Recommendations Of Committee Research Articles

Outcome prediction, quality of life, and life expectancy in metastatic spine tumors: WFNS spine committee recommendation.

This review aimed to formulate the most current, evidence-based recommendations for the prediction of outcome, life expectancy, and quality of life in patients with metastatic vertebral tumors. A systematic literature search on PubMed and Google Scholar from 2012-2022 was done, using the keywords "metastatic vertebral tumors + outcome prediction + prognoses," "quality of life + spine metastases," and "spine metastases + life expectancy." Our PubMed search yielded 402 articles for outcome prediction, whereas 40 articles were identified for life expectancy in spine metastases. These were carefully screened by the co-authors, resulting in 61 and 11 final articles analyzed for this study. Our PubMed search for quality of life yielded 137 articles, of which 63 were carefully analyzed for this study. This up-to-date information was reviewed at two separate Spine Committee meetings of the World Federation of Neurosurgical Societies (WFNS). Two rounds of the Delphi method were used to vote and arrive at a positive or negative consensus. The WFNS Spine Committee finalized seven recommendation guidelines on the prediction of outcome, life expectancy, and quality of life in metastatic vertebral tumors. Irrespective of the primary tumor, surgical decompression in appropriately selected patients potentially improves the quality of life. Pre-operative ambulatory status, overall performance, and age are independent predictors of outcome and overall survival. Prognostic scoring systems have evolved to principle-based algorithms, amongst which NOMS is the most widely used.The best tools to measure the quality of life are EUQOL5-D and SOSGOQ in patients with metastatic spine disease.

Cranio-Vertebral Junction Anomalies: WFNS Spine Committee Recommendations Overview.

The published literature on Cranio-vertebral Junction (CVJ) anomalies lacks a comprehensive appraisal that integrates common diagnostic, management and treatment concepts for different conditions, such as Chiari Malformation (CM), Basilar Invagination (BI), Os Odontoideum (OO) and Syndromic Malformations. The authors aimed to fill this knowledge gap offering guidelines and recommendations with a global outreach and applicability. A group of expert spine surgeons and WFNS Spine Committee members, most of which extensively published on CVJ anomalies in the past, reviewed the literature issued from 2011 to 2022. Following a common methodology, based on the Delphi method, the authors analyzed the strength of the literature and voted statements concerning diagnosis and management of these conditions. A total of eight papers were produced: (1) Chiari Malformation diagnosis, classifications, natural history, and conservative management, (2) Chiari malformation: indications for surgery and surgical options, (3) Pediatric Chiari malformation, (4) Syndromic atlanto-axial instability, (5) Os odontoideum, (6) Basilar invagination: diagnosis, radiology, and classification, (7) Surgical treatment of Basilar Invagination, and (8) Basilar invagination with associated Chiari malformation. Despite grey zones on natural history of CVJ anomalies and controversies on timing and type of surgical treatments, whenever atlantoaxial instability is present, C1-C2 stabilization through instrumentation and fusion is necessary. If only recurrent pain and neurological dysfunction occurs, surgical decompression is appropriate. If no atlantoaxial instability is present, Down's patients can participate in competitive sports. In general, contact sports are not recommended.

Surgical Treatment of Basilar Invagination: WFNS Spine Committee Recommendations.

A systematic literature review and consensus using Delphi method. This review aims to outline the therapeutic criteria and clarify the best surgical options for the different types of basilar invagination (BI). BI is a complex developmental malformation for which many surgical remedies have been proposed without clear consensus. Using PubMed, the authors reviewed the literature on the surgical treatment of BI published from 2011 to 2022 looking at different surgical options. A panel of spine surgeons and members of the WFNS Spine Committee used the Delphi technique to assess the strength of literature, elaborate, and vote on statements regarding the surgical management of BI. Thirteen recommendations were issued covering the most relevant topics related to the surgical treatment of BI. Posterior fossa decompression alone is an option to treat BI without instability. Most cases of BI and AAI can be treated by C1-C2 fixation. In selected cases, distraction of the atlantoaxial joint may be required. Current evidence is lacking which technique is better to correct irreducible BI. OCF can be used in case of atlas assimilation, dysgenesis of C1 lateral mass, in irreducible cases, odontoidectomy and revision of failed C1-C2 fixation. Complications of the OCF may reach up to 50%. The role for anterior fusion for treatment of BI need to be better assessed by further studies. In the setting of irreducible anterior compression caused by BI, the anterior odontoidectomy can be indicated supplemented by C1-C2/occipital-cervical fusion. There are multiple surgical options for basilar invagination depending on the existence of compression, AAD or irreducibility. The WFNS spine committee proposed consensus recommendations based on relevant literature published after 2011 to help surgeons standardize the level of care and improve outcomes following treatment across the globe.

