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Aaron Calodney,1 Nomen Azeem,2 Patrick Buchanan,3 Ioannis Skaribas,4 Ajay Antony,5 Christopher Kim,6 George Girardi,7 Chau Vu,8 Christopher Bovinet,9 Rainer Vogel,10 Sean Li,11 Navdeep Jassal,12 Youssef Josephson,13 Timothy Lubenow,14 Christopher M Lam,15 Timothy R Deer6 1Precision Spine Care, Tyler, TX, USA; 2Florida Spine and Pain Specialists, Tampa, FL, USA; 3Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA; 4Expert Pain P.A, Houston, TX, USA; 5The Orthopaedic Institute, Gainesville, FL, USA; 6The Spine and Nerve Center, Charleston, WV, USA; 7Front Range Pain Medicine, Fort Collins, CO, USA; 8Evolve Restoration Center, Santa Rosa, CA, USA; 9The Spine Center of Southeast Georgia, Brunswick, GA, USA; 10Comprehensive and Interventional Pain Management, Henderson, NV, USA; 11Premier Pain Centers, Shrewsbury, NJ, USA; 12Excel Pain and Spine, Lakeland, FL, USA; 13The Pain Management Center, Voorhees Township, NJ, USA; 14Rush University Medical Center, Chicago, IL, USA; 15University of Kansas Medical Center, Kansas City, KS, USACorrespondence: Aaron Calodney, Precision Spine Care, Tyler, TX, USA, Email aaroncalodney@me.comIntroduction: Research suggests that sacroiliac joint (SIJ) dysfunction is responsible for 15% to 30% of reported low back pain cases. Recently, there has been an increasing interest in SIJ fusion using minimally invasive surgery (MIS) due to safety. Initially, devices designed for MIS were intended for lateral approaches. A minimally invasive sacroiliac fusion implant for use with a posterior approach has been developed and is regulated for clinical use under the regulatory framework required for human cells, tissues, or cellular or tissue-based products (HCT/Ps).Methods: A multi-center, prospective, single-arm study was launched after initial studies provided preliminary data to support safety, efficacy, and durability of this minimally invasive sacroiliac posterior fusion LinQ allograft implant (NCT04423120). Preliminary results were reported previously. Final results for the full participant cohort are presented here.Results: One-hundred and fifty-nine (159) participants were enrolled across 16 investigational sites in the US between January 2020 and March 2022. One-hundred and twenty-two (122) participants were implanted. At the 1-month follow-up, 82 participants satisfied all criteria for the composite responder endpoint, representing 73.2% of the study cohort. These results stayed consistent across the remaining study timepoints with 66.0%, 74.4%, and 73.5% of participants classified as responders at the 3-, 6- and 12-month follow-up visits, respectively. VAS scores were significantly reduced (p < 0.0001) and ODI scores were significantly improved (p < 0.0001). All domains of the PROMIS-29 were also significantly improved (all p’s < 0.0001). Only one procedure-related serious AE was reported in the study.Conclusion: These results suggest that the posterior approach LinQ Implant System is a safe and effective treatment for sacroiliac joint dysfunction at 12 months, with results that are favorable compared to outcomes reported for an FDA-cleared lateral approach.Keywords: sacroiliac joint disease, sacroiliac fusion, single point posterior fusion, back pain, minimally invasive spine surgery, sacroiliitis

Anuj Shah,1 Jonathan M Hagedorn,2 Usman Latif,3 Ashley Bailey-Classen,4 Nomen Azeem,5 Douglas P Beall,6 Pankaj Mehta,7 Chad Stephens,8 Larry Khoo,9 Timothy Ray Deer10 1Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, MI, USA; 2Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 3Department of Anesthesiology and Pain Medicine, University of Kansas Health System, Kansas City, KS, USA; 4Trinity Pain Medicine Associates, Fort Worth, TX, USA; 5Florida Spine & Pain Specialists, Riverview, FL, USA; 6Comprehensive Specialty Care, Edmond, OK, USA; 7Pain Specialists of Austin and Central Texas Pain Center, Austin, TX, USA; 8Noble Pain Management and Sports Medicine, Southlake, TX, USA; 9The Spine Clinic of Los Angeles, Los Angeles, CA, USA; 10The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Anuj Shah, Department of Physical Medicine and Rehabilitation, Detroit Medical Center, 261 Mack Ave, Detroit, MI, 48220, USA, Tel +1 734646-0321, Email Anujshah74@gmail.comIntroduction: Lumbar spinal stenosis (LSS) is a common condition caused by degenerative changes in the lumbar spine with age. LSS is caused by a variety of factors, including degenerative spondylosis and spondylolisthesis. People suffering with LSS experience neurogenic claudication, which causes severe physical limitations, discomfort, and a decrease in quality of life. Less invasive procedures are now being researched to improve the prognosis, success rate, and safety of LSS treatments. Posterior lateral spinal arthrodesis (PLSA) is a new surgical treatment for LSS. This study looks at the procedural and patient safety of PLSA.Materials and methods: This study is a multicenter retrospective analysis of the safety of PLSA who met the clinical indications for PLSA and underwent the procedure at eight interventional spine practices. Data was collected on demographical information, pre-procedural numeric rating scale score (NRS), post-procedural NRS, and complication reporting. Patients who were included had LSS with or without spondylolisthesis and had failed conservative treatments. A descriptive statistical analysis was performed to report the outcomes. Results were reported as mean and standard deviations for continuous outcomes, and frequency (%) for categorical outcomes.Results: This retrospective analysis involved 191 patients and 202 PLSA implants. The majority of patients were male Caucasians with a mean age of 69.2 years and a BMI of 31.1. A large majority of implants were placed at the L4-5 level, and the average pre-procedural NRS was 6.3 while the average post-procedural NRS was 3.1, indicating a 50.8% reduction in pain (p < 0.0001). Two patients reported complications, but they were unrelated to the device or surgical procedure; no infections, device malfunctions, or migrations were reported in the patient cohort.Conclusion: Preliminary results with PLSA implants indicate that it is a safe treatment option for patients with moderate LSS who do not respond to conservative management.Keywords: lumbar spinal stenosis, spondylolisthesis, interspinous fusion, Minuteman, spinal simplicity, posterior lateral spinal arthrodesis

