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Abstract Health researchers are encouraged by governments, funders, and journals to conduct research in partnership with people with lived experience. However, conducting research with authentic engagement and partnership with those who are experts by experience, but may not have research methods training, requires resources and specialized skills. The McMaster Collaborative for Health and Aging developed a fellowship program for trainees that builds their capacity to conduct research in partnership with older adults with relevant lived experience. We share this case example, with its successes and challenges, to encourage creative reformation of traditional research training. The Collaborative used an iterative design process, involving researchers, trainees and older adult and caregiver partners, who, together, developed a fellowship program for trainees that provides support and mentorship to plan and conduct health research in partnership with people with lived experience. Since 2022, the Partnership in Research Fellowship has been offered biannually. The application process was purposefully designed to be both constructive and supportive. Opportunities for one-on-one consultations; key resources, including a guide for developing a plan to involve people with relevant lived experience; and feedback from older adult and researcher reviewers are provided to all applicants. Successful trainees engage with older adult and caregiver partners from the Collaborative to advance and enhance a range of skills from facilitating partner meetings to forming advisory committees. Trainees are awarded $1500 CAD to foster reciprocal partnerships. Ten graduate students from various disciplines have participated. Trainees reported positive impacts on their knowledge, comfort, and approach to partnered research. However, the time required for undertaking partnered research activities and involving diverse partners remain obstacles to meaningful engagement. Partnering with people with lived experience in the design of educational programs embeds the principles of partnership and can increase the value and reward for all involved. We share the Partnership in Research Fellowship as a case example to inspire new and transformative approaches in research training and mentorship that will move the field forward from engagement theory to meaningful enactment.

Abstract Engagement of patients and the public in health research is crucial for ensuring research relevance and alignment with community needs. However, there is a lack of nuanced evaluations and examples that promote collaborative and reflective learning about partnerships with partners. The aim of this paper is to provide a case example of a participatory evaluation of the engagement of older adult partners in an aging-focused research centre. We outline our process of co-planning and implementing an evaluation of the McMaster Collaborative for Health and Aging’s engagement strategy through the use of multiple methods, including a standardized tool and qualitative approaches. The team chose to explore and capture the engagement experiences and perspectives of the older adult partners within the Collaborative using a survey (the Public and Patient Engagement Evaluation Tool (PPEET)), an art-based method (photovoice), and a focus group. We present a brief summary of the findings but primarily focus this paper on the experiences of using each methodology and tool, with an emphasis on promoting dialogue on the benefits, limitations, and challenges. We reflect on the process of co-planning and the integration of both standardized tools and qualitative approaches to adopt a holistic approach to evaluating partnership within the Collaborative. Ultimately, this case example aims to provide practical guidance for other research groups navigating the complexities of partnership engagement and evaluation, thereby promoting meaningful partnerships in research.

Objetivo: Este estudo teve por objetivo comparar o perfil de expressão de quimiocinas e anticorpos (IgG) específicos ao SARS-CoV-2 em indivíduos convalescentes e/ou vacinados para COVID-19. Material e métodos: Os participantes foram distribuídos em grupos: G0 – n = 15 (controle - naive para SARS-CoV-2; não vacinados), G1 – n = 14 (naive para SARS-CoV-2; vacinados), G2 – n = 6 (convalescentes; não vacinados) e G3 – n = 15 (convalescentes; vacinados), totalizando 50 indivíduos. Foram avaliadas IL-8, RANTES, MIG, MPC-1, IP-10, concentrações de IgG contra SARS-CoV-2 (anti-nucleocapsídeo, anti-spike-S1 e anti-RBD) e a capacidade de inibição dos anticorpos neutralizantes (NAbs). Resultados: Observou-se maiores níveis de anti-spike S1 e anti-RBD (mediana = 100.153 pg/mL e 41.253 pg/mL, respectivamente), bem como maior taxa de neutralização (mediana = 98%) em G3 (convalescentes/vacinados) quando comparado com os demais grupos. Quanto às quimiocinas, os grupos G1 e G3 apresentaram menores níveis, estando inversamente correlacionados aos níveis de NAbs em G3. Em contrapartida, G2 apresentou níveis plasmáticos mais elevados de IP-10, IL-8 e anti-nucleocapsídeo, fatores que podem ser deletérios ao receptor de plasma. Discussão: Até junho de 2024 a doença do coronavírus 2019 (COVID-19) acometeu cerca de 775 milhões de pessoas. Múltiplos fatores influenciam a evolução da COVID-19, incluindo alterações imunológicas (imunidade celular, humoral, perfis de citocinas/quimiocinas), podendo estas contribuir na progressão para hiperinflamação sistêmica. A fim de mitigar a ação deste fenômeno inflamatório e a evolução da infecção viral, a terapia com plasma convalescente (TPC) foi uma alternativa considerada, podendo fornecer imunização passiva a indivíduos infectados, visando neutralizar o patógeno e amenizar efeitos da resposta inflamatória grave. Os resultados apontam para o potencial do plasma de indivíduos vacinados, independente de terem tido COVID-19, dado o conjunto de características que podem favorecer imunidade passiva, mediante as concentrações de IgGs específicas ao SARS-CoV-2 com maior capacidade de neutralização viral. Conclusão: Desta forma, os plasmas dos grupos G3 e G1, respectivamente, parecem agregar as características mais seguras e eficazes para TPC, de modo mais eficiente do que o plasma oriundo de indivíduos não vacinados e recuperados da COVID-19. Estas informações podem ser úteis ao enfrentamento de novas epidemias com vírus emergentes e reemergentes, considerando os desafios vivenciados com pela saúde pública na pandemia da COVID-19.

