bluuebunny/crossref_metadata_2025 huggingface dataset:
Advocacy counterstrategies to tobacco industry interference in policymaking: a scoping review of peer-reviewed literature
Authors: Matthes Britta K. , Kumar Praveen , Dance Sarah , Hird Tom , Carriedo Lutzenkirchen Angela , Gilmore Anna B.
Published: June 2023

Background

There has been remarkable tobacco control progress in many places around the globe. Tobacco industry interference (TII) has been identified as the most significant barrier to further implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Civil society has been recognised as a key actor in countering TII. While TII has been extensively studied for several decades now, there is little research that focuses on counteractions to limit it and their effectiveness to do so. This scoping review seeks to map the peer-reviewed literature on civil society’s activities of countering TII in policymaking to identify common counterstrategies and assess their effectiveness.

Methods

Data sources: We searched Embase, IBSS, JSTOR, PubMed, Science Direct, Scopus and Web of Science using the following terms: (“Tobacco industry” OR “Tobacco compan*”) AND. (“corporate political activity” OR “CPA” OR “lobbying” OR “interference”) AND (“advoca*” OR “counter*” OR “activi*”), without time or language restrictions. Study selection: Our selection criteria included peer-reviewed studies that were written in English, German, or Spanish that drew on primary data and/or legal and policy documents and reported at least one specific example of civil society members or organisations countering tobacco industry action-based strategies. Data extraction: Advocates’ counterstrategies were analysed inductively and countered industry strategies were analysed using the Policy Dystopia Model (PDM). Perceptions of effectiveness of countering attempts were analysed descriptively.

Results

We found five common counterstrategies among 30 included papers covering five WHO regions; 1. Exposing industry conduct and false claims; 2. Accessing decision-makers; 3. Generating and using evidence; 4. Filing a complaint or taking legal action; 5. Mobilising coalition and potential supporters. These counterstrategies were used to work against a wide range of industry strategies, which are captured by five action-based strategies described in the PDM (Coalition Management, Information Management, Direct Access and Influence, Litigation, Reputation Management). While some studies reported the outcome of the countering activities, their impact remained largely underexplored.

Conclusion

The review shows that peer-reviewed literature documenting how civil society actors counter TII is scarce. It suggests that advocates employ a range of strategies to counter TII in its different forms and use them flexibly. More work is needed to better understand the effects of their actions. This could stimulate discussions about, and facilitate learning from, past experiences and help to further enhance advocates’ capacity.
Are we happy with our work in globalization? Globalization experience, achievement motivation, and job seniority as predictors of work satisfaction in a group of office workers
Authors: Filipkowski Jakub , Derbis Romuald
Published: June 2023

Background

The main aim of this study was to determine whether globalization experience is a predictor of work satisfaction. In addition, we inspected a regression model consisting of globalization experience, job seniority, and goal achievement to determine how much variance in work satisfaction is accounted for by globalization experience. Most the theoretical texts about globalization suggest its negative impact on everyday life. The negative effects are – work–life balance problem, weakening of mechanisms to protect against the fear of death, and uncertainty.

Method

250 office workers participated in the study (Mage = 38.37; 145 females and 105 males). They responded to paper-and-pencil anonymous questionnaires measuring globalization experience, achievement goals, and work satisfaction. Respondents were also asked about their job seniority. We used Spearman’s rho correlations and multiple linear regression to check the basic linear relation between variables, and hierarchical multiple regression to determine which of them is the strongest predictor of work satisfaction.

Results

The results indicated that globalization experience (R2 change = 0.089; p < .05) is a statistically significant negative predictor of work satisfaction and job seniority (R2 change = 0.056; p < .05) while achievement goals (R2 change = 0.188; p < .001) are positive predictors of work satisfaction.

Conclusion

We concluded that further research on globalization experience is necessary because it is the precursory individualistic approach to globalization research and we obtained a statistically significant yet small relation with work satisfaction in correlation and regression analyses. The presented results are also the rationale for promoting mastery approach goals in the workplace to improve work satisfaction as they are statistically significant positive predictors of it.
Enhancing global health diplomacy for non-communicable diseases: application of the global health network framework
Authors: Afshari Mahnaz , Teymourlouy Ahmad Ahmadi , Maleki Mohammadreza , Asadi-Lari Mohsen
Published: June 2023

Background and aim

Understanding the characteristics of global policy actors and the political context in which they address diplomatic issues in the field of NCDs can play an important role in advancing NCD-related goals. The purpose of this study was to identify and analyze the network of global health actors in the field of NCDs in Iran.

Methods

This study was conducted in 2020 using a qualitative methodology and framework analysis. In-depth semi-structured interviews were conducted with subject-matter experts from all levels of diplomacy, including global, regional, and national, who had managerial, administrative, and academic experience.

Findings

A total of 21 interviews were conducted with individuals who met the inclusion criteria. Following the framework of the World Health Network, the findings were divided into three general areas: the features of the network and the actors; the policy environment; and the characteristics of the issue.