Provision of Evidence-Informed Psychological Interventions Following the Queensland (Australia) 2010-11 Floods and Cyclones; the Barriers and Successes.

The study assessed the impact on clinicians' 'perception of skills' in postdisaster evidence-informed care (EIC) following participation in an online training programme implemented following the Queensland floods and cyclones of 2010-11, clinician confidence to provide EIC, the frequency clinicians used EIC and barriers to providing postdisaster specialist mental health care. Clinician perception of pre and posttraining skills, confidence in providing therapies such as trauma-focused cognitive behaviour therapy (TF-CBT), frequency of therapies provided and clinician perception of barriers to the programme were assessed quantitatively and qualitatively. Clinical staff (n = 60) employed by the 2010-11 postdisaster mental health programme participated in an online survey conducted over the last 12 weeks of 2012. After the programme concluded an independent audit of the clinical record of mental health clients treated by clinicians employed in the specialist mental health programme was undertaken. Perception of clinical skills in various EIC modalities was completed pre and posttraining. Confidence to provide a treatment was rated on a five-point scale. The clinical record audit identified the treatments provided to clients. Barriers to programme delivery were rated on a five-point scale, with qualitative feedback highlighting programme concerns. Posttraining clinicians perceived skills in TF-CBT (p < 0.0001), cognitive behaviour therapy (CBT) (p < 0.001) and exposure therapy (p < 0.001) had improved. Following training, clinicians described themselves as moderately to extremely confident in implementing TF-CBT (87%), exposure therapy (80%) and skills for psychological recovery (SPR) (88%). Clinical records analysis indicates that 25% of cases received no TF-CBT, while 43% received one to five sessions. Barriers to care included a lack of cross-service relationships. Recommendations focused on training and early commencement of intervention programmes. The study echoes the findings of the 2020 Australian Bushfire Royal Commission recommendations that highlighted a need for clinician training in postdisaster EIC and the availability of clinicians with specialised postdisaster mental health skills.

Diagnosis, Classifications and Treatment of Os Odontoideum: WFNS Spine Committee Recommendations.

A systematic literature review and consensus using Delphi method. The aim was to formulate consensus recommendations regarding the natural history, diagnosis, classification and optimal treatment of Os Odontoideum with global applicability. Os odontoideum (OO) is a rare anomaly of the cranio-vertebral junction (CVJ). Due to the paucity of literature, there is still considerable debate about the clinical management of OO. Using PubMed, the authors reviewed the literature on OO published from 2011 to 2022. Using the Delphi method, a panel expert spine surgeons and members of the WFNS Spine Committee analyzed the strength of the published literature, elaborated and voted statements concerning diagnosis and management. The diagnosis may be established incidentally. Symptoms may manifest as neck discomfort or encompass occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Diagnosis is usually made with plain radiographs and CT can. Dynamic x-rays identify C1-C2 instability whereas MRI assess spinal cord integrity and compression. Asymptomatic cases lacking radiologic instability are generally handled through regular observation and serial imaging, until predictors of neurological deterioration necessitate surgical intervention. In the event of atlantoaxial instability or neurological dysfunction, surgical intervention with instrumentation and fusion is required to maintain stability. In irreducible cases, C1-2 joint manipulation and distraction permits re-alignment and deformity correction avoiding decompression, either from anterior or posterior. The management guidelines for asymptomatic OO are still a grey zone as our understanding of the natural history is still vague. Therefore, we need more large-center studies to investigate this condition further. Whenever symptomatic, unstable or asymptomatic presenting with risk factors, OO is better managed with atlanto-axial fusion avoiding occipital inclusion in the construct. In irreducible OO, C1-2 joint manipulation and distraction is preferred to decompression.

International myeloma working group immunotherapy committee recommendation on sequencing immunotherapy for treatment of multiple myeloma.

