Prevention Strategies Research Articles

Evolution of myeloproliferative neoplasms from normal blood stem cells.

Over the course of the last decade, genomic studies in the context of normal human hematopoiesis have provided new insights into the early pathogenesis of myeloproliferative neoplasms (MPN). A preclinical phase of MPN, termed clonal hematopoiesis (CH) was identified and subsequent lineage tracing studies revealed a multi-decade long time interval from acquisition of an MPN phenotypic driver mutation in a hematopoietic stem cell (HSC) to the development of overt MPN. Multiple germline variants associated with MPN risk have been identified through genome-wide association studies (GWAS) and in some cases functional interrogation of the impact of the variant has uncovered new insights into HSC biology and MPN development. Increasingly sophisticated methods to study clonal contributions to human hematopoiesis and measure HSC fitness have helped discern the biology underlying the tremendous clinical heterogeneity observed in MPN. Despite these advances, significant knowledge gaps remain particularly with respect to germline genetic contributors to both MPN pathogenesis and phenotypic diversity, as well as limitations in the ability to prospectively quantify rates of clonal expansion in individual MPN patients. Ultimately, we envisage a personalized approach to MPN care in the future, where an individualized genetic assessment can predict MPN trajectory and this information will be used to inform and guide therapy. MPN is particularly amenable to precision medicine strategies and our increased understanding of the evolution of MPN from normal blood stem cells provides a unique opportunity for early therapeutic intervention approaches and potentially MPN prevention strategies.

Suicide in mental health patients in the UK between 2005 and 2021: study of methods and clinical characteristics to inform prevention.

Tackling methods of suicide and limiting access to lethal means remain priority areas of suicide prevention strategies. Although mental health services are a key setting for suicide prevention, no recent studies have explored methods used by mental health patients. To investigate associations between main suicide methods and social, behavioural and clinical characteristics in patients with mental illness to inform prevention and improve patient safety. Data were collected as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. We examined the main suicide methods of 26 766 patients in the UK who died within 12 months of contact with mental health services during 2005-2021. Associations between suicide methods and patient characteristics were investigated using chi-square tests and univariate and multivariate logistic regression. Suicide methods were associated with particular patient characteristics: hanging was associated with a short illness history, recent self-harm and depression; self-poisoning with substance misuse, personality disorder and previous self-harm; and both jumping and drowning with ethnic minority groups, schizophrenia and in-patient status. A method-specific focus may contribute to suicide prevention in clinical settings. Hanging deaths outside of wards may be difficult to prevent but our study suggests patients with recent self-harm or in the early stages of their illness may be more at risk. Patients with complex clinical histories at risk of suicide by self-poisoning may benefit from integrated treatment with substance use services. Environmental control initiatives are likely to be most effective for those at risk of jumping or drowning.

Cardiovascular Disease in Patients with Chronic Kidney Disease: Current Understanding, Preventative Strategies, and Future Directions.

Chronic kidney disease (CKD) presents a significant burden on global health, with cardiovascular disease (CVD) being a leading cause of mortality in this population. Despite advancements in pharmacotherapies, preventing CVD in CKD patients remains challenging due to the intricate interplay of traditional risk factors and novel pathophysiological processes. This review aims to elucidate the current understanding of CVD prevention in CKD, encompassing epidemiology, risk factors, diagnostic considerations, and pharmacological therapeutic strategies. CKD patients exhibit a unique cardiovascular risk profile characterized by traditional risk factors such as hypertension and dyslipidemia, as well as CKD-specific factors including albuminuria, vascular calcification, and valvulopathies. The utility of coronary artery calcium scoring in risk stratification and the efficacy of aspirin, lipid-lowering agents, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and nonsteroidal mineralocorticoid receptor antagonists in CVD prevention are discussed. Despite promising findings, challenges such as lack of specific guidelines and data gaps persist, highlighting the need for multidisciplinary efforts to address the CVD burden in the CKD population effectively. Further research is warranted to optimize preventative strategies and improve outcomes in this high-risk population.