Conclusion

A successful and sustainable program to combat NCDs requires the participation of multiple actors from governments, the private sector, and civil society at international, national, and local levels. The Global Network for Prevention and Control of NCDs should enhance the effectiveness of NCDs policies by highlighting the need to simultaneously improve the internal factors of the network, including relationships among the actors; external factors, including the policy environment; and the complex nature of NCDs.
Impact of the COVID-19 pandemic on health care and daily life of patients with rare diseases from the perspective of patient organizations – a qualitative interview study
Authors: Zybarth David , Brandt Maja , Mundlos Christine , Inhestern Laura
Published: June 2023

Background

During the COVID-19 pandemic people affected by rare diseases (RD) or caregiver of affected children have faced additional challenges. The pandemic has affected physical and mental health, social life and has led to financial consequences. Our objectives were to identify the impact of COVID-19 (1) on health care and (2) on daily life and participation of patients with RDs or caregivers from the perspective of representatives of patient organizations. Moreover, we explored their perspective on experiences of pandemic stress and resources during the pandemic.

Results

We conducted 18 semi-structured interviews with representatives of patient organizations (e.g. chairperson, members of the steering committee), who were asked about the experiences of their members. The interviews were transcribed verbatim and analyzed using the framework approach. We contextualized our findings on the basis of the International Classification of Functioning, Disability and Health (ICF) model and adapted it according to identified subthemes. Patients and caregivers were confronted with aspects of pandemic stress such as lack of information, access and information regarding vaccination and being a risk group for COVID-19 infection. Physical and mental functioning was reported to be negatively impacted. Lock downs and contact restrictions led, e.g., to increasing lack of nursing services or lack of necessary informal support. Participation e.g. in social life and work was reduced. Health care services including medical care and supportive care as well as additional therapies were disrupted and greater effort was necessary to organize care. According to participants, central resources were informal support networks, digitalization, patient organizations and individual characteristics.

Conclusions

Our study highlights the consequences of the COVID-19 pandemic on the situation of people affected by RDs and caregivers. Contextualization of the results into the biopsychosocial model reinforces the impact of the pandemic on health care as well as daily life and participation. Major challenges and difficulties were experienced during lockdowns and contact restrictions. Depending on the risk of an infection with COVID-19, certain patient groups were still isolated and reduced social contacts or still followed strict hygienic measures (e.g., wearing medical masks). Future pandemic control measures, e.g. on lockdowns and closing facilities, should consider the challenges of people with RDs and caregivers of affected children.
Modifications of lung microbiota structure in traumatic brain injury ventilated patients according to time and enteral feeding formulas: a prospective randomized study
Authors: Cotoia A. , Paradiso R. , Ferrara G. , Borriello G. , Santoro F. , Spina I. , Mirabella L. , Mariano K. , Fusco G. , Cinnella G. , Singer P.
Published: June 2023

Background

Specialized diets enriched with immune nutrients could be an important supplement in patients (pts) with acute traumatic brain injury (TBI). Omega-3 and arginine may interact with immune response and microbiota. No data are available about the role of the specialized diets in modulating the lung microbiota, and little is known about the influence of lung microbiota structure in development of ventilator-associated pneumonia (VAP) in TBI pts. The aims of this study are to evaluate the impact of specific nutrients on the lung microbiota and the variation of lung microbiota in TBI pts developing VAP.

Methods

A cohort of 31 TBI pts requiring mechanical ventilation in ICU was randomized for treatment with specialized (16pts) or standard nutrition (15pts). Alpha and beta diversity of lung microbiota were analyzed from bronco Alveolar Lavage (BAL) samples collected at admission and 7 days post-ICU admission in both groups. A further analysis was carried out on the same samples retrospectively grouped in VAP or no VAP pts.

Results

None developed VAP in the first week. Thereafter, ten out of thirty-one pts developed VAP. The BAL microbiota on VAP group showed significant differences in beta diversity and Staphylococcus and Acinetobacter Genera were high. The specialized nutrition had influence on beta diversity that reached statistical significance only in Bray–Curtis distance.

Conclusion

Our data suggest that TBI patients who developed VAP during ICU stay have different structures of BAL microbiota either at admission and at 7 days post-ICU admission, while no correlation has been observed between different enteral formulas and microbiota composition in terms of richness and evenness. These findings suggest that targeting the lung microbiota may be a promising approach for preventing infections in critically ill patients.
The updates and implications of cutaneous microbiota in acne
Authors: Huang Cong , Zhuo Fan , Han Baoquan , Li Wenting , Jiang Bin , Zhang Kaoyuan , Jian Xingling , Chen Zhenzhen , Li Hui , Huang Haiyan , Dou Xia , Yu Bo
Published: June 2023

Acne is a chronic inflammatory skin disorder that profoundly impacts the quality of life of patients worldwide. While it is predominantly observed in adolescents, it can affect individuals across all age groups. Acne pathogenesis is believed to be a result of various endogenous and exogenous factors, but the precise mechanisms remain elusive. Recent studies suggest that dysbiosis of the skin microbiota significantly contributes to acne development. Specifically, Cutibacterium acnes, the dominant resident bacterial species implicated in acne, plays a critical role in disease progression. Various treatments, including topical benzoyl peroxide, systemic antibiotics, and photodynamic therapy, have demonstrated beneficial effects on the skin microbiota composition in acne patients. Of particular interest is the therapeutic potential of probiotics in acne, given its direct influence on the skin microbiota. This review summarizes the alterations in skin microbiota associated with acne, provides insight into its pathogenic role in acne, and emphasizes the potential of therapeutic interventions aimed at restoring microbial homeostasis for acne management.
Planning regulation and land value capture in Italy between traditional approaches and new perspectives
Authors: Colavitti Anna Maria , Serra Sergio
Published: June 2023

