Search Results (165)

Background/Objectives: The continued evolution and cross-species transmission of clade 2.3.4.4b H5Nx highly pathogenic avian influenza (HPAI) viruses underscores the need for broadly protective vaccines in swine, a key intermediary host. This study aimed to evaluate systemic and mucosal immune responses elicited by adenoviral-vectored (Ad) vaccines encoding a centralized consensus hemagglutinin antigen (H5CC) in mice and swine. Methods: We constructed H5CC-based vaccines that were delivered using replication-defective (Ad5 and Ad6) and replication-competent (Ad28 and Ad48) human adenoviral vectors. Using a serotype-switched prime-boost strategy, vaccines were delivered intramuscularly (IM) or intranasally (IN) in mice and swine. We determined humoral, mucosal, and cell-mediated immune responses by hemagglutination inhibition (HI), microneutralization assay (MNA), ELISA, and IFN-γ ELISpot. Protective efficacy was evaluated by lethal H5N1 challenge in mice. Results: All vaccine strategies and routes induced significant levels of anti-H5 immunity. Ad5/Ad6 IM immunization elicited strong systemic IgG and MNA titers and robust T cell responses. IN delivery with Ad5/Ad6 induced superior mucosal IgA levels in lungs and nasal secretion. In swine, Ad5/Ad6 IM conferred the highest MNA titer and T cell responses, while the IN route enhanced mucosal IgA. The Ad28/Ad48 vaccines induced immunity in a similar pattern as compared to the Ad5/Ad6 strategy, but to a slightly lesser degree, in general. The commercial H1/H3 swine influenza vaccine failed to elicit cross-protective immunity. All H5CC vaccinated mice survived lethal H5N1 challenge without weight loss. Conclusions: Adenoviral-vectored H5CC vaccines elicit broad, cross-clade immunity with route-dependent immune profiles. IM vaccination is optimal for systemic and cellular responses, while IN delivery enhances mucosal immunity. These findings support the advancement of adenoviral platforms for influenza control in swine and pandemic preparedness. Full article

Context: As quantum technologies advance with innovations in cardiovascular medicine, it can be challenging to distinguish genuine clinical progress from mere ideas. There will also be difficult transitions involved in moving technology from proof of concept demonstrated in the lab. This transition is complicated by the excitement and hype that comes with any new technology. Aim: This work aims to assess what quantum technologies are available in cardiovascular medicine for real-world use, to identify which applications are closer to clinically relevant translation, and to differentiate realistic advances from advanced-not-yet realities. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, IEEE Xplore, and arXiv. While real-world use of technologies was prioritized, we included all theoretical literature, regardless of date of publication. Search terms were a combination of the vocabulary of quantum technologies and the vocabulary of cardiovascular medicine. Peer-reviewed publications included primary research, reviews, theoretical works, and conference proceedings. Two reviewers independently screened all citations, and any disagreements were resolved through consensus discussion. Results: We identified three core application areas: (1) quantum sensing, such as cardiac magnetometry, where there is potential for SQUID magnetocardiography to be used for detecting cardiomyopathy; (2) quantum computing for cardiovascular risk prediction, and (3) next-generation quantum sensors for mobile cardiac imaging. Conclusions: Quantum technology in cardiovascular medicine represents modest promise in select applications, most notably, magnetocardiography. To go from “hype to hope”, clinical trials will be required to identify application domains where quantum technologies outweigh the challenges of implementation in clinical practice. Full article

Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus, diagnosed based on clinical symptoms and elevated eosinophil counts in esophageal mucosal biopsies. While endoscopic biopsy remains the gold standard for diagnosing and monitoring this disease, the average child with EoE receives at minimum yearly endoscopy. There are risks and high costs associated with repeated procedures. Studies have been developed to evaluate less invasive methods for disease diagnosis and surveillance. We will be reviewing the current literature on noninvasive biomarkers in eosinophilic esophagitis, including specific levels of markers in blood, urine, stool, and saliva samples, as well as the esophageal string test. To date, there are no consensus statements recommending the use of noninvasive biomarkers in symptomatic patients or in asymptomatic patients. Only the esophageal string test has been formally accepted as a potential alternative to endoscopic surveillance by the American Society for Gastrointestinal Endoscopy Consensus Conference. Further studies need to be conducted to validate the use of biomarkers in diagnosing and monitoring this disease. Full article

