Emergent perceptual biases from state-space geometry in trained spiking recurrent neural networks.

A stimulus held in working memory is perceived as contracted toward the average stimulus. This contraction bias has been extensively studied in psychophysics, but little is known about its origin from neural activity. By training recurrent networks of spiking neurons to discriminate temporal intervals, we explored the causes of this bias and how behavior relates to population firing activity. We found that the trained networks exhibited animal-like behavior. Various geometric features of neural trajectories in state space encoded warped representations of the durations of the first interval modulated by sensory history. Formulating a normative model, we showed that these representations conveyed a Bayesian estimate of the interval durations, thus relating activity and behavior. Importantly, our findings demonstrate that Bayesian computations already occur during the sensory phase of the first stimulus and persist throughout its maintenance in working memory, until the time of stimulus comparison.

Risk factors and clinical impact of multidrug resistance in healthcare-associated bacteremic urinary tract infections: a post-hoc analysis of a multicenter prospective cohort in Spain.

INTRODUCTION: The global burden associated with antimicrobial resistance is of increasing concern. The aim of this study was to evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated (HCA) bacteremic urinary tract infections (BUTI). METHODS: This is a post-hoc analysis a prospective multicenter study of patients with HCA-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48-72h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. RESULTS: 443 episodes were included, of which 271 (61.17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E. coli episodes (OR 3.13, 95% CI 2.11-4.69, p<0.001) and the extensively drug-resistant (XDR) pattern with P. aeruginosa etiology (OR 7.84, 95% CI 2.37-25.95; p=0.001). MDR was independently associated with prior use of fluoroquinolones (aOR 2.43; 95% CI 1.25-4.69), cephalosporins (aOR 2.14; 95% CI 1.35-3.41) and imipenem or meropenem (aOR 2.08; 95% CI 1.03-4.20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but with longer hospital stay. CONCLUSIONS: MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although was independently associated with longer duration of hospital stay.

Dispersal history of SARS-CoV-2 in Galicia, Spain.

The dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission are influenced by a variety of factors, including social restrictions and the emergence of distinct variants. In this study, we delve into the origins and dissemination of the Alpha, Delta, and Omicron-BA.1 variants of concern in Galicia, northwest Spain. For this, we leveraged genomic data collected by the EPICOVIGAL Consortium and from the GISAID database, along with mobility information from other Spanish regions and foreign countries. Our analysis indicates that initial introductions during the Alpha phase were predominantly from other Spanish regions and France. However, as the pandemic progressed, introductions from Portugal and the United States became increasingly significant. The number of detected introductions varied from 96 and 101 for Alpha and Delta to 39 for Omicron-BA.1. Most of these introductions left a low number of descendants (<10), suggesting a limited impact on the evolution of the pandemic in Galicia. Notably, Galicia's major coastal cities emerged as critical hubs for viral transmission, highlighting their role in sustaining and spreading the virus. This research emphasizes the critical role of regional connectivity in the spread of SARS-CoV-2 and offers essential insights for enhancing public health strategies and surveillance measures.

Proposal for a standardized methodology for performing endobronchial ultrasound-guided mediastinal cryobiopsy: a four-step approach.

Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy is a novel technique that increases the accuracy of diagnosing most pathologies that affect the mediastinum. Although EBUS-guided transbronchial needle aspiration (EBUS-TBNA) is the first choice in the diagnosis of mediastinal pathology, mediastinal cryobiopsy offers a larger and higher quality biopsy with minimal artifacts and no crushing when compared to conventional cytological samples obtained through EBUS-TBNA. It is particularly valuable in pathologies where EBUS-TBNA has diagnostic limitations, such as lymphoproliferative diseases, benign granulomatous conditions like sarcoidosis and silicosis, some rare infectious processes, metastases from rare non-pulmonary tumors, and in advanced stages of non-small cell lung cancer (NSCLC) where immunohistochemistry and molecular analysis are essential for personalized treatment. Therefore, mediastinal cryobiopsy seems to play a crucial role in these challenging scenarios. However, there is ongoing debate in the field of interventional pulmonology regarding the best approach for obtaining a mediastinal cryobiopsy. Some interventional pulmonologists use a high-frequency needle knife to create an incision in the tracheobronchial wall adjacent to the mediastinal lesion before inserting the cryoprobe, while others use a needle to create a pathway to the target area. There are also variations in the use of endoscopic or ultrasound imaging for guidance. In this article, we aim to review the current literature on different methods of performing mediastinal cryobiopsy and share our own clinical experience and methodology in a systematic way for its implementation in a safe, fast, and effective way.

