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Carotid Web (CaW) is a growingly recognized cause of ischemic stroke, associated with a high recurrence risk. Several therapeutic strategies have been proposed as a tertiary prevention including carotid stenting, endarterectomy and antithrombotic medications. Among these, carotid stenting with dual-layer stent may be promising to adequately cover the focal arterial dysplasia. Our aim was to investigate the safety and efficacy of the Casper stent in the treatment of symptomatic CaW.We conducted a retrospective analysis of consecutive patients presenting with a symptomatic CaW and included in the ongoing prospective observational multicenter CAROWEB registry. The study period was January 2015 to December 2021. Inclusion criteria were CaW treated with dual-layer Casper stent. Patients treated with other types of carotid stent, endarterectomy or antithrombotic medication were excluded. Clinical and radiological initial data and outcomes were recorded.twenty-seven patients (with 28 caw) were included. median age was 52 (iqr: 46-68). median delay between index cerebrovascular event and cervical stenting was 9 days (IQR: 6-101). In all cases, the cervical carotid stenting was successfully performed. No major perioperative complication was recorded. No recurrent stroke or transient ischemic attack was observed during a median follow-up time of 272 days (IQR: 114-635). Long-term imaging follow-up was available in 25/28 (89.3%) stented CaW with a median imaging follow-up of 183 days (IQR: 107-676; range: 90-1542). No in-stent occlusion or stenosis was detected.In this study, carotid stenting with dual-layer Casper stent in the treatment of symptomatic CaW was effective regarding stroke recurrence prevention and safe, without procedural nor delayed detected adverse event. However, the optimal therapeutic approach of symptomatic CaW still needs to be explored through randomized trials.

Nathanael Sirili,1 Doreen Mloka,2 Lilian Mselle,3 Rodrick Kisenge,4 Erasto Mbugi,5 Dennis Russa,6 Obadia Nyongole,7 Stephen E Mshana,8 Rose Laisser,9 Kien Mteta,10 Levina Msuya,11 Eligius Lyamuya,12 Judith Martin-Holland,13 Gideon Kwesigabo,14 Ephata Kaaya15 1Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 3Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 4Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 5Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 6Department of Anatomy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 7Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 8Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 9Archbishop Anthony Mayalla School of Nursing, Catholic University of Health and Allied Sciences, Mwanza, Tanzania; 10Department of Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 11Department of Paediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania; 12Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 13Department of Physiological Nursing, University of San Francisco California, San Francisco, CA, USA; 14Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania; 15Department of Pathology, Kilimanjaro Christian Medical University College, Moshi, TanzaniaCorrespondence: Nathanael Sirili, Email drnsirili@gmail.comBackground: In 2012, the Muhimbili University of Health and Allied Sciences (MUHAS) embarked on structured competency-based curricula (CBC) for its programmes. Other health profession training institutions continued with their traditional way of teaching and thus causing variability in the competencies of the graduates. We aimed to analyze the experiences of different stakeholders on the implementation of CBC specifically on biomedical sciences by MUHAS to inform the development of harmonized competency-based curricula in three health professional training institutions in Tanzania.Methods: We adopted an exploratory case study to analyse the implementation of CBC in programmes of Medicine and Nursing involving MUHAS graduates, immediate supervisors at the employment sites, faculty, and continuing students at MUHAS. Kiswahili guides were used to conduct the in-depth interviews (IDIs) and focus group discussions (FGDs). Qualitative content analysis was adopted for analysis.Results: From the 38 IDIs and 15 FGDs, four categories of human resources teaching and learning environment; curriculum content; and support systems emerged. Human resources were attributed to the shortage of an adequate number of faculty and teaching skills variation. The curriculum content category was linked to the redundancy of courses or topics, poor sequencing of some topics or courses, and limited time for teaching some essential courses or topics. Training and practice area mismatch, accommodation to students, teaching space, and library were the sub-categories linked to teaching and learning environment. Lastly, support systems related to teaching methods and opportunities for improving teaching and learning were revealed.Conclusion: The findings of this study highlight the challenges and opportunities for the implementation of CBC. The solutions to the revealed challenges are beyond the training institutions’ capacity. The latter call for multi-stakeholder engagement including those from the public and private sectors in health, higher education and finance for common and sustainable solutions.Keywords: competency-based curricula, biomedical sciences, teaching pedagogy, health training institutions, harmonized training, Tanzania

Scalp seborrheic dermatitis (SSD) is a prevalent chronic, relapsing inflammatory skin disease. The etiology is related to sebum production, bacterial proliferation – Staphylococcus sp., Streptococcus, and M. restricta – and host immunity factors – NK1+, CD16+ cells, IL-1, and IL-8. Trichoscopy features include mostly arborizing vessels and yellowish scales. New trichoscopic findings were described to guide the diagnosis as dandelion vascular conglomerate, “cherry blossom” vascular pattern, and intrafollicular oily material. Antifungals and corticosteroids constitute the essential therapy, but new treatments have been described. This article aims to review and discuss the etiology, pathophysiology, trichoscopy, histopathologic findings, main differential diagnoses, and therapeutic options of SSD.

Background: Whether endovascular therapy (EVT) added on best medical management (BMM), as compared to BMM alone, is beneficial in acute ischemic stroke with isolated posterior cerebral artery occlusion is unknown. Methods: We conducted a multicenter international observational study of consecutive stroke patients admitted within 6 hours from symptoms onset in 26 stroke centers with isolated occlusion of the first (P1) or second (P2) segment of the posterior cerebral artery and treated either with BMM+EVT or BMM alone. Propensity score with inverse probability of treatment weighting was used to account for baseline between-groups differences. The primary outcome was 3-month good functional outcome (modified Rankin Scale [mRS] score 0–2 or return to baseline modified Rankin Scale). Secondary outcomes were 3-month excellent recovery (modified Rankin Scale score 0–1), symptomatic intracranial hemorrhage, and early neurological deterioration. Results: Overall, 752 patients were included (167 and 585 patients in the BMM+EVT and BMM alone groups, respectively). Median age was 74 (interquartile range, 63–82) years, 329 (44%) patients were female, median National Institutes of Health Stroke Scale was 6 (interquartile range 4–10), and occlusion site was P1 in 188 (25%) and P2 in 564 (75%) patients. Baseline clinical and radiological data were similar between the 2 groups following propensity score weighting. EVT was associated with a trend towards lower odds of good functional outcome (odds ratio, 0.81 [95% CI, 0.66–1.01]; P =0.06) and was not associated with excellent functional outcome (odds ratio, 1.17 [95% CI, 0.95–1.43]; P =0.15). EVT was associated with a higher risk of symptomatic intracranial hemorrhage (odds ratio, 2.51 [95% CI, 1.35–4.67]; P =0.004) and early neurological deterioration (odds ratio, 2.51 [95% CI, 1.64–3.84]; P Conclusions: In this observational study of patients with proximal posterior cerebral artery occlusion, EVT was not associated with good or excellent functional outcome as compared to BMM alone. However, EVT was associated with higher rates of symptomatic intracranial hemorrhage and early neurological deterioration. EVT should not be routinely recommended in this population, but randomization into a clinical trial is highly warranted.

