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Objectives: Adolescent athletes with a primary anterior glenohumeral dislocations have been shown to have a relatively high incidence of recurrent instability. Evolving evidence on this topic has led to increasing rates of arthroscopic stabilization over the last 2 decades. However, the timing and role of surgery following a single dislocation episode is one of the most controversial topics in orthopaedics. While arthroscopic stabilization is effective in allowing return to play, adolescents have higher rates of subsequent recurrent instability than any other age group. Identifying patients at highest risk of such events postoperatively may facilitate optimized surgical decision-making in this population. The purpose of this study was to identify prognostic factors that are associated with recurrent instability requiring reoperation following arthroscopic Bankart repair in adolescents, with particular attention to the number of dislocations sustained prior to the index procedure. Methods: All patients 12 to 21 years old who had undergone arthroscopic Bankart repair surgery for anterior glenohumeral instability at a pediatric tertiary care hospital between 2000 and 2020 were included. The analysis was conducted using a multivariate Cox proportional hazards model, with percentage of patients with recurrent instability requiring a re-operation evaluated in a time-to-event analysis as the outcome. The effects from the Cox model were expressed as the hazard ratio (HR). All tests were 2-sided, with an alpha level of.05. Results: A total of 488 adolescent patients (78% male; mean age: 16.9 +/- 1.98 years) met study criteria, with the most common primary sports consisting of football (n=141, 29%), hockey (n=47, 10%), basketball (n=40, 8%), baseball (n=33, 7%), and lacrosse (n=30, 6%). A total of 270 (55%) athletes participated in contact sports, while 95 (20%) were overhead athletes. Overall, 86 patients (17.6%) required revision stabilization surgery for recurrent instability, with a cumulative risk of 8.8% at 2 years, 16.5% at 5 years, and 20% at 15 years. The revision stabilization procedures occurred at a mean of 31.1 +/- 25.1 months from the index procedure and consisted of open Latarjet (n=42, 49%), revision arthroscopic stabilization (n=24, 28%), or open capsulorraphy (n=20, 23%). Risk factors for recurrent instability requiring revision stabilization included more than 1 dislocation episode prior to the index procedure (2 dislocations: HR=7.4 (2.5-21.6), p=0.0003; 3+ dislocations: HR=10.9 (3.9 to 30.5), p<0.0001), presence of a Hill-Sachs lesion (small Hill-Sachs: HR=2.5 (1.2-5.1), p=0.0114; medium-large Hill-Sachs: HR=4.2 (1.9-9.3), p=0.0004), younger age at the time of the index stabilization procedure (one year decrease in age: HR=1.2 (1.1-1.4), p=0.0015), and participation in contact sports (HR=1.8 (1.1-2.9), p=0.01). Adolescents who had sustained 1 dislocation prior to surgery had a cumulative incidence of revision surgery (3.2%) that was significantly lower than those who had sustained 2 dislocations (24.2%) or 3+ dislocations (33.5%). Conclusions: The number of dislocation episodes prior to index arthroscopic Bankart repair was the strongest risk factor for recurrent instability requiring revision surgery in adolescents with anterior glenohumeral instability, with two dislocation episodes conferring more than 7-fold increased risk compared to those who had just a single dislocation episode preoperatively. Other significant risk factors included the presence of a Hill-Sachs lesion, younger age, and participation in contact sports. These data support consideration for arthroscopic stabilization for adolescents following a single dislocation, especially in younger patients, contact athletes or when a Hill Sachs lesion is present. [ABSTRACT FROM AUTHOR]

Chronic lymphocytic leukemia (CLL) is a malignancy defined by the accumulation of mature lymphocytes in the lymphoid tissues, bone marrow, and blood. Therapy for CLL is guided according to the Rai and Binet staging systems. Nevertheless, state-of-the-art protocols in disease monitoring, diagnostics, and prognostics for CLL are based on the assessment of minimal residual disease (MRD). MRD is internationally considered to be the level of disease that can be detected by sensitive techniques and represents incomplete treatment and a probability of disease relapse. MRD detection has been continuously improved by the quick development of both flow cytometry and molecular biology technology, as well as by next-generation sequencing. Considering that MRD detection is moving more and more from research to clinical practice, where it can be an independent prognostic marker, in this paper, we present the methodologies by which MRD is evaluated, from translational research to clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to quantify the rate and timing of recurrent ulnar collateral ligament (UCL) injuries among elite baseball players. Whereas several prior works focused on rates of return to play and performance after UCL reconstruction, the literature lacks evidence on recurrence rates for UCL injuries, especially for non-operative injuries. Addressing this literature gap is important because of the emphasis that team physicians place on UCL injury history as a determinant of future UCL injury risk. In a landmark study that surveyed Major League Baseball (MLB) team physicians and achieved an 80% response rate, McGahan et al. found that 60% of team physicians rated any prior UCL injury (regardless of injury severity or treatment modality) as "moderate risk" for future injury among pitchers entering the MLB draft. In the same survey, 52% of team physicians rated recent UCL strain as a "severe risk" for future injury among the same player cohort. The present study is the first to use comprehensive data from MLB on UCL injuries to quantify the frequency of recurrence and when these injuries are likely to recur. Quantifying the recurrence rate of UCL injuries is important for players at all levels of competition, including those without a documented injury history. For example, one single-center study found that 34% of asymptomatic MLB and Minor League Baseball (MiLB) players screened with a pre-signing MRI had evidence of UCL signal heterogeneity. Alternatively, if the recurrence rate of UCL injuries is relatively low, then players and teams may be inappropriately weighting prior injury as a predictor of future injury risk. This study builds on the work of McGahan et al. by quantifying the recurrence rate of UCL injuries in professional baseball players and defines the typical number of seasons until recurrence. These data will provide critical information to players, team management, and team physicians at all levels of competition with an eye toward better informing health and safety decisions. Methods: This study uses data supplied by Major League Baseball's Health and Injury Tracking System (HITS) on all MLB and MiLB players from 2010-2021. A comprehensive list of UCL injuries (regardless of severity or initial treatment modality) was generated by reviewing every elbow injury in MLB and MiLB during the study period. Use of this data source marks an important departure from prior studies on similar topics that relied on public injury reports to determine if a player had a UCL injury. Instead, these data are generated by the athletic trainers, team surgeons, and league office and are therefore more comprehensive than earlier studies of similar questions. Within HITS, each player is given a unique player identifier and each injury event is given a unique injury event identifier. Thus, if a player is injured in two separate seasons, the player ID would be present in both years but the event ID would be different. This differentiation allows player tracking over time and to determine when an injury recurs. We calculated the number of UCL injuries in each season of 2010-2016 and then determined the five-year recurrence rate. We chose the five-year time point because the median professional baseball career length is 5 seasons. We therefore present data on the five-year recurrence rate for the 2010-2016 seasons, but rely on data from throughout the study period (2010-2021) to determine those rates. We subsequently determined the median and interquartile range for when a recurrence was most likely to occur. Next, we calculated the five recurrence rate among players whose initial injury was managed non-peratively. Finally, we quantified the rate at which recurrent injuries were managed operatively stratified by initial treatment modality. Results: Throughout the study period (2010-2016), there were 1,766 documented UCL injuries. Of these injuries, 820 (46%) were managed initially with surgery, 177 (10.0%) recurred within five years, with a median of two seasons (Interquartile range [IQR] 1-3 seasons) until recurrence. When a recurrence occurred, 107 players (60.5%) underwent surgery, regardless of initial treatment modality. Among injuries that were initially treated non-operatively (946 injuries), 126 players (13.3%) experienced a recurrence within five years, with a median of two seasons (IQR 1-3 seasons) until recurrence, and 87 players (69.0%) underwent surgery to treat the recurrence. Conclusions: The present study offers the most comprehensive data to date on the natural history of UCL injuries among elite baseball players. As McGahan et al. showed, many team physicians use a history of UCL injury as an indicator of future UCL injury risk. It is therefore important to identify the risk of injury recurrence during the typical professional baseball career. We found a relatively low recurrence rate of 10% within the median professional baseball career length of five years. Even players who were initially treated non-operatively (identified by McGahan et al. as being perceived to be more likely to sustain a future UCL injury) had a relatively low five-year recurrence rate of 13.3%. Importantly, the majority of recurrences underwent surgery, suggesting that the risk tolerance for future recurrences beyond the first recurrence is similarly low. These results highlight the importance of understanding the natural history of common injuries among athletes across all levels of competition, and can be used to inform risk reduction plans for athletes across the competitive landscape. [ABSTRACT FROM AUTHOR]

