bluuebunny/crossref_metadata_2025 huggingface dataset:
USE of IMplanting the Biotronik PassEo-18 Lux drug coated balloon to treat failing haemodialysis arteRiovenous FIstulas and grafts (SEMPER FI Study)
Authors: Ho Tze Gek , Tang Tjun Yip , Yap Charyl Jia Qi , Yap Hao Yun , Chan Shaun Wen Yang , Leong Chuo Ren , Chan Dexter Yak Seng
Published: November 2023

Background:

Plain old balloon angioplasty has been the mainstay of treatment for arteriovenous fistula (AVF) stenoses. Recent studies suggest that drug coated balloons (DCB) may significantly reduce re-intervention rates on native and recurrent lesions. The Passeo-18 Lux DCB (Biotronik AG, Buelach, Switzerland) is packaged with a 3.0 µg/mm2 dose of paclitaxel. The hypothesis is that its use provides better target lesion primary patency (TLPP), primary assisted patency (PP), secondary patency (SP) rates and reduces the number of visits for re-intervention in a cohort of patients with stenotic AVF and arteriovenous grafts (AVGs).

Methods:

The USE of IMplanting the Biotronik PassEo-18 Lux DCB to treat failing haemodialysis arteRiovenous FIstulas and grafts trial (SEMPER FI) was a prospective double-centre, multi-investigator, non-consecutive, non-blinded single-arm study investigating the efficacy and safety of the Passeo-18 Lux DCB in patients with stenotic AVF/AVG lesions between January 2021 and January 2022. Patient demographics, clinical characteristics, vascular access history, operative indications, details and outcomes were collected prospectively. TLPP, circuit access primary patency (CAP), PP, SP and deaths 6- and 12-months post-intervention were studied.

Results:

Ninety-one patients with 110 lesions were recruited across the two centres. 62.6% ( n = 57) were male with a median age of 63.5 years (SD = 10.5). 62.6% ( n = 57) were taking anti-platelets. Eighty-five AVFs and six AVGs were treated. 60% ( n = 54) of AVFs intervened were radiocephalic. 52.7% ( n = 58) of targeted lesions were juxta-anastomotic stenosis (JAS) and one-third ( n = 33) at the AVF/AVG outflow. 70.9% ( n = 78) of lesions were recurrent. Median time from last intervention was 219 days. 78% of target lesions ( n = 85) and circuits ( n = 70) were patent at 6-months, of which 96.7% ( n = 87) of those requiring assisted intervention were patent.

Conclusion:

This study shows that the Passeo-18 Lux DCB can be an effective and safe tool in the treatment of failing haemodialysis AVFs/AVGs.
How do adolescents experience a newly developed Online Single Session Sleep Intervention? A Think-Aloud Study
Authors: Maity Ananya , Wang Angela W , Dreier Melissa J , Wallace Vuokko , Orchard Faith , Schleider Jessica L , Loades Maria E , Hamilton Jessica L
Published: November 2023

Background

Sleep problems are common in adolescents and have detrimental impacts on physical and mental health and daily functioning. Evidence-based treatment like cognitive behaviour therapy for insomnia (CBT-I) is often hard to access, and adolescents may not engage in and adhere to longer, clinician-delivered interventions. Brief, self-guided, and accessible sleep interventions are needed.

Objective

To explore the user experience of a prototype online self-help single session sleep intervention developed for adolescents.

Methods

Eleven participants aged 17–19 years (8 females, 3 males) took part in online retrospective think-aloud interviews. Participants first completed the prototype intervention independently and were then shown the intervention page by page and asked to verbalise their thoughts and experiences. Transcripts were analyzed thematically.

Results

Participants found the intervention helpful. Four themes were generated - ‘Educative: Learning, but more fun’, ‘Effortless: Quicker and Easier’, ‘Personalization: Power of Choice’, and ‘Positivity: Just Good Vibes’. The theme ‘Educative: Learning, but more fun’ encompassed two sub-themes ‘Opportunity to Learn’ and ‘Aesthetics and Learning’. These themes reflected participants’ views that the intervention was educative, personalised, solution-oriented and easy to use, but could incorporate more graphics and visuals to aid in learning and could be made more effortless and positive through modifications to its design.

Conclusions

Findings convey the importance of ensuring educative well-designed content, personalization, a positive tone, and ease of use while designing interventions targeting adolescents’s sleep and mental health. They also indicate areas for further developing the intervention.
Between Breaking Bad and Big Brother: Social Class and Television Preferences in Croatia
Authors: Krolo Krešimir , Tonković Željka , Vozab Dina
Published: November 2023