Kinga is one of the endangered languages in Tanzania. This study is on Kinga noun classes. It is important as it adds knowledge to the studies on Bantu languages. The qualitative approach was used in the study and data were collected by an unstructured interview. From the observation by the researcher, Kinga has 19 noun classes. Most of the classes have no immanent nouns completely belonging to a particular class, different nouns like animals, objects and geographical features can fit to different classes. Class one and two are the only classes that have defined nouns belonging to them; they are nouns referring to human beings. In some classes the nouns lack the prefix, the augment is used instead. There are wonderful semantic features in Kinga noun prefixes. Prefixes can communicate lot of information. The prefixes can communicate behavioral aspects of an individual. Kinga is endangered by Kiswahili. Kiswahili lexicon has penetrated Kinga language. Many Kiswahili words are used in Kinga. The contacts between the two languages endanger Kinga. An account of Kinga language is very minimal. With exception of the book by Schaderberg (1973) about Kinga being a restricted tone system, Kinga language can only be read in the religious books including the New Testament in Kinga written by SIL international. The researcher recommends documenting Kinga and other vernacular languages in Tanzania. It is vital for the future linguistic history. Syntactical, morphological, phonological, semantic and other aspects of language should be documented. Swahili may have a treasure from which lexicon may be added to Swahili instead of taking words from Arabic. Swahili is a Bantu language.

Background: Acute ischemic stroke (AIS) patients with a history of hypertension experience worse outcomes, which may be explained by a deleterious impact of the renin-angiotensin system (RAS) overactivation. We sought to investigate whether prestroke antihypertensive treatments (AHT) influenced baseline stroke severity and neurological outcomes, in patients with AIS successfully treated by endovascular therapy. Methods: We performed a post hoc analysis of the BP TARGET trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy) and included hypertensive patients with available data regarding AHT at admission, categorized as RAS inhibitors (ACE [angiotensin-converting enzyme] inhibitors, ARBs [angiotensin 2 receptor blockers], and β-blockers) and non-RAS inhibitors (calcium channel blockers and diuretics). Associations of each AHT with National Institutes of Health Stroke Scale (NIHSS) score at baseline were investigated in linear mixed model adjusted for the number of treatments and center. Associations of each AHT with 24-hour NIHSS change, intracranial hemorrhage were performed using linear mixed model adjusted for baseline NIHSS, the number of treatments, center, age, and sex and adjusted for age, sex, diabetes, and current smoking for favorable outcome. All analyses were performed on cases-available data regarding the low number of missing data. Results: Overall, 203 patients with at least one AHT were included. Patients under non-RAS inhibitor treatments had a higher NIHSS score at baseline (adjusted mean difference=3.28 [95% CI, 1.33–5.22]; P =0.001). Conversely, patients under RAS inhibitor treatments had a lower baseline NIHSS score (adjusted mean difference=−2.81 [95% CI, −5.37 to −0.25]; P =0.031). Intracranial hemorrhage occurrence was significantly more frequent in patients under non-RAS inhibitor treatments (adjusted odds ratio of 2.48 [95% CI, 1.12–5.47]; P =0.025). Conversely, the use of RAS inhibitor treatments before AIS was not associated with higher odds of radiographic intracranial hemorrhage. Patients with non-RAS inhibitor treatments had less improvement of NIHSS at 24 hours compared with patients without (adjusted mean difference, 2.83 [95% CI, −0.16 to 5.81]; P =0.063). Baseline RAS inhibitor or noninhibitor treatments were not associated with favorable outcome. Conclusions: We showed an opposite effect of baseline AHT, based on their effect on the RAS. Patients treated with RAS inhibitor agents before AIS exhibited less severe AIS compared with patients under non-RAS inhibitor treatments, developed less intracranial hemorrhage at 24 hours and had a trend toward better NIHSS score at 24 hours. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03160677.

ObjectivesThe TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate the predictive value of the TRI-SCORE for in-hospital mortality in patients with redo ITVS and to compare its accuracy with conventional surgical risk scores.MethodsUsing a mandatory administrative database, we identified all consecutive adult patients who underwent a redo ITVS at 12 French tertiary centres between 2007 and 2017. Baseline characteristics and outcomes were collected from chart review and surgical scores were calculated.ResultsWe identified 70 patients who underwent a redo ITVS (54±15 years, 63% female). Prior intervention was a tricuspid valve repair in 51% and a replacement in 49%, and was combined with another surgery in 41%. A tricuspid valve replacement was performed in all patients for the redo surgery. Overall, in-hospital mortality and major postoperative complication rates were 10% and 34%, respectively. The TRI-SCORE was the only surgical risk score associated with in-hospital mortality (p=0.005). The area under the receiver operating characteristic curve for the TRI-SCORE was 0.83, much higher than for the logistic EuroSCORE (0.58) or EuroSCORE II (0.61). The TRI-SCORE was also associated with major postoperative complication rates and survival free of readmissions for heart failure.ConclusionRedo ITVS was rarely performed and was associated with an overall high in-hospital mortality and morbidity, but hiding important individual disparities. The TRI-SCORE accurately predicted in-hospital mortality after redo ITVS and may guide clinical decision-making process (www.tri-score.com).

Patients with pre-stroke disability, defined as a modified Rankin Scale (mRS) ≥3, were excluded from most trials of endovascular thrombectomy (EVT) for acute stroke. We sought to evaluate the prognostic factors associated with favorable outcome in stroke patients with known disability undergoing EVT, and the impact of successful reperfusion.Consecutive acute stroke patients with pre-stroke disability, undergoing EVT, were retrospectively collected between 2016 to 2019 from a Canadian cohort and a multicenter French cohort (Endovascular Treatment in Ischemic Stroke registry-ETIS). Favorable outcome was defined as an mRS equal to pre-stroke mRS. Patients achieving successful reperfusion (defined as a modified Thrombolysis in Cerebral Infarction score of 2b/3) were compared with patients without successful reperfusion to determine if successful EVT was associated with better functional outcomes.Among 6220 patients treated with EVT, 280 (4.5%) patients with a pre-stroke mRS ≥3 were included. Sixty-one patients (21.8%) had a favorable outcome and 146 (52.1%) died at 3 months. Patients with successful reperfusion had a higher proportion of favorable 90-day mRS (27.6% versus 19.6%, p = 0.025) and a lower mortality (48.3% versus 69.6%, p = 0.008) than patients without successful reperfusion. After adjusting for baseline prognostic factors, successful reperfusion defined by TICI ≥2b was associated with favorable functional outcome (OR 3.16 CI95% [1.11-11.5]; p 0.048).In patients with pre-stroke disability, successful reperfusion is associated with a greater proportion of favorable outcome and lower mortality.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.

