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AbstractPurposeMethodsResultsConclusionTo evaluate the role of computed tomography-dacryocystography (CT-DCG) in the management of traumatic secondary acquired lacrimal duct obstruction (SALDO) and study its correlation with the intra-operative findings.Retrospective interventional case series. Eighty-five lacrimal drainage systems (LDS) of 79 patients diagnosed with traumatic SALDO, who underwent pre-operative CT-DCG, between January 2019 and June 2023, were analyzed. The lacrimal intervention included endoscopic dacryocystorhinostomy (En-DCR), external DCR(Ex-DCR), or dacryocystectomy (DCT) based on the clinical presentation, CT-DCG findings, local and systemic factors. Anatomical and functional outcomes were assessed.Eighty-five LDS of 79 patients with a mean age of 32 years and male predominance (n = 70, 89%) were studied. The median time of trauma to clinical presentation was 12 months and the duration of epiphora was 8 months. Naso-orbito-ethmoid fractures were seen in 56 (66%) cases and cribriform plate fracture in 5 (6%) patients. CT-DCG revealed a dilated sac in 60 (71%) LDS, shrunken in 13 (15%), while the sac could not be visualized in 3 (4%) LDS. Relative lacrimal sac displacement was seen in 51 (64%) LDS of which 21 (41%) were displaced posteriorly, 18 (35%) superiorly, 5 (10%) inferiorly, and 8 (16%) into the anterior orbit. Sac – duct junction was the most common location of obstruction (n = 78, 92%). At a mean follow up period of 3.5 months, 62 of the 63 LDS surgeries performed (98%) demonstrated anatomical and functional success. Of the 63 operated LDS, CT-DCG findings corroborated with intra-operative findings in 60 (95%) LDS.CT-DCG helps decide the surgical approach, possible complications, intra-operative course and hence has the potential to influence the outcomes. A thorough understanding of CT-DCG, therefore, should be a part of a Dacryologist’s armamentarium for managing complex SALDO. [ABSTRACT FROM AUTHOR]

Introduction: This consensus paper provides recommendations for oral health professionals on why and how to assess caries activity and progression with special respect to the site of a lesion. Methods: An expert panel was nominated by the executive councils of the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD). The steering committee built three working groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity and progression assessment, and (3) obtain individualized caries diagnoses. The experts of work group 2 phrased and agreed on provisional general and specific recommendations on caries lesion activity and progression, based on a review of the current literature. These recommendations were then discussed and refined in a consensus workshop followed by an anonymous Delphi survey to determine the agreement on each recommendation. Results: The expert panel agreed on general (n = 7) and specific recommendations (n = 6). The specific recommendations cover coronal caries on pits and fissures, smooth surfaces, proximal surfaces, as well as root caries and secondary caries/caries adjacent to restorations and sealants. 3/13 recommendations yielded perfect agreement. Conclusion: The most suitable method for lesion activity assessment is the visual-tactile method. No single clinical characteristic is indicative of lesion activity; instead, lesion activity assessment is based on assessing and weighing several clinical signs. The recall intervals for visual and radiographic examination need to be adjusted to the presence of active caries lesions and recent caries progression rates. Modifications should be based on individual patient characteristics. [ABSTRACT FROM AUTHOR]

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long‐standing scratch‐induced skin lesions and a therapy refractory itch‐scratch‐cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision‐makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non‐communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision‐makers in health policy, among payers and administrations as well as in practical care. [ABSTRACT FROM AUTHOR]

