[Optic pit maculopathy: incidence and clinical course]. / Grubenpapillen-Makulopathie: Inzidenz und klinischer Verlauf.

PURPOSE: The aim of this case series was to investigate the clinical course of patients with optic pit maculopathy. METHODS: The medical records of all patients diagnosed with optic pit maculopathy in the past 10 years were reviewed. Optic pit maculopathy was diagnosed when localized intraretinal or/and subretinal fluid spread from the optic nerve to the macula. Outcome measures included changes in best corrected visual acuity (BCVA), central retinal thickness (RT) as well as nasal parafoveal and perifoveal RT. RESULTS: An optic disc pit was detected in 18 patients (9 female, 9 male, mean age: 33 ± 23 years). Retinal fluid accumulation was present in 6 (33.3%) of the patients (1 intraretinal, 1 subretinal, 4 intraretinal and subretinal). Pars plana vitrectomy with removal of peripapillary vitreous traction and peeling of the internal limiting membrane (ILM) was indicated in 5 patients and was performed in 4 patients. One patient underwent nanopulse laser treatment instead. The patients with optic pit maculopathy were 47 ± 16 years old. In this group of patients, mean BCVA (decimal) improved from 0.3 ± 0.2 before treatment to 0.5 ± 0.2 3 months after treatment (p = 0.03). Visual acuity improved in all patients with optic disc pit maculopathy after pars plana vitrectomy. The mean central RT decreased from 796 ± 214 before treatment to 324 ± 57 3 months after treatment (p = 0.005). The mean nasal parafoveal RT decreased from 683 ± 87 before treatment to 372 ± 41 (p = 0.0003) and the mean nasal perifoveal RT decreased from 547 ± 89 before treatment to 360 ± 48 (p = 0.007). A completely dry macula was achieved in 4 eyes after a mean follow-up of 3 months. At long-term follow-up (2.5 ± 1.2 years), no recurrence occurred in the vitrectomized eyes. CONCLUSION: This case series showed that more than one third of the patients had optic pit maculopathy presumably caused by disruption of the Kuhnt intermediate tissue. Interventional treatment was indicated in all cases, of which 4 were surgically treated and resulted in significant improvement of function and anatomical retinal structures.

Weight loss maintenance after a digital commercial behavior change program (Noom Weight): Observational cross-sectional survey study.

Background: Behavioral weight loss programs often lead to significant short-term weight loss, but long-term weight maintenance remains a challenge. Most weight maintenance data come from clinical trials, in-person programs, or general population surveys, but there is a need for better understanding of long-term weight maintenance in real-world digital programs. Methods: This observational survey study examined weight maintenance reported by individuals who had used Noom Weight, a digital commercial behavior change program, and identified factors associated with greater weight maintenance. The cross-sectional survey was completed by 840 individuals who had lost at least 10% of their body weight using Noom Weight 6-24 months prior. Results: The study found that 75% of individuals maintained at least 5% weight loss after 1 year, and 49% maintained 10% weight loss. On average, 65% of initial weight loss was maintained after 1 year and 57% after 2 years. Habitual behaviors, such as healthy snacking and exercise, were associated with greater weight maintenance, while demographic factors were not. Conclusion: This study provides real-world data on the long-term weight maintenance achieved using a fully digital behavioral program. The results suggest that Noom Weight is associated with successful weight maintenance in a substantial proportion of users. Future research will use a randomized controlled trial to track weight maintenance after random assignment and at a 2 year follow-up.

Morphological and Functional Aspects and Quality of Life in Patients with Achromatopsia.

(1) Background: Achromatopsia is a rare disease of which the natural course and impact on life are still unknown to this date. We aimed to assess the morphological, functional characteristics, and quality of life in a large sample size of patients with achromatopsia. (2) A total of 94 achromats were included in this retrospective cohort study. Sixty-four were patients of the Department of Ophthalmology, Saarland University Medical Centre in Homburg/Saar, Germany, between 2008 and 2021. Thirty further participants with achromatopsia from the national support group were included using an online questionnaire, which is available under 'Supplementary data'. Statistical analysis was performed using SPSS Version 25; (3) The 94 patients (37 males (39.4%) and 57 females (60.6%)) showed a mean age of 24.23 ± 18.53 years. Visual acuity was stable (SD ± 0.22 logMAR at 1.0 logMAR) over a time of observation from 2008 to 2021. Edge filter glasses were the most used optical aids, while enlarged reading glasses were the most used low vision aids. (4) Conclusions: Our findings give an insight into describing the natural process and the quality of life of achromatopsia. The results demonstrate that achromatopsia is a predominantly stationary disease. The individual prescription of edge filters and low-vision aids is essential following a personalised fitting.