Global, Regional, and National Burden of Nasopharyngeal Carcinoma from 1990 to 2021.

This study analyzes nasopharyngeal carcinoma (NPC) from 1990 to 2021 across 204 countries, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs). It examines gender disparities, regional variations, age dynamics, and temporal trends to provide insights for health policy and resource allocation. We used the Global Burden of Disease (GBD) approach to assess NPC's health burden, including incidence, prevalence, mortality, and DALYs. Trends from 1990 to 2021 were illustrated using estimated annual percent change (EAPC). Subgroup analysis revealed variations by gender, age, Socio-Demographic Index (SDI), GBD classification, and country. Age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models predicted future trends. In 2021, there were 118,878 new NPC cases globally (1.38 per 100,000), with a prevalence of 525,219 cases (6.14 per 100,000), 75,359 deaths (0.87 per 100,000), and 249,019 DALYs (28.91 per 100,000). Males had higher rates across all metrics. Incidence peaked at ages 50-54, mortality at 70-74, and DALYs at 50-54. High SDI regions, especially East and Southeast Asia, showed higher burdens. Despite decreasing age-standardized incidence rates, absolute cases are rising, necessitating improved prevention and treatment strategies. NPC prevalence has increased due to better diagnosis and aging populations, despite decreasing age-adjusted incidence rates. Lower mortality rates indicate improved treatment. Males, especially in East and Southeast Asia, bear a higher NPC burden. These findings highlight the need for targeted interventions and tailored public health policies in high-risk regions. III Laryngoscope, 2024.

Asthma and sleep disordered breathing in the pediatric adenotonsillectomy trial for snoring study.

Although asthma is common in children with sleep-disordered breathing (SDB), it is unclear whether and to what extent asthma is associated with SDB-related outcomes. Our objectives are to describe risk factors for asthma among children with mild SDB (mSDB) and assess the association between asthma and the severity of sleep-related outcomes. Cross-sectional analyses were conducted for children aged 3-12.9years with mSDB enrolled in Pediatric Adenotonsillectomy for Snoring Children Study. Sleep-related outcomes included SDB symptoms (Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder scale(PSQ-SRBD)), SDB-specific quality of life (OSA-18), sleepiness (modified Epworth Sleepiness Score) and polysomnographic and actigraphic measures. Asthma was defined by caregiver-reported diagnosis with current asthma symptoms and medication use, or a Composite Asthma Severity Index (CASI) score ≥ 4. Asthma was further categorized into mild (CASI < 4) and moderate-to-severe (CASI ≥ 4). Regression analyses were conducted to identify asthma risk factors and estimate the associations between mild and moderate-to-severe asthma with sleep-related outcomes. The sample included 425 children (20.3%-Black,17.4%-Hispanic;51.7%-female). The prevalence of asthma was 19.1% (7.1% moderate-to-severe, 12.0% mild). Environmental tobacco smoke exposure and markers of atopy were associated with asthma in multivariable-adjusted analyses. Moderate-to-severe asthma was associated with increased OSA symptoms measured by PSQ-SRBD (adjusted effect estimate for moderate-to-severe vs. no asthma ( adj; 95%CI):0.08;0.01,0.15)) and decreased quality of life measured by OSA-18 ( adj;95%CI:7.5;1.20,13.82)), and a small increase in the arousal index ( adj;95%CI:0.80;0.09,1.51)). Moderate-to-severe asthma was associated with worse QoL and greaterSDB symptoms among children with mSDB. The co-occurrence of common risk factors for mSDB and asthma and worse symptoms and quality of life in children with both conditions support coordinated strategies for prevention and co-management of both disorders. Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040, https://clinicaltrials.gov/study/NCT02562040.

