bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethiopian Plasmodium vivax hypnozoites formation dynamics and their susceptibility to reference antimalarial drugs
Authors: Dembele Laurent , Diakite Ousmaila , Sogore Fanta , Kedir Soriya , Tandina Fatalmoudou , Maiga Mohamed , Abate Andargie , Golassa Lemu , Djimde Abdoulaye A.
Published: June 2023

One of the key obstacles to malaria elimination is largely attributed to Plasmodium vivax’s ability to form resilient hypnozoites in the host liver that cause relapsing infections. As a result, interruption of P. vivax transmission is difficult. P. vivax transmission occurs in Duffy-positive individuals and have been mainly thought to be absent in Africa. However, increasing studies using molecular tools detected P. vivax among Duffy-negative individuals in various African countries. Studies on the African P. vivax has been severely limited because most of malaria control program focus mainly on falciparum malaria. In addition, there is a scarcity of laboratory infrastructures to overcome the biological obstacles posed by P. vivax. Herein, we established field transmission of Ethiopian P. vivax for routine sporozoite supply followed by liver stage infection in Mali. Furthermore, we evaluated local P. vivax hypnozoites and schizonts susceptibilities to reference antimalarial drugs. The study enabled the assessment of local African P. vivax hypnozoite production dynamics. Our data displayed the ability of the African P. vivax to produce hypnozoite forms ex-vivo at different rates per field isolate. We report that while tafenoquine (1µM) potently inhibited both hypnozoites and schizont forms; atovaquone (0.25µM) and the phosphatidylinositol-4-OH kinase (PI4K)-specific inhibitor KDU691 (0.5µM) showed no activity against hypnozoites forms. Unlike hypnozoites forms, P. vivax schizont stages were fully susceptible to both atovaquone (0.25µM) and the (PI4K)-specific inhibitor KDU691 (0.5µM). Together, the data revealed the importance of the local platform for further biological investigation and implementation of drug discovery program on the African P. vivax clinical isolates.
Effect of cerebrospinal fluid area mask correction on 123I-FP-CIT SPECT images in idiopathic normal pressure hydrocephalus
Authors: Ohba Makoto , Kobayashi Ryota , Iseki Chifumi , Kirii Kazukuni , Morioka Daichi , Otani Koichi , Ohta Yasuyuki , Sonoda Yukihiko , Suzuki Koji , Kanoto Masafumi
Published: June 2023

Background

Cerebrospinal fluid (CSF) area mask correction reduces the influence of low [123I]-N-fluoropropyl-2b-carbomethoxy-3b-(4-iodophenyl) nortropane (123I-FP-CIT) accumulation in the volume of interest (VOI) by CSF area dilatation on the specific binding ratio (SBR) calculated using the Southampton method. We assessed the effect of CSF area mask correction on the SBR for idiopathic normal pressure hydrocephalus (iNPH) characterized by CSF area dilatation.

Methods

We enrolled 25 patients with iNPH who were assessed using 123I-FP-CIT single-photon emission computed tomography (SPECT) before shunt surgery or the tap test. The SBRs with and without CSF area mask correction were calculated, and changes in quantitative values were verified. Additionally, the number of voxels in the striatal and background (BG) VOI before and after CSF area mask correction were extracted. The number of voxels after correction was subtracted from that before correction, and the volume removed by the CSF area mask correction was calculated. The volumes removed from each VOI were compared to verify their effect on SBR.

Results

The images of 20 and 5 patients with SBRs that were decreased and increased, respectively, by CSF area mask correction showed that the volumes removed from the BG region VOI were higher and lower, respectively than those in the striatal region.

Conclusions

The SBR before and after CSF area mask correction was associated with the ratio of the volume removed from the striatal and BG VOIs, and the SBR was high or low according to the ratio. The results suggest that CSF area mask correction is effective in patients with iNPH.

Trial registration

This study was registered in the UMIN Clinical Trials Registry (UMIN-CTR) as UMIN study ID: UMIN000044826. 11/07/2021.
How does women’s empowerment relate to antenatal care attendance? A cross-sectional analysis among rural women in Bangladesh
Authors: Winters Solis , Pitchik Helen O. , Akter Fahmida , Yeasmin Farzana , Jahir Tania , Huda Tarique Md. Nurul , Rahman Mahbubur , Winch Peter J. , Luby Stephen P. , Fernald Lia C. H.
Published: June 2023

Background

In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women initiate antenatal care early in pregnancy and continue to attend after their first visit. One critical barrier to antenatal care attendance may be that women do not have sufficient power in their relationships, households, or communities to attend antenatal care when they want to. The main goals of this paper were to 1) understand the potential effects of intervening on direct measures of women’s empowerment—including household decision making, freedom of movement, and control over assets—on antenatal care attendance in a rural population of women in Bangladesh, and 2) examine whether differential associations exist across strata of socioeconomic status.

Methods

We analyzed data on 1609 mothers with children under 24 months old in rural Bangladesh and employed targeted maximum likelihood estimation with ensemble machine learning to estimate population average treatment effects.

