIP, triglyceride/high-density lipoprotein cholesterol (HDLc) and total cholesterol (Tc)/HDLc ratios were calculated. Independent predictors of CAD severity and the occurrence of major adverse cardiac events (MACE) during 2.57 (0.52) years of follow-up were identified using logistic regression and Cox proportional hazards regression.

Results

Sixty patients experienced a MACE during a cumulative 887.03 person-years. HbA1c, uric acid, hsCRP, Tc/HDLc and AIP were independent predictors of severe coronary lesions (CAD-RADS 4,5) on multivariate analysis with odds ratio 4.52 (2.37–8.61), 1.41 (1.08–1.84), 1.33 (1.09–1.62), 1.76 (1.27–2.44) and 1.29 (1.11–1.50), respectively. Only AIP and Tc/HDLc were independent predictors of MACE with hazard ratios of 1.41 (1.20–1.65) and 1.78 (1.33–2.39) besides patient age and CAD severity.

Conclusion

AIP is associated with both the severity of CAD and the occurrence of MACE within 3 years. It could serve as an effective marker of residual risk of CAD in patients devoid of traditional risk factors. Lipid-profile ratios, such as AIP are cost-effective and accessible parameters suitable for low and middle-income settings.
Ultrasound Versus Computed Tomography–Guided Native Parenchymal Kidney Biopsies for Hospitalized Patients
Authors: Vu Tuan , Shin Benjamin , Mittal Anisha , Sarwani Nabeel , McGillen Kathryn L.
Published: July 2022

Percutaneous native kidney biopsies performed with ultrasound (US) or computed tomography (CT) guidance are important in the workup of medical renal disease, with modality choice often dependent on the performing institution, with various complication rates reported. We compared the complication rates and types of complication of US- versus CT-guided native parenchymal renal biopsy among hospitalized patients. One hundred five consecutive inpatient US- and CT-guided native parenchymal renal biopsies performed by radiologists at a tertiary care academic center between 2006 and 2020 were reviewed retrospectively. Complication rates of biopsy were calculated and compared between the 2 modalities. Comparisons with regard to types of complications were made using the Society of Interventional Radiology grading scale, American Society of Anesthesiologists score, and other clinical data. One hundred five hospitalized adult patients (58 women and 47 men; average age, 53 years) underwent native parenchymal kidney biopsy during the study period. Sixty-three (60%) were CT-guided and 42 (40%) were US-guided. Complication rates between CT- versus US-guided biopsies were 40% versus 19% (P = 0.03), respectively. There were 7 major and 18 minor complications for CT-guided biopsies and 3 major and 5 minor complications for US-guided biopsies. No statistically significant difference was found in preprocedural American Society of Anesthesiologists Classification score, international normalized ratio, platelet count, or body mass index. Computed tomography–guided native parenchymal kidney biopsy was associated with a higher overall complication rate compared with US-guided biopsy for hospitalized patients. Most complications were minor, which required no treatment or additional follow-up.
AFCOS: The Development of a Cryptoglandular Anal Fistula Core Outcome Set
Authors: Iqbal Nusrat , Astrid Machielsen J.H.M. , Merel L. Kimman , Gillian Kane , Rebecca Woodcock , Ugo Grossi , Phil J. Tozer , Stéphanie O. Breukink
Published: July 2022

Objective:

To develop a cryptoglandular Anal Fistula Core Outcome Set: a minimum set of outcomes that should be measured in all studies of cryptoglandular anal fistula treatment.

Background:

Variability in the outcomes that are reported in studies of cryptoglandular anal fistula treatment hampers systematic evidence synthesis to identify the best treatment.

Methods:

This study followed guidance from the Core Outcome Measures in Effectiveness Trials initiative and consisted of three stages: (1) generation of candidate outcomes through systematic review of the literature and qualitative patient interviews; (2) prioritization of outcomes by key stakeholders, including patients, surgeons, gastroenterologists, and radiologists in an online Delphi consensus process; and (3) determination of the final Core Outcome Set (COS) in a consensus meeting attended by patients and clinicians.