Purpose: Our study aimed to validate culturally adapted English and Swahili versions of the Patient Health Questionnaire–9 (PHQ-9) for use with adolescents in Kenya. Criterion validity was determined with clinician-administered diagnostic interviews using the Kiddie Schedule of Affective Disorders and Schizophrenia. Methods: A total of 250 adolescents comprising 148 (59.2%) females and 102 (40.8%) males aged 10–19 years (mean = 14.76; standard deviation = 2.78) were recruited. The PHQ-9 was administered to all respondents concurrently in English and Swahili. Adolescents were later interviewed by clinicians using Kiddie Schedule of Affective Disorders and Schizophrenia to determine the presence or absence of current symptoms of major depressive disorder. Sensitivity specificity, positive predictive value (PPV) and negative predictive value (NPV), and likelihood ratios for various cut-off scores for PHQ-9 were analyzed using receiver operating characteristic curves. Results: The internal consistency (Cronbach's α) for PHQ-9 was 0.862 for the English version and 0.834 for Swahili version. The area under the curve was 0.89 (95% confidence interval, 0.84–0.92) and 0.87 (95% confidence interval, 0.82–0.90) for English and Swahili version, respectively, on receiver operating characteristic analysis. A cut-off of ≥ 9 on the English-language version had a sensitivity of 95.0%, specificity of 73.0%, PPV of 0.23, and NPV of 0.99; a cut-off of ≥ 9 on the Swahili version yielded a sensitivity of 89.0%, specificity of 70.0%, PPV of 0.20, and NPV of 0.90. Discussion: Psychometric properties were comparable across both English-adapted and Swahili-adapted version of the PHQ-9, are reliable, and valid instrument to detect major depressive disorder among adolescents which can be used in resource-limited settings for early identification of adolescents in need of mental health support.

Wilson's disease (WD) is usually diagnosed in children and young adults; limited data exist on late-onset forms.The aim was to characterize the clinical and paraclinical presentations, therapeutic management, and outcomes in patients with late-onset WD.Patients diagnosed with WD after age 40 years were identified from the French Wilson's Disease Registry (FWDR). Clinical, laboratory, and imaging findings and treatment were reported at diagnosis and last follow-up.Forty-five patients were identified (median age: 49, range: 40-64) and placed in three groups according to their clinical presentation: neurological (n = 20, median diagnostic delay: 20 months), hepatic (n = 13, diagnostic delay: 12 months), and family screening (n = 12), all confirmed genetically. Six neurological patients had an atypical presentation (1 torticollis, 2 writer's cramps, 2 functional movement disorders, and 1 isolated dysarthria), without T2/fluid-attenuated inversion recovery brain magnetic resonance imaging (MRI) hyperintensities; 5 of 6 had no Kayser-Fleischer ring (KFR); 5 of 6 had liver involvement. In the neurological group, 84% of patients improved clinically, and 1 developed copper deficiency. In the hepatic group, 77% had cirrhosis; 6 patients required liver transplantation. In the screened group, 43% had mild liver involvement; 3 were not treated and remained stable; 24-h urinary copper excretion was normal in 33% of patients at diagnosis.In the FWDR, late-onset forms of WD affect 8% of patients, mostly with neurological presentations. Thirty percent of the neurological forms were atypical (isolated long-lasting symptoms, inconspicuous brain MRI, no KFR). With personalized treatment, prognosis was good. This study emphasized that WD should be suspected at any age and even in cases of atypical presentation. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Background: Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolescent mental health. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant adolescents in Nairobi, Kenya. Methods: We recruited 153 pregnant adolescent (14-18 years) who were accessing maternal health services in one of two Nairobi County primary health care facilities in the cross-sectional survey conducted in 2021. The Patient Health Questionnaire 9 was used to screen for depression. Multivariate Stepwise linear regression modelling was used to identify key predictors of depression. Results: Using a cut off of 10 and above on PHQ-9, we found that 43.1% of the respondents were depressed. Depressive symptoms in were independently associated with being in school, experience of intimate partner violence, substance use within the family and having experienced pressure to use substances by family or peers. Limitations: Cross-sectional by design and the applications of our findings are limited to settings that are similar to our study population. The PHQ-9 used has not been psychometrically validated locally in this sample. Conclusion: We found a high prevalence of depressive symptoms among respondents. These risk factors identified merit further investigation. Comprehensive mental health screening needs to be integrated in primary and community health services on the possible presence of depression.

International audience; Background: In acute intracerebral hemorrhage (ICH), the prognostic value of the MRI spot sign on hematoma expansion (HE) and poor functional outcome is poorly known.Methods: We retrospectively included patients admitted over a 4-year period for an acute ICH in a single institution using MRI as the first-line imaging tool. The presence and number of MRI spot signs on contrast-enhanced T1-weighted imaging was evaluated by one neuroradiologist, blinded from outcomes. The primary outcome was HE, defined as > 6 mL or > 33% ICH volume growth from initial MRI to 24-48 h follow-up imaging; the secondary outcome was poor 3-month modified Rankin score (4-6).Results: Overall, 147 patients were included, and 62% had a spot sign. Among the 130 patients with follow-up imaging, 24% experienced HE. HE occurred in 6%, 21% and 43% patients with 0, 1 and ≥ 2 spots, respectively (P < 0.001). The MRI spot sign was independently associated with HE (adjusted OR 6.15 [95% CI 1.60-23.65]; P = 0.008), with a dose-dependent effect. The negative and positive predictive values of the spot sign for HE were 0.94 and 0.35, respectively. Poor functional outcome occurred in 27%, 32% and 71% patients with 0, 1 and ≥ 2 spots, respectively (P < 0.001). In multivariable analysis, the presence of ≥ 2 spots was independently associated with poor functional outcome (adjusted OR 3.67 [95% CI 1.21-11.10]; P = 0.024).Conclusion: The MRI spot sign is an independent biomarker of HE, and the presence of ≥ 2 spots is independently associated with poor 3-month outcome. The lack of spot sign is highly predictive of a favorable evolution.

La stimulation épidurale du cortex moteur (eMCS) a été conçue dans les années 1990 et a maintenant largement supplanté la stimulation thalamique pour soulager la douleur neuropathique. Ses mécanismes d’action impliquent l’activation de multiples zones cortico-sous-corticales via une activation initiée dans le thalamus, avec implication des opioïdes endogènes et une inhibition descendante vers la moelle épinière. Les preuves de l’efficacité clinique sont maintenant étayées par au moins sept essais randomisés et les effets favorables peuvent persister jusqu’à dix ans, mais seul un candidat sur deux est significativement soulagé en l’absence de critère approprié de sélection. La stimulation magnétique répétitive non invasive (rTMS) s’est d’abord développée comme un moyen de prédire l’efficacité des procédures épidurales, avec une forte valeur prédictive positive, puis comme une méthode analgésique à part entière. Des preuves raisonnables provenant d’au moins six essais randomisés sont en faveur d’un effet analgésique significatif de la rTMS à haute fréquence sur le cortex moteur dans la douleur neuropathique, et de manière moins reproductible dans la fibromyalgie. La stimulation du cortex frontal dorsolatéral ne s’est pas avérée significativement efficace jusqu’à présent. Le cortex operculo-insulaire postérieur est une cible nouvelle et attrayante, mais l’évidence en sa faveur reste encore limitée. La stimulation transcrânienne à courant continu (tDCS) est appliquée sur des cibles similaires à celles de la rTMS ; elle ne provoque pas de potentiels d’action, mais module l’état de repos de la membrane neuronale. La tDCS présente des avantages pratiques, notamment un faible coût, peu de problèmes de sécurité et la possibilité de protocoles à domicile ; cependant, la qualité limitée de la plupart des rapports publiés lui confère actuellement un faible niveau de preuve. Les patients réagissant à la tDCS peuvent différer de ceux qui sont améliorés par la rTMS, et dans les deux cas des séances répétées sur une longue période peuvent être nécessaires pour obtenir un soulagement cliniquement significatif. Ces procédures exercent leurs effets par le biais de multiples réseaux cérébraux distribués qui influencent les aspects sensoriels, affectifs et cognitifs de la douleur chronique. Leurs effets s’exercent principalement sur les états hyperexcitables anormaux plutôt que sur la douleur aiguë expérimentale. L’extension de la durée des effets sur le long terme reste un défi, pour lequel différentes stratégies sont discutées dans cette revue.

