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Eradication Therapy to Prevent Gastric Cancer in Helicobacter pylori–Positive Individuals: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Studies
Get PDFBackground & Aims
Screening for, and treating, Helicobacter pylori in the general population or patients with early gastric neoplasia could reduce incidence of, and mortality from, gastric cancer. We updated a meta-analysis of randomized controlled trials (RCTs) examining this issue.
Methods
We searched the literature through October 4, 2024, identifying studies examining effect of eradication therapy on incidence of gastric cancer in H pylori–positive adults without gastric neoplasia at baseline or H pylori–positive patients with gastric neoplasia undergoing endoscopic mucosal resection (EMR) in either RCTs or observational studies. The control arm received placebo or no eradication therapy in RCTs and no eradication therapy in observational studies. Follow-up was ≥2 years. We estimated relative risks (RR) of gastric cancer incidence and mortality.
Results
Eleven RCTs and 13 observational studies were eligible. For RCTs, RR of gastric cancer was lower with eradication therapy in healthy H pylori–positive individuals (8 RCTs, 0.64; 95% confidence interval [CI], 0.48–0.84) and H pylori–positive patients with gastric neoplasia undergoing EMR (3 RCTs, 0.52; 95% CI, 0.38–0.71). RR of death from gastric cancer was lower with eradication therapy in healthy H pylori–positive individuals (5 RCTs, 0.78; 95% CI, 0.62–0.98). In observational studies, RR of future gastric cancer was lower with eradication therapy in H pylori–positive subjects without gastric neoplasia at baseline (11 studies, 0.56; 95% CI, 0.43–0.73) and H pylori–positive patients with gastric neoplasia undergoing EMR (2 studies, 0.19; 95% CI, 0.06–0.61).
Conclusions
This meta-analysis provides further evidence that administering eradication therapy prevents gastric cancer in H pylori–positive individuals, with consistency in results among studies of different design
Large range sizes link fast life histories with high species richness across wet tropical tree floras
Get PDFUnderstanding how the traits of lineages are related to diversification is key for elucidating the origin of variation in species richness. Here, we test whether traits are related to species richness among lineages of trees from all major biogeographical settings of the lowland wet tropics. We explore whether variation in mortality rate, breeding system and maximum diameter are related to species richness, either directly or via associations with range size, among 463 genera that contain wet tropical forest trees. For Amazonian genera, we also explore whether traits are related to species richness via variation among genera in mean species-level range size. Lineages with higher mortality rates—faster life-history strategies—have larger ranges in all biogeographic settings and have higher mean species-level range sizes in Amazonia. These lineages also have smaller maximum diameters and, in the Americas, contain dioecious species. In turn, lineages with greater overall range size have higher species richness. Our results show that fast life-history strategies influence species richness in all biogeographic settings because lineages with these ecological strategies have greater range sizes. These links suggest that dispersal has been a key process in the evolution of the tropical forest flora
A model based cost-utility analysis of embedding referral to structured self-management education into standard practice (Embedding) compared to usual care for people with type 2 diabetes diagnosis in the last 12 months in England
Get PDFObjectives: To conduct a cost-utility analysis of an implementation package that has been developed aiming to embed the referral of people with type 2 diabetes mellitus (T2DM) to structured self-management education (SSME) from primary care into routine practice compared with usual care.
Design: Model-based cost-effectiveness analysis using the School for Public Health Research type 2 diabetes treatment model. With costs and effectiveness parameters coming from analyses of data from a cluster randomised control trial.
Setting: English National Health Service.
Participants: People with T2DM from 64 GP practices in England.
Interventions: Embedding SSME implementation package Usual care.
Primary and secondary outcome measures: The primary outcome measure was the incremental cost-effectiveness ratio. Secondary outcome measures included the probability of Embedding implementation package being cost-effective and value of information.
Results: The estimated cost of the intervention was £40 316 across the study sites, which equates to £0.521 per patient across all practices. For the base case, the estimated mean discounted incremental lifetime cost of the intervention per patient is £48.19. This is associated with a mean per patient incremental quality-adjusted life-year (QALY) estimate of 0.006, producing an incremental cost-effectiveness ratio of £8311 per QALY gained. This has a 73.1% probability of the intervention being cost-effective at a funding threshold of £20 000 per QALY gained. Scenario analyses indicate that alternative parameterisations can lead to this finding being overturned.
Conclusions: The effectiveness of the Embedding packages was hampered by the COVID-19 pandemic. However, our base case analysis shows that Embedding could be cost-effective for this patient population, but this was subject to significant structural uncertainty. This suggests that while implementation initiatives can be highly cost-effective in this population, more robust evidence or further incentivisation will be required before widespread adoption can be recommended.
