Competencies for Those Who Coach Physicians: A Modified Delphi Study.

The rapidly evolving coaching profession has permeated the health care industry and is gaining ground as a viable solution for addressing physician burnout, turnover, and leadership crises that plague the industry. Although various coach credentialing bodies are established, the profession has no standardized competencies for physician coaching as a specialty practice area, creating a market of aspiring coaches with varying degrees of expertise. To address this gap, we employed a modified Delphi approach to arrive at expert consensus on competencies necessary for coaching physicians and physician leaders. Informed by the National Board of Medical Examiners' practice of rapid blueprinting, a group of 11 expert physician coaches generated an initial list of key thematic areas and specific competencies within them. The competency document was then distributed for agreement rating and comment to over 100 stakeholders involved in physician coaching. Our consensus threshold was defined at 70% agreement, and actual responses ranged from 80.5% to 95.6% agreement. Comments were discussed and addressed by 3 members of the original group, resulting in a final model of 129 specific competencies in the following areas: (1) physician-specific coaching, (2) understanding physician and health care context, culture, and career span, (3) coaching theory and science, (4) diversity, equity, inclusion, and other social dynamics, (5) well-being and burnout, and (6) physician leadership. This consensus on physician coaching competencies represents a critical step toward establishing standards that inform coach education, training, and certification programs, as well as guide the selection of coaches and evaluation of coaching in health care settings.

Rapid Blueprinting: An Efficient Method for Designing Content of Assessments.

Problem: Many assessments in medical education involve measuring proficiency in a content area. Thus, proper content development (blueprinting) of tests in this field is of primary importance. Prior efforts to conduct content review as part of assessment development have been time- and resource-intensive, relying on practice analysis and then on linking methods. This monograph explores a "rapid, cost-effective" approach to blueprinting that allows efficient assessment development with rigor. Our investigation seeks to explore an efficient and effective alternate method for creating a content design (blueprint) for medical credentialing and evaluation examinations by focusing directly on assessment requirements. Approach: We employed a two-phase process to propose a rapid blueprinting method. Phase 1 involved a 1-day direct meeting of content experts/practitioners. Phase 2 involved a corroboration survey sent to a wider group of content experts/practitioners. The rapid blueprinting method was applied to developing eleven blueprints (five for medical specialty certification; five for health professions certification; and one for in-training assessment). Outcomes: The methods we used resulted in effective, well-balanced, operational examinations that successfully implemented the resulting blueprints in item writing assignments and test development. Assessments resulting from the use of the rapid blueprinting method also generated psychometrically sound inferences from the scores. For example, the assessments resulting from this methodology of test construction had KR-20 reliability coefficients ranging from .87 to .92. Next Steps: This approach leveraged the effectiveness and feasibility of the rapid blueprinting method and demonstrated successful examination designs (blueprints) that are cost- and time-effective. The rapid blueprinting method may be explored for further implementation in local assessment settings beyond medical credentialing examinations.

Assessment of Clinical Reasoning in Undergraduate Medical Education: A Pragmatic Approach to Programmatic Assessment.

PURPOSE: Clinical reasoning, a complex construct integral to the practice of medicine, has been challenging to define, teach, and assess. Programmatic assessment purports to overcome validity limitations of judgments made from individual assessments through proportionality and triangulation processes. This study explored a pragmatic approach to the programmatic assessment of clinical reasoning. METHOD: The study analyzed data from 2 student cohorts from the University of Utah School of Medicine (UUSOM) (n = 113 in cohort 1 and 119 in cohort 2) and 1 cohort from the University of Colorado School of Medicine (CUSOM) using assessment data that spanned from 2017 to 2021 (n = 199). The study methods included the following: (1) asking faculty judges to categorize student clinical reasoning skills, (2) selecting institution-specific assessment data conceptually aligned with clinical reasoning, (3) calculating correlations between assessment data and faculty judgments, and (4) developing regression models between assessment data and faculty judgments. RESULTS: Faculty judgments of student clinical reasoning skills were converted to a continuous variable of clinical reasoning struggles, with mean (SD) ratings of 2.93 (0.27) for the 232 UUSOM students and 2.96 (0.17) for the 199 CUSOM students. A total of 67 and 32 discrete assessment variables were included from the UUSOM and CUSOM, respectively. Pearson r correlations were moderate to strong between many individual and composite assessment variables and faculty judgments. Regression models demonstrated an overall adjusted R2 (standard error of the estimate) of 0.50 (0.19) for UUSOM cohort 1, 0.28 (0.15) for UUSOM cohort 2, and 0.30 (0.14) for CUSOM. CONCLUSIONS: This study represents an early pragmatic exploration of regression analysis as a potential tool for operationalizing the proportionality and triangulation principles of programmatic assessment. The study found that programmatic assessment may be a useful framework for longitudinal assessment of complicated constructs, such as clinical reasoning.

