How data on transformation products can support the redesign of sulfonamides towards better biodegradability in the environment

Sulfonamide antibiotics (SUAs) released into the environment can affect environmental und human health, e.g., by accelerating the development and selection of antimicrobial resistant bacteria. Benign by Design (BbD) of SUAs is an effective risk prevention approach. BbD principles aim for fast and complete mineralization or at least deactivation of the SUA after release into the aquatic environment. Main objective was to test if mixtures of transformation products (TPs) generated via photolysis of SUAs can be used as an efficient way to screen for similarly effective but better biodegradable SUA alternatives. Six SUAs were photolyzed (Hg ultraviolet (UV) light), and generated UV-mixtures analysed by high performance liquid chromatography coupled to an UV and tandem mass spectrometry detector. UV-mixtures were screened for antibiotic activity (luminescence bacteria test, LBT, on luminescence and growth inhibition of Aliivibrio Fischeri) and environmental biodegradability (manometric respirometry test, MRT, OECD 301F) using untreated parent SUAs in comparison. Additionally, ready environmental biodegradability of three commercially available hydroxylated sulfanilamide derivatives was investigated. SUA-TPs contributed to acute and chronic bacterial luminescence inhibition by UV-mixtures. LBT's third endpoint, growth inhibition, was not significant for UV-mixtures. However, it cannot be excluded for tested TPs as concentrations were lower than parents' concentrations and inhibition by most parental concentrations tested was also not significant. HPLC analysis of MRT samples revealed that one third of SUA-TPs was reduced during incubation. Three of these TPs, likely OH-SIX, OH-SMX and OH-STZ, were of interest for BbD because the sulfonamide moiety is still present. However, hydroxylated sulfanilamide derivatives, tested to investigate the effect of hydroxylation on biodegradability, were not readily biodegraded. Thus, improving mineralization through hydroxylation as a general rule couldn't be confirmed, and no BbD candidate could be identified. This study fills data gaps on bioactivity and environmental biodegradability of SUAs' TP-mixtures. Findings may support new redesign approaches.

Assessment of α9β1 ıntegrın as a new dıagnostıc and therapeutıc target ın Behcet's dısease

This study aimed to investigate the roles of α9β1 integrin and its ligands in Behçet's disease (BD) by examining serum levels and gene expressions. 15 healthy controls and 30 BD patients (14 active and 16 inactive) were included in the study. Serum levels of ITGA9, ITGB1, TNC, OPN, VCAM-1, VEGF, TSP1, TGM2, Emilin-1, and vWF, were measured by ELISA. Gene expressions of α9β1 (ITGA9 and ITGB1) and its ligands (TNC and SPP1) were evaluated by RT-PCR. Laboratory findings (CRP, ESR, HGB, WBC, RBC, neutrophil, lymphocyte, PLT, RDW, MPV, PCT, and HLA-B51) were obtained from the electronic database. Active BD patients had higher serum levels of α9β1 integrin and its ligands than inactive patients and healthy controls. No significant difference was observed between healthy controls and inactive patients. Gene expressions of ITGB1 and SPP1 were increased in both patient groups compared to healthy controls. ITGA9 and TNC gene expression levels were lower in the active group than in the inactive group. No noticeable differences were found in ITGB1 and SPP1 gene expressions between the patient groups. BD patients exhibited elevated CRP, ESR, WBC, neutrophil, PLT, and PCT levels, while HGB, RBC, and RDW values were lower than healthy controls. Active patients had higher CRP, ESR, WBC, neutrophil, and PLT levels. Significant positive correlations were found between CRP, ESR, WBC, neutrophil, PLT, PCT and serum levels of α9β1 integrin and its ligands. Increased release of α9β1 integrin and its ligands is associated with BD, suggesting their potential as markers for disease severity.

Dataset of 15-minute values of active and reactive power consumption of 1000 households during single year

This article presents a comprehensive dataset comprising average 15-minute values of active and reactive energy consumption in 1000 anonymized households located in the Slovak Republic, a central European country, throughout the year 2016. The dataset provides a valuable resource for researchers and practitioners interested in analysing energy consumption patterns at the individual household level within the unique context of Central Europe. Privacy concerns are addressed through anonymization techniques, ensuring the dataset's compliance with ethical considerations and privacy regulations. However, ZIP code information is included for each household. Researchers can confidently analyze the data without compromising the households' confidentiality. The dataset offers significant opportunities for researchers to explore energy consumption patterns, develop targeted energy management strategies, and contribute to the advancement of sustainable energy practices.

Associations of accelerometer-measured sedentary behavior and physical activity with sleep in older adults

BACKGROUND

Few studies have examined the non-linear relationships of objectively-measured sedentary behavior and physical activity with insomnia symptoms in older adults. We investigated such relationships of sedentary and physically-active behaviors with total sleep time and nocturnal wakefulness.

METHODS

We recruited adults aged 60 years and above who have received health check-ups or been to geriatric outpatient services from a hospital setting. Sedentary and physically-active behaviors, total sleep time, and wakefulness time after sleep onset were measured by Actigraphy, and their relationships were estimated using generalized additive models.

RESULTS

The 157 older adults receiving health-related services slept 7.5 h (20.8 min awake) on average per day. Total sleep time was negatively associated with sedentary and physically-active behaviors. By contrast, a U-shape relationship was found between sedentary behavior and wakefulness time after sleep onset, with a turning point at a daily sedentary time of 10.9 h.

CONCLUSION

Longer high-intensity physical activity time was related to a shorter wakefulness time after sleep onset. By contrast, daily sedentary time longer than 10.9 h was related to shorter total sleep time but more nocturnal wakefulness time. Future nonpharmacological strategies for sleep improvement should consider the sedentary threshold.

Testing of Novel Total Elbow Prostheses Using Active Motion Experimental Setup

PURPOSE

The goal of this study was to test a novel uncemented and unconstrained total elbow arthroplasty (Kaufmann total elbow) design that is stabilized through a ligament reconstruction.

METHODS

We quantified the implant stability after 25,000 cycles, which represents the time between implantation and when ligament and bone healing has occurred. We used an active motion experimental setup that applies tendon loads via pneumatic cylinders and reproduces the forearm-originating dynamic stabilizers of the elbow. The novel total elbow arthroplasty was actuated for 5,000 full flexion-extension cycles at 5 different shoulder positions. Four Sawbones and 4 cadaver elbows were employed. Angular laxity and implant stability were recorded prior to testing and after each 5,000-loading cycle.

RESULTS

Four Sawbones and 4 cadaver elbows were implanted with the uncemented total elbow arthroplasty and did not demonstrate fixation failure or substantial laxity after 25,000 cycles of loading imparted at different shoulder positions.

CONCLUSIONS

Our findings demonstrate that the Kaufmann total elbow replacement implanted into cadaver and Sawbones specimens did not exhibit fixation failure or excessive laxity after 25,000 cycles.

CLINICAL RELEVANCE

An uncemented, nonmechanically linked total elbow arthroplasty that gains component fixation using intramedullary screws and employs a ligament reconstruction to stabilize the elbow has the potential to be a valuable management option, particularly in younger patients.

Learning curve for active robotic total knee arthroplasty

PURPOSE

Total Knee Arthroplasty (TKA) procedures incorporate technology in an attempt to improve outcomes. The Active Robot (ARo) performs a TKA with automated resections of the tibia and femur in efforts to optimize bone cuts. Evaluating the Learning Curve (LC) is essential with a novel tool. The purpose of this study was to assess the associated LC of ARo for TKA.

METHODS

A multi-center prospective FDA cohort study was conducted from 2017 to 2018 including 115 patients that underwent ARo. Surgical time of the ARo was defined as Operative time (OT), segmented as surgeon-dependent time (patient preparation and registration) and surgeon-independent time (autonomous bone resection by the ARo). An average LC for all surgeons was computed. Complication rates and patient-reported outcome (PRO) scores were recorded and examined to evaluate for any LC trends in these patient related factors.

RESULTS

The OT for the cases 10-12 were significantly quicker than the OT time of cases 1-3 (p < 0.028), at 36.5 ± 7.4 down from 49.1 ± 17 min. CUSUM and confidence interval analysis of the surgeon-dependent time showed different LCs for each surgeon, ranging from 12 to 19 cases. There was no difference in device related complications or PRO scores over the study timeframe.

CONCLUSION

Active Robotic total knee arthroplasty is associated with a short learning curve of 10-20 cases. The learning curve was associated with the surgical time dedicated to the robotic specific portion of the case. There was no learning curve-associated device-related complications, three-dimensional component position, or patient-reported outcome scores.

