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Introduction: The expanding geographical range of blacklegged ticks (BLTs), Ixodes scapularis, and its ability to transmit Borrelia burgdorferi, Anaplasma phagocytophilum, Babesia microti, and Borrelia miyamotoi poses an emerging public health risk. Our study determined the geographic distribution and the minimum infection rate (MIR) of B. burgdorferi‐, A. phagocytophilum‐, Ba. microti‐, and B. miyamotoi‐infected BLTs in Manitoba submitted to the Public Health Agency of Canada's passive tick surveillance programme from 1995 to 2017. Methods: Regression models were used to test the association of the MIR by year for each pathogen. Ticks were tested using PCR for B. burgdorferi since 1995, A. phagocytophilum since 2006, and Ba. microti and B. miyamotoi since 2013. The global positioning system coordinates of infected and uninfected ticks submitted during the surveillance period were plotted on a map of Manitoba using ArcGIS Pro version 3.1.2 to detect changes in the geographic distribution of ticks over time. Results: The overall MIR for B. burgdorferi was 139.7 (95% confidence interval [CI]: 129.0–150.5) per 1000 BLTs; however, it varied over time. After remaining stable from 1995 to 2005, the MIR increased by 12.1 per 1000 BLTs per year from 2005 to 2017 (95% CI: 7.0%–17.2%, p‐value <0.01). The geographic distribution of B. burgdorferi‐infected BLTs was centred around Winnipeg, Manitoba, and spread outward from this locality. The MIRs of A. phagocytophilum, Ba. microti, and B. miyamotoi were 44.8 per 1000 BLTs (95% CI: 38.1–51.6), 10.8 (95% CI: 6.6–15.0), and 5.2 (95% CI: 2.3–8.1) per 1000 BLTs, respectively, and showed no significant change over time. Conclusion: Passive surveillance revealed the presence of A. phagocytophilum‐, Ba. microti‐, and B. miyamotoi‐infected BLTs in southern Manitoba and revealed an increased risk of exposure to B. burgdorferi‐infected BLTs due to the increasing geographic range and MIR. [ABSTRACT FROM AUTHOR]

Aims: Rat‐associated zoonotic pathogen transmission at the human–wildlife interface is a public health concern in urban environments where Norway rats (Rattus norvegicus) thrive on abundant anthropogenic resources and live in close contact with humans and other animal species. To identify potential factors influencing zoonotic pathogen occurrence in rats, we investigated associations between environmental and sociodemographic factors and Leptospira interrogans and Bartonella spp. infections in rats from Windsor, Ontario, Canada, while controlling for the potential confounding effects of animal characteristics (i.e., sexual maturity and body condition). Methods and Results: Between November 2018 and June 2021, 252 rats were submitted by collaborating pest control professionals. Kidney and spleen samples were collected for L. interrogans and Bartonella spp. PCR and sequencing, respectively. Of the rats tested by PCR, 12.7% (32/252) were positive for L. interrogans and 16.3% (37/227) were positive for Bartonella species. Associations between infection status and environmental and sociodemographic variables of interest were assessed via mixed multivariable logistic regression models with a random intercept for social group and fixed effects to control for sexual maturity and body condition in each model. The odds of L. interrogans infection were significantly higher in rats from areas with high building density (odds ratio [OR]: 3.76; 95% CI: 1.31–10.79; p = 0.014), high human population density (OR: 3.31; 95% CI: 1.20–9.11; p = 0.021), high proportion of buildings built in 1960 or before (OR: 11.21; 95% CI: 2.06–60.89; p = 0.005), and a moderate number of reports of uncollected garbage compared to a low number of reports (OR: 4.88; 95% CI: 1.01–23.63; p = 0.049). A negative association was observed between median household income and Bartonella spp. infection in rats (OR: 0.26; 95% CI: 0.08–0.89; p = 0.031). Conclusions: Due to the complexity of the ecology of rat‐associated zoonoses, consideration of environmental and sociodemographic factors is of critical importance to better understand the nuances of host–pathogen systems and inform how urban rat surveillance and intervention efforts should be distributed within cities. [ABSTRACT FROM AUTHOR]

