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Background: Obesity is a known risk factor for cholecystitis and is associated with technical complications during laparoscopic procedures. The present study seeks to assess the association between obesity class and conversion to open (CTO) during laparoscopic cholecystectomy (LC). Methods: Adult acute cholecystitis patients with obesity undergoing non-elective LC were identified in the 2017–2020 Nationwide Readmissions Database. Patients were stratified by obesity class; class 1 (Body Mass Index [BMI] = 30.0–34.9), class 2 (BMI = 35.0–39.9), and class 3 (BMI ≥ 40.0). Multivariable regression models were developed to assess factors associated with CTO and its association with perioperative complications and resource utilization. Results: Of 89,476 patients undergoing LC, 40.6 % had BMI ≥ 40.0. Before adjustment, class 3 obesity was associated with increased rates of CTO compared to class 1–2 (4.6 vs 3.8 %; p

Objective This study aims to evaluate the diagnostic value of human serum cysteine protease inhibitors (cystatin 4 [CST4]) in colorectal cancer (CRC) patients. Methods A total of 291 patients who were admitted to Zhuzhou Central Hospital for colonoscopy from January 2020 to December 2021 and met the inclusion criteria were selected. Serum samples of the patients were collected, and CST4 was detected by double-antibody sandwich enzyme-linked immunosorbent assay. Simultaneously, CEA and CA19-9 were detected, and the patients were divided into the CRC group, benign lesion group, and healthy control group. An attempt was made to construct a CRC prediction model including CST4 and draw a subject working characteristic curve as a diagnostic threshold for CRC prediction, and evaluate the diagnostic efficacy of the above indicators. At the same time, the expression analysis of CST4, CEA, and CA19-9 was verified by combining the data of CRC in the Tumor Genome Atlas (TCGA). Results In this study, the levels of serum CST4, CEA, and CA19-9 in the CRC group were higher than those in the colorectal benign lesion group and healthy control group, with statistical significance ( P

Chaperone-mediated autophagy (CMA) plays an important role in regulating a variety of cellular functions by selectively degrading damaged or functional proteins in the cytoplasm. One of the cellular processes in which CMA participates is the oxidative stress response. Oxidative stress regulates CMA activity, while CMA protects cells from oxidative damage by degrading oxidized proteins and preventing the accumulation of excessive reactive oxygen species (ROS). Changes in CMA activity have been found in many human diseases, and oxidative stress is also involved. Therefore, understanding the interaction mechanism of ROS and CMA will provide new targets for disease treatment. In this review, we discuss the role of CMA in combatting oxidative stress during the development of different conditions, such as aging, neurodegeneration, liver diseases, infections, pulmonary disorders, and cancers.

Drought is one of the common natural disasters with a wide range of occurrences in terms of space and time, and with varying levels of severity, that may result in economic damage and health issues to humans. This study focuses on assessing drought severity in the Central Highlands of Vietnam based on ground meteorological stations and multispectral remote sensing data. A Modification of the Normalized Difference Drought Index (MNDDI) was developed to enhance the effectiveness of remote sensing indices in the drought assessment. Results indicate that MNDDI outperforms Normalized Difference Drought Index and other investigated indicators, such as Normalized Difference Vegetation Index, Normalized Difference Latent Heat Index, and Normalized Difference Water Index, in representing the Earth's surface response to drought events. Correlations ranging from 0.85 to 0.63 were identified between MNDDI and various time scales of the commonly used meteorological drought indicator, namely the Standardized Precipitation Index, during the drought year of 2015. This work also reveals the superiority of MNDDI in portraying the response of land cover types to drought situations. The finding of a severe drought phenomenon in critical agricultural zones is highly consistent with the report from the Ministry of Agriculture and Rural Development of Vietnam. This study contributes valuable insights to the preliminary assessment of drought through remote sensing data, offering a foundation for precise drought outlooks and effective risk management strategies., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Atresia of the infrarenal inferior vena cava (IVC) is associated with thrombophilia and antithrombin (AT) deficiency (ATD) due to homozygosity for the so-called Budapest 3 variant, c.391C > T, in the gene, SERPINC1., Case Presentation: We report on a father and his two sons that had severe thrombosis at a young age. One son had absence of, and the other had very gracile infrarenal IVC. The father had gracile vena iliaca. All had significant collateral building. AT activity was determined with four different methods and varied between moderately reduced and borderline normal values, depending on the method. While all were heterozygous for c.391C > T, the father was also heterozygous for a variant of uncertain significance in SERPINC1., Conclusions: The findings support the association between c.391C > T in SERPINC1, thrombophilia, and atresia of the IVC system and indicate that even heterozygosity for c.391C > T may contribute to such anomalies. ATD detection was hampered by the varying sensitivity of methods used for AT activity measurement., (© 2024. The Author(s).)

