bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Laundry Practices in Eliminating Mpox Virus From Fabrics
Authors: Pitol Ana K , Richards Siobhan , Mirindi Patrick , Mahamed Hibak O , Baller April , Hughes Grant L , Beck Sara E
Published: December 2024

Background

The declaration of mpox as a public health emergency of international concern highlights the need for interventions to interrupt virus transmission, including transmission via fabrics. Current World Health Organization (WHO) guidance on clothes washing is based on a general consensus of virus inactivation; however, there is uncertainty about the efficacy of laundry detergents and disinfectants or the reduction of risk achieved by washing clothes for mpox virus (MPXV) specifically.

Methods

This study investigates the efficacy of manual washing for inactivating MPXV from clothes. Using a simulated washing method, we evaluated the efficacy of commonly used laundry products and high temperature water for inactivating MPXV on fabrics. Cotton and polyester fabrics were inoculated with MPXV for 1 minute, placed in a microcentrifuge tube containing water or water with test product for 20 minutes, with agitation every 5 minutes to simulate manual washing.

Results

Sodium hypochlorite, liquid sanitizer, and 2 powdered laundry detergents dissolved in room temperature water, as well as 70°C water alone, completely inactivated MPXV (>3 log10 reduction or >99.9% inactivation) on both cotton and polyester fabrics.

Conclusions

Given the expected concentrations of MPXV on fabrics, the low transfer rate of viruses from porous surfaces to skin, the effective inactivation of laundry processes, and the expected doses required for infection, we expect the risk of transmission after laundering contaminated fabrics to be low. This study provides evidence to support WHO guidance for MPXV inactivation, reducing the viral load on fabrics to prevent the spread of mpox in both health care and household settings.
Ubiquitous but heterogeneous: International organizations’ influence on public opinion in China, Brazil, Japan, and Sweden
Authors: Suong Clara H , Desposato Scott , Gartzke Erik
Published: December 2024

Existing work on the effect of international organizations’ (IOs) approval of the use of force on public support for it tends to focus on the established great powers in the Global North and its positive main effect. In this research note, we contribute to this literature in two ways with a survey experiment conducted in four countries: Brazil, China, Japan, and Sweden. First, we examine the generalizability of existing findings to relatively understudied countries that include aspiring great powers in the Global South. Second, we examine the heterogeneity of the effect of IOs’ authorization of the use of force. We confirm the generalizability of the positive effect of IOs’ approval on public support for war. At the same time, we find that individuals’ positive responses to IOs’ endorsement are heterogeneous and vary by their beliefs in militant internationalism and educational attainment, and by their home country.
Implementation of Integrated Clinical Pharmacogenomics Testing at an Academic Medical Center
Authors: Knezevic Claire E , Stevenson James M , Merran Jonathan , Snyder Isabel , Restorick Grant , Waters Christopher , Marzinke Mark A
Published: December 2024

Background

Pharmacogenomics has demonstrated benefits for clinical care, including a reduction in adverse events and cost savings. However, barriers in expanded implementation of pharmacogenomics testing include prolonged turnaround times and integration of results into the electronic health record with clinical decision support. A clinical workflow was developed and implemented to facilitate in-house result generation and incorporation into the electronic health record at a large academic medical center.

Methods

An 11-gene actionable pharmacogenomics panel was developed and validated using a QuantStudio 12K Flex platform. Allelic results were exported to a custom driver and rules engine, and result messages, which included a diplotype and predicted metabolic phenotype, were sent to the electronic health record; an electronic consultation (eConsult) service was integrated into the workflow. Postimplementation monitoring was performed to evaluate the frequency of actionable results and turnaround times.

Results

The actionable pharmacogenomics panel covered 39 alleles across 11 genes. Metabolic phenotypes were resulted alongside gene diplotypes, and clinician-facing phenotype summaries (Genomic Indicators) were presented in the electronic health record. Postimplementation, 8 clinical areas have utilized pharmacogenomics testing, with 56% of orders occurring in the outpatient setting; 22.1% of requests included at least one actionable pharmacogene, and 67% of orders were associated with a pre- or postresult electronic consultation. Mean turnaround time from sample collection to result was 4.6 days.

Conclusions

A pharmacogenomics pipeline was successfully operationalized at a quaternary academic medical center, with direct integration of results into the electronic health record, clinical decision support, and eConsult services.
Evaluation of kernel processing and processor type in whole-plant sorghum silage: effects on nutrient digestibility and animal performance in backgrounding beef heifers
Authors: Podversich Federico , Abdelhadi Leandro , Roskopf Sergio , Silva Gleise M , Angeli Emmanuel , Hein Gustavo J , Ortega Hugo H , Ruiz-Moreno Martin , Dubeux Jose C B , DiLorenzo Nicolas
Published: December 2024

