Notes

Guessing changes in cataract medical procedures wellbeing outcomes employing a cataract medical procedures relevance and also prioritization musical instrument.
Occipitocervical fusion (OCF) procedures are increasing due to an aging population and the prevalence of trauma, rheumatoid arthritis, and tumors. Reoperation rates and readmission risk factors for cervical fusions have been established, but in relation to OCF they have not been explored. This study investigates the patterns of readmissions and complications following OCF using a national database.

The 2016 U.S. Nationwide Readmissions Database was used for sample collection. Adults (>18 years) who underwent OCF were identified using the 2016 ICD-10 coding system, and we examined the readmission rates (30-day and 90-day) and reoperation rates.

Between January and September 2016, a total of 477 patients underwent OCF; the 30-day and 90-day readmission rates were 10.4% and 22.4%, respectively. The 90-day reoperation rate related to the index surgery was 5.7%. Mean age (68.58 years) was significantly greater in the readmitted group versus nonreadmitted group (61.76 years) (P < 0.001). The readmitted group had a significantly higher Charlson Comorbidity Index and Elixhauser Comorbidity Index (5.00 and 2.41, respectively) than the nonreadmitted group (3.25 and 1.15, respectively; P < 0.001). Nonelective OCF showed a higher readmission rate (29.18%) versus elective OCF (12.23%) (P < 0.001). Medicare and Medicaid patients showed the highest rates of readmission (27.27% and 20.41%, respectively). Readmitted patients had higher total health care costs.

Nonelective OCF was found to have a readmission rate of almost 2½× that of elective OCF. Understanding risk factors associated with OCF will help with operative planning and patient optimization.
Nonelective OCF was found to have a readmission rate of almost 2½× that of elective OCF. Understanding risk factors associated with OCF will help with operative planning and patient optimization.
We aimed to describe opioid prescribing practices after obstetric delivery and to evaluate how these practices compare with national opioid prescribing guidelines.

A closed survey was developed, evaluated for validity and reliability, and distributed by email to obstetrician members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) in December 2018. Descriptive statistics were used to summarize respondent demographics, pharmaceutical pain management strategies, and opioid prescribing practices. Logistic regression was used to measure associations between respondent characteristics and high-risk opioid prescribing practices (e.g., prescribing >50 mg morphine equivalent dose per day, prescribing >5 days, not screening for substance/opioid use disorder before prescribing).

Our survey had high content validity (content validity index 0.89; 95% CI 0.78-1.00) and adequate reliability (Kappa 0.70; 95% CI 0.63-0.84 and intraclass correlation coefficient 0.70; 95% CI 0.67-0.81). Of the 1019 SOGC members reached, 243 initiated the survey (response rate, 24%). Among respondents, 235 (92%) completed the survey. Among opioid prescribers, 47% reported at least 1 high-risk opioid prescribing practice, the most frequent being a lack of substance/opioid use disorder screening. In the adjusted logistic regression model, being in practice more than 20 years (adjusted odds ratio [aOR] 0.53; 95% CI 0.29-0.93) and practising in a non-central area of Canada (aOR 0.49; 95% CI 0.28-0.84) reduced the odds of high-risk prescribing.

Further research on barriers to screening are needed to support and enhance safer opioid prescribing practices among Canadian obstetricians.
Further research on barriers to screening are needed to support and enhance safer opioid prescribing practices among Canadian obstetricians.
Mental contamination (i.e., contamination concerns that arise in the absence of direct contact with a contaminant) is a common symptom in obsessive-compulsive disorder (OCD). Cognitive theories suggest that it results from individuals' misinterpretations of perceived violations. Cognitive theories of OCD also highlight the importance of appraisals of inflated responsibility in the maintenance of other OCD symptoms. However, the role of responsibility in mental contamination has not yet been examined experimentally. The present study examined the role of perceived responsibility and violation in the relationship between workplace sexual harassment imagery and subsequent mental contamination.

One hundred and forty-nine participants listened to a workplace sexual harassment imagery task, wherein responsibility was manipulated. Participants were randomly assigned to one of three conditions (high responsibility (HR), low responsibility (LR), no responsibility (NR)). Participants completed questionnaires assessing mental contamination and completed a hand washing task.

Those in the NR condition reported significantly lower levels of responsibility than those in the LR or HR conditions. Accordingly, those in the NR condition also reported significantly lower levels of anxiety and dirtiness than in the LR condition. There were no significant differences between the LR and HR condition on variables of interest.

The nature of the victim blaming used for the responsibility induction may have elicited compensatory responses from participants.