Dawood Sayed,1 Jay Grider,2 Natalie Strand,3 Jonathan M Hagedorn,4 Steven Falowski,5 Christopher M Lam,1 Vinicius Tieppo Francio,6 Douglas P Beall,7 Nestor D Tomycz,8 Justin R Davanzo,9 Rohit Aiyer,10 David W Lee,11 Hemant Kalia,12,13 Soun Sheen,13 Mark N Malinowski,14,15 Michael Verdolin,16 Shashank Vodapally,17 Alexios Carayannopoulos,18– 20 Sameer Jain,21 Nomen Azeem,22,23 Reda Tolba,24,25 George C Chang Chien,26,27 Priyanka Ghosh,28 Anthony J Mazzola,29 Kasra Amirdelfan,30 Krishnan Chakravarthy,31,32 Erika Petersen,33 Michael E Schatman,34,35 Timothy Deer36 1Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 2University of Kentucky, Lexington, KY, USA; 3Interventional Pain Management, Mayo Clinic, Scottsdale, AZ, USA; 4iSpine Pain Physicians, Maple Grove, MN, USA; 5Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA; 6Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 7Comprehensive Specialty Care, Edmond, OK, USA; 8AHN Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA; 9AHN Neurosurgery, Forbes Hospital, Monroeville, PA, USA; 10Interventional Pain Management and Pain Psychiatry, Henry Ford Health System, Detroit, MI, USA; 11Physical Medicine & Rehabilitation and Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA; 12Rochester Regional Health System, Rochester, NY, USA; 13Department of Physical Medicine & Rehabilitation, University of Rochester, Rochester, NY, USA; 14Adena Spine Center, Adena Health System, Chillicothe, OH, USA; 15Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA; 16Anesthesiology and Pain Medicine, Pain Consultants of San Diego, San Diego, CA, USA; 17Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA; 18Department of Physical Medicine and Rehabilitation, Rhode Island Hospital, Newport Hospital, Lifespan Physician Group, Providence, RI, USA; 19Comprehensive Spine Center at Rhode Island Hospital, Newport Hospital, Providence, RI, USA; 20Neurosurgery, Brown University, Providence, RI, USA; 21Interventional Pain Management, Pain Treatment Centers of America, Little Rock, AR, USA; 22Department of Neurology, University of South Florida, Tampa, FL, USA; 23Florida Spine & Pain Specialists, Riverview, FL, USA; 24Pain Management, Cleveland Clinic, Abu Dhabi, United Arab Emirates; 25Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; 26Pain Management, Ventura County Medical Center, Ventura, CA, USA; 27Center for Regenerative Medicine, University Southern California, Los Angeles, CA, USA; 28Remedy Medical Group, San Francisco, CA, USA; 29Mount Sinai Health System, New York City, NY, USA; 30IPM Medical Group, Inc., Walnut Creek, CA, USA; 31Division of Pain Medicine, Department of Anesthesiology, University of California San Diego, San Diego, CA, USA; 32Va San Diego Healthcare, San Diego, CA, USA; 33Department of Neurosurgery, University of Arkansas for Medical Science, Little Rock, AR, USA; 34Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA; 35Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA; 36The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Dawood Sayed, The University of Kansas Health System, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA, Tel +1 913-588-5521, Email dsayed@kumc.eduIntroduction: Painful lumbar spinal disorders represent a leading cause of disability in the US and worldwide. Interventional treatments for lumbar disorders are an effective treatment for the pain and disability from low back pain. Although many established and emerging interventional procedures are currently available, there exists a need for a defined guideline for their appropriateness, effectiveness, and safety.Objective: The ASPN Back Guideline was developed to provide clinicians the most comprehensive review of interventional treatments for lower back disorders. Clinicians should utilize the ASPN Back Guideline to evaluate the quality of the literature, safety, and efficacy of interventional treatments for lower back disorders.Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations. Experts from the fields of Anesthesiology, Physiatry, Neurology, Neurosurgery, Radiology, and Pain Psychology developed the ASPN Back Guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Scopus, and meeting abstracts to identify and compile the evidence (per section) for back-related pain. Search words were selected based upon the section represented. Identified peer-reviewed literature was critiqued using United States Preventive Services Task Force (USPSTF) criteria and consensus points are presented.Results: After a comprehensive review and analysis of the available evidence, the ASPN Back Guideline group was able to rate the literature and provide therapy grades to each of the most commonly available interventional treatments for low back pain.Conclusion: The ASPN Back Guideline represents the first comprehensive analysis and grading of the existing and emerging interventional treatments available for low back pain. This will be a living document which will be periodically updated to the current standard of care based on the available evidence within peer-reviewed literature.Keywords: back pain, intervention, clinical guideline, spinal cord stimulation, minimally invasive spine procedure, lumbar disorder, epidural steroid injection, radiofrequency ablation

Natalie Strand,1 Ryan S D’Souza,2 Jonathan M Hagedorn,3 Scott Pritzlaff,4 Dawood Sayed,5 Nomen Azeem,6 Alaa Abd-Elsayed,7 Alexander Escobar,8 Mark A Huntoon,9 Christopher M Lam,5 Timothy R Deer10 1Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 3iSpine Pain Physicians, Burnsville, MN, USA; 4Department of Anesthesiology and Pain Medicine, Division of Pain Medicine, University of California-Davis, Sacramento, CA, USA; 5The University of Kansas Medical Center, Kansas City, KS, USA; 6Florida Spine & Pain Specialists, Bradenton, FL, USA; 7Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 8Comprehensive Centers for Pain Management, Toledo, OH, USA; 9Department of Anesthesiology, Virginia Commonwealth University, Henrico, VA, USA; 10The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Natalie Strand, Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Scottsdale, AZ, USA, Tel +1 480-301-8000, Fax +1 480-342-2986, Email strand.natalie@mayo.eduAbstract: The objective of this peripheral nerve stimulation consensus guideline is to add to the current family of consensus practice guidelines and incorporate a systematic review process. The published literature was searched from relevant electronic databases, including PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science from database inception to March 29, 2021. Inclusion criteria encompassed studies that described peripheral nerve stimulation in patients in terms of clinical outcomes for various pain conditions, physiological mechanism of action, surgical technique, technique of placement, and adverse events. Twenty randomized controlled trials and 33 prospective observational studies were included in the systematic review process. There is Level I evidence supporting the efficacy of PNS for treatment of chronic migraine headaches via occipital nerve stimulation; chronic hemiplegic shoulder pain via stimulation of nerves innervating the trapezius, supraspinatus, and deltoid muscles; failed back surgery syndrome via subcutaneous peripheral field stimulation; and lower extremity neuropathic and lower extremity post-amputation pain. Evidence from current Level I studies combined with newer technologies facilitating less invasive and easier electrode placement make peripheral nerve stimulation an attractive alternative for managing patients with complex pain disorders. Peripheral nerve stimulation should be used judiciously as an adjunct for chronic and acute postoperative pain following adequate patient screening and positive diagnostic nerve block or stimulation trial.Keywords: post-amputation pain, low back pain, peripheral neuropathy, chronic postoperative pain