The effect of micro-movement on prevention of intraoperative acquired pressure injury in overweight patients undergoing posterior lumbar surgery: a randomized controlled trial

BackgroundIn posterior lumbar surgery, overweight patients are more prone to intraoperative acquired pressure injury (IAPI) due to bleeding, longer operative time, and increased pressure. The current prevention strategies have limited effects.MethodsThis was a single-blind, prospective, randomized controlled trial conducted from April 2023 to September 2024. Eligible participants were overweight patients (BMI ≥ 24 kg/m²) scheduled for lumbar posterior surgery under general anesthesia. Patients were randomly assigned to two groups: the micro-movement group and the silicone foam dressing group. The micro-movement group had regular adjustments to the operating table to change the patient’s position and alleviate pressure. The silicone foam dressing group used standard foam dressings at pressure points.ResultsA total of 277 patients were included in the analysis (137 in the micromovement group and 140 in the silicone foam dressing group). Compared with the silicone foam dressing group (8.6%), the incidence of IAPI in the micromovement group was significantly reduced (2.9%) (P < 0.05). There were no significant differences between the two groups in terms of IAPI stage, duration, or location (P > 0.05).ConclusionThe micromovement protocol is a safe and effective method for preventing IAPI in overweight patients undergoing posterior lumbar surgery. This simple intervention could significantly improve patient outcomes and reduce healthcare costs associated with IAPI.

Understanding preoperative health-related quality of life in rotator cuff tear patients: role of patients’ characteristics

BackgroundAssessing health-related quality of life (HRQoL) is a widely employed method in orthopedics to evaluate patient well-being and measure the effectiveness of surgical interventions. Understanding the relationship between specific baseline factors and preoperative HRQoL can help clinicians identify patients at risk for low quality of life and thus, develop preventive strategies that adequately address individual patient needs. The objective was to assess associations between baseline factors and preoperative HRQoL in patients undergoing arthroscopic rotator cuff repair (ARCR).MethodsThis study is part of a multicenter prospective Swiss cohort study that included patients undergoing ARCR between June 2020 and November 2021. Data were derived from baseline and surgery forms. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level (EQ-5D-5L) questionnaire to calculate EQ-5D index and EQ VAS scores. Univariable and multivariable linear regression models examined associations between the 21 factors and preoperative HRQoL. Final models were determined using stepwise backward regression.ResultsA total of 973 included patients (mean age [SD], 57.3 [9.4] years; 611 men [63%]) had a mean [SD] EQ-5D index and EQ VAS of 0.70 [0.23] and 68.7 [19.8], respectively. Being male (regression coefficient (β), 0.05; 95% CI [0.02–0.08]), having a higher age (β, 0.02; 95% CI [0.01–0.03]) and higher education levels (e.g., university, college: β, 0.11; 95% CI [0.06–0.16]) were associated with a higher EQ-5D index. Increased body mass index (β, -0.02; 95% CI [-0.04 to -0.01]) and worse sleep quality (β, -0.03; 95% CI [-0.04 to -0.03]) were associated with a lower EQ-5D index. Factors negatively associated with overall EQ VAS health were depression (e.g., moderate: β, -12.70; 95% CI [-16.18 to -9.21]), presence of at least one comorbidity (β, -3.71; 95% CI [-5.91 to -1.52]), and pain (β, -1.81; 95% CI [-2.36 to -1.26]).ConclusionOur results suggest that preoperative HRQoL is highly associated with sociodemographic and patient-related factors. Specifically addressing these factors may improve orthopedic care.

Advances of the exposome at individual levels and prevention in atopic dermatitis.

