National Institute Research Articles

Older Adults with Cancer and Common Comorbidities-Challenges and Opportunities in Improving Their Cancer Treatment Outcomes.

The older American population is rapidly increasing, and millions of older adults will be cancer survivors with comorbidities. This population faces specific challenges regarding treatment and has unique clinical needs. Recognizing this need, the National Cancer Institute (NCI), in collaboration with the National Institute on Aging (NIA), hosted a webinar series, entitled "Cancer, Aging, and Comorbidities." This commentary provides a reflection of five thematic areas covered by the webinar series, which was focused on improving cancer treatment for older adults with cancer and comorbidities: i) the impact of comorbidities on treatment tolerability and patient outcomes; ii) the impact of comorbidities on cancer clinical trial design; iii) the development of wearable devices in measuring comorbidities in cancer treatment; iv) the effects of nutrition and the microbiome on cancer therapy and; v) the role of senescence and senotherapy in age-related diseases. While advances have been made in these areas, many gaps and challenges exist and are discussed in this commentary. To improve cancer survivorship in older populations with comorbidities, aging and comorbidities must be jointly considered and incorporated across the spectrum of cancer research. This includes more basic research of the mechanisms linking comorbidities and cancer development and treatment response, building critical resources and infrastructure (eg, preclinical models and patient samples), conducting clinical trials focused on the older population, integrating geriatric assessment into cancer treatment, and incorporating novel technologies, such as wearable devices into clinical trials and cancer care.

The role of the Alzheimer's Disease Neuroimaging Initiative in establishing the Dominantly Inherited Alzheimer Network.

The Dominantly Inherited Alzheimer Network (DIAN) initially was funded by the National Institute on Aging (NIA) in 2008 and thus was able to adopt and incorporate the protocols developed by the Alzheimer's Disease Neuroimaging Initiative (ADNI) that had been established by the NIA in 2004. The use of ADNI protocols for DIAN neuroimaging studies and assays of biological fluids for Alzheimer disease (AD) biomarkers permitted examination of the hypothesis that autosomal dominant AD (ADAD), studied by DIAN, and "sporadic" late-onset AD (LOAD), studied by ADNI, shared the same pathobiological construct. In a collaborative effort, the longitudinal DIAN and ADNI databases were compared and the findings supported the conclusion that ADAD and LOAD share a similar pathophysiology. The importance of the DIAN study thus is amplified by its relevance to LOAD, as characterized by the "parent" ADNI program.

Isolamento e sensibilidade antimicrobiana de Staphylococcus sp. e Escherichia coli de peixe-boi-da-amazônia (Trichechus inunguis) em cativeiro

ABSTRACT: The Amazonian manatee (Trichechusinunguis) is an aquatic mammal threatened with extinction. However, few studies have investigated the pathogens in this species, which may affect both animal and human health. This study aimed to evaluate the frequency, distribution, and patterns of antimicrobial susceptibility of Staphylococcus spp. and Escherichiacoli colonizing the nasal and rectal cavities of Amazonian manatees kept in captivity at the National Institute for Amazonian Research (INPA) in the state of Amazonas, Brazil. Rectal and nasal swabs from 44 manatees of different ages were used in this study. The genus Staphylococcus was isolated from the nasal swabs of 32 (72.7%) animals, with two individuals harboring more than one species of Staphylococcus. S. sciuri was the most commonly isolated species. Resistance to penicillin was observed in 13 (40.6%) isolates, more frequent than the other antimicrobials tested (P = 0.01). E. coli was isolated from the rectal swabs of all animals, with phylogroup B1 being the most frequent among the strains obtained (P = 0.0008). Four isolates (6.8%) were positive for virulence factors, three of which were classified as enterotoxigenicE. coli (ETEC) and one as enteropathogenicE. coli (EPEC). To our knowledge, this is the first study to evaluate Staphylococcus spp. and E. coli in Amazonian manatee samples. This study revealed nasal colonization by Staphylococcus spp., mainly S. sciuri, and diarrheagenicE. coli isolates, including antimicrobial-resistant strains.