This article addresses TV preferences as a marker of class divisions both as a type of embodied cultural capital and as a pattern of consumption within the local and global cultural structure in Croatia. Data analysis is extracted from the survey ‘Social Stratification in Croatia: Structural and Subjective Aspects’, conducted on a nationally probabilistic sample of adult Croatian citizens. Factor analysis discovered two main dimensions of television preferences: reality spectacle and foreign fiction preferences, which were recognised as indicators of localised and globalised culture preferences. Further analysis established that these factors are also structured along the class positions of the respondents. Using multiple regression analysis, data suggest the conclusion that the working class prefers TV content in the domestic language and heavy on popular entertainment programming (soap operas, talent, and reality shows). However, the dominant class repudiate ‘lowbrow’ TV content, which highlights class divisions in the cultural field. The analysis sheds light not only on how class positions structure these preferences but also on the important role of age, gender, and music taste play in the formation of television preferences.
When growth is not enough: Do government transfers moderate the effect of economic growth on absolute and relative child poverty?
Authors: Sirén Sebastian
Published: November 2023

Economic growth is commonly seen as the main driver of poverty reduction in a global perspective, but its impact varies substantially across cases. Meanwhile, the literature has been relatively silent regarding the role of social policy in explaining this variation. In light of an emerging attention to redistribution and social protection in promoting inclusive growth, this article analyses how government cash transfer systems moderate the effect of economic growth on both relative and absolute child poverty across low- and middle-income countries. The empirical analyses compare trends within 16 countries, using data from the Luxembourg Income Study (LIS), by means of descriptive analyses and multivariate regression techniques. Findings show that both economic growth and the expansion of government transfer schemes were associated with falling absolute child poverty rates. While the association between growth and relative child poverty was on average more muted, the analyses found growth to be related to reductions in relative child poverty when combined with sufficiently extensive government transfers, while the opposite effect was found in the face of inadequate levels of transfers. The study provides a framework for studying interrelated effects of national institutions and economic processes, with the findings highlighting the fruitfulness of including indicators on social protection policies when inquiring about enabling conditions for inclusive growth in a development context.
Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review
Authors: Goldin Evans Melissa , Gee Rebekah E. , Phillippi Stephen , Sothern Melinda , Theall Katherine P. , Wightkin Joan
Published: November 2023

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.
Hippocrates: A Pioneer in Orthopaedics and Traumatology
Authors: Koutserimpas Christos , Naoum Symeon , Piagkou Maria , Alpantaki Kalliopi , Samonis George
Published: November 2023

Purpose

Hippocrates, the ancient Greek physician, is considered the father of Medicine; however, his contributions to Orthopaedics and Traumatology have not been highlighted enough. The present historical review represents an effort to present and categorize his work, in this field, per clinical disorder and anatomical region.

Methods

The “Hippocratic Corpus” original text was thoroughly studied to identify all Hippocrates’ contributions in Orthopaedics and Traumatology. Volume III of his works, especially “On Fractures”, “On Joints”, and “Mochlicon” includes a plethora of information regarding the management of traumas, as well as other disorders and clinical entities of the musculoskeletal system.

Results

In particular, Hippocrates describes reduction techniques for fractures, as well as joint dislocations, elaborates on the biology of the fractures’ healing process and the basic principles of fracture management and fixation, presents the signs and symptoms of gangrene, teaches the treatment of osseous infections and offers valuable insight on the biomechanics and treatment of spinal diseases.

Conclusions

Hippocrates’ contributions in Orthopaedics and Traumatology are unprecedented, making him a true pioneer in this field, while the basic principles that he presented were further studied and confirmed in the 19th and 20th centuries.
Experiment on the impact response of aluminum alloy wood core sandwich composites
Authors: Li Shusen , Zhang Yan
Published: November 2023

In this work, a protective structure with 2A12T4 aluminum alloy as the panel material and plywood as the core layer was designed. Penetration experiments were performed by firing multiple projectiles from a light gas gun. The impact behavior, damage mode, absorbed energy, and residual strength of the interlayer after impact were studied. The dynamic response and the failure of the interlayer were analyzed. Disbonding, fiber fracture, buckling, shear, and core fracture between the metal layer and the composite layer of the front panel were observed. The impact resistance of the sandwich plate was also studied. Based on the results of the experiments and numerical simulations, failure determination of the plywood core layer was achieved using the Hashin criterion, and a finite element model was established using ABAQUS software. High-speed impact testing was performed with a Hopkinson pressure bar. The stress–strain relationship under a high dynamic strain rate is given here, and the energy absorption efficiency under loading in different directions was analyzed. Finite element analysis of the representative volume elements in the wood microstructure was also carried out. The results reported here can be used to guide optimal design of sandwich structures suitable for use under high-speed impact conditions.
Management of complex thoracic aortic diseases with aberrant right subclavian artery
Authors: Akbulut Mustafa , Celik Ekin C , Ak Adnan , Arslan Özgür , Çekmecelioğlu Davut , Şişmanoğlu Mesut , Tunçer Mehmet A
Published: November 2023

Background

We retrospectively evaluated early and intermediate outcomes of hybrid repair of complex thoracic aortic diseases involving an aberrant right subclavian artery. This paper aims to report features and available treatment options for this rare, hard-to-diagnose, and manage, aorta-related vascular condition.