Atopic dermatitis (AD), or eczema, is an inflammatory skin disease related to environmental factors. As a heterogeneous disease, it presents with complex phenotypes and endotypes. A variety of intrinsic and extrinsic factors can promote the development of AD. While there has been extensive discussion on environmental exposure at the population and community levels, discourse on exposome at individual levels in AD remains insufficient. For example, allergens, microorganisms, parasites, dietary factors, and psychological factors such as stress and anxiety play important roles in AD development. Microorganisms, in particular, exhibit altered composition and diversity on the skin of AD patients, influencing skin barrier integrity and immune responses. The impact of certain microorganisms, such as fungi and viruses, on AD has garnered increasing attention because of their important role in maintaining skin homeostasis. Dietary factors, including sugar intake and histamine-rich foods, may modulate AD risk and severity, although findings are controversial. Allergens, particularly house dust mite allergens, and aeroallergens, exacerbate AD symptoms by promoting inflammation and barrier dysfunction. Since AD is often the first step in the atopic march, its primary prevention measures are crucial. Some preventive measures involving microorganisms, diet, and moisturizers remain controversial. Effective preventive strategies necessitate a clear understanding of the complex mechanisms of AD, especially host-microbe-environment interactions. This review summarizes recent advances in understanding various risk and protective factors, as well as primary prevention measures for AD.

FSTL1 protects against acute aortic dissection by suppressing vascular smooth muscle cell phenotypic switching and degradation of the extracellular matrix

Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency, which is closely related to the vascular smooth muscle cells (VSMCs) phenotypic switching and extracellular matrix (ECM) degradation. Previous studies have found that the secreted extracellular glycoprotein Follistatin-like 1 (FSTL1) is demonstrated as a protective factor for cardiovascular diseases. However, the role of FSTL1 in AAD remains elusive. We aimed to investigate whether FSTL1 could regulate VSMCs phenotypic switching and ECM degradation in AAD. Firstly, we found that FSTL1 expression in aorta was significantly decreased in human AAD examined by western blot and immunohistochemical staining. Then we established a mouse AAD model by administering β-aminopropionitrile (BAPN) dissolved in drinking water for 28 days. We found that FSTL1 expression in aorta was also decreased in mouse AAD. Exogenous supplement with recombinant human FSTL1 protein could rescue VSMCs phenotypic switching and ECM degradation to reduce the occurrence and progression of mouse AAD. In vitro, FSTL1 protein and adenovirus overexpressing FSTL1 (ad-FSTL1) reversed the primary VSMCs phenotypic switching and decreased the expression of MMP2 induced by PDGF-BB. Knocking down FSTL1 initiates VSMCs phenotypic switching and increases the expression of MMP2. In terms of mechanisms, AMPK phosphorylation was decreased and could be improved by FSTL1 protein in mouse AAD. FSTL1 protein and ad-FSTL1 reversed the decreased AMPK phosphorylation induced by PDGF-BB in primary VSMCs. These findings indicate that FSTL1 protects against VSMCs phenotypic switching and ECM degradation in AAD, and targeting FSTL1 may be a potential new strategy for prevention and treatment of AAD.

Hotspot mapping of pest introductions in the EU: A regional analysis of environmental, anthropogenic and spatial effects

Plant pests may pose a significant threat to global agriculture, natural ecosystems and biodiversity, causing severe ecological and economic damage. Identifying regions more susceptible to pest introductions is crucial for developing effective prevention, early detection and outbreak response strategies. While historical data on pest introductions in the European Union (EU) exist, they are typically reported at the regional level. This broad aggregation has posed a challenge for accurate analysis in plant health research. This study addresses this gap by leveraging existing regional data to identify hotspots of pest introductions within the EU and the UK, through a Bayesian hierarchical spatial model. Specifically, we employed the Besag, York, and Mollié (BYM) model to identify higher risk regions (NUTS2) by incorporating covariates and spatial effects to consider information from neighbouring areas. The results showed a positive effect of annual average temperature, annual average precipitation, and human population density on the risk of pest introduction, highlighting the relevance of the spatial component. Our analysis pinpoints high-risk regions in southern Europe, particularly northern Italy. Additionally, the high human population density and documented pest introductions in the Netherlands contributed to its elevated risk. While limitations exist due to the regional nature of the data, this study represents a methodological advancement, demonstrating the effectiveness of spatial models and offering a robust framework for future studies using regional data. It also provides insights that can inform targeted prevention, early detection and preparedness strategies, ultimately contributing to safeguarding agriculture, natural ecosystems and biodiversity in the EU and UK.

