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Introduction: The incidence of keratinocyte carcinoma (KC), i.e., basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), is increasing worldwide, placing a significant burden on healthcare resources. This is especially the case for tumors requiring surgical intervention. It remains unclear whether this increase is a result of the population aging or a genuine increase in risk of skin cancer. Understanding age-adjusted incidence trends of KC is crucial for improving future management of the disease. We studied these trends in a large nationwide cohort, focusing on large, invasive, and surgically challenging tumors., Methods: Information on all incident cases of BCC and SCC in Denmark was extracted from population-based databases in the calendar years 2007-2021. Age-adjusted incidence rates were calculated, standardized to the 2013 European Standard Population. Average annual percentage changes were estimated using Joinpoint regression models. Incidence trends for larger, more invasive tumors (tumor (T) category of ≥T2), and of those in the head and neck area, were elucidated with descriptive statistics., Results: We found 183,338 patients with a first-time incidence of BCC and 42,233 patients with a first-time incidence of SCC in the period 2007-2021. The incidence rate, adjusted for age, increased from 252 to 338 per 100,000 for BCC and from 49 to 104 per 100,000 for SCC. For SCC, the increase was particularly pronounced in the last two years of the study period. Tumors ≥T2, and those in the head and neck area, increased markedly., Conclusion: KC is the most common type of cancer worldwide, and the age-adjusted incidence rates of BCC and SCC increased significantly from 2007 to 2021, as did tumors with a higher T category and those located in anatomically sensitive areas. Since the primary treatment for many of these tumors is surgical, this raises concern about the strain on future healthcare resources., Competing Interests: Declaration of Competing Interest The authors report no conflicts of interest in this work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Sex cord-stromal cell tumors (SCST) are rare tumors of the ovary. Some of the SCSTs secrete hormone originating from the sex or stromal cell of the ovaries. Previous studies have indicated an increased risk of breast and endometrial cancers. However, these studies focused only on the SCST-subtype adult granulosa cell tumor, the estimates stem from selected cohorts and lack a well described cohort making it difficult to adjust for possible confounders., Objective: We examinined the incidence of other primary hormone sensitive cancers and comparing the risk to a matched cohort of women without SCST., Study Design: This is a nested cohort study evaluating women diagnosed with sex cord-stromal cell tumors (SCSTs). We established the cohort of women diagnosed with SCSTs using Systematized Medical Nomenclature for Medicine (SNOMED) codes from the Danish Pathology Register. SCST diagnoses were considered valid if the primary diagnosis was established at a tertiary referral center or confirmed by at least two pathologists. A 1:10 matched control group, matched on birth year, was selected from national registries. Variables for follow up of cases and controls were drawn from national registries including assessment of rates of breast, ovarian and endometrial cancer, hormone use, Charlson Comorbidity Index and sociodemographics. Hazard ratios (HRs) for cancer rates were calculated using multivariate Cox proportional hazards models with SCST exposure estimated in early and delayed models to capture cancer rates over time. Standardized incidence ratios (SIRs) for very rare SCSTs were determined using log-linear Poisson models., Results: Among the 1,516 tumors assigned SNOMED codes for SCSTs, 1,387 met the inclusion criteria after pathologic chart review. The majority had benign tumors, primarily thecoma/fibrothecoma (66%), while 26% had adult granulosa cell tumors (aGCTs). Increased rates for breast cancer were found in thecomas (HR: 1.2; 95% CI 1.0-1.4). In the analysis of all SCSTs combined, an increased rate of synchronous endometrial cancer was found (HR: 3.3; 95% CI 2.7-4.1). In sub-group analysis, malignant and benign SCSTs showed significantly higher HRs for synchronous endometrial cancer, notably in aGCTs (HR: 10.7; 95% CI 5.7-20.1). In the model assessing the rates of endometrial cancer two months after surgical removal of the SCST, no increased rates were found. Sertoli cell tumors were linked to an increased incidence of breast cancer (SIR: 18.9; 95% CI 2.7-134). Both Sertoli and Leydig cell tumors were associated with a higher incidence of synchronous endometrial cancer, with SIRs of 41.4 (95% CI 10.4-166) and 44.9 (95% CI 18.7-108), respectively., Conclusion: In conclusion, women with SCSTs have an increased rate of synchronous endometrial cancer and women with benign SCSTs have an increased rate of synchronous ovarian cancer. A marginally increased rate of breast cancer was found in women with thecomas. There is no increased rate of breast cancer among women with aGCT. It is recommended that women diagnosed with hormone-secreting SCSTs and additional risk factors for endometrial cancer (abnormal uterine bleeding and/or abnormal endometrial thickness) undergo an endometrial biopsy to assess for the presence of cancer., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

The incidence of keratinocyte carcinoma (KC) is rising globally, significantly burdening healthcare resources. Treatment options include medical treatment, non-invasive procedures, and surgery, each associated with their distinct benefits and risks. With advanced treatment, the procedures become increasingly invasive for the patients and expensive for the society. This nationwide cohort study examined the current surgical treatment trends for KC, including factors influencing the likelihood of undergoing reconstructive surgery. We retrieved data on all first-time incidences of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) that were treated at a Danish hospital in the calendar years 2007-2021, corresponding to 34,205 patients with BCC and 17,625 patients with SCC. Descriptive statistics were used to study the development of reconstructive surgery, and the associations between demographic factors, tumor-related factors, and comorbidity, and the use of reconstructive procedures were analyzed using multivariable logistic regression. Among the patients, 26% with BCC and 35% with SCC received reconstructive surgery as part of their surgical treatment. The volume of surgical treatment increased with time, but the proportion of reconstructive procedures for surgically treated KC decreased in the study period. The likelihood of undergoing reconstructive surgery was higher for men and increased with age. Patients with BCC and high comorbidity burden or those who stayed in assisted living facilities were less likely to undergo reconstructive surgery. This was not the case for patients with SCC. The rapid increase in surgical treatment for KC at Danish hospitals, with a notable increase in reconstructive procedures, reflects the global development in KC cases and highlights the continued need for tailored management strategies., (Copyright © 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background and Aims: Patients with inflammatory bowel disease (IBD) have lower health-related quality of life (HRQoL) than the general population. The highest incidence and prevalence rates of IBD in the world are found in the Faroe Islands, however, the HRQoL of Faroese patients is unknown. This study aimed to determine their HRQoL at diagnosis and two years of follow-up in comparison with Danish patients., Methods: All patients (15 years or older) were invited to answer the Short Form 12 questionnaire (SF-12) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) at diagnosis and follow-up. Faroese patients were included from 2010 to 2022, and Danish patients in 2010., Results: 160 Faroese patients and 160 Danish patients completed questionnaires twice. For Faroese patients with IBD, the physical and mental component summary scores (SF-12) significantly improved from 46.6 and 44.0 to 49.4 and 47.7, respectively. Total SIBDQ scores also improved from 46.6 to 53.9. However, Faroese patients had significantly lower scores at diagnosis of social functioning, mental health, and mental component summary (SF-12) as well as lower emotional scores (SIBDQ) compared with Danish patients., Conclusions: Faroese patients with IBD improved their HRQoL from diagnosis to follow-up, although greater improvements were observed for Danish patients. Increased awareness of the HRQoL of this patient group is warranted as Faroese patients had lower mental and emotional scores than Danish patients at diagnosis.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with poor prognosis, primarily due to its immunosuppressive tumor microenvironment (TME), which contributes to treatment resistance. Recent research shows that the microbiome, including microbial communities in the oral cavity, gut, bile duct, and intratumoral environments, plays a key role in PDAC development, with microbial imbalances (dysbiosis) promoting inflammation, cancer progression, therapy resistance, and treatment side effects. Microbial metabolites can also affect immune cells, especially natural killer (NK) cells, which are vital for tumor surveillance, therapy response and treatment-related side effects. Dysbiosis can affect NK cell function, leading to resistance and side effects. We propose that a combined biomarker approach, integrating microbiome composition and NK cell profiles, can help predict treatment resistance and side effects, enabling more personalized therapies. This review examines how dysbiosis contributes to NK cell dysfunction in PDAC and discusses strategies (e.g., antibiotics, probiotics, vaccines) to modulate the microbiome and enhance NK cell function. Targeting dysbiosis could modulate NK cell activity, improve the effectiveness of PDAC treatments, and reduce side effects. However, further research is needed to develop unified NK cell-microbiome interaction-based biomarkers for more precise and effective patient outcomes.

Inno4Vac, a public-private partnership funded by the IMI2/EU/EFPIA Joint Undertaking (IMI2 JU), brings together academic institutions, SMEs, and pharmaceutical companies to accelerate and de-risk vaccine development. The project has made significant strides in the selection and production of challenge agents for influenza, respiratory syncytial virus (RSV), and toxigenic Clostridioides difficile for controlled human infection model studies (CHIMs). A regulatory workshop held on March 20, 2024, addressed the standardisation of clinical procedures, ethical considerations, endpoints, and data integrity, highlighting the ongoing initiatives related to these CHIMs. Key discussions focused on refining trial protocols to balance statistical power with participant burden, overseen by a data safety monitoring board. The meeting emphasised the importance of harmonizing CHIM protocols to ensure robust, reproducible, and transparent research. Mandatory trial registration and adherence to the Findable, Accessible, Interoperable, and Reusable (FAIR) data principles were recommended to enhance data reuse and scientific value. This report consolidates efforts to standardise CHIM protocols, essential for accelerating therapeutic innovations and advancing global health research., Competing Interests: Declaration of competing interest Dileep Dasyam, Okba Haj-Ali Saflo, Sandra Morel, and Juan Pablo Yarzabal are employed by GSK and hold financial equities in GSK. These authors declare no other financial and non-financial relationships and activities. All other authors declare no competing interests., (Copyright © 2025. Published by Elsevier Ltd.)

