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Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This paper aims to describe the 2023 update position paper on MRONJ developed by the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Maxillofacial Surgery (SICMF). Methods: This is the second update following the 2013 and 2020 Italian position papers by the Expert panel, which is a representation of the two scientific societies (SIPMO and SICMF). The paper is based on an extensive analysis of the available literature from January 2003 to February 2020, and the subsequent review of literature conducted between March 2020 and December 2022 to include all new relevant published papers to confirm or modify the previous set of recommendations. Results: This position paper highlights the main issues of MRONJ on risk estimates, disease definition, diagnostic pathway, individual risk assessment, and the fundamental role of imaging in the diagnosis, classification, and management of MRONJ. Conclusion: The Expert Panel confirmed the MRONJ definition, the diagnostic work‐up, the clinical‐radiological staging system and the prophylactic drug holiday, as recognized by SIPMO‐SICMF; while, it presented novel indications regarding the categories at risk of MRONJ, the prevention strategies, and the treatment strategies associated with the therapeutic drug holiday. [ABSTRACT FROM AUTHOR]

Simple Summary: This review paper deals with incidentally found focal liver lesions (IFLLs) in otherwise healthy subjects, which is a frequent occurrence in daily practice. The clinical presentation and the imaging aspects play an important role in deciding whether and what further evaluation is required. In low-risk patients (i.e., those without a history of malignant or chronic liver disease or related symptoms, younger than 40 years old), more than 95% of IFLLs are benign. Shear Wave liver Elastography of the surrounding liver parenchyma should be considered to exclude liver cirrhosis and for further risk stratification. If an IFLL in a low-risk patient has a typical appearance on a B-mode ultrasound of a benign lesion, no further imaging is needed. Contrast-Enhanced Ultrasound (CEUS) should be considered as the first-line contrast imaging modality to differentiate benign from malignant IFLLs. In high-risk patients (i.e., with chronic liver disease or an oncological history), each IFLL should initially be considered as potentially malignant, and every effort should be made to confirm or exclude malignancy. An incidental focal liver lesion (IFLL) is defined as a hepatic lesion identified in a patient imaged for an unrelated reason. They are frequently encountered in daily practice, sometimes leading to unnecessary, invasive and potentially harmful follow-up investigations. The clinical presentation and the imaging aspects play an important role in deciding if, and what further evaluation, is needed. In low-risk patients (i.e., without a history of malignant or chronic liver disease or related symptoms), especially in those younger than 40 years old, more than 95% of IFLLs are likely benign. Shear Wave liver Elastography (SWE) of the surrounding liver parenchyma should be considered to exclude liver cirrhosis and for further risk stratification. If an IFLL in a low-risk patient has a typical appearance on B-mode ultrasound of a benign lesion (e.g., simple cyst, calcification, focal fatty change, typical hemangioma), no further imaging is needed. Contrast-Enhanced Ultrasound (CEUS) should be considered as the first-line contrast imaging modality to differentiate benign from malignant IFLLs, since it has a similar accuracy to contrast-enhanced (CE)-MRI. On CEUS, hypoenhancement of a lesion in the late vascular phase is characteristic for malignancy. CE-CT should be avoided for characterizing probable benign FLL and reserved for staging once a lesion is proven malignant. In high-risk patients (i.e., with chronic liver disease or an oncological history), each IFLL should initially be considered as potentially malignant, and every effort should be made to confirm or exclude malignancy. US-guided biopsy should be considered in those with unresectable malignant lesions, particularly if the diagnosis remains unclear, or when a specific tissue diagnosis is needed. [ABSTRACT FROM AUTHOR]

Objective: Increases in global temperatures and extreme weather events associated with climate change have complex yet poorly understood detrimental impacts on human health. We reviewed the current published literature on climate change–related effects and rheumatic conditions. Methods: To summarize our current understanding of the likely effects of climate change, including increased air pollution, on rheumatic disease, we searched the published, peer‐reviewed English‐language literature from January 2000 to December 2022. Articles were reviewed by a team of rheumatologists and clinical and translational science researchers. Systematic review articles were not included but informed additional literature searches. Results: After extensive examination and adjudication, 88 articles met inclusion criteria and were selected for review. Much of the epidemiologic investigations assessed associations between air pollution and increased risk of development of rheumatoid arthritis, anti–citrullinated protein antibodies, flares of gout, and hospitalizations for systemic lupus erythematosus. Increased heat vulnerability was associated with higher odds of recurrent hospitalizations across rheumatic conditions. Mechanisms for observed associations are poorly understood but could include the effects of epigenetic changes, oxidative stress, and inflammatory cytokines. Studies had limitations, including restricted geography and populations studied without focus on historically marginalized communities at highest risk for adverse effects from pollution and climate change, the relative lack of mechanistic evaluations, and most with only indirect links to climate change. Conclusion: To date, the published literature lacks studies that directly examine effects of climate change on rheumatic diseases. Collaborative translational and epidemiologic research is needed to enhance our understanding and awareness in this area. [ABSTRACT FROM AUTHOR]

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols. Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery. [ABSTRACT FROM AUTHOR]

Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, without compromising the outcomes of transplantation or the number of donations following brain death (BD). In India, majority of deceased donations happen following BD. While existing legislation allows for DCDD, there have been only a few reports of kidney transplantation following DCDD from the country. This document, prepared by a multi-disciplinary group of experts, reviews the international best practices in DCDD and outlines the path for furthering the same in India. The ethical, medical, legal, economic, procedural, and logistic challenges unique to India for all types of DCDD based on the Modified Maastricht Criteria have been addressed. India follows an opt-in system for organ donation that does not allow much scope for uncontrolled DCDD categories I and II. The practice of withdrawal of life-sustaining treatment (WLST) in India is in its infancy. The process of WLST, laid down by the Supreme Court of India, is considered time-consuming, possible only in patients in a permanent vegetative state, and considered too cumbersome for day-to-day practice. In patients where continued medical care is determined to be futile following detailed and repeated assessment, the procedure for WLST, as laid down and published by Vidhi Centre for Legal Policy in conjunction with leading medical experts is described. In controlled DCDD (category-III), the decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Once families are inclined toward organ donation, they are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand down and return to the intensive care unit without donation. While donation following neurologic determination of death (DNDD) is being increasingly practiced in the country, there are instances where the cardiac arrest occurs during the process of declaration of BD, before organ retrieval has been done. Protocol for DCDD category-IV deals with such situations and is described in detail. In DCDD category V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the intensive care. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and the use of techniques such as normothermic regional perfusion and ex vivo machine perfusion has been provided. With increasing experience, the outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for the successful execution of DCDD in India are described. [ABSTRACT FROM AUTHOR]

