bluuebunny/crossref_metadata_2025 huggingface dataset:
Modern universal standardised trends in worker and public exposure monitoring and control in 21st century by Sohrabi URPS-based hypothesis
Authors: Sohrabi M
Published: November 2023

The Universal Radiation Protection System (URPS) was recently hypothesised by Sohrabi in order to address the many deficiencies of current radiation protection system. The ICRP system is currently practiced worldwide based on the linear no-threshold (LNT) model with no supporting health risk data at low effective doses. The ICRP only considers worker occupational doses and sets dose limits only on one portion of doses a worker or public receives. The URPS hypothesis equals human heath-effect risks per unit dose either from natural or man-made sources; formulates dose limits on all integrated doses an individual receives; considers worker also a member of public; conserves ‘cause-effect principle’ for epidemiology risk estimation; introduces dose fractionation concept in radiation protection; introduces the ‘URPS Model’ for bridging LNT, hormesis and threshold models; recommends establishing ‘National Patient Dose Registering System’; and defines modified/new exposure terms and definitions commensurate with URPS hypothesis, as advanced since 2014.
Oklo: historic and lessons learned
Authors: Nimal J C
Published: November 2023

Two outstanding phenomena have taken place in earlier geological era where Gabon is now located: the presence of natural nuclear reactors and the appearance of a very elaborated form of life for its age. Calculations performed to establish the sustained fission history of Oklo site are presented first. Second, possible correlations between these two anomalies are discussed. Could the presence of ionizing radiation be the cause of genetic mutations? Today’s isotopic measurements allow us to improve our understanding of the irradiation suffered by organic matter over all times. The first objective is therefore to quantify the possible effects of such ionizing radiation. A second objective naturally appears: the storage of radioactive waste. Calculations issued from the first objective provide access to nuclear reactor waste formations and Oklo is the unique natural analogue of a long-term storage laboratory for nuclear waste. Returning to our primary objective, it is interesting to extend our reflections to other situations of naturally radioactive environments such as very old geological formations or lagoon.
Oklo, our scientific adventure with R. Naudet
Authors: Weber Francis
Published: November 2023

Following several years of studies of the Francevillian basin, I was a specialist of the Gabonese geology. Since the discovery of the Oklo phenomenon, I worked with Roger Naudet, Jean-Paul Pfiffelmann and François Gauthier-Lafaye on this exceptional scientific case. This article relates the beginning of this adventure.
Assessment of radioactivity levels and radiological hazard indices in phosphate and phosphate mine waste samples from Algeria
Authors: Djabou Rihab Elhouda , Belafrites Abdelfettah
Published: November 2023

Phosphate ore is the starting raw material for production of all phosphate products including fertilisers phosphate waste. It can be of sedimentary, volcanic or biological origin. Like any other geological material found in nature, it contains various amounts of naturally occurring primordial radionuclides, such as 238U series, 232Th series and 40K. Gamma-ray spectrometry was used to assess natural radioactivity levels and radiological hazard indices in phosphate samples. In this paper, the specific activity concentrations of 226Ra, 232Th and 40K of phosphate ores, merchant and mine waste samples were determined. Based on the activity concentrations, the radiation hazard indices (Raeq, Hex, Hin and I𝛾𝑟), and the radiation doses (D, AED and ELCR) were calculated. The results were discussed and compared with those from other studies as well as recommended safety limit values.
Environmental radiological baseline in unconventional oil and gas areas of Mexico
Authors: Hernández-Méndez Beatriz , Balcázar Miguel , Carranza Arturo Ángeles , Suárez-Contreras Sergio , Ponce Esperanza Quintero , Robles Mario Bárcenas , Meza Juan Carlos Sánchez , Segura Edith Erielia Gutiérrez
Published: November 2023

Environmental radioactivity study was performed in unconventional hydrocarbons areas for the first time in Mexico, where four unconventional hydrocarbon exploratory wells (UHEW) are planned. This study assesses natural radiological conditions in areas around UHEW. Equivalent dose rate distribution displayed in Geographic Information System (GIS) had a maximum of 1.83 mSv a−1 and minimum of 0.04 mSv a−1, GIS was also used for introducing land usage, water resources and population occupancy. Measurements of gross alpha and gross beta in water were below the national permissible limits for drinking water 0.5 and 1.0 Bq L−1 respectively, even though samples do not correspond to drinking water. Evaluation of 238U and 226Ra in groundwater were below minimum detectable concentration 1.3 and 1.0 Bq L−1, respectively. This study provides a radiological baseline for the impact of future industrial activities, especially if exploitation of unconventional hydrocarbons produces naturally occurring radioactive material.
Doing Refugee Right(s) with Technologies? Humanitarian Crises and the Multiplication of “Exceptional” Legal States
Authors: Twigt Mirjam
Published: November 2023

Like borders, refugee protection settings beyond the EU often serve as testing grounds for technologies. This article takes a socio-legal perspective to show how humanitarian experimentation in these contexts is made possible through different, interacting challenges to sovereignty. It argues that the understanding that actors or their positions are “exceptional” allows for and justifies data practices that would otherwise not be legally permissible. Examples of data practices in refugee protection settings are connected to work in geopolitics, science and technology studies, and sociology of law.