Objetivo: Avaliar a capacidade imunomoduladora de β-glucanas oralmente administradas na imunidade treinada (TRIM) obtida após primovacinação para COVID-19, com foco na maturação de linfócitos B e níveis de anticorpos neutralizantes. Material e métodos: Amostras de sangue periférico (SP) de 34 homens (18 a 49 anos) não imunes ao SARS-CoV-2 foram coletadas pré e pós-imunização para COVID-19 (ChAdOx1), perfazendo três momentos (M1: pré-vacinação/suplementação; M2: 30 dias após 1ªdose da vacina; M3: 30 dias após 2ªdose). Os participantes foram divididos em dois grupos: G1 (Controle, suplementado com placebo; n = 12) e G2 (Tratado, suplementado com β-glucana–500 mg/dia; n = 16). A suplementação foi realizada por 14 dias, 7 antes e 7 após a 1ªdose da vacina. A caracterização imunofenotípica foi feita por citometria de fluxo em SP para avaliação de plasmoblastos/plasmócitos (PB/PC) com uso dos marcadores CD45/CD19/CD27/CD38. A determinação do percentual de anticorpos neutralizantes (NAbs) ao SARS-CoV-2 foi realizada por ELISA em M2 e M3. Resultados: Observou-se que a população de PB/PC em M3 mostrou-se aumentada em G1 (p = 0,01061). Entretanto, houve uma correlação negativa entre os níveis de PB/PC e o percentual de NAbs em G2 (Cor:-0,7746185), ou seja, quanto menores os níveis de PB/PC circulantes, maiores os níveis de NAbs. Discussão: TRIM caracteriza-se em pré-condicionar células imune inatas com estímulo prévio (como b-glucanas), visando aumentar a robustez das respostas imunes, o que leva a reagirem mais rápido quando desafiadas com estímulo heterólogo e secundário, servindo como estratégia potente para protocolos de vacinação. A transformação de LB em plasmoblastos ocorre como consequência de modificações morfológicas e epigenéticas que induz à alta síntese proteica, visando a produção de anticorpos. Plasmoblastos recém-gerados precisam migrar através do SP até nichos na medula óssea ou tecidos da mucosa para completar a sua diferenciação em células secretoras de anticorpos, os plasmócitos. Assim, os níveis destas células circulantes podem ser influenciados por esta migração. Conclusão: De fato, nossos resultados corroboram com esta premissa, considerando os maiores níveis de NAbs e menor frequência de PB/PC circulantes de G2 após imunização completa. O que nos leva a inferir que as β-glucanas induziram TRIM favorecendo a aceleração da resposta imune frente ao estímulo (vacina), tornando-a mais eficiente no desenvolvimento de anticorpos funcionais anti-SARS-CoV-2.

