Psychometric characteristics of the Spanish version of instruments to measure neck pain disability

Background: The NDI, COM and NPQ are evaluation instruments for disability due to NP. There was no Spanish version of NDI or COM for which psychometric characteristics were known. The objectives of this study were to translate and culturally adapt the Spanish version of the Neck Disability Index Questionnaire (NDI), and the Core Outcome Measure (COM), to validate its use in Spanish speaking patients with non-specific neck pain (NP), and to compare their psychometric characteristics with those of the Spanish version of the Northwick Pain Questionnaire (NPQ). Methods: Translation/re-translation of the English versions of the NDI and the COM was done blindly and independently by a multidisciplinary team. The study was done in 9 primary care Centers and 12 specialty services from 9 regions in Spain, with 221 acute, subacute and chronic patients who visited their physician for NP: 54 in the pilot phase and 167 in the validation phase. Neck pain (VAS), referred pain (VAS), disability (NDI, COM and NPQ), catastrophizing (CSQ) and quality of life (SF-12) were measured on their first visit and 14 days later. Patients' self-assessment was used as the external criterion for pain and disability. In the pilot phase, patients' understanding of each item in the NDI and COM was assessed, and on day 1 test-retest reliability was estimated by giving a second NDI and COM in which the name of the questionnaires and the order of the items had been changed. Results: Comprehensibility of NDI and COM were good. Minutes needed to fill out the questionnaires [median, (P25, P75)]: NDI. 4 (2.2, 10.0), COM: 2.1 (1.0, 4.9). Reliability: [ICC, (95%CI)]: NDI: 0.88 (0.80, 0.93). COM: 0.85 (0.75,0.91). Sensitivity to change: Effect size for patients having worsened, not changed and improved between days 1 and 15, according to the external criterion for disability: NDI: -0.24, 0.15, 0.66; NPQ: -0.14, 0.06, 0.67; COM: 0.05, 0.19, 0.92. Validity: Results of NDI, NPQ and COM were consistent with the external criterion for disability, whereas only those from NDI were consistent with the one for pain. Correlations with VAS, CSQ and SF-12 were similar for NDI and NPQ (absolute values between 0.36 and 0.50 on day 1, between 0.38 and 0.70 on day 15), and slightly lower for COM (between 0.36 and 0.48 on day 1, and between 0.33 and 0.61 on day 15). Correlation between NDI and NPQ: r = 0.84 on day 1, r = 0.91 on day 15. Correlation between COM and NPQ: r = 0.63 on day 1, r = 0.71 on day 15. Conclusion: Although most psychometric characteristics of NDI, NPQ and COM are similar, those from the latter one are worse and its use may lead to patients' evolution seeming more positive than it actually is. NDI seems to be the best instrument for measuring NP-related disability, since its results are the most consistent with patient's assessment of their own clinical status and evolution. It takes two more minutes to answer the NDI than to answer the COM, but it can be reliably filled out by the patient without assistance

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Genome Analysis of Lactobacillus plantarum LL441 and Genetic Characterisation of the Locus for the Lantibiotic Plantaricin C

Bacteriocins are ribosomally synthesized peptides produced by bacteria with antimicrobial activity. The bacteriocins produced by lactic acid bacteria (LAB) may inhibit food-borne pathogens and spoilage organisms, and therefore have potential as natural preservatives. Lactobacillus plantarum LL441 produces a lantibiotic bacteriocin known as plantaricin C, a pore-forming antimicrobial peptide containing modified amino acids that inhibits cell wall synthesis by forming a complex with the peptidoglycan precursor lipid II. The present work describes the genome sequencing of L. plantarum LL441 and the characterisation of the plantaricin C locus. The draft genome sequence of L. plantarum LL441 consisted of 170 contigs and had a total 3,124,603 bp; the GC content was 44.52%. The plantaricin C locus was found in an 18 kbp-long contig, and consisted of six genes organized in an operon-like arrangement. This locus included the bacteriocin structural gene (plnC), followed by a gene encoding a LanM-like protein thought to be involved in the maturation of plantaricin C, and four downstream genes encoding ABC-type transporter components, probably belonging to its putative immunity and export machinery. plnC encodes a precursor of the bacteriocin, i.e., a 58-amino acid peptide containing a 31-amino acid double-glycine leader peptide and a 27-amino acid core peptide. In silico analysis and hybridisation experiments placed the plantaricin C locus to be located on pLL441-1, a large plasmid of L. plantarum LL441. Joining up the gaps between the contigs by conventional PCR, sequencing of the amplicons, and sequence assemblage, allowed the complete 55.3 kbp pLL441-1 molecule to be established. A portion of pLL441-1 larger than 34 kbp, which included the plantaricin C region, was identified in a plasmid-derived contig from the L. plantarum Nizo 3893 genome. Further, the plantaricin C coding locus (about 8.7 kbp) was shown to share 91% nucleotide identity with a portion of the plasmids pPECL-6 from Pediococcus claussenii ATCC BAA-344 and pL11995-4 from Lactobacillus paracollinoides TMW 1.1995. Knowledge of the sequence of the plantaricin C coding region will help in studying its molecular components and allow their involvement in bacteriocin synthesis to be investigated, facilitating the use of the bacteriocin or its genetic elements in new biotechnological applications