Urban development and regeneration processes are both influenced by changes in the level of land rents over time and space. Public intervention in land markets, including planning regulation, affects rent dynamics through discretionary decisions that create clear advantages and inequalities in landowner treatment. Focusing on Italian approaches to planning regulation and land value capture (LVC), the research investigates the evolution of the theoretical debate on windfalls for wipeouts and the different approaches and instruments for managing urban rents. The characteristics of the national housing market and the relevant socio-economic and territorial disparities require a better understanding of contemporary rent dynamics. The conclusions suggest that the traditional and mainstream conception of urban rent, as an unearned gain for the landowner, needs to be revised and LVC should be addressed to support regeneration policies.
Assessments of tree-ring intra-annual δ18O record for reconstructing hydroclimate with high temporal resolution
Authors: Watanabe Yumiko , Katayama Yoshito , Li Zhen , Nakatsuka Takeshi , Tazuru Suyako
Published: June 2023

Tree-ring cellulose oxygen isotopic ratios have been widely studied as a hydrological proxy in monsoonal Asia. There has been, however, little attempt to perform proxy assessment of the intra-annual isotopic data to reconstruct hydroclimate with higher temporal resolution. We presented new intra-annual cellulose oxygen isotopic records of Japanese cedar trees spanning A.D. 1918 to 2017, and validated it as a hydrological proxy by comparing with meteorological data. There are significant negative correlations between intra-annual isotopic ratios and summer precipitation/relative humidity, as similar to annual-resolution data of earlier studies. Notably on intra-annual scales, the period showing the highest correlation gradually shifted from May to August, in corresponding to the location within the annual ring. Principal component regression analyses show the regression was more accurate over a wider duration than single regression analysis using the annual data, therefore indicating that the subdivision of the annual ring could contribute to reconstruct higher-resolution hydroclimate.
The role of leukotriene inhibition using a 5‐lipoxygenase (5‐LO) inhibitor in a joint contracture model
Authors: Jeffs Alexander D. , Boyd Michael , Larabee Landon , Shelton Matthew , Bassil Alexander , Taylor Ross , Berkoff David
Published: June 2023

Purpose

Arthrofibrosis is a common inflammatory complication of joint trauma and surgery. 5lipoxygenase (5‐LO) is a key enzyme involved in inflammation. Inhibition of 5‐LO has been shown to reduce inflammation in heart and lung models but has not been examined in a joint contracture model.

Methods

Twenty‐six rats underwent joint contracture. Six rats served as non‐surgical controls. A 5‐LO inhibitor, caffeic acid (CA), suspended in 10% ethanol was orally administered to 14 rats and ethanol without CA to the remaining 12 rats daily for 21 days. Leukotriene B4 (LTB4) levels were measured, both systemically and locally. 5‐LO levels in the posterior capsule were quantified by measuring the ratio of the length of the posterior capsule demonstrating 5‐LO immunostaining to the total length of the capsule.

Results

Joint contracture was successfully achieved in all rats who underwent manipulation. Levels of 5‐ LO measured in the posterior capsule were significantly increased in the animals who underwent surgery (56%/44–64) compared to the non‐surgical control animals (7%/4–9). LTB4 levels were found to be significantly lower in the non‐surgical control animals (107.79 ± 34.08 pg/ml) compared to all surgical animals (157.6 ± 55.3 pg/ml).

Conclusion

Surgical intervention resulted in increased 5‐LO activity of the synovial surface of the posterior capsule and increased LTB4 levels in the patellar tendon—fat pad. Oral administration of the 5LO inhibitor, CA, was ineffective at reducing systemic and local LTB4 levels and preventing knee joint contracture. Inhibiting 5‐LO activity may still be effective in preventing arthrofibrosis and warrants further investigation.
Tumor dosimetry using 177Lu: influence of background activity, measurement method and reconstruction algorithm
Authors: Staanum Peter Frøhlich
Published: June 2023

Background

Image-based tumor dosimetry after radionuclide therapy, using the isotope 177Lu, finds application e.g., for tumor-to-organ dose comparison and for dose response evaluation. When the tumor extent is not much larger than the image resolution, and when 177Lu is found in nearby organs or other tumors, an accurate determination of tumor dose is particularly challenging. Here a quantitative evaluation of three different methods for determining the 177Lu activity concentration in a phantom is performed, and the dependence on a variety of parameters is described. The phantom (NEMA IEC body phantom) has spheres of different size in a background volume, and sphere-to-background 177Lu activity concentration ratios of infinity, 9.5, 5.0 and 2.7 are applied. The methods are simple to implement and well-known from the literature. They are based on (1) a large VOI encompassing the whole sphere, without background activity and with volume information from other sources, (2) a small VOI located in the sphere center, and (3) a VOI consisting of voxels with voxel value above a certain percentage of the maximum voxel value.

Results

The determined activity concentration varies significantly with sphere size, sphere-to-background ratio, SPECT reconstruction method and method for determining the concentration. Based on the phantom study, criteria are identified under which the activity concentration can be determined with a maximal error of 40% even in the presence of background activity.

