Final Evaluation Research Articles

Ramularia mali associated with symptoms of dry lenticel rot, an emerging postharvest disease on apples in Italy.

Ramularia mali Videira & Crous is an emerging postharvest pathogen on apple (Malus × domestica Borkh.) in Italy and other apple producing countries (Prencipe et al. 2023). After 3 to 6 months of cold storage at 1 - 2 °C and low oxygen levels of 0.5 - 2 %, lenticels show black-brown speckled dry rot of 1 mm - 5 mm in diameter, without colonizing underlying tissue. The most affected cultivar (cv.) in South Tyrol (northern Italy) is Golden Delicious and postharvest losses due to characteristic lenticel spots range from 10 % to above 50 %. Four symptomatic fruits, originating from two orchards (Latsch/Laces and Bozen/Bolzano; South Tyrol, Italy), respectively, were sampled after cold storage (= ultra-low oxygen; 0.5 % O2 and 1 °C). After surface disinfection with 70 % EtOH for 1 min, sixteen explants from lenticel spots were cultivated on potato dextrose agar (PDA) at 25 °C. Two isolates, morphologically identified as Ramularia sp., were sequenced and showed high identities to R. mali type culture CBS 129581: 100 % and 99.31 % identity for ITS region (MH865432); 94.66 % and 91.41 % for TEF-1α (KJ504693); 97.22% and 97.40% for RpbII (KJ504649). Isolates were cultivated at 25 °C for 2 weeks and conidia were harvested with 3.0 mL 0.05 % Tween®20. Inoculation was performed in triplicate on 5-month cold stored fruits cv. Golden Delicious. After surface disinfection for 1 min with cotton swabs, which were immersed in 70 % EtOH, 10 µL spore suspension of each isolate (8.50 × 107 spores mL-1 in 0.05 % Tween®20) were injected horizontally beneath the epidermis with a syringe (Hamilton® model 710N). Also, a mixture of both isolates was used. Controls were carried out with 0.05 % Tween®20 only. Apples were stored either at 9 °C in the dark or at 1°C and 0.5 % oxygen for 4 months. First symptoms were observed for both spore concentrations after 2 weeks at 9 °C. The injection pathway changed to a brownish color, whereas the control did not show any change (Fig. 1). Final evaluation was carried out after 4 months, but the fruits did not show further symptom development. Fruits stored at 1°C for 5 months were simultaneously evaluated, confirming that the pathogen invaded the tissue surrounding the injection site, without penetrating deeper into the fruit flesh. (Fig. 2). Reisolation from artificially infected apples was successfully achieved, and sequence analysis was performed on the DNA extracts from the obtained isolates. Concatenated sequences of ITS (deposited to GenBank under the accession numbers: PP439643 -PP439647), TEF-1α (PP480231-PP480235), and RbpII (PP480226-PP480230) were subjected to multi-locus sequence analysis. References sequences of R. nyssicola CBS 127665, R. collo-cygni CBS 101181, R. vizellae CBS 115981, R. eucalypti CBS 120726, R. hydrangeae-macrophyllae CBS 122272, R. glennii CBS 129441 and R. mali CBS 129581 included and aligned by the CLUSTALW algorithm within the software Geneious® 11.1.5 (Biomatters Inc., New Zealand). Phylogeny was reconstructed with MEGAX (Version 10.2.6) (Kumar et al. 2018) based on the Maximum Likelihood (ML) algorithm (Fig. 3). Isolates from artificially infected fruit clustered with the R. mali type culture. Although Gianetti et al. (2012) and Lindner (2013), respectively, first described Ramularia sp. as a postharvest pathogen on apple, the present study demonstrated the reproduction of lenticel dry rot symptoms by R. mali.

The usefulness of narrow-band Imaging (NBI) in nasopharyngeal lesions-Validation of the Ni NBI classification dedicated for vascular pattern in the nasopharynx.

