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Examining Associations between COVID-19 Distress, Multilevel Resilience, and HIV Viral Suppression among African American/Black Adults in the Southeastern United States
No full textThe COVID-19 pandemic may have exacerbated HIV viral suppression disparities between African American/Black and White people living with HIV in the United States. Although COVID-19 disrupted HIV care and caused distress, multilevel resilience resources may have mitigated the impact of COVID-19 distress on HIV viral suppression. We used prospective observational data on 124 African American/Black adults from two clinical cohorts in the Southeastern United States and modified Poisson regression to examine whether an intervention that reduced COVID-19 distress and enhanced multilevel resilience resources would have more effectively improved HIV viral suppression had such a dual intervention been implemented in the real-world during the COVID-19 pandemic. This examination did not yield strong evidence that a real-world dual intervention would have more effectively improved HIV viral suppression on the additive scale during the pandemic among study participants. Larger future studies that minimize systematic sources of bias are needed.</p
Development of the Rome V Diagnostic Questionnaires
No full textThis article describes the development of the Rome V adult and pediatric diagnostic questionnaires. Important updates from the Rome IV versions included improved response scaling, new questions to diagnose 3 additional adult DGBI and 14 additional pediatric DGBI (compared to the Rome IV questionnaires), extra questions to clarify the context of DGBI symptoms for research purposes, and the addition of anatomical images to enhance response accuracy. The performance of the Rome V adult questionnaire was tested in Internet surveys in 15 countries, and the pediatric questionnaires in 4 countries. The results indicate that the new questionnaires generally identify DGBI to a similar degree and with the same demographic patterns as the prior Rome IV versions. The Rome V Questionnaire Committee concluded that these new diagnostic questionnaire versions are well suited for epidemiologic and clinical research of DGBI in the Rome V era for both adult and pediatric populations
Prospective monitoring of biochemically recurrent prostate cancer (BCR) using prostate specific membrane antigen (PSMA) imaging: 21-month follow-up
No full text37Background: The use of PSMA imaging is impacting the management of BCR, but it remains unclear if treatment escalation is required for PSMA+ BCR. While patients (pts) at the highest risk of death from prostate cancer (e.g. PSA Doubling Time (DT) less than 6 months) may benefit from therapy, the majority of BCR pts will not die of prostate cancer. Longitudinal data pf PSMA+ BCR is required to better understand risk stratification for PSMA+ BCR. Methods: NCT05588128 enrolls BCR pts after definitive therapy +/- salvage options. Pts are required to have a PSA>0.5 ng/ml, negative bone scan and computed tomography (CT; lymph nodes (LNs) up to 1.5 cm are permitted.) Prior therapies are permitted as long as testosterone>100 ng/dL. If initial PSMA scan is positive, PSMA scan is repeated every 6 months, but annually if negative. While on-study, patients may have systemic therapy for less than 6 month intervals and radiation (RT) is permitted. Results: 129 patients are evaluable with a median potential follow-up of 21.75 months (mos). Median baseline age=71 years, PSA=2.3 ng/ml and PSA DT=11.0 mos but 35% have PSA DT <6 mos. At baseline 23 pts (18%) had negative PSMA, 22 (17%) had prostate only findings, 24 (19%) had 1 LN, 9 (7%) had 2-3 LNs and 33 (26%) had 4+ LNs. Also, 19 pts (15%) had bone findings, 4 (3%) had PSMA+ serosal lesions and 1pt had PSMA+ pulmonary nodule. During the course of follow-up, 28 pts elected androgen deprivation therapy (ADT)-sparing NCI protocols, 1 pt had ADT, 1 pt had salvage RT, and 7 had RT to PSMA+ finding(s). Of 107 pts with PSMA+ findings, only 4 (3.7%) had developed metastasis on CT/bone scan with a median f/u of 21.75 mos. Conclusions: Most patients with BCR will not die of prostate cancer and it remains unclear how PSMA imaging will help risk stratify pts. This ongoing study demonstrates that with nearly 2 years of median follow-up, the risk of metastatic progression on CT or bone scan remains low even if patients have PSMA+ findings at baseline. These data do not support using PSMA imaging as the sole criteria to initiate therapy for BCR pts including those with numerous PSMA findings. This study continues to accrue patients at the National Cancer Institute, Bethesda, MD. Clinical trial information: NCT05588128
Management of the Uterus During Prolapse Surgery: Hysterectomy vs Uterine Preservation
No full textPurpose of ReviewPelvic organ prolapse (POP) affects nearly 40% of women, with approximately 13% requiring surgery. Historically, hysterectomy was standard in prolapse repair, but evolving evidence has prompted a shift toward uterine preservation. This review examines whether uterine-preserving prolapse procedures (UPPS) offer outcomes comparable to hysterectomy-based approaches and explores factors influencing surgical decisions, including patient preferences and surgical innovations.Recent FindingsRecent randomized trials and meta-analyses are non-inferior to hysterectomy based surgeries in terms of anatomical success, recurrence, and patient satisfaction. Advantages include shorter operative time, less blood loss, fertility preservation, and psychological benefits. However, hysterectomy remains necessary for malignancy, abnormal bleeding, or anatomic distortion.SummaryUterine preservation is a safe, effective, and increasingly preferred option in the management of POP. For appropriately selected patients, it offers comparable outcomes to hysterectomy while honoring reproductive goals and self-identity. Shared decision-making remains critical, balancing patient values with individualized surgical planning
Vitamins and Hair: Sham or Science?
