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Plastics pollution, persistent chemical contamination and inadequately treated wastewater are three key aspects that hinder access to safe and affordable water for all. We argue that a strong priority on pollution avoidance, research for remediation, and tighter regulation and monitoring must be implemented to make progress.

Plastics pollution, persistent chemical contamination and inadequately treated wastewater are three key aspects that hinder access to safe and affordable water for all. We argue that a strong priority on pollution avoidance, research for remediation, and tighter regulation and monitoring must be implemented to make progress.

Abstract Background There has been a progressive increase in the use of percutaneous cholecystostomy (PC) in acute cholecystitis (AC) over the last decades due to population aging, and the support of guidelines (Tokyo Guidelines (TG), World Society of Emergency Surgery (WSES) Guidelines) as a valid therapeutical option. However, there are many unanswered questions about the management of PCs. An international consensus on indications and PC management using Delphi methodology with contributions from experts from three surgical societies (EAHPBA, ANS, WSES) have been performed. Methods A two-round Delphi consensus, which included 27 questions, was sent to key opinion leaders in AC. Participants were asked to indicate their ‘agreement/disagreement’ using a 5-point Likert scale. Survey items with less than 70% consensus were excluded from the second round. For inclusion in the final recommendations, each survey item had to have reached a group consensus (≥ 70% agreement) by the end of the two survey rounds. Results 54 completed both rounds (82% of invitees). Six questions got > 70% and are included in consensus recommendations: In patients with acute cholecystitis, when there is a clear indication of PC, it is not necessary to wait 48 h to be carried out; Surgery is the first therapeutic option for the TG grade II acute cholecystitis in a patient suitable for surgery; Before PC removal a cholangiography should be done; There is no indication for PC in Tokyo Guidelines (TG) grade I patients; Transhepatic approach is the route of choice for PC; and after PC, laparoscopic cholecystectomy is the preferred approach (93.1%). Conclusions Only six statements about PC management after AC got an international consensus. An international guideline about the management of PCs are necessary.

Abstract Ionized Mg (iMg) may offer a more reliable indicator of Mg status during acute illness than total Mg (tMg) concentrations. This study aimed to determine the prevalence of dysmagnesemia and their relationship using iMg and tMg. The clinical and biochemical characteristics as well as health outcomes and their association with iMg and tMg were also assessed. A prospective study including all eligible adult patients (≥18 years) who were hospitalized in the General Internal Medicine unit at Sultan Qaboos University Hospital (SQUH) for 3.5 months in 2023. The iMg and tMg concentrations were collected on all at the admission. In total 500 patients were included (females 49.2%) with a median age of 64.5 years (IQR: 48-77). The prevalence of hypomagnesemia and hypermagnesemia by iMg concentrations was 3.4% and 26.6%, respectively, while by tMg concentrations 13.2% and 11.0%, respectively. The agreement between both measurements was strong (r=0.665, p

This article draws on two surveys of international students in Sydney and Melbourne, undertaken in 2019 and during the 2020 COVID-19 lockdowns. Using the concept of bounded agency, we identify how the challenges of living in one of the world's most expensive rental housing markets impact students' perceptions of their academic attainment. We find housing insecurity, unaffordability and condition, amplified by financial stress, contribute significantly to student anxiety about their studies. These relationships differ by student background and education. We argue students' agency to meet their educational ambitions in Australia is constrained by the cost of housing and the housing choices they consequently make to mitigate financial stress. Our findings suggest the importance of 'town' or non-institutional aspects of the international student experience on their satisfaction and academic outcomes. We call for further research to explore these relationships in other global contexts.

Debates continue about the positioning of design within research-driven universities. While the idea of autonomy has had a strong appeal, it is the bridging across established academic cultures that has proved especially effective for legitimizing design research and research education. Revisiting a conception of design as a 'Third Space' and drawing on a case - the Swedish Faculty for Design Research and Research Education (2008-2015) - we discuss what 'thirdness' can entail in context. Our account of this case reveals the unsettled dynamics of navigating in, between and across academic cultures. Design research education, we argue, has prospects to cultivate a critical space within academia, in which its 'thirdness' entails sensitization and agitation of the territorial conditions of knowledge. There is a need for a reconsideration of design - and academia more generally - not as a static disciplinary order but as a contested archipelago that opens for alternative orientations.

