Clinical Scope Research Articles

What Can Really Be Considered a Syndrome? An Insight Based on 16p11.2 Microduplication.

What is the definition of Syndrome? Since the beginning of studies in genetics, certain terminologies have been created and used to define groups of diseases or alterations. With the advancement of knowledge and the emergence of new technologies, the use of basic concepts is being done in a mistaken or often confusing way. Because of this, revisiting and readjusting the old terms becomes imminent. Here, we explore these concepts and their use, through a literature compilation of an already well-defined genetic alteration (16q11.2 microduplication). We bring comparisons in clinical and molecular scope of the alteration itself and its diagnostic methods, to improve the report of cases, rescuing terminologies and their applicability nowadays.

Development of [177Lu]Lu-LNC1010 for peptide receptor radionuclide therapy of nasopharyngeal carcinoma.

Somatostatin Receptor 2 (SSTR2)-targeted radiopharmaceutical [68Ga]Ga-DOTATATE has potential advantages in the diagnosis of nasopharyngeal carcinoma (NPC). This study introduces a novel long-lasting SSTR2 analogue, LNC1010, based on DOTATATE, a truncated Evans blue-binding moiety, and a polyethylene-glycol linker. We hypothesised that peptide receptor radionuclide therapy (PRRT) is more effective with [177Lu]Lu-LNC1010 than with [177Lu]Lu-DOTATATE in treating metastatic NPC. We assessed binding characteristics of LNC1010 in vitro using C666-1 NPC cells and in-vivo pharmacokinetics of [68Ga]Ga/[177Lu]Lu-LNC1010 in C666-1 NPC xenografts via PET and SPECT imaging, biodistribution studies, and PRRT, and compared them with [68Ga]Ga/[177Lu] Lu-labelled DOTATATE. Furthermore, a proof-of-concept approach for imaging and therapy was conducted in a patient with metastatic NPC. LNC1010 exhibited strong uptake and specific affinity for SSTR2 in C666-1 NPC cells. PET and SPECT imaging demonstrated higher uptake and longer tumour retention of [68Ga]Ga/[177Lu]Lu-LNC1010 than [68Ga]Ga/[177Lu]Lu-DOTATATE in C666-1 NPC xenografts, indicating its suitability for PRRT applications in NPCs. Biodistribution studies confirmed the higher uptake and prolonged retention of [177Lu]Lu-LNC1010 than [177Lu]Lu-DOTATATE. In preclinical PRRT studies, [177Lu]Lu-LNC1010 showed greater inhibition of tumour growth in C666-1 NPC xenografts than [177Lu]Lu-DOTATATE. In a subsequent pilot clinical study, PRRT with [177Lu]Lu-LNC1010 achieved favourable therapeutic and negligible side effects in a patient with metastatic NPC. [177Lu]Lu-LNC1010 demonstrated increased tumour uptake and prolonged retention in SSTR2-positive NPCs, with superior anti-tumour efficacy to that of [177Lu]Lu-DOTATATE in preclinical studies. These findings suggest that PRRT with [177Lu]Lu-LNC1010 is a promising treatment for advanced NPC, extending the clinical scope of PRRT beyond neuroendocrine tumours.

Myristic Acid Solid Lipid Nanoparticles Enhance the Oral Bioavailability and Therapeutic Efficacy of Rifaximin against MRSA Pneumonia.

Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is one of the leading causes of death and an immense financial burden on healthcare systems. Rifaximin (RFX) has good antibacterial activity against MRSA, but its clinical application is limited due to its poor oral absorption. Solid lipid nanoparticles have good biocompatibility, high drug loading, sustained release performance, and the inertia of lipids in gastric acid, which facilitates oral drug delivery. In order to improve the oral bioavailability of rifaximin and expand the clinical application of RFX for MRSA pneumonia, this study developed RFX-loaded myristic acid solid lipid nanoparticles (RFX-SLNs). This study first prepared RFX-SLNs through hot melt emulsification and ultrasonic methods and selected the optimal formula of RFX-SLNs through single-factor screening. Afterward, the particle size, zeta potential, and polydispersity index (PDI) of the RFX-SLNs were measured, the morphology of RFX-SLNs was observed by transmission electron microscopy, and the encapsulation efficiency (EE) and drug loading capacity (LC) of RFX-SLNs were detected by high-performance liquid chromatography. Then, the sustained release ability and oral bioavailability of RFX-SLNs were studied through in vitro release and pharmacokinetics. Finally, the therapeutic effect of RFX-SLNs on MRSA pneumonia infection was studied by using a mouse MRSA pneumonia infection model. The optimal formulation of RFX-SLNs was 1% RFX with water (3% PVA) and oil (myristic acid) ratio of 1:19. RFX-SLNs were spherical in shape with a smooth surface and uniform size. The EE and LC of three different batches of RFX-SLNs were 89.35±2.47%, 90.45±3.69%, 88.72±1.18%, and 9.50 ± 0.01%, 10.09±0.01%, and 9.68±0.00%, respectively. In vitro release and pharmacokinetic studies showed that the myristic acid solid lipid nanoparticles showed excellent sustained release as expected and increased the oral bioavailability of RFX by 2.18 times. This indicates that RFX-SLNs can be used for the oral treatment of bacterial infections. Compared to RFX, RFX-SLNs showed good therapeutic effects in a mouse MRSA pneumonia infection model. This study indicates that the myristic acid solid lipid nanoparticles might be an effective way to enhance the oral absorption and therapy effects of RFX and other insoluble drugs. This not only opens up avenues for the clinical application of RFX but also provides a way for the development of new dosage forms of water-soluble drugs and the expansion of their clinical application scope.

Effectiveness of PBL Pedagogy Combined with Flipped Classroom in the Standardized Training of Resident Physicians

Objective: To analyze the application effect of the problem-based learning (PBL) teaching method combined with flipped classrooms in the standardized training of gastroenterology residents. Methods: Sixty-five resident trainees who were admitted to the Department of Gastroenterology of the hospital from January to December 2023 were selected and divided into the control group (n = 33) and the observation group (n = 32) by random number division method. The control group implemented the traditional clinical teaching method, and the observation group implemented the PBL combined flipped classroom teaching method. The study compared the two groups’ discharge learning performance, trainees’ subjective feeling score, and teaching satisfaction score index. Results: The difference in basic knowledge scores between the two groups of trainees under different teaching modes was not statistically significant (P > 0.05). However, the observation group was significantly higher than the control group in terms of the differences in case analysis, clinical operation skills, and total scores, and the differences were statistically significant (P < 0.05). The trainees of the observation group were more satisfied with the teaching and learning process in terms of learning efficiency, clinical thinking, communication, faculty-student collegiality, teamwork, self-study ability, classroom atmosphere, independent learning, clinical thinking and other subjective feelings of the scores are higher than the control group, the difference is statistically significant (P < 0.05). The observation group teaching total satisfaction rate is 96.87%, significantly higher than the control group’s 75.75% (P < 0.05). Conclusion: The application of the PBL teaching method combined with flipped classroom in the standardized training of residents is effective, which can not only significantly improve the basic theory and practical operation performance of the trainees, but also help to improve their case analysis ability, clinical thinking ability, and doctor-patient communication ability, so it is worthwhile to popularize its application in the clinical scope.

Evidence mapping of clinical studies on 23 commonly used Chinese patent medicines for treating insomnia

