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Appropriate healthcare and psychological support for children and adolescents is essential for the successful development and good mental health. Unfortunately, this is often a neglected element in the healthcare systems around the world. It is known that approximately half of all adult psychiatric disorders start under the age of 14 and that the prevalence of child and adolescent-onset psychiatric conditions is increasing. The real reason for this increase remains unclear, but it demands our attention as does the care of affected children, adolescents, and their families. Transitions between different age groups need to be made easily navigable for the patients and their families. Many challenges in child and adolescent psychiatry are present, especially in developing countries such as Serbia. A possible solution for overcoming these challenges is uniting the child and adolescent professional societies from all over the world. These societies should work together to develop unified strategies for diagnosis, treatment and support of children affected by psychiatric conditions. By working closely with pediatricians, family physicians, psychologists, nurses, and other professionals, child and adolescent psychiatry can use knowledge and skills to support practice while teaching other professionals how to optimize the utilization of child and adolescent psychiatry services.

To update the findings of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) on prognostic factors for whiplash-associated disorder (WAD) outcomes. We conducted a systematic review and best-evidence synthesis. We systematically searched MEDLINE, EMBASE, CINAHL and PsycINFO from 2000–2017. Random pairs of reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We retrieved 10,081 articles. Of those, 100 met inclusion criteria. After critical appraisal, 74 were judged to have low risk of bias. This adds to the 47 admissible studies found by the Neck Pain Task Force. Twenty-two related to course of recovery; 59 to prognostic factors in recovery; and 16 reported other WADs outcomes. Some studies related to more than one category. Findings suggest that half of those with WADs will experience substantial improvement within three months and cessation of symptoms within six months. Among factors associated with recovery are post-crash psychological factors, including expectations for recovery and coping. Our review adds to the Neck Pain Task Force by clarifying the role of prognostic factors. Evidence supports the important role of post-crash psychological factors in WADs recovery. CRD42013004610

Objectives This study aims to assess the possible relationship between 99mTc-pertechnetate hand perfusion scintigraphy (HPS) and nailfold capillaroscopy (NC) in systemic sclerosis (SSc) patients. Patients and methods The study group consisted of 25 SSc patients (6 males; 19 females; mean age 54.2±9.7 years; range, 32 to 67 years), 18 female patients with primary Raynaud's phenomenon (PRP) (mean age 47.1±9.5 years; range, 34 to 65 years) and 10 healthy individuals (3 males, 7 females; mean age 52.7±12.6 years; range, 37 to 73 years). NC and 99mTc-pertechnetate HPS were performed in all examinees. The capillaroscopic findings were classified as normal or scleroderma pattern ("early", "active", or "late"). The fingers-to-palm ratios were calculated for both blood flow (BF) and blood pool (BP) phases of the 99mTc-pertechnetate HPS. Results Systemic sclerosis patients showed a significantly lower BP ratio than PRP patients and healthy subjects (p=0.004). No statistically significant difference was observed between the SSc and PRP patients in respect to BF ratio. A gradual decrease of BF and BP with the severity of NC microangiopathy pattern ("early", "active" or "late") was found in SSc patients, while the differences were not statistically significant. Patients with diffuse SSc showed lower BF and higher BP than those with limited SSc, while these differences were without statistical significance. There was no significant correlation between BF or BP values and type of SSc (limited or diffuse) (p=0.77 versus p=0.54, respectively) as well as three microangiopathy patterns (p=0.22 versus p=0.54, respectively). Conclusion 99mTc-pertechnetate HPS improves the evaluation of vascular damage in SSc patients. There is no direct relationship between NC and 99mTc-pertechnetate HPS; however, the two methods complement each other in the assessment of microcirculation in SSc.

Introduction: Congenital adrenal hyperplasia (CAH) is an inherited autosomal recessive disorder characterized by a defect in the synthesis of steroid hormones of the adrenal cortex. This defect results in elevated serum androgen levels. Androgens have been shown to have a significant effect on the developing brain during prenatal and postnatal period, which can lead to impaired neurocognitive functioning and contribute to the development of psychiatric disorders. The aim: In this paper, we will present a patient with CAH who developed serious psychiatric problems during adolescence. The aim of this case report is to discuss a possible connection between these two conditions and to consider possible diagnostic and therapeutic interventions. Case report: The patient was diagnosed with the classic form of CAH at birth. After months of corticosteroid substitution therapy, the patient was surgically treated at 7 months of age with vaginoplasty and clitoroplasty. The patient developed serious psychiatric problems from the depressive-anxiety spectrum in the early adolescent period, followed by impaired impulse control and aggression. This report illustrates the diagnostic and therapeutic interventions conducted at the Clinical Department for Children and Adolescents of the Institute of Mental Health. Conclusion: Given the abundant evidence on the impact of CAH on cognitive ability and psychosocial functioning, it is necessary to develop and implement complementary multidisciplinary diagnostic and therapeutic interventions in these patients. Such interventions would aim to prevent the onset of psychiatric comorbidities and consequently improve the quality of life and functionality of these patients.

Background/Aim. Diagnosis of chronic rhinosinusitis (CRS) is based on clinical symptoms, and confirmed with endoscopic findings and computed tomography (CT) scans of paranasal sinuses. However, the results of numerous studies have shown that the symptoms that patients report are not in correlation with the degree of the disease spread obtained by radiological findings. The aim of our study was to examine is there a correlation between the degree of symptoms intensity of the non-polypous and polypous form of CRS and the degree of the disease spread, obtained on the basis of radiological diagnostics. Methods. A total of 60 patients, of which 30 patients with CRS without nasal polyps (CRSsNP) and 30 with CRS with nasal polyps (CRSwNP), were included in this cross-sectional study. Symptoms were evaluated using two questionnaires: Sino-Nasal Outcome Test 22 (SNOT-22) and Visual Analogue Score (VAS). The Lund Mackay CT score was used as a radiological parameter of the disease expansion. In addition, each of the subjects was examined for sensitivity to standard inhalation allergens. Results. In patients with CRSsNP, there were statistically significant positive correlations between the Lund Mackay CT score and the SNOT-22 score (r = 0.578, p = 0.001) and between the Lund Mackay CT score and the VAS (r = 0.408, p = 0.025). We found no correlation between the both questionnaire scores and the Lund Mackay score in CRSwNP patients. In patients with CRSwNP, a statistically significant difference was found in the values of SNOT-22 between patients with and without sensitivity to inhalation allergens, with higher values of the score in patients with allergy (p = 0.039). Conclusion. There is a positive correlation between the severity of the symptoms and the radiological findings only in patients with CRSsNP, which suggests that application of these questionnaires would be possible only in the case of this clinical entity.

The global pandemic caused by Corona Virus Disease 2019 (COVID-19) has led to major lifestyle changes in people living in the affected countries. Namely, most countries declared the state of emergency which included the implementation of different precautionary measures, such as restriction of movement, travel ban, isolation, social distancing and wearing protective equipment. The global fight with the unknown virus generated an abundance of different, often contradictory and inconsistent information. These new changes can have a potentially major impact on the physical and mental health of both children and adults. Children are a particularly vulnerable population in crisis situations. Although research shows that children and young people exhibit clinically significantly milder forms of COVID-19 compared to adults, their vulnerability is reflected in a greater susceptibility to develop serious psychological consequences. Mental problems of children most often develop due to the inability to adequately understand the new situation, fear, separation from peers, changes in the mental state of parents and greater susceptibility to abuse and neglect. Also, systematic changes in the country (closure of educational institutions, reduced workload or closure of health institutions or institutions of support and assistance to children and vulnerable individuals) contribute to the difficulty of overcoming the pandemic. These changes especially affect children with pre-existing mental disorders, neurodevelopmental difficulties, and children from vulnerable and minority groups who require more care and services from different support systems. In order to avoid harmful consequences for the health of children, we will present recommendations focused on children and parents, which are intended for the easier overcoming of crisis situations such as the current pandemic.