Understanding 'Good Health care' from the Patient's Perspective: Development of a Conceptual Model Using Group Concept Mapping.

BACKGROUND: There is an increasing focus on measuring performance indicators of health care providers, but there is a lack of patient input into what defines 'good care.' OBJECTIVE: The primary objective was to develop a conceptual model of 'good health care' from the patient's perspective. Exploratory analyses were also conducted to investigate (1) differences in patient priorities based on demographic and clinical factors, and (2) differences between patients and health stakeholders (e.g., clinicians, researchers) with respect to patient health care priorities. METHOD: These objectives were accomplished using group concept mapping. Following statement generation, PatientsLikeMe members, Baltimore community members recruited through a university-affiliated clinic, and stakeholders individually sorted the statements into meaningful categories and rated the statements with respect to importance. Qualitative and quantitative analyses generated a final conceptual model. RESULTS: One hundred and fifty-seven patients and 17 stakeholders provided input during statement generation. The 1779-statement pool was reduced to 79 statements for the structuring (sorting and rating) activities. In total, 221 patients and 16 stakeholders completed structuring activities through group concept mapping software. Results yielded a 10-cluster solution, and patient priorities were found to be relatively invariant across demographic/clinical groups. Results were also similar between patients and stakeholders. CONCLUSIONS: This comprehensive qualitative and quantitative investigation is an important first step in developing patient-reported outcome performance measures that capture the aspects of health care that are most important and relevant for patients. Limitations and future directions are discussed.

Long-read whole genome sequencing and comparative analysis of six strains of the human pathogen Orientia tsutsugamushi.

BACKGROUND: Orientia tsutsugamushi is a clinically important but neglected obligate intracellular bacterial pathogen of the Rickettsiaceae family that causes the potentially life-threatening human disease scrub typhus. In contrast to the genome reduction seen in many obligate intracellular bacteria, early genetic studies of Orientia have revealed one of the most repetitive bacterial genomes sequenced to date. The dramatic expansion of mobile elements has hampered efforts to generate complete genome sequences using short read sequencing methodologies, and consequently there have been few studies of the comparative genomics of this neglected species. RESULTS: We report new high-quality genomes of O. tsutsugamushi, generated using PacBio single molecule long read sequencing, for six strains: Karp, Kato, Gilliam, TA686, UT76 and UT176. In comparative genomics analyses of these strains together with existing reference genomes from Ikeda and Boryong strains, we identify a relatively small core genome of 657 genes, grouped into core gene islands and separated by repeat regions, and use the core genes to infer the first whole-genome phylogeny of Orientia. CONCLUSIONS: Complete assemblies of multiple Orientia genomes verify initial suggestions that these are remarkable organisms. They have larger genomes compared with most other Rickettsiaceae, with widespread amplification of repeat elements and massive chromosomal rearrangements between strains. At the gene level, Orientia has a relatively small set of universally conserved genes, similar to other obligate intracellular bacteria, and the relative expansion in genome size can be accounted for by gene duplication and repeat amplification. Our study demonstrates the utility of long read sequencing to investigate complex bacterial genomes and characterise genomic variation.

The Impact of Tai Chi Exercise on Self-Efficacy, Social Support, and Empowerment in Heart Failure: Insights from a Qualitative Sub-Study from a Randomized Controlled Trial.