Evidence mapping was performed to systematically search and review the clinical studies about the treatment of insomnia with Chinese patent medicines. The evidence distribution in this field was analyzed and the problems of the studies were summarized. Chinese-and English-language articles of the studies involving the Chinese patent medicines specified in three national drug catalogs for the treatment of insomnia were searched against the databases with the time interval from inception to August 2023. Figures and tables were established to present the results. Finally, 23 Chinese patent medicines were screened out, which were mentioned in 299 articles involving 236 randomized controlled trials(RCTs), 35 non-randomized controlled trials(non-RCTs), 7 retrospective studies, 17 systematic reviews/Meta-analysis, and 4 guidelines/expert recommendations or consensus. Bailemian Capsules, Wuling Capsules, and Yangxue Qingnao Granules were mentioned in a large proportion of articles. The outcome indicators included sleep rating scale, clinical response rate, safety indicators, and anxiety and depression scores. The results showed that the studies about the treatment of insomnia with Chinese patent medicines were growing. However, there was a scarcity of research evidence, and the available studies were single-center with small sample sizes and short periods. These studies spanned broad clinical scopes with inadequately emphasized advantages of TCM and insufficient outcome indicators about quality of life, follow-up, and recurrence rate. RCT exhibited a high risk of bias, and the systematic reviews/Meta-analysis demonstrated low overall quality. The retrospective studies received suboptimal scores, and the non-RCT failed to mention follow-up time, loss rate to follow-up, and sample size estimations, which compromised result reliability. It is recommended that the research protocol for Chinese patent medicines in treating insomnia should adhere to the clinical research standards of TCM. The TCM syndrome score can serves as a crucial outcome measure, and emphasis should be placed on patients' quality of life, follow-up, and recurrence prevention. Measures should be taken to enhance the accessibility and affordability of Chinese patent medicines and strengthen the connection between medical insurance policies and the policies pertaining to Chinese patent medicines. Furthermore, it is advisable to reasonably increase the inclusion of Chinese patent medicines with well-established efficacy and safety evidence in the category A list of medical insurance.

Midwives and Medwives: An Analysis of Technology Use among Canadian Midwives

The dichotomy of a midwife and 'medwife' underlies a deeper issue regarding the professional identity of midwifery in relation to legislation, integration, and the increasing expansion of clinical scope, in contrast to the “natural birth” movement.

1 Older Adults as Informed Consumers: Guidance in Discussing the Utility of Dietary Supplements for Cognitive Function

Objective:Nationally and internationally, life expectancies continue to increase, and so are age-related cognitive impairment (Stough et al., 2015). As a result, the rise of consumer dietary supplement products has increased significantly in the last 20 years as older adults are inundated with media related to improving cognitive function. However, research on these nootropics and natural supplements reveals mixed efficacy (Brownie, 2009; Stough et al., 2015). Serendipitously, the COVID-19 pandemic has unveiled the necessity for increased healthy equity and screening internationally across health service disciplines (Jensen et al., 2021; Wells & Dumbrell, 2006). This poster encompasses two primary aims: (1) to highlight common international dietary supplements marketed to an older adult population. Next, (2) develop best evidenced-based practices to approach effective use of nutritional information while maintaining a neuropsychologist’s scope of care.Participants and Methods:A literature review was conducted of peer review articles from 2006 to 2022 from the following databases PubMed and Google Scholar. Recommendations were constructed based on identifying and analyzing the emerging themes across identified articles. Keywords include neuropsychology, nootropics, natural supplement use, aging, Vitamin E, Vitamin D, Phosphatidylserine, feedback, cognition, older adults, and international.Results:Although supplement use and regulations may differ by country, current research suggests increased supplement use and inquiries to neuropsychologists (Armstrong & Postal, 2013; Aysin et al., 2021). Literature highlighting the benefit of taking a natural dietary supplement for older adults across the spectrum of cognitive decline has been variable (Brownie, 2009; Haider et al., 2020). Commonly explored vitamins such as Vitamin E, Vitamin D, Vitamin B 12, and Phosphatidylserine have proven to be beneficial in improvements in cognitive domains such as attention and memory for those experiencing mild cognitive impairment (Kang et al., 2022; La Fata et al., 2014; Richter et al., 2013; Van Der Shaft et al., 2013). Therefore, one alternative for defining the utility of supplement usage may be from preventive lens for those with mild or emerging cognitive concerns (Health Quality Ontario., 2013; Joshi & Practice-, 2012). Alternatively, older populations are at risk for malnutrition, which can negatively impact cognition (Well & Dumbrell, 2006).Conclusions:While recognizing their clinical scope, informed neuropsychologists must be up to date on emerging literature on the efficacy of these supplements. Neuropsychologists should consider following these general guidelines when discussing recommendations for older adult clients with varying degrees of cognitive impairment. For example, neuropsychologists should approach alternative treatments as an exploration of the possible risks, costs, and benefits with evidence-based research while balancing the client’s need for hope (Armstrong & Postal, 2013). Neuropsychologists should also have increased awareness of malnutrition screening amongst this population (Gestuvo & Hung, 2012; Wells & Dumbrell, 2006). Other practices should include ongoing consultation and referral to a nutritionist or following up with their primary care physicians to assist further. With these guidelines, Neuropsychologists can be better equipped to provide ethical recommendations to facilitate clients to become informed consumers.

