Distinct Epidemiological Characteristics Research Articles

Polygenic risk score of metabolic dysfunction-associated steatotic liver disease amplifies the health impact on severe liver disease and metabolism-related outcomes

BackgroundAlthough the inherited risk factors associated with fatty liver disease are well understood, little is known about the genetic background of metabolic dysfunction-associated steatotic liver disease (MASLD) and its related health impacts. Compared to non-alcoholic fatty liver disease (NAFLD), MASLD presents significantly distinct diagnostic criteria, and epidemiological and clinical features, but the related genetic variants are yet to be investigated. Therefore, we conducted this study to assess the genetic background of MASLD and interactions between MASLD-related genetic variants and metabolism-related outcomes.MethodsParticipants from the UK Biobank were grouped into discovery and replication cohorts for an MASLD genome-wide association study (GWAS), and base and target cohorts for polygenic risk score (PRS) analysis. Autosomal genetic variants associated with NAFLD were compared with the MASLD GWAS results. Kaplan–Meier and Cox regression analyses were used to assess associations between MASLD and metabolism-related outcomes.ResultsSixteen single-nucleotide polymorphisms (SNPs) were identified at genome-wide significance levels for MASLD and duplicated in the replication cohort. Differences were found after comparing these SNPs with the results of NAFLD-related genetic variants. MASLD cases with high PRS had a multivariate-adjusted hazard ratio of 3.15 (95% confidence interval, 2.54–3.90) for severe liver disease (SLD), and 2.81 (2.60–3.03) for type 2 diabetes mellitus. The high PRS amplified the impact of MASLD on SLD and extrahepatic outcomes.ConclusionsHigh PRS of MASLD GWAS amplified the impact of MASLD on SLD and metabolism-related outcomes, thereby refining the process of identification of individuals at high risk of MASLD. Supplementation of this process with relevant genetic backgrounds may lead to more effective MASLD prevention and management.

Our First Experience of Using Blue Light Laser for Endoscopic Endonasal Removal of Juvenile Angiofibromas

Background. Juvenile nasal angiofibroma (JNA) is a very rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent severe nasal bleedings and blockage the nose. Currently, even though surgery often caused severe operative bleeding, it is considered the ideal treatment for JNA. Refinement in preoperative embolization, which provides significant reduction of intraoperative bleeding. In spite of breakthrough of Endoscopic techniques which minimize the risk of residual disease, the search of new devises which can help to management of JNA is still continue in order to minimize the surgical complications. Laser methods as surgical treatment have been actively used in rhinology during the past decades. We purposed to summarize information about current lasers and their use in rhinology. Aim. The purpose of the study is the literature review and to describe our experience of using new blue laser during JNA removal. Evaluation of advantages and disadvantages, determination of indications and limits of its use in rhinosurgery Methods- A literature review from 2000 to 2022 using the PubMed database was employed. Keywords used included “laser surgery”, “blue light laser”, “photoangiolytic laser”, “laser in rhinosurgery”. The most up to date studies published for each rhinology condition that was treated with laser surgery was reviewed. Then endoscopic removal through the nose was performed. During the surgery TrueBlue laser was used to cut the tissues and coagulate injured vessels. Results. Rhinological conditions appropriate for laser applications are discussed. There are related papers to a number of applications including hereditary hemorrhagic telangiectasia, rhinitis, turbinate surgery, dacryocystorhinostomy, septoplasty, choanal atresia, and sphenopalatine artery ligation, paying attention to the outcomes of the studies. It is the first experience of using blue laser in rhinosurgery and particulary ib removing JNA. Conclusion. Intranasal laser surgery, despite the fact that interventions are performed almost bloodlessly, and often do not require nasal tamponade, indications for their performance are limited, due to deep burns of the nasal mucosa, and alteration of mucociliary clearance therefore lasers are not so often used in rhinology. The short-wave blue laser with a wavelength of 445 nm, used in Europe in oto- and laryngosurgery, may have some potential advantages in rhinosurgery, but the practical dataset are limited yet.

The immunological milieu of oropharyngeal squamous cell carcinoma (OPC) according to HPV and smoking status and its influence on prognosis.