Findings may highlight the central role of perceptions of violation in the understanding and treatment of mental contamination.
Findings may highlight the central role of perceptions of violation in the understanding and treatment of mental contamination.Arthrogryposis multiplex congenita (AMC) consists of congenital joint contractures that affect at least two joints. There are two types in the first, arthrogryposis is an additional sign in the context of various pathologies (neuromuscular diseases); in the second, it is the main and constant symptom. In the first type, the progression of the causal underlying disease must be considered. In the second type, there are two specific forms Amyoplasia corresponds to a significant congenital absence of muscles (epigenetic disease or vascular origin) while distal arthrogryposis has a genetic component and is transmissible. The orthopedic surgeon's purpose, which is usually to enhance movement, is not appropriate for an arthrogryposis patient. One must keep in mind that without muscle, movement is impossible. The goal differs between the upper and lower limbs for the upper limb, it is to allow grasping, and, if possible, to bring the hand to the mouth; for the lower limb, it is to ensure ambulation with plantigrade support, and the knees extended, which is the only stable position possible with little to no muscles. The rehabilitation, orthoses and/or surgical techniques are chosen to achieve this singular aim. While it may appear modest, it is crucial for patients. The goal is to achieve useful mobility, not maximum mobility. This multidisciplinary treatment, which evolves over time, must be explained to the family to get its adherence.The menisci play a key role in knee biomechanics and long-term cartilage protection. Preserving the meniscus is thus a major functional consideration in children and adolescents. In normal menisci, lesions are traumatic in origin. They are often vertical, in the posterior segment, associated with anterior cruciate ligament tear. In abnormal menisci, lesions are much more specific to children, occurring atraumatically, mainly in discoid menisci. Clinical signs of traumatic meniscal lesion are minimal, and associated ligament involvement should be systematically screened for. In contrast, clinical findings are rich and specific in discoid malformative pathology, sometimes showing the typical "clunk" sign highly suggestive of a detachment. The complementary examination of choice is MRI. In children more than in adults, lesions need screening for in apparently normal menisci. This particularly concerns ramp lesions of the medial meniscus. It is important also to be aware of false signs, and notably linear hypersi
Personal and social factors may account for much of the variation in patient reported outcome scores, yet little evidence exists on how psychological properties affect patient outcomes following reverse total shoulder arthroplasty (rTSA). The objective of this study is to determine if resilience, characterised by the ability to return to a healthy level of function after experiencing stress, correlates with patient reported outcome scores after rTSA.

Resilience score will correlate positively with patient reported outcomes after rTSA.

Seventy-three patients were identified that had undergone primary rTSA with minimum 2-year follow-up (4.7±1.8). These patients completed a phone survey that included the Brief Resilience Scale (BRS), a measure of general resilience in all aspects of life, along with American Shoulder and Elbow Surgeon (ASES), Penn, and Single Assessment Numerical Evaluation (SANE) scores. Mean outcome scores were calculated to identify any correlation between resilience and clinical outcomes.

The mean BRS score was 23.8±4.8 (range 12.0-30.0), with 41 patients classified as normal resilience (NR), 17 patients as low resilience (LR), and 15 as high resilience (HR). Postoperative BRS scores correlated with ASES (r=0.31, p=0.008), Penn (r=0.25, p=0.03), and SANE score (r=0.32, p=0.007). The mean ASES score was 14.0 points lower in the LR group (77.0 points), compared to the HR group (91.0 points; p=0.04). Similarly, the LR group had a mean SANE score that was 18.6 points lower than the HR group (73.4 and 91.9 points, respectively; p=0.021).

The observation that greater general life resilience correlates with lower pain intensity, lesser magnitude of limitations, and perception of greater normality of the shoulder after reverse total shoulder arthroplasty emphasises the importance of addressing personal and social health opportunities along with the physical in musculoskeletal care. Resilience may be a useful predictor of outcomes following rTSA.