Methods

Between January 2012 and May 2019, 13 patients (mean age, 60.1 ± 9.3 years; nine men) underwent complex thoracic aorta repair surgery. Six patients had a thoracic aortic aneurysm, two had type A aortic dissection, and five had complicated type B aortic dissection. Hybrid repair strategies included de-branching in combination with single-stage aortic arch replacement with the frozen elephant trunk technique performed in four patients, thoracic endovascular aortic repair in six patients, and 2-stage hybrid repair consisting of a total arch replacement with a conventional/frozen elephant trunk (first stage) and subsequent endovascular repair (second stage) in three patients.

Results

One early death occurred: a patient with acute type A aortic dissection, who underwent Bentall procedure and aortic arch replacement with the frozen elephant trunk technique, died in-hospital of multiorgan failure 41 days after the procedure. The remaining 12 patients were discharged in stable condition. The median follow-up duration was 36 months (2–71 months). Two late mortalities occurred: a patient with residual type A aortic dissection, who underwent arch replacement with the frozen elephant trunk technique, died of intracranial hemorrhage 3 months after the surgery. And 72 years old female patient died of acute exacerbation of chronic obstructive pulmonary disease 2 months after the surgery.

Conclusion

Our study indicates that various hybrid strategies can be used to treat complex thoracic aortic diseases involving an aberrant right subclavian artery. The approach of choice depends on the features of disease pathology, the aortic segments involved, and the operating surgeon's experience.
The relationship between rs968697 genetic polymorphism and gastric cancer susceptibility, TNM stage and survival prognosis
Authors: Hu Jun , Wang Xiaoting
Published: November 2023

Background

HMGA2 can promote the development of multiple malignancies. This study aimed to determine whether a putative functional genetic polymorphism (rs968697 T>C) in the HMGA2 gene promoter region was associated with malignancy susceptibility in the Chinese population.

Methods

The rs968697 genetic polymorphism was genotyped using the SNaPshot method in the case-control study. The odds ratios and 95% confidence intervals were calculated using a logistic regression model. STATA software was used to conduct the meta-analysis.

Results

The rs968697 genetic polymorphism was associated not only with susceptibility to malignant tumors [CC versus TT: OR = 0.45, 95%CI = 0.28–0.73, p = .001; CC versus (CT + TT): OR = 0.47, 95%CI = 0.29–0.75, p = .003] including gastric cancer (GC), but also with TNM stage and survival prognosis of GC patients. Genotype-tissue expression analysis, luciferase assay and bioinformatics analysis revealed that the rs968697 genetic polymorphism might affect the binding of transcription factors, especially POLR2A, which in turn regulate the expression of HMGA2.

Conclusions

The current research suggests that the rs968697 genetic polymorphism may be used as a biomarker for malignancy susceptibility and GC prognosis in the Chinese population.
Lung cancer is associated with acute ongoing cerebral ischemia: A population-based study
Authors: Naftali Jonathan , Barnea Rani , Eliahou Ruth , Pardo Keshet , Tolkovsky Assaf , Adi Meital , Hasminski Vadim , Saliba Walid , Bloch Sivan , Raphaeli Guy , Leader Avi , Auriel Eitan
Published: November 2023

Background and Objectives:

Cerebral microinfarcts (CMIs) are the most common type of brain ischemia; however, they are extremely rare in the general population. CMIs can be detected by magnetic resonance diffusion-weighted imaging (MRI-DWI) only for a very short period of approximately 2 weeks after their formation and are associated with an increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer (LC), which is strongly associated with ischemic stroke risk relative to other cancer types.

Methods:

We used the Clalit Health Services record (representing more than 5 million patients) to identify adults with LC and breast, pancreatic, or colon cancer (non-lung cancer, NLC) who underwent brain magnetic resonance diffusion (MRI) scan within 5 years following cancer diagnosis. All brain MRI scans were reviewed, and CMIs were documented, as well as cardiovascular risk factors.

Results:

Our cohort contained a total of 2056 MRI scans of LC patients and 1598 of NLC patients. A total of 143 CMI were found in 73/2056 (3.5%) MRI scans of LC group compared to a total of 29 CMI in 22/1598 (1.4%) MRI scans of NLC ( p < 0.01). Cancer type (e.g. LC vs NLC) was the only associated factor with CMI incidence on multivariate analysis. After calculating accumulated risk, we found an incidence of 2.5 CMI per year in LC patients and 0.5 in NLC.

Discussion:

CMIs are common findings in cancer patients, especially in LC patients and therefore might serve as a marker for occult brain ischemia, cognitive decline, and cancer-related stroke (CRS) risk.
Patient Care Gaps Prior to Maintenance Dialysis Initiation: A Population-Based Retrospective Study
Authors: Molnar Amber O. , Nash Danielle M. , Emblem Jennifer , Bota Sarah , McArthur Eric , Luo Bin , Liu Yaqing , Garg Amit X. , Blake Peter G. , Brimble K. Scott
Published: November 2023

Background:

Guidelines in Ontario, Canada, recommend timely referral for multidisciplinary kidney care to facilitate planned dialysis initiation. Many patients do not receive recommended multidisciplinary kidney care prior to dialysis.