3147 Background: OPC exhibits distinct epidemiological, genetic, and clinical characteristics, significantly influenced by the presence of HPV. Despite multidisciplinary therapy, approximately 40% of OPC patients (pts) experience recurrence, and those who achieve cure often endure late and morbid sequelae of treatment. In this study, we comprehensively explored the composition and functional status of the tumor immune microenvironment (TIME) in a cohort of OPC pts treated with curative intent and investigated TIME differences based on HPV infection, smoking status, and clinical outcomes. Methods: Two tissue microarrays with baseline OPC tissues were stained with a previously validated panel containing 33 metal-tagged markers. Imaging mass cytometry was performed with the Fluidigm Helios CyTOF instrument, and analysis performed with Visiopharm software. HPV status was determined by p16 IHC and/or DNA testing. Comparison of cell types and markers densities among subgroups (HPV positive vs negative) were analyzed with Wilcoxon signed-rank test and its association with clinical outcomes (recurrence vs no-recurrence) with log-rank and Cox Proportional Hazards. Multiple comparisons were corrected by Benjamini Hochberg procedure. Results: A total of 99 samples from 61 pts from a single institution were included in this study. The majority of pts were male (N=47, 77%) and heavy smokers (N=55, 90%); 72% were HPV-negative. The median age was 61 years (range, 39 – 87 years), and 52% of cases were diagnosed with stages III-IVB (AJCC 8th edition). Most pts (57%) was treated with surgery (±RT). Thirty-three pts (54%) experienced recurrent disease. Smoking, stage III-IVB, and HPV-negative tumors were associated with higher recurrence rates (p <0.01). Regarding the OPC TIME, the most prevalent cell populations in the stroma were fibroblasts (22%), followed by T-cells (17%) and endothelial cells (10%). The stroma of HPV+ tumors exhibited higher densities of memory T cells (FDR < 0.01), B cells (FDR = 0.02), and T cells (FDR = 0.02) compared to HPV negative counterparts, which displayed an increased density of neutrophils (FDR = 0.04). The density of cancer stem cells was directly associated with smoking history (FDR<0.001), and an increased density of intra-tumoral B-cells was found in non-smokers (FDR=0.01). Higher intra-tumoral neutrophil density was linked to recurrent disease (FDR < 0.001). Conversely, higher densities of memory CD8+ T cells and non-M2 macrophages in the TIME were associated with a lower chance of recurrence (FDR < 0.1). Conclusions: The intricate analysis of the OPC TIME revealed significant differences according to HPV and smoking status and highlighted the prognostic role of neutrophils, memory CD8+ T cells, and non-M2 macrophages. These findings may guide the development of personalized therapeutic strategies for OPC.

Clinical characteristics and risk factors for right-sided infective endocarditis in Korea: a 12-year retrospective cohort study

Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (LSIE) and exhibits distinct epidemiological, clinical, and microbiological characteristics. Previous studies have focused primarily on RSIE in patients with intravenous drug use. We investigated the characteristics and risk factors for RSIE in an area where intravenous drug use is uncommon. A retrospective cohort study was conducted at a tertiary hospital in South Korea. Patients diagnosed with infective endocarditis between November 2005 and August 2017 were categorized into LSIE and RSIE groups. Of the 406 patients, 365 (89.9%) had LSIE and 41 (10.1%) had RSIE. The mortality rates were 31.7% in the RSIE group and 31.5% in the LSIE group (P = 0.860). Patients with RSIE had a higher prevalence of infection with Staphylococcus aureus (29.3% vs. 13.7%, P = 0.016), coagulase-negative staphylococci (17.1% vs. 6.0%, P = 0.022), and gram-negative bacilli other than HACEK (12.2% vs. 2.2%, P = 0.003). Younger age (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.95–0.99, P = 0.006), implanted cardiac devices (aOR 37.75, 95% CI 11.63–141.64, P ≤ 0.001), and central venous catheterization (aOR 4.25, 95% CI 1.14–15.55, P = 0.029) were independent risk factors for RSIE. Treatment strategies that consider the epidemiologic and microbiologic characteristics of RSIE are warranted.

