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Tumour to tumour metastases are uncommon, and we report a case of carotid body paraganglioma metastatic to a hepatocellular adenoma. A 54-year-old man presented after a CT chest for chronic cough that incidentally identified two liver lesions in segment 3 and caudate. The imaging findings were suspicious for atypical haemangiomas versus hepatocellular adenoma. The segment 3 lesion was biopsied, demonstrating beta-catenin activated hepatocellular adenoma. He underwent partial hepatectomy with pathology showing the beta-catenin activated hepatocellular adenoma contained a central area of paraganglioma. On closer review, the patient revealed a carotid body paraganglioma with lymph node metastases requiring resection 24 years earlier. He subsequently underwent left hepatectomy including the resection bed and caudate, which confirmed the caudate lesion as metastatic paraganglioma. This case demonstrates how paraganglioma can metastasise to liver decades after initial resection and provide insight into the diagnostic workup for hepatocellular adenoma with neuroendocrine features.

Refereed/Peer-reviewed Seborrheic dermatitis (SD) is a common dermatological disorder with symptoms that include skin flaking, erythema and pruritus. This review discusses the topical products available for treating SD, which target several aspects of disease pathobiology, including cutaneous microbial dysbiosis (driven by Malassezia yeast), inflammation, sebum production and skin barrier disruption. Among the various treatments available, zinc pyrithione (ZnPT) based products that exhibit anti-fungal action are the market leaders. A skin compartment approach is presented here for combining ZnPT exposure information with threshold levels for anti-fungal efficacy and toxicity, overall providing a comprehensive picture of ZnPT therapeutics and safety. While Malassezia yeast on the surface are effectively targeted, yeast residing beyond the superficial follicle may not receive adequate ZnPT for anti-fungal effect forming the basis for skin re-colonisation. Levels entering systemic circulation from topical delivery are well below toxic thresholds, however the elevated zinc levels within the viable epidermis warrants further investigation. Strategies to improve formulation design can be broadly classified as influencing 1) topical delivery, 2) therapeutic bioactivity, 3) skin mildness, and 4) sensory attributes. Successful SD treatment ultimately requires formulations that can balance efficacy, safety, and consumer appeal.

AimsRevision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised.MethodsThis retrospective, observational study reviewed patients who underwent unilateral, aseptic rTKA at an academic orthopaedic speciality hospital between June 2011 and April 2020 with > one-year of follow-up. Patients were dichotomized based on whether this was their first revision procedure or not. Patient demographics, surgical factors, postoperative outcomes, and re-revision rates were compared between the groups.ResultsA total of 663 cases were identified (486 index rTKAs and 177 multiply revised TKAs). There were no differences in demographics, rTKA type, or indication for revision. Multiply revised patients had significantly longer rTKA operative times (p < 0.001), and were more likely to be discharged to an acute rehabilitation centre (6.2% vs 4.5%) or skilled nursing facility (29.9% vs 17.5%; p = 0.003). Patients who had been multiply revised were also significantly more likely to have subsequent reoperation (18.1% vs 9.5%; p = 0.004) and re-revision (27.1% vs 18.1%; p = 0.013). The number of previous revisions did not correlate with the number of subsequent reoperations (r = 0.038; p = 0.670) or re-revisions (r = −0.102; p = 0.251).ConclusionMultiply revised TKA had worse outcomes, with higher rates of facility discharge, longer operative times, and greater reoperation and re-revision rates compared to index rTKA.Cite this article: Bone Jt Open 2023;4(5):393–398.