How plant composition in margins influences the assemblage of pests and predators and its effect on biocontrol in melon fields.

Many agricultural landscapes offer few resources for maintaining natural enemy populations and floral plantings have frequently been adopted to enhance biological pest control in crops. However, restored margins may harbour both pests and natural enemies. The aim was to compare the abundance of pests and natural enemies in three types of margins (unmanaged, sown herbaceous floral strips and shrubby hedgerows) as well as in adjacent melon fields. Besides, yield was compared among melon fields as way of testing the effect of the type of margin on biocontrol. The research was carried out during 2 years in twelve melon fields from four different locations in southern Spain. Arthropods were sampled periodically in margins and melon fields by visual inspections and Berlese extraction. Hedgerow and floral strips hosted higher numbers of both pests and predators than unmanaged margins. Besides, hedgerows had a similar or higher number of natural enemies than floral strips but lower number of pests. In just a few occasions, the type of margin had a significant effect on the abundance of pests and natural enemies in melon fields, but rarely there was consistency between the two growing seasons. No differences were found in yield. We hypothesised that the lack of association in the abundances of pests and natural enemies between margins and melon fields could be attributed to the overriding effects of the landscape and/or the internal population dynamics of arthropods in melon fields. Overall, shrubby hedgerows are more recommended than herbaceous floral strips.

The efficient application of instilling negative pressure wound therapy with a hypochlorous acid-preserved wound cleanser: a case series and practical advice.

BACKGROUND: The use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be effective in removing nonviable tissue, reducing bioburden, and promoting granulation tissue formation in acute and chronic infected wounds. OBJECTIVE: To illustrate the clinical efficacy of the use of pure hypochlorous acid (pHA) antimicrobially preserved wound cleansing solution as the instillation fluid for NPWTi-d (NPWTi-d/pHA) in wound bed preparation in patients with complex wounds. CASE REPORT: The treatment protocol for use of NPWTi-d/pHA in preparing wound beds for final closure is demonstrated in 3 illustrative cases of patients with complex wounds resulting from necrotizing infection and trauma with heavy contamination. All 3 patients developed a healthy-appearing wound bed deemed suitable for primary closure an average of approximately 1 month following initial surgical debridement. CONCLUSION: The cases presented demonstrate the ability of a pHA antimicrobially preserved wound cleansing solution used as the instillation fluid with NPWTi-d to aid in bacterial reduction, mechanical debridement, and promotion of wound healing. Use of NPWTi-d/pHA in these cases of extensive necrotizing infection and posttraumatic injury with heavy contamination allowed for final closure an average of 1 month after initial surgical debridement.

Synergistic clinical application of synthetic electrospun fiber wound matrix in the management of a complex traumatic wound: degloving left groin and thigh auger injury.

BACKGROUND: Managing complex traumatic soft tissue wounds involving a large surface area while attempting to optimize healing, avoid infection, and promote favorable cosmetic outcomes is challenging. Regenerative materials such as ECMs are typically used in wound care to enhance the wound healing response and proliferative phase of tissue formation. CASE REPORT: The case reported herein is an example of the efficacious use of an SEFM in the surgical management of a large complex traumatic wound involving the left lower extremity and lower abdominal region. The wound bed was successfully prepared for skin grafting over an area of 1200 cm2, making this among the largest applications of the SEFM reported in the literature. CONCLUSION: This case report demonstrates the clinical versatility of the SEFM and a synergistic approach to complex traumatic wound care. The SEFM was successfully used to achieve tissue granulation for a successful skin graft across a large surface in an anatomic region with complex topography.