Housing is a major concern for many international students. This is especially so in those countries where students are mostly dependent on the private market for their accommodation. Australia is one such country, and is one of the world's major destinations for international students. This article analyses governmental failure to address problems relating to international student housing affordability and conditions. Using theory on 'policy inaction' to frame the analysis, we draw on 20 interviews with policy stakeholders to explain the Australian government's reliance on: (1) market-based housing provision for international students, and (2) a longstanding policy preference not to provide support. Interviewees were widely critical of the lack of action to address international student housing problems and understood inaction in relation, rather than in opposition, to the dominance of market-based action in housing and higher education. However, analysis of stakeholder perspectives also illuminates how policy-making "action" benefiting some emerges as "inaction" for others left behind or overlooked by the status quo. The interview data points to the need for government to overhaul its policy framework, and in doing so, to collaborate with higher education providers in revising the market-based regulatory approach. The main implications for theory and policy are discussed.

Abstract Intraventricular hemorrhage (IVH) is a common neurological injury following very preterm birth. Resting-state functional connectivity (RSFC) using functional magnetic resonance imaging (fMRI) is associated with injury severity; yet, fMRI is impractical for use in intensive care settings. Functional near-infrared spectroscopy (fNIRS) measures RSFC through cerebral hemodynamics and has greater bedside accessibility than fMRI. We evaluated RSFC in preterm neonates with IVH using fNIRS and fMRI at term-equivalent age, and compared fNIRS connectivity between healthy newborns and those with IVH. Sixteen very preterm born neonates were scanned with fMRI and fNIRS. Additionally, fifteen healthy newborns were scanned with fNIRS. In preterms with IVH, fNIRS and fMRI connectivity maps were compared using Euclidean and Jaccard distances. The severity of IVH in relation to fNIRS-RSFC strength was examined using generalized linear models. fNIRS and fMRI RSFC maps showed good correspondence. Connectivity strength was significantly lower in healthy newborns (p-value = 0.023) and preterm infants with mild IVH (p-value = 0.026) compared to infants with moderate/severe IVH. fNIRS has potential to be a new bedside tool for assessing brain injury and monitoring cerebral hemodynamics, as well as a promising biomarker for IVH severity in very preterm born infants.

Atractylis flava Desf. (AF) is common plant that is widely used for its anti- inflammatory and antioxidant properties. The purpose of this study was, therefore, to evaluate the cytotoxic effect and the molecular basis of antioxidant and anti-inflammatory effects of the ethyl acetate extract (AFEAE) obtained from the whole plant A. flava. This was accomplished through the use of NR8383 alveolar rat macrophage cells. Cultures of alveolar rat macrophage cells were treated with AFEAE (25–800 μg/mL), and cell viability was determined via WST-1 and LDH tests. In turn, the gene expression levels of nuclear factor κB (NF-κB), tumor necrosis factor-alpha (TNFα), interleukin 1 beta (IL1-β), interleukin 6 (IL-6), mitochondrial dynamin like GTPase (OPA1), Succinate dehydrogenase complex subunit A (SDHA) and neutrophil cytosolic factor 1 (NCF1) were assessed by applying RT-qPCR. The results show that ethyl acetate extracts of A. flava have non-cytotoxic effects, and the gene expression analysis demonstrates that AFEAF extracts generate significant downregulation of NF-κB, TNFα, IL-1 β, IL-6, NCF1, OPA1 and SDHA, compared to untreated cells. This study reveals that Atractylis flava ethyl acetate extract administration may be considered as a potential therapeutic strategy for inflammatory related diseases.

Abstract Background Pancreatic head cancer patients who undergo pancreatoduodenectomy (PD) often experience disease recurrence, frequently associated with a positive margin status (R1). Total mesopancreas excision (TMpE) has emerged as a potential approach to increase surgical radicality and minimize locoregional recurrence. However, its effectiveness and safety remain under evaluation. Methods We conducted a systematic review and meta-analysis to synthesize current evidence on TMpE outcomes. A systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases was conducted up to March 2024 to identify studies comparing TMpE with standard pancreatoduodenectomy (sPD). The risk ratio (RR) or mean difference (MD) was pooled using a random effects model. Results From 452 studies identified, 9 studies with a total of 738 patients were included, with 361 (49%) undergoing TMpE. TMpE significantly improved the R0 resection rate (RR 1.24; 95% CI 1.11–1.38; P