Simple Summary: This review paper deals with incidentally found focal liver lesions (IFLLs) in otherwise healthy subjects, which is a frequent occurrence in daily practice. The clinical presentation and the imaging aspects play an important role in deciding whether and what further evaluation is required. In low-risk patients (i.e., those without a history of malignant or chronic liver disease or related symptoms, younger than 40 years old), more than 95% of IFLLs are benign. Shear Wave liver Elastography of the surrounding liver parenchyma should be considered to exclude liver cirrhosis and for further risk stratification. If an IFLL in a low-risk patient has a typical appearance on a B-mode ultrasound of a benign lesion, no further imaging is needed. Contrast-Enhanced Ultrasound (CEUS) should be considered as the first-line contrast imaging modality to differentiate benign from malignant IFLLs. In high-risk patients (i.e., with chronic liver disease or an oncological history), each IFLL should initially be considered as potentially malignant, and every effort should be made to confirm or exclude malignancy. An incidental focal liver lesion (IFLL) is defined as a hepatic lesion identified in a patient imaged for an unrelated reason. They are frequently encountered in daily practice, sometimes leading to unnecessary, invasive and potentially harmful follow-up investigations. The clinical presentation and the imaging aspects play an important role in deciding if, and what further evaluation, is needed. In low-risk patients (i.e., without a history of malignant or chronic liver disease or related symptoms), especially in those younger than 40 years old, more than 95% of IFLLs are likely benign. Shear Wave liver Elastography (SWE) of the surrounding liver parenchyma should be considered to exclude liver cirrhosis and for further risk stratification. If an IFLL in a low-risk patient has a typical appearance on B-mode ultrasound of a benign lesion (e.g., simple cyst, calcification, focal fatty change, typical hemangioma), no further imaging is needed. Contrast-Enhanced Ultrasound (CEUS) should be considered as the first-line contrast imaging modality to differentiate benign from malignant IFLLs, since it has a similar accuracy to contrast-enhanced (CE)-MRI. On CEUS, hypoenhancement of a lesion in the late vascular phase is characteristic for malignancy. CE-CT should be avoided for characterizing probable benign FLL and reserved for staging once a lesion is proven malignant. In high-risk patients (i.e., with chronic liver disease or an oncological history), each IFLL should initially be considered as potentially malignant, and every effort should be made to confirm or exclude malignancy. US-guided biopsy should be considered in those with unresectable malignant lesions, particularly if the diagnosis remains unclear, or when a specific tissue diagnosis is needed. [ABSTRACT FROM AUTHOR]

Amyloidosis is a heterogeneous, hereditary or acquired disease characterized by the abnormal deposition of fibrillar proteins in various tissues. The disease can be either localized or systemic, leading to significant variability in its clinical presentation and often causing diagnostic delays. For this reason, early identification of signs and symptoms is essential to improve prognosis. The first Mexican position paper on cardiac amyloidosis aims to summarize the main features of the disease and its subtypes, identifying warning signs that increase clinical suspicion. Additionally, it provides a diagnostic algorithm incorporating the imaging and laboratory studies available in our country, to streamline decision-making and facilitate a fast, practical, and up-to-date diagnosis based on evidence-based recommendations. Once the diagnosis is confirmed, the various therapeutic challenges of this disease, both pharmacological and non-pharmacological, are discussed, as patients do not respond to conventional heart failure treatments. Therefore, treatment must be individualized for each patient, considering the presence of other comorbidities. Finally, the key prognostic factors are outlined to guide appropriate treatment, including results from genetic counseling. [ABSTRACT FROM AUTHOR]

Epidemiological studies have explored the relationship between allergic diseases and cancer risk or prognosis in AllergoOncology. Some studies suggest an inverse association, but uncertainties remain, including in IgE‐mediated diseases and glioma. Allergic disease stems from a Th2‐biased immune response to allergens in predisposed atopic individuals. Allergic disorders vary in phenotype, genotype and endotype, affecting their pathophysiology. Beyond clinical manifestation and commonly used clinical markers, there is ongoing research to identify novel biomarkers for allergy diagnosis, monitoring, severity assessment and treatment. Gliomas, the most common and diverse brain tumours, have in parallel undergone changes in classification over time, with specific molecular biomarkers defining glioma subtypes. Gliomas exhibit a complex tumour‐immune interphase and distinct immune microenvironment features. Immunotherapy and targeted therapy hold promise for primary brain tumour treatment, but require more specific and effective approaches. Animal studies indicate allergic airway inflammation may delay glioma progression. This collaborative European Academy of Allergy and Clinical Immunology (EAACI) and European Association of Neuro‐Oncology (EANO) Position Paper summarizes recent advances and emerging biomarkers for refined allergy and adult‐type diffuse glioma classification to inform future epidemiological and clinical studies. Future research is needed to enhance our understanding of immune–glioma interactions to ultimately improve patient prognosis and survival. [ABSTRACT FROM AUTHOR]