This study assessed the contribution of School Income Generating Projects on teaching and learning process in Secondary Schools at Ngara District in Kagera region, Tanzania. The objectives of the study were to: examine how the available income-generating projects contribute to teaching and learning process and toexplore the challenges heads of school face in managing income generating projects in secondary. Resources Dependency Theory was used to emphasiseschool as an organization to have internal sources of income. The study employed mixed research to avoid the bias of using one approach and respective convergent parallel research design. Piloting was conducted to ensure the validity and reliability of the research instruments. Respondents of the study were 1 District secondary educational officer, 4 Ward educational officer 4 Head of school 75 teachers and 95 students. Interview guide was used to gather information from District secondary educational officer, Ward educational officer and Head of school; questionnaires were used to obtain the data from teachers and students while observation was used by the researcher to observe the available income generating project. The findings showed that the income generating activities available do not contribute to the teaching and learning process as there is unsatisfactory results in2019 division four was 51%, while division zero was 23.7%, in 2020 division four was 56% while division zero was 7% in 2021 division four was 65% while division zero was 5% .The study recommends that the policy maker integrate the implementation of IGP in school to free education policy to emphasize its implementation and management with effective learning process. Also, the local government should provide knowledge and skills to school heads on how to initiate and manage IGP. Furthermore, school heads should involve all staff members in initiation and management.

Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (6%) but have relied on patient-reported symptomatic episodes, so the true incidence and timing of AF after PFO closure remain unknown.The aim of this study was to prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure on the basis of loop recorder monitoring.Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 at a single center by means of implantable loop recorder monitoring in patients considered at higher risk for AF (age ≥ 55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder monitoring in other patients. The primary endpoint was the incidence of AF, atrial flutter, or supraventricular tachycardia lasting30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed using a stepwise logistic regression model.A total of 225 patients were included. The primary endpoint occurred in 47 patients (20.9%), including 13 (9.9%) and 24 (28.9%) among patients monitored with external loop recorders and implantable loop recorders, respectively. Overall, the median delay from procedure to arrhythmia was 14.0 days (IQR: 6.5-19.0 days), and one-half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted OR: 1.67 per 10-year increase; 95% CI: 1.18-2.36), device left disc diameter ≥25 mm (adjusted OR: 2.67; 95% CI: 1.19-5.98) and male sex (adjusted OR: 4.78; 95% CI: 1.96-11.66).Using loop recorder monitoring for ≥28 days, supraventricular arrhythmia was diagnosed in 1 in 5 patients, with a median delay of 14 days, suggesting that this postprocedural event has so far been underestimated.

While high-frequency transcranial magnetic stimulation (HF-rTMS) is now included in the armamentarium to treat chronic neuropathic pain (NP), direct-current anodal stimulation (a-tDCS) to the same cortical targets may represent a valuable alternative in terms of feasibility and cost. Here we performed a head-to-head, randomized, single-blinded, cross-over comparison of HF-rTMS versus a-tDCS over the motor cortex in 56 patients with drug-resistant NP, who received 5 daily sessions of each procedure, with a washout of at least 4 weeks. Daily scores of pain, sleep, and fatigue were obtained during 5 consecutive weeks, and functional magnetic resonance imaging (fMRI) to a motor task was performed in a subgroup of 31 patients. The percentage of responders, defined by a reduction in pain scores of 2 SDs from pre-stimulus levels, was similar to both techniques (42.0% vs. 42.3%), while the magnitude of "best pain relief" was significantly skewed towards rTMS. Mean pain ratings in responders decreased by 32.6% (rTMS) and 29.6% (tDCS), with half of them being sensitive to only one technique. Movement-related fMRI showed significant activations in motor and premotor areas, which did not change after 5 days of stimulation, and did not discriminate responders from non-responders. Both HF-rTMS and a-tDCS showed efficacy at 1 month in drug-resistant NP, with magnitude of relief slightly favoring rTMS. Since a significant proportion of patients responded to one procedure only, both modalities should be tested before declaring a patient as unresponsive.

To assess the combined role of anti-viral monoclonal antibodies (mAbs) and vaccines in reducing severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) transmission and mortality in the United States, an agent-based model was developed that accounted for social contacts, movement/travel, disease progression, and viral shedding. The model was calibrated to coronavirus disease 2019 (COVID-19) mortality between October 2020 and April 2021 (aggressive pandemic phase), and projected an extended outlook to estimate mortality during a less aggressive phase (April-August 2021). Simulated scenarios evaluated mAbs for averting infections and deaths in addition to vaccines and aggregated non-pharmaceutical interventions. Scenarios included mAbs as a treatment of COVID-19 and for passive immunity for postexposure prophylaxis (PEP) during a period when variants were susceptible to the mAbs. Rapid diagnostic testing paired with mAbs was evaluated as an early treatment-as-prevention strategy. Sensitivity analyses included increasing mAb supply and vaccine rollout. Allocation of mAbs for use only as PEP averted up to 14% more infections than vaccine alone, and targeting individuals ≥ 65 years averted up to 37% more deaths. Rapid testing for earlier diagnosis and mAb use amplified these benefits. Doubling the mAb supply further reduced infections and mortality. mAbs provided benefits even as proportion of the immunized population increased. Model projections estimated that ~ 42% of expected deaths between April and August 2021 could be averted. Assuming sensitivity to mAbs, their use as early treatment and PEP in addition to vaccines would substantially reduce SARS-CoV-2 transmission and mortality even as vaccination increases and mortality decreases. These results provide a template for informing public health policy for future pandemic preparedness.