Women using antiseizure medication in pregnancy are often advised to use high doses of folic acid supplements (1mg to 5 mg) to reduce the risk of teratogenicity. Recently, we published a report showing an association between maternal prescription fill of high dose folic acid in relation to pregnancy and childhood cancer in the offspring. The report has sparked a debate about which dose of folic acid that should be recommended in pregnancy in women in need of antiseizure medication. In this Commentary, we explain our findings and the method used in our report, and answer recent questions that have emerged. [ABSTRACT FROM AUTHOR]

Exercise addiction has been investigated for almost half a decade in well over 1000 published papers. Studies adopt different terminologies like exercise addiction, overexercise, exercise dependence, compulsive exercise, obligatory exercise, and the like to refer to the same concept while creating conceptual confusion and rendering cross-study comparability challenging. The paradox is that fewer than ten research articles cover cases of clinical significance, yielding an extremely high ratio of publications to problematic cases. While there is evidence that significantly more clinically attention-meriting cases might exist, they surface in clinical practice rather than research settings. It is also peculiar that scholars search for a common path or shared etiology for exercise addiction, while each case, like those in substance use disorder, is unique, as also predicted by clinical models. Furthermore, the survey method uses scales yielding risk scores without diagnostic value. Most research in this direction, therefore, seems to be futile. Thus, it is not surprising that more than 10 years ago, the panel editing the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) found insufficient evidence for exercise addiction being a mental dysfunction. As a result, exercise addiction has no clinical diagnostic criteria. This position paper aims to identify conceptual and methodological research barriers that hinder progress in this field, ultimately calling for a paradigm shift toward more productive research. In conclusion, the position of this paper is that most currently used research methodologies on exercise addiction are unsatisfactory and, consequently, a paradigm shift is urgently needed. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Dental Hygiene is the property of Canadian Dental Hygienists Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The immune system interacts with many nominal 'danger' signals, endogenous danger‐associated (DAMP), exogenous pathogen (PAMP) and allergen (AAMP)‐associated molecular patterns. The immune context under which these are received can promote or prevent immune activating or inflammatory mechanisms and may orchestrate diverse immune responses in allergy and cancer. Each can act either by favouring a respective pathology or by supporting the immune response to confer protective effects, depending on acuity or chronicity. In this Position Paper under the collective term danger signals or DAMPs, PAMPs and AAMPs, we consider their diverse roles in allergy and cancer and the connection between these in AllergoOncology. We focus on their interactions with different immune cells of the innate and adaptive immune system and how these promote immune responses with juxtaposing clinical outcomes in allergy and cancer. While danger signals present potential targets to overcome inflammatory responses in allergy, these may be reconsidered in relation to a history of allergy, chronic inflammation and autoimmunity linked to the risk of developing cancer, and with regard to clinical responses to anti‐cancer immune and targeted therapies. Cross‐disciplinary insights in AllergoOncology derived from dissecting clinical phenotypes of common danger signal pathways may improve allergy and cancer clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Adolescent athletes with a primary anterior glenohumeral dislocations have been shown to have a relatively high incidence of recurrent instability. Evolving evidence on this topic has led to increasing rates of arthroscopic stabilization over the last 2 decades. However, the timing and role of surgery following a single dislocation episode is one of the most controversial topics in orthopaedics. While arthroscopic stabilization is effective in allowing return to play, adolescents have higher rates of subsequent recurrent instability than any other age group. Identifying patients at highest risk of such events postoperatively may facilitate optimized surgical decision-making in this population. The purpose of this study was to identify prognostic factors that are associated with recurrent instability requiring reoperation following arthroscopic Bankart repair in adolescents, with particular attention to the number of dislocations sustained prior to the index procedure. Methods: All patients 12 to 21 years old who had undergone arthroscopic Bankart repair surgery for anterior glenohumeral instability at a pediatric tertiary care hospital between 2000 and 2020 were included. The analysis was conducted using a multivariate Cox proportional hazards model, with percentage of patients with recurrent instability requiring a re-operation evaluated in a time-to-event analysis as the outcome. The effects from the Cox model were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha level of.05. Results: A total of 488 adolescent patients (78% male; mean age: 16.9 +/- 1.98 years) met study criteria, with the most common primary sports consisting of football (n=141, 29%), hockey (n=47, 10%), basketball (n=40, 8%), baseball (n=33, 7%), and lacrosse (n=30, 6%). A total of 270 (55%) athletes participated in contact sports, while 95 (20%) were overhead athletes. Overall, 86 patients (17.6%) required revision stabilization surgery for recurrent instability, with a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. The revision stabilization procedures occurred at a mean of 31.1 +/- 25.1 months from the index procedure and consisted of open Latarjet (n=42, 49%), revision arthroscopic stabilization (n=24, 28%), or open capsulorraphy (n=20, 23%). Risk factors for recurrent instability requiring revision stabilization included more than 1 dislocation episode prior to the index procedure (2 dislocations: HR=7.4 (2.5-21.6), p=0.0003; 3+ dislocations: HR=10.9 (3.9 to 30.5), p<0.0001), presence of a Hill-Sachs lesion (small Hill-Sachs: HR=2.5 (1.2-5.1), p=0.0114; medium-large Hill-Sachs: HR=4.2 (1.9-9.3), p=0.0004), younger age at the time of the index stabilization procedure (one year decrease in age: HR=1.2 (1.1-1.4), p=0.0015), and participation in contact sports (HR=1.8 (1.1-2.9), p=0.01). Adolescents who had sustained 1 dislocation prior to surgery had a cumulative incidence of revision surgery (3.2%) that was significantly lower than those who had sustained 2 dislocations (24.2%) or 3+ dislocations (33.5%). Conclusions: The number of dislocation episodes prior to index arthroscopic Bankart repair was the strongest risk factor for recurrent instability requiring revision surgery in adolescents with anterior glenohumeral instability, with two dislocation episodes conferring more than 7-fold increased risk compared to those who had just a single dislocation episode preoperatively. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports. These data support consideration for arthroscopic stabilization for adolescents following a single dislocation, especially in younger patients, contact athletes or when a Hill Sachs lesion is present. [ABSTRACT FROM AUTHOR]