III.
III.Patient information is now an ethical and legal obligation in France; it is the physician who is required to provide proof. The Law of March 4, 2002 and the code of ethics and main legal and regulatory texts are, however, imprecise on some points. Written documents, although not stipulated in law, are in practice essential, supplementing the indispensable oral information given by the surgeon in individual personalized interview. Patients remember only some of this information, and overestimate their own understanding of it. Written documents are therefore essential to compensate for this. Their contents need validation by scientific societies. In case of disagreement, the medical file is the essential means of assessing information quality, and should be kept up to date as rigorously as possible. A key document is the letter summarizing the preoperative consultation, validating surgery, which should be drawn up in a manner that meets the obligation to inform. Signed consent is not mandatory in law, but is necessary in practice and should be archived. For judges, proof of information is based on several elements the complete structured letter to the patient and community physician plus the signed information sheet and consent form constitute solid evidence and all three should be included in the medical file. Information has now become a part of health-care in itself. In a context of increasing litigation, "defensive medicine" is still to be avoided but physicians should have their own check-lists so as to be in a position to prove delivery of structured information if called upon to do so. In the absence of proven information, patients can plead loss of chance and/or prejudice for lack of preparation and/or infringement of dignity, and claim damages from the courts.At the elbow, the ulnar nerve (UN) may be the site of a static compression (by the cubital tunnel retinaculum and Osborne's ligament between the two heads of the flexor carpi ulnaris), or a dynamic compression, especially when the nerve is unstable (subluxation/dislocation outside the ulnar groove). The clinical basis for the diagnosis of ulnar neuropathy involves looking for subjective and objective signs of sensory and/or motor deficit in the ulnar nerve's territory in the hand, a pseudo-Tinel's sign, and doing manipulations to provoke UN irritation. The diagnosis is confirmed by electromyography and ultrasonography. In the early stages, patient education and elimination of flexion postures or repeated elbow flexion motions can provide relief. If this fails or signs of sensory and/or motor deficit are present, surgical treatment is proposed. If the nerve is stable, in-situ nerve decompression is typically done as the first-line treatment. If the nerve is unstable, anterior nerve transposition - generally subcutaneous - or more rarely, a medial epicondylectomy can be done. If surgical treatment fails, the patient's history is reviewed, and diagnostic tests can be repeated. Except in cases of a fibrotic scar, the main causes of failure are neuroma of a branch of the medial cutaneous nerve of the forearm, instability of the nerve and persistence of a compression point. In the latter two cases, surgical revision is justified and anterior nerve transposition or epicondylectomy can be proposed.The rate of recurrence of anterior unidirectional instability is lower after coracoid bone-block than with other techniques, even if failures still occur with this difficult procedure. Failure may consist in recurrent instability (dislocation, subluxation, unstable painful shoulder) or despite absence of obvious clinical signs, in radiologic failure (non-union, fracture), biologic failure (osteolysis) or infection, all of which may require revision surgery or lead to late instability or subclinical chronic apprehension. Clinical, X-ray and CT assessment identifies the type of failure and may lead to a second surgery being discussed with the patient according to functional demand. Technical error is often implicated and is generally due to deficient coracoid preparation, insufficient conjoint and coracoid tendon release or problems of positioning and fixing the bone-block on the glenoid. There are 2 types of revision surgery. Iliac bone-block involves the same demands as coracoid bone-block; it stabilises the shoulder and provides very good functional results. Although less effective, anterior capsule repair can also stabilise the shoulder when associated to posterior Hill-Sachs lesion remplissage by infraspinatus tenodesis. Osteoarthritis of the shoulder may set in after any surgical revision and impair the result.The function of the abductor mechanism (AM) of the hip can be disturbed, or even compromised, following tumor resection in the hip area. The consequences are instability (limping, dislocation), pain and altered walking ability. Several reconstruction techniques can be used for the same AM sacrifice. After defining the AM, this lecture will discuss the best technique for a given type of bone and muscle resection. These reconstruction techniques depend on exactly where the AM was sacrificed. For zone 1 resections of the ilium and/or iliac gluteal insertions, reconstruction is often optional. When muscle from the AM is resected, especially when the gluteal tendon is detached from its trochanteric insertion, isolated reconstruction can be done or reconstruction in combination with a tendon allograft or an allograft and/or tendon transfer from the surrounding area. This sacrifice, whether followed by reconstruction or not, in most cases leads to a good functional outcome, except when a complete musculotendinous unghly relevant issue in France, and partially explains the shift to reconstruction with a megaprosthesis. Lastly, we will look at the different clinical and diagnostic tests used to evaluate the function of the AM in an oncology context and the outcomes of the various types of reconstruction.Spinal balance can be defined as the trade-off between outside forces acting on the spine and the muscle response of the trunk, under sensorineural regulation, to maintain stable upright posture, both static and dynamic. Homo sapiens developed sagittal alignment along with bipedalism. The upright posture was an important step in human evolution, to master the environment, at the price of some instability in postural control in the trunk, and to maintain horizontal gaze. To make upright stance energetically economical and thus sustainable, reciprocal sagittal curvatures developed. Sagittal spinal organization is governed by strict rules under physiological conditions, enabling alignment between the center of mass and the lower limb joint centers. In children and adolescents, morphologic changes related to skeletal growth and postural control centers maturation alter spinal alignment and hence spinal balance, with increases in pelvic incidence, sacral slope and consequently lumbar lordosis and thoracic kyphosis. Global cervical lordosis remains stable, at the cost of an increase of the inferior cervical lordosis angle in correlation with T1 inclination or T1 slope. In pathology, spinal alignment may induce certain spinal pathologies such as growth-related spinal dystrophy or spondylolisthesis. It can also be altered by spinal deformity such as scoliosis, a regional disorder inducing adjacent compensatory mechanisms. The management of spinal pathologies is indissociable from understanding and maintaining or restoring individual sagittal alignment so as to ensure physiological distribution of stresses and limit onset of complications or decompensation in adulthood.
Underlying diseases, bone deformities and polyethylene wear affect outcome in young patients undergoing total hip arthroplasty (THA). These issues are not widely confirmed for ceramic-on-ceramic THA, particularly regarding cup fixation. Therefore, we did a retrospective long-term investigation on a large population of cementless ceramic-on-ceramic THA in patients aged 40 years or younger aiming to analyze 1) the complication rate; 2) clinical results; and 3) survival for cup loosening with regard to their preoperative conditions.

Cup loosening could be related to preoperative diagnosis in young patients with a cementless ceramic-on-ceramic THA.

Two hundred and seven hips in 171 patients (97 men and 74 women) underwent a cementless ceramic-on-ceramic THA at a mean age of 31.6±6.8 years. The most frequent diagnoses were avascular necrosis (AVN) of the femoral head (74 hips), pediatric hip diseases (35 hips), severe congenital hip dysplasia (CHD) (31 hips), juvenile rheumatoid arthritis (30 hips) and mild ry, outcome of cementless ceramic-on-ceramic THA in patients under the age of 40 years is satisfactory over ten years of follow up. Cup aseptic loosening was the main cause of failure and appears more related to the initial hip diseases than the age of the patient.