Results

Greater women’s empowerment was associated with an increased number of antenatal care visits. Specifically, among women who attended at least one antenatal care visit, having high empowerment was associated with a greater probability of ≥ 4 antenatal care visits, both in comparison to low empowerment (15.2 pp, 95% CI: 6.0, 24.4) and medium empowerment (9.1 pp, 95% CI: 2.5, 15.7). The subscales of women’s empowerment driving the associations were women’s decision-making power and control over assets. We found that greater women’s empowerment is associated with more antenatal care visits regardless of socioeconomic status.

Conclusions

Empowerment-based interventions, particularly those targeting women’s involvement in household decisions and/or facilitating greater control over assets, may be a valuable strategy for increasing antenatal care attendance.

Trial registration

ClinicalTrials.gov Identifier: NCT04111016, Date First Registered: 01/10/2019.
HYpofractionated, dose-redistributed RAdiotherapy with protons and photons to combat radiation-induced immunosuppression in head and neck squamous cell carcinoma: study protocol of the phase I HYDRA trial
Authors: Elbers Joris B. W. , Gunsch Pascal A. , Debets Reno , Keereweer Stijn , van Meerten Esther , Zindler Jaap , van Norden Yvette , Hoogeman Mischa S. , Verduijn Gerda M. , Kroesen Michiel , Nout Remi A.
Published: June 2023

Background

Radiotherapy (RT) is the standard of care for most advanced head and neck squamous cell carcinoma (HNSCC) and results in an unfavorable 5-year overall survival of 40%. Despite strong biological rationale, combining RT with immune checkpoint inhibitors does not result in a survival benefit. Our hypothesis is that the combination of these individually effective treatments fails because of radiation-induced immunosuppression and lymphodepletion. By integrating modern radiobiology and innovative radiotherapy concepts, the patient’s immune system could be maximally retained by (1) increasing the dose per fraction so that the total dose and number of fractions can be reduced (HYpofractionation), (2) redistributing the radiation dose towards a higher peak dose within the tumor center and a lowered elective lymphatic field dose (Dose-redistribution), and (3) using RAdiotherapy with protons instead of photons (HYDRA).

Methods

The primary aim of this multicenter study is to determine the safety of HYDRA proton- and photon radiotherapy by conducting two parallel phase I trials. Both HYDRA arms are randomized with the standard of care for longitudinal immune profiling. There will be a specific focus on actionable immune targets and their temporal patterns that can be tested in future hypofractionated immunoradiotherapy trials. The HYDRA dose prescriptions (in 20 fractions) are 40 Gy elective dose and 55 Gy simultaneous integrated boost on the clinical target volume with a 59 Gy focal boost on the tumor center. A total of 100 patients (25 per treatment group) will be recruited, and the final analysis will be performed one year after the last patient has been included.

Discussion

In the context of HNSCC, hypofractionation has historically only been reserved for small tumors out of fear for late normal tissue toxicity. To date, hypofractionated radiotherapy may also be safe for larger tumors, as both the radiation dose and volume can be reduced by the combination of advanced imaging for better target definition, novel accelerated repopulation models and high-precision radiation treatment planning and dose delivery. HYDRA’s expected immune-sparing effect may lead to improved outcomes by allowing for future effective combination treatment with immunotherapy.

Trial registration

The trial is registered at ClinicalTrials.gov; NCT05364411 (registered on May 6th, 2022).
The INFINITY study protocol: a retrospective cohort study on decision making and clinical impact of biomarker-driven precision oncology in routine clinical practice
Authors: Martens Uwe M. , Schröder Jan , Bengsch Fee , Sellmann Ludger , Busies Sabine , Frank-Gleich Stefanie , Zaiss Matthias , Decker Thomas , Schneeweiss Andreas , Schuler Martin , Grebhardt Sina , Zacharias Stefan , Marschner Norbert , Kasenda Benjamin , Potthoff Karin , Vannier Corinne
Published: June 2023

Background

Precision oncology, defined as treatment of patients with targeted therapies matched to specific molecular alterations, has entered routine clinical practice. Particularly in patients with advanced cancer or hematologic malignancies, for whom no further standard therapies are available, this approach is increasingly applied as last resort option outside of the approved indication. However, data on patient outcomes are not systematically collected, analyzed, reported, and shared. We have initiated the INFINITY registry to provide evidence from routine clinical practice to fill this knowledge gap.

Methods

INFINITY is a retrospective, non-interventional cohort study conducted at approximately 100 sites in Germany (office-based oncologists/hematologists and hospitals). We aim to include 500 patients with advanced solid tumors or hematologic malignancies who received a non-standard targeted therapy based on potentially actionable molecular alterations or biomarkers. INFINITY aims to provide insights into the use of precision oncology in routine clinical practice within Germany. We systematically collect details on patient and disease characteristics, molecular testing, clinical decision-making, treatment, and outcome.