Background/Objectives: Lymphocytic esophagitis is a rare inflammatory disease of the esophagus, first described in 2006. Since that time, interest in this disease entity has steadily increased, yet specific data on the etiology of the disease are still lacking. Lymphocytic esophagitis co-occurs with esophageal motility disorders, Crohn's disease, hypersensitivity (allergy, asthma), the use of certain medications, or immune disorders. Risk factors include smoking and alcohol abuse. The disease is more prevalent in women, developing predominantly within the sixth decade of life. The most important symptom is dysphagia, with odynophagia, epigastric, and chest pain or heartburn being less common. No particular endoscopic presentation is pathognomonic for lymphocytic esophagitis, the findings not infrequently resembling those of eosinophilic esophagitis. Conclusions: There is great need for an international consensus defining strict histopathological criteria for the diagnosis of lymphocytic esophagitis as well as relevant diagnostic and therapeutic management. This review paper presents the current state of knowledge on lymphocytic esophagitis. [ABSTRACT FROM AUTHOR]

Leticia Delgado-Herrera,1 Benjamin Banderas,2 Oluwafunke Ojo,2 Ritesh Kothari,3 Bernhardt Zeiher1 1Astellas Pharma Global Development, Inc., Northbrook, IL, 2Adelphi Values LLC, Boston, MA, 3ACCESS Medical LLC, Chicago, IL, USA Background: Subjects with diarrhea-predominant irritable bowel syndrome (IBS-D) experience abdominal cramping, bloating, pressure, and pain. Due to an absence of clinical biomarkers for IBS-D severity, evaluation of clinical therapy benefits depends on valid and reliable symptom assessments. A patient-reported outcome (PRO) instrument has been developed, comprising of two questionnaires – the IBS-D Daily Symptom Diary and IBS-D Symptom Event Log – suitable for clinical trials and real-world settings. This program aimed to support instrument conversion from pen-and-paper to electronic format.Materials and methods: Digital technology (Android/iOS) and a traditional mode of administration study in the target population were used to migrate or convert the validated PRO IBS-D pen-and-paper measure to an electronic format. Equivalence interviews, conducted in three waves, each had three parts: 1) conceptual equivalence testing between formats, 2) electronic-version report-history cognitive debriefing, and 3) electronic version usability evaluation. After each interview wave, preliminary analyses were conducted and modifications made to the electronic version, before the next wave. Final revisions were based on a full analysis of equivalence interviews. The final analysis evaluated subjects’ ability to read, understand, and provide meaningful responses to the instruments across both formats. Responses were classified according to conceptual equivalence between formats and mobile-format usability assessed with a questionnaire and open-ended probes.Results: Equivalence interviews (n=25) demonstrated conceptual equivalence between formats. Mobile-application cognitive debriefing showed some subjects experienced difficulty with font/screen visibility and understanding or reading some report-history charts and summary screens. To address difficulties, minor revisions/modifications were made and landscape orientation and zoom-in/zoom-out features incorporated.Conclusion: This study indicates that the two administration modes are conceptually equivalent. Since both formats are conceptually equivalent, both are psychometrically reliable, as established in the pen-and-paper version. Subjects found both mobile applications (Android/iOS) offered many advantages over the paper version, such as real-time assessment of their experience. Keywords: irritable bowel syndrome diarrhea-predominant, IBS-D, symptoms, mobile ­application, patient-reported outcomes, conceptual equivalence

