• Publicationsclose
• Research dataclose
• Open Access close
• Preprint close
• SI close

Abstract Background The main goal of the paper is to define, analyze and assess the basic security, development and institutional challenges faced by the Central Asian countries after 2022. Following the Covid-19 pandemic, and with the outbreak of the Ukrainian crisis, Europe faced the need to find other sources of energy supply outside the Russian Federation. The Central Asian region is rich in energy resources and is therefore of special importance, but at the same time it is also a region of special geopolitical interest of often conflicting parties - the region for which there are limited information and insufficient academic literature about development, various aspects of security, internal specificities and future challenges. Methods The research included qualitative and quantitative analyses carried out for Kazakhstan, the Kyrgyz Republic, Turkmenistan, Uzbekistan and Tajikistan. Data processing was performed on the basis of 16 selected indicators in the fields of economy, energy, governance and climate change, for the time period from 2011 to 2021. Data processing was performed using the correlation and regression analysis (ANOVA). Results The results showed that energy policy and corruption represent one of the biggest problems faced by the countries of Central Asia, which strongly affects the energy security and sustainable development, not only of the countries of Central Asia, but also of all countries that are supplied with energy products from this region, or plan to do so. Correlation analysis shows that the countries of Central Asia have certain similarities when it comes to economic and social policy. Energy security is positive only in the case of Turkmenistan. Regression analysis shows that Kazakhstan reported the best positive trend for most indicators. Data for Germany show consistent values over the observed period. Conclusions The main conclusions of the paper indicate that the countries of Central Asia have made little progress when it comes to overall sustainable development, with energy security, corruption and government efficiency being the biggest problems. The European Union and Europe as a whole must find ways and mechanisms to overcome these and many other impediments if they are to get energy products from the aforementioned region.

Abstract Background Respectful maternity care (RMC) remains a key challenge in Afghanistan, despite progress on improving maternal and newborn health during 2001–2021. A qualitative study was conducted in 2018 to provide evidence on the situation of RMC in health facilities in Afghanistan. The results are useful to inform strategies to provide RMC in Afghanistan in spite of the humanitarian crisis due to Taliban’s takeover in 2021.Methods Focus group discussions were conducted with women (4 groups, 43 women) who had used health facilities for giving birth and with providers (4 groups, 21 providers) who worked in these health facilities. Twenty key informant interviews were conducted with health managers and health policy makers. Motivators for, deterrents from using, awareness about and experiences of maternity care in health facilities were explored.Results Women gave birth in facilities for availability of maternity care and skilled providers, while various verbal and physical forms of mistreatment were identified as deterrents from facility use by women, providers and key informants. Low awareness, lack of resources and excessive workload were identified among the reasons for violation of RMC.Conclusion Violation of RMC is unacceptable. Awareness of women and providers about the rights of women to respectful maternity care, training of providers on the subject, monitoring of care to prevent mistreatment, and conditioning any future technical and financial assistance to commitments to RMC is recommended.

Abstract Kale (Brassica oleracea. acephala) is a nutrient-rich green leafy vegetable consumed as food and used in traditional medicine worldwide. An essential step in describing the available genetic resources and ensuring their effective use in breeding programs is to characterize the genetic diversity of available germplasm. In this study, the genetic diversity and structure of 26 kale accessions from South-East Europe were examined using 26 agro-morphological traits collected in the field and 12 SSR markers. Considerable agro-morphological variability was found in most quantitative (CV = 17.26–42.42%) and qualitative (H' = 0.61–1.79) traits. Multifactorial analysis (MFA) showed that country of origin (33.01%) and morphotype (32.30%) significantly influenced kale diversification. Leaf blade shape (20.62%), leaf incision (19.43%), anthocyanin distribution (16.43%), and leaf colour (15.55%) were the traits that most clearly differentiated accessions. The three common commercial kale varieties were identified as independent outliers that differed from the other kale accessions in both MFA and UPGMA clustering analysis. The SSR markers were highly informative with 108 alleles and polymorphic information content ranging from 0.395 to 0.856. Strong genetic diversity was detected at the accession level (H' = 0.58) while genetic differentiation was low (Fst = 0.05). Similar to UPGMA clustering, Bayesian clustering suggests that the kale collection can be divided into four clusters with a high degree of admixture and no geographic grouping pattern is apparent. Overall, the study showed that the kale collection studied represents a valuable reservoir of genetic and agro-morphological variability that could be used for future breeding initiatives.