Results:

Sixty-four outcomes were presented in the first Delphi survey round. A total of 191 participants from over 30 countries ranked these outcomes according to their importance in defining treatment success (57.6% surgeons and gastroenterologists, 8.9% radiologists, and 33.5% patients). After two rounds, 53 outcomes were identified as important and discussed in the consensus meeting attended by 10 patients and 12 clinicians. A final 10 outcomes were voted into the COS: clinical fistula healing, radiological healing, recurrence, development of additional fistulas, fistula symptoms, incontinence, psychological impact of treatment, complications and reinterventions, patient satisfaction, and quality of life.

Conclusion:

The final COS represents an international, multidisciplinary, patient-centered attempt to establish consistency in fistula research, with a substantial focus on patient priorities for treatment.
Home to Stay: A Randomized Controlled Trial Evaluating the Effect of a Postdischarge Mobile App to Reduce 30-Day Readmission Following Elective Colorectal Surgery
Authors: Pooni Aman , Brar Mantaj S. , Anpalagan Tharani , Schmocker Selina , Rashid Saira , Goldstein Rachel , Goriawala Alifiya , Easson Alexandra , Kennedy Erin D.
Published: July 2022

Objective:

A randomized controlled trial was conducted to evaluate the effect of a postdischarge app on 30-day readmissions and patient-reported outcomes following colorectal surgery.

Background:

Patients undergoing colorectal surgery are particularly vulnerable during their transition from hospital-to-home. There has been increasing interest in e-health to provide cost-effective transitional care. An integrated discharge monitoring program using a mobile app platform was developed to support patients after surgery.

Methods:

A 2 arm, superiority randomized control trial was conducted at an academic tertiary care center with patients undergoing elective colorectal surgery. The intervention group received usual postoperative care and postdischarge monitoring with the app. The primary outcome was 30-day readmissions following hospital discharge.

Results:

Two hundred eighty-two participants were randomized. The majority were young, had inflammatory bowel disease and underwent laparoscopic surgery. Intention to treat analysis showed no difference between groups for 30-day readmission (14.8% vs 17.6%, P=0.55), ER visits (25.0% vs 28.8%, P=0.49), primary care visits (12.5% vs 8.8%, P=0.34) or unplanned healthcare visits (34.4% vs 35.2%, P=0.89). All patient reported outcomes were significantly improved with median scores higher with the app for satisfaction [9, interquartile range (IQR): 8–10 vs 8, IQR: 7–9, P=0.001], well-being (7, IQR: 6–8 vs 6, IQR: 5–7, P=0.001) and significantly lower for anxiety (3, IQR: 2–5 vs 5, IQR: 3–6, P=0.001).

Conclusions:

Although the app did not show a significant reduction in 30-day readmission or ER visits, it did lead to significant improvements in patient-reported outcomes. The app may be an important tool to support patients following colorectal surgery.
Identifying Persistent Opioid Use After Surgery
Authors: Fernandez Anne C. , Bohnert Amy , Gunaseelan Vidhya , Motamed Mehrdad , Waljee Jennifer F. , Brummett Chad M.
Published: July 2022

Objective:

The present study assessed concordance in perioperative opioid fulfillment data between Michigan’s prescription drug monitoring program (PDMP) and a national pharmacy prescription database.

Background:

PDMPs and pharmacy dispensation databases are widely utilized, yet no research has compared their opioid fulfilment data postoperatively.

Methods:

This retrospective study included participants (N=19,823) from 2 registry studies at Michigan Medicine between July 1, 2016, and February 7, 2019. We assessed the concordance of opioid prescription fulfilment between the Michigan PDMP and a national pharmacy prescription database (Surescripts). The primary outcome was concordance of opioid fill data in the 91 to 180 days after surgical discharge, a time period frequently used to define persistent opioid use. Secondary outcomes included concordance of opioid dose and number of prescriptions fulfilled. Multinomial logistic regression analysis examined concordance across key subgroups.

