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Background Older people abuse includes intentional or unintentional conduct or omission of a specific behavior by a trusted person that causes injury or distress to older people. This study described older peoples’ perceptions of abuse in Iranian society. Methods This qualitative study applied a conventional content analysis method to understand the perceptions of abuse among older Iranian people. Twenty older residents were selected by purposeful sampling. Data were collected through in-depth, semi-structured, and face-to-face interviews. The six-step Graneheim and Lundman content analysis method guided data analysis. MAXQDA software version 10 was used to manage the data. Results The data analysis led to the identification of three main themes: broken toughness, hidden abuse, and exploitation. The first theme had two sub-themes: domination and disturbed peace and tranquility. Conclusion Abuse resulted from a combination of causes and factors. Abuse was hidden in many cases and was not limited to physical abuse. The other examples of abuse included disrespect, deprivation of authority, disturbed tranquility, and financial exploitation of older adults.

SARS-CoV-2 pandemic is one of the most critical pandemics during human civilization. Several therapeutic strategies for COVID-19 management have been offered; nonetheless, none of them seems to be sufficiently beneficial. In effect, vaccines have been proffered as a viable option. The critical issue now is to concentrate on protecting individuals against illness through immunization. One of the causes for concern among the researchers, physicians, and generally the whole community from the onset of vaccination has been the adverse effects (specifically blood clots) that may be observed after the injection of the COVID-19 vaccine. In some countries, such concerns have even resulted in the temporary or permanent discontinuation or abandonment of the application of some vaccines (especially AstraZeneca and Janssen). By evaluating rigorous studies published on this subject, the present article is aimed at identifying the association between blood clot incidence and COVID-19 vaccination. Various methods for producing the COVID-19 vaccines are analyzed, along with their possible pros and cons as well as common and rare side effects, especially VITT and blood clots. Finally, the differences of various vaccines on thrombotic events, WHO recommendations for VITT treatment, and blood clots statics are discussed.

The family members or friends of the patients undergoing treatment using radioiodine in nuclear medicine are inevitably exposed to ionization radiation. The purpose of this study is measurement of the dose received by the people taking care of the thyroid cancer patients treated by 131I. For this purpose, the dose amounts received by 29 people accompanying patients were measured using thermoluminescence dosimeters. A badge containing three TLD-100 chips was given to each caregiver. The people were asked to wear the badges for 24 days, when they are taking care of the patients. Finally the dose to each person was estimated by averaging the readings of the three TLDs. The measured dose amounts to the people were compared with the recommendations of international commitions. According to the results obtained in this study, the amounts of dose received by the caregivers were between 0.03 and 0.38 mSv, with the average of 0.12 mSv. By comparison of the results of this study with the recommendations of International Commission on Radiological Protection (ICRP), it can be observed that the dose to family members of the patients is less than the dose constraints. However, it is recommended that the caregivers be aware of the radiation protection principles in order to reduce their dose. [ABSTRACT FROM AUTHOR]

Background and Objective: Exact recognition of the needs of patients with leukemia and move to solve them will promote the health standards in the country. The aim of this study was to evaluate the needs and to assess the process of diagnosis and treatment of leukemia and their shortcomings according to experts’ views in this field. Materials and Methods: This study was a descriptive study and the population under study consisted of 101 specialists in Hemato-oncology and pathology across the country, who were selected by random cluster sampling. Data was collected by valid peer reviewed questionnaires with Cronbach's alpha coefficient of 0.80. The collected data were evaluated and analyzed using SPSS, and chi-square test. Results: According to specialists, lack of diagnostic facilities in small cities, timely diagnosis, especially in cases of chronic leukemia and inadequate attention to the mental state of patients during the treatment process was considered as the most important problems of health system in the diagnosis and treatment of leukemias. Conclusion: Shifting the health policies towards greater attention to equip the health care centers and reviewing the policies resulting in concentration of services in large cities, providing health care plans acceptable for the patient's mental state by counseling centers during the process of treatment and finally financial support of patients with leukemia (particularly low-income patients) by governmental and non-governmental organizations will certainly pave the way to achieve modern standards. [ABSTRACT FROM AUTHOR]