In its response to COVID-19 in 2020, the Australian Government excluded international students from the temporary financial assistance it offered most permanent residents. This article examines the status of international student welfare as a policy question before and during the pandemic, and discusses post-pandemic policy implications. It draws on pre- and during-COVID-19 survey data from international students in Sydney and Melbourne. We argue that the pandemic highlighted and exacerbated an existing policy absence, rather than constituting a fresh abandonment of international students. Since the Dawkins changes in the early 1990s, international students have been officially treated in policy as consumers, not as 'social citizens'. This made many of them vulnerable to socio-economic shocks, given widespread dependence on precarious employment and insecure private income sources. The central policy implication is that, to avoid disproportionate welfare diminutions in future crises, the government needs to align the treatment of international and domestic students.

We present a multicenter retrospective study of patients undergoing surgery for duodenal adenocarcinoma, from January 2010 to August 2020, in order to determine the epidemiological characteristics and the oncological results after surgical resection obtained in this rare tumor. Variables: demographics; tumor location; surgical intervention and immediate postoperative period; and post-surgical follow-up information, such as recurrence, overall survival (OS), and disease-free survival (DFS). A total of 32 patients underwent surgery. The median age was 69.74 years (IQR 60.47–79.09) and the male/female distribution was 3:1. The surgeries performed were: pancreaticoduodenectomy (PD) in 16 (50%) patients, segmental resection in 13 (40.6%), and the local excision of the lesion in three (9.4%). The R0 rate was higher in PD (86.7% vs. 42.9%; p = 0.013). The OS and DFS rate at one, three and five years was 95%, 70%, and 60% and 86%, 55%, and 48%, respectively. There was a greater trend towards recurrence in patients who did not undergo PD (53.8% vs. 25%; p = 0.14) and conservative surgery seemed to be associated with more local recurrence than PD (57.1% vs. 33.3%; p = 0.49). PD and limited resection are both valid options in the cases of non-ampullary duodenal adenocarcinoma, although PD presented lower rates of loco-regional recurrence.

IntroductionChemotherapy, notably docetaxel (Doc), stands as the primary treatment for castration-resistant prostate cancer (CRPC). However, its efficacy is hindered by side effects and chemoresistance. Hypoxia in prostate cancer (PC) correlates with chemoresistance to Doc-induced apoptosis via Heme Oxygenase-1 (HO-1) modulation, a key enzyme in heme metabolism. This study investigated targeting heme degradation pathway via HO-1 inhibition to potentiate the therapeutic efficacy of Doc in PC.MethodsUtilizing diverse PC cell lines, we evaluated HO-1 inhibition alone and with Doc on viability, apoptosis, migration, and epithelial- to- mesenchymal transition (EMT) markers and elucidated the underlying mechanisms.ResultsHO-1 inhibition significantly reduced PC cell viability under hypoxic and normoxic conditions, enhancing Doc-induced apoptosis through interconnected mechanisms, including elevated reactive oxygen species (ROS) levels, glutathione cycle disruption, and modulation of Signal Transducer and Activator of Transcription 1 (STAT1) pathway. The interplay between STAT1 and HO-1 suggests its reliance on HO-1 activation. Additionally, a decrease in cell migration and downregulation of EMT markers (vimentin and snail) were observed, indicating attenuation of mesenchymal phenotype.DiscussionIn conclusion, the combination of HO-1 inhibition with Doc holds promise for improving therapeutic outcomes and advancing clinical management in PC.

يؤدي التنبؤ بعدد خريجي جامعة تشرين دوراً هاماً في التخطيط السليم لواقع الخريجين حيث أن الدراسة الحالية استهدفت التنبؤ بعدد خريجي جامعة تشرين بالاستعانة بالسلسة الزمنية لأعداد الخريجين خلال الفترة (1979-(2020 لتحقيق الهدف المنشود تم استخدام التمهيد الأسي للتنبؤ بعدد خريجي جامعة تشرين, لما تمتلكه من قدره عالية في معالجة السلسلة الزمنية تم الاعتماد على المنهج الإحصائي الوصفي بالإضافة إلى المنهج الاستقرائي التحليلي بهدف وصف بيانات الدراسة وكذلك اختبار فرضياتها, وتوصلت الدراسة إلى أن نموذج التمهيد الأسي المضاعف أكثر كفاءة في التنبؤ وذلك لأنه يمتلك أقل قيمة لمعاير دقة التنبؤRMSE,MAE لذلك تم الاعتماد عليه في التنبؤ بعدد خريجي جامعة تشرين خلال الخمس سنوات القادمة, لما لهذا الموضوع من أهمية من أجل معرفة طبيعة العلاقة بين كفايات خريجي جامعة تشرين واحتياجات سوق العمل.