Two experiments were conducted to assess the effects of feeding whole-plant sorghum silage (WPSS) with different kernel processing techniques (KP). Experiment 1 contrasted KP for WPSS on intake and apparent total tract digestibility (ATTD) in beef heifers (n = 24, 13 ± 1 mo, 267 ± 10.9 kg of initial body weight [BW]) housed in individual pens (36 m2). Grain sorghum was harvested at hard dough, switching the kernel processor to obtain the WPSS treatments: A) unprocessed (UNP), B) conventionally processed (CONV), and C) shredlage processed (SHRD). Heifers (8/treatment) received ad libitum WPSS from their respective treatment, plus soybean meal top-dressed at 0.5% BW/d (DM basis). Feed, and feces were collected for 5 d; feed was offered once daily, and orts were collected the following day. Fecal samples were collected twice daily, and ATTD was determined using indigestible neutral detergent fiber (NDF) as a marker. Data were analyzed as a completely randomized design, with heifer as the experimental unit, and the following contrasts were performed 1) Processing: UNP vs. (CONV + SHRD) and 2) Processor: CONV vs. SHRD. Processing WPSS increased the ATTD of starch by 4.5% (P = 0.01), reduced fecal starch by 27.5% (P = 0.01), and reduced the change of NDF from feed to orts by 39% (P < 0.01). Heifers fed SHRD had 6.6% greater ATTD of NDF than CONV-fed heifers (P = 0.04). Experiment 2 evaluated the effects of feeding either SHRD or CONV-processed WPSS on growth performance of beef heifers. Whole-plant grain sorghum was harvested at the hard-dough stage, switching the KP as in experiment 1. Angus heifers (n = 96, 15 ± 1 mo, 249.6 ± 28.6 kg of BW) were blocked by initial BW, and randomly assigned to pens (8 heifers/pen, 6 pens/treatment). Diets consisted, all on a DM basis, of WPSS, either SHRD or CONV, at 90.5%, expeller soybean meal at 7.0%, and a vitamin–mineral–protein concentrate at 2.5%. After 14-d of adaptation, growth was measured for 56 d, and feed was offered once daily. Data were analyzed using a randomized complete block design with the pen as the experimental unit. Heifers fed CONV had a 9.6% greater gain-to-feed ratio (P = 0.05) and a 7.4% greater Kleiber ratio (P = 0.05) than SHRD-fed heifers. Apparent net energy of gain tended to be 7.1% greater in CONV-fed heifers (P = 0.06). In conclusion, kernel processing WPSS increased starch digestibility and reduced fecal starch concentration. Using SHRD increased NDF digestibility and feeding CONV-processed WPSS resulted in enhanced growth performance.
Risk factors for osteonecrosis of the jaw in patients with chronic kidney disease: a nested case-control study
Authors: Iseri Ken , Hida Noriko
Published: December 2024

Osteonecrosis of the jaw (ONJ) is a severe disease leading to decreased quality of life, but risk factors for ONJ in chronic kidney disease (CKD) patients remain unclear. We conducted a nested case-control study using a large Japanese administrative database to investigate. CKD patients were identified based on estimated glomerular filtration rate (eGFR) measurements, and ONJ cases were identified using ICD-10 codes and diagnostic terms. Controls were matched 1:4 by age and sex. Among 597 026 CKD patients, 75 ONJ cases were identified during a median follow-up of 2.9 yr (incidence rate: 3.27 per 100 000 patient-years). A total of 375 patients (250 males, 66.7%) with a median age of 72 yr (interquartile range (IQR), 64-78) were included after matching controls. The use of bisphosphonates and denosumab for tumor-related disorders in the case group was significantly higher compared to the control group. There was no significant association between kidney functions and the ONJ risk. Multivariate analysis revealed that anti-resorptive drugs for tumor-related disorders [odds ratio (OR): 74.74, 95% confidence interval (CI): 8.81-634.39, p<.001] and oral corticosteroids (OR: 13.23, 95% CI: 3.34-52.33, p<.001) were significantly associated with increased ONJ risk, while anti-resorptive drugs for osteoporosis and injectable corticosteroid use were not. Other relevant factors such as diabetes, liver disease, anabolic drugs, and radiation therapy did not have a significant association with ONJ risk. When stratified by indications for bisphosphonate use (known to be eliminated by renal excretion), bisphosphonate use for tumor-related disorders showed a significant association with ONJ risk (OR: 27.80, 95% CI: 2.47-313.29, p<.01), while bisphosphonates use for osteoporosis did not (OR: 0.74, 95% CI: 0.19-2.92, p=.67). These findings suggest that anti-resorptive drugs for tumor-related disorders and oral corticosteroids are associated with ONJ risk in CKD patients. Heightened surveillance may be necessary for CKD patients receiving these treatments to prevent or detect ONJ early.
Enhanced fatty acid oxidation in osteoprogenitor cells provides protection from high-fat diet induced bone dysfunction
Authors: Nandy Ananya , Helderman Ron C M , Thapa Santosh , Peck Sun H , Richards Alison , Jayapalan Shobana , Narayani Nikita , Czech Michael P , Rosen Clifford J , Rendina-Ruedy Elizabeth
Published: December 2024