Background and aims: Musculoskeletal disorders (MSDs) are a major cause of time loss, costs and work force injuries in the workplace. Awkward working posture is a main risk factor for developing MSDs. This study was conducted among assembly workers of an electronic industry with the objective of implementing an interventional ergonomic program to reduce postural stress on neck and trunk and to minimize awkward working postures. Methods: This interventional study was conducted on 81 assembly workers of an electronic industry. Nordic musculoskeletal questionnaire was used to determine prevalence of MSDs. Numeric rating scale was applied to evaluate body discomfort before and after the intervention (using a magnification lenses to improve visibility of the parts). Statistical analysis including independent t-test was performed using SPSS (version 16) software. Results: The results showed that MSDs occurred among assembly workers at high rate in neck, lower back, and shoulder/upper arm regions (more than 75%). After intervention, significant discomfort decrement was observed in neck, shoulder/upper arm, lower back, elbows and lower arm regions together with the whole body (p<0.05). More than 90% of the assemblers reported that using the magnification lenses facilitated assembly operation and was comfortable. After the intervention, 89% of the workers evaluated working conditions better as compared with that of before the intervention. Conclusion: It was indicated that using magnification lenses reduced discomfort in different body regions as well as the whole body. It could, therefore be expected that its application of magnification lenses would decrease MSDs of different body regions in long term. Findings showed assemblers satisfaction when using the lenses as well as effectiveness of the lenses application in manufacturing process. [ABSTRACT FROM AUTHOR]

MUSA is one of the novel techniques in CSA, which lays its foundation on linear goal programming, developed for overcoming prior CSA models’ weaknesses such as coping with ordinal nature of data and low fitness. Employing a simple questionnaire, MUSA develops the interval scale and the level of satisfaction as well as determining its determinants in addition to several fruitful indices. This paper aims to review the contemporary CSA literature while being more elaborated on MUSA’s methodology. According to that, after defining its modeling approach, MUSA compared to ordinary and ordinal regression models in case of banking firm. Findings depicted that MUSA in addition to criterion validity outperforms regression models where as it is vulnerable to asymmetrical data sets. The paper at the end reviews the weak points of multi criteria satisfaction analysis methods, hopping that, marketing scholars and practitioners effectively put them in practice

ackground & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality. Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed. Results: Significant difference was found between quality of nursing care in the experiment and control units (P

Background & Aim: Patient education, one of the most important nurses responsibilities, depend on their motivation therefore, this study was performed and the purpose of the study was for determining the nurses motivating factors related to the patients education . Methods & Materials: A descriptive cross sectional research was carried out among the nurses in the hospitals affiliated to Tehran University of medical science. Sample population was 214 nurses selected by stratified & cluster sampling. Data was collected by questioner through self reporting. The data were analyzed by SPSS computer software. Descriptive statistic and 2 Test, Fisher Exact Test, Exact Test Mont Carlo were used. Results: Data of motivating factors categorized in 3 levels, high, moderate, low with Lickrate scale showed that in nurses’ opinion salary and payment (48%), facilities (49.5%), supervision (57.5%), have average effect on their motivation related to the patient education. Job security (68%), respect & appreciation (76%), career development (74%), work-interest (81.5%), knowledge (85.5%), professional responsibilities (90%) have much effect on their motivation related to the patient education. Statistical test showed a meaningful relation between demographic variables and motivating factors. Conclusion: According to the findings, Job security, respect & appreciation, career development, work-interest, knowledge, professional responsibility have much effect on the motivation for patient education.

