Individual Cases Research Articles

Real-world experience with trastuzumab deruxtecan in patients with metastatic HER2-positive breast cancer and HER2-positive gastric cancer: A retrospective study

Aim. To evaluate the effectiveness of trastuzumab deruxtecan in real-world practice in the Russian Federation.
 Materials and methods. We performed a retrospective analysis of clinical case series related to the use of trastuzumab deruxtecan (N=15) in the setting of a single clinical center, University Headache Clinic (Dr. Laskov's Clinic), as part of the program for the import of an unapproved drug as a life-saving measure. The overall survival, progression-free survival, and objective response rate were assessed, and individual real-world cases of drug efficacy were presented.
 Results. Objective response rates are comparable to those shown in large randomized trials. The median follow-up was 67 days; the 6-month overall survival was 70.1% (95% confidence interval [CI] 49.4–99.6%), and the 6-month progression-free survival was 52.1% (95% CI 29.9–90.6%). There were no significant complications associated with therapy; in particular, no events of interstitial lung disease were reported.
 Discussion. The real-world efficacy of trastuzumab deruxtecan was comparable to that in randomized clinical trials. However, at the level of individual clinical cases, slightly lower efficacy was noted in initially frailer patients (ECOG score 3). Also, it should be noted that the study included patients who had the opportunity to purchase an expensive drug and, therefore, had a social status different from the general population, which could affect the results of this study.
 Conclusion. The use of trastuzumab deruxtecan in real-world settings has demonstrated high efficacy and a good safety profile.

Effectiveness of F3 feline facial pheromone analogue for acute stress reduction within clinical veterinary practice

PICO Question In cats within a clinical veterinary context, does the application of the F3 feline facial pheromone (Feliway™), when compared to placebo, reduce signs of acute stress? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Five papers were critically reviewed. There were three prospective, double-blinded, randomised controlled trials, one prospective, single-blinded, randomised controlled trial and one prospective, single-blinded, non-randomised controlled trial. Strength of evidence Moderate. Outcomes reported Four studies found improvement in select indicators of acute stress following F3 feline facial pheromone analogue (FFPA) exposure. One study showed FFPA reduced patient stress during routine physical examination, and improved caregiver impression of patient relaxation and ease of handling. One study revealed FFPA decreased vocalisations but had no effect upon systolic blood pressure during physical examination. One study determined that FFPA calmed but did not reduce struggling during venous catheterisation. One study demonstrated reduced time to sedation and propofol induction dose for routine surgical procedures when a transport protocol incorporating FFPA was applied. Finally, one study found no significant effect of FFPA upon behavioural and physiologic measures of acute stress during physical examination. No studies reported outward negative effects associated with FFPA exposure. Conclusion It can be concluded that FFPA may reduce signs of acute stress within a clinical veterinary context. Additionally, exposure to FFPA is unlikely to cause patient harm. To optimise patient welfare, FFPA is not recommended as a sole agent for stress mitigation and should instead be incorporated holistically with patient friendly handling, clinic design, and pharmacotherapy where indicated. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Treatment of malignant diseases with phytocannabinoids: promising observations in animal models and patients

Amazingly, almost 50 years after the first demonstration of anticancer effects of cannabinoids in vitro and in vivo, well-designed clinical trials that definitively prove tumour-inhibiting effects in man are still missing. Whereas a large number of preclinical studies exist that describe tumour-inhibiting effects of cannabinoids, alone or in combination, but also in the form of medical cannabis or natural extracts in vitro, the number of in vivo studies is still limited. Even more limited are well-documented experiences in man. Most animal studies and experience with cannabinoids in man concern brain tumours. This review summarises the effects of phytocannabinoids in brain, breast, colorectal, head and neck, haematological, liver, lung, pancreatic, ovarian, prostate, and skin cancers in animal models and, if available, in patients. The large majority of animal studies demonstrate tumour-inhibiting effects of cannabinoids, thus confirming in vitro data. Experiences in cancer patients are almost exclusively limited to individual case reports and case series without a control group. Many questions are currently unanswered such as the role of pure cannabinoids compared to combinations, cannabinoids as the eventual sole cancer therapy, optimal dosages, or duration of treatment. Pure cannabidiol (CBD) seems to be superior to pure delta-9-tetrahydrocannabinol (THC) in experimental settings. The role of medical cannabis or extracts is less clear as they vary in their phytochemical composition. In conclusion, cannabis/cannabinoids may slow the progression of tumours. However, the hope that cannabinoids could eventually cure cancer as often spread in social media, is, at present, wishful thinking. Above all, well-designed clinical trials paired with long-term follow-up of cancer patients are needed.

