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During thyroid surgery fast and reliable intra-operative pathological feedback has the potential to avoid a two-stage procedure and significantly reduce health care costs in patients undergoing a diagnostic hemithyroidectomy (HT). We explored higher harmonic generation (HHG) microscopy, which combines second harmonic generation (SHG), third harmonic generation (THG), and multiphoton excited autofluorescence (MPEF) for this purpose. With a compact, portable HHG microscope, images of freshly excised healthy tissue, benign nodules (follicular adenoma) and malignant tissue (papillary carcinoma, follicular carcinoma and spindle cell carcinoma) were recorded. The images were generated on unprocessed tissue within minutes and show relevant morphological thyroid structures in good accordance with the histology images. The thyroid follicle architecture, cells, cell nuclei (THG), collagen organization (SHG) and the distribution of thyroglobulin and/or thyroid hormones T3 or T4 (MPEF) could be visualized. We conclude that SHG/THG/MPEF imaging is a promising tool for clinical intraoperative assessment of thyroid tissue.

During thyroid surgery fast and reliable intra-operative pathological feedback has the potential to avoid a two-stage procedure and significantly reduce health care costs in patients undergoing a diagnostic hemithyroidectomy (HT). However, with current techniques, intra-operative assessment of histopathological characteristics is not always reliable within the operation time. Therefore, there is an urgent need for techniques that provide the surgeon with better pathological feedback during the operation. As a step towards this purpose, the potential of higher harmonic generation (HHG) microscopy, which combines second harmonic generation (SHG), third harmonic generation (THG), and multiphoton excited autofluorescence (MPEF) is explored. We used a compact, portable HHG microscope to record images of freshly excised healthy tissue, benign nodules (follicular adenoma) and malignant tissue (papillary carcinoma, follicular carcinoma and spindle cell carcinoma). The SHG/THG/MPEF images were generated on unprocessed tissue within minutes, typically, a 10 by 10 mm² area was acquired within 10 minutes. The SHG/THG/MPEF images show relevant morphological thyroid structures in good accordance with the histology images. The thyroid follicle architecture, cells, cell nuclei (THG), collagen organization (SHG) and the distribution of thyroglobulin and/or thyroid hormones T3 or T4 (MPEF) could be visualized. We conclude that SHG/THG/MPEF imaging is a promising tool for clinical intraoperative assessment of thyroid tissue. More patients need to be included, to assess the feasibility of HHGM to determine capsular or vascular invasion, features essential for intra-operative thyroid cancer diagnosis.

Recurrence after resection in patients with non-functional pancreatic neuroendocrine tumors (NF-pNET) has a considerable impact on overall survival. Accurate risk stratification will tailor optimal follow-up strategies. This systematic review assessed available prediction models, including their quality. This systematic review followed PRISMA and CHARMS guidelines. PubMed, Embase, and the Cochrane Library were searched up to December 2022 for studies that developed, updated, or validated prediction models for recurrence in resectable grade 1 or 2 NF-pNET. Studies were critically appraised. After screening 1883 studies, 14 studies with 3583 patients were included: 13 original prediction models and 1 prediction model validation. Four models were developed for preoperative and nine for postoperative use. Six models were presented as scoring systems, five as nomograms, and two as staging systems. The c statistic ranged from 0.67 to 0.94. The most frequently included predictors were tumor grade, tumor size, and lymph node positivity. Critical appraisal deemed all development studies as having a high risk of bias and the validation study as having a low risk of bias. This systematic review identified 13 prediction models for recurrence in resectable NF-pNET with external validations for 3 of them. External validation of prediction models improves their reliability and stimulates use in daily practice.

Background: Schoolboy rugby is a popular sport which forms the bedrock of rugby development in many African countries, including Zimbabwe. With burgeoning talent identification programmes, the development of multi-dimensional, logicallyvalidated, and reliable test batteries is essential to inform the objective selection of potentially talented young rugby athletes.Objectives: This study sought evidence on the absolute and relative test-retest reliability of the component test items in the newly-assembled SCRuM test battery.Methods: Utilising a pragmatic test-retest experimental design, a sample of 41 Under-19 schoolboy players playing competitive rugby in the elite Super Eight Schools Rugby League in Harare, Zimbabwe, participated in the study.Results: Physiological and game-specific skills tests which showed good to excellent relative reliability and acceptable absolute reliability, included: 20 m and 40 m speed, L-run, Vertical Jump (VJ), 60 s Push-Up, 2 kg Medicine Ball Chest Throw test (2 kg MBCT), Wall Sit Leg Strength test (WSLS), Repeated High Intensity Exercise test (RHIE), One Repetition Maximum Back Squat (1-RM BS) and Bench Press tests (1-RM BP), Yo-Yo Intermittent Recovery Level 1 test (Yo-Yo IRT L1), Tackling Proficiency test, Passing Ability Skill test and Running and Catching Ability skill test.Conclusion: All these tests are reliable and warrant inclusion in the SCRuM test battery for possible profiling of U19 schoolboy rugby players during the ‘in-season’ phase provided there is adequate participant familiarisation and test standardisation. The test-retest ICCs and measurement errors are generalisable to other young athletes in this population, making the tests useful for the evaluation of training and developmental effects of the measured constructs.