This study aims to explore the applicability of narrow-band imaging (NBI) involving the Ni classification for the diagnosis of nasopharyngeal mucosal lesions in order to distinguish malignant tumours (NPT) from non-malignant lesions. Each patient (n = 53) with a suspected nasopharyngeal lesion underwent a trans-nasal flexible video endoscopy with an optical filter for NBI. We assessed the suspected area using white light imaging (WLI) in terms of location and morphology as well as the vascular pattern (using Ni classification of nasopharyngeal microvessels) and surrounding tissue by using NBI. Based on the results of the NBI and WLI, patients were classified into "positive" or "negative" groups. All lesions of the nasopharynx were biopsied and submitted for final histological evaluation. NBI showed higher sensitivity, specificity, and accuracy than WLI. There was a significant correlation between the final histological result and the NBI pattern of the NPT: Chi2(1) = 31.34; p = 0.000001 and the WLI assessment of the NPT: Chi2(1) = 14.78; p = 0.00012. The assessment of the NPT in NBI using Ni NBI classification proved valuable in suspected mucosa assessment. NBI not only confirms the suspicious areas in WLI, but it also shows microlesions beyond the scope of WLI and allows for proper sampling.

Encapsulated papillary carcinoma of the breast clinicopathological features and management: Could sentinel lymph node biopsy be exempted?

Papillary lesions in the breast pose diagnostic and therapeutic challenges. Encapsulated papillary carcinoma (EPC) is a rare breast cancer. However, evidence-based guidelines are limited. For this reason, there is no complete clarity in diagnosis and treatment management, and there are insufficient studies in the literature. This study aimed to examine the necessity of sentinel lymph node sampling in the management of EPC, in line with patients' clinicopathological data. We retrospectively screened patients with EPC in our clinic between January 2012 and March 2022. We recorded and statistically evaluated patients' demographic, clinical, radiological, pathological, and treatment management. Sixty-four patients with EPCs were identified. The final pathologic evaluation revealed that 19 patients (18.7%) had pure EPC, 27 patients (43.7%) had EPC with associated ductal carcinoma in situ and 18 patients (37.5%) had EPC associated with invasion. The mean age was 61 years, and two patients were male. Breast-conserving surgery was performed in 62 patients, and simple mastectomy was performed in two patients. Sentinel lymph node biopsy (SLNB) was positive in only one patient. Sixty-three patients with EPC were hormone receptor-positive, and one patient was triple-negative and was associated with invasion. None of the patients died, one had a local recurrence, and a mastectomy was performed. The overall prognosis and long-term survival of patients with EPC were excellent. Our study and the current literature indicate that routine SLNB is overtreatment because surgical excision with negative margins is sufficient in EPC cases and lymph node metastasis is rare, even with an invasive component.

Providing an innovative model for social customer relationship management: Meta synthesis approach

Social Customer Relationship Management (SCRM) has revolutionized the interaction between companies and customers, creating new opportunities and challenges for both parties. This study aims to present an innovative model for identifying the dimensions and components of SCRM. The data were collected based on a qualitative research design utilizing the meta-synthesis method, following the seven steps outlined by Sandelowski and Barroso (2007). Considering the relevance to the research topic and the quality of sources, 31 studies were selected for the final evaluation. To assess the reliability of the findings, the kappa coefficient for inter-coder agreement was used, resulting in a kappa value of 0.79. The results, analyzed using MAXQDA20 software, 2 dimensions, 6 categories, and 16 concepts identified. The company-focused dimension included 3 categories: factors influencing adoption, inhibitors, and outcomes of implementation. Similarly, the customer-focused dimension identified 3 categories: factors influencing adoption, inhibitors, and outcomes of implementation. Ultimately, a comprehensive model for SCRM was developed. The results of this research can be utilized by academic references as well as companies and consumers.

Optical coherence tomography biomarkers in MYO7A-inherited retinal dystrophy: longitudinal study in pediatric patients.

This study aims to answer a key question: is MYO7A-inherited retinal dystrophy (MYO7A-IRD) a photoreceptor-first or retinal pigment epithelium-first disease? A second aim was to determine the most useful biomarkers to monitor disease progression in pediatric patients with Usher syndrome type 1B (USH1) secondary to MYO7A mutation. Fifty-two eyes from 26 patients with genetically-confirmed MYO7A-IRD underwent swept-source optical coherence tomography (SS-OCT). Structural abnormalities were evaluated and correlated with follow-up time and best corrected visual acuity (BCVA). All patients were evaluated at baseline and after ≥ 40 months of follow-up. The mean (SD) patient age was 9.92 (± 4.1) years. Mean follow-up time was 43 (± 3.2) months. At the final evaluation, the most common qualitative abnormalities in the subfoveal area were alterations in the photoreceptor outer segments (76.9% of eyes) and in the interdigitation zone (IZ) (80.8%). The presence of cystoid macular edema at baseline was independently associated with worse BCVA at the final assessment (increase in LogMAR estimate = 0.142; t(45.00) = 2.78, p = 0.009). The mean width of the ellipsoid and interdigitation zones decreased significantly (by 668 μm and 278 μm, respectively; both p < 0.001). This study shows that disruption of the photoreceptor outer segments and the IZ are the first alterations detected by SS-OCT in the early phases of MYO7A-IRD. These data highlight the potential value of measuring the width of the ellipsoid and IZ to evaluate disease progression. These findings also demonstrate the utility of monitoring for the emergence of cystic lesions as biomarkers of worse visual prognosis in patients with MYO7A-IRD.