Purpose: The current study aimed to investigate proof-of-concept efficacy of an individualized, robotmediated training regime for people with MS (pwMS) and stroke patients. Method: Thirteen pwMS and 14 chronic stroke patients performed 36 (stroke) or 40 (pwMS) training sessions with the I-TRAVLE system. Evaluation of upper limb function was performed at baseline, after training and at 3 months follow-up. Clinical outcome measures consisted of active range of motion (ROM), Motricity Index, Jamar handgrip strength, perceived fatigue and strength, Wolf Motor Function Test (WFMT) and ABILHAND. Robot-generated outcome measures consisted of movement velocity, ROM and actual covered distance compared to straight-line distance. Results: In pwMS, significant improvements were found after training in active shoulder ROM, handgrip strength, perceived strength and WMFT activities. No significant change in clinical outcome was found in stroke patients, except for perceived strength. Significant improvement in speed and movement duration was found after training in both groups. At follow-up, clinical outcome deteriorated in pwMS and was maintained in stroke patients. Conclusions: Robot-mediated training resulted in improved movement coordination in both groups, as well as clinical improvement in pwMS. Absence of functional improvements in stroke patients may relate to severe upper limb dysfunction at baseline. The authors would like to thank the Rehabilitation Centre Blixembosch for their cooperation regarding the development of the I-TRAVLE system (2009–2012), master students Wouter Dielkens and Sander Geurts for their help with the training and data collection and Prof. Dr. Bert Op‘t Einde for project management (2008–12). This research project is supported by Interreg (INTERREG IVA-VLANED-1.58: “I-TRAVLE” project).

BackgroundExposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs).MethodsData were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms.ResultsThe most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria.ConclusionsNearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

Objectives Objective of this study is to develop an evidence-based guideline for the noninvasive management of soft tissue disorders of the shoulder (shoulder pain), excluding major pathology. Methods This guideline is based on high-quality evidence from seven systematic reviews. Multidisciplinary experts considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience is clinicians; target population is adults with shoulder pain. Results When managing patients with shoulder pain, clinicians should (a) rule out major structural or other pathologies as the cause of shoulder pain and reassure patients about the benign and self-limited nature of most soft tissue shoulder pain; (b) develop a care plan in partnership with the patient; (c) for shoulder pain of any duration, consider low-level laser therapy; multimodal care (heat/cold, joint mobilization, and range of motion exercise); cervicothoracic spine manipulation and mobilization for shoulder pain when associated pain or restricted movement of the cervicothoracic spine; or thoracic spine manipulation; (d) for shoulder pain >3-month duration, consider stretching and/or strengthening exercises; laser acupuncture; or general physician care (information, advice, and pharmacological pain management if necessary); (e) for shoulder pain with calcific tendinitis on imaging, consider shock-wave therapy; (f) for shoulder pain of any duration, do not offer ultrasound; taping; interferential current therapy; diacutaneous fibrolysis; soft tissue massage; or cervicothoracic spine manipulation and mobilization as an adjunct to exercise (i.e., range of motion, strengthening and stretching exercise) for pain between the neck and the elbow at rest or during movement of the arm; (g) for shoulder pain >3-month duration, do not offer shock-wave therapy; and (h) should reassess the patient's status at each visit for worsening of symptoms or new physical, mental, or psychological symptoms, or satisfactory recovery. Conclusions Our evidence-based guideline provides recommendations for non-invasive management of shoulder pain. The impact of the guideline in clinical practice requires further evaluation. Significance Shoulder pain of any duration can be effectively treated with laser therapy, multimodal care (i.e., heat/cold, joint mobilization, range of motion exercise), or cervicothoracic manipulation and mobilization. Shoulder pain (>3 months) can be effectively treated with exercises, laser acupuncture, or general physician care (information, advice, and pharmacological pain management if necessary).

Objectives: To develop an evidence-based guideline for the non-pharmacological management of persistent headaches associated with neck pain (i.e., tension-type or cervicogenic). Methods: This guideline is based on systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost-effectiveness, societal and ethical values, and patient experiences when formulating recommendations. Target audience includes clinicians; target population is adults with persistent headaches associated with neck pain. Results: When managing patients with headaches associated with neck pain, clinicians should (a) rule out major structural or other pathologies, or migraine as the cause of headaches; (b) classify headaches associated with neck pain as tension-type headache or cervicogenic headache once other sources of headache pathology has been ruled out; (c) provide care in partnership with the patient and involve the patient in care planning and decision making; (d) provide care in addition to structured patient education; (e) consider low-load endurance craniocervical and cervicoscapular exercises for tension-type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; (f) consider general exercise, multimodal care (spinal mobilization, craniocervical exercise and postural correction) or clinical massage for chronic tension-type headaches; (g) do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension-type headaches; (h) consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization and exercises; and (i) reassess the patient at every visit to assess outcomes and determine whether a referral is indicated. Conclusions: Our evidence-based guideline provides recommendations for the conservative management of persistent headaches associated with neck pain. The impact of the guideline in clinical practice requires validation. Significance: Neck pain and headaches are very common comorbidities in the population. Tension-type and cervicogenic headaches can be treated effectively with specific exercises. Manual therapy can be considered as an adjunct therapy to exercise to treat patients with cervicogenic headaches. The management of tension-type and cervicogenic headaches should be patient-centred.

Coordination is the ability to control movements of the whole body or parts of the body in space. It is reflected in the fast and precise execution of complex motor tasks, i.e. rapid resolution of motor problems. It plays an important role in most sports. For performance in karate, in addition to explosive power and speed, motor skills are the most important. On the other hand, a sensitive period for the development of coordination is the period from 6 to 16 years. A KTK test (Korperkoordinationtest fur Kinder), which consists of four motor tests for children aged 5-14 years, can be used to assess co-ordination and the obtained results are converted into motor coefficient (MK). Based on MK, the motor skills of children or their coordination can be categorized as: high level of coordination, good level of coordination, average level of coordination, moderately damaged and severely damaged level of coordination. The KTK can also be applied to young karatists primarily for determining the level of coordination development and not for selection, which is not recommended at this age.

The puberty period in pigs depends on the functional activity of the endocrine system, which has an effect on the blood through the connective tissue. It has been established that steroid and thyroid hormones regulate the processes of metabolism and proliferation, differentiation and apoptosis of cells. The aim of the research was to establish the peculiarities of formation of the morphological composition of blood under the influence of steroid and thyroid hormones in the process of puberty in different directions of productivity in the pigs. Experiments were performed on two groups of clinically healthy pigs of Pietrain breed and Large White breed. To assess the hormonal and morphological blood was taken from pigs from the anterior hollow vein in the 4-, 5-.6-, 7-month-old age (when their live weight reaches 100 kg). The predominance of hemoglobin content and the amount of erythrocytes in the blood of piglets of Pietrain breed over a Large White breed on the 120–150th day of development (P < 0.05) was observed, against the background of the general decrease in leukocytes in pigs of both breeds at the age of 5 months with the next gradual increase. The age-related changes in the leukocyte formula were directly related to the direction of animal productivity. In the Large White breed, from the beginning of the experiment, there was an increase in the number of rodenuclear neutrophils to 210-day-olds, followed by a sharp decreasing on 36.4%. In Pietrain breed, the level of the rodenuclear neutrophils decreased on 28.6% (P < 0.01) at the age of 5 months, followed by a sharp increasing over the coming months. From the 5th to the 7th months of the development of animals, the concentration of estradiol decreased in the first genotype 2 times (P < 0.05); in the second genotype – 1.9 times (P < 0.01). The content of thyroxine and triiodothyronine increased in the blood serum in Pietrain breed pigs (P < 0.01) and Large White breed (P < 0.001) in the period from 120th to 180th day of development. It was found that the amount of progesterone in Large White breed was higher relatively to Pietrain breed in all investigated periods. The content of estradiol in pigs of both breeds from the 120th and the 150th day of development tended to decrease – by 2.8 times (P < 0.001) in Large White breed, 1.4 times (P < 0.05) in Pietrain breed, and testosterone increases, respectively, 2.1 (P < 0.05) and 1.9 (P < 0.05) times. The significant influence of progesterone on the number of lymphocytes and common leukocytes in Pietrain breed pigs was established. The level of estradiol significantly influenced the number of granulocytes in Pietrain breed pigs at the age of 5 months (r = 0.92 ... 0.99), and in animals of Large White breed the maximum correlation level was observed at the achievement of the 150th (r = 0.61) and 180 days of development (r = 0.94).