III; retrospective comparative study.
III; retrospective comparative study.Osteoporosis is a public health problem that is contributing to an increasing number of osteoporotic vertebral fractures. The aim of this lecture is to summarize the current state of knowledge about osteoporotic fractures by answering five questions. 1/How does the spine typically age and how is osteoporosis diagnosed? Various normal aging processes will gradually modify the vertebral column (static, dynamic, bone quality). Osteoporosis is diagnosed through a DEXA scan. 2/How is an osteoporotic fracture evaluated clinically and radiologically? Magnetic resonance imaging is the preferred modality for making the diagnosis and selecting the most appropriate treatment. 3/What are the treatment options for an osteoporotic fracture? The options are conservative treatment, conventional surgery, and minimally invasive techniques (cementoplasty, percutaneous instrumentation). 4/Which fractures should be treated, and which technique should be used? The choice is clear when neurological deficits are present, although the indications are less firm when there is no deficit. The treatment can be conservative (back brace) if the fracture is non-displaced and minimally painful, vertebroplasty if the fracture is painful and shows hyperintensity on T2-STIR sequences, vertebral expansion if the radiological deformity worsens along with symptoms. 5/What are the technical challenges and complications related to the presence of osteoporosis when treating vertebral fractures surgically? The reduced bone stock increases the risk of poor implant hold and postoperative mechanical complications (adjacent fracture, junctional kyphosis). Technical solutions have been developed (augmented screw fixation, transitional zone) to limit their impact. It is essential to know and master these techniques, and their indications. Treatment of the osteoporosis itself is crucial. Level of evidence V; Expert opinion.Cone-beam scanners (CBCT) enable CT to be performed under weight-bearing - notably for the foot and ankle. The technology is not new it has been used since 1996 in dental surgery, where it has come to replace panoramic X-ray. What is new is placing the scanner on the ground, so as to have 3D weight-bearing images, initially of the foot and ankle, and later for the knee and pelvis. This saves time, radiation and money. It is now increasingly used, but is unfortunately limited by not having specific national health insurance cover in France, and by the psychological reticence that goes with any technological breakthrough. A review of the topic is indispensable, as it is essential to become properly acquainted with this technique. To this end, we shall be addressing 5 questions. What biases does conventional radiography incur? Projecting a volume onto a plane incurs deformation, precluding true measurement. Conventional CT is therefore often associated with an increased dose of radiation. What is the impact of CBCT on radiation dose, costs and the care pathway? The conical beam turns around the limb (under weight-bearing if so desired) in less than a minute, making the radiation dose no greater than in standard X-ray. What does the literature have to say about CBCT, and what are the indications? CBCT is indicated in all foot and ankle pathologies, and indications now extend to the upper limb and the knee, and will soon include the pelvis. How are angles measured on this 3D technique? The recently developed concept of 3D biometry uses dedicated software to identify anatomic landmarks and automatically segment the bones, thereby enabling every kind of measurement. What further developments are to be expected? CBCT may become indispensable to lower-limb surgical planning. Artificial Intelligence will reveal novel diagnostic, prognostic and therapeutic solutions. LEVEL OF EVIDENCE V; expert opinion.There are a variety of options for filling defects during revision total knee arthroplasty cement with or without screws, structural or morselized allograft, highly porous cones and sleeves, massive bone allograft or megaprostheses. Our goal is to describe the techniques for these procedures and their indications. Any necrotic bone, fibrous tissue or granulomas must be excised, and the bone freshened. The height of the joint line must be restored using trial components stabilized by stems. The defect is the space between the bone and each of the two components. Whether contained or not, it can be evaluated using the AORI classification. Cement alone or supplemented with screws, which is pressurized to penetrate the bone, is now only used in small defects less than 10mm in diameter, especially contained one. It is preferable to use morselized compacted bone graft instead. Augments are used to fill AORI type 2 defects less than 10 mm deep in a condyle. They can also be used to position the femoral component andft, is essential. In older patients, a megaprothesis is simpler to use and faster. The femur is better suited to massive reconstruction than the tibia, where coverage must be ensured along with extensor mechanism continuity. LEVEL OF EVIDENCE V; expert opinion.Prosthetic joint infection (PJI) is a rare-and dreaded-complication of arthroplasty requiring multidisciplinary care. Given the dual goal of treating the infection and maintaining satisfactory function, it is preferable to determine how and when the implanted components can be retained. Bacteria and fungi organize themselves into biofilms that shield them from antibiotics and the immune system. This biofilm is in place after 15 days of active infection. Some antibiotics have a better activity on biofilms. The following factors have a negative impact on the probability of a successful debridement, antibiotics and implant retention (DAIR) intervention fracture or revision, use of cement, bacteremia, kidney and/or liver failure, immunosuppression and elevated CRP. Hematogenous infections have a worse prognosis than early postoperative infections. Using a decision algorithm increases the chances of DAIR being successful. The KLIC score applies to early postoperative infections ( less then 4 weeks postoperative anrral center for any PJI, although it is preferable that early infections be treated at the facility that performed the implantation.Dual-mobility and constrained cups can stabilise most recurrent dislocations of total hip arthroplasty (THA), but may fail in case of hip abductor mechanism loss. For such complex situations, we developed an original artificial iliofemoral and ischiofemoral ligament reconstruction technique using a polyglactin 910 mesh (Vicryl ™) associated to repositioning of a Lefèvre constrained liner adapted to hip range of motion to prevent cam effects. The technique was implemented in 2 patients showing recurrent dislocation after THA, associating total femur replacement and cemented constrained liner in a metal reinforcement ring. In one of the 2 cases, the abductor mechanism had been entirely sacrificed. This simple and accessible salvage technique prevented recurrence of dislocation at 12 months' follow-up in these complex cases, previously subject to several episodes per year.
Antegrade nailing of humeral fractures is a proven technique with well-documented results. The standard surgical approach requires incision of the supraspinatus tendon to insert a nail, which comes with the risk of damaging the rotator cuff. The aims of this study were to describe a new surgical technique for arthroscopic humeral nailing that does not require opening the rotator cuff and to report the clinical and radiological outcomes of this technique.