LEVEL OF EVIDENCE

Level II.

Physical activity before and during pregnancy and maternal mental health: A systematic review and meta-analysis of observational studies

OBJECTIVE

To examine the influence of physical activity before and during pregnancy on maternal mental health outcomes.

METHODS

Ten electronic databases were searched up to May 11, 2021. Studies of all observational designs (except case studies and reviews) were included, which contained information on the relevant population (women before and or during pregnancy), exposures (objective or subjective measures of physical activity), comparator (low or no physical activity), and outcomes (diagnosis and symptom severity of depression or anxiety, quality of life scores, stress and emotions).

RESULTS

Forty-four observational studies (N = 132,399) were included. 'Low' to 'very low' certainty evidence revealed that compared with low levels of PA during pregnancy, high levels of PA were associated with a reduced odds of developing prenatal depression (odds ratio (OR): 0.68, 95% confidence interval (CI): 0.58 to 0.80) and anxiety (OR: 0.67, 95% CI: 0.54 to 0.83). We also found a reduction in the severity of prenatal depressive symptoms (standardized mean difference (SMD): -0.37, 95% CI -0.57 to -0.17), prenatal anxiety symptoms (SMD: -0.45, 95% CI -0.64 to -0.27), and prenatal stress (SMD: -0.33, 95% CI -0.55 to -0.11), concurrent with improved quality of life (SMD: 0.38, 95% CI 0.23 to 0.54). PA before pregnancy did not impact the outcomes of interest.

CONCLUSION

Physical activity during pregnancy is associated with a reduction in the odds and severity of prenatal depression and anxiety, as well as reduced stress and improved quality of life. PROSPERO registration number: CRD42020208469.

Advanced design techniques in passive and active tubular solar stills: a review

Clean water production using green energy supply plays a significant role in the globe's health and economic development. In recent years, so much importance is given on developing the advanced designs of solar stills to improvise the productivity of conventional solar stills. Tubular solar stills (TSSs) are one of the emerging areas to improve clean water productivity. This paper's main aim is detailed review of passive and active tubular solar still design specifications and highlighting the specific merit of each design. The common tube materials in passive and active TSS are glass, stainless Steel 304, vinyl chloride, flexi glass, poly carbonate, and poly ethylene with variation in thickness from 0.07 to 2.5 mm. Diameter of the tube varied from 50 to 280 mm in both the cases. Also, the monetary analysis of TSS is discussed, and the average price of water for passive and active tubular solar still is $0.022 and $0.027 per liter of water. Future perspectives also included in the conclusion section for the possible design and material improvements one can do to enhance the performance of the TSS for the benefit of researches. The excellent cover material for TSS is polythene film when compared to the vinyl chloride sheet. TSS with PCM, wick materials, and corrugated absorber enhance productivity during night time. Multi-effect tubular stills performed 28.70% better in comparison to single-effect stills, and TSSs with horizontal axis are 19.12% more productive than vertical axis tubular stills.

Deciphering the conformational transitions of LIMK2 active and inactive states to ponder specific druggable states through microsecond scale molecular dynamics simulation

LIMK2 inhibitors are one of the potential therapeutic modalities for treating various diseases. In the current scenario, there is a paucity of effective LIMK inhibitors that are highly specific with minimal off-target effects. To date, the conformational transitions of LIMK2 from DFG_inαC_in (CIDI) (active) to DFG_outαC_out (CODO) (inactive) states are yet to be probed and are essential for capturing the unique, druggable conformations. Therefore, this study was intended to capture the diverse conformational states of LIMK2 for accelerating the rational identification of conformation specific inhibitors through high-end structural bioinformatics protocols. Hence, in this study, molecular modelling followed by an extensive microsecond timescale of molecular dynamics simulation was performed encompassing perturbation response scanning, metapath, and community analysis towards the conformational sampling of LIMK2. Overall this study precisely identifies the conformational ensemble of LIMK2 the intermediate inactive states namely, CIDO, CinterDinter, CIDinter, CinterDI, CinterDO, CODI, CODinter apart from CIDI and CODO. This also facilitated observing that β8 preceding XDFG, αC (F373, L374), and αD (L413) as the major effectors that may facilitate the regulation of varying conformational transitions among the states. Additionally, the conserved β sheets and the loops namely, C.l, b.l, and G/P.loop were observed to be involved in the metapath for allosteric communication among the intermediates with CIDI and CODO state. Moreover, only the CODO state was observed to have closed type A.l, while the CIDI and other intermediate states except for CIDO were observed to have open-DFG out type A.l, thereby enabling the binding of substrate. Apart from these, the druggable site analysis inferred that the CIDI and CODO states harbor prominent druggable sites spanning the conserved N-lobe, while the intermediates were observed to have unraveled allosteric druggable sites distal from the ATP binding site, majorly spanning the C-lobe of LIMK2. Thus, this study provides potential insights into the intermediate conformational druggable states of LIMK2 and also the druggable conformations, especially the inactive states of LIMK2, as a specific therapeutic targeting mode. Thus, providing a widened avenue to ponder the allosteric sites or the isoform selectivity conformations for targeting LIMK2 in various disease conditions.

Tuberculosis contact tracing yield and associated factors in Uganda

BACKGROUND

The yield of tuberculosis (TB) contact tracing is historically low in Uganda. We determined factors associated with a positive contact tracing yield at an urban public TB clinic in Kampala, Uganda.

METHODS

We reviewed contact tracing registers of index TB cases registered between 2015 and 2020 at Kitebi Health Center, a primary level facility. Contacts who had symptoms of TB were designated as having presumptive TB. A contact investigation that yielded a new TB case was designated as a positive yield. We used logistic regression to determine factors associated with a positive yield of contact tracing.

RESULTS

Of 778 index TB cases, 455 (58.5%) had a contact investigation conducted. Index cases with a telephone contact in the unit TB register (adjusted odds ratio (aOR) 1.66, 95% CI 1.02-1.97, p = 0.036) were more likely to have a contact investigation conducted than those who did not. Of 1350 contacts, 105 (7.8%) had presumptive TB. Of these, 73 (69.5%) were further evaluated for active TB and 29 contacts had active TB. The contact tracing yield for active TB was therefore 2.1% (29/1,350). The odds of a positive yield increased tenfold with each additional presumptive contact evaluated for active TB (aOR 10.1, 95% CI 2.95-34.66, p < 0.001). Also, retreatment index TB cases were more likely to yield a positive contact (aOR 7.69 95% CI 2.08-25.00, p = 0.002) than to new cases.

CONCLUSION

TB contact tracing should aim to evaluate all contacts with presumptive TB and contacts of retreatment cases to maximise the yield of contact tracing.

Association of physical activity on blood glucose in individuals with type 2 diabetes

Regular physical activity (PA) has been shown to improve glycemic control in persons with type 2 diabetes. This study aimed to investigate the impact of PA on blood glucose after controlling for medication use, demographics, and week of activation using a real-world population of individuals with type 2 diabetes. A longitudinal, retrospective study was performed evaluating weekly PA of Livongo members (N = 9,509), which analyzed fasting blood glucose (FBG), step counts, and daily active minutes. Linear mixed-effect modeling technique was used to investigate within member and between member effects of input variables on average weekly FBG. Of members enrolled, 6,336 (32%) had self-reported body mass index, qualified week with diabetes medications, and FBG measures. Members' baseline average age was 49.4 (SD 10.1) years old, 43% female, and 45,496 member weeks with an average of 7.2 qualified weeks (PA observable in ≥4 days) per member. Average weekly FBG was 140.5 mg/dL (SD 39.8), and average daily step counts were 4,833 (SD 3,266). Moving from sedentary (<5,000 steps per day) to active (≥5,000 steps per day) resulted in mean weekly FBG reduction of 13 mg/dL (95% CI: -22.6 to -3.14). One additional day of ≥8,000 steps reduced mean weekly FBG by 0.47 mg/dL (95% CI: -0.77 to -0.16). Members who completed 30 min of moderate to vigorous PA above the population average reduced mean weekly FBG by 7.7 mg/dL (95% CI: -13.4 to -2.0). PA is associated with a mean weekly FBG reduction of 13 mg/dL when changing from a sedentary to active lifestyle while participating in a remote diabetes monitoring program.

Understanding children's preference for park features that encourage physical activity: an adaptive choice based conjoint analysis

Background

Parks are a key setting for physical activity for children. However, little is known about which park features children prefer and which features are most likely to encourage them to be active in parks. This study examined the relative importance of park features among children for influencing their choice of park for engaging in park-based physical activity.