Analysis of adult vaccination in Shandong Province from 2018 to 2022

Objective: To analyze the utilization of adult vaccination among people aged 18 and above in Shandong Province from 2018 to 2022. Methods: Data on vaccination units in 2022 and individual cases of vaccination information for people aged 18 and above were extracted from the Shandong Immunization Information System. A descriptive analysis was conducted on the distribution of adult vaccination units and adult vaccination varieties. The total vaccination amount and vaccination rate were calculated. Results: By the end of 2022, there were 3 948 vaccination units providing adult vaccination in Shandong Province, with 0.36 adult vaccination clinics per 10 000 people. Adult vaccination including RabV(rabies vaccine for human use), InfV(influenza vaccine), HPV(human papillomavirus), HepB(hepatitis B vaccine), PPV23(23-valent pneumococcal polysaccharide vaccine), MenACYW135(meningococcal polysaccharide vaccine group ACYW135), MMR(measles, mumps and rubella combined attenuated live vaccine), HEV(hepatitise E vaccine), RZV(recombinant zoster vaccine), TV(tetanus vaccine) and HF(haemorrhagic fever with renal syndrome vaccine) vaccines were administered, with a cumulative dose of 40.056 9 million and an average of 0.1 doses per person per year from 2018 to 2022. The top three vaccines were RabV, InfV and HPV, accounting for 31.48%, 22.57%, and 15.93% of the total vaccination amount, respectively. The annual vaccination dose for adults increased from 3.477 3 million in 2018 to 13.308 6 million in 2022, with an average annual growth rate of 56.55%. The cumulative 5-year doses of RabV and TV were 15.90 doses per 100 people and 0.21 doses per 100 people. The average annual vaccination rate of InfV was 2.28%. The cumulative full vaccination rates of HPV, HepB, PPV23 and RZV were 12.44%, 1.61%, 0.52% and 0.17%, respectively. The cumulative 5-year doses of RabV and TV were 29.19 doses per 100 people and 0.43 doses per 100 people in the age group of 20 to<30 years old. The vaccination rates of InfV and PPV23 were 9.08% and 1.27% in the age group of 70 to<80 years old. The vaccination rate of RZV was 0.11% in the age group of 50 to<60 years old. The HPV vaccination rate was 18.09% in the age group of 20 to<30 years old, and the HepB, MenACYW135, MMR and HEV vaccination rates were 6.21%, 9.55%, 2.65%, and 2.83% in the 18-19 age group, respectively. Conclusion: There are relatively few types of adult vaccination in Shandong Province, with narrow coverage and low vaccination rates.

DUBAJ EXPO 2020 – PRZESTRZEŃ WYSTAWY ŚWIATOWEJ W KONTEKŚCIE DOSTĘPNOŚCI DLA OSÓB ZE SZCZEGÓLNYMI POTRZEBAMI

In today's world, accessibility poses a challenge for all communities worldwide. The achievements and civilizational progress are periodically showcased at global exhibitions. This article addresses the issue of accessibility for individuals with special needs and the implementation of facilities and solutions for accessibility in the context of the 76th World Expo 2020 in Dubai. The aim of the research undertaken in the article was to conduct a comparative analysis of accessibility within the exhibition space and pavilions, focusing on the occurrence of specific issues within the designated research area. The study also delved into individual cases, considering accessibility in various national pavilions at Expo 2020. The results of the accessibility study, conducted based on pre-established criteria, demonstrated the level of implementation of accessibility concepts within the exhibition space and pavilions from both comparative and problem-oriented perspectives.

Autologous point-of-care stromal vascular fraction transplantation in dogs with advanced osteoarthritis of the knee and hip joints.

