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Purpose Anterior cruciate ligament reconstruction (ACLR) using a short, quadrupled semitendinosus (ST-4) autograft, fixed  with an adjustable suspensory fixation (ASF), has several potential advantages. However, the construct is suspected to generate micromotion, tunnel widening and poor graft maturation. The aim of this study was to evaluate post-operative tibial tunnel expansion, graft maturation and clinical outcomes for this type of ACLR. Methods One-hundred and forty-nine patients were reviewed at a minimum of 2 years following 4-ST ACLR, mean 25.6 ± 3.5 months [24–55], with clinical follow-up and MRI scans. Graft maturity of the intra-articular part of the graft and the tibial tunnel portion was assessed using Signal-to-Noise Quotient (SNQ) and Howell score. Tibial tunnel expansion, bone–graft contact and graft volume in the tibial tunnel were calculated from the MRI scans. Results Mean tibial tunnel expansion was 13 ± 16.5% [12–122]. Mean SNQ for graft within the tibial tunnel was 3.8 ± 7.1 [ – 7.7 to 39] and 2.0 ± 3.5 [ – 14 to 17] for the intra-articular portion of the graft. The Howell score for graft within the tibial tunnel was 41% Grade I, 37% Grade 2, 20% Grade 3, 2% grade 4, and for the intra-articular part 61% Grade 1, 26% Grade 2, 13% Grade 3 and 1% Grade 4. The mean tibial tunnel bone–graft contact was 81 ± 23% [0–100] and mean graft volume was 80 ± 22% [0–100]. No correlation was found between tibial tunnel expansion and graft maturity assessed at both locations. Graft maturity was correlated with higher graft-bone contact and graft volume in the tibial tunnel ( p  < 0.05). Conclusions ST-4 ACLR with ASF had low levels of tunnel enlargement at 2 years. No correlation was found between graft maturation and tibial tunnel expansion. Graft maturity was correlated with graft–bone contact and graft volume in the tibial tunnel. Level of evidence Level III.

Background: It has been shown that adding lateral extra-articular tenodesis (LET) to standard anterior cruciate ligament (ACL) reconstruction significantly decreases the loads on the ACL composite graft. To date, the possible effect of LET on ACL graft incorporation is not known. Purpose: To compare the incorporation in tibial bone tunnels of a standard quadrupled semitendinosus (ST4) graft to an ST4 graft plus LET at 1 year postoperatively using magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 62 patients who underwent ACL reconstruction were enrolled prospectively: 31 received an ST4 graft, and 31 received an ST4 graft plus LET. Graft incorporation was evaluated with MRI at the 1-year follow-up visit. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel widening, graft healing, and graft maturity according to the Howell scale. The primary endpoint was the SNQ of the ST4 graft at 1 year postoperatively; this parameter was adjusted because of unequal baseline characteristics between groups. Clinical and functional outcomes as well as incorporation of the graft were analyzed as secondary endpoints. Results: The mean adjusted SNQ was 0.5 ± 2.1 (95% CI, 0.4-4.6) in the ST4 + LET group and 5.9 ± 3.7 (95% CI, 4.7-7.0) in the ST4 group (P = .0297). The mean tibial tunnel widening was 73.7% ± 42.2% in the ST4 + LET group versus 77.5% ± 46.7% in the ST4 group (P = .5685). Howell grade I, indicative of better graft maturity, was statistically more frequent in the ST4 + LET group (P = .0379). No statistically significant difference was seen between groups in terms of graft healing (P = .1663). The Lysholm score was statistically higher in the ST4 + LET group (P = .0058). No significant differences were found between groups in terms of the International Knee Documentation Committee subjective score (P = .2683) or Tegner score (P = .7428). The mean SNQ of the LET graft at the 1-year follow-up visit was 2.6 ± 4.9. Conclusion: At 1 year postoperatively, the MRI appearance of ACL grafts showed generally better incorporation and maturation when combined with LET.