Augmentin loaded functionalized halloysite nanotubes: A sustainable emerging nanocarriers for biomedical applications.

Clay minerals such as Halloysite nanotubes (HNTs), abundantly available green nanomaterial, exhibit a significant advantage in biomedical applications such as drug delivery, antibacterial and antimicrobials, tissue engineering or regeneration, etc. Because of the mesoporous structure and high absorbability, HNTs exhibit great potential as a nanocarrier in drug delivery applications. The sulfuric acid treatment enhances the surface area of the HNTs and thereby improves their drug-loading capacity by enlarging their lumen space/inner diameter. In the present investigation, based on the literature that supports the efficacy of drug loading after acid treatment, a dual treatment was performed to functionalize the HNTs surface. First, the HNTs were etched and functionalized using sulfuric acid. The acid-functionalized HNTs underwent another treatment using (3-aminopropyl) triethoxysilane (APTES) to better interact the drug molecules with the HNTs surfaces for efficient drug loading. Augmentin, a potential drug molecule of the penicillin group, was used for HNTs loading, and their antibacterial properties, cytotoxicity, and cumulative drug release (%) were evaluated. Different characterization techniques, such as X-ray diffractometer (XRD) and Fourier Transform Infra-Red (FT-IR), confirm the loading of Augmentin to the APTES@Acid HNTs. TEM images confirm the effective loading of the drug molecule with the HNTs. The drug encapsulation efficiency shows 40.89%, as confirmed by the Thermogravimetric Analysis (TGA). Also, the Augmentin-loaded APTES@Acid HNTs exhibited good antibacterial properties against E. coli and S. aureus and low cytotoxicity, as confirmed by the MTT assay. The drug release studies confirmed the sustainable release of Augmentin from the APTES@Acid HNTs. Hence, the treated HNTs can be considered as a potential nanocarrier for effectively delivering Augmentin and promoting enhanced therapeutic benefits.

Advancements in wearable technology for monitoring lactate levels using lactate oxidase enzyme and free enzyme as analytical approaches: A review.

Lactate is a metabolite that holds significant importance in human healthcare, biotechnology, and the food industry. The need for lactate monitoring has led to the development of various devices for measuring lactate concentration. Traditional laboratory methods, which involve extracting blood samples through invasive techniques such as needles, are costly, time-consuming, and require in-person sampling. To overcome these limitations, new technologies for lactate monitoring have emerged. Wearable biosensors are a promising approach that offers non-invasiveness, low cost, and short response times. They can be easily attached to the skin and provide continuous monitoring. In this review, we evaluate different types of wearable biosensors for lactate monitoring using lactate oxidase enzyme as biological recognition element and free enzyme systems.

Effectiveness of Deep Cervical Fascial Manipulation® and Sequential Yoga Poses on Pain and Function in Individuals with Mechanical Neck Pain: A Randomised Controlled Trial.

