Complex Polyploids: Origins, Genomic Composition, and Role of Introgressed Alleles.

Introgression allows polyploid species to acquire new genomic content from diploid progenitors or from other unrelated diploid or polyploid lineages, contributing to genetic diversity and facilitating adaptive allele discovery. In some cases, high levels of introgression elicit the replacement of large numbers of alleles inherited from the polyploid's ancestral species, profoundly reshaping the polyploid's genomic composition. In such complex polyploids, it is often difficult to determine which taxa were the progenitor species and which taxa provided additional introgressive blocks through subsequent hybridization. Here, we use population-level genomic data to reconstruct the phylogenetic history of Betula pubescens (downy birch), a tetraploid species often assumed to be of allopolyploid origin and which is known to hybridize with at least four other birch species. This was achieved by modeling polyploidization and introgression events under the multispecies coalescent and then using an approximate Bayesian computation rejection algorithm to evaluate and compare competing polyploidization models. We provide evidence that B. pubescens is the outcome of an autoploid genome doubling event in the common ancestor of B. pendula and its extant sister species, B. platyphylla, that took place approximately 178,000-188,000 generations ago. Extensive hybridization with B. pendula, B. nana, and B. humilis followed in the aftermath of autopolyploidization, with the relative contribution of each of these species to the B. pubescens genome varying markedly across the species' range. Functional analysis of B. pubescens loci containing alleles introgressed from B. nana identified multiple genes involved in climate adaptation, while loci containing alleles derived from B. humilis revealed several genes involved in the regulation of meiotic stability and pollen viability in plant species.

Effect of cationic surfactant on the physicochemical and antibacterial properties of colloidal systems (emulsions and microemulsions).

Colloidal systems have been used to encapsulate, protect and release essential oils in mouthwashes. In this study, we investigated the effect of cetylpyridinium chloride (CPC) on the physicochemical properties and antimicrobial activity of oil-in-water colloidal systems containing tea tree oil (TTO) and the nonionic surfactant polysorbate 80. Our main aim was to evaluate whether CPC could improve the antimicrobial activity of TTO, since this activity is impaired when this essential oil is encapsulated with polysorbate 80. These systems were prepared with different amounts of TTO (0-0.5% w/w) and CPC (0-0.5% w/w), at a final concentration of 2% (w/w) polysorbate 80. Dynamic light scattering (DLS) results revealed the formation of oil-swollen micelles and oil droplets as a function of TTO concentration. Increases in CPC concentrations led to a reduction of around 88% in the mean diameter of oil-swollen micelles. Although this variation was of only 20% for the oil droplets, the samples appearance changed from turbid to transparent. The surface charge of colloidal structures was also markedly affected by the CPC as demonstrated by the transition in zeta potential from slightly negative to highly positive values. Electron paramagnetic resonance (EPR) studies showed that this transition is followed by significant increases in the fluidity of surfactant monolayer of both colloidal structures. The antimicrobial activity of colloidal systems was tested against a Gram-negative (Escherichia coli) and Gram-positive (Staphylococcus aureaus) bacteria. Our results revealed that the inhibition of bacterial growth is observed for the same CPC concentration (0.05% w/w for E. coli and 0.3% w/w for S. aureus) regardless of TTO content. These findings suggest that TTO may not act as an active ingredient in polysorbate 80 containing mouthwashes.

Phylogenetic Analysis of Allotetraploid Species Using Polarized Genomic Sequences.

