Clinical Needs Should Drive InnovationJennifer N. Avari Silva, MD1, 2, 3, 4Affiliations: 1Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO;2Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO;3Sentiar, Inc, St. Louis, MO;4Excera, Inc, St. Louis, MOCorresponding Author:Jennifer N. Avari Silva, MD firstname.lastname@example.orgDisclosures: I am the co-founder and co-inventor of Sentiar and Excera, Inc. The technology has been licensed from Washington University to both Sentiar and Excera.Words:Conflicts: I have no relevant conflicts of disclosure.The tried-and-true methodology for designing medical devices starts with product ideation and rapid prototyping. But the most vital step starts prior to product ideation—that is, identifying the unmet clinical need. Starting with clear identification of clinical need may take time to fully elucidate and, importantly, may change over time as clinical practices, medical knowledge, and scientific discoveries change the field. Developing tools to address these unmet needs is the goal for medical device developers. When we start with developing tools that address unmet needs, the tools inherently provide added value. Conversely, tools are often developed to implement new technologies without a clear understanding of the need being addressed. Often, these technologies are in search of a clinically relevant use case—these tools become proverbial hammers in search of nails.In this study from Kumthekar et al1 in this month’s JCE, we learn the results of early feasibility testing of PeriScope in an animal (porcine) study. PeriScope is a novel percutaneous access tool for epicardial access developed to aid in the implantation of epicardial cardiac implantable electronic devices (CIEDs) in both pediatric and congenital patients who require systems at a young age. The clinical conundrum is that young patients who need CIEDs will often require lifelong devices, with transvenous systems often being delayed into adolescence (or later) due to small stature, linear growth, and concerns for causing venous stenosis or occlusion2, 3. Additionally, patients with congenital heart disease often have abnormal vasculature and anatomy which may prohibit transvenous CIED systems4, 5 This clinical problem has been debated rigorously in the pediatric EP community, with reports of transvenous systems placed in some of our youngest and smallest of patients6. This has been a longstanding need in the pediatric and congenital community which members of this investigative team have spent years working towards7-10.The authors set out to address this issue by creating a tool to ease epicardial device lead placement, and the first step in this multistep plan is epicardial access. The current data presented by Kumthekar et al1 demonstrate the use of this tool in an immature porcine model (Yorkshire piglets) to test the implant procedure characteristics and efficiencies. Early results are promising, showing the time from skin nick to sheath access in the pericardium was <10 minutes with a mean total procedure time of 16 minutes. Lead characteristics were acceptable, though not excellent, speaking to the need to develop additional new tools. To address the long-term goal of minimally invasive epicardial device implantation, adjunctive technologies will need to be developed, including leads designed for implantation via a minimally invasive approach and tools to simplify minimally invasive generator implantation. Given the breadth of tools that will be required to meet this need, an academic-industry partnership may emerge as a viable path for co-development.As with all novel tools and procedures, there is a learning curve and PeriScope is no different. Even within this small study with 6 piglets, there was a learning curve for the operator with piglet #1 having a longer procedure time than the rest of the cohort. Understanding learning curves, or assessments of performance over experience, for new technologies/tools and procedures is itself an entire field of study11 which over time has created standard learning curve models for guidance with certain types of procedures, including laparoscopic surgical procedures. With PeriScope, there appeared to be a steep learning curve with increased competency after a short experience (n=1). More experience with a varied user group will be invaluable to determining the true learning curve for the device.Finally, like many innovations developed to a specific clinical need, creative physicians will find novel, often off-label, use cases for technologies that address their own clinical needs. With the growing performance of epicardial ablation, accessing the