This review aims to identify and synthesize existing literature on non-pharmacological interventions in cancer patients in which perceived appetite was assessed as a specific outcome, either alone or as part of broader symptom or quality-of-life measures. Systematic searches were performed using Embase, PubMed, CINAHL, and PsycINFO databases. Eligible studies included quantitative research involving adult cancer patients with poor appetite. All records were screened independently by two reviewers. A total of 3021 records were screened, and 29 studies met the inclusion criteria. These studies were grouped into four categories: mindfulness and relaxation, psychological or psychosocial, education and self-care, and multicomponent/comprehensive supportive-care programs. Interventions were heterogeneous in type, intensity, and delivery. Across categories, structured, repeated, and actively guided interventions were more consistently associated with improvements in perceived appetite, whereas brief or passive interventions showed limited effects. Interventions that incorporated personalization and required active patient engagement demonstrated greater effectiveness, suggesting the importance of sustained and individualized support. To support interpretation of these heterogeneous findings, results were synthesized using a conceptual framework linking intervention characteristics to psychological, sensory, physiological, and behavioral mechanisms influencing appetite perception. Within this framework, non-pharmacological appetite support appears to operate indirectly through pathways such as emotional regulation, sensory engagement, stress reduction, and active coping, rather than through appetite-specific mechanisms alone. Structured, actively guided, and repeated non-pharmacological interventions show potential to improve perceived appetite in cancer patients, whereas brief or passive interventions appear less effective. Findings suggest that appetite support operates primarily through indirect psychological, sensory, and behavioral pathways, as captured in a conceptual framework. Further research should develop and evaluate well-defined, mechanism-informed interventions.
The etiology of pain in chronic pancreatitis is multi-factorial and includes altered central pain processing. Pancreatic Quantitative Sensory Testing (P-QST) indirectly assesses pain sensitization, yet its clinical significance in relation to psychological comorbidities and quality of life (QoL) remains unclear in Indian populations. The primary objective was to apply an unbiased, data-driven clustering approach using P-QST parameters to stratify patients into centrally sensitized and non-sensitized phenotypes and evaluate their associations with demographic, clinical and patient-reported outcome variables. This cross-sectional study enrolled Indian patients with painful chronic pancreatitis between June 2021 and October 2023. We assessed static (pressure pain thresholds and cold pressor endurance) and dynamic (temporal summation and conditioned pain modulation) P-QST parameters to characterize pain processing. Psychological comorbidities, pain catastrophizing and quality of life were measured using validated questionnaires. We compared demographic, clinical and patient-reported outcome variables across pain phenotypes identified from K-median clustering of P-QST parameters. We enrolled 264 patients (mean [SD] age- 35.6 [11.0] years, male [
Capnocytophaga canimorsus (C. canimorsus) is a zoonotic pathogen transmitted by dogs and cats that can cause severe infections in humans. Antimicrobial susceptibility data remain limited, but increasing genomic evidence suggests that functional β-lactamase genes may be more widespread than previously recognized. Three C. canimorsus isolates harboring class D β-lactamase genes were selected by genomic screening from a larger collection of the Global Capnocytophaga Consortium for detailed characterization: two isolates from human clinical infections from Sweden and New Zealand, and a commensal canine isolate from the Czech Republic. We used hybrid Illumina-Nanopore genome assemblies, phylogenetic analysis, and structural modeling to characterize the genomic context and the predicted protein features of the β-lactamase genes. The functional impact of the β-lactamases on antibiotic activity was assessed by minimum inhibitory concentration (MIC) testing and confirmed through recombinant expression in the β-lactamase-negative reference strain C. canimorsus 5 (Cc5). We detected blaOXA-347 in a canine isolate and, for the first time, in a clinical C. canimorsus isolate from human infection. Additionally, we identified a previously uncharacterized allele, newly designated blaOXA-1422, in another clinical isolate. Both β-lactamases were chromosomally encoded without clear mobile genetic elements and were part of a distinct phylogenetic cluster within the OXA family. Structural modeling showed conserved class D β-lactamase architecture. Strains carrying either gene had elevated MICs for multiple β-lactams, and expression of each gene in Cc5 recapitulated these effects. The identification and phenotypic characterization of OXA-type β-lactamases in clinical C. canimorsus isolates refine our understanding of β-lactamase diversity in this species and underscore the need for systematic investigations of β‑lactamase prevalence in this zoonotic pathogen.
BACKGROUND/AIMS:The aim of this study was to compare the efficacy and tolerability of topiramate and propranolol in preventing pediatric cyclic vomiting syndrome. METHODS:A retrospective medical-record review of patients who underwent prophylaxis after receiving a diagnosis of cyclic vomiting syndrome was performed. Patients who completed at least 12 months of treatment were included in the analysis. Responder rate, and adverseevent rates were also calculated from all patients. Response to treatment was assessed as the total number of vomiting attacks per year. Patients in whom the frequency of vomiting attack reduced greater or equal to 50% were defined as responders, and the remaining patients were classified as nonresponders. RESULTS:A total of 38 patients who were treated prophylactically with either topiramate (16 patients) or propranolol (22 patients) were identified. Fifty-nine percent of the patients in the propranolol group and 81% of the patients in the topiramate group reported freedom from attacks. A decrease of more than 50% in attacks per year occurred in 23% of patients in the propranolol group and 13% of patients in the topiramate group. The responder rates were 81% for propranolol group and 94% for topiramate group (P = 0.001). Despite minor adverse effects (drowsiness, nervousness, and dizziness) observed in a few patients, the adverse event rates were not significantly different between the 2 groups (P = 0.240). CONCLUSIONS:The efficacy of topiramate was superior to propranolol for the prophylaxis of pediatric cyclic vomiting syndrome.
Total hip arthroplasty (THA) presents unique technical challenges in patients who have morbid obesity, and benefits of imageless navigation in this population remain unclear. This study compared complications, thromboembolic events, and emergency department utilization between imageless navigation-assisted and manual THA in patients who have morbid obesity. A retrospective cohort study was performed using the PearlDiver database. Patients who have morbid obesity (BMI ≥ 40) undergoing elective primary THA between 2010 and 2021 were identified. Cases performed with robotic assistance or image-based navigation were excluded. Patients were stratified by intraoperative technique into manual and imageless navigation cohorts and matched 1:3 on age, sex, year of procedure, and comorbidities. Surgical complications, thromboembolic events, revision procedures, and emergency department visits were evaluated at multiple postoperative time points and compared using univariable regression. After matching, 4,499 patients who have morbid obesity were included, comprising 3,367 manual (74.8