Objectives: Social determinants of health (SDOH) are comprised of a patient's environmental conditions including social and economic factors, which influence access to health care and resources. Growing evidence in orthopaedic surgery has revealed that SDOH factors lead to differential access to care and ultimately health disparities after surgery. For shoulder instability, previous literature has demonstrated that the number of previous dislocations before a stabilization procedure increases the risk of recurrent instability after the procedure. The purpose of this study was to investigate the impact of SDOH on the number of dislocation events before surgical intervention. Methods: A retrospective review of patients who underwent shoulder stabilization surgery at a health system in a large metropolitan area between January 1, 2021 and April 13, 2023 were identified. Patients' demographic and social determinants variables were extracted using the electronic medical record. Social Vulnerability Index (SVI) socioeconomic subscore and Area of Deprivation Index (ADI) were collected using online mapping data based on patient zip codes. The number of dislocation events and the time they occurred were determined using clinical charts. Operative variables collected included the date of surgery to determine the time from clinical presentation to surgery and the procedure performed. Univariate linear regression analysis was used to evaluate potential predictors of increasing time to presentation and increasing time to surgery. Univariate logistic regression analysis was also performed of all potential predictors of having >1 dislocation event. A multivariate model was then created using all predictors with a P value < 0.05 in the univariate models. Results: There were 106 patients who underwent shoulder surgery for instability, including arthroscopic and open stabilization, and had complete social determinant data, with 54% (n = 57) identifying as White, 29% (n = 31) as Black/African American, and 17% (n = 18) as other. A total of 38 (35.8%) patients suffered 1 dislocation (single dislocation cohort) before undergoing surgery, and 68 (64.2%) experienced > 1 dislocation (recurrent cohort) before surgery. No significant variables were associated with increasing time to presentation or surgery. Univariate logistic regression revealed that decreasing age (odds ratio [OR] 0.94 [95% confidence interval (CI) 0.89- 0.99]; P = 0.02), decreasing body mass index (BMI) (OR 0.90 [95% CI 0.83-0.98]; P = 0.02), increasing SVI (OR 1.21 [95% CI 1.05-1.38]; P = 0.006), and increasing area deprivation index (ADI) (third tercile compared to first, OR 6.04 [95% CI 2.05-17.8]; P = 0.003) were associated with increased odds of having > 1 instability event before surgical intervention. There was no association with race found in terms of number of dislocations before surgery. Multivariate logistic regression modeling revealed that decreasing BMI (OR 0.87 [95% CI 0.78-0.98]; P = 0.02) and increasing ADI (third tercile compared to first tercile, OR 7.46 [95% CI 1.26-44.2]; P = 0.02) were associated with increased odds of having > 1 instability event before shoulder instability surgery. Conclusions: Lower socioeconomic status, as measured by ADI, is an independent predictor of a higher likelihood of recurrent instability before shoulder stabilization surgery. Recognizing these relationships may motivate surgeons to create pathways to prevent these treatment disparities among shoulder instability patients. Further studies are required to examine if these SDOH variables lead to disparities in postoperative outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Despite a known risk of cellulitis recurrence, the management of the wider impact and risk factors has been neglected. The innovative National Cellulitis Improvement Programme (NCIP) addresses this by providing evidence-based and individualised care to improve patient reported outcomes and reduce the risk of recurrence. The aim of this paper is to examine the longer-term impact of cellulitis and to identify a suitable and clinically relevant Patient Reported Outcome Measure (PROM). Methods: A review of existing cellulitis-specific PROMs was undertaken, alongside literature detailing the patient-focused impact of cellulitis, to identify a suitable PROM for clinical use. A group of expert therapists and patient representatives (n = 14) shared their individual and collective experiences over a series of events to discuss and debate the impact of cellulitis and review available PROMs. CELLUPROM© is introduced with anonymised PROM data and case study information reported to establish the impact of CELLUPROM© within usual NCIP care. Results: No cellulitis-specific PROMs were identified. Literature focused on the signs and symptoms of an acute episode of cellulitis, with outcome measures primarily used to evidence the impact of an intervention. An enduring physical, social and emotional impact of cellulitis was identified in this study, providing the basis for the new cellulitis-specific PROM (CELLUPROM©), which has been implemented with good effect in clinical care. Conclusion: This study has highlighted the lasting impact of cellulitis. Using CELLUPROM© within the risk-reduction NCIP has helped develop Value-Based Healthcare and support programme evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Personalised prevention aims to delay or avoid disease occurrence, progression, and recurrence of disease through the adoption of targeted interventions that consider the individual biological, including genetic data, environmental and behavioural characteristics, as well as the socio-cultural context. This protocol summarises the main features of a rapid scoping review to show the research landscape on biomarkers or a combination of biomarkers that may help to better identify subgroups of individuals with different risks of developing specific diseases in which specific preventive strategies could have an impact on clinical outcomes. This review is part of the "Personalised Prevention Roadmap for the future HEalThcare" (PROPHET) project, which seeks to highlight the gaps in current personalised preventive approaches, in order to develop a Strategic Research and Innovation Agenda for the European Union. Objective: To systematically map and review the evidence of biomarkers that are available or under development in cancer, cardiovascular and neurodegenerative diseases that are or can be used for personalised prevention in the general population, in clinical or public health settings. Methods: Three rapid scoping reviews are being conducted in parallel (February–June 2023), based on a common framework with some adjustments to suit each specific condition (cancer, cardiovascular or neurodegenerative diseases). Medline and Embase will be searched to identify publications between 2020 and 2023. To shorten the time frames, 10% of the papers will undergo screening by two reviewers and only English-language papers will be considered. The following information will be extracted by two reviewers from all the publications selected for inclusion: source type, citation details, country, inclusion/exclusion criteria (population, concept, context, type of evidence source), study methods, and key findings relevant to the review question/s. The selection criteria and the extraction sheet will be pre-tested. Relevant biomarkers for risk prediction and stratification will be recorded. Results will be presented graphically using an evidence map. Inclusion criteria: Population: general adult populations or adults from specific pre-defined high-risk subgroups; concept: all studies focusing on molecular, cellular, physiological, or imaging biomarkers used for individualised primary or secondary prevention of the diseases of interest; context: clinical or public health settings. Systematic review registration: https://doi.org/10.17605/OSF.IO/7JRWD (OSF registration DOI). [ABSTRACT FROM AUTHOR]

Objectives: Though recognized as a risk factor, posterior glenoid bone loss has only recently been characterized and is distinctly different than anterior glenoid bone loss patterns. Existing biomechanical studies are limited by employment of anterior glenoid bone loss models which are different in both orientation and morphology than posterior glenoid bone loss, and testing in a single neutral arm position thus not fully accounting for the contribution of capsuloligamentous structures in various at-risk arm positions. The purpose of this study was to evaluate the biomechanical effectiveness of a posterior labral repair in the setting of a clinically relevant bone loss model using 3-dimensional computed tomography modeling of patients with recurrent posterior shoulder instability in various at-risk arm positions. Methods: Ten fresh-frozen cadaveric shoulders (mean age: 55.4 years, range: 39-65) were prepared by removing all tissue except the capsule and distal rotator cuff insertions. A joint coordinate frame was established, the specimens were potted, then mounted to a customized fixture on 6-degrees-of-freedom robotic arm. A posterior labral tear was created, then repaired with 3 horizontal mattress sutures and secured by drilling 6 transosseous holes along the peripheral glenoid face exiting the anterior glenoid neck. The sutures were secured for the labral repair states to the mounted fixture under maximal tension and released for the labral tear states and for creating the sequential bone loss models. Bone loss models were created based off a cohort of CT data on patients undergoing revision posterior labral repair surgery to develop 2 clinically relevant 3D models of glenoid bone loss: the first simulating the mean bone loss in this cohort and represented 7% or small bone loss; the second was the mean + 2SD representing 28% or large bone loss. The bone loss was created on each specimen with a 3mm round burr to match each respective 3D printed template (Figure 1). Each specimen was tested in 7 consecutive states: (1) native anatomy, (2) posterior labral tear (6-9 o'clock), (3) posterior labral repair, (4) mean posterior glenoid bone loss with labral tear, (5) mean posterior glenoid bone loss with labral repair, (6) large posterior glenoid bone loss with labral tear, and (7) large posterior glenoid bone loss with labral repair. Each state underwent 75N of posterior-inferior force and 75N of compression during the four tests at 60 and 90 degrees of flexion and 60 and 90 degrees of scaption. Posterior-inferior translation, lateral translation, and dislocation force were measured for each condition. Statistical analysis was performed using two-factor random-intercepts linear mixed-effects models. Results: Compared to the labral tear state, significant increases in dislocation forces occurred with labral repair independent of bone loss state or arm position with values as follows: 14.8N (60° scaption), 12.2N (90° scaption), 11.1N (60° flexion), and 10.1N (90° flexion) with mean 12.1 ± 2.0N across all arm positions (Figure 2). Dislocation force significantly decreased between no bone loss and small bone loss (mean 12.4 ± 0.7N) and between small bone loss and large bone loss (mean 11.8 ± 2.1N) regardless of labral state in all arm positions (table 1). Posterior-inferior translation significantly decreased with labral repair compared to labral tear states independent of bone loss state in all arm positions (Table 1). Lateral translation of the humeral head significant increased when the labrum was repaired independent of bone loss state in all arm positions except 90° scaption and decreased progressively in all bone loss states in all arm positions (table 1). In the native state, the shoulder significantly translated posterior-inferior in scaption at 60° and 90° elevation compared to flexion (p<0.017) and was most unstable in 60° scaption with 29.9 ± 6.1mm posterior-inferior translation (Figure 3). Conclusions: This is the first study to biomechanically evaluate posterior glenoid bone loss using a clinical model in various at-risk arm positions on a 6 degree-of-freedom robot and through a precise linear effects model has established values for the increase in dislocation force posterior labral repair provides regardless of bone loss. The most significant finding of the study is that independent of bone loss, labral repair reduced posterior dislocation forces by 12.1 ± 2.0N and significantly decreased posterior-inferior translation. With a mean decrease in dislocation force of 12.4 ± 0.7N with small (7%) bone loss, labral repair alone may be enough to restore shoulder stability in most individuals. However, significant increases in posterior bone loss may require bony augmentation for adequate stability based on individual factors such as age and activity level. Table 1. Summary of statistically significance among modeled effects for labrum state and bone loss state. Separate linear mixed-effects models were constructed for each combination shoulder position, elevation and measurement. Numeric results reflect the estimated effect of moving from State A -> State B, as indicated in the column header. Up arrows indicate an increasing effect in the measure of interest, while down arrows indicate a decreasing effect, n.s. represents not statistically significant. Figure 2. Bar plots indicating mean and standard deviation values, stratified by shoulder position, elevation, and experimental status of the labrum and glenoid bone loss. Figure 3. Linear mixed-effects model estimates for shoulder position and elevation upon posterior inferior translation among native shoulders. [ABSTRACT FROM AUTHOR]

