Search Results (94)

Background & Aims: treat-to-target approach is essential for improving outcomes in inflammatory bowel disease (IBD). This study aimed to assess real-world achievement in objective monitoring (clinical, biomarker, and endoscopic assessments) and the correlation between patient-reported outcomes (PROs) and treatment targets. Methods: This retrospective study included consecutive IBD patients from January 2020 to December 2024. Disease activity was assessed using the Harvey-Bradshaw Index (HBI), partial Mayo score, PRO2, and PRO3, along with C-reactive protein (CRP) levels and endoscopic scores (SES-CD, MES). Clinical outcomes were evaluated at baseline, 1 year, and 2 years. Results: Among 112 IBD patients (55% with CD, median age at diagnosis: 45.2 years), clinical remission rates at baseline, 1 year, and 2 years were; CD: 75.8%, 70.0%, and 55.8%; UC: 84.0%, 79.5%, and 81.4%. CRP normalization rates at the same time points were; CD: 54.8%, 41.7%, and 63.8% UC: 78.0%, 70.5%, and 81.8%. Endoscopic remission rates were; CD: 58.1%, 50.0%, and 50.0%, UC: 71.4%, 64.5%, and 51.7% Flare-ups were more frequent in CD than in UC (32% vs. 20%), with an 8.1% rate of IBD-related surgery. In CD, PRO2 and PRO3 strongly correlated with clinical remission (AUC = 0.885 and 0.881), moderately with biomarkers (AUC = 0.737 and 0.755), and modestly with endoscopic remission (AUC = 0.695 and 0.685). In UC, PRO2 showed a strong correlation with clinical remission (AUC = 0.972) and moderate correlations with biomarkers (AUC = 0.653) and endoscopy (AUC = 0.783). Conclusions: Clinical remission was more frequent in UC than in CD. PROs showed a strong correlation with clinical remission but only moderate associations with biomarkers and endoscopic remission in both CD and UC. Full article

Background: Epstein–Barr virus-associated gastric cancer (EBVaGC) represents a distinct molecular subgroup with potential responsiveness to immunotherapy approved for programmed death-ligand 1 (PD-L1)-positive gastric cancer. This retrospective study aimed to assess the prevalence and association between EBVaGC and PD-L1 positivity among patients with gastric adenocarcinoma treated at a university hospital in Southern Thailand from January 2017 to October 2023. Methods: The EBV status of the patients and PD-L1 expression were determined using in situ hybridization and immunohistochemistry, respectively. Results: The prevalence of EBVaGC was 4.5% among 132 patients, whereas 9.1% of patients exhibited a PD-L1 combined positive score (CPS) of ≥1, with no significant association observed between them. EBVaGC was more prevalent in males, non-antral tumors, diffuse/mixed histologic subtypes, and poorly differentiated tumors. Median overall survival for patients with EBVaGC and PD-L1 CPS ≥ 1 was 9.48 and 14.19 months, respectively, compared with 10.32 and 9.79 months for those with non-EBVaGC (hazard ratio: 1.24; 95% CI: 0.50–3.04; p = 0.645) and PD-L1 CPS < 1 (hazard ratio: 0.82; 95% CI: 0.40–1.69; p = 0.590), respectively. Conclusions: Our findings revealed a low prevalence of EBVaGC and PD-L1 positivity in Thailand, with no significant association or survival impact observed. These findings highlight the regional variation in these biomarkers and support EBV as an independent biomarker from PD-L1. However, further research, particularly studies evaluating immunotherapy outcomes, is warranted to clarify the predictive and clinical significance of EBV in gastric cancer. Full article

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions requiring continuous monitoring. Today, endoscopy is the gold standard for assessing disease activity, with histological evaluation providing additional insights. Studies suggest that persistent histological inflammation, despite endoscopic remission, may be associated with a higher risk of relapse in UC, suggesting its role in treatment decisions. In CD, histological assessment is limited by its patchy nature, transmural inflammation and lack of validated scoring systems. Few retrospective studies with conflicting results have examined the prognostic value of histological remission in CD, and its role in predicting long-term outcomes remains unclear. This narrative review aims to summarize and discuss the available evidence regarding the additional value of histological assessment in IBD management. In UC, the ongoing VERDICT study is expected to provide evidence on the impact of incorporating histological remission as a treatment target compared to a strategy based on clinical and endoscopic activity. Recently published interim results indicate that targeting histological remission does not lead to better clinical/biochemical disease activity. Thus, while patients achieving histological healing are associated with better outcomes, the question arises whether achieving histological remission is an intrinsic (biological) characteristic of the patient and indicator of an easier to treat patient group or a result of more effective therapy. Full article

