Estimating the clinical and healthcare burden of metabolic dysfunction-associated steatohepatitis in England: a retrospective cohort study using routinely collected healthcare data from 2011 to 2020

OBJECTIVE

To characterise patients with metabolic dysfunction-associated steatohepatitis (MASH) in England and to estimate its associated healthcare resource use (HCRU) and costs, both overall and by progression status and comorbidities.

DESIGN

This was a retrospective observational study of adults with a MASH-coded primary and/or secondary care recorded diagnosis in England (2011-2020). The analysis used data from the Clinical Practice Research Datalink linked to the Hospital Episode Statistics and death registrations. Annualised all-cause and MASH-related (ie, coded as MASH, end-stage liver disease or major adverse cardiovascular event) HCRU and costs were calculated for patients with incident MASH. Subgroup analyses were conducted for patients with type 2 diabetes, overweight/obesity, cardiovascular disease or progression to cirrhosis. Comparative cost analysis was conducted between those with progressed MASH and those who did not progress.

RESULTS

A total of 2696 patients were included (mean follow-up: 4 years). Incidence of MASH was estimated at 4.7 per 100 000 person-years overall and increased among patients with key comorbidities. Patients who had type 2 diabetes had greater HCRU and costs than those who did not (eg, mean 1.8 vs 1.0 all-cause inpatient admissions and £2227 vs £1151 all-cause inpatient costs per-patient per-year). Some patients with MASH progressed to compensated (8.6%) or decompensated cirrhosis (6.5%) during the study. HCRU and costs were substantially higher among patients who progressed than among those who did not (eg, mean 2.4 vs 1.1 all-cause inpatient admissions and £3620 vs £1290 all-cause inpatient costs per-patient per-year).

CONCLUSION

HCRU and costs associated with MASH are higher among patients who have cardiometabolic comorbidities or who progress to advanced disease stages. Therefore, efforts to detect cases early and prevent disease progression could reduce healthcare burden.

Key strategies to reduce the global burden of myopia: consensus from the international myopia summit

In this paper, we describe key strategies to guide global collaborative efforts to further reduce the burden of myopia and myopia-related visual impairment. A modified Delphi method was applied as an iterative multistage process to collect expert and stakeholders' opinions and extract consensus strategies regarding myopia diagnosis, prevention and control. Anonymous pre-meeting preparation rounds, structured discussions for prioritisation and the development of key consensus areas were performed. Consensus was reached on three key areas to collaborate and complement existing frameworks: (1) Myopia defined not only as a refractive error but also as a disease with phenotypic features allowing for risk stratification of significant visual impairment. (2) In addition to preventive strategies, a focus is needed on preventing progression to high myopia (HM). (3) A focus on preventing and treating pathologic myopia (PM), that is, end-stage of myopia disease with irreversible visual impairment. In conclusion, the workgroup suggests a global, collaborative strategy that is needed across public health, healthcare and advocacy sectors to support efforts in reducing visual impairment from myopia. Complementary to existing preventive public health efforts, additional focus on defining myopia as a disease with risk stratification for visual impairment and an emphasis on reducing visual impairment associated with HM and PM should be considered.

Sequential administration of febuxostat and vitamin E protects against testicular ischemia/reperfusion injury via inhibition of sperm DNA damage in Wistar rats

The pathway of testicular ischemia-reperfusion injury (TIRI) has been shown to involve reactive oxygen species (ROS) generation in the ischemic phase and later phase of reperfusion. This study was therefore designed to investigate the effect of blockage of ROS in the ischemic and reperfusion phases of TIRI. Thirty male Wistar rats were grouped into five groups (n = 6 rats each): sham, torsion + detorsion (TD), febuxostat (FEB)-administered (TFD) group, vitamin E (V)-administered (TDV) group, and FEB and vitamin E-administered (TFDV) group. Blood samples (for inflammatory and hormonal assay), testicular (for oxidative stress and histopathology), and epididymal (for sperm DNA damage and indices) tissues were collected after 3 days of detorsion. The TFD and TFDV groups showed a significant reduction in XO and MDA (p < 0.001; η2 > 0.7), as well as a concomitant increase in CAT, thiols, and SOD levels when compared with the TD group (p < 0.01, η2 > 0.5). The TFD group significantly reduced all inflammatory markers (p < 0.05; η2 = 0.75). The observed increase (p < 0.05; η2 = 0.92) in LH level, in response to a low level of testosterone in the TD group, was significantly raised in TFD and TFDV groups. The observed decrease (p < 0.001) in inhibin level in the TD group was raised (p < 0.05; η2 = 0.90) in the TDV group only. A significant increase (p < 0.001) in sperm DNA damage in the TD group was significantly reduced (p < 0.05; η2 = 0.88) in all the treatment groups while the reduced sperm viability (p < 0.01) in the TD group was increased (p < 0.05) in the TFDV group only. There was an improvement in the testicular cytoarchitecture in the TFD and TFDV groups. This study showed that sequential administration of febuxostat in the ischemic phase of TT and vitamin E in the later phase of reperfusion protects the testes against TIRI via inhibition of oxidative stress, inflammation, and sperm DNA damage.

The Allergy Crossroads of Subtropical Regions: Mites, Crustaceans, and the Rise of Edible Insects

Background: Edible insects (EIs) are increasingly recognized as a sustainable protein source, yet concerns persist regarding allergic reactions, even in individuals without prior known consumption. This study examines the immune response profile in patients from a subtropical area to improve understanding of mite-related cross-reactivity and emerging food sensitizations. Methods: To assess sensitization to edible insects, we analyzed 634 patients from a tertiary care allergy institution with high perennial exposure to house dust mites and storage mites. Sensitization patterns were assessed using the ALEX²® MacroArray platform, a multiplex IgE diagnostic tool covering 282 allergens, including Locusta migratoria (Lm), Acheta domesticus (Ad), and T. molitor (Tm). Patients with IgE levels ≥0.3 kU/L were evaluated for cross-reactivity to both mite allergens and pan-allergens. Results: Of the 634 patients, 138 (21.76%) exhibited IgE sensitization to at least one EI extract. Tropomyosin was the most prevalent pan-allergen (63.76%), followed by troponin-C (28.98%) and arginine kinase (26.81%). Notably, 95.66% of EI-sensitized individuals also reacted to mite allergens. However, 23.18% lacked reactivity to common pan-allergens, suggesting alternative sensitization mechanisms. Conclusions: This investigation can highlight regional variations in EI sensitization, where high mite exposure in subtropical climates appears to influence IgE responses to insect proteins. The findings suggest that EI sensitization is not merely incidental but represents a distinct immunological phenomenon shaped by environmental factors and allergen cross-reactivity. Since the presence of food-specific IgE does not reliably indicate clinical allergy, and the lack of food challenge data constrains diagnostic certainty, acknowledging EI sensitization as a potential risk factor remains essential for ensuring food safety and protecting public health.

Operating Department Practitioner's research priorities: A Delphi study

With the 2022 Allied Health Professions' Research and Innovation Strategy and the College of Operating Department Practitioners joining the Council for Allied Health Professions Research, understanding the Operating Department Practitioner profession's vision for research and innovation and identifying its research priorities has become important. This Delphi study aimed to establish research priorities for the Operating Department Practitioner profession. Questionnaires were distributed to Operating Department Practitioners using College of Operating Department Practitioners and social media networks. Round 1 saw 49 eligible responses; this reduced to 21 in Round 2 and 17 in Round 3. Thirty-one research priorities were identified by consensus. Priority rank was determined by mean score, percentage agreement, and coefficient of variance. By reaching a consensus, Operating Department Practitioners co-created research priorities and identified several themes that will contribute to professional development and patient care and support funding opportunities. The five key themes were Workforce Transformation, Education, Patient Safety and Experience, Innovation and Technology, and Theatre Culture.

Consensus recommendations on multiple sclerosis management in Australia and New Zealand: part 1

INTRODUCTION

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system. There were 33 335 people with MS in Australia in 2021 and 2917 in New Zealand in 2006 and the prevalence and incidence are increasing with time. Although new treatments have substantially improved outcomes in recent decades, the treatment landscape has become increasingly complex due to the expanding number of disease-modifying therapies (DMTs) and associated safety considerations.

MAIN RECOMMENDATIONS

A total of 80 consensus recommendations were developed on the current best-practice management of MS in Australia and New Zealand. Part 1 of these guidelines outlines the consensus recommendations covering domains including DMT counselling and selection, pre-DMT assessments, monitoring disease activity on DMT, switching DMT, and discontinuing DMT. The remaining recommendations are outlined in Part 2, encompassing risk mitigation strategies during treatment with DMT, managing DMT in special situations (including pregnancy, postpartum, breastfeeding, active infection including COVID-19, and malignancy), general lifestyle measures, acute MS relapses, and symptomatic treatments for MS.

CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES

This two-part position statement provides a practical resource for clinicians on current best-practice consensus recommendations for managing adults (≥ 18 years old) with MS in the Australian and New Zealand health care settings. It outlines the 14 DMTs currently available through the Australian Pharmaceutical Benefits Scheme and eight through the New Zealand Pharmaceutical Schedule, including the unique efficacy, safety and monitoring considerations of each. Through these guidelines, we aim to support safe, timely and effective management of patients with MS in Australia and New Zealand.