Super‐resolution optical imaging tools are crucial in microbiology to understand the complex structures and behavior of microorganisms such as bacteria, fungi, and viruses. However, the capabilities of these tools, particularly when it comes to imaging pathogens and infected tissues, remain limited. MicroMagnify (µMagnify) is developed, a nanoscale multiplexed imaging method for pathogens and infected tissues that are derived from an expansion microscopy technique with a universal biomolecular anchor. The combination of heat denaturation and enzyme cocktails essential is found for robust cell wall digestion and expansion of microbial cells and infected tissues without distortion. µMagnify efficiently retains biomolecules suitable for high‐plex fluorescence imaging with nanoscale precision. It demonstrates up to eightfold expansion with µMagnify on a broad range of pathogen‐containing specimens, including bacterial and fungal biofilms, infected culture cells, fungus‐infected mouse tone, and formalin‐fixed paraffin‐embedded human cornea infected by various pathogens. Additionally, an associated virtual reality tool is developed to facilitate the visualization and navigation of complex 3D images generated by this method in an immersive environment allowing collaborative exploration among researchers worldwide. µMagnify is a valuable imaging platform for studying how microbes interact with their host systems and enables the development of new diagnosis strategies against infectious diseases. [ABSTRACT FROM AUTHOR]

Objective: Derive and confirm factor structure of the Montgomery‐Åsberg Depression Rating Scale (MADRS) in patients with treatment‐resistant depression (TRD) and evaluate how the factors evident at baseline change over 4 weeks of esketamine treatment. Methods: Two similarly‐designed, short‐term TRANSFORM trials randomized adults to esketamine or matching placebo nasal spray, each with a newly‐initiated oral antidepressant, for 4 weeks (TRANSFORM‐1: N = 342 patients; TRANSFORM‐2: N = 223 patients). The factor structure of MADRS item scores at baseline was determined by exploratory factor analysis in TRANSFORM‐2 and corroborated by confirmatory factor analysis in TRANSFORM‐1. Change in MADRS factor scores from baseline (day 1) to the end of the 28‐day double‐blind treatment phase of TRANSFORM‐2 was analyzed using a mixed‐effects model for repeated measures (MMRM). Results: Three factors were identified based on analysis of MADRS items: Factor 1 labeled affective and anhedonic symptoms (apparent sadness, reported sadness, lassitude, inability to feel), Factor 2 labeled anxiety and vegetative symptoms (inner tension, reduced sleep, reduced appetite, concentration difficulties), and Factor 3 labeled hopelessness (pessimistic thoughts, suicidal thoughts). The three‐factor structure observed in TRANSFORM‐2 was verified in TRANSFORM‐1. Treatment benefit at 24 h with esketamine versus placebo was observed on all 3 factors and continued throughout the 4‐week double‐blind treatment period. Conclusions: A three‐factor structure for MADRS appears to generalize to TRD. All three factors improved over 4 weeks of treatment with esketamine nasal spray. [ABSTRACT FROM AUTHOR]

