Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis

Ranking of migraine interventions using SUCRA values. (DOCX 17 kb

Elevated CO2 and Warming Altered Grassland Microbial Communities in Soil Top-Layers.

As two central issues of global climate change, the continuous increase of both atmospheric CO2 concentrations and global temperature has profound effects on various terrestrial ecosystems. Microbial communities play pivotal roles in these ecosystems by responding to environmental changes through regulation of soil biogeochemical processes. However, little is known about the effect of elevated CO2 (eCO2) and global warming on soil microbial communities, especially in semiarid zones. We used a functional gene array (GeoChip 3.0) to measure the functional gene composition, structure, and metabolic potential of soil microbial communities under warming, eCO2, and eCO2 + warming conditions in a semiarid grassland. The results showed that the composition and structure of microbial communities was dramatically altered by multiple climate factors, including elevated CO2 and increased temperature. Key functional genes, those involved in carbon (C) degradation and fixation, methane metabolism, nitrogen (N) fixation, denitrification and N mineralization, were all stimulated under eCO2, while those genes involved in denitrification and ammonification were inhibited under warming alone. The interaction effects of eCO2 and warming on soil functional processes were similar to eCO2 alone, whereas some genes involved in recalcitrant C degradation showed no significant changes. In addition, canonical correspondence analysis and Mantel test results suggested that NO3-N and moisture significantly correlated with variations in microbial functional genes. Overall, this study revealed the possible feedback of soil microbial communities to multiple climate change factors by the suppression of N cycling under warming, and enhancement of C and N cycling processes under either eCO2 alone or in interaction with warming. These findings may enhance our understanding of semiarid grassland ecosystem responses to integrated factors of global climate change

Analysis of the learning curve for transvaginal natural orifice transluminal endoscopic surgery in ovarian cystectomy

ObjectiveThis study aimed to evaluate the learning curve for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in ovarian cystectomy and to identify perioperative factors influencing operative time.MethodsThis prospective observational study included 39 patients who underwent vNOTES ovarian cystectomy at Chengdu Women’s and Children’s Central Hospital between June 2022 and June 2024. Patients were grouped into two surgical phases based on the operating team’s self-assessed proficiency. Cumulative sum analysis of operative time (CUSUMOT) was used to model the learning curve and define distinct learning stages. Multivariate linear regression was performed to identify independent predictors of operative time.ResultsThe mean patient age was 35.14 ± 9.73 years, and the mean operative time was 74.01 ± 30.09 min. Three cases (7.7%) required intraoperative conversion to transumbilical laparoscopy, and two patients (5.1%) experienced perioperative complications. CUSUMOT analysis revealed four distinct learning phases: learning (9 cases), plateau (10 cases), challenging (12 cases), and mature (8 cases). Operative time during the mature phase was significantly shorter than in earlier phases. Multivariate regression identified pelvic adhesions (β = 6.92, p = 0.027), bilateral cysts (β = 6.38, p = 0.019), cyst diameter (β = 2.85 per cm, p = 0.026), and learning curve phase (β = −17.10 for Phase II, p = 0.035) as independent predictors of operative time.ConclusionvNOTES is a safe and feasible approach for ovarian cystectomy with a measurable learning curve. Proficiency can be achieved after approximately 20 cases. Pelvic adhesions, cyst characteristics, and surgical experience significantly impact operative time. CUSUM analysis is a useful tool for evaluating surgical competency and guiding clinical training in vNOTES procedures

Global diversity and distribution of antibiotic resistance genes in human wastewater treatment systems

Antibiotic resistance poses a significant threat to human health, and wastewater treatment plants (WWTPs) are important reservoirs of antibiotic resistance genes (ARGs). Here, we analyze the antibiotic resistomes of 226 activated sludge samples from 142 WWTPs across six continents, using a consistent pipeline for sample collection, DNA sequencing and analysis. We find that ARGs are diverse and similarly abundant, with a core set of 20 ARGs present in all WWTPs. ARG composition differs across continents and is distinct from that of the human gut and the oceans. ARG composition strongly correlates with bacterial taxonomic composition, with Chloroflexi, Acidobacteria and Deltaproteobacteria being the major carriers. ARG abundance positively correlates with the presence of mobile genetic elements, and 57% of the 1112 recovered high-quality genomes possess putatively mobile ARGs. Resistome variations appear to be driven by a complex combination of stochastic processes and deterministic abiotic factors