Purpose This study aims to investigate the factors determining the readiness for uptake of open data (OD) in Tanzania. Specifically, this study intended to answer the question that sought to find out the factors that influence the implementation of OD in universities under study in a view to aligning with recommended strategies for optimizing the use of data in the open science era. Design/methodology/approach This study used a cross-sectional survey design whereby data were collected using quantitative and qualitative research approaches. A sample size of 212 respondents was drawn from the sampling frame of a population of 1,846 researchers from the participating universities using both probability and nonprobability sampling techniques. A self-administered questionnaire was used to collect data from researchers while interviews were administered to decision-makers. These two groups were believed to have the necessary knowledge for this study. Findings The findings indicate low or lack of skills and awareness on issues related to OD among researchers and decision-makers. This study also reveals inadequate infrastructure to support open science initiatives including OD. Moreover, this study shows a lack of supportive institutional strategies and policies that trigger the implementation of OD initiatives in Tanzania. This study recommends that universities should uplift the level of confidence of researchers by ensuring all necessary factors determining the uptake of OD are in place before and during the implementation of OD initiatives. Research limitations/implications This study was conducted during the time when researchers in universities are in an infant stage of adopting the concept from the developed world. In this regard, it is important to carry out a tracer study on establishing the OD phenomena after a number of universities have implemented OD initiatives in the country. Practical implications The researchers recommend the establishment of institutional policy and strategies to guide the implementation of OD among universities in Tanzania. Including awareness creation awareness through providing training among researchers and academics in universities. The results shed light to decision-makers on the understanding of the role of sharing research data in enhancing openness and validation of findings to increase the authenticity of results among researchers. Social implications The authors have revealed the factors affecting the implementation of OD among scholars in universities. This study reveals the level of acceptance of OD initiatives and the factors that could trigger adoption of OD. Originality/value This paper presents factors that determine the readiness for the uptake of OD in universities in Tanzania from the researcher’s perspective. This study was conducted to fill the knowledge gap that sought to establish understanding of researchers about OD. The gap was established through literature and it was found that none of the presented studies researched on this phenomenon in Tanzania.

PurposeDespite the potential for co-operatives to improve smallholder farmers' livelihoods, membership in the co-operatives is low. This study examines factors that influence smallholder farmers' decisions to join agricultural co-operatives.Design/methodology/approachThis study involved a survey of 1,274 smallholder chicken farmers. The data were analysed through a two-sample t-test of association, Pearson's Chi-square test and binary probit regression model.FindingsThe results suggest that farming as the main source of income, owning a chicken house, education attainment, attending training or accessing information, vaccination of goats and keeping a larger herd of goats are the key factors which significantly influence co-operative membership. However, gender, age, household size, distance to the nearest agrovet, vaccinating chicken and the number of chickens kept do not influence co-operative membership.Research limitations/implicationsThe survey did not capture data on some variables which have been shown to influence co-operative membership. Nevertheless, the results show key explanatory variables which influence membership in co-operatives.Practical implicationsThese findings have implications for development agencies that seek to use co-operatives for agricultural development and improvement of smallholder farmers' livelihoods. The agencies can use the results to initiate interventions relevant for different types of smallholder farmers through co-operatives.Originality/valueThis study highlights the influence of smallholder farmers' financial investments in farming and the extent of commercialisation on co-operative membership. Due to low membership in co-operatives, recognising the heterogeneity of smallholder farmers is the key in agricultural development interventions through co-operative membership.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2022-0165.

Cerebellum is a key structure for functional motor recovery after stroke. Enhancing the cerebello-motor pathway by paired associative stimulation (PAS) might improve upper limb function. Here, we conducted a randomized, double-blind, sham-controlled pilot trial investigating the efficacy of a 5-day treatment of cerebello-motor PAS coupled with physiotherapy for promoting upper limb motor function compared to sham stimulation. The secondary objectives were to determine in the active treated group (i) whether improvement of upper limb motor function was associated with changes in corticospinal excitability or changes in functional activity in the primary motor cortex and (ii) whether improvements were correlated to the structural integrity of the input and output pathways. To that purpose, hand dexterity and maximal grip strength were assessed along with TMS recordings and multimodal magnetic resonance imaging, before the first treatment, immediately after the last one and a month later. Twenty-seven patients were analyzed. Cerebello-motor PAS was effective compared to sham in improving hand dexterity (p: 0.04) but not grip strength. This improvement was associated with increased activation in the ipsilesional primary motor cortex (p: 0.04). Moreover, the inter-individual variability in clinical improvement was partly explained by the structural integrity of the afferent (p: 0.06) and efferent pathways (p: 0.02) engaged in this paired associative stimulation (i.e., cortico-spinal and dentato-thalamo-cortical tracts). In conclusion, cerebello-motor-paired associative stimulation combined with physiotherapy might be a promising approach to enhance upper limb motor function after stroke. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT 02284087. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13311-022-01205-y.

This study draws on theory of dyadic morality and categorization to disentangle opportunistic behaviors from the perception by their victim that leads to the moral categorization of the perpetrator as an opportunist. We show that it is this moral categorization, not the behaviors, that determines the trust beliefs of the victim. Further, the effect of psychic distance on the process of perpetrator moral categorization as an opportunist depends on the form of opportunistic behaviors. Finally, this study questions the cultural universality of opportunism by showing that effects of opportunistic behaviors on categorization vary across national cultures—based on data sets of French and Slovene exporters., This study draws on theory of dyadic morality and categorization to disentangle opportunistic behaviors from the perception by their victim that leads to the moral categorization of the perpetrator as an opportunist. We show that it is this moral categorization, not the behaviors, that determines the trust beliefs of the victim. Further, the effect of psychic distance on the process of perpetrator moral categorization as an opportunist depends on the form of opportunistic behaviors. Finally, this study questions the cultural universality of opportunism by showing that effects of opportunistic behaviors on categorization vary across national cultures - based on data sets of French and Slovene exporters.

International audience; Carcinoid heart disease is a rare condition affecting mostly tricuspid and pulmonary valves causing right-sided heart failure. Surgical valve replacement is the mainstay of treatment when patients become symptomatic and/or in the presence of right heart remodeling. We present a case of severe pulmonary valve regurgitation secondary to carcinoid heart disease occurring 4 years after a surgical tricuspid replacement, successfully treated with direct transcatheter pulmonary valve implantation without pre-stenting.

The authors adopted a task-sharing strategy in which lay health workers delivered group interpersonal psychotherapy (IPT-G) in primary care clinics in Nairobi, Kenya, to young mothers with HIV and depression. The study examined the acceptability, feasibility, and effectiveness of IPT-G in improving depression and antiretroviral therapy adherence.Twenty-four mothers (ages 18-24 years and 6-12 weeks postpartum) participated. The women were randomly assigned to IPT-G or to a waitlist. Eight lay providers administered the IPT-G sessions across 8 weeks. The primary outcome was pre- to postintervention change in depression scores as measured on the Edinburgh Postnatal Depression Scale. The secondary outcome was antiretroviral therapy adherence. All waitlist participants subsequently received the intervention, and a secondary outcome, within-group analysis, was conducted and included those participants.Participants' median age was 23.0 years, 17 (71%) lived with a partner, and 19 (79%) had fewer than two children. The intervention group had a mean±SD depression score of 15.9±4.3 at baseline and 6.8±7.0 postintervention. For the waitlist control group, the mean score was 17.3±5.9 at baseline and 13.2±6.6 at the first follow-up. Waitlist participants had significantly greater mean depression scores than did intervention group participants at the first follow-up (after the intervention group's 8-week IPT-G) (β=6.42, 95% confidence interval=1.17 to 11.66, p=0.017). No difference was observed between groups in antiretroviral therapy adherence.This study provides preliminary evidence that IPT-G led by community health workers may have benefits for postpartum depression among young mothers with HIV.