A Functional Metagenomic Analysis of Tetracycline Resistance in Cheese Bacteria

Metagenomic techniques have been successfully used to monitor antibiotic resistance genes in environmental, animal and human ecosystems. However, despite the claim that the food chain plays a key role in the spread of antibiotic resistance, metagenomic analysis has scarcely been used to investigate food systems. The present work reports a functional metagenomic analysis of the prevalence and evolution of tetracycline resistance determinants in a raw-milk, blue-veined cheese during manufacturing and ripening. For this, the same cheese batch was sampled and analyzed on days 3 and 60 of manufacture. Samples were diluted and grown in the presence of tetracycline on plate count milk agar (PCMA) (non-selective) and de Man Rogosa and Sharpe (MRS) agar (selective for lactic acid bacteria, LAB). DNA from the cultured bacteria was then isolated and used to construct four fosmid libraries, named after the medium and sampling time: PCMA-3D, PCMA-60D, MRS-3D, and MRS-60D. Clones in the libraries were subjected to restriction enzyme analysis, PCR amplification, and sequencing. Among the 300 fosmid clones analyzed, 268 different EcoRI restriction profiles were encountered. Sequence homology of their extremes clustered the clones into 47 groups. Representative clones of all groups were then screened for the presence of tetracycline resistance genes by PCR, targeting well-recognized genes coding for ribosomal protection proteins and efflux pumps. A single tetracycline resistance gene was detected in each of the clones, with four such resistance genes identified in total: tet(A), tet(L), tet(M), and tet(S). tet(A) was the only gene identified in the PCMA-3D library, and tet(L) the only one identified in the PCMA-60D and MRS-60D libraries. tet(M) and tet(S) were both detected in the MRS-3D library and in similar numbers. Six representative clones of the libraries were sequenced and analyzed. Long segments of all clones but one showed extensive homology to plasmids from Gram-positive and Gram-negative bacteria. tet(A) was found within a sequence showing strong similarity to plasmids pMAK2 and pO26-Vir from Salmonella enterica and Escherichia coli, respectively. All other genes were embedded in, or near to, sequences homologous to those of LAB species. These findings strongly suggest an evolution of tetracycline resistance gene types during cheese ripening, which might reflect the succession of the microbial populations. The location of the tetracycline resistance genes in plasmids, surrounded or directly flanked by open reading frames encoding transposases, invertases or mobilization proteins, suggests they might have a strong capacity for transference. Raw-milk cheeses should therefore be considered reservoirs of tetracycline resistance genes that might be horizontally transferred