Background/Objectives: Tumor budding (TB)—clusters of one to five tumor cells at the invasive front—has emerged as a prognostic marker in various cancers. Its prognostic value in head and neck squamous cell carcinoma (HNSCC) is unclear. Methods: We retrospectively analyzed 98 HNSCC patients. The tumor buds were counted on hematoxylin–eosin-stained sections as per the 2016 International Tumor Budding Consensus Conference (ITBCC) guidelines. An optimal cutoff was determined by ROC analysis using excisional lymph nodes and five-year overall survival (OS) as the endpoint, stratifying patients into low- (≤4 buds) and high-risk (>4 buds) groups. The associations with clinicopathological features, OS, and disease-free survival (DFS) were assessed using Kaplan–Meier curves and Cox regression. Results: Among the 98 patients (median follow-up 58 months, range 18–108), 32 (32.7%) died. The optimal TB cutoff was 4.5 (AUC 0.85, 95% CI 0.76–0.93). High TB was associated with poorer five-year OS (26.4% vs. 85.3%). Multivariate Cox regression identified TB and extranodal extension as independent predictors of OS (TB HR: 3.4, 95% CI 1.3–9.2, p = 0.013). In the laryngeal cancer subgroup, TB was associated with worse survival in the univariate analysis (HR 7.5, 95% CI 1.6–35.6, p = 0.011), though this was not significant in the multivariate modeling. High TB independently predicted neck lymph node metastasis (multivariate OR 4.9, 95% CI 1.2–20.5, p = 0.029), which was present in 65.8% of the high-TB vs. 31.7% of the low-TB patients. High TB correlated with advanced AJCC stage and lymphovascular invasion. No clinicopathological factors, including TB, independently predicted DFS, in either the full cohort or the laryngeal subgroup. Conclusions: High tumor budding denotes an aggressive HNSCC phenotype and may guide decisions on elective neck dissection. Its assessment is simple, cost-effective, and potentially valuable for routine pathology, pending external validation. Full article

The 26th annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Saskatoon, Saskatchewan, on 17–18 October 2024. The WCGCCC is an interactive multidisciplinary conference that was attended by healthcare professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) who are involved in the care of patients with hepatocellular and biliary tract cancers. Specialists from the fields of medical and radiation oncology, interventional radiology, pathology and laboratory medicine, and general and hepatobiliary surgery participated in presentations and discussions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of hepatocellular and biliary tract cancers. Full article

Background: Diabetic kidney disease (DKD) affects 20–50% of individuals with diabetes. The aim of this review was to identify interventions that positively influence the gut microbiota in DKD. Methods: Identification of relevant studies was conducted via a systematic search of databases and registers using the PRISMA guidelines. This review examined the relevant literature published up to 5 January 2025, using a systematic search in PubMed and Scopus. The search was conducted with combinations of keywords including DKD and therapy, supplementation and gut microbiota, and supplementation or probiotics or fecal microbiota transplant. The initial search fielded 132 results from PubMed and 72 from Scopus, which was narrowed to 135 relevant studies. The exclusion criteria included non-English language studies, letters to the editor, and conference abstracts. Eligible studies were independently assessed by a minimum of three authors, with discrepancies resolved through consensus. Results: Gut microbiota-targeted interventions, including probiotics, synbiotics, and dietary modifications, show promise in modulating the gut microbiota, but evidence specific to DKD remains limited. Some natural food components such as polyphenols and anthocyanins modulate the composition of the gut microbiota translocation of uremic toxins, which slows down the progression of diabetic kidney disease. In animal models, fecal microbiota transplantation (FMT) has shown positive effects in regulating dysbiosis and beneficial effects in chronic kidney disease, but studies involving humans with DKD are insufficient. Conclusions: Lactobacillus and Bifidobacterium strains, administered at doses ranging from 0.6 to 90 billion CFU, may help lower urea and creatinine levels, but outcomes vary by disease stage, duration of therapy, and amount used. High-fiber diets (>10.1 g/1000 kcal/day) and supplements such as resistant starch and curcumin (400–1500 mg/day) may reduce uremic toxins through gut microbiota modulation and reduction in oxidative stress. The effect of sodium butyrate requires further human studies. Full article