The aim of the study was to assess lameness in dogs with advanced osteoarthritis of the hip and knee joints after a single autologous point-of-care transplantation of the Stromal Vascular Fraction (SVF) into the affected joint. During a minilaparotomy, 10 g of falciform fat was removed from each patient for each joint to be treated. A modern and time-saving procedure (ARC TM System, InGeneron GmbH, Houston, USA) was used for the in-house preparation of the SVF, so that the isolated cells could be applied to the respective joint within 2 h after fat removal. In total, five knee joints of five patients and seven hip joints of four patients were treated. Improvement in lameness according to owner questionnaires was seen in 3 of 5 patients with knee joint arthritis and 2 of 4 patients with hip joint arthritis. Based on gait analysis, only one dog with gonarthrosis and one dog with coxarthrosis showed improvement up to a maximum of 3 months after surgery. This is the first case series on the treatment of osteoarthrosis of the knee or hip joint using point-of-care transplantation of the SVF. In individual cases, this method may represent a therapeutic approach for the treatment in dogs with advanced cox- or gonarthrosis, although only a short-term effect can be expected, which calls into question the effort and costs involved.

Identifying Key Issues in Climate Change Litigation: A Machine Learning Text Analytic Approach

As climate change, environmental, social, and governance (ESG), along with sustainability, become increasingly crucial for businesses and society, there is a noticeable scarcity of information and transparency regarding corporate practices. Often, government agency enforcement actions lead to litigation and are ultimately resolved by court decisions. Moreover, in instances when there is perceived inadequacy in government enforcement, citizens frequently turn to the courts for preventive judgments against businesses or agencies. In an effort to shed light on the multifaceted aspects of climate change, we adopted a novel, exploratory approach to analyze climate change-related litigation cases. Utilizing a blend of machine learning-based text analytics, we have extracted key insights from individual case narratives. Our analysis encompassed over four hundred cases from the Westlaw database through various keyword searches. The emergent topics from our case dataset revolved around four critical environmental themes: forest, land, water, and air emissions. Our findings provide insight into the nature and dimensions of climate change and also carry significant policy implications, laying the groundwork for future research in this domain.

Прогнозирование исходов программ экстракорпорального оплодотворения с использованием модели машинного обучения «Случайный лес»

Currently, in vitro fertilization (IVF) with embryo transfer is the main method of treatment of all forms of infertility, but successful cases ending in pregnancy still account for only a third of all cycles performed. It is necessary to take into account many parameters and investigate the connections between them in order to properly evaluate the results of IVF. Over the past decades, a number of IVF prediction models have been developed with the aim at assessing the outcomes in individual cases, but, given the generally poor prognostic capacity, only a few of them have proven to be clinically significant. This study aimed to create nonlinear IVF outcomes prediction models and identify the most significant factors affecting the said outcomes. Using a database containing information on more than 700 indicators of 7004 women aged 18 to 45 years who participated in the IVF program in Russia from 2010 to 2020, we trained a random forest model that predicted pregnancy in the IVF cycle with ROC-AUC = 0.69. This paper describes 20 most successful predictors of the resulting model and interprets their contribution to the prognosis. Of these, body mass index (BMI) and the number of received and fertilized oocytes have been covered in the scientific literature previously as predictors of IVF outcomes, but other parameters, such as anamnestic data, previous participation in an IVF program (number of cases and their results), as well as serum concentration of AMH, rarely appear in foreign prognostic models.

Modern Approaches to Detect Helicobacter pylori Infection

Helicobacter pylori infection is quite prevalent and lifelong if not treated and is associated with risks of severe complications, such as peptic ulcers, gastric carcinoma, and MALT lymphoma. So, proper and timely detection is really important. There are modern invasive and non-invasive detection methods most of which are highly sensitive and specific. Choosing the best detection method is important and depends on each individual case e.g. patient’s age and co-morbidity, as well as if previous eradication attempts have been done. It is wise to choose methods, that detect not just the infection itself, but also susceptibility to antimicrobial eradication agents as resistance rates are increasing worldwide. This review presents briefly the major H. pylori detection methods and aims to assist both clinicians and microbiologists in choosing the best diagnostic approach.