Abstract Introduction A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome.

Abstract Hypoxic-ischemic encephalopathy (HIE) results from a lack of oxygen to the brain during the perinatal period. HIE can lead to mortality and various acute and long-term morbidities. Improved bedside monitoring methods are needed to identify biomarkers of brain health. Functional near-infrared spectroscopy (fNIRS) can assess resting-state functional connectivity (RSFC) at the bedside. We acquired resting-state fNIRS data from 21 neonates with HIE (postmenstrual age [PMA] = 39.96), in 19 neonates the scans were acquired post-therapeutic hypothermia (TH), and from 20 term-born healthy newborns (PMA = 39.93). Twelve HIE neonates also underwent resting-state functional magnetic resonance imaging (fMRI) post-TH. RSFC was calculated as correlation coefficients amongst the time courses for fNIRS and fMRI data, respectively. The fNIRS and fMRI RSFC maps were comparable. RSFC patterns were then measured with graph theory metrics and compared between HIE infants and healthy controls. HIE newborns showed significantly increased clustering coefficients, network efficiency and modularity compared to controls. Using a support vector machine algorithm, RSFC features demonstrated good performance in classifying the HIE and healthy newborns in separate groups. Our results indicate the utility of fNIRS-connectivity patterns as potential biomarkers for HIE and fNIRS as a new bedside tool for newborns with HIE.

There is mounting evidence of increased international student financial and work precarity over the last decade in Australia. Yet, there has been a little scholarly analysis of which students are most affected by precarity and its sources. Drawing on two surveys of international students in Australia's two largest cities, conducted before and during the pandemic, we investigate the financial and work vulnerabilities of international students. We demonstrate that vulnerability is related to characteristics which describe particular cohorts of students: being from low-income countries, working class families, seeking a low-level qualification, enrolled in a non-university institution, and being without a scholarship. The concepts of "noncitizenship" and "work precarity" are used to explain how the mechanisms of each characteristic heighten vulnerability, thereby contributing to a broader evidence-base about the causality of international student precarity.

الدولة عند ابن خلدون شبيهة بالإنسان يولد وينمو ثم يفنى ويهرم، والفناء هو النهاية الحتمية لكل دولة ، فكل دولة تبلغ قمة حضارتها ثم تهرم وتتدهور لتأتي دولة جديدة تأخذ بعض ما تركته الدولة السابقة وتضيق عليها وتخلق حضارة مختلفة، حيث قامت دولة الأدارسة على أساس ديني وادعاء مؤسسها، إدريس بن عبد الله بأنه يعود بنسبه إلى النبي عليه الصلاة والسلام، وتمكن بهذا الإدعاء من تملك بلاد المغرب الأقصى، كما وتمكن بسياسته من توحيد وجذب قبائل البربر، بحيث كان عطاؤهم له بلا حدود وصادراً عن إيمان وتقدير واحترام، وبلغ وفاءهم لحفيد رسول الله عليه الصلاة والسلام، أن انتظروا زوجته الحامل حتى تضع مولودها، وهو إدريس الثاني، ولكن دولة الأدارسة كأي دولة حسب نظرية ابن خلدون تمر بالبداوة ثم الحضارة ثم تفنى وتنهار، وبالفعل فقد وحد الأدراسة صفوف البربر وانتقلوا بهم من البداوة ومرحلة القبائل وأسسوا لهم مدن كمدينة فاس، كما أسسوا جيشاً لحماية هذه الدولة، لكن هذا الحال لم يستمر طويلاً، إذ قام الإمام محمد بن إدريس الثاني، والإمام يحيى بتقسيم الدولة بين أقاربهم، وكان ذلك من أولى علائم الضعف، ثم قاموا بإصطناع الموالي والأتباع من غير البربر، كما أن انصياع بعض الأمراء الأدارسة لنزواتهم ، وتبديل ولائهم بين الحين والآخر من العوامل التي لعبت دوراً كبيراً في انهيار دولتهم وسقوطها بيد أمويي الأندلس.