epicardial space is no longer a need relegated to pediatric and congenital device implants, but is now an emerging need in adult, pediatric and congenital ablation. These changing needs over time are to be expected and reflect advances in medical knowledge and scientific discovery.By nature, cardiac electrophysiologists are innovators. We are fortunate to practice our field at a time when there is an abundance of devices being developed and engineered to address the unmet clinical needs emerging as we learn more about mechanisms of various substrates and develop best practices. Our mission is to ensure that these novel devices are practical, useful and of benefit to us and our patients.References:1. Kumthekar RN OJ, Mass P, M JC, Berul CI. Percutaneous Epicardial Pacing in Infants Using Direct VIsualization: A Feasibility Animal Study. Journal of Cardiovascular Electrophysiology . 2023.2. Berul CI, Triedman JK, Forbess J, Bevilacqua LM, Alexander ME, Dahlby D, Gilkerson JO and Walsh EP. Minimally invasive cardioverter defibrillator implantation for children: an animal model and pediatric case report. Pacing Clin Electrophysiol . 2001;24:1789-94.3. Kwak JG, Kim SJ, Song JY, Choi EY, Lee SY, Shim WS, Lee CH, Lee C and Park CS. Permanent epicardial pacing in pediatric patients: 12-year experience at a single center. Ann Thorac Surg . 2012;93:634-9.4. Maginot KR, Mathewson JW, Bichell DP and Perry JC. Applications of pacing strategies in neonates and infants. Prog Pediatr Cardiol . 2000;11:65-75.5. Rao V, Williams WG, Hamilton RH, Williams MG, Goldman BS and Gow RM. Trends in pediatric cardiac pacing. Can J Cardiol . 1995;11:993-9.6. Konta L, Chubb MH, Bostock J, Rogers J and Rosenthal E. Twenty-Seven Years Experience With Transvenous Pacemaker Implantation in Children Weighing <10 kg. Circ Arrhythm Electrophysiol . 2016;9:e003422.7. Clark BC, Kumthekar R, Mass P, Opfermann JD and Berul CI. Chronic performance of subxiphoid minimally invasive pericardial Model 20066 pacemaker lead insertion in an infant animal model. J Interv Card Electrophysiol . 2020;59:13-19.8. Clark BC, Opfermann JD, Davis TD, Krieger A and Berul CI. Single-incision percutaneous pericardial ICD lead placement in a piglet model. J Cardiovasc Electrophysiol . 2017;28:1098-1104.9. Kumthekar RN, Opfermann JD, Mass P, Clark BC, Moak JP, Sherwin ED, Whitman T, Marshall M and Berul CI. Minimally invasive percutaneous epicardial placement of a prototype miniature pacemaker with a leadlet under direct visualization: A feasibility study in an infant porcine model. Heart Rhythm . 2019;16:1261-1267.10. Kumthekar RN, Opfermann JD, Mass P, Clark BC, Moak JP, Sherwin ED, Whitman T, Marshall M and Berul CI. Percutaneous epicardial placement of a prototype miniature pacemaker under direct visualization: An infant porcine chronic survival study. Pacing Clin Electrophysiol . 2020;43:93-99.11. Hopper AN, Jamison MH and Lewis WG. Learning curves in surgical practice. Postgrad Med J . 2007;83:777-9.
The case report by Navarro-Lopez et al., (2023) in this issue describes a thorough differential diagnosis in an equine with acute neurological disease. Rabies was confirmed by direct fluorescent antibody test (DFA). Rabies virus (RABV) was isolated from brain tissue of the ill mare by intracerebral inoculation in sucking mice. Sequencing and phylogenetic inference allowed the identification of the rabies virus variant (RVV) associated with this case. Thus, Navarro-Lopez et al., reported that the rabid mare got infected with a rabies virus variant associated with skunks. This clinical commentary elaborates on the seemingly rare skunk rabies across North America (NA) highlighting its relevance in human and animal health that have remained somehow neglected
Pharmacoepidemiology and Drug Safety’s Core Concepts in Pharmacoepidemiology Section at One Year: Where Do We Go from Here? Jennifer L. Lund,1,2 Vincent Lo Re III3,41University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill, NC, USA2Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA3Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA4Division of Epidemiology, Center for Real-World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USARunning title: Core Concepts in Pharmacoepidemiology – Year 2Conflicts of interest: The authors report no conflicts of interest.Acknowledgements: The authors appreciated the critical input on the Core Concepts in Pharmacoepidemiology section from Brian Strom, Olaf Klungel, BJ Park, and the members of the International Society for Pharmacoepidemiology’s Publications and Communications Committee, particularly Elena Rivero, Patricia Saddier, Joan Largent, and Blànaid Hicks.
