Journal of Infection and Chemotherapy

BACKGROUND Diagnosis of Tuberculosis (TB) from stool specimen using the Xpert MTB/RIF Ultra assay (Xpert-Ultra assay) is important to confirm diagnosis for presumptive TB patients who are unable to produce sputum. We evaluated diagnostic performance of the Xpert-Ultra assay in stool specimen among adult migrant population living in generalized HIV epidemic situation. METHODS A prospective, cross-sectional study was conducted at outpatient and inpatient departments of the Shoklo Malaria Research Unit (SMRU) clinics and Mae Tao Clinic (MTC) located in Thailand-Myanmar border area. Presumptive TB patients of any age who were registered between November 14, 2022, and May 23, 2023, were eligible for inclusion based on reported signs and symptoms and/or radiological findings. Using liquid MTB culture in sputum as reference standard, evaluation of diagnostic performance of the Xpert-Ultra assay in stool was performed, and it was also compared with performance of smear microscopy and Xpert-Ultra assay in sputum specimen. RESULTS Total 113 participants were included in the analysis; 9 (7.96 %) had human immunodeficiency virus (HIV) infection, and 31 (27.43%) had confirmed TB on culture results. Among these culture-confirmed TB cases, the sensitivity of Xpert-Ultra assay in stool specimen was 90.32 % (95% confidence interval [CI], 74.25% to 97.96%). Although the absolute difference in sensitivity of Xpert-Ultra assay in stool was 3.23 % lower than sputum (95% CI: -9.46 % to 3.00 %), there was no statistically significant difference between the two sample types. The specificity of Xpert-Ultra assay in stool specimen was 98.78% (95% CI, 93.39% to 99.97%) against culture-negative TB cases, giving an absolute difference of 1.22 % (95% CI, -1.16% to 3.59%) compared to sputum Xpert-Ultra assay. This method demonstrated that diagnostic performance was consistent with World Health Organization (WHO) target product profiles on low-complexity assays for detecting Mycobacterium tuberculosis (MTB). CONCLUSIONS The Xpert-Ultra assay in stool specimen can be considered as a potential, alternative method in diagnosis of presumptive pulmonary TB in adults when respiratory sample is difficult to collect.

Seasonal influenza remains a major cause of morbidity and mortality worldwide. Although neuraminidase inhibitors improve outcomes, influenza-related deaths persist. We evaluated the impact of early aspirin (ASA) and non-aspirin nonsteroidal anti-inflammatory drug (NSAID) use on outcomes in adults hospitalized with influenza. This retrospective study included adults admitted to the University of Minnesota Medical Center from 2016 to 2018. Continuous variables were summarized as medians with interquartile ranges (IQRs) and categorical variables as counts and percentages. Group comparisons used Wilcoxon rank-sum, Chi-square, or Fishers exact tests. Analyses included case-control comparisons, assessments by vaccination status, and subgroup analyses by early ASA or NSAID use. Among 2,816 patients, 320 had laboratory-confirmed influenza, with vaccination less common among cases. Unvaccinated patients had higher rates of intensive care unit (ICU) admission (23.6% vs. 11.1%; P = 0.003) and ventilatory support (15.0% vs. 6.1%; P = 0.009). In vaccinated patients, early ASA use was associated with older age and higher in-hospital mortality, whereas early NSAID use was associated with no in-hospital deaths, better one- and three-year survival (P < 0.001), and fewer, though not statistically significant, cardiovascular complications. In unvaccinated patients, ASA use was associated with lower three-year survival (59.1% vs. 79.2%; P = 0.013), while NSAID use was associated with fewer ICU admissions and no cardiovascular or renal complications. In both vaccinated and unvaccinated adults hospitalized with influenza, early NSAID use was associated with improved survival and fewer complications, whereas ASA use was associated with worse outcomes.