No full textThere has been growing interest in supplements and haircare products outside of standard medical treatments to improve hair health. Vitamins are essential micronutrients required to maintain homeostasis in the body and are essential for hair growth. There is a robust literature that reveals vitamin deficiencies in patients with such hair disorders as alopecia areata and telogen effluvium; however, there is limited scientific backing to understand whether vitamin supplementation in healthy individuals has a tangible impact on hair health. We have reviewed the evidence, given that clinical trials are limited. Vitamins appear to help hair health in those with deficiencies; howevet, further evidence is needed to establish benefits for those with healthy baseline hair
E‑Commerce and Spatial Rebalancing of the Catering Industry in Zhuhai, China: a Pre‑ and Post‑Pandemic Comparison
No full textThe rise of e-commerce and the gig economy, accelerated by COVID-19, has rapidly expanded online-to-offline (O2O) takeaway services and reshaped the spatial distribution of the catering industry in Chinese cities. To examine this process in China, we first analyzed the spatial evolution of the catering industry in Zhuhai before (2019) and after (2023) the pandemic using a hotspot detection model, with particular attention to differences between traditional restaurants and those adopting O2O takeaway services. We find that the traditional core–periphery spatial structure of the catering sector has been disrupted and has evolved into a more non-hierarchical pattern. O2O takeaway restaurants are more diffusely distributed and contribute to the decline of traditional restaurants, a transformation that has been further accelerated by the pandemic. Further analysis using random forest and multi-level geographically weighted regression models suggests that this transformation is primarily driven by behavioral changes among a growing segment of younger, better-educated, digitally proficient, higher-income, and time-constrained consumers, which aligns with the innovation diffusion hypothesis
One hundred unanswered questions on the dispersal ecology of fungi
No full textFungi comprise millions of species that play numerous varied roles in Earth's natural and managed ecosystems, engaging in a multitude of positive and negative ecological interactions. The dispersal ecology of fungi is central to global biodiversity patterns, maintenance of terrestrial and aquatic ecosystem functions, and tracking human disease and plant pathogen outbreaks. Mycologists have been studying dispersal mechanisms for over a hundred years, but new technology as well as interdisciplinary approaches have reinvigorated research in the field. Here we present 100 research questions in fungal dispersal organized into ten themes: 1) dispersal traits and mechanisms, 2) effects of phenology and lifestyle, 3) spore liberation and transport mechanisms, 4) colonization and establishment, 5) ecosystem-level consequences of dispersal, 6) dispersal in symbiotic and host-associated fungi, 7) dispersal in anthropogenic and changing environments, 8) evolution and tradeoffs in dispersal, 9) role of dispersal in invasion and disease spread, and 10) methodology and techniques. The questions reflect a diversity of new research avenues from fundamental fungal biology to applied ecosystem management and conservation across spatial and temporal scales. They potentially enable integrating fungi and their unique life-history traits and dispersal strategies into existing dispersal frameworks developed around plant and animal systems. We aim to invigorate fungal dispersal research, sparking conversations and providing a focused agenda to widen the tent by illuminating unanswered questions and new research avenues in ecology and evolutionary biology
Practice, Policy, and Research Recommendations to Improve Decision-Making about Surgery for People Living with Dementia: A Delphi Panel Consensus
No full textIdentify consensus-based policy and practice recommendations and develop research priorities to enhance surgical decision-making in the context of dementia.