BACKGROUND: This study aimed to investigate the effect of fascial manipulation (FM) of the deep cervical fascia (DCF) and sequential yoga poses (SYP) on pain and function in individuals with mechanical neck pain (MNP). METHOD: Following the predefined criteria, ninety-nine individuals with MNP were recruited, randomised, and assigned to either the intervention group (IG) (n = 51) or the control group (CG) (n = 48). Individuals in the IG received FM (4 sessions in 4 weeks) and the home-based SYP (4 weeks). The CG participants received their usual care (cervical mobilisation and thoracic manipulation (4 sessions in 4 weeks) along with unsupervised therapeutic exercises (4 weeks). The participants underwent baseline and weekly follow-up measurements of pain using a numerical pain rating scale (NPRS) and elbow extension range of motion (EEROM) during the upper limb neurodynamic test 1 (ULNT1). The baseline and the fourth session follow-up measurements of the patient-specific functional scale (PSFS) and fear-avoidance behavior Questionnaire (FABQ) were also taken. RESULTS: A repeated-measures ANOVA was performed. There were statistically significant differences between the IG and CG on the NPRS third and fourth sessions, with mean differences (MD) of -1.009 (p < 0.05) and -1.701 (p < 0.001), respectively. Regarding EEROM, there was a 20.120° difference (p < 0.001) in the fourth session between the groups. The MD in FABQ was -5.036 (p < 0.001), but there were no significant differences in PSFS between the groups during the follow-up. CONCLUSION: FM and SYP can aid in reducing pain and fear-avoidance behaviour and improve the function and extensibility of the upper quarter region.

Developing an exclusive sensor based on molecularly imprinted polymer/Multi-walled carbon nanotubes/Fe3O4@Au nanocomposite for the selective determination of an anti-cancer drug imatinib.

Determination of pharmaceuticals especially anticancer drugs is one of the important issues in environmental and medical investigation and creating good information about human health. The presence sturdy introducing an electroanalytical sensor based on molecularly imprinted polymer (MIP)/Multi-walled carbon nanotubes (MWCNTs)/Au@Fe3O4 nanoparticles modified carbon paste electrode (PE) to determine imatinib (IMA). The MIP/MWCNTs/Au@Fe3O4/PE showed catalytic activity and also a sensitive strategy to sensing IMA in the concentration range 1-1000 µM with a limit of detection of 0.013 µM. The MIP/MWCNTs/Au@Fe3O4/PE has shown interesting results in the analysis of IMA in real samples, and the interference investigations results show the high selectivity of the MIP/MWCNTs/Au@Fe3O4/PE in the monitoring of IMA in complex fluids such as tablet and blood serum and results approved by F-test and t-test as statistical methods.

Natural waste-derived nano photocatalysts for azo dye degradation.

Due to their widespread application in water purification, there is a significant interest in synthesising nanoscale photocatalysts. Nanophotocatalysts are primarily manufactured through chemical methods, which can lead to side effects like pollution, high-energy usage, and even health issues. To address these issues, "green synthesis" was developed, which involves using plant extracts as reductants or capping agents rather than industrial chemical agents. Green fabrication has the benefits of costs less, pollution reduction, environmental protection and human health safety, compared to the traditional methods. This article summarises recent advances in the environmentally friendly synthesis of various nanophotocatalysts employed in the degradation of azo dyes. This study compiles critical findings on natural and artificial methods to achieve the goal. Green synthesis is constrained by the time and place of production and issues with low purity and poor yield, reflecting the complexity of plants' geographical and seasonal distributions and their compositions. However, green photocatalyst synthesis provides additional growth opportunities and potential uses.

The anatomical myofascial continuum between the neck and eyes.

The posterior myofascial chain (PMC) or superficial back line encompasses a series of muscles interlinked by the deep fascia, extending from the foot to the fascial sheath of the eyeball. The deep cervical fascia of the neck, the epicranial aponeurosis of the head, and the fascial sheath of eyeball, form the proximal PMC. Although the literature has reported an anatomical myofascial continuum between the neck, head, and eyes, the anatomical descriptions vary substantially. Moreover, there is still no plausible functional interrelationship between the proximal structural myofascial links. Chronic neck pain is usually associated with a plethora of symptoms including craniofacial pain and oculomotor disorders. Understanding the anatomy of the proximal myofascial chain could help clinicians improvise treatment strategies for managing such painful head and neck disorders.

