Search Results (18)

The objectives of our study were to determine the mortality rates, causes, and risk factors of people living with HIV in the modern antiretroviral therapy era, in a major HIV center in Israel. We retrospectively collected data from 1547 patients treated during 2001–2021. We used the Shapiro–Wilk test, Fisher’s exact test, Student’s t test, and chi-square to compare between patients who died and those who did not, and between patients who died from AIDS-related and non-AIDS-related causes. In total, 206 (13.3%) patients died. The causes of death were AIDS-defining diseases (33.5%), cardiovascular diseases (21.8%), non-AIDS infections (16%), and hepatic disorders (7%). The annual mortality rate was 1.31 ± 0.3%. Despite an increase in age (35 ± 13.2 in 2001, 49 ± 13.6 years in 2021; p < 0.001), the mortality rate decreased (2.12% during 2005–2008, 0.71% during 2018–2021; p = 0.0001). AIDS-defining diseases caused 75% of deaths during 2001–2002, and only 25% during 2019–2021. The proportion of cardiovascular deaths increased (8.3% in 2001–2003, 33.3% in 2019–2021; p < 0.001). Low CD4 and high viral load at diagnosis, male gender, non-MSM HIV acquisition (heterosexual transmission and people who inject drugs), and inability to achieve viral suppression because of non-compliance were risk factors for mortality. Mortality rates decreased during 2001–2021; however, the proportion of non-AIDS deaths increased. Early cardiovascular comorbidity screening and targeted adherence interventions in non-MSM populations and in patients with low CD4 are needed. Full article

Background: Antiretroviral therapy (ART) has transformed HIV into a chronic manageable condition, yet metabolic toxicities including pancreatic enzyme alterations remain concerns. While older ART regimens have been associated with hyperamylasemia, the impact of integrase strand transfer inhibitor (INSTI)-based therapies on serum amylase levels has not been specifically examined. Purpose: This study aimed to compare longitudinal patterns of serum amylase levels between people living with HIV receiving INSTI-based versus NNRTI/PI-based ART regimens. Methods: This retrospective observational study analyzed 99 HIV-positive patients at Kaplan Medical Centre, Israel (2002–2023). Participants received either INSTI-based (n = 49) or NNRTI/PI-based (n = 50) regimens for ≥24 months. Serum amylase, viral load, CD4 counts, and metabolic parameters were measured at baseline, one year, and two years. Repeated-measures ANOVA assessed longitudinal changes. Results: NNRTI/PI-treated patients maintained significantly higher mean amylase levels throughout follow-up (baseline: 122.9 ± 42.1 U/L; two years: 129.6 ± 38.0 U/L) compared to INSTI-treated patients (baseline: 78.7 ± 32.3 U/L; two years: 68.4 ± 23.4 U/L; p < 0.0001 at all timepoints). A significant linear time-by-group interaction (p = 0.037) demonstrated divergent trajectories. No clinical pancreatitis was observed in either treatment group during the follow-up period, and all observed variations in serum amylase were biochemical and asymptomatic. While these findings are reassuring regarding acute pancreatic toxicity, the clinical significance of chronic subclinical enzyme elevations remains uncertain. Conclusion: INSTI-based antiretroviral regimens suggest a favorable pancreatic and metabolic safety profile compared with NNRTI/PI-based therapies. Full article

Jerusalem’s prominent building material of limestone and dolostone, which is commonly known as “Jerusalem stone”, characterizes the city’s architecture and built environment. The distinctive stone was quarried from the Jerusalem landscape, prepared as building stone, and transported to building sites, a process referred to in this paper as the “lithic journey”. While these ancient quarries have been identified in previous studies, new evidence identifies the characteristics and the spatial distribution of these quarries and the connections between them. This study examined over one hundred archeological reports resulting from mainly salvage excavations conducted in the last decade (2012–2024), which has enabled the creation of updated mapping. Data collected from the Hadashot Arkheologiyot: Excavations and Surveys in Israel (HA-ESI), are included in a database that classifies quarry types, building material provenance, and specific characteristics of the ancient quarries that supplied Jerusalem’s building stones. The resulting expanded dataset of this open-access, online resource broadens our understanding of the quarry landscape and the continuous use of stone in the city’s building culture, while also offering an understanding of Jerusalem’s urban development and the design of Jerusalem’s cityscape from antiquity to the present day, as well as contribute to the city’s heritage management. Full article