Background: Various field tests can be used to evaluate children's motor skills. Because of the complexity of their motor skills, which at their age are still in a very intensive stage of development, it is inadequate to use the same test protocol as in the adult population, as children receive and process information in a different way. Some evidence showed that familiarization with test protocols is important in children's motor skills evaluation process. Objective: The purpose of this study was to examine the influence of familiarization on motor test results for the assessment of motor skills in preschool children population. A controlled research study design was conducted. Methods: The sample included 40 children, 20 boys and 20 girls (age 5.89 ± 0.42 years). Subjects underwent two testing sessions with two weeks between the trials, performed 6 motor skills: leg power, flexibility, abdominal muscles endurance, shoulder muscles endurance, agility, and running speed. Before the second testing session, subjects underwent a period of familiarization with motor tasks in 3 sessions, with 3 trials every 3 days. Results: Significantly better results in the second testing session were observed in countermovement jump (with both fixed and free arms), curl-ups, speed and agility test. The present study indicates that children significantly improved the results in the motor test of explosive strength, muscle endurance, speed and agility, being influenced by familiarization. Conclusions: The results of this study indicate that familiarization with the test procedures prior to testing affect the results of the motor test, and represent an important part of the evaluation of motor skills of preschool children.

Background A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. Objectives We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. Global summit The Global Summit took place on September 14–15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. Systematic review of the literature We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. Results We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. Conclusion Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.

Background: Pfeifer-Weber-Christian disease (PWCD) is one of many rare diseases that may be easily missed if there is not a high degree of suspicion. Angiolipomas are rare, benign subcutaneous tumors, composed of adipose tissue and blood vessels and often containing fibrin thrombi. The majority of angiolipomas occur sporadically; however, there is a minority of cases that have been associated with long-term corticosteroid use. Case presentation: We report here an unusual case of PWCD associated with benign multiple subcutaneous noninfiltrative angiolipomas confirmed by skin biopsy. Systemic corticosteroid therapy was not effective at reducing flares of panniculitis, and during this therapy angiolipomas gradually increased in size. In contrast, administration of oral Cyclosporine A (CyA) led to a rapid remission of the PWCD. Conclusions: As PWCD has no known aetiology and no specific treatment has been established, the successful therapy with the CyA supports the hypothesis that PWCD is a T cell mediated autoinflammatory condition. Also, this case represent very rare side effects of corticosteroid therapy, such as induction of de novo angiolipomas or increased growth of existing tumours. This case bring diagnostic difficulties in everyday clinical practice, especially in patients with panniculitides, but histopathological evaluation usually resolves the dilemma.

The early detection and continuous monitoring of children&rsquo, s motor competence levels and physical fitness is very important. The purpose of this study was to determine the differences in motor coordination of children enrolled in soccer and multisport activities. The participants of this study included 147 boys and girls (mean age 7.60 &plusmn, 0.85 years). The total sample of subjects was composed of two subgroups: children who were enrolled in organized exercise programs&mdash, multisports (n = 77), and children who were engaged in soccer training (n = 70). Motor coordination was evaluated with the Kiphard&ndash, Schilling body coordination test (KTK). Physical fitness was assessed with a 20 m shuttle run test, 4 &times, 10 m shuttle run test, standing long jump, and handgrip strength. The ANCOVA showed significant differences (p &lt, 0.05) with large effect size between groups for tests hopping for height (d = 0.93), total motor quotient (d = 1.31), jumping sideways (d = 1.32), and moving sideways (d = 1.59), after adjusting for age and gender. There were no significant differences between groups in the physical fitness tests. It can be concluded that children enrolled in multisport activities have higher levels of motor coordination than children who are enrolled only in soccer. Therefore, multiple sport training programs should be considered and encouraged by parents, educators, and other training professionals.

In Vivo Gamma-Aminobutyric Acid Increase as a Biomarker of the Epileptogenic Zone: An Unbiased Metabolomics Approach Hamelin S, Stupar V, Maziere L, et al. Epilepsia. 2021;62(1):163-175.Objective:Following surgery, focal seizures relapse in 20% to 50% of cases due to the difficulty of delimiting the epileptogenic zone (EZ) by current imaging or electrophysiological techniques. Here, we evaluate an unbiased metabolomics approach based on ex vivo and in vivo nuclear magnetic resonance spectroscopy (MRS) methods to discriminate the EZ in a mouse model of mesiotemporal lobe epilepsy (MTLE).Methods:Four weeks after unilateral injection of kainic acid (KA) into the dorsal hippocampus of mice (KA-MTLE model), we analyzed hippocampal and cortical samples with high-resolution magic angle spinning (HRMAS) MRS. Using advanced multivariate statistics, we identified the metabolites that best discriminate the injected dorsal hippocampus (EZ) and developed an in vivo MEGAPRESS MRS method to focus on the detection of these metabolites in the same mouse model.Results:Multivariate analysis of HRMAS data provided evidence that γ-aminobutyric acid (GABA) is largely increased in the EZ of KA-MTLE mice and is the metabolite that best discriminates the EZ when compared with sham and, more importantly, when compared with adjacent brain regions. These results were confirmed by capillary electrophoresis analysis and were not reversed by a chronic exposition to an antiepileptic drug (carbamazepine). Then, using in vivo noninvasive GABA-edited MRS, we confirmed that a high GABA increase is specific to the injected hippocampus of KA-MTLE mice.Significance:Our strategy using ex vivo MRS-based untargeted metabolomics to select the most discriminant metabolite(s), followed by in vivo MRS-based targeted metabolomics, is an unbiased approach to accurately define the EZ in a mouse model of focal epilepsy. Results suggest that GABA is a specific biomarker of the EZ in MTLE.

International audience; The physiological mechanism induced by the isocitrate dehydrogenase 1 (IDH1) mutation, associated with better treatment response in gliomas, remains unknown. The aim of this preclinical study was to characterize the IDH1 mutation through in vivo multiparametric MRI and MRS. Multiparametric MRI, including the measurement of blood flow, vascularity, oxygenation, permeability, and in vivo MRS, was performed on a 4.7 T animal MRI system in rat brains grafted with human‐derived glioblastoma U87 cell lines expressing or not the IDH1 mutation by the CRISPR/Cas9 method, and secondarily characterized with additional ex vivo HR‐MAS and histological analyses. In univariate analyses, compared with IDH1−, IDH1+ tumors exhibited higher vascular density (p

Objective To evaluate fenebrutinib, an oral and highly selective noncovalent inhibitor of Bruton's tyrosine kinase (BTK), in patients with active rheumatoid arthritis (RA). Methods Patients with RA and an inadequate response to methotrexate (MTX) (cohort 1; n = 480) were randomized to receive fenebrutinib (50 mg once daily, 150 mg once daily, or 200 mg twice daily), adalimumab (40 mg every other week), or placebo. Patients with RA and an inadequate response to tumor necrosis factor inhibitors (cohort 2; n = 98) received fenebrutinib (200 mg twice daily) or placebo. Both cohorts continued MTX therapy. Results In cohort 1, the percentages of patients in whom American College of Rheumatology 50% improvement criteria (ACR50) was achieved at week 12 were similar in the fenebrutinib 50 mg once daily and placebo groups, and were higher in the fenebrutinib 150 mg once daily group (28%) and 200 mg twice daily group (35%) than in the placebo group (15%) (P = 0.016 and P = 0.0003, respectively). Fenebrutinib 200 mg twice daily and adalimumab (36%) were comparable (P = 0.81). In cohort 2, ACR50 was achieved in more patients receiving fenebrutinib 200 mg twice daily (25%) than placebo (12%) (P = 0.072). The most common adverse events in the fenebrutinib groups included nausea, headache, anemia, and upper respiratory tract infections. Fenebrutinib had significant effects on myeloid and B cell biomarkers (CCL4 and rheumatoid factor). Fenebrutinib and adalimumab caused overlapping as well as distinct changes in B cell and myeloid biomarkers. Conclusion Fenebrutinib demonstrates efficacy comparable to adalimumab in patients with an inadequate response to MTX, and safety consistent with existing immunomodulatory therapies for RA. These data support targeting both B and myeloid cells via this novel mechanism for potential efficacy in the treatment of RA.