Objectives: Revision anterior cruciate ligament (ACL) reconstruction has been demonstrated to have outcomes inferior to those noted in primary ACL reconstructions in terms of patient-reported outcomes, return to activity and sports, and graft rupture rates. However, the long-term assessment of patients undergoing revision ACL reconstruction remains unknown, primarily due to the large number of patients needed to do an adequate analysis. A group was assembled to prospectively enroll and follow a revision ACL cohort to determine the risk factors for poor outcomes in a revision cohort, of which over 1,200 patients were enrolled from 83 surgeons and 52 sites and prospectively followed for 10 years. The overarching goal was to assess the long-term progression of outcomes following revision ACL reconstruction, and to determine how the initial factors at the time of revision surgery may influence and predict disease progression. The focus of this study is to characterize the 10-year natural history of this unique dataset, quantified by 3 complementary methodologies: patient-reported outcomes, radiologic measures, and physical examination measures. The purpose was to assess for clinical long-term outcomes, including incidence of graft failure, as well as signs and symptoms of knee osteoarthritis (OA) in this revision cohort at 10 years postoperatively. Methods: Patients were brought back to 6 sites for physical examination by an independent blinded sports medicine physician who was not involved with the revision ACL reconstruction. The physical exam included knee range of motion (ROM), ligamentous testing and bilateral KT-1000 assessment. A series of radiographs (standardized bilateral standing AP, synaflexer bent knee [similar to tunnel/Rosenberg], sunrise, and full extension lateral views) were obtained to assess for incidence of structural OA. Validated patient-reported outcome measures (PROMs) including International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Marx activity rating scale were also obtained. Two physicians independently graded the radiographs for severity of structural OA using the modified Kellgren-Lawrence (KL) grading system (grades 0 to 4). Structural OA was defined as a Kellgren-Lawrence grade of 3 or 4. Symptomatic OA was defined by the KOOS Pain subscale of < 70 points. Multivariate regression models were used to determine the predictors (risk factors) for both structural OA (KL grades 3 to 4) and symptomatic OA (KOOS pain < 70 points) at 10 years follow-up, controlling for the patient's age, sex, body mass index (BMI), baseline PROMs, ACL graft choice, prior and current meniscal pathology and treatment at the time of revision surgery, chondral pathology at the time of revision surgery, and incidence of any subsequent surgeries. Results: 205 patients (107 [52.4%] women) representing 40 surgeons returned at an average 12-year follow-up (range, 10-16 years). The mean (SD) age of this cohort at the time of their onsite evaluation was 40.2 (10.4) years with a BMI of 25.7 (range, 17.0-42.0). Physical Exam: Physical examination demonstrated loss of extension compared to the opposite knee in 118 (58%) and extension less than full (0 degrees) in 84 (41%). With regards to failure, a soft Lachman endpoint was noted in 41 patients (20%). A Lachman >5 mm was noted in 20 patients (10%), and 26 patients (13%) had a grade 2 pivot shift and 4 (2%) had a grade 3 pivot shift. KT-1000 measurements demonstrated 23 (11%) patients with 5 mm or greater involved versus uninvolved side-to-side difference. The blinded surgeons in their opinion detected 37 (18%) with a nonfunctional ACL. If all nonfunctional parameters were applied (Lachman ≥2, Pivot shift ≥2, KT-1000 side-to-side difference of ≥5mm, and surgeon determining failure) only 8 patients (4%) met all failure parameters. Radiographs: Radiographs demonstrated that 115 (56%) exhibited joint space narrowing of the tibiofemoral joint (K-L grades 3 to 4) in their involved knee compared to 28 (14%) in their uninvolved knee (Table 1). The significant drivers of a higher KL grade (structural OA) at 10 years were found to be higher age, higher baseline BMI, having a medial meniscus excision performed either prior to or at the time of revision surgery, having a prior lateral meniscal excision, or having a subsequent surgery (p<0.05; Table 2). Sex, baseline activity level, graft choice, and chondral pathology at the time of revision were not significant. PROMs: PROMs of the onsite group reflected the PROMs of the overall cohort at 10 years (Figure 2). There were 40 onsite subjects (20%) that reported KOOS pain scores of < 70 points (defined as symptomatic OA), while 91 subjects (44%) reported KOOS pain scores over 90 points (defined as no pain). The predictors of increased pain (lower KOOS pain score) at 10 years were subjects who had higher pain scores at the time of revision surgery, grades 3 to 4 chondral pathology in the lateral compartment at the time of revision surgery, medial meniscus excision performed prior to the time of revision surgery or having a subsequent surgery (p<0.05; Table 3). Conversely, having a hamstring autograft or an allograft (compared to a bone-tendon-bone autograft) at the time of revision surgery predicted less symptomatic pain at 10 years. Age, sex, baseline BMI, activity level, and lateral meniscal pathology at the time of revision were not significant predictors of increased knee pain at 10 years. Conclusions: Outcomes in this first ever report of a revision ACL cohort at minimum 10 years follow-up demonstrates worrisome outcomes at a still young age. This study demonstrated a loss of ROM in 41-58% of the cohort, an 18% graft failure rate, 56% who exhibited KL grades of 3 to 4, and 20% who reported KOOS pain scores of less than 70 points, which collectively, all emphasize the challenge of managing the revision ACL reconstruction patient. [ABSTRACT FROM AUTHOR]

Herein we report a quantitative, multiplex assay for disease markers in plasma based on an integrated setup of a portable scanner and a disposable paper-based analytical device (PAD). The quantitative analysis relies on the digital colorimetric reading of the three-layer PAD with 30 assay sites for performing respective chromogenic reactions for plasma uric acid, glucose, and triglyceride, which are considered as important risk factors for cardiovascular diseases. A portable scanner with WiFi transmission capability was used to produce high-quality color images of the PADs and wirelessly transfer them to a smartphone or other mobile devices for data processing. The concentrations of biomarkers in both standard solutions and plasma samples can be directly obtained using a custom-designed smartphone app that is also capable of constructing calibration curves. The detection limits of uric acid, glucose, and triglyceride were determined to be 0.50 mg/dL, 0.84 mmol/L, and 14 mg/dL, respectively, which are below the normal limits and adequate for clinical validation. Owing to the distinct advantages—simple, portable, and cost-effective—this mobile assay protocol can be used for point-of-care (POC) settings or resource-limited situations, and potentially for the diagnosis and prevention of infectious diseases. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the effects of uncoated paper on skin moisture, pressure injury risk and pressure injury incidence in neurological intensive care unit patients. Methods: A randomized controlled design was used. The experimental group (n = 68) received usual care (repositioning every 2 h and use of an air mattress) and application of uncoated paper on the sacral area for 5 days, whereas the control group (n = 67) received only usual care. A repeated measures analysis of variance was used to determine changes in the skin moisture and risk of pressure injury between the groups. A chi‐squared test was used to determine the change in the incidence of pressure injuries for sacral area. Data were collected from 20 October 2017 to 6 March 2018. Results: There were statistically significant differences in the skin moisture and risk of pressure injuries between the experimental and control groups. However, a significant difference was not observed in the incidence of pressure injuries between the groups. Conclusion: The use of uncoated paper may be a valid nursing intervention for the prevention of pressure injuries in neurological intensive care unit patients. SUMMARY STATEMENT: What is already known about this topic? The neurological intensive care unit patients with motor deficits, loss or deterioration of sensory function and decreased consciousness have high risk of pressure injuries.Although various guidelines consider excessive skin moisture as an important cause of pressure injuries, few targeted interventions exist to manage excessive skin moisture. What this paper adds? The uncoated paper application was effective in reducing skin moisture in neurologic intensive care unit patients.In addition, application of uncoated paper application has an effect on risk of pressure injury in neurologic intensive care unit patients. The implications of this paper: The use of uncoated paper may be a valid nursing intervention for the prevention of pressure injuries in neurological intensive care unit patients.Nurses should recognize that pressure injuries are potentially preventable adverse events and use various preventive interventions including skin moisture management. [ABSTRACT FROM AUTHOR]