This was a single center, retrospective study of patients who had a humeral shaft or surgical neck fracture at our hospital in 2017 and underwent antegrade intramedullary nailing by arthroscopy. The nail was introduced through the rotator interval without opening the rotator cuff. All were reviewed at 1-year postoperative clinical examination (joint range of motion and Constant score) plus AP and lateral radiographs of the shoulder.

Eighteen patients (12 women, 6 men) with a mean age of 65.4 years (37-84) were included retrospectively. One patient died during the follow-up period thus 17 patients were available for analysis. At the 1-year follow-up, the mean forward flexion was 152.1° (90-180), the mean external rotation was 56.1° (30-80), the mean absolute Constant score was 73.9 (54-88) points and the mean adjusted Constant score was 93.5 (67-100) points. Bone union was achieved in 16/17 patients (94%) with 1 patient experiencing a nonunion. There were no complications.

Arthroscopic antegrade nailing of humeral shaft and surgical neck fractures through the rotator interval yields good clinical and radiological results in our hands. This new, rotator cuff-sparing technique is a viable option for treating humeral fractures by arthroscopy.

IV; retrospective study without control group.
IV; retrospective study without control group.The HIV-1 epidemic in the US has historically been dominated by subtype B. HIV subtype diversity has not been extensively examined in most US cities to determine whether non-B variants have become established, as has been observed in many other global regions. We describe the diversity of non-B variants and present evidence of local transmission of non-B HIV in San Francisco. Viral sequences collected from patients between 2000 and 2016 were matched to the San Francisco HIV/AIDS case registry. HIV subtype was determined using COMET. Phylogenies were reconstructed using the pol region of subtypes A, C, D, G, CRF01_AE, CRF02_AG, and CRF07_BC, with reference sequences from the LANL HIV database. Associations of non-B subtypes and circulating recombinant forms (CRFs) with patient characteristics were assessed using multivariable logistic regression. Out of 11,381 sequences, 10,669 were from 7235 registry cases, of which 141 (2%) had non-B subtypes and CRFs and 72 (1%) had unique recombinant forms. CRF01_AE (0.8%) and subtype C (0.5%) were the most prevalent non-B forms. The frequency of non-B subtypes and CRFs increased in San Francisco during years 2000-2016. Out of 146 transmission events involving non-B study sequences, 18% indicated local transmission within the study population and 74% appeared to be inward migration of the virus. Compared to 7016 cases with only subtype B, 141 cases with non-B sequences were more likely to be of non-US country of birth (aOR = 11.02; p  less then  0.001), of Asian/Pacific-Islander race/ethnicity (aOR = 3.17; p  less then  0.001), and diagnosed after 2009 (aOR = 4.81; p  less then  0.001). Results suggest that most non-B infections were likely acquired outside the US and that local transmission of non-B forms has occurred but so far has not produced extensive transmission networks. Thus, non-B variants were not widely established in San Francisco, an observation that differs from cities worldwide with more diverse epidemics.The population genetic structure of Aedes aegypti (Linnaeus, 1762) has been studied in order to understand its role as an efficient vector. Several studies utilized an integrative approach; to combine genetic and phenotypic data to determine its population structure but these studies have only focused on female populations. To address this particular gap, our study compared the population variability and structuring between its male and female populations using phenotypic and genetic data from a highly-urbanized and dengue-endemic region of the Philippines, Metropolitan Manila. Five mosquito populations comprised of female (n = 137) and male (n = 49) adult mosquitoes were used in this study. All mosquito individuals underwent geometric morphometric (26 landmarks), and genetic (11 microsatellite loci) analyses. Results revealed that FST estimates (genetic) were 0.055 and 0.009 while QST estimates (phenotypic) were 0.318 and 0.309 in in male and female populations, respectively. Wing shape variation plots showed that male populations were distinctly separated from each other while female populations overlapped. Similarly, discriminant analysis of principal components using genetic data revealed that male populations were also distinctly separated from each other while female populations showed near-overlapping populations. Genetic and phenetic dendrograms showed the formation of two groups in male populations but no groups in female populations. Further analysis indicated a significant correlation (r = 0.68, p = 0.02) between the genetic and phenetic distances of male populations. Bayesian analysis using genetic data also detected multiple clusters in male (K = 3) and female (K = 2) populations, while no clusters were detected using the phenotypic data from both sexes. Our results revealed contrasting phenotypic and genetic patterns between male and female Ae. aegypti, indicating that male populations were more spatially structured than female populations.New Delhi metallo-β-lactamase (NDM) is a series of enzyme conferring resistance to β-lactam antibiotics including the carbapenems. The blaNDM gene has been reported in a variety of Gram-negative bacilli, especially in the Enterobacteriaceae and Acinetobacter spp., which is deeply disconcerting for public health worldwide. In this study, recombinase polymerase amplification assays using a basic detection (Basic-RPA) and a real-time fluorescent detection (Exo-RPA) were established for detecting blaNDM gene. The RPA reactions were performed at 39 °C and finished within 20 min. Using different copy numbers of pMD18T-NDM plasmid DNA as templates, we identified the detection limit of Basic-RPA assay (1.85 × 103 copies/μL), conventional PCR assay (1.85 × 104 copies/μL), Exo-RPA assay (1.85 × 102 copies/μL) and real-time PCR assay (1.85 × 102 copies/μL). Both Basic-RPA and Exo-RPA assays were highly specific for detecting blaNDM, as there were no cross-reactions with the strains without blaNDM gene. Examination of 62 clinical samples by RPA assays and PCR assays showed the same results, suggesting that RPA assays are reliable in clinical diagnosis. The amplification time of RPA is much shorter than that of other molecular techniques, it is easy to implement and has the potential for clinical application.The apicoplast is a non-photosynthetic relict plastid of Apicomplexa that evolved from a secondary symbiotic system. During its evolution, most of the genes derived from its alga ancestor were lost. Only genes involved in several valuable metabolic pathways, such as the synthesis of isoprenoid precursors, heme, and fatty acids, have been transferred to the host genome and retained to help these parasites adapt to a complex life cycle and various