Primary prophylaxis with G-CSF for patients with non-round cell soft tissue sarcomas: a systematic review for the Clinical Practice Guidelines for the Use of G-CSF 2022 of the Japan Society of Clinical Oncology.

Granulocyte colony-stimulating factor (G-CSF) is an essential supportive agent for chemotherapy-induced severe myelosuppression. We proposed two clinical questions (CQ): CQ #1, "Does primary prophylaxis with G-CSF benefit chemotherapy for non-round cell soft tissue sarcoma (NRC-STS)?" and CQ #2, "Does G-CSF-based intensified chemotherapy improve NRC-STS treatment outcomes?" for the Clinical Practice Guidelines for the Use of G-CSF 2022 of the Japan Society of Clinical Oncology. A literature search was performed on the primary prophylactic use of G-CSF for NRC-STSs. Two reviewers assessed the extracted papers and analyzed overall survival, incidence of febrile neutropenia, infection-related mortality, quality of life, and pain. Eighty-one and 154 articles were extracted from the literature search for CQs #1 and #2, respectively. After the first and second screening, one and two articles were included in the final evaluation, respectively. Only some studies have addressed these two clinical questions through a literature review. The clinical questions were converted to future research questions because of insufficient available data. The statements were proposed: "The benefit of primary G-CSF prophylaxis is not clear in NRC-STS" and "The benefit of intensified chemotherapy with primary G-CSF prophylaxis is not clear in NRC-STSs." G-CSF is often administered as primary prophylaxis when chemotherapy with severe myelosuppression is administered. However, its effectiveness and safety are yet to be scientifically proven.

Evaluation of a culture change program to reduce unprofessional behaviours by hospital co-workers in Australian hospitals

BackgroundUnprofessional behaviours between healthcare workers are highly prevalent. Evaluations of large-scale culture change programs are rare resulting in limited evidence of intervention effectiveness. We conducted a multi-method evaluation of a professional accountability and culture change program “Ethos” implemented across eight Australian hospitals. The Ethos program incorporates training for staff in speaking-up; an online system for reporting co-worker behaviours; and a tiered accountability pathway, including peer-messengers who deliver feedback to staff for ‘reflection’ or ‘recognition’. Here we report the final evaluation component which aimed to measure changes in the prevalence of unprofessional behaviours before and after Ethos.MethodsA survey of staff (clinical and non-clinical) experiences of 26 unprofessional behaviours across five hospitals at baseline before (2018) and 2.5–3 years after (2021/2022) Ethos implementation. Five of the 26 behaviours were classified as ‘extreme’ (e.g., assault) and 21 as incivility/bullying (e.g., being spoken to rudely). Our analysis assessed changes in four dimensions: work-related bullying; person-related bullying; physical bullying and sexual harassment. Change in experience of incivility/bullying was compared using multivariable ordinal logistic regression. Change in extreme behaviours was assessed using multivariable binary logistic regression. All models were adjusted for respondent characteristics.ResultsIn total, 3975 surveys were completed. Staff reporting frequent incivility/bullying significantly declined from 41.7% (n = 1064; 95% CI 39.7,43.9) at baseline to 35.5% (n = 505; 95% CI 32.8,38.3; χ2(1) = 14.3; P < 0.001) post-Ethos. The odds of experiencing incivility/bullying declined by 24% (adjusted odds ratio [aOR] 0.76; 95% CI 0.66,0.87; P < 0.001) and odds of experiencing extreme behaviours by 32% (aOR 0.68; 95% CI 0.54,0.85; P < 0.001) following Ethos. All four dimensions showed a reduction of 32–41% in prevalence post-Ethos.Non-clinical staff reported the greatest decrease in their experience of unprofessional behaviour (aOR 0.41; 95% CI 0.29, 0.61). Staff attitudes and reported skills to speak-up were significantly more positive at follow-up. Awareness of the program was high (82.1%; 95% CI 80.0, 84.0%); 33% of respondents had sent or received an Ethos message.ConclusionThe Ethos program was associated with significant reductions in the prevalence of reported unprofessional behaviours and improved capacity of hospital staff to speak-up. These results add to evidence that staff will actively engage with a system that supports informal feedback to co-workers about their behaviours and is facilitated by trained peer messengers.