RESUMO Introdução: A Aprendizagem Baseada em Problemas ocorre por meio do trabalho em pequenos grupos, facilitado pelos tutores, devendo haver contribuição de todos para o alcance dos objetivos de aprendizagem. O estudante com perfil dominante pode desequilibrar essa dinâmica do grupo. Objetivo: Este estudo teve como objetivo compreender, na perspectiva da aprendizagem colaborativa, os significados atribuídos pelos docentes e discentes à presença do estudante com perfil dominante no grupo tutorial. Método: Realizaram-se dois estudos, de natureza qualitativa, com tutores e estudantes de uma faculdade do Nordeste do Brasil. O primeiro estudo objetivou compreender a percepção dos docentes sobre presença do estudante dominante no grupo tutorial. Para tanto, utilizaram-se entrevistas semiestruturadas para coleta das informações. A população foi composta por tutoras da graduação de Fisioterapia, com mais de dois anos facilitando grupos tutoriais. O segundo estudo objetivou compreender os significados atribuídos por discentes à presença do perfil de dominância nas tutorias. Utilizou-se o grupo focal como método de coleta. Participaram estudantes de Medicina dos quatro primeiros anos do curso. O processo de análise e interpretação das falas dos dois estudos foi ancorado nos pressupostos teóricos da aprendizagem colaborativa, os quais também serviram de referência para elaboração do roteiro das entrevistas e do grupo focal. Adotou-se a técnica da análise de conteúdo de Bardin. Os estudos foram aprovados pelo Comitê de Ética em Pesquisa com CAAE nº 26191119.5.0000.5569 e CAAE nº 38005320.5.0000.5569, respectivamente. Resultado: Os tutores e estudantes enfatizaram a diversidade encontrada no perfil de dominância. Caracterizaram o estudante com esse perfil como colaborativo, participativo e preparado. Apontaram também características de impaciência, dificuldade em escutar e aceitar colocações contrárias às suas, além de comportamento intrusivo, silenciando e limitando a participação de outros. As tutoras reforçaram a dificuldade em lidar com o estudante dominante, inclusive em dar feedback. Os discentes relataram que os tutores, perante o estudante dominante, não percebiam a ausência de colaboração no grupo e apresentavam insegurança para intervir. Conclusão: Os discentes expressaram tolhimento e insegurança diante da presença do estudante dominante, com prejuízo na construção do conhecimento do grupo e no desempenho individual, bem como decepção quanto à atuação do tutor. Os tutores demonstraram reconhecer as sutilezas dentro do perfil de dominância, apesar de suas dificuldades em intervir adequadamente.

Surgically assisted rapid palatal expansion (SARPE) is a type of surgical intervention to correct a transverse maxillary deficiency in skeletally mature patients. Complications associated with SARPE can be divided into intraoperative complications such as hemorrhage, or postoperative complications that are associated with inadequate suture release. We present a case of a twenty-four year old female patient who reported a left-sided lingual anesthesia following the surgery. We hypothesized the cause to be related to peri-operative hematoma formation at the left maxillary region. Patient was managed conservatively, followed up periodically for three months and showed gradual improvement and complete recovery.

Background and Aims: We aimed to characterize the epidemiologic and comorbidities profiles of patients with chronic Hepatitis D (CHD) followed in clinical practice in Italy and explored their interferon (IFN) eligibility. Methods: This was a cross-sectional study of the PITER cohort consisting of consecutive HBsAg-positive patients from 59 centers over the period 2019-2023. Multivariable analysis was performed by logistic regression model. Results: Of 5492 HBsAg-positive enrolled patients, 4152 (75.6%) were screened for HDV, 422 (10.2%) were anti-HDV positive. Compared with HBsAg mono-infected, anti-HDV positive patients were more often younger, non-Italians, with a history of drug use, had elevated alanine transaminase (ALT), cirrhosis, or hepatocellular carcinoma (HCC). Compared with Italians, anti-HDV positive non-Italians were younger (42.2% age ≤ 40 years vs. 2.1%; P < 0.001), more often females (males 43.0% vs. 68.6%; P < 0.001) with less frequent cirrhosis and HCC. HDV-RNA was detected in 63.2% of anti-HDV-positive patients, who were more likely to have elevated ALT, cirrhosis, and HCC. Extrahepatic comorbidities were present in 47.4% of anti-HDV positive patients and could affect the eligibility of IFN-containing therapies in at least 53.0% of patients in care. Conclusions: CHD affects young, foreign-born patients and older Italians, of whom two-thirds had cirrhosis or HCC. Comorbidities were frequent in both Italians and non-Italians and impacted eligibility for IFN.