The study aims to analyze the effects of induction treatment with cyclophosphamide (CYC) pulse therapy followed by maintenance treatment with other mild immunosuppressive agents on lung function in scleroderma (SSc) patients. Thirty patients with SSc (mean age 52 years, mean disease duration

OBJECTIVE Cross-cultural validation of the Serbian version of the Modified Falls Efficacy Scale (MFES). METHODS This cross-sectional study involved 257 women aged 65 years and above who were referred for dual-energy x-ray absorptiometry examination at the Railway Healthcare Institute in Belgrade, Serbia, between January and April 2016. Data collection comprised of a sociodemographic questionnaire and Geriatric Depression Scale-Short Form (GDS-SF) questionnaire, and data related to fractures, level of physical activity, use of medications that can increase the risk of falls, and frequency of falls in the past 12 months. None of the study participants had been previously treated for osteoporosis. The internal consistency of the questionnaire items was assessed via Cronbach's alpha, whereas the interclass correlation coefficient (ICC) was used to calculate test-retest reliability based on the sample of 257 women. We also evaluated concurrent, convergent, and construct validity. RESULTS Cronbach's alpha for the total assay score was 0.98. Correlations among the items ranged from 0.84 to 0.93. While ICC for the scale as a whole was 0.99 (95% confidence interval 0.98-0.99), ICC pertaining to individual items ranged from 0.82 to 0.99. Concurrent validity analysis revealed a significant positive correlation between MFES scores and the reported level of physical activity (ρ = 0.34; P

Objective The purpose of this study was to establish consensus on a radiographic definition for cervical instability for routine use in chiropractic patients who sustain trauma to the cervical spine. Method We conducted a modified Delphi study with a panel of chiropractic radiologists. Panelists were asked to rate potential screening criteria for traumatic cervical spine instability when assessing cervical spine radiographs. Items rated as important for inclusion by at least 60% of participants in round 1 were submitted for a second round of voting in round 2. Items rated for inclusion by at least 75% of the participants in round 2 were used to create the consensus-based list of screening criteria. Participants were asked to vote and reach agreement on the final screening criteria list in round 3. Results Twenty-nine chiropractic radiologists participated in round 1. After 3 rounds of survey, 85% of participants approved the final consensus-based list of criteria for traumatic cervical spine instability screening, including 6 clinical signs and symptoms and 5 radiographic criteria. Participants agreed that the presence of 1 or more of these clinical signs and symptoms and/or 1 or more of the 5 radiographic criteria on routine static radiographic studies suggests cervical instability. Conclusion The consensus-based radiographic definition of traumatic cervical spine instability includes 6 clinical signs and symptoms and 5 radiographic criteria that doctors of chiropractic should apply to their patients who sustain trauma to the cervical spine.

Objective: To investigate the association of high baseline serum levels of metalloproteinases-3 (MMP-3) with structural damage to hand and feet joints, assessed by ultrasonography (US), in patients with early, treatment-naïve rheumatoid arthritis (RA), without initial X-ray-visible erosions, during 24 months follow-up. Methods: Sixty-three early RA (European League Against Rheumatism/American College of Rheumatology 2010), disease-modifying anti-rheumatic drugs/glucocorticoid naïve patients (mean age 53.4 ± 14.1) with symptom duration ≤12 months, had baseline serum levels of MMP-3 tested. OMERACT US group definition was used to detect the presence, as well as longitudinal diameter of erosions by US at study entry and after 24 months, at the level of wrists, metacarpophalangeal (MCP2/MCP5) joints of both hands, and fifth metatarsophalangeal joints. Results: Complete data were collected from 52 out of 63 patients. High baseline serum levels of MMP-3 (MMP-3-positive) were found in 46/63 patients. 122 bone erosions in total (1.9 bone erosions/patients) were detected by US at baseline visit and 213 erosions (4.3/patients) after 24 months. MMP-3 positive patients had significantly higher total number of erosions than MMP-3-negative (p = 0.039) and higher increase in size of bone erosions in the feet but not in the hand joints after follow-up (OR 4.82 [1.23–18.9], p = 0.024; OR 1.17 [0.320–4.26], p = 0.816 respectively). Conclusion: After 2 years of follow-up, US assessment showed a higher number of new bone erosions in MMP-3-positive compared to MMP-3-negative patients with early RA and no visible initial radiographic changes. High baseline levels of MMP-3 predict significantly higher structural damage progression at the level of feet, but not at the level of hand joints.

It is assumed that during the MSLT test, the sleep laboratory environment will be appropriately resourced to facilitate sleep. However, anecdotal evidence suggests that a variety of factors may actually hinder sleep onset, although this possibility has not been formally investigated in the literature. Thirty-four MSLT participants, who attended the sleep unit between 2018 and 2019, completed a questionnaire that was designed to test perception of sleep onset latency by asking them how easy/difficult it was for them to fall asleep on 17 items that came from four categories. The four categories were the 1. sleep unit environment, e.g. noise/ room temperature; 2. the MSLT procedure, e.g. wires/fixed nap times; 3. the MSLT staff e.g. manner/ clarity of explanations and 4. pain/distress unrelated to the test. All items were rated on a five-point Likert scale. Space was provided for written comments for each category. Overall, the relationship with staff had the greatest impact on perceived sleep onset latency. Forty-one percent of participants reported that the provision of a thorough explanation of the day’s procedure helped them fall asleep in naps. Thirty-five percent reported that their own pain and discomfort affected their ability to sleep. Light and noise had little impact. This research indicates that the staff-patient relationship plays a significant role in patient’s experience of the MSLT and may potentially affect test outcomes.

Background Obstructive sleep apnoea (OSA) is common, and its prevalence is increasing. Opportunities to screen for OSA using simplified diagnostic devices may be important to addressing this clinical burden. The NightOwl (Ectosense NV, Leuven, Belgium) is a small dual channel device that acquires data from a single fingertip and is available in a disposable version, in addition to the previously validated reusable option. The devices will provide a measure of sleep duration and derived apnoea-hypopnoea index (AHI) using a proprietary algorithm. Methods A prospective cohort study of patients undergoing laboratory polysomnography (PSG) for suspected OSA is underway at Monash Medical Centre, Clayton (ACTRN12621000444886). Participants are fitted with a NightOwl Sensor Mini (disposable) and a NightOwl Sensor Reusable on their index and middle fingers, in addition to the standard PSG setup (Compumedics Grael, Profusion 3). The primary outcome is the level of agreement between the NightOwl Sensor Mini, NightOwl Sensor Reusable and PSG derived AHI. We also intend to compare the proprietary algorithm against Compumedics Profusion 3 for determination of oxygen desaturation index. Level of agreement will be determined utilising Bland-Altman plots. Progress to date Recruitment is currently underway with 29 of an intended 100 participants having completed their sleep studies. Intended outcome and impact The intended outcome of this study is to externally validate the two NightOwl devices against PSG for detecting OSA and accurately assessing severity. We anticipate this will enable screening for OSA in an efficient and cost-effective manner.