Background: Evidence concerning workplace bullying as a risk factor for mental disorders is currently limited to depressive disorders and mainly based on non-clinical assessments. This study aims to examine the prospective association of self-reported workplace bullying with different types of register-based hospital-diagnosed mental disorders and redeemed psychotropic drug prescriptions., Methods: Using a cohort study design, we examined a pooled dataset of 75,252 participants from 14 questionnaire-based surveys conducted between 2004 and 2014. In the questionnaires, workplace bullying was measured by a single item. The questionnaires were linked to Danish registers on hospital-diagnosed mental disorders and redeemed psychotropic drug prescriptions up to 2016. Data were analysed by multivariate Cox proportional hazard models, including only participants without a history of mental disorders or prescriptions since 1995., Results: After adjustment for sex, age, marital and socio-economic status, workplace bullying was associated with an excess risk of any mental disorder (HR 1.37; 95 % CI: 1.17-1.59) as well as mood disorders and neurotic, stress-related, and somatoform disorders. In stratified analyses, this association were statistically significant only among women. Workplace bullying was also associated with any psychotropic drug prescription (fully-adjusted HR 1.43; 95 % CI: 1.35-1.53). This association was observed in both sexes and for all prescriptions, including anxiolytics, hypnotics and sedatives, antidepressants, and nootropics., Limitations: Firm conclusions about sex-related differences cannot be drawn. Residual confounding by unmeasured factors such as personality cannot be ruled out., Conclusions: Workplace bullying was associated with higher risks of diagnosed mental disorders among women and psychotropic drug prescriptions in both sexes., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Background: Over the past decade, the use of organophosphate insecticides including chlorpyrifos has faced increasing restrictions due to health concerns, leading to a rise in use of pyrethroids. Concerns about neurodevelopmental insults following pyrethroids exposure exist, but few studies have examined the long-term effects of childhood exposure to chlorpyrifos and pyrethroids on IQ., Objective: To investigate the prospective associations between pyrethroids and chlorpyrifos exposure at age 5 years and IQ scores assessed at age 7., Materials and Methods: A total of 1083 children from the Odense Child Cohort (OCC), born between 2010 and 2012, were included. Chlorpyrifos metabolite chlorpyrifos-methyl, 3,5,6-trichloro-2-pyridinol (TCPy) and pyrethroid metabolite 3-phenoxy-benzoic acid (3-PBA) were measured in urine at age 5. An abbreviated version of the Danish Wechsler Intelligence Scale for Children fifth edition (WISC-V) was administered at age 7 years., Results: Median urine concentrations of 3-PBA and TCPy at age 5 were 0.18 μg/L and 1.15 μg/L, respectively. Higher childhood urine TCPy concentration was associated with a reduction in IQ at 7 years (-0.80 (95%CI: -1.29, -0.31)) for each doubling of TCPy. The association was more pronounced in girls (-1.09 (95%CI: -1.80, -0.38)) than in boys. (-0.54 (95%CI: -1.21, -0.14)). No association was observed for 3-PBA., Conclusions: Even in this low exposed cohort, early childhood exposure to chlorpyrifos was associated with lower IQ at age 7. Our results align with previous reports in both animals and humans suggesting that chlorpyrifos exposure may adversely affect neurodevelopment. No association between pyrethroid exposure (3-PBA) and IQ scores was found. The lack of association for 3-PBA is likely due to the low and uniform exposure levels among the participants. To establish a definitive exposure-response relationship, studies or combined datasets with greater variability in exposure levels are required. Continued monitoring and regulation of insecticide use are recommended to protect the health of children., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Purpose:  Disease- or procedure-specific registers offer valuable information but are costly and often inaccurate regarding outcome measures. Alternatively, automatically collected data from administrative systems could be a solution, given their high completeness. Our primary aim was to validate a method for identifying secondary surgical procedures (reoperations) in the Danish National Patient Register (DNPR) within the first year following primary fracture surgery. The secondary aim was to evaluate the accuracy of the diagnosis and procedure codes used to determine the causes of these reoperations. Finally, we developed algorithms to enhance precision in identifying the reasons for reoperations., Methods:  In a national cohort of 11,551 patients with primary fracture surgery, reoperations were identified through subsequent surgical procedure codes in the DNPR. Each patient record was reviewed to confirm the reoperations and causes. To improve accuracy, a stepwise algorithm was developed for each cause., Results:  We identified 2,347 possible reoperations; 2,212 were validated as true reoperations by review of patient record, i.e., a 94% positive predictive value (PPV). However, the coding for the causes of these reoperations was inaccurate. Our algorithm identified major reoperations with a sensitivity/PPV of 89/77%, minor reoperations 99%/89%, infections 77/85%, nonunion 82/56%, early re-osteosynthesis 90/75%, and secondary arthroplasties 95/87%., Conclusion:  While the overall reported reoperations in the DNPR had a high PPV, the predefined diagnosis and procedure codes alone were not sufficient to accurately determine the causes of these reoperations. An algorithm was developed for this purpose, yielding acceptable results for all causes except nonunion.

Background: Diet significantly impacts the onset and progression of inflammatory bowel disease (IBD), and diet offers unique opportunities for treatment and preventative purposes. However, despite growing interest, no diet has been conclusively associated with improved long-term clinical and endoscopic outcomes in IBD, and evidence-based dietary guidelines for IBD remain scarce. This narrative review critically examines dietary assessment methods tailored to the unique needs of IBD, highlighting opportunities for precision and inclusivity., Methods: We conducted a comprehensive literature review using search terms related to diet, diet assessment, nutrition, food, sex, gender, equity, and IBD., Results: The identified dietary assessment tools evaluated nutritional quality, dietary patterns, food processing, lifestyle interactions, inflammatory potential, and effects of specific nutrients. Advanced methods, including biomarkers, multi-omics approaches, and digital tools, were highlighted as being complementary to traditional approaches, offering enhanced precision and real-time monitoring. Women remain under-represented in dietary research but face unique nutritional needs due to hormonal cycles, pregnancy, and higher malnutrition risks in IBD., Discussion: Traditional diet assessment methods remain valuable but are often limited by misreporting biases. Advanced approaches may provide greater precision, enabling real-time monitoring and personalised dietary tracking. Incorporating considerations of sex, gender, age, ethnicity, socioeconomic, and sustainability enhances the relevance and applicability of these methods. Addressing these multifaceted aspects of dietary assessment in IBD can facilitate robust interventional trials., Conclusions: Diet assessment tools are essential for developing personalised dietary interventions in IBD, informing evidence-based guidelines, and improving health outcomes and quality of life in IBD.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with poor outcomes due to frequent recurrence, metastasis, and resistance to treatment. A major contributor to this resistance is the tumor's ability to suppress natural killer (NK) cells, which are key players in the immune system's fight against cancer. In PDAC, the tumor microenvironment (TME) creates conditions that impair NK cell function, including reduced proliferation, weakened cytotoxicity, and limited tumor infiltration. This review examines how interactions between tumor-derived factors, NK cells, and the TME contribute to tumor progression and treatment resistance. To address these challenges, we propose a new "Triple NK Cell Biomarker Approach". This strategy focuses on identifying biomarkers from three critical areas: tumor characteristics, TME factors, and NK cell suppression mechanisms. This approach could guide personalized treatments to enhance NK cell activity. Additionally, we highlight the potential of combining NK cell-based therapies with conventional treatments and repurposed drugs to improve outcomes for PDAC patients. While progress has been made, more research is needed to better understand NK cell dysfunction and develop effective therapies to overcome these barriers.

Fluid biomarkers such as Glial Fibrillary Acidic Protein (GFAP) and Neurofilament Light (NfL) play important roles in the diagnosis, monitoring, and evaluation of therapeutic responses in conditions such as Multiple Sclerosis (MS) and Aquaporin-4 Neuromyelitis Optica Spectrum Disorder (AQP4-NMOSD). These biomarkers offer key insights into the underlying pathophysiological mechanisms of these diseases, enabling effective follow-up and personalized treatment approaches, which are essential for improving patient outcomes. Herein, we synthesize the structural attributes, functional roles, and clinical significance of GFAP and NfL in the context of MS and AQP4-NMOSD. We explore the critical implications of these biomarkers in disease manifestation and progression, emphasizing the necessity to develop standardized methodologies and multicentric studies to confirm their clinical applicability., Competing Interests: None., (© 2025 The Authors.)