Background: Oligometastatic non-small cell lung cancer (NSCLC) represents a biologically and clinically distinct state characterized by limited metastatic spread. Increasing evidence suggests that aggressive local therapies, including surgical resection, may confer a survival benefit in this population. The objective of this review is to evaluate the current role of surgery in the management of oligometastatic NSCLC, with emphasis on patient selection, surgical strategy, integration with systemic therapy, and ongoing clinical investigations. Methods: This narrative review synthesizes retrospective and prospective clinical data, meta-analyses, major consensus guidelines, and ongoing trials since 2012. We highlight prognostic factors, staging strategies, and the evolving role of molecular and biomarker-based stratification. Results: Multiple retrospective studies and several randomized trials have demonstrated improved progression-free and overall survival with local consolidative therapy in oligometastatic NSCLC. Prognostic factors associated with favorable outcomes include a limited number of metastases (≤3), good performance status, absence of mediastinal nodal disease, metachronous presentation, and actionable molecular alterations. The integration of surgery with systemic therapies, including targeted agents and immunotherapy, has become increasingly common in selected patients. Ongoing trials such as LONESTAR, NORTHSTAR, and BRIGHTSTAR are expected to further define the role of surgery in this setting. Conclusions: Surgery is emerging as a key component of multimodal treatment for carefully selected patients with oligometastatic NSCLC. Future efforts should focus on refining patient selection through molecular stratification and expanding prospective trial data to guide personalized biology-driven treatment strategies. Full article

Background: While dental implants have become a reliable solution for tooth loss, their long-term success is increasingly challenged by biological and technical complications such as impact fracture and peri-implantitis. These complications significantly impact implant longevity and patient satisfaction. Aim: This consensus conference aimed to identify and standardize clinical guidelines to prevent implant fractures and peri-implant diseases based on current evidence and expert opinions. Methods: A panel of 10 expert clinicians and researchers in prosthodontics participated in the Osstem Global Consensus Meeting. This paper focuses on the prosthetic division. A structured literature review was conducted, and evidence was synthesized to formulate consensus-based clinical recommendations. Participants answered structured questions and discussed discrepancies to achieve consensus. Results: The panel reached consensus on several key prosthetic risk factors, including (1) the role of biomechanical overload in implant fracture, (2) the impact of emergence profile design on peri-implant tissue stability, (3) the influence of implant positioning and connection geometry on marginal bone loss, and (4) the importance of occlusal scheme and restorative material selection, particularly in high-risk patients such as bruxers. Guidelines to prevent implant fracture and peri-implantitis were developed, addressing these factors with practical preventive strategies. Conclusions: Despite the limitations of narrative methodology and reliance on retrospective data and expert opinion, this consensus provides clinically relevant guidelines to aid in the prevention of mechanical failures and peri-implant diseases. The recommendations emphasize prosthetically driven planning, individualized risk assessment, and early intervention to support long-term implant success. Full article

Mobile technology advancements have led to cellphone bans in some school jurisdictions. The basis of these bans is judging their utilization by students as unhealthy, antisocial, and educationally controversial. Banning student cellphones neglects the positive mental health of cellphone use that comes from self-directed learning in students using them in the co-creation of virtual worlds through online communities. This scoping review examines peer-reviewed research from 2021–2025 demonstrating positive mental health value in self-directed mobile technology use through co-creating virtual worlds. The searches are of seven primary databases and one supplementary database, using the keywords “self-directed learning AND mobile technology AND co-creation AND virtual worlds”. Excluded are reviews, book chapters, abstracts, and conference proceedings. The assessment of the findings is that cellphone use promotes a combination of self-directed learning and consensus decision-making, and provides mental health benefits when virtual worlds are co-created by students permitted their use. Appraising these results—regarding self-directed learning, consensus decision-making, and student mental health—the conclusion is that in contemplating the school cellphone use of mobile technology, educators rethink banning their classroom use. The aim would be to support the co-creation of virtual worlds to promote increased self-direction, consensus decision-making, and positive mental health. Full article