Multidisciplinary expert consensus statements and recommendations for use of hypochlorous acid as a solution for negative pressure wound therapy with instillation.

BACKGROUND: HOCl (eg, pHAp) preserved solutions have antimicrobial properties and are considered safe and effective for wound management. NPWTi-d (or NPWTi) is an established adjunctive wound modality for a variety of wound etiologies in various anatomic locations in which an instillate solution dwells on the surface of the wound to assist in wound bed preparation. A variety of solutions have been used, including 0.9% normal saline wound cleansers and antiseptics. pHAp is growing in popularity as the solution of choice for NPWTi-d. OBJECTIVE: To evaluate consensus statements on the use of NPWTi-d with pHAp. METHODS: A 15-member multidisciplinary panel of expert clinicians in the United States, Canada, and France convened in person in April 2023 in Washington, D.C. and/or corresponded later to discuss 10 statements on the use of pHAp with NPWTi-d. The panelists then replied "agree" or "disagree" to each statement and had the option to provide comments. RESULTS: Ten consensus statements are presented, along with the proportion of agreement or disagreement and summary comments. Although agreement with the statements on NPWTi-d with pHAp varied, the statements appear to reflect individual preferences for use rather than concerns about safety or efficacy. CONCLUSION: The consensus indicates that NPWTi-d with pHAp can have a beneficial effect in wound care.

"Hg distribution and accumulation in soil and vegetation in areas impacted by artisanal gold mining in the Southern Amazonian region of Madre de Dios, Peru."

Artisanal and small-scale gold mining (ASGM) is the primary global source of anthropogenic mercury (Hg) emissions. It has impacted the Amazon rainforest in the Peruvian region of Madre de Dios. However, few studies have investigated Hg's distribution in terrestrial ecosystems in this region. We studied Hg's distribution and its predictors in soil and native plant species from artisanal mining sites. Total Hg concentrations were determined in soil samples collected at different depths (0-5 cm and 5-30 cm) and plant samples (roots, shoots, leaves) from 19 native plant species collected in different land cover categories: naked soil (L1), gravel piles (L2), natural regeneration (L3), reforestation (L4), and primary forest (L5) in the mining sites. Hg levels in air were also studied using passive air samplers. The highest Hg concentrations in soil (average 0.276 and 0.210 mg kg-1 dw.) were found in the intact primary forest (L5) at 0-5 cm depth and in the plant rooting zones at 5-30 cm depth, respectively. Moreover, the highest Hg levels in plants (average 0.64 mg kg-1 dw) were found in foliage of intact primary forest (L5). The results suggest that the forest in these sites receives Hg from the atmosphere through leaf deposition and that Hg accumulates in the soil surrounding the roots. The Hg levels found in the plant leaves of the primary forest are the highest ever recorded in this region, exceeding values found in forests impacted by Hg pollution worldwide and raising concerns about the extent of the ASGM impact in this ecosystem. Correlations between Hg concentrations in soil, bioaccumulation in plant roots, and soil physical-chemical characteristics were determined. Linear regression models showed that the soil organic matter content (SOM), pH, and electrical conductivity (EC) predict the Hg distribution and accumulation in soil and bioaccumulation in root plants.

Impact of Living Donor Liver Transplantation on the Improvement of Hepatocellular Carcinoma Treatment.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths, with increasing incidence. There are different treatment options, but only 30%-40% of HCC cases are diagnosed at an early stage for curative treatment. With the implementation of Milan Criteria for liver transplantation (LT) in HCC cases and its use for organ allocation with successful outcomes, LT has become an optimal treatment. Seeking new criteria for LT and developing updated algorithms for HCC treatment has become a hot topic nowadays. With the experience in living donor liver transplantation (LDLT), especially in Asian countries, LDLT was established and adopted with different criteria for HCC treatment, especially including criteria beyond Milan's size and number of tumors. Living donor grafts are uniquely different than deceased donor grafts as they are not considered a public resource. A living donor graft is rather a private gift intended for a specific recipient. Living donor livers are not limited by organ allocation systems, and this significant advantage of LDLT has opened new frontiers in the treatment of HCC. Improvements in LDLT have had remarkable parallel effects in the successful treatment of HCC as supported by a growing body of literature in the past decade.