Methods

Children (n = 252; 8-12 years, 42% male) attending three primary schools in Melbourne, Australia completed a survey at school. They were required to complete a series of Adaptive Choice-Based Conjoint analysis tasks, with responses used to identify the part-worth utilities and relative importance scores of selected park features using Hierarchical Bayes analyses within Sawtooth Software.

Results

For the overall sample and both boys and girls, the most important driver of choice for a park that would encourage them to be active was presence of a flying fox (overall conjoint analysis relative importance score: 15.8%; 95%CI = 14.5, 17.1), followed by a playground (13.5%; 95%CI = 11.9, 15.2). For the overall sample, trees for climbing had the third highest importance score (10.2%; 95%CI = 8.9, 11.6); however, swings had 3rd highest importance for girls (11.1, 95%CI = 9.3, 12.9) and an obstacle course/parkour area had the 3rd highest importance score for boys (10.7, 95%CI = 9.0, 12.4). For features with two levels, part-worth utility scores showed that the presence of a feature was always preferred over the absence of a feature. For features with multiple levels, long flying foxes, large adventure playgrounds, lots of trees for climbing, large round swings, large climbing equipment, and large grassy open space were the preferred levels.

Conclusion

To ensure parks appeal as a setting that encourages children to engage in physical activity, park planners and local authorities and organisations involved in park design should prioritise the inclusion of a long flying fox, large adventure playgrounds, lots of trees for climbing, large round swings and obstacle courses/parkour areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01203-x.

Effects of active and passive modified atmosphere packaging on biochemical properties of cut Dendrobium orchid flowers

Optimal storage conditions are essential to preserving the quality of postharvest produce and cut flowers during transportation, especially to overseas destinations. As a result, this research investigated the effects of active and passive modified atmosphere packaging (MAP) on the biochemical properties of cut Dendrobium Sonia orchid flowers. In active MAP, the orchid flowers were wrapped in MAP plastic film filled with 5 % carbon dioxide (CO₂) and 2 % oxygen (O₂). Meanwhile, in passive MAP the flowers were stored inside MAP plastic film without filling with 5 % CO₂ and 2 % O₂. The experimental MAP plastic films were polyethylene, low density polyethylene, high density polyethylene, polypropylene, and polyvinyl chloride films. The biochemical parameters included storage life, respiration rate, ethylene production, internal O₂ and CO₂, anthocyanin content, protein degradation, and electrolyte leakage. The results showed that the average storage life of orchid flowers under passive MAP condition was 9–15 days, depending on the plastic film types. The longest storage life of 15.66 days was achieved with polypropylene film. The storage life of orchid flowers in active MAP was 9.33 days on average. Without MAP (control), the storage life was 7 days under normal atmosphere condition (0.03 % CO₂ and 21 % O₂). The experiments also demonstrated that MAP efficiently reduced respiration rate, ethylene production, anthocyanin degradation, protein degradation, and electrolyte leakage. Unlike existing research on MAP which focused primarily on extending the shelf life of fresh produce or cut flowers, this study comparatively investigated the biochemical properties of cut orchid flowers stored in MAP environment, in addition to the storage life.

Comparison of clinical and paraclinical characteristics of patients with urge, mixed, and passive fecal incontinence: a systematic literature review

PURPOSE

Two subgroups of fecal incontinence (FI) are described in literature and used in clinical practice. However, the pertinence of this classification of FI is still unknown as there are no clear established guidelines. To a better understanding, we performed a systematic review to characterize the different types of FI (active, passive, or mixed) on the basis of clinical presentation and complementary explorations.

METHODS

This systematic literature review was performed in reference to recommendations for systematic review using PRISMA guidelines without date restriction, until May 2020. This systematic review was performed without temporal limitation using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases.

RESULTS

Six hundred nine unique citations were identified from all the databases combined. Of those, 21 studies met the inclusion criteria, with 8 retrospective observational studies and 13 prospective observational studies. There was a lack of homogeneity in definitions of passive and urge (active) FI among studies. Prevalence of passive and urge FI was respectively of 4.0-5.0 and 15.0-35.0%. Clinical characteristics, physical examination, and endoanal imaging were not evaluated in most studies. In anorectal manometry, maximal squeeze pressure was higher in passive FI subgroup in most studies and results regarding maximal resting pressure remain discordant. There seemed to be no difference regarding first sensation volume and maximal tolerable volume among subgroups. A few studies evaluated pudendal terminal nerve motor latency with no difference among subgroups.

CONCLUSION

There is a lack of well-conducted prospective studies comparing the different subtypes of FI with validated definitions in both clinical and paraclinical examinations.

Actions to enhance interactive learning in surgery

Introduction

Many educational institutions and academic organizations provide concise and highly organized educational material for the trainees and training programs, while others do not. The role of interactive technology-enhanced learning in surgical education is not entirely explored and disseminated despite common knowledge of such interactive educational technology. Utilizing such technology in the place of textbooks could replace a peer trainee and a teacher examiner.

Evidence

Maximizing involvement, participation, and interactivity from both surgical trainees and their faculty has been shown to improve the quality and outcomes of surgical education. Given that there is an increasing trend towards shifting from traditional unidirectional teaching to learner-centered interactive teaching. Improving the educational activities setting from the traditional – didactic unidirectional lecture to multi-directional, interactive, engaging, and stimulating activity can enhance learners' educational outcomes. With the advent of educational technology, interactive and shared learning became more feasible and creative. Various educational technology platforms, instructional designs, and tools serve different educational purposes guided by educational activity's objective. Educational systems have integrated numerous widely technologies such as smartphones, tablets, and cloud-based services that greatly facilitate instructional strategies and teaching methods. Many institutions and programs have embraced the new technologies to enhance the overall learning process. Educational technology offers new concepts and applications in learning beyond faster communication or storage of digital resources. Furthermore, active and interactive learning in surgical education has been found to carry a strong and implied impact depending on how it is structured. To enhance and promote interactive surgical education on a broad scale, the following initiatives will be reviewed; interactive adult learning worldwide, wide sharing of knowledge and skills, and use of educational technology where it is pertinent.

Conclusion

Residents and surgical training programs need assistance with the process of learning amid ongoing technological innovations. This guidance would leverage the training programs' educational efforts toward effective surgery training. Interactive educational learning technology is expected to fulfill this need by promoting knowledge sharing, skills learning to enhance educational outcomes.

•

With the widespread use of educational technologies, there is less emphases on interactive learning in surgery.

•

Interactive learning in surgical education carries a substantial educational impact depending on how it is structured.

•

Initiatives are proposed to enhance interactive surgical education.

Enhancement strategies for transdermal drug delivery systems: current trends and applications

Transdermal drug delivery systems have become an intriguing research topic in pharmaceutical technology area and one of the most frequently developed pharmaceutical products in global market. The use of these systems can overcome associated drawbacks of other delivery routes, such as oral and parenteral. The authors will review current trends, and future applications of transdermal technologies, with specific focus on providing a comprehensive understanding of transdermal drug delivery systems and enhancement strategies. This article will initially discuss each transdermal enhancement method used in the development of first-generation transdermal products. These methods include drug/vehicle interactions, vesicles and particles, stratum corneum modification, energy-driven methods and stratum corneum bypassing techniques. Through suitable design and implementation of active stratum corneum bypassing methods, notably microneedle technology, transdermal delivery systems have been shown to deliver both low and high molecular weight drugs. Microneedle technology platforms have proven themselves to be more versatile than other transdermal systems with opportunities for intradermal delivery of drugs/biotherapeutics and therapeutic drug monitoring. These have shown that microneedles have been a prospective strategy for improving transdermal delivery systems.

Atomic Force Microscopy Reveals Membrane Protein Activity at the Single Molecule Level

Atomic force microscopy has emerged as a valuable complementary technique in membrane structural biology. The apparatus is capable of probing individual membrane proteins in fluid lipid bilayers at room temperature with spatial resolution at the molecular length scale. Protein conformational dynamics are accessible over a range of biologically relevant timescales. This chapter presents methodology our group uses to achieve robust AFM image data of the General Secretory system, the primary pathway of protein export from the cytoplasm to the periplasm of E. coli. Emphasis is given to measuring and maintaining biochemical activity and to objective AFM image processing methods. For example, the biochemical assays can be used to determine chemomechanical coupling efficiency of surface adsorbed translocases. The Hessian blob algorithm and its extension to nonlocalized linear features, the line detection algorithm, provide automated feature delineations. Many of the methods discussed here can be applied to other membrane protein systems of interest.