A Semi-Selective Medium to Evaluate Over-Summering Survival of Neopestalotiopsis sp. in Florida Strawberry Fields.

Devastating disease outbreaks with leaf spot symptoms and fruit rot caused by a fungus identified as a cryptic species of Neopestalotiopsis have generated concern in the Florida strawberry industry. Some Neopestalotiopsis species are saprobes in soil and plant debris, but the ability of the new Neopestalotiopsis sp. to survive in strawberry debris was unknown. Therefore, the objectives of this study were to develop a semiselective medium for isolation of Neopestalotiopsis spp. and to evaluate Neopestalotiopsis sp. survival in soil and strawberry plant debris over the summer in Florida. The Neopestalotiopsis semiselective medium (NSM) inhibited growth of most fungal species pathogenic to strawberry in Florida, except Neopestalotiopsis rosae, Neopestalotiopsis sp., and Phomopsis obscurans, in addition to Penicillium spp., which are nonpathogenic. However, Neopestalotiopsis species, P. obscurans, and Penicillium spp. could be distinguished in the medium through morphological characteristics. Soil samples arbitrarily collected from six commercial fields toward the end of the season (May) and before (July) and after (September) preplant soil fumigation in the following season were processed with NSM, and Neopestalotiopsis spp. populations were calculated as CFU per gram of soil. CFU ranged from 48.3 to 2,410.8 at the end of the season and from 1.7 to 630.8 before soil fumigation, but Neopestalotiopsis spp. were not recovered after soil treatment. However, 1.7 to 25 CFU were obtained from the nontreated areas in the row middles. Neopestalotiopsis sp. survival was also evaluated on diseased strawberry plants (leaves and crowns) exposed to the environment for 17 months. On leaves, Neopestalotiopsis spp. were recovered for 6 months before leaf decomposition, whereas the number of CFU on crowns declined monthly, but colonies were still recovered during the final evaluation months. A high-resolution melting analysis confirmed most of the colonies from soil and crowns were the new Neopestalotiopsis sp. Our results show Neopestalotiopsis sp. can survive in soil and strawberry debris under Florida summer conditions and may serve as a source of inoculum for the subsequent season.

The Noteworthiness of Constructive Feedback and Student-Reflection to Approach Competence-Based Curriculum: An Explanatory Study of Medical Schools in Indonesia

Background: Competence-based medical curriculum requires the acquisition of complex abilities that should be assessed longitudinally. The programmatic assessment model can facilitate a complete picture of students' competencies. The five components of learning, assessment, supporting activities; and intermediate to final evaluation provide holistic learning experiences for students and mentors to participate in the learning strategies. We aim to assess the application of longitudinal components of the programmatic assessment model to the current assessment system based on student perceptions.Methods: This study used a cross-sectional mixed-method sequential explanatory design at six medical schools in Surabaya, East Java of Indonesia. The instrument was 43 items of validated questionnaire based on the five components and the focus group discussions. Results: This study obtained 442 respondents. The results reflected high reliability with a Cronbach alpha value of 0.969, and the validity test showed R arithmetic &gt; R table (R table 0.128 for n 442). The current assessment system was perceived as ‘good’, with 3.9 on 5 points Likert scale; but the ‘supporting activities’ where reflection and feedback lied; was at the lowest score although insignificant. Students underlined the lack of formative aspects (reflection, feedback, mentorship, and middle evaluation).Conclusion: The overall assessment system is well-perceived by the students; however, the 'supportive activities' component has been minimally applied. So the 'assessment of previous learning' is still prominent in the current assessment system.