Hollow-Core Microstructured Optical Fiber Based Refractometer: Numerical Simulation and Experimental Studies.

In this paper, we numerically and experimentally propose a novel hollow-core microstructured optical fiber (HC-MOF) biosensor for refractive index determination. The sensing mechanism of the proposed sensor is based on photonic bandgap effect and the location of transmission maxima of the fiber, which is strongly depend on the liquid analyte RI filled in the fiber core. The proposed HC-MOF biosensor demonstrates the spectral sensitivity of 5636.3 nm/RIU with a RI detection range of 1.333 to 1.3385 for different ratios of plasma in blood serum in our experimental studies. The HC-MOF proposed here can detect similar liquid analytes with RI close to 1.33. The proposed sensor with a high sensitivity, ease of operation and the possibility of real-time sensing has a strong potential for detection of liquid analytes and biomolecules with possible applications in medicine, chemistry, and biology.

The influence of fascial manipulation on function, ankle dorsiflexion range of motion and postural sway in individuals with chronic ankle instability.

BACKGROUND: Proprioceptive deficits may attribute to functional Chronic ankle instability (CAI) with impairments in balance and postural control. Physical therapy interventions such as taping, bracing, manual therapy, and balance training play an essential role in managing ankle instabilities. Fascial Manipulation (FM) is a manual therapy technique considered to restore function by improving the joint range of motion and proprioception. However, the effects of FM on Ankle dorsiflexion range of motion (ADROM) and postural sway in athletes with chronic ankle instability are unclear. OBJECTIVE: This study aims to determine the effect of FM on function, ADROM, and Postural sway in athletes with CAI. DESIGN: Single group, pretest-posttest design. METHODS: Individuals with a history of recurrent ankle sprains with the Cumberland ankle instability tool (CAIT) score of ≤27 were included. FM was applied to the painful and densified center of coordination points on the lower limb myofascial lines based on Stecco's FM method. The outcomes measures include Foot and ankle disability index (FADI), ADROM during the weight-bearing lunge, and postural sway (excursion of the center of pressure during single limb stance). RESULTS: There was a significant improvement in the FADI scores (Z = -3.626, p < 0.05), ADROM [F (2)=38.056, p<0.05], ηp 2 = 0.69 following FM. However, the center of pressure excursion with both opened and closed eyes showed no differences following FM. CONCLUSION: Since fascial manipulation had shown improvement in the function and ankle dorsiflexion range, it can be used as an adjunct treatment strategy in CAI management.

Effectiveness of deep cervical fascial manipulation and yoga postures on pain, function, and oculomotor control in patients with mechanical neck pain: study protocol of a pragmatic, parallel-group, randomized, controlled trial.

INTRODUCTION: Mechanical neck pain (MNP) is a commonly occurring musculoskeletal condition that is usually managed using electrical modalities, joint mobilization techniques, and therapeutic exercises, but has limited evidence of their efficacy. Pathology (densification) of the deep cervical fascia that occurs due to the increased viscosity of hyaluronic acid (HA) may induce neck pain and associated painful symptoms of the upper quarter region. Fascial manipulation (FM) and yoga poses are considered to reduce the thixotropy of the ground substances of the deep fascia and improve muscle function. The purpose of this study is to investigate the effect of FM and sequential yoga poses (SYP) when compared to the usual care on pain, function, and oculomotor control in MNP. METHODS: This FaCe-Man trial will recruit 160 patients with subacute and chronic mechanical neck pain diagnosed using predefined criteria. Participants will be randomized to either the intervention group or the usual care group, using a random allocation ratio of 1:1. Patients in the intervention group will receive FM (4 sessions in 4 weeks) and SYP (12 weeks) whereas the standard care group will receive cervical mobilization/ thoracic manipulation (4 sessions in 4 weeks) and therapeutic exercises (12 weeks). The primary outcome is the change in the numeric pain rating scale (NPRS). The secondary outcomes include changes in the patient-specific functional scale and oculomotor control, myofascial stiffness, fear-avoidance behavior questionnaire, and elbow extension range of motion during neurodynamics test 1. DISCUSSION: If found effective, FM along with SYP investigated in this trial can be considered as a treatment strategy in the management of mechanical neck pain. Considering the magnitude of the problem, and the pragmatic and patient-centered approach to be followed, it is worth investigating this trial. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2020/01/022934 . Registered on January 24, 2020 with ctri.nic.in. Clinical Trials Registry - India.