Conclusions

Tumor dosimetry is feasible in the presence of background activity using the above-mentioned methods, provided appropriate SPECT reconstructions are applied and tumors are selected for dosimetry analysis according to the following criteria for the three methods: (1) solitary tumor with diameter > 15 mm, (2) tumor diameter > 30 mm and tumor-to-background ratio > 2, and (3) tumor diameter > 30 mm and tumor-to-background ratio > 3.
Enhancing biofeedback-driven self-guided virtual reality exposure therapy through arousal detection from multimodal data using machine learning
Authors: Rahman Muhammad Arifur , Brown David J. , Mahmud Mufti , Harris Matthew , Shopland Nicholas , Heym Nadja , Sumich Alexander , Turabee Zakia Batool , Standen Bradley , Downes David , Xing Yangang , Thomas Carolyn , Haddick Sean , Premkumar Preethi , Nastase Simona , Burton Andrew , Lewis James
Published: June 2023

Virtual reality exposure therapy (VRET) is a novel intervention technique that allows individuals to experience anxiety-evoking stimuli in a safe environment, recognise specific triggers and gradually increase their exposure to perceived threats. Public-speaking anxiety (PSA) is a prevalent form of social anxiety, characterised by stressful arousal and anxiety generated when presenting to an audience. In self-guided VRET, participants can gradually increase their tolerance to exposure and reduce anxiety-induced arousal and PSA over time. However, creating such a VR environment and determining physiological indices of anxiety-induced arousal or distress is an open challenge. Environment modelling, character creation and animation, psychological state determination and the use of machine learning (ML) models for anxiety or stress detection are equally important, and multi-disciplinary expertise is required. In this work, we have explored a series of ML models with publicly available data sets (using electroencephalogram and heart rate variability) to predict arousal states. If we can detect anxiety-induced arousal, we can trigger calming activities to allow individuals to cope with and overcome distress. Here, we discuss the means of effective selection of ML models and parameters in arousal detection. We propose a pipeline to overcome the model selection problem with different parameter settings in the context of virtual reality exposure therapy. This pipeline can be extended to other domains of interest where arousal detection is crucial. Finally, we have implemented a biofeedback framework for VRET where we successfully provided feedback as a form of heart rate and brain laterality index from our acquired multimodal data for psychological intervention to overcome anxiety.
Single-dose trastuzumab monotherapy achieved pathological complete response (pCR) in a patient with HER2-positive breast cancer: a case report
Authors: Isogai Ayaka , Kotani Haruru , Sawaki Masataka , Hattori Masaya , Yoshimura Akiyo , Kataoka Ayumi , Nozawa Kazuki , Ozaki Yuri , Endo Yuka , Nakakami Akira , Komaki Rie , Iwata Hiroji
Published: June 2023

Background

With advances in breast cancer treatment, the importance of de-escalation therapy to reduce harm during the treatment of elderly patients has attracted attention in recent years. Certain patient populations are expected to have a superior response to anti-HER2 drugs, particularly those with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer. In this report, we describe our experience of dramatic anti-HER2 drug response in a patient who achieved pathological complete response (pCR) with a single dose of trastuzumab.

Case presentation

An 88-year-old woman presented with a 2-cm palpable mass in the left breast. Vacuum-assisted breast biopsy, ultrasonography, and positron emission tomography–computed tomography revealed estrogen receptor-negative and HER2-positive, T1N0M0, stage I breast cancer. Mastectomy was scheduled within 2 months of the initial visit; however, the patient was anxious about the length of the waiting period and requested medication in the interim. Therefore, prior to surgery, one cycle of trastuzumab monotherapy was administered at the discretion of the attending physician. Postoperative pathology showed no remnant of invasive carcinoma and pCR with only a 0.2-mm ductal carcinoma in situ remnant. The patient refused further medication after surgery because of severe diarrhea after trastuzumab administration. Postoperative treatment was limited to follow-up, and no recurrence was observed at 1 year and 6 months postoperatively.

Conclusion

This case suggests that trastuzumab monotherapy may be effective in certain patients with HER2-positive breast cancer. In the future, identifying patients who are more likely to respond to trastuzumab, as in this case, will allow for more options regarding de-escalation therapy without chemotherapy, particularly in elderly patients who are concerned about the side effects of chemotherapy.
ECMOLIFE intra-hospital transport in life-saving for pulmonary vein obstruction
Authors: Condello Ignazio , Nasso Giuseppe , Contegiacomo Gaetano , Solimando Carlo , Balducci Giuseppe , Scaringi Domenico , D’Alessandro Pasquale , Speziale Giuseppe
Published: June 2023

Background

Transport with extracorporeal membrane oxygenation (ECMO) in the hospital setting can become a challenge as well as in the out-of-hospital setting. In particular, the management of intra-hospital transport with ECMO support of the critically ill patient foresees his shift from the intensive care to the diagnostic areas, from the diagnostic areas to the interventional and surgical areas.

