Notes

Creutzfeldt-Jakob condition during pregnancy: the application of modified RT-QuIC to ascertain contamination in placental tissues.
The study underscores the importance of considering the fiber recruitment in formulating strain-based rupture metric, and suggests that ϵ¯≈0.1, where ϵ¯ is the effective strain metric defined in this work, can be considered as a criterion for assessing the imminent rupture risk of ascending aortic aneurysms. STATEMENT OF SIGNIFICANCE We advocate to use effective strain in ATAA rupture assessment. The effective strain is a measure of net strain in the collagen network after waviness uncrimping. We analyzed bulge inflation data of ATAA samples. It was found that, while the total strains at rupture varied from sample to sample, the effective strains were closely clustered around 0.1. And the hotspots of effective strain matched the rupture sites well. The work underlines the importance of considering collagen fiber waviness and recruitment when evaluating the rupture risk using strain, and suggests a new direction for developing sharper rupture metrics.
France is the Western country with the highest number of imported malaria cases. This study evaluates the cost and effectiveness of the potential reimbursement of drugs for malaria chemoprophylaxis (CP). It targets travelers with medical insurance in France who are heading to endemic regions in sub-Saharan Africa (SSA), the cost of which is currently fully borne by these travelers.

A decision-tree model was built to assess the cost-effectiveness of three CP reimbursement strategies compared to the current strategy of non-reimbursement from the French National Health Insurance (NHI) perspective. The three strategies targeted either (1) all travelers to SSA (2) travelers of African origin traveling to visit friends and relatives (VFR) and (3) all travelers to West and Central Africa (WCA). Base-case analysis is complemented with deterministic and probabilistic sensitivity analyses (PSA).

Reimbursement of CP would lead to a decrease in malaria cases. The base-case incremental cost per additional malaria case prevented (ICER) for strategies 1, 2 and 3 is estimated at € 34,623, € 15,136 and € 23,640, respectively. PSA confirms our results, showing that reimbursement has a very high probability of being cost-effective, especially under strategies 2 and 3.

Reimbursement of malaria CP by the French NHI could be cost-effective and have a positive effect on malaria prevention in France. Restricting reimbursement to VFRs allows lower ICERs but does not seem feasible in the current French context, while targeting travelers to WCA, who are at higher risk for malaria, could be a reasonably efficient policy.
Reimbursement of malaria CP by the French NHI could be cost-effective and have a positive effect on malaria prevention in France. Restricting reimbursement to VFRs allows lower ICERs but does not seem feasible in the current French context, while targeting travelers to WCA, who are at higher risk for malaria, could be a reasonably efficient policy.
Optimal duration of antimicrobial regimen after reimplantation of two-stage procedures for periprosthetic joint infection (PJI) is poorly standardized. The aim of this study was to assess the characteristics of reimplantation microbiology with 6 weeks (2nd stage positive culture) or 10 days (2nd stage negative culture) of antibiotics in patients with complex chronic PJI and factors associated with microbiology at reimplantation.

We performed a retrospective single-center study including all consecutive complex PJI recipients managed by two-stage surgery in a referral centre, from 2015 to 2018. Outcome was assessed at a minimum 2-year follow-up. Logistic regression analysis was performed to assess predictors of reimplantation microbiology.

Fifty patients (median age 69 [62-77] years) were included. Crenolanib supplier PJI predominantly involved the hip (48%). The most common microorganisms were Staphylococcus aureus (36%), and coagulase-negative staphylococci (24%). At the second stage, reimplantation microbiology was positermine the optimal duration of antibiotic therapy in case of negative microbiology.
Due to demographic changes and higher life expectancy especially in industrial nations, the number of liver resections in patients ≥70 years is rising. It is known that older age is associated with higher postoperative morbidity and mortality after surgery under general anesthesia. The aim of this analysis is to compare the postoperative outcome after liver resections for malignancies in patients aged below and above 70 years.

A prospectively collected electronic database of 1034 liver resections between January 2013 and December 2019 was retrospectively analyzed. Comparative analysis of patients <70 and≥70 years receiving liver resections for malignancies included 889 operations in 703 patients. Analysis of postoperative outcome and uni- and multivariate analyses of associated risk factors were performed.

Median age of the whole cohort was 65 years (range 18-87 years). N=582 liver resections (65.7%) were performed in patients <70 years with 42.8% major hepatectomies and n=307 (34.3%) liver resections in patients ≥70 years with 50.5% major hepatectomies (p=0.034). Relevant postoperative morbidity of the whole cohort was 27.9%. The 30-day mortality was 3.9% and re-operation rate 14.8%. Patients ≥70 years had significantly higher postoperative morbidity and mortality rates than patients <70 years. Major resections, longer operating time, need of intraoperative transfusions of blood products as well as biliodigestive anastomosis (BDA) and inferior vena cava (IVC) resection were independent risk factors for worse postoperative outcome.

