A 59-year-old man presented for implantable cardioverter-defibrillator placement after a wide QRS complex tachycardia cardiac arrest at an outside hospital. In this case report, we discuss the differential diagnosis of this patient's tachyarrhythmia and the electrophysiological studies that established the diagnosis and guided management. (Level of Difficulty: Intermediate.).

Keywords: ablation; supraventricular tachycardia; ventricular tachycardia.

Keywords: clinical trials; multiethnic.

Purpose: Our previous studies demonstrated the beneficial effects of the probiotic Lactobacillus paracasei HII01, prebiotic xylooligosaccharide (XOS), and synbiotics on several parameters in high-fat diet (HFD)-induced obese rats. However, the gut microbiota composition in these rats has not been investigated. Therefore, this study aimed to investigate the impact of biotic therapies on gut microbiota in HFD-induced obese-insulin-resistant rats.

Methods: Male Wistar rats were fed with a normal diet (ND, n = 5) and a HFD (n = 20) for 24 weeks. At week 13, HFD-fed rats were given either a probiotic (L. paracasei, HF-Pro, n = 5), prebiotic (XOS, HF-Pre, n = 5), synbiotic (XOS + L. paracasei, HF-Syn, n = 5), or vehicle (HF-V, n = 5) for 12 weeks. ND-fed rats received vehicle (ND-V, n = 5). At week 24, all rats were decapitated, and metabolic parameters and gut microbiota were analyzed.

Results: HF-V rats developed an obese-insulin-resistant condition as indicated by impaired metabolic parameters. The prebiotic and synbiotic restored those metabolic parameters to the same level of ND-V rats. The gut microbiota composition of ND-V and HF-V rats differed as indicated by beta diversity. Verrucomicrobia in ND-V rats and Firmicutes and Proteobacteria in HF-V rats were dominant. Interestingly, Verrucomicrobia was also prominent in the HF-Syn rats. HF-Pre rats showed a distinct gut microbiota the predominant family being Ruminococcaceae.

Conclusion: The changes in gut microbiota after HFD consumption included increased Firmicutes and Proteobacteria. The treatment with the prebiotic and synbiotic showed an association with the increase in Ruminococcaceae and Verrucomicrobia, respectively. These changes in gut microbiota due to biotics may mediate the beneficial effects on metabolic parameters.

Keywords: Gut microbiota; High-fat diet; Prebiotics; Probiotics; Synbiotics.

Purpose: The study objectives were (1) to evaluate risk factors related to 30-day hospital readmissions after arthroscopic knee surgeries and (2) to determine the complications that may arise from surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database data from 2012 to 2017 were researched. Patients were identified using Current Procedural Terminology codes for knee arthroscopic procedures. Ordinal logistic fit regression and decision tree analysis were used to examine study objectives.

Results: There were 83,083 knee arthroscopic procedures between 2012 and 2017 obtained from the National Surgical Quality Improvement Program database. The overall readmission rate was 0.87%. The complication rates were highest for synovectomy and cartilage procedures, 1.6% and 1.3% respectively. A majority of readmissions were related to the procedure (71.1%) with wound complications being the primary reason (28.2%) followed by pulmonary embolism and deep vein thrombosis, 12.7% and 10.6%, respectively. Gender and body mass index were not significant factors and age over 65 years was an independent risk factor. Wound infection, deep vein thrombosis, and pulmonary embolism were the most prevalent complications.

Conclusion: Healthcare professionals have a unique opportunity to modify treatment plans based on patient risk factors. For patients who are at higher risk of inferior surgical outcomes, clinicians should carefully weigh risk factors when considering surgical and non-surgical approaches.

Level of evidence: III.

Keywords: 30-day hospital readmissions; Clinical treatment plans; Complication risk factors; Knee arthroscopic surgery.