Case presentation

In this context, we present a life-saving transport case with the veno-venous (VV) configuration of the ECMOLIFE Eurosets system, for right heart and respiratory failure in a 54-year-old woman, due to thrombosed obstruction of the right superior pulmonary vein, following mitral valve repair surgery in minimally invasive approach in a patient already operated on for complex congenital heart disease. After stabilizing the vital parameters with Veno-venous ECMO for 19 h, the patient was transported to hemodynamics for angiography of the pulmonary vessels, where the diagnosis of obstruction of the pulmonary venous return was made. Subsequently, the patient was brought back to the operating room for a procedure of unblocking the right superior pulmonary vein using a minimally invasive approach, passing from the ECMO to the support in extracorporeal circulation.

Conclusions

The transportable ECMOLIFE Eurosets System was safe and effective during transport in maintaining the vital parameters of oxygenation and CO2 reuptake and systemic flow, allowing the patient to be mobilized for diagnostic tests instrumental to diagnosis. The patient was extubated 36 h after the surgical procedures and was discharged 10 days later from the hospital.
Seroprevalence of hepatitis E viral infection among apparently healthy personnels and patients with certain neurological disorders in Alexandria University Hospitals
Authors: Hanno Abd El-Fattah , Khouly Ehab El , Abdel-Rauof Mervat , Moghazy Ahmed , Dauod Shaimaa
Published: June 2023

Introduction

Hepatitis E virus (HEV) is one of the leading causes of acute viral hepatitis. There are thought to be 20 million infections per year in poorer nations with inadequate sanitation. In Egypt, awareness about the possible hazards linked to HEV infection is limited due to low socioeconomic and educational levels. Only a small number of sequences have been characterized, making HEV study in Egypt constrained. Numerous factors may have contributed to this neglect. Various extra-hepatic symptoms of HEV infection include neurological problems are recognized. Many European nations have implemented regular HEV monitoring, or targeted screening of blood provided by patients at greater risk to stop the spread of HEV by transfusion.

Aim

Assess the prevalence of HEV infection in asymptomatic blood donors. Increasing awareness about HEV testing in patients with some unexplained neurological disorders.

Methods

Cross-sectional study involving 550 patients: 500 apparently healthy blood donors and 50 patients with some neurological disorders. All subjects were tested for serological markers (IgG and IgM) for HEV using ELISA technique in addition to HEV RNA PCR testing for seropositive patients.

Results

Five hundred asymptomatic blood donors (370 males and 130 females), ages ranging from 20 to 50 years (median 33), 22.6% of them tested positive for HEV (IgG and IgM) of which 2 subjects only had positive HEV RNA PCR testing. In the second group 50 patients (26 males and 24 females) with various unexplained neurological disorders. Liver functions were within normal or showed only a mild increase. Forty-four percent of the patients had positive serology for HEV, with 6 patients testing positive for HEV RNA on PCR.

Conclusion

No need for mass screening for HEV serology among blood donors. HEV infection needs to be considered in patients with unexplained neurological disorders even if the liver functions are not markedly elevated.
Lower body positive pressure treadmill gait training for neurological patients: a systematic review
Authors: Almutairi Sattam M.
Published: June 2023

Background

Among various body weight-supported locomotor training methods for neurological patients, some studies have recognized the lower body positive pressure (LBPP) treadmill as superior for gait training in neurological patients. The aim of this study is to explore the clinical use and efficacy of LBPP treadmill gait training in neurological patients.

Methods

A systematic review was performed following PRISMA guidelines. The inclusion criteria were studies published in English using LBPP with neurological patients were included from the database's inception to March 2023 to avoid misinterpretation of translation. The search was conducted in multiple databases, including Google Scholar, PubMed, Scopus, PEDro, and the Cochrane Database. To improve accuracy and comprehensiveness, studies mentioned in the main articles were also evaluated.

Results

The search identified 16 articles that use LBPP with neurological patients. Only a few randomized control studies on the use of LBPP after stroke have been reported. For neurological rehabilitation, LBPP treadmill gait training is safe and feasible. Current research suggests that using the LBPP treadmill in conjunction with traditional rehabilitation treatment has a successively beneficial impact on motor function, particularly in patients with subacute to chronic stroke and Parkinson’s disease. There are no studies that compare the LBPP to the body weight supported treadmill (BWST). Furthermore, to the best of our knowledge, the LBPP treadmill has not yet been evaluated on for its effectiveness in treating traumatic brain injury (TBI) or spinal cord injury (SCI).

Conclusion

There was insufficient evidence to support the claim that LBPP is effective and superior to other gait training methods. Larger randomized control studies with sufficient sample sizes are needed to better understand the potential effects of the LBPP treadmill intervention on the functional performance of people with neurological disorders.
Tobacco-free campuses – a pipe dream? A survey of current smoking cessation practice in mental health units in Ireland
Authors: Harrington Colm , Walsh Elaine
Published: June 2023

Aims and method

Smoking and vaping are prohibited on Ireland's Health Service Executive (HSE) campuses. The HSE states that there is no evidence to suggest vaping is less damaging than cigarettes. Recent meta-analyses have shown that e-cigarettes are in fact less dangerous and can help smokers quit. Our study analyses the current smoking policies in place in mental health ‘approved centres’ in Ireland, what is being done to help smokers quit while in-patients and the level of support among staff for the introduction of e-cigarettes as a harm reduction tool. Clinical nurse managers from each mental health approved centre were surveyed to assess adherence to smoking policies.

Results

Only 5% of surveyed units enforce the HSE's Tobacco Free Campus Policy; 55% of units supported the idea of using e-cigarettes to help patients quit cigarettes.