Introduction. Acute aortic syndrome (AAS) is a rare clinical syndrome with a high mortality rate. The Canadian clinical practice guideline for the diagnosis of AAS was developed in order to reduce the frequency of misdiagnoses. As part of the guideline, a clinical decision aid was developed to facilitate clinician decision-making (RIPP score). The aim of this study is to validate the diagnostic accuracy of this tool and assess its performance in comparison to other risk prediction tools that have been developed. Methods. This was a historical case-control study. Consecutive cases and controls were recruited from three academic emergency departments from 2002–2020. Cases were identified through an admission, discharge, or death certificated diagnosis of acute aortic syndrome. Controls were identified through presenting complaint of chest, abdominal, flank, back pain, and/or perfusion deficit. We compared the clinical decision tools’ C statistic and used the DeLong method to test for the significance of these differences and report sensitivity and specificity with 95% confidence intervals. Results. We collected data on 379 cases of acute aortic syndrome and 1340 potential eligible controls; 379 patients were randomly selected from the final population. The RIPP score had a sensitivity of 99.7% (98.54–99.99). This higher sensitivity resulted in a lower specificity (53%) compared to the other clinical decision aids (63–86%). The DeLong comparison of the C statistics found that the RIPP score had a higher C statistic than the ADDRS (−0.0423 (95% confidence interval −0.07–0.02); P < 0.0009 ) and the AORTAs score (−0.05 (−0.07 to −0.02); P = 0.0002), no difference compared to the Lovy decision tool (0.02 (95% CI −0.01–0.05 P < 0.25 )) and decreased compared to the Von Kodolitsch decision tool (0.04 (95% CI 0.01–0.07 P < 0.008 )). Conclusion. The Canadian clinical practice guideline’s AAS clinical decision aid is a highly sensitive tool that uses readily available clinical information. It has the potential to improve diagnosis of AAS in the emergency department.

Background: Prior research supports a strong link between Alzheimer’s disease (AD) and metabolic dysfunction that involves a multi-directional interaction between glucose, glutamatergic homeostasis, and amyloid pathology. Elevated soluble amyloid-β (Aβ) is an early biomarker for AD-associated cognitive decline that contributes to concurrent glutamatergic and metabolic dyshomeostasis in humans and male transgenic AD mice. Yet, it remains unclear how primary time-sensitive targeting of hippocampal glutamatergic activity may impact glucose regulation in an amyloidogenic mouse model. Previous studies have illustrated increased glucose uptake and metabolism using a neuroprotective glutamate modulator (riluzole), supporting the link between glucose and glutamatergic homeostasis. Objective: We hypothesized that targeting early glutamatergic hyperexcitation through riluzole treatment could aid in attenuating co-occurring metabolic and amyloidogenic pathologies with the intent of ameliorating cognitive decline. Methods: We conducted an early intervention study in male and female transgenic (AβPP/PS1) and knock-in (APPNL - F/NL - F) AD mice to assess the on- and off-treatment effects of prodromal glutamatergic modulation (2–6 months of age) on glucose homeostasis and spatial cognition through riluzole treatment. Results: Results indicated a sex- and genotype-specific effect on glucose homeostasis and spatial cognition with riluzole intervention that evolved with disease progression and time since treatment. Conclusion: These findings support the interconnected nature of glucose and glutamatergic homeostasis with amyloid pathology and petition for further investigation into the targeting of this relationship to improve cognitive performance.

The functional inhibition account states that alpha-band (8–14 Hz) power implements attentional control by selectively inhibiting task-irrelevant neural representations. This account has been well supported by decades of correlational research showing attention-related changes in the topography of alpha power in anticipation of task-relevant stimuli and is a viable theory of how attention impacts sensory processing, namely, via alpha power changes in sensory areas before stimulus onset. In addition, attention is known to modulate neural responses to stimuli themselves. Thus, a critical prediction of the functional inhibition account is that preparatory alpha modulations should explain variance in the degree of attention-related modulation of neural responses to stimuli. The present article sought evidence for or against this prediction by scouring the literature on attention and alpha oscillations to review papers that explicitly correlated attention-related changes in prestimulus alpha with attention-related changes in stimulus-evoked neural activity. Surprisingly, out of over 100 papers that were examined, we found only 9 that explicitly computed such relationships. The results of these 9 papers were mixed, with some in support and some arguing against the functional inhibition account of alpha. Our synthesis draws out common design features that may help explain when effects are observed or not. Even among studies that do find correlations, there is inconsistency as to whether preparatory alpha modulations are predictive of sensory or postsensory components of stimulus responses, highlighting avenues for future research. A clear outcome of this review is that future studies on the role of alpha in attentional processing should analyze correlations between attention effects on alpha and attention effects on stimulus-evoked activity, as more data pertinent to this hypothesized relationship are needed.