OBJECTIVE: To qualitatively explore perceived physical and psychosocial effects and overall patient experience associated with a 12-week tai chi (TC) intervention and an education group in a clinical trial of patients with chronic heart failure (HF). SUBJECTS AND METHODS: We randomized 100 patients with chronic systolic HF (NYHA Class 1-3, ejection fraction≤40%) to a 12-week group TC program or an education control. At 12-weeks, semi-structured interviews were conducted on a random subset (n = 32; n = 17 in TC, n = 15 in control), audiorecorded and transcribed verbatim. Two independent reviewers extracted information using grounded-theory methods for emergent themes. We explored similarities and differences in themes/sub-themes between the groups, and examined qualitative association with changes from baseline to post-intervention in previously reported quantitative measures (e.g., Minnesota Living with HF, Cardiac Exercise Self Efficacy and Profile of Mood States). RESULTS: The mean age (±SD) of participants was 68±9 years, baseline ejection fraction 29±7%, and median New York Heart Association class 2 HF. We idenitifed themes related to the patient's experience of illness, perceptions of self, and relationship to others. Specific psychosocial and physical benefits were described. Common themes emerged from both groups including: social support and self-efficacy related to activity/exercise and diet. The tai chi group, however, also exhibited a more global empowerment and perceived control. Additional themes in TC included mindfulness/self-awareness, decreased stress reactivity, and renewed social role. These themes mirrored improvements in previously reported quantitative measures (quality-of-life, self-efficacy, and mood) in TC compared to control. Patients in TC also reported physical benefits (e.g., decreased pain, improved energy, endurance, flexibility). CONCLUSION: Positive themes emerged from both groups, although there were qualitative differences in concepts of self-efficacy and perceived control between groups. Those in tai chi reported not only self efficacy and social support, but overall empowerment with additional gains such as internal locus of control, self-awareness and stress management. Future studies of mind-body exercise might further examine perceived control, self-efficacy, and locus-of-control as potential mediators of effect.

Analysis of potential mercury policies: the impact of stream basin characteristics on susceptible populations.

Human exposure to Hg through fish consumption from local waterways is an ongoing concern to regulatory decision makers. Previously described population exposure and bioaccumulation models were combined to analyze the impact of potential policies on susceptible populations. The combined model simulated the problem of Hg exposure by examining the system from the point of Hg in the water column to its concentration in population biomarkers. Evaluated policy scenarios included the protectiveness of fish consumption advisories, total maximum daily load changes, and watershed management strategies. Simulations indicated that the characteristics of a basin combined with the unique pattern of intake rates of susceptible populations determine the risk associated with fish consumption from a given waterway. Each population had a unique pattern of biomarker response to changes in fish tissue Hg. Management strategies that lowered bioaccumulation rates also reduced ecosystem services. Reducing fish tissue contamination through reductions in Hg loading to watersheds is a long-term solution. For the short-term, fish consumption advisories should be used to protect populations from adverse exposures. The combination of characteristics of the basin and the populations that fish from the waterway should be the determinant for setting advisories.

A dynamic model using monitoring data and watershed characteristics to project fish tissue mercury concentrations in stream systems.

A complex interplay of factors determines the degree of bioaccumulation of Hg in fish in any particular basin. Although certain watershed characteristics have been associated with higher or lower bioaccumulation rates, the relationships between these characteristics are poorly understood. To add to this understanding, a dynamic model was built to examine these relationships in stream systems. The model follows Hg from the water column, through microbial conversion and subsequent concentration, through the food web to piscivorous fish. The model was calibrated to 7 basins in Kentucky and further evaluated by comparing output to 7 sites in, or proximal to, the Ohio River Valley, an underrepresented region in the bioaccumulation literature. Water quality and basin characteristics were inputs into the model, with tissue concentrations of Hg of generic trophic level 3, 3.5, and 4 fish the output. Regulatory and monitoring data were used to calibrate and evaluate the model. Mean average prediction error for Kentucky sites was 26%, whereas mean error for evaluation sites was 51%. Variability within natural systems can be substantial and was quantified for fish tissue by analysis of the US Geological Survey National Fish Database. This analysis pointed to the need for more systematic sampling of fish tissue. Analysis of model output indicated that parameters that had the greatest impact on bioaccumulation influenced the system at several points. These parameters included forested and wetlands coverage and nutrient levels. Factors that were less sensitive modified the system at only 1 point and included the unfiltered total Hg input and the portion of the basin that is developed.

Development and evaluation of a dynamic model that projects population biomarkers of methylmercury exposure from local fish consumption.