Background The COVID-19 pandemic substantially altered respiratory pathogen circulation worldwide. However, longitudinal analyses of changes in respiratory pathogen ecology across the pandemic and post-pandemic periods remain limited. Methods We analyzed 19,968 respiratory samples tested with the BioFire(R) FilmArray(R) Respiratory Panel at a hospital in Tokyo, Japan, between January 2020 and March 2026. We evaluated temporal changes in pathogen circulation, age-specific epidemiology, co-detection patterns, pairwise pathogen associations, and clinical parameters. Results At least one respiratory pathogen was detected in 27.8% of tests. Respiratory pathogens resurged asynchronously following the relaxation of COVID-19-related public health measures. Influenza virus circulation remained markedly suppressed until late 2022 before re-emerging in successive large seasonal epidemics, whereas other pathogens, including RSV, human metapneumovirus, and Mycoplasma pneumoniae, exhibited distinct resurgence patterns. Pathogen distributions also varied by age. Human rhinovirus/enterovirus remained predominant among young children, whereas SARS-CoV-2 predominated among older adults. Co-detection occurred in 14.0% of positive specimens and was significantly more frequent in younger patients. Pairwise analysis identified both positive and negative pathogen associations; however, the patterns varied across age groups and study periods. Conclusions Respiratory pathogen circulation changed substantially during the transition from the COVID-19 pandemic to the post-pandemic period, with pathogen-specific, age- and period-dependent patterns. Continued surveillance is warranted to determine how respiratory pathogen circulation will evolve and to inform infection control strategies in the post-pandemic era.

Objective To identify optimal initiation ages and screening intervals for low-dose computed tomography (LDCT) screening among never-smoking Asian women using an integrated polygenic risk score (PRS)-environmental tobacco smoke (ETS) risk model, and to evaluate the cost-effectiveness of alternative screening strategies at these optimized ages. Design Integrated PRS-ETS microsimulation modelling. Setting Japan. Participants Never-smoking women stratified into eight risk groups defined by combinations of PRS levels and ETS exposure. Interventions LDCT screening at intervals of 1 to 10 years, annual chest radiography (CXR), or no screening. Main outcome measures Costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), net monetary benefits, lung adenocarcinoma incidence and mortality, and optimal LDCT initiation ages. Sensitivity analyses used a willingness-to-pay threshold of US$50,000 per QALY gained. Results Optimal initiation ages ranged from 40 to 55 years across the eight PRS-ETS risk groups, with higher PRS-ETS risk associated with younger optimal initiation ages. Annual LDCT was the most cost-effective strategy across all PRS-ETS risk strata, yielding an ICER of US$40,471 per QALY in the lowest risk stratum and becoming cost-saving in higher risk strata. Over a lifetime, annual LDCT averted 8,534 lung adenocarcinoma deaths compared with annual CXR and 14,940 deaths compared with no screening. Conclusions Tailoring LDCT initiation age across integrated PRS-ETS risk groups maximizes mortality reduction achievable with cost-effective annual LDCT screening among never-smoking Asian women. These findings highlight an urgent limitation of global lung cancer screening guidelines that rely exclusively on smoking history and provide policy-ready evidence supporting the integration of PRS and ETS into future recommendations for precision LDCT screening for never-smoking populations.

In primary healthcare centers lacking advanced imaging, community-based active tuberculosis (TB) case finding often relies on basic symptom screening. This approach often misses cases and leads to the inefficient allocation of rapid molecular testing (RMT). We aimed to develop and internally validate a simple clinical triage scorecard to improve TB detection and guide RMT use in resource-constrained settings. We conducted a retrospective cross-sectional study of 15,137 adults ([&ge;]18 years) evaluated within the Zero TB Yogyakarta program (2020-2025). Participants with complete clinical assessments and confirmatory GeneXpert results were included. Using multivariable logistic regression, we identified independent clinical predictors, which were subsequently transformed into an integer-based point scorecard. Model performance was evaluated via discrimination and calibration, utilizing bootstrap resampling (1,000 iterations) for internal validation. Among the 15,137 participants, 251 (1.7%) were GeneXpert-positive. The final multivariable model identified eight independent predictors: age, male sex, body mass index, prolonged cough, hemoptysis, unexplained weight loss, TB contact history, and diabetes mellitus. The model demonstrated strong predictive accuracy, with an optimism-adjusted AUROC of 0.836 and good calibration. When translated to the integer scorecard and compared directly to standard national symptom screening, the scorecard performed (AUROC 0.81 vs. 0.73; p<0.001). At a high sensitivity cut off score of [&ge;] 0, the tool achieved 93.63% sensitivity and 41.33% specificity. This point-of-care clinical scorecard provides higher diagnostic accuracy than standard symptom screening algorithms. By offering flexible operational thresholds, it empowers local health programs to dynamically balance the urgency of case detection with available diagnostic capacity, optimizing GeneXpert allocation where advanced radiological imaging is unavailable.