Streamflow observations, essential for various water resource applications, are often unavailable at critical locations in need. Although different models have been proposed to enhance streamflow predictability at ungauged locations, the challenge extends beyond model fidelity. Differences in meteorologic forcing data sets, precipitation in particular, can significantly affect the accuracy of hydrologic predictions. This challenge intensifies across regions characterized by diverse hydro‐climatological and geographical conditions, such as in the conterminous US (CONUS) where a single precipitation product struggles to consistently replicate observed hydrographs, particularly peak flow dynamics. To enhance streamflow predictions, we utilize a VIC‐RAPID hydrologic modeling framework driven by multiple commonly used meteorological forcing data sets, such as Daymet, PRISM, ST4, AORC, and their hybrids and create multiple sets of 40‐year (1980–2019) hourly, daily, and monthly streamflow reanalysis, Dayflow Version 2, for 2.7 million river reaches across the CONUS. Most forcings lead to skillful streamflow performance, except for ST4 in the mountainous west, where severe radar blockage adversely affects the accuracy. The evaluation using over 6,000 hourly stream gauges shows that hourly AORC and ST4 lead to improved annual peak flow performance over Daymet—driven streamflow (Dayflow V1), particularly in smaller basins, highlighting the value of high temporal resolution forcings in hydrologic predictions. Compared with other benchmark data sets like National Water Model V3.0, AORC‐driven VIC‐RAPID exhibits improved regional streamflow performance, with comparable peak flow representation. We envision that multi‐forcing streamflow reanalysis data can inform regions in need of forcing data enhancement, diagnose hydrologic model performance, and benefit diverse water resource applications. Plain Language Summary Accurate prediction of streamflow is challenging in areas where direct observations are lacking. Though existing models aim to improve predictions at ungauged rivers, streamflow predictability is not dependent on the model alone. The quality of meteorological data sets, mainly related to precipitation, significantly influences hydrologic predictions. For regions like conterminous US with diverse hydro‐climatological and geographical conditions, a single forcing data set might not work well for all water resources applications. To overcome these challenges, we use a large‐scale hydrologic model driven by multiple widely used meteorological data sets to produce a 40‐year (1980–2019) high‐resolution streamflow reanalysis, Dayflow Version 2 (https://doi.org/10.13139/OLCF/2222888), for 2.7 million river reaches across the conterminous US. Most of these reaches demonstrate skillful streamflow performance with some regional patterns. The study shows that multi‐forcing streamflow reanalysis data can be valuable for enhancing forcing data in data‐scarce regions, evaluating hydrologic model performance, and supporting various water resource applications. Key Points CONUS‐wide high‐resolution streamflow reanalysis is presented for 1980–2019 across multiple forcings at 2.7 million river reaches Multiple forcings offer distinct advantages for various water resource applications The AORC forcing captures peak flow dynamics better, especially in smaller basins

Blastocystis hominis is a common globally distributed parasite. The prevalence of this parasite has been shown to vary among different countries. Molecular studies have also shown that there is a high level of genetic diversity among Blastocystis spp. isolated from humans and animals. Extensive information on parasitic genotypes will aid in devising more effective strategies for the identification and potential control of these pathogenic parasites. This study aimed to gain information on the prevalence and abundance of Blastocystis subtypes in Iran. Over a period of 3 months, 1,410 stool samples were collected and examined by microscopy. Samples found to be positive for B. hominis were concentrated and phylogenetic analysis was subsequently performed. A questionnaire was completed by all study participants. Blastocystis hominis was found to have a prevalence of 3.33% in the study population. There was no significant association of Blastocystis infection with age (P = 0.3) or gender (P = 0.57). The Blastocystis subtypes (ST) identified in this study were ST3, ST4, ST5, and ST7 with the most prevalent being ST4 (40.9%). The prevalence of B. hominis in the study area was lower than that reported for most developed countries, and unlike in other countries in the Middle East, ST4 was the most prevalent subtype.

Blastocystis sp. is one of the most frequently detected intestinal parasites in humans and can inhabit a wide range of animals. Close contact with animals is one of the transmission factors of Blastocystis sp. infection in humans. In this study, we aimed to investigate the molecular prevalence and subtypes of Blastocystis sp. in stray cats living in İzmir, Turkey. The PCR targeting the barcode region in the SSU rRNA gene was performed with DNA samples isolated from feces (n:465) to investigate the presence of Blastocystis sp. PCR positive samples were sequenced for subtyping analysis. Among the samples analyzed, Blastocystis sp. DNA was detected in 17 (3.65%) of them and sequence data were obtained from only seven isolates. Phylogenetic analysis showed that seven Blastocystis sp. isolates clustered with the reference Blastocystis ST4 isolates. Similarity rates were between 83.22% and 99.25%. In addition, Blastocystis database results confirmed that all of these were \"allele 42\" corresponding to ST4. As a result, the present study shows for the first time the presence of \"ST4 allele 42\", the prevalent subtype in humans, in stray cats in İzmir, Turkey. This finding supports the notion that stray cats can be a source of Blastocystis sp. infection in humans.

