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A Multimodal Patient-Centered Teleprehabilitation Approach for Patients Undergoing Surgery for Breast Cancer: A Clinical Perspective
No full textBreast cancer is the most common malignancy among women worldwide, and advances in early detection and treatment have significantly increased survival rates. However, people living beyond breast cancer often suffer from late sequelae, negatively impacting their quality of life. Prehabilitation, focusing on the period prior to surgery, is a unique opportunity to enhance oncology care by preparing patients for the upcoming oncological treatment and rehabilitation. This article provides a clinical perspective on a patient-centered teleprehabilitation program tailored to individuals undergoing primary breast cancer surgery. The proposed multimodal program includes three key components: patient education, stress management, and physical activity promotion. Additionally, motivational interviewing is used to tailor counseling to individual needs. The proposed approach aims to bridge the gap between diagnosis and oncological treatment and provides a holistic preparation for surgery and postoperative rehabilitation in breast cancer patients. The aim of this preparation pertains to improving mental and physical resilience. By integrating current evidence and patient-centered practices, this article highlights the potential for teleprehabilitation to transform clinical care for breast cancer patients, addressing both logistical challenges and holistic well-being.This work was supported by Kom op tegen Kanker [grant number ANI316]. K.M. is a predoctoral research fellow of the Research Foundation Flanders (FWO; grant nr. 1SH6W24N). E.H. is a postdoctoral research fellow of the Research Foundation Flanders (FWO; grant nr. 12AV224N). J.N. holds the Berekuyl Academy Chair in oncological rehabilitation, funded by the Berekuyl Academy, Hierden, the Netherlands, and awarded to the Vrije Universiteit Brussel, Belgium. This work was also supported by the Strategic Research Program SRP90 (“Pain Never Sleeps: Unravelling the Sleep-Pain Interaction in Patients with Chronic Pain”) funded by the research council of the Vrije Universiteit Brussel, Brussels, Belgium
Cichlid fishes are promising underutilized models to investigate helminth-host-microbiome interactions
No full textThe "Old Friends Hypothesis" suggests insufficient exposure to symbionts hinders immune development, contributing to increased immune-related diseases in the Global North. The microbiome is often the focus; helminths, potentially also offering health benefits, lack attention. Infection and effect of helminths are influenced and perhaps determined by microorganisms. Mechanisms behind parasite-microbiome interactions are poorly understood, despite implications on host health. These interactions are typically studied for single helminth species in laboratory animal models, overlooking helminth diversity. Reviewing research on relationships between helminth and microbial diversity yielded 27 publications; most focused on human or other mammalian hosts, relying on natural exposure rather than experimental helminth inoculation. Only about half investigated host health outcomes. Remaining knowledge gaps warrant considering additional candidate model systems. Given the high helminthiasis burden and species diversity of helminths, we propose seeking models in the Global South, where a considerable proportion of research on diversity aspects of helminth-microbiome interactions took place. Low availability of genomic resources for helminths in the Global South, however, necessitates more integrative helminthological research efforts. Given substantial similarities in immune systems, several fishes are models for human health/disease. More effort could be done to establish this for cichlids, whose representatives in the African Great Lakes provide a well-delineated, closed natural system relevant to human health in view of fish-borne zoonoses and other water-borne parasites. A good baseline exists for these cichlids' genomics, parasitology, and microbiology. We suggest exploring African Great Lake cichlids as model hosts for interactions between microbial diversity, helminth diversity, and host health. CITATION Vanhove MPM, Koblmüller S, Fernandes JMO, Hahn C, Plusquin M and Kmentová N (2025) Cichlid fishes are promising underutilized models to investigate helminth-host-microbiome interactions.The author(s) declare financial support was received for the
research, authorship, and/or publication of this article. The content
of this manuscript previously appeared online in a preprint (123).