ABSTRACT Introduction As the world's population ages, there has been increasing attention to developing health policies to support older adults. Engaging older adults in policy‐making is one way to ensure that policy decisions align with their needs and priorities. However, ageist stereotypes often underestimate older adults' ability to participate in such initiatives. This scoping review aims to describe the characteristics and impacts of public engagement initiatives designed to help inform health policy‐making for older adults. Methods A systematic search of peer‐reviewed and grey literature (English only) describing public engagement initiatives in health policy‐making for older adults was conducted using six electronic databases, Google and the Participedia website. No geographical, methodological or time restrictions were applied to the search. Eligibility criteria were purposefully broad to capture a wide array of relevant engagement initiatives. The outcomes of interest included participants, engagement methods and reported impacts. Results This review included 38 papers. The majority of public engagement initiatives were funded or initiated by governments or government agencies as a formal activity to address policy issues, compared to initiatives without a clear link to a specific policy‐making process (e.g., research projects). While most initiatives engaged older adults as target participants, there was limited reporting on efforts to achieve participant diversity. Consultation‐type engagement activities were most prevalent, compared to deliberative and collaborative approaches. Impacts of public engagement were frequently reported without formal evaluations. Notably, a few articles reported negative impacts of such initiatives. Conclusion This review describes how public engagement practices have been conducted to help inform health policy‐making for older adults and the documented impacts. The findings can assist policymakers, government staff, researchers and seniors' advocates in supporting the design and execution of public engagement initiatives in this policy sector. Patient or Public Contribution Older adult partners from the McMaster University Collaborative for Health and Aging provided strategic advice throughout the key phases of this review, including developing a review protocol, data charting and synthesis and interpreting and presenting the review findings. This collaborative partnership was an essential aspect of this review, enhancing its relevance and meaningfulness for older adults.

Summary: Replication origin assembly is a pivotal step in chromosomal DNA replication. In this process, the ORC complex binds DNA and, together with the CDC6 and CDT1, promotes the loading of the MCM helicase. Chemicals targeting origin assembly might be useful to sensitize highly proliferative cancer cells. However, identifying such compounds is challenging due to the multistage nature of this process. Here, using Xenopus laevis egg extract we set up a high-throughput screening to isolate MCM chromatin loading inhibitors, which led to the identification of NSC-95397 as a powerful inhibitor of replication origin assembly that targets CDC6 protein and promotes its degradation. Using systems developed to test selective drug-induced lethality we show that NSC-95397 triggers cell death both in human cells and Xenopus embryos that have higher proliferative ability. These findings demonstrate the effectiveness of molecules disrupting DNA replication processes in targeting hyperproliferating cells, highlighting their potential as anti-cancer molecules.

Immunotherapy has emerged as promising treatment in sarcomas, but the high variability in terms of histology, clinical behavior and response to treatments determines a particular challenge for its role in these neoplasms. Tumor immune microenvironment (TiME) of sarcomas reflects the heterogeneity of these tumors originating from mesenchymal cells and encompassing more than 100 histologies. Advances in the understanding of the complexity of TiME have led to an improvement of the immunotherapeutic responsiveness in sarcomas, that at first showed disappointing results. The proposed immune-classification of sarcomas based on the interaction between immune cell populations and tumor cells showed to have a prognostic and potential predictive role for immunotherapies. Several studies have explored the clinical impact of immune therapies in the management of these histotypes leading to controversial results. The presence of Tumor Infiltrating Lymphocytes (TIL) seems to correlate with an improvement in the survival of patients and with a higher responsiveness to immunotherapy. In this context, it is important to consider that also immune-related genes (IRGs) have been demonstrated to have a key role in tumorigenesis and in the building of tumor immune microenvironment. The IRGs landscape in soft tissue and bone sarcomas is characterized by the connection between several tumor-related genes that can assume a potential prognostic and predictive therapeutic role. In this paper, we reviewed the state of art of the principal immune strategies in the management of sarcomas including their clinical and translational relevance.