Abstract Background Prehabilitation aims at enhancing patients’ functional capacity and overall health status to enable them to withstand a forthcoming stressor like surgery. Our aim was to synthesise the evidence on the cost-effectiveness of prehabilitation for patients awaiting elective surgery compared with usual preoperative care. Methods We searched PubMed, Embase, the CRD database, ClinicalTrials.gov, the WHO ICTRP and the dissertation databases OADT and DART. Studies comparing prehabilitation for patients with elective surgery to usual preoperative care were included if they reported cost outcomes. All types of economic evaluations (EEs) were included regardless of design, analysis type and completion status. The primary outcome of the review was cost-effectiveness based on cost-utility analyses (CUAs). The risk of bias of trial-based EEs was assessed with the Cochrane Risk of Bias 2 tool and the ROBINS-I tool, and the credibility of model-based EEs with the ISPOR checklist. Methodological quality of full EEs was assessed using the CHEC checklist. The EEs’ results were synthesised narratively using vote counting based on direction of effect. Results We included 45 unique studies: 25 completed EEs and 20 ongoing studies. Among the completed EEs, there were 22 trial-based EEs, and three model-based EEs, corresponding to four CUAs, three cost-effectiveness analyses, two cost-benefit analyses, 12 cost-consequence analyses and four cost-minimization analyses. Three of the four trial-based CUAs (75%) found prehabilitation cost-effective. Overall, 16/25 (64.0%) EEs found prehabilitation cost-effective based on direction of effects. When excluding studies of insufficient credibility/critical risk of bias, this number reduced to 14/23 (60.9%). In 8/25 (32.0%) cost-effectiveness was unclear, and in one EE prehabilitation was not cost-effective. Discussion We found some evidence that prehabilitation for patients awaiting elective surgery is cost-effective compared to usual preoperative care. However, we suspect a relevant risk of publication bias, and most EEs were of high risk of bias and/or low methodological quality. Furthermore, there was relevant heterogeneity depending on the population, intervention, and methods. Future EEs should be performed over a longer time horizon and apply a more comprehensive perspective. Funding information and systematic review registration Funding: Innovationsausschuss of the Federal Joint Committee (G-BA) (01NVF18024). Registration: PROSPERO CRD42020182813.

Abstract Objective. To use a cascade of care approach to identify where most patients are lost along the continuum of hypertension care in Belgium, and to assess the main risk factors for attrition at various stages of hypertension management. Methods. Using cross-sectional data from the 2018 Belgian Health Interview Survey and Belgian Health Examination Survey, we estimated hypertension prevalence among the Belgian population aged 40-79 years, and the proportion that was (1) screened, (2) diagnosed, (3) linked to care, (4) in treatment, (5) followed up and (6) well-controlled. Cox regression was used to identify risk factors for being unlinked to hypertension care, untreated and not followed up appropriately. Results. The prevalence of hypertension based on self-reported and measured high blood pressure (BP) was 43.3%. While 98% of the hypertensive population had their BP measured in the past 5 years, only 56.7% was diagnosed. Furthermore, 53.4% of the hypertensive population was linked to care, 49.8% was in treatment and 43.4% received adequate follow-up. Less than a quarter (23.5%) achieved BP control. Males, those of younger age, without comorbidity, and smokers, were more likely to be unlinked to care. Younger age, lower BMI, financial hardship, and psychological distress were associated with a higher risk of being untreated. Finally, females, those of younger age, and without comorbidity were more likely to receive no adequate follow-up. Conclusion. Our results show that undiagnosed hypertension is the most significant barrier to BP control in Belgium. Health interventions are needed to improve the accurate and timely diagnosis of hypertension.

Abstract The morpho-structural, environmental and photocatalytical characteristics of Ag-graphene-TiO2 composite recovered from an used polylactic acid (PLA)-based film in comparison with those of the new prepared composite are reported. The recovered Ag-graphene-TiO2 composite displayed color, consistence, appearance, homogeneity and dispersion of nano-Ag similar with the new prepared compound. The FTIR spectroscopy showed that the oxygen and silver`s contents were 7 wt% higher in the recovered composite in comparison with the new prepared composite. The gap energy (Eg) of the recovered composite is 1.4 times and 2.3 times lower than that of new composite and TiO2, respectively. The anatase`s content decreased by 70% during the recovering, while that of rutile rised with the same magnitude. The photocatalytic activity of the recovered composite decreased only by 30% in comparison with the new composite. Additionally, the Life-Cycle Analysis (LCA) showed that the recovering procedure had a considerably lower environmental impact than the preparation of the new composite in terms of human health, ecosystem quality, climate change and resources. In conclusion, the recovering of the nanostructed composites from the active PLA-based films should be promising way to imporve the waste management.

Abstract Background CD103 is an integrin specifically expressed on the surface of cancer-reactive T cells. CD103 has been linked with better disease-specific survival in patients with ovarian, cervical, and endometrial cancer. The number of CD103+ T cells significantly increases during successful immunotherapy across human malignancies and therefore might be an attractive biomarker for non-invasive immune PET imaging of T cell infiltration. Indeed, we previously demonstrated that zirconium-89 (89Zr) radiolabeled anti-CD103 antibodies could be used for PET imaging of CD103+ T cells at relevant cell densities. However, the long half-life of antibodies precluded repeat imaging of CD103+ T cell dynamics early in therapy, and is associated with a significant radiation burden.Methods Two different anti-human CD103 Fab fragments radiolabeled with 89Zr or 68Ga were developed, namely 89Zr- hCD103 Fab and 68Ga-hCD103 Fab respectively. In vivo evaluation of these tracers was performed in nude mice (BALB/cOlaHsd-Foxn1nu) with established CD103-expressing CHO (CHO.CD103) or CHO wildtype (CHO.K1) xenografts, followed by serial PET imaging and ex vivo bio-distribution.Results In vivo, both 89Zr- and 68Ga- hCD103 Fab tracers showed high target-to-background ratios, high target site selectivity and high sensitivity in human CD103 positive xenografts.Conclusion We conclude that the two novel human CD103 immuno-PET tracers may be used for future non-invasive assessment of cancer reactive T cell infiltration. Consequently, both 89Zr and 68Ga- hCD103 Fab PET tracers should be explored in the clinical setting for stratification of patients who could benefit from immune checkpoint inhibition therapy.

