Rapid high-throughput processing of tissue samples for microbiological diagnosis of periprosthetic joint infections using bead-beating homogenization.

Enrichment of periprosthetic tissue samples in blood culture bottles (BCBs) for microbiological diagnosis of periprosthetic joint infections (PJI) is more reliable than the use of an enrichment broth. Nevertheless, the extremely time-consuming homogenization of the samples for BCB processing has so far limited its use, especially in high-throughput settings. We aimed to establish a highly scalable homogenization process of tissue samples for long-term incubation in BCBs. A protocol for homogenization of tissue samples using bead beating was established and validated. In a second step, the use of the homogenate for enrichment in BCBs was compared to the use of thioglycolate broth (TB) in terms of diagnostic accuracy using clinical tissue samples from 150 patients with suspected PJI. Among 150 analyzed samples, 35 samples met the microbiological criteria for PJI. Using BCB, 32 of 35 (91.4%) PJI were detected compared to 30 of 35 (85.7%) by TB. The use of BCB had a lower secondary contamination rate (2/115; 1.7% vs 4/115; 3.5%) but the trend was not significant due to low numbers of samples (P = 0.39). The time to process a batch of 12 samples using the established homogenization method was 23 ± 5 min (n = 10 batches). We established and validated a homogenization workflow that achieves the highest sensitivity in the microbiological diagnostic of PJI. The enrichment of the tissue homogenate in BCBs showed equally good results as the use of enrichment broth and allows semi-automated high-throughput processing while demonstrating lower contamination rates in our study.

Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline.

CLINICAL QUESTION: What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)? CURRENT PRACTICE: TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations. RECOMMENDATIONS: For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and ß blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids. HOW THIS GUIDELINE WAS CREATED: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective. THE EVIDENCE: Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD. UNDERSTANDING THE RECOMMENDATION: These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future.

Introducing a classification framework to urban waste policy: Analysis of sixteen zero-waste cities in China.

Chinese cities are experiencing rapid urban development while facing severe challenges of environmental pollution. China's central government has proposed several policies to reduce urban waste. However, little is known about the adoption of these policies. Here, we raise the question how can circular policies be classified, and how can this classification be applied to cities in China that wish become zero-waste cities? We develop a framework to classify urban waste policies according to: (a) the "5R" principles ("Rethink", "Reduce", "Reuse", "Recycle", and "Recover"), (b) four types of waste (industrial, agricultural, municipal, and hazardous) and (c) six types of policy instruments (legal, economic, network, communication, innovation and projects). We use this framework to analyze urban waste policies implemented by sixteen zero-waste demonstration projects in China. The present study emphasizes combinations of policy instruments, "R" strategy and waste type in the implementation of zero-waste policies. We find that the "Rethink", "Reduce", and "Recycle" principles have been widely implemented by local authorities in contrast to the principles "Reuse" and "Recover". Local governments address waste management by embracing regulations, innovation instruments, and project arrangements, while network-based, economic, or communicative policy instruments are used less often. Based on the results we suggest that local governments embrace a comprehensive approach to the use of the "5R" principles and deploy a diverse portfolio of policy instruments.

Telemedical management in patients waiting for transcatheter aortic valve implantation: the ResKriVer-TAVI study design.

Aims: The majority of patients with severe aortic stenosis (AS) planned for transcatheter aortic valve implantation (TAVI) are elective outpatients. During the COVID-19 pandemic, the time between the heart team's decision and TAVI increased due to limited healthcare resources. We therefore implemented telemedical approaches to identify AS patients at risk for clinical deterioration during the waiting time. The purpose of the prospective, randomized, controlled ResKriVer-TAVI study (DRKS00027842) is to investigate whether a digital concept of telemedical interventional management (TIM) in AS patients waiting for TAVI improves the clinical outcomes. In the present article, we report the study protocol of the ResKriVer-TAVI trial. Methods: ResKriVer-TAVI will enroll AS patients planned for elective TAVI. Randomization to the TIM group or standard care will be made on the day of the heart team's decision. TIM will include a daily assessment of weight, blood pressure, a 2-channel electrocardiogram, peripheral capillary oxygen saturation, and a self-rated health status until admission for TAVI. TIM will allow optimization of medical therapy or an earlier admission for TAVI if needed. Standard care will not include any additional support for patients with AS. All patients of the TIM group will receive a rule-based TIM including standard operating procedures when a patient is crossing prespecified values of a vital sign. Results: The primary endpoint consists of days lost due to cardiovascular hospitalization and death of any cause within 180 days after the heart team's decision. Major secondary endpoints include all-cause mortality within 365 days, the number of telemedical interventions, and adherence to TIM. Follow-up visits will be conducted at admission for TAVI as well as 6 and 12 months after the heart team's decision. Conclusions: ResKriVer-TAVI will be the first randomized, controlled trial investigating a telemedical approach before TAVI in patients with AS. We hypothesize that primary and secondary endpoints of AS patients with TIM will be superior to standard care. The study will serve to establish TIM in the clinical routine and to increase the resilience of TAVI centers in situations with limited healthcare resources.