Papillary thyroid microcarcinoma (PTMC) represents 35–40% of all papillary cancers; it is defined as a nodule ≤ 10 mm at the time of histological diagnosis. The clinical significance of PTMC is still controversial, and it may be discovered in two settings: incidental PTMC (iPTMC), in which it is identified postoperatively upon histological examination of thyroid specimens following thyroid surgery for benign disease, and nonincidental PTMC (niPTMC), in which it is diagnosed before surgery. While iPTMC appears to be related to mild behavior and favorable clinical outcomes, niPTMC may exhibit markers of aggressiveness. We retrospectively review our experience, selecting 54 PTMCs: 28 classified as niPTMC (52%) and 26 classified as iPTMC (48%). Patients with niPTMC showed significant differences, such as younger age at diagnosis (p < 0.001); a lower male/female ratio (p < 0.01); a larger mean nodule diameter (p < 0.001); and a higher rate of aggressive pathological findings, such as multifocality, capsular invasion and/or lymphovascular invasion (p = 0.035). Other differences found in the niPTMC subgroup included a higher preoperative serum TSH level, higher hospital morbidity and a greater need for postoperative iodine ablation therapy (p < 0.05), while disease-free long-term survival did not differ between subgroups (p = 0.331) after a mean follow-up (FU) of 87 months, with one nodal recurrence among niPTMCs. The differences between iPTMC and niPTMC were consistent: patients operated on for total thyroidectomy and showing iPTMC can be considered healed after surgery, and follow-up should be designed to properly calibrate hormonal supplementation; conversely, niPTMC may sometimes exhibit aggressive behavior, and so the FU regimen should be closer and aimed at early detection of cancer recurrence.

Background: Duodenal neuroendocrine tumors (NETs) are uncommon, accounting for less than 4% of all gastrointestinal neoplasms. Prognosis is related to tumoral staging and grading, as well as to the specific subtype. In this article, we retrospectively describe the clinical presentation and surgical treatment of two rare large duodenal NETs: a high-grade G3 NET and a Gangliocytic Paraganglioma (GP). Methods: Both patients presented with moderate-to-high-degree abdominal pain, without jaundice. Main vessel involvement and metastatic spread were excluded with imaging, while preoperative bioptic diagnosis was obtained via percutaneous needle citology and endoscopic ultrasound. Results: The presence of a sessile large lesion contraindicated any conservative approach in favor of a pancreaticoduodenectomy (PD). The detection of soft pancreatic tissue and a narrowed main pancreatic duct led us to perform a pancreaticogastrostomy to restore proper pancreatic drainage and to minimize the risk of postoperative leakage. Conclusion: PD may be a favorable choice in these cases; this procedure is challenging, but it results in a safer and more favorable clinical outcome for our patients. Pancreaticogastrostomy may guarantee lower rates of postoperative leak and appears to be preferred in this subset of patients.

Resumo Introdução: O assédio sexual é uma realidade que permeia as relações de poder hierárquicas e de gênero. Embora perceptível nos meios médico e acadêmico, é considerado uma violência silenciada que acarreta agravos orgânicos e psíquicos com grandes consequências para a vítima. Objetivo: Este estudo teve como objetivos elaborar e validar um instrumento de identificação da ocorrência de assédio sexual em estudantes de Medicina. Método: Após revisão da literatura sobre o tema, elaborou-se um instrumento, com repostas do tipo Likert em cinco níveis de opção, que possui duas partes: a primeira com informações sobre características sociodemográficas e acadêmicas dos participantes, e a segunda contendo 21 itens agrupados em três dimensões: formas de assédio, fatores facilitadores e identificação do assediador no meio acadêmico e na prática hospitalar. Efetuaram-se as validações semântica e de conteúdo por consenso de especialistas, e a validação FACE realizada por grupo focal de 12 estudantes, sendo dois de cada ano do curso. Para verificação da confiabilidade, o instrumento foi enviado a 1.146 estudantes de Medicina uma vez por semana, por quatro semanas. Obteve-se a resposta de 350 (30,5%) estudantes no teste, seguindo a recomendação para estudos psicométricos. Após 15 dias, iniciou-se o reteste com os 350 respondentes do teste, seguindo a mesma cronologia de envio para a verificação da estabilidade. No reteste, obtiveram-se 69 respostas. Para a elaboração do banco de dados, utilizou-se o programa Excel versão 16, e, para a análise, adotou-se o programa estatístico Stata versão 13. O instrumento foi aplicado on-line pelo software livre LimeSurvey. Resultado: A confiabilidade do instrumento ficou evidenciada pelo alfa de Cronbach de 0,8163 e de 0,7826 para o teste e reteste, respectivamente. Para a constatação da estabilidade, utilizou-se o teste de Stuart-Maxwell que apresentou um valor de p = 0,126. Adotou-se ainda o Kappa ponderado, em que o resultado de todas as 21 assertivas está contido no intervalo de confiança, demonstrando a homogeneidade da distribuição dos escores médios entre o teste e o reteste. Conclusão: Como o instrumento validado se mostrou confiável e estável, pode ser utilizado em escolas médicas para a identificação do assédio sexual em estudantes de Medicina.