The Dual Process Model of Coping with Bereavement (DPM, by Stroebe and Schut) is a well-known framework in contemporary grief research and counselling. It depicts how mourners oscillate between various tasks and reactions. There is a need to engage more with the intense feelings of loss (Loss-Oriented tasks), but also with other things in life and other parts of the adjustment process after a loss (Restoration-Oriented tasks). This interdisciplinary article applies the framework to ecological grief and extends it to collective levels. While the DPM has been broadened to family dynamics, many subjects of grief are even more collective and require mourning from whole communities or societies. Religious communities can play an important role in this. This article provides a new application called the DPM-EcoSocial and discusses the various tasks named in it, which are ultimately based on the grief researcher Worden’s work. The particularities of ecological grief are discussed, such as the complications caused by guilt dynamics, climate change denial, attribution differences about climate disasters, and nonfinite losses. Grief and grievance are intimately connected in ecological grief, and (religious) communities have important tasks for remembrance, mourning, and witness. The collective processes can lead to meaning reconstruction, transilience, and adversarial growth. Full article

The standardized hydrological index (SHI) is the standardized but not normalized (normal probability variate) value of the streamflow used to characterize a hydrological drought, akin to the standardized precipitation index (SPI, which is both standardized and normalized) in the realm of the meteorological drought. The time series of the SHI can be used as a platform for deriving the longest duration, L_T, and the largest magnitude, M_T (in standardized form), of a hydrological drought over a desired return period of T time units (year, month, or week). These parameters are predicted based on the SHI series derived from the annual, monthly, and weekly flow sequences of Canadian rivers. An important point to be reckoned with is that the monthly and weekly sequences are non-stationary compared to the annual sequences, which fulfil the conditions of stochastic stationarity. The parameters, such as the mean, standard deviation (or coefficient of variation), lag 1 autocorrelation, and conditional probabilities from SHI sequences, when used in Markov chain-based relationships, are able to predict the longest duration, L_T, and the largest magnitude, M_T. The product moment and L-moment ratio analyses indicate that the monthly and weekly flows in the Canadian rivers fit the gamma probability distribution function (pdf) reasonably well, whereas annual flows can be regarded to follow the normal pdf. The threshold level chosen in the analysis is the long-term median of SHI sequences for the annual flows. For the monthly and weekly flows, the threshold level represents the median of the respective month or week and hence is time varying. The runs of deficit in the SHI sequences are treated as drought episodes and thus the theory of runs formed an essential tool for analysis. This paper indicates that the Markov chain-based methodology works well for predicting L_T on annual, monthly, and weekly SHI sequences. Markov chains of zero order (MC0), first order (MC1), and second order (MC2) turned out to be satisfactory on annual, monthly, and weekly scales, respectively. The drought magnitude, M_T, was predicted satisfactorily via the model M_T = I_d × L_c, where I_d stands for drought intensity and L_c is a characteristic drought length related to L_T through a scaling parameter, ɸ (= 0.5). The I_d can be deemed to follow a truncated normal pdf, whose mean and variance when combined implicitly with L_c proved prudent for predicting M_T at all time scales in the aforesaid relationship. Full article

