Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey.

OBJECTIVES: This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. STUDY DESIGN: The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. METHODS: Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. RESULTS: Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043). CONCLUSIONS: Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

Colorectal cancer: the facts in the case of the microbiota.

The importance of the microbiota in the development of colorectal cancer (CRC) is increasingly evident, but identifying specific microbial features that influence CRC initiation and progression remains a central task for investigators. Studies determining the microbial mechanisms that directly contribute to CRC development or progression are revealing bacterial factors such as toxins that contribute to colorectal carcinogenesis. However, even when investigators have identified bacteria that express toxins, questions remain about the host determinants of a toxin's cancer-potentiating effects. For other cancer-correlating bacteria that lack toxins, the challenge is to define cancer-relevant virulence factors. Herein, we evaluate three CRC-correlating bacteria, colibactin-producing Escherichia coli, enterotoxigenic Bacteroides fragilis, and Fusobacterium nucleatum, for their virulence features relevant to CRC. We also consider the beneficial bioactivity of gut microbes by highlighting a microbial metabolite that may enhance CRC antitumor immunity. In doing so, we aim to elucidate unique and shared mechanisms underlying the microbiota's contributions to CRC and to accelerate investigation from target validation to CRC therapeutic discovery.

Fusobacterium nucleatum drives a pro-inflammatory intestinal microenvironment through metabolite receptor-dependent modulation of IL-17 expression.

The colorectal cancer (CRC)-associated microbiota creates a pro-tumorigenic intestinal milieu and shapes immune responses within the tumor microenvironment. However, how oncomicrobes - like Fusobacterium nucleatum, found in the oral cavity and associated with CRC tissues- affect these distinct aspects of tumorigenesis is difficult to parse. Herein, we found that neonatal inoculation of ApcMin/+ mice with F. nucleatum strain Fn7-1 circumvents technical barriers preventing its intestinal colonization, drives colonic Il17a expression prior to tumor formation, and potentiates intestinal tumorigenesis. Using gnotobiotic mice colonized with a minimal complexity microbiota (the altered Schaedler's flora), we observed that intestinal Fn7-1 colonization increases colonic Th17 cell frequency and their IL-17A and IL-17F expression, along with a concurrent increase in colonic lamina propria Il23p19 expression. As Fn7-1 stably colonizes the intestinal tract in our models, we posited that microbial metabolites, specifically short-chain fatty acids (SCFA) that F. nucleatum abundantly produces in culture and, as we demonstrate, in the intestinal tract, might mediate part of its immunomodulatory effects in vivo. Supporting this hypothesis, we found that Fn7-1 did not alter RORγt+ CD4+T cell frequency in the absence of the SCFA receptor FFAR2. Taken together, our work suggests that F. nucleatum influences intestinal immunity by shaping Th17 responses in an FFAR2-dependent manner, although further studies are necessary to clarify the precise and multifaceted roles of FFAR2. The potential to increase intestinal Th17 responses is shared by another oncomicrobe, enterotoxigenic Bacteroides fragilis, highlighting a conserved pathway that could potentially be targeted to slow oncomicrobe-mediated CRC.

The mannose receptor (CD206) identifies a population of colonic macrophages in health and inflammatory bowel disease.

To understand the contribution of mononuclear phagocytes (MNP), which include monocyte-derived intestinal macrophages, to the pathogenesis of inflammatory bowel disease (IBD), it is necessary to identify functionally-different MNP populations. We aimed to characterise intestinal macrophage populations in patients with IBD. We developed 12-parameter flow cytometry protocols to identify and human intestinal MNPs. We used these protocols to purify and characterize colonic macrophages from colonic tissue from patients with Crohn's disease (CD), ulcerative colitis (UC), or non-inflamed controls, in a cross-sectional study. We identify macrophage populations (CD45+CD64+ HLA-DR+) and describe two distinct subsets, differentiated by their expression of the mannose receptor, CD206. CD206+ macrophages expressed markers consistent with a mature phenotype: high levels of CD68 and CD163, higher transcription of IL-10 and lower expression of TREM1. CD206- macrophages appear to be less mature, with features more similar to their monocytic precursors. We identified and purified macrophage populations from human colon. These appear to be derived from a monocytic precursor with high CCR2 and low CD206 expression. As these cells mature, they acquire expression of IL-10, CD206, CD63, and CD168. Targeting the newly recruited monocyte-derived cells may represent a fruitful avenue to ameliorate chronic inflammation in IBD.

