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• CoQ10 promotes nerve regeneration by enhancing mitochondrial biogenesis. • CoQ10 improves antioxidative mechanisms led to accelerating neural tissue healing. • CoQ10 can protect against neuroinflammation in neurosensory disturbances. • Early CoQ10 supplementation enhances neuroprotection. • CoQ10 supplementation may serve as adjunctive treatment for peripheral nerve injury. Peripheral nerve injuries (PNIs) are prevalent conditions mainly resulting from systemic causes, including autoimmune diseases and diabetes mellitus, or local causes, for example, chemical injury and perioperative nerve injury, which can cause a varying level of neurosensory disturbances (NSDs). Coenzyme Q10 (CoQ10) is an essential regulator of mitochondrial respiration and oxidative metabolism. Here, we review the pathophysiology of NSDs caused by PNIs, the current understanding of CoQ10's bioactivities, and its potential therapeutic roles in nerve regeneration, based on evidence from experimental and clinical studies involving CoQ10 supplementation. In summary, CoQ10 supplementation shows promise as a neuroprotective agent, potentially enhancing treatment efficacy for NSDs by reducing oxidative stress and inflammation. Future studies should focus on well-designed clinical trials with large sample sizes, using CoQ10 formulations with proven bioavailability and varying treatment duration, to further elucidate its neuroprotective effects and to optimize nerve regeneration in PNIs-induced NSDs. [Display omitted] Graphical abstract legend Coenzyme Q10 may serve as a potential therapeutic agent in preventing and mitigating neurosensory disturbances induced by peripheral nerve injury, primarily through enhancing mitochondrial biogenesis and bolstering antioxidant mechanisms. Additionally, its anti-inflammatory properties offer an appealing avenue for shielding against neuroinflammation, thereby augmenting its efficacy in treating neurosensory disorders. [ABSTRACT FROM AUTHOR]

Post-stroke depression (PSD) is a common neurological and psychiatric sequelae following a stroke, often surpassing the primary effects of the stroke due to its strong correlation with high mortality rates. In recent years, non-pharmacological therapy has garnered significant attention as a supplementary treatment for PSD, becoming widely adopted in clinical practice. However, the efficacy of specific intervention strategies remains unclear. This study aimed to conduct a network meta-analysis (NMA) of published studies to compare the efficacy of different non-pharmacological therapies for treating PSD. We systematically searched five databases from inception through March 2024 to identify randomized controlled trials (RCTs) evaluating non-pharmacological therapies for the treatment of PSD. We considered individual intervention and intervention class. Intervention classes included traditional Chinese medicine (TCM), non-invasive electrotherapy stimulation (NIES), psychotherapy (PT), exercise therapy, hyperbaric oxygen, and combined interventions. The NMA was conducted using R and Stata software, following a frequency-based methodology. Assessment of methodological quality and risk of bias was conducted using the Risk of Bias assessment tool 2.0. Therapies were ranked using the P-score, and box-plots visualization, meta-regression, and sensitivity analysis, were performed to assess transitivity, heterogeneity, and consistency, respectively. The NMA included 43 studies with a total of 3138 participants. Random-effects models revealed significant efficacy for acupuncture (ACUP) (P-score = 0.92; pooled standardized mean difference (95% CI): −3.12 (−4.63 to −1.60)) and transcranial direct current stimulation (P-score = 0.85; −2.78 (−5.06 to −0.49)) compared to the treatment as usual (TAU) group. In categorical comparisons, TCM_PT (P-score = 0.82; −1.91 (−3.54 to −0.28)), TCM (P-score = 0.79; −1.65 (−2.33 to −0.97)), and NIES (P-score = 0.74; −1.54 (−2.62 to −0.46)) showed significant differences compared to TAU group. Furthermore, our results indicated no significant difference between PT and the control groups. However, Confidence in Network Meta-Analysis results indicated very low overall evidence grade. Limited evidence suggests that ACUP may be the most effective non-pharmacological therapy for improving PSD, and TCM_PT is the best intervention class. However, the evidence quality is very low, underscoring the need for additional high-quality RCTs to validate these findings, particularly given the limited number of RCTs available for each therapy. • Acupuncture showed the greatest improvement in depression symptoms in patients with post-stroke depression. • Given the overlap between stroke and depression symptoms, passive therapiesmay be more appropriate and efficacious for patients. • Categorical comparisons suggest that traditional Chinese medicine combined with psychotherapy may have the best efficacy in treating post-stroke depression. [ABSTRACT FROM AUTHOR]

In the current exploratory study we estimate comorbidity rates between FDs [fibromyalgia (FM), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and irritable bowel syndrome (IBS)]—and IDs—[major depressive disorder (MDD) and generalized anxiety disorder (GAD)] by using self-reported diagnostic criteria. We analyzed data from 107,849 participants (mean age = 49.3 (SD = 13.0), 58.6% women) of the Lifelines Cohort Study. Lifelines is a prospective population-based cohort study in the northeast of the Netherlands. Current IDs were assessed using the Mini-International Neuropsychiatric Interview. Current FM, ME/CFS, and IBS were assessed according to the 2010 American College of Rheumatology criteria, the 1994 Centers for Disease Control and Prevention criteria and the ROME IV criteria, respectively. We estimated tetrachoric correlations between diagnoses and tested for sex differences. Additionally, we estimated the ratio of observed-to-expected frequency for combinations of diagnoses. FDs and IDs are highly comorbid (odds ratios: 3.2–12.6) with associations stronger among men. Participants with at least three disorders/diagnoses were more prevalent than expected by chance. Studies that aim to explain sex differences and the comorbidity of specific combinations of IDs and FDs will be an important contribution to understanding the etiology of these conditions. • Internalizing disorders and functional disorders are highly comorbid. • Irritable bowel syndrome is not as closely related to internalizing disorders as the other functional disorders. • The association between functional disorders and internalizing disorders is larger in male participants. • Combinations of functional disorders/internalizing disorders including three or more conditions occur frequently. [ABSTRACT FROM AUTHOR]

To compare the prevalence of physical morbidities between older aged patients with bipolar disorder (OABD) and non-psychiatric comparisons (NC), and to analyze sex differences in prevalence. OABD was defined as bipolar disorder among adults aged ≥50 years. Outcomes analyzed were the prevalence of diseases affecting the cardiovascular, respiratory, gastrointestinal, genitourinary, renal, musculoskeletal, and endocrine systems. The analysis used cross-sectional data of OABD participants (n = 878; mean age 60.9 ± 8.0 years, n = 496 (56%) women) from the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset and NC participants recruited at the same sites (n = 355; mean age 64.4 ± 9.7 years, n = 215 (61%) women). After controlling for sex, age, education, and smoking history, the OABD group had more cardiovascular (odds ratio [95% confidence interval]: 2.12 [1.38–3.30]), renal (5.97 [1.31–43.16]), musculoskeletal (2.09 [1.30–3.43]) and endocrine (1.90 [1.20–3.05]) diseases than NC. Women with OABD had more gastrointestinal (1.56 [0.99–2.49]), genitourinary (1.72 [1.02–2.92]), musculoskeletal (2.64 [1.66–4.37]) and endocrine (1.71 [1.08–2.73]) comorbidities than men with OABD, when age, education, smoking history, and study site were controlled. This replication GAGE-BD study confirms previous findings indicating that OABD present more physical morbidities than matched comparison participants, and that this health burden is significantly greater among women. [ABSTRACT FROM AUTHOR]

Roundoff errors often disrupt interpolation methods for time-fractional equations, potentially causing suboptimal convergence or even failure. These issues primarily result from catastrophic cancellations. To address this, we introduce a novel framework for computing coefficients in standard and fast interpolation methods on nonuniform meshes. We propose δ -cancellation and associated threshold conditions to prevent such cancellations. If the thresholds aren't met, a Taylor expansion technique can be applied. Numerical experiments demonstrate our method's accuracy, on par with the Gauss–Kronrod quadrature, but significantly more efficient, allowing for extensive simulations with hundreds of thousands of time steps. [ABSTRACT FROM AUTHOR]

This study assessed the direct and indirect effects (via depressive symptoms) of lifetime use of a broad range of substances on suicide risk among US adolescents. This was a cross-sectional study. Data from the 2021 Youth Risk Behavior Survey were used (N = 12,303, 48.7% female). Associations between five types of substance use (cigarette, e-cigarette, alcohol, marijuana, and prescription pain medicine) and three dimensions of suicide risk (suicidal ideation, suicide plan, and suicide attempt) were measured by multivariate logistic regression models. The role of depressive symptoms was further examined by structural equation modeling. Almost three in five (57.5%) adolescents had used one or more substances in their lifetime (18.1% one type, 12.2% two types, 13.1% three types, 10.2% four types, and 3.8% five types). Adolescents using five substances were up to 16 times more likely to experience suicidal ideation and behaviors. Depressive symptoms significantly linked the pathway from substance use to suicide risk, resulting in much stronger indirect effects than the direct effects. Collectively, the five substance use behaviors and depressive symptoms explained about 60.4% of variance in suicidal ideation, 53.6% of variance in suicide plan, and 55.0% of variance in suicide attempt. Lifetime use of multiple substances is significantly correlated with suicidal ideation and behaviors among adolescents via the pathway of depressive symptoms. Routine screening for a broad range of substance use behaviors is needed to identify adolescents at risk for suicide and accessible mental health services could potentially attenuate the linkage between substance use and suicide risk. [ABSTRACT FROM AUTHOR]