T-cell redirecting therapy (TCRT), specifically chimeric antigen receptor T-cell therapy (CAR T-cells) and bispecific T-cell engagers (TCEs) represent a remarkable advance in the treatment of multiple myeloma (MM). There are several products available around the world and several more in development targeting primarily B-cell maturation antigen (BCMA) and G protein-coupled receptor class C group 5 member D (GRPC5D). The relatively rapid availability of multiple immunotherapies brings the necessity to understand how a certain agent may affect the safety and efficacy of a subsequent immunotherapy so MM physicians and patients can aim at optimal sequential use of these therapies. The International Myeloma Working Group conveyed panel of experts to review patient and disease-related factors affecting efficacy and safety of immunotherapy, summarize existing information on sequencing therapy and provide a series of core recommendations.

Open-source delay discounting assessment software: Development and usability.

Delay discounting (DD) describes the tendency of individuals to devalue the worth of a reward as a function of the delay in receiving it. DD is impaired in many clinical conditions and changes across development. Many existing automated DD tasks are built on copyrighted software and primarily designed for English speakers, which hinders content editing and accessibility. Given this scenario, we had three objectives: (1) to develop open-source DD software named the "Waiting Game" with a user interface (UI) that is easily editable (regarding language, reward type/magnitude and delay duration) via an Excel spreadsheet, and provides automated DD scoring; (2) to create a comprehensive manual (User Guide) to accompany the software; and (3) to assess the software's usability and the clarity of the manual through an online questionnaire completed by experts in cognitive assessment. The software was developed using game design and encompasses three tasks that assess DD under three conditions: (1) hypothetical delays (waiting is imagined) and no real rewards (only points) are gained); (2) real delays (waiting is necessary) and real rewards gained; and (3) real delays and hypothetical rewards. An expert evaluation using the System Usability Scale and the International Test Commission recommendations confirmed the software's suitability. Minor changes were made to the User Guide and UI based on the expert feedback. We conclude that the Waiting Game offers a valid, cost-free, and automated solution for DD assessment that facilitates reward and delay manipulations in hypothetical/real delay and reward paradigms across diverse sociocultural contexts.

Research Prospects for Necroptosis in Inflammatory Diseases: A Bibliometric Analysis.

Necroptosis is a modifiable form of cell death mainly dependent on RIPK3 and MLKL. The association between necroptosis and inflammation has been a key focus of research. An increasing number of studies have shown that necroptosis plays an important role in inflammatory diseases, such as inflammatory bowel disease. Articles published up to 2023 were searched on the Web of Science. VOSviewer, CiteSpace, Gephi, and Microsoft Office Excel were used for bibliometric analysis and visualisation. In addition, journal impact factors and journal partitions were obtained through the Web of Science. A total of 3011 articles were included in this study. The number of publications and citations in the field increased year by year. China had the highest number of publications. Cell Death & Disease published the most papers in the field. P. Vandenabeele is one of the most important scholars in this field. The most cited reference was "Molecular Mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death".We found substantial evidence that acute kidney injury, sepsis, cancer, and other diseases are closely related to necroptosis. In addition, we found that inhibitors of necroptosis have great potential in the treatment of inflammatory diseases. This is the first bibliometric analysis of studies related to necroptosis in inflammatory diseases. Our results provide an overview of basic and influential research, providing a basis for the identification of valuable research directions. Furthermore, this work offers general insight into the role of necroptosis in inflammatory human diseases.

A decade of AGO QS-Mamma – Adherence to the Recommendations of The AGO Breast Committee for Diagnosis and Treatment in EBC in Routine Therapy in Germany