A dynamic model was developed to project Hg concentrations in common biomarkers of exposure in response to changes in Hg concentrations in predatory fish from local waters. The model predicts biomarkers in susceptible populations for intake rates representing the mean, 90th, 95th, and 99 th percentiles of populations of interest. The biomarkers the model calculates are blood methylmercury, total hair Hg, and fetal blood methylmercury. Decision makers can use the model to determine the degree of reduction in fish tissue Hg levels necessary to protect the health of susceptible populations. Biomarker output was calibrated with literature sources. Output was then compared to additional literature sources to evaluate model function. Projected biomarkers were not different from literature sources. The model can be used as a tool to understand the impact of local fish consumption on susceptible populations.

Occupational exposure to trichloroethylene and cancer risk for workers at the Paducah Gaseous Diffusion Plant.

OBJECTIVE: The Paducah Gaseous Diffusion Plant (PGDP) became operational in 1952; it is located in the western part of Kentucky. We conducted a mortality study for adverse health effects that workers may have suffered while working at the plant, including exposures to chemicals. MATERIALS AND METHODS: We studied a cohort of 6820 workers at the PGDP for the period 1953 to 2003; there were a total of 1672 deaths to cohort members. Trichloroethylene (TCE) is a specific concern for this workforce; exposure to TCE occurred primarily in departments that clean the process equipment. The Life Table Analysis System (LTAS) program developed by NIOSH was used to calculate the standardized mortality ratios for the worker cohort and standardized rate ratio relative to exposure to TCE (the U.S. population is the referent for ageadjustment). LTAS calculated a significantly low overall SMR for these workers of 0.76 (95% CI: 0.72-0.79). A further review of three major cancers of interest to Kentucky produced significantly low SMR for trachea, bronchus, lung cancer (0.75, 95% CI: 0.72-0.79) and high SMR for Non-Hodgkin's lymphoma (NHL) (1.49, 95% CI: 1.02-2.10). RESULTS: No significant SMR was observed for leukemia and no significant SRRs were observed for any disease. Both the leukemia and lung cancer results were examined and determined to reflect regional mortality patterns. However, the Non-Hodgkin's Lymphoma finding suggests a curious amplification when living cases are included with the mortality experience. CONCLUSIONS: Further examination is recommended of this recurrent finding from all three U.S. Gaseous Diffusion plants.

Correction of aberrant axon growth in the developing mouse olfactory bulb.

During development of the primary olfactory system, sensory axons project from the nasal cavity to the glomerular layer of the olfactory bulb. In the process axons can branch inappropriately into several glomeruli and sometimes over-shoot the glomerular layer, entering the deeper external plexiform layer. However in the adult, axons are rarely observed within the external plexiform layer. While chemorepulsive cues are proposed to restrict axons to the glomerular layer in the embryonic animal, these cues are clearly insufficient for all axons in the postnatal animal. We hypothesised that the external plexiform layer is initially an environment in which axons are able to grow but becomes increasingly inhibitory to axon growth in later postnatal development. We have determined that rather than having short localised trajectories as previously assumed, many axons that enter the external plexiform layer had considerable trajectories and projected preferentially along the ventro-dorsal and rostro-caudal axes for up to 950 µm. With increasing age, fewer axons were detected within the external plexiform layer but axons continued to be present until P17. Thus the external plexiform layer is initially an environment in which axons can extensively grow. We next tested whether the external plexiform layer became increasingly inhibitory to axon growth by microdissecting various layers of the olfactory bulb and preparing protein extracts. When assayed using olfactory epithelium explants of the same embryonic age, primary olfactory axons became increasingly inhibited by extract prepared from the external plexiform layer of increasingly older animals. These results demonstrate that primary olfactory axons can initially grow extensively in the external plexiform layer, but that during postnatal development inhibitory cues are upregulated that reduce axon growth within the external plexiform layer.

Mortality patterns among Paducah Gaseous Diffusion Plant workers.