Background: Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods: A bibliographic search using major databases was performed using the terms "emergency surgery" "diaphragmatic hernia," "traumatic diaphragmatic rupture" and "congenital diaphragmatic hernia." GRADE methodology was used to evaluate the evidence and give recommendations. Results: CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions: Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving. [ABSTRACT FROM AUTHOR]

The present study was a review of cases of central cystadenocarcinoma over the past 29 years and provides clinical, radiological, and pathological information about these rare lesions. Six cases of central cystadenocarcinoma treated between 1991 and 2019 at Peking University Hospital of Stomatology in Beijing, China, were retrospectively analysed. A comprehensive review of clinical records was summarised and the histological diagnosis was revised using the 2017 World Health Organization criteria. The mean age of patients with central cystadenocarcinoma was 63 (range 51-75) years, and the male:female ratio 1:1. The clinical signs included localised swelling, pain, lower lip numbness, and trismus. There were more cases in the mandible than in the maxilla. All lesions were unilocular or multilocular in radiolucent regions with or without clear margins. The preferred treatment of central cystadenocarcinoma was surgical excision with wide margins, and no local recurrence was found during follow-up. Central cystadenocarcinoma often occurred in middle-aged or elderly patients. Because cystadenocarcinoma is somewhat rare, metastatic tumours of the jaw should be considered when diagnosing cystadenocarcinoma. [ABSTRACT FROM AUTHOR]

Epidemiologic data suggest an increased prevalence of pediatric food allergies and intolerances (FAIs) during the last decades. This changing scenario has led to an increase in the overall healthcare costs, due to a growing demand for diagnostic and treatment services. There is the need to establish Evidence-based practices for diagnostic and therapeutic intervention that could be adopted in the context of public health policies for FAIs are needed. This joint position paper has been prepared by a group of experts in pediatric gastroenterology, allergy and nutrition from the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP). The paper is focused on the Diagnostic Therapeutic Care Pathway (DTCP) for pediatric FAIs in Italy. [ABSTRACT FROM AUTHOR]

The paper does not explicitly mention non-motor symptoms as part of the clinical presentation of ET, but extensively quotes other neurologists who reported that ET-patients are often clinically presenting with a névrose trémulante (C. Achard) or psychical degeneration associated with a neuropathic stock (F. Raymond). Interestingly, Critchley separates essential tremor into mild high frequency tremor (resembling thyrotoxic or psychogenic tremor), medium frequency tremor (resembling Parkinsonian tremor) and even low-frequency intention tremor. Since then, there are two studies reporting that ET families22 and early-onset ET patients23 have a longer life expectancy but larger series are lacking. [Extracted from the article]

Heart failure—either with reduced or preserved ejection fraction (HFrEF/HFpEF)—is a clinical syndrome of multifactorial and gender-dependent aetiology, indicating the insufficiency of the heart to pump blood adequately to maintain blood flow to meet the body's needs. Typical symptoms commonly include shortness of breath, excessive fatigue with impaired exercise capacity, and peripheral oedema, thereby alluding to the fact that heart failure is a syndrome that affects multiple organ systems. Patients suffering from progressed heart failure have a very limited life expectancy, lower than that of numerous cancer types. In this position paper, we provide an overview regarding interactions between the heart and other organ systems, the clinical evidence, underlying mechanisms, potential available or yet-to-establish animal models to study such interactions and finally discuss potential new drug interventions to be developed in the future. Our working group suggests that more experimental research is required to understand the individual molecular mechanisms underlying heart failure and reinforces the urgency for tailored therapeutic interventions that target not only the heart but also other related affected organ systems to effectively treat heart failure as a clinical syndrome that affects and involves multiple organs. [ABSTRACT FROM AUTHOR]