This work was supported by the Special Research Fund of Hasselt
University (BOF21INCENT09) and by the AfroWetMaP project of
the Belgian Federal Science Policy Office (4255-FED-tWIN-G3
program, Prf-2022-049). This research was funded in part by the
Austrian Science Fund (FWF) (grant DOI: 10.55776/P32691). JMOF
acknowledges the institutional support of the grant ‘Severo Ochoa
Centre of Excellence’ accreditation (CEX2019-000928-S) funded by
AEI 10.13039/501100011033 (Spain). For open access purposes, the
authors have applied a CC BY public copyright license to any author accepted
manuscript version arising from this submission
Nutritional Care of Hospitalized Children in Belgium: A Follow-Up Survey
No full textBackground: A 2014 survey showed nutritional management could be improved in Belgian pediatric departments. This follow-up survey aimed to: (1) list allied health resources/staffing in Belgian pediatric departments, (2) survey nutritional screening and follow-up, and (3) identify barriers. Methods: A nationwide survey (February-April 2021) via national and regional pediatric associations. Results: 61/90 (67.8%) of Belgian pediatric departments responded (80.1% of all Belgian pediatric hospital beds); 60.7% of the respondents were from larger centers (LCs, >= 20 beds). A dietitian was present in 80.3% of all responding units (LCs vs. smaller centers (SCs): p = 0.133), compared to 46.5% in the 2014 survey. Most dietitians seldom or never participate in ward rounds (86.9%) and participate only ad hoc to case discussions (72.1%). Systematic nutritional screening is implemented in 32.8% of pediatric departments. The screening tool STRONGkids is used in 30% of responding centers, compared to 21% in 2014. The most common barriers to conducting nutritional screening were lack of time (59.0%), a lack of knowledge (47.5%), and a lack of staff (42.6%). In French-speaking centers (FrCs), a positive screening result most often led to referral to a dietitian (86.7%), whereas in Dutch-speaking centers (DuCs), it more frequently resulted in a discussion with the pediatrician about nutritional management (54.3%) than referral to a dietitian (34.8%). Nutritional follow-up after discharge is most often conducted by a physician, with or without the involvement of a dietitian (95.1%), rather than a dietitian alone (3.3%). Malnutrition management barriers included "no barriers" (50.8%), a lack of knowledge (34.4%), a lack of reimbursement (24.6%), and a lack of time (24.6%). The barriers remain largely unchanged compared to 2014. Conclusions: The increasing availability of dietitians and the use of a screening tool in pediatric departments suggest an encouraging but limited improvement in nutritional care in Belgium. Persistent barriers that have remained unchanged since 2014 continue to hinder substantial advancements in nutritional care
S. t. Tsjechië (EHRM, 37614/22) – Mooie woorden, geen daden: redelijke aanpassingen in het onderwijs
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Blood Brain Barrier transmigration triggers inflammasome activation in Th lymphocytes during neuroinflammation
No full textClimate litigation against companies: the Shell-judgment as a groundbreaking template?
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Voxel-level radiomics and deep learning for predicting pathologic complete response in esophageal squamous cell carcinoma after neoadjuvant immunotherapy and chemotherapy
No full textBackground Accurate prediction of pathologic complete response (pCR) following neoadjuvant immunotherapy combined with chemotherapy (nICT) is crucial for tailoring patient care in esophageal squamous cell carcinoma (ESCC). This study aimed to develop and validate a deep learning model using a novel voxel-level radiomics approach to predict pCR based on preoperative CT images.Methods In this multicenter, retrospective study, 741 patients with ESCC who underwent nICT followed by radical esophagectomy were enrolled from three institutions. Patients from one center were divided into a training set (469 patients) and an internal validation set (118 patients) while the data from the other two centers was used as external validation sets (120 and 34 patients, respectively). The deep learning model, Vision-Mamba, integrated voxel-level radiomics feature maps and CT images for pCR prediction. Additionally, other commonly used deep learning models, including 3D-ResNet and Vision