Slope stability is a critical factor in the mining industry, directly impacting operational safety and economic performance. In large open-pit mines, slope failures can cause work stoppages and significant financial losses. Regions like Mongolia, with their complex topography, irregular geometries, and heterogeneous rock conditions, present a particular challenge for assessing slope stability. Conventional two-dimensional (2D) slope stability analysis and deterministic approaches have limitations in accounting for these complex topographies, irregular pit geometries, and lateral resistance forces. For a large open-pit mine in Mongolia, this study applied three-dimensional (3D) analyses with varying slope widths, using both limit equilibrium and finite element methods, to achieve a more reliable stability assessment under complex topographic conditions. To further enhance the reliability of evaluations under heterogeneous rock mass conditions, probabilistic approaches were employed alongside traditional deterministic methods. This enabled a more accurate estimation of safety factors and the identification of potential failure zones. The comparative study results demonstrate that 3D and probabilistic analyses consistently show 17–20% higher factors of safety and lower probabilities of failure than conventional 2D deterministic analyses. These findings highlight the effectiveness of these advanced methods for reliable slope stability assessment in complex geological conditions. Ultimately, the results underscore the importance of incorporating 3D and probabilistic analyses for more accurate and reliable assessments in complex open-pit mining, thereby contributing to improved safety and optimized operational efficiency. Full article

Background/Objectives: Ochronosis is an uncommon metabolic condition caused by a deficiency of homogentisate 1,2-dioxygenase, leading to the accumulation of homogentisic acid (HGA) in connective tissues. This deposition of HGA in the joints can result in cartilage degeneration and advanced ochronotic arthritis. Although this condition is usually asymptomatic, it can demonstrate devastating articular destruction characterized by dark pigmentation of the tissues. Methods: A 64-year-old female with a medical history consisting of diabetes mellitus type 2, hypertension, and thoracic aortic aneurysm, with no personal or family history of ochronosis or related symptoms, has been diagnosed with progressive knee osteoarthritis, Kellgren and Lawrence grade III, unresponsive to conservative treatment. Results: The patient underwent staged bilateral, bicompartmental, cemented total knee arthroplasty (TKA), during which several pathological changes were incidentally discovered: black-pigmented, weakened articular cartilage and darkened synovial fluid, as well as brittle metaphyseal bone necessitating increased cement application to ensure prosthetic stability. Postoperative recovery was significant for anemia requiring a blood transfusion. Improved knee function was observed in the first month follow-up visit, and the patient was referred for diagnostic confirmation of her condition. Conclusions: This case underscores the importance of recognizing ochronosis as a potential cause of advanced joint degeneration in patients undergoing arthroplasty. Furthermore, the diagnosis might be of clinical relevance, since this case demonstrated postoperative anemia which required blood transfusion. This, combined with the brittleness of bone, highlights the need for meticulous surgical planning and tailored approaches by the unaware surgeon who might encounter such not-so-pleasant findings. Full article

Background: Neutrophils are key innate immune cells in peripheral blood. In recent years, sub-populations of neutrophils have been identified. In addition to the normal-density neutrophils (NDNs) in both healthy subjects and patients, low-density neutrophils (LDNs) were described in chronic inflammation and cancer. In lung transplants (LTx), neutrophils play crucial roles in reperfusion injury, acute rejection, and chronic lung allograft dysfunction. Our pilot study examines neutrophil subsets and function in LTx recipients during the first post-transplant year. Methods: We collected blood from 11 LTx recipients at various intervals. LDNs and normal-density neutrophils (NDNs) were isolated. The production of reactive oxygen species (ROS) by NDNs was measured after PMA activation using a Luminol-HRP assay. Neutrophil phenotypic markers were analyzed with flow cytometry. Results: The LDN-to-NDN ratio increased at 3 and 6 months post-transplant. Expression levels of CD62-L (aging marker), PDL-1 (immune checkpoint), CD15 (maturation), and CXCR4 (homeostasis regulator) showed modulation. Interestingly, ROS production by NDNs was mildly elevated at baseline, reduced at 6 months, and returned to baseline levels by 9 months post-transplant. Conclusions: Neutrophils exhibit dynamic changes in the first post-LTx year. Investigating neutrophil plasticity could reveal clinically relevant biomarkers and facilitate the development of diagnostic and therapeutic tools in LTx. Full article