Long coronavirus disease (COVID) is estimated to occur in up to 20% of patients with coronavirus disease 2019 (COVID-19) infections, with many having persistent pulmonary symptoms. Mesenchymal stromal cells (MSCs) have been shown to have powerful immunomodulatory and anti-fibrotic properties. Autologous adipose-derived (AD) stromal vascular fraction (SVF) contains MSC and other healing cell components and can be obtained by small-volume lipoaspiration and administered on the same day. This study was designed to study the safety of AD SVF infused intravenously to treat the pulmonary symptoms of long COVID. Five subjects with persistent cough and dyspnea after hospitalization and subsequent discharge for COVID-19 pneumonia were treated with 40 million intravenous autologous AD SVF cells and followed for 12 months, to include with pulmonary function tests and computed tomography scans of the lung. SVF infusion was safe, with no significant adverse events related to the infusion out to 12 months. Four subjects had improvements in pulmonary symptoms, pulmonary function tests, and computed tomography scans, with some improvement noted as soon as 1 month after SVF treatment. It is not possible to distinguish between naturally occurring improvement or improvement caused by SVF treatment in this small, uncontrolled study. However, the results support further study of autologous AD SVF as a treatment for long COVID. [ABSTRACT FROM AUTHOR]

Kidney replacement therapy (KRT) can provide lifesaving support for children with severely impaired kidney function. The decision about who needs KRT and when is often complex. Many acute kidney problems will resolve with conservative maanagemenent but some children with chronic or acute kidney impairment will find themselves in a position where KRT is required either as a bridge to recovery or kidney transplantation. Less commonly, children with metabolic disorders may find that the ability of their own kidneys is overwhelmed by excessive production of certain metabolites. These children may also benefit from short term KRT. This article aims to help paediatricians in training understand which children need kidney replacement therapy, the various types of treatment available, and when they are used. [ABSTRACT FROM AUTHOR]

Cystic kidney diseases encompass a range of genetic disorders in which the primary cilia of the cells are affected and thereby cysts form as a result. There are an increasing range of cystic renal diseases recognized due to the advances in genomics. The most common genetic kidney condition is autosomal dominant polycystic kidney disease (ADPKD). ADPKD leads to renal failure in adulthood. In children, hypertension is common and if treated, may slow down renal decline. The most common cystic kidney disease causing renal failure in children is autosomal recessive polycystic kidney disease (ARPKD). ARPKD also affects the liver. These conditions often have extra-renal features which also need to be addressed. Until recently, treatments were mainly supportive but now it is possible to slow down development of cyst formation and renal decline in ADPKD. This raises hope for treatment for other cystic renal conditions as more genes are identified and underlying mechanisms defined. [ABSTRACT FROM AUTHOR]

Bladder pain syndrome (BPS) is a benign condition of chronic bladder pain or discomfort that can significantly disrupt normal daily activities and reduce quality of life. It can be difficult to diagnose as it's a diagnosis of exclusion and symptoms are vague. Refractory cases are difficult to manage due to poorly understood aetiology and few universally effective treatments. Over the last two decades, there have been important efforts directed at understanding the syndrome's aetiology and therapeutic challenges. This article reviews the current literature on BPS aetiology, clinical presentation, diagnosis, and treatment options. [ABSTRACT FROM AUTHOR]

To examine joint associations of leisure-time physical activity (LTPA) and screen sitting time with subsequent sickness absence among the adult population. Registry linked follow-up study. A representative sample of Finnish adults (n = 10,300) were asked to fill out a questionnaire for the FinHealth 2017 survey. Self-reported LTPA was classified into three groups: inactive, moderately active, and active, and screen sitting time into two groups: 3 h or less and over three hours a day, yielding a six-category variable for the joint analyses. Questionnaire data were linked to the Finnish Social Insurance Institution's register data on sickness benefits (over 9 days), including diagnoses (follow-up 2.9 years). The analytical samples were restricted to working age (18–64 years), which included 5098 participants. Associations were examined using logistic regression analysis adjusting for covariates with SPSS 29. The inactive and high sitting time had a higher risk for sickness absence due to mental disorders (OR 2.07, 95% CI 1.03–4.18) compared with the physically active, low-sitting time group. Additionally, the inactive and low sitting time (OR 1.69 95% CI 1.12–2.55) and the moderately active and high-sitting time groups (OR 2.06 95% CI 1.15–3.67) had a higher risk. No significant associations were found for all-cause and musculoskeletal diseases sickness absence. Employers and policymakers could support reducing sitting in front of a screen and increase LTPA outside working hours to prevent mental health problems and related sickness absences. [ABSTRACT FROM AUTHOR]

The main objective was to determine the prevalence of falls and associated factors in older adults living in Qatar. Cross-sectional study. This is a cross-sectional study of older adults aged ≥60 years with at least one encounter with primary health care corporation (PHCC) in Qatar during the period 2017–2022. Data on documented falls, demographic variables, and medical comorbidities were extracted from all PHCCs in Qatar. Descriptive and inferential statistics were used to address the aim of the study. A total of 68,194 older adults had at least one encounter with PHCC. The median age was 65.0 years, 58.9% were males, and 32.6% were Qatari nationality. A higher percentage of falls was found in individuals with hypertension (80%), diabetes (74.2%), and dyslipidemia (48.9%), which were also the most prevalent comorbidities. The prevalence of falls was 6.7% (95% CI 6.6–6.9). Compared to individuals aged 60–69 years, individuals aged 70–79, 80–89, and 90–99 had increased odds of falls by 1.6 (95% CI 1.5, 1.8), 2.5 (95% CI 2.2, 2.8), and 2.6 (95% CI 2.0, 3.3), respectively. Females and individuals of Qatari nationality had increased odds of fall by 1.5 (95% CI 1.4, 1.6) and 1.2 (95% CI 1.1, 1.3), respectively. Orthostatic hypotension, syncope, Parkinson's disease, and hip arthritis showed the strongest associations with falls. Given the growing population of older adults in the Middle East and North African region, falls is a public health concern. The risk factors identified in this study suggest the need for proactive healthcare strategies tailored to the unique needs of older adult populations. [ABSTRACT FROM AUTHOR]

• Abetalipoproteinemia (ABL) is a rare monogenic familial hypobetalipoproteinemia caused by bi-allelic variants in MTTP gene. • We identified four French-Canadian patients homozygous for the same MTTP variant. • The ABL carrier frequency in Saguenay-Lac-Saint-Jean is estimated at 1:203. • This represents the 2nd highest worldwide carrier estimates for ABL. • Screening for ABL should be considered in this population. Abetalipoproteinemia (ABL) is a rare recessive genetic disease caused by bi-allelic pathogenic variants in the microsomal triglyceride transfer protein (MTTP) gene. This disease is characterized by a deficiency in the secretion of apolipoprotein B-containing lipoproteins. Patients with ABL present with neurological, hematological, and gastrointestinal symptoms due to fat malabsorption and a deficiency in liposoluble vitamins. In this report, we present a total of four ABL cases, including three new cases, all originating from the same French-Canadian founder population in Saguenay-Lac-Saint-Jean, Québec, Canada. These individuals are homozygous for the same pathogenic variant in the MTTP gene (c.419dup, p.Asn140Lysfs*2). We found that this variant is more common than anticipated in this population, with an estimated carrier frequency of 1:203. Early diagnosis is essential to initiate treatment known to prevent complications associated with ABL. Population carrier screening or newborn screening for ABL should be considered in this French-Canadian founder population. [ABSTRACT FROM AUTHOR]

• Serum RC levels were positively and independently associated with the severity of hepatic steatosis and liver fibrosis. • During follow-up, baseline serum RC levels were independently associated with increased risk of development and decreased likelihood of regression of MASLD. • Baseline serum RC levels were positively correlated with the incident of liver fibrosis. The aim of this study was to explore the associations of serum remnant cholesterol (RC) levels with the progression and regression of metabolic dysfunction-associated steatotic liver disease (MASLD) in Chinese adults. We conducted a cross-sectional study in 13,903 individuals who underwent transient elastography tests (cohort 1) and a longitudinal study in 17,752 individuals who underwent at least two health check-up exams with abdominal ultrasound (cohort 2). Anthropometric and biochemical parameters were collected. Serum RC levels were calculated. Noninvasive fibrosis indices such as FIB-4 were evaluated in cohort 2. In cohort 1, serum RC levels were positively and independently associated with the severity of hepatic steatosis and liver fibrosis according to logistic regression analysis. In cohort 2, baseline serum RC levels were increased in participants with the incidence of MASLD and decreased in participants with the regression of MASLD during the follow-up period. Baseline serum RC levels were independently associated with an increased risk of development and a decreased likelihood of regression of MASLD: the fully adjusted hazard ratios (HR) were 2.785 (95 % CI 2.332–3.236, P < 0.001) and 2.925 (95 % CI 2.361–3.623, P < 0.001), respectively. In addition, when we used FIB-4 to evaluate liver fibrosis, baseline serum RC levels were positively correlated with the incidence of high-intermediate probability of advanced fibrosis. However, we did not find an association between serum RC levels and the regression of liver fibrosis. Serum RC levels are independently correlated with the progression and regression of MASLD in Chinese adults, suggesting that RC may participate in the pathophysiological process of MASLD. [ABSTRACT FROM AUTHOR]