Background: In Ireland, radiographers typically work in the public or private sector. This study investigates the determinants influencing radiographers' employment choices between the public and private sectors, offering employers valuable insights into the key factors that shape these decisions., Methods: An online questionnaire was distributed nationally via social media and email. The survey gathered data on demographics, job acceptance factors, career progression, employee retention, and perceived sector advantages. Descriptive and qualitative analyses were employed., Results: One hundred and forty-one radiographers completed the survey, representing approximately 4.7 % of state-registered (CORU) radiographers in Ireland. Key differences between sectors emerged: public sector radiographers prioritized pension, job security, and paid sick leave. Private sector radiographers valued salary, benefits, working hour flexibility, and specialized training opportunities. Career progression was viewed more favorably in the private sector (58 %) compared to the public sector (41 %). Both sectors reported similar retention issues, primarily due to heavy workloads and burnout., Conclusion: Employers can improve radiographer retention by aligning their strategies with the motivations of these professionals. The appeal of the public sector is rooted in stability and comprehensive benefits, whereas the private sector attracts radiographers through flexibility, opportunities for professional development, and higher income potential. By effectively balancing compensation, resources, and incentives, in conjunction with promoting technological innovation, organizations can significantly enhance radiographer retention in Ireland., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Increased breast density (BD) is significantly correlated to higher rates of breast cancer (BC), yet awareness among women remains low. This study assesses women's understanding of BD, its implications for cancer risk, and their engagement in screening practices., Methods: A cross-sectional survey of 212 women aged 40 to 74 was conducted using an online questionnaire developed within Google Forms, including open and closed-ended questions. Demographic information was collected, followed by BC awareness and BD knowledge questions. Data were analyzed using IBM SPSS software, with categorical data reported as numbers and percentages, and Chi-square tests employed to explore associations between variables., Results: Of the 212 participants, those with healthcare involvement were significantly more likely to recognize BD as a BC risk factor, with 25.0 % acknowledging its impact compared to 16.8 % of non-professionals (χ 2  = 9.520, p = 0.009). Formal training was associated with increased engagement in breast self-examinations (BSE), with 58.6 % of trained individuals practicing BSE versus 30.1 % without training (χ 2  = 9.108, p = 0.003)., Conclusion: Findings underscore the need for targeted educational initiatives to improve BD awareness among women in the general public, empowering them to identify as at-risk and to participate in screening programs., Impact on Practice: This study emphasizes integrating BD awareness into clinical practice. Healthcare providers are encouraged to implement educational strategies that inform women of BD, its associated risks, and the value of regular screening. Enhancing self-awareness among patients may facilitate earlier detection, ultimately improving BC outcomes and public health efforts., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Introduction: Perceptions of environmental sustainability among radiographers can potentially be influenced by individual experiences and educational backgrounds. This study aims to investigate the perceptions and practices of radiographers regarding sustainability initiatives, emphasizing the significance of understanding their diverse experiences and backgrounds., Methods: This was an online survey involving 104 radiographers from various regions worldwide to evaluate their training related to global warming, their perceptions of sustainability, current practices, and the barriers they face in implementing sustainability practices., Results: Participants' knowledge regarding sustainability was significantly influenced by their social networks, including friends and family (χ 2  = 12.505, p = 0.004). Notable correlations were observed between years' of experience and the belief in pollution's contribution to climate change (χ 2  = 8.096,p = 0.038), as well as the perception of human activities as the primary cause of climate change (χ 2  = 22.68,p = 0.011). Furthermore, involvement in environmental protection initiatives (χ 2  = 19.268, p = 0.033) and the perception of local climate impacts (χ 2  = 22.478, p = 0.012) were positively correlated with experience. In the field of radiography, the adoption of energy-efficient practices (χ 2  = 10.482, p = 0.011) and the recycling of imaging waste (χ 2  = 25.778, p = 0.004) were significantly associated with levels of experience. Lastly, the barrier identified as "Lack of Authority to make change" also exhibited a significant relationship with years of experience (χ 2  = 9.449, p = 0.022)., Conclusion: This study indicates that staff experiences play a significant factor influencing sustainability engagement among radiographers. Barriers identified include financial constraints, insufficient leadership, safety concerns, and inadequate training., Impact on Practice: The current study highlights the essential requirement for customized strategies based on radiographers' experiences to improve sustainable practices in radiography. It acknowledges the impact of organizational barriers and suggests that progress toward a more sustainable future can be achieved through individual empowerment and collaboration within the healthcare sector., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.)

Background: Teriflunomide has been associated with an increased risk of hypertension. Real-world studies including adequate control groups are lacking. We hypothesized that patients with multiple sclerosis (MS) treated with teriflunomide would be at higher risk of developing hypertension than those treated with dimethyl fumarate., Methods: We conducted a cohort study linking the Danish Multiple Sclerosis Registry with national health registries during a 10-year period. Teriflunomide ( N = 2656) and dimethyl fumarate ( N = 2237) exposure was defined by the first treatment record lasting ⩾ 3 months, at which time follow-up started. We included 4893 adult patients without hypertension at baseline. Hypertension was defined as an International Classification of Diseases 10th Revision code for hypertension and by dispensed prescription drugs identified by the respective Anatomical Therapeutic Chemical codes. We used multivariable-adjusted Cox regression., Results: We found 40.6 (teriflunomide) and 13.1 (dimethyl fumarate) hypertension events per 1000 person-years. Compared to dimethyl fumarate-treated patients, patients treated with teriflunomide had a higher risk of developing hypertension (adjusted hazard ratio = 2.80; 95% confidence interval = 2.19-3.56). The number needed to harm was 16 and 9 at 3 and 5 years of follow-up, respectively., Conclusion: We found an increased risk of hypertension in adult patients with MS treated with teriflunomide., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Elisabeth Framke has nothing to disclose. Finn Sellebjerg has served on scientific advisory boards for, served as consultant for, received support for congress participation or received speaker honoraria from Alexion, Biogen, Bristol Myers Squibb, Merck, Novartis, Roche, and Sanofi Genzyme. His laboratory has received research support from Biogen, Merck, Novartis, Roche, and Sanofi Genzyme. Morten Stilund has served on scientific advisory boards for, received support for congress participation or received speaker honoraria from Biogen, Merck, Novartis, Roche, and Sanofi Genzyme. Henrik Boye Jensen has served on advisory boards for Merck and Roche, and as a speaker for Biogen. Zsolt Illes has received speakers’ honoraria and/or research grants from Biogen, Roche, Sanofi, Novartis, Merck, Alexion, Bristol Myers Squibb, Lundbeckfonden, Jascha Fonden, Scleroseforeningen, has been member of advisory boards at Alexion, Biogen, Sanofi, Merck, Roche, Novartis, has been member of adjudication relapse (clinical endpoint) committees in phase 3 trials, and has been principal investigator in studies sponsored by Biogen, Merck, and Sanofi. Tobias Sejbaek has served on scientific advisory boards for, served as consultant for, received support for congress participation or received speaker honoraria from, Biogen, Merck, Novartis, Roche, and Sanofi. His research group has received research support from Biogen, Merck, Roche, and Sanofi. Michael Broksgaard Jensen has served on scientific advisory boards, served as a consultant, received support for congress participation or received speaker honoraria from Biogen, Merck, Novartis, Roche, Sanofi Genzyme, and Teva. Jakob Schäfer has been member of advisory boards at Merck, Sanofi and received speaker honoraria from Merck and Novartis, has received support for congress participation from Merck, Sanofi, and Roche. Peter Vestergaard Rasmussen has served on scientific advisory boards, served as consultant, received support for congress participation or received speaker honoraria from Alexion, Biogen, Bristol Myers Squibb, Merck, Novartis, Roche, and Sanofi Genzyme. Jeppe Romme Christensen has received speaker honoraria from Biogen. Arkadiusz Weglewski served on scientific advisory boards for Merck, Roche, Sanofi. He has also received conference travel support from Biogen, Merck, Roche, Sanofi, and Novartis and speaker honoraria from Roche, Merck, and Sanofi. Sivagini Prakash received support for congress participation and honoraria from Merck, Sanofi Genzyme, Biogen, Roche. Melinda Magyari has served on scientific advisory board, as consultant, received support for congress participation or speaker honoraria from Biogen, Sanofi, Roche, Novartis, Merck, Alexion, Bristol Myers Squibb. The Danish MS Registry received research support from Biogen, Genzyme, Roche, Merck, Novartis. Matthias Kant, Nasrin Asgari, and Lena Christina Roug have nothing to disclose.

Aim: The aim of this study was to evaluate the differences in plaque composition and burden between normal glycemic status (NGS) and dysglycemia expressed as impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM)., Methods: Clinically indicated coronary computed tomography angiography was used to evaluate patients with suspected coronary artery disease (CAD). An oral glucose tolerance test was performed to assess glycemic status. Patients were stratified as NGS, IGT, and T2DM. Plaque volumes were quantified using validated software, with further compositional measurements of low-attenuation, non-calcified, and calcified plaque burden., Results: Of 355 patients with suspected CAD, 220 had NGS, 92 were diagnosed with IGT, and 43 with known T2DM. Low-attenuation plaque volume was significantly higher in IGT (209 mm 3 , p < 0.02) and T2DM (243 mm 3 , p = 0.005) compared with NGS (166 mm 3 ). Total plaque burden was similar between all groups, but a significantly greater low-attenuation plaque burden was seen in IGT ( p = 0.03) and T2DM ( p = 0.02) compared with NGS. The multivariate linear regression model adjusted for clinical risk factors showed that patients with IGT had a greater low-attenuation plaque burden compared with those with NGS ( p = 0.03). Interestingly, no significant differences in plaque burdens were observed between those with IGT and T2DM in both univariate and multivariate analyses., Conclusions: Dysglycemia, including impaired glucose tolerance and type 2 diabetes mellitus, was associated with increased low-attenuation plaque burden compared with normal glycemic status. Patients with IGT demonstrated plaque burden similar to patients with known T2DM, underscoring the need for early metabolic intervention.