In silico development of a novel anti-mutation, multi-epitope mRNA vaccine against MPXV variants of emerging lineage and sub-lineages by using immunoinformatics approaches

Over the past year, an unexpected surge in human monkeypox (hMPX) cases has been observed. This outbreak differs from previous ones, displaying distinct epidemiological characteristics and transmission patterns, believed to be influenced by a newly emerging monkeypox virus (MPXV) lineage. Notably, this emerging MPXV lineage has exhibited several non-synonymous mutations, some of which are linked to immunomodulatory activities and antigenic characteristics that aid in host detection. However, specific treatments or vaccines for human monkeypox are currently lacking. Hence, we aim to develop a multi-epitope mRNA vaccine by using immunoinformatics approaches against the MPXV, particularly its emerging variants. Six proteins (A29L, A35R, B6R, M1R, H3L, and E8L) were chosen for epitope and mutation site identification. Seventeen top-performing epitopes and eight epitopes containing mutation sites were selected and combined with adjuvants, the PADRE sequence, and linkers for vaccine development. The molecular and physical properties of the designed vaccine (WLmpx) were favorable. Immunological characteristics of WLmpx were assessed through molecular docking, molecular dynamics (MD) simulations, and immune simulations. Finally, the vaccine sequence was utilized to formulate an mRNA-based vaccine. The informatics-based predicted results indicated that the designed vaccine exhibits significant potential in eliciting high-level humoral and cellular immune responses, but further validation through in vivo and vitro studies is warranted. Communicated by Ramaswamy H. Sarma

Characteristics of pediatric mandibular condylar fractures in Southwest China: A single-center and 12-year retrospective study.

Mandibular condylar fractures in pediatric patients may exhibit distinct epidemiological characteristics attributed to their unique growth and development phase, as well as various anatomical, physiological, biomechanical, and behavioral factors that differentiate them from adults. This study aimed to investigate the demographics, injurious factors, classifications, clinical manifestations, and treatments of pediatric mandibular condylar fractures, as well as the concomitant injuries in maxillofacial and other body parts. This retrospective study analyzed the clinical data of 189 pediatric patients with mandibular condylar fractures between 2011 and 2022. Variables investigated included age, gender, timing of onset, causes, classification of condylar fracture, concomitant injuries, clinical manifestations, and treatment modalities. A total of 189 patients, a higher proportion of boys compared to girls was observed, with the highest incidence rate in children aged 1-3 years. They occurred primarily in July, June, and September as well as on Saturdays and Sundays. The most prevalent cause of mandibular condylar fractures was falls from heights in 73 patients (38.62%). Pediatric patients exhibited a higher susceptibility to condylar head fractures. A significant majority (81.48%) of these fractures were accompanied by soft tissue injuries in the maxillofacial region, with the chin being particularly vulnerable to injury. In addition, 61.90% of pediatric patients experienced fractures in other areas of the maxillofacial region, with the mandibular symphysis being the most commonly affected site. Dental trauma predominantly occurred in the anterior region (44.97%). Notably, a substantial proportion (28.04%) of cases also presented with multiple systemic injuries. The characteristics of pediatric mandibular condylar fractures exhibit distinct features in terms of age, gender, timing of onset, etiology, location and type, the presence of concomitant maxillofacial soft/hard tissue injuries and multiple systemic injuries, as well as clinical manifestations and treatment modalities. Therefore, clinicians should pay special attention to the diagnosis and treatment of pediatric condylar fractures.

Non-Polio Enteroviruses Isolated by Acute Flaccid Paralysis Surveillance Laboratories in the Russian Federation in 1998-2021: Distinct Epidemiological Features of Types.

More than 100 types of non-polio enteroviruses (NPEVs) are ubiquitous in the human population and cause a variety of symptoms ranging from very mild to meningitis and acute flaccid paralysis (AFP). Much of the information regarding diverse pathogenic properties of NPEVs comes from the surveillance of poliovirus, which also yields NPEV. The analysis of 265 NPEV isolations from 10,433 AFP cases over 24 years of surveillance and more than 2500 NPEV findings in patients without severe neurological lesions suggests that types EV-A71, E13, and E25 were significantly associated with AFP. EV-A71 was also significantly more common among AFP patients who had fever at the onset and residual paralysis compared to all AFP cases. In addition, a significant disparity was noticed between types that were common in humans (CV-A2, CVA9, EV-A71, E9, and E30) or in sewage (CVA7, E3, E7, E11, E12, and E19). Therefore, there is significant evidence of non-polio viruses being implicated in severe neurological lesions, but further multicenter studies using uniform methodology are needed for a definitive conclusion.

