A National School Health Campaign in Lebanon on Children Aged between 3 and 12 Years Old: Concordance Level between Parents' Reports and Medical Visit Findings about Physical and Mental Health

A school's commitment to promoting health extends beyond students' efforts to encompass parental involvement and must recognize the critical role of parents in enhancing overall student well-being. This study, conducted in 27 schools across Lebanon, assessed parents' awareness of their children's physical and mental health. A school health campaign involved direct medical interventions on 7184 students, followed by phone interviews with 3880 parents to compare their responses with the medical findings. Discordances ranged from extreme mismatches (≥50%) to mild mismatches (<15%), with notable disparities in incomplete vaccination (67.8%), BMI (59%), and mental health indicators (expressions of sadness (69.1%), loneliness (61.0%), and anxiety (53.4%)). Factors such as school type, child's age, governorate, family income, parents' occupation, education level, and marital status significantly influenced discordance rates. Notably, mental health aspects exhibited higher disparities, emphasizing the need for improved communication between parents, physicians, and children. Bridging these gaps could empower parents with better knowledge, fostering environments conducive to lifelong healthy behaviors in children. The study underscores the urgency for enhanced communication strategies to bridge discrepancies and ensure a more comprehensive understanding of children's physical and mental well-being.

Potential sources of time lags in calibrating species distribution models

The Anthropocene is characterized by a rapid pace of environmental change and is causing a multitude of biotic responses, including those that affect the spatial distribution of species. Lagged responses are frequent and species distributions and assemblages are consequently pushed into a disequilibrium state. How the characteristics of environmental change-for example, gradual 'press' disturbances such as rising temperatures due to climate change versus infrequent 'pulse' disturbances such as extreme events-affect the magnitude of responses and the relaxation times of biota has been insufficiently explored. It is also not well understood how widely used approaches to assess or project the responses of species to changing environmental conditions can deal with time lags. It, therefore, remains unclear to what extent time lags in species distributions are accounted for in biodiversity assessments, scenarios and models; this has ramifications for policymaking and conservation science alike. This perspective piece reflects on lagged species responses to environmental change and discusses the potential consequences for species distribution models (SDMs), the tools of choice in biodiversity modelling. We suggest ways to better account for time lags in calibrating these models and to reduce their leverage effects in projections for improved biodiversity science and policy.

The relationship between working time mismatch and depression according to actual hours worked

OBJECTIVES

The effect of the combination of working hours and working time mismatch on depression is unknown. This study was undertaken to confirm the relationship between working time mismatch and depression with respect to hours worked.

MATERIAL AND METHODS

The data of 45 514 adult workers that participated in the 6th Korean Working Conditions Survey (KWCS-VI 2020) were reviewed. Depression was defined using the World Health Organization 5 Well-Being Index (WHO-5) cut-off score of 50. Working time mismatch was defined as a difference between actual and desired working hours. To identify associations between working hour mismatch and depression according to weekly hours worked, stratification analysis was conducted by dividing the study subjects into 3 groups based on actual hours worked weekly (<40 h, 40-<52 h, or ≥52 h). Multiple logistic regression analysis adjusted for potential confounders was performed to calculate odds ratios of depression.

RESULTS

In the <40 h, 40-<52 h, and ≥52 h groups, the odds ratios (OR) of working more hours than desired were 1.51, 95% CI: 1.20-1.92 (<40 h), 1.70, 95% CI: 1.58-1.84 (40-<52 h), and 1.55, 95% CI: 1.41-1.69 (≥52 h), respectively, compared to a matched actual versus desired working hours group (the matched group). On the other hand, the odds ratios of working fewer hours than desired were 1.17, 95% CI: 1.07-1.27 (<40 h), 1.38, 95% CI: 1.20-1.60 (40-<52 h), and 1.98, 95% CI: 1.24-3.17 (≥52 h), respectively. The risk of depression was found to increase significantly with working time mismatch within all 3 working hour groups.

CONCLUSIONS

Working time mismatch increases the risk of worker depression regardless of hours worked. Int J Occup Med Environ Health. 2023;36(6):788-97.

Explaining the continuing high prevalence of trachomatous trichiasis unknown to the health system in evaluation units: a mixed methods explanatory study in four trachoma-endemic countries

BACKGROUND

We explored reasons for continuing higher-than-anticipated prevalence of trachomatous trichiasis (TT) unknown to the health system in population-based prevalence surveys in evaluation units where full geographical coverage of TT case finding was reported.

METHODS

A mixed-methods study in Ethiopia, Kenya, Nigeria and Tanzania was conducted. We compared data from clinical examination, campaign documentation and interviews with original trachoma impact survey (TIS) results.

RESULTS

Of 169 TT cases identified by TIS teams, 130 (77%) were examined in this study. Of those, 90 (69%) were a match (both TIS and study teams agreed on TT classification) and 40 (31%) were a mismatch. Of the 40 mismatches, 22 (55%) were identified as unknown to the health system by the study team but as known to the health system by the TIS team; 12 (30%) were identified as not having TT by the study team but as having TT by the TIS team; and six (15%) were identified as unknown to the health system in the TIS team but as known to the health system by the study team based on documentation reviewed.

CONCLUSIONS

Incorrectly reported geographical coverage of case-finding activities, and discrepancies in TT status between TIS results and more detailed assessments, are the key reasons identified for continuing high TT prevalence.

A comparative analysis exposes an amplification delay distinctive to SARS-CoV-2 Omicron variants of clinical and public health relevance

ABSTRACTMutations in the SARS-CoV-2 genome may negatively impact a diagnostic test, have no effect, or turn into an opportunity for rapid molecular screening of variants. Using an in-house Emergency Use Authorized RT-qPCR-based COVID-19 diagnostic assay, we combined sequence surveillance of viral variants and computed PCR efficiencies for mismatched templates. We found no significant mismatches for the N, E, and S set of assay primers until the Omicron variant emerged in late November 2021. We found a single mismatch between the Omicron sequence and one of our assay's primers caused a > 4 cycle delay during amplification without impacting overall assay performance.Starting in December 2021, clinical specimens received for COVID-19 diagnostic testing that generated a Cq delay greater than 4 cycles were sequenced and confirmed as Omicron. Clinical samples without a Cq delay were largely confirmed as the Delta variant. The primer-template mismatch was then used as a rapid surrogate marker for Omicron. Primers that correctly identified Omicron were designed and tested, which prepared us for the emergence of future variants with novel mismatches to our diagnostic assay's primers. Our experience demonstrates the importance of monitoring sequences, the need for predicting the impact of mismatches, their value as a surrogate marker, and the relevance of adapting one's molecular diagnostic test for evolving pathogens.

Host-Parasitoid Phenology, Distribution, and Biological Control under Climate Change

Climate change raises a serious threat to global entomofauna-the foundation of many ecosystems-by threatening species preservation and the ecosystem services they provide. Already, changes in climate-warming-are causing (i) sharp phenological mismatches among host-parasitoid systems by reducing the window of host susceptibility, leading to early emergence of either the host or its associated parasitoid and affecting mismatched species' fitness and abundance; (ii) shifting arthropods' expansion range towards higher altitudes, and therefore migratory pest infestations are more likely; and (iii) reducing biological control effectiveness by natural enemies, leading to potential pest outbreaks. Here, we provided an overview of the warming consequences on biodiversity and functionality of agroecosystems, highlighting the vital role that phenology plays in ecology. Also, we discussed how phenological mismatches would affect biological control efficacy, since an accurate description of stage differentiation (metamorphosis) of a pest and its associated natural enemy is crucial in order to know the exact time of the host susceptibility/suitability or stage when the parasitoids are able to optimize their parasitization or performance. Campaigns regarding landscape structure/heterogeneity, reduction of pesticides, and modelling approaches are urgently needed in order to safeguard populations of natural enemies in a future warmer world.