Background and Objectives: Robotic-assisted natural orifice specimen extraction surgery (NOSES) is a minimally invasive approach for mid-rectal cancer, but it is technically complex and lacks a standardized operational framework. This study aimed to propose and preliminarily validate a structured modular robotic NOSES II surgical procedure for mid-rectal cancer. Methods: This was a retrospective observational study that consecutively enrolled 11 patients with mid-rectal cancer who underwent modular robotic NOSES-II surgery at our center between December 2024 and August 2025. All procedures were performed by the same surgical team strictly following the predefined six-module structured surgical protocol. Perioperative indicators, pathological outcomes, and patient-reported outcomes (PROs) at 4 to 8 months postoperatively were collected. Key techniques were analyzed via high-definition surgical videos. Results: All 11 procedures were completed successfully without conversion to open surgery. The mean operative time was 299.6 plus or minus 54.2 minutes, and the mean intraoperative blood loss was 94.1 plus or minus50.6 mL. The mean number of harvested lymph nodes was 17.4 plus or minus 8.4, with a 100% R0 resection rate. No severe complications (Clavien-Dindo grade [&ge;] III) occurred. The mean postoperative hospital stay was 8.2 plus or minus 1.5 days. Postoperative PROs indicated good defecatory function, urinary function, and overall quality of life. Conclusions: Preliminary findings demonstrate that the structured modular robotic NOSES-II procedure is safe and feasible for the treatment of mid-rectal cancer. This modular protocol provides a clear and reproducible technical framework for this complex procedure, and it is expected to achieve favorable functional preservation while ensuring oncological radicality.

BACKGROUND Current polio vaccines face challenges including vaccine-derived poliovirus and high-containment manufacturing. We evaluated a recombinant trivalent virus-like particle (VLP)-based poliovirus vaccine (VPV) for safety and immunogenicity in a first-in-human phase 1 trial. METHODS In this randomized, observer-blind, active-controlled trial, 72 healthy adults (18 to 54 years) were assigned (1:1:1:1) to receive a single dose of VPV at low (45:8:25 D-antigen units [DU] + 0.1 mg aluminum phosphate [AP]), medium (45:8:25 DU + 0.3 mg AP), or high (90:12:45 DU + 0.3 mg AP) doses, or conventional inactivated poliovirus vaccine (cIPV). Primary outcomes were safety and tolerability. Secondary outcomes included neutralizing antibody titers through day 180. RESULTS No serious adverse events or Grade 3 reactions were reported. Solicited adverse events were reported in 77.8%, 55.6%, and 72.2% of the low-, medium-, and high-dose VPV groups, respectively, and 66.7% in the cIPV group. By day 29, VPV induced dose-dependent neutralizing antibody responses. For serotypes 1 and 2, the high-dose VPV group achieved geometric mean titers (GMTs) of 73,582 (95% CI, 31,198-173,545) and 110,623 (95% CI, 59,276-206,451), respectively, comparable to cIPV at 45,161 (95% CI, 20,973-97,244) and 112,361 (95% CI, 58,280-216,625). Although serotype 3 GMTs were lower for the high-dose VPV at 18,905 (95% CI, 8737-40,906) than for cIPV at 61,431 (95% CI, 31,123-121,251), 100% of high-dose VPV recipients achieved neutralizing titers [&ge;]1:1024. CONCLUSIONS A single dose of VPV was safe and highly immunogenic, supporting its potential as a next-generation vaccine to advance global polio eradication. (Funded by the Gates Foundation and Tianjin Leading Enterprises Innovative project 23YDLQSY00100; ClinicalTrials.gov number, NCT06101173).