In people with Parkinson's disease, what is the effect of adding external cueing (ie, visual, auditory or somatosensorial cueing) to walking training compared with walking training alone in terms of walking, mobility, balance, fear of falling and freezing? Are any benefits carried over to participation or maintained beyond the intervention period? Systematic review of randomised trials with meta-analysis. Ambulatory adults with Parkinson's disease. Walking training with external cueing compared with walking training without external cueing. Walking (ie, speed, stride length and cadence), mobility, balance, fear of falling, freezing and participation. Ten trials involving a total of 309 participants were included. The mean PEDro score of the included trials was 5 (range 4 to 8). Walking training with auditory cueing improved walking speed by 0.09 m/s (95% CI 0.02 to 0.15) more than walking training alone. Although the best estimate was that auditory cueing may also improve stride length by 5 cm, this estimate was imprecise (95% CI –2 to 11). The addition of visual cueing to walking training did not improve walking speed or stride length. Results regarding cadence, mobility, balance, fear of falling, and freezing and maintenance of benefits beyond the intervention period remain uncertain. This systematic review provided low-quality evidence that walking training with auditory cueing is more effective than walking training alone for improving walking speed in Parkinson's disease. Cueing is an inexpensive and easy to implement intervention, so the mean estimate might be considered clinically worthwhile, although the confidence interval spans clinically trivial and worthwhile effects. PROSPERO CRD42021255065. [ABSTRACT FROM AUTHOR]

Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups? Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression. Adults undergoing major elective abdominal surgery. Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone. PPC, hospital length of stay and 12-month mortality. Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain. There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery. [ABSTRACT FROM AUTHOR]

Both obesity and non-alcoholic fatty liver disease (NAFLD) increase the risk of metabolic abnormalities. However, the metabolic status of children suffering from NAFLD and exhibiting various subtypes of obesity is currently unclear. We aimed to explore the association between NAFLD and metabolic abnormalities in children with different weight statuses. We included 6086 participants aged 6–18 years from the China Child and Adolescent NAFLD Study (CCANS), all of whom had undergone ultrasonography or magnetic resonance imaging-proton density fat fraction (MRI-PDFF) to identify NAFLD and metabolic abnormalities, including hyperglycemia, high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), high low-density lipoprotein cholesterol, high total cholesterol, and hyperuricemia. Among the participants, there were 2408 children with obesity and NAFLD, 174 with NAFLD, 2396 with obesity, and 1108 without obesity and NAFLD. The odds ratios (ORs) of suffering from individual metabolic abnormalities were significantly greater in children with obesity and NAFLD than in children without obesity and NAFLD, with ORs ranging from 6.23 (95% CI: 4.56, 8.53) to 1.77 (95% CI: 1.06, 2.94). The ORs of metabolic abnormalities, except for low HDL-C, were greater in children with NAFLD alone than in children without obesity or NAFLD, with ORs ranging from 4.36 (95% CI: 2.77, 6.84) to 2.08 (95% CI: 1.14, 3.78). Notably, obesity and NAFLD had a multiplicative effect on overall metabolic abnormalities, high TG levels, and low HDL-C levels. Children with obesity and NAFLD could be at a significantly increased risk of metabolic abnormalities. Even for children without obesity, NAFLD appears to be associated with an increased risk of experiencing a worsened metabolic status. [ABSTRACT FROM AUTHOR]

• High-intensity interval training (HIIT) avoided liver steatosis in high-fat-fed mice. • HIIT (thrice weekly) prevented hyperglycemia and endoplasmic reticulum (ER) stress. • HIIT preserved mitochondrial ultrastructure and enhanced beta-oxidation. • HIIT targeted ER and mitochondrial homeostasis to prevent liver steatosis. Metabolic dysfunction-associated steatotic liver disease (MASLD) has attracted increasing attention from the scientific community because of its severe but silent progression and the lack of specific treatment. Glucolipotoxicity triggers endoplasmic reticulum (ER) stress with decreased beta-oxidation and enhanced lipogenesis, promoting the onset of MASLD, whereas regular physical exercise can prevent MASLD by preserving ER and mitochondrial function. Thus, the hypothesis of this study was that high-intensity interval training (HIIT) could prevent the development of MASLD in high-fat (HF)-fed C57BL/6J mice by maintaining insulin sensitivity, preventing ER stress, and promoting beta-oxidation. Forty male C57BL/6J mice (3 months old) comprised 4 experimental groups: the control (C) diet group, the C diet + HIIT (C-HIIT) group, the HF diet group, and the HF diet + HIIT (HF-HIIT) group. HIIT sessions lasted 12 minutes and were performed 3 times weekly by trained mice. The diet and exercise protocols lasted for 10 weeks. The HIIT protocol prevented weight gain and maintained insulin sensitivity in the HF-HIIT group. A chronic HF diet increased ER stress-related gene and protein expression, but HIIT helped to maintain ER homeostasis, preserve mitochondrial ultrastructure, and maximize beta-oxidation. The increased sirtuin-1/peroxisome proliferator-activated receptor-gamma coactivator 1-alpha expression implies that HIIT enhanced mitochondrial biogenesis and yielded adequate mitochondrial dynamics. High hepatic fibronectin type III domain containing 5 /irisin agreed with the antilipogenic and anti-inflammatory effects observed in the HF-HIIT group, reinforcing the antisteatotic effects of HIIT. Thus, we confirmed that practicing HIIT 3 times per week maintained insulin sensitivity, prevented ER stress, and enhanced hepatic beta-oxidation, impeding MASLD development in this mouse model even when consuming high energy intake from saturated fatty acids. HIIT prevented overweight and liver steatosis by mitochondrial and ER enhancement. Abbreviations: ACOX1, acyl-coenzyme A oxidase 1; Atf4 , activating transcription factor 4; ER, endoplasmic reticulum; GRP78, glucose-regulated protein 78; Chop , C/EBP homologous protein; Fgf21 , fibroblast growth factor 21; Gadd45 , growth arrest and DNA damage-inducible 45; Ppar , peroxisome proliferator-activated receptor-gamma coactivator 1-alpha (Pgc1-a); Xbp-a , X-box binding protein 1. Created with www.biorender.com. [Display omitted] [ABSTRACT FROM AUTHOR]

• Low serum Mn can be a noninvasive marker predicting myosteatosis among cirrhosis. • Mn concentrations negatively correlated with intramuscular adipose tissue content. • Measuring temporal Mn is a surrogate to monitor muscular abnormalities progression. Emerging evidence expands on a close connection between trace elements and muscular abnormalities, mostly focusing on sarcopenia. We hypothesized an association between concentrations of serum trace elements and myosteatosis, given that myosteatosis has a more pronounced clinical implication relative to sarcopenia, but there is a paucity of data in patients with cirrhosis. Consecutive patients were hospitalized for cirrhosis-associated complications. Serum trace elements (zinc, copper, manganese [Mn], magnesium, calcium, and iron) were measured by inductively coupled plasma mass spectrometry. The presence of myosteatosis was defined according to computed tomography–demarcated intramuscular adipose tissue content. In total, the 295 patients with cirrhosis analyzed had a median age of 63 years and 53.6% were male. Among them, 42 patients presented with myosteatosis (14.2%) and concomitant higher Model for End-stage Liver Disease-Sodium and triglyceride concentrations and lower neutrophil counts and serum Mn concentrations (all P <.05). No differences were found regarding other 5 trace elements in patients with versus without myosteatosis. The median serum Mn concentrations were 1.16 µg/L, and this population was categorized into high-Mn and low-Mn groups. The proportion of myosteatosis was significantly lower in high-Mn group than that in low-Mn group (8.1% vs 20.4%, P <.001). Univariable binary logistic regression indicated that low Mn was associated with myosteatosis (odds ratio, 2.906; 95% confidence interval, 1.424–5.932; P =.003) in the context of cirrhosis. This result was validated according to multivariable analysis by adjusting for confounding factors. In conclusion, low serum Mn can be predictive of myosteatosis, a novel muscular abnormality representing more clinical relevance and close relation to inferior outcomes among cirrhosis. Our preliminary results unveiled low serum Mn can be a noninvasive marker predicting myosteatosis among hospitalized patients with cirrhosis. We observed that concentrations of serum Mn were negatively correlated with the values of intramuscular adipose tissue content, an indicator identifying myosteatosis. Collectively, these findings implicated that temporal serum Mn may be a surrogate to keeping muscular abnormality progression under observation from both preventive and interventive insights. Abbreviations: Ca, calcium; Cu, copper; Fe, iron; Mg, magnesium; Mn, manganese; Zn, zinc. [Display omitted] [ABSTRACT FROM AUTHOR]