Background: Respiratory Syncytial Virus (RSV) is a significant cause of morbidity and mortality among lung transplant (LTx) recipients. Therapeutic options are limited, emphasizing the importance of prevention. The Arexvy^® vaccine (RSVPreF3) showed promising efficacy among immunocompetent adults; however, data on its immunogenicity in solid organ transplant recipients remain unclear. Methods: A single-center retrospective cohort study, including all LTx recipients who were vaccinated with Arexvy in February 2024. Baseline and follow-up serum samples (1, 3, and 6 months post-vaccination) were analyzed for antibody responses using a commercial RSV ELISA kit and micro-neutralization assays against historical reference RSV A/B ATCC strains and seasonal RSV strains. Adverse events were documented. Results: A total of 28 recipients received the vaccine. Twenty-one (75%) were male, and the median age was 62 years (interquartile range [IQR], 53–67). The median time from transplant was 486 days (IQR, 243–966). Vaccination elicited strong immunogenic responses, demonstrating a twofold increase in ELISA-determined antibody levels at one month post-vaccination, which were sustained for six months. At one month, 67% of recipients had antibody levels exceeding the cutoff threshold. Micro-neutralization assays showed a significant increase in neutralizing antibodies against all tested variants (RSV A/B ATCC and seasonal RSV A/B), with titers remaining at least twofold higher than pre-vaccination levels. No serious adverse events were observed. Conclusions: Our findings demonstrate a sustained antibody response to the Arexvy^® vaccine in a cohort of LTx recipients, with antibody titers sustained over six months. Further research is needed to assess the long-term durability of the immune response and the potential immunogenicity of this vaccine in LTx populations. Full article

Introduction: Variants of COVID-19 are responsible for 700 million infections and 7 million deaths worldwide. Vaccinations have high efficiency in preventing infection and secondary benefits of reducing COVID-19 hospital admissions, attenuating disease severity and duration of illness. Conflicting reports were published regarding COVID-19 among PLWH. Objective: The aim of this study was to evaluate COVID-19 morbidity, hospitalization, and the magnitude of immunological response to sequential BNT 162b2 mRNA vaccines in PLWH regarding demographic and clinical factors. Results: Our retrospective study included 784 PLWH who had at least one anti- SARS-CoV-2 antibody test between March 2021 and October 2021. Half of our patients (392) had CD4 cell counts above 500 cells/µL, 40.2% (315) had 200 < CD4 < 500 cells/µL and only 9.8% (77) had CD4 < 200 cells/µL at their last laboratory workup. The mean age was 50.2 ± 12.2 years. About 90% of our patients were given at least two doses of the BNT 162b2 Pfizer vaccines; about 60% received three doses of the vaccine. About a quarter of our patients (27.6%) had COVID-19 infection. Only six patients required hospital admission. All six patients recovered from COVID-19 infection. Titers of COVID-19 antibodies were lower for patients with CD4 cell counts of less than 200 cells/µL in the first, second, and third serological tests with statistical significance. In a multinomial logistic regression, the influence of other factors such as age, sex, and previous COVID-19 infection on first COVID-19 antibody titers was not significant. Conclusions: PLWH are responsive to COVID-19 vaccines. As was expected, patients with higher CD4 cell counts had higher titers of COVID-19 antibodies and lower hospitalization rate. Age, sex, and previous COVID-19 infection did not significantly affect antibody titers according to our study. Larger prospective studies with control groups are needed to further characterize immunologic response to COVID-19 vaccination among PLWH. Full article