Abstract Introduction: Protein energy wasting (PEW) is a common and serious co-morbidity in haemodialysis patients. Its importance as a prognostic factor has been increasingly recognised during past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in haemodialysis patients after 12 months of therapeutic intervention with ONS. Methods: 92 HD adult patients were enrolled in the study after three months wash-out period. At baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on haemodialysis day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle and hand-grip strength was analysed in 71 surviving patients. Results: After 12 months data for 71 patients, 39 (54.9%) male, 62.4±12.9 years, median haemodialysis vintage 53.3 (IQR 65.3) months, was available. Patients were divided into three groups: in group A were patients with normal nutritional status at baseline not necessitating ONS; in group B were patients who received ONS; and in group C were patients entitled to receive but refused to take ONS. Baseline results showed statistically significant differences between groups in serum albumin levels and phase angle but not hand-grip strength. Differences between groups remained statistically significant at month 12; we did not find any statistically significant positive changes within groups indicating no positive effect of intervention with ONS. Conclusions: In a prospectively designed interventional single-centre study, we did not find a statistically significant change of surrogate markers of PEW in our cohort of haemodialysis patients receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of haemodialysis patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during haemodialysis treatment, possibly providing psychological support and motivation.

Abstract Thrombotic complications are common in Coronavirus disease 2019 (COVID-19) patients, with pulmonary embolism (PE) being the most frequent. Randomised trials have provided inconclusive results on the optimal dosage of thromboprophylaxis in critically ill COVID-19 patients. We utilized data from the multicentre CAPACITY-COVID patient registry to assess the effect of differential application of Low Molecular Weight Heparin (LMWH) dose protocols on PE and in-hospital mortality risk in critically ill COVID-19 patients. An instrumental variable analysis was performed to estimate the intention-to-treat effect, utilizing differences in thromboprophylaxis prescribing behaviour between hospitals. We included 939 patients with PCR confirmed SARS-CoV-2 infection from 34 hospitals. Two-hundred-and-one patients (21%) developed a PE. The adjusted cause-specific HR of PE was 0.92 (95% CI: 0.73–1.16) per doubling of LMWH dose. The adjusted cause-specific HR for in-hospital mortality was 0.82 (95% CI: 0.65–1.02) per doubling of LMWH dose. This dose-response relationship was shown to be non-linear. To conclude, this study did not find evidence for an effect of LMWH dose on the risk of PE, but suggested a non-linear decreased risk of in-hospital mortality for higher doses of LMWH. However, uncertainty remains, and the dose-response relationship between LMWH dose and in-hospital mortality needs further investigation in well-designed studies.

Abstract Background Fahr’s disease and syndrome are rare disorders leading to calcification of the small arteries in the basal ganglia of the brain, resulting in a wide range of symptoms comprising cognitive decline, movement disorders and neuropsychiatric symptoms. No disease-modifying therapies are available. Studies have shown the potential of treatment of ectopic vascular calcifications with bisphosphonates. This paper describes the rationale and design of the CALCIFADE trial which evaluates the effects of etidronate in patients with Fahr’s disease or syndrome.Methods The CALCIFADE trial is a randomised, placebo-controlled, double-blind trial which evaluates the effects of etidronate 20 mg/kg during 12 months follow-up in patients aged ≥ 18 years with Fahr’s disease or syndrome. Etidronate and placebo will be administered in capsules daily for two weeks on followed by ten weeks off. The study will be conducted at the outpatient clinic of the University Medical Center Utrecht, The Netherlands. The primary endpoint is the change in cognitive functioning after 12 months of treatment. Secondary endpoints are the change in mobility, neuropsychiatric symptoms, volume of brain calcifications, dependence in activities of daily living, and quality of life.Results Patient recruitment started in April 2023. Results are expected in 2026 and will be disseminated through peer-reviewed journals as well as presentations at national and international conferences.Conclusions Fahr’s disease and syndrome are slowly progressive disorders with a negative impact on a variety of health outcomes. Etidronate might be a new promising treatment for patients with Fahr’s disease or syndrome.Trial registration ClinicalTrials.gov, NCT05662111. Registered 22 December 2022, https://clinicaltrials.gov/ct2/show/NCT01585402.