Currently, there is a lack of consensus regarding the accepted terminology pertaining to the pressure ulcer healing progression and recidivism. This lack of uniformity can negatively impact initiation of treatment pathways, completion of appropriate interventions, clinical documentation, medical coding, patient education, discharge planning and healthcare revenue through out the healthcare system. The purpose of this paper is to introduce a standard nomenclature as it pertains to pressure ulcer healing progression and any recidivism that may occur. The National Pressure Ulcer Advisory Panel has formulated a framework of terms regarding pressure ulcer progression. We also developed a clearer nomenclature for lack of progress and recidivism of pressure ulcers. This document should serve as a starting point for the discussion of the pressure ulcer care, research, and terminology. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the clinical and functional outcomes following arthroscopic Bankart repair for the treatment of anterior shoulder instability at long-term follow-up. It was hypothesized that arthroscopic Bankart repair would lead to an excellent clinical and functional outcome with a low rate of instability recurrence. Methods: Patients who underwent arthroscopic Bankart repair between October 1996 and April 2002 at a single institution were included. Patient-reported outcome measures (American Shoulder and Elbow Surgeons [ASES] Score, Constant-Murley Score [CMS], Visual Analog Scale for pain [VAS-P] and instability [VAS-I] at rest and during activity, satisfaction with the postoperative result [1-10 scale]), sporting ability as well as the rate of redislocation and reinstability (in patients without redislocations) were evaluated after a minimum follow-up of 20 years. Results: In total, 71 patients (78.9% male) were included in this study at a median follow-up of 23 (interquartile range 22-25) years. At the time of surgery, patients were 28.3 ± SD 8.6 years old. Arthroscopic Bankart repair was performed in 19.1% of patients following primary anterior shoulder dislocation and in 80.9% of patients for recurrent anterior shoulder instability. Shoulder function was good to excellent at follow-up (ASES Score: 95.0 [83.0-98.0], CMS: 81.1 ± 15.5). The median pain and instability levels were low both at rest (VAS-P: 1.0 [0-1.0], VAS-I: 0 [0-1.0] and during activity (VAS-P: 1.0 [0-2.0], VAS-I: 2.0 [1.0-4.0]). Overall satisfaction with the postoperative result was high (9.0 [8.0-10]). Postoperative redislocations occurred in 15.4% of patients. Subjective residual instability was reported in 18.2% of the patients that did not suffer a shoulder redislocation, resulting in an overall rate of any instability of 30.8%. Postoperative sporting ability improved in 46.8%, declined in 12.9% and remained unchanged in 40.3% of patients. Conclusions: Twenty years postoperatively, arthroscopic Bankart repair was associated with good to excellent shoulder function, low pain levels and high patient satisfaction. About 1 in 3 patients, however, suffered from shoulder instability of whom approximately half reported a redislocation postoperatively. [ABSTRACT FROM AUTHOR]

Objectives: Arthroscopic anatomic glenoid reconstruction (AAGR) is an increasingly popular treatment approach for shoulder instability. AAGR shows a promising short-term safety profile and clinicoradiological outcomes, suggesting its efficacy is comparable to Bankart repair. Recurrence rates reported in the literature are up to 30% following Bankart repair, however, there is a lack of literature comparing the long-term outcomes of AAGR versus Bankart repair. The purpose was to compare recurrence rates and patient-reported outcomes in patients who received AAGR to patients who received Bankart repair with a minimum of 5-year follow-up. Methods: This was a retrospective study comparing 73 patients who underwent AAGR and 76 patients who underwent Bankart repair consecutively between 2012 and 2018. Patients who had a minimum 5-year follow-up were included in the final analysis. Data collected included demographics, pre- and postoperative Western Ontario Shoulder Instability (WOSI) Index and Disabilities of the Arms, Shoulders, and Hands (DASH) Scores, postoperative complications and recurrence. The primary outcome measure was dislocation recurrence, with secondary outcome measures of patient-reported outcomes and postoperative complications. Results: The demographics and preoperative outcome scores were similar between groups. Patients in the AAGR group presented with significantly higher bone loss (>10%, p<0.05) than those in the Bankart group. There were fewer incidences of recurrence in the AAGR group (1.4%) than the Bankart group (18.4%). There was a significant difference in pre-to-post operative WOSI (p=0.02) and DASH (p=0.01) scores between groups, as well as a significant difference in the number of patients who met the WOSI (p<0.001) and the DASH (p<0.001) minimum clinically important difference threshold, with the AAGR group showing a greater improvement pre- to postoperatively. Conclusions: AAGR has better long-term outcomes and fewer incidences of recurrence compared to Bankart repair. [ABSTRACT FROM AUTHOR]

Most Human African Trypanosomiasis (HAT) control programmes in areas endemic for Trypanosoma brucei gambiense rely on a strategy of active mass screening with the Card Agglutination Test for Trypanosomiasis (CATT)/T. b. gambiense. We evaluated the performance, stability and reproducibility of the CATT/T. b. gambiense on blood-impregnated filter papers (CATT-FP) in Kajo-Keji County, South-Sudan, where some areas are inaccessible to mobile teams. The CATT-FP was performed with a group of 100 people with a positive CATT on whole blood including 17 confirmed HAT patients and the results were compared with the CATT on plasma (CATT-P). The CATT-FP was repeated on impregnated filter papers stored at ambient and refrigerated temperature for 1, 3, 7 and 14 days. Another 82 patients with HAT, including 78 with a positive parasitology, were tested with the CATT-FP and duplicate filter paper samples were sent to a reference laboratory to assess reproducibility. The CATT-FP was positive in 90 of 99 patients with HAT (sensitivity: 91%). It was less sensitive than the CATT-P (mean dilution difference: -2.5). There was no significant loss of sensitivity after storage for up to 14 days both at ambient and cool temperature. Reproducibility of the CATT-FP was found to be excellent (kappa: 0.84). The CATT-FP can therefore be recommended as a screening test for HAT in areas where the use of CATT-P is not possible. Further studies on larger population samples in different endemic foci are still needed before the CATT-FP can be recommended for universal use. [ABSTRACT FROM AUTHOR]

The role of repopulating lymphocytes after allogeneic stem cell transplantation (SCT) includes the prevention of serious infections and attacking residual tumour cells in the early post-transplant phase. Therefore, the current study analysed the role of the absolute lymphocyte count (ALC) on day 21 after SCT in predicting transplant outcomes of 82 patients in terms of the risk of opportunistic infections and recurrence of original disease. The median dose of CD34+, CD3+ and mononuclear cells (MNC) infused was 6·41 × 106/kg, 1·96 × 108/kg and 6·81 × 108/kg respectively. The high ALC group (high ALC on day 21; ≥0·35 × 109/l) was associated with the use of peripheral blood stem cells, matched sibling donors and higher cell doses of MNC, CD3+ and CD4+ cells. The high ALC group also exhibited a better overall survival (56·3% vs. 17·7%) and disease-free survival (50·1% vs. 15·9%) after 3 years and lower incidences of relapse (33·6% vs. 67·1%) and fungal infections (3·0% vs. 19·5%) after 1 year. The incidence of cytomegalovirus antigenaemia was lower in the high ALC group (47·7% vs. 73·7%). Accordingly, identifying the ALC on day 21 would appear to be a useful and simple measurement to predict those patients with a high risk of opportunistic infections and relapse after allogeneic SCT. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the relationship between factor VIII (FVIII) levels, measured by chromogenic and clotting assays, and risk of venous thromboembolism (VTE) recurrence. A total of 564 patients underwent clinical follow-up after oral anticoagulant withdrawal (total follow-up = 924·4 years). Recurrent VTE developed in 39 of 309 (12·6%) patients with a first idiopathic VTE and in 14 of 255 (5·5%) patients whose first event was secondary. In patients with a first idiopathic VTE, the risk of recurrence was more than fivefold higher in patients with FVIII levels exceeding the 90th percentile [chromogenic FVIII: relative risk (RR) 5·43 (95% CI 1·76–16·8); clotting FVIII: RR 6·21 (95% CI 1·57–24·5)] after adjustment for all possible confounding variables. In patients with a first secondary VTE, the risk of recurrence was slightly higher in patients with high FVIII levels [chromogenic FVIII: RR 2·62 (95% CI 0·34–19·9); clotting FVIII: RR 1·74 (95% CI 0·25–12·1)], but, given the low number of recurrences, the 95% CI were very large. In conclusion, this study shows that high FVIII levels are associated with increased risk of VTE recurrence in patients with a first idiopathic VTE. Although the measurement of FVIII levels by a specific chromogenic assay might, in principle, be preferred to avoid the risk of aspecific clotting effects, no significant differences in results obtained by chromogenic or clotting methods were found. [ABSTRACT FROM AUTHOR]