We show that the dynamics of high-intensity laser pulses undergoing self-focused propagation in a nonlinear medium can be understood in terms of the topological constraints imposed by the formation and evolution of spatiotemporal optical vortices (STOVs). STOVs are born from pointlike phase defects on the sides of the pulse nucleated by spatiotemporal phase shear. These defects grow into closed loops of spatiotemporal vorticity that initially exclude the pulse propagation axis, but then reconnect to form a pair of toroidal vortex rings that wrap around it. STOVs constrain the intrapulse flow of electromagnetic energy, controlling the focusing-defocusing cycles and pulse splitting inherent to nonlinear pulse propagation. We illustrate this in two widely studied but very different regimes, relativistic self-focusing in plasma and nonrelativistic self-focusing in gas, demonstrating that STOVs mediate nonlinear propagation irrespective of the detailed physics.

We demonstrate loss-free generation of 3 mJ, 1 kHz, few-cycle (5 fs at 750 nm central wavelength) double pulses with a pulse peak separation from 10 to 100 fs, using a helium-filled hollow core fiber (HCF) and chirped mirror compressor. Crucial to our scheme are simulation-based modifications to the spectral phase and amplitude of the oscillator seed pulse to eliminate the deleterious effects of self-focusing and nonlinear phase pickup in the chirped pulse amplifier. The shortest pulse separations are enabled by tunable nonlinear pulse splitting in the HCF compressor.

Background: The immunogenicity, safety, and efficacy of recombinant factor VIII (rFVIII) have gained increasing interest after the introduction of extended half-life products with various modifications of the rFVIII molecule, such as covalent attachment of polyethylene glycol (PEG). Anti-PEG antibodies may be associated with a temporary reduction of FVIII recovery, but according to previous studies, they usually disappear after continuous dosing. Anti-PEG antibodies with an inhibitory capacity have never been demonstrated in patients treated with PEGylated rFVIII products., Objectives: To routinely switch from standard half-life to PEGylated extended half-life rFVIII products in patients with hemophilia A., Methods: From December 2022 until May 2023, 83 adults with hemophilia A attending Oslo Haemophilia Comprehensive Care Centre received a test dose with a PEGylated rFVIII product to switch treatment. Four patients presented with decreased recovery without the presence of an FVIII inhibitor. Accordingly, we performed a variant inhibitor test utilizing different rFVIII concentrates as a source of FVIII and enzyme-linked immunosorbent assay to search for anti-PEG antibodies., Results: We found inhibitory anti-PEG/anti-PEGylated rFVIII antibodies in 4 patients (5%), both persistent and transient, explaining the impaired recovery. The patients had neutralizing anti-PEG antibodies prior to the first dosing of PEGylated rFVIII. We demonstrated neutralizing antibodies (mainly immunoglobuline G) specific for PEG and all 3 commercially available PEGylated rFVIII products., Conclusion: The number of patients with inhibitory anti-PEG antibodies was significant, and the presence of inhibitors against PEGylated rFVIII emphasizes the importance of individual monitoring when switching FVIII concentrates to ensure safety and efficacy of the treatment., Competing Interests: Declaration of competing interests P.A.H. has received grants and research support to institutions from Bayer, Octapharma, Pfizer, Shire, and Sobi and consultation fees/lecture honoraria from Bayer, CSL, Novo Nordisk, Octapharma, Pfizer, Roche, Shire, and Sobi. G.E.T. has received research grants from Mundipharma and Alexion Pharmaceuticals, advisory board honoraria from Alexion Pharmaceuticals and Janssen-Cilag, and lecture honoraria from Novartis, Janssen-Cilag, Alexion Pharmaceuticals, and Mundipharma. A.H., E.P.W., M.S.L., C.E.H., and R.J.M. declare no competing financial interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The COVID-19 outbreak disproportionally affects vulnerable populations including people who inject drugs (PWID). Social distancing and stay-at-home orders might result in a lack of access to medical and social services, poorer mental health, and financial precariousness, and thus, increases in HIV and HCV risk behaviors. This article explores how the HIV/HCV risk behaviors of PWID in Haiphong, a city with high harm reduction service coverage in Vietnam, changed during the early phase of the COVID-19 pandemic, and what shaped such changes, using the risk environment framework., Method: We conducted three focus group discussions with peer outreach workers in May 2020 at the very end of the first lockdown, and 30 in-depth interviews with PWID between September and October 2020, after the second wave of infection in Vietnam. Discussions and interviews centered on the impact of the COVID-19 pandemic on their lives, and how their drug use and sexual behaviors changed as a result of the pandemic., Results: The national shutdown of nonessential businesses due to the COVID-19 epidemic caused substantial economic challenges to participants, who mostly were in a precarious financial situation before the start of the epidemic. Unsafe injection is no longer an issue among our sample of PWID in Haiphong thanks to a combination of different factors, including high awareness of injection-related HIV/HCV risk and the availability of methadone treatment. However, group methamphetamine use as a means to cope with the boredom and stress related to COVID-19 was common during the lockdown. Sharing of smoking equipment was a standard practice. Female sex workers, especially those who were active heroin users, suffered most from COVID-related financial pressure and may have engaged in unsafe sex., Conclusion: While unsafe drug injection might no longer be an issue, group methamphetamine use and unsafe sex were the two most worrisome HIV/HCV risk behaviors of PWID in Haiphong during the social distancing and lockdown periods. These elevated risks could continue beyond the enforced lockdown periods, given PWID in general, and PWID who are also sex workers in particular, have been disproportionately affected during the global crisis., (© 2022. The Author(s).)