Leptospirosis is an infectious neglected zoonotic disease caused by pathogenic bacteria of the genus Leptospira. The genus comprises 43 pathogenic species, divided into two clades (P1 and P2), with the potential to cause disease on animals and humans. Despite the major impact of this disease on animal and human health, few quantitative real-time polymerase chain reaction (qPCR) assays have been validated to specifically detect all pathogenic Leptospira species, thwarting diagnosis and epidemiological studies. The gene encoding LipL32, the major leptospiral outer membrane protein, discriminates pathogenic P1 species from P2 and saprophytic. However, with the recent discovery of new species, the current lipL32-based qPCR assay cannot detect all classified P1 species. Furthermore, there are no currently validated molecular methods able to differentiate the presence of P1 and P2 species on clinical samples. Previous analyses have shown that the 23S ribosomal RNA gene displays considerable conservation in P1 and P2 species but sequence divergence in saprophytic species, a promising target for PCR-based detection and discrimination of those two clades. This study optimized and validated an improved lipL32- and 23S-based TaqMan qPCR assay using human and animal clinical samples. These newly optimized and developed assays resulted in a lower limit of detection and increased diagnostic sensitivity, resulting in the detection of all pathogenic species of the genus Leptospira currently described. These assays will improve the detection of leptospires from clinical and environmental samples, providing a valuable epidemiological and clinical tool to support One Health research on this important emerging disease.

Background: Blood culture-negative infective endocarditis (BCNIE) poses a significant diagnostic challenge. This study evaluated a multimodal diagnostic algorithm combining serological and molecular methods at the Argentine National Reference Laboratory. Methods: A prospective analysis was conducted on 53 consecutive patients with suspected BCNIE referred between January 2019 and December 2024. The diagnostic workflow included indirect immunofluorescence for Bartonella spp. and Coxiella burnetii, species-specific PCR for Bartonella spp. and Tropheryma whipplei, and broad-range 16S rRNA PCR with Sanger sequencing on available blood and valvular tissue specimens. Results: An etiological diagnosis was established in 17 of 53 patients (32.1%). Bartonella spp. was the predominant pathogen (47.1%; 8/17), followed by T. whipplei (35.3%; 6/17) and Streptococcus spp. (17.6%; 3/17). All Bartonella cases were initially detected via serology, with molecular confirmation achieved exclusively through valvular tissue analysis. Conclusions: Implementing a standardized multimodal diagnostic algorithm significantly enhances etiological yields in BCNIE. The findings emphasize the complementary value of frontline serology and targeted molecular testing, highlighting that simultaneous submission of serum, blood, and valvular tissue is essential for optimal diagnosis.

Background. The clinical course of coronavirus disease 2019 (COVID-19), and the ability to anticipate which patients will require intensive care, were poorly characterized in Central Asia during the first pandemic wave. We aimed to describe the clinical features of hospitalized COVID-19 patients at the Tashkent State Medical University, Uzbekistan, and to identify risk factors for intensive care unit (ICU) admission. Methods. In this single-centre cross-sectional study, we reviewed the records of 2500 consecutive patients hospitalized between 11 April and 8 August 2020. Patients were grouped as asymptomatic or symptomatic, and symptomatic patients were compared by ICU versus non-ICU status. Groups were compared with chi-square or Fisher's exact and Mann-Whitney U tests. Univariable and multivariable logistic regression identified risk factors for ICU admission. Results. Of 2500 patients (median age 36 years; 60.9% male), 989 (39.6%) were asymptomatic and 1511 (60.4%) symptomatic. In total, 129 (5.2%) were admitted to the ICU and 38 (1.5%) died. ICU patients were older (median 56 vs 40.5 years) and more often had bilateral pneumonia, oxygen desaturation and cardiometabolic comorbidity. In the multivariable model (AUC 0.82), the independent predictors of ICU admission were ischemic heart disease (aOR 4.20), shortness of breath (aOR 3.22), hypertensive heart disease (aOR 2.93) and male sex (aOR 2.00). Conclusions. Older age, cardiometabolic comorbidity and respiratory compromise identified patients at high ICU risk. As one of the first clinical COVID-19 descriptions from Uzbekistan, these data provide a baseline for preparedness in Central Asia.