Discussion

INFINITY will provide evidence on the current biomarker landscape driving treatment decisions in routine clinical care. It will also provide insights on effectiveness of precision oncology approaches in general, and of specific drug class/alteration matches used outside their approved indications.

Trial registration

The study is registered at ClinicalTrials.gov, NCT04389541.
Comparison of sutureless intrascleral fixation and sutured scleral fixation for the treatment of dislocated intraocular lenses
Authors: Zhang Yinglei , Zong Yuan , Zhu Xiangjia , Lu Yi , Jiang Chunhui
Published: June 2023

Background

To compare the outcomes of sutured transscleral fixation and sutureless intrascleral fixation for the treatment of a dislocated intraocular lens (IOL).

Methods

Thirty-five eyes of 35 patients who required IOL repositioning surgery due to IOL dislocation were included in this retrospective study. Sixteen eyes underwent two-point sutured transscleral fixation, eight eyes underwent one-point sutured transscleral fixation, and 11 eyes underwent sutureless intrascleral IOL fixation. The patients were followed for ≥ 12 months after repositioning surgery, and their postoperative outcomes were recorded and analyzed.

Results

The major cause of IOL dislocation was ocular blunt trauma (19/35, 54.3%). The mean corrected distance visual acuity (CDVA) improved significantly after IOL repositioning (P = 0.022). The mean postoperative change in endothelial cell density (ECD) was − 4.5%. There were no significant differences in the changes in CDVA or ECD among the three groups with different repositioning techniques (both P > 0.1). The mean vertical tilt of the IOLs in all enrolled patients was significantly greater than the horizontal value (P = 0.001). The vertical tilt was greater in the two-point scleral fixation group than that in the sutureless intrascleral fixation group (P = 0.048). The mean decentration values in the one-point scleral fixation group in the horizontal and vertical directions were greater than those in the other two groups (all P < 0.01).

Conclusion

All three IOL repositioning techniques resulted in favorable ocular prognosis.
Impact of an outdoor loose parts play intervention on Nova Scotian preschoolers’ physical literacy: a mixed-methods randomized controlled trial
Authors: Caldwell Hilary A. T. , Spencer Rebecca A. , Joshi Nila , Branje Karina , Cawley Jane , Hobson Heather , Kirk Sara F. L. , Stevens Daniel , Stone Michelle R.
Published: June 2023

Background

Physical activity participation among preschoolers in childcare settings are low, and interventions to increase physical activity levels have produced mixed results. The Physical Literacy in the Early Years (PLEY) project implemented a six-month childcare-based outdoor loose parts play intervention in childcare centres in Nova Scotia, Canada. The purpose of this study was to examine the impact of the PLEY project on the development of domains of physical literacy (physical activity, physical competence, confidence and motivation, knowledge and understanding) in preschoolers attending childcare centres using mixed-methods.

Methods

Preschoolers (3–5 years) were recruited from 19 childcare centres in Nova Scotia and centres were randomized (parallel design) to the outdoor loose parts play intervention group (n = 11) or control (n = 8) group for 6 months. Participants, early childhood educators, and assessors were not blinded to group assignment. Quantitative and qualitative measures were used to comprehensively assess the impact of the PLEY project on all domains of physical literacy. At 3- and 6-months, early childhood educators participated in focus groups to assess how the intervention supported the development of 4 physical literacy domains: physical activity, physical competence, confidence and motivation, and knowledge and understanding. Physical activity and physical competence were also assessed with accelerometry and the Test of Gross Motor Development-3, respectively.

Results

Two hundred and nine preschoolers participated in the study (intervention group: n = 115; control group: n = 94). Accelerometer data showed that while baseline physical activity was similar between groups, children in the intervention group had higher physical activity at 3- (F(1,187) = 8.30, p = 0.004) and 6-months (F(1,187) = 9.90, p = 0.002) post-intervention. There was no intervention effect on physical competence scores. Thematic analysis of focus group data revealed that outdoor loose parts play contributed to development in all 4 physical literacy domains, including increased movement repertoires, social development, and enjoyment of physical activity. No adverse events or side effects of the intervention were reported.

Conclusions

Participation in the PLEY project was associated with increased development of various domains of physical literacy and perceived physical literacy among preschoolers, and outdoor loose parts play may be encouraged as an effective strategy to increase physical literacy in early learning settings.

Trial registration

Biomed Central (ISRCTN14058106), 20/10/2017.
Disjuncture between self-perceived and clinically assessed risk of HIV among gay, bisexual, and other men who have sex with men in Ontario and British Columbia, Canada
Authors: Pico-Espinosa Oscar Javier , Hull Mark , Gaspar Mark , Lachowsky Nathan , Grace Daniel , Truong Robinson , Mohammed Saira , MacPherson Paul , Woodward Kevin , Tan Darrell H. S.
Published: June 2023

Background

Self-perceived and clinically assessed HIV risk do not always align. We compared self-perceived and clinically assessed risk of HIV and the reasons for self-perceived low risk of HIV among gay, bisexual, and other men who have sex with men (GBM) from large urban centers in Ontario and British Columbia, Canada.