Background/Aim. Osteoporosis mainly affects women in the early years following menopause. The aim of this study was to determine the level of knowledge about osteoporosis and osteoporosis related risk factors in postmenopausal women in Serbia. Methods. The study included postmenopausal women regardless if suffering from osteoporosis or not. Assessment of knowledge was carried out by using the Osteoporosis Knowledge Assessment Tool - Shorter Version (OKAT-S) questionnaire that was validated for Serbian population. Answers to the 9 questions were coded as 1 - true, or 0 - false or 'do not know'. Also, the following risk factors data for osteoporosis were collected: age, the onset and duration of menopause, body mass index (BMI), data on fractures, the incidence of falls, smoking, lifestyle (active, sedentary), regular sunbathing, calcium and vitamin D supplementation, intake of milk and dairy products. Results. A total of 132 postmenopausal women responded to the questionnaire with the response rate of 90.41%. Their knowledge varied from 27.94% to 74.26% of the correct answers, with the average OKAT-S score of 4.5 (SD = 2.55), which was 50% of the maximum possible score. Only 2 participants (1.47%) filled the all OKAT-S items correctly, while 11 (8.09%) of them did not have the proper answer to any question. A reduced bone density (T-score below -1) was registered in 40.91% of the women, previous fractures in 49 (34.51%), and more or less 3 falls registered in 9.59% or 4.79%, respectively. Conclusion. The Serbian version of the questionnaire OKAT-S revealed generally poor knowledge on osteoporosis among postmenopausal women in Serbia. Developing effective interventions and public health programms could be helpful in general education towards understanding osteoporosis and risk factors. Promotion of preventive measures and healthy behaviour may prevent or at least slow down the accelerated bone loss in postmenopausal women. Uvod/Cilj. Osteoporoza uglavnom pogađa žene u ranim godinama posle menopauze. Cilj rada bio je da se proceni znanje o osteoporozi i faktorima rizika kod žena u postmenopauzi u Srbiji. Metode. U studiju su bile uključene žene u postmenopauzi nezavisno od toga da li boluju od osteoporoze ili ne. Procena znanja o osteoporozi vršena je pomoću upitnika Osteoporosis Knowledge Assessment Tool - Shorter Version (OKAT-S) koji je validiran za srpsku populaciju. Odgovori na 9 pitanja kodirani su sa 1 - pravilan ili 0 - nepravilan odgovor ili 'ne znam'. Takođe, sakupljeni su sledeći podaci o faktorima rizika od osteoporoze: starost, početak i dužina trajanja menopauze, indeks telesne mase [body mass index (BMI)], podaci o prelomima, broj padova, pušenje, životni stil (sedeći ili aktivni), redovno sunčanje, dopuna kalcijumom i vitaminom D, korišćenje mleka i mlečnih proizvoda. Rezultati. Od ukupno 146 ispitanica, upitnik OKAT-S popunile su 132 ispitanice (nivo odgovora od 90,41%). Nivo njihovog znanja varirao je od 27,94% do 74,26% ispravnih odgovora, sa prosečnim OKAT-S skorom od 4,5 (SD = 2,55), što čini 50% od maksimalno mogućeg skora. Samo dve ispitanice (1,47%) pravilno su odgovorile na sva pitanja, dok njih 11 (8,09%) nije imalo nijedan ispravan odgovor. Snižen T-skor, manje od -1, registrovan je kod 40,91% ispitanica, a prethodni prelom kod 49 (34,51%). Kod 9,59% ispitanica registrovano je više od 3, a kod 4,79% manje od 3 pada. Zaključak. Srpska verzija upitnika OKAT-S otkrila je generalno loše znanje o osteoporozi kod žena u postmenopauzi u Srbiji. Poboljšano znanje o osteoporozi i faktorima rizika moguće je postići razvojem efikasnih interventnih i javnih zdravstvenih programa. Promocija preventivnih mera i zdravog ponašanja može sprečiti ili bar usporiti prerani gubitak koštane mase kod žena u postmenopauzi.

OBJECTIVE: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS: We screened 6618 articles; 21 were eligible for critical appraisal and nine (reporting on eight RCTs) had a low risk of bias. All RCTs with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low level laser therapy for persistent lateral epicondylitis. DISCUSSION: Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries. Language: en

Background context Little is known about the effectiveness of multimodal care for individuals with whiplash-associated disorders (WAD) and neck pain and associated disorders (NAD). Purpose To update findings of the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders and evaluate the effectiveness of multimodal care for the management of patients with WAD or NAD. Study design/setting Systematic review and best-evidence synthesis. Patient sample We included randomized controlled trials (RCTs), cohort studies, and case-control studies. Outcome measures Self-rated recovery, functional recovery (eg, disability, return to activities, work, or school), pain intensity, health-related quality of life, psychological outcomes (eg, depression, fear), or adverse events. Methods We systematically searched five electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials) from 2000 to 2013. RCTs, cohort, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized using evidence tables and synthesized following best-evidence synthesis principles. Results We retrieved 2,187 articles, and 23 articles were eligible for critical appraisal. Of those, 18 articles from 14 different RCTs were scientifically admissible. There were a total of 31 treatment arms, including 27 unique multimodal programs of care. Overall, the evidence suggests that multimodal care that includes manual therapy, education, and exercise may benefit patients with grades I and II WAD and NAD. General practitioner care that includes reassurance, advice to stay active, and resumption of regular activities may be an option for the early management of WAD grades I and II. Our synthesis suggests that patients receiving high-intensity health care tend to experience poorer outcomes than those who receive fewer treatments for WAD and NAD. Conclusions Multimodal care can benefit patients with WAD and NAD with early or persistent symptoms. The evidence does not indicate that one multimodal care package is superior to another. Clinicians should avoid high utilization of care for patients with WAD and NAD.

Background Context In 2008, the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). Purpose This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD. Study Design/Setting This is a systematic review and best evidence synthesis. Sample The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention. Outcome Measures The outcome measures were self-rated or functional recovery, pain intensity, health-related quality of life, psychological outcomes, or adverse events. Methods We systematically searched five databases from 2000 to 2014. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a low risk of bias were stratified by the intervention's stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. Funding was provided by the Ministry of Finance. Results We screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias. Evidence from seven exploratory studies suggests that (1) for recent but not persistent NAD grades I–II, thoracic manipulation offers short-term benefits; (2) for persistent NAD grades I–II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and (3) for NAD grades I–II, strain-counterstrain treatment is no better than placebo. Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I–II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I–II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I–II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits. Conclusions Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain.

Background Context In 2008, the lack of published evidence prevented the Bone and Joint Decade 2000–2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force [NPTF]) from commenting on the effectiveness of psychological interventions for the management of neck pain. Purpose This study aimed to update findings of the NPTF and evaluate the effectiveness of psychological interventions for the management of neck pain and associated disorders (NAD) or whiplash-associated disorders (WAD). Study Design/setting This study used systematic review and best-evidence synthesis. Sample Randomized controlled trials, cohort studies, and case-control studies comparing psychological interventions to other non-invasive interventions or no intervention were the samples used in this study. Outcome measures The outcome measures are (1) self-rated recovery; (2) functional recovery; (3) clinical outcomes; (4) administrative outcomes; and (5) adverse effects. Methods We searched six databases from 1990 to 2015. Randomized controlled trials, cohort studies, and case-control studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers used the Scottish Intercollegiate Guidelines Network criteria to critically appraise eligible studies. Studies with a low risk of bias were synthesized following best evidence synthesis principles. This study was funded by the Ontario Ministry of Finance. Results We screened 1,919 articles, 19 were eligible for critical appraisal and 10 were judged to have low risk of bias. We found no clear evidence supporting relaxation training or cognitive behavioral therapy (CBT) for persistent grades I–III NAD for reducing pain intensity or disability. Similarly, we did not find evidence to support the effectiveness of biofeedback or relaxation training for persistent grade II WAD, and there is conflicting evidence for the use of CBT in this population. However, adding a progressive goal attainment program to functional restoration physiotherapy may benefit patients with persistent grades I–III WAD. Furthermore, Jyoti meditation may help reduce neck pain intensity and bothersomeness in patients with persistent NAD. Conclusions We did not find evidence for or against the use of psychological interventions in patients with recent onset NAD or WAD. We found evidence that a progressive goal attainment program may be helpful for the management of persistent WAD and that Jyoti meditation may benefit patients with persistent NAD. The limited evidence of effectiveness for psychological interventions may be due to several factors, such as interventions that are ineffective, poorly conceptualized, or poorly implemented. Further methodologically rigorous research is needed.