Liver resections in patients ≥70 years are associated with a worse postoperative course after. Parenchyma sparing resections should be preferred in those patients.
Liver resections in patients ≥70 years are associated with a worse postoperative course after. Parenchyma sparing resections should be preferred in those patients.
To assess the performance of a deep learning (DL) algorithm for evaluating and supervising cataract extraction using phacoemulsification with intraocular lens (IOL) implantation based on cataract surgery (CS) videos.

DeepSurgery was trained using 186 standard CS videos to recognize 12 CS steps and was validated in two datasets that contained 50 and 21 CS videos, respectively. A supervision test including 50 CS videos was used to assess the DeepSurgery guidance and alert function. In addition, a real-time test containing 54 CSs was used to compare the DeepSurgery grading performance to an expert panel and residents.

DeepSurgery achieved stable performance for all 12 recognition steps, including the duration between two pairs of adjacent steps in internal validation with an ACC of 95.06% and external validations with ACCs of 88.77% and 88.34%. DeepSurgery also recognized the chronology of surgical steps and alerted surgeons to order of incorrect steps. Six main steps are automatically and simultaneously quantified during the evaluation process (centesimal system). In a real-time comparative test, the DeepSurgery step recognition performance was robust (ACC of 90.30%). In addition, DeepSurgery and an expert panel achieved comparable performance when assessing the surgical steps (kappa ranged from 0.58 to 0.77).

DeepSurgery represents a potential approach to provide a real-time supervision and an objective surgical evaluation system for routine CS and to improve surgical outcomes.
DeepSurgery represents a potential approach to provide a real-time supervision and an objective surgical evaluation system for routine CS and to improve surgical outcomes.Genistein, an isoflavonoid, is found in a plethora of plant-based foods, and has been approved for use in various therapies. A couple of studies in adult men observed a negative correlation between genistein exposure and reproductive parameters. To assess the effects of genistein exposure on reproduction and fertility in males and females, we performed quantitative meta-analyses by pooling data from published studies on animals that assessed various reproductive parameters. Pooled analysis showed significant decreases in sperm count in males exposed to genistein during adulthood (Hedges's g = -2.51, p = 0.013) and in utero (Hedges's g = -0.861, p = 0.016) compared with controls. In males exposed to genistein in utero, serum testosterone levels decreased (Hedges's g = -6.301, p = 0.000) and luteinizing hormone (LH) (Hedges's g = 7.127, p = 0.000) and FSH (Hedges's g = 6.19, p = 0.000) levels increased in comparison with controls. In females, the number of corpora lutea (Hedges's g = -2.103, p = 0.019) and the litter size (Hedges's g = -1.773, p-value = 0.000) decreased; however, female reproductive hormones remained unaffected. These meta-analyses show that genistein has detrimental effects on male reproductive system and on the progression and sustenance of pregnancy, with more pronounced adverse impact in males, particularly when exposed in utero.
Cigarette smoking prevalence is higher among rural compared with urban adults, yet access to cessation programming is reduced. The Increasing Digital Equity and Access (IDEA) study aims to evaluate three digital access and literacy interventions for promoting engagement with an online evidence-based smoking cessation treatment (EBCT) program among rural adults.

The pilot trial will use a pragmatic, three-arm, randomized, parallel-group design with participants recruited from a Midwest community-based health system in Minnesota, Wisconsin, and Iowa. All participants will receive an online, 12-week, EBCT program, and written materials on digital access resources. Participants will be stratified based on state of residence and randomly assigned with 111 allocation to one of three study groups (1) Control Condition-no additional study intervention (n=30); (2) Loaner Digital Device-Bluetooth enabled iPad with data plan coverage loaned for the study duration (n=30); (3) Loaner Digital Device + Coaching Support-loaner device plus up to six, 15-20min motivational interviewing-based coaching calls to enhance participants' digital access and literacy (n=30). All participants will complete study assessments at baseline and 4- and 12-weeks post-randomization. Outcomes are cessation program and trial engagement, biochemically confirmed smoking abstinence, and patient experience.

A rural community advisory committee was formed that fostered co-design of the study protocol for relevance to rural populations, including the trial design and interventions.

Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities.
Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities.
Tobacco use is increasing among youth in the U.S. The current study seeks to develop and pilot test a universal group-based Youth Brief Tobacco Intervention (Y-BTI) plus mobile phone automated text messaging (ATM) for 9th grade students to both prevent initiation among non-users and promote cessation among current users.

This study will use a sequential, multi-method research design beginning with mixed methods formative work with 9th grade students to adapt the existing young adult Brief Tobacco Intervention (BTI) for youth and develop automated text messages. The formative work with students will identify salient themes and strategies for the interventions and optimal delivery schedules for the ATM intervention. The second phase of the study evaluates the Y-BTI and ATM through a pilot cluster randomized controlled trial that compares four treatment combinations (1) Y-BTI+ATM, (2) Y-BTI alone, (3) ATM alone, or (4) standard of care. The Y-BTI is a single session, group-based intervention delivered in schools.
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