Metacognition is often considered a critical component of learning and higher-order cognition; however, does metacognitive accuracy remain constant across all tasks, specifically in tasks that involve physical or procedural components? To investigate the consistency of metacognitive judgments across various task types, participants completed word and number recall tasks, and also completed three simple physical skill tasks (e.g., catching a ball in a cup). Participants made metacognitive judgments about their performance in all tasks. Results indicated that while participants demonstrated traditional levels of relative metacognitive accuracy in more cognitive tasks, participants were significantly more accurate in their judgments for physical skill tasks. In other words, relative accuracy for metacognitive judgments in physical tasks appears to be significantly higher than for cognitive tasks. This represents the first such demonstration of this effect and suggests that characteristics of physical tasks somehow improve participants' judgments of how well they have learned.

Keywords: Metacognition; Skill learning.

Objective: To introduce a wireless high-definition endoscopic system (WHES) and compare it with a Storz HD system in image resolution, color resolution, weight and costs.

Materials and methods: The WHES incorporated a portable LED light source and a wireless camera module, which could be compatible with different types of endoscopes. Images were wirelessly transmitted to a monitor or mobile platform such as smartphone through a receiver. The ISO 12233 resolution chart image was used for the comparison of image resolution and Munsell Color Checker Chart for color resolution. 38 endourologists used a Likert questionnaire to blindly evaluate cystoscopic images from a patient with hematuria. The surgical team was inquired about the overall performance of WHES in twenty laparoscopic adrenalectomies by a nonvalidated subjective survey.

Results: there was no difference in image resolution between the two systems (5.82 vs 5.89 lp/mm). Without lens and respective light sources, there were better purple (ΔE=21.48 vs 28.73), blue (ΔE=34.88 vs 38.6) and red color resolution (ΔE=29.01 vs 35.45) for the camera of WHES (P<0.05), but orange (ΔE=43.45 vs 36.52) and yellow (ΔE=52.7 vs 35.93) resolution were better for the Storz HD camera (P<0.05). Comparing WHES to a Storz laparoscopic system, the Storz system still presented better resolution of orange and yellow, and the resolution of purple, blue and red was similar for the two systems. The expert comments of resolution, brightness, color for cystoscopy were not statistically different, but the ergonomics scores of WHES was higher (3.7 vs 3.33, P=0.038). The overall expense of WHES was $23000-25000 compared with $45000-50000 for a Storz system. There were 100% general satisfaction for WHES in the survey.

Conclusion: We developed a new WHES represented the same resolution images and acceptable color resolution with the advantages of wireless connection, small volume, low cost, portability and high-speed wireless transmission.

Phosphoglucose isomerase (PGI) is a key enzyme that participates in polysaccharide synthesis, which is responsible for the interconversion of glucose-6-phosphate (G-6-P) and fructose-6-phosphate (F-6-P), but there is little research focusing on its role in fungi, especially in higher basidiomycetes. The pgi gene was cloned from Lentinula edodes and named lepgi. Then, the lepgi-silenced strains were constructed by RNA interference. In this study, we found that lepgi-silenced strains had significantly less biomass than the wild-type (WT) strain. Furthermore, the extracellular polysaccharide (EPS) and intracellular polysaccharide (IPS) levels increased 1.5- to 3-fold and 1.5-fold, respectively, in lepgi-silenced strains. Moreover, the cell wall integrity in the silenced strains was also altered, which might be due to changes in the compounds and structure of the cell wall. The results showed that compared to WT, silencing lepgi led to a significant decrease of approximately 40% in the β-1,3-glucan content, and there was a significant increase of 2-3-fold in the chitin content. These findings provide support for studying the biological functions of lepgi in L. edodes.

Keywords: Lentinula edodes; cell wall integrity; extracellular polysaccharide; intracellular polysaccharide; phosphoglucose isomerase.