• Maternal copper deficiency induced growth retardation in offspring. • Maternal copper deficiency caused cardiac dysfunction and liver injury in offspring. • Autophagy is activated by copper deficiency in offspring. Maternal nutritional deficiencies during pregnancy result in birth defects and elevate the risk of cardiovascular diseases and metabolic diseases. Accumulating evidence suggests that deficiency of copper, a fundamental trace element involved in several pivotal physiological processes, promotes the onset of multiple diseases, notably heart and liver diseases. Yet, exploration into the effects of maternal copper deficiency (CuD) on offspring is still limited. In this study, we hypothesized that maternal CuD induced cardiomyopathy and liver injury in offspring through the activation of autophagy. We established a maternal CuD mouse model by feeding pregnant C57BL/6 mice with a CuD diet until the end of the experiment. Echocardiography, histological analysis, western blotting, and quantitative polymerase chain reaction were performed on offspring at postnatal day 14. We found that maternal CuD caused growth retardation and early postnatal death in the offspring. Furthermore, our results revealed that CuD induced cardiac systolic dysfunction, cardiac hypertrophy, hepatic steatosis, and liver injury. Moreover, higher expression of LC3 and lower expression of p62 were observed in the heart tissues and liver tissues of CuD mice compared with the control group, indicating that CuD induced autophagy activation. In conclusion, maternal CuD caused severely deleterious effects on the heart and liver of the offspring via activating autophagy. To explore the effect of dietary maternal CuD on offspring, we established an animal model by feeding pregnant mice with a CuD diet. We found that CuD caused cardiac systolic dysfunction and liver injury. Moreover, we presented the increased LC3 and decreased p62 in CuD mouse heart tissues and liver tissues. These results indicate that CuD causes systolic dysfunction and hepatic steatosis in offspring, which is associated with activation of autophagy. Abbreviations: CuA, copper adequate; CuD, copper deficiency. [Display omitted] [ABSTRACT FROM AUTHOR]

Beyond cardiovascular disease protection, the health consequences of very low concentrations of low-density lipoprotein-cholesterol (LDL-C) remain a matter of debate. In primary hypobetalipoproteinemia (HBL), liver steatosis and cirrhosis have occasionally been reported. Here, we aimed to investigate the association between HBL and the risk of hepatic complications (cirrhosis complications and/or primary liver cancer) in the general population. A cohort study was conducted in the French population-based cohort CONSTANCES. Participants with primary HBL (LDL-C <5th percentile for age and sex, [HBL]) were compared with those with normal LDL-C concentrations (40th-60th percentile, [Control]). Participants on lipid-lowering therapies were excluded. For hepatic complications, follow-up events were compared by calculating the incidence density ratio (IDR). The same analyses were replicated in the UK Biobank (UKBB) cohort. In the CONSTANCES and UKBB cohorts, 34,653 and 94,666 patients were analyzed, with median ages of 45 and 56 years, mean LDL-C concentrations (HBL vs. control) of 71 vs. 128 mg/dl and 86 vs. 142 mg/dl, and mean follow-up durations of 5.0 and 11.5 years, respectively. The HBL group presented a higher incidence of hepatic complications than the control group: 0.32/ vs. 0.07/1,000 person-years (IDR = 4.50, 95% CI 1.91-10.6) in CONSTANCES, and 0.69/ vs. 0.21/1,000 person-years (IDR = 3.27, 95% CI 2.63-4.06) in the UKBB. This risk proved to be independent of classic risk factors for liver disease (obesity, alcohol consumption, diabetes, viral hepatitis), including in a 5-year landmark analysis excluding early events. Sensitivity analyses based on apoliprotein-B levels (instead of LDL-C levels) or genetically defined HBL showed similar results. HBL is associated with a markedly increased risk of hepatic complications. HBL must be considered as a substantial independent risk factor for liver diseases which justifies specific prevention and screening. Hypobetalipoproteinemia (HBL) is a lipid disorder characterized by permanent, inherited low levels (below the 5th percentile) of low-density lipoprotein-cholesterol. While HBL is associated with a lower risk of cardiovascular events, some studies suggest that it may be associated with a potential risk of hepatic steatosis and hepatic complications. Here, we studied the association between HBL and hepatic complications (defined as cirrhosis complications and/or primary liver cancer) in two populations of several hundred thousand people, both in France (CONSTANCES cohort) and the United Kingdom (UKBB). The results show that HBL is associated with a significant and independent excess risk of hepatic complications, including primary liver cancer. Thus, in people with HBL, the value of regular liver monitoring must be studied. [Display omitted] • Hypobetalipoproteinemia is defined by permanent, inherited low LDL-cholesterol levels. • In two large population cohorts, hypobetalipoproteinemia increased the risk of cirrhosis complications and/or liver cancer. • This risk was observed independently of classical risk factors for liver disease (obesity, alcohol, diabetes, viral hepatitis). • Hypobetalipoproteinemia is a risk factor for liver disease complications that requires appropriate monitoring. [ABSTRACT FROM AUTHOR]

We consider a perturbation of a central force problem of the form x ¨ = V ′ (| x |) x | x | + ε ∇ x U (t , x) , x ∈ R 2 ∖ { 0 } , where ε ∈ R is a small parameter, V : (0 , + ∞) → R and U : R × (R 2 ∖ { 0 }) → R are smooth functions, and U is τ -periodic in the first variable. Based on the introduction of suitable time-maps (the radial period and the apsidal angle) for the unperturbed problem (ε = 0) and of an associated non-degeneracy condition, we apply an higher-dimensional version of the Poincaré–Birkhoff fixed point theorem to prove the existence of non-circular τ -periodic solutions bifurcating from invariant tori at ε = 0. We then prove that this non-degeneracy condition is satisfied for some concrete examples of physical interest (including the homogeneous potential V (r) = κ / r α for α ∈ (− ∞ , 2) ∖ { − 2 , 0 , 1 }). Finally, an application is given to a restricted 3-body problem with a non-Newtonian interaction. [ABSTRACT FROM AUTHOR]

Evidence shows stereotactic ablative body radiotherapy (SABR) is used as a non-invasive ablative therapy in the treatment of multisite oligometastatic (OM) and oligoprogressive (OP) diseases originating from metastatic breast cancer. This study aims to report the treatment outcomes and to investigate what factors that are prognostic in terms of local control, progression-free survival (PFS) and overall survival (OS) in patients receiving SABR for extracranial OM and OP diseases originating from metastatic breast cancer. A retrospective review on treatment records of patients with OM and OP from metastatic breast cancer who underwent SABR at a single was carried out. SABR was performed with daily image-guided radiotherapy (IGRT) using a dedicated robotic SABR machine. Local control, PFS and OS were calculated using Kaplan-Meier statistics and the post-treatment toxicity data was scored following the CTCAE v4.0 protocol. Univariate and multivariate Cox regression tests were used in the subgroup analysis of prognostic factors on PFS and OS including patients' age, types of follow-up imaging (staging CT only vs whole-body MR/PET), metastases status (OM vs OP), primary breast cancer tumour grade, hormone receptors (ER/PR/HER2) status, change of systemic treatments at SABR, number of metastases, SABR treatment sites and doses. 56 metastatic breast cancer patients (38 patients with OM and 18 patients with OP) were involved in this retrospective review. The median follow-up was 35.6 months (range 4.0–132.9 months). The estimated local control at 1 , 2 and 5 years were 90.9%, 88.7% and 88.7%, respectively. The estimated median PFS was 19.2 months (95%CI 10.3–28.1 months); the PFS at 1, 2 and 5 years were 63.3%, 44.4% and 33.2%. The estimated OS at 1, 2 and 5 years were 98.0%, 91.9% and 74.3%, respectively with the estimated median OS of 105.1 months (95%CI 51.5–158.7 months). The vast majority of patients tolerated the treatment well with the commonest acute side effects as grade 1 fatigue. There were no statistically significant factors found in OS regression analysis. The types of follow-up imaging, metastases status, oestrogen receptor status, and number of metastases for SABR were statistically significant factors (p < 0.05) in the multivariate Cox regression analysis on PFS. There are limited studies published on the efficacy and post-treatment toxicities of metastatic breast cancer OM and OP SABR with adequate length of follow-up. This study confirmed that SABR was a safe, non-invasive treatment option for patients with extracranial OM and OP diseases originated from primary breast cancer in terms of the acceptable post-treatment toxicities. • This study reported SABR treatment outcomes for multisite OM and OP diseases originating from metastatic breast cancer • It showed modest local control and post-treatment toxicities on the SABR of extracranial OM and OP from metastatic breast cancer. • The types of follow-up imaging, OM vs OP, oestrogen receptor status, and number of metastases for SABR can be used as PFS prognostic factors. [ABSTRACT FROM AUTHOR]

• Ticagrelor antithrombotic treatment can cause a significant increase in everolimus blood concentration, which can lead to severe immunosuppression, increasing the development of opportunistic infections. • Our case demonstrates that Stenotrophomonas maltophilia hemorrhagic pulmonary infection can occur without leukopenia and is independent of S. maltophilia bloodstream infection. • Rapid onset of thrombocytopenia associated with S. maltophilia infection and concomitant ticagrelor treatment can lead to hemorrhagic pneumonia. • Not only dyspnea and thrombocytopenia but also severe hyperkalemia, elevated concentrations of creatine kinase, lactate dehydrogenase, C-reactive protein, and interleukin-6 may indicate hemorrhagic pneumonia Pneumonia is a common nosocomial complication in transplant patients. Stenotrophomonas maltophilia is recognized as a common cause and is typically seen in immunocompromised and critically ill patients. S. maltophilia , a nonfermenting gram-negative rod, ranks as the third most common nosocomial pathogen, following Pseudomonas aeruginosa and Acinetobacter. The bacteria are frequently found in environmental sources and are prevalent in healthcare facilities, including in tap water faucets, shower outlets, air-cooling systems, intravenous fluids, catheters, dialysis machines, and oxygen humidifiers. This bacterium possesses the ability to rapidly form biofilms, enabling it to colonize new surfaces in less than 24 hours. While S. maltophilia generally exhibits low virulence, there remains uncertainty among many clinicians regarding whether it is merely a colonizer or the primary cause of infection. Although S. maltophilia infections are rare in immunocompetent individuals, the species is increasingly recognized as an opportunistic pathogen in vulnerable populations such as those with cystic fibrosis, cancer, and other conditions leading to immunosuppression. S. maltophilia now recognized as a causative agent in various clinical syndromes, primarily affecting the lungs and bloodstream. We present a case of S. maltophilia -associated lung infection in a kidney transplant recipient, emphasizing the significance of underlying diseases and associated signs and symptoms. [ABSTRACT FROM AUTHOR]