Music for Wellness in rehabilitation patients: programme description and evaluation results.

OBJECTIVE: The evaluation of real-world, hospital-based, arts programmes is important for quality assurance, to increase knowledge of successful practice and awareness of effective arts-health collaborations. The objective of this study was to describe the Music for Wellness programme and evaluation at St John of God Frankston Rehabilitation Hospital, Australia. STUDY DESIGN: An impact evaluation and quasi-experimental pre-post study was conducted. METHODS: The Music for Wellness programme for rehabilitation patients ran on a weekly basis for 18 weeks (i.e., 18 stand-alone workshops). Evaluation feedback was collected from patients and hospital staff/visitors. The primary outcome measures were pre-post workshop changes in patients' mood, measured via a 'faces' visual analogue scale; and pain, measured via a numerical rating scale. Linear mixed models and growth curve analyses were performed. Evaluation questions about mental well-being, pain reduction, musical skill attainment and the hospital environment were also asked and, a descriptive analysis was conducted. RESULTS: Between the baseline, preworkshop and postworkshop time points, a significant increase in rehabilitation patients' mood and decrease in self-reported pain were found. Changes were consistent over time. The patients and hospital staff/visitors agreed the programme enhanced the hospital environment and music skills, resulted in positive benefits (e.g., relaxation, opportunity to socialise) and should be continued. CONCLUSION: This study provides valuable information about a low-cost, non-pharmacological programme that successfully enhanced the hospital environment and supported patients' well-being in a rehabilitation setting.

Regulatory T cells control the dynamic and site-specific polarization of total CD4 T cells following Salmonella infection.

FoxP3+ regulatory T cells (Tregs) control inflammation and maintain mucosal homeostasis, but their functions during infection are poorly understood. Th1, Th2, and Th17 cells can be identified by master transcription factors (TFs) T-bet, GATA3, and RORγT; Tregs also express these TFs. While T-bet+ Tregs can selectively suppress Th1 cells, it is unclear whether distinct Treg populations can alter Th bias. To address this, we used Salmonella enterica serotype Typhimurium to induce nonlethal colitis. Following infection, we observed an early colonic Th17 response within total CD4 T cells, followed by a Th1 bias. The early Th17 response, which contains both Salmonella-specific and non-Salmonella-specific cells, parallels an increase in T-bet+ Tregs. Later, Th1 cells and RORγT+ Tregs dominate. This reciprocal dynamic may indicate that Tregs selectively suppress Th cells, shaping the immune response. Treg depletion 1-2 days post-infection shifted the early Th17 response to a Th1 bias; however, Treg depletion 6-7 days post-infection abrogated the Th1 bias. Thus, Tregs are necessary for the early Th17 response, and for a maximal Th1 response later. These data show that Tregs shape the overall tissue CD4 T cell response and highlight the potential for subpopulations of Tregs to be used in targeted therapeutic approaches.

River channel conveyance capacity adjusts to modes of climate variability.

River networks are typically treated as conduits of fixed discharge conveyance capacity in flood models and engineering design, despite knowledge that alluvial channel networks adjust their geometry, conveyance, planform, extent and drainage density over time in response to shifts in the magnitude and frequency of streamflows and sediment supply. Consistent relationships between modes of climate variability conducive to wetter-/drier-than-average conditions and changes in channel conveyance have never been established, hindering geomorphological prediction over interannual to multidecadal timescales. This paper explores the relationship between river channel conveyance/geometry and three modes of climate variability (the El Niño-Southern Oscillation, Atlantic Multidecadal Oscillation, and Arctic Oscillation) using two-, five- and ten-year medians of channel measurements, streamflow, precipitation and climate indices over seven decades in 67 United States rivers. We find that in two thirds of these rivers, channel capacity undergoes coherent phases of expansion/contraction in response to shifts in catchment precipitation and streamflow, driven by climate modes with different periodicities. Understanding the sensitivity of channel conveyance to climate modes would enable better river management, engineering design, and flood predictability over interannual to multidecadal timescales.