Norway rats (Rattus norvegicus) inhabit cities worldwide and live in close association with humans. Studies of urban rat zoonoses often rely on live‐trapping, with fewer studies using rats sourced through lethal pest control interventions. Our objectives were to evaluate the utility of rats collected by pest control professionals for zoonotic pathogen surveillance and determine whether we could detect Leptospira interrogans and Streptobacillus moniliformis in pest control sourced rats. Rat carcasses were submitted from Windsor, Canada by pest control professionals between November 2018 and March 2020. Submissions were categorized by season and land use. Necropsies were performed to classify carcass quality, collect tissue samples, and record demographic data. The association between carcass quality and the ability to collect tissue samples for pathogen surveillance was assessed via an exact logistic regression model. Using PCR, a subset of kidney and spleen samples were tested for L. interrogans and S. moniliformis, respectively. Our sample of pest control sourced rats had similar sex and age distributions to those of live‐trapping studies. Rats were primarily submitted from residential and industrial locations during fall, winter, and spring, which may reflect pest control service areas and peak business periods, rather than rat distribution. Of 124 submissions, 98 (79.0%) of rats showed only mild decomposition. The odds of collecting all tissue samples were reduced for fair compared to good‐quality carcasses (OR: 0.029; 95% CI: 0–0.25; p =.0009) and for poor compared to fair‐quality carcasses (OR: 0.048; 95% CI: 0.00085–0.53; p =.0065). Leptospira interrogans and S. moniliformis were detected in 9.1% (4/44) and 27.3% (15/55) of a subset of rats tested, respectively. Our results suggest that pest control sourced rats are suitable for surveillance for multiple zoonotic pathogens in urban environments. This method of rat collection may provide preliminary information to guide more detailed ecological studies. [ABSTRACT FROM AUTHOR]

Background and aims: Treatment‐resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD. Design Nested case–control study. Setting: Nation‐wide governmental health‐care registers in Sweden. Cases and controls: Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121 669) from 2006 to 2014. Of these, 15 631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio‐demographic data with five controls with depression. Measurements Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio‐demographic covariates. Findings Having any SUD during, or ≤ 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [≤ 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70–2.05]. Increased risks for TRD were found ≤ 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88–2.99), opioids (aOR = 2.02; 1.48–2.75), alcohol (aOR = 1.77; CI = 1.59–1.98) and combined substance use (aOR = 2.31; 1.87–2.99). Conclusions: Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression. [ABSTRACT FROM AUTHOR]

Background and aims: Treatment‐resistant depression (TRD) is common among patients with major depressive disorder (MDD). MDD may increase the risk for developing substance use disorders (SUD). The aim of this study was to investigate the risk for developing SUD among patients with TRD compared with other depressed patients. Design Observational cohort study. Setting: Nation‐wide governmental health registers in Sweden. Participants: All patients aged 18–69 years with an MDD diagnosis in specialized health care who had received at least one antidepressant prescription during 2006–14 were identified. Patients with at least three treatment trials within a single depressive episode were classified with TRD. Measurements Patients with TRD were compared with the whole MDD cohort regarding risk for obtaining a SUD diagnosis or medication using survival analyses adjusted for socio‐demographics and comorbidities. Findings Of 121 669 MDD patients, 13% were classified with TRD. Among the patients without any history of SUD, patients with TRD had a risk increase for any SUD both ≤ 1 and > 1 year after antidepressant initiation [> 1 year hazard ratio (HR) = 1.4; 95% confidence interval (CI) = 1.3–1.5]. Risks were elevated for the subcategories of opioid (HR = 1.9, 95% CI = 1.4–2.5) and sedative SUD (HR = 2.7, 95% CI = 2.2–3.2). Patients with a history of SUD had a risk increase for any SUD ≤ 1 year after start of treatment (HR = 1.2, 95% CI = 1.1–1.4), and both ≤ 1 year and > 1 year for sedative (> 1 year HR = 2.0, 95% CI = 1.3–3.0) and multiple substance SUD (HR = 1.9, 95% CI = 1.4–2.5). Conclusions: Patients with treatment‐resistant depression may be at greater risk for substance use disorders compared with other patients with major depressive disorder. Patterns may differ for patients with and without a history of substance use disorders, and for different categories of substance use disorder. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral nerve damage is associated with high long-term morbidity. Because of beneficial secretome, immunomodulatory effects, and ease of clinical translation, transplantation with adipose-derived stem cells (ASC) represents a promising therapeutic modality.Methods: Effect of ASC delivery in poloxamer hydrogel was assessed in a rat sciatic nerve model of critical-sized (1.5 cm) peripheral nerve injury. Nerve/muscle unit regeneration was assessed via immunostaining explanted nerve, quantitative polymerase chain reaction (qPCR), and histological analysis of reinnervating gastrocnemius muscle.Results: On the basis of viability data, 10% poloxamer hydrogel was selected for in vivo study. Six weeks after transection and repair, the group treated with poloxamer delivered ASCs demonstrated longest axonal regrowth. The qPCR results indicated that the inclusion of ASCs appeared to result in expression of factors that aid in reinnervating muscle tissue.Discussion: Delivery of ASCs in poloxamer addresses multiple facets of the complexity of nerve/muscle unit regeneration, representing a promising avenue for further study. Muscle Nerve 58: 251-260, 2018. [ABSTRACT FROM AUTHOR]