An Integrated Approach Using HLAMatchmaker and Pirche II for Epitopic Matching in Pediatric Kidney Transplant-A Romanian Single-Center Study

(1) Background: Renal transplantation (KT) is the most efficient treatment for chronic kidney disease among pediatric patients. Antigenic matching and epitopic load should be the main criteria for choosing a renal graft in pediatric transplantation. Our study aims to compare the integration of new histocompatibility predictive algorithms with classical human leukocyte antigen (HLA) matching regarding different types of pediatric renal transplants. (2) Methods: We categorized our cohort of pediatric patients depending on their risk level, type of donor and type of transplantation, delving into discussions surrounding their mismatching values in relation to both the human leukocyte antigen Matchmaker software (versions 4.0. and 3.1.) and the most recent version of the predicted indirectly identifiable HLA epitopes (PIRCHE) II score. (3) Results: We determined that the higher the antigen mismatch, the higher the epitopic load for both algorithms. The HLAMatchmaker algorithm reveals a noticeable difference in eplet load between living and deceased donors, whereas PIRCHE II does not show the same distinction. Dialysis recipients have a higher count of eplet mismatches, which demonstrates a significant difference according to the transplantation type. Our results are similar to those of four similar studies available in the current literature. (4) Conclusions: We suggest that an integrated data approach employing PIRCHE II and HLAMatchmaker algorithms better predicts histocompatibility in KT than classical HLA matching.

Mutational spectrum of DNA damage and mismatch repair genes in prostate cancer

Over the past few years, a number of studies have revealed that a significant number of men with prostate cancer had genetic defects in the DNA damage repair gene response and mismatch repair genes. Certain of these modifications, notably gene alterations known as homologous recombination (HRR) genes; PALB2, CHEK2 BRCA1, BRCA2, ATM, and genes for DNA mismatch repair (MMR); MLH1, MSH2, MSH6, and PMS2 are connected to a higher risk of prostate cancer and more severe types of the disease. The DNA damage repair (DDR) is essential for constructing and diversifying the antigen receptor genes required for T and B cell development. But this DDR imbalance results in stress on DNA replication and transcription, accumulation of mutations, and even cell death, which compromises tissue homeostasis. Due to these impacts of DDR anomalies, tumor immunity may be impacted, which may encourage the growth of tumors, the release of inflammatory cytokines, and aberrant immune reactions. In a similar vein, people who have altered MMR gene may benefit greatly from immunotherapy. Therefore, for these treatments, mutational genetic testing is indicated. Mismatch repair gene (MMR) defects are also more prevalent than previously thought, especially in patients with metastatic disease, high Gleason scores, and diverse histologies. This review summarizes the current information on the mutation spectrum and clinical significance of DDR mechanisms, such as HRR and MMR abnormalities in prostate cancer, and explains how patient management is evolving as a result of this understanding.

Comparing measured dietary variation within and between tropical hunter-gatherer groups to the Paleo Diet

BACKGROUND

Although human diets varied considerably before the spread of agriculture, public perceptions of preagricultural diets have been strongly influenced by the Paleo Diet, which prescribes percentage calorie ranges of 19-35% protein, 22-40% carbohydrate, and 28-47% fat, and prohibits foods with added sugar, dairy, grains, most starchy tubers, and legumes. However, the empirical basis for Paleolithic nutrition remains unclear, with some of its assumptions challenged by the archaeological record and theoretical first principles.

OBJECTIVES

We assessed the variation in diets among tropical hunter-gatherers, including the effect of collection methods on implied macronutrient percentages.

METHODS

We analyzed data on animal food, plant food, and honey consumption by weight and kcal from 15 high-quality published ethnographic studies representing 11 recent tropical hunter-gatherer groups. We used Bayesian analyses to perform inference and included data collection methods and environmental variables as predictors in our models.

RESULTS

Our analyses reveal high levels of variation in animal versus plant foods consumed and in corresponding percentages of protein, fat, and carbohydrates. In addition, studies that weighed food items consumed in and out of camp and across seasons and years reported higher consumption of animal foods, which varied with annual mean temperature.

CONCLUSIONS

The ethnographic evidence from tropical foragers refutes the concept of circumscribed macronutrient ranges modeling preagricultural diets.

The Impact of ABO Incompatibility on the Outcomes of Hematopoietic Stem Cell Transplantation: A Single-Center Study From Pakistan

Background and objective Allogeneic hematopoietic stem cell transplantation (alloHSCT) provides curative treatment for several hematological illnesses. In this study, we evaluated the impact of ABO compatibility and incompatibility on outcomes and complications related to hematopoietic stem cell transplantation (HSCT) performed for various hematological disorders at our center. Methodology This was a retrospective, single-center, cohort study in which patients were categorized according to the ABO match and mismatch status. The mismatch group was further subcategorized into major, minor, and bidirectional groups. Results A total of 117 patients underwent alloHSCT, out of which 82 (70.1%) were male and 35 (30%) were female. The median age of the patients was 9.5 years (range: 46 years). The most common indications for stem cell transplant were beta-thalassemia major (BTM; n=58, 49%) and aplastic anemia (AA; n=42, 35.8%). However, the outcomes in match and mismatch groups showed significant results for positive direct Coombs test (DCT), indicating the occurrence of hemolysis. Despite the increased need for blood transfusions, ABO blood group incompatibility (ABOi) had no negative impact on the clinical results. Conclusion Based on our findings, ABO incompatibility does not affect the outcomes in patients undergoing alloHSCT. Patient monitoring can aid in early detection and treatment, thereby minimizing the frequency of fatal events.

Electronic witnessing in the medically assisted reproduction laboratory: insights and considerations after 10 years of use

STUDY QUESTION

What have we learnt after 10 years of electronic witnessing?

SUMMARY ANSWER

When applied correctly, an electronic witnessing system can replace manual witnessing in the medically assisted reproduction lab to prevent sample mix-up.

WHAT IS KNOWN ALREADY

Electronic witnessing systems have been implemented to improve the correct identification, processing, and traceability of biological materials. When non-matching samples are simultaneously present in a single workstation, a mismatch event is generated to prevent sample mix-up.

STUDY DESIGN, SIZE, DURATION

This evaluation investigates the mismatch and administrator assign rate over a 10-year period (March 2011-December 2021) with the use of an electronic witnessing system. Radiofrequency identification tags and barcodes were used for patient and sample identification. Since 2011, IVF and ICSI cycles and frozen embryo transfer cycles (FET) were included; IUIs cycles were included since 2013.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The total number of tags and witnessing points were recorded. Witnessing points in a particular electronic witnessing system represent all the actions that have been performed from gamete collection through embryo production, to cryopreservation and transfer. Mismatches and administrator assigns were collected and stratified per procedure (sperm preparation, oocyte retrieval, IVF/ICSI, cleavage stage embryo or blastocyst embryo biopsy, vitrification and warming, embryo transfer, medium changeover, and IUI). Critical mismatches (such as mislabelling or non-matching samples within one work area) and critical administrator assigns (such as samples not identified by the electronic witnessing system and unconfirmed witnessing points) were selected.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 109 655 cycles were included: 53 023 IVF/ICSI, 36 347 FET, and 20 285 IUI cycles. The 724 096 used tags, led to a total of 849 650 witnessing points. The overall mismatch rate was 0.251% (2132/849 650) per witnessing point and 1.944% per cycle. In total, 144 critical mismatches occurred over the different procedures. The yearly mean critical mismatch rate was 0.017 ± 0.007% per witnessing point and 0.129 ± 0.052% per cycle. The overall administrator assign rate was 0.111% (940/849 650) per witnessing point and 0.857% per cycle, including 320 critical administrator assigns. The yearly mean critical administrator assign rate was 0.039 ± 0.010% per witnessing point and 0.301 ± 0.069% per cycle. Overall mismatch and administrator assign rates remained fairly stable during the evaluated time period. Sperm preparation and IVF/ICSI were the procedures most prone to critical mismatch and administrator assigns.