Episode-related factors and antidepressant treatment adequacy may be important determinants of recovery from a major depressive episode (MDE). We compared recovered and nonrecovered patients on baseline sociodemographic, clinical and episode-related measurements. Twenty-five inpatients with recurrent major depressive disorder diagnosed by SADS-L participated in this naturalistic, prospective, longitudinal study. Recovery, which was defined as a sustained return to non-depressed status lasting ≥ 8 consecutive weeks, was assessed at 6- and 12-month follow-up with the Streamlined Longitudinal Interval Continuation Evaluation (SLICE). Thirteen (52%) patients met recovery criteria. The cumulative proportion remaining depressed for at least 52 weeks was 42.5%. Recovered patients had shorter episodes preceding the index hospitalization (P = .01). Despite adequate antidepressant pharmacotherapy, the length of the current episode remains the most important correlate of recovery from MDE recurrence. Our small sample size and the uncontrolled nature of treatment may limit the generalizability of these findings. Depression and Anxiety 12:40–43, 2000. © 2000 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Objectives: The medial patellofemoral ligament (MPFL) is the primary soft tissue restraint to lateral patellar translation and is often disrupted with a lateral patellar dislocation. Surgical management for recurrent patellar instability focuses on restoring MPFL function with repair or reconstruction techniques. Recent studies have favored reconstruction over repair, but no long-term, comparative studies are available in the literature. Methods: A total of 55 patients (58 knees) with recurrent lateral instability were treated between 2005 and 2012 with either MPFL repair or MPFL reconstruction. Exclusion criteria included prior or concomitant tibial tubercle osteotomy or trochleoplasty, and follow-up less than 8 years. Pre- and post-operative demographic, surgical, imaging and clinical data were recorded for each patient. Results: MPFL repair was performed on 26 patients (29 knees; 14 females, 15 males) at a mean age of 19.1 years. MPFL reconstruction was performed on 29 patients (29 knees; 18 females, 11 males) at a mean age of 18.2 years. Mean follow-up was 12.0 years (range 8.3-18.9). The reconstruction group had a significantly lower rate of recurrent dislocation compared to the repair group (14% vs 41%, p=0.019) at final follow up. There were no differences in the number of pre-operative dislocations (greater than or less than 3), degree of patellar facet chondromalacia, TT-TG distance, or Tegner scores. The reconstruction group had significantly more time from injury to surgery compared to the repair group (median, 1,460 days vs 627 days, p =0.007). There were no differences in post-operative Tegner, Lysholm or Kujala scores at final follow-up. Additionally, there were no differences in return to play rates (repair 80.8% vs reconstruction 75.0%, p=0.610) or reoperation rates (repair 20.7% vs reconstruction 13.8%, p=0.487). Conclusions: Repair of the MPFL leads to nearly 3-fold higher rate of recurrent patellar dislocation (41% vs. 14%) at long term follow-up compared to MPFL reconstruction. However, MPFL repair and reconstruction provide similar clinical results, return to play rates and reoperation rates. [ABSTRACT FROM AUTHOR]

Background: Crohn's disease (CD) is a chronic condition characterized by a high recurrence rate after surgery, which seriously affects the quality of life of patients. Many studies have explored the risk factors for the recurrence of CD after surgery, there is a lack of meta-analysis focusing on endoscopic postoperative recurrence (ePOR) as a clinical outcome. Therefore, this paper aims to identify the risk factors for ePOR in CD patients through systematic review and meta-analysis. Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched for related literature from inception to 17th October 2023. Two researchers independently screened the literature and extracted information. Data analysis was performed using Stata18.0. Results: Twenty-three papers were included, with 5 case-control studies and 18 cohort studies. The National Institutes of Health quality assessment tool rated 17 studies as good and 6 studies as fair. The sample size of the 23 studies ranged from 40 to 346, and the number of patients with ePOR ranged from 23 to 169. The results of multivariate meta-analysis showed that smoking [OR = 2.06, 95% CI (1.65, 2.57), P = 0.0001], previous ileocolonic resection [OR = 1.71, 95% CI (1.23, 2.38), P = 0.002], disease localization at ileocolic resection [OR = 2.68, 95% CI (1.38, 5.22), P = 0.004], perianal disease [OR = 1.47, 95% CI (1.07, 2.03), P = 0.017], and anastomotic scattered ulcer [OR = 3.39, 95% CI (1.83, 6.28), P = 0.001] were risk factors for ePOR in CD patients. Postoperative prophylactic medication [OR = 0.53, 95% CI (0.38,0.75), P = 0.0001] was a protective factor for ePOR in CD patients. Conclusions: This systematic review identified multiple factors for ePOR in CD patients, as well as a protective factor. However, the number of articles included was limited. More high-quality clinical studies are required to further validate the conclusions. Trial registration: This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023483671). [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this paper is to conduct a bibliometric analysis to examine the research status and development trend of anterior cruciate ligament injury and reconstruction in children and adolescents over the past 20 years. Design: Descriptive Research. Methods: This study obtained information regarding studies on Anterior Cruciate Ligament Reconstruction in Children and Adolescents from the Web of Science Core Collection database. Visual and bibliometric analysis were conducted using VOSviewer, Origin 2022, Pajek64 5.18and Excel 2019. These analytic tools facilitated the analysis of various aspects, including countries/regions, institutions, authors, journals and keywords related to the research. Results: From 2003 to 2023, a total of 1328 articles were retrieved in WOS, and 637 articles were selected by two authors. The most productive institutions are Childrens Hosp Philadelphia, Kocher, ms. Their articles have the highest number of publications and citations. The American journal of sports medicine is the most frequently cited journal for articles on anterior cruciate ligament reconstruction in children and adolescents. The most common keywords used in these articles were "anterior cruciate ligament reconstruction", "injury, children, adolescent", and "skeletally immature patients". Conclusions: This study provides valuable insights into the research focus of anterior cruciate ligament reconstruction in children and adolescents. In recent years, there has been significant attention paid to areas of "the return to sport, re-repture rate and functional recovery after anterior cruciate ligament reconstruction" in this specific population. These aspects have emerged as key directions for future research in this field. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Objective: Antiplatelet drugs, such as Aspirin and Clopidogrel (Plavix) are effective in the primary prevention of thromboembolic events. They are commonly used to reduce the risk of recurrence of thromboembolism. The body's hemostatic system responds differently to these drugs in different people. Resistance testing for aspirin and Clopidogrel is now recommended before starting antiplatelet therapy. Methods: A systematic literature search was performed on May 12, 2021, using the medical search engines PubMed, Scopus, and Web of Science, and the local databases SID and Magiran. After data extraction, a meta-analysis was performed using Comprehensive Meta-Analysis (CMA2) software. The I2 statistic was used to measure heterogeneity between estimates. Results: Among the 949 papers, Clopidogrel resistance was assessed in 136 patients and Aspirin resistance in 400 patients. The prevalence of Aspirin resistance was found to be 52.1% and the prevalence of Clopidogrel resistance was found to be 20.5%. Conclusion: It seems that in Iran, the issue of Aspirin and Clopidogrel resistance is suboptimally addressed. This pattern could also occur in other developing countries in the Middle East region. [ABSTRACT FROM AUTHOR]

