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Edema in the subcutaneous soft tissue of the lumbar spine is a frequent incidental finding in spinal magnetic resonance imaging, however, its exact explanation is yet to be determined. The aim of this paper is to provide a systematic literature review on posterior lumbar subcutaneous edema (LSE). The present systematic literature search was carried out in October 2023 using electronic databases: PubMed, Cochrane library, and Scopus. The current evidence suggests that lumbar edema is correlated with clinical data such as weight and age, and potentially female sex. Moreover, LSE is related to several specific conditions, including both systemic and spinal disorders, such as heart or kidney disorders, as well as low back pain and degenerative and/or inflammatory diseases. It is important to be aware that there is an association between LSE and a variety systemic and spinal disorders. [ABSTRACT FROM AUTHOR]

Synovitis is a widely accepted sign of osteoarthritis (OA), characterised by tissue hyperplasia, where increased infiltration of immune cells and proliferation of resident fibroblasts adopt a pro-inflammatory phenotype, and increased the production of pro-inflammatory mediators that are capable of sensitising and activating sensory nociceptors, which innervate the joint tissues. As such, it is important to understand the cellular composition of synovium and their involvement in pain sensitisation to better inform the development of effective analgesics. Studies investigating pain sensitisation in OA with a focus on immune cells and fibroblasts were identified using PubMed, Web of Science and SCOPUS. In this review, we comprehensively assess the evidence that cellular crosstalk between resident immune cells or synovial fibroblasts with joint nociceptors in inflamed OA synovium contributes to peripheral pain sensitisation. Moreover, we explore whether the elucidation of common mechanisms identified in similar joint conditions may inform the development of more effective analgesics specifically targeting OA joint pain. The concept of local environment and cellular crosstalk within the inflammatory synovium as a driver of nociceptive joint pain presents a compelling opportunity for future research and therapeutic advancements. [ABSTRACT FROM AUTHOR]

In order to evaluate the early radiographic characteristics of the lateral talocalcaneal (L-TC) angle in patients with idiopathic clubfoot (ICF) and to investigate its prognostic significance for relapse after initial treatment with the Ponseti method. We retrospectively included 151 patients (96 males and 55 females; 227 feet) with ICF treated at our Institution between January 2005 and December 2014. The age at initial treatment was less than 6 months, and radiographs were obtained within 3 months of the Achilles tenotomy (mean age: 2.3 months; range: 0.77-6.8). All patients were followed up for at least 7 years (range, 7-18). The participants' feet were classified into 3 groups: relapsed (Group A), not relapsed (Group B), and normal foot groups which consisted of healthy feet in patients with unilateral ICF (Group C). All angle measurements were expressed in degrees. Forty-seven ICF feet in 33 patients relapsed, while 180 feet in 118 patients did not, and the age at relapse was 5.92 ± 1.91 years. Seventy-five normal feet were included in Group C. The average L-TC angle in Group A and B patients was 33.57° ± 12.05° and 39.37° ± 12.55°, respectively, while Group C was 49.61° ± 9.11°. A significant difference was found among the 3 groups of patients (F = 31.48, p <.001). The L-TC angle cut-off value below which a recurrence could be predicted was 36.1° (sensitivity, 74.47%). The L-TC angle of ICF patients treated using the Ponseti method were reduced compared to normal feet. An L-TC angle of <36.1° has relative value in predicting ICF relapse. [ABSTRACT FROM AUTHOR]

Retrusive profiles show an appearance of aging with an under-projected vermilion and pronounced nasolabial folds due to deficient bone support. A study was made of the association between orthognathic surgery and changes in the nasolabial and vermilion areas in patients with retrusive profiles. A retrospective cohort study evaluated patients subjected to bimaxillary surgery according to the Barcelona Line (BL) protocol during 2021 at Teknon Medical Center (Barcelona, Spain). Subjects with craniofacial syndromes, facial esthetic procedures, and dental rehabilitations involving lip changes, were excluded. The predictor variable was the timing of cephalometric measures, reported as T0 (preoperatively), T1 (1 month after surgery), and T2 (after 1 year of follow-up). The outcome variable corresponded to the soft tissue changes of the nasolabial and vermilion area, reported as the nasolabial fold length and angle, nasolabial angle, upper lip concavity, vermilion length, and upper lip sagittal distance from BL. The covariates comprised patient demographic data, the surgical-orthodontic protocol, and the magnitude and direction of the skeletal movements. Descriptive and inferential analyses were performed based on analysis of variance, the Bonferroni test, Pearson's linear coefficient, the nonparametric Mann-Whitney U-test, Kruskal-Wallis test, and multiple linear regression models. Statistical significance was considered for P <.05. The sample comprised 27 subjects with a mean age of 32.5 ± 11.2 years. A mean decrease in nasolabial angle of 5.5 ± 6° was recorded (P <.001), with a shortening of the nasolabial fold length of 4.4 ± 7.6 mm (P =.019). An increase in upper lip concavity angle of 14.4 ± 12° was recorded (P <.001), along with a vermilion lengthening of 1.6 ± 1.3 mm (P <.001) and an increase in upper lip sagittal distance to BL of 5.7 ± 7.3 mm (P =.001), indicating a more projected and everted upper vermilion. When adequate dentoskeletal support is provided by specific positional changes of the jaws planned through orthognathic surgery, the length of the nasolabial fold decreases, and the upper vermilion lengthens and becomes slightly everted. [ABSTRACT FROM AUTHOR]

Several randomized clinical trials comparing different bowel preparations (BP) have shown similar efficacy; however, there is a lack of real-world studies on this topic. This study aims to identify the most effective BP regimen in a real-world setting and any predictors of inadequate BP. A retrospective single-center study was conducted over 14 months at an academic hospital including outpatient colonoscopies in which adult patients did not teach on how to perform BP before colonoscopy. Colonoscopies with 1L-PEG, 2L-PEG and picosulphate mixtures were considered. A multivariable analysis for factors associated to poor BP was fitted. Overall, 1779 patients (51 %F, 60±14) years were included. The 1L-PEG regimen provided a higher rate of BP adequacy at multivariate analysis (adjusted OR 2.30, 95 %CI 1.67–3.16, p < 0.001) and was associated with higher median Boston Bowel Preparation Scale score (p < 0.001), higher rate of right-colon cleansing (p < 0.001) and exam completion (p = 0.04). Furthermore, we identified male sex, history of constipation, active smoking, previous pelvic surgery, concomitant psychiatric/neurological or chronic kidney diseases as predictors of inadequate BP. This is the largest real-world study comparing 1L-PEG to other BP regimens. Our results suggest 1L-PEG provides better BP in a non-controlled setting, improving clinical practice quality and minimizing the need for repeated colonoscopies and saving healthcare resources. [ABSTRACT FROM AUTHOR]

• One in five cirrhotic patients in a western European cohort developed HCC. • The one, three- and five-year HCC cumulative incidence is 1%, 10% and 17%. • In non-cirrhotic chronic hepatitis patients one in forty two (2%) developed HCC. • Follow up MRI of up to 10 months may suffice for detection of very early HCC. • Advanced stages of HCC are seen with prolonged time intervals (median 21 months). To investigate the utilization of MRI using a MRI liver protocol with extracellular contrast-enhanced series for hepatocellular carcinoma (HCC) surveillance in high-risk patients. Consecutive high-risk patients of a western European cohort who underwent repeated liver MRI for HCC screening were included. Lesions were registered according to the Liver Reporting & Data System (LIRADS) 2018. HCC was staged as very early stage HCC (BCLC stage 0) and more advanced stages of HCC (BCLC stage A-D). Differences in time interval between MRI's for BCLC stage 0 and stage A-D were calculated with the Mann-Whitney U test. The HCC cumulative incidence at one-, three- and five years was calculated with the Kaplan Meier estimator. From 2010 to 2019 a total of 240 patients were included (71% male; median age: 57 years; IQR: 50-64 years) with 1350 MRI's. Most patients (83 %) had cirrhosis with hepatitis C as the most common underlying cause. Patients underwent on average four MRI's (IQR: 3-7). Forty-two patients (17.5%) developed HCC (52 HCC lesions: 43 LIRADS-5, eight LIRADS-4, and one LIRADS-TIV). Eighteen patients (43%) had BCLC stage 0 HCC with a significant shorter screening time interval (10 months; IQR: 6-21) compared to patients with BCLC stage A-D (21 months; IQR: 10-32) (p = 0.03). Thirty seven percent of patients with a LIRADS-3 lesion (n=43) showed HCC development within twelve months (median: 7.4 months). One, three- and five-year HCC cumulative incidence in cirrhotic patients was 1%, 10% and 17%, respectively. High-risk patients who underwent surveillance with contrast-enhanced MRI developed HCC in 17.5 % during a follow up period of over 4 years median. Very early stage HCC was seen in compensated cirrhosis after a median time interval of 10 months. Later stages of HCC were related to prolonged screening time interval (median 21 months). [ABSTRACT FROM AUTHOR]