Background: Increased demand of the serological biomarker test (GastroPanel^®) in non-invasive diagnosis of gastric cancer (GC) risk conditions, i.e., atrophic gastritis (AG) and Helicobacter pylori (Hp) infection, prompted the design of GastroPanel^® Quick test (GPQT) (Biohit Oyj, Helsinki, Finland) for point-of-care (POC) settings. Objective: This study validated the diagnostic accuracy (DA) of GPQT in diagnosis of AG and Hp among gastroscopy referral patients. Methods: Altogether, 266 patients were enrolled among the consecutive gastroscopy referrals at the Department of Gastroenterology, Fortis Hospital (Punjab, India). All patients underwent gastroscopy with biopsies (n = 249) classified using the Updated Sydney System (USS) and finger prick blood sampling for GPQT testing. Results: Biopsy-confirmed AG was found in 15.3% (38/249) of the patients. The overall agreement between the GPQT and the USS classification was 71.4% (95% CI 65.4–77.0%), with the weighted kappa (κ_w) of 0.823 (95% CI 0.773–0.862). In ROC analysis for moderate/severe AG of the corpus (AGC) endpoint, AUC = 0.990 (95% CI 0.979–1.000) and AUC = 0.971 (95% CI 0.948–0.995) for PGI and PGI/PGII, respectively. Hp IgG Ab test detected biopsy-confirmed Hp with AUC = 0.836 (95% CI 0.783–0.889). Conclusions: The GPQT favourably competes in accuracy with the ELISA test version (unified-GP) in diagnosis of AG and Hp in patients referred for diagnostic gastroscopy. Full article

Inflammatory bowel diseases (IBDs), encompassing Ulcerative Colitis (UC) and Crohn’s Disease (CD), are chronic inflammatory disorders affecting the gastrointestinal tract. The association between IBD and colorectal cancer (CRC) is well-documented. Multiple factors have been identified as contributors to the risk of developing CRC in patients with IBD, including duration of disease, disease extension, family history of CRC, co-existance of primary sclerosing cholangitis (PSC), and potentially the presence of post-inflammatory polyps (PIPs). PIPs, often referred to as pseudopolyps, are polypoid structures that emerge as a result of severe mucosal inflammation. While their presence has been linked to greater disease severity, the role of PIPs in increasing CRC risk remains controversial. Increasing evidence suggests an association between post-inflammatory polyps (PIPs) and the risk of colorectal neoplasia, with PIPs potentially serving as an indicator of this risk through a history of enhanced inflammation. PIPs may also be linked to a distinct patient phenotype, including the presence of other known risk factors. More recent studies suggest that the risk burden (characterized by a high number or by large polyps) may be important. However, the evidence remains inconsistent, with some studies showing no clear association between PIPs and CRC risk after adjusting for other factors, including histological inflammation. In contrast, the data suggest a low rate of malignant transformation of the PIPs themselves. This narrative review aims to summarize the latest evidence regarding the relationship between PIPs and CRC in IBD, with a focus on UC. While some studies suggest that PIPs may serve as markers of higher disease severity and inflammation, their direct contribution to CRC risk remains unclear. Further research is needed to explore the inflammatory and carcinogenic pathways in patients with PIPs to better understand their role in colorectal cancer (CRC) development. Full article

The aim of this technical note is to describe the Cycle 46 reference configuration of the HARMONIE-AROME convection-permitting numerical weather prediction model. HARMONIE-AROME is one of the canonical system configurations that is developed, maintained, and validated in the ACCORD consortium, a collaboration of 26 countries in Europe and northern Africa on short-range mesoscale numerical weather prediction. This technical note describes updates to the physical parametrizations, both upper-air and surface, configuration choices such as lateral boundary conditions, model levels, horizontal resolution, model time step, and databases associated with the model, such as for physiography and aerosols. Much of the physics developments are related to improving the representation of clouds in the model, including developments in the turbulence, shallow convection, and statistical cloud scheme, as well as changes in radiation and cloud microphysics concerning cloud droplet number concentration and longwave cloud liquid optical properties. Near real-time aerosols and the ICE-T microphysics scheme, which improves the representation of supercooled liquid, and a wind farm parametrization have been added as options. Surface-wise, one of the main advances is the implementation of the lake model FLake. An outlook on upcoming developments is also included. Full article