There are many paths people take to gaining the IBCLC credential. Mine has been a bit more circuitous than many. This is a brief narrative in which I was invited to write about my journey and experience.

Both the Movement Assessment Battery for Children second edition (M-ABC-2) and Bruininks-Oseretsky Test of Motor Proficiency second edition short form (BOT-2-SF) are frequently used in research and in the clinical practice to evaluate motor competence in children. Despite its widespread use in research, no studies have reported the results of case identification in African children. Comparing these two motor assessment tools for a different target group is important in order to select the most appropriate clinical and research tool. Methods. A total of 444 children performed MABC-2, 165 children also performed the BOT-2-SF and subsamples were tested on specific subtests of the BOT-2 (Running and Agility, Balance, and Strength). Tests were administered to randomly selected children between 6 and 10 years of age. Results: 36% for the children scored at or below the 16th percentile of the MABC-2, while this was 43%, 27%, and 23% for the component score in Manual Dexterity, Aiming and Catching, and Balance, respectively. Of the children 16% scored at or below the 17th percentile of the BOT-2-SF total score, while this was 3%, 9% and 22% for the subtest scores Running and agility, Balance, and Strength, respectively. A moderate correlation (r = 0.44) was found between total scores of the two tests. No significant correlations were found between the dynamic MABC-2 item (Jumping/Hopping) standard scores and any of the 9 balance items of the BOT-2. Conclusion: Far more children scored in the clinical "at risk" range (

OBJECTIVE: This study aims to generate a reproducible and generalizable Workflow model of ICG-angiography integrating Standardization and Quantification (WISQ) that can be applied uniformly within the surgical innovation realm independent of the user.SUMMARY BACKGROUND DATA: Tissue perfusion based on indocyanine green (ICG)-angiography is a rapidly growing application in surgical innovation. Interpretation of have been subjective and error-prone due to the lack of a standardized and quantitative ICG-workflow and analytical methodology. There is a clinical need for a more generic, reproducible, and quantitative ICG perfusion model for objective assessment of tissue perfusion.METHODS: In this multicenter, proof-of-concept study, we present a generic and reproducible ICG-workflow integrating standardization and quantification for perfusion assessment. To evaluate our model's clinical feasibility and reproducibility, we assessed the viability of parathyroid glands after performing thyroidectomy. Biochemical hypoparathyroidism was used as the postoperative endpoint and its correlation with ICG quantification intraoperatively. Parathyroid gland are an ideal model as parathyroid function post-surgery is only affected by perfusion.RESULTS: We show that visual -subjective- interpretation of ICG-angiography by experienced surgeons on parathyroid perfusion cannot reliably predict organ function impairment postoperatively, emphasizing the importance of an ICG quantification model. WISQ was able to standardize and quantify ICG-angiography and provided a robust and reproducible perfusion curve analysis. A low ingress slope of the perfusion curve combined with a compromised egress slope was indicative for parathyroid organ dysfunction in 100% of the cases.CONCLUSION: WISQ needs prospective validation in larger series and may eventually support clinical decision-making to predict and prevent postoperative organ function impairment in a large and varied surgical population.

Summary Adrenal incidentalomas are regularly encountered during imaging for esophageal cancer patients, but their oncological significance remains unknown. This study aimed to describe the incidence and etiology of adrenal incidentalomas observed throughout the diagnostic workup. This retrospective cohort study included all esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016. Radiology and multidisciplinary team meeting reports were reviewed for adrenal incidentalomas. In case of adrenal incidentaloma, the 18FDG-PET/CT was reassessed by a radiologist blinded for the original report. In case of a metachronous incidentaloma during follow-up, visibility on previous imaging was reassessed. Primary outcome was the incidence, etiology and oncological consequence of synchronous adrenal incidentalomas. This study included 1,164 esophageal cancer patients, with a median age of 66 years. Patients were predominantly male (76.1%) and the majority had an adenocarcinoma (69.0%). Adrenal incidentalomas were documented in 138 patients (11.9%) during the diagnostic workup. At primary esophageal cancer workup, 22 incidentalomas proved malignant. However, follow-up showed that four incidentalomas were inaccurately diagnosed as benign and three malignant incidentalomas were visible on staging imaging but initially missed. Stage migration occurred in 15 of 22 (68.2%), but this would have been higher if none were missed or inaccurately diagnosed. The oncological impact of adrenal incidentalomas in patients with esophageal cancer is significant as a considerable part of incidentalomas changed treatment intent from curative to palliative. As stage migration is likely, pathological examination of a synchronous adrenal incidentaloma should be weighted in mind.