Hydroxychloroquine (HCQ) and chloroquine (CQ) are well‐established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)–prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID‐19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus‐based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long‐term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk–benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases. [ABSTRACT FROM AUTHOR]

Background: The gut microbiome is an important determinant of health and disease in preterm infants. Objectives: The objective of this article was to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols, aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants. Methods : This prospective, longitudinal study planned to recruit 160 preterm infants born <32 weeks gestational age or weighing <1,500 g and admitted to one of two Level III/IV neonatal intensive care units. During the neonatal intensive care unit period, the primary measures included events of early life pain/stress, gut microbiome, host genetic variations, and neurobehavioral assessment. During follow-up visits, gut microbiome; pain sensitivity; and medical, growth, and developmental outcomes at 4, 8-12, and 18-24 months corrected age were measured. Discussion : As of February 14, 2020, 214 preterm infants have been recruited. We hypothesize that infants who experience greater levels of pain/stress will have altered gut microbiome, including potential adverse outcomes such as necrotizing enterocolitis and host genetic variations, feeding intolerance, and/or neurodevelopmental impairments. These will differ from the intestinal microbiome of preterm infants who do not develop these adverse outcomes. To test this hypothesis, we will determine how alterations in the intestinal microbiome affect the risk of developing necrotizing enterocolitis, feeding intolerance, and neurodevelopmental impairments in preterm infants. In addition, we will examine the interaction between the intestinal microbiome and host genetics in the regulation of intestinal health and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Ischaemic heart disease (IHD) is a complex disorder and a leading cause of death and morbidity in both men and women. Sex, however, affects several aspects of IHD, including pathophysiology, incidence, clinical presentation, diagnosis as well as treatment and outcome. Several diseases or risk factors frequently associated with IHD can modify cellular signalling cascades, thus affecting ischaemia/reperfusion injury as well as responses to cardioprotective interventions. Importantly, the prevalence and impact of risk factors and several comorbidities differ between males and females, and their effects on IHD development and prognosis might differ according to sex. The cellular and molecular mechanisms underlying these differences are still poorly understood, and their identification might have important translational implications in the prediction or prevention of risk of IHD in men and women. Despite this, most experimental studies on IHD are still undertaken in animal models in the absence of risk factors and comorbidities, and assessment of potential sex-specific differences are largely missing. This ESC WG Position Paper will discuss: (i) the importance of sex as a biological variable in cardiovascular research, (ii) major biological mechanisms underlying sex-related differences relevant to IHD risk factors and comorbidities, (iii) prospects and pitfalls of preclinical models to investigate these associations, and finally (iv) will provide recommendations to guide future research. Although gender differences also affect IHD risk in the clinical setting, they will not be discussed in detail here. [ABSTRACT FROM AUTHOR]

The article appraises a systematic review of studies on patient-reported outcomes following vestibular rehabilitation on concussion-induced vertigo. Emphasis is given on the need for clinicians to monitor patients for potential adverse events and to modify treatment exercises and progressions. It considers the importance of the overall findings on the effectiveness of vestibular rehabilitation exercises and physical therapy programs for sports medicine providers and athletic training.

The article informs about pattern and prevalence of different findings in high resolution computed tomography (HRCT) images in patients with coronavirus disease and kidney injury. Topics include study demonstrated that atypical patterns are likely to be more common in Covid19 patients with kidney injury; and HRCT findings of the patients were reviewed independently by 2 radiologists.

Background: Preventing cancer is better than treating or curing it. Cancer prevention ensures reduced physical, emotional, financial burden to the individual. Methods: The focus of the preventive oncology unit at Healthcare Global (HCG) Enterprise Limited, Bangalore, India, is to increase the understanding of how lifestyle and risk of cancer are related. It also focusses on screening of normal individuals for estimating their risk of developing cancer, which in-turn can lead to earlier detection, improved treatment and outcomes. This unique endeavor started one year back, provides counseling and vaccination services for HPV (Human Papilloma Virus) and HBV (Hepatitis B Virus). Our outreach initiatives in collaboration with the State and City health Departments include screening camps, and awareness sessions focusing on HPV and HBV vaccination. Results: The focus of research is in the areas of cancer epidemiology, prevention, screening, and control. Such research involves a multidisciplinary approach involving the fields of epidemiology, biostatistics, behavioral science, nutrition, and basic science. Conclusion: This novel endeavor at a tertiary cancer hospital in a Developing Country is aimed at preventing the development or progression of the malignant cancer process. [ABSTRACT FROM AUTHOR]

There is some confusion surrounding the management of people with lymphoedema in the presence of deep vein thrombosis (DVT). This may be in relation to the suitability of commencing compression therapy or regarding the continuation of compression therapy in those who develop DVT. The purpose of this British Lymphology Society position paper is to support evidence-based practice and debunk the myths surrounding the management of DVT and lymphoedema. [ABSTRACT FROM AUTHOR]

