scholarly journals Prognosis of recurrent bacterial vaginosis based on longitudinal changes in abundance of Lactobacillus and specific species of Gardnerella

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256445
Author(s):  
Essence Turner ◽  
Jack D. Sobel ◽  
Robert A. Akins
Keyword(s):  
Bacterial Vaginosis ◽  
Clinical Outcomes ◽  
Species Abundance ◽  
Standard Of Care ◽  
Species Specific ◽  
Specific Species ◽  
Prevalent Species ◽  
Improve Patient ◽  
Oral Metronidazole

Refractory responses to standard-of-care oral metronidazole among recurrent bacterial vaginosis (BV) patients is not rare, and recurrence within a year is common. A better understanding of the bacterial determinants of these outcomes is essential. In this study we ask whether changes in specific species of Gardnerella are associated with poor short or long term clinical outcomes, and if and how resurgence of Lactobacillus species affects these outcomes. We quantify Lactobacillus isolates as a proportion of total vaginal bacteria using the LbRC5 qPCR assay, and 5 prevalent species of Gardnerella using primers that target species-specific polymorphisms within the cpn60 gene. The study includes 43 BV patients: 18 refractory, 16 recurrent, and 11 remission patients, sampled daily for up to two weeks post-treatment; clinical outcomes were tracked for up to 9 months. Persistently high titers of Gardnerella Gsp07 were associated with refractory responses, and persistently low abundance of Gardnerella Gsp07 and G. swidsinskii / G. leopoldii were associated with remission. Lactobacillus species abundance rose in 4–14 days after initiation of treatment in most but not all recurrent and remission patients, although increases were more sustained among remission patients. The findings suggest that Gardnerella Gsp07 and G. swidsinskii / G. leopoldii are markers of poor clinical outcome or may directly or indirectly suppress recovery of Lactobacillus species, thereby interfering with clinical recovery. Therapies that target these strains may improve patient outcome.

scholarly journals Treating male partners of women with bacterial vaginosis (StepUp): a protocol for a randomised controlled trial to assess the clinical effectiveness of male partner treatment for reducing the risk of BV recurrence

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lenka A. Vodstrcil ◽  
◽  
Erica L. Plummer ◽  
Michelle Doyle ◽  
Christopher K. Fairley ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Bacterial Vaginosis ◽  
Controlled Trial ◽  
Male Partner ◽  
Standard Of Care ◽  
Trial Registration ◽  
Current Standard ◽  
Randomised Controlled ◽  
Oral Metronidazole ◽  
Amsel Criteria

Abstract Background Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. Methods StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4–10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4–10 within 12 weeks of enrolment. The estimated sample size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. Discussion Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. Trial registration The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111–1228-0106, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883&isReview=true).

scholarly journals Changes in composition and abundance of functional groups of arctic fungi in response to long-term summer warming

2016 ◽  
Vol 12 (11) ◽  
pp. 20160503 ◽  
Author(s):  
József Geml ◽  
Tatiana A. Semenova ◽  
Luis N. Morgado ◽  
Jeffrey M. Welker
Keyword(s):  
Nutrient Cycling ◽  
Functional Groups ◽  
Community Composition ◽  
Species Abundance ◽  
Species Level ◽  
Fungal Communities ◽  
Summer Warming ◽  
Species Specific

We characterized fungal communities in dry and moist tundra and investigated the effect of long-term experimental summer warming on three aspects of functional groups of arctic fungi: richness, community composition and species abundance. Warming had profound effects on community composition, abundance, and, to a lesser extent, on richness of fungal functional groups. In addition, our data show that even within functional groups, the direction and extent of response to warming tend to be species-specific and we recommend that studies on fungal communities and their roles in nutrient cycling take into account species-level responses.

scholarly journals Evolution of Force Sensing Technologies

2017 ◽  
Vol 6 (2) ◽  
pp. 75
Author(s):  
Dipen Shah ◽  
Keyword(s):  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Contact Force ◽  
Standard Of Care ◽  
Lesion Size ◽  
Assessment Tools ◽  
Force Sensing ◽  
Target Tissue ◽  
Catheter Tip

In order to improve the procedural success and long-term outcomes of catheter ablation techniques for atrial fibrillation (AF), an important unfulfilled requirement is to create durable electrophysiologically complete lesions. Measurement of contact force (CF) between the catheter tip and the target tissue can guide physicians to optimise both mapping and ablation procedures. Contact force can affect lesion size and clinical outcomes following catheter ablation of AF. Force sensing technologies have matured since their advent several years ago, and now allow the direct measurement of CF between the catheter tip and the target myocardium in real time. In order to obtain complete durable lesions, catheter tip spatial stability and stable contact force are important. Suboptimal energy delivery, lesion density/contiguity and/or excessive wall thickness of the pulmonary vein-left atrial (PV-LA) junction may result in conduction recovery at these sites. Lesion assessment tools may help predict and localise electrical weak points resulting in conduction recovery during and after ablation. There is increasing clinical evidence to show that optimal use of CF sensing during ablation can reduce acute PV re-conduction, although prospective randomised studies are desirable to confirm long-term favourable clinical outcomes. In combination with optimised lesion assessment tools, contact force sensing technology has the potential to become the standard of care for all patients undergoing AF catheter ablation.