Methods

Never PrEP users recruited from sexual health clinics or online, completed a cross-sectional survey between July/2019 and August/2020. We contrasted self-perceived HIV risk against criteria from the Canadian PrEP guidelines and participants were categorized as concordant or discordant. We used content analysis to categorize participants’ free-text explanations for perceived low HIV risk. These were compared with answers to quantitative responses about condomless sex acts and number of partners.

Results

Of 315 GBM who self-perceived low risk of HIV, 146 (46%) were considered at high risk according to the guidelines. Participants with discordant assessment were younger, had less years of formal education, were more often in an open relationship and were more likely to self-identify as gay. Reasons for self-perceived low HIV risk in the discordant group were condom use (27%), being in a committed relationship/having one main partner (15%), having no or infrequent anal sex (12%) and having few partners (10%).

Conclusions

There is a disjuncture between self-perceived and clinically assessed risk of HIV. Some GBM may underestimate their HIV risk and clinical criteria may overestimate risk. Bridging these gaps requires efforts to increase HIV risk awareness in the community, and refinement of clinical assessments based on individualized discussions between the provider and the user.
Arabic version of the intermittent and constant osteoarthritis pain questionnaire (ICOAP-Ar): translation, cross-cultural adaptation, and measurement properties
Authors: Farrag Ahmed , Elsayed Walaa , Saleh Doaa Al , Hefny Ahmed , Shaheen Afaf
Published: June 2023

Background

Pain is the most incapacitating symptom of knee osteoarthritis (OA), with intermittent and/or continuous nature as described by the patients. Accuracy of pain assessment tools across different cultures is important. This study aimed to translate and culturally adapt the Intermittent and Constant OsteoArthritis Pain (ICOAP) measure into Arabic (ICOAP-Ar) and evaluate its psychometric properties in patients with knee OA.

Methods

The ICOAP was cross-culturally adapted following the recommended guidelines from English. Knee OA patients from outpatient clinics were recruited to assess the structural (confirmatory factor analysis) and construct validity (Spearman’s correlation coefficient - rho) to assess the relationship between the ICOAP-Ar and the pain and symptoms subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS), in addition to internal consistency (Cronbach’s alpha and the corrected item-total correlation). A week later, test-retest reliability (intraclass correlation coefficient (ICC)) was evaluated. Following four weeks of physical therapy treatment, the ICOAP-Ar responsiveness was evaluated using the receiver operating characteristic curve.

Results

Ninety-seven participants were recruited (age = 52.97 ± 9.9). A model with single pain construct showed acceptable fit (Comparative fit index = 0.92). The ICOAP-Ar total and subscales had a strong to moderate negative correlation with the KOOS pain and symptoms domains, respectively. The ICOAP-Ar total and subscales demonstrated satisfactory internal consistency (α = 0.86–0.93). The ICCs were excellent (ICCs = 0.89–0.92) with acceptable corrected item total correlations (rho = 0.53–0.87) for the ICOAP-Ar items. The ICOAP-Ar responsiveness was good with moderate effect size (ES = 0.51–0.65) and large standardized response mean (SRM = 0.86–0.99). A cut-off point of 51.1/100 was determined with moderate accuracy (Area under the curve = 0.81, sensitivity = 85%, specificity = 71%). No floor or ceiling effects were found.

Conclusions

The ICOAP-Ar exhibited good validity, reliability, and responsiveness after physical therapy treatment for knee OA, which renders it reliable for evaluating knee OA pain in clinical and research settings.
Experiences of pain debut and healthcare received in men with chronic pelvic pain syndrome
Authors: Zarur Shirin , Danielsson Louise
Published: June 2023

Background

Chronic Pelvic Pain Syndrome (CPPS) is the occurrence of chronic pelvic pain when there is no proven infection or other obvious local pathology that may account for the pain. It is often associated with negative cognitive, behavioural, sexual or emotional consequences, as well as with symptoms of lower urinary tract, sexual or bowel dysfunction. As there is a close link between psychosocial factors and the development of myofascial pain syndromes it is important for healthcare professionals to have knowledge of how the pain begins and the activities at the debut of the symptoms.

Aim

The aim of the study was to explore men’s experiences of the process leading to CPPS and healthcare received.

Methods

Information was obtained from semi-structured video interviews with 14 men with CPPS. Interviews were audio-recorded and transcribed. The text was then abstracted into codes and analysed with inductive content analysis.

Results

The age of the informants ranged between 22 and 73 (median 48), and the duration with CPPS ranged from 1 to 46 years. Two themes emerged, one with the heading Struggling to pin it down with four subthemes and The helpful and unhelpful healthcare with two subthemes. The four subthemes show that the informants experienced difficulties in their lives in the months before the debut of symptoms, for some it was several years. They had specific triggers for the onset of pain. These included cold, trauma to the perineum, chlamydia infection and possibly secondary to a symptomatic urethral stricture. Confusion and frustration were an important element in the informants’ overall experience of CPPS. Healthcare varied widely. The two subthemes about healthcare show expressions of being overlooked or wasting the doctor’s time, but also the experience of being validated and being thoroughly examined.