[Concerns about child´s surgery. Are there differences if you belong to health sector?] / La preocupación ante la cirugía de un hijo. ¿Hay diferencias si perteneces al sector sanitario?

INTRODUCTION: A surgical intervention is a stress situation for every human being. Parents of children who undergo scheduled surgeries have some degree of anxiety about them. OBJECTIVE: To identify the main paternal concerns regarding surgery. Assess the influence of working in health (nurses, auxiliary staff and doctors) to underestimate, magnify or mislead the real concerns. MATERIAL AND METHOD: A comparative cross-sectional study was conducted between two populations divided by their relationship with the hospital setting that completed a questionnaire with 35 items. 138 questionnaires were collected and analyzed. RESULTS: Differences are observed regarding the perception we have, as hospital staff, of the levels, relationships and types of concerns that we believe parents present before their child's surgery regarding the true perceptions that these parents present. CONCLUSION: The present study shows that, although the hospital staff has experience in the management of pediatric patients and their family environment, the habituation to the hospital environment can generate small distortions in terms of the levels and groupings of the different concerns present before the hospital surgery of a child, having to take it into account to offer the best care work.

INTRODUCCION: Una intervención quirúrgica es una situación de estrés para todo ser humano. Los padres de niños que se someten a cirugías programadas presentan cierto grado de ansiedad con respecto a las mismas. OBJETIVO: El objetivo del presente estudio es identificar las principales preocupaciones paternas frente a la cirugía y valorar si la pertenencia laboral al mundo sanitario (enfermeros, personal auxiliar y médicos, principalmente) supone infravalorar, magnificar o equivocar dichas preocupaciones reales. MATERIAL Y METODOS: Se realizó un estudio transversal comparativo entre dos poblaciones divididas por su relación o no con el ámbito hospitalario que cumplimentaron un cuestionario con 37 ítems. Se recogieron y analizaron 138 cuestionarios. RESULTADOS: Se observan diferencias en cuanto a la percepción que tenemos, nosotros, como personal hospitalario, de los niveles, de las relaciones y los tipos de preocupaciones que creemos presentan los padres ante la cirugía de su hijo respecto a las verdaderas percepciones que presentan estos padres sin las vivencias diarias de una persona que trabaja en el mundo hospitalario. en dos ML al suspender el tratamiento. Tres pacientes presentaron hipertransaminasemia e hipercolesterolemia, sin precisar tratamiento médico. CONCLUSIONES: El presente estudio pone de manifiesto que, aunque el personal hospitalario tenga la experiencia sobre el manejo de pacientes pediátricos y su entorno familiar y, a pesar incluso, de poder tener hijos propios a su cargo, parece que la habituación a dicho ambiente hospitalario puede generar pequeñas distorsiones en cuanto a los niveles reales y a las agrupaciones de las distintas preocupaciones presentes ante la cirugía de un hijo. Esto debería tenerse en cuenta para ofrecer la mejor labor asistencial y mejorar el nivel de ansiedad que genera una intervención quirúrgica en el entorno familiar del paciente pediátrico.

La preocupación ante la cirugía de un hijo. ¿Hay diferencias si perteneces al sector sanitario? / Concerns about child's surgery. ¿Are there differences if you belong to health sector?

Introducción: Una intervención quirúrgica es una situación de estrés para todo ser humano. Los padres de niños que se someten a cirugías programadas presentan cierto grado de ansiedad con respecto a las mismas. Objetivo. El objetivo del presente estudio es identificar las principales preocupaciones paternas frente a la cirugía y valorar si la pertenencia laboral al mundo sanitario (enfermeros, personal auxiliar y médicos, principalmente) supone infravalorar, magnificar o equivocar dichas preocupaciones reales. Material y métodos: Se realizó un estudio transversal comparativo entre dos poblaciones divididas por su relación o no con el ámbito hospitalario que cumplimentaron un cuestionario con 37 ítems. Se recogieron y analizaron 138 cuestionarios. Resultados: Se observan diferencias en cuanto a la percepción que tenemos, nosotros, como personal hospitalario, de los niveles, de las relaciones y los tipos de preocupaciones que creemos presentan los padres ante la cirugía de su hijo respecto a las verdaderas percepciones que presentan estos padres sin las vivencias diarias de una persona que trabaja en el mundo hospitalario. Conclusiones: El presente estudio pone de manifiesto que, aunque el personal hospitalario tenga la experiencia sobre el manejo de pacientes pediátricos y su entorno familiar y, a pesar incluso, de poder tener hijos propios a su cargo, parece que la habituación a dicho ambiente hospitalario puede generar pequeñas distorsiones en cuanto a los niveles reales y a las agrupaciones de las distintas preocupaciones presentes ante la cirugía de un hijo. Esto debería tenerse en cuenta para ofrecer la mejor labor asistencial y mejorar el nivel de ansiedad que genera una intervención quirúrgica en el entorno familiar del paciente pediátrico