Phylogenetic analysis of polyploid hybrid species has long posed a formidable challenge as it requires the ability to distinguish between alleles of different ancestral origins in order to disentangle their individual evolutionary history. This problem has been previously addressed by conceiving phylogenies as reticulate networks, using a two-step phasing strategy that first identifies and segregates homoeologous loci and then, during a second phasing step, assigns each gene copy to one of the subgenomes of an allopolyploid species. Here, we propose an alternative approach, one that preserves the core idea behind phasing-to produce separate nucleotide sequences that capture the reticulate evolutionary history of a polyploid-while vastly simplifying its implementation by reducing a complex multistage procedure to a single phasing step. While most current methods used for phylogenetic reconstruction of polyploid species require sequencing reads to be pre-phased using experimental or computational methods-usually an expensive, complex, and/or time-consuming endeavor-phasing executed using our algorithm is performed directly on the multiple-sequence alignment (MSA), a key change that allows for the simultaneous segregation and sorting of gene copies. We introduce the concept of genomic polarization that, when applied to an allopolyploid species, produces nucleotide sequences that capture the fraction of a polyploid genome that deviates from that of a reference sequence, usually one of the other species present in the MSA. We show that if the reference sequence is one of the parental species, the polarized polyploid sequence has a close resemblance (high pairwise sequence identity) to the second parental species. This knowledge is harnessed to build a new heuristic algorithm where, by replacing the allopolyploid genomic sequence in the MSA by its polarized version, it is possible to identify the phylogenetic position of the polyploid's ancestral parents in an iterative process. The proposed methodology can be used with long-read and short-read high-throughput sequencing data and requires only one representative individual for each species to be included in the phylogenetic analysis. In its current form, it can be used in the analysis of phylogenies containing tetraploid and diploid species. We test the newly developed method extensively using simulated data in order to evaluate its accuracy. We show empirically that the use of polarized genomic sequences allows for the correct identification of both parental species of an allotetraploid with up to 97% certainty in phylogenies with moderate levels of incomplete lineage sorting (ILS) and 87% in phylogenies containing high levels of ILS. We then apply the polarization protocol to reconstruct the reticulate histories of Arabidopsis kamchatica and Arabidopsis suecica, two allopolyploids whose ancestry has been well documented. [Allopolyploidy; Arabidopsis; genomic polarization; homoeologs; incomplete lineage sorting; phasing; polyploid phylogenetics; reticulate evolution.].

Clinical prediction tools for identifying antimicrobial-resistant organism (ARO) carriage on hospital admissions: a systematic review.

BACKGROUND: Increasing prevalence of antimicrobial-resistant organisms (AROs) is a growing economic and healthcare challenge. Increasing utilization of electronic medical record (EMR) systems and improvements in computation and analytical techniques afford an opportunity to reduce the spread of AROs through the development of clinical prediction tools to identify ARO carriers on admission to hospital. AIM: To identify existing clinical prediction tools for meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing organisms (CPOs), their predictive performance, and risk factors utilized in these tools. METHODS: The CHARMS checklist was followed. Medline, EMBASE, Cochrane SR, CRD databases (DARE, NHS EED), CINAHL and Web of Science were searched from database inception to 26th July 2021. Full-text articles were assessed independently, and quality assessment was conducted using the Prediction Model Risk of Bias Assessment Tool. FINDINGS: In total, 3809 abstracts were identified and 22 studies were included. Among these studies, risk score models were the most common prediction tool (N=16). Previous admission, recent antibiotic exposure, age and sex were the most common risk factors for ARO carriage. Prediction tools were commonly evaluated on sensitivity and specificity with ranges of 15-100% and 46-98.6%, respectively, for MRSA, and 30-81.3% and 79.8-99.9%, respectively, for CPOs. CONCLUSION: There is no gold standard ARO prediction tool. However, high-performance clinical prediction tools and identification of key risk factors for the early detection of AROs exist. Risk score models are easier to use and interpret; however, with recent improvements in machine learning techniques, highly robust models can be developed with data stored in an EMR.

What's Current and What's New in Mesothelioma?