OBJECTIVE: To determine whether Paducah Gaseous Diffusion Plant workers had mortality patterns that differed from the general US population and to investigate whether mortality patterns were associated with job title or workplace exposures. METHODS: A retrospective occupational cohort mortality study was conducted on 6759 workers. Standardized mortality ratio analyses compared the cohort with the referent US population. Internal comparisons producing standardized rate ratios were conducted by job title, metal exposure, and cumulative internal and external radiation exposures. RESULTS: Overall mortality and cancer rates were lower than the referent population, reflecting a strong healthy worker effect. Individual not significant standardized mortality ratios and standardized rate ratios were noted for cancers of the lymphatic and hematopoietic tissue. CONCLUSIONS: Although relatively low exposures to radiation and metals did not produce statistically significant health effects, no significant elevations for lymphatic and hematopoietic cancers were consistent with previous studies of nuclear workers.

The transcription factor Zfp281 controls embryonic stem cell pluripotency by direct activation and repression of target genes.

Oct4, Sox2, and Nanog are key components of a core transcriptional regulatory network that controls the ability of embryonic stem cells to differentiate into all cell types. Here we show that Zfp281, a zinc finger transcription factor, is a key component of the network and that it is required to maintain pluripotency. Zfp281 was shown to directly activate Nanog expression by binding to a site in the promoter in very close proximity to the Oct4 and Sox2 binding sites. We present data showing that Zfp281 physically interacts with Oct4, Sox2, and Nanog. Chromatin immunoprecipitation experiments identified 2,417 genes that are direct targets for regulation by Zfp281, including several transcription factors that are known regulators of pluripotency, such as Oct4, Sox2, and Nanog. Gene expression microarray analysis indicated that some Zfp281 target genes were activated, whereas others were repressed, upon knockdown of Zfp281. The identification of both activation and repression domains within Zfp281 suggests that this transcription factor plays bifunctional roles in regulating gene expression within the network. Disclosure of potential conflicts of interest is found at the end of this article.

Evaluation, using targeted aequorins, of the roles of the endoplasmic reticulum and its (Ca2++Mg2+)ATP-ases in the activation of store-operated Ca2+ channels in liver cells.

The process by which store-operated Ca2+ channels (SOCs) deliver Ca2+ to the endoplasmic reticulum (ER) and the role of (Ca2++Mg2+)ATP-ases of the ER in the activation of SOCs in H4-IIE liver cells were investigated using cell lines stably transfected with apo-aequorin targeted to the cytoplasmic space or the ER. In order to measure the concentration of Ca2+ in the ER ([Ca2+]er), cells were pre-treated with 2,5-di-tert-butylhydroquinone (DBHQ) to deplete Ca2+ in the ER before reconstitution of holo-aequorin. The addition of extracellular Ca2+ (Cao2+) to Ca2+-depleted cells induced refilling of the ER, which was complete within 5 min. This was associated with a sharp transient increase in the cytoplasmic Ca2+ concentration ([Ca2+]cyt) of about 15 s duration (a Cao2+-induced [Ca2+]cyt spike) after which [Ca2+]cyt remained elevated slightly above the basal value for a period of about 2 min (low [Ca2+]cyt plateau). The Cao2+-induced [Ca2+]cyt spike was inhibited by Gd3+, not affected by tetrakis-(2-pyridymethyl) ethylenediamine (TPEN), and broadened by ionomycin and the intracellular Ca2+ chelators BAPTA and EGTA. Refilling of the ER was inhibited by caffeine. Neither thapsigargin nor DBHQ caused a detectable inhibition or change in shape of the Cao2+-induced [Ca2+]cyt spike or the low [Ca2+]cyt plateau whereas each inhibited the inflow of Ca2+ to the ER by about 80%. Experiments conducted with carbonyl cyanide m-chlorophenyl-hydrazone (CCCP) indicated that thapsigargin did not alter the amount of Ca2+ accumulated in mitochondria. The changes in [Ca2+]cyt reported by aequorin were compared with those reported by fura-2. It is concluded that (i) there are significant quantitative differences between the manner in which aequorin and fura-2 sense changes in [Ca2+]cyt and (ii) thapsigargin and DBHQ inhibit the uptake of Ca2+ to the bulk of the ER but this is not associated with inhibition of the activation of SOCs. The possible involvement of a small sub-region of the ER (or another intracellular Ca2+ store), which contains thapsigargin-insensitive (Ca2++Mg2+)ATP-ases, in the activation of SOCs is briefly discussed.