The article shows how the position of the United Nations High Commissioner for Refugees (UNHCR) as negotiator on behalf of refugees and an emergency-driven techno-solutionism not only interacts with the already precarious legal context most people seeking refuge find themselves in. It coincides with the legal positioning of International Organisations and with citizenship-oriented conceptions of privacy, further constituting people seeking refuge as (digital) rights optional. This is problematic not least because of concerns about adequate data protection or the implications of bias. Data flows and algorithms are generative of the politics of contemporary societies, implying that the structural undermining of digital rights of people seeking refuge in the present can also hinder their access to rights in the future.
Risk of pre-term birth as a function of sleep quality and obesity: prospective analysis in a large Prematurity Research Cohort
Authors: Sutcliffe Siobhan , Zhao Peinan , Pilz Luisa Klaus , Oakes Megan , Frolova Antonina I , Herzog Erik D , England Sarah K
Published: November 2023

Study Objective

To investigate whether poor sleep quality is associated with pre-term birth (PTB) risk, overall and independent of sleep apnea and habitual snoring.

Methods

We used longitudinal data from the Washington University Prematurity Research Cohort to investigate the association between poor sleep quality (defined as a Pittsburgh Sleep Quality Index > 5) and PTB, overall and independent of sleep apnea and snoring (defined by the Berlin questionnaire and prior sleep clinic attendance). Associations were investigated for sleep quality early and throughout pregnancy. Stratified analyses were performed by factors previously shown to modify associations between sleep and PTB (race, pre-pregnancy obesity).

Results

Of the 976 eligible participants, 50.1% experienced poor sleep quality early in pregnancy (<20 completed weeks) and 14.2% delivered pre-term (n = 50 without and 89 with poor sleep quality). In multivariable-adjusted analyses, poor sleep quality early in pregnancy was associated with increased PTB risk (hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.02–2.14). This association persisted after further adjustment for sleep apnea and snoring (HR = 1.50, 95% CI = 1.02–2.20) and in analyses stratified by race. It varied, however, by pre-pregnancy obesity. Among individuals without obesity, no association was observed between poor sleep and PTB (HR = 1.08, 95% CI = 0.65–1.79), whereas among those with obesity, a positive association was observed (HR = 2.94, 95% CI = 1.52–5.69, p-interaction = .05). This association was limited to individuals with obesity who experienced poor sleep both earlier and later in pregnancy (HR = 3.94, 95% CI = 1.56–9.99).

Conclusion

Our findings suggest that improving sleep quality early in pregnancy may be important for PTB prevention, particularly among individuals with obesity.
Striatal correlates of Bayesian beliefs in self-efficacy in adolescents and their relation to mood and autonomy: a pilot study
Authors: Romaniuk Liana , MacSweeney Niamh , Atkinson Kimberley , Chan Stella W Y , Barbu Miruna C , Lawrie Stephen M , Whalley Heather C
Published: November 2023

Major depressive disorder often originates in adolescence and is associated with long-term functional impairment. Mechanistically characterizing this heterogeneous illness could provide important leads for optimizing treatment. Importantly, reward learning is known to be disrupted in depression. In this pilot fMRI study of 21 adolescents (16–20 years), we assessed how reward network disruption impacts specifically on Bayesian belief representations of self-efficacy (SE-B) and their associated uncertainty (SE-U), using a modified instrumental learning task probing activation induced by the opportunity to choose, and an optimal Hierarchical Gaussian Filter computational model. SE-U engaged caudate, nucleus accumbens (NAcc), precuneus, posterior parietal and dorsolateral prefrontal cortex (PFWE < 0.005). Sparse partial least squares analysis identified SE-U striatal activation as associating with one’s sense of perceived choice and depressive symptoms, particularly anhedonia and negative feelings about oneself. As Bayesian uncertainty modulates belief flexibility and their capacity to steer future actions, this suggests that these striatal signals may be informative developmentally, longitudinally and in assessing response to treatment.
Diving deep into fish bornaviruses: Uncovering hidden diversity and transcriptional strategies through comprehensive data mining
Authors: Eshak Mirette I Y , Rubbenstroth Dennis , Beer Martin , Pfaff Florian
Published: November 2023

Recently, we discovered two novel orthobornaviruses in colubrid and viperid snakes using an in silico data-mining approach. Here, we present the results of a screening of more than 100,000 nucleic acid sequence datasets of fish samples from the Sequence Read Archive (SRA) for potential bornaviral sequences. We discovered the potentially complete genomes of seven bornavirids in datasets from osteichthyans and chondrichthyans. Four of these are likely to represent novel species within the genus Cultervirus, and we propose that one genome represents a novel genus within the family of Bornaviridae. Specifically, we identified sequences of Wǔhàn sharpbelly bornavirus in sequence data from the widely used grass carp liver and kidney cell lines L8824 and CIK, respectively. A complete genome of Murray–Darling carp bornavirus was identified in sequence data from a goldfish (Carassius auratus). The newly discovered little skate bornavirus, identified in the little skate (Leucoraja erinacea) dataset, contained a novel and unusual genomic architecture (N-Vp1-Vp2-X-P-G-M-L), as compared to other bornavirids. Its genome is thought to encode two additional open reading frames (tentatively named Vp1 and Vp2), which appear to represent ancient duplications of the gene encoding the viral glycoprotein (G). The datasets also provided insights into the possible transcriptional gradients of these bornavirids and revealed previously unknown splicing mechanisms.
Comparative Pangenomic Insights into the Distinct Evolution of Virulence Factors Among Grapevine Trunk Pathogens
Authors: Garcia Jadran F. , Morales-Cruz Abraham , Cochetel Noé , Minio Andrea , Figueroa-Balderas Rosa , Rolshausen Philippe E. , Baumgartner Kendra , Cantu Dario
Published: November 2023