Dawood Sayed,1 Nasir Khatri,1 Adam Rupp,1 Christopher Bovinet,2 Nomen Azeem,3 Sean Li,4 Youssef Josephson,5 Jason Pope6 1Department of Anesthesiology, University of Kansas, Kansas City, KS, USA; 2The Spine Center of Southeast Georgia, Brunswick, GA, USA; 3Florida Spine & Pain Specialists, Riverview, FL, USA; 4Premier Pain Centers, Shrewsbury, NJ, USA; 5National Spine & Pain Centers, Voorhees Township, NJ, USA; 6Evolve Restorative Center, Santa Rosa, CA, USACorrespondence: Dawood Sayed, Department of Anesthesiology, University of Kansas, Kansas City, KS, USA, Email dsayed1@yahoo.comBackground: Studies have found that up to one-third of patients with LBP have sacroiliac joint (SIJ) dysfunction as a contributing cause. Historically, the management of SIJ dysfunction has been plagued by ineffectiveness or significant morbidity. In 2008, minimally invasive lateral SIJ fusion was developed. While this procedure is a safe and effective treatment, there is still a significant proportion of patients who will not experience therapeutic success. There is a paucity of data in the literature regarding the management of these patients. Recently, a novel posterior sacroiliac joint fusion device has been developed which minimizes complications compared to lateral approaches and may serve to salvage therapeutic failures in this patient population.Objective: Determine the efficacy and feasibility of a posterior SIJ fusion device as a salvage technique in patients who have not experienced therapeutic success following lateral SIJ fusion.Design: Multi-center retrospective observational study.Methods: Patients who had previously undergone lateral SIJ fusion and had persistent LBP were evaluated and diagnosed to have persistent primary SIJ pathology. All patients underwent posterior SIJ fusion utilizing a machined allograft transfixing sacroiliac fusion device. Demographic data and patient reported pain scores were collected.Results: A total of 7 patients who had undergone lateral SIJ fusion were included in the study and underwent posterior SIJ fusion. The mean patient reported pain improvement following posterior fusion was 80% with an average follow-up time of 10 months. Median morphine milliequivalents were 20 pre-procedure and 0 post-procedure.Conclusion: We were able to show significant reductions in pain scores and opioid consumption, which suggests that minimally invasive posterior SIJ utilizing a novel implant and technique may be a viable treatment option to salvage pain relief in this patient population. Further, the favorable safety profile of this posterior technique uniquely positions it to be an appropriate first-line surgical therapy.Keywords: sacroiliac joint pain, posterior SIJ fusion, lateral SIJ fusion, salvage, low back pain

Alaa Abd-Elsayed,1 Nomen Azeem,2 Pooja Chopra,3 Ryan S D’Souza,4 Dawood Sayed,5 Timothy Deer6 1Department of Anesthesiology, University of Wisconsin, Madison, WI, USA; 2Florida Spine & Pain Specialists, Tampa, FL, USA; 3Bux Pain Management, Danville, KY, USA; 4Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA; 5Department of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA; 6The Spine and Nerve Centers, Charleston, WV, USACorrespondence: Alaa Abd-Elsayed, Department of Anesthesiology University of Wisconsin Madison, WI, USA, Email alaaawny@hotmail.comObjective: The objective of this study was to survey current clinical practice related to lumbar radiofrequency (RFA) for the treatment of zygapophyseal (facet)-mediated low back pain.Methods: Survey questions regarding the clinical practice of lumbar RFA were created and piloted by the American Society of Pain and Neuroscience (ASPN) leadership. After revision for clarity, health-care professionals worldwide who hold membership status within the ASPN Society and who offer lumbar RFA in their clinical practice were recruited to participate in this online survey. All responses were tabulated and summarized descriptively.Results: A total of 329 participants responded in the survey. Most participants specialized in anesthesiology (68.4%) and physical medicine and rehabilitation (21.8%) and had been practicing pain management for more than five years (70.5%). Of physician respondents, 27.5% did not complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited pain medicine fellowship and 16.5% were not board-certified in pain medicine. The majority of providers (69.7%) reported that they perform two diagnostic medial branch blocks prior to proceeding with lumbar RFA. Bupivacaine 0.5% was the most common medication utilized for both the first (37.4%) and second (37.1%) diagnostic blocks. There were 32.6% of total respondents who reported not utilizing contrast dye when performing diagnostic blocks. The vast majority of providers (91.4%) reported using conventional RFA for lumbar medial branch neurotomy.Conclusion: This survey study provides a summary of the application of lumbar RFA for the treatment of axial low back pain in the real-world setting. We highlight a significant portion of providers who perform lumbar RFA yet do not have pain fellowship training at an ACGME-accredited institution or do not maintain current pain medicine board certification. We also report deviations from standard practice, specifically the type of local anesthetic used for comparative diagnostic blocks and the omission of contrast injection during diagnostic blocks.Keywords: radiofrequency ablation, low back pain, medial branch block, survey, clinical practice

Timothy R Deer,1 Adam Rupp,2 Ryan Budwany,3 Christopher J Bovinet,4 John W Chatas,5 Stephen T Pyles,6 Nomen Azeem,7 Sean Li,8 Ramana Naidu,9 Ajay Antony,10 Jonathan M Hagedorn,11 Dawood Sayed12 1The Spine & Nerve Centers of the Virginias, Charleston, WV, USA; 2Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, KS, USA; 3West Virginia University, Charleston, WV, USA; 4The Spine Center of Southeast Georgia, Brunswick, GA, USA; 5Michigan Pain Specialists, Ypsilanti, MI, USA; 6Pain Treatment Centers, Ocala, FL, USA; 7Florida Spine & Pain Specialists, Riverview, FL, USA; 8Premier Pain Centers, Shrewsbury, NJ, USA; 9California Orthopedics & Spine, Larkspur, CA, USA; 10The Orthopaedic Institute, Gainesville, FL, USA; 11Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA; 12Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS, USACorrespondence: Timothy R DeerThe Spine & Nerve Centers of the Virginias, Charleston, WV, 25301, USATel +1 304-347-6120Email doctdeer@aol.comBackground: Sacroiliac joint (SIJ) pain is a common cause of low back pain, a problem experienced by two-thirds of adults in the United States population. Traditionally, the management of persistent SIJ-related pain has involved conservative therapies (physical therapy, topical medications, oral anti-inflammatory medications), interventional therapies (SIJ steroid injections or ablation), and surgery (SIJ fusion; open and lateral approach). Recent advancements in technology have paved the way for SIJ fusion via a posterior approach, which aims to minimize complications and enhance recovery.Objective: The purpose of this study is to introduce the concept of the posterior approach to SIJ fusion as a feasible adjunct and salvage technique for patients with inadequate pain relief from other minimally invasive surgical procedures, and to validate its efficacy through a retrospective multicenter data analysis.Design: Multicenter retrospective observational study.Methods: Patients with refractory SIJ pain were treated by interventional pain physicians at one of the eight different pain management centers. All patients underwent posterior SIJ fusion via the LinQTM sacroiliac fusion procedure. Demographical data were collected, in addition to patient-reported pain relief.Results: A total of 111 patients were included in the study and underwent posterior SIJ fusion for refractory SIJ-related pain following the use of spinal cord stimulation (SCS), interspinous spacer (ISS), intrathecal drug delivery (IDDS), and/or minimally invasive lumbar decompression (MILD). Overall, the mean patient reported pain relief following posterior SIJ fusion was 67.6%. In patients with a history of failed back surgery syndrome, the mean patient reported pain relief was 76.5%.Conclusion: In this retrospective case series of patients with continued intolerable pain following SCS, ISS, IDDS, or MILD, a novel posterior SIJ fusion device provided significant pain relief in a salvage manner. These early results suggest that this intervention may be a therapeutic option to consider in these patients.Keywords: sacroiliac joint pain, posterior SIJ fusion, salvage, spinal cord stimulation, lumbar decompression