To assess the accuracy of intraoperative neurophysiological monitoring (IONM) in predicting immediate and 3-month postoperative neurological new deficit (or deterioration) in patients benefiting from spinal cord (SC) surgery; and to identify factors associated with a higher risk of postoperative clinical worsening.Consecutive patients who underwent SC surgery with IONM were included. Pre and postoperative clinical (modified McCormick scale), radiological (lesion-occupying area ratio), and electrophysiological features were collected.A total of 99 patients were included: 14 (14.1%) underwent extradural surgery, 50 (50.5%) intradural extramedullary surgery, and 35 (35.4%) intramedullary surgery. Cumulatively, multimodal IONM (motor and somatosensory evoked potentials, D-wave whenever possible) significantly predicted postoperative deficits (p0.001), with a sensitivity, specificity, positive predictive value, and negative predictive value of 0.81, 0.93, 0.83, and 0.92, respectively. Sixty (60.6%) patients displayed no IONM change, whereas 39 (39.4%) displayed IONM worsening. In multivariate analysis, predictors for postoperative clinical worsening were: abnormal preoperative electrophysiological assessment (p=0.03), intramedullary tumor (p0.001), lesion-occupying area ratio ≥0.7 (p0.001), and IONM alterations (p0.001). Three months after the surgical procedure, in patients presenting at least one of the risk factors described above, 45/81 (55.6%) and 19/81 (23.5%) were clinically and electrophysiologically improved, respectively; while 13/81 (16.0%) and 10/81 (12.3%) were clinically and electrophysiologically worsened.Multimodal IONM is an essential tool to guide SC surgery, and enables the accurate prediction of postoperative neurological outcome. Specific attention should be given to patients presenting with preoperative electrophysiological abnormalities, large tumor volume, and intramedullary tumor location.

Based on empirical information recorded in audio-visual and virtual media, online religionist and non-religious websites, and an academic literature review, I examine the relationships between religions and politics as they are disclosed in the context of the coronavirus outbreak in France. In secularized France, religions did not play an important role in the pandemic, either as facilitator of the disease or as a limitation on its spread. Religious repertoires served marginally, if at all, as resources for interpretation, except in circumscribed sectors of French society. Religious references, however, flourished under different oblique and rather discreet forms. I thus expose the reactions to COVID-19 in France and question the complex connections with secularism (laïcité). In contrast to other countries affected by COVID-19, in France the pandemic brought about the paradoxical situation of a secular country stimulating, on the one side, the engagement of religious organizations in the fight against the virus, and on the other, maintaining limitations to religious action in the public sphere.

Introduction:The European Society of Cardiology (ESC) 2020 guidelines propose an algorithm for in-hospital management of non-ST-elevation myocardial infarction (NSTEMI) based on risk stratification according to clinical, electrocardiographic, and biological data. However, out-of-hospital management is not codified.Study Objective:The objective of the present study was to evaluate the role of high-sensitivity cardiac troponin-I in out-of-hospital management of NSTEMI by Emergency Medical Services (EMS).Methods:This monocentric, retrospective, observational study analyzed the files of all patients having received a troponin assay in the EMS of Beaujon University Hospital, AP-HP (Paris region, France) from January 1, 2020 through December 31, 2020. Patients were classified as low risk, high risk, or very high risk according to the ESC 2020 algorithm at the time of their hospital treatment. The relationship between troponin in point-of-care and risk level according to time to onset of pain was analyzed using logistic regression. A search for predictors of risk level was performed using multivariate analysis. A P value Results:Out of 309 patients in the file, 233 were included. Men were 61% and the median age was 63 years. A positive troponin assay was associated with high-risk or very high-risk stratification regardless of the time to onset of pain (P Conclusion:The use of point-of-care troponin in EMS, combined with clinical and electrical criteria, allows risk stratification of NSTEMI patients from the prehospital management stage and optimization of referral to an appropriate care pathway. Patients classified as low risk should be referred to the emergency department (ED) and patients classified as high risk or very high risk to the cardiac intensive care unit or percutaneous coronary intervention (PCI) center.

Resistance to fibrinolysis, levels of procoagulant/antifibrinolytic neutrophil extracellular traps (NETs), and the severity of acute ischemic stroke (AIS) are increased by COVID-19. Whether NETs are components of AIS thrombi from COVID-19 patients and whether COVID-19 impacts the susceptibility of these thrombi to thrombolytic treatments remain unknown, however.We aimed to characterize AIS thrombi from COVID-19 patients by immunohistology and to compare their response to thrombolysis to that of AIS thrombi from non-COVID-19 patients.For this monocentric cohort study, 14 thrombi from COVID-19 AIS patients and 16 thrombi from non-COVID-19 patients, all recovered by endovascular therapy, were analyzed by immunohistology or subjected to ex vivo thrombolysis by tissue-type plasminogen (tPA)/plasminogen.COVID-19 AIS thrombi were rich in neutrophils and contained NETs, but not spike protein. Thrombolysis assays revealed a mean resistance profile to tPA/plasminogen of COVID-19 AIS thrombi similar to that of non-COVID-19 AIS thrombi. The addition of DNase 1 successfully improved thrombolysis by potentiating fibrinolysis irrespective of COVID-19 status. Levels of neutrophil, NETs, and platelet markers in lysis supernatants were comparable between AIS thrombi from non-COVID-19 and COVID-19 patients.These results show that COVID-19 does not impact NETs content or worsen fibrinolysis resistance of AIS thrombi, a therapeutic hurdle that could be overcome by DNase 1 even in the context of SARS-CoV-2 infection.

At present, every country strives to realize development for its people. Therefore, to achieve this requires the construction of various projects for the realization of a country's socio-economic and political development. However, the development of the projects is associated with various ecological challenges that can have an impact on society as a whole and the environment. Therefore, there is a need to conduct an environmental impact assessment (EIA), a tool that can be used to determine the environmental, social and economic impacts of a project before making a decision. The EIA process is linked to the detailed report containing all possible environmental, social and health impacts after, during and after the project. Therefore, this paper aims to deliver the critique of one of the EIA reports in the East African region. To achieve this, EIA legislation and guidelines for preparing and verifying EIA reports in the East African region will be examined. The critique contains the issues that include the advisory team (environmental and social impact assessment team), an executive or non-technical summary, a description of the proposed project, a description of the development, the local environment and initial conditions, the political, legal and administrative framework, and public participation/stakeholder analysis in the EIA process.

International audience; ObjectiveThe acoustic characteristics of stimuli influence the characteristics of the corresponding evoked potentials in healthy subjects. Own-name stimuli are used in clinical practice to assess the level of consciousness in intensive care units. The influence of the acoustic variability of these stimuli has never been evaluated. Here, we explored the influence of this variability on the characteristics of the subject’s own name (SON) P300.MethodsWe retrospectively analyzed 251 disorders of consciousness patients from Lyon and Paris Hospitals who underwent an “own-name protocol”. A reverse correlation analysis was performed to test for an association between acoustic properties of own-names stimuli used and the characteristics of the P300 wave observed.ResultsOwn-names pronounced with increasing pitch prosody showed P300 responses 66 ms earlier than own-names that had a decreasing prosody [IC95% = 6.36; 125.9 ms].ConclusionsSpeech prosody of the stimuli in the “own name protocol” is associated with latencies differences of the P300 response among patients for whom these responses were observed. Further investigations are needed to confirm these results.SignificanceSpeech prosody of the stimuli in the “own name protocol” is a non-negligible parameter, associated with P300 latency differences. Speech prosody should be standardized in SON P300 studies.