The permanent organs of grapevines ( Vitis vinifera L.), like those of other woody perennials, are colonized by various unrelated pathogenic ascomycete fungi secreting cell wall-degrading enzymes and phytotoxic secondary metabolites that contribute to host damage and disease symptoms. Trunk pathogens differ in the symptoms they induce and the extent and speed of damage. Isolates of the same species often display a wide virulence range, even within the same vineyard. This study focuses on Eutypa lata, Neofusicoccum parvum, and Phaeoacremonium minimum, causal agents of Eutypa dieback, Botryosphaeria dieback, and Esca, respectively. We sequenced 50 isolates from viticulture regions worldwide and built nucleotide-level, reference-free pangenomes for each species. Through examination of genomic diversity and pangenome structure, we analyzed intraspecific conservation and variability of putative virulence factors, focusing on functions under positive selection and recent gene family dynamics of contraction and expansion. Our findings reveal contrasting distributions of putative virulence factors in the core, dispensable, and private genomes of each pangenome. For example, carbohydrate active enzymes (CAZymes) were prevalent in the core genomes of each pangenome, whereas biosynthetic gene clusters were prevalent in the dispensable genomes of E. lata and P. minimum. The dispensable fractions were also enriched in Gypsy transposable elements and virulence factors under positive selection (polyketide synthase genes in E. lata and P. minimum, glycosyltransferases in N. parvum). Our findings underscore the complexity of the genomic architecture in each species and provide insights into their adaptive strategies, enhancing our understanding of the underlying mechanisms of virulence.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Mutagenesis of Wheat Powdery Mildew Reveals a Single Gene Controlling Both NLR and Tandem Kinase-Mediated Immunity
Authors: Bernasconi Zoe , Stirnemann Ursin , Heuberger Matthias , Sotiropoulos Alexandros G. , Graf Johannes , Wicker Thomas , Keller Beat , Sánchez-Martín Javier
Published: November 2023

Blumeria graminis f. sp. tritici ( Bgt) is a globally important fungal wheat pathogen. Some wheat genotypes contain powdery mildew resistance ( Pm) genes encoding immune receptors that recognize specific fungal-secreted effector proteins, defined as avirulence (Avr) factors. Identifying Avr factors is vital for understanding the mechanisms, functioning, and durability of wheat resistance. Here, we present AvrXpose, an approach to identify Avr genes in Bgt by generating gain-of-virulence mutants on Pm genes. We first identified six Bgt mutants with gain of virulence on Pm3b and Pm3c. They all had point mutations, deletions or insertions of transposable elements within the corresponding AvrPm3b2/c2 gene or its promoter region. We further selected six mutants on Pm3a, aiming to identify the yet unknown AvrPm3a3 recognized by Pm3a, in addition to the previously described AvrPm3a2/f2. Surprisingly, Pm3a virulence in the obtained mutants was always accompanied by an additional gain of virulence on the unrelated tandem kinase resistance gene WTK4. No virulence toward 11 additional R genes tested was observed, indicating that the gain of virulence was specific for Pm3a and WTK4. Several independently obtained Pm3a-WTK4 mutants have mutations in Bgt-646, a gene encoding a putative, nonsecreted ankyrin repeat-containing protein. Gene expression analysis suggests that Bgt-646 regulates a subset of effector genes. We conclude that Bgt-646 is a common factor required for avirulence on both a specific nucleotide-binding leucine-rich repeat and a WTK immune receptor. Our findings suggest that, beyond effectors, another type of pathogen protein can control the race-specific interaction between powdery mildew and wheat.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Bioprotection of Olive Trees Against Verticillium Wilt by Pomegranate and Carob Extracts
Authors: Antón-Domínguez Begoña I. , López-Moral Ana , Romero-Salguero Francisco J. , Trapero Antonio , Trapero Carlos , Agustí-Brisach Carlos
Published: November 2023