Bone homeostasis within the skeletal system is predominantly maintained by bone formation and resorption, where formation of new bone involves maturation of stromal cells to mineral and matrix secreting mature osteoblasts, which requires cellular energy or adenosine triphosphate. Alterations in systemic metabolism can influence osteoblast function. In line with this, type 2 diabetes mellitus (T2DM), a common metabolic disorder is also associated with reduced bone formation and increased risk of fracture. Impairment in lipid metabolism is one of the key features associated with T2DM-related pathologies in multiple tissues. Therefore, we tested the hypothesis that the reduced bone formation reported in obese murine models of impaired glucose tolerance is a function of disrupted lipid metabolism in osteoblasts. We first confirmed that mice fed a high-fat diet (HFD) have reduced bone microarchitecture along with lower bone formation rates. Interestingly, osteoblasts from obese mice harbor higher numbers of cytosolic lipid droplets along with decreased bioenergetic profiles compared to control cells. Further supporting this observation, bone cortex demonstrated higher total lipid content in HFD fed mice compared to control-fed mice. As a further proof of principle, we generated a novel murine model to conditionally delete Plin2 in osteoblast-progenitor cells using Prrx1-Cre, to enhance lipid droplet breakdown. Our data demonstrate that knocking down Plin2 in an osteoprogenitor specific manner protects from HFD induced osteoblast dysfunction. Furthermore, the mechanism of action involves enhanced osteoblast fatty acid oxidation. In conclusion, the current studies establish that HFD induced glucose intolerance leads to perturbations in osteoblast lipid metabolism, thus causing lower bone formation, which can be protected against by increasing fatty acid oxidation.
Verifying the effectiveness of romosozumab re-administration on bone mineral density
Authors: Kobayakawa Tomonori , Nakamura Yukio
Published: December 2024

Upon completing romosozumab therapy for osteoporosis, sequential treatment with other agents is required. However, for patients at high fracture risk despite such therapy, re-administration of romosozumab might be a potent subsequent option to prevent additional fractures. Currently, there is insufficient real-world clinical data verifying the efficacy of romosozumab re-administration. This study evaluated its efficacy. We enrolled 72 osteoporosis patients who remained at high risk of fractures after a 12-mo course of romosozumab, followed by sequential therapy either with bisphosphonates, denosumab, or teriparatide. Patients were re-administered another 12-mo romosozumab to assess changes in bone mineral density (BMD) and the percentages of patients achieving a T-score > −2.5 at the completion. Our result exhibited that BMD at the lumbar spine and femoral neck increased significantly through the re-administration phase (p < .001). The percentage of patients achieving a T-score > −2.5 in the lumbar spine, total hip and femoral neck increased significantly compared to before initial romosozumab therapy, with the greatest improvement seen after re-administration (all p < .001). Bone formation markers increased significantly (p < .001) during re-administration, while resorption markers showed no significant change (p = .408). The impact of prior sequential therapy was also evaluated. BMD increased significantly at all sites for patients who received bisphosphonates as sequential therapy (p < .05). After denosumab therapy, significant BMD increases were observed only in the lumbar spine (p < .01), while the total hip and femoral neck showed no significant change. After teriparatide therapy, BMD temporarily decreased during the sequential period but increased significantly after romosozumab re-administration, especially in the lumbar spine and femoral neck (both p < .001). In conclusion, romosozumab re-administration is an effective treatment. Furthermore, its efficacy varies depending on the sequential therapy used, with the highest effectiveness seen in the order of teriparatide, bisphosphonates, and denosumab.
Fearing Meningitis: Disease, Emotions and the Spotted Fever Epidemics of 1904-1907
Authors: Miller Ian
Published: December 2024

The meningitis (or spotted fever) outbreaks (c.1904-1907) caused worldwide alarm but remain largely forgotten. This article uses these outbreaks as an invaluable case study for understanding early twentieth-century responses (individual and collective) to a mysterious, potentially deadly infection. More specifically, it focuses on the social production of fear until physicians and medical scientists devised new ways of making meningitis more manageable, with reference to a range of actors who shaped public responses and feelings. Ultimately, the article argues that initial attempts to warn and educate about meningitis usually promoted fear and avoidance, but as meningitis became more manageable, emotional responses to its outbreaks altered significantly. Emotions were constructed and experienced in the context of a new medical modernity optimistic about public health and clinical interventions. Exploring the physical and emotional in tandem takes us to the heart of societal and personal experience of disease outbreaks.
Introduction: Invasive Species, Global Health, and Colonial Legacies
Authors: Skotnes-Brown Jules , Lynteris Christos
Published: December 2024

Bringing together seven papers spanning Southern and Eastern Africa, North America, England, and India, this special issue explores the historically neglected connections between invasive species and health in the long twentieth century. Drawing upon perspectives from medical history, the history of science, environmental history, and environmental as well as medical anthropology, the papers analyze the entanglements of invasive species and zoonotic disease, food security, pesticide, crime, and ecosystem health. This introduction provides an overview of the historiography of invasive species and argues the importance of studying the historical connections between invasives and health. It also historicizes the relations between animal invasions, technoscience, power, and colonialism.
From calico to catwalk: Addressing the UK’s enduring issue of fashion piracy
Authors: Wickens Alice
Published: December 2024

This article examines the long-standing issue of fashion piracy. By drawing parallels between the experiences of 18th and 19th century British calico printers and modern-day fashion designers, it notes that, despite living in vastly different ages, both groups face similar challenges when copied. While acknowledging certain unavoidable challenges, like the ever-improving ability to make knock-offs and the challenge of defining what constitutes a ‘copy’ in the cyclical and repetitive world of fashion, it argues that having an IP system is clearly preferable to having no protection at all. However, it emphasizes that more research is needed to establish the effectiveness of IP law, and improve it, particularly the use of pre-litigation settlements. It also suggests that greater effort should be put into making IP law—particularly, design rights, which are often costly and difficult to navigate—more accessible to all fashion designers.
Description of mitochondrial genomes and phylogenetic analysis of Megophthalminae (Hemiptera: Cicadellidae)
Authors: Sun Mingming , Wang Jiajia , Smagghe Guy , Dai RenHuai , Wang Xianyi , Yang Yanqiong , Li Min , You Siying
Published: December 2024