Shoulder stiffness following both primary anatomic and reverse total shoulder arthroplasty (TSA) is a potential complication that is likely underreported. The deleterious effects of postoperative stiffness following TSA and the burden placed on both the patient and the healthcare system have not been well studied. The purpose of this study is to determine the incidence of postoperative stiffness following primary TSA and analyze the effect it has on short-term outcomes up to 180 days following primary TSA. This was a retrospective, comparative cohort study. The Nationwide Readmissions Database was queried from 2010 to 2020 for patients who had undergone primary TSA using International Classification of Diseases Clinical Modification and Procedure Coding System codes. Patients were then separated into stiff and non-stiff cohorts. A one-to-one match was performed based on age, sex, and the Charlson comorbidity index. Statistical analyses included chi-square, sample t -tests, logistic, and linear regression. A total of 7792 subjects were included in the study. The overall incidence of postoperative stiffness was 1.8%. Patients with stiffness following primary TSA were 57% more likely to be readmitted within 180 days (odds ratio [OR] = 1.57) and had increased hospital costs by over $5000 (P <.001), but mortality rates were not increased. However, the odds of experiencing any medical complication or revision decreased by 52% and 76%, respectively, in the stiff group (OR = 0.48, and OR = 0.24, respectively). Postoperative stiffness was inversely predictive of prosthetic dislocation (OR = 0.03), loosening (OR = 0.03), and periprosthetic fracture (OR = 0.04). The incidence of postoperative stiffness following primary TSA was low at 1.8 %. These patients were found to be at increased risk for readmission within 180 days and incurred significantly higher hospital costs compared to the non-stiff cohort. However, postoperative stiffness did not increase the odds of experiencing increased medical complications, mechanical complications, mortality, or revision at 180 days. This information can help guide surgeons in discussion with and management of patients who develop stiffness following primary TSA. [ABSTRACT FROM AUTHOR]

Overlapping but divided literatures suggest certain depression facets may pose greater obesity and diabetes risk than others. Our objectives were to integrate the major depressive disorder (MDD) subtype and depressive symptom cluster literatures and to clarify which facets are associated with the greatest cardiometabolic disease risk. We conducted a systematic review of published studies examining associations of ≥2 MDD subtypes or symptom clusters with obesity or diabetes risk outcomes. We report which facets the literature is "in favor" of (i.e., having the strongest or most consistent results). Forty-five articles were included. Of the MDD subtype-obesity risk studies, 14 were in favor of atypical MDD, and 8 showed similar or null associations across subtypes. Of the symptom cluster-obesity risk studies, 5 were in favor of the somatic cluster, 1 was in favor of other clusters, and 5 were similar or null. Of the MDD subtype-diabetes risk studies, 7 were in favor of atypical MDD, 3 were in favor of other subtypes, and 5 were similar or null. Of the symptom cluster-diabetes risk studies, 7 were in favor of the somatic cluster, and 5 were similar or null. Limitations in study design, sample selection, variable measurement, and analytic approach in these literatures apply to this review. Atypical MDD and the somatic cluster are most consistently associated with obesity and diabetes risk. Future research is needed to establish directionality and causality. Identifying the depression facets conferring the greatest risk could improve cardiometabolic disease risk stratification and prevention programs. • Atypical MDD is most consistently associated with obesity and diabetes risk. • The somatic cluster is most consistently associated with obesity and diabetes risk. • Other depression facets are less associated with cardiometabolic disease risk. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND. MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340). A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality. This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND. [ABSTRACT FROM AUTHOR]

Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions. Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection. 17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3–24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000). Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs. • The all-time prevalence of mental health conditions and brain fog is 20.4% in long COVID. • The odds of mental health conditions and brain fog significantly increased over time. • The odds for brain fog being diagnosed significantly increased when validated instruments and cognitive tests were used. • The odds of brain fog significantly decreased with increasing vaccination rates. [ABSTRACT FROM AUTHOR]

Biomarkers for depression in patients with acute coronary syndrome (ACS) have not been identified. This study evaluated multiple serum biomarkers for depressive disorders after ACS. Thirteen serum biomarkers associated with seven functional systems, along with sociodemographic/clinical characteristics, were evaluated in 969 patients within 2 weeks after ACS onset (acute phase). In total, 711 patients were evaluated for depressive disorder using DSM-IV criteria 1 year later (chronic phase). Logistic regression was used for the analysis. Depressive disorders were observed in 378 patients (39.0%) in the acute phase of ACS and 183 patients (25.7%) in the chronic phase. The weighted scores of five serum biomarkers (high-sensitivity C-reactive protein, interleukin-6, homocysteine, troponin I, and creatine kinase-MB) were significantly associated with depressive disorder diagnosis in the acute phase, and the weighted scores of three other biomarkers (tumor necrosis factor-alpha, interleukin-1 beta, and homocysteine) were significantly associated with depressive disorders in the chronic phase, in a dose-dependent manner after adjusting for relevant covariates (all P -values <0.001). The combination of several serum biomarkers exhibited robust associations with depressive disorders in both the acute and chronic phases of ACS. • Biomarkers for depression in acute coronary syndrome (ACS) have not been determined. • Combination of hsCPR, IL-6, homocysteine, troponin I, CK-MB predicted depression at acute phase. • Combination of TNF-α, IL-1β, homocysteine predicted depression at chronic phase. • Multiple serum biomarkers improved identification of depression in ACS. [ABSTRACT FROM AUTHOR]

Endometriosis may be linked to the risk of iron deficiency through chronic systemic inflammation or heavy menstrual bleeding. No longitudinal studies, however, have examined the relationship between endometriosis and the risk of iron deficiency. This study included 3,294 participants born from 1973 to 1978 and followed as part of the Australian Longitudinal Study on Women's Health from 2000 to 2018. Participants with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. During each survey, participants were also asked to report the diagnosis of iron deficiency, and we validated diagnoses using an administrative health database. Generalized estimating equations for binary responses with an autoregressive correlation matrix were used to examine the association between endometriosis and the risk of iron deficiency over the seven time points. We found that women with endometriosis had a significantly higher risk of iron deficiency than those without endometriosis after adjusting for sociodemographic, lifestyle, reproductive, and nutrition factors (adjusted odds ratio [aOR] = 1.46; 95% confidence interval [CI] [1.29, 1.66]; p <.0001). Women with a surgically confirmed diagnosis and those with clinically suspected endometriosis had a higher risk of iron deficiency (aOR = 1.38; 95% CI [1.17, 1.64] and aOR = 1.53; 95% CI [1.30, 1.81]), respectively. These associations, however, were slightly attenuated (by 8%) when adjusted for the presence of heavy menstrual bleeding. Women with endometriosis are at a higher risk of developing iron deficiency than those without endometriosis. The findings suggest that iron deficiency should be concomitantly addressed during initial diagnosis and successive management of endometriosis. [ABSTRACT FROM AUTHOR]

The prevalence of overweight increases the risk of several non-communicable diseases (NCDs) and, consequently, the costs of health care systems. In this study, we aimed to project the economic burden of NCDs attributable to overweight in Brazil between 2021 and 2030. A cohort simulation of adults (17–117 years) using multistate lifetable modeling was used to estimate the costs of NCDs attributable to overweight in Brazil. The projections of direct health care costs (outpatient and inpatient expenses in the Unified Health System) and indirect costs (years of productive life lost) considered different trajectories of the prevalence of overweight between 2021 and 2030. In 2019, the prevalence of overweight was 55.4% in the adult Brazilian population. We estimate that around 1.8 billion international dollars (Int$) would be spent on the direct health care cost of NCDs between 2021 and 2030, through the continued increase in overweight prevalence observed between 2006 and 2020. The indirect costs over the same time would be approximately 20.1 billion Int$. We estimate that halving the annual increase in body mass index slope from the beginning of 2021 until 2030 would save 20.2 million Int$ direct and indirect costs by 2030. In the scenario of keeping the prevalence of overweight observed in 2019 constant until 2030, the savings would be 40.8 million Int$. Finally, in the scenario of a 6.7% reduction in the prevalence of overweight observed in 2019 (to be achieved gradually until 2030), 74.1 million Int$ would be saved. These results highlight the high economic burden of overweight in the Brazilian adult population. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is on the rise as a global health problem, but information on its burden in Asia is limited. This study aimed to assess the burden, trends, and underlying causes of HF in the Asian region. Data on HF in Asia from 1990 to 2019, including prevalence, years lived with disability (YLD), and underlying causes, were extracted from the Global Burden of Diseases 2019. The cases, the age-standardized prevalence, and the YLD were compared between the age groups, the sexes, the sociodemographic index, and the locations. The proportion of age-standardized prevalence rates of HF attributable to 16 underlying causes was also analyzed. In 2019, the age-standardized prevalence rate of HF per 100,000 persons in Asia was 722.45 (95% uncertainty interval [UI]: 591.97–891.64), with an estimated 31.89 million cases (95% UI: 25.94–39.25). From 1990 to 2019, the prevalence of age-standardized HF in Asia decreased by 4.51%, reflecting the global trend (−7.06%). Age-standardized YLD rates of HF exhibited patterns similar to prevalence rates. Among Asian countries, China had the highest age-standardized prevalence rate, followed by Kuwait and Jordan. Hypertensive heart disease was the leading cause of HF, followed by ischemic heart disease and rheumatic heart disease. Although the burden of HF in Asia showed a gradual decline between 1990 and 2019, it remains a significant health challenge that requires increased attention. Regional disparities in HF burden are evident, emphasizing the need for urgent prevention and control measures at the regional and national levels. [Display omitted] [ABSTRACT FROM AUTHOR]

The article explores the spread of ultrasound-guided injectate from the adductor canal to the genicular branch of the posterior obturator nerve and the popliteal plexus. Topics include cadaveric study and the predictive value of genicular nerve blocks for cooled radiofrequency ablation outcomes in chronic knee pain due to osteoarthritis.