Objectives: Posterior tibial slope (PTS) is a known anatomical factor in the biomechanical function of the anterior cruciate ligament. However, when PTS is typically measured on a lateral radiograph, this does not consider potential differences between the lateral and medial tibial plateau. The difference between medial posterior tibial slope (MPTS) and lateral posterior tibial slope (LPTS) in a knee is largely unknown. Generally, computed tomography (CT) is the gold standard for 3-dimensional osseus imaging but very few studies to date have attempted to quantify the medial and lateral PTS in the same knee using CT. Clinically, it is debated whether an elevated MPTS or the LPTS is critical for anterior cruciate ligament injury and reinjury. The objective of this study was to quantify the variation in the difference between MPTS and LPTS using full tibial CT scans. Methods: At our institution, CT-assisted preoperative planning is frequently used for osteotomies. Ninety-seven patients with clinically acquired CT scans went through the preoperative planning process (Bodycad, Quebec City, Canada) from Jan 2016 to Nov 2022. This includes patients undergoing coronal, sagittal or biplanar high tibial and distal femoral osteotomies. This process is semi-automated meaning that the user can intervene with the measurements and adjust the initial landmarks and best-fit. Distally, the software will find the center of the tibiotalar joint to provide a point for the tibial axis. The user may adjust that landmark if needed. To measure the tibial slope, the software finds the best fit tibial plateau in 3D and determines the slope angle medially and laterally. The software measures the MPTS and LPTS independently. The slope measurements were compiled and quantitatively analyzed including mean, median, range as well as the difference between the MPTS and LPTS. Patients were defined to have undergone a sagittal or coronal correction if there was more than 2 degrees of change in the sagittal plane or more than 5% change in the coronal plane weight bearing line. Patients were defined as having a biplanar correction when both conditions were met. The slopes were analyzed with respect to sex and laterality. Additionally, patients undergoing an osteotomy in conjunction with an ACL reconstruction (either single or two-staged) were compared to the other patients. Results: There are differences in the MPTS and LPTS within the same knee. When analyzing the whole group, the average absolute difference is 2.76⁰ with a standard deviation of 2.49. As shown in Table 1, 40% of knees had greater than a 2.5⁰ difference in MPTS and LPTS, 19% of knees had greater than a 5⁰ difference in MPTS and LPTS, 5% of knees had greater than a 7.5⁰ difference in MPTS and LPTS and 2% of knees had greater than a 10⁰ difference in MPTS and LPTS. The magnitude of the LPTS is greater than the MPTS 52% of the time. There is no significant difference in the average, standard deviation, mean or the 10th, 25th, 75th and 90th percentiles of the MPTS and LPTS as shown in Table 2. One hundred percent of the sagittal corrections and 84% of the biplanar corrections also underwent an ACL reconstruction in addition to an osteotomy. Characteristics of these groups of patients are shown in table 3. The sagittal and coronal osteotomy patients have a higher MPTS and LPTS than the patients undergoing a coronal osteotomy. Conclusions: The most important finding in this study is that the medial and lateral PTS can be very different within the same knee. There can be up to 11.62-degree difference in this population. Sixteen out of 97 patients had a difference of more than 5⁰ with 2 patients having a difference of greater than 10⁰. The data presented here has uncovered a description of the medial and lateral posterior tibial slope anatomy that was not evident with conventional lateral knee x-rays previously. We do not know the clinical significance of a large difference in the medial and lateral PTS and it brings forth an interesting set of clinical questions. 1) Which posterior tibial slope, medial or lateral, is most important for knee biomechanics, specifically regarding ACL stresses and function? 2) When performing a slope correcting osteotomy, is it the medial, lateral or average slope that should be the target for correction? 3) Should an intercondylar correction which only modifies one slope be considered? Further clinical studies should focus on investigating the relationship of differential PTS to native knee biomechanics as well as its implication for corrective osteotomy procedures and ACL reconstruction. [ABSTRACT FROM AUTHOR]

Introduction: Flexibility is an essential component of muscle function, and insufficient muscle flexibility may lead to muscle injuries. Decreased hamstring flexibility is one of the frequently reported risk factors for a hamstring strain and diminished athletic performance. Stretching is a commonly used intervention for increasing muscle length. There is a lack of evidence concerning the possible effects of hamstring stretching in balance and gait biomechanics. So, this study was designed to investigate the potential effects of static hamstring stretching on the range of motion (ROM), dynamic balance, and biomechanical variables of gait in athletes with hamstring tightness. Materials and Methods: This study is a single-group, pretest-posttest clinical trial performed on semi-professional female athletes. Twelve female athletes aged 20 to 35 years with bilateral hamstring tightness received a single session of unilateral static hamstring stretching on their randomly selected side. All subjects were assessed for straight leg raise, popliteal angle (using standard goniometry), perceived hamstring tightness (using a visual analog scale). They completed single-leg standing and 15-m walking and running tasks before and immediately after the intervention. The biomechanical parameters, including gait-line length, swing duration, and stance duration in walking tasks, maximum total force and mean total force in running task, and center of pressure (COP) displacement and standard deviation during balance task were measured using OpenGo sensor insole system. The pre-post values were compared using the paired sample t-test, and the level of significance was 0.05. Results: The values for straight leg raise and popliteal angle significantly increased (P<0.05) compared with the baseline, while perceived tightness significantly decreased following stretching (P<0.001). The amplitude (P₌0.006) and standard deviation (P₌0.016) of COP displacement in the mediolateral direction during the single leg stance balance task were significantly decreased after the intervention. Stance duration in slow walking (P₌0.004), as well as stance duration (P₌0.012) and swing duration (P<0.001) in fast walking, were significantly decreased (P<0.05) after stretching. No change was observed in gait biomechanical variables during the running test (P>0.05). Conclusion: The results of this study indicate that static hamstring stretching can be a promising intervention not just for increasing hamstring flexibility but also for improving balance ability. [ABSTRACT FROM AUTHOR]

It is commonly hypothesized that scientists are more likely to engage in data falsification and fabrication when they are subject to pressures to publish, when they are not restrained by forms of social control, when they work in countries lacking policies to tackle scientific misconduct, and when they are male. Evidence to test these hypotheses, however, is inconclusive due to the difficulties of obtaining unbiased data. Here we report a pre-registered test of these four hypotheses, conducted on papers that were identified in a previous study as containing problematic image duplications through a systematic screening of the journal PLoS ONE. Image duplications were classified into three categories based on their complexity, with category 1 being most likely to reflect unintentional error and category 3 being most likely to reflect intentional fabrication. We tested multiple parameters connected to the hypotheses above with a matched-control paradigm, by collecting two controls for each paper containing duplications. Category 1 duplications were mostly not associated with any of the parameters tested, as was predicted based on the assumption that these duplications were mostly not due to misconduct. Categories 2 and 3, however, exhibited numerous statistically significant associations. Results of univariable and multivariable analyses support the hypotheses that academic culture, peer control, cash-based publication incentives and national misconduct policies might affect scientific integrity. No clear support was found for the "pressures to publish" hypothesis. Female authors were found to be equally likely to publish duplicated images compared to males. Country-level parameters generally exhibited stronger effects than individual-level parameters, because developing countries were significantly more likely to produce problematic image duplications. This suggests that promoting good research practices in all countries should be a priority for the international research integrity agenda. [ABSTRACT FROM AUTHOR]