Results:

In total, 3076 participants had ≥1 opioid fulfillments 91 to 180 days after discharge, with 1489 (49%) documented in PDMP only, 243 (8%) in Surescripts only, and 1332 (43%) in both databases. Among participants with fulfillments in both databases, there were differences in the number (n=239; 18%) and dose (n=227; 17%). The PDMP database was more likely to capture fulfillment among younger and publicly insured participants, while Surescripts was more likely to capture fulfillment from counties bordering neighboring states. The prevalence of persistent opioid use was 10.7% using PDMP data, 5.5% using Surescripts data only, and 11.7% using both data resources.

Conclusions:

The state PDMP appears reliable for detecting opioid fulfillment after surgery, detecting 2 times more patients with persistent opioid use compared with Surescripts.
Test–Retest Reliability of Repetitive Ocular Vestibular Evoked Myogenic Potentials in Myasthenia Gravis Patients and Healthy Control Subjects
Authors: Keene Kevin R. , Bongers Julia , de Meel Robert H. P. , Venhovens Jeroen , Verschuuren Jan J. G. M. , Tannemaat Martijn R.
Published: July 2022

Purpose:

Repetitive ocular vestibular evoked myogenic potentials (ROVEMP) are a novel diagnostic test to quantify neuromuscular transmission deficits in extraocular muscles in myasthenia gravis. We aimed to investigate the test–retest reliability of the ROVEMP and the effect of amplitude and age.

Methods:

We performed the ROVEMP test twice in 19 patients with myasthenia gravis (52.7 ± 19.8 years) and in 15 healthy control subjects (46.5 ± 16 years). The Bland–Altman level of agreement was determined. The relationship between test–retest reliability and signal quality, participant age and signal amplitude was studied.

Results:

Limits of agreement were from −179.9 to 139.3 in myasthenia gravis patients and from −56.9 to 89.5 in healthy control subjects. Difference between measurements correlated with signal amplitude (r = −0.50, P < 0.001). Combining the primary cohort with previously published data from 114 subjects, we found a significant negative correlation between age and reference amplitude (r = −0.163, P = 0.045).

Conclusions:

This study shows that in our hands, the test–retest reliability of the ROVEMP is not optimal. Measurements with higher reference amplitude had a better quality, higher reproducibility, and increased diagnostic yield. We caution against the use of ROVEMP measurements of lower amplitude in clinical practice. In addition, given the correlation between age and amplitude, age matching of healthy control subjects and patients is essential in future studies.
Vagus Nerve Stimulation in Treatment-Resistant Depression: A Case Series of Long-Term Follow-up
Authors: Pigato Giorgio , Rosson Stella , Bresolin Nicola , Toffanin Tommaso , Sambataro Fabio , Olivo Daniele , Perini Giulia , Causin Francesco , Denaro Luca , Landi Andrea , D'Avella Domenico
Published: July 2022

Objectives

Vagus nerve stimulation (VNS) has been shown to be effective for treatment-resistant depression (TRD). However, long-term (>5 years) studies on the efficacy and tolerability of this treatment have been lacking. Here, we report a long-term clinical follow-up of 5 patients with severe and long-standing TRD, who received a VNS implant.

Methods

Of the initial 6 patients with TRD implanted with VNS at our center, 5 of them were followed for 6 to 12 years after implantation. Primary efficacy outcomes were clinical response and improved functioning at follow-up visits. The primary safety outcome was all-cause discontinuation, and the secondary safety outcomes were the number and the severity of adverse events.

Results

The VNS implant was associated with a sustained response (>10 years) in terms of clinical response and social, occupational, and psychological functioning in 3 patients. Two patients dropped out after 6 and 7 years of treatment, respectively. Vagus nerve stimulation was well tolerated by all patients, who reported only mild adverse effects. One patient, who discontinued concomitant drug treatment, had a hypomanic episode in the 10th year of treatment. The parameters of the VNS device were fine-tuned when life stressors or symptom exacerbation occurred.