Lung cancer (LC) remains the primary cause of cancer-related mortality, largely due to late-stage diagnoses. Effective strategies for early detection are therefore of paramount importance. In recent years, machine learning (ML) has demonstrated considerable potential in healthcare by facilitating the detection of various diseases. In this retrospective development and validation study, we developed an ML model based on dynamic ensemble selection (DES) for LC detection. The model leverages standard blood sample analysis and smoking history data from a large population at risk in Denmark. The study includes all patients examined on suspicion of LC in the Region of Southern Denmark from 2009 to 2018. We validated and compared the predictions by the DES model with diagnoses provided by five pulmonologists. Among the 38,944 patients, 9,940 had complete data of which 2,505 (25%) had LC. The DES model achieved an area under the roc curve of 0.77±0.01, sensitivity of 76.2%±2.04%, specificity of 63.8%±2.3%, positive predictive value of 41.6%±1.2%, and F 1 -score of 53.8%±1.0%. The DES model outperformed all five pulmonologists, achieving a sensitivity 6.5% higher than their average. The model identified smoking status, lactate dehydrogenase, age, total calcium levels, low values of sodium, leucocytes, neutrophil count, and C-reactive protein as the most important factors for LC detection. The results highlight the successful application of the ML approach in detecting LC, surpassing pulmonologists' performance. Incorporating clinical and laboratory data in future risk assessment models can improve decision-making and facilitate timely referrals., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Shared care between oncology specialists and general practice regarding the delivery of palliative care (PC) is necessary to meet the demands for a cohesive PC. The primary objective of this study is to investigate models of cross-sectorial integration between primary care and oncology specialists that have been developed to promote early and basic PC and factors influencing the process., Method: A scoping review was conducted using publications dated up until April 2023. Searches were conducted in MEDLINE, CINAHL, Embase, Web of Science and ProQuest Dissertations and Theses. Complementary searches were performed via reference lists and grey literature. Explicit early PC models aimed at patients with cancer aged ≥18 years with healthcare professionals from primary care and oncology constituted the inclusion criteria. The screening of the papers was performed independently by two reviewers. The reporting adheres to the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses., Results: The search provided 5630 articles of which six met the eligibility criteria, each describing a different model of early and cross-sectorial, integrated PC. 12 active components were identified. Education of staff as well as good communication and cooperation skills are essential factors to succeed with integrated, early PC., Conclusion: Integration of PC between general practice and oncology specialists has potential. The components of basic PC have been established. Factors known to influence the process are trust, communication and a common goal. Further research is required into strategies for approaching different levels of integration., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: To characterize the type, content, and results of care interventions that support spine surgery patients in their early post-discharge recovery., Methods: This systematic review was conducted according to PRISMA guidelines. The literature search was conducted in March 2022 (updated in May 2023) in MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ebsco), PsycINFO (Ovid), and Scopus. Given the heterogeneity of the interventions, outcome parameters, and controls, data for pooling for meta-analysis was not possible. We performed a thematic analysis to categorize the characteristics of the type, content, and results of care interventions., Results: A total of 14 articles met the eligibility criteria. The included studies were published between 2008 and 2022 and included 1,399 unique patients with mean reported ages of 42.3 to 62.3 years. The reported interventions were divided into two categories: "Early active rehabilitation" and "Telemonitoring". As for pain, function, quality of life, and activity the majority of the early active rehabilitation interventions showed no differences compared to usual care. In contrast, the telemonitoring interventions seemed mainly to be in favor of the interventions versus usual care in all of the aforementioned aspects., Conclusion: The included studies demonstrated diverse interventions across settings, populations, interventions, controls, follow-up times, and outcome measures. This variability suggests unclear patient needs and preferences for post-discharge care. Given the heterogeneity and overall study quality, further high-quality research is essential. Future studies should prioritize identifying these needs before intervention design., (© 2024. The Author(s).)

Objective: To investigate imaging biomarkers of tumour response by describing changes in imaging and pathology findings after neoadjuvant radiotherapy (nRT) and exploring their correlations., Materials and Methods: Tumour diameter, volume, and tumour-to-muscle signal intensity (SI) ratio were collected before and after radiotherapy in a cohort of 107 patients with intermediate/high-grade STS and were correlated with post-radiotherapy pathology findings (percentage of necrosis, viable cells, and fibrosis) using Spearman Rank test. Pathological complete response (pCR) was defined as no residual viable cells present, whereas the presence of < 10% viable cells was defined as near-complete pathologic response (near-pCR)., Results: Median amount of necrosis, viable cells, and fibrosis after nRT were 10%, 30%, and 25%, respectively. 7% of patients achieved pCR and 22% near-pCR. No changes in tumour volume were found except for subtypes myxoid liposarcoma (mLPS) -Δ54.47%, undifferentiated pleomorphic sarcoma (UPS) +Δ24.22% and dedifferentiated liposarcoma (dLPS) +Δ35.91%. The median change of tumour-to-muscle SI ratio was -19.7% for the entire population, whereas it was -19.55% and -36.26% for UPS and mLPS, respectively. Correlations (positive and negative) were found between change in volume and the presence of necrosis or fibrosis (r s  = 0.44; r s  = -0.44), as well as between tumour-to-muscle SI ratio and viable cells (r s  = 0.33) or fibrosis (r s  = -0.28)., Conclusion: STS displays extensive heterogeneity in response patterns after nRT. In some subgroups, particularly UPS and mLPS, tumour size changes or tumour-to-muscle SI ratio are significantly linked with the percentage of viable cells, fibrosis, or necrosis., Key Points: Question How do primary soft tissue sarcomas (STS) respond to neoadjuvant therapy, and what correlations exist between pathological findings and imaging characteristics in assessing treatment response? Findings mLPS shrank post-nRT; undifferentiated pleomorphic and dLPSs enlarged. Volume increase correlated with higher necrosis and lower fibrosis; tumour-to-muscle intensity ratio correlated with viable cells. Clinical relevance These findings emphasise the extensive heterogeneity in STS response to nRT across different subtypes. Preoperative correlations between tumour volume and SI changes with necrosis, fibrosis, and viable cells can aid in more precise treatment assessment and prognostication., Competing Interests: Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Prof. Regina G. H. Beets-Tan. Conflict of interest: R.G.H.B.-T. is a member of the Scientific Editorial Board of European Radiology (section: oncology). As such, they have not participated in the selection nor review processes for this article. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Statistics and biometry: Yury S. Velichko, PhD (co-author) provided statistical advice for this manuscript. No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was waived by the Institutional Review Board. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: The present work builds upon a previous study by our group, which was limited to comparing RECIST- and Choi-based response assessments and their correlation with pathology findings and clinical outcomes (Reijers et al [16], https://doi.org/10.1080/0284186x.2023.2166427 ). Methodology: Retrospective Observational Performed at one institution, (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Background and Aims: Lower extremity peripheral arterial disease (PAD) presents a substantial disease burden, yet lifetime estimates remain scant. This nationwide study quantified the lifetime risk of PAD and its clinical outcomes in Denmark., Methods: This cohort study included 4 275 631 individuals in Denmark aged 40-99 years between 1998 and 2018. We estimated the lifetime risk using a modified survival analysis method, considering death as a competing risk event., Results: Over a median 15.5-year follow-up, 151 846 individuals were diagnosed with PAD (median age at diagnosis 71.5 years, interquartile range 63.1-79.2). The overall lifetime risk of PAD from age 40 was 11.6% (95% confidence interval 11.6%-11.7%), decreasing from 12.9% in 1998-2002 to 10.7% in 2013-18. Males had a higher lifetime risk than females (12.8% vs. 10.5%). Socioeconomic disparities were evident, with higher risks for those with lower educational levels (risk difference 3.4%, 95% confidence interval 3.2%-3.6%) and lower income (risk difference 0.4%, 95% confidence interval 0.2%-0.5%). One year after PAD diagnosis, 21.4% had undergone lower limb revascularization, 8.0% had experienced a major amputation, and 16.2% had died. At 5 years, the corresponding proportions were 26.4%, 10.8%, and 40.8%, respectively. The risk of lower limb revascularization showed little variation by sex and socioeconomic status, whereas there was a strong socioeconomic gradient for major amputation and all-cause death., Conclusions: More than one in 10 Danish individuals are diagnosed with symptomatic PAD during their lifetime. Peripheral arterial disease diagnosis is associated with high morbidity and mortality at 1 and 5 years., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: Bitewing examinations are used to examine the pediatric dental status. The aim of this study was to compare the image quality and radiation dose between two different X-ray systems used for pediatric bitewing imaging., Materials and Methods: Data were obtained from both pediatric in vivo bitewing studies and phantom studies. Two X-ray systems were used: Trophy CCX digital (TCCX) (Trophy Irix 70, Marne-la-Vallee, France) and Planmeca Pro X (PPX) (Planmeca, Helsinki, Finland). An Unfors dosimeter (Unfors EDD-30, Billdal, Sweden) was used to measure the skin dose. Image quality was evaluated blindly by three experienced dentists using a Likert scale of 1-5 based on the visual representation of the anatomical structures with emphasis on caries., Results: The highest scoring in vivo bitewing images were obtained with TCCX, but the skin dose was 36% higher (mean 3029 ± 613 μGy) and 113% higher (mean 1364 ± 276 μGy) with standard settings than with compared to PPX. The evaluation of image quality revealed a higher median value for all ratings of TCCX compared to PPX for both the patient and phantom studies, meaning that the images of TCCX were rated as higher quality than the images from PPX. No correlation was found between the median score and the skin dose or between the median score and the exposure times., Conclusion: A significant difference in radiation dose and image quality was found between TCCX and PPX in bitewing imaging. TCCX generally produced higher doses and better graded images, although all images were suitable for diagnosis., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The diagnosis of suspected physical abuse (SPA) remains a continuous challenge to paediatric healthcare. Several studies have reported that computed tomography (CT) improves the evaluation of SPA. This study aims to systematically review the diagnostic performance of CT compared to radiography in investigating skull and chest fractures for SPA. Multiple databases were searched, using PRISMA methods, from 2008 to August 2024 for relevant studies in English. Two reviewers independently screened and selected relevant studies using Covidence software. The QUADAS-2 tool was used for the quality assessment of the included papers. Sensitivity, specificity and the effective radiation dose of CT and radiography from the included studies were extracted. Pooled sensitivity and specificity were calculated with their respective 95% confidence intervals (CI). GRADE criteria were used to appraise the overall quality of the synthesis. Of the 4057 identified papers, 10 met the inclusion criteria; all 10 included skull and/or chest. The overall sensitivity and specificity of CT were 96.5% (95% CI, 94.9-97.7%) and 99.5% (95% CI, 99.1-99.8%), respectively. Compared to the sensitivity and specificity of radiography, 59.8% (95% CI, 56.2-63.3%) and 99.7% (95% CI, 99.3-99.8%), respectively. Conclusion: CT sensitivity is significantly higher than radiography in detecting rib and skull fractures for SPA. The effective dose for chest LDCT is comparable to that of radiography. Therefore, LDCT should be considered a potential replacement to radiography in SPA investigations for the chest and skull. What is Known • CT shows higher diagnostic performance than radiography in detecting skull and rib fractures in the diagnosis of SPA. What is New • When a head CT scan is acquired for SPA diagnosis at any age, the two-view skull radiograph can be safely eliminated from the Skeletal Survey protocol, likewise, Chest CT can replace chest radiography for SPA diagnosis of rib fractures. • The effective dose and image quality of low-dose chest CT is comparable to that of two-view chest radiography for SPA diagnosis., Competing Interests: Declarations. Ethical approval: Institutional Review Board approval was not required for this systematic review. Guarantor: The scientific guarantor of this publication is Professor Mark McEntee. Statistics and biometry: No complex statistical methods were necessary for this paper. Methodology: Systematic review. Informed consent: Written informed consent was not required for this systematic review. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Chronic inflammatory diseases (CIDs) pose a growing healthcare challenge, with a substantial proportion of patients showing inadequate response to biological treatment. There is renewed interest in dietary changes to optimize treatment regimens, with a growing body of evidence suggesting beneficial effects with adherence to a gluten-free diet. This study compared the likelihood of achieving clinical response to biological treatment after 14-16 weeks in patients with CID with high versus low-to-medium gluten intake. Secondary outcomes of interest included changes in disease activity, health-related quality of life and C-reactive protein. The study was a multicentre prospective cohort of 193 participants with a CID diagnosis (i.e. Crohn's Disease, Ulcerative Colitis, Rheumatoid Arthritis, Axial Spondyloarthritis, Psoriatic Arthritis or Psoriasis) who initiated biological treatment between 2017 and 2020. Participants were stratified based on their habitual gluten intake: the upper 33.3% (high gluten intake) and the remaining 66.6% (low-to-medium gluten intake). The proportion of patients achieving clinical response to biological treatment after 14-16 weeks was compared using logistic regression models. The median gluten intake differed significantly between groups (12.5 g/day vs. 5.9 g/day, standardized mean difference = 1.399). In total, 108 (56%) achieved clinical response to treatment, with no difference between 35 (55%) in the high gluten group and 73 (57%) in the medium-to-low gluten group (OR = 0.96 [0.51-1.79], p = 0.897). No differences were found with secondary outcomes. In conclusion, this study found no association between gluten intake and response to biological treatment in patients with CID., (© 2024 The Author(s). Scandinavian Journal of Immunology published by John Wiley & Sons Ltd on behalf of The Scandinavian Foundation for Immunology.)