Study Objective: To describe the opioid prescribing practices in opioid-naive women undergoing elective gynecologic surgery for benign indications and identify risk factors associated with increased perioperative opioid use. We also explored factors associated with new persistent opioid use in women with perioperative opioid use., Design: Retrospective, population-based cohort study., Setting: We used linked administrative data from a government-administered single-payer provincial healthcare system in Canada. This study was undertaken at ICES, a not-for-profit research institute in Ontario, Canada., Patients: We followed opioid-naive adult women who underwent benign elective gynecologic surgery between 2013 and 2018., Interventions: None., Measurements and Main Results: The primary outcome was perioperative opioid use defined as ≥1 opioid prescription from 30 days before to 14 days after surgery. New persistent opioid use after gynecologic surgery was defined as having filled 1 or more opioid prescriptions between 91 days and 180 days postoperatively. Multivariable log-linear regression analyses were employed to adjust for clinical and demographic data. Of the 132 506 patients included in our cohort, most (74.3%) underwent minor gynecologic procedures. Perioperative opioid use was documented in 27 763 (21.0%) patients, and there was a significant decreasing trend (p <.001) in the proportion of patients with perioperative opioid use from 21.8% in 2013 to 18.5% in 2018. Factors associated with increased perioperative opioid use included younger age; higher income quintile; urban dwellers; and diagnosis of infertility, endometriosis, or adnexal mass. Perioperative opioid use was an independent risk factor for persistent use (adjusted relative risk 1.40; 95% confidence interval, 1.13-1.72) and for every 65 patients prescribed opioids associated with gynecologic surgery, one developed new persistent opioid use. The highest risk factor for developing persistent use was filling a high-dose opioid prescription (adjusted relative risk 5th quintileOME 2.33; 95% confidence interval, 1.83-2.96)., Conclusion: One in 5 women who undergo a gynecologic procedure has a new exposure to opioids. For every 65 patients who fill an opioid prescription after their gynecologic surgery, one will experience prolonged opioid use., (Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.)

Importance: Occupational therapy practitioners should use evidence-based practices, such as video modeling, to address work occupations supporting people with autism spectrum disorder, including those with co-occurring intellectual and developmental disabilities., Objective: To examine the evidence and relevance of video modeling supporting engagement in work occupations for people with autism and to translate these findings to occupational therapy practice., Data Sources: Cochrane Collection Plus, CINAHL, PubMed, ERIC, ProQuest, and peer-reviewed occupational therapy literature from 2008 to 2018. Study Selection and Data Collection: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study selection and data collection focused on occupational therapy scope of practice, autism spectrum disorder, co-occurring intellectual and developmental disabilities, video modeling, and work occupations for people age 16 yr and older., Findings: A total of 464 articles were screened. Six articles met inclusion criteria. Results indicated moderate evidence for video modeling to support work occupations for people with autism, specifically employment seeking and acquisition and specific job-performance skills. Samples were limited to people younger than age 28 yr and represented varied intellectual abilities, indicating potential for benefits across the spectrum of cognitive functioning., Conclusions and Relevance: This systematic review highlights the promising potential of video modeling to address work occupations for people with autism. However, more rigorous effectiveness research is needed, including studies by occupational therapy practitioners. What This Article Adds: Occupational therapy expertise paired with video modeling, as a strengths-based, client-centered, customizable, socially acceptable intervention, can provide meaningful support for work occupations., (Copyright © 2021 by the American Occupational Therapy Association, Inc.)