Detection of Some Virulence Genes in Diarrheagenic Escherichia Coli Pathotypes in Children Under Five Years in Aleppo City

Diarrheagenic Escherichia coli (DEC) strains can be classified into six main pathotypes based on their specific virulence properties. These pathotypes are associated with certain serotypes and exhibit distinct epidemiological and clinical features. The identification of DEC cannot be based solely on cultural and biochemical criteria, as they are indistinguishable from the non-pathogenic E. coli. However, the presence of virulence genes and DNA sequences specific to DEC can be used to determine its identity. The aim of this study is to investigate the prevalence of Diarrheagenic Escherichia coli (DEC) pathotypes among infected children under 5 years living in the city of Aleppo Syria. From June 2020 to September 2021, one hundred samples of diarrheal were collected from children under five years suffering from diarrhea admitted at Aleppo University Hospital and from some private laboratories in Aleppo city. Escherichia coli pathotypes were detected by using multiplex polymerase chain reaction and Phylogenetic genes were detected by Triplex PCR. The frequency of diarrheagenic E. coli was (48%), the most frequently isolated pathotypes were atypical enteropathogenic E. coli. (42%), followed by enterotoxigenic E. coli (4%), and enteroinvasive E. coli (2%). Enterohemorrhagic E. coli, enteroaggregative E. coli and Diffusely Adherent E. coli were not detected in any sample (0%). The most prevalent phylogenetic group of E. coli was "Phylogenetic group B2" which represented (62%), followed by "Phylogenetic group D" that comprised 33%, followed by "Phylogenetic group A" strains (3%). Strains of the "Phylogenetic group B1" were rare (2%). This study revealed that DEC strains contribute to cause diarrheal diseases in children, EPEC is the most commonly identified DEC strain. B2 and D groups are the most prevalent phylogenetic groups. In addition, they are virulent because these groups are associated with the presence of several virulence factors.

The History of New World Leishmaniases From a Brazilian Perspective

Abstract This article addresses the leishmaniases in the Americas from a Brazilian perspective. The first cases of cutaneous and mucocutaneous leishmaniasis were described in 1909 in São Paulo. Latin American researchers gained international projection because of their work on this disease they considered autochthonous, which came to be known as American tegumentary leishmaniasis. But visceral leishmaniasis only emerged as a public health problem in the Americas in 1934 thanks to a new diagnostic technique for yellow fever. Zoonoses earned greater attention later, especially in the laboratory founded in 1965 at the Evandro Chagas Institute by Ralph Lainson and Jeffrey Shaw. Here we examine their connections with other teams and the resulting changes when they proved that parasite, vector, and host populations were much more heterogeneous than previously imagined. Technical innovations provided a better understanding of the distinct epidemiological characteristics of the illnesses caused by different Leishmania amid a backdrop of far-reaching transnational networks.

A systematic review and meta-analysis of the global epidemiology of pediatric traumatic spinal cord injuries.