Optimal coding of blended seismic sources for 2d full waveform inversion in time

Full Waveform Inversion (FWI) schemes are gradually becoming more common in the oil and gas industry, as a new tool for studying complex geological zones, based on their reliability for estimating velocity models. FWI is a non-linear inversion method that iteratively estimates subsurface characteristics such as seismic velocity, starting from an initial velocity model and the preconditioned data acquired. Blended sources have been used in marine seismic acquisitions to reduce acquisition costs, reducing the number of times that the vessel needs to cross the exploration delineation trajectory. When blended or simultaneous without previous de-blending or separation, stage data are used in the reconstruction of the velocity model with the FWI method, and the computational time is reduced. However, blended data implies overlapping single shot-gathers, producing interference that affects the result of seismic approaches, such as FWI or seismic image migration. In this document, an encoding strategy is developed, which reduces the overlap areas within the blended data to improve the final velocity model with the FWI method.La inversión de onda completa (FWI, por sus siglas en inglés) ha llamado la atención de la comunidad de exploración de gas y petróleo, como una nueva herramienta para el estudio de zonas geológicas complejas, en donde es necesario el desarrollo de técnicas para la estimación de modelos de velocidad confiables. La inversión de onda completa es un método de inversión no lineal que iterativamente estima características del subsuelo como la velocidad sísmica, partiendo de un modelo inicial de velocidad y el dato adquirido en campo. Las fuentes blended o simultáneas han sido usadas en la adquisición sísmica marina con el fin de reducir los costos de adquisición, disminuyendo el número de veces que el buque de exploración debe pasar por la trayectoria delimitada de exploración. Cuando los datos blended son utilizados en la reconstrucción del modelo de velocidad empleando el método FWI, evitando la etapa previa de de-blending o separación, el tiempo de procesamiento es reducido. Sin embargo, un dato blended implica la superposición entre los disparos individuales contenidos en él, produciendo interferencia que afecta a el resultado final de la FWI. En este documento, se desarrolla una estrategia de codificación que disminuye las zonas de superposición dentro del dato blended con el fin de mejorar el modelo de velocidad final

Development and Use of a Real-Time Quantitative PCR Method for Detecting and Quantifying Equol-Producing Bacteria in Human Faecal Samples and Slurry Cultures

This work introduces a novel real-time quantitative PCR (qPCR) protocol for detecting and quantifying equol-producing bacteria. To this end, two sets of primers targeting the dihydrodaidzein reductase (ddr) and tetrahydrodaidzein reductase (tdr) genes, which are involved in the synthesis of equol, were designed. The primers showed high specificity and sensitivity when used to examine DNA from control bacteria, such as Slackia isoflavoniconvertens, Slackia equolifaciens, Asaccharobacter celatus, Adlercreutzia equolifaciens, and Enterorhabdus mucosicola. To demonstrate the validity and reliability of the protocol, it was used to detect and quantify equol-producing bacteria in human faecal samples and their derived slurry cultures. These samples were provided by 18 menopausal women under treatment of menopause symptoms with a soy isoflavone concentrate, among whom three were known to be equol-producers given the prior detection of the molecule in their urine. The tdr gene was detected in the faeces of all these equol-producing women at about 4–5 log10 copies per gram of faeces. In contrast, the ddr gene was only amplified in the faecal samples of two of these three women, suggesting the presence in the non-amplified sample of reductase genes unrelated to those known to be involved in equol formation and used for primer design in this study. When tdr and ddr were present in the same sample, similar copy numbers of the two genes were recorded. However, no significant increase in the copy number of equol-related genes along isoflavone treatment was observed. Surprisingly, positive amplification for both tdr and ddr genes was obtained in faecal samples and derived slurry cultures from two non-equol producing women, suggesting the genes could be non-functional or the daidzein metabolized to other compounds in samples from these two women. This novel qPCR tool provides a technique for monitoring gut microbes that produce equol in humans. Monitoring equol-producing bacteria in the human gut could provide a means of evaluating strategies aimed at increasing the endogenous formation of this bioactive compound

Characterization of indigenous vaginal lactobacilli from healthy women as probiotic candidates

The probiotic relevant characteristics of 45 strains of vaginal Lactobocillus isolated from healthy women were analyzed. Of these, 21 strains were classified as L. crispatus, 17 as L. jensenii, six as L. gasseri, and one as L. plantarum. The rate of acidification varied significantly between the strains as did their ability to form biofilms. None used glycogen as a fermentable carbohydrate. H(2)O(2) generation was common, especially among L. jensenii isolates (88%). No bacteriocinogenic strains were detected. Most strains harbored plasmids (from 1 to 7) of various sizes, those in excess of 50 kb being frequent. One of these plasmids was found to be promiscuous since it hybridized with extrachromosomal bands of 15 isolates. All strains were resistant to metronidazole, ciprofloxacin, gentamicin, clindamycin, trimethoprim, and sulfametoxazole and susceptible to a series of beta-lactams, erythromycin, tetracycline, and benzalkonium chloride. Almost half of the strains were highly resistant to nonoxinol 9, which is commonly used as a spermicide. Based on these analyses, strains of all three common species are proposed as new probiotic candidates

Caracterización microbiológica, genética y metabólica de la producción de equol por cultivos fecales humanos en presencia o ausencia de isoflavonas de soja