Malignant mesothelioma is a rare disease with limited treatment options. In malignant pleural mesothelioma (MPM), radical trimodality approaches, including surgery, radiotherapy and systemic chemo- and immunotherapy, have been delivered in some countries but remain controversial due to a lack of randomised evidence. Even in the unresectable scenario, surgery and radiotherapy play an important role in managing pleural effusions and pain, which may optimise wellbeing and maintain performance status. From the systemic treatment point of view, the recent incorporation of anti-angiogenics and, more importantly, immunotherapy has changed the standard of care in a space where chemotherapy with platinum and pemetrexed was the only therapeutic intervention with demonstrated benefits in overall survival. Histology is essential in determining an initial treatment plan as non-epithelioid MPMs may have a higher substantial survival improvement with dual immunotherapy compared with chemotherapy, whereas chemotherapy remains an option for epithelioid MPM; however, predictive biomarkers for systemic therapy are not entirely validated to guide the selection, as a subgroup of MPM patients might not benefit from immunotherapy. This overview approaches how the overall management of mesothelioma is evolving to incorporate the recent changes in the standards of care.

Retrospective analysis of the management strategies for surgical site infection post total hip or knee arthroplasty from tertiary care centres in Edmonton, Alberta.

BACKGROUND: Surgical site infection (SSI) following hip or knee arthroplasty poses a serious health and economic burden. AIM: To evaluate SSI management strategies and outcomes to help address this problem. METHODS: A retrospective cohort study was undertaken of adults undergoing primary total hip or knee arthroplasty who were identified to have a complex SSI by infection prevention and control surveillance audit. Audits identified SSI within 90 days of arthroplasty. Patients at two tertiary referral centres in Edmonton, Alberta, Canada from 2012 to 2019 were included, and SSI cases were followed for 2 years. FINDINGS: In total, 240 SSIs were identified. Of these, 202 (84%) cases were managed with debridement with antibiotics and implant retention (DAIR), of which 71% achieved cure. The use of any topical intra-operative antibiotic in DAIR was not associated with improved outcome (odds ratio 1.68, 95% confidence interval 0.91-3.10; P=0.097). DAIR performed 31-90 days after arthroplasty had a lower chance of cure compared with DAIR performed within 30 days of arthroplasty; however, this difference was not significant (60 vs 73%; P=0.123). Initial treatment failures requiring additional surgery had a 51% cure rate. The majority (78%) of treatment failures initially managed with DAIR ultimately required two-stage revision. CONCLUSIONS: This study provides insight from a population-based perspective into the surgical management of SSI after primary total hip or knee arthroplasty in a large cohort. Additionally, SSIs that had initial management failure were followed. These data can inform future studies, such as the economic burden associated with these infections, and may be used to plan interventions to optimize SSI management.

Radiometric analysis of haze in bright-annealed AISI 430 ferritic stainless steel.

The influence of both topography and optical constants on the optical reflection of bright-annealed AISI 430 ferritic stainless steel has been analyzed to correlate these characteristics with the occurrence of the unwanted haze effect in industrial products. This work reports the analysis of the total-integrated-scattering spectra of bright-annealed AISI 430 ferritic steel plates, on the basis of the microfacet model for the bidirectional reflectance function developed by He and Torrance [Siggraph '91, Proc. of the 18th Annual Conference on Computer Graphics and Interactive Techniques, (1991), p. 175]. Such an approach allows for modeling the optical reflection of these stainless-steel industrial products based on roughness parameters, root-mean square height, and autocorrelation length, derived from scale-limited topographic maps. The functional choice of the cutoff wavelength in the high-pass Gaussian filtering of the topographic map is proven critical. Additionally, optical constants n and k of the steels are estimated based on their total reflection spectra, measured in an 8°/di optical geometry. The results suggest that the haze effect could be due to a non-controlled increase in the thickness of the passive layer during the bright-annealing process.

Pyometra-associated insulin resistance assessment by insulin binding assay and tyrosine kinase activity evaluation in canine muscle tissue.