Widespread access to emerging information and communication technologies (ICT) allows its use for the screening of diseases in the general population. At the initiative of the Spanish Confederation of Associations of Families of People with Alzheimer's disease and other dementias (CEAFA), a website (http://www.problemasmemoria.com) has been created that provides information about Alzheimer's disease and includes questionnaires to be completed by family or friends concerned about memory problems of a relative. A cross-sectional, randomized, multicenter study was performed to evaluate feasibility, validity, and user satisfaction with an electronic method of completion vs. the current method of paper-based questionnaires for clinically dementia screening completed by the informants: the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Alzheimer's disease-8 screening test (AD8). A total of 111 pairs were recruited by seven memory clinics. Informants completed IQCODE and AD8 questionnaires both in their paper and electronic versions. The correlation between paper and electronic versions was significantly positive for IQCODE (r = 0.98; p < 0.001) and AD8 (r = 0.96; p < 0.001). The execution time did not differ significantly, and participants considered their use equally easy. This study shows that an electronic version of the IQCODE and AD8 questionnaires is suitable for its online use via the internet and achieves the same results as the traditional paper versions. [ABSTRACT FROM AUTHOR]

Objectives: Osteochondritis dissecans (OCD) is a condition characterized by abnormal subchondral bone with disturbance of overlying articular cartilage. Pathophysiology for the etiology and underlying mechanism of OCD lesion development is not fully understood. The purpose of this study was to determine the association of lower extremity weightbearing axis with femoral condyle OCD lesion location, and if this association was affected by certain patient and OCD lesion characteristics such as lesion stability, skeletal maturity, and the presence of the OCD lesion on the medial versus lateral femoral condyle. Methods: This was a retrospective case series at a single, large academic institution. The primary outcome was the association of femoral condyle OCD lesion location with lower extremity weightbearing axis as categorized by Cahill and Berg zones of the knee. Secondary outcomes included sub-group analyses (treatment, skeletal maturity, and lesion stability) and contribution of femoral and tibial mechanical axis to lower extremity weightbearing axis deviations (mechanical lateral distal femoral angle [mLDFA] and medial proximal tibial angle [MPTA]). For unilateral OCD lesions, mechanical axis was compared between affected and unaffected lower extremities. Results: Eighty-six patients and 95 knees with an OCD lesion of the femoral condyle were identified, with 9 patients (11%) having bilateral OCD lesions. There were 74% male patients with average age of 21 years old. 65% of knees had closed distal femoral physes, 82% of OCD lesions were unstable on MRI imaging, and 85% underwent a surgical procedure. Seventy-five percent of OCD lesions were located in Cahill and Berg zone 2 at the lateral aspect of the medial femoral condyle. Lower extremity mechanical axis was located in the same zone as the OCD lesion in 48% of cases and within the same knee compartment in 56% of cases. Over 90% of OCD lesions were within ±1 zone of the weightbearing axis. There were no significant differences in the association of mechanical axis and OCD lesion location in subgroup analysis of medial versus lateral femoral condyle OCD lesions, skeletal maturity, stability of the lesion, or treatment group. For patients with varus alignment and medial femoral condyle OCD lesions, the mean mLDFA was 89.9° and MPTA was 85.4°, whereas for valgus alignment and lateral femoral condyle lesions, the mLDFA was 84.8° and MPTA was 88.8°. Both the mLDFA and MPTA were significantly different when comparing medial to lateral femoral condyle OCD lesions (p <0.001 and <0.001, respectively). Patients with unilateral medial femoral condyle OCD lesions were more likely to have varus alignment of the affected extremity compared to the contralateral extremity (59% vs. 36%, p = 0.01). Conclusions: This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condyle OCD location. Patients with unilateral medial femoral condyle OCD lesions are more likely to have varus alignment in the affected extremity. Varus alignment associated with medial femoral condyle lesions had similar varus contributions from both femoral and tibial alignment whereas valgus alignment in the setting of lateral femoral condyle lesions appear to have predominantly femoral contributions. There were no significant differences in association with mechanical axis among medial versus lateral femoral condyle lesions, OCD lesion stability, or distal femoral physeal status. More work is required to better understand the relationship between mechanical axis and femoral condyle OCD lesion pathophysiology with the long-term goal of identifying patients at risk for progression of lesion instability and developing potential interventions to preserve articular cartilage. [ABSTRACT FROM AUTHOR]