Clinical implications

Ireland's hospital campuses are not tobacco free. Changes need to be made to our smoking policies and their enforcement.
Severe Hepatopathy in National Wilms Tumor Studies 3-5: Prevalence, Clinical Features, and Outcomes After Reintroduction of Chemotherapy
Authors: Oosterom Natanja , Gooskens Saskia L.M. , Renfro Lindsay A. , Perlman Elizabeth J. , van den Heuvel-Eibrink Marry M. , Hamilton Thomas E. , Green Daniel M. , Grundy Paul E. , Daw Najat C. , Geller James I. , Dome Jeffrey S. , Fernandez Conrad V. , Mullen Elizabeth A.
Published: June 2023

PURPOSE

The safety of reintroducing chemotherapy in the pediatric renal tumor setting after severe hepatopathy (SH), including sinusoidal obstruction syndrome (SOS), is uncertain. We describe the incidence, severity, outcomes, and impact on subsequent treatment for patients with SH from National Wilms Tumor Study (NWTS) protocols 3-5.

PATIENTS AND METHODS

Archived charts for patients enrolled on NWTS 3-5 who met study inclusion criteria for SH by using established hepatopathy grading scales and clinical criteria were reviewed for demographics, tumor characteristics, radio- and chemotherapy details, SH-related dose modifications, and oncologic outcomes. Genomic analysis for candidate polymorphisms associated with SH was performed in 14 patients.

RESULTS

Seventy-one of 8,862 patients (0.8%) met study inclusion criteria. The median time from therapy initiation to SH was 51 days (range, 2-293 days). Sixty percent received radiotherapy, and 56% had right-sided tumors. Grade 1-4 thrombocytopenia was noted in 70% at initial occurrence of SH (median 22,000/microliter). Among 69 of 71 children with SH occurring before the end of therapy (EOT) and post-SH treatment information available, chemotherapy was delayed posthepatopathy for 65% (69% of these at a reduced dose), continued without delay for 20% (57% of these at reduced dose), and stopped completely for 15% (4 of 10 of whom died of SH). Overall, 42% of patients with dose reductions achieved full dose by EOT. The five-year post-SH event-free survival for patients who continued therapy was 89% (95% CI, 81 to 98), with no significant differences by whether delay or dose reduction occurred. We identified no SH-associated pharmacogenomic polymorphism.

CONCLUSION

The incidence of SH on NWTS 3-5 was low; many had associated severe thrombocytopenia. Careful reintroduction of chemotherapy appeared to be feasible for the majority of patients who developed severe chemotherapy- and/or radiotherapy-induced liver toxicity.
Highly Sensitive Circulating Tumor DNA Assay Aids Clinical Management of Radiographically Occult Isolated Peritoneal Metastases in Patients With GI Cancer
Authors: Singh Harshabad , Klempner Samuel J. , Melnitchouk Nelya , Chander Deepak P. , Negrea Ovidiu George , Patel Anuj K. , Schlechter Benjamin L. , Rubinson Douglas A. , Huffman Brandon M. , Nambiar Chetan , Remland Joshua , Andrews Elizabeth , Leahy Megan E. , Brais Lauren K. , Enzinger Peter C. , Mamon Harvey J. , Giannakis Marios , Meyerhardt Jeffrey A. , Ng Kimmie , Perez Kimberly J. , Aguirre Andrew J. , Clark Jeffrey W. , Cleary James M. , Wolpin Brian M.
Published: June 2023

PURPOSE

GI cancers commonly spread to the peritoneal cavity, particularly from primary adenocarcinomas of the stomach and appendix. Peritoneal metastases are difficult to visualize on cross-sectional imaging and cause substantial morbidity and mortality. The purpose of this study was to determine whether serial highly sensitive tumor-informed circulating tumor DNA (ctDNA) measurements could longitudinally track changes in disease burden and inform clinical care.

METHODS

This was a retrospective case series of patients with gastric or appendiceal adenocarcinoma and isolated peritoneal disease that was radiographically occult. Patients underwent quantitative tumor-informed ctDNA testing (Signatera) as part of routine clinical care. No interventions were prespecified based on ctDNA results.

RESULTS

Of 13 patients studied, the median age was 65 (range, 45-75) years, with 7 (54%) women, 5 (38%) patients with gastric, and 8 (62%) patients with appendiceal adenocarcinoma. Eight (62%) patients had detectable ctDNA at baseline measurement, with median value 0.13 MTM/mL (range, 0.06-11.68), and assay was technically unsuccessful in two cases with appendiceal cancer because of limited tumor tissue. Five (100%) patients with gastric cancer and 3 (50%) patients with appendiceal cancer had detectable ctDNA at baseline. Although baseline levels of ctDNA were low, longitudinal assessment tracked with changes in disease burden among patients undergoing chemotherapy for metastatic disease. In two patients undergoing surveillance after definitive surgical management of gastric adenocarcinoma, detection of ctDNA prompted diagnosis of isolated peritoneal disease.

