Carbon metabolism and biogeography of candidate phylum "Candidatus Bipolaricaulota" in geothermal environments of Biga Peninsula, Turkey

Terrestrial hydrothermal springs and aquifers are excellent sites to study microbial biogeography because of their high physicochemical heterogeneity across relatively limited geographic regions. In this study, we performed 16S rRNA gene sequencing and metagenomic analyses of the microbial diversity of 11 different geothermal aquifers and springs across the tectonically active Biga Peninsula (Turkey). Across geothermal settings ranging in temperature from 43 to 79°C, one of the most highly represented groups in both 16S rRNA gene and metagenomic datasets was affiliated with the uncultivated phylum "Candidatus Bipolaricaulota" (former "Ca. Acetothermia" and OP1 division). The highest relative abundance of "Ca. Bipolaricaulota" was observed in a 68°C geothermal brine sediment, where it dominated the microbial community, representing 91% of all detectable 16S rRNA genes. Correlation analysis of "Ca. Bipolaricaulota" operational taxonomic units (OTUs) with physicochemical parameters indicated that salinity was the strongest environmental factor measured associated with the distribution of this novel group in geothermal fluids. Correspondingly, analysis of 23 metagenome-assembled genomes (MAGs) revealed two distinct groups of "Ca. Bipolaricaulota" MAGs based on the differences in carbon metabolism: one group encoding the bacterial Wood-Ljungdahl pathway (WLP) for H₂ dependent CO₂ fixation is selected for at lower salinities, and a second heterotrophic clade that lacks the WLP that was selected for under hypersaline conditions in the geothermal brine sediment. In conclusion, our results highlight that the biogeography of "Ca. Bipolaricaulota" taxa is strongly correlated with salinity in hydrothermal ecosystems, which coincides with key differences in carbon acquisition strategies. The exceptionally high relative abundance of apparently heterotrophic representatives of this novel candidate Phylum in geothermal brine sediment observed here may help to guide future enrichment experiments to obtain representatives in pure culture.

AB1495 THE QUALITY OF REPORTING IN RANDOMIZED CONTROLLED TRIALS OF STRENGTHENING EXERCISES IN TOTAL KNEE ARTHROPLASTY

Background

End-stage knee osteoarthritis (KOA) is a significant health issue worldwide resulting in severe pain and disability. Total knee arthroplasty (TKA) leads to significant improvements in pain and the performance of functional activities such as walking for patients with end-stage KOA. Although TKA reduces pain and improves perceived function, patients continue to exhibit reduced muscle strength, voluntary muscle activation, and functional performance even years after surgery (1). In addition, quarantine, and related social restrictions due to the current Covid-19 pandemic may have affected the recovery of patients undergoing TKA due to limited access to exercise, physiotherapy, face-to-face follow-up, and medical services (2).Limited recovery after TKA will require intensive rehabilitation programs in the future. Strengthening exercises(SE) are the most effective intervention for improving muscle strength and functionality and have been recommended in the guidelines for KOA management and in clinical reviews for TKA rehabilitation (3). Randomized controlled trials (RCTs) are the gold standard for assessing the effects of health care interventions. However, RCTs may yield misleading results if they lack methodological rigors(4). RCTs provide the highest quality clinical evidence in the selection of the SE method to be applied (5). However, there are no studies examining the quality of RCTs related to SE in patients with TKA.

Objectives

The aim of this study was to assess the reporting quality of RCTs of SE in patients with TKA.

Methods

RCTs published between 2002 and 2021 were sourced from clinical trial registers, PubMed, and the Cochrane Reviews. RCTs were included if they involved SE in patients who underwent TKA. Analysis was carried out with two assessment tools: PEDro scale and 9-items from CONSORT(6). In addition, we have identified some key methodological elements and examined their relationship to their methodological quality.

Results

We found 35 RCTs that included SE in individuals with TKA. The mean PEDro score was 6.40 ± 1, 73. The most common deficient PEDro Items were: Blinding of all therapists who administered the therapy (14,2 %: 5/35 trials), allocation was concealed (31,4 %; 11/35 trials), blinding of all subjects (31,4 %: 11/35 trials). The most common deficient CONSORT Criteria were: Statistical adjustment for multiple primary outcomes (40 %; 14/35 trials), funding sources (40 %; 14/35 trials) and identification as a randomized trial in the title (62,85%; 22/35 trials). Of the key methodological factors we identified, only exercise duration (weeks) was associated with PEDro score (R2 =.169, p<0.01).

Conclusion

Our results show that the quality of reporting in the literature on RCTs of SE in patients with TKA is insufficient. In order to increase muscle strength after TKA, the lack of face-to-face programs due to COVID-19 should be eliminated with telerehabilitation methods, video conferencing platforms and virtual reality applications, and high-quality RCTs should be planned where these programs are examined.

References

[1]Ciolac EG, et al. Clinics (Sao Paulo). 2011;66(12):2079-84.

[2]MacDonald, D. J. et al. Bone & joint open, 2021;2(6), 380–387.

[3]Unver B, et al. Arch Gerontol Geriatr. 2016;64:45-50.

[4]Ntala C, et al. Prim Care Respir J. 2013;22(4):417-24.

[5]Karpouzis F, et al. Chiropr Man Therap. 2016 Jun 9;24:19.

[6]Gonzalez GZ, et al. Arch Phys Med Rehabil. 2018 Jan;99(1):129-136.