The results of 3 proof-of-concept studies to evaluate carisbamate's efficacy and safety in treating neuropathic pain are presented. In studies 1 (postherpetic neuralgia, n = 91) and 2 (diabetic neuropathy, n = 137), patients received carisbamate 400 mg/day or placebo for 4 weeks and then crossed over to the other treatment for 4 weeks. In study 3 (diabetic neuropathy, higher carisbamate doses), patients ( n = 386) were randomized (1:1:1:1) to receive either carisbamate 800 mg/day, 1200 mg/day, pregabalin 300 mg/day or placebo for 15 weeks. Primary efficacy end point was the mean of the last 7 average daily pain scores obtained on days the study drug was taken, for all 3 studies. Least square mean (95% CI) differences between carisbamate and placebo groups on the primary end point were as follows: study 1: −0.512 (−1.32, 0.29) carisbamate 400 mg/day; study 2: −0.307 (−0.94, 0.33) carisbamate 400 mg/day; and study 3: −0.51 (−1.10, 0.08), carisbamate 800 mg/day; −0.55 (−1.13, 0.04), carisbamate 1200 mg/day; and −0.43 (−1.01, 0.15), pregabalin 300 mg/day. Neither carisbamate (all 3 studies) nor pregabalin (study 3) significantly differed from placebo, although multiple secondary end points showed significant improvement in efficacy with carisbamate in studies 1 and 2. Dizziness was the only treatment-emergent adverse event occurring at ≥10% difference in carisbamate groups versus placebo (study 1: 12% vs. 1%; study 3: 14% vs. 4%; study 2: 1% vs. 2%). Carisbamate, although well tolerated, did not demonstrate efficacy in neuropathic pain across these studies, nor did the active comparator pregabalin (study 3). [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Amnestic mild cognitive impairment MCI) represents the prodromal stage of Alzheimer's dementia and this disease progresses in a non-linear fashion. • Disease progression depends on a variety of demographic, biochemical, genetic and cognitive factors. WHAT THIS STUDY ADDS • Baseline CSF biomarkers carry information about disease pathology and critical thresholds for these markers (Aβ and p-tau181P) have been identified that allow segregation of the population into MCI progressers and non-progressers. AIM The objective is to develop a semi-mechanistic disease progression model for mild cognitive impairment (MCI) subjects. The model aims to describe the longitudinal progression of ADAS-cog scores from the Alzheimer's disease neuroimaging initiative trial that had data from 198 MCI subjects with cerebrospinal fluid (CSF) information who were followed for 3 years. METHOD Various covariates were tested on disease progression parameters and these variables fell into six categories: imaging volumetrics, biochemical, genetic, demographic, cognitive tests and CSF biomarkers. RESULTS CSF biomarkers were associated with both baseline disease score and disease progression rate in subjects with MCI. Baseline disease score was also correlated with atrophy measured using hippocampal volume. Progression rate was also predicted by executive functioning as measured by the Trail B-test. CONCLUSION CSF biomarkers have the ability to discriminate MCI subjects into sub-populations that exhibit markedly different rates of disease progression on the ADAS-cog scale. These biomarkers can therefore be utilized for designing clinical trials enriched with subjects that carry the underlying disease pathology. [ABSTRACT FROM AUTHOR]