The main objective of this study was to elucidate the effect of short- term exposure of Japanese quail eggs to acute high incubation temperature on embryonic development and on the ability of post- hatched chicks to cope with subsequent heat stress conditions during the growing period. A total of 998 Japanese quail eggs were divided into two groups, the first group (470 eggs) was maintained at the recommended incubation temperature (37.5 °C), while the second group (528 eggs) was exposed to 39.5 °C for two hours at days 3, 7 and 13 of embryogenesis. After hatching, chicks from each incubation temperature were randomly assigned to four dietary treatments, a control, a high-energy (+150 kcal ME/kg diet more than the recommended level); a high-lysine (10% more than in the control diet) and a vitamin C supplemented diet. During the experimental period all of the quail were fed ad libitum and they received similar hygienic and managerial conditions. The rearing temperature was 32±2 °C during the entire experimental period. Pre-hatching exposure of eggs to 39.5 °C did not significantly affect the post-hatching body weight and weight gain during the growing period. While, vitamin C or high-energy diet increased it. Body temperature, respiration rate (RR) and the relative weights of the thymus, spleen and bursa of Fabricius were not significantly affected by the pre-hatching temperature or the post-hatching dietary treatments. However, the high-energy and vitamin C diets caused obvious decreases in RR at 4 weeks of age. Pre-hatching heat treatments caused a slight increase in the plasma triiodothyronine (T3) and plasma thyroxine (T4) concentrations, however, was significantly decreased by both the pre- hatching temperature and post- hatching dietary treatments at 6 weeks of age. Based on the above results, it was concluded that pre-hatching exposure of quail eggs to high temperature and post-hatching feeding of a high-energy or vitamin C supplemented diet can be recommended for alleviating the deleterious effects of heat stress during the growing period. [ABSTRACT FROM AUTHOR]

The dynamics of charged particle in the vicinity of event horizon of a rotating charged black hole (BH) with gravitomagnetic charge from a class of vector-tensor theories of modified gravity immersed in an axially symmetric magnetic field (Bfield) has been studied. The presence of Bfield reduces the radii of innermost stable circular orbit (ISCO) of charged particle and the opposite phenomenon occurs due the parameter β which describes the deviation of modified gravity considered here from the usual Einstein-Maxwell gravity also acts to increase the radius of ISCO. Angular momentum also plays the role regarding the motion of particle which implies that larger the angular momentum easier for a particle to escape. We study the stability of orbits using Lyapunov characteristic exponent which implies more stability in the presence of Bfield. Generally, in the presence of Bfield it is easier for a particle to escape than its absence. We find twist in the trajectories of charged particles close to event horizon due to spin of BH in the presence of Bfield and there is no twist in the absence of it. Finally, we comment on possible utilization of our findings for the relativistic jets and magnetohydrodynamical out flows.

In this work, a collimated helium beam was used to activate a thiol-poly(ethylene glycol) (SH-PEG) monolayer on gold to selectively capture proteins in the exposed regions. Protein patterns were formed at high throughput by exposing a stencil mask placed in proximity to the PEG-coated surface to a broad beam of helium particles, followed by incubation in a protein solution. Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (ATR-FTIR) spectra showed that SH-PEG molecules remain attached to gold after exposure to beam doses of 1.5-60 µC/cm(2) and incubation in PBS buffer for one hour, as evidenced by the presence of characteristic ether and methoxy peaks at 1120 cm(-1) and 2870 cm(-1), respectively. X-ray Photoelectron Spectroscopy (XPS) spectra showed that increasing beam doses destroy ether (C-O) bonds in PEG molecules as evidenced by the decrease in carbon C1s peak at 286.6 eV and increased alkyl (C-C) signal at 284.6 eV. XPS spectra also demonstrated protein capture on beam-exposed PEG regions through the appearance of a nitrogen N1s peak at 400 eV and carbon C1s peak at 288 eV binding energies, while the unexposed PEG areas remained protein-free. The characteristic activities of avidin and horseradish peroxidase were preserved after attachment on beam-exposed regions. Protein patterns created using a 35 µm mesh mask were visualized by localized formation of insoluble diformazan precipitates by alkaline phosphatase conversion of its substrate bromochloroindoyl phosphate-nitroblue tetrazolium (BCIP-NBT) and by avidin binding of biotinylated antibodies conjugated on 100 nm gold nanoparticles (AuNP). Patterns created using a mask with smaller 300 nm openings were detected by specific binding of 40 nm AuNP probes and by localized HRP-mediated deposition of silver nanoparticles. Corresponding BSA-passivated negative controls showed very few bound AuNP probes and little to no enzymatic formation of diformazan precipitates or silver nanoparticles.

Ion Beam Aperture Array Lithography was applied to top-down fabrication of large dense (10(8)-10(9) particles/cm(2)) arrays of uniform micron-scale particles at rates hundreds of times faster than electron beam lithography. In this process, a large array of helium ion beamlets is formed when a stencil mask containing an array of circular openings is illuminated by a broad beam of energetic (5-8 keV) ions, and is used to write arrays of specific repetitive patterns. A commercial 5-micrometer metal mesh was used as a stencil mask; the mesh size was adjusted by shrinking the stencil openings using conformal sputter-deposition of copper. Thermal evaporation from multiple sources was utilized to form magnetic particles of varied size and thickness, including alternating layers of gold and permalloy. Evaporation of permalloy layers in the presence of a magnetic field allowed creation of particles with uniform magnetic properties and pre-determined magnetization direction. The magnetic properties of the resulting particles were characterized by Vibrating Sample Magnetometry. Since the orientation of the particles on the substrate before release into suspension is known, the orientation-dependent magnetic properties of the particles could be determined.

Raman scattering investigations based on density functional theory (DFT) calculations were performed to explore the vibrational modes of wurtzite structured CdS nanoparticles (NPs). The calculations were performed to obtain the Raman spectra for the CdS containing 2, 4, 8 and 12 atoms to study the size dependence. Several vibrational modes indicating stretching and bending features related to Cd and S atoms were observed. Modifications of the frequency and intensity of different Raman modes with an increase in number of atoms in NPs are discussed in detail. It is found that the frequency of the CdS symmetric stretching mode of vibration shows a consistent red shift and that of CdS anti‐symmetric stretching shows a consistent blue shift with the increase in the number of atoms. Hydrogen atoms were added in order to make the closed shell configuration and saturate the NPs as per the requisite for calculating the Raman spectra. This produced some additional modes of vibration related to hydrogen atoms. The SH stretching mode showed a consistent red shift and the CdH stretching mode showed a consistent blue shift with an increase in the number of atoms in NPs. The results generated are found to be in close agreement with the literature. The observed red shift in different modes is assigned to stimulated Raman stretching and blue shift is ascribed to the coherent anti‐stokes Raman scattering.

Competing Interests: Nabeel Azeem is a consultant for Boston Scientific. No conflict of interest for Pavithra Ramakrishnan.