Despite being relatively rare, pediatric traumatic spinal cord injury (TSCI) is a debilitating event with high morbidity and long-term damage and dependency. This study aims to provide insight on the epidemiological characteristics of pediatric TSCI worldwide. The studies were included if they provided data for the pediatric population with the diagnosis of TSCI. Information sources included PubMed, Embase, Web of Science, and Scopus. All databases were searched from 1990 to April 2023. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. The results of the meta-analysis were presented as forest plots. PROSPERO Registration code: CRD42020189757. We identified 87 studies from 18 developed and 11 developing countries. Of the 87 studies evaluated, 52 studies were considered medium quality, 27 studies were considered high quality, and 8 studies were considered low quality. In developed countries, the proportion of TSCIs occurring in patients aged 0-15 years was 3% (95% CI: 2.2%; 3.9%), while in developing countries, it was 4.5% (95% CI: 2.8%; 6.4%). In developed countries, the pooled incidence of pediatric TSCI was 4.3/millions of children aged 0-15/year (95% CI: 3.1; 6.0/millions children aged 0-15/year) and boys comprised 67% (95% CI: 63%; 70%) of cases. The most prevalent level of injury was cervical (50% [95% CI: 41%; 58%]). The frequency of SCI Without Obvious Radiological Abnormality (SCIWORA) was 35% (95% CI: 18%; 54%) among children 0-17 years. The most common etiology in developed countries was transport injuries (50% [95% CI: 42%; 57%]), while in developing countries falls were the leading cause (31% [95% CI: 20%; 42%]). The most important limitation of our study was the heterogeneity of studies in reporting age subgroups that hindered us from age-specific analyses. Conclusion: Our study provided accurate estimates for the epidemiology of pediatric TSCI. We observed a higher proportion of pediatric TSCI cases in developing countries compared to developed countries. Furthermore, we identified distinct epidemiological characteristics of pediatric TSCI when compared to adult cases and variations between developing and developed countries. Recognizing these unique features allows for the implementation of cost-effective preventive strategies aimed at reducing the incidence and burden of TSCI in children. What is Known: • Pediatric Traumatic Spinal Cord Injury (TSCI) can have profound physical and social consequences for affected children, their families, and society as a whole. • Epidemiological insights are vital for they provide the data and understanding needed to the identification of vulnerable populations, aiding in the development of targeted prevention strategies and effective resource allocation. What is New: • The estimated incidence of pediatric TSCI in developed countries is 4.3 cases per million children aged 0-15. The proportion of pediatric TSCI cases in relation to all-age TSCI cases is 3% in developed countries and 4.5% in developing countries. • The etiology of TSCI in pediatric cases differs between developing and developed countries. In developed countries, transport injuries are the most prevalent cause of pediatric TSCI, while falls are the least common cause. Conversely, in developing countries, falls are the leading cause of pediatric TSCI.

Epidemiology of cholangiocarcinoma

Cholangiocarcinoma (CCA) represents a heterogenous set of malignancies arising from the biliary tract. Classification of CCA subdivides tumours into intrahepatic (iCCA) and extrahepatic (eCCA), with eCCA further categorised as perihilar (pCCA) and distal (dCCA) lesions. Tumour subtypes show distinct epidemiological, genetic and clinical characteristics. Global incidence and mortality are rising, with the highest rates seen in Asian populations compared to the West. There has been a divergence in recent mortality trends observed between CCA subtypes, with rising rates of iCCA seen compared with eCCA. There are several drivers for these differing trends, including specific risk factors, misclassification of CCA subtypes and variation in diagnosis and surveillance. Risk factors for CCA can be divided into hepatobiliary, extra-hepatic and environmental, with hepatobiliary diseases conferring the largest risk. Surgery represents the only curative treatment for CCA, but can only be offered to early-stage candidates who are otherwise fit; the majority of patients are therefore treated with chemotherapy and, recently, immunotherapy. Due to late-stage presentation of disease, prognosis is poor, with 5-year survival <20%.

Hepatitis B Virus Genotype D: An Overview of Molecular Epidemiology, Evolutionary History, and Clinical Characteristics.

The hepatitis B virus (HBV) genotype D (HBV/D) is the most extensively distributed genotype worldwide with distinct molecular and epidemiological features. This report provides an up-to-date review on the history of HBV/D subgenotyping and misclassifications, along with large-scale analysis of over 1000 HBV/D complete genome sequences, with the aim of gaining a thorough understanding of the global prevalence and geographic distribution of HBV/D subgenotypes. We have additionally explored recent paleogenomic findings, which facilitated the detection of HBV/D genomes dating back to the late Iron Age and provided new perspectives on the origins of modern HBV/D strains. Finally, reports on distinct disease outcomes and responses to antiviral therapy among HBV/D subgenotypes are discussed, further highlighting the complexity of this genotype and the importance of HBV subgenotyping in the management and treatment of hepatitis B.