LIMITATIONS, REASONS FOR CAUTION

The procedures and methods of integration of an electronic witnessing system may vary from one laboratory to another and result in differences in the potential risks related to sample identification. Individual embryos cannot (yet) be identified by such a system; this makes extra manual witnessing indispensable at certain critical steps where potential errors are not recorded. The electronic witnessing system still needs to be used in combination with manual labelling of both the bottom and lid of dishes and tubes to guarantee correct assignment in case of malfunction or incorrect use of radiofrequency identification tags.

WIDER IMPLICATIONS OF THE FINDINGS

Electronic witnessing is considered to be the ultimate tool to safeguard correct identification of gametes and embryos. But this is only possible when used correctly, and proper training and attention of the staff is required. It may also induce new risks, i.e. blind witnessing of samples by the operator.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was either sought or obtained for this study. J.S. presents webinars on RIW for CooperSurgical. The remaining authors have nothing to declare.

TRIAL REGISTRATION NUMBER

N/A.

Decision Levels and Resolution for Low-Power Winner-Take-All Circuit

Sensors in many applications must select the largest element in a sequence of currents. This can be performed in an analog way by the Winner-Take-All (WTA) circuit. This paper considers the classic version of the WTA Lazzaro circuit, working with MOS devices in a subthreshold regime. Since the separation of the gainer by analytically computable "decision levels" has recently been introduced, this paper aims to numerically verify and discuss these levels and their dependence on circuit and device parameters. For VT, the threshold voltage of MOS devices, which is primarily responsible for differences between components (mismatch), its relationship with the output voltages is theoretically demonstrated and numerically checked.

Quantitative Analysis Method and Correction Algorithm Based on Directivity Beam Pattern for Mismatches between Sensitive Units of Acoustic Dyadic Sensors

Acoustic dyadic sensors (ADSs) are a new type of acoustic sensor with higher directivity than microphones and acoustic vector sensors, which has great application potential in the fields of sound source localization and noise cancellation. However, the high directivity of an ADS is seriously affected by the mismatches between its sensitive units. In this article, (1) a theoretical model of mixed mismatches was established based on the finite-difference approximation model of uniaxial acoustic particle velocity gradient and its ability to reflect the actual mismatches was proven by the comparison of theoretical and experimental directivity beam patterns of an actual ADS based on MEMS thermal particle velocity sensors. (2) Additionally, a quantitative analysis method based on directivity beam pattern was proposed to easily estimate the specific magnitude of the mismatches, which was proven to be useful for the design of ADSs to estimate the magnitudes of different mismatches of an actual ADS. (3) Moreover, a correction algorithm based on the theoretical model of mixed mismatches and quantitative analysis method was successfully demonstrated to correct several groups of simulated and measured beam patterns with mixed mismatches.

Unexpected sound omissions are signaled in human posterior superior temporal gyrus: an intracranial study

Context modulates sensory neural activations enhancing perceptual and behavioral performance and reducing prediction errors. However, the mechanism of when and where these high-level expectations act on sensory processing is unclear. Here, we isolate the effect of expectation absent of any auditory evoked activity by assessing the response to omitted expected sounds. Electrocorticographic signals were recorded directly from subdural electrode grids placed over the superior temporal gyrus (STG). Subjects listened to a predictable sequence of syllables, with some infrequently omitted. We found high-frequency band activity (HFA, 70-170 Hz) in response to omissions, which overlapped with a posterior subset of auditory-active electrodes in STG. Heard syllables could be distinguishable reliably from STG, but not the identity of the omitted stimulus. Both omission- and target-detection responses were also observed in the prefrontal cortex. We propose that the posterior STG is central for implementing predictions in the auditory environment. HFA omission responses in this region appear to index mismatch-signaling or salience detection processes.

Deep-learning-based estimation of attenuation map improves attenuation correction performance over direct attenuation estimation for myocardial perfusion SPECT

BACKGROUND

Deep learning (DL)-based attenuation correction (AC) is promising to improve myocardial perfusion (MP) SPECT. We aimed to optimize and compare the DL-based direct and indirect AC methods, with and without SPECT and CT mismatch.

METHODS

One hundred patients with different 99mTc-sestamibi activity distributions and anatomical variations were simulated by a population of XCAT phantoms. Additionally, 34 patients 99mTc-sestamibi stress/rest SPECT/CT scans were retrospectively recruited. Projections were reconstructed by OS-EM method with or without AC. Mismatch between SPECT and CT images was modeled. A 3D conditional generative adversarial network (cGAN) was optimized for two DL-based AC methods: (i) indirect approach, i.e., non-attenuation corrected (NAC) SPECT paired with the corresponding attenuation map for training. The projections were reconstructed with the DL-generated attenuation map for AC; (ii) direct approach, i.e., NAC SPECT paired with the corresponding AC SPECT for training to perform direct AC.

RESULTS

Mismatch between SPECT and CT degraded DL-based AC performance. The indirect approach is superior to direct approach for various physical and clinical indices, even with mismatch modeled.

CONCLUSION

DL-based estimation of attenuation map for AC is superior and more robust to direct generation of AC SPECT.

Structures of LIG1 active site mutants reveal the importance of DNA end rigidity for mismatch discrimination

ATP-dependent DNA ligases catalyze phosphodiester bond formation in the conserved three-step chemical reaction of nick sealing. Human DNA ligase I (LIG1) finalizes almost all DNA repair pathways following DNA polymerase-mediated nucleotide insertion. We previously reported that LIG1 discriminates mismatches depending on the architecture of the 3'-terminus at a nick, however the contribution of conserved active site residues to faithful ligation remains unknown. Here, we comprehensively dissect the nick DNA substrate specificity of LIG1 active site mutants carrying Ala(A) and Leu(L) substitutions at Phe(F)635 and Phe(F)F872 residues and show completely abolished ligation of nick DNA substrates with all 12 non-canonical mismatches. LIG1EE/AA structures of F635A and F872A mutants in complex with nick DNA containing A:C and G:T mismatches demonstrate the importance of DNA end rigidity, as well as uncover a shift in a flexible loop near 5'-end of the nick, which causes an increased barrier to adenylate transfer from LIG1 to the 5'-end of the nick. Furthermore, LIG1EE/AA/8oxoG:A structures of both mutants demonstrated that F635 and F872 play critical roles during steps 1 or 2 of the ligation reaction depending on the position of the active site residue near the DNA ends. Overall, our study contributes towards a better understanding of the substrate discrimination mechanism of LIG1 against mutagenic repair intermediates with mismatched or damaged ends and reveals the importance of conserved ligase active site residues to maintain ligation fidelity.

Brain volume, energy balance, and cardiovascular health in two nonindustrial South American populations

Little is known about brain aging or dementia in nonindustrialized environments that are similar to how humans lived throughout evolutionary history. This paper examines brain volume (BV) in middle and old age among two indigenous South American populations, the Tsimane and Moseten, whose lifestyles and environments diverge from those in high-income nations. With a sample of 1,165 individuals aged 40 to 94, we analyze population differences in cross-sectional rates of decline in BV with age. We also assess the relationships of BV with energy biomarkers and arterial disease and compare them against findings in industrialized contexts. The analyses test three hypotheses derived from an evolutionary model of brain health, which we call the embarrassment of riches (EOR). The model hypothesizes that food energy was positively associated with late life BV in the physically active, food-limited past, but excess body mass and adiposity are now associated with reduced BV in industrialized societies in middle and older ages. We find that the relationship of BV with both non-HDL cholesterol and body mass index is curvilinear, positive from the lowest values to 1.4 to 1.6 SDs above the mean, and negative from that value to the highest values. The more acculturated Moseten exhibit a steeper decrease in BV with age than Tsimane, but still shallower than US and European populations. Lastly, aortic arteriosclerosis is associated with lower BV. Complemented by findings from the United States and Europe, our results are consistent with the EOR model, with implications for interventions to improve brain health.