Acceptability of a self-help programme to address the use of indecent images of children

The use of indecent images of children (IIOC) is of continued concern and growing prevalence. A multi-agency approach to this online crime is necessary, as it cannot be eradicated by law enforcement alone. Previous research has examined the pathways to offending for this population, and prevention strategies that could be used to deter offending in the first instance, or to stop behaviour once it has begun. The current qualitative study aimed to explore acceptability of a prevention initiative; a self-help focussed service (a website and calls with a professional). Semi-structured interviews with eight individuals who had accessed IIOC and engaged in this self-help focussed service were conducted. Transcripts were analysed using qualitative framework approach, using the Theoretical Framework of Acceptability (TFA) domains as deductive codes. All seven domains of the TFA were identified in the transcripts, indicating the applicability of the framework. Overall, participants reported mixed acceptability of and satisfaction with the self-help programme and calls with practitioners, but high perceived effectiveness in the service supporting them stop their illegal behaviours. The implications of the study are considered in line with improvements that could be made to this existing self-help prevention initiative.

Factors that influence the increase of type 2 Diabetes Mellitus in children and adolescents: a systematic review

Type 2 diabetes mellitus (T2DM) has shown a significant increase among children and adolescents in recent decades, especially due to factors such as sedentary lifestyle and obesity. The Covid-19 pandemic has intensified these factors, resulting in an alarming scenario for global public health. This article carries out a systematic review of the literature, with the aim of identifying the main factors that influence the increase in T2DM cases in this age group. The analysis includes studies that address aspects related to lifestyle, dietary practices, and the direct and indirect impacts of the pandemic on the development of the disease. It is concluded that public health promotion policies, combined with preventive strategies, are essential to combat the advancement of T2DM in young people, in addition to highlighting the importance of future research that can deepen knowledge about the management and prevention of the disease in pediatric populations.

Nonhuman primate models of pediatric viral diseases

Infectious diseases are the leading cause of death in infants and children under 5 years of age. In utero exposure to viruses can lead to spontaneous abortion, preterm birth, congenital abnormalities or other developmental defects, often resulting in lifelong health sequalae. The underlying biological mechanisms are difficult to study in humans due to ethical concerns and limited sample access. Nonhuman primates (NHP) are closely related to humans, and pregnancy and immune ontogeny in infants are very similar to humans. Therefore, NHP are a highly relevant model for understanding fetal and postnatal virus-host interactions and to define immune mechanisms associated with increased morbidity and mortality in infants. We will discuss NHP models of viruses causing congenital infections, respiratory diseases in early life, and HIV. Cytomegalovirus (CMV) remains the most common cause of congenital defects worldwide. Measles is a vaccine-preventable disease, yet measles cases are resurging. Zika is an example of an emerging arbovirus with devastating consequences for the developing fetus and the surviving infant. Among the respiratory viruses, we will discuss influenza and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We will finish with HIV as an example of a lifelong infection without a cure or vaccine. The review will highlight (i) the impact of viral infections on fetal and infant immune development, (ii) how differences in infant and adult immune responses to infection alter disease outcome, and emphasize the invaluable contribution of pediatric NHP infection models to the design of effective treatment and prevention strategies, including vaccines, for human infants.

External Ventricular Drain Misadministration Events: Systematic Literature Review and Report of a Case.