Gentle Sterilization of Carrot-Based Purees by High-Pressure Thermal Sterilization and Ohmic Heating and Influence on Food Processing Contaminants and Quality Attributes.

Pressure-enhanced sterilization (PES) and ohmic heating (OH) are two emerging sterilization techniques, currently lacking implementation in the food industry. However, both technologies offer significant benefits in terms of spore inactivation using reduced thermal intensity in food products, as well as minimized effects on sensory and nutritional profiles. In this study, PES and OH were tested based on possible food safety process windows in comparison to thermal retorting, to optimize the food quality of carrot-based purees. The following parameters related to food quality were tested: texture, carotenoid content, color, and detectable amount of food processing contaminants (FPC) formed. Application of the innovative sterilization techniques resulted in a better retention of color, texture, and carotenoids (for PES) as well as a reduced formation of food processing contaminants. Importantly, a significant reduction in the formation of furan and its derivates was observed, compared to the retorted samples. Hence, both sterilization technologies showed promising results in the mitigation of potential toxic processing contaminants and retention of quality attributes.

The dynamics of Early Celtic consumption practices: A case study of the pottery from the Heuneburg.

The Early Celtic site of the Heuneburg (Baden-Wuerttemberg, Germany) has long been understood as a hallmark of early urbanization in Central Europe. The rich collection of Mediterranean imports recovered from the settlement, the elite burials in its surroundings and the Mediterranean-inspired mudbrick fortification wall further point to the importance of intercultural connections with the Mediterranean as a crucial factor in the transformation of Early Iron Age societies. We describe a new facet of this process by studying the transformation of consumption practices, especially drinking habits, brought about by intercultural encounters from the late 7th to the 5th century BC through the analysis of organic remains in 133 ceramic vessels found at the Heuneburg using Organic Residue Analysis (ORA). During the Ha D1 phase, fermented beverages, including Mediterranean grape wine, were identified in and appear to have been consumed from local handmade ceramics. The latter were recovered from different status-related contexts within the Heuneburg, suggesting an early and well-established trade/exchange system of this Mediterranean product. This contrasts with the results obtained for the drinking and serving vessels from the Ha D3 phase that were studied. The consumption of fermented beverages (wine and especially bacteriofermented products) appears to have been concentrated on the plateau. The ORA analyses presented here seem to indicate that during this time, grape wine was consumed primarily from imported vessels, and more rarely from local prestigious fine wheel-made vessels. In addition to imported wine, we demonstrate the consumption of a wide variety of foodstuffs, such as animal fats (especially dairy products), millet, plant oils and waxy plants, fruit and beehive products as well as one or several other fermented beverage(s) that were probably locally produced. Through this diachronic study of vessel function from different intra-site contexts, we inform on changing and status-related practices of food processing and consumption.

New insights into Early Celtic consumption practices: Organic residue analyses of local and imported pottery from Vix-Mont Lassois.

The rich Mediterranean imports found in Early Celtic princely sites (7th-5th cent. BC) in Southwestern Germany, Switzerland and Eastern France have long been the focus of archaeological and public interest. Consumption practices, particularly in the context of feasting, played a major role in Early Celtic life and imported ceramic vessels have consequently been interpreted as an attempt by the elite to imitate Mediterranean wine feasting. Here we present the first scientific study carried out to elucidate the use of Mediterranean imports in Early Celtic Central Europe and their local ceramic counterparts through organic residue analyses of 99 vessels from Vix-Mont Lassois, a key Early Celtic site. In the Mediterranean imports we identified imported plant oils and grape wine, and evidence points towards appropriation of these foreign vessels. Both Greek and local wares served for drinking grape wine and other plant-based fermented beverage(s). A wide variety of animal and plant by-products (e.g. fats, oils, waxes, resin) were also identified. Using an integrative approach, we show the importance of beehive products, millet and bacteriohopanoid beverage(s) in Early Celtic drinking practices. We highlight activities related to biomaterial transformation and show intra-site and status-related differences in consumption practices and/or beverage processing.

Plasmodial slime molds and the evolution of microbial husbandry.

Detailed analyses into the life cycle of the soil-dwelling microbe Dictyostelium discoideum led to the conclusion that this "social amoeba" practices some form of "non-monoculture farming" via the transfer of bacteria to novel environments. Herein, we show that in myxomycetes (plasmodial slime molds or myxogastrids) a similar "farming symbiosis" has evolved. Based on laboratory studies of two representative species in the genera Fuligo and Didymium, the sexual life cycle of these enigmatic microbes that feed on bacteria was reconstructed, with reference to plasmo- and karyogamy. We document that the spores carry and transfer bacteria and hence may inoculate new habitats. The significance of this finding with respect to Ernst Haeckel's work on myxomycetes and his concept of ecology are addressed.