Background & Aim: Nurses have the major role at care continuity and health promotion. They frequently affect total productivity in a organization. However, the nurses believe that due to several barriers they have not desire productivity, therefore the health care have been left at level of quality. The aim of this research are assessing nurses' view about productivity and role of human resource on it. Methods & Materials: This study has been done based on grounded theory method. Open interviews has been used for gathering of data. Sampling was purposive in beginning study but so that study was proceeding and categories were completed, it changes to theoretic sampling. Constant comparative analysis was method of data analyses. Results: Essential themes emerged from the data in human resource category. These are: systemic calculating number of staff, accurate staff select and use criteria for them, provide adequate staff from various categories in total year's day, accept patient when as coordinate to in charge nurse and well communication. These make necessary groundwork for productivity. Then accidents that emerged from inappropriate quantity and quality of human resource will be decreased. These enhance nursing productivity the biggest group of health care services. Model of Productivity and human resource effects on it’s, from nurses' view, has concluded of this research. Conclusion: In nurses' view that participates in this research, human resource can affect on productivity process and improve it, then it lead to develop quality care- health care vision and goal.

Background & Objective: Invasive procedures are severe stressors for "nin-patient children. The stress result in sleep disorder, reduced concentration, and increased pain. Nowadays, pharmacologic and nonpharmacologic interventions are used to control stress. We aimed to assess the effect of massage on children's anxiety level before intensive procedures. Methods & Materials: In this clinical trial, 70 children aged 7-11 were recruited from a children hospital. The participants were randomly allocated to the intervention and control groups. The intervention group received massage therapy in the Yeen tang point and palms for five minutes. The control group received the usual care. Anxiety was measured using OSBD-R. Data were analyzed using Mann-Wittny and Willcoxon statistical tests. Results: The anxiety level was not significantly different between two groups before the intervention (Control group: 3.24±0.48; Intervention group: 3.24±0.56) (P=0.472). Following the massage, the anxiety level decreased significantly in the intervention group (Intervention group: 1.57±0.54; Control group: 3.37±0.46) (P

Abstract Background This study aims to explore the experience of conflict as perceived by Iranian hospital nurses in Tehran, Islamic Republic of Iran. Although conflict-control approaches have been extensively researched throughout the world, no research-based data are available on the perception of conflict and effective resolutions among hospital nurses in Iran. Methods A qualitative research approach was used to explore how Iranian hospital nurses perceive and resolve conflicts at work. A purposive sample of 30 hospital nurses and nurse managers was selected to obtain data by means of in-depth semi structured interviews. Data were analysed by means of the content analysis method. Results The emerging themes were: (1) the nurses' perceptions and reactions to conflict; (2) organizational structure; (3) hospital management style; (4) the nature and conditions of job assignment; (5) individual characteristics; (6) mutual understanding and interaction; and (7) the consequences of conflict. The first six themes describe the sources of the conflict as well as strategies to manage them. Conclusion How nurses perceive conflict influences how they react to it. Sources of conflict are embedded in the characteristics of nurses and the nursing system, but at the same time these characteristics can be seen as strategies to resolve conflict. We found mutual understanding and interaction to be the main factor able to prevent and resolve conflict effectively. We therefore recommend that nurses and nurse managers encourage any virtues and activities that increase such understanding and interaction. Finally, as conflict can destroy individual nurses as well as the nursing system, we must act to control it effectively.