Adhesive capsulitis, or frozen shoulder, causes pain and reduces glenohumeral joint motion. This study aims to assesses ultrasound-guided hydrodistention with rehabilitation in hospital versus home settings. Forty patients with adhesive capsulitis were split into two groups: one received hydrodistention with hospital-assisted rehabilitation, and the other with home-based rehabilitation, following the same exercise protocol. Clinical assessments included range of motion (ROM), numeric pain rating scale (NPRS), shoulder pain and disability index (SPADI), disability of the arm, shoulder and hand (DASH), and assessment shoulder and elbow scale (ASES) The hospital-based group showed more rapid and substantial improvements in ROM and NPRS scores compared to the home-based group. The hospital-based group had a mean flexion ROM of 104.3 ± 31.6°, which increased to 149.5 ± 20.6° at the final follow-up. The home-based group started with a mean flexion ROM of 103.3 ± 29.2°, improving to 161.3 ± 23.2° by the end of the study. Both groups showed significant improvements, with the home-based group slightly outperforming in flexion ROM by the third follow-up. Initial NPRS scores were 4.7 ± 1.92 for the hospital-based group and 6.6 ± 1.63 for the home-based group. By the six-month mark, the hospital-based group's SPADI score dropped to 17.4 ± 19.5, while the home-based group's score was 10.5 ± 13.03. Both groups demonstrated significant improvements, with the hospital-based group showing slightly better outcomes at various follow-ups. Hydrodistention combined with supervised rehabilitation is optimal for treating frozen shoulder, though home-based therapy is also effective. Both methods significantly benefit from hydrodistention, highlighting its importance in treatment strategies. [ABSTRACT FROM AUTHOR]

Endoscopic Submucosal Dissection (ESD) has been reported as a feasible and effective treatment for Rectal Neuroendocrine Tumours (R-NETs). However, most of the experience on the topic comes from retrospective tertiary centre from Eastern Asia. Data on ESD for R-NETs in Western centres are lacking. This is a retrospective study, including patients who underwent endoscopic resection of R-NETS by ESD between 2015 and 2020 in Western Centres. Important clinical variables such as demographic, size of R-NETs, histological type, presence of lymphovascular invasion or distant metastasis, completeness of the endoscopic resection, recurrence, and procedure related complications were recorded. 40 ESD procedure on R-NETs from 39 patients from 8 centres were included. Mean R-NETs size was 10.3 mm (SD 4.01). Endoscopic en-bloc resection was achieved in 39/40 ESD (97.5 %), R0 margin resection was obtained in 87.5 % (35/40) of the procedures, one patient was referred to surgery for lymphovascular invasion, two procedures (5 %) reported significant episodes of bleeding, whereas a perforation occurred in one case (1/40, 2.5 %) managed endoscopically. Recurrence occurred in 1 patient (2.5 %). ESD is an effective and safe treatment for R-NETs in western centres. [ABSTRACT FROM AUTHOR]

The use of lower-pole sling products has made immediate breast reconstruction a feasible option in women undergoing skin-nipple sparing and skin-reducing mastectomies. To date, available data on the comparative efficacy of biological and synthetic meshes regarding postoperative complications are scattered and limited. A systematic literature search was performed to screen three different databases (PubMed, Web of Sciences, and Embase) using the following keywords: "breast reconstruction" AND "TiLOOP®" OR "Titanium-Coated Polypropylene Mesh" OR "TCPM". The perioperative and demographic characteristics of patients, complications profiles, and patient-reported outcomes were considered. We initially identified 234 articles, of which only 41, including 3923 patients and 5042 reconstructed breasts, fully satisfied the inclusion criteria. TiLOOP® Bra could be considered a safe and aesthetically valid alternative to Acellular Dermal Matrices (ADMs) in non-smokers patients undergoing skin-nipple sparing and skin-reducing mastectomies and immediate reconstruction. In such populations, complications are more likely to develop in patients with extreme body mass index values. The incidence of seroma with TiLOOP® Bra is comparable to that of ADMs as it is the beneficial effect in radiated patients, where TiLOOP® Bra seems superior to implant alone reconstruction. It has a good bio-integration with host tissues and resistance to infections in patients with a weakened immune system as a consequence of oncologic perioperative treatments. [ABSTRACT FROM AUTHOR]

Radiogenomics of clear cell renal cell carcinoma (ccRCC) has been developed thanks to the availability of genomic data, both gene expressions and gene mutations, obtained through the sequencing of ccRCC genome. These data are collected in the Cancer Genome Atlas (TCGA) Research Network-work. Disintegrin and metalloproteinase domain-containing protein 12 (ADAM12) gene belongs to the family of genes coding for multidomain and multifunctional type I transmembrane proteins ADAMs. These proteins are fundamental for regulating cell adhesion and mediating proteolysis of a series of cell surface receptors and signal molecules extracellular domains. Recently, a correlation was detected between ADAM12 expression in ccRCC and tumor aggressiveness in terms of cell proliferation, migration, invasion, tumor progression, metastases, and poor prognosis, suggesting ADAM12 as a prognostic marker and therapeutic target in ccRCC. The computed tomography (CT) imaging phenotype of ADAM12 expression in ccRCC has never been studied. The aim of this study is to investigate the CT imaging phenotype of ADAM12 expression in ccRCC patients. In this retrospective study, we enrolled 202 ccRCC patients divided into two groups: ccRCC patients with ADAM12 expression (n = 35) and ccRCC patients without ADAM12 expression (n = 167). Different imaging features were evaluated on CT scan at first diagnosis. The statistical significance threshold was set at p < 0.05. A statistically significant correlation was found with larger primary tumor size (p = 0.020), ill-defined tumor margins (p = 0.044), tumor necrosis (p = 0.011), and collecting system invasion (p = 0.014). This study demonstrates CT imaging features associated to ADAM12 expression in ccRCC. These results could help delve into ADAM12 gene status through CT approach and to further investigate towards the development of targeted therapies in ccRCC. [ABSTRACT FROM AUTHOR]

Winter is a critical period for the survival of local bird species in temperate regions. Some wintering birds may rely on transient food, such as that provided at birdfeeders, but bird communities around birdfeeders may also attract predators. However, these effects of birdfeeders on interspecific interactions between birds and their predators remain largely unexplored and have so far not been tested experimentally. We hypothesized that birdfeeders indirectly attract predators in winter because of the attraction of small birds, and tested this hypothesis using experimental feeders at 52 different urban and rural sites across western Poland. We found that the number of small birds increased around birdfeeders, particularly those with provided food. We found that birdfeeders that attracted more small birds (regardless of whether they provided food) attracted also more predators, such as sparrowhawks Accipiter nisus and feral cats Felis domesticus. Moreover, birdfeeders in urban habitats attracted relatively fewer small birds but not fewer predators compared to those in rural areas. Altogether, birdfeeders with food provided attracted small prey birds but they attracted also more predators, whose presence may hinder small birds from fully utilizing available resources, potentially impacting their winter survival through direct (mortality) and indirect (increased monitoring and vigilance) effects. [ABSTRACT FROM AUTHOR]

Excessive ballasted track deformations may occur during the railway operations due to poor load bearing capacity of the embankment (placed soil or natural ground) or the manifest accumulation of subsidence caused by the soil consolidation and the passage of trains. The principles of pressure grouting (or jet-grouting) technologies, used to create reinforcement elements for the rail trackbed stabilization, are presented, with reference to the specific construction condition on an existing and in-service railway track. A single-track railway, including the superstructure and substructure components, was modeled using the finite element method (FEM). Some soil stabilization options, based on the installation of grouted micropiles according to different layout configurations, were considered. The results of the numerical analyses, in the form of stress and strain behavior of the whole track structure, demonstrated that the use of jet-grouted micropiles is a rational and less expensive option, which can be installed on or close to the track, having positive effects on limiting the vertical deformations of the embankment without affecting the expected distribution of stress states in the embankment middle. [ABSTRACT FROM AUTHOR]