Carisbamate’s effect (200 mg twice-daily [study 1], 600 mg twice-daily [study 2]) on warfarin’s (25 mg single dose) pharmacokinetics and pharmacodynamics (international normalized ratio) was assessed during 2 open-label studies in healthy participants. Coadministration of either carisbamate regimen produced small changes on the mean maximum plasma concentration (Cmax) and mean area under the plasma concentration–time curve to the last measurable time point (AUClast) of (S)- and (R)-warfarin, which are unlikely to be clinically significant. For (S)-warfarin, the ratios (with carisbamate/without carisbamate) of geometric means for Cmax were 105.44 (study 1) and 98.48 (study 2) and for AUClast were 109.33 (study 1) and 114.43 (study 2); the corresponding 90% confidence intervals were within the bioequivalence limits of 80% to 125%. Results were similar for (R)-warfarin. Carisbamate at 600 mg (but not 200 mg) twice-daily prolonged the elimination half-life of (S)- and (R)-warfarin by ~10 hours (25% and 32% increase, respectively). Prothrombin time was unaltered by either carisbamate dose. Adverse events with the highest incidence were dizziness (50%) and headache (50%) in study 1 and somnolence (56%) in study 2. Warfarin exposure and international normalized ratio were unaffected by coadministration of carisbamate 200 mg or 600 mg twice-daily. Carisbamate was well tolerated. [ABSTRACT FROM PUBLISHER]

This case demonstrates the use of QRS scoring to quantify myocardial scar in a patient with cardiac sarcoidosis and left bundle branch block who progressively received an implantable defibrillator, cardiac resynchronization therapy (CRT), left ventricular assist device and cardiac transplantation. QRS scoring has been shown to correlate with magnetic resonance imaging measurements of scar, identify arrhythmogenic substrate and predict response to CRT, but had not previously been compared to pathology-documented scar in nonischemic cardiomyopathies. Further study is warranted to assess the ability of QRS scoring to guide therapy for individual patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: The Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) has been used widely as a cognitive end point in Alzheimer’s Disease (AD) clinical trials. Efforts to treat AD pathology at earlier stages have also used ADAS-Cog, but failure in these trials can be difficult to interpret because the scale has well-known ceiling effects that limit its use in mild cognitive impairment (MCI) and early AD. A wealth of data exists in ADAS-Cog from both historical trials and contemporary longitudinal natural history studies that can provide insights about parts of the scale that may be better suited for MCI and early AD trials. Methods: Using Alzheimer’s Disease Neuroimaging Initiative study data, we identified the most informative cognitive measures from the ADAS-Cog and other available scales. We used cross-sectional analyses to characterize trajectories of ADAS-Cog and its individual subscales, as well as other cognitive, functional, or global measures across disease stages. Informative measures were identified based on standardized mean of 2-year change from baseline and were combined into novel composite endpoints. We assessed performance of the novel endpoints based on sample size requirements for a 2-year clinical trial. A bootstrap validation procedure was also undertaken to assess the reproducibility of the standardized mean changes of the selected measures and the corresponding composites. Results: All proposed novel endpoints have improved standardized mean changes and thus improved statistical power compared with the ADAS-Cog 11. Further improvements were achieved by using cognitive–functional composites. Combining the novel composites with an enrichment strategy based on cerebral spinal fluid beta-amyloid (Aβ1-42) in a 2-year trial yielded gains in power of 20% to 40% over ADAS-Cog 11, regardless of the novel measure considered. Conclusion: An empirical, data-driven approach with e xisting instruments was used to derive novel composite scales based on ADAS-Cog 11 with improved performance characteristics for MCI and early AD clinical trials. Together with patient enrichment based on Aβ1-42 pathology, these modified endpoints may allow more efficient clinical trials in these populations and can be assessed without modifying current test administration procedures in ongoing trials. [Copyright &y& Elsevier]