Introduction: The cure for Early Breast Cancer (EBC) is increasing over the last decades due to the improvement of diagnosis and therapy. Individualization of cancer treatment in EBC requires constant optimization by implementing current guidelines. The AGO (working group gynecologic oncology) QS-Mamma initiative, a quality assurance program (QS) of the AGO Breast Committee, was introduced to provide insight in guideline adherence in real world practice in Germany. We evaluated 10 years of QS-Mamma data to identify gaps and trends implementing those guidelines. Methods: QS-Mamma is a retrospective sample survey providing a representative overview of the treatment landscape for the treatment of breast cancer in Germany. The last six cohorts were analyzed over a period of ten years. Across all cohorts, an average of 264 centers documented a total of n=4,577 patients with EBC. Results: Testing for BRCA mutations in triple-negative patients increased significantly. Breast conserving surgery has been standard of care since the start of data collection; choice of surgical procedure depends primarily on tumor size and nodal status according to the patient´s preference, if possible. Axillary intervention has shifted towards SLNE or targeted axillary procedures in patients with negative preoperative nodal staging. Neoadjuvant systemic therapy (NAST) in operable EBC is established. Anthracycline administration in the adjuvant setting decreases. We noted an uptake on using platinum-containing CTx in TNBC, corresponding to AGO recommendations. Dual HER2 blockade is established in HER2 positive EBC with increased risk of relapse. Changes in guidelines are reflected in real-world data. Conclusion: Guideline adherence in breast cancer care is high and new treatments and diagnostic options are implemented promptly. Finally, escalation and de-escalation of treatment is depending on individual tumor characteristics resulting in the individual risk of recurrence. Guidelines should be flanked by real-world evidence to ensure and survey their impact.

A New Way Forward for Women's Health Research at the National Institutes of Health: A Roadmap From the National Academies of Sciences, Engineering, and Medicine's Consensus Report.

Despite efforts to address inequities, research on women's health conditions (defined as those that uniquely or differently affect women and female individuals) remain significantly understudied. As directed by Congress, the National Institutes of Health (NIH) Office of Research on Women's Health requested the National Academies of Sciences, Engineering, and Medicine (National Academies) to conduct an assessment of the state of women's health research at the NIH. The findings of the National Academies committee include: 1) a significant funding inequity, with less than 8% of the total NIH grant budget for fiscal year 2023 allocated to women's health research; 2) a need for improved strategic NIH-wide priority setting, oversight, and adherence to existing policies to support women's health research; 3) a need for a specific institute for research on conditions specific to women's health; and 4) a need for sufficient training and additional funding to grow and retain the women's health research workforce. The National Academies committee recommends restructuring women's health research at the NIH by creating a new Women's Health Research Institute and cross-disciplinary Women's Health Research Fund, including greater accountability and an infusion of new funds to support both research and career development in women's health. The combination of the new institute, greater prioritization and accountability, and new funding would lead to more rapid innovations and advancements, with the ultimate goal of improving women's health and well-being, which, in turn, improves the well-being of families and communities and bolsters a vibrant, healthier society.

The potential impact of optimal blood pressure treatment intensity to reduce disparities in dementia between Black and White individuals.

Black adults have higher dementia risk than White adults. Whether tighter population-level blood pressure (BP) control reduces this disparity is unknown. Estimate the impact of optimal BP treatment intensity on racial disparities in dementia. A microsimulation study of US adults ≥18 across a life-time policy-planning horizon. BP treatment strategies were the Systolic Blood Pressure Intervention Trial (SPRINT) protocol, the Eighth Joint National Committee (JNC-8) recommendations, and usual care (non-intervention control). Outcomes were all-cause dementia, atherosclerotic cardiovascular disease (ASCVD), stroke, myocardial infarction, non-ASCVD death, global cognitive performance, and optimal brain health (being free of dementia, cognitive impairment, or stroke). Population-level and individual-level effects stratified by race were estimated. Optimal population-level implementation of a SPRINT-based BP treatment strategy, compared to usual care, would increase average annual dementia incidence in White, but not Black, adults (1% versus 0%), due to hypertensive individuals' greater survival, and reduce annual ASCVD events more in Black than White adults (13% versus 5%). Under a SPRINT-based strategy, individuals with hypertension gained more years lived without dementia, ASCVD, myocardial infarction, or stroke and more years lived in optimal brain health. A SPRINT-based strategy did not attenuate individual-level race disparities in outcomes, except stroke. Due to longer life expectancy, a SPRINT-based strategy did not substantially reduce lifetime dementia risk in either group. The JNC-8-based strategy had similar but smaller effects as the SPRINT-based strategy. Our results suggest that tighter population-level BP control would not reduce population-level disparities in dementia between US Black and White adults.

Breaking the Silence: A Community-Based Cross-Sectional Study Exploring the Attitude Towards Premenstrual Syndrome Among Adults in Perambalur District of Tamil Nadu, India.