The Andean–Patagonian forests of South America offer a great variety of wild edible mushrooms, many with ancestral use and others linked to new mycogastronomic offers. However, their sensory properties and detailed characterizations have not yet been deeply explored and described, nor have their alterations due to cold storage. The aims of this work were to perform a sensory characterization through a trained panel evaluation, perform target volatile compounds analysis and evaluate post-harvest preservation methods effects on nine species of wild edible mushrooms with different trophic habits (Cortinarius magellanicus, Panus dusenii, Fistulina antarctica, F. endoxantha, Gloeosoma vitellinum, Grifola gargal, Lepista nuda, Ramaria patagonica, and Cyttaria hariotii). The sensory description of dehydrated specimens through quantitative descriptive analysis showed that panelists were a significant source of variation; F. antarctica and R. patagonica registered distinct sweet flavor/spice odor and wood/sweet flavor, respectively, and different textures. Refrigeration produced a rapid loss of sensory characteristics, whereas freezer conservation satisfactorily maintained the characteristics in F. anctartica, R. patagonica, G. vitellinum, and C. hariotti for at least four months. A total of 60 target volatile organic compounds were detected, corresponding to grass, mushroom, alkane, and pungent odors in F. anctartica, R. patagonica, and G. vitellinum. The detailed sensory characterization and post-harvest conservation options of these novel products constitute crucial information to promote their sustainable use and local development through innovative activities linked to tourism, such as mushroom gastronomy and mycotourism. Full article

Background: In advanced-stage esophageal squamous cell carcinoma (ESCC), treatment of both the primary tumor and metastatic sites is imperatively required. Consequently, an optimal treatment modality should effectively control both aspects. Therefore, the benefits of concurrent chemoradiotherapy (CCRT) in cases of advanced-stage ESCC should be evaluated. Methods: This retrospective study compared the efficacy and safety of CCRT versus chemotherapy alone for advanced-stage ESCC patients from January 2012 to December 2023 at a university hospital in Southern Thailand. Survival was assessed using the Kaplan–Meier approach, with comparisons being made by the log-rank test. A p-value of <0.05 indicated statistical significance. Results: From a total of 196 patients with stage IV ESCC, 117 (59.7%) received CCRT, while 79 (40.3%) received chemotherapy alone. The median overall survival (OS) time was 9.04 months for CCRT and 5.79 months for chemotherapy (hazard ratio, HR: 0.58 [0.43–0.78]). CCRT significantly improved OS time in stage IVA patients (HR: 0.52 [0.29–0.93]), but not in stage IVB patients (HR: 0.76 [0.51–1.11]). The median progression-free survival (PFS) time was 6.04 months for CCRT and 3.50 months for chemotherapy (HR 0.48 [0.35–0.65]). The objective response rates (ORRs) were 43.6% and 22.8%, respectively (p = 0.003). Hematological toxicities were more common with CCRT, along with mild cases of treatment-associated pneumonitis and dermatitis. Conclusions: Although palliative chemotherapy is the standard treatment for advanced-stage ESCC, CCRT provides significant benefits for patients with stage IVA ESCC, improving OS, PFS, and ORRs, despite there being a higher incidence of adverse events. Thus, CCRT should be considered for patients with stage IVA ESCC with a good performance status. Full article

Climate change evokes many kinds of emotions, which have an impact on people’s behavior. This article focuses on three major climate emotions—guilt, grief, and anger—and other closely related emotional phenomena, such as climate anxiety/distress. The article explores ways in which these emotions could be engaged with constructively in religious communities, with a certain emphasis on Christian, monotheistic, and Buddhist communities. These religious communities have certain special resources for engaging with guilt and grief, but they often have profound difficulty working with constructive anger. The ways in which these emotions can affect each other are probed, and the complex dynamics of climate guilt are given special attention. Based on the work of psychologists Tara Brach and Miriam Greenspan, a four-step method of engaging with these emotions is proposed and discussed: self-reflection, exploration of various forms of these emotions, contextualization, and creative application of various methods to channel the energies in these emotions. The article draws from interdisciplinary research on eco-emotions, religion and ecology studies, and psychology. Full article

Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to evaluate the comparative efficacy of intravenous PPI infusion versus VPZ in preventing re-bleeding after endoscopic hemostasis in patients with high-risk peptic ulcers. Methods: A randomized, double-blind, controlled, and double-dummy design was employed. Patients with peptic ulcer bleeding (Forrest class IA/IB or IIA/IIB) who underwent endoscopic hemostasis were randomly assigned to either the PPI group or the VPZ group. Re-bleeding rates at 3, 7, and 30 days, the number of blood transfusions required, length of hospitalization, and ulcer healing rate at 56 days were assessed. Results: A total of 44 eligible patients were enrolled, including 20 patients (PPI group, n = 11; VPZ group, n = 9) with high-risk peptic ulcers. The mean age was 66 years, with 70% being male. Re-bleeding within 72 h occurred in 9.1% of the PPI group versus 0% in the VPZ group (p = 1.000). There was no significant difference in re-bleeding rates within 7 days and 30 days (18.2% vs. 11.1%, p = 1.000). Additionally, the ulcer healing rate did not significantly differ between the groups (87.5% vs. 77.8%). Conclusions: This pilot study demonstrates comparable efficacy between oral vonoprazan and continuous PPI infusion in preventing recurrent bleeding events among high-risk peptic ulcer patients following successful endoscopic hemostasis. Full article