External ventricular drain (EVD) is a common neurosurgical procedure with potential complications, including catheter misplacement, infection, mechanical obstruction, and inadvertent catheter pull-out. A less discussed but critical complication is the misadministration of medications into EVD. This project aimed to review the literature on EVD misadministration and discuss preventative measures, emphasizing the new International Organization for Standardization (ISO) standard for neuraxial connectors. A systematic review of PubMed, Embase, and SCOPUS databases was conducted to identify studies reporting misadministration in EVD systems. We also present a case of misadministration of a blood product into an EVD. Factors contributing to these events were researched, relevant guidelines from professional organizations were reviewed, and preventive strategies, including the novel NRFit® connector designed to prevent such errors, were discussed. The literature review identified 7 reports of 8 cases of misadministration involving substances such as gadolinium-based contrast agents, anesthetic agents, and antiepileptic drugs. In addition, we report a case of an 87-year-old man with multiple traumatic brain injuries, where a blood transfusion line was mistakenly connected to the EVD. This incident is the first reported case of blood misadministration through EVD. Despite immediate drainage and flushing of the EVD system with saline, the patient's condition did not improve, and he eventually died. Contributing factors included unfamiliarity with the EVD system, similarity to IV connectors, and poor visibility during procedures. Importantly, the novel ISO 80369 standard for all neuraxial connectors, including NRFit® connectors that have a 20% smaller nozzle outside diameter than traditional Luer connectors, has been recommended to prevent misconnection errors and mitigate associated risks. Misadministration to EVD connectors is a preventable event that highlights the need for enhanced safety solutions. Adoption of ISO standard neuraxial connectors, thorough training, and the use of distinctly marked equipment are critical steps in minimizing risks.

Assessment of Suicidal Risk through Clinical Scales: A Comparative Analysis of Measurement Tools and Their Effectiveness in Psychiatric Practice

&lt;p dir="ltr"&gt;&lt;span&gt;Suicide risk assessment is one of the critical components of mental health care, necessitating accurate, reliable, and sensitive tools to identify at-risk individuals and guide interventions. This article provides a comprehensive analysis of various clinical scales used to assess suicidal risk, exploring their psychometric properties, target populations, and practical applications. Key scales discussed include BSS, C-SSRS, SBQ-R, and SS. &lt;/span&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;span&gt;The analysis highlights the importance of integrating these tools into clinical practice to enhance early detection and management of suicidal behaviors, particularly among high-risk groups such as individuals with depression, mood disorders, adolescents, and so on. &lt;/span&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;span&gt;The effective application of these assessment scales is crucial in improving mental health outcomes, emphasizing a multifaceted approach that includes mental health support, community engagement, and targeted interventions for high-risk groups. The article underscores the need for ongoing research and refinement of these tools to adapt to the evolving understanding of suicidal behavior and prevention strategies.&lt;/span&gt;&lt;/p&gt;&lt;div&gt;&lt;span&gt;&lt;br /&gt;&lt;/span&gt;&lt;/div&gt;

The role of DNA methylation in placental development and its implications for preeclampsia

Preeclampsia (PE) is a prevalent and multifaceted pregnancy disorder, characterized by high blood pressure, edema, proteinuria, and systemic organ dysfunction. It remains one of the leading causes of pregnancy complications, yet its exact origins and pathophysiological mechanisms are not fully understood. Currently, the only definitive treatment is delivery, often requiring preterm termination of pregnancy, which increases neonatal and maternal morbidity and mortality rates, particularly in severe cases. This highlights the urgent need for further research to elucidate its underlying mechanisms and develop targeted interventions. PE is thought to result from a combination of factors, including inflammatory cytokines, trophoblast dysfunction, and environmental influences, which may trigger epigenetic changes, particularly DNA methylation. The placenta, a vital organ for fetal and maternal exchange, plays a central role in the onset of PE. Increasing evidence suggests a strong association between DNA methylation, placental function, and the development of PE. This review focuses on the impact of DNA methylation on placental development and its contribution to PE pathophysiology. It aims to clarify the epigenetic processes essential for normal placental development and explore potential epigenetic biomarkers and therapeutic targets for PE. Such insights could lead to the development of novel preventive and therapeutic strategies for this condition.