Competing Interests: Disclosure N. Azeem is a consultant for Boston Scientific. G. Trikudanathan is a consultant for Boston Scientific and the recipient of research funding from AbbVie for his other research projects. All other authors disclosed no financial relationships. Commentary This interesting and high-risk presentation of severe acute necrotizing pancreatitis demonstrates a few important points. First, according to the Atlanta classification, this case is consistent with acute necrotizing pancreatitis with walled-off necrosis. In addition to the well-known indications for treating infected or symptomatic necrosis, this patient experienced the more rare adverse events of both intracystic bleeding and fistulation into adjacent bowel. The authors were wise to be cautious in the setting of this bleeding, given that ≤10% of these cases will involve pseudoaneurysms, which should be treated by percutaneous vascular intervention first. Additionally, this patient had the potential for portal venous hypertension, given his alcohol history and diffusely hypoechoic appearance of the liver on the enhanced CT scan. With that settled, the patient underwent successful EUS-guided cystgastrostomy and direct endoscopic necrosectomy with the discovery of an associated colonic fistula. It is our experience that, after complete treatment, many of these fistulas will heal on their own. However, at times they can become persistent as a result of continual pancreatic fluid exposure and colonic soilage, requiring endoscopic closure and/or the multidisciplinary involvement of colorectal surgical colleagues. Hopefully, this man will recover without requiring diversion or other surgical intervention. Matthew T. Moyer MD, MS Division of GI-Hepatology Penn State Cancer Institute Penn State Hershey Medical Center Hershey, Pennsylvania, USA Amy Tyberg, MD, FASGE, FACG, Associate Editor for Focal Points

Choledocholithiasis is reported in up to 20% of patients undergoing cholecystectomy. It is recommended to remove common bile duct gallstones due to the risk of complications. A common approach to the management of choledocholithiasis is to combine laparoscopic cholecystectomy (LC) with endoscopic retrograde cholangiopancreatography (ERCP), which is typically completed during two separate sessions. The use of intraoperative cholangiogram (IOC) to facilitate combined LC and intraoperative endoscopic retrograde cholangiopancreatography (iERCP) may reduce overall operative time and hospital length of stay. We report two patients who underwent LC and iERCP under the same anesthetic administration for the treatment of choledocholithiasis. A large data set on the role of IOC in completing both LC and iERCP under a single anesthetic administration was analyzed. These two patients illustrate the utility of IOC in facilitating single-session LC/iERCP for the treatment of choledocholithiasis and our retrospective analysis highlights the effectiveness of IOC., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. University of Minnesota Medical Center issued approval IRB 1309M43986. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tang-Whitmore et al.)

Introduction: Inflammation-induced dysregulation of the coagulation cascade and vascular stasis in hospitalized patients with acute necrotizing pancreatitis (ANP) serve as a milieu for venous thromboembolism (VTE). Deep vein thrombosis (DVT) and pulmonary embolism (PE) are often underrecognized. We evaluated the incidence and risk factors for VTE in a cohort of patients with ANP., Methods: All adult patients with ANP at our center between 2009 and 2022 were followed for three months after index hospitalization and categorized into cases and controls based on development of VTE. Demographic, clinical, and radiologic characteristics during admission were compared. A multivariable analysis was done to identify independent predictors for VTE. A p value of <0.05 was taken as significant., Results: Among 643 ANP patients, 512 [males-350, median age-52 years] were eligible for inclusion. VTE developed in 64 (12.5 %) patients - 28 DVT (5 %), 22 PE (4 %) and both in 14 (3 %) after a median 16 days from the diagnosis of ANP. Significant independent predictors for VTE on multivariable analysis were age ≥60 years (OR 1.91; 95 % CI 1.04-3.53), peri-pancreatic extent of necrosis (OR 7.61; 95 % CI 3.94-14.70), infected necrosis (OR 2.26; 95 % CI 1.13-4.50) and total length of stay ≥14 days (OR 4.08; 95 % CI 1.75-9.50)., Conclusions: The overall incidence of VTE in our cohort of patients with ANP was 12.5 %, which was usually diagnosed within one month of hospitalization. High-risk patients can be stratified based on clinical and imaging characteristics and may benefit from intensive DVT screening and prophylaxis during hospitalization and following discharge., Competing Interests: Declaration of competing interest SKA, NA, SM, and GT are consultants for Boston Scientific Corporation. All other authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background and Aims: Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas ≥1 cm., Methods: This was a multicenter retrospective study of patients with nonampullary duodenal adenomas ≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence., Results: A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 [95% confidence interval, 1.1-102.1]; P = .036)., Conclusions: This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR., Competing Interests: Disclosure The following authors disclosed financial relationships: A. R. Schulman is a consultant for Apollo Endosurgery, Boston Scientific, Olympus, and Microtech and has grant funding through GI Dynamics and Fractyl. A. Kumar is a consultant for Olympus. R. E. Kim is a consultant for Medtronic, Cook Medical, and Apollo Endosurgery. N. Sharma is a consultant for Boston Scientific, Mauna Kea, Steris, Olympus, and Medtronic and is on the advisory board for EndoscopyNow. N. Azeem is a consultant for Boston Scientific. J. D. Mosko is a consultant for Boston Scientific, Pendopharm, Medtronic, and STERIS and is on the advisory board for Fuji. A. Saeed is a consultant for Boston Scientific, Olympus, Endogastric Solutions, and Medtronic. M. Bilal is a consultant for Boston Scientific. All other authors disclosed no financial relationships., (Copyright © 2024 American Society for Gastrointestinal Endoscopy. All rights reserved.)

Competing Interests: Dr Azeem is a consultant for Boston Scientific. All other authors disclosed no financial relationships relevant to this publication.

Video 1EUS-guided gastrojejunostomy and pyloric exclusion for a duodenal-renal-colonic fistula., Competing Interests: Dr Azeem is a consultant for Boston Scientific. The other authors disclosed no financial relationships relevant to this publication., (© 2024 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

The present work was conducted to assess the effect of diets supplementation to heat-stressed buck rabbits with different zinc (Zn) sources on the thermoregulatory and hematobiochemical parameters, and antioxidant status. A total of 24 mature buck rabbits (32-36 weeks of age) were randomly distributed into four groups (6 each). Group 1, non-heat-stressed control (NHSC), was reared in the absence of heat stress (HS) conditions and received the basal diet only. The other three groups (groups 2, 3 and 4) were kept in HS conditions. Group 2, heat-stressed control (HSC), received the basal diet only. The diet supplemented with 75 mg Zn/kg diet either in the inorganic form (Zn sulfate) or in the organic form (Zn picolinate) for groups 3 and 4, respectively. Zn supplementation to rabbits' diets lowered the heat stress-related increase of serum urea, alanine transaminase and malondialdehyde (MDA) concentration. These supplementations also increased the concentration of testosterone under HS conditions. Zn picolinate was more effective than Zn sulfate in restoring serum concentrations of urea, testosterone, and MDA. In conclusion, Zn addition to rabbits' diets from different sources, especially Zn picolinate, exhibits an ameliorative effect against the harmful impact of HS on hematobiochemical parameters and antioxidant status.