To elucidate phylogenetic relationships within the leafhopper’s subfamily Megophthalminae (Hemiptera: Cicadellidae), mitogenomes of 12 species of the subfamily were sequenced and assembled. These were added to the mitogenomes of the eight other species that are currently available. Mitogenome size ranged from 15,193 bp in Onukigallia onukii (Matsumura, 1912) to 15,986 bp in Multinervis guangxiensis (Li and Li, 2013), they all contained 37 genes, and gene order was similar to that in other leafhoppers. Nucleotide composition analysis showed that the AT content was higher than that of GC, and the protein-coding genes usually ended with A/T at the 3rd codon position. The Ka/Ks ratio showed that the CYTB gene has the slowest evolutionary rate, while ND4 is the gene with the fastest evolutionary rate. Relative synonymous codon usage analysis revealed the most frequently used codon was UUA (L), followed by CGA (R), and the least frequently used codon was CCG (P). Parity plot and neutrality plot analyses showed that the codon usage bias of mitochondrial genes was influenced by natural selection and mutation pressure. However, natural selection plays a major role, while the effect of mutation pressure was small. Effective number of codons values were 40.15–49.17, which represented relatively low codon bias. Phylogenetic analyses based on three datasets (AA, 13PCG, 13PCG_2rRNA) using two methods (maximum likelihood and Bayesian inference). In the obtained topology, the Megophthalminae species were clustered into a monophyletic group. In conclusion, our results clarify structural modules of the mitochondrial genes and confirm the monophyly of Megophthalminae within Cicadellidae.
IL-17A/IFN-γ producing γδ T cell functional dichotomy impacts cutaneous leishmaniasis in mice
Authors: dos-Santos Júlio Souza , Firmino-Cruz Luan , Oliveira-Maciel Diogo , da Fonseca-Martins Alessandra Marcia , Ramos Tadeu Diniz , Nunes-Sousa Letícia , Bittencourt dos Santos Igor , Pedro Soares Rodrigo , Claudio Oliveira Gomes Daniel , Mengel José , Silva-Santos Bruno , de Matos Guedes Herbert Leonel
Published: December 2024

γδ T cells play diverse roles in immune responses, producing either interleukin (IL)-17A or interferon γ (IFN-γ). Here, we investigated the impact of this functional dichotomy on cutaneous leishmaniasis. We demonstrate that in Sv129 mice susceptible to Leishmania amazonensis, Vγ4+ γδ T cells are the main source of IL-17A. In type 1 IFN receptor–deficient (A129) mice with heightened susceptibility, there is an increased frequency of IL-17A–producing γδ T cells. L. amazonensis' lipophosphoglycan induces these IL-17A–producing γδ T cells. Notably, C57BL/6 mice deficient in γδ T cells or IL-17 receptor exhibit smaller lesions, indicating a pathogenic role of IL-17A–producing γδ T cells in cutaneous leishmaniasis. Conversely, adoptive transfer of fluorescence-activated cell sorting (FACS)–sorted γδ T cells lead to an accumulation of IFN-γ–producing γδ T cells, associated with control of lesion development. On the other hand, adoptive transfer of FACS–sorted IFN-γ–deficient γδ T cells abolished the control of lesion development. These data demonstrate a pathophysiological dichotomy in which IL-17A–producing γδ T cells promote pathogenesis, while IFN-γ–producing γδ T cells offer therapeutic potential in cutaneous leishmaniasis.
Differential long-term tamoxifen therapy benefit by menopausal status in breast cancer patients: secondary analysis of a controlled randomized clinical trial
Authors: Johansson Annelie , Dar Huma , Nordenskjöld Anna , Perez-Tenorio Gizeh , Tobin Nicholas P , Yau Christina , Benz Christopher C , Esserman Laura J , van ‘t Veer Laura J , Nordenskjöld Bo , Stål Olle , Fornander Tommy , Lindström Linda S
Published: December 2024

Background

Estrogen receptor–positive breast cancer patients have a long-term risk of distant metastatic disease, and premenopausal patients have a higher risk. Randomized studies with long-term follow-up are essential to understand treatment benefit. We elucidated the long-term tamoxifen therapy benefit by menopausal status in the Stockholm tamoxifen trials with 20 years complete follow-up.

Methods

Secondary analysis of 1242 estrogen receptor–positive and HER2-negative patients that were randomly assigned to 2-5 years of 40 mg adjuvant tamoxifen or no endocrine therapy. Distant recurrence-free interval in tamoxifen-treated vs endocrine untreated patients was assessed by Kaplan–Meier, Cox proportional hazards regression, and time-varying analyses.

