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The study of physical activity in older adults is becoming more and more relevant. For evaluation of physical activity recommendations, intensity-specific accelerometer cut-points are utilized. However, research on accelerometer cut-points for older adults is still scarce. The aim of the study was to generate placement-specific cut-points of ActiGraph GT3X+ activity counts and raw measures of acceleration to determine physical activity intensity in older adults. A further aim was to compare the validity of the generated cut-points for a range of different physical activities. The study was a single experimental trial using a convenience sample. Study participants were 20 adults aged 59 to 73 years. Accelerometers were worn at six different placements (one on each wrist, one on each ankle, and two at the hip) and breath-by-breath indirect calorimetry was used as the reference for energy. The experiment comprised of two parts; a) The first required participants to walk on a treadmill at incremental speeds (3.0–5.0 km·h -1 ), and b) Five different everyday activities (reading, cleaning, shopping, cycling, aerobics) were staged in the laboratory setting. Accelerometer cut-points (activity counts, raw data) were derived for each of the investigated placements by linear regression using the treadmill part. Performance of the cut-points was assessed by applying the cut-points to the everyday activities. We provide cut-points for six placements and two accelerometer metrics in the specific age group. However, the derived cut-points did not outperform published ones. More research and innovative approaches are needed for improving internal and external validity of research results across populations and age groups.

Background.A retrospective study of the clinical, epidemiologic, and virologic features of norovirus gastroenteritis in 12 adult allogeneic hematopoietic stem cell transplant (HSCT) recipients. Methods.Norovirus infection was diagnosed by reverse-transcriptase polymerase chain reaction. Strains were genotyped by nucleic acid sequence of the most highly conserved region of the norovirus gene encoding the capsid S (shell) domain. Results.Ten of 12 patients presented with vomiting of short duration, but diarrhea was present in all. The median time from onset to norovirus diagnosis was 1 month (range, 0.25–6.0 months). Eleven patients were receiving immunosuppression when norovirus infection was diagnosed: 8 for graft-versus-host disease (GVHD) in an organ other than gut, 1 for previous gut GVHD, and 2 for presumed gut GVHD that proved to be norovirus gastroenteritis. Six patients required enteral or parenteral nutrition for severe weight loss. In 10 patients, diarrhea lasted a median of 3 months (range, 0.5–14 months) and virus was shed at a high level throughout. The remaining 2 patients died after 4 months of diarrhea (one died of unrelated complications, and the other died of malnutrition). The noroviruses found were GII (untyped), GII-3, GII-4, and GII-7 in 1, 1, 9, and 1 patients, respectively. Eleven of the 12 patients had acquired their infection in the community. Phylogenetic analysis of the GII-4 strains demonstrated that all differed. Conclusions.Noroviruses are a hitherto unsuspected cause of prolonged morbidity and mortality in adults after allogeneic HSCT. The use of reverse-transcriptase polymerase chain reaction to detect high viral load levels in feces distinguishes norovirus gastroenteritis from gut GVHD.

Due to their negligible cytoplasm and composition of the sperm plasmalemma, spermatozoa are particularly vulnerable to lipid peroxidative damage induced by reactive oxygen species (ROS). Most ROS are referred to as free radicals because they have unpaired electrons, causing them to scavenge electrons from atoms within tissues, resulting in oxidative damage to cellular components including cell membranes, intracellular organelles, and DNA. The potential consequences of oxidative stress include impaired sperm function, DNA fragmentation, and apoptosis. Understanding the mechanisms that mediate sperm damage during cryopreservation is key to the development of improved sperm freezing media formulations and methodology to mitigate its occurrence. Historically, elucidation of those mechanisms has proven largely elusive and is complicated by the positive role that ROS also play as messengers in redox signaling and the different pathways that mediate sperm DNA damage and apoptosis. More recently, oxidative stress has been revealed as the most likely suspect in cryopreservation-induced sperm DNA damage. This narrative review was intended to provide an in-depth analysis of the mechanisms involved and offer insight into possible improvements in sperm cryopreservation.