To determine the epidemiology characteristics of intestinal colonization of carbapenem-resistant (CRE) among inpatients in a pediatric hospital in China. A retrospective study was conducted from April to December 2019. Medical records were reviewed to extract the clinical information. Antimicrobial susceptibility was performed by broth microdilution method. Drug resistance determinants and plasmid types were analyzed using polymerase chain reaction (PCR) assays. Multilocus sequence typing (MLST) and Enterobacterial repetitive intergenic consensus sequences PCR (ERIC-PCR) were employed to determine the genetic relationships between strains. A total of 90 CRE strains were isolated, with a fecal carriage rate of 8.6% (90/1052), and mainly distributed in (n=30), (n=25) and (n=23). More than 50% of CRE colonizers had a history of invasive procedures and antibiotic exposures. As high as 91.1% (82/90) of CRE isolates carried carbapenemase genes, with (n=56) being the most common, and mainly found in (51.8%, 29/56) and (32.1%, 18/56) isolates, which primarily belonged to ST4 (100%, 29/29) and ST692 (55.6%, 10/18), respectively. Followed by (n=12), and all found in ST11 isolates. Other carbapenemase genes including , and . Meanwhile, ESBL genes ( , and ) and AmpC genes ( and ) were also detected. All CRE isolates showed high resistance to cephalosporins and carbapenemases (97.8%-100.0%) but remained susceptible to tigecycline (98.9%). IncX3 was a major plasmid type in NDM-containing strains (91.3%), and 91.7% of KPC-2-producing harboring IncFII and IncFIB plasmids. The ERIC-PCR revealed that several strains with identical STs were genetically similar. This study revealed a major intestinal colonization of ST4 NDM-5 , ST11 KPC-2 and ST692 NDM-5 strains among inpatients in a pediatric hospital. Infection control measures should be implemented immediately to prevent the spread of these strains in clinical settings.

IntroductionThe aim of this study was to assess the differential laxity after reconstruction of the anterior cruciate ligament (ACL) by the TLS® technique using a single tendon, the semitendinosus in four-strand graft, compared with the hamstring technique which uses both the gracilis and semitendinosus. We hypothesised that this surgical technique would provide post-surgical differential laxity measurements at least as good as those of the hamstring technique.Materials and methodsWe carried out a prospective monocentric study on patients undergoing unilateral anterior cruciate ligament repair between December 2014 and June 2016. All patients were followed up for at least 12 months. The series compares 61 patients operated on using the TLS® technique by the same surgeon, with 33 patients operated on using the hamstring technique by a second surgeon. The main objective of the study was to compare the post-operative differential laxity, measured using the KT1000, between the two techniques.ResultsThere was no significant difference in the patients’ epidemiological characteristics and pre-operative scores between the two groups. Average pre-operative differential laxity was 6.5 mm ± 2.1 (min 3; max 12) in the TLS group and 6.4 mm ± 2.0 (min 0; max 11) in the hamstring group, with no statistically significant difference. The average post-operative difference in laxity was − 0.1 mm ± 1.9 (min − 5; max 4) in the TLS group and 0.3 mm ± 2.0 (min − 7; max 5) in the hamstring group. Again, no significant difference was observed between groups.DiscussionThis study demonstrates a level of post-operative differential laxity control using TLS comparable with that of the ACL reconstruction technique using a hamstring graft with preserved tibial insertion.Level of evidenceII, prospective cohort study.

This chapter reviews the bacterial genus Cronobacter (formerly Enterobacter sakazakii), which can cause severe illness in neonates, in infants, and most often in the elderly. In recent years, this group of organisms has gone from obscurity to international concern. This chapter covers current methods in molecular typing of Cronobacter which are based on advances in our understanding of the taxonomy of these organisms. These methods include a range of DNA‐based profiling and typing methods such as pulsed‐field gel electrophoresis (PFGE), PCR‐based serotyping, and multilocus sequence typing (MLST). The latter has the advantage of its own curated open‐access database and has been used to define five new Cronobacter species. MLST has identified the prevalence of one particular clonal lineage (C. sakazakii ST4) in neonatal meningitis cases. MLST was used to choose representative members of the seven major Cronobacter species for whole‐genome comparative study of the genus (Joseph et al., ). Phylogenetic analysis of the whole‐genome sequence supported the phylogeny generated by MLST (Joseph et al., ). The seven‐loci Cronobacter MLST scheme has been extended to “Tax‐MLST” and “Cronobacter Bacterial Isolate Genome Sequence Database (BIGSdb).” Tax‐MLST enables single loci (rpoB or ompA) to be used for taxonomic designation of isolates. In Cronobacter BIGSdb, online genotyping based on hundreds of alleles is now feasible through the open access of whole‐genome sequences and the application of the BIGSdb. Two detailed studies are presented in this chapter. The first is the goeBURST analysis of Cronobacter strains collected worldwide, and the second is the genotyping of the highly publicized Cronobacter strains associated with infections in the United States in 2011.