Background: Reports of increasing presentations of new cases of acute psychosis both locally, nationally and internationally during the COVID-19 pandemic, warranted further investigation. International case reports almost exclusively reported only clinical outcome (e.g. remission of psychotic symptoms), and fail to report on social precipitants or social outcomes. This is a common omission when investigating new psychosis cases such as acute and transient psychotic disorder (ATPD). In order to assess social impacts and outcomes, we conducted a rapid review of recent evidence. Aims: To conduct a rapid review of the recent evidence of social outcomes on new cases of psychosis emerging during the COVID-19 pandemic. Method: Four databases (Medline, Embase, Psychinfo and Cochrane COVID-19) were searched for ATPD, psychosis and social outcomes in adults aged 18+. Duplicates were removed. There were no language limitations. Results: There were 24 papers consisting of 18 original data research papers and 6 reviews. Additionally, 33 papers/letters, reporting on 60 individual cases of psychosis emerging during the COVID-19 pandemic. These two sets of papers were reviewed separately. Many original data research papers and reviews were sub optimal in their quality, with 44% online surveys, with the remainder being routinely collected data. Conclusion: There is a consensus that clinical outcomes of ATPD and other brief psychotic disorders (BPD) are good in the short term. The focus only on symptomatic clinical presentation and outcomes, leaves a gap in our understanding regarding social stressors and longer term social outcomes. ATPD and BPD often may not come to the attention of Early Intervention in Psychosis services, and if they do, are discharged following symptomatic remission. Without an understanding of the social stress factors and social outcomes, opportunities may be missed to prevent increased social disability and future relapse with these presentations. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: People with mental health problems are often left behind, forgotten and excludedLittle is known or written from a service user perspective about experiences of psychiatry, mental health nursing, Mental Health Tribunals and alternative approaches (such as counselling, peer support, psychological and recovery approaches, cognitive behavioural therapy—CBT and creative/art/music/drama/horticultural/dance therapies). What the paper adds to existing knowledge?: This paper aims to remedy this gap in knowledgeIt focuses on positive and negative experiences of psychiatry, Mental Health Tribunals and alternative treatments from a service user's perspective. What are the implications for practice?: The paper makes several recommendations. In brief, (1) psychiatrists need to listen more attentively rather than being focused on signs of psychosis; (2) de‐escalation techniques (for example, talking calmly with the patient) should be used by nurses before physical restraint; (3) psychiatry should be less biomedical. Nurses and social care professionals deserve better training, time for and practice in alternative and more therapeutic forms of care; (4) carers need to be more involved; (5) there need to be better, more democratic, more open processes of law; (6) voluntary work and supported employment schemes should be run by health and social services for people who want to work and want to have a vocational life. This paper aims to describe the lived experience of mental illness, coercive treatment by psychiatry and mental health nursing, and the problematic case and bias of Mental Health Tribunals. It then looks at more positive experiences of alternative approaches and makes recommendations for improving mental health services and people's experiences of them. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) was defined as a rare disease in China due to its low prevalence. For a long time, interferon β was the only approved disease-modifying therapy (DMT). Since the first oral DMT was approved in 2018, DMT approval accelerated, and seven DMTs were approved within 5 years. With an increasing number of DMTs being prescribed in clinical practice, it is necessary to discuss the standardized MS treatment algorithms depending on the disease activity and DMT availability. In this review paper, more than 20 Chinese experts in MS have reviewed the therapeutic progress of MS in China and worldwide and discussed algorithms for treating relapsing MS (RMS) based on the available DMTs in China, providing insights for establishing the standardized RMS treatment algorithms in this country. Plain language summary: Treatment algorithms of relapsing multiple sclerosis in China In this review paper, more than 20 Chinese experts in MS have reviewed the therapeutic progress of MS in China and worldwide and discussed algorithms for treating relapsing MS (RMS) based on the available DMTs in China, providing insights for establishing the standardized RMS treatment algorithms in this country: 1) CIS and RRMS account for more than 90% of the MS patients and most of them are mild to moderate; 2) MS patients should initiate DMT treatments as soon as the disease has been diagnosed in order to reduce the risk of disease progression; 3) Patients who have been diagnosed with MS should start treatment with fundamental DMTs unless the disease course has been highly active; 4) MAGNIMS score may be a suitable and simplified assessment tool for measuring treatment response to DMTs; 5) Patients treated with corticosteroids and NSIS should be switched to the standardized DMT treatment during remission in accordance with disease activity. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to provide a commentary response to "Stakeholder experiences of deprescribing psychotropic medicines for challenging behaviour in people with intellectual disabilities". Design/methodology/approach: The commentary provides some evidence-based perspectives on the risks and challenges of psychiatric drug-withdrawal, emphasising the importance of the patient experience in deprescribing decisions. It also makes the case for clinical clarity and carer-engagement in optimising deprescribing outcomes for individuals. Some clinical reflections are provided. Findings: Whilst efforts to reduce the overmedication of people with learning disabilities are welcomed, there is lacking evidence around this population's experience of adverse effects from psychiatric deprescribing decisions, including differentiating between withdrawal and relapse effects. Clinical clarity and carer engagement are key to safe and effective prescribing, although in reality, this can be challenging. Originality/value: This paper will be of value to all professionals with a role in the effective deprescribing of psychiatric medications with and/or for people with intellectual disability. It provides perspectives on aspects of stakeholder experience that warrant further consideration and research. [ABSTRACT FROM AUTHOR]

Objectives: Based on findings from our multi-center, double-blinded randomized controlled trial comparing arthroscopic Bankart repair with/without remplissage for the treatment of traumatic recurrent shoulder instability there is a greater risk of postoperative recurrent instability in patients without a remplissage at two years follow-up. The objective of the current study is to determine whether our short-term findings change with medium-term follow-up. Methods: This was a double-blinded, randomized clinical trial with two 1:1 parallel groups conducted at two sites. Patients were randomized intra-operatively to an arthroscopic Bankart with remplissage (REMP) or isolated Bankart repair (NO REMP) between 2011 and 2017. Inclusion criteria were patients 14 years or older diagnosed with traumatic anterior shoulder instability with a glenoid defect >15% and the presence of a Hill-Sachs defect (of any size). Patients were contacted by telephone (Spring 2020) and asked standardized questions to determine whether any additional information regarding subluxations, dislocation or additional surgery occurred since their two-year follow-up. "Recurrent instability" was defined as patient-reported dislocation, or two or more episodes of subluxation. Kaplan-Meier survival analyses were performed to assess survival distribution between groups. For the time factor in the survival analysis, the number of months from time of surgery to outcome (either failure or no failure) was based on the time of the long-term follow-up phone call, or from the time of last reported outcome based on clinical or study follow-ups, whichever was the greatest. These were conducted for: 1) recurrent instability and 2) dislocations. Odds ratios with 95% confidence intervals were also calculated. Results: Study groups were similar at baseline with respect to age, gender and BMI. Fifty-four patients were randomized to each study group at the time of the original study., with 52 REMP and 50 NO REMP included in the analyses up to 24-months post-operative. Of those, 36 from each group were available for mid-term follow-up. Mean months (mean) from surgery to last follow-up was 53.8 for REMP and 49.3 for NO REMP. The rate of postoperative recurrent instability at medium term follow-up was 10% (5/52) in the REMP group at an average of 24 months and 30% (15/50) in NO REMP at an average of 19.5 months (p=0.010). The odds ratio of recurrent instability in the NO REMP group relative to the REMP group was 4.029 (1.337-12.135; p=0.010) and the survival curve was significantly different favouring REMP (χ2 = 6.958, P=0.008; Figure 1). With respect to dislocations only, the odds ratio in the NO REMP group relative to REMP was 3.385 (0.999-11.463; p=0.041) and the survival curve was also significantly different favouring the REMP (χ2 = 4.412, p=0.036; Figure 2). Conclusions: At medium-term follow-up, patients undergoing a Bankart repair with remplissage have a better rate of survival than those with an isolated Bankart repair. Figure 1. Survival curve for patients undergoing Bankart and remplissage or bankart only comparing time to recurrence of instability (dislocation and/or recurrent subluxation). Figure 2. Survival curve for patient undergoing Bankart and remplissage or Bankart only comparing time to dislocation. [ABSTRACT FROM AUTHOR]

This paper aims to analyze the risk factors for the recurrence or progression of non-functioning pituitary adenomas (NFPAs) in male patients after transnasal sphenoidal surgery and to develop a predictive model for prognosis. Clinical and follow-up data of 126 male patients with NFPAs treated by transnasal sphenoidal surgery from January 2011 to January 2021 in Fuzhou 900th Hospital were retrospectively analyzed. Lasso regression analysis was used to screen the best predictors, and the predictors were further screened by multivariate logistic regression analysis, and the nomogram prediction model was constructed. The performance of the model was verified by three aspects: discrimination, calibration and clinical utility by using the consistency index (C-index), receiver operating characteristic curve (ROC), calibration curve, clinical decision curve (DCA) and Clinical impact curve (CIC). Out of 126 cases, 7 (5.56%) showed postoperative tumor recurrence, and 18 (14.29%) exhibited postoperative residual regrowth (progression). Age (P = 0.024), maximum tumor diameter (P < 0.001), modified Knosp grade (P < 0.001), resection extent (P < 0.001), Ki67 (P < 0.001), pressure symptom (P < 0.001), Pre-op hypopituitarism (P = 0.048), Post-op new hypopituitarism (P = 0.017) showed significant differences among the recurrence group, the progression group, and the alleviation group. Three independent risk factors (Ki67, modified Knosp grade, and resection extent) affecting postoperative remission were used to construct a predictive model for long-term postoperative failure to remit. The C-index of the nomogram model was 0.823, suggesting that the model had a high discriminatory power, and the AUC of the area under the ROC curve was 0.9[95% CI (0.843, 0.958)]. A nomogram prediction model based on modified Knosp grading (grades 3B-4), resection extent (partial resection), and Ki-67 (≥ 3%) predicts the recurrence or progression of NFPAs in men after transnasal sphenoidal surgery. [ABSTRACT FROM AUTHOR]

Recurrent deformity following hallux valgus surgery can be technically challenging to treat. In cases of revision surgery, a surgical technique with greater corrective power is often chosen compared to the primary surgery. Therefore, minimally invasive surgery is not commonly performed. On the other hand, minimally invasive surgery minimizes soft tissue damage and allows for greater correction of deformity compared to traditional open approaches. This paper reports four cases of recurrent hallux valgus treated with a minimally invasive distal transverse metatarsal osteotomy - Akin osteotomy (MITA), resulting in significant improvements in the clinical and radiographic outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: The aim of this systematic review is to describe the epidemiology of chordoma and to provide a clear overview of clinical prognostic factors predicting progression-free and overall survival.Methods: Four databases of medical literature were searched. Separate searches were performed for each of the two objectives. Reference and citation tracking was performed. Papers were processed by two independent reviewers according to a protocol that included risk of bias analysis. Disagreement was resolved by discussion. Pooled analyses were planned if homogeneity of data would allow.Results: Incidence-incidence rates ranged between 0.18 and 0.84 per million persons per year and varied between countries and presumably between races. On average patients were diagnosed in their late fifties and gender data indicate clear male predominance. Two of the largest studies (n = 400 and n = 544) reported different anatomical distributions: one reporting the skull base and sacrococcygeal area affected in 32% and 29% of cases, whereas the other reporting that they were affected in 26% and 45% of cases, respectively.Prognostic Factors: Statistically significant adverse prognostic factors predicting progression-free and overall survival include female sex, older age, bigger tumour size, increasing extent of tumour invasion, non-total resection, presence of metastasis, local recurrence, and dedifferentiated histological subtype.Conclusions: Incidence rate and anatomical distribution vary between countries and presumably between races. Most chordomas arise in the skull base and sacrococcygeal spine, and the tumour shows clear male predominance. Multiple adverse prognostic factors predicting progression-free and overall survival were identified in subgroups of patients. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