Carbapenemase-producing organisms (CPOs) are Gram-negative bacteria that are typically resistant to most or all antibiotics and are responsible for a global pandemic of high mortality. Rapid, accurate detection of CPOs and the classification of their carbapenemases are valuable tools for reducing the mortality of the CPO-associated infections, preventing the spread of CPOs, and optimizing use of new β-lactamase inhibitor combinations such as ceftazidime/avibactam, meropenem/vaborbactam and imipenem/relebactam. The current study evaluated the performance of CPO Complete, a novel, manual, phenotypic carbapenemase detection and classification test. The test was evaluated for sensitivity and specificity against 262 CPO isolates of Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter baumannii and 67 non-CPO isolates. It was also evaluated for carbapenemase classification accuracy against 205 CPOs that produced a single carbapenemase class. The test exhibited 100% sensitivity 98.5% specificity for carbapenemase detection within 90 minutes and detected 74.1% of carbapenemases within 10 minutes. In the classification evaluation, 99.0% of carbapenemases were correctly classified for isolates that produced a single carbapenemase. The test is technically simple and has potential for adaptation to automated instruments. With lyophilized kit storage at temperatures up to 38°C, the CPO Complete test has the potential to provide rapid, accurate carbapenemase detection and classification in both limited resource and technologically advanced laboratories.

Background: The aim of this study was to assess the performance of shear wave elastography combined with BI-RADS classification of greyscale ultrasound images for benign/malignant differentiation in a large group of patients. Methods: One hundred and seventy-five consecutive patients with solid breast masses on routine ultrasonography undergoing percutaneous biopsy had the greyscale findings classified according to the American College of Radiology BI-RADS. The mean elasticity values from four shear wave images were obtained. Results: For mean elasticity vs greyscale BI-RADS, the performance results against histology were sensitivity: 95% vs 95%, specificity: 77% vs 69%, Positive Predictive Value (PPV): 88% vs 84%, Negative Predictive Value (NPV): 90% vs 91%, and accuracy: 89% vs 86% (all P >0.05). The results for the combination (positive result from either modality counted as malignant) were sensitivity 100%, specificity 61%, PPV 82%, NPV 100%, and accuracy 86%. The combination of BI-RADS greyscale and shear wave elastography yielded superior sensitivity to BI-RADS alone ( P =0.03) or shear wave alone ( P =0.03). The NPV was superior in combination compared with either alone (BI-RADS P =0.01 and shear wave P =0.02). Conclusion: Together, BI-RADS assessment of greyscale ultrasound images and shear wave ultrasound elastography are extremely sensitive for detection of malignancy.

The diagnosis and prognosis of chronic kidney disease (CKD) currently relies on very few circulating small molecules, which can vary by factors unrelated to kidney function. In end-stage renal disease (ESRD), these same small molecules are used to determine dialysis dose and dialytic clearance. Therefore, we aimed to identify novel plasma biomarkers to estimate kidney function in CKD and dialytic clearance in ESRD. Untargeted metabolomics was performed on plasma samples from patients with a single kidney, non-dialysis CKD, ESRD and healthy controls. For ESRD patients, pre- and post-dialysis plasma samples were obtained from several dialysis modalities. Metabolomics analysis revealed over 400 significantly different features in non-dialysis CKD and ESRD plasma compared to controls while less than 35 features were significantly altered in patients with a single kidney. N,N,N-trimethyl-L-alanyl-L-proline betaine (TMAP, AUROC = 0.815) and pyrocatechol sulfate (AUROC = 0.888) outperformed creatinine (AUROC = 0.745) in accurately identifying patients with a single kidney. Several metabolites accurately predicted ESRD; however, when comparing pre-and post-hemodialysis, TMAP was the most robust biomarker of dialytic clearance for all modalities (AUROC = 0.993). This study describes TMAP as a novel potential biomarker of kidney function and dialytic clearance across several hemodialysis modalities.