Synthesis, Characterization, and in vitro Anti-Inflammatory Activity of Novel Ferrocenyl(Piperazine-1-Yl)Methanone-based Derivatives.

Inflammation is closely related to the occurrence and development of various diseases in the clinical scope. Finding effective anti-inflammatory agents is of great significance for clinical treatment. A series of novel ferrocenyl(piperazine-1-yl)methanone-based sulfamides and carboxamides were synthesized to discover potent anti-inflammatory agents. The compounds were characterized by 1H NMR, 13C NMR, and MS spectra. Compound 5h was further determined by single crystal X-ray diffraction. All the target compounds were screened for anti-inflammatory activity by evaluating the inhibition effect of LPS-induced NO production in RAW264.7 macrophages. The novel compound (4i) is the preliminary anti-inflammatory mechanism detected by western blot. In a multi-stage screening campaign, compound 4i was shortlisted, which exhibited physicochemical properties suitable for human administration. Among them, compound 4i was found to be most potent in inhibiting NO production (IC50 = 7.65 μM) with low toxicity. This compound also exhibited significant inhibition of the production of iNOS and COX-2. Preliminary mechanism studies indicated that compound 4i could inhibit the activation of the LPS-induced TLR4/NF-κB signaling pathway. The promising anti-inflammatory activity of compound 4i compared with the reference drug suggests that this compound may contribute as a lead compound in the search for new potential anti-inflammatory agents.

Simultaneous detection of C-reactive protein and lipopolysaccharide based on a dual-channel electrochemical biosensor for rapid Gram-typing of bacterial sepsis

Sepsis is a life-threatening multi-organ failure syndrome, with bacterial infections being the most common cause. Rapid Gram-typing is imperative to assist in antibiotic intervention. C-reactive protein (CRP) and lipopolysaccharide (LPS) are effective biomarkers for discerning the Gram type of bacteria but differ by several orders of magnitude in clinical detection, thereby impeding their simultaneous detection. And two independent methods are time-consuming and laborious. In this study, a dual-channel electrochemical biosensor was developed for simultaneous detection of LPS and CRP. Under optimal conditions, linear ranges of LPS (0.5–1000 pg/mL) and CRP (0.1–20 μg/mL) were obtained in line with the clinical evaluation scopes. In simulated sample tests, Gram-positive, Gram-negative, and healthy plasma samples were clearly distinguished by the developed biosensors, and these results were consistent with that of enzyme-linked immunosorbent assay (ELISA). In addition, the results of the plasma samples tested by the electrochemical biosensor matched those derived from blood cultures in the laboratory. Collectively, the electrochemical biosensor was expected to provide the scientific basis for the rapid Gram-typing and point-of-care detection of bacterial sepsis.