Bioprotection through the use of plant extracts is an environmentally friendly strategy in crop protection. Effective control of Verticillium wilt of olive (Olea europaea; VWO), caused by Verticillium dahliae, has proven challenging because of the ineffectiveness of chemicals, which makes it necessary to search for new control tools. Thus, the aim of this study was to evaluate the effect of pomegranate (Punica granatum) and carob (Ceratonia siliqua) extracts on VWO. Extracts derived from pomegranate peels and carob pods and leaves were obtained using ethanol, methanol, or ethyl acetate as a solvent. A targeted analysis of their metabolite composition was performed using QTRAP ultrahigh-performance liquid chromatography with mass spectrometry. Remarkably, gallic acid was detected in all extracts at a high concentration. The effect of the extracts on the mycelial growth and on the germination of conidia and microsclerotia of V. dahliae was evaluated by in vitro sensitivity tests at various doses: 0 (control), 3, 30, 300, and 3,000 mg of extract/liter. Extracts obtained with ethanol or methanol significantly reduced the viability of V. dahliae structures when applied at the highest dose, while those obtained with ethyl acetate were ineffective across all doses. The most effective extracts, as determined in vitro, were then evaluated against the disease in olive plants. Potted plants of the cultivar Picual were treated by spraying (foliar application) or irrigation (root application) of extracts at 3,000 mg/liter, followed by inoculation with V. dahliae. The results indicated that foliar applications were ineffective, while root treatments with pomegranate peel or carob leaf extracts were more effective in reducing disease severity, regardless of the solvent, compared with that of the untreated control.
Original Research: Exploring Medication Safety Practices from the Nurse's Perspective
Authors: Arkin Laura , Schuermann Andrea A. , Loerzel Victoria , Penoyer Daleen
Published: November 2023

Background:

Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so.

Purpose:

The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors.

Methods:

A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis.

Results:

A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be.

Conclusions:

The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
Frailty Is Associated With Decreased Survival in Adult Patients With Nonoperative and Operative Traumatic Subdural Hemorrhage: A Retrospective Cohort Study of 381,754 Patients
Authors: Courville Evan N. , Owodunni Oluwafemi P. , Courville Jordyn T. , Kazim Syed F. , Kassicieh Alexander J. , Hynes Allyson M. , Schmidt Meic H. , Bowers Christian A.
Published: November 2023

Objective:

We investigated frailty’s impact on traumatic subdural hematoma (tSDH), examining its relationship with major complications, length of hospital stay (LOS), mortality, high level of care discharges, and survival probabilities following nonoperative and operative management.

Background:

Despite its frequency as a neurosurgical emergency, frailty’s impact on tSDH remains underexplored. Frailty characterized by multisystem impairments significantly predicts poor outcomes, necessitating further investigation.

Methods:

A retrospective study examining tSDH patients ≥18 years and assigned an abbreviated injury scale score ≥3, and entered into ACS-TQIP between 2007 and 2020. We employed multivariable analyses for risk-adjusted associations of frailty and our outcomes, and Kaplan-Meier plots for survival probability.

Results:

Overall, 381,754 tSDH patients were identified by mFI-5 as robust—39.8%, normal—32.5%, frail—20.5%, and very frail—7.2%. There were 340,096 nonoperative and 41,658 operative patients. The median age was 70.0 (54.0–81.0) nonoperative, and 71.0 (57.0–80.0) operative cohorts. Cohorts were predominately male and White. Multivariable analyses showed a stepwise relationship with all outcomes P < 0.001; 7.1% nonoperative and 14.9% operative patients had an 20% to 46% increased risk of mortality, that is, nonoperative: very frail (HR: 1.20 [95% CI: 1.13–1.26]), and operative: very frail (HR: 1.46 [95% CI: 1.38–1.55]). There were precipitous reductions in survival probability across mFI-5 strata.

Conclusion:

Frailty was associated with major complications, LOS, mortality, and high level care discharges in a nationwide population of 381,754 patients. While timely surgery may be required for patients with tSDH, rapid deployment of point-of-care risk assessment for frailty creates an opportunity to equip physicians in allocating resources more precisely, possibly leading to better outcomes.
Surgical management of acetabular fractures associated with pelvic ring disruption, the time-dependent effect of delay
Authors: Sameeh Islam , Safwat Yamen , Khalid Saleh Mohammed
Published: November 2023

Background:

Associated fractures of the acetabulum and pelvic ring represent considerable percentage of polytrauma victims. These types of injuries are different from isolated acetabular or pelvic injuries regarding injury severity scores, haemodynamic status, blood transfusion requirements, and higher mortality rates up to 13%. Both Letournel and Matta have definitively shown that anatomic reduction of the fracture is the most influential factor predictive of clinical outcome. The ability of obtaining anatomical reduction is affected by age, fracture pattern, associated injuries, patient general condition, timing to surgery and complications.

Design:

Retrospective cohort study.

Methods:

It is a retrospective study among 24 patients performed in Zagazig university hospitals between May 2017 and February 2019. Matta scoring system was used to quantify the radiological outcome of both acetabular and pelvic components while, both Majeed and Merle d’Aubigné were used for clinical grading at the final follow up. Timing to surgery was found to affect the quality of reduction significantly.

Results:

We divided our cases into 2 groups; First group including the patients underwent operative management from day 0 to day 10 which include 18 cases and Second group including the patients underwent operative management from day 11 to day 21 which include 6 cases and we will observe if there is a correlation between the preoperative delay and Matta scoring for both acetabular and pelvic components.

Among the operatively managed acetabular fracture There was significant association between preoperative delay and Matta scoring system for acetabular component (P<0.05) Among the operatively managed pelvic ring injuries There was significant association between preoperative delay and Matta scoring system for pelvic component (P<0.05).

