Sex-differences in the longitudinal recovery of neuromuscular function in COVID-19 associated acute respiratory distress syndrome survivors

Introduction: Patients admitted to the intensive care unit (ICU) following severe acute respiratory syndrome 2 (SARS-CoV-2) infection may have muscle weakness up to 1 year or more following ICU discharge. However, females show greater muscle weakness than males, indicating greater neuromuscular impairment. The objective of this work was to assess sex differences in longitudinal physical functioning following ICU discharge for SARS-CoV-2 infection. Methods: We performed longitudinal assessment of physical functioning in two groups: 14 participants (7 males, 7 females) in the 3-to-6 month and 28 participants (14 males, 14 females) in the 6-to-12 month group following ICU discharge and assessed differences between the sexes. We examined self-reported fatigue, physical functioning, compound muscle action potential (CMAP) amplitude, maximal strength, and the neural drive to the tibialis anterior muscle. Results: We found no sex differences in the assessed parameters in the 3-to-6-month follow-up, indicating significant weakness in both sexes. Sex differences emerged in the 6-to-12-month follow-up. Specifically, females exhibited greater impairments in physical functioning, including lower strength, walking lower distances, and high neural input even 1 year following ICU-discharge. Discussion: Females infected by SARS-CoV-2 display significant impairments in functional recovery up to 1 year following ICU discharge. The effects of sex should be considered in post-COVID neurorehabilitation

Listeria Monocytogenes Hijacks CD147 to Ensure Proper Membrane Protrusion Formation and Efficient Bacterial Dissemination

Efficient cell-to-cell transfer of Listeria monocytogenes (L. monocytogenes) requires the proper formation of actin-rich membrane protrusions. To date, only the host proteins ezrin, the binding partner of ezrin, CD44, as well as cyclophilin A (CypA) have been identified as crucial components for L. monocytogenes membrane protrusion stabilization and, thus, efficient cell-to-cell movement of the microbes. Here, we examine the classical binding partner of CypA, CD147, and find that this membrane protein is also hijacked by the bacteria for their cellular dissemination. CD147 is enriched at the plasma membrane surrounding the membrane protrusions as well as the resulting invaginations generated in neighboring cells. In cells depleted of CD147, these actin-rich structures appear similar to those generated in CypA depleted cells as they are significantly shorter and more contorted as compared to their straighter counterparts formed in wild-type control cells. The presence of malformed membrane protrusions hampers the ability of L. monocytogenes to efficiently disseminate from CD147-depleted cells. Our findings uncover another important host protein needed for L. monocytogenes membrane protrusion formation and efficient microbial dissemination

Listeria monocytogenes Exploits Host Caveolin for Cell-to-Cell Spreading

Listeria monocytogenes moves from one cell to another using actin-rich membrane protrusions that propel the bacterium toward neighboring cells. Despite cholesterol being required for this transfer process, the precise host internalization mechanism remains elusive. Here, we show that caveolin endocytosis is key to this event as bacterial cell-to-cell transfer is severely impaired when cells are depleted of caveolin-1. Only a subset of additional caveolar components (cavin-2 and EHD2) are present at sites of bacterial transfer, and although clathrin and the clathrin-associated proteins Eps15 and AP2 are absent from the bacterial invaginations, efficient L. monocytogenes spreading requires the clathrin-interacting protein epsin-1. We also directly demonstrated that isolated L. monocytogenes membrane protrusions can trigger the recruitment of caveolar proteins in a neighboring cell. The engulfment of these bacterial and cytoskeletal structures through a caveolin-based mechanism demonstrates that the classical nanometer-scale theoretical size limit for this internalization pathway is exceeded by these bacterial pathogens

Listeria Membrane Protrusion Collapse: Requirement of Cyclophilin A for Listeria Cell-to-Cell Spreading

Listeria generate actin-rich tubular protrusions at the plasma membrane that propel the bacteria into neighboring cells. The precise molecular mechanisms governing the formation of these protrusions remain poorly defined. In this study, we demonstrate that the prolyl cis-trans isomerase (PPIase) cyclophilin A (CypA) is hijacked by Listeria at membrane protrusions used for cell-to-cell spreading. Cyclophilin A localizes within the F-actin of these structures and is crucial for their proper formation, as cells depleted of CypA have extended actin-rich structures that are misshaped and are collapsed due to changes within the F-actin network. The lack of structural integrity within the Listeria membrane protrusions hampers the microbes from spreading from CypA null cells. Our results demonstrate a crucial role for CypA during Listeria infections

Consensus Report : 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis

Bringing critical emergency medicine, resuscitation and trauma education and training back to armed rivalry-affected community: why the conflict in Sudan matters?