Clinical Applicability of Autologous Chondrocyte Implantation for the Treatment of Osteochondral Defects: A Meta-analysis.

Osteoarthritis and other joint disorders are the leading cause of disability in the elderly and the treatment of joint lesions is challenging. Autologous chondrocyte implantation (ACI) has been reported with variable effects for the treatment of osteochondral and other joint lesions. In this study, we performed a meta-analysis of the recent literature to determine the clinical applicability of ACI for osteochondral defects. A meta-analysis was performed on the recent literature showing the effects of ACI on osteochondral defects. The PUBMED, ScienceDirect and Google Scholar databases were used to identify eligible studies from Jan 2010 to Sep 2022. Both fixed and random models of meta-analysis were applied with all reported scoring systems to quantify the effectiveness of ACI on osteochondral defects. The pool data of 965 patients as a case series after ACI from a fixed model showed a significant improvement in the osteochondral defects (odds ratio = 8.75, 95%CI = 7.127 to 10.743, p = 0.000). These results were further verified by a random model of meta-analysis. The data also showed a substantial heterogeneity among the studies used in the meta-analysis (Q-value = 160.41, I-squared = 87.53, p = 0.000). Furthermore, this meta-analysis also compared different ACI procedures with different scoring systems but the overall outcome remains the same as ACI was found to be useful for the healing of the osteochondral defects. This meta-analysis of 965 case series revealed that the ACI markedly improved the damage osteochondral defects scores but the optimal treatment is still controversial, therefore further studies are needed to validate these findings in a clinical setting.

Faecal immunochemical testing (FIT) in primary care: a follow-up service evaluation

AimColorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute for Health and Care Excellence guidance for faecal immunochemical testing (FIT), we introduced a service...

Endovascular therapy in patients with internal carotid artery occlusion and patent circle of Willis

BackgroundOcclusion of the internal carotid artery (ICA) may extend into the middle or anterior cerebral artery (ICA-T) or be confined to the intracranial (ICA-I) or extracranial segment (ICA-E). While there...

Atrial fibrillation is associated with higher first pass effect following thrombectomy for large vessel occlusion

BackgroundFirst pass effect (FPE), defined as single-pass complete or near complete reperfusion during endovascular thrombectomy (EVT) for large vessel occlusion (LVO) strokes, is a critical performance metric. Atrial fibrillation (AF)-related...

Incidence and predictors of futile recanalisation after endovascular therapy in acute vertebrobasilar artery occlusion patients: insight from the ANGEL-ACT registry

ObjectivesTo identify the occurrence rate and predictors of futile recanalisation after endovascular therapy (EVT) for acute vertebrobasilar artery occlusion (VBAO).MethodsParticipants of the Endovascular Treatment Key Technique and Emergency Workflow Improvement...

Is intraprocedural intravenous aspirin safe for patients who require emergent extracranial stenting during mechanical thrombectomy?

BackgroundIntraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy (MT). Most patients undergoing MT are also given thrombolysis. Antiplatelet agents are contraindicated within 24 hours of thrombolysis. We...

COmbination of Targeted temperature management and Thrombectomy after acute Ischemic Stroke (COTTIS): a pilot study

BackgroundTo evaluate the feasibility and safety of a fast initiation of cooling to a target temperature of 35°C by means of transnasal cooling in patients with anterior circulation large vessel...

Technology Prospection of Ora-pro-Nóbis (Pereskia aculeata Mill.): A Non-conventional Food Plant.