The chance for the development of right AFL is strictly related to changes in functional conduction properties of the atrial myocardium which are greatly influenced by fibrotic/scar tissue and increased atrial volume. If these circumstances take place, reduction in conduction velocity can favor a macro-reentry circuit with the wavefront that does not meet its refractory tail and perpetuate the arrhythmia. Therefore, the time required to traverse the entire circuit is related to the circuit’s functional properties. With pacing from the coronary sinus os the right atrial collision time (RACT) of the two wavefronts traveling the circuit in counterclockwise and clockwise direction is calculated. in this prospective study, a cut-off of 115.5 ms of RACT showed a sensitivity and specificity of 92.7% and 93.0% respectively for diagnosis of AFL and an ROC curve indicated an AUC of 0.96 (95% CI: 0.93-1.0, p<0.01). Based on these premises, RACT could be utilized as new marker for the propensity of developing typical AFL.
Epigenetic processes have taken center stage for the investigation of many biological processes and epigenetic modifications have shown to influence phenotype, morphology and behavioral traits such as stress resistance by affecting gene regulation and expression without altering the underlying genomic sequence. The multiple molecular layers of epigenetics synergistically construct the cell type-specific gene regulatory networks. DNA methylation occurring on the 5’ carbon of cytosines in different genomic sequence contexts is the most studied epigenetic modification. DNA methylation has been shown to provide a molecular record of a large variety of environmental factors, which might be persistent through the entire lifetime of an organisms and even be passed onto the offspring. Animals might display altered phenotypes mediated by epigenetic modifications depending on the developmental stage or the environmental conditions as well as during evolution. Therefore, the analysis of DNA methylation patterns might allow deciphering previous exposures, explaining ecologically relevant phenotypic diversity and predicting evolutionary trajectories enabling accelerated adaption to changing environmental conditions. Despite the explanatory potential of DNA methylation. studies of DNA methylation are still scarce in the field of ecology. This might be at least partly due to the complexity of DNA methylation analysis and the interpretation of the acquired data. In the current issue of Molecular Ecology Resources, Laine and colleagues (2023) provide a detailed summary of guidelines and valuable recommendations for researchers in the field of ecology to avoid common pitfalls and perform interpretable genome-wide DNA methylation analyses.
with other laboratory and clinical investigations. Early and accurate diagnosis of inherited conditions generally leads to better medical care for patients and their families, with improved knowledge of the natural history of the condition and early intervention. It is therefore essential that equitable access to such testing is established for indigenous and isolated populations, in order to further narrow the health disparity gap. Although supported by funding from a few sources, this study signals a success for the Silent Genomes Project, with one of the cases having been identified by whole genome sequencing within that project, after negative whole exome sequencing. Furthermore the study has potential life-changing clinical consequences and provides starting points for possible interventions for respiratory medicine in the Inuit population. These include increased awareness of the possibility of PCD in patients presenting with neonatal respiratory distress, bronchiectasis or otitis media leading to early intervention; and in conjunction with Inuit organizations and public health officials, targeted analysis of the DNAH11 variant in the population with the possible introduction of newborn screening for PCD.