Diestrus is associated with insulin resistance in bitches and pyometra can further impair insulin sensitivity. This study aimed to compare insulin sensitivity, insulin binding, and tyrosine kinase activity in bitches in anestrus, diestrus, or with pyometra. Patients submitted to elective ovariohysterectomy were divided into anestrus (n = 11) or diestrus (n = 13) according to reproductive history, vaginal cytology, and uterine histology. The group pyometra (n = 8) included bitches diagnosed with the disease based on clinical presentation and abdominal ultrasound findings and further confirmed by uterine histopathology. All patients were submitted to an intravenous glucose tolerance test (IVGTT) before ovariohysterectomy, and rectus abdominis muscle samples were collected during surgery for plasmatic membrane suspension preparation. Muscle-membranes were submitted to cold saturation insulin binding assay for dissociation constant (Kd) and maximum binding capacity (Bmax) determination, as well as exogenous substrate Poly (Glu: Tyr 4:1) phosphorylation assay for basal tyrosine kinase evaluation. Bitches with pyometra showed higher basal insulin (P < 0.001) and higher area under the curve (AUC) for insulin (P = 0.01) and glucose (P < 0.001) response during the IVGTT in comparison with bitches in anestrus or diestrus. Diestrus (P < 0.0001) and pyometra (P = 0.001) were associated with reduced tyrosine kinase activity in comparison with anestrus. No differences were documented in Kd and Bmax results for the low-affinity/high-capacity insulin receptors; however, high-affinity/low-capacity insulin receptors showed higher Kd and Bmax results in bitches in diestrus or with pyometra (P < 0.05) in comparison with anestrus. Despite the pyometra group showed the highest Kd values (P < 0.01), its Bmax results did not differ from the diestrus group (P > 0.05). Diestrus' higher Kd values and reduced tyrosine kinase activity in muscle tissue were compensated by increased total insulin binding capacity. Absent differences in IVGTT results between diestrus and anestrus bitches corroborate this finding. However, in bitches with pyometra, the highest Kd values were not compensated by increased total insulin binding capacity. This finding was associated with insulin resistance and glucose intolerance in IVGTT results. Moreover, pyometra resolution restored insulin sensitivity and glucose tolerance. These features can play a key role in pyometra-associated CDM, as well as in diabetic remission after pyometra resolution.

Incremento del conocimiento en soporte vital básico facilitado por un recurso educativo digital / Basic life support knowledge acquisition using a digital educational resource / Incremento do conhecimento em suporte vital básico facilitado por um recurso educativo digital

Resumen Introducción: La enfermedad cardiovascular es responsable de 17.3 millones de muertes por año en el mundo y conlleva a complicaciones como el paro cardiorrespiratorio, el cual se puede presentar tanto en el escenario intra como extrahospitalario. Tener una comunidad capacitada posibilita la sobrevida y/o mitigación de secuelas. Con el propósito de aumentar la población capacitada en soporte vital básico, favorecer el aprendizaje y dedicar más tiempo al desarrollo de habilidades prácticas, se construyó un recurso educativo digital. Objetivo: Determinar el efecto de un recurso educativo digital en el proceso de aprendizaje de soporte vital básico en integrantes de la comunidad de una institución de educación superior. Métodos: Estudio cuantitativo, pre-experimental tipo pre-prueba/pos-prueba en un solo grupo. Resultados: El recurso educativo digital para el aprendizaje de soporte vital básico en 110 estudiantes incrementó el conocimiento, mostró una diferencia estadísticamente significativa en los resultados del post-test en comparación con el pre-test: p<0.01 para grupos ajustados al modelo gaussiano y p<0.05 para el grupo no ajustado. Discusión: Los resultados de implementar un recurso educativo digital para la enseñanza de soporte vital básico es consecuente con los beneficios hallados en otros estudios similares. Los Objetos Virtuales de Aprendizaje favorecen en los estudiantes la motivación, el aprendizaje autorregulado y la apropiación de conocimientos, por lo que los proponen como estrategia de aprendizaje. Conclusión: El recurso educativo digital favoreció el aprendizaje e incrementó el conocimiento, requisito necesario en la formación como primer respondiente en los tres grupos de estudiantes de pregrado que participaron en el presente estudio.