Objectives: Revision anterior cruciate ligament (ACL) reconstruction has been demonstrated to have outcomes inferior to those noted in primary ACL reconstructions in terms of patient-reported outcomes, return to activity and sports, and graft rupture rates. However, the long-term assessment of patients undergoing revision ACL reconstruction remains unknown, primarily due to the large number of patients needed to do an adequate analysis. A group was assembled to prospectively enroll and follow a revision ACL cohort to determine the risk factors for poor outcomes in a revision cohort, of which over 1,200 patients were enrolled from 83 surgeons and 52 sites and prospectively followed for 10 years. The overarching goal was to assess the long-term progression of outcomes following revision ACL reconstruction, and to determine how the initial factors at the time of revision surgery may influence and predict disease progression. The focus of this study is to characterize the 10-year natural history of this unique dataset, quantified by 3 complementary methodologies: patient-reported outcomes, radiologic measures, and physical examination measures. The purpose was to assess for clinical long-term outcomes, including incidence of graft failure, as well as signs and symptoms of knee osteoarthritis (OA) in this revision cohort at 10 years postoperatively. Methods: Patients were brought back to 6 sites for physical examination by an independent blinded sports medicine physician who was not involved with the revision ACL reconstruction. The physical exam included knee range of motion (ROM), ligamentous testing and bilateral KT-1000 assessment. A series of radiographs (standardized bilateral standing AP, synaflexer bent knee [similar to tunnel/Rosenberg], sunrise, and full extension lateral views) were obtained to assess for incidence of structural OA. Validated patient-reported outcome measures (PROMs) including International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Marx activity rating scale were also obtained. Two physicians independently graded the radiographs for severity of structural OA using the modified Kellgren-Lawrence (KL) grading system (grades 0 to 4). Structural OA was defined as a Kellgren-Lawrence grade of 3 or 4. Symptomatic OA was defined by the KOOS Pain subscale of < 70 points. Multivariate regression models were used to determine the predictors (risk factors) for both structural OA (KL grades 3 to 4) and symptomatic OA (KOOS pain < 70 points) at 10 years follow-up, controlling for the patient's age, sex, body mass index (BMI), baseline PROMs, ACL graft choice, prior and current meniscal pathology and treatment at the time of revision surgery, chondral pathology at the time of revision surgery, and incidence of any subsequent surgeries. Results: 205 patients (107 [52.4%] women) representing 40 surgeons returned at an average 12-year follow-up (range, 10-16 years). The mean (SD) age of this cohort at the time of their onsite evaluation was 40.2 (10.4) years with a BMI of 25.7 (range, 17.0-42.0). Physical Exam: Physical examination demonstrated loss of extension compared to the opposite knee in 118 (58%) and extension less than full (0 degrees) in 84 (41%). With regards to failure, a soft Lachman endpoint was noted in 41 patients (20%). A Lachman >5 mm was noted in 20 patients (10%), and 26 patients (13%) had a grade 2 pivot shift and 4 (2%) had a grade 3 pivot shift. KT-1000 measurements demonstrated 23 (11%) patients with 5 mm or greater involved versus uninvolved side-to-side difference. The blinded surgeons in their opinion detected 37 (18%) with a nonfunctional ACL. If all nonfunctional parameters were applied (Lachman ≥2, Pivot shift ≥2, KT-1000 side-to-side difference of ≥5mm, and surgeon determining failure) only 8 patients (4%) met all failure parameters. Radiographs: Radiographs demonstrated that 115 (56%) exhibited joint space narrowing of the tibiofemoral joint (K-L grades 3 to 4) in their involved knee compared to 28 (14%) in their uninvolved knee (Table 1). The significant drivers of a higher KL grade (structural OA) at 10 years were found to be higher age, higher baseline BMI, having a medial meniscus excision performed either prior to or at the time of revision surgery, having a prior lateral meniscal excision, or having a subsequent surgery (p<0.05; Table 2). Sex, baseline activity level, graft choice, and chondral pathology at the time of revision were not significant. PROMs: PROMs of the onsite group reflected the PROMs of the overall cohort at 10 years (Figure 2). There were 40 onsite subjects (20%) that reported KOOS pain scores of < 70 points (defined as symptomatic OA), while 91 subjects (44%) reported KOOS pain scores over 90 points (defined as no pain). The predictors of increased pain (lower KOOS pain score) at 10 years were subjects who had higher pain scores at the time of revision surgery, grades 3 to 4 chondral pathology in the lateral compartment at the time of revision surgery, medial meniscus excision performed prior to the time of revision surgery or having a subsequent surgery (p<0.05; Table 3). Conversely, having a hamstring autograft or an allograft (compared to a bone-tendon-bone autograft) at the time of revision surgery predicted less symptomatic pain at 10 years. Age, sex, baseline BMI, activity level, and lateral meniscal pathology at the time of revision were not significant predictors of increased knee pain at 10 years. Conclusions: Outcomes in this first ever report of a revision ACL cohort at minimum 10 years follow-up demonstrates worrisome outcomes at a still young age. This study demonstrated a loss of ROM in 41-58% of the cohort, an 18% graft failure rate, 56% who exhibited KL grades of 3 to 4, and 20% who reported KOOS pain scores of less than 70 points, which collectively, all emphasize the challenge of managing the revision ACL reconstruction patient. [ABSTRACT FROM AUTHOR]