Objective:

To better understand why this gap in pre-dialysis care exists, we conducted a study to describe the pathways by which patients initiate maintenance dialysis.

Design:

A retrospective cohort study.

Setting:

Population-based, using health care administrative databases from Ontario, Canada.

Patients:

Adults initiating maintenance dialysis from April 2016 to March 2019.

Measurements and methods:

Patients were grouped based on whether they received recommended multidisciplinary kidney care prior to dialysis initiation (at least 1 year of care with at least 2 visits). For those who did not receive recommended care, we grouped patients as having no identified care gap or into the following groups: (1) lack of timely chronic kidney disease (CKD) screening, (2) late nephrology referral (<1 year), or (3) late or no referral for multidisciplinary kidney care among patients followed by a nephrologist for at least 1 year.

Results:

A total of 9216 patients were included with a mean (standard deviation) age of 66 (15) years, and 61.5% were male. Of the total, 896 (9.7%) patients died, 7671 (83.2%) remained on dialysis at 90 days, and 649 (7.0%) had stopped dialysis due to kidney function recovery within 90 days. Of the 9216 patients, 5434 (59%) had not received recommended multidisciplinary kidney care. Among those without recommended care, there were 2251 (41.4%) patients with no identified care gaps, 1351 (24.9%) patients with a lack of timely CKD screening, 359 (6.6%) patients with late nephrology referral, and 1473 (27.1%) patients with late or no referral for multidisciplinary kidney care.

Limitations:

We could not determine if patients were referred but declined multidisciplinary kidney care.

Conclusions:

More than half of patients had not received recommended multidisciplinary kidney care. Many patients experienced an acute decline in kidney function, which may not be preventable, but in others, there were missed opportunities for CKD screening or early referral to nephrology, or at the level of nephrology practice for early referral for multidisciplinary care. This work could be used to inform policies aimed at improving increased uptake of multidisciplinary kidney care prior to dialysis.
Community Perceptions of Health Equity: A Qualitative Study
Authors: Salisu Margaret , Blackwell Tenya , Lewis Gwendolyn , Hoglund Mark W , DiVittis Anthony , Chahal Kunika , Samuels Chellandra , Boutin-Foster Carla , Montgomery Douglas , Afable Aimee
Published: November 2023

Introduction:

Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients’ experiences of care is paramount for reducing health inequities.

Methods:

In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn.

Results:

The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants’ interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive.

Conclusions:

Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare.
Behavioral Skills Training to Teach Self-Instruction of Video Activity Schedules for Vocational Skills
Authors: Spriggs Amy D. , Shepley Sally B. , Samudre Mark D. , Keene Hannah E. , O’Neill Kai , Hall Shealynn
Published: November 2023

This study evaluated the effects of behavior skills training (BST) as a means to acquire and generalize self-instruction behaviors using video activity schedules (VidAS) loaded on an iPod Touch for four U.S. high school students with intellectual disabilities. Behavior skills training procedures were implemented in two different vocational training environments and evaluated using a multiple probe across participants design. Following the mastery criterion in the training environments, the generalization of self-instruction behaviors to two different vocational training environments was assessed. All participants acquired self-instruction behaviors with BST instruction. However, only three of four participants independently generalized responding to two additional vocational environments. Results and directions for future research regarding training loosely and using multiple exemplars to program for generalization are discussed.
Understanding the Impact of Team Cognitive Load and Advice Compliance in Urban Search and Rescue Task
Authors: Willett Matthew M. , Demir Mustafa
Published: November 2023

This research concentrates on the impact of Artificial Social Intelligence (ASI)'s advice intervention text messages and the compliance of three human team members, who communicate via voice to carry out victim rescue operations, on the team's performance. This experiment takes place in a simulated Urban Search and Rescue (USAR) task environment built using Minecraft. The ASI agent, utilizing its analytical components designed around interactive real-time measurements, oversees the team's behavior in the USAR task environment. The agent discerns and forecasts the human team members' actions, offering interventions via text messages to foster and sustain team efficacy. The study examines (1) the influence of the team's cognitive load on message compliance from the advisor, and (2) how these elements collectively affect team performance. The results show a positive association between cognitive load, compliance, and enhanced task performance, despite the lack of a significant correlation between cognitive load and compliance.
Small-Gauge Vitrectomy for Macular Surgery Using a Systematic Approach to Wound Closure: 27-Gauge vs 25-Gauge
Authors: Christensen Cory A. , Thompson Ian A. , Nielsen Jared S.
Published: November 2023