Background: Post-intensive care syndrome encompasses physical, cognitive, and psychological impairments that persist in patients after discharge from an intensive care unit. There is considerable variation in the tools used for assessment. This systematic review aimed to summarize the consensus-based recommendations for assessing post-intensive care syndrome. Methods: A comprehensive literature search identified four consensus-based guidelines. A quality assessment carried out using the Appraisal of Guidelines for Research and Evaluation II tool demonstrated high methodological standards across all the included papers. Results: The guidelines consistently emphasize assessing cognition, mental health, and physical function as the core domains. However, there are notable differences in the specific tools recommended. Major et al. focused on physical examinations, while Mikkelsen et al. proposed a fundamental package of five tools covering the key domains. Spies et al. aimed for a pragmatic set of freely available instruments administrable within 30 min. Nakanishi et al. provided a detailed ranking of instruments for each domain. The availability of validated translations varied considerably across languages. Some tools developed specifically for post-intensive care syndrome were not considered by any consensus conference. Conclusions: Further work is needed to establish a universally accepted standard for assessing post-intensive care syndrome that considers practical implementation across diverse settings and languages. Full article

Background/objectives: According to the Chapel Hill Consensus Conference nomenclature, single-organ cutaneous small vessel vasculitis (SOCV) is defined histopathologically by immune complex-mediated vasculitis of the dermal capillaries/venules without systemic involvement. There is a lack of investigations studying predictors of SOCV outcomes. This multicenter retrospective study aimed to assess whether baseline serum liver scores could predict SOCV recurrence. Methods: Data from 204 inpatients with histopathologically confirmed idiopathic SOCV treated between 2000 and 2022 were analyzed. All patients had baseline blood tests for platelets and liver parameters; those with systemic diseases were excluded. The study evaluated the AST to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) index, and De Ritis ratio (DRR). Results: Recurrence was observed in 17.6% of patients. Univariable analysis identified hospital stay length, DRR, cutaneous extent, and cardiovascular comorbidities as predictors, but logistic regression confirmed only cutaneous extent and DRR as independent predictors of disease recurrence. Conclusions: A higher DRR (cut-off > 1.13) may indicate necrosis from reduced blood flow, making it a potential predictor of SOCV recurrence. Full article

Most premature adult deaths and chronic diseases, with their associated costs, are directly related to unhealthy behaviors, particularly poor nutrition. The 2022 White House Conference on Hunger, Nutrition, and Health emphasized the importance of nutrition equity and security as a key to preventing chronic diseases. What and how we eat also have important environmental impacts, with 26% of anthropogenic greenhouse gas emissions attributed to the total food supply chain, primarily ultra-processed food (UPF) production. A new paradigm is needed to better educate patients and the public to adopt healthier eating behaviors. Culinary education, emphasizing skills such as shopping, food storage, and meal preparation is a burgeoning field, aimed at reducing UPF consumption and improving nutrition while addressing cultural and socioeconomic factors. The term Culinary Medicine (CM) is becoming popular in describing these interventions; however, a consensus on its definition has not yet been reached. There are no consensual curricular outlines and/or competencies, and the potential for addressing food security and equity has not yet been fully developed. We believe that consensual competencies will formalize CM and ensure appropriate outcomes followed by improved assessments of learners, thus promoting CM research and further implementation of this novel nutrition education approach. Full article