In industrial applications, local exhaust systems have been used extensively for capturing and confining contaminants at their source. The present study investigates the efficacy of these systems in mitigating the spread of exhaled pollutants by combining them with mixing and displacement ventilation. Experiments were conducted in a simulated meeting room with six closely situated workstations, featuring five exposed persons (simulated with heated dummies) and one infected person (simulated with a breathing manikin). Six overhead local exhaust units, merged with panels, corresponding to workstations, were installed using a lowered false ceiling. Additionally, a table plenum setting for air inlets was introduced to enhance displacement ventilation effectiveness along with local exhaust systems. Results from 16 experimental cases are presented, using the local air quality index and ventilation effectiveness in the breathing zone. The local exhaust system improved the local air quality at the measuring locations closest to the infector in almost all test scenarios. The improvement, particularly significant with displacement ventilation, marked a maximum 35% increase in the local air quality index adjacent to the infector and 25% in the entire breathing zone of the tested meeting room. Moreover, the table plenum settings, coupled with displacement ventilation, further enhanced conditions in the breathing zone. Under the specific conditions of this investigation, the number of operational local exhausts had a marginal impact on mixing ventilation but a significant one on displacement ventilation tests. The efficacy of local exhaust systems was also influenced by the levels of heat gains present in the room. Overall, the study aims to contribute to ongoing efforts to identify sustainable solutions to mitigate indoor airborne diseases with a combination of supply and local exhaust units. Full article

Cotton is an important plant-based protein. Cottonseed cake, a byproduct of the biodiesel industry, offers potential in animal supplementation, although the presence of the antinutritional sesquiterpenoid gossypol limits utilization. The macrofungus Panus lecomtei offers potential in detoxification of antinutritional factors. Through an enzymatic and proteomic analysis of P. lecomtei strain BRM044603, grown on crushed whole cottonseed contrasting in the presence of free gossypol (FG), this study investigated FG biodegradation over a 15-day cultivation period. Fungal growth reduced FG to levels at 100 μg/g, with a complex adaptive response observed, involving primary metabolism and activation of oxidative enzymes for metabolism of xenobiotics. Increasing activity of secreted laccases correlated with a reduction in FG, with enzyme fractions degrading synthetic gossypol to trace levels. A total of 143 and 49 differentially abundant proteins were observed across the two contrasting growth conditions after 6 and 12 days of cultivation, respectively, revealing a dynamic protein profile during FG degradation, initially related to constitutive metabolism, then later associated with responses to oxidative stress. The findings advance our understanding of the mechanisms involved in gossypol degradation and highlight the potential of P. lecomtei BRM044603 in cotton waste biotreatment, relevant for animal supplementation, sustainable resource utilization, and bioremediation. Full article

Near real-time aerosol fields from the Copernicus Atmospheric Monitoring Services (CAMS), operated by the European Centre for Medium-Range Weather Forecasts (ECMWF), are configured for use in the HARMONIE-AROME Numerical Weather Prediction model. Aerosol mass mixing ratios from CAMS are introduced in the model through the first guess and lateral boundary conditions and are advected by the model dynamics. The cloud droplet number concentration is obtained from the aerosol fields and used by the microphysics and radiation schemes in the model. The results show an improvement in radiation, especially during desert dust events (differences of nearly 100 W/m² are obtained). There is also a change in precipitation patterns, with an increase in precipitation, mainly during heavy precipitation events. A reduction in spurious fog is also found. In addition, the use of the CAMS near real-time aerosols results in an improvement in global shortwave radiation forecasts when the clouds are thick due to an improved estimation of the cloud droplet number concentration. Full article