Functional mitral regurgitation induces adverse effects on the left ventricle and the left atrium. Left atrial (LA) dilatation and reduced LA strain are associated with poor outcomes in heart failure (HF). Transcatheter edge-to-edge repair (TEER) of the mitral valve reduces heart failure hospitalization (HFH) and all-cause death in selected HF patients. The aim of this study was to evaluate the impact of LA strain improvement 6 months after TEER on the outcomes of patients enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. The difference in LA strain between baseline and the 6-month follow-up was calculated. Patients with at least a 15% improvement in LA strain were labeled as "LA strain improvers." All-cause death and HFH were assessed between the 6- and 24-month follow-up. Among 347 patients (mean age 71 ± 12 years, 63% male), 106 (30.5%) showed improvement of LA strain at the 6-month follow-up (64 [60.4%] from the TEER + guideline-directed medical therapy [GDMT] group and 42 [39.6%] from the GDMT alone group). An improvement in LA strain was significantly associated with a reduction in the composite of death or HFH between the 6-month and 24-month follow-up, with a similar risk reduction in both treatment arms (P interaction = 0.27). In multivariable analyses, LA strain improvement remained independently associated with a lower risk of the primary composite endpoint both as a continuous variable (adjusted HR: 0.94 [95% CI: 0.89-1.00]; P = 0.03) and as a dichotomous variable (adjusted HR: 0.49 [95% CI: 0.27-0.89]; P = 0.02). The best outcomes were observed in patients treated with TEER in whom LA strain improved. In symptomatic HF patients with severe mitral regurgitation, improved LA strain at the 6-month follow-up is associated with subsequently lower rates of the composite endpoint of all-cause mortality or HFH, both after TEER and GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079) [Display omitted] [ABSTRACT FROM AUTHOR]

The impact of prosthesis-patient mismatch (PPM) on major endpoints after transcatheter aortic valve replacement (TAVR) is controversial and the effects on progression of heart damage are poorly investigated. Therefore, our study aims to evaluate the prevalence and predictors of PPM in a "real world" cohort of patients at intermediate and low surgical risk, its impact on mortality and the clinical-echocardiographic progression of heart damage. 963 patients who underwent TAVR procedure between 2017 and 2021, from the RECOVERY-TAVR international multicenter observational registry, were included in this analysis. Multiparametric echocardiographic data of these patients were analyzed at 1-year follow-up (FU). Clinical and echocardiographic features were stratified by presence of PPM and PPM severity, as per the most current international recommendations, using VARC-3 criteria. 18% of patients developed post-TAVR. PPM, and 7.7% of the whole cohort had severe PPM. At baseline, 50.3% of patients with PPM were male (vs 46.2% in the cohort without PPM, P =.33), aged 82 (IQR 79-85y) years vs 82 (IQR 78-86 P =.46), and 55.6% had Balloon-Expandable valves implanted (vs 46.8% of patients without PPM, P =.04); they had smaller left ventricular outflow tract (LVOT) diameter (20 mm, IQR 19-21 vs 20 mm, IQR 20-22, P =.02), reduced SVi (34.2 vs 38 mL/m2, P <.01) and transaortic flow rate (190.6 vs 211 mL/s, P <.01). At predischarge FU patients with PPM had more paravalvular aortic regurgitation (moderate-severe AR 15.8% vs 9.2%, P <.01). At 1-year FU, maladaptive alterations of left ventricular parameters were found in patients with PPM, with a significant increase in end-systolic diameter (33 mm vs 28 mm, P =.03) and a significant increase in left ventricle end systolic indexed volume in those with moderate and severe PPM (52 IQR 42-64 and 52, IQR 41-64 vs 44 IQR 35-59 in those without, P =.02)). No evidence of a significant impact of PPM on overall (P =.71) and CV (P =.70) mortality was observed. Patients with moderate/severe PPM had worse NYHA functional class at 1 year (NYHA III-IV 13% vs 7.8%, P =.03). Prosthesis size≤23 mm (OR 11.6, 1.68-80.1) was an independent predictor of PPM, while SVi (OR 0.87, 0.83-0.91, P <.001) and LVOT diameter (OR 0.79, 0.65-0.95, P =.01) had protective effect. PPM was observed in 18% of patients undergoing TAVR. Echocardiographic evaluations demonstrated a PPM-related pattern of early ventricular maladaptive alterations, possibly precursor to a reduction in cardiac function, associated with a significant deterioration in NYHA class at 1 year. These findings emphasize the importance of prevention of PPM of any grade in patients undergoing TAVR procedure, especially in populations at risk. [Display omitted] [ABSTRACT FROM AUTHOR]

There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events. A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0–122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P =.002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P =.05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation. In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years. [Display omitted] [ABSTRACT FROM AUTHOR]

Driving after drinking is a preventable threat to public health. We examined the prospective association of adolescent-reported parental monitoring knowledge (PMK) with recurrent driving after drinking in emerging adulthood. We analyzed six annual rounds (1–4, 6, 11) of the National Longitudinal Survey of Youth 1997 with a sample of 5,261 participants. PMK variables were created to recategorize parental monitoring measures by age of the youth. Recurrent driving after drinking was measured in 2002 and 2007 and dichotomized. Unadjusted and adjusted binary logistic regressions analyzed the association of PMK at ages 14, 15, 16, and 17 with recurrent drinking after driving in 2002 (ages 18–23) and 2007 (ages 22–28). Adjusted models included age, sex, race, household income, and education. Mother's PMK from ages 14 to 17 was inversely associated with recurrent driving after drinking in 2002 (adjusted odds ratios [AORs]: 0.89 [ p =.003, age 14], 0.93 [marginal p =.062, age 15], 0.88 [ p =.0003, age 16], 0.88 [ p =.0003, age 17]). By 2007, the only significant association between mother's PMK and recurrent driving after drinking was for age 16 (AOR: 0.95, p =.017). For father's PMK, significant inverse associations were only found for ages 16 and 17 with 2002 recurrent driving after drinking (AORs: 0.93, p =.025 and.88, p =.0005) and age 15 (AOR: 0.95, p =.021) with 2007 recurrent driving after drinking. Adolescent perceived PMK appears to offer protection against recurrent driving after drinking in emerging adulthood. This protective effect appears to wane as youth reach their mid-twenties. [ABSTRACT FROM AUTHOR]

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Conversational chatbots, fueled by large language models, spark debate over their potential in education and medical career exams. There is debate in the literature about the scientific integrity of the outputs produced by these chatbots. This study evaluates ChatGPT 3.5 and Perplexity AI's cross-sectional performance in responding to questions from the 2023 Italian national residency admission exam (SSM23), comparing results and chatbots' concordance with previous years SSMs. Gastroenterology-related SSM23 questions were input into ChatGPT 3.5 and Perplexity AI, evaluating their performance in correct responses and total scores. This process was repeated with questions from the three preceding years. Additionally, chatbot concordance was assessed using Cohen's method. In SSM23, ChatGPT 3.5 outperforms Perplexity AI with 94.11% correct responses, demonstrating consistency across years. Concordance weakened in 2023 (κ=0.203, P = 0.148), but ChatGPT consistently maintains a high standard compared to Perplexity AI. ChatGPT 3.5 and Perplexity AI exhibit promise in addressing gastroenterological queries, emphasizing potential educational roles. However, their variable performance mandates cautious use as supplementary tools alongside conventional study methods. Clear guidelines are crucial for educators to balance traditional approaches and innovative systems, enhancing educational standards. [ABSTRACT FROM AUTHOR]

While serum osteopontin (OPN)'s established role in cardiometabolic risk is recognized, its potential as a predictor of metabolic syndrome (MetS) improvement through a urine assay has not yet been demonstrated. In this study, we propose its potential predictive role over a 12-month period of standard care, with the ability to complement anthropometric measures. Hierarchical clustering revealed a notable association of urinary OPN (uOPN) with MetS criteria and overcame anthropometric measures in predicting the improvement at 12 months (OR of 2.74 [95% CI 1.32 to 6.29]). uOPN significantly contributed to the homogeneity of the nodes in the random forest and ultimately enhanced the performance of anthropometric measures when assessed for accuracy and area under the curve (AUC). Our findings offer insights into potential applications in cardiometabolic medicine for uOPN, which is easily detectable in non-invasive biological samples through an affordable assay. • Cardiometabolic diseases are linked with aging process. • Osteopontin has an established role in Cardiometabolic risk, but not when assayed in urine. • Osteopontin has a potential as predictor of metabolic syndrome improvement over 12 months of standard of care. • Osteopontin may improve the accuracy of anthropometric measure in defining cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Children's bone loss of limbs represents a significant challenge for surgeons, especially given that children are growing individuals. In the pediatric population, we compared bone reconstruction using vascularized fibula flaps with the induced membrane technique. The primary purpose of this study was to evaluate the delay and quality of consolidation. Data from patients who underwent limb reconstruction using either the fibula flap or the induced membrane were retrospectively collected from files across two centers. Perioperative and long-term complications were documented, along with functional and aesthetic outcome. Between 2004 and 2020, 31 children underwent limb reconstruction using a fibula flap, and 13 patients were treated using the induced membrane technique. The etiologies included 76% tumors, 20% congenital pseudarthroses, and 3.7% infections. The median size of the bone resection was 12.5 cm (range: 1.8 to 31 cm). The median time to consolidation after free fibula flap transfer was 10 months (range: 2 to 55 months) versus 7.5 months (range: 1 to 64 months) for the Masquelet technique (p = 0.54). Limb length inequality occurred in 52% of fibula cases and 39% of the induced membrane cases (p = 0.55). Both of free fibula flap and the induced membrane technique are effective options for bone reconstructing long bones in children. These techniques yield good functional outcomes and have comparable consolidation times. [ABSTRACT FROM AUTHOR]