Genetic barcoding of dark-spored myxomycetes (Amoebozoa)-Identification, evaluation and application of a sequence similarity threshold for species differentiation in NGS studies.

Unicellular, eukaryotic organisms (protists) play a key role in soil food webs as major predators of microorganisms. However, due to the polyphyletic nature of protists, no single universal barcode can be established for this group, and the structure of many protistean communities remains unresolved. Plasmodial slime moulds (Myxogastria or Myxomycetes) stand out among protists by their formation of fruit bodies, which allow for a morphological species concept. By Sanger sequencing of a large collection of morphospecies, this study presents the largest database to date of dark-spored myxomycetes and evaluate a partial 18S SSU gene marker for species annotation. We identify and discuss the use of an intraspecific sequence similarity threshold of 99.1% for species differentiation (OTU picking) in environmental PCR studies (ePCR) and estimate a hidden diversity of putative species, exceeding those of described morphospecies by 99%. When applying the identified threshold to an ePCR data set (including sequences from both NGS and cloning), we find 64 OTUs of which 21.9% had a direct match (>99.1% similarity) to the database and the remaining had on average 90.2 ± 0.8% similarity to their best match, thus thought to represent undiscovered diversity of dark-spored myxomycetes.

What an Intron May Tell: Several Sexual Biospecies Coexist in Meriderma spp. (Myxomycetes).

Specimens of the snowbank myxomycete Meriderma atrosporum agg. from five European mountain ranges were sequenced for parts of the nuclear small subunit ribosomal RNA gene (SSU) and the protein elongation factor 1 alpha gene (EF1A). A phylogeny of the EF1A gene, including a very variable spliceosomal intron, resulted in seven phylogroups, and this topology was confirmed by SSU sequences. Two thirds of all specimens were heterozygous for the EF1A gene, and the two haplotypes of these specimens occurred always in the same phylogroup. Except for two cases in closely related phylogroups all ribotypes were as well limited to one phylogroup. This pattern is consistent with the assumption of reproductively isolated sexual biospecies. Numbers of EF1A-haplotypes shared between mountain ranges correlate with geographical distance, suggesting relative isolation but occasional long-distance dispersal by spores. Most subpopulations (divided by putative biospecies and mountain ranges) were in Hardy-Weinberg equilibrium. A simulation assuming panmixis within but not in between subpopulations suggested that similar numbers of shared genotypes can be created by chance through sexual reproduction alone. Our results support the biospecies concept, derived from experiments with cultivable members of the Physarales. We discuss the results on the background of possible reproductive options in myxomycetes.

Species-specific cell mobility of bacteria-feeding myxamoebae in plasmodial slime molds.

On decaying wood or litter in forests, plasmodial slime molds (myxomycetes) represent a large fraction of eukaryotic protists that feed on bacteria. In his seminal book Experimental Physiology of Plants (1865), Julius Sachs referred to the multinucleate plasmodium of myxomycetes, which were considered at that time as primitive plants (or fungi). Today it is well established that myxomycetes are members of the Amoebozoa (Protista). In this study we compare the mobility of myxamoebae of 3 European species, Lycogala epidendrum (order Liceales), Tubulifera arachnoidea, and Trichia decipiens (order Trichiales). Using agar plates, on which 3 separate bacterial species were cultivated as prey organisms (Methylobacterium mesophilicum, Escherichia coli, Agrobacterium tumefaciens), we document large differences in cell motility between the myxomycetes investigated. In addition, we show that the 3 species of myxamoebae can be distinguished based on their average cell size. These data shed light on the mode of co-occurrence via differential substrate utilization in these members of the Amoebozoa.

Methylobacterium bullatum sp. nov., a methylotrophic bacterium isolated from Funaria hygrometrica.

A novel, pink-pigmented aerobic, facultatively methylotrophic bacterial strain (F3.2(T)) isolated from the phyllosphere of Funaria hygrometrica, was analyzed using a polyphasic approach. Cells were Gram-negative, motile rods, strictly aerobic and non-spore-forming and exhibited surface structures varying in quantity, distribution and morphology. The isolate grew at 10-33°C over a pH range of 5.5-8.0 and in the presence of less than 1.0% NaCl. Strain F3.2(T) shared less than 70% DNA-DNA binding to the next type strain of the genus Methylobacterium (M. adhaesivum DSM 17169(T)). In addition to the major cellular fatty acid C(18:1)ω7c (81.7%), present in all Methylobacterium species (and also members of the genus Alphaproteobacteria), a high value (11.7%) of the fatty acids (summed feature) C(16:1)ω7c and/or iso-C(15:0)2OH was determined. Phylogenetic analyses based on 16S rDNA and methanol dehydrogenase gene sequences, DNA-DNA hybridization values, chemotaxonomic and phenotypic characteristics indicate that the strain F3.2(T) represents a novel species within the genus Methylobacterium. We propose the name Methylobacterium bullatum sp. nov. for this species. The type strain is the strain F3.2(T) (DSM 21893(T)=LMG 24788(T)).