Abstract Introduction: Cardiovascular diseases are accountable for 17.3 million deaths per year in the world. Cardiac arrests can happen anywhere. Therefore, having a correspondingly trained community can increase the survival chance and decrease the possible aftermath of those suffering complications. Objective: To estimate the effect of using a digital educational resource in the learning process related to basic life support among participants of a higher education institution. Methods: This is a quantitative, pre-experimental, pre-test-post-test study on a single group. Results: The use of a digital educational resource in the learning process related to basic life support increased knowledge acquisition in 110 students, demonstrating a statistically significant difference between the pre-test and post-test levels (p < 0.01 for the gaussian model adjusted group, and p < 0.05 for the unadjusted one). Discussion: These results are consistent with the findings of other similar studies. Since Virtual Learning Objects can foster motivation, self-regulated learning, and knowledge acquisition among students, this methodology is recommended as a complementary learning strategy. Conclusion: The digital educational resource increased knowledge acquisition related to basic life support among the participating students, making them better suited to address possible complications of cardiovascular diseases.

Resumo Introdução: A doença cardiovascular é responsável de 17.3 milhões de mortes por ano no mundo e envolve a complicações como a paragem cardiorrespiratória, o qual se pode apresentar tanto no cenário intra como extra-hospitalar. Ter uma comunidade capacitada possibilita a sobrevida e/ou mitigação de sequelas. Com o propósito de aumentar a população capacitada em suporte vital básico, favorecer a aprendizagem e dedicar mais tempo no desenvolvimento de habilidades práticas, construiu-se um recurso educativo digital. Objetivo: Determinar o efeito de um recurso educativo digital no processo de aprendizagem de suporte vital básico em integrantes da comunidade de uma instituição de educação superior. Métodos: Estudo quantitativo, pre-experimental tipo pre-teste/pos-teste apenas em um grupo. Resultados: O recurso educativo digital para a aprendizagem de suporte vital básico em 110 estudantes incrementou o conhecimento, mostrou uma diferença estatisticamente significativa nos resultados do post-teste em comparação com o pre-teste: p<0.01 para grupos ajustados ao modelo gaussiano e p<0.05 para o grupo não ajustado. Discussão: Os resultados para desenvolver um recurso educativo digital para o ensino de suporte vital básico, é consequente com os benefícios encontrados em outros estudos similares. Os Objetos Virtuais de Aprendizagem favorecem aos estudantes na motivação, na aprendizagem autorregulada e na apropriação de conhecimentos, pelo que os propõem como estratégia de aprendizagem. Conclusão: O recurso educativo digital favoreceu na aprendizagem e incrementou o conhecimento, requerimento necessário na formação como primeiro respondente nos três grupos de estudantes de pré-grau que participar no presente estudo.

Defining microbial invasion of the bloodstream: a structured review.

Background: Microbial invasion of the bloodstream is associated with a major burden of illness. Despite its importance, there is inconsistency in utilization of terms used to define it.Objective: To characterize the contemporary use of terms to define microbial invasion of the bloodstream for surveillance and research purposes.Methods: Structured review of publications reported from 2000 to 2019.Results: The search strategy retrieved 10,095 citations of which bloodstream infection, bacteraemia and fungaemia were included in 2813, 6900 and 1054 articles, respectively. There was a tripling of the number of annual citations during the study and although bacteraemia was most frequent, there was a progressive increase in the use of the term bloodstream infection. Among the 100 reports randomly selected for detailed review, the terms bacteraemia, bloodstream infection and fungaemia were used in 57, 51 and 19 publications, respectively. Explicit definitions for bloodstream infection (26/51; 51%), bacteraemia (13/57; 23%) and fungaemia (7/19; 37%) were included in reports where these terms were used. Although nearly all (95%) of the studies indicated a positive blood culture as an inclusion criteria and/or definition, only a minority indicated means to exclude contaminants (33%) or specific attributes to support clinical significance (38%). Use of explicit definitions was more common among reports that exclusively used the term bloodstream infection as compared to bacteraemia.Conclusions: Terms have been inconsistently defined and imprecisely used to refer to microbial invasion of the bloodstream. Clinically relevant and objective definitions that are widely acceptable are needed for surveillance and research purposes.