Introduction: Endoscopic full-thickness resection (EFTR) is used to resect difficult superficial mucosal lesions and sub-epithelial lesions (SELs). We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EFTR for upper gastrointestinal tract (GIT) lesions., Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov, and Scopus databases for studies published in the English language that addressed outcomes of EFTR for upper GIT lesions through November 2021. The weighted pooled rates with the 95% confidence interval (CI) were calculated. Cochran Q test and I statistics were used to calculate heterogeneity., Results: We identify 740 articles on the initial search and six studies met the inclusion criteria. 140 patients (45.7% females) with 142 lesions were analyzed. Four studies used the full-thickness resection device (FTRD®). EFTR was performed for 26 adenomas, 97 SELs, six adenocarcinomas, and ten full-thickness biopsies. The overall technical success rate was 86.9% (CI 79.8-94%, I 2 = 38.9%), R0 resection was 80% (CI 67.6-92.3%, I 2 = 75.6%), and the overall adverse events rate was 18.6% (9.8-27.2%, I 2 = 49.4%). Major adverse events included six episodes of major bleeding, three micro-perforations, one large duodenal perforation, and one case of mucosal damage from FTRD®. At 3-6 months follow-up, there were only two cases of recurrence (R0 was not achieved in both)., Conclusion: EFTR has a high technical and clinical success rate in managing upper GIT lesions with an acceptable safety profile. Large prospective studies comparing EFTR with conventional endoscopic resection techniques are needed., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aims: The endoscopic powered resection (EPR) device (EndoRotor, Interscope Inc, Northbridge, Mass, USA) is a novel nonthermal device that can be used for polyp and tissue removal in the GI tract. Here, we review the EPR device and illustrate its use for resection of scarred or fibrotic lesions in the GI tract., Methods: In this article and accompanying video, we describe the EPR device features, provide step-by-step instructions for device setup, and review case examples in which the EPR device was used for scarred polyp resection. We also review the current literature describing the use of the EPR device for scarred or challenging polyps., Results: Four lesions with scarring or fibrosis were successfully resected with the EPR device, either with the EPR device alone or as an adjunct to conventional resection methods. No adverse events occurred. A follow-up endoscopy was available in 1 case, which demonstrated no endoscopic or histologic evidence of residual or recurrent lesion., Conclusions: The endoscopic powered resection device can be used alone or as an adjunct to facilitate resection of lesions with significant fibrosis or scarring. This device serves as a useful addition to endoscopists' toolbox in the management of scarred lesions where other modalities might be technically challenging to use., (© 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.)

Prostate cancer (PCa) is the second leading cause of cancer-causing death in the United States. As the most common malignancy in men, it is pertinent to explore whether novel immunotherapies may improve the quality of life and overall survival (OS) of patient populations. This systematic review and post hoc analysis curates a patient-by-patient pool of evidence adhering to PRISMA Statement 2020 guidelines. In total, 24 patients were analyzed for treatment history and associated variables including prostate-specific antigen (PSA) levels at diagnosis and post-treatment, Gleason score, secondary tumor locations, success/failure of therapy, and post-immunotherapy outcomes including OS. In total, 10 types of immunotherapies were identified with Pembrolizumab (among 8 patients) followed by IMM-101 (among 6 patients) being the most commonly administered. The mean OS for all patients was 27.8 months (24 patients) with the relatively highest mean OS reported with IMM-101 (56 months) followed by tumor-infiltrating lymphocytes (30 months). This research article provides critical insights into the evolving landscape of immunotherapies being tested for PCa and addresses gaps in oncological research to advance the understanding of PCa.

Prostate cancer is the most commonly diagnosed cancer in men worldwide, making up 21% of all cancer cases. With 345,000 deaths per year owing to the disease, there is an urgent need to optimize prostate cancer care. This systematic review collated and synthesized findings of completed Phase III clinical trials administering immunotherapy; a current clinical trial index (2022) of all ongoing Phase I-III clinical trial records was also formulated. A total of four Phase III clinical trials with 3588 participants were included administering DCVAC, ipilimumab, personalized peptide vaccine, and the PROSTVAC vaccine. In this original research article, promising results were seen for ipilimumab intervention, with improved overall survival trends. A total of 68 ongoing trial records pooling in 7923 participants were included, spanning completion until June 2028. Immunotherapy is an emerging option for patients with prostate cancer, with immune checkpoint inhibitors and adjuvant therapies forming a large part of the emerging landscape. With various ongoing trials, the characteristics and premises of the prospective findings will be key in improving outcomes in the future.

There are little data about antioxidants' status responses to early thermal conditioning (TC) on broiler chickens. Therefore, the present study was conducted to investigate the different time ages of thermal conditioning on antioxidants responses and the growth rate of broiler chicks. A total of two hundred forty-one-day-old male broiler chicks (Cobb 500) weighed on average 51.5 ± 0.5g were randomly distributed into four equal groups (60 chicks each), and chicks of each group were ranked in five replicates. The first group reared under the ambient temperature, while the second, third and fourth groups (TC3, TC5 and TC7) were subjected to early-age thermal conditioning at 39°C for 6 h on the third, fifth and seventh day of age respectively. Broilers were fed ad-libitum, and drinking water was a free choice during the experimental period. At the end of the experimental period that lasted 5 weeks, all experimental groups were exposed to heat challenge at 36°C for 6 h. Early-age thermal conditioning did not affect growth performance. Plasma corticosterone elevation in TC5 (as a post-challenge response) was the lowest among the experimental groups. Hepatic malondialdehyde significantly increased in TC5 and TC7 groups both at the post-conditioning stage and at the end of the experimental period. Hepatic glutathione, glutathione S-transferases, catalase and superoxide dismutase significantly decreased by early-age thermal conditioning compared with non-conditioned broilers. Microscopic examination of the liver sections from broilers chickens in TC5 and TC7 groups showed all the basic features of normal liver tissue, while the control and TC3 groups showed few necrotic areas. It could be concluded that early-age thermal conditioning at 39°C for 6 h on the fifth day of age could improve the antioxidant defence system of broilers without any adverse effects on growth performance., (© 2022 Wiley-VCH GmbH.)

Background and Aims: The clinical course of necrotizing pancreatitis (NP) is variable and unpredictable, with some patients managed conservatively, but a significant proportion become symptomatic and needing intervention for drainage and/or necrosectomy. The aim of this study was to identify patients based on baseline clinical and imaging metrics who will likely need intervention and therefore closer follow-up., Methods: All NP patients managed in our institution between 2010 and 2019 were identified from a prospective database and those who did not undergo intervention during initial hospitalization were followed longitudinally post discharge until clinical and imaging resolution of necrosis. Patients were categorized into a conservative arm or intervention arm (endoscopic/percutaneous/surgical drainage and/or necrosectomy) for criteria defined according to IAP/APA guidelines. Clinical and imaging characteristics during initial presentation were analyzed between the two groups to identify independent predictors for eventual intervention using multivariable logistic regression. A nomogram was designed based on factors that were significant as defined by P value < 0.05., Results: Among 525 patients, 340 who did not meet criteria for intervention during initial admission were included for study and followed for an average 7.4 ± 11.3 months. 140 were managed conservatively and 200 needed intervention (168 within 6 months and 32 after 6 months). Independent predictors of need for eventual intervention were white race [OR 3.43 (1.11-10.62)], transferred status [OR 3.37 (1.81-6.27)], and need for TPN [OR 6.86 (1.63-28.9)], necrotic collection greater than 6 cm [OR 8.66 (4.10-18.32)] and necrotic collection with greater than 75% encapsulation [OR 41.3 (8.29-205.5)]. A prediction model incorporating these factors demonstrated an area under the curve of 0.88., Conclusions: Majority of NP patients do not need intervention during initial admission but may require drainage/necrosectomy mostly in the first 6 months following discharge. Need for subsequent intervention can be accurately predicted by a combination of clinical and imaging features on index admission., (Copyright © 2022. Published by Elsevier B.V.)