Background: Monteggia-equivalent fractures are similar to Monteggia fractures but involve different patterns and locations. When these fractures include a severe radial head fracture, radial head arthroplasty (RHA) should be considered. RHA can be performed using Kocher’s approach or the less commonly used trans-olecranon approach, which has been less studied. This study evaluates the clinical and radiological outcomes of the trans-olecranon approach for RHA over 15 years. Methods: In this retrospective study, 45 cases of Monteggia-equivalent fractures were analyzed, focusing on patients over 18 with radial head fractures, treated by the same surgeon with RHA and open reduction and internal fixation (ORIF) of the proximal ulna via the trans-olecranon approach. Results: The cohort of 45 patients showed a mean flexion of 112.37° ± 13.7°, mean extension of 24.27° ± 17.9°, mean supination of 57.63° ± 28.9°, and mean pronation of 62.16° ± 29.07°. Clinical and radiographic measurements indicated satisfactory results, with acceptable complication and secondary procedure rates. Conclusion: The trans-olecranon, single-incision approach is effective for managing fractures involving the proximal ulna and radial head, offering adequate access to lateral elbow structures while minimizing damage to surrounding soft tissue. Therefore, this approach should be considered for patients presented with a Monteggia-equivalent fracture and an indication for RHA. Full article

Hearing impairment among adults with intellectual disability (ID) is notably prevalent yet frequently underdiagnosed due, in part, to the challenges associated with traditional hearing screening methods in this population. This study explores the effectiveness of the Digit-in-Noise (DIN) test as a viable alternative for hearing screening within natural settings and with familiar personnel. A total of 16 Hebrew-speaking adults with ID were recruited from supported employment programs, 10 of whom completed the study. The DIN test, which was administered in a daily environment using a simple digital device, evaluated the speech recognition threshold in noise. Results indicated that while some participants performed comparably to typically developing individuals, others showed varying levels of hearing thresholds, suggesting diverse auditory capabilities within the ID population. This pilot study confirms that the DIN test can be feasibly integrated into routine care settings, offering a friendly and accessible method for assessing hearing abilities in adults with ID. The findings advocate for the broader adoption of and potential modifications to the DIN Test to enhance its applicability and inclusiveness, thereby improving diagnostic accuracy and subsequent auditory care for this underserved population. Full article

Upper tract urothelial carcinoma (UTUC) in a duplex collecting system (DCS) is a relatively uncommon presentation with unclear management guidelines. Herein, we retrospectively reviewed all published cases of DCS with UTUC aiming to suggest personalized clinical care options for future cases. We conducted a systematic search for all cases of UTUC in DCS from published literature using the following keywords: UTUC, urothelial carcinoma (UC), collecting duct carcinoma, and DCS. The cases were summarized based on demographics, clinical presentation, predisposing risk factors, tumor location, management, and follow-up. We present an additional case based on our experience with a 69-year-old female with high-grade (HG) UTUC of the upper moiety in complete DCS. The patient underwent a robotic upper pole hemi-nephroureterectomy (hemi-NU) with a common sheath distal ureterectomy and a bladder cuff, followed by lower pole ureteral reimplantation. Overall, 34 patients with 35 renal units of UTUC in DCS were included and analyzed. To conclude, UTUC of DCS is rare and underreported. Hence, it is difficult to define a standard treatment. Although hemi-NU has been previously described, to the best of our knowledge, this is the first case report of robot-assisted hemi-NU for complete DCS with single-moiety UC. Full article

Concerns raised by parents regarding their child’s development are compatible with the child’s final diagnosis of autism spectrum disorder. A better understanding of the relationship between parental concerns and a final diagnosis of autism spectrum disorder is therefore critical. In the current study, we compared the frequencies of parental concerns related to DSM-5 criteria for autism spectrum disorder between pair-matched groups with and without a final diagnosis of autism spectrum disorder and determined which parental concerns predicted a final diagnosis of autism spectrum disorder. The cohort included 80 participants (48–154 months of age, IQ > 70) assessed for a possible autism spectrum disorder diagnosis. Parental concerns were retrieved from the free-description portion of the introductory questions of the Autism Diagnostic Interview-Revised and analyzed to assess whether they corresponded to any of the seven DSM-5 criteria for ASD. The two groups only differed in the frequency of parental concerns relating to deficits in social–emotional reciprocity. Parents of children diagnosed with autism spectrum disorder were four times as likely to report deficits in social–emotional reciprocity. This finding highlights the significance of parental concerns regarding deficits in social–emotional reciprocity in predicting a final diagnosis of autism spectrum disorder. Full article