First United Kingdom experience of the novel Osia active transcutaneous piezoelectric bone conduction implant

PURPOSE

Bone conduction hearing devices are widely used and indicated in cases of conductive, mixed or single-sided deafness where the conventional hearing aids are not indicated or tolerated. This prospective study aims to investigate the surgical and hearing outcomes of a novel active piezoelectric transcutaneous bone conduction device (t-BCD).

METHODS

Prospective data were collected from the first 10 patients who underwent implantation with the t-BCD Osia (Cochlear, Australia) (between Dec 2018 and March 2019) in a tertiary referral centre. The main outcome measures include: surgical outcome, free field speech testing with speech recognition thresholds, audiological gain and patient-reported outcomes including the 'Glasgow Benefit Inventory' (GBI) and the 'Client Oriented Scale of Improvement (COSI).

RESULTS

The mean length of surgery was 70.6 min (range 50-87, SD = 9.5). Mean skin thickness measured was 5.6 mm (range 4-8, SD = 1.1). There were two post-operative wound infections which settled conservatively. One required revision surgery to thin skin. The average gain in hearing with the implant was + 39.4 dB. Pre-implantation mean unaided SRT was 38.1 dB (SD = 7.8) and the post-implantation mean-aided SRT was 22.7 dB (SD = 4.6) (p = 0.000078). There was improvement in COSI domains. The mean Glasgow disability score dropped from 52% pre-implantation to 20% post-implantation (p = 0.001).

CONCLUSIONS

This new active t-BCHD provides excellent audiological gain and improvement in speech recognition. Patient-reported outcomes have also been very positive. The surgery was straightforward with no major surgical complications reported. Further studies will be required to examine long-term outcomes in larger number of patients.

All bursts are equal, but some are more equal (to burst firing): burstDR stimulation versus Boston burst stimulation

Introduction: Since the introduction of burst spinal cord stimulation for neuropathic pain, several companies have developed their own version of burst stimulation, which is confusing the marketplace and clinicians of what burst stimulation truly is, the value and utilization of the therapy.Areas covered: We review those two burst stimulation designs and notice important differences. The original burstDR^TM stimulation tries to mimic physiologic burst firing, which involves closely spaced high frequency sodium spikes nested on a calcium mediated plateau. This is realized by generating a train of 5 monophasic spikes of increasing amplitude with passive charge balance after the last spike, in contrast to the other burst designs which involve a version of cycling 4-5 spikes each being individually actively charge balanced spikes.Expert opinion: Based on the neurobiology of burst firing as well as abductive reasoning we like to clarify that burstDR^TM is a true physiologic burst stimulation, and that other versions being called burst stimulation are essentially clustered tonic stimulation. This differentiating terminology will prevent confusion for healthcare providers, regulators, and the marketplace of what burst stimulation is.

The genomic survey of Tc1-like elements in the silkworm microsporidia Nosema bombycis

BACKGROUND

Microsporidia Nosema bombycis is the destructive pathogen in the production of sericulture. The Tc1/mariner elements belong to important component of DNA transposon.

METHODS

The genomic data of N. bombycis and related Nosema species were screened to identify the Tc1-like elements and analyzed the phylogenetic relationship, based on bioinformational analysis. High-throughput data of transcriptomes and small RNAs were used to evaluate the expressed level and potential rasiRNAs for the Tc1-like elements of N. bombycis.

RESULTS

Twelve complete Tc1-like elements belonging to DD34,E clade is confirmed in the whole genome of N. bombycis, and divided into two branches. Six of them are sole in N. bombycis and thereby would be the molecular marker to differentiate this species from others Nosema spp. Most of the elements have the transcriptional active and are the source of sRNAs.

CONCLUSION

Abundant Tc1-like elements in N. bombycis reflect the expansion of transposons for this genomic characters, comparing with others Nosema spp. The finding of distribution, phylogeny and potential functional activity for Tc1Nbs in N. bombycis will help understanding the role of the DNA transposon in genomic evolution of microsporidia.

Pulmonary tuberculosis: An analysis of isolation practices and clinical risk factors in a tertiary hospital

BACKGROUND

Inadequate isolation of patients with active pulmonary tuberculosis causes exposure whereas over-cautious isolation generates time and cost inefficiencies. This study aims to ascertain the delays involved in isolating subjects and the importance of risk factors.

METHODS AND MATERIAL

Between December 2010 and January 2013, a retrospective analysis of 271 subjects was performed. Information was obtained from discharge letters, radiological and microbiological results.

RESULTS

The median time taken to isolate subjects was 0 days, and 71.7% were isolated within 1 day. Most subjects (75.3%) had sputum samples obtained after isolation, of which 14.7% were positive. The median time from admission to first sputum sample was 1 day. Smear was negative in 174 subjects (85.3%). Country of birth (high or low risk) did not significantly affect sputum positivity (25.5% vs 19.4%, p=0.52). Suspicious radiological findings were noted in 38.6% subjects, and 32.8% had a suspicious clinical history. Subjects with both clinical and radiological probability had more sputum positivity (46.2%), compared to subjects who had neither (2.7%).

CONCLUSION

There are delays with isolation and diagnosis of subjects with a high probability of tuberculosis. Clinical and radiological probability were more significant in predicting sputum positivity than country of birth.

Byssinosis and tuberculosis amongst "home-based" powerloom workers in Madhya Pradesh State, India

BACKGROUND

Byssinosis is an occupational lung disease observed among workers exposed to cotton, flax, and hemp dust. The severity and extent of Byssinosis are well recognised in the high-income countries and control measures have been implemented to prevent the disease. In India, there are conflicting evidence on burden estimation of the disease, followed by inadequate prevention and control of Byssinosis.

DESIGN/METHODS

We did a cross-sectional study to assess the prevalence of Byssinosis in "home-based" power-loom workers in Mominpura, an administrative ward of Burhanpur Municipality with 2800 population in the state of Madhya Pradesh, India. 290 adults working from "home-based" power loom units were randomly selected, profiled and screened for Byssinosis like symptoms with the help of a semi-structured questionnaire and simple hand-held peak expiratory flow monitor. For epidemiological purposes the symptoms were classified based on Schilling's classification. Chest x-rays were done for selected subjects. Sputum smear microscopy for detecting TB was done for those who had Byssinosis like symptoms.

RESULTS

Prevalence of Byssinosis among "home based" powerloom workers was found to be 98% [n = 283, 95 CI (95.65-98.96)]. Peak expiratory flow rate (PEFR) was reduced in 44% (n = 124), of which 81 (29%) had more than 50% PEFR reduction, and of these, 69 (29%) were in early stage of Byssinosis (Grade 0.5). 11% of study participants who had Byssinosis like symptoms, also had TB.

CONCLUSIONS

Byssinosis is highly prevalent in "home-based" power loom units in Madhya Pradesh. Adequate advocacy on awareness and prevention; prompt diagnosis and linkages to treatment services in "home-based" power loom units are urgently required to address Byssinosis at an early disease stage.

Active and passive procrastination in terms of temperament and character

Background

While passive procrastination is usually associated with distress and dysfunction active procrastination may be an effective coping style. To test this possibility, we examined passive and active procrastination in terms of temperament, character, and emotional intelligence (EI), as well as by a short-term longitudinal study.

Methods

Adult community volunteers (N = 126) self-reported twice in an online short-term longitudinal study. At baseline on active and passive procrastination, as well as on the temperament and character inventory of personality (TCI-140) and EI. At first testing, they were asked to freely describe three personal goals and to make action plans to achieve each within the next two weeks. Two weeks later they reported on progress on their personal goals (PPG).

Results

PPG correlated positively with active procrastination and negatively with passive procrastination. Dividing the participants into median splits on active and passive procrastination resulted in four groups: Active, Passive, Active-Passive, and Non-Procrastinators. Analysis of variance showed that active procrastinators had an advantage in temperament and character traits as well as EI. Active procrastinators were also higher than the other groups on personality profiles i.e. combinations of traits; dependable temperament and well-developed character.

Conclusions

Active procrastination can be an adaptive and productive coping style. It is associated with dependable temperament, well-developed character, and high emotional intelligence and predicts meeting personal goals.

Characteristics of mucosa-associated gut microbiota during treatment in Crohn’s disease

BACKGROUND

The dysbiosis of the gut microbiome is evident in Crohn’s disease (CD) compared with healthy controls (HC), although the alterations from active CD to remission after treatment are unclear.

AIM

To characterize the mucosa-associated gut microbiota in patients with CD before and after the induction therapy.