Evaluating sarcopenia and nutritional status in outpatients with liver cirrhosis: concordance of diagnostic methods

Introduction

Introduction and objectives: malnutrition and sarcopenia are prevalent in individuals with cirrhosis, but their diagnosis remains challenging due to limited access to suitable methods across different levels of healthcare. This study aimed to identify the most effective method for diagnosing sarcopenia in outpatients with liver cirrhosis and to evaluate the concordance between subjective and objective diagnostic methods. Patients and methods: patients aged ≥ 18 years with a diagnosis of cirrhosis (regardless of etiology) under outpatient care were included. Exclusion criteria were: a) neoplasia, b) acute liver failure, c) pregnancy/lactation, d) HIV infection, e) special situations requiring liver transplantation, and f) history of organ failure. Nutritional and sarcopenia assessments used subjective methods, including the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), SARC-F, SARC-Calf, and RFH-Global Assessment (RFH-GA); and objective methods, including anthropometry, handgrip strength (HGS), the sit-and-stand test (15s), and appendicular skeletal muscle mass index (ASMI) by Dual-Energy X-ray Absorptiometry (DXA). Concordance between ASMI and traditional methods was analyzed. Significance was set at p < 0.05. Results: a total of 45 patients were analyzed, with alcoholic liver disease being the most frequent etiology (44.4 %). The sit-and-stand test (15s) combined with muscle depletion by DXA diagnosed the most cases of sarcopenia (42.2 %). Moderate agreement was found between muscle depletion and isolated calf circumference (CC) (κ = 0.581; p < 0.001). Conclusions: our study suggests excluding SARC-F and SARC-CalF from sarcopenia screening in outpatients with cirrhosis. While ASMI remains the most reliable diagnostic method, CC may serve as a feasible alternative when DXA is unavailable.

Long COVID clinical evaluation, research and impact on society: a global expert consensus

BACKGROUND

Long COVID is a complex, heterogeneous syndrome affecting over four hundred million people globally. There are few recommendations, and no formal training exists for medical professionals to assist with clinical evaluation and management of patients with Long COVID. More research into the pathology, cellular, and molecular mechanisms of Long COVID, and treatments is needed. The goal of this work is to disseminate essential information about Long COVID and recommendations about definition, diagnosis, treatment, research and social issues to physicians, researchers, and policy makers to address this escalating global health crisis.

METHODS

A 3-round modified Delphi consensus methodology was distributed internationally to 179 healthcare professionals, researchers, and persons with lived experience of Long COVID in 28 countries. Statements were combined into specific areas: definition, diagnosis, treatment, research, and society.

RESULTS

The survey resulted in 187 comprehensive statements reaching consensus with the strongest areas being diagnosis and clinical assessment, and general research. We establish conditions for diagnosis of different subgroups within the Long COVID umbrella. Clear consensus was reached that the impacts of COVID-19 infection on children should be a research priority, and additionally on the need to determine the effects of Long COVID on societies and economies. The consensus on COVID and Long COVID is that it affects the nervous system and other organs and is not likely to be observed with initial symptoms. We note, biomarkers are critically needed to address these issues.

CONCLUSIONS

This work forms initial guidance to address the spectrum of Long COVID as a disease and reinforces the need for translational research and large-scale treatment trials for treatment protocols.

The Critical Role of Vitamin D Supplementation for Skeletal and Neurodevelopmental Outcomes in Preterm Neonates

Background/Objectives: Metabolic bone disease of prematurity (MBDP) is a multifactorial disorder resulting from disrupted transplacental mineral transfer and postnatal nutritional deficits, particularly affecting preterm neonates born before 32 weeks of gestation or weighing under 1500 g. Although substantial research has focused on skeletal outcomes, few studies have explored the association between MBDP and neonatal neurological impairment. This narrative review is the first to integrate the pathophysiological mechanisms, diagnostic methods, and preventive strategies for MBDP, while simultaneously investigating its potential impact on neurodevelopment. Methods: A narrative review of recent peer-reviewed studies, systematic reviews, and clinical trials was performed focusing on biochemical markers (alkaline phosphatase, FGF23, calcium, and phosphorus), emerging tools such as bioelectrical impedance analysis (BIA), and the effects of early nutritional interventions on both skeletal and neurodevelopmental outcomes in preterm infants (n = seven included articles). Results: Early elevations in ALP, particularly when combined with low serum phosphorus and FGF23 levels, provide sensitive markers for identifying MBDP. Furthermore, insufficient vitamin D levels during gestation and in the neonatal period have been associated with increased risks of seizures, hypotonia, and developmental delays. Studies suggest that enhanced vitamin D supplementation in preterm infants (up to 800 IU/day) may improve mineral absorption and bone formation and confer neuroprotective benefits through anti-inflammatory and antioxidant mechanisms. Conclusions: This is the first review on the neurological implications of biochemical actors of MBDP. As a result, diagnostic and therapeutic strategies, including vitamin D supplementation, can improve bone and neurodevelopmental outcomes. Future prospective studies are required to standardize diagnostic criteria and optimize therapeutic regimens for enhanced long-term benefits.

Development of a generalised tool for evaluating success of clinical practice guidelines implementation (A-GIST)

OBJECTIVES

To develop a generalised tool to evaluate the success of implementation of clinical practice guidelines (CPGs).

DESIGN AND SETTING

Systematic review, group brainstorming discussion and modified Delphi method.

PARTICIPANTS

A steering group (3 members) was assembled responsible for the guidance and ensuring stakeholder's involvement. A tool development group (24 members) of leading experts provided expertise in refining the frame and items during the development and participated in the Delphi process. And a secretary group (7 members) was responsible for the organization and coordination, systematic reviewing, drafting of the preliminary list of items, documenting and revising the tool according to the suggestions of the development group.

INTERVENTIONS

Four process stages were employed. First, the project was launched with core groups formed for the development. Second, based on the Reach Effectiveness Adoption Implementation Maintenance framework, a systematic review of existing methods for evaluating the success of CPGs implementation and a brainstorming discussion were conducted to form a preliminary list. Third, a modified Delphi method was organised, integrating a multidisciplinary face-to-face consultation meeting with two rounds of online Delphi consultations. Fourth, the tool was revised and finalised incorporating all expert suggestions.

RESULTS

Development teams comprising multidisciplinary experts were formed. In the systematic review, 7 biomedical literature databases were searched, and 208 pieces of literature were included. After three rounds of brainstorming discussions on items identified in the literature, a 23-item preliminary list was produced. In the modified Delphi method, 14 experts made 23 main suggestions in the face-to-face meeting on the list. 13 experts participated in the first round of Delphi consultation, reached agreement on 20 items, removed 4 items and added 1 new item. 11 experts attended the second-round consultation and had an agreement to include 20 items after revision.

CONCLUSIONS

The Guideline Implementation Success Assessment Tool (A-GIST) was systematically developed as a comprehensive tool to assess the success of CPGs implementation. It comprises 5 dimensions, Reach, Adoption, Implementation, Effectiveness and Maintenance, encompassing 20 items that integrate perspectives from both clinicians and patients. A-GIST is designed to facilitate evaluating, benchmarking and cross-comparison of implementation success between guidelines, facilities and regions. Additionally, it provides evidence-based insights to inform the development of targeted strategies for optimising guideline implementation practices.

The role of resistance exercise-induced local metabolic stress in mediating systemic health and functional adaptations: could condensed training volume unlock greater benefits beyond time efficiency?

The majority of "specialised" exercise configurations (e.g., supersets, drop sets, blood flow restriction) are being assessed as "shortcuts" to hypertrophy and strength improvements. However, these advanced training techniques may also offer significant benefits for systemic health and functional outcomes across recreational and clinical populations via locally induced metabolic responses. Stress-regulating mechanisms are known to enhance the body's resilience by facilitating allostasis, the process of coordinating adaptive processes in reaction to stressors such as physical training. Yet, the role of the local metabolic stress provoked by resistance exercise has not gained much research attention despite its wide potential. Positive effects are not only linked to improved muscular endurance, hypertrophy and strength via primary and secondary mechanisms, but also to the release of myokines, hormones, microRNAs, immune factors, inflammatory substances and other endocrine molecules that initiate numerous health-promoting modifications on a systemic level. Resistance exercise strategies that maximise the local accumulation of metabolites are not well defined, although high volume, close proximity to failure and shorter rests seem to be a necessity. Additionally, blood flow restriction training provides a potent alternative for inducing local acidosis, thereby triggering several pathways associated with improved immunity and physical function even in remote muscle tissues. Future research is warranted to further explore advanced resistance training techniques, as these approaches may offer comparable benefits for physical and mental health to those seen with other forms of exercise such as high-intensity interval training and heavy resistance training.

A structured framework for standardized 3D leg alignment analysis: an international Delphi consensus study

PURPOSE

To reach consensus among international experts on a structured framework for standardized 3D leg alignment analysis based on 3D bone models, ensuring consistency and improving clinical applicability.

METHODS

A Delphi study was performed in four rounds. Rounds 1 and 2 involved a steering and rating group that developed statements based on principles preserving the 3D complexity of anatomical structures, identified through a systematic review. These statements encompassed approaches for deriving joint centres and joint orientations, and defining coordinate systems using 3D bone models. In Rounds 3 and 4, a panel of 35 international experts, including clinicians (54%) and engineers (46%), with participants from Europe (80%), Oceania (9%), Asia (6%), and the Americas (6%), evaluated these statements. Consensus was defined as ≥80% agreement.

RESULTS

Rounds 1 and 2 resulted in 31 statements to be included in the survey. Of these, 26 achieved consensus in Round 3, with the five remaining statements refined and reaching consensus in Round 4. Experts agreed on utilising all available relevant surface data to define joint centres, joint orientations, and individual femoral and tibial coordinate systems alongside a combined leg coordinate system, and adopting central 3D axes for femoral version and tibial torsion.

CONCLUSIONS

This international Delphi consensus study provides a structured framework for a standardized 3D leg alignment analysis based on 3D bone models. This framework aims to enhance clinical applicability for preoperative planning and execution of uni- and multiplanar correction osteotomies around the knee, reduce the methodological variability in 3D leg alignment analysis literature, and improve cross-study comparability.

LEVEL OF EVIDENCE

Level V.