Expanding the genotype–phenotype correlations in Alport syndrome: novel mutations, digenic inheritance, and genetic modifiers

BackgroundAlport syndrome (AS) is the second most prevalent genetic cause of kidney failure, behind autosomal-dominant polycystic kidney disease, affecting at least one in 5000 individuals worldwide. AS is caused by COL4A3, COL4A4, and COL4A5 mutations. It is characterized as three distinct disorders of type IV collagen 3/4/5 based on a genetic evaluation: X-linked, autosomal, and digenic. About two-thirds of AS cases are X-linked (XLAS), 15% are autosomal recessive (ARAS), and 20% are autosomal dominant (ADAS). The spectrum of phenotypes associated with AS ranges from increasing renal disease with extrarenal abnormalities to isolated hematuria. Coinherited genetic mutations contribute significantly to clinical severity and variability.MethodsIn this study, an AS panel (COL4A3/COL4A4/COL4A5) and clinical exome sequencing (CES) were performed on 18 patients.ResultsNineteen specific AS mutations, including 15 novel mutations, were found in these 18 cases, which included 17 Turkish families and 1 Syrian family. Digenic inheritance was observed in one patient, and eight coinherited genetic mutations were discovered.ConclusionsThis research reveals many novel AS mutations and shows robust genotype–phenotype heterogeneity in the disease. The results expand the clinical and molecular scope of AS and clarify the ADAS and digenic AS phenotypes, further enhancing our understanding of the complex nature of AS and its association with genetic modifiers. The data broaden the spectrum of AS-related gene mutations and provide new insights on genotype–phenotype correlations in AS.

FRI544 Serological Profile In Rheumatoid Arthritis And Its Interplay With Autoimmune Thyroid Diseases

Abstract Disclosure: T. Kolitz: None. S. Kivity: None. I. Tessler: None. Y. Marcus-Perlman: None. E. Izkhakov: None. I. Yaish: None. Y. Greenman: None. Objective: Autoimmune thyroid diseases (AITD) are the most common organ-specific autoimmune disorders, with an estimated prevalence of 5%. AITD encompass the clinical scope of Hashimoto’s thyroiditis (HT) and Graves’s disease (GD). Rheumatoid arthritis (RA) is a relatively common non-organ-specific autoimmune disease with an estimated global prevalence of 0.5-1%. Numerous studies have investigated the association of thyroid disorders and RA in various populations, but results were inconsistent. This study is aimed to assess the rate of AITD in RA patients and to further investigate these rates in subgroups of patients with seronegative RA, seropositive RA and dual-positive RA antibodies [i.e., positive anti-cyclic citrullinated peptide (CCP) and rheumatoid factor (RF)]. Methods: We used a big-data platform (MDClone Ltd., Israel) to create a cohort of RA patients with and without coexistent AITD. The cohort included 1316 patients who were treated in the Tel Aviv Sourasky Medical Center for any diagnosis between January 2008 and December 2022. Results: There were 340 men (25.8%) and 976 (74.2%) women in the cohort. The mean age at time of initial coding of RA diagnosis in our referral center was 62.5±15 years. AITD was found in 15.5% of the entire RA cohort. Hypothyroidism was the most common thyroid-associated diagnosis (in 95.8% of patients with RA and AITD). When RA patients were further sub-classified to seronegative, seropositive, and dual-positive RA, the rates of AITD were 11.8%, 17.6% and 25%, respectively (p=0.007). AITD rates in seropositive women and men were 20.6% and 8%, respectively (p<0.001). In the RA-seronegative subgroup, the rate of AITD was 15.6% in women and 2.7% in men (p<0.001). The mortality rates in RA-seronegative patients, RA-seronegative patients with AITD, RA-seropositive patients and RA-seropositive patients with AITD were 5.5%, 8.3%, 21.6% and 29.5%, respectively (p=0.05). Conclusion: Our findings suggest that the prevalence of AITD in patients with RA is associated with the specific serological profile, with highest rates in RA patients who are positive for both anti-CCP and RF. Randomized prospective studies are required to explore any cause-and-effect correlation and to delineate the impact of AITD on RA outcome and mortality rates. Presentation: Friday, June 16, 2023

Framework for Classifying Explainable Artificial Intelligence (XAI) Algorithms in Clinical Medicine.