Background. Congenital central hypoventilation syndrome (CCHS) is a rare autosomal-dominant disorder of the autonomic nervous system that results from mutations in the PHOX2B gene. A national CCHS center was founded in Israel in 2018. Unique new findings were observed. Methods. All 27 CCHS patients in Israel were contacted and followed. Novel findings were observed. Results. The prevalence of new CCHS cases was almost twice higher compared to other countries. The most common mutations in our cohort were polyalanine repeat mutations (PARM) 20/25, 20/26, 20/27 (combined = 85% of cases). Two patients showed unique recessive inheritance while their heterozygotes family members were asymptomatic. A right-sided cardio-neuromodulation was performed on an eight-year-old boy for recurrent asystoles by ablating the parasympathetic ganglionated plexi using radiofrequency (RF) energy. Over 36 months’ follow-up with an implantable loop-recorder, no bradycardias/pauses events were observed. A cardiac pacemaker was avoided. Conclusions. A significant benefit and new information arise from a nationwide expert CCHS center for both clinical and basic purposes. The incidence of CCHS in some populations may be increased. Asymptomatic NPARM mutations may be much more common in the general population, leading to an autosomal recessive presentation of CCHS. RF cardio-neuromodulation offers a novel approach to children avoiding the need for permanent pacemaker implantation. Full article

This article explores Jerusalem-based art practice from the 1930s to the 1960s, focusing particularly on the German immigrant artists that dominated this field in that period. I describe the distinct aesthetics of this art and explain its role in the Zionist nation-building project. Although Jerusalem’s art scene participated significantly in creating a Jewish–Israeli national identity, it has been accorded little or no place in the canon of national art. Adopting a historiographic approach, I focus on the artist Mordecai Ardon and the activities of the New Bezalel School and the Jerusalem Artists Society. Examining texts and artworks associated with these institutions through the prism of migratory aesthetics, I claim that the art made by Jerusalem’s artists was rooted in their diasporic identities as East or Central European Jews, some German-born, others having settled in Germany as children or young adults. These diasporic identities were formed through their everyday lives as members of a Jewish diaspora in a host country—whether that be the Russian Empire, Poland, or Germany. Under their arrival in Palestine, however, the diasporic Jewish identities of these immigrants (many of whom were not initially Zionists) clashed with the Zionist–Jewish identity that was hegemonic in the nascent field of Israeli art. Ultimately, this friction would exclude the immigrants’ art from being inducted into the national art canon. This is misrepresentative, for, in reality, these artists greatly influenced the Zionist nation-building project. Despite participating in a number of key Zionist endeavours—whether that of establishing practical professions or cementing the young nation’s collective consciousness through graphic propaganda—they were marginalized in the artistic field. This exclusion, I claim, is rooted in the dynamics of canon formation in modern Western art, the canon of Israeli national art being one instance of these wider trends. Diasporic imagery could not be admitted into the Israeli canon because that canon was intrinsically connected with modern nationalism. Full article

Mieke Bal’s concept of “migratory aesthetics” and the observation by Saloni Mathur and Anne Ring Peterson that “traditional notions of location, origin and authenticity seem obsolete and in urgent need of reconsideration” perfectly encompass the phrase “Jewish art”, and within that difficult-to-define subject, Israeli art (which, among other things, is not always “Jewish”). As Hava Aldouby has noted, Israeli art presents a unique inflection of the global condition of mobility—which in fact contributes to the problem of easily defining the category of “Israeli art”. Nothing could be more appropriate to the discussion of Israeli art, or to the larger definitional problem of “Jewish art” than to explore it through Nicolas Bourriaud’s botanical metaphor of the “radicant”, and thus the notion of “radicant art”. The important distinction that Bourriaud offers between radical and radicant plants—whereby the former type depends upon a central root, deep-seated in a single nourishing soil site, whereas the latter is an “organism that grows its roots and adds new ones as it advances…” with “…a multitude of simultaneous or successive enrootings”—is a condition that may be understood for both Israeli and Jewish art, past and present: Aldouby’s notion that the image of the Wandering Jew offers the archetypal radicant, informs both the “altermodernity” concept and Israeli art. Full article