CONCLUSION

Quantitative tumor-informed serial ctDNA testing aids clinical management of patients with isolated peritoneal disease. Low levels of baseline ctDNA suggest a role for highly sensitive ctDNA approaches over panel-based testing. Further exploration of this approach should be considered in patients with isolated peritoneal malignant disease.
Evaluation of the Potential for Drug-Drug Interactions with Inhaled Itraconazole Using Physiologically Based Pharmacokinetic Modelling, Based on Phase 1 Clinical Data
Authors: Bergagnini-Kolev Mackenzie , Kane Katie , Templeton Ian E. , Curran Aidan K.
Published: June 2023

Itraconazole is a potent inhibitor of cytochrome P450 3A4 (CYP3A4), associated with numerous drug-drug interactions (DDI). PUR1900, a dry powder formulation of itraconazole for oral inhalation, results in high lung and low systemic exposure. This project used physiologically based pharmacokinetic (PBPK) modeling to assess the DDI potential of inhaled PUR1900, using midazolam as a “victim drug.” The basic and mechanistic static models evaluated the DDI potential of PUR1900, assuming 5 mg of midazolam coadministration at steady-state itraconazole exposure. Subsequently, Simcyp® PBPK simulation software and pharmacokinetic data from a Phase 1 clinical trial with PUR1900 (NCT03479411) were used to optimize an existing itraconazole PBPK model. The model was applied to investigate the potential for CYP3A4 DDI when 5 mg of midazolam is co-administered with inhaled PUR1900 at a steady state in a virtual healthy population at PUR1900 doses up to 40 mg per day. The basic static and mechanistic static models suggested a strong likelihood for DDI with inhaled PUR1900. The PBPK model was consistent with PUR1900 Phase 1 trial data. The geometric mean Cmax and AUC ratios of midazolam at a maximum dose of 40 mg PUR1900 were 1.14 and 1.26, respectively, indicating a minimal likelihood of DDI with inhaled PUR1900. The low systemic exposure of itraconazole when administered as PUR1900 results in minimal to no CYP3A4 inhibition, reducing the concern of drug-drug interactions. As the risk of CYP3A4 DDI is predicted to be significantly lower when itraconazole is administered via oral inhalation as PUR1900, it is likely that PUR1900 can be safely used for the treatment of pulmonary fungal infections in patients taking pharmaceuticals currently contraindicated with oral itraconazole.

Graphical Abstract
Substance Use and the Nervous System
Authors: Stitt Derek
Published: June 2023

OBJECTIVE

This article informs and updates the practicing neurologist on the current landscape of known neurologic injuries linked to the use of illicit drugs, focusing on emerging agents.

LATEST DEVELOPMENTS

Synthetic opioids such as fentanyl and similar derivatives have exploded in prevalence, becoming the leading cause of overdose fatalities. The higher potency of synthetic opioids compared with semisynthetic and nonsynthetic opiates poses an increased risk for unintentional overdose when found as an adulterant in other illicit drug supplies such as heroin. Conversely, misinformation about the risk of symptomatic exposure to fentanyl through casual contact with the skin and ambient air has led to misdirected fear and stigma that threatens to impede valid harm-reduction measures for fentanyl users at risk of actual overdose. Finally, during the COVID-19 pandemic, overdose rates and deaths continued to climb, especially among those who use opioids and methamphetamine.

ESSENTIAL POINTS

A variety of potential neurologic effects and injuries can occur with illicit drug use owing to the diverse properties and mechanisms of action of the various classes. Many high-risk agents are not detected on standard drug screens, including so-called designer drugs, and the practicing neurologist is best served by recognizing the clinical features of the traditional toxidrome and other potential idiosyncratic effects of various illicit agents.
Neurologic Complications of Cancer Treatment
Authors: Porter Alyx B.
Published: June 2023

Objective

Advances in cancer treatment have led to extended survival and increased risk of neurologic complications in an aging population. This review summarizes potential neurologic complications in patients who have undergone treatment for neurologic and systemic malignancies.

Latest Developments

Radiation and cytotoxic chemotherapy along with other targeted therapies continue to be the mainstay of cancer treatment. These advances in cancer care have led to improved outcomes and increased the need to understand the spectrum of neurologic complications that may arise from treatment. While radiation and older therapies including cytotoxic chemotherapies have side effect profiles that are widely known and well understood, this article serves as a review of the more commonly associated neurologic complications of both traditional and newer treatments being offered to this patient population.

Essential Points

Neurotoxicity is a common complication of cancer-directed treatment. In general, neurologic complications of radiation therapy are more common in central nervous system malignancies, and neurologic complications of chemotherapy are more common in non-neurologic malignancies. Attempts at prevention, early detection, and intervention remain paramount in the reduction of neurologic morbidity.
Neurologic Complications of Critical Medical Illness
Authors: Morris Nicholas A. , Sarwal Aarti
Published: June 2023

Objective

This article reviews the neurologic complications encountered in patients admitted to non-neurologic intensive care units, outlines various scenarios in which a neurologic consultation can add to the diagnosis or management of a critically ill patient, and provides advice on the best diagnostic approach in the evaluation of these patients.

Latest Developments

Increasing recognition of neurologic complications and their adverse impact on long-term outcomes has led to increased neurology involvement in non-neurologic intensive care units. The COVID-19 pandemic has highlighted the importance of having a structured clinical approach to neurologic complications of critical illness as well as the critical care management of patients with chronic neurologic disabilities.

