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Following the report of a non-travel-associated cluster of monkeypox cases by the United Kingdom in May 2022, 41 countries across the WHO European Region have reported 21,098 cases and two deaths by 23 August 2022. Nowcasting suggests a plateauing in case notifications. Most cases (97%) are MSM, with atypical rash-illness presentation. Spread is mainly through close contact during sexual activities. Few cases are reported among women and children. Targeted interventions of at-risk groups are needed to stop further transmission.

On 31 March 2022, Public Health Scotland was alerted to five children aged 3-5 years admitted to hospital with severe hepatitis of unknown aetiology. Retrospective investigation identified eight additional cases aged 10 years and younger since 1 January 2022. Two pairs of cases have epidemiological links. Common viral hepatitis causes were excluded in those with available results. Five children were adenovirus PCR-positive. Other childhood viruses, including SARS-CoV-2, have been isolated. Investigations are ongoing, with new cases still presenting.

Objectives: The aim of this study was to investigate the association between pelvic kinematics during the standing knee lift (SKL) test and low back pain (LBP) in youth floorball and basketball players., Design: A prospective cohort study., Setting: Finnish elite youth floorball and basketball players., Participants: Finnish elite youth female and male floorball and basketball players (n = 258, mean age 15.7 ± 1.8)., Main Outcome Measures: LBP resulting in time loss from practice and games was recorded over a 12-month period and verified by a study physician. Associations between LBP and sagittal plane pelvic tilt and frontal plane pelvic obliquity during the SKL test as measured at baseline were investigated. Individual training and game hours were recorded, and Cox's proportional hazard models with mixed effects were used for the analysis., Results: Cox analyses revealed that sagittal plane pelvic tilt and frontal plane pelvic obliquity were not associated with LBP in floorball and basketball players during the follow-up. The hazard ratios for pelvic tilt and pelvic obliquity ranged between 0.93 and 1.08 (95% CIs between 0.91 and 1.07 and 0.83 and 1.29), respectively., Conclusions: Pelvic movement during the SKL test is not associated with future LBP in youth floorball and basketball players., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Prospective studies investigating risk factors for low back pain (LBP) in youth athletes are limited. The aim of this prospective study was to investigate the association between hip-pelvic kinematics and vertical ground reaction force (vGRF) during landing tasks and LBP in youth floorball and basketball players., Methods: Three-hundred-and-eighty-three Finnish youth female and male floorball and basketball players (mean age 15.7 ± 1.8) participated and were followed up on for 3 years. At the beginning of every study year the players were tested with a single-leg vertical drop jump (SLVDJ) and a vertical drop jump (VDJ). Hip-pelvic kinematics, measured as femur-pelvic angle (FPA) during SLVDJ landing, and peak vGRF and side-to-side asymmetry of vGRF during VDJ landing were the investigated risk factors. Individual exposure time and LBP resulting in time-loss were recorded during the follow-up. Cox's proportional hazard models with mixed effects and time-varying risk factors were used for analysis., Results: We found an increase in the risk for LBP in players with decreased FPA during SLVDJ landing. There was a small increase in risk for LBP with a one-degree decrease in right leg FPA during SLVDJ landing (HR 1.09, 95% CI 1.02 to 1.17, per one-degree decrease of FPA). Our results showed no significant relationship between risk for LBP and left leg FPA (HR 1.04, 95% CI 0.97 to 1.11, per one-degree decrease of FPA), vGRF (HR 1.83, 95% CI 0.95 to 3.51) or vGRF side-to-side difference (HR 1.22, 95% CI 0.65 to 2.27) during landing tasks., Conclusions: Our results suggest that there is an association between hip-pelvic kinematics and future LBP. However, we did not find an association between LBP and vGRF. In the future, the association between hip-pelvic kinematics and LBP occurrence should be investigated further with cohort and intervention studies to verify the results from this investigation., Level of Evidence: Prognosis, level 1b.