Top of line corrosion (TOLC) is typically a concern in the first few kilometres of wet gas pipelines where water in the warm gas condenses on the cold pipe walls. With the introduction of a subsea tieback to existing infrastructure, the changing fluid composition and temperature profiles may increase condensation in sections not previously expected to have condensation. Accurate prediction of the water condensation rate (WCR) becomes essential to support reliable corrosion modelling. Transient flow simulation of pipeline operating conditions and detailed heat transfer modelling is required to calculate the WCR. This calculation is complicated because the mass of water condensation is very small compared to the fluid mass in the pipeline, and sensitive to glycol that is often present in the aqueous phase for hydrate management purposes. This paper introduces a method to calculate WCR by using detailed transient modelling of the pipeline operating conditions. The fluid thermal hydraulic behaviour and hydraulic pressure drop in the pipeline are considered in the model. The fluid composition in the pipeline and glycol component in the aqueous phase are calculated by using a PVT software package. A few sensitivity studies will also be presented. The implications of Equation of State (EoS) and transient flow module on WCR calculation will be quantified. The WCR sensitivity results will be analysed based on varying inlet temperatures, glycol concentrations, and pipeline heat transfer coefficients. A WCR calculation method will be recommended for TOLC modelling.

OBJECTIVE To determine whether axial twisting within an ending loop negatively impacts maximum load to failure and failure mode of suture knots. SAMPLES 525 knots (15 samples each of 7 different suture types/sizes tested in 5 knot-twist configurations each). PROCEDURES Each suture type (polydioxanone [PDO], Monoderm [polyglecaprone 25], and Nylon) and size (1, 0, 2-0, 3-0) were used to create a starting square knot, and each of the following ending square knot configurations: 0 twists, 1 twist, 4 twists, and 10 twists. Each suture was tested for failure using a universal testing machine (Instron, Instron Corp) with a 100 kg load cell at a speed of 100 mm/min. Each suture and knot was evaluated for a mode of failure using gross evaluation of the knots and video footage recorded during testing. Maximum load at failure (P-value set at .005) and failure mode (p-value set at 0.003) were recorded for each group. RESULTS Maximum load at failure was decreased in knots tied within ending loops containing more twists for some types and sizes of the suture. With 4 twists, 0-PDO, 1 PDO, and 2-0 Nylon was more likely to fail at the knot than knots with 0 twists. All sutures containing 10 twists, except 3-0 Monoderm, were more likely to fail at the knot than knots with 0 twists. CLINICAL RELEVANCE The number of twists within the ending loop may not increase the risk of failure at the knot; however, it can decrease the maximum load to failure at a knot, particularly as the suture size increases.

Introduction: Family-centred rounds benefit families and clinicians and improve outcomes in general paediatrics, but are understudied in subspecialty settings. We sought to improve family presence and participation in rounds in a paediatric acute care cardiology unit. Methods: We created operational definitions for family presence, our process measure, and participation, our outcome measure, and gathered baseline data over 4 months of 2021. Our SMART aim was to increase mean family presence from 43 to 75% and mean family participation from 81 to 90% by 30 May, 2022. We tested interventions with iterative plan-do-study-act cycles between 6 January, 2022 and 20 May, 2022, including provider education, calling families not at bedside, and adjustment to rounding presentations. We visualised change over time relative to interventions with statistical control charts. We conducted a high census days subanalysis. Length of stay and time of transfer from the ICU served as balancing measures. Results: Mean presence increased from 43 to 83%, demonstrating special cause variation twice. Mean participation increased from 81 to 96%, demonstrating special cause variation once. Mean presence and participation were lower during high census (61 and 93% at project end) but improved with special cause variation. Length of stay and time of transfer remained stable. Conclusions: Through our interventions, family presence and participation in rounds improved without apparent unintended consequences. Family presence and participation may improve family and staff experience and outcomes; future research is warranted to evaluate this. Development of high level of reliability interventions may further improve family presence and participation, particularly on high census days.