Results

In premenopausal patients, a statistically significant tamoxifen benefit was observed for lymph node–negative (adjusted hazard ratio [HR] = 0.46, 95% confidence interval [CI] = 0.24 to 0.87), progesterone receptor–positive (adjusted HR = 0.61, 95% CI = 0.41 to 0.91), and genomic low-risk tumors (adjusted HR = 0.47, 95% CI = 0.26 to 0.85) but only lasted beyond 10 years for genomic low-risk tumors. Postmenopausal patients showed long-term benefit for all good-prognosis markers including low-grade (adjusted HR = 0.55, 95% CI = 0.41 to 0.73), lymph node–negative (adjusted HR = 0.44, 95% CI = 0.30 to 0.64), progesterone receptor–positive (adjusted HR = 0.60, 95% CI = 0.44 to 0.80), Ki-67 low (adjusted HR = 0.51, 95% CI = 0.38 to 0.68), and genomic low-risk tumors (adjusted HR = 0.53, 95% CI = 0.37 to 0.74), and regardless of tumor size (≤20 mm: adjusted HR = 0.55, 95% CI = 0.39 to 0.77; >20 mm: adjusted HR = 0.64, 95% CI = 0.44 to 0.94). Premenopausal patients with no poor-prognosis tumor characteristics (clinical marker score = 0) showed early benefit and postmenopausal long-term benefit.

Conclusions

Our study suggests differential tamoxifen benefit by menopausal status. Improved long-term endocrine therapy prediction in premenopausal patients is needed and could involve molecular markers because standard tumor characteristics cannot predict benefit beyond 10 years.
Mechanically modeling chemical mechanical planarization from wafer to molecular scales: a review and discussion of future direction
Authors: Tsai Kuan-Ting Yeh and Hung-Yin
Published: December 2024

The chemical mechanical planarization (CMP) process plays an increasingly important role in integrated circuit (IC) manufacturing. To understand the mechanism broadly, we review different scales of models describing the removal phenomenon and predicting the material removal rate (MRR). At the wafer scale, there is the empirical Preston equation and its extensions incorporating different mechanical and chemical factors. Toward feature and particle scales, we introduce several models postulating the material removal mechanism and their experimental verification. Finally, we mention several mechanical models on the molecular scale and propose that at the moment they lack generality and do not give us further useable, quantifiable insight into the CMP phenomenon. We conclude with how we may, and should, achieve finding this mechanical model on a molecular scale.
Does a religious universalism haunt secular religious education?
Authors: Lewin David
Published: December 2024

Contemporary theories of non-confessional religious education (RE) imagine the subject as inclusive and non-indoctrinatory. Any latent confessional tendencies towards universalism—encouraging or promoting a singular religious vision—have been exorcised within secular, liberal education systems. But can universalism be so easily avoided? In this article, I argue that some forms of universalism are unjustified, while others are educationally inevitable. The argument acknowledges that failures to distinguish between different forms of universalism lead to confusion about the purposes and justification of RE, and contribute to the poor status of the subject in schools within England and Wales. Knowing when, how, and why universalism operates educationally can help to improve all kinds of education, particularly RE. This article is part of a suite of articles, titled ‘Universal Individuals’, which explore the relations and tensions between forms of universalism (political, civic, philosophical) and individualism.
Medicines safety information from regulators in clinical practice guidelines: a mixed-method case study
Authors: Andersen Armin , Møllebæk Mathias , Almarsdóttir Anna Birna
Published: December 2024

Objectives

The role of Danish clinical practice guidelines in making the health care sector aware of and act in accordance with medicines safety information from regulators, has not been extensively studied. The objectives of this study were 1) to describe the extent to which information from additional risk minimization measures is included in Danish clinical practice guidelines and 2) to explore guideline developers’ attitudes towards including additional risk minimization measures in Danish clinical practice guidelines.

Methods

The study focused on five therapeutic areas and combined quantitative document analyses of 91 Danish clinical practice guidelines and qualitative semi-structured interviews with 14 key informants expected to have knowledge about the guideline development in Denmark.

Key findings

The average inclusion rate of clinical actions from additional risk minimization measures in Danish clinical practice guideline is low (3.5%), and guideline developers have a low willingness to include information originating from additional risk minimization measures in the guidelines. Guideline developers typically claim to have sufficient access to new risk information on medicinal products via other sources, especially direct and targeted messages.

Conclusions

The findings confirm previous studies highlighting the paramount role of direct and targeted messages as opposed to guidelines when disseminating medicinal risk information to clinicians. The findings provide a new in-depth understanding of attitudes towards various types of medicinal risk information in clinical practice and guidelines and give rise to future studies assessing clinicians’ access to, awareness of, compliance with, and unmet needs regarding any medicinal risk information.
Infections and Antibiotic Resistance in Malawian Children Under Five-Years Old Hospitalized With Severe Acute Malnutrition
Authors: Vonasek Bryan J , Nyirongo Mwawi , Kondwani Alexander , Kamvaunamwali Tiwonge , Ng’oma Doris , Ciccone Emily J , Kaphatika James , Tepeka Amazing-Grace , Kumwenda Mercy , Eickhoff Jens , Garcia-Prats Anthony J , Mvalo Tisungane
Published: December 2024

This prospective cohort study from Malawi updates our understanding of the burden of bacterial infections and drug resistance in children <5 years hospitalized with severe acute malnutrition. Urinary tract infection was diagnosed in 20% and bacteremia in 10%. Resistance to first- and second-line antibiotics occurred in >1/3 of the bacteria isolated.
(025) IMPLANTABLE NEUROSTIMULATOR FOR ERECTILE FUNCTION TREATMENT ON SPINAL CORD INJURED PATIENTS – EARLY RESULTS
Authors: Glina S , Seligra Lopes L , Neves Neto O , Lessa P , Glina F , Juliano R , Cintra C , Rios L
Published: December 2024

Introduction

Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, many men present with erectile dysfunction (ED). Recently, an implantable neurostimulator (CaverSTIM) has been developed to deliver electrostimulation to the cavernosal nerves. This is a first-in-human investigation to evaluate CaverSTIM safety, tolerability, and effectiveness in patients with SCI.

