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Under natural and well-managed conditions, the buffalo has good reproductive and productive indices. However, in vitro embryo production (IVEP) has been used commercially to maximise the number of elite animals. In this species, several factors (donor management, in vitro culture medium, semen, in vitro conditions, embryo transfer) still affect the IVEP results. In addition, the cost of this technique is very high for this purpose. Therefore, more studies, as well as adequate plans, are needed to achieve this objective efficiently. In this review, we discussed the current commercial status, influencing factors (in vivo and in vitro), and the progress and future challenges of IVEP in buffalo. A total of 81 references were used from 1979 to 2022. The relevant data or literature were searched using the following databases: Google, ResearchGate, Science Alert, Science Direct and PubMed, using the following keywords: buffalo oocytes/COCs, buffalo embryos, pregnancy and calving or live birth rate after embryo transfer. The best maturation, cleavage and blastocyst rates in the in vitro production of buffalo embryos were 95.8, 75.2 and 33.4%, respectively. The pregnancy and live birth rates ranged from 22.2% to 43.5% and from 15.3% to 36.5%, respectively, after the transfer of fresh embryos produced in vitro to the recipients. This review will help to contextualise IVEP in buffaloes, as well as create an adequate plan for implementing IVEP in buffaloes.

Michael E Crawford,1 Peter Bo Poulsen,2 Berit Schiøttz-Christensen,3 Andreas Habicht,4 Mette Strand,2 Flemming W Bach5 1Copenhagen City Pain Clinic, Copenhagen K, 2Pfizer Denmark ApS, Ballerup, 3Spine Center Southern Denmark, Lillebælt Hospital, Middelfart, 4Signifikans ApS, Vedbæk, 5Department of Neurology, Aalborg University Hospital, Aalborg, Denmark Objective: The aim of this study was to provide evidence regarding the real-life efficacy of pregabalin in the treatment of peripheral neuropathic pain (NeP) in Denmark. Methods: In this prospective, observational, noninterventional study, pregabalin (Lyrica®) was prescribed following usual clinical practice. Compared with baseline, the primary study end points after 3 months of observation were changes in 1) the average level of pain during the past week, 2) the worst level of pain during the past week, and 3) the least level of pain during the past week. The Wilcoxon signed-rank test was used to perform paired analyses, and a multivariate regression analysis investigated factors driving change in pain. Results: A total of 86 of the 128 patients included were regarded as efficacy evaluable (those completing 3 months of pregabalin treatment). Patients (59 years) were long-time sufferers of peripheral NeP, and 38% of them had comorbidities. The majority had previously been treated with tricyclic antidepressants or gabapentin. The average dose of pregabalin was 81.5 mg/d at baseline and 240 mg/d after 3 months. A clinically and statistically significant improvement of 2.2 points in the average level of pain intensity was found after 3 months. The higher the pain intensity at baseline, the higher was the reduction of the pain score. Positive results were also found for pain-related sleep interference, patients’ global impression of change, quality of life, and work and productivity impairment. Twenty-one patients reported 28 adverse events. Conclusion: This real-life study indicates that for some patients (two-thirds), addition of pregabalin for peripheral NeP helps to reduce their pain intensity significantly. Keywords: noninterventional study, pain intensity, usual clinical practice, sleep interference and quality of life

Vibeke Strand,1 Louis F McIntyre,2 William R Beach,3 Larry E Miller,4,5 Jon E Block5 1Stanford University School of Medicine, Palo Alto, CA, USA; 2New York University Medical Center, White Plains, NY, USA; 3Tuckahoe Orthopaedics, Richmond, VA, USA; 4Miller Scientific Consulting, Inc., Asheville, NC, USA; 5The Jon Block Group, San Francisco, CA, USA Background: Intra-articular injection of hyaluronic acid is a common, yet controversial, therapeutic option for patients with knee osteoarthritis (OA). The purpose of this research was to determine the safety and efficacy of US-approved viscosupplements for symptomatic knee OA. Methods: We searched MedLine and EMBase for randomized, sham-controlled trials evaluating safety and/or clinical efficacy of US-approved viscosupplements in patients with symptomatic knee OA. Knee pain severity and knee joint function were assessed at 4 to 13 weeks and 14 to 26 weeks. Safety outcomes included serious adverse events, treatment-related serious adverse events, patient withdrawal, and adverse event-related patient withdrawal occurring at any time during follow-up. Results: A total of 29 studies representing 4,866 unique patients (active: 2,673, control: 2,193) were included. All sham-controlled trials used saline injections as a control. Viscosupplementation resulted in very large treatment effects between 4 and 26 weeks for knee pain and function compared to preinjection values, with standardized mean difference values ranging from 1.07 to 1.37 (all P