Background/Objectives: Chronic bacterial prostatitis (CBP) is a prevalent urological condition significantly impacting patients’ quality of life. Accurate diagnosis is essential to differentiate bacterial from non-bacterial prostatitis and to guide appropriate antimicrobial therapy. In the context of antimicrobial resistance (AMR), the Meares and Stamey (M&S) test is a valuable diagnostic tool for targeted antibiotic use and a valuable antimicrobial stewardship (AMS) measure. Despite its clinical relevance, its adoption is limited by practical and logistical challenges. Methods: Relevant databases were searched by using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The keywords used included “Meares and Stamey test,” “antimicrobial stewardship and prostatitis,” and “chronic bacterial prostatitis and Meares.” Results: We enclosed seven studies: one single-center prospective observational comparative study, two national surveys, three cross-sectional studies, and one consensus conference. The M&S test remains the gold standard for diagnosing CBP, offering high specificity in identifying bacterial infections localized within the prostate. The test enables precise pathogen identification and facilitates targeted antimicrobial therapy. Despite its clinical relevance, its adoption is hindered by procedural complexity, patient discomfort, and the apparent need for specialized personnel and facilities. Alternative diagnostic methods, such as the two-glass pre- and post-massage test (PPMT), have demonstrated comparable diagnostic sensitivity while being more practical and time-efficient. Additionally, emerging microbiological techniques are under investigation to increase the M&S test’s sensitivity. Conclusions: The M&S test plays a crucial role in AMS by ensuring targeted antimicrobial therapy in CBP. Overcoming its limitations through patient stratification, clinician education, and the integration of emerging microbiological techniques is essential to enhance its applicability in modern urological practice. Full article

The Eastern Canadian Gastrointestinal Cancer Consensus Conference was an annual meeting that was held in St. John’s, Newfoundland and Labrador, from 26 to 28 September 2024. This included experts in medical oncology, radiation oncology, surgical oncology, nuclear medicine, and general practitioners in oncology (GPO) from across the eastern Canadian provinces who are involved in the management of patients with gastrointestinal malignancies. This consensus statement generated by the conference addresses multiple topics, including the management of localized rectal cancer, liver-limited colorectal cancer, systemic therapy for advanced biliary tract cancers, radioligand therapy for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), systemic therapy for pancreatic and midgut well-differentiated NETs, and systemic therapy for HER2-positive gastroesophageal cancers. Full article

Background/Objectives: There is still no consensus as to whether patients with upfront resectable synchronous colorectal liver metastases (sCRLM) should receive neoadjuvant treatment prior to liver surgery. Two randomized controlled trials have assessed the role of peri-operative chemotherapy in sCRLM; neither have shown a survival benefit in the neoadjuvant group. The aim of this population-based study was to examine overall survival in patients treated with neoadjuvant chemotherapy and hepatectomy compared to patients who had upfront surgery. Methods: This is a retrospective observational study between 2009 and 2017 containing data extracted from two Swedish national registries. Descriptive statistics and Cox regression analyses were employed. Results: In total, 2072 patients with sCRLM were treated with liver surgery between 2009 and 2017. A majority (n = 1238, 60%) were treated with neoadjuvant chemotherapy, and 834 patients (40%) had upfront surgery. Patients in the upfront surgery group were older (median age 70 compared to 65 years, p ≤ 0.001). Median overall survival in the upfront surgery group was 26 months (95% CI 23–29 months) compared to 57 months (95% CI 42–48 months) in the neoadjuvant group, log rank p ≤ 0.001. In the multivariable Cox regression analysis, age ≥ 70 years (HR 1.46, 95% CI 1.25–1.70), T category of primary cancer (HR 1.41, 95% CI 1.09–1.84), lymphatic spread of primary cancer (HR 1.68, 95% CI 1.41–1.99), and number of liver metastases (six or more metastases resulted in HR 2.05, 95% CI 1.38–3.01) negatively influenced overall survival. By contrast, adjuvant therapy was protective (HR 0.80, 95% CI 0–69–0.94), whereas neoadjuvant treatment compared to upfront surgery did not influence overall survival (HR 1.04, 95% CI 0.86–1.26). Conclusions: Neoadjuvant treatment in sCRLM did not confer a survival benefit compared to upfront surgery. Full article