Enhancing HIV positivity yield in southern Mozambique: The effect of a Ministry of Health training module in targeted provider-initiated testing and counselling.

In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas.

Ti/Ta-based composite polysaccharide scaffolds for guided bone regeneration in total hip arthroplasty.

Guided bone regeneration can play an important role in orthopedic applications. This work presents the synthesis and characterization of composite scaffolds based on polysaccharides loaded with microparticles of titanium or tantalum as novel materials proposed for composite systems with promising characteristics for guided bone regeneration. Ti/Ta composite scaffolds were synthesized using chitosan and gellan gum as organic substrates and crosslinked with oxidized dextran resulting in stable inorganic-organic composites. Physico-chemical characterization revealed a uniform distribution of metal nanoparticles within the scaffolds that showed a release of metals lower than 5 %. In vitro biological assays demonstrated that Ta composites exhibit a 2 times higher ALP activity than Ti and a higher capacity to support the full differentiation of human mesenchymal stem cells into osteoblasts. These results highlight their potential for bone regeneration applications.

Global mercury concentrations in biota: their use as a basis for a global biomonitoring framework.

An important provision of the Minamata Convention on Mercury is to monitor and evaluate the effectiveness of the adopted measures and its implementation. Here, we describe for the first time currently available biotic mercury (Hg) data on a global scale to improve the understanding of global efforts to reduce the impact of Hg pollution on people and the environment. Data from the peer-reviewed literature were compiled in the Global Biotic Mercury Synthesis (GBMS) database (>550,000 data points). These data provide a foundation for establishing a biomonitoring framework needed to track Hg concentrations in biota globally. We describe Hg exposure in the taxa identified by the Minamata Convention: fish, sea turtles, birds, and marine mammals. Based on the GBMS database, Hg concentrations are presented at relevant geographic scales for continents and oceanic basins. We identify some effective regional templates for monitoring methylmercury (MeHg) availability in the environment, but overall illustrate that there is a general lack of regional biomonitoring initiatives around the world, especially in Africa, Australia, Indo-Pacific, Middle East, and South Atlantic and Pacific Oceans. Temporal trend data for Hg in biota are generally limited. Ecologically sensitive sites (where biota have above average MeHg tissue concentrations) have been identified throughout the world. Efforts to model and quantify ecosystem sensitivity locally, regionally, and globally could help establish effective and efficient biomonitoring programs. We present a framework for a global Hg biomonitoring network that includes a three-step continental and oceanic approach to integrate existing biomonitoring efforts and prioritize filling regional data gaps linked with key Hg sources. We describe a standardized approach that builds on an evidence-based evaluation to assess the Minamata Convention's progress to reduce the impact of global Hg pollution on people and the environment.

Prevalence of extra-intestinal symptoms according to irritable bowel syndrome subtype.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder commonly associated with extra-intestinal symptoms. However, the prevalence of these symptoms according to IBS subtype is not well established. AIM: To compare the prevalence of extra-intestinal symptoms among patients with different subtypes of IBS. METHODS: A descriptive cross-sectional study including patients with IBS according to Rome IV criteria was performed between July 2022 and April 2023. Patients were classified according their subtype of IBS: IBS-D (diarrhea-predominant), IBS-C (constipation-predominant), and IBS-M (mixed bowel habits). Patients completed the IBS severity scoring system questionnaire (IBS-SSS) to determine severity of IBS symptoms and patient health questionnaire- 9 (PHQ-9) to define presence and severity of depressive symptoms. The prevalence of reported extra-intestinal symptoms was also assessed and compared between groups. KEY RESULTS: A total of 4862 patients with IBS were included; 608 IBS-D (12.5%), 1978 IBS-C (40.7%), and 2276 IBS-M (46.8%). Patients with IBS-C had significantly lower IBS-symptoms severity (mean IBS-SSS 290 vs. 310 and 320 for IBS-D and IBS-M, respectively, p = 0.03). The prevalence of obesity was also significantly lower in these patients (17.1% vs. 30.9% IBS-D and 27.9% IBS-M, p = 0.0001). Patients with IBS-D showed a significantly higher prevalence of food intolerance perception (9.5%, p = 0.03), history of cholecystectomy (17.8%, p = 0.03), and fecal incontinence (36.2%, p = 0.0001) as compared to the other groups. Patients with IBS-M had significantly higher mean PHQ-9 score (12.7 vs. 11.1 IBS-D and 10.5 IBS-C, p = 0.001) and prevalence of depressive symptoms (80.0%, p = 0.01). Patients with IBS-M also had higher prevalence of extra-intestinal symptoms such as arthralgia (62.4%, p = 0.0001), extremity numbness (64.5%, p = 0.0001), atopic dermatitis (28.2%, p = 0.02), and chronic cervicalgia (81.0%, p = 0.01). CONCLUSIONS & INFERENCES: The prevalence of most extra-intestinal symptoms is higher among patients with IBS-M. Further research is needed to better characterize IBS subtypes, which could potentially help refining tailored therapeutic strategies.