Basic life support training for intensive care unit nurses at a general hospital in Tabriz, Iran: a best practice implementation project

ABSTRACT Introduction and objectives: Basic life support (BLS) is foundational to the care delivered to cardiac arrest victims. This study evaluated current practices and implemented best practices related to BLS training for intensive care unit (ICU) nurses in a general hospital in Tabriz, Iran. Methods: This interventional before-after study was informed by the JBI Evidence Implementation Framework. An audit, feedback, and re-audit strategy was used to measure baseline compliance with best practices, develop an implementation strategy to address gaps in compliance, and undertake a final evaluation to measure changes in compliance. The JBI Practical Application of Clinical Evidence System (JBI PACES) and situational analysis Getting Research into Practice (GRiP) tool were used to support data collection and implementation planning. There were 13 evidence-based criteria and a sample of 9 ICU nurses. Results: The baseline audit revealed gaps between current practice and best practice in 9 of the 13 criteria. Barriers included insufficient education tools and programs, insufficient supervision, lack of skills laboratories, and a lack of continuous BLS education. Improvement strategies included providing a human stimulator manikin, developing an education program for nurses, as well as establishing a cardiopulmonary-cerebral resuscitation department, a skills laboratory, and continuous BLS education based on the American Heart Association guidelines. The follow-up audit revealed improvement of 100% across all criteria. Conclusions: This project indicates that a clinical audit is effective for assessing evidence-based BLS education for ICU nurses, thereby improving resuscitation performance and patient outcomes. Spanish abstract: http://links.lww.com/IJEBH/A213

Pengembangan Aplikasi Mobile untuk Pembelajaran Bahasa Arab dengan Pendekatan Kontekstual

This research focuses on developing a mobile application for Arabic language learning using a contextual approach, designed for eighth-grade students. The Research and Development methodology with the ADDIE model was implemented, encompassing stages of needs analysis, design, development, implementation, and application evaluation. The validation process involved media and material experts, resulting in a highly favorable assessment with average scores of 94.4% for technical aspects and 95.2% for curriculum alignment. The application's implementation actively engaged teachers and students, generating very positive responses. The app was deemed user-friendly, relevant to learning needs, and effective in enhancing students' motivation and understanding of Arabic language materials. The final evaluation phase identified several areas for improvement, which were then integrated to refine the application, enhancing its support for contextual and interactive learning. The significance of this research lies in its contribution to educational technology development, particularly in the domain of Arabic language learning. The findings demonstrate great potential for wider adoption in other educational institutions. The contextual approach implemented in this mobile application offers an innovative solution to improve effectiveness and engagement in Arabic language learning, aligning with the trends of education digitalization and the need for more adaptive and personalized learning methods.

Failure of Pavlik Harness Treatment in Infants Under 6 Months Old with Dislocated Hips: Short- and Intermediate-Term Results of Subsequent Treatment Modalities

ObjectiveThis study aimed to determine the short- and medium-term outcomes of hip dislocation in infants who failed Pavlik harness therapy and were subsequently treated with brace, closed reduction (CR) or open reduction (OR) before 6 months of age.MethodsFifty infants (66 hip dislocations) who failed Pavlik harness therapy between 2000 and 2018 and were treated with a rigid abduction brace or undergoing a CR or OR/cast were evaluated. All demographic data obtained from the medical system, developments and complications during the follow-up and treatment process were recorded and evaluated.ResultsFifty infants (66 hips) with dislocated hips failed Pavlik harness therapy. Of these, 9 infants (12 hips) underwent rigid abduction splint therapy: 9 hips were successful, 2 hips had CR and 1 had OR. Thirty-eight infants (51 hips) had index CR, of which 3 (3 hips) failed and had OR. Radiographs of 49 hips (44 patients) were normal at the final evaluation. Pavlik harness therapy starting after 3 weeks (P = 0.028) and unilateral dislocations (P = 0.028) increased the risk of needing operating room. There was an association between OR and avascular necrosis (P = 0.025), but not between OR and other complications—dysplasia and re-dislocation/subluxation (P = 0.257 and P = 0.508, respectively).ConclusionClosed treatment of hip dislocation is possible in most babies who fail Pavlik treatment. Babies who are started on Pavlik therapy after 3 weeks of age may be at increased risk of needing an operating room.Level of EvidenceIV.