Lack of evidence for the match-mismatch hypothesis across terrestrial trophic interactions

Climate change has led to widespread shifts in the timing of key life history events between interacting species (phenological asynchrony) with hypothesized cascading negative fitness impacts on one or more of the interacting species-often termed 'mismatch'. Yet, predicting the types of systems prone to mismatch remains a major hurdle. Recent reviews have argued that many studies do not provide strong evidence of the underlying match-mismatch hypothesis, but none have quantitatively analysed support for it. Here, we test the hypothesis by estimating the prevalence of mismatch across antagonistic trophic interactions in terrestrial systems and then examine whether studies that meet the assumptions of the hypothesis are more likely to find a mismatch. Despite a large range of synchrony to asynchrony, we did not find general support for the hypothesis. Our results thus question the general applicability of this hypothesis in terrestrial systems, but they also suggest specific types of data missing to robustly refute it. We highlight the critical need to define resource seasonality and the window of 'match' for the most rigorous tests of the hypothesis. Such efforts are necessary if we want to predict systems where mismatches are likely to occur.

The future of evolutionary medicine: sparking innovation in biomedicine and public health

Evolutionary medicine - i.e. the application of insights from evolution and ecology to biomedicine - has tremendous untapped potential to spark transformational innovation in biomedical research, clinical care and public health. Fundamentally, a systematic mapping across the full diversity of life is required to identify animal model systems for disease vulnerability, resistance, and counter-resistance that could lead to novel clinical treatments. Evolutionary dynamics should guide novel therapeutic approaches that target the development of treatment resistance in cancers (e.g., via adaptive or extinction therapy) and antimicrobial resistance (e.g., via innovations in chemistry, antimicrobial usage, and phage therapy). With respect to public health, the insight that many modern human pathologies (e.g., obesity) result from mismatches between the ecologies in which we evolved and our modern environments has important implications for disease prevention. Life-history evolution can also shed important light on patterns of disease burden, for example in reproductive health. Experience during the COVID-19 (SARS-CoV-2) pandemic has underlined the critical role of evolutionary dynamics (e.g., with respect to virulence and transmissibility) in predicting and managing this and future pandemics, and in using evolutionary principles to understand and address aspects of human behavior that impede biomedical innovation and public health (e.g., unhealthy behaviors and vaccine hesitancy). In conclusion, greater interdisciplinary collaboration is vital to systematically leverage the insight-generating power of evolutionary medicine to better understand, prevent, and treat existing and emerging threats to human, animal, and planetary health.

Unusual Microsatellite-Instable Mixed Neuroendocrine and Non-neuroendocrine Neoplasm: A Clinicopathological Inspection and Literature Review

BACKGROUND

Mixed neuroendocrine and non-endocrine neoplasms (MiNENs) are challenging to diagnose and manage clinically. The current understanding of MiNENs' pathobiology, molecular mechanisms, and management is incomplete. Though microsatellite instability (MSI) is known to impact carcinogenesis, reports examining MSI mechanisms for MiNENs are rare.

METHODS

We report an unusual colonic MSI-MiNEN uncovered in an 89-year-old woman and the review of the literature.

RESULTS

Pathologic inspection revealed a high-grade carcinoma composed of tumor cells with neuroendocrine histologic traits and immunophenotype intermixed with mucin-containing signet ring-like cells arranged in nested and micronodular patterns. Loss of MLH1 and PMS2 mismatch repair proteins was detected in tumor cells. INSM1 immunostaining highlighted about 50% of the tumour, further reinforcing the MiNEN diagnosis. Next-generation sequencing identified multiple carcinogenic mutations. Because of the advanced stage of the tumor and its adhesion to the adjacent organs, surgical resection was aborted; immunotherapy was initiated. The tumor is in remission 30 months following initiation of treatment, and the patient remains asymptomatic.

CONCLUSION

This unique MSI MiNEN was characterized by its immunohistochemical and molecular signatures and illustrated how correctly diagnosing MSI can strongly improve a patient's outcomes.

Evolutionary biological perspectives on current social issues of breastfeeding and weaning

Breastfeeding and weaning are actively studied from evolutionary, medical, and social research perspectives because of their close association with infant mortality, lifetime health, and human population dynamics. Each discipline benefits from an interdisciplinary exchange of knowledge regarding the bases, processes, and consequences of these phenomena. However, current social issues related to breastfeeding and weaning have received little attention from an evolutionary biology perspective. We address this gap by reviewing current social issues related to human breastfeeding and weaning in an evolutionary framework. This approach helps build a conceptual framework with the goal of better understanding ultimate causes of or influences on these current social issues. The six social issues reviewed here fall into three categories: the spatiotemporal constraints of breastfeeding, abuse of breast milk as valuable material, and mismatch in breastfeeding practices. Some of these issues have an evolutionary basis. We analyze the structure of these social issues and discuss their possible solutions in terms of extension of the trade-off theory in evolutionary biology. Our discussion on the current social issues in breastfeeding and weaning highlights the effectiveness of an approach rooted in evolutionary theory and biological anthropology.

Environmental refuges from disease in host-parasite interactions under global change

The physiological performance of organisms depends on their environmental context, resulting in performance-response curves along environmental gradients. Parasite performance-response curves are generally expected to be broader than those of their hosts due to shorter generation times and hence faster adaptation. However, certain environmental conditions may limit parasite performance more than that of the host, thereby providing an environmental refuge from disease. Thermal disease refuges have been extensively studied in response to climate warming, but other environmental factors may also provide environmental disease refuges which, in turn, respond to global change. Here, we (1) showcase laboratory and natural examples of refuges from parasites along various environmental gradients, and (2) provide hypotheses on how global environmental change may affect these refuges. We strive to synthesize knowledge on potential environmental disease refuges along different environmental gradients including salinity and nutrients, in both natural and food-production systems. Although scaling up from single host-parasite relationships along one environmental gradient to their interaction outcome in the full complexity of natural environments remains difficult, integrating host and parasite performance-response can serve to formulate testable hypotheses about the variability in parasitism outcomes and the occurrence of environmental disease refuges under current and future environmental conditions.

Human Leucocyte Antigen System and Selection of Unrelated Hematopoietic Stem Cell Donors: Impact of Patient-Donor (Mis)matching and New Challenges with the Current Technologies

The selection of hematopoietic stem cell donors for allogeneic transplantation (allo-HSCT) is mainly driven by human leucocyte antigen (HLA) matching between patient and donor, with HLA-identical matched siblings being the preferred choice in most situations. Although other clinical and demographical variables matter, especially, donor age, which is unequivocally associated with better transplant outcomes, the histocompatibility criteria have a central role in the search for the best donor, particularly in the setting of unrelated allo-HSCT where HLA disparities between patient and donor are frequent. The present review is focused on the role of HLA incompatibilities on patient outcome according to the most recent literature, in an attempt to guide transplant physicians and search coordinators during the process of adult unrelated-donor selection. The technological progresses in HLA typing, i.e., with next-generation sequencing (NGS), now allow disclosing a growing number of HLA incompatibilities associated with a heterogeneous and sometimes unknown spectrum of clinical severity. Their immunogenic characteristics, i.e., their position inside or outside the antigen recognition domain (ARD), their permissiveness, their intronic or exonic nature and even the expected expression of the HLA loci where those mismatches occur, will be presented and discussed here, integrating the advances in the immunobiology of transplantation with survival and toxicity outcomes reported in the most relevant studies, within the perspective of improving donor selection in the current practice.

Influence of Body Mass Index in Donor-Recipient Size Mismatch in Pediatric Heart Transplantation

BACKGROUND

Body weight is the traditional metric for matching donor and recipient size for pediatric heart transplantation (pHT). We hypothesized that mismatch in body mass index (BMI) or body surface area (BSA) rather than weight is better associated with outcomes of transplantation and therefore should be used for donor-recipient size matching.