Summary: The International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement. Introduction: Fracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level. Methods: The Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs. Results: Eleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started anti-osteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50–80% and > 80% levels except for treatment recommendation where a level of 50% was used. Conclusion: This KPI set compliments the existing Best Practice Framework to support FLSs to examine their own performance using patient-level data. By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realise the full potential of secondary fracture prevention and improved clinical outcomes for their local populations. [ABSTRACT FROM AUTHOR]

Context: Within only 30 days after the first announcement of infection with "SARS-CoV-2" in Wuhan, it spread to more than 20 countries and become a pandemic by WHO as a "high alarming level of infection" with 136,343 involved cases all over the world. Methods: To uncover more about the probable gastrointestinal transmission and its clinical manifestations, we reviewed all research publications with keywords including: "COVID-19", "SARS-CoV-2", "Coronavirus", "outbreak", "ARAS-CoV" in Medline, Scopus, Google Scholar as well as all news in social media about "novel COVID-19 pandemic". Out of 40 recent publications, 10 articles were studied by 2 authors. Results: Although the SARS-CoV-2 tends to infect respiratory epithelial cells through the respiratory tracts, recent investigations detected the virus in the stool specimen, raising the question of the fecal-oral transmission route. Different studies showed that almost all gastrointestinal signs and symptoms were seen in elderly patients (more than 65 years old). including anorexia (40%), nonspecific abdominal pains (8%), diarrhea (10%) and nausea and Vomiting in about 8% of patients. Anorexia and generalized abdominal pain suffer many treated cases even 10-20 days after negative blood tests (like CRP, lymphopenia) and negative PCRof respiratory samples. The main reason for this prolonged anorexia and abdominal pain may be due to the long persistence of COVID-19 in the gastrointestinal tracts after primary treatment. Conclusions: Comparing to SARS, patients with COVID-19 showed less diarrhea, nausea, vomiting and/or abdominal discomfort before respiratory symptoms. Feces as a potential contagious source of Viral RNA can last even after viral clearance in the respiratory tract. We strongly recommend all cured patients of COVID-19 to disinfect and clean their toilets until 17-20 days after negative blood tests and solving their respiratory disorders. Gastrointestinal manifestations have seen in all men while no women referred with GI signs. [ABSTRACT FROM AUTHOR]

Introduction: Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team. Methods: This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023). Results: In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described. Discussion: Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented. [ABSTRACT FROM AUTHOR]

Objective: Patients taking antiresorptive medications in dental clinics are at risk of medication-related osteonecrosis of the jaw (MRONJ), which poses daily challenges for their clinicians. This paper aimed to summarize and revisit the three most recognized practice guidelines for the management and prevention of MRONJ, which were proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), and presented by the Journal of Bone and Mineral Research (JBMR) and the Journal of Clinical Oncology (JCO). Results and case studies: The AAOMS position paper focused on risk stratification by different medications, management decision trees, risk factors, pathophysiology, and disease staging. The JBMR international consensus presented eight focused questions, which were addressed by systematic reviews. The JCO clinical practice guideline presented six clinical questions, and each concluded with practical recommendations. Practical information was summarized and converted into an adoptable patient care workflow for clinicians to follow and apply in daily practice. Three case studies presented were treated following these guidelines. Each patient underwent advanced surgeries including alveoloplasty, tooth extraction, implant placement, and particulate bone grafting. Some of the considerations not fully informed were discussed and illustrated in each step of the patient care workflow, which included specifics for risk communication, updates on the use of antibiotics, biomarkers, and drug holidays. Conclusion and practical implications: Structured risk communication with official informed consent documentation should be considered before initiating invasive treatments. Disease control phase with home care therapy should be provided prior to staged reconstructive therapy. Drug holidays and antibiotics coverage can be customized based on individual conditions and related procedures with interprofessional coordination. [ABSTRACT FROM AUTHOR]

An introduction is presented in which author discusses articles on topics including focuses on analyzing the factors influencing ERCP outcomes in PAD patients and compare the technical success of ERCP between PAD and non‑PAD patients.

The Fulker Award was Established by the Behavior Genetics Association in Memory of David Fulker, a past President the Association and Executive Editor of the Journal, who died in 1998 (Hewitt, [7]). References 1 Balbona JV, Kim Y, Keller MC (2021 May) Estimation of Parental Effects Using Polygenic Scores. [Extracted from the article]

Purpose: The purpose of this is to examine the visualization, dynamicity, and collaborative networking of scientific production on visible light (VL) and skin aging through scientometric analysis. Materials and Methods: This research consisted of a cross‐sectional and descriptive design with a scientometric approach that examined the publication trends and collaborative patterns among authors and institutions from 2018 to 2023. A comprehensive search strategy was also employed by using specific keywords related to VL and skin aging. In this case, several indicators were employed, including scholarly output, view count, field‐weighted citation impact (FWCI), and citation count. The analyses were performed by using SciVal software and R Studio version 4.3.2. Results: A total of 180 sources were identified, with 280 documents generated, indicating an annual growth rate of 6.72%. The documents, averaging 3.25 years in age, received an average of 12.14 citations, revealing their impact. Additionally, collaborations were evident, with a ratio of 5.6 coauthors per paper and 25.71% consisting of international collaborations. In terms of institutions, there were notable disparities in scholarly activities and impact metrics, highlighting the diversity of the research landscape. Meanwhile, journals, such as Photodermatology, Photoimmunology and Photomedicine, revealed a substantial impact (FWCI 2.05). Overall, the impact of the journals showed a general upward trend, reflecting dynamicity and variability over time. Conclusion: An annual growth rate of 6.72% was found, with 180 sources and 280 papers on VL and skin aging. Moreover, international collaborations, the positive impact in leading journals, and the distribution patterns identified through scientometric laws underscored the vitality and complexity of the field. These results offer valuable insights into guiding future research in this multidisciplinary field. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective of this study was to determine the failure rate (defined by secondary meniscectomy) of ramp repairs performed at the time of anterior cruciate ligament reconstruction (ACLR). The secondary objective was to investigate the association of patient and surgical characteristics with the risk of failure. Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent repair of a meniscal ramp lesion through a posteromedial portal at the time of primary ACLR, performed between January 2013 and December 2020, were considered for study eligibility. At the end of the study period, secondary meniscectomy rates were determined. Kaplan Meier analyses were used to evaluate repair survivorship. Risk factors associated with meniscal repair failure were analyzed using a logistic regression model. Results: 1037 patients were deemed eligible and included in the final analysis. The overall mean follow-up was 72.4 ± 27.1 months. The overall rate of secondary medial meniscectomy was 7.7%. Age, sex, Tegner score, and the duration of time between the injury and surgery were not found to be significant risk factors for secondary meniscectomy. The only significant risk factor for failure of ramp repair was the use of an isolated ACLR technique when compared to a combined ACLR + lateral extra-articular procedure (LEAP). The rate of secondary medial meniscectomy was 12.9% in the isolated ACLR group, compared to 4.8% in the combined ACLR + LEAP group (P< 0.0001). The odds of having a secondary medial meniscectomy were 62% lower for patients with combined ACLR + LEAP. Conclusions: At a mean follow-up of 72.4 months after ACLR + ramp repair, the failure rate was 7.7%. The failure rate was 2 times lower when a LEAP was performed in conjunction with ACLR. The only significant risk factor identified for failure of a ramp lesion was the use of an isolated ACLR instead of a combined ACLR + LEAP. [ABSTRACT FROM AUTHOR]