Impact of isolation precautions on quality of life: a meta-analysis.

Impact of isolation precautions on psychological wellbeing of patients has yet to be fully quantified. To assess the impact of isolation precautions on patients' health-related quality of life and depression or anxiety scales and estimate per day cost of anxiety and depression. Literature pertaining to impact of isolation precautions was searched on EMBASE and PubMed databases and Google Scholar. A two-step independent screening of the articles was performed. Articles that compared isolated and non-isolated patients using different quality of life and psychological burden scales were included. A meta-analysis was conducted using the Hospital Anxiety and Depression Scales (HADS-A and HADS-D). Psychological burden measures from selected literature were presented in a graph as effect sizes. Per day cost of anxiety and depression was estimated using pooled mean difference from meta-analysis. Out of 106 articles, 94 were excluded due to inclusion criteria, leaving 12 for full text review. After review of full text of the articles, seven articles were shortlisted for empirical analysis and four out of these seven for meta-analysis. The pooled mean difference estimates for HADS-A was -1.4 (P=0.15) and that for HADS-D was -1.85 (P=0.09). In the empirical analysis of psychological burden scales, the effect in all studies except one was negative. Results from meta-analysis and empirical analysis of psychological burden implied that isolated patients are worse off in general. The implied estimated per day cost of anxiety and depression in terms of quality-adjusted life years (QALYs) is approximately US$10.

[Functional and quality of life results after a total knee replacement per year and five years of follow-up]. / Resultados funcionales y de calidad de vida tras una artroplastía total de rodilla al año y cinco años de seguimiento.

INTRODUCTION: Classically the results of any joint replacement surgery are evaluated at a minimum of 5 years. This period could be considered excessive to evaluate the functional results of this procedure. The objective of this study is to compare functional and quality of life results to 1 and five years of follow-up following a total knee replacement (TKR). MATERIAL AND METHODS: Prospective observational study. All patients visited one year after the implantation of TKR were included. All of these filled out the SF-36 questionnaire and the KSS valuation scale. Both were administered again at age five after surgery. RESULTS: 689 patients were initially included in the study (163 men [23.7%] and 526 women [76.3%]) with an average age of 72.2 years. At age 5,585 (84.9%) of these patients were re-analyzed. While the knee section of the KSS scale remained similar in these two periods, the function section of the KSS titration scale showed a slight worsening over time (p = 0.008). With respect to SF-36, the physical summation worsened at five years (p = 0.00) and the mental summation remained stable (n.s.) between the year and five years after surgery. DISCUSSION: Five years after a TKR, the physical exam does not vary from the year of surgery. However, the subjective evaluation measured by the function-KSS section and the physical SF-36, worsen slightly during this period. This could be due to aging patients.

INTRODUCCIÓN: Clásicamente los resultados de cualquier cirugía de reemplazo articular se evalúan en un mínimo de cinco años. Este período podría considerarse excesivo para evaluar los resultados funcionales de este procedimiento. El objetivo de este estudio es comparar los resultados funcionales y de calidad de vida a uno y cinco años de seguimiento tras una artroplastía total de rodilla (ATR). MATERIAL Y MÉTODOS: Estudio prospectivo observacional. Se incluyeron todos aquellos pacientes visitados un año después de la implantación de una ATR. Todos ellos rellenaron el cuestionario SF-36 y la escala de valoración KSS. Ambos fueron administrados nuevamente al cabo de cinco años de la cirugía. RESULTADOS: 689 pacientes fueron incluidos inicialmente en el estudio (163 hombres [23.7%] y 526 mujeres [76.3%]) con una edad media de 72.2 años. A los cinco años, 585 (84.9%) de estos pacientes fueron analizados de nuevo. Mientras que la sección rodilla de la escala KSS se mantenía similar en estos dos períodos, la sección función de la escala de valoración KSS mostraba un leve empeoramiento con el tiempo (p = 0.008). Con respecto al SF-36, el sumatorio físico empeoraba a los cinco años (p = 0.00) y el sumatorio mental se mantenía estable (n.s.) entre un año y cinco años tras la cirugía. DISCUSIÓN: Después de cinco años de una ATR, el examen físico no varía con respecto al año de la cirugía. Sin embargo, la evaluación subjetiva medida mediante la sección función-KSS y el SF-36 físico empeoran ligeramente durante este período. Esto podría ser debido al envejecimiento de los pacientes.