Abstract Objective To assess the knowledge, attitude, and practice of Brazilian physicians about immediate postpartum and postabortion intrauterine device insertion. Methods Cross-sectional online survey involving physicians on duty in public Brazilian hospitals. Participants answered an anonymous questionnaire with close-ended questions to assess their knowledge, attitude, and experience on the immediate postpartum and postabortion insertion of copper intrauterine devices. Results One hundred twenty-seven physicians working in 23 hospitals in the 5 geographic regions of Brazil completed the questionnaire. Most were female (68.5%) and worked in teaching hospitals (95.3%). The mean (standard deviation) knowledge score (0–10 scale) was 5.3 (1.3); only 27.6% of the participants had overall scores ≥7.0. Most physicians (73.2%) would insert a postpartum intrauterine device in themselves/family members. About 42% of respondents stated that they had not received any training on postpartum or postabortion intrauterine device insertion. In the past 12 months, 19.7%, 22.8%, and 53.5% of respondents stated they had not inserted any intrauterine device during a cesarean section, immediately after a vaginal delivery, or after an abortion, respectively. Conclusion Most study participants have a positive attitude toward the insertion of intrauterine devices in the immediate postpartum period, but they have limited knowledge about the use of this contraceptive method. A large percentage of respondents did not have previous training on postpartum and postabortion intrauterine device insertion and had not performed any such insertions in the last 12 months. Strategies are needed to improve the knowledge, training, and experience of Brazilian physicians on immediate postpartum and postabortion intrauterine device insertion.

ABSTRACT This study aimed to evaluate the performance of reproductive culled lambs kept in confinement, through weight gain, carcass yield, and the state of non-carcass components using two high concentrate diets (90%). One diet was formulated on the property compared to commercially available concentrate. The cost-benefits of each diet were analyzed and compared. We used 24 Corriedale lambs, aged 180 days weighing an average of 28 ± 4 kg. The animals were randomly separated into two groups: the commercial concentrate group (CC) which received 0.4% and 4% of their live weight in Tifton hay and commercial concentrate, respectively, and the property concentrate group (CP) received hay and a high-concentrate diet produced on the property (using whole grain corn as a base), in the same proportions. The study was conducted, for a period of 55 days, along with ten days of adaptation, until they reached 40 ± 2 kg body weight (BW). Animals in the property concentrate group achieved a higher average daily gain (0.232 kg/day), but there was no significant difference in carcass yield between the groups The weights of non-carcass components such as the liver, spleen, and kidneys with fat were higher in the concentrate group. The property concentrate group presented a net income of R$ 0.40, while the animals that received the commercial concentrate presented a negative income of R$ - 0.45, per day. Therefore, the use of a high-grain diet produced on the property under the conditions of this study allowed for better weight gain, and a better cost-benefit ratio.

Tonya L Rich,1,2 Hannah L Phelan,1,3 Amy A Gravely,1 Kierra J Falbo,1,2 Jacob A Finn,1,4 Mary E Matsumoto,1,5 Katherine J Muschler,1 Christine M Olney,1,2,6 Jessica E Kiecker,1 Andrew H Hansen1,2,7 1Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA; 2Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA; 3Medical College of Wisconsin, Milwaukee, WI, USA; 4Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA; 5Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA; 6Department of Nursing, University of Minnesota, Minneapolis, MN, USA; 7Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USACorrespondence: Tonya L Rich, Tel +1 612-467-5463, Fax +1 612-725-2093, Email tonya.rich@va.govBackground: Phantom limb pain (PLP) commonly occurs post-amputation and can negatively affect the daily functioning of persons with amputation. Best practices for medication and non-drug management remain unclear.Objective: To better understand the PLP experience and patients’ familiarity with treatments, phone interviews were conducted at the Minneapolis Veterans Affairs Regional Amputation Center in Veterans with amputations.Methods: Fifty Veteran participants (average age 66, 96% male) with lower limb amputation were recruited for phone-based data collection of patient-reported outcomes (ie, demographics using the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) and pain experience using the Phantom Phenomena Questionnaire) to characterize the population and a semi-structured interview. Notes taken during interviews were analyzed using the Krueger and Casey constant comparison analysis method.Results: Participants had an average of 15 years since amputation, and 80% reported PLP as identified with the Phantom Phenomena Questionnaire. Investigators identified several core themes from the qualitative interviews including 1) high variability in the experience of PLP, 2) acceptance and resilience, and 3) PLP treatment perceptions. The majority of participants reported trying common non-drug treatments with none endorsed consistently as highly effective.Conclusion: More research is needed to inform identification and implementation of clinical best practices for non-drug interventions for PLP and understand the factors that influence engagement in non-drug interventions. The participants in this study were largely male, so these results may not be generalizable to females.Keywords: amputation, phantom limb pain, rehabilitation, non-drug interventions, pain