Objectives: Social determinants of health (SDOH) are comprised of a patient's environmental conditions including social and economic factors, which influence access to health care and resources. Growing evidence in orthopaedic surgery has revealed that SDOH factors lead to differential access to care and ultimately health disparities after surgery. For shoulder instability, previous literature has demonstrated that the number of previous dislocations before a stabilization procedure increases the risk of recurrent instability after the procedure. The purpose of this study was to investigate the impact of SDOH on the number of dislocation events before surgical intervention. Methods: A retrospective review of patients who underwent shoulder stabilization surgery at a health system in a large metropolitan area between January 1, 2021 and April 13, 2023 were identified. Patients' demographic and social determinants variables were extracted using the electronic medical record. Social Vulnerability Index (SVI) socioeconomic subscore and Area of Deprivation Index (ADI) were collected using online mapping data based on patient zip codes. The number of dislocation events and the time they occurred were determined using clinical charts. Operative variables collected included the date of surgery to determine the time from clinical presentation to surgery and the procedure performed. Univariate linear regression analysis was used to evaluate potential predictors of increasing time to presentation and increasing time to surgery. Univariate logistic regression analysis was also performed of all potential predictors of having >1 dislocation event. A multivariate model was then created using all predictors with a P value < 0.05 in the univariate models. Results: There were 106 patients who underwent shoulder surgery for instability, including arthroscopic and open stabilization, and had complete social determinant data, with 54% (n = 57) identifying as White, 29% (n = 31) as Black/African American, and 17% (n = 18) as other. A total of 38 (35.8%) patients suffered 1 dislocation (single dislocation cohort) before undergoing surgery, and 68 (64.2%) experienced > 1 dislocation (recurrent cohort) before surgery. No significant variables were associated with increasing time to presentation or surgery. Univariate logistic regression revealed that decreasing age (odds ratio [OR] 0.94 [95% confidence interval (CI) 0.89- 0.99]; P = 0.02), decreasing body mass index (BMI) (OR 0.90 [95% CI 0.83-0.98]; P = 0.02), increasing SVI (OR 1.21 [95% CI 1.05-1.38]; P = 0.006), and increasing area deprivation index (ADI) (third tercile compared to first, OR 6.04 [95% CI 2.05-17.8]; P = 0.003) were associated with increased odds of having > 1 instability event before surgical intervention. There was no association with race found in terms of number of dislocations before surgery. Multivariate logistic regression modeling revealed that decreasing BMI (OR 0.87 [95% CI 0.78-0.98]; P = 0.02) and increasing ADI (third tercile compared to first tercile, OR 7.46 [95% CI 1.26-44.2]; P = 0.02) were associated with increased odds of having > 1 instability event before shoulder instability surgery. Conclusions: Lower socioeconomic status, as measured by ADI, is an independent predictor of a higher likelihood of recurrent instability before shoulder stabilization surgery. Recognizing these relationships may motivate surgeons to create pathways to prevent these treatment disparities among shoulder instability patients. Further studies are required to examine if these SDOH variables lead to disparities in postoperative outcomes. [ABSTRACT FROM AUTHOR]

A new study challenges the prevailing theory that sleep helps cleanse the brain of waste products and toxins. The study found that the mouse brain clears small dye molecules more efficiently while awake than when asleep or under anesthesia. While some researchers see this as a blow to the sleep clearance theory, others argue that the new study's methods are too different from previous work to be credible. The debate continues, with researchers exploring different mechanisms for waste clearance in the brain. [Extracted from the article]

Simple Summary: Pelvic radiotherapy is used to treat a range of cancers. Radiotherapy can damage surrounding, non-cancerous tissue and organs, causing long-term problems, including bowel symptoms such as bleeding, pain, and incontinence. The provision of support and treatment for those affected as well as shared decision making regarding treatment should be informed by a solid understanding of the prevalence, nature, and severity of symptoms. We conducted a systematic review of population-based studies presenting patient-reported bowel symptoms to synthesize evidence on symptom prevalence and severity following pelvic radiotherapy. Multiple different bowel symptoms have been reported, and prevalence varies from 1% (bleeding) to 59% (anal bleeding for >12 months). We found substantial variation in the reported methods and few data pertaining to cancers other than prostate. Our review supports the view that bowel symptoms are a significant problem following pelvic radiotherapy and highlights limitations of the evidence base that should be addressed in future research. Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, n = 39; gynecological, n = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function ('score', 26 papers, 'bother', 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for >12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence/severity was greater/worse in radiotherapy groups and symptoms more common/worse post-radiotherapy than pre-diagnosis/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support. [ABSTRACT FROM AUTHOR]

Aims: Anticholinergic medications are widely used in the treatment of overactive bladder (OAB), as well as for short‐term treatment of bladder symptoms following a variety of urologic surgeries. Mounting evidence points to an association between anticholinergic medications and the increased risk of incident dementia. The Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) thus convened a committee of subject experts to contextualize the current understanding of the cognitive risks of anticholinergic medications in the urologic patient population and to provide practical clinical guidance on this subject. Methods: Statements are based on an expert literature review and the committee's opinion. The document has been reviewed and approved by the SUFU board. Results: Chronic use (>3 months) of OAB anticholinergic medications is likely associated with an increased risk of new‐onset dementia. Short‐term (<4 weeks) use of most OAB anticholinergic medications is likely safe in most individuals. Clinicians should consider potential cognitive risks in all patient populations when prescribing OAB anticholinergics for chronic use. Consideration should be given to progressing to advanced therapy (botulinum toxin or neuromodulation) earlier in the OAB treatment paradigm Conclusions: The current body of literature supports a likely small but significant increased risk of dementia with chronic exposure to OAB anticholinergic medications. Potential harms should be balanced against potential quality of life improvement with treatment. [ABSTRACT FROM AUTHOR]