How to Refine and Prioritize Key Performance Indicators for Digital Health Interventions: Tutorial on Using Consensus Methodology to Enable Meaningful Evaluation of Novel Digital Health Interventions

Digital health interventions (DHIs) have the potential to improve health care and health promotion. However, there is a lack of guidance in the literature for the development, refinement, and prioritization of key performance indicators (KPIs) for the evaluation of DHIs. This paper presents a 4-stage process used in the Gravitate Health project based on stakeholder consultation and consensus for this purpose. The Gravitate Health consortium, which comprises private and public partners from across Europe and the United States, is developing innovative digital health solutions in the form of Federated Open-Source Platform and G-lens to present users with individualized digital information about their medicines. The first stage of this was the consultative process for the development of KPIs involving stakeholder (Gravitate Health project leads) consultations at the planning stages of the project. This resulted in the formation of an extensive list of KPIs organized into 7 categories. The second stage was conducting a scoping review, which confirmed the need for extensive stakeholder consultation in all stages of the KPI development, refinement, and prioritization process. The third stage was a period of further consultation with all consortium members, which resulted in the elimination of 1 category of KPIs. The fourth stage involved using the Delphi technique for refining and prioritizing the remaining 6 categories of KPIs. It is unusual to use this methodology in a nonresearch exercise, but it provided a clear consultative framework and structure that facilitated the achievement of consensus within a large consortium of 250 members on a substantial list of KPIs for the project. Consortium members ranked the relevance and importance of each KPI. The final list of KPIs provides substantial indicators sensitive to the needs of a broad group of stakeholders that are being used to capture real-world data in developing and evaluating DHIs.

Implication of taxonomic abundance of gut microbiota in prediabetes: a systematic review

Background

Prediabetes is defined by blood glucose levels that are higher than normal but below the diagnostic threshold for diabetes. Environmental factors associated with diabetes may contribute to its development through alterations in the gut microbiota. Recent studies suggest that changes in the composition and function of the gut microbiota play a role in the pathogenesis of diabetes mellitus and other metabolic disorders.

Objective

This study aims to systematically examine taxonomic abundance and its implications in the gut microbiota of individuals with prediabetes, identify key dysbiotic patterns, and explore their potential role in inflammation, insulin resistance, and progression to type 2 diabetes.

Methods

We conducted a systematic literature review following PRISMA guidelines. The review included sources from PubMed, ClinicalKey, ScienceDirect, Springer, and Scopus. We retrieved original research articles published in English that focused on prediabetes and gut microbiota from 2015 to the date of our search. Out of 827 full-text articles screened, 6 were selected based on defined inclusion and exclusion criteria.

Results

Dysbiosis of the gut microbiota in prediabetes is characterized by a reduction in butyrate-producing bacteria such as Faecalibacterium prausnitzii and Roseburia, along with an increase in potentially harmful taxa such as Escherichia/Shigella and Prevotella species. This imbalance is associated with systemic inflammation and insulin resistance, evidenced by elevated levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and lipopolysaccharide-binding protein (LBP). Increased intestinal permeability facilitates the translocation of bacterial components such as lipopolysaccharides (LPS), further linking gut microbiota changes to the development of insulin resistance and type 2 diabetes.

Conclusion

This review highlights the need for further research to explore the potential therapeutic role of gut microbiota in prediabetes.

Systematic Review Registration

Prospero; Identifier CRD42025637369.

A Delphi study of current practices and establishing consensus regarding assessment of fitness to drive among patients with brain tumours

PURPOSE

Evaluating fitness to drive among patients with brain tumours remains a challenge for clinicians. Due to difficulties in conducting prospective driving studies in this patient cohort, a Delphi study was performed to formulate new driving guidelines for patients with brain tumours.

METHODS

The survey questions, which were designed by utilising Australian driving guidelines and previous Delphi studies, established panelists' expertise, and then used a 9-point Likert scale to formulate new driving guidelines. An expert group of panelists comprising medical oncologists, radiation oncologists, neurosurgeons, and neurologists were chosen based on membership to professional societies with validation in part one of the survey. Two rounds of anonymised surveys were performed using REDCap for data entry, and a novel automated methodology on R for data analysis.

RESULTS

46 statements regarding fitness to drive were developed. Among the 37 surveys distributed, there were 26 responses (70.3% response rate) from round one, and 17 responses (65.4% response rate) for round two. Among the 46 statements, 19 (41.3%) achieved consensus. In addition to establishing a framework for assessing patients, there was notable consensus agreement for stable imaging required as part of evaluation and the need for continual reassessment.

CONCLUSION

Despite clinicians being aware of driving guidelines, determining fitness to drive among patients with brain tumours remains a challenge. This Delphi study identified consensus agreement for the need for stable imaging, and continually reassessing fitness to drive. These novel findings could be translated into future driving guidelines and consensus statements can be integrated into clinical practice.

Optimizing predictive features using machine learning for early miscarriage risk following single vitrified-warmed blastocyst transfer

Research question

Can machine learning models accurately predict the risk of early miscarriage following single vitrified-warmed blastocyst transfer (SVBT)?

Design

A dual-center retrospective analysis of 1,664 SVBT cycles, including 308 early miscarriage cases, was conducted across two reproductive centers. Multiple machine learning models, such as Logistic Regression, Random Forest, Gradient Boosting, and Voting Classifier, were developed. Metrics including Area Under the Curve(AUC), accuracy, precision, recall, F1 score, and specificity were used to evaluate model performance. Key predictors were identified through Mutual Information and Recursive Feature Elimination (RFE).

Results

Maternal age, paternal age, endometrial thickness, blastocyst quality, and ovarian stimulation parameters were identified as critical predictors. Compared to traditional statistical models such as logistic regression (AUC = 0.584), ensemble models demonstrated significantly improved predictive performance. The Voting Classifier achieved the highest AUC (0.836), accuracy (0.780), precision (0.914), and specificity (0.942), outperforming individual machine learning classifiers. The Gradient Boosting Classifier also exhibited strong performance (AUC 0.831, accuracy 0.777), confirming the effectiveness of ensemble learning in capturing complex predictors of early miscarriage risk.

Conclusion

Ensemble machine learning models, particularly the Voting Classifier and Gradient Boosting Classifier, significantly improve the prediction of early miscarriage following SVBT. These models provide accurate, individualized risk assessments, enhancing clinical decision-making and advancing personalized care in ART.

A phase 1, first-in-human, open label, single ascending dose study to evaluate the safety, tolerability, pharmacokinetics, and pharmacodynamics of stabilized isoamyl nitrite nasal spray in healthy adult participants

Stabilized isoamyl nitrite (SIAN) is a novel small molecule, therapeutic candidate for the treatment of cyanide poisoning. SIAN improves survival and has a demonstrated pharmacodynamic (PD) effect in cyanide challenged nonhuman primates. Here, we report results of phase 1, first-in-human study evaluating the safety, tolerability, pharmacokinetic (PK), and PD of SIAN nasal spray in healthy human subjects (NCT05194358). SIAN was intranasally administered in ascending doses at 2 sites in Texas and Tennessee in the United States. A total of 47 subjects were enrolled across 7 dose cohorts evaluating single doses from 20 to 300 μL. Following the dosing of sentinels in each cohort, safety, PK, and PD data were interpreted by a Safety Monitoring Committee to permit dosing of additional subjects in the cohort or escalation to the next dose level. Isoamyl alcohol peak plasma concentrations were reached within 2 minutes and were highest after a 250 μL dose (125 μL/nostril). This trend was also observed for PD parameters, including a metHB peak at 2 minutes with associated increase in heart rate and systolic and diastolic blood pressure. SIAN was generally well tolerated, no serious or severe drug-related effects were observed, and there were no clinically significant changes in vitals or laboratory parameters. We conclude that SIAN, a potential new treatment for cyanide poisoning, was safe, well tolerated, and showed a relationship between PK and PD parameters at the doses tested. SIGNIFICANCE STATEMENT: This is the first-in-human clinical study to evaluate intranasal stabilized isoamyl nitrite, which was shown to be safe, well tolerated, and to elicit a measurable pharmacokinetic and pharmacodynamic response in healthy human subjects at the doses tested. This study paves the way for investigating stabilized isoamyl nitrite further as a potential emergency treatment for cyanide poisoning.

User requirements for quantitative radiological reports in multiple sclerosis

OBJECTIVES

Quantitative radiological reports (QReports) can enhance clinical management of multiple sclerosis (MS) by including quantitative data from MRI scans. However, the lack of consensus on the specific information to include, on and clinicians' preferences, hinders the adoption of these imaging analysis tools. This study aims to facilitate the clinical implementation of QReports by determining clinicians' requirements regarding their use in MS management.

MATERIALS AND METHODS

A four-phase Delphi panel approach was employed, involving neurologists and (neuro)radiologists across Europe. Initial interviews with experts helped develop a questionnaire addressing various QReport aspects. This questionnaire underwent refinement based on feedback and was distributed through the MAGNIMS network. A second questionnaire, incorporating additional questions, was circulated following a plenary discussion at the MAGNIMS workshop in Milan in November 2023. Responses from both questionnaire iterations were collected and analyzed, with adjustments made based on participant feedback.

RESULTS

The study achieved a 49.6% response rate, involving 78 respondents. Key preferences and barriers to QReport adoption were identified, highlighting the importance of integration into clinical workflows, cost-effectiveness, educational support for interpretation, and validation standards. Strong consensus emerged on including detailed lesion information and specific brain and spinal cord volume measurements. Concerns regarding report generation time, data protection, and reliability were also raised.

CONCLUSION

While QReports show potential for improving MS management, incorporation of the key metrics and addressing the identified barriers related to cost, validation, integration, and clinician education is crucial for practical implementation. These recommendations for developers to refine QReports could enhance their utility and adoption in clinical practice.

KEY POINTS

Question A lack of consensus on essential features for quantitative magnetic resonance imaging reports limits their integration into multiple sclerosis management. Findings This study identified key preferences, including detailed lesion information, specific brain and spinal cord measurements, and rigorous validation for effective quantitative reports. Clinical relevance This study identified essential features and barriers for implementing quantitative radiological reports in multiple sclerosis management, aiming to enhance clinical workflows, improve disease monitoring, and ultimately provide better, data-driven care for patients through tailored imaging solutions.

Contraindications to Whole-Body Cryostimulation (WBC). A position paper from the WBC Working Group of the International Institute of Refrigeration and the multidisciplinary expert panel

Background

Whole-Body Cryostimulation (WBC) is a treatment that involves short exposures of the entire body to very cold and dry air in specially adapted cryochambers. A growing body of literature suggests the safe application of this technique in medical settings.

Aim

The primary purpose of this study was to generate an international consensus on the updated contraindications for WBC through an interactive process of questionnaire interspersed with controlled feedback from a steering committee.