The genome of Halobacterium strain 63-R2 was recently reported and provides the opportunity to resolve long-standing issues regarding the source of two widely used model strains of Hbt. salinarum, NRC-1 and R1. Strain 63-R2 was isolated in 1934 from a salted buffalo hide (epithet ‘cutirubra’), along with another strain from a salted cowhide (91-R6T, epithet ‘salinaria’, the type strain of Halobacterium salinarum). Both strains belong to the same species according to genome-based taxonomy analysis (TYGS), with chromosome sequences showing 99.64% identity over 1.85 Mb. The chromosome of strain 63-R2 is 99.99% identical to the two laboratory strains NRC-1 and R1, with only 5 indels, excluding the mobilome. The two reported plasmids of strain 63-R2 share their architecture with plasmids of strain R1 (pHcu43/pHS4, 99.89% identity; pHcu235/pHS3, 100.0% identity). We detected and assembled additional plasmids, using PacBio reads deposited at the SRA database, further corroborating that strain differences are minimal. One plasmid, pHcu190 (190,816 bp) corresponds to pHS1 (strain R1) but is even more similar in architecture to pNRC100 (strain NRC-1). Another plasmid, pHcu229, assembled partially and completed in silico (229,124 bp), shares most of its architecture with pHS2 (strain R1). In deviating regions, it corresponds to pNRC200 (strain NRC-1). Further architectural differences between the laboratory strain plasmids are not unique but are present in strain 63-R2, which contains characteristics from both of them. Based on these observations, it is proposed that the early 20th-century isolate 63-R2 is the immediate ancestor of the twin laboratory strains NRC-1 and R1.
Huiyong Hu1#, Xiaoping Jing2#, Xiuhua Duan3, Leiping Zhou4, Yunfeng Xu1*1 Department of the Ultrasonography, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai 200040, China;2 Department of Traditional Chinese Medicine, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai 200040, China;3 Department of Radiology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai 200040, China;4 Department of Radiology, International Peace Maternity & Child Health Hospital of China welfare institute, Shanghai Jiao Tong University, school of medicine, Shanghai 200030, China;# These authors contributed equally to this work.* Corresponding author: Yunfeng Xu, Department of the Ultrasonography, Shanghai Children’s Hospital, Shanghai Jiao Tong University, school of medicine;Address: 1400 West Beijing Road, Shanghai, China Lane 24 Zip Code 200040;Phone: 18917128478E-mail: xuyunfeng65@163. com (F X).During a prenatal ultrasonography examination late in the second trimester, a fetus was found to have a right diaphragmatic hernia (Figure S1). Multidepartment dynamic monitoring was instituted, and the fetus was later successfully delivered by cesarean section after fetal distress became evident. After intubation, the infant was stabilized and transferred to the Department of Neonatology at our hospital.The enhanced computed tomography of the chest and stomach displayed multiple air-filled intestinal shadows in the right chest cavity, the widest being about 20.0 mm. The right lung, mediastinum, and heart were compressed and displaced, and most of the lung tissue in the right lung was consolidated. Atelectasis is evident in the irregular enhancement shadow at the right upper abdomen, about 43.5 × 32.0 mm in size. The boundary between some sections and the posterior margin of the right lobe of the liver was unclear, but the blood supply (hepatic artery and portal vein branches) was visible (Figure). Blood gases, routine bloodwork, liver and kidney function, and myocardial enzymes were essentially normal.At 40 + 4 weeks, with the infant under total anesthesia, hernia repair was performed. The liver and intestines in the thoracic cavity were brought back into the abdominal cavity; the tissues around the hernia ring in the diaphragm were carefully dissociated; and patch repair and suturing were performed (Figures S2–S4). After the operation, the infant’s vital signs were stable and their condition remained good during follow-up.Congenital diaphragmatic hernia (CDH) is a potentially fatal birth defect[1-3]. In China today, all pregnant women undergo ultrasonography to uncover pregnancy- related conditions. A “green channel” – that is, a multidepartment collaborative for the emergency treatment of perioperative pulmonary hypertension, pulmonary dysplasia, and other complications in newborns with CDH – has been established, helping to assure the best prognosis for those infants.
In this paper, we study a class of sequential fractional differential inequalities involving Caputo fractional derivatives with different orders. The nonexistence of nontrivial global solutions is investigated in a suitable space via the test function technique and some properties of fractional integrals. Our results are supported by numerical examples.