Background: Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism in cryptogenic stroke has tremendously increased, thanks to the availability of better techniques to diagnose cardiac right-to-left shunt by ultrasounds and of percutaneous means of PFO treatment with interventional techniques. Many studies have been published that have attempted to define diagnostic methodology, prognosis, and optimal treatment (pharmacological or percutaneous closure) of PFO patients with cryptogenic stroke. Unfortunately, even today, definitive evidence is still lacking, and clinical management is not consistent among cardiologists.Aims: This review aims to evaluate the role of PFO in cryptogenic stroke, the diagnostic accuracy of transcranial Doppler, contrast transthoracic and transesophageal echocardiography in the diagnosis of left-fright shunt and PFO; and discuss the indications to medical treatment and percutaneous closure of PFO.Methods: All studies published in the literature on PFO and cryptogenic stroke are considered and discussed.Results: We define an appropriate diagnostic and clinical management of PFO patients with cryptogenic stroke.Conclusion: After many years of interest on PFO and many concluded studies, there are still no definitive data. However, we are on good track for an appropriate management of PFO patients and cryptogenic stroke. [ABSTRACT FROM AUTHOR]

Introduction: Looking into the literature, many articles accuse bacterial persister cells as important causes of infection relapse/recalcitrance. This opinion paper, highlights the knowledge gaps and scientific misconceptions in experimental procedures regarding the role of persisters in relapse/recalcitrance of infections and recommends a roadmap for investigations in this field. Conclusion: It is debated in this paper, that unless the queries and missing points are addressed clearly, persisters cannot be stigmatized as the culprit of infection relapse/recalcitrance. [ABSTRACT FROM AUTHOR]

Objectives: It remains unclear which subset of patients with recurrent patellofemoral instability would benefit from a concomitant bony realignment procedure in addition to a medial patellofemoral ligament (MPFL) reconstruction. The purpose of this study is to provide midterm results on previously reported patient reported outcomes (PRO), return to sport (RTS) and imaging measurements collected for patients who underwent an isolated MPFL reconstruction as part of an ongoing prospective trial. This includes minimum 5-year outcomes data on a cohort of 55 patients as well as 2-year outcomes data on an expanded cohort of 121 patients. Methods: Patients with recurrent patellar instability who did not meet exclusion criteria were prospectively enrolled in an institutional registry beginning in March 2014. Exclusion criteria included patients with a prior history of a patellar stabilization procedure, an off-loadable (inferior/lateral) Outerbridge Grade IV chondral defect, obligatory dislocators (patients who require patellar dislocation in order to achieve full knee extension) or patients with a "Jumping J" sign and patients who reported anterior knee pain as more than 50% of their chief complaint. All patients who were not excluded by the above criteria underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomy (tibial tubercle - trochlear groove (TT-TG), trochlear morphology, trochlear depth, or patellar height) for treatment of recurrent patellar instability. Patient data including PROs, episodes of recurrent instability or dislocation, and ability to return to sport (RTS) was obtained annually. Radiographic MRI measurements including TT-TG, Caton-Deschamps Index (CDI), Patellar Trochlear Index (PTI), Trochlear Depth Index (TDI), Patellar Tendon to Lateral Trochlear Ridge (PT-LTR) and Tibial Tubercle to Lateral Trochlear Ridge (TT-LTR) were obtained at baseline. Results: 138 patients (72% female; mean age 20.1 ± 6.1 years) underwent isolated MPFL reconstruction between March 2014 and December 2019. 55 patients reached the ≥5-year postoperative time point, of which 40 (72%) completed follow-up PROs. 121 patients reached the ≥2-year postoperative time point, of which 89 (74%) completed follow-up PROs. 99% (n=136) of patients at 2 years and 96% (n=132) of patients at ≥ 5 years had no self-reported post-operative patellofemoral instability: 6 patients (4%) reported recurrent instability at a mean of 3.0 ± 0.7 years postoperatively. Activities during which failure occurred included jumping on a trampoline, dancing, and playing lacrosse. Preoperatively, 100 (72%) patients participated in sports or physical activity, of which 87 reported return to sport (87%). All patients that returned to sport did so within 24 months postoperatively with a mean RTS of 9.3 months. KOOS-Qol, Pedi-Fabs, IKDC, KOOS-PS and Kujala PROS are reported in Table 1. The mean TT-TG was 15.1 ± 4.9 mm (1.90 to 27.2 mm), mean CDI was 1.14 ± 0.16 (0.72 to 1.65), mean PTI was 46.9 ± 15.1% (13 to 100%) and mean trochlear depth was 2.5 ± 1.2 mm (-1.55 to 5.15 mm). Trochlear dysplasia, defined as a TDI < 3 mm, was present in 77 (56%) of patients. The mean measure of extensor mechanism containment, TT-LTR, was -8.4 ± 5.7 mm (-24.0 to 3.20 mm) and the rate of TT-LTR within 1 mm, found to be predictive of recurrent instability, was 8% (n=11). The mean PT-LTR, a measurement of lateral patellar tracking, was 5.7 ± 6.2 mm (-5.70 to 21.1 mm). The six patients who experienced recurrent instability after an isolated MPFL reconstruction had a mean CDI of 1.19 and a mean TT-TG of 18.75. Individual imaging data for these six patients can be seen in Table 2. Conclusions: Midterm outcomes for patients who underwent isolated MPFL reconstruction (within strict exclusion criteria parameters) are shown to be favorable and maintained at 5 years. Additionally, the outcomes for the expanded cohort of patients with a minimum of 2-year follow up supports the previously published results. Most athletes were able to return to sport. Completion of this study enrollment with long term follow up will allow for more robust assessment of long-term outcomes and incidence of recurrent instability after isolated MPFL reconstruction. The ultimate goal of this work is the creation of a predictive model utilizing the bony and clinical characteristics of those patients who sustain recurrent instability in order to better predict who might benefit from additional bony realignment procedures at the time of their index procedure. Table 1. Patient Reported Outcomes at Baseline, 2 years and ≥ 5 years Table 2. Radiographic Measurements for Patients with Recurrent Patellar Instability after Isolated MPFL Reconstruction [ABSTRACT FROM AUTHOR]

Objectives: Recurrent pain, instability and loss of function are challenging complications that can occur after arthroscopic treatment of posterior shoulder instability and SLAP tears in athletes. Many surgeons allow return to sport after a designated arbitrary postoperative time point. Recent evidence has demonstrated that a majority of athletes have residual strength and functional limitations at 6 months postoperatively – the time at which most time-based protocols allow full return to sport. Recent data has also been presented that patients undergoing arthroscopic Bankart repair who are required to meet objective return to sport testing criteria have a 4x lower rate of recurrent anterior instability than those who return based on time elapsed since surgery. Considering these findings, the purpose of this study is to investigate the use of a similar objective return to sport testing protocol on recurrence rates following arthroscopic surgery for posterior shoulder instability and SLAP tears. We hypothesized that patients who meet objective return to sport criteria would have a lower rate of reoperation and recurrence of symptoms compared to those who did not undergo the testing and were cleared to return based on time from surgery. Methods: Consecutive patients (Group 1) who underwent arthroscopic posterior shoulder stabilization surgery with or without SLAP repair by a single surgeon from 2016 to 2019, had a minimum of 1 year follow up, and completed functional and strength testing to evaluate readiness for return to sport were included in this retrospective case-controlled study. These patients were compared to a control group of historical consecutive cases (Group 2) from 2012-2016 who did not undergo return to sports testing and were cleared for sports after a minimum of 6 months following surgery. Failure was defined as recurrent symptoms of pain or instability requiring reoperation. Exclusion criteria were: patients undergoing isolated anterior stabilization procedures with or without concomitant SLAP tears, multidirectional instability, and open procedures. Chi-square, Fisher exact tests and two-tailed Students T-test were performed. Statistical significance was set at p<0.05. Results: There were 33 patients in Group 1 who underwent return to sport testing, and 91 patients in Group 2, the historical control. There were no differences between groups regarding sex (p=0.46), hand dominance (p=0.16), side affected (p= 0.69). The average age of Group 1 (20.8 +/- 4 yrs) was significantly younger than Group 2 (31.5 +/- 9.1 yrs, p< 0.00001). Patients who underwent return to sport criteria-based testing protocol had a rate of recurrent symptoms of pain or instability of 12.1% compared to 18.6% for those who did not (p= 0.43). Similarly, there were no reoperations for in Group 1, while three patients in group 2 (3.3%) underwent revision surgery for recurrent symptoms. This difference, however, did not reach statistical significance (p= 0.5633). Conclusions: In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. This may be related to an overall lower rate of reoperation in patients undergoing arthroscopic posterior stabilization or SLAP repairs in general compared to those undergoing arthroscopic anterior stabilization and differences in tolerance and presentation of recurrent posterior instability/SLAP tears versus anterior instability. It is possible that criteria-based return to sport testing prior to clearance to return to sport may be less critical for improving failure rates following arthroscopic posterior stabilization and SLAP repair than for anterior stabilization. Alternatively, given low reoperation rates overall, future studies investigating the role of return to sport testing after arthroscopic surgery for posterior shoulder instability and SLAP repairs may need to include more patients in order to detect differences related to the testing protocol. This study provides a basis upon which further studies, involving larger patient populations, may be conducted to elucidate any impact on functional scores and recurrence rates that may be associated with return-to-sport protocols based on functional testing rather than time since surgery. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics which include the effectiveness of physiotherapist-derived exercise and pain coping skills training in knee osteoarthritis, the differential patterns of cytokine expression in neuraxis, and the epidemiology of recurrent low back pain.