Following the reflection in the editorial on the importance of indeterminacy as a thematic and a way to look at intergenerationality in a dynamic fashion, I present the tendency to refuse indeterminacy versus going into it. I present the authors' critic of the first tendency and I highlight how they implicitly present indeterminacy. I refer to Bergson's concept of empty form to guide my analysis that aims to making visible some tacit aspects in the authors' analysis. Then, I go more deeply into the authors' invisible reasoning by getting inspiration from Goethe's concept of active absence-I use one of the papers to present the hidden conditions of catalytic process characterizing indeterminacy. I particularly shed light on one of the authors hidden aspect-affectivity as an intermediary form that is made invisible probably because it does not fit with their theoretical framework acting as a screen (putting some dimensions into the shadow). This leads me to delve into how indeterminacy enables cracking the SURFACE-going under the superficial aspect of our life (our tendency to refuse indeterminacy). I also delve into the poetic dimension of indeterminacy and present some general implications of this analysis for theorization.

Keywords: Active absence; Empty form; Indeterminacy; Intergenerationality; Theorization.

Motivation: Many genomics applications require the computation of nucleotide coverage of a reference genome or the ability to determine how many reads map to a reference region.

Results: BamToCov is a toolkit for rapid and flexible coverage computation that relies on the most memory efficient algorithm and is designed for integration in pipelines, given its ability to read alignment files from streams. The tools in the suite can process sorted BAM or CRAM files, allowing the user to extract coverage information via different filtering approaches and to save the output in different formats (BED, Wig or counts).The BamToCov algorithm can also handle strand-specific and/or physical coverage analyses.

Availability: This program, accessory utilities, and their documentation are freely available at https://github.com/telatin/BamToCov.

Supplementary information: Supplementary data are available at Bioinformatics online.

Background: Existing emergency general surgery (EGS) guidelines rarely include evidence from low- and middle-income countries (LMICs) and may lack relevance to low-resource settings. The aim of this study was to develop global guidelines for EGS that are applicable across all hospitals and health systems.

Methods: A systematic review and thematic analysis were performed to identify recommendations relating to undifferentiated EGS. Those deemed relevant across all resource settings by an international guideline development panel were included in a four-round Delphi prioritization process and are reported according to International Standards for Clinical Practice Guidelines. The final recommendations were included as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack relevant resources at present but should plan for future implementation).

Results: After thematic analysis of 38 guidelines with 1396 unique recommendations, 68 recommendations were included in round 1 voting (410 respondents (219 from LMICs)). The final guidelines included eight essential, one desirable, and three critically unwell patient-specific recommendations. Preoperative recommendations included guidance on timely transfers, CT scan pathways, handovers, and discussion with senior surgeons. Perioperative recommendations included surgical safety checklists and recovery room monitoring. Postoperative recommendations included early-warning scores, discharge plans, and morbidity meetings. Recommendations for critically unwell patients included prioritization for theatre, senior team supervision, and high-level postoperative care.

Conclusion: This pragmatic and representative process created evidence-based global guidelines for EGS that are suitable for resource limited environments around the world.

Myasthenia gravis is an autoimmune disease affecting neuromuscular transmission and causing skeletal muscle weakness. Additionally, systemic inflammation, cognitive deficits and autonomic dysfunction have been described. However, little is known about myasthenia gravis-related reorganization of the brain. In this study, we thus investigated the structural and functional brain changes in myasthenia gravis patients. Eleven myasthenia gravis patients (age: 70.64 ± 9.27; 11 males) were compared to age-, sex- and education-matched healthy controls (age: 70.18 ± 8.98; 11 males). Most of the patients (n = 10, 0.91%) received cholinesterase inhibitors. Structural brain changes were determined by applying voxel-based morphometry using high-resolution T₁-weighted sequences. Functional brain changes were assessed with a neuropsychological test battery (including attention, memory and executive functions), a spatial orientation task and brain-derived neurotrophic factor blood levels. Myasthenia gravis patients showed significant grey matter volume reductions in the cingulate gyrus, in the inferior parietal lobe and in the fusiform gyrus. Furthermore, myasthenia gravis patients showed significantly lower performance in executive functions, working memory (Spatial Span, P = 0.034, d = 1.466), verbal episodic memory (P = 0.003, d = 1.468) and somatosensory-related spatial orientation (Triangle Completion Test, P = 0.003, d = 1.200). Additionally, serum brain-derived neurotrophic factor levels were significantly higher in myasthenia gravis patients (P = 0.001, d = 2.040). Our results indicate that myasthenia gravis is associated with structural and functional brain alterations. Especially the grey matter volume changes in the cingulate gyrus and the inferior parietal lobe could be associated with cognitive deficits in memory and executive functions. Furthermore, deficits in somatosensory-related spatial orientation could be associated with the lower volumes in the inferior parietal lobe. Future research is needed to replicate these findings independently in a larger sample and to investigate the underlying mechanisms in more detail.