Purpose: To evaluate the effectiveness of and to compare vitrectomy performed with 25-gauge or 27-gauge instrumentation for macular surgery by assessing the surgical duration, wound closure, and complication rate using a systematic approach to wound closure. Methods: In this retrospective chart review, 125 25-gauge and 125 27-gauge consecutive small-gauge vitrectomy surgeries for epiretinal membrane, macular hole, vitreomacular adhesion, or a combination were analyzed during and immediately after surgery. Wound closure was performed using a systematic protocol. Results: Baseline characteristics were not statistically different between the 2 groups. The surgical duration was similar with 25-gauge vitrectomy and 27-gauge vitrectomy ( P = .07). Although spontaneous wound closure was common in both groups, it was more common in the 27-gauge group ( P = .22). Intraoperative and postoperative complications were uncommon in both groups. Conclusions: Findings show that 27-gauge vitrectomy is a safe, effective alternative to the more commonly used 25-gauge vitrectomy for macular surgery. Less manipulation was required to achieve wound closure with 27-gauge vitrectomy using a standardized wound-closure protocol. Smaller 27-gauge vitrectomy did not increase surgical time or complications over 25-gauge vitrectomy for macular surgery.
Assessing Comparative Efficacy of Biologics for the Treatment of Psoriasis With Nail Involvement: A Systematic Review
Authors: Khan Madiha , Wallace Carly E. , Ahmed Fahad , Rahman Syed Minhaj , Memon Nashwah , Haque Adel
Published: November 2023

Background

Despite recent advances in biologics, there is a lack of significant evidence regarding the comparative efficacy of biologics in treating more resistant features of psoriasis, namely nail psoriasis. A systematic review synthesizing data from multiple studies is efficacious in assessing the comparative efficacy among biologics for the treatment of nail psoriasis.

Objective

To evaluate and compare the efficacy of biologics for the treatment of nail psoriasis.

Methods

Utilizing PRISMA guidelines, a systematic literature review was conducted using the Pubmed database on November 16, 2022. Studies selected were phase 3 or 4 randomized clinical trials, clinical studies, or other randomized trials with data on the treatment with biologics for adults with nail psoriasis.

Results

Sixteen studies meeting inclusion criteria were included for analysis. At 24 weeks, the highest mean NAPSI percent improvement achieved at week 24 was by brodalumab (76.9%) followed by etanercept (74%) and ixekizumab (70.5%) while the biologics achieving the greatest proportion of NAPSI 0 were adalimumab (44.6%) and ixekizumab (41%).

Conclusions

This study helps elucidate the comparative efficacy of biologics for the treatment of nail psoriasis. This review suggests that brodalumab and etanercept are associated with the highest percent improvement in nail psoriasis while adalimumab and ixekizumab are associated with the greatest probability of complete nail resolution.
France Reports Rise in Severe Neonatal Infections Caused by a New Enterovirus (Echovirus-11) Variant
Authors: Chandran Deepak , Chakraborty Sandip , Ahmed Sirwan Khalid , Chopra Hitesh , Islam Md. Rabiul , Dhama Kuldeep
Published: November 2023

The surge in severe neonatal sepsis cases caused by a novel variant of Echovirus 11 (E-11) in France and several European countries has sparked concern. The affected infants, mostly premature and twins, displayed rapid clinical decline within days after birth, presenting symptoms akin to septic shock with hepatic impairment and multi-organ failure. Laboratory findings revealed profound coagulopathy, low platelet counts, and acute renal failure, indicating severe disease progression. Genetic analysis identified a distinct recombinant E-11 lineage, previously unseen in France before July 2022. Despite its novelty, the exact pathogenicity remains uncertain. Although the World Health Organization downplaying immediate public health risks, the absence of a robust global surveillance program hinders accurate prevalence assessment. To mitigate the impact of this novel E-11 variant, establishing robust surveillance, refining diagnostic capabilities, and exploring therapeutic interventions such as intravenous immunoglobulin (IVIg) and pocapavir are imperative for effective management and prevention strategies.
The phase 2 LYSA study of prednisone, vinblastine, doxorubicin, and bendamustine for untreated Hodgkin lymphoma in older patients
Authors: Ghesquières Hervé , Krzisch Daphné , Nicolas-Virelizier Emmanuelle , Kanoun Salim , Gac Anne Claire , Guidez Stéphanie , Touati Mohamed , Laribi Kamel , Morschhauser Franck , Bonnet Christophe , Waultier-Rascalou Agathe , Orsini-Piocelle Frédérique , André Marc , Fournier Marguerite , Morand Fabienne , Berriolo-Riedinger Alina , Burroni Barbara , Damotte Diane , Traverse-Glehen Alexandra , Quittet Philippe , Casasnovas Olivier
Published: November 2023