Pain in hospitalized infants, children, and young people (ICYP) is a well-known phenomenon but remains undertreated. This study aimed to examine documented pain management practices provided for ICYP and compare practices adopted in neonatal and pediatric units. This national retrospective multi-center study was conducted in 40 of the 42 Danish neonatal and pediatric units in November 2020. Data were collected from the medical records of ICYP admitted to a participating unit. We performed a total of 846 medical record audits of which pain was assessed in 51.9% of the ICYP. Pain assessment was documented for more infants (57.8%) than for children and young people (CYP) (47.4%) ( p = 0.003). CYP more often received pain treatment (37.7%) than infants (6.9%, p < 0.0001) and more frequently had a pain treatment plan (50.8% versus 10.2%, p < 0.0001). Use of non-pharmacological treatment was documented for 6.3% of the ICYP. Our findings indicate that pain assessment is insufficiently documented in Danish neonatal and pediatric units. Among cases in which pain scores indicated that the patient had experienced pain, pain treatment was documented in a larger proportion of the pediatric population than in the neonatal population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The incidence and prevalence of inflammatory bowel disease (IBD) in the Faroe Islands have increased drastically during the past 60 years, presumably due to changing environmental risk factors in a genetically susceptible population., Aim: This study investigated differing environmental factors present in Faroese and Danish patients., Methods: From 2010 to 2022, all incident Faroese patients with IBD were invited to complete the International Organization of IBD (IOIBD) questionnaire about environmental factors at the time of their diagnosis. The findings were compared to a cohort of incident Danish patients diagnosed between 2010 and 2011., Results: Questionnaires were completed by 293 of 388 Faroese patients (75%), of whom 15% (n = 45) had Crohn's disease (CD), 63% (n = 185) had ulcerative colitis (UC), and 22% (n = 63) had IBD unclassified (IBDU). Faroese patients with IBD and UC were found to have higher pertussis vaccination coverage (p < 0.05), and more childhood infections of measles and pertussis (p < 0.05). Faroese patients with IBD consumed more fast food and less fiber but consumed less sugar (p < 0.001) and more caffeine (p < 0.001). No differences were found regarding gender, having been breastfed, use of oral contraceptives, or the number of first-degree relatives with IBD; however, differences in smoking at diagnosis were found in a subset analysis of Faroese patients diagnosed in 2010-11 compared with Danish patients., Conclusions: Faroese patients with IBD were more exposed to some environmental risk factors prior to diagnosis than Danish patients. However, certain beneficial dietary habits were more common in Faroese patients than in Danish patients., Competing Interests: Declarations. Conflict of interest: JB reports grants and personal fees from AbbVie, Janssen-Cilag, MSD, Takeda, Tillots Pharma, and Bristol Myers Squibb. JB also reports personal fees from Celgene, Pfizer, Samsung Bioepis, Pharmacosmos, Ferring, and Galapagos and grants from Novo Nordisk, unrelated to the submitted work. EL reports speaker’s fees from Ferring Pharmaceuticals, Takeda, Janssen-Cilag, Tillotts, and MSD. EL also reports having served as an advisory board member for Ferring Pharmaceuticals and Takeda. VA reports personal fees from MSD (Merck) unrelated to the submitted work., (© 2024. The Author(s).)

Purpose: In 2013, the Scandinavian Neurotrauma Committee, produced an evidence-based guideline for the use of Computed Tomography (CT) in patients presenting following recent (<24 h) head injury (HI). A head CT scan is recommended for medium-risk patients with a Glasgow Coma Scale (GCS) score of 14-15, who are > 65 years old and on anti-platelet medication. The aim of this study was to determine the prevalence of intracranial hemorrhage (ICH) on head CT scans in this population, and to test for associations between ICH and baseline characteristics, symptoms and objective clinical findings., Methods: This register-based retrospective study determined the prevalence of ICH on head CT scans performed over a 1-year period based on written CT-reports. Patient medical charts and imaging records were examined for data on symptomatology, objective findings and comorbidities., Results: The study population included 325 unique head CT scans with a 5.2% prevalence of ICH. Risk ratios (RR's) signified higher risk of ICH with a GCS score of 14 compared to a GCS score of 15 (RR 5.35, 95%CI 2.14-13.47). ICH risk was lower in patients on Clopidogrel medication compared to Acetylsalicylic Acid medication (RR 0.33, 95%CI 0.12-0.93)., Conclusions: The associations between ICH and the GCS score call attention to the importance of comprehensive clinical examination of HI patients to minimize CT overuse. The implications for patients and healthcare resources in scanning patients > 65 years on anti-platelet medication should be determined by future prospective studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Studies have investigated ways to reduce infants' pain during heel lancing, but research on preventing adverse events is scarce. This study investigated whether or not the number of infants with normal comfort (>8 and ≤14), distress (≤4), and pain (≤4) scores increased and whether or not the number of adverse events (blue and/or edematous heels and improperly placed incisions) decreased during and after heel lancing following an intervention., Methods: A pre- and post-quality improvement intervention including 189 and 186 heel lances, respectively, in infants (postmenstrual age ≥ 28 + 0 to ≤ 43 + 6 weeks) was conducted in May to July 2020 and April to July 2022. The intervention comprised five initiatives: skin-to-skin contact, comforting, sucrose/breastfeeding, warming cold heels, and ergonomics for staff. ComfortNeo score, along with distress and pain scores assessed the infants' pain and discomfort before, during, and after heel lancing. Adverse events were assessed visually., Results: Post-intervention, there was a significant increase in the number of infants with normal pain and distress scores during (86% to 95%, p = 0.01, and 82% to 93%, p = 0.01, respectively) and after (95% to 99%, p = 0.04, and 90% to 99%, p < 0.01, respectively) heel lancing compared to the pre-intervention. A non-significant reduction in the number of adverse events was observed (41 to 30, p = 0.17)., Conclusions: Cost-free procedural changes can decrease pain, discomfort, and adverse events in infants undergoing heel lancing. Painful procedures should be evaluated and optimized. Staff and parents should collaborate to manage pain and adverse events.

Background/Objectives : Lung cancer (LC) is the leading cause of cancer mortality, making early diagnosis essential. While LC screening trials are underway globally, optimal prediction models and inclusion criteria are still lacking. This study aimed to develop and evaluate Bayesian Network (BN) models for LC risk prediction using a decade of data from Denmark. The primary goal was to assess BN performance on datasets varying in size and completeness, simulate real-world screening scenarios, and identify the most valuable data sources for LC screening. Methods : The study included 38,944 patients evaluated for LC, with 11,284 (29%) diagnosed. Data on comorbidities, medications, and general practice were available for the entire cohort, while laboratory results, smoking habits, and other variables were only available for subsets. The cohort was divided into four subsets based on data availability, and BNs were trained and validated across these subsets using cross-validation and external validation. To determine the optimal combination of variables, all possible data combinations were evaluated on the samples that contained all the variables (n = 5587). Results : A model trained on the small, complete dataset (AUC 0.78) performed similarly on a larger dataset with 21% missing data (AUC 0.78). Performance dropped when 39% of data were missing (AUC 0.67), resulting in informative variables missing completely in the dataset. Laboratory results and smoking data were the most informative, significantly outperforming models based only on age and smoking status (AUC 0.70). Conclusions : BN models demonstrated moderate to strong predictive performance, even with incomplete data, highlighting the potential value of incorporating laboratory results in LC screening programs.