Design

The study design was based on a systematic review of the literature and Delphi methodology.

Setting

Administration of electronic online questionnaires concerning contraindications to WBC.

Population

A multidisciplinary panel of 48 experts in the fields of rehabilitation, cardiology, neurology, endocrinology, oncology, clinical nutrition or in the clinical application of WBC was invited to participate in this consensus study.

Methods

A systematic search of PubMed, Scopus and Embase databases was carried out to identify possible items for inclusion in a form. A two-round Delphi survey was then conducted according to international guidelines, consisting of an electronic online questionnaire. The experts had to rate their agreement with each item in the questionnaires on a 5-point Likert scale. Expert consensus was assessed.

Results

A total of 28 European experts participated in the Delphi survey. The first round consisted of 59 items, 3 of which were discarded after data analysis. The second round was rearranged according to the previous suggestions of the panellists. All 28 experts completed the two rounds. At the end of the survey, consensus was reached and a final list of temporal and absolute contraindications to WBC was identified.

Conclusions

This process resulted in multidisciplinary expert consensus statements on contraindications to WBC. The European experts agreed on most of the decisions and produced a list of contraindications.

Clinical rehabilitation impact

The results provide a robust evidence framework to help clinicians improve clinical practice and patient safety.

Unravelling the cleavage-rate relationship from both the experimental and theoretical standpoint: The instance of fluorite dissolution

The phenomenon of solid dissolution into a solution constitutes a fundamental aspect in both natural and industrial contexts. Nevertheless, its intricate nature at the microscale poses a significant challenge for precise quantitative characterization at a foundational level. In this work, the influence across three specific cleavage planes, namely (100), (111), and (110) on the dissolution kinetics of fluorite in aqueous environments was examined from both experimental and theoretical standpoints. For the very first time, the surface potential of fluorite planes during dissolution was measured by means of a fluorite single-crystal electrode. Experimental results indicate that the dissolution of fluorite leads to a marked increase in surface roughness as well as an augmentation in the surface area of all analyzed surfaces. The most significant alteration in roughness is observed on the (111) plane, whereas the most substantial increase in surface area occurs on the (110) plane. In comparison to the (100) crystallographic plane, which demonstrates the slowest dissolution kinetics, the (111) and (110) planes display dissolution at a comparatively expedited rate. Theoretical simulations corroborate this trend, concurrently facilitating an effective examination of the system's free-energy landscape to analyze the dynamics and rates associated with the attachment and detachment of ions to the fluorite surface. Notably, the presence of interfacial defects has the potential to influence the free energy landscape, thereby altering the transition of ions into the bulk solution. Ultimately, the interplay of correlations and discrepancies between experimental findings and theoretical predictions is critically examined.

Efficacy of pharmacological intervention for smokeless tobacco cessation in adults: a systematic review and meta-analysis

BACKGROUND & OBJECTIVES

Smokeless tobacco (SLT) use is a global burden, and its long-term use can result in health issues like oral cancers, oral potentially malignant disorders, etc. This review assessed the effectiveness of behavioural and pharmacological interventions for SLT cessation, adding new dimensions to the evidence found earlier in the literature, including recent trials.

SEARCH METHODS

Four electronic databases were used in the search: PubMed, Scopus, Cochrane, and Web-of-Science. Study Selection included randomized control trials (RCTs) comparing pharmacological and behavioural interventions with or without placebo to help users quit SLT with 3 & 6 months follow-up. Two review writers who separately evaluated abstracts for possible inclusion extracted data from included trials. Mantel-Haenszel's random-effect method was used to assess pooled effects for trial subgroups. Furthermore, the effectiveness of the intervention was evaluated from the reported odds ratios, confidence intervals and quit rates.

RESULTS

Nineteen, consisting of 4575 participants, fulfilled the requirements to be listed in the review. A significant difference was observed at 6 months for pharmacological versus behavioural intervention with a low heterogeneity at a 95% confidence interval. Pooling the fifteen pharmacotherapy-versus-behavioural modification studies in adults, we discovered that pharmacotherapy had a statistically significant impact on raising quit rates by the conclusion of the follow-up period (OR 1.21, 95% CI 1.03 to 1.43; 3271 participants) with low heterogeneity (I2 = 19%).

CONCLUSION

Worldwide, there has been minimal data on interventions for SLT cessation, yet the pharmacological interventional methods have been found to be comparatively effective than behavioural intervention. Adequate awareness, health care professionals training, and law implementation are necessary to achieve habit cessation.

CLINICAL TRIAL NUMBER

Not Applicable. The present systematic review is registered in PROSPERO's International Prospective Register of Systematic Reviews (registration number CRD42023399178 dated 13th Feb 2023).

Design, synthesis and in vitro validation of bivalent binders of SARS-CoV-2 spike protein: Obeticholic, betulinic and glycyrrhetinic acids as building blocks

SARS-CoV-2 is the virus responsible for the COVID-19 pandemic, which caused over 6.7 million deaths worldwide. The Spike protein plays a crucial role in the infection process, mediating the binding of the virus to its cellular receptor, angiotensin-converting enzyme 2 (ACE2), and its subsequent entry into target cells. Previous studies identified, through virtual screening, several natural products capable of binding to two distinct pockets of the Spike protein: triterpenoids binding to pocket 1 and bile acid derivatives binding to pocket 5. Building on these findings, our study advances the field by developing bivalent compounds 1-4 that through a spacer combine a triterpenoid (betulinic acid or glycyrrhetinic acid) with a semisynthetic bile acid derivative (obeticholic acid). These bivalent compounds are designed to simultaneously bind both pockets of the Spike protein, offering significant advantages over single molecules or the combination of the two natural products. In vitro cell assays using pseudotyped recombinant lentiviral particles with selected SARS-CoV-2 Spike proteins demonstrated that 1 and 2 exhibit enhanced activity in reducing viral entry into target cells compared to individual natural products, thus highlighting their potential as superior antiviral agents with reduced side effects.

Exosomal biomarkers: A novel frontier in the diagnosis of gastrointestinal cancers

Gastrointestinal (GI) cancers, which predominantly manifest in the stomach, colorectum, liver, esophagus, and pancreas, accounting for approximately 35% of global cancer-related mortality. The advent of liquid biopsy has introduced a pivotal diagnostic modality for the early identification of premalignant GI lesions and incipient cancers. This non-invasive technique not only facilitates prompt therapeutic intervention, but also serves as a critical adjunct in prognosticating the likelihood of tumor recurrence. The wealth of circulating exosomes present in body fluids is often enriched with proteins, lipids, microRNAs, and other RNAs derived from tumor cells. These specific cargo components are reflective of processes involved in GI tumorigenesis, tumor progression, and response to treatment. As such, they represent a group of promising biomarkers for aiding in the diagnosis of GI cancer. In this review, we delivered an exhaustive overview of the composition of exosomes and the pathways for cargo sorting within these vesicles. We laid out some of the clinical evidence that supported the utilization of exosomes as diagnostic biomarkers for GI cancers and discussed their potential for clinical application. Furthermore, we addressed the challenges encountered when harnessing exosomes as diagnostic and predictive instruments in the realm of GI cancers.

Microbiome Gut-Brain-Axis: Impact on Brain Development and Mental Health

The current discovery that the gut microbiome, which contains roughly 100 trillion microbes, affects health and disease has catalyzed a boom in multidisciplinary research efforts focused on understanding this relationship. Also, it is commonly demonstrated that the gut and the CNS are closely related in a bidirectional pathway. A balanced gut microbiome is essential for regular brain activities and emotional responses. On the other hand, the CNS regulates the majority of GI physiology. Any disruption in this bidirectional pathway led to a progression of health problems in both directions, neurological and gastrointestinal diseases. In this review, we hope to shed light on the complicated connections of the microbiome-gut-brain axis and the critical roles of gut microbiome in the early development of the brain in order to get a deeper knowledge of microbiome-mediated pathological conditions and management options through rebalancing of gut microbiome.

Improving concordance with long-term compression therapy amongst people with venous ulceration: A Delphi study- clinician cohort

Research by Nelson and Adderley (2016)reveals that 60-80 % of individuals affected by chronic venous insufficiency (CVI) develop venous leg ulcers (VLU). The gold standard treatment for VLU is the application of compression therapy (CT), which promotes venous return, reduces venous pressure, and minimizes stasis (Bullock & Manias, 2022). Patient concordance to CT is suboptimal, with only 40 % concordance, leading to a higher risk of VLU recurrence (Eri ckson et al., 1995; Fi nlayson et al., 2014; K app et al., 2013). This poses a significant and costly healthcare challenge (Smith & McGuiness, 2010). A Delphi study was conducted to ascertain the factors that influence concordance with CT using a clinician cohort. The study asked participants to rank factors that facilitated concordance and those that acted as barrier. Results revealed that clinicians identified 44 factors that facilitated concordance and 46 factors that acted as a barrier in the initial phase. The consensus level, measured by a Kendall W Coefficient, ranged from moderate to strong amongst the participants (Zanotti & Chiffi, 2015).

Core functions and forms in home-delivered meal programs: a stakeholder-driven approach to identifying essential practices

BACKGROUND

The rapid growth of the aging population underscores the need for programs tailored to older adults' complex health needs. Home-delivered meal programs are critical, providing nutrition and socialization support to older adults with greatest economic and social need. However, variations in local implementation complicate our understanding of how specific program practices influence older adult outcomes. This present study applies the core functions and forms framework to identify and prioritize essential home-delivered meal practices-or forms-that can be replicated by other meal programs.

METHODS

This study was conducted within a pragmatic randomized effectiveness trial comparing two home-delivered meal models and their impacts on health outcomes among older adults. The study involved nine meal programs across the United States and used a three-phase approach characterized by the following: (1) core functions of home-delivered meal programs were identified based on Title III of the Older Americans Act; (2) the full spectrum of program "forms" was gathered through site visits, surveys, and listening sessions; and (3) a modified e-Delphi process was conducted with stakeholders to determine consensus on the most essential forms of home-delivered meal programming.