Photonic Crystal Fiber-Based Reconfigurable Biosensor Using Phase Change Material.

A reconfigurable biosensor with different spectral sensitivities could provide new opportunities to increase the label-free selectivity and sensitivity for biomolecules. Here, we propose and numerically demonstrate a phase change chalcogenide material (Ge2 Sb2 Te5)-based photonic crystal fiber (PCF) sensor for tunable and enhanced refractive index sensing at near infrared (NIR) wavelengths. In order to achieve this, we integrate a thin hybrid sensing layer of Au/Ge2 Sb2 Te5 with D-shaped PCF. By switching the structural phase of Ge2 Sb2 Te5 from amorphous to crystalline, we realize tunable and enhanced refractive index sensing with a large figure of merit (FOM) for the sensing range from 1.35 to 1.40, which covers most known analytes such as proteins, cancer cells, glucose and viruses or DNA/RNA. The obtained average bulk refractive index sensitivity is 17,600 nm/RIU and 8,000 nm/RIU for crystalline and amorphous phase, respectively. The observed large tunable differential response of the proposed sensor offers a promising opportunity to design an assay for the selective detection of higher and lower molecular weight biomolecules through future artificial intelligence-based sensing.

Assessing Competence in Critical Care Echocardiography: Development and Initial Results of an Examination and Certification Processes.

OBJECTIVES: To describe the development and initial results of an examination and certification process assessing competence in critical care echocardiography. DESIGN: A test writing committee of content experts from eight professional societies invested in critical care echocardiography was convened, with the Executive Director representing the National Board of Echocardiography. Using an examination content outline, the writing committee was assigned topics relevant to their areas of expertise. The examination items underwent extensive review, editing, and discussion in several face-to-face meetings supervised by National Board of Medical Examiners editors and psychometricians. A separate certification committee was tasked with establishing criteria required to achieve National Board of Echocardiography certification in critical care echocardiography through detailed review of required supporting material submitted by candidates seeking to fulfill these criteria. SETTING: The writing committee met twice a year in person at the National Board of Medical Examiner office in Philadelphia, PA. SUBJECTS: Physicians enrolled in the examination of Special Competence in Critical Care Electrocardiography (CCEeXAM). MEASUREMENTS AND MAIN RESULTS: A total of 524 physicians sat for the examination, and 426 (81.3%) achieved a passing score. Of the examinees, 41% were anesthesiology trained, 33.2% had pulmonary/critical care background, and the majority had graduated training within the 10 years (91.6%). Most candidates work full-time at an academic hospital (46.9%). CONCLUSIONS: The CCEeXAM is designed to assess a knowledge base that is shared with echocardiologists in addition to that which is unique to critical care. The National Board of Echocardiography certification establishes that the physician has achieved the ability to independently perform and interpret critical care echocardiography at a standard recognized by critical care professional societies encompassing a wide spectrum of backgrounds. The interest shown and the success achieved on the CCEeXAM by practitioners of critical care echocardiography support the standards set by the National Board of Echocardiography for testamur status and certification in this imaging specialty area.

Enhanced tuning of Smith predictor based series cascaded control structure for integrating processes.