Background: Minimal invasive inguinal hernia repair is conducted using among others the laparoscopic transabdominal preperitoneal (TAPP) procedure or the extended totally extraperitoneal (eTEP) approach. Robotic-assisted TAPP (R-TAPP) has recently been introduced as an alternative to laparoscopic TAPP and TEP, and a growing number of robotic-assisted procedures are performed worldwide. The present study was conducted to determine the risk of chronic pain and recurrence associated with the two methods., Methods: Three hundred ninety-five patients were retrospectively included in the study and underwent either laparoscopic TAPP (n = 177) or R-TAPP (n = 218). Data on patient demographics, hernia characteristics, and postoperative outcomes were retrieved from medical records. Kaplan-Meier curves and Cox proportional hazards regression were used to assess hernia recurrence. Logistic regression was used to analyze secondary outcomes such as inpatient status, hematoma, and chronic pain., Results: The Kaplan-Meier curves indicated a consistently higher cumulative incidence of recurrence in the TAPP group compared to the R-TAPP. Consistent with this finding, the Cox regression showed a higher risk of recurrence in patients undergoing TAPP, with a hazard ratio (HR) of 3.489 (95% CI: 1.232 to 9.880, p = 0.019). The E-value for this HR was 6.44, suggesting robustness to unmeasured confounding. There was no difference in the rates of chronic pain between the groups (OR: 1.233, 95% CI: 0.430 to 3.533, p = 0.696). A logistic regression analysis for other postoperative complications revealed no significant differences., Conclusion: This study provides evidence that robotic-assisted TAPP is associated with a lower risk of recurrence than laparoscopic TAPP., Competing Interests: Declarations. Ethical approval: This research study was conducted retrospectively from data obtained for clinical purposes. According to MRC regulations, this study does not require ethical approval. Human and animal rights: This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: Data on patient characteristics and short and long-term outcomes was anonymously retrieved from patient records. The local ethical committee assessed data collection under these circumstances not to require a statement of informed consent. Conflict of interest: Dr. Inan Ihsan has no conflict of interest to declare in direct relation to this article. Outside the context of this article, he has worked as a consultant for Intuitive Surgical Inc. and Medtronic Inc. Otherwise, the authors declare no conflicts of interest as stated by the authors’ ICMJE forms for disclosure of potential conflicts of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Shared decision-making (SDM) involves patients in choosing their treatment or care options. SDM enhances patient engagement and treatment satisfaction. SDM has proved difficult to implement and sustain in routine clinical practice, hence a supportive tool is needed. This quality improvement study focuses on the development of a generic tool, labeled SDM:KOMPASS, which is intended to support hospital settings by facilitating the visualization of their formative progress and the setting of goals for the SDM implementation into routine clinical practice. The main objective of the present paper is to describe the development of this generic tool. A six-step development process was performed to develop a tool and investigate the tool's overall perceived usability. Qualitative methods, such as observations, individual and focus group interviews, provided insights. A 10-item quantitative survey gauged informants' immediate attitudes towards the tool. Purposefully sampled informants (N = 20), including healthcare professionals and patients, contributed diverse perspectives regarding; 1) The tool's readability and clarity, 2) the construct's domains and content, and 3) the tool's perceived usability. In alignment with real-world challenges, SDM:KOMPASS emerges as a potentially valuable resource for healthcare organizations embedding SDM. The six-step development process revealed how the tool SDM:KOMPASS has potential to enhance SDM implementation's manageability, goal-setting, and focus. Professionals engaged in strategic implementation within somatic and mental hospital departments find the tool potentially beneficial and feasible. The tool shows promise and usability but requires careful attention due to its comprehensiveness. The next step is to alpha test the tool in clinical practice., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lund et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Research to date suggests that frailty is higher in women and is associated with functional difficulty. This study builds on the evidence by examining the association between frailty and functional difficulty between low- and higher-income groups and between older men and women in these income groups., Methods: This study adopted a cross-sectional design that complied with the STROBE checklist and included steps against confounding and common methods bias. The population was community-dwelling older adults aged 50 years or older in two urban neighbourhoods in Accra, Ghana. Participants were either in the low-income group in a low socioeconomic neighbourhood (n = 704) or the higher-income group in a high socioeconomic neighbourhood (n = 510). The minimum sample necessary was calculated, and the hierarchical linear regression analysis was utilised to analyse the data., Results: Frailty was positively associated with functional difficulty in the low- and higher-income samples, but this association was stronger in the higher-income sample. Frailty was positively associated with frailty in men and women within the low- and higher-income samples., Conclusion: The association of frailty with functional difficulty was consistent between low- and higher-income samples, although the strength of the relationship differed between these samples. In both income samples, the foregoing relationship was consistent between men and women, although the strength of the relationship differed between men and women., Competing Interests: Declarations Ethics approval and consent to participate This study received an institutional ethics review and approval from Africa Centre for Epidemiology (004–10-2022-ACE) after its study protocol was reviewed. All the participants provided written informed consent before participating, and all research protocols were approved by the foregoing ethics review committee. All methods and procedures were carried out in accordance with ethical regulations and guidelines. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Shared  decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices. It was developed in Canada with French and English versions, and recently translated into German. This study aims to adapt the IcanSDM measure for Danish-speaking healthcare professionals, and evaluate its psychometric properties., Methods: Cultural adaptation and translation based on Beaton et al.'s approach was applied. A forward translation by ten people and a backward translation by two people were performed. To assess comprehensibility, cognitive interviews were conducted with 24 healthcare professionals. Eighty healthcare professionals who were trained in shared decision making for either one hour (n = 65) or one day (n = 15) participated in the psychometric evaluation. The evaluation concerned acceptance, item characteristics, skewness, item difficulties, corrected item-total correlations, inter-item correlations, factorial structure, internal consistency, and responsiveness., Results: The forward and backward translation revealed few discrepancies, and participants understood the items well. The psychometric evaluation showed a high completion rate and acceptable item difficulties and discrimination values. Both the factor analysis and the internal consistency showed a 2-factor structure: 1) healthcare professionals' capacity to implement shared decision making; and 2) healthcare professionals' capacity to practise shared decision making. The IcanSDM&#95;Danish obtained a Cronbach's alpha coefficient of 0.74. The evaluation of responsiveness showed improvement, but was not statistically significant., Conclusion: The IcanSDM&#95;Danish has good cross-cultural validity and internal consistency, and a 2-factor structure. The IcanSDM&#95;Danish is capable of providing reliable and valid measurement when evaluating constructed knowledge about shared decision making, and may be able to support the implementation of shared decision making training and evaluation of its impact., Competing Interests: Declarations Ethics approval and consent to participate The participants, all of whom were HCPs were informed that participation in the study was voluntary and that they could decline to participate by not completing the questionnaires. Due to Danish law, this type of study, do not need any ethical approval (https://www.retsinformation.dk/eli/lta/2023/1776). The study was conducted in accordance with the Helsinki Declaration and approved by the Danish Data Protection Agency (reference number: 1–16-02–284-23). Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Suicide bereavement increases the probability of adverse outcomes related to grief, social functioning, mental health, and suicidal behavior. While more support for individuals bereaved by suicide has become available, the evidence regarding its effectiveness is not straightforward. The literature suggests that identifying best-practice components is key in designing effective postvention interventions. Background: This metareview aims to identify components of suicide bereavement interventions perceived to be effective by suicide-bereaved people. Aims: The review adhered to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Systematic searches in Medline, PsycINFO, Embase, Emcare, EBM Reviews, Scopus, and Web of Science identified 11 eligible systematic reviews published between 2008 and 2023. The methodological quality was assessed using the Measurement Tool to Assess Systematic Reviews (AMSTAR-2) (PROSPERO registration CRD42023458300). Method: Our narrative synthesis reported the components perceived to be effective in relation to structure and content of interventions, facilitators, and modality (peer, group, community, online). Results: The quality of the included reviews varied considerably, and not all reviews reported on perceived effectiveness of interventions' components. Meta-analysis of findings was not possible due to study heterogeneity. Limitations: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.Conclusion: The findings provide crucial information for researchers, service providers, and policymakers to enhance the provision of evidence-based support for people bereaved by suicide.

Pericoronary adipose tissue attenuation (PCAT a ), observed from coronary computed tomography angiography (CCTA), is emerging as an inflammation marker. This study evaluated the relationship between PCAT a and plaque characteristics, including plaque type, burden, and coronary calcification. An observational study was conducted on 466 patients with suspected chronic coronary syndrome who underwent clinically indicated CCTA. PCAT a was measured along the proximal 40 mm of the coronary arteries and averaged to represent the patient's level. Plaque type was assessed, compositional plaque volumes were measured, and plaque burdens were quantified. The coronary calcification scores (CCSs) were categorized into groups. Statistical methods included t -tests, ANOVA, and multivariate regression analysis. PCAT a differed significantly between calcified (-81.7 Hounsfield units (HU)) and soft (-77.5 HU) plaques. PCAT a was positively associated with total plaque burden (β = 3.6) and non-calcified plaque burden (β = 7.0), but negatively correlated with calcified plaque burden (β = -3.5), independent of clinical factors and tube voltage ( p < 0.05). The effect of PCAT a was stronger when plaques of a different composition were absent. No significant differences in PCAT a were found among different CCS groups. PCAT a increased for calcified compared to soft plaques. The non-calcified plaque burden was associated with a higher PCAT a , while the calcified plaque burden was associated with a lower PCAT a .