Objectives Development and pilot evaluation of a personalized decision support intervention to help men with early‐stage prostate cancer choose among active surveillance, surgery, and radiation. Methods We developed a decision aid featuring long‐term survival and side effects data, based on focus group input and stakeholder endorsement. We trained premedical students to administer the intervention to newly diagnosed men with low‐risk prostate cancer seen at the University of California, San Francisco. Before the intervention, and after the consultation with a urologist, we administered the Decision Quality Instrument for Prostate Cancer (DQI‐PC). We hypothesized increases in two knowledge items from the DQI‐PC: How many men diagnosed with early‐stage prostate cancer will eventually die of prostate cancer? How much would waiting 3 months to make a treatment decision affect chances of survival? Correct answers were: “Most will die of something else” and “A little or not at all.” Results The development phase involved 6 patients, 1 family member, 2 physicians, and 5 other health care providers. In our pilot test, 57 men consented, and 44 received the decision support intervention and completed knowledge surveys at both timepoints. Regarding the two knowledge items of interest, before the intervention, 35/56 (63%) answered both correctly, compared to 36/44 (82%) after the medical consultation (P = .04 by chi‐square test). Conclusions The intervention was associated with increased patient knowledge. Data from this pilot have guided the development of a larger scale randomized clinical trial to improve decision quality in men with prostate cancer being treated in community settings., Men with low‐risk prostate cancer are at risk for making decisions based on misconceptions about treatment options and outcomes. A decision support intervention, delivered by premedical students acting as health coaches, increased patient knowledge of key facts about prognosis.

Objective To investigate the timing of transition through different patterns of nailfold microvascular damage in systemic sclerosis (SSc) patients and to determine the significance of this transition. Methods In the period January 2012 to December 2017, 400 SSc patients were followed up by nailfold videocapillaroscopy (NVC) the same operator (SPD) every 6 months. Demographic, clinical and laboratory data were recorded. The capillaroscopic findings were classsified as normal, nonspecific or scleroderma pattern (“early”, “active”, or “late”).The evolution on the NVC pattern over time was monitored and recorded. Results The transition of microvascular damage through different NVC patterns of microangiopathy was seen in 53/400 (13.25%) SSc patients. At the baseline 11/53 (21%) patients had the non-specific changes, the early pattern had 25/53 (47%) patients, and the active pattern had 17/53 (32%) SSc patients. The mean ± SD time of progression from one to another NVC patterns was 27.68 ± 35.11 months. Improvement of the NVC patterns was found in 15/53 (28%) patients and deterioration in the remaining 38 (72%) patients. The mean time of progression from non-specific to early pattern (in 10 patients) and non-specific to active pattern (in 1 patient) was 14.5 ± 9.73 vs. 12 months, respectively. Time of changed from early to nonspecific (in 7 patients), early to active (in 17 patients) and early to late pattern (in 1 patient) was 30.85 ± 22.56 vs 22.29 ± 16.61 vs 24 months, respectively. Time of changed from active to early (in 8 patients) and active to late pattern (in 9 patients), was 26.25 ± 11.1 vs 18.00 ± 13.97 months, respectively. Progression of non-specific to early or active NVC pattern was related with limited form of SSc (91%), diffuse hand swelling (54%), arthralgia/arthirtis (45%) and involvement of lungs (48%). Also, progression of early to active NVC pattern was related with limited form of SSc (64%), sclerodactyly (48%) and involvement of lungs (48%). In contrast, progression of active to late NVC pattern was related with diffuse form of SSc (53%), digital ulcerations (35%) and more frequent involvement of lungs (65%). These differences in the frequency of involvement of certain organs were not statistically significant. Conclusion These results demonstrate dynamic transition of microvascular damage through different NVC patterns of microangiopathy in about 13% of SSc patients. Patients with rapid progression from the early to active, as well as active to the late NVC patterns ( Disclosure of Interests Slavica Pavlov-Dolijanovic: None declared, Nemanja Damjanov Grant/research support from: AbbVie, Pfizer and Roche, Consultant for: Abbvie, Gedeon Richter, Merck, Novartis, Pfizer and Roche., Speakers bureau: Abbvie, Gedeon Richter, Merck, Novartis, Pfizer and Roche., Nada Vujasinovic Stupar: None declared

ObjectiveTo evaluate the effectiveness of a government-regulated rehabilitation guideline compared with education and activation by general practitioners, and to a preferred-provider insurance-based rehabilitation programme on self-reported global recovery from acute whiplash-associated disorders (WAD) grade I–II.DesignPragmatic randomised clinical trial with blinded outcome assessment.SettingMultidisciplinary rehabilitation clinics and general practitioners in Ontario, Canada.Participants340 participants with acute WAD grade I and II. Potential participants were sampled from a large automobile insurer when reporting a traffic injury.InterventionsParticipants were randomised to receive one of three protocols: government-regulated rehabilitation guideline, education and activation by general practitioners or a preferred-provider insurance-based rehabilitation.Primary and secondary outcome measuresOur primary outcome was time to self-reported global recovery. Secondary outcomes included time on insurance benefits, neck pain intensity, whiplash-related disability, health-related quality of life and depressive symptomatology at 6 weeks and 3, 6, 9 and 12 months postinjury.ResultsThe median time to self-reported global recovery was 59 days (95% CI 55 to 68) for the government-regulated guideline group, 105 days (95% CI 61 to 126) for the preferred-provider group and 108 days (95% CI 93 to 206) for the general practitioner group; the difference was not statistically significant (Χ2=3.96; 2 df: p=0.138). We found no clinically important differences between groups in secondary outcomes. Post hoc analysis suggests that the general practitioner (hazard rate ratio (HRR)=0.51, 95% CI 0.34 to 0.77) and preferred-provider groups (HRR=0.67, 95% CI 0.46 to 0.96) had slower recovery than the government-regulated guideline group during the first 80 days postinjury. No major adverse events were reported.ConclusionsTime-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.Trial registration numberNCT00546806.

Background: The puberty period in pigs depends on the functional activity of the endocrine system, which has an effect on the blood through the connective tissue. It has been established that during puberty period, the steroidal and thyroid hormones regulate the processes of metabolism and proliferation, differentiation and apoptosis of cells. The aim of the research was to find out the effects of the morphological composition of blood under the influence of steroidal and thyroid hormones during the process of puberty in different directions of productivity in the pigs. Methods: Experiments were performed on two groups of clinically healthy piglets from Pietrain and Large White (LW) breed. To assess the steroidal and thyroid hormone levels, the morphological blood was collected from the anterior hollow vein at the puberty ages of 120, 150, 180 and 210 days, when their live weights achieved to 100 kg. Results: The predominance of hemoglobin content and the amount of erythrocytes in the blood were observed higher (p

PURPOSE: To develop an evidence-based guideline for the management of grades I-III neck pain and associated disorders (NAD).METHODS: This guideline is based on recent systematic reviews of high-quality studies. A multidisciplinary expert panel considered the evidence of effectiveness, safety, cost-effectiveness, societal and ethical values, and patient experiences (obtained from qualitative research) when formulating recommendations. Target audience includes clinicians; target population is adults with grades I-III NAD RECOMMENDATION 1: Clinicians should rule out major structural or other pathologies as the cause of NAD. Once major pathology has been ruled out, clinicians should classify NAD as grade I, II, or III.RECOMMENDATION 2: Clinicians should assess prognostic factors for delayed recovery from NAD.RECOMMENDATION 3: Clinicians should educate and reassure patients about the benign and self-limited nature of the typical course of NAD grades I-III and the importance of maintaining activity and movement. Patients with worsening symptoms and those who develop new physical or psychological symptoms should be referred to a physician for further evaluation at any time during their care.RECOMMENDATION 4: For NAD grades I-II ≤3 months duration, clinicians may consider structured patient education in combination with: range of motion exercise, multimodal care (range of motion exercise with manipulation or mobilization), or muscle relaxants. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, strain-counterstrain therapy, relaxation massage, cervical collar, electroacupuncture, electrotherapy, or clinic-based heat.RECOMMENDATION 5: For NAD grades I-II >3 months duration, clinicians may consider structured patient education in combination with: range of motion and strengthening exercises, qigong, yoga, multimodal care (exercise with manipulation or mobilization), clinical massage, low-level laser therapy, or non-steroidal anti-inflammatory drugs. In view of evidence of no effectiveness, clinicians should not offer strengthening exercises alone, strain-counterstrain therapy, relaxation massage, relaxation therapy for pain or disability, electrotherapy, shortwave diathermy, clinic-based heat, electroacupuncture, or botulinum toxin injections.RECOMMENDATION 6: For NAD grade III ≤3 months duration, clinicians may consider supervised strengthening exercises in addition to structured patient education. In view of evidence of no effectiveness, clinicians should not offer structured patient education alone, cervical collar, low-level laser therapy, or traction. RECOMMENDATION 7: For NAD grade III >3 months duration, clinicians should not offer a cervical collar. Patients who continue to experience neurological signs and disability more than 3 months after injury should be referred to a physician for investigation and management. RECOMMENDATION 8: Clinicians should reassess the patient at every visit to determine if additional care is necessary, the condition is worsening, or the patient has recovered. Patients reporting significant recovery should be discharged.