This work combines the benefits of cascaded control, Smith predictor, moment matching, and outer-loop decomposition to design an enhanced series cascaded control approach with Smith Predictor for some industrial integrating plants. The inner-loop controller is assumed as a PI/PID type. If the outer-loop process model is of second-order, it is split into first-order models and an individual control-loop is established for each model. This technique is called 'outer-loop decomposition'. PI controller is employed in the loop having a first-order lag whereas proportional control is used if the loop contains an integrator. Controller parameters are obtained by moment matching i.e. equating the Maclaurin series of expected and real closed-loop system functions. Suitable equations and procedures are given to tune adjustable parameters to attain an expected maximum sensitivity. This makes the proposed method more beneficial than the contemporary schemes that require a hit and trial search within a given range of values. It is seen that the suggested scheme yields noteworthy enhancement in closed-loop response compared to some recent strategies even in the presence of perturbed process dynamics.

The plausible role of Deep Cervical Fascia and its continuum in chronic craniofacial and Cervicobrachial Pain: A case report.

BACKGROUND: The painful conditions of the Upper quarter region (UQR) such as chronic Craniofacial Pain (CFP) and Cervicobrachial Pain (CBP) usually occur with a plethora of symptoms. Although biological and psychosocial factors are attributed to such conditions, the involvement of the Deep Cervical Fascia (DCF) is ambiguous and needs further exploration. OBJECTIVE: We reported a case of CFP and CBP with an intent to showcase the possible involvement of impaired DCF in such presentations and to explore the short-term effect of Fascia directed approach (Fascial Manipulation). METHODS: This is a report of a 25-year-old female college student with chronic head, temporomandibular, neck, and arm pain over the past four years with acute pain exacerbation. After identifying the densified Centre of Coordination points along the myofascial continuum of the DCF, Fascial Manipulation (FM) was performed by deep manual friction. The patient-reported outcomes such as the Numerical Pain Rating Scale (NPRS), Temporomandibular disability index (TMDI), and Patient-Specific Functional Scale (PSFS) were assessed. RESULTS: Following FM treatment, there is a reduction in pain and improved function between the baseline and follow up evaluation after one week based on all the outcomes (NPRS, PSFS, and TMDI). CONCLUSION: This case report highlights the possible role of dysfunction of the DCF and the importance of assessing myofascial chains in patients with pain in the UQR. The report has also shown that FM may be beneficial and can be considered an adjunct in the rehabilitation of chronic CFP and CBP. Nevertheless, future studies with multiple sessions and follow-ups are imperative.

Comparison of respiratory parameters in participants with and without chronic low back pain.

BACKGROUND: Individuals with chronic low back pain (CLBP) may lack coordination between the stabilising and respiratory functions of trunk muscles. The trunk stabilisers compromise breathing to maintain spinal stability, leading to breathing dysfunctions. Maximal voluntary ventilation (MVV) is indicative of the respiratory muscle endurance and strength whereas end-tidal carbon dioxide (PETCO2) gives an estimate of breathing patterns that closely reflect the arterial measurement of CO2. CLBP has been shown to have a significant effect on respiratory functions. However, the impact has not yet been quantified. Further, there is a dearth of literature comparingrespiratory functions between CLBP and healthy individuals. This study investigates respiratory functions in participants with and without CLBP. METHODS: The study compared the respiratory functions of maximal voluntary ventilation (MVV) and End-Tidal Carbon Dioxide (PETCO2) between 14 participants with CLBP and 14 healthy individuals. Participants in both groups were matched for age, height, weight and body surface area. The assessment of MVV and PETCO2 were performed sitting, standing on a stable surface, and on an unstable surface (BOSU ball). RESULTS: The mean of measured MVV (L/min) was found to be lower (p < 0.05) in the CLBP group when compared to the healthy group. Mean PETCO2 and respiratory rate was found to be higher in CLBP group when compared to the healthy group in all three positions, although this was not found to be statistically significant. CONCLUSION: The findings of this study demonstrated sub-optimal respiratory parameters in participants with chronic low back pain. However, when adjusted for gender, the difference was not found to be significant between the two groups.