Conclusion:

The quality of reduction can be controlled by controlling the time to surgery after optimization of the general condition of the patient and controlling the local complications. In our study the earlier to operate on both components within the first 10 days after initial trauma the better to get anatomical reduction.
Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial*
Authors: Dijkstra Boukje M. , Rood Paul J.T. , Teerenstra Steven , Rutten Anne M.F. , Leerentveld Crista , Burgers-Bonthuis Dominique C. , Festen-Spanjer Barbara , Klarenbeek Toine , Van Den Boogaard Mark , Ewalds Esther , Schoonhoven Lisette , Van Der Hoeven Johannes G. , Vloet Lilian C.M. ,   from the EFfect of FAMily PARTicipation in essential care (EFFAMPART) Study Group
Published: November 2023

OBJECTIVES:

To determine the effect of a standardized program for family participation in essential care activities in the ICU on symptoms of anxiety, depression, posttraumatic stress and satisfaction among relatives, and perceptions and experiences of ICU healthcare providers (HCPs).

DESIGN:

Multicenter stepped-wedge cluster randomized controlled trial.

SETTING:

Seven adult ICUs, one university, and six general teaching hospitals.

PARTICIPANTS:

Three hundred six relatives and 235 ICU HCPs.

INTERVENTIONS:

A standardized program to facilitate family participation inpatient communication, amusement/distraction, comfort, personal care, breathing, mobilization, and nutrition.

MEASUREMENTS AND MAIN RESULTS:

Data were collected through surveys among relatives and ICU HCPs. There were no significant differences in symptoms of anxiety in relatives in the intervention period compared with the control period (median Hospital Anxiety and Depression Scale [HADS] 5 [interquartile range (IQR) 2–10] vs 6 [IQR 3–9]; median ratio [MR] 0.72; 95% CI, 0.46–1.13; p = 0.15), depression (median HADS 4 [IQR 2–6] vs 3 [IQR 1–6]; MR 0.85; 95% CI, 0.55–1.32; p = 0.47) or posttraumatic stress (median Impact of Event Scale-Revised score 0.45 [IQR 0.27–0.82] vs 0.41 [IQR 0.14–1]; MR 0.94; 95% CI, 0.78–1.14; p = 0.54). Reported satisfaction was slightly lower in the intervention period (mean 8.90 [sd 1.10] vs mean 9.06 [sd 1.10], difference –0.60; 95% CI, –1.07 to –0.12; p = 0.01). ICU HCPs perceived that more relatives knew how to participate: 47% in the intervention period versus 22% in the control period (odds ratio [OR] 3.15; 95% CI, 1.64–6.05; p < 0.01). They also reported relatives having sufficient knowledge (41% vs 16%; OR 3.56; 95% CI, 1.75–7.25; p < 0.01) and skills (44% vs 25%; OR 2.38; 95% CI, 1.22–4.63; p = 0.01) to apply family participation.

CONCLUSIONS:

Application of a standardized program to facilitate family participation did not change mental health symptoms in relatives of ICU patients 3 months after discharge. ICU HCPs reported increased clarity, knowledge, and skills among relatives and ICU HCPs.
An economic evaluation of two cervical screening algorithms in Belgium: HR-HPV primary compared to HR-HPV and liquid-based cytology co-testing
Authors: Dombrowski Caroline , Bourgain Claire , Ma Yixuan , Meiwald Anne , Pinsent Amy , Weynand Birgit , Turner Katy M.E. , Huntington Susie , Adams Elisabeth J. , Bogers Johannes , Croes Romaric , Sahebali Shaira
Published: November 2023

Objective

To assess the costs and benefits of two algorithms for cervical cancer screening in Belgium (1) high-risk human papillomavirus (HR-HPV) primary screening and (2) HR-HPV and liquid-based cytology (LBC) co-testing.

Methods

A decision tree was adapted from published work and parameterised using HORIZON study data and Belgian cost and population data. The theoretical model represents two different screening algorithms for a cohort of 577 846 women aged 25–64 attending routine cervical screening. Scenario analyses were used to explore the impact of including vaccinated women and alternative pricing approaches. Uncertainty analyses were conducted.

Results

The cost per woman screened was €113.50 for HR-HPV primary screening and €101.70 for co-testing, representing a total cost of €65 588 573 and €58 775 083, respectively, for the cohort; a 10% difference. For one screening cycle, compared to HR-HPV primary, co-testing resulted in 13 173 more colposcopies, 67 731 more HR-HPV tests and 477 020 more LBC tests. Co-testing identified 2351 more CIN2+ cases per year (27% more than HR-HPV primary) and 1602 more CIN3+ cases (24% more than HR-HPV primary) than HR-HPV primary.

Conclusion

In Belgium, a co-testing algorithm could increase cervical pre-cancer detection rates compared to HR-HPV primary. Co-testing would cost less than HR-HPV primary if the cost of the HPV test and LBC were cost-neutral compared to the current cost of LBC screening but would cost more if the cost per HPV test and LBC were the same in both co-testing and HR-HPV primary strategies.
The pathogenesis of obesity in people living with HIV
Authors: Bailin Samuel S. , Koethe John R. , Rebeiro Peter F.
Published: November 2023

Purpose of review

The public health challenge of overweight and obesity increasingly affects people living with HIV (PWH). These effects have also accelerated as the prevalence of antiretroviral therapy (ART) use has increased among PWH. It is therefore also critical that we examine and understand the pathogenesis of obesity among PWH.

