Do animal husbandry operations contaminate groundwater sources with antimicrobial resistance: systematic review.

Antimicrobial resistance (AMR) is a critical global health concern. Animal husbandry operations are AMR hotspots due to heavy antibiotic use and dissemination of animal waste into the environment. In this systematic review, we examined the impact of swine, poultry, and cattle operations on AMR in groundwater. We searched PubMed, Web of Science, CAB Direct, and the North Carolina State University Agricultural and Environmental Science databases in June 2022. The search returned 2487 studies. Of the 23 eligible studies, 17 were conducted in high-income countries (primarily the USA, also Canada, Saudi Arabia, Cyprus), and 6 were conducted in a single upper-middle-income country (China). Studies investigated facilities for swine (13), poultry (4), cattle (3), and multiple types of animals (3). The sampling distance ranged from onsite to > 20 km from facilities; the majority of studies (19) sampled onsite. Most studies collected samples from monitoring wells; only 5 studies investigated private drinking water wells. AMR in groundwater was associated with animal husbandry operations in 74% (17/23) of all studies, 65% (11/17) of studies in high-income countries, and 100% (6/6) of studies in China. Contamination was mostly found in onsite wells, especially downgradient of waste lagoons, but also in offsite private wells up to 2-3 km away. Few studies reported weather data, but AMR contamination appeared to increase with rainy conditions. Future studies should sample private wells at varying distances from animal husbandry operations under different weather conditions and include low- and middle-income countries where food animal production is intensifying.

Prevalence of Ankle Charcot Neuroarthropathy Presenting in a Tertiary Care Center.

Charcot neuroarthropathy's (CN) anatomic classification was originally formulated by the Brodsky article and the Trepman et al modification, including midfoot (type 1), rearfoot (type 2), ankle (type 3a), calcaneus (type 3b), multiarticular (type 4), and forefoot (type 5). In these classic studies, ankle joint and multijoint CN are reported as 9% and 6% to 9%, respectively, but we believe ankle CN to be more common than that in a tertiary setting. We retrospectively reviewed patients presenting initially or as referral between 2004 and 2020. Initial presentation radiographs were reviewed and classified by 3 authors based on Brodsky's model with Trepman and colleagues' modification, and any discrepancies were reviewed by the fourth author. A total of 175 patients (205 feet) were assessed. This revealed 80 cases classified as type 1 (39.0%), 23 cases type 2 (11.2%), 17 cases type 3a (8.3%), 2 cases type 3b (1.0%), and 83 cases type 4 (40.5%). After subdividing type 4, total prevalence included 150 with type 1 anatomic location (73.2%), 103 type 2 (50.2%), 44 type 3a (21.5%), and still 2 type 3b (1.0%). This study revealed a similar prevalence of isolated ankle CN (8.5%) compared to the Trepman et al article (9%), however, in total, ankle CN (21.5%) occurred 2.4-times more than the original 9%. Our study also found there to be a higher prevalence of ankle CN in the setting of multiarticular CN, which has not been evaluated in past studies. The prevalence of multiarticular CN was found to be 4.5-fold greater than the Trepman article (6%-9%).

Safety and Complication Rate of Ring External Fixation in the Foot and Ankle.

External fixation is a powerful tool for foot and ankle surgeons. Currently, there is no consensus on true complication rate. The purpose of this study was to report our institution's complication rate of ring external fixation performed by a single surgeon. We retrospectively evaluated electronic medical record of 224 patients with 238 circular frames between 2009 and 2021 at a single institution. Minor complications were defined as a frame managed without early frame removal or return to operating room. Major complications were defined as early return to operative room or early removal defined by our institution as less than 2 months. We recorded over 1642 Ilizarov wires and 278 half pins; 10% (n = 163) of wires and 7% (n = 19) of half pins had a complication. We recorded 44% (n = 104) minor complications and 9% (n = 22) major complications. Minor complications average (mean) onset was 4 weeks, 89% (n = 93) involved wires, and 73% resolved without additional care. Major complications average (mean) onset was 3.7 weeks. Of these, 32% (n = 7) went on to successful revision. This revealed a significant correlation between minor complications and history of osteomyelitis (p < .05). While minor complications do appear high, this was due to wire irritation and local erythema which resolved without additional intervention. To better assess complications with external fixation the authors believe that wire irritation and pin site erythema should be recognized as an expected outcome. A better understanding of ring external fixation in foot and ankle surgery is vital to appropriate perioperative management and patient care.

Kidney collecting duct cells make vasopressin in response to NaCl-induced hypertonicity.

Vasopressin has traditionally been thought to be produced by the neurohypophyseal system and then released into the circulation where it regulates water homeostasis. The questions of whether vasopressin could be produced outside of the brain and if the kidney could be a source of vasopressin are raised by the syndrome of inappropriate antidiuretic hormone secretion (vasopressin). We found that mouse and human kidneys expressed vasopressin mRNA. Using an antibody that detects preprovasopressin, we found that immunoreactive preprovasopressin protein was found in mouse and human kidneys. Moreover, we found that murine collecting duct cells made biologically active vasopressin, which increased in response to NaCl-mediated hypertonicity, and that water restriction increased the abundance of kidney-derived vasopressin mRNA and protein expression in mouse kidneys. Thus, we provide evidence of biologically active production of kidney-derived vasopressin in kidney tubular epithelial cells.