living environments. The biological function of an apicoplast is essential for most apicomplexan parasites. Considering their potential as drug targets, the metabolic functions of this symbiotic organelle have been intensively investigated through computational and biological means. Moreover, we know that not only organellar metabolic functions are linked with other organelles, but also their biogenesis processes have developed and evolved to tailor their biological functions and proper inheritance. Several distinct features have been found in the biogenesis process of apicoplasts. For example, the apicoplast borrows a dynamin-related protein (DrpA) from its host to implement organelle division. The autophagy system has also been repurposed for linking the apicoplast and centrosome during replication and the division process. However, many vital questions remain to be answered about how these parasites maintain and properly inherit this symbiotic organelle. Here we review our current knowledge about its biogenesis process and discuss several critical questions remaining to be answered in this field.Based on a taxonomic approach, combining morphological characters with DNA sequences (i.e.,18S rDNA, ITS1, 5.8S rDNA and ITS2), Susanlimocotyle n. gen. is proposed to accommodates Susanlimocotyle narina n. sp. from the nostrils of the ariid Sciades herzbergii (Bloch) from the coast of the state of Pará, Brazil. Susanlimocotyle n. gen. is characterized by species possessing an intestinal ceca confluent posteriorly; a male copulatory organ, comprising a variable tube, articulated with the accessory piece; a sclerotized vagina, vaginal aperture dextro-ventral; an onchium; a robust ventral bar; two dorsal bars; a ventral anchor with elongated shaft and a dorsal anchor with deep root expanding into wings. In addition, new molecular data of Chauhanellus spp. are also provided and used for the evaluation of the phylogenetic relationships among monogenoids parasitizing siluriforms. Susanlimocotyle n. gen. exhibited a higher genetic divergence level for 18S rDNA (4.6 to 7.2% [83-130 bp]) with respect to Chauhanellus spp. despite sharing S. herzbergii as a host, than Hamatopeduncularia spp., (4.1 to 5.8% [75-110 bp]) from Oriental ariids. For the 18S rDNA, 5.8S rDNA, ITS1 and ITS2 regions, C. boegeri and C. susamlimae were observed to have the smallest interspecific distances, and C. velum was revealed to be the most genetically distant species to Chauhanellus. The proposal for Susanlimocotyle n. gen. is also supported by phylogenetic analysis based on the 18S rDNA gene, which supports the close relationship between the new genus and Hamatopeduncularia and Chauhanellus from ariids from the South America and Oriental regions. Moreover, the patterns towards the shared diversification between monogenoids and their ariid hosts were addressed.Blastocystis is a common intestinal protozoan parasite of humans and a variety of animal species. To date, the prevalence of Blastocystis and major subtypes distribution in the domestic animals inhabiting in the Qinghai-Tibetan Plateau Area (QTPA) of China is yet poorly studied. In this study, we investigated the distribution and genetic diversity of Blastocystis in seven animal species in QTPA in China. Four hundred and five fresh fecal samples were collected from domestic animals in Qinghai, Yunnan, and Tibet of China and analyzed using nested PCR and SSU rRNA gene sequencing. It was found that the overall prevalence of Blastocystis infection was 40.2% (163/405) in the animals studied. The most predominant subtype of Blastocystis was ST10 (57.7%) followed by ST14 (28.8%) and ST2 (13.5%). These results reveal the epidemiological features of Blastocytis infection in animals in the high altitude plateau area. The finding of presence of ST2 in a number of animal species suggests a zoonotic nature of Blastocystis and might be of importance of public health.Zn-0.8 wt.% Li-0.1 wt.% Mn wire with the diameter of 0.3 mm was fabricated and further processed into gastrointestinal staple, and its in vitro and in vivo biodegradation behavior and biocompatibility were studied systematically. The experimental Zn-Li-Mn alloy staple could deform from the original U-shape to B-shape without fracture, indicating its good mechanical property. Due to the residual stress concentration caused by anastomosis deformation, the feet and leg arc part of the staple were more prone to degradation. The Zn-Li-Mn alloy staple sustained integrity after immersion in Hanks' solution and simulated gastric fluid (SGF) for 28 days, and the degradation rate in SGF was about 4 times of that in Hanks' solution. Furthermore, Zn-Li-Mn alloy staples were utilized for gastrointestinal anastomosis in pig models, with clinically-used titanium alloy staples as a comparison. No anastomotic leakage and severe inflammation were observed after operation. The Zn-Li-Mn alloy staple maintained mechanical integrity within 8 weeks' implantation. The gastrointestinal tissue healed after 12 weeks, and no obvious side effects were detected during the whole implantation period, demonstrating the good biocompatibility of Zn-Li-Mn alloy staple. Thus, Zn-Li-Mn alloy staple fabricated in this work displayed the promising potential in the gastrointestinal anastomosis.Damages in pelvic floor muscles often cause dysfunction of the entire pelvic urogenital system, which is clinically challenging. A bioengineered skeletal muscle construct that mimics structural and functional characteristics of native skeletal muscle could provide a therapeutic option to restore normal muscle function. However, most of the current bioengineered muscle constructs are unable to provide timely innervation necessary for successful grafting and functional recovery. We previously have demonstrated that post-synaptic acetylcholine receptors (AChR) clusters can be pre-formed on cultured skeletal muscle myofibers with agrin treatment and suggested that implantation of AChR clusters containing myofibers could accelerate innervation and recovery of muscle function. In this study, we develop a 3-dimensional (3D) bioprinted human skeletal muscle construct, consisting of multi-layers bundles with aligned and AChR clusters pre-formed human myofibers, and investigate the effect of pre-formed AChR clusters in bioprinted skeletal muscle constructs and innervation efficiency in vivo. Agrin treatment successfully pre-formed functional AChR clusters on the bioprinted muscle constructs in vitro that increased neuromuscular junction (NMJ) formation in vivo in a transposed nerve implantation model in rats. In a rat model of pelvic floor muscle injury, implantation of skeletal muscle constructs containing the pre-formed AChR clusters resulted in functional muscle reconstruction with accelerated construct innervation. This approach may provide a therapeutic solution to the many challenges associated with pelvic floor reconstruction resulting from the lack of suitable bioengineered tissue for efficient innervation and muscle function restoration.Macrophages are