The long-term consequences of exposure to excess stress, particularly during sensitive developmental windows, on the initiation and progression of many complex, common physical and mental disorders that confer a major global burden of disease are well established. The period of intrauterine life represents among the most sensitive of these windows, at which time the effects of stress may be transmitted inter-generationally from a mother to her as-yet-unborn child. As explicated by the concept of fetal or developmental programming of health and disease susceptibility, a growing body of evidence supports the notion that health and disease susceptibility is determined by the dynamic interplay between genetic makeup and environment, particularly during intrauterine and early postnatal life. Except in extreme cases, an adverse intrauterine exposure may not, per se , ‘cause’ disease, but, instead, may determine propensity for disease(s) in later life (by shaping phenotypic responsivity to endogenous and exogenous disease-related risk conditions). Accumulating evidence suggests that maternal psychological and social stress during pregnancy represents one such condition that may adversely affect the developing child, with important implications for a diverse range of physical and mental health outcomes. In this paper we review primarily our own contributions to the field of maternal stress during pregnancy and child mental and physical health-related outcomes. We present findings on stress-related maternal-placental-fetal endocrine and immune/inflammatory processes that may mediate the effects of various adverse conditions during pregnancy on the developing human embryo and fetus. We enunciate conceptual and methodological issues related to the assessment of stress during pregnancy and discuss potential mechanisms of intergenerational transmission of the effects of stress. Lastly, we describe on-going research and some future directions of our program. [ABSTRACT FROM AUTHOR]

Background: Rapid advances in mobile technologies and applications and the continued growth in digital network coverage have the potential to transform data collection in low- and middle-income countries. A common perception is that digital data collection (DDC) is faster and quickly adaptable.Objective: The objective of this study was to test whether DDC is faster and more adaptable in a roadside environment. We conducted a reliability study comparing digital versus paper data collection in 3 cities in Ghana, Vietnam, and Indonesia observing road safety risk factors in real time.Methods: Roadside observation of helmet use among motorcycle passengers, seat belt use among 4-wheeler passengers, and speeding was conducted in Accra, Ghana; Ho Chi Minh City (HCMC), Vietnam; and Bandung, Indonesia. Two independent data collection teams were deployed to the same sites on the same dates and times, one using a paper-based data collection tool and the other using a digital tool. All research assistants were trained on paper-based data collection and DDC. A head-to-head analysis was conducted to compare the volume of observations, as well as the prevalence of each risk factor. Correlations (r) for continuous variables and kappa for categorical variables are reported with their level of statistical significance.Results: In Accra, there were 119 observation periods (90-min each) identical by date, time, and location during the helmet and seat belt use risk factor data collection and 118 identical periods observing speeding prevalence. In Bandung, there were 150 observation periods common to digital and paper data collection methods, whereas in HCMC, there were 77 matching observation periods for helmet use, 82 for seat belt use, and 84 for speeding. Data collectors using paper tools were more productive than their DDC counterparts during the study. The highest mean volume per session was recorded for speeding, with Bandung recording over 1000 vehicles on paper (paper: mean 1092 [SD 435]; digital: mean 807 [SD 261]); whereas the lowest volume per session was from HCMC for seat belts (paper: mean 52 [SD 28]; digital: mean 62 [SD 30]). Accra and Bandung showed good-to-high correlation for all 3 risk factors (r=0.52 to 0.96), with higher reliability in speeding and helmet use over seat belt use; HCMC showed high reliability for speeding (r=0.99) but lower reliability for helmet and seat belt use (r=0.08 to 0.32). The reported prevalence of risk factors was comparable in all cities regardless of the data collection method.Conclusions: DDC was convenient and reliable during roadside observational data collection. There was some site-related variability in implementing DDC methods, and generally the productivity was higher using the more familiar paper-based method. Even with low correlations between digital and paper data collection methods, the overall reported population prevalence was similar for all risk factors. [ABSTRACT FROM AUTHOR]

Purpose: To give an overview of the multicenter Prostate Cancer Outcomes (PCO) study, involving paper-based and web-based collection of patient-reported outcome measures (PROM) in patients undergoing local treatment for prostate cancer in certified centers in Germany. The PCO study is part of the larger Movember-funded TrueNTH Global Registry. The article reports on the study's design and provides a brief progress report after the first 2 years of data collection. Methods: Prostate cancer centers (PCCs) certified according to German Cancer Society requirements were invited to participate in collecting patient-reported information on symptoms and function before and at least once (at 12 months) after treatment. The data were matched with disease and treatment information. This report describes progress in patient inclusion, response rate, and variations between centers relative to online/paper use, and also data quality, including recruitment variations relative to treatment in the first participating PCCs. Results: PCC participation increased over time; 44 centers had transferred data for 3094 patients at the time of this report. Patient recruitment varied widely across centers. Recruitment was highest among patients undergoing radical prostatectomy. The completeness of the data was good, except for comorbidity information. Conclusions: The PCO study benefits from a quality improvement system first established over 10 years ago, requiring collection and harmonization of a predefined clinical dataset across centers. Nevertheless, establishing a PROM routine requires substantial effort on the part of providers and constant monitoring in order to achieve high-quality data. The findings reported here may be useful for guiding implementation in similar initiatives. [ABSTRACT FROM AUTHOR]

The implementation of new surgical techniques offers chances but carries risks. Usually, several years pass before a critical appraisal and a balanced opinion of a new treatment method are available and rely on the evidence from the literature and expert's opinion. The frozen elephant trunk (FET) technique has been increasingly used to treat complex pathologies of the aortic arch and the descending aorta, but there still is an ongoing discussion within the surgical community about the optimal indications. This paper represents a common effort of the Vascular Domain of EACTS together with several surgeons with particular expertise in aortic surgery, and summarizes the current knowledge and the state of the art about the FET technique. The majority of the information about the FET technique has been extracted from 97 focused publications already available in the PubMed database (cohort studies, case reports, reviews, small series, meta-analyses and best evidence topics) published in English. [ABSTRACT FROM AUTHOR]