A suggested Strategy Based on Information Technology and its Impact on Developing Creative Writing Skills and Academic Self-efficacy among Alzawyaa EFL university Students

The current study aimed to construct a strategy based on information technology for teaching English (English course102), and its impact on developing creative writing skills and academic self-efficacy among Alzawya EFL university students. The literature and previous studies were analyzed to describe the study variables and construct the strategy the proposed strategy, in which teaching and educational practices in the strategy stages (revitalization, research and viewing, design the writing framework, digital publishing of written creativity, and final evaluation) were described. A test of creative writing skills (fluency, flexibility, and originality) was also prepared Including 9 items graded open-ended essay questions in creative writing skills, also the preparation of the academic self-efficacy scale, including (25) items in the following dimensions: (the student's self-motivation to learn, the student's confidence in the ability to achieve, perseverance and continuity in learning, self-regulation of learning and recall habits). The study relied on the experimental method, designing two groups, the experimental and the control group (before - after). The study based on the experimental method, designing two groups, the experimental and the control group (pre - post). The study sample consisted of (60) second-year college students studying the course (English 102), which aims to develop language proficiency in writing skills. The sample was divided into two groups: experimental (30) and control (30)

Development and Validation of a Bedside Scale for Assessing Upper Limb Function Following Stroke: A Methodological Study.

Background Numerous tools are available for evaluation of upper limb (UL) functions among stroke survivors. Despite the excellent psychometric properties, many require considerable amount of time, are resource-intensive, and often impractical for bedside evaluation. Objectives To develop and concurrently validate a simple, resource-efficient, and time-efficient bedside tool for evaluating UL function in stroke survivors. Methods Relevant literature review was carried out to conceptualize and define the theoretical framework of day-to-day UL movement tasks. Subsequently, an item pool of 18 UL movements was developed. A mini-Delphi method was employed to verify content validity. During the iterative rounds, 18-items were revised and refined to a 12-items scale. The final bedside upper limb evaluation tool (BUFET) scale underwent concurrent validation by correlating the scores with Wolf Motor Function Test (WMFT) scores using Spearman’s correlation coefficient. Internal consistency was evaluated through Cronbach’s alpha. Results Concurrent validity and internal consistency of the scale were supported by a high correlation coefficient (r = 0.937; p&lt;0.001) with WMFT and high Cronbach’s alpha (0.948). Conclusions Newly developed BUFET was found to be a valid and reliable bedside tool in the evaluation of upper limb functions and can be administered in a resource and time-efficient manner.

Non-wounding contact-based Inoculation of fruits with fungal pathogens in postharvest

BackgroundFungal pathogens significantly impact the quality of fruits and vegetables at different stages of the supply chain, leading to substantial food losses. Understanding how these persistent fungal infections occur and progress in postharvest conditions is essential to developing effective control strategies.ResultsIn this study, we developed a reliable and consistent inoculation protocol to simulate disease spread from infected fruits to adjacent healthy fruits during postharvest storage. We tested different combinations of relevant fruit commodities, including oranges, tomatoes, and apples, against impactful postharvest pathogens such as Penicillium digitatum, Penicillium italicum, Botrytis cinerea, and Penicillium expansum. We assessed the efficacy of this protocol using fruits treated with various postharvest methods and multiple isolates for each pathogen. We optimized the source of infected tissue and incubation conditions for each fruit-pathogen combination. Disease incidence and severity were quantitatively evaluated to study infection success and progression. At the final evaluation point, 80% or higher disease incidence rates were observed in all trials except for the fungicide-treated oranges inoculated with fungicide-susceptible Penicillium spp. isolates. Although disease incidence was lower in that particular scenario, it is noteworthy that the pathogen was still able to establish itself under unfavorable conditions, indicating the robustness of our methodology. Finally, we used multispectral imaging to detect early P. digitatum infections in oranges before the disease became visible to the naked eye but after the pathogen was established.ConclusionsWe developed a non-invasive inoculation strategy that can be used to recreate infections caused by contact or nesting in postharvest. The observed high disease incidence and severity values across fruit commodities and fungal pathogens demonstrate the robustness, efficacy, and reproducibility of the developed methodology. The protocol has the potential to be tailored for other pathosystems. Additionally, this approach can facilitate the study of fruit-pathogen interactions and the assessment of innovative control strategies.

Efficacy of the Novel Formulation of Topical Liothyronine and Liothyronine-insulin in Mild to Moderate Diabetic Foot Ulcer: A Randomized, Triple-blind Clinical Trial.