Abstract: Using data from the North Carolina School Asthma Survey about the respiratory health of 64,432 adolescents attending public schools in North Carolina and data provided by school employees about the environmental health conditions of the school buildings, we assessed the prevalence of daytime wheezing during the past year among students estimated to be exposed to air pollutants arising from pulp and paper mills located near the schools. Of the schools the students attended, 14% (37/266) were located within 30 miles of one or more pulp and paper mills and odor from the mills was identified by survey respondents for 9 of the 266 schools. The prevalences of daytime wheezing in smokers and nonsmokers with household cigarette smoke exposure were elevated among students attending schools located within 30 miles of a pulp and paper mill, compared to the prevalence among students attending schools located beyond 30 miles (⩽10 miles, prevalence ratio (PR): 1.21, 95% confidence interval (95% CI): 0.99, 1.43; 10–⩽30 miles, PR: 1.06, 95% CI: 0.96, 1.16) and among students attending schools with noticeable odor from a pulp and paper mill (PR: 1.12, 95% CI: 0.93, 1.31). These results indicate a possible association between paper mill location and wheezing symptoms among adolescents and suggest that community-based exposure to pulp and paper mill emissions may have a greater impact on smokers and individuals exposed to cigarette smoke in the home than on nonsmokers without such household exposure. [Copyright &y& Elsevier]

The article discusses the combination of corticosteroid injections and exercise for tendinopathy treatment. It mentions that while corticosteroid injections provide short-term pain relief, they may hinder the long-term effectiveness of exercise. The study suggests that a judicious approach to exercise, including education and pain monitoring, should be the primary treatment, with corticosteroid injections reserved for cases where they are necessary due to their limited short-term benefit.