This study compared the activity of cefepime + zidebactam (FEP-ZID) and selected currently available antibacterial agents against a panel of multidrug-resistant (MDR) clinical isolates chosen to provide an extreme challenge for antibacterial activity. FEP–ZID had a very broad and potent in vitro spectrum of activity, and was highly active against many MDR isolates of Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii. Notably, it inhibited isolates producing carbapenemases of Ambler classes A, B, and D, and P. aeruginosa isolates with multiple resistance mechanisms including combinations of upregulated efflux, diminished or non-functional OprD porins, and AmpC overproduction. Its clinical role will be determined initially by the breakpoints assigned to it, comparison studies with other investigational β-lactamase inhibitor combinations, and ultimately by the developing body of therapeutic outcome data.

Background: Response of invasive breast cancer to neoadjuvant chemotherapy (NAC) is variable, and prediction of response is imperfect. We aimed to ascertain whether tissue stiffness in breast cancers, as assessed by shear-wave elastography (SWE) before treatment, is associated with response. Methods: We retrospectively compared pre-treatment tumour mean tissue stiffness, with post-treatment Residual Cancer Burden (RCB) scores and its components in 40 women with breast cancer treated by NAC using Pearson’s correlation coefficient (CC), a general linear model and multiple linear regression. Subgroup analysis was carried out for luminal, HER2-positive and basal immuno-histochemical subtypes. Results: Statistically significant correlations were shown between stiffness and RCB scores and between stiffness and percentage tumour cellularity. The correlation between stiffness and percentage cellularity was strongest (CC 0.35 ( P <0.0001) compared with CC 0.23 ( P =0.004) for the RCB score). The results of a general linear model show that cellularity and RCB score maintain independent relationships with stiffness. By multiple linear regression, only cellularity maintained a significant relationship with stiffness. Conclusion: Pre-treatment tumour stiffness measured by SWE, has a statistically significant relationship with pathological response of invasive breast cancer to NAC.

Doleritic sill complexes, which are an important component of volcanic continental margins, can be imaged using 3D seismic reflection data. This allows unprecedented access to the complete 3D geometry of the bodies and an opportunity to test classic sill emplacement models. The doleritic sills associated with basaltic volcanism in the North Rockall Trough occur in two forms. Radially symmetrical sill complexes consist of a saucer-like inner sill at the base with an arcuate inclined sheet connecting it to a gently inclined, commonly ragged, outer rim. Bilaterally symmetrical sill complexes are sourced by magma diverted from a magma conduit feeding an overlying volcano. With an elongate, concave upwards, trough-like geometry bilaterally symmetrical sills climb away from the magma source from which they originate. Both sill complex types can appear as isolated bodies but commonly occur in close proximity and consequently merge, producing hybrid sill complexes. Radial sill complexes consist of a series of radiating primary flow units. With dimensions up to 3 km, each primary flow unit rises from the inner saucer and is fed by primary magma tube. Primary flow units contain secondary flow units with dimensions up to 2 km, each being fed by a secondary magma tube branching from the primary magma tube. Secondary flow units in turn are composed of 100-m scale tertiary flow units. A similar branching hierarchy of flow units can also be seen in bilaterally symmetrical sill complexes, with their internal architecture resembling an enlarged version of a primary flow unit from a radial sill complex. This branching flow pattern, as well as the interaction between flow units of varying orders, provides new insights into the origin of the structures commonly seen within sill complexes and the hybrid sill bodies produced by their merger. The data demonstrate that each radially symmetrical sill complex is independently fed from a source located beneath the centre of the inner saucer, grows by climbing from the centre outwards and that peripheral dyking from the upper surface is a common feature. These features suggest a laccolith emplacement style involving peripheral fracturing and dyking during inner saucer growth and thickening. The branching hierarchy of flow units within bilaterally symmetrical sill complexes is broadly similar to that of primary flow units within a radially symmetrical sill complex, suggesting that the general features of the laccolith emplacement model also apply.[PUBLICATION ABSTRACT]