Global diversity and biogeography of bacterial communities in wastewater treatment plants

Microorganisms in wastewater treatment plants (WWTPs) are essential for water purification to protect public and environmental health. However, the diversity of microorganisms and the factors that control it are poorly understood. Using a systematic global-sampling effort, we analysed the 16S ribosomal RNA gene sequences from ~1,200 activated sludge samples taken from 269 WWTPs in 23 countries on 6 continents. Our analyses revealed that the global activated sludge bacterial communities contain ~1 billion bacterial phylotypes with a Poisson lognormal diversity distribution. Despite this high diversity, activated sludge has a small, global core bacterial community (n = 28 operational taxonomic units) that is strongly linked to activated sludge performance. Meta-analyses with global datasets associate the activated sludge microbiomes most closely to freshwater populations. In contrast to macroorganism diversity, activated sludge bacterial communities show no latitudinal gradient. Furthermore, their spatial turnover is scale-dependent and appears to be largely driven by stochastic processes (dispersal and drift), although deterministic factors (temperature and organic input) are also important. Our findings enhance our mechanistic understanding of the global diversity and biogeography of activated sludge bacterial communities within a theoretical ecology framework and have important implications for microbial ecology and wastewater treatment processes

Evaluating the safety and efficiency of day-care hysterectomy: a comparative study using propensity score matching

ObjectiveTo compare the outcomes of hysterectomy performed via traditional inpatient procedure versus day-care procedure with a focus on surgical time, post-operative recovery, costs, and patient satisfaction, using propensity score matching (PSM) to adjust for confounding variables.MethodsA total of 519 patients undergoing hysterectomy were initially identified. After PSM, 340 patients were included for analysis. Primary outcomes included perioperative complications, surgical time, post-operative discomfort, hospital stay, total cost, and patient satisfaction. Multiple linear regression analysis was performed to explore factors associated with operative bleeding and surgical time. Binary logistic regression was employed to analyze the factors influencing postoperative discomfort.ResultsAfter PSM, the day-care group demonstrated significantly lower hemoglobin decline, post-operative discomfort rates, hospital stay, and total cost, along with higher patient satisfaction (p < 0.05). Multivariate analysis showed a significant correlation between post-operative discomfort and both surgical modality and procedure time. For each additional minute of surgery time, the risk of post-operative discomfort increased by 2% (95% CI: 1.01, 1.03, p < 0.001). Furthermore, the ERAS-based day-care surgical modality reduced the risk of post-operative discomfort by 80% (95% CI: 0.08, 0.50, p < 0.001).ConclusionThe day-care procedure, guided by an enhanced recovery after surgery protocol, not only reduces hospital stay and overall costs but also improves patient satisfaction and reduces post-operative complications without compromising safety. These findings support the feasibility and benefits of day-care hysterectomy as a viable option for appropriately selected patients, offering significant advantages in terms of recovery and cost-efficiency

Carvacrol, a Food-Additive, Provides Neuroprotection on Focal Cerebral Ischemia/Reperfusion Injury in Mice

Carvacrol (CAR), a naturally occurring monoterpenic phenol and food additive, has been shown to have antimicrobials, antitumor, and antidepressant-like activities. A previous study demonstrated that CAR has the ability to protect liver against ischemia/reperfusion injury in rats. In this study, we investigated the protective effects of CAR on cerebral ischemia/reperfusion injury in a middle cerebral artery occlusion mouse model. We found that CAR (50 mg/kg) significantly reduced infarct volume and improved neurological deficits after 75 min of ischemia and 24 h of reperfusion. This neuroprotection was in a dose-dependent manner. Post-treatment with CAR still provided protection on infarct volume when it was administered intraperitoneally at 2 h after reperfusion; however, intracerebroventricular post-treatment reduced infarct volume even when the mice were treated with CAR at 6 h after reperfusion. These findings indicated that CAR has an extended therapeutic window, but delivery strategies may affect the protective effects of CAR. Further, we found that CAR significantly decreased the level of cleaved caspase-3, a marker of apoptosis, suggesting the anti-apoptotic activity of CAR. Finally, our data indicated that CAR treatment increased the level of phosphorylated Akt and the neuroprotection of CAR was reversed by a PI3K inhibitor LY-294002, demonstrating the involvement of the PI3K/Akt pathway in the anti-apoptotic mechanisms of CAR. Due to its safety and wide use in the food industry, CAR is a promising agent to be translated into clinical trials