Diabetic foot ulcer (DFU) is one of the challenging complications of chronic diabetes. The study aimed to investigate whether liothyronine (T3) and liothyronineinsulin (T3/Ins) topical preparations could significantly reduce the healing time of DFU. A prospective, randomized, placebo-controlled, patient-blinded clinical trial was conducted on patients with mild to moderate DFU, over a lesion area of no greater than 100 cm2. The patients were randomized to receive T3, T3/Ins, or honey cream 10% as the routine of care twice a day. Patients were examined for tissue healing weekly for 4 weeks, or until the total lesion clearance was observed, whichever was earlier. Of 147 patients with DFUs, 78 patients (26 per group) completed the study and were included in the final evaluation. At the time of study termination, all participants in each of the T3 or T3/Ins groups were free of symptoms based on the REEDA score, while about 40% of participants in the control group were detected with each of grades 1, 2, or 3. A significant difference was observed on days 7, 14, and 21 of consumption of topical preparations (p-value < 0.001). The mean time to complete wound closure in the routine care group was about 60.6 days, while it was 15.9 and 16.4 days in T3 and T3/Ins groups, respectively. Within the T3 and T3/Ins groups, significant earlier wound closure was detected at day 28 (p-value < 0.001). T3 or T3/Ins topical preparations are effective for wound healing and acceleration of wound closure in mild to moderate DFUs.

Promoting social inclusion and quality of life in older adults through aerobic exercise programs

Background: Aging is an individual and collective process that alters health and quality of life of older adults. It deteriorates the musculoskeletal, neuromuscular and cardiovascular systems and causes damage to functionality. In the same way, the main risk factors for chronic diseases are overweight and sedentary lifestyle. The key to improve the quality of life is to be physically and mentally active. Objective: to apply an intervention to improve the life quality of older adults through an aerobic exercise program. Methods: a quantitative, observational and longitudinal approach was applied. The program lasted 12 weeks with an initial and final evaluation. The population consisted of 30 older adults, who underwent a warm-up, aerobic exercise (dance therapy) and flexibility and stretching exercises. The SF-36 quality of life questionnaire and the International Physical Activity Questionnaire (IPAQ) were used. Results: it was established with a value p&lt;0.001 that the dimensions evaluated by the SF-36 questionnaire improved. There was a change in physical function, physical role, bodily pain, general health, vitality, social function, emotional role and mental health, as well as in the level of physical activity. Conclusions: a positive change was observed. The aerobic exercise program reduces the musculoskeletal pain associated with aging and produces an increase in physical functionality. As a consequence, it favors an improvement in self-efficacy and self-esteem.

Safety and Efficacy of Lemborexant in Insomnia Patients: Results of a Postmarketing Observational Study of Dayvigo® Tablets.

A prospective, postmarketing observational study was conducted to evaluate the safety and efficacy of lemborexant (LEM) tablets in daily clinical practice in Japan. No other studies of a similar size have been conducted since the marketing approval of LEM, making this the first report of its kind. Insomnia patients (n=550) administered LEM (5-10 mg daily) for the first time were enrolled. Adverse events were collected for target events (somnolence, parasomnia, narcolepsy and associated conditions, suicidal ideation and suicidal behavior). Overall improvement of insomnia symptoms was assessed by the investigator based on the patient's complaint. Subjective sleep onset latency (sSOL) and subjective total sleep time (sTST) were investigated as sleep parameters. A case report form was obtained from 539 patients. The incidence of adverse drug reactions (ADRs) was 7.65% for somnolence, 1.76% for nightmares, 0.59% for abnormal dreams, and 0.20% for sleep paralysis. No serious ADRs or ADRs related to suicidal ideation or suicidal behavior were observed. The efficacy rate at the final evaluation was 80.83%. Decreased sSOL and increased sTST were observed as assessed starting from Week 8 of treatment. Based on the results of this study, the safety result was consistent with the safety profile described in the current package insert. Efficacy results also indicated that LEM is clinically useful.

Osteoimmunological Principles Adapted to Achieve Mechanically Superior Posterolateral Fusion in a New Zealand White Rabbit Model Using Antigen-Coated, Electrospun Beta-Tricalcium Phosphate.