Objectives: Recurrent pain, instability and loss of function is a challenging complication that can occur after arthroscopic treatment of posterior shoulder instability and SLAP tears in athletes. Many surgeons allow return to sport after a designated arbitrary postoperative time point. Recent evidence has demonstrated that a majority of athletes have residual strength and functional limitations at 6 months postoperatively – the time at which most time-based protocols allow full return to sport1. Recent data has also been presented that patients undergoing arthroscopic Bankart repair who are required to meet objective return to sport testing criteria have a 4x lower rate of recurrent anterior instability than those who return based on time elapsed since surgery2. Considering these findings, the purpose of this study is to investigate the use of a similar objective return to sport testing protocol on recurrence rates following arthroscopic surgery for posterior shoulder instability and SLAP tears. We hypothesized that patients who meet objective return to sport criteria would have a lower rate of reoperation and recurrence of symptoms compared to those who did not undergo the testing and were cleared to return based on time from surgery. Methods: Consecutive patients (Group 1) who underwent arthroscopic posterior shoulder stabilization surgery with or without SLAP repair by a single surgeon from 2016 to 2019, had a minimum of 1 year follow up, and completed functional and strength testing to evaluate readiness for return to sport were included in this retrospective case-controlled study. These patients were compared to a control group of historical consecutive cases (Group 2) from 2012-2016 who did not undergo return to sports testing and were cleared for sports after a minimum of 6 months following surgery. Failure was defined as recurrent symptoms of pain or instability requiring reoperation. Exclusion criteria were: patients undergoing isolated anterior stabilization procedures with or without concomitant SLAP tears, multidirectional instability, and open procedures. Chi-square, Fisher exact tests and two-tailed Students T-test were performed. Statistical significance was set at p<0.05. Results: There were 33 patients in Group 1 who underwent return to sport testing, and 90 patients in Group 2, the historical control. There were no differences between groups regarding sex (p=0.46), hand dominance (p=0.16), side affected (p= 0.69. The average age of Group 1 (20.8 +/- 4 yrs) was significantly younger than Group 2 (31.6 +/- 9.1 yrs, p< 0.00001). Patients who underwent return to sport criteria-based testing protocol had a rate of recurrent symptoms of pain or instability of 12.1% compared to 18.9% for those who did not (p= 0.43). Similarly, there were no reoperations for in Group 1, while three patients in group 2 (3.3%) underwent revision surgery for recurrent symptoms. This difference, however, did not reach statistical significance (p= 0.5633). Conclusions: In our cohort of young patients undergoing arthroscopic surgery for posterior shoulder instability, we detected no significant difference in reoperation rate and recurrence of symptoms between athletes who underwent objective return to sport testing and those who were released to sport on a time-based protocol. This may be related to an overall lower rate of reoperation in patients undergoing arthroscopic posterior stabilization or SLAP repairs in general compared to those undergoing arthroscopic anterior stabilization and differences in tolerance and presentation of recurrent posterior instability/SLAP tears versus anterior instability. It is possible that criteria-based return to sport testing prior to clearance to return to sport may be less critical for improving failure rates following arthroscopic posterior stabilization and SLAP repair than for anterior stabilization. Alternatively, given low reoperation rates overall, future studies investigating the role of return to sport testing after arthroscopic surgery for posterior shoulder instability and SLAP repairs may need to include more patients in order to detect differences related to the testing protocol. Objective functional testing may be a viable alternative to arbitrary, time-based criteria for returning to sport in patients who have undergone arthroscopic posterior shoulder stabilization and SLAP repairs. [ABSTRACT FROM AUTHOR]

Heavy substance use (SU) and substance use disorders (SUD) have complex etiologies and often severe consequences. Certain personality traits have been associated with an increased risk for SU(D), but far less is known about personality changes related to SU(D). This review aims to synthesize the existing literature on this research question. A systematic literature search was conducted from November 2022 to February 2023 in PubMed, EbscoHost, and Web of Science. Peer-reviewed original papers on SU(D)-related personality changes were included. Of 55 included studies, 38 were observational population-based studies and 17 were intervention studies. Overall, personality and SU measures, samples, study designs, and statistical approaches were highly heterogenous. In observational studies, higher SU was most consistently related to increases in impulsivity-related traits and (less so) neuroticism, while interventions in the context of SU(D) were mostly associated with increases in conscientiousness and self-efficacy and lasting decreases in neuroticism. Findings for traits related to extraversion, openness, conscientiousness, and agreeableness were mixed and depended on SU measure and age. Studies on bidirectional associations suggest that personality and SU(D) both influence each other over time. Due to their strong association with SU(D), impulsivity-related traits may be important target points for interventions. Future work may investigate the mechanisms underlying personality changes related to SU(D), distinguishing substance-specific effects from general SU(D)-related processes like withdrawal, craving, and loss of control. Furthermore, more research is needed to examine whether SU(D)-related personality changes vary by developmental stage and clinical features (e.g. initial use, onset, remission, and relapse). [ABSTRACT FROM AUTHOR]

The aim of this systematic review is to analyze epidemiology, clinical presentation, histopathological features, treatment and oncological outcomes in laryngeal mucoepidermoid cancer (MEC) in order to improve the knowledge on the management of such a rare malignant neoplasm. Specifically, authors highlight patients' and tumors' features about local, regional, and distant recurrence of disease. PRISMA 2020 guidelines were applied in this systematic literature review. A computerized search was performed using the Embase/Pubmed, Scopus, and Cochrane databases, for articles published from 1971 to December 2023. A descriptive and univariate analysis including selected papers with low or intermediate risk of bias was performed. Twenty‐seven papers (11 case series and 16 case reports) were included in this review. Fifty‐six patients were included in the analyses, with a mean age of 56.7 years; 84% of them were males. Most patients (86%) underwent a primary surgical approach. Clinical stage was reported as follows: early stage (26 patients) and locally advance and advanced stage (19 patients). Overall survival (OS) and disease‐free survival (DFS) at 2 years was 80% and 78%, respectively. The mean time to local recurrence was 18.7 months (range 8–36 months). The survival after recurrence is about 85% and 70% at 5 years, respectively. The mean time of lymph node recurrence was 14.7 months (range 7–19 months). Finally, the mean time of distant recurrence was 15 months (range 7–36 months) with a poor prognosis: all patients died due to the disease in a range of 0–7 months after metastasis evidence. Laryngeal MEC is a rare neoplasm of minor salivary glands in the larynx. No guidelines or indications about the management of this neoplasm are reported in the literature. The lower incidence of regional recurrence of the disease and the better OS and DFS underline how the prognosis of MEC is more favorable respect to other malignant histotypes. [ABSTRACT FROM AUTHOR]

Background: Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up. Methods: This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps. Results: Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory. Conclusions: Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence. [ABSTRACT FROM AUTHOR]

Chronic subdural hematomas (CSDH) with isolated psychiatric presentation are rare. In this paper, we report a case of 77-year-oldfemale patient who had psychotic depression after repetitive head trauma without any neurological symptoms. The brain magnetic resonance imaging revealed an 20 mm subdural hematoma in the right frontoparietal region and a 7 mm subdural hematoma in the left frontal region. The psychiatric symptoms improved within the first week after evacuation but relapsed with the occurrence of right sided pneumocephalus. In the follow up, with the disappearance of the pneumocephalus, the psychiatric symptoms improved. It should be kept in mind that isolated psychiatric symptoms can be seen due to subdural hematoma and evacuation of the hematoma has an important role in improving the psychiatric symptoms. [ABSTRACT FROM AUTHOR]

The genus Borrelia has been divided into Borreliella spp., which can cause Lyme Disease (LD), and Borrelia spp., which can cause Relapsing Fever (RF). The distribution of genus Borrelia has broadened due to factors such as climate change, alterations in land use, and enhanced human and animal mobility. Consequently, there is an increasing necessity for a One Health strategy to identify the key components in the Borrelia transmission cycle by monitoring the human-animal-environment interactions. The aim of this study is to summarize all accessible data to increase our understanding and provide a comprehensive overview of Borrelia distribution in the Mediterranean region. Databases including PubMed, Google Scholar, and Google were searched to determine the presence of Borreliella and Borrelia spp. in vectors, animals, and humans in countries around the Mediterranean Sea. A total of 3026 were identified and screened and after exclusion of papers that did not fulfill the including criteria, 429 were used. After examination of the available literature, it was revealed that various species associated with LD and RF are prevalent in vectors, animals, and humans in Mediterranean countries and should be monitored in order to effectively manage and prevent potential infections. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the studies by R. Gold and colleagues and RJ Fox and colleagues on the Placebo-controlled phase 3 study of oral BG-12 or glatiramer for relapsing multiple sclerosis. He states that in Gold's study, the relapse rate over two years was reduced by 27% for twice daily dose and 26% for the thrice daily dose compared to placebo. He says that in Fox's study, the reduction rate was 44% for the twice daily dose and 51% for the thrice daily compared to placebo.