The concept of repression has been relegated to the periphery in current psychoanalytic theorizing. This is in part due to a reflexive and ill-informed avoidance of Freudian metapsychology, and in part due to preoccupation with 'primitive' and 'deeper' states of mind, a perspective that presumes that repression operates exclusively in 'higher level' or 'neurotic' forms of psychopathology. A careful scrutiny of psychoanalytic theory and clinical practice does not uphold such compartmentalization. Repression is ubiquitous in mental life. It contributes to normality (e.g., onset of latency), undergirds the 'psychopathology of everyday life' (e.g., parapraxes), exists alongside splitting in severe character disorders (e.g., borderline patients "forgetting" their appointments) and, by permitting a modified return of exiled mental contents, gives birth to neurotic symptoms as well as creative imagination. Taking Freud's seminal discourse on repression (in: Repression. Standard Edition, vol 14. Hogarth, London, pp 141–158 1915a) as its starting point, this paper elucidates the complex, nuanced, and pervasive nature of this defense. It deconstructs Freud's unitary concept of repression into four implicit binaries and updates his proposals in the light of contemporary psychoanalytic theory. The paper offers clear guidelines for clinical applications of these ideas. [ABSTRACT FROM AUTHOR]

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Purpose. To provide a bibliographical-historical perspective and main interest in the field of myopia. Methods. In this bibliographic study, the Web of Science Database was searched from 1999 to 2018. Recorded parameters included journal name, impact factor, year and language, number of authors, type and origin, methodology, number of subjects, funding, and topics. Results. Epidemiological assessments were the leading type of article (28%), and half of the papers were prospective studies. The number of citations for multicenter studies was significantly higher (P = 0.034). The articles were published in 27 journals, with the majority in Investigative Ophthalmology, Vision Sciences (28%), and Ophthalmology (26%). Etiology, signs and symptoms, and treatment equally encompassed the topics. Papers addressing etiology, specifically genetic and environmental factors (P = 0.029), signs and symptoms (P = 0.001), and prevention, specifically public awareness (47%, P = 0.005), received significantly more citations. Treatment to decrease myopia progression was a much more common topic (68%) than refractive surgery (32%). Optical treatment was the most popular modality (39%). Half of the publications came from 3 countries: the United States (US), Australia, and Singapore. The highest ranked and cited papers came from the US (P = 0.028) and Singapore (P = 0.028). Conclusions. To our knowledge, this is the first report of the top-cited articles on myopia. There is a predominance of epidemiological assessments and multicenter studies originating from the US, Australia, and Singapore, assessing etiology, signs and symptoms, and prevention. These are more frequently cited, emphasizing the great interest in mapping the increase in the incidence of myopia in different countries, public health awareness, and myopia control. [ABSTRACT FROM AUTHOR]

Up to 40% of patients with symptoms suspicious of gastroesophageal reflux disease (GERD) do not respond completely to proton pump inhibitor (PPI) therapy. The term "refractory GERD" has been used loosely in the literature. A distinction should be made between refractory symptoms (ie, symptoms may or may not be GERD‐related), refractory GERD symptoms (ie, persisting symptoms in patients with proven GERD, regardless of relationship to ongoing reflux), and refractory GERD (ie, objective evidence of GERD despite adequate medical management). The present ESNM/ANMS consensus paper proposes use the term "refractory GERD symptoms" only in patients with persisting symptoms and previously proven GERD by either endoscopy or esophageal pH monitoring. Even in this context, symptoms may or may not be reflux related. Objective evaluation, including endoscopy and esophageal physiologic testing, is requisite to provide insights into mechanisms of symptom generation and evidence of true refractory GERD. Some patients may have true ongoing refractory acid or weakly acidic reflux despite PPIs, while others have no evidence of ongoing reflux, and yet others have functional esophageal disorders (overlapping with proven GERD confirmed off therapy). In this context, attention should also be paid to supragastric belching and rumination syndrome, which may be important contributors to refractory symptoms. [ABSTRACT FROM AUTHOR]

There is some confusion surrounding the management of people with lymphoedema in the presence of deep vein thrombosis (DVT). This may be in relation to the suitability of commencing compression therapy or regarding the continuation of compression therapy in those who develop DVT. The purpose of this British Lymphology Society position paper is to support evidence-based practice and debunk the myths surrounding the management of DVT and lymphoedema. [ABSTRACT FROM AUTHOR]