Introduction Triggering the immune system via antigenic stimulation at the time of spinal fusion surgery may enhance bone morphogenesis and result in successful bony arthrodesis. We sought to demonstrate that bone morphogenesis could be enhanced via antigenic immunologic stimulation of a surgical fusion site. Methods New Zealand white rabbits underwent non-instrumented posterolateral fusion of L5-6 with implantation of either an immunologically activated graft (inert beta-tricalcium phosphate) or harvested autograft. Fusion was evaluated using plain radiographs, micro-computed tomography (CT), mechanical palpation, and biomechanical testing. The final evaluation was carried out at 12 weeks postoperatively. Results Eight rabbits received immunologically activated grafts; 10 received autografts and served as historical controls. Fusion rates were identical between groups (both 50%). Radiographs and micro CT of the fusion mass showed no significant difference between groups, and both showed good incorporation of the transverse processes into the fusion masses with radiographic evidence confirming trabeculation and bone remodeling. However, mechanical testing of the fusion sites showed superior fusion strength in the rabbits that received immunologically activated grafts, approaching a factor of two on flexion/extension, lateral bending, and axial rotation. Little to no graft material was appreciable in the non-fused antigen-treated specimens. Conclusions There is a long-standing need for a graft material that can replace autograft bone, due to the negative clinical consequences and financial costs pertaining to autologous bone harvesting. No allograft bone substitute to date has been able to reliably replicate the success of harvested autograft bone. This study suggests that immunological enhancement of inert beta-tricalcium phosphate can potentially be a substitute for allograft bone that can meet and even exceed the success of harvested autograft bone.

Exploration of neoadjuvant chemotherapy and post-tumor microenvironment for advanced gastric cancer (GC) or gastroesophageal junction cancer (EGJ).

e16099 Background: Neoadjuvant chemotherapy (NAC) is still the main strategy for operable local advanced gastric cancer (GC) or gastroesophageal junction cancer (EGJ). Keynote585 and Matterhorn studies had demonstrated the improvement of pathologic complete response rate (PCR), however, the overall survival benefit remains unclear. Little is known why patients’ response differently to NAC in terms of chemotherapy regiment and post neoadjuvant tumor microenvironment (TME). Methods: We retrospectively analyzed the resectable GC or EGJ patients who had been treated with neoadjuvant chemotherapy followed by surgery during 2019.11.26-2023.8.18 in the Chinese PLA general hospital. Patients with complete survival data were enrolled in the final evaluation. The association between clinical features or chemotherapy regiment and outcomes including TGR grade (NCCN criteria) and survival data were explored. Furthermore, tumor-microenvironment by means of multiplex fluorescence staining(mIHC) (CD8, CD68, CD56, PD1, PDL1, PANCK) after SOX neoadjuvant chemotherapy was analyzed. Results: 184 patients were offered neoadjuvant chemotherapy and underwent surgery. Due to follow-up lost, 141 patients with complete survival data were included in this analysis finally. Average age was 61, majority of patients were male. 85 patients received Sox and 33 received Xelox and 12 patients with docetaxel and S1(DS) and 11 patients were administered with triplets (FOLT and DOS). The median cycle of neoadjuvant treatment was 4(range from 1-7). Large proportion of patients were performed Laparoscopic. 31 patients suffered from post surgery complication. Above all, 1-year DFS and 2-year DFS, 3-year DFS rate were 72.6%, 54.8%, 49.0% respectively. 2-year OS and 3-year OS rate were 76.9%, 64.5%. PCR rate was 6.38% (n=9), which is consistent with other previous studies. 9 patients achieved TRG 0 and 26 had TRG 1. There is no statistical difference between triplets and double regiment of NEC for TRG0-1 group (45.5% vs 23.1%, p=0.099). The addition of docetaxel to oxaliplatin based therapy had not improved the TRG0-1 population compared with docetaxel-free regiment (30.4% VS 23.7%, p=0.496). YN0 is a predictor of longer survival in contrast YN+( 1-year DFS, 89.4% vs 62.8%, p=0.000).In the mIHC analyses, the density of CD8 positive and CD8+PD1- in the TGR0-1 group is higher than those cells in the TGR 2-3 group(P&lt;0.05). TGR0-1 group had lower density of PDL1+,CD68+PDL1+ and CD68+PDL1- cells in contrast to TGR 2-3 group(P&lt;0.05).Other multi-dimensional analyses were ongoing to be further disclosure. Conclusions: Neoadjuvant chemotherapy led to nearly 7% PCR rate for patients with local advanced GC. YN0 after NAC is a predictor of longer survival. CD8 positive and CD8+PD1- might be the determinant immune cells for better anticancer-response when exposed to chemotherapy.