Conclusion

The informants in our study described clear and specific triggers for CPPS such as being cold, having digestive issues and trauma to the perineum. Stressful events seemed to have a big impact on these informants and very possibly affected the start of symptoms. This information should be helpful healthcare professionals to understand the patient and his needs.
The clinical effect evaluation of multidisciplinary collaborative team combined with palliative care model in patients with terminal cancer: a randomised controlled study
Authors: Liu Yu-Jing , Wu Li-Ping , Wang Hong , Han Qing , Wang Shu-Na , Zhang Jing
Published: June 2023

Objective

To evaluate the clinical effect of a multidisciplinary collaboration team combined with a palliative care model in patients with terminal cancer.

Method

A total of 84 patients diagnosed with terminal cancer in our hospital were included and randomly divided into an intervention group and a control group, with 42 cases in each group. Patients in the intervention group were treated by a multidisciplinary collaborative team combined with the palliative care model, and patients in the control group were treated by routine nursing intervention. The Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS) were used to evaluate negative emotions and anxiety and depression of patients before and after intervention. The Quality of Life Scale (European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30) and Social Support Scale (SSRS) were used to evaluate the quality of life and social support of patients. This study has been registered in 13/01/2023 (ClinicalTrials.gov Identifier: NCT05683236).

Result

The general data of the two groups were comparable. After intervention, the SAS (43.7 ± 7.4 vs. 54.2 ± 9.3) and SDS scores (38.4 ± 6.5 vs. 53.1 ± 8.4) of the intervention group were significantly lower than those of the control group. The total SSRS score, subjective support score, objective support score and utilisation of support of the intervention group were significantly higher than those of the control group (P < 0.05). The overall quality of life score of the intervention group was higher than that of the control group, and the difference was statistically significant (79.5 ± 4.5 vs. 73.2 ± 3.6, P < 0.05). The scores of each functional scale were significantly higher than those of the control group (P < 0.05).

Conclusion

Compared with conventional nursing, the application of the multidisciplinary collaborative team combined with tranquilisation therapy in patients with terminal cancer can significantly reduce the anxiety and depression of patients, enable patients to obtain comprehensive social support, and effectively improve the quality of life of patients.

Trial registration

ClinicalTrials.gov Identifier NCT05683236, 13/01/2023, Retrospectively registered.
Development and usability evaluation of a mHealth application for albinism self-management
Authors: Mortezaei Saman , Rabiei Reza , Asadi Farkhondeh , Emami Hassan
Published: June 2023

Background

Reduced or absence of melanin poses physical, social, and psychological challenges to individuals with albinism. Mobile health (mHealth) applications have the potential to improve the accessibility of information and services while reducing time and costs. This study aimed to develop and evaluate a mHealth application for self-management of albinism.

Methods

This applied study was conducted in two stages (development and evaluation) in 2022. Initially, the functional requirements were determined, and the conceptual model of the application was then developed using Microsoft Visio 2021. In the second phase, the application was evaluated using the Mobile Application Usability Questionnaire (MAUQ) involving patients with albinism to reflect their views on the usability of the application.

Results

The key capabilities of the application included: reminders, alerts, educational content, useful links, storage and exchange of images of skin lesions, specialist finder, and notifications for albinism-relevant events. Twenty-one users with albinism participated in the usability testing of the application. The users were predominantly satisfied with the application (5.53 ± 1.10; Max: 7.00).

Conclusions

The findings of this study suggest that the developed mobile application could assist individuals with albinism to effectively manage their condition by considering the users’ requirements and services that the application should deliver.
Tannic acid-functionalized 3D porous nanofiber sponge for antibiotic-free wound healing with enhanced hemostasis, antibacterial, and antioxidant properties
Authors: Huang Zihang , Wang Donghui , Sønderskov Steffan Møller , Xia Dan , Wu Xiaotong , Liang Chunyong , Dong Mingdong
Published: June 2023

Developing an antibiotic-free wound dressing with effective hemostasis and antibacterial and antioxidant capacity is highly desirable. In this work, a three-dimensional (3D) chitosan/polyvinyl alcohol-tannic acid porous nanofiber sponge (3D-TA) was prepared via electrospinning. Compared with two-dimensional (2D) fiber membrane, the unique fluffy 3D-TA nanofiber sponge had high porosity, water absorption and retention ability, hemostatic capacity. Furthermore, the 3D sponge functionalized by tannic acid (TA) endow the sponge with high antibacterial and antioxidant capacity without loading antibiotics. In addition, 3D-TA composite sponges have shown highly biocompatibility against L929 cells. The in vivo experiment shows the 3D-TA is enable to accelerate wound healing. This newly 3D-TA sponges hold great potential as wound dressings for future clinical application.
‘The objective was about not blaming one another’: a qualitative study to explore how collaboration is experienced within quality improvement collaboratives in Ethiopia
Authors: Hill Zelee , Keraga Dorka , Kiflie Alemayehu Abiyou , Schellenberg Joanna , Magge Hema , Estifanos Abiy
Published: June 2023

Background

Quality improvement collaboratives are a common approach to improving quality of care. They rely on collaboration across and within health facilities to enable and accelerate quality improvement. Originating in high-income settings, little is known about how collaboration transfers to low-income settings, despite the widespread use of these collaboratives.