Predictors of salvage therapy for parasagittal meningiomas treated with primary surgery, radiosurgery, or surgery plus adjuvant radiotherapy.

OBJECTIVE: Parasagittal meningiomas (PM) are treated with primary microsurgery, radiosurgery (SRS), or surgery with adjuvant radiation. We investigated predictors of tumor progression requiring salvage surgery or radiation treatment. We sought to determine whether primary treatment modality, or radiologic, histologic, and clinical variables were associated with tumor progression requiring salvage treatment. METHODS: Retrospective study of 109 consecutive patients with PMs treated with primary surgery, radiation (RT), or surgery plus adjuvant RT (2000-2017) and minimum 5 years follow-up. Patient, radiologic, histologic, and treatment data were analyzed using standard statistical methods. RESULTS: Median follow up was 8.5 years. Primary treatment for PM was surgery in 76 patients, radiation in 16 patients, and surgery plus adjuvant radiation in 17 patients. Forty percent of parasagittal meningiomas in our cohort required some form of salvage treatment. On univariate analysis, brain invasion (OR: 6.93, p < 0.01), WHO grade 2/3 (OR: 4.54, p < 0.01), peritumoral edema (OR: 2.81, p = 0.01), sagittal sinus invasion (OR: 6.36, p < 0.01), sagittal sinus occlusion (OR: 4.86, p < 0.01), and non-spherical shape (OR: 3.89, p < 0.01) were significantly associated with receiving salvage treatment. On multivariate analysis, superior sagittal sinus invasion (OR: 8.22, p = 0.01) and WHO grade 2&3 (OR: 7.58, p < 0.01) were independently associated with receiving salvage treatment. There was no difference in time to salvage therapy (p = 0.11) or time to progression (p = 0.43) between patients receiving primary surgery alone, RT alone, or surgery plus adjuvant RT. Patients who had initial surgery were more likely to have peritumoral edema on preoperative imaging (p = 0.01). Median tumor volume was 19.0 cm3 in patients receiving primary surgery, 5.3 cm3 for RT, and 24.4 cm3 for surgery plus adjuvant RT (p < 0.01). CONCLUSION: Superior sagittal sinus invasion and WHO grade 2/3 are independently associated with PM progression requiring salvage therapy regardless of extent of resection or primary treatment modality. Parasagittal meningiomas have a high rate of recurrence with 80.0% of patients with WHO grade 2/3 tumors with sinus invasion requiring salvage treatment whereas only 13.6% of the WHO grade 1 tumors without sinus invasion required salvage treatment. This information is useful when counseling patients about disease management and setting expectations.

Long-term effectiveness and safety of tolvaptan in autosomal dominant polycystic kidney disease.