C-reactive protein, genetic susceptibility, and the long-term risk of venous thromboembolism in patients with past cancer.

Several studies indicated that C-reactive protein (CRP) is associated with the risk of venous thromboembolism (VTE) in general population. But CRP appears to be unrelated to VTE events in newly diagnosed cancer patients. However, as the survival time of cancer patients increases, the effect of CRP on the long-term risk of VTE may change. We aimed to investigate the association between CRP and VTE in cancer survivors, and further assess the modification effect of genetic susceptibility. Cox proportional hazards model was used to evaluate the association between serum CRP levels and VTE risk, as well as to investigate the joint effect of CRP and genetic susceptibility. The Kaplan-Meier curve and the restricted cubic spline were used to visualize the relationship between CRP and VTE. This study included 30,145 participants with cancer diagnosis at baseline in the UK Biobank. Over a follow-up period of 344,636 person-years, a total of 1,151 VTE events were recorded. Participants were divided into four groups based on the quartiles of CRP levels. The adjusted hazard ratios (95% CIs) of Q1, Q2, Q3, and Q4 were 1.00, 1.20 (0.99-1.44), 1.25 (1.04-1.50), and 1.51 (1.25-1.82), respectively. For those with high genetic risk of VTE, high CRP had an additional increased risk for VTE. CRP can be used as a predictive biomarker for VTE risk in cancer survivors, especially for those with high genetic risk. Future research can explore whether prevention and treatment strategies for VTE can be developed based on CRP for cancer survivors.

Potential impacts and priority areas of research of the on-going invasion of green crabs along the SW Atlantic

The European green crab (Carcinus maenas) is one of the most extensively studied decapod species worldwide and it currently inhabits every continent except Antarctica. Its effects are observed across various spatio-temporal scales, impacting a wide range of taxa and environments. While extensive research has been conducted in the Northern Hemisphere, populations in the Southern Hemisphere (e.g., Argentina, Australia, and South Africa) have not been thoroughly investigated. This study has three main goals: 1) summarise and contextualise the invasion history of green crabs in the Southwest Atlantic since their initial detection in 2000, 2) present nine case studies identifying the potential ecological and economic impacts of green crabs on coastal ecosystems and to highlight priority research areas, and 3) discuss appropriate management actions in response to the species' rapid spread in the region. Our findings suggest that green crabs are likely to impact foundation species along rocky shores, alter the physical characteristics of soft-bottom environments, and affect infaunal organisms in sandy shores. Most of these impacts are either occurring or expected to occur in numerous marine protected areas. We also examine green crab interactions with other key species, highlighting its dual role as both an invasive predator and prey for native species, thus serving as a novel food resource. Furthermore, we consider their effects on commercially important species, tourism, and implications for threatened native species. Finally, we recommend prioritising prevention and rapid response strategies for managing green crab invasions, emphasising the importance of early detection and prompt action to address new incursions.

Cell-free supernatant of Lactobacillus gasseri 1A-TV shows a promising activity to eradicate carbapenem-resistant Klebsiella pneumoniae colonization.