Trabajo presentado en el VII Workshop Probióticos, Prebióticos y Salud: Evidencia Científica, celebrado en Sevilla (España) el 28 y 29 de enero de 2016La transformación de las isoflavonas en compuestos más activos, como el equol a partir de la daidzeína, la llevan a cabo poblaciones poco caracterizadas de la microbiota intestinal. Con el fin de profundizar en el metabolismo microbiano de este compuesto, en este trabajo se caracterizaron cultivos fecales de mujeres menopáusicas en tratamiento con isoflavonas de soja. Extractos fecales de mujeres productoras y no productoras de equol se inocularon en un medio colónico enriquecido o no con isoflavonas y se incubaron en anaerobiosis a 37ºC. Tras el cultivo, el equol y los ácidos grasos de cadena corta (AGCC) se analizaron y cuantificaron por medio de UHPLC y CG, respectivamente. La diversidad y la estructura de poblaciones microbianas de los cultivos se determinó mediante ultrasecuenciación de amplicones del ADNr 16S. Por último, mediante qPCR, se detectaron y cuantificaron genes involucrados en la síntesis de equol. La bioconversión de daidzeína a equol se observó solo en los cultivos inoculados con heces de mujeres productoras. La producción de equol se asoció con biotipos como Collinsella, Faecalibacterium y miembros del grupo Clostridium XIVa, entre otros. La adición de isoflavonas al medio favoreció la formación de AGCC en los cultivos fecales, con ratios acético/propiónico más bajos en los cultivos productores de equol. La formación de equol se correlacionó también con los genes que participan en su síntesis. El análisis de las curvas de melting sugiere que la producción de equol se lleva a cabo por microorganismos diferentes en cada caso, pudiendo existir biotipos distintos a los que se reconocen en la actualidad.Peer reviewe

Development of an in vitro model based on fecal slurries to study the metabolism of soy isoflavones by the microbiota of the human gut

Trabajo presentado en la International Scientific Association for Probiotics and Prebiotics (ISAPP) Conference, celebrada en Washington (Estados Unidos), del 19 al 21 de mayo de 2015Isoflavones are a class of polyphenols with estrogenic activity present in relatively high concentration in soy. Consumption of isoflavones has been epidemiologically correlated with a decrease of menopause symptoms in women and a lower incidence of hormonedependent and aging-associated diseases, such as osteoporosis, cardiovascular diseases and cancer. To be active, isoflavones require their transformation by the gut microbiota into more bioavailable and active metabolites, such as S-(-)equol. However, intestinal populations involved in isoflavone metabolism and equol production are not yet well characterized. Indeed, only 25-30% of Western individuals are able to produce equol. Conceivably, these individuals might be those who benefit from the health effects of soy isoflavone intake. The aim of this work was to develop an in vitro colonic model based on fecal slurries to study the role of fecal microbial constituents in the metabolism of isoflavones. Identification of beneficial microbes would lead to their application in functional foods. Fecal slurries from menopausal women were grown in a rich colonic medium (MCB) supplemented or not with isoflavone concentrates. Cultures were carried out in anaerobiosis at 37ºC for 24 h with mild stirring. Microbial communities were analyzed by DGGE and phylogenetic metagenomics. Short-chain fatty acids and isoflavone metabolites were analyzed by GC and UHPLC, respectively. Slurries from equolproducer women yielded equol in vitro. Changes in both microbial communities and isoflavone metabolites were observed. However, clear-cut associations between populations and metabolites were not obtained. This might be due to huge interindividual variations in microbiota composition.Peer reviewe

Mosaic Tetracycline Resistance Genes and Their Flanking Regions in Bifidobacterium thermophilum and Lactobacillus johnsonii▿

For the first time, mosaic tetracycline resistance genes were identified in Lactobacillus johnsonii and in Bifidobacterium thermophilum strains. The L. johnsonii strain investigated contains a complex hybrid gene, tet(O/W/32/O/W/O), whereas the five bifidobacterial strains possess two different mosaic tet genes: i.e., tet(W/32/O) and tet(O/W). As reported by others, the crossover points of the mosaic tet gene segments were found at similar positions within the genes, suggesting a hot spot for recombination. Analysis of the sequences flanking these genes revealed that the upstream part corresponds to the 5′ end of the mosaic open reading frame. In contrast, the downstream region was shown to be more variable. Surprisingly, in one of the B. thermophilum strains a third tet determinant was identified, coding for the efflux pump Tet(L)