This review will aim to summarize relevant and recent literature related to the risks of weight gain and obesity associated with HIV disease progression, cardiometabolic disease, and multimorbidity among PWH. Further, we will discuss adipose tissue changes associated with weight gain and obesity and how these changes relate to metabolic complications.

Recent findings

Several observational and experimental studies in recent years have evaluated the role of contemporary ART regimens, particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF), as contributors to weight gain, obesity, and cardiometabolic disease, though the mechanisms remain unclear. Metabolic dysregulation has also been linked to ectopic fat deposition and alterations in innate and adaptive immune cell populations in adipose tissue that accompany HIV and obesity. These factors continue to contribute to an increasing burden of metabolic diseases in an aging HIV population.

Obesity accompanies an increasing burden of metabolic disease among PWH, and understanding the role of fat partitioning and HIV and ART-related adipose tissue dysfunction may guide prevention and treatment strategies.
Meconium Concentrations of Pesticides and Risk of Hypospadias: A Case–Control Study in Brittany, France
Authors: Rouget Florence , Bihannic Adèle , Le Bot Barbara , Mercier Fabien , Gilles Erwann , Garlantezec Ronan , Multigner Luc , Cordier Sylvaine , Arnaud Alexis , Pladys Patrick , Chevrier Cécile
Published: November 2023

Background:

Hypospadias is a male genital tract defect for which an increase in prevalence has been documented over the last few decades. A role for environmental risk factors is suspected, including prenatal exposure to pesticides.

Objectives:

To study the risk of hypospadias in association with multiple pesticide measurements in meconium samples.

Methods:

The Brittany Registry of Congenital Anomalies (France) conducted a case–control study between 2012 and 2018. Cases were hypospadias, ascertained by a pediatrician and a pediatric surgeon, excluding genetic conditions, following European Surveillance of Congenital Anomalies guidelines (N = 69). Controls (N = 135) were two male infants without congenital anomaly born after each case in the same maternity unit. Mothers in the maternity units completed a self-administered questionnaire, we collected medical data from hospital records, and medical staff collected meconium samples. We performed chemical analysis of 38 pesticides (parent compound and/or metabolite) by UHPLC/MS/MS following strict quality assurance/quality control criteria and blind to case–control status. We carried out logistic regression accounting for frequency-matching variables and major risk factors.

Results:

Among the 38 pesticides measured, 16 (42%) were never detected in the meconium samples, 18 (47%) were in <5% of samples, and 4 (11%) in ≥5% of the samples. We observed an association between the detection of fenitrothion in meconium and the risk of hypospadias (OR = 2.6 [1.0–6.3] with ncases = 13, ncontrols = 21), but not the other pesticides.

Conclusions:

Our small study provides a robust assessment of fetal exposure. Fenitrothion’s established antiandrogenic activities provide biologic plausibility for our observations. Further studies are needed to confirm this hypothesis.
Carotid intima media thickness and cardiometabolic dysfunction: the Study of Women's Health Across the Nation
Authors: Leis Aleda M. , Jackson Elizabeth A. , Baylin Ana , Barinas-Mitchell Emma , El Khoudary Samar R. , Karvonen-Gutierrez Carrie A.
Published: November 2023

Objective

Carotid artery intima media thickness (cIMT) and adventitial diameter (AD) are subclinical atherosclerosis indicators. Metabolic syndrome (MetS) and obesity are risk factors for atherosclerosis, but their combined impact on atherosclerosis risk is unknown. This study sought to examine the effect of the co-occurrence of MetS with obesity on cIMT and AD.

Methods

The Study of Women's Health Across the Nation (SWAN) is a multi-center, multi-ethnic study. Carotid ultrasound assessments and concurrent physiologic measurements were undertaken between 2009 and 2013. This cross-sectional analysis included 1,433 women with body mass index ≥18.5 kg/m2 and free of prevalent clinical cardiovascular disease. Multivariable linear regression models were used to relate maximum cIMT and AD (dependent variables) with obesity, MetS and their interaction.

Results

The average age was 60.1 years (standard deviation [SD], 2.7 y). The prevalence of obesity and MetS was 44% and 35%, respectively. Women with obesity had a 0.051 mm larger mean cIMT and women with MetS had a 0.057 mm larger cIMT versus women without the respective conditions (both P < 0.001). There was a statistically significant interaction between obesity and MetS (P = 0.011); women with both had a model-adjusted predicted mean cIMT of 0.955 mm (95% confidence interval [CI], 0.897-1.013), higher than those with MetS alone (0.946 mm; 95% CI, 0.887-1.005), obesity alone (0.930 mm; 95% CI, 0.873-0.988), or neither condition (0.878 mm; 95% CI, 0.821-0.935). AD results were similar.