The ora-pro-nóbis (Pereskia aculeata Mill.) is a plant from Brazilian biodiversity used for food and medicinal purposes. It has ample technological potential, however, it is still underutilized, being classified as a Non-Conventional Food Plant (PANC). Prospective studies in intellectual property banks make it possible to expand perspectives for scientific research, enhancing the generation of new products. Evaluate the patents of products containing Pereskia aculeata Mill. for the areas of food and health in intellectual property databases. The study was conducted through structured prospective investigation (collection, processing and analysis) in 4 patent databases: National Institute of Intellectual Property (INPI) - Brazil, United States Patent and Trademark Office, World Trade Organization Intellectual Property (WIPO) and Espacenet. The evaluation showed a reduced number of registered patents. In general, 8 patent applications were examined, of which 7 are directly associated with the species (and its derivatives) and 1 is related to a device specially designed for harvesting leaves/fruits and removing thorns. The focus of the patents was the use of the species in the food, pharmaceutical and biotechnological areas, with emphasis on the use of the leaves in the extraction of mucilage and proteins. This study showed that Pereskia aculeata Mill. is a technologically promising plant, because of its nutritional and medicinal composition, and it is important to encourage innovation and the development of new products with the species.

Matched-pair analysis of patients with ischemic stroke undergoing thrombectomy using next-generation balloon guide catheters

BackgroundBalloon guide catheters (BGCs) have not been widely adopted, possibly due to the incompatibility of past-generation BGCs with large-bore intermediate catheters. The next-generation BGC is compatible with large-bore catheters. We...

Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia.

Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care. This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia. The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed. The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group. HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.

Sociological analysis of military education in Kazakhstan

Relevance. High-quality military education, which guarantees the creation of effective armed forces capable of repelling threats to national security, is one of the main factors in determining the strength and influence of a state in the international arena. Purpose. The purpose of the study was to determine the features and specifics of military education in Kazakhstan by studying the activities of military educational institutions and departments in large cities of the country. Methodology. The study used system-analytical method, with the help of which it became possible to consider the basic characteristics of the military education system in Kazakhstan; and the historical method, facilitating the analysis of the process of training in military specialities over time. Results. The determining factors and prerequisites for the formation and development of the independent armed forces of the Republics of Kazakhstan were identified and the state's military education system was characterized at all levels, from school to postgraduate education and advanced training courses. Key points in the processes of transformation of state military education were identified, in particular regarding the reorganization of a number of higher military institutions and the creation of a state higher educational institution � National University of Defence of the First President of the Republic of Kazakhstan � Elbasy. The effectiveness of the military sector was measured using qualitative and quantitative indicators. Additionally, the main military specialities and faculties offered in higher educational institutions in major cities were listed. Conclusions. This study covered the main directions, issues, tasks, and methods of the educational process in Kazakh military universities. It also examined the development of military education in Turkey and Russia, identifying key factors affecting their educational systems. The findings and conclusions can serve as a practical foundation for enhancing national programs to train military specialists in Kazakhstan and other countries. Keywords: army training; higher education institutions; specialized departments; military science; national security

Sociological analysis of military education in Kazakhstan

Relevance. High-quality military education, which guarantees the creation of effective armed forces capable of repelling threats to national security, is one of the main factors in determining the strength and influence of a state in the international arena. Purpose. The purpose of the study was to determine the features and specifics of military education in Kazakhstan by studying the activities of military educational institutions and departments in large cities of the country. Methodology. The study used system-analytical method, with the help of which it became possible to consider the basic characteristics of the military education system in Kazakhstan; and the historical method, facilitating the analysis of the process of training in military specialities over time. Results. The determining factors and prerequisites for the formation and development of the independent armed forces of the Republics of Kazakhstan were identified and the state's military education system was characterized at all levels, from school to postgraduate education and advanced training courses. Key points in the processes of transformation of state military education were identified, in particular regarding the reorganization of a number of higher military institutions and the creation of a state higher educational institution � National University of Defence of the First President of the Republic of Kazakhstan � Elbasy. The effectiveness of the military sector was measured using qualitative and quantitative indicators. Additionally, the main military specialities and faculties offered in higher educational institutions in major cities were listed. Conclusions. This study covered the main directions, issues, tasks, and methods of the educational process in Kazakh military universities. It also examined the development of military education in Turkey and Russia, identifying key factors affecting their educational systems. The findings and conclusions can serve as a practical foundation for enhancing national programs to train military specialists in Kazakhstan and other countries. Keywords: army training; higher education institutions; specialized departments; military science; national security