Keywords: BDNF; VBM; myasthenia gravis; neuroplasticity; neuropsychological testing.

Objectives: To establish statewide consensus priorities for safer in-person school for children with medical complexity (CMC) during the coronavirus disease 2019 (COVID-19) pandemic using a rapid, replicable, and transparent priority-setting method.

Methods: We adapted the Child Health and Nutrition Research Initiative Method, which allows for crowdsourcing ideas from diverse stakeholders and engages technical experts in prioritizing these ideas using predefined scoring criteria. Crowdsourcing surveys solicited ideas from CMC families, school staff, clinicians and administrators through statewide distribution groups/listservs using the prompt: "It is safe for children with complex health issues and those around them (families, teachers, classmates, etc.) to go to school in-person during the COVID-19 pandemic if/when…" Ideas were aggregated and synthesized into a unique list of candidate priorities. Thirty-four experts then scored each candidate priority against 5 criteria (equity, impact on COVID-19, practicality, sustainability, and cost) using a 5-point Likert scale. Scores were weighted and predefined thresholds applied to identify consensus priorities.

Results: From May to June 2021, 460 stakeholders contributed 1166 ideas resulting in 87 candidate priorities. After applying weighted expert scores, 10 consensus CMC-specific priorities exceeded predetermined thresholds. These priorities centered on integrating COVID-19 safety and respiratory action planning into individualized education plans, educating school communities about CMC's unique COVID-19 risks, using medical equipment safely, maintaining curricular flexibility, ensuring masking and vaccination, assigning seats during transportation, and availability of testing and medical staff at school.

Conclusions: Priorities for CMC, identified by statewide stakeholders, complement and extend existing recommendations. These priorities can guide implementation efforts to support safer in-person education for CMC.

The present study investigated the positive effects of relatively low-dose metformin combined with Sargassum fusiforme polysaccharide (LMET-SFP) in high-fat diet and streptozotocin-induced diabetic rats, and explored the underlying mechanisms of LMET-SFP as compared to metformin alone in managing diabetes. The results indicate that both metformin and LMET-SFP can attenuate body weight loss and ameliorate hyperglycemia, insulin resistance and hyperlipidemia, and LMET-SFP exhibited better effects in lowering fasting blood glucose levels, insulin resistance index and serum cholesterol compared to metformin only. The administration of LMET-SFP could ameliorate liver dysfunction in diabetic rats. In addition, fecal bile acid data implied that LMET-SFP intervention contributed to an increase in fecal total bile acids, ursodesoxycholic acid and tauroursodesoxycholic acid profiles when compared to metformin treatment. Additionally, intestinal microbiological analysis showed that the acknowledged probiotics Lactobacillus and Bifidobacterium exhibited higher levels in the LMET-SFP group compared to the metformin group. RT-qPCR results demonstrated that the better hypoglycemic effects of LMET-SFP were mainly attributed to the down-regulation of 3-hydroxy-3-methylglutaryl-coenzyme A, cytosolic phosphoenolpyruvate carboxykinase and glucose-6-phosphatase expression, and the up-regulation of cholesterol 7α-hydroxylase expression, in contrast to metformin alone. These results suggest that SFP may be used as an auxiliary hypoglycemic substance for metformin in the future.

Background and aims: The defensive role of spines has previously been related to leaves, young shoots, and reproductive organs. However, some woody species harbour spines on their trunks where none of those organs are present. Several explanations are plausible: they could be 1- climbing aids, 2- remnants from defence of leaves or reproductive organs during an earlier development phase, or 3- an as-yet undescribed defence. Here we investigate whether they could play a role against either bark feeding or preventing climbing animals accessing food resources in the tree canopy.

Methods: We described 31 woody species with spines on their trunk, growing in a botanical garden, to test whether morphological strategies could be identified and suggest which could be their most likely function. As testing their function is difficult experimentally for large pools of species, we performed virtual experiments to evaluate the potential roles of trunk spines against bark removal and climbing animals of different sizes. We then compared for each species and their confamilial non-spiny species, the nutritional profiles of leaf, bark, and reproductive organs to test whether trunk spines were associated to a nutritious organ (more likely targeted by herbivores).

Key results: We identified four morphological syndromes of trunk spines. Two corresponded to already known functions (anchorage for lianas and crown defence against large ground mammals), two strategies are newly described trait syndromes with traits suggesting a defence against bark-feeders and climbing mammals. By simulation, we show how each strategy could translate into defence against debarking and prevent herbivores from climbing.

Conclusions: We identified trunk spines strategies and the criteria to classify them, their most likely function and the likely feeding mode and size of animal against which different trunk spine strategies may be effective. We discuss further perspectives for testing their function and their ecological significance.

Keywords: bark; climbing; defence; function; mammal; morphological syndrome; spine; trunk spine.

Most published autism research, and the funding that supports it, remains focused on basic and clinical science. However, the public health impact of autism drives a compelling argument for utilizing a public health approach to autism research. Fundamental to the public health perspective is a focus on health determinants to improve quality of life and to reduce the potential for adverse outcomes across the general population, including in vulnerable subgroups. While the public health research process can be conceptualized as a linear, 3-stage path consisting of discovery - testing - translation/dissemination/implementation, in this paper we propose an integrated, cyclical research framework to advance autism public health objectives in a more comprehensive manner. This involves discovery of primary, secondary and tertiary determinants of health in autism; and use of this evidence base to develop and test detection, intervention, and dissemination strategies and the means to implement them in 'real world' settings. The proposed framework serves to facilitate identification of knowledge gaps, translational barriers, and shortfalls in implementation; guides an iterative research cycle; facilitates purposeful integration of stakeholders and interdisciplinary researchers; and may yield more efficient achievement of improved health and well-being among persons on the autism spectrum at the population-level. LAY SUMMARY: Scientists need better ways to identify and address gaps in autism research, conduct research with stakeholders, and use findings to improve the lives of autistic people. We recommend an approach, based in public health science, to guide research in ways that might impact lives more quickly.

Keywords: autism spectrum disorder; communication; knowledge; public health; quality of life.

The trunk movements of an individual paralyzed by spinal cord injury (SCI) can be restored by Functional Neuromuscular Stimulation (FNS), which applies low-level current to the motor nerves to activate muscles to generate torques, to actuate the trunk. FNS can be modulated to vary the bio-torques to drive the trunk to follow user-defined reference motions and maintain it at a desired postural set-points. However, a stabilizing modulation policy (i.e., control law) is difficult to derive as the biomechanics of the spine and pelvis are complex and the neuromuscular dynamics are not fully known. Therefore, a control method that can stabilize it with FNS without knowing the accurate skeletal and neuromuscular dynamics is desired. To achieve this goal, we propose a control framework consisting of a robust control module that generates stabilizing torques while an artificial neural network-based mapping mechanism with an anatomy-based updating law ensures that the muscle-generated torques converge to the stabilizing values. For the robust control module, two sliding-mode robust controllers (i.e., a high-compensation controller and an adaptive controller), were investigated. System stability of the proposed control method was analyzed based on the assumption that the skeletal dynamics can be approximated by Euler-Lagrange equations with bounded disturbances. We present experiments in a simulation environment where an anatomically realistic 3D musculoskeletal model of human trunk moved in various directions while perturbations were applied. The satisfactory simulation results suggest the potential of this control technique in clinical environment.

Introduction: Primary laboratory tests performed in the diagnosis of multiple myeloma (MM) include bone marrow examination and free light chain assay; however, these may only be ordered after clinical suspicion of disease. In contrast, routine blood test results are readily available.

Methods: Machine learning algorithms (ML) combined with routine blood tests were used to detect MM. Feature selection was performed to achieve improved classification performance. The robustness of the classification models was assessed in an internal and external validation data set. To minimize the divergence, the training and validation data sets were combined and used to assess the performance of the ML algorithms.

Results: The AdaBoost-DecisionTable produced the best performance (accuracy =94.75%, sensitivity =87.70%, positive predictive value (PPV) =92.50%, F-measure =90.00%, and areas under the receiver operating characteristic curves (AUC) =97.50%) in the training data set using a 10-fold cross-validation. Performance in the validation data sets was affected by the divergence of the data sets, with accuracy greater than 85% and AUC greater than 90% in the validation data sets. The ML algorithm achieved a high accuracy of 92.61%, high AUC (96.80%), a sensitivity value of 85.20%, a PPV value of 88.50%, and an F-measure of 86.80% in a test set that was randomly selected from the combined data set.

Conclusions: Combining ML and routine serum biomarkers hold a potential benefit in MM diagnosis.

Keywords: diagnosis; machine learning; multiple myeloma; routine biomarkers.

 : Proteins binding to specific nucleotide sequences, such as transcription factors, play key roles in the regulation of gene expression. Their binding can be indirectly observed via associated changes in transcription, chromatin accessibility, DNA methylation and histone modifications. Identifying candidate factors that are responsible for these observed experimental changes is critical to understand the underlying biological processes. Here we present monaLisa, an R/Bioconductor package that implements approaches to identify relevant transcription factors from experimental data. The package can be easily integrated with other Bioconductor packages and enables seamless motif analyses without any software dependencies outside of R.

Availability: monaLisa is implemented in R and available on Bioconductor at https://bioconductor.org/packages/monaLisa with the development version hosted on GitHub at https://github.com/fmicompbio/monaLisa.

Supplementary information: Supplementary data are available at Bioinformatics online.

T-complex polypeptide-1 (TCP1) is a group II chaperonin that folds various cellular proteins. About 10% of cytosolic proteins in yeast have been shown to flux through the TCP1 protein complex indicating that it interacts and folds a plethora of substrate proteins that perform essential functions. In Leishmania donovani, the gamma subunit of TCP1 (LdTCP1γ) has been shown to form a homo-oligomeric complex and exhibited ATP-dependent protein folding activity. LdTCP1γ is essential for the growth and infectivity of the parasite. The interacting partners of L. donovani TCP1γ, involved in many cellular processes, are far from being understood. In this study, we utilized co-immunoprecipitation assay coupled with liquid chromatography-mass spectrometry (LC-MS) to unravel protein-protein interaction (PPI) networks of LdTCP1γ in the L. donovani parasite. Label-free quantification (LFQ) proteomic analysis revealed 719 interacting partners of LdTCP1γ. String analysis showed that LdTCP1γ interacts with all subunits of TCP1 complex as well as other proteins belonging to pathways like metabolic process, ribosome, protein folding, sorting, and degradation. Trypanothione reductase, identified as one of the interacting partners, is refolded by LdTCP1γ. In addition, the differential expression of LdTCP1γ modulates the trypanothione reductase activity in L. donovani parasite. The study provides novel insight into the role of LdTCP1γ that will pave the way to better understand parasite biology by identifying the interacting partners of this chaperonin.

Keywords: Heat shock protein; Interacting partners; LC–MS/MS; Leishmania donovani; Refolding; T-complex protein-1 gamma subunit.