Artificial intelligence (AI) applied to medicine offers immense promise, in addition to safety and regulatory concerns. Traditional AI produces a core algorithm result, typically without a measure of statistical confidence or an explanation of its biological-theoretical basis. Efforts are underway to develop explainable AI (XAI) algorithms that not only produce a result but also an explanation to support that result. Here we present a framework for classifying XAI algorithms applied to clinical medicine: An algorithm's clinical scope is defined by whether the core algorithm output leads to observations (eg, tests, imaging, clinical evaluation), interventions (eg, procedures, medications), diagnoses, and prognostication. Explanations are classified by whether they provide empiric statistical information, association with a historical population or populations, or association with an established disease mechanism or mechanisms. XAI implementations can be classified based on whether algorithm training and validation took into account the actions of health care providers in response to the insights and explanations provided or whether training was performed using only the core algorithm output as the end point. Finally, communication modalities used to convey an XAI explanation can be used to classify algorithms and may affect clinical outcomes. This framework can be used when designing, evaluating, and comparing XAI algorithms applied to medicine.

Intraprofessional learning: Dentistry and oral health students' readiness and experience.

Intraprofessional learning is a promising approach to enhance teamwork and patient care. This mixed-method study aimed to assess the readiness and experience of dental and oral health students toward intraprofessional learning. Dental and oral health students were paired alternatively in a clinician and assistant role in a pediatric clinical setting. The Readiness for Interprofessional Learning Scale was adapted for a pre- and post-survey. Focus groups were conducted to elicit the students' shared learning experience. Approximately 50% of dental and oral health students participated in the pre- and post-survey. Pre-test findings revealed similar attitudes toward intraprofessional practice for both groups. However, a statistically significant lower score (p<0.022) for the oral health students in the post-test suggested a less positive attitude toward their experience. Qualitative results indicated that dental students acquired a better understanding of the clinical scope of oral health students, and they learned clinical skills and behavior management from their counterparts. Conversely, oral health students experienced a hierarchical lack of collegiality and reciprocity from dental students, which may have contributed to their lower post-test score. Despite this, some oral health students gained more confidence in their roles and abilities within the intraprofessional team. Overall, dental students valued this learning experience more and desired more intraprofessional opportunities. Both groups of dental and oral health students had similar readiness levels to enter intraprofessional practice, appreciated the intraprofessional experience, and gained an increased appreciation for the collaborative approach to patient care. Intraprofessional learning during training may assist with developing collegiality across the dental professions in practice.

Clinical scope and healthcare utilization in childhood interstitial lung disease at a tertiary center.

Childhood interstitial lung disease (chILD) is a heterogeneous group of diffuse lung diseases that can be challenging to diagnose. With relative rarity of individual entities, data are limited on disease prevalence, care patterns, and healthcare utilization. The objective of this study was to evaluate chILD prevalence and review diagnostic and clinical care patterns at our center. A single-center, retrospective cohort study was conducted of patients receiving care at the Children's Hospital of Philadelphia (CHOP) between 1 January 2019 and 31 December 2021. Through query of selected ICD-10 billing codes relevant for chILD and medical chart review, a total of 306 patients were identified receiving pulmonary care during this period. Respiratory symptom onset was documented to have developed before 2 years of age for 40% of cases. The most common diagnostic categories included those with oncologic disease (21.2%), bronchiolitis obliterans (10.1%), and connective tissue disease (9.5%). Genetic testing was performed in 49% of cases, while 36% underwent lung biopsy. Hospitalization at CHOP had occurred for 80.4% of patients, with 45.1% ever hospitalized in an intensive care unit. One-third of children had required chronic supplemental oxygen. Seven (2.3%) patients died during this 3-year period. Collectively, these data demonstrate the scope of chILD and extent of health care utilization at a large volume tertiary care center. This approach to cohort identification and EMR-driven data collection in chILD provides new opportunities for cohort analysis and will inform the feasibility of future studies.

Dental Materials Applied to 3D and 4D Printing Technologies: A Review.