High prevalence of tobacco use is seen in low- and middle-income countries (LMIC). In the recent years, tobacco users have switched to alternatives falling under the framework of electronic nicotine delivery systems (ENDS). This review provides an overview of tobacco control-related policies in Bangladesh, India, and Pakistan, and suggested recommendations to bridge this gap to address Tobacco-free Nations. This paper's findings are relevant for developing countries worldwide that have a high tobacco-related health burden, a complex landscape of use, and inadequate resources to offer tobacco cessation and smokeless tobacco control., Competing Interests: None., (© 2022 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)

Background: The ongoing global coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was first reported in South Asia on 30 th January 2020 in India. Ever since, certain countries have witnessed multiple waves of COVID-19, requiring attention by public health experts and strategists in the region. The objectives of this study are to assess social contributors to the recurrent waves of COVID-19 in South Asia including first demographic traits, second household characteristics and social measures, third workplace trends and personal protective equipment use, and fourth satisfaction and attitudes concerning public health measures and vaccination status. The study also aims to plan for control strategies focusing on India, Pakistan, Bangladesh, Sri Lanka, and Nepal, countries with the highest burden of COVID-19 in South Asia., Methods: A population-based large cross-sectional study was conducted from 1st July to August 10th, 2021 using online mediums. The survey consisted of 31 questions divided into sociodemographic and COVID-19 status information, household characteristics and social measures, workplace trends and personal protective measures, satisfaction and attitudes towards public health measures, and vaccination status. Bivariate, receiver operating characteristic (ROC) analysis, and the Kruskal Wallis test was conducted for factors associated to COVID-19 infection and positive vaccination status., Findings: We enrolled 1046 participants with 57.1% females and 41.8% males, comprising 48.9% healthcare workers. Statistically significant associations were found using ANOVA based on the Kruskal-Wallis test for differences between thoughts towards public health authorities implementing standard operating procedures (SOPs) and HCW status were statistically significant (P = 0.002). The most important social predictors for positive vaccination status based on the ROC analysis were gender (P < 0.001), job role (P < 0.001), income group (P < 0.001), healthcare worker status (P < 0.001), household member tested positive (P = 0.007), personal vehicle ownership (P < 0.001), job requiring close contacts (P < 0.001) and co-worker masking habits (P = 0.02)., Conclusions: Public health experts and strategists are required to focus control strategies on political and religious gatherings, reopening offices, noncompliance of SOPs by the masses, and crowded commuting to limit the reemergence of COVID-19 infections in countries with the highest burden in the region., Competing Interests: All authors declare no conflict of interest., (© 2022 The Authors.)

Background and Aims: Visceral artery pseudoaneurysm (PSA) in necrotizing pancreatitis (NP) is associated with significant morbidity and mortality. This study aimed to evaluate the incidence, clinical presentation, management, and outcomes of PSA in NP., Methods: All NP patients managed at our institution between 2010 and 2020 were retrospectively reviewed from a prospectively maintained database for PSA. Demographics, clinical presentation, method of diagnosis, management, and outcomes were collected., Results: Thirty-nine of 607 patients (6.4%) with NP had a confirmed diagnosis of PSA. Demographics, presence of infected necrosis, development of organ failure(s), and severity of disease were similar between PSA and no PSA. Endoscopic and percutaneous drainages for walled-off necrosis (WON) were more common in the PSA group. Seven patients developed PSA without requiring any intervention for WON, and 17 patients (43.6%) had lumen-apposing metal stents (LAMSs) placed before PSA diagnosis. The time from NP diagnosis to PSA diagnosis was shorter in these patients (n = 17) compared with the remaining patients (n=22; 47 days [interquartile range {IQR}: 17-85] vs 109 days [IQR: 61-180.5, P=0.009]). In addition, 7 of 11 patients (63.6%) with early PSA (defined by <3 weeks from index cystgastrostomy/cystduodenostomy) had an indwelling LAMS at the time of the PSA diagnosis. Seventy-seven percent of patients presented with anemia, 74.3% with GI bleeding, and 30% with hemorrhagic shock. CT was diagnostic for PSA in 83.9% with a false-negative rate of 16.1%. Splenic (50%) and gastroduodenal (28%) arteries were the most common arteries involved by PSA. Angiography and embolization for PSA were successful in 33 of 35 patients. In-hospital mortality was observed in 9 patients (23.1%)., Conclusions: Although visceral artery PSA affects a small percentage of NP patients, it is associated with significant morbidity and mortality. In addition, bleeding from PSA induced by erosion of LAMSs may occur in the first 2 weeks, prompting individualization of removal intervals., (Copyright © 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Introduction: Sacroiliac joint disease is a prominent diagnosis across the world. A novel fixation technique employing a posterior approach, single point, bone allograft transfixation has proven to be helpful anecdotally. The purpose of this is study is to investigate prospectively the safety and efficacy of this approach., Methods: A multicenter, prospective, single arm study was performed after patient identification and treatment with the novel posterior fusion, single-point transfixation system and followed for 24 months. Target enrollment is 100 patients. Interim results on the first 69 consecutive patients at 6 months is presented. Primary endpoint at 6-month analysis was Pain Intensity reduction by visual analogue scale and functional improvement by Oswestry Disability Index. Adverse events were assessed for safety analysis., Results: In total, 69 patients were identified for this analysis. At 6 months, a mean improvement of 34.9 was identified by a reduction in VAS and functional improvement was demonstrated by a mean reduction in ODI of 17.7. There were three adverse events, all unrelated to the device., Conclusion: The posterior single point transfixation is safe and efficacious for the treatment of sacroiliac joint dysfunction with statistical improvements in pain and function.

Endoscopic resection has become the gold standard for the management of most of the large colorectal polyps. Various endoscopic resection techniques include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). ESD is a minimally invasive method for the resection of advanced lesions in the gastrointestinal (GI) tract to achieve en-bloc resection. While, EFTR is more commonly used in lesions with suspected deeper submucosal invasion, lesions originating from muscularis propria, or those with advanced fibrosis. This article reviews the indications, technique, and adverse events for use of ESD and EFTR in the colon., Competing Interests: Disclosure None., (Published by Elsevier Inc.)

Background: The evolutionary stages of manufacturing have led us to conceptualize the use of Industry 4.0 for COVID-19 (coronavirus disease 2019), powered by Industry 4.0 technologies. Using applications of integrated process optimizations reliant on digitized data, we propose novel intelligent networks along the vaccine value chain. Vaccine 4.0 may enable maintenance processes, streamline logistics, and enable optimal production of COVID-19 vaccines., Vaccine 4.0 Framework: The challenge in applying Vaccine 4.0 includes the requirement of large-scale technologies for digitally transforming manufacturing, producing, rolling-out, and distributing vaccines. With our framework, Vaccine 4.0 analytics will target process performance, process development, process stability, compliance, quality assessment, and optimized maintenance. The benefits of digitization during and post the COVID-19 pandemic include first, the continual assurance of process control, and second, the efficacy of big-data analytics in streamlining set parameter limits. Digitization including big data-analytics may potentially improve the quality of large-scale vaccine production, profitability, and manufacturing processes. The path to Vaccine 4.0 will enhance vaccine quality, improve efficacy, and compliance with data-regulated requirements., Discussion: Fiscal and logistical barriers are prevalent across resource-limited countries worldwide. The Vaccine 4.0 framework accounts for expected barriers of manufacturing and equitably distributing COVID-19 vaccines. With amalgamating big data analytics and biometrics, we enable the identification of vulnerable populations who are at higher risk of disease transmission. Artificial intelligence powered sensors and robotics support thermostable vaccine distribution in limited capacity regions, globally. Biosensors isolate COVID-19 vaccinations with low or limited efficacy. Finally, Vaccine 4.0 blockchain systems address low- and middle-income countries with limited distribution capacities., Conclusion: Vaccine 4.0 is a viable framework to optimize manufacturing of vaccines during and post the COVID-19 pandemic.