Older patients with classical Hodgkin lymphoma (cHL) require more effective and less toxic therapies than younger patients. In this multicenter, prospective, phase 2 study, we investigated a new firstline therapy regimen comprising 6 cycles of prednisone (40 mg/m2, days 1-5), vinblastine (6 mg/m2, day 1), doxorubicin (40 mg/m2, day 1), and bendamustine (120 mg/m2, day 1) (PVAB regimen) every 21 days for patients with newly diagnosed cHL aged ≥61 years with an advanced Ann Arbor stage. A Mini Nutritional Assessment score ≥17 was the cutoff value for patients aged ≥70 years. The primary end point was the complete metabolic response (CMR) rate after 6 cycles. The median age of the 89 included patients was 68 years (range, 61-88 years), with 35 patients (39%) aged ≥70 years. Seventy-eight patients (88%) completed the 6 cycles. The toxicity rate was acceptable, with a 20% rate of related serious adverse events. CMR was achieved by 69 patients (77.5%; 95% confidence interval [CI], 67-86). After a median follow-up of 42 months, 31 patients progressed or relapsed (35%), and 24 died (27%) from HL (n = 11), toxicity during treatment (n = 4), secondary cancers (n = 6), or other causes (n = 3). The 4-year progression-free survival (PFS) and overall survival rates were 50% and 69%, respectively. Multivariate analysis showed that liver involvement (P = .001), lymphopenia (P = .001), CRP (P = .0005), and comedications (P = .003) were independently associated with PFS. The PVAB regimen yielded a high CMR rate with acceptable toxicity. Over long-term follow-up, survival end points were influenced by unrelated lymphoma events. This trial was registered at www.clinicaltrials.gov as #NCT02414568 and at EudraCT as 2014-001002-17.
Putative novel outer membrane antigens multi-epitope DNA vaccine candidates identified by Immunoinformatic approaches to control Acinetobacter baumannii
Authors: Tabibpour Niloofar Sadat , Doosti Abbas , Sharifzadeh Ali
Published: November 2023

Multi-epitope polypeptide vaccines, a fusion protein, often have a string-of-beads system composed of various specific peptide epitopes, potential adjuvants, and linkers. When choosing the sequence of various segments and linkers, many alternatives are available. These variables can influence the vaccine’s effectiveness through their effects on physicochemical properties and polypeptide tertiary structure.

The most conserved antigens were discovered using BLASTn. To forecast the proteins’ subcellular distribution, PSORTb 3.0.2 was used. Vaxign was used for the preliminary screening and antigenicity assessment. Protein solubility was also predicted using the ccSOL omics. Using PRED-TMBB, it was anticipated that the protein would localize across membranes. The IEDB and BepiPred-2.0 databases were used to predict the immunogenicity of B cell epitopes. A multi-epitope construct was developed and analyzed to evaluate. Twenty epitopes from A. baumannii’s outer membrane protein (omp) were included in the vaccination. TLR4 agonist explosibility was investigated. The physicochemical characteristics, secondary and tertiary structures, and B-cell epitopes of vaccine constructs were assessed. Additionally, docking and MD experiments were used to examine the relationship between TLR4 and its agonist.

Thirteen antigens were discovered, and eight of the 13 chosen proteins were predicted to be surface proteins. The 34 kDa outer membrane protein, Omp38, Omp W, CarO, putative porin, OmpA, were chosen as having the right antigenicity (≥0.5). FhuE and CdiA were eliminated from further study because of their low antigenicity. The vaccine design was developed by combining the most effective 10 B-cell and 10 MHC-I/MHCII combined coverage epitopes. The molecular formula of the vaccine was determined to be C1718H2615N507O630S17. The vaccine form has a molecular weight of 40,996.70 Da and 47 negatively charged residues (Asp + Glu), whereas 28 positively charged residues (Arg + Lys). The estimated half-life was 7.2 hours (mammalian reticulocytes, in vitro), > 20 hours (yeast, in vivo) and > 10 hours (Escherichia coli, in vivo) for the vaccine. The multi-epitope vaccine insertion is carried via the expression vector pcDNA3.1 (+).

The multi-epitope vaccine may stimulate humoral and cellular immune responses, according to our findings, and it may be a candidate for an A. baumannii vaccine.
Unveiling antibacterial and antioxidant activities of zinc phosphate-based nanosheets synthesized by Aspergillus fumigatus and its application in sustainable decolorization of textile wastewater
Authors: El-Sharkawy Reyad M. , Abbas Mohamed H. H.
Published: November 2023

Background

The development of an environment-friendly nanomaterial with promising antimicrobial and antioxidant properties is highly desirable. The decolorization potentiality of toxic dyes using nanoparticles is a progressively serious worldwide issue.

Methods

The successful biosynthesis of zinc nanoparticles based on phosphates (ZnP-nps) was performed using the extracellular secretions of Aspergillus fumigatus. The antibacterial activity of the biosynthetic ZnP-nps was investigated against Gram-negative bacteria and Gram-positive bacteria using the agar diffusion assay method. The antioxidant property for the biosynthetic nanomaterial was evaluated by DPPH and H2O2 radical scavenging assay.