[1.1.1]Propellane, a compound whose structure includes two saturated carbons in which all four bonds are directed into a single hemisphere, is of theoretical interest, but has also seen recent practical applications. Mono-, di-, and trisubstituted derivatives of this propellane (by substitution of its CH2 bridges with O, S, NH, CF2, CO, SO, and SO2) remain unknown despite several computational studies that have suggested some may be stable. In this study, we show that, in several cases, substituted propellanes are spontaneously formed upon the attempted computational optimization of the geometries of anionic bridgehead bromide precursors using the ωB97X-D/aug-cc-pVDZ DFT method. Spontaneous formation suggests that these propellanes are at lower energy relative to the precursors and, therefore, are promising synthetic targets. The success or failure to spontaneously form the propellane is considered in relation to the length and strain energy of the central bridgehead-bridgehead bond, as well as the total strain energy of each propellane.

The SSGSA STEM Sustainability Case Competition is an annual research case competition hosted by undergraduate students from the STEM Students Guelph Support Association (SSGSA). The mission of this competition is to provide University of Guelph undergraduate students with an opportunity to develop their own research proposal while gaining valuable experience in innovative thinking and critical research analysis. Each year students, in teams of up to three are paired with an experienced mentor to develop and present a novel research proposal aligning with the competition’s theme. During the competition, students are taught fundamental principles outlining three lab techniques which they could write about in their proposal. The theme of the competition this year was Genetic Engineering, and competitors learned about CRISPR-Cas9, CAR T-cell therapy, and PCR. In the 2022-2023 SSGSA STEM Sustainability Case Competition over 100 participants submitted abstracts for judgment, and we present the Top 20 winning submissions to be read by you in our competition abstract booklet. We hope you enjoy reading this year’s best abstract submissions and encourage you to participate in the growing SSGSA community as we strive to encourage interest in novel scientific research fields surrounding STEM.

Glass ionomer cements (GICs) have been available for use by clinicians for almost 50 years. Their beneficial properties, such as adhesion to tooth substance, have long been recognized, but early materials suffered from brittleness, lack of translucency, poor wear resistance and solubility in oral fluids. Hence, over the years, new variants have been developed with a view to overcoming these difficulties. If the latest materials were found to be clinically successful in loadbearing situations in posterior teeth, they could hold advantages because of their easier placement than resin composite materials and possibly be more cost-effective. It is therefore the purpose of this article to review recent research into the performance of the laboratory and clinical performance of high viscous GICs and the so-called glass hybrid materials that have developed from the conventional GICs. CPD/Clinical Relevance: Glass ionomer materials, which, unlike resin composite restorations do not need a separate bonding agent, may hold technique advantages during restoration placement.

Indirect restorative procedures are integral to clinical dentistry. Over the past 50 years however, minimally invasive, direct adhesive restorative techniques have gradually replaced many of the indications for traditional indirect restorations. While numerous indirect procedures are still carried out every year, multiple studies have demonstrated that these restorations have limited longevity and are subject to a wide range of clinical complications, including the reduction in lifespan of the restored teeth and an increased risk of dento-legal problems. This article provides an update on the current status of indirect restorations and presents a comprehensive step-by-step guide to optimising all clinical stages, including case selection, patient assessment, diagnosis, aesthetic considerations, treatment planning, tooth preparation design, impression techniques, temporization, cementation and maintenance. CPD/Clinical Relevance: In contemporary dental practice there is a reduced need for indirect restorations. When indicated however, all clinical stages must be optimised to maximize longevity and minimise complications.

AimsObesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m2) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m2) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach.MethodsThis retrospective cohort study observes peri- and postoperative outcomes of MO and HW patients who underwent a primary, unilateral THA with the ABMS approach. Data from surgeries performed by three surgeons at a single institution was collected from January 2013 to August 2020 and analyzed using Microsoft Excel and Stata 17.0.ResultsThis study compares 341 MO to 1,140 HW patients. Anaesthesia, surgery duration, and length of hospital stay was significantly lower in HW patients compared to MO. There was no difference in incidence of pulmonary embolism, periprosthetic fracture, or dislocation between the two groups. The rate of infection in MO patients (1.47%) was significantly higher than HW patients (0.14%). Preoperative patient-reported outcome measures (PROMs) show a significantly higher pain level in MO patients and a significantly lower score in functional abilities. Overall, six-week and one-year postoperative data show higher levels of pain, lower levels of functional improvement, and lower satisfaction scores in the MO group.ConclusionThe comorbidities of obesity are well studied; however, the implications of THA using the ABMS approach have not been studied. Our peri- and postoperative results demonstrate significant improvements in PROMs in MO patients undergoing THA. However, the incidence of deep infection was significantly higher in this group compared with HW patients.Cite this article: Bone Jt Open 2023;4(5):299–305.

—Most engineering and technology-focused program curricula are firmly fixated on the required technical skills to meet the profession’s needs. Yet, in today’s rapidly changing, globalized world, engineers and technologists need more than technical competencies to meet the requirements of their professional work. This work illustrates how the LinkedIn Learning (LiL) platform was used as a “learning partner” to complement undergraduate engineering management courses to enrich metacognition and nudge lifelong learning tendencies. The rationale for integrating LiL into the course framework is examined, including study design and survey results. Summary research indicates students appreciated the LiL coursework assignments. Most respondents perceived that the LiL courses increased their knowledge and skills in the subject matter presented. The study illustrated movement towards self-determined learning behaviour and improved reflective capabilities.

Ferroportin (Fpn)—expressed at the plasma membrane of macrophages, enterocytes, and hepatocytes—mediates the transfer of cellular iron into the blood plasma. Under the control of the iron-regulatory hormone hepcidin, Fpn serves a critical role in systemic iron homeostasis. Although we have previously characterized human Fpn, a great deal of research in iron homeostasis and disorders uses mouse models. By way of example, the flatiron mouse, a model of classical ferroportin disease, bears the mutation H32R in Fpn and is characterized by systemic iron deficiency and macrophage iron retention. The flatiron mouse also appears to exhibit a manganese phenotype, raising the possibility that mouse Fpn serves a role in manganese metabolism. At odds with this observation, we have found that human Fpn does not transport manganese, so we considered the possibility that a species difference could explain this discrepancy. We tested the hypothesis that mouse but not human Fpn can transport manganese and performed a comparative analysis of mouse and human Fpn. We examined the functional properties of human Fpn, mouse Fpn, and mutant mouse Fpn by using radiotracer assays in RNA-injected Xenopus oocytes. We found that neither mouse nor human Fpn transports manganese. Mouse and human Fpn share identical properties with respect to substrate profile, calcium dependence, optimal pH, and hepcidin sensitivity. We have also demonstrated that Fpn is not an ATPase pump. Our findings validate the use of mouse models of ferroportin function in iron homeostasis and disease.

Rope sampling methodologies were assessed for porcine reproductive and respiratory syndrome virus (PRRSV) detection in 6 pens. Results showed that shared ropes detected PRRSV 50% and 66.7% of the time compared to unshared ropes. One rope provided better detection than 2 ropes per pen under the conditions of this study.