Background Menstruation is a natural process crucial for female reproductive health. Premenstrual syndrome (PMS) is characterized by physical and emotional symptoms occurring before menstruation. Social and cultural factors significantly influence menstrual attitudes and PMS perception. Cultural norms and a lack of confidence during this phase may impede women's ability to lead innovation. This is where men can play a crucial role in driving change by actively engaging in menstrual health advocacy. By challenging restrictive practices and negative perceptions surrounding menstruation, men can contribute to better menstrual hygiene management. The objective of this study was to determine the independent predictors of attitude towards PMS among both male and female adult populations in Perambalur district, Tamil Nadu, India. Materials and methods A community-based cross-sectional study was conducted from August 2024 to October 2024. A pre-tested, structured questionnaire was utilized to assess the attitude towards PMS. The questions on attitude towards PMS were scored as per the recommendation of an expert committee. The data were entered into Microsoft Excel, numerically coded, and analyzed using IBM SPSS version 26. Descriptive statistics was used to characterize the study participants and was expressed in frequencies, percentages, and mean (±standard deviation (SD)). Independent samples t-test and one-way ANOVA were used to determine the significant difference between the mean attitude score and the independent variables. A multivariable linear regression model was used to determine the independent predictors of attitude score. A p-value <0.05 was considered statistically significant. Results The study included a total of 281 study participants. The mean (±SD) age of the study participants' age was 32.21 (±8.64) years. The mean (±SD) attitude score among the study participants was 7.12 (±2.17). The independent predictors, which had a positive impact on attitude score, were as follows: (1) age groups (18-25 years, 26-35 years, and 36-45 years), (2) male gender (B = 0.77; 95% CI 0.28-1.27), (3) school education (B = 0.74; 95% CI 0.21-1.28). The independent predictor, which had a negative impact on attitude scores, was a rural area of residence (B = -0.53; 95% CI -1.07 to -0.26). Conclusion The attitude towards PMS is multifaceted. Interventions should address the gaps through multi-pronged approaches, including education, community awareness, and policy changes, while also considering broader social and environmental factors impacting menstrual health.

The Road Ahead: ALA Publishing Committee Recommends CRediT as a Best Practice

The Road Ahead: ALA Publishing Committee Recommends CRediT as a Best Practice

Congenital Cytomegalovirus Infection: Update on Screening, Diagnosis and Treatment: Scientific Impact Paper No. 56.

Cytomegalovirus (CMV) is the most common cause of viral infection in newborn babies, and affects 1 in 200 of all live born infants in high-income countries; and 1 in 71 in low- and middle-income countries. It is a major cause of hearing loss and brain damage. Women may get CMV infection for the first time during pregnancy (primary infection) or may experience 'non-primary' infection, either by reactivation of previous CMV infection or by a new infection with a different strain of the virus. The most common source of infection to pregnant women is the saliva and urine of young children. Therefore, all pregnant women, especially those in regular contact with young children, should be informed about hygiene-based measures to reduce the risks, e.g. handwashing. The UK National Screening Committee recommends against universal antenatal or newborn screening for CMV. Testing for CMV is usually offered only to women who develop symptoms of influenza, glandular fever or hepatitis (liver inflammation) during pregnancy, or for those whom a routine ultrasound scan detects fetal anomalies that suggests possible CMV infection. The risk of harm to the fetus is greatest following primary CMV infection of the woman in early pregnancy, and appears to be very low following infection after 12 weeks of pregnancy. Babies with CMV infection at birth may have jaundice, a rash, enlarged liver or spleen, a small brain, or be small for their gestational age. Around 1 in 8 babies born with CMV infection will have clinically detectable signs at birth. The rest will not have any features detectable by clinical examination alone. Therefore, all infants with CMV infection at birth should be followed up at a minimum of up to 2 years of age or later, depending upon the disease status, to check hearing and brain development. Following primary CMV infection in the first 12 weeks of pregnancy, if the woman starts taking the antiviral medicine valaciclovir (valacyclovir) it reduces the risk of the baby becoming infected. Where CMV infection of the fetus in the womb has been confirmed (by amniocentesis, for example), regular ultrasound scans should be offered every 2-3 weeks until birth. Detailed assessment of the fetal brain is an essential part of these scans. Where maternal CMV infection occurs, but fetal infection is not confirmed, repeated ultrasound scans of the fetus should be offered every 2-3 weeks until birth. In infected fetuses, as well as ultrasound scans, an MRI scan of the brain should be offered at 28-32 weeks of gestation (and sometimes repeated 3-4 weeks later) to assess for any signs of harm to the fetal brain. All babies born to women with confirmed or suspected CMV infection should be tested for CMV with a urine or saliva sample within the first 21 days of life. In newborns with symptomatic CMV infection at birth, treatment with antiviral medicine (valganciclovir or ganciclovir) can reduce hearing loss in 5 out of 6 babies, and improve long-term brain development outcomes in some. There is no licensed vaccine for CMV.