Transformer, as well as traditional radiomics methods, were developed for comparison. Model performance was evaluated using accuracy, area under the curve (AUC), sensitivity, specificity, and prognostic stratification capabilities. The SHapley Additive exPlanations analysis was employed to interpret the model's predictions.Results The Vision-Mamba model demonstrated robust predictive performance in the training set (accuracy: 0.89, AUC: 0.91, sensitivity: 0.82, specificity: 0.92) and validation sets (accuracy: 0.83-0.91, AUC: 0.83-0.92, sensitivity: 0.73-0.94, specificity: 0.84-1.0). The model outperformed other deep learning models and traditional radiomics methods. The model's ability to stratify patients into high and low-risk groups was validated, showing superior prognostic stratification compared with traditional methods. SHAP provided quantitative and visual model interpretation.Conclusions We present a voxel-level radiomics-based deep learning model to predict pCR to neoadjuvant immunotherapy combined with chemotherapy based on pretreatment diagnostic CT images with high accuracy and robustness. This model could provide a promising tool for individualized management of patients with ESCC.Zhejiang Medical and Health Science and Technology Project [2025
Elderly patients treated with Onyx versus Orsiro drug-eluting coronary stents in a randomized clinical trial with long-term follow-up
No full textBackground Percutaneous coronary intervention (PCI) with new-generation drug-eluting stents is increasingly performed in elderly patients, who generally have more comorbidities and more technically challenging target lesions. Nevertheless, there is a paucity of reported data on the long-term safety and efficacy of PCI with contemporary stents in elderly all-comers. Methods This prespecified secondary analysis of a large-scale randomized clinical trial (BIONYX; clinicaltrials.gov:NCT02508714) compared in elderly all-comers (>= 75 years) the 5-year outcome after PCI with the novel, more radiopaque Onyx zotarolimus-eluting stent (ZES) versus the Orsiro sirolimus-eluting stent (SES). We assessed the main composite endpoint target vessel failure (TVF: cardiac death, target vessel myocardial infarction, or target vessel revascularization) and several secondary endpoints. Results Of 2,488 trial participants, 475(19.1%) were elderly (79.5 +/- 3.5 years), including 165(34.7%) women. There was a significant between-stent difference in the main endpoint TVF in favor of the Onyx ZES (14.4% vs. 24.2%, HR: 0.60, 95% CI 0.39-0.93, p(log-rank) = 0.02). The time-to-event curves displayed between-stent dissimilarities across all components of TVF, yet not statistically significant. Landmark analysis between 1- and 5-year follow-up showed in Onyx ZES-treated patients significantly lower rates of TVF (7.8% vs.8.9%, p = 0.002) and target vessel revascularization (3.0% vs.8.3%, p = 0.029). In addition, the 5-year rates of all-cause mortality and several composite endpoints were lower (p < 0.03) in Onyx ZES-treated patients. Conclusions In elderly all-comer patients, those treated with Onyx ZES showed a lower 5-year incidence of the main endpoint of safety and efficacy, as well as several secondary endpoints, than patients treated with Orsiro SES. Further research on this issue is warranted. Clinical trial registration information https://clinicaltrials.gov/study/NCT02508714.The present analysis was performed without any external financial support. The main BIONYX trial was equally funded by Biotronik and Medtronic
Recente ontwikkelingen op het gebied van milieu- en energierecht (oktober - december 2023)
No full textDe laatste maanden van 2023 brachten enkele zeer belangrijke evoluties met zich mee op vlak van het Energierecht. Op Europees niveau heeft de in de literatuur fel bediscussieerde derde herziening van de Richtlijn 2018/2001 ter bevordering van energie uit hernieuwbare bronnen doorgang gevonden middels de Richtlijn 2023/2413 (de zogenaamde “RED III”). Naast de wijzigingen met betrekking tot de vergunningsprocedure, staat deze bijdrage ook stil bij de minder besproken aspecten van RED III. Een tweede groot Europees dossier betreffende de verduurzaming van de luchtvaart wordt vervolgens besproken. Op Vlaams niveau wordt voortgeborduurd op de RED III en worden enkele wijzigingen aan het Energiedecreet aangehaald. In de wijzigingen wordt een interessant sanctioneringsmechanisme doorgevoerd