The prevalence of burnout and depression among abdominal transplant surgeons has been well described. However, the incidence of early-career transplant surgeons leaving the field is unknown. The objective of this study was to quantify the incidence of attrition among early-career abdominal transplant surgeons.A custom database from the Organ Procurement and Transplantation Network with encrypted surgeon-specific identifiers was queried for transplant surgeons who entered the field between 2008 and 2019. Surgeons who experienced attrition, defined as not completing a subsequent transplant after a minimum of 5, were identified. Surgeon-specific case volumes, case mix, and recipient outcomes were modeled to describe their association with attrition.Between 2008 and 2018, 496 abdominal transplant surgeons entered the field and performed 76,465 transplant procedures. A total of 24.4% (n = 121) experienced attrition, with a median time to attrition of 2.75 years. Attrition surgeons completed fewer kidney (7 vs 21, P.01), pancreas (0.52 vs 1.43, P.01), and liver transplants (1 vs 4, P.01) in their first year of practice. Attrition surgeons completed a smaller proportion of their transplant center's volume (9% vs 18%, P.01) and were less likely to participate in pediatric transplants (26.5% vs 52.5%, P.01) and living donor kidney transplants (64.5% vs 84.5%, P.01). On multivariable analysis, performing fewer kidney (odds ratio: 0.98, 95% confidence interval: 0.98-0.99) and liver transplants (odds ratio: 0.98, 95% confidence interval: 0.97-0.98) by year 5 and completing a smaller proportion of their centers' volume (odds ratio: 0.96, 95% confidence interval: 0.94-0.98) were associated with attrition. Furthermore, attrition surgeons had worse allograft and patient survival for liver transplant recipients (both log-rank P.01).This investigation was the first to quantify the high incidence of attrition experienced by early-career abdominal transplant surgeons and its association with surgeon-specific case volumes, case mix, and worse recipient outcomes. These findings suggested the abdominal transplant workforce is struggling to retain their fellowship-trained surgeons.

For several decades, Northern Québec has been exploited by mining companies for its mineral resources, yet, research documenting the effects of toxic stress on fish health in subarctic environments remains limited. In this study, one lake directly affected by mining activities in the Schefferville area, two lakes close to mining facilities in the Fermont and Schefferville areas, and one reference lake were sampled for water, sediment, and fish. Our results suggest that manganese bioaccumulation induced an oxidative stress in Catostominæ, as demonstrated by the positive relationships between manganese concentrations and catalase (CAT) activity and 8-hydroxy-2′-deoxyguanosine (8-OHdG) concentrations, as well as the negative relationship with glutathione peroxidase (GPx) activity (both CAT and GPx activities being biomarkers of antioxidant capacities and 8-OHdG an indicator of deoxyribonucleic acid oxidative damage). Similarly, selenium bioaccumulation was positively correlated with 8-OHdG concentrations in Salmoninæ. These results suggest a prooxidant role of excess selenium and manganese, and highlight the interspecific variability of fish responses to contaminated areas around historical and current iron ore mining operations.

With the increasing appreciation for sex as a biological variable and the inclusion of female mice in research, it is important to understand the influence of the estrous cycle on physiological function. Sex hormones are known to modulate vascular function, but the effects of the mouse estrous cycle phase on arterial stiffness, endothelial function, and arterial estrogen receptor expression remain unknown. In 23 female C57BL/6 mice (6 mo of age), we determined the estrous cycle stage via vaginal cytology and plasma hormone concentrations. Aortic stiffness, assessed by pulse wave velocity, was lower during the estrus phase compared with diestrus. In ex vivo assessment of isolated pressurized mesenteric and posterior cerebral arteries, the responses to acetylcholine, insulin, and sodium nitroprusside, as well as nitric oxide-mediated dilation, were not different between estrous cycle phases. In the aorta, expression of phosphorylated estrogen receptor-α was higher for mice in estrus compared with mice in proestrus. In the cerebral arteries, gene expression for estrogen receptor-β (

PURPOSE: Frailty predicts poor outcomes in older adults with cancer, but how it differs between different cancer types is unknown. We examined differences in pretreatment frailty between colorectal (CRC), pancreatic, and hepatobiliary cancers. METHODS: We included older adults age 60 years or older with the above cancer types enrolled in the Cancer and Aging Resilience Evaluation registry. Frailty was defined using a 44-item Cancer and Aging Resilience Evaluation frailty index constructed on the basis of the principles of deficit accumulation (including several geriatric assessment impairments encompassing malnutrition, functional status, comorbidities, anxiety, depression, cognitive complaints, health-related quality of life, falls, ability to walk one block, interference in social activities, and polypharmacy). Multivariable logistic regression models were used to examine the adjusted odds ratio (aOR) of frailty between cancer types. RESULTS: A total of 505 patients were included (mean age 70 years, 59% male): 211 (41.8%) CRC, 178 (35.2%)pancreatic cancer, and 116 (23.0%) hepatobiliary cancer. Patients with pancreatic cancer had the highest prevalence of frailty (23.3% CRC, 40.6% pancreatic, 34.3% hepatobiliary; P = .001). Both pancreatic (aOR, 2.18; 95% CI, 1.38 to 3.45), and hepatobiliary cancer (aOR, 1.73; 95% CI, 1.03 to 2.93) were independently associated with higher odds of frailty relative to CRC. Frailty was driven by higher rates of malnutrition and instrumental activities of daily living impairments in patients with pancreatic cancer and higher number of comorbidities in patients with hepatobiliary cancer. CONCLUSION: Older adults with pancreatic and hepatobiliary cancers are at high-risk of pretreatment frailty. Early interventions to improve nutritional and functional status and optimization of comorbidities may help improve outcomes.