Apparent stress as an indicator of stress meta-instability: The 2021 MS6.4 Yangbi earthquake in Yunnan, China

Investigating spatiotemporal changes in crustal stress associated with major earthquakes has implications for understanding seismogenic processes. However, in individual earthquake cases, the characteristics of the stress after it reaches its maximum value are rarely discussed. In this study, we use the 2021 MS6.4 Yangbi earthquake in Yunnan, China and events of magnitudes ML ≥ 3.0 occurred in the surrounding area in the previous 11 years to investigate the spatiotemporal evolution of apparent stress. The results indicate that apparent stress began to increase in January 2015 and reached a maximum in January 2020. Apparent stress then remained at a high level until October 2020, after which it declined considerable. We suggest that the stress was in the accumulation stage from January 2015 to January 2020, and entered the meta-instability stage after October 2020. During the meta-instability stage, the zone of decreasing stress expanded continuously and the apparent stress increased around the Yangbi earthquake source region. These features are generally consistent with the results of laboratory rock stress experiments. We propose that apparent stress can be a good indicator for determining whether the stress at a specific location has entered the meta-instability stage and may become the epicenter of an impending strong earthquake.

#216 : High Live Birth Rates After Low Dose Lymphocyte Immunization Therapy (LD-LIT) with Partner Lymphocytes in Recurrent Miscarriage Patients

Background and Aims: Recurrent Miscarriage (RM) affects 1–2% of couples trying to conceive, with 50% remaining unexplained. Meta-analyses suggest LIT improves pregnancy outcomes for RM couples. However, results are conflicting due to differing criteria and protocols. This study evaluates low dose LIT effectiveness in patients with unexplained RM and Th1/Th2/Treg paradigm disorders. Method: Self-controlled, prospective study of 23 RM patients receiving partner lymphocyte immunization from August 2021 to October 2022, with [Formula: see text]3 miscarriages less than 12 weeks when endometrium at ET was [Formula: see text]8mm and PGT embryos were used. Patients with abnormal Th1/Th2/Treg cell proportions and biomarkers were treated with paternal lymphocytes twice before embryo transfer (ET) and once post-pregnancy confirmation. Results: Significant decrease in Th1 and increase in Th2 cytokines like TNF-a and IFN-g and significantly increase in Treg cells and TGF-b noted and blocking antibodies detected in all patients after LIT therapy. 20/23 (87%) post LIT conceived and 4 delivered healthy full-term babies (17%) and 3 patients have yet to undergo ET. 48% (11/23) uneventful ongoing pregnancies crossed [Formula: see text]14 weeks. 3 patients had miscarriages (13%). 1 patient (4%) did not conceive. 1(4%) conceived spontaneously ([Formula: see text]25 wks) and 1(4%) opted to try to conceive naturally. Cumulative uneventful pregnancy outcome 65%. Conclusion: LIT was associated with high live birth rates, especially in women with RM. It not only ameliorates patient’s cellular immune function, but also further increases patient’s pregnancy success rate with high safety, which is worthy of clinical application and promotion. Being small size self-controlled study, this result needs to be validated with large we’ll planned RCTs. LIT may be considered a safe and effective treatment for RM/RIF in IVF patients in individual cases based on immunoprofiling (Th1/Th2/Treg paradigm disorders), after ruling out other potential causes of RM or RIF.

Local post-hoc interpretable machine learning model for prediction of dementia in young adults

&lt;p&gt;Dementia is still the prevailing brain disease with late diagnosis. There is a large increase in dementia disease among young adults. The major reason is over indulgence of young adults on social media resulting in denial of disease and delayed clinical diagnosis. Dementia is preventable and curable if diagnosed at an early stage, however, no attempts are being made to miti gate dementia in young adults. Today artificial intelligence (AI) based advanced technology with real-life consultations in clinical or remote setups are proved beneficial and is used to detect dementia. Most AI-based test is dependent on computer-aided di agnosis (CAD) tools and uses non-invasive imaging technology such as magnetic resonance imaging (MRI) data for disease diagnosis. In this paper, a local post-hoc interpretable machine learning (LPIML) model for prediction of dementia in young adults is proposed. The performance parameters are computed and compared based on accuracy, specificity, precision, F1 score and recall. The proposed work yields 98.87% training accuracy on original images and 99.31% training accuracy on morphologically enhanced images. The performance results are intrinsic and intuitive in learning the prediction results of individual case. The adoption of the proposed work will accelerate the diagnosis process in the era of digital healthcare.&lt;/p&gt;

OOPHORECTOMY: When and Why? A Novel Risk Stratification Tool as an Aid to Decision Making at Gynecological Surgeries.