Disclosure of Interests

None declared

AB1494 THE QUALITY OF REPORTING IN RANDOMIZED CONTROLLED TRIALS OF BALANCE EXERCISES IN TOTAL KNEE ARTHROPLASTY

Background

Total knee arthroplasty (TKA) is used to treat patients with end-stage osteoarthritis who experience pain and struggle to perform activities of daily living owing to having degenerative knee joints. Although TKA can improve the quality of life of patients, some may experience a decrease in their proprioception and the ability to balance after surgery (1). Decreased balance ability makes it difficult to undertake daily life activities in patients after TKA, impairs walking capacity and increases the risk of falling (2). Almost all studies which investigate the risk of falling conclude that physical activity(PA) are effective methods in order to maintain an intact balance control and prevent falls(4). Today, however, measures aimed at controlling COVID-19 include quarantines that lead to PA restrictions (5). In these days when PA cannot be increased due to quarantines, the most effective way to prevent falls in TKA patients may be to apply balance exercises (3). The “gold standard” in clinical trials are randomized controlled trials(RCTs) in which healthcare professionals make decisions about the safety and efficacy of treatments. However, poorly designed and reported RCTs can give misleading results. Methodological quality (MQ) assessment of clinical trials is important because it can prevent erroneous results in clinical practice and improve the quality of medical care. (6) Although RCTs provide the highest quality clinical evidence selection of balance exercises(BE) to be applied, there is no study in the literature investigating the MQ of RCTs of BE in TKA patients.

Objectives

The aim was to investigate assess the reporting MQ of RCTs of BE in patients with TKA.

Methods

We analyzed 17 published full-text reports of RCTs using BE in patients who underwent TKA. RCTs were sourced from PubMed, the Cochrane Reviews and PEDro Database. The PEDro scale and the 9-item CONSORT (7) were used to evaluate the MQ of the studies.

Results

The mean PEDro score was 6,64 ± 1,57. Classification of RCTs according to total PEDro score revealed that 1 study was classified as excellent, 13 studies as good, and 3 as fair. The least fulfilled criteria in the PEDro scale were: Blinding of all therapists who administered the therapy (1[5.88%]), allocation was concealed (5[29.4%]) and blinding of all subjects (7[41.17%]). The adherence of the reports to CONSORT items ranged from 41.17 % to 100%. The most underreported CONSORT items were: funding sources (7[41.17%]), statistical adjustment for multiple primary outcomes (8[47.05%]), and number of primary outcomes (8[47.05%]).

Conclusion

Our findings show that the quality of reporting for RCTs of BE in TKA patients is not high quality. Since it is not possible to improve balance with PA today, when there are quarantine due to COVID-19, patients should be encouraged to participate in BE programs with telerehabilitation, home-based or web-based exercises, and high quality RCTs should be planned in these programs.

References

[1]Lee, H. G., et al International journal of environmental research and public health, 2021;18(5), 2513.

[2]Matsumoto H, et al. Arch Orthop Trauma Surg. 2012;132(4):555–63.

[3]Doma K, et al. Sports Med. 2018 Oct;48(10):2367-2385.

[4]Thomas, E., et al. Medicine, 2019;98(27), e16218.

[5]Füzéki, E., et al. Journal of occupational medicine and toxicology (London, England), 2020;15, 25.

[6]McCormick F, et al. J Shoulder Elbow Surg. 2013 Sep;22(9):1180-5

[7]Gonzalez GZ, et al. Arch Phys Med Rehabil. 2018 Jan;99(1):129-136.

Disclosure of Interests

None declared

Ovarian metastasis of a primary renal cell carcinoma: case report and review of literature

Ovarian metastases from renal cell carcinoma (RCC) are very rare, with only 23 cases reported in the literature. We report a case of 54-year-old women who developed bilateral ovarian metastasis 39 months after diagnosis of clear cell carcinoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. Subsequently she was treated with sunitinib and her disease stabilized. She is still alive four years after diagnosis of the renal primary, and disease has stabilized on sunitinib. We conclude that, although rare, the possibility of metastatic RCC should be considered in the differential diagnosis of clear cell tumors of the ovary. Due to therapeutic and prognostic implications, it is very important to differentiate if the tumor is a primary ovarian tumor or a metastasis from a renal cell carcinoma. Early diagnosis of this rare metastatic tumor results in prompt treatment and prolonged patient survival.

Primary carcinoid tumor arising in a mature cystic teratoma of the ovary: a case report

OBJECTIVE

To present an extremely rare case of a primary carcinoid tumor arising in a mature cystic teratoma of the ovary. Malignant transformation of mature cystic teratoma is an uncommon complication occuring in approximately 1-3% of patients with mature cystic teratoma.

CLINICAL PRESENTATION AND INTERVENTION

A 54-year-old woman presented with abdominal swelling and abnormal uterine bleeding. Physical examination revealed a smooth, non-painful, 8-9 cm diameter mass in the right anterior pelvis which was diagnosed histologically as carcinoid tumor arising in a mature cystic teratoma. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and was scheduled for surveillance CT of the abdomen and pelvis at 3-monthly intervals.

CONCLUSION

This case adds to the rare reports in the literature of a carcinoid of low malignant potential occurring in a mature cystic teratoma. The treatment for early-stage ovarian carcinoid tumors confined to one ovary is surgery alone and excellent outcomes can be expected in these cases.

Primary lymphoma of the trigeminal nerve

Although malignant lymphoma of the central nervous system (CNS) is rarely seen, its frequency is increasing as a result of more common observation of immunocompromised patients. Primary CNS lymphoma arise usually in the white matter of brain and account for only 0.5-1.5% of all primary brain tumours. However, skull base and cranial nerve lymphomas are extremely rare. We present here the third primary lymphoma of the trigeminal nerve in the literature.

Malignant Leydig cell tumour of the testis: a case report and review of the literature

A rare case of malignant Leydig cell tumour of the testis is presented. There was no standard therapy regimen. Leydig cell carcinoma is relatively refractory to radiotherapy and chemotherapy. So a retroperitoneal node dissection should be performed before or after chemotherapy for staging and also for therapeutic reasons.