Podcasting in Medicine: A Review of the Current Content by Specialty.

Background Podcasts and their use in medical education is growing and becoming more popular, all while not knowing what podcasts are available for each specialty. Objectives To ascertain the number of podcasts available by specialty and collect basic characteristics of each podcast.  Methods This was a Google-based, investigational study of medical podcasts by specialty undertaken by all authors from January to June 2019. Search terms included "podcasts in ____", where various specialties were inserted to identify current podcasts. Results Over the course of a six month period, 19 specialties were investigated for podcasting content. Emergency medicine, internal medicine, and pediatrics had the most active podcasts. Obstetrics and gynecology, ophthalmology, and orthopedic surgery have the most inactive podcasts. Neurosurgery was the only specialty searched without any identifiable active podcasts. Conclusions While emergency medicine has a large number of podcasts, both active and available other specialties have less of a selection.

Peroxidasin and eosinophil peroxidase, but not myeloperoxidase, contribute to renal fibrosis in the murine unilateral ureteral obstruction model.

Renal fibrosis is the pathological hallmark of chronic kidney disease (CKD) and manifests as glomerulosclerosis and tubulointerstitial fibrosis. Reactive oxygen species contribute significantly to renal inflammation and fibrosis, but most research has focused on superoxide and hydrogen peroxide (H2O2). The animal heme peroxidases myeloperoxidase (MPO), eosinophil peroxidase (EPX), and peroxidasin (PXDN) uniquely metabolize H2O2 into highly reactive and destructive hypohalous acids, such as hypobromous and hypochlorous acid. However, the role of these peroxidases and their downstream hypohalous acids in the pathogenesis of renal fibrosis is unclear. Our study defines the contribution of MPO, EPX, and PXDN to renal inflammation and tubulointerstitial fibrosis in the murine unilateral ureteral obstruction (UUO) model. Using a nonspecific inhibitor of animal heme peroxidases and peroxidase-specific knockout mice, we find that loss of EPX or PXDN, but not MPO, reduces renal fibrosis. Furthermore, we demonstrate that eosinophils, the source of EPX, accumulate in the renal interstitium after UUO. These findings point to EPX and PXDN as potential therapeutic targets for renal fibrosis and CKD and suggest that eosinophils modulate the response to renal injury.

Misconceptions about health and disease prevention behaviors of rural Appalachian Americans.

BACKGROUND: Appalachia is one of the unhealthiest regions in the United States due to poor disease prevention behaviors. OBJECTIVE: Determine if self-perceived health of rural Appalachians is related to participation in disease prevention behaviors. METHODS: Rural Appalachian adults (n=437) were surveyed regarding their self-perceived health and disease prevention behaviors. Healthy behaviors included: moderate (≥ 90 min/wk) and vigorous (≥ 45 min/wk) physical activity, sugared drink consumption (≤ 1 sugared drink/d), smoking (non-smoker), alcohol consumption (≤ 1 drink/d), blood pressure (≤ 120/80 mm Hg), and fast food consumption (≤ 1 time/wk). Participants were grouped where healthy = (self-health rating > 5 on a 0-10 scale), BMI < 25, and blood pressure (≤ 120/80 mm Hg). Jaccard Binary Similarity (JBS) coefficients and Russell and Rao (RR) dichotomy coefficients determined the association and predictability of self-health ratings and disease prevention behaviors. T-tests determined group differences in the number of disease prevention behaviors. RESULTS: Individuals who reported being healthy had high JBS coefficients for having healthy sugared drink consumption (0.552), not smoking (0.704), low alcohol consumption (0.742), and low fast food consumption (0.481). RR results were similar to JBS results. Not smoking and low alcohol consumption were highly correlated (r=0.87). Those with a good health perception practiced more disease prevention behaviors (mean±SEM, 2.84±0.06) than those with a poor health perception (2.19±0.10, p<0.001). Good health perceptions were not strongly related to obesity and inactivity. CONCLUSIONS: Appalachians are not indifferent about their health. However, Appalachians may not understand how inactivity and obesity relate to disease.

Differential responses of extracellular GABA to intrastriatal perfusions of 3-nitropropionic acid and quinolinic acid in the rat.

Although both quinolinic acid and 3-nitropropionic acid destroy medium sized, GABAergic, spiny projection neurons after direct perfusion of neurotoxin into the rat striatum, changes in extracellular GABA concentration in the striatum within the first 90 min reflect different toxic mechanisms in these two animal models for Huntington's disease. Since quinolinic acid acts as a potent excitotoxin, the early depolarizing response in GABAergic neurons results in an early increase in extracellular GABA activity (peak at 40 min) whereas the more indirect action of 3-nitropropionic acid on mitochondrial energy metabolism results in a delayed increase in extracellular GABA activity (peak at 60 min) with a pattern of gradual increase and decline. The localized delivery of cytotoxin provides an opportunity for kinetic comparisons of direct and indirect cytotoxic mechanisms that can be useful in developing neuroprotective treatment strategies in Huntington's disease.