Risks to human and animal health from the presence of bromide in food and feed.

The European Commission mandated EFSA to assess the toxicity of bromide, the existing maximum residue levels (MRLs), and possible transfer from feed into food of animal origin. The critical effects of bromide in experimental animals are on the thyroid and central nervous system. Changes in thyroid hormone homeostasis could result in neurodevelopmental toxicity, among other adverse effects. Changes in thyroid hormone concentrations and neurophysiological parameters have also been observed in experimental human studies, but the evidence was limited. Dose-response modelling of decreased blood thyroxine concentrations in rats resulted in a reference point of 40 mg/kg body weight (bw) per day. The Scientific Committee established a tolerable daily intake (TDI) of 0.4 mg/kg bw per day and an acute reference dose (ARfD) of 0.4 mg/kg bw per day to protect against adverse neurodevelopmental effects. The TDI value is supported by the results of experimental human studies with a NOAEL of 4 mg/kg bw per day and 10-fold interindividual variability. The TDI and ARfD are considered as conservative with 90% certainty. Insufficient evidence related to the toxicological effects of bromide was available for animals, with the exception of dogs. Therefore, the reference point of 40 mg/kg bw per day was extrapolated to maximum safe concentrations of bromide in complete feed for other animal species. Bromide can transfer from feed to food of animal origin, but, from the limited data, it was not possible to quantify the transfer rate. Monitoring data exceeded the current MRLs for some food commodities, generally with a low frequency. A conservative safety screening of the MRLs indicated that the TDI and ARfD are exceeded for some EU diets. Dietary exposure assessment for animals was not feasible due to insufficient data. The Scientific Committee recommends data be generated to allow robust dietary exposure assessments in the future, and data that support the risk assessment.

Radiation therapy, radiosurgery, chemotherapy and targeted therapies for metastatic spine tumors: WFNS Spine committee recommendations

Radiation therapy, radiosurgery, chemotherapy and targeted therapies for metastatic spine tumors: WFNS Spine committee recommendations

ENTERAL NUTRITION OF PRETERM INFANTS (2022): A POSITION PAPER FROM THE EUROPEAN SOCIETY FOR PAEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION AND INVITED EXPERTS

A professional translation into Ukrainian of the updated ESPGHAN Nutrition Committee consensus statements and recommendations on nutrient intake and nutritional management for preterm infants with birth weight &lt;1800 g. These recommendations can be used in clinical practice, but highlight the lack of convincing evidence in several topic areas and the need for further high quality research, especially studies that assess long-term functional outcomes. The article is accompanied by additional digital content that provides a more complete explanation of the literature and relevant physiology: introduction and overview; background on human milk; intake of water, protein, energy, fat, carbohydrate, electrolytes, minerals, trace elements, water-soluble vitamins and fat-soluble vitamins; feeding regimen, including minimum enteral feeding, rate of increase in feeding volume, management of gastric residues, gastric tube placement and bolus or continuous feeding Growth; breast milk, oral colostrum, donor breast milk and risk of cytomegalovirus infection; hydrolysed protein and osmolality; supplemental bionutrients and use of breast milk fortification.