METHODS

The basic information was collected from the subjects and the CD activity index (CDAI) was calculated in patients. A 16S rRNA sequencing approach was applied to determine the structures of microbial communities in mucosal samples including the terminal ileal, ascending colon, descending colon and rectum. The composition and function of mucosa-associated gut microbiota were compared between samples from the same cohort of patients before and after treatment. Differential taxa were identified to calculate the microbial dysbiosis index (MDI) and the correlation between MDI and CDAI was analyzed using Pearson correlation test. Predictive functional profiling of microbial communities was obtained with PICRUSt.

RESULTS

There were no significant differences in microbial richness among the four anatomical sites in individuals. Compared to active disease, the alpha diversity of CD in remission was increased towards the level of HC compared to the active stage. The principal coordinate analysis revealed that samples of active CD were clearly separated from those in remission, which clustered close to HC. Sixty-five genera were identified as differentially abundant between active and quiescent CD, with a loss of Fusobacterium and a gain of potential beneficial bacteria including Lactobacillus, Akkermansia, Roseburia, Ruminococcus and Lachnospira after the induction of remission. The combination of these taxa into a MDI showed a positive correlation with clinical disease severity and a negative correlation with species richness. The increased capacity for the inferred pathways including Lipopolysaccharide biosynthesis and Lipopolysaccharide biosynthesis proteins in patients before treatment negatively correlated with the abundance of Roseburia, Ruminococcus and Lachnospira.

CONCLUSION

The dysbiosis of mucosa-associated microbiota was associated with the disease phenotype and may become a potential diagnostic tool for the recurrence of disease.

Ultrasound elastography of the patellar tendon in young, asymptomatic sedentary and moderately active individuals

BACKGROUND

The recent use of ultrasound elastography to study patellar tendon softness has demonstrated increased tendon softness in high-level athletes. We hypothesized that measurable alterations in patellar tendon softness may be present in young asymptomatic subjects engaging in moderate levels of physical activity.

METHODS

This was a cross-sectional study. Gray-scale ultrasound and ultrasound elastography of the right and left patellar tendons were performed in young asymptomatic sedentary subjects and moderately active subjects who engaged in at least 30 min of physical activity 4-5 times weekly. The distribution of soft, intermediate and stiff tissue within each tendon was analyzed. Tendon softness was correlated with subject age, gender and level of athletic activity.

RESULTS

Sixty patellar tendons in 30 subjects were evaluated (18 males, 12 females, mean age 22.5 years). Seventeen subjects were defined as "active" and 13 as "sedentary." All tendons had a normal gray-scale sonographic appearance. Tendon softness was significantly higher in active subjects (P = 0.01) and decreased with age (P = 0.04). In sedentary individuals there was no significant correlation between age and tendon softness (P = 0.404). Similarly, gender showed no correlation with tendon softness (P > 0.05).

CONCLUSIONS

Patellar tendon softness is higher in young subjects and in those engaging in moderate physical activity. This may reflect an adaptation to increased tendon load. Tendon softness in active subjects decreases with age, while it remains at a constant value in sedentary individuals.

LEVEL OF EVIDENCE

Level 3.

An acute bout of cycling does not induce compensatory responses in pre-menopausal women not using hormonal contraceptives

There is a clear need to improve understanding of the effects of physical activity and exercise on appetite control. Therefore, the acute and short-term effects (three days) of a single bout of cycling on energy intake and energy expenditure were examined in women not using hormonal contraceptives. Sixteen active (n = 8) and inactive (n = 8) healthy pre-menopausal women completed a randomised crossover design study with two conditions (exercise and control). The exercise day involved cycling for 1 h (50% of maximum oxygen uptake) and resting for 2 h, whilst the control day comprised 3 h of rest. On each experimental day participants arrived at the laboratory fasted, consumed a standardised breakfast and an ad libitum pasta lunch. Food diaries and combined heart rate-accelerometer monitors were used to assess free-living food intake and energy expenditure, respectively, over the subsequent three days. There were no main effects or condition (exercise vs control) by group (active vs inactive) interaction for absolute energy intake (P > 0.05) at the ad libitum laboratory lunch meal, but there was a condition effect for relative energy intake (P = 0.004, η_p² = 0.46) that was lower in the exercise condition (1417 ± 926 kJ vs. 2120 ± 923 kJ). Furthermore, post-breakfast satiety was higher in the active than in the inactive group (P = 0.005, η_p² = 0.44). There were no main effects or interactions (P > 0.05) for mean daily energy intake, but both active and inactive groups consumed less energy from protein (14 ± 3% vs. 16 ± 4%, P = 0.016, η_p² = 0.37) and more from carbohydrate (53 ± 5% vs. 49 ± 7%, P = 0.031, η_p² = 0.31) following the exercise condition. This study suggests that an acute bout of cycling does not induce compensatory responses in active and inactive women not using hormonal contraceptives, while the stronger satiety response to the standardised breakfast meal in active individuals adds to the growing literature that physical activity helps improve the sensitivity of short-term appetite control.

Active Rehabilitation of Concussion and Post-concussion Syndrome

Concussion is a physiological brain injury with physical, cognitive, and emotional sequelae. The macrophysiological insult to the brain affects the autonomic nervous system and its control of cerebral blood flow. Most patients recover within 2 weeks, but some do not. Persistence of symptoms beyond the generally accepted time frame for recovery is called post-concussion syndrome (PCS). PCS is not a single entity; it is a group of disorders that requires specific forms of therapy. Rest has been the mainstay of the treatment for concussion and PCS. This article discusses the rationale for the active treatment of concussion and PCS.

Comparison of efficacy of once daily multimatrix mesalazine 2.4 g/day and 4.8 g/day with other 5-aminosalicylic acid preparation in active ulcerative colitis: a randomized, double-blind study

Background/Aims

This study compared the efficacy of multimatrix mesalazine 2.4 g/day and 4.8 g/day with controlled-release mesalazine 2.25 g/day.

Methods

In this multicenter, randomized, double-blind study, 251 patients with mildly to moderately active ulcerative colitis received multimatrix mesalazine 2.4 g/day once daily (Multimatrix-2.4), 4.8 g/day once daily (Multimatrix-4.8), or controlled-release (time-dependent) mesalazine 2.25 g/day 3 times daily (Time-2.25) for 8 weeks. The primary efficacy endpoint was the change in the ulcerative colitis-disease activity index (UC-DAI) score.

Results

The mean change in the UC-DAI score and standard deviation in the per protocol set was -1.9±2.5 for Multimatrix-2.4 and -2.4±2.8 for Time-2.25. The difference between Multimatrix-2.4 and Time-2.25 was 0.3 (two-sided 95% confidence interval [CI], -0.5 to 1.1), thus non-inferiority was not demonstrated based on the pre-defined non-inferiority margin (1.0). In the full analysis set, the difference between Multimatrix-4.8 and Time-2.25 was -1.2 (two-sided 95% CI, -2.0 to -0.5), and the mean change in UC-DAI score in the FAS was -3.3 (two-sided 95% CI, -3.9 to -2.8) for Multimatrix-4.8 and -1.9 (two-sided 95% CI, -2.5 to -1.3) for Multimatrix-2.4, indicating that Multimatrix-4.8 was more effective than Time-2.25 and Multimatrix-2.4. There was no difference among the treatment groups in terms of safety.

Conclusions

This study showed that the efficacy of multimatrix mesalazine 2.4 g/day was comparable to controlled release mesalazine 2.25 g/day, although non-inferiority was not demonstrated. Importantly, this was the first study to indicate that multimatrix mesalazine 4.8 g/day was more effective than 2.4g/day with no associated safety concerns.

A hypothesis study on bionic active noise reduction of auditory organs

BACKGROUND

Noise exposure can lead to hearing loss and multiple system dysfunctions. As various forms of noise exist in our living environments, and our auditory organs are very sensitive to acoustic stimuli, it is a challenge to protect our hearing system in certain noisy environments.

PRESENTATION OF THE HYPOTHESIS

Herein, we propose that our hearing organ could serve as a noise eliminator for high intensity noise and enhance acoustic signal processing abilities by increasing the signal-noise ratio. For suprathreshold signals, the hearing system is capable of regulating the middle ear muscles and other structures to actively suppress the sound level to a safe range.

TESTING THE HYPOTHESIS

To test our hypothesis, both mathematic model analyses and animal model studies are needed. Based on a digital 3D reconstructed model, every structure in the auditory system can be analyzed and tested for its contribution to the process of noise reduction. Products manufactured by this bionic method could be used and verified in animal models and volunteers.

IMPLICATIONS

By mimicking the noise-reduction effect of the sophisticated structures in the hearing system, we may be able to provide a model that establishes a new active-sound-suppression mode. This innovative method may overcome the limited capabilities of current noise protection options and become a promising possibility for noise prevention.