Pain paths among post-COVID-19 condition subjects: A prospective cross-sectional study with in-person evaluation.

New-onset chronic pain has been acknowledged as part of the post-COVID-19 condition. However, available fine-grained data about its clinical phenotype, trajectories and main associated characteristics remain scarce. We described the distinct temporal evolutions of post-COVID-19 pain and their epidemiological and phenotypical features. A prospective cross-sectional study enrolled post-COVID-19 condition patients (i.e. who had persisting COVID-19-related symptoms over 30 days since their first positive laboratory test), whose COVID-19 diagnosis had been supported by RT-PCR of oral/nasopharyngeal swab or serology. They underwent in-person evaluations with a structured interview, pain and quality-of-life-related questionnaires and thorough physical examination. Chronic pain (CP) and probable neuropathic pain (NP) were defined according to IASP criteria. The present study included 226 individuals, 177 (78.3%) of whom presented over 3 months since their first COVID-19 symptom. New-onset pain occurred in 170 (75.2%) participants and was chronic in 116 (68.2%). A chronic course was associated with COVID-19-related hospitalization, new-onset fatigue, lower cognitive performance, motor and thermal sensory deficits, mood and sleep impairments and overall lower quality-of-life levels. Probable NP occurred in only 7.6% new-onset pain patients, and was associated with pain chronification, new-onset fatigue, motor and thermal sensory deficits, mechanical allodynia and lower rates of SARS-CoV-2 vaccination. Previous CP was reported by 86 (38.1%) individuals and had aggravated after the infection in 66 (76.7%) of them, which was associated with orthostatic hypotension. Post-COVID pain phenomena follow different paths, which are associated with specific clinical and epidemiological features, and possibly distinct underlying mechanisms, prognostic and therapeutic implications. COVID-19-related pain usually follows a chronic course and is non-neuropathic. Its possible courses and phenotypes are associated with distinct clinical and epidemiological features. This suggests differing underlying mechanisms, which may have significant prognostic and therapeutic implications.

Impacts of meteorological factors on the risk of scrub typhus in China, from 2006 to 2020: A multicenter retrospective study.

Scrub typhus is emerging as a global public health threat owing to its increased prevalence and remarkable geographic expansion. However, it remains a neglected disease, and possible influences of meteorological factors on its risk are poorly understood. We conducted the largest-scale research to assess the impact of meteorological factors on scrub typhus in China. Weekly data on scrub typhus cases and meteorological factors were collected across 59 prefecture-level administrative regions from 2006 to 2020. First, we divided these regions into 3 regions and analyzed the epidemiological characteristics of scrub typhus. We then applied the distributed lag nonlinear model, combined with multivariate meta-analysis, to examine the associations between meteorological factors and scrub typhus incidence at the total and regional levels. Subsequently, we identified the critical meteorological predictors of scrub typhus incidence and extracted climate risk windows. We observed distinct epidemiological characteristics across regions, featuring obvious clustering in the East and Southwest with more even distribution and longer epidemic duration in the South. The mean temperature and relative humidity had profound effects on scrub typhus with initial-elevated-descendent patterns. Weather conditions of weekly mean temperatures of 25-33°C and weekly relative humidity of 60-95% were risk windows for scrub typhus. Additionally, the heavy rainfall was associated with sharp increase in scrub typhus incidence. We identified specific climatic signals to detect the epidemic of scrub typhus, which were easily monitored to generalize. Regional heterogeneity should be considered for targeted monitoring and disease control strategies.

Current Status and Future Prospects for Esophageal Cancer.

Esophageal cancer (EC) is the ninth most common cancer and the sixth leading cause of cancer deaths worldwide. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are the two main histological subtypes with distinct epidemiological and clinical features. While the global incidence of ESCC is declining, the incidence of EAC is increasing in many countries. Decades of epidemiologic research have identified distinct environmental exposures for ESCC and EAC subtypes. Recent advances in understanding the genomic aspects of EC have advanced our understanding of EC causes and led to using specific genomic alterations in EC tumors as biomarkers for early diagnosis, treatment, and prognosis of this cancer. Nevertheless, the prognosis of EC is still poor, with a five-year survival rate of less than 20%. Currently, there are significant challenges for early detection and secondary prevention for both ESCC and EAC subtypes, but Cytosponge™ is shifting this position for EAC. Primary prevention remains the preferred strategy for reducing the global burden of EC. In this review, we will summarize recent advances, current status, and future prospects of the studies related to epidemiology, time trends, environmental risk factors, prevention, early diagnosis, and treatment for both EC subtypes.