Trial registration number: ISRCTN23474120, registered 05/04/2018
Tropical montane forest loss dominated by increased 1–10 hectare-sized patches
Get PDFTropical forest loss continues across mountain regions at alarming rates, threatening biodiversity, carbon storage and ecosystem sustainability. To improve our understanding of the dynamics of tropical mountain forest loss, this study focuses on the trends in patch sizes of forest loss during the 21st century. The annual area of tropical mountain forest loss surged from 0.7 million hectares in 2001–2003 to >2.5 million hectares in 2019–2021. There was an increase across all categories in terms of the size of forest loss patches, but strikingly, more than half of this increase was attributed to the proliferation of intermediate-sized forest loss patches spanning 1–10 hectares. Concurrently, there was a diminishing proportion of small-scale montane forest loss patches (<1 ha) across all tropical continents over time. Despite their reduced overall proportion, the annual area of small forest loss patches increased, primarily influenced by trends in the Asia-Pacific region. Our study provides up-to-date and spatially explicit information on the scale of tropical mountain forest loss, and temporal trends associated with these patterns, which is crucial for assessing the sustainability of mountain forest ecosystems, highlighting the need for targeted, region-specific strategies to slow or reverse forest loss
Development of a methodology for in vitro and in silico simulation of transcatheter aortic valve replacement using 3D-printed valve frames
Get PDFBackground:
Transcatheter aortic valve implantation (TAVI) is experiencing continued growth as an option for the treatment of aortic stenosis. Both in vitro and in silico methods have proven reliable in assessing the performance of TAVI devices, which can be used in procedure planning and prototyping new concepts. 3D printing of TAVI frames has the potential for revolutionizing frame designs by making it possible to create more complex geometries. However, the mechanical performance of additively manufactured frames, in terms of crimping and deployment into an aortic root, needs to be verified if such frames are to provide a plausible and reliable method for benchtop testing.
Methods:
Having previously established a suitable set of process parameters for laser powder bed fusion (LPBF) manufacture of TAVI frames based on the SAPIEN S3 design, the deployment of such a frame into a patient-specific, 3D printed aortic root phantom was undertaken and assessed using a high resolution CT scan of the result. In parallel, a full computational model was developed to simulate the same deployment procedure and validated against the in vitro study. Further, an interesting case study was setup using this approach to assess deployment of the LPBF frame into the same aortic root phantom but with two of the leaflets fused together.
Results:
The LPBF-manufactured frame had sufficient radial strength to fully open the leaflets within the aortic root phantom and anchor the frame in place for both fused and non-fused leaflet cases. There was good agreement between the in vitro and in silico tests in terms of frame position with an average nodal position error of 0.37 mm and 1.29 mm for non-fused and fused cases respectively. Similarly, the frame diameter difference between the in vitro and in silico deployments were 1.01% for the non-fused and 3.17% for the fused cases.
Conclusion:
Manufacture of a SAPIEN S3 type heart valve frame using LPBF has been shown to provide a viable procedure for producing frames for testing and assessment when crimped and deployed into a model of an aortic root. Further, the validated in silico model developed in this study can be used to computationally design and test novel frame concepts to be manufactured by LPBF
GnIH secreted by green light exposure, regulates bone mass through the activation of Gpr147
Get PDFReproductive hormones associated with the hypothalamic-pituitary-gonadal (HPG) axis are closely linked to bone homeostasis. In this study, we demonstrate that Gonadotropin inhibitory hormone (GnIH, one of the key reproductive hormones upstream of the HPG axis) plays an indispensable role in regulating bone homeostasis and maintaining bone mass. We find that deficiency of GnIH or its receptor Gpr147 leads to a significant reduction in bone mineral density (BMD) in mice primarily by enhancement of osteoclast activation in vivo and in vitro. Mechanistically, GnIH/Gpr147 inhibits osteoclastogenesis by the PI3K/AKT, MAPK, NF-κB and Nfatc1 signaling pathways. Furthermore, GnIH treatment was able to alleviate bone loss in aging, ovariectomy (OVX) or LPS-induced mice. Moreover, the therapy using green light promotes the release of GnIH and rescues OVX-induced bone loss. In humans, serum GnIH increases and bone resorption markers decrease after green light exposure. Therefore, our study elucidates that GnIH plays an important role in maintaining bone homeostasis via modulating osteoclast differentiation and demonstrates the potential of GnIH therapy or green light therapy in preventing osteoporosis
SN 2023tsz: a helium-interaction-driven supernova in a very low-mass galaxy
Get PDFSN 2023tsz is a Type Ibn supernova (SN Ibn), an uncommon subtype of stripped-envelope core-collapse supernovae (SNe), discovered in an extremely low-mass host. SNe Ibn are characterized by narrow helium emission lines in their spectra and are believed to originate from the collapse of massive Wolf–Rayet (WR) stars, though their progenitor systems still remain poorly understood. In terms of energetics and spectrophotometric evolution, SN 2023tsz is largely a typical example of the class, although line profile asymmetries in the nebular phase are seen, which may indicate the presence of dust formation or unshocked circumstellar material. Intriguingly, SN 2023tsz is located in an extraordinarily low-mass host galaxy that is in the second percentile for stripped-envelope SN host masses and star formation rates (SFRs). The host has a radius of 1.0 kpc, a g-band absolute magnitude of , and an estimated metallicity of . The SFR and metallicity of the host galaxy raise questions about the progenitor of SN 2023tsz. The low SFR suggests that a star with sufficient mass to evolve into a WR would be uncommon in this galaxy. Further, the very low metallicity is a challenge for single stellar evolution to enable H and He stripping of the progenitor and produce an SN Ibn explosion. The host galaxy of SN 2023tsz adds another piece to the ongoing puzzle of SNe Ibn progenitors, and demonstrates that they can occur in hosts too faint to be observed in contemporary sky surveys at a more typical SN Ibn redshift
Tidal Thinking and Times of Conflict
Get PDFAkin to flotsam washed up by the sea, this article combs through what it calls a “molecular configuration” comprised of bits of Paul Valéry, Jean Grenier, Albert Camus, René Char, Martin Heidegger and Georg Trakl as an exercise in “tidal thinking.” Conflict, mainly in the form of war, makes its presence felt throughout, as does the haunting prospect of the irreversible climate crisis
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