The tear cytokine profile in patients with active Graves' orbitopathy

PURPOSE

The primary aim of this study is to isolate cytokines specific for active Graves' orbitopathy (GO) in the tears of affected patients. The secondary aim is to identify other cytokines of interest and to look at the profile of their levels over time.

METHODS

This is a prospective pilot study conducted at the Singapore National Eye Centre. A total of 10 patients with active GO and 10 patients from each of 3 control groups were recruited. The 3 control groups were the following: age-matched normal female patients, patients with GO who were clinically inactive and patients with bilateral viral conjunctivitis. Tears from patients from the control groups were collected on a single visit. For patients with active GO, tears were collected on presentation, at 6 months, 12 months and 18 months.

RESULTS

Of all the cytokines examined, only IL-7 yielded a difference when the concentration in patients with active GO was compared with concentrations in all the control groups. This difference was most significant at the 18-month follow-up visit.

CONCLUSIONS

Low concentrations of IL-7 in tears exhibit specificity for active GO in patients nearly 2 years from the clinical onset of activity. Although using IL-7 in tears as a biomarker for disease activity may be limited due to its late manifestation, targeting immune restitution using IL-7 may have disease modifying effects.

VUB-CYBERLEGs CYBATHLON 2016 Beta-Prosthesis: case study in control of an active two degree of freedom transfemoral prosthesis

BACKGROUND

Here we present how the CYBERLEGs Beta-Prosthesis was modified with a new control system to participate in the Powered Leg Prosthesis event, and to report on our experience at the CYBATHLON 2016 which was held in Zurich, Switzerland in October 2016. The prosthesis has two active degrees of freedom which assist the user with extra joint power at the knee and ankle to complete tasks. The CYBATHLON is a championship for people with disabilities competing in six disciplines, using advanced assistive devices. Tasks for CYBATHLON 2016 were chosen to reflect everyday normal task such as sitting and standing from a chair, obstacle avoidance, stepping stones, slope walking and descent, and stair climbing and descent.

METHODS

The control schemata were presented along with the description of each of the six tasks. The participant of the competition, the pilot, ran through each of the trials under lab conditions and representative behaviors were recorded.

RESULTS

The VUB CYBERLEGs prosthesis was able to accomplish, to some degree, five of the six tasks and here the torque and angle behaviors of the device while accomplishing these tasks are presented. The relatively simple control methods were able to provide assistive torque during many of the events, particularly sit to stand and stair climbing. For example, the prosthesis was able to consistently provide over 30 Nm in arresting knee torque in the sitting task, and over 20 Nm while standing. Peak torque of the device was not sufficient for unassisted stair climbing, but was able to provide around 60 Nm of assistance in both ascent and descent. Use of the passive behaviors of the device were shown to be able to trigger state machine events reliably for certain tasks.

CONCLUSIONS

Although the performance of the CYBERLEGs prosthesis during CYBATHLON 2016 did not compare to the other top of the market designs with regards to speed, the device performed all of the tasks that were deemed possible by the start of the competition. Moreover, the Pilot was able to accomplish tasks in ways the Pilot's personal microcontrolled prosthesis could not, with limited powered prosthesis training. Future studies will focus on decreasing weight, increasing reliability, incorporating better control, and increasing the velocity of the device. This is only a case study and actual benefits to clinical outcomes are not yet understood and need to be further investigated. This competition was a unique experience to illuminate problems that future versions of the device will be able to solve.

Knowledge and Behavior Regarding Cosmetics in Koreans Visiting Dermatology Clinics

Background

Cosmetics can affect the skin condition profoundly, and yet no survey has been performed in Koreans visiting dermatology clinics.

Objective

To assess knowledge and consumer behavior regarding cosmetics in Koreans visiting dermatology clinics.

Methods

A questionnaire consisting of 43 questions concerning demographics and use/knowledge/selection/purchase of cosmetics was given to patients and accompanying persons who visited dermatologic clinics in university and private clinic settings.

Results

In total 1,015 subjects (73.2% females, mean age 32.5 years) completed the survey. Education level was college or higher in 72.8%. Thirty-one percent had been diagnosed with a skin disorder, atopic dermatitis and seborrheic dermatitis being the most frequent diagnoses (33.7% and 16.8%, respectively). The frequency of makeup/sunscreen/functional cosmetics use, amount of sunscreen use, recognition of functional cosmetics, and knowledge of shelf life were significantly correlated with level of education. Among “functional cosmetics,” whitening products were used most frequently (29.2%). Regardless of education level, 79.2% purchased cosmetics without checking ingredients, and 85.7% were unaware of the all-ingredient-labelling regulations, and yet subjects considered ingredient the most important factor when purchasing a product.

Conclusion

Outpatient subjects in their twenties and thirties are the most knowledgeable about cosmetics in Korea.

Maternal and perinatal mortality and morbidity associated with tuberculosis during pregnancy and the postpartum period: a systematic review and meta-analysis

BACKGROUND

There is a dearth of data on the clinical features and outcomes of active tuberculosis (TB) in pregnancy. Studies have shown varied results and the relationship between TB and adverse pregnancy outcomes remains unclear.

OBJECTIVES

We conducted a systematic review and meta-analysis to evaluate pregnancy outcomes associated with TB.

SEARCH STRATEGY

Major databases were searched from inception until December 2015 without restrictions using the terms: 'TB', 'pregnancy', 'maternal morbidity', 'mortality' and 'perinatal morbidity', 'mortality'.

SELECTION CRITERIA

We included studies that compared the outcomes of pregnant women with and without active TB.

DATA COLLECTION AND ANALYSIS

We computed odds ratios for maternal and perinatal complications, and pooled them using a random effects model. We assessed for heterogeneity using chi-squared tests and evaluated its magnitude using the I2 statistic. We used the Newcastle-Ottawa scale for quality assessment.

MAIN RESULTS

Thirteen studies, including 3384 pregnancies with active TB and 119 448 without TB were included. Compared with pregnant women without TB, pregnant women with active TB was associated with increased odds of maternal morbidity [odds ratio (OR) 2.8, 95% CI 1.7-4.6; I2  = 60.3%], anaemia (OR 3.9, 95% CI 2.2-6.7; I2  = 29.8%), caesarean delivery (OR 2.1, 95% CI 1.2-3.8; I2  = 61.1%), preterm birth (OR 1.7, 95% CI 1.2-2.4; I2  = 66.5%), low birth weight (OR 1.7, 95% CI 1.2-2.4; I2  = 53.7%), birth asphyxia (OR 4.6, 95% CI 2.4-8.6; I2  = 46.3), and perinatal death (OR 4.2, 95% CI 1.5-11.8; I2  = 57.2%).

AUTHOR'S CONCLUSION

Active TB in pregnancy is associated with adverse maternal and fetal outcomes. Early diagnosis of TB is important to prevent significant maternal and perinatal complications.

TWEETABLE ABSTRACT

Active tuberculosis in pregnancy is associated with adverse maternal and perinatal outcomes.

Immunizations: An Evolving Paradigm for Oral Health Care Providers

Oral health care professionals are at risk for the transmission of bacterial and viral microorganisms. Providers need to be knowledgeable about the exposure/transmission of life-threatening infections and options for prevention. This article is designed to increase the oral health care provider's awareness of the latest assessment of vaccine-preventable diseases that pose a high risk in the dental health care setting. Specific dosing strategies are suggested for the prevention of infections based on available evidence and epidemiologic changes. This information will provide a clear understanding for prevention of vaccine-preventable diseases that pose a public health consequence.

Evidence toads may modulate landing preparation without predicting impact time

Within anurans (frogs and toads), cane toads (Bufo marinus) perform particularly controlled landings in which the forelimbs are exclusively used to decelerate and stabilize the body after impact. Here we explore how toads achieve dynamic stability across a wide range of landing conditions. Specifically, we suggest that torques during landing could be reduced by aligning forelimbs with the body's instantaneous velocity vector at impact (impact angle). To test whether toad forelimb orientation varies with landing conditions, we used high-speed video to collect forelimb and body kinematic data from six animals hopping off platforms of different heights (0, 5 and 9 cm). We found that toads do align forelimbs with the impact angle. Further, toads align forelimbs with the instantaneous velocity vector well before landing and then track its changes until touchdown. This suggests that toads may be prepared to land well before they hit the ground rather than preparing for impact at a specific moment, and that they may use a motor control strategy that allows them to perform controlled landings without the need to predict impact time.

Poststroke agitation and aggression and social quality of life: a case control study

BACKGROUND AND OBJECTIVE

Aggression and agitation are common after a stroke. The association between agitation/aggression following stroke and Health-Related Quality of Life (HRQoL) in stroke survivors is unknown. This study aimed to examine the association between agitation/aggression and HRQoL in Chinese stroke survivors.