As computer-aided design and computer-aided manufacturing (CAD/CAM) technologies have matured, three-dimensional (3D) printing materials suitable for dentistry have attracted considerable research interest, owing to their high efficiency and low cost for clinical treatment. Three-dimensional printing technology, also known as additive manufacturing, has developed rapidly over the last forty years, with gradual application in various fields from industry to dental sciences. Four-dimensional (4D) printing, defined as the fabrication of complex spontaneous structures that change over time in response to external stimuli in expected ways, includes the increasingly popular bioprinting. Existing 3D printing materials have varied characteristics and scopes of application; therefore, categorization is required. This review aims to classify, summarize, and discuss dental materials for 3D printing and 4D printing from a clinical perspective. Based on these, this review describes four major materials, i.e., polymers, metals, ceramics, and biomaterials. The manufacturing process of 3D printing and 4D printing materials, their characteristics, applicable printing technologies, and clinical application scope are described in detail. Furthermore, the development of composite materials for 3D printing is the main focus of future research, as combining multiple materials can improve the materials' properties. Updates in material sciences play important roles in dentistry; hence, the emergence of newer materials are expected to promote further innovations in dentistry.

129 Anatomical Approaches to Treating Obstructive Sleep Apnea in Patients who Fail CPAP: State of the Art Review

OBJECTIVES/GOALS: The aim of this study was to evaluate current and new anatomical approaches to treating obstructive sleep apnea (OSA) in patients who fail continuous positive airway pressure (CPAP). Understanding the breadth of devices and procedures increases clinical scope of practice and innovator opportunities. METHODS/STUDY POPULATION: A comprehensive review of literature, FDA approvals, patents, and commercially available technologies was undertaken with regards to anatomical approaches for treating OSA. These include experimental therapies, surgical approaches, and non-surgical ablative procedures. Oral appliances, positive airway pressure devices, and therapeutics were excluded. Key search terms included obstructive sleep apnea,’ anatomy,’ surgery,’ devices,’ experimental therapy,’ innovation,’ technology,’ and translational research.’ Publications were limited to the last five years. Innovations were evaluated for relevance to OSA treatment and then assessed in greater depth based on scientific literature. RESULTS/ANTICIPATED RESULTS: Numbers of preclinical and commercially available innovations pertinent to the anatomical treatment of OSA were reported along with clinically relevant outcome metrics. The greatest number of innovations was found in surgical approaches, including soft-tissue removal, orthognathic surgery, and electrical stimulation. Outcome parameters included safety, efficacy, patient compliance, and mean disease alleviation as a ratio of efficacy to compliance. Innovations were grouped by their intended anatomical targets including retrolingual, palatal, oropharyngeal, epiglottic, nasal, and complete concentric collapse, making special note of gaps in the treatment armamentarium. DISCUSSION/SIGNIFICANCE: In the last decade, sleep surgery has trended toward innovative CPAP alternatives. Nerve stimulation and ablative procedures have grown, but some anatomical presentations have been frequently excluded. These developments present opportunities for innovators to fill persistent gaps in treatment.

The influence of the physical therapist's clinical practice time on the perception of body stability of the traditional frontal plank exercise: a pilot study

Background: The traditional frontal plank exercise has a greater demand for biomechanical stability and has been widely prescribed and used in the practice of health professionals and, verifying the influence of the time of clinical practice can contribute positively in the clinical, scientific and social scope. Objective: To verify the influence of the physical therapist's clinical practice time on the perception of body stability of the traditional frontal plank exercise. Method: Individuals were selected in a non-probabilistic and intentional way, constituting a sample of young male adults, with a body mass index within the normal range, with a self-reported level of moderate to advanced physical activity and with at least six months of previous training experience. of resistance. The subjects were instructed to perform the frontal plank for 30 seconds, seeking to maintain all the items in the description of the technique. No verbal commands and encouragement were given during the exercise in order to direct only the influence of the different times of clinical practice of the evaluators. At the end of the exercise, the two evaluators self-reported their feedback through a control sheet prepared by the researchers. Results: The sample of this study consisted of 10 participants, with a mean age of 30.6 years (±4.03). All were male, white, and had no history of trauma/injury. The evaluator with six months of experience pointed out that eight subjects performed the frontal plank with high stability, while the evaluator with six years of experience observed only three subjects with high stability in the execution of the exercise. Conclusion: The findings of this study showed that there is a tendency towards a difference in the proportions of perceptions of stability in the traditional frontal plank between physical therapists with six months and six years of clinical experience.