This study aims to present the medium-term outcomes of Extra-Design engineering endografts with inner branches (EDE-iBEVARs, Artivion) in endovascular aortic repairs of complex aneurysms building upon promising early results. A retrospective, international, multi-center study was conducted including consecutive patients who underwent complex endovascular aortic repairs using EDE-iBEVARs between 2018 and 2022. Patient demographics, aneurysm anatomical features, procedural details, reinterventions, complications, and endograft failures during follow-up were assessed. The primary outcome was aneurysm-related mortality. Secondary outcome measures included the freedom from all-cause mortality and reintervention, technical and clinical success, and late related complications including branch instability, endoleaks, and serious adverse events. Our study encompassed a total of 260 patients across 13 European centers. The cohort included patients with thoracoabdominal aortic aneurysms (n = 116), suprarenal or juxta-renal aneurysms (n = 95), and those who had previous open repair or previous endovascular aortic repair with type 1A endoleak (n = 49). Of 982 possible inner branches (937 antegrade and 45 retrograde), 962 (98%) were successfully cannulated and bridged with covered stents during the index procedure. Overall, the endograft was successfully deployed in 98% of patients, and 93% were discharged from hospital following surgery. At 3 years, freedom from aneurysm-related mortality was 97%, whereas the freedom of all-cause mortality was 89%. Freedom from reinterventions was 91% and 76% at 1 and 3 years, respectively. The rate of late complications such as endoleaks or branch instability events was 12% (n = 30). The late branch occlusion rate during follow-up was 1.5% (n = 15), of which 12 were renal branches. EDE-iBEVARs demonstrate satisfactory medium-term outcomes with reintervention rates comparable to other endografts. Encouragingly, rates of branch patency were high, and major adverse events were low. This technology could expand the treatment options for patients with challenging complex aortic conditions. [ABSTRACT FROM AUTHOR]

• This study evaluates the prognostic value of VR-12 MCS on MIS-TLIF outcomes. • VR-12 MCS < 50 reported significantly inferior scores in all PROMs preoperatively. • MIS-TLIF patients with VR-12 MCS < 50 reported inferior postoperative outcomes. • VR-12 MCS < 50 reported greater rates of clinical improvement in mental health. • VR-12 MCS < 50 does not limit postoperative improvement in MIS-TLIF patients. No study has examined the prognostic value of the Veterans RAND-12 (VR-12) Mental Component Score (MCS) on postoperative outcomes in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) patients. This study examines the effect of preoperative VR-12 MCS on postoperative patient-reported outcome measures (PROMs) in MIS-TLIF patients. Patients were separated into 2 cohorts: VR-12 MCS < 50 and VR-12 MCS ≥ 50. PROMs of VR-12 MCS/Physical Component Score (PCS), Short Form-12 (SF-12) MCS/PCS, Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Back/Leg Pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected. Of 329 patients, 151 were in the VR-12 MCS < 50 cohort. The VR-12 MCS < 50 cohort reported significantly inferior scores in all PROMs preoperatively, significantly inferior VR-12 MCS, SF-12 MCS, PROMIS-PF, PHQ-9, and ODI scores at 6-weeks postoperatively, and significantly inferior scores in all PROMs, except for VAS-BP at final follow-up. Magnitude of 6-week postoperative improvement was significantly greater in the VR-12 MCS < 50 cohort for VR-12 MCS, SF-12 MCS, and PHQ-9. Magnitude of final postoperative improvement was significantly greater in the VR-12 MCS < 50 cohort for VR-12 MCS, SF-12 MCS/PCS, and PHQ-9. MCID achievement rates were significantly greater in the VR-12 MCS < 50 cohort for VR-12 MCS, SF-12 MCS, and PHQ-9. MIS-TLIF patients with lesser preoperative VR-12 MCS reported inferior postoperative outcomes in mental health, physical function, pain, and disability. However, patients with inferior preoperative mental health reported greater rates of clinically meaningful improvement in mental health. Inferior preoperative mental health does not limit postoperative improvement in patients undergoing MIS-TLIF. [ABSTRACT FROM AUTHOR]

• This study finds that the impact of MW on PROMs has no significant differences. • Preoperative MW imparts minimal influence on PROMs in LLIF patients. • Preoperative MW imparts minimal influence on MCID achievement in LLIF patients. This study measures the impact of preoperative motor weakness (MW) on Patient-Reported Outcome Measures (PROMs) in lateral lumbar interbody fusion (LLIF) patients. Retrospectively-sourced data from a prospectively-maintained, single-surgeon database created two cohorts of LLIF patients: patients with/without documented MW. Demographics/perioperative characteristics/PROMs were collected preoperatively and at six-weeks/final follow-up (FF). Studied outcomes were Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form (SF-12) Physical/Mental Component Score (PCS/MCS), Patient Health Questionnaire (PHQ-9), Visual Analog Scale Back/Leg Pain (VAS-BP/LP), and Oswestry Disability Index (ODI). Multivariable linear/logistic regression calculated/compared intercohort minimum clinically important difference (MCID). Mean postoperative follow-up time was 11.5 ± 7.52 months. In total, 214 LLIF patients from December 2010 to May 2023 were included, with 149 having documented MW. In Table 1, self-reported gender was significant between cohorts (p < 0.025). Other significant demographic characteristics were smoker status (p < 0.002), diabetes (p < 0.016), and CCI score (p < 0.011). Table 2 shows notably significant perioperative characteristics: spinal pathology (degenerative spondylolisthesis/foraminal stenosis/herniated nucleus pulposus) (p < 0.005, all), estimated blood loss/length of stay/postoperative day (POD)-zero narcotic consumption (p < 0.001, all). Table 3 outcomes/MCID achievement percentages demonstrated insignificant intercohort differences besides a weakly significant FF ODI score (p < 0.036). MW, a frequently reported symptom in spine surgery, is poorly studied in LLIF patients. Thus, this study evaluates MW impact on PROMs and notes no significant differences. However, one exception regarding FF disability scores was recorded. MW did not affect MCID achievement for our patient population. Therefore, the preliminary findings suggest preoperative MW imparts minimal influence on PROMs/MCID in LLIF patients. [ABSTRACT FROM AUTHOR]

• We discuss different lines of findings showing impact of pre-stimulus activity (e.g., in alpha band) on post-stimulus and associated contents of consciousness, through various explanatory levels (neurophysiological, neurocomputational, neurodynamic, neuropsychological, neurophenomenal). • The empirical findings suggest that the interaction between pre- and post- stimulus activity is not additive but non-additive and negative in the alpha frequency band. • The non-additive interaction is mediated by trial-to-trial variability, dynamic attractors, and fractal-oscillatory signal components. • Neuropsychologically, the finding shows that particularly the subjective features of consciousness are carried over from pre- to post-stimulus activity. This suggests that neurophenomenologically the contents of consciousness are related to the subject's point of view. • In addition to considering the spatial dimension of NCCs ("where are the NCCs"), we discuss the temporal dimension of NCCs ("when do the NCCs occur"), considering the time period from pre-stimulus to post-stimulus, and the mediating mechanism of NCCs ("how are the NCCs mediated"), proposing non-additive pre-post-stimulus interaction as a key mechanism of the NCCs. The current discussion on the neural correlates of the contents of consciousness (NCCc) focuses mainly on the post-stimulus period of task-related activity. This neglects the substantial impact of the spontaneous or ongoing activity of the brain as manifest in pre-stimulus activity. Does the interaction of pre- and post-stimulus activity shape the contents of consciousness? Addressing this gap in our knowledge, we review and converge two recent lines of findings, that is, pre-stimulus alpha power and pre- and post-stimulus alpha trial-to-trial variability (TTV). The data show that pre-stimulus alpha power modulates post-stimulus activity including specifically the subjective features of conscious contents like confidence and vividness. At the same time, alpha pre-stimulus variability shapes post-stimulus TTV reduction including the associated contents of consciousness. We propose that non-additive rather than merely additive interaction of the internal pre-stimulus activity with the external stimulus in the alpha band is key for contents to become conscious. This is mediated by mechanisms on different levels including neurophysiological, neurocomputational, neurodynamic, neuropsychological and neurophenomenal levels. Overall, considering the interplay of pre-stimulus intrinsic and post-stimulus extrinsic activity across wider timescales, not just evoked responses in the post-stimulus period, is critical for identifying neural correlates of consciousness. This is well in line with both processing and especially the Temporo-spatial theory of consciousness (TTC). [ABSTRACT FROM AUTHOR]