METHODS

Three hundred and twenty-four stroke patients entered this cross-sectional study. Agitation/aggression was assessed using the Chinese version of Neuropsychiatric Inventory (CNPI). HRQoL was measured with the Stroke Specific Quality of Life (SSQoL).

RESULTS

Three months after the index stroke, agitation/aggression was found in 60 (18.5%) patients. In the agitation/aggression group, 44 patients (73.3%) showed passive agitation/aggression, whereas 16 (26.7%) displayed passive and active agitation/aggression. No patients showed only active agitation/aggression. Patients with agitation/aggression were more likely to have history of diabetes and greater severity of depression, as well as lower SSQoL total score and Personality Changes and Social Role scores. Controlling for diabetes and depression severity did not alter the above results. The Energy and Thinking scores of the SSQoL were significantly lower in the passive/active agitation/aggression group relative to the passive agitation/aggression group (adjusted for CNPI aggression/agitation score).

CONCLUSION

In this study sample, agitation/aggression was preponderantly of the passive type and was associated with poorer HRQoL independently from depression or medical conditions. Patients with both passive and active agitation/aggression had lower Quality of Life (QoL) than patients with only passive agitation/aggression. The causality of the association between low QoL and agitation/aggression needs to be explored in future studies.

Comparing glycaemic benefits of Active Versus passive lifestyle Intervention in kidney Allograft Recipients (CAVIAR): study protocol for a randomised controlled trial

Background

Lifestyle modification is widely recommended to kidney allograft recipients post transplantation due to the cardiometabolic risks associated with immunosuppression including new-onset diabetes, weight gain and cardiovascular events. However, we have no actual evidence that undertaking lifestyle modification protects from any adverse outcomes post transplantation. The aim of this study is to compare whether a more proactive versus passive interventional approach to modify lifestyle is associated with superior outcomes post kidney transplantation.

Methods/design

We designed this prospective, single-centre, open-label, randomised controlled study to compare the efficacy of active versus passive lifestyle intervention for kidney allograft recipients early post transplantation. A total of 130 eligible patients, who are stable, nondiabetic and between 3 and 24 months post kidney transplantation, will be recruited. Randomisation is being undertaken by random block permutations into passive (n = 65, leaflet guidance only) versus active lifestyle modification (n = 65, supervised intervention) over a 6-month period. Supervised intervention is being facilitated by two dietitians during the 6-month intervention period to provide continuous lifestyle intervention guidance, support and encouragement. Both dietitians are accredited with behavioural intervention skills and will utilise motivational aids to support study recruits randomised to active intervention. The primary outcome is change in abnormal glucose metabolism parameters after 6 months of comparing active versus passive lifestyle intervention. Secondary outcomes include changes in a wide array of cardiometabolic parameters, kidney allograft function and patient-reported outcome measures. Long-term tracking of patients via data linkage to electronic patient records and national registries will facilitate long-term comparison of outcomes after active versus passive lifestyle intervention beyond the 6-month intervention period.

Discussion

This is the first randomised controlled study to investigate the benefits of active versus passive lifestyle intervention in kidney allograft recipients for the prevention of abnormal cardiometabolic outcomes. In addition, this is the first example of utilising behaviour therapy intervention post kidney transplantation to achieve clinically beneficial outcomes, which has potential implications on many spheres of post-transplant care.

Trial registration

This study was registered with the Clinical Trials Registry on 27 August 2014 (ClinicalTrials.org Identifier: NCT02233491).

Long-term results of total knee arthroplasty in young and active patients with posterior stabilized design

BACKGROUND

The aim of this study was to evaluate long-term quality and performance of cemented posterior-stabilized (PS) total knee arthroplasty (TKA) in young and active patients with gap balancing technique.

METHODS

Between January 2000 and October 2001, 55 TKAs (21 rotating platform [RP] and 34 fixed bearing [FB]) in 41 patients, 60 years and younger, with University of California Los Angeles (UCLA) activity score of five and above were included in this study and prospectively followed. Clinical assessments included Western Ontario and McMaster Universities (WOMAC), Knee Society, UCLA activity score, and Patient Administered Questionnaire (PAQ). Radiographic measurements included component positioning, patellar tilt and thickness, radiolucency, loosening or osteolysis.

RESULTS

At a mean follow-up of 12.3±0.5 years (11 to 13), there was no instability, malalignment, or patellofemoral maltracking. Sixty eight percent of patients were still participating in regular recreational activities at the final follow-up. The mean satisfaction score was 9.1±1.9 and 8.5±2.1 in RP-PS and FB-PS groups, respectively. There was no malalignment or osteolysis, no revision for osteolysis or loosening. One patient in the FB-PS group underwent open reduction and internal fixation for a peri-prosthetic fracture. Overall Kaplan-Meier survivorship was 98%.

CONCLUSION

The PS TKA in young and active patients can provide long-term durability and high quality of function.

LEVEL OF EVIDENCE

III.

Future of the transdermal drug delivery market--have we barely touched the surface?

INTRODUCTION

Transdermal drug delivery is the movement of drugs across the skin for absorption into the systemic circulation. Transfer of the drug can occur via passive or active means; passive transdermal products do not disrupt the stratum corneum to facilitate delivery whereas active technologies do. Due to the very specific physicochemical properties necessary for successful passive transdermal drug delivery, this sector of the pharmaceutical industry is relatively small. There are many well-documented benefits of this delivery route however, and as a result there is great interest in increasing the number of therapeutic substances that can be delivered transdermally.

AREAS COVERED

This review discusses the various transdermal products that are currently/have been marketed, and the paths that led to their success, or lack of. Both passive and active transdermal technologies are considered with the advantages and limitations of each highlighted. In addition to marketed products, technologies that are in the investigative stages by various pharmaceutical companies are reviewed.

EXPERT OPINION

Passive transdermal drug delivery has made limited progress in recent years, however with the ongoing intense research into active technologies, there is great potential for growth within the transdermal delivery market. A number of active technologies have already been translated into marketed products, with other platforms including microneedles, rapidly progressing towards commercialisation.

Comparative evaluation of passive, active, and passive-active distraction techniques on pain perception during local anesthesia administration in children

Local anesthesia forms the backbone of pain control techniques and is necessary for a painless dental procedure. Nevertheless, administering a local anesthetic injection is among the most anxiety-provoking procedures to children. This study was performed to compare the efficacy of different distraction techniques (passive, active, and passive-active) on children's pain perception during local anesthesia administration. A total of 90 children aged four to nine years, requiring inferior alveolar nerve block for primary molar extraction, were included in this study and randomly divided into three groups according to the distraction technique employed during local anesthesia administration. Passive distraction group: the children were instructed to listen to a song on headphones; Active distraction group: the children were instructed to move their legs up and down alternatively; and Passive-active distraction group: this was a combination between both techniques. Pain perception during local anesthesia administration was evaluated by the Sounds, Eyes, and Motor (SEM) scale and Wong Baker FACES® Pain Rating Scale. There was an insignificant difference between the three groups for SEM scale and Wong Baker FACES Pain Rating Scale at P = 0.743 and P = 0.112 respectively. The examined distraction techniques showed comparable results in reducing pain perception during local anesthesia administration.

Vertical Distribution of Functional Potential and Active Microbial Communities in Meromictic Lake Kivu

The microbial community composition in meromictic Lake Kivu, with one of the largest CH4 reservoirs, was studied using 16S rDNA and ribosomal RNA (rRNA) pyrosequencing during the dry and rainy seasons. Highly abundant taxa were shared in a high percentage between bulk (DNA-based) and active (RNA-based) bacterial communities, whereas a high proportion of rare species was detected only in either an active or bulk community, indicating the existence of a potentially active rare biosphere and the possible underestimation of diversity detected when using only one nucleic acid pool. Most taxa identified as generalists were abundant, and those identified as specialists were more likely to be rare in the bulk community. The overall number of environmental parameters that could explain the variation was higher for abundant taxa in comparison to rare taxa. Clustering analysis based on operational taxonomic units (OTUs at 0.03 cutoff) level revealed significant and systematic microbial community composition shifts with depth. In the oxic zone, Actinobacteria were found highly dominant in the bulk community but not in the metabolically active community. In the oxic-anoxic transition zone, highly abundant potentially active Nitrospira and Methylococcales were observed. The co-occurrence of potentially active sulfur-oxidizing and sulfate-reducing bacteria in the anoxic zone may suggest the presence of an active yet cryptic sulfur cycle.