Conclusions

Our case series showed that VNS can have long-term and durable effectiveness in patients with severe multiepisode chronic depression, and this could be associated with its neuroplastic effects in the hippocampus. In light of good general tolerability, our findings support VNS as a viable treatment option for TRD.
Clinical correlates and prognostic impact of binge-eating symptoms in major depressive disorder
Authors: Olgiati Paolo , Fanelli Giuseppe , Atti Anna Rita , De Ronchi Diana , Serretti Alessandro
Published: July 2022

Binge-eating (BE) symptoms are relatively common in major depressive disorder (MDD), but their prognostic role is not fully understood. This study compared two groups of patients with MDD experiencing or not BE symptoms to ascertain differences in terms of clinical manifestations, presence of bipolar features, and antidepressant treatment outcomes. The study involved 482 outpatients collected within the Combining Medications to Enhance Depression Outcomes (CO-MED) trial, who were assessed with scales for depressive and hypomanic symptomatology, suicidality, comorbid mental disorders, and childhood traumas. BE symptoms were reported in 95 patients (20%). Patients with MDD experiencing BE symptoms were characterized by higher scores of negative self-outlook (P = 0.0018), negative outlook of future (P = 0.0014), irritability (P = 0.0043), comorbid anxiety disorders (generalized anxiety disorder: P = 0.0006; panic disorder: P < 0.0001; social phobia: P < 0.0001), obsessive-compulsive disorder (P = 0.0053), hypomanic symptoms (increased talkativeness: P = 0.0029; reduced need for sleep: P = 0.0171), and suicidality (suicidal propensity: P = 0.0013; suicidal risk: P = 0.0148; lifetime suicidal behavior: P = 0.0052). BE symptoms (OR = 2.02; 95% CI = 1.06–3.84) and depression severity (OR = 1.04; 95% CI = 1.00–1.08) were independently associated with lifetime attempted suicide. The presence of BE symptoms might indicate higher severity of depressive disorder. Suicidal risk is a major issue in these patients, whereas the association between BE and bipolar features needs further research.
Is paternal oxytocin an oxymoron? Oxytocin, vasopressin, testosterone, oestradiol and cortisol in emerging fatherhood
Authors: Bakermans-Kranenburg Marian J. , Verhees Martine W. F. T. , Lotz Anna M. , Alyousefi-van Dijk Kim , van IJzendoorn Marinus H.
Published: July 2022

How do hormonal levels in men change from pregnancy to after the birth of their firstborn child, and what is the role of oxytocin, alone or in interplay with other hormones, in explaining variance in their parenting quality? We explored in 73 first-time fathers the development of five hormones that have been suggested to play a role in parenting: oxytocin (OT), vasopressin (AVP), testosterone (T), oestradiol (E2) and cortisol (Cort). In an extended group of fathers (
N
= 152) we examined associations with fathers’ behaviour with their 2-month-old infants. OT and E2 showed stability from the prenatal to the postnatal assessments, whereas AVP and T decreased significantly, and Cort decreased marginally. OT on its own or in interplay with other hormones was not related to paternal sensitivity. Using an exploratory approach, the interaction between T and E2 emerged as relevant for fathers’ sensitive parenting. Among fathers with high E2, high T was associated with lower sensitivity. Although we did not find evidence for the importance of OT as stand-alone hormone or in interplay with other hormones in this important phase in men's lives, the interaction between T and E2 in explaining variation in paternal behaviour is a promising hypothesis for further research.