RESULTS

Three core functions were identified from Title III of the Older Americans Act: provide meals to reduce hunger and malnutrition, provide opportunities for socialization, and provide opportunities to promote health and well-being. Out of 103 identified program forms, 25 were deemed essential for achieving the core functions of home-delivered meal programs. Essential practices included dietary customization, emergency meal provision, and meaningful client-driver interactions, as examples.

DISCUSSION

This study demonstrates that while program variability allows flexibility to meet local client needs, establishing core functions and essential forms provides a foundation for evaluating home-delivered meal program effectiveness. The findings inform home-delivered meal program improvements at the national level, emphasizing a balance between standardized practices and local adaptations. This work serves as a model for characterizing complex interventions in community-based settings, advancing the science of implementation and the impact of home-delivered meals on older adult populations.

TRIAL REGISTRATION

NCT registration: NCT05357261 ; April 27, 2022.

Vision techniques for anatomical structures in laparoscopic surgery: a comprehensive review

Laparoscopic surgery is the method of choice for numerous surgical procedures, while it confronts a lot of challenges. Computer vision exerts a vital role in addressing these challenges and has become a research hotspot, especially in the classification, segmentation, and target detection of abdominal anatomical structures. This study presents a comprehensive review of the last decade of research in this area. At first, a categorized overview of the core subtasks is presented regarding their relevance and applicability to real-world medical scenarios. Second, the dataset used in the experimental validation is statistically analyzed. Subsequently, the technical approaches and trends of classification, segmentation, and target detection tasks are explored in detail, highlighting their advantages, limitations, and practical implications. Additionally, evaluation methods for the three types of tasks are discussed. Finally, gaps in current research are identified. Meanwhile, the great potential for development in this area is emphasized.

Evaluating the diagnostic validity of CBCL-OCS in Chinese children and adolescents with OCD

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) is recognized globally as a serious mental health concern among children and adolescents. Accurate early diagnosis and intervention are crucial for effective management and improving patient outcomes. The primary objective of this study was to evaluate the diagnostic validity of the Child Behavior Checklist-Obsessive Compulsive Scale (CBCL-OCS) in Chinese children and adolescents, ensuring its cultural adaptability. The secondary objective was to explore the clinical characteristics of OCD, including prevalence, symptom severity, and comorbidities.

METHODS

A cross-sectional epidemiological survey was conducted among 8,595 middle school students in Liaoning Province, China. The CBCL-OCS was employed as the primary screening tool. The optimal cutoff value for OCD screening was determined through receiver operating characteristic (ROC) curve analysis.

RESULTS

The study found an OCD prevalence of 1.710%, which was consistent with the global estimation. ROC analysis determined a cutoff score of 2.5 for CBCL-OCS, with a sensitivity of 0.789 and a specificity of 0.899. Furthermore, adolescents exhibited significantly higher CBCL-OCS scores compared to younger children, suggesting an increase in OCD severity with age. Significant associations were also found between OCD symptoms and comorbid emotional disorders, behavioral problems, and anxiety symptoms.

CONCLUSIONS

This study confirms the utility of CBCL-OCS as an effective early screening tool for OCD in Chinese middle school students, highlighting its sensitivity and specificity, and cultural adaptability. Results contributed valuable insights to the epidemiology of OCD among children and adolescents, underscoring the need for targeted interventions during critical developmental periods, especially in adolescence.

Synergistic interaction of phosphate nanoparticles from fish by-products and phosphate-solubilizing bacterial consortium on maize growth and phosphorus cycling

Phosphate nanomaterials, such as hydroxyapatite/β-tricalcium nanoparticles (nHAs) derived from food industry by-products, offer a sustainable alternative to enhance P-use efficiency in agriculture. However, their limited solubility remains a challenge. This study first investigated the mechanisms of P solubilization of salmon and tuna bones (SnHAs and TnHAs) in fifteen strains of phosphate-solubilizing bacteria (PSB) by an in vitro system. Then, best-performing strains were assembled in a consortium and tested in vivo on maize. We hypothesized that combining nHAs and the PSB consortium inoculated as seed coating (SC) outperforms single treatments alone in promoting plant growth and P cycling, and ensures the establishment in plant-soil system without a bacterial reinforcement (BR) by an additional inoculum suspension. The synergistic effect of nHAs and PSB was proved, improving maize root (+22 %) and total plant biomass (+29 %), as well as P (+32 %) and K (66 %) uptake compared to single treatments. With nHAs and SC, P-use efficiency and recovery increased by 25 % and three-fold, respectively, compared to nHAs alone or with bacterial reinforcement. Consistently, root and substrate bacterial biomass were associated with nHAs plus SC, while nHAs alone or with PSB upregulated PHT1;1 and PHT1;2 transporter genes in maize. Finally, linking the in vitro and in vivo system, we demonstrated that propionic acid production and P-solubilization efficiency of PSB co-applied with nHAs are key drivers of maize growth and P uptake. Our findings indicated that co-applying nHAs and PSB through SC offers a sustainable strategy to improve maize P-use efficiency.

Increased monocytes and their derived indicators are associated with clinical severity of acute heart failure following acute myocardial infarction

Objective

Monocytes play a significant role in the pathophysiology of acute myocardial infarction (AMI). The relationship between monocytes, their derived indicators, and the severity of acute heart failure following AMI remains unclear. Therefore, this study aims to investigate the association of monocytes and their derived indicators with clinical severity of acute heart failure in the patients with AMI.

Methods

In total of 173 patients with AMI were enrolled in this retrospective study. The demographic data and relevant medical histories were obtained. Monocytes and lipid levels were measured. All patients were divided into two groups based on killip classification. Killip class III-IV was defined as acute severe heart failure, while killip class I-II was defined as acute non-severe heart failure.

Results

Monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were significantly higher in patients with acute severe heart failure compared to those with acute non-severe heart failure (P < 0.05). Multivariate logistic regression analysis showed that monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were independently associated with acute severe heart failure (P < 0.05). Moreover, monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio were linked to NT-proBNP concentrations (P < 0.05). Receiver-operating characteristic curve analysis showed that monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio could identify acute severe heart failure in patients following AMI to some extent (P < 0.05).

Conclusion

The elevation of monocyte count, monocyte-to-white blood cell ratio, and monocyte-to-lymphocyte ratio correlated with clinical severity of acute heart failure following AMI, and offered potential discriminating value for cardiogenic pulmonary edema and shock following AMI.

Delphi Consensus on the Distinct Clinical and Histopathological Features of Lichen Planopilaris and Frontal Fibrosing Alopecia: Insights From the Hair Diseases EADV Task Force

BACKGROUND

Frontal fibrosing alopecia (FFA) has been defined as a lichen planopilaris (LPP) variant, and both are characterized by lymphocytic scarring alopecia. Despite histopathological similarities, they differ clinically, suggesting potentially different pathogenetic factors. This Delphi study aimed to collect expert opinions to clarify the relationship between FFA and LPP.

METHODS

The Delphi method was employed via an anonymous survey among experts in hair disorders from the Hair Diseases Task Force of the European Academy of Dermatology and Venereology (EADV), ensuring broad international representation. Two rounds of online questionnaires assessed the definition, clinical presentation, diagnosis, and management of LPP and FFA. The statements, developed based on an extensive literature review, were validated by the core expert panel. A 5-point Likert scale was utilized to quantify agreement levels, with strong consensus defined as ≥ 75% agreement or disagreement. Statements lacking strong consensus in the first round were revised and merged for inclusion in the second round.

RESULTS

Seventeen experts from seven countries joined the Delphi consensus process. In the first round, 65 statements underwent qualitative content analysis, yielding strong consensus in 30.7% of cases. Participants provided written justifications for their assessments. In the second round, an increased consensus rate (53.7%) was reached after the expert panel statement's revision.

CONCLUSIONS

This study confirms that FFA and LPP are clinical variants within the same lichenoid spectrum. While moderate consensus supports FFA as a variant of LPP, uncertainties remain regarding its demographic distribution, the presence of vellus hairs, and blue-gray dots. The study refines diagnostic and management approaches but is limited by the absence of dermatopathologists and basic researchers.

The Relationship Between Clinical Features of Ischemic Stroke and miRNA Expression in Stroke Patients: A Systematic Review

Background/Objectives: Ischemic stroke remains a leading cause of death and disability worldwide. Despite significant progress in reperfusion therapy, the optimal ischemic stroke management strategy has not been developed. Recent studies demonstrate that microRNA may play an essential role in the pathophysiology of ischemic stroke and its possible potential to be a treatment target point. The proposed systematic review aimed to report the relationship between IS's clinical severity and miRNA expression. Secondary outcomes included infarct volume, systemic inflammatory markers, and prognosis, as well as additional features such as stroke subtype, comorbidity, and risk of subsequent stroke in correlation to miRNA expression. Methods: We have performed a systematic search of database resources according to PRISMA statement guidelines. Twenty-seven studies on a total number of 3906 patients were assessed as suitable for the present SR. Included studies analyzed the expression of 30 different miRNA fragments. Results: After investigating available data, we have identified a set of possible miRNA fragment candidates that may be used in stroke diagnostics and have the potential to be a base for the development of future treatment protocols. Conclusions: Studies included in the presented SR indicate that miRNA expression may be significantly associated with clinical severity, infarct volume, and inflammation in ischemic stroke. More prospective, properly designed protocols with consistent methods of miRNA testing and optimized clinical assessment are needed to confirm the role of miRNA expression in the course of a stroke.

Helicobacter pylori culture positivity and antimicrobial susceptibility profiles (Vancouver, Canada)

INTRODUCTION

Helicobacter pylori is associated with gastrointestinal diseases including gastritis and peptic ulcers. Despite its significance, there is a scarcity of antimicrobial susceptibility testing (AST) data available for this organism in North America.

OBJECTIVES

The aim of this study was to assess the AST profile and identify factors associated with H. pylori culture positivity in a cohort of patients with refractory H. pylori undergoing gastric biopsies.