Background: Pancreatic ductal adenocarcinoma (PDAC) has remained one of the most serious malignancies and is still a leading cause of cancer-related deaths worldwide. Great attention has been paid to the relationship between diabetes mellitus and PDAC. The aim of our study was to analyse the mutual association of PDAC and diabetes mellitus in the entire population of the Czech Republic within a 5-year period. Methods: The incidence of PDAC in 2018-2022 was estimated based on the individual population data from the Czech National Cancer Registry. Another data source, the National Registry of Reimbursed Health Services that collects data from health insurance companies, was used to identify individuals recently diagnosed with diabetes mellitus. For the purpose of this study, diagnosis of new-onset of diabetes mellitus was defined as the time of the first prescription of any antidiabetic drug or another related health care service. Subsequently, patients diagnosed with PDAC in 2022 were followed retrospectively to see if they had been diagnosed with diabetes mellitus in the last five years before diagnosis of pancreatic cancer. Results: In 2022, 2,189 patients aged 60 years or older were diagnosed with pancreatic cancer. New-onset diabetes was observed in 17.4% within five years prior to diagnosis, with the highest occurrence (12.4%) within the last three years. Among patients aged 60-74 years, the respective proportions were 14.4% within three years and 5.7% four to five years prior to pancreatic cancer diagnosis. Conclusion: The incidence of pancreatic cancer in the Czech Republic is among the highest in Europe. One-fifth of PDAC cases are diagnosed following new-onset diabetes mellitus in patients over sixty. Unintended significant weight loss combined with new-onset diabetes thus must not be overlooked, as these can be early signs of PDAC. An individualised diagnostic work-up should follow without any unnecessary delay.

Background: Patient-reported measures (PRMs), including patient-reported outcome and experience measures, capture patients perspectives on their health status and healthcare experiences. In cancer genetics, PRMs have been used to assess genetic knowledge, psychosocial outcomes, and decision-making. However, patients must understand these measures to provide useful information, an ability which is influenced by general and health literacy levels. Readability guidelines recommend that patient-facing materials be written at or below a Grade 6 level. This study evaluated the readability of PRMs used in a cancer genetic testing context. Objective: To assess whether PRMs used in heritable cancer genetic testing meet recommended readability levels using validated indices. Methods: PRMs were identified from a recent systematic review of PRMs used in heritable cancer genetic testing, which reported 83 instruments across eight categories. English-language PRMs containing structured question items and response scales were eligible for extraction and converted into plain text for analysis. Readability was assessed using four validated indices: Flesch Kincaid Grading Level (FKGL), FORd, CAylor, and STicht (FORCAST) formula, Flesch Reading Ease Score (FRES), and Simple Measure of Gobbledygook (SMOG) via an automated readability software. Descriptive analysis and numerical comparison evaluated readability levels across PRM categories and against the recommended Grade 6 reading level. Results: Sixty-five PRMs met the eligibility criteria, with most, including validated instruments, exceeding the recommended Grade 6 reading level. Across the eight categories, genetics-specific PRMs required the highest readability levels, indicating higher readability demands. Conclusions: Most PRMs, particularly those specific to genetics, do not meet readability guidelines. This may limit their accessibility to individuals with limited general and health literacy. Development of PRMs specific to genetics should consider strategies to improve readability, such as plain-language approaches and involvement of individuals with limited general or health literacy. Keywords: readability, patient-reported measures, cancer, genetic testing, health literacy