Results

Remarkable antibacterial and antiradical scavenging activities of ZnP-nps were observed in a dose-dependent manner. The minimum inhibitory concentration (MIC) for Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli was 25 µg/ml, however, the MIC for Bacillus subtilis was 12.5 µg/ml. The maximum adsorptive performance of nanomaterial was respectively achieved at initial dye concentration of 200 mg/L and 150 mg/L using methylene blue (MB) and methyl orange (MO), where sorbent dosages were 0.5 g for MB and 0.75 g for MB; pH was 8.0 for MB and 4.0 for MO; temperature was 30 °C; contact time was 120 min. The experimental data was better obeyed with Langmuir’s isotherm and pseudo-second-order kinetic model (R2 > 0.999). The maximum adsorption capacity (qmax) of MB and MO dyes on nanomaterial were 178.25 mg/g and 50.10 mg/g, respectively. The regenerated nanomaterial, respectively, persist > 90% and 60% for MB and MO after 6 successive cycles. The adsorption capacity of the prepared zinc phosphate nanosheets crystal toward MB and MO, in the present study, was comparable/superior with other previously engineered adsorbents.

Conclusions

Based on the above results, the biosynthesized ZnP-nanosheets are promising nanomaterial for their application in sustainable dye decolorization processes and they can be employed in controlling different pathogenic bacteria with a potential application as antiradical scavenging agent. Up to our knowledge, this is probably the first study conducted on the green synthesis of ZnP-nanosheets by filamentous fungus and its significant in sustainable dye decolorization.
Increased bacterial taxonomic and functional diversity is associated with impaired rotavirus vaccine immunogenicity in infants from India and Malawi
Authors: Cunningham-Oakes Edward , Bronowski Christina , Chinyama End , Jere Khuzwayo C. , Sindhu Kulandaipalayam Natarajan C. , Kang Gagandeep , Iturriza-Gómara Miren , Darby Alistair C. , Parker Edward P. K.
Published: November 2023

The immunogenicity and effectiveness of oral rotavirus vaccines (ORVs) against severe rotavirus-associated gastroenteritis are impaired in low- and middle-income countries (LMICs) where the burden of disease is highest. Determining risk factors for impaired ORV response may help identify strategies to enhance vaccine effectiveness. In this study, we use metagenomic sequencing to provide a high-resolution taxonomic analysis of stool samples collected at 6 weeks of age (coinciding with the first ORV dose) during a prospective study of ORV immunogenicity in India and Malawi. We then analyse the functional capacity of the developing microbiome in these cohorts. Microbiome composition differed significantly between countries, although functional capacity was more similar than taxonomic composition. Our results confirm previously reported findings that the developing microbiome is more diverse in taxonomic composition in ORV non-seroconverters compared with seroconverters, and we additionally demonstrate a similar pattern in functional capacity. Although taxonomic or functional feature abundances are poor predictors of ORV response, we show that skews in the direction of associations within these microbiome data can be used to identify consistent markers of ORV response across LMIC infant cohorts. We also highlight the systemic under-representation of reference genes from LMICs that limit functional annotation in our study (7% and 13% annotation at pathway and enzyme commission level, respectively). Overall, higher microbiome diversity in early life may act as marker for impaired ORV response in India and Malawi, whilst a holistic perspective of functional capacity may be hidden in the “dark matter” of the microbiome.
Differences between physician and patient preferences for cancer treatments: a systematic review
Authors: Zhang Mengqian , He Xiaoning , Wu Jing , Xie Feng
Published: November 2023

Background

Shared decision-making is useful to facilitate cancer treatment decisions. However, it is difficult to make treatment decisions when physician and patient preferences are different. This review aimed to summarize and compare the preferences for cancer treatments between physicians and patients.

Methods

A systematic literature search was conducted on PubMed, Embase, PsycINFO, CINAHL and Scopus. Studies elicited and compared preferences for cancer treatments between physicians and patients were included. Information about the study design and preference measuring attributes or questions were extracted. The available relative rank of every attribute in discrete choice experiment (DCE) studies and answers to preference measuring questions in non-DCE studies were summarized followed by a narrative synthesis to reflect the preference differences.

Results

Of 12,959 studies identified, 8290 were included in the title and abstract screening and 48 were included in the full text screening. Included 37 studies measured the preferences from six treatment-related aspects: health benefit, adverse effects, treatment process, cost, impact on quality of life, and provider qualification. The trade-off between health benefit and adverse effects was the main focus of the included studies. DCE studies showed patients gave a higher rank on health benefit and treatment process, while physicians gave a higher rank on adverse effects. Non-DCE studies suggested that patients were willing to take a higher risk of adverse effects or lower health benefit than physicians when accepting a treatment.

Conclusions

Physicians and patients had important preference differences for cancer treatment. More sufficient communication is needed in cancer treatment decision-making.
Understanding the management of pediatric spondylodiscitis based on existing literature; a systematic review
Authors: Lashkarbolouk Narges , Mazandarani Mahdi , Ilharreborde Brice , Nabian Mohammad Hossein
Published: November 2023

Background

Spondylodiscitis (SD), a rare disease in children, poses diagnostic challenges due to non-specific presenting symptoms, scarcity in incidence, and difficulty expressing pain in non-verbal children.