Objective

The purpose of this study is to assess in a limited number of SCI patients the long-term safety and tolerability of CaverSTIM, as a method for enhancing penile erection in the treatment of ED.

Methods

Men with stable SCI, which occurred at least 1 year prior to study enrolment with IIEF-15 score of the erectile function domain (sum of questions 1, 2, 3, 4, 5 and 15) equal to or less than 25 points and responsive to PDE-5 inhibitors were recruited. CaverSTIM was implanted by extraperitoneal video laparoscopy procedure. After stabilizing the pneumoperitoneum, the ventral prostatic fat was removed and the puboprostatic ligaments will be identified. The endopelvic fascia will be carefully dissected, bilaterally, to expose the neurovascular bundles and the paddles of the device were inserted with the electrodes facing the neurovascular bundle and an intraoperative stimulation will be performed to optimize paddle positioning prior to fixation. The implantable pulse generator was implanted subcutaneously in the lower abdomen. Patients were followed for 6 months. Erectile function of all participants was assessed at 44, 90 and 180 days after surgery, using the IIEF questionnaire.

Results

In this ongoing investigation, 5 patients have been successfully implanted with CaverSTIM. No serious adverse event has been observed and the device was well tolerated. Functional data with IIEF 6 at 44 days post-operative has been collected from 4 patients until now as shown in Fig. 1.

Conclusions

CaverSTIM implantation in SCI patients seems to be safe and well tolerated. Early results indicate Caverstim shows promise in improvement of the erectile function of those patients.

Disclosure

Yes, this is sponsored by industry/sponsor: Comphya.

Clarification: Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: Comphya.
(034) ARTIFICIAL INTELLIGENCE (AI) AS AN AID FOR ADULT MEN WITH LOWER URINARY SYMPTOM (LUTS)
Authors: Wang EY , Malmström P
Published: December 2024

Introduction

Lower Urinary Symptom (LUTS) are very common among adult men, but they rarely seek medical help, and these issues are not prioritized in healthcare, leading to long wait times to visit a doctor. The potential of AI as an aid has received considerable attention, and a number of apps have started being used in the interaction between patients and healthcare providers. For women with urinary incontinence, there is now an AI applications (APP) reported to give good results. However, for men, there is no available app. Our hypothesis in this study is that AI algorithms applied to self-generated data can provide recommendations that men can follow during the often long wait for a doctor’s visit. We believe that the APP can be used as a complement to a medical examination and thus serve as decision support for healthcare providers in primary care.

Objective

The purpose of our project is to investigate whether it is possible to partially replace a visit to the health center for men with LUTS by the help of digital medical history and AI-generated individualized recommendations. Furthermore, the collected data can serve as decision support for healthcare providers in outpatient care.

Methods

Our project is divided into four phases: Phase 1: A retrospective database was established based on data collected during routine doctor’s visits. From this, an algorithm is developed using AI. Phase 2: A prospective database is established with data on patients managed in primary care. The aim is to validate the previously developed algorithm. When patients visit a doctor, they are asked if they want to participate in a study where their information is anonymized and used in the database. Phase 3: The goal is to investigate whether the mobile application can be useful during a doctor’s visit. Phase 4: The value of the app will be evaluated in a randomized study.

Results

Phase 1: An app with questions that mimic a standardized medical interview has been developed. Phase 2: 150 men over 50 years old with urinary problems will be recommended to fill out the IPSS (symptom questionnaire), a fluid diary and perform urine flow measurements at home. We now have results from the first evaluable 50 patients. It seems relatively few receive treatment at the first visit. Less than half received the same treatment recommendation at the first visit that the AI algorithm would have suggested. Phase 3 and Phase 4: on going.

Conclusions

As far as we know, this study will be the first to evaluate the possibilities of improving the health of adult men using digital medical history and AI-based advice. In addition to better quality of life, it can also lead to reduced strain on healthcare by saving medical visits and improving the management of such visits through pre-answered questionnaires.

Disclosure

No.
(040) ASSOCIATION BETWEEN STROKE AND ERECTILE DYSFUNCTION: RESULTS FROM A CROSS-SECTIONAL STUDY AND MENDELIAN RANDOMIZATION ANALYSIS
Authors: Dilixiati D , Kadier K , Zhang W , Lu J , Aisihaer M , Azhati B , Rexiati M
Published: December 2024

Introduction

The relationship between stroke and erectile dysfunction (ED) remains insufficiently understood. This investigation seeks to elucidate the connection between the stroke and ED.

Objective

This investigation seeks to elucidate the connection between the stroke and ED.