Nasr AO, Lulic I, Mustafa MT, Tilsed J, Lulic D, Thies K-C. Bringing critical emergency medicine, resuscitation and trauma education and training back to armed rivalry-affected community: why the conflict in Sudan matters? European Journal of Trauma and Emergency Surgery. 2023

Differential regional pectoralis major activation indicates functional diversity in healthy females

Pectoralis major activation enables the performance of several upper extremity movements. Its regional activation, however, is not documented in healthy females. This work used high-density surface electromyography to investigate regional pectoralis major activation in twenty-nine healthy young females across two independent experiments in several ramp and hold isometric tasks and force levels. Regional mean root mean square amplitudes (normalized to the task-specific maxima) were quantified for the clavicular, superior, and middle sternocostal regions. Two-way ANOVAs were used to determine if differences in normalized regional activation exist within each task and force level. The middle sternocostal region activated 12–108% more than the clavicular and the superior sternocostal region in extension, adduction with external rotation, and high elevation internal rotation. In high elevation adduction, the middle sternocostal region activated more (7–22%) than the superior sternocostal region. In low elevation, internal rotation (60°), the clavicular and middle sternocostal regions activated more (9–13%) than the superior sternocostal region, while in adduction 60°, the clavicular region activated 9–19% more than the superior sternocostal region. Lastly, in forward and horizontal flexion, all three regions activated similarly irrespective of the force level, except at 25% MVF in forward flexion, where the clavicular region activated 21% more than the superior sternocostal region. This work provides a first comprehensive evaluation of the normalized regional pectoralis major activation in healthy females. The present findings indicate that the performance of isometric tasks in different directions activates different pectoralis major regions in healthy females, suggesting regional specificity to functional actions

Standard bipolar surface EMG estimations mischaracterize pectoralis major activity in commonly performed tasks

The pectoralis major assists in several shoulder movements, such as humeral vertical and horizontal adduction, flexion, extension, and internal rotation. Despite its involvement in numerous functional activities, its role in typical shoulder function is ambiguous. Due to this, its purpose in arm movement is largely diminished. However, mounting evidence associates pectoralis major injuries to long-term debilitating arm disability. Therefore, a more deliberate investigation of its role in typical shoulder function is paramount. The purpose of this paper is to outline the current limitations in the acquisition and characterization of pectoralis major activation using standard bipolar surface electromyography. Macroscopic level analyses are used to investigate pectoralis major activation in eight tasks at low (15–25% of maximal voluntary effort (MVE) and moderate (50% MVE) efforts in healthy males. Virtually derived bipolar EMG amplitudes are quantified for the clavicular and the upper sternocostal regions based on the common locations used to acquire EMG signals from classic EMG. HD-sEMG amplitudes from three pectoralis major regions (i.e. clavicular, upper, and lower sternocostal) were compared to virtually derived bipolar EMG amplitudes (i.e. clavicular and upper sternocostal) to determine if current EMG methods misestimate pectoralis major activity. Current findings indicate that classic EMG recordings mischaracterize pectoralis major activation in several tasks and effort levels, highlighting the importance of acquiring signals from multiple pectoralis major regions

Neural control of the healthy pectoralis major from low-to-moderate isometric contractions

The pectoralis major critically enables arm movement in several directions. However, its neural control remains unknown. High-density electromyography (HD-sEMG) was acquired from the pectoralis major in two sets of experiments in healthy young adults. Participants performed ramp-and-hold isometric contractions in: adduction, internal rotation, flexion, and horizontal adduction at three force levels: 15%, 25%, and 50% scaled to task-specific maximal voluntary force (MVF). HD-sEMG signals were decomposed into motor unit spike trains using a convolutive blind source separation algorithm and matched across force levels using a motor unit matching algorithm. The mean discharge rate and coefficient of variation were quantified across the hold and compared between 15% and 25% MVF across all tasks, whereas comparisons between 25% and 50% MVF were made where available. Mean motor unit discharge rate was not significantly different between 15% and 25% MVF (all P > 0.05) across all tasks or between 25% and 50% MVF in horizontal adduction (P = 0.11), indicating an apparent saturation across force levels and the absence of rate coding. These findings suggest that the pectoralis major likely relies on motor unit recruitment to increase force, providing first-line evidence of motor unit recruitment in this muscle and paving the way for more deliberate investigations of the pectoralis major involvement in shoulder function. NEW & NOTEWORTHY This work is the first to investigate the relative contribution of rate coding and motor unit recruitment in the pectoralis major muscle in several functionally relevant tasks and across varying force levels in healthy adults. Our results demonstrate the absence of motor unit rate coding with an increase in EMG amplitude with increases in force level in all tasks examined, indicating that the pectoralis major relies on motor unit recruitment to increase force

Role and models for compensation of tobacco use prevention and cessation by oral health professionals

Appropriate compensation of tobacco use prevention and cessation (TUPAC) would give oral health professionals better incentives to provide TUPAC, which is considered part of their professional and ethical responsibility and improves quality of care. Barriers for compensation are that tobacco addiction is not recognised as a chronic disease but rather as a behavioural disorder or merely as a risk factor for other diseases. TUPAC-related compensation should be available to oral health professionals, be in appropriate relation to other dental therapeutic interventions and should not be funded from existing oral health care budgets alone. We recommend modifying existing treatment and billing codes or creating new codes for TUPAC. Furthermore, we suggest a four-staged model for TUPAC compensation. Stages 1 and 2 are basic care, stage 3 is intermediate care and stage 4 is advanced care. Proceeding from stage 1 to other stages may happen immediately or over many years. Stage 1: Identification and documentation of tobacco use is part of each patient's medical history and included into oral examination with no extra compensation. Stage 2: Brief intervention consists of a motivational interview and providing information about existing support. This stage should be coded/reimbursed as a short preventive intervention similar to other advice for oral care. Stage 3: Intermediate care consists of a motivational interview, assessment of tobacco dependency, informing about possible support and pharmacotherapy, if appropriate. This stage should be coded as preventive intervention similar to an oral hygiene instruction. Stage 4: Advanced care. Treatment codes should be created for advanced interventions by oral health professionals with adequate qualification. Interventions should follow established guidelines and use the most cost-effective approaches