To explore the impact of oligohydramnios on fetal movement and hip development, given its association with developmental dysplasia of the hip (DDH) but unclear mechanisms. Chick embryos were divided into four groups based on the severity of oligohydramnios induced by amniotic fluid aspiration (control, 0.2 mL, 0.4 mL, 0.6 mL). Fetal movement was assessed by detection of movement and quantification of residual amniotic fluid volume. Hip joint development was assessed by gross anatomic analysis, micro-computed tomography (micro-CT) for cartilage assessment, and histologic observation at multiple time points. In addition, a subset of embryos from the 0.4 mL aspirated group underwent saline reinfusion and subsequent evaluation. Increasing volumes of aspirated amniotic fluid resulted in worsening of fetal movement restrictions (e.g., 0.4 mL aspirated and control group at E10: frequency difference −7.765 [95% CI: −9.125, −6.404]; amplitude difference −0.343 [95% CI: −0.588, −0.097]). The 0.4 mL aspirated group had significantly smaller hip measurements compared to controls, with reduced acetabular length (−0.418 [95% CI: −0.575, −0.261]) and width (−0.304 [95% CI: −0.491, −0.117]) at day E14.5. Histological analysis revealed a smaller femoral head (1.084 ± 0.264 cm) and shallower acetabulum (0.380 ± 0.106 cm) in the 0.4 mL group. Micro-CT showed cartilage matrix degeneration (13.6% [95% CI: 0.6%, 26.7%], P = 0.043 on E14.5). Saline reinfusion resulted in significant improvements in the femoral head to greater trochanter (0.578 [95% CI: 0.323, 0.833], P = 0.001). Oligohydramnios can cause DDH by restricting fetal movement and disrupting hip morphogenesis in a time-dependent manner. Timely reversal of oligohydramnios during the fetal period may prevent DDH. [ABSTRACT FROM AUTHOR]

Diagnostic errors impact patient health and healthcare costs. Artificial Intelligence (AI) shows promise in mitigating this burden by supporting Medical Doctors in decision-making. However, the mere display of excellent or even superhuman performance by AI in specific tasks does not guarantee a positive impact on medical practice. Effective AI assistance should target the primary causes of human errors and foster effective collaborative decision-making with human experts who remain the ultimate decision-makers. In this narrative review, we apply these principles to the specific scenario of AI assistance during colonoscopy. By unraveling the neurocognitive foundations of the colonoscopy procedure, we identify multiple bottlenecks in perception, attention, and decision-making that contribute to diagnostic errors, shedding light on potential interventions to mitigate them. Furthermore, we explored how existing AI devices fare in clinical practice and whether they achieved an optimal integration with the human decision-maker. We argue that to foster optimal Human-AI collaboration, future research should expand our knowledge of factors influencing AI's impact, establish evidence-based cognitive models, and develop training programs based on them. These efforts will enhance human-AI collaboration, ultimately improving diagnostic accuracy and patient outcomes. The principles illuminated in this review hold more general value, extending their relevance to a wide array of medical procedures and beyond. [ABSTRACT FROM AUTHOR]

Asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) have been proposed as mediators of endothelial dysfunction. In this study, we aimed to investigate the diagnostic and prognostic role of ADMA and SDMA in acute cerebrovascular disease. A prospective case-control study was performed, enrolling 48 patients affected by ischemic stroke with no cardioembolic origin, 20 patients affected by TIA, 40 subjects at high cardiovascular risk and 68 healthy subjects. ADMA levels were significantly lower in high-risk subjects (18.85 [11.78–22.83] μmol/L) than in patients with brain ischemic event, both transient (25.70 [13.15–40.20] μmol/L; p = 0.032) and permanent (24.50 [18.0–41.33] μmol/L; p = 0.001). SDMA levels were different not only between high-risk subjects and ischemic patients, but also between TIA and stroke patients, reaching higher levels in TIA group and lower levels in stroke group (1.15 [0.90–2.0] vs 0.68 [0.30–1.07] μmol/L; p < 0.001). SDMA was also correlated with short-term prognosis, with lower levels in case of adverse clinical course, evaluated by type of discharge (p = 0.009) and need of prolonged rehabilitation (p = 0.042). The present study highlights the relationship between l -arginine, ADMA, SDMA and acute cerebrovascular events. Therefore, our results suggested a potential role of SDMA as a specific marker of transient ischemic damage and as a short-term positive prognostic marker. • ADMA, SDMA and their ratio with l -arginine are markers of endothelial dysfunction. • SDMA seems to be specific for the diagnosis of transient ischemic damage. • SDMA are inversely proportional to oxidative stress degree and may be a laboratory indicator of the extent of the neurological deficit and as a short-term positive prognostic marker in the patients affected from ischemic stroke. • ADMA, SDMA and their ratio with l -arginine may represent a new diagnostic and prognostic tool in the management of cardio-cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

In the present study, we report for the first time the presence of Vitrina pellucida and Arion silvaticus as invasive species in Isla Grande of Tierra del Fuego, Argentina. Additionally, our research confirmed the presence in the same region of Deroceras reticulatum a previously reported invasive species from continental Patagonia. Taxonomic identification was achieved through morphological and molecular analyses (ribosomal 5.8S-ITS2-28S region and 16S rRNAgene). The finding of V. pellucida constitutes the first record of Vitrinidae for South America. This species is already naturalized in southern Tierra del Fuego and invaded natural areas of the National Park but still with small populations. In the case of Arion silvaticus , we observed a comparable situation, as this species has not only been collected from urban areas but also from within the forests of the protected area. These exotic species of land snails are exclusively cold-adapted Pulmonates. Their feeding types and diets range from herbivores on fresh plant material to omnivorous, occasionally on dead animals. The native micro snail species, coexisting in the same habitats, due to their minimal dispersal capacity and probable dependence on particular microhabitats, are particularly vulnerable not only to anthropogenic disturbances but also to the impacts and activities of these exotic species. Given the tourist impact in the region, the introduction of V. pellucida and Arion silvaticus in Tierra del Fuego has most likely occurred through accidental transport in soil by tourists arriving on the island. Another possible pathway of introduction is plant transportation. [ABSTRACT FROM AUTHOR]

Wildfires are an increasingly alarming phenomenon that affects forests and agroecosystems, generating several cascade effects among which soil erosion is one of the most deleterious. A robust body of data-based evidence on post-fire soil erosion and sediment yield at the watershed scale is, thus, required, especially when dealing with areas where wildfires are particularly frequent, such as the Mediterranean basin. This study analyzes the impact of the first rains after a large wildfire in terms of soil erosion and sediment yield at the watershed scale in a Mediterranean area, the Pisan Mountains, central Italy. Here about 1,000 ha of olive groves, maquis, maritime pine, and chestnut forests, all on steep slopes, burned in 2018. Fire (or burn) severity was mapped by remote sensing and checked by a field survey. Sediment yield was assessed by sampling earthy materials deposited upstream of a check dam at the outlet of the studied watershed. Finally, a hydrological model was developed in the hydrologic engineering center–hydrological modelling system (HEC–HMS) environment to explore the relationship between the erosion–deposition events observed in the watershed and the rainfall-induced hydrological processes. The first two post-fire rainy events relocated a high mass of sediment, mostly non-organic and characterized by light color, perhaps already in the stream before fire, while the subsequent four rain showers deposited materials rich in pyrogenic organic matter. Overall, the soil erosion caused by these six major rainfall events–the larger of which had a return time of one year–was estimated to amount to 7.85 t/ha (0.26 mm in the watershed), corresponding to 42% of the watershed average annual potential erosion rate in unburned conditions. This value is lower than expected, and, overall, moderate if compared to other Mediterranean case studies, possibly because of the nature of soils in the watershed, i.e., shallow and stony, thus, poor in fines prone to erosion. [ABSTRACT FROM AUTHOR]