Background Wilson's disease (WD) is an autosomal recessive genetic disorder due to a mutation of the ATP7B gene, resulting in impaired hepatic copper excretion and accumulation in various tissues. Lifelong decoppering treatments are the keystone of the treatment. These treatments can prevent, stabilize, or reverse the symptoms making WD a chronic disease. Quality of life (QoL) is one of the best outcome measures of any therapeutic intervention in chronic diseases but has not been evaluated in large cohorts of WD patients.Method To better evaluate the QoL in WD and the correlation with different clinical or demographic factors we have performed a prospective cross-sectional study.Results Two hundred fifty-seven patients (53.3% men, mean age of 39.3 years and median disease duration of 18.8 years) were included between 1st January 2021 and 31st December 2021. Hepatoneurological form of the disease and depression were significantly correlated with low QoL (p Conclusions Neurological patients should be closely monitored to prevent and treat symptoms of depression that impact their quality of life.

Introduction The African Copperbelt is a site of intense artisanal and industrial mining and refining of copper and cobalt. Based on a preliminary case-control study of erectile dysfunction among mineworkers in the former Katanga province of the Democratic Republic of Congo (Musa et al. Occupational and Environmental Medicine 2020), Objective We further investigated possible factors associated with erectile dysfunction in copper and cobalt miners in the Katanga province. Methods In a cross-sectional study of 138 miners and 140 controls (bakers), we administered questionnaires face-to-face in French or Swahili to obtain socio-demographic and occupational data, and to assess male sexual function [International Index of Erectile Function (IIEF-15)] and marital relation quality [Revised Dyadic Adjustment Scale (DAS)]. We measured trace metals in blood and urine and testosterone and thyroid hormones in serum. Results Miners and bakers had similar median (IQR) age [35.6 y (30.6–40.0)]. Miners had significantly lower scores than bakers for IIEF-15 [66 (49–73) vs 73 (66–74)] and for the three DAS domains (Consensus; Satisfaction; Cohesion). Miners had significantly lower free testosterone (8.1 ng/dL) and thyroxin (13.45 pmol/L) than bakers (9.3 and 14.75, respectively). Factors associated with IIEF- EF scores ≤ 22 were: mining-related job (aOR 2.09, 95% CI 1.14–3.81; p=0.016), work seniority in mining (aOR 1.07, 95% CI 1.02–1.13; p=0.005) and regular use of aphrodisiacs (aOR 2.80, 95% CI 1.56–5.02; p=0.001). Mediation analysis showed that consensus mediated by 50% the relation between work seniority in mining and erectile function. Conclusions Compared to controls, miners had poorer sexual function and marital relation, and lower free testosterone and thyroxin. This may be due to their high exposure to trace metals (especially Pb). Erectile dysfunction is found to be increased by lower consensus in couples possibly due to longer time spent working away from home. Disclosure No

The gut is continuously invaded by diverse bacteria from the diet and the environment, yet microbiome composition is relatively stable over time for host species ranging from mammals to insects, suggesting host-specific factors may selectively maintain key species of bacteria. To investigate host specificity, we used gnotobiotic Drosophila, microbial pulse-chase protocols, and microscopy to investigate the stability of different strains of bacteria in the fly gut. We show that a host-constructed physical niche in the foregut selectively binds bacteria with strain-level specificity, stabilizing their colonization. Primary colonizers saturate the niche and exclude secondary colonizers of the same strain, but initial colonization by Lactobacillus species physically remodels the niche through production of a glycan-rich secretion to favor secondary colonization by unrelated commensals in the Acetobacter genus. Our results provide a mechanistic framework for understanding the establishment and stability of a multi-species intestinal microbiome.

The biochar addition to enhance anaerobic co-digestion (AD) of fecal sludge and food waste for methane production was investigated with a focus on biochar dosage and particle size of biochar. Optimal dosage range of biochar was determined as 5 - 20 g/l working volume based on lab-scale batch AD. Effects of biochar with different particle sizes at optimal dosage of 15 g/l were evaluated in a semi-continuous AD experiment, results of which showed that all the examined biochar’s with different particle sizes 0.075mm, 0.15mm and 0.45mm substantially enhanced the average methane yields (270ml/gVS, 241 ml/gVS and 222ml/gVS) compared to control digesters less than 200ml/gVS. The core reason for this phenomenon was that the biochar’s with different particle sizes had different properties i.e density, surface area and pore size and that the floating of large particle size of biochar was not conducive to microbial growth. Methane (CH4) in the biochar and control treatments were significantly different in all experiments. The results show that biochar added to digesters can significantly reduce H2S production with rising CH4 production.

BackgroundErectile dysfunction (ED) is the inability to achieve and maintain a steady erection for sexual performance. Erectile dysfunction (ED) is becoming more common in the general population, particularly among elderly men with lower urinary tract symptoms and those with benign prostatic hyperplasia. This rise in erectile dysfunction has also been attributed by several other etiologies, which includes inflammatory, mechanical, psychological, occlusive vascular, trauma, endocrine, neurologic, chemical and extra factors (prostatectomy, old age). The purpose of the study was to assess erectile dysfunction in patients with benign prostate hyperplasia before treatment using international index of erectile function (IIEF) tool.MethodologyHospital-based cross-sectional study from March 2021 to June 2022, which involved 188 patients clinically diagnosed with benign prostatic enlargement. Convenient sampling method was used to recruit participants and structured questionnaires were used to attain social demographic characteristics. The international prostate symptom score (IPSS) was used to assess, diagnose patients with BPH as well as the severity of LUTS and international index of erectile function (IIEF) was used to assess erectile dysfunction. Data was analyzed using SPSS software version 27.ResultsThe proportion of ED in patients with benign prostate hyperplasia/LUTS using IIEF tool was found to be 154(82%) and those with no erectile dysfunction was 34(18%). The factors that were statistically associated with erectile dysfunction were age, marital status, cigarette smoking, and diabetes mellitus.ConclusionErectile dysfunction is very common in men who have Benign Prostate Hyperplasia. The prevalence and severity of ED increased with age, diabetes, cigarette smoking, lower urinary tract symptoms, and hypertension, according to the study.

ispartof: INTENSIVE CARE MEDICINE vol:47 issue:3 pages:344-348 ispartof: location:United States status: published