The decision regarding oophorectomy during gynecological surgeries, especially in perimenopausal and postmenopausal women, has historically posed a significant dilemma. Traditionally, it was widely believed that conserving the ovaries held no benefits, leading to a common practice of recommending bilateral salpingo-oophorectomy alongside hysterectomy for benign conditions in women aged 40-45 and above. Given our evolving comprehension of postmenopausal ovarian function and the genetic susceptibility to ovarian epithelial cancers, the decision regarding oophorectomy poses a dilemma. Oophorectomy is recommended for women with a higher risk of ovarian cancer and ovarian conservation is necessary with women with higher risk of co-morbidities. This paper reviews the available literature on these aspects of oophorectomy. Despite a wealth of literature narrating the advantages and disadvantages of oophorectomy, covering various aspects such as ovarian cancer risk, myocardial infarction incidence, and post-oophorectomy peritoneal cancer, there is a notable absence of a comprehensive evaluation system for risk stratification. The objective of the present paper is to address this gap by consolidating existing literature into a risk stratification system. This system will provide treating physicians a tool that facilitates more informed, case-specific decisions in collaboration with patients and their families. While recognizing that the ultimate decision must be tailored to the individual case and agreed upon mutually by the surgeon, patient, and family, the proposed system seeks to streamline risk stratification. This, in turn, should aid in determining the most suitable course of treatment that maximizes benefits for the patient.

Inpatient covid-19-related comorbidities and ct-semiotics

Introduction. In the Russian Federation, registration of individual COVID-19 cases started at the end of January 2020 that markedly increased in the second half of March. At the moment, the situation with COVID-19 is unstable. As of 2023, COVID-19 incidence in descending order is as follows: USA (104 958 987 people), India (44 684 775 people) and France (39 582 057 people). Russia ranked 10th regarding total COVID-19 incidence (22 137 084 people, including 395 727 fatalities). The infection is able to “overlap” with the underlying pathology, thereby worsening patient’s condition up to death. Lung multislice computed tomography (MSCT) is recommended for all patients with COVID-19. If unavailable, a chest X-ray is performed. The aim of the study was to identify the most frequent comorbid diseases and changes on radiological scan in patients with COVID-19.Materials and methods. The study was carried out at the Infectious Disease Department No. 1, Regional Public Health Institution “Clinical Hospital No. 1” Smolensk. For this, there were analyzed 69 hospital patient records with basic diagnosis — coronavirus infection. The data of anamnesis and additional instrumental investigations were taken into account.&#x0D; Results. 69 patients aged between 18 and 91 years were included in the study. Respiratory failure was not observed in 75.81% of cases. A group of patients (66.67%) with comorbidities of organs and systems was identified, among which most common were: arterial hypertension (95.65%), coronary heart disease (78.26%), diabetes mellitus (30.43%), grade 1–2 obesity (17.39%), chronic hepatitis (17.39%). Diseases of the gastrointestinal tract and respiratory system were less prevalent. The rate of reported complications is as follows: bilateral polysegmental pneumonia — 72.46%; unilateral polysegmental pneumonia — 2.8%; pleurisy — 4.35%; unilateral hydrothorax — 1.45%. Each of the inpatients underwent radiological examination during hospitalisation. X-ray examination accounted for a smaller proportion (39.13%) and multispiral chest computed tomography (MSCT) — for a bigger percentage (60.87%). Chest MSCT at the beginning of inpatient treatment visualized CT-2 stage (64.29%) in the vast majority, less — CT-1 (26.19%), least frequently — CT-3 (7.14%) and CT-4 (2.38%). Before patient discharge, an average of 12.16% improvement in the radiological picture was found in patients with initial CT-1 stage, 14% — in CT-2, 12% and 26% — in CT-3 and CT-4, respectively.Conclusion. The moderate disease course without respiratory depression prevailed among the patients. Co-morbidities were found mainly in the anamnesis of persons over 50 years old. The most frequent clinical complication of coronavirus infection was bilateral pneumonia. After patient’s hospitalization, clinical and instrumental picture gradually improved, which was confirmed by radiological data.