METHODS

Analysis of the United Network for Organ Sharing database limited to pHT recipients was performed. Donor and recipient mismatch groups were created for weight, BMI, and BSA ratios. Differences in recipient characteristics between each cohort and the impact of mismatch on outcomes were statistically analyzed.

RESULTS

A total of 4,465 patients were included in the analysis of which 43% had congenital heart disease (CHD). There were significant differences in patient characteristics by matching, independent of the matching parameter. Multivariable regression analysis showed that a low donor-recipient BMI ratio (compared to normal) (CHD OR 1.70; non-CHD 2.78) was a predictor of one-year mortality (all P < .001) in both CHD and non-CHD cohorts. Low BMI ratio was also associated with worse long-term survival in non-CHD groups, but not in the CHD cohort. Weight and BSA ratio did not predict one year or long-term survival.

CONCLUSION

The use of low BMI donors compared to recipient may predict poor early and long-term survival and therefore should be avoided in pHT. The use of BMI matching may improve donor-recipient matching in pHT.

Demographic and Clinical Characteristics of Persons with HIV with Viral Load:Adherence Mismatch Who Are at Risk of Future Viremia

The potency of modern antiretroviral therapy (ART) allows for greater forgiveness to missed doses while still achieving, and maintaining, viral suppression. However, imperfect ART adherence, even if sufficient to maintain viral suppression, has been associated with adverse clinical outcomes. ART adherence can be objectively quantified using tenofovir diphosphate (TFV-DP) in dried blood spots (DBS), a biomarker of cumulative adherence that is predictive of future viremia-even among persons with HIV (PWH) with an undetectable HIV viral load (VL). Within a prospective cohort of PWH on tenofovir disoproxil fumarate-including ART, mismatch between drug concentration and HIV VL (i.e., low concentrations of TFV-DP in DBS in the setting of viral suppression with subsequent viremia at the following visit) was observed more frequently in PWH who were Black (36% vs. 15%; p = .04), had body mass index >30 kg/m2 (40% vs. 13%; p = .01), and reported <100% 3 months (68% vs. 50%; p = .005) and 30 days (56% vs. 31%; p = .001) adherence, compared with PWH without mismatch. Identifying PWH at risk for future viremia could help clinicians implement targeted timely interventions before episodes of breakthrough viremia.

Skewness in bee and flower phenological distributions

Phenological distributions are characterized by their central tendency, breadth, and shape, and all three determine the extent to which interacting species overlap in time. Pollination mutualisms rely on temporal co-occurrence of pollinators and their floral resources, and although much work has been done to characterize the shapes of flower phenological distributions, similar studies that include pollinators are lacking. Here, we provide the first broad assessment of skewness, a component of distribution shape, for a bee community. We compare skewness in bees to that in flowers, relate bee and flower skewness to other properties of their phenology, and quantify the potential consequences of differences in skewness between bees and flowers. Both bee and flower phenologies tend to be right-skewed, with a more exaggerated asymmetry in bees. Early-season species tend to be the most skewed, and this relationship is also stronger in bees than in flowers. Based on a simulation experiment, differences in bee and flower skewness could account for up to 14% of pairwise overlap differences. Given the potential for interaction loss, we argue that difference in skewness of interacting species is an underappreciated property of phenological change.

Overqualification at work and risk of hospitalization for psychiatric and somatic diseases among immigrants in Sweden - a prospective register-based study

OBJECTIVES

This study aimed to (i) describe the prevalence of overqualification at work among immigrants in Sweden and (ii) analyze any association between overqualification and the risk of hospitalization for somatic and psychiatric disease among refugees and labor immigrants.

METHODS

We performed a prospective register study in a cohort of 120 339 adults who immigrated to Sweden in 1991-2005 and were employed in 2006. Education-occupation status was defined as the combination of an individual's highest level of education and their occupation skill level. Individuals were followed from 2007 to 2016 with regard to hospitalization for a psychiatric, cardiovascular, respiratory or musculoskeletal disease or diabetes. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated in a multivariate Cox regression analysis adjusted for age, gender, reason for residence and duration of residence.

RESULTS

The overall prevalence of overqualification among immigrants with an academic education was 39%. Overqualified individuals had an increased risk of hospitalization for any disease (HR 1.33, 95% CI 1.21-1.46) compared to "job-matched with an academic education". However, the risk estimates were lower than that of "job-matched with no academic education" (HR 1.56, 1.46-1.68). The increased risk of hospitalization for a psychiatric disease of overqualified individuals did not differ from that of job-matched with no academic education.

CONCLUSION

Our study showed that being overqualified was associated with poorer health outcomes than job-matched individuals with an academic education. Considering the high prevalence of overqualification in immigrants, this constitutes a concern, for both society and individuals.

Structural basis for Cas9 off-target activity

The target DNA specificity of the CRISPR-associated genome editor nuclease Cas9 is determined by complementarity to a 20-nucleotide segment in its guide RNA. However, Cas9 can bind and cleave partially complementary off-target sequences, which raises safety concerns for its use in clinical applications. Here, we report crystallographic structures of Cas9 bound to bona fide off-target substrates, revealing that off-target binding is enabled by a range of noncanonical base-pairing interactions within the guide:off-target heteroduplex. Off-target substrates containing single-nucleotide deletions relative to the guide RNA are accommodated by base skipping or multiple noncanonical base pairs rather than RNA bulge formation. Finally, PAM-distal mismatches result in duplex unpairing and induce a conformational change in the Cas9 REC lobe that perturbs its conformational activation. Together, these insights provide a structural rationale for the off-target activity of Cas9 and contribute to the improved rational design of guide RNAs and off-target prediction algorithms.

An Analysis of Noise in Multi-Bit ΣΔ Modulators with Low-Frequency Input Signals

Digital and smart sensors are commonly implemented using multi-bit ΣΔ Modulators. Undesired signals can be present at the ADC input, such as low-frequency signals with medium or high amplitude, as a consequence of mechanical artifacts in the MEMS and/or temporary signal overload. Simulations and measurements of those sensors with such signals show temporary increments of in-band noise power. This paper investigates the factors that produce this transient performance loss. Interestingly, noise increments happen when the modulator is forced to toggle between three adjacent levels and is not correlated with the typical tonal behavior of ΣΔ Modulators. Hence, the sensor performance is sensitive to some specific input patterns even if tonal behavior is decreased by dithering the input of the ADC. Different error sources, such as the mismatch between DAC cells, loop filter linearity error, and quantization error, contribute to the observed noise increments. Our aim is to analyze each of these error sources to understand and quantify in-band noise power increments, and to desensitize the ADC from the undesired input patterns. Some estimation equations are proposed and verified through extensive simulations, by means of deterministic and stochastic methods. These equations are influenced by some modulator parameters and can be used to optimize them in order to reduce such in-band noise power increments.

Climate change creates nutritional phenological mismatches

Climate change is creating phenological mismatches between consumers and their resources. However, while the importance of nutritional quality in ecological interactions is widely appreciated, most studies of phenological mismatch focus on energy content alone. We argue that mismatches in terms of phenology and nutrition will increase with climate change.

Perspective: Darwinian Applications to Nutrition-The Value of Evolutionary Insights to Teachers and Students

Evolutionary biology informs us that the living world is a product of evolution, guided by the Darwinian mechanism of natural selection. This recognition has been fruitfully employed in a number of issues in health and nutrition sciences; however, it has not been incorporated into education. Nutrition and dietetics students generally learn very little or nothing on the subject of evolution, despite the fact that evolution is the process by which our genetically determined physiological traits and needs were shaped. In the present Perspective article, 3 examples of topics (inflammatory diseases, nutrition transition, and food intolerance) that can benefit from evolutionary information and reasoning are given, with relevant lines of research and inquiry provided throughout. It is argued that the application of evolutionary science to these and other areas of nutrition education can facilitate a deeper and more coherent teaching and learning experience. By recognizing and reframing nutrition as an aspect and discipline of biology, grounded in the fundamental principle of adaptation, revelatory light is shed on physiological states and responses, contentious and unresolved issues, genomic, epigenomic, and microbiomic features, and optimal nutrient status and intakes.