Physiotherapy rehabilitation for osteoporotic vertebral fracture-a randomised controlled trial and economic evaluation (PROVE trial).

The trial compared three physiotherapy approaches: manual or exercise therapy compared with a single session of physiotherapy education (SSPT) for people with osteoporotic vertebral fracture(s). At 1 year, there were no statistically significant differences between the groups meaning there is inadequate evidence to support manual or exercise therapy. INTRODUCTION: To evaluate the clinical and cost-effectiveness of different physiotherapy approaches for people with osteoporotic vertebral fracture(s) (OVF). METHODS: >Prospective, multicentre, adaptive, three-arm randomised controlled trial. Six hundred fifteen adults with back pain, osteoporosis, and at least 1 OVF participated. INTERVENTIONS: 7 individual physiotherapy sessions over 12 weeks focused on either manual therapy or home exercise compared with a single session of physiotherapy education (SSPT). The co-primary outcomes were quality of life and back muscle endurance measured by the QUALEFFO-41 and timed loaded standing (TLS) test at 12 months. RESULTS: At 12 months, there were no statistically significant differences between groups. Mean QUALEFFO-41: - 1.3 (exercise), - 0.15 (manual), and - 1.2 (SSPT), a mean difference of - 0.2 (95% CI, - 3.2 to 1.6) for exercise and 1.3 (95% CI, - 1.8 to 2.9) for manual therapy. Mean TLS: 9.8 s (exercise), 13.6 s (manual), and 4.2 s (SSPT), a mean increase of 5.8 s (95% CI, - 4.8 to 20.5) for exercise and 9.7 s (95% CI, 0.1 to 24.9) for manual therapy. Exercise provided more quality-adjusted life years than SSPT but was more expensive. At 4 months, significant changes above SSPT occurred in endurance and balance in manual therapy, and in endurance for those ≤ 70 years, in balance, mobility, and walking in exercise. CONCLUSIONS: Adherence was problematic. Benefits at 4 months did not persist and at 12 months, we found no significant differences between treatments. There is inadequate evidence a short physiotherapy intervention of either manual therapy or home exercise provides long-term benefits, but arguably short-term benefits are valuable. TRIAL REGISTRATION: ISRCTN 49117867.

Multi-species okadaic acid contamination and human poisoning during a massive bloom of Dinophysis acuminata complex in southern Brazil.