the central immune cell involved in the foreign body reaction to the implants. Furthermore, the magnesium-based materials could modulate macrophage functions, and subsequently influence bone formation via not clearly understood mechanisms. To analysis the roles of materials (magnesium and its gadolinium-based alloy; Mg and Mg-10Gd) on secretion of macrophages and their effects on pro-osteogenic activity, human mesenchymal stem cells (MSC) and macrophages were cocultured directly on the materials surface. Here, oncostatin M (OSM) - glycoprotein 130 (gp130) signaling complex as well as BMP6/SMAD were found to be involved in the Mg and Mg-10Gd multifactorial modulating osteogenic differentiation. Furthermore, materials upregulated the gene expression of bone morphogenetic protein 6 (BMP6) in macrophages, as well as its protein receptors and mothers against decapentaplegic homolog (SMAD) 1/4/5 in cocultured MSC. Besides, both materials could reduce the secretion of tumour necrosis factor alpha (TNFα) and interleukin 1 beta (IL1β) in macrophages and cocultures. These results collectively imply that Mg and Mg-10Gd could create a beneficial microenvironment for osteogenic differentiation and further support Mg-based biomaterial immunomodulatory properties by modulating the interactions of macrophages and MSC for bone regeneration. STATEMENT OF SIGNIFICANCE Mg-activated macrophages could regulate the pro-osteogenic activity via OSM/gp130 and Smad-related signalling. The neutralisation assay was utilised to confirm the hypothesis of inductive osteoblastic differentiation of human MSC via OSM/gp130 signalling. Current study are essential to evidence that the coordinated communication between macrophages and MSC (OSM/gp130/BMP6/TNFα/IL1β), which could be utilised for improving magnesium-based bone biomaterials and therapeutic applications.Because of their many useful and unique properties, boronic acids are well suited for biomedical applications such as antitumor chemotherapy and boron neutron capture therapy (BNCT). Bortezomib, a boronic acid derivative, has drawn a lot of attention as a potent proteasome inhibitor. Nevertheless, because of rapid excretion and off-target effects, the clinical translation of boronic acid-containing drugs is limited. To this end, we employed a polymeric carrier to stably encapsulate boronic acid-containing drugs and achieve superior pharmacokinetics with an on-target drug release capability. Accordingly, to construct a supramolecular polymeric nanoparticle, we took advantage of the facile, stable, and pH-sensitive conjugation between boronic acids and diethanolamine-installed polymeric carriers. We demonstrated the feasibility of our molecular design by generating and applying bortezomib-loaded nanoparticles to a subcutaneous tumor-bearing mouse model. Stable encapsulation and pH-sensitive release of bortezomib facilitated antitumor efficacy and alleviated hepatotoxicity. We also verified the versatility of our approach through biological evaluations of the nanoparticles encapsulating benzo(b)thiophene-2-boronic acid, phenylboronic acid, and p-phenylene-diboronic acid.Blood clots are essential biomaterials that prevent blood loss and provide a temporary scaffold for tissue repair. In their function, these materials must be capable of resisting mechanical forces from hemodynamic shear and contractile tension without rupture. Fibrin networks, the primary load-bearing element in blood clots, have unique nonlinear mechanical properties resulting from fibrin's hierarchical structure. This structure provides multiscale load bearing from fiber deformation to protein unfolding. Here, we study the fiber and molecular scale response of fibrin under shear and tensile loads in situ using a combination of fluorescence and vibrational (molecular) microscopy. Imaging protein fiber orientation and molecular vibrations, we find that fiber alignment and molecular unfolding in fibrin appear at much larger strains under shear compared to uniaxial tension. Alignment levels reached at 150% shear strain were reached already at 60% tensile strain, and molecular unfolding of fibrin was only detected at shear strains above 300%, whereas fibrin unfolding began already at 20% tensile strain. Moreover, shear deformation caused progressive changes in vibrational modes consistent with increased protofibril and fiber packing that were already present even at very low tensile deformation. Together with a bioinformatic analysis of the primary fibrinogen structure, we propose a scheme for the molecular response of fibrin from low to high deformation, which may relate to the teleological origin of fibrin's resistance to shear and tensile forces.Primary cell therapy continues to face significant hurdles to therapeutic translation including the inherent variations that exist from donor to donor, batch to batch, and scale-up driven modifications to the manufacturing process. Cardiosphere-derived cells (CDCs) are stromal/progenitor cells with clinically demonstrated tissue reparative capabilities. Mechanistic investigations have identified canonical Wnt/β-catenin signaling as a therapeutic potency marker, and THY1 (CD90) expression as inversely correlated with potency. Here we demonstrate that the cardiosphere formation process increases β-catenin levels and enriches for therapeutic miR content in the extracellular vesicles of these cells, namely miR-146a and miR-22. We further find that loss of potency is correlated with impaired cardiosphere formation. Finally, our data show that small GSK3β inhibitors including CHIR, and BIO and "pro-canonical Wnt" culturing conditions can rescue β-catenin signaling and reduce CD90 expression. These findings identify strategies that could be used to maintain CDC potency and therapeutic consistency.Atherosclerosis can lead to most cardiovascular diseases. Although some biomimetic nanomaterials coated by macrophage membranes have been reported in previous studies of atherosclerosis, to our knowledge, no studies regarding the detection of early lesions of atherosclerosis (foam cells) using such a strategy have yet been reported. In the present study, Fe3O4 biomimetic nanoparticles coated with a macrophage membrane (Fe3O4@M) were prepared to investigate the imaging effect on the early lesions of atherosclerosis (foam cells). The results showed that the Fe3O4@M particles are spheres with average diameters of approximately 300 nm. T1 and T2 relaxation values showed that the ratio of r2 to r1 was 26.09. The protein content accounted for approximately 27% of the total weight in Fe3O4@M, and Fe3O4@M nanoparticles exhibited high biosafety. Further testing showed that Fe3O4@M effectively targets early atherosclerotic lesions by the specific recognition of integrin α4β1 to VCAM-1. Taken together, Fe3O4@M is a promising contrast agent for the diagnosis of early stage atherosclerosis.
Klebsiella pneumoniae carbapenemase (KPC) has spread across the world. The present study focused on exploring the sequences of two new KPC-harbouring plasmids in K. pneumoniae.