Introduction

This Edition of the Journal comprise eleven papers, of which six are related to the COVID- 19 pandemic. The papers are balanced between those mainly concerned with media or online pedagogies (four), staff development and experiences (three) and strategic university wide policy or institutional change (four). The papers continue to reflect a varied range of participant countries both in terms of the authors, but perhaps more importantly the study sites, (Colombia, Italy, Indonesia, Iran, Lebanon, South Africa, Spain, and Turkey). Universities from both the state and private sector are represented, either through individual case studies or via multi-site studies in subject areas, departments, or institutions. What is fascinating, and perhaps unsurprising, is that common themes emerge from different countries. From the papers in this edition, several issues emerge. First, we can conclude that with distance learning there was/is a particular challenge of dealing with cheating and plagiarism- and exhibited during the pandemic. Second, responses, or readiness to change, with respect to new initiatives and pedagogies can vary by discipline within the same institution, between institutions and within a country. Third, it was noted that when change is made, either planned or in an emergency, the extent of the impact is related to the prior experience and expertise of both teachers and students and the available infrastructure with respect to the new situation. Several papers raised concerns about the pedagogical competences of the teaching staff and how, when this is limited in relation to a required change in pedagogy, stress and workload problems are encountered by both teachers and students. Furthermore, the learning experience is hindered and, where technology changes are involved, students can become isolated and demotivated. Accessibility and equality e.g. (gender, age, income, access to resources) issues were also raised, most evident during the pandemic and emergency remote teaching. The conclusion is perhaps that universities need to plan more carefully for emergency situations taking account of their demographic and socio-economic community – whether teachers, students or other stakeholders.

Musculoskeletal chest pain prevalence in emergency department presentations: A retrospective case notes review.

Musculoskeletal (MSK) causes of chest pain are considered common in emergency care, yet management is limited, reported outcomes are poor and prevalence data in New Zealand are lacking. The present study aims to estimate the prevalence of MSK chest pain in New Zealand EDs and describe the characteristics of MSK chest pain cases. A retrospective chart review was conducted based on de-identified clinical notes extracted from four hospitals within the South Island of New Zealand from 3 months spanning 1 March to 31 May 2021. Individual cases were categorised to the single best-fitting cause of chest pain using systems-based categorisation, based primarily on the doctors' documented final impression. A total of 1344 cases were categorised in the present study. MSK chest pain had a prevalence of 15% (range 11-31%) of chest pain presentations across all study sites. This represented the second most common system responsible for chest pain, after the cardiovascular system. The mean age of MSK chest pain cases was 46.9 (standard deviation [SD] 19.1) years, compared to 55.5 (SD 19.7) years in all cases. Age and gender-specific data, data from rural hospitals and MSK sub-type data are presented. These data provide a conservative estimate of MSK chest pain prevalence in EDs within the South Island of New Zealand. The findings highlight MSK chest pain as common in emergency care, providing a basis and justification for further research to improve management and outcomes for people with MSK chest pain.

In free-roaming dog populations, does egg-based oral rabies vaccination programmes result in improved bait efficacy?

PICO Question In free-roaming dog populations, does an egg-based oral rabies vaccination (ORV) compared with meat and fish based ORVs result in improved bait efficacy? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Three non-blinded, control trials were critically reviewed. Strength of evidence Weak. Outcomes reported Variables assessed in this Knowledge Summary included the type of bait that stray dogs were most interested in, and whether or not the dog was successfully vaccinated by release of the vaccine sachet into the oral cavity. Conclusion There is weak evidence to show that stray dogs prefer egg-based baits in compared to other bait types, despite egg-based baits allowing for more successful perforation of the vaccine sachet, and hence a higher chance of a successful oral rabies vaccination. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

Implementing an adaptive, two-tiered SARS-CoV-2 wastewater surveillance program on a university campus using passive sampling

Building-level wastewater-based surveillance (WBS) has been increasingly applied upstream from wastewater treatment plants to conduct targeted monitoring for SARS-CoV-2. In this study, a two-tiered, trigger-based wastewater surveillance program was developed on a university campus to monitor dormitory wastewater. The objective was to determine if passive sampling with cotton gauze as a sampling medium could be used to support institution-level public health action. Two nucleocapsid gene targets (N1 and N2) of SARS-CoV-2 as well as the endogenous fecal indicator pepper mild mottle virus (PMMoV) were quantified using RT-qPCR. >500 samples were analyzed during two contrasting surveillance periods. In the Fall of 2021 community viral burden was low and a tiered sampling network was able to isolate individual clinical cases at the building-scale. In the Winter of 2022 wastewater signals were quickly elevated by the emergence of the highly transmissible SARS-CoV-2 Omicron (B.1.1.529) variant. Prevalence of SARS-CoV-2 shifted surveillance objectives from isolating cases to monitoring trends, revealing both the benefits and limitations of a tiered surveillance design under different public health situations. Normalization of SARS-CoV-2 by PMMoV was not reflective of upstream population differences, suggesting saturation of the material occurred during the exposure period. The passive sampling method detected nearly all known clinical cases and in one instance was able to identify one pre-symptomatic individual days prior to confirmation by clinical test. Comparisons between campus samplers and municipal wastewater influent suggests that the spread of COVID-19 on the campus was similar to that of the broader community. The results demonstrate that passive sampling is an effective tool that can produce semi-quantitative data capable of tracking temporal trends to guide targeted public health decision-making at an institutional level. Practitioners of WBS can utilize these results to inform surveillance program designs that prioritize efficient resource use and rapid reporting.