Method

A comprehensive search was conducted on three databases, including PubMed/Medline, Web of Science, and Scopus until March 2023. The inclusion criteria were studies that investigated the clinical characteristics, treatment, and complications of children’s spondylodiscitis. Full text of cross-sectional and cohort studies were added. The quality assessment of cohort studies was conducted using the Newcastle-Ottawa Quality Assessment Scale. The search, screening, and data extraction were performed by two researchers independently.

Result

Clinical manifestations of discitis in children are nonspecific, such as back pain, fever, reduced ability or inability to walk or sit, limping, and reduced range of movements. The mean delay in the time of diagnosis was 4.8 weeks. The most affected site of all the studies was the lumbar spine. 94% of studies reported increased inflammatory markers such as white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Less than 30% of patients had positive blood cultures and biopsy findings. The most common microbiological results (64%) were Staphylococcus Aureus and Kingella kingae. In radiographic evaluation, intervertebral disk narrowing, lumbar lordosis reduction, loss of disk height, and destruction of the vertebral body have been reported. In all studies, antibiotic therapy was initiated; in 52% immobilization was employed, and 29% of studies reported surgery was performed, and the follow-up period differed from 1.5 months to 156 months. 94% of studies reported complications such as vertebral body destruction, back pain, kyphosis, reduced range of movement, scoliosis, and neurological complications.

Conclusion

Spondylodiscitis is an uncommon, heterogeneous, multifactorial disease with resulting difficult and delayed diagnosis. Due to its morbidity, it is essential to investigate children with refusal to walk, gait disturbances, or back pain, particularly when associated with elevated inflammatory markers.
General and subspecialist pediatrician perspectives on barriers and strategies for referral: a latent profile analysis
Authors: Bohnhoff James C. , Guyon-Harris Katherine , Schweiberger Kelsey , Ray Kristin N.
Published: November 2023

Background

Children in need of pediatric subspecialty care may encounter multiple barriers, and multiple strategies have been suggested to improve access. The purpose of this study was to describe the perceptions of general and subspecialty pediatric physicians regarding barriers to subspecialty care and the value of strategies to improve subspecialty access.

Methods

We surveyed a national sample of 1680 general pediatricians and pediatric subspecialists in May and June 2020 regarding 11 barriers to subspecialty care and 9 strategies to improve access to subspecialty care, selected from recent literature. Using latent profile analysis, respondents were grouped according to the degree to which they believed each of the barriers impacted access to subspecialty care. Using chi-squared tests, we compared the profiles based on respondent characteristics and perspectives on strategies to improve access.

Results

The response rate was 17%. In 263 responses completed and eligible for inclusion, the barriers most frequently described as “major problems” were wait times (57%), lack of subspecialists (45%) and difficulty scheduling (41%). Respondents were classified into 4 profiles: “Broad concerns,” “Subspecialist availability concerns,” “Clinician communication concerns,” and “Few concerns.” These profiles varied significantly by respondent specialty (p < .001, with medical subspecialists overrepresented in the “Clinician communication” profile, psychiatrists in the “subspecialist availability” profile, and surgeons in the “few concerns” profile); and by respondents’ typical wait time for appointments (p < .001, with physicians with the longest wait times overrepresented in the “subspecialist availability” profile).

Conclusions

We found specific profiles in clinician views regarding barriers to subspecialty care which were associated with perspectives on strategies aimed at overcoming these barriers. These results suggest that health systems aiming to improve subspecialty access should first identify the barriers and preferences specific to local clinicians.
A multidisciplinary primary prevention intervention to increase adherence to the Mediterranean diet: a pilot study
Authors: De Marco Silvia , Marziali Eleonora , Nachira Lorenza , Arcaro Paola , Villani Leonardo , Galasso Valerio , Bruno Stefania , Laurenti Patrizia
Published: November 2023

Background

The role of the Mediterranean Diet (MD) in reducing cardiovascular (CV) risk is widely demonstrated and many studies have shown the effectiveness of educational interventions in primary prevention. This study aimed to evaluate the impact of a multidisciplinary educational intervention, that included nutritional, psychological and physical activity coaching, on adherence to MD and on CV risk.

Methods

In a Roman neighborhood, general practitioners enrolled 41 subjects to take part in the educational intervention from November 2018 (T0) to November 2019 (T1). Participants’ anthropometric measures, haematochemical parameters and CV risk score were assessed before and after the intervention. Furthermore, their adherence to MD was evaluated through the analysis of food frequency questionnaires using Medi-Lite.

Results

The study found a significant reduction of 2.5 points in individual CV risk score, and an increase of 2.5 point in adherence to the MD. The stratification by gender showed statistically significant decreases in weight of 1.16 kg, BMI of 0.47, LDL cholesterol of 14.00 mg/dL, and individual CV risk score of 1.16 points among female participants.

Conclusions

These results show that a multidisciplinary educational intervention model including the adoption of MD could be an effective strategy in Public Health for CV primary prevention and improvement of people’s lifestyles.