Eighteen KPC-harbouring K. pneumoniae isolates were collected from a tertiary teaching hospital in 2014 in Fujian, China, among which two new KPC-harbouring plasmids (pF77 and pF5) we identified. The characteristics of the plasmids and the isolates carrying them were investigated in detail.

The two KPC-harbouring plasmids (pF5 and pF77) carried the antimicrobial resistance genes bla
, bla
, bla
, catA2 and fosA3. Detailed sequence comparison revealed that the two plasmids might have evolved from recombination of the previously reported plasmids pKP1034 and pCT-KPC, which were considered to evolve from ancestor plasmids pHN7A8, pKPC-LK30 and pKPHS2. Plasmids pF5 and pF77 were non-conjugative and were mainly identified in sequence type 11 (ST11) K. pneumoniae isolates. Additionally, 4-55 core single nucleotide polymorphisms (SNPhe importance of plasmid analysis in the surveillance and control of antibiotic resistance spread in clinical isolates.We assess the outcomes of a sustained-release intracanalicular dexamethasone insert (Dextenza) in the treatment of postoperative ocular inflammation in children undergoing cataract surgery. Seventeen eyes of 17 children were analyzed. The anterior chamber was clear in 18% of eyes at 1-2 weeks after surgery. A spike in intraocular pressure requiring intervention was observed in 18% of eyes. Rescue medications using topical steroids were required in 29% of eyes. Our initial experience suggests that the dexamethasone insert reduced or eliminated the need for postoperative steroid drops.Cellular blood components and plasma-derived medicinal products (PDMPs) are obtained from blood donated by volunteers. In a growing number of countries, in line with World Health Organization advice issued since the mid-1970s, donors are not remunerated. In recent decades, considerable efforts have been made to restrict the indications for labile blood components to those based on evidence, to ensure efficacy and safety. By contrast, the producers of PDMPs have developed pathogen reduction techniques for inactivating the microorganisms in (pooled) plasma, but little attention has been paid to the pertinence of the clinical indications for these products. The use of blood, and of erythrocytes in particular, has declined by almost 40%, but the use of immunoglobulins (IG) tripled between 2004 and 2018, making it necessary to pay donors to obtain sufficient blood to meet the market demand for these products. We analyzed the reasons for this increase to unsustainable levels of use, by investigating (practice) guidelines, recommendations, Cochrane data analyses and systematic reviews for clinical indications for IG over time. We found no new evidence explaining the huge increase up to 2018 or the predicted 5-7% yearly annual increase until 2024. For some former evidence-based indications, biologics have largely replaced IG, but the administration of IG for doubtful indications (up to 40%) has not decreased in recent decades. The main development since 2004 is that IG use in Europe has become market-driven rather than evidence-guided. As transfusion specialists and blood therapists, we must raise the alarm that this situation is likely to continue in the absence of good clinical studies determining the place of IG alongside other treatments, and for as long as market profitability remains the dominant driving force. We discuss here approaches for reversing this trend and moving towards European self-sufficiency through non-remunerated voluntary blood donation.
Read More: