Nevin Manimala

Ticks Tick Borne Dis. 2022 Mar 10:101939. doi: 10.1016/j.ttbdis.2022.101939. Online ahead of print.

ABSTRACT

Equine piroplasmosis is a disease of equids, caused by tick-borne apicomplexan protozoan pathogens Babesia caballi and Theileria equi, which, according to the World Organisation for Animal Health (OIE), can be diagnosed by enzyme-linked immunosorbent assay (ELISA), immunofluorescent antibody test (IFAT) and polymerase chain reaction (PCR). The present study was conducted to evaluate and compare the assays available for the diagnosis of equine piroplasmosis. Data employed were obtained from 1300 blood samples collected between 2012-2014 from asymptomatic and symptomatic equines (horses and donkeys) of central-southern regions of Italy and analyzed by ELISA, IFAT, PCR (one commercial and one from literature) and blood smear microscopic examination. Statistical differences of the proportions of positivity for each parasite and group (asymptomatic and symptomatic) among the methods were verified by the z test to identify the most sensitive. The concordance between each pair of methods – for each parasite and within the groups – and trends in detection of suspect samples of four hypothetical diagnostic algorithms using serological and biomolecular assays were evaluated to identify the most suitable laboratory diagnostic workflow. The results of this study highlighted a lower capacity to detect suspect samples of commercial ELISA for B. caballi in all groups when compared to biomolecular methods and IFAT; and of the commercial PCRs in asymptomatic animals, identifying a PCR from literature and IFAT as the best choice for a combined diagnosis. For T. equi, IFAT detected more suspect samples than ELISA, even if the latter showed good performance and some samples were positive only by the ELISA and PCR, indicating that their simultaneous employment is still advantageous. Host-parasite interaction, amino-acid/genetic diversity and differences in detection limits among the assays could be among the reasons in explaining the present results. In view of further studies, ELISA should be used in combination with PCR, that should regularly be included in the laboratory diagnosis to maximise the detection of early infections and support the evaluation of pharmacological treatment.

PMID:35474261 | DOI:10.1016/j.ttbdis.2022.101939

Sci Rep. 2022 Apr 26;12(1):6809. doi: 10.1038/s41598-022-10787-8.

ABSTRACT

.Impairment of mentalization may impact coping strategies, regulation of affect and stress. The influence of impaired mentalization on dissociation in patients with adverse childhood experiences (ACEs) could be important for treatment strategies. The aim of this study is to assess the relationship between ACEs, mentalizing and dissociation in adult individuals. Sixty-seven patients with ACEs completed the Mentalization Questionnaire (MZQ), the Essener Trauma Inventory (ETI) and the Brief Symptom Inventory-18 (BSI-18). The SPSS PROCESS macro tool was applied to test if mentalization mediated the relationship of ACEs and dissociation. ACEs were significantly associated with higher dissociation (β = 0.42, p < 0.001) and lower mentalization (β = – 0.49, p < 0.001). When mentalization was added to the model as a predictor, the association of ACEs with dissociation was no longer significant (β = 0.11, p = 0.31) and a statistically significant indirect effect was found (β = 0.32, 95% CI 0.16-0.47). The overall explained variance of dissociation notably improved after inclusion of mentalization (17.5% to 49.1%). Thus, the results indicated that the association of ACEs on dissociation was fully mediated by mentalization. Our results suggest that ACEs are associated with lower mentalization and higher dissociation. Lower mentalization was also associated with worse depression, anxiety, somatization and PTSD symptoms. These findings underline the increasing importance of early treatment of individuals affected by ACEs with a focus to foster the development of mentalization.

PMID:35474233 | DOI:10.1038/s41598-022-10787-8

J Environ Manage. 2022 Apr 23;314:115101. doi: 10.1016/j.jenvman.2022.115101. Online ahead of print.

ABSTRACT

Nitrate (NO₃^–) contamination in groundwater has diverse sources and complicated transformation processes. To effectively control NO₃^– pollution in groundwater systems, quantitative and accurate identification of NO₃^– sources is critical. In this work, we applied hydrochemical characteristics and isotope analysis to determine NO₃^– source apportionment. For the first time, the NO₃^– source contributions were calculated using hydrochemical indicators combined with multivariate statistical model (PCA-APCS-MLR). The results interpret that chemical fertilizers (58.11%) and natural sources (22.69%) were the primary NO₃^– sources in the vegetable cultivation area (VCA) which were rather close to the estimation by Bayesian isotope mixing model (SIAR). In particular, the contributions of chemical fertilizers in the VCA differed by only 3.79% between the two methods. Compared with previous approaches e.g. SIAR, the key advantage of the proposed PCA-APCS-MLR model is that it only requires the hydrochemical indicators which can be easily measured. A series of complicated experiments including measurement of isotope data of NO₃^– in groundwater, monitoring of in-situ pollution source information and calculation of isotopic enrichment factor can be simply avoided. The PCA-APCS-MLR model offers a much more convenient and faster method to determine the contribution rates of NO₃^– pollution sources in groundwater.

PMID:35472839 | DOI:10.1016/j.jenvman.2022.115101

Stat Med. 2022 Apr 26. doi: 10.1002/sim.9418. Online ahead of print.

ABSTRACT

The number needed to treat (NNT) is an efficacy index commonly used in randomized clinical trials. The NNT is the average number of treated patients for each undesirable patient outcome, for example, death, prevented by the treatment. We introduce a systematic theoretically-based framework to model and estimate the conditional and the harmonic mean NNT in the presence of explanatory variables, in various models with dichotomous and nondichotomous outcomes. The conditional NNT is illustrated in a series of four primary examples; logistic regression, linear regression, Kaplan-Meier estimation, and Cox regression models. Also, we establish and prove mathematically the exact relationship between the conditional and the harmonic mean NNT in the presence of explanatory variables. We introduce four different methods to calculate asymptotically-correct confidence intervals for both indices. Finally, we implemented a simulation study to provide numerical demonstrations of the aforementioned theoretical results and the four examples. Numerical analysis showed that the parametric estimators of the NNT with nonparametric bootstrap-based confidence intervals outperformed other examined combinations in most settings. An R package and a web application have been developed and made available online to calculate the conditional and the harmonic mean NNTs with their corresponding confidence intervals.

PMID:35472818 | DOI:10.1002/sim.9418

Klin Monbl Augenheilkd. 2022 Apr;239(4):513-517. doi: 10.1055/a-1766-7268. Epub 2022 Apr 26.

ABSTRACT

PURPOSE: Multiple approaches for quantifying parameters such as vessel density (VD) and vessel length density (VLD) in optical coherence tomography angiography (OCTA) en-face segmentations are currently available. While it is common knowledge that data gathered from different methods should not be directly compared to each other, a comparison of the different methods can help to further the understanding of differences between different methods of measurement. Here we compare a common method of semiautomatically quantifying VD and VLD with an automated method supplied by the manufacturer of an OCTA device and report on differences in performance in order to probe for and highlight differences in values gathered by both methods.

METHODS: OCTA was performed using the swept source PLEX Elite 9000 device, software version 2.0.1.47652 (Carl Zeiss Meditec Inc., Dublin, CA, USA). Scans of 3 mm × 3 mm from healthy volunteers centred on the fovea were acquired by a well-trained certified ophthalmologist. Scans with a signal strength of 8 out of 10 or higher were included. Quantitative parameters of the 3 mm × 3 mm cube scans were automatically generated and segmented into superficial capillary plexus (SCP) and deep capillary plexus (DCP) layers using layer segmentation produced by the instrument software and prototype analysis VD quantification software (Macular Density v.0.7.1, ARI Network Hub, Carl Zeiss Meditec Inc., Dublin, CA, USA) supplied by the manufacturer. An alternative approach of quantitative analysis of VD and VLD was performed manually with ImageJ (National Institutes of Health, Bethesda, Maryland, USA), as previously reported. VD was assessed as the ratio of the retinal area occupied by vessels. VDL was measured as the total length of the skeletonised vessels using 1-pixel centre line extraction of the blood vessels.

RESULTS: We report differences in standard deviation (SD) in OCTA parameters obtained using different methods. The standard deviation of VD and VLD measurements was statistically significantly different in VD of 3 mm × 3 mm DCP (p = 0.009), VLD of 3 mm × 3 mm SCP (p = 0.000), and VLD of 3 mm × 3 mm DCP (p = 0.021). No statistically significant differences were found in VD of 3 mm × 3 mm SCP (p = 0.128) or VLD of 3 mm × 3 mm SCP (p = 0.107).

CONCLUSIONS: As expected, we were able to demonstrate significant differences in quantitative OCTA parameters gathered from the same images using different methods of quantification. Values gathered using different methods are not interchangeable. In scientific studies and in situations where long-term follow-up is necessary, the same device and the same method of quantification should be used to maintain retrospective comparability of measurements.

PMID:35472795 | DOI:10.1055/a-1766-7268

Klin Monbl Augenheilkd. 2022 Apr;239(4):500-512. doi: 10.1055/a-1766-7448. Epub 2022 Apr 26.

ABSTRACT

PURPOSE: To analyse structural (OCT), microvascular (OCTA), and functional changes (BCVA, mfERG) associated with fovea plana and to compare it to healthy controls.

METHODS: A retrospective observational study was performed on 13 patients (26 eyes; aged 34.46 y ± 20.26) with a clinical picture of fovea plana and 15 controls (30 eyes; aged: 41.47 y ± 14.03).

RESULTS: In fovea plana, BCVA ranged from 0.25 to 1.0, with a spherical error of – 5.5 to + 18.0 dpt. Posterior segment changes included elevated papillomacular retinal fold, uveal effusion syndrome, crowded optic discs, and hypopigmented fundus. OCTA imaging of the superficial (FAZ-S), intermediate (FAZ-I), and deep foveal avascular zone (FAZ-D) confirmed absence of foveal avascular zone (FAZ-S in 13 eyes, FAZ-I in 21 eyes, and FAZ-D in 10 eyes). Fovea plana patients had a significantly smaller FAZ-S, FAZ-I, and FAZ-D than controls (p < 0.001). Within the fovea plana group, a smaller FAZ-S correlated with reduced BCVA (p = 0.004) and with reduced mfERGs in zones 1 and 2 (p = 0.001 and p = 0.017). Also, a smaller FAZ-D showed positive correlations with the mfERG, with statistically significant values in zones 1 and 2 (p = 0.003 and p = 0.017).

CONCLUSION: In conclusion, our results confirm an altered structural, microvascular, and functional pattern in patients with a clinical picture of fovea plana. As documented by the functional microvascular interactions in our study, the developmental arrest in foveation reflects the functional maturation by means of visual acuity and central retinal function.

PMID:35472794 | DOI:10.1055/a-1766-7448

Klin Monbl Augenheilkd. 2022 Apr;239(4):494-499. doi: 10.1055/a-1770-4037. Epub 2022 Apr 26.

ABSTRACT

BACKGROUND: After the introduction of a “treat-and-extend” regimen (T&E) with aflibercept for exudative age-related macular degeneration, naive eyes were compared with eyes pretreated with a “pro re nata” scheme (PRN).

PATIENTS AND METHODS: The Ethics Committee of Eastern Switzerland approved the retrospective single-centre study (EKOS20/084, project ID: 2020-01193). The study included 342 eyes of 303 patients newly treated with or switched to T&E between January 2018 and March 2018 at the Eye Clinic of the Cantonal Hospital St. Gallen. The gender distribution of the treated eyes was 63.5% (n = 217) female and 36.5% (n = 125) male. The mean age was 81.6 years (SD = 8.6 years). The collective was divided into three groups: 1) naive, untreated eyes (n = 92), 2) eyes with ≤ 6 previous treatments with PRN (n = 37), 3) eyes with > 6 previous treatments with PRN (n = 213). The following parameters were analysed up to December 2019: the evolution of visual acuity, the number of intravitreal injections, the number of recurrences, the duration of the follow-up, the dropout rate, and the duration of the last treatment interval.

RESULTS: During the observation period, group 1 showed a statistically significant improvement in visual acuity of + 1.5 ETDRS, while groups 2 and 3 showed a decrease in visual acuity of – 2.9 and – 3.7 ETDRS, respectively. Group 1 had better development of visual acuity than groups 2 and 3 (p = 0.005), while groups 2 and 3 were not significantly different (p = 0.92). The other parameters examined in the three groups did not differ significantly between groups.

CONCLUSIONS: Treatment with aflibercept in T&E shows significantly better visual acuity in naive eyes than in eyes pretreated with PRN.

PMID:35472793 | DOI:10.1055/a-1770-4037

Klin Monbl Augenheilkd. 2022 Apr;239(4):484-489. doi: 10.1055/a-1788-3967. Epub 2022 Apr 26.

ABSTRACT

PURPOSE: To compare the efficacy and safety of core vitrectomy and pars plana vitrectomy for lens exchange in patients with intraocular lens dislocation.

METHODS: This is a retrospective study conducted at one eye center in Zurich, Switzerland. We reviewed 124 eyes with dislocated intraocular lens undergoing lens exchange carried out by two surgeons between 03/2016 and 12/2019 (45 months). Intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were analyzed preoperatively and at 5 time points up to 12 months after lens exchange. Data on postoperative complications were collected.

RESULTS: There were 124 eyes with intraocular lens dislocation that were referred for lens exchange. Of these eyes, 59 (48%) received core vitrectomy and 65 (52%) received pars plana vitrectomy with lens exchange. Glaucoma was more frequent in the core vitrectomy group (78%) than in the pars plana vitrectomy group (32%; p < 0.001). In the core vitrectomy group, 19 (32%) eyes presented with visual impairment, 17 (29%) eyes presented with high IOP alone, and 23 (39%) eyes presented with both at the same time prior to surgery. Mean preoperative IOP in the core vitrectomy group decreased from 22.4 ± 9.2 mmHg to 14.7 ± 3.1 mmHg 12 months after surgery (p < 0.001). Mean BCVA changed from 0.40 ± 0.41 logMAR preoperatively to 0.32 ± 0.37 logMAR at 12 months postoperatively (p = 0.598) in the core vitrectomy group. In the pars plana vitrectomy group, 44 (68%) eyes presented with a change in vision, 7 (11%) eyes presented with high IOP alone, and 14 (22%) eyes presented with pressure elevation and visual impairment at the visit prior to surgery. Mean preoperative IOP in the pars plana vitrectomy group decreased from 20.9 ± 8.3 mmHg to 15.1 ± 3.5 mmHg at 12 months after lens exchange (p < 0.001). Mean BCVA in the pars plana vitrectomy group was 0.57 ± 0.62 logMAR preoperatively and 0.22 ± 0.35 logMAR 12 months postoperatively (p < 0.001). Postoperative pressure decompensation occurred more frequently in the core vitrectomy group (20%) than in the pars plana vitrectomy group (6%; p = 0.018). There was no statistically significant difference for postoperative cystoid macular edema (p = 0.055), anisometropia (p = 0.986), and high astigmatism (p = 0.362).

CONCLUSION: Core vitrectomy and pars plana vitrectomy with lens exchange are equally efficient and safe in the management of intraocular lens dislocation.

PMID:35472791 | DOI:10.1055/a-1788-3967

Int J Hyg Environ Health. 2022 Apr 23;242:113971. doi: 10.1016/j.ijheh.2022.113971. Online ahead of print.

ABSTRACT

BACKGROUND: Refined coal tar sealant (RCTS) emulsions are used to seal the surface of asphalt pavement. Nine of the 22 polycyclic aromatic hydrocarbons (PAHs) evaluated in this study are classified as known, probable, or possible human carcinogens. Exposure assessment research for RCTS workers has not been published previously.

OBJECTIVES: The overall objective of this study was to develop a representative occupational exposure assessment of PAH exposure for RCTS workers based on worksite surveys. The specific aims were to: 1) quantify full-shift airborne occupational exposures to PAHs among RCTS workers; 2) quantify workers’ dermal exposures to PAHs; 3) quantify biomarkers of PAH exposure in workers’ urine; 4) identify specific job titles associated with RCTS exposure; and 5) apply these results to a biological exposure index to assess risk of potential genotoxicity from occupational exposures.

METHODS: A total of twenty-one RCTS workers were recruited from three companies. Personal and area air samples were collected using a modification of NIOSH Method 5515. Dermal exposure was assessed by hand and neck wipes before and after shifts. Twenty-two PAHs were quantified via gas chromatography-mass spectrometry selected ion monitoring. Internal dose was estimated by quantifying select PAH metabolites in pre- and post-shift urine samples using on-line solid phase extraction-high performance liquid chromatography-tandem mass spectrometry.

RESULTS: PAH levels in the worker breathing zones were highest for naphthalene, acenaphthene, and phenanthrene, with geometric means of 52.1, 11.4, and 9.8 μg/m³, respectively. Hand wipe levels of phenanthrene, fluoranthene and pyrene were the highest among the 22 PAHs with geometric means of 7.9, 7.7, and 5.5 μg/cm², respectively. Urinary PAH biomarkers for naphthalene, fluorene, phenanthrene, and pyrene were detected in all workers and were higher for post-shift samples than those collected pre-shift. Urinary concentrations of the metabolite 1-hydroxypyrene were greater than the American Conference of Governmental Industrial Hygienists (ACGIH) Biological Exposure Index (BEI) for this metabolite in 89 percent of post-shift samples collected on the final day of the work week or field survey. Statistically significances were found between concentrations of fluorene, naphthalene, and phenanthrene in the breathing zone of workers and their corresponding urinary PAH biomarkers. Workers were placed in two work place exposure groups: applicators and non-applicators. Applicators had higher total PAH concentrations in personal breathing zone (PBZ) air samples than non-applicators and were more likely to have post-shift hand wipe concentrations significantly higher than pre-shift concentrations. Concentrations of post-shift urinary biomarkers were higher, albeit not significantly, for applicators than non-applicators.

CONCLUSIONS: The exposure results from RCTS worker samples cannot be explained by proximal factors such as nearby restaurants or construction. Air and skin concentration levels were substantially higher for RCTS workers than previously published levels among asphalt workers for all PAHs. PAH profiles on skin wipes were more consistent with RCTS sealant product than air samples. Last day post-shift urinary concentrations of 1-hydroxypyrene greatly exceeded the ACGIH BEI benchmark of 2.5 μg/L in 25 of 26 samples, which suggests occupational exposure and risk of genotoxicity. When pyrene and benzo[a]pyrene were both detected, concentration ratios from personal exposure samples were used to calculate the adjusted BEI. Concentrations of 1-hydroxypyrene exceeded the adjusted BEIs for air, hand wipes, and neck wipes in most cases. These results indicate the need to increase safety controls and exposure mitigation for RCTS workers.

PMID:35472749 | DOI:10.1016/j.ijheh.2022.113971

J Surg Res. 2022 Apr 23;277:100-109. doi: 10.1016/j.jss.2022.03.011. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients after polytrauma suffer from posttraumatic immune system dysregulation and multiple organ dysfunction. Genome-wide microarray profiling in monocytes revealed a regulatory network of inflammatory markers around the transcription factor AP-1 in severely injured patients. Recent research focuses on the role of neutrophils in posttraumatic inflammation. The aim of this study was, therefore, to evaluate the impact of this inflammatory network in neutrophils.

MATERIALS AND METHODS: Blood sampling and neutrophil separation were performed on admission of the patient and at 6 h, 12 h, 24 h, 48 h, and 72 h after trauma. Neutrophil expression levels of the target genes c-Jun, c-Fos, BCL2A, MMP-9, TIMP-1, ETS-2, IL-1β, and MIP-1β were quantified by RT-qPCR. Patients were assorted into groups according to distinct clinical parameters like massive transfusion (>10 RBC units/24 h), injury severity (ISS), 90-d survival, and the presence of traumatic brain injury (defined by ICI on head CT). Statistics were calculated by Mann-Whitney Rank-Sum Test, Receiver Operating Curves, and binary multiple logistic regression.

RESULTS: Forty severely injured patients (mean ISS 36 ± 14) were included. BCL2A, MMP-9, TIMP-1, and ETS2 levels showed a significant correlation to 90-d-survival in the early posttraumatic period (6 h-24 h). Furthermore, differential BCL2A, IL-1β, MIP-1β, and MMP-9 regulation was observed in patients requiring massive transfusion. We could further show a significant TIMP-1 response in trauma PMN associated with traumatic brain injury.

CONCLUSIONS: This study of seriously injured patients highlights very early posttraumatic transcriptional changes in PMNs, which were clearly associated with posttraumatic events and outcomes.

PMID:35472724 | DOI:10.1016/j.jss.2022.03.011