BackgroundThere is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety, and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises, where the needs are highest. Step-by-Step (SbS), a digital mental health intervention for depression, anxiety, and stress-related disorders, proved to be effective for Lebanese citizens and war-affected Syrians residing in Lebanon. Assessing the cost-effectiveness of SbS is crucial because Lebanon’s overstretched health care system must prioritize cost-effective treatment options in the face of continuing humanitarian and economic crises. ObjectiveThis study aims to assess the cost-effectiveness of SbS in a randomized comparison with enhanced usual care (EUC). MethodsThe cost-effectiveness analysis was conducted alongside a pragmatic randomized controlled trial in 2 parallel groups comparing SbS (n=614) with EUC (n=635). The primary outcome was cost (in US $ for the reference year 2019) per treatment response of depressive symptoms, defined as >50% reduction of depressive symptoms measured using the Patient Health Questionnaire (PHQ). The secondary outcome was cost per remission of depressive symptoms, defined as a PHQ score 75% probability to be cost-saving while gaining response or remission. ConclusionsTo our knowledge, this study is the first cost-effectiveness analysis based on a large randomized controlled trial (n=1249) of a guided digital mental health intervention in an LMIC. From the principal findings, 2 implications flowed, from the (1) health care perspective and (2) wider societal perspective. First, our findings suggest that SbS is associated with greater health benefits, albeit for higher costs than EUC. It is up to decision makers in health care to decide if they find the balance between additional health gains and additional health care costs acceptable. Second, as seen from the wider societal perspective, there is a substantial likelihood that SbS is not costing more than EUC but is associated with cost-savings as SBS participants become more productive, thus offsetting their health care costs. This finding may suggest to policy makers that it is in the interest of both population health and the wider Lebanese economy to implement SbS on a wide scale. In brief, SbS may offer a scalable, potentially cost-saving response to humanitarian emergencies in an LMIC. Trial RegistrationClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID)RR2-10.2196/21585

Despite the importance of agricultural sector in Iraq, the reality indicates the inability of this sector to meet the needs required of it, as the reason for this lies in the fact that it is managed by individuals who do not possess the most basic elements of human development, the study aims to measure and explain the impact of human development variables in raising the agricultural growth rate in Iraq during the period from 1990-2022. In order to apply the quantitative aspect of the study, the agricultural output growth rate was adopted as a dependent variable Y. As for independent variables, they included agricultural capital X1, mechanical technology X2, chemical technology X3, agricultural labor X4 and agricultural education X5, depending on the statically software E-views10 and its tests according to the ordinary least squares method (OLS), the results showed the significance of the variables of capital and chemical technology with a positive effect in agricultural growth rate in short and long terms. The negative significant effect of mechanical technology and labor force appeared only in long term, while agricultural education appeared to have a significant and positive effect in the long term. The most important conclusions were reached was that human resources contribute to the development of agricultural businesses until they are considered the main means of achieving large-scale production. We recommend increasing government spending in the areas of education, training and rehabilitation in rural Iraq, as it enables the population to employ their skills and experience in raising the rate of agricultural growth.

Abstract Background MTR gene encodes the cytoplasmic enzyme methionine synthase, which plays a pivotal role in the methionine cycle of one-carbon metabolism. This cycle holds a significant importance in generating S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH), the respective universal methyl donor and end-product of epigenetic transmethylation reactions. cblG type of inherited disorders of vitamin B12 metabolism due to mutations in MTR gene exhibits a wide spectrum of symptoms, including a retinopathy unresponsive to conventional therapies. Methods To unveil the underlying epigenetic pathological mechanisms, we conducted a comprehensive study of epigenomic-wide alterations of DNA methylation by NGS of bisulfited retinal DNA in an original murine model with conditional Mtr deletion in retinal tissue. Our focus was on postnatal day 21, a critical developmental juncture for ocular structure refinement and functional maturation. Results We observed delayed eye opening and impaired visual acuity and alterations in the one-carbon metabolomic profile, with a notable dramatic decline in SAM/SAH ratio predicted to impair DNA methylation. This metabolic disruption led to epigenome-wide changes in genes involved in eye development, synaptic plasticity, and retinoid metabolism, including promoter hypermethylation of Rarα, a regulator of Lrat expression. Consistently, we observed a decline in cone photoreceptor cells and reduced expression of Lrat, Rpe65, and Rdh5, three pivotal genes of eye retinoid metabolism. Conclusion We introduced an original in vivo model for studying cblG retinopathy, which highlighted the pivotal role of altered DNA methylation in eye development, cone differentiation, and retinoid metabolism. This model can be used for preclinical studies of novel therapeutic targets.