To update findings of the 2000–2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and evaluate the effectiveness of non-invasive and non-pharmacological interventions for the management of patients with headaches associated with neck pain (i.e., tension-type, cervicogenic, or whiplash-related headaches). We searched five databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case–control studies comparing non-invasive interventions with other interventions, placebo/sham, or no interventions. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria to determine scientific admissibility. Studies with a low risk of bias were synthesized following best evidence synthesis principles. We screened 17,236 citations, 15 studies were relevant, and 10 had a low risk of bias. The evidence suggests that episodic tension-type headaches should be managed with low load endurance craniocervical and cervicoscapular exercises. Patients with chronic tension-type headaches may also benefit from low load endurance craniocervical and cervicoscapular exercises; relaxation training with stress coping therapy; or multimodal care that includes spinal mobilization, craniocervical exercises, and postural correction. For cervicogenic headaches, low load endurance craniocervical and cervicoscapular exercises; or manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine may also be helpful. The management of headaches associated with neck pain should include exercise. Patients who suffer from chronic tension-type headaches may also benefit from relaxation training with stress coping therapy or multimodal care. Patients with cervicogenic headache may also benefit from a course of manual therapy.

Background Soft-tissue therapy is commonly used to manage musculoskeletal injuries. Objective To determine the effectiveness of soft-tissue therapy for the management of musculoskeletal disorders and injuries of the upper and lower extremities. Design Systematic Review. Methods We searched six databases from 1990 to 2015 and critically appraised eligible articles using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Evidence from studies with low risk of bias was synthesized using best-evidence synthesis methodology. Results We screened 9869 articles and critically appraised seven; six had low risk of bias. Localized relaxation massage provides added benefits to multimodal care immediately post-intervention for carpal tunnel syndrome. Movement re-education (contraction/passive stretching) provides better long-term benefit than one corticosteroid injection for lateral epicondylitis. Myofascial release improves outcomes compared to sham ultrasound for lateral epicondylitis. Diacutaneous fibrolysis (DF) or sham DF leads to similar outcomes in pain intensity for subacromial impingement syndrome. Trigger point therapy may provide limited or no additional benefit when combined with self-stretching for plantar fasciitis; however, myofascial release to the gastrocnemius, soleus and plantar fascia is effective. Conclusion Our review clarifies the role of soft-tissue therapy for the management of upper and lower extremity musculoskeletal disorders and injuries. Myofascial release therapy was effective for treating lateral epicondylitis and plantar fasciitis. Movement re-education was also effective for managing lateral epicondylitis. Localized relaxation massage combined with multimodal care may provide short-term benefit for treating carpal tunnel syndrome. More high quality research is needed to study the appropriateness and comparative effectiveness of this widely utilized form of treatment.

OBJECTIVE: The purpose of this study was to determine the test-retest reliability and the Minimal Detectable Change (MDC) of the Whiplash Disability Questionnaire (WDQ) in individuals with acute whiplash-associated disorders (WADs).METHODS: We performed a test-retest reliability study. We included insurance claimants from Ontario who were at least 18years of age, within 21days of their motor vehicle collision and diagnosed as having acute WAD grades I to III. The WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability), was administered to all participants at baseline and by telephone 3days later. We computed the intraclass correlation coefficient (model 2,1) and the MDC with 95% confidence intervals (CIs; MDC95).RESULTS: The mean (SD) age of the 66 participants was 41.6 (12.7) years and 71.2% were female. Twenty-nine percent had WAD I and 71.2% had WAD II. Time since injury ranged from 0 to 19 days. The mean (SD) baseline WDQ score was 49.3 (28.8) and 46.5 (29.8) 3days later. The intraclass correlation coefficient for the WDQ total score was 0.89 (95% CI, 0.85-0.92) in the entire sample and 0.83 (95% CI, 0.69-0.93) for the 15 participants reporting no change in neck pain. The MDC95 of the WDQ was 21.4 (SD = 14.9) for participants reporting no change.CONCLUSION: The WDQ was reliable in individuals with acute WAD. There is 95% confidence that a change of approximately one-sixth of the total score is beyond the daily variation of a stable condition. This level of measurement error must be taken into consideration when interpreting change in WDQ scores.

BACKGROUND CONTEXT: Few instruments are available to measure disability associated with whiplash-associated disorders (WAD). The Whiplash Disability Questionnaire (WDQ) was developed to measure disability resulting from WAD, but its validity is unknown for acute WAD.PURPOSE: The aim was to determine the structural and construct validity of the WDQ in individuals with acute WAD.STUDY DESIGN/SETTING: This was a cohort study.PATIENT SAMPLE: Ontario adults with WAD were enrolled within 3 weeks of their motor vehicle collision.OUTCOME MEASURES: The outcome measure was the WDQ.METHODS: We included insurance claimants who were aged 18 years or older and diagnosed with acute WAD Grades I to III. All participants completed the WDQ, a 13-item questionnaire scored from 0 (no disability) to 130 (complete disability). We assessed the factor structure of the WDQ and tested its construct validity against self-perceived recovery, neck pain (Numerical Rating Scale [NRS]), neck disability (Neck Disability Index [NDI] and Neck Bournemouth Questionnaire), health-related quality of life (36-Item Short Form Health Survey [SF-36]), and depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]).RESULTS: The mean age of the 130 participants was 42.1 years (standard deviation [SD]=13.2), and 70% were women. Twenty-six percent had WAD I, 73.1% had WAD II, and 0.8% had WAD III. Mean time since injury was 6.5 days (SD=4.9). The mean WDQ score was 49.8 (SD=29.1). Our analysis suggested that the WDQ includes two factors: daily activities and emotional status. This factor structure remained stable in sensitivity analyses (eg, zeros imputed for missing values, and the item with the most missing values or resulting in complex loading excluded). Strong correlations were found between the total WDQ score and the NDI, the Bournemouth questionnaire, the SF-36 physical function, and the NRS (for the neck, shoulder, mid and low back pain) satisfying a priori hypotheses. We found a priori hypothesized moderate correlations between the WDQ, and the CES-D and SF-36 mental function.CONCLUSIONS: The WDQ includes two factors and has strong construct validity in individuals with acute WAD. Our results demonstrate that the WDQ is valid for use as an overall summative scale or as the daily activities and emotional subscales in clinical and research settings to determine disability status.

Background Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear. Objective Determine the effectiveness of exercise for shoulder pain. Methods We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology. Results We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care. Conclusion The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care. Systematic review registration number CRD42013003928.