Background: The importance of data and information sharing for the prevention and control of infectious diseases has long been recognised. In recent years, public health emergencies such as avian influenza, drug-resistant malaria, and Ebola have brought renewed attention to the need for effective communication channels between health authorities, particularly in regional contexts where neighbouring countries share common health threats. However, little empirical research has been conducted to date to explore the range of factors that may affect the transfer, exchange, and use of public health data and expertise across borders, especially in developing contexts., Methods: To explore these issues, 60 interviews were conducted with domestic and international stakeholders in Cambodia and Vietnam, selected amongst those who were involved in regional public health programmes and networks. Data analysis was structured around three categories mapped across the dataset: (1) the nature of shared data and information; (2) the nature of communication channels; and (3) how information flow may be affected by the local, regional, and global system of rules and arrangements., Results: There has been a great intensification in the circulation of data, information, and expertise across borders in Southeast Asia. However, findings from this study document ways in which the movement of data and information from production sites to other places can be challenging due to different standards and practices, language barriers, different national structures and rules that govern the circulation of health information inside and outside countries, imbalances in capacities and power, and sustainability of financing arrangements., Conclusions: Our study highlights the complex socio-technical nature of data and information sharing, suggesting that best practices require significant involvement of an independent third-party brokering organisation or office, which can redress imbalances between country partners at different levels in the data sharing process, create meaningful communication channels and make the most of shared information and data sets.

Health sector decentralization has created an urgent need to strengthen public health management capacity in many countries throughout the developing world. This article describes the establishment of a national management training network in Vietnam that used Project-Based Learning to strengthen management competencies of HIV program workers and linked training to measurable improvement in HIV/AIDS public health program outcomes. Skills were taught using a combination of classroom learning and mentored fieldwork. From 2005 to 2015, 827 HIV/AIDS program managers were trained with this method throughout Vietnam by trainers in 3 regional training centers. A total of 218 applied learning projects were carried out by trainees during this period; 132 resulted in measurable improvements in HIV/AIDS program outputs, and 86 produced well-organized plans for implementing, monitoring, and evaluating HIV/AIDS intervention strategies. Vietnam's management training network represents an important advancement in public health workforce development that helps prepare workers for new roles and responsibilities in a decentralized health system.

Objective: This study determines rates and risk factors associated with hepatitis B surface antigen (HBsAg) and hepatitis B 'e' antigen (HBeAg) seroclearance, two important prognostic indicators during infection with hepatitis B virus (HBV), in a large contemporary cohort of patients coinfected with HIV-HBV., Design: Prospective cohort study of predominately antiretroviral therapy (ART) experienced, coinfected patients., Methods: Participants enrolled in the French HIV-HBV Cohort had complete HBV serological battery conducted at inclusion and every yearly visit. Piecewise-exponential survival models were used to determine risk factors associated with seroclearance., Results: A total of 290 patients, of whom 151 (52.1%) were HBeAg positive, had been followed for a median 7.4 years (interquartile range [IQR] = 3.1-8.0). Tenofovir (TDF) containing ART became increasingly more frequent, as rates of undetectable HBV-DNA increased accordingly (at baseline = 39.3%, end of follow-up = 91.0%). In HBeAg-positive patients, 60 of 151 had HBeAg seroclearance (cumulative 46.4% at end of follow-up) after a median 3.0 years (IQR = 2.0-4.9). Overall, 17 of 290 patients had HBsAg seroclearance (cumulative 7.4% at end of follow-up) after a median 4.6 years (IQR = 2.1-7.2). Lower levels of time-averaged cumulative HBV-DNA were significantly associated with both HBeAg and HBsAg seroclearance (P < 0.001 and P = 0.01, respectively). In post hoc analysis among patients initiating TDF, incidence rates of HBeAg seroclearance peaked at year 4 of TDF treatment (13.1/100 person-years), whereas a steep drop in HBsAg seroclearance incidence rates occurred after year 3 (at year 3 = 1.2/100 person-years versus thereafter = 0.6/100 person-years)., Conclusion: HBsAg seroclearance and, to a lesser extent, HBeAg seroclearance remain difficult endpoints for patients coinfected with HIV-HBV to achieve. HBV-DNA suppression, associated with effective treatment, is strongly linked to seroclearance, but this mostly occurs within the first years of ART-containing highly potent anti-HBV activity.