Abstract 95: The Mobile Interventional Stroke Team (MIST) Model Improves Early Outcomes in Elvo Stroke: The NYC Mist Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jacob R Morey ◽  
Thomas J Oxley ◽  
Daniel Wei ◽  
Hazem Shoirah ◽  
Xiangnan Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Standard Of Care ◽  
Patient Transfer ◽  
Vessel Occlusion ◽  
Delivery Of Care ◽  
Stroke Team ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Patient Presentation

Introduction: Endovascular therapy (EVT) has become the standard of care for treatment of emergent large vessel occlusion (ELVO) in ischemic stroke. It is a time sensitive procedure that has previously only been performed at comprehensive stroke centers (CSC). Transfer was required for patients presenting at a primary stroke center (PSC). PSCs with interventional capacity (PSCI) have emerged to increase access to EVT. We have developed a Mobile Interventional Stroke Team (MIST) model, in which a MIST transfers from a CSC to PSCI to perform EVT. Hypothesis: The delivery of care by the MIST at PSCIs is more time efficient and leads to improved clinical outcomes in comparison to transferring patients from a PSC to PSCI or CSC and comparable to direct presentation to a CSC. Methods: Analysis of prospectively collected data from 228 patients who received EVT for ELVO at a CSC or 4 PSCIs between June 2016 - December 2018 was performed. The cohorts include: Mothership with patient presentation to CSC (n=20), Drip-and-Ship with patient transfer from PSC or PSCI to CSC (DS) (n=114), MIST and patient presentation to PSCI (n=64), and DS with patient transfer from PSC to PSCI and MIST (DS/MIST) (n=30). The primary outcome was initial door-to-recanalization. Secondary outcomes measured other time intervals and clinical outcomes at discharge and 3 months. Results: MIST had a faster mean initial door-to-recanalization time than DS by 83 minutes (p < 0.05). MIST and Mothership had similar median times of 192 minutes and 181 minutes, respectively (p = 0.84). A greater proportion of patients reached a discharge NIHSS of 0 or 1 in MIST compared to DS (34% vs. 17%; p < 0.01). MIST led to 53% with a mRS of ≤ 2 at 3 months compared to 39% in DS, although not statistically significant (p = 0.10). Conclusions: MIST has led to significantly faster initial door-to-recanalization times compared to DS. This decrease in time has translated into improved short-term outcomes and a trend towards improved long-term outcomes.

scholarly journals Evolution of Force Sensing Technologies

2017 ◽  
Vol 6 (2) ◽  
pp. 75 ◽  
Author(s):  
Dipen Shah ◽  
Keyword(s):  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Contact Force ◽  
Standard Of Care ◽  
Lesion Size ◽  
Assessment Tools ◽  
Force Sensing ◽  
Target Tissue ◽  
Catheter Tip

In order to improve the procedural success and long-term outcomes of catheter ablation techniques for atrial fibrillation (AF), an important unfulfilled requirement is to create durable electrophysiologically complete lesions. Measurement of contact force (CF) between the catheter tip and the target tissue can guide physicians to optimise both mapping and ablation procedures. Contact force can affect lesion size and clinical outcomes following catheter ablation of AF. Force sensing technologies have matured since their advent several years ago, and now allow the direct measurement of CF between the catheter tip and the target myocardium in real time. In order to obtain complete durable lesions, catheter tip spatial stability and stable contact force are important. Suboptimal energy delivery, lesion density/contiguity and/or excessive wall thickness of the pulmonary vein-left atrial (PV-LA) junction may result in conduction recovery at these sites. Lesion assessment tools may help predict and localise electrical weak points resulting in conduction recovery during and after ablation. There is increasing clinical evidence to show that optimal use of CF sensing during ablation can reduce acute PV re-conduction, although prospective randomised studies are desirable to confirm long-term favourable clinical outcomes. In combination with optimised lesion assessment tools, contact force sensing technology has the potential to become the standard of care for all patients undergoing AF catheter ablation.

scholarly journals Detecting temporal trends in species assemblages with bootstrapping procedures and hierarchical models

2010 ◽  
Vol 365 (1558) ◽  
pp. 3621-3631 ◽  
Author(s):  
Nicholas J. Gotelli ◽  
Robert M. Dorazio ◽  
Aaron M. Ellison ◽  
Gary D. Grossman
Keyword(s):  
Hierarchical Model ◽  
Temporal Trends ◽  
Species Abundance ◽  
Null Model ◽  
Species Assemblages ◽  
Imperfect Detection ◽  
Methods Of Analysis ◽  
Species Specific ◽  
Incomplete Sampling

Quantifying patterns of temporal trends in species assemblages is an important analytical challenge in community ecology. We describe methods of analysis that can be applied to a matrix of counts of individuals that is organized by species (rows) and time-ordered sampling periods (columns). We first developed a bootstrapping procedure to test the null hypothesis of random sampling from a stationary species abundance distribution with temporally varying sampling probabilities. This procedure can be modified to account for undetected species. We next developed a hierarchical model to estimate species-specific trends in abundance while accounting for species-specific probabilities of detection. We analysed two long-term datasets on stream fishes and grassland insects to demonstrate these methods. For both assemblages, the bootstrap test indicated that temporal trends in abundance were more heterogeneous than expected under the null model. We used the hierarchical model to estimate trends in abundance and identified sets of species in each assemblage that were steadily increasing, decreasing or remaining constant in abundance over more than a decade of standardized annual surveys. Our methods of analysis are broadly applicable to other ecological datasets, and they represent an advance over most existing procedures, which do not incorporate effects of incomplete sampling and imperfect detection.

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