3D shoulder kinematics for static vs dynamic and passive vs active testing conditions

Shoulder motion analysis provides clinicians with references of normal joint rotations. Shoulder joints orientations assessment is often based on series of static positions, while clinicians perform either passive or active tests and exercises mostly in dynamic. These conditions of motion could modify joint coordination and lead to discrepancies with the established references. Hence, the objective was to evaluate the influence of static vs dynamic and passive vs active testing conditions on shoulder joints orientations. Twenty asymptomatic subjects setup with 45 markers on the upper limb and trunk were tracked by an optoelectronic system. Static positions (30°, 60°, 90° and 120° of thoracohumeral elevation) and dynamic motion both in active condition and passively mobilised by an examiner were executed. Three-dimensional sternoclavicular, acromioclavicular, scapulothoracic and glenohumeral joint angles (12 in total) representing the distal segment orientation relative to the proximal segment orientation were estimated using a shoulder kinematical chain model. Separate four-way repeated measures ANOVA were applied on the 12 joint angles with factors of static vs dynamic, passive vs active, thoracohumeral elevation angle (30°, 60°, 90° and 120°) and plane of elevation (frontal and sagittal). Scapulothoracic lateral rotation progressed more during arm elevation in static than in dynamic gaining 4.2° more, and also in passive than in active by 6.6°. Glenohumeral elevation increased more during arm elevation in active than in passive by 4.4°. Shoulder joints orientations are affected by the testing conditions, which should be taken into consideration for data acquisition, inter-study comparison or clinical applications.

Compared with what? An analysis of control-group types in Cochrane and Campbell reviews of psychosocial treatment efficacy with substance use disorders

BACKGROUND AND AIMS

A crucial, but under-appreciated, aspect in experimental research on psychosocial treatments of substance use disorders concerns what kinds of control groups are used. This paper examines how the distinction between different control-group designs have been handled by the Cochrane and the Campbell Collaborations in their systematic reviews of psychosocial treatments of substance abuse disorders.

METHODS

We assessed Cochrane and Campbell reviews (n = 8) that were devoted to psychosocial treatments of substance use disorders. We noted what control groups were considered and analysed the extent to which the reviews provided a rationale for chosen comparison conditions. We also analysed whether type of control group in the primary studies influenced how the reviews framed the effects discussed and whether this was related to conclusions drawn.

RESULTS

The reviews covered studies involving widely different control conditions. Overall, little attention was paid to the use of different control groups (e.g. head-to-head comparisons versus untreated controls) and what this implies when interpreting effect sizes. Seven of eight reviews did not provide a rationale for the choice of comparison conditions.

CONCLUSIONS

Cochrane and Campbell reviews of the efficacy of psychosocial interventions with substance use disorders seem to underappreciate that the use of different control-group types yields different effect estimates. Most reviews have not distinguished between different control-group designs and therefore have provided a confused picture regarding absolute and relative treatment efficacy. A systematic approach to treating different control-group designs in research reviews is necessary for meaningful estimates of treatment efficacy.

Effects of an acute bout of aerobic exercise on immediate and subsequent three-day food intake and energy expenditure in active and inactive pre-menopausal women taking oral contraceptives

This study examined the effects of an acute bout of exercise of low-intensity on food intake and energy expenditure over four days in women taking oral contraceptives. Twenty healthy, active (n = 10) and inactive (n = 10) pre-menopausal women taking oral contraceptives completed two conditions (exercise and control), in a randomised, crossover fashion. The exercise experimental day involved cycling for one hour at an intensity equivalent to 50% of maximum oxygen uptake and two hours of rest. The control condition comprised three hours of rest. Participants arrived at the laboratory fasted overnight; breakfast was standardised and an ad libitum pasta lunch was consumed on each experimental day. Participants kept a food diary to measure food intake and wore an Actiheart to measure energy expenditure for the remainder of the experimental days and over the subsequent 3 days. There was a condition effect for absolute energy intake (exercise vs.

CONTROL

3363 ± 668 kJ vs. 3035 ± 752 kJ; p = 0.033, d = 0.49) and relative energy intake (exercise vs.

CONTROL

2019 ± 746 kJ vs. 2710 ± 712 kJ; p <0.001, d = -1.00) at the ad libitum lunch. There were no significant differences in energy intake over the four days in active participants and there was a suppression of energy intake on the first day after the exercise experimental day compared with the same day of the control condition in inactive participants (mean difference = -1974 kJ; 95% CI -1048 to -2900 kJ, p = 0.002, d = -0.89). There was a group effect (p = 0.001, d = 1.63) for free-living energy expenditure, indicating that active participants expended more energy than inactive participants during this period. However, there were no compensatory changes in daily physical activity energy expenditure. These results support the use of low-intensity aerobic exercise as a method to induce a short-term negative energy balance in inactive women taking oral contraceptives.

Oxytocin discontinuation after the active phase of labor is established

Despite the widespread usage of oxytocin, there is still no consensus on its mode of administration. The scope of the present meta-analysis was to assess the effect of oxytocin discontinuation after the active phase of labor is established on maternal fetal and neonatal outcomes. We searched Medline, Scopus, Popline, ClinicalTrials.gov and Google Scholar databases. Eight studies were finally retrieved, which involved 1232 parturient. We observed significantly decreased rates of cesarean sections among parturient that discontinued oxytocin (OR 0.51, 95% CI 0.35, 0.74) as well as decreased rates of uterine hyperstimulation (OR 0.33, 95% CI 0.19, 0.58). Similarly, cases of non-reassuring fetal heart rates were fewer among women that did not receive oxytocin after the establishment of the active phase of labor (OR 0.63, 95% CI 0.41, 0.97). Keeping in mind the aforementioned maternal and neonatal adverse effects that seem to result from infusion of oxytocin until delivery, future practice should aim towards its discontinuation after the establishment of the active phase of labor, as it does not seem to influence the total duration of labor. Future studies should aim towards specific populations of parturient in order to clarify whether different approaches are needed.

Active and intelligent packaging systems for a modern society

Active and intelligent packaging systems are continuously evolving in response to growing challenges from a modern society. This article reviews: (1) the different categories of active and intelligent packaging concepts and currently available commercial applications, (2) latest packaging research trends and innovations, and (3) the growth perspectives of the active and intelligent packaging market. Active packaging aiming at extending shelf life or improving safety while maintaining quality is progressing towards the incorporation of natural active agents into more sustainable packaging materials. Intelligent packaging systems which monitor the condition of the packed food or its environment are progressing towards more cost-effective, convenient and integrated systems to provide innovative packaging solutions. Market growth is expected for active packaging with leading shares for moisture absorbers, oxygen scavengers, microwave susceptors and antimicrobial packaging. The market for intelligent packaging is also promising with strong gains for time-temperature indicator labels and advancements in the integration of intelligent concepts into packaging materials.

Rasayans and non-rasayans herbs: Future immunodrug - Targets

Ayurvedic therapeutics describes vast number of medicinal herbs used as “Vyadhirodhak Chamatav” that has enlightened the application of herbs used as corner stone in various diseases especially those modulating the immune system. Ayurveda literature comprises of rasayana and non-rasayana herbs. Materia Medica entirely enriched with enormous data of rasayana medicinal herbs acting as immunomodulators in existence. However, as such there is no specific review of literature available for non-Rasayana herbs that have immense potential as immunomodulators. This review article empowers data on non-rasayana medicinal herbs as promising future target for immunotherapy.

Active drug encapsulation and release kinetics from hydrogel-in-liposome nanoparticles

Herein, we demonstrate for the first time the use of hydrogel-in-liposome nanoparticles (lipogels) as a promising drug delivery vehicle for the active encapsulation of the anticancer drug 17-DMAPG, a geldanamycin (GA) derivative. This model drug was chosen due to its improved aqueous solubility (4.6 mg/ml) compared to the parent GA (<0.01 mg/ml), and presence of a tertiary amine which readily protonates at low pH. For the design of lipogels, a PAA hydrogel core was formed inside liposomes through UV-initiated DEAP activation and polymerization of AA and BA. We have demonstrated here that electrostatic interactions between drug and gel are critical for active encapsulation and sustained release of 17-DMAPG. We found that optimal loading conditions could be obtained (88% loading efficiency) through control of pH, temperature and incubation time. Dramatic sustained drug release from lipogels was achieved independent of the external solution pH (ca. 54 h to 50% drug release) and confirmed that the lipid bilayer was intact in the presence of the gel core. In vitro cell culture studies revealed that at the highest concentration tested, which corresponded to approximately 0.4 mg/ml of material, lipogels did not exert cytotoxicity to cells.