Primary Health Care (PHC) is the backbone of health systems and a cornerstone of Universal Health Coverage. In 2018, political commitment to PHC, including a comprehensive approach based on essential care throughout the lifespan, integrated public health functions, and community empowerment was reaffirmed by international stakeholders in Astana. As recent events exposed weaknesses of health care systems worldwide, growing attention has been paid to strengthening PHC. While the role of care providers as health advocates has been recognized, they may lack skills, opportunities, and resources to actively engage in advocacy. Particularly for PHC providers, guidance and tools on how to advocate to strengthen PHC are scarce. In this article, we review priority policy areas for PHC strengthening with relevance for several settings and health care systems and propose approaches to empower PHC providers-physician, non-physician, or informal PHC providers-to advocate for strengthening PHC in their countries by individual or collective action. We provide initial ideas for a stepwise advocacy strategy and recommendations for practical advocacy activities. Our aim is to initiate further discussion on how to strengthen health care provider driven advocacy for PHC and to encourage advocates in the field to reflect on their opportunities for local, national, and global action.

Background: COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in myocarditis, with inflammation of the heart muscle., Objective: This systematic review collates current evidence about demographics, symptomatology, diagnostic, and clinical outcomes of COVID-19 infected patients with myocarditis., Methods: In accordance with PRISMA 2020 guidelines, a systematic search was conducted using PubMed, Cochrane Central, Web of Science and Google Scholar until August, 2021. A combination of the following keywords was used: SARS-CoV-2, COVID-19, myocarditis. Cohorts and case reports that comprised of patients with confirmed myocarditis due to COVID-19 infection, aged >18 years were included. The findings were tabulated and subsequently synthesized., Results: In total, 54 case reports and 5 cohorts were identified comprising 215 patients. Hypertension (51.7%), diabetes mellitus type 2 (46.4%), cardiac comorbidities (14.6%) were the 3 most reported comorbidities. Majority of the patients presented with cough (61.9%), fever (60.4%), shortness of breath (53.2%), and chest pain (43.9%). Inflammatory markers were raised in 97.8% patients, whereas cardiac markers were elevated in 94.8% of the included patients. On noting radiographic findings, cardiomegaly (32.5%) was the most common finding. Electrocardiography testing obtained ST segment elevation among 44.8% patients and T wave inversion in 7.3% of the sample. Cardiovascular magnetic resonance imaging yielded 83.3% patients with myocardial edema, with late gadolinium enhancement in 63.9% patients. In hospital management consisted of azithromycin (25.5%), methylprednisolone/steroids (8.5%), and other standard care treatments for COVID-19. The most common in-hospital complication included acute respiratory distress syndrome (66.4%) and cardiogenic shock (14%). On last follow up, 64.7% of the patients survived, whereas 31.8% patients did not survive, and 3.5% were in the critical care unit., Conclusion: It is essential to demarcate COVID-19 infection and myocarditis presentations due to the heightened risk of death among patients contracting both myocardial inflammation and ARDS. With a multitude of diagnostic and treatment options available for COVID-19 and myocarditis, patients that are under high risk of suspicion for COVID-19 induced myocarditis must be appropriately diagnosed and treated to curb co-infections.

Platelet-leukocyte aggregates (PLAs) are associated with increased thrombosis risk. The influence of PLA formation is especially important for cancer patients, since thrombosis accounts for approximately 10% of cancer-associated deaths. Our objective was to characterize and quantify PLAs in whole blood samples from lung cancer patients compared to healthy volunteers with the intent to analyze PLA formation in the context of lung cancer-associated thrombosis. Consenting lung cancer patients (57) and healthy volunteers (56) were enrolled at the Dana Cancer Center at the University of Toledo Health Science Campus. Peripheral blood samples were analyzed by flow cytometry. Patient medical history was reviewed through electronic medical records. Most importantly, we found lung cancer patients to have higher percentages of platelet-T cell aggregates (PTCAs) than healthy volunteers among both CD4+ T lymphocyte and CD8+ T lymphocyte populations. Our findings demonstrate that characterization of PTCAs may have clinical utility in differentiating lung cancer patients from healthy volunteers and stratifying lung cancer patients by history of thrombosis., Competing Interests: The authors have declared that no competing interests exist.

Objective: To conduct a systematic literature review of peripheral nerve stimulation (PNS) for pain., Design: Grade the evidence for PNS., Methods: An international interdisciplinary work group conducted a literature search for PNS. Abstracts were reviewed to select studies for grading. Inclusion/exclusion criteria included prospective randomized controlled trials (RCTs) with meaningful clinical outcomes that were not part of a larger or previously reported group. Excluded studies were retrospective, had less than two months of follow-up, or existed only as abstracts. Full studies were graded by two independent reviewers using the modified Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria., Results: Peripheral nerve stimulation was studied in 14 RCTs for a variety of painful conditions (headache, shoulder, pelvic, back, extremity, and trunk pain). Moderate to strong evidence supported the use of PNS to treat pain., Conclusion: Peripheral nerve stimulation has moderate/strong evidence. Additional prospective trials could further refine appropriate populations and pain diagnoses., (© 2020 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives  To assess the clinical and radiological features of repetitive stress injuries (RSIs), specifically de Quervain's (DQ) disease, tennis elbow (TE), and plantar fasciitis (PF). Methods This was an observational study conducted for eight months (March 2019 to September 2019) at the Orthopedic Department in collaboration with the Radiology Department. Clinically diagnosed RSI patients from both genders, aged between 30 and 50 years, were included in the study. Clinical features that were considered include pain, swelling, and site of injury. Radiological findings from ultrasound, X-ray, and magnetic resonance imaging (MRI) were identified in all participants of the study. Data were analyzed using SPSS Version 21 (IBM Corp., Armonk, NY, USA). Data were represented as frequency and percentages. Results There were a total of 82 patients (40 males,42 females) with repetitive stress injury (RSI), with a mean age of 42.63±8.53 years. Of the 82 patients, 34 (41.4%) had DQ disease, 28 (34.1%) had TE, and 20 (24.4%) had PF. Pain and swelling were observed in all patients. In TE, the most affected site was the right lateral epicondyle process. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, and calcification in soft tissues. Cozen's test was positive in most patients. In DQ, the most affected sites were left and right radial styloid processes. The common radiological findings were hypoechoic fascia, increased fluid within the first extensor, cortical erosion, and periosteal reaction. Finkelstein's test was also positive in most patients. In PT, the most affected site was the left heal plantar surface. The common radiological findings were hypoechoic fascia, increased thickness of fascia (>4.5 mm), increased fluid within the first extensor tendon compartment, cortical erosion, sclerosis in soft tissues, calcaneal spur, periosteal reaction, and calcification in soft tissues. Cozen's and Finkelstein's tests were also positive in most patients. Conclusions History, physical examination, laboratory findings, and imaging modalities all are important tools for the differential diagnosis of RSI. Our study results showed that if some clinical findings fail to diagnose any RSI, then ultrasound, X-ray, and magnetic resonance imaging (MRI) are the best and useful options before treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Azeem et al.)