Аварія на Ленінградській АЕС (1975) у контексті передумов Чорнобиля

The purpose of the study is to reconstruct and analyze a set of issues related to the accident at the Leningrad NPP in the context of clarifying the prerequisites of the Chernobyl disaster. Our study examines issues related to the accident at Unit 1 of the Leningrad NPP (LNPP) in 1975. This is the largest accident in the «pre-Chernobyl» period, a precursor to Chernobyl. This topic remains ignored in domestic historical scientific literature. The article by the co-authors, based on published sources, mostly memoirs, attempts to highlight a number of aspects related to the accident at the Leningrad NPP. The research methodology is based on a combination of general scientific (analysis, synthesis, generalization) and special historical (historical-genetic, historical-typological, historical-comparative) methods with the principles of historicism, systematicity, scientificity and verification. The scientific novelty of the work lies in the fact that the development of aspects related to the problems of the history of nuclear energy in the USSR is almost not studied in domestic historical science. In this regard, in particular, the study of the prehistory and prerequisites of the Chernobyl disaster is important. Conclusions. It was established that the design of the RBMK-1000 reactor and other technological systems of the power unit were far from perfect. It has been established that the design of the RBMK-1000 reactor and other technological systems of the power unit were far from perfect. It is shown that the process of improving the reactor installation took place during installation and operation, including through various experiments. The available sources to a certain extent make it possible to reconstruct the causes, prerequisites, nature and circumstances of this accident. First of all, it is found that the accident revealed serious shortcomings of the RBMK-1000 reactor. The article highlights the socio-economic and human factors of the accident. In particular, it is shown that at Soviet nuclear power plants the policy of prioritizing the plan for generating electricity over the requirements of regulatory documents for the safe operation of the reactor dominated. A similar phenomenon occurred at the Chernobyl Nuclear Power Plant (ChNPP). Based on the sources, it was possible to clarify the key role in creating the accident of a certain person, namely the senior reactor control engineer Mikhail Karrask. Our study also pays attention to covering the work of the special commission to investigate the accident. In this regard, it was particularly important to understand whether information about the nature of the accident and the commission's recommendations on improving the operation of the RBMK-1000 reactor reached the attention of the personnel of other nuclear power plants, primarily the Chernobyl NPP.

Enfortumab Vedotin (Padcev)

The pan-Canadian Oncology Drug Review Expert Review Committee (pERC) recommends that public drug programs reimburse Padcev, in combination with pembrolizumab, for treating patients with locally advanced urothelial cancer (UC) or metastatic urothelial cancer (mUC). Padcev, in combination with pembrolizumab, should only be covered to treat adult patients with unresectable locally advanced UC or mUC with no prior systemic therapy for mUC and who are in relatively good health. Eligible patients include those who have received chemotherapy before surgery (neoadjuvant) or after surgery (adjuvant) and experienced disease recurrence more than 12 months after the completion of treatment or received adjuvant immunotherapy with nivolumab and experienced disease recurrence more than 6 months after the completion of treatment. Padcev, in combination with pembrolizumab, should only be reimbursed if prescribed by a clinician who has experience treating patients with locally advanced UC or mUC and if the price of Padcev is reduced.

Clinical evaluation, diagnosis, and decision-making for metastatic spine tumors: WFNS spine committee recommendations.

Spinal metastases are a significant concern for patients with advanced cancer, leading to pain, neurological deficits, and reduced quality of life. They occur in up to 70% of cancer patients, with the vertebral column being the most common osseous site for metastatic disease1-3. An approximate 10% of patients with vertebral body metastases eventually develop spinal cord compression, which can potentially cause severe and permanent disability4-6. This article aims to summarize the consensus statements developed by the World Federation of Neurosurgical Societies (WFNS) Spine Committee on the clinical evaluation, diagnosis, and decision-making for metastatic spine tumors. A systematic literature search was conducted in PubMed and Google Scholar from 2014 to 2023 using the search terms "clinical evaluation" + "spine metastases," "spine metastases" + "diagnosis," and "spine metastases" + "decision making" + "treatment." Based on the review of this literature, six members of the WFNS Spine Committee developed five consensus statements using the Delphi method, which were voted on during two rounds of voting at two international meetings. We agree that a high index of suspicion is required for early detection and diagnosis of spinal metastasis in cancer patients and adult patients more than 60 years presenting with new onset fractures / neurological deficits. Pain is the most common symptom followed by motor deficit. Bowel and bladder dysfunction is noted in nearly half of patients with metastatic spinal cord compression. An effective treatment for spinal metastases should be able to achieve pain relief, tumor control, prevention of neurological compromise and treat instability. Separation surgery combined with SRS is an effective treatment for spinal metastases. These consensus statements provide evidence-based guidelines for clinical evaluation, diagnosis, and decision-making in patients with metastatic spine tumors.