A general reaction norm model of any order can be formulated as a linear mixed model. From this follows that estimates of mean phenotypic traits in a population (fixed effects), and predictions of individual additive genetic deviations from mean reaction norm parameter values (random effects), can be found from the best linear unbiased predictions (BLUP) equation in matrix form. The resulting BLUP model is dynamical in the sense that the incidence matrix varies with time. This leads to a straightforward and multivariate alternative to infinite-dimensional and random regression modeling of reaction norms. Based on such a BLUP model, the within-generation changes in predicted mean reaction norm parameter values can be found by use of the Robertson-Price identity, applied on the predicted random effects. From this follows that the between-generation change in the mean values are found from Robertson’s secondary theorem of natural selection, applied on the predicted random effects. This explains why and to which extent the variances of BLUP random effects are underestimated, which is a well-known observation. The dynamical BLUP model will thus produce the mean reaction norms over time, which makes it possible to disentangle the microevolutionary and plasticity components in for example climate change responses. The BLUP responses will depend on the additive genetic relationship matrix A_t. When A_t is an identity matrix, the results will be identical to the results from a variant of the multivariate breeder’s equation, based on the selection gradient with respect to the individual phenotypic trait values. Parameters are assumed to be known and constant, but it is discussed how they can be estimated by means of a prediction error method. Generations are assumed to be non-overlapping, but adjustments for overlapping generations can easily be done.
Prediction categories in the Critical Assessment of Structure Prediction (CASP) experiments change with the need to address specific problems in structure modeling. In CASP15, four new prediction categories were introduced: RNA structure, ligand-protein complexes, accuracy of oligomeric structures and their interfaces, and ensembles of alternative conformations. This paper lists technical specifications for these categories and describes their integration in the CASP data management system.
Treatment of guttural pouch mycosis with salpingopharyngostomyAmanda R Watkins1 and Eric J Parente11University of Pennsylvania New Bolton Center, Kennett Square PAThe case report by Rowe et al (2023) published in this issue describes a case of bilateral guttural pouch mycosis in a 9-month-old thoroughbred colt that was diagnosed due to unusual severe neurologic abnormalities including neck pain and abnormal head carriage. There was no evidence of hemorrhage in this case and therefore the colt was treated with debridement of the mycotic plaques, topical enilconazole, and ultimately a salpingopharyngeal fistula in the dorsal pharyngeal recess to inhibit the growth of the mycosis. The treatments were successful, and the colt went on to race.The guttural pouch is an diverticulum of the auditory tube that is found in ungulates possessing an odd number of toes, including the horse.1 The guttural pouches are susceptible to fungal and bacterial infections and the intimate association of the pouches with major arteries and nerves makes such infections potentially life-threatening. While the purpose of the guttural pouch is an area of speculation among equine researchers it is thought that cooling the blood before it reaches the brain especially during exercise is an important function.1 The cooling of the blood is achieved by a large air filled space separated from the internal carotid artery by only a thin membrane. Therefore, any locally invasive disease within the guttural pouches can have dire consequences.Fungal infection of the guttural pouch occurs rarely but, due to its anatomical position in relation to many neurovascular structures of the head, even mild disease can result in fatal hemorrhage and neurological sequelae.2 Obtaining a positive culture from these cases can be difficult however the most commonly isolated fungal species is Aspergillus fumigatus.2 The warm, dark, and humid environment of the guttural pouch may predispose it as a site of fungal infection. Jukic et al showed that the oxygen and carbon dioxide partial pressures within the guttural pouch vary significantly between horses and that they remain relatively static throughout the respiratory cycle in a normal guttural pouch.3 This inter-horse variation may explain the seemingly