Extensive patient heterogeneity is a challenge in the management of inflammatory bowel disease (IBD). Sex and gender, as well as the interaction of sex and gender with other social identities, referred to as intersectionality, contribute to this heterogeneity and might affect IBD outcomes. An interdisciplinary team of clinicians, researchers, patients, and sex and gender experts reviewed current literature on the effect of sex and gender dimensions on IBD outcomes. The team also investigated the role that stakeholders have in advancing sex-based and gender-based IBD knowledge, as comprehensive studies are scarce. Acknowledging and integrating sex and gender into the organisation and content of research (eg, study design, participant recruitment, data analysis, data interpretation, data dissemination, and impact evaluation) could enhance the validity, relevance, and applicability of research. Such gendered innovation has potential for advancing personalised medicine and improving the quality of life for people with IBD., Competing Interests: Declaration of interests JH has served as a speaker or advisory board member for AbbVie, Aqilion, Bristol Myers Squibb, Celgene, Celltrion, Eli Lilly, Ferring, Galapagos, Gilead, Hospira, Index Pharma, Janssen, Meda Pharmaceuticals, Medivir, Novartis, Pfizer, Prometheus Laboratories, Sandoz, Shire, Takeda, Thermo Fisher Scientific, Tillotts Pharma, Vifor Pharma, and Union Chimique Belge, and has received grant support from Janssen, Merck Sharpe & Dohme, and Takeda. VA has served as an advisory board member for Merck Sharpe & Dohme. MDJ has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Tillotts Pharma, Takeda, Norgine, and Olympus. MR reports consulting fees from Janssen as part of a half-day advisory meeting concerning the use of a medication in clinical gastroenterology and payment from AbbVie as compensation for one lecture during Swedish Gastro Week on quality management within IBD; compensation for both was administrated as part of his job as a consultant of gastroenterology and hepatology. JDF reports support for attending meetings and travel from Tillotts and the Danish Society for Gastroenterology and Hepatology. MC has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Vifor Pharma. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Background: Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaques, offering diagnostic and prognostic value. Interscan reproducibility studies on plaque volume measurements are limited. This study aims to assess the interscan reproducibility of coronary plaque quantification and the implications of clinical and technical characteristics on interscan reproducibility., Methods: CCTA was performed twice in 101 patients with known coronary artery disease at a 1-h interval. The scans were conducted using identical CCTA acquisition protocols. Coronary plaque volumes were quantified using a semi-automated software and performed on a per-lesion, per-vessel, and per-patient level., Results: Median plaque volumes were comparable between the first and second CCTA scan. Interscan correlation was high for total plaque (TP), non-calcified plaque (NCP), and calcified plaque (CP) across all analyses (Pearson's coefficient 0.93-0.99), but lower for low-density non-calcified plaque (LD-NCP) volume measurements (Pearson's coefficient 0.74-0.77). Bland-Altman analyses demonstrated higher interscan agreement on a per-patient level compared to on per-vessel and per-lesion level. Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p ​= ​0.003), or lowest image reconstructive iteration level (p ​< ​0.001). Limits of agreement were significantly narrower for TP, NCP, and CP volumes in LAD-lesions and vessels compared to non-LAD lesions and vessels (p ​≤ ​0.001)., Conclusion: Overall reproducibility of repeated CCTA derived plaque measurements by a semi-automated software was modest, and was influenced by image quality, image reconstruction settings, and lesion location., Competing Interests: Declaration of competing interest Bjarne L. Nørgaard has received unrestricted research grants from the Novo Nordic Research Foundation. Damini Dey received software royalties from Cedars-Sinai Medical Center and has a patent. Damini Dey is funded by National Heart, Lung, and Blood Institute, USA (1R01HL148787–01A1 and R01HL151266). The remaining authors had no disclosures to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Although family-centred care (FCC) is recommended in neonatal intensive care units (NICUs), barriers still exist. This study aimed to identify and understand and nurse-related factors contributing to the implementation of a father-friendly NICU (FF-NICU)., Methods: Eleven pre- and post-implementation focus groups were conducted with 21 nurses. Data were analysed using meaning condensation., Results: Four pre-implementation themes emerged: 1) fathers' limited presence, 2) worries, vulnerability, and emotions, 3) types of fathers, and 4) involvement of fathers.Eight themes contributed to the implementation of FF-NICU: 1) Advantage for the infant/family, 2) Presence of fathers, 3) Less work for the nurses, 4) Daily work routines, 5) Taking something from the mother, 6) Different approaches, 7) Creativity and flexibility, and 8) Implementation process., Conclusion: Important for the implementation of FF-NICU were that the change was necessary, advantageous for the nurses, and beneficial for the families. Still, nurses needed to be flexible and creative in the care of the fathers/families., Innovation: This study focused on fathers - an underexposed target group. Examining key factors for those executing the intervention and discussing the findings using the theoretical framework of John P. Kotter's implementation strategy, we contribute to a better understanding of implementation processes., Competing Interests: Betty Noergaard reports financial support was provided by Institute of Regional Health Research, University of Southern Denmark (no. K03-03). Research Council University Hospital of Southern Denmark. Sister Marie Dalgaard Foundation (no. 36130). The Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark., (© 2024 The Authors. Published by Elsevier B.V.)

Introduction: Physical exercise (PE) improves symptoms and quality of life in people with multiple sclerosis (pwMS). However, incorporating PE into daily lives of pwMS pose difficulties. As an alternative to in-person PE, e-based PE has been proposed because of its advantages in terms of accessibility and convenience., Objective: To synthesize existing evidence on e-based PE at home in adults MS and discuss study designs, rehabilitation programs, intervention effects and possible knowledge gaps., Methods: In this scoping review, a systematic search in electronic databases including Embase, Medline, CINAHL and Cochrane Library was conducted following the PRISMA guidelines. Peer-reviewed articles in English on e-based PE interventional studies at home involving adult pwMS, published from 2008 until April 2023, were identified and exported to Covidence. Data from the included studies were extracted and synthesized. This scoping review identified different types of e-based PE interventions used in pwMS across different study designs, but when evaluating intervention effects, this review focused solely on randomized controlled trials (RCTs)., Results: A total of 3,006 studies were retrieved and 179 studies were screened in full text, resulting in the inclusion of 54 studies with a total of 2,359 pwMS. Of those, 33 were RCTs and three were qualitative studies. The studies reported on various e-based interventions including video-based programs, telerehabilitation, and web-based programs. The interventions evaluated muscle strength, cardiorespiratory fitness, walking speed, endurance, balance, and fatigue, as well as symptoms of depression and cognitive dysfunction. E-based PE interventions at home in RCTs demonstrated improvement of depressive symptoms and anxiety, while inconsistent results were reported for fatigue, walking speed and balance. No significant benefits were observed regarding dexterity. Results were generally heterogeneous and were limited by small sample sizes. Several limitations were identified, such as lack of physical activity assessment prior to the intervention and poor reporting of duration, intensity, frequency and adherence to e-based PE interventions., Conclusion: E-based PE interventions in pwMS may improve MS-related symptoms, but the study quality is generally low, and findings are often inconsistent. Several important limitations of the existing literature have been identified in the present review, which can guide future research., Competing Interests: BW receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for neuromyelitis optica spectrum disorders, served on adjudication committee for clinical trials conducted by MedImmune/VielaBio, Alexion, and UCB Biosciences and consulted for Chugai/Roche/Genentech, Horizon Therapeutics and Mitsubishi-Tanabe regarding neuromyelitis optica spectrum disorders. He has received honoraria for speaking at internal meetings of Genentech, Novartis, and Horizon and at external meetings for Roche. FP served on the scientific advisory boards of Novartis and MedImmune; received travel funding and/or speaker honoraria from Bayer, Novartis, Biogen, Teva, Sanofi-Aventis/Genzyme, Merck Serono, Alexion, Chugai, MedImmune, and Shire; is an associate editor of Neurology: Neuroimmunology & Neuroinflammation; is an academic editor of PLoS ONE; consulted for Sanofi Genzyme, Biogen, MedImmune, Shire, and Alexion; received research support from Bayer, Novartis, Biogen, Teva, Sanofi-Aventis/Geynzme, Alexion, and Merck Serono; and received research support from the German Research Council, Werth Stiftung of the City of Cologne, German Ministry of Education and Research, Arthur Arnstein Stiftung Berlin, EU FP7 Framework Program, Arthur Arnstein Foundation Berlin, Guthy-Jackson Charitable Foundation, and NMSS. SSk received personal fees from Munksgaard, TrustMe-Ed, and Nestlé Health Science, outside the submitted work, and co-founder of GLA:D®, a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice. SSk was funded by a program grant from Region Zealand (Exercise First) and two grants from the European Union's Horizon 2020 research and innovation program, one from the European Research Council (MOBILIZE, grant agreement No. 801790) and the other under grant agreement No. 945377 (ESCAPE). UD has received research support, travel grants and/or teaching honorary from Biogen, Merck Serono, Novartis, Bayer Schering and Sanofi Aventis as well as honoraria from serving on scientific meetings of Biogen and Sanofi Genzyme. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Adnan, Roikjaer, Samadzadeh, Richter, Weinshenker, Paul, Skou, Dalgas and Asgari.)