Introduction: A surgical intervention is a stress situation for every human being. Parents of children who undergo scheduled surgeries have some degree of anxiety about them. Objective. To identify the main paternal concerns regarding surgery. Assess the influence of working in health (nurses, auxiliary staff and doctors) to underestimate, magnify or mislead the real concerns.. Material and method: A comparative cross-sectional study was conducted between two populations divided by their relationship with the hospital setting that completed a questionnaire with 35 items. 138 questionnaires were collected and analyzed. Results: Differences are observed regarding the perception we have, as hospital staff, of the levels, relationships and types of concerns that we believe parents present before their child's surgery regarding the true perceptions that these parents present. Conclusion: The present study shows that, although the hospital staff has experience in the management of pediatric patients and their family environment, the habituation to the hospital environment can generate small distortions in terms of the levels and groupings of the different concerns present before the hospital surgery of a child, having to take it into account to offer the best care work

Salmonella enterica Serovar Typhimurium Travels to Mesenteric Lymph Nodes Both with Host Cells and Autonomously.

Salmonella infection is a globally important cause of gastroenteritis and systemic disease and is a useful tool to study immune responses in the intestine. Although mechanisms leading to immune responses against Salmonella have been extensively studied, questions remain about how bacteria travel from the intestinal mucosa to the mesenteric lymph nodes (MLN), a key site for Ag presentation. In this study, we used a mouse model of infection with Salmonella enterica serovar Typhimurium (STM) to identify changes in intestinal immune cells induced during early infection. We then used fluorescently labeled STM to identify interactions with immune cells from the site of infection through migration in lymph to the MLN. We show that viable STM can be carried in the lymph by any subset of migrating dendritic cells but not by macrophages. Moreover, approximately half of the STM in lymph are not associated with cells at all and travel autonomously. Within the MLN, STM associates with dendritic cells and B cells but predominantly with MLN-resident macrophages. In conclusion, we describe the routes used by STM to spread systemically in the period immediately postinfection. This deeper understanding of the infection process could open new avenues for controlling it.

Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures: What Are the Latest Data?

Osteoporotic vertebral compression fractures frequently result in significant morbidity and health care resource use. For patients with severe and disabling pain, vertebral augmentation (vertebroplasty and kyphoplasty) is often considered. Although vertebroplasty was introduced >30 years ago, there are conflicting opinions regarding the role of these procedures in the treatment of osteoporotic vertebral compression fractures. This review article updates clinicians on the published prospective randomized controlled data, including the most recent positive trials that followed initial negative trials in 2009. Analysis of multiple national claim datasets has also provided further insight into the utility of these procedures. Finally, we considered the recent recommendations of national organizations and medical societies that advise on the use of vertebral augmentation procedures for osteoporotic vertebral compression fractures.

Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies.

BACKGROUND AND PURPOSE: Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. MATERIALS AND METHODS: We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3. RESULTS: We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64). CONCLUSIONS: Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.

TICI and Age: What's the Score?