Merkel cell carcinoma (MCC) is a neuroendocrine cutaneous malignancy that may present as metastatic disease without a known primary site but, most commonly originates in the sun-exposed skin of the head, neck, and extremities. We present a 66-year-old male treated with chemo-radiation for T3N2cM0 laryngeal squamous cell carcinoma (SCCa) six years before he was diagnosed with MCC isolated to the radiated laryngopharynx. Mucosal MCC is rare and radiation-induced MCC has been hypothesized to occur in previously radiated tissue but, never before to the laryngopharynx. Implications regarding cancer biology and management is focused with discussion on relevant advances in pathologic assessment and immunotherapy., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to investigate the incidence of back pain in young basketball and floorball players under 21 years of age. The secondary aim was to examine risk factors especially for low back pain (LBP). Nine basketball and nine floorball teams (n = 396) participated in this prospective follow-up study (2011-2014). Young athletes (mean age 15.8 ± 1.9) performed physical tests and completed a questionnaire at baseline. The follow-up lasted 1-3 years per player. During the follow-up, back pain reported by the players was registered on a weekly basis and verified by a study physician. The exposure time (AE) on team practices and games was recorded by the coach. Altogether back pain was reported 61 times by 51 players. The incidence of back pain was 87 per 1000 athlete-years and 0.4 per 1000 hours of AE. Hamstrings, quadriceps and iliopsoas extensibility and general joint hypermobility were not associated with LBP. Furthermore, no association between LBP and leg extension strength or isometric hip abduction strength asymmetry was found in these young basketball and floorball players. In conclusion, back pain can lead to a considerable time-loss from training and competition among young basketball and floorball players and the pain tends to reoccur. Lower extremity muscle extensibility, general joint hypermobility or investigated lower extremity strength measures were not associated with the risk of LBP., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Pancreatic ductal adenocarcinoma (PDAC) is one of the most clinically challenging cancers to manage. An estimated 48,960 people will be diagnosed with pancreatic cancer in 2015, of that population, 94% are projected to perish within 5 years. These dismal survival rates can be attributed, in part, to an advanced diagnosis occurring in 80% of cases. The heterogeneous and dynamic microenvironment of pancreatic cancer, and the lack of both specific risk factors and efficacious screening tools contribute to the challenge of diagnosing pancreatic cancer in its early stages. These clinical challenges have directed research into the unique characteristics that define PDAC. Recently, there has been an increased focus on the interaction of tumor cells with their microenvironment in the hope of identifying new therapeutic targets. One of the most promising avenues in this new vein of research is targeting protein communication between the cancer cells and the extracellular matrix. The secreted protein acidic and rich in cysteine (SPARC) is one such extracellular matrix protein that has shown potential as a therapeutic target due to its influence on PDAC invasion and metastasis. In this review, we discuss the complex interaction of SPARC with PDAC cells and its potential to guide treatment and eventually improve the survival of patients diagnosed with this devastating disease.

Background: Needle exchange services are vital for the distribution of clean injecting equipment and disposal of equipment used for intravenous drug users. From the number of clean needles and syringes distributed and the estimated number of injecting drug users (IDUs), there may be insufficient use of needle exchange services. This highlighted the need to consider how services could be improved to encourage the use., Methods: A structured, short, anonymous questionnaire was distributed to IDUs through a wide range of agencies and services in North East Scotland. A form of snowball sampling was also used., Results: A total of 370 individuals responded. Respondents noted the following in their two prioritized preferred options: 'Provision of paraphernalia' (citric acid, water and filters; 54%), 'weekend opening hours' (24%) and 'antibiotic prescribing' (23%). Other service developments noted were: 'friendly, approachable staff' (16%), 'family planning' (10.4%), 'dressings for wounds/sores' (9%), 'leaflets on safer injecting' (7.0%), 'advice from staff on safer injecting' (3.0%) and 'evening opening hours' (0.8%). Geographical gaps in current needle exchange services were identified. There was homogeneity of responses across demographic groups., Conclusion: IDUs were willing to participate and suggested more provision of paraphernalia.

24 patients (19 females and 5 males) between 45 and 81 years of age (average age 61.6) with chronic left bundle branch block and with no signs of reduced left ventricular function have been studied by M-Mode echocardiography. These patients have been split into three groups: A) pts. with normal indexes of left ventricular function and normal thickness of the left ventricular walls; B) pts. with normal indexes of left ventricular function and thickness of the interventricular septum at upper limits or increased; C) pts. with different cardiac pathologies but with no signs of reduced ventricular function. The contractility indexes and the motion of the interventricular septum in both the basal and the medial portion have been studied. The results did not show any important variation concerning the ventricular function compared to the normal values. The study of the septal motion pointed out, as a main feature of the left bundle branch block, a preejective posterior motion followed by: a) a normal posterior systolic motion of the interventricular septum, or b) a posterior systolic motion followed by a further posterior protodiastolic motion (delayed motion), or c) an anterior systolic and posterior diastolic motion (paradoxical motion). The alterations of the septal movement ranked in different degrees. The clearest alterations were peculiarly found in the patients of the first group. The patiens of the third group, besides, have shown the lightest alterations. The results allowed to deduce that patients with left bundle branch block can have both normal motion or alterations of the interventricular septum motion of different degree.(ABSTRACT TRUNCATED AT 250 WORDS)