The use of beneficial bacteria like Lactobacillus spp. is a potential innovative approach to fight antibiotic-resistant pathogens. Klebsiella pneumoniae is one of the most concerning multi drug-resistant (MDR) pathogens, and its ability to colonize the human gut is considered to be the main reason for recurrent infections in critically ill patients. In this study, Lactobacillus gasseri 1A-TV, already described for its probiotic activity, was characterized at the genomic level. Moreover, its cell-free supernatant (CFS) was tested for antimicrobial activity against extended-spectrum β-lactamase (ESBL)- and carbapenemase (KPC)-producing K. pneumoniae clinical isolates. Whole-genome sequencing showed that the L. gasseri 1A-TV genome was of 2,018,898 bp in size with 34.9% GC content, containing 1,937 putative protein coding sequences, 55 tRNA, and 4 rRNA detected by RAST and classified in 20 functional groups by Cluster of Orthologous Genes (COG). BAGEL4 (BActeriocin GEnome minimal tooL) and the antiSMASH 7.0 pipeline identified two bacteriocin biosynthetic gene clusters (BBGCs), namely, BBGC1 that comprises two class IIc bacteriocins including gassericin A-like bacteriocin, and BBGC2 carrying the class III bacteriocin helveticin J. Strikingly, 1A-TV CFS inhibited the growth of all K. pneumoniae isolates only after 8 h of incubation, showing a bactericidal effect at 24 h and interfering, even at lower concentrations, with the biofilm production of biofilm-producer strains independently of a bactericidal effect. NMR analysis of CFS identified and quantified several metabolites involved in carbohydrate metabolism and amino acid metabolism, and organic acids like ethanol, lactate, acetate, and succinate. Finally, in vitro assays of 1A-TV showed significant co-aggregation effects against carbapenem-resistant K. pneumoniae, namely, strains 1, 2, 3, and 7. Our findings highlight the antimicrobial activity of 1A-TV as a probiotic candidate or its CFS as a natural bioproduct active against MDR K. pneumoniae strains, underlining the importance of novel therapeutic strategies for prevention and control of ESBL- and carbapenemase-producing K. pneumoniae colonization.

Broken Drill Bits During Surgical Procedures: A Review of 156 Patient Safety Events

Background Broken surgical drill bits pose a risk to patient safety. A routine review of event reports submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) uncovered an increase in the number of event reports related to broken drill bits, prompting an exploration to better understand patterns of drill bit breakage in Pennsylvania. Methods We queried the PA-PSRS database to identify event reports describing a broken drill bit during surgery submitted between January 1, 2021, and December 31, 2023. Event reports were manually coded to identify the procedure, anatomic location of breakage in the patient’s body, timing of discovery, and fragment fate. Results A total of 156 relevant event reports were identified. The procedure being performed was determined in 64 of 156 event reports. Fracture repair procedures were most commonly reported to encounter a broken drill bit (27 of 64; 42.2%). We were able to determine the anatomic location in the patient’s body where the drill bit breakage occurred in 108 of 156 event reports. The most commonly reported anatomic location was the femur (27 of 108; 25.0%). We were able to determine the fate of the broken drill bit in 141 of 156 event reports, and most drill bits were retained in the patient (99 of 141; 70.2%). Conclusion This data analysis provides insight into broken drill bits in Pennsylvania facilities. Because drill bits are commonly broken pieces of equipment and the fragments from these broken pieces are frequently retained, it is important to prevent drill bit breakage to improve patient safety. Table 2 (251188) outlines prevention strategies established by equipment manufacturers and previous research. Implementing these strategies can address breakage across multiple procedures and patients. Plain Language Summary While a rare occurrence, surgical instruments may break during a procedure. In the case of drill bits, which are one of the most frequently broken surgical instruments, pieces that are left inside of a patient could cause harm, and may migrate to other parts of the body. When Patient Safety Authority researchers noted an increased number of events involving broken and retained drill bits during surgery, they analyzed data from the Pennsylvania Patient Safety Reporting System (PA-PSRS) to help decrease the risk of broken drill bits in surgery. In studying cases involving a drill bit breaking during surgery, researchers learned that most of these events occurred during fracture repair procedures and joint replacement surgery, and drill bits most frequently broke in the femur (thigh bone). In most event reports, the broken drill bit was discovered during the procedure, but in 2.6% of event reports (4 out of 156 reports) it was discovered after the operation. Removing drill bit fragments is recommended; however, surgeons may decide to leave them in place if removal risks damage to the surrounding area, and in many event reports broken drill bits were retained following the surgery with no further intervention. Hospitals and surgical facilities should look to existing literature and device manufacturers’ guidelines for prevention strategies, such as recommended surgical techniques; drill bit sterilization, reprocessing, and storage; and general safety measures, some of which are summarized in the article.