Methods

This study encompassed both cross-sectional analysis and Mendelian randomization(MR) investigations. The cross-sectional study enrolled 4110 male participants selected from the National Health and Nutrition Examination Survey (NHANES) database spanning 2001-2002, representing a total population of 87 355 061 males in the United States. Genetic variants associated with stroke as well as its subtypes and ED were identified through genome-wide association studies (GWAS). MR analysis was utilized to investigate the distinct causal relationships between stroke and its subtypes with ED. Various tests were conducted to assess both heterogeneity and pleiotropy within these associations.

Results

In the cross-sectional study, the prevalence of ED among individuals with stroke was found to be 67.72% (95% CI, 55.76-79.68). The multivariate model’s findings reveal a positive correlation between stroke and an elevated prevalence of ED in the US population (OR 2.45; 95% CI, 1.24-4.86; P < 0.001). In the MR study, the results from the inverse variance weighted (IVW) analysis demonstrate a significant association between stroke and an increased risk of ED, with an OR of 1.282 (95% CI, 1.052–1.562).

Conclusions

Our study delineates a substantial correlation between stroke and ED, as evidenced by a cross-sectional analysis encompassing a representative sample from the United States population. Moreover, the results derived from the MR study provide compelling evidence of a causal link between stroke and ED.

Disclosure

No.
(065) ASSOCIATION BETWEEN LEVATOR ANI MUSCLE AVULSION INJURY AND SEXUAL FUNCTION IN PAROUS WOMEN
Authors: Morin M , Dumoulin C , Kruger J , Tu LM , Mayrand M , Dubois M , Girard I , Wong V
Published: December 2024

Introduction

Childbirth is a major risk factor for levator ani muscle (LAM) trauma. In 21%-36% of women, stretching of the LAM leads to an avulsion injury, which is the detachment of the LAM from its insertion points on the pubic symphysis. LAM avulsion injury has been found to be significantly associated with important consequences such as higher rates and greater severity of stress urinary incontinence and pelvic organ prolapse. However, little is known about the impact of this obstetrical injury on sexual function.

Objective

This study aimed to examine the association between LAM avulsion injury and sexual function in parous women.

Methods

This multicenter prospective study involved 322 primiparous and multiparous women aged 18 to 45 years. Participants underwent a 3D/4D transperineal assessment, ≥ 3-month after delivery with a physiotherapist experienced in assessing LAM injury. The avulsion diagnosis was confirmed by two offline reviewers blinded to the patient’s clinical data following a validated protocol. A third reviewer was involved in case of discrepancy. Sexual function was measured with the Female Sexual Function Index (FSFI) questionnaire. Multiple linear regressions were computed to examine the association between avulsion injury and sexual function while controlling for potentially confounding variables (maternal age, time since last childbirth, stage of perineal tears 0-4, use of hormonal contraception, breastfeeding, urinary incontinence assessed with the International Consultation Incontinence Questionnaire – Urinary Incontinence (ICIQ-IU-SF), and pelvic organ prolapse evaluated with the Pelvic Organ Prolapse Symptom Score (POPSS).

Results

Of the 322 women who completed the study, 194 had an intact LAM, 77 had a unilateral avulsion, and 51 had a bilateral avulsion. Participants had a median parity of 2 (IQR 2-3) as well as a median of 4.4 (IQR 1.7-9.4) years since last childbirth. Avulsion was significantly associated with lower sexual function (β = -0.143, p = 0.011) as measured by the FSFI total score. Further analyses of the FSFI domains revealed that avulsion was also significantly associated with lower arousal (β = -0.160, p = 0.004), decreased lubrication (β = -0.128, p = 0.023) and lower orgasm (β = -0.146, p = 0.010).

Conclusions

The findings of this study support the role of LAM avulsion in sexual dysfunction. LAM avulsion was associated with poorer sexual function overall and more specifically, lower arousal, lubrication, and orgasm. Given the impact of LAM avulsion on sexual function, women diagnosed with this obstetrical injury should be screened for sexual dysfunction and offered appropriate treatment and counselling. Further research is needed to explore effective interventions and support for sexual dysfunctions in women sustaining this injury.

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No.
(067) UNCONSUMMATED MARRIAGE AMONG COUPLES COMPLAINING OF INFERTILITY
Authors: Kaabia O
Published: December 2024

Introduction

Unconsummated marriage (UCM) is defined as the failure at all attempts of vaginal coitus that a faithful couple, married or not, might have tried in vain, for at least 3 consecutive months of night-time cohabitation. It is a common medical and social problem facing fertility specialists in conservative communities.

Objective

This study aims to report the prevalence of unconsummated marriage among couples consulting for infertility. The secondary aim is to identify the clinical features and describe the therapeutic approaches of unconsummated marriage (UCM) among couples consulting for infertility.

Methods

This is a case series including the couples diagnosed with UCM among those initially complaining of infertility between July 2021 and June 2023 at our fertility consultation.

Results

Among the 879 couples consulting for infertility, 15 have been diagnosed with UCM, with a prevalence of 1.7%. The mean age of the husbands was 34,20 ± 9,14 years, and that of the brides was 29,64 ± 5,62 years. The average length of marriage was 15 months (range 1–45 months). The sexual dysfunctions noted were: erectile dysfunction (ED) in 5 cases, premature ejaculation in 2 cases, a low sexual desire in men in 2 cases, and vaginismus in 6 cases. The first-line treatment was based on sex education and sex therapy, associated in all cases of ED with oral drugs. After a mean follow-up of 3 months (range 1–12 months), the outcomes of treatment were: good prognosis with consummation of marriage in 13 cases, failure with persistent UCM in 2. The fertility complaint was treated independently of the UCM with intra-vaginal insemination.