ExsgRNA: reduce off-target efficiency by on-target mismatched sgRNA

Clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 gene editing technology has been widely used to facilitate efficient genome editing. Current popular sgRNA design tools only consider the sgRNA perfectly matched to the target site and provide the results without any on-target mismatch. We suppose taking on-target gRNA-DNA mismatches into consideration might provide better sgRNA with similar binding activity and reduced off-target sites. Here, we trained a seq2seq-attention model with feedback-loop architecture, to automatically generate sgRNAs with on-target mismatches. Dual-luciferase reporter experiment showed that multiple sgRNAs with three mismatches could achieve the 80% of the relative activity of the perfect matched sgRNA. Meanwhile, it could reduce the number of off-target sites using sgRNAs with on-target mismatches. Finally, we provided a freely accessible web server sgRNA design tool named ExsgRNA. Users could submit their target sequence to this server and get optimal sgRNAs with less off-targets and similar on-target activity compared with the perfect-matched sgRNA.

The Neural Representation of a Repeated Standard Stimulus in Dyslexia

The neural representation of a repeated stimulus is the standard against which a deviant stimulus is measured in the brain, giving rise to the well-known mismatch response. It has been suggested that individuals with dyslexia have poor implicit memory for recently repeated stimuli, such as the train of standards in an oddball paradigm. Here, we examined how the neural representation of a standard emerges over repetitions, asking whether there is less sensitivity to repetition and/or less accrual of "standardness" over successive repetitions in dyslexia. We recorded magnetoencephalography (MEG) as adults with and without dyslexia were passively exposed to speech syllables in a roving-oddball design. We performed time-resolved multivariate decoding of the MEG sensor data to identify the neural signature of standard vs. deviant trials, independent of stimulus differences. This "multivariate mismatch" was equally robust and had a similar time course in the two groups. In both groups, standards generated by as few as two repetitions were distinct from deviants, indicating normal sensitivity to repetition in dyslexia. However, only in the control group did standards become increasingly different from deviants with repetition. These results suggest that many of the mechanisms that give rise to neural adaptation as well as mismatch responses are intact in dyslexia, with the possible exception of a putatively predictive mechanism that successively integrates recent sensory information into feedforward processing.

Structural and functional insight into mismatch extension by human DNA polymerase α

Human DNA polymerase α (Polα) does not possess proofreading ability and plays an important role in genome replication and mutagenesis. Polα extends the RNA primers generated by primase and provides a springboard for loading other replication factors. Here we provide the structural and functional analysis of the human Polα interaction with a mismatched template:primer. The structure of the human Polα catalytic domain in the complex with an incoming deoxycytidine triphosphate (dCTP) and the template:primer containing a T-C mismatch at the growing primer terminus was solved at a 2.9 Å resolution. It revealed the absence of significant distortions in the active site and in the conformation of the substrates, except the primer 3′-end. The T-C mismatch acquired a planar geometry where both nucleotides moved toward each other by 0.4 Å and 0.7 Å, respectively, and made one hydrogen bond. The binding studies conducted at a physiological salt concentration revealed that Polα has a low affinity to DNA and is not able to discriminate against a mispaired template:primer in the absence of deoxynucleotide triphosphate (dNTP). Strikingly, in the presence of cognate dNTP, Polα showed a more than 10-fold higher selectivity for a correct duplex versus a mismatched one. According to pre-steady-state kinetic studies, human Polα extends the T-C mismatch with a 249-fold lower efficiency due to reduction of the polymerization rate constant by 38-fold and reduced affinity to the incoming nucleotide by 6.6-fold. Thus, a mismatch at the postinsertion site affects all factors important for primer extension: affinity to both substrates and the rate of DNA polymerization.

Balloon-Expandable Transcatheter Aortic Valve Replacement

Prosthesis−patient mismatch (PPM) is associated with worse outcomes following surgical aortic valve replacement (SAVR). PPM has been identified in a significant proportion of TAVR, particularly in patients with small aortic annuli. Our objective was to evaluate the hemodynamic performances of balloon-expandable (BE) (Sapiens 3TM) versus two different self-expandable (SE) (Evolut ProTM, Accurate NeoTM) TAVR devices in patients with small aortic annulus defined by a computed tomography aortic annulus area (AAA) between 330 and 440 mm2. We enrolled 131 consecutive patients corresponding to 76 Sapiens 3 23 mm (58.0%), 26 Evolut Pro (19.9%) and 29 Accurate Neo (22.1%). Mean age was 82.5 ± 7.06 years, 22.9% of patients were male and mean Euroscore was 4.0%. Mean AAA was 374 ± 27 mm2 for Sapiens 3, 383 ± 29 mm2 for Corevalve Evolut Pro and 389 ± 25 mm2 for Accurate Neo. BE devices were associated with significantly higher rates of PPM (39.5%) as compared to SE devices (15.4% for Corevalve Evolut Pro and 6.9% for Accurate Neo) (p < 0.0001). Paravalvular leaks ≥ 2/4 were more often observed in SE devices (15.4% for Corevalve Evolut Pro and 17.2% for Accurate Neo) than in BE devices (2.6%) (p = 0.007). In conclusion, SE TAVR devices did achieve better hemodynamic results despite higher rates of paravalvular leaks. Therefore, SE TAVI devices could be considered as first choice in small aortic anatomy.

Climate warming changes synchrony of plants and pollinators

Climate warming changes the phenology of many species. When interacting organisms respond differently, climate change may disrupt their interactions and affect the stability of ecosystems. Here, we used global biodiversity facility occurrence records to examine phenology trends in plants and their associated insect pollinators in Germany since the 1980s. We found strong phenological advances in plants but differences in the extent of shifts among pollinator groups. The temporal trends in plant and insect phenologies were generally associated with interannual temperature variation and thus probably driven by climate change. When examining the synchrony of species-level plant-pollinator interactions, their temporal trends differed among pollinator groups. Overall, plant-pollinator interactions become more synchronized, mainly because the phenology of plants, which historically lagged behind that of the pollinators, responded more strongly to climate change. However, if the observed trends continue, many interactions may become more asynchronous again in the future. Our study suggests that climate change affects the phenologies of both plants and insects and that it also influences the synchrony of plant-pollinator interactions.

Programming Soft Shape-Morphing Systems by Harnessing Strain Mismatch and Snap-Through Bistability: A Review

Multi-modal and controllable shape-morphing constitutes the cornerstone of the functionalization of soft actuators/robots. Involving heterogeneity through material layout is a widely used strategy to generate internal mismatches in active morphing structures. Once triggered by external stimuli, the entire structure undergoes cooperative deformation by minimizing the potential energy. However, the intrinsic limitation of soft materials emerges when it comes to applications such as soft actuators or load-bearing structures that require fast response and large output force. Many researchers have explored the use of the structural principle of snap-through bistability as the morphing mechanisms. Bistable or multi-stable mechanical systems possess more than one local energy minimum and are capable of resting in any of these equilibrium states without external forces. The snap-through motion could overcome energy barriers to switch among these stable or metastable states with dramatically distinct geometries. Attributed to the energy storage and release mechanism, such snap-through transition is quite highly efficient, accompanied by fast response speed, large displacement magnitude, high manipulation strength, and moderate driving force. For example, the shape-morphing timescale of conventional hydrogel systems is usually tens of minutes, while the activation time of hydrogel actuators using the elastic snapping instability strategy can be reduced to below 1 s. By rationally embedding stimuli-responsive inclusions to offer the required trigger energy, various controllable snap-through actuations could be achieved. This review summarizes the current shape-morphing programming strategies based on mismatch strain induced by material heterogeneity, with emphasis on how to leverage snap-through bistability to broaden the applications of the shape-morphing structures in soft robotics and mechanical metamaterials.