• Perioperative hyperglycemia is a proven risk factor for postoperative infectious complications in neurosurgery. • Scheduled BGC monitoring and the use of low-dose insulin infusion protocol can decrease the postoperative infection rate in patients undergoing elective craniotomy. • Implementation of the perioperative BGC monitoring and the correction protocol prevented both severe hyperglycemia (≥180 mg/dl) and hypoglycemia (<70 mg/dl). Severe perioperative hyperglycemia (SH) is a proven risk factor for postoperative complications after craniotomy. To reduce this risk, it has been proposed to implement the standardized clinical protocol for scheduled perioperative blood glucose concentration (BGC) monitoring. This would be followed by intravenous (IV) insulin infusion to keep BGC below 180 mg/dl in the perioperative period. The aim of this prospective observational study was to assess the impact of this type of protocol on the postoperative infection rate in patients undergoing elective craniotomy. A total of 42 patients were prospectively enrolled in the study. Protocol included scheduled BGC monitoring in the perioperative period and rapid-acting insulin IV infusion when intraoperative SH was detected. The diagnosis of infection (wound, pulmonary, blood stream, urinary tract infection or central nervous system infection) was established according to CDC criteria within the first postoperative week. A previously enrolled group of patients with sporadic BGC monitoring and subcutaneous insulin injections for SH management was used as a control group. An infectious complication (i.e., pneumonia) was diagnosed only in one patient (2 %) in the prospective group. In comparison with the control group, a decrease in the risk of postoperative infection was statistically significant with OR = 0.08 [0.009 – 0.72] (p = 0.02). Implementation of the perioperative BGC monitoring and the correction protocol prevented both severe hyperglycemia and hypoglycemia with BGC < 70 mg/dl. Scheduled BGC monitoring and the use of low-dose insulin infusion protocol can decrease the postoperative infection rate in patients undergoing elective craniotomy. Future studies are needed to prove the causality of the implementation of such a protocol with an improved outcome. [ABSTRACT FROM AUTHOR]

Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR). This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+). MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements. Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, −6.3% [95% CI: −11.1% to −1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, −4.4% [95% CI: −5.9% to −2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, −4.1% [95% CI: −7.6% to −0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, −1.9% [95% CI: −2.5% to −1.3%]; P < 0.001) and mortality. RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667) [Display omitted] [ABSTRACT FROM AUTHOR]

To analyze the frequency of sequential oral squamous cell carcinomas (s-OSCC), preceded by oral potentially malignant disorders, and OSCC de novo (OSCC-dn) and explore differences in their clinicopathologic presentations. A structured electronic search strategy identified studies that analyzed frequency, clinical, biological, demographic, biomarkers, and prognostic features of s-OSCC and OSCC-dn according to PRISMA guidelines in PubMed, Scopus, Cochrane Library, and Google Scholar, up to January 31, 2023. Inclusion criteria were original English, Spanish, Portuguese, French, Italian, and German cross-sectional, cohort, and case-control studies. The quality of studies was assessed using the Agency for Research and Health Quality tool and the Newcastle–Ottawa Scale tool. The final selection included 40 studies. OSCC-dn and s-OSCC represent, respectively, 71% and 29% of cases of OSCC (P =.00), showing a higher percentage of T1 or of T1+T2 in s-OSCC (P <.0001). The association meta-analysis showed OSCC-dn with a significant association. The meta-analysis showed that s-OSCC was significantly associated with smaller tumor size, absence of distant metastases, relapses, male sex, and tumor sites different from tongue; and OSCC-dn was associated with more advanced tumor size, more regional and distant metastases, more advanced stages, and worse survival. S-OSCC was less frequent than expected. OSCC-dn seems to have specific clinical, biological, and prognostic features. Future perspectives on oral cancer prevention should address novel approaches and alternatives to screening, such as urgent referral of OSCC-dn. [ABSTRACT FROM AUTHOR]

Multiple colorectal adenomas (MCRAs) can result from APC (AFAP) or biallelic MUTYH (MAP) mutations, but most patients are wild type and referred to as non-APC/MUTYH polyposis (NAMP). We aim to examine the risk of colorectal cancer (CRC) and the role of endoscopy in managing patients with MCRAs, with a specific focus on clinical features and genotype. Records of MRCAs between 2000 and 2022 were retrospectively analysed. Patients were divided according to the genotype (MAP vs. NAMP) and the number of categorised polyps' burden (group 1: 10–24, group 2: 25–49, and group 3: 50–99 adenomas). Predictors of outcome were CRC-free survival (CRC-FS) and Surgery free-survival (S-FS). 220 patients were enrolled (NAMP n = 178(80.0%)). CRC at diagnosis was more frequent in group 3 (p = 0.01), without significant differences between the genotypes (p = 0.20). At a follow-up of 83(41–164) months, 15(7%) patients developed CRC during surveillance. CRC-FS was not correlated to genotype (p = 0.07) or polyps' number (p = 0.33), while S-FS was similar in MAP and NAMP (p = 0.22) and lower in groups 2 and 3 (p = 0.0001). MAP and NAMP have the same CRC risk and no difference in treatment. Endoscopic surveillance compared favorably with surgery in avoiding CRC risk, even in patients with more severe colorectal polyposis. [ABSTRACT FROM AUTHOR]

The current knowledge on pancreatic ductal adenocarcinoma (PDAC) risk factors is limited and no study has comprehensively tested the exposome in combination with the genetic variability in relation to the disease susceptibility. The aim of this study was to analyze the exposome and its interaction with known genetic susceptibility loci, in relation to PDAC risk. A case-control study nested in UK Biobank cohort was conducted on 816 PDAC cases and 302,645 controls. A total of 347 exposure variables, and a polygenic risk score (PRS) were analyzed through logistic regression. Gene-environment interaction analyses were conducted. A total of 52 associations under the Bonferroni corrected threshold of p < 1.46 × 10−4 were observed. Known risk factors such as smoking, pancreatitis, diabetes, PRS, heavy alcohol drinking and overweight were replicated in this study. As for novel associations, a clear indication for length and intensity of mobile phone use and the stress-related factors and stressful events with increase of PDAC risk was observed. Although the PRS was associated with PDAC risk (P = 2.09 × 10−9), statistically significant gene-exposome interactions were not identified. In conclusion, our results suggest that a stressful lifestyle and sedentary behaviors may play a major role in PDAC susceptibility independently from the genetic background. [ABSTRACT FROM AUTHOR]

GLIM definition of malnutrition is recognised all over the world and, when is referring to cancer, it specifies that weight or muscle loss are associated with an inflammatory status. However, the real-world practice shows that GLIM definition cannot encompass all the wide and heterogenous clinical presentations of cancer patients with malnutrition, which involves many other drivers beyond inflammation. Moreover, placing an excessive emphasis on the inflammation can overshadow, in the clinical practice, the role of the nutritional support in malnourished cancer patients. The aim of this paper is not to criticize the rationale of the GLIM definition of cancer cachexia, but to show the complexity and heterogeneity of malnutrition of cancer patients and reasons why nutritional support should deserve such a better consideration among the oncologists. Literature pertinent to pathophysiology of malnutrition of cancer patients is scrutinised and reasons for the frequent underuse of nutritional support are critically analysed. The appraisal of the literature shows that there are various pathophysiological patterns of malnutrition among cancer patients and inflammatory markers are not universally present in weight-losing cancer patients. Inflammation alone does not account for weight loss in all cancer patients and factors other than inflammation can drive hypophagia and weight loss, and hypophagia appears to be a primary catalyst for weight loss. Furthermore, malnutrition may be the consequence of the presence of several Nutrition Impact Symptoms or of the oncologic therapy. The nutritional support may fail to show benefits in malnourished cancer patients because the golden standard to validate a therapy relies on RCT, but it is ethically impossible to have an unfed control group of malnourished patients. Furthermore, nutritional interventions often fell short of the optimal standards, adherence to treatment plans was often poor, nutritional support was mainly reserved for very advanced patients and the primary endpoints of the studies on nutritional support were sometimes unrealistic. There is a gap between the suggestion of the guidelines which advocate the use of nutritional support to improve the compliance of patients facing intensive oncologic treatments or to prevent an early demise when patients enter a chronic phase of slow nutritional deterioration, and the poor use of nutrition in the real-world practice. This requires a higher level of awareness of the oncologists concerning the reasons for the lacking evidence of efficacy of the nutritional support and an understanding of its potential contribute to improve the outcome of the patients. Finally, this paper calls for a change of the oncologist's approach to the cancer patient, from only focusing on the cure of the tumour to taking care of the patient as a whole. [ABSTRACT FROM AUTHOR]

Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well-established therapy in patients with reduced left ventricular ejection fraction, heart failure, and left bundle branch block. Left bundle branch area pacing (LBBAP) has recently been shown to be a feasible and effective alternative to BVP. Comparative data on the risk of complications between LBBAP and BVP among patients undergoing CRT are lacking. The aim of this study was to compare the long-term risk of procedure-related complications between LBBAP and BVP in a cohort of patients undergoing CRT. This prospective, multicenter, observational study enrolled 668 consecutive patients (mean age 71.2 ± 10.0 years; 52.2% male; 59.4% with New York Heart Association class III-IV heart failure symptoms) with left ventricular ejection fraction 33.4% ± 4.3% who underwent BVP (n = 561) or LBBAP (n = 107) for a class I or II indication for CRT. Propensity score matching for baseline characteristics yielded 93 matched pairs. The rate and nature of intraprocedural and long-term post-procedural complications occurring during follow-up were prospectively collected and compared between the 2 groups. During a mean follow-up of 18 months, procedure-related complications were observed in 16 patients: 12 in BVP (12.9%) and 4 in LBBAP (4.3%) (P =.036). Compared with patients who underwent LBBAP, those who underwent BVP showed a lower complication-free survival (P =.032). In multivariate analysis, BVP resulted an independent predictive factor associated with a higher risk of complications (hazard ratio 3.234; P =.042). Complications related to the coronary sinus lead were most frequently observed in patients who underwent BVP (50.0% of all complications). LBBAP was associated with a lower long-term risk of device-related complications compared with BVP in patients with an indication for CRT. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is common in patients with cardiac amyloidosis (CA) and is a significant risk factor for heart failure hospitalization and thromboembolic events. This study was designed to investigate the atrial electrofunctional predictors of incident AF in CA. A multicenter, observational study was conducted in 4 CA referral centers including sinus rhythm patients with light-chain (AL) and transthyretin (ATTR) CA undergoing electrocardiography and cardiac magnetic resonance imaging. The primary end point was new-onset AF occurrence. Overall, 96 patients (AL-CA, n = 40; ATTR-CA, n = 56) were enrolled. During an 18-month median follow-up (Q1–Q3, 7–29 months), 30 patients (29%) had incident AF. Compared with those without AF, patients with AF were older (79 vs 73 years; P =.001). They more frequently had ATTR (87% vs 45%; P <.001); electrocardiographic interatrial block (IAB), either partial (47% vs 21%; P =.011) or advanced (17% vs 3%; P =.017); and lower left atrial ejection fraction (LAEF; 29% vs 41%; P =.004). Age (hazard ratio [HR], 1.059; 95% CI, 1.002–1.118; P =.042), any type of IAB (HR, 2.211; 95% CI, 1.03–4.75; P =.041), and LAEF (HR, 0.967; 95% CI, 0.936–0.998; P =.044) emerged as independent predictors of incident AF. Patients exhibiting any type of IAB, LAEF <40%, and age >78 years showed a cumulative incidence for AF of 40% at 12 months. This risk was significantly higher than that carried by 1 (8.5%) or none (7.6%) of these 3 risk factors. In patients with CA, older age, IAB on 12-lead electrocardiography, and reduced LAEF on cardiac magnetic resonance imaging are significant and independent predictors of incident AF. A closer screening for AF is advisable in CA patients carrying these features. [Display omitted] [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Scapular dyskinesis (SD) is defined as an altered position of the scapula or altered motion patterns and their relationship with shoulder pain (SP) is still under debate. The modified scapular assistance test (mSAT) modifies scapular kinematics and is used to determine the impact of scapular dyskinesis in shoulder pain. However, data about the relationship between SD and the result of mSAT is scarce. The aim of this study is to establish the frequency of positive mSAT in patients with SP and compare the prevalence in those with and without SD. As a secondary objective, we compare changes in pain intensity during the mSAT in patients with a positive test between those with and without SD. Cross-sectional study. Adult patients with a diagnosis of SP and with pain ≥2 during anterior flexion were included. The mSAT, scapular dyskinesis test (SDT), and shoulder function were assessed. The study was conducted between August 2018 and May 2022 and included 70 patients. The prevalence of SDT was 54.29%. No statistically significant associations were detected when assessing the relation between the presence of mSAT and SDT (p -value 0.83). When comparing pain response during the mSAT in patients with a positive test, no differences were seen between patients with SD and patients without SD (p -value 0.26). The prevalence of positive mSAT results was equal between individuals with and without SD. These findings suggest that the presence or absence of SD in individuals with SP was independent of the mSAT result. The mSAT should not be used solely for the assessment of SD in clinical practice nor be influenced by the SDT result. More research is needed to determine if the result of this test could inform prognosis and guide treatment choices. • There were no significant differences between the prevalence of positive mSAT in those with or without scapular dyskinesia. • Patients with dyskinesia did not exhibit larger pain modifications during the modified scapular assistance test than patients with normal scapular motion. • The prevalence of positive mSAT in patients with shoulder pain was 28.5%. [ABSTRACT FROM AUTHOR]

The effect of one-lung ventilation (OLV) strategy based on low tidal volume (TV), application of positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARM) to reduce postoperative acute respiratory distress syndrome (ARDS) and pulmonary complications (PPCs) compared with higher TV without PEEP and ARM strategy in adult patients undergoing lobectomy or pneumonectomy has not been well established. Multicenter, randomized, single-blind, controlled trial. Sixteen Italian hospitals. A total of 880 patients undergoing elective major lung resection. Patients were randomized to receive lower tidal volume (LTV group: 4 mL/kg predicted body weight, PEEP of 5 cmH 2 O, and ARMs) or higher tidal volume (HTL group: 6 mL/kg predicted body weight, no PEEP, and no ARMs). After OLV, until extubation, both groups were ventilated using a tidal volume of 8 mL/kg and a PEEP value of 5 cmH 2 O. The primary outcome was the incidence of in-hospital ARDS. Secondary outcomes were the in-hospital rate of PPCs, major cardiovascular events, unplanned intensive care unit (ICU) admission, in-hospital mortality, ICU length of stay, and in-hospital length of stay. ARDS occurred in 3 of 438 patients (0.7%, 95% CI 0.1-2.0) and in 1 of 442 patients (0.2%, 95% CI 0-1.4) in the LTV and HTV group, respectively (Risk ratio: 3.03 95% CI 0.32-29, p = 0.372). Pulmonary complications occurred in 125 of 438 patients (28.5%, 95% CI 24.5-32.9) and in 136 of 442 patients (30.8%, 95% CI 26.6-35.2) in the LTV and HTV group, respectively (risk ratio: 0.93, 95% CI 0.76-1.14, p = 0.507). The incidence of major complications, in-hospital mortality, and unplanned ICU admission, ICU and in-hospital length of stay were comparable in both groups. In conclusion, among adult patients undergoing elective lung resection, an OLV with lower tidal volume, PEEP 5 cmH 2 O, and ARMs and a higher tidal volume strategy resulted in low ARDS incidence and comparable postoperative complications, in-hospital length of stay, and mortality. [ABSTRACT FROM AUTHOR]

• VR-12 PCS < 30 reported worse baseline mental and physical health and disability. • VR-12 PCS < 30 report greater postoperative improvements in mental/physical health. • At 6 weeks, lesser physical function correlates with worse physical health/PHQ-9. • At 6 weeks, VR-12 PCS < 30 saw better physical health/VR-12 MCS improvement. • VR-12 PCS < 30 saw better physical health/PHQ-9 improvement by final follow-up. • VR-12 PCS < 30 had higher MCID achievement rates for PHQ-9 and ODI. No study has evaluated the preoperative impact of Veterans RAND-12 Physical Composite Score (VR-12 PCS) on anterior lumbar interbody fusion (ALIF) patients. This study examines its influence on physical function, mental health, pain, and disability outcomes. Two cohorts of ALIF patients with preoperative VR-12 PCS scores were formed using a single-surgeon registry: VR-12 PCS < 30 and VR-12 PCS ≥ 30. Demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected. PROMs of VR-12 PCS/Mental Composite Score (MCS), Short Form-12 (SF-12) PCS/MCS, Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale-Back/Leg Pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected pre/postoperatively up to 2-years. Demographics, perioperative characteristics, and preoperative PROMs were compared. Intercohort postoperative 6-week/final PROMs and improvements were compared. Of 80 patients, there were 41 in the VR-12 PCS < 30 cohort. Besides VR-12 PCS, VR-12 PCS < 30 patients reported inferior preoperative VR-12 MCS/SF-12 PCS/PROMIS-PF/PHQ-9/ODI scores (p ≤ 0.003, all). At 6-weeks postoperatively, VR-12 PCS < 30 reported inferior VR-12 PCS/SF-12 PCS/PROMIS-PF/PHQ-9 (p ≤ 0.030, all). There was greater improvement up to 6-weeks postoperatively in VR-12 PCS < 30 for VR-12 PCS/MCS and SF-12 PCS (p ≤ 0.020, all). VR-12 PCS < 30 reported superior improvement by final follow-up in VR-12 PCS/SF-12 PCS/PHQ-9 (p ≤ 0.006, all). MCID achievement rates were higher in VR-12 PCS < 30 for PHQ-9 and ODI (p ≤ 0.013, both). VR-12 PCS < 30 patients reported inferior postoperative physical function, mental health, and disability, yet superior magnitude of improvement in physical function and mental health. Rates of clinically meaningful improvement for VR-12 PCS < 30 were greater in mental health and disability. [ABSTRACT FROM AUTHOR]