METHODS

We retrospectively reviewed gastric biopsy specimens received for culture between July 2009 and February 2023. We analyzed specimen transport time, Gram smear results, direct urease test findings, culture positivity and AST profiles. Using gradient strip methodology and European Committee on Antimicrobial Susceptibility Testing breakpoints, AST was conducted for amoxicillin, clarithromycin, metronidazole, levofloxacin and tetracycline.

RESULTS

Of 579 biopsy samples received for H. pylori culture, 228 (39.4%) tested positive. Samples transported within <1 h had significantly higher odds (1.81 times, P < 0.015) of being culture positive compared to those with longer transport times. Smear-positive samples had substantially higher odds (18.8 times, P < 0.001) of culture positivity compared to smear-negative. Urease-positive samples demonstrated notably higher odds (7.7 times, P < 0.001) of culture positivity compared to urease-negative samples. The collection of isolates from gastric biopsies showed susceptibility rates of 97.3% to amoxicillin, 99.1% to tetracycline, 50.4% to levofloxacin, 25.9% to metronidazole and 12.9% to clarithromycin.

CONCLUSIONS

Short sample transport time was associated with improved H. pylori recovery rates. In this cohort of refractory H. pylori cases, susceptibility rates were high for amoxicillin and tetracycline and low for clarithromycin, metronidazole and levofloxacin. Susceptibility rates remained stable over time.

Case Report: Neuropsychological Profile of a Patient With Intravascular Large B-Cell Lymphoma Following Infection and Vaccination

OBJECTIVE

Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive lymphoma that can have heterogeneous central nervous system involvement and cerebrovascular complications. The development of IVLBCL can be fatal. Although relatively rare, the development of specific clinical syndromes, such as IVLBCL, has been implicated following infection and vaccination. To our knowledge, this is the first comprehensive neuropsychological evaluation assessing neurocognitive and psychological status after IVLBCL diagnosis.

METHODS

The current study presents a right-handed mid-60-year-old male with a university-level education, who was diagnosed with IVLBCL following viral vector SARS-CoV-2 vaccination. He presented with a complex medical history including antiphospholipid syndrome, deafness (prior to cochlear implant), and cardiovascular complications secondary to lymphoma. Brain magnetic resonance imaging showed parietal, frontal, and cerebellar infarcts; encephalomalacia; and periventricular deep chronic ischemic changes. A comprehensive neuropsychological evaluation was completed.

RESULTS

In consideration of an individual with an estimated above-average baseline, his neurocognitive profile demonstrated impairments across multiple domains that were more lateralized to the non-dominant hemisphere including visual attention, visual processing speed, visuo-construction, memory, motor dexterity, and right-sided ataxia (e.g., dysmetria). Clinical elevations for depression, hopelessness, and anxiety were also found.

CONCLUSIONS

The current study highlights a novel cognitive profile of IVLBCL and comorbidities with the patient having more predominant nondominant hemispheric-related deficits. There was evidence of disruption to visual processing networks, largely consistent with neuroimaging lesions. The current case also describes the unique experience of an individual coping with a rare condition, especially when resulting in functional decline (e.g., loss of audition). Implications are discussed.

The Impact of Minimally Invasive Surgical Modality and Task Complexity on Cognitive Workload: An fNIRS Study

BACKGROUND

Minimally invasive surgical techniques, including laparoscopic and robotic surgery, have profoundly impacted surgical practice by improving precision, reducing recovery times, and minimizing complications. However, these modalities differ in their cognitive demands and skill acquisition requirements, which can influence the learning curve and operative performance. To assess and evaluate this variability across these modalities, a functional near-infrared spectroscopy (fNIRS) system is used as an objective method for monitoring cognitive activity in surgical trainees. fNIRS can provide insights and further our understanding of the mental demands of different surgical techniques and their association with varying task complexity.

OBJECTIVE

This study seeks to assess the influence of surgical modality (laparoscopy vs. robotic surgery) and task complexity (pick and place (PP) vs. knot tying (KT)) on cognitive workload through fNIRS. We compare real-world and simulation-based training environments to determine changes in brain activation patterns and task performance.

METHODS

A total of twenty-six surgical trainees (general and gynecologic surgery residents and specialists) participated in this study. Participants completed standardized laparoscopic and robotic surgical tasks at varying levels of complexity while their cognitive workload was measured using fNIRS. This study included both simulation-based training and real-world surgical environments. Hemodynamic responses in the prefrontal cortex (PFC), task completion times, and performance metrics were analyzed.

RESULTS

Laparoscopic surgery elicited higher activity changes in the prefrontal cortex, indicating increased cognitive demand compared with robotic surgery, particularly for complex tasks like knot tying. Task complexity significantly influenced mental load, with more intricate procedures eliciting greater neural activation. Real-world training resulted in higher cognitive engagement than simulation, emphasizing the gap between simulated and actual surgical performance.

CONCLUSIONS

Cognitive workload was lower and significantly different during robotic surgery than during laparoscopy, potentially due to its ergonomic advantages and enhanced motor control. Simulation-based training effectively prepares surgeons, but the cognitive workload results indicate that it may not fully replicate real-world surgical environments. These findings reveal the importance of cognitive workload assessment in surgical education and suggest that incorporating neuroimaging techniques such as fNIRS into training programs could enhance skill acquisition and performance.

Adult glioblastoma in England: Incidence, treatment, and outcomes with novel population-based strata

INTRODUCTION

Malignant brain tumours are the leading cause of cancer death in the under 40's and they have the highest average-years of life lost. England has a long-running system for national cancer data collection. In this work we present data on incidence, treatment and survival in all adult glioblastoma patients in England diagnosed between 2013 and 2018.

METHODS

GlioCova uses a linked pseudo-anonymised data set of all adult patients in England diagnosed with a primary brain tumour between 2013 and 2018. We identified all patients with a glioblastoma (GBM) based on ICD-10 diagnosis and tumour morphology.

RESULTS

In the 6-year period of the study (2013-2018 inclusive), 15,181 patients were diagnosed with a GBM in England. The national age-standardised incidence was 4.98 adult glioblastoma patients per 100,000 per year, with men having a higher incidence than women (6.3 and 3.8 respectively). Overall, 79 % of patients received treatment (76 % female vs. 81 % male, p = 0.22), with younger patients more likely to be treated than older patients. Median overall survival was 16 months in those receiving aggressive treatment, but 7 months in the whole cohort. 21 % of patients received no treatment, and 17 % of patients underwent surgery or biopsy alone.

CONCLUSION

Age-adjusted incidence of GBM is stable, although absolute numbers are rising, and prognosis remains poor. Only 29 % of patients receive aggressive multi-modality treatment, and we suggest that taking a population-level approach to GBM reveals significant areas for improvement.

Identification of essential topics and procedural skills for inclusion in a contextualised undergraduate anaesthesia and critical care clerkship in Rwanda: results of a modified Delphi process

INTRODUCTION

Low anaesthesia workforce numbers contribute to shortfalls in access to surgical care globally. Investment in contextualised education and training can help address this issue by inspiring graduates to enter into training and imparting important knowledge and skills to non-specialists. We undertook a modified Delphi study to identify physician anaesthesiologist consensus on themes, topics, and skills for inclusion in undergraduate anaesthesia and critical care (ACC) medical school curricula in sub-Saharan Africa (SSA) and Rwanda.

METHODS

A list of ACC topics/skills was compiled through grey literature review, guiding survey development for a 3-round Delphi process. The first two rounds solicited responses from physician anaesthesiologists across SSA. The final round included only Rwandan physician anaesthesiologists. Respondents rated topics/skills on a 4-point Likert scale from 1 ("exclude from the curriculum") through 4 ("essential for inclusion"). Item-level Content Validity Index (I-CVI, the proportion of respondents rating a topic/skill as 3 or 4) was used for stratification. A first-round I-CVI threshold of 80% and 70% for subsequent rounds was used to define consensus for inclusion. Excluded topics/skills were considered for re-inclusion in subsequent rounds; 50% agreement was set as threshold for re-inclusion. The first round also sought consensus regarding aims, objectives, and delivery methodology.

RESULTS

A total of 147 topics/skills across 12 domains were identified for initial survey inclusion. Fifty-one respondents from 12 countries completed round one. Ninety-six (65.3%) topics/skills met consensus threshold. One additional skill ("pain assessment") was incorporated into round two following suggestions from respondents. The clerkship outcome ranked as most important and achievable was to 'inspire students to undertake anaesthesia specialty training' (n = 25, 49.0% and n = 26, 51.0% respectively). Thirty-six respondents from 12 countries completed round two. Eighty (82.5%) topics/skills met consensus threshold. Seventeen Rwandan specialists completed round three. Seventy-eight (97.5%) topics/skills met consensus threshold. From 67 previously excluded topics/skills, 14 (20.9%) met re-inclusion threshold.

DISCUSSION AND CONCLUSION

A modified Delphi process identified 92 essential topics/skills for inclusion in a Rwandan undergraduate ACC clerkship. Experts prioritised 'inspiring students' over 'achieving clinical competence' for undergraduates. A similar Delphi approach may be useful for educational content development in other settings across the African continent and for other specialties.

TRIAL REGISTRATION

Not applicable (study described is not a clinical trial). UGHE IRB protocol number: 194.

Determining the Prioritization of Behavior Change Techniques for Long-Term Stroke Rehabilitation: Delphi Survey Study

Background

Stroke results in both physical disability and psychological distress. The impact can be minimized through rehabilitation, but it is a long-term process, making it difficult for patients to adhere to treatment. Thus, a better understanding of long-term behavior change interventions for patients with stroke is needed as well as how such interventions can support not only rehabilitation of motoric functions but also mental well-being.

Objective

The aim of this study is to understand both the most important behavior change technique (BCT) clusters for long-term stroke rehabilitation in general as well as which are most relevant for each aspect of stroke rehabilitation: behavioral, cognitive, and emotional.

Methods

We applied the 16 BCT clusters. The study used a 2-round Delphi survey, as reliable consensus was obtained among a group of 12 international experts. Experts represented three main backgrounds involved in behavioral intervention in the health context: (1) specialists in behavioral science (n=4), (2) behavioral designers (n=4), and (3) expert health care professionals (n=4). Experts were brought together in this way for the first time. In the first round, web-based questionnaires were used to collect data from the experts. This was followed by a personalized second round. Consensus was determined by statistically aggregating the responses and evaluating IQR and percentage consensus. BCT clusters reaching consensus (IQR ≤1 and percentage ≥50%) were then ranked.