To assess the association of primary and third doses of vaccination with the risk of post-acute sequelae of COVID-19. This retrospective cohort study utilized a combined database of nationwide health care claims data, COVID-19 patient registry, and vaccination records from South Korea. Individuals diagnosed with COVID-19 in the Omicron variant-dominant period of January–March 2022 were tracked for 30–120 days post-infection. The exposure of interest was the receipt of primary and third doses of the SARS-CoV-2 vaccine. The occurrence of 26 specific conditions in eight domains was compared using Cox regression with inverse probability of treatment weighting. This study included 394 773 unvaccinated individuals and 7 604 081 individuals receiving ≥2 doses of vaccine. Compared with unvaccinated individuals, vaccination with at least two doses was associated with a reduced risk (adjusted hazard ratio; 95% CI) of several conditions, including ischaemic heart disease (0.73; 0.57–0.94), heart failure (0.55; 0.48–0.63), cardiac dysrhythmia (0.72; 0.61–0.85), cardiac arrest (0.41; 0.33–0.51), pulmonary embolism (0.66; 0.52–0.84), venous thromboembolism (0.54; 0.44–0.66), acute renal failure (0.56; 0.46–0.67), new dialysis (0.45; 0.34–0.59), chronic obstructive pulmonary disease (0.74; 0.65–0.84), acute pancreatitis (0.64; 0.51–0.80), and diabetes (0.82; 0.71–0.95). The risks of heart failure, cardiac dysrhythmias, cardiac arrest, pulmonary embolism, and new dialysis were lower in those who were vaccinated with three doses compared with those who were vaccinated with two doses. Vaccination was associated with a decreased risk of post-acute sequelae of COVID-19, suggesting its potential role in mitigating the indirect impacts of COVID-19. [ABSTRACT FROM AUTHOR]

Although orthostatic hypotension (OH) and orthostatic intolerance (OI) are prevalent in patients with Parkinson disease (PD), it remains unclear how these conditions primarily affect the trajectory of decline in specific cognitive domains. This study aimed to explore the effects of OH and OI on longitudinal domain-specific cognitive changes in patients with PD. An 8-year follow-up of the Parkinson Progression Markers Initiative cohort study. A total of 403 patients with early, untreated PD and 195 matched healthy controls were included. They were classified into OH, OI, and normal groups. OH was defined according to the international consensus, and OI was defined as the presence of orthostatic symptoms without meeting the criteria for OH. The patients underwent detailed neuropsychological testing annually for up to 8 years of follow-up. Linear mixed effects models were used to investigate the associations between OH, OI, and longitudinal cognitive changes. The prevalence of both OH and OI in patients with PD was significantly higher than that in controls (13.4% vs 7.2%, P =.002, for OH, and 29.3% vs 14.4%, P <.001, for OI). The OH group in patients with PD showed a faster decline in Letter-Number Sequencing (LNS) (β = −0.11, 95% CI −0.20 to −0.02, t = −2.44, P =.015) and Semantic Fluency Test (SFT) (β = −0.44, 95% CI –0.81 to −0.08, t = −2.42, P =.016) scores than the normal group. Similarly, the OI group showed a steeper decline in LNS (β = −0.08, 95% CI –0.14 to −0.01, t = −2.20, P =.028) and SFT (β = −0.36, 95% CI –0.63 to −0.08, t = −2.55, P =.011) scores compared to the normal group. There were no significant longitudinal changes in the other neuropsychological test scores between the groups. Both OH and OI may be associated with a faster decline in executive function among cognitive domains of patients with PD. These findings may highlight the potential importance of orthostatic blood pressure control in PD patients with OH and even those with orthostatic symptoms without OH. [ABSTRACT FROM AUTHOR]

[Display omitted] • CC16 is an anti-inflammatory, immunomodulatory protein expressed in respiratory club cells. • Severe abdominal obesity and arterial hypertension robustly decrease serum CC16. • ACEi/ARBs, uricosurics and chronic heart failure robustly increase serum CC16. • Effects might be mediated by adipose tissue inflammation as well as RAAS and uric acid disturbance. • Findings indicate a complex interplay of the metabolic, respiratory and cardiovascular system. Clara cell 16-kDa protein (CC16) is an anti-inflammatory, immunomodulatory secreted pulmonary protein with reduced serum concentrations in obesity according to recent data. Studies focused solely on bodyweight, which does not properly reflect obesity-associated implications of the metabolic and reno-cardio-vascular system. The purpose of this study was therefore to examine CC16 in a broad physiological context considering cardio-metabolic comorbidities of primary pulmonary diseases. CC16 was quantified in serum samples in a subset of the FoCus (N = 497) and two weight loss intervention cohorts (N = 99) using ELISA. Correlation and general linear regression analyses were applied to assess CC16 effects of lifestyle, gut microbiota, disease occurrence and treatment strategies. Importance and intercorrelation of determinants were validated using random forest algorithms. CC16 A38G gene mutation, smoking and low microbial diversity significantly decreased CC16. Pre-menopausal female displayed lower CC16 compared to post-menopausal female and male participants. Biological age and uricosuric medications increased CC16 (all p < 0.01). Adjusted linear regression revealed CC16 lowering effects of high waist-to-hip ratio (est. −11.19 [−19.4; −2.97], p = 7.99 × 10−3), severe obesity (est. −2.58 [−4.33; −0.82], p = 4.14 × 10−3) and hypertension (est. −4.31 [−7.5; −1.12], p = 8.48 × 10−3). ACEi/ARB medication (p = 2.5 × 10−2) and chronic heart failure (est. 4.69 [1.37; 8.02], p = 5.91 × 10−3) presented increasing effects on CC16. Mild associations of CC16 were observed with blood pressure, HOMA-IR and NT-proBNP, but not manifest hyperlipidemia, type 2 diabetes, diet quality and dietary weight loss intervention. A role of metabolic and cardiovascular abnormalities in the regulation of CC16 and its modifiability by behavioral and pharmacological interventions is indicated. Alterations by ACEi/ARB and uricosurics could point towards regulatory axes comprising the renin-angiotensin-aldosterone system and purine metabolism. Findings altogether strengthen the importance of interactions among metabolism, heart and lungs. [ABSTRACT FROM AUTHOR]

This article aims to analyze which of the main arthroscopic discopexy techniques has the best results and if there are differences between the techniques for both pain and maxillary intercuspid opening. A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed with no publication date restriction in PubMed, Ovid and Embase. The PICO criteria: (P) Patients: With temporomandibular internal disorders with discopexy indication. (I) Intervention: Temporomandibular joint arthroscopic discopexy. (C) Comparison: Arthroscopic discopexy among different techniques classified as non-rigid, semi-rigid and rigid. (O) Outcomes: Impact in clinical conditions such as pain and maximum mouth opening. The inclusion criteria were Patients with temporomandibular internal disorders with discopexy indication performed with different techniques classified as non-rigid, semi-rigid and rigid. The outcomes evaluated were pain and maximum mouth opening. Case series, cohort studies, quasi-experimental studies, and randomized clinical trials with at least 3 months of follow-up were included. The exclusion criteria considered were patients with related concomitant surgeries, patients with associated neoplastic disease or connective tissue disease. A total of 1515 joints where 1400 discopexies were performed including 849 females and 204 males. The most common diagnostic was Wilkes stage III in 257 joints. For pain and oral opening, the semi-rigid technique shows the best results median (MD) 4.84 (CI 2.52–7.16; p = 0.001, I2:100%), MD -2.78 (CI -4.34, −1.21; p = 0.001, I2:99%), respectively. The rigid technique has the greatest probability for complications MD 0.14 CI 95% (0.00, −0.28). Although the semi-rigid technique showed better results, there is no statistically significant difference. However, due to the heterogeneity of the studies, the results should be interpreted with caution. [ABSTRACT FROM AUTHOR]