Abstract Background Ovarian hyperstimulation syndrome (OHSS) is a complication of controlled ovarian hyperstimulation (COH). It is a potentially life-threatening condition that usually occurs either after human chorionic gonadotropins (hCG) administration in susceptible patients or as a result of an implanting pregnancy, regardless of whether it was achieved by natural conception or infertility treatments. Despite many years of clinical experience regarding the adoption of preventive measures and the identification of patients at high risk, the pathophysiology of OHSS is poorly understood and no reliable predictive risk factors have been identified. Cases presentation We report about two unexpected cases of OHSS following infertility treatments, occurring after freeze-all strategy with embryo cryopreservation approaches. The first case developed spontaneous OHSS (sOHSS), despite efforts to prevent its manifestation by a segmentation approach, including frozen embryo replacement cycle. The second case developed a late form of iatrogenic OHSS (iOHSS), even though the absence of any risk factors. No mutations in the follicle-stimulating hormone (FSH) receptor (FSHR)-encoding gene were detected, suggesting that the high levels of hCG due to the twin implanting pregnancies could be the only triggering factor of OHSS outbreak. Conclusion Freeze-all strategy with embryo cryopreservation cannot entirely prevent the development of OHSS, which may occur in its spontaneous form independently from the FSHR genotype. Although OHSS remains a rare event, all infertile patients requiring ovulation induction or controlled ovarian stimulation (COS) may be at potential risk of OHSS, either in the presence or in the absence of risk factors. We suggest closely monitoring cases of pregnancy following infertility treatments in order to provide early diagnosis and adopt the conservative management.

Objective: The study aimed to evaluate the vancomycin and amikacin concentrations in serum and dialysate for automatic peritoneal dialysis (APD) patients. Methods: A total of 558 serum and dialysate samples of 12 episodes of gram-positive and 18 episodes of gram-negative peritonitis were included to investigate the relationship between vancomycin and amikacin concentrations in serum and dialysate on the first and third days of treatment. Samples were analysed 30, 120 min, and 48 h after intraperitoneal administration of vancomycin in peritonitis caused by gram-positive agents and 30, 120 min, and 24 h after intraperitoneal administration of amikacin in peritonitis caused by gram-negative agents. Vancomycin was administered every 72 h and amikacin once a day. The target therapeutic concentration of amikacin was 25-35 mg/l at the peak moment and 4-8 mg/l at the trough moment; and after 48 h for vancomycin, 15-20 mg/l at the trough moment. Results: For peritonitis caused by gram-negative agents, at the peak moment, therapeutic levels of amikacin were reached in dialysate in 80.7% of patients with evolution to cure and in 50% of patients evaluated as non-cure (p = 0.05). At the trough moment, only 38% were in therapeutic concentrations in the dialysate in the cure group and 42.8% in the non-cure group (p = 1). Peak plasma concentrations were subtherapeutic in 98.4% of the samples in the cure group and in 100% of the non-cure group. At the trough moment, therapeutic concentrations were present in 74.4% of the cure group and 71.4% of the non-cure group (p = 1). Regarding vancomycin and among gram-positive agents, therapeutic levels were reached at the peak moment in 94% of the cure group and 6% of the non-cure group (p = 0.007). After 48 h, 56.8% of the cure group had a therapeutic serum concentration whereas for the non-cure group it was only 33.3% (p = 0.39). Conclusion: Despite a small sample size, we demonstrated peak dialysate amikacin level and peak serum vancomycin level correlates well with Gram-negative and Gram positve peritonitis cure, respectively. It is suggested to study the antibiotics pharmacodynamics for a better understanding of therapeutic success in a larger sample.