Method

We explored collaboration within quality improvement collaboratives in Ethiopia through 42 in-depth interviews with staff of two hospitals and four health centers and three with quality improvement mentors. Data were analysed thematically using a deductive and inductive approach.

Results

There was collaboration at learning sessions though experience sharing, co-learning and peer pressure. Respondents were used to a blaming environment, which they contrasted to the open and non-blaming environment at the learning sessions. Respondents formed new relationships that led to across facility practical support. Within facilities, those in the quality improvement team continued to collaborate through the plan-do-study-act cycles, although this required high engagement and support from mentors. Few staff were able to attend learning sessions and within facility transfer of quality improvement knowledge was rare. This affected broader participation and led to some resentment and resistance. Improved teamwork skills and behaviors occurred at individual rather than facility or systems level, with implications for sustainability. Challenges to collaboration included unequal participation, lack of knowledge transfer, high workloads, staff turnover and a culture of dependency.

Conclusion

We conclude that collaboration can occur and is valued within a traditionally hierarchical system, but may require explicit support at learning sessions and by mentors. More emphasis is needed on ensuring quality improvement knowledge transfer, buy-in and system level change. This could include a modified collaborative design to provide facility-level support for spread.
Transient plasma viral rebound after SARS-CoV-2 vaccination in an exceptional HIV-1 elite controller woman
Authors: Di Girolamo L. , Ferrara M. , Trevisan G. , Longo B. M. , Allice T. , Burdino E. , Alladio F. , Fantino S. , Di Perri G. , Calcagno A. , Bonora S.
Published: June 2023

Background

Elite controllers are able to control viral replication without antiretroviral therapy. Exceptional elite controllers do not show disease progression for more than 25 years. Different mechanisms have been proposed and several elements of both innate and adaptive immunity are implicated. Vaccines are immune stimulating agents that can promote HIV-RNA transcription; transient plasma HIV-RNA detectability has been described within 7–14 days after different vaccinations. The most reliable mechanism involved in virosuppressed people living with HIV is a generalized inflammatory response that activates bystander cells harboring latent HIV. So far no data about viral load increase in elite controllers after SARS-CoV-2 vaccination are reported in literature.

Case presentation

We report the case of a 65-year-old woman of European ancestry, diagnosed with HIV-1/HCV co-infection more than 25 years ago. Since then, HIV-RNA remained undetectable and she never received ARV therapy. In 2021 she was vaccinated with mRNA-BNT162b2 vaccine (Pfizer-BioNTech®). She was administered with three doses in June, July and October 2021, respectively. The last available viral load was undetectable in March 2021. We observed an increase of VL at 32 cp/ml and 124 cp/mL, two and seven months after the second vaccine dose, respectively. During monthly follow-up, HIV-RNA gradually and spontaneously dropped becoming undetectable without ARV intervention. COVID-19 serology was positive with IgG 535 BAU/mL, showing response to vaccination. We measured total HIV-DNA at different time-points and we found it detectable both at the time of the higher plasma HIV-RNA (30 cp/10^6 PBMCs) and when it was undetectable (13 cp/10^6 PBMCs), in reduction.

Conclusions

This case is the first report, to our knowledge, describing a rebound of plasma HIV-RNA in an elite controller after three doses of mRNA-BNT162b2 vaccine for SARS-CoV-2. Concomitantly with a spontaneous reduction of plasma HIV-RNA ten months after the third dose of mRNA-BNT162b2 vaccine (Pfizer-BioNTech®) without antiretroviral therapy intervention, we observed a reduction of total HIV-DNA in peripheral mononuclear cells. The potential role of vaccinations in altering HIV reservoir, even in elite controllers when plasma HIV-RNA is undetectable, could be a valuable aspect to take into account for the future HIV eradication interventions.
Unconventional surgery for thoracic esophageal rupture with empyema and mediastinitis: a case report and literature review
Authors: Deng Yong-jun , Liu Huan-peng , Zou Jian-bin
Published: June 2023

Treatment of esophageal perforation or rupture is complicated and controversial, especially in advanced cases. In fact, it is generally accepted that this disease must be treated individually according to the location, causes and clinical features of rupture or perforation. A very rare case was admitted to our department, who was injured 5 days ago by high-pressure gas of a running air compressor and resulted in a long-term longitudinal rupture of the thoracic esophagus. Although the patient suffered from empyema and mediastinitis at the same time, and his condition was very serious, the debridement and desquamation of empyema were still implemented, followed by left thoracic esophagectomy and left neck approach esophagogastrostomy in the same period successfully. The patient got a good result finally.
Granulomatous inflammation mimicking a hematoma around the replaced ascending aorta in magnetic resonance imaging: a case report
Authors: Lee June , Lim Hyun Ah , Hong Seok Beom , Kim Do Yeon , Kim Yong Han , Kim Hwan Wook
Published: June 2023

Background

Granulomatous inflammation results from various causes including infections and allergic reactions. It can appear as high signal intensity in T2-weighted or contrast-enhanced T1-weighted magnetic resonance imaging (MRI). Here, we describe a case of granulomatous inflammation looking like a hematoma on an ascending aortic graft in MRI.