Conclusions

UCM is quite frequent among the population of couples complaining of infertility in conservative societies. The best treatment is prevention based on sexual education and premarital counseling. The treatment of the sexual dysfunctions is independent of the quest for fertility.

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No.
(076) SERUM TESTOSTERONE LEVEL AS A PREDICTOR OF ADVERSE PATHOLOGICAL OUTCOMES IN MEN WITH PROSTATE CANCER
Authors: Mulhall J , Elshafei A , Flores J
Published: December 2024

Introduction

Debated in the literature is the link between total testosterone (TT) levels and pathological outcomes in prostate cancer (CaP) patients, with some literature suggesting that low TT levels predict higher grade/stage cancer. We investigated the correlation between preoperative TT and the presence of unfavorable pathology (UP) in such men.

Objective

We investigated the correlation between preoperative TT and the presence of unfavorable pathology (UP) in such men.

Methods

Men with CaP treated with RP constituted the analyzed population. Men who had androgen deprivation therapy (ADT) prior to RP or within 3 months after RP were excluded from the study. Morning TT levels were measured by LCMS within 3 months of RP with low TT defined as <300 ng/dl. UP was defined as any Gleason grade grouping (GGG) with extracapsular extension (ECE), seminal vesicle invasion (SVI), positive surgical margins (PSM) and lymph node involvement (LNI) or GGG ≥4 irrespective of other pathological parameters. Variables included in the univariate model (UVA): age, comorbid conditions, pre-RP PSA, clinical T stage (cT), biopsy GGG, total MRI prostate volume (PV), and low TT. Multivariable analysis (MVA) was conducted to define independent predictors of UP using those factors found to be significant on UVA.

Results

1599 men were analyzed. Median age 63 (57, 68) years, PSA 6 (4,9) ng/ml, TT 447 (343, 575) ng/dl. Median GGG 2 (2, 3). 57% had ECE, 12% SVI, 22% PSM, 14% LNI. On UVA, older age (p < 0.001), clinical stage ≥T2b (p < 0.001), higher pre-RP PSA (<0.001), higher biopsy GGG (p < 0.001), and smaller MRI PV (p = 0.001) were significantly associated with UP while peri-operative TT (≤300 ng/dl) (p = 0.8) was not associated with UP. On MVA, higher biopsy GGG, clinical stage ≥T2b, higher pre-RP PSA, smaller PV and older age were independent predictors of UP, while peri-operative TT (≤300 ng/dl) was not associated with UP. (Table) Furthermore, we found no correlation between very low TT (≤200 ng/dl) and UP.

Conclusions

Peri-operative TT is not associated with adverse pathology in men treated by RP.

Disclosure

No.
(079) IMPLEMENTATION OF A HYBRID VIRTUAL/IN-PERSON SEXUAL HEALTH CLINIC IN A HIGH- VOLUME CANCER CENTRE
Authors: Matthew A , Incze T , Stragapede E , Guirguis S , Peres D , Kemerer B , Elterman D
Published: December 2024

Introduction

Sexual health concerns are some of the most prevalent and challenging side effects of cancer treatment. A hybrid virtual and in-person Sexual Health Clinic (SHC) was recently established within a high-volume Cancer Centre to provide patients with comprehensive sexual health assessment and intervention. Previous research has highlighted the importance of implementation in the achievement of successful outcomes. As part of a robust program evaluation, implementation research methods were used to support the integration of the SHC.

Objective

The objective of this study was to employ a systematic framework to guide the implementation of an innovative hybrid virtual and in-person SHC within an oncology setting.

Methods

The study setting was a high-volume oncology Centre situated in a large urban setting. Participants were purposefully sampled to ensure involvement of relevant stakeholders, including healthcare providers (HCPs) and patient participants representing each identified cancer site (eg, prostate, testicular, bladder, kidney, cervical, ovarian and head & neck cancers). The Quality Implementation (QI) Framework was used to guide the knowledge translation and implementation strategy. The procedure involved conducting 30-minute, semi-structured interviews with patients, clinic personnel, and oncologists. The interviews were transcribed and analyzed using Framework Analysis methodology. The goal of the interviews was to determine ideal SHC implementation methods directly from the perspectives of both patients and HCPs.

Results

In total, 20 semi-structured interviews were conducted (6 patients and 14 HCPs) transcribed and analysed. After employing the Framework Analysis Method, 3 main themes and 10 subthemes were determined. The 3 main themes and associated sub themes include: 1) Recognized Need (Current Gap in Care, Common Concerns Across Populations, and Unique Needs by Population); 2) Confinements of Current Care (Mutual Avoidance/Silence, Concern of Providing Inadequate Care, and Lack of Time); and 3) Strategic Implementation (Need for a Unique Space and Team, Need for Flexibility, Need for Patient Awareness, and Multiple and Ongoing Engagement into Patient Workflow).

Conclusions

This study successfully identified the barriers and facilitators to implementing a hybrid in-person/virtual SHC within a high-volume urban oncology Centre. These findings offer practical insights into integrating sexual health programming into patient workflows, enhancing patient accessibility and engagement.

Disclosure

No.