Introduction: Tumor-Infiltrating Lymphocytes (TILS) is a well-known predictor of response to primary chemotherapy1,2 and a prognostic factor for improved survival in different breast cancer subtypes3. We present data on the association of the level of TILs and morphologic characteristics of such infiltrate with pCR. Material and methods: A series of 477 breast cancer patients (479 tumors) treated with primary chemotherapy at Catalan Institut of Oncolgy - H.U. Bellvitge between January 2009 and December 2016. Chemotherapy consisted on anthracyclines and taxanes (plus trastuzumab if Her-2 positive disease). Levels of percentage of TILs using hematoxylin-eosin-stained sections of diagnostic core-needle biopsy were evaluated according to international guidelines in a prospectively defined retrospective analysis. Characterization of TILS consisted on identification of plasma cells, intraepithelial infiltrate vs stromal infiltrate and homogeneous vs heterogeneous infiltrate. A sub-classification using levels of TILS and heterogeneity was done for statistical purposes. Levels of TILS and their morphological characteristics were examined for their associations with pCR adjusted for predictive clinic-pathological factors, by univariate and multivariate logistic regression, statistical significance set at 0.05. A ROC curve was performed to look for a cut-point of TILs to predict PCR. Results: The mean value of TILs was 23.79% (SD, 24%). TILs were significantly higher in ductal carcinomas (39.1% vs 0%, p=0.007), grade 3 (55.2 vs 17.7%p30 (48.8% vs 24.5%, p 20% (15.2% vs 41.5%, OR: 3.96 [95%CI, 2.57-6.10]; P < 0.001); plasma cells (OR 6.61 [95%CI, 1.51-28.8]; P=0.01), intraepithelial TILS (OR: 10.34 [95%CI, 2.22-48.01]; P =0.003), homogeneous high infiltrate (OR: 13.6 [95%CI, 3.04-60.77]; P =0.001). In luminal tumors, TILs over 20% predicted pCR (OR 12.3 [95%CI, 4.0-37.7]; P < 0.001) as well as in TNBC (OR 4.32 [95%CI, 1.77-10.53]; P=0 .001) but not in those cases with HER2 positive tumors (luminalB HER2 + HER2) (OR 1.65 [95%CI, 0.88-3.07]; P=0.118). In the multivariate analyses, levels of TILs > 20% were associated with higher pCR rates (adjusted odds ratio, 2.44 [95%CI, 1.48-4.01]; P < .001). Conclusions: The presence of TILs over 20% at diagnosis is an independent, positive, predictive marker of pCR in early breast cancer treated with neoadjuvant chemotherapy. Interestingly, the predictive information added by TILs >20% was higher in luminal and triple negative tumors compared to HER2 positive cases. Careful morphological characterization of TILS may add valuable predictive information and can be done in current pathologic laboratories with a well-trained breast cancer pathologist. References: 1.J Clin Oncol 2009; 28:105-113. doi: 10.1200/JCO.2009.23.73702.JAMA Oncol. 2015;1(4):448-454. doi:10.1001/jamaoncol.2015.08303.Lancet Oncol 2018: 19: 40-50 http://dx.doi.org/10.1016/S1470-2045(17)30904-X. N%Age years (mean, sd)Grade*I326.7II19540.7III15152.6Ki 67≤3020442.6>3027557.4Molecular subtype*Luminal A469.6Luminal B HER2 -14329.9Luminal B HER2+9219.2HER+ enriched7615.9Triple negative12225.5Pathologic responseNon-pCR35874.7pCR12125.3 Citation Format: Catalina Falo, Juan Azcarate, Ana Petit, Andrea Vethencourt, Sergi Fernandez Gonzalez, Amparo Garcia-Tejedor, Silvia Vazquez, Hector Perez, Maria Laplana, Charo Taco, Esther Guerra, Anna Guma, Raul Ortega, Agostina Stradella, Sabela Recalde, Adela Fernandez-Ortega, Rafael Villanueva, F Javier Perez, M Jesus Pla, Miriam Campos, Diana Perez, Eulalia Fernandez-Montoliu, Veronica Obadia, Monica Cejuela, Miguel Gil-Gil, Sonia Pernas, Mar Varela, Teresa Soler-Monzo. Morphologic characterization of tumor-infiltrating lymphocytes and its relation with pathological response in a series of breast cancer patients treated with primary chemotherapy [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-08-26.

Background: Most breast cancers (BC) exhibit low immune infiltration and are unresponsive to immunotherapy. Inhibitors of the Receptor Activator of NFkB (RANK) pathway, such as denosumab, used for the treatment of bone metastasis, have been shown to prevent BC, reducing tumor cell proliferation and survival. Our recent data supports that RANK pathway inhibition in BC cells enhances anti-tumor immune response. However, the population of BC patients who may benefit from denosumab remains to be identified. The aim of the study is to evaluate the antiproliferative, proapoptotic and/or immunomodulatory activity of denosumab in early BC and to identify biomarkers of response. Methods: Patients with early stage HER2-negative BC, candidates to tumor excision as first therapeutic approach were included. Patients were randomized 2: 1 to denosumab (two doses of 120mg/Kg subcutaneous denosumab, days 1 and 8 plus oral calcium 1000 mg daily for a month) and control arm (no treatment). Blood and tumor samples were collected at baseline and at surgery (2-4 weeks later). Putative changes in tumor cell proliferation by Ki67 immunohistochemistry (IHC), survival by Cleaved caspase-3 IHC and tumor infiltrating lymphocytes (TILs) quantified in H&E were evaluated between initial biopsy and surgery. RANK and RANKL expression will be analysed by IHC and the infiltrating immune populations will be characterized by specific antibodies (CD3, CD4, CD8, CD20, FoxP3, CD68, PDL1, PD1). We will analyse denosumab driven gene expression changes in tumor samples and tools such as CIBERSORT will be used to characterize the immune infiltrate. To assess the increase in TILs and the variation in Ki 67 and Cleaved caspase-3, the T-test for paired samples was used. A value of p less than 0.05 was defined as statistically significant. Result: We present results from the initial 45 patients enrolled out of 60, 31 cases in the experimental arm and 13 in the control arm. Mean age was 55,97 (range 37-88) years. 38 women with luminal breast cancer were analysed and 7 cases of triple negative BC (5 in experimental arm and 2 in control arm). Clinical and tumor characteristics were well balanced between both groups. No relevant toxicities were reported. There was no reduction of Ki67 in either of the two arms and no changes in Cleaved caspase-3 were observed. Interestingly, a statistically significant increase in TILs was observed in the denosumab treated group (p=0.0092, Paired t test) but not in the control group (p=0.68). 29.03% of patients treated with denosumab showed a ≥10% increase in TILs vs 7.14% in the control group (p=0.13). Denosumab was associated with an effective systemic inhibition of RANKL. No relationship was found between serum RANKL levels at baseline and response to denosumab. RNAseq analysis and immunophenotyping is still in progress. Conclusion: Short term neoadjuvant denosumab induces an immunomodulatory effect with an increase in stromal TILs in early BC. ClinicalTrials.gov Identifier: NCT03691311 Table 1.ResultsBiopsySurgeryKi 67 (mean frequency) Control24.5729.57Ki 67 (mean frequency) Experimental22.3927.90Cleaved caspase 3 (mean area) Control0.260.58Cleaved caspase 3 (mean area) Experimental0.350.42TILs (mean percentage) Control9.3410.29TILs (mean percentage) Experimental8.2913.54TILs incrementControl p=0.68 vs. Experimental p=0.009 Citation Format: Andrea Vethencourt, Eva M Trinidad, Anna Petit, María T Soler-Monsó, Clara Gómez Aleza, Ander Urruticochea, Amparo García-Tejedor, Anna Gumà Martinez, Veronica Obadia, Silvia Vazquez, Rafael Villanueva, Adela Fernánez, Monica Cejuela, Sabela Recalde Penabad, Agostina Stradella, Miguel Gil-Gil, Sonia Pernas, Eva Gonzalez-Suarez, Catalina Falo. First results of the randomized window of opportunity clinical trial D-Biomark: Immunomodulatory effect of denosumab in early breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-08-10.