On June 2016, a major bloom of Dinophysis acuminata complex was noticed over the coast of Paraná State (PR), southern Brazil, an area unprotected by any official monitoring program. Here we report the results of an extensive sampling effort that ultimately led PR authorities to issue the first State shellfish-harvesting ban due to multi-species okadaic acid (OA) contamination. During its peak, the bloom covered an area of 201 km2 (∼2.0-3.5 × 54.0 km), attaining unprecedentedly high cell densities along the shallow (<15 m) continental shelf (mean 2.2 × 105, maximum 2.1 × 106 cells L-1) and adjacent sandy beaches (mean 2.8 × 105, maximum 5.2 × 106 cells L-1). Only OA was detected in suspension (max. 188 ng L-1). Toxin levels measured in bivalves were several times greater than the regulatory limit of 160 ng g-1, reaching up to 3600 ng g-1 in Crassostrea gasar, by far the highest OA concentrations ever reported in oysters worldwide, 7700 ng g-1 in brown mussels, Perna perna, and lower levels in clams, Anomalocardia brasiliana, and mangrove mussels, Mytella spp. Nine cases of human intoxication were officially reported and five people were hospitalized with typical symptoms of Diarrhetic Shellfish Poisoning linked to the consumption of contaminated bivalves. All bivalves quickly converted most of the OA into its esterified form, DTX-3, and eliminated the toxins only a few weeks following the bloom, with C. gasar being the slowest-detoxifying species. Lower OA levels were accumulated in zooplankton, gastropods and several novel toxin vectors, including benthic organisms such as sand dollars Mellita quinquiesperforata and the ghost-shrimp Callichirus major, which may act as a good indicator of the presence of toxins in sandy beaches, and pelagic fish species that can serve as potential alternative sources of OA to humans (Chaetodipterus faber and Mugil liza). Monitoring toxin contamination in seafood other than bivalves is thus recommended to ensure comprehensive human health protection during massive Dinophysis blooms. Additionally, since OA was also present at low concentrations in the liver of Guiana dolphins Sotalia guianensis and penguins Spheniscus magellanicus, exposure to biotoxins should be considered in conservation actions involving threatened and near-threatened marine organisms in this region.

Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man".

OBJECTIVE: We aimed to test whether a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) had an impact on patient outcomes. DESIGN: Natural-experiment (April 2008-December 2016). Interrupted time-series regression assessed impact on trends before-during-after ERAS implementation. SETTING: Primary operations from the UK National Joint Registry (NJR) were linked with Hospital Episode Statistics (HES) data which contains inpatient episodes undertaken in National Health Service (NHS) trusts in England, and Patient Reported Outcome Measures (PROMs). PARTICIPANTS: Patients undergoing primary planned TKR aged ≥18 years. INTERVENTION: ERAS implementation (April 2009-March 2011). OUTCOMES: Regression coefficients of monthly means of Length of stay (LOS), bed day costs, change in Oxford knee scores (OKS) 6-months after surgery, complications (at 6 months), and rates of revision surgeries (at 5 years). RESULTS: 486,579 primary TKRs were identified. Overall LOS and bed-day costs decreased from 5.8 days to 3.7 and from £7607 to £5276, from April 2008 to December 2016. Oxford knee score (OKS) change improved from 15.1 points in April 2008 to 17.1 points in December 2016. Complications decreased from 4.1 % in April 2008 to 1.7 % in March 2016. 5-year revision rates remained stable at 4.8 per 1000 implants years in April 2008 and December 2011. After ERAS, declining trends in LOS and bed costs slowed down; OKS improved, complications remained stable, and revisions slightly increased. CONCLUSIONS: Different secular trends in outcomes for patients having TKR have been observed over the last decade. Although patient outcomes are better than a decade ago ERAS did not improve them at national level.

[Biometric analysis of the Spanish studies on neurorehabilitation in cases of stroke indexed in Medline (2008-2017)]. / Analisis bibliometrico de las investigaciones españolas sobre neurorrehabilitacion en el ictus indizadas en Medline (2008-2017).

TITLE: Analisis bibliometrico de las investigaciones españolas sobre neurorrehabilitacion en el ictus indizadas en Medline (2008-2017).

Predictors of mortality and length of stay in patients with hospital-acquired Clostridioides difficile infection: a population-based study in Alberta, Canada.

In a population-based, five-year retrospective cohort study of 5304 adult patients with hospital-acquired Clostridioides difficile infection across Alberta (N=101 hospitals), 30-day all-cause and attributable mortality were 12.2% and 4.5%, respectively. Patients >75 years of age had the highest odds of attributable mortality (odds ratio (OR) 9.34, 95% confidence interval (CI) 2.92-29.83) and largest difference in mean length of stay (11.7 days, 95% CI 8.2-15.2). A novel finding was that elevated white blood cell count at admission was associated with reduced attributable mortality (OR 0.67, 95% CI 0.50-0.90) which deserves further study. Advancing age was incrementally and significantly associated with all outcomes.