• Lp(a) level should be measured at least once in all adults. • Lp(a) levels represent a continuum of risk, not a risk threshold at a dichotomous cutpoint. • Risk classification by Lp(a) level ranges from low (<75 nmol/L) to high (≥125 nmol/L). • Lp(a) risk categories apply across races and ethnicities. • High Lp(a) levels warrant early and more-intensive risk factor management. Since the 2019 National Lipid Association (NLA) Scientific Statement on Use of Lipoprotein(a) in Clinical Practice was issued, accumulating epidemiological data have clarified the relationship between lipoprotein(a) [Lp(a)] level and cardiovascular disease risk and risk reduction. Therefore, the NLA developed this focused update to guide clinicians in applying this emerging evidence in clinical practice. We now have sufficient evidence to support the recommendation to measure Lp(a) levels at least once in every adult for risk stratification. Individuals with Lp(a) levels <75 nmol/L (30 mg/dL) are considered low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) are considered high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30–50 mg/dL) are at intermediate risk. Cascade screening of first-degree relatives of patients with elevated Lp(a) can identify additional individuals at risk who require intervention. Patients with elevated Lp(a) should receive early, more-intensive risk factor management, including lifestyle modification and lipid-lowering drug therapy in high-risk individuals, primarily to reduce low-density lipoprotein cholesterol (LDL-C) levels. The U.S. Food and Drug Administration approved an indication for lipoprotein apheresis (which reduces both Lp(a) and LDL-C) in high-risk patients with familial hypercholesterolemia and documented coronary or peripheral artery disease whose Lp(a) level remains ≥60 mg/dL [∼150 nmol/L)] and LDL-C ≥ 100 mg/dL on maximally tolerated lipid-lowering therapy. Although Lp(a) is an established independent causal risk factor for cardiovascular disease, and despite the high prevalence of Lp(a) elevation (∼1 of 5 individuals), measurement rates are low, warranting improved screening strategies for cardiovascular disease prevention. [Display omitted] [ABSTRACT FROM AUTHOR]

• Multifactorial chylomicronemia syndrome (MCS) increases the risk of acute pancreatitis (AP). • Environmental and genetic factors are known to influence the risk of AP in MCS. • Polygenic risk score (PRS) assesses the impact of common genetic variants. • We show that a high pancreatitis-PRS was associated with an increased risk of AP in MCS. • PRS could help clinicians to identify MCS patients at higher risk of AP. Multifactorial chylomicronemia syndrome (MCS) is a severe form of hypertriglyceridemia associated with an increased risk of acute pancreatitis (AP). The risk of AP is heterogenous and is associated with increased level of triglycerides (TG) and presence of rare variants in TG metabolism-related genes. To determine if the accumulation of common variants in pancreatitis susceptibility genes, measured with a weighted polygenic risk score (PRS), is associated with AP in MCS patients. A total of 114 patients with MCS underwent genetic testing for eight single nucleotide polymorphisms (SNPs) in known pancreatitis susceptibility genes (ABCG8, CLDN2, CTRB1/2, CTRC, PRSS1, PRSS2, SPINK1 and TWIST2). A weighted PRS was calculated to account for the phenotypic effect of each SNP locus. A high pancreatitis-PRS score (≥ 0.44) was associated with a 2.94-fold increase risk of AP (p = 0.02) among patients with MCS. MCS patients with a high pancreatitis-PRS and a rare variant in TG metabolism-related gene have a 9.50-fold increase risk of AP (p = 0.001), compared to those with a low-PRS and no rare variant. A multivariate analysis including the presence of rare variants, the maximal TG values and a high pancreatitis-PRS explained 26% of the variability in AP in MCS patients. This study shows for the first time that the accumulation of common variants in pancreatitis susceptibility genes is associated with AP in MCS patients. Pancreatitis-PRS could help clinicians to identify MCS patients who may be at higher risk of AP and who may benefit from more aggressive treatment. [ABSTRACT FROM AUTHOR]

• The first comparative study of lipid ratios in youth and their relationship to subclinical atherosclerosis. • Triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) had the highest correlation with arterial stiffness. • TG/HDL-C had the highest correlation with small, dense LDL cholesterol. • All lipid ratios investigated were independent predictors of arterial stiffness with TG/HDL-C being the strongest predictor. Elevated lipid levels are risk factors for early atherosclerosis. Lipid ratios have emerged as potentially stronger predictors of adverse cardiovascular changes and atherogenic cholesterol. Risk stratification in youth with obesity or type 2 diabetes may be improved by using lipid ratios. We sought to determine if lipid ratios would identify abnormalities in arterial structure and stiffness in adolescents and young adults. A total of 762 youth aged 10-24 years had laboratory, anthropometric, blood pressure, and carotid intima-media thickness and arterial stiffness data collected. Subjects were stratified into tertiles (low, mid, high) of lipid ratios and non-high-density lipoprotein cholesterol (HDL-C). Vascular outcomes by tertile were assessed by analyses of variance. General linear models were constructed for each lipid value and included demographics, risk factors, and vascular measures. Correlations between lipid markers, vascular measures, and low-density lipoprotein (LDL) particle size and number were conducted. There was a progressive increase in arterial thickness and stiffness across all three lipid ratios and non-HDL-C. The triglyceride to HDL-C (TG/HDL-C) ratio remained an independent predictor of arterial thickness and stiffness after adjusting for other cardiovascular risk factors. TG/HDL-C had the highest correlations with arterial stiffness and small, dense LDL. Arterial stiffness is increased in youth with high lipid ratios with TG/HDL-C being the most consistent marker of vascular changes. These data suggest that identification of high TG/HDL-C in these individuals may lead to earlier intervention to prevent atherosclerotic cardiovascular disease. [ABSTRACT FROM AUTHOR]

• Among 762 patients with LDL-C≥190 mg/dL without a history of ASCVD or heart failure, coronary artery calcification (CAC), and thoracic aortic calcification (TAC) scores were associated with increased rates of HF hospitalizations. However, only CAC demonstrated an independent association with HF hospitalizations. • EAT, and NAFLD are known cardiometabolic risk factors but were not associated with increased HF hospitalizations in this cohort. • Adding ordinal CAC score to traditional risk factors improved risk stratification for HF hospitalizations. • Given the number of non-cardiac chest CT scans performed in clinical practice, this could represent an opportunity to capitalize on risk information. Coronary artery calcium (CAC), thoracic aorta calcification (TAC), non-alcoholic fatty liver disease (NAFLD), and epicardial adipose tissue (EAT) are associated with atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). We aimed to determine whether these cardiometabolic and atherosclerotic risk factors identified by non-contrast chest computed tomography (CT) are associated with HF hospitalizations in patients with LDL-C≥ 190 mg/dL. We conducted a retrospective cohort analysis of patients with LDL-C ≥190 mg/dL, aged ≥40 years without established ASCVD or HF, who had a non-contrast chest CT within 3 years of LDL-C measurement. Ordinal CAC, ordinal TAC, EAT, and NAFLD were measured. Kaplan-Meier curves and multivariable Cox regression models were built to ascertain the association with HF hospitalization. We included 762 patients with median age 60 (53–68) years, 68% (n=520) female, and median LDL-C level of 203 (194–216) mg/dL. Patients were followed for 4.7 (interquartile range 2.75–6.16) years, and 107 (14%) had a HF hospitalization. Overall, 355 (47%) patients had CAC=0, 210 (28%) had TAC=0, 116 (15%) had NAFLD, and median EAT was 79 mL (49-114). Moderate-Severe CAC (log-rank p <0.001) and TAC (log-rank p=0.006) groups were associated with increased HF hospitalizations. This association persisted when considering myocardial infarction (MI) as a competing risk. NAFLD and EAT volume were not associated with HF. In patients without established ASCVD and LDL-C≥190 mg/dL, CAC was independently associated with increased HF hospitalizations while TAC, NAFLD, and EAT were not. Association of cardiometabolic and atherosclerotic markers on non-contrast Chest CT with Heart Failure Hospitalization in Patients with Severe Hypercholesterolemia. * Unadjusted Hazard Ratio for the moderate-to-severe category. ASCVD: atherosclerotic cardiovascular disease, CAC: coronary artery calcification. HF: heart failure, LDL-C: low-density lipoprotein cholesterol, NAFLD: non-alcoholic fatty liver disease, TAC: thoracic aorta calcification. [Display omitted] [ABSTRACT FROM AUTHOR]

Children with neurodisabilities are a very diverse group. Endocrine dysfunction is not always anticipated but screening for potential risk of developing hypopituitarism is important in clinical practice. Hypopituitarism in children with neurodisability can be part of an underlying congenital syndrome or acquired. Diagnosis of hypopituitarism on clinical grounds is challenging in some cases. Accurate growth monitoring is more difficult in this group due to orthopaedic factors, such as spasticity, spinal deformities such as scoliosis or joint contractures. Moreover, the signs and symptoms of hypopituitarism may mimic those associated with their neurodisability itself. These can overlap or exacerbate each other and the onset is sometimes insidious. In this review, we focus on the pituitary hormone deficiencies most commonly associated with neurodisability and offer practical advice for healthcare professionals. We explain when it is important to consider further pituitary function investigations and when and why referral to a paediatric endocrinologist is required. [ABSTRACT FROM AUTHOR]

• MASLD is the most common liver disease worldwide and the most growing liver transplant indication in Western countries. • The natural course of the disease exhibits significant dynamism and bidirectionality. • The fibrosis stage is the most accurate predictor of mortality. • Cardiovascular disease and associated events are the predominant contributing factors to death among MASLD patients. • MASH-related decompensated cirrhosis appears to have worse prognosis than decompensated cirrhosis of other etiologies. Metabolic dysfunction-associated steatotic liver disease (MASLD), which has been the term for non-alcoholic fatty liver disease (NAFLD) since June 2023, represents the most common liver disease worldwide and is a leading cause of liver-related morbidity and mortality. A thorough knowledge of the disease's natural history is required to promptly stratify patients' risks, since MASLD is a multifaceted disorder with a broad range of clinical phenotypes. The histological disease spectrum ranges from isolated hepatic steatosis, currently named as metabolic dysfunction-associated steatotic liver (MASL), to metabolic dysfunction-associated steatohepatitis (MASH) and eventually may accumulate hepatic fibrosis and develop cirrhosis and/or hepatocellular carcinoma (HCC). Several risk factors for fibrosis progression have been identified, while the disease's progression displays notable dynamism and bidirectionality. When compared to the general population, all MASLD histological stages are substantially related with greater overall mortality, and this association exhibits a disease severity-dependent pattern. Interestingly, the fibrosis stage is the most accurate predictor of mortality among MASLD patients. The mortality attributed to MASLD predominantly stems from issues linked with the liver and cardiovascular system, as well as HCC and extrahepatic cancers. In light of the disease natural course, it is crucial to prioritize the identification of at-risk patients for disease progression in order to effectively address and change modifiable risk factors, hence mitigating disease complications. Further investigation is required to define the phenotype of rapid progressors more precisely as well as to improve risk stratification for HCC in non-cirrhotic individuals. [ABSTRACT FROM AUTHOR]