Background: Retail red meat may act as a source of foodborne pathogens, antimicrobial resistant bacteria, and antibiotic residues, posing a significant public health concern in Bangladesh. Objectives: This study aimed to isolate and identify major bacterial pathogens from retail red meat, determine their antimicrobial susceptibility patterns, assess the prevalence of antibiotic resistant bacteria, and detect antibiotic residues in meat samples. Methods: A cross-sectional study was conducted from January to June 2019 using 60 retail red meat samples (20 cattle, 20 goat, and 20 buffalo) collected from Rajshahi and Naogaon districts. Bacterial isolates were identified using standard cultural, morphological, staining, and biochemical techniques. Antimicrobial susceptibility was evaluated by the Kirby Bauer disc diffusion method according to CLSI guidelines. Antibiotic residues were screened in 15 representative samples using thin layer chromatography (TLC). Results: Overall prevalence of Escherichia coli, Salmonella spp., and Staphylococcus aureus was 10.0%, 13.3%, and 28.3%, respectively. E. coli showed complete resistance to penicillin (100%) and high resistance to amoxicillin (83.3%), while remaining highly susceptible to ciprofloxacin (83.3%) and gentamicin (66.7%). Salmonella spp. exhibited highest resistance to penicillin (87.5%) and tetracycline (75.0%), whereas gentamicin (87.5%) and ciprofloxacin (75.0%) remained the most effective agents. S. aureus demonstrated marked resistance to penicillin (94.1%), ampicillin (58.8%), tetracycline (47.1%), and amoxicillin (47.1%), but high susceptibility to gentamicin (88.2%) and ceftriaxone (70.6%). TLC detected ciprofloxacin and oxytetracycline residues in one cattle meat sample each (6.7%). Conclusions: Retail red meat marketed in the study areas harbored multidrug-resistant bacterial pathogens and detectable antibiotic residues, highlighting potential risks to food safety and public health. Continuous surveillance, prudent antimicrobial use, improved slaughterhouse hygiene, and strict compliance with antibiotic withdrawal periods are essential to minimize antimicrobial resistance and residue contamination.

Long-term data describing cancer patterns in Iraq remain generally limited. This retrospective observational study was conducted to evaluate the distribution and longitudinal patterns of malignant solid tumors diagnosed over a period of 12 years (2014-2025) at a major tertiary oncology center in the Kurdistan Region of Iraq. Demographic characteristics, cancer types, and temporal trend changes in cancer distribution were analyzed. Comparisons were made between the first (2014-2019) and second (2020-2025) halves of the study period. Descriptive statistics, Chi-square tests, and linear regression analyses were used to evaluate the temporal trends. After excluding records with incomplete data, 11,704 patients were included. Breast cancer was the most frequently diagnosed malignancy, accounting for over one-quarter of all cases, followed by lung, colorectal, prostate, and bladder cancers, in descending order. Women represented the majority of patients, and the mean age at diagnosis increased significantly over time. In general, the relative distribution of colorectal, genitourinary, pancreatic, uterine, and thyroid cancers increased during the study period, whereas breast and lung cancers showed a modest but significant proportional decline despite remaining the most common malignancies. A marked reduction in case numbers was observed in 2020, followed by progressive recovery in subsequent years. To conclude, cancer patterns in the Kurdistan Region of Iraq changed substantially during the 12-year study period, with increasing proportions of colorectal and several other malignancies alongside an older age at diagnosis. These findings likely reflect a combination of demographic changes, evolving lifestyle-related risk factors, and improvements in cancer detection and referral. The results provide contemporary evidence to support regional cancer control strategies, screening programs, resource allocation, and future epidemiological research.