Radiotherapy as a treatment method for glioblastoma is limited due to the intrinsic apoptosis resistance mechanisms of the tumor. Administration of higher radiation doses contributes to toxicities in normal tissues and organs at risk, like optic chiasma. Cellular senescence represents an alternative mechanism to apoptosis following radiotherapy in glioblastoma, occurring in both normal and neoplastic cells. Although it impedes the growth of tumors and sustains cells in their cycle, it can also act as a cause of tumor development and recurrence following treatment. In this review, we discuss detailed insights into the significance of radiation-induced senescence in glioblastoma and the underlying mechanisms that lead to radioresistance. We also discuss senescence biomarkers and the role of senescence-associated secretory phenotype (SASP) in tumor recurrence. Finally, we review the studies that have administered potential interventions to eradicate or inhibit senescent cells in glioblastoma after treatment with radiation., Competing Interests: Declaration of competing interest The authors report no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Titanium implants are commonly used for surgical fixation in orthopedic trauma, and have many benefits compared to stainless steel implants. Despite these benefits, some orthopedic surgeons remain hesitant to use titanium implants due to concerns of difficulty with future implant removal, given concerns with cold-welding and screw strippage. The objective of this study was to assess difficulties associated with titanium plate and screw implant removal., Methods: This is a retrospective case series from a large hospital system. Patients were identified using Current Procedural Terminology (CPT) code 20,680 from 2017 to 2020. Patients were included if they had removal of titanium plate and screws from the upper or lower extremity, were at least18 years of age, and considered skeletally mature. The ease of titanium plate/screw removal was determined by assessing for implant cold-welding, broken screws, stripped screws, and the need for advanced tools (screw removal set, trephine, burr)., Results: 157 patients were identified, with a mean age of 54 years and 59 % female. In total 1274 screws were removed: 14 (1.1 %) were stripped, 8 (0.6 %) were cold-welded, 42 (3.3 %) were loose, and 13 (1.0 %) were broken. 183 plates were removed in total, and 15 (8.2 %) had bone overgrowth that required removal. 12 (7.6 %) procedures were complicated and required the use of advanced tools. Complicated implant removal operations occurred after significantly longer in vivo implant time (mean of 3.7 vs. 1.1 years, p = 0.036), were associated with a younger age, were more likely to occur in lower extremity procedures (p = 0.034), and took significantly longer time for removal (95 vs. 42 min, p < 0.001)., Conclusions: Despite concerns with titanium implants, we found a low rate of screw strippage, breakage, and cold welding during the removal process. However, 7.6 % of the 157 surgeries required additional tools other than just a screwdriver, and needed additional operative time. This information allows treating surgeons to plan for implant removal when titanium implants have been used for fixation., Level of Evidence: IV., Competing Interests: Declaration of competing interest Nicholas Frane, Arjun Vohra, Robert O'Connor, Sorka Deeyor, Clayton Hui have no declarations of interest. Niloofar Dehghan is a consultant for Stryker. Michael McKee is a consultant for Stryker and receives royalties., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Case: A 77-year-old man experienced acute failure of fixation of his humeral shaft fracture after fixation with IlluminOss photodynamic system stabilization (Photodynamic Bone Stabilization System [PBSS]). Owing to the well-fixed IlluminOss PBSS implant to the humeral intramedullary canal, complete removal was deemed not indicated. Partial implant removal and revision open reduction internal fixation with a proximal humerus plate was performed. However, this was complicated by recalcitrant deep hardware infection that failed multiple surgical debridements, requiring eventual humeral osteotomy to remove the remainder of the infected IlluminOss PBSS implant., Conclusion: This is one of the first articles highlighting the technical challenges and morbidity associated with removal of an IlluminOss PBSS., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C468)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Many patients cannot tolerate low-dose weekly methotrexate (MTX) therapy for inflammatory arthritis treatment due to life-threatening toxicity. Although biologics offer a target-specific therapy, it raises the risk of serious infections and even cancer due to immune system suppression. We introduce an anti-inflammatory arthritis MTX ester prodrug using a long-circulating biocompatible polymeric macromolecule: folic acid (FA) functionalized hyperbranched polyglycerol (HPG). In vitro the drug MTX is incrementally released through pH and enzymatic degradation over 2 weeks. The role of matrix metalloproteinases (MMPs) in site-specific prodrug activation was verified using synovial fluid (SF) of 26 rheumatology patients and 4 healthy controls. Elevated levels of specific MMPs-markers of joint inflammation-positively correlated with enhanced prodrug release explained by acid-catalyzed hydrolysis of esters by proteases. Intravenously administered 111 In-radiolabeled prodrug confirmed by SPECT/CT imaging that it accumulated preferentially in inflamed joints while reducing off-target side-effects in a mouse model of rheumatoid arthritis (RA). Added FA as a targeting vector prolonged prodrug action; prodrug with 4x less MTX applied every 2 weeks was as effective as weekly MTX therapy. The preclinical results suggest a prodrug-based strategy for the treatment of inflammatory joint diseases, with potential for other chronic inflammatory diseases and cancer., (© 2024 The Author(s). Advanced Healthcare Materials published by Wiley‐VCH GmbH.)