This article is part of the theme issue ‘Interplays between oxytocin and other neuromodulators in shaping complex social behaviours’.
Effect of sex and autism spectrum disorder on oxytocin receptor binding and mRNA expression in the dopaminergic pars compacta of the human substantia nigra
Authors: Frehner Sage S. , Dooley Kip T. , Palumbo Michelle C. , Smith Aaron L. , Goodman Mark M. , Bales Karen L. , Freeman Sara M.
Published: July 2022

Oxytocin is an endogenous neuropeptide hormone that influences social behaviour and bonding in mammals. Variations in oxytocin receptor (OXTR) expression may play a role in the social deficits seen in autism spectrum disorder. Previous studies from our laboratory found a dense population of OXTR in the human substantia nigra (SN), a basal ganglia structure in the midbrain that is important in both movement and reward pathways. Here, we explore whether differences in OXTR can be identified in the dopaminergic SN pars compacta of individuals with autism. Postmortem human brain tissue specimens were processed for OXTR autoradiography from four groups: males with autism, females with autism, typically developing (TD) males and TD females. We found that females with autism had significantly lower levels of OXTR than the other groups. To examine potential gene expression differences, we performed
in situ
hybridization in adjacent slides to visualize and quantify OXTR mRNA as well as mRNA for tyrosine hydroxylase. We found no differences in mRNA levels for either gene across the four groups. These results suggest that a dysregulation in local OXTR protein translation or increased OXTR internalization/recycling may contribute to the differences in social symptoms seen in females with autism.

This article is part of the theme issue ‘Interplays between oxytocin and other neuromodulators in shaping complex social behaviours’.
Humibacter ginsenosidimutans sp. nov., with ginsenoside-converting activity isolated from activated sludge
Authors: Choi Gyu-Min , Lee Young-Woo , Choe Hanna , Kim So-Yeon , Im Wan-Taek
Published: July 2022

A novel Gram-stain-positive, thin rod-shaped, non-motile, aerobic and creamy-white pigmented bacterium (designated strain WJ7-1T) was isolated from activated sludge sampled in Suwon, Republic of Korea. 16S rRNA gene sequence analysis indicated that the isolate belongs to the genus

Humibacter

, family

Microbacteriaceae

, with a sequence similarity of 97.9 % to its nearest neighbour

Humibacter albus

KACC 20986T. Strain WJ7-1T contained menaquinone (MK)-10 (16.0 %), 11 (48.5 %) and 12 (35.5 %) as major respiratory quinones. The predominant cellular fatty acids (>15 %) were anteiso-C17 : 0, iso-C16 : 0 and anteiso-C15 : 0. The peptidoglycan of strain WJ7-1T contained the diagnostic diamino acid ornithine and 2,4-diaminobutyric acid alanine. Alanine, glutamic acid and glycine were also present in the cell wall. The characteristic whole-cell sugars present were glucose, galactose, xylose and rhamnose. The polar lipids consisted of phosphatidylglycerol, diphosphatidylglycerol, an unidentified glycolipid and two unidentified phospholipids. Strain WJ7-1T possessed ginsenoside-converting (β-glucosidase) activity, which enabled it to transform ginsenoside protopanaxadiol-type Rb1 (one of the dominant active components of ginseng) to compound K. The genome size of strain WJ7-1T has 4.2 Mbp and the G+C content is 68.3 mol%. Average nucleotide identity, amino acid identity and digital DNA–DNA hybridization values between strain WJ7-1T and the closely related strain were 79.8, 36.1 and 23.5 %, respectively, indicating that strain WJ7-1T represents a novel species of the genus

Humibacter

. Strain WJ7-1T could be distinguished from the other members of the genus

Humibacter

by a number of chemotaxonomic and phenotypic characteristics. Based on polyphasic taxonomic analysis, strain WJ7-1T (=KACC 19729T=LMG 30802T) represents a novel species within the genus

Humibacter

, for which the name Humibacter ginsenosidimutans sp. nov. is proposed.
Actinomadura parmotrematis sp. nov., isolated from the foliose lichen, Parmotrema praesorediosum (Nyl.) Hale
Authors: Somphong Achiraya , Poengsungnoen Vasun , Buaruang Kawinnat , Suriyachadkun Chanwit , Sripreechasak Paranee , Tanasupawat Somboon , Phongsopitanun Wongsakorn
Published: July 2022