Background Tumor hypoxia and abnormal vasculature are closely associated with aggressiveness in solid tumors. Therefore, noninvasive assessment of these features in primary breast cancer is needed. Photoacoustic (PA) imaging is an emerging modality that enables real-time visualization of vascular architecture and hemoglobin oxygenation. Methods Breast PA imaging was performed in patients with primary breast cancer using a bed-type PA imaging system equipped with a hemispherical sensor and a flat specimen holder enabling mild breast compression. Three independent evaluators assessed predefined characteristics of tumor-associated vasculature: centripetal/disrupted vessels and intratumoral vessel-like signals. Oxygenation (S-factor) of tumor-associated vessels was estimated using dual-wavelength laser irradiation at 756 and 797 nm. Results PA imaging was performed in 9 tumors from 8 patients. Eight tumors were evaluable, after the exclusion of 1 tumor with segmental bloody discharge. Centripetal/disrupted vessels were identified in 7 tumors (87.5%). Intratumoral vessel-like signals were observed in all tumors (100%), with higher signal density than in surrounding tissue in 5 lesions (62.5%). Increased intratumoral signal density was associated with a higher Ki67-labeling index (two-sided P = .01). Mean intratumoral S-factor level (76.9% {+/-} 9.1%) was significantly lower than that of peritumoral vessels at 5 mm (86.4% {+/-} 5.9%) and 20 mm (88.5% {+/-} 4.9%) from the tumor margin (two-sided P < .01). Conclusion PA imaging with a flat specimen holder enables noninvasive visualization of tumor-associated vasculature with reduced oxygenation in primary breast cancer. This approach may provide a novel imaging platform for the early detection and functional assessment of breast cancer.

Klebsiella aerogenes, a member of the Enterobacteriaceae, is a causative agent of healthcare-associated infections, and outbreaks caused by drug-resistant K. aerogenes have been reported worldwide. The range of antimicrobial agents available for treating infections caused by carbapenem-resistant K. aerogenes is limited. While in vivo animal experiments using clinical K. aerogenes isolates to evaluate antimicrobial therapy could facilitate selection of the most effective treatment, conducting infection experiments involving large numbers of mammals such as mice is challenging due to ethical concerns related to animal welfare. Silkworms are invertebrates increasingly used as experimental models for infectious disease research to evaluate antimicrobial efficacy. In this study, we aimed to establish a silkworm infection model using a clinical K. aerogenes isolate to evaluate its utility for determining effective antimicrobial doses. K. aerogenes strains were isolated from a patient at a Japanese hospital, and a silkworm infection model was established using the clinical isolate. The non-metallo-beta-lactamase-producing strain K. aerogenes TUM25562, isolated from a patient with a complicated urinary tract infection, was susceptible to meropenem (MEPM) and gentamicin (GM) in vitro. During treatment, additional isolates with increased resistance to MEPM and subsequently to both MEPM and GM emerged. K. aerogenes TUM25562 caused dose-dependent mortality in silkworms. Treatment with clinically equivalent weight-based doses of MEPM or GM did not cure the infected silkworms. The median effective (ED50) doses of MEPM and GM were therefore investigated using the silkworm infection model. Administration of higher doses corresponding to four times the ED50 significantly prolonged the survival of infected silkworms. These results suggest that a silkworm infection model using clinical K. aerogenes isolates may provide a practical approach for evaluating antimicrobial efficacy and determining effective antimicrobial doses.

Objective: The purpose of this study is to determine how family history of cancer, genetic mutations, presenting symptoms, and comorbidity burden collectively influence cancer outcomes in patients with epithelial ovarian cancer. Methods: A retrospective analysis was conducted on all patients with epithelial ovarian cancer treated at the University of Missouri and Ellis Fischel Cancer Center between 2008 and 2024. Patient charts were reviewed for histological subtypes, stage of cancer, status of metastasis, CA-125 values, presenting symptoms, comorbidities, family history of cancer, genetic mutations, and survival outcome. Cox regression and association analyses were performed. Results: In this cohort of patients, comorbidities and genetic mutations did not influence ovarian cancer survival. While histological subtypes, CA-125 levels, and cancer stage remained strongly associated with survival. Significant associations were observed between certain presenting symptoms and cancer histological subtype, a family history of breast cancer, stage of cancer at diagnosis, the status of metastasis, and CA-125 levels. Conclusion: Comorbidities and genetic mutations were not significantly associated with ovarian cancer survival. Presenting symptoms were associated with several clinical and pathological variables linked to ovarian cancer diagnosis.