Introduction: There is a lack of research on the state of racial, ethnic, and gender diversity in the emerging orthopedic trauma workforce. The purpose of this study was to analyze the training pathway for diverse candidates in orthopedic trauma as it relates to race, ethnicity, and sex., Methods: Self-reported demographic data were compared among allopathic medical students, orthopedic surgery residents, orthopedic trauma fellows, and the general population in the United States (2013-2022). Race categories consisted of White, Asian, Black, and Native American/Alaskan Native (NA/AN), and Native Hawaiian/Pacific Islander (NH/PI). Ethnicity categories were Hispanic/Latino or non-Hispanic/Latino. Sex categories were male and female. Representation was calculated at each stage of accredited training. Participation-to-prevalence ratios (PPRs) quantified the equitable representation of demographic groups in the emerging orthopedic trauma workforce relative to the US population. PPR thresholds were used to classify representation as overrepresented (PPR > 1.2), equitable (PPR = 0.8-1.2), and underrepresented (PPR < 0.8)., Results: Relative to medical school and orthopedic surgery residency, fewer female (48.5 % vs 16.7 % vs 18.7 %, P < 0.001), Hispanic (6.1 % vs 4.5 % vs 2.6 %, P < 0.001), Black (6.9 % vs 5.0 % vs 3.1 %, P < 0.001), and Asian (24.0 % vs 14.3 % vs 12.2 %, P < 0.001) trainees existed in orthopedic trauma fellowship training. In contrast, more male (51.5 % vs 83.3 % vs 81.3 %, P < 0.001) and White (62.8 % vs 79.1 % vs 84.0 %, P < 0.001) trainees existed in orthopedic trauma fellowship relative to earlier training stages. There were zero NA/AN or NH/PI trainees in orthopedic trauma (PPR = 0). Relative to the US population, Hispanic (PPR = 0.14), Black (PPR = 0.25), and female (PPR = 0.37) trainees were underrepresented in orthopedic trauma. In contrast, Asian (PPR = 2.04), male (PPR = 1.64), and White (PPR = 1.36) trainees were overrepresented in orthopedic trauma., Conclusion: Women, racial, and ethnic minorities are underrepresented in the emerging orthopedic trauma workforce relative to the US population, and earlier stages of training. Targeted recruitment and guided mentorship of these groups may lead to greater interest, engagement, and diversity in orthopedic trauma., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This bibliometric review examines the current state of research on fucoidan, a sulphated polysaccharide found in brown seaweed species, and its potential for wound healing. The review included 58 studies that investigated fucoidan's effects on wound healing, revealing that it possesses anti-inflammatory and antioxidant properties that could aid in the healing process. Fucoidan was also found to promote cell proliferation, migration, and angiogenesis, essential for wound healing. However, the optimal dosage, treatment duration, safety, and efficacy of fucoidan in various wound types and patient populations still require further investigation. Additionally, advanced wound dressings like hydrogels have garnered significant attention for their potential in wound healing. While this review indicates promise for fucoidan as a natural wound healing compound, it underscores the need for additional clinical trials to determine its optimal use as a commercial therapeutic agent in wound healing.