Flow augmentation STA-MCA bypass evaluation for patients with acute stroke and unilateral large vessel occlusion: a proposal for an urgent bypass flowchart

OBJECTIVE

Endovascular recanalization trials have shown a positive impact on the preservation of ischemic penumbra in patients with acute large vessel occlusion (LVO). The concept of penumbra salvation can be extended to surgical revascularization with bypass in highly selected patients. For selecting these patients, the authors propose a flowchart based on multimodal MRI.

METHODS

All patients with acute stroke and persisting internal carotid artery (ICA) or M1 occlusion after intravenous lysis or mechanical thrombectomy undergo advanced neuroimaging in a time window of 72 hours after stroke onset including perfusion MRI, blood oxygenation level-dependent functional MRI to evaluate cerebrovascular reactivity (BOLD-CVR), and noninvasive optimal vessel analysis (NOVA) quantitative MRA to assess collateral circulation.

RESULTS

Symptomatic patients exhibiting persistent hemodynamic impairment and insufficient collateral circulation could benefit from bypass surgery. According to the flowchart, a bypass is considered for patients 1) with low or moderate neurological impairment (National Institutes of Health Stroke Scale score 1-15, modified Rankin Scale score ≤ 3), 2) without large or malignant stroke, 3) without intracranial hemorrhage, 4) with MR perfusion/diffusion mismatch > 120%, 5) with paradoxical BOLD-CVR in the occluded vascular territory, and 6) with insufficient collateral circulation.

CONCLUSIONS

The proposed flowchart is based on the patient's clinical condition and multimodal MR neuroimaging and aims to select patients with acute stroke due to LVO and persistent inadequate collateral flow, who could benefit from urgent bypass.

Possibilities and challenges of small molecule organic compounds for the treatment of repeat diseases

The instability of repeat sequences in the human genome results in the onset of many neurological diseases if the repeats expand above a certain threshold. The transcripts containing long repeats sequester RNA binding proteins. The mechanism of repeat instability involves metastable slip-out hairpin DNA structures. Synthetic organic chemists have focused on the development of small organic molecules targeting repeat DNA and RNA sequences to treat neurological diseases with repeat-binding molecules. Our laboratory has studied a series of small molecules binding to mismatched base pairs and found molecules capable of binding CAG repeat DNA, which causes Huntington's disease upon expansion, CUG repeat RNA, a typical toxic RNA causing myotonic dystrophy type 1, and UGGAA repeat RNA causing spinocerebellar ataxia type 31. These molecules exhibited significant beneficial effects on disease models in vivo, suggesting the possibilities for small molecules as drugs for treating these neurological diseases.

Testing the match-mismatch hypothesis in bighorn sheep in the context of climate change

In species with long gestation, females commit to reproduction several months before parturition. If cues driving conception date are uncoupled from spring conditions, parturition could be mistimed. Mismatch may increase with global change if the rate of temporal changes in autumn cues differs from the rate of change in spring conditions. Using 17 years of data on climate and vegetation phenology, we show that autumn temperature and precipitation, but not vegetation phenology, explain parturition date in bighorn sheep. Although autumn cues drive the timing of conception, they do not predict conditions at parturition in spring. We calculated the mismatch between individual parturition date and spring green-up, assessed whether mismatch increased over time and investigated the consequences of mismatch on lamb neonatal survival, weaning mass and overwinter survival. Mismatch fluctuated over time but showed no temporal trend. Temporal changes in green-up date did not lead to major fitness consequence of mismatch. Detailed data on individually marked animals revealed no effect of mismatch on neonatal or overwinter survival, but lamb weaning mass was negatively affected by mismatch. Capital breeders might be less sensitive to mismatch than income breeders because they are less dependent on daily food acquisition. Herbivores in seasonal environments may access sufficient forage to sustain lactation before or after the spring 'peak' green-up, and partly mitigate the consequences of a mismatch. Thus, the effect of phenological mismatch on fitness may be affected by species life history, highlighting the complexity in quantifying trophic mismatches in the context of climate change.

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty

Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended.

Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced).

Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty.

Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately.

Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake.

Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results.

Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures.

Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080

Interaural Place-of-Stimulation Mismatch Estimates Using CT Scans and Binaural Perception, But Not Pitch, Are Consistent in Cochlear-Implant Users

Bilateral cochlear implants (BI-CIs) or a CI for single-sided deafness (SSD-CI; one normally functioning acoustic ear) can partially restore spatial-hearing abilities, including sound localization and speech understanding in noise. For these populations, however, interaural place-of-stimulation mismatch can occur and thus diminish binaural sensitivity that relies on interaurally frequency-matched neurons. This study examined whether plasticity-reorganization of central neural pathways over time-can compensate for peripheral interaural place mismatch. We hypothesized differential plasticity across two systems: none for binaural processing but adaptation for pitch perception toward frequencies delivered by the specific electrodes. Interaural place mismatch was evaluated in 19 BI-CI and 23 SSD-CI human subjects (both sexes) using binaural processing (interaural-time-difference discrimination with simultaneous bilateral stimulation), pitch perception (pitch ranking for single electrodes or acoustic tones with sequential bilateral stimulation), and physical electrode-location estimates from computed-tomography (CT) scans. On average, CT scans revealed relatively little BI-CI interaural place mismatch (26° insertion-angle mismatch) but a relatively large SSD-CI mismatch, particularly at low frequencies (166° for an electrode tuned to 300 Hz, decreasing to 14° at 7000 Hz). For BI-CI subjects, the three metrics were in agreement because there was little mismatch. For SSD-CI subjects, binaural and CT measurements were in agreement, suggesting little binaural-system plasticity induced by mismatch. The pitch measurements disagreed with binaural and CT measurements, suggesting place-pitch plasticity or a procedural bias. These results suggest that reducing interaural place mismatch and potentially improving binaural processing by reprogramming the CI frequency allocation would be better done using CT-scan than pitch information.SIGNIFICANCE STATEMENT Electrode-array placement for cochlear implants (bionic prostheses that partially restore hearing) does not explicitly align neural representations of frequency information. The resulting interaural place-of-stimulation mismatch can diminish spatial-hearing abilities. In this study, adults with two cochlear implants showed reasonable interaural alignment, whereas those with one cochlear implant but normal hearing in the other ear often showed mismatch. In cases of mismatch, binaural sensitivity was best when the same cochlear locations were stimulated in both ears, suggesting that binaural brainstem pathways do not experience plasticity to compensate for mismatch. In contrast, interaurally pitch-matched electrodes deviated from cochlear-location estimates and did not optimize binaural sensitivity. Clinical correction of interaural place mismatch using binaural or computed-tomography (but not pitch) information may improve spatial-hearing benefits.

Influenza B Lineages Have More in Common Than Meets the Eye. Trivalent Influenza Vaccines Trigger Heterotypic Antibodies Against Both Influenza B Viruses

Influenza B is accountable for an important burden during flu epidemics, causing special impact in children and the elderly. Vaccination is the best approach to address influenza infections. However, one of the main problems of this virus is that two different lineages circulate together, Victoria and Yamagata; and trivalent vaccines, that only contain one of these lineages, are still in use. For that reason, if during an epidemic, the lineage not included in the vaccine predominates, a mismatch would occur, and the vaccine effectiveness will be very poor. In this work, we evaluated the cross-protection given by the trivalent Influenza vaccine and compared serological profiles based on age, sex, and the type of vaccine used. We performed a retrospective analysis of serum samples obtained before and after seasonal influenza vaccination during 20 seasons (1998–2018). The results showed that heterotypic reactivity between both influenza B lineages is common, but always lower than the homologous response. Age is a relevant factor for this cross-reactivity between both lineages, while the sex and the type of vaccine not. Vaccination with trivalent influenza vaccines elicits cross-reactive antibodies against both lineages, however, this response might not be enough to provide an appropriate serological protection in case of mismatch.