People Living with Dementia (PLWD) and their families and healthcare providers face clinical, ethical, and psychosocial challenges when making surgical decisions.
We conducted a modified Delphi panel August-December 2024, consisting of interviews, surveys, and virtual discussions. Panel members rated potential recommendations on importance and feasibility for practice and policy recommendations, and priority for research recommendations.
23 stakeholders, including surgeons, other clinicians, researchers, policy experts, PLWD and care partners participated on the panel. Policy and practice recommendations (n=28) and research recommendations (n=21) covered the following domains: 1) Obtaining information about cognitive impairment, physical function, capacity to consent, and general goals of care for patients with surgical conditions; 2) Advancing resources to support surgical decision-making in the context of dementia; 3) Enhancing care collaboration and team-based care for patients with surgical conditions in the context of dementia; 4) Using policy to enhance surgical decision-making for patients living with dementia; 5) Increasing surgical clinician knowledge and understanding of the dementia context. Of 28 policy and practice recommendations rated by the panel, 25 achieved consensus for high importance but uncertain feasibility, 2 reached consensus for both high importance and feasibility, and 1 remained uncertain on both importance and feasibility. All 21 research recommendations reached consensus for high priority.
This study provides direction to inform surgical practice, policy development, and future research to support surgical decision-making for PLWD, families, and clinicians
MTAS-MENA: adapting the Stroke Access Barrier Index (SABI) to enhance mechanical thrombectomy access in the Middle East and North Africa region
No full textBackground and purposeWe developed and preliminarily validated the Stroke Access Barrier Index (SABI), adapted from the global MTAS framework, then applied it to assess potential barriers to mechanical thrombectomy access in the MENA region.MethodsCross-sectional survey with embedded instrument development and validation study. We surveyed 352 stroke and neurointerventional facility directors across the Middle East and North Africa (MENA) region, defined as 22 countries/territories, with responses obtained from 17 countries (March–June 2024), receiving 102 responses (29%). The SABI tool evaluates 12 attributes scored 0-3, yielding a total score from 0-36. Emergency medical services (EMS) utilization and health literacy were key measures.ResultsThe median SABI score for the MENA region was 18.5 (IQR: 10.0–24.0; 95% CI: 16.8–20.2), significantly lower (p < 0.001) than the global median of 22.0 (IQR: 14.0-28.0; 95% CI: 21.3–22.7). High-income countries scored 24.0, while low-income countries scored 10.0. Physical barriers (median: 4.5/9.0) and sociocultural barriers (median: 4.0/9.0) were most prominent. EMS utilization (median: 1.0) and health literacy (median: 1.0) were consistently low across all income levels. Urban facilities (median: 20.5) substantially outperformed rural facilities (median: 13.0, p < 0.001).ConclusionsThe SABI provides an exploratory framework for identifying potential MT access barriers in the MENA region. While preliminary findings suggest substantial challenges (median score 18.5), these results require validation through prospective studies linking scores to actual MT utilization and patient outcomes. This initial assessment may guide hypothesis generation for future intervention studies
Stem Cell-based Nerve Regenerative Therapies: The Role of Adipose-Derived Stem Cells (ADSCs) in Preventing Nerve Adhesions and Promoting Axonal Nerve Repair
No full textDamage to either the central or peripheral nervous system can result in significant impairments of movement and sensation, with poor regeneration often resulting from complications such as nerve adhesion and fibrosis. Adipose-derived stem cells (ADSCs) have emerged as a promising therapeutic candidate in promoting nerve regeneration owing to their regenerative potential, abundance, ease of harvest, low immunogenicity, and anti-inflammatory properties. ADSCs, isolated from adipose tissue, can differentiate into neural lineages, secrete a broad spectrum of neurotrophic and anti-fibrotic factors, and thereby foster axonal sprouting, remyelination, and scar attenuation. Additionally, these cells have demonstrated efficacy in preventing nerve adhesion, a common complication of nerve injury that impedes functional recovery. This review explores the properties, advantages, and regenerative potential of ADSCs, highlighting their roles in promoting axonal regeneration, myelination, and reducing fibrosis. Preclinical studies and early clinical trials associated with the peripheral and central nervous system injuries have reported promising results in terms of functional recovery and reduced scar formation, but challenges remain in standardizing ADSC-based therapies and achieving full functional restoration. Future advancements in ADSC therapies may include optimized delivery systems, genetic modifications, and the integration of advanced biomaterials to enhance their regenerative capabilities