Background: Orthopaedic surgery has consistently remained one of the least diverse specialties in medicine. There are limited data on the match rate by sex into orthopaedic fellowships., Purpose: The goals of this study were to determine (1) how the percentage of women applying to orthopaedic fellowships has changed from 2011 to 2021, (2) whether there was a correlation between sex and the likelihood of a successful fellowship match, and (3) which subspecialties tend to have a greater proportion of female applicants and fellows., Methods: The San Francisco (SF) Match service was used to obtain US orthopaedic fellowship applicant data from 2010 to 2021. San Francisco Match has run the match for the orthopaedic fellowship match since 2010. International medical graduates' applications, incomplete applications, or withdrawn applications were excluded. The following variables were collected and assessed: sex, subspecialty choice (except for hand because they do not use SF Match services), and match outcome. The number of female applicants and matches was recorded by year and compared with the number of male applicants and matches. Chi-square analysis was used to analyze categorical variables., Results: A total of 6969 applicants to all orthopaedic specialties within SF Match were included during the study period. Overall, 859 were female (12.3%), and 6110 were male (87.7%). The number of female applicants had an increasing trend over the 10-year period from 65 applicants in 2011 to 111 in 2021. The overall proportion of female applicants was between 10.1% and 14.4%. The annual match rate for female applicants was 90.7% to 100% during the study period while the match rate for male applicants was 93.7% to 97.3%. Regarding successful matches, pediatrics had the highest proportion of women (range: 30.2% to 46.2%), followed by foot and ankle (range: 9.8% to 26.4%). Spine (range: 3.2 to 10.9%) and adult reconstruction (range: 3.9% to 9%) had the least number of women among matched applicants., Discussion: This study found that the number of female applicants to orthopaedic fellowships has increased over the past 10 years. The difference in fellowship match rates among male versus female applicants did not statistically differ during this 10-year period; however, the proportion of female fellows is not equally distributed among subspecialties, with a higher proportion of women matching into pediatrics and foot and ankle and lower proportion in reconstruction and spine. These data can provide a benchmark for department chairs and society leadership to ensure they are recruiting, interviewing, and selecting candidates who are representative of the current sex demographics of orthopaedic fellowship graduates., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Objectives: To assess the safety of immediate upper extremity weight-bearing as tolerated (WBAT) rehabilitation protocol after clavicle fracture open reduction internal fixation (ORIF)., Design: Retrospective cohort study., Setting: Three Level 1 trauma centers., Patients Selection Criteria: Patients older than 18 years who had ORIF of mid-shaft clavicle fractures and lower extremity fractures who were allowed immediate WBAT on their affected upper extremity through use of a walker or crutches were included. All clavicles were fixed with either precontoured clavicular plates or locking compression plates. Included patients were those who had clinical/radiographic follow-up until fracture union, nonunion, or construct failure., Outcome Measures and Comparisons: WBAT patients were matched in a one-to-one fashion to a cohort with isolated clavicle fractures who were treated non-weight-bearing (NWB) postoperatively on their affected upper extremity. Matching was done based on age, sex, and temporality of fixation. After matching, treatment and control groups were compared to determine differences in possible confounding variables that could influence the primary outcome, including patient demographics, fracture classification, cortices of fixation, and construct type. All patients were assessed to verify conformity with weight-bearing recommendation. Primary outcome was early hardware failure (HWF) with or without revision surgery. Secondary outcomes included postoperative infections and union of fracture., Results: Thirty-nine patients were included in the WBAT cohort; there were no significant differences with the matched NWB cohort based on patient demographics. Both the WBAT and the NWB cohorts had 2.5% chance of acute HWF that required surgical intervention ( P = 1.0). Additionally, there was no difference in overall HWF ( P = 0.49). All patients despite weight-bearing status including those who required revision ORIF for acute HWF had union of their fracture ( P = 1.0)., Conclusions: Our data would support that immediate weight-bearing after clavicle fracture fixation in patients with concomitant lower extremity trauma does not lead to an increase in HWF or impact ultimate union. This challenges the dogma of prolonged postoperative weight-bearing restrictions and allow for earlier rehabilitation., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The purpose of this review was to determine whether there is a benefit to early weight bearing or mobilization in surgically treated ankle fractures. All randomized controlled trials that analyzed early vs delayed weight bearing and/or mobilization after an ankle surgery were included. The primary outcome measure was the pooled Olerud Molander Ankle Score 1 year postoperatively. No significant differences in ankle function were found at 1 year postoperatively between early and delayed weight bearing and mobilization. The 12-week results demonstrated superior early ankle function scores for patients who had early weight bearing. Patients who had early mobilization were at increased risk for postoperative complications. In surgically treated ankle fractures, early weight bearing resulted in improved short-term ankle function scores. [ Orthopedics . 2024;47(2):71-78.].