Cardiomyocytes facing fibrotic conditions re-express extracellular matrix transcripts.

Pathophysiological conditions, such as myocardial infarction and mechanical overload affect the mammalian heart integrity, leading to a stiffened fibrotic tissue. With respect to the pathophysiology of cardiac fibrosis but also in the limelight of upcoming approaches of cardiac cell therapy it is of interest to decipher the interaction of cardiomyocytes with fibrotic matrix. Therefore, we designed a hydrogel-based model to engineer fibrotic tissue in vitro as an approach to predict the behavior of cardiomyocytes facing increased matrix rigidity. Here, we generated pure induced pluripotent stem cell-derived cardiomyocytes and cultured them on engineered polyacrylamide hydrogels matching the elasticities of healthy as well as fibrotic cardiac tissue. Only in cardiomyocytes cultured on matrices with fibrotic-like elasticity, transcriptional profiling revealed a substantial up-regulation of a whole panel of cardiac fibrosis-associated transcripts, including collagen I and III, decorin, lumican, and periostin. In addition, matrix metalloproteinases and their inhibitors, known to be essential in cardiac remodeling, were found to be elevated as well as insulin-like growth factor 2. Control experiments with primary cardiac fibroblasts were analyzed and did not show comparable behavior. In conclusion, we do not only present a snapshot on the transcriptomic fingerprint alterations in cardiomyocytes under pathological conditions but also provide a new reproducible approach to study the effects of fibrotic environments to various cell types. STATEMENT OF SIGNIFICANCE: The ageing population in many western countries is faced with an increasing burden of ageing-related diseases such as heart failure which is associated with cardiac fibrosis. A deeper understanding of the interaction of organotypic cells with altered extracellular matrix mechanical properties is of pivotal importance to understand the underlying mechanisms. Here, we present a strategy to combine hydrogel matrices with induced pluripotent stem cell derived cardiomyocytes to study the effect of matrix stiffening on these cells. Our findings suggest an active role of matrix stiffening on cardiomyocyte function and heart failure progression.

Relative reduction of biological and phylogenetic diversity of the oral microbiota of diabetes and pre-diabetes patients.

BACKGROUND: A reciprocal relationship between oral health and systemic disease, such as type 2 diabetes, has been suggested, whereby a systemic disease is a predisposing factor for oral infection. If the infection occurs, it in turn aggravates the progression of the systemic disease. According to several studies, certain constituents of the oral microbiota are linked to diabetes, metabolic syndrome, and obesity. In the current study, we aimed to compare the microbial diversity and population structure of the oral microbiota of normoglycemic, impaired glucose tolerance (IGT), and diabetes patients. METHODOLOGY: The study followed a case-control design, with 15 type 2 diabetes patients, 10 IGT subjects, and 19 control subjects. All subjects underwent assessment of periodontitis and oral health. Saliva samples were collected, and DNA was isolated from these samples. Hypervariable regions of the 16Sr RNA gene were amplified and sequenced, and the generated sequences underwent bioinformatics analysis. Statistical analysis and diversity index calculations were made using the statistical software R, vegan R-package, and Past3.20 software. RESULTS: Overall, 551 operational taxonomic units (OTUs) were identified. Based on OTU analysis, a clear reduction of the number of species was observed in both IGT (412) and diabetes groups (372) compared with that in the normoglycemic group (502). This was associated with a similar pattern of reduction of biological diversity among the three groups. The phylogenetic diversity (PD-SBL) value in the normoglycemic group was higher than that in the diabetes group. The diabetes group exhibited the highest evenness value and the highest microbiota bacterial pathogenic content. CONCLUSION: A clear reduction of the biological and phylogenetic diversity was apparent in the diabetes and pre-diabetes oral microbiota in comparison with that in the normoglycemic oral microbiota. However, this was associated with an increase in the pathogenic content of the hyperglycemic microbiota. The results of this study may aid to better understanding of the directionality of the mysterious reciprocal relationship.