Advanced technology has rationalized and simplified operations at sea; however, this development has resulted in higher demands being made of the operator. Good health has become an important safety factor: a good state of health is crucial both to preventing strain injuries and to ensuring alertness and optimal performance at work. Physical activity is a powerful preventive "medicine" for the maintenance of good health and the prevention of overweight and musculoskeletal disorders. The aim of this paper is to analyse the habits and preferences of seafarers with regard to physical activity. Individual health factors, physical activity levels and work-related problems were surveyed on board vessels in a Norwegian shipping company. A questionnaire was completed by 577 seafarers. The results demonstrated that 70% of the respondents exercised twice or more times per week when at home, whereas only 39% exercised on board. Twenty per cent never exercised on board, and 5% never exercised at home. Walking is preferred by 70% of seafarers at home, as well as cycling and doing manual work. On board, walking, cycling and manual work are the most common types of exercise. Strength training is more often preferred on board than at home. Preventing illness and injury, a pleasant and inviting gym on board, and keeping weight under control are the three most important motivational factors. The results show that there is significant potential for improving and organising exercise-related activities on board as a means of maintaining good health and improving the performance of seafarers.

Revision of the Sludge (Use in Agriculture) Regulations in the UK has resulted in the requirement of a final product standard in terms of E. coli per gram of dry solids. Conventional mesophilic digestion including 14-day secondary storage should normally provide adequate treatment to meet the Treated Sludge Standard. Any process capable of greater pathogen reduction would ensure more process security and compliance comfort. Such a process would be a welcome alternative to extra secondary storage where an existing works does not have sufficient capacity, particularly if the differences in costs between the options are small. Enzymic hydrolysis was found to be up to ten-fold more effective in E. coli reduction than conventional secondary digestion. A two-stage digestion process based on this technique has been developed by United Utilities and Montgomery Watson Harza (termed the enzymic hydrolyser, patent pending). Studies showed that the mean numbers of E. coli were significantly lower in the enzymic hydrolyser systems (P > 0.05; t = 13.19) compared to conventional digesters. Increased stability was a secondary benefit of the system (foam was eliminated or greatly reduced in the enzymic hydrolyser units). Another benefit of the system for retrofit to existing assets is the decreased tankage volumes required compared to secondary digestion to achieve more than twice the log kill of pathogens.

The effect of nodularin on selective atrophy of left lobes in the liver was investigated in F344 rats. Nodularin was injected for 10 weeks from the third week of initiation with saline or N-nitrosodiethylamine (DEN), grouped as S/N and D/N, respectively. Nodularin significantly decreased weights of left (LL) and caudate (CL) lobes but increased right (RL) and middle (ML) lobes in S/N rats. Activity of protein phosphatases [types 1 (PPI) and 2A (PP2A)] was more severely reduced in S/N than D/N rats; moreover, in LL compared with RL of S/N rats, activity was significantly inhibited by nodularin treatment from week 4, which corresponded to 2 weeks after nodularin injection. However, nodularin significantly induced peroxisomal palmitoyl-CoA oxidase and cytochrome P-450 4A1 expression in S/N compared with D/N rats. An effect of nodularin on apoptosis was evident since expression of Bcl-Xs was clearly induced in LL of S/N rats as opposed to various inductions of Bcl-XL. However, Bcl-XL in RL was persistently induced, with undetectable Bcl-Xs expression. These results demonstrate biochemical evidence of selective atrophy of LL by inhibition of PP1 and PP2A activity, increase of peroxisomal enzymes and induction of Bcl-Xs expression, in contrast to proliferation of RL in rats treated with nodularin alone. However, nodularin endowed DEN-altered hepatocytes with regenerating power and concomitant restoration of phosphatase activity as well as persistent expression of Bcl-XL in D/N rats.