Henoch Schönlein purpura (HSP) and Kawasaki disease (KD) are two main inflammatory diseases among childhood vasculitis. Considering the anti-inflammatory effects of 25-hydroxyvitamin D3, we decided to investigate the association of serum 25-hydroxy vitamin D3 level with the type and severity of these conditions. The present study was performed as a historical cohort of 254 affected children with KD and HSP vasculitis. The required data were extracted, using a researcher-made questionnaire from patients' electronic file, and then they were analyzed after collecting information of the patients. In HSP group, 54% of participants were boys. Similarly, in KD group, boys were more affected than girls. The comparative 25-hydroxyvitamin vitamin D3 level in HSP patients with and without renal involvement (P = 0.02), hematuria (P = 0.14), and in two groups with and without heart disease, and also with and without coronary artery dilatation in KD patients (P < 0.001) were significant. The findings showed that insufficient level of vitamin D3 were significantly associated with the exacerbation of complications of both diseases, and therefore it seems that vitamin D deficiency can be an effective predictive factor of severity in HSP and KD patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the shape of the time-varying relationship between herpes zoster infection, nominally shingles, and the occurrence of stroke. Retrospective cohort study. Using the Italian Health Search Database, a cohort of patients aged ≥18 years who were registered between 2002 and 2021 was selected. In this cohort, a nested case–control analysis was used to model the time-varying distance (in months) between the dates of shingles and post-herpetic stroke, using a regression cubic spline, based on the odds of the occurrence of stroke compared with those without shingles. The dataset comprised 42,513 cases (51.1% males; mean age [stanndard deviation {SD}]: 71.0 [11.8] years) and 425,124 related controls (51.1% males; mean age [SD]: 70.9 [12] years). In the first 12 months following shingles diagnosis, a rapid increase in the risk of stroke was observed, reaching an odds ratio of 1.31 (95% confidence interval: 1.21–1.41); subsequently, there was some risk reduction and a new symmetric increase within the first 4.2 years of follow-up, thus shaping a bimodal distribution. Then, a new increase in the stroke risk was reported, although less steep, which was followed by a regular risk reduction (still 10% higher compared with those without shingles), resulting in a right-skewed relationship between the time from the shingles diagnosis and the occurrence of stroke. This association was no longer statistically significant 13.1 years after shingles diagnosis. This study demonstrated that the risk of post-herpetic stroke has a short- and long-term association according to a risk continuum relationship. These findings confirm the relevance of vaccination coverage for herpes zoster. [ABSTRACT FROM AUTHOR]

Studies have reported increased rates of long-term neuropsychiatric sequelae after SARS-CoV-2 infection using electronic health-record (EHR) data; however, the majority were conducted before Omicron and booster rollout. We estimated the long-term risks and excess burdens of pre–specified new-incident neuropsychiatric diagnoses after Delta versus Omicron BA.1/2 infection in a highly-vaccinated and boosted cohort of adult Singaporeans. The national SARS-CoV-2 testing registry was used to construct cohorts of Singaporean adults infected during periods of Delta and Omicron BA.1/2 predominance and a contemporaneous test-negative control group. New-incident neuropsychiatric diagnoses recorded in the national health care claims database were identified up to 300 days postinfection. Risks and excess burden were estimated using a doubly robust competing-risks survival analysis. 104 179 and 375 903 infected cases were assigned to Delta and Omicron cohorts and compared against test-negative controls (Delta: N = 666 575 and Omicron: N = 619 379). Elevated risk of cognition or memory disorders was consistently reported across Omicron (Adjusted hazards ratio [aHR], 1.24; 95% CI, 1.12–1.38) and Delta cohorts (aHR, 1.63; 95% CI, 1.39–1.92). Delta-variant infection was associated with an increased risk of anosmia or dysgeusia (aHR, 4.53; 95% CI, 2.78–7.41) and psychosis (aHR, 1.65; 95% CI, 1.22–2.22). By contrast, Omicron-variant infection was associated with a risk of abnormal involuntary movements (aHR, 1.93; 95% CI, 1.32–2.83). Risks of neuropsychiatric sequelae predominantly accrued in hospitalized individuals. A modestly increased risk of cognition and memory disorders at 300 days after SARS-CoV-2 infection was observed among adult Singaporeans infected during the Delta/Omicron BA.1/2 transmission. There was no overall increased risk of neuropsychiatric sequelae observed across other domains. Variant-specific differences were also observed in individual neuropsychiatric sequelae, including an elevated risk of anosmia or dysgeusia after Delta-variant infection. [ABSTRACT FROM AUTHOR]

Fetal anaemia is a relatively rare occurrence, but it carries a risk of significant fetal morbidity and mortality. The most common causes of fetal anaemia are haemolytic disease of fetus and newborn and parvovirus B19 infection. The only diagnostic test for fetal anaemia is fetal blood sampling, but this is an invasive test with associated risk of miscarriage, preterm membrane rupture or intrauterine fetal death. Therefore it is only performed if there is a strong suspicion of fetal anamia based on the patient's history and ultrasound findings of raised peak systolic velocity in middle cerebral artery and/or fetal hydrops. The treatment for fetal anaemia is symptomatic rather than curative in most of the cases. In severely anaemic fetuses intrauterine blood transfusion is undertaken which corrects the anaemia but does not deal with the underlying cause. The aim of this intervention is to reach the gestation when the delivery is safer. [ABSTRACT FROM AUTHOR]

Individuals with rotator cuff-related shoulder pain (RCRSP) have altered proprioception. The relationship between shoulder pain and proprioception is not well understood. This study aimed to investigate the relationship between shoulder pain and proprioception. This was a cross-sectional comparative study. Twenty-two participants with RCRSP (mean age 27.6 ± 4.8 years) and 22 matched pain-free participants (23.4 ± 2.5 years) performed two upper limb active joint position sense tests: (1) the Upper Limb Proprioception Reaching Test (PRO-Reach; reaching toward seven targets) in centimeters and (2) Biodex System at 90% of maximum internal rotation in degrees. Participants performed three memorization and three reproduction trials blindfolded. The proprioception error (PE) is the difference between the memorized and estimation trials. Pain levels were captured pre- and post-evaluation (11-point Likert Numerical Pain Rating Scale). Relationships between PE and pain were investigated using independent t- tests and Spearman rank correlations. Overall, 22.7% RCRSP participants indicated an increase in pain following the PRO-Reach (X̅ increase of 1.4 ± 1.5 points), while 59% did so with the Biodex (X̅ increase of 2.3 ± 1.8 points), reflecting a clinically important increase in pain. Weak-to-moderate correlations between pain and PEs were found with the Biodex (r = 0.39-0.53) and weak correlations with the PRO-Reach (r = −0.26 to 0.38). Concerning PEs, no significant differences were found between groups with the Biodex (p = 0.32, effect size d = −0.31 [−0.90 to 0.29]). The RCRSP participants demonstrated lower PEs with the PRO-Reach in elevation compared to pain-free participants (global X̅ = 4.6 ± 1.2 cm vs 5.5 ± 1.5 cm; superior 3.8 ± 2.1 cm vs 5.7 ± 2.9 cm; superior-lateral nondominant targets 4.3 ± 2.2 cm vs 6.1 ± 2.8 cm; p = 0.02-0.05, effect size d = 0.72-0.74 [0.12-1.3]). Individuals with RCRSP demonstrated better upper limb proprioception in elevation, suggesting a change to interoception (sensory reweighting) in the presence of pain. • Associations between pain and upper limb proprioception are weak to moderate. • Individuals with RCRSP have better upper limb proprioception when reaching. • There is a possibility of a change to interoception in the presence of pain. • Our understanding of proprioception in the presence of pain is still developing. [ABSTRACT FROM AUTHOR]

Ankle instability is a common problem in children and adolescents. What may seem like an initial, relatively benign ankle injury for a child may lead to chronic pain, chronic instability and gradual loss of the ability to participate in certain activities. The complications of an ankle injury can include osteochondral defects, which may require urgent surgical attention and may be associated with an increased long-term risk of osteoarthritis. This article aims to provide trainees and general orthopaedic surgeons with a systematic approach to the assessment, diagnosis and management of ankle instability in the paediatric population. We explore the mechanisms of the initial injury together with factors that may increase the risk of injury to the child. Guidance on clinical examination and of the ankle joint is provided. Though short periods of immobilization and proprioceptive activities are the mainstay of treatment, there is a small subset of these patients who will benefit from further imaging and surgical intervention to prevent the chronic sequelae of ankle instability. [ABSTRACT FROM AUTHOR]