Results

In total, 12 of 16 BCT clusters reached consensus for general importance in stroke rehabilitation, with 11, 9, and 6 BCT clusters achieving consensus for, respectively, the behavioral, cognitive, and emotional aspects of rehabilitation. The overall most relevant BCT clusters were repetition and substitution, social support, feedback and monitoring, and self-belief, with similar outcomes for behavioral and cognitive rehabilitation. For emotional rehabilitation, social support and identity were emphasized. The least relevant BCT clusters were natural consequences, covert learning, and comparison of behavior.

Conclusions

This expert panel study using a 2-round Delphi survey ranked the importance of BCT clusters for long-term stroke rehabilitation. The process yielded a number of novel insights highlighting differences in importance between general rehabilitation and that specifically focused on the behavioral, cognitive, and emotional aspects of stroke recovery. This provides a first but important step toward unlocking the prioritization of BCT clusters for long-term intervention contexts such as stroke rehabilitation and enables effective intervention mapping addressing long-term behavior change and treatment adherence.

Expert Consensus on Vitamin B6 Therapeutic Use for Patients: Guidance on Safe Dosage, Duration and Clinical Management

Purpose

Vitamin B6 is a crucial water-soluble vitamin found in many foods and is involved in numerous physiological processes, including neurotransmitter synthesis and nervous system function. Although essential for overall health, both deficiency and excessive intake of vitamin B6 may lead to health complications, particularly peripheral neuropathy. This consensus statement aims to provide healthcare professionals with clear guidance on the safe and effective use of vitamin B6, focusing on its benefits, risks, recommended dosages, and treatment course.

Methods

This consensus statement was developed using a Delphi approach involving a panel of six experts from various medical specialties. This process includes a comprehensive literature review, two rounds of anonymous online surveys, and a virtual expert roundtable discussion. The GRADE approach was used to assess the quality of evidence for each recommendation.

Results

The expert panel reached consensus on five key statements. These key recommendations encompass the function of vitamin B6, complications due to vitamin B6 deficiency, dosage recommendations, adverse events, and monitoring guidance throughout the course of treatment. A washout period of 20-40 days for the complete clearance of vitamin B6 was calculated based on pharmacokinetic parameters. A clinical pathway for managing patients who might benefit from vitamin B6 treatment was proposed.

Conclusion

This consensus statement highlights the importance of recognizing the benefits and potential risks of vitamin B6. While the therapeutic dosage of vitamin B6 can be beneficial to treat deficiency, excessive intake can lead to adverse effects. This statement emphasizes the need for individualized patient care considering factors such as medical history, lifestyle, and potential drug interactions. Further research is needed to establish clearer dosage guidelines, understand the mechanisms of vitamin B6-induced neurological side effects, and optimize patient outcomes.

Developing Meaningful Score Differences for the Bayley-4 and Vineland-3 in Angelman Syndrome using a Delphi Panel

Objectives

To develop within-patient meaningful score differences (MSDs) on the Bayley Scales of Infant Development, Fourth Edition (Bayley-4), and the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), for individuals with Angelman syndrome (AS).

Methods

A Delphi method, involving a panel of 19 caregivers of individuals with AS, was used to establish MSDs for Bayley-4 and Vineland-3 Growth Scale Values. MSD was defined as the smallest change that would noticeably impact the daily functioning of an individual with AS or family quality of life in a way that was important to the individual with AS or their family. For each subscale of the Bayley-4 and Vineland-3, the panel was presented with 2 to 4 vignettes describing varying levels of baseline functioning and asked to select a MSD from a range of potential values. An iterative process involving three rounds of ratings and two rounds of discussion was used to build consensus. The median caregiver rating from round 3 was retained as the final recommended MSD value for each vignette.

Results

Final MSD ratings for the five subscales of Bayley-4 and 10 subscales of the Vineland-3 had an agreement rate of 70% or higher. MSD thresholds for each subscale were not single cut-offs, but rather reflected a range of MSD values dependent on level of baseline functioning.

Conclusions

The Delphi Panel method incorporates the caregiver perspective to provide preliminary estimates of what constitutes meaningful within person change on the Bayley-4 and Vineland-3 in individuals with AS with various levels of baseline functioning.

Highlights

⍰ To acquire regulatory approval in drug development, sponsors must demonstrate both statistical significance and clinical meaningfulness of a treatment effect.While several clinical trials are underway in AS, within person meaningful score difference thresholds are not yet established for the most commonly used outcome measures, namely the Bayley and Vineland.⍰ Aligning with FDA guidance, we have developed an innovative qualitative approach using a Delphi panel to incorporate caregiver perspectives in defining meaningful change and generated preliminary patient-informed meaningful score differences (MSDs) for individuals with Angelman Syndrome.⍰ What caregivers of individuals with AS consider to be a MSD on the measures depends primarily on the baseline severity of their child's presentation.

Classification of ocular surface diseases: Deep learning for distinguishing ocular surface squamous neoplasia from pterygium

PURPOSE

Given the significance and potential risks associated with Ocular Surface Squamous Neoplasia (OSSN) and the importance of its differentiation from other conditions, we aimed to develop a Deep Learning (DL) model differentiating OSSN from pterygium (PTG) using slit photographs.

METHODS

A dataset comprising slit photographs of 162 patients including 77 images of OSSN and 85 images of PTG was assembled. After manual segmentation of the images, a Python-based transfer learning approach utilizing the EfficientNet B7 network was employed for automated image segmentation. GoogleNet, a pre-trained neural network was used to categorize the images into OSSN or PTG. To evaluate the performance of our DL model, K-Fold 10 Cross Validation was implemented, and various performance metrics were measured.

RESULTS

There was a statistically significant difference in mean age between the OSSN (63.23 ± 13.74 years) and PTG groups (47.18 ± 11.53) (P-value =.000). Furthermore, 84.41% of patients in the OSSN group and 80.00% of the patients in the PTG group were male. Our classification model, trained on automatically segmented images, demonstrated reliable performance measures in distinguishing OSSN from PTG, with an Area Under Curve (AUC) of 98%, sensitivity, F1 score, and accuracy of 94%, and a Matthews Correlation Coefficient (MCC) of 88%.

CONCLUSIONS

This study presents a novel DL model that effectively segments and classifies OSSN from PTG images with a relatively high accuracy. In addition to its clinical use, this model can be potentially used as a telemedicine application.

Biosimilars versus biological therapy in inflammatory bowel disease: challenges and targeting strategies using drug delivery systems

Inflammatory bowel disease (IBD) is a multifactorial illness with a climbing prevalence worldwide. While biologics are commonly prescribed especially for severe cases, they may worsen patients' outcomes due to financial burden. Consequently, there has been an increased focus on biosimilars to improve overall disease outcomes by maintaining similar efficacy and safety while minimizing the cost of therapy. Infliximab-dyyb was the first biosimilar approved by US-FDA for IBD. Since that, the US-FDA approved 14 biosimilars with different mechanisms of action and different routes of administration for IBD patients (four infliximab biosimilars, nine adalimumab biosimilars, and most recently one ustekinumab biosimilar). It should be noted that more biologics are in the pipeline as golimumab and natalizumab patents are set to expire in the near future, and biosimilars are now in pre-clinical to phase 3 trials. Different studies have evaluated biologics' effectiveness and safety and concluded that the majority of available biosimilars are efficacious and have similar adverse effect profiles compared to their reference biologics. It is worth mentioningthat post-marketing surveillance reports revealed some risks associated with biosimilars which should be taken into consideration in future research and clinical trials to avoid health hazards. Most biologics and biosimilars are administered parenterally which results in several drawbacks such as raised risk of infections, hypersensitivity, autoimmunity, development of malignancies, liver toxicity as well as worsening of heart failure. Several drug delivery systems based on passive and active targeting mechanisms are under active investigation to overcome these limitations. This review sheds light on the emergence of biologics and biosimilars as alternatives in IBD management, the differences between them, challenges and risks, and future perspectives in IBD therapy and new trends in drug delivery systems.

Identification of Crohn's Disease-Related Biomarkers and Pan-Cancer Analysis Based on Machine Learning

Background: In recent years, the incidence of Crohn's disease (CD) has shown a significant global increase, with numerous studies demonstrating its correlation with various cancers. This study aims to identify novel biomarkers for diagnosing CD and explore their potential applications in pan-cancer analysis. Methods: Gene expression profiles were retrieved from the Gene Expression Omnibus (GEO) database, and differentially expressed genes (DEGs) were identified using the "limma" R package. Key biomarkers were selected through an integrative machine learning pipeline combining LASSO regression, neural network modeling, and Support Vector Machine-Recursive Feature Elimination (SVM-RFE). Six hub genes were identified and further validated using the independent dataset GSE169568. To assess the broader relevance of these biomarkers, a standardized pan-cancer dataset from the UCSC database was analyzed to evaluate their associations with 33 cancer types. Results: Among the identified biomarkers, S100 calcium binding protein P (S100P) and S100 calcium binding protein A8 (S100A8) emerged as key candidates for CD diagnosis, with strong validation in the independent dataset. Notably, S100P displayed significant associations with immune cell infiltration and patient survival outcomes in both liver and lung cancers. These findings suggest that chronic inflammation and immune imbalances in CD may not only contribute to disease progression but also elevate cancer risk. As an inflammation-associated biomarker, S100P holds particular promise for both CD diagnosis and potential cancer risk stratification, especially in liver and lung cancers. Conclusion: Our study highlights S100P and S100A8 as potential diagnostic biomarkers for CD. Moreover, the pan-cancer analysis underscores the broader clinical relevance of S100P, offering new insights into its role in immune modulation and cancer prognosis. These findings provide a valuable foundation for future research into the shared molecular pathways linking chronic inflammatory diseases and cancer development.