A novel actinomycete strain PM05-2T was isolated from the lichen Parmotrema praesorediosum (Nyl.) Hale collected from Chaiyaphum Province, Thailand. The taxonomic position of the strain was studied using the polyphasic approach. Based on the morphology and chemotaxonomic properties, strain PM05-2T was identified as a member of the genus

Actinomadura

. The whole-cell hydrolysate contained meso-diaminopimelic acid, rhamnose, ribose, xylose, madurose, glucose and galactose. The polar lipids were phosphatidylglycerol, diphosphatidylglycerol, phosphatidylinositol, phosphatidylinositol mannoside, one unidentified phosphoglycolipid, four unidentified phospholipids and one unidentified lipid. The menaquinones were MK-9(H6), MK-9(H4), MK-9(H2), MK-9(H8) and MK-9(H0). The major cellular fatty acids were C16:0 and C18:1 ω9c. Strain PM05-2T showed the highest 16S rRNA gene similarity to

Actinomadura hibisca

NBRC 15177T (98.58%),

Actinomadura kijaniata

NBRC 14229T (98.29 %) and

Actinomadura namibiensis

DSM 44197T (98.14 %). The phylogenetic tree analysis revealed that strain PM05-2T was related to

A. hibisca

NBRC 15177T,

A. kijaniata

NBRC 14229T,

A. namibiensis

DSM 44197T and

Actinomadura macrotermitis

RB68T. The genomic analysis revealed that average nucleotide identity values based on both blast and MUMmer between strain PM05-2T and the relative type strains ranged from 77.6 to 86.4%. The digital DNA–DNA hybridization values among the strains were lower than the threshold for assigning to the same species. The taxonomic results suggested that strain PM05-2T represented a novel species of the genus

Actinomadura

for which the name Actinomadura parmotrematis is proposed. The type strain is PM05-2T (=TBRC 15492T=NBRC 115416T).
Abnormal prion protein, infectivity and neurofilament light-chain in blood of macaques with experimental variant Creutzfeldt-Jakob disease
Authors: Yakovleva Oksana , Bett Cyrus , Pilant Teresa , Asher David M. , Gregori Luisa
Published: July 2022

Transmissible spongiform encephalopathies (TSEs) are fatal neurodegenerative infections. Variant Creutzfeldt-Jakob disease (vCJD) and sporadic CJD (sCJD) are human TSEs that, in rare cases, have been transmitted by human-derived therapeutic products. There is a need for a blood test to detect infected donors, identify infected individuals in families with TSEs and monitor progression of disease in patients, especially during clinical trials. We prepared panels of blood from cynomolgus and rhesus macaques experimentally infected with vCJD, as a surrogate for human blood, to support assay development. We detected abnormal prion protein (PrPTSE) in those blood samples using the protein misfolding cyclic amplification (PMCA) assay. PrPTSE first appeared in the blood of pre-symptomatic cynomolgus macaques as early as 2 months post-inoculation (mpi). In contrast, PMCA detected PrPTSE much later in the blood of two pre-symptomatic rhesus macaques, starting at 19 and 20 mpi, and in one rhesus macaque only when symptomatic, at 38 mpi. Once blood of either species of macaque became PMCA-positive, PrPTSE persisted through terminal illness at relatively constant concentrations. Infectivity in buffy coat samples from terminally ill cynomolgus macaques as well as a sample collected 9 months before clinical onset of disease in one of the macaques was assayed in vCJD-susceptible transgenic mice. The infectivity titres varied from 2.7 to 4.3 infectious doses ml–1. We also screened macaque blood using a four-member panel of biomarkers for neurodegenerative diseases to identify potential non-PrPTSE pre-symptomatic diagnostic markers. Neurofilament light-chain protein (NfL) increased in blood before the onset of clinical vCJD. Cumulatively, these data confirmed that, while PrPTSE is the first marker to appear in blood of vCJD-infected cynomolgus and rhesus macaques, NfL might offer a useful, though less specific, marker for forthcoming neurodegeneration. These studies support the use of macaque blood panels to investigate PrPTSE and other biomarkers to predict onset of CJD in humans.