Objective: The study aimed to evaluate the vancomycin and amikacin concentrations in serum and dialysate for automatic peritoneal dialysis (APD) patients. Methods: A total of 558 serum and dialysate samples of 12 episodes of gram-positive and 18 episodes of gram-negative peritonitis were included to investigate the relationship between vancomycin and amikacin concentrations in serum and dialysate on the first and third days of treatment. Samples were analysed 30, 120 min, and 48 h after intraperitoneal administration of vancomycin in peritonitis caused by gram-positive agents and 30, 120 min, and 24 h after intraperitoneal administration of amikacin in peritonitis caused by gram-negative agents. Vancomycin was administered every 72 h and amikacin once a day. The target therapeutic concentration of amikacin was 25-35 mg/l at the peak moment and 4-8 mg/l at the trough moment; and after 48 h for vancomycin, 15-20 mg/l at the trough moment. Results: For peritonitis caused by gram-negative agents, at the peak moment, therapeutic levels of amikacin were reached in dialysate in 80.7% of patients with evolution to cure and in 50% of patients evaluated as non-cure (p = 0.05). At the trough moment, only 38% were in therapeutic concentrations in the dialysate in the cure group and 42.8% in the non-cure group (p = 1). Peak plasma concentrations were subtherapeutic in 98.4% of the samples in the cure group and in 100% of the non-cure group. At the trough moment, therapeutic concentrations were present in 74.4% of the cure group and 71.4% of the non-cure group (p = 1). Regarding vancomycin and among gram-positive agents, therapeutic levels were reached at the peak moment in 94% of the cure group and 6% of the non-cure group (p = 0.007). After 48 h, 56.8% of the cure group had a therapeutic serum concentration whereas for the non-cure group it was only 33.3% (p = 0.39). Conclusion: Despite a small sample size, we demonstrated peak dialysate amikacin level and peak serum vancomycin level correlates well with Gram-negative and Gram positve peritonitis cure, respectively. It is suggested to study the antibiotics pharmacodynamics for a better understanding of therapeutic success in a larger sample.

The assessment of antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of critical importance to verify the protective efficacy of available vaccines. Hospital healthcare workers play an essential role in the care and treatment of patients and were particularly at risk of contracting the SARS-CoV-2 infection during the pandemic. The vaccination protocol introduced in our hospital protected the workers and contributed to the containment of the infection’ s spread and transmission, although a reduction in vaccine efficacy against symptomatic and breakthrough infections in vaccinated individuals was observed over time. Here, we present the results of a longitudinal and prospective analysis of the anti-SARS-CoV-2 antibodies at multiple time points over a 17-month period to determine how circulating antibody levels change over time following natural infection and vaccination for SARS-CoV-2 before (T0–T4) and after the spread of the omicron variant (T5–T6), analyzing the antibody response of 232 healthy workers at the Pio XI hospital in Desio. A General Estimating Equation model indicated a significant association of the antibody response with time intervals and hospital area, independent of age and sex. Specifically, a similar pattern of antibody response was observed between the surgery and administrative departments, and a different pattern with higher peaks of average antibody response was observed in the emergency and medical departments. Furthermore, using a logistic model, we found no differences in contracting SARS-CoV-2 after the third dose based on the hospital department. Finally, analysis of antibody distribution following the spread of the omicron variant, subdividing the cohort of positive individuals into centiles, highlighted a cut-off of 550 BAU/mL and showed that subjects with antibodies below this are more susceptible to infection than those with a concentration above the established cut-off value.

The work presents an integrated system for combined heat and power generation based on a topping biodiesel internal combustion engine (ICE) and a bottoming transcritical organic Rankine cycle (TORC). A 0D/1D mathematical model is developed to evaluate the performance of the innovative biodiesel system in design and off-design conditions for a wide range of rated power and organic fluids. The analysis highlights that the TORC integration improves the total full load electric power by more than 12%, and the engine size significantly influences the integrated system performance. The total electric efficiency increases from 35.0% to 47.9%, whereas the thermal efficiency decreases from 27.2% to 19.8% when the ICE’s nominal power moves from 10 kWel to 500 kWel.Afterward, a multi-objective investigation is carried out to define the most suitable power of the proposed biodiesel system and its capability to satisfy the energy request of specific users. A thermal self-consumption equal to 100%, an electric self-consumption larger than 94%, and a payback time of 5.2 years are found. Lastly, a sensitivity analysis demonstrates the economic feasibility of the proposed biodiesel integrated system for a wide range of prices of energy vectors and system components.