The Dynamic Genome at Altitude: Mitochondrial DNA Copy Numbers in Acute and Chronic Hypoxia

Mitochondria contain a tiny circular DNA (mtDNA) that encodes components of the electron transport chain, including Complex IV, where over 95% of oxygen is consumed in the process of generating energy. Each mitochondrion contains tens to hundreds of copies of mtDNA, which decrease with aging and disease, but little is known regarding how mtDNA levels change in response to hypoxia. Here we compare samples with different durations and magnitudes of exposure to high-altitude hypoxia: Ethiopian Amhara with >5000 years exposure and the potential for evolved adaptations, Ethiopian Oromo with ~500 years of generations of lifelong acclimatization, and acutely exposed European trekkers with 15 days of abrupt individual acclimatization followed by descent to baseline. Lowland natives of the same ethnicities provide unstressed reference samples. Our previous studies found that Amhara adapted to hypoxia through increased blood flow due to nitric oxide-mediated vasodilation, while Oromo have increased carrying capacity through elevated hemoglobin concentration. We measured mtDNA copy numbers relative to nuclear DNA (mtDNA-CN) in 326 healthy adults: 52 low-altitude Amhara at 1200 m, 113 high-altitude Amhara at 3700 m; 47 low-altitude Oromo at 1700 m, and 105 high-altitude Oromo at 4000 m; and 9 European lowlanders at a baseline of 1300 m, after ascent to 5050 m, and upon return to 1300 m. High-altitude Amhara had 21% higher median mtDNA-CN than their low-altitude counterparts (median (IQR): high-altitude, 363.0 (281.0–427.0); low-altitude, 299.0 (246.1–333.2); p<0.0001), while high-altitude Oromo had 17% lower mtDNA-CN than their low-altitude counterparts (high-altitude, 236.7 (165.2–315.6); low-altitude, 283.7 (216.9–335.6); p=0.01). High-altitude Amhara had significantly higher median mtDNA-CN than high-altitude Oromo (p<.0001). European lowlanders had 44% lower mtDNA-CN after an 13-day ascent to 5050 m (1300 m, 322.5 (262.8–356.4); 5050 m 180.9 (145.1–230.5); p=0.002) that returned to baseline (319.5 (247.3–267.6); p=0.5) after a 6-day descent to 1300 m. These findings further confirm variation in acute and chronic responses to hypoxia, within and across populations. These findings require validation and expansion to address the mechanisms connecting expression of mtDNA copy numbers to oxygen-requiring bioenergetics. This work is supported by the National Heart, Lung, and Blood Institute HL060917 and National Science Foundation BCS-0452326. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Barthel Index, SPAN-100, and NIHSS Studies on the Predictive Value of Prognosis in Patients With Thrombolysis.

We mainly explore the predictive value of Barthel Index (BI), SPAN-100, and National Institute of Health stroke scale (NIHSS) scores on clinical prognosis and functional outcomes in thrombolytic patients and compare the differences in the predictive values of the above 3 scales so as to provide an effective basis to evaluate the prognosis of thrombolytic patients. Data were collected from 212 patients with the first-onset AIS (acute ischemic stroke). The enrolled patients were treated with recombinant tissue plasminogen activator thrombolytic therapy and were divided into 2 groups according to the modified Rankin Scale (mRS) score at discharge: the prognosis group (mRS≤2 points) and the poor prognosis group (mRS≥3 points). Logistic multivariate analysis was used to analyze the predictors of poor prognosis in patients with thrombolysis. MedCalc software was used to plot receiver operating characteristic (ROC) curves, calculate the area under the ROC curve (AUC), and compare the prediction performance of the 3 scales by the Delong and colleagues' method, and the difference of P <0.05 was statistically significant. Logistic binary regression multivariate analysis suggested that BI was a predictor of poor prognosis for thrombolytic therapy in patients with AIS. The lower the BI score, the poorer the prognosis. The AUC for BI score was 0.862, 95% CI (0.808-0.906), NIHSS score AUC was 0.665, 95% CI (0.597-0.728), and SPAN-100 score AUC was 0.640, 95% CI (0.572-0.705). AUC comparison of 3 scoring ROC curves suggested statistically significant differences between BI and NIHSS ( PC =0.0000), BI and SPAN-100 ( PC =0.0000); no significant difference was observed between SPAN-100 and NIHSS ( PC =1.7997). Simple BI scores have a high prognostic value for thrombolytic therapy in AIS.

Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines.

Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

Predictors of good functional outcome in ischaemic stroke patients without delayed neurological improvement after mechanical thrombectomy.

This study aimed to identify predictors of 90-day good functional outcome (GFO) in patients with acute ischaemic stroke (AIS) who were treated with mechanical thrombectomy but did not achieve a delayed neurological improvement (DNI). In-hospital neurological improvement in patients with AIS is consistently associated with long- -term GFO. Patients who experience neither early nor delayed neurological improvement can still achieve long-term GFO, but predictors of such an outcome have not been studied. This single-centre retrospective study involved 307 patients with anterior circulation AIS treated with mechanical thrombectomy. Multiple clinical, biochemical, radiological, and treatment-related variables were collected and analysed. DNI on day 7 was defined as at least a 10-point reduction in the National Institutes of Health Stroke Scale (NIHSS) score or NIHSS score < 2. GFO on day 90 was defined as a modified Rankin Scale (mRS) score ≤ 2. We compared the characteristics of patients with and without DNI, with special attention paid to patients who achieved 90-GFO despite a lack of DNI. Multivariate analyses were then performed to establish independent predictors of 90-day GFO among patients without DNI. DNI occurred in 150 out of 307 patients (48.7%) and significantly increased the odds for 90-day GFO (odds ratio [OR]: 13.99; p < 0.001). Among patients without DNI, 41.4% achieved 90-day GFO. Younger age (OR: 0.96; 95% confidence interval [CI]: 0.93-0.99; p = 0.008), lower baseline NIHSS score (OR: 0.80; 95% CI: 0.73-0.89; p < 0.001), treatment with intravenous thrombolysis (OR: 3.06; 95% CI: 1.25-7.49; p = 0.014), lack of an undetermined aetiology (OR: 0.40; 95% CI: 0.16-0.998; p = 0.050), lack of pneumonia (OR: 0.08; 95% CI: 0.02-0.31; p < 0.001), and higher haemoglobin concentration on admission (OR: 1.31; 95% CI: 1.04-1.69; p = 0.024) were identified as predictors of 90-day GFO in this subgroup. Almost half of patients with AIS in anterior circulation treated with mechanical thrombectomy experience DNI, which is a good predictor of 90-day GFO. Furthermore, 40% of patients without DNI achieve 90-day GFO which can be independently predicted by younger age, lower baseline NIHSS score, treatment with intravenous thrombolysis, higher haemoglobin concentration on admission, lack of undetermined ischaemic stroke aetiology, and lack of pneumonia.

A Longitudinal Investigation of Lower-Risk Gambling Limits in the Canadian National Study.

Recent years have seen increased attention given to identifying and describing the levels of gambling participation that confer a risk of harm in order to generate public health advice regarding lower-risk gambling. However, most of the existing literature has failed to explicitly assess these limits in a prospective manner. The purpose of this study is to employ a methodology consistent with prior investigations to evaluate the level of gambling participation associated with an increased risk of future gambling-related harm. Using data from the Alberta Gambling Research Institute's National Project Online Panel Survey, risk ratios and Receiver Operating Characteristic (ROC) analyses were used to determine the relative risk of gambling-related harm associated with participating in a greater number of gambling formats, gambling more days per month, and spending a greater proportion of income gambling. Prospective lower-risk limits were largely consistent with those identified in previous cross-sectional analyses (e.g., no more than two gambling formats, no more than once a week), with the exception that higher limits were found for the percent of household income spent gambling (3.4-6.4% vs. 1%). We advise that future research on lower-risk gambling limits consider the use of more granular assessment instruments and prospective methods to more closely evaluate the association between gambling participation and gambling harm.