Conclusions

Early detection and treatment of atherosclerotic changes may prevent significant disease. This study suggests there is a minimal impact of obesity on carotid artery thickness beyond MetS alone. All individuals with metabolic dysfunction, regardless of obesity status, should be considered at increased risk for atherosclerotic changes.
Bilateral Free Deep Inferior Epigastric Artery Perforator Flaps for Reconstruction following Mastectomy in Poland Syndrome Patients
Authors: Malekpour Mahdi , Tozzi Federico , Walker John , Fries Charles Anton , Hosein Rayaad C.
Published: November 2023

Background:

Poland syndrome is classically described as symbrachydactyly, with hypoplasia of the pectoralis major and other upper thoracic musculoskeletal structures. It is thought to be caused by intrauterine interruption in subclavian arterial flow and often includes breast hypoplasia. Affected vasculature can pose a challenge for reconstruction with free flaps because inflow may not be reliable in this patient population.

Methods:

We present the rare case of a 28-year-old woman with left-sided Poland syndrome, significant family history of breast cancer, and BRCA1+ mutation who underwent bilateral prophylactic nipple-sparing mastectomies with successful immediate bilateral deep inferior epigastric artery perforator free flap reconstruction. The surgical literature in this clinical scenario is also reviewed.

Results:

Preoperative computed tomography angiography of the chest successfully demonstrated the patency and quantified the caliber of the internal mammary vessels to support free flap breast reconstruction.

Conclusions:

Free tissue transfer is a viable option for breast reconstruction in patients with Poland syndrome undergoing mastectomy guided by preoperative computed tomography angiography to characterize the internal mammary vasculature.
Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study
Authors: Lin Ying-Sheng , Kuan Chen-Hsiang , Lo Chiao , Tsai Li-Wei , Wu Chien-Hui , Huang Chieh-Huei , Yeong Eng-Kean , Tai Hao-Chih , Huang Chiun-Sheng
Published: November 2023

Background:

In breast cancer patients receiving axillary lymph node dissection (ALND), immediate lymphatic reconstruction (ILR) with lymphovenous anastomosis is an emerging technique for reducing the risk of arm lymphedema. However, the oncologic safety of surgically diverting lymphatic ducts directly into venules in a node-positive axilla is still a concern of inadvertently inducing metastasis of remaining cancer cells. This study aimed to assess the oncologic safety of ILR.

Methods:

From January 2020 to January 2022, 95 breast cancer patients received ALND, and 45 of them also received ILR. Patients with recurrent cancer, with follow-up less than 12 months, and with missed data were excluded. Variables were compared between ILR and non-ILR groups, and the outcome of interest was the rate of distant recurrence after follow-up for at least 1 year.

Results:

Thirty-four patients in the ILR group and 32 patients in the non-ILR group fulfilled the inclusion criteria for analysis. No statistically significant difference was noted between groups in terms of age, body mass index, type of breast surgery, pathologic cancer staging, histologic type and grade of breast cancer, molecular subtypes, frequency of axillary lymph node metastasis, or adjuvant therapy. For the patients receiving follow-up for at least 1 year, no statistically significant difference was found in terms of distant recurrence rates between ILR and non-ILR groups (P = 0.44).

Conclusion:

For breast cancer patients receiving ALND, ILR with lymphovenous anastomosis is oncologically safe, within an average follow-up period of 21 months.
Cystic fibrosis screening, evaluation, and management of hepatobiliary disease consensus recommendations
Authors: Sellers Zachary M. , Assis David N. , Paranjape Shruti M. , Sathe Meghana , Bodewes Frank , Bowen Melissa , Cipolli Marco , Debray Dominique , Green Nicole , Hughan Kara S. , Hunt William R. , Leey Julio , Ling Simon C. , Morelli Giuseppe , Peckham Daniel , Pettit Rebeca S. , Philbrick Alexander , Stoll Janis , Vavrina Kay , Allen Stacy , Goodwin Tara , Hempstead Sarah E. , Narkewicz Michael R.
Published: November 2023

Cystic fibrosis (CF) may cause a spectrum of hepatobiliary complications, including portal hypertension, multilobular cirrhosis, and liver failure. Current guidelines on the detection and monitoring of hepatobiliary complications in CF were published in 1999. The CF Foundation assembled a committee to evaluate research advances and formulate revised guidelines for CF-associated liver disease. A committee of hepatologists, gastroenterologists, pulmonologists, pharmacists, nurses, dietitians, individuals with CF, and the parents of a child with CF devised “population, intervention, comparison, and outcome” questions regarding hepatobiliary disease in CF. PubMed literature searches were performed for each population, intervention, comparison, and outcome question. Recommendations were voted on with 80% agreement required to approve a recommendation. Public comment on initial recommendations was solicited prior to the formulation of final recommendations. Thirty-one population, intervention, comparison, and outcome questions were assembled, 6401 manuscripts were title screened for relevance, with 1053 manuscripts undergoing detailed full-text review. Seven recommendations were approved for screening, 13 for monitoring of existing disease, and 14 for treatment of CF-associated hepatobiliary involvement or advanced liver disease. One recommendation on liver biopsy did not meet the 80% threshold. One recommendation on screening ultrasound was revised and re-voted on. Through a multidisciplinary committee and public engagement, we have assembled updated recommendations and guidance on screening, monitoring, and treatment of CF-associated hepatobiliary involvement and advanced liver disease. While research gaps remain, we anticipate that these recommendations will lead to improvements in CF outcomes through earlier detection and increased evidence-based approaches to monitoring and treatment.
Liver disease in germline mutations of telomere-related genes: Prevalence, clinical, radiological, pathological features, outcome, and risk factors
Authors: Sidali Sabrina , Borie Raphaël , Sicre de Fontbrune Flore , El Husseini Kinan , Rautou Pierre-Emmanuel , Lainey Elodie , Goria Odile , Crestani Bruno , Cadranel Jacques , Cottin Vincent , Bunel Vincent , Dumortier Jérôme , Jacquemin Emmanuel , Reboux Noémi , Hirschi Sandrine , Bourdin Arnaud , Meszaros Magdalena , Dharancy Sebastien , Hilaire Sophie , Mallet Vincent , Reynaud-Gaubert Martine , Terriou Louis , Gottrand Frédéric , Abou Chahla Wadih , Khan Jean-Emmanuel , Carrier Paul , Saliba Faouzi , Rubbia-Brandt Laura , Aubert John-David , Elkrief Laure , de Lédinghen Victor , Abergel Armand , Olivier Tournilhac , Houssel Pauline , Jouneau Stephane , Wemeau Lidwine , Bergeron Anne , Leblanc Thierry , Ollivier-Hourmand Isabelle , Nguyen Khac Eric , Morisse-Pradier Hélène , Ba Ibrahima , Boileau Catherine , Roudot-Thoraval Françoise , Vilgrain Valérie , Bureau Christophe , Nunes Hilario , Naccache Jean-Marc , Durand François , Francoz Claire , Roulot Dominique , Valla Dominique , Paradis Valérie , Kannengiesser Caroline , Plessier Aurélie
Published: November 2023