Case presentation

A 75-year-old female was undergoing assessment for chest pain. She had a history of hemi-arch replacement for aortic dissection 10 years earlier. The initial chest computed tomography and subsequent chest MRI were suggestive of a hematoma, implying a pseudoaneurysm of the thoracic aorta, which is associated with high mortality in reoperation. Through redo median sternotomy, severe adhesion was found in the retrosternal space. A sac in the pericardial space contained yellowish and pus-like material, confirming that there was no hematoma around the ascending aortic graft. The pathologic finding was chronic necrotizing granulomatous inflammation. Microbiological tests including polymerase chain reaction analysis were negative.

Conclusion

Our experience indicates that an MRI finding of a hematoma at the site long after cardiovascular surgery suggests that there may be granulomatous inflammation.
Estrogen receptor blockade and radiation therapy cooperate to enhance the response of immunologically cold ER+ breast cancer to immunotherapy
Authors: O’Leary Kathleen A. , Bates Amber M. , Jin Won Jong , Burkel Brian M. , Sriramaneni Raghava N. , Emma Sarah E. , Nystuen Erin J. , Sumiec Elizabeth G. , Ponik Suzanne M. , Morris Zachary S. , Schuler Linda A.
Published: June 2023

Background

Most patients with estrogen receptor positive (ER+) breast cancer do not respond to immune checkpoint inhibition (ICI); the tumor microenvironment (TME) of these cancers is generally immunosuppressive and contains few tumor-infiltrating lymphocytes. Radiation therapy (RT) can increase tumor inflammation and infiltration by lymphocytes but does not improve responses to ICIs in these patients. This may result, in part, from additional effects of RT that suppress anti-tumor immunity, including increased tumor infiltration by myeloid-derived suppressor cells and regulatory T cells. We hypothesized that anti-estrogens, which are a standard of care for ER+ breast cancer, may ameliorate these detrimental effects of RT by reducing the recruitment/ activation of suppressive immune populations in the radiated TME, increasing anti-tumor immunity and responsiveness to ICIs.

Methods

To interrogate the effect of the selective estrogen receptor downregulator, fulvestrant, on the irradiated TME in the absence of confounding growth inhibition by fulvestrant on tumor cells, we used the TC11 murine model of anti-estrogen resistant ER+ breast cancer. Tumors were orthotopically transplanted into immunocompetent syngeneic mice. Once tumors were established, we initiated treatment with fulvestrant or vehicle, followed by external beam RT one week later. We examined the number and activity of tumor infiltrating immune cells using flow cytometry, microscopy, transcript levels, and cytokine profiles. We tested whether fulvestrant improved tumor response and animal survival when added to the combination of RT and ICI.

Results

Despite resistance of TC11 tumors to anti-estrogen therapy alone, fulvestrant slowed tumor regrowth following RT, and significantly altered multiple immune populations in the irradiated TME. Fulvestrant reduced the influx of Ly6C+Ly6G+ cells, increased markers of pro-inflammatory myeloid cells and activated T cells, and augmented the ratio of CD8+: FOXP3+ T cells. In contrast to the minimal effects of ICIs when co-treated with either fulvestrant or RT alone, combinatorial treatment with fulvestrant, RT and ICIs significantly reduced tumor growth and prolonged survival.

Conclusions

A combination of RT and fulvestrant can overcome the immunosuppressive TME in a preclinical model of ER+ breast cancer, enhancing the anti-tumor response and increasing the response to ICIs, even when growth of tumor cells is no longer estrogen sensitive.
Ti3C2 (MXene) nanosheets disrupt spermatogenesis in male mice mediated by the ATM/p53 signaling pathway
Authors: Wei Yang , Bao Ruilin , Hu Le , Geng Yanqing , Chen Xuemei , Wen Yixian , Wang Yingxiong , Qin Mao , Zhang Yue , Liu Xueqing
Published: June 2023

Background

Two-dimensional ultrathin Ti3C2 nanosheets are increasingly being used in biomedical applications owing to their special physicochemical properties. But, the biological effects of its exposure on the reproductive system is still unclear. This study evaluated the reproductive toxicity of Ti3C2 nanosheets in the testes.