random distribution of horses that are affected by guttural pouch mycosis. Additionally the individual differences may contribute to the less aggressive phenotype that resolves without treatment in 15-28 days that is seen in the experimentally induced Aspergillus guttural pouch mycosis model.4 The case described in this report may have been complicated by the mixed infection cultured from the guttural pouch of both Aspergillus fumigatus and Streptococcus equi subsp. zooepidemicus .Salpingopharyngostomy is the creation of a fistula between the pharynx and the guttural pouch and has been described as a treatment for guttural pouch mycosis.3,5–7 The theory behind this procedure is that it opens the guttural pouch to the fluctuating change of respiratory gases and temperatures of the respiratory tract. Jukicet al demonstrated that following salpingopharyngostomy there was no difference in the mean partial pressures of oxygen and carbon dioxide within the guttural pouch however, the variability of the pressures was significantly increased with the partial pressures oscillating with the respiratory pattern.3 This introduction of varying gas levels may change the environment within the guttural pouches making them less hospitable to fungal growth and allowing for faster resolution of the infection. In this case, due to the bilateral nature of the disease the authors created a single salpingopharyngostomy in the dorsal pharyngeal recess to gain access to both guttural pouches simultaneously. Creating a bilateral opening is easily created and can even be made larger and more likely to remain patent by ablating part of the septum between the two pouches.Aspergillus species are highly aerobic and can grow in most oxygen environments. However, they are also capable of growing at low oxygen tension and growth under these conditions may affect their pathogenicity by allowing secretion of virulence factors.8Hyperbaric oxygen treatment of A. fumigatus biofilms in vitro resulted in decreased biofilm proliferation by over 50%, though the effect was transient with growth re-establishing at 6 hours post treatment.9 In human medicine, individuals with invasive fungal infections caused by Aspergillus spp . are routinely treated with hyperbaric oxygen therapy in addition to surgical debridement and anti-fungal medications.10 Though there is a lack of controlled evidence to support this therapeutic in fungal infection, the complications are minimal and it is thought to improve the efficacy of neutrophils and macrophages by meeting their increased oxygen demands when clearing infections.11Additionally increased oxygen may improve the quality of the collagen matrix being created during the healing process.11An additional therapeutic that might have been helpful in this case prior to salpingopharyngeal fistulation is topical oxygen therapy (TOT) which has been recently published by Lepage et al for use as an adjunct treatment in epistaxis cases following transarterial coil embolization (TACE) or as a primary treatment in non-bleeding cases.12 Part of the rationale behind pursuing additional treatment options by this group is the percentage of horses that fail to completely resolve the neurologic sequelae of the disease which has been reported at 50%.13 When examining the issue of recurrent epistaxis following TACE the survival rate is 84% which places this high level of persistent neurological abnormalities into sharp relief. Dysphagia particularly can be severe enough to necessitate euthanasia even in the face of successful hemorrhage management. Certainly, dysphagia can be reversible as in the case published by Whitehead et al that was managed successfully with topical anti-fungals, carotid occlusion and esophagostomy but it can be a lengthy process that not all owners or patients will tolerate.14Guttural pouch mycosis does not lend itself to aggressive surgical debridement given the closely associated vessels and nerves to the mycotic plaques, however the somewhat enclosed environment of the guttural pouch may be an advantage for TOT. Lepage et al treated cases with TOT 4 times per day at 15 L/min for 1-2 weeks by placing an indwelling catheter into the affected guttural pouch and leaving it in place as much as possible for the duration of hospitalization. During treatments the horses were restrained with their heads at the height of the withers to decrease the opening of the guttural pouch orifice to maintain a closed high oxygen environment, though swallowing would still result in transient openings of the orifices.12Following a minimum of two treatments the fungal plaques were seen to begin