Liquid Biopsy: A Highly Useful Tool to Decide Personalized Therapy in Veteran Patients with Metastatic Pancreaticobiliary Cancer

Abstract Introduction/Objective Pancreatic cancer is one of the leading causes of death in Veteran patients. Early detection and treatment of the pancreatic cancers are key to the successful management of pancreatic cancer with good patient outcome. The National Comprehensive Cancer Network (NCCN) recommends tumor molecular profiling in all patient cases of unresectable or metastatic pancreatic adenocarcinomas and biliary tract cancers who are candidates for chemotherapy. This testing can be performed using liquid biopsy to obtain this molecular profiling from circulating tumor cells (CTC) to obtain information that may impact treatment. However, the literature of metastatic pancreaticobiliary cancers targeted by liquid biopsies and the mutations found is sparse, particularly for the veteran population. Methods/Case Report A retrospective review was performed of all patients with a submitted liquid biopsy specimen at a Veteran Affairs Medical Center (VAMC) from April 2020 to March 3rd, 2023, to examine those patients with metastatic pancreaticobiliary cancers, specifically pancreatic adenocarcinoma, and cholangiocarcinoma. Information on mutations detected was collected. Results (if a Case Study enter NA) There were a total of 5 patient specimens with a history of metastatic pancreatic adenocarcinoma (4 cases/5) and cholangiocarcinoma (1 case/5). The first liquid biopsy from a patient with a history of metastatic pancreaticobiliary cancer was sent on April 14th, 2020, and the last was sent on November 12th, 2021. TP53 was detected on all the successfully tested pancreatic adenocarcinoma cases. Other mutations detected in the individual pancreatic adenocarcinoma cases were KRAS, TET2 BCOR, DNMT3A, FUBP1, RAD21, and STAG2. The mutations found on the single cholangiocarcinoma case included DNMT3A and TP53. 1 of the 4 cases sent on a patient with pancreatic adenocarcinoma resulted in a sample failure. Conclusion Liquid biopsies provided comprehensive molecular profiling in cases of metastatic pancreatic adenocarcinoma and biliary tract cancer in the veteran population treated at a local VAMC to help decide on personalized therapy, in compliance with the recommendations of the NCCN. The results of this pilot quality assurance study help highlight the potential of liquid biopsies to detect most commonly mutated genes such as KRAS and T53 in pancreatic cancer.

Clustering Business Models of Heterogeneous Nature-Based Solutions Implementing Innovative Governance and Financing Concepts

Nature-based solutions (NBSs) are considered sustainable, cost-efficient, and resource-efficient land-use management approaches. When analysing NBS business models, two major challenges are commonly identified as slowing down broader NBS implementation: governance and financing barriers. This explorative study aims first to test the applicability of a NBS specific business model template and, second, to provide a clustered NBS business model pilot case study collection, which enables transferable solutions for overcoming the typical implementation challenges to be derived. Methodically, this is achieved by using the Nature-based Sustainability Business Model Canvas (NB S BMC for guided interviews. Twenty-three NBS case studies from proGIreg’s four Front Runner Cities, namely Dortmund, Ningbo, Turin, and Zagreb, are examined. Pestoff’s welfare triangle enables the NBS business models to be clustered. The main business model clusters are public provision, sales, and diversified. NBSs’ governance models are very adaptable to individual NBS cases, of the independent type, and can include a huge diversity of involved stakeholders regarding their functions in the NBS implementation. Our findings highlight adaptable governance models across diverse stakeholder functions and confirm the NB S BMC as a robust framework for understanding NBS business models. These insights extend to land-use practices beyond NBSs, offering a template for innovative urban planning strategies.