Supplemental material, sj-pdf-1-jad-10.1177_10870547221146244 for A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis by Lize Kleeren, Ann Hallemans, Jasmine Hoskens, Katrijn Klingels, Bouwien Smits-Engelsman and Evi Verbecque in Journal of Attention Disorders

Objective: To map the effect of motor-based interventions on motor skills in children with ADHD. Method: A systematic literature search was performed in Pubmed, Web of Science, and the SCOPUS database (last search: October 30th 2022). Methodological quality was assessed using the PEDro-scale and the quality of evidence was determined with the GRADE-method. Meta-analysis was performed when at least five studies were available. Results: Thirteen studies (7 RCTs) satisfied the inclusion criteria, five of which were eligible for meta-analysis. Only one of the included studies reached the low risk of bias threshold. Comparing different motor-based interventions to any non-motor control intervention showed large motor skill improvements (SMD = 1.46; 95% CI = [1.00;1.93]; I² = 47.07%). The most effective type of motor-based intervention and the optimal treatment parameters could not be determined yet. Conclusion: Motor-based interventions in general seem to improve motor skills in children with ADHD. Additional RCTs are needed to increase current low GRADE confidence.

Background. Injury risk is high in Physical Education Teacher Education (PETE) students. Insights into specific injury locations per sex, setting, sports, and curriculum year are needed to develop preventive measures. Purpose. To compare injury distributions by body locations in PETE students and how these distributions differ by sex, type, onset, curriculum year, settings, or sports. Methods. In a historical cohort study over 14 years, data from 2899 students (male 76.2%, n = 1947) enlisted in the first three years of a PETE curriculum were analysed. Injuries reported at the institution’s medical facility were categorised per sex, body location, onset, type, setting, sports, and curriculum year. Results. Forty-three percent (n = 1247) of all students (female 54.9%, n = 523, male 37.2%, and n = 429) reported a total of 2129 injuries (freshmen 56.4%; 2nd year 28.2%; 3rd year 15.5%). The most prevalent sudden onset injury locations (63.4% of all injuries) were the ankle (32.5%) and knee (16.6). The most prevalent gradual onset injuries were the lower leg (27.8%) and knee (25.2%). Joint/ligament injuries (45.8%) and muscle/tendon injuries (23.4%) were the most prevalent injury types. Proportions for injury locations and injury types differed significantly between curriculum years. Injury prevalence per setting and sport differed significantly between the sexes. Injury locations differed significantly between sports and between the sexes per sport. Conclusion. A differential approach per injury location, onset, type, sex, setting, sports, and curriculum year is needed to develop adequate preventive measures in PETE studies. The engagement of precurricular, intracurricular, and extracurricular stakeholders is needed in the development of these measures.

Supplemental material, sj-docx-1-jad-10.1177_10870547221146244 for A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis by Lize Kleeren, Ann Hallemans, Jasmine Hoskens, Katrijn Klingels, Bouwien Smits-Engelsman and Evi Verbecque in Journal of Attention Disorders

Supplemental material, sj-pdf-2-jad-10.1177_10870547221146244 for A Critical View on Motor-based Interventions to Improve Motor Skill Performance in Children With ADHD: A Systematic Review and Meta-analysis by Lize Kleeren, Ann Hallemans, Jasmine Hoskens, Katrijn Klingels, Bouwien Smits-Engelsman and Evi Verbecque in Journal of Attention Disorders

The original version of this article unfortunately contained a mistake on the fifth and eleventh author names, from Schelto Kruijf to Schelto Kruijff and from Tessa van Ginhoven to Tessa M. van Ginhoven. The corrected author names are shown below. Schelto Kruijff and Tessa M. van Ginhoven.

Aim Open resection of small bowel neuroendocrine neoplasms (SB-NEN) is still considered standard-of-care, mainly because of frequently encountered multifocality and central mesenteric masses. The aim of this study was to evaluate surgical approach for SB-NEN at a national level and determine predictors for overall survival. Methods Patients with SB-NEN who underwent resection between 2005 and 2015 were included from the Netherlands Cancer Registry. Patient and tumor characteristics were compared between laparoscopic and open approach. Overall survival was assessed by Kaplan–Meier and compared with the Log-rank test. Independent predictors were determined by Cox proportional hazards model. Results In total, 482 patients were included, of whom 342 (71%) underwent open and 140 (29%) laparoscopic resection. The open resection group had significantly more multifocal tumors resected (24% vs. 14%), pN2 lymph nodes (18% vs. 7%) and stage IV disease (36% vs. 22%). Overall survival after open resection was significantly shorter compared to laparoscopic resection (3-year: 81% vs. 89%, 5-year: 71% vs. 84%, p = 0.004). In multivariable analysis, age above 60-years (60–75, HR 3.38 (95% CI 1.84–6.23); > 75 years, HR 7.63 (95% CI 3.86–15.07)), stage IV disease (HR 1.86 (95% CI 1.18–2.94)) and a laparoscopic approach (HR 0.51 (95% CI 0.28–0.94)) were independently associated with overall survival, whereas multifocal primary tumor, grade and resection margin status were not. Conclusion Laparoscopic resection was the approach in 29% of SB-NEN at a national level with selection of the more favorable patients. Laparoscopic resection remained independently associated with better overall survival besides age and stage, but residual confounding cannot be excluded.