Simple Summary: Adult-type diffuse gliomas are the most common primary brain tumours. Radiotherapy is one of the therapeutic options offered upfront and/or after surgery both in naïve and recurrent patients. Magnetic resonance imaging (MRI) is the recommended technique for treatment response evaluation and follow-up. However, in patients previously treated with radiotherapy, MRI might be difficult to interpret since recurrent disease and treatment-related changes often appear similar. Therefore, other imaging modalities, including positron emission tomography (PET), have been explored in this clinical setting. The present work focused on PET imaging in adult-type diffuse gliomas aims to review available literature data and assess the capability of PET in discriminating between radiation necrosis and disease relapse in irradiated patients. Adult-type diffuse gliomas are treated with a multimodality treatment approach that includes radiotherapy both in the primary setting, and in the case of progressive or recurrent disease. Radiation necrosis represents a major complication of radiotherapy. Recurrent disease and treatment-related changes are often indistinguishable using conventional imaging methods. The present systematic review aims at assessing the diagnostic role of PET imaging using different radiopharmaceuticals in differentiating radiation necrosis and disease relapse in irradiated adult-type diffuse gliomas. We conducted a comprehensive literature search using the PubMed/MEDLINE and EMBASE databases for original research studies of interest. In total, 436 articles were assessed for eligibility. Ten original papers, published between 2014 and 2022, were selected. Four articles focused on [18F]FDG, seven on amino acid tracers ([18F]FET n = 3 and [11C]MET n = 4), one on [11C]CHO, and one on [68Ga]Ga-PSMA. Visual assessment, semi-quantitative methods, and radiomics were applied for image analysis. Furthermore, 2/10 papers were comparative studies investigating different radiopharmaceuticals. The present review, the first one on the topic in light of the new 2021 CNS WHO classification, highlighted the usefulness of PET imaging in distinguishing radiation necrosis and tumour recurrence, but revealed high heterogeneity among studies. [ABSTRACT FROM AUTHOR]

Background: Eczema, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. This paper presents the case of a 30-year-old male patient, who came to the outpatient department (OPD) of the Kashmir Tibbia College Hospital and Research Centre, Shilvath, Bandipora, Kashmir, India. Clinical presentation: His chief complaints were lesions on the palm of his left hand for one year. The patient also complains that his skin is black and thickened with severe itching on the affected area. Diagnosis: The patient was diagnosed clinically with hand eczema resembling Nar-e-Farsi in the Unani system of medicine. Interventions: For 30 days, Marham Kafoor was topically applied twice a day at a dose of 8-10 gm. Outcome: The patient was assessed before, the 15th day and 30th day of treatment based on the EASI, POEM, and VAS. Results: After the intervention, significant improvement was observed in all scales from baseline to 30th day. EASI changes from 18 (moderate) to 5 (mild), POEM changes from 19 (severe) to 7(mild), and VAS from 8 (severe) to 1 (mild). Conclusion: Marham Kafoor has been proven beneficial in treating hand eczema and enhancing patients' quality of life [ABSTRACT FROM AUTHOR]

Background: Acute and transient psychotic disorder (ATPD) was recognized as separate from other psychotic disorders and described in the International Classification of Diseases (ICD) tenth revision for the first time. A lot of research on ATPD has been conducted in India over the last six decades, but a review focusing exclusively on Indian research on ATPD is not available. Aim: This paper aims to review the literature on ATPD emerging from India. Methodology: A combination of search terms "Acute and Transient Psychosis," "acute psychosis," "non-affective psychosis," "non-affective psychotic disorder," "reactive psychosis," "first-episode psychosis," and "India" were searched on various search engines like PUBMED, Medknow, Hinari, and Google Scholar. We also did a hand search for additional relevant articles, including published abstracts of the Indian Journal of Psychiatry from 2007 to 2023. Relevant papers were selected. Results: The prevalence of ATPD varies across different study settings, and it tends to have an abrupt to acute onset, and is primarily associated with stress. Few studies have assessed the subtypes of ATPD, and symptom profile has been inconsistently reported. There is a lack of trials on the effectiveness or efficacy of antipsychotics in ATPD patients. In a large proportion of patients initially diagnosed with ATPD, the diagnosis remains stable, with recurrence varying from 10% to 46.6% based on the duration of follow-up. Conclusion: There is a need for more multicentric studies, studies with larger sample sizes, and consistency in data about risk factors. There is a need to evaluate symptom profile, course, outcome, and treatment outcomes in patients with ATPD using validated instruments to improve our understanding. Further, there is a need for comparative studies to evaluate the risk factors for ATPD. [ABSTRACT FROM AUTHOR]

The article presents va4rious papers published on wound healing. Topics dicussed include barriers associated with treatment of chronic venous leg ulcers, along with long-term clinical outcomes associated with the same; risk factors associated with delayed healing and recurrence of venous leg ulceration; and the growing number of patients with wounds.

The use of remote measurement technologies (RMTs) across mobile health (mHealth) studies is becoming popular, given their potential for providing rich data on symptom change and indicators of future state in recurrent conditions such as major depressive disorder (MDD). Understanding recruitment into RMT research is fundamental for improving historically small sample sizes, reducing loss of statistical power, and ultimately producing results worthy of clinical implementation. There is a need for the standardisation of best practices for successful recruitment into RMT research. The current paper reviews lessons learned from recruitment into the Remote Assessment of Disease and Relapse- Major Depressive Disorder (RADAR-MDD) study, a large-scale, multi-site prospective cohort study using RMT to explore the clinical course of people with depression across the UK, the Netherlands, and Spain. More specifically, the paper reflects on key experiences from the UK site and consolidates these into four key recruitment strategies, alongside a review of barriers to recruitment. Finally, the strategies and barriers outlined are combined into a model of lessons learned. This work provides a foundation for future RMT study design, recruitment and evaluation. [ABSTRACT FROM AUTHOR]

Background: Secondary lymphedema is a chronic swelling of the upper limb that may occur after treatment for breast cancer. During the acute phase, intensive treatment with a therapist is provided, while during the maintenance phase the patient needs to detect any re-swelling by self-examination. Objective: To assess the test-retest reliability and the concurrent validity of self-measurement upper limb volume among women post-breast cancer. Design: A cross-sectional study of 17 women post-breast cancer that experience a period of intensive unilateral upper limb lymphedema treatment in the past. Methods: On day 1 and day 10 at the clinic, the physiotherapist measured the volume of the upper limbs with the water displacement method (i.e. the 'gold standard' for volume measure) as well as with the more common method of plastic tape. The participants performed self-measurement twice with the paper tape under the supervision of a physiotherapist in the clinic. After a week the participants performed self-measurement at home with the paper tape. Results: The intra-class correlations measures indicated excellent values for the self-measure tape measurements on the operated side (0.97-0.99) as well as on the opposite arm (0.96-0.99). The self-measurement revealed a moderate association with the criterion measure, the water displacement ( rp 0.59-0.68, ( p < 0.05)), and strong concurrent validity with therapist tape measurements ( rp 0.88-0.95, ( p < 0.05)). Conclusions: Women post-breast cancer can self-measure upper limb volume using a paper tape which is both, reliable and valid. [ABSTRACT FROM AUTHOR]

Introduction: Lyme disease is a multisystem infectious disease caused by the spirochete Borellia burgdoferi and transmitted via tick bite. Aim: This study aims to draw the attention of health professionals and the community about the preventive measures and treatment of Lyme disease. Methods: Extensive literature search in the electronic database “Pubmed”, “Google Scholar”, the website of the center for Disease Control and Prevention (CDC) and in scientific journals via search engine with the keywords: Lyme disease, symptoms, removal, treatment. There was a time restriction, the last ten years. A key criterion for the selection of articles was English language. Results: Lyme disease is the most common disease transmitted by ticks in many countries. I f not treated immediately may cause serious complications. The diagnosis is based primarily on the presence of erythema migrans, characteristic of the disease. Listed events in the skin, musculoskeletal and central nervous system. The treatment is simple and involves antibiotic therapy. However, a proportion of patients may develop most-treatment Lyme disease syndrome, which makes treatment difficult. Finally, it occurs more frequently in children and in young adults living in rural areas. Conclusions: Because of the increase of incidents of Lyme disease in many countries of the world, it is vital that the mobilization of both, health professionals and the community to prevent and deal with it. Moreover, deemed necessary and further investigation of the phenomenon. [ABSTRACT FROM AUTHOR]

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods. [ABSTRACT FROM AUTHOR]