Prioritizing gaps in stroke care: A two-round Delphi process

BACKGROUND

Despite international recognition of stroke as a significant health priority, discrepancies persist between the target values for stroke quality measures and the actual values that are achieved in clinical practice, referred to as gaps. This study aimed to reach consensus among international experts on prioritizing gaps in stroke care.

METHODS

A two-round Delphi process was conducted, surveying an international expert panel in the field of stroke care and cerebrovascular medicine, including patient representatives, healthcare professionals, researchers, policymakers, and medical directors. Experts scored the importance and required effort to close 13 gaps throughout the stroke care continuum and proposed potential solutions. Data were analyzed using descriptive statistics and qualitative analysis methods.

RESULTS

In the first and second Delphi rounds, 35 and 30 experts participated, respectively. Expert consensus was reached on the high importance of closing 11 out of 13 gaps. Two out of 13 gaps were considered moderately important to close, with expert consensus for one of these two gaps. Expert consensus indicated that only one gap, related to the prevention of complications after stroke, requires moderate effort to close, whereas the others were considered to require high effort to close. Key focus areas for potential solutions included: "Care infrastructure," "Geographic disparities," "Interdisciplinary collaboration," and "Advocacy and funding."

CONCLUSIONS

While closing gaps in stroke care primarily requires high effort and substantial resources, targeted interventions in the identified key focus areas may provide feasible and clinically meaningful improvements.

Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement

Background

The objective was to summarize the methodology used to develop the international minimum data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement. This is a recommended list of elements to be collected and reported when conducting injury surveillance research in military settings.

Methods

A Delphi methodology was employed to reach consensus. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge gaps, and 3) establish future research priorities. A sequential three-round Delphi consensus survey followed, including relevant stakeholders from militaries around the world, using results to conduct an asynchronous knowledge user meeting (mixture of in-person and live video conference and recording) to explore the level of agreement among subject matter experts. Knowledge users, including former and current military service members, civilian practitioners working in military health networks, and international subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored questions on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5).

Results

Literature review and surveys helped inform the scope of potential variables. Three rounds were necessary to reach minimum consensus. Ninety-five, 65, and 42 respondents participated in the first, second and third rounds, respectively.

Conclusions

Achieving consensus across relevant knowledge users representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature.

The road to successful implementation of innovation in radiotherapy: A research-based implementation protocol

BACKGROUND AND PURPOSE

Radiotherapy (RT) is rapidly advancing, yet only 50 % of innovations are implemented promptly. Despite the availability of Implementation Science (ImpSci) theories, models, and frameworks (TMFs), a theory-practice gap persists in effectively applying these insights in RT clinical practice. This study aims to develop a consensus-based implementation protocol for RT innovations using validated ImpSci knowledge.

MATERIAL AND METHODS

A literature review of TMFs (May-August 2023) and 20 semi-structured interviews with Dutch RT professionals (August-December 2023) identified key RT components for implementation. These insights informed a draft RT implementation protocol, which was refined through a three-round international Delphi study (March-September 2024) involving 11 RT and 5 ImpSci experts. Consensus was determined using a 5-point Likert scale, analysing medians, interquartile ranges (IQRs), and percentage scoring.

RESULTS

The Knowledge-to-Action (KTA) Framework and input from expert interviews were used to draft the protocol. Delphi response rates were 100 %, 93.8 %, and 88.9 % across rounds. In round 1, 88.9 % of elements achieved consensus (median = 4.0, IQR = 0.0-1.3); only the application of a prediction model for timely implementation (step 3c) needed revision after rounds 1 and 2. In round 3, also for step 3c consensus was reached (median = 4.0, IQR = 0.3). The protocol includes defining innovation types, stakeholder analysis, tailored implementation strategies, and a phased evaluation plan to ensure sustainability.

CONCLUSION

This is the first consensus-based RT innovation implementation protocol, addressing the theory-practice gap with a structured clinical approach. Future research should validate the protocol and assess the impact of preparation on implementation success.

Development and validation of the social frailty scale for the older adult in China

Objectives

Existing social frailty instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide social frailty. To develop a Chinese version of a Social Frailty Scale (CVSFS) for the older adult and to examine the psychometric properties of this instrument.

Method

Based on the recommendations of the COSMIN guidelines, the scale development inclued three phases: development of the initial scale, optimisation of scale items, and validation test for scale. The initial CVSFS 1.0 version was developed through literature review, semi-structured interviews, research team discussion, and Delphi method. Then, cross-sectional survey was conducted (n = 265) and scale items were optimized based on the survey results using item analysis and exploratory factor analysis (EFA) to form CVSFS 2.0 version. Lastly, the cross-sectional survey (n = 287) was repeated using CVSFS 2.0 version, and the reliability and validity of the scale's measurement properties were tested.

Results

The initial scale stage of development formed a 42-item CVSFS 1.0 version. After item analysis and EFA, six items were excluded to form a four-dimension with 36-item CVSFS 2.0 version including individual level, family level, interpersonal level, community and social level. The CVSFS 2.0 version demonstrated good reliability and validity, with a Cronbach's α coefficient of 0.926 and a McDonald's ω estimate of 0.931, split-half reliability of 0.928, and test-retest reliability of 0.978. The I-CVI of the scale was calculated to be 0.889~1.000, and the S-CVI/Ave was 0.930. Confirmatory factor analysis results indicated satisfactory fit indices: χ2/df = 2.17, GFI = 0.813, TLI = 0.932, CFI = 0.937, RMSEA = 0.064.

Conclusions

The CVSFS 2.0 version developed in this study based on a social-ecological framework has high reliability and validity, making it a suitable instrument for evaluating social frailty among the older adult in China.

Prevention strategies against academic burnout: the perspective of Romanian health sciences students in the aftermath of the COVID-19 pandemic

Background

Burnout in academia can have important long-term consequences. This study aimed to investigate academic burnout and the perception of its prevention strategies among Romanian health sciences students.

Methods

Three hundred and five health sciences students (from General Medicine, Dental Medicine, Pharmacy, and Midwifery and Nursing) (36 men, 269 women, mean age 21.9, standard deviation 1.911) self-rated their burnout using the Burnout Assessment Tool (BAT) and a visual analog scale, and answered a survey with open and closed questions about the most effective coping strategies to prevent burnout.

Results

Above average scores (mean = 3.05; SD = 0.67) on burnout were met (with the highest scores on exhaustion and psychological distress and the lowest on mental distance and psychosomatic symptoms). Women were more affected than men by burnout and associated emotional impairment and secondary symptoms. Participants rated supportive relationships as the most effective in preventing burnout (mean = 3.75; SD = 0.55), followed by relaxation-meditation (mean = 3.32; SD = 0.85), while they also positively valued cognitive-behavioral therapy (those with high burnout scores), and physical activity (those with low burnout scores). Organizational strategies have included re-evaluating the university curriculum (mean = 3.83; SD = 0.48) and increasing access to psychological support programs (mean = 3.72; SD = 0.58) and to programs that increase self-efficacy and resilience (mean = 3.65; SD = 0.61). The qualitative analysis showed that freely chosen individual strategies included, in descending order, detachment, active actions, healthy lifestyle, and specialist help, while the most preferred organizational were better academic organization and program optimization.

Conclusion

These results may be useful in designing more sustainable and effective burnout prevention strategies in health sciences academic settings.

Adaptation and modification of the professional identity formation scale for postgraduate trainees in basic health science: a mixed method study

BACKGROUND

The professional identity formation (PIF) of postgraduate trainees in basic health sciences is critical to their educational journey. Yet, appropriate measurement tools are lacking. This research aimed to adapt and modify an existing PIF scale to assess the professional identities of postgraduate basic health sciences trainees.

METHODS

A mixed-method study was conducted to validate a modified PIF scale. An instrument was developed following AMEE Guide 87 (A. R. Artino et al.) (1). Seven medical educationalists and basic health science postgraduate supervisors established its content validity and reliability. Cognitive interviews were conducted with 15 participants, and the tool was validated through the Delphi technique. Piloting was undertaken on a simple random sample of 500 postgraduate trainees. Psychometric analyses, including structure factor analysis, internal consistency testing, and qualitative content analysis, were used to evaluate the modified scale.

RESULTS

Five factors related to professional identity formation were identified: "Commitment to Professional Identity, belonging and Values," "Pursuit of Knowledge and Excellence," "Professional Growth and Collaboration," Personal Growth and Reflection," and "Confidence and impact." The modified PIF scale demonstrated robust psychometric properties, including a well-defined factor structure, significant reliability, and high internal consistency. With a Cronbach alpha 0.97, the PIF scale's five kept variables accounted for 99.99% of the variance.

CONCLUSIONS

The study found the modified PIF scale to be a reliable tool for assessing the professional identities of postgraduate trainees in basic health sciences. It developed a 50-item tool with five valid factors to evaluate professional identity for postgraduate trainees.

Mapping Binding Domains of Viral and Allergenic Proteins with Dual-Cleavable Cross-Linking Technology

The dual-cleavable nature of the cross-linking technology (DUCCT) enhances the reliable identification of cross-linked peptides via mass spectrometry. The DUCCT approach uses a cross-linking agent that can be selectively cleaved by two different tandem mass spectrometry techniques: collision-induced dissociation (CID) and electron transfer dissociation (ETD). This results in distinct signatures in two independent mass spectra for the same cross-linked precursor, leading to unambiguous identification and the validation of the spectra. In this study, we expanded the application of the DUCCT cross-linker to evaluate the binding domains of a specific cat dander allergen, Fel d 1, which exists as the Fel d 1 A and B protein complex, and a viral spike protein from SARS-CoV-2, which invades host cells. To assess the cross-linked products obtained by DUCCT, we utilized a software tool called Cleave-XL, which effectively identified cross-linked sites using data from CID and ETD. Dual cleavable cross-linking studies identified cross-linked peptides in these complexes, which have been reported in bioinformatics analysis and proposed for immunotherapy using synthetic peptides. A benchmark study was also conducted using a commercial cross-linker disuccinimidyl suberate (DSS). Overall, we expect that DUCCT cross-linking technology will greatly facilitate the rapid screening of binding interfaces, thereby advancing structural biology and cell signaling investigations.