A mixed methods study was conducted to determine if a mandatory hybrid service-learning course had an effect on the civic attitudes and skills of college students attending a private university in Ecuador. The Civic Attitudes and Skills Questionnaire (CASQ) was used in a quasiexperimental design using MANOVA with follow up t tests. After this analysis, results showed that civic action was not significantly different while the other five factors of the CASQ had a significant difference. A case-study interview approach was used for the qualitative portion, and students reported feeling engaged with the community and perceived a positive impact in each of the CASQ six factors: civic action, interpersonal and problem-solving skills, political awareness, leadership skills, social justice attitudes, and diversity attitudes.

Abstract Background Textbook outcome (TO) is a multidimensional measure used to assess the quality of surgical practice. It is a reflection of an “ideal” surgical result, based on a series of benchmarks or established reference points that may vary depending on the pathology in question. References to TO in the literature are scarce, and the few reports that are available were all published very recently. In the case of gastric surgery, there is no established consensus on the parameters that should be included in TO, a circumstance that prevents comparison between series. Aim To present a review of the literature on TO in gastric surgery (TOGS) and to try to establish a consensus on its definition. Material and methods Following the PRISMA guide, we performed an unlimited search for articles on TOGS in the MEDLINE (PubMed), EMBASE and Cochrane, Latindex, Scielo, and Koreamed databases, without language restriction, updated on December 31, 2022. The inclusion criterion was any type of study assessing TO in adult patients after oncological gastric surgery. Selected studies were assessed, and TOGS was measured. The parameters used to assess the achievement of TOGS in selected studies were also recorded. Results Twelve articles were included, comprising a total of 44,581 patients who had undergone an oncological gastric resection. The median rate of TOGS was 38.6%. All the publications but one included mortality as a TO variable, showing statistically significant differences in favor of the group in which TOGS was achieved. All articles included the number of nodes examined in the surgical specimen, with the assessment of fewer than 15 being associated with a low rate of TOGS achievement in five studies (41.7%). The variable postoperative complications according to the Clavien-Dindo score was the most important cause of failure to achieve TOGS in four studies (33.3%). Seven articles (58.3%) found a significant increase in long-term survival in patients who obtained TO. Advanced age, elevated ASA, and Charlson score had a negative impact on obtaining TOGS. Conclusions The standardization of TOGS is necessary to be able to establish comparable results between groups.

Abstract Background Stenotrophomonas maltophilia is a bacterial pathogen that can be fatal in hospitalized and immunocompromised patients with mortality as high as 69%. Pediatric cancer patients often have risk factors that are common for this infection, making them particularly susceptible. Managing S. maltophilia is especially challenging as it has inherent resistance to several antibiotics. Furthermore, soft tissue infections in neutropenic patients may deviate from the typical clinical presentation of S. maltophilia. Case Details This case series describes an in‐depth examination of three cases involving immunocompromised pediatric patients with S. maltophilia infections. Each case exhibited a distinct clinical presentation, encompassing infection of the blood, lung, and skin, which highlights the variability in which S. maltophilia manifests in immunocompromised pediatric patients. These patients were treated at MD Anderson Cancer Center (MDACC) from 2020 to 2023, unfortunately resulting in fatality. Conclusions The study aims to provide valuable insights and guidance for the management of patients with S. maltophilia infections. Emphasizing a heightened clinical suspicion will potentially lead to early initiation of directed therapy against S. maltophilia. Timely intervention may play a pivotal role in improving patient outcomes and reduce further burden to the healthcare system.