Results

Ti3C2 nanosheets at doses of 2.5 mg/kg bw and 5 mg/kg bw in mice caused defects in spermatogenic function, and we also clarified an underlying molecular mechanism of it in vivo and in vitro model. Ti3C2 nanosheets induced an increase of reactive oxygen species (ROS) in testicular and GC-1 cells, which in turn led to the imbalance in oxidative and antioxidant systems (also known as oxidative stress). Additionally, oxidative stress often induces cellular DNA strand damages via the oxidative DNA damages, which triggered cell cycle arrest in the G1/G0 phase, leading to cell proliferation inhibition and irreversible apoptosis. ATM/p53 signaling manifest key role in DNA damage repair (DDR), and we demonstrate that ATM/p53 signaling was activated, and mediated the toxic damage process caused by Ti3C2 nanosheet exposure.

Conclusion

Ti3C2 nanosheet-induced disruption of proliferation and apoptosis of spermatogonia perturbed normal spermatogenic function that was mediated by ATM/p53 signaling pathway. Our findings shed more light on the mechanisms of male reproductive toxicity induced by Ti3C2 nanosheets.

Graphical abstract
Comparing position sense and isokinetic strength of the muscles of elbow joint between aikidokas and non-athlete people
Authors: Mirsalari Rezvan , Kordi Yoosefinejad Amin , Yazdani Farzaneh , Haghighat Farzaneh , Amiripanah Ali Asghar , Parandavarfard Saeid
Published: June 2023

Background

Aikido is a martial art comprises of locking techniques and falls. During the locking techniques, the elbow joint is forced into extended position. Moreover, the elbow hits the ground during the falling techniques. These might compromise joint position sense (JPS). The objectives of this study were to compare JPS and strength of the muscles of elbow joint between Aikidokas and a non-athlete group and to evaluate the correlation between JPS and muscle strength among Aikidokas.

Methods

All male Jiyushinkai style Aikidokas and a healthy matched non-athlete group participated in this cross-sectional study. Passive JPS at a speed of 4°/s and the isokinetic strength of elbow flexors and extensors were assessed.

Results

Evaluating the isokinetic parameters revealed no significantly difference between the groups in either flexion or extension at speeds of 60 (P-value range: 0.2–0.99) and 120 °/s (P-value range: 0.05–0.96). Also, the groups had no significant difference regarding different types of reconstruction error including constant error (P-value range: 0.38–0.91), variable error (P-value range: 0.09–0.87), and total variability (P-value range: 0.30–0.80). Moreover, very weak to weak correlation was observed between isokinetic parameters and passive JPS (r-value range: 0.01–0.39).

Conclusions

JPS was not impaired in Aikidokas in spite of the repetitive stress applied to the elbow joint during the performance of Aikido techniques. The lack of significant difference in isokinetic between Aikidokas and healthy non-athletes, and the absence of an acceptable correlation between IPS and muscle strength in Aikidokas, might be attributed to the soft nature of Aikido.
The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy
Authors: Jean Baptiste Anne Eudes , Van der Schans Jurjen , Bawa Samuel , Masresha Balcha , Wagai John , Oteri Joseph , Dieng Boubacar , Soyemi Margaret , Eshuchi Rufus , Yehualashet Yared G. , Afolabi Oluwole , Braka Fiona , Bita André , Hak Eelko
Published: June 2023

Background

Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of “non-selective” measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign.

Methods

We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs.

Results

The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs.

Conclusions

Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.
Effect of long-term application of bioorganic fertilizer on the soil property and bacteria in rice paddy
Authors: Li Zu-ren , Luo Si-quan , Peng Ya-jun , Jin Chen-zhong , Liu Du-cai
Published: June 2023

The application of novel bioorganic fertilizer (BIO) has been established as a weed biocontrol strategy, and reduce herbicides pollution and negatively effects on agricultural ecosystems. However, its long-term influences on soil bacterial communities are unknown. Here, 16 S rRNA sequencing to identify the changes that occur in soil bacterial community and enzyme under BIO treatments after five years in a field experiment. BIO application effectively controlled weeds, however no obvious differences between treatments were observed under BIO-50, BIO-100, BIO-200 and BIO-400 treatment. Anaeromyxobacter and Clostridium_ sensu_ stricto_1 were the two dominant genera among BIO-treated soil samples. The BIO-800 treatment had a slight influence on the species diversity index, which was more remarkable after five years. The seven significantly-different genera between BIO-800 treatment and untreated soils included C._sensu_stricto_1, Syntrophorhabdus, Candidatus_Koribacter, Rhodanobacter, Bryobacter, Haliangium, Anaeromyxobacter. In addition, BIO application had different effects on soil enzymatic activities and chemical properties. The extractable P and pH saliency correlated with Haliangium and C._Koribacter, and C._sensu_stricto_1 observably correlated with exchangeable K, hydrolytic N and organic matter. Taken together, our data suggest that BIO application effectively controlled weeds and a slight influence on soil bacterial communities and enzymes. These findings expand our knowledge of the application of BIO as widely used as a sustainable weed control in rice paddy.