regressing. Additionally the reported resolution or significant improvement of 10/12 neurologic disorders is encouraging compared to the 9/18 cases of resolution reported in a larger retrospective study on TACE.13It is unlikely TOT and salpingopharyngostomy would have any additive effect if done concurrently since it is unlikely the higher oxygen tension could be achieved with the fistula. The two procedures could be considered in series with the salpingopharyngostomy created after initial TOT. The advantage of the salpingopharyngostomy alone is that it is a single treatment without the need for further treatments or hospitalization. Furthermore, while Jukic et al showed some variations in partial pressures of gas in horses with salpingopharyngostomies there was not significant variation in temperature or humidity. The horses were housed in a controlled environment during short sampling periods in that study and variations may be greater if horses with salpingopharyngostomies are not housed in an environmentally controlled condition.Some of the clinical signs of this case report are difficult to attribute directly to the mycosis infection and there was confounding evidence of bacterial infection and other treatments. Regardless, guttural pouch mycosis can result in severe and possibly fatal disease as it almost did in this case report. Salpingopharyngostomy is an alternative treatment strategy to traditional medical treatment that should be considered in horses with guttural pouch mycosis.References1. Baptiste KE, Naylor JM, Bailey J, Barber EM, Post K, Thornhill J. A function for guttural pouches in the horse. Nature . 2000;403:382-383.2. Ludwig A, Gatineau S, Reynaud MC, Cadoré JL, Bourdoiseau G. Fungal isolation and identification in 21 cases of guttural pouch mycosis in horses (1998–2002). Vet J . 2005;169(3):457-461. doi:10.1016/j.tvjl.2004.06.0053. Jukic CC, Cowling NR, Perkins NR, Eps AW, Ahern BJ. Evaluation of the effect of laser salpingopharyngostomy on the guttural pouch environment in horses. Equine Vet J . 2020;52(5):752-759. doi:10.1111/evj.132214. Greppi MC, Guillot J, Melloul E, Bourdoiseau G, Lepage O, Cadoré JL. Experimental induction of mycotic plaques in the guttural pouches of horses. Med Mycol . Published online October 4, 2016:myw073. doi:10.1093/mmy/myw0735. Koch DW, Ericksen KA, Easley JT, Hackett ES. Clinical outcome of horses with guttural pouch infection following transpharyngeal fenestration. J Am Vet Med Assoc . Published online May 5, 2022:1-5. doi:10.2460/javma.22.01.00416. Koch DW, Easley JT, Nelson BB, Delcambre JJ, McCready EG, Hackett ES. Comparison of two techniques for transpharyngeal endoscopic auditory tube diverticulotomy in the horse. J Vet Sci . 2018;19(6):835. doi:10.4142/jvs.2018.19.6.8357. Watkins AR, Parente EJ. Salpingopharyngeal fistula as a treatment for guttural pouch mycosis in seven horses. Equine Vet J . 2018;50(6):781-786. doi:10.1111/evj.128308. Hall LA, Denning DW. Oxygen requirements of Aspergillus species.J Med Microbiol . 1994;41(5):311-315. doi:10.1099/00222615-41-5-3119. Dhingra S, Buckey JC, Cramer RA. Hyperbaric Oxygen Reduces Aspergillus fumigatus Proliferation In Vitro and InfluencesIn Vivo Disease Outcomes. Antimicrob Agents Chemother . 2018;62(3):e01953-17. doi:10.1128/AAC.01953-1710. Segal E. Hyperbaric Oxygen in the Treatment of Invasive Fungal Infections: A Single-Center Experience. 2007;9.11. Kaufman H, Gurevich M, Tamir E, Keren E, Alexander L, Hayes P. Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience. J Wound Care . 2018;27(7):426-433. doi:10.12968/jowc.2018.27.7.42612. Lepage OM, Di Francesco P, Moulin N, et al. The Effect of Topical Oxygen Therapy in Horses Affected with Mycosis of the Guttural Pouch: An Experimental Pilot Study and a Case Series. Anim Open Access J MDPI . 2021;11(11):3329. doi:10.3390/ani1111332913. Lepage OM, Piccot-Crézollet C. Transarterial coil embolisation in 31 horses (1999-2002) with guttural pouch mycosis: a 2-year follow-up.Equine Vet J . 2010;37(5):430-434. doi:10.2746/04251640577447996014.Whitehead AE, Whitty J, Scott M, Léguillette R. Reversible dysphagia secondary to guttural pouch mycosis in a gelding treated medically with voriconazole and surgically with carotid occlusion and esophagostomy.Can Vet J . 2018;59(2):165-170.
Title: Prioritizing equitable access to Human Papillomavirus (HPV) vaccination for MSM in Africa: Addressing disparities in disease prevention and controlAuthor:Ejovwokeoghene Joseph OmohwovoAffiliation:University of Port Harcourt, Choba NigeriaEmail: email@example.comORCID: 0000-0002-2182-1583Keywords: MSM; vaccination; human papillomavirus