Coronary CT angiography (CTA) derived fractional flow reserve (FFR CT ) is recommended for physiological assessment in intermediate coronary stenosis for guiding referral to invasive coronary angiography (ICA). In this study, we report real-world data on the feasibility of implementing a CTA/FFR CT test algorithm as a gatekeeper to ICA at referral hospitals. Retrospective all-comer study of patients with new onset stable symptoms and suspected coronary stenosis (30-89%) by CTA. Evaluation of CTA datasets, interpretation of FFR CT analysis, and decisions on downstream testing were performed by skilled CT-cardiologists. CTA was performed in 3974 patients, of whom 381 (10%) were referred directly to ICA, whereas 463 (12%) to non-invasive functional testing: FFR CT 375 (81%) and perfusion imaging 88 (19%). FFR CT analysis was rejected in 8 (2%) due to inadequate CTA image quality. Number of patients deferred from ICA after FFR CT was 267 (71%), while 100 (27%) were referred to ICA. Obstructive coronary artery disease (CAD) was confirmed in 62 (62%) patients and revascularization performed in 53 (53%). Revascularization rates, n (%), were higher in patients undergoing FFR CT -guided versus CTA-guided referral to ICA: 30-69% stenosis, 28 (44%) versus 8 (21%); 70-89% stenosis, 39 (69%) versus 25 (46%), respectively, both p < 0.05. Implementation of FFR CT at referral hospitals was feasible, reduced the number of invasive procedures, and increased the revascularization rate., (© 2024. The Author(s).)

Introduction: Neuromyelitis Optica Spectrum Disorders (NMOSD) is a neuroinflammatory condition characterized by optic neuritis and transverse myelitis. While the current approach to NMOSD focuses on relapse-associated worsening (RAW), recent evidence indicates Relapse-Independent Disease Activity (RIDA) in patients., Method: Databases including Embase, PubMed, Scopus, and Web of Sciences were systematically searched up to December 2023. No restrictions were applied. Inclusion criteria focused on studies reporting evidence of RIDA in NMOSD patients. Data extraction involved details such as study title, author, participant characteristics, treatment, evaluation methods, positive findings according to RIDA, and prevalence of findings in NMOSD patients. This study is conducted following the PRISMA guidelines with a registered protocol on PROSPERO (ID = CRD42023492352)., Result: Of 802 studies, 38 were included in the systematic review, covering 1881 NMOSD patients. AQP4-IGg status was positive in 90.6 % of the patients. Ocular findings indicative of RIDA were reported in 23 studies, including thinning of GCIPL, RNFL, GCC, and GCL layers, foveal and macular shape and volume abnormalities, vessel loss, and visual evoked potentials (VEPs) abnormalities. MRI findings supporting the RIDA were reported in 13 studies, including new lesion incidence and brain and spinal cord atrophy. Serum and CSF RIDA-supporting findings were reported in five studies, including elevation in sGFAP and sNFL. Biopsies and autopsies suggested inflammatory processes in relapse-free patients in 2 studies. The predominant manifestation of RIDA in NMOSD was identified in the visual system, suggesting the impaired retinal glial cells like Müller cells during the relapse-free period in NMOSD., Interpretation: Our systematic review provides valuable insights into RIDA in NMOSD. Establishing guidelines for the diagnosis and treatment of RIDA is crucial. Further studies are needed to provide robust evidence on RIDA in NMOSD patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Tumor budding, a biomarker traditionally evaluated using hematoxylin and eosin (H&E) staining, has gained recognition as a prognostic biomarker for stage II colon cancer. Nevertheless, while H&E staining offers valuable insights, its limitations prompt the utilization of pan-cytokeratin immunohistochemistry (IHC). Consequently, this study seeks to evaluate the prognostic significance of tumor budding using IHC in a contemporary cohort of stage II colon cancer patients, aiming to deepen our understanding of this critical facet in cancer prognosis. We conducted a retrospective, population-based cohort study including 493 patients with stage II colon cancer and evaluated tumor budding using IHC, following the H&E-based guidelines proposed by the International Tumor Budding Consensus Conference Group. Correlation between H&E-based and IHC-based tumor budding was assessed using a four-tiered scoring system that included a zero budding (Bd0) category. Survival analyses explored the prognostic significance of tumor budding assessed by IHC and H&E. As expected, IHC-based tumor budding evaluation yielded significantly higher bud counts compared to H&E (p < 0.01). Interestingly, 21 patients were identified with no tumor budding using IHC. This was associated with significantly improved recurrence-free survival (HR = 5.19, p = 0.02) and overall survival (HR = 4.47, p = 0.04) in a multivariate analysis when compared to tumors with budding. The Bd0 category demonstrated a 100% predictive value for the absence of recurrence. In conclusion, IHC-based tumor budding evaluation in stage II colon cancer provides additional prognostic information. The absence of tumor budding is associated with a favorable prognosis and may serve as a potential marker for identifying patients with no risk of recurrence., (© 2024. The Author(s).)

A hereditary component of breast (BC) and colorectal cancer (CRC) has been described in approximately one-third of these tumor types. BC patients have an increased risk of developing CRC as a second primary tumor and vice versa. Germline genomic variants (NextSeq550, Illumina) were investigated in 24 unrelated BC and/or CRC patients and 7 relatives from 3 index patients. Fifty-six pathogenic or likely pathogenic variants were identified in 19 of 24 patients. We detected single-nucleotide variants (SNVs) in CRC predisposition genes ( MLH1 and MUTYH ) and other promising candidates ( CDK5RAP3 , MAD1L1 , NOS3 , and POLM ). Eighteen patients presented SNVs or copy number variants (CNVs) in DNA damage repair genes. We also identified SNVs recently associated with BC or CRC predisposition ( PABPC1 , TYRO3 , MAP3K1 , SLC15A4 , and LAMA1 ). The PABPC1 c.1255C>T variant was detected in nine unrelated patients. Each patient presented at least one SNV/CNV in a candidate gene, and most had alterations in more than one gene, reinforcing a polygenic model for BC/CRC predisposition. A significant fraction of BC/CRC patients with a family history of these tumors harbored deleterious germline variants in DNA repair genes. Our findings can lead to strategies to improve the diagnosis, genetic counseling, and treatment of patients and their relatives.

Study Design: Retrospective quality improvement study., Objective: To investigate if the rate of unsuspected malignancy in biopsies in patients with VCF who underwent percutaneous vertebroplasty (PVP) at the same orthopedic department has changed after the implementation of a new MRI scanning protocol., Summary of Background Data: Discrimination between benign and malign vertebral compression fracture (VCF) can be difficult. However, early diagnosis of malignant VCF is crucial to further treatment and prognosis. An earlier study at an orthopedic department reported a rate of unsuspected malignancy of 4.9% in patients with VCF who underwent PVP when biopsies were obtained during the procedure. The MRI scanning protocol was changed in this period., Methods: Retrospective on 427 patients with vertebral compression fracture undergoing PVP from April 28, 2017 to April 28, 2022, identifying operated patients from the Danish national DaneSpine registry. Subsequently, individual clinical information was collected in journal records., Results: The rate of unsuspected malignancy was 0.9% (4/427), and the overestimation of malignant VCF was 50% (16/32)., Conclusion: During the last 5 years, the rate of unsuspected malignancy in patients with VCF undergoing PVP has improved considerably from 4.9% to 0.9%. Furthermore, MRI is over-diagnosing malignancies. Thus, the new scanning procedure is effective in differentiating between benign and malign VCFs., Level of Evidence: 3., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The prevalence and disease burden of chronic inflammatory diseases (CIDs) are predicted to rise. Patients are commonly treated with biological agents, but the individual treatment responses vary, warranting further research into optimizing treatment strategies. This study aimed to compare the clinical treatment responses in patients with CIDs initiating biologic therapy based on smoking status, a notorious risk factor in CIDs. In this multicentre cohort study including 233 patients with a diagnosis of Crohn's disease, ulcerative colitis, rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis or psoriasis initiating biologic therapy, we compared treatment response rates after 14 to 16 weeks and secondary outcomes between smokers and non-smokers. We evaluated the contrast between groups using logistic regression models: (i) a "crude" model, only adjusted for the CID type, and (ii) an adjusted model (including sex and age). Among the 205 patients eligible for this study, 53 (26%) were smokers. The treatment response rate among smokers (n = 23 [43%]) was lower compared to the non-smoking CID population (n = 92 [61%]), corresponding to a "crude" OR of 0.51 (95% CI: [0.26;1.01]) while adjusting for sex and age resulted in consistent findings: 0.51 [0.26;1.02]. The contrast was apparently most prominent among the 38 RA patients, with significantly lower treatment response rates for smokers in both the "crude" and adjusted models (adjusted OR 0.13, [0.02;0.81]). Despite a significant risk of residual confounding, patients with CIDs (rheumatoid arthritis in particular) should be informed that smoking probably lowers the odds of responding sufficiently to biological therapy. Registration: Clinical.Trials.gov NCT03173144., (© 2024 The Author(s). Scandinavian Journal of Immunology published by John Wiley & Sons Ltd on behalf of The Scandinavian Foundation for Immunology.)

Background: High nurse turnover in hospitals is a worldwide problem with dire consequences for patient care such as increased mortality and a decrease in patient safety. A specific effort to retain nurses is urgently needed due to the many vacant nursing positions, especially across the Medical hospital departments., Aim: To identify the principal deteriorating factors experienced by nurses relating to their intentions to leave the medical department at a university hospital., Methods: A rapid qualitative research methodology was used. Participants comprised 22 registered nurses employed in five university hospital medical department units. The Rigorous and Accelerated Data Reduction (RADaR) technique was therefore used for data collection through qualitative semi-structured interviews and analysis. COREQ was used for reporting the study., Results: The RADaR analysis detected a downward spiral of five principal deteriorating factors influencing nurses' intentions to leave their position in the medical department. The factors were resignations from several nursing colleagues combined with too few and inexperienced nurses present during shifts, additional tasks assigned, a management refraining from improving the problematic issues, leading to decisive consequences for patient care and a declining feeling of professional care., Conclusions: The lack of nurses in the department caused missed nursing care, which affected the nurses' job satisfaction and intentions to leave their positions. Future research initiatives must focus on evaluating successful interventions to maintain the nurses in the positions. Further knowledge, is also needed, to investigate how we can change the downward spiral to a story of retention success., (© 2024 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)