Optimizing Patient Pathways in Advanced Biliary Tract Cancers: Recent Advances and a French Perspective.

Biliary tract cancers (BTCs) are a heterogeneous group of tumors that are rare in Western countries and have a poor prognosis. Three subgroups are defined by their anatomical location (intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma and gallbladder carcinoma) and exhibit distinct clinical, molecular, and epidemiologic characteristics. Most patients are diagnosed at an advanced disease stage and are not eligible for curative-intent resection. In addition to first- and second-line chemotherapies (CisGem and FOLFOX, respectively), biologic therapies are now available that target specific genomic alterations identified in BTC. To date, targets include alterations in the genes for isocitrate dehydrogenase (IDH) 1, fibroblast growth factor receptor (FGFR) 2, v-raf murine sarcoma viral oncogene homolog B1 (BRAF), human epidermal growth factor receptor 2 (HER2 or ERRB2), and neurotrophic tyrosine receptor kinase (NTRK), and for those leading to DNA mismatch repair deficiency. Therapies targeting these genomic alterations have demonstrated clinical benefit for patients with BTC. Despite these therapeutic advancements, genomic diagnostic modalities are not widely used in France, owing to a lack of clinician awareness, local availability of routine genomic testing, and difficulties in obtaining health insurance reimbursement. The addition of durvalumab, a monoclonal antibody targeting the immune checkpoint programmed cell death ligand-1, to CisGem in the first-line treatment of advanced BTC has shown an overall survival benefit in the TOPAZ-1 trial. Given the high mortality rates associated with BTC and the life-prolonging therapeutic options now available, it is hoped that the data presented here will support updates to the clinical management of BTC in France.

Trends in the Incidence and Etiology of Non-Traumatic Spinal Cord Injury in Korea: A Nationwide Population-Based Study From 2007 to 2020.

Although patients with non-traumatic spinal cord injury (NTSCI) have distinct epidemiological characteristics compared to those with traumatic spinal cord injury, no previous study has reported the incidence of NTSCI on a national scale in Korea. In this study, we examined the trend in incidence of NTSCI in Korea and described the epidemiological characteristics of patients with NTSCI using nationwide insurance data. National Health Insurance Service data were reviewed for the period from 2007 to 2020. The International Classification of Diseases, 10th revision, was used to identify patients with NTSCI. Inpatients with newly diagnosed NTSCI on their first admission during the study period were included. Crude incidence was calculated using the annual number of NTSCI cases divided by the mid-year population estimates. Age-specific incidence was calculated by dividing the number of cases in 10-year age groups by the total number of individuals in that age group. Age-adjusted incidence was calculated using direct standardization. Annual percentage changes were calculated using Joinpoint regression analysis. The Cochrane-Armitage trend test was conducted to examine the trends of NTSCI incidence according to the types or etiologies of NTSCI. The age-adjusted incidence of NTSCI increased continuously from 24.11 per million in 2007 to 39.83 per million in 2020, with a significant annual percentage change (4.93%, P < 0.05). The age-specific incidence for those in their 70s and 80s or older was the highest and rapidly increased from 2007 to 2020. According to the types of paralysis in NTSCI, the proportion of tetraplegia decreased, whereas those of paraplegia and cauda equina increased significantly from 2007 to 2020. The proportion of degenerative diseases was the largest among all etiologies and increased significantly during the study period. The annual incidence of NTSCI in Korea is increasing significantly, particularly among older adults. As Korea is one of the countries with most rapidly aging population in the world, these results have significant implications, indicating that preventive strategies and sufficient rehabilitation medical services are warranted for the population of older adults.