We compared the immunogenicity of three licensed egg-based inactivated influenza vaccines, including TetrAnflu (Sinovac quadrivalent), Fluarix Tetra (GSK quadrivalent), and Vaxigrip (Sanofi trivalent), in adult healthcare workers in Hong Kong during the 2025/26 season. Paired pre- and post-vaccination sera from age- and sex-matched recipients (n=30 to 40 per group) were tested by hemagglutination-inhibition assays against vaccine strains. After adjustment for age, sex, and sampling interval, the vaccines induced broadly comparable rises in antibody titers, proportions achieving titers >=40, and seroconversion rates, with a superior response to A(H1N1) after TetrAnflu. These real-world findings support the interchangeability of these vaccines for influenza vaccination programs.

Introduction: SkinScan3D (SS3D) is a novel, artificial intelligence-enabled device that provides objective three-dimensional measurements for monitoring Kaposi Sarcoma (KS) lesions. Prior to launching a clinical trial of the device, we obtained end-user perspectives to guide device refinement. Methods: Between April and May 2025, we conducted six focus group discussions and 28 in-depth interviews with patients, healthcare providers, and community representatives in Kenya and Uganda. Participants viewed a demonstration video and handled the SS3D prototype. Data were analyzed using hybrid deductive-inductive thematic analysis informed by the Health Information Technology Usability Evaluation Model and the Consolidated Framework for Implementation Research. Results: Qualitative findings were synthesized into a conceptual framework for SS3D adoption with two interconnected themes: 1) experiences and context, and 2) device perceptions and implementation factors. Participants' receptivity to the device was first shaped by experiences with medical technologies and the broader sociocultural context, including trust in providers, health beliefs, and gender preferences. After interacting with the prototype, participants viewed the SS3D as intuitive, accurate, and potentially capable of improving the objectivity and efficiency of KS lesion monitoring. They identified concerns related to safety, infection prevention, data security, affordability, maintenance, and workflow integration. Successful implementation was perceived to depend on device refinement, supportive organizational factors, including leadership engagement, provider training, maintenance capacity, and patient education to address misconceptions about the device. Participants proposed hardware, software, connectivity, and training refinements to support safe integration into routine clinical care. Conclusion: End users demonstrated overall satisfaction and receptivity to the SS3D, given potential benefits for both patients and providers. We identified targeted refinements to optimize the device's functionality and integration into the oncology environment to improve its fit with the local context.

Introduction: Postgraduate clinical training is crucial for developing professional competence, communication skills, and effective teamwork. Although resident physician selection is crucial, little is known about how Japanese residency programs select residents and whether selection practices are associated with difficulties during training. Methods: We conducted a nationwide cross-sectional survey of residency programs participating in Japan's 2023 General Medicine In-Training Examination (GM-ITE). Program directors completed a questionnaire assessing selection methods, interview content, quality-assurance measures, and resident difficulties, defined as at least one postgraduate year 1 or 2 resident physician receiving disciplinary action or a severe warning. Free-text responses were coded using the Situation, Task, Action, and Result framework. Associations between selection methods and resident difficulties were examined using adjusted logistic regression models controlling for hospital type and number of GM-ITE examinees. Results: Of 151 participating physician-selection programs, 150 provided valid responses. Interviews were used by 90.1% of programs and were identified as the most important selection component by 87.3%. Thirty-five programs (23.3%) reported difficulties with resident physicians, involving professionalism and workplace conduct including rule, ethics, or boundary violations, work avoidance or unavailability, and inappropriate communication. Use of applicants' pre-clinical-clerkship computer-based test scores as a selection criterion was associated with resident difficulties (adjusted OR, 4.60; 95% CI, 1.50-14.11; P = 0.008; FDR-adjusted P = 0.048). No significant associations were observed for essays, academic tests, medical school grades, or personality assessment. Program-level GM-ITE total and domain scores did not differ significantly between programs with and without reported resident physician difficulties. Discussion: Resident physician selection in Japan is highly interview-centered; reported difficulties were more often related to professionalism and workplace conduct than to knowledge deficits. Although these exploratory findings are program-level, they highlight the importance of strengthening the quality assurance processes in resident selection systems, particularly for assessing professionalism-related attributes in applicants.