Background and Aim:

Germline mutations of telomere-related genes (TRG) induce multiorgan dysfunction, and liver-specific manifestations have not been clearly outlined. We aimed to describe TRG mutations-associated liver diseases.

Approach and Results:

Retrospective multicenter analysis of liver disease (transaminases > 30 IU/L and/or abnormal liver imaging) in patients with TRG mutations. Main measurements were characteristics, outcomes, and risk factors of liver disease in a TRG mutations cohort. The prevalence of liver disease was compared to a community-based control group (n = 1190) stratified for age and matched 1:3 for known risk factors of liver disease. Among 132 patients with TRG mutations, 95 (72%) had liver disease, with associated lung, blood, skin, rheumatological, and ophthalmological TRG diseases in 82%, 77%, 55%, 39%, and 30% of cases, respectively. Liver biopsy was performed in 52/95 patients, identifying porto-sinusoidal vascular disease in 48% and advanced fibrosis/cirrhosis in 15%. After a follow-up of 21 months (12–54), ascites, hepato-pulmonary syndrome, variceal bleeding, and HCC occurred in 14%, 13%, 13%, and 2% of cases, respectively. Five-year liver transplantation-free survival was 69%. A FIB-4 score ≥ 3·25 and ≥1 risk factor for cirrhosis were associated with poor liver transplantation-free survival. Liver disease was more frequent in patients with TRG mutations than in the paired control group [80/396, (20%)], OR 12.9 (CI 95%: 7.8–21.3, p < 0.001).

Conclusions:

TRG mutations significantly increase the risk of developing liver disease. Although symptoms may be mild, they may be associated with severe disease. Porto-sinusoidal vascular disease and cirrhosis were the most frequent lesions, suggesting that the mechanism of action is multifactorial.
Aesthetic Outcome and Psychosexual Distress After Treatment for Vulvar High-Grade Squamous Intraepithelial Lesions
Authors: Trutnovsky Gerda , Holter Magdalena , Gold Daniela , Kopera Daisy , Deban Julia , Misut Dina , Aust Stefanie , Tamussino Karl , Greimel Elfriede
Published: November 2023

Objectives

This study compared aesthetic outcome, psychosexual distress, and treatment satisfaction between women receiving surgical treatment or medical treatment with imiquimod for vulvar high-grade squamous intraepithelial lesion.

Materials and Methods

This is an extended analysis of the multicenter, randomized noninferiority trial “topical imiquimod versus surgery for vulvar intraepithelial neoplasia.” Patients were randomized to primary topical treatment or surgery and stratified by unifocal or multifocal disease. Digital photos of vulvar appearance were subsequently assessed for aesthetic outcome by 3 investigators blinded to group allocation. Psychosexual distress and treatment satisfaction were assessed with the Cervical Dysplasia Distress Questionnaire, the Sexual Activity Questionnaire, and the Client Satisfaction Questionnaire at baseline and follow-up.

Results

One hundred ten patients aged between 19 and 82 years were enrolled. Per-protocol analysis showed complete clinical response in 80% (37/46) using imiquimod, compared with 79% (41/52) after one surgical intervention. Photodocumentation at baseline and 6-month follow-up was available for 84 of these patients (44 imiquimod, 40 surgery). Blinded reviewer assessments of lesion size and lesion severity showed improvement from baseline to follow-up, with no differences between treatment groups. Sexual pleasure, discomfort, and distress remained stable from baseline to follow-up in both groups.

Conclusions

Good aesthetic outcome of vulvar high-grade squamous intraepithelial lesion treatment can be achieved with imiquimod and surgery, consisting of ablation or local excision. Treatment satisfaction and stable psychosexual health may not be dependent on chosen treatment modality, but rather on counseling in accordance with patients’ preferences.