Objective: In 2020, the Canadian Vasculitis Research Network (CanVasc) published their updated recommendations for the management of ANCA-associated vasculitides (AAV). The current addendum provides further recommendations regarding the use of avacopan in AAV based on a review of newly available evidence., Methods: An updated systematic literature review on avacopan (formerly, CCX168) using Medline, Embase, and the Cochrane Library was performed for publications up to September 2022. New recommendations were developed and categorized according to the EULAR grading levels, as done for previous CanVasc recommendations. A modified Delphi procedure and videoconferences were used to reach ≥80% consensus on the inclusion, wording and grading of each recommendation., Results: Three new recommendations were developed. They focus on avacopan therapy indication and duration, as well as timely glucocorticoid tapering., Conclusion: These 2022 addended recommendations provide rheumatologists, nephrologists and other specialists caring for patients with AAV with guidance for the use of avacopan, based on current evidence and consensus from Canadian experts., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Myeloid and erythroid precursor vacuolation is a common dysplastic finding associated with myeloid malignancies, toxins, drug, and nutritional deficiencies. It has been described as a core morphologic feature in VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. We sought to determine the number of cases attributable to VEXAS syndrome in bone marrow biopsies and aspirates (BAMB) reporting myeloid precursor vacuolation. We reviewed 1318 individual BAMB reports from January 2020 to July 2021 where "vacuole(s)," "vacuolation," or "vacuolated" was reported. Bone marrow biopsies with vacuolation confined to blasts or those completed as routine workup prior to stem cell transplant or post induction chemotherapy for AML (acute myeloid leukemia) were excluded. Myeloid and erythroid precursor vacuolation was noted in 219 reports representing 210 patients. The most common etiology was myelodysplastic syndrome (MDS) (38.6%), AML (16.7%), lymphoproliferative disorders and multiple myeloma (7.6%), drug or toxin exposure (5.2%) myeloproliferative neoplasm (MPN) or MPN/MDS overlap syndrome (4.3%). VEXAS syndrome was determined to be the etiology in 2.9% of patients. Two additional cases of VEXAS syndrome with bone marrow biopsies reported in the specified time frame did not explicitly report myeloid or erythroid precursor vacuolation but were identified based on clinical suspicion and repeat BAMB review. Myeloid and erythroid precursor vacuolation is a dysplastic feature attributable to VEXAS syndrome in at least 2.9% of cases. Standardized reporting of vacuolization, triaging of molecular sequencing and optimal treatment of this disorder are critical issues facing those seeing patients with suspected VEXAS syndrome., (© 2023 The Authors. European Journal of Haematology published by John Wiley & Sons Ltd.)

➤: Current evidence suggests that the majority of clavicular fractures in adolescents can and should be treated nonoperatively., ➤: Although rare, in certain patients or fracture patterns, nonoperative management may be associated with delayed healing, prolonged disability, and/or poor functional outcome requiring secondary reconstruction., ➤: When warranted, primary open reduction and internal fixation with plate and screw application has consistently good outcomes with a low complication rate, with the most common complication being implant-related symptoms requiring a secondary surgical procedure for implant removal., ➤: Prospective, comparative studies examining operative and nonoperative treatment, including measures of early return to function, injury burden, return to athletic activity, complication and reoperation rates, and shoulder-girdle-specific, long-term outcome measures are warranted to further elucidate which fractures may benefit from primary fixation., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H419 )., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)