Yngvar Nilssen,1 Trond-Eirik Strand,1 Robert Wiik,2 Inger Johanne Bakken,3 Xue Qin Yu,4,5 Dianne L O'Connell,4–7 Bjørn Møller1 1Department of Registration, Cancer Registry of Norway, Oslo, 2Norwegian Patient Register Department, Norwegian Directorate of Health, Trondheim, 3Norwegian Institute of Public Health, Oslo, Norway; 4Cancer Research Division, Cancer Council NSW, 5School of Public Health, University of Sydney, 6School of Public Health and Community Medicine, University of New South Wales, Sydney, 7School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia Objective: To construct an updated comorbidity index (Patient Register Index [PRI]) using national data collections from Norway and compare its predictive ability of 1-year mortality with the Charlson Comorbidity Index (CCI). Materials and methods: Data regarding over 1.11 million patients registered in the Norwegian Patient Register in 2010 and 2011 were used to construct the PRI. The PRI was evaluated by comparing its model fit and discrimination with the CCI. Results: Compared with the CCI, the PRI weights decreased for six, increased for four, and were unchanged for seven diseases. When the PRI was added to the model including age and sex, the age effects were reduced by up to 38% for patients older than 50 years. All measures of model fit improved for the PRI model. Conclusion: Adjustment for comorbidity is especially important for patients 50 years of age or older, and its effect on 1-year mortality is almost comparable to the age effect. The PRI is based on more recent data than the CCI, and is more representative of the general population due to its construction. Keywords: comorbidity, National Patient Register, Charlson Comorbidity Index, predictive ability, patient-register index, prognostic value

Sarah L StrandDepartment of Health and Human Sciences, Loyola Marymount University, Los Angeles, CA, USAAbstract: The objective of this case study was to identify the signs and symptoms of concussion and post-concussive syndrome in a collegiate, female basketball player, as well as her progress to becoming symptom free. The patient, a previously healthy, 21-year-old with no previous head injuries, experienced a concussion and continued to participate in her sport. Even though the athlete knew the risks of playing while symptomatic, she did not report her symptoms, and continued playing until the season ended. This case highlights that even when patients know the risks, they may be willing to overlook them to continue playing and it emphasizes the importance of further education. In addition, it shows that even when following recommended guidelines, and with normal neurocognitive testing, symptoms may come back upon return to play.Keywords: concussion, basketball, mild traumatic brain injury, female athletes

Reinhard Strametz,1,* Hannah Roesner,1,2,* Thomas Neusius,1,* Isabell Wiesenhuetter,1 Stefan Bushuven,3,4 José Joaquín Mira,2,5 Dominik Hinzmann,6 Susanne Heininger7 1Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain UAS, Wiesbaden, Germany; 2Miguel Hernández University of Elche, Elche, Spain; 3Training Center for Emergency Medicine (NOTIS e.V), Engen, 78234, Germany; 4Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, 79106, Germany; 5Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Alicante, Spain; 6Department Clinical Medicine, Department of Anesthesiology and Intensive Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany; 7Faculty for Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany*These authors contributed equally to this workCorrespondence: Reinhard Strametz, Wiesbaden Institute for Healthcare Economics and Patient Safety, RheinMain UAS, Bleichstr. 3, Wiesbaden, 65183, Germany, Email reinhard.strametz@hs-rm.dePurpose: The objective of this study is to evaluate whether the nationwide establishment and institutionalization of a peer-support program, is economically justified given the potential positive effects on the Second Victim Phenomenon (SVP) among healthcare professionals in Germany.Methods: A comprehensive methodological approach was employed, using data from the SeViD studies to assess the prevalence and duration of SVP among physicians and nurses in Germany. Economic impact assessments were conducted to estimate the potential cost savings associated with implementing a peer-support program.Results: The economic analysis reveals significant annual costs associated with SVP-induced absenteeism: approximately 1.56 billion euros for physicians and 1.87 billion euros for nurses. Implementing comprehensive peer-support programs could reduce these costs to approximately 0.85 billion (physicians) and 1.02 billion euros (nurses), respectively, demonstrating substantial potential economic benefits.Conclusion: Investing in a structured peer-support program could yield annual savings exceeding 1.55 billion euros while enhancing workforce resilience and improving patient care. This underscores the economic rationale for scaling up peer support initiatives in healthcare settings.Keywords: peer support program, economic impact, second victim phenomenon, healthcare professionals

Abstract This investigation aimed to develop a radiographic 3D cephalometric index to grade severity of dentofacial deformity in patients with juvenile idiopathic arthritis (JIA), and to perform a validation against expert evaluations. Data were collected from a population-based Nordic JIA cohort of 240 patients that received a cone-beam computed tomography (CBCT) scan approximately 17 years after onset of JIA. The cohort was randomized into two groups: A baseline group for establishing the index (n = 210) and a test group (n = 30). The standardized index generation process led to the inclusion of six radiographic outcome measures, each representing different facets of dentofacial deformities. Specific severity scores were established for three domains; dentofacial asymmetry (0–8), vertical deviation (0–8), and sagittal deviation (0–8). An overall dentofacial deformity index score was computed by aggregating the scores from the six variables, with the total score ranging from 0 to 24. The validity of the index was assessed by comparing the index score with expert evaluations. Based on the generated index, 10 patients exhibited severe deformities. Reliable agreement between data-generated index scores and expert assessments was found. A 3D radiographic dentofacial deformity index was generated and tested. This index can support an objective assessment of the severity of dentofacial deformities related to JIA in a clinical setting and future research.