BACKGROUND AND OBJECTIVES: Evidence on the long-term use of tolvaptan in autosomal dominant polycystic kidney disease (ADPKD) is limited. The aim was to evaluate the tolvaptan effectiveness and safety in real clinical setting. MATERIAL AND METHODS: A single-center observational study (2016-2022) involving ADPKD patients treated with tolvaptan was conducted. Annual change in serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) before and after treatment initiation were evaluated. Change in total kidney volume (TKV), blood pressure (BP) and urinary albuminuria at 12, 24 and 36 months after initiation were also determined. Adverse events (AEs) according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 were analyzed. RESULTS: A total of 22 patients were included. No significant differences pre- vs post tolvaptan treatment in annual rate of change in eGFR (-3.52ml/min/1.73m2 [-4.98%] vs -3.98ml/min/1.73m2 [-8.48%], p=0.121) and sCr (+0.06mg/dL [4.22%] vs +0.15mg/dL [7.77%], p=0.429) were observed. Tolvaptan improved urinary osmolality at 12 (p=0.019) and 24 months (p=0.008), but not at 36 months (p=0.11). There were no changes in TKV, BP control and urinary albuminuria at 12, 24 or 36 months. A worse response was shown in patients with rapid kidney function decline (p=0.042). A 36.4% of the patients developed grade III/IV AEs. A 22.7% discontinued treatment due to unacceptable toxicity. CONCLUSIONS: This study shows a modest benefit of tolvaptan in ADPKD patients, as well as safety concerns.

HIV care retention in three multi-month ART dispensing: a retrospective cohort study in Mozambique.

OBJECTIVE: Evaluate the effect of three multimonth dispensing (3MMD) of antiretroviral therapy (ART) on HIV care retention in southern Mozambique. DESIGN: Retrospective cohort study. METHODS: We analyzed routine health data from people with HIV (PWH) aged 10 years old and older who started ART between January 2018 and March 2021. Individuals were followed until December 2021. Cox proportional-hazards models were used to compare attrition (lost to follow-up, death, and transfer out) between 3MMD and monthly ART dispensing. Results were stratified by time on ART before 3MMD enrolment: 'early enrollers' (<6 months on ART) and 'established enrollers' (≥6 months on ART), and age groups: adolescents and youth (AYLHIV) (10-24 years) and adults (≥25 years). RESULTS: We included 7378 PWH (25% AYLHIV, 75% adults), with 59% and 62% enrolled in 3MMD, respectively. Median follow-up time was 11.3 [interquartile range (IQR): 5.7-21.6] months for AYLHIV and 10.2 (IQR: 4.8-20.9) for adults. Attrition was lower in PWH enrolled in 3MMD compared with monthly ART dispensing, in both established (aHR AYLHIV = 0.65; 95% CI: 0.54-0.78 and aHR adults = 0.50; 95% confidence interval (CI): 0.44-0.56) and early enrollers (aHR AYLHIV = 0.70; 95% CI: 0.58-0.85 and aHR adults = 0.63; 95% CI: 0.57-0.70). Among individuals in 3MMD, male gender (aHR = 1.30; 95% CI: 1.18-1.44) and receiving care in a medium-volume/low-volume healthcare facility (aHR = 1.18; 95% CI: 1.03-1.34) increased attrition risk. Conversely, longer ART time before 3MMD enrolment (aHR = 0.93; 95% CI: 0.92-0.94 per 1 month increase) and age at least 45 years (aHR = 0.77, 95% CI: 0.67-0.89) reduced risk of attrition. CONCLUSION: 3MMD improves retention in care compared with monthly dispensing among established and early enrollers, although to a lesser extent among the latter.

The clinical application of incisional negative pressure wound therapy in severe subcutaneous emphysema: A case series.

Severe subcutaneous emphysema (SSE) is the presence of a high-volume accumulation of air in the subcutaneous tissue caused by traumatic injuries, infections, iatrogenic causes, or can also manifest spontaneously. A variety of techniques have been reported, with varying levels of success. We present a multicenter case series detailing four patients who developed SSE and were treated with Incisional Negative Pressure Wound Therapy (INPWT). All patients significantly improved with the INPWT treatment within 6 to 48 h. Our experience suggests INPWT is a valuable procedure available for treating SSE and recommend prospective randomized studies be conducted to determine targeted patient selection and clinical application of INPWT among the SSE patient population.