Orchard design (intra- and inter-row distance) defines the space allotted to each tree and the light environment for growth in olive hedgerows. Shading between neighboring trees affects the light intensity and quality, modifying the tree vegetative, flowering and fruiting characteristics. In this study, the incident photosynthetically active radiation (PAR) was simulated and the red-to-far-red ratio (R/FR) reflected by neighboring hedgerows down the canopy walls was measured. An analysis is presented of the response of olive vegetative, flowering, fruiting and productive traits to hedgerows of high (HD) and super-high density (SHD) orchards. The study was carried out during the 2018–2019 and 2019–2020 seasons in two 10-year-old olive cv. Genovesa orchards, one in HD (7 x 3.5 m) and the other in SHD (4 x 1.5 m). In both systems, continuous rows were used for measurements of light environment and vegetative, flowering and fruiting characteristics. The R/FR ratio and mean daily horizontal incident PAR were significantly higher in HD than in SHD. One-year-old shoots of HD hedgerows had shorter internodes in L position than U, M and L positions of SHD. Inflorescence number per shoot in the M and L positions of HD were triple than those of corresponding positions of SHD hedgerows. The mean yield per ha for both seasons was similar between HD and SHD hedgerows (average 9.3 and 9.4 t/ha, respectively). A greater planting density in olive hedgerows reduces the R/FR ratio reflected by neighboring trees while reducing incident PAR with increases in the hedgerow height. As a result, more illuminate HD hedgerows have greater specific leaf mass, higher leaf area density and higher axis-order angle compared to SHD hedgerows. This study seeks a new way to understand and measure the suitability of an olive cultivar trained in hedgerows at different planting densities. [ABSTRACT FROM AUTHOR]

Endoscopic resection is standard treatment for adenomatous colorectal lesions. Depending on lesion morphology and resection technique, recurrence can occur. Scarred adenomas are challenging to resect and may require surgical management. This study evaluated the safety and effectiveness of an endoscopic powered resection (EPR) system for scarred adenomatous colorectal lesions. This single-arm, prospective, multicenter study was conducted from January 2018 to January 2021 at 12 sites. Patients with persistent flat or sessile colorectal lesions were enrolled. Primary end points were technical success (the ability of the device to resect the lesion[s] without use of other resection devices without device-related serious adverse events [AEs]) and safety (the occurrence of AEs through 90 days). Secondary end points included endoscopic confirmation of resection completeness, occurrence of colon stenosis, disease persistence, and diagnostic value of resected specimens. Sixty-five patients were in the intention-to-treat/safety analysis population. Primary analysis was performed on 45 per-protocol (PP) patients with 48 lesions. All PP patients were solely treated by using the EPR device. Technical success was achieved in 44 (98%) patients. Three (5%) serious AEs occurred: 2 delayed self-limited bleeds and 1 perforation. Nonserious AEs included 4 (6%) cases of mild intraprocedural bleeding. Completeness of resection and histopathologic diagnosis of tissue specimens were achieved in all patients. Twenty-one (46.7%) patients had disease persistence after the first treatment, and there was no colon stenosis. EPR is safe and effective for benign, persistent, large (>20 mm), scarred colorectal adenomas and should be considered as an alternative treatment in lieu of surgery. A persistence rate of 46.7% indicates that >1 treatment is necessary for effective endoscopic treatment. (Clinical trial registration number: NCT04203667.) [ABSTRACT FROM AUTHOR]

Non–small cell lung cancer (NSCLC) is Argentina's first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector. We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment – General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC. We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P <.05) and lower impairment of daily activities (41% vs 59%; P =.01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P <.05) but showed no differences when financial toxicity was assessed as a dichotomic variable. Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals. • The study provides a comprehensive assessment of the health-related quality of life and economic burden in patients with non–small cell lung cancer (NSCLC) in Argentina, a population with predominantly advanced-stage diagnoses and limited expected survival. • Comparison between private and public healthcare sectors reveals significant differences in disease severity, socioeconomic factors, and health outcomes. Patients in the private sector exhibit lower disease severity and higher educational attainment and household income. • The study suggests that patients with NSCLC receiving care in private healthcare centers experience higher utility and less impairment of daily activities, indicating a potentially improved quality of life compared with those treated in public hospitals. In addition, private sector patients display reduced financial toxicity, as evidenced by lower Comprehensive Score for Financial Toxicity scores. These findings have important implications for healthcare decision making and resource allocation in Argentina's NSCLC management. [ABSTRACT FROM AUTHOR]

Few data are available on flow cytometry (FC) for monitoring intraepithelial lymphocytes (IELs) in refractory celiac disease (RCD), non-responsive celiac disease (NRCD), and non-celiac enteropathies (NCEs). AIMS.1) To investigate the significance of monitoring IELs immunophenotype with FC in patients with NRCD, RCD and NCEs; 2) to evaluate FC concordance with immunohistochemistry (IHC) and γ-TCR clonality analysis. Patients investigated between January-2012 and February-2023 were divided into two groups: 1)confirmed RCD or NRCD being investigated for persistent symptoms and suspected complications of celiac disease (CD); 2)NCEs lacking clinical/histological response. Clinical/molecular features and outcomes were retrospectively collected and analysed according to presence/absence of aberrant IELs on FC (cut-off≥20 % CD103+sCD3-CD8-iCD3+ IELs). 52 patients (18 RCD,21 NRCD,13 NCEs; 38F, 55±13 years; median follow-up 30 months, IQR 2-58) underwent 100 FC IELs determinations. 22/52 had ≥2 FC determinations and IEL phenotype remained unchanged over time in all them (κ=1.00). Aberrant IEL phenotype in CD was associated with increased mortality (HR 4.2, 95 % CI 1.5–11.9, p < 0.01). No patients with NCEs had an aberrant IEL phenotype at FC, although 3/13 developed lymphoma and 4/13 died. Concordance of FC was fair with both IHC (κ=0.40) and γ-TCR clonality analysis (κ=0.22). FC is accurate for assessing and monitoring IEL phenotype and providing important prognostic information in celiac patients. Further study is needed on its role in NCEs. [ABSTRACT FROM AUTHOR]

Despite recent improvement in preoperative staging, nodal and mediastinal upstaging occur in about 5% to 15% of cN0 patients. Different clinical and tumor characteristics are associated with upstaging, whereas the role of the surgeon's experience is not well evaluated. This study aimed to investigate if operator experience might influence nodal upstaging during video-assisted thoracic surgery anatomical lung resection. Clinical and pathological data from the prospective video-assisted thoracic surgery Italian nationwide registry were reviewed and analyzed. Patients with incomplete data about tumor and surgical characteristics, ground glass opacities tumors, cN2 to 3, and M+ were excluded. Clinical data, tumor characteristics, and surgeon experience were correlated to nodal and mediastinal (N2) upstaging using Pearson's χ2 statistic or Fisher exact test for categorical variables and Mann–Whitney U and t tests for quantitative variables. A multivariable model was built using logistic regression analysis. Surgeon experience was categorized considering the number of video-assisted thoracic surgery major anatomical resections and years after residency. Final analysis was conducted on 3,319 cN0 patients for nodal upstaging and 3,471 cN0N1 patients for N2 upstaging. Clinical tumor-nodes-metastasis stage was stage I in 2,846 (81.9%) patients, stage II in 533 (15.3%), and stage III (cT3N1) in 92 (2.8%). Nodal upstaging occurred in 489 (13.1%) patients, whereas N2 upstaging occurred in 229 (6.1%) patients. Years after residency (P =.60 for nodal, P =.13 for N2 upstaging) and a number of video-assisted thoracic surgery procedures(P =.49 for nodal, P =.72 for nodal upstaging) did not correlate with upstaging. Multivariable analysis confirmed cT-dimension (P =.001), solid nodules (P <.001), clinical tumor-nodes-metastasis (P <.001) and maximum standardized uptake values (P <.001) as factors independently correlated to nodal upstaging, whereas cT-dimension (P =.005), clinical tumor-nodes-metastasis (P <.001) and maximum standardized uptake values (P =.028) resulted independently correlated to N2 upstaging. Our study showed that surgeon experience did not influence nodal and mediastinal upstaging during -assisted thoracic surgery anatomical resection, whereas cT-dimension, clinical tumor-nodes-metastasis, and maximum standardized uptake values resulted independently correlated to nodal and mediastinal upstaging. [ABSTRACT FROM AUTHOR]