Clinico-epidemiological profile of childhood vitiligo: Experience from a tertiary care center of Northeast India

Background: Vitiligo is a common acquired skin disease characterized by depigmented macules and patches due to loss of functional melanocytes. Childhood-onset vitiligo has distinct epidemiological and clinical characteristics as compared to that of late-onset disease. Studies on childhood vitiligo are rare from the North-eastern part of the country. Aims and Objectives: The aim of the study was to study the clinical pattern of childhood vitiligo and its systemic association. Materials and Methods: All children up to 13 years presenting with childhood vitiligo were taken as study participants. A detailed history, general physical examination, cutaneous examination including hair, nail, genitalia, mucosae, and systemic examination to note down associated diseases was done. Relevant investigations were carried out whenever necessary. Eye and ear examination was performed for each patient. The findings were recorded in a pro forma for analysis and interpretation of data. Results: A total of 2544 pediatric patients attended the dermatology outpatient department during the study period, of which 52 cases had vitiligo. Thus, the occurrence of childhood vitiligo in the outpatient pediatric population was 2.04%. The most common age group at presentation was between 5 and 10 years (29; 55.77%). The most common initial site of involvement was head and neck (27; 51.92%). Vitiligo vulgaris was the most common type seen in 26 (50%) patients. A positive family history of vitiligo was obtained in 10 (19.23%) of the vitiligo patients. Seven (13.46%) childhood vitiligo patients were reported to have other associated diseases. Conclusion: Childhood vitiligo is a common entity in this part of the country. Most patients of childhood vitiligo have a limited body surface area involvement and therefore have to be treated accordingly; avoiding systemic treatments whenever not necessary. Autoimmune and cutaneous associations are rare in childhood vitiligo, though may develop later on, lest the disease progresses.

Pyrethroid-Resistant and Susceptible Triatoma infestans (Klug, 1834) (Hemiptera, Triatominae): Analysis of Their Vectorial Characteristics by Metacyclogenesis, Feeding/Defecation Patterns, and Parasite Load

Populations of Triatomas infestans with different susceptibility to pyrethroid insecticides were reported to have distinct evolutionary and epidemiological characteristics. We aimed at evaluating metacyclogenesis and parasite load as measures of vector competence and feeding/defecation patterns as vectorial capacity estimates of a group of resistant (“R”) and susceptible (“S”) T. infestans. Third instar nymphs of each group were fed on mice infected with Trypanosoma cruzi (Tulahuén strain, DTU VI). Parasite concentration in blood was quantified by real-time PCR (qPCR) for each mouse. The time at which feeding started, the span of feeding, the volume of blood consumed, and the time taken to defecate were measured. At 30 days post-feeding, feces were analyzed in parallel by optical microscopy (percentage of metacyclic trypomastigotes, % MT), and qPCR (total T. cruzi DNA). The ratio of parasites consumed/defecated by nymphs of each group was used to estimate the parasites’ survival and multiplication inside the triatomines’ gut. It was estimated that for each blood trypomastigote consumed, 6.6 parasites were obtained in the feces of “R” nymphs, and 7.9 in “S”. “R” nymphs consumed a higher volume of blood, had lower % MT in their feces (lower vectorial competence), and took longer to defecate (lower vectorial capacity) than “S”.

Covid-19 Effect on Community Mobility and Stock Market of Malaysia

Physical distancing is believed to contain the spread of COVID-19 virus. With data provided by COVID-19 Community Mobility Reports from Google, this study examines the mobility patterns at different stages of Movement Control Order (MCO) and investigates whether lower mobility reduces the number of new cases, death cases, and recovery rate. This research also covers the time spent in places such as i) retail and recreation, ii) grocery and pharmacy, iii) parks, iv) transit stations, v) the workplace, and vi) residential areas. As each of these types of places has distinct epidemiological characteristics, they may spread transmission differently. This study also correlates the stock market with mobility patterns of Malaysians in order to evaluate the effectiveness of lockdowns on COVID-19 incidents and its impact on the stock market, in this case; Kuala Lumpur Composite Index (KLCI). Findings of this study highlight the effects of pandemic COVID-19 on stock market daily performance by utilizing prospect and uncertainty theory in predicting the short-term impacts of the epidemic. Keywords: COVID-19; Malaysia; MCO; mobility; KLCI