Essential Points

Critical illness is often accompanied by neurologic complications. Neurologists need to be aware of the unique needs of critically ill patients, especially the nuances of the neurologic examination, challenges in diagnostic testing, and neuropharmacologic aspects of commonly used medications.
Impossible Scale: Amitav Ghosh against History
Authors: Parsons Cóilín
Published: June 2023

Focusing on Amitav Ghosh's Ibis trilogy—comprising the novels Sea of Poppies, River of Smoke, and Flood of Fire—this article asks how novels can (or sometimes cannot) narrate the history of an ocean. Given the fact that realist novels are often strictly bounded by time and space, and by an imperative to offer detailed characterization and setting, there is a discrepancy between the scales of oceanic thinking and the capacities of the novel to do justice to them. Instead of turning to experimental forms that reimagine the possibilities of the novel, Ghosh reanimates the realist novel to tell the story of the opium trade across the Indian Ocean and the South China Sea. In doing so, he looks back to a conservative vision of empire while at the same time offering flashes of radical critique. At its most inventive, the Ibis trilogy reconfigures novelistic plot as a horizontally organized system rather than a vertically organized flow and retools the realist novel for a different scale of time and space. Despite attempts to claim Ghosh for a radical politics, or to induct him into a pantheon of historians, these novels create a complicated world, often profoundly incompatible with itself. Ghosh grapples with the challenges of scale—of how to narrate large-scale historical processes while at the same time paying due mind to his unwavering commitment to setting a scene.
Urgent surgical approach for comminuted mandible fracture and considerations regarding airway risk. Case report
Authors: Damaceno Fernandes Vinicius Juliate , Sol Izabella , Rodrigues Cristóvão Marcondes de Castro , Almeida Vinícius Lima de , Batista Jonas Dantas , Silva Cláudia Jordão
Published: June 2023

Introduction: Jaw fractures are one of the most common sites of maxillofacial injuries. The location of the jaw makes it very vulnerable to direct impacts. The purpose of treatment is to restore aesthetic function. Case Report: The purpose of this report is to present a case of comminuted mandible fracture in a young male patient, treated urgently due to the need for maintenance of the airways, where fracture osteosynthesis surgery was submitted. Conclusion: The initial assessment of these trauma patients should follow the Trauma Life Support protocol, and structural damage should be investigated. Introduction: Jaw fractures are one of the most common sites of maxillofacial injuries. The location of the jaw makes it very vulnerable to direct impacts. The purpose of treatment is to restore aesthetic function. Case Report: The purpose of this report is to present a case of comminuted mandible fracture in a young male patient, treated urgently due to the need for maintenance of the airways, where fracture osteosynthesis surgery was submitted. Conclusion: The initial assessment of these trauma patients should follow the Trauma Life Support protocol, and structural damage should be investigated.
New insight on antioxidants and anti-obesity properties of two Indonesian seagrass Thalassia hemprichii and Zostera marina: an integrated molecular docking simulation with in vitro study
Authors: Wagey Billy Theodorus , Gunawan William Ben , Lasabuda Ridwan , Mayulu Nelly , Al Mahira Msy Firyal Nadya , Lailossa Deogifta Graciani , Riswanda Fitra , Berta Elizabeth Levyna , Dewa Putra Mahakarya , Yudisthira Dewangga , Alisaputra Darmawan , Arnamalia Astri , Sabrina Nindy , Taslim Nurpudji Astuti , Hayes Clarin , Nurkolis Fahrul
Published: June 2023

Background: The oceans are teeming with a diverse range of marine organisms that offer unique health benefits, such as seagrass which is one of many key marine products that have garnered attention for their potential therapeutic properties. However, until now there have been few successful reports of seagrass’s metabolites profile and biological activity. Therefore, this work aims to profile metabolites or chemical constituents and assess the potential antioxidants and anti-obesity effects of two Indonesian seagrasses, Thalassia hemprichii and Zostera marina.

Methods: Once authenticated, T. hemprichii and Z. marina were extracted with two different solvents, polar (ethanol) and nonpolar (hexane). Metabolite profiling was performed using untargeted metabolomic profiling via liquid chromatography coupled to high-resolution tandem mass spectrometry method analysis, and then antioxidant and anti-obesity capabilities were assessed by molecular docking and in vitro studies on selected receptors.

Results: A total of 9 and 11 metabolites were observed from T. hemprichii and Z. marina and continued molecular docking. Some of the observed compounds have promising potential as inhibitors of human inducible nitric oxide synthase, reactive oxygen species (ROS) 1 kinase, human pancreatic lipase, and fat mass and obesity-associated (FTO) proteins, including luteolin, 6-hydroxy compounds luteolin O-glucoside, luteolin-O-sulphate, Thalassiolin A, Thalassiolin C, kaempferol-7,4'-dimethylether-3-O-sulfate, apigenin, and diosmetin. T. hemprichii ethanol extract (THE) EC50 value shows antioxidant capabilities via ABTS radical scavenging activity of 76.00 μg/mL, a smaller value than standard antioxidant controls (Trolox, 76.54 μg/mL) and followed by EC50 of lipase inhibition activity by THE which has the same pattern (EC50 THE < EC50 Orlistat).

Conclusions: This concludes that the two Indonesian seagrasses have promising biological activity as candidates for functional food and/or drugs in combating free radicals and obesity.