Epigenetic clocks and female fertility timeline: A new approach to an old issue?

Worldwide increase in life expectancy has boosted research on aging. Overcoming the concept of chronological age, higher attention has been addressed to biological age, which reflects a person's real health state, and which may be the resulting combination of both intrinsic and environmental factors. As epigenetics may exert a pivotal role in the biological aging, epigenetic clocks were developed. They are based on mathematical models aimed at identifying DNA methylation patterns that can define the biological age and that can be adopted for different clinical scopes (i.e., estimation of the risks of developing age-related disorders or predicting lifespan). Recently, epigenetic clocks have gained a peculiar attention in the fertility research field, in particular in the female counterpart. The insight into the possible relations between epigenetic aging and women's infertility might glean additional information about certain conditions that are still not completely understood. Moreover, they could disclose significant implications for health promotion programs in infertile women. Of relevance here is that the impact of biological age and epigenetics may not be limited to fertility status but could translate into pregnancy issues. Indeed, epigenetic alterations of the mother may transfer into the offspring, and pregnancy itself as well as related complications could contribute to epigenetic modifications in both the mother and newborn. However, even if the growing interest has culminated in the conspicuous production of studies on these topics, a global overview and the availability of validated instruments for diagnosis is still missing. The present narrative review aims to explore the possible bonds between epigenetic aging and fertility timeline. In the "infertility" section, we will discuss the advances on epigenetic clocks focusing on the different tissues examined (endometrium, peripheral blood, ovaries). In the "pregnancy" section, we will discuss the results obtained from placenta, umbilical cord and peripheral blood. The possible role of epigenetic aging on infertility mechanisms and pregnancy outcomes represents a question that may configure epigenetic clock as a bond between two apparently opposite worlds: infertility and pregnancy.

An investigation into the clinical scope of practice of MRI reporting radiographers within the United Kingdom

IntroductionRadiographers have been reporting Magnetic Resonance Imaging (MRI) examinations for over ten years, and there is an increasing body of evidence confirming the efficacy of this role expansion. However, little is known about the clinical scope of practice of radiographers undertaking this enhanced level of practice. The aim of this study was to investigate the clinical scope of practice of MRI reporting radiographers within the United Kingdom (UK). MethodsMRI reporting radiographers who are actively reporting within the UK were invited to participate in a short online survey investigating the anatomical areas reported, clinical referral pathways and onward referral practices they routinely undertake. The survey was distributed via social media channels with snowball sampling encouraged. ResultsThere were n = 14 responses received, with an estimated response rate of 21.5%. The majority (93% n = 13/14) practised in England, with one response from Scotland. All participants (n = 14/14) undertook reporting of general practitioner (GP) and community healthcare practitioner's referrals, with 93% reporting for outpatient referrers. There was statistically significant variation in the anatomical areas reported when compared against those qualified less than two years and those qualified over ten years (p = 0.003). No other statistically significant variation was seen. ConclusionThere was no statistical difference in the implementation of MRI reporting by radiographers identified. All participants indicated reporting for GP and community healthcare practitioner referrers which align well with the implementation of community diagnostic centre rollout across the UK. Implication for practiceThis is believed to be the first study of its kind in the realm of MRI reporting. The study has suggested that MRI reporting radiographers are well placed to contribute to the rollout of community diagnostic centres within the UK.

The clinical scope of Islamic psychotherapy: A grounded theory study.

The clinical scope of Islamic psychotherapy: A grounded theory study.