BACKGROUND AND PURPOSE: Previous studies have suggested that advanced age predicts worse outcome following mechanical thrombectomy. We assessed outcomes from 2 recent large prospective studies to determine the association among TICI, age, and outcome. MATERIALS AND METHODS: Data from the Solitaire FR Thrombectomy for Acute Revascularization (STAR) trial, an international multicenter prospective single-arm thrombectomy study and the Solitaire arm of the Solitaire FR With the Intention For Thrombectomy (SWIFT) trial were pooled. TICI was determined by core laboratory review. Good outcome was defined as an mRS score of 0-2 at 90 days. We analyzed the association among clinical outcome, successful-versus-unsuccessful reperfusion (TICI 2b-3 versus TICI 0-2a), and age (dichotomized across the median). RESULTS: Two hundred sixty-nine of 291 patients treated with Solitaire in the STAR and SWIFT data bases for whom TICI and 90-day outcome data were available were included. The median age was 70 years (interquartile range, 60-76 years) with an age range of 25-88 years. The mean age of patients 70 years of age or younger was 59 years, and it was 77 years for patients older than 70 years. There was no significant difference between baseline NIHSS scores or procedure time metrics. Hemorrhage and device-related complications were more common in the younger age group but did not reach statistical significance. In absolute terms, the rate of good outcome was higher in the younger population (64% versus 44%, P < .001). However, the magnitude of benefit from successful reperfusion was higher in the 70 years of age and older group (OR, 4.82; 95% CI, 1.32-17.63 versus OR 7.32; 95% CI, 1.73-30.99). CONCLUSIONS: Successful reperfusion is the strongest predictor of good outcome following mechanical thrombectomy, and the magnitude of benefit is highest in the patient population older than 70 years of age.

Size-exclusion chromatography of poly(ethylene 2,6-naphthalate).

A solvent mixture of 1,1,1,3,3,3-hexafluoro-2-propanol (HFIP) and dichloroacetic acid (DCAA) is used to dissolve difficultly soluble poly(ethylene 2,6-naphthalate) (PEN). Solutions can be diluted and analyzed in a common size-exclusion chromatography (SEC) eluent, HFIP. The HFIP/DCAA mixture is better at dissolving PEN than either solvent individually and it is easier and safer to work with than phenolic and strongly acidic eluents. Dissolution temperatures between 50 and 60 °C are sufficiently low to minimize hydrolytic degradation of the polyester. PEN does not dissolve in the solvent mixture if the water concentration is greater than 0.76 wt%, and preferably the water content should be less than 0.13 wt% to eliminate minor prepeak artifacts. The procedure is suitable for PEN that is less than 48% crystalline, including prepolymers, oriented films and some solid-state polymerized materials. Highly crystalline polymers can be melt-quenched into a more amorphous state to render them soluble. The dilute solution conformational properties of PEN are compared to PET in HFIP, and molar mass-intrinsic viscosity scaling constants and unperturbed dimensions are calculated from SEC data.

Prevention of postpartum smoking relapse in mothers of infants in the neonatal intensive care unit.

OBJECTIVE: Approximately 40% of women who smoke tobacco quit smoking during pregnancy, yet up to 85% relapse after delivery. Those who resume smoking often do so by 2 to 8 weeks postpartum. Smoking mothers are more than twice as likely to quit breastfeeding by 10 weeks postpartum. The hospitalization of a newborn, while stressful, is an opportunity to emphasize the importance of a smoke-free environment for babies. Supporting maternal-infant bonding may reduce maternal stress and motivate mothers to remain smoke free and continue breastfeeding. The objective of this study was to reduce postpartum smoking relapse and prolong breastfeeding duration during the first 8 weeks postpartum in mothers who quit smoking just before or during pregnancy and have newborns admitted to the Neonatal Intensive Care Unit (NICU). STUDY DESIGN: This study was an Institutional Review Board-approved prospective randomized clinical trial. After informed consent, mothers of newborns admitted to the NICU were randomized to a control or intervention group. Both groups received weekly encouragement to remain smoke free and routine breastfeeding support. Mothers in the intervention group were also given enhanced support for maternal-infant bonding including information about newborn behaviors, and were encouraged to frequently hold their babies skin-to-skin. RESULT: More mothers were smoke free (81 vs 46%, P<0.001) and breastfeeding (86 vs 21%, P<0.001) in the intervention than in the control group at 8 weeks postpartum. CONCLUSION: Interventions to support mother-infant bonding during a newborn's hospitalization in the NICU are associated with reduced rates of smoking relapse and prolonged duration of breastfeeding during the first 8 weeks postpartum.