Despite the many mistakes we make while speaking, people can effectively communicate because we monitor our speech errors. However, the cognitive abilities and brain structures that support speech error monitoring are unclear. There may be different abilities and brain regions that support monitoring phonological speech errors versus monitoring semantic speech errors. We investigated speech, language, and cognitive control abilities that relate to detecting phonological and semantic speech errors in 41 individuals with aphasia who underwent detailed cognitive testing. Then, we used support vector regression lesion symptom mapping to identify brain regions supporting detection of phonological versus semantic errors in a group of 76 individuals with aphasia. The results revealed that motor speech deficits as well as lesions to the ventral motor cortex were related to reduced detection of phonological errors relative to semantic errors. Detection of semantic errors selectively related to auditory word comprehension deficits. Across all error types, poor cognitive control related to reduced detection. We conclude that monitoring of phonological and semantic errors relies on distinct cognitive abilities and brain regions. Furthermore, we identified cognitive control as a shared cognitive basis for monitoring all types of speech errors. These findings refine and expand our understanding of the neurocognitive basis of speech error monitoring.

Purpose Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies. Findings Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful. Conclusion Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.

It is important that breast cancer patients know where they can access evidence-based nutrition information because misinformation may lead to confusion for patients regarding dietary requirements, as well as potentially causing harm to health. There are gaps in knowledge about where and when patients seek nutrition information. Our exploratory study used telephone interviews to investigate where patients with breast cancer obtained nutrition information pre and postdiagnosis, and their preferred sources and timing for receiving nutrition information. We interviewed 29 women diagnosed with breast cancer who had attended the Cross Cancer Institute in Edmonton, Alberta. The structured interview included 13 closed-ended questions and 1 open-ended question. Interviews revealed that motives for seeking nutrition information changed between pre and postdiagnosis, but the sources did not. The majority of participants did not access a registered dietitian (RD) postdiagnosis but did specify that meeting with a RD would be their preferred source of information. Responses varied for the preferred sources and timing of nutrition information provision. Our study suggests that further research is necessary to know how to best meet the nutrition information needs of patients diagnosed with breast cancer.

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in the emergency department (ED) and when patients present in acute AF with rapid ventricular rate (RVR), it can result in significant morbidity and mortality. Primary treatment modalities are aimed at rate control with the two most common agents being intravenous metoprolol and diltiazem. Some evidence suggests that diltiazem may be more effective at controlling rate in these patients; however, the dosing strategies, pharmacologic differences, and study designs may play a role in the observation of these differences. The purpose of this article is to review the evidence for using weight-based metoprolol in the treatment of AF with RVR. The vast majority of studies comparing metoprolol and diltiazem for the treatment of acute AF with RVR compare a flat dose of metoprolol to a weight-based dose of diltiazem. Following a comprehensive review, only two studies have compared a weight-based dosing strategy of intravenous (IV) metoprolol versus IV diltiazem for this disease state. Overall, the two studies only contained 94 patients and failed to meet power. Beyond differing dosing strategies, differences in pharmacokinetics between the two medications (like the onset of action and metabolism) could have played a role in the differences observed in the studies. Further studies are warranted to provide better guidance on which agent should be used in the treatment of acute AF with RVR.