Conformational dynamics during misincorporation and mismatch extension defined using a DNA polymerase with a fluorescent artificial amino acid

High-fidelity DNA polymerases select the correct nucleotide over the structurally similar incorrect nucleotides with extremely high specificity while maintaining fast rates of incorporation. Previous analysis revealed the conformational dynamics and complete kinetic pathway governing correct nucleotide incorporation using a high-fidelity DNA polymerase variant containing a fluorescent unnatural amino acid. Here we extend this analysis to investigate the kinetics of nucleotide misincorporation and mismatch extension. We report the specificity constants for all possible misincorporations and characterize the conformational dynamics of the enzyme during misincorporation and mismatch extension. We present free energy profiles based on the kinetic measurements and discuss the effect of different steps on specificity. During mismatch incorporation and subsequent extension with the correct nucleotide, the rates of the conformational change and chemistry are both greatly reduced. The nucleotide dissociation rate, however, increases to exceed the rate of chemistry. To investigate the structural basis for discrimination against mismatched nucleotides, we performed all atom molecular dynamics simulations on complexes with either the correct or mismatched nucleotide bound at the polymerase active site. The simulations suggest that the closed form of the enzyme with a mismatch bound is greatly destabilized due to weaker interactions with active site residues, nonideal base pairing, and a large increase in the distance from the 3'-OH group of the primer strand to the α-phosphate of the incoming nucleotide, explaining the reduced rates of misincorporation. The observed kinetic and structural mechanisms governing nucleotide misincorporation reveal the general principles likely applicable to other high-fidelity DNA polymerases.

Determinants of visual-functional mismatches as assessed by coronary angiography and quantitative flow ratio

OBJECTIVE

We aimed to evaluate the determinants of visual-functional mismatches between quantitative coronary angiography (QCA) and the quantitative flow ratio (QFR).

BACKGROUND

The fractional flow reserve (FFR) has been established as a method to estimate the functional stenosis severity of coronary artery disease and to optimize decision-making for revascularization. The QFR is a novel angiography-derived computational index that can estimate the FFR without pharmacologically induced hyperemia or the use of pressure wire.

METHODS

A total of 504 de novo intermediate-to-severe stable lesions that underwent angiographic and physiological assessments were analyzed. All lesions were divided into four groups based on the significance of visual (QCA-diameter stenosis [DS] > 50% and ≤ 50%) and functional (QFR ≤ 0.80 and > 0.80) stenosis severity. Patient characteristics, angiographic findings, and physiological indices were compared.

RESULTS

One-hundred seventy-eight lesions (35.3%) showed discordant visual-functional assessments; mismatch (QCA-DS > 50% and QFR > 0.80) in 75 lesions (14.9%) and reverse mismatch (QCA-DS ≤ 50% and QFR ≤ 0.80) in 103 lesions (20.4%), respectively. Reverse mismatch was associated with non-diabetes, lower ejection fraction, higher Duke jeopardy score, and lower coronary flow reserve (CFR). Mismatch was associated with smaller QCA-DS, larger reference diameter, shorter lesion length, lower Duke jeopardy score, and higher CFR. Lesion location and microcirculatory resistance was not associated with the prevalence of mismatches. Reverse mismatch group had the higher prevalence of discordant decision-makings between QFR and FFR than the other three groups.

CONCLUSIONS

The CFR and subtended myocardial mass were predictors of visual-functional mismatches between QCA-DS and the QFR. Caution should be exercised in lesions showing QCA-DS/QFR reverse mismatch.

Garments furniture design for Bangladeshi workers considering ergonomic principles

BACKGROUND

In Bangladesh, workers typically spend at least eight hours a day at garment factories in sitting and/or standing position. Prolonged sitting on ergonomically unfit furniture causes back, neck, and shoulder pain, which reduces the working efficiency and leading to low productivity.

OBJECTIVE

The aim of this study is to design ergonomically correct furniture for Bangladeshi garment workers considering multivariate analysis on the anthropometric data.

METHODS

Twelve anthropometric measures and five furniture dimensions were measured. The sample comprised of 600 volunteer workers from different garment industry. The furniture dimensions were compared with the relevant anthropometric characteristics and found a high level of mismatch (e.g. seat height (male 18%, female 94.25%), seat depth (male 96%, female 63.50%), seat width (male 9.50%, female 36.25%), sewing table height (male 56.50%, female 50%), and desk height for inspection, cutting and ironing table (male 100%, female 100%).

RESULTS

New design specifications were proposed of the worker which improved the match percentage. The multivariate anthropometric analysis generated 8 cases and for each case the ranges of anthropometric measurements have been identified.

CONCLUSION

The results will help to design robust ergonomic garments furniture.

Pediatric urgent heart transplantation with age or weight mismatched donors: Reducing waiting time by enlarging donor criteria

BACKGROUND

Despite considerable progress in heart transplantation, pediatric waiting list mortality is still high, and often patients do not have enough time to wait. We hypothesized that extending the donor criteria regarding age and weight mismatch does not significantly affect the early follow-up.

METHODS

We retrospectively analyzed our pediatric heart transplantation patients operated on from 2014 to 2020 for high (>3.0) or low (<0.6) donor-recipient weight ratio (DRWR) or chronological age mismatches (donor organ >5 years older than recipient age). This patient cohort constituted "mismatched heart transplantations" (mHTX). We compared mHTX preoperative status, postoperative course, 1-year survival, and early clinical follow-up to standard pediatric heart transplantations (sHTX).

RESULTS

We performed 20 pediatric heart transplantations-10 mHTX and 10 sHTX. The minimum DRWR was 0.44, the maximum was 5.60, and the maximum age mismatch was 42.6 years. Median days in the intensive care unit (p = .436) and time-to-first-rejection episode (p = .925) were comparable. Nine patients in each group were alive after 1 year, two patients were operated within 1 year of follow-up. One mHTX patient developed cardiac allograft vasculopathy after 15 months and died 648 days after transplantation (p = .237). All other patients were alive at the end of follow-up and in good clinical conditions (median follow-up for mHTX was 732.5 days, 1149.5 days for sHTX).

CONCLUSION

Postoperative course and early follow-up after mHTX were comparable to sHTX. In urgent clinical situations, extended donor criteria may be considered an additional option for pediatric heart transplantation.

Biomechanics of anatomic and reverse shoulder arthroplasty

The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics.With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening.The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis.The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont's reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm.More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014.

Usefulness of 123I-BMIPP and 201TlCl nuclide scintigraphy in evaluation of myocarditis in patients with polymyositis or dermatomyositis

To investigate the usefulness of 123I-BMIPP/201TlCl scintigraphy for evaluating the presence of myocarditis in patients with polymyositis (PM) or dermatomyositis (DM).We performed a retrospective study of 26 patients diagnosed with new-onset active PM/DM who underwent 123I-BMIPP/201TlCl scintigraphy between 01 April 2010 and 20 March 2015. We determined the 123I-BMIPP/201TlCl ratio and grouped the patients according to presence or absence of a mismatch. We evaluated the relationship between mismatch and the laboratory and echocardiographic findings.Mismatch was found in 13 (50%) patients. There was no statistically significant difference in age, cardiac troponin T, myoglobin, myosin light chain, aldolase levels, E wave/A wave ratio, right ventricular systolic pressure between the mismatch and non-mismatch groups. Left ventricular end-diastolic and end-systolic dimensions were significantly greater in the mismatch group (45.0 vs 42.5 mm, P =  < .01 and 29.5 mm vs 25.0 mm, P < .01). Left ventricular ejection fraction was significantly lower in the mismatch group (63.5% vs 71.5%, P = .04). Significant inverse correlation (r = -0.44, P = .03) was observed between left ventricular ejection fraction and mismatch ratio.The use of 123I-BMIPP/ 201TlCl scintigraphy may be considered for evaluating myocarditis in patients with PM/DM.