BackgroundAnaphylaxis manifests as a severe immediate-type hypersensitivity reaction initiated through the immunological activation of target B-cells by allergens, leading to the release of mediators. However, the well-known underlying pathological mechanisms do not fully explain the whole variety of clinical and immunological presentations. We performed a systemic review of proteomic and metabolomic studies and analyzed the extracted data to improve our understanding and identify potential new biomarkers of anaphylaxis.MethodsProteomic and metabolomic studies in both human subjects and experimental models were extracted and selected through a systematic search conducted on databases such as PubMed, Scopus, and Web of Science, up to May 2023.ResultsOf 137 retrieved publications, we considered 12 for further analysis, including seven on proteome analysis and five on metabolome analysis. A meta-analysis of the four human studies identified 118 proteins with varying expression levels in at least two studies. Beside established pathways of mast cells and basophil activation, functional analysis of proteomic data revealed a significant enrichment of biological processes related to neutrophil activation and platelet degranulation and metabolic pathways of arachidonic acid and icosatetraenoic acid. The pathway analysis highlighted also the involvement of neutrophil degranulation, and platelet activation. Metabolome analysis across different models showed 13 common metabolites, including arachidonic acid, tryptophan and lysoPC(18:0) lysophosphatidylcholines.ConclusionOur review highlights the underestimated role of neutrophils and platelets in the pathological mechanisms of anaphylactic reactions. These findings, derived from a limited number of publications, necessitate confirmation through human studies with larger sample sizes and could contribute to the development of new biomarkers for anaphylaxis.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024506246.

IntroductionDigital interventions are increasingly regarded as a potential solution for the inaccessibility of mental health treatment across low-and-middle-income settings, especially for common mental disorders. Step-by-Step (SbS) is a digital, guided self-help intervention for depression found effective in two Randomized Controlled Trials (RCTs) in Lebanon. For research implementation and further scale-up, this paper reports the results of a qualitative evaluation of SbS among the Lebanese and others and displaced Syrians in Lebanon.MethodsThirty-four Key Informant Interviews (KIIs) were executed with participants of the RCTs, SbS staff members, and external stakeholders. Questions garnered feedback about the feasibility, acceptability, enabling factors, and barriers to adhering to the research, implementation, and the SbS intervention. A thematic analysis was conducted using NVivo, and key themes, topics, and recommendations, on research methods and the intervention itself, were generated and reported.ResultsResults showed a high level of acceptability of SbS among Lebanese and Syrians and identified sub-groups for whom acceptance or use might be lower, such as older adults and people with limited access to the internet or smartphones. Furthermore, interviews identified the main enabling factors and barriers to adherence related to the research design, content, and delivery approach. Barriers related to feasibility included lengthy assessments as part of the RCTs, and mistrust related to delays in study compensations. Other common challenges were forgetting login credentials, poor internet connection, being busy and competing needs. Enabling factors and best practices included motivating participants to use the intervention through the weekly support provided by helpers, setting an oral contract for commitment, and dividing the compensations into several installments as part of the RCTs. Recommendations regarding sustainability were given.DiscussionThe findings show that overall, SbS is feasible, acceptable, and much needed in Lebanon among the Lebanese and Syrians. This assessment identifies reasons for low adherence to the research and the intervention and presents improvement solutions. Recommendations generated in this paper inform the upscale of SbS and the planning, design, and implementation of future digital interventions in research and service provision settings in the mental health field.

Abstract Background On March 24, 2020, the Mexican Government established social distancing measures to address the outbreak of the COVID-19 pandemic. The resulting home confinement affected daily lifestyle habits such as eating, sleeping, and physical activity (PA). The objectives of this study were to determine changes in PA behaviors among Mexican women due to the COVID-19 pandemic and to assess potential factors associated with these changes. Methods This was a cross-sectional study based on an anonymous online questionnaire developed by the Task Force on Physical Activity for Persons with Disabilities (PAPD) within the International Society of Physical and Rehabilitation Medicine (ISPRM). Descriptive, quantitative statistics were used for data analysis. A Chi-squared (χ²) test was used to explore associations between dependent and independent variables. Results A total of 1882 surveys were completed. Among the respondents, 53.3% declared that their PA was reduced during the pandemic, 26.6% reported similar PA behavior, and 20.1% declared that their PA had increased during the pandemic. Lower PA behavior during the pandemic was associated with lower education levels, stricter pandemic constraints, obesity, and lower self-perceived functioning levels. A statistically significant association between poorer self-perceived mental health and decreased PA behaviors was also found. Respondents who were younger, self-perceived as unimpaired, not overweight, and whose income was not impacted by COVID-19 were associated with higher levels of reported physical and mental health. Conclusions The study results identify disparities experienced in PA behavior during the COVID-19 pandemic among Mexican women and highlights the need for social support for PA participation.