Introduction Soft tissue injuries of the leg, ankle, or foot are common and often treated by exercise. The purpose of this study was to determine the effectiveness of exercise for the management of soft tissue injuries of the leg, ankle, or foot. Methods A systematic review of the literature was conducted. We searched five databases from 1990 to 2015. Relevant articles were critically appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria. The evidence from studies with low risk of bias was synthesized using the best-evidence synthesis methodology. Results We screened 7946 articles. We critically appraised ten randomized trials and six had a low risk of bias. The evidence suggests that for recent lateral ankle sprain: 1) rehabilitation exercises initiated immediately post-injury are as effective as a similar program initiated one week post-injury; and 2) supervised progressive exercise plus education/advice and home exercise lead to similar outcomes as education/advice and home exercise. Eccentric exercises may be more effective than an AirHeel brace but less effective than acupuncture for Achilles tendinopathy of more than two months duration. Finally, for plantar heel pain, static stretching of the calf muscles and sham ultrasound lead to similar outcomes, while static plantar fascia stretching provides short-term benefits compared to shockwave therapy. Conclusions We found little evidence to support the use of early or supervised exercise interventions for lateral ankle sprains. Eccentric exercises may provide short-term benefits over a brace for persistent Achilles tendinopathy and plantar fascia stretching provides short-term benefits for plantar heel pain.

Background:Many treatments have been tried in therapy systemic sclerosis (SSc) patients but use of hyperbaric oxygen therapy (HBOT) is very limited.Objectives:To assess the effects of HBOT to quality of life and state of microcirculation in SSc patients.Methods:18 female patients aged 29-68 years (mean 57 years) with limited SSc and digital or leg ulcers were included in this work. The HBOT protocol comprised 20 sessions 5 day/weekly, 60 min, 100% oxygen at 2.2 ATA. The treated patients were evaluated at baseline and after 20 HBOT sessions. Evaluation consisted of physical examination, capillaroscopy, pulmonary function tests, biochemical analyses, socio-demographic and clinimetric questionnaires: Systemic Sclerosis Questionnaire (SySQ) and Health Assessment Disaability index Questionnaire (HAQ-DI).Results:Mean value [before: after, mean (range)] for SySQ [15.5 (4-48) vs 9.0 (3-31)], HAQ-DI [0.60 (0-2.88) vs 0.35 (0 -1.75)], erythrocyte sedimentation rate [21 (4-42) vs 12 (3-27)], forced vital capacity (96.61±14.44% vs 115.94±16.69%), diffusing lung capacity of carbon monoxide (73.61±6.63% vs 87.33±9.30%) significantly improved after HBOT sessions (pConclusion:Our data confirm the efficacy of HBOT in treating SSc patients. Further studies are required to evaluate the protocol and to understand the durattion of the clinical effect.References:[1]Mirasoglu B, Bagli BS, Aktas S. Hyperbaric oxygen therapy for chronic ulcers in systemic sclerosis - case series. Int J Dermatol. 2017;56(6):636-640.[2]Gerodimos C, Stefanidou S, Kotsiou M, et al. Hyperbaric oxygen treatment of intractable ulcers in a systemic sclerosis patient.Aristotle Un Med J. 2013;(40)3:19-22.[3]Wallace DJ, Silverman S, Goldstein J, Hughes D. Use of hyperbaric oxygen in rheumatic diseases: case report and critical analysis. Lupus. 1995;4(3):172-5.Disclosure of Interests:Slavica Pavlov-Dolijanovic: None declared, Vesna Koletic: None declared, Nada Vujasinovic Stupar: None declared, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche

This is the peer-reviewed version of the article: Pejovic Milovancevic, M.; Kesic, A.; Grujicic, R.; Stojkovic, A.; Zivotic, S.; Stupar, D.; Borovnica, V.; Radosavljev-Kircanski, J.; Manojlovic, I.; Stojiljkovic, D. J. Inpatient Care in Serbia: Trends in Hospitalization and Diagnostics over Time. Eur Child Adolesc Psychiatry 2018, 27 (12), 1645–1651. [https://doi.org/10.1007/s00787-018-1191-3]

Background The aim of this study was to assess possible relationship between the altered blood perfusion at hands analysed by 99mTc-pertechnetate hand perfusion scintigraphy (99mTcPHPS) and, morphological microvascular abnormalities detected by nailfold capillaroscopy (NC) in SSc patients. Methods The study group consisted of 25 patients with SSc (14 with diffuse SSc, and 11 with limited SSc) and 28 control subjects (18 patients with primary RP, and10 healthy individuals). NC and 99mTcPHPS was performed in all the groups examined. The capillaroscopic pattern was classsified as normal or scleroderma (”early”, ”active”, or ”late”) pattern. Gamma-camera dynamic first-pass study during the first 60 s and a static scintigraphy after 5 min were recorded following a bolus injection of 99m Tc-pertechnetate via a cubital vein. Regions of interest were drawn on the summed images around the fingers and the palmar region. The fingers-to-palm ratios were then calculated. Results SSc patients showed a significantly lower blood flow (BF) and blood pool (BP), (0.43±0.21 vs 0.36±0.07, respectively), than PRP patients (0.45±0.18 vs 0.42±0.06, respectively) and healthy subjects (0.58±0.19 vs 0.44±0.06, respectively), (p-value 0.039 vs 0.004, respectively). A gradual decrease of BF and BP was found in SSc patients with progressive severity of NVC patterns of microangiopathy [”early” (0.49±0.03 vs 0.39±0.04, respectively), ”active” (0.43±0.11 vs 0.38±0.06, respectively) or ”late” (0.40±0.28 vs 0.36±0.08, respectively), (p- value 0.462 vs 0.728 respectively], but these differences were not statistically significant. Patients with diffuse SSc showed lower BF, and higher BP (0.42±0.26 vs 0.37±0.07, respectively) than those with limited SSc, (0.44±0.14 vs 0.35±0.064, respectively), but this differences is not statistical significantly (p=0.76 vs p=0.53, respectively). There was no significant correlation between BF and BP values and type of SSc (limited or diffuse) (r=−0.06, p=0.77; r=0.13, p=0.54, respectively) as well as three microangiopathy patterns (r=−0.253, p=0.22; r=– 0.13, p=0.54, respectively). Conclusions NC represents the best method to analyse microvascular damage in rheumatic diseases, especially SSc. 99m TcPHPS improves the evaluation of vascular damage in SSc patients. There is no direct relationship between these two methods, but one method complements another in the study of vascular damage in SSc patients. Disclosure of Interest None declared

Background The mechanisms by which hypertonic sodium lactate (HSL) solution act in injured brain are unclear. We investigated the effects of HSL on brain metabolism, oxygenation, and perfusion in a rodent model of diffuse traumatic brain injury (TBI). Methods Thirty minutes after trauma, anaesthetised adult rats were randomly assigned to receive a 3 h infusion of either a saline solution (TBI–saline group) or HSL (TBI–HSL group). The sham–saline and sham–HSL groups received no insult. Three series of experiments were conducted up to 4 h after TBI (or equivalent) to investigate: 1) brain oedema using diffusion-weighted magnetic resonance imaging and brain metabolism using localized 1 H-magnetic resonance spectroscopy ( n = 10 rats per group). The respiratory control ratio was then determined using oxygraphic analysis of extracted mitochondria, 2) brain oxygenation and perfusion using quantitative blood-oxygenation-level-dependent magnetic resonance approach ( n = 10 rats per group), and 3) mitochondrial ultrastructural changes ( n = 1 rat per group). Results Compared with the TBI–saline group, the TBI–HSL and the sham-operated groups had reduced brain oedema. Concomitantly, the TBI–HSL group had lower intracellular lactate/creatine ratio [0.049 (0.047–0.098) vs 0.097 (0.079–0.157); P vs 66% (55–73); P vs 38.4 (31.0–47.5) nm; P Conclusions These findings indicate that the hypertonic sodium lactate solution can reverse brain oxygenation and metabolism dysfunction after traumatic brain injury through vasodilatory, mitochondrial, and anti-oedema effects.

Objective To compare patient-reported outcomes (PROs) of surgical correction of Peyronie's disease (PD) with the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant after surgical correction of penile curvature. Patients and Methods We performed a retrospective review of men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Treatment-related PROs and satisfaction were evaluated with a non-validated questionnaire. Results The response rate to the questionnaire was 70.9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 patients, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD preoperatively (range 2.1–3.2 cm). Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range 0.4–1.2 cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by the loss of length. Conclusions Penile length loss due to PD affects most patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.